Next Article in Journal
French Public Familiarity and Attitudes toward Clinical Research during the COVID-19 Pandemic
Next Article in Special Issue
Safety Leadership, Safety Attitudes, Safety Knowledge and Motivation toward Safety-Related Behaviors in Electrical Substation Construction Projects
Previous Article in Journal
Correction: Wachs, S., et al. Associations between Witnessing and Perpetrating Online Hate in Eight Countries: The Buffering Effects of Problem-Focused Coping. Int. J. Environ. Res. Public Health 2019, 16, 3992
Previous Article in Special Issue
Selecting Appropriate Words for Naming the Rows and Columns of Risk Assessment Matrices
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

An Assessment of Ergonomics Climate and Its Association with Self-Reported Pain, Organizational Performance and Employee Well-Being

1
Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran
2
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran
3
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(5), 2610; https://doi.org/10.3390/ijerph18052610
Submission received: 27 December 2020 / Revised: 27 February 2021 / Accepted: 1 March 2021 / Published: 5 March 2021
(This article belongs to the Special Issue Risk-Reduction Research in Occupational Safety and Ergonomics)

Abstract

:
Previous studies have demonstrated that a positive ergonomics climate with an equal focus on improving operational performance and employee well-being is beneficial to both employee health and organizational performance. This study aimed to assess the ergonomics climate at two power plants and examine its association with self-reported pain, performance, and well-being. At two power plants in Iran, survey responses from 109 and 110 employees were obtained. The questionnaires contained data on ergonomics climate, organizational performance, employee health, and self-reported pain. Results showed that the mean ergonomics climate scores between the Besat and Rey power plants were significantly different (p < 0.001). The overall ergonomics climate score, and all subscales scores, were positively associated with organizational performance (p < 0.001). The overall ergonomics climate score, and some of its subscales, were significantly associated with employees’ general health (p < 0.001). The ergonomics climate score was significantly higher in the group of employees who reported musculoskeletal pain than those who did not report musculoskeletal pain (p < 0.05). Investigation of ergonomics climate can provide organizations with a baseline for prioritizing their values and finding areas for improving organizational performance and employee health.

1. Introduction

The high level of competition in the global market has compelled companies to implement new technologies, change organizational structure, and introduce novel workplace improvement programs. For example, ergonomics programs with a strong focus on preventing work-related injuries and human error accidents have been employed in various industries [1,2]. Ergonomics is a system-oriented approach focused on both human interactions with work and the design of work processes. Generally, organizations implement ergonomic programs to reduce injury costs, decrease waste, and reduce the rate of absenteeism. Ergonomic programs can also increase employee motivation and productivity while improving the quality of the products and services [3,4,5,6]. Measurements of an organizations ergonomics climate are utilized to quantify the value that an organization places on integrating ergonomics principles to maximize operational performance and well-being outcomes [7]. This measure was first introduced in a study by Hoffmeister et al. [7] at a large manufacturing facility in the United States.
Ergonomics climate was defined as “employee perceptions of the extent to which the organization emphasizes and supports the design and modification of work such that both operational performance and employee well-being are maximized” [7,8]. Climate reflects the employees’ perception and knowledge of the organization’s field of activities and represents the atmosphere and space in which the employees work [9,10]. In the definition of ergonomics climate, operational performance refers to the economic aspects of an organization’s functions. These include productivity, efficiency, quality, sustainability, competitive advantage, and the ability to perform the organization’s task to stay successful [11]. Operational performance is a broad concept that shows the state or quality of performance for different activities and their associated outcomes [12]. Managers often consider these activities a high priority because they directly impact their organization’s productivity and effectiveness [13,14]. As an organization’s human resources, employees play a significant role in improving productivity and effectiveness, which can promote overall organizational performance [15]. Employee well-being refers to the organization’s focus on maintaining a high level of health and safety in the workforce. Some of the variables considered in employee well-being include injury and illness rates, job satisfaction, stress, absenteeism, and work-life balance [16,17,18].
According to the definition of ergonomics climate, the workplace’s design and modification can improve employee well-being while improving operational performance [8]. This approach has long been considered one of the most comprehensive methods for improving the work environment [19,20].
Organizations should strive for a climate that supports both operational performance and employee well-being to maximize their overall success as a company. Organizations that value performance improvement more than health and safety report higher work-related musculoskeletal pain levels among their workforce [21]. Organizations that value employee well-being more than performance may still report higher levels of work-related pain among their employees because of a decline in productivity, increasing pressure to compensate for this lack of productivity in the future. Organizations that equally value performance and employee well-being and act by a system-oriented approach can expect the highest amount of growth and success [7,22]. Although many studies have explored the safety climate [23,24,25] and performance climate [26,27,28], there is only one published study on ergonomics climate in the workplace [7]. Safety climate focuses on employee safety but does not reflect employee work performance, represented by ergonomics climate [29]. Ergonomics climate assesses deeper and more diverse values within an organization than other climate measures. However, like safety climate measures, ergonomic climate measures are also leading, rather than lagging, indicators of work performance outcomes. The purpose of this study was to evaluate ergonomics climate and its association with employee well-being and organizational performance at two Iranian power plants.

2. Materials and Methods

2.1. Participants

A cross-sectional study was utilized to assess the ergonomics climate at the Besat and Rey power plants in Tehran, Iran. Both plants had similar departments, including maintenance, operations, engineering, planning, and administration. The Rey power plant had previously provided ergonomics training for management and employees. There were 570 active employees total at the two facilities working in different departments. The sample size was estimated using statistical power analysis and the following formula:
N = 2 2 ( z 1 2 + z 1 β ) 2 ( μ 0 μ 1 ) 2 ,     ( 2 = 1.04 2 ) ,
whereby power was calculated at 1 β = 0.80 with a margin of error α = 0.05. According to a previous study, the and μ 0 μ 1 values were determined as 1.04 and 0.04, respectively. As a result, a minimum of 106 employees was required for recruitment in each power plants. A total of 150 employees were invited to complete the survey in each facility. Employees were randomly selected from different departments at each facility to complete the surveys. Each facility provided a list of all employees, and random numbers were used for employee selection. The response rates were 72% (109 employees) and 73% (110 employees) for the Besat and Rey power plant, respectively. Additional information on the collected sample size is presented in Table 1 and Table 2.
Before data collection, the required information about the study’s purpose and procedures was provided to the employees and their supervisors. Participation in the survey was voluntary, and consent was obtained before participation. The Ethics Committee of Tehran University of Medical Sciences (Project identification code: IR.TUMS.SPH.REC.1396.3728) approved the study’s protocol.

2.2. Measures

An Ergonomic Climate Assessment questionnaire [7] was used to measure ergonomics climate score. The Ergonomic Climate questionnaire was translated from English into Persian for the present study by two experts in occupational health and ergonomics, whose native language was Persian. The validity and reliability of the Persian translation were determined in our previous study [30]. A panel of experts composed of 10 professionals in occupational health and ergonomics was assembled to conduct a validity assessment. The panel of experts computed a Content Validity Index (CVI) to determine item relevance and a Content Validity Ratio (CVR) to determine if each item was essential [31,32]. The CVI and CVR were 0.94 and 0.90, respectively. Panel members provided suggestions to improve the content and sentence structure. Reliability was evaluated by using Cronbach’s alpha as a measure of internal consistency. For this purpose, a cross-sectional study was carried out on 50 employees of the Besat power plant. The Cronbach’s alpha was calculated using the SPSS 21 software (α = 0.96), which indicate internal consistency reliability based on the George and Mallery guideline [31,33,34]. The Ergonomic Climate measure has consisted of four subscales, including management commitment, employee involvement, hazard identification/control, and training/knowledge. A 5-point Likert scale was used to record the responses according to five possible choices of 1-strongly disagree, 2-disagree, 3-neither agree nor disagree, 4-agree, and 5-strongly agree. The scores were summed for ten subscales, resulting in two operational performance and employee well-being scores. The overall ergonomics climate score was determined by adding the scores of these two values.
Demographic characteristics, including age, gender, and work experience, were collected. The ergonomics climate scores obtained were used to assess the impact of ergonomics climate on self-reported pain, organizational performance, and employee well-being.
Individuals were asked if they had experienced any work-related pain in the past 12 months in nine different areas of their body regarding the measurement of self-reported pain. The yes (1) or no (0) binary variable was used to record self-reported pain. Hersey and Goldsmith Standard Questionnaire and General Health Questionnaire (GHQ) assessed organizational performance and employee well-being. Additional details for all three questionnaires are presented in Table 3.

2.3. Data Analysis

The data were analyzed using SPSS-21 upon completion of all questionnaires. Statistical variables were described using parameters including percentage, mean, and standard deviation. The Kolmogorov-Smirnov test and Independent T-test were used to investigate the normality of quantitative variables and analyze the mean difference between the two facilities. The Spearman correlation and Chi-square tests were used to determine the relationship between variables. A p-value of 0.05 or less was considered statistically significant [38].

3. Results

3.1. Descriptive Results

Among the sample population, 95.6% (Besat) and 99.1% (Rey) of the employees were male. Participant’s mean age was 35.2 ± 6.2 and 35.1 ± 6.7 years at Besat and Rey facilities, respectively. Respondents reported work experience in three categories, the largest being in the 5 to 10 years group (53.2% at Besat and 54.6% at Rey). All demographic information on the workers is presented in Table 4.
Analysis of the self-reported pain data revealed that employees at the Besat plant experienced the highest level of pain in the neck, lower back, and knee (22%), and employees at the Rey plant experienced the highest level of pain in the neck (23.6%), as depicted in Figure 2.
The organizational performance data from the Hersey and Goldsmith Standard Questionnaire indicated that the mean organizational performance was 140.0 ± 23.0 at the Besat plant and 147.7 ± 24.8 at the Rey plant, as shown in Figure 3.
The General Health Questionnaire result indicated that 76.8% and 60.2% of employees at the Besat and Rey plants, respectively, reported the presence of at least one disorder (Figure 4).

3.2. Analytical Results

The mean scores of ergonomics climate were significantly different at Besat and Ray power plant (p < 0.001). The mean scores of the operational performance and employee well-being facets of the ergonomics climate and their subscales were significantly higher at the Rey facility, as shown in Table 5.
Also, there was a significant difference between the overall ergonomics climate scores of two groups of employees, those who reported at least one general health disorder and those who did not. Those two groups also differed in the subscale scores of management commitment and employee involvement, as shown in Table 6.
There was a significant difference between the mean of overall ergonomics climate scores of the two groups of employees, those who did and did not report musculoskeletal pain in the wrist, lower back, hip/thigh, and ankle/foot Table A1 (Appendix A).
The results of assessing the relationship between two facets of ergonomics climate (i.e., operational performance and employee well-being), as well as their corresponding subscales and self-reported pain in nine areas of the body, are summarized in Table A1 (Appendix A)
A significant correlation was observed between the overall ergonomics climate and each of its subscales with organizational performance. There was a positive and moderate correlation between the overall ergonomics climate and organizational performance (p < 0.001), as shown in Figure 5.

4. Discussion

This study utilized previously developed measures but is the first to assess the ergonomics climate to investigate its association with employee well-being and organizational performance. In the ergonomics climate subscales, the mean operational performance score was higher than the mean employee well-being score at both facilities.
There was a significant difference between the overall ergonomics climate score and each subscale score at two Rey and Besat power plants. Holding an ergonomics awareness training session for management and employees at Rey power plant may be a primary source for the difference between ergonomics climate scores at the two power plants. In both operational performance and employee well-being, management commitment had the highest mean value at the Rey facility. The difference was significant betweenthe overall ergonomics climate scores and each subscale scores at two power plants. The employee’s perception of management commitment was reported higher at the Rey facility due to various practices. These practices include more collaborative relationships between management and employees, employee involvement in the decision-making to address ergonomics and safety issues, and employees participantion in ergonomics training awareness. Previous studies have introduced management commitment as a factor that can influence the other dimensions of safety [39,40,41].
Further studies indicated the critical role of management commitment in implementing the ergonomic principle and its influence on employee buy-in and commitment to the organization [42,43]. Management commitment to operational performance usually manifests itself in employee training and job enrichment which can ultimately improve employee perceptions regarding the quality of goods and services [44]. Management support and psychosocial attitudes are the most important predictors of an ergonomics program’s success or failure [45].
The ergonomics climate measure included another subscale, employee involvement, which can be positively influenced by management support of employee participation in providing solutions for controlling the workplace hazards. The employee involvment subscale was significantly higher at the Rey plant when compared to the Besat plant. The high level of employee involvement likely influenced the level of perceived ergonomics climate at the Rey facility. Previous studies have found that the employee perception of an organization’s climate directly affects the employee perception of involvement [46,47]. The climate of an organization should be considered an essential factor in promoting employee involvement. Ultimately, a climate of management support and commitment encourages employee involvement, directly influencing climate perception [48,49].
Training and knowledge also promoted a higher perception of the ergonomics climate at the Rey plant. Training employees leads to self-protection practices, resulting in several beneficial outcomes for the organization [50]. Similar to our research finding, Mazzetti et al. (2020) demonstrated that the perception of a safety climate among construction workers is inversely associated with the higher perception of risk and safety knowledge [51]. Training can reduce the rate of absenteeism and accidents, lower healthcare costs, and increase productivity [52]. Ergonomics training can improve employee knowledge of how they interact with the work environment as individuals and teams. This knowledge and the ability to apply it can decrease health-related issues and increase organizational performance. Several studies have shown that training significantly impacts overall job satisfaction and identifies work-related hazards [53,54]. Ergonomics training has previously been considered a key element in improving employee’s safety, well-being, and productivity [55,56]. All subscales of the ergonomics climate are essential, and it is beneficial to consider how they influence each other. Based on this study and previous studies, management commitment directly influences employee involvement, affecting the effectiveness of training and workers’ ability to identify and control hazards.
The mean ergonomics climate score was reported as significantly higher by employees who did not self-report pain than those who reported musculoskeletal pain. Hence, a higher perceived ergonomics climate is likely associated with lower musculoskeletal pain levels [57]. An ergonomics program that focuses on the design and modification of the workplace to improve overall health and operational performance can significantly impact employee perceptions regarding the ergonomics climate [8]. Implementing an effective ergonomics program can help reduce the prevalence of musculoskeletal disorders while also improving the efficiency and productivity of the employees [5,58,59]. A similar study also showed an association between psychosocial working conditions including low autonomy, low quality of leadership, and increased risk of reporting higher physical exertion [6].
A positive association was observed between the overall ergonomics climate and each of its subscales and organizational performance. Other studies have also observed a similar relationship. A positive correlation between applying ergonomics principles to reduce workplace-related problems and enhanced quality has been observed [60]. Additionally, the implementation of ergonomic and safety regulations to improve productivity and worker well-being can produce a more efficient production system [61,62]. Another study showed that enhancing efficiency and quality of work will reduce absenteeism and work-related injuries and diseases [63]. The implementation of ergonomics principles in designing a training program can be highly effective in individual’s learning performance [63]. Organizations that aim to improve their organizational performance should evaluate their ergonomics climate to develop targeted interventions [14].
Furthermore, the mean overall ergonomics climate score of employees with the absence of a disorder was significantly higher than the employees with the presence of disorder regarding their general health. The mean of each subscale score of ergonomics climate was higher in the employees with the absence of disorder than the group with the risk of developing the disorder. However, this difference was only significant in the management commitment and employee involvement subscales for operational performance and management commitment for employee well-being. Overall, higher levels of general health were reported when the organization had a higher ergonomics climate. It has been suggested that social supports of coworkers and supervisors in the workplace, as one of the characteristics of an ergonomics approach, can reduce the incidence rate of diseases in employees [64,65]. Similar to the significant relationship between each of the ergonomics climate subscales, including management commitment and employee involvement, was observed in this study, Vosoughi et al. [66] demonstrated that an organization’s climate and the relationships between employees and management had an impact on work-related stress. This stress had a positive correlation with the physical and mental well-being of employees [67]. Finally, other studies indicated that the organizational climate and management style could affect the mental well-being of employees [7,68,69]. Assessing the organization’s ergonomics climate and creating interventions based on the results could be an effective way to improve employees’ general health.
The present study was based on cross-sectional and self-reported data collected through three separate questionnaires. This type of study design and data have several limitations, such as the inability to determine a causal relationship and analyze data over time. The relationships between the ergonomics climate score and the outcomes are associations at the time of the questionnaire administration, and do not suggest causal inferences. Because the ergonomics climate measure is relatively new, and little research has been conducted using this measure, various outcomes were measured to investigate their possible association with the ergonomics climate scores. With many comparisons, this increases the possibility of getting a significant result simply by chance (type I error). Since this was the first study ever to use ergonomics climate to compare two occupational settings from the same industry the results should guide the path for future studies. Future studies should be conducted in various industries and workplaces, multilevel designs, and a large number of employees. Prospective cohort studies encompassing ergonomics climate measures would be beneficial in demonstrating possible causal pathways.

5. Conclusions

The translated (English to Persian) version of the Ergonomics Climate Assessment was an appropriate and beneficial tool for assessing the ergonomics climate’s status at two Iranian power plants. The ergonomics climate assessment can assist in prioritizing resources devoted to safety and production improvements within occupational settings, such as the power plants described in the present study. Furthermore, climate subscales can provide valuable and specific information to assist with targeted interventions for improving both worker well-being and operational metrics. The present study has demonstrated the cross-cultural use of the ergonomics climate assessment tool. A longitudinal study employing the ergonomics climate assessment tool to assess the effectiveness of systematic ergonomic interventions in a variety of occupational settings is needed.
This study confirms the findings of previously published work that implementing ergonomics’ principles focusing on improving both employee well-being and operational performance is beneficial for both the organization and employees. We believe that our findings have important policy implications. Future work policies should focus on leading indicators rather than lagging indicators to improve worker and organizational health and well-being [7]. Leading indicators allow organizations to be proactive rather than reactive in their safety and operational performance.
In the present study, higher ergonomics climate scores were associated with less self- reported musculoskeletal pain among the workers and higher operational performance for the company. Thus, businesses that focus their climate messages on the goals that include a system approach to workplace ergonomics will tend to have a healthier and more productive workforce.

Author Contributions

Conceptualization, E.F. and S.A.Z.; methodology, E.F., S.A.Z. and K.A.; formal analysis, E.F. and K.A.; investigation, E.F., S.A.Z.; writing—original draft preparation, E.F. and S.A.Z.; writing—review and editing, E.F., K.H., and J.R.; supervision, S.A.Z., and K.A.; funding acquisition, S.A.Z. All authors have read and agreed to the published version of the manuscript.

Funding

This research was supported by the Tehran University of Medical Sciences (decree number: 9111196041-1) and by the Mountains and Plains Education and Research Center at Colorado State University; Grant Number T42H009229.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by Ethics Committee of Tehran University of Medical Sciences (Project identification code: IR.TUMS.SPH.REC.1396.3728 dated 28 April 2018).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Acknowledgments

This study was part of the MSc thesis of E.faez verified by the research department of the Tehran University of Medical Science under code No 9411457003. We would like to present our most sincere thanks and appreciation to the Research Department of the Tehran University of Medical Sciences for their financial support. The author would like to sincerely thank all the employees at the Besat and Rey power plants, specifically Parvin Baghi, at the Rey power plant’s occupational health sector.

Conflicts of Interest

The authors declare no conflict of interest.

Appendix A

Table A1. Relationship between Ergonomics Climate sub-scales and self-reported Pain in a different part of the body.
Table A1. Relationship between Ergonomics Climate sub-scales and self-reported Pain in a different part of the body.
Operational Performance
Management CommitmentEmployee InvolvementHazard Identification and ControlTraining and Knowledge
Self-Reported PainNMean ± SDp-Value *NMean ± SDp-Value *NMean ± SDp-Value *NMean ± SDp-Value *
NeckNo16816.7 ± 5.40.8616815.9 ± 5.20.7316616.5 ± 4.50.8216615.7 ± 5.10.72
Yes5016.8 ± 4.25015.7 ± 4.65015.7 ± 4.25015.5 ± 4.7
ShoulderNo18516.8 ± 5.20.6218515.9 ± 5.30.7918316.5 ± 4.50.9418515.7 ± 5.00.72
Yes3316.3 ± 4.53315.7 ± 3.93316.5 ± 43315.4 ± 4.8
Upper backNo17816.8 ± 5.30.7617616.0 ± 5.210.5517416.5 ± 4.60.6817415.8 ± 5.10.52
Yes4216.5 ± 4.44215.4 ± 4.64216.8 ± 4.04215.2 ± 4.6
ElbowNo20616.7 ± 5.10.720615.9 ± 5.10.5420416.5 ± 4.40.7620415.7 ± 4.90.6
Yes1216.2 ± 5.81215 ± 5.61216.2 ± 61214.7 ± 6.9
WristNo20217.0 ± 4.90.008 **20216.1 ± 4.90.005 **20116.6 ± 4.40.7120115.8 ± 4.90.25
Yes1613.4 ± 6.41612.4 ± 6.01516.1 ± 5.01514.3 ± 5.9
Lower backNo17817.1 ± 5.00.01 **17816.3 ± 5.00.01 **17716.7 ± 4.40.1717715.9 ± 5.00.15
Yes4015.0 ± 5.24014.2 ± 5.23915.7 ± 4.43914.6 ± 5.1
Hip/ThighNo20716.9 ± 5.00.008 **20716.1 ± 5.00.004 **20616.6 ± 4.40.1120615.8 ± 5.00.03 **
Yes1112.3 ± 6.21111.5 ± 5.71014.3 ± 3.91012.4 ± 3.0
KneeNo18616.7 ± 5.00.0818616.1 ± 5.00.0718516.6 ± 4.50.5518515.8 ± 5.00.23
Yes3215.3 ± 6.23214.4 ± 5.73116.0 ± 4.43114.8 ± 5.1
Ankle/FootNo20116.9 ± 5.00.1120116.0 ± 5.00.2720015.8 ± 5.00.5720116.0 ± 5.00.18
Yes1714.8 ± 6.21714.6 ± 5.71614.0 ± 4.71714.6 ± 5.2
Employee Well-Being
Management CommitmentEmployee InvolvementHazard Identification and ControlTraining and Knowledge
Self-Reported PainNMean ± SDp-Value *NMean ± SDp-Value *NMean ± SDp-Value *NMean ± SDp-Value *
NeckNo16816.3 ± 5.80.3516815.5 ± 5.40.616616.4 ± 4.80.6116615.5 ± 5.30.65
Yes5015.2 ± 5.25015.0 ± 4.85016.0 ± 4.55015.1 ± 4.6
ShoulderNo18515.5 ± 5.40.1518515.5 ± 5.40.4118316.4 ± 4.80.518315.5 ± 5.30.48
Yes3314.7 ± 4.43314.7 ± 4.43315.2 ± 4.53314.8 ± 4.2
Upper backNo17616.3 ± 5.70.2617615.5 ± 5.40.5717416.4 ± 4.80.4517415.5 ± 5.20.53
Yes4215.2 ± 5.14215.0 ± 4.74215.8 ± 4.54214.9 ± 4.7
ElbowNo20616.2 ± 5.50.5220615.4 ± 5.30.9720416.4 ± 4.60.4220415.5 ± 5.00.23
Yes1214.7 ± 7.91215.3 ± 5.31215.3 ± 6.01213.7 ± 6.6
WristNo20216.4 ± 5.40.009 **20215.6 ± 5.20.01 **20116.4 ± 4.70.1920115.6 ± 5.10.05 **
Yes1612.6 ± 7.21612.4 ± 5.81514.8 ± 4.91512.9 ± 5.5
Lower backNo17816.6 ± 5.50.002 **17815.9 ± 5.20.05 **17716.7 ± 4.70.03 **17715.7 ± 5.10.02 **
Yes4013.6 ± 5.84013.3 ± 5.23914.8 ± 4.43913.7 ± 5.0
Hip/ThighNo20716.3 ± 5.50.04 **20715.6 ± 5.20.00720616.4 ± 4.70.2420615.5 ± 5.10.05 **
Yes1112.8 ± 7.91111.2 ± 4.81014.6 ± 4.41012.3 ± 5.2
KneeNo18616.4 ± 5.50.0918615.7 ± 5.20.05 **18516.5 ± 4.80.2718515.6 ± 5.10.1 **
Yes3214.5 ± 6.63213.8 ± 5.83115.5 ± 4.53114 ± 5.4
Ankle/FootNo20116.3 ± 5.50.02 **20115.6 ± 5.20.0720016.5 ± 4.70.220015.5 ± 5.10.07
Yes1713.1 ± 7.11713.2 ± 6.01614.6 ± 4.71613.2 ± 4.8
Overall Ergonomics Climate
Self-Reported PainNMean ± SDp-Value *
NeckNo168121.27 ± 36.900.25
Yes50114.72 ± 30.33
ShoulderNo185120.69 ± 36.340.36
Yes33114.60 ± 30.61
Upper backNo176120.75 ± 35.990.40
Yes42115.66 ± 33.68
ElbowNo206120.62 ± 35.380.14
Yes12105.25 ± 36.60
WristNo202121.02 ± 34.900.045 **
Yes16104 ± 40.81
Lower backNo178122.68 ± 34.880.01 **
Yes40106.82 ± 3.97
Hip/ThighNo207120.90 ± 34.830.04 **
Yes1198.45 ± 43.45
KneeNo186121.55 ± 35.470.07
Yes32109.43 ± 34.67
Ankle/FootNo201121.25 ± 35.340.03 **
Yes17102.29 ± 34.15
* Independent sample t-test. ** p < 0.5.

References

  1. Zare, M.; Black, N.; Sagot, J.-C.; Hunault, G.; Roquelaure, Y. Ergonomics interventions to reduce musculoskeletal risk factors in a truck manufacturing plant. Int. J. Ind. Ergon. 2020, 75, 102896. [Google Scholar] [CrossRef]
  2. Lima, T.M.; Coelho, D.A. Ergonomic and psychosocial factors and musculoskeletal complaints in public sector administration–a joint monitoring approach with analysis of association. Int. J. Ind. Ergon. 2018, 66, 85–94. [Google Scholar] [CrossRef]
  3. Hendrick, H.W. Applying ergonomics to systems: Some documented “lessons learned”. Appl. Ergon. 2008, 39, 418–426. [Google Scholar] [CrossRef]
  4. Dul, J.; Neumann, W.P. Ergonomics contributions to company strategies. Appl. Ergon. 2009, 40, 745–752. [Google Scholar] [CrossRef] [Green Version]
  5. Drury, C.G. Ergonomics Quality and Cost-Benefit Issues. In Occupational Ergonomics: Design and Management of Work Systems; Karwowski, W., Marras, W.S., Eds.; CRC Press, Taylor & Francis Group: New York, NY, USA, 2003; pp. 1–6. [Google Scholar]
  6. Lewis, R.J.; Krawiec, M.; Confer, E.; Agopsowicz, D.; Crandall, E. Musculoskeletal disorder worker compensation costs and injuries before and after an office ergonomics program. Int. J. Ind. Ergon. 2002, 29, 95–99. [Google Scholar] [CrossRef]
  7. Hoffmeister, K.; Gibbons, A.; Schwatka, N.; Rosecrance, J. Ergonomics Climate Assessment: A measure of operational performance and employee well-being. Appl. Ergon. 2015, 50, 160–169. [Google Scholar] [CrossRef]
  8. Robertson, M.M.; Huang, Y.H.; Lee, J. Improvements in musculoskeletal health and computing behaviors: Effects of a macroergonomics office workplace and training intervention. Appl. Ergon. 2017, 62, 182–196. [Google Scholar] [CrossRef] [PubMed]
  9. Griffin, M.A.; Neal, A. Perceptions of safety at work: A framework for linking safety climate to safety performance, knowledge, and motivation. J. Occup. Health Psychol. 2000, 5, 347. [Google Scholar] [CrossRef] [PubMed]
  10. Schneider, B.; Ehrhart, M.G.; Macey, W.H. Organizational climate and culture. Annu. Rev. Psychol. 2013, 64, 361–388. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  11. Drucker, P.F. The new productivity challenge. Qual. Higher Educ. 1995, 37, 45–53. [Google Scholar]
  12. Neely, A. Defining performance measurement: Adding to the debate. Perspect. Perform. 2005, 4, 14–15. [Google Scholar]
  13. West, M.A.; Smith, H.; Feng, W.L.; Lawthom, R. Research excellence and departmental climate in British universities. J. Occup. Organ. Psychol. 1998, 71, 261–281. [Google Scholar] [CrossRef]
  14. Battini, D.; Faccio, M.; Persona, A.; Sgarbossa, F. New methodological framework to improve productivity and ergonomics in assembly system design. Int. J. Ind. Ergon. 2011, 41, 30–42. [Google Scholar] [CrossRef]
  15. Kangis, P.; Gordon, D.; Williams, S. Organisational climate and corporate performance: An empirical investigation. Manag. Decis. 2000, 38, 531–540. [Google Scholar] [CrossRef]
  16. Cotton, P.; Hart, P.M. Occupational wellbeing and performance: A review of organisational health research. Aust. Psychol. 2003, 38, 118–127. [Google Scholar] [CrossRef]
  17. Dawal, S.; Taha, Z.; Ismail, Z. Effect of job organization on job satisfaction among shop floor employees in automotive industries in Malaysia. Int. J. Ind. Ergon. 2009, 39, 1–6. [Google Scholar] [CrossRef]
  18. Smith, M.J.; Sainfort, P.C. A balance theory of job design for stress reduction. Int. J. Ind. Ergon. 1989, 4, 67–79. [Google Scholar] [CrossRef]
  19. Sanders, M.S.; McCormick, E.J. Human Factors in Engineering and Design, 7th ed.; McGraw-Hill Professional: New York, NY, USA, 1992. [Google Scholar]
  20. de Macedo Guimarães, L.B.; Anzanello, M.J.; Ribeiro, J.L.D.; Saurin, T.A. Participatory ergonomics intervention for improving human and production outcomes of a Brazilian furniture company. Int. J. Ind. Ergon. 2015, 49, 97–107. [Google Scholar] [CrossRef]
  21. Yeow, P.H.; Sen, R.N. Quality, productivity, occupational health and safety and cost effectiveness of ergonomic improvements in the test workstations of an electronic factory. Int. J. Ind. Ergon. 2003, 32, 147–163. [Google Scholar] [CrossRef]
  22. Zare, M.; Bodin, J.; Cercier, E.; Brunet, R.; Roquelaure, Y. Evaluation of ergonomic approach and musculoskeletal disorders in two different organizations in a truck assembly plant. Int. J. Ind. Ergon. 2015, 50, 34–42. [Google Scholar] [CrossRef]
  23. Neal, A.; Griffin, M.A. A study of the lagged relationships among safety climate, safety motivation, safety behavior, and accidents at the individual and group levels. J. Appl. Psychol. 2006, 91, 946. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Zohar, D. Modifying supervisory practices to improve subunit safety: A leadership-based intervention model. J. Appl. Psychol. 2002, 87, 156. [Google Scholar] [CrossRef]
  25. Pousette, A.; Larsson, S.; Törner, M. Safety climate cross-validation, strength and prediction of safety behaviour. Saf. Sci. 2008, 46, 398–404. [Google Scholar] [CrossRef]
  26. Cappelli, P.; Neumark, D. Do “high-performance” work practices improve establishment-level outcomes? ILR Rev. 2001, 54, 737–775. [Google Scholar]
  27. Aryee, S.; Walumbwa, F.O.; Seidu, E.Y.; Otaye, L.E. Impact of high-performance work systems on individual-and branch-level performance: Test of a multilevel model of intermediate linkages. J. Appl. Psychol. 2012, 97, 287. [Google Scholar] [CrossRef] [PubMed]
  28. Maciel, R. Participatory ergonomics and organizational change. Int. J. Ind. Ergon. 1998, 22, 319–325. [Google Scholar] [CrossRef]
  29. Kongsvik, T.; Dahl, Ø.; Holmen, I.M.; Thorvaldsen, T. Safety climate and health complaints in the Norwegian aquaculture industry. Int. J. Ind. Ergon. 2019, 74, 102874. [Google Scholar] [CrossRef]
  30. Faez, E.; Zakerian, S.A.; Azam, K. Validity and Reliability of the Persian Version of the Ergonomics Climate Assessment Questionnaire. J. Sch. Public Health Inst. Public Health Res. 2018, 16, 307–316. [Google Scholar]
  31. Coluci, M.Z.; Alexandre, N.M.; Rosecrance, J. Reliability and validity of an ergonomics-related Job Factors Questionnaire. Int. J. Ind. Ergon. 2009, 39, 995–1001. [Google Scholar] [CrossRef]
  32. Heiden, M.; Zetterberg, C.; Lindberg, P.; Nylén, P.; Hemphälä, H. Validity of a computer-based risk assessment method for visual ergonomics. Int. J. Ind. Ergon. 2019, 72, 180–187. [Google Scholar] [CrossRef]
  33. Mallery, P.; George, D. SPSS for Windows Step by Step: A Simple Guide and Reference; Allyn & Bacon: Boston, MA, USA, 2003. [Google Scholar]
  34. Howard, N.; Spielholz, P.; Bao, S.; Silverstein, B.; Fan, Z.J. Reliability of an observational tool to assess the organization of work. Int. J. Ind. Ergon. 2009, 39, 260–266. [Google Scholar] [CrossRef]
  35. Yaghoubi, M.; Javadi, M.; Rakhsh, F.; Bahadori, M. A study of determining factors affecting the performance of nurses based on the achieve model in selected hospital of Isfahan (Iran). J. Educ. Health Promot. 2013, 2, 49. [Google Scholar] [CrossRef] [PubMed]
  36. Taghavi, S. Validity and reliability of the general health questionnaire (ghq-28) in college students of shiraz university. J. Psychol. 2002, 5, 381–398. [Google Scholar]
  37. Sterling, M. General health questionnaire–28 (GHQ-28). J. Physiother. 2011, 57, 259. [Google Scholar] [CrossRef] [Green Version]
  38. Joshi, M.; Deshpande, V. A systematic review of comparative studies on ergonomic assessment techniques. Int. J. Ind. Ergon. 2019, 74, 102865. [Google Scholar] [CrossRef]
  39. Newaz, M.T.; Davis, P.R.; Jefferies, M.; Pillay, M. Developing a safety climate factor model in construction research and practice: A systematic review identifying future directions for research. Eng. Constr. Architect. Manag. 2018, 25, 738–757. [Google Scholar] [CrossRef]
  40. Lestari, F.; Sunindijo, R.Y.; Loosemore, M.; Kusminanti, Y.; Widanarko, B. A Safety Climate Framework for Improving Health and Safety in the Indonesian Construction Industry. Int. J. Environ. Res. Public Health 2020, 17, 7462. [Google Scholar] [CrossRef]
  41. Stewart, J. The turnaround in safety at the Kenora pulp & paper mill. Prof. Saf. 2001, 46, 34. [Google Scholar]
  42. Eisenberger, R.; Huntington, R.; Hutchison, S.; Sowa, D. Perceived organizational support. J. Appl. Psychol. 1986, 71, 500. [Google Scholar] [CrossRef]
  43. Ingelgård, A.; Norrgren, F. Effects of change strategy and top-management involvement on quality of working life and economic results. Int. J. Ind. Ergon. 2001, 27, 93–105. [Google Scholar] [CrossRef]
  44. Babakus, E.; Yavas, U.; Karatepe, O.M.; Avci, T. The effect of management commitment to service quality on employees’ affective and performance outcomes. J. Acad. Mark. Sci. 2003, 31, 272–286. [Google Scholar] [CrossRef]
  45. Korunka, C.; Dudak, E.; Molnar, M.; Hoonakker, P. Predictors of a successful implementation of an ergonomic training program. Appl. Ergon. 2010, 42, 98–105. [Google Scholar] [CrossRef] [PubMed]
  46. Naweed, A.; Ward, D.; Gourlay, C.; Dawson, D. Can participatory ergonomics process tactics improve simulator fidelity and give rise to transdisciplinarity in stakeholders? A before–after case study. Int. J. Ind. Ergon. 2018, 65, 139–152. [Google Scholar] [CrossRef]
  47. Marchington, M.; Wilkinson, A.; Ackers, P.; Goodman, J. Understanding the meaning of participation: Views from the workplace. Hum. Relat. 1994, 47, 867–894. [Google Scholar] [CrossRef]
  48. Shadur, M.A.; Kienzle, R.; Rodwell, J.J. The relationship between organizational climate and employee perceptions of involvement: The importance of support. Group Organ. Manag. 1999, 24, 479–503. [Google Scholar] [CrossRef]
  49. Mazzetti, G.; Valente, E.; Guglielmi, D.; Vignoli, M. Safety Doesn’t Happen by Accident: A Longitudinal Investigation on the Antecedents of Safety Behavior. Int. J. Environ. Res. Public Health 2020, 17, 4332. [Google Scholar] [CrossRef]
  50. Mital, A.; Pennathur, A.; Huston, R.; Thompson, D.; Pittman, M.; Markle, G.; Kaber, D.; Crumpton, L.; Bishu, R.R.; Rajurkar, K.P. The need for worker training in advanced manufacturing technology (AMT) environments: A white paper. Int. J. Ind. Ergon. 1999, 24, 173–184. [Google Scholar] [CrossRef]
  51. Abdollahi, T.; Pedram Razi, S.; Pahlevan, D.; Yekaninejad, M.S.; Amaniyan, S.; Leibold Sieloff, C.; Vaismoradi, M. Effect of an Ergonomics Educational Program on Musculoskeletal Disorders in Nursing Staff Working in the Operating Room: A Quasi-Randomized Controlled Clinical Trial. Int. J. Environ. Res. Public Health 2020, 17, 7333. [Google Scholar] [CrossRef] [PubMed]
  52. Mariscal, M.; López-Perea, E.; López-García, J.; Herrera, S.; García-Herrero, S. The influence of employee training and information on the probability of accident rates. Int. J. Ind. Ergon. 2019, 72, 311–319. [Google Scholar] [CrossRef]
  53. Harrington, S.S.; Walker, B.L. The effects of ergonomics training on the knowledge, attitudes, and practices of teleworkers. J. Saf. Res. 2004, 35, 13–22. [Google Scholar] [CrossRef]
  54. King, P.M.; Fisher, J.C.; Garg, A. Evaluation of the impact of employee ergonomics training in industry. Appl. Ergon. 1997, 28, 249–256. [Google Scholar] [CrossRef]
  55. Robertson, M.M.; Huang, Y.-H.; O’Neill, M.J.; Schleifer, L.M. Flexible workspace design and ergonomics training: Impacts on the psychosocial work environment, musculoskeletal health, and work effectiveness among knowledge workers. Appl. Ergon. 2008, 39, 482–494. [Google Scholar] [CrossRef]
  56. Faisting, A.L.R.F.; de Oliveira Sato, T. Effectiveness of ergonomic training to reduce physical demands and musculoskeletal symptoms-An overview of systematic reviews. Int. J. Ind. Ergon. 2019, 74, 102845. [Google Scholar] [CrossRef]
  57. Yassierli. Implementation of ergonomic programs to reduce sick leave due to low back pain among nickel mining operators. Int. J. Ind. Ergon. 2017, 61, 81–87. [Google Scholar] [CrossRef]
  58. Hasani, S.; Mobaraki, H.; Moghadami Fard, Z. The importance of ergonomics in increasing productivity and improving the performance of the staff of the Ministry of Health. Ther. Med. Educ. tkj 2013, 4, 92–101. [Google Scholar]
  59. Ouellet, S.; Vézina, N. Work training and MSDs prevention: Contribution of ergonomics. Int. J. Ind. Ergon. 2014, 44, 24–31. [Google Scholar] [CrossRef]
  60. González, B.A.; Adenso-Díaz, B.; Torre, P.G. Ergonomic performance and quality relationship: An empirical evidence case. Int. J. Ind. Ergon. 2003, 31, 33–40. [Google Scholar] [CrossRef]
  61. Eklöf, M.; Ingelgård, A.; Hagberg, M. Is participative ergonomics associated with better working environment and health? A study among Swedish white-collar VDU users. Int. J. Ind. Ergon. 2004, 34, 355–366. [Google Scholar] [CrossRef]
  62. Brito, M.F.; Ramos, A.L.F.A.; Carneiro, P.; Gonçalves, M.A.; Ferreira, J.A.d.V.; Frade, A.B.T. Improving the Production Performance and Ergonomic Aspects Using Lean and Agile Concepts. Open Cybern. Syst. J. 2018, 12, 122–135. [Google Scholar] [CrossRef]
  63. Yusuff, R.M.; Abdullah, N.S. Ergonomics as a lean manufacturing tool for improvements in a manufacturing company. In Proceedings of the International Conference on Industrial Engineering and Operations Management, Kuala Lumpur, Malaysia, 8–10 March 2016; p. 10. [Google Scholar]
  64. Cotton, J.L.; Vollrath, D.A.; Froggatt, K.L.; Lengnick-Hall, M.L.; Jennings, K.R. Employee participation: Diverse forms and different outcomes. Acad. Manag. Rev. 1988, 13, 8–22. [Google Scholar] [CrossRef]
  65. Fischer, F.M.; Paraguay, A.I.B.; de Castro Bruni, A.; Moreno, C.R.d.C.; Berwerth, A.; Riviello, C.; Vianna, M.M.L. Working conditions, work organization and consequences for health of Brazilian petrochemical workers. Int. J. Ind. Ergon. 1998, 21, 209–219. [Google Scholar] [CrossRef]
  66. Vosoughi, N.A.; Rohollahi, A.; Mohamad, H.H. The effect of job stress on general health and job performance on air traffic controllers (atc). Iran Occup. Health 2016, 13, 47–57. [Google Scholar]
  67. Sackey, J.; Sanda, M.-A. Influence of occupational stress on the mental health of Ghanaian professional women. Int. J. Ind. Ergon. 2009, 39, 876–887. [Google Scholar] [CrossRef] [Green Version]
  68. Foladvand, K. The relationship between organizational climate and the mental health of hospital workers in ham state hospitals. J. Ilam Univ. Med. Sci. 2007, 15, 44–50. [Google Scholar]
  69. Vink, P.; Peeters, M.; Gründemann, R.; Smulders, P.; Kompier, M.; Dul, J. A participatory ergonomics approach to reduce mental and physical workload. Int. J. Ind. Ergon. 1995, 15, 389–396. [Google Scholar] [CrossRef]
Figure 1. Ergonomics Climate Questions Structure.
Figure 1. Ergonomics Climate Questions Structure.
Ijerph 18 02610 g001
Figure 2. Percentage of self-reported pain by body part from the Ergonomics Climate Questionnaire.
Figure 2. Percentage of self-reported pain by body part from the Ergonomics Climate Questionnaire.
Ijerph 18 02610 g002
Figure 3. Organizational Performance scores from the Hersey and Goldsmith Questionnaire.
Figure 3. Organizational Performance scores from the Hersey and Goldsmith Questionnaire.
Ijerph 18 02610 g003
Figure 4. Frequency of disorders from the General Health Questionnaire.
Figure 4. Frequency of disorders from the General Health Questionnaire.
Ijerph 18 02610 g004
Figure 5. Spearman correlation coefficients for ergonomics climate measures and organizational performance.
Figure 5. Spearman correlation coefficients for ergonomics climate measures and organizational performance.
Ijerph 18 02610 g005
Table 1. Additional information on the collected sample size.
Table 1. Additional information on the collected sample size.
Total Numbers of EmployeeMinimum Number of Required SampleNumber of Administrated Questionnaires with Consideration of 70% Response RateReceived Valid Response
Besat power plant 290106150109
Rey power plant280106150110
Table 2. Number of sampled employees sorted by departments.
Table 2. Number of sampled employees sorted by departments.
Power Plant Departments
MaintenanceOperationEngineeringPlanning and AdministrationTotal
Besat power plant24521023109
Rey power plant36451118110
Total60972141219
Table 3. Additional details for all three questionnaires.
Table 3. Additional details for all three questionnaires.
Name DevelopersNumber of QuestionsSubscalesScoring SystemReliability CoefficientRef.
Hersey and Goldsmith questionnaireHersey and Goldsmith, 198042
  • Ability (4 questions)
  • Clarity (7 questions)
  • Help (5 questions)
  • Incentive (6 questions)
  • Evaluation (9 questions)
  • Validity (6 questions)
  • Environment (5 questions)
Five-point Likert scaleα = 0.85[35]
General health questionnaireGoldberg and Hiller, 197928
  • Somatic symptoms (8 questions)
  • Anxiety and insomnia (6 questions)
  • Social dysfunction disorder (7 questions)
  • Depression symptoms (7 questions)
The four-point scoring system using a binary method (0-0-1-1)α = 0.90[36,37]
Ergonomics climate assessmentHoffmeister et al., 201540
  • Management commitment (10 questions) *
  • Employee involvement (10 questions) *
  • Job hazard identification and control (10 questions) *
  • Training and knowledge (10 questions) *
Five-point Likert scaleα = 0.96[30]
* Each subscale was assessed by two aspects of ergonomics climate (operational performance and employee well-being) as depicted in Figure 1.
Table 4. Demographic characteristics of sampled employees.
Table 4. Demographic characteristics of sampled employees.
Besat Power Plant Rey Power Plant
RangeFrequency (N)Frequency (%)Frequency (N)Frequency (%)
Age<3013121110
30–3445415752
35–3929272321
40–448743
≥4514131514
GenderFemale5411
Male1049510999
Work experience (years)<518172018
5–1058536055
>1033303027
Table 5. Comparison of the ergonomics climate sub-scales score between two power plants.
Table 5. Comparison of the ergonomics climate sub-scales score between two power plants.
Ergonomics Climate SubscalesBesatReyp-Value *
(N = 108)(N = 110)
Mean ± SDMean ± SD
Operational performance58.0 ± 19.170.8 ± 15.9p < 0.001
Management commitment15.0 ± 5.518.4 ± 4.2p < 0.001
Employee involvement14.2 ± 5.117.5 ± 4.5p < 0.001
Hazard identification and control15.2 ± 4.517.8 ± 4.0p < 0.001
Training and knowledge14.2 ± 5.017.0 ± 4.6p < 0.001
Employee Well-being55.8 ± 20.069.7 ± 16.9p < 0.001
Management commitment14.0 ± 6.018.0 ± 4.5p < 0.001
Employee involvement13.5 ± 5.317.2 ± 4.7p < 0.001
Hazard identification and control15.0 ± 4.817.6 ± 4.3p < 0.001
Training and knowledge13.8 ± 5.216.8 ± 4.7p < 0.001
Overall ergonomics climate113.7 ± 38.3125.7 ± 31.7p < 0.001
* Independent sample t-test.
Table 6. Comparison of ergonomics climate subscales between two employee groups regarding their general health condition.
Table 6. Comparison of ergonomics climate subscales between two employee groups regarding their general health condition.
Ergonomic Climate SubscalesGeneral Healthp-Value *
Absence of DisorderPresence of Disorder
Mean ± SDMean ± SD
Operational performance
Management commitment18.0 ± 4.516.2 ± 5.00.01
Employee involvement16.7 ± 5.015.5 ± 4.80.01
Hazard identification and control17 ± 4.516.3 ± 4.20.26
Training and knowledge16.6 ± 5.115.3 ± 4.70.08
Employee Well-being
Management commitment17.5 ± 5.115.6 ± 5.50.01
Employee involvement16.3 ± 5.414.9 ± 50.08
Hazard identification and control16.7 ± 5.016.1 ± 4.40.4
Training and knowledge16.0 ± 5.214.9 ± 4.90.12
Overall ergonomics climate129.9 ± 32.9116.7 ± 33.20.01
* Independent sample t-test.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Faez, E.; Zakerian, S.A.; Azam, K.; Hancock, K.; Rosecrance, J. An Assessment of Ergonomics Climate and Its Association with Self-Reported Pain, Organizational Performance and Employee Well-Being. Int. J. Environ. Res. Public Health 2021, 18, 2610. https://doi.org/10.3390/ijerph18052610

AMA Style

Faez E, Zakerian SA, Azam K, Hancock K, Rosecrance J. An Assessment of Ergonomics Climate and Its Association with Self-Reported Pain, Organizational Performance and Employee Well-Being. International Journal of Environmental Research and Public Health. 2021; 18(5):2610. https://doi.org/10.3390/ijerph18052610

Chicago/Turabian Style

Faez, Elham, Seyed Abolfazl Zakerian, Kamal Azam, Kyle Hancock, and John Rosecrance. 2021. "An Assessment of Ergonomics Climate and Its Association with Self-Reported Pain, Organizational Performance and Employee Well-Being" International Journal of Environmental Research and Public Health 18, no. 5: 2610. https://doi.org/10.3390/ijerph18052610

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop