Wearable device-based interventions in heat-exposed outdoor workers - a scoping review and an explanatory...

Global climate change poses a challenge to the health prevention of heat-exposed outdoor workers. Interventions with mobile or wearable devices monitoring physiological and environmental parameters may be one solution to maintain and promote their health. Based on the recognized potential of wearables in mitigating heat stress, a detailed analysis of the contextual factors, mechanisms, and outcomes of wearable device-based interventions is lacking. A scoping review was carried out to address the objectives of contextual analysis, fundamental mechanisms, and an assessment of outcomes to propose an explanatory intervention model based on the findings.

Web of Science and PubMed databases were searched by search strings related to (1) wearables (2), outdoor workers, and (3) heat stress. Study characteristics and relevant data regarding the context-mechanism-outcome configurations were extracted and analyzed.

Out of 410 articles detected, 19 publications were eligible for in-depth review. Wearables are well-accepted for the prevention of heat stress symptoms. By recording relevant indicators, i.e., heart rate and temperature, real-time health alerts can be issued as risk-based early warnings, and personalized feedback or recommendations towards behavior adaptation can be generated. A high risk of occupational heat stress was identified for construction, agriculture, and groundwork workers. Heat-exposed outdoor workers were mainly young to middle-aged males and often overweight or obese, with increased heart and breathing rates in hot work environments. Wearable device-based interventions are particularly effective if a mindset of safety culture is present in the workplace and environmental health literacy is promoted to increase heat risk awareness and willingness to change work health behavior.

Based on these findings, we developed an explanatory intervention model. This model draws on well-established frameworks, theories, and models. It helps to identify, describe, and explain what works, for whom, and under what circumstances in the context of wearable usage in heat-exposed outdoor workers. Incorporating environmental health literacy and precision prevention in occupational health approaches with continuous monitoring of environmental and physiological parameters will allow for real-time, tailored feedback, leading to more effective heat stress prevention.