A stage of change approach to reducing musculoskeletal disorders (MSD) in the workplace

With a view to improving the efficacy of MSDs interventions, this work examined the applicability of the stage of change approach to occupational health interventions. An initial study explored the current practices of ergonomics consultants in tackling MSDs, and revealed that consultants' recommendations generally focused on physical aspects of the work environment, and did not take explicit account of employees' knowledge or attitudes. A second study evaluated leaflets aimed at helping employers and/or employees tackle MSDs, and revealed that leaflets generally overlooked the maintenance of risk reducing measures. Due to the importance of maintaining risk reducing measures on an ongoing basis, this may be a fundamental limitation to their effectiveness. Tools were developed to assess both managerial and worker stage of change, and were found to possess high levels of reliability. To evaluate these tools in practice, 24 interventions aimed at reducing MSDs were monitored within a variety of organisations. In half of these cases, approaches were tailored according to managers' and workers' stage of change. Significant reductions were found in self-reported musculoskeletal pain in the upper arm, elbow, forearm, wrist, hand, lower back, and legs. No significant differences in self-reported musculoskeletal pain were identified following standard interventions. To gain qualitative information regarding the intervention process, post-intervention interviews were also conducted with managers. Interviewees identified issues relating to knowledge, attitudes, perceptions, and behaviour change, in addition to structural factors, as the main barriers and facilitators in the process of implementing interventions to tackle MSDs. Both the quantitative and qualitative findings of this work are compatible with calls for the application of the stage of change approach to the workplace. The findings suggest that scope exists for improving the success of health and safety interventions by tailoring approaches according to stage change. By tackling the attitudes, beliefs, and behavioural intentions that underpin an individuals' current stage, tailored approaches can increase the uptake, implementation, and maintenance of risk-reducing measures.