Kathrine Greby Schmidt

Objectives: Compare home health care (HHC) with self-governing and conventional team structure regarding self-reported low back pain (LBP) and work-related factors. Methods: A natural experiment was assessed using a cross-sectional design. Primary outcome was LBP intensity; secondary outcomes included LBP duration and work limitations as well as intensity, duration and work limitations of neck/shoulder pain, stress, productivity, influence at work, meaning at work, sickness absence, interpersonal collaboration, and variation in physical behaviour. Home health care (HHC) workers in the self-governing teams were surveyed about their appraisal of the self-governing structure. Data were collected through a questionnaire, except for physical behaviour, which was obtained via accelerometry. Differences between groups were analyzed using t-tests. Results: From 10 HHC-teams across four municipalities, 125 HHC-workers completed the questionnaire (self-governing n = 60; conventional n = 65). LBP intensity was similar among HHC-workers in the two team structures (self-governing = 4.1; conventional = 4.0, 0–10 scale). Self-governing teams experienced significantly higher levels of (i) meaning at work (5.8 points, 0-100 scale), (ii) improved collaboration with manager (7.5 points, 0-100 scale) and (iii) improved collaboration with needs assessors (11.9 points, 0-100 scale) compared to conventional teams. No significant differences were found in the other outcomes. Conclusions: The higher scores for self-governing teams in meaning at work, collaboration with manager and collaboration with needs assessors are positive. The lack of a lower report in LBP and neck/shoulder pain calls for more focused efforts to enhance HHC-workers’ health in addition to the reorganization into the self-governing structure.

Objective Poor cardiorespiratory fitness and health is common among childcare workers. We designed the `Goldilocks-games` according to the Goldilocks Work principle to provide high-intensity physical activity for childcare workers. We investigated the effectiveness of this Goldilocks Work intervention in increasing occupational high-intensity physical activity and improving work-related health. Methods In a two-arm cluster randomized trial, 16 childcare institutions with 142 workers were randomly allocated to either an 8-week Goldilocks Work intervention or a control group. The primary outcome was occupational time in high-intensity physical activity. Secondary outcomes were occupational time in active physical behaviors, heart rate during sleep, pain, physical exhaustion, energy at work, work productivity, and need for recovery. Results The intervention was successfully delivered and received. Both groups had a low amount of occupational high-intensity physical activity at baseline, and the intervention group reported playing the games 3.1 [standard deviation (SD) 1.5] times/week for a duration of 112.2 (SD 175.0) min/week. However, the intervention did not increase high-intensity physical activity or the secondary outcomes, except for energy at work, measured on a scale from 0–10, increasing 0.65 [95% confidence interval (CI) 0.08–1.21], and need for recovery, measured on a scale from 1–5, decreasing -0.32 (95% CI, -0.54– -0.09). Conclusion The intervention was successfully delivered and received, but did not increase high-intensity physical activity. The intervention group increased their energy at work and decreased their need for recovery, but not the other health-related outcomes. Further research on how to design and implement health-promoting work environment interventions in childcare is needed.

Childcare workers are reported to have poor cardiorespiratory fitness and health. The Goldilocks Work Principle argues that productive work should be designed with the right composition, intensity and alternations of physical behaviors so that workers get fit and healthy. The purpose of this study was to investigate: (1) composition, (2) intensity and (3) alternations of physical behaviors during work and leisure among childcare workers. Data were collected using accelerometers and heart rate monitors over five workdays among 51 childcare workers at five Danish childcare institutions. Workers mainly spent their work time sedentary (43.0%), spent little time (0.7%) at sufficiently high cardiometabolic intensity to increase cardiorespiratory fitness and often alternated between physical behaviors (67.0% occurred in bouts of <5 min). These findings indicate that the workers have a composition of behaviors at work dominated by sedentary time, little time with high cardiometabolic intensity, and frequent alternations between behaviors. During leisure, workers spent more time sedentary (59.4%), more time at high cardiometabolic intensity (3.4%) and less time occurred in bouts <5 min (38.7%). We see a potential for promoting cardiorespiratory fitness and health of childcare workers by redesigning the way they play with the children, so that work time with high cardiometabolic intensity is increased.

Childcare workers are reported to have high variation in physical activity during work hours, but also to sit for about half of the workday and have almost no high intensity physical activity (HIPA). No study has investigated if their work can be re-designed to introduce HIPA, thus promoting fitness and health according to the Goldilocks principle. This study investigated the feasibility of designing pedagogical games (‘Goldilocks-games’) intended to lead to more HIPA. Heart rate was measured in nineteen childcare workers during Goldilocks-games, and compared to measurements during a regular workday. Worker perceptions of feasibility, and researcher observations of contextual factors were also collected. The Goldilocks-games (33 min) elicited significantly more HIPA (18/33 min) compared to the most active period of equal length on a regular workday (0.5/33 min). Seventy-four-percent of the childcare workers reported that it was feasible to integrate the Goldilocks-games pedagogically, and seventy-two-percent could see themselves using them. Thus, we found it possible to re-design a work task in childcare according to the Goldilocks principle so that it leads to substantial time with HIPA. The sustainability of Goldilocks-games in childcare, and their effectiveness in improving fitness and health among childcare workers, needs to be tested in further studies.

The aim of this study is to evaluate the inter-rater reliability of a newly developed instrument-TRACK (observaTion woRk demAnds Childcare worK) for observations of ergonomic work demands in childcare work. Two trained raters conducted thirty hours of concurrent observation of fifteen childcare workers in three different day nurseries. Inter-rater reliability of ergonomic work demands was evaluated using Gwet’s Agreement Coefficient (AC₁) and interpreted by the Landis and Koch benchmark scale. Twenty ergonomic work demand items were evaluated. Inter-rater reliability was ‘almost perfect’ for nine items (AC₁ 0.81–1.00), ‘substantial’ for four items (AC₁ 0.61–0.80), ‘moderate’ for four items (AC₁ 0.41–0.60), ‘fair’ for two items (AC₁ 0.21–0.40), and ‘slight’ (AC₁ 0.00–0.20) for one item. No items had ‘poor’ (AC₁ < 0.00) agreement. The instrument is reliable for assessing ergonomic work demands in childcare in real-life settings.