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Stelson EA, Sabbath-Clayton LL, Sorensen G, Kubzansky LD, Berkman LF, Sabbath EL. Residential addiction treatment providers: Identifying the role of social context in worker health and turnover. Soc Sci Med 2022; 314:115462. [PMID: 36327634 DOI: 10.1016/j.socscimed.2022.115462] [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] [Received: 06/22/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
Increased lethality and availability of addictive substances has strained US addiction treatment services, further exacerbating workforce shortages in these settings. The emotional and physical health toll of providing treatment may contribute to shortages. This community-initiated qualitative study aimed to identify conditions that affect provider health and turnover in residential addiction treatment from a Total Worker Health® perspective. Providers (direct service, supervisors, leaders) working in nonprofit residential treatment facilities in Massachusetts were recruited by role and geography to participate in interviews and focus groups. NVivo12 facilitated coding and analysis. 25% of transcripts were double coded to assess interrater reliability and coding consistency (mean Kappa = 0.82). Providers (N = 49) participated in 33 interviews and 4 focus groups. Many participants reported personal addiction histories. Analysis revealed how socio-contextual factors originating outside of residential facilities were dominant influences on "downstream" working conditions, worker health, staff turnover, and by extension, client care. Four primary socio-contextual themes surfaced:1) Changes in type and potency of substances and client need not reliably accompanied by shifts in treatment practices; 2) challenges balancing state requirements and state-provided resources; 3) influence of structural discrimination and addiction stigma on pay and professional advancement; and 4) geographic location of facilities shape work and quality of life. Results were used to develop a conceptual model for residential addiction treatment to illustrate pathways by which ecological factors interact to affect provider health and turnover. Findings indicate that protecting health and wellbeing of providers-many of whom are in addiction recovery themselves- is integral to improving addiction treatment. From this workforce's perspective, recent changes in socio-contextual factors have intensified already challenging working conditions (job demands, pay, advancement), negatively impacting worker health, turnover, and client care. Any interventions to improve treatment outcomes or working conditions in nonprofit addiction facilities must consider larger socio-contextual factors influencing these organizations.
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Affiliation(s)
- Elisabeth A Stelson
- Harvard T.H. Chan School of Public Health, Dept. of Social and Behavioral Sciences, 677 Huntington Ave., Boston, MA, 02115, USA.
| | | | - Glorian Sorensen
- Harvard T.H. Chan School of Public Health, Dept. of Social and Behavioral Sciences, 677 Huntington Ave., Boston, MA, 02115, USA; Dana-Farber Cancer Institute, Boston, MA, USA
| | - Laura D Kubzansky
- Harvard T.H. Chan School of Public Health, Dept. of Social and Behavioral Sciences, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Lisa F Berkman
- Harvard T.H. Chan School of Public Health, Dept. of Social and Behavioral Sciences, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Erika L Sabbath
- Boston College School of Social Work, Chestnut Hill, MA, USA
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Schwatka NV, Dally M, Shore E, Tenney L, Brown CE, Scott JG, Dexter L, Newman LS. Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business. BMC Public Health 2022; 22:1039. [PMID: 35610627 PMCID: PMC9128251 DOI: 10.1186/s12889-022-13435-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health ("TWH") leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later. METHODS The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest. RESULTS Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes. CONCLUSIONS This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business. TRIAL REGISTRATION The trial was retrospectively registered with ClinicalTrials.gov ( ID U19OH011227 ).
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Affiliation(s)
- Natalie V Schwatka
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA.
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA.
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Erin Shore
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Present Address: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Carol E Brown
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Joshua G Scott
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Present Address: 2U, Inc., Lanham, MD, USA
| | - Lynn Dexter
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
| | - Lee S Newman
- Center for Health, Work & Environment, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
- Department of Epidemiology, Colorado School of Public Health, and Department of Medicine, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17th Pl., 3rd Floor, Mail Stop B119 HSC, Aurora, CO, 80045, USA
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Sorensen G, Peters SE, Nielsen K, Stelson E, Wallace LM, Burke L, Nagler EM, Roodbari H, Karapanos M, Wagner GR. Implementation of an organizational intervention to improve low-wage food service workers' safety, health and wellbeing: findings from the Workplace Organizational Health Study. BMC Public Health 2021; 21:1869. [PMID: 34656090 PMCID: PMC8520284 DOI: 10.1186/s12889-021-11937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/05/2021] [Indexed: 02/01/2023] Open
Abstract
Background Many organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention. Methods This proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed. Results Over the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers’ availability and limited the full implementation of the intervention. Conclusions Despite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing commitment and support from both the parent employer and the host client. Trial registration This study was retrospectively registered with the Clinical Trials. Gov Protocol and Results System on June 2, 2021 with assigned registration number NCT04913168.
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Affiliation(s)
- Glorian Sorensen
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA. .,Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Susan E Peters
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Karina Nielsen
- University of Sheffield, Conduit Rd, Sheffield, S10 1FL, UK
| | - Elisabeth Stelson
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | | | - Lisa Burke
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Eve M Nagler
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Hamid Roodbari
- University of Sheffield, Conduit Rd, Sheffield, S10 1FL, UK
| | - Melissa Karapanos
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Gregory R Wagner
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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Robertson MM, Tubbs D, Henning RA, Nobrega S, Calvo A, Murphy LA. Assessment of organizational readiness for participatory occupational safety, health and well-being programs. Work 2021; 69:1317-1342. [PMID: 34366313 DOI: 10.3233/wor-213552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/12/2023] Open
Abstract
BACKGROUND Organizational readiness for change measures were reviewed to develop an assessment tool for guiding implementation of an occupational safety and health program based on Total Worker Health (TWH) principles. Considerable conceptual ambiguity in the theoretical and empirical peer-reviewed literature was revealed. OBJECTIVE Develop and validate an assessment tool that organizations can use to prepare for implementation of a participatory TWH program. METHODS Inclusion criteria identified 29 relevant publications. Analysis revealed eight key organizational characteristics and predictors of successful organizational change. A conceptual framework was created that subject matter experts used to generate prospective survey items. Items were revised after pretesting with 10 cognitive interviews with upper-level management and pilot-tested in five healthcare organizations. Reliability of the domain subscales were tested based on Cronbach's α. RESULTS The Organizational Readiness Tool (ORT) showed adequate psychometric properties and specificity in these eight domains: 1) Current safety/health/well-being programs; 2) Current organizational approaches to safety/health/well-being; 3) Resources available for safety/health/well-being; 4) Resources and readiness for change initiatives to improve safety/health/well-being; 5) Resources and readiness for use of teams in programmatic initiatives; 6) Teamwork; 7) Resources and readiness for employee participation; and 8) Management communication about safety/health/well-being. Acceptable ranges of internal consistency statistics for the domain subscales were observed. CONCLUSIONS A conceptual model of organizational readiness for change guided development of the Organizational Readiness Tool (ORT), a survey instrument designed to provide actionable guidance for implementing a participatory TWH program. Initial internal consistency was demonstrated following administration at multiple organizations prior to implementation of a participatory Total Worker Health® program.
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Affiliation(s)
- Michelle M Robertson
- Department of Psychology, Center for Promotion of Health in the New England Workplace, University of Connecticut, Storrs, CT, USA.,D'Amore-McKim School of Business, Northeastern University, Boston, MA, USA
| | - Diana Tubbs
- Department of Psychology, Center for Promotion of Health in the New England Workplace, University of Connecticut, Storrs, CT, USA
| | - Robert A Henning
- Department of Psychology, Center for Promotion of Health in the New England Workplace, University of Connecticut, Storrs, CT, USA
| | - Suzanne Nobrega
- Biomedical Engineering, Center for Promotion of Health in the New England Workplace, University of Massachusetts, Lowell, MA, USA
| | - Alec Calvo
- Department of Psychology, Center for Promotion of Health in the New England Workplace, University of Connecticut, Storrs, CT, USA
| | - Lauren A Murphy
- D'Amore-McKim School of Business, Northeastern University, Boston, MA, USA
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Chang CH, Shao R, Wang M, Baker NM. Workplace Interventions in Response to COVID-19: an Occupational Health Psychology Perspective. ACTA ACUST UNITED AC 2021;:1-23. [PMID: 33842692 DOI: 10.1007/s41542-021-00080-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
The outbreak of COVID-19 has imposed significant threats to individuals’ physical health and has substantially changed the socioeconomic order and the nature of our work and life all over the world. To guide organizations to design effective workplace interventions to mitigate the negative impacts of COVID-19, we take the occupational health psychology (OHP) perspective to propose a framework that highlights important areas for organizations to intervene in order to better protect workers’ physical health and safety and to promote workers’ psychological well-being. Specifically, we integrate the prevention-based public health model with the Total Worker Health (TWH) and OHP-based approaches to propose a comprehensive set of primary, secondary, and tertiary interventions that target different groups of employees with varied exposure risks to the new coronavirus. We believe these proposed interventions can contribute positively to the development of healthy and safe work. Implications of these proposed interventions for workers, organizations, and policy makers are also discussed.
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Wipfli B, Wild S, Hanson GC, Shea SA, Winters-Stone K, Thosar SS. The active workplace study: Protocol for a randomized controlled trial with sedentary workers. Contemp Clin Trials 2021; 103:106311. [PMID: 33539991 DOI: 10.1016/j.cct.2021.106311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Sedentary behavior is pervasive in the workplace and is harmful to health. Research on the effectiveness of comprehensive workplace interventions to reduce sedentary behavior and improve worker health and safety is crucial as sedentary jobs become more common. METHODS We developed a Total Worker Health intervention targeting sedentary behavior in call centers, and are evaluating intervention effectiveness in a randomized controlled trial. Four worksites will be randomly assigned to an intervention or control condition. The intervention condition includes the provision of active workstations along with programs and procedures at environmental, organizational, and individual levels. Control worksites will receive active workstations with no additional support, following common organizational practices. RESULTS Outcomes include objectively measured physical activity, biological markers of health, and self-report survey data at baseline, after the 6-month intervention or control period, and at a 12-month follow-up. CONCLUSIONS The aims of the study are to determine whether a Total Worker Health intervention has stronger impacts on workplace sedentary behavior, uninterrupted bouts of sitting, and worker health and safety compared to a usual practice control condition. The study will inform future workplace sedentary behavior intervention and dissemination research, along with organizational best practices for reducing sedentary behavior in the workplace.
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Sorensen G, Dennerlein JT, Peters SE, Sabbath EL, Kelly EL, Wagner GR. The future of research on work, safety, health and wellbeing: A guiding conceptual framework. Soc Sci Med 2021; 269:113593. [PMID: 33341740 PMCID: PMC10868656 DOI: 10.1016/j.socscimed.2020.113593] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
Work plays a central role in health. A conceptual model can help frame research priorities and questions to explore determinants of workers' safety, health, and wellbeing. A previous conceptual model focused on the workplace setting to emphasize the role of conditions of work in shaping workers' safety, health and wellbeing. These conditions of work include physical, organizational, and psychosocial factors. This manuscript presents and discusses an updated and expanded conceptual model, placing the workplace and the conditions of work within the broader context of socio-political-economic environments and consequent trends in employment and labor force patterns. Social, political and economic trends, such as growing reliance on technology, climate change, and globalization, have significant implications for workers' day-to-day experiences. These structural forces in turn shape employment and labor patterns, with implications for the availability and quality of jobs; the nature of relationships between employers and workers; and the benefits and protections available to workers. Understanding these patterns will be critical for anticipating the consequences of future changes in the conditions of work, and ultimately help inform decision-making around policies and practices intended to protect and promote worker safety, health, and wellbeing. This model provides a structure for anticipating research needs in response to the changing nature of work, including the formation of research priorities, the need for expanded research methods and measures, and attention to diverse populations of enterprises and workers. This approach anticipates changes in the way work is structured, managed, and experienced by workers and can effectively inform policies and practices needed to protect and promote worker safety, health and wellbeing.
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Affiliation(s)
- Glorian Sorensen
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jack T Dennerlein
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Susan E Peters
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erika L Sabbath
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Erin L Kelly
- MIT Sloan School of Management, Cambridge, MA, USA
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Smith TD, Mullins-Jaime C, Dyal MA, DeJoy DM. Stress, burnout and diminished safety behaviors: An argument for Total Worker Health® approaches in the fire service. J Safety Res 2020; 75:189-195. [PMID: 33334477 PMCID: PMC8509082 DOI: 10.1016/j.jsr.2020.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 12/03/2019] [Revised: 05/05/2020] [Accepted: 09/22/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Firefighting is stressful work, which can result in burnout. Burnout is a safety concern as it can negatively impact safety outcomes. These impacts are not fully understood within the fire service. Further, the fire service needs support that safety strategies are needed to protect and promote the health and wellbeing of firefighters. METHODS Structural equation modeling was completed to examine a hypothesized model that linked stress and burnout to diminished safety behavior outcomes among a sample of career firefighters. RESULTS Findings support a full mediation model. Firefighter stress perceptions were positively associated with burnout and burnout was negatively associated with safety compliance behavior, personal protective equipment behavior, safe work practices, and safety citizenship behavior. CONCLUSIONS These results illustrate the negative impact of health impairment on firefighter safety behaviors. Practical Applications: These outcomes suggest that interventions aimed at protecting and promotion firefighter health are needed. Total Worker Health® (TWH) approaches may provide the framework for these interventions.
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Affiliation(s)
- Todd D Smith
- Indiana University School of Public Health - Bloomington, Department of Applied Health Science, Bloomington, IN, USA.
| | - Charmaine Mullins-Jaime
- Indiana State University, College of Technology, Department of Built Environment, Terre Haute, IN, USA
| | - Mari-Amanda Dyal
- Kennesaw State University, Department of Health Promotion and Physical Education, Kennesaw, GA, USA
| | - David M DeJoy
- Workplace Health Group, Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
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Punnett L, Nobrega S, Zhang Y, Rice S, Gore R, Kurowski A. Safety and Health through Integrated, Facilitated Teams (SHIFT): stepped-wedge protocol for prospective, mixed-methods evaluation of the Healthy Workplace Participatory Program. BMC Public Health 2020; 20:1463. [PMID: 32993607 PMCID: PMC7526105 DOI: 10.1186/s12889-020-09551-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing. METHODS Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame). DISCUSSION This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed. TRIAL REGISTRATION ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.
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Affiliation(s)
- Laura Punnett
- Center for the Promotion of Health in the New England Workplace (CPH-NEW), Lowell, MA, USA.
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA.
| | - Suzanne Nobrega
- Center for the Promotion of Health in the New England Workplace (CPH-NEW), Lowell, MA, USA
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA
| | - Yuan Zhang
- Center for the Promotion of Health in the New England Workplace (CPH-NEW), Lowell, MA, USA
- Solomont School of Nursing, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA
| | - Serena Rice
- Center for the Promotion of Health in the New England Workplace (CPH-NEW), Lowell, MA, USA
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA
| | - Rebecca Gore
- Center for the Promotion of Health in the New England Workplace (CPH-NEW), Lowell, MA, USA
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA
| | - Alicia Kurowski
- Center for the Promotion of Health in the New England Workplace (CPH-NEW), Lowell, MA, USA
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA
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Vaughn AE, Willis EA, Ward DS, Smith F, Grummon A, Linnan LA. Workplace-based opportunities to support child care workers' health and safety. Prev Med Rep 2020; 19:101154. [PMID: 32714774 PMCID: PMC7369321 DOI: 10.1016/j.pmedr.2020.101154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022] Open
Abstract
Child care workers earn among the lowest wages in the United States and they struggle with many health issues. The purpose of this study was to describe workplace supports for nutrition, physical activity, other health behaviors (e.g., smoking cessation, stress management), and occupational health and safety available to child care workers, and thereby inform the development of future workplace-based interventions to improve worker well-being. Between 2015 and 2016, 74 North Carolina child care centers (and directors), participating in a larger randomized controlled trial, completed a Workplace Health and Safety Assessment (interview and observation) measuring four domains: Infrastructure, Organizational Policies and Procedures, Programs and Promotions, and Internal Physical Environment. This study used baseline data to report means and standard deviations. Participating child care centers employed, on average, 12.7 ± 8.4 employees. Total scores from the Workplace Health and Safety Assessment averaged 41.3 ± 12.6 out of a possible 154, demonstrating many missed opportunities for supporting health/safety. More specifically, centers scored on average 9.5 ± 3.9 on Infrastructure (35% of potential points), 11.1 ± 3.9 on Organizational Policies and Procedures (32% of potential), 7.6 ± 5.4 on Programs and Promotions (12% of potential), and 13.1 ± 2.2 on Internal Physical Environment (49% of potential). The most frequent supports available were for occupational health and safety issues, while fewer supports were available for physical activity and other health behaviors. Child care workers could benefit greatly from more comprehensive workplace health and safety interventions; however, strategies must overcome centers' limited capacity and resources.
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Affiliation(s)
- Amber E Vaughn
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Erik A Willis
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA.,Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, CB7461, Chapel Hill, NC 27599-7461, USA
| | - Falon Smith
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Anna Grummon
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA.,Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 307 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA
| | - Laura A Linnan
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 307 Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440, USA
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Syed IUB. Diet, physical activity, and emotional health: what works, what doesn't, and why we need integrated solutions for total worker health. BMC Public Health 2020; 20:152. [PMID: 32005215 PMCID: PMC6995193 DOI: 10.1186/s12889-020-8288-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background Current research advocates lifestyle factors to manage workers’ health issues, such as obesity, metabolic syndrome, and type II diabetes mellitus, among other things (World Health Organization (WHO) Obesity: preventing and managing the global epidemic, 2000; World Health Organization (WHO) Obesity and overweight, 2016), though little is known about employees’ lifestyle factors in high-stress, high turnover environments, such as in the long term care (LTC) sector. Methods Drawing on qualitative single-case study in Ontario, Canada, this paper investigates an under-researched area consisting of the health practices of health care workers from high-stress, high turnover environments. In particular, it identifies LTC worker’s mechanisms for maintaining physical, emotional, and social wellbeing. Results The findings suggest that while particular mechanisms were prevalent, such as through diet and exercise, they were often conducted in group settings or tied to emotional health, suggesting important social and mental health contexts to these behaviors. Furthermore, there were financial barriers that prevented workers from participating in these activities and achieving health benefits, suggesting that structurally, social determinants of health (SDoH), such as income and income distribution, are contextually important. Conclusions Accordingly, given that workplace health promotion and protection must be addressed at the individual, organizational, and structural levels, this study advocates integrated, total worker health (TWH) initiatives that consider social determinants of health approaches, recognizing the wider socio-economic impacts of workers’ health and wellbeing.
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Affiliation(s)
- Iffath U B Syed
- School of Health Policy and Management, York University, Stong College, 3rd Floor, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
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Abstract
PURPOSE OF REVIEW This review provides an evidence-based approach to improve health, reduce excessive medical costs, and optimize productivity for health care employees and their families. What opportunities and challenges are unique or specific to health care organizations particularly as aligned with value and competitive advantage in achieving the Quadruple Aim? RECENT FINDINGS An integrated approach to improving health and performance is essential. The strategy includes the employer "environment" (broadly defined), health and medical care behaviors, care delivery modalities, benefits alignment, and a supportive, total health and productivity integrated data analytic capability. Epigenetics and lifestyle medicine represent a promising direction in accelerating the prevention, treatment, and reversal of common chronic disease. An integrated health and productivity approach, emerging science, and practices can accelerate health care systems' goal to improve employee health and organizational competitiveness. Additional published examples of health care specific employer experience will further advance refinement of existing models and tailoring to the medical care setting.
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Affiliation(s)
- Michael D Parkinson
- Principal, P3 Health ("Prevention, Performance, Productivity"), 5864 Aylesboro Avenue, Pittsburgh, PA, 15217, USA.
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