Mapping ergonomics application to improve SMEs working condition in industrially developing countries: a critical review

In industrially developing countries (IDC), small and medium enterprises (SMEs) account for the highest proprotion of employment. Unfortunately, the working conditions in SMEs are often very poor and expose employees to a potentially wide range of health and safety risks. This paper presents a comprehensive review of 161 articles related to ergonomics application in SMEs, using Indonesia as a case study. The aim of this paper is to investigate the extent of ergonomics application and identify areas that can be improved to promote effective ergonomics for SMEs in IDC. The most urgent issue found is the need for adopting participatory approach in contrast to the commonly implemented top-down approach. Some good practices in ergonomics application were also revealed from the review, e.g. a multidisciplinary approach, unsophisticated and low-cost solutions, and recognising the importance of productivity. The review also found that more work is still required to achieve appropriate cross-cultural adaptation of ergonomics application. Practitioner Summary: Despite continuous efforts in addressing ergonomics issues in SMEs of IDC, workers are still exposed to poor work conditions. We reviewed factual-based evidence of current ergonomics application to inform future strategies of ergonomics in IDC, using Indonesia as a case study.


Introduction
The role of small and medium enterprises (SMEs) as the major source of present and future employment in all countries has been recognised. However, due to their limited resources and technical capacity, SMEs are also more prone to occupational hazards and risks than large enterprises. This situation is worsened in industrially developing countries (IDC) since SMEs are commonly overlooked by formal safety and health legislation. Unsurprisingly, the employment conditions in SMEs are frequently very poor, e.g. low wages, insecure employment and unsanitary working conditions (Hil 2002), which then result in low levels of productivity, often poor-quality products and generally serving small, localised markets. While there have been efforts by International Labour Organisation (ILO) to overcome this situation (e.g. Kawakami, Khai, and Kogi 2005;Krungkraiwong, Itani, and Amornratanapaitchit 2006), the contribution of the regional researchers through ergonomics application towards their efforts was unclear. Few studies, if any, attempt to chart and investigate the contribution of regional researchers in supporting the application of ergonomics in SMEs, and use this information as a road map to guide future research.
Ergonomics in Indonesia was begun with the establishment of the Indonesian Ergonomics Society (PEI) in 1987. It was founded to support the implementation of ergonomics methods and approaches by academics, researchers and industrial practitioners. Much effort has been applied to improve working conditions at Indonesian SMEs through ergonomics application (Wignjosoebroto 2007). However, despite this effort, the annual report of the National Employment Accident Insurance Program (Jamsostek 2011) showed a steady increase of number of accidents occurring in workplaces. Furthermore, it was also reported that most of these accidents occurred in SMEs (Trihandoyo, Trisnowibowo, and Nugraheni 2001). The small impact of ergonomics in reducing work-related accidents in Indonesian SMEs suggests the possibility that contribution of the regional ergonomics researchers may not be effective. Therefore, reflection and evaluation based on current and factual ergonomics applications in Indonesian SMEs are needed. This will assist in mapping ergonomics application to date and identifying areas that need to be improved in order to achieve the ultimate goal, i.e. a decrease in work accidents in Indonesian SMEs.
The main objective of this paper is to review and analyse the extent of ergonomics application in improving SMEs working conditions and, where possible, identify its direct impact. This paper also aims to identify gaps in the ergonomics application in improving SMEs working conditions and providing recommendations for future research and area of improvements. To the extent of the authors' knowledge, this paper is the first paper that provides a thorough review of the ergonomics application for SMEs in IDC based on factual evidence. While existing papers such as Kawakami, Batino, and Khai (1999), O'Neill (2000) and Nuwayhid (2004) also discuss the ergonomic applications in developing countries, they were commonly based on theoretical views and did not specifically address SMEs in a wider context. This paper begins by describing how studies that were included in the review were identified and how they were analysed. Next, the results of the review and analysis are explained in detail. The last section of the paper discusses recurrent issues or phenomenon from the reviewed studies and identifies emerging issues and future research questions that need to be addressed to advance the ergonomics application in Indonesian SMEs. This paper's main contribution lies on the identification of gaps and how to address these gaps through recommendation for future research. Although this paper is limited to reviewing the application of ergonomics in Indonesian SMEs, it is highly likely that the findings will also be applicable for other IDC.

Methods
The articles included in this review were primarily identified from articles that are freely available online from Ei Compendex, Scopus, Indonesian Scientific Journal Database (ISJD) and Google Scholars from 2000 to May 2013. The search was not limited to publications with English-language communications as many of the published articles are in Indonesian. The term 'ergonomics' and its Indonesian equivalences, i.e. 'ergonomi', 'ergonomika' and 'ergonomis', were used to perform the search. 'Human factors' and its equivalent term in Indonesian ('faktor manusia') were also used as a search term. In addition to this, accessible hard copies of national conference proceedings (organised by PEI in 2004PEI in , 2007PEI in and 2013 and international conference proceedings (organised by the South East Asian Ergonomic Society in and 2008, and South East Asian Network Ergonomics Society in 2012 were also included. Only articles that reported ergonomics applications related to improving SMEs working conditions were included. SME terminology such as 'industri rumah tangga' (household industry), 'industry kecil' (small industry) and 'usaha kecil dan menengah' (small and medium business) were used. The number of employees of an SME was used to identify whether or not a study was related to an SME, according to Statistic Indonesia (Saputra and Rindrasih 2012). An industry with less than 5 employees is considered a household industry (micro), that with 5 -19 employees is considered a small industry and that with 20-99 employees is considered a medium industry.
For each study, we identify four themes as follows: (1) Sector of the SMEs. The sector categorisation given by Indonesian Statistic Centre Bureau (Badan Pusat Statistik 2008) was adopted for the purpose of this paper. There are nine sectors of SMEs: (i) agriculture, forestry, husbandry and fisheries; (ii) mining; (iii) processing industry; (iv) electricity, gas and water; (v) construction; (vi) trade, hotels and restaurants; (vii) transportation and telecommunication; (viii) finance and leasing; (ix) services.
(2) Domain of ergonomics applications. The domain categorisation given by the International Ergonomics Association (International Ergonomics Association 2013) was adopted. There are three main domains of ergonomics application: (i) physical ergonomics -concerning with the relationship between physical activity and physical characteristics of a person and encompassing topics such as working postures, materials handling, workplace layout and safety and health; (ii) cognitive ergonomics -concerning with the mental processes and encompassing topics such as mental workload, work stress and training; and (iii) organisational ergonomics -concerning with the optimisation of a sociotechnical system and encompassing topics such as work design, design of working times and participatory design. (3) Chosen ergonomics method(s). Ergonomics method(s) that were used in the reviewed studies, commonly adopted ergonomics method(s) and evidence of a multidiscipline approach were identified. (4) Reported outcome. The final outcome of each study and its level of contribution to the wider knowledge of ergonomics such as validation of a new method/framework were identified.
Results Figure 1 provides a flow chart documenting the results of the study selection process, which resulted in the inclusion of a total of 161 articles in this review. Of these, 124 articles were obtained from the systematic search encompassing publications in the form of journal articles, conference articles, master theses, dissertations and technical report. An additional 37 articles were extracted from hard copies of national conference proceedings (organised by PEI) and international conference proceedings (organised by the South East Asian Ergonomic Society and South East Asian Network Ergonomics Society). Appendix 1 provides an overview of all of the reviewed studies. It has to be noted that the list of studies in this review is not necessarily exhaustive since this review was primarily limited to full-text scientific publications that were accessible online. Figure 2 shows the proportion of sectors in which the ergonomics investigations were applied. Two sectors, i.e. processing industries and agriculture, forestry, husbandry and fisheries, were the areas in which ergonomics were most commonly applied. This is then followed by trade, hotel and restaurants, constructions and mining. With respect to domain of ergonomics application, the highest application is in the physical ergonomics domain (145 studies), followed by organisational ergonomics domain (17 studies). None of the reviewed articles falls in the cognitive ergonomics domain. The following subsections will report the details in each domain.

Ergonomics application in physical ergonomics domain
The proportion of ergonomics issues that were addressed in the physical ergonomics domain is shown in Figure 3. Working posture and design of workstations/tool were the most frequently addressed ergonomics issues in this domain. Most of the studies in this category were mainly aimed at redesigning and evaluating workstations/tools in order to fit anthropometry dimensions of Indonesian workers and/or promote better working postures. None of the studies related to redesigning workstations/tools indicated any involvement of employees and employers during the redesign process. There was also no indication of communicating the positive results of the implementation to employees or employers. Interestingly, some of the studies (e.g. Achiraeniwati and Rejeki 2010;Apriyandhi 2012;Ilman, Yuniar, and Helianty 2012;Kristanto and Sugiantoro 2012) implied the need for employers and employees to take more active roles in addressing issues related to work postures.
Material handling and work-related musculoskeletal disorders (MSDs) are the next issues that were commonly addressed. Most of the studies in material handling were mainly aimed at evaluating existing working conditions and providing recommendations related to lifting tasks through widely adopted methods such as the Revised National Institute for Occupational Safety and Health (NIOSH) lifting equation (NIOSH 1994). A similar widely adopted method, i.e. Nordic Standardized Questionnaire (Kuorinka et al. 1997), was also commonly applied in studies of work-related MSDs. Surprisingly, environmental factors did not receive much attention, despite the fact that most of the tasks in SMEs demand physical exertion under hot, humid and tropical environmental conditions.  There is a noticeable trend of approaches in which existing or redesigned workstations and tools were evaluated. The three approaches that stood out as the most common methods to evaluate workstation/tools were (1) workload, (2) working posture and (3) productivity. Each will be discussed in details in the following.
(1) Most of the studies utilised heart rate measurement to classify physical workload; most authors cited its practicalities as their main reason of use. A table that provides the relationship between physical workload, heart rate and energy consumption, such as Å strand and Rodahl (1986) and Sanders and McCormick (1987), was found to be commonly used to classify the physical workload. A major drawback associated with the use of heart rate is related to the susceptibility of an increase caused by other factors such as psychology, environment and emotion (Roscoe 1992). This means that these factors need to be taken into account while collecting and interpreting the measurement results, especially when they cannot be controlled, e.g. when measurements are performed in a real work setting. Unfortunately, despite the fact that most of the reviewed studies collected heart rate measurements in a real work setting, only a few of the studies acknowledged the possible effects of some of these external factors (e.g. Tirtayasa, Adiputra, and Djestawana 2003;Ariati and Dewantara 2011;Widana 2012). Another issue with the use of heart rate to classify workload is the fact that the heart rate depends on the nature of the work, i.e. whether the work is static, involving only a small number of muscles (Grandjean and Kroemer 1997). Therefore, ideally, the heart rate measurement is accompanied by direct measurement of oxygen consumption whenever possible. Based on the review, there was only one study that adopted this approach, i.e. Fatah et al. (2011). The review also found that, in order to increase the accuracy of the heart rate measurement to predict the energy consumption, some studies, e.g. Dewi (2011), Ernawan (2000, Sulistyosari (2010) and Akbar (2008), incorporated step test results to provide baseline measurement of the workload. This was done in recognition that maximal aerobic power varies greatly from one person to another, i.e. a workload that is fairly easy for one worker may be quite exhausting for another (Roscoe 1992). Therefore, the workload was analysed based on the individual's maximal aerobic power and the ratio between load and power was assessed individually (Rodahl 1989 (Hignett and McAtamney 2000) and Ovako Working posture Analysis System (OWAS) (Karhu, Kansi, and Kuorinka 1977) were found to be the most commonly applied methods in assessing working posture, respectively. When direct assessment of the redesigned workplace layout or tool design is not feasible, some studies utilised ergonomics digital human modelling such as Jack (Siemens PLM Software 2013) and ManneQuinPRO (NexGen Ergonomics 2013) to aid the assessment of working postures (e.g. Putro 2009b; Pratiwi, Muslimah, and Seytojati 2010;Muslim, Nurtjahyo, and Ardi 2011) In one particular study by Muslim, Nurtjahyo, and Ardi (2011) a mannequin was created based on partial data of a worker and was then used to assess the digital workplace layout. Although this approach is accommodated by the software, it should be adopted with care as data that were not supplied were interpolated based on US Army data (Blanchonette 2010). This, in the end, may lead to an inaccuracy of the simulation results (Oudenhuijzen, Hudson, and Zehner 2000).
(3) Based on the review findings, productivity measurements were always applied as part of an evaluation of workplace layout and tools design/redesign. The most common measure of productivity was the number of product outputs that was calculated based on a time study (Taylor 1911). In addition to this, a few studies also used motion study (Gilbreth and Gilbreth 1917) investigation to demonstrate the potential improvement in productivity (e.g. Rohman 2008;Dewi 2011). Both methods are part of industrial engineering methodologies. The inclusion of these methods as part of ergonomics studies is likely due to the fact that ergonomics is mostly introduced as part of syllabus in industrial engineering major in Indonesia.

Ergonomics application in organisational ergonomics domain
As previously mentioned, organisational ergonomics is comparatively less popular than physical ergonomics. The review revealed that the main issue addressed in organisational ergonomics is improvement of work design, with a so-called 'total ergonomics approach' (Manuaba 2006) cited as the most common method in some studies (Oesman and Adiatmika 2007;Purnomo, Manuaba, and Adiputra 2007;Sudiajeng, Adiputra, and Suyasning 2007;Oesman and Adiatmika 2008;Purnawati 2008;Adiatmika 2009;Josephus 2011). The total ergonomics approach specifically referred to adoption of technology with consideration to six criteria, i.e. technical, economic, ergonomic, sociocultural, energy consumption and environment. While analysing each criteria, a so-called 'SHIP (systemic, holistic, interdisciplinary and participatory)' approach is applied. This approach emphasises involvement of stakeholders (employers, employee, etc.) during the process. This is notably different than the application of ergonomics in physical ergonomics in which stakeholders acted passively. Another issue that is addressed in this domain is modelling the ideal working conditions by considering each aspect of a sociotechnical system (i.e. Purnomo and Ferdianto 2011).

Outcome of ergonomics application
The outcome of ergonomics application, irrespective of sectors and domains, seems to suggest that application of ergonomics affects productivity positively, providing further support to similar findings (e.g. Mirka et al. 2003;Yeow and Sen 2006). However, most of the productivity was measured in a short duration while putting the workers under direct observation of the researchers. There is a risk that this kind of approach could result in the unwanted Hawthorne effect (Rothlisberger and Dickson 1939). This commonly occurs in a situation where a change proves to be very effective in terms of productivity because the workforces find themselves in the spotlight and respond positively to the extra attention they are receiving. The outcome of ergonomics application also varies from a simple recommendation to a practical intervention which directly involved real end-users/employees in their original work setting.
All of the reviewed studies were geared towards resolving existing and particular issues in SMEs. As a result, the contribution of the studies towards the wider knowledge of ergonomics was limited. However, there was a strong evidence of multidisciplinary approach in addressing ergonomics-related issues, e.g. the use of time and motion study to quantify productivity to evaluate ergonomics intervention, and the inclusion of ergonomics aspects as part of computer modelling of productivity.

Discussions
The review and analysis of the 161 articles revealed that cognitive ergonomics is the least applied domain in Indonesian SMEs. It is likely that the low rate of ergonomics application in this area is due to the utilisation of simple tools at SMEs, shown by studies such as Sutjana (2000a), Bangun (2009), Af-Faruqy (2011) and Yusianto (2012. Therefore, evaluations on cognitive demands while operating these tools are not necessary. The review also clearly demonstrated that ergonomics application in Indonesian SMEs is still focused on the physical ergonomics domain. Major issues addressed in this domain, i.e. work layout and tool design, and manual handling and work postures, correspond to ergonomics issues identified in previous publications (e.g. Kogi and Sen 1987;O'Neill 2000). This suggests that ergonomists in IDC still face the same basic ergonomics problems even though more than a decade has passed. The review also revealed that a large proportion of the studies addressed a classic ergonomics problem related to work layout by providing small-scale, unsophisticated and low-cost improvement that can be easily administered. This is considered as a positive approach in promoting the uptake of ergonomics in IDC (Kogi et al. 2003;Scott and Charteris 2004), especially where 'cost benefiting' is a critical element towards the acceptance of ergonomics change within a workplace.
The emphasis on productivity is an indicator of awareness and understanding of ergonomists in Indonesia towards the importance of productivity for SMEs. SMEs workers' are often paid based on their productivity, even if that means higher exposure to MSDs, work-related injuries, etc. Unlike many larger businesses or those that operate in industrially developed countries, financial costs of injuries may be far less of a concern than their consequence -the loss of productivity. Therefore, demonstrating that the adoption of ergonomics can actually improve productivity and does not result in additional expense is essential. Unfortunately, most of the reviewed studies based their productivity evaluation on a short-duration observation and simply extrapolated this data to predict daily, weekly or monthly productivity. Thus, more efforts are required to evaluate the long-term effectiveness of ergonomics in increasing the productivity. This can only be easily achieved if both employers and employees are involved from the start of the ergonomics intervention. Sadly, this is not the case; the review revealed that most studies adopted a top-down approach and simply focused on resolving existing problems without involving relevant stakeholders such as employees and employers. This finding suggests that, despite repeated calls for participatory approaches in ergonomics (e.g. Kogi 1995;O'Neill 2000;Shahnavaz 2000;Scott and Charteris 2004), the implementation of a participatory approach is very limited. Apart from a few studies such as Oesman and Adiatmika (2008), Josephus (2011), Purnawati (2008) and Adiatmika (2009), most studies did not seem to indicate any effort in establishing communications with stakeholders prior to and during the ergonomics intervention. This is certainly detrimental as most of the ergonomics application is aimed at supporting engineering controls in promoting health and safety by controlling or eliminating the hazard at its source. Failure in communicating, educating and encouraging the employees to adopt safe work practices will certainly impact on the sustainability of the ergonomics intervention, especially since, as shown from the reviewed studies, the workers in SMEs are mostly of low-level education. Incidentally, a recent study by Bao, Silversten, and Stewart (2013) specifically identified participation of stakeholders as the key to a successful ergonomics intervention in two rural Nicaraguan coffee farmers.
The review findings also suggest that issues related to technology transfers to IDC (Abeysekera and Shahnavaz 1987;Shahnavaz 1989) were not yet a prominent ergonomics issue in Indonesian SMEs. This was likely due to the fact that most of Indonesian SMEs used either traditional or low-level technology tools that can be accommodated locally. An initiative by the Indonesian government, managed by Indonesian Institute of Science (LIPI), has certainly played a key role in this. An example of the LIPI' initiatives is IPTEKDA (Implementation and Utilisation of Science and Technology) which encourages researchers from local universities and research institutes to take active roles in supporting SMEs through invention and implementation of low-level technology tools. The initiative, which has gone on for the last 15 years, requires the researchers to work closely with the SME and solve their problems. A reflection on the initiative revealed that at least 75% of the technologies are suitable, well received and used sustainably by SMEs (Brojonegoro and Darwin 2006).
The Indonesian government has put emphasis on the implementation of occupational health and safety for larger businesses. In fact, Indonesia is one of the Asian countries that has a comprehensive regulation and auditing mechanism on occupational health and safety, especially for high-risk domains. Unfortunately, the same level of attention has not yet been given to SMEs. One of a few government initiatives related to SMEs is the formation of Advisory Team on Occupational Health and Safety (Panitia Pembina Keselamatan dan Kesehatan Kerja), which is intended to improve the enforcement of health and safety at work for SMEs with more than 50 employees. Unfortunately, this initiative was rarely followed, and even if it was, it was a mere formality (Topobroto 2002). Furthermore, the limit imposed on the minimum number of workers also excludes some of SMEs with less than 50 employees. On the contrary, the Indonesian Statistic Centre Bureau (Badan Pusat Statistik 2006) reported that 84.47% of the Indonesian workforce were employed in SMEs with less than 50 employees, leaving the majority of the Indonesian workforce uncovered by health and safety legislation. Expansion of the coverage of policy and better enforcement of the policy could potentially improve the uptake of ergonomics application in Indonesia by stakeholders. To complicate matters, there is also evidence of poor implementation and enforcement of health and safety law by Indonesian government, which contributes further to lax attitude with respect to health and safety issues in SMEs (Sutjana 2006). Several studies (e.g. Haviland et al. 2010;Levine, Toffel, and Johnson 2012;Sinclair and Cunningham 2014) have shown that enforcement of health and safety through inspection and penalties reduced workrelated incidents to a certain extent. Yani's (2006) finding also showed that SME workers' knowledge in occupational health and safety is more limited than those working in the larger business. The lack of knowledge, mainly due to low literacy and socio-economic level, furthers ignorance towards aspects and rights of health and safety at work. Thus, unsurprisingly, Markkanen (2004) has called for shifting the attention on occupational health and safety from workers in larger industries to workers in SMEs. Indonesian ergonomists could play an important role in this area by ensuring that they do not simply solve SMEs' ergonomics problem, but also involve the stakeholders (both SMEs owners and workers) during the process as a means to raise their awareness and educate them on some aspect of occupational health and safety.
The review indicated that there was evidence of multidisciplinary approaches to address ergonomics issues, especially with respect to industrial engineering. The multidisciplinary approach is largely contributed by Indonesian universities, which include ergonomics in various disciplines, e.g. industrial engineering, agricultural engineering, public heath and occupational medicine. The inclusion of ergonomics in various disciplines will likely be beneficial in the future as this means that there are more 'change agents' that can introduce and promote ergonomics in developing countries.
Another aspect that can be observed from the review is the type of ergonomics methods that were used. Most of the studies have used well-known and established methods which have been validated, used worldwide and are not likely to be affected by geography, e.g. RULA, OWAS, REBA and the NIOSH lifting equation. However, there were also a large number of studies that adapted Standardised Nordic Questionnaire (SNQ) without indicating whether or not the crosscultural adaptation was assessed according to the internationally recommended methodology, i.e. translation, backtranslation, committee review and pre-testing. A similar comment also applies to work fatigue questionnaire that was established by Research Committee in Industrial Fatigue -Japan (1969). There is also evident of inappropriate use of tools, i.e. some studies attempted to utilise tools such as SNQ to show that the new design of tools or workplace layout can potentially reduce MSDs, while SNQ is likely to be inappropriate in assessing MSDs in such a short time. Overall, in terms of methodologies, apart from the total ergonomics/SHIP approach by Manuaba (2006), it is argued that the ergonomics application in Indonesia has showed little contribution to the wider knowledge of ergonomics.
Based on the results of the review and discussions, several points that could be adopted by Indonesian ergonomists, and possibly by other IDC's ergonomists, to improve working condition in SMEs are identified: (1) Adoption of participatory approach. The steady increase of work-related accidents despite continuous application of ergonomics suggests that current approach, i.e. a top-down approach, is not effective. This approach excludes employers and employees from the process, thus wasting an opportunity to educate them regarding safe working practices and to instil ownership on the ergonomics changes. In contrast, a participatory or bottom-up approach enables addressing ergonomics while simultaneously raising the awareness of safe working practices for both SMEs owners and workers. Indonesian universities could potentially play a key role to encourage the adoption of participatory approach by putting more emphasis on participatory ergonomics. (2) More initiatives to encourage creation of local technology and tool for SMEs. Unlike larger businesses, this review found that technology transfer was not (yet) a big problem in SMEs. This was due to the fact that most of the tools and technology used by SMEs can be accommodated locally. Although it is unclear how much Indonesian ergonomists' role is in this area, it is important that they continuously get involved.
(3) Appropriate adaptation and modification of ergonomics tools. Having an appropriate adaptation and modification of ergonomics tools will definitely be beneficial in the future. For instance, by having an appropriate adaptation of SNQ, MSDs data from different studies can be compared and can contribute towards documenting work-related MSDs in Indonesian SMEs. A step towards adaptation and modification of ergonomics tools for Indonesian has been started by Widyanti, Johnson, and de Waard (2013).

Conclusions
It is evident from the review that there are still issues related to ergonomics application in Indonesian SMEs that need to be addressed. The most urgent issue is the need for adopting participatory approach as part of resolving ergonomics issues at workplace. Despite repeated calls, the review clearly demonstrated that only few ergonomics studies heeded this call. Ironically, most of the studies cited the need for more active roles from employers and employees in addressing some of the ergonomics problem. Some good practices in ergonomics application were also revealed from the review, e.g. multidisciplinary approach, unsophisticated and low-cost solution, and recognising the importance of productivity. The approach increased productivity and reduced workload, fatigue and musculoskeletal discomfort Although the workload was still within the allowed limit, prolonged standing caused fatigue and musculoskletal discomfort 157 Sena (2000) A study to evaluate various sitting posture (on the floor, on a slopped chair, on a balai chair) for workers at a traditional loom industry Fatigue questionnaire (RCIF-Japan) Siiting on a sloped chair or a balai chair decreased workers' fatigue 158 Susila (2000) A study to evaluate working postures of stone carvers Observation, interview, digital human modelling A combination of awkward and static sitting posture on a stool caused musculokeletal discomfort and the use of a table and bench was recommended; musculoskeletal discomfort data 159 Sutjana (2000a) A study to evaluate a redesigned sickle for farmers Productivty, workload (heart rate), interview The redesigned sickle improved productivity and reduced energy expenditure of farmers 160 Sutjana (2000b) A qualitative study to investigate the relationship between machine use and working accidents in roof tile industries Interview, observation, anthropometry A combination of the absence of safety devices on the mill and lack of workers' knowledge and adoption of safety behaviour were found to be major causes of work-related accidents 161 Wignjosoebroto and Sutaji (2000) A study to redesign and evaluate a traditional weaver Biomechanics analysis, anthropometry, workload (heart rate), SNQ A prototype of traditional weaver reduced energy expenditure and musculoskeletal discomfort