1. |
- Aboagye, Emmanuel, et al.
(author)
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Individual preferences for physical exercise as secondary prevention for non-specific low back pain : a discrete choice experiment
- 2017
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In: PLOS ONE. - : Public library science. - 1932-6203. ; 12:12
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Journal article (peer-reviewed)abstract
- Background: Exercise is effective in improving non-specific low back pain (LBP). Certain components of physical exercise, such as the type, intensity and frequency of exercise, are likely to influence participation among working adults with non-specific LBP, but the value and relative importance of these components remain unknown. The study's aim was to examine such specific components and their influence on individual preferences for exercise for secondary prevention of non-specific LBP among working adults. Methods: In a discrete choice experiment, working individuals with non-specific LBP answered a webbased questionnaire. Each respondent was given ten pairs of hypothetical exercise programs and asked to choose one option from each pair. The choices comprised six attributes of exercise (i.e., type of training, design, intensity, frequency, proximity and incentives), each with either three or four levels. A conditional logit regression that reflected the random utility model was used to analyze the responses. Results: The final study population consisted of 112 participants. The participants' preferred exercise option was aerobic (i.e., cardiovascular) rather than strength training, group exercise with trainer supervision, rather than individual or unsupervised exercise. They also preferred high intensity exercise performed at least once or twice per week. The most popular types of incentive were exercise during working hours and a wellness allowance rather than coupons for sports goods. The results show that the relative value of some attribute levels differed between young adults (age <= 44 years) and older adults (age <= 45 years) in terms of the level of trainer supervision required, exercise intensity, travel time to exercise location and financial incentives. For active study participants, exercise frequency (i.e., twice per week, 1.15; CI: 0.25; 2.06) influenced choice of exercise. For individuals with more than one child, travel time (i.e., 20 minutes, - 0.55; CI: 0.65; 3.26) was also an influential attribute for choice of exercise, showing that people with children at home preferred to exercise close to home. Conclusions: This study adds to our knowledge about what types of exercise working adults with back pain are most likely to participate in. The exercise should be a cardiovascular type of training carried out in a group with trainer supervision. It should also be of high intensity and preferably performed twice per week during working hours. Coupons for sports goods do not appear to motivate physical activity among workers with LBP. The findings of the study could have a substantial impact on the planning and development of exercise provision and promotion strategies to improve non-specific LBP. Providers and employers may be able to improve participation in exercise programs for adults with non-specific LBP by focusing on the exercise components which are the most attractive. This in turn would improve satisfaction and adherence to exercise interventions aimed at preventing recurrent non-specific LBP.
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2. |
- Arapovic-Johansson, Bozana, et al.
(author)
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Experience of Stress Assessed by Text Messages and Its Association with Objective Workload-A Longitudinal Study
- 2020
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:3
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Journal article (peer-reviewed)abstract
- Exploring stress trajectories in detail and over a long time may give valuable information in terms of both understanding and practice. We followed a group of primary health care employees in a randomized controlled trial. The objective was to describe their experience of stress, explore the intra-individual variability and examine the association between the experience of stress and the objective workload. Weekly text messages with a single item stress question were distributed in two time series: 12 weeks at the beginning of the trial and 26 weeks after the 6-month follow up. Aggregated objective data about workload were collected from their administration office and related to stress levels. There was a seasonal variation, with higher stress during the fall than in spring and summer. The analysis comparing high and low stress subgroups showed that the stress trajectory of a high-stress subgroup was different from that of a low-stress subgroup. Individuals with high exhaustion scores had higher odds of belonging to a subgroup of individuals with high intra-individual variability in stress experience. The objective workload was measured in two ways and was strongly associated with the stress experience. We found that the lower the productivity, the higher the feeling of stress.
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3. |
- Arapovic-Johansson, Bozana, et al.
(author)
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Participatory work place intervention for stress prevention in primary health care. A randomized controlled trial
- 2018
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In: European Journal of Work and Organizational Psychology. - : Routledge. - 1359-432X .- 1464-0643. ; 27:2, s. 219-234
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Journal article (peer-reviewed)abstract
- The aim of this study is to explore whether a participatory, organizational intervention can reduce work-related risk factors, and thereby prevent stress-related ill health. We build on the job demand-control and effort-reward imbalance models of stress. It is a two-armed randomized trial, with one primary health care unit receiving the intervention and a two-unit control group. Validated questionnaires for the assessment of psychosocial work environment and health were administered, at the baseline and at 6 and 12-month follow up. The primary outcome was job strain. Secondary outcomes were effort-reward imbalance, exhaustion, sleep, and recovery. Group-level objective data on workload and data about relevant processes during the study were continuously collected. The changes in the intervention group with regard to job strain, effort-reward imbalance, exhaustion, sleep and recovery were not statistically different from changes in the control group. For the non-exhausted employees though, reward was significantly higher at follow up compared to baseline, but only in the intervention group. An important piece of information is that the objective workload was statistically significantly higher in the intervention group throughout the study. Not all the components of the intervention were implemented as intended. Context and process information, such as objective data and implementation fidelity are necessary for a valid interpretation of the results.
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4. |
- Arapovic-Johansson, Bozana, et al.
(author)
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Process Evaluation of a Participative Organizational Intervention as a Stress Preventive Intervention for Employees in Swedish Primary Health Care
- 2020
-
In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:19
-
Journal article (peer-reviewed)abstract
- This study is a process evaluation of a trial examining the effects of an organizational intervention (Productivity Measurement and Enhancement System or ProMES) on employee stress. The aims were to explore the implementation process and fidelity to the intervention guidelines, examine the influence of contextual factors (hindrances and facilitators) and explore participants experience of working with ProMES. We used the UK Medical Research Council (MRC) guidance to guide the process evaluation. The recruitment, reach and dose delivered were satisfactory and participation high. The employees felt ProMES clarified priorities, gave control and increased participation in decision-making. However, difficulty in obtaining statistical productivity data from the central administration office (a central feature of the intervention) hindered full implementation and regular feedback meetings. Staffing shortages interfered with the implementation process, while having seven design teams and one consultant prevented all occupational groups from working simultaneously. A detailed examination of access to necessary organizational data should be undertaken before implementing ProMES. We recommend a better introduction for new employees, more work on design and packaging and giving employees more training in how to use the software program. The study contributes to our understanding of process evaluations in research into organizational stress management interventions.
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5. |
- B Jensen, Irene, et al.
(author)
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Promoting Evidence-Based Practice for Improved Occupational Safety and Health at Workplaces in Sweden. Report on a Practice-Based Research Network Approach.
- 2020
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:15
-
Journal article (peer-reviewed)abstract
- Despite the rapid growth in research and R&D expenditures, the translation of research into practice is limited. One approach to increase the translation and utilization of research is practice based research networks. With the aim of strengthening evidence-based practice (EBP) within occupational health services in Sweden (OH-Services), a practice-based research network (PBRN-OSH) was developed. The PBRN-OSH includes researchers and representatives from end-users. This paper reports on the development, outputs and lessons learned in the PBRN-OSH. The PBRN-OSH resulted in several practice-based research projects as well as different measures to ensure EBP in OSH such as the governmentally sanctioned national guidelines for the OH-services. Moreover, results show that the competence in EBP increased among practitioners at the OH-services. Conducting research in a PBRN is more resource demanding; however, this does not imply that it is less cost effective. To succeed in increasing the utility of research findings via PBRN, resources must be invested into an infrastructure that supports collaboration in the PBRN, including costs for a variety of means of dissemination. Further, translation activities need to be included in academic career paths and reward systems if a major improvement in the impact and return of investments from research is to be expected.
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6. |
- Bergsten, Eva L., et al.
(author)
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Daily shoulder pain among flight baggage handlers and its association with work tasks and upper arm postures on the same day
- 2017
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In: Annals of Work Exposures and Health. - : Oxford University Press (OUP). - 2398-7308 .- 2398-7316. ; 61:9, s. 1145-1153
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Journal article (peer-reviewed)abstract
- Objectives: This study of flight baggage handlers aimed at examining the extent to which shoulder pain developed during single work shifts, and whether a possible development was associated with biomechanical exposures and psychosocial factors during the same shift.Methods: Data were collected during, in total, 82 work shifts in 44 workers. Right and left shoulder pain intensity was rated just before and just after the shift (VAS scale 0-100 mm). Objective data on time in extreme and time in neutral upper arm postures were obtained for the full shift using accelerometers, and the baggage handlers registered the number of aircrafts handled in a diary. During half of the shift, workers were recorded on video for subsequent task analysis of baggage handling. Influence at work and support from colleagues were measured by use of Copenhagen Psychosocial Questionnaire (COPSOQ). Associations between exposures and the increase in pain intensity during the shift (daily pain) were analysed for the right and left shoulder separately using Generalized Estimating Equations (GEE).Results: Daily pain was observed in approximately one third of all shifts. It was significantly associated with the number of aircrafts handled for both the right and left shoulder. In multivariate models including both biomechanical exposures and the psychosocial factors influence at work and support from colleagues, aircrafts handled was still significantly associated with daily pain in both shoulders, and so was influence and support, however in opposite directions.Conclusions: Daily pain was, in general, associated with biomechanical exposures during the same shift and with general influence and support in the job. In an effort to reduce pain among flight baggage handlers, it may therefore be justified to consider a reduction of biomechanical exposures during handling of aircrafts, combined with due attention to psychosocial factors at work.
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7. |
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8. |
- Bergsten, Eva L., 1969-, et al.
(author)
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Evaluation of an ergonomic intervention in Swedish flight baggage handlers
- 2016
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Conference paper (peer-reviewed)abstract
- Background: Flight baggage handling is a worldwide occupation where baggage and cargo is sorted, loaded and unloaded on and off aircrafts. With the ultimate purpose of reducing and preventing musculoskeletal disorders among flight baggage handlers in Sweden, the Vocational Training and Working Environment Council (TYA) - a council formed by employers and unions in the Swedish transportation sector – initiated and implemented a project (2010-2012). This project revealed that ergonomics equipment was not used adequately, and this was considered a major factor of concern. Therefore, a training program was initiated 2014 in one handling company, aiming to improve ergonomics, behavior and attitudes. We evaluated the implementation process with regard to process items, intermediate outcomes, barriers and facilitators; for the purpose of gaining knowledge that could facilitate successful implementation in other handling companies. Methods: A mixed methods design was applied, based on qualitative and quantitative data. We evaluated six process items, recruitment, context, reach, dose delivered, dose received and satisfaction; intermediate outcomes of the intervention; skills, confidence and behaviour in the workforce; barriers and facilitators for successful implementation. Data was retrieved using company data, course evaluations, web questionnaires, and telephone interviews with company ‘observers’ and key persons. Preliminary results: The implementation process was judged to be feasible with regard to some of the process items. According to the informants, work place behaviour related to use of equipment had, however, not changed after the training period. Reported barriers were, 1) insufficient time and leader support for practicing new procedures during and after the training, 2) simultaneous reorganization of teams and work tasks, 3) lack of follow-up of the training, which would have supported good performance according to the informants. Conclusion: The implementation process was hampered by barriers, some of which could be addressed in future ergonomics training programs in other baggage handling companies.
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9. |
- Bergsten, Eva L., 1969-, et al.
(author)
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Implementation of an ergonomics intervention in a Swedish flight baggage handling company : a process evaluation
- 2018
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:3
-
Journal article (peer-reviewed)abstract
- Objective: To conduct a process evaluation of the implementation of an ergonomics training program aimed at increasing the use of loading assist devices in flight baggage handling.Methods: Feasibility (recruitment, reach, context, dose delivered, dose received, satisfaction); intermediate outcomes (skills, confidence and behaviors); and barriers and facilitators of the training intervention were assessed by qualitative and quantitative methods.Results: Implementation proved feasible regarding dose delivered, dose received and satisfaction. Confidence among participants in the training program in using and talking about devices, observed use of devices among colleagues, and internal feedback on work behavior increased significantly (p<0.01). Main facilitators were self-efficacy, motivation, and perceived utility of training among the trainees. Barriers included lack of peer support, opportunities to observe and practice behaviors, and follow-up activities; as well as staff reduction and job insecurity.Conclusions: In identifying important barriers and facilitators for a successful outcome, our study can help supporting the effectiveness of future interventions. Our results show that barriers caused by organizational changes may likely be alleviated by recruiting motivated trainees and securing strong organizational support for the implementation.
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10. |
- Bergsten, Eva L
(author)
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Working conditions and musculoskeletal disorders in flight baggage handling
- 2017
-
Doctoral thesis (other academic/artistic)abstract
- Introduction: Baggage handling is considered to be a heavy manual handling job including biomechanical exposures suspected of increasing the risk for musculoskeletal disorders. Aims: To document low back pain (LBP), shoulder pain (SP), and physical and psychosocial factors in baggage handlers, and to evaluate the implementation of an ergonomic intervention aiming to increase the use of loading assist devices. Methods: A questionnaire was utilized to characterize pain and psychosocial work conditions in 525 baggage handlers. The postures of 55 baggage handlers during 114 shifts were measured using inclinometry, half shift video-recordings were made for subsequent task analysis, and the number of aircraft handled was registered. Associations for psychosocial and biomechanical exposures with pain were assessed using regression analyses. An ergonomic intervention was implemented and evaluated using questionnaires and repeated interviews. Feasibility, intermediate outcomes, barriers and facilitators were assessed. Results: The prevalence rates of reported LBP and SP were 70% and 60%, respectively. Pain interfering with work (LBP - 30% and SP - 18%) and high pain intensity (LBP - 34% and SP - 28%) were associated with poor psychosocial working conditions. Extreme postures with arms elevated >60° occurred for 6.4% of the total time, and in trunk flexion >60° for 2.1% total time. In contrast, 71% of the total time was spent in a neutral trunk posture. The 90th percentile trunk forward flexion was 34.1°. Daily shoulder pain increased in approximately one-third of all shifts and was positively associated with extreme work posture and the number of aircraft handled; this association was modified by influence and support. The intervention was delivered as planned, and dose received and satisfaction were rated as high. Motivated trainees facilitated implementation while lack of manager support, opportunities to observe and practice behaviors, follow-up activities, staff reduction, and job insecurity were barriers. Conclusion: The high prevalence rates of LBP and SP in baggage handlers were associated with psychosocial exposures, and daily shoulder pain was associated with higher biomechanical exposure. Barriers to implementation can be minimized by recruiting motivated trainees, securing strong organizational support, and carrying out follow-up activities.
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11. |
- Boström, Maria, et al.
(author)
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Health and work environment among female and male Swedish elementary school teachers - A cross-sectional study
- 2020
-
In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVES: Changes in teachers' work situation in Sweden since the 1990s may have contributed to an increase in common mental disorders (CMDs) and burnout. However, there is a lack of research in this field. The aim was to describe how Swedish elementary school teachers experience their health, organizational and social work environment, and the psychosocial safety climate at the workplace, and especially differences and similarities between female and male teachers.MATERIALS AND METHODS: Data were collected with the COPSOQ, OLBI, UWES and PSC-12 from 478 elementary teachers, 81.0% of them women, from twenty schools. The response rate was 96.4%.RESULTS: Teachers reported relatively good general health but experienced high stress, high work pace and emotional demands, low influence at work and a poor psychosocial safety climate. These factors were especially prominent among female teachers. Both women and men experienced good development possibilities and high work engagement.CONCLUSIONS: The results of this study can help us to develop a more sustainable work environment for female and male teachers. A more sustainable work environment might attract more people to the profession and incentivize existing teachers to remain in the profession.
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12. |
- Bramberg, Elisabeth Bjork, et al.
(author)
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Development of evidence-based practice in occupational health services in Sweden : a 3-year follow-up of attitudes, barriers and facilitators
- 2017
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In: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 90:4, s. 335-348
-
Journal article (peer-reviewed)abstract
- The Swedish government initiated an investigation of how to secure and develop the competence of the occupational health services. The primary aim of the present study was to investigate whether the development of evidence-based practice (EBP) in the Swedish occupational health services in relation to attitudes, knowledge and use improved during the first 3 years of the government's initiative. The study has a mixed methods design combining questionnaires and interviews with data collection at baseline and at 3-year follow-up. The response rate was 66% at baseline and 63% at follow-up. The results show that practitioners' knowledge of EBP was moderate at baseline and improved at follow-up (p = 0.002; 95% CI 0.01; 0.21). Practitioners experienced lower levels of organizational and managerial support for EBP at follow-up (p < 0.001; 95% CI 0.18; 0.38). The results revealed that managers viewed responsibility for implementing EBP as a matter for individual practitioners rather than as an organizational issue. Occupational health service managers and practitioners are generally positive to EBP. However, the findings emphasize the need to educate managers in how to support EBP at the organizational level by creating an infrastructure for EBP in the OHS.
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13. |
- Brämberg, Elisabeth Björk, et al.
(author)
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Facilitators, barriers and ethical values related to the coordination of return-to-work among employees on sick leave due to common mental disorders : a protocol for a qualitative study (the CORE-project)
- 2019
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:9
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Journal article (peer-reviewed)abstract
- Introduction Diagnoses related to common mental disorders such as anxiety, depression, adjustment disorders and stress-related disorders are one of the leading causes of long-term sick leave for both women and men in Organisation for Economic Co-operation and Development countries. To increase the rate of return-to-work workplace involvement in a coordinated return-to-work process has been included in recent best practice guidelines. This form of cooperation is a complex process, involving political structures and a wide range of stakeholders. The study's first aim is to describe facilitators and barriers to the coordination of return-to-work from the perspectives of: (A) employees on sick leave due to common mental disorders, (B) employers, (C) rehabilitation coordinators, (D) physicians and (E) other stakeholders. The second aim is to identify ethical issues that arise in the coordination of return-to-work and analyse how these can be resolved. Methods and analysis The study has a qualitative design using interviews with employees on sick leave due to common mental disorders, employers, rehabilitation coordinators, physicians and other stakeholders. The study is conducted in the Swedish primary healthcare. Employees, employers and rehabilitation coordinators are recruited via primary healthcare centres. Rehabilitation coordinators receive information about the study and those who consent to participation are asked to recruit employees and employers. Interview guides have been developed from the consolidated framework for implementation research and ethical values and norms found in Swedish healthcare, social services and workplace legislation. Data will be analysed with qualitative content analysis reflecting manifest and latent content, and ethical issues will be analysed by means of reflective equilibrium methodology. Ethics and dissemination The study was approved by the Regional Ethical Review Board in Stockholm, Sweden (Reg.no 2018/677-31/2 and 2018/2119-32). The findings will be disseminated through publication in scientific journals, social media, seminars and national and international conferences.
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14. |
- Casely-Hayford, Jeffrey, et al.
(author)
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Enculturating a Protective Professional Community - Processes of Teacher Retention in a Swedish Hard-to-Staff School
- 2024
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In: Education Sciences. - : MDPI. - 2227-7102. ; 14:1
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Journal article (peer-reviewed)abstract
- This study presented a positive deviant case: a Swedish hard-to-staff school which has had a low rate of teacher turnover over time. In line with the purpose of studying positive deviance in organisations, our exploratory inquiry was geared towards understanding how and why 'at-risk' teachers, i.e., teachers who teach in subjects which are known to have high levels of staffing difficulties in Sweden, stayed at this particular school. Using a modified grounded theory approach, our results suggested that teachers remained at the school due to being embedded in a protective professional community that was enculturated by different expressions of collegiality. Finally, these findings are discussed in relation to the theoretical concepts of teachers' job embeddedness and social capital.
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15. |
- Casely-Hayford, Jeffrey, et al.
(author)
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What makes teachers stay? : A cross-sectional exploration of the individual and contextual factors associated with teacher retention in Sweden.
- 2022
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In: Teaching and Teacher Education. - : Elsevier. - 0742-051X .- 1879-2480. ; 113
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Journal article (peer-reviewed)abstract
- This cross-sectional study aimed to identify individual and contextual factors associated with Swedish teachers' intention to remain in the profession. A sample of 5903 elementary-year teachers completed a questionnaire between 2004 and 2011 assessing their health and perception of individual and contextual factors at work. The findings showed that teachers' intention to remain in the profession is mainly explained by individual factors, predominantly by teachers' perceived health state, work motivation and collegial support. The main implication is the importance of teachers' perceived health state for their intention to remain, underscoring the importance of a health promoting work environment in schools. (c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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16. |
- Elinder, Liselotte Schäfer, et al.
(author)
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IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) - study protocol for a cluster-randomized trial.
- 2021
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 21:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5-7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents' risk of developing type 2 diabetes.METHODS: IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents' feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability.DISCUSSION: This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools.TRIAL REGISTRATION: Registered prospectively at ClinicalTrials.gov ID: NCT04984421 , registered July 30, 2021.
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17. |
- Hagströmer, Maria, et al.
(author)
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A holistic approach in measuring occupational physical activity : challenges and potentials
- 2015
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Conference paper (peer-reviewed)abstract
- Considering that adults spend a considerable proportion of their day at work, employment is a key determinant for daily PA. However, specifics of how and under what circumstances occupational PA (OPA) influences total PA, including other PA domains (e.g. leisure time PA, transport), are unclear. Little is also known about OPA patterns in different occupational groups and how OPA patterns can be changed, among for example those who have mostly sedentary occupations. One important issue concerns if working in a standing position and the use of dynamic chairs has any effect on OPA levels, for instance among office workers. This despite the fact that ergonomists advocate sedentary workers to work in a standing position or use an “active sitting” approach using “dynamic” chairs. To be able to give recommendations regarding PA to employees with different OPA, more insight is needed on how to optimally measure OPA. To move the field forward, knowledge should be combined from different disciplines involved in measuring OPA. Therefore, we want to initiate an interdisciplinary discussion on appropriate measurements of OPA. The aim of the symposium is to present a holistic approach to measuring OPA by combining our expertise in the field of PA and health, measurement of PA using objective measures and self-reported measures, ergonomics, occupational health and public health science.
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18. |
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19. |
- Holmlund, Lisa, et al.
(author)
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Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders : a qualitative study
- 2023
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In: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 45:13, s. 2118-2127
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Journal article (peer-reviewed)abstract
- PurposeIdentify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs).Material and methods41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values.ResultsFive themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders’ interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities.ConclusionThe main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator’s professional role, and facilitate ongoing boundary work between stakeholders.
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20. |
- Karlsson, Ida, et al.
(author)
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Ethical challenges from a problem-solving intervention with workplace involvement: a qualitative study among employees with common mental disorders, first-line managers, and rehabilitation coordinators
- 2024
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In: International Journal of Qualitative Studies on Health and Well-being. - : TAYLOR & FRANCIS LTD. - 1748-2623 .- 1748-2631. ; 19:1
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Journal article (peer-reviewed)abstract
- Purpose This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n=6), employees (n=13), and first-line managers (n=8). Reflexive thematic analysis was used to analyse and interpret themes. Results A main theme was identified “the workplace and healthcare hold different organizational value logics” and four sub-themes: “the PSI-WPI challenged the organizational goals and values of the workplace and healthcare”, “the PSI-WPI challenged organizational values on fairness”, “the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators” and “the PSI-WPI introduced a need for the employee to juggle the employee and patient roles”. Conclusion Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders’ roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.
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21. |
- Karlsson, Ida, et al.
(author)
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Experiences of participating in a problem-solving intervention with workplace involvement in Swedish primary health care: a qualitative study from rehabilitation coordinator's, employee's, and manager's perspectives
- 2023
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In: BMC Public Health. - : BMC. - 1471-2458. ; 23:1
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Journal article (peer-reviewed)abstract
- BackgroundWork-directed interventions that include problem-solving can reduce the number of sickness absence days. The effect of combining a problem-solving intervention with involvement of the employer is currently being tested in primary care in Sweden for employees on sickness absence due to common mental disorders (PROSA trial). The current study is part of the PROSA trial and has a two-fold aim: 1) to explore the experiences of participating in a problem-solving intervention with workplace involvement aimed at reducing sickness absence in employees with common mental disorders, delivered in Swedish primary health care, and 2) to identify facilitators of and barriers to participate in the intervention. Both aims targeted rehabilitation coordinators, employees on sickness absence, and first-line managers.MethodsData were collected from semi-structured interviews with participants from the PROSA intervention group; rehabilitation coordinators (n = 8), employees (n = 13), and first-line managers (n = 8). Content analysis was used to analyse the data and the Consolidated Framework for Implementation Research was used to group the data according to four contextual domains. One theme describing the participation experiences was established for each domain. Facilitators and barriers for each domain and stakeholder group were identified.ResultsThe stakeholders experienced the intervention as supportive in identifying problems and solutions and enabling a dialogue between them. However, the intervention was considered demanding and good relationships between the stakeholders were needed. Facilitating factors were the manual and work sheets which the coordinators were provided with, and the manager being involved early in the return-to-work process. Barriers were the number of on-site meetings, disagreements and conflicts between employees and first-line managers, and symptom severity.ConclusionsSeeing the workplace as an integral part of the intervention by always conducting a three-part meeting enabled a dialogue that can be used to identify and address disagreements, to explain CMD symptoms, and how these can be handled at the workplace. We suggest allocating time towards developing good relationships, provide RCs with training in handling disagreements, and additional knowledge about factors in the employee's psychosocial work environment that can impair or promote health to increase the RCs ability to support the employee and manager.
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22. |
- Karlsson, Ida, et al.
(author)
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Is a Problem-Solving Intervention with Workplace Involvement for Employees on Sickness Absence Due to Common Mental Disorders More Effective, than Care as Usual, in Reducing Sickness Absence Days? Results of a Cluster-Randomised Controlled Trial in Primary Health Care
- 2024
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In: JOURNAL OF OCCUPATIONAL REHABILITATION. - : Springer. - 1053-0487 .- 1573-3688.
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Journal article (peer-reviewed)abstract
- PurposeThe aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up.MethodsWe conducted a cluster-randomised controlled trial including 197 employees blinded to allocation (85 PSI-WPI and 112 CAU). As sickness absence data was skewed and over-dispersed, generalised estimating equations was used to enable a comparison between the intervention and control group for each month of the follow-up period.ResultsThe median number of sickness absence days over the 18-month follow-up was 78 days, inter-quartile range (IQR) 18-196 for employees receiving PSI-WPI and 64 days, IQR 18-161 for employees receiving CAU. The time x group generalised estimating equations analysis showed no statistically significant difference in sickness absence days per month.ConclusionThe addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.Trial registration.The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.ConclusionThe addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.Trial registration.The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.ConclusionThe addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.Trial registration.The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.
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23. |
- Keus van de Poll, Marijke, Fil.Dr, 1984-, et al.
(author)
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Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress
- 2020
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:14
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Journal article (peer-reviewed)abstract
- The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI;n= 41) or care as usual (CAU;n= 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer's perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average euro101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer's perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.
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24. |
- Keus van de Poll, Marijke, Doktorand, 1984-, et al.
(author)
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Preventing sickness absence among employees with common mental disorders or stress-related symptoms at work : a cluster randomised controlled trial of a problem-solving-based intervention conducted by the Occupational Health Services
- 2020
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In: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 77:7, s. 454-461
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Journal article (peer-reviewed)abstract
- Objectives Common mental disorders (CMDs) are among the main causes of sickness absence and can lead to suffering and high costs for individuals, employers and the society. The occupational health service (OHS) can offer work-directed interventions to support employers and employees. The aim of this study was to evaluate the effect on sickness absence and health of a work-directed intervention given by the OHS to employees with CMDs or stress-related symptoms.Methods Randomisation was conducted at the OHS consultant level and each consultant was allocated into either giving a brief problem-solving intervention (PSI) or care as usual (CAU). The study group consisted of 100 employees with stress symptoms or CMDs. PSI was highly structured and used a participatory approach, involving both the employee and the employee’s manager. CAU was also work-directed but not based on the same theoretical concepts as PSI. Outcomes were assessed at baseline, at 6 and at 12 months. Primary outcome was registered sickness absence during the 1-year follow-up period. Among the secondary outcomes were self-registered sickness absence, return to work (RTW) and mental health.Results A statistical interaction for group × time was found on the primary outcome (p=0.033) and PSI had almost 15 days less sickness absence during follow-up compared with CAU. Concerning the secondary outcomes, PSI showed an earlier partial RTW and the mental health improved in both groups without significant group differences.Conclusion PSI was effective in reducing sickness absence which was the primary outcome in this study.
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25. |
- Kwak, Lydia, et al.
(author)
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A randomized controlled trial in schools aimed at exploring mechanisms of change of a multifaceted implementation strategy for promoting mental health at the workplace
- 2022
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In: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 17:1
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Journal article (peer-reviewed)abstract
- Background: This study will explore implementation mechanisms through which a single implementation strategy and a multifaceted implementation strategy operate to affect the implementation outcome, which is fidelity to the Guideline For The Prevention of Mental Ill Health within schools. The guideline gives recommendations on how workplaces can prevent mental ill health among their personnel by managing social and organizational risks factors in the work environment. Schools are chosen as the setting for the study due to the high prevalence of mental ill health among teachers and other personnel working in schools. The study builds on our previous research, in which we compared the effectiveness of the two strategies on fidelity to the guideline. Small improvements in guideline adherence were observed for the majority of the indicators in the multifaceted strategy group. This study will focus on exploring the underlying mechanisms of change through which the implementation strategies may operate to affect the implementation outcome. Methods: We will conduct a cluster-randomized-controlled trial among public schools (n=55 schools) in Sweden. Schools are randomized (1:1 ratio) to receive a multifaceted strategy (implementation teams, educational meeting, ongoing training, Plan-Do-Study-Act cycles) or a single strategy (implementation teams, educational meeting). The implementation outcome is fidelity to the guideline. Hypothesized mediators originate from the COM-B model. A mixed-method design will be employed, entailing a qualitative study of implementation process embedded within the cluster-randomized controlled trail examining implementation mechanisms. The methods will be used in a complementary manner to get a full understanding of the implementation mechanisms. Discussion: This implementation study will provide valuable knowledge on how implementation strategies work (or fail) to affect implementation outcomes. The knowledge gained will aid the selection of effective implementation strategies that fit specific determinants, which is a priority for the field. Despite recent initiatives to advance the understanding of implementation mechanisms, studies testing these mechanisms are still uncommon. Trial registration: ClinicalTrials.org dr.nr 2020-01214.
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26. |
- Kwak, Lydia, et al.
(author)
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Associations between physical activity, fitness, and academic achievement.
- 2009
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In: Journal of Pediatrics. - : Elsevier BV. - 0022-3476 .- 1097-6833. ; 155:6, s. 914-918.e1
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To explore the associations between objectively assessed intensity levels of physical activity and academic achievement and test whether cardiovascular fitness mediates the association between physical activity and academic achievement.STUDY DESIGN: Cross-sectional data were gathered in Swedish 9th-grade students (n = 232; mean age = 16 years; 52% girls). School grades, pubertal phase, skinfold thickness, cardiovascular fitness, and physical activity were measured objectively. Mother's education, family structure, and parental monitoring were self-reported. Data were analyzed with linear regression analyses.RESULTS: After controlling for confounding factors, academic achievement was associated with vigorous physical activity in girls (beta = .30, P < .01; explained variance of the model 26%), which remained after inclusion of fitness (beta = .23, P < .05; explained variance 29%). The association was not mediated by fitness. In boys, academic achievement was associated with pubertal phase (beta = .25, P < .05). After inclusion of fitness, it was only associated with fitness (beta = .25, P < .05; explained variance of the model 30%).CONCLUSION: In girls, academic achievement was associated with vigorous physical activity and not mediated by fitness, whereas in boys only fitness was associated with academic achievement. Further studies are necessary to investigate the potential longitudinal effect of vigorous physical activity on academic achievement, the role of fitness herein and the implications of these findings for schools.
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27. |
- Kwak, Lydia, et al.
(author)
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Developing a practice guideline for the occupational health services by using a community of practice approach : A process evaluation of the development process
- 2017
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 17:1
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Journal article (peer-reviewed)abstract
- Background: One way to facilitate the translation of research into the occupational health service practice is through clinical practice guidelines. To increase the implementability of guidelines it is important to include the end-users in the development, for example by a community of practice approach. This paper describes the development of an occupational health practice guideline aimed at the management of non-specific low back pain (LBP) by using a community of practice approach. The paper also includes a process evaluation of the development providing insight into the feasibility of the process. Methods: A multidisciplinary community of practice group (n = 16) consisting of occupational nurses, occupational physicians, ergonomists/physical therapists, health and safety engineers, health educators, psychologists and researchers from different types of occupational health services and geographical regions within Sweden met eleven times (June 2012-December 2013) to develop the practice guideline following recommendations of guideline development handbooks. Process-outcomes recruitment, reach, context, satisfaction, feasibility and fidelity were assessed by questionnaire, observations and administrative data. Results: Group members attended on average 7.5 out of 11 meetings. Half experienced support from their workplace for their involvement. Feasibility was rated as good, except for time-scheduling. Most group members were satisfied with the structure of the process (e.g. presentations, multidisciplinary group). Fidelity was rated as fairly high. Conclusions: The described development process is a feasible process for guideline development. For future guideline development expectations of the work involved should be more clearly communicated, as well as the purpose and tasks of the CoP-group. Moreover, possibilities to improve support from managers and colleagues should be explored. This paper has important implications for future guideline development; it provides valuable information on how practitioners can be included in the development process, with the aim of increasing the implementability of the developed guidelines.
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28. |
- Kwak, Lydia, et al.
(author)
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Implementation of the Swedish Guideline for Prevention of Mental ill-health at the Workplace : study protocol of a cluster randomized controlled trial, using multifaceted implementation strategies in schools
- 2019
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In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 19:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Given today's high prevalence of common mental disorders and related sick leave among teachers, an urgent need exists for a more systematic approach to the management of social and organizational risk factors within schools. In 2015, we launched the first Swedish occupational health guideline to support a structured prevention of these risks at the workplace. The existence of guidelines does however not guarantee their usage, as studies show that guidelines are often underused. Knowledge is therefore needed on effective implementation strategies that can facilitate the translation of guidelines into practice. The primary aim of the randomized waiting list-controlled trial described in this study protocol is to compare the effectiveness of a multifaceted implementation strategy versus a single implementation strategy for implementing the Guideline for the prevention of mental ill-health at the workplace within schools. The effectiveness will be compared regarding the extent to which the recommendations are implemented (implementation effectiveness) and with regard to social and organisational risk factors for mental ill-health, absenteeism and presenteeism (intervention effectiveness).METHODS: The trial is conducted among primary schools of two municipalities in Sweden. The single implementation strategy is an educational strategy (an educational meeting). The multifaceted strategy consists of the educational meeting, an implementation team and a series of workshops. The outcome measure of implementation effectiveness is guideline adherence. The primary outcome of intervention effectiveness is exhaustion. Secondary outcomes include demands at work, work organization and job contents, interpersonal relations and leadership, presenteeism, work performance, recovery, work-life balance, work-engagement, self-reported stress, self-perceived health, sickness absence and psychosocial safety climate. Process outcomes as well as barriers and facilitators influencing the implementation process are assessed. Data will be collected at baseline, 6, 12, 18 and 24 months by mixed methods (i.e. survey, focus-group interviews, observation).DISCUSSION: The study described in this protocol will provide valuable knowledge on the effectiveness of implementation strategies for implementing a guideline for the prevention of common mental disorders within schools. We hypothesize that successful implementation will result in reductions in school personnel's perceived social and organizational risk factors, mental ill-health and sick-leave.TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03322839 (trial registration: 09/19/2017).
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29. |
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30. |
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31. |
- Svärd, Veronica, et al.
(author)
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Collaboration in the return-to-work process after sick leave due to common mental disorders : a qualitative study of stakeholders' views on goals and roles
- 2024
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
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Journal article (peer-reviewed)abstract
- BackgroundThis study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders’ roles and responsibilities in relation to these goals.MethodsInterviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted.ResultsThree main themes and overarching goals when collaborating on RTW were identified. In the first theme, ‘creating an informative environment’, all stakeholders emphasised clear roles and responsibilities. The second theme, ‘striving for consensus in an environment of negotiations’, addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders’ goals, roles and responsibilities in collaboration. The third theme identified goals for ‘creating a supportive environment’ for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers.ConclusionsCompeting goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.
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32. |
- Thurston, Charlotte, et al.
(author)
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Mobile health to promote physical activity in people post stroke or transient ischemic attack : study protocol for a feasibility randomised controlled trial
- 2023
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In: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND– Let’s get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.Methods: One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.Discussion: We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.
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33. |
- Toropova, Anna, et al.
(author)
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Effectiveness of a multifaceted implementation strategy for improving adherence to the guideline for prevention of mental ill-health among school personnel in Sweden : a cluster randomized trial
- 2022
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In: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 17:1
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Journal article (peer-reviewed)abstract
- Background: There is limited research on prevention of mental ill-health of school personnel and the systematic management of school work environments. The aim of this study was to assess the effectiveness of implementing the guideline recommendations for the prevention of mental ill-health in schools, in particular, whether there was a difference in adherence to guideline recommendations between a multifaceted (group 1) and single implementation strategy (group 2) from baseline to 6 and to 12 months. Method: We conducted a cluster-randomized controlled trial with a 6- and 12-month follow-up. Data was collected from nearly 700 participants in 19 Swedish schools. Participants were school personnel working under the management of a school principal. The single implementation strategy consisted of one educational meeting, while the multifaceted implementation strategy comprised an educational meeting, an ongoing training in the form of workshops, implementation teams and Plan-Do-Study-Act cycles. Adherence was measured with a self-reported questionnaire. Generalized Linear Mixed Models were used to assess the difference between groups in adherence to the guideline between baseline, 6-, and 12-months follow-up. Results: There were no statistically significant differences between the groups in improvements in adherence to the guideline between baseline, 6-, and 12-months follow-up. However, among those schools that did not undergo any organizational changes during the 12 months of the study significant differences between groups were observed at 12 months for one of the indicators. Conclusions: The multifaceted strategy was no more effective than the single strategy in improving guideline adherence. There are some limitations to the study, such as the measurement of the implementation outcome measure of adherence. The outcome measure was developed in a systematic manner by the research team, assessing specific target behaviors relevant to the guideline recommendations, however not psychometrically tested, which warrants a careful interpretation of the results. Trial registration: ClinicalTrials.gov, 150571. Registered 12 September 2017.
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