An exploration of rollover protective structures (ROPS) rebate program media coverage: strategies for implementation and sustainment.

BACKGROUND: Media advocacy plays an important role in public health initiatives, as it can provide vital information to target populations, policy makers, or other relevant stakeholders. Unfortunately, little is currently known about the use of media advocacy to promote occupational safety and health programs. This study explores media coverage related to the Rollover Protection Structure (ROPS) Rebate Programs, which were designed to encourage the use of rollover protection on agricultural tractors, thus reducing the risk of tractor overturn fatalities. The Program's portrayal in the media, as well as the role that the media has played in implementing and sustaining these Programs. METHODS: Media articles pertaining to any of the state-based or National ROPS Rebate Programs and published between November 1, 2006 and October 31, 2018 were included for review. Discourse analysis was used to understand the messages portrayed by the media and how those messages shaped the outcomes of the ROPS Rebate Programs. RESULTS: During the study period, 212 unique articles were published about the ROPS Rebate Programs. While these articles all portrayed the ROPS Rebate Programs in a largely positive light, they were used at different stages, from pre-implementation through sustainment of the ROPS Rebate Programs, and to different extents. CONCLUSIONS: Media articles have played an important role in implementing and sustaining the ROPS Rebate Programs. Based on the results of this study, more robust and continuous media coverage are important for the longevity and success of public health programs.

Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review.

BACKGROUND: Despite much research to develop life-saving innovations for the agriculture, forestry, and fishing workforce, these populations continue to face the highest fatal and non-fatal injury rates in the United States, as many of these solutions are not fully adopted. METHODS: A scoping review was conducted to provide an overview of research to practice efforts in this field. The language used to describe these initiatives, the utility of the NIH T0-T4 model, and the progress along the research to practice continuum were examined. RESULTS: Fourteen eligible references demonstrated that progress in implementation science is lacking and that there is little consistency in how researchers apply the T0-T4 model; thus, a new model is presented. CONCLUSIONS: Researchers in this field face several challenges when moving from research to practice. While some challenges are addressed with the proposed model, additional resources and infrastructure to support such initiatives are necessary.

Do Cialdini's "Principles of Influence" Motivate Safe Practices on Farms?

On farms, power take-off (PTO) drivelines pose serious risks in terms of both fatal and non-fatal injuries. PTO shielding can prevent such injuries; however, is often underutilized by the farm population. This study aims assesses seven influence campaigns and their ability to change attitudes toward PTO shielding in order to encourage sustainable behavior change. Seven strategies based on common principles of influence (liking, social proof, authority, consistency, reciprocity, and scarcity) were implemented in seven agricultural counties in upstate New York. Pre- and post- tests focused on shielding behaviors and attitudes, as well as the presence of the influence strategies, were used to assess changes resulting from these interventions. Little change in the presence of influence strategies was noted from baseline to follow-up. Additionally, there were no significant changes in behavior or attitude toward PTO shielding in the same time period, indicating the failure of the interventions to create change. The findings of this study support the challenges identified in past efforts to increase the use of PTO shields on farms and highlight the need for more intensive, focused interventions. Future studies can use these lessons to develop more robust interventions for improved outcomes.

A Scoping Review of Safety and Health Interventions in the High-Risk Dairy Industry: Gaps in Evidence Point to Future Directions in Research.

The occupational injury rate of the dairy industry (6.6 per 100 full-time workers) is twice that of the national average across all industries (3.3 per 100 full-time workers). While dairy farms are becoming larger in size and fewer in number, this rate has not changed. A scoping review was conducted to identify published reports of occupational safety interventions in the dairy industry. An additional criterion was that the study included an evaluation of the intervention. Out of 22 articles that met the first criterion (discussion of interventions specific to the dairy industry), 19 met the second of having an evaluative component. These 19 articles corresponded to 16 unique studies, because 4 articles corresponded to the same study. Of the 16 unique studies, only 3 had a comparison of treatment vs. control effects, and none measured the impact of the intervention on injuries and fatalities. Of the 16 interventions, 6 were focused on training or informational campaigns in which the evaluations primarily measured knowledge acquisition. Additionally, none of these studies had a sufficient sample size to compare injury rates as an outcome. Our study demonstrates that the literature lacks any rigorous evaluation of whether dairy safety interventions are making an impact on injury prevention. Given this, it is not possible to determine how work-related injuries and deaths can be prevented in the dairy industry. Recommendations for future research include incorporating rigorous evaluation into research designs and attempting to develop low-cost, unobtrusive methods for collecting data on intermediate and final outcomes.

Cost Analysis of a PTO Driveline Shielding Program: Are Effective Programs Cost-Effective?

HIGHLIGHTS: This article describes a cost assessment of a PTO driveline shielding intervention. Considerations for effective occupational safety interventions beyond reductions in injuries or fatalities are described. The financial viability of combining various on-farm services to reduce intervention costs is discussed. ABSTRACT: PTO entanglements are a primary injury concern on U.S. farms, affecting adults and children. These events often lead to severe injury and permanent disability but can be prevented with proper use of PTO shielding. A promising strategy for increasing PTO shielding on farms has been the introduction of user-friendly shielding options by qualified safety specialists. This study looks at the cost-effectiveness of this approach. The cost-effectiveness of this PTO shielding strategy was calculated based on program-related costs, the PTO shield cost, the lifespan of PTO shields, and the number of PTO shields needed to prevent an entanglement. The cost per entanglement prevented was then calculated by dividing the total costs by the number of entanglements prevented in several cost-estimate scenarios. Costs were adjusted for inflation to 2019 dollars. Costs per entanglement prevented ranged from a low of $921,544 (assuming a 10-year PTO lifespan and using 12,487 as the number needed to treat, i.e., to prevent a PTO entanglement, referred to as the NNT) to a high of $18,583,492 (assuming a three-year PTO lifespan and 67,119 as the NNT). The cost per entanglement prevented at the median PTO lifespan of five years and median NNT of 39,802 was $6,612,244. Based on our estimates, the cost-efficacy of increasing PTO shielding using qualified safety specialists differs widely based on the shield lifespan and the number of shields needed to avoid one entanglement. However, if the cost of introducing PTO shields in on-farm visits is coupled with other on-farm services that defray these costs, then the cost-efficacy increases considerably.

Understanding Trends in PTO Shielding Using Kelman's Processes of Change.

Background: Kelman's Processes of Change suggest that individuals participate in behaviors for one of three reasons: because it is required (compliance), because the behavior allows them to maintain a particular social status (identification), or because the behavior aligns with the individuals core beliefs (internalization). This study aims to assess the utility of this model in understanding farmers' attitudes and behaviors regarding power take-off (PTO) shielding to prevent entanglements.Methods: Surveys collected data on 673 farmers' attitudes and behaviors related to PTO shielding in 14 highly agricultural counties of New York. Participants were classified based on Kelman's Processes of Change.Results: In total, 59.44% of participants could be classified into one of the three Kelman categories based on both attitude and behavior. Of these participants, 18% were classified in the compliance phase, 3% in identification, and 79% in internalization. Of participants who did not display appropriate shielding behavior, 77% still reported having internalized the importance of PTO shielding.Conclusions: Two main challenges occurred in using Kelman's Processes of Change to assess PTO shielding behaviors among farmers. First, the attitude and behaviors of participants were not always reflective of one another, and second, participants tended to have difficulties distinguishing their primary motivations for PTO shielding (compliance, identification, or internalization). Though participants can be classified based on Kelman's Processes of Change and researchers can benefit from a more in-depth understanding of motivations related to changing safety behaviors, this study indicates that there are challenges in accurately assigning individuals to their appropriate "change" classification.

Evaluating the Evolution of Social Networks: A Ten-Year Longitudinal Analysis of an Agricultural, Fishing and Forestry Occupational Health Research Center.

As part of our evaluation of the NIOSH-funded Northeast Center for Occupational Health and Safety: Agriculture, Forestry and Fishing (NEC), we present methodology, findings and the potential implications of a sequential social network analysis (SNA) conducted over ten years. Assessing the effectiveness of the center's scientific projects was our overarching evaluation goal. The evaluation design employed SNA to (a) look at changes to the center's network over time by visualizing relationships between center collaborators annually, (b) document collaborative ties and (c) identify particularly strong or weak areas of the network. Transdisciplinary social network criteria were applied to the SNA to examine the collaboration between center personnel, their partners and the industry groups they serve. SNA participants' perspectives on the utility of the SNA were also summarized to assess their interest in ongoing SNA measures. Annual installments of the SNA (2011-2020) showed an expansion of the network with a 30% increase in membership from baseline, as well as an increase in total relational ties (any type of contact). SNA measures also indicated significant increases in co-publication, cross-sector and transdisciplinary ties. Overall, SNA is an effective tool in visualizing and sustaining an occupational safety and health research and outreach network. Its utility is limited by how ties are characterized, grant cycle timeframes and how SNA metrics relate to productivity.

Stakeholders Team up for Action in New York Dairy (STAND): A Collaborative Action-Planning Workshop to Combat Toxic Stress among New York Dairy Farmers.

Objectives: Mental health challenges on farms, especially dairies, are increasing. A Future Search workshop was held in December 2018 to develop collaborative strategies for addressing this issue. This brief report outlines the methods used at this workshop and its outcomes.Methods: Participants from eight sectors related to producer wellbeing were invited to participate in the 3-day workshop. This included: male and female farmers, health, mental health, government, agricultural, and dairy-specific organizations, and processors. Together, the group worked through activities dealing with the past, present, and future. These activities led to the development of common ground missions and action steps to achieve these goals.Results: The workshop participants developed goals and action steps to create change in nine areas: peer support and social networks; environment; healthcare; business planning; regulations; milk pricing; marketing and consumer education; education, research and technology; and workforce.Conclusions: Much was achieved during the 3-day workshop. Additional follow-up with participants will ensure that momentum toward shared goals continues.

Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health.

BACKGROUND: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. METHODS: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. RESULTS: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. CONCLUSIONS: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research.

Objectives On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes. Methods Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes. Results Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating. Conclusions The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.

Marketing Farm Safety: Using Principles of Influence to Increase PTO Shielding.

OBJECTIVES: Despite much work to reduce the frequency and severity of agricultural injuries, these events still occur. Power take-off entanglements are one example of agricultural events that can lead to death or permanent disability. This manuscript considers the use of marketing techniques to reduce agricultural injuries. Specifically, the "principles of influence" (liking, social proof, authority, consistency, reciprocity, and scarcity) are explored as methods of promoting power take-off shielding among New York farmers. METHODS: Focus group discussions were held with farmers and agricultural service providers in seven agricultural counties in New York. Participants were provided with background information about power take-off injuries, as well as information on one principle of influence. Facilitators then guided the groups through a brainstorming discussion to formulate intervention strategies. RESULTS: Thirty-nine individuals participated in the discussions. Participants provided feedback on individuals and organizations that could serve as influencers, potential incentives for participants, and beliefs about what would not work in their community. CONCLUSION: Overall, participants were enthusiastic about using principles of influence to promote power take-off shielding. These methods appear to be promising for improving safety on farms, and have the potential to save both time and money compared to other intervention strategies.

Assisting New York Dairy Farms with Preparing for OSHA Safety Inspections.

In 2013, the Occupational Safety and Health Administration announced a Local Emphasis Program targeted at New York farmers. This program involved random inspections of dairy farms across the state. This article provides an overview of the efforts made in New York to prepare farmers for these inspections. As a result of this program launch, several safety services offered by the New York Center for Agricultural Medicine and Health were significantly impacted, and required expansion and modification in order to meet the needs of New York farmers.

"I Would Go if My Arm Were Hanging off": A Qualitative Study of Healthcare-Seeking Behaviors of Small Farm Owners in Central New York State.

Compared to their rural non-farming peers, farmers are less likely to access preventive healthcare services; however, the reasons for this disparity are poorly understood. We conducted semi-structured interviews with a total of 30 farm household members in central New York. Interview topics included farming identity, perceptions of one's health, past experiences with acute and preventive healthcare, and attitudes toward seeking healthcare services. Grounded Theory analysis of the interview transcripts revealed that (1) utilizing healthcare services is felt to be in conflict with the farming identity, (2) the need to conserve time and money for farm applications poses a barrier to healthcare utilization, (3) farmers decide to seek healthcare when they believe it is necessary to ensure survival of the farm, and (4) the decision to seek healthcare is most strongly driven by the presence of intolerable symptoms, prompting from others, and the perception that treatment will yield clear benefits. Efforts to increase farmers' utilization of healthcare services must address these considerations.

Symbolic Interactionism: A Framework for Understanding Risk-Taking Behaviors in Farm Communities.

Risk behaviors are key drivers of occupationally related injuries and illnesses, considerably impacting the uptake and success of injury interventions, technologies, and practices. This is certainly true in the agricultural sector, where farmers often ignore recommended safety practices or have even been known to disable safety technologies. Although research studies have characterized specific individual safety or risk behaviors, few studies have thoroughly examined farmers' risk and safety orientations or how these develop in response to environmental and societal exposures. This study utilizes data collected over the past decade with a variety of small to midsize farm personnel to explore the meanings that farmers ascribe to risk and safety and how these influence risk and safety behaviors. In all, over 90 interviews with farmers, farm-wives, and family members were reviewed. Researchers used a grounded theory approach to identify patterns of environmental and societal exposures, as well as their impact on farmers' risk and safety orientations. Analysis revealed exposures and orientations to risk and safety, which could be largely explained through the lens of symbolic interactionism. This framework posits that people create a sense-of-self as a way of adjusting and adapting to their environment. For farmers in this study, belief in their ability to persevere allows them to succeed, despite the considerable stressors and challenges they face each day. However, this identity can, at times, be maladaptive when it is applied to safety decisions and hazard exposures. The authors discuss the implications of this research and how it may be used to productively inform future farm safety efforts.

A Comparison of Interventional Approaches for Increasing Power Take-off Shielding on New York Farms.

OBJECTIVE: Power take-off (PTO) driveline entanglements are a primary source of injury on US farms. As with many farm injury concerns, hazard control technology is widely available for mitigating the risk of these entanglements. Despite the availability of hazard control technology, PTO shields are damaged or missing on approximately 57% of PTO driveline implements in New York. Given the catastrophic nature of entanglements and the ready access to safety technology, a better understanding of what motivates farmers to install or replace PTO shields is warranted. METHODS: To examine this question, agricultural health and safety researchers in New York State conducted an initial comparison of PTO shield sales on farms receiving one of three different interventional approaches. These included PTO shield audits, a social marketing campaign, and on-farm safety services. PTO shield purchases were tracked from January 2011 through June 2016 on farms receiving these interventions and on other farms that were not exposed to interventional strategies. RESULTS: Results indicate that a significantly higher number of PTO shields were purchased on farms that requested and received on-farm safety services versus farms that were exposed to PTO shield audits, the social marketing campaign, or the control group. PTO shield sales were slightly elevated on farms receiving driveline audits, as compared with control farms (although these differences were not significant). CONCLUSIONS: No marked differences in sales were noted between control farms and farms exposed to the social marketing campaign. Only one of the three interventional strategies (on-farm safety services) approached the number of PTO shield sales necessary to prevent an entanglement.

Development and Evaluation of a Basic First Aid Curriculum for Spanish-Speaking Dairy Workers.

. Over the past decade, the New York State dairy industry has grown substantially, resulting in an increase in immigrant workers who speak languages other than English. Estimates suggest that over 50% of workers on large New York dairies are Spanish-speaking individuals who immigrated to the U.S. from Guatemala, Mexico, and other Latin American countries. With a growing population of Spanish-speaking workers, safety concerns on farms have become a prominent issue. This article reviews the development and evaluation of a basic dairy first aid curriculum, which is intended to educate Spanish-speaking immigrant dairy workers on emergency response and first aid. The materials developed are culturally relevant and can be easily understood by low-literacy, non-English-speaking workers. In evaluation of the materials using pre- and post-testing, a significant knowledge gain was identified in workers who participated in the training.

Implementing a National Tractor Safety Program: Using "Whole System in a Room" to Mobilize Partners and Implement Solutions.

Fatalities due to tractor overturns have long plagued the U.S. farm community. Constituting 20% of agricultural fatalities, tractor overturns contribute significantly to high rates of fatal injuries. In the past, many efforts have been directed toward reducing tractor overturns, with one successful US-based program offering rebates to farmers who retrofit their tractors with rollover protective structures (ROPS). In an effort to expand the program, the National Tractor Safety Coalition was formed. This coalition hosted a "Whole System in the Room" workshop to bring 50 stakeholders together. During this workshop, participants worked together to identify a common vision for the future of tractor safety and ROPS programs and commit to action. At the close of the workshop, coalition members set out to begin work on 100 short- and long-term commitments to begin implementing a National ROPS Rebate Program.