Available via license: CC BY 4.0
Content may be subject to copyright.
1
HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Workplace interventions that aim to improve
employee health and well- being in male- dominated
industries: a systematicreview
Paige M Hulls ,1,2 Rebecca C Richmond,1,2 Richard M Martin,1,2,3
Yanaina Chavez- Ugalde,1,4 Frank de Vocht 1,4,5
Systematic review
To cite: HullsPM,
RichmondRC,
MartinRM, etal.
Occup Environ Med Epub
ahead of print: [please include
Day Month Year]. doi:10.1136/
oemed-2020-107314
►Additional supplemental
material is published online
only. To view, please visit the
journal online (http:// dx. doi.
org/ 10. 1136/ oemed- 2020-
107314).
1Population Health Sciences,
Bristol Medical School,
University of Bristol, Bristol, UK
2MRC Integrative Epidemiology
Unit, University of Bristol, Bristol,
UK
3NIHR Bristol Biomedical
Research Centre, University
Hospitals Bristol NHS
Foundation Trust and the
University of Bristol, Bristol, UK
4National Institute for Health
Research, School for Public
Health Research, Newcastle
upon Tyne, UK
5National Institute for Health
Research Collaboration for
Leadership, Applied Health
Research and Care West (NIHR
CLAHRC West), Bristol, UK
Correspondence to
Paige M Hulls, School of Social
and Community Medicine,
University of Bristol School of
Social and Community Medicine,
Bristol, UK;
paige. hulls@ bristol. ac. uk
Received 16 December 2020
Revised 31 March 2021
Accepted 2 April 2021
© Author(s) (or their
employer(s)) 2021. Re- use
permitted under CC BY.
Published by BMJ.
ABSTRACT
The published evidence on whether workplace health
and well- being interventions are as effective in male-
dominated industries compared with mixed- gender
environments has not been synthesised. We performed
a systematic review of workplace interventions aimed
at improving employee health and well- being in male-
dominated industries. We searched Web of Knowledge,
PubMed, Medline, Cochrane Database and Web of
Science for articles describing workplace interventions in
male- dominated industries that address employee health
and well- being. The primary outcome was to determine
the effectiveness of the intervention and the process
evaluation (intervention delivery and adherence). To
assess the quality of evidence, Cochrane Collaboration’s
Risk of Bias Tool was used. Due to the heterogeneity of
reported outcomes, meta- analysis was performed for only
some outcomes and a narrative synthesis with albatross
plots was presented. After full- text screening, 35 studies
met the eligibility criteria. Thirty- two studies delivered
the intervention face- to- face, while two were delivered
via internet and one using postal mail. Intervention
adherence ranged from 50% to 97%, dependent
on mode of delivery and industry. 17 studies were
considered low risk of bias. Albatross plots indicated
some evidence of positive associations, particularly for
interventions focusing on musculoskeletal disorders.
There was little evidence of intervention effect on body
mass index and systolic or diastolic blood pressure.
Limited to moderate evidence of beneficial effects was
found for workplace health and well- being interventions
conducted within male- dominated industries. Such
interventions in the workplace can be effective, despite
a different culture in male- dominated compared with
mixed industries, but are dependent on delivery, industry
and outcome. CRD42019161283.
BACKGROUND
Beyond providing income to meet basic needs,
being employed can benefit health by providing
meaningful activity and structure to the day, oppor-
tunities for social contact, and making up a key part
of one’s social identity.1 The WHO defines a healthy
workplace as ‘one in which workers and managers
collaborate to use a continual improvement process
to protect and promote the health, safety and well-
being of all workers and the sustainability of the
workplace’.2 However, certain work activities can
put employees’ health at risk in the form of occu-
pational risks and hazards, as well as the impact on
their mental health.
Male- dominated industries are commonly
defined as comprising over 70% male workers, and
include agriculture, construction, manufacturing,
mining, transport and technology.1 Masculine
norms, ‘culturally accepted rules and standards that
guide and constrain masculine behaviours’, may
also contribute to poorer health outcomes of both
men and women in male- dominated occupations.3
Due to the nature of the work, employees in male-
dominated industries have an elevated risk of work-
related injuries and fatalities,3 while they also have
a higher prevalence of poor health outcomes (in
men and women) compared with gender- balanced
industries.4 The combination of poor physical
and psychological working conditions is thought
to partially explain the higher prevalence of risky
health behaviours and elevated disease burden in
male- dominated industries.3
Key messages
What is already known about this subject?
►Male- dominated industries have a higher
prevalence of risky health behaviours and
masculine norms can contribute to poorer
health outcomes in men.
►Systematic reviews in this field have focused
on specific theme, instead of comparing
the different areas of employee health and
well- being.
What are the new findings?
►The albatross plots indicated evidence
of positive associations, particularly for
musculoskeletal disorders.
►Intervention adherence ranged from 50%
to 97%, dependent on mode of delivery and
industry, and 32 of the 35 included studies
delivered the intervention face- to- face.
How might this impact on policy or clinical
practice in the foreseeable future?
►Improving employee health and well- being
with workplace interventions is possible, but
intervention content and delivery must be
considered.
►Researchers need to consider an organisational
rather than individual approach to have a
beneficial effect on employees’ health and
well- being.
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
2 HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
Workplace health interventions offer an opportunity to reach
a significant proportion of the working population. Interven-
tions have emerged as a set of comprehensive health promotion
and occupational health strategies implemented at the work-
place to improve work- related outcomes.5 There is a strong
case for employers to engage in employee health and well-
being programmes, alongside legal obligations and corporate
social responsibility. Benefits at the organisational level include
increased productivity, improved employee retention, reduced
sickness absence and greater employee resilience.6
While systematic reviews on interventions in the male-
dominated industries have been conducted, they have focused
on one specific theme (eg, mental health, physical activity and
smoking cessation) instead of comparing the different areas of
employee health and well- being.1 Our aim was to systematically
review workplace interventions aimed at improving employee
health and well- being specifically in male- dominated industries
and quantify their effectiveness.
METHODS
Patient and public involvement
No patients were involved.
Protocol and registration
This systematic review was registered with the International
Prospective Register of Systematic Reviews (PROSPERO; regis-
tration number CRD42019161283; available from https://
www. crd. york. ac. uk/ prospero/ display_ record. php? ID=
CRD42019161283). It was conducted and reported following
the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) statement for reporting systematic reviews
and meta- analyses.7
Eligibility criteria
Studies had to have been written in the English language and
published in a peer- reviewed journal. Grey literature, including
conference abstracts, abstracts and dissertations, were not
considered. Studies were not excluded if they were developed
and/or launched by employers and then effectiveness was evalu-
ated by research teams. Studies had to have quantitatively eval-
uated an intervention implemented in the workplace and which
aimed to alter the health behaviours of employees. Study designs
were either a randomised controlled trial (RCT) or a non-
randomised intervention group allocation. Only studies in indus-
tries with male- dominated employee populations were included.
Assignment of male- dominated industries was a priori based
on the industrial sector: construction, manufacturing, mining,
transport, agriculture and technology.1 Studies had to include
information and measures of physical or psychological health
and risk behaviours that may affect, or be the result of, physical
or psychological health issues, that is, blood pressure, weight,
alcohol consumption or mental well- being. Further details on
the methodology have been described in the study protocol.8
Search strategy
Five electronic databases were searched to identify articles
published up to 26 October 2020: Web of Knowledge, PubMed,
Medline, Cochrane Database and Web of Science. The search
strategy used medical subject headings (MeSH) and keywords
(eg, male- dominated, stress, employee, intervention). Specific
search strategies are outlined in online supplemental figure
2. The reference lists of the articles that were included in the
final review were screened for additional eligible articles that
the online bibliographic database search had missed. After the
initial search, references were imported into EndNote to remove
duplicates (identified by title, author and DOI). Following the
PROSPERO and PRISMA guidelines, titles and abstracts of
identified articles were screened, followed by full- text screening,
conducted by one of the authors (PH). The titles and abstracts
of selected studies were also independently screened by a second
author (YC- U) and discrepancies between the authors were
discussed until consensus was reached.
Data extraction
The criteria for data extraction were determined prior to starting
the review. The primary outcomes of interest were effectiveness
of the intervention (as defined by the individual study author),
intervention delivery, intervention adherence, measures of phys-
ical health and measures of psychological health or occupational
stress using validated scales. Summary data from each study
were collected into a standardised, predetermined form and
included study design, participants, setting (workplace industry),
intervention details (type and content), outcomes (pre, post and
follow- up) and acceptability or participant satisfaction relating
to the intervention. While we included studies that focused on
job strain, we chose not to use the definition based on Karasek’s
model to ensure that we were able to include all interventions
that were aimed to impact on job strain itself, as defined in the
Karasek’s model, or on intermediate biological factors closely
related to job strain.
Quality assessment
Study methodologies were assessed using the Cochrane Collab-
oration’s Risk of Bias Tool for randomised and non- randomised
interventions. Studies were categorised by PH into low risk
of bias, unclear risk of bias or high risk of bias, based on the
following criteria: selection bias, reporting bias, performance
bias, detection bias, attrition bias and other bias.
Data analysis
Due to the heterogeneity of interventions, measures and
outcomes reported by the included studies, the findings are
presented in narrative synthesis incorporating effect sizes
and CIs where reported, or p values where these were not
provided. From the 35 studies, 54 objective and 61 subjective
(self- reported) outcomes were included. Of the 107 outcomes,
16 outcomes were reported across multiple studies. For studies
measuring body mass index (BMI) and blood pressure, forest
plots were constructed to examine underlying effect sizes from
the workplace interventions and the heterogeneity across the
studies. I2 statistics were used to assess between- study hetero-
geneity. An albatross plot was created to display the direction
of the observed effects of all included interventions. The plot
is a graphical tool that allows the presentation of results of
diversely reported studies in a systematic review.9 All analyses
were conducted using Stata V.15.10
RESULTS
The initial search resulted in a total of 837 articles, not including
duplicates. Based on titles and abstracts, 435 full texts were
retrieved for a full review. Of these, a further 407 were excluded.
A PRISMA flow diagram displaying the search results can be
found in figure 1.
The studies were conducted in Asia (one Indian, seven Japa-
nese, one Chinese, one South Korean), Europe (six Dutch, four
Danish, two Swedish, one Belgian, one Swiss, one Spanish, one
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
3
HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
Italian, one German, one Polish), North America (three Amer-
ican), South American (one Chilean) and Australasia (three
Australian). Of the studies, 13 were in the construction sector,
12 in the manufacturing sector, 4 in the information technology
(IT) sector, 1 in the transport sector and 1 in the mining sector.
Based on the intervention aim, nine health and well- being
domains were identified: job strain (n=8), musculoskeletal
disorders (n=7), lifestyle (n=5), diet and physical activity (n=4),
physical activity (n=4), nutrition (n=2), smoking cessation
(n=2), mental health (n=2), alcohol (n=1), depression (n=1)
and sleep (n=1).
The length of the interventions varied from 2 weeks to 3
years, with 34% of studies having a 6- month intervention and
the average intervention length being 28 weeks.
The review includes both male and female workers in male-
dominated industries. Of the 35 studies included in the system-
atic review, 13 studies had male- only samples11–24 and 2 studies
had female- only samples.20 25 Of the 20 studies with a mixed
sample, only 3 provided information regarding gender- specific
effects of the intervention.26–28
In male workers there was a negative intervention effect
for intrinsic reward (p=0.040) and in female workers there
was a favourable intervention effect for depression and vigour
(p<0.05), working in Japanese manufacturing companies.
There was no significant effect observed for sick leave in either
gender.27 In the same population,26 there was no significant
intervention effect (p>0.05) on job strain, via mailed advice, on
analysis of subgroups classified by gender. A lifestyle interven-
tion in Dutch manufacturing employees had a favourable inter-
vention effect on serum cholesterol levels in male (p=0.02) and
female (p=0.09) workers.28
Table 1 summarises each study and online supplemental table
1 provides a summary of their main findings.
Risk of bias
Of the 35 studies, 17 were considered to have a low risk of
bias, 16 had an unclear risk of bias and 2 had a high risk of bias
(figure 2). As only two studies had a high risk of bias, they were
not excluded from any results analysis. Studies whose interven-
tion focus included lifestyle, diet and physical activity, physical
activity, smoking cessation, and mental health were rated to be at
low risk of bias overall. In comparison, reporting in studies that
aimed to address job strain, musculoskeletal disorders, nutrition,
alcohol, depression and sleep was less comprehensive and they
were rated as having unclear risks of bias.
Intervention delivery
The majority of studies (32) implemented the intervention face-
to- face, while two studies delivered the intervention using the
internet in IT,29–31 and one study sent intervention content to
participants via postal mail26 in the manufacturing industry. Of
the studies using face- to- face delivery, 13 were conducted in the
construction industry,11–18 22 23 27 32 33 10 in the manufacturing
industry,18 20 24 25 28 34–39 1 in the mining industry19 and 1 in the
transport industry.40
Intervention adherence
Intervention adherence, defined by the individual study authors,
across studies ranged from 50% to 97%. Adherence to internet
interventions ranged between 50% and 78%29 30; when using
postal mail adherence was 89%,26 while face- to- face intervention
adherence was between 57% and 99%.11–19 21–25 27 28 32–34 36–39 41–46
Four studies did not disclose adherence rates.20 31 35 40 Within the
construction industry, intervention adherence ranged from 57%
to 94%,11–18 22–24 27 32 33 41 while in the manufacturing industry
intervention adherence was 50%–99%,20 25 26 28 29 34–39 42 45 46
78%–95% for studies within the IT industry21 30 43 44 and 97%
for the intervention in the mining industry.19
Measures of physical health
Studies commonly used objective measures of physical health
as their primary or secondary outcomes, including cholesterol,
blood pressure, heart rate, BMI and waist circumference. Nine
studies were in the construction sector,11–15 23 24 32 41 47 three in
the manufacturing sector,26 28 39 two in the IT sector30 43 and one
in the transport sector.40 There were four studies focusing on
diet and physical activity,14 15 24 30 three studies focused on job
strain,26 40 43 three studies focused on lifestyle,23 28 41 two studies
focused on nutrition11 32 and three studies focused on physical
activity.12 13 39
Blood pressure was assessed as an outcome in 10 studies. Five
studies reported an intervention effect on blood pressure, two of
which focused on job strain,40 43 two focused on lifestyle28 30 41
(as defined by the individual study authors) and one focused
on diet and physical activity.15 For the two studies focusing on
job strain, one reported an intervention effect on systolic blood
Figure 1 PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta- Analyses.
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
4 HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
Table 1 Summary of characteristics of studies that included workplace interventions aiming to improve employee health and well- being in male-
dominated industries
Author (year) Design Industry
Participants,
context/setting/%
of men Intervention Outcomes
Follow- up
time points
Risk of
bias
Intervention
evaluation
Anderson and
Dusenbury (1999)32 Quasi- experimental;
participants assigned to
intervention 1 (n=61),
intervention 2 (n=35)
and control (n=118).
Construction. 234 blue- collar
employees from
worksites/USA/52.5%.
Intervention 1: group
education classes for risk
factors, nutrition.
Intervention 2: online
individual programme
for risk factors, nutrition.
Cholesterol; blood
pressure; height;
weight; behavioural
risk factor survey; 10-
item questionnaire.
Baseline, 6 and
12 months.
Unclear. Local government
and research
study.
Blake et al (2019)31 Cluster RCT; participants
assigned to the
intervention (n=196)
and control (n=86).
Information
technology.
282 office workers/
China/50.3%.
10 min Qigong exercise
session delivered twice
per day at set times for
12 weeks via video.
Physical activity
(IPAQ); work
performance (WHO
HPQ); weekday sitting
hours.
Baseline and
12 weeks.
Low. Research study.
Braeckman et al
(1999)11 RCT; participants
assigned to the
intervention (n=272)
and control (n=366).
Construction. 638 workers from
four local worksites/
Belgium/100%.
Adopt a low- fat diet.
Received personal
counselling, feedback
and 2- hour group
session.
BMI; high- density
cholesterol; non-
fasting total serum
cholesterol; 24- hour
food record.
Baseline and 3
months.
Unclear. Research study.
Evans et al (1999)40 Controlled trial;
participants assigned to
the intervention (n=10)
and control (n=31).
Transport. 41 full- time
bus operators/
Sweden/67.5%.
Changes on a major
bus route: separate bus
lanes, priority traffic
signal system.
Blood pressure; heart
rate; Swedish measure
of perceived stress;
on- the- job hassles.
Baseline and
18 months.
High. Local government
and research
study.
Faude et al (2015)33 Longitudinal controlled
trial; participants
assigned to the
intervention (n=45) and
control (n=25).
Construction. 70 employees from
one construction
company/Switzerland/
ND.
Neuromuscular training
for 15 min daily for 13
weeks.
COP path length;
beam balancing (3
cm); beam balancing;
jump height; Freiburg
Physical Activity
Questionnaire.
Baseline, 8 and
13 weeks.
Unclear. Research study.
Gram et al (2012)12 RCT; participants
assigned to the
intervention (n=35) and
control (n=32).
Construction. 67 employees from
three construction
companies/
Denmark/100%.
Exercise programme of
3×20 min sessions per
week. Participants kept a
training log.
Pain intensity; work
ability; productivity;
perceived physical
exertion; sick leave.
Baseline and 6
months.
Low. Research study.
Gram et al (2012)13 RCT; participants
assigned to the
intervention (n=35) and
control (n=32).
Construction. 67 employees from
three construction
companies/
Denmark/100%.
Exercise programme of
3×20 min sessions per
week. Participants kept a
training log.
Pain intensity; work
ability; productivity;
perceived physical
exertion; sick leave.
Baseline and 6
months.
Unclear. Research study.
Groeneveld et al
(2010)15 RCT; participants
assigned to the
intervention (n=408)
and control (n=408).
Construction. 816 construction
workers/the
Netherlands/100%.
3×60 min and 4×30
min sessions. Chose
diet, physical activity or
smoking cessation.
Body weight; BMI;
systolic and diastolic
blood pressure; HDL
cholesterol; total
cholesterol; HbA1c.
Baseline 6 and
12 months.
Low. Research study.
Groeneveld et al
(2011)14 RCT; participants
assigned to the
intervention (n=408)
and control (408).
Construction. 816 construction
workers/the
Netherlands/100%.
3×60 min and 4×30
min sessions. Chose
diet, physical activity or
smoking cessation.
Body weight; BMI;
systolic and diastolic
blood pressure; HDL
cholesterol; total
cholesterol; HbA1c.
Baseline, 6 and
12 months.
Low. Research study.
Gupta et al (2018)34 Cluster RCT; participants
assigned to the
intervention (n=193)
and control (n=122).
Manufacturing. 415 employees
from three
manufacturing plants/
Denmark/70.4%.
Participated in visual
mapping talk with
line management.
Leaders, union and H&S
representatives also
participated.
Worker’s recovery;
work ability; mental
health; well- being;
physical work
demands; resources;
productivity.
Baseline,
10 and 12
months.
Low. Research study.
Hammer et al (2015)41 RCT; participants
assigned to the
intervention (n=167)
and control (n=125).
Construction. 264 employees from
an urban municipal
department/
USA/90%.
Supervisors participated
in FSSB and SBS
computer- based
training. All employees
participated in workshop
planning.
Blood pressure; SF-12;
safety behaviours.
Baseline and
12 months.
Unclear. Research study.
Holmström and
Ahlborg (2005)16 Cluster RCT; participants
assigned to the
intervention (n=30) and
control (n=17).
Construction. 57 employees from
a construction
company/Sweden/ND.
10 min exercises before
work for 3 months.
Neck mobility; spine
mobility; shoulder joint
mobility.
Baseline and 3
months.
Unclear. Research study.
Kang et al (2018)35 RCT; participants
assigned to the
intervention (n=12) and
control (n=12).
Manufacturing. 24 employees from an
automobile assembly
plant/South Korea/ND.
Performed exercises for
30 min each day for 6
weeks.
Back muscle strength;
stork balance stand
test; VAS; Oswestry
Disability Index; Beck
Depression Inventory.
Baseline and 6
weeks.
Unclear. Research study.
Kawakami et al
(1999)26 RCT; participants
assigned to the
intervention (n=81) and
control (n=77).
Manufacturing. 158 employees from a
manufacturing plant/
Japan/81%.
Participants received
personalised letters with
their stress levels and
recommendations to
help improve.
GHQ; blood pressure;
serum cholesterol;
triglycerides; sick
leave.
Baseline and
12 months.
Unclear. Research study.
continued
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
5
HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
Author (year) Design Industry
Participants,
context/setting/%
of men Intervention Outcomes
Follow- up
time points
Risk of
bias
Intervention
evaluation
Kobayashi et al
(2008)27 Controlled trial;
participants assigned to
the intervention (n=348)
and control (n=918).
Manufacturing. 1266 employees from
a manufacturing
plant/Japan/92.9%.
Participated in a mental
health workshop, identify
three actions to improve
the workplace.
Absenteeism; BJSQ;
job stress assessment
diagram.
Baseline and
12 months.
Low. Company and
research study.
Limaye et al (2017)30 RCT; participants
assigned to the
intervention (n=133)
and control (n=132).
Information
technology.
266 employees from
two information
technology industries/
India/74.8%.
Attended group session
and OW/OB participants
aimed to lose 5% weight
via four goals.
BMI; waist
circumference; blood
pressure; plasma
glucose; triglyceride;
total cholesterol; HDL
cholesterol; lifestyle
questionnaire.
Baseline, 3,
6, 9 and 12
months.
Low. Research study.
Limm et al (2011)42 RCT; participants
assigned to the
intervention (n=75) and
control (n=79).
Manufacturing. 174 employees from a
manufacturing plant/
Germany/99%.
Participated in 24×45
min group sessions on
individual work stress
situations.
Stress reactivity
scale; effort- reward
imbalance model;
cortisol; α-amylase;
HADS.
Baseline and
12 months.
Low. Research study.
Maes et al (1998)28 Quasi- experimental;
participants assigned to
the intervention (n=234)
and control (n=130).
Manufacturing. 264 employees from
Brabantia assembly
sites/the Netherlands/
ND.
Year 1: lifestyle changes
with three weekly
sessions.
Years 2 and 3: quality
of work changes with
leadership session.
BMI; heart rate;
systolic and diastolic
blood pressure;
total cholesterol;
absenteeism; wellness
at work; Symptom
Checklist-90; Work
Stress Questionnaire.
Baseline, years
1, 2 and 3.
Unclear. Company and
evaluated as a
research study.
Matsugaki et al
(2019)39 RCT; participants
assigned to the
intervention (n=30) and
control (n=30).
Manufacturing. 60 employees from
manufacturing
companies/Japan.
Monthly, face- to- face
personalised physical
activity and nutrition
education programme
for 6 months.
30 s chair stand; grip
strength; balance;
body composition.
Baseline and 6
months.
Low. Research study.
McCraty et al (2003)43 RCT; participants
assigned to the
intervention (n=18) and
control (n=14).
Information
technology.
38 employees from
an information
technology company/
America/71.5%.
Participated in a
16- hour programme
addressing positive
emotion refocusing and
emotional restricting
techniques.
Blood pressure,
emotional health;
workplace- related
measures.
Baseline and 3
months.
Unclear. Company and
evaluated as a
research study.
Milner et al (2018)18 RCT; participants
assigned to the
intervention (n=343)
and control (n=302).
Construction. 682 employees
from construction
companies/
Australia/100%.
Access to the
Contact+Connect
programme with 1
weekly message for 6
weeks.
Self- Stigma
of Depression
Scale; suicidal
ideation; suicide
communication;
SBQ- R.
Baseline and 6
weeks.
Low. Company and
evaluated as a
research study.
Milner et al (2020)17 RCT; participants
assigned to the
intervention (n=227)
and control (n=215).
Construction. 442 employees
from construction
companies/
Australia/100%.
Access to the
Contact+Connect
programme with 1
weekly message for 6
weeks.
Self- Stigma
of Depression
Scale; suicidal
ideation; suicide
communication;
SBQ- R.
Baseline and 6
weeks.
Low. Company and
evaluated as a
research study.
Molek- Winiarska and
Żołnierczyk- Zreda
(2018)19
RCT; participants
assigned to the
intervention (n=32) and
control (n=34).
Mining. 66 employees from
a mining company/
Poland.
Received the MBSR
intervention, sessions
were held in 4×8- hour
meetings and one
mindfulness days.
JCQ; GHQ-28. Baseline and 3
months.
Unclear. Research study.
Muñoz- Poblete et al
(2019)38 RCT; participants
assigned to the
intervention (n=53) and
control (n=56).
Manufacturing. 109 employees
from manufacturing
companies/
Chile/80.8%.
Received a resistance-
based exercise
programme, 3 times a
week for 15 min. Control
group received stretching
exercises.
VAS; DASH
questionnaire;
psychosocial risk
measurement; physical
risk measurement.
Baseline and
16 weeks.
Unclear. Research study.
Muyor et al (2012)20 RCT; participants
assigned to the
intervention (n=27) and
control (n=31).
Manufacturing. 58 employees from
a manufacturing
company/Spain/0%.
Hamstring stretches/
exercises three times a
week for 12 weeks.
Straight leg raise (right
and left leg); toe- touch
test.
Baseline and
12 weeks.
Unclear. Research study.
Nakao et al (2007)21 Cohort; participants
assigned to the
intervention (n=283)
and control (n=22).
Information
technology.
305 employees
from an information
technology company/
Japan/100%.
Offered counselling via
email/phone and referred
to psychiatric clinic.
Attended five seminars.
HAM- D and JCQ. Baseline and 2
years.
Unclear. Company and
research study.
Nishinoue et al
(2012)44 RCT; participants
assigned to the
intervention (n=62) and
control (n=62).
Information
technology.
127 employees
from an information
technology company/
Japan/85.75%.
Sleep hygiene education
session followed by
individual session
discussing their chosen
behaviour modification.
PSQI. Baseline and 3
months.
Unclear. Research study.
Table 1 continued
continued
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
6 HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
pressure with p<0.0140 and one reported an average reduction
of 9.0±3.0 mm Hg in one study43 and p<0.01 in another,40 but
no effects for systolic or diastolic blood pressure. For the two
studies focusing on lifestyle, the intervention reduced systolic
blood pressure by −1.9 mm Hg (95% CI −3.2 to –0.6; p=0.45)
and diastolic blood pressure by −1.3 mm Hg (95% CI −2.3
to –0.3; p=0.03) at 6 months, but not at 12 months,31 while
Hammer et al41 reported an intervention effect on mean blood
pressure of −2.2 mm Hg (95% CI −2.32 to 2.89; p<0.038)
at 12 months. A diet and physical activity intervention lowered
diastolic blood pressure versus the control group (−1.7 mm Hg,
95% CI −3.3 to –0.1; p<0.05) at 6 months, but not systolic
blood pressure (−2.2 mm Hg, 95% CI −4.6 to 0.3).
No interventions effects were reported for four studies
focusing on nutrition,32 physical activity,13 job strain26 and diet
and physical activity,24 respectively. After a 12- week physical
activity intervention, no evidence was reported for an effect
on systolic blood pressure (2.9 mm Hg, 95% CI −4.9 to 6.6;
p=0.77), diastolic blood pressure (2.4 mm Hg, 95% CI −3.2 to
6.4; p=0.51) and total cholesterol (0.2 mmol/L, 95% CI −0.1 to
0.4; p=0.56).13 Similarly, for interventions aimed at reducing job
strain, there was little evidence of intervention effect for systolic
blood pressure (p=0.93), diastolic blood pressure (p=0.31) and
total cholesterol (p=0.23).26 There was little evidence at both
6 and 12 months of an effect from a diet and physical activity
intervention on systolic blood pressure (−0.5 mm Hg, 95% CI
−3.9 to 2.9; and 0.5 mm Hg, 95% CI −3.1 to 4.1) (p=0.77
and p=0.78), diastolic blood pressure (−0.05 mm Hg, 95% CI
−2.3 to 2.2; and 2.0 mm Hg, 95% CI −0.4 to 4.5) (p=0.97
and p=1.02) and total cholesterol (0.03 mmol/L, 95% CI −0.2
to 0.2; and 0.07 mmol/L, 95% CI −0.1 to 0.2) (p=0.73 and
p=0.40).24 For the intervention focusing on nutrition, there was
no reported effect on either systolic or diastolic blood pressure
and cholesterol.32
Eight studies measured BMI as an outcome,11 13–15 24 30 32 39
of which seven were RCTs and one had a quasi- experimental
design.32 Six found that the workplace intervention resulted in
an improvement in BMI in the intervention group compared
with the control group. Two RCTs reported differing effects
in the intervention group on BMI; one decreased and another
increased BMI: −0.4 kg/m2 (95% CI −0.6 to –0.2)30 and 0.26
kg/m2 (95% CI 0.13 to 0.39),11 on average. Another two RCTs
Author (year) Design Industry
Participants,
context/setting/%
of men Intervention Outcomes
Follow- up
time points
Risk of
bias
Intervention
evaluation
Oude Hengel et al
(2012)22 RCT; participants
assigned to the
intervention (n=171)
and control (n=122).
Construction. 293 employees from
six construction
companies/the
Netherlands/99%.
Individual training
sessions with three
physical goals. Two
group mental health
sessions.
JCQ; Utrecht Work
Engagement Scale;
physical workload;
VBBA.
Baseline, 3,
6, 9 and 12
months.
Low. Research study.
Oude Hengel et al
(2013)23 RCT; participants
assigned to the
intervention (n=171)
and control (n=122).
Construction. 293 employees from
six construction
companies/the
Netherlands/99%.
Individual training
sessions with three
physical goals. Two
group mental health
sessions.
Absenteeism; Work
Ability Index; SF-12;
Dutch Musculoskeletal
Questionnaire.
Baseline, 3,
6, 9 and 12
months.
Low. Research study.
Pidd et al (2018)36 Cluster non- RCT;
participants assigned to
the intervention (n=169)
and control (n=148).
Manufacturing. 317 employees from
three manufacturing
companies/
Australia/87.4%.
Formal alcohol
workplace policy,
employee programme,
manager training session
and employee referral
pathway.
3- item AUDIT- C;
European alcohol
workplace and alcohol
baseline questionnaire;
alcohol- related harm
in the workplace;
policy awareness.
Baseline and
12 months.
Unclear. Company and
research study.
Rasotto et al (2015)25 Cluster RCT; participants
assigned to the
intervention (n=30) and
control (n=30).
Manufacturing. 60 employees from
a manufacturing
company/Italy/0%.
Exercise programme for
30 min twice a week for
6 months.
VAS (neck, elbow,
shoulder, wrist); SH (el,
ab); FL head; EX head;
LI head; RO head;
DASH questionnaire;
NPDS-1.
Baseline and 6
months.
Low. Research study.
Umanodan et al
(2009)45 Controlled trial;
participants assigned to
the intervention (n=96)
and control (n=53).
Manufacturing. 149 employees from
a steel company/
Japan/90%.
6- monthly sessions
lasting 30 min following
a multicomponent SMT
programme.
BJSQ; MBI- GS; WHO
HPQ.
Baseline and 6
months.
High. Research study.
Umanodan et al
(2014)46 Cluster RCT; participants
assigned to the
intervention (n=142)
and control (n=121).
Manufacturing. 263 employees from
a manufacturing
company/
Japan/92.6%.
Computer- based SMT
intervention, each
split into two sessions.
Suggested pace of 1 per
week.
BJSQ; UWES- J; WHO
HPQ; BSCP.
Baseline, 9 and
19 weeks.
Low. Research study.
Viester et al (2018)24 RCT; participants
assigned to the
intervention (n=162)
and control (n=152).
Construction. 314 employees
from construction
companies/the
Netherlands/100%.
Individual coaching
sessions to change
lifestyle behaviour over
6 months.
BMI; waist
circumference;
blood pressure; total
cholesterol; SQUASH
questionnaire.
Baseline, 6 and
12 months.
Research study.
Zebis et al (2011)37 RCT; participants
assigned to the
intervention (n=282)
and control (n=255).
Manufacturing. 537 employees from
two manufacturing
companies/
Denmark/15.5%.
Exercise programme for
1 hour per week over 20
weeks.
Modified Nordic
Questionnaire; training
frequency.
Baseline and 6
weeks.
Low. Research study.
AUDIT- C, Alcohol Use Disorders Identification Test - Consumption; BSCP, Brief Scales for Coping Profile; FSSB, Family- Supportive Supervisor Behaviours; HADS, Hospital Anxiety and Depression
Scale; HAM- D, Hamilton Depressing Rating Scale; HbA1c, Haemoglobin A1c; H&S, Health and Safety; MBI- GS, Maslach Burnout Inventory - General Survey; MBSR, Mindfulness- Based Stress
Reduction; PSQI, Pittsburgh Sleep Quality Index; SBS, Supervisor Based Safety; SH (el, ab), Shoulder (elevation, abduction); SMT, Stress Management Training; UWES- J, Utrecht Work Engagement
Scale - Japanese.
Table 1 continued
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
7
HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
reported intervention effects on BMI (−0.6 kg/m2, 95% CI 0.8
to –0.3) both at 6 and 12 months, versus the control group.14 15
An RCT measuring 6 months and 12 months post interven-
tion reported an intervention effect on BMI of −0.29 kg/m2
(95% CI −0.52 to –0.05; p=0.02) and −0.25 kg/m2 (95%
CI −0.55 to 0.05; p=0.11),24 respectively. Two studies—one
quasi- experimental design42 (data not provided) and the other
an RCT46—did not report evidence of an intervention effect on
BMI (0.1 kg/m2, 95% CI −0.3 to 0.6; p=0.55).
Several studies relied on questionnaires to measure physical
health, including Short Form Health Survey (SF-12) and General
Health Questionnaire. Using the SF-12 questionnaire, a diet
and physical activity intervention for construction workers on
work ability, health and sick leave found no intervention effects
on either physical or mental health status (−0.04 points; 95%
CI −1.43 to 1.35).23 Another RCT for construction and utility
workers provided an intervention for work–life stress and safety-
related psychosocial risk factors. While there was a reduction in
blood pressure at 12 months (−2.15 mm Hg; p<0.05), there
was no effect between control and intervention groups for mean
SF-12 physical activity composite scores (−0.32 points; 95% CI
−19.3 to 1.29).41
Measures of psychological health or occupational stress
Seventeen studies used measures of psychological health or occu-
pational stress for either primary or secondary outcomes. Of these,
seven studies were in the manufacturing sector,26 28 29 36 42 45 46
seven studies were in the construction sector,12 17 18 22 23 27 41 two
studies in the IT sector,21 43 one study in the transport sector40 and
one study in the mining sector.19 The majority of these studies
aimed to reduce job strain,19 26 27 40 42 43 45 46 lifestyle,22 23 28 41
mental health,17 18 depression,21 alcohol,36 physical activity12 and
tinnitus distress.29
The most commonly used validated scales were the Brief
Job Stress Questionnaire,27 45 46 Job Content Questionnaire
(JCQ)19 21 22 and Utrecht Work Engagement Scale.22 46 A study
with Japanese manufacturing employees27 concluded that there
was little evidence that the implementation of an organisational
intervention had an effect in men. However, for women, skill
underutilisation (test value=3.9, 95% CI 2.09 to 2.71), super-
visor and coworker support (test value=22.4, 95% CI 5.68 to
7.32; and test value=4.5, 95% CI 6.75 to 8.44) and psycholog-
ical distress (test value=5.1, 95% CI 5.52 to 7.28) improved
(p<0.05). While delivering a stress management training
programme face- to- face over 6 months, one study reported a
positive effect on knowledge (F=32.9, p<0.001).45 In compar-
ison, an intervention delivered using a computer to improve
psychological well- being and work performance in manufac-
turing employees had little effect on psychological distress.46
In a mindfulness- based stress reduction intervention for
workers in a copper mine, there was a positive interven-
tion effect measured by the JCQ, for decision latitude (0.22
points; p<0.001, η2=0.219), supervisor social support (0.13;
p<0.004, η2=0.130) and coworker social support (0.1; p<0.02,
η2=0.083).19 A study measuring changes in depression and
suicide- related behaviours in male employees in an IT company
found there was no intervention effect between baseline and
follow- up in both control and intervention groups for three JCQ
scales: demand (0.9, 95% CI 0.9 to 1.0; p=0.757), control (1.0,
95% CI 0.9 to 1.0; p=0.422) and support (0.9, 95% CI −0.9
to 1.0; p=0.099).21 However, total Hamilton depression rating
scale (HAM- D) scores favourably decreased in the intervention
group (1.7, 95% CI 1.3 to 1.8; p=0.001). An intervention for
Figure 2 Risk of Bias Tool.
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
8 HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
Dutch construction workers using the JCQ did not result in any
intervention effects on social support at work (0.03, 95% CI
−0.39 to 0.46), including coworker social support (0.00, 95%
CI −0.21 to 0.20) or supervisor support (0.09, 95% CI −0.18 to
0.36).22 Furthermore, as measured by the Utrecht Work Engage-
ment Scale, there were no intervention effects for work engage-
ment (0.02, 95% CI −0.12 to 0.15) and the accompanying
subscales (vigour 0.02, 95% CI −0.19 to 0.15; dedication 0.07,
95% CI −0.08 to 0.22) and a small negative effect for absorp-
tion (−0.09, 95% CI −1.64 to 1.46) at 3, 6 and 12 months.
Albatross plots
An albatross plot is presented of all studies with contours for
standardised mean differences (figure 3). The studies were
spread out across the plot, but there was some evidence of an
improvement in employee health and well- being due to a clus-
tering on the right- hand side. In particular, all studies with a
focus on musculoskeletal disorder had a positive association,
while studies focusing on lifestyle, mental health and nutrition
had a negative or no association. The results for studies with low
risk of bias only are provided in online supplemental figure 5.
These results indicate greater clustering on the right- hand side
of the plot, compared with all studies, suggesting that interven-
tions with low risk of bias reported greater positive effect on
employee health and well- being.
Meta-analyses
Several studies evaluated interventions based on modifying
blood pressure and BMI, with the outcomes being sufficiently
similar to justify combined analysis (random effects).
Blood pressure
Ten studies reported measuring blood pressure as an outcome,
but only five were sufficiently similar to combine in a meta-
analysis. Based on the five studies that were included, there was
little evidence of a positive effect on diastolic blood pressure
(p=0.25) or on systolic blood pressure (p=0.49) (online supple-
mental figures 2 and 3). There was no evidence of heteroge-
neity in either the diastolic or systolic blood pressure findings
(I2=1% and I2=0%, respectively). For studies with low risk of
bias, there was also little evidence of a positive effect on diastolic
blood pressure (p=0.63) or on systolic blood pressure (p=0.86),
with no evidence of heterogeneity (I2=0%) (online supplemental
figures 5 and 6).
Body mass index
Seven studies reported measuring BMI; however, one study was
excluded as it did not report the BMI effect sizes in the paper
and two studies did not include SDs. Three studies measured
outcomes at 12- month follow- up15 24 30 and one study measured
outcomes at 6 months.39 Based on the four included studies,
there was little evidence of an effect on BMI, as shown in online
supplemental figure 4, with low heterogeneity (I2=25%). All
studies were classified as low risk of bias.
DISCUSSION
This systematic review was based on published literature
for RCTs or non- randomised intervention group allocation
reporting the effectiveness of workplace interventions aimed at
improving health and well- being in male- dominated industries.
A total of 35 studies met the inclusion criteria, undertaken in 14
different countries between 1998 and 2020. Given the hetero-
geneity across the interventions and outcome measures, meta-
analysis could only be conducted for blood pressure and BMI.
The sensitivity analysis indicated that studies with a low risk of
bias reported larger effect sizes compared with high risk of bias
studies. The main conclusion from this review is that there is
some evidence that interventions specifically targeted at male-
dominated industries and aimed at improving employee health
and well- being can be effective. Evidence from more gender-
mixed or female- dominated industries generally reports much
more positive findings.48
It has been proposed that interventions addressing the level
of work organisations or the work environment may produce
more sustainable effects on the health of employees than inter-
ventions focusing mainly on individual behaviours.49 Five
studies in this review27 28 34 36 40 used an organisational approach
rather than addressing individual- level characteristics. In three
of these studies, the intervention had a favourable effect on
outcome measures, in comparison with 16 (out of 27) studies
that focused on individual- level characteristics. Interventions
addressing individual behaviours, that is, smoking cessation,
sedentary behaviour and alcohol consumption, limited the
long- term adherence to behaviour changes. This suggests that
including employees alongside management in the promotion of
behaviour changes provides a learning experience to understand
the working environment and ultimately increase the effective-
ness of the intervention.27
Various delivery methods were used in the interventions
included in this systematic review. A systematic review which
reviewed web- based interventions delivered in the workplace
concluded that interventions can have positive effects post
intervention on both employees’ psychological well- being and
work effectiveness.50 A study included in this review surmised
that delivering the intervention via the internet for reducing risk
factors for type 2 diabetes led to a reduction in the prevalence
of overweight/obesity significantly in the intervention group.30
In comparison with face- to- face delivery, using the internet
can be more cost- effective, sustainable and potentially scalable
to a wider audience. Furthermore, due to the transient nature
of an employee’s working environment, particularly common
within male- dominated industries, an internet intervention can
be relevant to remote workers and those with non- conventional
schedules.
Limitations of the studies in the review
One of the limitations of the studies included in this review
was that the majority of interventions had only relatively short
1 10 100 500 1,000 2,000
Number of participants
0.001 0.01 0.05 1 0.05 0.01 0.001
P value
Mean Difference = ±6.31 Mean Difference = ±12.62 Mean Difference = ±18.93
alcohol depression diet and physical activity
job strain lifestyle mental health
musculoskeletal disorders nutrition physical activity
sleep smoking cessation, diet and physical activity
Negative Association Null Positive Association
Effect contours drawn using a standard deviation of 651.81
Grouped by: study_area_str
Figure 3 Albatross plot.
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
9
HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
follow- up up to 6–12 months. This provides little data on
whether these workplace interventions have led to sustainable
behaviour changes. Therefore, we were limited in assessing the
long- term effects and sustainability of the interventions.
While not a selection criterion, most of the studies solely
focused on quantitative analysis of the outcomes, and therefore
we were unable to understand if the failure in the effectiveness
was due to unsuccessful implementation or if the underlying
theories used in intervention development were incorrect. The
absence of information regarding intervention design, context
and process in studies has previously been discussed.51 Only
five of the studies included provided information regarding
qualitative evaluation, including intervention satisfaction,29
intervention implementation,41 intervention acceptability30 and
participant engagement.18 Of the 35 studies included in this
review, 2 studies had a high risk of bias and 16 studies had an
unclear risk of bias. Studies with an unclear risk of bias did not
provide details regarding selection and performance bias, in
respect to allocation concealment and blinding.
Within workplace interventions, low recruitment of partic-
ipants has been a common problem.52 In this systematic
review, the studies recorded the follow- up rate of between
50% and 94%, with six studies not providing any informa-
tion regarding retention rates. For countries such as the USA,
where employers directly pay an employee’s health insurance,
improving health and well- being of the workforce has signif-
icant financial rewards. However, it has been suggested that
long- term investment in health and job satisfaction, rather than
tools for employee health and well- being, may be a more effec-
tive approach.
Workplaces provide an ideal environment to implement an
intervention as employees spend more than one- third of their
waking hours at work, men more than women.53 However,
it is important to recognise that interventions do not always
consider the impact of an employee’s life outside of work on
their health and well- being. More employees have caring
responsibilities outside of the workplace which can impact the
work–life balance, as well as the wider political and economic
climate, including Brexit. None of the studies included in this
systematic review measured non- work- related factors as part of
the intervention.
Limitations of this review
There are several limitations to this review that should be consid-
ered. Several studies could not be included due to the definition
of ‘male- dominated industry’. There also may have been missed
research studies as health- related outcomes relating to employee
health and well- being were often identified as secondary
outcomes and therefore not always included in the abstracts. In
addition, grey literature was not included in the search strategy.
Searches were limited to articles that had been published in the
English language, increasing the likelihood that other, non- peer
reviewed studies were not included and the possibility of any
language bias.
There is currently no general agreement on the definition of
employee health and well- being, and as a result an absence of a
shared definition. Therefore, in this systematic review the defi-
nition by Grant et al54 was used, which includes three different
dimensions of employee health and well- being. While this defi-
nition was selected because it explores three dimensions, some
studies will be excluded from the review if they have adhered to
a different definition.
Strengths of this review
To the best of our knowledge there is no published evidence
synthesis of the effectiveness of workplace interventions that aim
to improve employee health and well- being specifically in male-
dominated industries. This paper reviews interventions that have
been conducted in workplace settings and as a result identifies
real- life problems that researchers, policy makers and employers
should consider prior to implementation. The studies included
in the systematic review came from multiple locations across the
globe, including Asia, Europe, North America and Australasia.
Therefore, the results are transferable to other geographical
locations.
Further research
Future studies should consider understanding the long- term
implications of adhering to workplace intervention, both
for employees and employers. Most of the studies included
in this review included a follow- up period of up to a year
postintervention, with only three studies with a follow- up
longer than 1 year. Researchers also need to consider the
health economics of the intervention and the impact of
changing employee health and well- being has on a busi-
ness’ outcomes in both public and private sectors. Within
male- dominated industries, many employees are required
to work various shift patterns in transient environments.
Further work therefore should explore how interventions
can address these barriers in implementing a workplace
intervention.
Researchers need to consider an organisational rather than
individual approach. To remove additional burden, organi-
sations need to ensure that the intervention outcomes align
with their business activities and what behaviour changes
they wish to prioritise. By changing the culture from the
promotion of risk- taking behaviours, employees will have
a greater chance of adhering to the intervention for full
duration and allowing researchers to measure long- term
implications.
CONCLUSION
The currently available evidence indicated that interven-
tions that aim to improve employee health and well- being
in the workplace of male- dominated industries had none
or only limited positive effect. Improving employee health
and well- being with workplace interventions is possible, but
intervention content and delivery must be considered. While
the majority of interventions were based at individual level,
those who engaged at multiple levels, that is, policy, environ-
mental and individual, appeared to be more effective. This
systematic review further indicated that despite the different
culture within male- dominated industries compared with
mixed- gender industries, workplace interventions that aim
to improve health and well- being in employees can have
positive outcomes.
Twitter Frank de Vocht @frankdevocht
Contributors PH conducted the systematic review and wrote the manuscript as
part of her PhD research under the supervision of FdV, RR and RM. PH conducted the
literature search, selected and classified the appropriate articles, created the tables/
figures, and wrote the manuscript. YC- U assisted in the search strategy, literature
searches and methodological procedure of the systematic review. All authors
contributed directly by consistently giving comments and feedback to the review
write- up. All authors read and approved the final manuscript.
Funding This work is funded by the Wellcome Trust (108902/Z/15/Z). FdV is partly
funded by National Institute for Health Research Applied Research Collaboration
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
10 HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust. RCR is
a de Pass VC Research Fellow, Vice Chancellor’s Research Fellow at the University
of Bristol. This work was supported by Cancer Research UK (C18281/A29019).
RCR and RMM are members of the MRC Medical Research Council Integrative
Epidemiology Unit at the University of Bristol, supported by the Medical Research
Council (MC_UU_00011/1 and MC_UU_00011/5). The work was also supported
by Cancer Research UK (C18281/A19169) and the Economic and Social Research
Council (ESRC) (ES/N000498/1). RMM is supported by the National Institute for
Health Research (NIHR) Bristol Biomedical Research Centre, which is funded by the
NIHR and is a partnership between University Hospitals Bristol NHS Foundation Trust
and the University of Bristol.
Disclaimer The views expressed are those of the authors and not necessarily those
of the NHS, the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It
has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have
been peer- reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the content
includes any translated material, BMJ does not warrant the accuracy and reliability
of the translations (including but not limited to local regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits
others to copy, redistribute, remix, transform and build upon this work for any
purpose, provided the original work is properly cited, a link to the licence is given,
and indication of whether changes were made. See:https:// creativecommons. org/
licenses/ by/ 4. 0/.
ORCID iDs
Paige MHulls http:// orcid. org/ 0000- 0002- 8466- 874X
Frankde Vocht http:// orcid. org/ 0000- 0003- 3631- 627X
REFERENCES
1 Roche AM, Pidd K, Fischer JA, etal. Men, work, and mental health: a systematic
review of depression in Male- dominated industries and occupations. Saf Health Work
2016;7:268–83.
2 World Health Organisation. Who healthy workplace framework and model:
background and supporting literature and practise, 2010. Available: http://www. who.
int/ occupational_ health/ healthy_ workplace_ framework. pdf [Accessed 03 Jul 2018].
3 Milner A, Kavanagh A, King T, etal. The influence of masculine norms and
occupational factors on mental health: evidence from the baseline of the Australian
longitudinal study on male health. Am J Mens Health 2018;12:696–705.
4 BHF. CVD Statistics - BHF UK Factsheet, 2018. Available: https://www. bhf. org. uk/
research/ heart- statistics/ heart- statistics- publications [Accessed 29 Jun 2018].
5 Tarro L, Llauradó E, Ulldemolins G, etal. Effectiveness of workplace interventions for
improving absenteeism, productivity, and work ability of employees: a systematic
review and meta- analysis of randomized controlled trials. Int J Environ Res Public
Health 2020;17:1901.
6 Bevan S. The business case for employee health and wellbeing, 2010. Available: http://
investorsinpeople. ph/ wp- content/ uploads/ 2013/ 08/ The- Business- Case- for- Employee-
Health- and- Wellbeing- Feb- 2010. pdf [Accessed 20 Feb 2020].
7 Moher D, Shamseer L, Clarke M, etal. Preferred reporting items for systematic review
and meta- analysis protocols (PRISMA- P) 2015 statement. Syst Rev 2015;4:1.
8 Hulls PM, Richmond RC, Martin RM, etal. A systematic review protocol examining
workplace interventions that aim to improve employee health and wellbeing in male-
dominated industries. Syst Rev 2020;9:10.
9 Harrison S, Jones HE, Martin RM, etal. The albatross plot: a novel graphical tool for
presenting results of diversely reported studies in a systematic review. Res Synth
Methods 2017;8:281–9.
10 StataCorp. Stata 14, 2016. Available: http://www. stata. com/ [Accessed 08 Dec 2016].
11 Braeckman L, De Bacquer D, Maes L, etal. Effects of a low- intensity worksite- based
nutrition intervention. Occup Med 1999;49:549–55.
12 Gram B, Holtermann A, Bültmann U, etal. Does an exercise intervention improving
aerobic capacity among construction workers also improve musculoskeletal pain,
work ability, productivity, perceived physical exertion, and sick leave?: a randomized
controlled trial. J Occup Environ Med 2012;54:1520–6.
13 Gram B, Holtermann A, Søgaard K, etal. Effect of individualized worksite exercise
training on aerobic capacity and muscle strength among construction workers
– a randomized controlled intervention study. Scand J Work Environ Health
2012;38:467–75.
14 Groeneveld IF, Proper KI, van der Beek AJ, etal. Short and long term effects of a
lifestyle intervention for construction workers at risk for cardiovascular disease: a
randomized controlled trial. BMC Public Health 2011;11:836.
15 Groeneveld IF, Proper KI, van der Beek AJ, etal. Sustained body weight reduction
by an individual- based lifestyle intervention for workers in the construction industry
at risk for cardiovascular disease: results of a randomized controlled trial. Prev Med
2010;51:240–6.
16 Holmström E, Ahlborg B. Morning warming- up exercise--effects on musculoskeletal
fitness in construction workers. Appl Ergon 2005;36:513–9.
17 Milner A, Aitken Z, Law PCF, etal. The relationship between an electronic mental
health stigma campaign and suicidal thoughts and behaviours: a two- arm
randomized controlled trial in the Australian construction industry. Health Promot Int
2020;35:478–85.
18 Milner A, Law PCF, Mann C, etal. A smart- phone intervention to address mental
health stigma in the construction industry: a two- arm randomised controlled trial. SSM
Popul Health 2018;4:164–8.
19 Molek- Winiarska D, Żołnierczyk- Zreda D. Application of mindfulness- based stress
reduction to a stress management intervention in a study of a mining sector company.
Int J Occup Saf Ergon 2018;24:546–56.
20 Muyor JM, López- Miñarro PA, Casimiro AJ. Effect of stretching program in an
industrial workplace on hamstring flexibility and sagittal spinal posture of adult
women workers: a randomized controlled trial. J Back Musculoskelet Rehabil
2012;25:161–9.
21 Nakao M, Nishikitani M, Shima S, etal. A 2- year cohort study on the impact of an
employee assistance programme (EAP) on depression and suicidal thoughts in male
Japanese workers. Int Arch Occup Environ Health 2007;81:151–7.
22 Oude Hengel KM, Blatter BM, Joling CI, etal. Effectiveness of an intervention at
construction worksites on work engagement, social support, physical workload, and
need for recovery: results from a cluster randomized controlled trial. BMC Public
Health 2012;12:1008.
23 Oude Hengel KM, Blatter BM, van der Molen HF, etal. The effectiveness of a
construction worksite prevention program on work ability, health, and sick leave:
results from a cluster randomized controlled trial. Scand J Work Environ Health
2013;39:456–67.
24 Viester L, Verhagen EALM, Bongers PM, etal. Effectiveness of a worksite intervention
for male construction workers on dietary and physical activity behaviors, body mass
index, and health outcomes: results of a randomized controlled trial. Am J Health
Promot 2018;32:795–805.
25 Rasotto C, Bergamin M, Sieverdes JC, etal. A tailored workplace exercise program
for women at risk for neck and upper limb musculoskeletal disorders: a randomized
controlled trial. J Occup Environ Med 2015;57:178–83.
26 Kawakami N, Haratani T, Iwata N, etal. Effects of mailed advice on stress
reduction among employees in Japan: a randomized controlled trial. Ind Health
1999;37:237–42.
27 Kobayashi Y, Kaneyoshi A, Yokota A, etal. Effects of a worker participatory program
for improving work environments on job stressors and mental health among workers:
a controlled trial. J Occup Health 2008;50:455–70.
28 Maes S, Verhoeven C, Kittel F, etal. Effects of a Dutch work- site wellness- health
program: the Brabantia project. Am J Public Health 1998;88:1037–41.
29 Abbott J- AM, Kaldo V, Klein B, etal. A cluster randomised trial of an Internet- based
intervention program for tinnitus distress in an industrial setting. Cogn Behav Ther
2009;38:162–73.
30 Limaye T, Kumaran K, Joglekar C, etal. Efficacy of a virtual assistance- based lifestyle
intervention in reducing risk factors for type 2 diabetes in young employees in the
information technology industry in India: limit, a randomized controlled trial. Diabet
Med 2017;34:563–8.
31 Blake H, Lai B, Coman E, etal. Move- It: a cluster- randomised digital worksite exercise
intervention in China: outcome and process evaluation. Int J Environ Res Public Health
2019;16:3451.
32 Anderson J, Dusenbury L. Worksite cholesterol and nutrition: an intervention project in
Colorado. Aaohn J 1999;47:99–106.
33 Faude O, Donath L, Bopp M, etal. Neuromuscular training in construction
workers: a longitudinal controlled pilot study. Int Arch Occup Environ Health
2015;88:697–705.
34 Gupta N, Wåhlin- Jacobsen CD, Abildgaard JS, etal. Effectiveness of a participatory
physical and psychosocial intervention to balance the demands and resources of
industrial workers: a cluster- randomized controlled trial. Scand J Work Environ Health
2018;44:58–68.
35 Kang T- W, Lee J- H, Park D- H, etal. Effect of 6- week lumbar stabilization exercise
performed on stable versus unstable surfaces in automobile assembly workers with
mechanical chronic low back pain. Work 2018;60:445–54.
36 Pidd K, Roche A, Cameron J, etal. Workplace alcohol harm reduction intervention in
Australia: cluster non- randomised controlled trial. Drug Alcohol Rev 2018;37:502–13.
37 Zebis MK, Andersen LL, Pedersen MT, etal. Implementation of neck/shoulder
exercises for pain relief among industrial workers: a randomized controlled trial. BMC
Musculoskelet Disord 2011;12:205.
38 Muñoz- Poblete C, Bascour- Sandoval C, Inostroza- Quiroz J, etal. Effectiveness
of workplace- based muscle resistance training exercise program in preventing
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
11
HullsPM, etal. Occup Environ Med 2021;0:1–11. doi:10.1136/oemed-2020-107314
Systematic review
musculoskeletal dysfunction of the upper limbs in manufacturing workers. J Occup
Rehabil 2019;29:810–21.
39 Matsugaki R, Sakata M, Itoh H, etal. Effects of a physical therapist led workplace
Personal- Fitness management program for manufacturing industry workers: a
randomized controlled trial. J Occup Environ Med 2019;61:e445–51.
40 Evans GW, Johansson G, Rydstedt L. Hassles on the job: a study of a job intervention
with urban bus drivers. J Organ Behav 1999;20:199–208.
41 Hammer LB, Truxillo DM, Bodner T, etal. Effects of a workplace intervention
targeting psychosocial risk factors on safety and health outcomes. Biomed Res Int
2015;2015:1–12.
42 Limm H, Gündel H, Heinmüller M, etal. Stress management interventions in the
workplace improve stress reactivity: a randomised controlled trial. Occup Environ Med
2011;68:126.
43 McCraty R, Atkinson M, Tomasino D. Impact of a workplace stress reduction
program on blood pressure and emotional health in hypertensive employees. J Altern
Complement Med 2003;9:355–69.
44 Nishinoue N, Takano T, Kaku A, etal. Effects of sleep hygiene education and
behavioral therapy on sleep quality of white- collar workers: a randomized controlled
trial. Ind Health 2012;50:123–31.
45 Umanodan R, Kobayashi Y, Nakamura M, etal. Effects of a worksite stress
management training program with six short- hour sessions: a controlled trial among
Japanese employees. J Occup Health 2009;51:294–302.
46 Umanodan R, Shimazu A, Minami M, etal. Effects of computer- based stress
management training on psychological well- being and work performance in Japanese
employees: a cluster randomized controlled trial. Ind Health 2014;52:480–91.
47 Groeneveld IF, Proper KI, van der Beek AJ, etal. Design of a RCT evaluating the
(cost-) effectiveness of a lifestyle intervention for male construction workers at risk
for cardiovascular disease: the health under construction study. BMC Public Health
2008;8:1.
48 Schliemann D, Woodside JV. The effectiveness of dietary workplace interventions: a
systematic review of systematic reviews. Public Health Nutr 2019;22:942–55.
49 Montano D, Hoven H, Siegrist J. Effects of organisational- level interventions at work
on employees’ health: a systematic review. BMC Public Health 2014;14:135.
50 Carolan S, Harris PR, Cavanagh K. Improving employee well- being and effectiveness:
systematic review and meta- analysis of web- based psychological interventions
delivered in the workplace. J Med Internet Res 2017;19:e271.
51 Aust B, Rugulies R, Finken A, etal. When workplace interventions lead to negative
effects: learning from failures. Scand J Public Health 2010;38:106–19.
52 Odeen M, Magnussen LH, Maeland S, etal. Systematic review of active workplace
interventions to reduce sickness absence. Occup Med 2013;63:7–16.
53 Verdonk P, Seesing H, de Rijk A. Doing masculinity, not doing health? A qualitative
study among Dutch male employees about health beliefs and workplace physical
activity. BMC Public Health 2010;10:712.
54 Grant AM, Christianson MK, Price RH. Happiness, health, or relationships? managerial
practices and employee well- being tradeoffs. Acad Manag Perspect 2007;21:51–63.
on May 25, 2021 by guest. Protected by copyright.http://oem.bmj.com/Occup Environ Med: first published as 10.1136/oemed-2020-107314 on 25 May 2021. Downloaded from
