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PREVENTION OF PSYCHOSOCIAL RISKS AT WORK IN HEALTH PROFESSIONALS

IN BRAZIL AND PERU: ADHESION FOR TRAINING

Article · March 2017

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Research Paper E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017

PREVENTION OF PSYCHOSOCIAL RISKS AT WORK IN HEALTH

PROFESSIONALS IN BRAZIL AND PERU: ADHESION FOR
TRAINING

*Luis F. Abregú Tueros 1 | Jussara M. Rosa Mendes 2

1
Federal University of Rio Grande do Sul, Pos graduation in Psychology Social and Institutional Program, Porto Alegre, Brazil - postal
code 90010.
2
Federal University of Rio Grande do Sul, Pos graduation in Psychology Social and Institutional Program, Porto Alegre, Brazil - postal
code 90010.
ABSTRACT

Objective: Evaluate and compare the evidence of preventive intervention (PI)for psychosocial risks at work(PRW)in health
professionals in Brazil and Peru.
Method: A systematic review wasdevelopedbased on scoping study, in databases: PubMed, EBSCO-Host, BioMed Central, Embase,
CINAHL, Lilacs, Cochrane Register of Trials y Web of Science; additionally in IBICT (Brasil) and CONCYTEC (Peru).
Results: Of 2.461 identified studies they were analyzed to sixteen.Compared IPs are focused on mixed protocols (didactic, interactive)
or workshops:a) ascribed to promote changes in complex behaviors and health prevention in hospital environment, with minimum
duration of three weeks, b) circumscribed to improve the professional practice in health, and develop leadership in management and
teamwork (duration about six months), always premunted for the follow-up and participation of health officials and workers.
Conclusion: The most useful PI for PRW in both countries was training aimed essentially at communication team development, both in
conflict management and in professional interaction.

Keywords: Occupational health. Psychosocial risks at work. Primary interventions. Training. Training - coaching. Healthcare
professionals. Scoping study.
Introduction:
The psychosocial risk at work (PRW) is an emerging factor
turned into a global problem due to its impact on health workers
(HW), given the nature of the tasks they perform and because
they affect both work performance and health (OIT, 2012;
Stavroula y Aditya, 2010; Van Stolk et al, 2012).Globally, the
incidence rate of health-related conditions at work is 5,736 x
100,000 cases; In Europe, is the second health problem (OIT,
2013; Van Stolk et al, 2012);; meanwhile, in Australia, 39% of
HW revealed to have experienced moral siege in the workplace
(Jimmieson et al., 2016), in Brazil, 36.4% of workers were in a
situation of high demand or professional demand, and in Peru,
26% perceived labor dissatisfaction due to the presence of
several PRW factors (Fortaleza et al., 2010; INSM, 2012).
The PRW in addition to being less tangible are difficult to
manage and prevent especially when the models are proactive
towards the origin (Simões& Santos, 2013; WHO, 2008), and
when the overall analysis includes individual consequences as
organizational and social, constituting three levels of
intervention: The first, primary prevention, which is directed at
the PRW factor;the second, oriented to the individual;and the
third, a rehabilitation approach (Leka et al., 2008).Being the
area of study, analyze within the first level that is based on two
types of intervention: a) Awareness and training of workers
(ATW) y, b) implementing organizational management
policies –OMP– (Luis & Ramos, 2015), so that in the latter
type, they include varied and integral strategies but of greater
complexity than the first.
Although these interventions have particular requirements for
application and its advantages are greater, because they may
have positive effects on a set of PRW factors (Jimmieson et al.,
2016; Veloso, 2015), some health institutions in several
European countries postpone or go unnoticed the PIs oriented
towards the management of such risks (EASHW, 2010;
Simões& Santos, 2013). It is pertinent to compare PIs from the
perspective of good practices for awareness raising and
implementation, in a group of health professionals (HP)of
higher risk of Ibero-American countries, between a
middle-income (Brazil) and a low-income (Peru); and analyze
the preventive approach developed in different work situations
that create favorable conditions for improving the management
of those risks. Being the objective to evaluate and to compare
qualitatively the IP applied for the PRW in health professionals
of Brazil and Peru.
Materials and Methods:
A systematic review was developed based on the scoping study,
where the approach and search question are broad but the
evaluation of the quality of the studies is less rigorous (Arksey
and O'Malley 2005;Levac et al., 2010). For the review question
the PIC scheme (participants, object of interest, context)
represented with "P" (Health Professionals), "I" (interventions
to prevent PRW) and "C" (context: Brazilian health
establishments And Peruvian); adapted from the general
scheme PICOS that the protocol PRISMA (preferred reporting
items for systematic reviews and meta-analyses) indicates for
the analysis of included studies (Moher et al., 2015).Two

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL 20

Research Paper E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017
search strategies were used: a) The first, in the databases; (Brazil-Peru) are: i) For the promotion of group
PubMed, EBSCO-Host, Lilacs, BioMed Central, CINAHL and cohesion and the awareness of teamwork, among
Embase; using descriptors as “Health and safety at work”, health professionals, which involves improving
“primary prevention”, “clinical trial”, “humans” y communication, interpersonal relationships and
“healthcare”; b) In the second, the descriptors were used institutional participation (Arévalo et al., 2003;
“intervention¨, “health human resources”, “innovation & Brischialiari et al., 2008; De Lima, 2013; Garcia et
research” and “healthcare staff”. They were also consulted in al., 2003;Girot& Enders, 2004; Huaroto et al., 2013;
the databases of institutions related to health at work (The Huaroto& Espinoza, 2009; Henriques&Saporiti,
Cochrane Library, The Campbell Collaboration), and 2008; Tsuji et al., 2009; Westphal et al., 1995);ii) To
additionally in (Brazil) and CONCYTEC (Peru). The period of increase the active participation during the promotion
search for scientific production ranged from 1 January 1995 to of professional practices of the health, that involve
31 July 2016 limited to the English, Portuguese and Spanish changes of varied and complex behavior for the
languages (articles, thesis). They were excluded from the execution of tasks(Amaral et al., 2012; Arévalo et at.,
review when subjects of interest were not health professionals 2003; Brischialiari et al., 2008; De Lima, 2013;
and when interventions were not preventative for PRW. Garcia et al., 2003; Girot& Enders, 2004; Huaroto&
Espinoza, 2009; Marra et al., 2011; Mendoza, 2012;
For the systematization of data, each included study was
Tsuji et al., 2009; Westphal et al., 1995); iii) For the
evaluated in four items, using for that a qualitative-quantitative
management of hospital work conditions, which
analysis and interpretation record: a) Method employed, b)
required adapting personal strategies, work
participants, c) Interventions (sessions, number and duration,
gymnastics and breaks during the day (Arévalo et at.,
control group, sequence), d) Qualitative results (developed
issues) and quantitative results (effect size, percentage change). 2003; De Lima, 2013; Huaroto& Espinoza, 2009;
In order to label the case, the type and dimension of the PRW Mendoza, 2012).
was identified. Of the total included studies (n=16) we B) The PIs in different training formats in two phases are:
identified randomized controlled trials –RCT (n=8; 50%), i) In Brazil, for the development of leadership skills in
following quasi-randomisation –QR (n=5) and descriptive the prevention of PRW (greater than 3 weeks) which
studies –DE (n = 3), whose subjects are linkedto: a) Execution involve the management of interpersonal conflicts
and content of tasks, b) The organizational culture in the health (Amaral et al., 2012; Arévalo et al., 2003; De Cássia,
establishment. 2012; Huaroto et al., 2013; Marra et al., 2010; Marra
et al., 2013); for building trust and emotional support,
Results: improved personal interaction and improvement of
In selecting studies for the first search strategy they identified team communication, Including the development of
2,461 documents, which were excluded for duplicates, by group dynamics exercises for the change of mentality
analysis of titles and abstracts (stage screening) and not in Health Professionals and officials(Brischialiari et
respond to the question PIC elements -stage eligibility- 94 al., 2008; De Lima, 2013; Girot& Enders, 2004;
removed), resulting in 16 eligible studies for the qualitative Henriques&Saporiti, 2008; Tsuji et al., 2009;
assessment (Figure 1). About participants involved in 95 Westphal et al., 1995); ii)In Peru, to generate
health facilities (Peru: Brazil 69.5% versus 30.5%) were awareness in maintaining healthy work environments
reported 1,974 health professionals (Brazil: 85.7%). and to encourage the exchange of ideas (Arévalo et at.,
Figure 1: Selection process the studies included for systematic review
2003; Huaroto& Espinoza, 2009; Mendoza,
2012).Sustained institutional support is considered as
a condition of change.
Identification

Literature search in databases of Additional records identified

related articles with a sensitive through other sources: The reports related to the second type of intervention (OMP)
methodological filter 1 (Ibicit, Bras.) + 3 (Concytec, Perú) are still incipient, approaching only the evaluation of the
(n= 2,461) (n= 4) management of PRW and the performance of the health
professional, which includes the use of reports
(Henriques&Saporiti, 2008;Marra et al., 2010; Tsuji et al.,
Screening

Literature search of related articles using

specific text search terms 2009), Leaving the PIs suggested for the organizational
(n= 146 changes, the working days, and for the redesign and enrichment
of the post Luís& Ramos, 2015). Standing out the first type of
intervention (ATW) Eight studies targeting five to seven PRW
Eligibility

Literature search of related articles using Articles excluded from

specific text search terms full-text article review
factors (Figure 2). Confirming the advantages of these IPs
(n= 52) (n= 36)
pointed out by Jimmieson et al (2016) and Veloso (2015) for its
positive effects on a set of risk factors.
Included

Studies included in systematic review for

qualitative assesment
(n= 16)

In relation to the first type of intervention (ATW):

A) The common format training PIs in two phases

INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL 21

Research Paper E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017
Figure 2: Effect of PI in several PRF
Psychosocial risk factors
Tsuji et al. 2009
Amaral et al 2012
Huaroto et al 2013
Arévalo et al 2003
Girot & Enders 2004
Westphal 1995
De Lima 2013
García 2003
PI: inte rve n.pre ve ntiv.; PRF: psychosoc.risk factors
Since the reports are focused on coach and continued training
for the first type of PI –ATW– based on mixed protocols
(didactic-interactive) or workshops, it is evident that it is the
privileged and useful intervention for PRW in professionals of
health in both Brazil and Peru, is training. In this regard, the
reflection is that, although such intervention is necessary for the
correct implementation of interventions for PRW(Veloso,
2015). The tendency in the last two decades to solve the
majority of risks with the training resources can cause IPs to
end up without achieving the desired effects, when such actions
are not properly adapted and complemented with other
strategies of an operational nature such as organizational and
procedural models (OMP). The limitations are related to the
frequency of studies (50% are not RCTs, six studies do not
report baseline and intervention control), the quantitative
outcomes are partial in 31.2% and three studies do not reveal
number of participants.
Conclusion and Recommendations:
The most useful PI for PRWs in health professionals in both
countries, are adherence to training, oriented basically to team
communication development, both in conflict management
and in professional interaction. Itis recommended to promote
the prevention of PRW based on preconized and contractual
working conditions such as the participation of workers, and
to evaluate the PI from the perspective of engineering in
resilience.The new lines of research should be oriented to
systematic reviews on interventions involving workers, good
practices in resolving interpersonal conflicts and on
work-family compatibility.
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