What determines childcare workers physical behaviours at work? An investigation of determinants at the institution, team, and worker levels in Danish day nurseries.

Objectives: The childcare sector faces several challenges such as high rates of sick leave, employee turnover, and pain. We know that the physical behaviours the workers do at work are important for their musculoskeletal health and sick leave. However, we lack knowledge of which workplace factors determine the physical behaviours of workers. Therefore, we aimed to investigate which organisational levels and factors of Danish day nurseries determine the physical behaviours at work of childcare workers.

Methods: This cross-sectional study included 178 childcare workers from 73 teams and 16 day nurseries in Denmark. Workers were, on average, 36.5 years of age, mostly female (84%) and 57% were educated pedagogues. We measured physical behaviours (i.e. sedentary, light physical activity, and moderate-to-vigorous physical activity) during working hours using a thigh-worn accelerometer, and expressed them as isometric log-ratio coordinates for analysis according to compositional data analysis procedures. We examined 15 potential determinants of physical behaviours at work at three organisational levels: institutions (e.g. permanent-to-not-permanent staff ratio), teams (e.g. worker-to-child ratio), and workers (e.g. age, BMI, physical exertion). Variance component analysis identified the percentage contribution to the total variance of physical behaviours of each organisational level. Linear mixed models were used to investigate associations between determinants at each level and the physical behaviours.

Results: The largest contribution to the total variance in childcare workers' physical behaviours was observed at the worker level (95.5%), while team (2%) and institution (2.5%) levels contributed to only a minor extent. Two individual factors at the worker level-physical exertion (P < 0.01) and pain intensity (P = 0.01)-were significantly, but weakly associated with physical behaviours. Specifically, an increased physical exertion was associated with a 3.7% increase in moderate-to-vigorous physical activity (P = 0.019) and a 6% decrease in sedentary behaviour (P = 0.009), relative to the remaining behaviours. Also, an increased pain intensity was associated with a 3.6% decrease in moderate-to-vigorous physical activity (P = 0.008), relative to the remaining behaviours. No determinants at the institution and team levels were significantly associated with physical behaviours.

Conclusions: In this study, worker level determines nearly all of the variability in physical behaviours while the institution and team levels only explain a little. That only two individual worker-level factors were weakly associated with physical behaviours indicates that other unmeasured worker-level factors are important determinants of the physical behaviours of childcare workers.