Effect of a participatory organizational-level occupational health intervention on job satisfaction, exhaustion and sleep disturbances: results of a cluster randomized controlled trial

Framke et al. BMC Public Health (2016) 16:1210 DOI 10.1186/s12889-016-3871-6 RESEARCH ARTICLE Open Access Effect of a participatory organizational-level occupational health intervention on job satisfaction, exhaustion and sleep disturbances: results of a cluster randomized controlled trial Elisabeth Framke1,2* , Ole Henning Sørensen1, Jacob Pedersen2 and Reiner Rugulies2,3,4 Abstract Background: We examined whether the implementation of a participatory organizational-level intervention aiming to improve the working environment with a focus on the core task at work, increased job satisfaction and reduced exhaustion and sleep disturbances among pre-school employees. Methods: The study sample consisted of 41 intervention group pre-schools with 423 employees and 30 control group pre-schools with 241 employees. The intervention lasted 25 months and consisted of seminars, workshops, and workplace specific intervention activities that were developed by focusing on the core task at work. We analyzed within-group changes in the three outcome variables from baseline to follow-up with t-tests for paired samples, separately for intervention and control group. Between-group differences in changes in the three outcome variables were analyzed using a mixed model with a repeated statement to account for the clustering effect of workplaces. Results: Within-group analyses showed that exhaustion decreased statistically significantly in both the intervention and the control group. There were no statistically significantly changes in job satisfaction and sleep disturbances. Between-group analyses showed that there was no statistically significant difference between the two groups for changes in any of the outcome variables, neither in the unadjusted or in the adjusted analyses. Conclusions: We found no evidence that participating in an organizational-level occupational health intervention aiming to improve the working environment with a focus on the core task at work has an effect on pre-school employees’ job satisfaction, exhaustion and sleep disturbances. Trial registration: ISRCTN16271504, November 15, 2016. Keywords: Psychosocial, Stress-as-Offense-to-Self, Core task, Occupational health, Well-being at work * Correspondence: 1 Center for Industrial Production, Aalborg University Copenhagen, A. C. Meyers Vænge 15, DK-2450 Copenhagen, Denmark 2 National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark Full list of author information is available at the end of the article © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Framke et al. BMC Public Health (2016) 16:1210 Background The relation of the psychosocial work environment with employees’ health and well-being is likely highly complex and characterized by many factors [1]. Adverse psychosocial working conditions that had been related to health endpoints include for example mismatches between high demands and low control [2–4], and high effort and low reward [5, 6], poor management style [7] and organisational injustice [8]. Psychosocial resources at work, such as high workplace social capital [9–11] may contribute to the protection of employees’ health. Organizational-level occupational health interventions aim for reducing health-hazardous and enhancing health promoting working conditions [12]. It has been argued, that in particular participatory organizational interventions may have a positive impact on employees’ health, partly because these types of interventions improve employees’ job control [13]. The participatory approach refers to employees’ involvement and participation and implies that employees participate in workplace problem analysis and take an active part in developing and implementing intervention activities tailored their own workplace [14, 15]. However, results from organizational interventions are inconsistent and study quality is often low [16, 17]. According to the Stress-As-Offense-to-Self (SOS) theory, the distinction between core tasks and illegitimate tasks at work are key for understanding employees’ health and well-being [18]. Core tasks are activities that are essential for fulfilling the purpose of the organization and are closely linked to the professional identity of an employee. For a nurse, for example, it is a core task to take care of the medical needs of a patient. In the SOS theory, illegitimate work tasks are defined as the opposite of core work tasks and regarded as stressors, potentially affecting employees’ health and well-being. They are conceptualized as either unnecessary, i.e. they should not be done at all or as unreasonable, i.e. they are outside one’s occupation or occupational status and should be done by others. Previous research has shown that carrying out illegitimate tasks, as opposed to core tasks, is associated with counterproductive work behavior [19], higher level of cortisol [20], elevated stress level [21], decreased mental health [22], sleep disturbances [23], lowered self-esteem [18, 24] and feelings of resentment towards ones organization and burnout [18]. In this article, we evaluate the effect of a participatory organizational intervention that aimed to improve the working environment with a focus on the core task at work. In a previous article, we had shown that the intervention predicted a lower risk of sickness absence in the intervention group compared to the control group [25]. In this article, we test the effect of the intervention on three variables: job satisfaction, exhaustion and sleep Page 2 of 8 disturbances. We hypothesized that the intervention will lead to increased job satisfaction and reduced exhaustion and sleep disturbances in intervention group participants compared to control group participants. The hypothesis is built on the underlying assumption that a psychosocial workplace intervention focusing on the core tasks at work will reduce exposure to adverse psychosocial working conditions, i.e. work stressors, and that reduced exposure to work stressors will result in more job satisfaction and less exhaustion and sleep disturbances. We choose job satisfaction as a general measure of employees’ well-being at work, as suggested in previous studies, for example Bond and Bunce [26], Pryce et al [27], and DeJoy et al [28]. There is a strong relationship between job satisfaction and health, in particular for aspects of mental health [29]. Exhaustion and s (...truncated)