title: What are possible barriers and facilitators to implementation of a Participatory Ergonomics programme?
abstract: BACKGROUND
  Low back pain (LBP) and neck pain (NP) are common among workers. Participatory Ergonomics (PE) is used as an implementation strategy to prevent these symptoms. By following the steps of PE, working groups composed and prioritised ergonomic measures, and developed an implementation plan. Working group members were responsible to implement the ergonomic measures in their departments. Little is known about factors that hamper (barriers) or enhance (facilitators) the implementation of ergonomic measures. This study aimed to identify and understand the possible barriers and facilitators that were perceived during implementation.
  
  
  METHODS
  This study is embedded in a cluster randomised controlled trial that investigated the effectiveness of PE to prevent LBP and NP among workers. For the purpose of the current study, questionnaires were sent to 81 working group members. Their answers were used to make a first inventory of possible barriers and facilitators to implementation. Based on the questionnaire information, 15 semi-structured interviews were held to explore the barriers and facilitators in more detail. All interviews were audio taped, transcribed verbatim, and analysed according to a systematic approach.
  
  
  RESULTS
  All possible barriers and facilitators were obtained from questionnaire data, indicating that the semi-structured interviews did not yield information about new factors. Various barriers and facilitators were experienced. The presence of implementation plans for ergonomic measures that were already approved by the management facilitated implementation before the working group meeting. In these cases, PE served as a strategy to improve the implementation of the approved measures. Furthermore, the findings showed that the composition of a working group (i.e., including decision makers and a worker who led the implementation process) was important. Moreover, stakeholder involvement and collaboration were reported to considerably improve implementation.
  
  
  CONCLUSIONS
  This study showed that the working group as well as stakeholder involvement and collaboration were important facilitating factors. Moreover, PE was used as a strategy to improve the implementation of existing ergonomic measures. The results can be used to improve PE programmes, and thereby may contribute to the prevention of LBP and NP.
  
  
  BACKGROUND
  ISRCTN27472278.
authors.affiliation: Body@Work TNO VUmc, Research Center Physical Activity, Work and Health, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. h.anema@vumc.nl.
authors.forename: Maurice T
authors.initials: MT
authors.lastname: Driessen
authors.forename: Karin
authors.initials: K
authors.lastname: Groenewoud
authors.forename: Karin I
authors.initials: KI
authors.lastname: Proper
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Bongers
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek