Acceptability of a Multicomponent Intervention for Musculoskeletal Disorders among Blue-Collar Workers in Denmark – a Mixed-methods Feasibility Study

For millions of people around the world, the simple act of working can become a source of persistent pain. In countries like Denmark, nearly one-third of the workforce reports regular aches and pains, a number that climbs to half for those whose jobs involve heavy lifting, repetitive motions, or awkward postures. This is not just a matter of personal discomfort; it is a significant economic and social burden that affects health, ability to work, and the stability of the labor market. For decades, experts have understood that these musculoskeletal disorders are not caused by a single factor, such as a bad back or a weak muscle, but are the result of a complex mix of physical, mental, and social influences. This understanding, known as the bio-psycho-social model, suggests that to truly help workers, interventions must address more than just the body. They must also consider how people think about pain, how they interact with their colleagues, and how their workplace culture supports or hinders their well-being. Yet, despite this clear understanding, many workplace programs remain fragmented, focusing narrowly on exercises or equipment without weaving these different elements together.

Against this backdrop, researchers in Denmark set out to test a new, integrated approach called PATH@work. The goal was to see if a program that combined education, physical movement, and group problem-solving could be welcomed and accepted by blue-collar workers. The intervention was designed as a series of fifteen short sessions spread over eight weeks, delivered during work hours by a trained safety professional. The first part taught workers about the nature of pain and how physical, mental, and social factors connect. The second part involved whole-body physical exercises designed to build strength and confidence. The third part, perhaps the most ambitious, was participatory ergonomics, a process where workers and managers sat down together to identify specific risks in their daily tasks and create their own plans to fix them. Before rolling this out on a massive scale, the team needed to know if the workers would actually like it, if they would find it fair, and if it would fit into their busy lives without causing too much trouble.

To find the answers, the researchers gathered 61 workers from four different industrial and contracting companies. They asked these workers to fill out surveys before and after the eight-week program, and they also sat down for in-depth conversations with a smaller group of participants to hear their stories in their own words. The results were largely encouraging. When asked if they liked the intervention, nearly all the workers said yes. They felt the program was fair to include at their workplace and found it generally acceptable. The physical exercise component was the clear favorite. Workers described the sessions as a refreshing break that helped them feel less stiff and improved their mood. Many noted that the exercises created a positive atmosphere, allowing colleagues to laugh together and strengthen their social bonds. One worker described it as a way to get the body moving and the mind focused, while another noted that it helped them feel less stiff when they started their day. The education portion also resonated, helping workers understand that pain is not a sign of weakness and that it is okay to talk about limitations.

However, the story was not entirely smooth, and the researchers discovered a significant cultural hurdle. While the workers embraced the physical movement and the educational talks, they struggled with the participatory ergonomics component. This part of the program asked workers to openly discuss their pain and workplace challenges with their peers and managers. Many found this difficult because, in their workplace culture, talking openly about physical pain was unfamiliar and sometimes even seen as a sign of weakness. One worker explained that there was a sense of "male pride" that kept people quiet about their aches, while another admitted that while they might tell a close friend, they would not bring it up in a group setting. This silence meant that the collaborative problem-solving aspect of the program did not take root as easily as the researchers had hoped. The workers felt that the idea of talking about pain was a good one, but the social norms of their specific workplaces made it hard to act on that idea.

The data also revealed a nuance regarding the "burden" of the program. On paper, the survey results suggested that nearly half of the workers felt the program required a lot of effort from them. Yet, when the researchers listened to the workers' stories, a different picture emerged. The workers explained that while the sessions did take time away from their regular tasks, the workplace was flexible enough to handle it. They could swap tasks with colleagues or catch up later without feeling pressured. The perceived "burden" was not about the time itself, but perhaps about the mental effort of changing habits or the awkwardness of the new discussions. This distinction is important because it suggests that the program is manageable in practice, even if it feels demanding at first. Furthermore, the study found no significant changes in the actual levels of pain or the number of days workers took off due to illness. This was not a surprise, as the study was small and short, designed to test if the program could work rather than to prove it would cure pain. The baseline levels of pain were already quite low, and the intervention period was too brief to expect major shifts in long-term health outcomes.

The researchers concluded that the PATH@work intervention is a feasible and well-received idea for blue-collar workers, particularly because of the physical exercises and the educational value. The program successfully showed that workers are willing to engage with health initiatives when they are presented in a supportive, non-judgmental way. However, the study also made it clear that simply introducing a program is not enough. For the participatory parts to succeed, the workplace culture needs to shift. Managers must be more actively involved to signal that talking about pain is safe and encouraged. The workers themselves suggested that having "ambassadors" or peer leaders within each team could help bridge the gap between the program's goals and the daily reality of the shop floor. The study did not claim to have solved the problem of workplace pain, but it did provide a clear roadmap for the next step: refining the program to better fit the social realities of the workplace, ensuring that the conversation about health becomes as natural as the work itself.