Dissemination and Implementation Science Approaches for Occupational Safety and Health Research: Implications for Advancing Total Worker Health.

Total Worker Health® (TWH), an initiative of the U.S. National Institute for Occupational Safety and Health, is defined as policies, programs, and practices that integrate protection from work-related health and safety hazards by promoting efforts that advance worker well-being. Interventions that apply the TWH paradigm improve workplace health more rapidly than wellness programs alone. Evidence of the barriers and facilitators to the adoption, implementation, and long-term maintenance of TWH programs is limited. Dissemination and implementation (D&I) science, the study of methods and strategies for bridging the gap between public health research and practice, can help address these system-, setting-, and worker-level factors to increase the uptake, impact, and sustainment of TWH activities. The purpose of this paper is to draw upon a synthesis of existing D&I science literature to provide TWH researchers and practitioners with: (1) an overview of D&I science; (2) a plain language explanation of key concepts in D&I science; (3) a case study example of moving a TWH intervention down the research-to-practice pipeline; and (4) a discussion of future opportunities for conducting D&I science in complex and dynamic workplace settings to increase worker safety, health, and well-being.

A Comparison of Safety, Health, and Well-Being Risk Factors Across Five Occupational Samples.

Objective: The aim of this study was to present safety, health and well-being profiles of workers within five occupations: call center work (N = 139), corrections (N = 85), construction (N = 348), homecare (N = 149), and parks and recreation (N = 178). Methods: Baseline data from the Data Repository of Oregon's Healthy Workforce Center were used. Measures were compared with clinical healthcare guidelines and national norms. Results: The prevalence of health and safety risks for adults was as follows: overweight (83.2%), high blood pressure (16.4%), injury causing lost work (9.9%), and reported pain (47.0%). Young workers were least likely to report adequate sleep (46.6%). Construction workers reported the highest rate of smoking (20.7%). All of the adult workers reported significantly lower general health than the general population. Conclusion: The number of workers experiencing poor safety, health and well-being outcomes suggest the need for improved working conditions.

Generalizability of Total Worker Health® Online Training for Young Workers.

Young workers (under 25-years-old) are at risk of workplace injuries due to inexperience, high-risk health behaviors, and a lack of knowledge about workplace hazards. Training based on Total Worker Health® (TWH) principles can improve their knowledge of and ability to identify hazards associated with work organization and environment. In this study, we assessed changes to knowledge and behavior following an online safety and health training between two groups by collecting information on the demographic characteristics, knowledge, and self-reported behaviors of workplace health and safety at three different points in time. The participants' age ranged from 15 to 24 years. Age adjusted results exhibited a significant increase in knowledge immediately after completing the training, although knowledge decreased in both groups in the follow-up. Amazon Marketplace Mechanical Turk (MTurk) participants demonstrated a greater increase in knowledge, with a significantly higher score compared to the baseline, indicating retention of knowledge three months after completing the training. The majority of participants in both groups reported that they liked the Promoting U through Safety and Health (PUSH) training for improving health and safety and that the training should be provided before starting a job. Participants also said that the training was interactive, informative and humorous. The participants reported that the PUSH training prepared them to identify and control hazards in their workplace and to communicate well with the supervisors and coworkers about their rights. Training programs based on TWH improves the safety, health and well-being of young workers.

Building a Healthier Workforce: An Evaluation of an Online Nutrition Training for Apprentices.

OBJECTIVE: Construction workers face barriers to healthy eating, including work organization and environmental factors, that can affect productivity and lead to chronic conditions. The objective was to evaluate the effectiveness of an online nutrition training to improve knowledge and behaviors and evaluate the feasibility of conducting this training among apprentices in the highway construction trades. METHODS: A pretest-posttest control group design was used. The intervention was conducted using a Web-based electronic learning platform. RESULTS: A total of 36 highway construction apprentices (78% male) completed the study. Intervention participants demonstrated improvements in knowledge immediately after the training, reported modest weight loss, decreased body mass index, and decreased fast food consumption compared with control participants. However, increases in knowledge were not seen at follow-up. The training content and format were well-received, indicating that electronic learning approaches were acceptable for this population. CONCLUSIONS AND IMPLICATIONS: This project established the acceptability of using an online nutrition training to promote health among apprentices.

Addressing Younger Workers' Needs: The Promoting U through Safety and Health (PUSH) Trial Outcomes.

Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety and Health). All younger workers (14-24 years old) hired for summer work at a large parks and recreation organization were invited to participate in an evaluation of an online training and randomized into an intervention or control condition. Baseline and end-of-summer online instruments assessed acceptability, knowledge, and self-reported attitudes and behaviors. One-hundred and forty participants (mean age 17.9 years) completed the study. The innovative training was feasible and acceptable to participants and the organization. Durable increases in safety and health knowledge were achieved by intervention workers (p < 0.001, effect size (Cohen's d) 0.4). However, self-reported safety and health attitudes did not improve with this one-time training. These results indicate the potential utility of online training for younger workers and underscore the limitations of a single training interaction to change behaviors. Interventions may need to be delivered over a longer period of time and/or include environmental components to effectively alter behavior.

Focus Groups Move Online: Feasibility of Tumblr Use for eHealth Curriculum Development.

BACKGROUND: Constructing successful online programs requires engaging potential users in development. However, assembling focus groups can be costly and time consuming. OBJECTIVE: The aim of this study is to assess whether Tumblr can be used to prioritize activities for an online younger worker risk reduction and health promotion program. METHODS: Younger summer parks and recreation employees were encouraged to visit Tumblr using weekly announcements and competitions. Each week, new activities were posted on Tumblr with linked survey questions. Responses were downloaded and analyzed. RESULTS: An average of 36 young workers rated each activity on its likeability and perceived educational value. The method was feasible, efficient, and sustainable across the summer weeks. Ratings indicated significant differences in likeability among activities (P<.005). CONCLUSIONS: Tumblr is a means to crowdsource formative feedback on potential curricular components when assembling an online intervention. This paper describes its initial use as well as suggestions for future refinements.

Characterizing the needs of a young working population: making the case for total worker health in an emerging workforce.

OBJECTIVE: Young workers are at increased risk for occupational injuries. Many lack appropriate skills to avoid workplace hazards. In addition, existing safety programs neither address total worker health principles nor align with the relatively high technological expectations of young workers. This article aimed to identify the content and process for an on-line total worker health training for young workers. METHODS: During the summer of 2012, an on-line survey (n = 187) assessed young workers' behavior, knowledge, and attitudes on total worker health topics and on-line training delivery methods. RESULTS: Forty-five percent of the workers indicated this was their first job; new workers demonstrated lower safety knowledge scores than returning workers. In addition, results demonstrated that workers would benefit from health behavior interventions delivered through technology-based means. CONCLUSIONS: Findings characterize the work-related needs for this population and demonstrate the utility of using on-line training.