The Intervention Research Process in Occupational …

1 The Intervention Research Process inOccupational Safety and Health: An OverviewFrom the National Occupational ResearchAgenda Intervention Effectiveness ResearchTeamLinda M. Goldenhar, PhDAnthony D. LaMontagne, ScD, MA, MEdTheodore Katz, MPAC atherine Heaney, PhDPaul Landsbergis, PhD, EdDThe goal of Occupational safety and health Intervention effectivenessresearch is to determine whether specific interventions work to preventwork-related injury and illness. But that is not the whole story. It is alsoimportant that the development and implementation of the interventionbe evaluated. All three phases (development, implementation, andeffectiveness) are central to a model of Intervention Research proposed bythe National Occupational Research Agenda Intervention EffectivenessResearch team. Areas for future Research are also presented.

2 ( J OccupEnviron ;43:616 622)The National Institute for Occupa-tional Safety and Health engaged500 stakeholders from the occupa-tional safety and health communityto help define a national occupa-tional Research agenda (NORA) toimprove worker safety and ,2 Twenty-one priority Research areaswere identified, of which interven-tion effectiveness Research was overarching goal of interventioneffectiveness Research is to demon-strate the impact of interventions toprevent work injury and illness. Con-ducting scientifically rigorous inter-vention effectiveness Research ischallenging because of the variedscope and complexity of interven-tions and the complicated, changing,real-world conditions potentially af-fecting interventions and their out-comes. Public funds for such re-search have been relatively recognition of this situ-ation, and the increasing pressure tojustify and improve safety and healthinvestments, helped influence the se-lection of Intervention effectivenessresearch as one of the NORA priorityareas.

3 This article presents a frame-work for understanding the processof Intervention Research in occupa-tional safety and health. It is basedon work done by the NORA Inter-vention Effectiveness Research Im-plementation Team, which is com-posed of persons drawn from thebroad Occupational safety and healthFrom the Division of Applied Research and Technology, National Institute for Occupational Safetyand Health, Cincinnati (Dr Goldenhar); the Department of Epidemiology & Preventive Medicine,Monash Medical School at the Alfred Hospital, Australia (Dr LaMontagne); the Office of the Director,National Institute for Occupational Safety and Health, (Atlanta, GA) (Dr Katz); the Department ofPreventive Medicine, Ohio State University (Dr Heaney); and the Division of Hypertension, WeillMedical College of Cornell University (Dr Landsbergis).

4 Address correspondence to: Linda M. Goldenhar, PhD, Institute for Health Policy and HealthServices Research , University of Cincinnati Medical Center, Box 670840, Cincinnati, OH45267-0840; e-mail: by American College of Occupational and Environmental Medicine616 Intervention Research Process Goldenhar et alcommunity, including labor, indus-try, academia, and government. AnOverview of the Intervention Re-search ProcessThe team believes that interven-tion effectiveness studies must beconsidered within the context of thebroader Intervention Research studies that inform inter-vention development, and studiesthat evaluate whether the interven-tion was implemented as planned,complement effectiveness relationships between threebroad Intervention Research phases(development, implementation, andevaluation) are presented in Fig.

5 1 asthe core of the NORA InterventionEffectiveness Research team s inter-vention Research Research ProcessPhasesIntervention DevelopmentResearchIntervention development researchstudies provide answers to the fol-lowing questions: (1) What changesare needed to enhance the health ofthe target population? (2) What arethe best ways to bring about thesechanges? (3) What principles or the-ories in Occupational safety andhealth and related fields might applyin a particular situation? (4) Whatbarriers hinder the desired changesfrom happening? (5) To what extentdoes the target audience understandand buy into the need for thechanges? Answers to these questionsmight lead to the development ofnew interventions or the selection,and possibly adaptation, of one de-veloped help answer these questions,one can look to surveillance andepidemiological data to ascertain andisolate the problem of interest and itscause(s), results of previous inter-vention Research studies, informationabout the target population, theories,and other Intervention surveillance is the systematic collectionand analysis of information aboutdisease, injury, risk factors, or expo-sures.

6 This information can be usedto guide the development of inter-ventions. For example, Silverstein etal4examined how various health andhazard surveillance systems canguide the development of interven-tions to reduce work-related muscu-loskeletal disorders. Epidemiologicalstudies, claims data, medical recordsand expert opinions provide addi-tional information for is the perspective of targetpopulation(s)?The knowledge, atti-tudes, and behaviors of the targetpopulation are critical for developingeffective interventions. For example,Kidd et al5collected data from farm-ers using focus groups to explicatethe link between psychosocial stressand injuries among farmers. Thisinformation was then used to de-velop specific Intervention strategiesthat were consistent with occupa-tional safety and health principlesand the farmers is the context for the inter-vention?

7 Intervention developersmust understand the context in whichthe proposed Intervention is to betested. For example, Levenstein6states that standards-based regula-tory approaches to occupationalsafety and health may be less suc-cessful when a government is com-mitted to deregulation or an industryis faced with declining markets, be-cause the support for occupationalsafety and health activities obtain buy-in from stakeholders,the economic feasibility of imple-menting the Intervention should alsobe theory into do authors provide aclear theoretical basis for selectingone Intervention over ,11 Too often, investigators do not evendescribe the Intervention or addressthe issue of why or how it is ex-pected to bring about the desiredchange. Well-designed, theory-driven, Intervention development re-Fig.

8 Process : a conceptual Volume 43, Number 7, July 2001617search potentially increases the like-lihood that an Intervention willultimately be effective because thereis a greater level of understanding ofhow the Intervention (s) might affectthe target populations. Two vital is-sues must be addressed: (1) the bestway to incorporate the theoreticalprinciples/constructs into the inter-vention itself, and (2) the kinds ofmeasurement tools that should bedeveloped to assess any change inthose constructs. Sinclair et al7de-scribe how they incorporated theo-retical constructs into a videotapedbloodborne pathogen training inter-vention and also how they developedways to measure any change in thoseconstructs. Other examples includehow Leviton and Sheehy8appliedbehavioral theory to encourage smallbusinesses to adopt effective tech-nologies to prevent worker expo-sures to health hazards and how theyused engineering theory and princi-ples to develop and implement ven-tilation and equipment designchanges to reduce asphalt fumeemissions during road ImplementationResearch PhaseImplementation Research studies(also referred to as formative evalu-ation, Process evaluation, programmonitoring, and implementation as-sessment)12 16systematically docu-ment how an Intervention is carriedout.

9 Weak, inconsistent, or nonexist-ent implementation is as common inoccupational safety and health as it isin other ,11,17It is notrecommended that a resource-inten-sive, time-consuming effectivenessstudy be conducted before determin-ing whether the implementation pro-cedures are sufficient. By document-ing the experience of recipients/participantsreceivingtheinter vention, implementation re-search helps explain how and researchhelps answer such questions as (1)What are the components (eg, activ-ities, materials, technology) of theintervention and how were they pro-vided to the target audience? (2)What was the quality of the interven-tion components (eg, were trainerswell qualified, was equipment prop-erly calibrated)? (3) How many andwho in the target audience experi-enced the Intervention ?

10 (4) Did cer-tain workers reject the Intervention ?(5) How did implementation of theintervention deviate from expecta-tions, and why?Implementation studies serve sev-eral purposes. First, they providefeedback for improving the interven-tion. The hazard communicationstandard of the Occupational Safetyand Health Administration (OSHA)provides an excellent example of thevalue of a stand-alone implementa-tion national survey ofwork establishments was showed that roughly onefourth of responding employers werenot providing hazard communicationworker training and were thereforenot complying with the , noncompliance with train-ing, material safety data sheets, andlabeling requirements was 53%,46%, and 41%, respectively, sug-gesting that greater effort wasneeded to improve implementationof the standard before evaluating second purpose of implementa-tion Research is to help interpret ef-fectiveness study findings.