Understanding avoidance of medical surveillance for hand-arm vibrations in Sweden: a mixed-methods approach

Introduction: Hand-arm vibration syndrome (HAVS) is a chronic disease to vessels and nerves caused by vibrations. In Sweden, the medical check-up for vibrations (MCV) implements the EU surveillance system to detect early cases. No earlier research has shown participation in MCVs, nor why MCVs is avoided. We aimed to improve the understanding on avoidance of MCVs among vibration-exposed workers. Methods: We used a mixed method. Participation was estimated from sales data registries from the three largest occupational health services (OHS) in Sweden, comprising 50% of the market share. Exposure figures for the quantitative estimates came from both public data and exposure-data from a meta-analysis. The qualitative aim was explored through strategic telephone interviews with 26 workers with known symptoms of HAVS using hermeneutical methods. Results: MCV-participation has increased five-fold from 2016-2022. In 2020-2022, 11,643 MCVs were performed in the three OHS, giving a national estimate of 22,000 MCVs. We estimated the number of exposed workers to be 218,000 by exposure, and 400,000 by statistical sources only. MCVs were mainly avoided because they are not offered by employers despite being mandatory, and due to fear of the socio-economic consequences of a HAVS diagnosis. Other reasons included bullying, inconvenience, perceived lack of necessity, and limited awareness. Discussion: Only 5%-10% of exposed Swedish workers attend an MCV despite its importance. A cohesive and transparent process is proposed to increase the low participation rate to avoid the common, chronic, and debilitating injuries from HAVS.