Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Janice C. Probst


Home–based direct care workers (DCWs) provide care in a unique workplace environment: the patient’s home. The high rate of injuries experienced by this subcategory of healthcare workers compared to other industries and occupations make the need to understand the risk factors for these injuries vital. This study builds on prior research and specifically profiles occupational injury patterns among home–based DCWs who deliver care primarily in patient homes and the association of individual, perceived environmental and ergonomic characteristics on predicting occupational injury. The study used a cross–sectional analysis of secondary data from the 2007 National Home Health Aide Survey (NHHAS), sampling six eligible DCWs across the United States in home health, hospice, and mixed agencies. All analyses were conducted using STATA 12.0. Multivariable logistic regression was used to determine if perceived training, work environment and ergonomic factors predict workers risk for occupational injury. The findings Holding other variables constant race, hours worked per week, and number of current employers were found to be risk factors for occupational injury. The prevalence of injury reporting was lower in non–White and part time employed HHAs consistent with findings of previous studies. In addition, race, education level, hourly pay rate and agency location, type, and ownership status were found to be risk factors for injury severity. Overall, HHAs were satisfied with their perceived training topic areas, work environment and availability of safety devices. Multivariate adjusted analyses revealed perceived training was not a risk factor for injury or its severity. Perceived poor organizational culture was found to increase the risk for work–related injury by three folds and the lack of needed devices to perform job duties safely increased HHAs risk for occupational injury. Thus, addressing modifiable risk factors for occupational injury may reduce preventable injuries and improve worker safety.