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

Voice as a Working Tool for Teachers: A Qualitative Study of Work-Related Perceptions and Impact

BACKGROUND

Teachers rely heavily on their voices, making them susceptible to voice disorders affecting their teaching efficacy and well-being. This study explores the role of voice as a working tool for teachers and its impact on their professional lives, a necessary step in designing intervention points.

METHODS

Using a phenomenological approach, we conducted qualitative interviews with 18 teachers (13 females, 5 males) from diverse backgrounds. They represented diverse teaching areas, grade levels, and school districts. Data were analyzed through content analysis. In this process, 52 codes were identified, totaling 753 code references.

FINDINGS

This study uncovered insights into the role of voice as a working tool for teachers and its impact on their professional lives. In-depth analysis of the interviews with 18 teachers resulted in 6 key themes: (1) Voice is a crucial occupational tool for teachers for instruction, engagement, and classroom management; (2) working conditions significantly impact teachers' vocal health, with environmental factors and vocal load contributing to voice problems; (3) vocal health concerns are frequently reported by teachers, emphasizing the need for comprehensive health management strategies; (4) there are notable best practices and gaps in vocal care, with teachers expressing the need for more resources and formal training; (5) amplification devices play a significant role in sustaining teachers' vocal health, although access to and use of these tools is inconsistent; and (6) voice-related problems have a significant emotional and psychosocial impact on teachers, affecting their self-perception, professional identity, and well-being.

DISCUSSION

This study highlights the critical role of vocal health in teachers' professional lives, revealing its impact on teaching efficacy, well-being, and professional identity. The findings highlight the need for comprehensive support systems, including vocal health programs, resources like amplification devices, and counseling for emotional impacts. The six identified themes emphasize the necessity of holistic interventions to enhance teachers' well-being and effectiveness.

Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis

Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.

Pragmatic Approach to the Assessment and Use of Digital Mental Health Interventions for Health Workers

Symptoms of poor mental health among working people, especially health workers, are on the rise in the United States, contributing to a burgeoning market of thousands of mental health technology products, few of which have undergone rigorous evaluation. Most research on these products focuses on deploying digital mental health interventions as ancillary support in clinical practice and community settings. Little is known of the effectiveness of these tools when employers offer them. We describe the landscape of digital mental health interventions, providing an overview of mental health conditions that are addressed with technology-based solutions in the workplace and the products and services available. We argue for employers to apply a methodical approach to evaluating and selecting technologies for their organizations, and we review relevant frameworks for evaluation. Considering the rapidly evolving landscape of digital mental health interventions, we offer evidence-informed recommendations to organizations and decision-makers seeking to support workplace mental health and well-being, and we advocate the development of products that help organizations assess how they can mitigate workplace conditions that may contribute to poorer mental health. (Am J Public Health. 2024;114(S2):S171-S179. https://doi.org/10.2105/AJPH.2023.307505).

Dissemination and Implementation of a Text Messaging Campaign to Improve Health Disparities among Im/Migrant Workers

The use of short message service (SMS) text messaging technology has grown in popularity over the last twenty years, but there is limited data on the design and feasibility of campaigns to reduce work-related injury, particularly among rural workers, non-native English speakers, and illiterate or low-literacy populations. Although there is a critical need for tech equity or 'TechQuity' interventions that reduce injury and enhance the wellbeing of under-reached communities, the barriers and benefits to implementation must be empirically and systematically examined. Thus, our team used D&I science to design and implement an 18-week texting campaign for under-reached workers with a higher-than-average risk of fatal and non-fatal injury. The experimental project was conducted with English-, Spanish-, and Vietnamese-speaking commercial fishermen in the Gulf of Mexico to test the design and feasibility, and messaging focused on preventing injury from slips, trips, and falls, as well as hurricane preparedness. The ubiquity of mobile devices and the previous success of texting campaigns made this a promising approach for enhancing health and preventing injury among an under-reached population. However, the perceived benefits were not without their barriers. The lessons learned included the difficulty of navigating federal regulations regarding limits for special characters, enrolling migratory participants, and navigating areas with limited cellular service or populations with limited accessibility to technology. We conclude with short- and long-term suggestions for future technology interventions for under-reached worker populations, including ethical and policy regulations.

Workplace Health Promotion Embedded in Medical Surveillance: The Italian Way to Total Worker Health Program

In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.

COVID-19 Workplace Mitigation Strategies and Employee Leave Policies Implemented during the Height of the Pandemic, United States, Fall 2020 and 2021

COVID-19 workplace mitigation strategies implemented within US businesses have been effective at preventing disease and protecting workers, but the extent of their use is not well understood. We examined reported COVID-19 workplace mitigation strategies by business size, geographic region, and industry using internet panel survey data from US adult respondents working full- or part-time outside the home (fall 2020, N = 1168) andfull- or part-time, inside or outside the home (fall 2021, N = 1778). We used chi-square tests to assess the differences in the strategies used (e.g., masking and COVID-19 screening) and ANOVA tests to examine the group differences on a mitigation strategies summative score. Fewer COVID-19 mitigation strategies were reported by respondents in fall 2021 (compared to fall 2020) across businesses of different sizes and regions. The participants in microbusinesses (1-10 employees) reported significantly (p < 0.05) lower mitigation scores than all other business sizes, and the respondents in these businesses were significantly less likely (p < 0.05) to have paid leave than those in enterprises with >10 employees. The healthcare and education sectors had the highest reported mean score of COVID-19 workplace mitigation strategies. Small and essential businesses are critical to the US economy. Insight is needed on their use of mitigation strategies to protect workers during the current and future pandemics.

Louisiana trucking companies' implementation of workplace health promotion programs: Explanatory sequential mixed method case study

BACKGROUND

Trucking companies may be key partners for workplace health promotion programs to improve heavy and tractor-trailer drivers' health and wellbeing.

OBJECTIVE

To identify barriers and facilitators to implementing workplace health promotion programs among Louisiana trucking companies' leadership and staff.

METHODS

A case study approach following an explanatory sequential mixed method research design was used. A quantitative survey, based on the Theoretical Domains Framework (TDF), was adapted and distributed online to a convenience sample. Survey respondents were recruited for an interview to gain additional insight on multi-level barriers to implementing workplace health promotion programs. Quantitative data was analyzed using descriptive statistics to describe barriers and facilitators following TDF constructs. Qualitative data were independently coded among two researchers following the TDF and the Consolidated Framework for Implementation Research (CFIR) to determine themes.

RESULTS

Eleven workplace leaders or staff took the survey. Two engaged in a follow-up interview. Regarding the quantitative results, most (82%) believed workplace health promotion programs would save their company money, although were not offering them. No TDF constructs were indicated as barriers given mixed results; however, several were facilitators: Social/Professional Role and Identity; Emotion; Action Planning; Knowledge; Motivation and Goals; and Beliefs about Consequences. Qualitative results captured several Inner (e.g., time, money) and Outer Setting contextual (e.g., truckers' needs and resources) factors considered important to trucking companies' implementation of health promotion programs.

CONCLUSION

Results suggest leadership and staff of Louisiana trucking companies value workplace health promotion programs, although are challenged by limited resources and the broader trucking environment.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

Research and Scholarly Methods: Implementation Science Studies

Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence-based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (1) evidence-based intervention; (2) implementation strategies; (3) IS theory, model, or framework; (4) IS outcomes and measures; and (5) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (1) pre-implementation; (2) implementation; and (3) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster randomized trial comparing two clinical decision support tools to improve guideline-concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies,as well as IS-related learning resources.

Methods to improve the translation of evidence-based interventions: A primer on dissemination and implementation science for occupational safety and health researchers and practitioners

Objective

A limited focus on dissemination and implementation (D&I) science has hindered the uptake of evidence-based interventions (EBIs) that reduce workplace morbidity and mortality. D&I science methods can be used in the occupational safety and health (OSH) field to advance the adoption, implementation, and sustainment of EBIs for complex workplaces. These approaches should be responsive to contextual factors, including the needs of partners and beneficiaries (such as employers, employees, and intermediaries).

Methods

By synthesizing seminal literature and texts and leveraging our collective knowledge as D&I science and/or OSH researchers, we developed a D&I science primer for OSH. First, we provide an overview of common D&I terminology and concepts. Second, we describe several key and evolving issues in D&I science: balancing adaptation with intervention fidelity and specifying implementation outcomes and strategies. Next, we review D&I theories, models, and frameworks and offer examples for applying these to OSH research. We also discuss widely used D&I research designs, methods, and measures. Finally, we discuss future directions for D&I science application to OSH and provide resources for further exploration.

Results

We compiled a D&I science primer for OSH appropriate for practitioners and evaluators, especially those newer to the field.

Conclusion

This article fills a gap in the OSH research by providing an overview of D&I science to enhance understanding of key concepts, issues, models, designs, methods and measures for the translation into practice of effective OSH interventions to advance the safety, health and well-being of workers.

Applying Translational Science Approaches to Protect Workers Exposed to Nanomaterials

Like nanotechnology, translational science is a relatively new and transdisciplinary field. Translational science in occupational safety and health (OSH) focuses on the process of taking scientific knowledge for the protection of workers from the lab to the field (i.e., the worksite/workplace) and back again. Translational science has been conceptualized as having multiple phases of research along a continuum, beyond scientific discovery (T0), to efficacy (T1), to effectiveness (T2), to dissemination and implementation (D&I) (T3), to outcomes and effectiveness research in populations (T4). The translational research process applied to occupational exposure to nanomaterials might involve similar phases. This builds on basic and efficacy research (T0 and T1) in the areas of toxicology, epidemiology, industrial hygiene, medicine and engineering. In T2, research and evidence syntheses and guidance and recommendations to protect workers may be developed and assessed for effectiveness. In T3, emphasis is needed on D&I research to explore the multilevel barriers and facilitators to nanotechnology risk control information/research adoption, use, and sustainment in workplaces. D&I research for nanomaterial exposures should focus on assessing sources of information and evidence to be disseminated /implemented in complex and dynamic workplaces, how policy-makers and employers use this information in diverse contexts to protect workers, how stakeholders inform these critical processes, and what barriers impede and facilitate multilevel decision-making for the protection of nanotechnology workers. The T4 phase focuses on how effective efforts to prevent occupational exposure to nanomaterials along the research continuum contribute to large-scale impact in terms of worker safety, health and wellbeing (T4). Stakeholder input and engagement is critical to all stages of the translational research process. This paper will provide: (1) an illustration of the translational research continuum for occupational exposure to nanomaterials; and (2) a discussion of opportunities for applying D&I science to increase the effectiveness, uptake, integration, sustainability, and impact of interventions to protect the health and wellbeing of workers in the nanotechnology field.

Occupational Health and Safety Scope Significance in Achieving Sustainability

A safe and healthy working environment is vital for overall sustainability, due to the fact that it affects opportunities of economic and social development. However, according to the International Labour Organization (ILO), despite the international commitment to Occupational Health and Safety (OSH) via the 2030’s Agenda Sustainable Development Goals (SDGs), work-related accidents are still far too common. Work-related mortality accounts for 5% of all deaths worldwide; a toll which has increased dramatically due to the COVID-19 pandemic. Yet, in the context of COVID-19, new demands on the labour market, such as teleworking, adequate protective measures, and proper use of personal protective equipment when physical presence cannot be avoided, are necessitating new approaches to ensure health and safety. Arguably, education can be viewed as a cross-cutting strategy in advance of a culture of safety for future generations, through strengthening skills and broadening knowledge. Indeed, even though education cannot be considered a panacea, related to SDG 4, which seeks to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, it can be considered a critical component to deal with OSH issues using a preventive, rather than a reactive, approach. Given this fact, European Agency for Safety and Health at Work (EU-OSHA) has stressed the prevention approach through mainstreaming OSH in education at all levels, and in all fields of vocational and academic training. Aware of the potential of universities to provide graduates the broad-based knowledge to produce labour-market skills including OSH, the aim of this study is to contribute to the discussion on mainstreaming OSH into Greek university education, using Harokopio University (HUA) as a case study. For this purpose, a web-based survey was conducted to address HUA’s students, faculty members, and staff OSH knowledge, risks awareness, and attitudes, as well as their perceptions, opinions, and beliefs about the role of OSH for academia. A statistical analysis depicted respondents’ high level of willingness to contribute to the promotion of OSH, while additional evidence suggests a considerable commitment of the respondents to participate in HUA’s OSH-related training and education.

Promising Occupational Safety, Health, and Well-Being Approaches to Explore the Future of Work in the USA: An Editorial

The future of work continues to undergo profound and fundamental changes in response to shifting social, technological, economic, environmental, and political contexts [...].

Leveraging an Implementation Science Framework to Measure the Impact of Efforts to Scale Out a Total Worker Health® Intervention to Employers

The role of dissemination and implementation (D&I) science is critical to the translation of Total Worker Health^® into practice and to the success of interventions in addressing current and future implications for worker safety, health, and well-being. D&I frameworks can guide researchers to design Total Worker Health (“TWH”) delivery approaches that use flexible implementation strategies to implement the core components of programs for employers with varying contextual factors, including small/mid/large-sized businesses and different industry types. To date, there have been very few examples of applying implementation frameworks for the translation and delivery of interventions into organizational settings that require adoption and implementation at the business level to benefit the working individuals. We present a TWH case study, Health Links™, to illustrate an approach to applying an existing implementation framework, RE-AIM, to plan, design, build, and then evaluate TWH implementation strategies. Our case study also highlights key concepts for scaling-out TWH evidence-based interventions where they are implemented in new workplace settings, new delivery systems, or both. Our example provides strong support of key implementation planning constructs including early and consistent stakeholder engagement, tailored messaging and marketing, flexibility, and adaptations in implementation strategies to maximize adoption, implementation, and maintenance among participating businesses.