The inequality paradox: hospital-based safe patient handling intervention decreases overall worker injuries and pain, but widens socioeconomic disparities.

Details

• Personal Author:
  Boden L ; Dennerlein J ; Hashimoto D ; Hopcia K ; Sabbath E ; Sorensen G ; Wagner G ; Yang J
• Description:
  Background: The "inequality paradox" posits that public health interventions, even if they improve overall population health, may increase health disparities by improving outcomes primarily in more-advantaged groups. This phenomenon has received scant attention in the occupational health literature. Evaluation of a comprehensive, hospital-wide safe patient handling intervention among hospital patient care workers in 2013found that, compared with workers at a control hospital, those at a hospital who received the intervention had improved perceptions of workplace norms around safe patient handling and reduced workplace injuries (particularly lifting and exertion injuries). The present study aims to test whether the intervention improved safe patient handling behavior and reduced injury for everyone, or whether such changes occurred primarily in higher-wage workers (nurses), who as a group perform fewer patient lifts and have lower overall injury rates than low-wage workers (patient care associates or PCAs). Methods: For these analyses, we used data from the Boston Hospital Workers Health Study, a cohort study of approximately 8,500 nurses and nursing assistants at two large Boston-area hospitals. We also had longitudinal survey data from 2012 and 2014 on a subset (n=1,595) of workers across the two hospitals. First, using the survey data and comparing high-wage and low-wage workers, we examined changes in perceptions of workplace health and safety, and in self-reported pain, before and after the intervention. We also had employer-provided injury data and payroll data for the entire cohort. We used the latter data sources to examine changes in injury rates in the two hospitals, again comparing high-wage and low-wage workers. Results: In the intervention hospital, low-wage workers showed more improvements than high-wage workers in self-reported safe patient handling behaviors and bigger reductions in number of lifts per shift, comparing pre-intervention and post-intervention surveys. While both high-wage and low-wage workers had improvements in self-reported overall pain, only high-wage workers reported reductions in shoulder/ neck pain, pain interference with work, and moderate to high pain severity; low-wage workers actually reported (non-significantly) higher levels of the preceding three variables post-intervention. Among high-wage workers, administratively-reported injury rates decreased from 14% to 12% pre- to post-intervention, but for low-wage workers, injury rates remained steady at 20% both pre- and post-intervention. Therefore, while the overall injury rate decreased following the intervention, the disparity in injury rates between high- and low-wage workers actually grew wider. Discussion: These results have implications for both intervention development and analysis. In terms of intervention development, low-wage workers in this study received the same training in safe patient handling as their high-wage counterparts, and they did report that their handling practices improved, but they did not see the concomitant reductions in pain and injury that were seen in high-wage workers. Further analyses may reveal the explanation for this disconnect, and could potentially point to ways that this intervention (and others) could be delivered in a way that has similar uptake for diverse working populations. From an analytic perspective, this paper demonstrates the necessity of analyzing occupational health interventions for disparities in intervention effectiveness, and of collecting data on relevant social and demographic characteristics so that researchers are able to test for such disparities.
• Subjects:
  Accidents, Occupational Occupational Health Preceptorship Risk Assessment Risk Factors Safety Safety Management Workplace
• Keywords:
  Health Care Workers Health Disparities Injury Prevention Intervention Effectiveness Lifting Nurses Patient Handling Total Worker Health TWH
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  111-112
• NIOSHTIC Number:
  nn:20065670
• Citation:
  National Occupational Injury Research Symposium 2018, (NOIRS 2018), October 16-18, 2018, Morgantown, West Virginia. Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 2018 Oct; :111-112
• Email:
  Erika.Sabbath@bc.edu
• Federal Fiscal Year:
  2019
• NORA Priority Area:
  Construction ; Healthcare and Social Assistance
• Performing Organization:
  Harvard University, Boston, Massachusetts
• Peer Reviewed:
  False
• Start Date:
  20070901
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ec7ff368f9e211baa54ac23a033ca5e3669687c89b879223ff8c0832375f670a27cb198c53487611915210bc44f4d7311b7b7aeae3d3b9fde22d9a4469749f53
• Download URL:
  https://stacks.cdc.gov/view/cdc/181957/cdc_181957_DS1.pdf
• File Type:
  [PDF - 41.35 KB ]