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Objective: The objective of this scoping review was to identify studies combining the concepts of eHealth and work participation for sick-listed employees across diagnostic groups in health care and workplace contexts. Introduction: There is an increased demand for better health care services and technologies, and eHealth is proposed as a useful tool to improve efficiency and reduce costs. eHealth functions at the intersection of medical informatics, public health, and business, and may be a promising solution for managing the process of return to work among employees on sick leave. Assessment of work outcomes is essential in evaluating the effectiveness of health services, and there is a need to map the research literature on existing eHealth interventions to facilitate work participation. Inclusion criteria: This scoping review considered studies combining two core concepts: eHealth and work participation. It considered studies on eHealth interventions for employees (18 to 65 years of age) on sick leave due to any type of diagnosis or disability, conducted by any stakeholder in workplace or health care contexts and in any country. Empirical data from both quantitative and qualitative studies were included. Methods: Published and unpublished studies from January 1, 2008, to August 21, 2020, written in English were included in this review. The search was conducted in MEDLINE, Scopus, Embase, PsycINFO, WHO clinical registry, and ClinicalTrials.gov. A three-step search strategy was followed. Data extraction was performed by two independent reviewers and undertaken using an extraction tool developed specifically for the scoping review objectives. Results: This review identified 15 studies eligible for inclusion. Four studies delivered the eHealth intervention by telephone, while 10 interventions were web-based. Of the web-based interventions, five had a blended approach, such as website and email support, or website and social media platforms. One study used an app-based intervention. Only eight studies targeted employees sick-listed due to common sick leave diagnoses, such as common mental disorders and musculoskeletal disorders. The workplace context was the target of the eHealth intervention in seven studies, although the intervention was still delivered by health personnel such as therapists or occupational physicians. Collaboration on individual cases between the health professional, employer, and employee to facilitate work participation seemed to be rare. Four studies reported both a theoretical and an empirical base for the intervention used. Conclusions: This review demonstrated that the use of eHealth interventions to facilitate work participation is limited, and there is a need for future studies on the use of eHealth technology for this purpose. Developing eHealth interventions specifically for populations at risk of long-term sick leave, and encouraging collaboration between all relevant stakeholders, may help improve work participation.

Objective To identify occupations where employees with type 2 diabetes have a high risk of cardiovascular disease (CVD) and mortality, and their prevalence of CVD risk factors. This study can contribute in the creation of targeted interventions at the workplace. Research design and methods This nationwide registry-based study included all employees with type 2 diabetes born in Sweden in 1937–1979 (n = 180,620) and followed up in 2002–2015. We calculated age-standardized incidence (per 100,000 person-years) of all-cause and CVD mortality, ischemic heart disease (IHD) and stroke across the 30 most common occupations. Information on prognostic factors was retrieved from the National Diabetes Register. Results In males with type 2 diabetes, mortality rates were highest in manufacturing workers (1782) and machine operators (1329), and lowest in specialist managers (633). The risk of death at age 61–70 years was 21.8% in manufacturing workers and 8.5% in managers. In females with type 2 diabetes, mortality rates were highest in manufacturing workers (1150) and cleaners (876), and lowest in writers and artists (458); the risk of death at age 61–70 years was 12.4% in manufacturing workers and 4.3% in writers and artists. The same occupations also had relatively high incidences of CVD mortality, IHD and stroke. Occupational groups with poor prognosis had high prevalence of CVD risk factors including poor glycemic control, smoking and obesity. Conclusions Manufacturing workers, machine operators and cleaners with type 2 diabetes have two to three times higher mortality rates than managers, writers and artists with type 2 diabetes. Major health gains would be made if targeted workplace interventions could reduce CVD risk factors in these occupations.

OBJECTIVES: This study aimed to evaluate the effectiveness of a workplace intervention (WI) added to an inpatient multimodal occupational rehabilitation program (I-MORE) on sickness absence. METHODS: In this researcher-blinded randomized controlled trial with parallel groups, individuals on sick leave due to musculoskeletal, unspecified- or common mental health disorders were randomized to I-MORE (N=87) or I-MORE+WI (N=88). I-MORE lasted 2+1 weeks (with one week at home in between) and consisted of "acceptance and commitment therapy", physical exercise, and work-related problem solving. The additional WI consisted of a preparatory part, a workplace meeting involving the sick-listed worker, the employer, and the primary rehabilitation therapist at the rehabilitation center, and follow-up work related to the meeting. The primary outcomes were number of sickness absence days and time until sustainable return to work (RTW) during 12 months of follow-up, measured by registry data. RESULTS: The median number of sickness absence days during the 12-month follow-up for I-MORE was 115 days [interquartile range (IQR) 53–183] versus 130 days (IQR 81–212) for I-MORE+WI. The difference between groups was not statistically significant (P=0.084). The hazard ratio for sustainable RTW was 0.74 (95% confidence interval 0.48–1.16; P=0.192) in favor of I-MORE. CONCLUSIONS: This study provided no evidence in favor of I-MORE+WI compared to only I-MORE for long-term sickness absent individuals with musculoskeletal-, common mental- or unspecified disorders.

Background To test the effects of guided endurance training on work ability in middle-aged female hospital workers of various occupations. Methods We randomized 265 healthy, sedentary, middle-aged women (45–65 years) to an endurance training group (EG 210 min/week) or a wait-list control group (CG). At baseline and at 6-month follow-up, we assessed work ability (Work Ability Index [WAI]), physical activity (Freiburger activity questionnaire) and peak oxygen uptake (VO2peak) by cardiopulmonary exercise testing. To examine the influence of baseline work ability, participants were divided into poor-moderate (WAI 1, 7–36 points, n = 83), good (WAI 2, 37–43 points, n = 136) and excellent (WAI 3, 44–49 points, n = 46) WAI subgroups. Results Cardiorespiratory fitness improved significantly after 6 months in the EG but not in the CG. The WAI total score increased significantly in the EG (38.3 ± 5.0 to 39.8 ± 4.9 points) but not in the CG (39.4 ± 4.7 to 39.3 ± 4.9 points), with a significant difference between groups (p p Conclusions A 6-month guided exercise training intervention significantly increases cardiorespiratory fitness with concomitant improvements in work ability in middle-aged previously sedentary hospital employees. Women with low baseline work ability seem to particularly benefit from the intervention, which implies that similar interventions may be particularly beneficial for this group of individuals. Trial registration German Clinical Trails Register Identifier: DRKS00005159. Registered 25 September 2013.

Purpose: To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers.Materials and methods: Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients (n = 6 C-VR, n = 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis.Results: Three themes emerged for usefulness ("patient factors," "content," "dosage") and six themes emerged for feasibility ("satisfaction," "intention to continue use," "perceived appropriateness," "positive/negative effects on target participants," "factors affecting implementation ease or difficulty," "adaptations"). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible.Conclusions: The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted.Implications for rehabilitationBoth comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient.Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and country-specific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs.

OBJECTIVES: Workplace exercise interventions are known to reduce musculoskeletal complaints and are widely offered to promote employee`s health. The psychosocial effects of such interventions are not clear. This review evaluates the effects of workplace exercise interventions on the psychosocial work environment and mental health. METHODS: A systematic review was performed by screening four scientific databases (Pubmed, Cochrane Database, PsycINFO and Web of Science) for published randomized controlled trials in English from 1998–2018. The review followed the PRISMA statement guidelines using the Cochrane tool for assessing risk of bias and the GRADE approach for assessment of quality. Two researchers independently performed database search, study screening, and evaluation. RESULTS: Twenty two randomized controlled trials met the inclusion criteria. Substantial heterogenicity in the studies included was found in study populations, types of intervention, and outcome measures performed. Quality assessment revealed a generally low level of quality in the studies included. This was partly the result of the limited possibilities for blinding and the self-reported outcome measures. CONCLUSION: Workplace exercise interventions seem to have limited effects on mental health and the psychosocial work environment. Future studies should incorporate blinding and independent outcome measures.

Healthcare professionals’ exposure to work-family conflict negatively affects the health and well-being of the whole family and organizational outcomes. Specified workplace interventions are lacking. Therefore, the aim of the study was to evaluate the feasibility of a two-day group-treatment specifically designed for the needs of healthcare professionals with family responsibilities concerning participation, satisfaction with the intervention and family- and individual-related outcome variables. 24 mostly female (85.7%) participants of a community hospital in southern Germany attended the treatment. Data were collected at baseline (T0), directly after the treatment (T1) and two months later (T2). A two-factor analysis of variance with repeated measures showed a statistically significant time x group effect for self-efficacy (F = 5.29, p = 0.011). Contrasts displayed substantial pre-post (T1-T0, T2-T0) increases of self-efficacy in the intervention group as compared with the control group. Non-parametric Mann-Whitney-U tests are in line with these findings. The results indicate that the group-treatment adapted to the needs of healthcare professionals has the potential to boost self-efficacy among healthcare professionals and that participants were predominantly satisfied. Perspectives for future research and practical implications are discussed in the light of the manifest lack of healthcare professionals.

Background Despite the numerous benefits associated with physical activity (PA), most nurses are not active enough and few interventions have been developed to promote PA among nurses. A secondary analysis of raw data from a single-centre, three-arm parallel-group randomized controlled trial was conducted to assess whether work-related characteristics and general mood states predict changes in total weekly moderate-to-vigorous intensity PA (MVPA) and average daily step-count among nurses participating in a 6-week web-based worksite intervention. Methods Seventy nurses (meanage: 46.1 ± 11.2 years) were randomized to an individual-, friend-, or team-based PA challenge. Participants completed questionnaires pre- and post-intervention assessing work-related characteristics (i.e., shift schedule and length, number of hours worked per week, work role) and general mood states (i.e., tension, depression, anger, confusion, fatigue, vigour). Participants received a PA monitor to wear before and during the 6-week PA challenge, which was used to assess total weekly MVPA minutes and average daily step-count. Data were analyzed descriptively and using multilevel modeling for repeated measures. Results Change in total weekly MVPA minutes, but not change in average daily step-count, was predicted by shift schedule (rotating vs. fixed) by time (estimate = − 17.43, SE = 6.18, p = .006), and work role (clinical-only vs. other) by time (estimate = 18.98, SE = 6.51, p = .005). General mood states did not predict change in MVPA or change in average daily step-count. Conclusions Given that nurses who work rotating shifts and perform clinical work showed smaller improvements in MVPA, it may be necessary to consider work-related factors/barriers (e.g., time constraints, fatigue) and collaborate with nurses when designing and implementing MVPA interventions in the workplace. Trial registration ClinicalTrials.gov: NCT04524572. August 24, 2020. This trial was registered retrospectively. This study adheres to the CONSORT 2010 statement guidelines.

In Japan, standing while working has not yet become commonplace, and there is little evidence to support the benefits of standing during the workday. Therefore, this study assessed the relationship between the introduction of a sit–stand desk and its ability to reduce the negative effects of sitting too long and increase employees’ general health and productivity. Seventy-four Japanese desk workers participated in this three-month intervention study. Using a randomized controlled trial, the participants were divided into intervention (n = 36) and control (n = 38) groups. The participant characteristics were ascertained using a questionnaire. The intervention effectiveness was assessed by measuring health-, physical activity-, and work-related outcomes. The results indicate that the intervention group significantly decreased their sitting time at work (p = 0.002) and had reduced neck and shoulder pain (p = 0.001). There was a significant increase in subjective health (p = 0.002), vitality in work-related engagement (p &lt, 0.001), and self-rated work performance over a four-week period (p = 0.017). These findings indicate a significant difference between the two groups, demonstrating the effectiveness of a sit–stand desk in reducing sedentary behavior and improving workers’ health and productivity. Future research can accumulate further evidence of best practice use of sit–stand desks.

Objectives Excess salt intake is a major risk factor for hypertension and cardiovascular disease. Modifying workplace environments has been recognized to be important for reducing salt intake. However, studies examining the effects of improving the workplace environment regarding salt reduction are limited. This study aimed to evaluate the effects of workplace dietary intervention on employees' salt intake and sodium‐to‐potassium (Na/K) ratio. Methods A quasi‐experimental study was conducted. Two small business establishments in Saitama Prefecture, Japan, were allocated as the intervention (n = 69) and comparison (n = 68) workplaces, respectively. The 1‐year intervention involving healthy lunch and nutrition education was implemented in the intervention workplace. Spot urine samples, physical assessments, and self‐administered questionnaire data were collected at baseline, 6 months, and 1 year after the start of the intervention. Analysis of covariance was conducted to investigate differences in the salt intake or Na/K ratio between the study workplaces at year 1. Educational status and rotating work schedules were included as covariates. Results Salt intake in the intervention workplace decreased significantly from 10.7 to 9.3 g (−1.4 g change; 95% confidence interval [CI]: “−2.4, −0.5”). The adjusted difference in changes in salt intake between workplaces was statistically significant (−3.7 g change; 95% CI: “−5.2, −2.3”). Although no significant change was observed in the Na/K ratio in the intervention workplace (3.37–3.08; −0.29 change; 95% CI: “−0.59, 0.01”), the adjusted difference in changes between the workplaces was statistically significant (−0.60 change; 95% CI: “−1.03, −0.17”). Conclusions Providing healthy lunch and nutrition education may be effective approaches to reduce employees' salt intake and Na/K ratio.

Worksite health promotion programs have been identified as having the potential to mitigate chronic health risks. In the most recent 2017 U.S. CDC survey of workplace health promotion, respondents identified several perceived barriers related to program adoption and implementation. The analysis indicates that challenges negatively associated with having worksite program were lack of senior management support (OR = 0.50, 95% CI: 0.32–0.78), lack of qualified vendors (OR = 0.56, 95% CI: 0.4–0.79), lack of qualified personnel (OR = 0.56, 95% CI: 0.35–0.73), and cost (OR = 0.58, 95% CI: 0.39–0.88). Challenges associated with having a program were lack of employee interest (OR = 2.09, 95% CI = 1.44–3.03), lack of space (OR = 1.76, 95% CI: 1.26–2.48), and demonstrating program results (OR = 2.09, 95% CI = 1.44–3.03). These findings can provide insights to policy makers, insurers, and employers seeking to implement workplace-based health promotion initiatives.

Background: Consuming larger portion sizes, i.e., in excess of a typically recommended serving size, has been attributed to the obesity epidemic. The workplace acts as an efficient target for health promotion activities. Aims: To assess the effectiveness of a food portion size educational programme in increasing knowledge among the employees of a software company in Puducherry. Methodology: An interventional study was conducted with a pre-post design. A single group of software company employees (N = 120), age ≥30 years selected by simple random sampling was included in the study. The intervention consisted of a health education programme on the portion sizes of common food items including fruits and vegetables. A self-administered questionnaire was used to collect information on personal and sociodemographic details. Self-regulation on eating was assessed using the Self-Regulation of Eating Behaviour Questionnaire (SREBQ). Results: The mean age of the study participants was 27 ± 5 years. Most of the participants were males, i.e., 72 (60%). Of the total, 55 (47.8%) participants were obese and 18 (15.7%) were overweight. The median number of meals and snacks consumed by the participants was 3 (1–3) and 1 (1–2), respectively. The median (interquartile range [IQR]) knowledge scores of the food portion size significantly increased from 9 (0–16) to 14 (5–19) (P < 0.05). Conclusions: This study has demonstrated that an educational intervention in the workplace setting is feasible and effective in increasing the knowledge of food portion size over a short term.

OBJECTIVES: Psychological and educational interventions for the prevention of depression have a small-to-moderate effect. However, little is known about their effectiveness in the workplace. We aimed to evaluate the effectiveness of such interventions through a systematic review and meta-analysis of randomized controlled trials (RCT). METHODS: We searched PubMed, PsycINFO, EMBASE, CENTRAL, CIS-DOC and Open Grey for RCT. Search was supplemented with manual searches of reference lists of relevant meta-analyses and trials. We included RCT that assessed either the incidence of depression or the reduction of depressive symptoms, which excluded participants with baseline depression. Measurements were required to have been made using validated instruments and participants recruited in the workplace. Independent evaluators selected studies, evaluated risk bias (Cochrane Collaboration’s tool) and extracted from RCT. The combined OR was estimated using the fixed-effects model. Heterogeneity was measured by I^2 and Cochrane’s Q. RESULTS: Of the 1963 abstracts reviewed, 69 were selected for review in fulltext. Only three RCT met our inclusion criteria, representing 1246 workers from three different countries and continents. The combined odds ratio was 0.25 [95% confidence interval (CI) 0.11–0.60, P=0.002]; I^2=0% and Q=0.389 (P=0.823). The risk of bias was low in one RCT and moderate and high in the other two, respectively. CONCLUSION: Psychological or educational interventions in the workplace may prevent depression, although the quality of evidence was low.

Background Sedentary Behaviour (SB) gets an increasing attention from ergonomics and public health due to its associated detrimental health effects. A large number of studies record SB with ActiGraph counts-per-minute cut-points, but we still lack valid information about what the cut-points tell us about office work. This study therefore analysed the concurrent and discriminant validity of commonly used cut-points to measure SB, activity level, and posture. Methods Thirty office workers completed four office tasks at three workplaces (conventional chair, activity-promoting chair, and standing desk) while wearing two ActiGraphs (waist and wrist). Indirect calorimetry and prescribed posture served as reference criteria. Generalized Estimation Equations analysed workplace and task effects on the activity level and counts-per-minute, and kappa statistics and ROC curves analysed the cut-point validity. Results The activity-promoting chair (p p = 1.0) increased the activity level, and both these workplaces increased the waist (p ≤ 0.003, ES ≥ 0.63) but not the wrist counts-per-minute (p = 0.74) compared to the conventional chair. The concurrent and discriminant validity was higher for activity level (kappa: 0.52–0.56 and 0.38–0.45, respectively) than for SB and posture (kappa ≤0.35 and ≤ 0.19, respectively). Furthermore, the discriminant validity for activity level was higher for task effects (kappa: 0.42–0.48) than for workplace effects (0.13–0.24). Conclusions ActiGraph counts-per-minute for waist and wrist placement were – independently of the chosen cut-point – a measure for activity level and not for SB or posture, and the cut-points performed better to detect task effects than workplace effects. Waist cut-points were most valid to measure the activity level in conventional seated office work, but they showed severe limitations for sit-stand desks. None of the placements was valid to detect the increased activity on the activity-promoting chair. Caution should therefore be paid when analysing the effect of workplace interventions on activity level with ActiGraph waist and wrist cut-points.

Objective To assess the effects of adding a workplace intervention to inpatient occupational rehabilitation on return-to-work self-efficacy, and whether changes in return-to-work self-efficacy were associated with future work outcomes. Design Randomized clinical trial. Subjects Individuals aged 1860 years, sick-listed 212 months were randomized to multimodal inpatient rehabilitation with (n?=?88) or without (n?=?87) a workplace intervention. Methods Between-group differences for 4 months follow-up were assessed using linear mixed models. Associations between self-efficacy scores and future sickness absence days during 12 months of follow-up were assessed by linear regression. Results There were no statistically significant between-group differences in self-efficacy during follow-up. Participants with high or medium self-efficacy scores at the end of rehabilitation had fewer sickness absence days during follow-up compared with participants with low scores. Participants with consistently high scores or an increasing score throughout the programme showed fewer sickness absence days than those with reduced or consistently low scores. Conclusion Receiving an added workplace intervention did not increase return-to-work self-efficacy more than standard inpatient occupational rehabilitation alone. High scores and a positive development in return-to-work self-efficacy were associated with higher work participation. This suggests that return-to-work self-efficacy could be an important factor to consider in the return-to-work process.

While smoking is widely acknowledged to be a social activity, limited evidence exists on the extent to which friends influence each other during worksite-based tobacco cessation interventions. Drawing on data from adult smokers (N = 1823) in a large, cluster randomized controlled trial in worksites in Thailand, this study examines the presence of social spillovers in the decision to abstain from smoking. We leverage a unique aspect of social network structure in these data—the existence of non-overlapping friendship networks—to address the challenge of isolating the effects of peers on smoking behavior from the confounding effects of endogenous friend selection and bidirectional peer influence. We find that individuals with workplace friends who have abstained from smoking during the trial are significantly more likely to abstain themselves. Instrumental variables estimates suggest that abstinence after 3 and 12 months increases 26 and 32 percentage points, respectively, for each additional workplace friend who abstains. These findings highlight the potential for workplace interventions to use existing social networks to magnify the effect of individual-level behavior change, particularly in low- and middle-income countries where tobacco cessation support tends to be limited., Highlights • Decisions to abstain from smoking spreads across social networks. • Smokers are more likely to abstain from smoking if their friends also abstain. • Effects of peers' smoking abstinence persist at least one year after a 3-month intervention.

Background: HIV poses a threat to global health. With effective treatment options available, education and testing strategies are essential in preventing transmission. Text messaging is an effective tool for health promotion and can be used to target higher risk populations. This study reports on the design, delivery and testing of a mobile text messaging SMS intervention for HIV prevention and awareness, aimed at adults in the construction industry and delivered during the COVID-19 pandemic. Method: Participants were recruited at Test@Work workplace health promotion events (21 sites, n = 464 employees), including health checks with HIV testing. Message development was based on a participatory design and included a focus group (n = 9) and message fidelity testing (n = 291) with assessment of intervention uptake, reach, acceptability, and engagement. Barriers to HIV testing were identified and mapped to the COM-B behavioural model. 23 one-way push SMS messages (19 included short web links) were generated and fidelity tested, then sent via automated SMS to two employee cohorts over a 10-week period during the COVID-19 pandemic. Engagement metrics measured were: opt-outs, SMS delivered/read, number of clicks per web link, four two-way pull messages exploring repeat HIV testing, learning new information, perceived usefulness and behaviour change. Results: 291 people participated (68.3% of eligible attendees). A total of 7726 messages were sent between March and June 2020, with 91.6% successfully delivered (100% read). 12.4% of participants opted out over 10 weeks. Of delivered messages, links were clicked an average of 14.4% times, max 24.1% for HIV related links. The number of clicks on web links declined over time (r = &minus, 6.24, p = 0.01). Response rate for two-way pull messages was 13.7% of participants. Since the workplace HIV test offer at recruitment, 21.6% reported having taken a further HIV test. Qualitative replies indicated behavioural influence of messaging on exercise, lifestyle behaviours and intention to HIV test. Conclusions: SMS messaging for HIV prevention and awareness is acceptable to adults in the construction industry, has high uptake, low attrition and good engagement with message content, when delivered during a global pandemic. Data collection methods may need refinement for audience, and effect of COVID-19 on results is yet to be understood.

Background Despite extensive efforts, issues like obesity and poor physical capacity remain challenges for a healthy work life in several occupations. The Goldilocks work principle offers a new approach, encouraging design of productive work to promote physical capacity and health. This paper presents the protocol for the Goldilocks-childcare study, a randomised controlled intervention trial aiming to evaluate the effectiveness of implementing the Goldilocks work principle in childcare. The primary aim of the intervention is to increase time in moderate to vigorous physical activity (MVPA) by having the childcare workers act as active role models for children in daily playful physical activities, and thereby improve cardiorespiratory fitness and health of the workers. Methods The study is a cluster-randomised trial with a usual-practice wait-list control group. The 10-week intervention consists of two phases. In the first, the childcare workers will participate in two participatory workshops aiming to a) develop playful physical activities (‘Goldilocks-games’) for children in which childcare workers participate as active role models at MVPA intensity, and b) develop action plans for implementation of the Goldilocks-games in daily work routines. In the second phase, childcare institutions will implement the Goldilocks-games. The primary outcome is working time spent in MVPA, and secondary outcomes are cardiorespiratory fitness, sleeping heart rate, perceived need for recovery, and productivity. Primary outcome and process evaluation will be based on direct measurements of physical activity and heart rate, determination of cardiorespiratory fitness, and questionnaires. Discussion If proven effective, the Goldilocks work principle has a large potential for promoting sustainable health and working lives of childcare workers. Trial registration ISRCTN, ISRCTN15644757, Registered 25th December 2019

Background Workers with a low socioeconomic position (SEP) have a higher risk for health problems and premature dropout from the workforce. Unfavorable working conditions and unhealthy behaviors are more prevalent among this group of workers. The Participatory Approach (PA), is an evidence-based method to identify and solve problems at the workplace related to health issues of the worker. Health problems among workers with a low SEP are usually caused by an interplay of problems in and outside the workplace. To solve health problems on multiple life domains for workers with a low SEP we aim to adapt this approach to a broader perspective. Methods An Intervention Mapping (IM) protocol was used to adapt the PA. First, a needs assessment was conducted combining literature with data from interviews and focus groups with workers with a low SEP, employers and occupational health professionals (OHPs). Based on the needs assessment a program goal and performance and change objectives were defined, which resulted in methods and practical strategies to solve problems on multiple life domains. Based on the results of these steps, the PA was adapted and an implementation and evaluation plan were developed. Results The needs assessment confirmed that an interplay of problems on multiple life domains affect work functioning and health of workers with a low SEP. Moreover, they perceived difficulties with solving problems or used passive or avoidant coping styles towards these problems. The program goal is to identify and solve problems on multiple life domains that affect healthy functioning at work. To achieve this workers need support from OHPs to solve problems. The PA protocol and materials were adapted using theoretical concepts of the Self-Determination Theory (SDT), which resulted in the Grip on Health intervention. For OHPs a training was developed on how to implement this intervention in practice. The intervention will be evaluated in a pilot implementation study among workers with a low SEP and other relevant stakeholders. Conclusions IM was a valuable tool for the adaptation of the PA to better support workers with a low SEP to improve their work functioning and health from a broader perspective.

This study aimed to assess the effect of systematic self-observation, hetero-observational feedback, and feedforward and intrinsic feedback (SsObserWork components) on workers&rsquo, knowledge and behaviour of a manual material handling (MMH) technique in the industrial sector. Blue-collar workers recruited from a food processing company in Catalonia (Spain) were randomized into SsObserWork (N = 31) and control (N = 30) groups. SsObserWork group members participated individually in two sessions and a three-week follow-up between sessions where they received the SsObserWork components. The control group participated individually in two sessions where they received a standard MMH training. An ad hoc instrumentcalled the MMH-SsObserWork instrument was used to assess the MMH behaviour, and an adaption of the instrument was done to assess the workers&rsquo, knowledge. Significant differences were found between groups for the identification of recommended back positions in the first session and also on comparing both sessions. However, no differences were found for the rest of the criteria. There also were significant differences between groups in the score changes of the back, knee joints, elbow joints, and interaction criterion, indicating that the SsObserWork group improved the MMH performance in these criteria (behaviour). SsObserWork intervention showed a positive effect on improving the knowledge and behaviour of the MMH technique, specifically on back posture.

Police work can be stressful and demanding and can impact on employee wellbeing. This study aimed to understand mental health (MH) issues and risk factors for poor MH in officers and staff of the Police Service of Scotland (PSoS); and gather their ideas of workplace wellbeing interventions that are suitable for this workforce. Face-to-face/telephone interviews were conducted with 30 Superintendents and eight stakeholders, recruited throughout PSoS. Interview topics included: MH issues; health/health behaviours; employment; and potentially beneficial workplace interventions. A thematic analysis approach was adopted. High levels of occupational stress and anxiety, currently or in the past, were reported, as were experiences of PTSD, anxiety and depression. The main stressors reported were working hours, workload, culture, leadership and organisational change. Officers and staff recognised progress towards promoting and managing MH in the service but identified interventions, including training, counselling, and environmental workplace changes as needed to address mental health issues within police cultures.

Quitting smoking is easier if you receive a reward for it. This research shows that employees refrained from smoking better if they received a reward in combination with quit-smoking training at work. The research involved 604 smokers who wanted to stop smoking from 61 companies in the Netherlands. Half of the smokers participated in a group training only (control group) and the other half participated in the group training and received a reward (intervention group). The reward consisted of gift certificates totalling €350. After the training, those who had stopped smoking received €50, after three months another €50, after six months again €50 and after 12 months €200. After a year, some people had started smoking again, but there was a large different between the intervention and control groups (41% vs. 26%). This demonstrates that a quit-smoking group training at work will be more successful if combined with a reward in the form of gift certificates. The results of this research have been published in the leading scientific journal The Lancet Public Health, among others.Funded by KWF Kankerbestrijding, ZonMw

Background: Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown. Objective: To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses. Methods: A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9–3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed. Results: Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change. Conclusions: Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses’ health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.

OBJECTIVES: The aim of the systematic review was to provide an overview of the evidence on the effectiveness of brief interventions targeting mental health and well-being in organizational settings and compare their effects with corresponding interventions of common (ie, longer) duration. METHODS: An extensive systematic search was conducted using the Medline and PsycINFO databases for the period of 2000–2016. Randomized-controlled trials (RCT) and quasi-experimental studies evaluating primary or secondary brief interventions carried out in the workplace settings were included. Subsequently, common interventions matching brief interventions by type and assessed outcomes were included. The methodological quality of included studies was appraised using NICE guidelines and the best evidence synthesis approach was applied. RESULTS: The review identified 11 brief interventions and 9 corresponding common interventions. Included studies varied substantially in sample size and characteristics, methodological quality, duration of follow-up, types of intervention, and assessed outcomes. All but one study evaluating brief interventions had high risk of bias. No evidence was found on the effectiveness of brief stress management, relaxation, massage, mindfulness meditation, or multimodal interventions. We found limited evidence on the effectiveness of brief positive psychology interventions. CONCLUSIONS: Our review highlights the need for high-quality studies evaluating brief mental health and well-being interventions in organizational settings. Future studies should use methodologically rigorous designs and improved reporting of methods and results to provide conclusive evidence on the effectiveness and sustainability of the intervention effects.

Background We determined whether favourable changes in physical workload and environmental factors reduce sickness absence (SA) days using observational cohort data as a pseudo-experiment. Methods The data from the Finnish Helsinki Health Study included three cohorts of employees of the City of Helsinki [2000/2002–07 (N = 2927), 2007–12 (N = 1686) and 2012–17 (N = 1118), altogether 5731 observations]. First, we estimated the propensity score of favourable changes (reduction in exposures) in physical workload and environmental factors during each 5-year follow-up period on the baseline survey characteristics using logistic regression. Second, we created and stabilized inverse probability of treatment weights for each participant using the propensity scores. Lastly, we used generalized linear model and fitted negative binomial regression models for over-dispersed count data to estimate whether the favourable changes decrease the risk of short-term (1–3 days), intermediate-term (4–14 days) and long-term (>14 days) SA using employer’s register data. Results During a 5-year follow-up, 11% of the participants had favourable changes in physical workload factors, 13% in environmental factors and 8% in both factors. The incidence of short-term, intermediate-term and long-term SA were lower in employees with favourable workplace changes compared with those without such changes. The reductions were largest for long-term SA. Reporting favourable changes in both workload and environmental factors reduced the number of SA days by 41% within 1 year after the changes and by 32% within 2 years after the changes. Conclusion This pseudo-experimental study suggests that improving physical working conditions reduces SA.

Background Mental health has long been recognised as a major global health issue. Some work-related characteristics have been identified to be associated with common mental health problems, and thus the workplace is an important venue for the prevention of mental health problems and promoting mental wellness. Burnout is one of the important aspects of workplace organisational stressors and, in recent years, the lack of mental health literacy has also been identified as a fundamental issue. Studies have demonstrated that an improvement in mental health literacy is an effective measure for enhancing mental well-being. It would be prudent to combine an organisation-directed component and the enhancement of mental health literacy in an intervention programme. This trial will examine the novel approach of an intervention aiming to provide an evidence-based prevention programme. Methods This study utilised a wait-listed cluster randomised control trial design. Using branch offices as the primary sampling units, employees from three large companies in different industries will be recruited. Upon enrolment and after the baseline assessment of the outcome measures, participants nested in the branch offices will be allocated to the intervention or wait-listed arms. The intervention programme comprises of two main elements: an organisation-directed component and individual-directed psychoeducation training. This intervention will be delivered by a senior social worker well-versed in workplace issues over a period of 3 months. The trial will determine whether an integrated workplace mental health literacy and well-being programme is effective in increasing the mental health literacy scores and reducing burnout and stress scores, as measured by standardised and validated scales. Discussion If the trial results are in line with the hypothesis that supports the efficacy of the intervention programme, this will provide an evidence-based approach for an effective workplace mental well-being intervention programme that could not only enhance the understanding of mental health issues, but also reduce work-related burnout and stress as well as increase workers’ quality of life. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000464167. Registered prospectively on 20 March 2019.

OBJECTIVE: This systematic review aimed to provide an overview of the effectiveness of health promotion interventions at the workplace on physical and mental health outcomes related to chronic diseases. METHODS: A search for reviews published between 2009 and 2018 was performed in electronic databases. References of the included reviews were checked for additional reviews. Workplace health promotion interventions were included if they studied metabolic risk factors as important predictors of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) or if they studied mental or musculoskeletal health outcomes. Review quality was assessed using the AMSTAR checklist. RESULTS: Of the 23 reviews included, 9 were of high quality. For weight-related outcomes, there was strong evidence for favorable effects of workplace interventions, especially for interventions targeting physical activity and/or diet. For the remaining metabolic risk factors, there was no evidence for a positive effect of workplace health promotion interventions due to the absence of high quality reviews and mixed conclusions between the reviews. There was also strong evidence for a positive, small effect on the prevention of mental health disorders of workplace psychological interventions, especially those that use e- health and cognitive behavioral therapy techniques. Furthermore, strong evidence was found for the prevention of musculoskeletal disorders through workplace interventions, especially resistance exercise training. CONCLUSIONS: This review found evidence for the effectiveness of workplace interventions on the prevention of weight-related outcomes as well as mental health and musculoskeletal disorders. Future research is however needed on the factors that contribute to the successful implementation of an intervention.

Purposes Intervention mapping (IM) is a protocol for developing effective behavior change interventions. It has been used for 10 years to develop work disability prevention (WDP) interventions, but it is not known to what extent and with what success. The main objective of this study was to review the effectiveness of these interventions. Secondary objectives were to review their fidelity to the IM protocol, their theoretical frameworks and their content. Methods A search strategy was conducted in MEDLINE, Web of Science, PsycINFO, Pascal, Francis, and BDSP. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by two reviewers blinded to each other. Results Eight WDP interventions were identified aimed at return to work (RTW; n = 6) and self-management at work (n = 2). RTW interventions targeted workers with stress-related mental disorders (n = 1), low back pain (n = 1), musculoskeletal disorders (n = 1), cancer (n = 2) and gynecological surgery (n = 1). The fidelity to the IM protocol was weaker for the participatory planning group. Matrices of change, change methods, and applications were systematically reported. The main theoretical frameworks used were the attitude-social influence-self efficacy model (n = 4) and the theory of planned behavior (n = 2). Half of the interventions included a workplace component (n = 4). Two interventions were reported as effective, and one partially effective. Conclusion The IM protocol is used in WDP since 2007. The participative dimension appears underused. Few theoretical frameworks were used. Implications are to better consider the stakeholders involvement, and mobilize theoretical frameworks with greater attempts to intervene on the work environment.

Objectives: To assess the cost-effectiveness of workplace-delivered interventions designed to reduce sitting time as primary prevention measures for cardiovascular disease (CVD) in Australia. Methods: A Markov model was developed to simulate the lifetime cost-effectiveness of a workplace intervention for the primary prevention of CVD amongst office-based workers. An updated systematic review and a meta-analysis of workplace interventions that aim to reduce sitting time was conducted to inform the intervention effect. The primary outcome was workplace standing time. An incremental cost-effectiveness ratio (ICER) was calculated for this intervention measured against current practice. Costs (in Australia dollars) and benefits were discounted at 3% annually. Both deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. Results: The updated systematic review identified only one new study. Only the multicomponent intervention that included a sit-and-stand workstation showed statistically significant changes in the standing time compared to the control. The intervention was associated with both higher costs ($6820 versus $6524) and benefits (23.28 versus 23.27, quality-adjusted life year, QALYs), generating an ICER of $43,825/QALY. The DSA showed that target age group for the intervention, relative risk of CVD relative to the control and intervention cost were the key determinants of the ICER. The base case results were within the range of the 95% confidence interval and the intervention had a 85.2% probability of being cost-effective. Conclusions: A workplace-delivered intervention in the office-based setting including a sit-and-stand desk component is a cost-effective strategy for the primary prevention of CVD. It offers a new option and location when considering interventions to target the growing CVD burden.

Purpose. The aim of this article was to evaluate the effects of cycle and treadmill desks on energy expenditure and car- diovascular and biochemical indicators in sedentary workers.Materials and methods. In February 2018, six databases were searched. Both parallel and crossover design studies evaluating workplace cycle and treadmill desks compared to a conventional seated condition were included.Results. Twenty-two studies met the inclusion criteria. Cycle and tread- mill desks significantly increased energy expenditure (standard mean difference [SMD]=3.84,p&nbsp

Purpose A multifaceted implementation strategy was targeted at supervisors to encourage them to apply a participatory approach (PA) in dealing with employees’ work functioning problems due to health concerns. This paper assesses the effect on employees’ perceived social norms regarding the use of the PA to deal with work functioning problems. Methods Three organizations participated in a cluster randomized controlled trial, with randomization at the department level. Supervisors in the PA intervention departments received the implementation strategy consisting of a working group meeting, supervisor training, and optional coaching. Supervisors in the control departments received written information about the PA only. In two of the organizations, employees were invited to complete surveys at baseline and at 6-month follow-up. The primary outcome was perceived social norms regarding the use of the PA to deal with work functioning problems. Secondary measures included attitudes and self-efficacy, and intention regarding joint problem solving, and sick leave data. Effects were analyzed using multilevel analyses to account for nesting of cases. Results At baseline, 273 employees participated in the survey, with follow-up analyses of 174 employees. There were no statistically significant group effects on employee outcome measures. The intervention group showed a larger reduction in mean sick days (from 4.6 to 2.4 days) versus the control group (from 3.8 to 3.6 days), but this difference did not reach statistical significance (p > .05). Conclusion The multifaceted strategy to implement the participatory approach for supervisors did not show effects on outcomes at the employee level. To gain significant effects at the employee level, may require that an implementation strategy not only targets management and supervisors, but also employees themselves.Trial registration: NTR3733.

To determine the effectiveness of workplace interventions and the most effective methodological design for the improvement of employee productivity, work ability, and absenteeism. A meta-analysis of randomized controlled trials (RCTs) of workplace interventions was conducted (PROSPERO, CRD42018094083). The PubMed, Scopus, PsycINFO, and Cochrane databases were searched. RCTs from 2000 to 2017 and with employees (18−65 years) were selected. Then, intervention characteristics and work-related outcomes data were extracted. A total of 47 RCTs were included in the systematic review, and 19 RCTs (11 absenteeism, 7 productivity, and 5 work ability) were included in the meta-analysis. The meta-analysis showed that the effectiveness of workplace interventions for absenteeism was −1.56 (95% CI, −2.67 to −0.44) and −2.65 (95% CI, −4.49 to −0.81) considering only moderate quality RCTs. In contrast, only a few studies of workplace interventions for productivity and work ability were included, which was insufficient for determining the effectiveness and best design for improving these work outcomes. The workplace is an interesting environment to reduce absenteeism, and individualized and counseling interventions with

Objectives The aim of this review was to assess the evidence that occupational safety and health (OSH) legislative and regulatory policy could improve the working environment in terms of reduced levels of industrial injuries and fatalities, musculoskeletal disorders, worker complaints, sick leave, and adverse occupational exposures. Methods A systematic literature review covering the years 1966‒2017 (February) was undertaken to capture both published and gray literature studies of OSH work environment interventions with quantitative measures of intervention effects. Studies that met specified in-and exclusion criteria went through an assessment of methodological quality. Included studies were grouped into five thematic domains: (i) introduction of OHS legislation, (ii) inspection/enforcement activity, (iii) training, such as improving knowledge, (iv), campaigns, and (v) introduction of technical device, such as mechanical lifting aids. The evidence synthesis was based on meta-analysis and a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results The search for peer-reviewed literature identified 14 743 journal articles of which 45 fulfilled the inclusion criteria and were eligible for meta-analysis. We identified 5181 articles and reports in the gray literature, of which 16 were evaluated qualitatively. There was moderately strong evidence for improvement by OHS legislation and inspections with respect to injuries and compliance. Conclusions This review indicates that legislative and regulatory policy may reduce injuries and fatalities and improve compliance with OHS regulation. A major research gap was identified with respect to the effects of OSH regulation targeting psychological and musculoskeletal disorders.

OBJECTIVE: Extended working lives due to an ageing population will necessitate the maintenance of work ability across the life course. This systematic review aimed to analyze whether workplace interventions positively impact work ability. METHODS: We searched Medline, PsycINFO, CINAHL and Embase databases using relevant terms. Work-based interventions were those focused on individuals, the workplace, or multilevel (combination). Work ability – measured using the work ability index (WAI) or the single-item work ability score (WAS) – was the outcome measure. Grading of Recommendations Assessment, Development & Evaluation (GRADE) criteria was used to assess evidence quality, and impact statements were developed to synthesize the results. Meta-analysis was undertaken where appropriate. RESULTS: We reviewed 17 randomized control trials (comprising 22 articles). Multilevel interventions (N=5) included changes to work arrangements and liaisons with supervisors, whilst individual-focused interventions (N=12) involved behavior change or exercise programs. We identified only evidence of a moderate quality for either individual or multilevel interventions aiming to improve work ability. The meta-analysis of 13 studies found a small positive significant effect for interventions on work ability [overall pooled mean 0.12, 95% confidence interval (CI) 0.03–0.21] with no heterogeneity for the effect size (Chi^2=11.28, P=0.51; I^2=0%). CONCLUSIONS: The meta-analysis showed a small positive effect, suggesting that workplace interventions might improve work ability. However, the quality of the evidence base was only moderate, precluding any firm conclusion. Further high quality studies are require to establish the role of interventions on work ability.

Adverse psychosocial work factors are recognized as a significant source of psychological distress, resulting in a considerable socioeconomic burden. The impact of occupational health standards that aim to reduce these adverse work factors, such as the Quebec Healthy Enterprise Standard (QHES), is of great interest for public health. The aim of this study was to evaluate, for the first time, the effect of QHES interventions targeting adverse psychosocial work factors on the prevalence of these factors and of psychological distress among ten Quebec organizations. These outcomes were assessed by questionnaire using validated instruments before (T1, n = 2849) and 2–3 years following (T2, n = 2560) QHES implementation. Beneficial effects of interventions were observed for two adverse psychosocial work factors: low rewards (ratio of prevalence ratios (PRs) = 0.77, 95% CI = 0.66–0.91) and low social support at work (ratio of PRs = 0.89, 95% CI = 0.77–1.03). Moreover, beneficial effects of interventions were also observed on the prevalence of high psychological distress (ratio of PRs = 0.86, 95% CI = 0.75–0.998). Psychosocial interventions implemented in the context of this standard improved the psychosocial work environment and had beneficial effects on workers’ mental health.

Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a workplace program designed to engage the private sector in HIV prevention. A cross-sectional survey conducted in 2008 to measure program outcomes in factories in Thailand was used in this study. The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and workers, and distribution of educational materials and condoms. A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18–24 years), controlling for their individual socio-demographic characteristics. Interventions related to the management and services component including workplace AIDS policy formulation, condom services programs and behavioral change campaigns were found to be significantly related to increased AIDS knowledge, perceived accessibility to condoms and condom use with regular partners. The effect of the HIV/AIDS training for managers, peer leaders and workers was positive but not statistically significant. With some revision of program components, scaling up of workplace interventions and the engagement of the private sector in HIV prevention should be seriously considered.Keywords: factory workers, workplace intervention, regular sexual partner, condom vending machine, HIV/AIDS prevention, Thailand

OBJECTIVES: This study aimed to assess the economic credentials of a workplace-delivered intervention to reduce sitting time among desk-based workers. METHODS: We performed within-trial cost-efficacy analysis and long-term cost-effectiveness analysis (CEA) and recruited 231 desk-based workers, aged 24–65 years, across 14 worksites of one organization. Multicomponent workplace-delivered intervention was compared to usual practice. Main outcome measures including total device-measured workplace sitting time, body mass index (BMI), self-reported health-related quality of life (Assessment of Quality of Life-8D, AQoL-8D), and absenteeism measured at 12 months. RESULTS: Compared to usual practice, the intervention was associated with greater cost (AU$431/person), benefits in terms of reduced workplace sitting time [-46.8 minutes/8-hour workday, 95% confidence interval (CI): -69.9– -23.7] and increased workplace standing time (42.2 minutes/8-hour workday, 95% CI 23.8–60.6). However, there were no significant benefits for BMI [0.148 kg/m^2 (95% CI-1.407–1.703)], QoL-8D [-0.006 (95% CI -0.074–0.063)] and absenteeism [2.12 days (95% CI -2.01–6.26)]. The incremental cost-efficacy ratios (ICER) ranged from AU$9.94 cost/minute reduction in workplace sitting time to AU$13.37/minute reduction in overall sitting time. CEA showed the intervention contributed to higher life year (LY) gains [0.01 (95% CI 0.009–0.011)], higher health-adjusted life year (HALY) gains [0.012 (95% CI 0.0105 – 0.0135)], and higher net costs [AU$344 (95% CI $331–358)], with corresponding ICER of AU$34 443/LY and AU$28 703/HALY if the intervention effects were to be sustained for five-years. CEA results were sensitive to assumptions surrounding intervention-effect decay rate and discount rate. CONCLUSIONS: The intervention was cost-effective over the lifetime of the cohort when scaled up to the national workforce and provides important

OBJECTIVES: This study aims to evaluate the effectiveness of a "blended" workplace health-promotion intervention, alongside identification of key components beneficial for future implementation strategies. METHODS: Within a cluster randomized controlled trial, 491 employees at increased risk of cardiovascular disease were allocated to the limited (N=217; 9 clusters) or extensive (N=274; 8 clusters) intervention. The extensive intervention consisted of motivational interviewing (MI) within the framework of a web-based health risk assessment (HRA), a blended care approach. The limited intervention received solely the web-based HRA. Occupational health physicians (N=21) within three organizations delivered the intervention. Implementation components investigated included: HRA (reach and participation), newsletters (percentage read), and MI sessions (number and quality). MI quality was determined by scoring audiotaped MI sessions, using the MI treatment integrity code. After 6 and 12 months, effects on participation in health-promotion activities and its associations with components of implementation were determined by mixed-effects models. RESULTS: Over 80% of employees participated in health-promotion activities, with an additional 8% in the extensive compared to the limited group. In the extensive intervention, those with more or better quality MI sessions were more likely to participate in health-promotion activities. Increased MI quality was associated with sustained participation. CONCLUSIONS: This study suggests that participation in health-promotion activities can be increased by adding MI to a web-based approach and improving the quality of the MI delivered. Interventions with MI should include optimized delivery and quality of MI sessions.

BACKGROUND: While strength training for the neck and shoulder muscles may be effective in reducing headache, the optimal combination of exercise frequency and duration is unknown. This study investigates the effect of different time-wise combinations of one weekly hour of strength training for the neck and shoulder muscles on headache frequency, intensity, and use of analgesics.METHODS: A total of 573 office workers were randomly allocated at the cluster-level to five groups; 3 × 20 min a week of minimally supervised (3MS), 1 × 60 (1WS), 3 × 20 (3WS) or 9 × 7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Headache frequency, intensity, and use of analgesics in relation to headache were determined by questionnaire at baseline and follow-up.RESULTS: The intention-to-treat analysis showed reduced headache frequency and intensity of approximately 50% in all training groups compared with REF at 20-week follow-up (P < 0.001). Use of analgesics was lower in the supervised training groups (1WS, 3WS and 9WS), but not in the group with minimal training supervision (3MS), compared with REF at follow-up.CONCLUSION: One hour of specific strength training - regardless of the distribution during the week - effectively reduced both headache frequency and intensity in office workers. Thus, a large time-wise flexibility exists when implementing specific strength training at the workplace. However, only supervised training led to a reduction in use of analgesics for headache.

Purpose To study the effectiveness of a multifaceted strategy to implement the participatory approach (PA) for supervisors to increase their self-efficacy in addressing risk of sick leave of employees. Methods Supervisors from three organizations were invited to participate. Randomization was performed at department level. Supervisors (n = 61) in the intervention departments received the implementation strategy consisting of a working group meeting, supervisor training in PA application, and optional supervisor coaching. Supervisors in the control departments (n = 55) received written information on PA. The primary outcome was supervisors’ self-efficacy to apply the PA, measured at baseline and 6 months’ follow-up. The number of employees with whom supervisors discussed work functioning problems or (risk of) sick leave was also assessed. Effects were tested using multilevel analyses. Results The strategy did not increase self-efficacy to apply the PA. Subgroup analyses showed that self-efficacy increased for supervisors who at baseline reported to have discussed (risk of) sick leave with less than three employees during the last 6 months (B = 1.42, 95 % CI 0.34–2.50). Furthermore, the implementation strategy increased the number of employees with whom supervisors discussed work functioning problems or risk of sick leave (B = 1.26, 95 % CI 0.04–2.48). Conclusion Although the implementation strategy cannot be recommended for all supervisors, for supervisors who less frequently discuss (risk of) sick leave with employees the implementation strategy might be helpful. Trial registration NTR3733.

Purpose To evaluate the effectiveness of a workplace integrated care intervention on at-work productivity loss in workers with rheumatoid arthritis (RA) compared to usual care. Methods In this randomized controlled trial, 150 workers with RA were randomized into either the intervention or control group. The intervention group received an integrated care and participatory workplace intervention. Outcome measures were the Work Limitations Questionnaire, Work Instability Scale for RA, pain, fatigue and quality of life (RAND 36). Participants filled out a questionnaire at baseline, and after 6 and 12 months. We performed linear mixed models to analyse the outcomes. Results Participants were on average 50 years of age, and mostly female. After 12 months, no significant intervention effect was found on at-work productivity loss. We also found no significant intervention effects on any of the secondary outcomes. Conclusions We did not find evidence for the effectiveness of our workplace integrated care intervention after 12 months of follow up. Future studies should focus on investigating the intervention in groups of workers with severe limitations in work functioning, and an unstable work situation.

Objective: This study assessed the effect of a default nudge to reduce sedentary behaviour at work over time.Design and main outcome measures: A field study was conducted at a governmental organisation. In the present study, the default setting of sit–stand desks (SSDs) was changed from sitting to standing height during a two-week intervention. Stand-up working rates were calculated based on observations that were done prior to, during, two weeks after and two months after the intervention. Additionally, a pre-measure survey (n = 606) and post-measure survey (n = 354) were completed. Intention and social norms concerning stand-up working were compared for the 183 employees who completed both pre- and post-assessments (45.4% female, Mage = 44.21).Results: Stand-up working rates raised from 1.82% in the baseline to 13.13% during the intervention. After the nudge was removed the percentage was 10.01% after two weeks and 7.78% after two months. A multilevel analysis indicated a significant increase in both intention and social norms after the nudge intervention.Conclusions: This study shows that a default nudge can increase stand-up working rates in offices with SSDs at least until two months after the nudge intervention.

Sedentary behaviour has been shown to have a negative impact on health. As such, prolonged sitting in the workplace is being increasingly seen as a public health problem. Multi-component interventions to reduce sedentary time at work are being used as a way of addressing the different environmental, personal and organisational influences on sedentary behaviour. The role of the organisational context on behaviour has rarely been explored in depth or theorised in the sedentary workplace behaviour literature yet a rich body of theory and evidence exists outside the field. The current article applies an organisational cultural framework for exploring how organisational factors and dynamics impact on sedentary behaviour in the workplace. Empirical data are taken from a qualitative study of office workers’ responses to a ‘sit less’ initiative. Thirteen in-depth interviews and documentary analysis were conducted to help elucidate the ways in which organisational assumptions, strategy, structures, activities, operations, actions and norms combine to constrain reduced sitting time at work. The article\ud offers a theoretical approach to understanding how organisational culture can influence interventions aimed at encouraging people to sit less in the workplace. It\ud also offers an opportunity to consider how intervention design can better account for the ‘whole systems’ of an organisation and how ‘sit less’ initiatives can be positioned within them.

This study aimed to investigate the processes of a participatory ergonomics program among 594 eldercare workers with emphasis on identified risk factors for low back pain and solutions, and reveal barriers and facilitators for implementation. Sixty-nine per cent of the identified risk factors were physical ergonomic, 24% were organisational and 7% were psychosocial risk factors. Most solutions were organisational (55%), followed by physical (43%) and psychosocial solutions (2%). Internal factors (e.g. team or management) constituted 47% of the barriers and 75% of the facilitators. External factors (e.g. time, financial resources, collaboration with resident or relatives) constituted 53% of the barriers and 25% of the facilitators. This study revealed the processes and implementation of a participatory ergonomics program among eldercare workers. The findings can be transferred to workers, workplaces, health and safety professionals, and researchers to improve future participatory ergonomics programs.

Work modification is considered as an essential element in enhancing return to work (RTW) among persons with musculoskeletal problems (1) although systematic reviews have called for more studies (2) and pointed out that the net gain in sickness absence days has been only modest and economic effects uncertain (3). Loisel and his co-workers (4) showed for the first time that an occupational intervention – and especially an occupational intervention combined with a clinical intervention – was associated with a faster RTW compared with clinical intervention alone or usual care. The developed Sherbrooke model has been tested with a randomized controlled trial (RCT) in the Netherlands. Workers sick-listed for 2–6 weeks due to low-back pain (LBP) were first randomized into a workplace intervention or usual care, and those who had not returned to work by 8 weeks were further randomized to graded activity or usual care. Workplace intervention was shown to enhance RTW, whereas graded activity did not (5). Loisel has suggested that the subacute phase of low-back disability is the “golden hour” for prevention of further disability, when unnecessary measures can be avoided and focus can be placed on those with risk for prolonged disability (6). Van Duijn et al (7) calculated the potential gain in sickness absence days and the cost-benefits of hypothetical interventions based on information of RTW rates and effectiveness of various types of interventions. They concluded that only low-cost and quickly administered interventions (eg, workplace modifications) have the potential to be cost-beneficial at an early stage of disability, whereas the optimal time window for more complex interventions would be 8–12 weeks (7). Currently many healthcare providers agree that the Sherbrooke model has a sound basis. However, refraining at an early stage of disability from larger diagnostic procedures to arrive at a specific diagnosis at tissue level and medication believed to cure or alleviate a disease, and instead providing suitable workload through work modification to prevent further disability has not yet been adopted into medical practice. Prescribing work modification as a treatment is not straightforward either. In this issue of the Scandinavian Journal of Work Environment & Health, the Fassier et al paper (8) looks at the barriers and facilitators in the implementation of the Sherbrook model with a qualitative approach. Representatives of the healthcare, health insurance, and the workplace systems each identified barriers and facilitators that were structured in their external, organizational, and individual context. The authors note that, due to the existence of barriers at multiple levels (from workplace to broader systems), interventions that are limited to one particular level are unlikely to be successful. They draw attention to the importance of a systems approach in RTW interventions in order to address the interplay between local behavior and broader structural conditions. The result is that the implementation of the model is discussed in detail, demonstrating well the complexity of the issue and all phases where the implementation may fail. The healthcare providers – paid by time or “piece-rate” have to decide on a trade-off between diagnostic examinations and documentation, on the one hand, and searching and discussing solutions at the workplace, on the other. Adopting this kind of social role may be felt as a proper professional role for some but not all, and it may come at a cost to physician income. For the health insurance system, there is the challenge of keeping on track in order not to lose the appropriate time window for potentially effective interventions. At the workplace, crucial aspects are having enough competence in ergonomics and policies of work accommodation, providing responsibility, and maintaining well-functioning interpersonal collaborations. Goodwill and trust at all levels can facilitate RTW interventions (9). A component of achieving these conditions is understanding and acknowledging the roles and efforts of key individuals involved in the RTW process. For instance, the hidden but important role of co-workers in the success or failure of RTW is increasingly recognized at the workplace level (10, 11). An ongoing challenge to communication between stakeholders at various levels (eg, workplace, healthcare, insurance) is the privacy legislation common across jurisdictions that guards different parties from accessing medical information about the worker. Workers require privacy; at the same time, incomplete information for key decision-makers, such as workplace managers, can lead to misdirected rehabilitation approaches, especially when health conditions (such as poor mental health or chronic pain) are not immediately visible. As suggested by Fassier et al, patient disclosure is a practical solution implementable within current conditions. This also calls for good will and trust as it requires engaging the patient in planning the RTW process in a way that they feel confident about the procedural fairness with which their information will be handled by RTW parties (12, 13). In workplaces with rapid turnover of workers and supervisors, external expert advisers may be useful for providing workplaces with consistent and continuous support with RTW planning and processes (14). National health insurance and occupational legislation can support efforts to organize work modifications and enhance RTW. Indeed, changes have been made in the national legislation in several countries. For instance, the possibility to work part-time for a restricted period due to health reasons has existed in some Nordic countries for several years, and this has been recommended as the first option when considered as a safe alternative by the medical assessment in some of these countries. Assessments of the effects of partial sick leave have in general concluded that it enhances RTW and is well-received by its users (15). In Finland, the introduction of partial sickness benefit (to compensate for earnings losses due to part-time sick leave) was made as late as 2007. Assessed as a quasi-experiment with difference-in-differences and propensity score analyses, the use of partial sickness benefit was associated with a considerable increase in work participation (16). In Denmark, a national RTW program was launched in 2008, including provision of a tailored and multidisciplinary program with a RTW coordinator and extensive support for persons with work disability lasting >8 weeks and poor perspectives to resume work within the next 3 months. An RCT assessing the effect of this program in three municipalities found it to be effective in one but not the other municipalities (17). Similarly, the Norwegian Inclusive Working Life Program, taking place for the first time in 2001, was not found to reduce the overall long-term sickness absence rate in companies that had adopted the agreement (18). These somewhat contradictory results may indicate that decisions to prescribe sick leave or look for RTW alternatives may not be easily changed by legislation. Moreover, such legislation may require changes in attitudes among several stakeholders – especially those at the workplace – to be implemented in a way that bring about the expected result. A beginning point may be at the level of health policy changing how the work of physicians is organized and compensated so that incentives to participate in RTW processes are encouraged. The development and testing of the efficacy of the Sherbrooke model has represented a new way of thinking in disability prevention associated with LBP, putting forward the importance of the workplace context. At the same time, the role of medication and many other forms of conservative therapy as well as surgery have been redefined. This has resulted in revolutionary changes in the prevention and treatment of LBP, introducing work modification as both a preventive and therapeutic tool. LBP is multifactorial and can only partly be prevented. Preventing consequences of LBP (eg, work disability) has proven to be challenging – but rewarding when successful.

Objectives Major depressive disorder (MDD) is associated with absenteeism. In this study, the effectiveness of collaborative care, with a focus on return to work (RTW), was evaluated in its effect on depressive symptoms and the duration until RTW in sick-listed workers with MDD in the occupational health setting. Methods In this randomised controlled trial, 126 sick-listed workers with MDD were randomised to usual care (N=61) or collaborative care (N=65). Collaborative care was applied by the occupational physician care manager, supported by a web-based tracking system and a consultant psychiatrist. Primary outcome measure was time to response. Secondary outcome measures were time to remission, depressive symptoms as continuous measure and the duration until full RTW. Results Collaborative care participants had a shorter time to response, with a difference of 2.8 months. However, no difference was found on time to remission or depressive symptoms as continuous measure. With a mean of 190 days in the collaborative care group, and 210 days in the usual care group, the groups did not differ significantly from each other in the duration until full RTW. Adherence to the collaborative care intervention was low. Conclusions These results do not justify a widespread implementation of collaborative care in occupational healthcare, as it was operationalised in this study. However, since the study might have been underpowered for RTW and because treatment integrity was low, further research, with larger sample sizes, is needed to develop the best fitting (collaborative care) model for addressing RTW in depressed sick-listed workers. Trial registration: ISRCTN78462860

ObjectiveExplore employees' perceptions of ability to follow the Mediterranean diet (MedDiet), preferences for setting goals if asked to follow the MedDiet, and expectations of an Internet-based, workplace MedDiet intervention.DesignSeven focus groups to guide intervention development.SettingFour workplaces (business/professional services, government branches) in Southwest England.ParticipantsEmployees (n = 29, 51.7% women), ages 24–58 years.Phenomenon of InterestAbility to follow the MedDiet; preferences for goal-setting if asked to follow the MedDiet; intervention content.AnalysisData were analyzed with the use of thematic analysis.ResultsParticipants perceived that adhering to some MedDiet recommendations would be challenging and highlighted cost, taste, and cooking skills as adherence barriers. Behavior change preferences included a tailored approach to goal-setting, reviewing goal progress via a website/smartphone app, and receiving expert feedback via an app/website/text/face-to-face session. Desirable features of an Internet-based MedDiet application included recipes, interactivity, nutritional information, shopping tips, cost-saving information, and a companion smartphone app. Engaging in social support was deemed important to facilitate adherence.Conclusions and ImplicationsAn Internet-based, workplace MedDiet intervention should address adherence barriers, utilize a tailored approach to setting and reviewing goals, and activate social support to facilitate adherence. These findings provide insights to planning to promote the MedDiet in non-Mediterranean regions

OBJECTIVE: The aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (