Suzanne Nobrega

Participatory ergonomics as a model for integrated programs to prevent chronic disease.

Objective: To describe the value of participatory methods for achieving successful workplace health promotion (WHP) programming, and specifically the relevance of participatory ergonomics (PE) for the Total Worker Health (TWH) initiative. Methods: We review the concept of macroergonomics, and how PE is embedded within that framework, and its utility to modern WHP approaches such as “social health promotion.” We illustrate these constructs in practice within TWH. Results and Conclusions: Participatory ergonomics is relevant to WHP because (1) psychosocial stress contributes to individual health behaviors as well as chronic diseases; (2) job stress cannot be addressed without employee involvement in hazard identification and solutions; (3) the interaction of multiple levels within an organization requires attention to needs and constraints at all levels, just as the social-ecological model addresses higher-level determinants of and constraints on individual behaviors.

The Intervention Design and Analysis Scorecard: a planning tool for participatory design of integrated health and safety interventions in the workplace.

Objective: As part of a Research-to-Practice Toolkit development effort by the Center for the Promotion of Health in the New England Workplace, to develop and test a structured participatory approach for engaging front-line employees in the design of integrated health protection and promotion interventions. Methods: On the basis of a participatory ergonomics framework, the Intervention Design and Analysis Scorecard (IDEAS) provides a stepwise approach for developing intervention proposals, including root cause analysis and setting evaluation criteria such as scope, obstacles, and cost/benefit trade-offs. The IDEAS was tested at four diverse worksites with trained facilitators. Results: Employees were able to develop and gain management support for integrated interventions at each worksite. Conclusions: The IDEAS can be used effectively by front-line employees to plan integrated interventions in a program dedicated to continuous improvement of employee health protection/promotion and Total Worker Health.

Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion.

Background. Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. Methods. A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. Results. Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. Conclusions. Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

Work organization and health issues in long-term care centers.

This qualitative study explored common and divergent perceptions of caregivers and managers regarding occupational health and safety, work organization, and psychosocial concerns in long-term care centers. Both common and differing issues were identified. Both groups agreed on the importance of ergonomic concerns, the high prevalence of stress, and receptiveness to participatory health promotion programs. However, numerous work organization issues and physical and psychosocial workplace hazards were identified by certified nursing assistants but were not mentioned by managers. The results suggest that different perceptions naturally arise from peoples varying positions in the occupational hierarchy and their consequent exposures to health and safety hazards. Improved systems of communication that allow frontline workers to express their concerns would make it possible to create solutions to these problems.

Obesity/Overweight and the Role of Working Conditions: A Qualitative, Participatory Investigation

The rising U.S. prevalence of obesity has generated significant concern and demonstrates striking socioeconomic and racial/ethnic disparities. Most interventions target individual behaviors, sometimes in combination with improving the physical environment in the community but rarely involving modifications of the work environment. With 3.6 million workers earning at or below the federal minimum wage, it is imperative to understand the impact of working conditions on health and weight for lower income workers. To investigate this question, a university–community partnership created a participatory research team and conducted eight focus groups, in English and Spanish, with people holding low-wage jobs in various industries. Analysis of transcripts identified four themes: physically demanding work (illnesses, injuries, leisure-time physical activity), psychosocial work stressors (high demands, low control, low social support, poor treatment), food environment at work (available food choices, kitchen equipment), and time pressure (scheduling, having multiple jobs and responsibilities). Physical and psychosocial features of work were identified as important antecedents for overweight. In particular, nontraditional work shifts and inflexible schedules limited participants’ ability to adhere to public health recommendations for diet and physical activity. Workplace programs to address obesity in low-wage workers must include the effect of working conditions as a fundamental starting point.

Healthy Workplaces? A Survey of Massachusetts Employers

Purpose. This study examines worksite health promotion (WHP) and occupational health and safety (OHS) activities by Massachusetts employers, and the extent to which workplaces with programming in one domain were more likely to have the other as well. Design. In 2008, the Massachusetts Department of Public Health surveyed a stratified sample of Massachusetts worksites. Setting. A mailed questionnaire to be completed by workplace representatives. Subjects. Massachusetts worksites returning the questionnaire. Measures. Questionnaire items about worksite characteristics, WHP, and some OHS practices. Analysis. We scored levels of WHP and OHS activity; examined the relationship between activities in the two domains by employer characteristics; and assessed self-reported coordination between them. Results. The 890 responding worksites had higher scores for OHS (mean = 48% of practices, SD = 24%) than WHP (mean = 20%, SD = 12%). The difference between these scores varied by a factor of two across industry sectors and was smallest for workforces of 100+ employees (p = .001). Employers with no unionized workers reported fewer activities in both domains (p < .0001). Only 28% of respondents reported always/often coordinating OHS and WHP efforts; these organizations had more activities overall in both domains. Conclusion. Larger and unionized workplaces in Massachusetts were more likely to offer both WHP and OHS programming. Self-reported coordination was somewhat associated with more activity in both domains, although levels of WHP activity varied widely.

Field tests of a participatory ergonomics toolkit for Total Worker Health

Growing interest in Total Worker Health® (TWH) programs to advance worker safety, health and well-being motivated development of a toolkit to guide their implementation. Iterative design of a program toolkit occurred in which participatory ergonomics (PE) served as the primary basis to plan integrated TWH interventions in four diverse organizations. The toolkit provided start-up guides for committee formation and training, and a structured PE process for generating integrated TWH interventions. Process data from program facilitators and participants throughout program implementation were used for iterative toolkit design. Program success depended on organizational commitment to regular design team meetings with a trained facilitator, the availability of subject matter experts on ergonomics and health to support the design process, and retraining whenever committee turnover occurred. A two committee structure (employee Design Team, management Steering Committee) provided advantages over a single, multilevel committee structure, and enhanced the planning, communication, and teamwork skills of participants.

Designing an Organizational Readiness Survey for Total Worker Health® Workplace Initiatives

The aim of the present study was to develop a means to assess organizational readiness for a Total Worker Health® initiative, a comprehensive approach for improving employee safety health and wellbeing. A systematic literature review was conducted to integrate past multidisciplinary peer-reviewed theoretical and empirical work. Although the initial search of the organizational change literature revealed nearly 300,000 related titles, there was considerable conceptual ambiguity and only a limited number were focused on major occupational health and safety initiatives. A revised set of inclusion criteria identified 30 relevant publications that yielded the following eight key organizational characteristics and predictors: (1) culture, (2) communication, (3) leadership, (4) change history, (5) job design, (6) teams and relationships, (7) flexible organizational practices and policies, and (8) positive organizational climate. The findings from this review of the literature and our subsequent conceptual model provide the foundation for developing an organizational readiness assessment tool that researchers and practitioners will be able to use prior to implementing comprehensive workplace safety, health and wellbeing initiatives.