This study aimed to investigate the prevalence of occupational hazards, health effects, and the use of PPE among MFDRs. We conducted an analysis focusing on the association between occupational hazards and health. The majority of MFDRs frequently encounter physical hazards, with heat and sunlight being the most prevalent (91.6%). Additionally, chemical hazards such as exposure to exhaust smoke (90.1%) and PM (86.1%) are commonly reported. A significant proportion of MFDRs experience work-related health issues, particularly musculoskeletal disorders (62.1%) and ocular conditions (45.1%). The most frequently reported musculoskeletal complaints include shoulder pain (39.2%) and neck pain (38.1%), while burning eyes (33.3%) was the most common ocular symptom. The findings indicate that prolonged exposure to static postures, repetitive movements, awkward working positions, and whole-body vibration is significantly associated with WRMSDs (p < 0.05). Furthermore, psychological hazards demonstrate a significant correlation with symptoms such as headaches, insomnia, and feeling depressed (p < 0.05). Physical hazards, including prolonged exposure to sunlight and heat, noise, and whole-body vibrations, are also significantly linked to symptoms such as headaches, flu-like symptoms, and insomnia (p < 0.05). Regarding the use of PPE, the most commonly worn items among MFDRs include helmets (99.72%), long-leg pants (99.72%), face masks (99.29%), and thermal jackets (98.17%).

Biomechanical hazards with work-relatedness musculoskeletal disorders among MFDRs

In this study, WRMSDs are the most common new-onset and/or exacerbated health problems suffered by the respondents, which had a prevalence of two-third of participants. (62.1%) The prevalent was similar and higher than a study conducted in China and Korea which reported the prevalent of MSDs of 55 – 67.9% and 29.3-41.3% respectively [4, 7, 21] However, the prevalence in our research was slightly lower than that in Malaysia which around three-fourth (74.9%) of food delivery riders had suffered from MSDs [22]. The most common affected regions in our study were shoulder (39.2%) and neck pain (38.1%) which were consistent to the findings of Yang’s, Li’s, and Yoo’s [4, 7, 21]. Shoulder pain can cause the highest daily life disturbance and those who suffered were more likely to be absent from work [22]. These health effects could be the results from cumulative traumatic injuries as consequences from the exposure to various physical and biomechanical hazards such as arm-hand vibration, painful positions, repetitive movements [23]. Other factors such as age, gender, riding time and BMI were also related to the disorders [24,25,26]. Elbow is the region that is least injured by the respondents with only around 5%, however it is significantly associated with ergonomic hazard such as repetitive movements and whole-body vibration. Hand-arm vibration during ride can cause more inclined to grip handles leading to increased static muscle activity in the upper limbs such as arms, elbow, neck, and shoulders [27]. Inappropriate prolonged posture such as excessive elongation of neck could lead to kinematic alterations of body structure such as spine and resulting in more severe MSDs [28, 29].

Physical hazards and health effects among MFDRs

The prevalence of MFDRs suffered from headache (32.2%) and sleep disturbance (16.9%) in Thailand is quite more common than previous study in Korea (28.5% and 1%) [4]. The possible explanation may be due to longer working hours of Thai MFDRs. Around three-fourths of participants reported experiencing from noise hazards. Traffic noise and motorcycle engine sounds remain inevitable problems leading to problems ranging from annoyance and headaches to sleep disturbances and more severe conditions like ischemic heart disease [30]. Our study supports these findings, showing that noise hazards are associated with headaches and insomnia. The prevalence of ocular symptoms, with no comparable prior study, are more striking than expected. A possible explanation is that these ocular symptoms result from the intense and prolonged use of the eyes, combined with exposure to sunlight and heat, especially during long periods of riding. The results also revealed that only about half of the participants (52.75%) used protective eyewear, which increases their exposure to dust particles, prolonged sunlight, and the risk of dry eyes [31,32,33].

Psychological hazards and health effects among MFDRs

In the present study, approximately 30 to 55% of participants reported experiencing work-related stress. This is significantly lower comparing to a study in Korea, with the prevalence (Insufficient rest: 68.3%, Dealing with people: 72.3%, Future uncertainty: 70.8%, Time pressure: 74.3%) and notably lower than the reported rate of 95% from MFDR in China [34]. The differences may be attributed to variations in working habits, norms, and perceptions of riders across these countries.

Work-related stress has a significantly negative impact on both physical and mental well-being of workers [34]. Many platform riders experience significant psychosocial stressors such as dealing with customers, time pressure, income uncertainty, long working hours, unfair customer satisfactions rating, and competitive work environment [4, 35]. Which eventually can lead to increased labor intensity, depression, burnout, and higher turnover rates [36] In this study, we also found that occupational stress is significantly associated with feeling depressed, headaches, and insomnia. Previous research has reported a high prevalence of depressive symptoms and occupational stress among platform workers compared to general population [37]. This is largely due to high job strain and low job security, especially during the COVID-19 outbreak in China, which demonstrated that depression among workers is directly related to work environment stressors [38,39,40]. Additionally, riders in Thailand tend to work longer hours than their counterparts in other countries, with an average of 55.1 h per week compared to around 42 h for Korean riders [4]. Longer working hours have been significantly associated with occupational stress, depression, fatigue, and poor well-being among employees [38, 41].

PPE used among MFDRs

The use of PPE during work is crucial for the safety and health well-being MFDRs [17]. In our study, helmets were the most used PPE among participants (99.7%). This is a notable finding, as previous research in Thailand indicated helmet-wearing rates among motorcyclists were only about 30.0–55.0% [42,43,44]. Facial masks were also another frequent used PPE employed by the MFDRs (99.29%). As mentioned before, facial masks were utilized as PPE, serving to safeguard against not only pollution but also the biological aerosols such as COVID-19 [45]. Therefore, nearly all participants in our study (99.2%) reported wearing facial masks, consistent with findings from studies involving food delivery riders in the Philippines [46] and Vietnam [5], where almost all riders wore masks. Interestingly, apart from face masks, the use of other PPE among participants in our study was higher than reported in previous studies focusing on motorcyclists [42]. One possible explanation is that five out of six commonly used PPE items (long leg pants, helmets, face masks, boots, and thermal jackets), worn by more than 90.0% of the participants, were required by the delivery company’s rules and regulations. The company enforces penalties, including permanent suspension, for riders who fail to comply with these PPE requirements. This highlights the importance of company policies and regulations in promoting rider health, which could be further supported through collaboration with health sectors. However, after the COVID-19 pandemic, the prevalence of some PPE such as facial mask used might be decreased since the protection measures in all sectors (customers, restaurants, and riders) have significantly decrease.

Although gloves were commonly worn by participants, they were not specified in the company regulations. The likely reason is that most riders experience heat and sunlight, as evidenced by our study (91.6%). Riders use gloves to prevent skin burns and soft-tissue injuries while gripping motorcycle handles [47]. In contrast, protective eyewear was less commonly used (52.75%). Eye protection is crucial for motorcyclists as it shields the eyes from debris, dust, and particles, enhances visibility in adverse weather conditions, and provides protection from harmful UV rays. Earplugs were not commonly used, even though approximately three-fourths of participants reported exposure to noise hazards. A possible explanation for this is that most participants preferred using earphones to communicate with restaurants and customers. While prior studies have demonstrated that earplugs can be effective in preventing temporary hearing loss among motorcyclists, the long-term efficacy of earplugs remains a subject of debate [6].

To address occupational hazards and consequences health effects are the challenges topic for MFDRs. As part of the hierarchy of controls, the proposed strategies to mitigate the negative impacts of hazards and prevent their occurrence primarily focus on ‘Administrative Controls’ by the platforms and health sectors and ‘PPE’ by the riders. Administrative controls include enhancing worker awareness through education about hazards and their potential consequences, alongside training on proper posture and techniques to mitigate ergonomic risks. Regulatory measures, such as ensuring regular breaks and job rotation, are recommended to limit prolonged exposure by capping maximum daily working hours. Health surveillance is crucial, with routine health check-ups for workers exposed to hazardous conditions, including lung function tests for air pollution, hearing assessments for noise exposure, and screenings for non-communicable diseases like depression and hypertension. Furthermore, providing PPE through companies and health sectors could help reduce the financial burden on riders. In terms of PPE, promoting and supplying effective yet less commonly used equipment is crucial to reducing the incidence of prevalent symptoms, such as providing protective eyewear to prevent ocular issues.

Limitations

This study has several limitations. First, since the research was using a cross-sectional design, we could only capture the associations between occupational hazards and health effects, but not the causality. Second, recall bias could have affected the results due to the reliance on self-reported questionnaires. Third, riders with more severe health conditions might be missing from the survey since those severe conditions would restrict them from work, and therefore not fulfilled the inclusion requirement of the study. Since the study was conducted during the COVID-19 pandemic, certain aspects need to be considered, particularly the prevalence of biological hazards and the use of facial masks. The prevalence of biological hazards might be higher in the post-COVID-19 period, while the use of facial masks might have decreased, as protective measures in all sectors (customers, restaurants, and riders) have significantly declined after the COVID-19 period. Future research comparing MFDRs with other delivery groups using different modes of transportation should be conducted to enhance understanding and inform evidence-based interventions in this field. Additionally, longitudinal studies examining health effects over time, along with in-depth analyses of critical issues such as physical assaults, should be prioritized. Furthermore, focusing on significant health effects and emerging issues among MFDRs, such as musculoskeletal disorders, is strongly recommended.