How does informal employment affect health and health equity? Emerging gaps in research from a scoping review and modified e-Delphi survey.

INTRODUCTION: This article reports on the results from a scoping review and a modified e-Delphi survey with experts which aimed to synthesize existing knowledge and identify research gaps on the health and health equity implications of informal employment in both low- and middle-income countries (LMICs) and high-income countries (HICs). METHODS: The scoping review included peer-reviewed articles published online between January 2015 and December 2019 in English. Additionally, a modified e-Delphi survey with experts was conducted to validate our findings from the scoping review and receive feedback on additional research and policy gaps. We drew on micro- and macro-level frameworks on employment relations and health inequities developed by the Employment Conditions Knowledge Network to synthesize and analyze existing literature. RESULTS: A total of 540 articles were screened, and 57 met the eligibility criteria for this scoping review study, including 36 on micro-level research, 19 on macro-level research, and 13 on policy intervention research. Most of the included studies were conducted in LMICs while the research interest in informal work and health has increased globally. Findings from existing literature on the health and health equity implications of informal employment are mixed: informal employment does not necessarily lead to poorer health outcomes than formal employment. Although all informal workers share some fundamental vulnerabilities, including harmful working conditions and limited access to health and social protections, the related health implications vary according to the sub-groups of workers (e.g., gender) and the country context (e.g., types of welfare state or labour market). In the modified e-Delphi survey, participants showed a high level of agreement on a lack of consensus on the definition of informal employment, the usefulness of the concept of informal employment, the need for more comparative policy research, qualitative health research, and research on the intersection between gender and informal employment. CONCLUSIONS: Our results clearly identify the need for more research to further understand the various mechanisms through which informal employment affects health in different countries and for different groups of informal workers.

The Country That Never Retires: The Gendered Pathways to Retirement in South Korea.

OBJECTIVES: Among all Organization for Economic Cooperation and Development countries, South Korean older adults work until the latest age. We investigate the extent to which work experiences over the life course and family circumstances can be associated with older workers' incentives to remain in the labor force beyond the statutory pension age. We explore gender-specific patterns of labor force exit and labor force re-entry in later life. METHODS: Using panel data of South Korean older workers and retirees from 2006 to 2016, we estimate multilevel discrete-time models with random effects to predict their labor force transition process that unfolds over time. RESULTS: Results show that skilled manual workers are less likely to exit employment and more likely to re-enter the labor force. A longer history of self-employment is related to later retirement. The relationship between career characteristics and the risk of retirement is only significant for men. Late-aged employment transition among women appears to be more related to family conditions. Women who receive financial support from adult offspring are more likely to remain out of the labor force but this relationship is not pronounced among men. DISCUSSION: Policies aimed at extending working lives need to provide various types of social support to older job seekers, especially those who had low-class jobs and those without family networks.

The interprofessional Veterans Affairs Quality Scholars program pre- and postdoctoral nurse fellow outcomes.

BACKGROUND: The Department of Veterans Affairs (VA) Quality Scholars (VAQS) program, an interprofessional fellowship that includes pre- and postdoctoral nurses, aims to inspire practice change leaders. Fellows participate in a national curriculum, lead improvement/research teams, and establish professional development plans with expert mentor guidance. PURPOSE: To describe the distinctive elements of the VAQS program, nurse fellow outcomes, and accomplishments of nurse alumni as leaders, researchers, and educators. METHODS: Data were reviewed and aggregated from past and current fellow surveys. FINDINGS: Nurse fellows completed research and improvement projects that benefitted both the VA and the local health systems. Scholarly outcomes include publications, conference presentations, grant submissions, teaching/leading quality improvement, and research initiatives. Graduates transition to positions as nurse scientists, academic faculty, and operational leaders. DISCUSSION: Fellows contribute to the strategic priorities of local and national VA and external health care organizations providing a pipeline of health system expert leaders, educators, and researchers. CONCLUSION: Doctoral nursing fellowship experiences build human capital for enhancing the science of improvement and implementation, interprofessional collaboration, and leadership.

The effects of job characteristics, organizational justice and work engagement on nursing care quality in China: A mediated effects analysis.

AIM: To analyse the structural associations among job characteristics, organizational justice, work engagement and nursing care quality in Chinese nurses. BACKGROUND: Nursing care quality helps ensure patient safety, which are core concerns. The explicit relationships among the study's variables from a management perspective can help hospital managers to implement effective strategies to improve nursing care quality. METHODS: This cross-sectional study was conducted to investigate the relationships among the variables in 1,615 nurses in eight Chinese tertiary hospitals. Structural equation modelling was used to test a proposed model of these relationships. RESULTS: The scores of job characteristics, organizational justice, work engagement and nursing care quality were 3.55 ± 0.41, 3.84 ± 0.77, 4.67 ± 1.30 and 3.42 ± 0.70. Job characteristics and organizational justice had direct effects on nursing care quality. Work engagement mediated the relationship of nursing care quality with job characteristics and organizational justice. The final model explained 24% of nursing care quality. CONCLUSION: The results provide a better understanding of the associations between the study's variables. Perceived job characteristics and organizational justice can improve nursing care quality through work engagement. IMPLICATIONS FOR NURSING MANAGEMENT: Reconfiguring work design to strengthen nurses' positive perceptions of job characteristics and organizational justice can enhance nursing care quality.

Considerations in developing a specialized epilepsy employment program: A sponsor's playbook.

Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.

The Relationship of Caregiving to Work Conflict and Supervisor Disclosure With Emotional, Physical, and Financial Strain in Employed Family Caregivers.

Objective: To determine whether employed family caregiver reports of caregiving to work conflict (CWC) are associated with emotional, physical, and financial strain, and whether organizational factors, including supervisor disclosure and caregiver-friendly workplace policies, attenuate these effects. Method: We examined 369 full-time employed caregivers of adults aged 50 years and above from the 2015 AARP and National Alliance for Caregiving population-based study, Caregiving in the United States, using ordinary least squares hierarchical regression and moderation analyses. Results: Regression analyses showed that caregiver reports of more CWC, in addition to disclosure of caregiving, were associated with greater emotional, physical, and financial strain after controlling for demographics and caregiving stressors, and workplace policies did not attenuate strain. Neither disclosure nor policies moderated the impact of CWC on caregiver strain. Discussion: Results suggest the importance of workplace strain in the caregiving stress process and suggest that disclosing caregiving responsibilities to supervisors should be closely examined.

Support for Breastfeeding Employees: Assessing Statewide Worksite Lactation Support Recognition Initiatives in the United States.

BACKGROUND: Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites' efforts. RESEARCH AIM: To identify and describe statewide worksite lactation support recognition initiatives in the United States. METHODS: Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state (N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative. RESULTS: Twenty-six states had a current initiative, and some had requirements for providing a private space (n = 19; 73%) and time (n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy (n = 10; 38%). CONCLUSIONS: This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.

Measuring precarious employment in Sweden: translation, adaptation and psychometric properties of the Employment Precariousness Scale (EPRES).

OBJECTIVES: Precarious employment (PE) is a determinant of poor health and health inequality. However, the evidence of health consequences and mechanisms underlying the associations, are still limited due to a lack of a comprehensive multidimensional definition and measurement instrument. The Employment Precariousness Scale (EPRES) is a Spanish, multidimensional scale, developed to measure degree of PE. The aim of this study was to translate the EPRES-2010 into Swedish, adapt it to the Swedish context and to assess the psychometric properties of the Swedish EPRES. METHOD: EPRES was translated, adapted and implemented for data collection within the research project PRecarious EMployment in Stockholm (PREMIS). During 2016-2017, questionnaire data were collected from 483 non-standard employees in Stockholm, Sweden, sampled with web-based respondent-driven sampling. Analyses included item descriptive statistics, scale descriptive statistics and exploratory factor analysis. RESULTS: The final EPRES-Se (Swedish version of the EPRES),consisted of six dimensions and 23 items. There was a high response rate to all items and response options. Global Cronbach's alpha was 0.83. Subscales 'vulnerability', 'rights' and 'exercise rights' had reliability coefficients between α=0.78-0.89 and item-subscale correlations between r=0.48-0.78. 'Temporariness' had poor reliability (α=-0.08) and inter-item correlation (r=-0.04), while 'disempowerment' showed acceptable psychometric properties (α=0.5; r=0.34). Exploratory factor analysis confirmed the original EPRES factor structure. CONCLUSIONS: 'Vulnerability', 'wages', 'rights', 'exercise rights' and 'disempowerment' worked in the Swedish context; however, 'temporariness' would need revising before implementing the EPRES-Se in further research. Continued work and validation of EPRES-Se is encouraged. In order to enable international comparisons and multinational studies, similar studies in other European countries are also called for.

Center-based childcare expansion and grandparents' employment and well-being.

Grandparents, especially grandmothers, are highly involved in childcare globally. There is a rising interest in studying the relationship between providing care and grandmothers' economic well-being in social science and health literature. However, little is known about how grandmothers' behavior responds to a government's family policy. This paper examines the effects of a large government-led formal childcare expansion on the well-being of working-age grandparents living with their adult children in China. We exploit the variation in program intensity across provinces and years and find that a higher coverage rate of center-based childcare increases the employment of grandmothers. By contrast, grandfathers' employment is not responsive. Further investigation reveals that the effect is stronger among the women who were richer, more educated, lived in urban areas, and paternal grandmothers. We find that the childcare expansion decreases grandmothers' chance of having chronic disease and depression.

Disrupting Policy and Practice: Refugees Shaping the Future.

For decades, refugee policies on local, national, regional, and international levels have set the narrative surrounding refugees' identities and roles in society. Often, these policies negatively affect refugees and can hinder any effort for successful integration (ie, employment). The focus of this article is to identity how refugees, specifically refugee nurses, are reshaping standard policy practices when it comes to integration and inclusion, as well as economic and social well-being. With an estimated 68.5 million forcibly displaced persons worldwide (25.4 million of which are refugees), it is important to shed light on the importance of including their voices in the dialogue during all stages of the policy development process. They should be included in the dialogue, from agenda setting to evaluation, in order to challenge current beliefs and attitudes. It is critical for societies to recognize refugee nurses' professional qualifications, skills, and abilities in order to address the ongoing shortages of health professionals that many nations are facing today.

The nurse work environment in Spanish nurses following an economic recession: From 2009 to 2014.

AIM: To detect possible changes in perception of the nurse work environment, job satisfaction and burnout between the years 2009 and 2014 among nurses working in the Spanish National Health System. BACKGROUND: The global economic crisis has had a great impact on nurses in the Spanish National Health Service: tougher working conditions, lower pay and a reduction in social benefits. It is not known whether these changes affect the nurses' work environment, job satisfaction and burnout. METHOD: Comparative, cross-sectional study performed in seven hospitals in the Spanish National Health System between 2009 and 2014, through 1,454 surveys of nurses working in internal medicine, surgery and intensive care. RESULTS: Nurses participating in the second period (2012-2014) were more satisfied with their current job (p = 0.001), perceived their work environment to be more favourable (p < 0.001) and had lower levels of burnout (p < 0.01). Professional factors as 'autonomy at work,' 'opportunities for advancement,' 'professional status' and 'nursing foundations for quality care,' as well as 'collegial nurse-physician relations' and 'nurse participation in hospital affairs' were the most important variables associated with these topics. CONCLUSIONS: Professional factors may influence these changes more than labour conditions and remuneration aspects. IMPLICATIONS FOR NURSING MANAGEMENT: In times of economic recession, encouraging interpersonal relationships, autonomy and participation in decision-making may improve the work environment, satisfaction and burnout of nurses.

The relationship between employment and health and health care among working-age adults with and without disabilities in the United States.

Purpose: To better understand the relationship between employment and health and health care for people with disabilities in the United States (US). Methods: We pooled US Medical Expenditure Panel Survey (2004-2010) data to examine health status, and access to health care among working-age adults, comparing people with physical disabilities or multiple disabilities to people without disabilities, based on their employment status. Logistic regression and least squares regression were conducted, controlling for sociodemographics, health insurance (when not the outcome), multiple chronic conditions, and need for assistance. Results: Employment was inversely related to access to care, insurance, and obesity. Yet, people with disabilities employed in the past year reported better general and mental health than their peers with the same disabilities who were not employed. Those who were employed were more likely to have delayed/forgone necessary care, across disability groups. Part-time employment, especially for people with multiple limitations, was associated with better health and health care outcomes than full-time employment. Conclusion: Findings highlight the importance of addressing employment-related causes of delayed or foregone receipt of necessary care (e.g., flex-time for attending appointments) that exist for all workers, especially those with physical or multiple disabilities. Implications for rehabilitation These findings demonstrate that rehabilitation professionals who are seeking to support employment for persons with physical limitations need to ensure that overall health concerns are adequately addressed, both for those seeking employment and for those who are currently employed. Assisting clients in prioritizing health equally with employment can ensure that both areas receive sufficient attention. Engaging with employers to develop innovative practices to improve health, health behaviors and access to care for employees with disabilities can decrease turnover, increase productivity, and ensure longer job tenure.

Evaluation of a Placement Coaching Program for Recipients of Disability Insurance Benefits in Switzerland.

Purpose During 2009‒2013 a pilot project was carried out in Zurich which aimed to increase the income of disability insurance (DI) benefit recipients in order to reduce their entitlement to DI benefits. The project consisted of placement coaching carried out by a private company that specialized in this field. It was exceptional with respect to three aspects: firstly, it did not include any formal training and/or medical aid; secondly, the coaches did not have the possibility of providing additional financial incentives or sanctioning lack of effort; and thirdly due to performance bonuses, the company not only had incentives to bring the participants into (higher paid) work, but also to keep them there for 52 weeks. This paper estimates the medium-run effects of the pilot project and assesses the net benefit from the Swiss social security system. Methods Different propensity score matching estimators are applied to administrative longitudinal data in order to construct suitable control groups. Results The estimates indicate a reduction in DI benefits and an increase in income even in the medium-run. A simple cost-benefit analysis suggests that the pilot project was a profitable investment for the social security system. Conclusion Given a healthy labor market, it seems possible to enhance the employment prospects of disabled persons with a relatively inexpensive intervention, which does not include any explicit investments in human capital.

Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies.

Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.

An assessment of the relationship between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status.

INTRODUCTION: A study was conducted to assess if there is an association between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status. METHODS: A cross-sectional analysis was conducted using data from a student perception survey completed by third-year pharmacy students. The survey collected demographic information on age, gender, level of education, ethnicity, and pharmacy-related work experience. A series of Likert scale items were used to assess students' perceptions regarding their competency in specific skills areas essential for participation in emergency responses. An independent samples t-test was used to compare mean scores for Likert scale items between working and nonworking students. Multivariate linear regression models were developed to determine if work status was an independent predictor of students' self-reported competencies after adjusting for covariates. RESULTS: Sixty-six of 69 (95.7%) students completed the student perception survey. Students currently working in a pharmacy reported higher mean scores on several of the measured competencies. After covariates adjustment, current work status was associated with higher scores on self-reported competencies related to proficiency in evaluating information from patient assessment and collaborating with other individuals to develop processes related to the optimizing flow of care. CONCLUSIONS: These results suggest that students who are working tend to have more confidence in their ability to contribute to emergency responses as well as work better in a team setting. Incorporating cases related to emergency response readiness in pharmacy curriculum may be needed to enhance skills and confidence of non-working pharmacy students.

Association between health-related quality of life and work status in older Korean adults.

AIM: Employment status has consistently been associated with health-related quality of life. This study investigated the effect of age on the association between work status and health-related quality of life in Korean adults using a large, nationally representative sample. METHODS: We used data from the Korean Health Panel, and ran a series of random effects panel models to test the relationship between quality of life as measured by the EuroQol five-dimension questionnaire and work status. The moderation effect of age on the relationship between quality of life and work status was also tested in the same model. RESULTS: Overall, Korean adults who were employed reported a higher level of quality of life than those who were unemployed. Furthermore, the relationship between quality of life and work status was stronger for those who were aged ≥60 years compared with those who were not. CONCLUSIONS: Employment status among older people was found to have a greater association on quality of life than among younger people. Thus, it is necessary to carry out further research for employment status of older people about the relationship with quality of life. Geriatr Gerontol Int 2018; 18: 1629-1633.

Employment Interventions in Health Settings: A Systematic Review and Synthesis.

PURPOSE: Employment is a key social determinant of health. People who are unemployed typically have worse health than those employed. Illness and disability can result in unemployment and be a barrier to regaining employment. We combined a systematic review and knowledge synthesis to identify both studies of employment interventions in health care settings and common characteristics of successful interventions. METHODS: We searched the peer-reviewed literature (1995-2017), and titles and abstracts were screened for inclusion and exclusion criteria by 2 independent reviewers. We extracted data on the study setting, participants, intervention, methods, and findings. We also conducted a narrative synthesis and iteratively developed a conceptual model to inform future primary care interventions. RESULTS: Of 6,729 unique citations, 88 articles met our criteria. Most articles (89%) focused on people with mental illness. The majority of articles (74%) tested interventions that succeeded in helping participants gain employment. We identified 5 key features of successful interventions: (1) a multidisciplinary team that communicates regularly and collaborates, (2) a comprehensive package of services, (3) one-on-one and tailored components, (4) a holistic view of health and social needs, and (5) prospective engagement with employers. CONCLUSIONS: Our findings can inform new interventions that focus on employment as a social determinant of health. Although hiring a dedicated employment specialist may not be feasible for most primary care organizations, pathways using existing resources with links to external agencies can be created. As precarious work becomes more common, helping patients engage in safe and productive employment could improve health, access to health care, and well-being.

Using an adapted Delphi process to develop a survey evaluating employability assessment in total and permanent disability insurance claims.

BACKGROUND: No research has been undertaken about employability assessment of total and permanent disability (TPD) insurance claims. Employability assessment provides vocational information to life insurers to help decide claims. To determine how helpful employability assessment is, a new measure was needed to survey insurers. OBJECTIVE: To generate survey items by harnessing the knowledge and agreement of rehabilitation advisors with expertise in employability assessment. METHODS: A panel of 10 (89% of eligible Australian rehabilitation advisors) participated in an adapted three-round Delphi process. Rounds 2 and 3 were incorporated into a novel real-time card sort format. RESULTS: From 94 potential items submitted for first round qualitative analysis, 36 items in four domains-quality, content, utility, and claims-were generated. Two quantitative ranking rounds in one face-to-face session produced a 21-item prototype. The final electronic survey instrument contained 11 sections seeking insurer demographics and feedback on: external providers; employability assessment concepts, components, quality, and usefulness; functional, occupational, labor market items; and finally, cost and type. Our Delphi process was anonymous, completed in four weeks with 100% response rate and 75% agreement. More time between Rounds 2 and 3 would enhance statistical analysis. CONCLUSIONS: Our adapted Delphi methodology for survey item generation is generalizable for any panel able to meet in person.

Retirement: A concept for nurses to consider.

PROBLEM: The large number of aging retirees is changing the landscape of US healthcare and economic systems. Many nurses will be among these retirees. While retirement has been studied in many fields, it has been explored considerably less in nursing science. Retirement as a concept is complex, not well-defined across disciplines, and the impact of this important transition on health and well-being is not well-understood. PURPOSE: The purpose of this article is to explore the concept of retirement as a transition that may be related to health and well-being in aging individuals. FINDINGS: Conceptual exploration supports that retirement is defined by two identified attributes: (a) It is a transitional period surrounding stopping or changing full or part-time, paid or unpaid employment status, and (b) it occurs at a time when a person self-identifies as being retired. Identified antecedents and consequences of retirement are closely related to health. CONCLUSION: Many life changes often occur during the transition of retirement. As a concept, retirement is linked to healthy, transitional aging. Nursing's holistic perspective of addressing client needs can be better understood when caring for individuals who have retired or are planning to retire.

What makes clinical labour different? The case of human guinea pigging.

Each year thousands of individuals enrol in clinical trials as healthy volunteers to earn money. Some of them pursue research participation as a full-time or at least a part-time job. They call themselves professional or semiprofessional guinea pigs. The practice of paying healthy volunteers raises numerous ethical concerns. Different payment models have been discussed in literature. Dickert and Grady argue for a wage-payment model. This model gives research subjects a standardised hourly wage, and it is based on an assumption that research participation is morally indistinguishable from other forms of unskilled labour. In this paper, I will challenge this assumption. I will argue that human guinea pigging has particular characteristics which taken together make it significantly different from other forms of labour. (1) Participation in research is skill-independent. Healthy volunteers are valuable not because they are skilful persons, but because they are human bodies. (2) The role of research volunteers is mainly passive. They are not asked to produce goods or deliver services. They are paid for enduring unpleasant, painful and risky interventions performed by investigators. (3) Research volunteering involves inherent risks and uncertainties, and subjects have little or no control over their minimisation and materialisation. I conclude that participation in clinical research is a specific kind of activity. It is more like renting out one's body to strangers, than working. Thus, research participation should not be treated on par with other forms of employment.