Workplace health promotion and employee health in municipal social care organizations

Sammanfattning: Background: People working in social care constitute the largest occupational group in Sweden and they have the highest prevalence of sickness absence. Since sickness absence results in great human and societal costs, there is incentive to develop initiatives to promote health for this group. Previous research about both what measures are effective and how soon effects occur are limited and more knowledge about this is needed. Aim: The overall aim of the thesis was to gain more knowledge about associations between workplace health promotion and employee health, sickness absence, and sickness presence in municipal social care organizations. Method: Four studies were conducted concerning social care organizations and their employees in 60 Swedish municipalities, based on data from registers as well as from surveys to employees, top managers, and policy makers, respectively. A randomized sample of 60 of the 290 municipalities in Sweden and a randomized sample of 15,871 people employed at least half time throughout 2006 within the social care sector in these 60 municipalities was used. A questionnaire was sent to the employees selected (9270) and 58% replied (study I-IV). Another questionnaire was sent to top managers who represented the employer in the same 60 municipalities (n=60) (study II). A third questionnaire was sent to policymakers in the 60 municipalities (study III). Register data was obtained on sickness absence (>14 days) in 2006 for the 9270 employees and on long-term sickness absence (>90 days) in 2007–2012 for all social service workers in the 60 municipalities. Both cross-sectional (study I–II and IV) and prospective (study III) study designs were used, using individual level data (study IV) and organizational level data (study I-III). Descriptive statistics, bivariate and multiple linear and logistic regression analyses, and structural equation modelling analyses were performed. Results: Organizations that had more favorable employee ratings of individual- and organizational-directed (psychosocial work conditions) workplace health promotion measures had better health and lower sickness absence levels among their employees (study I). Organizational- and individual-directed workplace health promotion measures and employee satisfaction with workplace health promotion measures were associated with better employee health (study II). There was an association between provision of organizational-directed workplace health promotion measures (prevention program) and future lower levels of long-term sickness absence (study III). There were associations present between the use of health profile assessment and fitness activities and a lower odds ratio of being sickness present (study IV). Conclusions: There were low or moderate associations between provision/use of workplace health promotion for individual and/or organizational approaches and lower levels of poor self-rated health, lower future incidence of long-term sickness absence, and lower odds ratio for sickness presence.