Organizational Approaches to Total Worker Health for Low-Income Workers

 描述（由申请人提供）：迫切需要循证干预措施，以降低肌肉骨骼疾病（MSD）的风险，改善低收入工人的健康和安全行为。这些健康成果通过工作组织共享共同的途径。针对这些组织特征和工作经验的上游干预措施可能在预防不良健康结果方面特别有效，因为它们解决了风险升高的根本来源，对低工资工人可能特别重要。与高收入工人相比，低收入工人的时间表控制较少，工作时间更不规则，由于完成工作任务的时间压力而缩短休息时间。本研究的目的是开发和测试可行的干预方法，以修改工作组织，并有助于降低MSD风险和改善一组低收入工人的饮食模式：食品服务工人。食品服务业在美国雇用了950万工人，其中许多人面临着一系列健康状况不佳的风险。NIOSH的Total Worker Health（TM）（TWH）计划提供了一种创新方法，用于解决工作组织和环境中影响MSD风险和健康与安全行为的共享途径。这项研究利用了一个不寻常的机会，展示了与致力于与本研究合作做出此类改变的行业合作伙伴合作的工作组织变化的影响。我们的中心假设是，针对工作组织，以及工作环境和个人健康和安全行为的干预，将显示出有希望的改善MSD的结果和饮食模式。本研究主要有两个目的。首先，本研究将确定的工作组织，可以通过管理实践的变化，可行的修改的特点，基于与食品服务经理和焦点小组与工人的访谈。第二，我们将确定一个综合的TWH干预在改善工人的人体工程学的做法，MSD症状和饮食模式，以及在改变工作组织和环境的可行性和潜在的有效性。这项干预措施将在10个食品服务工作场所进行概念验证试验，这些工作场所被随机分配到干预和对照组。为期16个月的干预将针对组织和物理工作环境和管理实践的变化，并支持安全的人体工程学实践和健康的饮食模式。我们将比较干预和控制站点之间的差异，通过对工人的调查，在工人的健康和安全行为和MSD症状的干预前后的变化，并在工作组织和环境，通过经理调查和现场走查的。将采用严格的过程评价来评估干预措施的可行性。这项研究的贡献将是显著的，因为它预计将有助于减少这些健康结果的差异，直接干预这些差异的根本来源。

 DESCRIPTION (provided by applicant): There is an urgent need for evidence-based interventions to reduce risk of musculoskeletal disorders (MSDs) and improve health and safety behaviors for low-income workers. These health outcomes share common pathways through the work organization. Upstream interventions addressing these organizational characteristics and work experiences may be especially effective in preventing adverse health outcomes because they address underlying sources of elevated risk, and may be particularly important for low-wage workers. Compared to higher earning workers, low-wage workers have less schedule control, more irregular working hours, and shortened breaks due to time pressure to complete work tasks. The objective of this study is develop and test feasible intervention methods to modify the work organization and contribute to reductions in MSD risk and improvements in dietary patterns among one group of low-income workers: food service workers. The food service industry employs 9.5 million workers in the U.S, many of whom are at elevated risk for a range of poor health outcomes. NIOSH's Total Worker Health(tm) (TWH) Program provides an innovative approach for addressing the shared pathways in the work organization and environment that impact both MSD risk and health and safety behaviors. This study takes advantage of an unusual opportunity to demonstrate the impact of changes in the work organization in collaboration with an industry partner that has committed to making such changes in concert with this study. Our central hypothesis is that an intervention targeting the work organization, as well as the work environment and individual health and safety behaviors, will show promising improvements in MSD outcomes and dietary patterns. This study focuses on two aims. First, this study will identify characteristics of the work organization that can be feasibly modified through changes in management practices, based on interviews with food service managers and focus groups with workers. Second, we will determine the feasibility and potential efficacy of an integrated TWH intervention in improving workers' ergonomic practices, MSD symptoms and dietary patterns, as well as in changing the work organization and environment. This intervention will be tested in a proof-of-concept trial in 10 food service worksites randomly assigned to intervention and control. The 16-month intervention will target changes in the organizational and physical work environment and management practices, and supporting safe ergonomic practices and healthful dietary patterns. We will compare differences between intervention and control sites in changes between pre- and post-intervention in worker health and safety behaviors and MSD symptoms through surveys of workers, and in the work organization and environment through manager surveys and on-site walk-through's. A rigorous process evaluation will be used to assess intervention feasibility. The contribution of this study will be significant because it is expected to contribute to reducing disparities in these health outcomes by directly intervening on an underlying source of these disparities.