Mental health and HIV among call centre employees in the Philippines: Co-producing a workplace intervention using a systems approach.

Call centres are a fast-growing industry in the Philippines. Although well-paid, call centre employees have little control over their work, must deal regularly with angry clients, and must meet high demands under time pressure. These stressful conditions can lead to mental ill-health which can affect their performance at work as well as whether they take risks with their health, and whether they have positive social relationships. Poor mental health can also affect how well the organisation performs; it can lead to lower productivity, increased sickness absence and higher staff turnover rates.

At the same time, the Philippines has the fastest growing HIV epidemic in the world and call centre employees are believed to be at risk due to high levels of unprotected sexual activity. High-stress and high disposable income in this young workforce, combined with a relatively high proportion of men who have sex with men (MSM), are also thought to contribute to increased HIV risk. Stigma and discrimination around sexual identity, behaviour and HIV status are both contributors to poor mental ill health.

Previous research has shown that poor mental health and HIV risk often exist together and each makes the other worse, particularly where people also experience things like stigma and discrimination. For this reason, researchers have urged that the two health issues should be tacked together. There are lots of effective ways to address mental health and reduce HIV in workplace settings but little work has been done to bring these together, and little has been done to address issues specific to call centres in LMIC.

The aim of this project is to understand how the workplace setting (or system) shapes both mental health and HIV risk. We will work with call centre employees and their managers to understand their priorities and identify aspects of the workplace that they think could provide potential solutions. Having agreed on these solutions we will try them out in the workplace and ask managers and employers for their views on how well they address the issues, how easy they are to implement and whether they represent value for money. The solutions will need to consider the physical environment, working culture and wider social influences to ensure it is acceptable, and easy to deliver in the long-term. The project will involve workshops with employees and managers, as well as interviews with employees and outside experts. Our aim will be to come up with a final design that call centres and stakeholders in industry and government think would be worth evaluating on a wider scale. We will also share lessons with other researchers on methods for designing interventions in corporate settings.

BACKGROUND: Call centres in the Philippines are the mainstay of their burgeoning business processes outsourcing (BPO) industry. Currently, the Philippines has the fastest growing HIV epidemic in the world and call centre workers are believed to be at an elevated risk. Workplace factors associated with call centres - including high stress and demands, low autonomy, high disposable income in a young workforce, and relatively high proportion of men who have sex with men (MSM) - contribute to this elevated risk. Stigma relating to HIV, sexual behaviour and minority sexual identity, along with stressful working conditions, are known contributors to poor mental health. Workplaces are one of the most important settings for mental health promotion, and offer an entry point for HIV prevention on a wider scale.
AIM: To develop a systems-informed workplace intervention to promote mental health and reduce HIV risk among call centre workers in the Philippines.
METHODS: Brief scoping review to identify drivers of poor mental and sexual health and select full 'menu' of candidate interventions (organisational, relational and individual components); GIS mapping of local environment 'risk' venues and health facilities; 9 'soft-systems' mapping workshops to identify concepts, relationships, and actors in the workplace system; 6 key informant interviews to understand the wider system (commercial, political, social); evidence synthesis and co-production workshops (6) to agree mechanisms of change and select/refine intervention components; small-scale testing and formative evaluation of intervention components over several cycles.
OUTCOMES:An innovative and holistic intervention designed to work across the whole workplace system; plus resources for research on improving the wellbeing of a growing occupational cohort with unique risk factors, and on the methodological and ethical implications of using soft systems methods and co-production approaches within corporate environments.

250 WORD PATHWAYS TO IMPACT STATMENT:

We will achieve impact in the following ways:
Responding to a gap in knowledge and intervention for a known risk group: Call centres are a rapidly expanding employment sector within LMIC settings, yet little has been done to address the systemic ways in which they drive poor mental health, or harness possibilities for improving health. Young people and MSM are disproportionately represented in call centres, providing an entry point for these high-risk groups. Bringing together multiple actors across call centre systems and academic expertise, we will contribute new ways to improve health among employees in stressful working conditions.

Influencing policy: a briefing brochure and video will provide policy and practitioners with insight into how BPO industries can affect employee health, and the potential for a systems-informed and participatory approach to effecting lasting change.

Influencing practice: a briefing tailored towards the BPO industries in Philippines will be of interest to companies looking for opportunities to respond to the rapidly escalating HIV epidemic; to meet the requirements of national directives to improve employee mental health; and to address absence and staff turnover rates

Influencing the research agenda. Academics will benefit from the generation of new evidence and capacity building in systems-based approaches to population health improvement and using the workplace as a setting for health promotion and improvement.

Raising public awareness: High quality materials (e.g. a video) will be developed and shared with the general public in the Philippines and UK, to further understanding of work-related influences on health.