Promoting construction workers' health: a multi-level system perspective

Construction workers suffer poor mental and physical health. To address this, organizations have implemented behavioural health promotion programmes. However, targeting workers' lifestyle behaviour without addressing relevant environmental factors is unlikely to produce significant or sustained improvement. An ecological perspective offers a different way of understanding the determinants of health, reflecting the interplay of factors at multiple levels and the dynamic, reciprocal and non-linear relationships between them. Qualitative data collected during focus groups and in interviews with workers and managers were analysed to explore factors impacting the effectiveness of a health promotion programme implemented at two work sites in Queensland, Australia. A qualitative causal loop diagram identifying determinants of construction workers' health behaviour was developed. The findings suggest that the adoption of healthy behaviours is influenced by factors operating at and between individual, family, workplace and industry levels. These factors suggest key leverage points that can be addressed in the design of future health promotion interventions for the construction industry. The research provides qualitative evidence of the need to consider workers' health in a holistic way and develop multi-level strategies to produce improved health behaviour and outcomes in the construction industry.