Explaining occupational disorders and work ability among home care workers

The overall aim of this thesis was to investigate what factors and conditions contribute to explain the incidences of reported occupational disorders (occupational injuries and work-related diseases and symptoms) and work ability (long-term work ability, long-term sick leave and disability pension) among home care workers (HCWs).Factors at three levels were investigated in this thesis: the macro-organisational level, the workplace level and the individual level. Incidence of occupational disorders, long-term sick leave, disability pension and prevalence of long-term work ability, of the total working population of HCWs, was calculated and analysed from register-based data. The impact of workplace factors on disability pension was investigated through a case-control design. The rehabilitation process of HCWs with musculo-skeletal disorders was investigated retrospectively. A qualitative approach was applied to gain a deeper understanding of conditions related to recognising, communicating and reporting occupational disorders among HCWs.The results show great differences in municipal incidence of occupational disorders, long-term sick leave, disability pension and the municipal prevalence of workers with long-term work ability in Sweden. Female HCWs had a higher incidence of occupational disorders, long-term sick leave and disability pension. Municipal prevalence of long-term work ability was related to the proportion of non-fulltime workers. Workplace factors were related to disability pension, and exposure to several risk factors constituted a strong risk for disability pension. Few HCWs received occupational rehabilitation. A formally approved occupational disorder was related to receiving occupational rehabilitation and more rehabilitation. The important condition for reporting was that it was easy to communicate and define the occupational disorder in terms of time and place. Communicability of occupational disorders was qualitatively related to experienced work environment problems. Disorders derived from "meeting-moving-carrying-hurrying", were easier to communicate and report than disorders derived from a mixture of work elements.In conclusion, there are several individual and workplace factors and conditions that together contribute to explain occupational disorders, and work ability among HCWs. Physical demands, also in interaction with psychosocial factors, seem to be crucial for disability pension. The low rehabilitation activity within this occupational group, in combination with the few opportunities for reduced physical workload, may also play a central role for work ability. Work-group influence and support, in addition to emotional demands at work, seems to contribute to risks but also to experienced benefits