A Total Worker Health Intervention on Commercial Construction Sites

Transcription

1 A Total Worker Health Intervention on Commercial Construction Sites @NUPTMRS 18 September 2018

2 Cadre of health and safety issues 2

3 Fatalities Musculoskeletal Disorders 3

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6 Challenges in the work environment. 6

7 Number of workers who left site Number of new workers who completed baseline survey and those still on-site for follow up B=baseline (new workers) F#=follow up number (returning workers) B B B B B F1 B F1 F1 F2 F2 F1 F2 F2 F3 B B F1 F1 F2 F2 F3 F4 F3 F4 Workers come and go on construction sites Month of the study on the worksites 7

8 8 Organizational framework for a construction worksite Owner/General Contractor Site supervisor, site safety manger, Other Subcontractors Foreman, Coworkers Worksite Subcontractor (Trade) Employer Foreman, Coworkers, (Safety manger) Union Steward Worker - Employee Trade, Age, Gender Trade (Union) Training, benefits Sparer et al, Am J Ind Med Sep;58(9): Zohar and Polachek 2014 (J. Appl Psychol) Sparer et al., Scand J Work Environ Health Jul 1;42(4):329-37

9 All the Right Moves Aim 1: Develop a worksite-based, multi-component, and integrated musculoskeletal disorders prevention and health promotion intervention for workers in commercial construction Aim 2: Complete a feasibility study of the developed worksite based intervention on ten sites, randomly assigned to either intervention (five sites) or controls (five sites) with workers measured at baseline and at one and sixmonth follow up

10 Build off existing practices Safety Management System Hazard ID/Control Inspections Feedback Task Pre-planning and hazard reduction methods Supervisor and worker training Added Ergonomics Manual materials handing Overhead work Ground work Safety Week Five days of activities surrounding safety topics Tools box talks Fliers, tool box cards Improve workplace practices Focus on Health Activities

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12 12 Communication: Safety Performance Feedback Inspection (Identifying Controls and Hazards) Site and subs Scores to workers Superintendent mitigates hazard Hazards Reported Super/SM/PM Controls & Hazards Foremen Reports Sparer et al, New Solutions, 2015 May;25(1):42-58

13 A u g S e p t O c t N o v D e c J a n F e b M a r A p r M a y J u n J u l A u g S e p t O c t N o v D e c J a n F e b M a r A p r M a y J u n J u l A u g S e p t O c t N o v D e c J a n F e b M a r A p r M a y J u n J u l A u g S e p t O c t N o v D e c D R P I P C A B C D E F G H Evaluated Cluster Randomized Trial on 8 (4 pairs) sites Key: DR = Dry run of intervention PI = Pilot of intervention PC = Pilot of control A-H = Full scale RCT sites A-H Each color represents a matched pair Intervention Control Intervention Control Intervention Control Intervention Control Dry Run Pilot Intervention Pilot Control Data collection methods & control

14 14 Change in safety climate score Effect estimate SE Effect Size P-value Model 1 Simple % 0.06 Model 2 Adjusted for pair/block % 0.01 Model 3 Adjusted for baseline differences % Safety Climate Improved! Amount of improvement varied across pairs Intervention Control Pair 1 Pair 2 Pair 3 Pair 4 Mean Sparer et al, Scand J Work Environ Health, (4):329-37

15 Qualitative Results Safety communication: "It helped safety wise definitely, to be cautious of other people and what s around you, and that's huge. Communication is key between the trades.. Teambuilding: The trades were working together with the program, and other trades were watching out for everyone else. Normally they would never do that, but now I see talking amongst the trades this came from the program. Positive reinforcement of safe work practices: "It felt good to finally get a report in a meeting to say I did something right" Sparer et al, Scand J Work Environ Health, (4):329-37

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17 Reality hit Key informant, focus groups, and pilot testing. Can t do many Physical Activity activities on site Physical Activity of construction work is already high Best intervention for construction workers is health coaching 17

18 Activities: All the Right Moves Musculoskeletal health Cardiovascular Health StIPP Soft Tissue Injury Prevention Program Health Week (get workers signed up for Health Coaching) Task pre-planning: Checklist for the Ergo 4 Ergo Simple Solutions Database of solutions Posted Ergo 4 solutions Employee feedback Inspections: Including Ergo 4 Weekly Reports to Foremen and workers Supervisor training: StIPP (1/2 hr) Adding Ergo to pre-task planning workshop (1/2 hr) Weekly Meetings with foreman Monday: What is health coaching Tuesday: StIPP Program the components Wednesday: Tobacco cessation CO measurements Thursday: Food and Activity Friday: Questions and Health Coaching sign up Health Coaching: 4 sessions No cost to worker PA/Diet, Tobacco Cessation Tobacco cessation referral: NRT Online Resources QUIT NOW Worker training: Toolbox talk on Ergo and Health

19 Soft-tissue Injury Prevention(StIPP) Feedback Pre-task plans SIPP Inspections Work Tasks Built from safety programs (Z10) and matching our own implementation guidelines 19

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23 23 Health week Education & engagement & health coaching

24 Activities: StIPP Soft Tissue Injury Prevention Program Health Week (get workers signed up for Health Coaching) Task pre-planning: Checklist for the Ergo 4 Ergo Simple Solutions Database of solutions Posted Ergo 4 solutions Employee feedback Inspections: Including Ergo 4 Weekly Reports to Foremen and workers Supervisor training: StIPP (1/2 hr) Adding Ergo to pre-task planning workshop (1/2 hr) Weekly Meetings with foreman Monday: What is health coaching Tuesday: StIPP Program the components Wednesday: Tobacco cessation CO measurements Thursday: Food and Activity Friday: Questions and Health Coaching sign up Health Coaching: 4 sessions No cost to worker PA/Diet, Tobacco Cessation Tobacco cessation referral: NRT Online Resources QUIT NOW Worker training: Toolbox talk on Ergo and Health 24

25 Cluster Randomized Controlled Trial 10 Construction Sites 5 Pairs Matched and randomized within GC Concurrent treatment/reference Intervention Treatment Sites StIPP Six Weeks Offered 4 telephone health coaching sessions Data Collection Treatment & Reference Baseline N =

26 Conceptual Framework for Evaluation Enterprise Characteristics Workplace Policies, Programs, & Practices Degree of integration Indicators of integration Worker / Work Force Characteristics Conditions of work Physical Environment Organization of Work Psychosocial Factors Job Tasks & Demands Worker Proximal Outcomes Health & Safety Behaviors Engagement in Programs Beliefs Knowledge Skills Worker Outcomes Injury Illness Wellbeing Enterprise Outcomes Productivity & Quality Turnover & Absence Health Care Costs Sorensen et al. Prev Med Aug 12;91:

27 Conceptual Framework for Evaluation Construction Worksites Characteristics Workplace Policies, Programs, & Practices Soft Tissue Injury Prevention program Health Week Construction workers Conditions of work Ergonomic Practices (Amick) Physically Demanding Work Worker Proximal Outcomes Smoking Physical Activity (BFRSS) Diet (Food Frequency) Worker Outcomes Pain and Injury (Nordic Questionnaire) Enterprise Outcomes Work Limitations Questionnaire. Peters et al. International Journal of Environmental Research and Public Health. To Be Submitted Peters et al. International Journal of Environmental Research and Public Health. To Be Submitted 27

28 Ergonomics and Work Follow up 1 (~1 month on worksite) Ref: Control Sites N Β-Coefficient (95% CI) P-Value Ergonomics Practices (0.03, 0.33) Physically Demanding Work (-0.09, 0.48) Peters et al. International Journal of Environmental Research and Public Health. To Be Submitted 28

29 Worker Health Behvior Follow up 2 (6 months post health week mailed) Ref: Control Sites N Β-Coefficient (95% P-Value CI) Recreational physical activity (4.02, 58.05) Dietary balance (-0.68, 2.30) 0.25 Healthy diet (-0.17, 1.43) 0.08 Unhealthy diet (-1.07, 0.83) Peters et al. International Journal of Environmental Research and Public Health. To Be Submitted 29

30 Pain and Injury Outcomes Follow up 1 (~1 month on worksite) Ref: Control Sites N OR (95% CI) P-Value New pain or injury since baseline (0.43, 0.80) New pain in the last 3 months (0.40, 1.30) Follow up 2 (6 months post health week mailed) Ref: Control Sites N OR (95% CI) P-Value New pain or injury since baseline (0.20, 1.59) New pain in the last 3 months (0.34, 1.79) Peters et al. International Journal of Environmental Research and Public Health. To Be Submitted 30

31 Treatment reduced new incidence of worker pain, improved ergonomics, and improved self-reported health behaviors. Change in psychosocial support and worker knowledge about ergonomic approaches Discussed qualitative research StIPP program had limitations Needed more upstream changes and planning including the bidding process Sub-Contractors did not have infrastructure for larger changes based on ergonomics.

32 Future Create a system for multi-employer workplaces ARM Focus on General Contractor, Worksite level ARM for Subs Developing communication infrastructure for subcontractors» Most Workers are employed by sub contractors» Provide front line workers with front line resources Integrate work-site/gc level with sub-contractor level 32

33 Bottom-line Messages Construction workers have high rates of MSDs and Chronic Health Issues Construction work environment/place has many challenges for implementing worker health initiatives We designed a worksite program to incorporate these ideas to improve worksite ergonomics and improve worker health behaviors We evaluated the program through a cluster randomized control trial The program changed workers ergonomic practices, pain and behavior. Reach of the program did not overcome all challenges.

34 Thank you! Our Shared Goal Protect and promote worker safety, health, and well-being A Total Worker Health Center of Excellence Funded in part by grant U19OH from the CDC/NIOSH Follow 34

35 Thank you! Our Shared Goal Protect and promote worker safety, health, and well-being A Total Worker Health Center of Excellence Funded in part by grant U19OH from the CDC/NIOSH Follow 35