The data suggests that the LTC workers in the urban region of study typically reported consumption of healthy diet and participation in physical activity in order to influence their health and wellbeing. This study also supports evidence that physical activity participation also occurred in group or social settings, suggesting they are important factors for behavior modification.
The findings reveal that the majority of front line health care workers, many of whom were racialized persons, immigrants, and/or women, relied on particular mechanisms for self-care such as healthy eating and exercise, including walking, yoga, swimming, and going to the gym. While the data suggests that participants routinely engaged in these activities, a few participants reported they did not do so, which was explained by cost-related barriers.
The evidence from this study demonstrates several important points. Firstly, the findings shed light on under-researched areas of how workers engage with health-conscious behaviors in order to access their preferred health and wellness practices and maintain emotional health. This study also provides interesting perspectives as to what care workers perceived as healthy or unhealthy. For instance, processed foods, sugar, and salt were considered unhealthy by some participants while salad was considered healthy by others.
Thirdly, the findings demonstrate that many of the workers must rely upon their own resources to achieve their optimal health and wellbeing, including costs. This is an important point because behavioral interventions are modulated by social and material circumstances which could otherwise impact morbidity and mortality [13]. Occupational health and safety issues among vulnerable groups, such as racialized and immigrant workers in Canada for example, are often associated with particular working conditions, work exposures, or ergonomics issues [45]; however, there might be additional factors that influence patterns of sickness in workers, such as income and social status [13]. Indeed, the work of Magnavita [23] indicates that low wages can drastically reduce the motivation of employees to participate in workplace health promotion. Magnavita [23] further advises that at the level of the organization, time constraints, financial and human resource shortages, lack of flexibility in work organization such as job rotation, as well as attitudes of employees and managers (e.g. reluctance to change work habits and practices) were obstacles in carrying out workplace health promotion for older workers. Thus, it is imperative that workplace health promotion interventions should be addressed from both collective and individual points of view that improve working conditions, the occupational environment, work organization, family, community, and social contexts [23].
Canadian research suggests that (im)migrants, racialized populations, and women are vulnerable to poverty, illness, and diseases related to low income, psycho-social/ chronic stress, and socioeconomic status disparities ([8, 14, 15, 28, 29, 32, 33, 41, 47, 48]). The literature also shows that racialized and immigrant workers are vulnerable to both acute and chronic health problems because of structural issues in the labour market [11, 12, 48] that lead to major health risks such as work-related accidents or illness, mental stress, as well as income inequalities and health inequities [4, 8, 15, 16, 42, 45, 48, 49, 52]. Accordingly, it is imperative that these groups are targeted in order to reduce health inequities.
How might this research impact on policy or clinical practice in the foreseeable future?
Given the above literature, the findings from this study contribute new information to interdisciplinary occupational health scholarship and contextualize health-conscious behavioral practices from one of the most highly intensive work environments and sectors of employment. The findings are important because the knowledge of personal health practices among workers could reflect resistance and resilience strategies, demonstrate how agency is expressed, as well as illuminating any barriers or limitations. It is increasingly recognized that work influences health and disease in a number of ways, including job-related factors such as income and wages, hours of work, work-load and stress levels, interactions with coworkers, access to paid or unpaid sick leave, and work environments, among other things, all of which impact not only the health and well-being of workers but also their families and communities [19, 47]. Consequently, policies may be introduced to minimize barriers and improve access to these interventions. Magnavita [23] suggests that there are also structural barriers that would need to be addressed. For example, workplace health promotion for older workers is less common in small companies than larger ones due to financial and human resource shortages (ibid).
While this study contributes new knowledge, more work can be done. For instance, there are a number of opportunities for further research, such as examining incomes, income distribution, and as well as factors that impact emotional health, such as reporting of workplace violence, or sleep hygiene. The latter two are important given the nature of Canadian LTC work, which is often carried out in shifts, and where exposures to workplace violence have also been reported. Research further suggests that work-related stress and workloads in the LTC sector can be overwhelming [47]; however, strategies to address these issues are often limited, and would require a holistic approach which considers income, employment, education, i.e. socioeconomic status, and other social determinants of health (SDoH). For example, diet and physical activity are just a few interventions that can modulate worker health and wellbeing. There are also more integrated interventions which seek to collectively address worker safety, health, and well-being, known as total worker health (TWH) initiatives [19]. TWH involve work-related environmental, organizational, and psychosocial factors [6], and include the control of physical, biological, and psychosocial hazards and exposures; organization of work; compensation and benefits; built environment supports; and work-life integration [19]. The TWH initiatives have been advocated through the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention (CDC), and various researchers, including those at the Harvard School of Public Health and elsewhere [26, 27, 35, 36, 44]. TWH explores opportunities to protect workers and advance their health and well-being, and that of their families by improving working conditions through workplace programs, practices, and policies [19]. The rationale for the above measures is to reduce the burden on the workforce, and control health care costs and economic costs to society [31].
In order to improve management of care work, such as in the case of the LTC sector selected for this study, there needs to be commitment to total worker health and wellbeing, which involves the home, family, and community of the workers. While individual, behavioral factors were addressed in this study, it would be beyond the scope and scale of this study to investigate structural factors such as work organization, family, community, and social contexts; although these factors would be good starting points of further investigation for future studies.
Furthermore, given the diversity of care workers in the region of study, such approaches would need to be culturally appropriate, and adequate supports must be provided to the workers. This means that not only do services and provisions need to exist, but they also need to be available, affordable, and accessible to the workers who require them. When such services and support systems are made available to workers, they can perform the work better, safely, with less of a personal toll on their health and wellbeing, and with better outcomes for the recipients of care. Additional approaches that would be beneficial if they were to be applied to this and other sectors of employment include: allocating limited resources for provisions of good, stable jobs; decent income; poverty-reduction strategies; and advocating the SDoH ([38, 39]; [7, 34];).
