Reliability of an extended version of the 3m™ Eargage tool to assess earcanal size and assist earplug selection.

OBJECTIVE: Evaluate the ability of an extended version of the 3 MTM Eargage to estimate the earcanal size and assess the likelihood that a particular earplug can fit an individual's earcanal, ultimately serving as a tool for selecting earplugs in the field. DESIGN: Earcanal morphology, assessed through earcanal earmolds scans, is compared to earcanal size assessed with the extended eargage (EE) via box plots and Pearson linear correlations coefficients. Relations between attenuation measured on participants (for 6 different earplugs) and their earcanal size assessed with the EE are established via comparison tests. STUDY SAMPLE: 121 participants exposed to occupational noise (103 men, 18 women, mean age 47 years). RESULTS: The earcanal size assessed with the EE allows for estimating the area of the earcanal's first bend cross-section (correlation coefficient  r = 0.533, p < 0.001). Extremely large earcanals (12.7% of earcanals in our sample) lead to significantly lower earplug attenuation (potentially inadequate) than smaller earcanals. CONCLUSIONS: The EE is a simple and inexpensive tool easily deployable in the field to assist earplugs selection. When extended with sizes larger than the maximum size of the commercial tool, it allows for detecting individuals with extremely large earcanals who are most likely to be under-protected.

Validation of the Return-to-Work Obstacles and Self-Efficacy Scale for Women on Sick Leave Due to Breast Cancer (ROSES-BC).

PURPOSE: Breast cancer (BC) is the most frequently diagnosed cancer among women. Approximately 40% of BC survivors are diagnosed during the peak years of their professional career. Women face numerous obstacles when returning to work (RTW) after BC. Their decision-making process and self-efficacy to overcome these barriers may undergo alterations. The objective of this study was to validate the Return-to-work Obstacles and Self-Efficacy Scale (ROSES) for BC survivors, with a focus on three psychometric properties: construct validity, test-retest reliability, and predictive validity. METHODS: This prospective study consists of three phases: Phase 1 (baseline, during sick leave) was conducted to evaluate construct validity, Phase 2 (2 weeks later) assessed test-retest reliability, and Phase 3 (6-month follow-up, RTW or not) aimed to evaluate predictive validity. A total of 153 BC survivors participated in Phase 1 of the study, where they completed the 10 dimensions of the ROSES (e.g., fear of relapse, cognitive difficulties). Confirmatory factor analyses (CFA), Pearson correlations, and Cox regressions were performed, with respect to each phase. RESULTS: The mean duration for RTW with the same employer was 62.7 weeks. CFAs confirmed the ROSES structure, which had previously been established for other health conditions, showing satisfactory coefficients. Significant Pearson correlation coefficients were observed between the ROSES dimensions from Phase 1 to Phase 2, ranging from 0.66 to 0.88. When considering various confounding variables, chemotherapy treatment and cognitive difficulties (ROSES dimension) emerged as the only significant predictors of RTW. CONCLUSION: These findings support the utilization of the ROSES in clinical and research settings for BC survivors to improve their successful RTW. After an initial screening using the ROSES, occupational health professionals can further conduct a focused and thorough evaluation of specific dimensions, such as cognitive difficulties. Additional research and information are required to assist BC survivors in dealing with cognitive impairments induced by chemotherapy when they return to work.

A Systematic Search and Review of Questionnaires Measuring Individual psychosocial Factors Predicting Return to Work After Musculoskeletal and Common Mental Disorders.

Purpose Individual psychosocial factors are crucial in the return to work (RTW) process of workers with musculoskeletal disorders (MSDs) and common mental disorders (CMDs). However, the quality and validity of the questionnaires used to measure these factors have rarely been investigated. The present systematic search and literature review aims at identifying, categorizing, and evaluating the questionnaires (measurement tools) used to measure individual psychosocial factors related to the perception of the personal condition and motivation to RTW that are predictive of successful RTW among workers with MSDs or CMDs. Methods Through a systematic search on PubMed, Web of Science, and PsycINFO library databases and grey literature, we identified the individual psychosocial factors predictive of successful RTW among these workers. Then, we retrieved the questionnaires used to measure these factors. Finally, we searched for articles validating these questionnaires to describe them exhaustively from a psychometric and practical point of view. Results: The review included 76 studies from an initial pool of 2263 articles. Three common significant predictors of RTW after MSDs and CMDs emerged (i.e., RTW expectations, RTW self-efficacy, and work ability), two significant predictors of RTW after MSDs only (i.e., work involvement and the self-perceived connection between health and job), and two significant predictors of RTW after CMDs only (i.e., optimism and pessimism). We analyzed 30 questionnaires, including eight multiple-item scales and 22 single-item measures. Based on their psychometric and practical properties, we evaluated one of the eight multiple-item scales as questionable and five as excellent. Conclusions: With some exceptions (i.e., self-efficacy), the tools used to measure individual psychosocial factors show moderate to considerable room for improvement.

Tools Appraisal of Organizational Factors Associated with Return-to-Work in Workers on Sick Leave Due to Musculoskeletal and Common Mental Disorders: A Systematic Search and Review.

Purpose The objective of this study was to identify organizational factors that are predictive of return-to-work (RTW) among workers with musculoskeletal (MSD) and common mental disorders (CMD), and to subsequently catalogue and characterize the questionnaires (tools) used to measure them. Methods A systematic search on PubMed, Web of Science and PsycINFO library databases and grey literature was conducted. First, a list of organizational factors predictive of RTW for the two populations considered was built. Second, the questionnaires used to measure these factors were retrieved. Third, we looked in the scientific literature for studies on the psychometric properties and practical relevance of these questionnaires. Results Among the factors retained, perceived social support from supervisor and co-workers, work accommodations, and job strain were identified as common RTW factors. Other risk/protective factors, and associated tools, specifically targeting either people with MSD or CMD were also analysed. Conclusions Researchers and practitioners are often uncertain of which tools to use to measure organizational factors which can facilitate or hinder RTW. This study provides an evaluation of the tools measuring predictive organizational RTW factors in people with MSD and CMD. The identified tools can be used in everyday practice and/or research.

Assessing the comfort of earplugs: development and validation of the French version of the COPROD questionnaire.

Earplugs are a common form of protection for workers exposed to hazardous noise levels. Their comfort directly impacts the effective protection by influencing their consistent and correct use. Nevertheless, comfort definition may vary according to the studies. Thus, a previous review of the literature has shown that to improve our understanding of perceived comfort and to reduce measurement variability, it is advisable to consider comfort through a multidimensional construct (physical, acoustical, functional and psychological). On this basis, the COPROD (COnfort des PROtections auDitives/COmfort of hearing PROtection Devices) questionnaire was developed. It is intended for people working in noisy environments. Nine earplug models were evaluated by 118 participants over a six-week period. This paper presents the successive analyses that were used to validate the structure of the questionnaire and confirm the relevance of the proposed dimensions and of the addressed items. First results suggest a preference for custom moulded earplugs. Practitioner Summary: Earplugs comfort conditions the hearing protection of the users. As the definition of comfort can vary between studies, the COPROD questionnaire was developed to jointly evaluate all its dimensions. Nine earplugs models were evaluated by 118 participants during six weeks. This paper presents the validation process of the questionnaire. Abbreviations: COPROD: COnfort des PROtections auDitives/COmfort of hearing PROtection Devices; HPD: hearing protection devices; SEM: structural equation modeling; CFA: confirmatory factor analysis; GOF: goodness of fit; RMSEA: root mean square error of approximation; CFI: comparison fit index; SRMR: standardised root mean square residual.

A critical review of the literature on comfort of hearing protection devices: definition of comfort and identification of its main attributes for earplug types.

Objective: This article presents a comprehensive literature review of past works addressing Hearing Protection Devices (HPD) comfort and to put them into perspective regarding a proposed holistic multidimensional construct of HPD comfort.Design: Literature review.Study samples: Documents were hand searched and Internet searched using "PubMed", "Web of Science", "Google Scholar", "ProQuest Dissertations and Theses Professional", "Scopus" or "Google" search engines. While comfort constructs and measurement methods are reviewed for both earplugs and earmuff types, results and analyses are provided for the earplug type only.Results: This article proposed a multidimensional construct of HPD comfort based on four dimensions: physical, functional, acoustical and psychological. Seen through the prism of the proposed holistic construct of HPD comfort, the main comfort attributes of earplugs have been identified for each comfort dimension.Conclusions: The observed lack of consensus on the definition of HPD comfort in the scientific community makes it difficult to prioritise the importance of comfort attributes yet necessary for future design of comfortable earplugs.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach.

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression?

Background In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that "the supervisors' intention to take measures to facilitate their employees' RTW" was the only significant predictor of the RTW at the time of the interview. The Kaplan-Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.

Development of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES) and Validation with Workers Suffering from a Common Mental Disorder or Musculoskeletal Disorder.

Introduction Common mental disorders (CMDs) and musculoskeletal disorders (MSDs) lead the list of causes for work absence in several countries. Current research is starting to look at workers on sick leave as a single population, regardless of the nature of the disease or accident. The purpose of this study is to report the validation of the Return to Work Obstacles and Self-Efficacy Scale (ROSES) for people with MSDs and CMDs, based on the disability paradigm. Methods From a prospective design, the ROSES' reliability and validity were investigated in a Canadian sample of workers on sick leave due to MSDs (n = 206) and CMDs (n = 157). Results Exploratory and confirmatory factor analyses revealed that 46 items spread out on 10 conceptual dimensions (e.g., Fears of a relapse, Job demands, Difficult relation with the immediate supervisor), with satisfactory alpha coefficients and test-retest reliability for all subscales. Finally, several dimensions of ROSES also predict the participant's RTW within 6 months for MSDs (e.g., job demands), and CMDs (e.g., difficult relation with the immediate supervisor), even when adjusted by several variables (e.g., age, severity of symptoms). Apart from the job demands dimension, when the ROSES dimension is more external to the individual, only the perception of obstacles remains significant to predict RTW whereas it is the opposite result when the dimension is more internal (e.g., fears of a relapse). Conclusion The ROSES demonstrated satisfactory results regarding its validity and reliability with people having MSDs or CMDs, at the time of the return-to-work process.

[Return to Work Strategies of Employees who Experienced Depression: Employers and HR's Perspectives]. / Stratégies de retour au travail d'employés ayant fait l'expérience d'une dépression : perspectives des employeurs et des cadres des ressources humaines.

Major depression is one of the leading causes of work disability across the world. In Canada, the lifetime prevalence of depression varies from 10 to 12%. Depression impacts not only the employee who is often stigmatized and can lose his professional identity, but also has consequences on colleagues and supervisors in organizations. In the literature, four models are described from which employers and managers use in their organizations to make decisions regarding the work disability of employees on sick leave: biomedical, financial management, personnel management, and organizational development. These models can also be supported by economic, legal and ethical interests. Even though these models are essential to better understand the decision of employers and HR regarding work disability, information remains scarce regarding the concrete strategies used by these stakeholders to facilitate the return to work for employees on sick leave due to depression.Objectives the aim of this paper is to document, considering employers' and human resources' perspectives, the best strategies to put in place to facilitate the return to work of employees on sick leave due to depression.Method This study was part of a larger study carried out in Canada to assess factors influencing the return to work after a depression-related sick leave, taking into account the viewpoint of four types of stakeholders: employers/human resources, supervisors, unions and people diagnosed with depression. 219 employers (68.5%) and human resources directors (31.5%) from 82.6% organizations having more than 100 employees accepted to answer a telephone semi-structured interview. The question of interest in this study is: In your opinion, what are the best strategies to help an employee who has had a depression to return to work? Coding was influenced by empirical findings and theories related to psychosocial risk factors that the authors use in their respective disciplines as well as return to work principles/steps mentioned in the literature. The main objective was to keep all the strategies mentioned by participants, and analyzing them with major principles of return to work.Results 24 return to work strategies spread on six principles emerged: 1) Contact with the employee during his sick leave (10 strategies); 2) Evaluate and plan the return to work without precipitating it (6); 3) Training for managers and colleagues regarding mental health in the workplace (4); 4) Concertation between key return to work stakeholders (4); 5) Progressive return to work with work accommodations (4); 6) Health and work follow-up regarding the employee (6).Conclusion These six principles including 34 strategies are usually related to the timeframe process of the return to work, though they can be implemented sometimes in parallel. This possible overlap reinforces the idea to consider the return to work as sustainable in order to prevent potential relapses and improve the performance at work. Next steps will be to systematically implement these principles and strategies in organizations in order to evaluate their impact on return to work of employees on sick leave due to depression.

Union perceptions of factors related to the return to work of employees with depression.

PURPOSE: Between 30 and 60% of the societal cost of depression is due to losses related to decreased work productivity. To date, only a few studies have focused on union perspectives related to factors influencing the return-to-work of employees absent due to depression, despite evidence of the importance of these perspectives. The purpose of this study is to develop a better understanding of union perspectives on the factors surrounding the return-to-work of employees who were absent from work due to depression. METHODS: In this qualitative study, conducted in Canada (Québec), 23 individuals (union representatives and peer workers) from the three largest unions (mixed industries) in Quebec took part in one of three focus groups. RESULTS: Fourteen emerging themes (e.g., work environment, attitudes toward depression) were distributed over five categories of stakeholders involved in the return-to-work of employees on sick leave (i.e., employers and immediate supervisors, co-workers, employees on sick leave due to depression, general physicians, and unions). We observed four major cross-cutting themes that arose beyond these five categories: (1) organizational culture in which mental health issues and human aspects of work are central, (2) support and follow-up during the work absence and the return-to-work, (3) lack of resources to assist the employee in the return-to-work, and (4) stakeholders' prejudices and discomfort regarding depression. CONCLUSIONS: Our results clarify the factors, from a union perspective, that may facilitate or hinder the return-to-work of employees absent from work due to depression.

Psychosocial well-being construct in people with severe mental disorders enrolled in supported employment programs.

The main purpose of this prospective study is to validate the construct of psychosocial well-being (PSWB) for people with severe mental disorders enrolled in Supported Employment (SE) programs. This paper also aims to assess the impact of job acquisition on PSWB after obtaining competitive employment. A two-phase study approach was used and 231 individuals with severe mental disorders enrolled in SE programs who took part in both phases. The shortened versions of the Psychological Well-Being Scale (Keyes et al. in J Personal Soc Psychol, 82(6):1007-1022, 2002; Ryff and Keyes in J Personal Soc Psychol 69(4):719-727, 1995) and the Social Well-Being Scale (Keyes in Soc Psychol Q 61(2):121-140, 1998) were used. The PSWB's multidimensionality construct was confirmed. The results of repeated measure ANOVA analyses revealed that job acquisition, as well as, being involved in a work-seeking process increase the PSWB of people with severe mental disorders. Employment specialists might find clinical utility in using this validated tool for assessing PSWB in their clients with severe mental disorders. In a recovery oriented approach to psychiatric services and SE programs, clinicians and employment specialists should continue to encourage their clients in their work integration process even though they may not all obtain competitive employment quickly.

Systematic review and tools appraisal of prognostic factors of return to work in workers on sick leave due to musculoskeletal and common mental disorders.

With the overall objective of providing implication for clinical and research practices regarding the identification and measurement of modifiable predicting factors for return to work (RTW) in people with musculoskeletal disorders (MSDs) and common mental disorders (CMDs), this study 1) systematically examined and synthetized the research evidence available in the literature on the topic, and 2) critically evaluated the tools used to measure each identified factor. A systematic search of prognostic studies was conducted, considering four groups of keywords: 1) population (i.e., MSDs or CMDs), 2) study design (prospective), 3) modifiable factors, 4) outcomes of interest (i.e., RTW). Studies showing high risk of bias were eliminated. Tools used to measure prognostic factors were assessed using psychometric and usability criteria. From the 78 studies that met inclusion criteria, 19 (for MSDs) and 5 (for CMDs) factors reaching moderate or strong evidence were extracted. These factors included work accommodations, RTW expectations, job demands (physical), job demands (psychological), job strain, work ability, RTW self-efficacy, expectations of recovery, locus of control, referred pain (back pain), activities as assessed with disability questionnaires, pain catastrophizing, coping strategies, fears, illness behaviours, mental vitality, a positive health change, sleep quality, and participation. Measurement tools ranged from single-item tools to multi-item standardized questionnaires or subscales. The former generally showed low psychometric properties but excellent usability, whereas the later showed good to excellent psychometric properties and variable usability. The rigorous approach to the selection of eligible studies allowed the identification of a relatively small set of prognostic factors, but with a higher level of certainty. For each factor, the present tool assessment allows an informed choice to balance psychometric and usability criteria.

Assessing the multidimensional comfort of earplugs in virtual industrial noise environments.

Earplugs' comfort is primarily evaluated through cost-effective laboratory evaluations, yet these evaluations often inadequately capture the multidimensional comfort aspects due to design limitations that do not replicate real-world conditions. This paper introduces a novel laboratory method for comprehensive assessment of the multidimensional comfort aspects of earplugs, combining questionnaire-based evaluations and objective perceptual tests within virtual industrial sound environments replicating in-situ noise exposure. Objective perceptual results confirm that the sound environment affect participants' ability to detect alarms in a noisy environment and comprehend speech-in-noise while wearing earplugs. Subjective questionnaire results reveal that the earplugs family has an effect on the primary attributes of the acoustical, physical and functional comfort's dimension. Participants reported the physical dimension as the most important factor they take into account when evaluating earplugs' comfort. The functional dimension was considered the second most important factor by the participants, followed by the psychological dimension, and the acoustical dimension.

Validation of the Karasek-Job Content Questionnaire to measure job strain in Vietnam.

The objective of this study was to validate the Karasek-Job Content Questionnaire in Vietnamese. A translation/back-translation of the questionnaire was performed prior to its administration to 344 health personnel in Vietnam. Several psychometric properties of the Vietnamese version of the Karasek-Job Content Questionnaire were assessed. A valid Vietnamese version of the Karasek-Job Content Questionnaire was produced, composed of five subscales based on the original theoretical model: Psychological demands, Social support at work, Decision latitude-Autonomy, Decision latitude-Authority, and Skill discretion. Internal consistency and reliability coefficients for each subscale of the questionnaire were satisfactory. The correlations with depression and work absence indicators were weak but statistically significant, as expected. The Vietnamese version of the Karasek-Job Content Questionnaire will help Vietnamese researchers and clinicians appropriately evaluate and document the job strain of workers in Vietnamese workplaces.

Can psychological capital promote safety behaviours? A systematic review.

Objectives.Occupational health and safety (OHS) is a relevant issue for many systems and stakeholders. This systematic literature review aims to expand knowledge on this topic starting from the integrated safety model (ISM) and to evaluate the role of psychological capital (PsyCap) on safety behaviours (SBs) (i.e., safety performance and prevention of occupational accidents and injuries). Methods. A total of 2704 studies was initially identified in the Scopus, PsycINFO and Web of Science databases. After rigorous screening, 20 empirical studies were included. Results. The results showed the relevant contribution of PsyCap in promoting SBs as a direct antecedent, a mediator between organizational factors and SBs or a moderator between job demands and SBs. Conclusion. Findings indicate that when workers feel resourceful, they feel also more confident and engaged, and, in turn, more focused on safety issues. Moreover, the results sometimes turn out to be contradictory, showing the dark side of personal resources. Considering these results, a plan to monitor and develop PsyCap could be implemented to promote SBs and safety environment. Indeed, PsyCap can be an essential individual resource for behaving safely also by reducing job demands' perceptions and improving safety leadership.

Adaptation and validation of the cardiovascular version of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES-CVD) to the Italian context.

PURPOSE: Effective cardiac rehabilitation interventions must provide adequate support to overcome psychosocial return-to-work (RTW) barriers. No validated instrument is available for this aim for cardiovascular patients. The Return-to-work Obstacles and Self-Efficacy Scale (ROSES) measures RTW obstacles workers perceive and the self-efficacy for overcoming them through 46 items and ten dimensions. This study aimed to adapt and validate ROSES for cardiovascular disease (CVD) in the Italian context. METHODS: This prospective study involved 183 CVD working patients at baseline and 121 six months later. ROSES-CVD internal consistency, construct, and predictive validity was evaluated with Cronbach's α, Confirmatory factor analyses (CFA), and ANCOVAs. RESULTS: CFAs adequately replicated the original ROSES model (CFI = .92-.96; TLI = .91-.94; RMSEA = .042-.057; SRMR = .046-.071) with α close or higher than .70 for all dimensions. Four ROSES-CVD dimensions significantly predicted the number of days to RTW controlling for age, gender, educational level, and surgery type. Workers who perceived salient RTW obstacles and low self-efficacy in any of these dimensions in mean returned to work from 38 to 53 days later. CONCLUSIONS: The study supported the validity and reliability of ROSES-CVD. This tool can be used in rehabilitation to detect CVD patients at risk of a longer RTW process and define appropriate cardiac rehabilitation intervention.IMPLICATIONS FOR REHABILITATIONVocational rehabilitation interventions should provide tailor-made support to overcome RTW barriers based on individual risk assessmentThe Italian translation of ROSES-CVD is a valid and reliable tool to measure psychosocial barriers to RTW among CVD working patientsThe use of ROSES-CVD would allow detection of CVD patients at risk of longer RTW processAdministering ROSES-CVD can help focus traditional vocational intervention on individually relevant obstacles to RTW.

Towards a Holistic Model Explaining Hearing Protection Device Use among Workers.

Offering hearing protection devices (HPDs) to workers exposed to hazardous noise is a noise control strategy often used to prevent noise-induced hearing loss (NIHL). However, HPDs are used incorrectly and inconsistently, which explains their limited efficiency. Numerous models based on social cognition theories identify the significant factors associated with inconsistent HPD use and aim to improve HPD training programs and to increase HPD use. However, these models do not detail (dis)comfort aspects originating from complex interactions between characteristics of the triad "environment/person/HPD" while these aspects are known to largely influence HPD (mis)use. This paper proposes a holistic model explaining HPD (mis)use, based on the integration of a comfort model adapted to HPDs into an existing behavioral model already developed for HPDs. The model also takes into account the temporal dimension, which makes it possible to capture the scope of change in HPD-related health behaviors. This holistic description of HPD use could be used as a tool for stakeholders involved in HPD use to effectively prevent NIHL among workers.

A critical review of the literature on comfort of hearing protection devices: analysis of the comfort measurement variability.

Objective. This article proposes a comprehensive literature review of past works addressing hearing protection device (HPD) comfort with the aim of identifying the main sources of variability in comfort evaluation. Methods. A literature review of study samples was performed: documents were hand searched and Internet searched using PubMed, Web of Science, Google Scholar, ProQuest Dissertations and Theses Professional, Scopus or Google search engines. While comfort constructs and measurement methods are reviewed for both earplugs and earmuff HPD types, results and analyses are provided for earplugs only. Results. The literature shows that the multiple sources of the perceived comfort measurement variability are related to the complexity of the concept of comfort and to the various physical and psychosocial characteristics of the triad 'environment/person/earplug', which differ from one study to the other. Conclusions. Considering the current state of knowledge and in order to decrease comfort measurements variability, it is advised to: (a) use a multidimensional construct of comfort and derive a comfort index for each comfort dimension;, (b) use exhaustive and valid questionnaires; (c) quantify as many triad characteristics as possible and use them as independent or control variables; (d) assess the quality of the earplug fitting and the attenuation efficiency.