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Intervention studies in the health care work environment : Lessons learned

01 Jan 2000-

TL;DR: Five different methods of integration are proposed: a qualitative approach as a foundation for the design of a quantitative study, qualitative studies to gain deeper insight and better analyses of the results from a qualitative study, quantitative research to study frequencies and distributions of phenomena discovered by qualitative approaches, parallel and integrated use of qualitative and quantitative approaches, and quantifying qualitative data.

AbstractThe old controversy between qualitative and quantitative approaches to the study of workplace stressors and workers ́ health may be bypassed by looking at them as complementary to each other. Especially, intervention research would profit from the integrated use of both approaches when it comes to validity and reliability of the data. This applies to assessment of both the work and health related problems as well as the effects of the intervention. Also quite practical issues must be considered, such as the question of status for the two approaches within the research group, the possibility to integrate the two methods, not only conduct them in separate and parallel processes, and the sequencing of the approaches. Five different methods of integration are proposed: 1) a qualitative approach as a foundation for the design of a quantitative study, 2) qualitative studies to gain deeper insight and better analyses of the results from a quantitative study, 3) quantitative research to study frequencies and distributions of phenomena discovered by qualitative approaches, 4) parallel and integrated use of qualitative and quantitative approaches, and 5) quantifying qualitative data.

Topics: Health care (70%)

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Citations
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Journal ArticleDOI
TL;DR: The Practice Environment Scale–Nursing Work Index (PES–NWI) seems to be one of the most promising instruments because of its appropriateness, its structure, which has a rather good fit, and its ability to discriminate magnet hospitals like other NWI derivates (discriminant validity).
Abstract: This systematic review assesses the validity of epidemiological questionnaires used to measure psychosocial and organizational work factors (POWFs) in nurses Of the 632 articles published between 1980 and July 2008 identified in this review, 108 provide some data concerning analysis of the intrinsic characteristics of such instruments (content validity or conceptual basis, reliability, validation of internal construction) and their external validity with respect to health aspects (concurrent validity and predictive validity) Psychometric properties of generalist questionnaires validated among blue collar or white collar workers were also assessed in the nurse population The Job Content Questionnaire (JCQ), because of its longevity and reputation, was the generalist questionnaire most used among this population Although its structure often raises questions in the nurse population, its dimensions (mainly the control one) have been shown to be predictive of some health outcomes measured with "objective" indicators concerning absenteeism, injuries, and musculoskeletal disorders Effort Reward Imbalance (ERI), which has a structure more stable among the nurse population, has shown concurrent validity in terms of intent to leave the nursing profession No questionnaire specifically designed for nurses can claim to satisfy all of the recommendations in terms of internal validity Nevertheless, the Practice Environment Scale-Nursing Work Index (PES-NWI) seems to be one of the most promising instruments because of its appropriateness (content validity), its structure, which has a rather good fit (construct validity), its ability to discriminate magnet hospitals like other NWI derivates (discriminant validity), and it has also been associated in cross-sectional studies with health outcomes, especially nurses' self-assessed mental health but also with patients' health outcomes objectively assessed (concurrent validity) However, elements for predictive validity are still lacking with NWI derivates The Discussion provides recommendations for measuring POWFs, encompassing the use of external validated measurements

67 citations


Cites methods from "Intervention studies in the health ..."

  • ...Recommendations for measuring change in psychosocial working conditions (Smith & Beaton, 2008) and for interventions aimed at reducing adverse POWFs in health care establishments have been published (Cox, Randall, & Griffiths, 2002; Mykletun et al., 2000)....

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Journal ArticleDOI
TL;DR: The (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites is described to raise serious questions concerning design, analyses and interpretation of results.
Abstract: Interventions in occupational health often target worksites rather than individuals. The objective of this paper is to describe the (lack of) stability in units of analysis in occupational health and safety intervention projects directed toward worksites. A case study approach is used to describe naturally occurring organizational changes in four, large, Nordic intervention projects that ran 3–5 years, covered 3–52 worksites, cost 0.25 mill–2.2 mill €, and involved 3–7 researchers. In all four cases, high rates of closing, merging, moving, downsizing or restructuring was observed, and in all four cases at least one company/worksite experienced two or more re-organizations during the project period. If individual worksites remained, ownership or (for publicly owned) administrative or legal base often shifted. Forthcoming closure led employees and managers to seek employment at other worksites participating in the studies. Key employees involved in the intervention process often changed. Major changes were the rule rather than the exception. Frequent fundamental changes at worksites need to be taken into account when planning intervention studies and raises serious questions concerning design, analyses and interpretation of results. The frequent changes may also have deleterious implications for the potential effectiveness of many real life interventions directed toward worksites. We urge researchers and editors to prioritize this subject in order to improve the quality of future intervention research and preventive action.

45 citations


Cites background from "Intervention studies in the health ..."

  • ...During 1997–99 the Nordic Council of Ministers sponsored a series of meetings of occupational intervention researchers to develop intervention research in the Nordic countries [4]....

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Journal ArticleDOI
TL;DR: The results of the analyses with time lag (longitudinal) did not support the hypothesis that psychosocial and physical strain from 1 day of work predicts pain onset the following day, but physical exertion, stress, and, to some extent, time pressure were associated with pain on the day of onset.
Abstract: Objectives The aim of this study was to investigate psychosocial factors and physical exertion at work in relation to the onset of low-back pain. Methods The study was carried out as a case-crossover investigation of nursing aides caring for the elderly. Cases were identified among 157 nursing aides over a period of 2 years. Psychosocial factors, physical exertion, and low-back pain were reported daily in diary questionnaires over three consecutive days at work, repeated in six periods of 3 days. For each subject, case observations were identified as pain onset from one day to the next and matched with reference observations with no pain onset from the same person. Prospective data collection allowed analyses to be conducted with and without a lag in time between exposure and pain onset. Results The results of the analyses with time lag (longitudinal) did not support the hypothesis that psychosocial and physical strain from 1 day of work predicts pain onset the following day. However, physical exertion, stress, and, to some extent, time pressure were associated with pain on the day of onset. Conclusion The effect period, if any, of exposure to physical exertion, stress, and time pressure on the onset of acute low-back pain is considered to be less than 24 hours.

42 citations


Journal ArticleDOI
TL;DR: The NWI-EO is a useful tool for assessing POWFs among RNs and NAs in order to determine priorities for preventive action to improve work organisation at the unit level and was found to have good psychometric properties.
Abstract: Background Quality of care, job satisfaction and the health of registered nurses (RNs) are associated with their exposure to psychosocial and organisational work factors (POWFs). Objectives To develop and validate an extended version of the Revised Nursing Work Index (NWI-R), the NWI-EO (Extended Organisation) tool specifically designed for occupational physicians and those involved in prevention programmes in healthcare institutions to assess the perception of POWFs, and then to determine priorities for preventive action to improve work organisation at the hospital staff level. Methods The tool was validated in the ORSOSA study, a multicentre French cohort of RNs and NAs ( n =4085) recruited in 214 work units of 7 French university hospitals. A total of 34 items (19 candidate items developed by a focus group and 15 items from the NWI-R) were analysed using principal component analysis (PCA) based on a randomised split-half of the data. In addition, construct validity, test–retest reliability, internal consistency and concurrent validity were assessed. Results Response rate was 91%. Twenty-two items were selected (9 of the 15 NWI-R items and 13 of the 19 candidate items) by PCA, resulting in an 8-factor solution that explained 53% of the common variance. The stability of the factorial structure of this 22-item NWI-EO questionnaire was confirmed by PCA on the other half-sample as well as by PCA on subgroups (age, gender, occupational group, specialty area, hospital). Reliability, assessed by internal consistency and test–retest, was satisfactory. Concurrent validity with two external measurements of organisational characteristics of work units was also observed. Conclusion The NWI-EO was found to have good psychometric properties. Several POWFs accessible to prevention programmes can be evaluated with this tool: poor communication in the work unit, lack of support from senior nurses, inadequate staffing to perform duties, poor relationships between workers, frequency of interruptions during tasks, low level of shared values within the team with regard to work, lack of support from the administration, and changes in planned vacations and time off. We believe the NWI-EO is a useful tool for assessing POWFs among RNs and NAs in order to determine priorities for preventive action to improve work organisation at the unit level.

29 citations


Journal ArticleDOI
01 Jun 2005
TL;DR: The results showed that the experience of workload, ergonomic troubles, psychosocial troubles and work stress had decreased at the same time as theExperience of stimulation and of joy at work had increased.
Abstract: A work environment intervention to test a model of age related workload was carried out at a local hospital. The staff received training about life course, work and work ability. Efforts at making changes in the work place were encouraged. Action plans were to be presented and the participating wards were given a grant in relation to the existing age structure, to carry out changes and to recruit younger persons. The results showed that the experience of workload, ergonomic troubles, psychosocial troubles and work stress had decreased at the same time as the experience of stimulation and of joy at work had increased. It was not possible to see any reduction in the HR costs or change in the working time and sick leaves. The action plans showed limited suggestions of changes. The organization's complexity and the traditional hierarchy of hospitals do not stimulate change, but the supervisors' involvement is also critical to the result of the staff's work. Work environment interventions are complicated and complex and influenced by many factors. One year is a very short time for an intervention. The importance of the experience of the staff of an improved work environment is however not to be diminished.

10 citations


References
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Book
01 Oct 1984
Abstract: Buku ini menyediakan sebuah portal lengkap untuk dunia penelitian studi kasus, buku ini menawarkan cakupan yang luas dari desain dan penggunaan metode studi kasus sebagai alat penelitian yang valid. Dalam buku ini mencakup lebih dari 50 studi kasus, memberikan perhatian untuk analisis kuantitatif, membahas lebih lengkap penggunaan desain metode campuran penelitian, dan termasuk wawasan metodologi baru.

77,868 citations


"Intervention studies in the health ..." refers background in this paper

  • ...This flexible approach is also defended by Yin (1984) in his often-cited book on case-study design....

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Book
01 Jan 1962
Abstract: Contents Preface CHAPTER 1. ELEMENTS OF DIFFUSION CHAPTER 2. A HISTORY OF DIFFUSION RESEARCH CHAPTER 3. CONTRIBUTIONS AND CRITICISMS OF DIFFUSION RESEARCH CHAPTER 4. THE GENERATION OF INNOVATIONS CHAPTER 5. THE INNOVATION-DECISION PROCESS CHAPTER 6. ATTRIBUTES OF INNOVATIONS AND THEIR RATE OF ADOPTION CHAPTER 7. INNOVATIVENESS AND ADOPTER CATEGORIES CHAPTER 8. DIFFUSION NETWORKS CHAPTER 9. THE CHANGE AGENT CHAPTER 10. INNOVATION IN ORGANIZATIONS CHAPTER 11. CONSEQUENCES OF INNOVATIONS Glossary Bibliography Name Index Subject Index

38,710 citations


Book
01 Jan 1974
Abstract: Here is a monumental work that continues in the tradition pioneered by co-author Richard Lazarus in his classic book Psychological Stress and the Coping Process. Dr. Lazarus and his collaborator, Dr. Susan Folkman, present here a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping which have become major themes of theory and investigation. As an integrative theoretical analysis, this volume pulls together two decades of research and thought on issues in behavioral medicine, emotion, stress management, treatment, and life span development. A selective review of the most pertinent literature is included in each chapter. The total reference listing for the book extends to 60 pages. This work is necessarily multidisciplinary, reflecting the many dimensions of stress-related problems and their situation within a complex social context. While the emphasis is on psychological aspects of stress, the book is oriented towards professionals in various disciplines, as well as advanced students and educated laypersons. The intended audience ranges from psychiatrists, clinical psychologists, nurses, and social workers to sociologists, anthropologists, medical researchers, and physiologists.

35,437 citations


"Intervention studies in the health ..." refers background in this paper

  • ...The pain is supposed to have a multifactorial aetiology (1, 27, 38), developing from complex interactions between external psychological and physical loads, individual psychological and biological characteristics, and psychological and biological reactions (3, 4, 25)....

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Journal ArticleDOI
TL;DR: Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
Abstract: Background Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. Methods A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. Results In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Conclusions Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.

20,182 citations


Journal ArticleDOI

18,643 citations