Action research on occupational stress: involving workers as researchers

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.

Broadening the Scope of Worksite Stress Programs: A Guiding Framework

Worksite stress programs have proliferated in recent years. A large proportion of these programs focus on helping individual employees learn about stress and develop better coping skills. Few programs attempt to reduce the stressful aspects of the job or the organizational context. In order to facilitate the development of a broader array of stress reduction programs, the authors provide: 1) a conceptual framework upon which worksite stress programs should be based, 2) a guide to the variety of decision points in the program development process, 3) an exploration of the reasons why a broader range of stress programs have not heretofore been developed, and 4) suggestions for creating a context amenable to innovative worksite stress programs.

Conducting Action Research: Relationships between Organization Members and Researchers

Action research in an organizational setting draws researchers and the employees involved into a joint process aimed at meeting both research and intervention objectives. The active collaboration of participants has major implications for researcher roles, and the manner in which these role shifts are carried out has a significant effect on study outcomes. Few have concretely analyzed the issues faced by researchers and organization members as they assume shared roles in the action research process. This article treats the relational aspect of researcher-participant co-investigation as a methodological issue. The authors share aspects of their experience in implementing an action research project aimed at understanding and reducing the deleterious effects of occupational stress. Relationships between researchers and organization members are dynamic. As they develop over time, role-related tensions and differences may arise around the issues of values and interests, resources and skills, control, political realities, and rewards and costs. Each of these is addressed, using examples from the authors' recently completed 6-year study. Further, the action research study participants helped revise this article and that process taught the authors much about these methodological issues.

From Theory to Practice: A Determinants Approach to Workplace Health Promotion in Small Businesses

A determinants approach to workplace health promotion focuses on the sources of health and ill health in the workplace itself. Key practice requirements of such an approach include the capacity to shift focus beyond the individual to the work environment, to cross disciplinary and jurisdictional boundaries in identifying problems and solutions, to foster health promotion self-sufficiency within the workplace, to enable worker participation in the process, and to adapt practice strategies to a business setting. This article identifies the challenges of such practice by reference to the experiences of health promoters in a Canadian public health department who attempted a determinants-centered stress reduction program for small-sized businesses. Findings under-score the significance for workplace health promotion of the broader structural context in which the workplace and the intervention are located, of differing perspectives between health professionals and workplace parties, and of conflicting professional accountabilities. Possibilities for addressing these challenges are considered.

Evaluation of a participatory ergonomics intervention in small commercial construction firms

BACKGROUND

Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results.

METHODS

Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short-term and intermediate impacts and long-term outcomes from surveys and field records.

RESULTS

Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers' knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort.

CONCLUSIONS

The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve contractor involvement for reducing WMSD. Am. J. Ind. Med. 59:465-475, 2016. © 2016 Wiley Periodicals, Inc.

Using participatory action research to identify strategies to improve pandemic vaccination

OBJECTIVE

Developing and implementing effective strategies to increase influenza vaccination rates among health care personnel is an ongoing challenge, especially during a pandemic. We used participatory action research (PAR) methodology to identify targeted vaccination interventions that could potentially improve vaccine uptake in a medical center.

METHODS

Front-line medical center personnel were recruited to participate in 2 PAR teams (clinical and nonclinical staff). Data from a recent medical center survey on barriers and facilitators to influenza (seasonal, pandemic, and combination) vaccine uptake were reviewed, and strategies to increase vaccination rates among medical center personnel were identified.

RESULTS

Feasible, creative, and low-cost interventions were identified, including organizational strategies that differed from investigator-identified interventions. The recommended strategies also differed by team. The nonclinical team suggested programs focused on dispelling vaccination-related myths, and the clinical team suggested campaigns emphasizing the importance of vaccination to protect patients.

CONCLUSIONS

PAR methodology was useful to identify innovative and targeted recommendations for increasing vaccine uptake. By involving representative front-line workers, PAR may help medical centers improve influenza vaccination rates across all work groups.

Medical Evaluation of Work-related Illness: Evaluations by a Treating Occupational Medicine Specialist and by Independent Medical Examiners Compared

Treating physicians' and independent medical examiners' (IMEs') opinions were compared to identify differences of opinion and to develop a basis for understanding the differences. Twenty-three patients of an occupational health center (OHC) who had been examined by an IME were studied. OHC and IME opinions regarding diagnosis, work-relatedness, treatment recommendations, and disability assessment were categorized by degree of agreement. There was agreement on all four issues for only one patient. Opinions were most divergent with regard to disability assessment and least divergent with regard to diagnosis. Disagreement was unidirectional: the IMEs made fewer diagnoses, deemed fewer illnesses work-related, made fewer treatment recommendations, and assessed lower levels of disability than the OHC examiners. The results suggest that differences in opinion between the OHC and IMEs are due to differences in perspective, rather than skill or training.

Using community-based participatory research to design and initiate a study on immigrant worker health and safety in San Francisco's Chinatown restaurants

BACKGROUND

Restaurant workers have among the highest rates of work-related illness and injury in the US, but little is known about the working conditions and occupational health status of Chinese immigrant restaurant workers.

METHODS

Community-based participatory research (CBPR) was employed to study restaurant working conditions and worker health in San Francisco's Chinatown. A community/academic/health department collaborative was formed and 23 restaurant workers trained on research techniques and worker health and safety. A worker survey instrument and a restaurant observational checklist were collaboratively developed. The checklist was piloted in 71 Chinatown restaurants, and the questionnaire administered to 433 restaurant workers.

RESULTS

Restaurant workers, together with other partners, made substantial contributions to construction of the survey and checklist tools and improved their cultural appropriateness. The utility of the checklist tool for restaurant-level data collection was demonstrated.

CONCLUSIONS

CBPR holds promise for both studying worker health and safety among immigrant Chinese restaurant workers and developing culturally appropriate research tools. A new observational checklist also has potential for restaurant-level data collection on worker health and safety conditions.

Building a strong foundation for occupational health and safety: Action research in the workplace

BACKGROUND

Action research (AR) holds promise as a method to improve occupational health and safety.

METHODS

This case study explores the challenges and accomplishments during the first 6 months of an AR occupational health and safety committee at a manufacturing facility.

RESULTS

Critical steps in the formative phase of the AR project included: (1) addressing differing power levels and perceived ownership of management and production committee members; (2) developing a collaborative approach to communication and problem solving; and (3) transitioning from dependence on university leadership to shared leadership among the committee.

CONCLUSIONS

AR can lead to greater empowerment to address occupational health and safety issues, and to improved dialog between labor and management. AR can increase the likelihood that the problem will be understood, and effective solutions will be developed and their application supported and used throughout the organization.

Participatory action research methodology in disaster research: results from the World Trade Center evacuation study

OBJECTIVE

Participatory action research (PAR) methodology is an effective tool in identifying and implementing risk-reduction interventions. It has been used extensively in occupational health research, but not, to our knowledge, in disaster research. A PAR framework was incorporated into the World Trade Center evacuation study, which was designed to identify the individual, organizational, and structural (environmental) factors that affected evacuation from the World Trade Center Towers 1 and 2 on September 11, 2001. PAR teams-comprising World Trade Center evacuees, study investigators, and expert consultants-worked collaboratively to develop a set of recommendations designed to facilitate evacuation from high-rise office buildings and reduce risk of injury among evacuees.

METHODS

Two PAR teams worked first separately and then collectively to identify data-driven strategies for improvement of high-rise building evacuation.

RESULTS

The teams identified interventions targeting individual, organizational, and structural (environmental) barriers to safe and rapid evacuation.

CONCLUSIONS

PAR teams were effective in identifying numerous feasible and cost-effective strategies for improvement of high-rise emergency preparedness and evacuation. This approach may have utility in other workplace disaster prevention planning and response programs.

Evaluation of a partnership approach to translating research on breast cancer and the environment

BACKGROUND

The growing literature on community-based participatory research (CBPR) suggests that a participatory approach benefits science in important ways. However there have been few formal evaluations of a CBPR approach itself, and few standards developed to assist in such efforts.

OBJECTIVES

This evaluation used CBPR guidelines developed by Green and colleagues to evaluate the participatory approach of the Community Outreach and Translation Core (COTC) of the Bay Area Breast Cancer and the Environment Research Center (BABCERC) in translating scientific findings from two key projects to the public.

METHOD

To assess key stakeholders' perceptions of alignment between the projects and the guidelines, four COTC members, four researchers, and four community members rated the projects on each of the 26 guidelines. These data were triangulated with transcripts from interviews with the same participants and a focus group with a subset of the participants.

RESULTS

The participatory approach by the COTC resulted in many important benefits including improved relationships among diverse stakeholders, knowledge generation, increased sensitivity and propriety of the research, and increased community support of research. However, several atypical features of this collaboration-for example, the basic and etiological nature of the science being undertaken, and the multiple communities (lay and activist/advocate) involved-resulted in different levels and qualities of participation among stakeholders.

CONCLUSIONS

Further research should focus on the adaptation of participatory research principles for different kinds of community partners and on the development and refinement of standards and tools to assist in evaluating the process and outcome of participatory research.

Do neighborhood economic characteristics, racial composition, and residential stability predict perceptions of stress associated with the physical and social environment? Findings from a multilevel analysis in Detroit

As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.

A change management framework for macroergonomic field research

With the proliferation of macroergonomic field research, it is time to carefully examine how such research should be managed and implemented. We argue that the importance of attending to high-quality implementation of field research is equal to that of methodological rigor. One way to systematically manage the implementation process is to adopt a change management framework, wherein the research project is conceptualized as an instance of organization-level change. Consequently, principles for successful organization-level change from the literature on change management can be used to guide successful field research implementation. This paper briefly reviews that literature, deriving 30 principles of successful change management, covering topics such as political awareness, assembling the change team, generating buy-in, and management support. For each principle, corresponding suggestions for macroergonomic field research practice are presented. We urge other researchers to further develop and adopt frameworks that guide the implementation of field research.

Racial disparities in sense of community and health status: implications in community-based participatory interventions targeting chronic disease in African Americans

This study examined the relation between sense of community (SOC), sociodemographic characteristics, and health status to inform community-based interventions designed to prevent and reduce chronic disease in African Americans. A telephone survey was conducted with 1463 randomly selected residents in Nashville, Tenn. Respondents were majority female (69%), African American (59%), and single (59%), with a mean age of 55 (+/-17.61 years). African Americans have lower overall SOC scores, or lower scores on the domains related to perceived influence over community and sharing of common community values compared to Whites. High rates of chronic disease and low SES, combined with a low SOC, can hinder efforts to reduce and eliminate disparities. The goal of community-based participatory initiatives is to create programs that are sustainable by the target community after the funding is gone. Thus, to maximize the success, uptake, and sustainability of disease-specific interventions, it is imperative to incorporate assessment of SOC, identify factors that depress SOC, and engage in community collaboration to develop a plan to improve SOC.

Engaging urban residents in assessing neighborhood environments and their implications for health

Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.

Moderating Effects of Control on the Relationship Between Stress and Change

Given the well-documented impact of stress on employees, it is important to understand moderating factors, especially in behavioral health treatment settings, where constant change occurs. Staff members at four mental health (n=663) and four substance abuse (n=256) treatment agencies completed questionnaires inquiring about perceptions of direct and indirect agency changes, stress experienced due to changes, and control and input into the changes. Results revealed that as direct and indirect change increased, stress increased; as level of control and input into changes increased, stress decreased. Control and input served as a moderating variable between stress and direct change, but not for indirect change.

Improvement in malaria services in an urban setting: role of staff motivation

Urban health centres and the private clinics (PCs) providing malaria services in an urban setting were compared on seven utilization-determining factors to assess why people preferred one over the other. On the other hand, motivation level of the technical staff of the corporation in the malaria services was studied to find out the extent to which the motivation level of the staff was responsible for the observed mean scores of the factors studied. It was found that PCs fared better on all of them. However, the two differed mostly on wait-in period at the outlet, distance from residence, ambience of the outlet, and getting relief. The study further showed that for the doctors and the primary health workers, the opportunity of influencing people was the strongest motivation to work in the corporation and for the subsanitary inspectors, it was affiliation. Based on this, a model is suggested to introduce changes based on motivation mix of the malaria staff.

The East Side Village Health Worker Partnership: integrating research with action to reduce health disparities

This article describes the work of the East Side Village Health Worker Partnership as a case study of an initiative that seeks to reduce the disproportionate health risks experienced by residents of Detroit's east side. The Partnership is a community-based participatory research and intervention collaboration among academia, public health practitioners, and the east side Detroit community. The Partnership is guided by a steering committee that is actively involved in all aspects of the research, intervention, and dissemination process, made up of representatives of five community-based organizations, residents of Detroit's east side, the local health department, a managed care provider, and an academic institution. The major goal of the East Side Village Health Worker Partnership is to address the social determinants of health on Detroit's east side, using a lay health advisor intervention approach. Data collected from 1996 to 2001 are used here to describe improvements in research methods, practice activities, and community relationships that emerged through this academic-practice-community linkage.

Using theory to understand the multiple determinants of low participation in worksite health promotion programs

Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective--political economy of health--that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.

Disentangling measures of individual perceptions of community social dynamics: results of a community survey

This study examined how different measures of individual perceptions of community social dynamics relate to each other and how these measures relate to self-reported general health and depressive symptoms. Results of a principal components analysis conducted to investigate the interrelationships between these individual measures suggest that these measures measure separate phenomena. In addition, in results of multiple-regression analyses conducted to examine associations between the various measures of individual perceptions of community social dynamics and the dependent variables of self-reported general health and depressive symptoms, sense of community, perceived neighborhood control, and neighborhood participation were all associated with the outcome variables in separate regression models. In a regression model with these three variables added to control variables, only sense of community was significantly, albeit modestly, associated with depressive symptoms and self-reported general health.

The intervention research process in occupational safety and health: an overview from the National Occupational Research Agenda Intervention Effectiveness Research team

The goal of occupational safety and health intervention effectiveness research is to determine whether specific interventions work to prevent work-related injury and illness. But that is not the whole story. It is also important that the development and implementation of the intervention be evaluated. All three phases (development, implementation, and effectiveness) are central to a model of intervention research proposed by the National Occupational Research Agenda Intervention Effectiveness Research team. Areas for future research are also presented.

Identifying and prioritizing gaming workers' health and safety concerns using mapping for data collection

BACKGROUND

This research was prompted by the clinical presentation of workers from a variety of gaming occupations with injuries and illnesses and multiple health and safety concerns.

METHODS

Using participatory action research principles, 51 gaming workers in Ontario and 20 gaming workers in Manitoba were consulted during a series of focus group sessions. Mapping exercises were used to survey the participants about their health concerns, perceived occupational hazards and the impact of working conditions on their personal lives. Participants were then asked to prioritize their concerns and make recommendations for improvements.

RESULTS

Gaming workers from both provinces identified similar health, hazard and psycho-social concerns. They prioritized the issues of stress, ergonomics, indoor air quality (including second-hand smoke and temperature), biological hazards, physical hazards and noise.

CONCLUSIONS

This study points to a need to more fully investigate and address health and safety issues in the gaming industry. It also demonstrates the effectiveness of a worker-driven, participatory consultation.

Empowerment evaluation of worker safety and health education programs

BACKGROUND

The need to expand the use of evaluation to learn how education programs contribute to workers' occupational safety and health is well documented. Similarly recognized is the need to expand workers' involvement as primary stakeholders in program evaluation.

METHODS

Articles for this review were identified through computer database and manual searches related to: intervention research and evaluation; occupational safety, health training, and education; and worker participation and empowerment.

RESULTS

After identifying empowerment as a multilevel and multidimensional concept, this review used a theoretical framework of evaluation to show how various participatory and empowering approaches can affect evaluation studies and their use.

CONCLUSIONS

The field of occupational safety and health has a unique historical opportunity to further expand workers' involvement in their own education through the use of participatory and empowering approaches to evaluation. Use of these approaches has the potential to strengthen capacities for organizational learning and improve both program theory and practice.

Action research: a suitable method for promoting change in nurse education

This paper arose from a research study and its follow-up in four schools of nursing and midwifery. The study was concerned with evaluating the extent to which a philosophy of health had been integrated into the educational curricula of nurses, midwives and health visitors. The purpose of the follow-up was to disseminate and implement the study findings in the four centres. The findings showed that the interpretation and implementation of a philosophy of health in nursing had been variable. Health was operationalized as both health education and health promotion ranging from individualized information giving and disease prevention. Action research was chosen as the appropriate methodology for the follow-up because of its emphasis on participation and partnership. As the follow-up study progressed a number of issues emerged which were indicative of the changes taking place in nurse education as its institutional base shifted into higher education. Other issues were associated with the gap between the rhetoric and reality of action research and the expectations and needs of the key partners. The authors conclude that the follow-up study presented both challenges and opportunities to nurse educators in their endeavour to undertaken research and implement educational change.

Impact of a participatory organizational intervention on job characteristics and job stress

Increased employee control and participation are recommended to achieve both "flexible organization" and improvements in health, as outlined in occupational stress intervention models. This study evaluates the impact of a participatory organizational intervention on job stress and job characteristics. The intervention was carried out in two post offices in the Norwegian Postal Service. "Local theories" were seen as the key drivers for organizational improvement and increased control. The underlying dynamics of the intervention were to manipulate employees' learning opportunity and decision authority so as to improve work environment and health. Work groups, in dialogue with a steering committee, conducted diagnosis, action planning, and action taking. Work conditions deteriorated during the observation period in the control groups. In one of the intervention groups, this negative trend was reduced by the intervention. Lack of positive results in the other intervention group may have been due to organizational restructuring and turbulence.

Power between evaluator and community: research relationships within New Mexico's healthier communities

The relationship between evaluators and communities has been changing in the last two decades to a model of research 'with' the community, instead of research 'on' the community. This shift has paralleled increasing community demands for accountability and authority as community participation rhetoric has given way to words such as partnership, collaboration and community empowerment. Despite the rhetoric, there has been little reflection on the problematic and contradictory relationships between communities and researchers, specifically as related to their differing positions of power. This article provides a reflective examination of the contested power dynamics of the research relationship within a participatory evaluation process of the Healthier Communities initiative in New Mexico. An in-depth literature review of the philosophical principles and the complex realities of evaluations based on participatory, community-driven and post-modern inquiry precedes the case study. Without ongoing consideration of power issues, the article argues that evaluation design, implementation and utilization of findings will be compromised.

Implications of the results of community intervention trials

This paper examines the results of population-level interventions conducted in three settings: entire communities, worksites, and schools. Four major conclusions are discussed: (a) Directions for the next generation of community-based interventions include targeting multiple levels of influence; addressing social inequalities in disease risk; involving communities in program planning and implementation; incorporating approaches for "tailoring" interventions; and utilizing rigorous process evaluation. (b) In addition to randomized controlled trials, it is time to use the full range of research phases available, from hypothesis generation and methods development to dissemination research. (c) The public health research agenda may have contributed to observed secular trends by placing behavioral risk factors on the social and media agendas. (d) The magnitude of the results of community intervention trials must be judged according to their potential public health or population-level effects. Small changes at the individual level may result in large benefits at the population level.

Review of community-based research: assessing partnership approaches to improve public health

Community-based research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and to integrate the knowledge gained with action to benefit the community involved. This review provides a synthesis of key principles of community-based research, examines its place within the context of different scientific paradigms, discusses rationales for its use, and explores major challenges and facilitating factors and their implications for conducting effective community-based research aimed at improving the public's health.

Job strain and health behaviors: results of a prospective study

PURPOSE

To assess the association between job demands, job decision latitude, and job strain (defined by Karasek as a combination of high demands and low decision latitude) and cardiovascular disease-related health behaviors such as cigarette smoking, alcohol use, lack of exercise, and overweight.

DESIGN

Cross-sectional and prospective.

SETTING

Nine New York City public and private sector worksites.

SUBJECTS

Two hundred eighty-five male employees, aged 30 to 60, in a wide variety of white-collar and blue-collar job titles.

MEASURES

Medical examinations and surveys, which included demographic, health behavior, and job characteristics data.

RESULTS

Prospectively, among 189 men, increase in job decision latitude over 3 years was associated with decrease in cigarette smoking, by analysis of covariance, controlling for age, race, education, marital status, and number of children at home (F (8, 180) = 4.37, p = .005). The largest increase in latitude occurred among the 13 men who quit smoking. However, change in job characteristics was not associated with change in overweight or alcohol use. Cross-sectional analyses did not produce consistent associations.

CONCLUSIONS

The effectiveness of smoking cessation may be aided by modification of structural features of the work environment, such as job decision latitude. This study is limited by the small number of subjects who were engaged in high risk behaviors.

Detroit's East Side Village Health Worker Partnership: community-based lay health advisor intervention in an urban area

In recent years, there have been few reports in the literature of interventions using a lay health advisor approach in an urban area. Consequently, little is known about how implementation of this type of community health worker model, which has been used extensively in rural areas, may differ in an urban area. This article describes the implementation of the East Side Village Health Worker Partnership, a lay health advisor intervention, in Detroit, Michigan, and notes how participatory action research methods and principles for community-based partnership research are being used to guide the intervention. Findings are presented on how the urban context is affecting the design and implementation of this intervention. Implications of the findings for health educators are also presented and include the utility of a participatory action research approach, the importance of considering the context and history of a community in designing a health education intervention, and the importance of recognizing and considering the differences between rural and urban settings when designing a health education intervention.

Evaluation of the impact of employee ergonomics training in industry

This study examined the effects of three different types of ergonomics training methods upon employee knowledge, attitude and behavior. Employees within intact processing lines (N = 104) were randomized into four groups, one group serving as a control group. Pre- and post-test measures were implemented. Results showed training to have a significant effect upon knowledge of ergonomics. No significant differences were noted among all four groups according to empowerment and human factors measures. Training had a significant impact upon employee's job satisfaction, and the recognition and reporting of health hazards associated with their jobs.

The Latino Health Advocacy Program: a collaborative lay health advisor approach

There have been numerous calls in the literature for health educators to develop programs to improve access to and utilization of health and human services by traditionally underserved communities, including Latinos. While the literature suggests several principles that can guide the development of these programs, it is important to address the needs, and build on the strengths, of the specific community of interest. It is, therefore, important to use collaborative approaches in which community members take an active role in the initiation, design, implementation, and evaluation of program activities. Lay health advisor programs are particularly well suited to this approach as they are designed to build on the strength of already existing community relationships to improve community health. This article describes a collaborative, culturally appropriate, holistic, and ecological lay health advisor program--the Latino Health Advocacy Program. Lessons learned and implications for future program development are discussed.

Knowledge, skills and experiences for community health nursing practice: the perceptions of community nurses, administrators and educators

Nursing in Canada is committed to preparing all new graduates at the baccalaureate level for entry to nursing practice by the year 2000. This goal has major implications for community health nursing education and practice. Health care reform is also expected to move care out of the hospital and into the community. It was against this backdrop that the researchers mounted a study on the educational preparation needed for graduates to begin to practice community health nursing. In this paper, the knowledge, professional and personal skills, and experiences that graduates need to begin community practice are reported. The study was carried out within an action-research framework. All major groups of stakeholders involved in community health nursing throughout the study province were involved in the project. This included nurses and administrators from two public health agencies (provincial and municipal), home care nurses, home health nurses (i.e. non-governmental visiting nurses), community health centres, provincial health care and nursing consultants, and faculty from two universities. In addition to the generation of relevant research findings for use by the educational institutions, the study was initiated to set the stage for future and ongoing interactions between the researchers and community experts to implement the findings from the project. Data were collected from 118 participants by means of 27 focus groups of community nurses, administrators and educators. Interviews were tape-recorded, transcribed and analysed using latent content analysis and constant comparison techniques. Findings indicated that qualified nurses from university programmes need a wide range of knowledge, skills and experiences to begin to practice community health nursing. Detailed accounts of these requirements are outlined and the implications for practice and education put forward.

Role of control and support in occupational stress: an integrated model

Drawing from the Demand-Control Model and the conceptual framework of the stress process developed by researchers at the University of Michigan's Institute for Social Research, this paper presents and tests an "integrated model" of occupational stress. The results indicate that control and social support are strongly correlated with negative job feelings. The effect of control on health was found to depend on the type of control and organizational level at which control is exercised. Specifically, the effect of participation on health outcomes was found to differ at the job and organizational levels, and participation without influence was associated with increased negative job feelings. The effect of social support was found to depend on the type of support and from whom the support was provided. Results also indicate that it is important to test for moderating, mediating, and direct effects of control on health, and underscore the complementary nature of qualitative and quantitative data in furthering knowledge and understanding.

A Critical Perspective on Action Research as a Method for Information Systems Research

This paper reviews the origins, techniques and roles associated with action research into information systems (IS). Many consider the approach to be the paragon of post-positivist research methods, yet it has a cloudy history among the social sciences. The paper summarizes the rigorous approach to action research and suggests certain domains of ideal use (such as systems development methodology). For those faced with conducting, reviewing or examining action research, the paper discusses various problems, opportunities and strategies.

The integrated model: implications for worksite health promotion and occupational health and safety practice

Within a single firm it is common to find both occupational safety and health and worksite health promotion interventions operating in isolation from one another, with different intervention targets, methods, and personnel. Overcoming the segmentation of the two fields will require, among other things, the promulgation of an overarching model of work and health. The purpose of this article is to describe an integrated model and to show how it can be applied to improve worksite health interventions for both occupational safety and health and worksite health promotion. Practice examples from both fields are used to illustrate interventions that focus on different areas of the model (individual behavior, psychosocial, organization, and contextual factors). It is argued that occupational safety and health and worksite health promotion practitioners need to develop more comprehensive interventions and rigorously evaluate these programs to determine if they are more effective than programs with a more narrow focus.