Psykosocial arbetsmiljö i en yrkesgrupp med krav på hög kvalitet : orkestrar inom konstmusik

Detta är en avhandling från Stockholm : Karolinska Institutet, Department of Public Health Sciences

Sammanfattning: The long-term goal of the studies performed within the framework of the thesis was to contribute to an improved psychosocial work environment for orchestra musicians. The perspective was the daily round of life of orchestra musicians as well as the context of working as an orchestra musician. The theoretical point of departure was Herzberg´s motivational theory that meaningful work content motivates and leads to work satisfaction and good health. A pilot study was performed with the aim of identifying work environment factors that are specifically important for orchestra musicians. For this purpose 20 musicians and other key persons were interviewed (n=27). This was followed by a questionnaire study exploring prevalence of a diverse number of psychosocial work environment factors and their correlation with health, study A. Half of the orchestra members in 12 orchestras (320) were asked on participation, 250 (78%) participated. Finally a study was performed in order to evaluate effects of a psychosocial intervention, study B. Two middle sized symphony orchestras were followed for two years. A psychosocial intervention was planned in one of the orchestras while the other one would serve as a comparison group. Repeated assessments at start and then once every half-year for two years (altogether five assessment occasions) were performed with questionnaires and psychophysiological measures assessments. The physiological measures were 24-hour ECG assessments of heart rate variability (HRV) and saliva testosterone concentration (STC). The participation rate for the questionnaire examination was on average 84% for the five occasions (74-92%), 64% responded to all five questionnaires. For the psychophysiological assessments the participation rate was on average 72% for the five occasions. 48% participated on all five occasions. Paper 1 describes correlations between different environmental and health factors in study A. The variable with the most consistent and statistically significantly independent value in relation to health was work content , i e disruption and frustration due to poor conductor, monotonous rehearsals and bad music. Paper 2-4 illustrate the need for good conditions for recuperation. In the long perspective the advice is to take into account the need for recuperation both in short and long cycles already in planning the repertoire for a whole year. Paper 2 explores the correlation between work posture with a high arm position and the duration of actively playing on one hand and pain in neck and shoulders on the other hand. The results showed that musicians working in an elevated arm position (violinists, violists, flutists and trumpet players) had a higher prevalence of neck-shoulder pain than those working in a more neutral position, even after psychosocial problems have been accounted for in the statistical analyses. Paper 3 shows that hearing problems in orchestra musicians are correlated with 24-hour ECG recordings of heart rate variability the lower the high frequency power (HFP) the more problems with hearing. HFP has been assumed to mirror the activity in the parasympathetic system which is important to the recuperation/anabolism and which needs beneficial conditions if good health is to be maintained and improved. In paper 4 it is shown how the activity of two other indicators of parasympathetic activity increased when a difficult psychosocial problem in one of the orchestras was solved. Those two indicators were: 1. from the 24-hour ECG recording very low frequency power (VLFP) which is assumed to mirror the sensitivity in the pressure regulating receptors in the artery walls and which is described as a slowly reacting indicator of the parasympathetic system 2. Saliva testosterone concentration (STC) which is also partly mirroring the parasympathetic activity as well as recuperation/anabolism. In paper 5 the procedures and the results from study B are described. No specific effects of the intervention program were shown. However the activities that the musicians chose related to work content; quality, roles and responsibility. An important conclusion to be drawn from the studies is that interventions aiming at improved work environment and health should depart from the meaning of the work task. The focus on the psychosocial processes may in itself have contributed to the insight that clear roles are important in orchestras.

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