Brief clinical screening tool shows potential at identifying precarious employment

Key takeaways:

• Those with two or more positive responses were four times as likely to be precariously employed.
• The screening tool could help start conversations about the impact of precarious employment on health.

A three-question screening tool was effective at identifying patients with precarious employment, a recent study found.

According to Julia W. Ho, PhD, a researcher at a Toronto nonprofit research laboratory called UpStream Lab, and colleagues, precarious employment “describes a set of conditions characterized by employment insecurity, low wages and benefits, and a lack of protections and rights at work.”

“People who are precariously employed have worse health (likely due to having lower incomes), a lower sense of security, more stress within the workplace, and lack of access to benefits (including paid sick days and health insurance),” they wrote in the Annals of Family Medicine.

The researchers noted that screening tools are needed as social determinants of health become a focus for many health care systems. However, no screenings exist for precarious employment.

“Also, primary care is often the first point of contact for patients experiencing health concerns related to precarious employment, occupational injuries, and unemployment,” they wrote.

So, Ho and colleagues developed a three-question screening tool that addressed key areas of precarious employment:

• whether patients were employed in a casual, short-term or temporary position;
• if they were fearful they could be fired for raising employment concerns; and
• if their pay varies from month to month.

They screened 204 patients aged 18 to 72 years, with a mean age of 38 years. Slightly fewer than half (45.6%) were men.

The researchers found that respondents who reported two or more items as positive were almost four times more likely to be precariously employed (positive likelihood ratio = 3.84; 95% CI, 2.15-6.8).

Overall, 33.5% of participants had precarious employment, whereas 24% were deemed vulnerable.

The study had limitations, the researchers said, including a lack of generalizability because it was conducted in Canada, although the questions in the screening tool are universal to precarious employment. Also, the study may have been biased away from patients who, because of precarious employment, may not have been able to participate during clinic hours.

Ho and colleagues explained that screening for precarious employment is “particularly important” in a primary care setting, although clinicians need support to be able to know how to use the information they receive from screenings to intervene.

“A positive screen may open up a conversation between a clinician and patient about employment and the impact on symptoms, particularly exposure to physical hazards and mental health concerns,” they wrote. “When identifying patients experiencing precarious employment, clinicians can refer patients to community resources that address worker rights, legal supports, and alternative employment.”