The implementation of ergonomics advice and the stage of change approach
Introduction
In professional practice ergonomics and injury prevention advice commonly comprises a series of recommended changes to work systems, the work environment and individual work practices (Rothmore et al., 2013). However, even when actively sought, this advice may not be fully implemented or simply ignored (Trevelyan and Haslam, 2001). Compounding this is the absence of routine evaluation by ergonomics consultants of the implementation and effectiveness of the advice provided (Whysall et al., 2004).
The paucity of evaluation to explore the implementation of ergonomics advice provided by professional ergonomics consultants has been primarily related to client/company disinterest due to the associated costs, but also in part, due to the consultants’ views that requests for evaluation might indicate a lack of confidence in the effectiveness of the interventions they had proposed (Whysall et al., 2004). Reasons for the lack of implementation of advice may include issues of cost, concerns over effectiveness, a lack of understanding of company priorities on the part of the consultant engaged or simply a lack of “desire” on the part of the company to introduce change (Trevelyan and Haslam, 2001). These factors suggest the need for consultants to frame their advice in a manner which will maximise its potential adoption (Rothmore et al., 2013).
Injury prevention advice typically proposes changes to the work environment, work systems and individual work practices (Rothmore et al., 2013). Such changes inevitably involve a change in behaviour.
Various methods have been proposed to improve the implementation and effectiveness of ergonomics advice according to behaviour change principles (DeJoy, 1996, Haslam, 2002, Urlings et al., 1990). The most frequently applied of the behaviour change methods in workplace settings has been Prochaska and DiClemente's Stage of Change (SOC) framework (Barrett et al., 2005, Prochaska et al., 2001, Village and Ostry, 2010, Whysall et al., 2006a, Whysall et al., 2006b) in which readiness to change is assessed using a short series of closed questions after which they are assigned to one of five stages:
- 1.
Pre-contemplation (unaware or unconcerned about workplace hazards)
- 2.
Contemplation (considering change but not yet ready to act)
- 3.
Preparation (intend to change in the near future)
- 4.
Action (made changes in the previous 6 months)
- 5.
Maintenance (made changes and are working to consolidate gains and avoid relapse)
Advice is then tailored, according to the stage of change, in order to improve receptiveness. For example, while those in the more advanced stages will benefit from practical information on how to make, or maintain change, those in the earlier stages will benefit from information on the risks and hazards linked with their current behaviour and actions, which may encourage progression onto later stages.
The SOC approach has been evaluated by measuring progression through the various stages of change, post-intervention, assuming that those in more advanced stages will be more “risk aware” and therefore adopt less risky behaviour (Barrett et al., 2005, Whysall et al., 2006b). Other measures have included changes in self-reported body part discomfort or safety culture as indicators of effectiveness (Whysall et al., 2006b).
In their study of workplace interventions using the SOC approach, Whysall et al. (2006b) reported that organisations in receipt of SOC-based ergonomics advice were significantly more effective in promoting risk awareness and desired safety behaviour among their workers. Significant reductions in worker self-reported body part discomfort were also reported. These health benefits and risk awareness changes were maintained at 15 and 20 months post-intervention (Shaw et al., 2007).
Potential barriers to the implementation of advice exist not only at the consultant/client interface but also at the manager/worker level. When Whysall et al. (2006a) interviewed company managers who were responsible for implementing workplace changes designed to reduce the incidence of musculoskeletal disorders the strongest reported barriers included: resistance to change by employees; difficulties in gaining senior manager authorisation for change; and managers’ attitudes to health and safety in general. While the tailoring of advice according to the SOC approach may be effective in overcoming resistance to change, empirical evidence, while encouraging, is limited.
Using a mixed methods approach the aims of this study were:
- •
To determine whether the rate of implementation of ergonomics and injury prevention advice provided to companies could be improved if it was tailored according stage of change principles, and
- •
To identify the barriers and facilitators experienced by managers in the implementation of the proposed changes
Section snippets
Sample
Purposive sampling was used to select medium-large organisations from industry groups in South Australia known to be at high risk of musculoskeletal injury according to statistical data from the State's Workers' Compensation Authority. These organisations were contacted via e-mail or telephone. Each participating organisation was asked to recruit 10 to 20 of its own employees (on a voluntary basis) who performed substantially similar tasks, were members of the same identifiable workgroup and
Companies
Table 1 presents descriptive statistics for industry sector, nature of work, company size, and manager characteristics. Small companies (those with less than 20 employees) did not participate in this study.
Managers
Table 1 presents descriptive statistics for the participating workplace managers’ age, experience and whether they had control of an OHS budget. The average age of the managers interviewed was 47.68 years (ranging from 32 to 62 years). The average length of tenure in their current position
Discussion
This paper has reported on a mixed methods evaluation of injury prevention advice tailored according to the SOC approach. The randomised quantitative component found that at 12-month follow-up, the companies in receipt of tailored advice had implemented recommended changes at a rate more than 60% higher than the standard group. This higher rate of implementation was seen primarily in the introduction of lower order changes, which were introduced at more than twice the rate in the tailored
Limitations
While comparable reports were provided to companies in the standard and tailored groups it was decided to supplement these for companies in receipt of the tailored advice with a visit to explain its rationale (they had been previously blinded to their group allocation). Standard practice amongst consultants varies and may include sending final reports or arranging follow-up visits to present and discuss their findings. For pragmatic reasons we elected to send reports to those in the standard
Conclusions
The results of this study suggest that the tailoring of advice according to behaviour-change principles can improve its implementation. Not only were recommended changes implemented at a higher rate in companies which received tailored advice but they also introduced more additional changes (i.e. changes which were not specifically proposed). This may be indicative of a larger effect for the behaviour change approach within organisations. Larger studies are needed to confirm this.
The field of
Acknowledgements
We thank the participating companies, and SafeWork South Australia for funding support, under the Commissioned Research Grants Scheme.
SafeWork SA and the South Australian Government do not endorse the content of this material and the views expressed herein are not reflective of SafeWork SA or the South Australian Government.
References (16)
- et al.
Assessing attitudes and beliefs using the stage of change paradigm - case study of health and safety appraisal within a manufacturing company
Int. J. Industrial Ergonomics
(2005) Theoretical models of health behavior and workplace self-protective behavior
J. Saf. Res.
(1996)Targeting ergonomics interventions–learning from health promotion
Appl. Ergon.
(2002)- et al.
Musculoskeletal disorders in a handmade brick manufacturing plant
Int. J. Industrial Ergonomics
(2001) - et al.
Assessing attitudes, beliefs and readiness for musculoskeletal injury prevention in the construction industry
Appl. Ergon.
(2010) - et al.
Implementing health and safety interventions in the workplace: an exploratory study
Int. J. Industrial Ergonomics
(2006) - et al.
A stage of change approach to reducing occupational ill health
Prev. Med.
(2006) - et al.
Processes, barriers, and outcomes described by ergonomics consultants in preventing work-related musculoskeletal disorders
Appl. Ergon.
(2004)
Cited by (35)
Barriers to and facilitators for implementing an office ergonomics programme in a South African research organisation
2019, Applied ErgonomicsCitation Excerpt :lack of specialist support (Van Eerd et al., 2010). Facilitators for the implementation of workplace health programmes include: management support and commitment; good communication and information; knowledge of ergonomics, in particular knowledge of the benefits of the intervention; and change of management (i.e. a new manager may have a more favourable attitude towards implementation) (Fassier et al., 2015; Rothmore et al., 2015; Van Eerd et al., 2010; Whysall et al., 2006). A recent literature review found that management commitment was the most important facilitator towards successful implementation of a workplace health programme, because management is able to ensure the availability of the required resources (Burgess-Limerick, 2018).
Establishing a dynamic ergonomic evaluation index system for complex product designs based on the theory of product life cycle
2019, International Journal of Industrial ErgonomicsHow do Employees with Chronic Musculoskeletal Disorders Experience the Management of Their Condition in the Workplace? A Metasynthesis
2023, Journal of Occupational RehabilitationBarriers on Implementing Ergonomic Practices in Hotel Housekeeping
2023, International Journal of Hospitality and Tourism SystemsManaging Risks and Risk Assessment in Ergonomics—A Case Study
2023, Springer Proceedings in Complexity