A Cluster Randomized Controlled Trial of a Total Worker Health® Intervention on Commercial Construction Sites

Abstract

This study evaluated the efficacy of an integrated Total Worker Health® program, “All the Right Moves”, designed to target the conditions of work and workers’ health behaviors through an ergonomics program combined with a worksite-based health promotion Health Week intervention. A matched-pair cluster randomized controlled trial was conducted on ten worksites (five intervention (n = 324); five control sites (n = 283)). Worker surveys were collected at all sites pre- and post- exposure at one- and six-months. Linear and logistic regression models evaluated the effect of the intervention on pain and injury, dietary and physical activity behaviors, smoking, ergonomic practices, and work limitations. Worker focus groups and manager interviews supplemented the evaluation. After controlling for matched intervention and control pairs as well as covariates, at one-month following the ergonomics program we observed a significant improvement in ergonomic practices (B = 0.20, p = 0.002), and a reduction in incidences of pain and injury (OR = 0.58, p = 0.012) in the intervention group. At six months, we observed differences in favor of the intervention group for a reduction in physically demanding work (B = −0.25, p = 0.008), increased recreational physical activity (B = 35.2, p = 0.026) and higher consumption of fruits and vegetables (B = 0.87, p = 0.008). Process evaluation revealed barriers to intervention implementation fidelity and uptake, including a fissured multiemployer worksite, the itinerant nature of workers, competing production pressures, management support, and inclement weather. The All the Right Moves program had a positive impact at the individual level on the worksites with the program. For the longer term, the multi-organizational structure in the construction work environment needs to be considered to facilitate more upstream, long-term changes.

Designing a Participatory Total Worker Health® Organizational Intervention for Commercial Construction Subcontractors to Improve Worker Safety, Health, and Well-Being: The “ARM for Subs” Trial

“…In our previous worksite-based program for general contractors, "All the Right Moves (ARM)" we found that an intervention focused on both health promotion (through toolbox talks) and health protection (through worksite ergonomic evaluations and changes) was effective in improving worker safety and health behaviors [27]. However, our data suggested that the ARM program could have been more effective if the program included resources and activities specifically targeting the subcontractor.…”

“…We conducted formative research to determine what characteristics needed to be considered for the success of the intervention and its implementation, and to establish the intervention components and their methods. The focus of the formative research was on the adaptation of a previous and successful worksite-based intervention [27], and determining the feasibility and practical application of the intervention components.…”

“…We completed key informant interviews with general managers and safety managers from subcontractors from various trades in Massachusetts to learn more about subcontractors' employment patterns and to determine effective strategies for implementing and evaluating a TWH ® organizational intervention to improve subcontracting workers' safety, health and well-being. Participants were recruited through our existing construction projects from a previous study [27]. Semi-structured interviews were conducted in-person and were recorded, transcribed and content analyzed using Atlas.ti 7 Windows (Atlas.ti Scientific Software Development GmbH, Berlin, Germany).…”

“…We vetted the intervention components, activities, timing, delivery and implementation methods with union representatives, and subcontractor safety and human resource representatives through interviews, as well as two focus groups-one with general contractor and subcontractor representatives and another with managers and workers from one subcontracting company. Participants were recruited from our previous and existing construction projects [27,31]. To test out new ideas during this vetting process, we made changes to the intervention protocol sequentially, and hence no two touch points reviewed the same intervention protocol.…”

A Systematic Review of Workplace Interventions to Rehabilitate Musculoskeletal Disorders Among Employees with Physical Demanding Work

“…Multifaceted 15 studies reporting on 16 different interventions were identified and grouped within the multifaceted domain [35,49,[62][63][64][65][66][67][68][69][70][71][72][73][74]. 11 interventions from high-quality studies and 2 interventions from medium quality studies presented no benefit of multifaceted workplace-interventions on MSD.…”