Interventions for musculoskeletal disorders in computer-intense office work: a framework for evaluation

Workplace interventions for work-related musculoskeletal disorders (WMSDs) are usually multifaceted. These interventions tend to deal with multiple work organizational and physical risk factors and have components occurring at different organizational levels. The organizations are often changing, with shifting initiatives and priorities. Evaluation of such interventions poses challenges in documentation of implementation, reduction in exposures, and assessment of improved health outcomes. We describe a means-outcomes framework for evaluating field interventions that includes strategies, activities, objectives and metrics for outcomes using quantitative and qualitative methods. We demonstrate application of the framework to our work with a large newspaper, which builds on existing laboratory, aetiological and best practice evidence to improve musculoskeletal health. The newspaper had adopted several organizational strategies aimed at improving financial performance, including restructuring into teams, a major set of moves/renovations and introduction of new software. Concomitant WMSD-related organizational strategies include an ergonomics policy, human resources activities, promotion of team work, changes in environment and equipment specifications and development of information systems. We have found the framework useful for focusing the purpose of data collection and ensuring coverage of important components. At the same time, it provides sufficient flexibility to respond to the changing process of implementation.     

Editorial: Cognitive science,occupational stress and organizational health

A number of studies have shown that musculoskeletal symptoms are related to the physical and psychosocial work environments. Workers with musculoskeletal symptoms are often advised to cope by such measures as changing working technique, using lifting equipment and discussing health and environmental problems with supervisors and colleagues. Intervention studies at the individual level, however, have shown that such advice has limited effects in reducing the prevalence of musculoskeletal symptoms. The hypothesis for this study was that negative social and organizational factors may prevent workers from implementing such coping strategies. All 103 motor vehicle mechanics surveyed in 12 different garages responded to a questionnaire on coping with musculoskeletal symptoms and the psychosocial work environment. Positive and significant relationships were shown between how mechanics coped with their musculoskeletal symptoms and such psychosocial factors as work demands, social support, control, manager's involvement in health and safety work, and whether the garages had regular meetings between management and workers. Achieving positive results from preventive work through back schools and other ergonomic interventions seems to require that an organization with positive attitudes towards health and safety work be created before such interventions are implemented.     

How the psychosocial work environment of motor vehicle mechanics may influence coping with musculoskeletal symptoms

A number of studies have shown that musculoskeletal symptoms are related to the physical and psychosocial work environments. Workers with musculoskeletal symptoms are often advised to cope by such measures as changing working technique, using lifting equipment and discussing health and environmental problems with supervisors and colleagues. Intervention studies at the individual level, however, have shown that such advice has limited effects in reducing the prevalence of musculoskeletal symptoms. The hypothesis for this study was that negative social and organizational factors may prevent workers from implementing such coping strategies. All 103 motor vehicle mechanics surveyed in 12 different garages responded to a questionnaire on coping with musculoskeletal symptoms and the psychosocial work environment. Positive and significant relationships were shown between how mechanics coped with their musculoskeletal symptoms and such psychosocial factors as work demands, social support, control, manager's involvement in health and safety work, and whether the garages had regular meetings between management and workers. Achieving positive results from preventive work through back schools and other ergonomic interventions seems to require that an organization with positive attitudes towards health and safety work be created before such interventions are implemented.     

Organizational interventions: A research-based framework for the evaluation of both process and effects

Abstract

Organizational interventions are often recommended when organizations want to improve employee psychological health and well-being. Research, however, has revealed inconsistent results and reviewers have called for research on why interventions either bring about desired change or fail to do so. Answering the “how” and “why” of intervention outcomes requires a close examination of the elements that hinder or facilitate desired outcomes, thus moving beyond evaluation of only the overall effects. In this paper, we present an evaluation framework based on recent intervention research and process-oriented organization theory. The framework offers suggestions for which elements to include when evaluating organizational interventions. Within the framework, elements crucial to intervention evaluation are grouped into four overarching categories that we argue are crucial to evaluation over the five phases of an intervention programme. These categories are: the organizational “actors”; the mental models of those actors; the context of the intervention; and intervention design and process. Evaluation during the process as well as of the overall effects, as recommended by this framework, should throw light on what works for whom, why, how and under which circumstances.     

The validity of the occupational stress indicator

During the last two decades two potent groups of predictors for work-related musculoskeletal problems have been identified: physical work load and poor psychosocial working conditions. However, little is known about their combined effects. In this study the buffering effect of control at work with respect to the negative effects of psychological demands and physical work load on musculoskeletal problems is examined. All study variables were sampled from 431 people working in geriatric nursing homes in Germany by means of questionnaires. Main effects and interactions were tested with multiple regression analysis. The results showed that control buffered the effects of high psychological demands, but not of high physical work load; the buffering effect of control was observed only when physical work load was low. The combined effects of demands and physical work load were over-additive. Thus, the power of different predictors for musculoskeletal symptoms depended on the level of other predictors. This suggests that the efficiency of certain strategies for the prevention of musculoskeletal problems is likely to depend on the level of risk factors, with different strategies being appropriate for different levels of risk.     

Implementing workforce development in health care: A conceptual framework to guide and evaluate health service reform

Abstract

The term ‘workforce development’ is increasingly popular in the health-care field. It appears to encompass a range of human and organizational development activity. However, there has been limited explication of the concept of workforce development in Australian health care at area health service levels. It is timely to develop a framework for workforce development and processes to guide any evaluation of the implementation of workforce development strategies. This paper presents a framework that has been developed through consultative processes in an area health service and an associated review of literature.     

Work-related reproductive health: A review

This paper reviews the literature concerning the impact of work on reproductive health. In doing so, it offers a framework model for guiding future research and practice. Contemporary models of occupational health usually identify at least two pathways linking exposure to workplace hazards to their effects on health. The study of work-related reproductive health has been largely restricted to the effects of the more tangible and physical hazards of work mediated by a largely physico-chemical pathway. However, the growth of research into the psycho-physiological influence of stress on reproductive health provides a new direction for research in this domain with the exploration of a complementary pathway. The extension of this new approach into the investigation of the effects of work design and management on reproductive health represents a potentially important and further development.     

Assisting employees with drinking problems: Changes in mental health, job perceptions and work performance

A sample of 104 British transportation employees with alcohol-related problems were examined for changes in mental health and job perceptions before and after a company-based counselling programme. Data was mainly obtained by means of structured interviews. When clients were assessed at a 6-month follow-up, significant positive changes were found for the group as a whole in terms of context-free mental health, self- and supervisor ratings of work performance as well as measures of absenteeism. Small positive differences were observed for measures relating to perceived work demands. However, no significant differences were observed for the measures of job satisfaction and job commitment. The findings are discussed in relation to the expected client and organizational outcomes of workplace counselling interventions.     

Organizational-level interventions to reduce occupational stressors

Abstract

Occupational stress research continues to grow, and is increasingly being used to inform national policy on worker health and well-being. Most models of occupational stress emphasize notions of person-environment fit. Two approaches for intervention to minimize adverse consequences of occupational stress follow from such models. One emphasizes the strengthening and enhancement of indwiduals and their resources, the other emphasizes the reduction ofcommon workplace-based sources ofoccupational stress. This paper reviews 10 organizational-level interventions to reduce stress at work which have been examined in various field studies. These interventions were generally found to have positive effects, and, given the limited success of individual-level interventions in addressing occupational sources of stress, should be encouraged.     

Evaluating organizational-level work stress interventions: Beyond traditional methods

Abstract

Since the early 1990s, there has been a growing literature on organizational-level interventions for work-related stress, and associated calls for such interventions to be evaluated. At the same time, doubts have been expressed about the adequacy of traditional scientific research methods in applied psychology (the natural science paradigm) in providing an effective framework for such evaluations. This paper considers some of the philosophical and methodological issues raised by evaluation research in relation to organizational-level interventions for work-related stress. Four key issues are discussed: the concept of a study being “fit for purpose” in relation to research designs and the nature of acceptable evidence; the issue of control of research conditions in real-world studies; the need to evaluate process as well as outcome, including the interrelated nature of process and outcome; and the interpretation of imperfect evidence sets. The starting point of this paper is the reality of organizational life, which is complex and continually changing. Its main objective is not to offer an alternative to a scientific approach but to argue for a more broadly conceived and eclectic framework for evaluation that acknowledges the limitations of the traditional approach. It espouses an approach that is reflective of the reality of organizational life and in which the methods used for evaluating an intervention are fit for purpose. The paper concludes by offering an outline framework for this broader approach to the evaluation of interventions.     

The drivers of work engagement: A meta-analytic review of longitudinal evidence

ABSTRACT

Work engagement is currently one of the most popular outcomes in occupational health psychology. According to the motivational process within the job demands-resources (JD-R) framework, job resources stimulate work engagement, which in turn fosters job performance. While the general positive impact of job resources on work engagement is well established, it remains unclear how different types of job resources differentially predict work engagement over time. In our meta-analytic review, we identified 55 longitudinal studies that investigate the impact of various job resources on work engagement. To uncover the drivers of work engagement, we examined the differential impact of job resources on work engagement at group level, leader level, and organisational level via meta-analytic structural equation modelling. The findings suggest that job resources at each of the three levels predict work engagement over time. However, organisational-level resources (reflecting how the work is organised, designed and managed) contribute much more strongly to work engagement than group-level, and leader-level resources. All three levels of job resources and work engagement are highly stable. We advocate for interventions at any of the three levels. However, interventions at the organisational-level are most promising for enhancing work engagement and we thus strongly recommend strengthening those job resources.     

Personality and organizational health: the role of conscientiousness

Organizational health research identifies processes through which the work environment and individual differences combine to influence both individual and organizational outcomes. This study investigated the contribution of conscientiousness to organizational health. Research in the areas of occupational stress, work performance, and organizational climate was used to develop a framework for integrating different elements of organizational health. Within this framework, the work environment was assessed by perceptions of workload and role clarity ; individual well-being was assessed by psychological distress and job satisfaction ; and behaviour important for organizational success was assessed by contextual performance. Conscientiousness was investigated within the framework using self-reports from a sample of 104 Australian employees. Conscientiousness directly influenced contextual performance but did not influence well-being or perceptions of the work environment. Conscientiousness also reduced the impact of role clarity on both psychological distress and job satisfaction. The role of conscientiousness in a comprehensive model of organizational health is discussed.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

Abstract

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

A process evaluation of individual and organizational occupational stress and health interventions

There is reason to believe that many health and stress interventions fail due to inattention to the effects of intervention implementation processes, but evaluations of these processes are found only rarely in the literature. The objective of the present study was to explore the issue of obstacles to implementation that may occur when stress and health interventions are introduced in work organizations. The study was conducted as a process evaluation of seven different individual and organizational interventions. Interviews were conducted in 22 post offices, 12 organizational units (such as care homes and local administrative units) of a Norwegian municipality, and in 10 shops in a shopping mall. The interviews took place before and after the interventions. The following key process factors were identified: (1) the ability to learn from failure and to motivate participants; (2) multi-level participation and negotiation, and differences in organizational perception; (3) insight into tacit and informal organizational behaviour; (4) clarification of roles and responsibilities, especially the role of middle management; and (5) competing projects and reorganization. For improved studies of interventions in the future we recommend that qualitative and quantitative methods be combined, that researchers build more on natural interventions that occur naturally within the organization, and that a pilot study be undertaken in order to investigate the cultural maturity of the organization.     

The Japanese version of the Effort-Reward Imbalance Questionnaire: A study in dental technicians

To test the psychometric properties and criterion validity of the Japanese version of the EffortReward Imbalance (ERI) Questionnaire (Siegrist, 1996), a survey was conducted among 105 male dental technicians. The Japanese version of the questionnaire was developed through a backtranslation process. Internal consistency and factorial structure were tested and the criterion validity with respect to musculoskeletal symptoms was estimated with the help of a correlation matrix and logistic regression analysis. In psychometric terms, the factorial structure of the scales measuring the components of the theoretical concept was replicated satisfactorily, and internal consistencies of the scales measuring the extrinsic and intrinsic components of the model were appropriate. Significant associations between components of the ERI and musculoskeletal symptoms were found. Logistic regression analysis revealed a significantly elevated risk of musculoskeletal symptoms in participants scoring high on the scale measuring the model's intrinsic component, 'overcommitment'. This study indicates that, at least for the occupational group under study, the Japanese version of the ERI Questionnaire is a feasible and psychometrically well justified new measure for assessing psychosocial stress at work with relevance to health.     

Management consultancy’s role in delivering lasting [triple bottom line] benefits

Abstract

Management consultants have become ubiquitous in helping improve organizational performance. This paper presents an investigation of the impact of their interventions on organizational sustainability and growth through the performance improvement work carried out for and with their clients. The paper presents the findings of a questionnaire survey of 440 respondents from 206 countries; 197 of respondents were Small and Medium Sized Enterprises (SMEs) and 243 from large organizations. There is a particular focus on knowledge transfer in terms of urgency and impact of the work with regard to the extent to which consulting interventions in SMEs, as well as large multinational corporations, embed long-term sustainability practices.     

Regulations,policies and practices concerning work stress in five European countries

Abstract

A comparative inventory of regulations, policies and practices in The Netherlands, Sweden, UK, Germany and France with regard to the prevention of work stress was carried out. In each country data were collected by means of interviews with key informants and through exploring relevant documents and literature. It was found that Sweden, The Netherlands and the UK—those countries with framework legislation in the field of health and safety—recognize stress as an important health and safety topic, whereas Germany and France do not yet recognize stress as an important policy issue. However, even in the first group of countries less attention is being paid towards psychosocial work characteristics when compared with traditional health and safety issues, such as noise, machine safety and toxic agents. There is a clear lack of well-documented (national) ‘examples of good preventive practice’, even in Sweden and The Netherlands. Recommendations are being formulated concerning type of legislation, guidance and information, monitoring and risk assessment, costs and benefits, examples of good practice and European networking.     

7 Getting There from Here: Research on the Effects of Work–Family Initiatives on Work–Family Conflict and Business Outcomes

Abstract

Many employing organizations have adopted work–family policies, programs, and benefits. Yet managers in employing organizations simply do not know what organizational initiatives actually reduce work–family conflict and how these changes are likely to impact employees and the organization. We examine scholarship that addresses two broad questions: first, do work–family initiatives reduce employees’ work–family conflict and/or improve work–family enrichment? Second, does reduced work–family conflict improve employees’ work outcomes and, especially, business outcomes at the organizational level? We review over 150 peer‐reviewed studies from a number of disciplines in order to summarize this rich literature and identify promising avenues for research and conceptualization. We propose a research agenda based on four primary conclusions: the need for more multi‐level research, the necessity of an interdisciplinary approach, the benefits of longitudinal studies that employ quasi‐experimental or experimental designs and the challenges of translating research into practice in effective ways.     

Book reviews and books received

Abstract

In the field of stress research it is often assumed that social support as well as coping behaviour contributes to feelings of health and well-being. However, until now it has not been altogether clear whether a main-effect model or a buffer model was the more appropriate for explaining the role of these factors in response to stressful situations. In this paper, a research project is described in which both the direct and indirect effects of social support and coping were studied in the work situation of nurses. The results offer more support for a main-effect model than for a buffer or moderating-effect model, especially with regard to the coping strategies ‘active problem-solving’ and ‘palliative behaviour’. However, some moderating effects on nurses‘ reactions to their work situation were found for social support and for ‘comforting cognitions’ as a coping strategy.