Improving occupational health care for construction workers: a process evaluation

Abstract

BackgroundTo evaluate the process of a job-specific workers’ health surveillance (WHS) in improving occupational health care for construction workers.MethodsFrom January to July 2012 were 899 bricklayers and supervisors invited for the job-specific WHS at three locations of one occupational health service throughout the Netherlands. The intervention aimed at detecting signs of work-related health problems, reduced work capacity and/or reduced work functioning. Measurements were obtained using a recruitment record and questionnaires at baseline and follow-up. The process evaluation included the following: reach (attendance rate), intervention dose delivered (provision of written recommendations and follow-up appointments), intervention dose received (intention to follow-up on advice directly after WHS and remembrance of advice three months later), and fidelity (protocol adherence). The workers scored their increase in knowledge from 0–10 with regard to health status and work ability, their satisfaction with the intervention and the perceived (future) effect of such an intervention. Program implementation was defined as the mean score of reach, fidelity, and intervention dose delivered and received.ResultsReach was 9% (77 workers participated), fidelity was 67%, the intervention dose delivered was 92 and 63%, and the intervention dose received was 68 and 49%. The total programme implementation was 58%. The increases in knowledge regarding the health status and work ability of the workers after the WHS were graded as 7.0 and 5.9, respectively. The satisfaction of the workers with the entire intervention was graded as 7.5. The perceived (future) effects on health status were graded as 6.3, and the effects on work ability were graded with a 5.2. The economic recession affected the workers as well as the occupational health service that enacted the implementation.ConclusionsProgramme implementation was acceptable. Low reach, limited protocol adherence and modest engagement of the workers with respect to the intervention were the most prominent aspects that influenced the intervention process. The increase in the workers’ knowledge about their health status and work ability was substantial, and the workers’ satisfaction with the intervention was good. The perceived effect of the advised preventive actions on health status was sufficient.Trial registrationNetherlands Trial Register: http://NTR3012

Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review

“…It was unclear who intervention deliverers were in 12 studies (21.8%) [26, 39, 46, 50, 51, 55, 59–64], but in studies where this information was identifiable, deliverers were most frequently nurses (10 studies, 18.2%) [33, 35–37, 40, 47, 52, 65–67]. With regards to level and mode of delivery, interventions were most frequently delivered at the individual (25 studies, 45.5%) [27–29, 33, 34, 40, 41, 45, 46, 48, 50–52, 54, 56, 60, 63, 65, 66, 68–73] and group level (19 studies, 35.1%) [26, 31, 32, 38, 39, 42, 43, 49, 53, 55, 58, 61, 62, 64, 67, 74–77]. Face to face was the most common (28 studies, 50.9%) mode of delivery [27, 29, 31, 32, 35–38, 41–45, 49, 50, 56, 58, 60–62, 66–68, 74–78].…”

“…Spouses/partners in the PaTH intervention group attended CR with the patient and participated in exercise sessions and educational classes to make the same positive changes in exercise and diet (Therapeutic Lifestyle Change [TLC] Diet recommended by the American Heart Association). Spouses in the usual care group were invited to attend the educational sessions that were part of the CR program.AttendanceAttendance logs33 Zauszniewski [45]Grandmothers who were raising grandchildrenPersonal and social resourcefulness skills training.√√Use of skills learnt during interventionSelf-report of use of resourcefulness skills (questionnaire)Self-report of skills learnt and used (qualitative- daily journals/voice recordings)34 Arends [68]Workers aged between 18–63 years, diagnosed with a common mental disorder.Evidence-based guideline directed at structuring physicians’ treatment to help sick-listed workers with mental health problems to return to work, using strategies such as problem-solving.Intervention components completedSelf-report of number of assignments completed (questionnaire)Intervention content receivedSelf-report of topics discussed (questionnaire)35 Bjelland [59]11–12 year oldsIntervention aimed at reducing intake of sugarsweetened beverages and sedentary behaviour in adolescent school children.ExposureSelf-report of awareness of intervention components, receipt of and exposure to intervention materials (questionnaire)SatisfactionSelf-report of satisfaction (questionnaire)Receipt of intervention materials36 Boschman [60]Construction workersIntervention aimed at detecting signs of workrelated health problems, reduced work capacity and/or reduced work functioning.√Recall of intervention-related adviceSelf-report (questionnaire)Intention to act on intervention advice37 Branscum [26]YMCA-sponsored after school programsKnowledge and theory-based childhood obesity prevention intervention implemented in afterschool programs. The knowledge-based intervention chose program activities to mediate behaviour change solely based on building awareness and knowledge, such as being aware of the recommended number of servings of fruits and vegetables.…”

“…none of the studies included from the electronic database search reported using the BCC framework). Other frameworks that informed the studies reviewed included the process evaluation framework by Linnan and Steckler (2002) [22] in 11 (20.0%) [27, 46, 52, 53, 55, 60, 66, 68, 69, 71, 74], Lichstein et al’s Treatment Implementation Model (TIM) [21] in 4 (7.3%) studies [28, 39, 40, 67], Saunders et al’s framework [23] in 5 (9.1%) studies [26, 30, 46, 49, 59], the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework [79] in 2 (3.6%) studies [46, 70], Dane & Schneider’s framework [80] in 2 (3.6%) studies [38, 76], Dusenbury et al’s framework [81, 82] in 2 (3.6%) studies [38, 62], Baranowski et al’s framework [83] in 1 (1.8%) study [52]. A brief definition of how receipt is defined in these frameworks is available in notes below the Table in Additional file 2.…”

When is job rotation perceived useful and easy to use to prevent work-related musculoskeletal complaints?

“…Also, supportive management and positive attitude among workers towards the intervention contributed to higher satisfaction and participation of aging hospital workers with a worksite health promotion program (Strijk et al, 2011). Conversely, an unaccommodating organizational climate and modest engagement among workers resulted in very low attendance rate of construction workers at the job-specific workers' health surveillance (Boschman et al, 2013). In addition, most construction workers had not undertaken the advised preventive actions, because they perceived the (future) effect as limited.…”

“…Elimination of adverse physical work demands is not always feasible for construction trades, so minimizing accumulated exposures through job rotation is often recommended by the Occupational Safety and Health Administration (OSHA) and Health and Safety Executive (HSE) as an alternative to technical measures. In addition, implementing an intervention in the construction industry is considered a challenge (Boschman et al, 2013;Oude Hengel et al, 2011). Therefore, we expect this industry particularly able to provide considerations for researchers and practitioners who are planning to conduct job rotation interventions.…”