Primary Care Uptake Interventions in Taxi, App-Based, and Other For-Hire Vehicle Drivers: The HAILL Cluster Randomized Controlled Trial

Background

Taxi, app-based, and other for-hire vehicle drivers have major health risks and poor healthcare access.

Objective

Compare workplace interventions to improve driver healthcare access.

Design

Taxi Health Access Intervention for Linkages and Lifestyle (HAILL) was a three-arm cluster randomized controlled trial (2015–2022; analyses 2024) with outcomes assessed at 12 months. Randomization was at the cluster (taxi garage) level.

Participants

We approached 97 taxi garages in New York City (garages with ≥ 100 drivers and app-based driver hubs), 32 were excluded, and 65 enrolled. Drivers attending workplace Health Fairs at the garages were consecutively screened for participation; 735 enrolled.

Interventions

All sites received the Health Fair intervention (health history, screenings [blood pressure, etc.], clinician consult, and 3 months of primary care access facilitation follow-up). Arm 1 received the Health Fair only. Arm 2 received the Health Fair and Navigator case management for up to 12 months. Arm 3 received the Health Fair and up to 12 months of appointment reminder text messages and peer support.

Main Measures

Medical Expenditure Panel Survey items measured primary care uptake (primary outcome). A Behavioral Risk Factor Surveillance Survey item measured insurance enrollment (secondary outcome). Two independent-sample t tests compared arm 1 versus 2 and arm 1 versus 3 primary care uptake proportions.

Key Results

Sixty-one garages participated (arm 1, n = 20; arm 2, n = 22; arm 3, n = 19). In the cluster intention-to-treat analyses, primary care uptake was 44% in arm 1 versus 57% in arm 2 (P = .264) and versus 43% in arm 3 (P = .994); health insurance enrollment was 63% in arm 1 versus 58% in arm 2 (P = .627) and versus 50% in arm 3 (P = .197).

Conclusions

All interventions increased healthcare access, with a positive trend in primary care uptake between arms 1 and 2. Health Fairs and Navigator case management should be considered by policy makers.