Work Design, Self-Management, and Work Ability in Workers with Diabetes

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PROJECT SUMMARY Diabetes is a common chronic condition among U.S. adults, affecting an estimated 34.1 million adults; it also disproportionately affects those of lower socio-economic status. Diabetes management is complex, involving lifestyle changes (i.e., physical activity and dietary changes), weight management, glucose level monitoring, the use of oral medications or insulin, and regular medical care visits. Unfortunately, poor treatment adherence increases the risk for diabetes related complications (e.g., chronic kidney disease, vision loss, heart disease, and nerve damage) and mortality. The workplace is a critical context that can influence disease management, and work can interfere with health management in workers with chronic conditions. Blue-collar and service sector workers are likely at greater risk, given their relative lack of flexibility at work compared to white-collar workers. Our long-term goal is to develop and assess an intervention to address work-related factors that lead to low work ability, and poor self-management in blue-collar and service workers with diabetes, as such interventions are currently lacking. In this current R03 study, we assess work-related predictors of diabetes self-management and work ability in U.S. blue-collar and service sector workers with diabetes; results will inform future interventions. This R03 study is a mixed methods study, in which we will first interview 25 blue- collar and service workers with type 2 diabetes to get their perceptions of what they need at work to maintain their work ability and manage their diabetes alongside work. This qualitative data will allow us to check some of our propositions from theory, revise the model, and/or add variables that we did not initially propose. Then, we will validate the resulting model using quantitative survey data from 270 workers with diabetes at two time points, and finish with interviews with 5 workers with diabetes to check survey study results. The model will include work-related predictors (organizational support, supervisor support, health-supportive supervisor behaviors, job control, various forms of flexibility), individual predictors (habit strength, diabetes management self-efficacy, and disease burden), and work ability and diabetes self-management (unintentional medication non-adherence, glucose monitoring, physical activity, dietary management, and medical appointments) as outcomes. Results will include identifying the most important predictors of self-management and work ability through relative importance analysis. This work supports NIOSH’s Total Worker Health® (TWH) mission, NIOSH’s strategic goal 7 and strategic goals of the Healthy Work Design and Well-Being cross-sector program to promote safe and healthy work design and well-being in vulnerable workers. Scientific outputs will include presentations and peer-reviewed journal articles that present study results. In terms of Research to Practice (R2P), these data will provide necessary information prior to developing and evaluating an organizational intervention to support workers with diabetes, which we plan to do in a future R01 proposal. Through these outputs, this study will address a critical unmet need in the U.S. workforce.