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Effect of Public Transport Health Education on Respiratory Hygiene Practices among Commercial Bus Drivers in Nigeria

Abstract

Respiratory infections remain an important public health concern in Nigeria, particularly in settings where individuals spend prolonged periods in crowded or poorly ventilated environments. Commercial bus drivers may experience frequent close contact with passengers and co-workers and may be exposed to respiratory droplets, aerosols, coughing and sneezing, poor ventilation, and contaminated surfaces during daily operations. Inadequate respiratory hygiene practices, including failure to cover the mouth and nose when coughing or sneezing, improper disposal of tissues, poor hand hygiene, and continued close contact with passengers while experiencing respiratory symptoms, may increase the potential for transmission of respiratory infections. Public transport health education provides an opportunity to improve drivers' knowledge of respiratory infection prevention and promote appropriate hygiene practices within public transport settings. Against this background, this study investigates the effect of public transport health education on respiratory hygiene practices among commercial bus drivers in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Social Ecological Model. The Health Belief Model explains how drivers' perceptions of susceptibility to respiratory infections, perceived severity, perceived benefits of respiratory hygiene, perceived barriers, and cues to action may influence preventive behaviours. Social Cognitive Theory emphasizes observational learning, behavioural modelling, self-efficacy, reinforcement, and environmental influences in developing and maintaining appropriate respiratory hygiene practices. The Social Ecological Model emphasizes the influence of individual, interpersonal, organizational, transport-terminal, community, and broader environmental factors on respiratory hygiene behaviours. Collectively, these theoretical perspectives provide a suitable framework for explaining how public transport health education may influence respiratory hygiene practices among commercial bus drivers in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise commercial bus drivers aged 18 years and above operating in selected urban, semi-urban, and intercity transport routes across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, transport terminals, bus parks, transport unions or associations, routes, and eligible drivers. Public transport health education will be assessed using indicators such as exposure to health education sessions, frequency and duration of education, knowledge of respiratory infection transmission, recognition of respiratory symptoms, cough and sneeze etiquette, hand hygiene, use of face masks when appropriate, ventilation practices, safe disposal of tissues, cleaning of frequently touched surfaces, appropriate response to respiratory illness, and awareness of when to seek medical care. Respiratory hygiene practices will be assessed using indicators such as covering the mouth and nose when coughing or sneezing, use and proper disposal of tissues, handwashing or hand sanitization after coughing or sneezing, appropriate mask use when indicated, avoidance of unnecessary close contact when experiencing respiratory symptoms, maintaining adequate ventilation, cleaning high-touch surfaces, avoiding spitting in or around vehicles, and encouraging symptomatic passengers to observe appropriate respiratory hygiene where feasible. Data will be collected using structured questionnaires, respiratory hygiene observation checklists, health education attendance records, driver training records, and relevant transport health programme documents. Descriptive statistics will be used to summarize drivers' characteristics, work patterns, previous health education, exposure to respiratory risks, and respiratory hygiene practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of public transport health education on respiratory hygiene practices. Where a quasi-experimental design is adopted, respiratory hygiene practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that public transport health education has a significant positive effect on respiratory hygiene practices among commercial bus drivers in Nigeria. Drivers exposed to structured and practical health education are expected to demonstrate better respiratory hygiene practices than drivers without comparable exposure. Education may improve understanding of respiratory infection transmission and strengthen drivers' ability to apply cough and sneeze etiquette, appropriate hand hygiene, mask use when indicated, ventilation practices, and safe disposal of tissues. Practical demonstrations and repeated health messages may increase confidence and consistency in applying preventive behaviours during daily transport operations. Improved respiratory hygiene practices may also contribute to reducing opportunities for respiratory infection transmission within vehicles and transport terminals. However, overcrowded buses, limited ventilation, long working hours, lack of water or hand-hygiene facilities, passenger behaviour, cost of hygiene supplies, inadequate access to masks or sanitizers, and limited enforcement of transport health measures may reduce the effectiveness of health education alone. The study therefore expects practical, continuous, accessible, and transport-specific health education, supported by appropriate hygiene facilities and healthier vehicle environments, to contribute significantly to improved respiratory hygiene practices among commercial bus drivers in Nigeria. The study is expected to contribute to the literature on respiratory hygiene, public transport health, health education, respiratory infection prevention, occupational health, transport workers' health, infection prevention and control, community health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Transportation, Nigeria Centre for Disease Control and Prevention, state ministries of health and transportation, local government health authorities, transport unions, terminal managers, healthcare professionals, environmental health officers, public health practitioners, development partners, and policymakers regarding strategies for reducing respiratory infection risks in public transport settings. The study will also provide evidence-based recommendations for integrating respiratory health education into commercial driver training programmes, strengthening respiratory hygiene facilities at transport terminals, promoting appropriate ventilation and vehicle cleaning, improving access to hand-hygiene materials, developing transport-specific infection-prevention guidelines, and strengthening public health interventions for commercial transport workers across Nigeria.

Keywords: Public transport health education, respiratory hygiene practices, commercial bus drivers, respiratory infection prevention, health education, public transport health, occupational health, infection prevention, Nigeria, public health.