ORIGINAL ARTICLE
Effectiveness of multifactorial and single interventions on safety climate and safe patient handling and movement practices: a cluster randomized controlled trial
1
Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Clinical Medicine, Occupational and Environmental Medicine, Linköping University, Linköping, Sweden
2
Department of Orthopaedics in Linköping, Region Östergötland, Linköping, Sweden
3
Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy, Linköping University, Linköping, Sweden
4
Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
5
Department of Health, Medicine and Caring Sciences, Division of Health and Society, Linköping University, Linköping, Sweden
6
Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
7
Clinical Department of Occupational and Environmental Medicine in Linköping, Region Östergötland, Linköping, Sweden
8
Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Submission date: 2026-06-26
Acceptance date: 2026-10-20
Online publication date: 2026-11-06
Corresponding author
Sebastian Buck
Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Clinical Medicine, Occupational and Environmental Medicine, Linköping University, Linköping, Sweden
Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Clinical Medicine, Occupational and Environmental Medicine, Linköping University, Linköping, Sweden
KEYWORDS
healthcare personneloccupational healthorganizational interventionpatient safetysafety culturesafety climatepatient handlingrandomized controlled trialRCT
ABSTRACT
Objective(s):
Evidence regarding the effectiveness of safe patient handling and movement (PHM) programs is limited. This study compared the effectiveness of a multifactorial and a single intervention for safe PHM in the Swedish healthcare sector.
Methods:
This cluster randomized controlled trial included 46 healthcare units (HCU) from Swedish hospital care units and nursing homes, randomized to a multifactorial or single safe PHM intervention. Primary outcomes were changes in safety climate (NOSACQ-50) and PHM specific practices (SafePHM-14) over 12 months, analyzed using mixed models at aggregated HCU level, adjusting for organization type.
Results:
Overall intervention-group differences were observed for management of safety justice [dimension 3, P=0.048] and workers’ safety commitment (dimension 4, P=0.026). However, no significant time × intervention group interactions were observed for any of the seven NOSACQ-50 dimensions or the 14 SafePHM-14 items. Significant time effects were observed in NOSACQ-50 management safety priority and ability (dimension 1, P=0.001), management safety empowerment (dimension 2, P=0.001), workers’ safety priority and risk non-acceptance (dimension 5, P=0.008), and peer safety communication, learning, and trust (dimension 6, P<0.001). SafePHM-14 practices improved over time in collaborative effort (item 1, P=0.005), equipment use (item 4, P=0.004), policy and guideline use (items 5–7, all P<0.001), risk assessment (item 8, P<0.001), patient mobility assessment (item 11, P=0.036), training (item 13, P<0.001), and injury prevention discussions (item 14, P<0.001).
Conclusion(s):
A multifactorial intervention was not more effective than a single intervention in improving safety climate related to PHM. However, safety climate and PHM practices improved over time in both groups. Given the minimal additional benefit observed, the value of implementing the more resource-intensive multifactorial intervention may be questioned.
Evidence regarding the effectiveness of safe patient handling and movement (PHM) programs is limited. This study compared the effectiveness of a multifactorial and a single intervention for safe PHM in the Swedish healthcare sector.
Methods:
This cluster randomized controlled trial included 46 healthcare units (HCU) from Swedish hospital care units and nursing homes, randomized to a multifactorial or single safe PHM intervention. Primary outcomes were changes in safety climate (NOSACQ-50) and PHM specific practices (SafePHM-14) over 12 months, analyzed using mixed models at aggregated HCU level, adjusting for organization type.
Results:
Overall intervention-group differences were observed for management of safety justice [dimension 3, P=0.048] and workers’ safety commitment (dimension 4, P=0.026). However, no significant time × intervention group interactions were observed for any of the seven NOSACQ-50 dimensions or the 14 SafePHM-14 items. Significant time effects were observed in NOSACQ-50 management safety priority and ability (dimension 1, P=0.001), management safety empowerment (dimension 2, P=0.001), workers’ safety priority and risk non-acceptance (dimension 5, P=0.008), and peer safety communication, learning, and trust (dimension 6, P<0.001). SafePHM-14 practices improved over time in collaborative effort (item 1, P=0.005), equipment use (item 4, P=0.004), policy and guideline use (items 5–7, all P<0.001), risk assessment (item 8, P<0.001), patient mobility assessment (item 11, P=0.036), training (item 13, P<0.001), and injury prevention discussions (item 14, P<0.001).
Conclusion(s):
A multifactorial intervention was not more effective than a single intervention in improving safety climate related to PHM. However, safety climate and PHM practices improved over time in both groups. Given the minimal additional benefit observed, the value of implementing the more resource-intensive multifactorial intervention may be questioned.
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