abstract: 'Background

  Flexible working conditions are increasingly popular in developed

  countries but the effects on employee health and wellbeing are largely

  unknown.

  Objectives

  To evaluate the effects ( benefits and harms) of flexible working

  interventions on the physical, mental and general health and wellbeing

  of employees and their families.

  Search strategy

  Our searches ( July 2009) covered 12 databases including the Cochrane

  Public Health Group Specialised Register, CENTRAL; MEDLINE; EMBASE;

  CINAHL; PsycINFO; Social Science Citation Index; ASSIA; IBSS;

  Sociological Abstracts; and ABI/Inform. We also searched relevant

  websites, handsearched key journals, searched bibliographies and

  contacted study authors and key experts.

  Selection criteria

  Randomised controlled trials (RCT), interrupted time series and

  controlled before and after studies (CBA), which examined the effects of

  flexible working interventions on employee health and wellbeing. We

  excluded studies assessing outcomes for less than six months and

  extracted outcomes relating to physical, mental and general health/ill

  health measured using a validated instrument. We also extracted

  secondary outcomes ( including sickness absence, health service usage,

  behavioural changes, accidents, work-life balance, quality of life,

  health and wellbeing of children, family members and co-workers) if

  reported alongside at least one primary outcome.

  Data collection and analysis

  Two experienced review authors conducted data extraction and quality

  appraisal. We undertook a narrative synthesis as there was substantial

  heterogeneity between studies.

  Main results

  Ten studies fulfilled the inclusion criteria. Six CBA studies reported

  on interventions relating to temporal flexibility: self-scheduling of

  shift work (n = 4), flexitime ( n = 1) and overtime ( n = 1). The

  remaining four CBA studies evaluated a form of contractual flexibility:

  partial/gradual retirement ( n = 2), involuntary part-time work ( n = 1)

  and fixed-term contract ( n = 1). The studies retrieved had a number of

  methodological limitations including short follow-up periods, risk of

  selection bias and reliance on largely self-reported outcome data.

  Four CBA studies on self-scheduling of shifts and one CBA study on

  gradual/partial retirement reported statistically significant

  improvements in either primary outcomes ( including systolic blood

  pressure and heart rate; tiredness; mental health, sleep duration, sleep

  quality and alertness; self-rated health status) or secondary health

  outcomes (co-workers social support and sense of community) and no ill

  health effects were reported. Flexitime was shown not to have

  significant effects on self-reported physiological and psychological

  health outcomes. Similarly, when comparing individuals working overtime

  with those who did not the odds of ill health effects were not

  significantly higher in the intervention group at follow up. The effects

  of contractual flexibility on self-reported health ( with the exception

  of gradual/partial retirement, which when controlled by employees

  improved health outcomes) were either equivocal or negative. No studies

  differentiated results by socio-economic status, although one study did

  compare findings by gender but found no differential effect on

  self-reported health outcomes.

  Authors'' conclusions

  The findings of this review tentatively suggest that flexible working

  interventions that increase worker control and choice ( such as

  self-scheduling or gradual/partial retirement) are likely to have a

  positive effect on health outcomes. In contrast, interventions that were

  motivated or dictated by organisational interests, such as fixed-term

  contract and involuntary part-time employment, found equivocal or

  negative health effects. Given the partial and methodologically limited

  evidence base these findings should be interpreted with caution.

  Moreover, there is a clear need for well-designed intervention studies

  to delineate the impact of flexible working conditions on health,

  wellbeing and health inequalities.'
affiliation: 'Bambra, C (Corresponding Author), Univ Durham, Dept Geog, Wolfson Res
  Inst, Queens Campus, Stockton On Tees TS17 6BH, Teesside, England.

  Bambra, Clare, Univ Durham, Dept Geog, Wolfson Res Inst, Stockton On Tees TS17 6BH,
  Teesside, England.

  Pabayo, Roman, Univ Montreal, Montreal, PQ, Canada.

  Critchley, Julia A., Newcastle Univ, Inst Hlth \& Soc, Newcastle Upon Tyne NE1 7RU,
  Tyne \& Wear, England.'
article-number: CD008009
author: Joyce, Kerry and Pabayo, Roman and Critchley, Julia A. and Bambra, Clare
author-email: clare.bambra@durham.ac.uk
author_list:
- family: Joyce
  given: Kerry
- family: Pabayo
  given: Roman
- family: Critchley
  given: Julia A.
- family: Bambra
  given: Clare
da: '2023-09-28'
doi: 10.1002/14651858.CD008009.pub2
eissn: 1361-6137
files: []
issn: 1469-493X
journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
keywords-plus: 'SELF-RATED HEALTH; BRITISH CIVIL-SERVANTS; CORONARY-HEART-DISEASE;

  WORKPLACE REORGANIZATION; SOCIAL INTERVENTIONS; SYSTEMATIC REVIEWS;

  GRADUAL RETIREMENT; DECISION LATITUDE; SICKNESS ABSENCE; SHIFT SYSTEM'
language: English
number: '2'
number-of-cited-references: '165'
orcid-numbers: 'P, Roman/0000-0003-4018-4898

  Bambra, Clare l/0000-0002-1294-6851

  Critchley, Julia/0000-0002-5248-4188'
papis_id: fc9ff0916c31135ab870069b1420b306
ref: Joyce2010flexibleworking
researcherid-numbers: 'P, Roman/AAO-3485-2020

  Bambra, Clare l/C-1392-2010

  '
tags:
- review
times-cited: '197'
title: Flexible working conditions and their effects on employee health and wellbeing
type: Review
unique-id: WOS:000274654300007
usage-count-last-180-days: '5'
usage-count-since-2013: '260'
web-of-science-categories: Medicine, General \& Internal
year: '2010'