Marian Flum

Organizational features of work often pose obstacles to workforce health, and a participatory change process may address those obstacles. In this research, an intervention program sought to integrate occupational safety and health (OSH) with health promotion (HP) in three skilled nursing facilities. Three facilities with pre-existing HP programs served as control sites. The intervention was evaluated after 3–4 years through focus groups, interviews, surveys, and researcher observations. We assessed process fidelity in the intervention sites and compared the two groups on the scope of topics covered (integration), program impact, and medium-term sustainability. The intervention met with initial success as workers readily accepted and operationalized the concept of OSH/HP integration in all three intervention facilities. Process fidelity was high at first but diminished over time. At follow-up, team members in two intervention sites reported higher employee engagement and more attenti...

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers' and employees' perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational healt...

CPH-NEW is a NIOSH-funded initiative with partners in private sector, labor, and two state health departments. The Center will evaluate models for integrating health promotion (HP) with workplace occupational ergonomic interventions, with a strong emphasis on worker involvement. Outcomes include musculoskeletal health (with an expanded definition), mental and cardiovascular health. Qualitative methods are directed to development of participatory groups in the workplace, in addition to process evaluation. Work organization is a key mediator of workplace stressors as well as a potential source of constraints on health behaviors. Relevant features of the work environment, ranging from scheduling to supervisory-employee relations, can be barriers or enhancements to health behaviors. Effective HP programs should address organizational as well as individual behaviors. Decision latitude is particularly important in this regard. Participatory selection, design and implementation of HP or er...

PhotoVoice is a photographic participatory action research methodology that has been used primarily for community-based research to engage those with little or no power to identify and describe their concerns and to promote policy change to address those concerns. This project is among the first to adapt PhotoVoice to the workplace to involve workers in identifying health and safety hazards through photographic methods. This project was conducted at a large Midwestern public university as part of an evaluation by the American Federation of State, County and Municipal Employees (AFSCME) of a joint labor-management OSH management system that had been in place for two years in the Facilities Management Division. Though many improvements appeared to occur, custodian injuries remained among the highest in the country. The PhotoVoice project, conducted through AFSCME's worker-based evaluation team and UMass Lowell, engaged custodians on all shifts to take pictures of workplace hazards...

Health promotion (HP) programs that target individual behavior alone can lead to behavior change and thus improvements in health; however the best approaches employ participatory interventions to instill a sense of empowerment and bolster program effectiveness. This participatory intervention is intended to improve and protect the health of nursing home employees and produce sustainable health protection and improvement programs. It will address psychosocial environment and work organization issues that impact negatively on health of nursing home workers, as well as general health concerns of workers at study sites. It broadens the concept of health promotion to include addressing occupational and institutional barriers to health. It is also intended to increase empowerment and self-efficacy of employees at the study sites. The aim is to develop a permanent participatory health protection and promotion (HPP) program that becomes part of the ongoing operation of the study sites. Iden...

Working conditions in the nursing center industry contributed to over 200,000 occupational injuries to clinical staff in 2003. With the number of residents in these centers on the rise, approximately three-quarters of which require assistance in at least three daily activities, the number of occupational injuries to caregivers is sure to increase. These figures have guided various initiatives which more closely examine the work lives of these caregivers. The goal of this presentation is to examine common work environment concerns identified by the clinical staff members at one of three intervention sites in Massachusetts, and to address these issues with a non-management, employee governed Health and Wellness Team (HWT). Using participatory intervention through the HWT, the facilitators hope to improve employee health, reduce job stress, and increase job satisfaction. A series of focus groups were conducted at the center to establish site selection criteria which included the level ...

This is the second part of an article on employment conditions as social determinants of health and health inequalities. In part I of this article, we explored structural (external) employment conditions that affect health inequalities and health gradients. In this article, we try to examine the internal aspects of employment conditions that affect the same variables. It is not our intention to "box" employment conditions in a rigid framework within an internal domain of person-hazard interaction. The objective of examining this variable is to scrutinize internal aspects of employment conditions at a comprehensive policy level in conjunction with external contextual variables. Major occupational health concerns are examined in relationship to globalization, child labor, and work in the formal and informal sectors. Interventions that can eliminate or greatly reduce these exposures as well as those that have been unsuccessful are reviewed. Innovative interventions including work organization change, cleaner production, control banding, national and international coalitions, participatory training, and participatory approaches to improving the work environment are reviewed.

The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was the...

Focus groups were conducted with over 150 certified nursing assistants (CNAs) in seven nursing homes to obtain their opinions on how the work environment supported or impeded their caregiving to residents. Strong opinions emerged about work environment interference with CNAs' ability to provide quality and comprehensive care. Participants also believed that their supervisors did not respect the value of the care and nurturing that CNAs provided. This contrasted with the respect that CNAs voiced for residents. The findings highlight the need for improved relationships between CNAs and management and suggest some desirable features of work organization in nursing homes.