The long term goal of this study is to prevent work-related musculoskeletal disorders associated with physically demanding activities through the adoption of an ergonomics intervention. The adoption was considered a process that involves multiple stages of behavioral change towards intervention use based on the Stages of Change Model. Factors believed to affect an individual's adoption stage were examined for their positive impact as a facilitator or negative impact as a barrier. The current study was conducted in the context of health care workers' adoption of a lifting device. The aims of this study were to (1) develop a survey instrument that could be used to assess adoption stages of a lifting device and categorize the barriers and facilitators, (2) identify key factors that differentiate between stages and (3) develop adoption models that classify an individual's adoption stage based upon that individual's response to selected factors.
This study used a survey instrument to assess individuals' adoption stages and to assess factors that potentially affect individuals at each adoption stage in specific resident-handling situations where a lifting device with a full-body sling is recommended to use by The National Institute for Occupational Safety and Health. These situations include the following: Situation 1 represented the transfer of a non-cooperative resident that was able to partially bear weight, Situation 2 represented the transfer of a cooperative resident unable to bear weight, and Situation 3 focused on repositioning a patient. Survey data were collected from 297 healthcare professionals in 12 skilled nursing facilities. Based on reported frequency of use and intention to use a lift device, an individual was classified as a full adopter, partial adopter, trial user, contemplator, pre-contemplator, or non-adopter.
The results indicate that the distribution of adoption stages varies by resident-handling situation. In Situation 1, participants were evenly distributed over the adoption stages. In Situation 2, a majority of participants were identified as full adopters. In Situation 3, a majority of participants were pre-contemplators with no intention of lift use.
A frequency analysis of survey responses indicated that participants' endorsement of factors varied by adoption stage and by situation. In Situations 1 and 2, in comparison to partial adopters and trial users (the PT group), full adopters agreed more with multiple categories of facilitators, including organizational facilitators, colleague behaviors, perceived ergonomic advantages, and how residents would benefit from device use. Barriers affecting the PT group were their perceived physical capability for manual transfer and availability of other, preferred transferring methods. In Situation 1, the PT group (in comparison to contemplators) endorsed the facilitators of personal safety concern, colleague support, and perceived benefits of lift use to a resident. Contemplators were affected by the barriers of resident safety concerns and a conflict between lift use and resident therapy regime. Conversely, in Situation 3, results from a comparison between contemplators and pre-contemplators were demonstrated with multiple categories of facilitators perceived by contemplators.
In Situation 1, a discriminant function analyses and a frequency analysis demonstrated consistent results. The predictor that exhibited the greatest effect on differentiating full adopters from the PT group was a combination of physical capability for manual transfer and preference of other transferring methods rather than a lifting device (for the PT group), followed by protocol of lift use and managerial encouragement (for the full adopters). Predictors that exhibited at least moderate effect on differentiating the PT group from contemplators were colleague support (for the PT group) and a combination of concern for resident safety and difficulty in putting a sling under a resident (for the contemplators). A model that differentiated between contemplators and pre-contemplator indicated that the strongest predictor for contemplators was concern for personal safety. In Situations 2 and 3, the adopter group (including full and partial adopters) was differentiated from non-users. The smoothness of resident-handling tasks was a common predictor endorsed by the adopters, while the perception of physical capability for manual transfer and preference of other transferring method rather than lift use were indicated as barriers of non-users (contemplators and pre-contemplators).
In conclusion, this study demonstrated the applicability of the Stages of Change Model in illuminating the adoption process of a lifting device. Quantitative approaches were used to indicate key facilitators and barriers in order to classify adoption stages. Overall, the acceptance of manual transfer was a prevalent barrier, while positive attitudes toward lift use appeared to be formed by the combined effect of multiple facilitators.