Validation of a New Metric for Assessing the Integration of Health Protection and Health Promotion in a Sample of Small- and Medium-Sized Employer Groups

Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods

OBJECTIVES

To validate and test the dimensionality of six constructs from the Workplace Integrated Safety and Health (WISH) assessment, an instrument that assesses the extent to which organisations implement integrated systems approaches for protecting and promoting worker health, safety and well-being, in a sample of nursing homes in the USA.

DESIGN

Validation of an assessment scale using data from a cross-sectional survey.

SETTING

Nursing homes certified by the Centers for Medicaid and Medicare services in three states of the USA: Ohio, California and Massachusetts.

PARTICIPANTS

569 directors of nursing from nursing homes serving adults and with more than 30 beds participated in the study.

RESULTS

Graded response Item Response Theory (IRT) models showed that five out of six constructs were unidimensional based on balanced interpretation of model fit statistics-M2 or C2 with p value >0.05, Comparative Fit Index >0.95, lower bound of the root mean squared error of approximation 90% CI <0.06 and standardised root mean square residual <0.08. Overall measure and construct reliability ranged from acceptable to good. Category boundary location parameters indicated that items were most informative for respondents in lower range of latent scores (ie, β1, β2, β3 typically below 0). A few items were recommended to be dropped from future administrations of the instrument based on empirical and substantive interpretation.

CONCLUSIONS

The WISH instrument has utility to understand to what extent organisations integrate protection and promotion of worker health, safety and well-being; however, it is most informative in organisations that present lower scores.

Degree of Integration Between Occupational Safety and Health Programs and Wellness Programs: First-year Results From an Insurer-Sponsored Wellness Grant for Smaller Employers

OBJECTIVE

The aim of this study was to describe levels of integration between occupational safety and health (OSH) and workplace wellness programs/practices/policies ("programs") among participants in an insurer-sponsored wellness grant program.

METHODS

We analyzed survey responses about year 1 of an insurer-sponsored grant to start a wellness program from 220 small- and medium-sized employers. Responses yielded 25 indicators of OSH-wellness integration, and 10 additional indicators to summarize multiple responses.

RESULTS

At least half of the employers (N = 220) reported some level of integration within five of seven categories of OSH-wellness integration. Employers sometimes considered ergonomics, safety, or substance exposure hazards while designing their wellness program (15%) or reduced such hazards to support their wellness program (24%). Few meaningful differences were observed by employer size.

CONCLUSIONS

Although high levels of integration were unusual, some degree of integration was common for most indicator categories.

Cross-cultural adaptation of Dimensions of Corporate Well-Being Scorecard to the Brazilian Portuguese language

BACKGROUND

The integration of occupational risk management initiatives and health promotion and well-being in the workplace poses a challenge to organizations from different sectors.

OBJECTIVE

Cross-cultural adaptation of the Dimensions of Corporate Well-Being Scorecard (DCWS) to the Brazilian Portuguese language.

METHOD

The process of cross-cultural adaptation of the Dimensions of Corporate Well-Being Scorecard to the Brazilian Portuguese language evolved along six steps: translation, reconciliation, back-translation, revision by internal expert committee, revision by expert panel (pretest) and final revision.

RESULTS

The stringent protocols adopted in the present study resulted in a satisfactory and adequate instrument to analyze programs which target workers' health, safety and well-being at organizations operating in Brazil.

CONCLUSION

The Brazilian version of DCWS, entitled Questionário sobre as Dimensões do Bem-Estar Corporativo (QDBC) represents an advance in the evaluation of the effectiveness of integrated actions for health promotion and workers' well-being in different work environments.

Total Worker Health: A Small Business Leader Perspective

Total Worker Health® (TWH) frameworks call for attention to organizational leadership in the implementation and effectiveness of TWH approaches. It is especially important to study this within in the small business environment where employees face significant health, safety, and well-being concerns and employers face barriers to addressing these concerns. The purpose of this study was to gain a better understanding of how small business leaders perceive employee health, safety, and well-being in the context of their own actions. We conducted semi-structured interviews with 18 small business senior leaders and used a qualitative coding approach to analyze the transcripts to determine the frequency with which leaders discussed each code. When we asked leaders about their leadership practices for health, safety, and well-being, leaders reflected upon their business (65%), themselves (28%), and their employees (7%). Leaders rarely discussed the ways in which they integrate health, safety, and well-being. The interviews demonstrate that small business leaders care about the health of their employees, but because of the perceived value to their business, not to employees or themselves. Thus, they may lack the knowledge and skills to be successful TWH leaders. The present study supports a need for continued small business TWH leadership research.

Cross-cultural adaptation of Dimensions of Corporate Safety Scorecard to the Brazilian Portuguese language

INTRODUCTION

A broad-scoped approach to the assessment, documentation and application of health inputs at the workplace is needed to perform effective interventions, reduce occupational hazards and promote workers' health and safety. Effective efforts might thus be organized into programs and initiatives to preserve and improve the health and safety of workers.

OBJECTIVE

To perform the translation and cross-cultural adaptation of the Dimensions of Corporate Safety Scorecard for use in Brazil to broaden the scope of means to approach and measure the effectiveness of workplace safety actions.

METHODS

The translation and cultural adaptation of the Dimensions of Corporate Safety Scorecard followed recommendations applied in similar studies which establish six steps: foreword translation, reconciliation, back translation, review by internal committee, cultural evaluation of the translation by an external expert panel (pretest) and final review.

RESULTS

Adoption of the described procedure enabled a detailed analysis of possible options in case of divergences in statements between versions. Thus the quality of the results was ensured and the semantic qualities of the original version were preserved in the translation.

CONCLUSIONS

The Brazilian Portuguese version of Dimensions of Corporate Safety Scorecard, entitled "Questionário sobre Dimensões da Segurança Corporativa," obtained in the present study represents the first step in the use of this instrument for measurement of the effectiveness of health, safety and well-being actions in different work environments.

Measuring Best Practices for Workplace Safety, Health, and Well-Being: The Workplace Integrated Safety and Health Assessment

OBJECTIVE

To present a measure of effective workplace organizational policies, programs, and practices that focuses on working conditions and organizational facilitators of worker safety, health and well-being: the workplace integrated safety and health (WISH) assessment.

METHODS

Development of this assessment used an iterative process involving a modified Delphi method, extensive literature reviews, and systematic cognitive testing.

RESULTS

The assessment measures six core constructs identified as central to best practices for protecting and promoting worker safety, health and well-being: leadership commitment; participation; policies, programs, and practices that foster supportive working conditions; comprehensive and collaborative strategies; adherence to federal and state regulations and ethical norms; and data-driven change.

CONCLUSIONS

The WISH Assessment holds promise as a tool that may inform organizational priority setting and guide research around causal pathways influencing implementation and outcomes related to these approaches.

Validation and Dimensionality of the Integration of Health Protection and Health Promotion Score: Evidence From the PULSE Small Business and VA Medical Center Surveys

OBJECTIVE

To conduct validation and dimensionality analyses for an existing measure of the integration of worksite health protection and health promotion approaches.

METHODS

A survey of small to medium size employers located in the United States was conducted between October 2013 and March 2014 (N = 115). A survey of Department of Veterans Affairs (VA) administrative parents was also conducted from June to July 2014 (N = 140). Exploratory factor analysis (EFA) was used to determine the dimensionality of the Integration Score in each sample.

RESULTS

Using EFA, both samples indicated the presence of one unified factor. The VA survey indicated that customization improves the relevance of the Integration Score for different types of organizations.

CONCLUSIONS

The Integration Score is a valid index for assessing the integration of worksite health protection and health promotion approaches and is customizable based on industry.

CLINICAL SIGNIFICANCE

The Integration Score may be used as a single metric for assessing the integration of worksite health protection and health promotion approaches in differing work contexts.

Field tests of a participatory ergonomics toolkit for Total Worker Health

Growing interest in Total Worker Health® (TWH) programs to advance worker safety, health and well-being motivated development of a toolkit to guide their implementation. Iterative design of a program toolkit occurred in which participatory ergonomics (PE) served as the primary basis to plan integrated TWH interventions in four diverse organizations. The toolkit provided start-up guides for committee formation and training, and a structured PE process for generating integrated TWH interventions. Process data from program facilitators and participants throughout program implementation were used for iterative toolkit design. Program success depended on organizational commitment to regular design team meetings with a trained facilitator, the availability of subject matter experts on ergonomics and health to support the design process, and retraining whenever committee turnover occurred. A two committee structure (employee Design Team, management Steering Committee) provided advantages over a single, multilevel committee structure, and enhanced the planning, communication, and teamwork skills of participants.

Key Organizational Characteristics for Integrated Approaches to Protect and Promote Worker Health in Smaller Enterprises

OBJECTIVE

The aim of this study was to investigate relationships between worksite organizational characteristics (size, industrial sector, leadership commitment, and organizational supports) and integrated approaches to protecting and promoting worker health implemented in smaller enterprises.

METHODS

We analyzed web-based survey data of Human Resource Managers at 114 smaller enterprises (<750 employees) to identify organizational factors associated with levels of integrated approaches among their worksites.

RESULTS

The companies' mean integration score was 13.6 (SD = 9.6) of a possible 44. In multivariate analyses, having a safety committee (P = 0.035) and top leadership support for health promotion (HP) (P = 0.004) were positively associated with higher integration scores.

CONCLUSIONS

Smaller enterprises in one U.S. region have relatively low levels of implementing integrated safety and promotion approaches. Having a safety committee and leadership support for HP may be important contributors to implementing integrated approaches in smaller enterprises.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.