Feasibility of Goldilocks Work in Home Care Settings: Investigating Redesign Opportunities for "Just Right" Occupational Physical Activity in Home Care Workers
Abstract
Out of 5.4 million citizens living in Norway, around 200,000 receive home care services every year. With an increasing elderly population and political discussions steering healthcare services towards more home care, this number is expected to increase. At the same time, home care services struggle with high sick leave, and recruitment and retention of home care workers (HCW). Musculoskeletal pain is a leading cause of sick leave, and high occupational physical activity is considered to be a main contributor. To ensure sustainable healthcare services in Norway, efforts should be made to enhance HCWs’ working conditions.
Goldilocks Work, a new occupational health framework, aims to promote workers’ health and capacity by (re)designing the work in collaboration with stakeholders, to incorporate a “just right” balance between physical load and recovery. Implementing Goldilocks Work has shown potential in some occupational settings, but has not been studied in home care settings.
The objective of this PhD thesis was to investigate (re)design opportunities in line with Goldilocks Work, and to assess the feasibility of a Goldilocks Work intervention in a home care setting. The thesis consists of three separate studies (Papers I-III).
The study in Paper I is a participatory, exploratory study in which home care employees from three urban home care units in Norway participated in digital workshops suggesting Goldilocks Work (re)designs suitable for home care settings. These suggestions were then subject to researcher and manager evaluation, to evaluate the suggestions’ fulfilment of Goldilocks Work. Two redesign concepts were found to be in line with Goldilocks Work: “Operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs” and “Operation coordinators should distribute transportation modes more evenly between HCWs.” The latter was considered to be a high impact - low effort redesign.
The study in Paper II is a pre-post feasibility study with mixed-methods evaluation. In this study, active and passive transportation modes were planned to be more evenly distributed between HCWs in one urban Norwegian home care unit. The operation coordinator’s experience from implementing a planning tool for this purpose and the impact of different transportation modes on accelerometer-measured occupational physical activity behaviours among HCWs were also investigated. Accelerometer data revealed that HCWs were less sedentary and spent more time standing and in physical activity on workdays when walking or using an electrical bicycle for client visits, compared to when driving a car. The planning tool developed was found suitable for achieving a balanced distribution of transportation modes between HCWs.
The study in Paper III is a qualitative focus group study. The study aims to understand HCWs’ perceptions and experiences of using different transportation modes at work, and how they may influence health. Results show that both walking and driving were, separately, regarded as having both positive and negative health impacts. When using a variety of transportation modes for client visits, assignment predictability is important for HCWs, as this may alleviate unnecessary stress. While many HCWs thought that walking from time to time could be health-promoting, participants believed that it was relevant to consider HCWs’ age, physical health and individual preferred transportation mode used when planning HCWs’ use of transportation modes in an occupational health perspective.
In conclusion, the home care setting is constrained and complex, and thus limited opportunities to implement Goldilocks Work redesign were found in this thesis. However, two opportunities were identified. While both were deemed to impact HCWs’ occupational physical activity, distributing transportation modes more evenly between HCWs was chosen for further investigation. The results in this thesis indicate that the assignments of transportation modes to HCWs can be used to alter HCWs’ occupational physical activity behavior and such approach a more “just right” balance. This could ensure that all HCWs’ gets at least some health promoting physical activity during the working week, and reduce the proportion who are overburdened. HCWs’ believed that some individual adjustments should be made and indicate that plans should be made in advance to ensure predictability for the HCWs.
Further research is needed to investigate the health impacts of Goldilocks Work interventions in home care settings, and thus what “just right” occupational physical activity constitutes for HCWs.