Work conversations in healthcare: how, where, when and by whom: a review to understand conversations about work in healthcare and identify opportunities to make work conversations a part of everyday health interactions

Executive summary. As part of a 10-year strategy to improve employment outcomes for working-age people with health conditions and/or disabilities, the Joint Work and Health Unit (WHU) has funded Public Health England (PHE) to implement a 'work as a health outcome' programme. The programme seeks primarily to promote healthcare professionals' (HCPs) understanding of the health benefits of good work and encourage HCPs to have supportive conversations about work and health. The programme has been informed by the evidence base for Making Every Contact Count (MECC) (1). To further understand whether and/or to what extent the MECC framework is transferable to this context, a comprehensive literature review with stakeholder engagement was conducted. Following a search of peer-reviewed and grey literature sources, 79 articles and documents were included in a realist best evidence synthesis. In addition, 59 online stakeholder surveys were completed, and 16 telephone interviews were conducted. Data were synthesised and presented as key findings, aligned to specified research questions. An in-depth examination of interactions with a wide range of HCPs for a variety of health conditions was produced, providing a more detailed understanding of conversations about work in healthcare: how, when, where and by whom. Despite the launch of numerous, potentially relevant initiatives over the last decade, few have been directed specifically at stimulating conversations about work during routine clinical encounters. Promotion and implementation of these initiatives has been limited and, as a result, healthcare awareness, engagement, and adoption has remained low. The evidence reveals many barriers. Most of these barriers are underpinned by the lack of a consistent, agreed description or measure of 'supportive' conversations, and because the purpose of such conversations has not been clearly articulated or formally embedded within clinical practice. There was no evidence from research or evaluation to establish the outcome or efficacy of any particular components, content, or strategies of conversations about work in healthcare, nor how these may be measured. It was found that most HCPs accept that work is generally good for health and wellbeing, but these fundamental limitations mean that most do not engage their patients in conversations about work. However, there are reasons for optimism: the evidence points to some short- and longterm policy solutions that will better equip HCPs to have supportive conversations about work, and to further advance the ‘work as a health outcome’ agenda within routine healthcare. These are conceptualised as 'cultural awareness', 'conversation starters' and 'practice integration'

Inequity in recording of risk in a local population-based screening programme for cardiovascular disease

Background: Screening for cardiovascular disease is an important primary preventive measure, yet research has documented that not all population groups receive the same quality of preventive healthcare. Design: Longitudinal analysis of cardiovascular disease risk factor recording. Methods: Data were made available from a local population-based screening programme for cardiovascular disease (1989-1999), whereby residents aged 35-60 years were invited for screening every 5 years (n=84 646). Data were recorded for major risk factors including blood pressure, cholesterol, body mass index, smoking status, and alcohol consumption. Completeness of risk factor recording was compared between groups in the screened population defined by gender, ethnicity (Caucasian/South Asian) and employment status (employed/unemployed). Results: Recording of risk in the screened population was significantly less complete for women and South Asian participants over the duration of the screening programme, compared with men and Caucasian participants respectively. Conversely, recording of risk was significantly more complete for the unemployed compared with the employed participants. Conclusions: These findings present evidence of a less systematic screening procedure for women and South Asians, whilst it seems that men, Caucasian participants and the unemployed were appropriately screened. Inequalities at the primary preventive level will likely influence outcome, because equitable identification of risk is important for the provision of successful treatment measures, and to reduce inequalities in morbidity and mortality due to cardiovascular disease

Empathy is key to addressing obstacles to policy progress: the example of ‘work focused healthcare’

Background: In 2019, Public Health England commissioned the authors of this paper to conduct research examining healthcare professionals' conversations about work with their patients to inform policy aimed at reducing work loss due to ill-health. Aims & objectives: The purpose of this paper is to show how the commission provided a unique opportunity for the authors to collaborate with the funders to address obstacles to policy progress. Methods: A steering group was established to revise the original remit of research. In outlining that process here, qualitative data collected from a wide range of healthcare professionals as part of the commission are presented for the first time. We are able to further illuminate and expand on the previously published report findings and policy recommendations, revealing novel insights on researcher-policy engagement. Findings: Robust implementation of ‘work-focused healthcare’ policy has been limited, resulting in an overwhelming lack of empirical data and misguided directives. However, the existing evidence did provide important information about obstacles to policy progress and how to overcome them. The qualitative data were instrumental in this respect, with healthcare professionals revealing various interpretations of, and discourse on the policy. Discussion and Conclusions: This paper adds to the expanding literature which suggests that long term, mutualistic, collaborative working is central to addressing barriers to improving evidence use and mobilising health policy into practice. It was shown that tacit, generous, open, empathic and ongoing knowledge exchange, advocacy, and alliances are needed

Socio-economic status and prevention of cardiovascular disease in Italy: evidence from a national health survey

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death and disability in the world. Many cardiovascular risk factors can be prevented. We assessed whether socio-economic factors are associated with individual preventive behaviours in Italy. METHODS: A cross-sectional analysis of a nationally representative sample of 47,391 adults aged 40-69 years was undertaken using 2004-05 National Health Interview Survey data. Logistic regression models were developed to assess the association between socio-economic status (SES) and regular monitoring of blood pressure, cholesterol, body mass index and glycaemia. SES was estimated according to education and occupation. RESULTS: SES was significantly associated with regular monitoring of risk factors for CVD. The most educated were more likely to monitor cholesterol levels than those with less education [men odds ratio (OR) 1.64, 95% confidence interval (CI) 1.46-1.86; women OR 1.36, 95% CI 1.19-1.55]. Individuals in the highest occupational class controlled weight more frequently than those disadvantaged with an OR of 1.24 (95% CI 1.04-1.49) for men and an OR of 1.26 (95% CI 1.12-1.42) for women. CONCLUSION: Socio-economic disparities in the prevention of risk factors for CVD were clearly observed among Italian adults, generally favouring higher socio-economic groups

Comparative levels and time trends in blood pressure, total cholesterol, Body Mass Index and smoking among Caucasian and South-Asian participants of a UK primary-care based cardiovascular risk factor screening programme

<p>Abstract</p> <p>Background</p> <p>Individuals of South-Asian origin have a comparatively higher cardiovascular disease burden, but there is uncertainty about whether this is due to differences in risk factor levels and trends. We therefore studied comparative levels and time trends in blood pressure (BP), total cholesterol, body mass index (BMI) and current smoking among UK Caucasian and South-Asian individuals.</p> <p>Methods</p> <p>Repeatable cross-sectional survey of men and women aged 35–60 attending for first screening as part of a primary-care based cardiovascular risk factor screening programme 1989 and 1999.</p> <p>Results</p> <p>Of 34,122 men and 37,294 women participants, 499 men (1.5%)and 381 women (1%) were of South-Asian origin. South-Asian men had lower systolic [(-4.91 mmHg (95% Confidence Iterval (CI): -3.58 to -6.23)] and diastolic BP [-2.87 mmHg (-2.02 to -3.72)], with no significant differences in cholesterol and BMI. South-Asian women had lower systolic BP [-1.77 mmHg, 95% (-0.21 to -3.33)], diastolic BP [-1.87 mmHg (-0.92 to -2.82)], cholesterol [-0.24 mmol/l (-0.08 to -0.39)]; and higher BMI [+0.78 kg/m²(0.25 to 1.3)]. South-Asian men and women had significantly lower prevalence of self-reported current smoking (29.0% and 1.8% respectively). With the exception of self-reported current smoking, between ethnic group risk factor trends were not converging.</p> <p>Conclusion</p> <p>With the exception of women's BMI, South-Asian individuals had either lower or similar levels of the examined cardiovascular risk factors, compared with Caucasian individuals. Although time trends in smoking were converging, other risk factors trends were similar between the two ethnic groups. Overall the findings do not support the hypothesis that the relatively high cardiovascular disease burden in UK South-Asians is due to higher levels exposure to the examined risk factors. Other hypotheses, such as higher frequency of diabetes and increased genetic predisposition, require further exploration.</p

Fatores de risco físicos e organizacionais associados a distúrbios osteomusculares relacionados ao trabalho na indústria têxtil

Distúrbios osteomusculares relacionados ao trabalho (DORT) atingem trabalhadores de diversas ocupações e constituem um dos maiores problemas de saúde em muitos países. Este estudo foi realizado em dois setores de fiação de uma mesma indústria têxtil, sendo um deles tecnologicamente mais moderno. Os objetivos foram identificar os fatores de risco físicos e organizacionais associados aos DORT nos dois setores e determinar a prevalência de sintomas de dor entre esses trabalhadores. Tendo como referencial a análise ergonômica, foram observadas as atividades de trabalho de 12 indivíduos; e 50 trabalhadores responderam a um questionário. Os fatores de risco físico identificados foram os seguintes: posturas inadequadas de ombro, trabalho na posição em pé, repetitividade de movimentos e aspectos ambientais desfavoráveis. Os fatores organizacionais identificados foram: ritmo intenso de trabalho, fragmentação e invariabilidade das tarefas, inexistência de pausas e impossibilidade de comunicação com os colegas. Foi encontrada prevalência de 60% e 76% de dor nos dois setores estudados, respectivamente. As conclusões mostram que investimentos em tecnologia que não acompanham mudanças na organização e nas condições de trabalho resultam na manutenção ou no agravamento das situações de risco reconhecidamente associadas aos DORT.Work-related musculoskeletal disorders (WRMD) affect workers in several occupations and are one of the major health problems in many countries. This study was developed in two sectors of a textile industry, one of them being technologically more advanced. The objectives were to identify physical and organizational risk factors associated to WRMD in the two sectors and estimate prevalence of pain among these workers. The workplace and working activity of 12 individuals were observed on ergonomic grounds, and 50 workers answered a questionnaire. The following physical risk factors were identified: awkward shoulder postures, standing work position, repetitive movements, and unfavourable environmental features. Main organizational risk factors identified were: intense work pace, uneven and repetitive tasks, absence of pauses and impossibility of communication with peers. Pain symptoms prevalence of 60% and 76% was found in the two sectors. Conclusion shows that investments in technology that do not follow changes in work condition and organization may result in maintenance or aggravation of risk situations associated to WRMD