Hand-in-Hand-improving occupational health and quality of care in early education and care: study protocol for a cluster-randomized controlled trial.
7 affiliations
- 1Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.
- 2Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
- 3Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
- 4National Research Center for the Working Environment, Copenhagen, Denmark.
- 5Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands.
- 6Unit kindergarten, Moss Municipality, Moss, Norway.
- 7Kanvas Foundation, Oslo, Norway.
Abstract
Introduction
In Norway, the early education and care (ECEC) sector has the highest rate of work-related fatigue and sickness absence across all sectors. Work in ECEC can be characterized as physically and emotionally demanding, which may lead to fatigue and the two most common causes of sickness absence in the ECEC sector, i.e., musculoskeletal and mental health issues. Improvements to the work environment can lead to better health for ECEC employees and improve ECEC quality. Therefore, work environment, employee health, and ECEC quality go Hand-in-Hand. This paper presents the protocol for conducting a trial to evaluate the effectiveness and implementation of the tailored participatory Hand-in-Hand workplace intervention.Methods and analysis
The study is a 1-year pragmatic cluster-randomized controlled trial with a wait-listed control group. Nineteen ECEC centers were recruited from two Norwegian municipalities, with an estimated 350 employees. The intervention is facilitated by external consultants and includes one workshop and two workplace visits. This includes training the employees in the Hand-in-Hand toolbox, a systematic method for developing workplace measures. Data collection will consist of accelerometer and heart rate measurements, questionnaires, diaries, interviews and registry data; baseline measurements were conducted in October/November 2025. The primary outcome of the effect evaluation will be work-related fatigue. The effectiveness of the intervention will be analyzed using multilevel analyses. In addition, a process evaluation will assess intervention implementation to help understand why the intervention is effective (or not), and for whom and under which circumstances.Discussion
The intervention adopts an interdisciplinary approach, integrating emotion work, sensor-based measurements of physical workload, and quality in early childhood education and care. The study aims to provide theoretical, methodological, and practical insights into how to design and implement a complex intervention in an ECEC setting.Trial registration
https://www.isrctn.com/ISRCTN81684777, identifier: ISRCTN81684777.
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BibTeX
@article{morud2026handinhandimproving,
title = {{Hand-in-Hand-improving occupational health and quality of care in early education and care: study protocol for a cluster-randomized controlled trial.}},
author = {Emily Morud and Markus Koch and Fiona Aanesen and Skender Elez Redzovic and Emil Sundstrup and Pieter Coenen and Ingrid Christensen and Ramus Kleppe and Suzanne L Merkus},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1981528},
url = {https://europepmc.org/article/MED/42899158},
note = {CC BY},
}
RIS
TY - JOUR
TI - Hand-in-Hand-improving occupational health and quality of care in early education and care: study protocol for a cluster-randomized controlled trial.
AU - Emily Morud
AU - Markus Koch
AU - Fiona Aanesen
AU - Skender Elez Redzovic
AU - Emil Sundstrup
AU - Pieter Coenen
AU - Ingrid Christensen
AU - Ramus Kleppe
AU - Suzanne L Merkus
PY - 2026
DA - 2026/10/05
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1981528
UR - https://europepmc.org/article/MED/42899158
AB - Introduction In Norway, the early education and care (ECEC) sector has the highest rate of work-related fatigue and sickness absence across all sectors. Work in ECEC can be characterized as physically and emotionally demanding, which may lead to fatigue and the two most common causes of sickness absence in the ECEC sector, i.e., musculoskeletal and mental health issues. Improvements to the work environment can lead to better health for ECEC employees and improve ECEC quality. Therefore, work environment, employee health, and ECEC quality go Hand-in-Hand. This paper presents the protocol for conducting a trial to evaluate the effectiveness and implementation of the tailored participatory Hand-in-Hand workplace intervention.Methods and analysis The study is a 1-year pragmatic cluster-randomized controlled trial with a wait-listed control group. Nineteen ECEC centers were recruited from two Norwegian municipalities, with an estimated 350 employees. The intervention is facilitated by external consultants and includes one workshop and two workplace visits. This includes training the employees in the Hand-in-Hand toolbox, a systematic method for developing workplace measures. Data collection will consist of accelerometer and heart rate measurements, questionnaires, diaries, interviews and registry data; baseline measurements were conducted in October/November 2025. The primary outcome of the effect evaluation will be work-related fatigue. The effectiveness of the intervention will be analyzed using multilevel analyses. In addition, a process evaluation will assess intervention implementation to help understand why the intervention is effective (or not), and for whom and under which circumstances.Discussion The intervention adopts an interdisciplinary approach, integrating emotion work, sensor-based measurements of physical workload, and quality in early childhood education and care. The study aims to provide theoretical, methodological, and practical insights into how to design and implement a complex intervention in an ECEC setting.Trial registration https://www.isrctn.com/ISRCTN81684777, identifier: ISRCTN81684777.
SN - 2296-2565
ER -