Occupational health research beyond the work setting: inclusive inquiry with ethnic minority and immigrant workers

Ethnic minority and immigrant workers comprise a sizable proportion of the low-wage workforce. They are surprisingly understudied despite their workplace prominence. Factors such as workplace policies, structures, worker-related characteristics, and research designs preclude their comprehensive research participation when studies are conducted in work settings. Consequently, ethnic minority and immigrant workers continue to be under-represented in inquiry and simultaneously over-represented with compromising occupational health risks. The purpose of this paper is to provide strategies to promote the inclusion of ethnic minority and immigrant workers in occupational health research. Using three different research-based examples, we illustrate the benefit of conducting occupational health research in non-workplace settings as a way to ensure research representation of ethnic minority and immigrant workers.

Industry Context as an Essential Tool for the Future of Healthy and Safe Work: Illustrative Examples for Occupational Health Psychology from the Hospitality Industry

Contextual nuance holds value for occupational health and safety, particularly as workplace challenges and solutions become more complex. However, disciplines that inform occupational safety and health vary in the degree to which they target breadth and depth of understanding. The future of work presents challenges related to work, the workplace, and the workforce, and an appreciation of the context of industry will ready researchers and practitioners with the most informed solutions. Broadly developed solutions for future of work challenges may flounder without an appreciation for the context of industry, as evidenced by two examples provided in this review. As occupational safety and health disciplines answer the call provided by the future of work, this review provides an account for the value of industry context and recommendations for achieving both breadth and depth of scientific inquiry and practical reach.

Protecting the Mental Health of Small-to-Medium Enterprise Owners: A Randomized Control Trial Evaluating a Self-Administered Versus Telephone Supported Intervention

OBJECTIVE

Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers.

METHODS

Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey.

RESULTS

Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change.

CONCLUSION

The provision of telephone support for self-administered interventions in this context appears warranted.

Reasons for Engagement: SME Owner-Manager Motivations for Engaging in a Workplace Mental Health and Wellbeing Intervention

OBJECTIVE

Small-to-medium enterprises (SMEs) require specialized attention regarding workplace mental health (WMH), but can be challenging to engage in WMH promotion interventions. This cross-sectional study analyzed self-reported motivations of SME owner/managers who engaged in a WMH promotion intervention specifically designed for SMEs.

METHODS

Data from 297 SME owner/managers was thematically coded before conducting multinominal logistical regression analyses to determine reasons for engagement based on a series of predictors, including owner/manager psychological distress, recent experience of a stressful work event, and business confidence.

RESULTS

Owner/manager psychological distress, experience of a recent stressful workplace, and low 12-month business confidence incident were important predictors of engagement.

CONCLUSION

The findings provide important insights into the uptake of a WMH promotion intervention, which can inform the design and future recruitment strategies for WMH promotion interventions within the SME sector.

Effects of organizational safety on employees' proactivity safety behaviors and occupational health and safety management systems in Chinese high-risk small-scale enterprises

Based on the characteristics of small-scale enterprises, the improvement of occupational health and safety management systems (OHS MS) needs an effective intervention. This study proposed a structural equation model and examined the relationships of perceived organization support for safety (POSS), person-organization safety fit (POSF) and proactivity safety behaviors with safety management, safety procedures and safety hazards identification. Data were collected from 503 employees of 105 Chinese high-risk small-scale enterprises over 6 months. The results showed that both POSS and POSF were positively related to improvement in safety management, safety procedures and safety hazards identification through proactivity safety behaviors. Our findings provide a new perspective on organizational safety for improving OHS MS for small-scale enterprises and extend the application of proactivity safety behaviors.

A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries

BACKGROUND

The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents.

METHODS

A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries.

RESULTS

A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents.

CONCLUSIONS

The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).

Effects of Social Determinants on Chinese Immigrant Food Service Workers' Work Performance and Injuries: Mental Health as a Mediator

OBJECTIVE

The effects of social discrimination, job concerns, and social support on worker mental health and the influence of mental health on occupational health outcomes have been documented intermittently. We propose an integrated, theory-driven model to distinguish the impact of social determinants on work performance and injuries and the mediating effects of mental health problems.

METHODS

The US Chinese immigrant food service workers (N = 194) completed a multimeasure interview; we tested the integrated model using structural equation modeling.

RESULTS

Mental health problems, which were associated with decreased work performance and increased injuries, also mediated relationships between job/employment concerns and both work performance and injuries but did not mediate the influences of discrimination and social support.

CONCLUSIONS

This research reveals mechanisms by which social determinants influence immigrant worker health, pointing to complementary strategies for reducing occupational health disparities.

Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning

OBJECTIVES

We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees).

METHODS

We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect.

RESULTS

Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff.

CONCLUSIONS

Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.

Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector

Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more "good" work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a "good" work day may be useful for intervention research in other sectors.

Understanding small business engagement in workplace violence prevention programs

PURPOSE

Worksite wellness, safety, and violence prevention programs have low penetration among small, independent businesses. This study examined barriers and strategies influencing small business participation in workplace violence prevention programs (WVPPs).

APPROACH

A semistructured interview guide was used in 32 telephone interviews.

SETTING

The study took place at the University of North Carolina Injury Prevention Research Center.

PARTICIPANTS

Participating were a purposive sample of 32 representatives of small business-serving organizations (e.g., business membership organizations, regulatory agencies, and economic development organizations) selected for their experience with small businesses.

INTERVENTION

This study was designed to inform improved dissemination of Crime Free Business (CFB), a WVPP for small, independent retail businesses.

METHODS

Thematic qualitative data analysis was used to identify key barriers and strategies for promoting programs and services to small businesses.

RESULTS

Three key factors that influence small business engagement emerged from the analysis: (1) small businesses' limited time and resources, (2) low salience of workplace violence, (3) influence of informal networks and source credibility. Identified strategies include designing low-cost and convenient programs, crafting effective messages, partnering with influential organizations and individuals, and conducting outreach through informal networks.

CONCLUSION

Workplace violence prevention and public health practitioners may increase small business participation in programs by reducing time and resource demands, addressing small business concerns, enlisting support from influential individuals and groups, and emphasizing business benefits of participating in the program.

Workplace health understandings and processes in small businesses: a systematic review of the qualitative literature

INTRODUCTION

Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS).

METHODS

The review was conducted as part of a larger mixed-method review and in consultation with stakeholders. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative articles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethnographic findings synthesis.

RESULTS

This review finds that SBs have distinctive social relations of work, apprehensions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader structures, policies and systems shape the practice of workplace health in SBs. The themes contribute to 'layers of evidence' that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels.

CONCLUSIONS

This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers' and employers' apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.

A conceptual framework for integrating workplace health promotion and occupational ergonomics programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health--especially ergonomics--with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Organizational health promotion: broadening the horizon of workplace health promotion

This article argues that efforts to improve the health and well-being of the workforce should begin with the organization itself. The term organizational health promotion is introduced to expand the scope of worksite health promotion. Organizational health promotion delves into the basic structural and organizational fabric of the enterprise--to how work is organized. The core themes of healthy work organization are introduced, and the status of our ability to identify organizational risk factors is discussed. A conceptual model of healthy work organization is presented, along with a process for expanding the health promotive capacity of the organization. The final section addresses challenges related to adopting an organizational health promotion perspective.

Making youth tobacco control programs more ecological: organizational and professional profiles

PURPOSE

To identify the organizational and professional correlates of the integration of the ecological approach in Canadian public health organizations' tobacco control programs for youth.

DESIGN

Cross-sectional survey.

SETTING

Canadian public health organizations.

SUBJECTS

One hundred and ten tobacco control programs implemented in 90 organizations. The response rate for the organizations was 87%.

MEASURES

Descriptions of programs were obtained by telephone interviews. An analytical procedure was applied to the program data to identify intervention settings, targets and strategies for each program. Using this information, a summary score of the integration of the ecological approach was estimated for each program. Organizational and professional variables were assessed by self-administered questionnaires to managers and professionals involved in these programs.

RESULTS

The level of integration of the ecological approach in programs was related to organizational (frequency of contacts and collaborations with external partners, team composition) and extraorganizational factors (size of the city in which the public health unit is located). Cognitive attributes of the practitioners (knowledge and beliefs) also emerged as significant predictors. Finally, positive associations were observed between practitioners' personal characteristics (educational achievement, working status in health promotion [full vs. part-time], previous experience, gender, and disciplinary/professional background) and cognitive predictors.

CONCLUSIONS

Organizational environment and staff preparation play a critical role in the adoption of the ecological approach in tobacco control programs.