=Paper=
{{Paper
|id=Vol-2102/paper_1_Kekkonen
|storemode=property
|title=Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
|pdfUrl=https://ceur-ws.org/Vol-2102/paper_1_Kekkonen.pdf
|volume=Vol-2102
|authors=Markku Kekkonen,Harri Oinas-Kukkonen,Piiastiina Tikka
|dblpUrl=https://dblp.org/rec/conf/persuasive/KekkonenOT18
}}
==Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review==
https://ceur-ws.org/Vol-2102/paper_1_Kekkonen.pdf
Systems Supporting Occupational Health Behavior
Change: A Systematic Literature Review
Markku Kekkonen1, Harri Oinas-Kukkonen1 and Piiastiina Tikka1
1 University of Oulu, Faculty of Information Technology and Electrical Engineering,
Oulu Advanced Research on Service and Information Systems, 90570 Oulu, Finland
{markku.kekkonen, harri.oinas-kukkonen,
piiastiina.tikka}@oulu.fi
Abstract. Occupational health interventions for behavior change have potential
to reduce or prevent health risks, such as influencing absenteeism. This system-
atic literature review concentrates on searching for and presenting interventions
in occupational health settings with the focus on targeting behavior change. Lack
of descriptions of the actual intervention features and implementations, lack of
results, and coercive (rather than persuasive) elements led to the exclusion of
several studies from the analysis. Persuasive software feature examples were
identified from the included studies with the help of Persuasive Systems Design
Model. The recognized software features can be utilized in the planning and de-
velopment of occupational health support systems for behavior change.
Keywords: Occupational healthcare, occupational health interventions, behav-
ior change support systems, Persuasive Systems Design, information systems,
web, mobile
1 Introduction
Health issue related work absence has a negative impact on productivity in a workplace.
With many places of employment relying on various degrees of training and education
these days, enabling the workforce to maintain good health and able to remain at work
is in the best interests for employers – and naturally for the employees themselves in
the form of improved personal health.
Occupational health is strongly focused on primary prevention of hazards and deals
with all aspects of health and safety in the occupational environments [1]. Risk factors
at the workplace can, for example, lead to cancers, accidents, musculoskeletal diseases,
respiratory diseases, hearing loss and stress related disorders (ibid.).
Large enterprises have better resources to solve problems relating to occupational
health and safety, compared to small enterprises [2]. The situation in relation to absen-
teeism due to health issues might be dire in small companies, in case an employee is
absent from work and a replacement is hard to come by. The aforementioned situation
might be unbearable in a one-man business, where the absence from work due to a
health issue is reflected directly to the productivity and earning capacity of the business.
Lifestyle related problems might cause absences from work (and loss of productivity),
10 Sixth International Workshop on Behavior Change Support Systems (BCSS’18):
Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
which brings high costs to the society, therefore emphasizing the importance of self-
motivation (for healthy behavior) as there is no possibility to support everyone individ-
ually with the current healthcare resources [3]. Thou again, the argument could be re-
phrased that with the advancement of technology, everyone can be supported with the
current healthcare resources by improving the self-motivation of individuals for healthy
behavior. Workplaces often provide excellent settings and infrastructure to support
health-related interventions, therefore making occupational environments interesting
for health promotions [4].
A study by Bolier et al. [5] shows that web-based preventive workers’ health sur-
veillance program (online screening, personalized feedback and a personalized offer of
online self-help interventions) can enhance positive mental health and can have a sig-
nificant impact on occupational mental health. Monitoring and analyzing the workers’
health is required for planning improvements to working conditions [6].
Occupational health interventions could make a difference in changing the behavior
and attitude of workers towards healthier direction. In order to establish the present
situation in research regarding occupational health interventions and behavior change,
we conducted a systematic literature review on what scientific studies have been con-
ducted of interventions in occupational health settings with the focus on targeting be-
havior change. The review covers native mobile information systems, web information
systems (whether used via mobile or other technological platforms) and traditional in-
formation systems (systems which are not native mobile or web information systems),
while taking persuasion and persuasive system features into account.
The basic assumption was that there is not a large amount of scientific studies con-
ducted about occupational health interventions for behavior change relating to tradi-
tional information systems, web information systems or native mobile information sys-
tems. The assumption was somewhat correct, but the amount of studies included for the
systematic literature review is suitable (18 studies). Most fitting persuasive software
feature examples were identified with the help of the Persuasive Systems Design (PSD)
model [7], and are presented as practical implications to be taken into consideration for
planning and developing an occupational health support system targeting behavior
change.
The outline for this paper (after introduction) is the following: background infor-
mation, research methods (including the complete search process), results (including
examples for practical implications), discussion and conclusion.
2 Background
There is potential for information and communication technology (ICT) to provide per-
sonalized (and motivational) tools for health management [8]. Interventions for man-
aging health risks can be individual or group interventions, or target changing the en-
vironment (ibid.).
Healthcare information systems in general are under-represented in leading infor-
mation system journals, despite the importance of such systems, but the tide on pre-
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Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
senting healthcare information systems has been turning and the interest has been in-
creasing [9]. In the past, information systems for general healthcare were mainly used
for patient records or for aiding health professionals, but the systems can be used to
tailor health information for individual patients [10].
ICT (internet, mobile phones and wireless applications), combined with an interest
in creating a culture of health, has the ability to reach high volume of people for en-
hancing health and to lower the costs (of healthcare) [11]. Personalized prevention in-
tervention can reduce health risks, but the individuals must be proactive about their
health, which can be achieved by technology and interactive web-based tools (ibid.).
Getting individuals to participate in web-based physical activity intervention is as-
sociated with smaller increases in healthcare costs, when compared to those of nonpar-
ticipant individuals and therefore it is important to encourage participation [12]. The
level of participation increases by implementing online intervention modules, as the
participants can complete them at convenient moments [13]. Internet-based interven-
tions are most cost-effective as well (ibid.). There is evidence that web-based interven-
tions can be more effective in achieving the desired outcome and behavioral change
[14]. However, there is also evidence that web-based interventions can have only lim-
ited or no better effectiveness over non-web-based interventions [15].
Mobile applications are the next step from web-based approaches, as they can simi-
larly reach people for interventions, but the adherence rate for engaging with the appli-
cation appears to be better than with web-based approaches [16]. The evolution of wire-
less technologies and connectivity has enabled health services to be used in mobile
devices (mHealth), with improved mobility and reduced location dependency, when
compared to other branches of eHealth [17]. In addition, mobile browsers now enable
the use of web-based health interventions on the mobile devices. Even though mHealth
applications are the third fastest-growing category of applications after games and util-
ities, one of the downsides is the lack of security – a serious problem, considering how
mHealth applications gather information to be compiled and analyzed [18].
2.1 Behavior Change and Persuasive System Features
Persuasion is a planned attempt to change attitudes or behaviors (or both) without using
coercion or deception, as persuasion is voluntary [19]. Persuasion is based on the in-
tentions, not the outcomes; therefore, unintended outcomes are side effects, as persua-
sion is focused on intended design of behavior or attitude change (ibid.).
Persuasive systems enable affecting users’ behavior, even in situations where their
attitude is not favorable towards the behavior, as attitudes do not necessarily predict or
determine behavior [7]. When analyzing the persuasion event, both use context and user
context should be taken into consideration, and the goal of the users should be under-
stood, including past performance and current progress (ibid.). Persuasion and convinc-
ing are two different things, but separating them from each other may be difficult (ibid.).
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3 Research Methods
Systematic literature review was used as the research method, following the recommen-
dations and guidance described in Webster and Watson [20]. The following databases
were searched for records: ACM Digital Library (The ACM Guide to Computing Lit-
erature extended search), IEEE Xplore (IEEE/IEE Electronic Library), Medic (Finnish
database), Medline (Ovid) and Scopus. There were no further limitations on the lan-
guage of the results (Medic was searched with Finnish words/terms, the other databases
with English words/terms) or on the dates and years. The coverage of the databases was
compared against each other in order to gain a variety of sources, with making sure that
the current Senior Scholars’ Basket of Journals [21] was included.
3.1 Search Process
The search process of the databases was done by combining main search terms with all
of the specified search terms (see table 1 for the terms), and in case the records found
exceeded 400, specific limitation terms were used to restrict the records found to be
below 400 per main search term and search term pair.
Table 1. Search terms
Main Specified Main (Medic) Specified (Medic)
occupational well-being mobile työterveys matkapuhelin
occupational health smartphone työhyvinvointi älypuhelin
occupational health care smart phone työterveydenhuolto puhelinpohjainen
occupational healthcare mobile phone työntekijöiden terveys web*
welfare at work mobile-based net*
workers’ health mhealth internet
industrial health web nettipohjainen
web-based webbipohjainen
internet e-health
e-health ohjelmisto
software informaatiojärjestelmä*
information datajärjestelmä*
system*
data system* käytöksen muutos
data processing käyttäytymisen muutos
system*
behavio* tietojenkäsittely
change
persuas*
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Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
To ensure the reliability of the search process, the usage of “health care” and
“healthcare” in separate searches was intentional, as the spelling may differ between
countries. Likewise, to ensure the reliability of the search process, the usage of
“smartphone” and “smart phone” in separate searches was intentional as the spelling
may differ between countries and between dates of the publications. The asterisk (*) in
the terms denotes a wildcard. English words such as web and e-health have been
adopted into the Finnish language as loanwords and the possible problems in the search
relating to case suffixes were solved with using wildcards when appropriate.
In case the pairing of main search terms and specified search terms gave an output
of more than 400 records, additional limitation terms were used: intervention, ran-
domi*ed controlled trial. The asterisk (*) denotes a wildcard. The first limitation term
used was “intervention” and if the output was still more than 400 records, the second
limitation term, “randomi*ed controlled trial”, was used. For example, Scopus had an
output of 5089 records with the combination of “occupational health” and “information
system*”, with added limitation term, “intervention”, the output was 601 records and
after the second limitation term, “randomi*ed controlled trial”, the output was 81 rec-
ords.
The output of records (below 400) was scanned through by reading the title of the
record and by reading the abstract if it was unclear should the record be included or not.
Duplicates were excluded during the search process. The search process and scanning
of the records founded lasted from 1st of September to 15th of October (year 2016).
Additional searches of the databases in the last week of the search process were also
done in order to gain such records that might have been added since 1st of September
(year 2016).
Inclusion Criteria. The record had to be related to an occupational health setting, the
record had to be related to either traditional information systems, native mobile infor-
mation systems or web information systems, and the record had to be related to health
behavior interventions. Behavior change and persuasiveness had their own additional
search round, and randomized controlled trials were preferred overall, but were not
compulsory for a record to be included.
Exclusion Criteria. Information communication technology was used in the study only
indirectly, occupational health setting was not included, intervention was not mentioned
or described, the record was about an altogether different subject matter.
Studies Found. 403 records were identified from a total of 23155 records found by
searching the databases. 193 duplicates were removed from the 403 records identified,
leaving total of 210 records for the scanning round, at which point the records were
referred to as studies. The remaining 210 studies were scanned through (title and ab-
stract) and a total of 47 were included in the next round (screening). The scanning of
14 Sixth International Workshop on Behavior Change Support Systems (BCSS’18):
Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
the 210 studies also included reading through those that showed potential for back-
ground information. The screening round consisted of reading through the studies care-
fully.
Backward Search. All the studies (47) included in the systematic literature review
after the scanning process were searched “backwards” as instructed by Webster and
Watson [20], meaning that all the references of the studies were scanned through and
all the relevant studies were included. All the studies found in the backward search were
given a backward search of their own. An amount of seven studies was included into
the screening round of the systematic literature review.
Forward Search. All the studies included in the systematic literature review were
searched “forward” as instructed by Webster and Watson [20], meaning that all those
studies that had cited the included studies were scanned through and relevant studies
were added into the systematic review. All the studies included in the forward search
were given a forward search of their own, as well as backward searches. Therefore, all
the studies included into the screening round were searched backwards and forwards
for relevant studies. An amount of two studies was included into the screening round
of the systematic literature review.
Final Search Process. The interventions in the included studies (18 out of 56) of the
screening round did not have coercive elements, they had results, and the actual inter-
ventions were described. Interventions with limited description of software features
could be included if there was a screenshot present.
Fig. 1. Descriptive flowchart diagram of the search process.
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Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
4 Results
As the subject area is relatively wide with three different system platforms for the in-
terventions, and with several types of problem domains (stress, physical activity, de-
pression, et cetera), it was difficult to find a single unifying theme between the inter-
vention studies. In order to form a big picture of the intervention studies, the success-
fulness of the interventions was addressed, as well as the change in health behavior.
Examples of PSD principle implementations are provided as practical implications to
be considered when developing behavior change support systems. Additionally, ‘goal
setting’ examples found from the studies are also introduced as practical implications.
4.1 Excluded Studies
Some issues emerged, while reading through all (56) the studies, which led to the ex-
clusion of 38 studies. The exclusion of studies in the screening round was 67.85% (38
out of 56), with the main reason being that the description of the intervention was in-
sufficient for analysis (25 out of 38), while the other reasons being the lack of results
or issues with the results (9 out of 38) and coercion (4 out of 38). More often than not,
the actual intervention was not described from the viewpoint of traditional information
systems, native mobile information systems or web information systems. For example,
only the content matter was provided [22] or a link to an external web page of the
intervention was provided, but the page was in other language than English [23], or
password protected [24]. Additionally excluded full studies were for example study
protocols [25] or design papers [26] without results from the interventions. As a rule, if
screen captures of the intervention were provided in the studies, in addition to descrip-
tion (even if just content matter), the studies were included. One study was excluded
because there was only a screen capture of the intervention, but no proper content mat-
ter or description [27].
4.2 Recognized Application Domains
A total of 18 studies are included in this systematic literature review (see table 2) after
the exclusion in the final search process. Fourteen studies had web information systems
as platform, whereas three had native mobile information systems and only one had
traditional information systems (systems which are not native mobile or web infor-
mation systems).
Two interventions [28-29] compared a web-based approach to traditional print and
in the case of the Active Living [28], which was dealing with physical activity, there
was no difference between the two approaches (both increased the physical activity
slightly). The same phenomenon could also be seen in the Health Connection [29],
which was dealing with stress, physical activity, and dietary practices. The exception
here was dietary practice measurement, where web-based intervention approach was
significantly better than the traditional print (ibid.). Both studies are over a decade old,
calling to question how the results have withstood the developments with the Web and
its role in people’s everyday life
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Table 2. Included studies
Study Problem domain User context Use and technology context
[3] Wellness, activity, Technology group of the Wellness diary, training
relaxation Nuadu trial (119 recruited) plans, personal relaxation
[30] Stress reduction Employees of a major Web-based health promotion
technology company (309)
[29] Diet, stress, activ- Employees of a human re- Multimedia health promo-
ity sources company (419) tion
[31] Continued sitting University and environ- Web-based intervention with
mental agency (213) tailored feedback
[32] Musculoskeletal Ohio drug and poison call Software reminder prompt
discomfort center employees (37) monitoring activity
[33] High-risk drinking 18- to 24-year-old employ- Web-based survey program
ees (196) with feedback
[34] Depressive symp- 6 international companies Web-based problem-solving
toms in Netherlands (231) and therapy
[35] Workplace walking Academic and administra- Web-based workplace walk-
tive staff at 5 campus (390) ing program
[36] Stress and health 4 ICT and 2 media compa- Web-based health promotion
nies (303) and stress management
[37] Stress General population with Web-based health and prob-
symptoms of stress (264) lem-solving
[38] Physical activity IBM employees (126,372 Online behavior change tool
eligible, 67,324 partici-
pated)
[39] Depressive symp- Employees of 2 Japanese Web-based Manga stories
toms IT companies (762) with feedback
[40] Stress management Middle managers of Swe- Smartphone behavioral
dish companies (73) stress intervention applica-
tion
[28] Physical activity Members of an Australian Interactive website with
university staff (655) feedback and goal-setting
[41] Mental health well- 2 Finnish ICT companies Smartphone and web appli-
being (25 included in analysis) cation for stress management
[42] Absenteeism Financial service company Web-based health promotion
(3826 enrolled) program
[43] Weight manage- IBM employees (7743) Interactive weight manage-
ment ment tool
[44] Weight loss Overweight or obese em- Internet-based multimedia
ployees (75) intervention program
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Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
Excessive Sitting. The sole traditional information systems (see Fig 1) intervention
study included [32] utilized a prompt on desktop computer, a similar technology used
in three excluded interventions [45-47], with the exception that the included interven-
tion had an active prompt, which could be ignored (persuasion instead of coercion).
The included intervention was successful, as both sit-stand workstations and the soft-
ware produced similar effect in relation to musculoskeletal discomfort. The Start to
Stand [31], another intervention targeting excessive sitting, managed to decrease self-
reported total workday sitting, leisure time sitting and increased objectively measured
breaks at work.
Stress. The Health Connection [29] was successful in reducing stress, increasing phys-
ical activity and affecting dietary practices, even though the print approach had a similar
effect. The Stress and Mood Management [30] showed significant positive effects on
stress, in addition to related behavioral health problems of anxiety, depression and sub-
stance abuse. The intervention for stress management and health promotion [36] was
also successful with beneficial (6-month) effects from the stress management part, in
addition to improvement of mental health and psychological indicators for the partici-
pants. The GET.ON Stress [37] is the newest of the interventions that had stress as a
problem domain, and is highly efficient in reducing perceived stress. There seems to be
no single similar feature in the four interventions that would seem to be the key factor
for reducing or managing stress, except for the fact that they are all web-based. It might
be because only the GET.ON Stress (ibid.) is purely for stress management, while the
others have other problem domains included. Nevertheless, based on these four inter-
ventions from 2005 to 2016, web-based occupational health interventions for behavior
change can have a positive effect on stress, with the newest intervention being the most
efficient.
The native mobile information system intervention for stress management [40] was
moderately successful, as it had a moderate effect on stress. Another mobile interven-
tion [41] had a different problem domain (mental health), but had stress management
and mental well-being as the focus of the intervention. The intervention for mental
health (ibid.) was not successful, as there were no significant changes observed in well-
being, even though some participants reported relief in stressful situations.
Physical Activity. The Health Connection [29] also managed to increase physical ac-
tivity. The Walk@Work [35] was successful in increasing walking of all participants,
with the most active group increasing the least and the least active group increasing the
most. The Virtual Fitness Center [38] managed to increase the participation rate from
13% (previous year) to 53% with a cash incentive, and those of the participants who
were active enough to earn cash rebate reduced their physical inactivity risk and high-
risk status significantly. The Active Living [28] was not highly successful: the interven-
tion increased physical activity of the participants only slightly. All four interventions
had a wide content matter, but when comparing the oldest (2003) to the newest (2013),
the difference between the results affecting physical activity might be explained by the
differences in technological solutions (which have evolved in a decade), and people
18 Sixth International Workshop on Behavior Change Support Systems (BCSS’18):
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having become accustomed to web-based solutions within the decade separating the
studies. In the case of the Virtual Fitness Center (ibid.), the success of the intervention
might be explained by the cash incentive: the total participation rate quadrupled from
the previous year, following the implementation of the incentive. The Mobile Coach
[3] had a positive influence on motivating participants who used the application the
whole intervention period, as their exercising became regular during the intervention.
Depression. Depression, depressive symptoms and anxiety as problem domains were
present in three interventions. The Stress and Mood Management [30] managed to in-
crease the awareness and understanding of signs and symptoms of depression and anx-
iety, but was not intended to treat those. The Happy@Work [34] compared the outcome
of depressive symptoms between the intervention and control groups (post-treatment),
and no difference between the groups was found as both groups showed significant
improvements in depressive symptoms, with a significant but small effect in favor of
the web-based approach in anxiety. The Internet CBT program [39] differed from all
the other interventions, by using a Manga (Japanese comic) story of a psychologist and
a client worker to motivate the participants and facilitate easy learning. The intervention
showed a significant positive effect on depression (ibid.).
Weight Management. The Virtual Food Pro [43] managed to improve the eating hab-
its of the participants, and some participants reduced their weight. The other interven-
tion dealing with weight loss [44] managed to produce significant clinical weight
losses. Both interventions had a strong emphasis on self-monitoring as one of the core
functions.
Substance Abuse. The Stress and Mood Management [30] concentrated mainly on
stress management, with substance abuse prevention as a part of the stress management
techniques. The intervention managed to reduce binge drinking (ibid.). The CheckYour-
Drinking [33] decreased weekend drinking significantly when compared to the control
group. In the CheckYourDrinking (ibid.), when comparing the standalone web-based
intervention and web-based intervention (combined with motivational interview), the
study shows that, the standalone web-based intervention could be used as such (without
a motivational interview).
Absenteeism. A web-based health promotion program, The Prevention Compass [42]
had an immediate effect on reducing absenteeism with total reduction of 20.3%. The
intervention (ibid.) addressed several health problems with a personal health plan,
which might explain the substantial change in the absenteeism level.
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Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
4.3 Persuasive Software Features and Implementation Considerations
The Persuasive Systems Design model [7] was used to identify exemplary persuasive
software features from the included studies. The examples can be utilized as practical
guidance material for designing occupational health behavior change support systems.
Primary Task Support. The Virtual Food Pro [43], a successful intervention, provides
the users a four-step framework that was designed to help the users to progress through
the program in order to reach the goal. Therefore, the effort to perform the target be-
havior is ‘reduced’ to help the users [7].
A moderately successful intervention [40] from the included studies provides tai-
lored content for a user group (middle managers), thus making the system more per-
suasive [7]. A successful intervention with significant positive effect on the problem
domain, the Stress and Mood Management [30], provides an assessment instrument for
the users in order to offer personalized content, which can increase the capability for
persuasion [7]. In case developers would see ‘personalization’ challenging from the
viewpoint of programming, ‘tailoring’ could be used instead.
The users should be offered a way to keep track of their own performance or status
by a system in order to help the users to achieve goals [7], and as goal setting is one of
the key issues for persuasion, ‘self-monitoring’ should be taken into consideration. A
successful intervention [36] from the included studies provides the users real-time mon-
itoring of perceived current health and stress status, in addition to a diary. Supporting
and motivating the users to reach a set goal by ‘self-monitoring’ should not be a cum-
bersome obstacle from the viewpoint of programming, as a simple diary may be suffi-
cient (depending on the problem domain). The Wellness Diary for example showed the
users’ progression towards their goals, thus increasing motivation [3]. If the users are
allowed to set the goals themselves, it could enhance the participation rate, as the users
could set goals that are reasonable. The Mobile Coach generated training plans, based
on the personal goals of the users, which were seen as persuading and motivating by
the users [3]. An occupational health support system should therefore let users set the
goals themselves, monitor the progression towards the goals, and allow ‘self-monitor-
ing’ for the users.
Dialogue Support. The highly efficient intervention, GET.ON Stress [37], provided
the users the possibility to receive automatic text messages (e.g. short relaxation exer-
cises) on their mobile phones either every other day or several a day. ‘Reminders’ can
help the users to perform a target behavior [7], but the amount and frequency of possible
‘reminders’ should be consider carefully while giving the users a chance to choose be-
tween options.
A system should have a look and feel that appeals to the users, in other words a
system should be visually attractive [7]. The Internet CBT program; Useful mental
health solutions series for business [39], an effective intervention, provided training
along a Japanese Manga comic story, which could be seen as appealing for the target
users (Japanese people).
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Social Support. The CheckYourDrinking [33], a successful intervention, provided nor-
mative data about drinking alcohol and the risks associated with drinking alcohol. ‘Nor-
mative influence’ can be used to help and motivate the users as leverage to adopt a
target behavior [7].
5 Discussion
Black-box thinking [48], lack of providing specific details of the system described, was
present in the majority (25 out of 38) of excluded papers, which could be because of
the limited space. Another reason for leaving out support system details could be that
researchers are possibly unfamiliar with the field of computer science [49].
The results of the interventions were overall successful in all system platforms, from
slight to significant effect into the problem domains addressed. The only exception,
with a distinct failure as a result was the intervention, in which the participants were
not allowed to use the system in an occupational environment [41]. In Health Connec-
tion [29], the authors discuss how the improvements in all the health topics of the in-
tervention might be attributable partly because of the Hawthorne effect [50].
Traditional intervention approaches (printed material et cetera) are not the only ones
that employers should consider, as both the Active Living [28] and the Health Connec-
tion [29] proved out to be equivalent to traditional print as interventions. Additionally,
the WorkPace [32] produced similar effect as sit-stand workstations for discomfort in
shoulders, upper back, and lower back.
When looking for similarities between the interventions, no single unifying software
feature was found, possibly because the interventions were handling problem domains
varying from each other (and some had several domains). All the interventions had
persuasive features, for example ‘personalization’ [31] and ‘self-monitoring’ [44]. All
the interventions included into this systematic literature review were targeting a health
behavior change, while having traditional information systems, native mobile infor-
mation systems or web information systems as platforms. The composition and amount
of participants in the interventions were also differing when compared against each
other, so there were no single unifying factor between the participants either, with the
exception that they all were employees.
When considering improving the working conditions of workers by monitoring their
health [6], there might be some ethical and/or legal issues. In worst-case scenario, an
employer might dismiss an employee with health issues, even though it could be re-
solved by a health intervention or the health problem does not have an influence on the
productivity of the employee. In the European Union, the General Data Protection Reg-
ulation will be applied starting 25th of April 2018, which will be completed and clarified
by national regulation, thus having strict rules (at least in Finland) on how and to what
purposes collected data can be used [51]. The legal (and ethical) grounds for dismissing
employees might be less strict in some countries in the world, thus monitoring employ-
ees might lead into a situation where the aim is not to improve the working conditions.
The amount of excluded studies because of insufficient intervention description (25)
was large when compared to the amount of included studies (18), thus giving evidence
Sixth International Workshop on Behavior Change Support Systems (BCSS’18): 21
Systems Supporting Occupational Health Behavior Change: A Systematic Literature Review
that black-box thinking described by Oinas-Kukkonen [48] is a common phenomenon
in research papers relating to occupational health interventions for behavior change.
6 Conclusion
Employees might face different health problems, thus occupational health interventions
might target several health problem domains at the same time. Modern technology can
provide recommendable alternatives (e.g. behavior change support systems) for tradi-
tional intervention approaches. Although monitoring and analyzing employees’ health
might be beneficial for both the employer and employee, the legal and ethical aspects
of monitoring could be problematic in the end. Absenteeism originating from stress for
example or from unhealthy behavior of employees might be reduced by promoting
health in worksites, which could both increase the productivity of the employees, as
well as improve their general well-being. Participating in a worksite health promotion
program (intervention) could have a significant impact on absenteeism by improving
the health of employees, which alone should be motivation enough for employers to
spend resources on health support systems for behavior change. Employees already fa-
miliar with the organization and production procedures are valuable assets, therefore
further research on how to improve health of employees could be beneficial for the
employers as well. It would help if the researchers would add proper descriptions of
support systems used in the interventions into the published studies, which should not
be an insurmountable effort, even though space on papers might be scarce at times.
Acknowledgements. This research has been funded by the Strategic Research Council
at the Academy of Finland, contract no. 303430 (Finnish Institute of Occupational
Health), contract no. 303431 (University of Oulu, OASIS), as well as Finnish Cultural
Foundation.
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