بررسی روند مداخله ارگونومیک مشارکتی در کار آشپزخانه

We evaluated a participatory ergonomic intervention process applied in 59 municipal kitchens. In groups of three to five kitchens, the workers participated in eight workshops, and generated and evaluated solutions to optimize musculoskeletal load in their work. An ergonomist initiated and supported the process. By the end, 402 changes were implemented. Evaluative data were collected using research diaries, questionnaires, and focus group interviews. The intervention model proved feasible and the participatory approach was mostly experienced as motivating. The workers’ knowledge and awareness of ergonomics increased, which improved their ability to tackle ergonomic problems by themselves. The changes in ergonomics were perceived to decrease physical load and improve musculoskeletal health. As hindering factors for implementation, lack of time and motivation, and insufficient financial resources were mentioned. In addition, the workers expressed a wish for more support from the management, technical staff, and ergonomists.

Both physical load and psychosocial factors at work have been shown to play a role in the aetiology of musculoskeletal disorders (Ariens et al., 2001; Hoogendoorn et al., 1999 and Hoogendoorn et al., 2000; National Research Council and Institute of Medicine, 2001; Riihimäki and Viikari-Juntura, 1999). We can therefore hypothesize that musculoskeletal problems can be reduced by optimizing the biomechanical and psychosocial load at work. The participatory approach has been successfully used in several studies to reduce physical work demands and to prevent musculoskeletal disorders (Hignett et al., 2005; van der Molen et al., 2005a; Vink et al., 2006). In this approach, workers play an active role in the analysis of work and the planning of improvements (Haines and Wilson, 1998). Its benefits have been the utilization of workers’ experience and knowledge, learning of participants, and their commitment and better acceptance of changes (Wilson, 1995). Intervention programmes have seldom been documented and evaluated adequately (Lincoln et al., 2000; van Poppel et al., 1997; Westgaard and Winkel, 1997). Among the most obvious objects of evaluation are the incidence of disorders, work satisfaction, and productivity. However, even the process of intervention deserves to be assessed, e.g., the number of changes implemented, participants’ satisfaction with their involvement (Wilson and Haines, 2001), as well as their awareness and knowledge of ergonomics. Kitchen work includes many physical and psychosocial load factors and the employees have plenty of musculoskeletal problems (Arbetsmiljöverket and Statistiska centralbyrån, 2004; Huang et al., 1988; Ono et al., 1998; Pekkarinen and Anttonen, 1988; Perkiö-Mäkelä et al., 2006; Shibata et al., 1991). This study is part of a randomized controlled trial aimed at reducing the occurrence of musculoskeletal disorders. The aims of the intervention were to increase workers’ knowledge and awareness regarding ergonomics of their work, to encourage workers to be active participants in developing ergonomics, and to implement improvements in kitchen ergonomics. This article describes the intervention process and evaluates its feasibility with regard to the elements of the intervention process, and available resources and support. We also report the effects of the intervention on ergonomic knowledge and awareness, and the workers’ expectations and perceived effects of the intervention on workload and musculoskeletal health. The efficacy of the intervention will be reported elsewhere.

The participatory ergonomic intervention process applied in 59 municipal kitchens was evaluated using questionnaires, focus group interviews and research diaries. The applied model was feasible and the participatory approach motivated the workers. The knowledge and awareness of ergonomics increased, and workers estimated the effects of the intervention on musculoskeletal load and disorders as positive. Yet their expectations regarding these effects before the intervention were higher than their assessments of them after the intervention. Furthermore, more support was desired from the management, technical staff, and ergonomists. The applied approach proved to be practicable. Similar approach has been used earlier (de Jong and Vink, 2002; Rosecrance and Cook, 2000; Wilson, 1995; Vink et al., 1995), but in our study the workshops were held alternately in each kitchen of a series. This provided all employees the opportunity to become acquainted with other kitchens and share ideas and experiences with the other participants. The workers considered this very useful, but they would have desired more time to be allocated to this kind of practical learning. Visiting other workplaces of the same industry was also applied in a previous study, but only small representative groups of workers made these visits (Wilson, 1995). Although the employees work much as a team in the kitchens, the participatory approach was a new concept and training could have been helpful in getting off the ground faster (Gjessing et al., 1994). The role of the ergonomist was more active at the start of the project, when he/she gave basic information on ergonomics, laying the foundation for the development process and activating the workers. Later the ergonomist worked more in the background by supporting the workers as has been proposed in earlier studies (Haims and Carayon, 1998; Westlander et al., 1995). However, in some kitchens more guidance from ergonomists might have given better results. In this project, the workers were active members of the teams while the role of the management was to provide commitment and support to the project as well as to organize time and resources for the implementation of the interventions. The project was well accepted by the workers: none of kitchens dropped out during the intervention phase. The participation rate in the workshops was high, although it was often difficult to allocate time and simultaneously manage the ordinary tasks. According to the questionnaire, the workers were not satisfied with the support from the management, but unfortunately we did not ask what kind of support was wished for (e.g., participation in the workshops, support during changes, financial support, time resources). Active participation of the management and technical staff would most likely accelerate the implementation of the interventions (Hignett et al., 2005), and this varied: in some series the management did not participate in the workshops at all and therefore the workers might have questioned their commitment to the project. It is possible that the role of the foodservice management was not made clear enough at the beginning. Based on the experiences in the first two cities, the ergonomists encouraged the foodservice management to participate more actively later on during the study. On the other hand, the participation of the management in the workshops may limit discussions between workers (Gjessing et al., 1994). In our study, the more satisfied the kitchen was with the support from the management the better the effects were evaluated by the workers. According to the focus group interviews, the workers’ level of ergonomic knowledge and awareness of ergonomic aspects increased, which improved their confidence and ability to tackle these problems by themselves. The increase in general knowledge regarding ergonomics was associated with participation activity in the workshops, suggesting that the goal to disseminate information was reached. More than 400 changes were implemented during the intervention phase. The kitchens had no extra funding for the development and therefore most of the changes were targeted at working methods and practices, and low-cost solutions. Major changes of equipment are often expensive, for example, in dishwashing. In some kitchens, environmental constructions and equipment were old and therefore more extensive structural changes would have been needed. However, one benefit of the limited financial resources was that workers realized that good ergonomic solutions could be achieved at low cost. About 100 planned measures were not completed. Most often the reason for non-completion was, as in a previous study (Rosecrance and Cook, 2000), the lack of time or motivation of some workers. Passivity and resistance to change were also major obstacles in developing ergonomics according to the ethnographic part of this study carried out in four kitchens in one city (Riihimäki, 2005). According to the focus group interviews, it was difficult to find common time for all workers. In spite of the participatory model, the kitchen manager had often taken the main responsibility for the development. The intervention phase was time-consuming. The aim was that workers internalize the way of thinking of ergonomics, which would then lead to a sustainable change. Such a change may take time and therefore perhaps even a longer intervention period would have been beneficial. Long intervention studies, however, may be unshielded from unexpected changes (Cole et al., 2003; Kilbom, 1988; Silverstein and Clark, 2004; Smedley et al., 2003; Westlander et al., 1995). In our study during the intervention phase, major reorganization of foodservice began in two cities, which may have affected accessible personnel and financial resources, as well as the motivation of the workers. Nevertheless, the intervention phase proceeded well in spite of reorganization of kitchen work. According to the literature (Haines and Wilson, 1998; Goldenhar et al., 2001; Van der Molen et al., 2005b), there is a number of ways to evaluate participatory programmes. In the present study, our focus was to evaluate the process mainly from the workers’ viewpoint. In focus group interviews also, the perception of the management was obtained. The study, however, provided a limited scope of the production system as a whole. In conclusion, the participatory approach proved to be feasible and motivating. By combining theoretical learning and practical training with learning from each others’ solutions, the workers’ knowledge and awareness of ergonomics increased. Most workers were satisfied with the intervention and a great proportion of them felt that it had a positive influence on physical load and musculoskeletal health. A substantial number of changes were implemented in the kitchens, even though no extra funding for improvements was available. It may be that more active participation of the management and technical personnel as well as better collaboration and communication between workers, management, and technical personnel could have resulted in an even higher number of changes. The participation model used in this study could be modified for the use of occupational health or ergonomics services in development projects in kitchens and other workplaces.