The psychosocial and health effects of workplace reorganisation. 2. A systematic review of task restructuring interventions

Social Determinants of Mental and Behavioral Health

Both mental illness and overall mental health are determined by a complicated interplay of life experiences and genetic predisposition. While genetic predisposition is difficult to modify, many of the life experiences that worsen mental health and exacerbate serious mental illness are associated with social policies and cultural norms that are changeable. Now that we have identified these associations, it is time to rigorously test scalable interventions to address these risks. These interventions will need to focus on high-impact stages in life (like childhood) and will need to address risk beyond the individual by focusing on the family and community.

Work-related causes of mental health conditions and interventions for their improvement in workplaces

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Association of Psychosocial Stress With Risk of Acute Stroke

IMPORTANCE

Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions.

OBJECTIVES

To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population.

DESIGN, SETTING, AND PARTICIPANTS

INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13 462 patients with stroke and 13 488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13 350 cases and 13 462 controls with available data on psychosocial stress.

EXPOSURES

Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work.

MAIN OUTCOMES AND MEASURES

The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control.

RESULTS

Among 26 812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58]; P = .008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < .001 for interaction) for acute stroke.

CONCLUSIONS AND RELEVANCE

Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.

The Predictive Validity of the Danish Psychosocial Work Environment Questionnaire With Regard to Onset of Depressive Disorders and Long-Term Sickness Absence

OBJECTIVES

To investigate the predictive validity of 32 measures of the Danish Psychosocial Work Environment Questionnaire (DPQ) against two criteria variables: onset of depressive disorders and long-term sickness absence (LTSA).

METHODS

The DPQ was sent to 8958 employed individuals in 14 job groups of which 4340 responded (response rate: 48.4%). Depressive disorders were measured by self-report with a 6-month follow-up. LTSA was measured with a 1-year follow-up in a national register. We analyzed onset of depressive disorders at follow-up using logistic regression models, adjusted for age, sex, and job group, while excluding respondents with depressive disorders at baseline. We analyzed onset of LTSA with Cox regression models, adjusted for age, sex, and job group, while excluding respondents with previous LTSA.

RESULTS

The general pattern of the results followed our hypotheses as high job demands, poorly organized working conditions, poor relations to colleagues and superiors, and negative reactions to the work situation predicted onset of depressive disorders at follow-up and onset of LTSA during follow-up. Analyzing onset of depressive disorders and onset of LTSA, we found risk estimates that deviated from unity in most of the investigated associations. Overall, we found higher risk estimates when analyzing onset of depressive disorders compared with onset of LTSA.

CONCLUSIONS

The analyses provide support for the predictive validity of most DPQ-measures. Results suggest that the DPQ constitutes a useful tool for identifying risk factors for depression and LTSA in the psychosocial work environment.

A Moderated Mediation Analysis of New Work-Related Stressors, Psychological Distress, and Absenteeism in Health Care During a Pandemic: Is Recognition the Cure for Preventing Falling in Battle?

OBJECTIVES

We aimed to evaluate the effects of new work-related stressors on psychological distress and absenteeism and the role of recognition in these relationships.

METHODS

Moderated path analyses were carried out on a sample of 1128 health care workers.

RESULTS

Increased workload related to COVID-19 (coronavirus disease 2019) ( β = 1.511, P ≤ 0.01) and fear of COVID-19 ( β = 0.844, P ≤ 0.01) were directly associated with a higher level of psychological distress and indirectly ( β = 2.306, P ≤ 0.01; and β = 1.289, P ≤ 0.05, respectively) associated with a higher level of absenteeism. Recognition ( β = 0.260, P ≤ 0.001) moderated the association between teleworking and psychological distress. Furthermore, this significant moderation effect had a significant impact on absenteeism ( β = 0.392, P ≤ 0.05). Regardless of the workplace (on site or teleworking), high recognition was beneficial for psychological distress. This effect seems more important when working on site.

CONCLUSIONS

The results propose that specific new work-related stressors should be addressed in the context of organizational change (eg, a pandemic).

Delegation and consultation on operational and tactical issues: Any difference in their potentialities for a healthier psychosocial work environment?

Background

Despite the growing number of studies on direct participation labor‐management practices, little is known about the role of their different discretionary degrees (delegation or consultation) and topics in their relationship with the psychosocial work environment by occupational groups.

Methods

Cross‐sectional study on the relationship between direct participation and work‐related psychosocial risks (using COPSOQ‐ISTAS21 v3) on a representative sample of the salaried and wage‐earning employees in Spain (n = 1807). Prevalence ratios were calculated using adjusted Poisson regression models, controlling for 10 other labor‐management practices, sex, and age, and stratified by occupational group.

Results

The use of direct participation was either associated consistently with a healthier psychosocial work environment (mostly in manual occupations, which presented twice as many positive associations as nonmanual occupations, and of greater strength, mostly in the control and social support dimensions) or there were no significant associations (mostly among nonmanual occupations and in relation to work pace). More frequent and stronger associations were observed when consultation and delegation were used in combination. If used separately, consultation achieved better results among manual occupations and delegation among nonmanual occupations. Direct participation topics were not important for results in manual occupations whereas results were better on tactical (vs. operational) issues in nonmanual occupations.

Conclusions

Direct participation does not change power structure, but it may be a useful intervention at the company level to reduce work‐related psychosocial exposures and associated diseases among workers in manual occupations, and consequently for decreasing occupational exposures and health inequalities.

Team Matters: Cross-sectional study examining the acceptance of an internet-based team development tool aimed at improving work-related wellbeing in nurses (Preprint)

Background

Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use.

Objective

This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers.

Methods

A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses.

Results

Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam.

Conclusions

For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable.

Associations between combinations of job demands and job control among 6,16,818 people aged 55-64 in paid work with their labour market status 11 years later: a prospective cohort study

BACKGROUND

Given current discussions about extending working lives, more knowledge is needed on working conditions associated with labour market status in older age.

OBJECTIVE

To explore associations between combinations of job demands and job control among workers aged 55-64 years and their labour market status 11 years later.

METHODS

A population-based prospective cohort study using nationwide register data. The 616,818 individuals in Sweden aged 55-64 who in 2001 were in paid work were categorised using a job exposure matrix based on tertiles (reference = medium control/medium demands). Participants were followed up in 2012 regarding their main labour market status (paid work, old-age pension, no income/social assistance, sickness absence/disability pension, emigrated, dead; reference = old-age pension) using multinomial logistic regression for odds ratios (OR) and 95% confidence intervals (CI). The fully adjusted analyses included adjustment for sociodemographic factors and unemployment or sickness absence/disability pension for more than half the year in 2001.

RESULTS

Those in occupations with low job control at baseline were less likely to be in paid work at follow-up (OR low demands/low control 0.74, CI 0.71-0.78; high demands/low control 0.81, CI 0.75-0.87). Those in occupations with baseline high demands were less likely to have no income/social assistance at follow-up (OR high demands/low control 0.71, CI 0.52-0.96; high demands/high control 0.59, CI 0.47-0.75).

CONCLUSION

Job demands and control when aged 55-64 were associated with labour market status 11 years later: high control was associated with greater chance of being in paid work, and high demands were associated with lower risk of no income/social assistance.

Abusive leadership, psychological well-being, and intention to quit during the COVID-19 pandemic: a moderated mediation analysis among Quebec's healthcare system workers

Purpose

To examine the effects from work-organization conditions, abusive leadership, and their interaction on Quebec healthcare system workers’ psychological well-being and intention to quit during the COVID-19 pandemic.

Methods

Mediation and moderated mediation analyses were performed using MPlus software on a sample of 921 Quebec healthcare system workers.

Results

Skill utilization, decision authority, social support from co-workers and supervisors, and recognition were associated directly and positively with psychological well-being, while psychological and physical demands were associated directly and negatively with psychological well-being. Skill utilization, irregular work schedule, and recognition were associated directly and negatively with intention to quit, while psychological demands were associated directly and positively with intention to quit. Moreover, the results demonstrated that abusive leadership attenuated the effects from recognition and decision authority on psychological well-being (moderation effects), contributing to greater intention to quit among workers (moderated mediation effects).

Conclusions

The obtained results underline the importance of work-organization conditions and leadership style on healthcare system workers’ psychological health and their intention to quit their jobs during a pandemic. In particular, and given their key role, leaders/managers must be sensitized concerning leadership style and its possible effects on their employees’ psychological well-being and intention to quit. Therefore, training programs should be offered to leaders/managers to prevent adoption of abusive leadership styles.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01790-z.

Social Enterprise, Population Health and Sustainable Development Goal 3: A Public Health Viewpoint

Although there is no consensus on the definition of “social enterprises (SEs),” various scholars have agreed that SEs are “sustainable ventures that combine business principles with a passion for social impact.” Using a public health lens, this viewpoint paper attempts to discuss the potential role SEs might play in the achievement of sustainable population health and Sustainable Development Goal 3 (SDG 3): “Health for all at all ages.” Through their impact on social determinants of health (the conditions in which people are born, grow, work, and age), SEs have a potential to contribute to SDGs, specifically SDG 3. They can do so by acting on and modifying the economic, social and environmental challenges communities face, to help promote health and wellbeing and improve the quality of life among children, adolescents, working adults and elderly across countries, societies and generations. Social enterprises present an opportunity to engage business as partners in health promotion – which is yet to materialize in all societies globally.

Effects of a participatory organisational, core work task focused workplace intervention on employees' primary healthcare consultations: secondary analysis of a cluster RCT

OBJECTIVES

We aimed to examine whether a participatory organisational workplace intervention focusing on core tasks at work resulted in lower primary healthcare utilisation of employees.

METHODS

The cluster randomised controlled trial included 78 preschools, 44 allocated to the intervention group (1745 employees) and 34 allocated to the control group (1267 employees). The intervention aimed to involve employees in improving the psychosocial work environment while focusing on core tasks at work. Using Poisson regression, we tested the rate ratios (RRs) of consultations in the intervention compared with the control group in terms of all consultations in primary healthcare and general practitioner (GP) consultations, respectively, per person-year during 31 months of follow-up. The fully adjusted model included adjustment for sex, age, job group, workplace type and size, and previous primary healthcare utilisation.

RESULTS

During the follow-up, intervention group employees had 11.0 consultations/person-year, while control group employees had 11.6 consultations/person-year (RR 0.97, 95% CI 0.92 to 1.01). Employees in the intervention group had 7.5 GP consultations/person-year, while control group employees had 8.2 GP consultations/person-year (RR 0.95, 95% CI 0.90 to 0.99). Post hoc analyses indicated that the effect of the intervention was particularly strong in employees in preschools with a moderate or high level of implementation.

CONCLUSIONS

The participatory organisational workplace intervention focusing on core tasks at work among preschool employees had a small, statistically non-significant effect on overall primary healthcare utilisation and a small, statistically significant effect on GP consultations. These results suggest a beneficial effect of the participatory organisational intervention on employees' health.

TRIAL REGISTRATION NUMBER

ISRCTN16271504.

A Revised Ecological Model of Occupational Stress: Applications to 9-1-1 Telecommunicators

Background: A cohesive body of scientific evidence has documented the adverse impacts of occupational stress on worker health and safety and, to a lesser extent, on organizational outcomes. How such adverse impacts may be prevented and/or ameliorated are important to understand, but progress has been limited due to the lack of a robust and comprehensive theoretical model of occupational stress. Methods: Building on a review of existing theoretical models of occupational stress and an ecological framework, a multilevel conceptual model of occupational stress and strain is proposed that identifies various and potentially interacting sources of occupational stressors as well as potential protective factors. Results: The revised ecological model proposed herein embraces a broad conceptualization of outcomes and includes an individual worker, work unit (team) performance as well as organizational level outcomes; for example, resilience/dysfunction. Conclusion/Application to Practice: This model provides occupational health nurses with an improved understanding of occupational and worker health as well as guidance in developing targeted interventions and generating new lines of occupational stress research.

Psychosocial working conditions and depressive disorder: disentangling effects of job control from socioeconomic status using a life-course approach

PURPOSE

Job control, the combination of skill discretion and decision authority, is considered a central component of the psychosocial working environment. This longitudinal study examines the relation between job control and risk of incident depressive disorder using a life-course approach.

METHODS

We analyze data from The Danish Work Life Course Cohort study, including all Danish individuals aged 15-30 who entered the Danish labor market during 1995-2009 and were free from depressive disorder at entry (955,573 individuals). We measured job control using a job exposure matrix. Depressive disorders were measured using information from nationwide registers of psychiatric in- and outpatient admissions. Using Cox regression models we estimated the prospective association between job control and risk of incident depressive disorders. Analyses accounted for a range of potential confounders prior to workforce entry including socioeconomic status in adolescence and parental psychiatric and somatic diagnoses prior to labor market entry, together with potential confounders in adulthood including income, education, and demographics.

RESULTS

Lower levels of past year job control were associated with a higher risk of depressive disorder after adjustment for all covariates (HR = 1.27, 95% CI 1.16-1.38). Results stratified by gender showed associations for both men (HR = 1.38, 95% CI 1.19-1.61) and women (HR = 1.19, 95% CI 1.08-1.32).

CONCLUSIONS

Our findings suggest that the level of job control at work affects the risk of clinically diagnosed depressive disorder, and that this association is not due to confounding by socioeconomic status.

Does Depression Mediate the Effect of Work Organization Conditions on Job Performance?

OBJECTIVE

The present study proposes to shed light on the impact of workers' depression on their work performance.

METHODS

We implemented a path analyses adjusted for design effects resulting from cluster sampling using MPlus software on a sample of 1957 workers. These analyses allowed us to evaluate direct and indirect effects (mediation) while taking into account the nonindependence of observations due to cluster sampling (workers nested in their workplace).

RESULTS

Results indicate that three indirect associations were found to be significant. Psychological demands, work schedule, and job insecurity were indirectly associated with lower levels of professional efficacy/job performance because of their positive associations with depression.

CONCLUSIONS

The results obtained suggest that interventions targeting specific work organization conditions could be warranted.

What is the evidence that differences in 'control over destiny' lead to socioeconomic inequalities in health? A theory-led systematic review of high-quality longitudinal studies on pathways in the living environment

BACKGROUND

Low control and high demand in the places where people work has been shown to partially explain why those in lower socioeconomic positions experience poorer health than their counterparts in higher socioeconomic positions. It would seem likely then that experiences of control in the wider living environment, beyond people's places of work, might also play a role in shaping these health inequalities. Our recent review of theory revealed potential pathways by which low control in the living environment might explain the social patterning of health via low control beliefs and low actual control.

METHODS

Based on the potential pathways identified in our review of theory, we conducted a systematic review of longitudinal studies on the relationship between low control in the living environment and social inequalities in health published by January 2019, in English.

RESULTS

Six studies were included in the review. Taken together, they provide evidence that lower social positions are associated with lower control beliefs and poorer health outcomes, in terms of heart disease, anxiety, depression and self-rated health, and that some of the association between low social position and health outcomes is explained by low control beliefs. No studies investigated the pathway from low actual control to poorer health in more disadvantaged groups.

CONCLUSION

There is strong evidence from a small number of high-quality longitudinal studies that low perceived control in the living environment may play an important role in the pathways leading from low social position to poorer health and well-being. Further studies are needed to distinguish between the effects of having low control beliefs and having actual low control.

A Six Sigma Approach to Analyze Time-to-Assembly Variance of Surgical Trays in a Sterile Services Department

INTRODUCTION

We analyze the assembly of surgical trays in a hospital's sterile services department. The department assembles 520 different tray setups. However, tray assembly times are unknown, imposing a challenge to production planners. To respond to demand, workers from other departments are often called, leading to higher operational costs and more frequent quality problems due to workers' poor training and inconsistency.

METHODS

Conducting traditional time-motion studies is infeasible in such a high variety production setting. Thus, we used design of experiments to optimize the data acquisition. Assembly times of 36 trays were sampled using a 2-factor nested factorial design. Through regression analysis, we built a model to estimate completion times of trays not sampled in the experiment.

RESULTS

A prediction model with 90.8% accuracy was obtained from the experimental data. The model was validated with assembly times from several trays not included in the experiment. Predicted assembly times had an absolute error of 7.83% on average compared with observed assembly times.

CONCLUSIONS

Design of experiments and regression analysis combined were able to optimize time data acquisition using a small sample of trays, resulting in a model that predicted assembly times within an acceptable margin of error.

Effect of a participatory organizational workplace intervention on workplace social capital: post-hoc results from a cluster randomized controlled trial

BACKGROUND

A high level of workplace social capital (WSC) may contribute to the protection of employees' health. We hypothesized that a participatory workplace intervention would increase the level of WSC defined as vertical WSC (i.e. WSC linking together employees and their leaders) and horizontal WSC (i.e. WSC bonding employees together).

METHODS

We conducted a secondary data analysis of a cluster randomized controlled trial that was implemented among all employees in 78 municipal Danish pre-schools (44 intervention and 34 control group schools). The study sample consisted of 606 employees, 386 in the intervention and 220 in the control group. The intervention aimed to improve the psychosocial working environment by using a participatory approach and focusing on core job tasks. Vertical and horizontal WSC was measured by five and four items, respectively, at baseline and at 24-months follow-up. We estimated intervention effect by calculating the interaction of change over time by group assignment (intervention versus control group) and included workplace identification number in a repeated statement to take into account that employees were nested within workplaces. We conducted post-hoc analyses to examine whether intervention effect differed by implementation degree.

RESULTS

WSC decreased in both groups. In the main analyses, there was no statistically significant difference between intervention and control group, neither for vertical nor horizontal WSC. However, when we excluded intervention workplaces with a low degree of implementation, we found a statistically significant difference between the intervention and the control group (estimate: 0.25, 95% CI: 0.00 to 0.50, p = 0.049), indicating that vertical WSC decreased in the control group and remained stable in the intervention group.

CONCLUSIONS

There was not a statistically significant difference between intervention and control group in the main analysis. Post-hoc analyses, however, suggest that the intervention may have prevented a decrease in vertical WSC among employees in workplaces with a high or a medium degree of implementation. A conference abstract with the key results of this study has been previously presented and published, European Journal of Public Health, Volume 28, Issue suppl_4, November 2018, cky260, https://academic.oup.com/eurpub/article/28/suppl_4/cky260/5187184 .

TRIAL REGISTRATION

ISRCTN16271504 , retrospectively registered on November 15, 2016.

Dissecting the effect of workplace exposures on workers' rating of psychological health and safety

Objectives

To validate the factor structure of the Copenhagen Psychosocial Questionnaire (COPSOQ) in a North American population and dissect the associations between psychosocial factors and workplace psychological health and safety.

Methods

Confirmatory factor analysis and multivariate linear regression were used to determine the associations between COPSOQ dimensions and a global rating of workplace psychological health and safety. Models were stratified by sex, gender roles, and age.

Results

The COPSOQ factor structure was verified among Canadian workers. Three factors were found to significantly contribute to the global rating of the psychological health and safety for all workers. Few differences were observed across sex, gender roles, and age.

Conclusions

This study identified dimensions of the psychosocial work environment that are strongly associated with the global rating of workplace psychological health and safety. Using a standardized questionnaire like the COPSOQ allows for comparisons over time, between different industries, and worker populations.

The Evaluation of Organizational Well-Being in An Italian Teaching Hospital Using the ANAC Questionnaire

In Italy, the Italian National Anti-Corruption Authority (Autorità Nazionale Anti-corruzione—ANAC) has developed a questionnaire to assess the organizational well-being of employees within public agencies. The study aimed to explore the relationship among variables in the ANAC questionnaire: Several job resources (lack of discrimination, fairness, career and professional development, job autonomy, and organizational goals’ sharing) and outcomes of well-being at work, such as health and safety at work and sense of belonging. The research was carried out among workers in an Italian hospital in Northwest Italy (N = 1170), through an online self-report questionnaire. Data were grouped into two job categories: Clinical staff (N = 939) and non-clinical staff (N = 231). The hypothesized model was tested across the two groups through multi-group structural equation modeling. Results showed that health and safety at work and sense of belonging had significant positive relationships with the other variables; some differences emerged between the determinants of the two outcomes and among groups. The study aims to identify some reflections and suggestions regarding the assessment of well-being in the health care sector; implications for practice are identified to promote organizational well-being and health in organizations.

Psychosocial Stressors at Work and Ambulatory Blood Pressure

PURPOSE OF REVIEW

Psychosocial stressors at work from the demand-latitude and effort-reward imbalance models are adverse exposures affecting about 20-25% of workers in industrialized countries. This review aims to summarize evidence on the effect of these stressors on blood pressure (BP).

RECENT FINDINGS

Three systematic reviews have recently documented the effect of these psychosocial stressors at work on BP. Among exposed workers, statistically significant BP increases ranging from 1.5 to 11 mmHg have been observed in prospective studies using ambulatory BP (ABP). Recent studies using ABP have shown a deleterious effect of these psychosocial stressors at work on masked hypertension as well as on blood pressure control in pharmacologically treated patients. Evidence on the effect of these psychosocial stressors on BP supports the relevance to tackle these upstream factors for primary prevention and to reduce the burden of poor BP control. There is a need for increased public health and clinical awareness of the occupational etiology of high BP, hypertension, and poor BP control.

Distress and worry as mediators in the relationship between psychosocial risks and upper body musculoskeletal complaints in highly automated manufacturing

As a result of changes in manufacturing including an upward trend in automation and the advent of the fourth industrial revolution, the requirement for supervisory monitoring and consequently, cognitive demand has increased in automated manufacturing. The incidence of musculoskeletal disorders has also increased in the manufacturing sector. A model was developed based on survey data to test if distress and worry mediate the relationship between psychosocial factors (job control, cognitive demand, social isolation and skill discretion), stress states and symptoms of upper body musculoskeletal disorders in highly automated manufacturing companies (n = 235). These constructs facilitated the development of a statistically significant model (RMSEA 0.057, TLI 0.924, CFI 0.935). Cognitive demand was shown to be related to higher distress in employees, and distress to a higher incidence of self-reported shoulder and lower back symptoms. The mediation model incorporating stress states (distress, worry) as mediators is a novel approach in linking psychosocial risks to musculoskeletal disorders. Practitioners' Summary With little requirement for physical work in many modern automated manufacturing workplaces, there is often minimal management focus on Work-Related Musculoskeletal Disorders (WRMSDs) as important occupational health problems. Our model provides evidence that psychosocial factors are important risk factors in symptoms of WRMSD and should be managed.

Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers

Background: While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.

Methods: Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.

Results: Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P<.01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P<.05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P<.05), at least one healthcare visit in the IT sample, OR 1.35 (P<.01), and with more visits in the IT sample, IRR 1.35 (P<.01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P<.05), in the IT sample.

Conclusion: Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.

The relationship between workplace psychosocial environment and retirement intentions and actual retirement: a systematic review

Psychosocial work characteristics are potential determinants of retirement intentions and actual retirement. A systematic review was conducted of the influence of psychosocial work characteristics on retirement intentions and actual retirement among the general population. This did not include people who were known to be ill or receiving disability pension. Relevant papers were identified by a search of PubMed, PsycINFO and Web of Science databases to December 2016. We included longitudinal and cross-sectional papers that assessed psychosocial work characteristics in relation to retirement intentions or actual retirement. Papers were filtered by title and abstract before data extraction was performed on full texts using a predetermined extraction sheet. Forty-six papers contained relevant evidence. High job satisfaction and high job control were associated with later retirement intentions and actual retirement. No consistent evidence was found for an association of job demands with retirement intentions or actual retirement. We conclude that to extend working lives policies should increase the job control available to older employees.

Participatory redesign of work organisation in hospital nursing: A study of the implementation process

AIMS

The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units.

BACKGROUND

Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing.

METHODS

The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them.

RESULTS

Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals.

CONCLUSION

Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation.

IMPLICATIONS FOR NURSING MANAGEMENT

Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process.

Evaluation of the Quebec Healthy Enterprise Standard: Effect on Adverse Psychosocial Work Factors and Psychological Distress

Adverse psychosocial work factors are recognized as a significant source of psychological distress, resulting in a considerable socioeconomic burden. The impact of occupational health standards that aim to reduce these adverse work factors, such as the Quebec Healthy Enterprise Standard (QHES), is of great interest for public health. The aim of this study was to evaluate, for the first time, the effect of QHES interventions targeting adverse psychosocial work factors on the prevalence of these factors and of psychological distress among ten Quebec organizations. These outcomes were assessed by questionnaire using validated instruments before (T1, n = 2849) and 2-3 years following (T2, n = 2560) QHES implementation. Beneficial effects of interventions were observed for two adverse psychosocial work factors: low rewards (ratio of prevalence ratios (PRs) = 0.77, 95% CI = 0.66-0.91) and low social support at work (ratio of PRs = 0.89, 95% CI = 0.77-1.03). Moreover, beneficial effects of interventions were also observed on the prevalence of high psychological distress (ratio of PRs = 0.86, 95% CI = 0.75-0.998). Psychosocial interventions implemented in the context of this standard improved the psychosocial work environment and had beneficial effects on workers' mental health.

Estimating the Economic Benefits of Eliminating Job Strain as a Risk Factor for Depression

OBJECTIVE

The aim of this study was to quantify the economic benefits of eliminating job strain as a risk factor for depression, using published population-attributable risk estimates of depression attributable to job strain (13.2% for men, 17.2% for women).

METHODS

Cohort simulation using state-transition Markov modeling estimated costs and health outcomes for employed persons who met criteria for lifetime DSM-IV major depression. A societal perspective over 1-year and lifetime time horizons was used.

RESULTS

Among employed Australians, $890 million (5.8%) of the annual societal cost of depression was attributable to job strain. Employers bore the brunt of these costs, as they arose from lost productive time and increased risk of job turnover among employees experiencing depression.

CONCLUSIONS

Proven, practicable means exist to reduce job strain. The findings demonstrate likely financial benefits to employers for expanding psychosocial risk management, providing a financial incentive to complement and reinforce legal and ethical directives.

[The evaluation of organizational well-being in the public sector: an integration of the ANAC questionnaire]

BACKGROUND

In Italy, the work-related stress and organizational well-being evaluation is subject to specific norms and regulations. The Italian National Anti-Corruption Authority (Autorità Nazionale Anticorruzione - ANAC) has developed a questionnaire to assess the organizational well-being of the employees in Public Administration Institutions.

OBJECTIVES

The study aims to analyse, according to the Job Demands-Resources Theory, the relationship between some job demands (workload, discrimination) and job resources (supervisors and colleagues support, job autonomy, fairness, career opportunities, membership), and some outcomes (work-related stress, emotional exhaustion, job satisfaction).

METHODS

The research involved a public administration and was conducted through a self-report questionnaire (N=414, 60% of the employees). The ANAC questionnaire was integrated with measures from national and international literature on the topic of well-being and stress at work.

RESULTS

Multiple regression analyses highlighted the relationship between outcomes, job demands and resources. Work-related stress showed a positive relation with demands (work load β coefficient=0.22; perceived discrimination β=0.14) and a negative one with some resources (supervisors' support β=-0.21 and membership β=-0.11). Emotional exhaustion had a negative relationship with some job resources, specifically career opportunities (β=-0.14), autonomy (β=-0.21) and membership (β=-0.25). Job satisfaction showed a positive relationship with all job resources considered.

CONCLUSIONS

The study seeks to integrate the assessment of well-being and work-related stress thus highlighting the importance of linking the different outcomes with job demands and resources. The results identify possible practices to promote well-being in the organization.

Making it fit: Associations of line managers' behaviours with the outcomes of an organizational-level intervention

Line managers' behaviours are important during implementation of occupational health interventions. Still, little is known about how these behaviours are related to intervention outcomes. This study explored the relationship between line managers' intervention-specific transformational leadership (IsTL), intervention fit (the match between the intervention, persons involved, and the surrounding environment), and change in intrinsic motivation and vigour. Both direct and indirect relationships between IsTL and change in intrinsic motivation and vigour were tested. Ninety employees participating in an organizational-level occupational health intervention provided questionnaire ratings at baseline and after 6 months. The results showed IsTL to be related to intervention fit and intervention fit to be related to intrinsic motivation. Using intervention fit as a mediator, the total effects (direct and indirect combined) of IsTL on change in intrinsic motivation and vigour were significant. In addition, IsTL had a specific indirect effect on intrinsic motivation. This study is the first to use IsTL as a measure line managers' behaviours. It is also the first to empirically evaluate the association between intervention fit and intervention outcomes. By including these measures in evaluations of organizational-level occupational health interventions, we can provide more informative answers as to what can make interventions successful.

Workaholism as a Mediator between Work-Related Stressors and Health Outcomes

It is currently unknown if unfavorable working conditions, reflected by the demand–control–support model and the effort–reward imbalance model, directly influence health or if the effects may be mediated by work-related attitudes and behaviors such as workaholism. In the present study, 988 employees (55.6% males, mean age 36.09, SD = 9.23) from a large consultant firm participated in a cross-sectional survey assessing work variables such as job demands, job control, social support, effort, reward, and overcommitment. Workaholism was also assessed together with eight different health-related outcomes. Although direct effects of the work stressors on health were found on most health outcomes, the work-related stressors were overall strongly related to workaholism (R² = 0.522), which, in turn, was positively related to four (anxiety/insomnia, somatic symptoms, emotional exhaustion, and social dysfunction) of the eight outcome variables. Of a total of 40 relationships between work-related stressors and health outcomes, workaholism fully mediated three of these, and partly mediated 12. Overall, the study suggests that the effects of work-related stressors on health in many cases may be mediated by workaholism.

Changes in Allostatic Load during workplace reorganization

OBJECTIVE

Allostatic Load (AL) represents the strain on the body produced by repeated physiologic or allostatic responses activated during stressful situations. Several cross-sectional studies have found empirical substantiation for the relationship between impaired psychosocial work environment and high AL. The aim of this longitudinal study is to investigate changes in AL during workplace reorganization that has been shown to cause impaired psychosocial work environment. Moreover, we aim to investigate the association between changes in AL and changes in psychosocial work environment (job strain, effort-reward imbalance) and psychological distress (stress symptoms and perceived stress).

METHODS

A major reorganization of non-state public offices was effectuated in Denmark on 1 January 2007. In 2006 and 2008, we collected clinical and questionnaire data from 359 participants, 265 women and 94 men, employed in seven municipality or county administrations. Four municipalities and one county merged with others, while one municipality and one county remained unmerged. We calculated the AL score based on 13 physiological markers reflecting stress responses of the cardiovascular, metabolic, neuroendocrine and immune systems. We analysed changes in AL from 2006 to 2008.

RESULTS

AL increased significantly during workplace reorganization in the whole study group but we observed only a tendency of significant increase in AL in the merger group compared with the control group. Moreover, we observed no association between the changes in AL and changes in psychosocial work environment and psychological distress.

CONCLUSIONS

This result leaves the conclusion unclear but contributes to the limited research in this area with a longitudinal design and focus on low-risk levels and small changes in AL in healthy people as predictor of future disease.

Working Conditions and Individual Differences Are Weakly Associated with Workaholism: A 2-3-Year Prospective Study of Shift-Working Nurses

This study focuses on individual differences and the demand-support-control model in relation to workaholism. We hypothesized that unfavorable working conditions (high job demands, low job control/decision latitude, and low social support at work) and individual differences concerning sleep/wake-related variables (high flexibility, high morningness, and low languidity) would be related to workaholism measured 2–3 years later. Survey data stemmed from a prospective cohort of shift-working nurses (N = 1,308). The results showed that social support at work was negatively related to workaholism, whereas job demands were positively related to workaholism. Flexibility in terms of time for working/sleeping was also positively related to workaholism. The analyses further revealed that workaholism was inversely associated with age as well as having a child or having a child move in. Conjointly, the independent variables explained 6.4% of the variance in workaholism, while their relative importance was small overall. After controlling for all other independent variables, high job demands had the strongest relationship (small-to-medium) with workaholism. This implies that less pressure from the external environment to work excessively hard may prevent an increase in workaholic behaviors. Overall, the study adds to our understanding of the relationships between working conditions, individual differences, and workaholism.

Job design, employment practices and well-being: a systematic review of intervention studies

There is inconsistent evidence that deliberate attempts to improve job design realise improvements in well-being. We investigated the role of other employment practices, either as instruments for job redesign or as instruments that augment job redesign. Our primary outcome was well-being. Where studies also assessed performance, we considered performance as an outcome. We reviewed 33 intervention studies. We found that well-being and performance may be improved by: training workers to improve their own jobs; training coupled with job redesign; and system wide approaches that simultaneously enhance job design and a range of other employment practices. We found insufficient evidence to make any firm conclusions concerning the effects of training managers in job redesign and that participatory approaches to improving job design have mixed effects. Successful implementation of interventions was associated with worker involvement and engagement with interventions, managerial commitment to interventions and integration of interventions with other organisational systems. Practitioner Summary: Improvements in well-being and performance may be associated with system-wide approaches that simultaneously enhance job design, introduce a range of other employment practices and focus on worker welfare. Training may have a role in initiating job redesign or augmenting the effects of job design on well-being.

A comparison of working in small-scale and large-scale nursing homes: A systematic review of quantitative and qualitative evidence

BACKGROUND AND OBJECTIVE

Ongoing shortages of care workers, together with an ageing population, make it of utmost importance to increase the quality of working life in nursing homes. Since the 1970s, normalised and small-scale nursing homes have been increasingly introduced to provide care in a family and homelike environment, potentially providing a richer work life for care workers as well as improved living conditions for residents. 'Normalised' refers to the opportunities given to residents to live in a manner as close as possible to the everyday life of persons not needing care. The study purpose is to provide a synthesis and overview of empirical research comparing the quality of working life - together with related work and health outcomes - of professional care workers in normalised small-scale nursing homes as compared to conventional large-scale ones.

DESIGN

A systematic review of qualitative and quantitative studies.

DATA SOURCES

A systematic literature search (April 2015) was performed using the electronic databases Pubmed, Embase, PsycInfo, CINAHL and Web of Science. References and citations were tracked to identify additional, relevant studies.

REVIEW METHODS

We identified 825 studies in the selected databases. After checking the inclusion and exclusion criteria, nine studies were selected for review. Two additional studies were selected after reference and citation tracking. Three studies were excluded after requesting more information on the research setting.

RESULTS

The findings from the individual studies suggest that levels of job control and job demands (all but "time pressure") are higher in normalised small-scale homes than in conventional large-scale nursing homes. Additionally, some studies suggested that social support and work motivation are higher, while risks of burnout and mental strain are lower, in normalised small-scale nursing homes. Other studies found no differences or even opposing findings. The studies reviewed showed that these inconclusive findings can be attributed to care workers in some normalised small-scale homes experiencing isolation and too high job demands in their work roles.

CONCLUSION

This systematic review suggests that normalised small-scale homes are a good starting point for creating a higher quality of working life in the nursing home sector. Higher job control enables care workers to manage higher job demands in normalised small-scale homes. However, some jobs would benefit from interventions to address care workers' perceptions of too low social support and of too high job demands. More research is needed to examine strategies to enhance these working life issues in normalised small-scale settings.

Kentucky worksite health promotion 2014 survey results

Purpose

The purpose of this paper is to conduct a statewide assessment of worksite health promotion (WHP) programs to identify the number of comprehensive programs and the health needs of worksites in Kentucky.

Design/methodology/approach

A random sample of 1,200 worksites in Kentucky was selected to receive the Centers for Disease Control and Prevention (CDC) Worksite Health ScoreCard to collect cross-sectional information on their health promotion practices.

Findings

Few worksites in Kentucky have WHP programs and even fewer have comprehensive programs. More businesses rely on health insurance to treat chronic diseases than WHP programs to reduce chronic diseases. Small companies were less likely than larger companies to have WHP programs and less likely to have intentions of starting a program.

Research limitations/implications

The response rate of 37 percent was a potential threat to external validity. Respondents had to recall activities conducted during the past 12 months, which could have led to recall bias. Response bias was a potential, as many of the respondents were human resources personnel who may not be as familiar with WHP programs in their worksites. Lastly, four sections of the survey had yet to be validated.

Practical implications

WHP programs, if accessible and comprehensive, have the potential to improve the working population’s health status.

Originality/value

Very little information on the availability and effectiveness of health promotion programs at worksites is available. A statewide assessment on WHP programs has never been conducted in Kentucky.

How to Measure the Intervention Process? An Assessment of Qualitative and Quantitative Approaches to Data Collection in the Process Evaluation of Organizational Interventions

Organizational interventions aiming at improving employee health and wellbeing have proven to be challenging to evaluate. To analyze intervention processes two methodological approaches have widely been used: quantitative (often questionnaire data), or qualitative (often interviews). Both methods are established tools, but their distinct epistemological properties enable them to illuminate different aspects of organizational interventions. In this paper, we use the quantitative and qualitative process data from an organizational intervention conducted in a national postal service, where the Intervention Process Measure questionnaire (N = 285) as well as an extensive interview study (N = 50) were used. We analyze what type of knowledge about intervention processes these two methodologies provide and discuss strengths and weaknesses as well as potentials for mixed methods evaluation methodologies.

Globalization, Work, and Cardiovascular Disease

Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in “upstream” factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD.

The Relocation of a Health Care Department's Impact on Staff: A Cross-Sectional Survey

OBJECTIVE

This survey compares certain quality of work-life factors between a relocated work group and a control group.

METHODS

A self-administered, cross-sectional survey was conducted 12 months after five departments (304 workers) had been relocated between two public health sites. The survey explored the workers' psychosocial job characteristics, their perceived health, and psycho-organizational constraints. The results compared both the relocated and control groups by using univariate and then multivariate statistical analyzes.

RESULTS

When compared with the control group (n = 272), the relocated group (n = 180) showed a higher prevalence of psychosocial job characteristic "isostrain." The relocated group showed greater psycho-organizational constraints regarding the organizations favoring communication and team relationships.

CONCLUSIONS

It seems that staff relocation can provoke a sense of uncertainty and isolation. Perhaps better communication might have reduced this and deter possible negative health outcomes.

Investigating variations in implementation fidelity of an organizational-level occupational health intervention

BACKGROUND

The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions.

PURPOSE

The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units.

METHOD

The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied.

RESULTS

Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity.

CONCLUSION

Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.

Pilot study of a cluster randomised trial of a guided e-learning health promotion intervention for managers based on management standards for the improvement of employee well-being and reduction of sickness absence: GEM Study

OBJECTIVES

To investigate the feasibility of recruitment, adherence and likely effectiveness of an e-learning intervention for managers to improve employees' well-being and reduce sickness absence.

METHODS

The GEM Study (guided e-learning for managers) was a mixed methods pilot cluster randomised trial. Employees were recruited from four mental health services prior to randomising three services to the intervention and one to no-intervention control. Intervention managers received a facilitated e-learning programme on work-related stress. Main outcomes were Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), 12-item GHQ and sickness absence <21 days from human resources. 35 in-depth interviews were undertaken with key informants, managers and employees, and additional observational data collected.

RESULTS

424 of 649 (65%) employees approached consented, of whom 350 provided WEMWBS at baseline and 284 at follow-up; 41 managers out of 49 were recruited from the three intervention clusters and 21 adhered to the intervention. WEMWBS scores fell from 50.4-49.0 in the control (n=59) and 51.0-49.9 in the intervention (n=225), giving an intervention effect of 0.5 (95% CI -3.2 to 4.2). 120/225 intervention employees had a manager who was adherent to the intervention. HR data on sickness absence (n=393) showed no evidence of effect. There were no effects on GHQ score or work characteristics. Online quiz knowledge scores increased across the study in adherent managers. Qualitative data provided a rich picture of the context within which the intervention took place and managers' and employees' experiences of it.

CONCLUSIONS

A small benefit from the intervention on well-being was explained by the mixed methods approach, implicating a low intervention uptake by managers and suggesting that education alone may be insufficient. A full trial of the guided e-learning intervention and economic evaluation is feasible. Future research should include more active encouragement of manager motivation, reflection and behaviour change.

TRIAL REGISTRATION NUMBER

ISRCTN58661009.

Exploring Work-Related Causal Attributions of Common Mental Disorders

PURPOSE

Common mental disorders (CMDs) are major causes of sickness absence and disability. Prevention requires knowledge of how individuals perceive causal mechanisms, and in this study we sought to examine work-related factors as causal attribution of CMDs.

METHODS

A trial sample of n = 1,193, recruited because they struggled with work participation due to CMDs, answered an open-ended questionnaire item about what they believed were the most important causes of their CMDs. The population included participants at risk of sickness absence, and participants with reduced work participation due to sickness absence, disability or unemployment. We used thematic content analysis and categorized responses from 487 participants who reported work-related factors as causal attributions of their CMDs. Gender differences in work-related causal attributions were also examined.

RESULTS

The participants attributed their CMDs to the following work-related factors; work stress, leadership, reduced work participation, job dissatisfaction, work conflict, social work environment, job insecurity and change, workplace bullying, and physical strain. Women tended to attribute CMDs to social factors at work.

CONCLUSION

Findings from this study suggest several work-related risk factors for CMDs. Both factors at the workplace, and reduced work participation, were perceived by study participants as contributing causes of CMDs. Thus, there is a need to promote work participation whilst at the same time targeting aversive workplace factors. Further, our findings indicate that work-related factors may affect women and men differently. This illustrates that the association between work participation and CMDs is complex, and needs to be explored further.

A Longitudinal Analysis of Changes in Job Control and Mental Health

Deteriorating job control has been previously shown to predict poor mental health. The impact of improvement in job control on mental health is less well understood, yet it is of policy significance. We used fixed-effects longitudinal regression models to analyze 10 annual waves of data from a large Australian panel survey (2001-2010) to test within-person associations between change in self-reported job control and corresponding change in mental health as measured by the Mental Component Summary score of Short Form 36. We found evidence of a graded relationship; with each quintile increase in job control experienced by an individual, the person's mental health increased. The biggest improvement was a 1.55-point increase in mental health (95% confidence interval: 1.25, 1.84) for people moving from the lowest (worst) quintile of job control to the highest. Separate analyses of each of the component subscales of job control-decision authority and skill discretion-showed results consistent with those of the main analysis; both were significantly associated with mental health in the same direction, with a stronger association for decision authority. We conclude that as people's level of job control increased, so did their mental health, supporting the value of targeting improvements in job control through policy and practice interventions.

Pilot study of a randomised trial of a guided e-learning health promotion intervention for managers based on management standards for the improvement of employee well-being and reduction of sickness absence: the GEM (Guided E-learning for Managers) study

Background

Psychosocial work environments influence employee well-being. There is a need for an evaluation of organisational-level interventions to modify psychosocial working conditions and hence employee well-being.

Objective

To test the acceptability of the trial and the intervention, the feasibility of recruitment and adherence to and likely effectiveness of the intervention within separate clusters of an organisation.

Design

Mixed methods: pilot cluster randomised controlled trial and qualitative study (in-depth interviews, focus group and observation).

Participants

Employees and managers of a NHS trust. Inclusion criteria were the availability of sickness absence data and work internet access. Employees on long-term sick leave and short-term contracts and those with a notified pregnancy were excluded.

Intervention

E-learning program for managers based on management standards over 10 weeks, guided by a facilitator and accompanied by face-to-face meetings. Three clusters were randomly allocated to receive the guided e-learning intervention; a fourth cluster acted as a control.

Main outcome measures

Recruitment and participation of employees and managers; acceptability of the intervention and trial; employee subjective well-being using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS); and feasibility of collecting sickness absence data.

Results

In total, 424 employees out of 649 approached were recruited and 41 managers out of 49 were recruited from the three intervention clusters. Of those consenting, 350 [83%, 95% confidence interval (CI) 79% to 86%] employees completed the baseline assessment and 291 (69%, 95% CI 64% to 73%) completed the follow-up questionnaires. Sickness absence data were available from human resources for 393 (93%, 95% CI 90% to 95%) consenting employees. In total, 21 managers adhered to the intervention, completing at least three of the six modules. WEMWBS scores fell slightly in all groups, from 50.4 to 49.0 in the control group and from 51.0 to 49.9 in the intervention group. The overall intervention effect was 0.5 (95% CI –3.2 to 4.2). The fall in WEMWBS score was significantly less among employees whose managers adhered to the intervention than among those employees whose managers did not (–0.7 vs. 1.6, with an adjusted difference of 1.6, 95% CI 0.1 to 3.2). The intervention and trial were acceptable to managers, although our study raises questions about the widely used concept of ‘acceptability’. Managers reported insufficient time to engage with the intervention and lack of senior management ‘buy-in’. It was thought that the intervention needed better integration into organisational processes and practice.

Conclusions

The mixed-methods approach proved valuable in illuminating reasons for the trial findings, for unpacking processes of implementation and for understanding the influence of study context. We conclude from the results of our pilot study that further mixed-methods research evaluating the intervention and study design is needed. We found that it is feasible to carry out an economic evaluation of the intervention. We plan a further mixed-methods study to re-evaluate the intervention boosted with additional elements to encourage manager engagement and behaviour change in private and public sector organisations with greater organisational commitment.

Study registration

Current Controlled Trials ISRCTN58661009.

Funding

This project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 3, No. 9. See the NIHR Journals Library website for further project information.