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

Use of Community Health Workers Among U.S. Male Latino Population: A Scoping Review

Community Health Workers (CHWs) are an effective strategy to address the health needs of specified communities. The purpose of this scoping review was to explore the use of CHWs to address the health needs of the Latino male population. This project used specific search terms to identify relevant articles from PubMed, PsycINFO, and Google Scholar. Eligible articles included studies, conducted in the U.S. and in English from 2010 to 2022, that assessed the use of CHWs among a predominantly male (≥ 50%) Latino population. Twenty articles consisting of 13 interventions were identified for review and were further categorized into male-only participant samples (n = 10) and mixed-gender but predominantly-male participant samples (n = 10) for synthesis. Male-only participant samples focused on occupational health and participant's social support and networks. Predominantly-male, mixed-gender participant sample interventions were disease-centered and emphasized the longitudinal support of CHWs as well as social networks. Of the 13 interventions reviewed, almost all (n = 10) utilized existing social networks for engagement and nearly half (n = 6) employed community-based participatory research (CBPR) principles. Findings suggest that recruiting CHWs from within existing social networks and using CBPR are important factors for successful health promotion among male Latinos.

Development and refinement of a corner-based injury prevention programme for Latino day labourers

Objective

Latino day labourers (LDLs) in the USA are at increased risk for non-fatal and fatal occupational injuries, which are compounded by stressors that include wage theft, job insecurity and discrimination. This paper describes the development and refinement of Vales+Tú (You are Worthy of More), an injury prevention programme currently being evaluated as part of a cluster randomised trial in which health promotion is taken directly to the 'corners' (e.g. street corners, home improvement store parking lots, and public parks) where workers gather to seek employment.

Design

Vales+Tú comprises two corner-based intervention approaches, group problem-solving (small group discussions) and brief motivational interviewing (one-on-one dialogue), that aim to activate LDL agency to control their safety and that of their peers.

Setting

Corners in Houston, Texas, where LDLs seek employment.

Method

Intervention Mapping informed the refinement of Vales+Tú for the current trial. We provide a narrative review of the development process based on needs assessment and formative development activities (surveys, focus group discussions and pilot tests).

Results

In addition to documenting the need for LDL injury prevention, with 20.2%-41.6% of Houston-based LDLs surveyed between 2013-2014 and 2019 reporting a severe work-related injury in the past year, we describe key facets of the Vales+Tú corner-based intervention approaches - including their theoretical basis and LDL-centred activities, as well as enhancements made informed by formative evaluation.

Conclusion

The community-engaged development process of Vales+Tú resulted in two practical intervention approaches that can be adopted by worker centres and other organisations to promote LDL worker safety.

Vales+Tú: a cluster-randomized pilot study to reduce workplace injuries among US Latino day laborers

Latino day laborers (LDL) are a vulnerable population of workers facing considerable risk for occupational injury. Under the guidance of our Community Advisory Board, we developed and tested the feasibility, acceptability and preliminary effects of Vales+Tú (You Are Worth More), a workplace injury risk-reduction program implemented by promotores on street-corners where LDL seek employment. The program was informed by theoretical perspectives emphasizing individual and group agency and self-determination. A pilot three-arm cluster-randomized community trial was conducted among 75 LDL. The intervention arms consisted of an individualized Brief Motivational Interview, a Group Problem Solving activity and a standard of care control (OSHA safety cards). We met our study goal of 25 LDL per intervention arm, and contacted 88% of participants post intervention. Participants evaluated the interventions favorably. At post-test, the Brief Motivational Interview group reported significant reductions in exposure to workplace hazards and increases in risk-reduction practices. The Group Problem Solving participants showed significant reductions in exposure to hazards (t-test −4.16, p < 0.001). Both intervention groups increased their reliance on corner peers, a measure of social support. Standard of care participants increased in self-efficacy to work safely. Overall, the only significant different between the three study conditions was in self-efficacy. These findings provide evidence of the feasibility and acceptability of Vales+Tú and show preliminary program efficacy. A large-scale replication trial will permit a more formal modeling of the study findings. Clinical Trial Registration (ClinicalTrials.gov): NCT04378348.

Community Health Workers Should be Worker Advocates

Community health workers (CHWs) are frontline health workers who connect underserved populations to the health care system, provide health education, and advocate for their clients. CHWs can be particularly helpful to their clients in addressing social determinants of health that affect many chronic illnesses such as asthma, high blood pressure, poor mental health, and kidney and heart diseases. However, in one social determinant-the world of work-CHWs do not often play a role as facilitators and advocates. Low-income and other disadvantaged workers experience many hazards to their health and well-being, and knowledgeable CHWs could play a significant role in assisting them to confront such challenges.

Lessons Learned From a Qualitative COVID-19 Investigation Among Essential Workers With Limited English Proficiency in Southwest Kansas

In this commentary, we briefly describe our methodology in conducting a remote qualitative investigation with essential workers from southwest Kansas, and then describe some key considerations, challenges, and lessons learned in recruiting and conducting interviews remotely. From August 4, 2020 through August 26, 2020, Centers for Disease Control and Prevention (CDC) staff conducted five phone interviews with culturally and linguistically diverse employees in southwest Kansas to understand COVID-19 knowledge, attitudes, and practices and communication preferences. Our experience details the potential challenges of the federal government in recruiting individuals from these communities and highlights the possibilities for more effectively engaging health department and community partners to support investigation efforts. Optimizing recruitment strategies with additional participation from community partners, developing culturally and linguistically appropriate data collection tools, and providing supportive resources and services may augment participation from refugee, immigrant, and migrant (RIM) communities in similar remote investigations.

Development of a child-centred community-based participatory research approach to injury prevention

BACKGROUND

Community-based participatory research (CBPR) approaches to injury prevention are conducted so as to foster inclusiveness and collaboration in research processes and settings. Despite the benefits of using CBPR approaches to represent voices in research that are typically marginalised, they are overwhelmingly used in collaborations with youth and adults. Developing a child-centred CBPR approach can serve the important purpose of fostering awareness for children's voices and needs in injury prevention, and can help future researchers engage communities of children in a genuine and respectful way.

PURPOSE

To develop a four-staged model of a child-centred CBPR approach to injury prevention and outline the development.

An Evaluation of Safety Training for a Diverse Disaster Response Workforce: The Case of the Deepwater Horizon Oil Spill

(1) Background: In this case study, we examined the safety-training-related experiences of individuals from six racial-ethnic groups (Asians (Vietnamese), Blacks, Hispanics, Isleños, Native Americans, and Whites) involved in the cleanup of the Deepwater Horizon oil spill. (2) Methods: We assessed, via a survey, 495 disaster response trainees’ reactions to the design and delivery of training, learning, safety performance, and injury and illness experience. (3) Results: Our results showed statistically significant racial-ethnic group differences with respect to reactions to training, components of learning (i.e., cognitive, skill, and affective), and safety performance (i.e., use of personal protective equipment, engaging in safe work practices, communicating of safety information, and exercising employee rights and responsibilities). In general, Asians and Isleños group members had lower reactions to training, self-reported learning, and safety performance. Additionally, we found that the safety climate interacted with learning to positively affect safety performance. (4) Conclusions: We discuss the implications of our findings for improving the quality of safety training in relation to addressing language and literacy concerns, developing training that is useful and engaging for volunteer and other cleanup workers from the contaminated region, and promoting a positive safety climate to enhance training transfer.

Participatory approaches in the development of health interventions for migrants: a systematic review

OBJECTIVE

Analysis of participatory approaches to developing health interventions for migrants and how approaches embody core participatory principles of inclusivity and democracy.

DESIGN

A systematic review of original articles. Electronic searches within the databases MEDLINE, Embase, Global Health and PsychINFO (from inception-November 2020).

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Original peer-reviewed articles reporting research to develop and implement a health intervention for migrants, incorporating participatory approaches. We defined migrants as foreign-born individuals. Only articles reporting the full research cycle (inception, design, implementation, analysis, evaluation, dissemination) were included.

DATA EXTRACTION

We extracted information related to who was involved in research (migrants or other non-academic stakeholders), the research stage at which they were involved (inception, design, implementation, analysis, evaluation, dissemination), the method of their involvement and how this aligned with the core principles of participatory research-categorising studies as exhibiting active or pseudo (including proxy and indirect) participation.

RESULTS

1793 publications were screened, of which 28 were included in our analysis. We found substantial variation in the application of participatory approaches in designing health interventions targeting migrants: across 168 individual research stages analysed across the 28 studies, we recorded 46 instances of active participation of migrants, 30 instances of proxy participation and 24 instances of indirect participation. All studies involved non-academic stakeholders in at least one stage of the research, only two studies exhibited evidence of active participation of migrants across all research stages. Evidence is limited due to the variability of terms and approaches used.

CONCLUSIONS

Important shortfalls in the meaningful inclusion of migrants in developing health interventions exist, suggesting a more rigorous and standardised approach is warranted to better define and deliver participatory research and improve quality.

REGISTRATION

This review followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and is registered on the Open Science Framework (osf.io/2bnz5).

Pilot of a Community Health Worker Video Intervention for Immigrant Day Laborers at Occupational Health Risk

Significance: Immigrant day laborers suffer from disproportionate occupational health risks from hazardous reconstruction jobs after natural disasters.

Methods: We conducted a randomized controlled trial of a short-video educational intervention to improve safety knowledge and intent to engage in safety preventive behaviors among 98 Hispanic day laborers (49 randomized to video and 49 control). The short video featured a male promotor and a female promotora who narrated 3 stories of day laborers who were injured while doing construction work in post-Katrina New Orleans. The main outcome measures were changes in scores for day laborer-reported safety knowledge and safety behaviors derived from interviewer-delivered baseline and post-intervention surveys.

Results: Video participants reported improvement in overall average safety knowledge score (mean score of 11.3 out of a max score of 12 or 94% when standardized to 0–100% scale), as compared to the control group (mean score of 8.6 or 72%) who were not offered the video (p < 0.00001). The intervention was highly successful in workers stating that they learned and were willing to change their safety preventive behaviors to reduce their occupational risk. The average safety behavior score was higher among those watching the video (17.2 out of a max of 22 or 78.1% when standardized on a scale 0–100%) as compared to control (14.5 or 65.9%) (p = 0.0024).

Conclusion: A short video intervention can improve knowledge and intent to engage in preventive behaviors among Hispanic workers for which there is a dearth of construction safety preventive research.

Risk Perception and Coping Behavior of Construction Workers on Occupational Health Risks-A Case Study of Nanjing, China

To reduce harm caused by occupational health risks of construction workers exposed to working environments, especially those for interior decoration, it is crucial for them to actively recognize and prevent these risks. Therefore, how to improve their occupational health risks perception and regulate their coping behaviors should be of great concern. However, most prior studies target construction worker safety, and little research focuses on risk analysis from the psychological level of workers. Hence, construction workers' occupational health risk perception level and coping behavior level in Nanjing and the influencing factors were analyzed through statistical analysis with 341 valid questionnaires. Bootstrapping was applied to test the mediating effects of risk perception on the proposed factors and coping behaviors. This study revealed that construction workers have a high-level of occupational health risk perception, yet low-level coping behavior. Gender, age, education level, and unit qualification cause differences in individual risk perception level. Personal knowledge and group effects significantly affect the level of risk perception, which subsequently affect coping behavior. Education level, monthly income, and personal knowledge influence the coping behavior through risk perception. Recommendations were put forward for risk perception and coping behavior improvement from the perspectives of construction workers themselves, enterprises, and governments. This study sheds new light for research areas of occupational health and risk management and provides beneficial practice for improving construction workers' responses to occupational health risks.

A Systematic Review of Community Health Workers' Role in Occupational Safety and Health Research

We systematically reviewed the literature to describe how community health workers (CHWs) are involved in occupational health and safety research and to identify areas for future research and research practice strategies. We searched five electronic databases from July 2015 through July 2016. Inclusion criteria were as follows: (1) study took place in the United States, (2) published as a full peer-review manuscript in English, (3) conducted occupational health and safety research, and (4) CHWs were involved in the research. The majority of 17 included studies took place in the agriculture industry (76%). CHWs were often involved in study implementation/design and research participant contact. Rationale for CHW involvement in research was due to local connections/acceptance, existing knowledge/skills, communication ability, and access to participants. Barriers to CHW involvement in research included competing demands on CHWs, recruitment and training difficulties, problems about research rigor and issues with proper data collection. Involving CHWs in occupational health and safety research has potential for improving inclusion of diverse, vulnerable and geographically isolated populations. Further research is needed to assess the challenges and opportunities of involving CHWs in this research and to develop evidence-based training strategies to teach CHWs to be lay-health researchers.

Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations

Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.

Small business Total Worker Health: A conceptual and methodological approach to facilitating organizational change

Nearly half of Americans are employed by small businesses, and future projections suggest that the number of those employed by small businesses will rise. Despite this, there is relatively little small business intervention research on the integration of health protection and health promotion, known as Total Worker Health® (TWH). We first discuss the importance of studying small businesses in TWH research and practice. Second, we describe an example of a small business TWH intervention, Health Links™ plus TWH owner/senior manager leadership training, that we are evaluating via the Small+Safe+Well (SSWell) study. Key features of the intervention and the SSWell study include attention to multi-level influences on worker health, safety and well-being; organizational change; and dissemination and implementation science strategies via the RE-AIM model. We offer several considerations for future small business TWH research and practice both in terms of the small business context as well as intervention development and evaluation. Our goal is to provide TWH researchers and practitioners with a framework and an example of how to approach small business TWH interventions. Ultimately, through the SSWell study, we aim to provide small businesses with strong evidence to support the use of TWH strategies that are practical, effective and sustainable.

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.

Safety Climate Among Nontraditional Workers in Construction: Arguing for a Focus on Construed External Safety Image

Safety climate, employees' perceptions of work-related safety, ¹ has been promoted as a leading indicator of workplace safety in construction. ^{2 , 3} While research has primarily examined internal organizational sources (e.g., manager attitudes, formal organizational policies) on these perceptions, external sources of information might be more relevant to construction workers in nontraditional jobs who work for a limited time and/or have limited interaction with other employees. This paper argues for the future development of a construed external safety image scale to measure employees' perceptions about how external groups view their organization's safety. ⁴ The construed external safety image would capture the external sources that nontraditional workers use to assess safety climate and will allow public health researchers to identify and change dangerous workplaces while more effectively communicating information about safe workplaces to workers. The public health relevance of safety climate and construed external safety image for monitoring and communicating safety to nontraditional workers require examination.

Promoting Community Preparedness and Resilience: A Latino Immigrant Community-Driven Project Following Hurricane Sandy

As community residents and recovery workers, Latino immigrants play important roles after disasters, yet are rarely included in preparedness planning. A community-university-labor union partnership created a demonstration project after Hurricane Sandy to strengthen connections to disaster preparedness systems to increase community resilience among Latino immigrant communities in New York and New Jersey. Building ongoing ties that connect workers and community-based organizations with local disaster preparedness systems provided mutual benefits to disaster planners and local immigrant communities, and also had an impact on national disaster-related initiatives.

Occupational Safety and Health in the Temporary Services Industry: A Model for a Community-University Partnership

Workers in the temporary staffing industry face hazardous working conditions and have a high risk of occupational injury. This project brought together local workers' centers and university investigators to build a corps of Occupational Health Promoters (OHPs) and to test a survey tool and recruitment methods to identify hazards and raise awareness among workers employed by temporary staffing companies. OHPs interviewed ninety-eight workers employed by thirty-three temporary agencies and forty-nine client companies, working mainly in shipping and packing, manufacturing, and warehousing sectors. Surveys identified workplace hazards. OHPs reported two companies to OSHA, resulting in several citations. Partners reported greater understanding of occupational safety and health challenges for temporary workers and continue to engage in training, peer education, and coalition building.

Effectiveness of OSHA Outreach Training on carpenters' work-related injury rates, Washington State 2000-2008

INTRODUCTION

Despite the size and breadth of OSHA's Outreach Training program for construction, information on its impact on work-related injury rates is limited.

METHODS

In a 9-year dynamic cohort of 17,106 union carpenters in Washington State, the effectiveness of OSHA Outreach Training on workers' compensation claims rate was explored. Injury rates were calculated by training status overall and by carpenters' demographic and work characteristics using Poisson regression.

RESULTS

OSHA Outreach Training resulted in a 13% non-significant reduction in injury claims rates overall. The protective effect was more pronounced for carpenters in their apprenticeship years, drywall installers, and with increasing time since training.

CONCLUSIONS

In line with these observed effects and prior research, it is unrealistic to expect OSHA Outreach Training alone to have large effects on union construction workers' injury rates. Standard construction industry practice should include hazard awareness and protection training, coupled with more efficient approaches to injury control. Am. J. Ind. Med. 60:45-57, 2017. © 2016 Wiley Periodicals, Inc.

Latino immigrant day laborer perceptions of occupational safety and health information preferences

BACKGROUND

We address immigrant day laborers' experiences with occupational safety in the construction industry in New Orleans, and opinions about content and method of communication for educational interventions to reduce occupational risks.

METHODS

In 2011, we conducted seven focus groups with 48 Spanish-speaking day laborers (8 women, 40 men, 35 years on average). Focus group results are based on thematic analysis.

RESULTS

Most employers did not provide safety equipment, threatened to dismiss workers who asked for it, and did not provide health insurance. Attitudes toward accepting unsafe work conditions varied. Women faced lower pay and hiring difficulties than men. Day laborers preferred audio format over written, and content about consequences from and equipment for different jobs/exposures.

CONCLUSIONS

Day laborers have common occupational experiences, but differences existed by gender, literacy and sense of control over safety. Day laborer information preferences and use of media needs further studying. Am. J. Ind. Med. 59:476-485, 2016. © 2016 Wiley Periodicals, Inc.

Health disparities of Latino immigrant workers in the United States

Purpose

– The purpose of this paper is to provide an overview of the literature pertaining to occupational health disparities experienced by Latino immigrant workers in the USA and to advance a general framework based on systems science to inform epidemiological and intervention research.

Design/methodology/approach

– Using papers and other sources from 2000 to the present, the authors examined the employment conditions and health outcomes of Latino immigrant workers and critically analyzed the pervasive evidence of health disparities, including causal mechanisms and associated intervention programs.

Findings

– The occupations, including the work environment and resultant living conditions, frequently performed by Latino immigrants in the USA represent a distinct trigger of increased injury risk and poor health outcomes. Extant intervention programs have had modest results at best and are in need of more comprehensive approaches to address the complex nature of health disparities.

Practical implications

– An integrated, systems-based framework concerning occupational health disparities among Latino immigrant workers allows for a holistic approach encompassing innovative methods and can inform high-leverage interventions including public policy.

Originality/value

– Reductionist approaches to health disparities have had significant limitations and miss the complete picture of the many influences. The framework the authors have provided elucidates a valuable method for reducing occupational health disparities among Latino immigrant workers as well as other populations.

Work safety climate, personal protection use, and injuries among Latino residential roofers

BACKGROUND

This analysis describes work safety climate, personal protective equipment (PPE) use, and injuries among Latino residential roofers, and examines the associations of work safety climate with PPE use and injuries.

METHODS

Eighty-nine North Carolina residential roofers completed a baseline interview and daily logs about perceptions and use of PPE, occurrence of injuries in last 12 months, and work safety climate.

RESULTS

The mean work safety climate score was 26.5 (SD = 5.6). In the baseline interview, participants reported that the majority of employers provided PPE and that they used it most or all of the time; daily log data indicated that PPE was used for half or fewer of hours worked. 39.9% reported any injury in the last 12 months. Work safety climate was significantly correlated with the provision and use of most types of PPE, and was inversely associated with injury.

CONCLUSIONS

Supervisors promoting safety may increase the PPE use and decrease injuries.

The influence of demographics and working conditions on self-reported injuries among Latino day laborers

BACKGROUND

The majority of day laborers in the USA are Latinos. They are engaged in high-risk occupations and suffer high occupational injury rates.

OBJECTIVES

To describe on-the-job injuries reported by Latino day laborers, explore the extent that demographic and occupational factors predict injuries, and whether summative measures for total job types, job conditions, and personal protective equipment (PPE) predict injuries.

METHODS

A community survey was conducted with 327 participants at 15 corners in Houston, Texas. Hierarchical and multiple logistic regressions explored predictors of occupational injury odds in the last year.

RESULTS

Thirty-four percent of respondents reported an occupational injury in the previous year. Education, exposure to loud noises, cold temperatures, vibrating machinery, use of hard hats, total number of job conditions, and total PPE significantly predicted injury odds.

CONCLUSION

Risk for injury among day laborers is not only the product of a specific hazard, but also the result of their exposure to multiple occupational hazards.

Work-Related Musculoskeletal Symptoms among Building Construction Workers in Riyadh, Saudi Arabia

Objectives: To investigate the work-related musculoskeletal symptoms among building construction workers.

Methods: Total 389 apparently healthy, male volunteers were selected with mean age 34.56±8.33 years and a mean working duration in building construction as 5.76±2.68 years. Musculoskeletal complaints were recorded through a detailed clinical interview and comprehensive questionnaire.

Results: Substantial number of building construction workers developed musculoskeletal symptoms including neck pain 29 (7.5%), shoulder pain 41(10.5%), upper back pain 24(6.2%), lower back pain 64 (16.5%), legs pain 93 (23.9%), feet pain 52 (13.4%), head heaviness 44 (11.3%) and whole body fatigue 78 (20.1%). These complaints were significantly associated with long-term duration-response in building construction industry. Furthermore, cigarette smokers had little higher percentage of musculoskeletal complaints compared to non-smoker companions.

Conclusions: Building construction occupation is a prolific source of musculoskeletal ailments and complaints were significantly increased with long-term working duration in building construction industry.

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.

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.