i) Demographic details of the participants
The online questionnaire was distributed (sent to their official work email address) among 800 HCW of primary healthcare corporation and 507 responded with a response rate of 63%. In the study a significant percentage (65%) of participants were females (Table 1). 71% of the participants were between 30 to 49 years of age. Half of the PHCC staff (n = 258) that participated in the survey were doctors followed by dentists, nurses and other allied healthcare professionals, researchers and administrative staff as depicted in Table 1.
Table 1
Variables | Number of participants (n) | Percentage (%) |
Gender Male Female Total | 178 329 507 | 35.1 64.9 100 |
Age groups < 30 years of age 30–39 years of age 40–49 years of age 50 years of age and above total | 17 239 172 79 507 | 3.4 47.1 33.9 15.6 100 |
Designation of participants (within PHCC) Doctor Dentist Nurse Physiotherapist Dietician Health educator Quality and accreditation officer Clinical researcher Clinical coding specialist Administrative staff Laboratory technologist Pharmacist Total | 258 52 65 12 18 09 03 23 03 31 13 20 507 | 50.9 10.2 12.8 2.4 3.5 1.8 0.6 4.5 0.6 6.1 2.6 4 100 |
Years of employment within PHCC 6 months to 1 year Between 1 to 2 years Between 2 to 3 years Between 3 to 4 years Between 4 to 5 years More than 5 years Total | 78 48 77 85 57 162 507 | 15.4 9.4 15.2 16.8 11.2 32 100 |
ii) Staff satisfaction and application of ergonomics within healthcare settings
A significant percentage (71%) of the PHCC staff that participated in the survey reported that they had received adequate training pertaining to ergonomic practices within their respective work settings as shown in Table 2. A significant percentage of participants responded positively to the application of ergonomic principles which included workstations designed to meet ergonomic standards, being supported by colleagues and line managers regarding mental health and emotional wellbeing and having good lighting conditions at workspace (Table 2). However, 22% (n = 109) of staff members reported that they were not provided equipment to minimize physical strain while performing tasks. Half of the staff (50%) documented that they were either satisfied or very satisfied with work-life balance at PHCC as depicted in Table 2.
Table 2
Staff satisfaction and responses relating to practical application of ergonomics in primary healthcare settings.
Frequency of items indicating staff satisfaction and application of ergonomic principles in work environment (N = 507) | N | % |
Received training/guidance on proper ergonomic practices at PHCC | 360 | 71.0 |
Aids/equipment provided to minimize physical strain in performing tasks | 109 | 21.5 |
Having an adjustable chair and monitor stand that allows maintaining a comfortable eye level and posture while working at a computer | 380 | 75.0 |
Feeling supported by colleagues and supervisors in terms of mental and emotional well-being at work | 382 | 75.3 |
Satisfied or very satisfied with workstation setup and the arrangement of equipment for work related activities | 317 | 62.5 |
Often or very often taking short breaks (2–5 minutes) to stretch or change sitting posture during your work hours | 156 | 30.8 |
Satisfied or very satisfied with your work-life balance at PHCC | 254 | 50.1 |
Good or excellent lighting conditions in the workspace | 401 | 79.1 |
Satisfied or very satisfied with your overall well-being while working at PHCC | 313 | 62 |
iii) Multiple logistic regression model to assess the risk of experiencing any discomfort or health issues related to work environment.
To assess the net contribution of a set of explanatory/predictor variables towards predicting the risk of experiencing any discomfort / health issues related to work environment a multiple logistic regression model was used (Table 3). The model was statistically significant with an overall predictive accuracy of 71.3%. Gender, availability of aids/equipment to minimize physical strain in performing tasks, feeling supported by colleagues and supervisors in terms of mental and emotional well-being at work, and being satisfied/very satisfied with your work-life balance at PHCC were the important and statistically significant predictors for work related discomfort (Table 3). Being a male significantly reduced the risk of declaring a work-related discomfort by half (adjusted OR = 0.56) compared to females after adjusting for the possible confounding effect of all the remaining explanatory variables included in the model (Table 3). The availability of aids/equipment to minimize physical strain in performing tasks significantly decreased the risk of documenting work related health issues by 2.18 times after adjusting for other confounders. Feeling supported by colleagues and supervisors in terms of mental and emotional well-being at work significantly reduced the risk of reporting a work-related discomfort by half (adjusted OR = 0.54) after adjusting for the remaining explanatory variables included in the model (Table 3). In addition, being satisfied/very satisfied with your work-life balance at PHCC significantly reduced the risk of declaring a work-related discomfort by more than a half (adjusted OR = 0.43) after adjusting for the remaining explanatory variables as shown in Table 3.
Table 3
Findings of the multiple logistic regression model
Variables | Adjusted OR | 95% confidence interval OR | P |
Male gender compared to female | 0.56 | (0.35 to 0.88) | 0.012 |
Received training/guidance on proper ergonomic practices at PHCC | 0.81 | (0.49 to 1.34) | 0.42[NS] |
Availability of aids/equipment provided to minimize physical strain in performing tasks | 2.18 | (1.28 to 3.73) | 0.004 |
Having an adjustable chair and monitor stand that allows maintaining a comfortable eye level and posture while working at a computer | 0.62 | (0.36 to 1.05) | 0.08[NS] |
Feeling supported by colleagues and supervisors in terms of mental and emotional well-being at work | 0.54 | (0.29 to 0.98) | 0.043 |
Age group (Years) | | | 0.5[NS] |
Being 30–39 years old compared to < 30 years | 2.13 | (0.65 to 7) | 0.22[NS] |
Being 40–49 years old compared to < 30 years | 2.41 | (0.7 to 8.27) | 0.16[NS] |
Being 50 + years old compared to < 30 years | 2.76 | (0.73 to 10.46) | 0.13[NS] |
Hours per day spent on average using a computer or other digital devices for work-related tasks | | | 0.33[NS] |
Second (Average) tercile (6.1–7.0) compared to First (lowest) tercile ( < = 6.0) | 1.32 | (0.82 to 2.13) | 0.25[NS] |
Being Third (highest) tercile (7.1+) compared to First (lowest) tercile ( < = 6.0) | 0.88 | (0.47 to 1.64) | 0.69[NS] |
Satisfied/very satisfied with workstation setup and the arrangement of equipment for work related activities | 0.64 | (0.38 to 1.07) | 0.09[NS] |
Often/very often performing physically demanding tasks as part of daily job | 1.41 | (0.9 to 2.19) | 0.13[NS] |
Often/very often taking short breaks (2–5 minutes) to stretch or change sitting posture during your work hours | 0.68 | (0.43 to 1.09) | 0.11[NS] |
Satisfied/very satisfied with your work-life balance at PHCC | 0.43 | (0.25 to 0.74) | 0.002 |
Moderate/high level of stress in the work environment | 1.60 | (0.92 to 2.78) | 0.09[NS] |
Good/excellent lighting conditions in the workspace | 0.67 | (0.37 to 1.24) | 0.21[NS] |
Very loud/too loud noise levels in the workspace | 0.56 | (0.26 to 1.2) | 0.13[NS] |
Satisfied/very satisfied with your overall well-being while working at PHCC | 0.75 | (0.42 to 1.34) | 0.33[NS] |
Constant | 4.18 | | 0.05[NS] |
Overall predictive accuracy = 71.3% |
P (Model) < 0.001 |
iv) Qualitative feedback of primary healthcare staff pertaining to work environment, satisfaction levels, wellbeing, and awareness about ergonomics
Four important themes emerged from qualitative analysis of the responses given to the open-ended question in the survey pertaining to the overall satisfaction, work environment and awareness about the significance of application of ergonomics in healthcare settings. These include 1) desirable workspace, 2) working hours, 3) awareness about ergonomics and 4) satisfaction levels among staff (Table 4).
1. Desirable workspace
The staff expressed their desire to be equipped with chairs that were ergonomically designed to support their spine and help maintain posture to prevent musculoskeletal disease (MSD) cases. Participants emphasized the significance of having adequate room space which influenced their satisfaction with work environment and overall wellbeing. For instance, a doctor commented:
‘Rooms for consultation should be fixed, every time room is changed (depending on Availability of the room) causes discomfort. in some room one can’t adjust the chair, examination couch etc. according to the need’.
Moreover, the staff felt that computer screens should be covered with protective screen to prevent eye strain and there should be thermostats within individual rooms to adjust temperature as the unregulated aircons made the work environment uncomfortable to work in.
2. Working hours
Working continuous for long hours was associated with physical strain and negative effect on the mental health of the staff. A nurse working in primary health clinic said:
With overwhelming workloads and long shifts takes a toll on my mental health. There is no balance. I struggle to maintain work life balance.
Suggestions were given to facilitate and relieve the staff during long shifts particularly night duties (Table 4). A pharmacist suggested:
It really drains me when I have night shifts due to long hours standing. I think there should be short breaks and rest areas provided in between night shifts.
3. Awareness about ergonomics
The staff documented that there should be training regarding ergonomics for new staff recruited in PHCC, ongoing training sessions and regular visits and screening to ensure the principles of ergonomics are applied and required standards always met (Table 4).
4. Satisfaction levels among staff
Lower satisfaction levels were documented by staff who had regular evening shifts and regular outdoor visits (Table 4). A doctor reported:
I feel that there can be reduced satisfaction among PHCC staff mainly because of late evenings shifts issue. It is extremely exhausting to work late hours.
Among the different suggestions to increased satisfaction levels among staff, participants mainly reported to encourage short breaks during continuous working, having relaxing space (lounge) and creating a friendly workplace by encouraging multicultural environment. For example, a clinical researcher emphasized:
Something that can create a health work environment leading to satisfaction with job I would say is that we need to look into establishing multicultural environment which will also ultimately help individual and team to have success stories in PHCC.
Table 4
Findings of thematic analysis
Theme | Sub-theme | Quotes |
Desirable workspace | Preference for chairs Room space and preferred work environment Computer screens | ‘Choose a chair that supports your spine’. ‘Chairs arm support are not adjustable which interferes with the desk so as per height is incompatible.’ ‘Adjustable chair can minimize the back pain and good posture especially in triage’. ‘Kindly provide good chair for nurses. Some desktop tables are too high, and chair cannot adjust to that much height’. ‘Replace the leather covered chair with cushion seated chairs, provide an orientation class to customer service call center agents regarding the rules and regulations of transfer protocols in health centers.’ ‘Overall, I feel the clinic rooms are small with less moving space around, feels congested. not having a window in the room, feels claustrophobic at times.’ ‘Rooms for consultation should be fixed, every time room is changed (depending on Availability of the room) causes discomfort. in some room one can’t adjust the chair, examination couch etc. according to the need’. ‘Our clinics have no windows we feel suffocated’. ‘The sitting area for staff should be carefully adjusted with working stations providing adequate space to move about with good lighting and ventilation’. ‘I would recommend placing standalone workstations to balance the work in sitting and standing position’. ‘Poor crowd control and logistical management and constant opening and banging of doors causes regular headaches.’ ‘Poor crowd control and logistical management and constant opening and banging of doors causes regular headaches.’ ‘Please add a screen cover to reduce the harmful rays emanating from the screen towards the eyes.’ ‘It is important that we are encouraged to move about and take breaks while working long hours on computers. I don’t see this happening in my office and colleagues sit too long staring at their computers’. |
| Temperature control | ‘The very difficult control air condition most time so cold or make it off so hot why no control key in every room like any central cooling.’ ‘I struggle in summers as it gets too cold at times with central air conditioning, there should be thermostat within individual rooms, it will really be helpful.’ ‘There should be more natural light and the temperature of the air conditioning should be made normal and not freezing.’ |
Working hours | Mental health issues Facilitating factors | ‘With overwhelming workloads and long shifts takes a toll on my mental health. There is no balance. I struggle to maintain work life balance.’ ‘Working continuously for hours can without rest can seriously affect mental health of staff and policies should be revised considering the maximum a staff can work in one go.’ ‘The night shifts can be difficult, if we can have a resting bed for the night shifts that would be lovely.’ ‘It really drains me when I have night shifts due to long hours standing. I think there should be short breaks and rest areas provided in between night shifts.’ ‘We should be given dedicated break for lunch or dinner as shifts are long.’ ‘I hope there will be an official stated break time that is sufficient for the employee to pray and have a breakfast.’ ‘I think it will be beneficial if we are given reminders about stretching and relaxing our muscles during long shifts.’ |
Awareness about ergonomics | Training of new staff Ongoing training of existing staff Regular visits and screening | ‘I would strongly recommend that the ergonomics department should play a role in screening the newly joined staff to provide the necessary support needed if he or she has a pre-employment condition that needs ergonomics related support, like back problems etc. Every new staff should receive training and how to approach the ergometric department when they need them.’ ‘It would be great if we have ergonomics session/ training at least monthly or quarterly. This will help the staff be aware about the importance of ergonomics and how to avoid MSDs.’ ‘Regular occupational Health and safety briefing should be done for all staffs yearly. We need to find any high-risk staffs related to back or neck pain and give support by change in workplace arrangements |
Satisfaction levels among staff | Effect of late hour shifts Facilities that can increase staff satisfaction Significance of multicultural environment Outdoor shifts | ‘I feel that there can be reduced satisfaction among PHCC staff mainly because of late evening and night shifts. It can be exhausting to work late hours.’ ‘We need break time during the working hours. Facilities like relaxing lounge and a common cafeteria can lead to overall job satisfaction among the staff.’ ‘Something that can create a health work environment leading to satisfaction with job I would say is that we need to look into establishing multicultural environment which will also ultimately help individual and team to have success stories in PHCC.’ ‘When we have an outdoor shift, which I know is only limited to home care team, it is stressful and more challenging due to travelling and making home visits. In the summers its always exhausting due to humidity and heat.’ |