Targeting ergonomics interventions--learning from health promotion

Can biofeedback training in combination with ergonomic information reduce pain among young adult computer users with neck and upper extremity symptoms? - A randomized controlled intervention study

The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.

The problem with "ergonomics injuries": What can ergonomists do?

Effects of psychosocial hazards on risk of musculoskeletal disorders (MSDs) are often very substantial, but workplace risk management practices focus largely on biomechanical hazards, as do the risk assessment methods used by ergonomists. Translation of research evidence into more effective workplace practices demands a more holistic risk management framework that encompasses both types of hazard. In this context, we evaluate the validity of different MSD risk assessment methods for different purposes, focusing particularly on requirements for routine workplace risk management. These include choice of fit-for-purpose assessment methods, prioritisation of hazards that are most affecting risk, and control actions as high as possible in the risk control hierarchy. Ergonomists could facilitate more effective workplace risk management by promoting: awareness of the need for change; improvements to guidance from OHS regulators; research on MSD-related workplace management issues; and professional development programs on this topic for ergonomists and other OHS practitioners.

Ergonomics training coupled with new Sit-Stand workstation implementation influences usage

Currently, there is no guidance on the training programme approach that should be provided to new sit-stand workstation users to optimally integrate workstation usage patterns into their working day. The objective of this research study was to determine if a training programme could influence long-term usage of sit-stand workstations. Thirty-five employees from the University of Waterloo volunteered to participate in this longitudinal study. Two different types of training programmes were delivered: (1) an example from industry and (2) based on current literature. There was an influence of training programme on the frequency of sit to stand transitions made each day. Those who received the additional training programme also reported sitting less, standing more and used their sit-stand workstations more consistently day-to-day than those who did not. Practitioner Summary: A longitudinal study was conducted to assess the impact of training programmes on sit-stand workstation usage. A training programme based on current literature resulted in more consistent sit-stand usage than an industry example.

Walking Works Wonders: a tailored workplace intervention evaluated over 24 months

This article presents longitudinal data from 1120 participants across 10 worksites enrolled in Walking Works Wonders, a tailored intervention designed to increase physical activity and reduce sedentary behaviour. The intervention was evaluated over 2 years, using a quasi-experimental design comprising 3 conditions: tailored information; standard information and control. This study explored the impact of the intervention on objective measures (BMI, %Fat, waist circumference, blood pressure and heart rate) and self-reported measures of physical activity, sedentary behaviour, physical and psychological health. Interventions tailored to employees' stage of change significantly reduced BMI and waist circumference compared to standard and control conditions. Employees who received either a standard or tailored intervention demonstrated significantly higher work ability, organizational commitment, job motivation, job satisfaction and a reduction in intention to quit the organization. The results suggest that adopting a tailored approach to interventions is particularly effective in terms of improving health in the workplace. Practitioner Summary: This study describes Walking Works Wonders, a tailored intervention, which aims to encourage physical activity in the workplace. The study evaluated Walking Works Wonders over a 2 year period and demonstrated that interventions are more effective in improving health outcomes where the information is tailored to employees' stage of change.

Barriers for implementation of successful change to prevent musculoskeletal disorders and how to systematically address them

This scoping review identified common barriers and facilitators encountered during the implementation of changes to prevent musculoskeletal disorders (MSD) and examined their relationship with those encountered in general Occupational Health and Safety (OHS) efforts. Thematic analysis of the literature identified 11 barriers: (i) Lack of time; (ii) Lack of resources; (iii) Lack of communication; (iv) Lack of management support, commitment, and participation; (v) Lack of knowledge and training; (vi) Resistance to change; (vii) Changing work environment; (viii) Scope of activities; (ix) Lack of trust, fear of job loss, or loss of authority; (x) Process deficiencies; and (xi) Difficulty of implementing controls. Three facilitators identified were: (i) Training, knowledge and ergonomists' support; (ii) Communication, participation and support; and (iii) An effective implementation process. The barriers and facilitators identified were similar to those in general OHS processes. The integration of MSD prevention into a general management system approach may overcome these barriers.

A long-term evaluation of the stage of change approach and compensable injury outcomes - a cluster-randomised trial

This study investigated the long-term injury outcomes for workers in companies from a range of industries which had been randomly allocated to receive ergonomics interventions tailored according to the stage of change (SOC) approach or standard ergonomics advice. Differences in compensable injury outcomes between the groups were analysed using logistic regression models. Questionnaire results from face-to-face interviews to assess musculoskeletal pain and discomfort (MSPD), job satisfaction and other factors were also analysed. Although not significant at the 0.05 level, after adjusting for workgroup clustering, workers in receipt of tailored advice were 55% (OR = 0.45, 95% CI = 0.19-1.08) less likely to report a compensable injury than those in receipt of standard ergonomics advice. Workload, job satisfaction and MSPD were significantly correlated with injury outcomes. The observed outcomes support the potential value of the SOC approach, as well as highlighting the need to consider workload, job satisfaction and MSPD when planning injury prevention programmes. Practitioner Summary: This study investigated compensable injury outcomes for workers who had received ergonomics advice tailored according to the stage of change (SOC) approach compared with standard ergonomics advice. The results support the potential value of the SOC approach and highlight the need to consider workload, job satisfaction and musculoskeletal pain and discomfort when planning injury prevention interventions.

The stage of change approach for implementing ergonomics advice - Translating research into practice

The Stage of Change (SOC) approach has been proposed as a method to improve the implementation of ergonomics advice. However, despite evidence for its efficacy there is little evidence to suggest it has been adopted by ergonomics consultants. This paper investigates barriers and facilitators to the implementation, monitoring and effectiveness of ergonomics advice and the adoption of the SOC approach in a series of focus groups and a subsequent survey of members of the Human Factors Societies of Australia and New Zealand. A proposed SOC assessment tool developed for use by ergonomics practitioners is presented. Findings from this study suggest the limited application of a SOC based approach to work-related musculoskeletal injury prevention by ergonomics practitioners is due to the absence of a suitable tool in the ergonomists' repertoire, the need for training in this approach, and their limited access to relevant research findings. The final translation of the SOC assessment tool into professional ergonomics practice will require accessible demonstration of its real-world usability to practitioners and the training of ergonomics practitioners in its application.

Office chairs are often not adjusted by end-users

To find out how many office workers adjust their chairs, 350 office workers in Spain and the Netherlands are observed and questioned on whether they adjust their chairs. It appears that 24% of 236 Spanish office workers and 61% of 100 Dutch subjects never adjust their chair. If the chair is adjusted, it concerns mostly the seat height. Except for the seat height, other adjustment possibilities are not used by the majority of the study population. Reasons for not adapting could be awareness, complexity of the control system and expected effects.

Intervention development to reduce musculoskeletal disorders: Is the process on target?

Work related musculoskeletal disorders remain an intractable OHS problem. In 2002, Haslam proposed applying the stage of change model to target ergonomics interventions and other health and safety prevention activities. The stage of change model proposes that taking into account an individual's readiness for change in developing intervention strategies is likely to improve uptake and success. This paper revisits Haslam's proposal in the context of interventions to reduce musculoskeletal disorders. Effective MSD interventions require a systematic approach and need to take into account a combination of measures. Research evidence suggests that in practice, those charged with the management of MSDs are not consistently adopting such an approach. Consequently, intervention development may not represent contemporary best practice. We propose a potential method of addressing this gap is the stage of change model, and use a case study to illustrate this argument in tailoring intervention development for managing MSDs.

Rapid Translational Field Research Approach for eHealth R&D

Successfully implementing eHealth research and design (R&D) requires a combination of rapid-cycle, flexible, and field-based design, development, and testing methods not readily achievable within traditional academic research programs. We report on an attempt to establish a model for facilitating and speeding up R&D projects, wherein academic faculty, design experts, students, and clinicians cooperate to produce, test, and deploy eHealth products in clinical practice. The first test of this model was performed in a project called Project T, a test of tablet use by older adults with depression, dementia, or both, recruited from a safety net health system. Fifteen tests were performed in a six-month period, which included purchasing, instrument development, approval, coordination, data collection, and interim analysis. The project exceeded its anticipated two-month timeline due to multiple barriers and delays. Having learned from this initial attempt, plans to reorganize the team’s working model for translational field research are described.

Developing the Stage of Change Approach for the Reduction of Work-related Musculoskeletal Disorders

Musculoskeletal disorders remain the most prevalent form of occupational ill health, prompting examination of why attempts to manage the problem have been less successful than perhaps hoped. With a view to improving the efficacy of such interventions, this study examined the applicability of the stage of change approach to the workplace. Tools were developed to assess individual and organizational stage of change towards reducing the risks of musculoskeletal disorders. The tools were tested in a range of occupational sectors, and demonstrated high levels of validity and reliability. Implications for the application of the model in the workplace for improving intervention effectiveness are discussed.

When is job rotation perceived useful and easy to use to prevent work-related musculoskeletal complaints?

Job rotation is often recommended to optimize physical work demands and prevent work-related musculoskeletal complaints, but little is known about possible facilitators and barriers to its usefulness and ease of use. Following a qualitative research design, semi-structured interviews with employers (n = 12) and workers (n = 11) from the construction industry were conducted. Organizational climate, job autonomy, job characteristics and work processes were mentioned as either facilitators or barriers on an organizational level. Worker characteristics, work behavior and attitude were mentioned as either facilitators or barriers on an individual level. Following a structured approach to assess usefulness of job rotation to optimize physical work exposures and identifying barriers to usefulness and ease of use in relevant stakeholder groups is necessary in order to select or develop strategies to overcome these barriers, or to reject job rotation as a useful or easy to use intervention in the given context.

The implementation of ergonomics advice and the stage of change approach

This paper investigates the implementation of injury prevention advice tailored according to the Stage of Change (SOC) approach. The managers of 25 workgroups, drawn from medium to large companies across a wide range of occupational sectors were allocated to receive either standard ergonomics advice or ergonomics advice tailored according to the workgroup SOC. Twelve months after the advice was provided, semi-structured interviews were conducted with each manager. In a multivariate model, managers who had received tailored advice were found to have implemented significantly more of the recommended changes (IRR = 1.68, 95% CI 1.07-2.63) and more "additional" changes (IRR = 1.90, 95% CI 1.12-3.20). Qualitative analysis identified that the key barriers and facilitators to the implementation of changes were largely related to worker resistance to change and the attitudes of senior managers towards health and safety. The findings from this study suggest that the implementation of ergonomics recommendations may be improved by the tailoring of advice according to SOC principles.

It’s not about the hoist: A narrative literature review of manual handling in healthcare

The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, substantial rates of manual handling injuries persist internationally within the nursing profession. This paper reviews the contemporary international literature regarding manual handling interventions noting the unique context for injury prevention strategies within healthcare. The review includes the recognition of underlying assumptions inherent in the conceptualisation of manual handling and its management, and the preponderance of the post-positivist paradigm in this field.

The complexity of manual handling in healthcare has resulted in a theoretical shift from single factor interventions based on technique training towards an emerging multidimensional approach. However the key elements for sustainable solutions to reduce nurses’ manual handling injuries have not yet been identified and consensus is lacking regarding the implementation and appropriate evaluation of injury prevention programmes. Furthermore, whilst the literature is replete with data derived from surveys or insurance industry records of compensation claims, there is a dearth of literature exploring nurses’ manual handling experiences. The in-depth investigation of nurses’ perspectives on manual handling may uncover new knowledge critical to improvement of the manual handling issues.

In search of a representative sample of residential building work

Most research investigating injuries in construction work is limited by reliance on work samples unrepresentative of the multiple, variable-cycle tasks involved, resulting in incomplete characterisation of ergonomic exposures. In this case study, a participatory approach was used including hierarchical task analysis and site observations of a typical team of house builders in New Zealand, over several working days, to obtain a representative work sample. The builders' work consisted of 14 goal-defined jobs using varying subsets of 15 task types, each taking from less than 1 s to more than 1 h and performed in a variety of postures. Task type and duration varied within and between participants and days, although all participants spent at least 25% of the time moving from place to place, mostly carrying materials, and more than half the time either reaching up or bending down to work. This research has provided a description of residential building work based on a work sample more nearly representative than those previously published and has demonstrated a simple, low-cost but robust field observation method that can provide a valid basis for further study of hazard exposures.

An evaluation of EU legislation concerning risk assessment and preventive measures in occupational safety and health

The European Council Directive 89/391/EC of 12 June 1989 is concerned with the introduction of measures to encourage improvements in the occupational safety and health. For example, it deals with risk assessment and preventive measures. The Finnish legislation enacts the risk assessment and prevention measures in a similar way as the EU Directive 89/391/EC. The aim of this study was to examine: 1) the implementation of risk assessment process as a part of OSH management, and 2) the effectiveness of the OSH legislation concerned with risk assessment. The quantitative method involved an online questionnaire. The respondents were employers (N = 1478), workers (N = 1416) and occupational care (OHC) professionals' units (N = 469). Three quarters of the employer respondents and two thirds of the workers and OHC service providers felt that the EU legislative provisions have promoted the engagement of the management. According to the study, improvement is needed in ensuring the cooperation between employers and workers. The combined variables of Risk Assessment Process revealed positive impacts both on Cooperation and Management Measures and on the Concrete Preventive Measures among the employers and the workers. The combined variables of Use of Documents of Risk Assessments highlighted positive impacts on both the Exploiting of Results of Risk Assessments in Planning and Management and on the Exploiting of Results of Risk Assessment in Cooperation and Technology.

The Ergonomic Program Implementation Continuum (EPIC): integration of health and safety--a process evaluation in the healthcare sector

INTRODUCTION

This article presents a health and safety intervention model and the use of process evaluation to assess a participatory ergonomic intervention.

METHOD

The effectiveness of the Ergonomic Program Implementation Continuum (EPIC) was assessed at six healthcare pilot sites in Ontario, Canada. The model provided a framework to demonstrate evaluation findings.

RESULTS

Participants reported that EPIC was thorough and identified improvements related to its use. Participants believed the program contributed to advancing an organizational culture of safety (COS). Main barriers to program uptake included resistance to change and need for adequate funding and resources. The dedication of organizational leaders and consultant coaches was identified as essential to the program's success.

IMPACT ON INDUSTRY

In terms of impact on industry, findings contribute to the evidence-based knowledge of health and safety interventions and support use of the framework for creating a robust infrastructure to advance organizational COS and link staff safety and wellness with patient safety in healthcare.

Assessing attitudes, beliefs and readiness for musculoskeletal injury prevention in the construction industry

The objectives are to determine attitudes and beliefs among construction workers and supervisors related to taking action to reduce musculoskeletal injuries (MSIs). "Action" stage of change was confirmed if workers in the last 6 months are continuing to take steps to reduce MSIs. Surveys (520 workers; 35% and 171 supervisors; 67%) revealed that more workers are concerned about MSIs (p<0.05) and are taking action to reduce MSIs (p<0.05) than supervisors. Workers taking action tended to be younger and less experienced than other workers (p=0.00). The final multivariate model showed those workers taking action were more likely to be mechanics and general laborers, to have experienced pain within the last week, to be involved in health and safety, to feel that changes aimed at reducing MSIs would be effective, and that injuries are due to adverse work conditions rather than with characteristics of individual workers. This information can be used to target ergonomics interventions in this industry.

Process and implementation of participatory ergonomic interventions: a systematic review

Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.

Effects of a Multifaceted Minimal-Lift Environment for Nursing Staff: Pilot Results

Nursing staff are at risk for musculoskeletal injuries because of the physical nature of patient handling. The purpose of this study is to examine the effectiveness of a multifaceted minimal-lift environment on reported equipment use, musculoskeletal injury rates, and workers’ compensation costs for patient-handling injuries. The pilot study consists of a mixed measures design, with both descriptive and quasi-experimental design elements. The intervention consists of engineering (minimal-lift equipment), administrative (nursing policy), and behavioral (peer coach program) controls. The comparison nursing unit has received engineering controls only. The convenience sample includes nursing staff employed on two medical-surgical nursing units, who provide direct patient care at least 50% of the time. Nursing staff employed in a multifaceted lift environment report greater lift equipment use and experience less injury, with reduced worker’s compensation costs.

Health behavior change models and theories: contributions to rehabilitation

PURPOSE

This article highlights the importance of health behavior change (HBC) theory, and its relevance to rehabilitation research and practice.

METHOD

An extensive review of HBC-related literature pertinent to rehabilitation was conducted, focusing on the potential impact of these theories and models in enhancing long-term results of rehabilitation with regard to lifestyle change and health promotion, and outlining the benefits of incorporating HBC themes into rehabilitation practice. For our purposes, the HBC concept is based on initiation and maintenance of health behaviors, functioning, wellness, and self-management of chronic conditions or disabilities within an environmental context. While comparing and contrasting three widely known theories of HBC, the contributions of these theories to rehabilitation research and practice are discussed.

RESULTS

Three propositions are put forward: (1) HBC variables should regularly be used as outcome measures in evidence-based rehabilitation research; (2) there should be a better understanding of the role of the rehabilitation provider as a facilitator in eliciting healthy behaviors; and (3) there is a need to expand the HBC concept into a more comprehensive view encompassing a person's functioning within the environmental context.

CONCLUSIONS

A conceptual merger between HBC theories and rehabilitation practice can have major implications for individuals with disabilities, their functioning, health, and well-being.

The role of contextual factors for musculoskeletal disorders in the New Zealand meat processing industry

Musculoskeletal disorders (MSD) are the leading cause of occupational injury internationally. In New Zealand, the highest incidence of MSD is in meat processing, accounting for over half the injury compensation costs for the sector. MSD in meat processing have proven highly resistant to physical, micro-level interventions, suggesting a new approach is required. This paper reports on part of a 2-year study looking at MSD in the New Zealand meat processing industry. The qualitative study involved interviews with 237 workers, management, union and safety personnel in 28 processing sites. These data were summarised into a list of contextual factors, which, it is postulated, may create conditions under which greater exposure to physical and psychosocial factors can occur in meat processing. Some of the contextual factors are recognised as problematic by the industry, but have not previously been associated with MSD risk. The paper concludes by reflecting on conducting MSD research with a focus on contextual factors and how this may influence MSD prevention. The manuscript provides industry-based data on MSD risk and outlines the approach used in its collection. Identifying contextual factors and understanding their role in creating MSD risk may help improve the acceptance and effectiveness of MSD interventions in industry.

Condução de ações em saúde e segurança do trabalho em pequenas e médias empresas: análise de três casos

Construir ações relacionadas à saúde e segurança nas Pequenas e Médias Empresas (PME) não é tarefa fácil, uma vez que essas empresas precisam lidar com o provimento deficitário de informações, poucos recursos disponíveis e metodologias de ação desenvolvidas de acordo com as características das empresas de grande porte. Partindo de estudos de caso e de metodologia qualitativa, o presente estudo teve como objetivo investigar, em três PME do setor industrial, a maneira como ações de saúde e segurança são conduzidas - inclusive ações ergonômicas -, bem como as justificativas para sua forma de condução, utilizando, para tanto, entrevistas e questionários. A investigação comprovou que aspectos, tais como poucos recursos financeiros, pouco acesso à informação, cultura e o modelo gerencial assumido, exercem grande influência sobre a forma como as ações em Saúde e Segurança do Trabalho (SST) serão conduzidas, sendo que a Ergonomia, quando houver, será caracterizada pela condução perceptiva e informal das mudanças no local de trabalho. Concluiu-se que algumas normas e leis, assim como ferramentas ergonômicas, deveriam ser desenvolvidas e adaptadas às PME. Moldar as ações segundo as necessidades e limitações de cada empresa poderia facilitar sua utilização e assim promover uma melhora das condições de saúde e segurança nas PME.

Effectiveness of participatory ergonomic interventions on health outcomes: a systematic review

The objective of this study was to conduct a systematic review of the literature on the effectiveness of participatory ergonomic (PE) interventions for improving workers' health. The search strategy targeted six electronic databases and identified 442 potential articles. Each article was examined by pairs of reviewers for relevance (assessed a participative ergonomic workplace intervention, with at least one health outcome, published in English in peer reviewed literature). Twenty-three articles met relevance criteria and were then appraised for methodological strength. Using a best evidence synthesis approach, 12 studies that were rated as 'medium' or higher provided partial to moderate evidence that PE interventions have a positive impact on: musculoskeletal symptoms, reducing injuries and workers' compensation claims, and a reduction in lost days from work or sickness absence. However, the magnitude of the effect requires more precise definition.

Improving work style behavior in computer workers with neck and upper limb symptoms

INTRODUCTION

The goal of this study was to assess the effectiveness of a group-based interactive work style intervention in improving work style behavior.

METHODS

Computer workers with neck and upper limb symptoms were randomised into the work style group (WS, N = 152), the work style and physical activity group (WSPA, N = 156), or the usual care group (N = 158). Both intervention groups received the same work style intervention but the WSPA group also received a lifestyle physical activity intervention. Participants from the intervention groups attended six group meetings which focused on behavioral change with regard to body posture and workstation adjustment, breaks, and coping with high work demands in order to reduce work stress. Stage of change, breaks and exercise behavior, and stress outcomes were assessed by questionnaire at baseline (T0) and after 6 (T1) and 12 months (T2). Body posture and workstation adjustment were assessed by observation and by questionnaire at T0, T1, and T2. Multilevel analyses were used to study differences in work style behavior between study groups.

RESULTS

The work style intervention was effective in improving stage of change with regard to body posture, workstation adjustment, and the use of sufficient breaks during computer work. These findings were confirmed by higher self-reported use of breaks and exercise reminder software and less working hours without breaks. However, self-reported changes in body posture and workstation adjustment were less consistent. The work style intervention was ineffective in changing stress outcomes.

CONCLUSION

A group-based work style intervention seems to be effective in improving some elements of work style behavior. Future studies should investigate the effectiveness of work style interventions on all dimensions of the Feuerstein work style model.

Nurses' Expectations, Experiences and Attitudes towards the Intervention of a ‘No Lifting Policy’

The aim of the study was to evaluate expectations and attitudes towards a No Lifting Policy programme, the "No Lift system", among nurses at hospitals where an introduction of the intervention was planned (PreNLS hospitals), and to make a comparison with nurses' experiences and attitudes at one hospital where the intervention had already been implemented (NLS hospital). A cross-sectional study of nurses at two PreNLS hospitals and one NLS hospital was performed. Most nurses at both the PreNLS hospitals and the NLS hospital were positive or very positive to the intervention. The expected and experienced obstacles differed between nurses at the PreNLS hospitals and the NLS hospital; however, there was more agreement concerning benefits. The most frequently expected obstacles at the PreNLS hospitals were organisational issues and obstacles related to the facilities, while most obstacles identified at the NLS hospital concerned specific transfers or were patient-related. A decrease in the number of injuries was the most often considered benefit among most nurses. Nurses at the NLS hospital rated their physical exertion as lower in seven out of nine specific patient transfers compared with nurses at the PreNLS hospitals. They also reported increased well-being at work and an improved ability to manage their daily work. The comprehensive approach and participatory design, including all levels of staff and extensive support from the nurses' own union and management, is probably one important explanation for the positive attitudes and successful introduction of the intervention.

An intervention method for occupational safety in farming -- evaluation of the effect and process

In order to increase safety in Swedish farming an intervention methodology to influence attitudes and behaviour was tested. Eighty eight farmers and farm workers in nine groups gathered on seven occasions during 1 year. The basic concept was to create socially supportive networks and encourage discussions and reflection, focusing on risk manageability. Six of the groups made structured incident/accident analyses. Three of the latter groups also received information on risks and accident consequences. Effects were evaluated in a pre-post questionnaire using six-graded scales. A significant increase in safety activity and significant reduction in stress and risk acceptance was observed in the total sample. Risk perception and perceived risk manageability did not change. Analysing incidents/accidents, but not receiving information, showed a more positive outcome. Qualitative data indicated good feasibility and that the long duration of the intervention was perceived as necessary. The socially supportive network was reported as beneficial for the change process.

Integrative interventions for MSDs: nature, evidence, challenges & directions

BACKGROUND

When applied to workplace interventions, integrative may be seen in various ways, requiring elucidation.

METHODS

Identification of primary studies through systematic reviews, limited bibliographic literature searches, the Cochrane Occupational Health Field database on intervention studies, and authors' files. Focus was 2000 on. Categorization according to the Cochrane classes and lenses on integrative. Synthesis as narrative review.

RESULTS

Examples of each lens on integrative were uncovered: biomechanical and psychosocial, multiple component, primary and secondary prevention, organizational, and system. Each contributed different understanding to the potential impacts on different knowledge, exposure, behavior, health and administrative outcomes.

CONCLUSIONS

Considerable opportunities exist to expand the range of integrative interventions, particularly at the organizational and system levels, and incorporate a combination of knowledge transfer and exchange with intervention evaluation.

Workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research

INTRODUCTION

The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented.

METHODS

This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions.

RESULTS

Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders' involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. The role of the researcher in engaging stakeholders, and ethical aspects associated with that process are discussed.

CONCLUSIONS

Recommendations for future research include developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders' interests.

Behavioural change phases of different stakeholders involved in the implementation process of ergonomics measures in bricklaying

The objective of this qualitative study was to assess whether a hypothesised sequential order of behavioural change phases would be fulfilled in different groups of stakeholders involved at the start of a process to implement ergonomic [corrected] measures in bricklaying teams. The measures include trestles, bricklaying scaffolds, mast climbing work platforms [corrected] and cranes. The behavioural change phases were: (1) being aware of measures, (2) understanding measures, (3) wanting measures, (4) intention to buy or hire measures, (5) ability to use measures, (6) using measures (experience), and (7) continuing to use measures. Structured interviews were conducted to examine the change phases in two groups of stakeholders (employers/work planners (n=11) [corrected] and foremen/bricklayers (n=9) [corrected] from nine companies) thought to be relevant in the decision to adopt and use the ergonomic [corrected] measures. The results show that the fulfilled behavioural change phases differ between individual stakeholders, groups of stakeholders, companies and also between ergonomic measures. The hypothesised order of fulfilled consecutive behavioural change phases for individual stakeholders has not been confirmed by this study. The relationship between [corrected] fulfilled and unfulfilled change phases by each stakeholder (group) and actual use of each ergonomic measure requires further study, so as to improve the selection of suitable implementation strategies [corrected]

Paddling upstream: a contextual analysis of implementation of a workplace ergonomic policy at a large newspaper

Efforts to implement workplace ergonomic programs aimed at reducing the burden of work-related musculoskeletal disorders (WMSD) have to address multiple physical and psychosocial aspects of work environments yet often contextual factors limit their success. We describe the processes involved in an ergonomic program to reduce neck and upper limb WMSDs at a large Canadian newspaper. Using qualitative data collection and analysis methods, we illustrate the impact of key contextual characteristics of: (1) the program (management commitment, union involvement, experience and skill of program leaders, and researcher involvement); (2) the organization (drive for productivity, management control, organizational culture); and (3) the broader social context (economic climate, nature of newspaper work, technology and nature of WMSD). We argue for increased attention to identification and response to the contextual factors affecting program implementation in order to more successfully address upstream determinants of WMSD.

Using a matrix in life transition research

Life transitions can be planned or can occur unexpectedly. They can cause a major change to a person's life patterns and well-being. Older adulthood is a time for many life transitions as a result of changes in life roles and health status. In this exploratory study, the authors investigate the transition involved in driving cessation for older people. In analyzing and organizing the data, they develop a matrix that incorporated descriptive and temporal factors associated with the transition. This matrix is useful in organizing and communicating the findings as a whole and could be used in describing individual experiences. It might be of use for the organization of qualitative data about other life transitions such as illness, retirement, and the development and adoption of new behaviors.

Processes, barriers, and outcomes described by ergonomics consultants in preventing work-related musculoskeletal disorders

Despite the importance of reducing work-related musculoskeletal disorders, there appears to have been little evaluation of routine ergonomics consultancy interventions aimed at reducing risks leading to these conditions. In many instances, the effectiveness of advice depends on organisations accepting and implementing measures recommended, involving changes of both individual and collective behaviour. Behaviour change theory, developed elsewhere, suggests that if change is to take place, recipients need to hold positive attitudes and beliefs relating to the desirable behaviour. To investigate the extent to which this is accommodated by current ergonomics consultancy practices, 14 ergonomics consultants were interviewed to explore the consultancy process from which recommendations are developed, exploring the factors that are assessed by consultants, perceived barriers to promoting change, and the extent to which evaluation of outcomes takes place. Consultants' recommendations generally focused on physical aspects of the work environment and did not take explicit account of employees' knowledge or attitudes. Little evaluation of outcomes was conducted by the consultants interviewed. Implications of these findings for improving the efficacy of interventions to reduce work-related musculoskeletal disorders within organisations are discussed.

Efficacy of adjusting working height and mechanizing of transport on physical work demands and local discomfort in construction work

The efficacy of ergonomics measures to reduce physical work demands in a real working situation is often assumed, but seldom studied. In this study, the effect of adjusting working height and mechanization of transport on physical work demands and local discomfort of bricklayers' work was evaluated during a field experiment in the construction industry. In a within-subjects controlled experiment, 10 bricklayers and 10 bricklayers' assistants worked in two different conditions. Working height of bricks and mortar, and transport of materials were manipulated. The physical work demands were assessed through real time observations at the work site. Local discomfort of the lower back and of the shoulder region was measured by means of a visual analogue scale. Working with a scaffolding console to adjust the working height of the storage of materials resulted in a significant reduction of the frequency and duration of trunk flexion (> 60 degrees) by 79% and 52% respectively, compared with bricks set out on the ground floor. Mechanization of transport of materials resulted in a significant reduction of the frequency and duration of trunk flexion (> 60 degrees) by 94% and 92% respectively, compared with the condition of manual handling. The frequency of handling objects (> 4 kg) reduced significantly by 86%. Local discomfort of the lower back was significantly less in the ergonomic conditions, while no significant difference was found for local discomfort of the shoulder between both conditions in bricklayers' assistants.