Testing the "Work Ability House" Model in hospital workers

Martinez, Maria Carmen; Latorre, Maria do Rosário Dias de Oliveira; Fischer, Frida Marina

doi:10.1590/1980-5497201600020016

ABSTRACT:

Objective:

To test the Work Ability House model, verifying the hierarchy of proposed dimensions, among a group of hospital workers.

Methods:

A cohort study (2009-2011) was conducted with a sample of 599 workers from a hospital in the city of São Paulo. A questionnaire including sociodemographics, lifestyle and working conditions was used. The Brazilian versions of Job Stress Scale, Effort-Reward Imbalance, Work-Related Activities That May Contribute To Job-Related Pain and/or Injury, and the Work Ability Index (WAI) were also used. A hierarchical logistic regression analysis was performed: the independent variables were allocated into levels according to the dimensions of the theoretical model in order to evaluate the factors associated with work ability.

Results:

Variables associated with impairment of work ability in each dimension were as follows: (a) sociodemographics: age < 30 years (p = 0.20), (b) health: without report of occurrence of work injuries (p = 0.029), (c) professional competence: low educational level (p = 0.008), (d) values : intensified in overcommitment (p < 0.001), and (e) work: intensification of effort-reward imbalance (p = 0.009) and high demands (p = 0.040).

Conclusion:

The results confirmed the dimensions proposed for the Work Ability House model, indicating that it is valid as a representation of a multidimensional construct of multifactorial determination and can be used in the management of work ability.

Keywords:
Work capacity evaluation; Occupational health; Workers; Workload; Work environment; Health personnel

[1] Corresponding author: Maria Carmen Martinez. Department of Environmental Health, School of Public Health, Universidade de São Paulo. Avenida Doutor Arnaldo, 715, CEP: 01246-904, São Paulo, SP, Brasil. E-mail: mcmarti@uol.com.br

Variable	Maintaining		Aggravation		Total		p-value*
Variable	n	%	n	%	n	%
Sociodemographics
Gender
Female	281	72.6	154	72.6	435	72.6	0.993
Male	106	27.4	58	27.4	164	27.4
Age group					164	27.4
< 30	90	23.3	70	33.0	160	26.7	0.010
≥ 30	296	76.5	142	67.0	438	73.1
Not informed	1	0.3	0	0.0	1	0.2
Marital status					1	0.2
Single	144	37.2	90	42.5	234	39.1	0.420
Married/partner	201	51.9	99	46.7	300	50.1
Separated/divorced/widow(er)	38	9.8	20	9.4	58	9.7
Not informed	4	1.0	3	1.4	7	1.2
Monthly Family income					7	1.2
≥ 5.1 minimum wages	209	54.0	100	47.2	309	51.6	0.074
< 5.0 minimum wages	164	42.4	107	50.5	271	45.2
Not informed	14	3.6	5	2.4	19	3.2
Responsibility for underage children/					19	3.2
No	188	48.6	108	50.9	296	49.4	0.656
Sporadically/yes	188	48.6	100	47.2	288	48.1
Not informed	11	2.8	4	1.9	15	2.5
Health and functional capacity
Alcohol consumption
Sporadic consumption (0 - 1 day/week)	355	91.7	192	90.6	547	91.3	0.736
Regular consumption (≥ 2 days/week)	23	5.9	14	6.6	37	6.2
Not informed	9	2.3	6	2.8	15	2.5
Smoking					15	2.5
Never smoked/former smoker	345	89.1	199	93.9	544	90.8	0.135
Yes, I smoke	37	9.6	13	6.1	50	8.3
Not informed	5	1.3	0	0.0	5	0.8
Nutritional status					5	0.8
Eutrophic	203	52.5	126	59.4	329	54.9	0.249
Overweight	132	34.1	60	28.3	192	32.1
Obesity	46	11.9	23	10.8	69	11.5
Not informed	6	1.6	3	1.4	9	1.5
Practice of physical activities					9	1.5
Yes	143	37.0	78	36.8	221	36.9	0.994
No	235	60.7	128	60.4	363	60.6
Not informed	9	2.3	6	2.8	15	2.5
Work injury					15	2.5
No	335	86.6	193	91.0	528	88.1	0.032
Yes	35	9.0	9	4.2	44	7.3
Not informed	17	4.4	10	4.7	27	4.5
Professional competence
Educational Level
Elementary school	8	2.1	12	5.7	20	3.3	0.023
incomplete/finished high school	366	94.6	198	93.4	564	94.2
Not informed	13	3.4	2	0.9	15	2.5
Years in the profession					15	2.5
Less than 6	96	24.8	72	34.0	168	28.0	0.011
6 and more	285	73.6	133	62.7	418	69.8
Not informed	6	1.6	7	3.3	13	2.2
Position					13	2.2
Others	367	94.8	190	89.6	557	93.0	0.017
Technicians	20	5.2	22	10.4	42	7.0
Not informed	0	0.0	0	0.0	0	0.0
Total	387	100.0	212	100.0	599	100.0

Variable	Maintaining		Aggravation		Total		p-value*
Variable	n	%	n	%	n	%
Values
Overcommitment
No changes	161	41.6	74	34.9	235	39.2	< 0,001
Aggravation	98	25.3	90	42.5	188	31.4
Improvement	120	31.0	43	20.3	163	27.2
Not informed	8	2.1	5	2.4	13	2.2
Work					13	2.2
Work violence (points)							0.602
7 (no violence)	254	65.6	134	63.2	388	64.8
8	67	17.3	29	13.7	96	16.0
9	34	8.8	23	10.8	57	9.5
10 or more	14	3.6	9	4.2	23	3.8
Not informed	18	4.7	17	8.0	35	5.8
Work sector					35	5.8
Corporate areas	34	8.8	12	5.7	46	7.7	0.320
Hotel	62	16.0	49	23.1	111	18.5
Other operations/services	13	3.4	6	2.8	19	3.2
Nursing services	207	53.5	103	48.6	310	51.8
Medical superintendence	32	8.3	16	7.5	48	8.0
Services of diagnosis and therapy	21	5.4	13	6.1	34	5.7
Supplies	18	4.7	13	6.1	31	5.2
Not informed	0	0.0	0	0.0	0	0.0
Work shift					0	0.0
Administration	102	26.4	43	20.3	145	24.2	0.246
Morning	101	26.1	55	25.9	156	26.0
Afternoon	75	19.4	53	25.0	128	21.4
Night	106	27.4	56	26.4	162	27.0
Not informed	3	0.8	5	2.4	8	1.3
Work load					8	1.3
No changes	153	39.5	97	45.8	250	41.7	0.531
Aggravation	76	19.6	40	18.9	116	19.4
Improvement	89	23.0	45	21.2	134	22.4
Not informed	69	17.8	30	14.2	99	16.5
Work demands					99	16.5
No changes	180	46.5	110	51.9	290	48.4	0.010
Aggravation	123	31.8	73	34.4	196	32.7
Improvement	81	20.9	23	10.8	104	17.4
Not informed	3	0.8	6	2.8	9	1.5
Effort-reward imbalance					9	1.5
No changes	75	19.4	41	19.3	116	19.4	< 0.001
Aggravation	117	30.2	100	47.2	217	36.2
Improvement	181	46.8	59	27.8	240	40.1
Not informed	14	3.6	12	5.7	26	4.3
Social support					26	4.3
No changes	184	47.5	91	42.9	275	45.9	0.002
Aggravation	119	30.7	92	43.4	211	35.2
Improvement	82	21.2	26	12.3	108	18.0
Not informed	2	0.5	3	1.4	5	0.8
Control over work					5	0.8
No changes	208	53.7	115	54.2	323	53.9	0.524
Aggravation	84	21.7	51	24.1	135	22.5
Improvement	88	22.7	40	18.9	128	21.4
Not informed	7	1.8	6	2.8	13	2.2
Situations that favor pain/injury					13	2.2
No aggravation (delta < 15,0)	254	65.6	113	53.3	367	61.3	0.004
Aggravation (delta ≥ 15,0)	117	30.2	88	41.5	205	34.2
Not informed	16	4.1	11	5.2	27	4.5
Total	387	100.0	212	100.0	599	100.0

Dimension/variable	Univariate		Multiple
	OR_crude	p-value	OR_adjusted	_{95%CI of ORadj}	p-value
Sociodemographics
Gender
Female	1.00	0.993	1.00	0.63 - 1.35	0.672
Male	1.00		0.92
Age group
< 30	1.00	0.011	1.00	0.43 - 0.93	0.020
≥ 30	0.62		0.64
Family income
≥ 5.1 minimum wages	1.00	0.074	1.00	0.53 - 1.05	0.093
< 5.0 minimum wages	1.36		0.74
Health/functional capacity^*
Previous occurrence of work injuries
No	1.00	0.032	1.00	0.20 - 0.92	0.029
Yes	0.45		0.43
Smoking
Never smoked/quit	1.00	0.138	1.00	0.30 - 1.18	0.141
Current smoking	1.64		0.60
Professional competence (knowledge/skills)^**
Years in the profession
< 6	1.00	0.012	1.00	0.47 - 1.12	0.149
≥ 6	0.62		0.73
Job title
Others	1.00	0.019	1.00	0.95 - 3.46	0.073
Technicians	2.13		1.81
Educational level
Concluded elementary school	1.00	0.028	1.00	0.11 - 0.71	0.008
Incomplete high school and more	0.36		0.27
Values (attitude/motivation)^***
Overcommitment
No aggravation	1.00	<0.001	1.00	1.46 - 3.06	< 0.001
Aggravation	2.21		2.11
Work^****
Work shift
Others	1.00	0.088	1.00	0.82 - 1.95	0.284
Afternoon	1.42		1.27
Work sector
Others	1.00	0.033	1.00	0.99 - 2.47	0.055
Hotel	1.58		1.56
Effort-reward imbalance
Improvement	1.00	< 0.001	1.00	1.15 - 2.58	0.009
No improvement	2.25		1.72
Social support
No aggravation	1.00	0.002	1.00	0.88 - 1.93	0.187
Aggravation	1.76		1.30
Work demands
Improvement	1.00	0.003	1.00	1.03 - 3.04	0.040
No improvement	2.13		1.77
Situations that favor pain/injury
No aggravation	1.00	0.004	1.00	0.80 - 1.80	0.371
Aggravation	1.69	1.20