Risks, solutions and implementation of a participatory ergonomic intervention in 16 day nurseries: A process evaluation of the TOY wait-list cluster-randomized controlled trial.

More evidence-based initiatives to reduce physical work demands during childcare work to prevent ill health and promote the ability to care for the children among childcare workers are needed. In a process evaluation performed alongside a two-arm, cluster-randomized study with a waiting-list control among 16 day nurseries lasting 20-weeks that significantly reduced musculoskeletal pain-related sickness absence we investigated 1) risk factors and solutions perceived by the childcare workers, and 2) implementation of the intervention. Most of the perceived risk factors were categorized as physical (70 %) with most of the suggested solutions also being categorized as physical (61 %). The remaining risk factors were categorized as organizational risk factors (16 %) and psychosocial risk factors (13 %). The remaining solutions were distributed almost equally between the organizational (20 %) and psychosocial categories (19 %). About half (51 %) of the action plans showed high implementation success. Of 16 workshops, 100 % were delivered with a fidelity of 83 %. Average participation, exposure, responsiveness and implementation were 68 %, 56 %, 83 % and 47 %. The implementation score differed for timing of intervention but not for nursery characteristics. This study showed that complex and diverse participatory ergonomic interventions should focus on physical, organizational and psychosocial factors to have a positive effect.

Effects of a participatory organisational, core work task focused workplace intervention on employees' primary healthcare consultations: secondary analysis of a cluster RCT.

OBJECTIVES: We aimed to examine whether a participatory organisational workplace intervention focusing on core tasks at work resulted in lower primary healthcare utilisation of employees. METHODS: The cluster randomised controlled trial included 78 preschools, 44 allocated to the intervention group (1745 employees) and 34 allocated to the control group (1267 employees). The intervention aimed to involve employees in improving the psychosocial work environment while focusing on core tasks at work. Using Poisson regression, we tested the rate ratios (RRs) of consultations in the intervention compared with the control group in terms of all consultations in primary healthcare and general practitioner (GP) consultations, respectively, per person-year during 31 months of follow-up. The fully adjusted model included adjustment for sex, age, job group, workplace type and size, and previous primary healthcare utilisation. RESULTS: During the follow-up, intervention group employees had 11.0 consultations/person-year, while control group employees had 11.6 consultations/person-year (RR 0.97, 95% CI 0.92 to 1.01). Employees in the intervention group had 7.5 GP consultations/person-year, while control group employees had 8.2 GP consultations/person-year (RR 0.95, 95% CI 0.90 to 0.99). Post hoc analyses indicated that the effect of the intervention was particularly strong in employees in preschools with a moderate or high level of implementation. CONCLUSIONS: The participatory organisational workplace intervention focusing on core tasks at work among preschool employees had a small, statistically non-significant effect on overall primary healthcare utilisation and a small, statistically significant effect on GP consultations. These results suggest a beneficial effect of the participatory organisational intervention on employees' health. TRIAL REGISTRATION NUMBER: ISRCTN16271504.

The effect of training for a participatory ergonomic intervention on physical exertion and musculoskeletal pain among childcare workers (the TOY project) - a wait-list cluster-randomized controlled trial.

Objective Many employees have high physical exertion at work and suffer from musculoskeletal pain (MSP) leading to sickness absence with large costs. Participatory ergonomics is a potentially effective intervention for reducing physical exertion, MSP and sickness absence. The main aim of this study was to investigate the effectiveness of a 20-week workplace participatory ergonomic intervention among childcare workers on physical exertion and MSP. Methods In a two-arm cluster-randomized trial, 190 workers were recruited from 16 childcare institutions and randomly assigned to either a 20-week participatory ergonomics intervention consisting of three training workshops or a control group receiving usual care. Primary outcomes were physical exertion during work, maximal pain intensity, number of pain regions, and pain-related work interference. Secondary outcomes were MSP-related sickness absence, need for recovery (NFR), employee involvement, and self-efficacy. We followed the intention-to-treat principle and adhered to the registered study protocol (ISRCTN10928313). Results After 20 weeks, half the workers noticed some positive changes in their work. However, there were no statistically discernible effects in physical exertion, maximum pain intensity, pain-related work interference, or number of pain regions. We found a significant reduction of MSP-related sickness absence in the intervention compared to the control group [-0.48 days per month (95% confidence interval (CI), -0.8- -0.1]. We found no significant effects in NRF or involvement of employees, but self-efficacy was reduced in the intervention compared to the control group [-0.2 (95% CI, -0.3- -0.0)]. Conclusion This 20-week training for a participatory ergonomic intervention in childcare workers did not show effects on physical exertion and MSP, but was both feasible and effective in reducing MSP-related sickness absence.

Effect of a participatory organizational workplace intervention on workplace social capital: post-hoc results from a cluster randomized controlled trial.

BACKGROUND: A high level of workplace social capital (WSC) may contribute to the protection of employees' health. We hypothesized that a participatory workplace intervention would increase the level of WSC defined as vertical WSC (i.e. WSC linking together employees and their leaders) and horizontal WSC (i.e. WSC bonding employees together). METHODS: We conducted a secondary data analysis of a cluster randomized controlled trial that was implemented among all employees in 78 municipal Danish pre-schools (44 intervention and 34 control group schools). The study sample consisted of 606 employees, 386 in the intervention and 220 in the control group. The intervention aimed to improve the psychosocial working environment by using a participatory approach and focusing on core job tasks. Vertical and horizontal WSC was measured by five and four items, respectively, at baseline and at 24-months follow-up. We estimated intervention effect by calculating the interaction of change over time by group assignment (intervention versus control group) and included workplace identification number in a repeated statement to take into account that employees were nested within workplaces. We conducted post-hoc analyses to examine whether intervention effect differed by implementation degree. RESULTS: WSC decreased in both groups. In the main analyses, there was no statistically significant difference between intervention and control group, neither for vertical nor horizontal WSC. However, when we excluded intervention workplaces with a low degree of implementation, we found a statistically significant difference between the intervention and the control group (estimate: 0.25, 95% CI: 0.00 to 0.50, p = 0.049), indicating that vertical WSC decreased in the control group and remained stable in the intervention group. CONCLUSIONS: There was not a statistically significant difference between intervention and control group in the main analysis. Post-hoc analyses, however, suggest that the intervention may have prevented a decrease in vertical WSC among employees in workplaces with a high or a medium degree of implementation. A conference abstract with the key results of this study has been previously presented and published, European Journal of Public Health, Volume 28, Issue suppl_4, November 2018, cky260, https://academic.oup.com/eurpub/article/28/suppl_4/cky260/5187184 . TRIAL REGISTRATION: ISRCTN16271504 , retrospectively registered on November 15, 2016.

The association of vertical and horizontal workplace social capital with employees' job satisfaction, exhaustion and sleep disturbances: a prospective study.

PURPOSE: Workplace social capital (WSC) may be beneficial for employees' health and well-being; however, most studies have analyzed WSC on the individual and not the workplace level. We test whether higher compared to lower levels of vertical WSC (WSC between employees and superiors) and horizontal WSC (WSC between employees), measured at the workplace level, is prospectively associated with higher levels of employees' well-being. METHODS: Using data from an intervention study, we analyzed associations between workplace aggregated vertical and horizontal WSC at baseline with job satisfaction, exhaustion and sleep disturbances at 24-months follow-up. The sample included 606 municipal pre-school employees (71 workplaces). We adjusted for individual and workplace characteristics, baseline scores of outcomes, intervention status, and the interaction of exposure with intervention status. We used the Genmod procedure in SAS with a repeated statement to account for correlation of individuals within workplaces. We repeated analyses using individual-level WSC measurements. RESULTS: Higher levels of vertical and horizontal WSC at baseline predicted a higher level of job satisfaction (0.20, p = 0.01 and 0.24, p = 0.01, respectively) and a lower level of exhaustion (- 0.33, p = 0.04 and - 0.43, p = 0.04) at follow-up in the most adjusted model. Analyses with individual-level measures yielded similar results and further showed an association of a higher level of horizontal WSC with a lower level of sleep disturbances. CONCLUSIONS: Higher levels of vertical and horizontal WSC were prospectively associated with better well-being of employees in municipal pre-schools. Workplaces may thus consider focusing on improving WSC as a means for ensuring or improving employees' well-being.

Improving work for the body - a participatory ergonomic intervention aiming at reducing physical exertion and musculoskeletal pain among childcare workers (the TOY-project): study protocol for a wait-list cluster-randomized controlled trial.

BACKGROUND: The prevalence of musculoskeletal pain (MSP) is persistently high throughout the world. Work-related factors such as high physical workload (lifting, bending and twisting of the back) are considered to be among the main causes of MSP. Work in childcare includes the need to lift, carry, and support children in a range of activities, requiring several demanding postures and movements, such as bending forward and twisting of the back and sitting on the floor. Participatory ergonomics may represent a solution for decreasing the physical workload to reduce MSP. We present the protocol of a study aiming to evaluate the effect and process of a participatory ergonomics intervention designed to reduce physical exertion during work and MSP (including MSP interfering with work) among childcare workers. METHODS/DESIGN: This study will use a two-arm cluster-randomized design employing a wait-list control, with childcare institutions forming the clusters. Three workshops will be conducted during the 4-month intervention period. Participants will identify risk factors for strenuous work and MSP, develop solutions for reducing the identified risk factors, and implement them in their team. An ergonomic consultant will guide the process. The data collection will consist of questionnaires and objective measures of heart rate and physical activity, observations of physical workload, and information on sickness absence based on company records. Primary outcomes are physical exertion during work and MSP (including pain-related work interference) measured at 4 months. Secondary outcomes measured at 4 months are sickness absence due to MSP; objectively measured occupational physical activity and heart rate; and self-reported self-efficacy, employee involvement, and need for recovery. Alongside the trial, a process evaluation and an economic evaluation will be conducted. DISCUSSION: The study will evaluate the effect and process of a participatory ergonomics intervention to reduce physical exertion at work and MSP among childcare workers. By performing a cluster-randomized controlled trial with an effect evaluation based on both objective and self-reported measures with the addition of a process evaluation and economic evaluation, this study will contribute to the evidence for prevention of MSP among a less studied occupational group. Results are expected in 2018-2019. TRIAL REGISTRATION: ISRCTN, ISRCTN10928313 . Registered on 11 January 2017.

Can illegitimate job tasks be reduced by a participatory organizational-level workplace intervention? Results of a cluster randomized controlled trial in Danish pre-schools.

Objectives We examined whether a cluster randomized controlled participatory organizational-level workplace intervention affected the level of unnecessary, unreasonable, and illegitimate tasks. Methods A cluster randomized controlled trial was implemented in municipal pre-schools. The intervention used a participatory approach and aimed improving the psychosocial working environment by focusing on core tasks. The sample consisted of 41 pre-schools with 404 employees in the intervention group and 30 pre-schools with 230 employees in the control group. We measured unnecessary and unreasonable tasks at baseline and at two-year follow-up by one item on unnecessary and one item on unreasonable tasks, respectively, and combined both items into a measure of illegitimate tasks. We analyzed within- and between-groups changes in unnecessary and unreasonable tasks and in the combined measure of illegitimate tasks. Results The scores for unnecessary, unreasonable, and illegitimate tasks remained virtually unchanged in the intervention group and increased in the control group. The different development in the two groups was statistically significant for unreasonable tasks (+0.02 versus +0.13, P=0.04) and the combined measure of illegitimate tasks (+0.01 versus +0.11, P=0.04) but not for unnecessary tasks (+0.00 versus +0.08, P=0.16). Conclusion A comprehensive participatory organizational-level intervention with a focus on core job tasks may protect against an increase in illegitimate tasks in Danish pre-schools.

Effect of a participatory organizational-level occupational health intervention on job satisfaction, exhaustion and sleep disturbances: results of a cluster randomized controlled trial.

BACKGROUND: We examined whether the implementation of a participatory organizational-level intervention aiming to improve the working environment with a focus on the core task at work, increased job satisfaction and reduced exhaustion and sleep disturbances among pre-school employees. METHODS: The study sample consisted of 41 intervention group pre-schools with 423 employees and 30 control group pre-schools with 241 employees. The intervention lasted 25 months and consisted of seminars, workshops, and workplace specific intervention activities that were developed by focusing on the core task at work. We analyzed within-group changes in the three outcome variables from baseline to follow-up with t-tests for paired samples, separately for intervention and control group. Between-group differences in changes in the three outcome variables were analyzed using a mixed model with a repeated statement to account for the clustering effect of workplaces. RESULTS: Within-group analyses showed that exhaustion decreased statistically significantly in both the intervention and the control group. There were no statistically significantly changes in job satisfaction and sleep disturbances. Between-group analyses showed that there was no statistically significant difference between the two groups for changes in any of the outcome variables, neither in the unadjusted or in the adjusted analyses. CONCLUSIONS: We found no evidence that participating in an organizational-level occupational health intervention aiming to improve the working environment with a focus on the core task at work has an effect on pre-school employees' job satisfaction, exhaustion and sleep disturbances. TRIAL REGISTRATION: ISRCTN16271504 , November 15, 2016.

Effect of a participatory organizational-level occupational health intervention on short-term sickness absence: a cluster randomized controlled trial.

OBJECTIVES: The aim of this study was to examine whether employees in pre-schools that implemented a participatory organizational-level intervention focusing on the core task at work had a lower incidence of short-term sickness absence compared to employees in the control group. METHODS: The cluster randomized controlled trial (RCT) comprised 78 pre-schools that were allocated to the intervention (44 pre-schools with 1760 employees) or control (34 pre-schools with 1279 employees) group. The intervention lasted 25 months and followed a stepwise and structured approach, consisting of seminars, workshops, and workplace-directed intervention activities focusing on the core task at work. Using Poisson regression, we tested differences in incidence rates in short-term sickness absence between the intervention and control groups during a 29-months follow-up. RESULTS: Estimated short-term sickness absence days per person-year during follow-up were 8.68 and 9.17 in the intervention and control groups, respectively. The rate ratio (RR) for comparing incident sickness absence in the intervention to control groups during follow-up was 0.93 [95% confidence interval (95% CI) 0.86-1.00] in the crude analysis and 0.89 (95% CI 0.83-0.96) when adjusting for age, sex, job group, type and size of workplace, and workplace average level of previous short-term sickness absence. A supplementary analysis showed that the intervention also was associated with a reduced risk of long-term sickness absence with a crude RR of 0.83 (95% CI 0.69-0.99) and an adjusted RR of 0.84 (95% CI 0.69-1.01). CONCLUSIONS: Pre-school employees participating in an organizational-level occupational health intervention focusing on the core task at work had a lower incidence of short-term sickness absence during a 29-month follow-up compared with control group employees.