The Implementation of Workers' Health Surveillance by Occupational Physicians: A Survey Study

Exploring Work Absences and Return to Work During Social Transition and Following Gender-Affirming Care, a Mixed-Methods Approach: 'Bridging Support Actors Through Literacy'

PURPOSE

Research on return to work (RTW) following transition-related gender-affirming care (GAC) is lacking. We aim to study the RTW outcomes and experiences of transgender and gender diverse (TGD) people during social and medical transition to understand their needs better and provide tailored support.

METHODS

In this convergent mixed-methods study, the questionnaires of 125 employed TGD people, who took steps in transition (social and GAC), were analyzed for personal- and work characteristics, medical work absences, RTW, support at work, and health literacy. In-depth interviews were held with twenty TGD people to explore perceived facilitators and barriers to RTW.

RESULTS

One hundred and nine participants reported an average of 38 sick days after GAC. The majority (90.2%) resumed their job at the same employer. Although TGD workers felt supported, their health literacy (55.1%) was lower compared to the general population. The qualitative data analysis revealed four major themes: (1) the need and access to information; (2) having multidisciplinary TGD allies; (3) the influence of the occupational position; (4) the precarious balance between work, life, and GAC. Especially participants with a low health literacy level experienced RTW barriers by struggling: (1) to find and/or apply information; (2) to navigate (occupational) health and insurance services.

CONCLUSION

Our research has shown that RTW for TGD individuals is a multifaceted process, affected by personal factors, work-related elements, and the characteristics of the healthcare and social insurance system. Enhancing support for TGD people at work and their RTW requires a high need for centralized information and promoting health literacy while engaging relevant stakeholders, such as prevention services and employers.

A workers' health surveillance online training programme for occupational physicians

BACKGROUND

To support occupational physicians (OPs) in the implementation of workers' health surveillance (WHS), a training programme was developed.

AIMS

(i) To evaluate the effects of a WHS training programme for OPs on knowledge, self-efficacy and skills to implement WHS. (ii) To evaluate to what extent a WHS training programme is acceptable and feasible for implementation in practice.

METHODS

A single-blinded randomized controlled trial with waiting-list control group was used. The WHS training programme consisted of an e-learning and a 4.5-h online training session. OPs completed a knowledge test (0-8), self-efficacy questionnaires on knowledge and skills (6-60), and vignette assignments (0-16) to measure skills. OPs completed the questionnaires, either before and after the WHS training programme (intervention group), or before the training programme (control group) while receiving the training programme after the waiting period. All OPs completed questionnaires about the training's acceptability, and feasibility for implementation in practice. ANCOVA and Poisson regression analyses were conducted.

RESULTS

The self-efficacy score (M = 44.1 versus M = 37.2) (P < 0.001) and skills score (M = 9.6 versus M = 8.3) (P < 0.05) of OPs in the training group (N = 16) were higher than the control group (N = 23). No effect was found on knowledge. Evaluation of acceptability and feasibility showed that 21 (58%) OPs were very satisfied with the training part on initiating WHS, and 29 (85%) would recommend the WHS training programme to colleagues.

CONCLUSIONS

This WHS training programme has a positive effect on self-efficacy and skills of OPs to implement WHS, and may be acceptable and feasible to implement in practice.

Enterprise-Based Participatory Action Research in the Development of a Basic Occupational Health Service Model in Thailand

Various basic occupational health services (BOHS) are provided, particularly in-plant BOHS; however, it might be necessary to start expanding BOHS. The current study focuses on BOHS model development using participatory action research (PAR) at a large-sized enterprise in northeastern Thailand. The PAR began with a situation analysis using ILO Convention C161, problem and cause analysis, the development of an action plan, observation and action, evaluation, and replanning. The research tools included interviews, focus group discussions (FGDs), and participant observations. The participants included managers, human resource staff, safety officers, and workers. Both inductive and deductive thematic analyses were undertaken. The results showed that (1) education and learning experience led to the workers detecting work-related diseases early by themselves and the implementation of medical surveillance programs; (2) the workers' occupational health needs led to return-to-work assessments and first aid room system development; (3) the employer's experience led to appropriate fit-for-work examinations and emergency preparedness; and (4) the feedback from BOHS providers led to a hospital-to-in-plant return-to-work conversion. The study concluded that the enterprise could develop fit-for-work and return-to-work assessments as per the ILO Convention C161 under the policy; however, medical surveillance and the first aid room system need to be developed through counseling at the hospital's occupational medicine clinic.

Proportions distribution of pneumoconiosis stages in China: a study based on a meta-analysis and field investigation

Occupational pneumoconiosis is the most serious work-related disease in China. In this paper, pneumoconiosis stages distribution was obtained to study the stages severity of occupational pneumoconiosis patients in China. A meta-analysis was conducted among screening the published literature on the pneumoconiosis epidemiology in China by Stata 15.0. Moreover, a field survey was conducted on 510 migrant workers suffering from pneumoconiosis in four provinces of China, and the results were analyzed by simple linear analysis and ordinal logistic regression analysis. The stage I, II and III pneumoconiosis accounted for 0.71, 0.21, 0.08, respectively, by the results of meta-analysis. The publication bias of these articles is not obvious based on the Egger's test and funnel plots. There was no significant linear correlation between the distribution of pneumoconiosis stages and the economic status and medical conditions in this study. Migrant workers pneumoconiosis stage I, II and III accounted for 0.14, 0.2, 0.66 respectively, which was significantly correlated with length of work and provinces. In China, migrant workers lack effective occupational health protection so that they have higher occupational health risks than urban workers. Therefore, occupational health protection for migrant workers in the occupational health management system needs to be strengthened.

Development of occupational health culture scale: A study based on miners and construction workers

Culture is an essential influence on effectiveness of workplace health promotion, which can promote occupational health protection behavior. The aim of this research was to develop and validate an occupational health culture scale available to Chinese workers. Occupational health culture scale (OHCS) was developed based on elements of health culture and safety culture in workplace. Nine techniques steps of scale development were used, including a 15-member expert group, 10 workers for cognitive interview, and 1,119 questionnaires (from 710 miners and 409 construction workers) for formal investigation. Welch's variance analysis, independent samples t-test, Kruskal-Wallis test, Spearman correlation analysis was employed, respectively, to verified nine hypotheses about impact relationship on OHCS score. After the analysis reliability and validity, the final scale consisted of 21 items in five domains: leadership support, co-workers support, values, policy and norms, employee involvement, physical environment. Moreover, respirable dust concentration from individual sampler had the largest negative correlation coefficient on OHCS score, -0.469 (p < 0.01). The development of an occupational health culture among Chinese workers is necessary for the sustainability of human resources and the implementation of corporate responsibility.

Uptake of Voluntary Occupational Health Care—Assessments of German Occupational Health Physicians and Employees

Workers’ health surveillance is considered essential for employees’ health and protection against hazardous working conditions. It is one part of occupational health care and thus one of four pillars of holistic workplace health management. In Germany, employers are obliged to provide mandatory and voluntary occupational health care (OHC) to employees, dependent on the defined occupational hazards. However, employees are not obliged to make use of voluntary OHC. No empirical information is available about the uptake of voluntary OHC by employees and the influencing factors in Germany. Thus, we carried out an explorative multi-perspective study with qualitative and quantitative elements to get insights from the view of occupational health physicians (OHPs) and employees. We conducted a survey among OHPs based on prior statements from two focus group discussions. A multivariate logistic regression analysis was performed to detect enablers and barriers regarding employee uptake of the offered voluntary OHC. We used extended qualitative methods among employees instead of an analogous survey. In total, 460 OHPs participated in the survey (response rate 29.1%), and 25 employees took part in interviews. Most of the employees had not heard the term voluntary OHC before, and only a few remembered respective occupational health care after explanatory request. In total, 78% of the OHPs assessed that employees always/mostly take up voluntary OHC. The most important attributed reason for non-uptake was that employees see no need for occupational health care when they feel healthy. The most important enabler for the perceived high uptake of voluntary OHC in the regression analysis was a positive attitude of the OHP toward voluntary OHC. While OHPs perceived that voluntary OHC was accepted by a majority of employees, this was not confirmed by the interviews with selected employees. This could indicate that the OHP respondents overestimated the amount of uptake. Since it became clear that employees are often unfamiliar with the terminology itself, we see a need for more and better information regarding the objectives and content of occupational health care to improve this important pillar of workplace health management.

Workers’ health surveillance targeting mental health: evaluation of a training

Background

Mental health complaints occur frequently among healthcare workers. A workers’ health surveillance mental health module (WHS-MH) was found to be effective in improving work functioning of nurses, although not implemented regularly. Therefore, training for occupational physicians and nurses to facilitate the implementation of WHS-MH was developed and evaluated.

Aims

This study was aimed to evaluate the effect of training on knowledge, self-efficacy and motivation to implement WHS-MH, and to evaluate participants’ satisfaction with the training.

Methods

Three-hour training was held among 49 occupational physicians and nurses in the Netherlands. Effect on knowledge, self-efficacy and motivation was assessed using knowledge tests and questionnaires before and immediately after the training. Satisfaction with the training was measured using questionnaires after the training.

Results

A mean knowledge test score of 5.3 (SD = 1.6) was found before training, which did not significantly increase after training (M = 5.6, SD = 1.8). In total, 43% agreed or strongly agreed to have sufficient skills to implement WHS-MH, which significantly increased to 78% after the training. Furthermore, 87% agreed or strongly agreed to be motivated to initiate WHS, which significantly increased to 94% after the training. The majority of participants were satisfied with the training.

Conclusions

Training may enhance the implementation of the WHS-MH through increasing self-efficacy and motivation. However, no effect on level of knowledge to implement WHS-MH was found.

Supporting Occupational Physicians in the Implementation of Workers' Health Surveillance: Development of an Intervention Using the Behavior Change Wheel Framework

Workers’ health surveillance (WHS) is an important preventive activity aimed at prevention of work-related diseases. However, WHS is not regularly implemented in some EU-countries. As occupational physicians (OPs) have to play an important role in implementation of WHS, this study aimed to develop an intervention to support OPs in implementation of WHS. The behavior change wheel framework (BCW) was used to develop the intervention. First, the problem was defined, and target behavior was selected by using results from a survey study among OPs. Subsequently, change objectives in target behavior were specified. Finally, appropriate intervention functions, behavior change techniques, and modes of delivery were identified to develop the intervention. Target behaviors were (1) OPs initiate WHS, and (2) OPs conduct preventive consultations with workers. OPs’ capabilities, and experienced opportunities were identified as change objectives. Intervention functions (education, training, enablement) and behavior change techniques (information about consequences, demonstration, instructions, behavioral practice, feedback on behavior, goal setting, action planning, reviewing goals) were selected to develop the intervention, delivered by face-to-face group training and e-learning. The proposed intervention consists of training and e-learning to support OPs in implementing WHS. Feasibility and effect of the intervention will be evaluated in future studies.

Caring for the Workforce of a Health System During the COVID-19 Epidemic in Brazil: Strategies of Surveillance and Expansion of Access to Care

OBJECTIVES

To describe the strategies to monitor and expand access to care for a health system workers in the first 2 months of the COVID-19 epidemic in Brazil.

METHODS

Description of the implemented strategy based on the guidelines developed to address the surveillance and care of a large health system's workforce in the COVID-19 epidemic.

RESULTS

During phase 1, the surveillance strategy focused on monitoring suspected cases among employees. In phase 2, surveillance was restricted to employees with confirmed COVID-19, aiming at monitoring of symptoms and following hospitalizations. Access to care was expanded. A total of 1089 employees were diagnosed with COVID-19, 89 required hospitalizations and none had died.

CONCLUSION

The strategies adopted were promptly implemented and could be adapted to the changing epidemic dynamics, allowing low rates of adverse outcomes in this high-risk population.