Evaluation Results From the Healthy Work Collaborative: A Cross-Sectoral Capacity Building Partnership to Address Precarious Employment.

BACKGROUND: The COVID-19 pandemic has illuminated the profound health and safety risks of precariously employed workers, many of whom are disproportionately Latinx and Black. Precarious employment (PE) is a social determinant of health (SDOH) characterized by low wages, hazardous conditions, unstable work schedules, no termination protection, and few benefits. Even before COVID-19, calls for more effective health promotion efforts to address SDOH like PE existed. PURPOSE: The University of Illinois at Chicago Center for Healthy Work, Healthy Communities Through Healthy Work developed the Healthy Work Collaborative (HWC) as an evidence-informed capacity building policy, systems, and environmental change (PSE) initiative. The HWC aimed to facilitate cross-sectoral partnerships between health and labor sector partners. The labor sector provided technical assistance (TA) to participants to improve their ability to address PE through PSE. METHODS: This article reports findings from a mixed-methods evaluation using the Kirkpatrick training model including participants' reactions, learning, behavior, and outcomes. A pre-post survey was administered to participants (N = 21) and analyzed descriptively; 3-month post HWC interviews were conducted (N = 13) and thematically analyzed. CONCLUSION: Findings included positive results at all Kirkpatrick levels. Participants' reported that the HWC curriculum and delivery was valuable and well received; they demonstrated gains toward addressing PE through PSE knowledge and skills and increased or strengthened health/labor partnerships. In addition, HWC influenced participants' application of HWC concepts, and in a few cases, participants' made changes in policies and plans in their organizational settings. The HWC may serve as a model to address other SDOH through cross-sectoral PSE change.

Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home).

Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.

Development of the Healthy Work Collaborative: Findings From an Action Research Study to Inform a Policy, Systems, and Environmental Change Capacity-Building Initiative Addressing Precarious Employment.

Precarious employment (PE) is a complex problem that affects an increasing number of workers across all economic sectors who experience low wages, hazardous conditions, and few benefits, and results in adverse health outcomes. PE is characterized by nontraditional work arrangements, precluding workplace-based interventions. Policy, systems, and environmental initiatives that engage cross-sectoral stakeholders may be an applicable health promotion approach to address PE. The University of of Illinois at Chicago Center for Healthy Work's Healthy Communities through Healthy Work (HCHW) is an outreach project of the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health-funded Center of Excellence for Total Worker Health that conducted a multiphased qualitative action research (AR) study. AR designs may be a novel approach to develop initiatives to address problems like PE. This article reports on HCHW's first AR phase to answer four research questions: (1) What are participants' perceptions of PE? (2) What are participants' perceptions of their roles in addressing PE? (3) What initiatives are under way that address PE? and (4) How can the findings be used to facilitate opportunities for healthy work? Key informant interviews with health (public health and health care; N = 23) and labor sector organizations (worker centers, worker advocacy organizations, and unions; N = 21) were conducted. Data were thematically analyzed alongside a chart-based content analysis, and shared in 11 key stakeholder meetings. Findings revealed an opportunity for the labor sector to improve health sector readiness to address PE in the context of health, and were used to develop the Healthy Work Collaborative, a cross-sectoral health promotion capacity building policy, systems, and environmenta change initiative to address PE.

Attitudes and behaviors of chiropractic interns toward occupational history taking.

OBJECTIVE: This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking. METHODS: All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study. RESULTS: The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was "very important." Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). CONCLUSION: Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.

Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing.

OBJECTIVE: Individuals in transitional housing programs often have a goal of reaching stable employment, but the unique needs and barriers for achieving this warrants further study. METHODS: A structured interview guide was administered orally and descriptive data analysis was done for this exploratory mixed-methods study. RESULTS: Commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning. CONCLUSIONS: Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.

Perceived Stress and Health among Home Care Aides: Caring for Older Clients in a Medicaid-Funded Home Care Program.

Home care aides (HCAs) provide housekeeping and personal care services to help older clients remain in the community. However, little is known about the health of HCAs, who themselves constitute an underserved population. The goal of this study was to investigate how HCAs' work and life contexts manifest themselves in HCAs' health as perceived by HCAs. Six focus groups were conducted with HCAs (N=45). Analysis revealed how HCAs' work-and life-related stress accumulated over time and affected HCAs' health and interaction with their older clients. Home care aides were interested in personal health promotion and client well-being. Home care aides may constitute an underused resource for the care of older adults with disabilities. Information about intricately intertwined work and life contexts should inform policymakers and home care providers in their efforts to improve the quality of publicly funded home care services.

Health and Safety of Limited English Speaking Asian Homecare Aides in Chicago: A Pilot Study.

OBJECTIVES: To identify health and safety hazards and needs among limited English speaking Asian home care aides, and characterize their acculturation status and how it affects their health and safety. METHODS: Surveyed 60 home care aides and interviewed six home care service providers to assess health and safety hazards and needs of the study population. RESULTS: The majority of the study participants were older and did not speak English or did not speak English well. They communicated with senior clients in their native language only or most of the time. Many experienced work related injuries and musculoskeletal pain. DISCUSSION: The Asian homecare aides met the critical needs of an aging community. They experienced many challenges working as a home care aide and as a result of cultural barriers.

Slips, Trips, and Falls Among Home Care Aides: A Mixed-Methods Study.

OBJECTIVE: To address the gap of knowledge about slips, trips, and falls (STFs) among home care aides (HCAs) who work in clients' homes. METHODS: This mixed method study used survey and focus group data of HCAs in a Medicaid-funded homecare program. RESULTS: STFs were common with over 12% of HCAs reporting occurrence in the previous 12 months, of whom 58% fell to the ground. Both survey and focus group data identified ice, clutter, workload, rushing and other hazards. Focus group data explained the reasons for not reporting STFs, even among those who sustained injury, and added HCAs' voices to the understanding of causes, consequences and prevention strategies for STFs. CONCLUSIONS: Empowering HCAs with knowledge, training, and involvement may transform "near miss" STFs into opportunities to prevent STFs among care workers and their clients.

Workers' compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers.

BACKGROUND: The working poor are at highest risk of work-related injuries and have limited access to occupational health care. OBJECTIVES: To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers' compensation (WC) among the working poor. METHODS: Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs. RESULT: Fifty-one interviews of minority workers across sectors identified 23 prior work-related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated. CONCLUSIONS: Patients in CHCs work in jobs that put them at risk for work-related injuries. CHCs are a good site for accessing at-risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.

Promoting Seniors' Health With Home Care Aides: A Pilot.

Purpose: Regular physical activity (PA) benefits older adults. However, frail older adults lack opportunities to be physically active. This pilot study aimed to test and enhance the feasibility of a PA program delivered by home care aides (HCAs) for community-dwelling older adults in a Medicaid-funded home care setting and to generate preliminary efficacy and cost data. Design and Methods: HCAs were trained to deliver a brief motivational enhancement and three chair-bound movements to motivate their older clients to do PA daily and to help maintain their independence in the community. Mixed methods were used to evaluate clients' function and health before and after the 4-month intervention. Results: Clients' daily activity function and health outcomes (physical fitness, self-rated health, pain interference, and fear of falling) improved significantly. The program was well-received by clients (N = 54) and their HCAs (N = 46) as indicated by high retention rates among client participants (93%) and remarks provided by clients. Implications: Building PA into the everyday care of older adults and the routine work of HCAs is feasible. The intervention has the potential for further implementation and dissemination.

"Then They Trust You ": Managing Ergonomics in Home Care.

The home care workforce, already at 2.7 million caregivers, will become the nation's fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients' physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.

Co-learning with home care aides and their clients: collaboratively increasing individual and organizational capacities.

Changes in health care provide unprecedented opportunities for collaboration across research, education, and practice for the common goal of enhancing the well-being of older adults and their caregivers. This article describes how a pilot project, Promoting Seniors' Health with Home Care Aides, has synergistic education, research, and practice effects that enhance individual and organizational capacities. This pilot is an innovative partnership with home care aides to deliver a safe physical activity program appropriate for frail seniors in a real-life public home care program. The intervention and research occur in older adults' homes and thus provide rare opportunities for the research team and partners to learn from each other about dynamics of home care in older adults' life contexts. Co-learning is essential for continuous quality improvement in education, research and practice. The authors propose to establish "teaching home care" to ensure ongoing co-learning in gerontology and geriatrics.

Occupational safety and health education and training for underserved populations.

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

More than training: Community-based participatory research to reduce injuries among hispanic construction workers.

BACKGROUND: Workplace mortality and severe injury are disproportionately distributed among foreign born and Hispanic construction workers. Worker Centers (WCs) provide services and advocacy for low-wage workers and a way for investigators to reach them. The goal of this project is to prevent occupational injuries by increasing awareness of hazards and self-efficacy among foreign born, Hispanic construction workers and by expanding the agenda of WCs to include occupational health and safety (H&S). METHODS: Investigators partnered with eight WCs in seven cities to train worker leaders to deliver a modified OSHA 10-hr curriculum to their peers. RESULTS: Thirty-two worker leaders trained 446 workers over 3 years. There was a demonstrated improvement in knowledge, hazard identification, self-efficacy, and sustainable H&S activities. CONCLUSIONS: This study provides evidence for successful implementation of a training intervention for low wage, low literacy Hispanic construction workers using a community-based participatory research approach.

Evaluating goals in worker health protection using a participatory design and an evaluation checklist.

Spanish-speaking immigrant workers in construction are considered hard to reach and at high risk for work-related injury and fatality. This evaluation study describes the use of participatory methods and an evaluation checklist to consider a health and safety (H&S) training program for these workers. A previously developed training manual and model were disseminated to eight worker centers (WCs) through participatory research collaboration. It incorporated H&S training for workers while strengthening the role of WCs as sources for leadership development and worker empowerment. Design, delivery, reaction, application, and extension were assessed through individual interviews with participants, trained trainers, and center staff and through observation of training sessions and partner debriefs; pre- and post-training tests assessed participant learning. Results indicate moderate learning and application by participants and strong evidence for structural gains in and among WCs. We conclude that such partnerships and models are valuable tools for collaborating with hard-to-reach workers.

Medical interpretation for immigrant workers.

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. Our goal was to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages. We conducted interviews and a focus group of MIs regarding their attitudes toward foreign-born workers, knowledge of occupational health, and perceived roles. They were familiar with occupational injuries and sympathetic toward foreign-born workers, and they described their roles as conduits, cultural brokers, and advocates for hospitals, providers, and patients. More detailed and representative data would require a larger investigation. However, the time-sensitive nature of policy-making at this point mandates that occupational health stakeholders participate in the national dialogue on standards, training, and licensure for MIs to promote improved access and quality of health care for LEP patients who have been injured at work.

An approach to assessing data quality in an area probability survey using CBPR.

Community-based participatory research (CBPR) approaches attempt to engage community members in all aspects of research conducted in the community. Proponents of CBPR suggest that among the many advantages to using CBPR is higher acceptance of and cooperation in research endeavors than is usually achieved through more traditional research approaches. Using secondary analysis of sample disposition data from two area probability surveys of the same community areas, one involving community interviewers in a fully collegial CBPR study and the other using professional interviewers, this study finds that data collected using CBPR techniques may lead to higher cooperation and lower refusal rates than data collected by professional interviewers. However, when compared to external population indicators such as census data, the sample produced by CBPR interviewers overrepresents certain population groups whereas the survey data produced by professional interviewers may underrepresent key population groups.

Implementation and evaluation of interventions for home care aides on blood and body fluid exposure in large-group settings.

Participatory research conducted with academic, union and management cooperation resulted in the development, implementation, and process evaluation of interventions designed to reduce occupational blood and body fluid exposure among home care aides. Home care aides working for a large urban home care agency took part in the design and implementation of an interactive participatory training program conducted in large-group settings, and the development and evaluation of two training tools: an information card for home care aides and a sharps safety magnet for their clients. A process evaluation conducted immediately following the interactive training program found that 72 percent of the home care aides preferred it to lecture-style trainings typically offered, while only 9 percent preferred typical trainings. Home care aides were able to effectively articulate information learned during the interactive training program, with less than 2 percent providing inaccurate information about what was taught during the training. Home care aides overall responded positively to the information card and the magnet, with aides caring for clients who used sharps rating the tools as more useful. Participatory training programs can be effectively implemented in a large-group setting.

Youth violence prevention curriculum evaluation: outcomes of a Cook County, Illinois community based partnership.

The John H. Stroger, Jr. Hospital Departments of Trauma and Emergency created a youth violence prevention curriculum for healthcare providers and staff with a community partnership of practitioners and professionals. A participatory, train-the-trainer approach was used to develop and present the curriculum. Participants were offered voluntary participation in the anonymous evaluation survey to determine their interests, work experience, expectations, knowledge, and skill development, use of, and improvement for the curriculum. Responses from 49 complete surveys were qualitatively analyzed with a response rate of 42% (49/116). The activity, and efforts of professionals and community members to engage and educate themselves through this violence prevention partnership, are an example of how healthcare providers can deploy resources to benefit communities as well as to respond to the needs of individual patients, particularly in the compelling area of youth violence prevention.