Work Environment Interventions Research Articles

Creating Clarity and Crew Courage: Preventive and Promotive Measures for a Maritime Industry Without Bullying and Harassment

Seafaring shares many characteristics with contemporary working life ashore. However, a major difference is that seafarers can spend up to 12 months aboard a ship that constitutes a work, living and recreational environment. Onboard work includes many stressors that can potentially contribute to workplace bullying and harassment, which in turn can affect safety critical operations. The aim of this study was to identify underlying causes in the organizational and social work environment that can cause workplace bullying and harassment at sea, and to suggest appropriate preventive and promotive strategies and measures. Data were collected mainly through World Café workshops with 56 participants from the Swedish maritime industry. Seafarer occupational health, safety, and wellbeing is largely determined by interdependent factors at micro, meso, and macro levels, where different stakeholders play various roles. Strategies and measures starting at the individual seafarer, and gradually expanding outwards toward the maritime industry are suggested. It is important that a victim of bullying or harassment receives adequate support. Creating crew courage enables employees to both recognize troubling situations and know how to act and respond to a situation. To bridge the gap between policy and practice, the legislative framework needs translating into practical procedures to make sense to the middle manager at the sharp end, with limited knowledge, time, resources, and decision latitude. Future research should evaluate the effectiveness of work environment interventions – what works, for whom, and under which circumstances.

Linear and non-linear relationships between job demands-resources and psychological and physical symptoms of service sector employees. When is the midpoint a good choice?

Related to the research of working conditions, the link between organizational factors and health was traditionally analyzed using linear models. However, the literature analysis suggests inconsistencies in linear models predicting workers’ health levels. To clarify this issue, this exploratory research compares the linear and non-linear relationships between job demands-resources (task complexity, time pressure, contact with users, and job autonomy), and the psychological and physical symptoms of employees working in the main five service subsectors: commerce, horeca (hotels, restaurants, and cafés), public administration, education, and healthcare. With a final sample of 4,047 participants, our study data were extracted from the II Andalusian Working Conditions Survey. Following the theoretical framework of JD-R Model and considering the Vitamin Model theoretical approach for non-linear relationships, our results showed that there were significant differences among the five subsectors analyzed regarding the linear and non-linear relationships between job demands-resources and psychological and physical symptoms of employees. Furthermore, task complexity generated non-linear relationships in higher proportion than time pressure and contact with users. Likewise, non-linear relationships found showed a U-shape. Moreover, the findings of non-linear relationships suggested that medium levels of task complexity should not be exceeded to avoid further negative impact on psychological and physical symptoms for service sector employees, preserving their health. Finally, some general practical implications of work environment interventions are suggested.

Are Organizational Interventions Effective in Protecting Healthcare Worker Mental Health during Epidemics/Pandemics? A Systematic Literature Review.

It is unclear how to effectively protect healthcare workers’ mental health during infectious disease epidemics. Targeting the occupational determinants of stress may hold more promise than individual stress management, which has received more focus. Through a systematic review of the 2000–2021 English- and French-language scientific literature, we evaluated the effectiveness of organizational and psychosocial work environment interventions to protect healthcare workers’ mental health in an epidemic/pandemic context. Evidence from medium- and high-quality studies was synthesized using GRADE. Among 1604 unique search results, 41 studies were deemed relevant, yielding 34 low-quality and seven medium-quality studies. The latter reported on promising multi-component prevention programs that combined staffing adjustments, work shift arrangements, enhanced infection prevention and control, recognition of workers’ efforts, psychological and/or logistic support during lockdowns (e.g., accommodation). Our confidence in the effectiveness of reviewed interventions is low to very low, however, owing to methodological limitations. We highlight gaps in the reporting of intervention process and context elements and discuss theory and implementation failure as possible explanations for results. We conclude by urging authors of future studies to include and document detailed risk assessments of the work environment, involve workers in solution design and implementation and consider how this process can be adapted during an emergency.

Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature

Introduction: Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies. Methods: A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues. Results: Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles. Conclusions: This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed. Practical Application: Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs.

A framework for participatory work environment interventions in home care \u2013 success factors and some challenges

BackgroundHome care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations.MethodsThe framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design.ResultsParts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful.ConclusionsThe participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.

Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study.

BackgroundThe work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees.ObjectiveThe aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting.MethodsA mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed.ResultsThe mixed methods evaluation of the quality improvement project received funding from Futurum–Academy for Health and Care, Jönköping County Council and Region Jönköping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021.ConclusionsThe study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole.International Registered Report Identifier (IRRID)DERR1-10.2196/34152

Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector

Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention. The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence. The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence. It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases. The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities. This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

Nursing turnover intentions: The role of leader emotional intelligence and team culture.

To explore the influence of leader emotional intelligence on the working culture prevailing in teams that ultimately impacts nurses' intent to leave the job. Global shortages of nursing professionals have been concerning issues of extreme vitality in the delivery of superior services. Though the state-of-the-art system provides relief, the hospital management continued worrying about losing highly skilled nursing professionals due to a higher level of emotional exhaustion exhibiting progressive turnover. A survey technique was employed for data collection from nurses. Further data were analysed by structural equation modelling in the light of 313 substantial responses by using SmartPLS. The findings revealed that leader emotional intelligence impulses critical constructive effects by fulfilling the needs of nurses and has an impact on their turnover intentions simultaneously. The research provides an empirical lens of leadership and culture, which noticeably explain turnover intention. This study affirmed solid connections amongst the leader emotional intelligence, team culture and turnover intentions. The study provides valuable insight for health management organisations to focus on factors that decrease the turnover intention of nurses. Considering a global shortage of nurses, nursing management must consider crucial aspects of the work environment and plan interventions to restrain nursing turnover intentions.

Systematic review of interventions to improve nurses' work environments.

To evaluate the current evidence that examined the effects of nurses' work environment interventions on nurse, patient, and hospital outcomes; and the key intervention characteristics. Quantitative systematic review without meta-analysis. Nine databases (British Nursing Index, CINAHL, EMBASE, Global Health, Global Health Archives, MEDLINE, Ovid Nursing, PubMed, and Web of Science) were searched following Systematic review Without Meta-analysis guideline to elicit studies that examined effects of interventions aimed at improving nurses' work environments among peer-reviewed publications from inception to April 2019. Database search used the following keywords: nurs*, patient, hospital, healthcare intervention, organizational improvement, nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, and their MeSH terms. The Cochrane's Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) was used for quality appraisal. Donabedian model of Quality of Care was used as the framework to categorize interventions components focusing on structure and process aspects of the nurse work environments. The interventions included the use of accreditation process, educational strategies, and participatory approach. By defining the interventions which demonstrated positive effects on the nurse, patient, and hospital outcomes as effective, it appears that they are more consistently characterized as focusing on process improvement, adopting participatory approach, with greater involvement of frontline and nurse executives and at unit-level implementation. Although the heterogeneity in the design of the review studies precludes making conclusive insights on the best evidence to improve nurses' work environments, the review informs the major research gaps in the topic area and the ways to design better interventions to enhance the outcomes. The study provides insights on intervention components and strategies that can contribute to healthy nurse work environments. By adapting unit-level process improvements that actively involve frontline and nurse executives, nurse leaders may provide a more directed approach towards achieving favourable outcomes.

Beginning teachers’ work satisfaction, self-efficacy and willingness to stay in the profession: a question of job demands-resources balance?

ABSTRACTAs many other countries around the world, Sweden is currently facing an urgent need for new teachers. Creating sound work environments that can retain beginning teachers in the profession—as well as attract new ones—is one way to address the problem. In order to accomplish this task, research must be able to reflect the complex nature of work environments. In the present study, a cluster analysis of four job demands and five job resources among 328 Swedish teachers in their first year of teaching, resulted in four typical work situations: the advantageous situation (n = 103); the balanced situation (n = 148); the threat situation (n = 34); and the pressed situation (n = 43). Clear differences were found in how teachers in these different clusters perceived their work satisfaction, self-efficacy and willingness to stay, with the teachers in the former two work situations scoring significantly higher than the latter two. The results indicate that teachers can have a very different experience of work at the start of their careers. These findings imply that work environment interventions and induction programmes to support new teachers and prevent them from leaving the profession must be well adapted to the context.

Antecedents of women managers’ resilience: conceptual discussion and implications for HRM

PurposeThis paper aims to provide a framework with the antecedents of women managers’ resilience in SMEs.Design/methodology/approachThis developmental study uses a comprehensive literature review and a set of propositions to identify the antecedent of women managers’ resilience and develops a conceptual framework for resilience.FindingsThe results indicate that in addition to personal resilience traits, interactive engagement with the work environment, career adaptability and positive human resource management (HRM) interventions are the main antecedents of women managers’ resilience.Research limitations/implicationsThis paper contributes to theory by providing a new perspective on the study of resilience as a process at the organisational level and as a trait at personal level. It contributes to the women employee-centric resilience discussion in HRM literature and explores the relationship between resilience and women managers’ career progression. This is a developmental study, and despite the strengths of the undertaken approach, there are a number of limitations due to the lack of empirical evidence. Therefore, future research activities should focus on validating the framework and determining any potential boundaries of this resilience framework.Practical implicationsThe study reveals a number of practical implications leading to a recommended resilience toolkit for HR managers of organisations to develop and promote resilience in their women managers and aspiring managers.Social implicationsThe social implications of this study include the social relationships within the work-setting, better employee engagement and interaction with the work environment and flexible career progression pathways.Originality/valueThe paper is based on rich conceptual and theoretical discussion that identifies the key antecedents of women managers’ resilience. The study also conceptually establishes the moderating relationship between women managers’ resilience and work stress and burnout.

Investigating the Effect of Educational - Counseling, Sports Exercises and Improving the Work Environment Interventions on Cardiovascular Risk Factors Including High BMI, Triglyceride and Cholesterol Levels in Military Flight Pilots and Personnel

Investigating the Effect of Educational - Counseling, Sports Exercises and Improving the Work Environment Interventions on Cardiovascular Risk Factors Including High BMI, Triglyceride and Cholesterol Levels in Military Flight Pilots and Personnel

Systematic literature review on the effects of occupational safety and health (OSH) interventions at the workplace

Objectives The aim of this review was to assess the evidence that occupational safety and health (OSH) legislative and regulatory policy could improve the working environment in terms of reduced levels of industrial injuries and fatalities, musculoskeletal disorders, worker complaints, sick leave and adverse occupational exposures. Methods A systematic literature review covering the years 1966‒2017 (February) was undertaken to capture both published and gray literature studies of OSH work environment interventions with quantitative measures of intervention effects. Studies that met specified in- and exclusion criteria went through an assessment of methodological quality. Included studies were grouped into five thematic domains: (i) introduction of OHS legislation, (ii) inspection/enforcement activity, (iii) training, such as improving knowledge, (iv), campaigns, and (v) introduction of technical device, such as mechanical lifting aids. The evidence synthesis was based on meta-analysis and a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results The search for peer-reviewed literature identified 14 743 journal articles of which 45 fulfilled the inclusion criteria and were eligible for meta-analysis. We identified 5181 articles and reports in the gray literature, of which 16 were evaluated qualitatively. There was moderately strong evidence for improvement by OHS legislation and inspections with respect to injuries and compliance. Conclusions This review indicates that legislative and regulatory policy may reduce injuries and fatalities and improve compliance with OHS regulation. A major research gap was identified with respect to the effects of OSH regulation targeting psychological and musculoskeletal disorders.

The Interplay of Sensemaking and Material Artefacts during Interventions: A Case Study

This study focuses on the interplay of different aspects of organization during work environment interventions. Specifically how the interplay of collective sensemaking, and material artefacts influence an intervention. We analyze an organization-level psychosocial work environment intervention conducted in two postal areas in the Danish Postal service. It provides a case study of the dynamics of a work environment intervention by focusing on how the intervention affects the organization, how sensemaking and materiality in the organization interact during the intervention is implemented, and how the intervention in turn is affected by the materiality and sensemaking of the organization. The present study adds to the current literature by demonstrating the role of sensemaking and materiality in interventions. The paper ends with a discussion of the links between sensemaking and sociomaterial artifacts and what role they play during work environment interventions, suggesting that interventions needs to align with both to be successful.

Impact of the transition shock and work environment on turnover intention among new nurses

Objective To explore the impact of transition shock and work environment on turnover intention of new nurses, and to provide evidence for nursing management and intervention of new nurses. Methods From June to November 2016, 500 new nurses from one classⅢ grade A hospital of Heilongjiang province were selected as the research subject. A cross-sectional survey was used to investigate 500 new nurses with Turnover Intention Scale, Chinese Version of Perceived Nursing Work Environment Scale and new nurses' Transition Impact Rating Scale. The database was established by the method of double entry, and the data were analyzed with SPSS 20.0 software. Results The total score of turnover intention of 500 new nurses was (18.25±2.64) . The results of single factor analysis showed that there were significant differences in the scores of turnover intention of new nurses in different departments (P<0.05) ; The correlation analysis showed that social culture and development aspect, physical aspect were positively related to the turnover intention of new nurses (r=0.870, 0.812; P<0.001) . Human and material resources were negatively related to the turnover intention of new nurses in the perception of nursing work environment (P<0.001) . Multivariate Logistic regression analysis showed that in the transformation impact of new nurses, human and material resources in social culture and development, physical and working environment were the main factors of turnover intention of new nurses. Conclusions The turnover intention of new nurses is relatively high. Nursing managers can reduce the turnover rate of new nurses by improving the new nurses' transition shock and improving their work environment intervention, so as to reduce the job stress of new nurses. Key words: Nurses; Transition shock; Work environment; Turnover intention

Forms of participation: The development and application of a conceptual model of participation in work environment interventions

In the realm of work environment improvements, the Nordic countries have led the way in demonstrating that employee participation is a key requisite for achieving improvements. Despite this, there is a lack of precision as to what ‘participatory’ in a participatory work environment intervention means. In this study, the authors present a conceptual model for participation in work environment interventions and apply it to protocols and manuals from eight participatory interventions to determine the form of participation used in each intervention. The authors suggest that the conceptual model can be applied in the design and assessment of participatory work environment interventions.

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.

Darbuotojo gerovė ir pozityvi darbo aplinka : integruotas teorinis modelis

Business sector in developed countries faces financial losses related to health problems of their employees. These expenses are related to economic as well as to human losses. Therefore it is important to enhance employee well-being in order to prevent these problems. Traditional understanding of health mostly stresses the problem solving strategy, thus neglecting the search of factors, strengthening both the individual and the organization well-being. Compared to other EU countries, a subjective happiness level in Lithuania is rather low, therefore, a thorough study of positive psychological and social factors, encouraging personality development applicable to an organizational setting, creates a new impulse for the search of a harmonious combination of the person and the organization. Having this in mind the project aiming at developing a comprehensive model of the employee and the workplace well-being, based on biopsychosocial understanding of health and promoting positive healthrelated factors in an organization, was initiated. The object of the study is positive psychosocial factors affecting the employee and the workplace well-being. The present article presents a generalised view on the benefits of the employee and his workplace well-being interventions based on a thorough analysis of research literature of foreign and Lithuanian scientists. The authors introduce an Integrated Theoretical Model of Employee Well-being and Positive Work Environment. The model was formed based on the literature analysis. Publications for the analysis were collected from databases using keywords such as ‘organization’, ‘well-being’, ‘wellness’. The model is based on the biopsychosocial understanding of health including the interplay of healthrelated biological, social and psychological factors, as well as emphasizing promotion of the health-affecting positive psychosocial factors. The methods of the study were analysis of scientific literature, expert survey, comparison and generalisation. Effectiveness of employee health, well-being and positive work environment interventions . Most research findings on the benefits of health and wellbeing programmes in organizations confirm positive impact of the programmes upon the employee health and wellbeing: employees become more healthy, health costs are reduced, employee morale increased, productivity enhanced, decreased turnover, sick-leaves, increased employee endurance, self-esteem, sharpness of mind, new social bonds are created (Ginn, Henri, 2003). Therefore attention should be drawn on promotion not only of biological, but also of psychological and social wellbeing which is beneficial not only for employees, but for organizations as well. Separation of positive psychosocial factors affecting employee and workplace well-being. The literature analysis was performed in two phases: a) well-being models were analysed, b) analysis was focused on expanding the existing models by separate health and well-being related factors. Such an organization of the systematic literature analysis allowed to make a thorough list of well-being-related factors. These factors were grouped into several groups: a) individual characteristics of an employee determining employee well-being in general (sense of coherence, purpose and meaning in life, orientation towards personality growth, positive attitude towards life, positive affectivity, emotional intellect, playfulness, spirituality and values, general health and wilful personal responsibility for it; b) specific psychological personality characteristics related to a specific job (subjective satisfaction with one’s job and career, finding meaning in one’s job, job involvement, organizational commitment, psychological empowerment); c) interaction between the employee and the organization (a balance between professional and personal life having leisure time); d) organizational factors having impact on the employee well-being (sense of control and job demands, work conditions, work schedule, safety, organizational resources); e) quality of social relationships in the organization (positive organizational climate, organizational culture and healthpromoting organizational values, social support, characteristics of the leader); f) context of personality life (political and social formation, quality of personal relationships, positive interpersonal relationships, social network). Elaboration of the Integrated Theoretical Employee Well-being and Positive Workplace Model. The above-mentioned factors were combined into a model consisting of three basic groups of factors: individual psychological as well as organizational factors, mediated by home-work balance, within the context of broader social circumstances. The Integrated Theoretical Model of Employee Well-being and Positive Work Environment creates theoretical basis for practical intervention programmes in organizations. The Model needs to be empirically verified in order to assess the significance of its components on the employee well-being and positive work environment. This research was funded by a grant (No.MIP- 145/2010) from the Research Council of Lithuania.

Commentary

Mika Kivimaki initiated the Individual Participant Data (IPD) Meta-Analysis Consortium, which currently has 50 members. The Consortium recently published several research reports on the relationship between job strain (high psychological demands and low decision latitude at work), on the one hand, and cardiovascular disease and its risk factors, on the other hand. Since IPD repre- sents a novel way to conduct epidemiological research collaboration and as some of the findings from the IPD Consortium have been criticized, this commentary aims to address the rationales behind the approach and discuss some of the main criticisms of the Consortium.Researchers must tackle many problems when inter- preting associations between a psychosocial work envi- ronment factor and a health outcome. First of all, work environment factors belong to a "distal" rather than a "proximal" group. In other words, the closer one gets to a biological mechanism relevant for disease development, the more likely it is that a relevant association will be strong. For instance, small samples are needed to establish an individual "brain" factor associated with depression or emotional exhaustion - simply because the brain factor is more or less depression. Factors related to work orga- nization, on the other hand, are more "distal" since there are many factors that influence the relationship between the environment and the body's organs. Accordingly, it is sometimes difficult to obtain sufficient statistical power for the establishment of an undisputable association. For instance, the long "distance" between job strain and the outcome, myocardial infarction (MI), explains why we should expect a weaker association than in the study of "proximal" factors, for instance myocardial metabolism in relation to MI. Nevertheless, on a societal level, job strain is very important since it affects many working people, with a prevalence in the working population (in the IPD Consortium study's operational definition) of around 15%. Accordingly, if an unequivocal association is established, it is of major importance to those respon- sible for work organization and interventions designed to improve working conditions. However, large samples are needed to establish unequivocal proof.Since Karasek introduced his demand-control model (1), there have been many studies of the association between job strain and risk of MI. These studies have become increasingly sophisticated over the years. In addi- tion, there is accumulated indirect evidence from longitu- dinal studies of the relationship between job strain, on the one hand, and blood pressure variations and endocrine, metabolic, and immunological parameters, on the other hand. The results from these studies give us a plausible physiological explanation of the assumed relationship between job strain and MI risk.A reason why this research field has attracted strong attention is that MI is an undisputable illness outcome. The study of MI risk, therefore, serves as a good scientific model for studying the relationship between job strain and adverse health outcomes in general.Establishment of and rationale behind the IPD ConsortiumThere have been divided opinions about the relationship between job strain and risk of MI. The main reason for the controversy has been that, despite the relatively large size of several of the published cohort studies with number of observation years often in the range of 50 000, the statistical power has been too small for an unequivocal establishment of an association. As a result, Mika Kivimaki invited a number researchers, who had included psychosocial job factors in their study protocols and had or had not published results on the relationship between job strain and MI risk, to establish the IPD Consortium. Including unpublished cohorts was important as this provided a possibility to address the problem of publication bias - the tendency of research- ers and journals to publish only positive findings that can lead to inflated associations. …

Understanding significant processes during work environment interventions to alleviate time pressure and associated sick leave of home care workers--a case study.

BackgroundErgonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention.MethodsThe study, using a historic prospective mixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses.ResultsThe work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers.ConclusionsEstablishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures.