Background  This study explored eating disorders (ED) prevalences, comorbidity of ED with other mental disorders, and risk factors for ED among university students. ED included binge eating disorder (BED), bulimia nervosa (BN), or other specified feeding and eating disorders (OSFED).

Methods  A total of 3425 first-year university students in Sweden completed an online survey covering a range of criteria for psychiatric diagnoses, within the World Mental Health International College Student (WMH-ICS) initiative. Pearson’s χ² -tests were used to compare algorithm-based diagnostic prevalences for eating disorders and other comorbid psychiatric disorders between three groups: students with ED with or without other comorbid psychiatric disorders (A), students with psychiatric disorders but no ED comorbidity (B), and students with no psychiatric disorders (C). Multinomial logistic regression was used to calculate between-group comparisons of odds ratios for independent risk factors, where group B served as the reference group for comparisons with groups A and C.

Results  Of the total sample, 75% had at least one psychiatric disorder and 28% had at least one lifetime ED diagnosis. Students with ED (group A) reported higher prevalences for comorbid anxiety disorders, depression, suicidal behavior, and non-suicidal self-injury compared to students with psychiatric disorders but no ED (group B). Group A participants exhibited a higher risk of hazardous drinking, were more likely to have received medical treatment, and to identify as bisexual. Compared to group B, students with no psychiatric disorders (group C) were more likely to report better mental and physical health, but less likely to engage in hazardous drinking, and to have sought mental health treatment.

Conclusions  A large proportion of students with ED had additional psychiatric disorders, indicating that individuals with ED suffer from multiple mental health problems. It is crucial that student health services acquire competency to offer effective ED assessment and treatment.

Purpose: Job insecurity characterizes academic work, with potential risks for the health, well-being, and personal lives of faculty. Notwithstanding, faculty with job insecurity experiences may still find academia conducive to pursuing personal fulfilment. As faculty experiences of psychological well-being may be coloured by insecurity, this study sought to qualitatively investigate the ways in which experiences of insecurity and psychological well-being co-occur.

Methods: This study followed a questionnaire study of a representative sample of faculty in Swedish academia and their job insecurity perceptions, inviting the most insecure to participate. The participant group included 19 faculty from nine public Swedish higher education institutions. Transcripts of the semi-structured interviews were analysed using reflexive thematic analysis, guided by the six theoretical dimensions of psychological well-being.

Results: Two themes were developed: 1) Staying afloat?, and 2) I’m not yet where I’m supposed to be. These themes elucidate faculty experiences of managing their current work (and personal) situations, and reveal how faculty orient themselves in relation to their futures, pasts and presents.

Conclusions: The findings demonstrate how experiences of insecurity co-exist with psychological well-being in constraining and enhancing faculty well-being. This reveals how psychological well-being involves a dynamic process of negotiation, especially during transitional periods.

Aim: The COVID-19 pandemic and associated restrictions posed challenges to people’s private and work lives. This included a rapid shift from on-site to remote work for many working adults in Sweden and internationally, and limited opportunities for indoor social and leisure activities. This involved risks for increased loneliness and social isolation, particularly among those mainly working remotely. In this context, nature visits may mitigate loneliness. This study adds to existing research in investigating whether a higher degree of remote work during COVID-19 was related to increased loneliness and whether nature visits mitigated loneliness, especially for those who mainly worked remotely. Subject and methods: The sample comprised a subsample of respondents to the Swedish Longitudinal Occupational Survey of Health 2020 (n = 984). Nature-related habits (NRH) were measured using self-reported frequency of visits to various natural environments. The effect of remote work, NRH, and time on loneliness (before – during COVID-19) was analyzed using linear mixed models while controlling for confounders. Results: Loneliness levels during COVID-19 were highest and increased the most compared to before the pandemic among individuals with the greatest degree of working remotely. Engaging daily in NRH was associated with lower loneliness levels, particularly among individuals mostly working remotely. This was observed in a three-way interaction effect between remote work, NRH, and time on loneliness. Conclusion: Daily nature visits may protect against loneliness during and beyond crises like COVID-19, particularly for those mainly working remotely. Policies preserving and facilitating access to nature may promote resilience during and beyond crises like COVID-19.

Background: Addressing the effects of non-compliance with health-related recommendations in pandemics is needed for informed decision-making. This longitudinal study investigated the effects of non-compliance on mental health and academic self-efficacy among university students in Sweden. Methods: Baseline assessments were conducted in May 2020, with follow-ups after 5 and 10 months. Students (n = 3123) from 19 universities completed online questionnaires covering compliance, mental health, and academic self-efficacy. Effects of non-compliance were estimated using causal inference and multilevel multinomial regression. Results: Non-compliant students constituted a minority, but their proportion increased over time. Regarding mental health and academic self-efficacy, few differences were observed between compliant and non-compliant students. When differences were identified, non-compliant students experienced fewer negative effects on mental health and academic self-efficacy than compliant students. Conclusion: The findings may suggest that non-compliance may have involved a trade-off between increased individual freedom and mitigating negative outcomes. Addressing the research gap on non-compliance effects is crucial for informed decision-making and promoting the common good. This may guide strategies balancing individual autonomy and collective well-being during future pandemics. Pre-registration: Center for Open Science (OSF), https://accounts.osf.io/login?service=https://osf.io/37dhm/.

Introduction: Sickness absence (SA) has been shown to be associated with several negative consequences, both for the affected individual as well as for society on the whole, in terms of economic loss. The most common reason for SA is SA due to common mental disorders (CMDs). Previous studies have indicated that there is an association between exposure to work-related offensive behaviours, such as harassment, bullying, violence and threats of different kinds and CMDs. However, the mechanistic pathway in this association is still largely unknown. For example, the associations between exposure to offensive or abusive behaviours and health outcomes may partially be explained by individual characteristics, including genetic predispositions and early experiences. The aim of the present study was to investigate the role of familial factors (genetics and shared early-life environment) and neuroticism in the associations between exposure to work-related violence/threats and harassment/bullying, and SA due to CMDs.

Method: The study sample included 8795 twin individuals from the Swedish Twin project of Disability pension and Sickness absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE) linked to national register data. Self-reported work-related violence and/or threats and work-related harassment including bullying and register data on SA due to CMDs were analysed using logistic regression on the whole sample, and conditional logistic regression among complete same-sex twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years or until their first incident SA spell due to CMD. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses.

Results: Exposure to work-related violence/threats were associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children living at home, education, type of residential area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment/bullying (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to either of the kinds of exposure or exposure to both kinds, i.e. violence/threats and/or harassment/bullying (OR 1.98 95% CI 1.52-2.59), compared with the unexposed. Analyses of twin pairs discordant on exposure, using the unexposed twin sibling as reference, showed somewhat reduced ORs that were no longer statistically significant for all exposures. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, with higher odds of SA due to CMDs in the group scoring lower on neuroticism.

Conclusion: Exposure to work-related offensive behaviours were associated with SA due to CMDs. The results of the matched twin pair analysis indicated that these associations may be confounded by familial factors. In addition, an interaction effect between violence/threats and neuroticism was found. Thus, future studies investigating associations and causality between offensive behaviours at work and mental health-related outcomes should, when possible, consider familial factors and neuroticism.

Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities’ management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities’ capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students’ academic performance will be adversely affected.

Background: Job insecurity increasingly characterizes academic work. Faculty who experience insecurity may be at risk for impaired health and well-being, but what might insecurity mean for experiences and expressions of positive psychological functioning, namely psychological well- being? Because psychological well-being is important for mental health, it is relevant to explore insecure faculty’s expressions of positive psychological functioning (or a lack thereof). Thus, this study seeks to understand: How are experiences of insecurity and psychological well-being expressed by faculty in Swedish academia?

Method: This study is a qualitative follow-up to a questionnaire study, which revealed that some faculty in Swedish academia experience high insecurity. The participant group consisted of some 20 insecure faculty from public Swedish HEIs. The interviews were semi-structured and were analyzed using reflexive thematic analysis, deductively, including the six theoretical dimensions of psychological well-being.

Results: Preliminary findings suggest that some experiences and expressions of insecurity and psychological well-being span across professional and personal domains, while other experiences and expressions are restricted: by the rules and conventions of the academic system in Sweden, but also by individual facultys’ personal circumstances.

Discussion: This study reveals how experiences of insecurity within academia can sometimes be experienced as barriers to one’s ability to strive to reach one’s full potential. Simultaneously, psychological well-being is also facilitated through academic work. A nuanced understanding of the ways insecurity in academia is experienced in relation to psychological well-being is important for understanding faculty motivation, and the complex interplay between academic work and positive psychological functioning.

Aims Spending time in natural environments has been linked to mental health benefits, and may have been an important resilience factor during the COVID-19 pandemic, but longitudinal studies are limited. This longitudinal study aimed to investigate the development of nature-related habits and their relationship to different mental health outcomes before and during early and later phases of COVID-19 (2019–2022). Furthermore, the buffering potential of nature-related habits on effects of major life events on mental health outcomes was investigated.

Subject and methods A subsample of the Swedish Longitudinal Occupational Survey of Health (SLOSH) was studied during 2018–2022, including follow-ups in early 2021 (n  = 1902) and 2022 (n = 1580). Visits to various types of nature, mental health outcomes (symptoms of depression, anxiety, loneliness, sleep difficulties), and major life events were analyzed across the study period while controlling for confounders.

Results Greater overall engagement in nature visits, particularly visiting forests or using one’s garden, was associated with lower levels of depression, anxiety, loneliness, and sleep problems in early 2021 and 2022.

Importantly, changes in nature visits were consistently negatively associated with investigated mental health outcomes across the study period. All nature visits, except for garden time, increased in the long term (2019–2022). Visiting forests also increased in the short term, while overall nature visits initially decreased (2019–2020).

Conclusion Generally, nature visits increased longitudinally and were associated with better mental health outcomes during the COVID-19 pandemic. This underscores the importance of green- and blue-space accessibility for facilitating outdoor recreation in natural environments, to support resilience and public health during pandemics.

Objective This study used causal inference to estimate the longitudinal effects of contagion in cohabitants and family members on university students’ mental health and academic self-efficacy during the COVID-19 pandemic. Design A prospective longitudinal study including a baseline online measurement in May 2020, and online follow-ups after 5 months and 10 months. Participants were recruited through open-access online advertising. Setting Public universities and university colleges in Sweden. Participants The analytical sample included 2796 students. Outcome measures Contagion in cohabitants and in family members was assessed at baseline and at the 5-month follow-up. Mental health and academic self-efficacy were assessed at the 5-month and 10-month follow-ups. Results Mild symptoms reported in cohabitants at baseline resulted in negative mental health effects at follow-up 5 months later, and mild baseline symptoms in family members resulted in negative effects on academic self-efficacy at follow-ups both 5 and 10 months later. Conclusions Notwithstanding the lack of precision in estimated effects, the findings emphasise the importance of social relationships and the challenges of providing students with sufficient support in times of crisis.

Bakgrund

Rapporten har tagits fram inom ramen för Myndigheten för arbetsmiljökunskaps uppgift att utvärdera och analysera effekter av beslutade och genomförda statliga insatser och initiativ. Utvärderingen avser ett regeringsuppdrag som Arbetsmiljöverket genomförde i form av olika insatser inom ramen för programmet Kvinnors arbetsmiljö under åren 2012 till och med 2014.

Syfte

Det övergripande syftet med utvärderingen var att undersöka om de insatser som genomförts inom ramen för regeringsuppdraget, med huvudsakligt fokus på de två projekten Ergonomi i kvinnors arbetsmiljö (EKA) och Hållbar arbetsmiljö med kvinnor i fokus (HAK), gett bestående avtryck i form av erfarenheter, insikter och lärdomar och därmed bidragit till att förebygga att kvinnor slås ut från arbetslivet på grund av arbetsmiljöproblem. Det inkluderade att tydliggöra vilka villkor och förutsättningar som behövs för att inspektioner och därtill relaterade förändringar ska kunna bidra till en bättre arbetsmiljö. Ännu ett specifikt syfte var att undersöka bestående avtryck inom Arbetsmiljöverkets interna verksamhet. En ytterligare aspekt handlade om att klargöra vilka villkor och förutsättningar som bör finnas på plats för att möjliggöra en utvärdering av ett genomfört program och därmed tydliggöra vilka insikter och lärdomar som kan göras utifrån de förutsättningar som funnits för föreliggande utvärderingsarbete.

Genomförande

Inledningsvis genomfördes en områdesöversikt (kap. 1, och bil. 1) samt ett förarbete (kap. 1, och bil. 2). Områdesöversikten inkluderade en sammanfattning av en tidigare uppföljande utvärdering och forskning om programmet Kvinnors arbetsmiljö och ett förarbete som fokuserade på att tydliggöra vilka olika dataunderlag som fanns att tillgå för en utvärdering av programmet. Med utgångspunkt i resultaten från områdesöversikten genomfördes en långtidsutvärdering.

För att undersöka om programmet Kvinnors arbetsmiljö gett något avtryck kombinerades en kvantitativ och en kvalitativ metodansats (kap. 3). Den kvantitativa utvärderingen baserades på arbetsskadestatistik för de verksamheter och arbetsplatser som varit föremål för inspektion inom EKA- projektet. Analysen av arbetsskadestatistik kom huvudsakligen att fokusera på arbetsskador, arbetsolyckor, och arbetssjukdomar med belastningsrelaterade orsaker totalt sett samt för kvinnor respektive män (kap. 4, och bil. 4).

Den kvalitativa utvärderingen inkluderade intervjuer samt dokumentstudierav inspektionsmeddelanden, protokoll och förelägganden från verksamheter som varit föremål för inspektion inom EKA eller HAK-projektet. Sammantaget inkluderades fem specifika arbetsställen, eller fall, från EKA-projektet samt sex olika kommuner från HAK-projektet (kap. 5 och bil. 5).

Resultat

Utifrån den kvantitativa arbetsskadestatistiken finns inga samband mellan inspektion inom EKA-projektet och lägre förekomst av belastningsrelaterade arbetsskador, arbetsolyckor och arbetssjukdomar. Det är alltså svårt att talaom kvantitativt mätbara avtryck av EKA-projektet på en övergripande nivå. Samtidigt går det inte att utesluta att EKA-projektet som sådant gett avtrycki arbetsmiljön på de olika arbetsställen som inspekterades. Andra, liknande program, insatser och projekt har genomförts både nationellt och lokalt. Tillsammans med andra samhälleliga processer kan det ha haft en övergripande påverkan på alla eller flera delar av arbetslivet. Det saknas därmed möjlighet att dra säkra slutsatser.

Analys av det kvalitativa datamaterialet pekar på att en del av de inspektioner som genomfördes inom ramen för projekten EKA respektive HAK potentiellt sett gett bestående avtryck. Däremot finns inget stöd för bestående avtryck i alla fall eller kommuner. Likväl visar det övergripande resultatet från de fem fallen i EKA-projektet och de sex kommunerna inom HAK-projektet att ett kontinuerligt och systematiskt arbetsmiljöarbete (SAM) är en förutsättning för att en inspektion ska kunna ge ett bestående avtryck. Det är alltså avgörande att arbetsgivare och högsta ledning kunnat ta till sig syftet med en inspektion samt de implikationer som följer och sedan prioriterat att arbeta vidare med frågorna. Totalt sett inkluderar den kvalitativa utvärderingen dock ett fåtal verksamheter av alla de verksamheter som inkluderades i EKA respektive HAK. Likväl visar den kvalitativa utvärderingen att inspektionsinsatser har potential att bidra till en god arbetsmiljö. Svårigheten består i att bibehålla fokus över tid och därigenom åstadkomma bestående förändringar. Samtidigt är det omöjligt att säkert slå fast att de avtryck som identifierats enbart beror av EKA och HAK. Genom åren har det funnits olika projekt och initiativ, både på nationell och lokal nivå. Det betyder att de bestående avtryck som framkommit kan ha förstärkts av senare projekt eller helt vara resultat av senare insatser. De kan därmed ha en starkare koppling till sådant som går bortom EKA och HAK. Det framkommer dock att de tekniska och organisatoriska förändringar som genomförts i de fall som ingick i EKA-projektet medfört bättre förutsättningar att upprätthålla dessa förändringar över tid. Det hänger troligen samman med att förändringarna ofta krävde konkreta rutiner och utbildningsinsatser. Jämförelsevis kan det vara svårare att omsätta insikter och kunskaper från HAK-projektet till konkreta mål och strategier. Likväl kan systematiska rutiner från HAK ändå fortleva. Det gäller exempelvis dokumentation av antalet underställda per chef och återkommande jämförelser av villkor i kvinno- respektive mansdominerade verksamheter. Det gäller särskilt om någon funktion i verksamheten får detta som ett tydligt uppdrag. Det här tyder på att vissa organisatoriska förutsättningar behöver finnas på plats för att en inspektion ska få tydlig effekt på arbetsmiljöarbetet. Sådana förutsättningar inkluderar exempelvis en förberedelse för att kunna ta emot de synpunkter som lyfts i samband med en inspektion samt möjlighet att kunna hantera synpunkterna. Här kan, som i något av fallen, uppföljande inspektioner eller tydlig samverkan, underlätta fortsatt långsiktig förändring, utveckling och lärande.

Det övergripande resultatet visar inga entydigt systematiska avtryck av de tillsynsinsatser som genomfördes inom programmet Kvinnors arbetsmiljö. Det resultatet avser den kvantitativa arbetsskadestatistiken samt utvärderingen av kvalitativa data från inspekterade arbetsplatser. Samtidigt finns vissa avtryck som kan kopplas till programmet. Det är inte överraskande att det saknas bestående avtryck som på ett entydigt sätt kan härledas till programmet. Även om det relativt sett genomfördes många professionellt utförda inspektioner, med hjälp av särskilt framtagna metoder, är en inspektion fortfarande ett tillfälligt ingrepp i en organisation. Det gör att avtrycken ofta blir lokala och tidsbegränsade snarare än långvariga. När det gäller EKA kan sådana direkta och kortsiktiga förändringar ge omedelbara förändringar i form av minskade arbetsskador. Samtidigt kan en förändring som gör att något uppmärksammas också bidra till en ökad rapportering. Det kan i sin tur spegla en ökad förekomst av arbetsskador under en period. För att få till stånd en långsiktig förändring behöver arbetsgivare prioritera ett fortsatt systematiskt arbete med arbetsmiljöfrågor och utveckla hållbara arbetsprocesser som möjliggör sådant systematiskt arbete. Det här betyder att långsiktiga förändringar är avhängiga goda organisatoriska förutsättningar och villkor.

I och med att regeringen gav Arbetsmiljöverket i uppdrag att genomföra programmet Kvinnors arbetsmiljö hade myndigheten en självklar nyckelroll. Intervjuer med nio inspektörer från Arbetsmiljöverket visar att de metoder som utarbetades inom ramen för programmet fortfarande används. Det framkommer också att det fortfarande finns en god kunskap och medvetenhet om ergonomi samt om arbetsmiljön i kvinnodominerade verksamheter. På liknande sätt finns det fortfarande kunskap och medvetenhet kring jämställd arbetsmiljö, villkor för kvinnor och män samt kvinno- respektive mansdominerade verksamheter. Den här kunskapen och medvetenheten utgör tydliga och bestående avtryck av programmet. Utvärderingen visar också att erfarenheterna från programmet lever kvar i nya projekt och i tillsynsutbildning för nya inspektörer. Det ärett avgörande avtryck eftersom det betyder att erfarenheter och kunskap från programmet kan föras vidare inom Arbetsmiljöverkets fortsatta, interna arbete.

Slutsatser

Sammanfattningsvis har programmet gjort tydliga avtryck i Arbetsmiljöverkets interna arbete. Samtidigt finns andra projekt och initiativ, vilket kan orsaka konflikter i det praktiska arbetet när flera olika frågor ska prioriteras parallellt. Det finns därmed utmaningar i att aktualisera och synliggöra flera perspektiv. För att hantera sådana konflikter och utmaningar har konkreta erfarenheter förts in i Arbetsmiljöverkets inspektionsverksamhet och i det systematiska arbetsmiljöarbetet. Det visar hur de perspektiv som ingick i programmet Kvinnors arbetsmiljö fortlever samtidigt som det verkar finnas behov av ett helhetsperspektiv som på ett konsekvent sätt gör det möjligt att inkludera flera områden.

Utifrån de oklara resultaten av den här utvärderingen uppstår frågan om vad som behövts för att komma fram till mer entydiga resultat som möjliggjort tydligare slutsatser. Svaren på en sådan fråga kan ge insikter och lärdomar till kommande programsatsningar och insatser av liknande karaktär som de som aktualiserats inom ramen för programmet Kvinnors arbetsmiljö. I sammanhanget är det angeläget att dra lärdom av den kunskap som finns om systematisk planering och genomförande av förändrings- och utvecklingsarbete. Det är viktigt att tidigt tydliggöra vilka insatser och aktiviteter som ska genomföras.

På ett övergripande plan gjordes det inom programmet Kvinnors arbetsmiljö där regeringsuppdraget klargjorde vilken typ av insatser som skulle genomföras. Däremot fanns inga tydliga krav på former för systematisk kort- eller långsiktig utvärdering av dessa insatser. Om sådana krav funnits hade Arbetsmiljöverket också haft att leverera en tydlig utvärderande analys som gått bortom beskrivningar av kortsiktiga resultat och hur dessa kommer att omsättas i myndighetens ordinarie verksamhet. För programmet Kvinnors arbetsmiljö finns visserligen dokumentation som beskriver vad som gjorts och ungefär när, men den tid som gått innebär att det saknas systematisk dokumentation. Det gör det svårare att på ett konsekvent sätt utvärdera i vilken mån olika insatser och aktiviteter fortlevt.

Sammanfattningsvis ger resultaten inget underlag för att kunna dra några slutsatser om huruvida programmet bidragit till att nå avsett resultat ellerinte. Likväl kan den här rapporten vara av värde för ett fortsatt arbete med att förbättra arbetsmiljön i kvinnodominerade verksamheter. Rapporten lyfter fram vikten av ett initialt och parallellt planeringsarbete av insatser och utvärdering för att möjliggöra långtidsutvärderingar av hög kvalitet. Det i sig utgör en avgörande insikt och lärdom från den här utvärderingen av programmet Kvinnors arbetsmiljö.

Background

This report forms part of the Swedish Work Environment Authority and itstask relating to the evaluation and analysis of the effects of governmental activities, initiatives, interventions, and programs. This evaluation concerns a government decision to task the Swedish Work Environment Authority with initiating activities focusing on the work environment of women. Starting in 2012 and ending in 2014, these activities were carried out within the program Women’s Work Environment (Swedish: Kvinnors arbetsmiljö). Specifically, this evaluation focused on two projects within the program, that is Ergonomics in Women’s Work Environment (Swedish: Ergonomi i kvinnors arbetsmiljö, EKA) and Sustainable Work Environment focusing on Women (Swedish: Hållbar arbetsmiljö med kvinnor i fokus, HAK). The overall aim of the evaluation was to examine whether the activities that were carried out within these two projects had had any lasting impact and thus contributed to preventing the early exiting of women from the labour market due to a straining work environment.

Methods

The initial work included reviewing the area (Chapter 1 and Appendix 1) and preparatory pilot work (Chapter 1 and Appendix 2). The review included summarizing a prior follow-up and research relating to the program Women’s Work Environment and the preparatory work that focused on clarifying the types of data that was of potential use to evaluate the program. Based on the results of this, a long-term evaluation was carried out.

At the core of this report is its’ quantitative and qualitative parts which aimed to investigate whether the activities carried out within the program had had any long-term impact in the organizations and workplaces where inspections had been carried out. This included clarifying whether these activities had had any lasting impact in terms of experiences, insights, and lessons learned in

the organizations and workplaces that had been included in different parts of the program. This aimed to clarify the prerequisites and conditions needed in order for inspections to improve the work environment. Another aim was to examine lasting impacts within the internal operations of the Swedish Work Environment Authority. A further issue related to clarifying the conditions needed to enable the post hoc evaluation of a program and thereby clarify insights and lessons learned of the present long-term evaluation.

In order to evaluate whether the program had had any impact, quantitative and qualitative methodological approaches were combined (Chapter 3). The quantitative evaluation was based on occupational injury statistics for the organizations and workplaces that had been subject to inspections within the EKA-project (Chapter 4 and Appendix 4). The reason for including EKA only was due to the fact that the project included inspections involving newly developed assessment methods. As information was available for a number of years, variation over time was investigated for the workplaces includedin the EKA-project. Then, these statistics were compared to occupational injury statistics for other workplaces. In addition, women and men were compared. Given that the program and the inspections within the EKA-project targeted ergonomics, the analysis of occupational injury statistics focused on occupational injuries, accidents, and occupational illness associated with physical strain.

The qualitative evaluation involved interviews at one point in time and the analysis of documents covered, for instance, inspection notes and protocols from the workplaces and organizations that were included in the inspections that were carried out within the EKA- or HAK-projects. In total, the qualitative evaluation included five workplaces, or case studies, from the-EKA project and six different municipalities from the HAK-project (Chapter 5 and Appendix 5).

Results

From the quantitative data, there are no associations suggesting that the inspections performed within the EKA-project were related to fewer strain- related occupational injuries, accidents and less occupational illness. Thus, at an overall level, based on existing statistics, it is difficult to identify any quantifiable impact of EKA. At the same time, it would be impossible to rule out thatthe EKA-project had no impact on the work environment of the different workplaces that were subject to inspection. However, other similar programs, initiatives, and projects that have been carried out both nationally and locally, along with other societal changes may have had an overall impact on all or several parts of working life. In view of this, it is impossible to draw any firm conclusions.

The analysis of the qualitative data suggests that some of the inspectionsthat were carried out within EKA and HAK may have had a lasting impact. However, there is no support for any lasting impacts for all cases or in all municipalities. Nevertheless, the overall combined findings from the analysis of the five cases from EKA and the six municipalities within HAK show that a continuous and systematic work environment management is a prerequisite for an inspection to have a lasting impact. This points up a key factor, namely that employers and upper management need to understand the purposeof an inspection and the implications that follow from it, and to prioritize the continued work relating to the relevant issues. Overall, the qualitative evaluation, which came to include only a small number of organizations of all the organizations included in EKA and HAK, shows that inspections have a potential to improve the work environment. Challenges involve maintaining the focus over time in order to achieve a lasting impact. Still, it is impossible to claim that the impact identified is solely due to EKA and HAK. Over the years, various projects and initiatives have been carried out, both at national and local levels. This means that the long-term impact that was identified may have been supported by later projects or be the result of other, later activities or interventions and thus be related to processes going beyond EKA and HAK. This is important to take into consideration and particularly so given that the evaluation of both EKA and HAK included few cases and a limited number of municipalities which also chose themselves to participate in this long-term evaluation. However, it seems like the technical and organizational changes implemented in the cases included in the EKA-project were better equippedto maintain these changes over time. This was likely due to the fact that such changes often required hands-on procedures and training. In comparison, it may be more difficult to translate insights and knowledge from the HAK-project into tangible goals and strategies. Nevertheless, systematic procedures from HAK, including documenting the number of subordinates per manager and recurring comparisons of the conditions in workplaces and organizations dominated by women and men respectively, may be maintained over time. This may be facilitated by clearly appointing the task to keep up these systematic procedures to a function or role within the organization. This suggests that certain organizational prerequisites need to be met in order for an inspection to impact the management of the work environment. Such prerequisites include, for instance, being prepared to receive feedback following an inspection along with the ability and competence to handle the issues raised. This, in turn, requires the active engagement from the staff involved, managers, management, as well as union and safety representatives. Moreover, it is obvious that the process following an inspection is important for the continued work within an organization. As seen in one of the cases, follow-up inspections, as well as the joint collaboration around the inspection, may facilitate long-term changes, organizational development and learning.

The overall findings show no systematic impact of the inspections that were carried out within the program. This holds for the inspection of the quantitative data which included occupational injury statistics but also for the evaluationof qualitative data from the workplaces that were inspected. In parallel, the program can be argued to have had some impact. However, any impact may be the result of other, subsequent national or local activities and initiatives. The lack of any lasting impact that can be clearly attributed to the program is not surprising. Despite the large number of professionally conducted inspections using newly developed methods, an inspection is still to be considered a temporary activity intervention. From this follows that its impact is oftenlocal and temporary, rather than long-lasting. As for EKA, the direct and short-term changes may have yielded immediate changes that are reflected in fewer occupational injuries. However, targeted changes may yield an increased reporting that is reflected in increased numbers of occupational injuries over a period of time. To achieve long-term changes, employers need to prioritize the continued systematic work environment management and the development of sustainable processes that enable this work. This means that long-term changes are dependent on adequate organizational prerequisites and conditions. When the Swedish Work Environment Authority was tasked with executing the program, the Authority had a key role. Based on the interviews with nine inspectors from the Swedish Work Environment Authority, the analysis shows that the methods that were developed within program are still being used. Moreover, there is an understanding and recognition of ergonomics and the work environment in organizations dominated by women. Similarly, there is an understanding and recognition of equality at work, working conditions for women and men, and organizations dominated by women and men. Such knowledge can be identified as clear and lasting effects of the program. Furthermore, the evaluation shows that the experiences gained within the program have been transferred to new projects and in the education and training activities of new inspectors. All in all, the findings show that the program has brought to the fore issues that are of relevance to women’s work environment in the operations of the Swedish Work Environment Authority. This impact is key as it suggests that experiences and knowledge gained during the program can be transferred and translated into the internal operations of the authority.

Conclusions

The findings show a clear impact of the program on the internal operations of the Swedish Work Environment Authority. At the same time, there are other projects and initiatives. This may yield conflicts when having to prioritize several topics and perspectives in parallel. This means that there are challenges in bringing several parallel perspectives to the fore and translating these into practice. To manage such conflicts and challenges, hands-on experiences have been incorporated into the inspection activities and systematic work environment management. This shows clearly how the perspectives from the program are sustained, while there also seems to be a need for an overall holistic perspective that makes it possible to include and consistently consider different areas.

Based on the unclear findings of the present evaluation, it is necessary to consider if anything could have been done differently to allow for more consistent conclusions. Such rethinking of the conditions relating to this long-term evaluation can result in important insights and learning for future initiatives that are similar to those of this program. Here, it is important to consider existing knowledge relating to the systematic planning and implementation of organizational development and change. A key aspect involves clarifying, at an early stage, the initiatives and activities that are to be included. At an overall level, this was done when launching the program by detailing the key activities. However, there were no clear requirements regarding the systematic short-term or long-term evaluation of these activities. Had

such requirements been included, this would have tasked the Swedish Work Environment Authority with producing a clear-cut evaluation going beyond descriptions of short-term findings and the translation of these into the regular operations of the authority. Despite the existing documentation of the program describing what was done and about when, it has been about a decade since the program was initiated which means that there is little or no systematic documentation available. This makes it difficult to consistently evaluate the extent to which various initiatives and activities have had an impact and continued over time.

Taken together, the findings from the quantitative and qualitative data analyzed in this evaluation allow no firm conclusions as to whether or not the program contributed to achieving its intended results. Regardless, this report may be valuable for continued efforts to improve the work environment in organizations dominated by women. The report underscores the importance of an initial and parallel planning of initiatives and activities and their evaluation in order to enable high-quality long-term evaluations. This is an important insight and lesson to be learned from this long-term evaluation of this governmental initiative.