* Universidade Fernando Pessoa cbarros@ufp.pt
**Centro de Psicologia da Universidade do Porto (CPUP) – Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto lcunha@fpce.up.pt; lacomb@fpce.up.pt
ABSTRACT
ABSTRACT
The issue of health and work relations provides a particularly rich research field due to both the need to comply with the legislation and a greater awareness of the consequences of professional risks. In spite of this concern, understanding the consequences of work on health and well-being calls for an integrated analysis centred on the worker’s perspective.
The tool we present, the Health and Work Survey (INSAT), is inspired in already developed and implemented inquiries. It provides a contribution to prevention management and also aims to promote workers to reflect upon the consequences of working conditions, rendering their own statements more explicit.
Key Words:
Key Words:
Prevention management; Work-Health relations; Working conditions; Self-questioning; Work surveillance and occupational medicine; Worker’s perspective.
1. INTRODUCTION
The issue of health and work relations provides a particularly rich research field due to both the need to comply with the legislation and a greater awareness of the consequences of professional risks. The most recent data [1] reveal that, in parallel with the work-related illnesses, such as those linked with the respiratory system and to occupational deafness, musculoskeletal disorders, such as tendonitis and paralysis, are becoming increasingly common in statistical data.
In fact, if the data available still reflect a predominance of the major traditional occupational pathologies (which do not cease to cause concern), other health problems that have been considered hitherto as not particularly serious, are becoming increasingly relevant and carry greater weight now when discussing the relations between health and work.
Indeed, and as was highlighted in the fourth and most recent European Report on Working Conditions [2], in order to better consider the consequences of working conditions, it is of fundamental importance to analyse a set of different variables – work characteristics and employment conditions, health and safety, work organisation, development opportunities at work and the work-life balance.
It therefore becomes necessary to adopt a different perspective, one already taken by a number of scientific studies developed in the area of health and safety at work [3], [4], [5], [6], [7], in order to appreciate more fully the factors affecting the various
dimensions of health and to include other problems and illnesses caused by working conditions, in addition to the officially recognised work-related illnesses [8].
These consist of a set of infra-pathological health problems that are not obviously serious: hearing impairment, joint pain, sleep problems, weariness, anxiety or consumption of tranquilizers [9], yet which may manifest themselves in profound psychological or physical problems, and which occupational health workers and researchers must later deal with in their prevention practices.
Hence, studying health at work may lead one to reflect on the worker’s perspective, as expressed in his/her declarations – in the perceptions, complaints and feelings harboured about his/her work and health – and signal the need for a new approach in this matter.
It was within this perspective that the Health and Work Survey – INSAT was conceived and designed, taking the form of a proposed methodology for analysing the effects of working conditions on health.
2. INSAT: HEALTH AND WORK SURVEY
Construction of INSAT [10] was inspired in the information explored by surveys already conceived and improved in interaction with qualitative analyses and epidemiological knowledge: the SUMER survey; the EVREST survey and the SIT survey.
The objective of the INSAT survey is to study the consequences of work and working conditions, whether current or past, at the level of health and well-being. It is an epidemiological survey that currently aims to characterise, via a significant sample, the major occupational risks in a number of sectors of activity and understand the influence that work constraints have on the worker’s health.
The specific objectives are as follows:
- Characterize the working conditions associated with the professional activity in different sectors of activity;
- Identify the main risk factors and the interactions between them, together with theinfluence of certain variables related with the work content and organisation;
- Offer a support to researchers for defining the priorities of future studies;
- Define measures that might foster improvement in work situations that concomitantly minimize the effects of those situations on the risk of health deterioration for workers in their daily activity;
- Help employers and occupational physicians to identify the risks to which workers are exposed and thus enable them to develop a chart for exposure to hazards or work situations that are likely to be harmful to health;
- To encourage individual and collective rising of awareness as to the effects of workand working conditions on health and well-being.
3. PRESENTATION OF THE INSTRUMENT
INSAT is based on the following areas: work and working conditions, the difficulties experienced at work, the state of health and occupational health. These themes were included in the structure of INSAT, in such a way that the questions posed followed a coherent and integrating logic – from work to the effects of work on health – allowing the respondent to acquire a gradual and progressive awareness of the consequences of work on health and well-being.
INSAT is thus organized into 7 main areas: (I) The work; (II) Conditions and characteristics of the work; (III) Conditions of life outside work; (IV) What bothers me most at work; (V) Training and work; (VI) My state of health; and (VII) Occupational health.
The survey begins with a number of questions that allow for the collection of information of a socio-demographic nature on the worker (gender, age, educational level) and on the employing establishment (business sector, type of company).
The first part of the survey – The work – includes a set of questions referring to the work situation: it is concerned with specifying and characterizing the type of activity carried out, referring also to the type of employment contract and the working hours.
What we term the second part of the survey – Conditions and characteristics of the work – covers the questions dedicated to analysing the worker’s exposure to given conditions, organized into three categories: physical environment and constraints, namely noise, vibrations, indoor climate, exposure to radiation, biological and chemical agents, loads and posture, among others; organizational and relational constraints, namely work times, rhythms, autonomy and margins for initiative, labour relations, contact with the public; and characteristics of the work, namely workers’ assessments of some aspects of the work, together with their estimation of satisfaction with the current work. For each situation presented, the worker must state whether s/he was exposed or not to the constraint identified. If so, s/he must state whether s/he is currently exposed or whether the exposure occurred in the past, also indicating if the situation is or was wearing, in other words, if the situation is or was a possible cause of premature aging.
The third part corresponds to the characterisation of the – Conditions of life outside work –, with the worker being asked about the number of persons for which s/he is responsible, number of children and use of free time. The question of work-life balance is addressed, as is the amount of time spent on domestic chores and/or family support.
The fourth part of the Survey – What bothers me most at work – represents the worker’s subjective perception of the conditions experienced at work. In this part, the worker is asked to indicate the level of suffering each situation encountered in the current job represents to him/her.
The questions that permit us to characterize the type of training received by the workers, and to what extent this does or does not directly relate to the work, falls into the fifth part of the survey – Training and work.
In the sixth part – My state of health – questions on the worker’s state of health are explored, with the emphasis being on problems that might have led to given limitations, even if these do not fall within the framework of a pathology. In concrete terms, these include cardio-respiratory, neuro-psychic, digestive and musculoskeletal disorders. Questions regarding the eyesight and hearing of the worker are also included.
The more specific questions on occupational health are grouped into the seventh and final part of the Survey – Health at work – and in three particular domains: the identification of work accidents and work-related illnesses that the worker may have suffered or the situations that might have sparked a work-related illness; information on occupational risks, with this section including questions to gather information on
occupational risks and the protection and prevention against such risks, and the last domain analysed, health and work, features various health problems – physical and psychosocial – which the worker must indicate as to whether s/he is experiencing or has ever experienced them. In the case of an affirmative answer, the worker is asked for an opinion on the relation of the problem or complaint bears to the work: that is to say, if it could have been caused or aggravated by the work. In this case, the aim is that the questions posed should favour analysis of the association or lack thereof established by the worker between his/her health problems and the characteristics and conditions of his/her work, current or past.
It should also be mentioned that anonymity is guaranteed by the research team, with no identifying data being solicited to the worker at any time. This deontological procedure is of indisputable importance in studies of this kind, since to disregard it could compromise the pursuit and validity of the process.
4. METHODOLOGY
The survey now presented is the result of the evolution of various versions with the objective of making it into a self-administered instrument centred on the worker’s perspective.
This option is justified by the intention to grant the worker the possibility of intermediary-free expression (unlike the case in previously presented surveys, which are essentially administered sometimes by the physician and sometimes by the psychologist). In other words, the proposal is to understand how workers assess the characteristics and conditions of their work, their state of health, and the type of relations they establish between their health and their work.
Different versions were developed and progressively improved with reference to these objectives. INSAT was then conceived as a self-administered questionnaire to be filled in by the worker himself/herself. The reflection that was previously prompted by the physician or psychologist was integrated into the structure of this survey, via an evolution in the kind of questions posed (which progressively appeal to more subjective dimensions, with the worker being asked to state which of the situations to which s/he is exposed cause the most distress). This allows for a simultaneous growing awareness and evolution in reflection and in the declarations made as the survey is completed.
The final version of INSAT was preceded by preliminary versions, so as to test the appropriateness of the questions and the respective response scales and their framework in light of the defined objectives. As the different versions were being tested with other researchers in the same field and with occupational physicians, new questions and instructions for filling in the questionnaire were being introduced, so as to facilitate understanding of what was asked.
In sum, the various versions of INSAT were tested with a sample of workers (n=175) from different sectors of activity. The final version of INSAT also underwent spoken discourse with 25 workers, who had the opportunity to express and discuss the difficulties they had in interpreting and answering, i.e. regarding the content and format of the questions and the response scales.
Analysis and interpretation of the results
Despite the statistical potential of this kind of study, interpretation of the results must be accompanied by prudent and careful reflection on its comprehension, bearing in mind the complexity of the relationships between health and work. Hence, recourse to qualitative research assumes a crucial role in analysing the statistical results [5], namely the field studies, which complete, enrich and confirm the results obtained by analysing the work activity [11]. Moreover, as previously stated, one of our concerns in creating the surveys was to select questions that had been already analysed and debated in field studies whose method of analysis was based on discovering and understanding real problems in a real work context [11].
In this case, we would stress the importance of caution with regard to the “scores” [12] and the possibilities for generalisation, and our concern to compare and integrate the results with information garnered from the qualitative methods.
5. FINAL CONSIDERATIONS
Analysis of the less visible relations between work and health, guided by a worker- centred approach, opens up a new perspective for reading the effects of one on the other. This means that by including the worker’s perspective, expressed in his/her perceptions and complaints about health as revealed by INSAT, associated with the opinion of occupational health professionals, we can achieve an integrated and more dynamic view of the consequences of work on health.
INSAT may thus be seen as a mediator in the dialogue between the agents involved in prevention, within the framework of a concerted intervention. The approach made visible in INSAT may offer new ways of reading reality and new opportunities for improvement in work context - in centring the research on the worker’s statements - and basing priorities of intervention, also, on worker’s perspective.
6. BIBLIOGRAPHY
[10] Barros-Duarte, C., Cunha, L. & Lacomblez, M. (2007). INSAT: uma proposta metodológica para análise dos efeitos das condições de trabalho sobre a saúde. Laboreal, 3, (2), 54-62.
http://laboreal.up.pt/revista/artigo.php?id=37t45nSU547112311:499682571
[3] Daubas-Letourneux, V. & Thébaud-Mony, A. (2002). Organisation du travail et santé dans l’Union Européenne. Luxembourg: Office des Publications Officielles des Communautés Européennes.
[5] Derrienic, F., Touranchet, A. & Volkoff, S. (1996). ESTEV, une méthode d’enquête. In Derrienic, Touranchet & Volkoff (Eds.).Âge, travail, santé. Études sur les salariés âges de 37 à 52 ans. Enquête ESTEV 1990 (33-55). Paris: INSERM.
[2] European Foundation for the Improvement of Living and Working Conditions (2007). Fourth European Working Conditions Survey 2000. Luxembourg: Office for Official Publications of the European Communities.
[8] Gollac, M. & Volkoff, S. (2000). Les Conditions de Travail. Paris: Éditions La Découverte.
[1] Institute of Informatics and Social Security Statistics (2007). Dados estatísticos relativos às doenças profissionais: pensionistas com incapacidade permanente de 2001/2006. Instituto de Informática, Departamento de Gestão de Informação. Retirado em 22 de Outubro de 2007, de http://195.245.197.202/left.asp?02.21.03.07
[4] Lacomblez, M. (2000). Factores psicossociais associados aos riscos emergentes. Riscos emergentes da nova organização do trabalho. Lisboa: IDICT.
[6] Marquié, J-C., Paumès, D., & Volkoff, S. (1995). Le travail au fil de l’âge. Toulouse: Éditions Octares.
[9] Molinié, A-F. & Volkoff, S. (2002). La démographie du travail pour anticiper le vieillissement. Paris: ANACT. Fascicolo 1.
[7] Teiger, C. (1989). Le vieillissement différentiel par et dans le travail: un vieux problème dans un contexte récent. Le Travail Humain, 52, 1, 21-56.
[11] Volkoff, S. (1998). Représentativité, significativité, causalité: l’ergonomie au contact des méthodes épidémiologiques. In M-F. Dessaigne & I. Gaillard (Eds.), Des évolutions en ergonomie... (pp. 225-236). Toulouse: Éditions Octares.
[12] Volkoff, S. (2002). Des comptes à rendre: usages des analyses quantitatives en santé au travail pour l’ergonomie. Noisy-le-Grand: Centre d’Etudes de l’Emploi.
Papers relacionados
