From Isolated Work to a Team‐Based Approach in Home Care Services: Impact on Labor Conditions and Physical Health

BACKGROUND: Barcelona's municipal Home Care Services (HCS) have undergone a teamwork- and proximity-based reorganization aimed, among other goals, at improving workers' labor conditions. Although team-based home care has been commonly studied in relation to job satisfaction and autonomy, evidence on workers' physical health is limited. OBJECTIVE: To assess the impact of HCS reorganization on workers' employment conditions, ergonomic hazards, and physical health outcomes. METHODS: Mixed-method quasi-experimental pre-post design (2022-2024). Quantitative data included 1288 survey observations from intervention and comparison groups across three waves (pre: 550 workers; post1: 397 workers; post2: 341 workers). Qualitative data comprised 27 longitudinal interviews with intervention group workers at two time points, with one participant lost to follow-up. RESULTS: Quantitative descriptive results showed increased full-time employment and shorter travel times between users' homes in the intervention group. Ergonomic risk exposure was high across groups, but lifting or moving people augmented only among intervention workers. These workers also reported higher levels of fatigue and poorer self-rated health over time. Multivariable analyses confirmed results on travel times, exposure to lifting or moving people, and fatigue. Qualitative findings suggest sustained exposure to ergonomic hazards and indirect effects of the reorganization as potential mechanisms behind fatigue. CONCLUSIONS: Among intervention workers, three main changes were associated with the HCS reorganization: shorter travel times between users' homes, more frequent lifting or moving people, and higher fatigue levels. Further strategies are needed to reduce physical strain and safeguard workers' health in this essential care sector.