Studies conducted in Brazil
Social participation: an essential principle in the field of Worker’s Health
One of the selected studies evaluated the Worker’s Health Reference Center of Ceará, Brazil (CEREST-CE) based on the beliefs of union representatives and users. The authors identified that there was a lack of dissemination of CEREST-CE activities, and thus, the lack of knowledge of workers to occupy this space, which is an ally in the implementation of important policies in the area13.
Another study14 showed another problem related to social participation. The authors described how the participation of the workers’ segments occurred in a Municipal Health Council, however, their results pointed out that besides not being clear among those who were part of the workers’ representatives, their performance was mostly technical and minimally politicized.
It is known that social participation is crucial to bring about changes in public policies. Surveillance, protection, and health promotion practices should occur in a dialogic and participatory manner and should provide the inclusion of workers and their representatives in this process, which requires much more than the mere creation of legal provisions46.
Working conditions and workers’ suffering
Studies covered by this topic show a diversity of factors, related to working conditions, that cause suffering to the worker. Respondents reported:
- Lack of identification with the task23;
- Difficulty in interpersonal relationship with the work team16,17,23,24;
- Exposure to workplace violence18,23,24,26;
- Devaluation of the worker18,23;
- Feeling helpless, given the non-resolution of problems, which require greater State participation18,24;
- Uninterrupted work24,26;
- Lack of materials and adequate infrastructure to perform their work 16,17,18,21,24,26;
- Unavailability of adequate food in the workplace25;
- Exposure to unhealthy conditions26;
- Alteration of family dynamics by the imposition of new production processes20;
- Non-participation in decision making processes20,21;
- Misalignment between new productive activities and ecological characteristics of the territory20;
- Repetitive work21;
- And unpredictability of the task21.
The relationship between work and mental health has been increasingly studied, given the consequences to the worker and the economic sphere of a country, which loses in terms of workforce47. Although only one of the selected studies addresses this topic specifically23, the impact that working conditions have on their mental health is implicit in the interviewees’ speech.
Perceptions/meanings on health promotion
Understanding the workers’ meanings and perceptions about health promotion can bring elements that help in the preparation of health policies in this area, as well as evidence that its concept is not yet clear for this population. In this case, the lack of knowledge can be problematic because it becomes an obstacle to the workers’ struggle for a right already provided for in the constitution: health3.
In one of the selected studies, the main thematic category of their results concerns the time available to perform health promotion activities15. Workers reported that it was necessary to know how to manage time for physical exercises and leisure. Work enters this scenario as a restrictor to health promotion, as it is reported that there is an excessive workload, in addition to the time taken to get to the workplace.
In addition, it is observed that the perception of workers about health promotion is very focused on the individual character of actions, thus disregarding the responsibility of the State in the implementation of this public policy. This more individualistic view of health promotion also appears in other studies19,27,28.
The study by Santos and Hennington22 shows as one of the important elements for health promotion, the meaning that the worker attributes to his work. This perspective allows the worker to avail himself as a subject endowed with desires and needs. In addition, the authors report how the difficulty of access to primary care health services in Brazil has been an obstacle for these workers to participate in health promotion actions. This result shows a failure in the health system, as health promotion and its protection must be made possible through programs and services, at different levels of care, for the entire population3,48.
Studies conducted in other countries
Raise awareness to change lifestyles
Some selected studies allowed to identify that workers’ awareness of aspects of their life and health can motivate them to bring about changes in their lifestyles. This awareness occurred in more personal aspects of women’s lives (the double workday - in and out of the house)29 but was also related to the physical health of workers32,39,44.
An important piece of data identified in this study concerns employers’ stereotypes. It was elucidated that the understanding of many about health promotion through incentives for lifestyle changes was considered very personal, and sometimes intrusive30,34,37. In addition, for some employers, workers would not be interested in programs that promote health, given the individual characteristics of workers (for example, age)34, work intensity36, or that their interest would be directed to the purchase of health insurance30, or interested in just making money36,37.
Working conditions and the risk of illness
Many workers reported difficulties, present or related to work, to effect change in their lifestyle. An intense or irregular workday has been reported as barriers to physical activity30,33,38,43. Another very common issue in this category concerns the unavailability of healthy food in the workplace31,39,40,41. Considering that the worker spends a third or more of his day at the workplace, it is essential to have options for a balanced diet.
Social support at work
An aspect also present in the selected studies concerns the importance of social support at work. This factor was seen as facilitating the adherence of workers to health promotion interventions. The favorable organizational climate for these activities promoted a greater sense of acceptability35,42,43.
The importance of communication to promote occupational health
When it comes to health promotion, the role of communication in this process is evident. Information needs to be clear, objective and accessible to all42. Therefore, some workers reported preferring to have the information shared personally32,41,43.
Technology and its possibilities/difficulties
With the advancement of technology, interventions to promote workers’ health gained another ally. The use of applications and/or websites through smartphones, computers, or tablets can be useful tools in this area, especially when the target audience of interventions is not very available given the particularities of their work (transport sector)45. Using these resources enables more objective and practical learning and can enable greater interaction between coworkers44. A barrier to the use of these technologies in the workplace for health promotion concerns the cost of such equipment, but also the unfamiliarity that some workers may have with the platforms used45.
The present scoping review is one of the first that proposed to analyze studies with a qualitative approach with this subject, comparing results present in Brazilian research with those from other countries. Despite its specificity, there are limitations. Not all existing databases were consulted for this research. The articles selected were those that were fully available for reading. Therefore, articles that are not open to access were not analyzed. Finally, given the specificity of the objective of this research, only studies with qualitative approach were analyzed.
Recommendations for future work
Considering that other research approaches may bring important results for the advancement of the worker health promotion policy, future researches should cover other methodologies. In addition, as noted in this review, many qualitative surveys have been conducted to evaluate workplace health promotion interventions, so further research could focus on participant adherence and the impact of these interventions. Finally, given the increased use of technology in health interventions, other reviews could focus on this specific tool to highlight the advantages and limitations in the various work scenarios.