Development of evidence-based practice in occupational health services in Sweden: a 3-year follow-up of attitudes, barriers and facilitators

Ergonomists' experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration

Background

In order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists’ experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution.

Methods

Semi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data.

Results

The ergonomists’ experiences were summarized in one theme “A joint roadmap supporting a participatory process” and two categories “Clear structure provided by the components” and “The process influenced by collaboration and context”. The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies’ routines and the ergonomist’s intra-organizational support, such as access to IT-resources, could also affect the process.

Conclusions

The findings reveal that this process model facilitates the ergonomists’ work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08601-2.

Professional knowledge development and evidence-based practice in confusing vs. supportive work organizations: A grounded theory situational analysis of Swedish elderly care

BACKGROUND

This article focuses on knowledge development and health professionals' opportunities to use evidence-based practice (EBP). We studied registered physiotherapists (PT), occupational therapists (OT) and nurses (RN) in Swedish elderly-care institutions, a sector known for high turnover and shortages of competent staff.

OBJECTIVE

To examine the perspectives of healthcare providers on professional knowledge development and EBP in their organization.

METHODS

We conducted on-site qualitative interviews with a purposive sample of PTs, OTs and RNs, in six elderly care institutions. Situational analysis was used to analyze the material.

RESULTS

Three discursive professional positions were found: 1) Professional ambition in confusing work organization; 2) Professional ambition in a knowledge-promoting work organization; and 3) Professional indifference with few aspirations for knowledge development. Professional aspirations toward knowledge development were high in two of these positions, whereas the third represents a slightly different approach with fewer aspirations for knowledge development. Linked to these professional approaches to knowledge development is a continuum of aggravating or facilitating factors within the work organization, including varying degrees of support from leadership of the organization, as well as few opportunities for rewards.

DISCUSSION AND CONCLUSIONS

It is concluded that elderly care needs to develop strategies for evidence-based practice in order for the sector to become a sustainable arena for health professionals' career development, and in order to improve the quality of care for the elderly.

Workplace Musculoskeletal Disorder Prevention Practices and Experiences

Introduction. Musculoskeletal disorders (MSD) remain a substantial burden to society and to workplaces worldwide. Evidence-based practice approaches may be helpful; however, current research evidence is not consistently strong. Workplaces must address MSD regardless of the state of the research evidence. The study objective was to describe workplace MSD prevention practices experiences and perspectives of workers, managers, and occupational health and safety practitioners. Methods. This descriptive study used a convenience sample from Newfoundland and Labrador workplaces. Data were collected via survey and interviews. The survey data was analyzed using descriptive statistics and the interview data was analyzed using thematic analysis. Results. Results were examined from 645 survey respondents and 17 interviewees. Survey findings revealed that about half of respondents reported MSD policies existed in their workplace. Many MSD practices (such as ergonomics and force reduction) were considered available by most respondents. Over fifty percent of respondents received some training on MSD. The person most often endorsed as responsible to support workers with MSD was a manager. Interview findings showed that MSD prevention practices related to awareness, training, and hazard reduction are considered important and effective. Facilitators of MSD prevention include practices that are proactive and customized and increase knowledge about MSD prevention. Barriers concerning lack of resources and poor implementation were consistently mentioned. Conclusions. Evidence from current practices may help workplaces reduce MSD burden. However, with only about fifty percent of respondents reporting that MSD policies exist in the workplace, further work to address MSD is required. Future research should examine workplace practices as an important source of evidence. OHS professionals can use the study findings and adapt it to their context(s) to guide their design and implementation of MSD prevention practices. Improved MSD prevention practices and interventions can lead to decreases in MSD in workplaces across all industrial sectors.

Measuring societal impact of research—Developing and validating an impact instrument for occupational health and safety

Research funders and policymakers increasingly focus on societal benefits of their investments in research. Research institutions thus face increasing pressure to demonstrate their societal impact to prove their legitimacy and worth. To this end, research institutions need reliable, quantitative methods to measure societal impact. This article describes the development and test of an instrument to quantitatively measure societal impact of applied research at research institution and program levels. It demonstrates the successful validation of the instrument in the multi-disciplinary field of occupational health and safety. The instrument, the Societal Impact Instrument: Occupational Health and Safety Research (SII:OHSR), produces an aggregate measure of societal impact for the research institution as a whole and subscales for each research program. The SII:OHSR instrument is built on a process model of knowledge translation and exchange. It has been developed in the context of multi-disciplinary occupational health and safety research. The instrument is constructed as a generalized and context-independent tool that can be relocated to other research domains and languages. To the best of our knowledge, it is the first singular instrument that quantitatively measures societal impact. It is therefore highly pertinent for the research evaluation field.

Exploring ergonomists' experiences after participation in a theoretical and practical research project on observational risk assessment tools

Objective. The aim of this qualitative study was to explore how ergonomists experienced an e-learning concept as a tool for knowledge translation; furthermore, to explore what, if any, impact the knowledge translation had regarding the ergonomists' work with risk assessments. Methods. Twelve Swedish ergonomists employed in the occupational health service (OHS) participated in a research project, which included an e-learning program in risk assessment training. Focus group interviews and individual interviews were used for data collection. Results. The ergonomists appreciated the e-learning concept, e.g., its flexibility enabled them to decide when and where to practice. The concept was considered feasible within the context of the OHS. The ergonomists experienced an increased knowledge of different observation-based risk assessment tools, which expanded their professional toolboxes. Additionally, they began to reflect more regarding the reliability of risk assessment tools and how to enhance quality in risk assessment assignments. Conclusion. This study showed that e-learning may comprise an efficient knowledge translation for improved risk assessments in the OHS. The program contributed to changes in ergonomists' risk assessment procedures, e.g., in the selection of tools, increasing the number of observers, employing a participatory approach and more often actively involving stakeholders during the risk assessment process.

Promoting Evidence-Based Practice for Improved Occupational Safety and Health at Workplaces in Sweden. Report on a Practice-Based Research Network Approach

Despite the rapid growth in research and R&D expenditures, the translation of research into practice is limited. One approach to increase the translation and utilization of research is practice based research networks. With the aim of strengthening evidence-based practice (EBP) within occupational health services in Sweden (OH-Services), a practice-based research network (PBRN-OSH) was developed. The PBRN-OSH includes researchers and representatives from end-users. This paper reports on the development, outputs and lessons learned in the PBRN-OSH. The PBRN-OSH resulted in several practice-based research projects as well as different measures to ensure EBP in OSH such as the governmentally sanctioned national guidelines for the OH-services. Moreover, results show that the competence in EBP increased among practitioners at the OH-services. Conducting research in a PBRN is more resource demanding; however, this does not imply that it is less cost effective. To succeed in increasing the utility of research findings via PBRN, resources must be invested into an infrastructure that supports collaboration in the PBRN, including costs for a variety of means of dissemination. Further, translation activities need to be included in academic career paths and reward systems if a major improvement in the impact and return of investments from research is to be expected.

Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer's perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer's perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.

Factors influencing ergonomists' use of observation-based risk-assessment tools

BACKGROUND:

Several observation-based risk-assessment tools have been developed in recent decades. Studies reporting their use often focus only on the user, the ergonomist. The influence of context and the attributes of the tools may also affect the use but are factors that are seldom considered.

OBJECTIVE:

The aim of the present study was to explore the process of risk-assessment assignments and to identify factors influencing the use of research-based observation-based risk-assessment tools among Swedish ergonomists, with a background as reg. physiotherapists, employed in Occupational Health Services (OHS).

METHODS:

A web-based questionnaire (n = 70) was combined with semi-structured interviews (n = 12).

RESULTS:

There was limited use of several observation-based risk-assessment tools. Furthermore, the results showed that ergonomics risk-assessment assignments are most commonly initiated reactively and that interventions were seldom evaluated. Factors that influence use are related both to the ergonomist and to the attributes of the tools as well as to contextual factors assigned to authorities, and internal organisations both within occupational health service companies and client companies.

CONCLUSION:

There was a lack of systematic approaches in ergonomics risks assessment and low use and knowledge of risk-assessment tools. This indicates that there is a need to support OHS companies in implementing systematic tools in their practice.