Project A: Integrated Approaches to Improving the Health and Safety of Health Care Workers

May 6, 2015 updated by: Glorian Sorensen, Harvard School of Public Health (HSPH)

While most of the research on integrated approaches of occupational health and safety and worksite health promotion to date has focused on manufacturing settings, employment is shifting to the service sector. Within this sector, health care employs over 12 million workers, and is the second fastest growing industry in the U.S. economy. In contrast to workers in other industries, rates of occupational injuries and illnesses among health care workers have increased over the past decade. The purpose of this study is to lay the foundation for integrated interventions in health care through examination of the associations of worker health outcomes and risks on and off the job with work policies and practices and to address the prevalent issues of musculoskeletal disorders (MSDs), particularly low back pain disability (LBPD), and health promotions through physical activity among patient care workers. The specific aims of this study are:

  1. To estimate the efficacy and determine the feasibility of an integrated intervention, addressing both health protection and health promotion in order to reduce MSD symptoms and improve health behaviors among healthcare workers. We will assess between-group differences in MSD symptoms, health behaviors, including physical activity, and a set of secondary outcomes, including unplanned absence, reported injuries, worker compensation claims and costs, turnover and retention, intention to leave the job, and work-role function. This study will explore the working hypothesis that: Workers employed at baseline in patient-care units receiving the intervention will report greater reductions in their MSD symptoms (primary outcome) and greater improvements in health behaviors, compared with workers employed at baseline in units assigned to the Usual Care control group.
  2. To determine the factors in the work environment which contribute over time to reductions in MSD symptoms and improvements in safe and healthy behaviors. (1) The work environment, work organization, and psychosocial factors, measured in our current study, will be associated with changes in workers' health behaviors and health outcomes between the assessments in the current and proposed studies; (2) Improvements in the work environment over time will be associated with improvements in workers' health behaviors and health outcomes. We will conduct multilevel modeling analysis to evaluate the simultaneous effects of worker-level and unit-level factors on MSD symptoms and safety and health behaviors.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Improving and protecting the health and well-being of healthcare workers requires addressing key risks in the work environment as well as promoting safe and healthy behaviors. Healthcare workers are at elevated risk for musculoskeletal disorders (MSDs) due to a range of job factors, including lifting and transferring patients; working long hours (often at night); and limited control over decisions on the job. Among these, nurses and nurses aides bear the largest burden of injury. Back injuries in particular constitute the greatest source of their disability. These risks are likely to increase in coming years due to the aging nursing workforce, increase in work demands, and labor shortages. Health behaviors, including physical activity, inadequate sleep, and dietary patterns associated with being overweight or obese, are also influenced by the work environment and psychosocial factors on the job, and are also associated with MSD risk. Traditional approaches to redressing these risks have focused separately on health protection, including efforts to reduce MSD risk, and health promotion aimed at improving health behaviors. Little research has systematically examined the dual and potentially synergistic effects of the work environment on risk of MSDs and worker health behaviors, and there is insufficient evidence to determine the most efficacious ways to ameliorate the combined effects of these health risks. Our long-term goal is to improve the overall health and well-being of healthcare workers by making available evidence-based worksite policies, programs, and practices that foster a healthy work environment, reduce potential hazardous job exposures, and promote safe and healthy behaviors. The proposed study is the next logical step in building this evidence base. Factors in the work environment, including high work demands, low social support, and long work hours, have been shown to increase risk of MSDs, as well as risk-related behaviors. Yet little research has systematically explored these cross-cutting pathways and their implications for improving the effectiveness of worksite interventions to address the broad spectrum of worker health outcomes.

The proposed research provides a novel approach to worksite interventions that integrate occupational safety and health and worksite health promotion, taking into account the shared factors in the work environment shaping both MSDs and health behaviors. Standard approaches to occupational health and safety and worksite health promotion are based on a parallel structure of separate silos functioning relatively independently in the worksite, each drawing from their own disciplines and training experiences within public health. Although these parallel efforts share the common mission of improving worker health, their strategies are based on different assumptions about and approaches to improving worker health outcomes. The proposed research integrates these parallel approaches. Although our prior research has rigorously tested the efficacy of this integrated intervention model in changing worker health behaviors, to our knowledge no prior research has examined the impact of this integrated model on health outcomes associated with work exposures - here, notably, on MSD symptoms.

Study Type

Interventional

Enrollment (Actual)

9500

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, United States, 02114
        • Massachusetts General Hospital
      • Boston, Massachusetts, United States, 02115
        • Harvard School of Public Health

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion criteria:

  • Adult and pediatric in-patient care units at Massachusetts General Hospital that have ceiling lifts in place (n=42 units) are eligible for the intervention.
  • Patient care workers, including registered nurses (RNs), licensed practical nurses (LPNs), patient care assistants (PCAs)/nursing assistants (NAs) and Nurse Leaders working in in-patient units for at least 20 hours per week (n= 9500).
  • Of those patient care workers, those working in adult and pediatric in-patient care units (n=90 units) are eligible to be randomly selected for surveys.

Exclusion criteria:

N/A

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Allocation: Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control
No intervention
Experimental: Intervention
Be Well Work Well
Other: Be Well Work Well

The intervention follows principles for integrated approaches to promoting and protecting worker health. It will occur on 4 inpatient units at Massachusetts General Hospital beginning in January 2013, and will continue for 1 year.

Overall intervention objectives:

  1. Motivate individual staff members to engage in targeted health and safety behavior changes;
  2. build awareness of ergonomic and safety hazards and of opportunities for healthy dietary choices and physical activity;
  3. facilitate unit-level norms supportive of breaks, safe patient handling, and targeted health and safety behaviors; and
  4. promote co-worker and supervisor support for targeted health and safety behaviors.
Other Names:
  • OSH protection and health promotion program

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain
Time Frame: Baseline and 1 year
  • Musculoskeletal disorder pain
  • Self-report via survey
Baseline and 1 year
Physical Activity
Time Frame: Baseline and 1 year
Self-report via survey
Baseline and 1 year
Diet
Time Frame: Baseline and 1 year
Self-report via survey
Baseline and 1 year
Sleep
Time Frame: Baseline and 1 year
Self-report via survey
Baseline and 1 year

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safe patient handling
Time Frame: Baseline and 1 year
Self-report via survey
Baseline and 1 year
Work role function/limitations
Time Frame: Baseline and 1 year
Self-report via survey
Baseline and 1 year
BMI/obesity
Time Frame: Baseline and 1 year
Self-report via survey
Baseline and 1 year

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Economic/systems outcomes
Time Frame: Baseline and 1 year
  • Unplanned absence
  • Reported injuries
  • Worker compensation
  • Turnover/retention
  • Healthcare utilization/costs

Self-report via survey
Baseline and 1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Harvard School of Public Health (HSPH)

Collaborators

Boston University
Massachusetts General Hospital
Dana-Farber Cancer Institute
Brigham and Women's Hospital
HealthCore-NERI
Partners HealthCare

Investigators

  • Principal Investigator: Glorian Sorensen, PhD, MPH, Harvard School of Public Health (HSPH)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

April 1, 2012

Primary Completion (Actual)

June 1, 2014

Study Completion (Actual)

June 1, 2014

Study Registration Dates

First Submitted

March 19, 2013

First Submitted That Met QC Criteria

April 24, 2013

First Posted (Estimate)

April 29, 2013

Study Record Updates

Last Update Posted (Estimate)

May 7, 2015

Last Update Submitted That Met QC Criteria

May 6, 2015

Last Verified

May 1, 2015

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • U19OH008861 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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