Striving to provide opportunities for farm worker community participation in research.

Hispanic farm workers and their families in the U.S. face a number of environmental and occupational health risks, yet they are rarely given the opportunity to choose the focus of the research and interventions that take place in their communities. Community-based participatory research (CBPR) can be one effective approach to changing this situation. CBPR is an approach to research that makes community members partners in research rather than subjects of research. This article describes the experience of El Proyecto Bienestar (The Well-Being Project), a CBPR project in the Yakima Valley, Washington, with the aim of facilitating the Hispanic community's involvement in the identification and prioritization of occupational and environmental health issues among farm workers. The project utilized three forms of data collection (key informant interviews, community surveys, and a town hall meeting) to create a list of environmental and occupational health issues of concern. Investigators strove to provide opportunities for community participation in the various stages of research: study concept and design, data collection, data analysis and interpretation, conclusions, and dissemination of results. This article describes the involvement that community members had at each stage of the three forms of data collection and outlines the basic findings that led the Community Advisory Board to prioritize four areas for future work. In addition, it describes the challenges the project faced from the researcher perspective. Using examples from this experience, we conclude that this model may be an effective way for farm workers and their families to have a voice in prioritizing health and safety issues for research and action in their communities.

An evaluation of factors affecting hazardous waste workers' use of respiratory protective equipment.

The purpose of this study was to describe the perceptions of a group of hazardous waste workers about their workplace hazards and to understand their beliefs and attitudes about the use of respiratory protective equipment (RPE). There were two phases of data collection: (1) interviews to identify factors that influence respirator use and (2) a written survey to evaluate the importance of these factors. This article describes the findings from the written survey completed by 255 eligible respondents (return rate = 46.5%, 255/548). Subjects used a weighting system to score 18 identified factors that influence the use of RPE. Scores were compared according to type of respirator, frequency of use, and associated health symptoms. The factors that had the most positive influence on respirator use were concern about work exposure, fit-testing, and training. The most negative influences were communication, personal comfort, effect on vision, structural environment, and fatigue. More frequent users (once per month or more) were significantly more likely to view fit-testing, health effects, and effects on vision negatively than were less frequent users. Persons who reported health symptoms associated with respirator use had more negative scores than persons without health symptoms. Workers categorized as laborers were more likely to be frequent respirator users and to wear supplied-air respirators, and were significantly more likely to view vulnerability to disease negatively, than were other worker groups. The findings from this study indicate that respiratory protection programs must extend beyond training and education; to be maximally effective, health professionals must be responsive to the specific concerns of the workers.

Barriers and solutions in implementing occupational health and safety services at a large nuclear weapons facility.

The Hanford Nuclear Reservation is one of the U.S. Department of Energy's largest nuclear weapons sites. The enormous changes experienced by Hanford over the last several years, as its mission has shifted from weapons production to cleanup, has profoundly affected its occupational health and safety services. Innovative programs and new initiatives hold promise for a safer workplace for the thousands of workers at Hanford and other DOE sites. However, occupational health and safety professionals continue to face multiple organizational, economic, and cultural challenges. A major problem identified during this review was the lack of coordination of onsite services. Because each health and safety program operates independently (albeit with the guidance of the Richland field operations office), many services are duplicative and the health and safety system is fragmented. The fragmentation is compounded by the lack of centralized data repositories for demographic and exposure data. Innovative measures such as a questionnaire-driven Employee Job Task Analysis linked to medical examinations has allowed the site to move from the inefficient and potentially dangerous administrative medical monitoring assignment to defensible risk-based assignments and could serve as a framework for improving centralized data management and service delivery.

Ecological model of occupational stress. Application to urban firefighters.

1. Multiple individual and organizational barriers make it difficult for occupational health nurses and other providers to understand and handle stress in the workplace. 2. Recent research suggests adverse health effects resulting from occupational stress are more related to the context or conditions of work than workers' characteristics. 3. The ecological approach described in this article provides a means to examine the context in which stress occurs through an analysis of four levels of influence. The levels of influence include the microsystem, the organizational system, the peri-organizational system, and the extra-organizational system. 4. Through a careful analysis using this approach, an identification of the entire spectrum of factors contributing to the occurrence of workplace stressors can be identified, and more effective interventions addressing existing and potential problems related to occupational stress can be developed.

Structure and function of occupational health services within selected Department of Energy sites.

The mission of the United States Department of Energy sites has recently changed from nuclear weapons production to site remediation. Considering the mass of radiological and chemical contaminants at these sites, ensuring the health and safety of workers is a major challenge. This study used the findings from a written survey to describe occupational health services at 10 Department of Energy sites. The study aims were to describe and compare: (1) the primary hazards associated with the site activities; (2) the occupational safety and health structure, including service providers; and (3) the occupational health and safety functions, including surveillance, training, and service provision. Although explosions and radiological agents were identified as the hazards with the greatest associated risks, workers at these sites were most likely to be exposed to physical hazards, ergonomic hazards, and/or chemicals, including asbestos. Physicians accounted for 2.4% of service providers, nurses for 5.5%, industrial hygienists for 12.2%, safety personnel for 11.8%, and health physicists for 64.9%. It was concluded that there is an imbalance between the most important hazards and the types of health and safety personnel at these sites.

A description of factors affecting hazardous waste workers' use of respiratory protective equipment.

This article describes the first phase of a study that was designed to gain an understanding of hazardous waste workers' attitudes and beliefs about the use of respiratory protective equipment. Exploratory, open-ended interviews were conducted among 28 respirator users at a US Department of Energy facility. Subjects were asked to describe their knowledge, attitudes, and beliefs about their risks to hazards at their worksites and to discuss their use of respiratory protective equipment. A detailed content analysis of the interviews resulted in the generation of a taxonomy of issues and concerns which fell into three general categories: 1) Knowledge, Beliefs, and Attitudes, 2) Physical and Psychological Effects, and 3) External Influences. Knowledge, Beliefs, and Attitudes included Training, Fit Testing, Medical Clearance, Work Exposures, Respirator Use, and Vulnerability to Disease. Physical and Psychological Effects included Somatic/Health Effects, Personal Comfort, Visual Effects, Fatigue, Communication, and Anxiety. External Influences included Structural Environment, Quality and Availability of Equipment, Other PPEs, Co-Worker Influence, Supervisor Influence, and Organizational Culture. The findings from this study have important implications to training and education programs. Effective respiratory protection programs depend on a knowledge of the factors that affect workers' use of equipment. This study suggests that efforts to assure equipment comfort and fit, to assist workers who see and hear less well as a result of their equipment, and to develop strategies to allay worker anxiety when wearing equipment should all be components of a program. An organizational culture that supports and abets the appropriate use of equipment is also a critical element in a successful program.

Evaluating case management services for injured workers. Use of a quality assessment model.

An increasing number of employers and third party administrators are choosing case management as a strategy to coordinate services for workers who sustain an occupational injury or illness. The successful delivery of case management services requires the service provider possess special skills and knowledge. Occupational health nurses are uniquely qualified to provide case management services to injured and ill workers. The effectiveness of case management services is generally described in terms of costs and quality of services; thus, determining the effectiveness of a case management program requires an evaluation of costs and service quality.

Injured workers' perceptions of case management services. A descriptive study.

This article describes the findings from a study of injured workers conducted as part of a multifaceted evaluation study of a case management program. The sample consisted of workers who filed a workers' compensation claim between January 1 and September 30, 1995. Data collection consisted of written surveys (n = 45), personal interviews (n = 27), and telephone interviews (n = 16). The findings from this study provided many insights into the injured workers' personal and work experiences, and, in particular, their perceptions of their experience with the nurse case management program. Workers satisfied with services described the nurse case manager (NCM) as having the ability to see the "big picture," to develop appropriate goals, and to anticipate client needs. Dissatisfied workers reported feeling unimportant in terms of service provision. They reported feeling that "the system" did not respond to their needs, and that the NCM was uninterested and disrespectful. This vivid portrayal of workers' experiences and perceptions of case management services provides valuable information about the world view of the injured worker.

Return to work experience of injured workers in a case management program.

A major goal of case management programs is the worker's timely return to work. Few studies have examined return to work from the perspective of the injured worker. This article describes the findings from the case management evaluation that describe the return to work experience of workers who sustained catastrophic injuries, or who had secondary conditions or complications following the injury occurrence. Among the factors determined to affect the return to work experience were structural factors (i.e., psychosocial variables including job satisfaction and relationship with employer and coworkers, financial pressures, and system issues such as securing benefits) and process factors (i.e., interaction with service providers and with the workers' compensation system). Outcomes are described in terms of satisfaction with services and return to work.

Case management services for injured workers. Providers' perspectives.

The perceptions of service providers involved in case management services are described here. The service providers included claims managers, occupational nurse consultants, attending physicians, and nurse case managers. The purposes of this phase of the study were to describe these providers' perceptions about the case management program; to organize findings according to the quality assessment model that guided this study (including structure, function, and outcomes); and to identify barriers and facilitators to satisfaction with case management services. Structural factors that affected services included the workers' compensation system, construction of the service team, roles within the program, and individual attributes of service providers. Process factors were conflicts among parties, role of communication, and interaction with workers. Outcomes were described in terms of program efficiency and effectiveness. Data are used to illustrate and explain each of these themes.

Case management for injured workers. A descriptive study using a record review.

A record review was used to examine case management services provided to 36 workers who sustained a catastrophic or medically complex injury, and who were referred to a case management program. The aims of this phase of the evaluation were to identify and describe: Workers' demographics and personal attributes, The structures and processes that affected the course of these cases, and The role of the nurse case manager (NCM). A data collection instrument was developed to collect quantitative and qualitative information. Structural factors that emerged as most consequential included the quality and quantity of the injured worker's social support and the employment situation, including the availability of a job post-injury, employer support, and worker motivation. Process variables identified included the interactions of service providers including communication, and collaboration. The NCM was described as a monitor, coordinator, supporter, and advocate for the worker. Additionally, the NCM served as a consultant to other service providers and played a key role in the implementation of cost containment strategies.

Evaluation of a case management program. Summary and integration of findings.

1. Occupational health nurses can advocate for fair and equitable policies for both workers and employers. Assisting workers to understand and negotiate through the workers compensation system can minimize suspicion among workers and service providers, and can increase the effectiveness and efficiency of service provision. 2. Occupational health nurses can work with the team of service providers and the injured worker to develop appropriate and realistic goals for service provision. Make sure there is clarity related to the roles and responsibilities of all persons on the team (including the injured worker) is essential. Consistency and continuity of services throughout the life of the case is crucial. 3. The injury and its sequelae have personal meaning to the worker that may profoundly affect the outcome of their case. The OHN/CM must be sensitive and responsive to the worker's issues and concerns, and respectful of their views. Workers must be assisted to identify and tap into their social support systems. 4. Occupational health nurse/case managers should take an active role in developing and advocating for strategies that will assure effective and meaningful communication among all parties involved in a case.

Hispanic women's beliefs about breast cancer and mammography.

Although breast cancer rates are lower among Hispanic women than among White women, Hispanics are more likely to die from this disease if they do get it. This may be related to the fact that Hispanic women are less likely to participate in mammographic screening. This study used a two-stage decision model to describe a group of rural, Hispanic women's beliefs and attitudes about breast cancer and mammography. The first stage consisted of exploratory interviews to identify factors, both positive and negative, that affect the mammography decision. The second stage will use a survey to weigh the identified factors in order to determine their importance to the decision. This article presents the stage 1 findings of this study. Twenty-nine rural, Hispanic women between the ages of 38 and 74 participated in the interviews. The majority had annual incomes of < $10,000, and 30% completed < or = 8 years of education. The subjects identified 18 factors, which fell into three general categories: Knowledge and Attitudes (How Well It Works, Personal Risk, Other Ways of Knowing, Fear of Cancer and/or treatment, Belief in Fate, Cultural Issues), Issues Related to Participation (Language, Getting There, Time, Cost, Radiation Exposure, Pain), and Social Concerns (Role Model, Responsibility to Self, Responsibility to Others, Influence of Family/Friends, Influence of Doctors, Influence of Society). Verbatim description of each of these factors are presented. The implication of the findings to health professionals is discussed.

Dealing with hypertension: using theory to promote behavioral change.

1. Controlling hypertension and related disease requires that health professionals focus more attention on primary prevention strategies as a means of decreasing hypertensive risks. 2. Behavioral theories help identify attitudes, beliefs, and knowledge influencing behaviors that increase one's risk for hypertension. 3. Using information based on the behavioral theories will help occupational health nurses develop more effective programs for primary prevention of hypertension.

An evaluation of mammography beliefs using a decision model.

The purpose of this study was to identify factors that contribute to a group of working women's decision related to mammography. The study was guided by a decision model called the Multiattribute Utility Model. Exploratory interviews were conducted among 36 women to identify positive and negative factors associated with the mammography decision. Eighteen factors emerged and were categorized into three broad areas: Knowledge and Attitudes (Confidence in Efficacy, Personal Risk, Other Means of Knowing, Fear of Cancer/Treatment, Belief in Fate, Embarrassment), Issues Related to Participation (Accessibility and Convenience, Difficulty Arranging, Time, Cost, Pain, Radiation), and Social Concerns (Role Model, Responsibility to Self, Responsibility to Others, Family/Friends' Influence, Societal Influences, Health Care Providers' Influence). This information served as the basis of a survey among 87 women to determine the importance of these factors. Seven factors emerged as significantly different between compliers and noncompliers. In order of significance, they were Difficulty Arranging, Fear of Cancer/Treatment, Cost, Accessibility and Convenience, Time, Other Means of Knowing, and Influence of Health Care Provider. The predictive validity of this analysis was 85%. Implications of findings are discussed.