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.

To address the challenge of labor market shortages, and workforce aging, this cross-sectional study explore the individual, work, and family factors associated with early (age ≤ 64) or late (age ≥ 66) expected retirement timing (ERT) among older long-term care (LTC) workers in Sweden. Data were drawn from the Swedish Longitudinal Occupational Survey of Health in 2018, comprising a sample of men and women aged 50-64 (n=550), working in LTC for older people. The results suggest that higher job demands and higher job satisfaction increase the likelihood of older LTC workers' early ERT. Shorter tenure and factors in work that enhance family life were associated with increased likelihood for late ERT.

We investigated effects on economic (cost savings), environmental (CO2 emission), and social sustainability (factors reflecting a positive psychosocial environment at work) of a 6-mo intervention from November 2021 through April 2022, during which employees were offered scheduled telework in a municipality in Sweden. Economic and environmental sustainability were estimated by the municipality whereas social sustainability was assessed by the researchers. Using analysis of covariance, we examined outcomes in 3 groups, ie scheduled teleworkers (n = 36), non-scheduled teleworkers (n = 55), and office workers (n = 11). The results indicated that scheduled telework resulted in reduced costs since unutilized premises could be disposed, and less CO2 emission due to a combination of reduced commuting time, lower energy use, and less need to construct new buildings. However, the 3 groups did not differ significantly regarding social sustainability. The results support the notion that telework can lead to positive outcomes in terms of decreased premises costs and environmental footprint, without deteriorating social sustainability.

Objectives

The aim of this study was to evaluate the cost-effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) compared with care as usual (CAU) among employees on sick leave due to common mental disorders in Swedish primary healthcare centers.

Methods

Employees aged 18 to 59 years on sick leave for common mental disorders (n = 197) were included in a controlled cluster-randomized trial by coordinators (n = 19) recruited at primary care centers in Region Västra Götaland, Sweden. The study was conducted between February 2018 and August 2021, with 18 months of follow-up per participant. The economic evaluation included a cost-effectiveness analysis comparing changes in sick leave with direct costs from a healthcare perspective, calculated from register data, and intervention costs; a cost-utility analysis based on EQ-5D questionnaires and a societal perspective included indirect costs calculated from registered sick leave. Sensitivity analyses explored robustness to alternative missingness assumptions.

Results

The PSI-WPI resulted in more sickness absence (average 40 extra days; 95% confidence interval, 3-77 days) compared with CAU and higher healthcare costs (SEK 21 650, SEK 4962-48 262) over 18 months. At 12 months, the cost of care was SEK 23 734 (SEK 537-46 931) higher in the PSI-WPI group. The difference in quality-adjusted life-years between the groups was negligible. The sensitivity analysis indicated robust results, and diagnoses not targeted by the study were important cost drivers.

Conclusions

The PSI-WPI was not cost-effective for employees on sick leave due to common mental disorders compared with CAU only.

ArticleAuthorsMetricsCommentsMedia CoverageAbstract1. Introduction2. Method3. Results4. DiscussionsAcknowledgmentsReferencesReader CommentsFigures

AbstractThis longitudinal study explored the perceptions of psychosocial work factors, work-related health, and job satisfaction of 745 professional service staff, working in a higher education setting in Sweden, during the transition from full remote work to a hybrid work arrangement over 12-months. The study also explored whether these perceptions differed due to gender and household composition. The questionnaire data were analyzed using linear mixed-effects models with estimated marginal means and Bonferroni-adjusted pairwise comparisons. The results showed that while overall perceptions of psychosocial work factors showed modest changes during the transition, except for social support from colleagues, which significantly increased over time. Professional service staff reported higher levels of stress and exhaustion during the transition, while job satisfaction remained unchanged. The results also highlighted significant gender differences during the transition, as women reported less favourable perceptions of psychosocial work factors and higher levels of stress, while men’s perceptions remained largely stable across these outcomes. Significant overall differences in household composition were also observed, as individuals living in single-person households and in single-parent households reported less favourable perceptions of psychosocial work factors and their work-related health compared to cohabitants and cohabitants with children, though all household groups followed similar trajectories during the transition. The findings suggest that higher education institutions should implement action plans for gender equality and family-supportive practices in hybrid work arrangements to ensure that the benefits of hybrid work are accessible to all employees.

Background: Temporary employment is widely used in eldercare to address staffing shortages, but heavy reliance on temporary workers may compromise continuity of care, staff workload, and quality of care. Managers are key to how staffing is organised and handled in daily practice. This study examined how managers at different organisational levels perceived the opportunities and challenges of temporary employment in municipal eldercare.

Methods: This qualitative study was based on semi-structured interviews with 16 managers across four organisational levels in Swedish municipal eldercare, including residential care homes, home care services, and higher-level management. The interview guide focused on managers' experiences of temporary employment, staffing practices, care continuity, work environment, and perceived effects on care quality. Data were analysed using qualitative content analysis.

Results: Three themes were identified. Balancing staffing on a tightrope describes managers' struggle to ensure continuity in a system that relies on short-term solutions and often prioritising shift coverage over competence. Leading with tied hands captures managers' limited control over recruitment and workforce planning, which reinforced reliance on temporary employment. From rigidity to flexibility highlights managers' suggestions for improving staffing stability. Managers across levels identified similar challenges, but their priorities differed. First-line managers focused on daily staffing, staff well-being, and quality of care, while higher-level managers emphasised long-term planning. Temporary workers helped cover staffing gaps, but also increased permanent employees' workloads and complicated workforce planning. Managers expressed frustration with centralised staffing decisions that prioritised immediate coverage over long-term stability. Temporary workers were often treated as interchangeable rather than integrated team members, reflecting systemic problems in staffing practices.

Conclusion: Temporary workers are essential for keeping eldercare services running, but over-reliance on temporary employment may reinforce reactive staffing practices, increase pressure on permanent staff, and weaken continuity. Managers suggested better onboarding, greater local hiring control, and dedicated staffing pools. Addressing these issues requires both immediate measures to integrate temporary workers into regular teams and longer-term changes in workforce planning, staffing levels, and local managerial influence.

Purpose: This process evaluation examined the implementation of a problem-solving intervention with workplace involvement (PSI-WPI) for employees with common mental disorders, developed to reduce sickness absence. The aim was to understand factors influencing the "problem-solving in primary care" (PROSA) effect evaluation, which showed no significant difference in sickness absence days between PSI-WPI and care-as-usual (CAU).

Methods: PSI-WPI included a five-step process typically delivered over three sessions by primary care rehabilitation coordinators. Process outcomes assessed were reach, dose delivered, dose received, fidelity and dose response. Data came from questionnaires, medical records, and registry data. Kruskal-Wallis tests assessed associations between number of PSI-WPI sessions and sickness absence days. A post hoc analysis explored characteristics of employees receiving no, one or ≥ three PSI-WPI sessions.

Results: PSI-WPI coordinators reported slightly more face-to-face sessions and three-part meetings, whereas CAU coordinators reported more telephone sessions. Coordinator support was received by 85% of PSI-WPI participants compared to 43% of CAU; 41% PSI-WPI participants received ≥ three sessions. Employees receiving ≥ three sessions had significantly more sickness absence days during 18-months follow-up than those receiving none.

Conclusion: The intervention was largely delivered as intended and supported by sufficient training and resources. Dose-response findings suggest the intervention was primarily delivered to employees with more complex needs, highlighting the importance of accounting for preintervention sickness absence and targeting support. Future studies should strengthen implementation planning, refine theoretical assumptions, and ensure alignment between intervention design and participant needs, particularly when adapting return-to-work interventions from occupational health services to primary health care.

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

Background: Health care systems are increasingly challenged by demographic shifts, rising chronic illnesses, human resource constraints, and growing efficiency demands. Improving both occupational safety and health (OSH) and patient safety (PS) management has been identified as a pivotal strategy to address these challenges. However, there is a paucity of evidence-based methods that support systematic and integrated OSH and PS. In response, the Systematic and Integrated Occupational Safety and Health and Patient Safety Management Systems (SIOHPS) intervention was developed, guided by the Safer Culture Framework and the Medical Research Council (MRC) framework for complex interventions.

Objective: This paper outlines the study protocol for a process evaluation embedded in the SIOHPS trial.

Methods: The process evaluation will use a convergent parallel mixed methods design. The SIOHPS trial is conducted in 13 Swedish hospital settings. Guided by the Consolidated Framework for Implementation Research (CFIR), quantitative and qualitative data will be collected before, during, and after the trial through questionnaires, telephone interviews, focus group interviews (FGIs), observations, the SIOHPS digital tool, and other relevant documentation. In line with the convergent parallel mixed methods study design, the quantitative and qualitative data will be analyzed in a stepwise manner, initially independently from each other, followed by iterative triangulation.

Results: Funding began in January 2023. The development phase was completed in early 2024, and the evaluation phase started in June 2024, with completion planned in early February 2026. Quantitative data collection for two of three clusters (baseline, 4- and 8-month follow-up) is complete, and data cleaning is underway. All qualitative data collected to date have been transcribed. Final data collection for cluster III, including the 8-month survey and FGIs, is scheduled for the end of January and early February 2026. Data analysis will begin in early 2026, with results to be disseminated through publications and conference presentations later in 2026.

Conclusions: The process evaluation will integrate quantitative and qualitative data sources to elucidate the mechanisms through which the SIOHPS intervention influences safety culture, health care worker (HCW) health, PS, and quality of care. This comprehensive approach unpacks the "black box" of the implementation process, which will provide an in-depth nuanced picture of the intervention's effectiveness and valuable insights into scalability and transferability across diverse health care contexts.

Trial registration: ClinicalTrials.gov NCT06398860; https://clinicaltrials.gov/study/NCT06398860.

International registered report identifier (irrid): DERR1-10.2196/89185.

Objectives: The workplace is an important arena for identifying and managing early symptoms of mental health problems. This study aimed to explore how private sector employees at risk of sickness absence due to mental health problems experienced promoting and hindering factors for working.

Methods: Semi-structured interviews were conducted with 18 employees with mental health problems (≥3 on the General Health Questionnaire or who answered yes to a question on self-predicted sickness absence in the coming year due to common mental disorders). Reflexive thematic analysis was used to analyze the data.

Results: The analysis resulted in three themes: influence of life stage on working while having mental health problems; managing mental health problems in the social and organizational context; and preserving one's identity and agency when working while having mental health problems. Promoting and hindering factors occurred at the individual, group, leader and organizational levels. Promoting factors included social support from colleagues, a trusting relationship with the first-line manager, and engaging in leisure-time physical activity. Hindering factors included perceiving the cause of symptoms to be primarily outside work leading to delayed access to help, a cold or noisy work environment, and schedule mismatch.

Conclusion: Promoting and hindering factors occurred at multiple levels. Fostering a supportive and inclusive work environment where there is space for enjoyment can help employees manage mental health problems at work. Other promoting factors include having an active and present manager, reasonable production goals, and leisure-time physical activity. Employees who perceive the cause of their symptoms to be related to their private life tend not to seek help from the workplace, despite the impact on their work. This should be considered in the development of future interventions. Our study supports a life-course perspective on the understanding of how employees experience promoting and hindering factors for working while having mental health problems.