Improving the quality of life of the hotel housekeepers: a cluster randomized trial evaluating a complex intervention in primary care

Oana Bulilete, Xenia Chela Alvarez, Maria Clara Vidal Thomas, Cristian Sanchez, Estela Terrer Hernandez, Carmen Zarzosa Merino, Esther Garcia Buades, Joan Llobera Canaves

Keywords: quality of life, primary care, housekeeping

Background:

The actual segregation of the labor market concentrates women in jobs with high time pressure and heavy workloads, such as hotel housekeepers (HHs). Their working conditions and occupational risk factors (e.g., physical, psychosocial) have a significant impact on their health and quality of life (QoL). A multifaceted intervention based on health promotion and empowerment conducted in primary healthcare (PHC) may improve the QoL of HHs.

Research questions:

The main objective of this study was to assess the effectiveness of a complex intervention to improve HHs’ QoL, their lifestyles, psychological well-being and to reduce chronic pain.

Method:

Cluster randomized trial, 35 PHC centers: 17 randomized to intervention group (IG); 18 control group (CG).
Participants: HHs≥18 years; health coverage in the Balearic Islands; worked in 2019 season.
Intervention: theoretical framework: intervention mapping process and integrated model for change (I-Change), multi-level: individual, group and community delivered by nurses, physiotherapists, psychologists (8 weeks). IG-3 individual+5 group visits, social prescription; CG-3 individual visits; usual care. Follow-up visit: 6 months.
Sample size: 594 HHs.
Measurements: QoL (SF36), smoking status, Mediterranean diet (PREDIMED), physical activity (IPAQ), chronic pain, Five Well-Being Index (WHO-5), Perceived Stress Scale, Self-efficacy, self-perceived health, social support (Duke).
Statistical analysis: intention-to-treat, generalized equation model.

Results:

35 PHC centers (17 IG, 18 CG). 1.223 HHs (IG 48.7%,CG 51.3%); mean age:47.2±8.7 vs46.4±9.5;Spanish nationality 54.9% vs57.8%; 4-stars hotels: 56.7% vs61.9%;mean rooms/day: 17.4±6.0 IG vs8.1±6.8 CG; mean beds/day:43.9±20.3 vs42.6±19.4. QoL:general health: β coefficient 0.2(CI95% -0.5-0.9),mental component score β 0.7(-0.2-1.5),physical component score β 0.6(-0.3-1.5);tobacco OR 2.1(1.2-3.6);Predimed OR 1.8(1.4-2.4);IPAQ OR 1.2(0.9-1.5);chronic pain OR 1.1(0.8-1.4);WHO-5 OR 1.0(0.8-1.4);stress β -0.3(-0.7-0.5);self-efficacy β 0.1(-0.5-0.6);Duke OR 1.2(0.7-2.1);self-perceived health OR 1.2(1.0-1.6).

Conclusions:

A complex intervention based on health promotion and empowerment did not improve the QoL of HHs compared to usual care. IG had two-fold higher probability of no smoking at 6 months and were more adherent to the Mediterranean diet.

Points for discussion:

quality of life

complex intervention

prevention, healthy lifestyles and empowerment

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