Healthy express couriers: Tackling stress at work in a digital era

Lead Research Organisation: University of Manchester
Department Name: School of Health Sciences


Evidence shows that digital surveillance for the purpose of performance monitoring at work can exert a negative health impact on the monitored workers. Nevertheless, workplace surveillance is becoming the norm in a fast growing new job sector called Online-to-Offline (O2O) that is closely associated with surging global online consumption. A prominent feature of this sector is a digitally optimised operation that sorts and shifts a massive amount of goods and services highly efficiently with each step timed and tracked. Express delivery, including express parcel delivery and takeaway delivery is the key to connecting the last mile between the online platform and actual delivery addresses. O2O is also loosely termed as gig economy or platform economy, typically structured as an online consumption platform employing a large, precarious workforce. The rising O2O sector has seen a significant increase in monitoring practices with new characteristics, e.g., tracking with wearable sensors that intensify the relationship between the system and the monitored. These features add up to a stressful working environment that contributes to physical and mental ill-health. Indeed, media reports on Amazon, Uber Eats, Deliveroo, Eleme and Meituan continue to surface in many countries, revealing health implications due to excessive workload, work-related stress, which may also lead to injuries, suicide attempts and death. However, there is currently little or no evidence from observational and intervention research about the impact of workplace surveillance on occupational stress in this new sector to provide support to industry and policy makers. To understand and define the problem, we choose express couriers in China as the targeted population to develop a system-level intervention program. We do so for two reasons. First, China is the global leader of O2O e-commerce with $877.00 billion online sales in 2017, which grew by 28% compared with 2016. Industry evidence compiled by the largest online Chinese platforms Alibaba and Meituan suggests at least 6.5 million express couriers were employed in 2016. We conducted preliminary qualitative research in March 2019 in China and found that current working practice may present multiple health hazards; forcing young couriers to leave their jobs after only a few years due to stress and mental ill-health, musculoskeletal disorders, cardiovascular and respiratory diseases, injuries and other chronic and acute conditions. They typically work to digitally optimized time and route schedules that are pushing human boundaries. Especially for takeaway couriers, with the expectation of 30 minutes lead time and route complication, e.g., high-rise building blocks, achieving optimised efficiency during peak hours is a particularly stressful task. In addition, the system in China include rewards and penalties for speed and quality of service. This has the potential to add significantly to the stressful nature of the job. Second, occupational health and mental health research have been identified by China's National Health Commission as two under-researched priority areas. Therefore, the main aim of this early phase project is to develop and pilot an intervention program to reduce work-related stress and associated health outcomes among express delivery couriers caused by surveillance systems to optimize delivery operation and monitor performance and record customer feedback. Our ultimate goal is develop protocols in the main study for workplace surveillance using wearable sensors to inform policy and practice in a way that it will ameliorate the long and short-term health consequences on monitored workers. It is undoubtedly a global and growing phenomenon and the outcome of this research will benefit working populations that are constantly tracked and monitored in both developing and developed countries, including the UK.

Technical Summary

The intervention program (main study) will likely comprise an improved operation and surveillance system that adjusts rate of order dispatch when excessive workload is detected, a performance incentive system that limits penalisation and a customer review system that prevents malicious comments without foundations. This system level digital intervention programme will be developed based on the Learning Health System methodology that guides incremental development and accumulative progress. The early phase study will develop the intervention programme in collaboration with an Advisory Board that comprises the express and/or takeaway couriers and other stakeholders as well as with the algorithm engineers of the platform companies. Subsequently, we will apply the intervention in a small-scale pilot study to test acceptability and fidelity by couriers and the platform companies. While the digital platforms are mainly based in Beijing or Shanghai, the intervention program can be rolled out to most cities in China through their system. The pilot study will compare baseline data with during and after intervention data to evaluate likely impact for progression and enable next stage of evaluation. Criteria for progression shall be grounded in the analysed results of process, impact and outcome evaluation of the pilot study, including the likely effectiveness of the intervention (as assessed by researcher and AB) and the acceptability/fidelity of the companies and couriers. Should all be positive and feasible, we will work with the AB to define the most appropriate trial design (RCT, step-wedge) and study population with sufficient power for evaluation of the intervention in the main study.

Planned Impact

1. Impact on Knowledge

This research addresses an important knowledge gap around effective interventions that aim to reduce occupational mental ill-health amongst workforce involved in delivery services associated with surging global online consumption, in particular the additional stress due to digitally optimised operation and costumer feedback systems associated with bonuses and penalties. Findings have the potential to be published in top peer-reviewed journals in the areas of global health, health psychology and occupational health.

2. Impact on Policy
The evidence will support the establishment or revisions of internal company practices, national policies and, if necessary, regulatory standards for digitally optimised operation involving performance monitoring of the workforce with wearable devices involved, such as used within the takeaway delivery and other courier services. Our starting point is with CHEA , which is an influential policy advisor and the China CDC , which is a policy making agent and runs national health data bases and surveillance system.

3. Impact on Practice
Large takeaway platforms in China have expressed interests in participating the research. They are keen to work with digital health experts from Manchester and China CDC to improve the algorithm to incorporate the health perspective.

4. Economic impact

A reduction in the cost of work-related mental ill-health and injuries

5. Social impact

To create a fairer working environment for workforce in this sector

How to realise the impact:

a) Building a collaborative research network with the China CDC, CHEA, and BNU as key members and reach out to industrial partners, technology developers and NGOs.
b) Publishing findings in peer-reviewed journals
c) Continue applying for large grant to fund the main study
d) An online tool for evaluating work-related stress in Chinese O2O context
e) A database to collate data from GSR sensors for evaluating stress levels at work
f) Engagement events to ensure participation and contribution from local stakeholders.


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Description Healthy express couriers: Tackling stress at work in a digital era
Amount £83,978 (GBP)
Funding ID MR/T027215/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 08/2020 
End 10/2021
Title Burnout scale for Chinese couriers 
Description We aim to develop a burnout scale that is culturally adapted to the Chinese couriers population. At this moment, a stimulus scale has been developed for a think-aloud study. The next steps are to revise the stimulus scale to be ready for factor analyses and validation. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2020 
Provided To Others? No  
Impact The stimulus scale has not been released to any couriers for testing. It will be tested by 5-10 couriers by April to collect feedback for improvement. 
Description Collaborative partnership with BNU 
Organisation Beijing Normal University
Department School of Psychology
Country China 
Sector Academic/University 
PI Contribution We are contributing to the development of data collection tools, including literature searches on standard burnout scales, study protocol, the stimulus burnout scale customized to Chinese couriers, and think-aloud study scripts.
Collaborator Contribution BNU has been leading this part of the study and the development of data collection tools, including literature searches on Chinese version of standard burnout scales, study protocol, the stimulus burnout scale customized to Chinese couriers, and think-aloud study scripts.
Impact Not yet
Start Year 2020
Description Collaborative partnership with NCNCD, China CDC 
Organisation Chinese Center for Disease Control and Prevention (China CDC)
Department National Center for Chronic and Noncommunicable Disease Control and Prevention
Country China 
Sector Public 
PI Contribution We are contributing to the development data collection tools, including the provision of Empatica E4 wristbands and associated data collection form, study protocol, acceptability interview schedule and informal discussions with potential business participants.
Collaborator Contribution The NCNCD has been leading the engagement of potential business participants, development of data collection tools, including Empatica E4 wristbands data collection form, study protocol, acceptability interview schedule and informal discussions with and visits to potential business participants.
Impact Not yet.
Start Year 2020
Description Announcement of reward on WeChat Moments 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact A brief announcement of award was made in Chinese through Dr. Hua Wei's personal WeChat account in April 2020.
Year(s) Of Engagement Activity 2020
Description Engagement activities with delivery platform company 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Initial talks were held between the research team, including the Chinese partners, with, one of China's largest online shopping platform and delivery company. Two representatives from operation and health and safety participated. NCNCD, one of the Chinese partners that is leading this part of the study has also paid visit to JD Beijing branch and sites. The research purpose of the project was introduced to the company and their feedback on research design and introduction about their operation were discussed.
Year(s) Of Engagement Activity 2020