Towards person-centred work-focused healthcare for people with cardiovascular disease: a qualitative exploration of patients' experiences and needs.

PURPOSE: To explore the experiences and needs concerning work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease based on all facets of person-centred care. METHODS: Nineteen patients who experienced or continue to experience problems with work participation due to cardiovascular disease participated in semi-structured interviews preceded by preparatory written assignments. The transcripts were analysed by means of directed qualitative content analysis. Adapted principles of the Picker Institute for Person-Centred Care provided a template for the analysis. RESULTS: 28 experiences and needs emerged and were grouped into the eight principles for person-centred work-focused healthcare. Randomly presenting one theme for each of the eight principles, the themes included: (1) frequent encounters with occupational healthcare professionals; (2) substantive work-related advice; (3) transparency in communication; (4) support for family; (5) information provision on the work-focused healthcare process; (6) personal control during the process; (7) empathy for the personal situation; and (8) tailored work-focused support. CONCLUSIONS: The identified experiences and needs for work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease clearly indicate the need to improve the delivery of person-centred work-focused healthcare to better meet the individual needs of patients.

Provided work-focused healthcare services do not always align with the patient's needs when experiencing disease-related sick leave, potentially impacting their ability to stay in or return to work.This overview of patients' experiences and needs for work-focused healthcare may provide professionals with better insight into the patients' needs and aids to adapt the healthcare provision to these needs.When professionals target the patient's needs, it may facilitate better provision of person-centred work-focused healthcare.

Intermethod agreement of self-reports compared to register data collection for return to work and sickness absence: a systematic review and meta-analysis.

OBJECTIVES: To determine the intermethod agreement of self-reported vs. register data of 'sickness absence' (SA) and 'return to work' (RTW) outcome measurements. STUDY DESIGN AND SETTING: We conducted a systematic review and a meta-analysis of studies reporting mean differences (MDs) and sensitivity and specificity for self-report vs. register data and an inductive analysis of the self-report question formulations. An information specialist searched Medline, Embase, PsycINFO for studies published from inception to November 2022. Screening and data extraction was done by two authors independently. RESULTS: Twenty-three studies were included of which eighteen with an overall high risk of bias. Self-reports had a pooled MD of 1.84 SA days (95% confidence interval [CI] 0.26-3.41, I2 98%, 18 studies, 38,716 participants) compared to registries which varied among studies from 204 more to 17 days less. The median average sick leave in studies in the self-report group was 8 days (interquartile range 4-23 days). Being absent from work measured with self-report had a sensitivity of 0.83 (0.76-0.88 95% CI) and a specificity of 0.92 (0.88-0.94 95% CI) compared to registry data. The high heterogeneity amongst the studies could not be explained by recall time, gender, register type, prospective or retrospective self-reports, health problem, SA at baseline or risk of bias. Studies lacked standard outcome reporting, had unclearly formulated questions in self-reports and there was little information on the registers' quality. CONCLUSION: Current self-reports may differ from register-based absence data but in an inconsistent way. Due to inconsistency and high risk of bias the evidence is judged to be of very low certainty. Further research is needed to develop clear standard questions which can be used for SA and RTW self-reports. Quality of registers needs to be better evaluated. Percentage positive and negative agreement, MDs and 2 × 2 tables should be reported for studies investigating agreement between SA and RTW outcome measures.

Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study.

BACKGROUND: People living with cardiovascular diseases (CVD) often experience work participation problems. Good work-focused healthcare, defined as the received advice, treatment, and guidance focusing on work participation, can support the patient and work place. However, experiences with work-focused healthcare are generally not always positive which is a barrier for work participation. Therefore, the objective of this study is to gain insight into the work-focused healthcare journey from the perspective of patients with work participation problems due to CVD, to understand their experiences and needs, and to derive opportunities for improving work-focused healthcare service at a system level. METHODS: Semi-structured interviews, preceded by preparatory assignments, were conducted with 17 patients who experience(d) work participation problems due to CVD. The patient experience journey map (PEJM) approach was used to visualize the patients' work-focused healthcare journey, including experiences and needs over time and place, from which opportunities to improve work-focused healthcare from the patient's perspective were derived. RESULTS: An aggregated PEJM consisting of six phases was composed and graphically mapped. The first phase, working, represents a period in which CVD health problems and subsequent functional limitations occur. The next two phases, short- and long-term sick leave, represent a period of full sick leave. The last three phases, start-, partial-, and full vocational reintegration, focus on the process of return to work that takes place ranging from a few months up to several years after sick-listing. For each phase the touchpoints, timespan, stakeholders, activities, experiences and needs from the perspective of the patients were identified. Finally, for better work-focused healthcare nine opportunities for improvement were derived from the PEJM, e.g. emphasize the need for work adjustment prior to the medical intervention, provide more personalized advice on handling work limitations, and putting more compelling pressure on the employer to create suitable work positions for their employees. DISCUSSION/CONCLUSION: This paper contributes insights to provide a more patient-centered work-focused healthcare trajectory for patients employed in paid jobs when living with CVD. The PEJM provides an understanding of the patients' perspectives throughout their work-focused healthcare journey and highlights opportunities for improvement towards a better suited and seamless patient journey, Although this research was conducted within the Dutch healthcare system, it can be assumed that the findings on integrated work-focused healthcare are largly transferable to other healthcare systems.

Which outcomes should always be measured in intervention studies for improving work participation for people with a health problem? An international multistakeholder Delphi study to develop a core outcome set for Work participation (COS for Work).

OBJECTIVE: Synthesising evidence of the effects of interventions to improve work participation among people with health problems is currently difficult due to heterogeneity in outcome measurements. A core outcome set for work participation is needed. STUDY DESIGN AND SETTING: Following the Core Outcome Measures in Effectiveness Trials methodology, we used a five-step approach to reach international multistakeholder consensus on a core outcome set for work participation. Five subgroups of stakeholders took part in two rounds of discussions and completed two Delphi voting rounds on 26 outcomes. A consensus of ≥80% determined core outcomes and 50%-80% consensus was required for candidate outcomes. RESULTS: Fifty-eight stakeholders took part in the Delphi rounds. Core outcomes were: 'any type of employment including self-employment', 'proportion of workers that return to work after being absent because of illness' and 'time to return to work'. Ten candidate outcomes were proposed, among others: 'sustainable employment', 'work productivity' and 'workers' perception of return to work'. CONCLUSION: As a minimum, all studies evaluating the impact of interventions on work participation should include one employment outcome and two return to work outcomes if workers are on sick leave prior to the intervention.

A general framework for selecting work participation outcomes in intervention studies among persons with health problems: a concept paper.

BACKGROUND: Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classification of Functioning is the foremost model in defining work functioning and its counterpart work disability, but it does not provide a critical (core) set of outcomes. Standardizing the definitions and nomenclature used in the research of work participation would ensure that the outcomes of studies are comparable, and practitioners and guideline developers can better decide what works best. As work participation is a broad umbrella term including outcome categories which need unambiguous differentiation, a framework needs to be developed first. AIM: To propose a framework which can be used to develop a generic core outcome set for work participation. METHODS: First, we performed a systematic literature search on the concept of (work) participation, views on how to measure it, and on existing classifications for outcome measurements. Next, we derived criteria for the framework and proposed a framework based on the criteria. Last, we applied the framework to six case studies as a proof of concept. RESULTS: Our literature search provided 2106 hits and we selected 59 studies for full-text analysis. Based on the literature and the developed criteria we propose four overarching outcome categories: (1) initiating employment, (2) having employment, (3) increasing or maintaining productivity at work, and (4) return to employment. These categories appeared feasible in our proof-of-concept assessment with six different case studies. CONCLUSION: We propose to use the framework for work participation outcomes to develop a core outcome set for intervention studies to improve work participation.

Changes in Fruit and Vegetable Consumption and Leisure Time Physical Exercise after a Citizen Science-Based Worksite Health Promotion Program for Blue-Collar Workers.

Blue-collar workers have, on average, poorer health than white-collar workers. Existing worksite health promotion programs (WHPPs) are often not successful among blue-collar workers. This study evaluates the effect of the Citizen Science-based WHPP on the targeted lifestyle behaviors among construction workers. The data of 114 participants were retrieved from questionnaires before (T0) and after (T1) the WHPP. Outcome measures were mean and categorical changes in daily fruit and vegetable intake and weekly leisure time physical exercise. Changes were tested using Wilcoxon signed rank tests and McNemar tests. No statistically significant changes were found between T0 and T1. In total, 73.7% of the participants felt involved in the WHPP. Changes in the outcome measures were not significantly different between subgroups based on age, nor in subgroups based on feelings of involvedness. The low intensity of the developed program could be an explanation for this lack of significant change. Future studies using the Citizen Science approach in an occupational setting should aim at developing a more intensified program and should test its effectiveness by comparing changes in a (randomized) controlled trial.

The effect of the Progressive Goal Attainment Program on cognitions, perceptions, and work participation of workers with chronic health problems: study protocol for a randomized controlled trial.

BACKGROUND: Cognitions and perceptions of workers with chronic health problems, such as catastrophizing thoughts and fear-avoidance beliefs, can negatively influence work participation. The Progressive Goal Attainment Program (PGAP) is an intervention developed in Canada with the aim of decreasing limiting cognitions and perceptions and increasing work participation. The objective of this protocol article is to describe the design of a randomized controlled superiority trial to study whether PGAP is effective in decreasing limiting cognitions and perceptions and increasing workability and work participation of workers with chronic health problems in the Netherlands. METHODS: This study is a randomized controlled superiority trial with two (parallel) groups, in which workers on sick leave are randomly assigned to an intervention group (PGAP intervention) or to a waiting-list control group (care as usual). The PGAP intervention consists of a maximum of 10 weekly individual sessions provided by a trained PGAP professional in which the worker learns about staying active, planning activities, and setting goals. Participants in this risk-targeted behavioral activation intervention also learn to be more aware of their cognitions and perceptions and learn about solution-focused problem-solving skills in challenging situations. The primary outcome is the degree of catastrophizing. Secondary outcomes are other personal cognitions and perceptions (e.g., expectations regarding return to work, self-efficacy), health symptoms (e.g., fatigue, depression), work participation (e.g., sick leave status, work hours), and other work-related outcomes (e.g., workability, quality of working life). DISCUSSION: Although PGAP shows positive effects in Canada, we do not know whether this intervention is effective in the Netherlands. This study is the first randomized controlled trial to test the effect of PGAP on limiting cognitions and perceptions and on work participation of workers with chronic health problems in the Netherlands. If PGAP is effective it could be implemented in the Netherlands in order to stimulate workability and work participation of workers. TRIAL REGISTRATION: The protocol of this study is registered in the Netherlands Trial Register (NL9832) in October 2021.

The process evaluation of a citizen science approach to design and implement workplace health promotion programs.

BACKGROUND: Many workplace health promotion programs (WHPPs) do not reach blue-collar workers. To enhance the fit and reach, a Citizen Science (CS) approach was applied to co-create and implement WHPPs. This study aims to evaluate i) the process of this CS approach and ii) the resulting WHPPs. METHODS: The study was performed in two companies: a construction company and a container terminal company. Data were collected by questionnaires, interviews and logbooks. Using the framework of Nielsen and Randall, process measures were categorized in the intervention, context and mental models. Interviews were transcribed and thematically coded using MaxQDA software. RESULTS: The involvement in the CS approach and co-creating the WHPPs was positively experienced. Information provision, sustained engagement over time and alignment with the workplace's culture resulted in barriers in the CS process. As to the resulting WHPPs, involvement and interaction during the intervention sessions were particularly experienced in small groups. The reach was affected by the unfavorable planning off the WHPPs and external events of re-originations and the covid-19 pandemic. DISCUSSION: Continuous information provision and engagement over time, better alignment with the workplace's culture and favorable planning are considered to be important factors for facilitating involvement, reach and satisfaction of the workers in a Citizen science approach to design and implement a WHPP. Further studies continuously monitoring the process of WHPPs using the CS approach could be helpful to anticipate on external factors and increase the adaptability. CONCLUSIONS: Workers were satisfied with the involvement in WHPPs. Organizational and social cultural factors were barriers for the CS approach and its reach. Involvement and interaction in WHPPs were particularly experienced in small grouped sessions. Consequently, contextual and personal factors need be considered in the design and implementation of WHPPs with CS approach among blue-collar workers.

The relationship between the living lab approach and successful implementation of healthcare innovations: an integrative review.

OBJECTIVES: The concept of living labs as a research method to enhance participation of end-users in the development and implementation process of an innovation, gained increasing attention over the past decade. A living lab can be characterised by five key components: user-centric, cocreation, real-life context, test innovation and open innovation. The purpose of this integrative literature review was to summarise the literature on the relationship between the living lab approach and successful implementation of healthcare innovations. METHODS: An integrative literature review searching PubMed, EMBASE, PsycINFO and Cinahl databases between January 2000 and December 2019. Studies were included when a living lab approach was used to implement innovations in healthcare and implementation outcomes were reported. Included studies evaluated at least one of the following implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration or sustainability. Quality was assessed based on a tool developed by Hawker et al. RESULTS: Of the 1173 retrieved articles, 30 studies were included of which 11 of high quality. Most studies involved a combination of patients/public (N=23) and providers (N=17) as key stakeholders in the living lab approach. Living lab components were mostly applied in the development phase of innovations (N=21). The majority of studies reported on achievement of acceptability (N=22) and feasibility (N=17) in terms of implementation outcomes. A broader spectrum of implementation outcomes was only evaluated in one study. We found that in particular six success factors were mentioned for the added-value of using living lab components for healthcare innovations: leadership, involvement, timing, openness, organisational support and ownership. CONCLUSIONS: The living lab approach showed to contribute to successful implementation outcomes. This integrative review suggests that using a living lab approach fosters collaboration and participation in the development and implementation of new healthcare innovations. PROSPERO REGISTRATION NUMBER: CRD42020166895.

Workers' health surveillance targeting mental health: evaluation of a training.

BACKGROUND: Mental health complaints occur frequently among healthcare workers. A workers' health surveillance mental health module (WHS-MH) was found to be effective in improving work functioning of nurses, although not implemented regularly. Therefore, training for occupational physicians and nurses to facilitate the implementation of WHS-MH was developed and evaluated. AIMS: This study was aimed to evaluate the effect of training on knowledge, self-efficacy and motivation to implement WHS-MH, and to evaluate participants' satisfaction with the training. METHODS: Three-hour training was held among 49 occupational physicians and nurses in the Netherlands. Effect on knowledge, self-efficacy and motivation was assessed using knowledge tests and questionnaires before and immediately after the training. Satisfaction with the training was measured using questionnaires after the training. RESULTS: A mean knowledge test score of 5.3 (SD = 1.6) was found before training, which did not significantly increase after training (M = 5.6, SD = 1.8). In total, 43% agreed or strongly agreed to have sufficient skills to implement WHS-MH, which significantly increased to 78% after the training. Furthermore, 87% agreed or strongly agreed to be motivated to initiate WHS, which significantly increased to 94% after the training. The majority of participants were satisfied with the training. CONCLUSIONS: Training may enhance the implementation of the WHS-MH through increasing self-efficacy and motivation. However, no effect on level of knowledge to implement WHS-MH was found.

Stimulating Sunscreen Use Among Outdoor Construction Workers: A Pilot Study.

Background: Outdoor workers (OW) receive a higher dose of ultraviolet radiation (UVR) compared to indoor workers (IW) which increases the risk of non-melanoma skin cancer (NMSC). Regular sunscreen use reduces the NMSC risk, however, adequate sun-safety behavior among OW is poor. The main objective was to conduct method- and intervention-related elements of a future intervention trial among OW, based on providing sunscreen and assessing sunscreen use on group- and individual level. Methods: This pilot study was conducted at a construction site in the Netherlands from May-August 2021. Nine dispensers with sunscreen (SPF 50+) were installed at the worksite. OW (n = 67) were invited to complete two (cross-sectional) questionnaires on sun-safety behavior, before and after providing sunscreen. Stratum corneum (SC) samples for the assessment of UV-biomarkers were collected from the forehead and behind the ear from 15 OW and 15 IW. The feasibility of the following elements was investigated: recruitment, (loss to) follow-up, outcome measures, data collection, and acceptability of the intervention. Results: The first questionnaire was completed by 27 OW, the second by 17 OW. More than 75 percent of the OW were aware of the risks of sun exposure, and 63% (n = 17) found sunscreen use during worktime important. The proportion of OW never applying sunscreen in the past month was 44.4% (n = 12) before, and 35.3% (n = 6) after providing sunscreen. A majority of OW (59.3%, n = 16) found sunscreen provision encouraging for sunscreen use, the dispensers easy to use (64.7%, n = 17) and placed in practical spots (58.8%, n = 18). Collecting SC-samples was fast and easy, and several UV-biomarkers showed higher levels for sun-exposed compared to less exposed body parts. There was no significant difference in UV-biomarker levels between OW and IW. Conclusions: This pilot study revealed low sunscreen use among OW despite providing sunscreen, overall satisfaction with the sunscreen, and the sufficient awareness of the risks of UVR-exposure. Collecting SC-samples at the workplace is feasible and several UV-biomarkers showed to be promising in assessing UVR-exposure. The low participation rate and high loss to follow-up poses a challenge for future intervention studies.

Preferred Methods of Measuring Work Participation: An International Survey Among Trialists and Cochrane Systematic Reviewers.

Purpose Heterogeneity in work participation (WP) outcomes measurements hampers large scale evidence synthesis in systematic reviews of trials. In this survey we explore authors' reasons for choosing specific WP outcomes and their measurement methods, including employment status, absence from work, at-work productivity loss, and employability. Methods We contacted authors of 260 trials and 69 systematic reviews and asked closed and open-ended questions about previously used WP outcomes and measurement methods as well as their opinion on the best way to measure WP. Results In total, 91 authors from a wide range of professional backgrounds completed the survey. The majority of authors (86%) chose WP outcomes based on their use in previous similar studies. In most studies (88%), patients had not been involved in the process of selecting the WP outcome. Authors judged feasibility to be an important factor for choosing a measurement instrument (67%). Additionally, valid measurement tools should be available, easy to administer and not too time consuming. Although authors preferred registry data for long term follow-up, the availability and validity of registries was seen as a barrier. Most of the reviewers (72%) struggled to pool data because of variation in follow-up times and cut off points and varying definitions of work outcomes. Almost all (92%) respondents support the use of a Core Outcome Set for Work. Conclusions There is strong support from authors of trials and systematic reviews to develop a core outcome set on work participation outcomes for the evaluation of interventions.

The perceived importance of prognostic aspects considered by physicians during work disability evaluation: a survey.

BACKGROUND: Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment. METHODS: Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both "in general" and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses. RESULTS: Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0-9.0), with less differing opinions among participants (IQR 1.0-3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0-8.0, with IQR 2.0-5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence. CONCLUSIONS: Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.

Effects of a training program for occupational health professionals on the cognitions and perceptions of workers: a randomized controlled trial.

PURPOSE: To evaluate the effects of a training program for occupational health professionals (OHPs) on their ability to identify the cognitions and perceptions of workers with a chronic disease that may hinder work participation, and on their ability to recommend evidence-based interventions aimed at the identified cognitions and perceptions. METHODS: A randomized controlled trial was conducted in which OHPs were randomly assigned to a training program on the cognitions and perceptions of workers with a chronic disease (n = 29) or to a control group that did not receive training (n = 30). Participants received home assignments in which they had to identify the cognitions and perceptions of workers in video vignettes and had to indicate which interventions they would recommend to foster work participation. A generalized linear model repeated measures ANOVA was conducted to study the effects of the training program. RESULTS: The results of the analyses showed an increase in the ability to identify the cognitions and perceptions of workers of OHPs who received the training compared to the control group (p < 0.001). The results also showed an increased ability to recommend evidence-based interventions aimed at these cognitions and perceptions (p < 0.001) as a result of participation in the training. CONCLUSION: The training program helps OHPs to identify cognitions and perceptions and to recommend evidence-based interventions. This can support them in their activities to increase the work participation of workers with a chronic disease.

Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation.

BACKGROUND: In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs' satisfaction with the training and the feasibility of the training and learned skills. METHODS: The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills. RESULTS: The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time. CONCLUSIONS: OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease.

Extensive variability of work participation outcomes measured in randomized controlled trials: a systematic review.

OBJECTIVE: To investigate how work participation outcomes in randomized controlled trials are measured internationally and across disciplines. STUDY DESIGN AND SETTING: We identified trials that reported on work participation in Medline, Embase, PsycINFO and Cochrane Central published between 2014 and 2019. Screening, selection, and data extraction were done by two authors independently. We grouped outcomes into four categories ("employment status", "absence from work", "at-work productivity loss," and "employability") and created subcategories according to how the outcome was measured. RESULTS: From 10,022 database hits we selected 269 trials reporting on 435 work participation outcomes. Authors used inconsistent outcome terminology to describe the measured constructs. Grouped in four main categories we identified 70 outcomes that reported on "employment status", 196 on "absence from work" and return-to-work, 132 on "at-work productivity loss," and 37 on "employability" outcomes. Variability in measurement methods existed across all categories. Employment status and absenteeism measures consisted mostly of clinimetrically unvalidated tools. "At-work productivity loss" and "employability" were measured by at least 41 different questionnaires. CONCLUSION: Extensive variability exists among trials in the measurement of outcomes, measurement methods and measurement instruments that focus on work participation. This study is a first step towards the development of a Core Outcome Set for work participation.

E-nergEYEze, a vision-specific eHealth intervention based on cognitive behavioral therapy and self-management to reduce fatigue in adults with visual impairment: study protocol for a randomized controlled trial.

BACKGROUND: More than half of the adults with visual impairment experience severe symptoms of fatigue, with a negative impact on daily life. Since there is no evidence-based treatment to reduce fatigue in adults with visual impairment, we developed E-nergEYEze, an eHealth intervention based on cognitive behavioral therapy and self-management tailored to the needs of visually impaired adults. The aim is to describe the study protocol of a randomized controlled trial testing E-nergEYEze. METHODS: A randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of E-nergEYEze to reduce fatigue severity compared to care as usual from a healthcare and societal perspective. A total of 172 severely fatigued adults with visual impairment will be recruited and randomized to either the E-nergEYEze intervention plus care as usual or to care as usual only (ratio 1:1). Inclusion criteria are having a visual impairment, experiencing severe fatigue (Checklist Individual Strength - subscale Fatigue Severity: CIS-FS > 35), being 18 years or older, understanding the Dutch language, and having access to the internet. The intervention consists of one face-to-face session and a computer training followed by internet-based modules with information and assignments on coping with fatigue. During this 5-month intervention, participants will be digitally supported by a social worker. All measurements will be administered at baseline, after 6 and 12 months, and additionally, those related to cost-effectiveness at 3 and 9 months. The primary outcome is fatigue severity (CIS-FS). DISCUSSION: Severe fatigue on top of visual impairment compromises quality of life and is associated with incremental societal costs that largely determine the economic burden of low vision or blindness. E-nergEYEze contributes to the evidence base of potentially feasible interventions to reduce the important health-related consequences of vision loss and could fulfill the gap in knowledge, skills and treatment options for low vision services. TRIAL REGISTRATION: Dutch Trial Register NTR7764 . Registered on 28 May 2019.

Supporting Occupational Physicians in the Implementation of Workers' Health Surveillance: Development of an Intervention Using the Behavior Change Wheel Framework.

Workers' health surveillance (WHS) is an important preventive activity aimed at prevention of work-related diseases. However, WHS is not regularly implemented in some EU-countries. As occupational physicians (OPs) have to play an important role in implementation of WHS, this study aimed to develop an intervention to support OPs in implementation of WHS. The behavior change wheel framework (BCW) was used to develop the intervention. First, the problem was defined, and target behavior was selected by using results from a survey study among OPs. Subsequently, change objectives in target behavior were specified. Finally, appropriate intervention functions, behavior change techniques, and modes of delivery were identified to develop the intervention. Target behaviors were (1) OPs initiate WHS, and (2) OPs conduct preventive consultations with workers. OPs' capabilities, and experienced opportunities were identified as change objectives. Intervention functions (education, training, enablement) and behavior change techniques (information about consequences, demonstration, instructions, behavioral practice, feedback on behavior, goal setting, action planning, reviewing goals) were selected to develop the intervention, delivered by face-to-face group training and e-learning. The proposed intervention consists of training and e-learning to support OPs in implementing WHS. Feasibility and effect of the intervention will be evaluated in future studies.

Protection Against Solar Ultraviolet Radiation in Outdoor Construction Workers: Study Protocol for a Non-randomized Controlled Intervention Study.

Introduction: Non-melanoma skin cancer (NMSC) incidence is increasing, and occupational solar exposure contributes greatly to the overall lifetime ultraviolet radiation (UVR) dose. This is reflected in an excess risk of NMSC showing up to three-fold increase in outdoor workers. Risk of NMSC can be reduced if appropriate measures to reduce UVR-exposure are taken. Regular use of sunscreens showed reduced risk of NMSC. However, sun-safety behavior in outdoor workers is poor. The objective of this study is to investigate the effectiveness of an intervention aiming at increasing sunscreen use by construction workers. Methods: This non-randomized controlled intervention study is comprised of two intervention and two control groups recruited at four different construction sites in the Netherlands. The study population comprises ~200 construction workers, aged 18 years or older, followed during 12 weeks. The intervention consists of providing dispensers with sunscreens (SPF 50+) at construction sites and regular feedback on the application achieved by continuous electronic monitoring. All groups will receive basic information on UV-exposure and skin protection. Stratum corneum (SC) samples will be collected for measurement of biomarkers to assess internal UV-dose. External UV-dose will be assessed by personal UV-sensors worn by the workers during work-shifts in both groups. To detect presence of actinic keratosis (AK) or NMSC, a skin check of body parts exposed to the sun will be performed at the end of the study. The effect of the intervention will be assessed from data on self-reported sunscreen use by means of questionnaires collected on baseline and after 12 weeks of intervention (primary outcome). Levels of SC biomarkers of internal UV-dose, external UV-dose, number of sunburn episodes, and prevalence of NMSC including AK will be assessed as secondary outcomes. The electronically monitored sunscreen consumption will be assessed as process outcome. Discussion: This study is intended to provide evidence of the effectiveness of a technology-driven intervention to increase sunscreen use in outdoor construction workers. Furthermore, it will increase insight in the UV-protective behavior, external and internal UV-exposure, and the prevalence of NMSC, including AK, in construction workers. Trial Registration: The Netherlands Trial Register (NTR): NL8462 Registered on March 19, 2020.

The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence). DATA SOURCES: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of occupational exposure to ergonomic risk factors (any exposure to force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing ≥ 2 h/day) compared with no or low exposure to the theoretical minimum risk exposure level (<2 h/day) on the prevalence or incidence of MSD or OA. STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using Navigation Guide tools adapted to this project. RESULTS: In total eight studies (4 cohort studies and 4 case control studies) met the inclusion criteria, comprising a total of 2,378,729 participants (1,157,943 females and 1,220,786 males) in 6 countries in 3 WHO regions (Europe, Eastern Mediterranean and Western Pacific). The exposure was measured using self-reports in most studies and with a job exposure matrix in one study and outcome was generally assessed with physician diagnostic records or administrative health data. Across included studies, risk of bias was generally moderate. Compared with no or low exposure (<2 h per day), any occupational exposure to ergonomic risk factors increased the risk of acquiring MSD (odds ratio (OR) 1.76, 95% confidence interval [CI] 1.14 to 2.72, 4 studies, 2,376,592 participants, I2 70%); and increased the risk of acquiring OA of knee or hip (OR 2.20, 95% CI 1.42 to 3.40, 3 studies, 1,354 participants, I2 13%); Subgroup analysis for MSD found evidence for differences by sex, but indicated a difference in study type, where OR was higher among study participants in a case control study compared to study participants in cohort studies. CONCLUSIONS: Overall, for both outcomes, the main body of evidence was assessed as being of low quality. Occupational exposure to ergonomic risk factors increased the risk of acquiring MSD and of acquiring OA of knee or hip. We judged the body of human evidence on the relationship between exposure to occupational ergonomic factors and MSD as "limited evidence of harmfulness" and the relationship between exposure to occupational ergonomic factors and OA also as "limited evidence of harmfulness". These relative risks might perhaps be suitable as input data for WHO/ILO modelling of work-related burden of disease and injury. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053 PROSPERO registration number: CRD42018102631.