Occupational safety and health interventions : incentives and economic consequences

Sammanfattning: Aim: The overall aim of this thesis was to extend the knowledge of factors that from an employer perspective could increase the use of research based occupational safety and health (OSH) interventions and work-place health promotion (WHP). The aim of Study I was to explore and describe what incentives influence when employers make their decisions about engaging in OSH interventions and WHP. The aim of Study II was to examine if work related stress is associated with production loss. Methods: In Study I, focus group interviews were carried out with 20 representatives from 19 workplaces across Sweden. The study population was managers with responsibility for making decisions about OSH interventions and WHP, or employees directly involved in this work with equivalent knowledge and mandate from their managers to answer questions about these decisions. The interviews were transcribed and the data were analyzed using latent content analysis. In Study II, a cross-sectional study design was used. Data was collected through a work environment and health survey sent out to all employees at a medium sized municipality in Sweden (n=2,766). Job strain and exhaustion were used as indicators of work-related stress. Production loss at work was measured on a 10-point scale to capture the influence of work environment problems and health problems on performance during the last seven days. The scale was converted from 0-10 to 0-100 to capture the percentage loss of work time. Associations were investigated using a general linear model (GLM) regression analysis, and confounders were checked for by a mixture of backward and forward selection. Results: In Study I, the following incentives were identified in the analysis: “law and provisions,” “consequences for the employer,” “knowledge of worker health and workplace health interventions,” “characteristics of the intervention,” and “communication and collaboration with the provider.” The incentives seemed to influence the decision making parallel with each other and the employers most often considered several incentives at the same time when deciding on whether or not to engage in OSH interventions and WHP. In Study II, the average production loss associated with job strain was 8.2% (work environment-related production loss) and 4.3% (health-related production loss). For mild and severe exhaustion the association was 2.0% and 12.7% regarding work environment-related production loss; for health-related production loss it was 5.4% and 17.8%. Conclusion: The present thesis contributes to further knowledge of factors that could increase the use of research-based OSH interventions and WHP. The conclusion of Study I was that employers’ decisions to engage in OSH interventions and WHP were influenced by several incentives. Some incentives led to a desire to engage in these kinds of interventions, while other incentives were related to other aspects such as the characteristics of the employer, the provider, and the intervention. All incentives seemed important to consider in order to understand the decision making process for OSH interventions and WHP, and to bridge the gap between what is produced through research and what is used in practice. The conclusion of Study II was that work-related stress, measured as job strain and exhaustion, was associated with increased production loss at the workplace resulting in economic consequences for the employer. If employers would be able to reduce the proportion of employees experiencing job strain and/or exhaustion, this could have a positive effect on work productivity and efficiency, and thereby be used as an economic incentive to reduce work-related stress.