The present study explored the characteristics of WRMSD reporting among NAs in long-term care institutions in Korea and identified associated factors. Our findings showed that a substantial number of NAs with a WRMSD (84.4%) did not report it to their management. This figure is higher than reporting rates in previous studies that ranged from 21–74% [13, 17, 18, 35, 36]. WRMSD reporting to management was related to positive attitudes toward reporting, experience of witnessing the injury reporting of others, good safety climate, and not having WRMSDs resulting in changed of jobs, tasks, or work due to WRMSDs.
The present study found a significant association between reporting attitudes and injury reporting. Notably, more positive attitudes toward reporting were strongly associated with higher prevalence of WRMSD reporting. Similar to our findings, in a study of U.S. transportation workers by Jiang et al. (2018), negative safety-related reporting attitudes were associated with underreporting of workplace aggression and underreporting of near misses, which refers to incidents that could have led to injury but did not [37]. Tucker and Turner (2013) also found that teen workers with negative reporting attitudes were more likely to hesitate to report work-related problems to their management.[38] In the theory of planned health behavior, personal attitude serves as one of the key factors that leads to individual behavior via behavioral intention [39]. Although the relationship between attitudes and behavior is still on the debate, many meta-analyses reviews provided the evidence of the attitude-behavior relationship on the basis of various assumptions [40–42]. Glassman and Albarracin (2006) indicated that the attitudes were related with behavior more strongly when attitudes were confident. In the current study, the experience of WRMSD reporting was limited to the past 12 months so that the attitudes toward injury reporting may be easy to recall [41].
This study found that witnessing the injury reporting of others was associated with a greater likelihood of reporting. This result is consistent with previous findings [43]. Markary et al. (2007) found that the odds of nonreporting of needlestick injury reporting were 19.29 times higher among surgeons who were aware of injury by another person than those who were not [43]. In a study of workers in a Korea semiconductor company, one of the reasons for not reporting of WRMSDs was that the workers had never seen injury reporting of others [17]. By witnessing other’s experience, workers may gain specific information or knowledge such as where, how, and to whom to report their work-related problems. Another possible explanation lies in workers’ reporting attitudes. Workers may hesitate to report a problem without precedents due to fear of repercussions from reporting and feel uncertain if their voice would influence in the workplace.
This study finding indicates that safety climate is an important factor affecting workers’ reporting decision and behavior. Mounting evidence supports the role of safety climate on injury reporting. Lipscomb et al. (2015) found that worker safety priority was associated with higher prevalence of reporting injuries to a management [44]. The prevalence of reporting without fear was also higher when workers perceived good safety climate [44]. Similar patterns were observed in other studies [38, 45]. The number of accident reporting increased as the safety climate was perceived to be more positive [34]. Furthermore, the likelihood of speaking up increased when workers perceived their managements was genuinely open to hearing concerns [38]. When workers perceive that their management values workers’ safety, they may feel themselves being protected and believe that the company will do something to fix safety problems—all of which may facilitate workers’ engagement in reporting their work-related problems.
This study found an inverse relationship between WRMSDs resulting in changed jobs or tasks and injury reporting. This finding aligns with research that workers with low back pain resulting in any changes in jobs or tasks were less likely to file a workers’ compensation (WC) claim [46, 47]. In a study of Australian workers, of workers with a repeated WC claim, about two thirds were workers who remained in the same employment and this group also had shorter duration between first and second claim than those who changed their working conditions such as employers or workplaces [47]. Workers who experienced aggravation of symptoms while performing certain jobs or tasks can feel better by changing jobs or working condition. A new job implies a new working environment. Workers who changed jobs may hesitate to report their work-related problems since they are not familiar with new reporting systems and changed safety climate.
Limitations
Limitations of this study should be acknowledged. First, a convenience sampling approach used in this study may introduce selection bias impacting on external validity. Yet, based on the data collected from 19 long-term care facilities which represent 5.4% of the facilities in three cities and the high response rates (82%) in the present study, findings on this study may be generalizable to NAs in other long-term care settings in Korea. Second, the study findings may have been affected by a healthy workers effect—those who remain employed tend to be healthier [48]. Although the half of the participants had WRMSDs and more than 70% of them visited a doctor due to their symptoms in the present study, NAs with severe WRMSD condition may already be left out from the workplace, which may have led to an underestimation of the findings. Last, as the study findings depended on a self-reported questionnaire, reporting or recall bias cannot be excluded regarding the WRMSDs status and prevalence of reporting. However, according to Gabbe et al. (2003), approximately 80% of participants accurately recalled the number of injuries they had and the affected physical regions [49].