Clinical validation of brief mental health scales for use in South African occupational healthcare

Orientation: South Africa carries a high burden of mental ill-health. Screening to identify individuals for further referral is emerging as one pathway to promote access to mental health interventions. Existing occupational health surveillance infrastructure may be a useful mechanism for clinical mental health screening.Research purpose: This study explored the clinical validity of a range of brief mental health measures in the context of occupational health surveillance.Motivation for the study: To meaningfully screen for mental health as part of occupational health surveillance, tools are required that are empirically validated, clinically useful, locally available and practical to administer.Research approach/design and method: Workers (n = 1816), recruited through workplace occupational health surveillance programmes, completed the Patient Health Questionnaire-9, Brief Symptom Inventory 18-somatisation subscale, Generalised Anxiety Disorder scale-7, Primary Care Post-Traumatic Stress Disorder Screen, Intense (panic-like) anxiety scale and CAGE scale and partook in a diagnostic interview with a clinical psychologist.Main findings: Basic psychometric characteristics were reported, including confirmatory factor analyses, measurement invariance, internal consistencies and socio-demographic effects. Clinical utility was explored through receiver operating/operator characteristics curve analyses, and calculations of positive and negative predictive values, as well as sensitivity and specificity. These indicators provided evidence of clinical validity in the study context.Practical/managerial implications: The findings support the use of psychological screening as a brief, practicable and easily accessible mode of occupational mental health support.Contribution/value-add: This article presented evidence of structural and criterion validity for these scales and described their clinical application for practical use in occupational mental health surveillance.

Company Representatives’ Experiences of Occupational Health Surveillance for Workers Exposed to Hand-Intensive Work: A Qualitative Study

Exposure assessment seldom precedes the medical health checks in occupational health surveillance. In order to emphasize the interconnection between exposure assessment and medical health checks, a process model was developed. The process model aimed to guide employers and Occupational Health Service providers through the execution of occupational health surveillance. The objective of this qualitative study is to explore company representatives’ experiences of the process model, in terms of feasibility and values, and to identify factors that facilitate or impede the process. Thirty-three company representatives from ten companies were interviewed. Interviews were analyzed using content analysis. The company representatives experienced that the model contributed to increased risk awareness and understanding of the exposure effects on workers’ health. They valued the exposure assessments performed by an ergonomics expert, which led to the discovery of previously unidentified risks. The feasibility was facilitated by: a joint start-up meeting in which the process was planned, clear communication between the involved parties, and clarity regarding the process ownership. The findings reveal that a guiding process model is valuable for the execution of occupational health surveillance. However, the model should not only define the components included; a practical guide concerning how the process can be executed is also needed.

Study Protocol for a Qualitative Research Project Exploring an Occupational Health Surveillance Model for Workers Exposed to Hand-Intensive Work

The objective of this study protocol is to describe the development of a process model for occupational health surveillance for workers exposed to hand-intensive work (the HIW-model), and to describe the studies that will explore the model. The studies are designed to: (1) explore stakeholders’ experiences of the model, and (2) explore if, and how, the model affects actions for reduction of exposure to hand-intensive work. The study protocol presents a research project that is described as two studies. The first study will explore company representatives’ and ergonomists’ experiences of the execution of the HIW-model and its various components concerning feasibility and values. Semi-structured interviews will constitute the data source. The second study will explore whether the execution of the HIW-model leads to work environmental changes, such as actions for reduction of exposure to hand-intensive work, and whether these potential actions are based on the ergonomist’s feedback of the exposure assessment and the medical health checks. A mixed method approach will be applied, in which the data sources will be comprised of semi-structured interviews, questionnaires, and documents. The project is expected to generate knowledge regarding the values of the HIW-model. The project is anticipated to shed light on factors that facilitate or impede execution of the model from the different stakeholders’ perspectives; the employer’s as having the legal responsibility for the work environment, and the occupational health service consultants’, being the work environment experts supporting the employers.

Occupational Tuberculosis Among Laboratory Workers in South Africa: Applying a Surveillance System to Strengthen Prevention and Control

Background: Tuberculosis (TB) is recognized as an important health risk for health workers, however, the absence of occupational health surveillance has created knowledge gaps regarding occupational infection rates and contributing factors. This study aimed to determine the rates and contributing factors of active TB cases in laboratory healthcare employees at the National Health Laboratory Service (NHLS) in South Africa, as identified from an occupational surveillance system. Methods: TB cases were reported on the Occupational Health and Safety Information System (OHASIS), which recorded data on occupation type and activities and factors leading to confirmed TB. Data collected from 2012 to 2019 were used to calculate and compare TB risks within NHLS occupational groups. Results: During the study period, there were 92 cases of TB identified in the OHASIS database. General workers, rather than skilled and unskilled laboratory workers and medical staff, had the highest incidence rate (422 per 100,000 person-years). OHASIS data revealed subgroups that seemed to be well protected, while pointing to exposure situations that beckoned policy development, as well as identified subgroups of workers for whom better training is warranted. Conclusions: Functional occupational health surveillance systems can identify subgroups most at risk as well as areas of programme success and areas where increased support is needed, helping to target and monitor policy and procedure modification and training needs.

A comparative analysis of health surveillance strategies for administrative video display terminal employees

Background The objective of this study was to develop a strategy to optimize medical health surveillance protocols for administrative employees using video display terminals (VDTs). A total of 2453 medical examinations were analysed for VDT users in various sectors. From these data, using Bayesian statistics we inferred which factors were most relevant to medical diagnosis of the main disorders affecting VDT users. This information was used to build an influence diagram to evaluate the time and monetary costs associated with each diagnostic test and define an optimal protocol strategy based on occupational risks. Results Musculoskeletal and ophthalmological diseases were identified as the most frequent disorders among VDT users. The Bayesian network inferred age, sleep quality, activity level, smoking and the consumption of alcohol as risk factors. The blood count was the most costly test (5.23 USD/employee) and the second most costly test in time terms (4 min/employee), yet is a diagnostic test that has little influence on the medical decision regarding an employee’s capacity to perform their job. Conclusions Current occupational health surveillance protocols for VDT users may lead to expenditure that is 54% greater than necessary. For many employees and employers, failure to perform a wide range of medical tests for occupational health surveillance purposes is subjectively perceived as a threat to health. Awareness needs to be raised of the appropriate role of different health areas, so as to optimize diagnostic efficiency on the basis of greater flexibility.