Changes implemented during a workplace psychosocial intervention and their consistency with intervention priorities.

OBJECTIVES: To describe the changes implemented as part of a workplace psychosocial intervention. METHODS: The intervention was conducted in a public organization employing 1630 white-collar workers. The intervention was defined as all changes implemented to reduce adverse psychosocial work factors. A logbook was held to describe the changes implemented in the intervention group and in a comparable control group (N = 1282). RESULTS: Social support and reward were the psychosocial factors most targeted (41% to 83%). In comparison with the control group, the intervention group implemented four times more major changes and implemented changes, improving the employees' workload. CONCLUSIONS: Changes mainly targeted social support and reward. The intervention group implemented four times more major changes than the control group. The intervention group implemented changes targeting the workload, whereas no such changes were implemented in the control group.

Relationship-based care and behaviours of residents in long-term care facilities.

Introduction. In long-term care (LTC), person-centred approaches are encouraged. One such approach, relationship-based care (RBC), aims among other things to reduce residents' agitated behaviours. RBC has been used in numerous Quebec LTC facilities over the past decade but it has never been studied. Objective. Explore correlations between use of RBC by trained caregivers and the frequency of agitated and positive behaviours of residents with cognitive impairments. Methods. Two independent raters observed fourteen caregiver/resident dyads in two LTC facilities during assistance with hygiene and dressing. Checklists were used to quantify caregivers' RBC use and residents' agitated and positive behaviours. Results. Scores for RBC use were high, suggesting good application of the approach by caregivers. Correlation analyses showed that offering residents realistic choices and talking to them during care were associated with both positive and agitated behaviours (P from 0.03 to 0.003). However, many other components of RBC were not associated with residents' behaviours during care. Conclusions. There were only a few quantitative links between the RBC checklist items and the frequency of agitated or positive behaviours. Other studies with a more rigorous research design are needed to better understand the impact of relationship-based care on residents' behaviours.

Person-centered care training in long-term care settings: usefulness and facility of transfer into practice.

The person-centered approach is increasingly recommended in long-term care facilities to increase quality of care. In Quebec, Canada,. caregivers were specifically trained in "relationship-based care. "This study analyzed caregivers' assessment of this approach's usefulness and their capacity, after training, to apply it to care practices. Questionnaires with open-ended questions were administered to caregivers (n= 392) one month after training. Caregivers' answers were categorized using a qualitative approach. Respondents perceive some features of this approach are beyond their reach or in opposition to their beliefs. They reported feeling pressure related to time constraints, their peers and the families of residents. These results indicate that training itself is insufficient to transform practice. Institutions wishing to implement such an approach must also act upon the beliefs of individuals, as well as upon work situations.

Intervention study on psychosocial work factors and mental health and musculoskeletal outcomes.

Organizations are facing ever-stiffer competition in the current globalized economy, and employees are consequently being exposed to increasingly adverse psychosocial work factors. Psychosocial work factors, also called psychosocial stressors, refer to all organizational factors and interpersonal relationships in the workplace that may affect workers' health. Two well-defined and internationally recognized theoretical models are used to assess these factors: the Karasek demand-latitude-support model and the Siegrist effort-reward imbalance model. The Karasek and Siegrist models reflect specific components of the work environment for which there is empirical evidence of a deleterious effect on health. Preventive interventions targeting these factors are conducted in workplaces. However, few studies have rigorously documented these interventions and their effectiveness in reducing adverse work factors and improving health outcomes. Most previous intervention studies were limited by (1) a short follow-up that may not have provided sufficient time for effects to appear, (2) small sample sizes (N ≤ 100) that limited the statistical power and the possibility of detecting results and (3) rare assessment of the Siegrist model. The current paper presents the overall design and the main results of an intervention study on psychosocial work factors and related mental health and musculoskeletal outcomes. The study integrated (1) a development phase that aimed at identifying the changes needed to reduce psychosocial factors in the target population and the best ways to bring about these changes, (2) an implementation phase that systematically documented how the intervention was carried out and (3) an effectiveness phase that evaluated whether the intervention was successful in reducing adverse psychosocial work factors and health problems. In addition, the study used repeated measurements of psychosocial work factors and health indicators at baseline and six and 30 months post-intervention to assess short- and medium-term effects of the intervention.

The adverse effects of psychosocial constraints at work: a participatory study to orient prevention to mitigate psychological distress.

Studies conducted with the JDC (job demand-control) or ERI (effort-reward imbalance) models highlight the links between constraints in the psychosocial work environment and psychological distress. However, the underlying mechanisms are not very well understood. The present participatory qualitative study explored these mechanisms with a view to identifying both the processes at work in these relationships and some targets for problem prevention. This investigation was conducted with white-collar workers from a public service organisation within one Canadian province (Quebec) who participated in six discussion groups during an intervention designed to reduce psychosocial environment constraints. The data gathered in these groups was subjected to content analysis through thematic categorization. The findings indicate that psychosocial constraints take root in situations that adversely affect subjective dimensions relating to personal and professional experience. An interpretive model is proposed on the basis of these findings, which helps to elucidate the dynamic relationships that exist among the various aspects of work experience that can lead to psychological distress. From this model, some targets for problem prevention have emerged.

Allowing for MSD prevention during facilities planning for a public service: an a posteriori analysis of 10 library design projects.

Research was conducted to identify an ergonomics-based intervention model designed to factor in musculoskeletal disorder (MSD) prevention when library projects are being designed. The first stage of the research involved an a posteriori analysis of 10 recent redesign projects. The purpose of the analysis was to document perceptions about the attention given to MSD prevention measures over the course of a project on the part of 2 categories of employees: librarians responsible for such projects and personnel working in the libraries before and after changes. Subjects were interviewed in focus groups. Outcomes of the analysis can guide our ergonomic assessment of current situations and contribute to a better understanding of the way inclusion or improvement of prevention measures can support the workplace design process.

Workplace prevention and promotion strategies.

Psychosocial factors refer to all organizational factors and interpersonal relationships in the workplace that may affect the health of the workers. Currently, two psychosocial risk models are universally recognized for producing solid scientific knowledge regarding the vital link between social or psychological phenomena at work and the development of several diseases, such as cardiovascular diseases or depression. The first is the "job demand-contro-support" model, which was defined by Karasek and to which the concept of social support has been added; the second is the "effort/reward imbalance" model defined by Siegrist. The public health perspective calls for theoretical models based on certain psychosocial attributes of the work environment for which there is empirical evidence of their pathogenic potential for exposed workers. Not only do these models reduce the complexity of the psychosocial reality of the work to components that are significant in terms of health risks, but they also facilitate the development and implementation of workplace interventions. Psychosocial risk intervention strategies currently implemented by companies are predominantly individual-oriented and aim chiefly at reducing the effects of stressful work situations by improving individual ability to adapt to the situation and manage stress. Like personal protection equipment for exposure to physical or chemical risks, these secondary prevention measures are commendable but insufficient, because they aim to reduce only the symptoms and not the cause of problems. Any intervention program for these risks should necessarily include a primary prevention component with a view to eliminating, or at least reducing, the psychosocial pathogenic agents in the workplace. Several authors have suggested that well-structured organizational approaches are most effective and should generate more important, longer-lasting effects than individual approaches. However, the evidence should be strengthened by more systematic studies to assess the models, their implementation and the outcomes for employers and employees alike. The research agenda on mental health and the workplace should have the following goals; to foster the development and evaluation of well-adapted models of interventions designed to reduce adverse psychosocial factors and their mental health effects to give a better understanding of the prevalence of work organization risk factors in Canada, how they may be changing and how they affect mental health in the long term to acquire an understanding of the effects on mental health of prominent trends in organizational practices, such as restructuring, lean production and flexible staffing (all of which result in precarious employment), that may pose special risks for women, immigrants or aging workers in Canada to collect data on the considerable direct and indirect costs to business, workers and society of work-related stress in Canada.

Understanding the transfer of knowledge and skills from training to preventive action using ergonomic work analysis with 11 female VDT users.

A qualitative evaluation of 11 VDT users, who participated in a training program for the prevention of musculoskeletal and visual problems, investigated the extent of the application of the taught principles in everyday work. Data were collected over a 2 to 3 day period for each trainee, through an ergonomic work analysis in situ and semi-structured interviews, followed by recommendations, when appropriate, corresponding to the taught principles. A case analysis and a cross analysis of the data provided information about the developed ability for self-analysis of work regarding posture and visual comfort and what influenced it. A model depicting the process of transfer of knowledge and skills, from the training program to preventive action, was abstracted from data analysis. This model allows both the identification of problems in applying taught principles and the means to readjust the training program.