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Anttilainen J, Pehkonen I, Savinainen M, Haukka E. Social and health care top managers' perceptions and aims of strategic work ability management in the midst of change. Work 2024; 77:533-545. [PMID: 37742684 PMCID: PMC10894579 DOI: 10.3233/wor-230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Existing research has mostly focused on themes related to returning to or staying at work and studied organizations' operational rather than strategic level actions to support work ability. Top managers' understanding of work ability management (WAM) may influence how work ability support processes are implemented in organizations. OBJECTIVE To find out how top managers define WAM, what the aims of WAM were and whether the aims were on a strategic level. METHODS Altogether 28 semi-structured interviews among Finnish social and health care top managers were conducted during the years 2019-2021 and analyzed inductively using qualitative thematic analysis. RESULTS Top managers' definition of WAM was mainly multidimensional. Two main aims were identified, i.e., to support work ability 1) at the individual and 2) at the organizational level. The aims of the former were to anticipate the decrease of health and functional capacity, to support workers already decrease in these, to develop competence, and to manage the effects of changes on work ability. The aims at the organizational level were to improve labor availability and personnel retention, to ensure the flow of work, and to increase trust and create shared values. Top managers described the aims as being at a strategic level, but this was not yet realized in their organizations because the actions were reactive rather than proactive. CONCLUSION Top managers' multidimensional perception of WAM, emphasizing proactive actions, and strategic level aims are crucial and require the commitment of the top managers for strategic WAM, especially during constant changes.
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Affiliation(s)
| | | | | | - Eija Haukka
- Finnish Institute of Occupational Health, Helsinki, Finland
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Leino T, Turunen JKA, Pehkonen I, Juvonen-Posti P. Important collaborative conditions for successful economic outcomes of work disability management: A mixed methods multiple case study. Work 2022; 74:685-697. [PMID: 36278370 DOI: 10.3233/wor-210026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Work disability management (WDM) interventions have usually focused on a single factor and its impact on outcomes such as employee health or work disability costs. Research on company-level WDM activities and their economic impact is scarce. OBJECTIVE The aim of this study was to explain the change in company-level work disability costs and their relation to WDM practices, and to identify the mechanisms of impact through which the successful economic outcome emerged. METHODS The study design was a convergent mixed methods design with a multiple case study. The data from 14 business units concerned business context, personnel, investments in and processes of WDM, and the costs of work disability in 2010-2013. The data were constructed into case descriptions which were analysed using qualitative comparative analysis. The economic analysis was carried out from the employers' perspective. RESULTS Five business units gained net benefits of approximately 1.5-2.5% of the payroll sum from their investments in WDM. These benefits were characterised by a combination of four strategic processes: i) dismantling barriers to co-operation, ii) improving the visibility of the strategic goals of work ability management in everyday practice, iii) WDM actions targeting the company's main work disability risks, and iv) the facilitation of multi-actor co-operation through co-ordination and flow of information. CONCLUSION Strategic processes to support the effectiveness of WDM were found. When aiming for economic success in work disability management, in addition to measuring and managing disability costs, it is also essential to maintain collaborative operations in everyday practice.
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Affiliation(s)
- Timo Leino
- Finnish Institute of Occupational Health, Työterveyslaitos, Finland
| | | | - Irmeli Pehkonen
- Finnish Institute of Occupational Health, Työterveyslaitos, Finland
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Nevala N, Pehkonen I, Teittinen A, Vesala HT, Pörtfors P, Anttila H. The Effectiveness of Rehabilitation Interventions on the Employment and Functioning of People with Intellectual Disabilities: A Systematic Review. J Occup Rehabil 2019; 29:773-802. [PMID: 31098847 PMCID: PMC6838041 DOI: 10.1007/s10926-019-09837-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Purpose This systematic review analyzed the effectiveness of rehabilitation interventions on the employment and functioning of people with intellectual disabilities (ID), as well as barriers and facilitators of employment. Methods This was a systematic review of quantitative, qualitative, and mixed methods studies. The outcomes were employment, transition to the open labor market and functioning. The review included qualitative studies of employment barriers and facilitators. The population comprised people with ID aged 16-68 years. Peer-reviewed articles published in English between January 1990 and February 2019 were obtained from the databases Cinahl, the Cochrane Library, Embase, Eric, Medic, Medline, OTseeker, Pedro, PsycInfo, PubMed, Socindex, and the Web of Science. We also searched Google Scholar and Base. The modified selection instrument (PIOS: participants, intervention, outcome, and study design) used in the selection of the articles depended on the selection criteria. Results Ten quantitative (one randomized controlled, one concurrently controlled, and eight cohort studies), six qualitative studies, one multimethod study, and 21 case studies met the inclusion criteria. The quantitative studies showed that secondary education increases employment among people with ID when it includes work experience and personal support services. Supported employment also increased employment in the open labor market, which sheltered work did not. The barriers to employment were the use of sheltered work, discrimination in vocational experience, the use of class teaching, and deficient work experience while still at school. The facilitators of employment were one's own activity, the support of one's family, job coaching, a well-designed work environment, appreciation of one's work, support form one's employer and work organization, knowledge and experience of employment during secondary education, and for entrepreneurs, the use of a support person. Conclusions The employment of people with ID can be improved through secondary education including proper teaching methods and personal support services, the use of supported work, workplace accommodations and support from one's family and employer. These results can be utilized in the development of rehabilitation, education, and the employment of people with ID, to allow them the opportunity to work in the open labor market and participate in society.
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Affiliation(s)
- Nina Nevala
- Finnish Institute of Occupational Health, PO Box 40, 00032, Työterveyslaitos, Finland.
| | - Irmeli Pehkonen
- Finnish Institute of Occupational Health, PO Box 40, 00032, Työterveyslaitos, Finland
| | - Antti Teittinen
- The Finnish Association On Intellectual and Developmental Disabilities, Viljatie 4 A, 007004, Helsinki, Finland
| | - Hannu T Vesala
- The Finnish Association On Intellectual and Developmental Disabilities, Viljatie 4 A, 007004, Helsinki, Finland
| | - Pia Pörtfors
- National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Heidi Anttila
- National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
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Haukka E, Martimo KP, Kivekäs T, Horppu R, Lallukka T, Solovieva S, Shiri R, Pehkonen I, Takala EP, MacEachen E, Viikari-Juntura E. Efficacy of temporary work modifications on disability related to musculoskeletal pain or depressive symptoms--study protocol for a controlled trial. BMJ Open 2015; 5:e008300. [PMID: 25986643 PMCID: PMC4442237 DOI: 10.1136/bmjopen-2015-008300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Previous research suggests that work with a suitable workload may promote health and work retention in people with disability. This study will examine whether temporary work modifications at the early stage of work disability are effective in enhancing return to work (RTW) or staying at work among workers with musculoskeletal or depressive symptoms. METHODS AND ANALYSIS A single-centre controlled trial with modified stepped wedge design will be carried out in eight enterprises and their occupational health services (OHSs) in nine cities in Finland. Patients seeking medical advice due to musculoskeletal pain (≥4 on a scale from 0-10) or depressive symptoms (≥1 positive response to 2 screening questions) and fulfilling other inclusion criteria are eligible. The study involves an educational intervention among occupational physicians to enhance the initiation of work modifications. Primary outcomes are sustained RTW (≥4 weeks at work without a new sickness absence (SA)) and the total number of SA days during a 12-month follow-up. Secondary outcomes are intensity of musculoskeletal pain (scale 0-10), pain interference with work or sleep (scale 0-10) and severity of depressive symptoms (Patient Health Questionnaire, PHQ-9), inquired via online questionnaires at baseline and 3, 6, 9 and 12 months after recruitment. Information on SA days will be collected from the medical records of the OHSs over 12 months, before and after recruitment. The findings will give new information about the possibilities of training physicians to initiate work modifications and their effects on RTW in employees with work disability due to musculoskeletal pain or depressive symptoms. ETHICS AND DISSEMINATION The Coordinating Ethics Committee of Hospital District of Helsinki and Uusimaa has granted approval for this study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN74743666.
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Affiliation(s)
- Eija Haukka
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kari-Pekka Martimo
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
- Client Services, Occupational Health Collaboration, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Teija Kivekäs
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
- Development of Work and Organizations, Mental Health and Cognition, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ritva Horppu
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Svetlana Solovieva
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Rahman Shiri
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Irmeli Pehkonen
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Esa-Pekka Takala
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ellen MacEachen
- University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Eira Viikari-Juntura
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
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Solovieva S, Pehkonen I, Kausto J, Miranda H, Shiri R, Kauppinen T, Heliövaara M, Burdorf A, Husgafvel-Pursiainen K, Viikari-Juntura E. Development and validation of a job exposure matrix for physical risk factors in low back pain. PLoS One 2012; 7:e48680. [PMID: 23152793 PMCID: PMC3495969 DOI: 10.1371/journal.pone.0048680] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim was to construct and validate a gender-specific job exposure matrix (JEM) for physical exposures to be used in epidemiological studies of low back pain (LBP). MATERIALS AND METHODS We utilized two large Finnish population surveys, one to construct the JEM and another to test matrix validity. The exposure axis of the matrix included exposures relevant to LBP (heavy physical work, heavy lifting, awkward trunk posture and whole body vibration) and exposures that increase the biomechanical load on the low back (arm elevation) or those that in combination with other known risk factors could be related to LBP (kneeling or squatting). Job titles with similar work tasks and exposures were grouped. Exposure information was based on face-to-face interviews. Validity of the matrix was explored by comparing the JEM (group-based) binary measures with individual-based measures. The predictive validity of the matrix against LBP was evaluated by comparing the associations of the group-based (JEM) exposures with those of individual-based exposures. RESULTS The matrix includes 348 job titles, representing 81% of all Finnish job titles in the early 2000s. The specificity of the constructed matrix was good, especially in women. The validity measured with kappa-statistic ranged from good to poor, being fair for most exposures. In men, all group-based (JEM) exposures were statistically significantly associated with one-month prevalence of LBP. In women, four out of six group-based exposures showed an association with LBP. CONCLUSIONS The gender-specific JEM for physical exposures showed relatively high specificity without compromising sensitivity. The matrix can therefore be considered as a valid instrument for exposure assessment in large-scale epidemiological studies, when more precise but more labour-intensive methods are not feasible. Although the matrix was based on Finnish data we foresee that it could be applicable, with some modifications, in other countries with a similar level of technology.
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Affiliation(s)
- Svetlana Solovieva
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
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Kausto J, Miranda H, Pehkonen I, Heliövaara M, Viikari-Juntura E, Solovieva S. The distribution and co-occurrence of physical and psychosocial risk factors for musculoskeletal disorders in a general working population. Int Arch Occup Environ Health 2010; 84:773-88. [DOI: 10.1007/s00420-010-0597-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 10/20/2010] [Indexed: 11/24/2022]
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Takala EP, Pehkonen I, Forsman M, Hansson GÅ, Mathiassen SE, Neumann WP, Sjøgaard G, Veiersted KB, Westgaard RH, Winkel J. Systematic evaluation of observational methods assessing biomechanical exposures at work. Scand J Work Environ Health 2009; 36:3-24. [PMID: 19953213 DOI: 10.5271/sjweh.2876] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This systematic review aimed to identify published observational methods assessing biomechanical exposures in occupational settings and evaluate them with reference to the needs of different users. METHODS We searched scientific databases and the internet for material from 1965 to September 2008. Methods were included if they were primarily based on the systematic observation of work, the observation target was the human body, and the method was clearly described in the literature. A systematic evaluation procedure was developed to assess concurrent and predictive validity, repeatability, and aspects related to utility. At least two evaluators independently carried out this evaluation. RESULTS We identified 30 eligible observational methods. Of these, 19 had been compared with some other method(s), varying from expert evaluation to data obtained from video recordings or through the use of technical instruments. Generally, the observations showed moderate to good agreement with the corresponding assessments made from video recordings; agreement was the best for large-scale body postures and work actions. Postures of wrist and hand as well as trunk rotation seemed to be more difficult to observe correctly. Intra- and inter-observer repeatability were reported for 7 and 17 methods, respectively, and were judged mostly to be good or moderate. CONCLUSIONS With training, observers can reach consistent results on clearly visible body postures and work activities. Many observational tools exist, but none evaluated in this study appeared to be generally superior. When selecting a method, users should define their needs and assess how results will influence decision-making.
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Affiliation(s)
- Esa-Pekka Takala
- Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland.
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Haukka E, Pehkonen I, Leino-Arjas P, Viikari-Juntura E, Takala EP, Malmivaara A, Hopsu L, Mutanen P, Ketola R, Virtanen T, Holtari-Leino M, Nykänen J, Stenholm S, Ojajärvi A, Riihimäki H. Effect of a participatory ergonomics intervention on psychosocial factors at work in a randomised controlled trial. Occup Environ Med 2009; 67:170-7. [PMID: 19737735 DOI: 10.1136/oem.2008.043786] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To study the effect of a participatory ergonomics intervention on psychosocial factors among kitchen workers. DESIGN A cluster randomised controlled trial. SETTING Four cities in Finland, 2002-2005. PARTICIPANTS 504 workers in 119 municipal kitchens. INTERVENTION Kitchens were randomised to intervention (n=59) and control (n=60) groups. The intervention lasted 11-14 months and was based on the workers' active participation in work analysis, planning and implementing the ergonomic changes aimed at decreasing the physical and mental workload. MAIN OUTCOME MEASURES Mental stress, mental strenuousness of work, hurry, job satisfaction, job control, skill discretion, co-worker relationships and supervisor support. Data were collected by questionnaire at baseline, at the end of the intervention, and at a 12-month follow-up (PI(12)). RESULTS At the end of the intervention, the OR of job dissatisfaction for the intervention group as compared with the control group was 3.0 (95% CI 1.1 to 8.5), of mental stress 2.3 (1.2 to 4.7) and of poor co-worker relationships 2.3 (1.0 to 5.2). At the PI(12), the OR of job dissatisfaction was 3.0 (1.2 to 7.8). Analysis of the independent and joint effects of the intervention and unconnected organisational reforms showed that adverse changes were accentuated among those with exposure to both. CONCLUSIONS No favourable effects on psychosocial factors at work were found. The adverse changes were due to a joint effect of the intervention and the unconnected organisational reforms. The findings do not support the usefulness of this kind of intervention in changing unsatisfactory psychosocial working conditions.
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Affiliation(s)
- Eija Haukka
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250, Helsinki, Finland.
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Abstract
This paper describes a new video-based observation method aimed to assess musculoskeletal load in kitchen work, aspects of its repeatability and validity, and problems confronted by the observers. Two pairs of researchers observed individually 117 video clips recorded in kitchens. Interobserver repeatability was assessed by computing the proportion of agreement and weighted kappa values (kappa(w)). Validity was analyzed by studying the distribution of the assessments over the rating scales and the ratings before and after the interventions, which were compared with expert assessments made from the same intervention targets. The proportion of agreement ranged from 57 to 88%. Interobserver repeatability based on weighted kappa values was mainly good to moderate. The method detected the changes in physical load due to the interventions. Direction of the changes corresponded with the expert assessments. Further development of the method is needed to assess the load on the hands and wrists.
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Affiliation(s)
- Irmeli Pehkonen
- Finnish Institute of Occupational Health, Helsinki, Finland.
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Pehkonen I, Miranda H, Haukka E, Luukkonen R, Takala EP, Ketola R, Leino-Arjas P, Riihimäki H, Viikari-Juntura E. Prospective study on shoulder symptoms among kitchen workers in relation to self-perceived and observed work load. Occup Environ Med 2009; 66:416-23. [PMID: 19228678 DOI: 10.1136/oem.2008.043349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the occurrence of shoulder symptoms among professional kitchen workers, and whether reduction in self-perceived and observed physical work load decreases future symptoms. METHODS In this prospective study conducted in 2002-2005 in municipal kitchens in Finland, changes during a 1-year follow-up in the physical strenuousness of work tasks were self-assessed by 376 female workers (substudy I). Changes in exposure to manual lifting and awkward upper arm posture during the follow-up were also observed by experts in 69 kitchens with 183 workers (substudy II). Information on shoulder symptoms was collected with questionnaires at baseline and at follow-up. The risk of shoulder symptoms at follow-up related to changes in exposure was estimated with logistic regression. RESULTS The 3-month prevalence of shoulder pain was 34% at baseline and 41% at follow-up. Reduction during follow-up in work tasks perceived as the most strenuous physically (ie, receiving and storing raw food) led to a significantly reduced risk of future shoulder pain with an adjusted odds ratio (OR) of 0.41 (95% CI 0.17 to 0.98) and trouble caused by the pain with an OR of 0.34 (0.14 to 0.83). The observed reduction in lifting was also associated with a lower risk for future shoulder symptoms. CONCLUSIONS Reduction in lifting showed beneficial protective effects on the shoulder. Although more risk factor and intervention studies are needed to estimate the health impacts of kitchen work, special attention should be paid to work tasks that include lifting when assessing risk and designing preventive measures.
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Affiliation(s)
- I Pehkonen
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FIN-00250 Helsinki, Finland.
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Pehkonen I, Takala EP, Ketola R, Viikari-Juntura E, Leino-Arjas P, Hopsu L, Virtanen T, Haukka E, Holtari-Leino M, Nykyri E, Riihimäki H. Evaluation of a participatory ergonomic intervention process in kitchen work. Appl Ergon 2009; 40:115-123. [PMID: 18314091 DOI: 10.1016/j.apergo.2008.01.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 12/04/2007] [Accepted: 01/04/2008] [Indexed: 05/26/2023]
Abstract
We evaluated a participatory ergonomic intervention process applied in 59 municipal kitchens. In groups of three to five kitchens, the workers participated in eight workshops, and generated and evaluated solutions to optimize musculoskeletal load in their work. An ergonomist initiated and supported the process. By the end, 402 changes were implemented. Evaluative data were collected using research diaries, questionnaires, and focus group interviews. The intervention model proved feasible and the participatory approach was mostly experienced as motivating. The workers' knowledge and awareness of ergonomics increased, which improved their ability to tackle ergonomic problems by themselves. The changes in ergonomics were perceived to decrease physical load and improve musculoskeletal health. As hindering factors for implementation, lack of time and motivation, and insufficient financial resources were mentioned. In addition, the workers expressed a wish for more support from the management, technical staff, and ergonomists.
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Affiliation(s)
- Irmeli Pehkonen
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FIN-00250 Helsinki, Finland.
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Haukka E, Leino-Arjas P, Viikari-Juntura E, Takala EP, Malmivaara A, Hopsu L, Mutanen P, Ketola R, Virtanen T, Pehkonen I, Holtari-Leino M, Nykänen J, Stenholm S, Nykyri E, Riihimäki H. A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders. Occup Environ Med 2008; 65:849-56. [PMID: 18417560 DOI: 10.1136/oem.2007.034579] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E Haukka
- Finnish Institute of Occupational Health, Centre of Expertise for Health and Work Ability, Topeliuksenkatu 41 a A, FI-00250, Helsinki, Finland.
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