Who would rescue the dilemma of Chinese elderly care? An evolutionary game analysis and simulation research on the formalization of the domestic service industry with subsidy policy.

Since China entered the aging society, the surging demand for elderly care and the industrial upgrading of "silver economy" has forced the domestic service industry to face endogenous challenges. Among them, the formalization of the domestic service industry can effectively reduce the transaction costs and risks of actors, innovate the endogenous vitality of the industry, and promote the improvement of elderly care quality through a triangular employment relationship. By constructing a tripartite asymmetric evolutionary game model of clients, domestic enterprises and governmental departments, this study uses the stability theorem of differential equations to explore the influencing factors and action paths of the system's evolutionary stable strategies (ESS), and uses the research data collected from China to assign values to models for simulation analysis. This study finds that the ratio of the initial ideal strategy, the difference between profits and costs, subsidies to clients, and subsidies or punishments for breach of contract to domestic enterprises are the key factors affecting the formalization of the domestic service industry. Subsidy policy programs can be divided into long-term and periodic programs, and there are differences in the influence paths and effects of the key factors in different situations. Increasing domestic enterprises' market share with employee management systems, formulating subsidy programs for clients, and setting up evaluation and supervision mechanisms are efficient ways through which to promote the formalization of the domestic service industry in China. Subsidy policy of governmental departments should focus on improving the professional skills and quality of elderly care domestic workers, and also encourage domestic enterprises with employee management systems at the same time, to expand the scope of service beneficiaries by running nutrition restaurants in communities, cooperating with elderly care institutions, etc.

Developing and Testing Strategies for Improving Cleanliness of Shared Sanitation in Low-Income Settlements of Kisumu, Kenya.

Sharing of sanitation is common in low-income settlements in Sub-Saharan Africa. However, shared (limited) sanitation facilities have been thought to pose health risks due to poor hygiene levels. Interventions to improve user behavior and cleanliness of shared sanitation are few, both in literature and in practice. This study details the codesign and testing of strategies to improve the cleanliness of shared sanitation facilities in low-income areas of Kisumu City in Kenya. The strategies included a cleaning plan, monitoring system, and discussions among users, and were codesigned through workshops with stakeholders and group discussions with landlords and tenants. These strategies were tested in 38 compound houses through the Trials of Improved Practices approach over a 5-month period. Field staff visited the compounds, observed the cleanliness of the shared toilets, and through discussions, encouraged users to develop a formal cleaning system and a monitoring plan. The discussions built social capital and collective action and facilitated uptake of the cleaning plan with notable improvements in cleanliness of shared toilets. The results support the acceptability of shared sanitation in low-income settlements, the importance of codesigning and coproducing solutions with users, and the need to evaluate the effects of these strategies on cleanliness of shared sanitation.

Fathers matter: Intrahousehold responsibilities and children's wellbeing during the COVID-19 lockdown in Italy.

The lockdown imposed during the spring of 2020 as a result of the COVID-19 pandemic upset families lives, in addition to the health consequences of the virus, forcing parents to completely reorganize their labor, domestic work and childcare time. At the same time, school closures forced children to rearrange their lives and learning processes: in Italy, schools and nurseries were closed for four months, and the incidence and quality of distance learning activities was heterogeneous across education levels and among schools. Using real-time survey data on families with under-16 children collected in April 2020, which include information on parents' market and household work, and their perception of their children's wellbeing, we estimate how the lockdown has affected children's use of time, their emotional status and their home learning, and whether the reallocation of intrahousehold responsibilities during the lockdown played a role in this process. Changes in the parental division of household tasks and childcare, mostly induced by the labor market restrictions imposed during the lockdown, point to a greater involvement of fathers in childcare and homeschooling activities. This positive variation in fathers' involvement is accompanied by an increase in children's emotional wellbeing and by a reduction in TV and passive screen time. On the other hand, the quality of children's home learning does not appear to depend on which parent is overseeing their work, but rather on the type of distance learning activities proposed by their teachers.

Cost-Benefit Analysis of Allowing Additional Time in Cleaning Hospital Contact Precautions Rooms.

Increasing cleaning time may reduce hospital-acquired transmission of Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococcus (VRE). We constructed a cost-benefit model to estimate the impact of implementing an enhanced cleaning protocol, allowing hospital housekeepers an additional 15 minutes to terminally clean contact precautions rooms. The enhanced cleaning protocol saved the hospital $758 per terminally-cleaned room when accounting for only C. difficile. Scaling up to a hospital with 100 cases of C. difficile/year, and the US annual C. difficile incidence, cost savings were $75,832/year and $169.8 million/year, respectively. These results may inform infection control strategic decision-making and resource allocation.

Recomendaciones para la desinfección de ambientes hospitalarios expuestos a COVID-19 / Recommendations for the disinfection of hospital environments exposed to COVID-19

GENERALIDADES: Objetivo y población de las recomendaciones clínicas: Objetivos de las recomendaciones clínicas: Brindar recomendaciones para la desinfección de ambientes hospitalarios expuestos a COVID-19. Ámbito a la cual se aplicarán recomendaciones clínicas: Ambientes hospitalarios expuestos a COVID-19. Usuarios y ámbito de las recomendaciones clínicas: Usuarios de las recomendaciones: Estas recomendaciones están dirigidas a gerentes o directores de los establecimientos de salud, líderes de equipo de trabajo de salud y personal encargado de la limpieza y desinfección de ambientes, para prevenir problemas de infección por COVID-19. Ámbito de las recomendaciones clínicas: El presente documento es de aplicación en las IPRESS de las Redes Asistenciales, Redes Prestacionales y en los Órganos Prestadores Nacionales de EsSalud a nivel nacional. MÉTODOS: 1. Búsqueda y selección de protocolos, guías de práctica clínica y documentos técnicos prévios: El 22 de abril de 2020 se buscaron pautas, protocolos de manejo, y documentos técnicos que aborden procedimientos a seguir para la desinfección de ambientes hospitalarios expuestos a COVID-19, cuya versión a texto completo se encuentre en español o inglés. 2. Formulación de las recomendaciones. Para la formulación de las recomendaciones se revisaron pautas y protocolos encontrados que describieron más ampliamente los procedimientos a realizar para la desinfección de ambientes hospitalarios expuestos a COVID-19. Producto de ello se establecieron las recomendaciones. 3. Desarrollo de las recomendaciones: Persistencia del virus COVID-19 (coronavirus disease 2019). Alcances generales para la desinfección. Medidas de desinfección recurrente. Desinfección según área y condiciones del entorno hospitalário.

The association between janitor physical workload, mental workload, and stress: The SWEEP study.

BACKGROUND: Approximately 2.38 million janitors are employed in the U.S. While high physical workload may explain a lost-work days rate 2.7 times greater than other occupations, little is known about the association between janitors' physical workload, mental workload, and stress. OBJECTIVE: The objective of this study was to assess the associations between physical (ergonomic) and mental workload exposures and stress outcomes among janitors. METHODS: Questionnaire data, focused on ergonomic workload, mental workload and stress, were collected from Minnesota janitors for a one-year period. Physical workload was assessed with Borg Scales and Rapid Entire Body Assessments (REBA). Mental workload assessment utilized the NASA Task Load Index (TLX). Stress assessments utilized single-item ordinal stress scale (SISS) and Perceived Stress Scale-4 (PSS-4) measures. Descriptive and multivariable analyses, including bias adjustment, were conducted. RESULTS: Odds ratios (OR) and 95% confidence intervals (CI) for ergonomic workload (task frequency) effects on SISS were: REBA (1.18 OR, 1.02-1.37 CI); Borg (1.25 OR, 1.00-1.56 CI); combined REBA and Borg (1.10 OR, 1.01-1.20 CI). Mental workload was associated with higher PSS-4 levels (0.15 Mean Difference, 0.08-0.22 CI) and a 3% increased risk for each one-unit increase in the SISS scale (1.03 OR, 1.02-1.05 CI). CONCLUSIONS: This research demonstrated a moderate effect of physical and mental workloads on stress among janitors.

Using the OVAKO working posture analysis system in cleaning occupations.

BACKGROUND: Cleaning workers experience severe musculoskeletal symptoms. OBJECTIVE: The objective of this paper was to examine musculoskeletal symptoms in cleaners of different heights to evaluate the effects of height on working postures in the work environment (schools). METHODS: We used a three-stage method including using the Nordic Musculoskeletal Questionnaire (NMQ) to evaluate musculoskeletal symptoms, a task analysis to confirm typical cleaning tasks, and the OVAKO Working Posture Assessment System (OWAS) for posture analysis. Multinomial logistic regression was performed to evaluate the adjusted effects of individual characteristics on painful body regions, using individuals without any pain as the reference category. RESULTS: This study found that the prevalence of musculoskeletal symptoms is very high for cleaners, especially in the shoulders, elbows, and lower back. Odds ratios for the accumulation of two or more risk factors were higher among men and were inversely associated with national economic indicators. The relatively high prevalence of musculoskeletal symptoms may stem from the multiple operations involved in cleaning tasks, such as trash collecting, floor mopping, toilet cleaning, and mirror polishing. Workers of different heights had differential work loadings for different tasks. CONCLUSIONS: This paper proposes recommendations for job adaptations and occupational safety training. Cleaners of different heights execute the typical tasks via different postures, and awkward postures often result in musculoskeletal symptoms. Cleaners should be provided with specific tools and training regarding working postures on the basis of height. These findings can be used as a reference for related operation designs and task improvements to ensure correct tool usage and safer working postures during cleaning.

Cleaning workers' exposure to volatile organic compounds and particulate matter during floor polish removal and reapplication.

The floor polish removal (FPR) and reapplication (FPA) are important cleaning tasks in public buildings that have hard floor surfaces. Usually, the FPR and FPA are conducted once or twice a year, during the periodic cleaning of these buildings. The FPR can be performed either chemically (CFPR) or by using dry scrubber (DFPR), when the polish is ground from the floor. In this study, cleaning workers' exposure to volatile organic compounds (VOCs) and particulate matter (PM) during the FPR and FPA, and the differences in the exposures between the two FPR methods were investigated. In total, three buildings located in Central Finland were included, and total of six cleaning workers (two per building) participated in the study. In Buildings 1 and 2, the CFPR and FPA were performed and in Building 3, the DFPR was conducted. TVOC (total volatile organic compounds) concentrations in the breathing zone of the workers during the CFPR were 8,740 and 390 µg/m3 (SD 3,290 and 180 µg/m3) for Buildings 1 and 2, respectively. During the DFPR in Building 3, the average TVOC concentration was 400 µg/m3 (SD 180 µg/m3, stationary sampling). The TVOC concentrations during the FPA were high, 1,640 and 2,170 µg/m3 on average (SD 1,570 and 930 µg/m3) for Buildings 1 and 2, respectively. Glycol ethers were the most prominent VOCs during the CFPR and FPA, whereas carboxylic acids were the most common during the DFPR. The inhalable dust concentrations in the workers' breathing zone were noticeably higher during the DFPR (1.55 mg/m3 on average, SD 0.01 mg/m3) than the CFPR (0.24 mg/m3 on average, SD 0.05 mg/m3). Finnish occupational exposure limit value for organic inhalable dust is 5 mg/m3. As the products used during the CFPR and FPA contain glycol ethers and ethanolamines that are absorbed via the skin as well, the use of skin protection is recommended. Whereas the use of FFP3 respirators and skin protection are recommended during the DFPR to prevent the PM exposure.

The ergonomic impact of a mattress lift tool and bottom sheet type on hotel room cleaners while making beds.

The purpose of this study was to quantify biomechanical and cardiovascular exposure while making beds with and without interventions (mattress lift tool and fitted sheet). Sixteen female hotel room cleaners participated in this multifactorial (tool and sheet) laboratory study of crossover design. Exertion in the upper extremity (<2) and back (<3) was consistently lower when using the tool and fitted sheet (p < 0.05). The average number of lifts per bed was reduced by 48% with an 18 s increase in cycle time per bed. Peak forearm flexor activity was significantly lower when using a tool(p < 0.05). Spinal lateral plane range of motion (p < 0.02) and maximum twisting velocity (p < 0.03) were lowest using the tool and fitted sheet together. Interventions such as a mattress lift tool used with a fitted sheet reduced the number of mattress lifts and lowered perceived exertion among hotel room cleaners while making beds.

Effort-reward imbalance and ambulatory blood pressure among female Las Vegas hotel room cleaners.

BACKGROUND: Effort-reward imbalance (ERI) was hypothesized to be associated with ambulatory blood pressure (ABP) and pulse pressure (PP) among female hotel room cleaners. METHODS: ERI, ABP, and PP were assessed among 419 cleaners from five hotels during 18 waking hours. Adjusted linear regression models were used to assess associations of ERI with ABP and PP during 18-hours, work hours, and after work hours. RESULTS: There was a pattern of higher ERI being associated with higher 18-hour systolic ABP and 18-hour PP although the results were imprecise. An increase of ERI by half its range was associated with a 1.6 mmHg (95% CI, -1.6-4.7) increase in 18-hour systolic blood pressure (SBP) and a 0.7 mmHg (95% CI, -1.1-2.5) increase in 18-hour PP. An increase in rewards by half its range was associated with a 2 mmHg decrease in after-hours SBP (-2.2, 95% CI, -5.4-1.0) and after-hours PP (-1.9, 95% CI, -3.8-0.0). Among females 45 years or older, ERI was associated with 2.1 and 2.2 mmHg increase in 18-hour and work hours diastolic ABP, respectively, compared to a 0 mmHg change in 18-hour and work hours diastolic ABP in younger women. The number of dependents at home attenuated the association. CONCLUSIONS: ERI was positively associated with ABP, particularly SBP, and the association was modified by age and the number dependents at home, although the estimates were imprecise. Workplace interventions that integrate stress management and active ABP surveillance appear warranted. However, larger studies with Latina women need to confirm our results.

Upper extremity muscular load during carpet vacuuming with household upright cleaners.

Ergonomics of household vacuuming has received little attention despite the pervasive nature of this task. The aim of this study was to quantitatively assess the level of muscular load of the upper extremity during carpeted floor vacuuming with household upright cleaners, which represent the most common type of vacuum cleaners in the US. Eighteen participants conducted five different vacuuming tasks with three upright cleaner models. Electromyography data from seven upper extremity muscles were recorded and analyzed. Normalized muscle activation levels were significantly higher in women compared to men across the five tasks for each muscle group. Median muscular load ranged from 4.5% to 47.5% of the maximum voluntary contraction capacity for female participants and from 2.7% to 23.6% for male participants. These results suggest that household vacuuming with upright vacuum cleaners is physically intensive work, especially for women. Study findings have potential implications for the design of upright vacuum cleaners.

An Overview of Strategies for Reducing Upper Extremity Physical Exposure Associated With Floor Mopping: A Systematic Review.

OBJECTIVE: This systematic review synthesizes literature on upper extremity physical exposure associated with floor mopping, in order to (a) assess the impact of changes in mopping systems on physical exposure and (b) propose recommendations for strategies to reduce exposure. BACKGROUND: Floor-cleaning tools and equipment have undergone major improvements. Existing studies have focused on mop design modifications and cleaning efficiency. However, less is known about strain responses caused by modern tools and methods. METHOD: Studies from 1987 to February 2017 were identified by electronic and manual search. All selected studies underwent a quality assessment. The evidence was organized into categories representing different strategies for reducing exposure. The levels of evidence were determined using a best evidence synthesis approach. RESULTS: Eleven studies were included. Based on the review findings, currently there is moderate evidence suggesting that reduced physical exposure has been achieved through development of mopping systems. Levels of evidence for strategies associated with positive effects on physical exposure were: moderate evidence for mop design and handle type, insufficient evidence for mopping technique, and mixed evidence for mopping methods and environment modifications. Therefore, the present study suggests the use of adjustable mop handles as a strategy for reducing physical exposure. CONCLUSION: A more comprehensive approach to reducing physical exposure concerning floor mopping work is necessary. APPLICATION: Knowledge regarding physical exposure reduction can be applied as the basis for decision making in cleaning practice. Information can be incorporated into future research regarding development of floor-cleaning methods.

A pilot study: Exploring the musculoskeletal risk exposure associated with drying laundry using the public housing pipe-socket system amongst women in Singapore.

BACKGROUND: The biomechanics of homemakers has been minimally studied. The way laundry-drying is performed in Singapore public-housing, using the pipe-socket-system (PSS), could expose the homemakers to musculoskeletal disorder risk. OBJECTIVE: This study aims to quantify the musculoskeletal risk exposure (MRE) associated with laundry-drying amongst female homemakers using the PSS in Singapore public-housing. METHODS: Using snowball sampling approach, five female homemakers familiar with the described laundry-drying method were recruited. The postures of the participants were analysed from video-recorded data and scored using the Rapid Entire Body Assessment (REBA). RESULTS: This pilot study revealed very strong evidence (p = 0.001) that the participants were exposed to medium risk (REBA score 4.3) when performing this housework task. CONCLUSIONS: Extreme awkward postures and repetitive motions were observed from the participants during the analysis. High REBA scores were frequently associated with the awkward postures adopted due to constraints of physical work space.

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning.

BACKGROUND: Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge. AIM: To construct a conceptual representation of how occupational therapists make clinical decisions for such program. METHOD: Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. RESULTS: Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. CONCLUSIONS: The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients' willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.

Resuspension of house dust and allergens during walking and vacuum cleaning.

Conventional wisdom has been that hard, resilient surfaces resuspend fewer particles than carpeted surfaces, however, exceptions to this have been demonstrated and uncertainty remains about the factors that lead to this resuspension, notably, the effect of vacuum cleaning on either increasing or reducing resuspension from flooring. The purpose of this study was to determine how resuspension of house dust by aerodynamic size or particle type, including cat allergen and bacterial endotoxin, is affected by flooring, dust loading, embedding dust, and walking/cleaning activities. House dust was blown in and allowed to settle in a walk-in chamber after overnight deposition followed by walking or a vacuum cleaning procedure. Using an aerosol particle sizer and large-volume air samplers at different heights in the chamber, concentrations of airborne particles, resuspension rates, and fractions were computed for four types of flooring conditions during six walking activities. Carpeting resulted in significantly more airborne cat allergen and airborne endotoxin than a laminate floor. Height does have an effect on measured allergen over carpet and this is apparent with concentrations at the infant and adult air samplers. Walking on laminate flooring resuspends less house dust than walking on an equally dusty carpeted floor, where dust is entirely on the surface of the carpet. However, vacuum cleaning a laminate floor resuspended more dust than vacuum cleaning carpets, at large particle sizes of 5 µm and 10 µm. Activities following a deep cleaning of hard resilient or a carpeted surface is likely to leave no differences in resuspended particles between them.

How are nursing homes cleaned? Results of a survey of 6 nursing homes in Southeast Michigan.

This brief report details 2 surveys that were conducted to better understand current cleaning practices in 6 nursing home facilities in Southeast Michigan. Each facility's environmental services supervisor answered questions regarding cleaning policy and procedures, roles and responsibilities of the staff, and frequency of education and training; one environmental services employee from each facility answered questions addressing education and training, employer evaluation and feedback, and workload. We identify gaps in knowledge and behaviors and note substantial variations in cleaning practices.

Effect of automated ultraviolet C-emitting device on decontamination of hospital rooms with and without real-time observation of terminal room disinfection.

BACKGROUND: We studied the effectiveness of an ultraviolet C (UV-C) emitter in clinical settings and compared it with observed terminal disinfection. METHODS: We cultured 22 hospital discharge rooms at a tertiary care academic medical center. Phase 1 (unobserved terminal disinfection) included cultures of 11 high-touch environmental surfaces (HTSs) after terminal room disinfection (AD) and after the use of a UV-C-emitting device (AUV). Phase 2 (observed terminal disinfection) included cultures before terminal room disinfection (BD), AD, and AUV. Zero-inflated Poisson regression compared mean colony forming units (CFU) between the groups. Two-sample proportion tests identified significance of the observed differences in proportions of thoroughly cleaned HTSs (CFU < 5). Significant P value was determined using the Bonferroni corrected threshold of α = .05/12 = .004. RESULTS: We obtained 594 samples. Risk of overall contamination was 0.48 times lower in the AUV group than in the AD group (P < .001), with 1.04 log10 reduction. During phase 1, overall proportion of HTSs with <5 CFUs increased in AUV versus AD by 0.12 (P = .001). During phase 2, it increased in AD versus BD by 0.45 (P < .001), with no significant difference between AD and AUV (P = .02). CONCLUSIONS: Use of UV-C with standard cleaning significantly reduced microbial burden and improved the thoroughness of terminal disinfection. We found no further benefit to UV-C use if standard terminal disinfection was observed.

Gross and relative energy cost of domestic household activities in Asian men.

BACKGROUND/OBJECTIVES: Obesity is on the rise and participation in exercise has declined. Domestic household activities may help meet the recommended daily physical activity levels. This study aimed to measure the energy costs of household activities among Asian males. SUBJECTS/METHODS: This was a randomised cross-over study conducted in a whole-body calorimeter. The energy costs of 14 domestic household activities, divided into two studies, were measured in 10 healthy Asian males. Participants' weight, height, body composition and basal metabolic rate were measured on the first test visit. A standard breakfast was served and participants rested for an hour before the measurement of energy costs of domestic household activities. During the measurements, each activity was performed for 20 min, and participants rested for 30 min between activities. RESULTS: The mean energy costs of domestic household activities ranged from 5.92 to 11.97 kJ/min, which were significantly different between activities (repeated measures analysis of variance, P<0.001). When expressed as metabolic equivalents (METS), all domestic household activities were classified as low-intensity physical activities. Actual METS (METSactual) were significantly different to standard METS of eight activities, which may be partly explained by the universal assumption of 3.5 ml O2/kg/min made during the calculation of METS in the Asian population. CONCLUSIONS: The energy costs of a range of domestic household activities reported in this study may assist in the planning of physical activities among Asians to meet national physical activity guidelines.

Understanding decision-making towards housework among women with upper limb repetitive strain injury.

BACKGROUND: Among women with upper limb repetitive strain injury (RSI), occupational therapy interventions include education to facilitate ergonomic practices in housework. From a client-centred perspective, an understanding of women's decision-making about housework is needed to design effective occupational therapy programmes. This study addresses a gap in research in this area by exploring women's views about changing housework habits. AIM: The aim was to construct a conceptual representation to explain decision-making in housework by drawing on experiences of a sample of Singapore Chinese women with upper limb RSI from one hand therapy clinic. METHODS: Based on a constructivist grounded theory methodology, data were collected through in-depth interviewing with 15 women. Interviews were audiotaped and transcribed. Data were analysed with line by line coding, focussed coding and axial coding with constant comparison throughout data collection. RESULTS: Decision-making in housework among these women involved three main themes: (i) emotional attachment to housework; (ii) cognitively informed decision; and (iii) emotionally influenced decision. Women with upper limb RSI had to make cognitive decisions for or against a change in housework to manage their condition. However, the women's cognitively informed decisions were shaped by their emotional attachment to housework. As such, they experienced strong emotional barriers to changing their housework practices even when they had cognitively accepted the necessity and possibility of making a change. CONCLUSIONS: Therapists need to be aware that counselling to address the emotional barriers experienced by women is important during ergonomic education.