Work environment, health and well-being in dental hygienists : a work-health-culture model

Abstract: The overall aim of this thesis was to elucidate dental hygienists' physical and psychosocial work conditions, health and well-being. Although the physical work conditions and musculoskeletal disorders have been central issues in dental hygiene, it is also important to study how occupational health and well-being is achieved in a mixture of human interactions at workplaces i. e., in co-operation with colleagues, patients, leadership-management, and overall organisation. On this basis a broad perspective was applied. The present thesis covers five studies based on three surveys, the first conducted in 1994 involving 471 Swedish dental hygienists and the second conducted in 1998 on 575 Swedish and 376 Australian dental hygienists. The main occupational health problems identified in dental hygienists were musculoskeletal disorders and symptoms of arthritic hands as well as loss of sensitivity in the arm-hand region. Except for good general health, symptoms of mental well-being and an increased prevalence of musculsokeletal disorders since 1994 specifically in the arm-hand were reported. Primarily, stress from physical work conditions related to musculoskeletal disorders in 1994. However, in 1998, except for physical stress from scaling work, stress from psychosocial work conditions such as work-family conflicts and work relations, related to musculoskeletal disorders. Active leisure and high clinical practise fraction along with high management support at work were positively related to general health. High mastery of work and high management support at work were positively associated with mental well-being, while work-family conflicts and work efficiency had negative influence. Symptoms of arthritic hands, as well as loss of sensitivity in arm-hand was related to age and finger disorders to scaling-work and years in the profession. High job satisfaction was best predicted by a job with development potential for dental hygienists, even for those who were not satisfied in their work. High job influence and clear information from leadership facilitated fuller use of professional skills. Despite many similarities between the countries' work conditions, Australian dental hygienists perceived more musculoskeletal disorders and lower mental well-being as compared to Swedish hygienists. There were country-associated differences in work attitudes, coping strategies, and stress from patients. A work-health-culture model for the dental hygiene profession was presented. Main conclusion: In order to improve work conditions for dental hygienists there is a need to enhance both the physical/ergonomic work conditions, e.g. scaling tasks, as well as the psychosocial characteristics and organisational structure. In addition, cultural/country factors appear to be important additional factors to include in work-health models for dental hygienists. There is a need to investigate what specific factors that actually contribute to the observed differences between countries.