This longitudinal study examines the relationship of psychosocial safety climate and psychosocial work factors with teacher turnover rates at 12- and 24-months follow-ups using objective turnover data from 14 schools in two Swedish municipalities. The study used an open cohort repeated cross-sectional research design and merged teachers’ self-reported survey data on psychosocial safety climate and psychosocial work environment factors, which were aggregated to the school level, during the first school year (n = 440) and in the second school year (n = 406), to investigate their associations with annual school-level turnover data for each school year. Given the micro–macro data situation and the few higher-level groups (n = 14 schools), school-level data were analysed using disaggregation and hierarchical regression. The findings show that differences in teacher turnover between schools were mainly explained by municipal effects and labour market dynamics rather than differences in schools’ psychosocial safety climate and psychosocial work factors.

Trial registration: ClinicalTrials.gov identifier: NCT03322839.

The rise in the number of people on sick leave for common mental disorders is a growing concern, both from a societal and individual perspective. One common suggestion to improve the return-to-work process is increased cooperation between the relevant parties, including at least the employer, the social insurance agency and health care. This suggestion is often made on the presumption that all parties share the common goal of reintegrating the patient-employee back into the workplace. In this paper we investigate this presumption by mapping out the ethical frameworks of these three key actors in any return-to-work process. We show that although the goals of these actors often, and to a large extent, overlap there are potential differences and tensions between their respective goals. Further, we emphasise that there may be other limitations to an actor's participation in the process. In particular the health care system is required to respect patient autonomy and confidentiality. There is also an inherent tension in the dual roles of health care professionals as therapists and expert witnesses in work ability assessment. In conclusion, there are potential tensions between the key actors in the return-to-work process. These tensions need to be addressed in order to enable an increased cooperation between actors and to facilitate the development of a feasible plan of action for all parties, including the employee.

Introduction. Eldercare organizations face high sickness absence rates and staff turnover and rely heavily on temporary workers to fill staffing gaps. Temporary workers may experience differences in job demands and resources compared to permanent workers, but this has been largely understudied.

Aim. To compare perceived job demands and resources between permanent and temporary Swedish eldercare workers.

Methods. Permanent and temporary eldercare workers in a Swedish municipality were invited to answer a digital survey on work environment conditions. Differences between permanent and temporary workers in job demands and resources were analyzed using multivariate analysis of variance adjusted for age, sex, place of birth, and percent of full-time work and univariate analyses were conducted to consider differences in specific factors.

Results. 1076 permanent and 675 temporary workers received the survey and the final study sample included 451 permanent and 151 temporary workers. Multivariate analyses revealed that temporary workers reported statistically significant lower job demands compared to permanent workers, but no statistically significant differences in resources were found between the groups. Univariate analyses showed that temporary workers reported lower quantitative demands, perceived exertion, and time spent bending forward, than permanent workers. These data suggest comparable support across groups, but a higher workload among permanent workers.

Conclusion. Our findings indicate that temporary workers experienced lower job demands than permanent workers, but that no notable difference was found in resources. Interventions aimed at distributing job demands more evenly among eldercare workers with different employment forms may be necessary.

Background

Integrated occupational safety and health and patient safety management are essential for addressing the challenges faced by healthcare services today. Developing and evaluating tools that support this work is crucial. This project aims to assess the effectiveness of a structured method for systematic and integrated occupational safety and health and patient safety management systems (SIOHPS). Additionally, the project includes embedded economic and process evaluation. This article presents the overall design of the SIOHPS-project, with a specific focus on the design and evaluation of the (cost-)effectiveness study.

Methods

The project is guided by the Medical Research Council (MRC) framework for complex interventions and is coproduced with key stakeholders. The intervention is designed to support systematic occupational health and patient safety management systems, incorporating both Safety I and Safety II perspectives. It is grounded in safety culture theory and knowledge about team debriefing for learning. The intervention consists of several core components, including targeted education, end-of-shift team debriefings, and support for systematic management. The intervention is supported by a digital tool. A program theory guides the evaluation. A pragmatic stepped-wedge cluster-controlled design (p-SWD) is used, with hospital healthcare units as clusters. The p-SWD includes three steps, with at least four clusters transitioning from the control to the intervention group at each step. A minimum of twelve healthcare units from two different regions in Sweden will participate. The intervention effect will be evaluated using sick leave and quality of care as primary outcomes. Secondary outcomes include safety climate, work environment factors, healthcare worker health, performance, patient safety and quality of nursing care. Primary and secondary analyses are conducted based on intention-to-treat approach. Cost-effectiveness will be assessed using cost-benefit and cost-consequence analyses.

Discussion

The need of methods that integrate systematic occupational safety and health and patient safety management has been emphasized by different stakeholders worldwide. The SIOHPS study has strong potential for nationwide implementation in Sweden to help healthcare organizations address current challenges. Additionally, the project will contribute to existing safety culture theory by exploring the integration of these domains.

Trial registration

ClinicalTrials.gov Identifier: NCT06398860. Registration date: 2024-04-30.

Purpose

The aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up.

Methods

We conducted a cluster-randomised controlled trial including 197 employees blinded to allocation (85 PSI-WPI and 112 CAU). As sickness absence data was skewed and over-dispersed, generalised estimating equations was used to enable a comparison between the intervention and control group for each month of the follow-up period.

Results

The median number of sickness absence days over the 18-month follow-up was 78 days, inter-quartile range (IQR) 18–196 for employees receiving PSI-WPI and 64 days, IQR 18–161 for employees receiving CAU. The time x group generalised estimating equations analysis showed no statistically significant difference in sickness absence days per month.

Conclusion

The addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.

Trial registration.

The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.

Introduction: The combination at work of physical activity behaviours (e.g. sitting, standing, and physical activity) and psychosocial factors (e.g. influence and leadership quality) may be more important for preventing work-related pain than each of the exposures isolated (i.e., sitting or influence at work). However, this needs to be tested using accurate measurements of physical behaviours. We aimed to investigate the independent and combined associations of physical behaviours and psychosocial factors with pain in a sample of eldercare workers with high occurrence of pain.

Methods: We analysed cross-sectional data on 191 eldercare workers in a Swedish municipality. Participants responded to a web-survey and took part in technical measurements of physical behaviours using thigh-worn accelerometers over 7 days. We determined the proportion of time spent in sitting, standing and active behaviours during working hours for each participant. We then used the Aitchison distance to calculate the closeness (on a scale from 0 “worst possible” to 100 “ideal”) to the composition recommended by the EU (60%,30%,10% for sitting, standing and active, respectively). Leadership quality and influence at work were assessed using COPSOQIII. Pain intensity (0-10 scale) and worsening of pain due to work (0-5 scale) were used as outcomes in MANCOVA models with closeness and psychosocial factors as predictors.

Results: We found that being closer to the recommended composition of sitting, standing and being active at work was associated with lower pain intensity (F=6.3, p=0.01) and less worsening of pain due to work (F=9.2, p=0.003), independent of leadership quality and influence at work. We found no statistically significant interactions between closeness and psychosocial factors regarding these outcomes, but both higher leadership quality and influence at work showed associations with lower pain. 

Discussion: Physical behaviours and psychosocial factors at work were independently associated with pain in eldercare workers, while combining the exposures did not contribute to any additional explained variance in pain. These results should be interpreted with caution due to the cross-sectional design and risk of confounding by non-measured factors.

Conclusion: Musculoskeletal pain in eldercare workers was associated with the composition of sitting, standing and active, expressed in terms of closeness to EU guidelines, and physical and psychosocial exposures did not interact. Further research is required to understand the effects on musculoskeletal health of combining physical and psychosocial exposures, including their temporal patterns, in various occupational settings.

Background

The study aimed to explore which sociodemographic, health-related, and work-related factors were associated with the number of sickness absence days during 18 months among employees on sickness absence due to common mental disorders.

Methods

A longitudinal study with participants from a cluster-randomized controlled trial was conducted. Participants from both intervention and control groups were treated as one cohort. Factors included in the analysis were sociodemographic, health-related, and work-related variables collected through questionnaires at baseline. The outcome was cumulative net sickness absence days for sickness absence spells exceeding 14 days and was collected from a national register. Data was analyzed using generalized estimating equations.

Results

The sample consisted of 197 employees. Lower-rated work ability in relation to physical demands ([exp (B) 1.19], 95% CI 1.02–1.40) and higher-rated job demands ([exp (B) 1.28], 95% CI 1.01–1.61), were associated with increased number of sickness absence days during the 18 months follow-up. Higher certainty of return to work within three months ([exp (B) 0.63], 95% CI 0.48–0.83) was associated with a decreased number of sickness absence days during the 18 months follow-up.

Conclusions

Our study suggests that work-related factors, i.e., high job demands and impaired work ability, are associated with an increased number of days on sickness absence. Additionally, the certainty of returning to work within three months is associated with fewer days on sickness absence. The results highlight the importance of addressing specific workplace factors when designing interventions aimed at decreasing sickness absence for employees on sickness absence due to CMDs. The results could be used to inform a dialogue between healthcare personnel and employees on sickness absence due to CMDs, and to serve as basis for a structured inventory to assist healthcare personnel in addressing workplace factors.

Objectives

Recent research has emphasized that return to work (RTW) is a dynamic, gradual and often uneven process with a great degree of individual variation. This study aimed to identify RTW trajectories of Swedish employees on sick-leave due to common mental disorders (CMDs). The second aim was to explore which demographic, employment, health-related and work environment characteristics predicted RTW trajectory membership.

Methods

Data comes from two 2-armed cluster-randomized controlled trials (RCT) with a 12-month follow-up. A participative problem-solving intervention aimed to reduce sick-leave was compared to care as usual (CAU) involving any kind of work-directed interventions. Participants on sick-leave due to CMDs at baseline (N = 197) formed the study sample. Latent growth mixture modeling and logistic regression were the main analytical approaches.

Results

Five distinct RTW trajectories of Swedish employees were identified: Early RTW (N = 65), Delayed RTW (N = 50), Late RTW (N = 39), Struggling RTW (N = 21) and No RTW (N = 22). RTW trajectories differed consistently with regard to previous sick-leave duration and social support at work. More unique predictors of RTW trajectories included gender, rewards at work, work performance impairment due to health problems, home-to-work interference and stress-related exhaustion disorder.

Conclusion

The study may have important clinical implications for identifying patients belonging to a particular RTW trajectory. Knowledge on the modifiable work environment factors that differentiated between the RTW trajectories could be useful for designing effective workplace interventions, tailored to particular needs of employees with CMDs. However, in a first step, the results need to be replicated.

Objective: We aimed to assess the impact of telework conditions on stress levels among 294 Swedish white-collar workers.

Methods: Telework during the COVID-19 pandemic was evaluated in terms of the allowance to telework (ie, the degree to which the employee could decide whether to telework), and the utilization of that allowance, using self-reported questions with answers dichotomized into 'high' and 'low'. Perceived stress was measured using the Single Item Stress Question and physiological stress was measured using parameters of heart rate variability (HRV) continuously for three days [root mean square of successive differences (RMSSD) and standard deviation of the interbeat intervals of normal heart beats (SDNN)]. Multilevel linear mixed models examined the effects of telework allowance and utilization on perceived stress and HRV during work, leisure and sleep.

Results: High allowance was associated with higher HRV (lower stress), while a high utilization of telework was associated with higher perceived stress and lower HRV (more stress). After adjusting for age, sex, body mass index, and objectively measured physical activity, these associations became smaller and/or non-significant, with exception of high allowance still being positively associated with higher RMSSD.

Conclusions: Our findings indicate that allowing employees more autonomy in telework decisions (ie, a high allowance in this study) is associated with reduced physiological stress. These results can be used by organizations to improve telework conditions (how, where and how much), while being observant that white-collar workers do not utilize increased autonomy to work extensively and for long hours outside work. Further verification, preferably using prospective designs, is needed to confirm our results.

Background: High levels of occupational physical activity (OPA) may be related to pain and sickness absence in the eldercare sector, which is dependent on foreign-born workforce. However, no study has investigated the closeness of OPA in eldercare to the recommendations proposed by EU-OSHA and compared workers born in different countries, which is important to address inequalities in occupational health.

Aim: To determine how close the physical activity compositions of Swedish-born and foreign-born eldercare workers are to EU-OSHA's recommended composition (60% sitting, 30% standing, and 10% moving) during work hours. 

Methods: We analyzed data from 222 eldercare workers in three Swedish municipalities. Physical activity was assessed with a thigh-worn accelerometer for seven days.  Time spent sitting, standing, and moving at work (diary based) was analyzed using the Actipass software. The Aitchison distance between each observed OPA composition and the composition recommended by EU-OSHA was calculated and expressed as a closeness index ranging from 0 (‘worst possible’ composition [1:1:98]) to 100 (EU-OSHA composition [60:30:10]). The closeness indices for Swedish-born and foreign-born workers were compared using linear mixed models.

Results: The Swedish-born group (n=160, 72.1%) had an average composition of 49:39:12, which led to a closeness index of 88.3 [SD 7.1], while the foreign-born had a composition of 44:40:15 and closeness index of 84.9 [SD 7.6]. The two groups were significantly different (β=3.34; CI=[1.19:5.48]; p<0.01), even after adjustments for age, gender and sector (nursing home or homecare) (β=3.98; CI=[1.74:6.22]; p<0.01).

Conclusions: Compositions of OPA among foreign-born workers were further from the EU-OSHA recommendation compared to their Swedish peers. Task-related differences in patient care may explain our findings. Future studies should consider alternations between sitting, standing and moving, and develop interventions to promote a more balanced OPA between Swedish-born and foreign-born workers, and thus address potential inequalities in the eldercare sector.