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Title: Addressing health inequities : validating the Chinese-WSF28 workstyle for work-related musculoskeletal symptoms among cleaners
Authors: Cheung, K 
Ma, KY 
Cheung, ESP 
Sin, BCH
Mui, KW
Ko, YK
Tsoi, SM
Leung, NH 
Lui, KY 
Ng, WWM 
Chan, PSB 
Lau, HC 
Lee, YHB 
Issue Date: 2025
Source: International journal for equity in health, 2025, v. 24, 213
Abstract: Background: This pioneering study examined the psychometric properties of workstyle related to work-related musculoskeletal symptoms (WRMS) among cleaners, a neglected workforce. Like many low-income, low-skilled workers, cleaners have unique workstyles. This research assessed the Workstyle-Short Form (WSF) to identify WRMS in various body parts among cleaners.
Methods: 433 cleaners were surveyed in the study. The items were modified from Chinese-WSF24 (C-WSF24) and new items were added according to the unique working environment of Chinese cleaners. A scale with 33 items of the workstyle was rigorously analysed for its psychometric properties through content validity, factor analysis, known group validity and convergent validity.
Results: A panel of 13 experts reviewed the scale over three rounds until a consensus was reached. Factor analysis generated a four-factor solution using exploratory factor analysis, which included working through pain, social reactivity at work, demands at work and breaks. This solution comprised 28 items and accounted for 46.12% of the total variance. The overall results of the confirmatory factor analysis further support this hypothesized factor structure, supported by the Workstyle Model. Validation against known groups also showed that the Chinese-WSF28 (C-WSF28) can discriminate between cleaners with and without WRMS in various body parts. Furthermore, C-WSF28 demonstrated convergent validity through statistically significant association with factors contributing to WRMS.
Conclusion: The C-WSF28 is a valid instrument, enabling comprehensive measurement of cleaners’ workstyle and facilitating rigorous evaluation of workstyle interventions for enhanced outcomes.
Keywords: Cleaners
Construct validity
Factor analysis
Work-related musculoskeletal symptoms
Workstyle
Publisher: BioMed Central Ltd.
Journal: International journal for equity in health 
EISSN: 1475-9276
DOI: 10.1186/s12939-025-02587-z
Rights: © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
The following publication Cheung, K., Ma, K., Cheung, E. et al. Addressing health inequities: validating the Chinese-WSF28 workstyle for work-related musculoskeletal symptoms among cleaners. Int J Equity Health 24, 213 (2025) is available at https://doi.org/10.1186/s12939-025-02587-z.
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