Development of multi-dimensional action checklist for promoting new approaches in participatory occupational safety and health in small and medium-sized enterprises

To meet diversified health needs in workplaces, especially in developed countries, occupational safety and health (OSH) activities should be extended. The objective of this study is to develop a new multi-dimensional action checklist that can support employers and workers in understanding a wide range of OSH activities and to promote participation in OSH in small and medium-sized enterprises (SMEs). The general structure of and specific items in the new action checklist were discussed in a focus group meeting with OSH specialists based upon the results of a literature review and our previous interviews with company employers and workers. To assure practicality and validity, several sessions were held to elicit the opinions of company members and, as a result, modifications were made. The new multi-dimensional action checklist was finally formulated consisting of 6 core areas, 9 technical areas, and 61 essential items. Each item was linked to a suitable section in the information guidebook that we developed concomitantly with the action checklist. Combined usage of the action checklist with the information guidebook would provide easily comprehended information and practical support. Intervention studies using this newly developed action checklist will clarify the effectiveness of the new approach to OSH in SMEs.     

Social context for workplace health promotion: feasibility considerations in Costa Rica,Finland, Germany,Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.     

A cultural economy approach to workplace health promotion in Australian small and medium sized workplaces: a critical qualitative study

Workplace health promotion (WHP) is advocated to progress the health and well-being of employees. However, research findings on its uptake and impacts are equivocal, particularly in smaller workplaces. This paper describes managers’ and workers’ responses to a WHP programme in the Australian Capital Territory. Informed by a cultural economy framework, in-depth interviews were conducted with 44 workers and managers from 10 small to medium sized enterprises (SMEs). Examining their availability and acceptability to workers and managers, we found a limited array of health promotion activities were adopted; a caring environment, provision of healthy foods, occasional health checks and health advice. Physical activity programmes during work hours were unlikely to be accepted by managers due to time costs, and workers were reluctant to spend their non-paid time on them. Casual workers were often excluded from WHP activities because their work times did not synchronize with other employees’ hours. This study illuminates how WHP is shaped by a complex of employment regulations that stress individual performance, associated limits on employer and worker time and resources, and organizational, cultural norms and practices regarding healthy work environments. We conclude that SMEs are implementing a limited array of behaviour change initiatives reflecting a particular view of health promotion. While organizational change may expand adoption of health practices during the workday, there are impediments to workers adopting wholesale changes in their health practices given a national culture of long hours, and intense job demands embedded in Australia’s neoliberal employment system.     

Workplace health promotion and stakeholder positions: a Finnish case study

Modern workplace health promotion (WHP) requires collaboration, partnerships, and alliances with both internal and external stakeholders. However, the identification of the key stakeholders as well as the systematic mapping of their views has barely been covered in the existing research literature. This article describes the stakeholders and stakeholder positions in WHP in Finland. In this study, the stakeholders were classified as internal, interface, and external stakeholders. Furthermore, based on the authors' research, stakeholders and their positions were represented on a stakeholder map as well as by the power-interest matrix of the stakeholders. The governmental authorities play a key role in driving the strategic change toward WHP by preparing the required legislation and regulatory measures. However, both active employers and active employees can through their own work accelerate the development of new WHP services. Close collaboration between employers and employees is required at the individual workplaces. Some stakeholders, such as pension funds and occupational health services (OHS) providers, can act as important driving forces and support the strategic implementation of WHP in the workplaces. However, alone they have only limited opportunities to organize the WHP activities. Understanding the various stakeholders and the systematic mapping of their positions is essential for the successful planning and implementation of WHP activities.     

Networking grassroots efforts to improve safety and health in informal economy workplaces in Asia

Many workers in Asia are in the informal economy. They often work in substandard conditions, exposed to hazards in the workplace. Learning from the recent successes of participatory training programmes to improve safety and health in Asia, the ILO has strengthened its partnership efforts with local people to improve safety and health of informal economy workplaces. The target groups were: (1) home workplaces in Cambodia and Thailand, (2) salt fields and fishing villages in Cambodia where many young workers are working, and (3) small construction sites in Cambodia, Laos, Mongolia, Thailand and Vietnam. The walk-through survey results showed that the workers and owners in the target informal economy workplaces had the strong will to improve safety and health at their own initiatives and needed practical support. In the participatory, action-oriented training workshops carried out, the participated workers and owners were able to identify their priority safety and health actions. Commonly identified were clear and safe transport ways, safer handling of hazardous substances, basic welfare needs such as drinking water and sanitary toilets, and work posture. The follow-up visits confirmed that many of the proposed actions were actually taken by using low-cost available materials. These positive changes were possible by applying the participatory training tools such as illustrated checklists and extensive use of photographs showing local good examples and placing emphasis on facilitator roles of trainers. In conclusion, the target informal economy workplaces in Asia made positive changes in safety and health through the participatory, action-oriented training focusing on local initiative and low-cost improvement measures. Local network support mechanisms to share lessons from good practices played essential roles in encouraging the voluntary implementation of practical improvement actions. It is important to increase our joint efforts to reach more informal economy workplaces in industrially developing countries and provide practical support measures focusing on local self-help initiatives.     

A participatory workplace health and safety training program for ethylene oxide.

The Occupational Safety and Health Administration (OSHA) has regulated ethylene oxide (EtO) on the basis of its acute toxicity and its potential carcinogenic and reproductive effects since 1971. OSHA's 1984 EtO standard and its 1988 revisions focused new attention on health and safety training and other preventive measures. An EtO health and safety training program for hospital sterilization workers was developed by the staff of an independent occupational and environmental health clinic. Participatory and empowerment training methods were central to the approach. Also included were hands-on, demonstration, interactive presentation, and other methods. An EtO Health and Safety Training Manual was developed based on the training experiences. This paper presents the challenges, benefits, and limitations of incorporating participatory and empowerment approaches in the design, implementation, and evaluation of EtO health and safety training.     

Participatory approaches to improving safety and health under trade union initiative--experiences of POSITIVE training program in Asia

The participatory, action-oriented training program in occupational safety and health named POSITIVE (Participation-Oriented Safety Improvements by Trade Union InitiatiVE) was established in Pakistan and extended to other countries in Asia. The steps taken in the development of the POSITIVE program included collecting local good examples in safety and health, developing an action-checklist, testing a participatory training program, and conducting follow-up activities to examine local achievements. Training manuals were compiled to provide workers with the practical, easy-to-understand information on safety and health improvements and on the positive roles of trade unions. Trade union trainers trained in the methodology conducted serial POSITIVE training workshops in Pakistan and then in Bangladesh, Mongolia, Nepal, the Philippines and Thailand and recently in China. These workshops resulted in many low-cost improvements at the workplace level. These improvements were carried out in the technical areas of materials handling, workstations, machine safety, physical environment, and welfare facilities. The trade union networks have been vital in reaching an increasing number of grass-root workplaces and in expanding the program to other countries. This included the visits to Mongolia and Thailand of Pakistani trade union trainers to demonstrate the POSITIVE training. The participatory training tools used in the POSITIVE program such as the action checklist and group discussion methods were commonly applied in different local situations. Participatory approaches adopted in the POSITIVE program have proven useful for providing practical problem-solving measures based on the local trade union initiative.     

Development of interactive workplace improvement programs in collaboration with trade associations of small-scale industries

Serial participatory action programs for reducing occupational safety and health risks were undertaken to know the types of support suited for small-scale industries. Working groups were formed with workplace people and occupational safety and health experts. It was agreed to develop an action-oriented strategy focusing on improving both work environment and productivity by making low-cost improvements through group work. Many workplace improvements achieved by participating enterprises and the group work procedures taken were analyzed. As supporting tools for effectively implementing the workplace improvement action programs, we developed action checklists according to industry and workplace implementation guides. Collections of local good examples also served as part of these support tools. These experiences show that keys to the sustainable action in small-scale industries are: (1) mobilization of the industry-wise network by trade associations, (2) an output-oriented strategy based on interactive group work and (3) the effective use of support tools such as low-cost action checklists and group work methods.     

Collaborative field research and training in occupational health and ergonomics

Networking collaborative research and training in Asian developing countries includes three types of joint activities: field studies of workplace potentials for better safety and health, intensive action training for improvement of working conditions in small enterprises, and action-oriented workshops on low-cost improvements for managers, workers, and farmers. These activities were aimed at identifying workable strategies for making locally adjusted improvements in occupational health and ergonomics. Many improvements have resulted as direct outcomes. Most these improvements were multifaceted, low-cost, and practicable using local skills. Three common features of these interactive processes seem important in facilitating realistic improvements: 1) voluntary approaches building on local achievements; 2) the use of practical methods for identifying multiple improvements; and 3) participatory steps for achieving low-cost results first. The effective use of group work tools is crucial. Stepwise training packages have thus proven useful for promoting local problem-solving interventions based on voluntary initiatives.     

SALTRA: a regional program for workers' health and sustainable development in Central America

In 2003, the university-based Program on Work and Health in Central America, SALTRA, was launched to build national and regional capacities in occupational safety and health with the goal of preventing and reducing poverty in Central America. SALTRA has implemented 20 projects including action projects in priority sectors (e.g., construction, sugarcane, hospitals, migrant coffee workers); strengthening of surveillance (occupational health profiles, carcinogenic exposures, fatal injuries and pesticides); a participatory model for training and risk monitoring by workers; building occupational health capacity for professionals, employers, and workers, with collaborating networks between the countries; strengthening of universities in work, environment, and health; studies of serious occupational and environmental situations; communication channels; and continued efforts to raise political awareness. SALTRA has placed issues of workers' health on political, business, and academic agendas throughout the region and has laid the foundations for achieving substantial future improvements in health conditions of all workers in the region. External evaluators envisioned SALTRA as an innovative development model.     

参与式培训在珠宝加工企业健康教育中应用效果分析

目的 探讨适合珠宝加工企业的健康教育方式。 方法 实验组采用多媒体授课、小组讨论、个人防护用品使用练习等参与式培训方式对100名工人进行培训;传统组采用传统的授课方式对另100名工人进行相同内容的培训。在培训前后对两组进行测验,对得分进行汇总、分析。 结果 两组员工培训后绝大部分得分有所提高。实验组工人培训前得分总分为(41.29 ±8.59)分,培训后得分总分为(81.06 ±11.78)分,两者比较,差异有统计学意义(t=10.11,P < 0.05)。传统组培训前得分为(53.68 ±10.58)分,培训后得分为(61.37 ±15.39)分,两者比较,差异无统计学意义(t=1.39,P > 0.05)。实验组不同学历、工龄、技术职称的员工得分在培训前后比较,差异均有统计学意义(P < 0.05)。传统组小学及以下人员、工龄小于15个月人员和初级工在培训后得分有提高,但与培训前相比,差异无统计学意义(P > 0.05)。 结论 参与式培训在珠宝加工企业健康教育中效果明显,可以很好地提高工人的职业健康安全知识水平。     

Report on role of occupational health nurses in the United States

The purpose of this paper is to present the differences and similarities in the roles of occupational health nurses (OHNs) between the United States and Japan by reporting the results of interviews with seven OHNs who work at seven industries in the city and the suburbs of San Francisco. Four out of seven OHNs responded that one of their essential roles was "Case Manager", in regard to the prevention of work force reduction and the scaling back of workers' medical expenditures associated with work-related accidents. Only one of them responded that "Health Promotion Specialist" was the leading role, whereas 30% of the Japanese OHNs were engaged in this role, according to the results of a previous study. Similarly to the other roles of the Japanese OHNs, they also consider Clinicians, Managers, and OHS Coordinators as their important roles. Together, the result of interviewing the nurses indicated that the differences in the role delineation of the OHNs between the two countries depend upon their educational system of licensing as well as implementation of their responsibilities to the laws and regulations, including the Occupational Health and Safety Act, health examination of the OSHA Standard and employment of occupational medical doctors, medical insurance and compensation for workmen's accidents, etc. Furthermore, this visiting opportunity gave the authors suggestions for the advancement of educational programs to reinforce the professional activities of occupational health nursing in Japan.     

Moral issues in workplace health promotion

Purpose  

There is debate to what extent employers are entitled to interfere with the lifestyle and health of their workers. In this context, little information is available on the opinion of employees. Within the framework of a workplace health promotion (WHP) program, moral considerations among workers were investigated.     

Developing an action-based health and safety training project in southern China

A project brought together international footwear manufacturers, labor rights groups, local contract factories, and occupational health professionals to strengthen factory health and safety programs in southern China. Steps involved in the two-year project, including needs assessment, interviews and focus groups with workers and supervisors; design and development of a participatory workshop; development of plant-wide health and safety committees in three footwear factories; and evaluation project impact, are discussed. The project significantly increased occupational safety and health knowledge, and hazards in the factories were identified and corrected. Successes and challenges faced by three functioning worker-management health and safety committees are discussed. Key elements to create effective programs with meaningful participation by workers include: 1) developing clear guidelines that enable multi-stakeholder groups to collaborate; 2) obtaining top-level management support; 3) building workers' knowledge and capacity to fully participate; 4) involving local labor rights groups and occupational professionals in support and technical assistance; and 5) connecting project goals to larger issues within a country and the global economy.     

Current status of employment and labor of occupational nurses in external agencies for industrial health

The purposes of this study were to survey the actual conditions of the employment status and activities of occupational health nurses who are employed in Japanese Industrial Health Organizations (IHOs), and to investigate whether the OHNs provide quality health services to employees. We mailed 1,780 questionnaires to nurses who belong to 92 IHOs (members of the National Federation of Industrial Health Organizations). A total of 976 questionnaires were returned (54.8% valid response rate) and 968 questionnaires were considered eligible for analysis. The results showed the following issues: 1) most public health nurses belonged to the department of occupational health service, but they did not have enough experience with industrial hazards or workers safety or health; 2) public health nurses want to participate more directly in care for workers; 3) Public Health Nurses provided health counseling in the charge of their enterprises, but they did not take managerial roles, including place-of-work patrol, attendance to safety, and health committees in their workplaces; 4) they were not satisfied with the present roles demanded by the other staff and their managers; 5) they did not have enough opportunities to attend the job training. Together, the results of this study suggest that the OHNs in IHOs need to have more opportunities to perform their expertise in industrial health & safety and job training in order to provide autonomous health services to the workers.     

Work improvement and occupational safety and health management systems: common features and research needs

There is a growing trend in re-orientating occupational health research towards risk management. Such a trend is accelerated by the increasing attention to occupational safety and health management systems. The trend, also seen in many Asian countries, is offering new opportunities for strengthening primary prevention. Useful examples are provided from recent work improvement projects dealing with technology transfer, small workplaces and rural areas. Common features of both these work improvement projects and accepted occupational risk management principles are reviewed based on recent experiences in Asian countries. Such features seem highly relevant in examining the occupational health research strategies. These experiences clearly show that locally adjusted procedures for risk assessment and control must be developed. There are new research needs concerning (a) the effective ways to encourage voluntary control at the workplace; (b) practical methods for local risk assessment; and (c) the types of participatory steps leading to continual improvements in the varying local context. Criteria of action-oriented research that can contribute to more effective risk control in different settings are discussed. Six relevant criteria may be mentioned: (a) adaptive risk management; (b) work/risk relationships; (c) action-oriented risk assessment; (d) use of collective expertise; (e) participation of local people; and (f) mutual learning. It appears crucial to stimulate research into the practical risk control procedures adjusted to the local situation.     

United States health professionals in international health work

This article reports results of a survey of 1,257 potential employers of US health professionals overseas, interviews with informants in international health, an analysis of career patterns of a small group of international health workers, and a review of numbers of health professionals trained in schools of public health for international health work. There are approximately 9,000 US health professionals in the international health field. Doctors (1,400), nurses (1,500) and administrators (900) are the largest groups. Church-related agencies (2,200 people), private voluntary agencies (1,700 people), and universities (1,000 people) are the largest employers.     

Participatory learning materials for health promotion in Ghana-a case study

This paper reports on operational research carried out by the Kumasi Health Education Project in Ghana to study the utilisation of participatory/empowerment learning methods for health promotion. The Project used community-based workshops to develop an extensive range of participatory materials on child health and followed these up with in-service training of 367 teachers and 157 public health workers (nurses and environmental health officers). A simple random sample of about half (262) of the participants was taken 6 months later and these personnel were asked to complete a self-reporting questionnaire to evaluate the format, content and usefulness of the materials. Results were compared with focus-group discussions with mothers attending well baby clinics, at home, in market-places and with pupils at school. The field agents reported a high degree of satisfaction with the training and claimed to be utilising the methods. However, this contrasted with the interviews with target groups who reported a low level of exposure to the materials. Those who had been exposed to materials reported a high level of satisfaction and recall of messages. Further focus-group discussions were carried out with field agents and their managers, and four sets of reasons for low utilisation emerged: the quality of participatory learning materials; personal attributes of the users and the impact of training; situational factors including the location and timing of educational sessions; and the support from peers/supervisors. The experiences in Kumasi are critically assessed and indicate that uptake of participatory/empowerment methods for health promotion depends on the quality of the materials and the selection, training and support provided to field staff.     

Factors affecting the work of an occupational health nurse

Society, economies, work-life and work are undergoing changes that will have global impact on occupational health services (OHS) and the work of occupational health nurses (OHNs) during the next 5-10 years. These changes will bring new challenges to both occupational health services and representatives of specialist groups within those services. The changes will require new ways of working, work methods, performance monitoring, and evaluation of impacts. These developments will also call for changes in the education of occupational health nurses.     

On the line: worker democracy and the struggle over occupational health and safety

In this article we present a qualitative analysis of worker involvement in a participatory project to improve occupational health and safety at a Canadian manufacturing site. Based on interviews with workers in the plant, we consider the manner and degree to which workers experienced meaningful participation in the intervention process and some of the main barriers to worker participation. Findings emphasize the importance of the social and political context in conditioning the dynamics of joint management labor ventures specifically in relation to health initiatives. Interviews revealed few instances in which workers felt included in the participatory initiative; most often they felt marginalized. In the absence of structural change in the plant, workers described the health initiative as seriously limited in its ability to render meaningful worker participation. These results extend beyond this analysis of a participatory workplace health initiative, offering insights into the dynamics of institutional participatory process, and into participatory research practice generally.