The implementation of interventions to prevent musculoskeletal injury at work and the stage of change approach

Abstract

Background: The targeting of injury prevention advice according to behaviour change principles has been proposed by researchers as a means for improving the effectiveness of advice. However, despite promising results, this has not been adopted by practitioners. Aims: The aim of this thesis is to review contemporary approaches to the application of the behaviour-change approaches in the development of workplace injury prevention interventions; evaluate the implementation of stage of change based ergonomics advice; evaluate its effectiveness in musculoskeletal injury prevention; and to explore the barriers and facilitators to its adoption by practitioners. Methods: A mixed methods approach was used, comprising a literature review/discussion paper and three inter-related studies. Results: Literature review/Discussion paper: The structuring of injury prevention advice according to behaviour change principles has been most frequently applied using the Stage of Change (SOC) framework. However, despite favourable results there is little evidence that this has been adopted by practitioners. The translation of research findings into professional practice has been hindered by a ‘research-practice gap’ and the need to actively engage practitioners in the research process. Study 1 The managers of 25 workgroups, across a range of sectors were allocated to receive either standard ergonomics advice or ergonomics advice tailored according to the workgroup SOC profile. Twelve months later managers who had received tailored advice were found to have implemented significantly more recommended changes (IRR = 1.68, 95% CI 1.07-2.63) and more “additional” changes (IRR = 1.90, 95% CI 1.12-3.20). The findings suggest that the implementation of ergonomics recommendations may be improved by the tailoring of advice according to SOC principles. Study 2 Injury data on 169 workers (from 21 workgroups) who had been randomly assigned to receive standard ergonomics advice or advice tailored according to the SOC approach was analysed. Workers in receipt of tailored advice were 55% (OR=0.45, 95% CI 0.19-1.08) less likely to report a compensable injury than those in receipt of standard advice. While the effect was not statistically significant at a 0.05 level (p=0.073) the observed outcomes support the potential value of the SOC approach when planning injury prevention programs. Study 3 The barriers and facilitators to the adoption of the SOC approach were investigated in a series of practitioner focus groups and a subsequent survey of members of the Human Factors and Ergonomics Societies of Australia and New Zealand. A proposed SOC assessment tool was presented and its perceived utility critiqued. The results suggest the limited application of a SOC based approach is due to the absence of a suitable tool, the need for training and limited access to research findings. Conclusion: The SOC approach has been proposed as means to improve the implementation and effectiveness of ergonomics advice. Despite some encouraging results there is little evidence that this has been adopted by practitioners. This translation of research to practice may have been hindered by a lack of engagement with practitioners, and the absence of a suitable assessment tool. This thesis has addressed these issues in a series of inter-related studies. The outcomes are an improved evidence base for the potential effectiveness of the SOC approach, an investigation of the barriers and facilitators to its adoption by practitioners and their engagement in the development of a draft SOC assessment tool.