Norwegian municipal enterprises with employees in the home care sector have been randomized to three different experimental groups and to one control group. We hypothesize a significant lower level of work environmental exposures and health complaints, after adjusting for pre-intervention measures, in the experimental groups compared to the control group.

A variety of work environmental exposures are shown to cause ill health. Compliance with occupational health and safety legislation and regulation is assumed to prevent work-related ill health.

Regulatory Tools

The Norwegian Labour Inspection Authority oversees that enterprises comply with the requirements of the working environment laws and regulations. The agency possesses two key regulatory tools to ensure compliance, i.e. inspections and guidance.

Inspections are used to check whether enterprises meet legal requirements. If inspectors reveal violations to legal requirements, the Labour Inspection Authority may respond with orders, coercive fines, and shutdown of operations and in worst-case report enterprises to the police.

Guidance are used to notify the enterprises of the legal requirements pertaining to work environmental standards, and to advice the employers and employee representatives concerning the most effective means of realizing compliance with the legal requirements.

Intervention activities

Enterprises randomized to the experimental groups will receive different intervention activities from the Labour Inspection Authority, i.e. targeted inspection visits, participation on a one-day workshop led by two inspectors on how to reach compliance with occupational health and safety (OHS) standards.

The interventions will be carried out at the organizational level (enterprise), whereas the effects of the interventions on working environment and health complaints will be measured at the individual level (employee). Two months before the Labour Inspection Authority perform their interventions, a baseline questionnaire assessing self-reported organizational, psychosocial and mechanical work factors and health complaints will be sent to all home-care workers employed in the included municipal enterprises.

The effects of the different interventions on work environment and employee health will be evaluated through questionnaire measurements 6, 12 and 20 months post interventions.


The study conducted a process evaluation in order to assess the implementation of the interventions and how they were received by the target population. Overall, the both labour inspections and guidance-through-workshops were conducted according to protocol. Both interventions were perceived by managers and employee representatives as useful and educational. Additionally, managers in the labour inspection group were significantly more likely to report having implemented changes, or planning to, in order to improve the work environment than managers in the control group.

Based on data from labour inspections visits the study assessed improvements in compliance with regulations. The results showed improved compliance in the labour inspection group, significantly so for psychosocial factors. Labour inspections were also conducted in all groups post-follow-up and the labour inspection group had significantly higher compliance compared to the control group. Similar results were not seen for the guidance group.

While the interventions were well received and labour inspections had a significant impact on compliance with current regulations, neither interventions had a significant impact on work factors, both psychosocial and mechanical, nor on employee self-reported health and physician certified sickness absences.

Project leader and project team

Project leader: Håkon A. Johannessen

Project team: Bjørnar Finnanger Garshol, Øivind Skare, Jan Shahid Emberland, Shahrooz Elka, Stein Knardahl