| Author: | Cheung, Shuk Ping |
| Title: | Implementing a multi-dimensional musculoskeletal health promotion program in managing the musculoskeletal symptoms among Chinese cleaners in Hong Kong : a feasibility cluster randomised controlled trial |
| Advisors: | Cheung, Kin (SN) |
| Degree: | DHSc |
| Year: | 2025 |
| Subject: | Cleaning personnel -- Health and hygiene -- China -- Hong Kong Musculoskeletal system -- Diseases Musculoskeletal system -- Wounds and injuries Occupational diseases Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xxii, 311 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Cleaners are exposed to significant occupational hazards, with work-related musculoskeletal symptoms (WRMS) being among the most prevalent. WRMS negatively impacts their health and work performance, highlighting the urgent need for supportive interventions. While limited evidence supports workplace-specific interventions tailored for cleaners, multi-dimensional health promotion programs have shown promising results in managing musculoskeletal problems in other working population. As cleaners' risks for WRMS are multi-factorial, a comprehensive, multi-dimensional health promotion approach is essential to maximise its impact on the cleaners' musculoskeletal health. Thus, tailored intervention is desirable to address the unique characteristics of cleaners regarding their working condition, socioeconomical status, and health perception. Objective: This study investigates the feasibility, acceptability, and preliminary effect of the intervention—Multi-dimensional Musculoskeletal Health Promotion Programme (MMHPP)—to manage cleaners' WRMS. Methods: A two-arm prospective feasibility cluster randomised control trial was conducted from August to December 2023 across three districts in Hong Kong. Cleaners aged 30 or above, who reported WRMS at least seven days in the past 12 months were recruited and cluster-randomised into intervention or control groups. The intervention group (IG) received an eight-week MMHPP which comprised of weekly 75-minutes training sessions that included health education, ergonomic training and exercise training components, while the control group (CG) received usual care. The primary outcome, feasibility and acceptability of the programme, was evaluated by the recruitment, attendance and retention rates, participants' satisfaction with and acceptance level of the programme. The secondary outcome, the preliminary effect of the intervention, was evaluated by the changes in (i) the number of body regions affected by WRMS and the WRMS severity level in each body region, as measured by Nordic Musculoskeletal Questionnaire (NMQ), (ii) perceived musculoskeletal health, as measured by Versus Arthritis Musculoskeletal Health Questionnaire (MSK-HQ), (iii) perceived quality of life (QoL), (iv) perceived work ability, as measured by the single-item Work Ability Index (sWAI)), (v) understanding of WRMS, as measured by MSK-HQ#12, (vi) confidence in symptom management, as measured by MSK-HQ#13), and (vii) participant compliance with the recommendation of regular exercise. Combining quantitative and qualitative methods, data collection was conducted with questionnaires at baseline (T0), after intervention (T1) and four weeks post-intervention (T2); as well as through feedback form and focus group interviews at T1. Results: The research team approached 158 cleaners and successfully recruited 85 eligible participants from 10 clusters, achieving a recruitment rate of 53.08%. The program demonstrated optimal attendance (79.44%) and retention rate (94.12%). The participants in the intervention group (IG) reported high level of satisfaction with mean score of 8.8/10, and great acceptance of the programme, in terms of relevance, understandability and practicability of the contents. A significant reduction in the number of body regions affected by WRMS (mean= 3.11 at T0 to 1.76 at T1, and to 1.33 at T2, p < .001) among participants in IG and a notable difference between groups (Mdiff= -2.19 at T1, p < .001) were observed post intervention, which was sustained four weeks later (Mdiff= -2.89 at T2, p < .001). Moreover, a significant improvement was also reported in a majority of the outcome variables in IG, including MSK-HQ (mean= 37.16 at T0, to 41.56 at T1, and to 42.51 at T2, p < .001), QoL (mean= 3.36 at T0 to 3.89 at T2, p < .001), sWAI (mean= 7.04 at T0 to 7.71 at T1, to 7.93 at T2, p < .001), understanding of WRMS (mean= 1.31 at T0 to 2.71 at T1 and 2.49 at T2, p < .001) and confidence in symptoms management (mean= 1.47 at T0 to 2.64 at T1 and 2.51 at T2, p < .001) post-intervention, suggesting that the improvement in these variables were sustained four weeks post-intervention. When comparing between groups, significant differences in MSK-HQ#12 and MSK-HQ#13 were noted at both T1 (MSK-HQ#12 Mdiff= 0.74, p= .002; MSK-HQ#13 Mdiff= 0.89, p < .001) and T2 (MSK-HQ#12 Mdiff= 0.61, p= .006; MSK-HQ#13 Mdiff= 1.14, p< .001). However, no significant differences between groups were observed in variables of MSK-HQ (Mdiff= 0.61, p= .860), QoL (Mdiff= 0.11, p= .533) and sWAI (Mdiff= -0.16, p= .542) post-intervention. When comparing the median exercise frequency between groups, participants in IG demonstrated significantly better compliance with the recommended exercise pattern (i.e., performing more than three 15-minute exercise sessions per week) than those in CG after the intervention (n= 28 vs. 8 at T1; n= 20 vs. 8 at T2, respectively). Significant improvements in median exercise frequency (0.0d ay/week at T0 to 4.0 days/week at T1, p < .001) was observed during the intervention period. However, compliance significantly declined (median frequency dropped to 2.0 days/week, p= .042; median duration dropped from 120 min/week to 60 min/week, p < .001) after the completion of intervention, highlighting the need for further investigation. Discussion and Conclusion: The MMHPP intervention was found to be feasible and acceptable for supporting cleaners in managing WRMS in the community setting. Acceptable recruitment, attendance, and retention rates were achieved through a community partnership with Caritas Labour-friendly Communities Project (CLCP) and programme adaptations tailored to cleaners, such as programme schedules and content. Recruitment can be further improved through strategies such as word-of-mouth promotion, workplace health screenings, and incentives. Preliminary positive outcomes provide a foundation for larger-scale studies to refine and evaluate the intervention. The program grounded with workforce-specific strategies and theory-driven from the Health Belief Model (HBM) constructs, effectively targets cleaners' risk factors and needs. However, limitations such as small sample size, limited generalisability, potential selection bias, and contamination issues highlight areas for improvement in future research. Beyond scaling up, future studies should also explore the programme's adoption, integration, and sustainability into real-world settings with implementation science study. It also can be applied to cleaners in other workplaces and for minority groups within the workforce. By adopting the MMHPP framework, practitioners can address cleaners' WRMS needs and promote sustainable behavioral change in a community setting. Stakeholders and policymakers play a vital role in enhancing occupational safety and health (OSH) initiatives by fostering supportive workplace cultures, implementing regular programmes, and raising awareness among cleaners. Additionally, policymakers should prioritise creating policies to protect cleaners' health and reduce the WRMS burden on this vulnerable workforce. |
| Rights: | All rights reserved |
| Access: | restricted access |
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|---|---|---|---|---|
| 8640.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 36.75 MB | Adobe PDF | View/Open |
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