Systematic Health-promoting Work Environment Management in Dentistry

There is a lack of information about how systematic work environment management works in dental care. This includes the dental staff's and management's experience of how and how well systematic health-promoting work environment management is applied, what individual workplace adaptations are used, what support they lack and what they think is good regarding the work environment management. The dental work environment includes dentists, dental hygienists and dental nurses. Perceptions of the work environment and work-related interventions are poorly studied.

Overall aim: Based on a health-promoting basis, the research project aims to study conditions in the work environment in dental care and what support is needed in the systematic work environment management.

Sub-study one is a quantitative cross-sectional study and sub-study two is a qualitative interview study.

Sub-study 1

Aim, sub-study 1: The aim is to investigate how employees and managers in dental care perceive their work environment, support in the organization, safety at work and the need for work environment measures and work adaptations. Furthermore, the aim is to map the employees' self-rated health. The study also aims to describe how managers perceive opportunities to actively work with systematic work environment management in dental care.

Research questions in sub-study 1:

• How do dental staff estimate perceived physical and mental health and work ability?
• Are there differences between those who have good health, musculoskeletal illness and mental illness with regard to perceptions of the work environment? How is the need for support for systematic work environment management described, including individual workplace adaptations among employees and managers?

Participants: Employees and managers in dental care. The goal is to recruit at least 200 dental professionals.

Inclusion criteria

are to have employment (or self-employed) as a dentist, dental hygienist, dental nurse, clinic coordinator or operations manager in private or public dental care. All employees are included, including those on sick leave and parental leave, regardless of their level of work and employment. There is no exclusion criteria, those working in dental care had to understand the Swedish language and will thereby be able to understand the survey/questions.

Recruitment: The study is national and recruitment takes place in all regions in Sweden with a selective selection where the goal is to get a wide range of respondents in different counties. Brief information about the project and a QR code for the project's website will be disseminated through advertising in various media channels, intra-regional mailings, digital platforms and personal contacts. The investigators will also disseminate information to prospective participants via the trade unions, HR and managers. In addition, contact persons at various dental clinics and trade unions will assist with the distribution. On the website, detailed information about the study is available to give prospective participants an understanding of the purpose of the study and how their data will be processed. Participants are informed to give their consent to participate in the study by answering the first question in the survey.

The data collection consists of a digital survey in the digital tool Webropol, which is answered via an open link on the project's website.

The questionnaire contains questionnaires that measure perceived work ability, health, work-related problems, pain, stress, sleep, productivity and a questionnaire for the study. Background questions such as occupation, type of employment, age, family situation and issues related to perceptions of safety at work, the need for work environment measures and workplace adaptations, as well as opportunities to receive and provide support in this area, are also included. Open-ended questions are asked about their experience of work environment management at the workplace and what support they would like to see. Before the cross-sectional study is conducted, the questionnaire is tested in a smaller pilot study to ensure that it is not too long or difficult to answer. For managers, the survey also contains questions about the conditions for taking responsibility for and driving systematic work environment management and individual work adaptations, as well as what support they would like. The questionnaire ends with a question about whether they are interested in participating in sub-study 2 (link to participant information is available and contact information for the project member) and in any contact for a follow-up study. If participants are interested in this, they are asked to provide their name, social security number and contact details. Those who do not want to provide personal data are anonymous (i.e. the researchers do not know their name and contact details, theoretically the IP address could be traced but we do not intend to do so / knowledge and therefore consider the participants anonymous).

Analysis: Data will be analyzed using descriptive statistics (mean and spread), correlation analyses where independent t-test and Mann-Whitney U-test will be used. Correlation and regression analyses are also used in the analyses. Furthermore, the responses from different subgroups of employees (gender, type of work, degree of anxiety/depression) will be analyzed to understand possible variations regarding the relationship between work ability, work-related problems and the systematic work environment management.

The hypothesis is that with a lower assessment of work ability, higher demands at work and a higher estimation of work-related problems, the greater the importance of the opportunities for work adaptations at work and a well-executed systematic work environment management.

For this study, power is based on work ability single item, with a 90% power and effect size of 0.5. A difference in average with three steps and spread of 1, we need at least 70 employees and managers/clinic coordinators. To enable subgroup analyses, at least 200 people will be recruited.

Open-ended questions are analyzed with content analysis.

Sub-study 2

Purpose of sub-study 2: The aim is to explore managers' perceptions of systematic work environment management, their role in and experiences of systematic work environment management and what need for support participants have to be able to work with health promotion.

Research questions in sub-study 2:

• How do managers in dental care experience a health-promoting and good work environment?
• What in the business do the managers perceive to be the greatest risks of ill health?
• What experiences do they describe of systematic work environment management?
• What support would they like in the systematic work environment management?

Recruitment: Managers from sub-study 1. Managers are recruited through a strategic selection principle in order to obtain as broad a description of perceptions as possible. Possible factors such as gender, age, professional experience, size of the business may be relevant for the selection. The investigators also want to include both private and public activities in different regions. Information about the project will be disseminated through contact persons in dental care and digitally. Contact persons ask prospective participants about their interest in participating and to provide contact information for the research group. Information will also be disseminated via digital channels such as social media (X, Facebook, LinkedIn) (appendix 2) and via blogs. People who are interested in participating can read more about the project and register their interest by filling out a digital form on the project's website. Thereafter, after the expression of interest, the research group contacts interested persons to provide further information about the study and obtain informed consent.

Data collection: Individual semi-structured interviews (see appendix 3) with managers and clinic coordinators in dental care will be conducted digitally through audio recording only. An interview guide on the areas to be covered (see Annex 3) will be tested in 2-3 pilot interviews. Background questions and open questions.

Interview guide:

Background data: age, gender, profession, year within the profession, year as a manager

• Can you describe your role and mission? (On a general level)
• Can you describe your role and mission with regard to the work environment?
• How do you see the relationship between health and work environment?
• What do you think a satisfactory and healthy work environment can look like in your business?
• Can you describe your experiences of systematic work environment management (SAM) in your organisation?

• Can you give some examples where it worked well?
• Which interventions do you think have helped (the most)?
• How do you see the work on the application of SAM in your business? (Challenges)
• How do you feel about being able to support your employees in continuing and functioning at work or returning to work? (Linked to possible challenges and need for support?)
• A. Can you describe your experiences of providing support in rehabilitation and individual workplace adaptations? B. Can you describe how you feel that the employees' need for work adaptation looks like in your business?

• Can you give some examples where it worked well?
• Which interventions do you think have helped (the most)?
• Can you describe situations when it felt difficult or didn't turn out as planned? (Challenges, obstacles).
• Based on your role of responsibility, how do you see any need for support for systematic work environment management and health-promoting work environment for all employees? (Linked to any challenges, employees' need for support, your need for support)
• Is there anything else that you would like to bring up regarding your role in and experiences of systematic work environment management that we have not discussed?

Analysis: The interviews are transcribed verbatim and analyzed with content analysis.

Inclusion criteria

• To have employment (or self-employed) as a dentist, dental hygienist, dental nurse, clinic coordinator or operations manager in private or public dental care.
• All employees are included, including those on sick leave and parental leave, regardless of their level of work and employment.

Exclusion criteria

• None. (To be able to work in a dental health care profession in Sweden it is a requirement to understand the Swedish language, language will therefore not be a criteria).