Case 5 EPH2022

Question 1

Define workplace intervention

Answer 1

Interventions focusing on changes in:
- workplace & equipment design
- work organisation (including working relationships)
- job situation or in environmental conditions.

Question 2

What are changes in workplace & equipment?

Answer 2

prevention of accidents and injuries, changes in workplace furniture, tools/devices, or materials needed to perform the work tasks.

Question 3

What are changes in work organisation?

Answer 3

• e.g. changes in work schedules/tasks, training in task performance, job rotation, training directed to improve task performance, & communication processes between coworkers.
• Interventions more directed to prevention of psychosocial strains imposed by the organisation structure and also to facilitate the return to work.

Question 4

What are changes in job situation?

Answer 4

Financial & contractual arrangements to facilitate return to work

Question 5

What are changes in the work environment?

Answer 5

concern noise, lighting, vibration, etc.

Question 6

What important elements do workplace interventions carry?

Answer 6

1. involvement of relevant stakeholders during return to work process
2. implementation of changes at workplace & work organisation.

Question 7

Define & explain the participatory approach

Answer 7

• Different stakeholders are active participants throughout process of development and implementation of changes which may increase the possibility of a more sustainable and successful return to work.
• Idea of approach is that participation of workers may help to overcome the implementation difficulties.

Question 8

What are some types of workplace interventions?

Answer 8

• Based on diagnosis, budget, priorities & risk evaluation choose primary, secondary, tertiary prevention or combination.
• Individual level (or group of individuals): intervention addresses individual & personal characteristics (lifestyle, resilience, etc)
• Organisation/department: changes in work environment, work characteristics.
• Interface between individual & organisation: don’t adjust work characteristics/organise work process but try to influence how individual interacts with job/department
  *Institutional occupational healthcare→ employees on sick leave can go to occupational physician focused on the workplace & situation of employee.
• Vocational rehabilitation → Supporting employees in returning to work

Question 9

Why is a holisitic approach important in the promotion. &improvement of a healthy work environment?

Answer 9

• Aims to address all aspects of work environment, including both physical & social determinants.
• Can be observed in two key models for workplace action: WHO Healthy Workplace Model & National Institute for Occupational Safety & Health (NIOSH) Total Worker Health strategy.
• Models recognise that work-related injuries & disease don’t stem from single source & therefore strategy that addresses a wide range of health & safety issues is needed.

Question 10

What is a selective intervention?

Answer 10

• Intervention that targets a sub-group of population based on their specific characteristic that would make them susceptible and create a high-risk group
• E.g. Based on characteristics smoking is highly prevalent in certain jobs = only select those people. Don’t know whether people have symptoms or show risk factors but you know based on certain characteristics such as age, type of work, tend to have these risk factors or tend to smoke, etc.

Question 11

What is indicative prevention?

Answer 11

focus on individuals at risk (screening). E.g. quit smoking then smokers are group at risk and you only want people who actually smoke (at risk)

Question 12

What is universal prevention?

Answer 12

prevention focused on total population. E.g. advertisements by bus stops, etc. But can also be an entire community, school, or entire population of a country

Question 13

What is MSD?

Answer 13

• Injuries or dysfunctions affecting muscles, bones, nerves, tendons, ligaments, joints, cartilages, and spinal discs.
• MSDs include sprains, strains, tears, soreness, pain, carpal tunnel syndrome, hernias, and connective tissue injuries.
• Episodic - the pain often disappears, only to recur later. Many MSDs are transient, with symptoms disappearing with rest or change of activity. Some MSDs may become persistent or irreversible.

Question 14

What are risk factors for work-related MSDs ?

Answer 14

• Upper limbs (the hand, wrist, elbow and shoulder), neck & lower back are particularly vulnerable to MSDs
• repetitive motion, excessive force, awkward and/or sustained postures, prolonged sitting and standing.
• Also affected by levels of stress, autonomy & support from colleagues, individuals’ prior medical history, physical capacity & age, & social factors such as leisure activities.

Question 15

What causes MSDs?

Answer 15

Caused when physical capacity of muscles, joints, ligaments etc is not in balance with the external forces that act upon the body.

Question 16

What are different groups of factors that can contribute to MSDs?

Answer 16

1. Physical or biomechanical work-related factors
2. Organisational or psychosocial work-related factors
3. Individual or personal factors
4. Factors relating to social content

Question 17

Explain the physical or biomechanical work-related factors for MSDs

Answer 17

• Include work procedures, equipment & environment that lead to biomechanical stress in muscles, tendons, spinal discs & nerves.
• Force, repetition, awkward postures or long-term static postures, vibration & work in low temperatures are physical work-related risk factors for MSDs

Question 18

What are the organisational or psychosocial work-related factors for MSDs?

Answer 18

• Daily exposure to physical risk factors & insufficient rest/recovery time
• Providing knowledge, skills & information on working methods & techniques, & on working movements, postures & loads, can reduce risk of MSDs.
• Mental strain can cause muscular tension, & increase existing physical strain.

Question 19

What are work conditions that can increase mental strain for MSDs?

Answer 19

Work conditions that may increase mental strain include:
* Psychologically demanding activities, where workers exposed to high levels of work stress, work pressure & mental demands, due to e.g. tight deadlines and low levels of autonomy
* Activities where little support from colleagues, supervisors & managers.

Question 20

What are the individual/personal factors for MSDs?

Answer 20

• Individuals differ in susceptibility to MSDs.
• Factors such as prior medical history, physical capacity & age are very important.
• Obesity, pregnancy, rheumatoid arthritis, acute trauma and endocrinological disorders are other examples of individual non-occupational factors that may affect occurrence of MSDs.

Question 21

What are factors relating to social context for MSDs?

Answer 21

• Some types of sport, leisure activities & housekeeping work at home can all increase susceptibility to MSDs.
• Relation between work activities & particular MSD is multi-factorial. Means that when different physical factors are present, coexisting with organisational factors (also individual & social factors), a work situation may arise in which there is a high risk of developing MSDs.

Question 22

What are some examples of primary level interventions for the workplace?

Answer 22

Organisational polcies & procedures:
* Policies for work-related stress/psychosocial hazards (e.g. poor work-life balance, workplace harassment)
* Policies outline aim, intentions of tackling aim, responsibility of organisation, employees, etc.

Job design & workload management:
* change aspects of work so better suits the skills, interests & resources of employee
* Reduce ambiguity or conflicts
* Effective workload management can reduce amount of demand placed on employee without reducing workload itself.

Improving control:
* Increase workers autonomy & ability to influence their work environment.
* Giving workers say on hours, workload, teams, resouces & personal development.

Training:
Interventions aim to increase employers & workers awareness, recognition & understanding of work-related stress & work harassment, negative health effects & employers responsibilities

Question 23

What are some examples of secondary level interventions for the workplace?

Answer 23

Stress management training:
* Aim to increase essential skills & encourages workers. to change way they think about stressful situation through learning coping mechanisms & positive thinking.

Time management training

Organisational stress management interventions:
* Aim to reduce risks & improve psychosocial work environment
* E.g. participative work conference (search conference) involving employees in organisational planning & decision making.

Question 24

What are some examples of tertiary level interventions for the workplace?

Answer 24

Planning for emergency response:
* OH personnel can assist in developing plans to cope with disaster s in the workplace that may also effect surrounding community

Workers compensation:
* Provides income support, medical payments & rehabilitation payments to workers injured on job & provide benefits to family & dependents of injured workers.

Health promotion at workplace:
* Process of enabling peopel to increase ccontrol over & to improve their health
* Activities include cessation of smoking, providing dietary advice, encouraging physical activity, promoting healthy lifestyles, reducing CVD & other risks, & emphasising compliance with health and safety measures at workplace.

Employee assistance programmes:
* Identify & help resolve employee concerns that affect performance & well-being.
* Done by offering employees range of work & non-work (such as debt management & legal advice) support, including counselling, skills training, health advice & access to preventative healthcare.

Return to work programmes
* Help workers adjust back to work

Rehabilitative measures:
- Provide psychological support to address any trauma an employee may suffer.

Question 25

What are some examples of multi-level interventions for the workplace?

Answer 25

• Developing continuous & sustainable initiatives to promote employee & organisational health & well-being through psychosocial risk prevention & management requires development of strategies that address psychosocial risks & associated health effects.
• Obligates organisations to move beyond single-model interventions that practise either only individual or organisational approaches to multi-model interventions that use a combination of approaches.

Such comprehensive strategies should draw from across all intervention levels:
* Eliminating psychosocial risks in workplace to reduce & prevent stress & harassment (primary level)
* Where psychosocial risks cannot be eliminated, training employees & provide resources to optimise coping abilities & personal management strategies (secondary level)
* For those who ‘fall through the cracks’ & experience symptoms associated with work-related stress, providing them with rehabilitative resources & support (tertiary level).

Question 26

*What is EU legislation on prevention of MSDs?

Answer 26

• 90/269/EEC on minimum health and safety requirements for the manual handling of loads, where there is a risk particularly of back injury to workers
• 90/270/EEC on the minimum safety and health requirements for work with display screen equipment
• 2002/44/EC on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibration)
• Council Directive 89/391/EEC on the introduction of measures to encourage improvements in the safety and health of workers at work.

Question 27

How do you select an intervention?

Answer 27

**Phase 1: preparation phase **
e.g. the organisation’s readiness for change is discussed & constructed. Phase also includes planning of project & how will be communicated to organisation.

**Phase 2: risk assessment phase ** involves identification of risks that have possibility to harm health or safety of employees.

Phase 3: Development of action plan.
* Results of risk assessment discussed, risks identified are prioritised & action plan to tackle risks is developed.
* Action plan include measures to be used, plan for implementation of interventions, communication & evaluation plans. Participatory approach used.

Phase 4: Implementation of solutions & interventions (also called risk reduction) in which interventions planned are carried out.

Phase 5: Evaluation phase - outcomes, effectiveness, & implementation process all considered & assessed.

Question 28

What should workplace interventions be based on?

Answer 28

• risk factors identified in studies of high methodological quality (risk factor reduction)
• expertise of qualified professionals (e.g., ergonomists)
• expertise & educated opinion of workers & work-place administrators.

= Modifications may become more feasible and more likely to succeed.

Question 29

How can interventions be more effective?

Answer 29

• Individual-directed interventions have no strong long-lasting effects
• Organisation-directed interventions are very complicated, evaluation is complicated, time consuming, sometimes also expensive for e.g job redesign
• Comprehensive/integrated interventions are most effective - E.g. focus on individual & organisational level, make interventions multidisciplinary, focusing on multiple outcomes/determinants
• Booster sessions or iteration increase effectiveness - Make sure intervention is not one time occurrence. Intervention should be kept vivid in organisations, preferably part of regular day to day processes.

Question 30

*What are some difficulties with studying the effectiveness of interventions?

Answer 30

• Difficult to study effectiveness
• High quality studies are scarce - difficult to use high quality design to evaluate type of interventions - When want to implement interventions in organisations, lots of things can occur which impacts evaluation of intervention, so how make sure organisations keep participating in evaluation study.
• Empirical evidence is scarce
• Ethical problems
• Many pitfalls and “noise” in practice
• Effectiveness depends on outcomes you want to achieve under study & how you implement intervention a.o. E.g if you want to achieve improvement in lifestyle behaviour, it will be different from achieving a reduction in sick-ness absence, more difficult to achieve results on that level?

Question 31

What are the core components of sustainable employability?

Answer 31

1. Health
2. Productivity
3. Valuable work
4. Long-term perspective (employable until retirement)