Evaluating the impact of the live healthy, work healthy program on organizational outcomes: A randomized field experiment

The prevalence of chronic health conditions is increasing, with over half the current workforce attempting to manage one or more chronic conditions. The Live Healthy, Work Healthy (LHWH) program is a version of the Chronic Disease Self-Management Program translated to the workplace, with the goal of improving and sustaining the health, well-being, and productivity of employees living with chronic health conditions. Using organizational support theory as a theoretical framework and a clustered randomized controlled trial design, this article demonstrates how the LHWH program positively impacts work-related quality of life, orientations toward the organization, and organizational cognitions and behaviors. Participants in the program experienced increases in perceived organizational support (POS), with a large intervention effect. Direct intervention effects were also found for burnout, work engagement, work ability, affective organizational commitment, and organizational citizenship behaviors. Within-person changes in POS during the intervention was a key mechanism through which participants of the program experienced changes in organizationally relevant outcomes. Finally, offering the program on work time strengthened these effects indirectly through greater changes in POS during the intervention period. This article provides evidence to researchers and organizational decision-makers that offering the LHWH program not only improves the health and well-being of employees but also improves important organizational outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Occupational Stress and Burnout in the Fire Service: Examining the Complex Role and Impact of Sleep Health

The occupational stress inherent in firefighting poses both physiological and psychological risks to firefighters that have been found to possess a reciprocal nature. That is, the nature of these relationships in terms of indicator and impact are elusive, especially as it relates to sleep health (e.g., quality, quantity, hygiene, etc.) as a specific physiological risk and burnout as a specific psychological risk. A series of mediation models were assessed to examine the reciprocal relationships between occupational stress, burnout, and sleep health in a sample of 161 career firefighters. The mediation models confirmed reciprocity among the variables in so much that relationships were best described by the underlying mechanism at work. Comprehensive assessments of both subjective and objective markers of sleep health should be incorporated into firefighter research to supplement behavioral health assessments and interventions, especially related to burnout and occupational stress.

Stress, burnout and diminished safety behaviors: An argument for Total Worker Health® approaches in the fire service

INTRODUCTION

Firefighting is stressful work, which can result in burnout. Burnout is a safety concern as it can negatively impact safety outcomes. These impacts are not fully understood within the fire service. Further, the fire service needs support that safety strategies are needed to protect and promote the health and wellbeing of firefighters.

METHODS

Structural equation modeling was completed to examine a hypothesized model that linked stress and burnout to diminished safety behavior outcomes among a sample of career firefighters.

RESULTS

Findings support a full mediation model. Firefighter stress perceptions were positively associated with burnout and burnout was negatively associated with safety compliance behavior, personal protective equipment behavior, safe work practices, and safety citizenship behavior.

CONCLUSIONS

These results illustrate the negative impact of health impairment on firefighter safety behaviors. Practical Applications: These outcomes suggest that interventions aimed at protecting and promotion firefighter health are needed. Total Worker Health® (TWH) approaches may provide the framework for these interventions.

Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters

Traditionally, safety-related research on firefighting has focused on fires and fireground smoke as the primary source of non-fatal firefighter injury. However, recent research has found that overexertion and musculoskeletal disorders may be the primary source of firefighter injury. This study aimed to provide an update on injury occurrence among career firefighters. Injury data were collected over a two-year period from two large metropolitan fire departments in the U.S. Injury data were categorized based on the Bureau of Labor Statistics’ Occupational Injury and Illness Classification System. Cross-tabulations and Chi-square tests were used to determine the primary causes of injury, as well as the injury region. Between the two fire departments, there were 914 firefighters included in the analysis. The median age was 40.7 years old with those aged 40–49 as the largest age group for injury cases (38.3%). The most frequently reported cause of injury was ‘overexertion and bodily reaction’ (n = 494; 54.1%). The most reported injury region was in ‘multiple body parts’ (n = 331; 36.3%). To prevent subsequent musculoskeletal disorders that may arise due to overexertion, initiatives that promote enhanced fitness and ergonomics based on an analysis of the physical demands of firefighting are suggested.

Translating CDSMP to the Workplace: Results of the Live Healthy Work Healthy Program

PURPOSE

Report the results of a randomized, controlled trial of Live Healthy, Work Healthy (LHWH), a worksite translation of the Chronic Disease Self-Management Program (CDSMP).

DESIGN

14 worksites were randomly assigned to LHWH, standard CDSMP (usual care) or no-intervention (control) group.

SETTING

The diverse set of work organizations centered around a rural community in SE US.

SUBJECTS

411 participants completed baseline data with 359 being included in the final analyses.

INTERVENTION

LHWH had been adapted to fit the unique characteristics of work organizations. This translated program consists of 15 sessions over 8 weeks and was facilitated by trained lay leaders.

MEASURES

The primary outcomes including health risk, patient-provider communication, quality of life, medical adherence and work performance were collected pretest, posttest (6 mos.) and follow-up (12 mos.).

ANALYSIS

Analyses were conducted using latent change score models in a structural equation modeling framework.

RESULTS

79% of participants reported at least one chronic condition with an average of 2.7 chronic conditions reported. Results indicated that LHWH program demonstrated positive changes in a most outcomes including significant exercise (uΔ = 0.89, p < .01), chronic disease self-efficacy (uΔ = 0.63, p < .05), fatigue (uΔ = -1.45, p < .05), stress (uΔ = -0.98, p < .01) and mentally unhealthy days (uΔ = -3.47, p < .001).

CONCLUSIONS

The translation of LHWH is an effective, low cost, embeddable program that has the potential to improve the health and work life of employees.

Safety specific transformational leadership, safety motivation and personal protective equipment use among firefighters

Personal protective equipment (PPE) use, although normally the last line of preferred hazard control, is vital to protecting firefighters. It is vital that research identify factors that positively influence firefighter behaviors associated with PPE use. Data were collected from 742 career firefighters working for metropolitan fire departments in both the eastern and western United States. Structural equation modeling was used to assess the hypothesized model and relationships between safety-specific transformational leadership, safety motivation and effective use of personal protective equipment. Safety-specific transformational leadership was positively associated with firefighter safety motivation and safety motivation was positively associated with personal protective equipment use. There was also a significant direct relationship between safety-specific transformational leadership and personal protective equipment use. Transformational leadership has not been an emphasis in the fire service because of its hierarchical structure and paramilitary-like traditions. Current fire service stakeholders have called for changes in leadership strategies and the overall culture within the fire service. This research provides additional evidence that safety-specific transformational leadership can bolster safety motivation among firefighters and can result in enhanced safety performance, including the proper and effective use of personal protective equipment.

The workplace health group: A case study of 20 years of multidisciplinary research

The Workplace Health Group (WHG) was established in 1998 to conduct research on worker health and safety and organizational effectiveness. This multidisciplinary team includes researchers with backgrounds in psychology, health promotion and behavior, and intervention design, implementation, and evaluation. The article begins with a brief history of the team, its guiding principles, and stages of team formation and development. This section provides examples of the roles, team composition, structure, processes, cognition, leadership, and climate played in the various stages of team development, as well as how they influenced team effectiveness. The WHG formed with functional diversity-variety in knowledge, skills, and abilities-in mind, and the impact of this diversity is discussed throughout the article. Illustrations of how the functional diversity of the WHG has led to real-world impact are provided. The article concludes with some lessons learned and recommendations for creating and sustaining multidisciplinary teams based on the WHG's 20 years of experience and the team science literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reach, Uptake, and Satisfaction of Three Delivery Modes of FUEL Your Life

Background. FUEL Your Life (FYL) is a worksite translation of the Diabetes Prevention Program (DPP). In a randomized controlled trial, participants in a phone coaching condition demonstrated greater weight loss compared to participants in a group coaching or self-study condition. The purpose of this article is to describe the differences in participant reach, intervention uptake, and participant satisfaction for each delivery mode. Method. Employees who were overweight, obese, or at high risk for diabetes were recruited from city-county governments. Process evaluation data were collected from health coach records, participant surveys, and research team records. Differences between groups were tested using Pearson chi-square test and one-way analysis of variance. Results. Employee reach of targeted enrollment was highest for the self-study condition. Overall, intervention uptake was highest in the phone coaching condition. Participants who received phone coaching had increased uptake of the participant manual and self-monitoring of food compared to participants who received group coaching or self-study. Discussion. FYL demonstrated that DPP could be effectively delivered in the worksite by three different modalities. When implemented in a self-study mode, reach is greater but intervention uptake is lower. Phone health coaching was associated with greater intervention exposure.

Multi-level safety climate associations with safety behaviors in the fire service

INTRODUCTION

Limited research associated with safety climate has been completed within the fire service. Given this dearth of information, the present study sought to identify a valid and reliable measure of safety climate at both the workgroup and organizational levels within the fire service.

METHODS

Researchers surveyed 994 firefighters in two large metropolitan fire departments. Preliminary analyses including psychometrics, confirmatory factor analyses, and shared perception analyses were completed. A linear mixed model analysis was then completed to assess the relationships between workgroup safety climate, organizational safety climate, and safety behaviors, including both safety compliance and safety citizenship behaviors.

RESULTS

Measures of safety climate at the workgroup (WGSC) and organizational levels (OSC) were derived. WGSC factors include supervisor support (α = 0.92), vertical cohesion (α = 0.89), and horizontal cohesion (α = 0.94). OSC factors include management commitment (α = 0.91), safety programs/policies (α = 0.89), perceived fairness (α = 0.86) and incident command (α = 0.90). Confirmatory factor analyses confirmed our multi-factor models were a good fit to the data. The linear mixed model analysis found that WGSC positively predicted safety compliance behavior (B = 0.13, p < .001) and safety citizenship behavior (B = 0.22, p < .001) and OSC positively predicted safety compliance behavior (B = 0.16, p < .001) and safety citizenship behavior (B = 0.15, p < .001).

CONCLUSIONS

This work presents reliable and valid measures of both workgroup and organizational safety climate, which have positive relationships with safety behavior outcomes. Practical application: The measures, which were developed through an extensive multi-method process, provide a means for researchers and practitioners to assess safety climate in the fire service and provides guidance for future safety climate research, including informing intervention research, which could potentially bolster safety climate and enhance safety in the fire service.

Cost Effectiveness of a Weight Management Program Implemented in the Worksite: Translation of Fuel Your Life

OBJECTIVE

Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination.

METHODS

Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs).

RESULTS

The phone condition was most costly ($601 to $589/employee) and the self-study condition was least costly ($145 to $143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% confidence interval [CI]: $10,600/QALY-dominated).

CONCLUSIONS

Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost-effectiveness of the program.

Impact of work pressure, work stress and work-family conflict on firefighter burnout

Little research has explored burnout and its causes in the American fire service. Data were collected from career firefighters in the southeastern United States (n = 208) to explore these relationships. A hierarchical regression model was tested to examine predictors of burnout including sociodemographic characteristics (model 1), work pressure (model 2), work stress and work-family conflict (model 3) and interaction terms (model 4). The main findings suggest that perceived work stress and work-family conflict emerged as the significant predictors of burnout (both p < .001). Interventions and programs aimed at these predictors could potentially curtail burnout among firefighters.

Safety climate and firefighting: Focus group results

BACKGROUND

Firefighting is a hazardous occupation and there have been numerous calls for fundamental changes in how fire service organizations approach safety and balance safety with other operational priorities. These calls, however, have yielded little systematic research.

METHODS

As part of a larger project to develop and test a model of safety climate for the fire service, focus groups were used to identify potentially important dimensions of safety climate pertinent to firefighting.

RESULTS

Analyses revealed nine overarching themes. Competency/professionalism, physical/psychological readiness, and that positive traits sometimes produce negative consequences were themes at the individual level; cohesion and supervisor leadership/support at the workgroup level; and politics/bureaucracy, resources, leadership, and hiring/promotion at the organizational level. A multi-level perspective seems appropriate for examining safety climate in firefighting.

CONCLUSIONS

Safety climate in firefighting appears to be multi-dimensional and some dimensions prominent in the general safety climate literature also seem relevant to firefighting. These results also suggest that the fire service may be undergoing transitions encompassing mission, personnel, and its fundamental approach to safety and risk.

PRACTICAL APPLICATIONS

These results help point the way to the development of safety climate measures specific to firefighting and to interventions for improving safety performance.

Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses

Antineoplastic drugs pose risks to the healthcare workers who handle them. This fact notwithstanding, adherence to safe handling guidelines remains inconsistent and often poor. This study examined the effects of pertinent organizational safety practices and perceived safety climate on the use of personal protective equipment, engineering controls, and adverse events (spill/leak or skin contact) involving liquid antineoplastic drugs. Data for this study came from the 2011 National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers which included a sample of approximately 1,800 nurses who had administered liquid antineoplastic drugs during the past seven days. Regression modeling was used to examine predictors of personal protective equipment use, engineering controls, and adverse events involving antineoplastic drugs. Approximately 14% of nurses reported experiencing an adverse event while administering antineoplastic drugs during the previous week. Usage of recommended engineering controls and personal protective equipment was quite variable. Usage of both was better in non-profit and government settings, when workers were more familiar with safe handling guidelines, and when perceived management commitment to safety was higher. Usage was poorer in the absence of specific safety handling procedures. The odds of adverse events increased with number of antineoplastic drugs treatments and when antineoplastic drugs were administered more days of the week. The odds of such events were significantly lower when the use of engineering controls and personal protective equipment was greater and when more precautionary measures were in place. Greater levels of management commitment to safety and perceived risk were also related to lower odds of adverse events. These results point to the value of implementing a comprehensive health and safety program that utilizes available hazard controls and effectively communicates and demonstrates the importance of safe handling practices. Such actions also contribute to creating a positive safety climate.

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13), cardiovascular diseases (n = 8), and diabetes (n = 6). Intervention strategies included instructional education/counseling (n = 20), workplace environmental change (n = 6), physical activity (n = 10), use of technology (n = 10), and incentives (n = 13). Self-reported data (n = 21), anthropometric measurements (n = 17), and laboratory tests (n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

Does Organizational and Coworker Support Moderate Diabetes Risk and Job Stress Among Employees?

PURPOSE

Examine the moderating role of perceived organizational and coworker support on the relationship between job stress and type 2 diabetes risk among employees.

DESIGN

A cross-sectional survey was administered to employees at the workplace.

SETTING

One national retail organization.

PARTICIPANTS

Baseline data were obtained from 1595 employees in 21 retail stores.

MEASURES

Self-reported organizational and coworker support to encourage and fulfill job responsibilities and job stress. Diabetes risk was calculated using age, gender, race/ethnicity, blood pressure, physical activity, weight status, and self-reported diagnosed type 2 diabetes.

ANALYSIS

Multilevel multiple regression was conducted to test the interaction effect of support on the association between job stress and diabetes risk.

RESULTS

Mean age was 37.95 years (±12.03) and body mass index was 26.72 (±4.95). Three percent of participants reported diagnosed diabetes. Organizational support was positively associated with coworker support. Both were negatively associated with job stress. Organizational support, but not coworker support, moderated the relationship of job stress with diabetes risk. Participants with greater perceived organizational support had lower diabetes risk scores compared to those with lower perceived organizational support.

CONCLUSION

Organizational support may be a key factor for workplaces to reduce stress and diabetes risk. Further testing of organizations' supportive role on employee health may be helpful in developing future workplace programs.

A Prospective Programmatic Cost Analysis of Fuel Your Life: A Worksite Translation of DPP

OBJECTIVE

An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination.

METHODS

A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives.

RESULTS

The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1).

CONCLUSIONS

This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.

A Revised Model of the Warnings Process Derived from Value-Expectancy Theory

Recent research indicates that product-related perceptions and expectations account for a major portion of the variance in user self-protective behavior. The present paper examines value-expectancy theory and research and proposes a replacement for the information processing model of the warnings process. The revised model focuses on the risk appraisal activities of the user and attempts to capture the dynamic nature of precautionary behavior.

The Optimism Bias and Traffic Safety

In this study, college students were asked to rate their overall accident likelihood, driving skill, and level of safety relative to other drivers. They also made comparative risk judgements for a variety of specific accident situations. Consistent with previous research, subjects perceived themselves as safer, more skillful, and less likely to be involved in an accident than other drivers. Optimism increased with driving experience, but was unrelated to age or sex. Substantial optimism was also evident in response to the specific accident situations, and further analysis indicated that the perceived controllability of the accident was a strong predictor of optimism. The importance of controllability in this study is consistent with research on other life events, and suggests that perceptions of control play an important role in the optimism bias.

Gender Differences in Traffic Accident Risk Perception

Excessive optimism has often been implicated in the disproportionate involvement of young males in traffic crashes. In this study, male and female students (ages 18–24) were asked to judge their relative driving safety, skill, and accident likelihood. They also rated 15 risky driving behaviors in terms of frequency, seriousness, accident potential, and apprehension likelihood. Driving experience/history data were also collected. Substantial optimism was evident in both sexes, but males tended to be more optimistic, especially when judging their driving skill. Males and females held similar perceptions concerning the frequencies and apprehension likelihoods of the risky behaviors, but males perceived the behaviors as less serious and less likely to result in accidents. Regression analyses showed that considerably more variance in optimism could be explained for males than females.

Consumer Product Warnings: Review and Analysis of Effectiveness Research

This paper provides a critical review of recent research (1984-1988) on the effectiveness of consumer product warnings. The majority of available data come from laboratory studies of college students, and wide variations in effectiveness have been reported. The perceived hazardousness of the product, its familiarity, and the ease of complying with the warning all appear to be important factors. Some preliminary trends have emerged concerning the contribution of various message attributes; however, these factors do not appear to be as important as the user's product-related expectations. The implications and limitations of these findings are discussed.

FUEL Your Life: A Translation of the Diabetes Prevention Program to Worksites

Purpose.

To evaluate the effectiveness of FUEL Your Life, a translation of the Diabetes Prevention Program for worksites.

Design.

A randomized control group design was conducted in five worksites of a large transportation company. Measures were collected pretest, posttest (6 months), and follow-up (12 months).

Setting.

Railroad maintenance facilities of Union Pacific Railroad.

Subjects.

Participants consisted of 362 workers (227 treatment, 135 control).

Intervention.

FUEL Your Life was translated from the Diabetes Prevention Program to better fit within the context of the worksite. The primary difference was the use of peer health coaches to provide social support and reinforcement and an occupational nurse to provide lesson content (six sessions of 10 minutes) to participants instead of the lifestyle coaches employed by the Diabetes Prevention Program, resulting in a less structured meeting schedule.

Measures.

The primary outcomes were weight and body mass index (BMI), with secondary outcomes including eating behaviors, physical activity, and social support.

Analysis.

Latent growth modeling was used to measure changes in the outcomes over time.

Results.

Participants in the intervention group maintained weight/BMI (–.1 pounds/–.1 BMI), whereas the control participants gained weight/BMI (+2.6 pounds/+.3 BMI), resulting in a statistically significant difference between groups. Fifty-five percent of intervention participants lost some weight, whereas only 35% of the control group lost weight.

Conclusions.

FUEL Your Life, a low intensity intervention, was not effective for promoting weight loss, but was effective for helping workers maintain weight over a 12-month period.

Chronic disease self-management program in the workplace: opportunities for health improvement

Disease management is becoming increasingly important in workplace health promotion given the aging workforce, rising chronic disease prevalence, and needs to maintain a productive and competitive American workforce. Despite the widespread availability of the Chronic Disease Self-Management Program (CDSMP), and its known health-related benefits, program adoption remains low in workplace settings. The primary purpose of this study is to compare personal and delivery characteristics of adults who attended CDSMP in the workplace relative to other settings (e.g., senior centers, healthcare organizations, residential facilities). This study also contrasts characteristics of CDSMP workplace participants to those of the greater United States workforce and provides recommendations for translating CDSMP for use in workplace settings. Data were analyzed from 25,664 adults collected during a national dissemination of CDSMP. Only states and territories that conducted workshops in workplace settings were included in analyses (n = 13 states and Puerto Rico). Chi-squared tests and t-tests were used to compare CDSMP participant characteristics by delivery site type. CDSMP workplace participant characteristics were then compared to reports from the United States Bureau of Labor Statistics. Of the 25,664 CDSMP participants in this study, 1.7% (n = 435) participated in workshops hosted in worksite settings. Compared to CDSMP participants in non-workplace settings, workplace setting participants were significantly younger and had fewer chronic conditions. Differences were also observed based on chronic disease types. On average, CDSMP workshops in workplace settings had smaller class sizes and workplace setting participants attended more workshop sessions. CDSMP participants in workplace settings were substantially older and a larger proportion were female than the general United States workforce. Findings indicate opportunities to translate CDSMP for use in the workplace to reach new target audiences.

National workplace health promotion surveys: the Affordable Care Act and future surveys

This commentary reviews findings from the four previous national surveys of workplace health promotion activities (1985, 1992, 1999, and 2004, respectively) and offers recommendations for future surveys mandated under the Affordable Care Act of 2010. Future surveys should place greater emphasis on assessing program quality, reach, and effectiveness. Both employer and employee input should be sought. In addition, sampling plans should differentiate worksites from employers, and results should include public as well as private sector organizations. Ideas are offered for addressing these limitations and for creating a sustainable survey process and multifunctional database of results.

Sociotechnical attributes of safe and unsafe work systems

Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social-organisational and technical-work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human-system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human-systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice.

PRACTITIONER SUMMARY

The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social--organisational and technology--work process factors as they impact work system analysis, design and operation.

Typing performance and body discomfort among overweight and obese office workers: A pilot study of keyboard modification

Obesity in the workplace is associated with loss of productivity, high medical care expenses, and increased rates of work-related injuries and illness. Thus, effective, low-cost interventions are needed to accommodate the size of today's obese office worker while alleviating potential physical harm associated with musculoskeletal disorders. Utilizing a sample of 22 overweight and obese office workers, this pilot study assessed the impact of introducing an alternative, more ergonomically-sound keyboard on perceptions about design, acceptability, and usability; self-reported body discomfort; and typing productivity. Data were collected using self-reported questionnaires and objective typing tests administered before and after the intervention. The intervention duration was six weeks. After switching from their standard work keyboard to an alternative keyboard, all participants reported significant decreases in lower back discomfort (t = 2.14, P = 0.044); although obese participants reported significant decreases in both upper (t = 2.46, P = 0.032) and lower (t = 2.39, P = 0.036) back discomfort. No significant changes were observed in overall typing performance scores from baseline to follow-up. Findings suggest that such interventions may be introduced into the workforce with positive gains for workers without reducing short-term worker productivity.

Applying RE-AIM to the Evaluation of FUEL Your Life

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce.

Worksite translation of the Diabetes Prevention Program: formative research and pilot study results from FUEL Your Life

This article summarizes formative research and pilot study findings from a workplace translation of the Diabetes Prevention Program (DPP). The overarching goal was to devise a relatively straightforward weight management intervention suitable for use in a wide array of work settings. This project was conducted in conjunction with Union Pacific Railroad at one of their locomotive maintenance facilities. Participating employees were predominately male and middle-aged. Formative data were collected through stakeholder interviews, focus groups, and direct observation of the work environment. These results were used to adapt the DPP into a largely self-directed intervention augmented by peer health coaches and the on-site nurse. A small pilot test of the adapted program (n = 67) produced modest but statistically significant weight reductions at both 6 (core intervention period) and 12 months (maintenance period). These results are discussed in terms of the original DPP and other DPP translation studies.

Process evaluation results from an environmentally focused worksite weight management study

There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively simple, low-cost environmental modifications designed to facilitate healthy eating and physical activity; the intense treatment added elements intended to actively involve and engage management in program efforts. Fidelity varied across the 11 interventions comprising the two treatment conditions but did not vary systematically by treatment condition (moderate vs. intense). Environmental assessments showed improvements in workplace supports for weight management and significant differences by treatment level. Positive shifts in health climate perceptions also occurred, but sites receiving the intense treatment were not perceived as more supportive by employees. Challenges and limitations associated with environmental interventions are discussed with specific reference to activating management support.

Occupational injury in America: An analysis of risk factors using data from the General Social Survey (GSS)

INTRODUCTION

Although much is known about the distribution of occupational injury in terms of various job and employment factors, considerably less is known about other possible risk factors, particularly those involving psychosocial and organizational factors. These factors have not been emphasized in most injury surveillance systems or large scale, population based surveys.

METHOD

In this study, data from the 2002 General Social Survey (GSS) and NIOSH Quality of Work Life (QWL) module were used to examine the risk of occupational injury in terms of socio-demographic factors, employment characteristics, and organizational factors.

RESULTS

The most informative results were obtained from Poisson regression analyses, which identified race, occupational category, and work-family interference as risk factors, and safety climate and organizational effectiveness as protective factors for occupational injury. These results provide guidance for targeting interventions and protective measures to curtail occupational injury in the United States.

Line-of-duty deaths among U.S. firefighters: an analysis of fatality investigations

More than 100 firefighters die in the line-of-duty in the U.S. each year and over 80,000 are injured. This study examined all firefighter fatality investigations (N = 189) completed by the National Institute for Occupational Safety and Health (NIOSH) for fatalities occurring between 2004 and 2009. These investigations produced a total of 1167 recommendations for corrective actions. Thirty-five high frequency recommendations were derived from the total set: six related to medical fatalities and 29 to injury-related fatalities. These high frequency recommendations were mapped onto the major operational components of firefighting using a fishbone or cause-effect diagram. Over 70% of the 30 non-external recommendations were categorized within the personnel and incident command components of the fishbone diagram. Root cause techniques suggested four higher order causes: under-resourcing, inadequate preparation for/anticipation of adverse events during operations, incomplete adoption of incident command procedures, and sub-optimal personnel readiness. These findings are discussed with respect to the core culture of firefighting.

Management support of workplace health promotion: field test of the leading by example tool

PURPOSE

This study tested a repeated-measures application of the Leading by Example (LBE) questionnaire, a self-report instrument measuring organizational leadership support for health promotion.

DESIGN

The efficacy of the LBE was tested in a quasi-experimental health promotion intervention trial. Twelve worksites were assigned to three intervention conditions (i.e., control, moderate, high intensity).

SETTING

The worksites were selected from a large U.S.-based chemical company.

SUBJECTS

Baseline data were collected from employees in various job roles in 2005 (N  =  125). Follow-up data were collected in 2006 (N  =  114) and 2007 (N  =  106). Response rates ranged from 54% to nearly three-fourths of potential respondents.

INTERVENTION

Worksites assigned to both treatment conditions received changes in the built environment via supports for weight management. Worksites assigned to the intense condition received additional elements designed to impact leadership's support for a positive health promotion climate.

MEASURES

Four LBE factors measuring management support for health were assessed over time.

ANALYSIS

The Kruskal-Wallis H-test and analyses of variance/covariance were used to compare LBE scores.

RESULTS

Significant changes from baseline to 2006 were identified for the four factors (p  =  .000) of the LBE. No significant changes were found from 2006 to 2007.

CONCLUSIONS

The LBE effectively captured perceptions of management support for health. Researchers and practitioners alike should consider using the LBE to track and evaluate perceptions of management support for health promotion.

Dose relations between goal setting, theory-based correlates of goal setting and increases in physical activity during a workplace trial

The effectiveness of an intervention depends on its dose and on moderators of dose, which usually are not studied. The purpose of the study is to determine whether goal setting and theory-based moderators of goal setting had dose relations with increases in goal-related physical activity during a successful workplace intervention. A group-randomized 12-week intervention that included personal goal setting was implemented in fall 2005, with a multiracial/ethnic sample of employees at 16 geographically diverse worksites. Here, we examined dose-related variables in the cohort of participants (N = 664) from the 8 worksites randomized to the intervention. Participants in the intervention exceeded 9000 daily pedometer steps and 300 weekly minutes of moderate-to-vigorous physical activity (MVPA) during the last 6 weeks of the study, which approximated or exceeded current public health guidelines. Linear growth modeling indicated that participants who set higher goals and sustained higher levels of self-efficacy, commitment and intention about attaining their goals had greater increases in pedometer steps and MVPA. The relation between change in participants' satisfaction with current physical activity and increases in physical activity was mediated by increases in self-set goals. The results show a dose relation of increased physical activity with changes in goal setting, satisfaction, self-efficacy, commitment and intention, consistent with goal-setting theory.

Do intervention fidelity and dose influence outcomes? Results from the move to improve worksite physical activity program

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; chi(2) = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

Making work safer: testing a model of social exchange and safety management

INTRODUCTION

This study tests a conceptual model that focuses on social exchange in the context of safety management. The model hypothesizes that supportive safety policies and programs should impact both safety climate and organizational commitment. Further, perceived organizational support is predicted to partially mediate both of these relationships.

METHODS

Study outcomes included traditional outcomes for both organizational commitment (e.g., withdrawal behaviors) as well as safety climate (e.g., self-reported work accidents). Questionnaire responses were obtained from 1,723 employees of a large national retailer.

RESULTS

Using structural equation modeling (SEM) techniques, all of the model's hypothesized relationships were statistically significant and in the expected directions. The results are discussed in terms of social exchange in organizations and research on safety climate.

IMPACT ON INDUSTRY

Maximizing safety is a social-technical enterprise. Expectations related to social exchange and reciprocity figure prominently in creating a positive climate for safety within the organization.

Individual reactions to high involvement work processes: investigating the role of empowerment and perceived organizational support

This study sought to understand how high involvement work processes (HIWP) are processed at the employee level. Using structural equation modeling techniques, the authors tested and supported a model in which psychological empowerment mediated the effects of HIWP on job satisfaction, organizational commitment, job performance, and job stress. Furthermore, perceived organizational support (POS) was hypothesized to moderate the relationships between empowerment and these outcomes. With exception for the empowerment-job satisfaction association, support was found for our predictions. Future directions for research and the practical implications of our findings for both employees and organizations are discussed.

First-year results of an obesity prevention program at The Dow Chemical Company

OBJECTIVE

To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company.

METHODS

A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests.

RESULTS

After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased.

CONCLUSIONS

Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.

Promoting fruit and vegetable consumption in different lifestyle groups: recommendations for program development based on behavioral research and consumer media data

Fruit and vegetable consumption affects the etiology of cardiovascular disease as well as many different types of cancers. Still, Americans' consumption of fruit and vegetables is low. This article builds on initial research that assessed the validity of using a consumer-based psychographic audience segmentation in tandem with the theory of planned behavior to explain differences among individuals' consumption of fruit and vegetables. In this article, we integrate the findings from our initial analyses with media and purchase data from each audience segment. We then propose distinct, tailored program suggestions for reinventing social marketing programs focused on increasing fruit and vegetable consumption in each segment. Finally, we discuss the implications of utilizing a consumer-based psychographic audience segmentation versus a more traditional readiness-to-change social marketing segmentation. Differences between these two segmentation strategies, such as the ability to access media usage and purchase data, are highlighted and discussed.

Assessing management support for worksite health promotion: psychometric analysis of the leading by example (LBE) instrument

PURPOSE

Describe the development of the leading by example (LBE) instrument.

METHODS

A total of 135 responses from employees of a private corporation working at 11 different worksites were factor analyzed in 2005. Exploratory factor analysis was used to obtain an initial factor structure. Factor validity was evaluated using confirmatory factor analysis methods. A second sample was collected in 2006 from the same population (N = 178) and was used to confirm the factor structure via confirmatory factor analysis. Cronbach's alpha and item-total correlations provided information on the reliability of the factor subscales.

RESULTS

Four subscales were identified: business alignment with health promotion objectives, awareness of the health-productivity link, worksite support for health promotion, and leadership support for health promotion. Factor by group comparisons revealed that the initial factor structure was effective in detecting differences in organizational support for health promotion across different employee groups.

CONCLUSIONS

Management support for health promotion can be assessed using the LBE, a brief self-report questionnaire. Researchers can use the LBE to diagnose, track, and evaluate worksite health promotion programs.

Evaluation of social-cognitive versus stage-matched, self-help physical activity interventions at the workplace

PURPOSE

To compare the effectiveness of stage-matched vs. social-cognitive physical activity interventions in a work setting. Both interventions were designed as minimal-contact, self-help programs suitable for large-scale application.

DESIGN

Randomized trial. Participants were randomized into one of the two intervention groups at baseline; the follow-up assessment was conducted 1 month later.

SETTING

A large, public university in the southeastern region of the United States.

SUBJECTS

Employees from two academic colleges within the participating institution were eligible to participate: 366 employees completed the baseline assessment; 208 of these completed both assessments (baseline and follow-up) and met the compliance criteria.

INTERVENTION

Printed, self-help exercise booklets (12 to 16 pages in length) either (1) matched to the individual's stage of motivational readiness for exercise adoption at baseline or (2) derived from social-cognitive theory but not matched by stage.

MEASURES

Standard questionnaires were administered to assess stage of motivational readiness for physical activity; physical activity participation; and exercise-related processes of change, decisional balance, self-efficacy, outcome expectancy, and goal satisfaction.

RESULTS

The two interventions were equally effective in moving participants to higher levels of motivational readiness for regular physical activity. Among participants not already in maintenance at baseline, 34.9% in the stage-matched condition progressed, while 33.9% in the social-cognitive group did so (chi2 = not significant). Analyses of variance showed that the two treatment groups did not differ in terms of physical activity participation, cognitive and behavioral process use, decisional balance, or the other psychological constructs. For both treatment groups, cognitive process use remained high across all stages, while behavioral process use increased at the higher stages. The pros component of decisional balance did not vary across stage, whereas cons decreased significantly between preparation and action.

CONCLUSIONS

Minimal-contact, one-shot physical activity interventions delivered at work can help people increase their participation in regular physical activity. Stage matching may not necessarily add value to interventions that otherwise make good use of behavior change theory. The findings also reinforce the importance of barrier reduction in long-term adherence. A limiting factor in this study is that employees in the earliest stage of change (precontemplation) were not well-represented in the sample.

Effects of an active ergonomics training program on risk exposure, worker beliefs, and symptoms in computer users

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of an active ergonomics training (AET) program in computer users. Two constructs from the social-cognitive theory were adopted to provide a more comprehensive assessment of the proximal markers of behavior change.

METHOD

Eighty-seven symptomatic and asymptomatic employees who worked at a computer for a minimum of 10 hours per week took part in a prospective randomized controlled study. Subjects participated in a six-hour training intervention at their workplace. Key elements of the AET intervention were skill development in workstation analysis, active participation, and implementation of multiple prevention strategies.

RESULTS

After receiving AET, risk factor exposure was significantly reduced for participants at higher risk [F(1,82) = 6.42, p < 0.01]. Significant increases in knowledge [F(1,74) = 8.39, p < 0.01], self-efficacy [F(1,73) = 6.95, p < 0.01], and outcome expectations [F(1,75) = 8.75, p < 0.01] were found in the intervention group. When the participants were stratified according to the presence of symptoms at baseline, the group with pain that received the AET intervention had significantly less upper back pain intensity (z = -2.03, p < 0.05), pain frequency (z = -2.70, p < 0.01), and pain duration (z = -3.25, p < 0.01) post-intervention than the control group with pain.

CONCLUSION

Results from this study provide evidence that participative training in workstation ergonomics can improve work postures, work practices, risk factor exposure, and pain.

Creating safer workplaces: assessing the determinants and role of safety climate

PROBLEM

Although there has been considerable interest in safety climate, relatively little attention has been given to the factors that determine safety climate or to testing the hypothesized mediating role of safety climate with respect to safety-related outcomes.

METHOD

Questionnaire responses were obtained from 2,208 employees of a large national retail chain in 21 different locations.

RESULTS

After controlling for demographic variables, three factors: environmental conditions, safety-related policies and programs, and general organizational climate, accounted for 55% of the variance in perceived safety climate. Interestingly, organizational climate made a significant contribution to safety climate, even after controlling for the other more safety-relevant variables. Partial correlations showed that safety policies and programs had the largest observed correlation with safety climate, followed by two of the dimensions of organizational climate (communication and organizational support). Using Baron and Kenny's (J. Pers. Soc. Psychol. 51 (1986) 1173) procedures, the principal effects of the various work situation factors on perceived safety at work were found to be direct rather than mediated by safety climate. Safety climate influenced perceived safety at work, but its role as a mediator was limited.

IMPACT ON INDUSTRY

These results are discussed in terms of other recent findings on safety climate and the growing interest in understanding management and organizational factors in the context of workplace safety.