Suzanne Nobrega - Academia.edu (original) (raw)

Papers by Suzanne Nobrega

BMC Public Health, Jan 25, 2019

Background: In the United States, worksite wellness programs are more often offered by larger emp... more Background: In the United States, worksite wellness programs are more often offered by larger employers. The Massachusetts Working on Wellness (WoW) program is an innovative, statewide capacity-building model designed to increase the number of smaller employers (200 or fewer workers) adopting health promotion initiatives. This article describes the WoW program design and approaches to recruitment, implementation, and evaluation. Methods/design: WoW provides employer training, technical assistance and seed funding, utilizing a Wellness Program Development framework based on recognized good practices. For-profit employers with 200 employees or fewer are eligible for and encouraged to apply for a Massachusetts Small Business Wellness Tax Credit. During the phase described in this paper, employer organizations applied to the program and committed to designating a champion responsible for program implementation. Interventions were to include policy and environmental supports, as well as those targeting individual behavior change through raising awareness and education. Supports provided to employers included seed grants for qualifying activities (up to $10,000 with matching required), community linkages, data collection and organization-specific feedback tools, an on-line curriculum supplemented with technical assistance, and an expert webinar series. Data collection at multiple time points, from the initial application through program completion, provides information for evaluation of recruitment, planned and completed activities. Discussion: This model is grounded in literature on good practices as well as in local knowledge about Massachusetts employers. It does not directly address the influence of working conditions, which can affect both worker participation and health behaviors. Implementation may be less successful with some organizations, such as those with many workers who are part-time or geographically distributed rather than in a centralized physical location. Program evaluation will assess the extent to which WoW achieves its goals. The data are expected to increase understanding of the needs of smaller employers and industries not traditionally implementing employee wellness programs.

International journal of qualitative methods, 2021

Focus groups are often used for qualitative investigations. We adapted a published focus group me... more Focus groups are often used for qualitative investigations. We adapted a published focus group method for evaluating impact of an organizational intervention for virtual delivery using video conferencing. The method entailed convening small groups of three to five participants for a 2-hour facilitated workshop. We delivered the virtual workshops, adding qualitative evaluation with researchers and participants, to assess the effectiveness of the protocol. We address the questions of how to structure the data collection procedures; whether virtual delivery permits cross participant interactions about a studied intervention; and how easy and comfortable the experience was for participants. Participants were university faculty members who were the focus of an institutional diversity program. The results indicated that the virtually delivered focus group workshop could be successfully implemented with strong fidelity to the original protocol to achieve the workshop goals. The workshops generated rich data about the impacts of the institutional program as well as other events and conditions in the working environment that were relevant to consider along with the observed program outcomes. A well-planned virtual focus group protocol is a valuable tool to engage intervention stakeholders for research and evaluation from a distance. Video conferencing is especially useful during the current COVID-19 pandemic, but also whenever geography separates researchers and evaluators from program stakeholders. Careful planning of privacy measures for a secure online environment and procedures for structured facilitation of group dialogue are critical for success, as in any focus group. This article addresses a gap in the literature on feasibility and methodology for using video conference technology to conduct qualitative data collection with groups.

International journal of human factors and ergonomics, 2015

Total Worker Health™ (TWH) interventions for improved employee safety, health and wellbeing depen... more Total Worker Health™ (TWH) interventions for improved employee safety, health and wellbeing depend on integrated approaches that involve changes to the workplace or work organisation as well as behavioural or lifestyle changes made by workers. Intervention Design and Analysis Scorecard (IDEAS) Tool to engage front-line employees in planning TWH interventions and obtaining needed management support. The IDEAS Tool consists of seven planning steps in a scorecard approach that helps front-line employees systematically examine root causes of health/safety problems/issues and develop intervention alternatives. A comprehensive business case is then developed for each proposed intervention through analysis of costs/benefits, resources and barriers, and scope of impact. A case study is presented in which maintenance technicians at a property management firm used the IDEAS Tool to plan and successfully implement multiple interventions to reduce work overload. A participatory systems taxonomy is used to help explain why such a structured approach to intervention planning is needed to create a sustainable program for the continuous improvement of employee safety, health and wellbeing for TWH.

Annals of Work Exposures and Health, Jan 31, 2020

The effects of work and the conditions of employment on health behaviors and intermediate health ... more The effects of work and the conditions of employment on health behaviors and intermediate health conditions have been demonstrated, to the extent that these relationships should be addressed in efforts to prevent chronic disease. However, conventional health promotion practice generally focuses on personal risk factors and individual behavior change. In an effort to find solutions to the myriad of health challenges faced by the American workforce, the U.S. National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health ® (TWH) program. Originally organized around the paradigm of integrating traditional occupational safety and health protections with workplace health promotion, TWH has evolved to a broader emphasis on workplace programs for enhancing worker safety, health, and well-being. Among the research programs and approaches developed by investigators at NIOSH Centers of Excellence for TWH and elsewhere, definitions of 'integration' in workplace interventions vary widely. There is no consensus about which organizational or individual outcomes are the most salient, how much to emphasize organizational contexts of work, or which program elements are necessary in order to qualify as 'Total Worker Health'. Agreement about the dimensions of integration would facilitate comparison of programs and interventions which are self-defined as TWH, although diverse in content. The specific criteria needed to define integration should be unique to that concept-i.e. distinct from and additive to conventional criteria for predicting or evaluating the success of a workplace health program. We propose a set of four TWHspecific metrics for integrated interventions that address both program content and process: (i) coordination and interaction of workplace programs across domains; (ii) assessment of both work and

International Journal of Workplace Health Management, Jun 11, 2021

Purpose –Total Worker Health® (TWH) programs, which represent a holistic approach for advancing w... more Purpose –Total Worker Health® (TWH) programs, which represent a holistic approach for advancing worker safety, health and well-being, require an employer to adapt programmatic coordination and employee involvement in program design and delivery. Organizational readiness for such measures requires competencies in leadership, communication, subject expertise and worker participation. In the absence of documented methods for TWH readiness assessment, the authors developed a process to prospectively identify implementation facilitators and barriers that may be used to strengthen organizational competencies and optimize the organizational “fit” in advance.Design/methodology/approach –The mixed-method baseline assessment instruments comprised an online organizational readiness survey and a key leader interview; these were administered with key organizational and labor leaders in five US healthcare facilities. Findings about organizational resources, skills available and potential implementation barriers were summarized in a stakeholder feedback report and used to strengthen readiness and tailor implementation to the organizational context.Findings –The research team was able to leverage organizational strengths such as leaders’ commitment and willingness to address nontraditional safety topics to establish new worker-led design teams. Information about program barriers (staff time and communication) enabled the research team to respond with proactive tailoring strategies such as training on participant roles, extending team recruitment time and providing program communication tools and coaching.Originality/value –A new method has been developed for prospective organizational readiness assessment to implement a participatory TWH program. The authors illustrate its ability to identify relevant organizational features to guide institutional preparation and tailor program implementation.

Research Square (Research Square), Dec 30, 2020

Background: The Total Worker Health program represents a holistic approach to advancing worker we... more Background: The Total Worker Health program represents a holistic approach to advancing worker wellbeing that combines occupational safety and health practices with other workplace policies and programs that are not traditionally linked. Total Worker Health requires new types of interdisciplinary collaboration and programmatic coordination. Pre-implementation assessment is thus important to plan for successful organizational " t" when the program is introduced. This study prospectively identi ed potential implementation facilitators and barriers among ve public healthcare facilities that had already agreed to participate in a study to implement and evaluate the Healthy Workplace Participatory Program. Methods: A mixed methods baseline assessment comprised an online survey and follow-up interviews.

American Journal of Evaluation

Program evaluations that lack experimental design often fail to produce evidence of impact becaus... more Program evaluations that lack experimental design often fail to produce evidence of impact because there is no available control group. Theory-based evaluations can generate evidence of a program's causal effects if evaluators collect evidence along the theorized causal chain and identify possible competing causes. However, few methods are available for assessing competing causes in the program environment. Effect Modifier Assessment (EMA) is a method previously used in smaller-scale studies to assess possible competing causes of observed changes following an intervention. In our case study of a university gender equity intervention, EMA generated useful evidence of competing causes to augment program evaluation. Top-down administrative culture, poor experiences with hiring and promotion, and workload were identified as impeding forces that might have reduced program benefits. The EMA addresses a methodological gap in theory-based evaluation and might be useful in a variety of p...

Musculoskeletal disorders are well documented in the nursing profession and are particularly prev... more Musculoskeletal disorders are well documented in the nursing profession and are particularly prevalent among nursing assistants in nursing homes. In 2004, a corporation with 217 nursing homes began implementing a No-Lift Program (NLP), introducing resident lifting equipment, procedures, and policies. We investigated the effect on observed ergonomic exposures of nursing assistants using PATH (Postures, Activities, Tools, and Handling) in four nursing homes. We also collected survey and focus group data on health, work history and working conditions in this population to assess factors associated with lift equipment use. Ergonomic observations and surveys were collected at baseline, three-month, 12-month and 24-month periods following NLP implementation. After one year, the proportion of time that nursing assistants were handling residents dropped from 13.8% to 9.3%. While resident handling, nursing assistants used lifting equipment 14.6% of the time vs 5.7% before the NLP, and neutra...

Advances in health promotion research have demonstrated the importance of addressing the underlyi... more Advances in health promotion research have demonstrated the importance of addressing the underlying social and environmental factors that can negatively influence individuals' health behaviors. Working conditions are an important source of physical hazards (e.g., noise, heavy lifting) and psychosocial stressors (e.g., harassment, high demands coupled with low control) that are well-known to increase the risk of conditions such as cardiovascular disease, musculoskeletal disorders, and depression. Occupational health and safety programs (OHS), which help to assure safe working conditions, are rarely carried out in coordination with workplace health promotion (WHP) programs, despite the potential effectiveness for integrated programs to support changes in health behaviors, reduce risk and prevalence of chronic diseases, and realize cost and productivity savings. We analyzed results from a 2008 survey of Massachusetts employers to assess the extent to which employers offer worksite ...

Journal of Workplace Behavioral Health, 2010

, CEAP, for their review and input on this manuscript. We thank the Massachusetts-Rhode Island Ch... more , CEAP, for their review and input on this manuscript. We thank the Massachusetts-Rhode Island Chapter of EAPA for assistance with recruitment and their continuing support and dialogue on the topic of job stress. And finally, we want to acknowledge the contributions of Deborah Van Langen, MS, who conducted the initial interviews, and Julie Brodie, MA who assisted with word processing and references.

Journal of Occupational and Environmental Medicine, 2013

As part of a Research-to-Practice Toolkit development effort by the Center for the Promotion of H... more As part of a Research-to-Practice Toolkit development effort by the Center for the Promotion of Health in the New England Workplace, to develop and test a structured participatory approach for engaging front-line employees in the design of integrated health protection and promotion interventions. On the basis of a participatory ergonomics framework, the Intervention Design and Analysis Scorecard (IDEAS) provides a stepwise approach for developing intervention proposals, including root cause analysis and setting evaluation criteria such as scope, obstacles, and cost/benefit trade-offs. The IDEAS was tested at four diverse worksites with trained facilitators. Employees were able to develop and gain management support for integrated interventions at each worksite. The IDEAS can be used effectively by front-line employees to plan integrated interventions in a program dedicated to continuous improvement of employee health protection/promotion and Total Worker Health.

Journal of Workplace Behavioral Health, 2010

This manuscript has not been submitted nor published in any other trade or peer reviewed journal.

Journal of Occupational and Environmental Medicine, 2013

Objective: To describe the value of participatory methods for achieving successful workplace heal... more Objective: To describe the value of participatory methods for achieving successful workplace health promotion (WHP) programming, and specifically the relevance of participatory ergonomics (PE) for the Total Worker Health (TWH) initiative. Methods: We review the concept of macroergonomics, and how PE is embedded within that framework, and its utility to modern WHP approaches such as "social health promotion." We illustrate these constructs in practice within TWH. Results and Conclusions: Participatory ergonomics is relevant to WHP because (1) psychosocial stress contributes to individual health behaviors as well as chronic diseases; (2) job stress cannot be addressed without employee involvement in hazard identification and solutions; (3) the interaction of multiple levels within an organization requires attention to needs and constraints at all levels, just as the social-ecological model addresses higher-level determinants of and constraints on individual behaviors.

Journal of Gerontological Nursing, 2011

This qualitative study explored common and divergent perceptions of caregivers and managers regar... more This qualitative study explored common and divergent perceptions of caregivers and managers regarding occupational health and safety, work organization, and psychosocial concerns in long-term care centers. Both common and differing issues were identified. Both groups agreed on the importance of ergonomic concerns, the high prevalence of stress, and receptiveness to participatory health promotion programs. However, numerous work organization issues and physi-cal and psychosocial workplace hazards were identified by certified nursing assistants but were not mentioned by managers. The results suggest that different perceptions naturally arise from people's varying positions in the occupational hierarchy and their consequent exposures to health and safety hazards. Improved systems of communication that allow frontline workers to express their concerns would make it possible to create solutions to these problems.

American Journal of Health Promotion, 2013

Purpose. This study examines worksite health promotion (WHP) and occupational health and safety (... more Purpose. This study examines worksite health promotion (WHP) and occupational health and safety (OHS) activities by Massachusetts employers, and the extent to which workplaces with programming in one domain were more likely to have the other as well.

Journal of Workplace Behavioral Health, 2010

BMC Public Health, Jan 25, 2019

Background: In the United States, worksite wellness programs are more often offered by larger emp... more Background: In the United States, worksite wellness programs are more often offered by larger employers. The Massachusetts Working on Wellness (WoW) program is an innovative, statewide capacity-building model designed to increase the number of smaller employers (200 or fewer workers) adopting health promotion initiatives. This article describes the WoW program design and approaches to recruitment, implementation, and evaluation. Methods/design: WoW provides employer training, technical assistance and seed funding, utilizing a Wellness Program Development framework based on recognized good practices. For-profit employers with 200 employees or fewer are eligible for and encouraged to apply for a Massachusetts Small Business Wellness Tax Credit. During the phase described in this paper, employer organizations applied to the program and committed to designating a champion responsible for program implementation. Interventions were to include policy and environmental supports, as well as those targeting individual behavior change through raising awareness and education. Supports provided to employers included seed grants for qualifying activities (up to $10,000 with matching required), community linkages, data collection and organization-specific feedback tools, an on-line curriculum supplemented with technical assistance, and an expert webinar series. Data collection at multiple time points, from the initial application through program completion, provides information for evaluation of recruitment, planned and completed activities. Discussion: This model is grounded in literature on good practices as well as in local knowledge about Massachusetts employers. It does not directly address the influence of working conditions, which can affect both worker participation and health behaviors. Implementation may be less successful with some organizations, such as those with many workers who are part-time or geographically distributed rather than in a centralized physical location. Program evaluation will assess the extent to which WoW achieves its goals. The data are expected to increase understanding of the needs of smaller employers and industries not traditionally implementing employee wellness programs.

International journal of qualitative methods, 2021

Focus groups are often used for qualitative investigations. We adapted a published focus group me... more Focus groups are often used for qualitative investigations. We adapted a published focus group method for evaluating impact of an organizational intervention for virtual delivery using video conferencing. The method entailed convening small groups of three to five participants for a 2-hour facilitated workshop. We delivered the virtual workshops, adding qualitative evaluation with researchers and participants, to assess the effectiveness of the protocol. We address the questions of how to structure the data collection procedures; whether virtual delivery permits cross participant interactions about a studied intervention; and how easy and comfortable the experience was for participants. Participants were university faculty members who were the focus of an institutional diversity program. The results indicated that the virtually delivered focus group workshop could be successfully implemented with strong fidelity to the original protocol to achieve the workshop goals. The workshops generated rich data about the impacts of the institutional program as well as other events and conditions in the working environment that were relevant to consider along with the observed program outcomes. A well-planned virtual focus group protocol is a valuable tool to engage intervention stakeholders for research and evaluation from a distance. Video conferencing is especially useful during the current COVID-19 pandemic, but also whenever geography separates researchers and evaluators from program stakeholders. Careful planning of privacy measures for a secure online environment and procedures for structured facilitation of group dialogue are critical for success, as in any focus group. This article addresses a gap in the literature on feasibility and methodology for using video conference technology to conduct qualitative data collection with groups.

International journal of human factors and ergonomics, 2015

Total Worker Health™ (TWH) interventions for improved employee safety, health and wellbeing depen... more Total Worker Health™ (TWH) interventions for improved employee safety, health and wellbeing depend on integrated approaches that involve changes to the workplace or work organisation as well as behavioural or lifestyle changes made by workers. Intervention Design and Analysis Scorecard (IDEAS) Tool to engage front-line employees in planning TWH interventions and obtaining needed management support. The IDEAS Tool consists of seven planning steps in a scorecard approach that helps front-line employees systematically examine root causes of health/safety problems/issues and develop intervention alternatives. A comprehensive business case is then developed for each proposed intervention through analysis of costs/benefits, resources and barriers, and scope of impact. A case study is presented in which maintenance technicians at a property management firm used the IDEAS Tool to plan and successfully implement multiple interventions to reduce work overload. A participatory systems taxonomy is used to help explain why such a structured approach to intervention planning is needed to create a sustainable program for the continuous improvement of employee safety, health and wellbeing for TWH.

Annals of Work Exposures and Health, Jan 31, 2020

The effects of work and the conditions of employment on health behaviors and intermediate health ... more The effects of work and the conditions of employment on health behaviors and intermediate health conditions have been demonstrated, to the extent that these relationships should be addressed in efforts to prevent chronic disease. However, conventional health promotion practice generally focuses on personal risk factors and individual behavior change. In an effort to find solutions to the myriad of health challenges faced by the American workforce, the U.S. National Institute for Occupational Safety and Health (NIOSH) established the Total Worker Health ® (TWH) program. Originally organized around the paradigm of integrating traditional occupational safety and health protections with workplace health promotion, TWH has evolved to a broader emphasis on workplace programs for enhancing worker safety, health, and well-being. Among the research programs and approaches developed by investigators at NIOSH Centers of Excellence for TWH and elsewhere, definitions of 'integration' in workplace interventions vary widely. There is no consensus about which organizational or individual outcomes are the most salient, how much to emphasize organizational contexts of work, or which program elements are necessary in order to qualify as 'Total Worker Health'. Agreement about the dimensions of integration would facilitate comparison of programs and interventions which are self-defined as TWH, although diverse in content. The specific criteria needed to define integration should be unique to that concept-i.e. distinct from and additive to conventional criteria for predicting or evaluating the success of a workplace health program. We propose a set of four TWHspecific metrics for integrated interventions that address both program content and process: (i) coordination and interaction of workplace programs across domains; (ii) assessment of both work and

International Journal of Workplace Health Management, Jun 11, 2021

Purpose –Total Worker Health® (TWH) programs, which represent a holistic approach for advancing w... more Purpose –Total Worker Health® (TWH) programs, which represent a holistic approach for advancing worker safety, health and well-being, require an employer to adapt programmatic coordination and employee involvement in program design and delivery. Organizational readiness for such measures requires competencies in leadership, communication, subject expertise and worker participation. In the absence of documented methods for TWH readiness assessment, the authors developed a process to prospectively identify implementation facilitators and barriers that may be used to strengthen organizational competencies and optimize the organizational “fit” in advance.Design/methodology/approach –The mixed-method baseline assessment instruments comprised an online organizational readiness survey and a key leader interview; these were administered with key organizational and labor leaders in five US healthcare facilities. Findings about organizational resources, skills available and potential implementation barriers were summarized in a stakeholder feedback report and used to strengthen readiness and tailor implementation to the organizational context.Findings –The research team was able to leverage organizational strengths such as leaders’ commitment and willingness to address nontraditional safety topics to establish new worker-led design teams. Information about program barriers (staff time and communication) enabled the research team to respond with proactive tailoring strategies such as training on participant roles, extending team recruitment time and providing program communication tools and coaching.Originality/value –A new method has been developed for prospective organizational readiness assessment to implement a participatory TWH program. The authors illustrate its ability to identify relevant organizational features to guide institutional preparation and tailor program implementation.

Research Square (Research Square), Dec 30, 2020

Background: The Total Worker Health program represents a holistic approach to advancing worker we... more Background: The Total Worker Health program represents a holistic approach to advancing worker wellbeing that combines occupational safety and health practices with other workplace policies and programs that are not traditionally linked. Total Worker Health requires new types of interdisciplinary collaboration and programmatic coordination. Pre-implementation assessment is thus important to plan for successful organizational " t" when the program is introduced. This study prospectively identi ed potential implementation facilitators and barriers among ve public healthcare facilities that had already agreed to participate in a study to implement and evaluate the Healthy Workplace Participatory Program. Methods: A mixed methods baseline assessment comprised an online survey and follow-up interviews.

American Journal of Evaluation

Program evaluations that lack experimental design often fail to produce evidence of impact becaus... more Program evaluations that lack experimental design often fail to produce evidence of impact because there is no available control group. Theory-based evaluations can generate evidence of a program's causal effects if evaluators collect evidence along the theorized causal chain and identify possible competing causes. However, few methods are available for assessing competing causes in the program environment. Effect Modifier Assessment (EMA) is a method previously used in smaller-scale studies to assess possible competing causes of observed changes following an intervention. In our case study of a university gender equity intervention, EMA generated useful evidence of competing causes to augment program evaluation. Top-down administrative culture, poor experiences with hiring and promotion, and workload were identified as impeding forces that might have reduced program benefits. The EMA addresses a methodological gap in theory-based evaluation and might be useful in a variety of p...

Musculoskeletal disorders are well documented in the nursing profession and are particularly prev... more Musculoskeletal disorders are well documented in the nursing profession and are particularly prevalent among nursing assistants in nursing homes. In 2004, a corporation with 217 nursing homes began implementing a No-Lift Program (NLP), introducing resident lifting equipment, procedures, and policies. We investigated the effect on observed ergonomic exposures of nursing assistants using PATH (Postures, Activities, Tools, and Handling) in four nursing homes. We also collected survey and focus group data on health, work history and working conditions in this population to assess factors associated with lift equipment use. Ergonomic observations and surveys were collected at baseline, three-month, 12-month and 24-month periods following NLP implementation. After one year, the proportion of time that nursing assistants were handling residents dropped from 13.8% to 9.3%. While resident handling, nursing assistants used lifting equipment 14.6% of the time vs 5.7% before the NLP, and neutra...

Advances in health promotion research have demonstrated the importance of addressing the underlyi... more Advances in health promotion research have demonstrated the importance of addressing the underlying social and environmental factors that can negatively influence individuals' health behaviors. Working conditions are an important source of physical hazards (e.g., noise, heavy lifting) and psychosocial stressors (e.g., harassment, high demands coupled with low control) that are well-known to increase the risk of conditions such as cardiovascular disease, musculoskeletal disorders, and depression. Occupational health and safety programs (OHS), which help to assure safe working conditions, are rarely carried out in coordination with workplace health promotion (WHP) programs, despite the potential effectiveness for integrated programs to support changes in health behaviors, reduce risk and prevalence of chronic diseases, and realize cost and productivity savings. We analyzed results from a 2008 survey of Massachusetts employers to assess the extent to which employers offer worksite ...

Journal of Workplace Behavioral Health, 2010

, CEAP, for their review and input on this manuscript. We thank the Massachusetts-Rhode Island Ch... more , CEAP, for their review and input on this manuscript. We thank the Massachusetts-Rhode Island Chapter of EAPA for assistance with recruitment and their continuing support and dialogue on the topic of job stress. And finally, we want to acknowledge the contributions of Deborah Van Langen, MS, who conducted the initial interviews, and Julie Brodie, MA who assisted with word processing and references.

Journal of Occupational and Environmental Medicine, 2013

As part of a Research-to-Practice Toolkit development effort by the Center for the Promotion of H... more As part of a Research-to-Practice Toolkit development effort by the Center for the Promotion of Health in the New England Workplace, to develop and test a structured participatory approach for engaging front-line employees in the design of integrated health protection and promotion interventions. On the basis of a participatory ergonomics framework, the Intervention Design and Analysis Scorecard (IDEAS) provides a stepwise approach for developing intervention proposals, including root cause analysis and setting evaluation criteria such as scope, obstacles, and cost/benefit trade-offs. The IDEAS was tested at four diverse worksites with trained facilitators. Employees were able to develop and gain management support for integrated interventions at each worksite. The IDEAS can be used effectively by front-line employees to plan integrated interventions in a program dedicated to continuous improvement of employee health protection/promotion and Total Worker Health.

Journal of Workplace Behavioral Health, 2010

This manuscript has not been submitted nor published in any other trade or peer reviewed journal.

Journal of Occupational and Environmental Medicine, 2013

Objective: To describe the value of participatory methods for achieving successful workplace heal... more Objective: To describe the value of participatory methods for achieving successful workplace health promotion (WHP) programming, and specifically the relevance of participatory ergonomics (PE) for the Total Worker Health (TWH) initiative. Methods: We review the concept of macroergonomics, and how PE is embedded within that framework, and its utility to modern WHP approaches such as "social health promotion." We illustrate these constructs in practice within TWH. Results and Conclusions: Participatory ergonomics is relevant to WHP because (1) psychosocial stress contributes to individual health behaviors as well as chronic diseases; (2) job stress cannot be addressed without employee involvement in hazard identification and solutions; (3) the interaction of multiple levels within an organization requires attention to needs and constraints at all levels, just as the social-ecological model addresses higher-level determinants of and constraints on individual behaviors.

Journal of Gerontological Nursing, 2011

This qualitative study explored common and divergent perceptions of caregivers and managers regar... more This qualitative study explored common and divergent perceptions of caregivers and managers regarding occupational health and safety, work organization, and psychosocial concerns in long-term care centers. Both common and differing issues were identified. Both groups agreed on the importance of ergonomic concerns, the high prevalence of stress, and receptiveness to participatory health promotion programs. However, numerous work organization issues and physi-cal and psychosocial workplace hazards were identified by certified nursing assistants but were not mentioned by managers. The results suggest that different perceptions naturally arise from people's varying positions in the occupational hierarchy and their consequent exposures to health and safety hazards. Improved systems of communication that allow frontline workers to express their concerns would make it possible to create solutions to these problems.

American Journal of Health Promotion, 2013

Purpose. This study examines worksite health promotion (WHP) and occupational health and safety (... more Purpose. This study examines worksite health promotion (WHP) and occupational health and safety (OHS) activities by Massachusetts employers, and the extent to which workplaces with programming in one domain were more likely to have the other as well.

Journal of Workplace Behavioral Health, 2010