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Psychosocial and organisational factors
affecting the development and control of
occupational asthma: A critical review of the
literature
HSL/2005/43
Project Leader: Jennifer Lunt
Author(s): Jennifer Lunt, Joanne White
Science Group: Human Factors
© Crown Copyright (2005)
ACKNOWLEDGEMENTS
The authors would like to acknowledge the help of Andrew Curran, Anil Adisesh, Jo Elms,
David Fishwick, Steven Naylor, Kate Jones, Rachel O’Hara, Andrew Pinder, Nick Vaughan,
Helen Chambers, Peter Walsh and Martin Roff from HSL in gathering the literature together.
The authors would also like to thank the steering team, Helen Smith, Androulla Michael,
Laura Smethurst, Andew Weyman, Len Morris, Andrew Garrod and Roger Rawbone for their
guidance over the course of the project. Finally, the project leader would like to thank her
fellow author, Joanne White for her unstinting support throughout the review.
2
CONTENTS
1
2
3
4
5
6
7
Introduction ....................................................................................................................... 7
1.1
Background ............................................................................................................... 7
1.2
Occupational Asthma Prevention and Management: Current Approach................... 8
1.3
Psychosocial/Behavioural Issues............................................................................. 10
1.4
HSE Asthma Strategy and Targets .......................................................................... 12
1.5
Objectives of the Review......................................................................................... 12
Method............................................................................................................................. 15
2.1
Search Strategy: overview ....................................................................................... 15
2.2
Data Extraction and coding ..................................................................................... 22
2.3
Evidence Weighting ................................................................................................ 22
2.4
Articles .................................................................................................................... 23
Summary of Results ........................................................................................................ 24
3.1
Contributors............................................................................................................. 24
3.2
Diagnostic Barriers.................................................................................................. 39
3.3
Occupational Asthma Management Barriers (tertiary interventions)...................... 42
3.4
Variations by Organisational Size ........................................................................... 46
3.5
Variations by Industry Sector .................................................................................. 46
Discussion ....................................................................................................................... 47
4.1
Caveats .................................................................................................................... 47
4.2
Knowledge Gaps/Weaknesses................................................................................. 48
4.3
Intervention Recommendations............................................................................... 49
4.4
Research Recommendations.................................................................................... 70
Bibliography.................................................................................................................... 71
5.1
HSE / HSL Literature .............................................................................................. 71
5.2
External Literature................................................................................................... 77
Glossary, Acronyms and Websites................................................................................ 103
6.1
Glossary................................................................................................................. 103
6.2
Acronyms .............................................................................................................. 107
6.3
Possible Relevant Occupational Asthma Websites ............................................... 108
Appendices .................................................................................................................... 110
7.1
Appendix 1: Recommendation Tables .................................................................. 110
7.2
Appendix 2: Main Review..................................................................................... 147
7.3
Appendix 3: Tables of Psychosocial Factors References ...................................... 207
7.4
Appendix 4: Industry Sector Characteristics Evidence ......................................... 279
3
EXECUTIVE SUMMARY
A critical literature review was conducted to identify the psychosocial contributors and
barriers surrounding behavioural non-compliance with occupational asthma (OA) prevention
and management measures. The review was undertaken on behalf of the Health and Safety
Executive’s (HSE) Disease Reduction Programme (DRP). The review sought to evaluate
literature that informs:
1. Psychosocial and other organisational factors involved in the development of
occupational asthma symptoms.
2. Psychosocial and organisational factors that act as barriers to occupational asthma
prevention.
3. Psychosocial and organisational barriers to successful diagnosis and management of
occupational asthma once symptoms have arisen.
Variables identified are categorised according to whether they stem from the individual, the
immediate work environment, the organisation, or from outside work. Those receiving
strongest support within the literature are summarised as follows.
OA contributors:
According to the literature reviewed, workers’ appraisal of the risks presented by the
asthmagens with which they work is strongly influenced by their general knowledge of risk,
of the health effects associated with asthma, and of appropriate controls. Risk perception
biases, in particular, underestimation of risk generated by the latency of the health threat,
asthmagen familiarity, and an assumption that personal protective equipment (PPE) provides
risk immunity, are implicated as highly influential in distorting risk judgements. The decision
to comply with health and safety guidance can be framed as a wider ‘cost benefit’ judgement.
Immediate work environment characteristics, notably control availability, ease of use,
comfort, communication obstruction, task interference, and consequent productivity
interference can act as powerful determinants in ensuring that the costs of compliance are
construed to outweigh its benefit. Prevention of an uncertain and distant health threat such as
OA appears largely ineffective in motivating self-protective behaviour. Consequently, the risk
of enforcement is essential for ensuring that the perceived costs of non-compliance outweigh
the perceived benefits for the employer. Workers’ perceptions or belief that they possess the
necessary skills for regulating risk, and that their actions will be effective, will also shape
their motivation to comply. Even where motivated, pre-existing habits and coping strategies,
such as tendency to actively seek or avoid risk communication, can thwart compliance.
Strong evidence implies that peer pressure and management commitment to occupational
health act as powerful, albeit indirect, moderators of compliance. This is reflected in their
tendency to engage in occupational health and involve staff, unions and health and safety
advisors in related decisions. Workers are also more receptive to risk communication
perceived as relevant, expressed in language they can readily understand, and stemming from
a credible source. At the wider organisational level, performance based incentive schemes
that preclude occupational health considerations is likely to reinforce a culture that prioritises
health behind performance, and even safety; so too will inadequate OH and health
surveillance provision, widely cited amongst smaller organisations. Frequently occurring
financial and time constraints can also elevate productivity above occupational health
concerns. From outside the organisation, evidence implies that workers from lower socioeconomic groupings are predisposed to OA risk. Collectively, each of these individual,
organisational and external factors interacts to determine behavioural non-compliance with
OA guidelines. The relative contribution of each appears to vary at a local level between
different industry sectors and organisational size profiles.
4
Diagnostic barriers:
Early diagnosis and removal from asthmagens is recognised as essential for optimising
workers’ overall prognosis. Individual factors that can hamper the diagnostic process include
symptom misattribution and reluctance to relinquish control for the condition. Seemingly
justified fears of the economic ramifications following a positive OA diagnosis appear to
represent a significant barrier to early diagnosis and honest contribution to health
surveillance. For the employee, these concern limited redeployment and retraining options
with the same employer and poor employment prospects. Uncertain and sub-salary
compensation payouts can further discourage them from seeking a prompt diagnosis. For the
employer, diagnostic fears can stem from their having to burden most of the costs associated
with OA, such as sickness, absenteeism and potential compensation claims. Rather than
acting as an incentive for encouraging preventative measures, it appears that the
compensation system can, potentially, suppress reporting of OA by employee and employers
alike. Inadequate OH provision, limited health surveillance availability amongst smaller
organisations, lack of diagnostic consensus and an uncertainty in differentiating work from
non-work causes, also protract the diagnostic process.
OA management barriers:
Effective management of OA whilst at work can be thwarted by the widely recognised
difficulties asthma sufferers have in adhering to treatment regimes. Symptom misattribution,
environmental distracters, reliance on reliever rather than controller medication, prescription
costs and regime complexity all represent challenges to treatment adherence. Low
comprehension ability is acknowledged within the literature as a significant predictor of fatal
asthma attacks. Compliance is more likely where symptoms are more severe and less
intermittent. However, the very unpredictable nature of symptom manifestation can
undermine sufferers’ sense of control over their condition. A vicious cycle of poor
compliance, erratic symptoms and learned helplessness can then ensue. Some sufferers may
adopt denial as a means of coping with the unpredictable nature of the condition. Although
these relate to the general experiences of asthma sufferers in general, they have bearing on the
workplace through adding to the challenges workers encounter in keeping their condition
under control. Limited redeployment and retraining options identified in the literature may
force employees to continue working in conditions from which they should otherwise be
removed. Optimal return to work approaches concern modifying work demands, increasing
workers’ control over their workload, pacing and scheduling breaks, as well as reviewing and
upgrading controls, to enable a graded return to work. Accommodating such options act as a
further disincentive for employers to retain workers with OA.
Recommendations:
Preventative recommendations are based on a risk assessment framework, which guides the
sequence of decisions for overcoming psychosocial contributors to OA. Accordingly, the risk
assessment framework applies a similar methodology to those used within HSE’s
management standards for stress. It would proceed as follows
•
•
•
Hazard/Risk Identification: A standardised psychosocial diagnostic questionnaire,
developed by HSE, combined with qualitative techniques could be used identify salient
psychosocial risk factors. Alternatively employers may prefer to develop ‘in house’
behavioural risk assessment tools.
Identifying who is at risk: Response variations by group would enable detection of
employees at greatest risk.
Actions: Apparent variation in the relative contribution of psychosocial risk factors
between organisations implies that the content of interventions should be determined at
5
•
the local level, in consultation with staff, and with HSE inspectors where necessary.
HSE could provide guidelines on intervention options. The actual option chosen would
have to be contingent on employees’ (managers and front line staff) attitude to
compliance, as gauged by the initial risk assessment. Inadequate risk awareness
necessitates risk knowledge training. Risk awareness without compliance intentions
will require persuasive risk communication that is perceived as personally relevant.
Testimonies from employees with OA, biomarker feedback and video monitoring
tailored to ‘employee types’ could provide employees more tangible evidence of the
link between behaviour and health risks. Their basis on ‘employee type’ would balance
personal relevance with cost considerations. However, such communication will not
realise risk acceptance where workers do not believe that they possess the necessary
skills or have the necessary control for affecting training. In these instances, risk
communication will need to be accompanied by skills training, ensuring adequate
availability of appropriate controls, and minimisation of job hindrances or stressors.
Having raised compliance intentions, interventions then need to focus on enabling
workers to implement change through planning, in detail, how they are going to
improve compliance and providing highly behaviourally specified guidelines to support
this process. Consistent reinforcement of appropriate compliance behaviour by line
management is more likely to ensure sustained change.
Evaluation: To provide triangulation of evidence that more clearly delineates
causal pathways, a combination of psychological, social, biomarker and air monitoring
measures are recommended. This can then support subsequent intervention monitoring
and review.
Recommendations for overcoming diagnostic barriers focus on mitigating employee and
employers’ fears of the economic consequences. Compensation just below full salary levels
could stem such fears. Employer reluctance for such systems could be stemmed by
development of a state funded ‘national job bank’, coordinating redeployment and retraining
options for workers with a range occupational health problems. In principle, employees would
only become eligible for compensation payouts once redeployment and retraining options
have been fully explored. Sector specific business cases, contrasting employer costs incurred
by early or delayed diagnosis could lend employers greater incentive to widen access to
occupational health services. Improved worksite management of OA could be fostered
through applying principles from tailored self-management plans. Accordingly, sensitised
employees could be issued prompt cards reminding them of their treatment requirements, as
well as their need to monitor their symptoms and manage their exposure according to the
tasks and hazards they are working with for that day.
Identifying psychosocial risk factors implicated in the development of OA has, in many
instances, been extrapolated from related occupational conditions, To clarify the precise role
they play in OA development, further front line investigation, surveying workers at risk of
OA, and variations by industry sector and organisational size needs to be undertaken.
6
1
1.1
INTRODUCTION
BACKGROUND
Asthma represents an exaggerated narrowing or constriction of the airways resulting in
wheezing and shortness of breath and is associated with chronic airway inflammation. It can
bring about hypoxia1 or in extreme cases, irreversible and complete obstruction of the airways
(Boorman, 2004; Control of Substances Hazardous to Health (COSHH), fifth addition,
Approved Code of Practice and Guidance, 2005). Symptoms can be characterised according
to their intermittency (attack frequency), severity and reversibility (spontaneous or treatment
related remission) (Lombardo and Balmes, 2000).
Occupational asthma (OA)2 refers to new onset asthma that is caused by workplace exposure
and is distinguished from work-aggravated asthma3, whereby pre-existing or coincidental
new onset asthma is worsened by workplace exposure (BOHRF, 2005, 2004). Almost 90% of
the 1,500-3,000 estimated cases of OA that arise each year as reported by the Health and
Safety Executive (HSE) are hypersensitivity or allergic/immunologic4 induced (BOHRF,
2004) and is typified by a latency period between first time exposure and symptom onset
(BOHRF, 2004, 2005). Once established, hypersensitivity is irreversible. Symptoms
subsequently occur at much lower exposure levels than those that initially provoked the
condition (Frew, 2003). The remaining cases of OA are irritant/non-immunologic5 induced in
which symptoms occur promptly following high exposure to an irritant gas, fume or vapour
(e.g. Reactive Airways Dysfunction Syndrome6) or, in some cases, arise more gradually
alongside multiple exposure to lower concentration levels (Corbridge and Corbridge, 2003).
Predisposing risk factors for OA comprise atopy7, genetics and smoking. These combined
with exposure to causative agents at work can precipitate OA onset (BOHRF 2004, 2004,
King, Mannino & Holguin, 2004, Lombardo & Balmes, 2000). Those agents or asthmagens8
most frequently associated with OA include isocyanates, flour, wood and grain dust,
colophony and fluxes, latex, laboratory animals and aldehydes (BOHRF, 2005, Boorman,
2004, Snashall, 2003). Workers at greatest risk of developing OA therefore encompasses
those directly involved in baking, food processing, forestry, chemicals, plastics and rubber,
welders, textiles, electrical and electric production work, storage, farming, waiting tables,
cleaners, painters, health care professionals, dentistry and laboratories (BOHRF, 2005). The
role of such agents as causes of OA is used in its broadest sense. Understanding of the
mechanisms by which each agent contributes to OA remains incomplete (Frew, 2003). It does
not adequately explain, for example, difficulties in reliably predicting induction of a
hypersensitive state in at-risk individuals, variations in the amount of material necessary for
creating hypersensitivity or why some agents, such as isocyanates, can act as both sensitisers9
and irritants10 (Frew, 2003, Tarlo and Liss, 2002). However, with the exception of some low
molecular weight (LMW) sensitisers, such as colophony fumes, hypersensitivity has been
attributed to the reactivity of a specific antibody (Immunoglubulin E or IgE) (Corbridge and
Corbridge, 2003). Conversely, irritants serve to inflame airways by damaging epithelial
surface permeability (Lombardo and Balmes, 2000). Once OA develops, the asthma can be
induced by many non-specific triggers11 common to non-occupational asthma (Burge, Pantin,
1
See Glossary for definition
See Glossary for definition
3
See Glossary for definition
4
See Glossary for definition
5
See Glossary for definition
6
See Glossary for definition
7
See Glossary for definition
8
See Glossary for definition
9
See Glossary for definition
10
See Glossary for definition
11
See Glossary for definition
2
7
Newton, Gannon, Bright, Belcher, McCoach, Baldwin and Burge, the Midlands Thoracic
Society Research Group, 1999) such as humidity, exercise, house dust mites, moulds and pets
(Spector, 1991).
On developing OA, prognosis is best where workers have a shorter duration of symptoms
prior to diagnosis12, had relatively normal lung function at the time of diagnosis, and have no
further asthmagen exposure subsequent to diagnosis (BOHRF, 2004, 2005). Whilst avoiding
exposure does not necessarily bring about full symptom remission due to increased nonspecific sensitivity, failure to avoid continued exposure to work-related asthmagens risks
long-term disability, unemployment and a severe impairment in quality of life (BOHRF,
2004, 2005; Cullinan, Tarlo & Nemery, 2003; Frew 2003, Juniper 1999).
1.2
OCCUPATIONAL ASTHMA PREVENTION AND MANAGEMENT:
CURRENT APPROACH
1.2.1
Prevention of Occupational Asthma
By law, under regulation 7 of the Control of Substances Hazardous to Health (COSHH)
Regulations, (Fifth Edition, 2005, page 28) employers are expected to “ensure that the
exposure to substances hazardous to health is either prevented, or where this is not
reasonably practicable, adequately controlled”. An Approved Code of Practice (ACOP)
specific to Occupational Asthma (COSHH Regulations, Fifth Edition, 2005, page 137)
expands further by stipulating, “limited scientific knowledge on levels below which substances
will not cause asthma means that it will be necessary to reduce exposure as far as is
reasonably practical”. In order to meet these obligations, regulation 7 outlines the sequence
of stages by which exposure can be controlled:
1. So far as is reasonably practicable, substituting or replacing the substance or process
hazardous to health with an alternative that either eliminates or reduces risks to health
(primary prevention13).
2. Where this is not reasonably practical use protection measures, consistent with an
appropriate risk assessment, to control risk (secondary prevention14). In order of
priority these include:
a. Designing appropriate work processes, systems and engineering controls and
ensuring the provision of suitable work equipment and materials,
b. Controlling exposure at source through adequate ventilation systems and
organisational measures, and
c. Providing appropriate personal protective equipment (PPE) where exposure
control cannot be achieved by alternative means.
These measures are intended to apply to handling, storage and transport, maintenance
procedures, the number of workers involved, and hygiene measures as well as the control of
the working environment. The following schedule (see table 1) has been drawn up for the
fifth edition of the COSHH regulations to enable compliance with regulation 7:
12
See Glossary for definition
See Glossary for definition
14
See Glossary for definition
13
8
Table 1: Principles of good practice for the control of exposure to substances hazardous
to health
(a)
Design and operate processes and activities to minimise emission, release and
spread of substances hazardous to health.
(b)
Take into account all relevant routes of exposure – inhalation, skin absorption and
ingestion – when developing control measures.
(c)
Control exposure by measures that are proportionate to the health risk.
(d)
Choose the most effective and reliable control option which minimises the escape
and spread of substances hazardous to health.
(e)
Where adequate control of exposure cannot be achieved by other means, provide, in
combination with other control measures, suitable personal protective equipment.
(f)
Check and review regularly all elements of control measures for their continuing
effectiveness.
(g)
Inform and train all employees on the hazards and risks from the substances with
which they work and the use of control measures developed to minimise the risks.
(h)
Ensure that the introduction of control measures does not increase the overall risk to
health and safety.
(Taken from COSHH Regulations [fifth edition], 2005, Schedule 2A, page 88)
1.2.2
Health Surveillance and Diagnosis
In accordance with regulation 11 of COSHH (2005), the ACOP for occupational asthma also
stipulates that all employees exposed or liable to be exposed to asthmagens should be under
suitable health surveillance. Health surveillance has been found to be effective in detecting
OA at an earlier stage and improving outcomes for OA workers compared to when it is not
applied (BOHRF, 2004, 2005). Corresponding techniques include a combination of medical
screening15 (respiratory questionnaires, spirometry as a lung function test and skin prick tests
for detecting IgE sensitization) and exposure monitoring performed in tandem (Occupational
Asthma: A guide for Employers, Workers and their Representatives – BOHRF, HSE, TUC,
2004; British Guidelines on the Management of Asthma, Thorax, 2003). Actual diagnosis of
occupational asthma is contingent on the medical history demonstrating a clear relationship
with work and the specificity16 and sensitivity17 of the accompanying physiological measures
used. The medical history will therefore need to take account of any symptom improvement
away from work, increase in symptoms during the working week, and variation according to
changing work environments (Lombardo & Balmes, 2000). More widely used physiological
diagnostic measures include serial peak expiratory flow measurements (lung function tests),
forced expiratory volume to a lesser extent and IgE skin prick tests (BOHRF 2004, 2005).
Although regarded as the gold standard method, specific bronchial provocation testing
(SBPT) is not widely used due to it being expensive, time consuming and of limited
availability (Lad, 2003). Accurate diagnosis is made more difficult by identifying a clear
relationship with work due to persistency of symptoms when away from work, consequent
difficulties in differentiating work from non-work causes and lack of consensus over
diagnostic criteria (Curran and Fishwick, 2003). Diagnostic difficulties, and reliance on
incomplete registries of occupational asthma prevalence18 such as the Survey of Work and
Occupational Respiratory Disease (SWORD) means that population incidence19 of OA may
be underestimated by as much as 50% (BOHRF, 2005). The SWORD scheme is regarded as
providing a limited indication of OA through exclusion of data from primary care and case
notification variances between the expert centres (occupational and respiratory physicians)
that supply the data (Curran and Fishwick, 2003).
15
See Glossary for definition
See Glossary for definition
17
See Glossary for definition
18
See Glossary for definition
19
See Glossary for definition
16
9
1.2.3
OA Management
The ACOP for occupational asthma requires that employers compile procedures for
responding to confirmed new cases of occupational asthma (COSHH Regulations, Fifth
Edition, 2005, page 136), in terms of protecting the employee with OA symptoms, reviewing
assessment and control measures and reporting the case to the enforcing authority as required
by RIDDOR. The optimal method for protecting the employee concerns eliminating exposure
by relocation to a non-hazardous area or substitution of the hazard. Failing this, relocating
workers to lower exposure areas to reduce exposure should be considered next, alongside
increased health surveillance. Improved PPE or RPE (e.g. air fed helmets) should represent a
last resort, although remains necessary where exposure risk cannot be removed by other
means (Occupational Asthma: A guide for Employers, Workers and their Representatives –
BOHRF, HSE, TUC, 2004; British Guidelines on the Management of Asthma, Thorax, 2003).
British Thoracic Society guidelines suggest that no worker should be advised to give up
without referral to a specialist centre and specialist investigation (Williams, 2003).
1.3
PSYCHOSOCIAL/BEHAVIOURAL ISSUES
COSHH Regulations provide a framework for guiding employers through the sequence of
decisions and actions they need to take in order to minimize employee exposure to hazardous
substances. This sequence reflects the hierarchy of control approach employed within
occupational hygiene (e.g. Roelofs, Barbeau, Ellnebecker and Moure-Eraso, 2003) in which
substitution and design and engineering solutions have traditionally taken precedence over
solutions that overtly rely on behavioural compliance, such as wearing Personal Protective
Equipment (PPE). To this end, the COSHH Regulations provides a decision making tree, or
route map, to support ‘non-health and safety experts’ such as small and medium sized
enterprises (SMEs) employers in meeting their COSHH obligations. This is outlined in figure
1 below.
10
What substances
(products) do you use?
Figure 1: COSHH
essentials route map
for SMEs/nonprofessionals
What are the health hazards (see R-phrases on safety
data sheets and/or product label)?
Are you following the principles of good control practice? or
Are your controls equivalent to those suggested
by COSHH essentials? or
Can you demonstrate your controls are adequate?
Yes
Maintain current
controls
Don’t know
Seek advice, e.g. COSHH
essentials or equivalent
No
Investigate improvements
(apply COSHH essentials
guidance or equivalent)
Notwithstanding preference for ‘engineering’ or ‘administering out’ reliance on behavioural
compliance as a means of reducing exposure, behavioral20 and psychosocial21 factors are,
nonetheless, implicated within each of the components outlined in the principles of good
practice (see table 1) and the above route map. Each step requires a decision that will be
influenced, for example, by knowledge, training, experience and risk perception biases. For
instance, a recent anonymous report estimates that asthma may potentially cost employers £3
billion over the next decade because of refusal by employers to substitute asthma inducing
products with safer alternatives (Occupational Health, March 2002). This example implies
that exposure control decisions may be influenced by motives other than pure health and
safety concerns and the potential consequence of such motives. A workshop convened by
HSE to discuss information needs for reducing the national incidence of occupational asthma
highlighted ‘behaviour’ as a main area of need (Curran and Fishwick, 2003a, b). It was
recognised that in order to affect change in the workplace, and improve compliance with
COSHH, the factors driving behavioural non-compliance needed to be better understood and
overcome if HSE’s occupational asthma targets are to be met.
20
21
See Glossary for definition
See Glossary for definition
11
1.4
HSE ASTHMA STRATEGY AND TARGETS
In 2000, HSE estimated new cases of OA to cost society between £579 million and £1,159
million over 10 years. As part of its Asthma Strategy (2001), the Health and Safety
Executive/Commission (HSE/C) set the target of reducing the incidence of asthma caused by
workplace exposure to asthmagens by 30% by 2010. These targets are implicit within later
Public Service Agreement (PSA) targets agreed with the Department of Work and Pensions
during 2004. In order to deliver a 6% reduction in incidence rate of cases of work-related ill
health set for 2007/2008, PSA targets for ill health specifiy that the following needs to be
achieved:
•
•
•
8% reduction in ill health caused by stress;
8% reduction in ill health caused by muscoloskeletal disorders;
3% reduction in ill health caused by chemicals.
In order to meet these PSA targets, HSE has set up a “Fit for work, Fit for life, Fit for
tomorrow” (FIT3) strategic programme, which includes amongst its aims the reduction in the
incidence of diseases, such as OA, arising from exposure to hazardous substances.
1.5
OBJECTIVES OF THE REVIEW
To enable HSE to meet its targets of occupational asthma reduction (see section 1.4), a critical
review of available literature was conducted to identify the psychosocial contributors and
barriers surrounding behavioural non-compliance with OA prevention and management
measures. The review was undertaken on behalf of the HSE Disease Reduction Programme
(DRP). Specifically, the review aimed to critically evaluate literature that informs:
1. Psychosocial and other organisational factors involved in the development of
occupational asthma symptoms (contributors). These relate to the period between
stage 1 and 2 in figure 2 below.
2. Psychosocial and organisational factors that act as barriers to occupational asthma
prevention. These also relate to the period between stage 1 and 2 in figure 2 below.
3. Psychosocial and organisational barriers to successful diagnosis and management of
occupational asthma once symptoms have arisen. These concern the period between
stage 2 and 3 in figure 2 below.
4. Behavioural change recommendations for reducing the risk of developing or
aggravating occupational asthma (OA). These concern the period between stage 3
and 4 in figure 2 below.
12
1. Symptom/sensitisation
free
2a.Sensitisation/
symptomatic
3. OA
diagnosis
4. OA symptom
control/management
2b:Sensitisation/
asymptomatic
Contributors/prevention barriers
Diagnostic barriers
OA symptom management
Figure 2: Occupational asthma development and progression stages to be covered by the review
In agreement with the client, the following review parameters were observed: Since
behavioural non-compliance is likely to be mediated by a range of psychosocial
factors, this review endeavoured to profile the wider psychosocial influences
impacting upon occupational asthma risk rather than simply focusing on behaviour
alone.
As a way of keeping the complexity of relationships examined manageable, it was
determined that the recommendations focus on occupational asthma (asthma caused
by workplace factors) as opposed to work-aggravated asthma (WAA). Overlap with
non-work influences and increased susceptibility to non-specific triggers may have
rendered the recommendations unwieldy through inclusion of WAA.
When identifying diagnostic barriers, it was also decided to centre on those
encountered within occupational health provision, due to substantial work already
having been undertaken by HSL isolating those operating within primary and
secondary care settings.
Efforts were made to identify psychosocial and behavioural influences differentiating
sensitised and symptomatic employees from those that were known be sensitised and
asymptomatic (see stage 2 of figure 2).
“Hard” organisational factors were separated from psychosocial factors in order to
ensure that the review, for example, covered barriers operating at a policy level (e.g.
occupational health or rehabilitation policy). Such barriers fall outside strict
interpretations of what constitutes a psychosocial factor.
From the review outset, psychosocial factors were differentiated into barriers and
contributors. Whilst the two inevitably overlap, to assume them to be one of the same
construct may have risked oversight of relevant information.
Any read-across of the psychosocial factors encountered to other occupational health
conditions would be indicated.
Based on the psychosocial precursors and barriers identified the recommendations endeavour
to accomplish the following:
Provide workable solutions for enhancing the effectiveness of OA prevention and
management interventions.
Accommodate variations according to demographic and psychosocial characteristics
(e.g. safety culture and industry networks) for the main industry sectors within which
OA arises.
Accommodate similar variations according to organisational size.
13
Relate to a range of workplace stakeholders22, including employees, employers,
occupational health providers, employee representatives, trade associations, supply
chains and insurance companies.
Consider appropriate intervention media, evaluation strategies and ongoing
knowledge dissemination.
22
See Glossary for definition
14
2
2.1
METHOD
SEARCH STRATEGY: OVERVIEW
The literature search process was divided into 3 stages, (a) an initial orientation phase, (b) a
review of relevant HSE/HSL research and (c) more specific searches of literature falling
outside the HSE domain. The precise strategy used differed between each of the stages, as
described in subsequent sections. Throughout, the overall strategy endeavoured to meet the
following objectives:
Ensure the review adequately captured the range and diversity of psychosocial
factors likely to act as contributors to OA development, or barriers to OA prevention
and control. Accordingly, the diagram in figure 3, based on HSE’s human factors in
industrial health and safety model (HSG 65, page 10) was used as a framework for
guiding the literature search strategy. Within this diagram, factors were firstly broken
down into layers representing individual, job, “soft23” organisational, “hard24”
organisational and external or societal influences. Each layer was then divided into
categories of related psychosocial themes.25
Given an anticipated shortage of psychosocial research surrounding OA, the review
drew on material from “related” areas to inform the research aims. Accordingly, a
“bottom up” approach was therefore used for gauging relevance as a way of keeping
the volume of material examined manageable within timescale and budget
parameters. Consequently, for each layer of the model, inclusion criteria were
gradually broadened out to less relevant areas depending on the extent to which
preceding searches yielded informative material.
Accordingly, the inclusion criteria were based on disease similarity, evidence quality
and recency:
Occupational disease similarity was judged according to its resemblance to
OA in terms of it arising from exposure to a hazardous substance, latency
characteristics and severity of consequences. Despite a shorter latency
interval, occupational dermatitis was considered the most relevant due to it
also resulting from sensitiser or irritant exposure, and posing a chronic rather
than terminal health threat. Although also respiratory related, chronic
obstructive pulmonary disorder (COPD) and asbestosis, for example, were
considered less relevant since they are terminal diseases, and consequently
are likely to have different psychological and psychosocial ramifications
than OA. Likewise, MSDs and stress were also considered less relevant still
as they are not caused by exposure to a hazardous substance, per se.
Research addressing psychosocial aspects of non-work related asthma was
only considered relevant for individual and societal factors (see section
2.1.3).
Peer reviewed research and formal empirical or qualitative investigations
were prioritised over “grey literature” such as anecdotal evidence or material
based on expert opinion. Section 2.3 describes the quality criteria used for
describing the evidence base underpinning each psychosocial theme.
23
In this context “soft” organisational factors refer to experiential variables operating in the wider organisation environment such
as health and safety culture or communication.
24
In this context “hard” organisational factors refer to more tangible administrative and policy facets of the organisations that act
as OA barriers or contributors.
25
The themes listed in figure 2 represent the type of factors it was anticipated the review would uncover before the review
actually commenced. Theme labels and grouping were subsequently revised and relabelled as the review progressed to ensure
they adequately reflected literature findings.
15
Key reviews found relating to given psychosocial/organisational factors were
used as a steering point for isolating the time frame26 that the corresponding
literature search into that factor would cover. Where key reviews were not
found, the time frame chosen for some psychosocial and organisational
themes depended on the amount of research undertaken during more recent
years, or the potential likelihood of having been affected by the launch of
Revitalising Health and Safety (RHS) and Securing Health Together (SH2)
in 2000
Articles not written in English, or focusing on children were excluded across
all the phases.
2.1.1
Orientation Phase
Aim: To scope (a) contemporary issues and challenges surrounding OA prevention and
management, (b) current guidance for OA management and, (c) the range of psychological
issues that might apply.
Strategy: Accordingly, this phase focused on identifying general occupational asthma reviews
or psychosocial reviews of asthma conducted within the last 10 years. No reviews were found
of psychosocial factors surrounding occupational asthma per se. Corresponding search terms
(expressed using a Boolean format and using wild cards) comprised articles containing the
following terms:
•
•
•
•
Occupational asthma AND review
(Occupational health OR condition) AND psych*
Asthma AND psych* AND review
Chronic illness AND psych* AND review
Inclusion criteria: All articles were scan read to assess whether they contained information
concerning guidelines for the prevention and management of occupational asthma, or
mentioned psychological, psychosocial or organisational factors that might act as contributors
or intervention barriers. Those that did were read in more depth and subjected to data coding
(see section 2.2).
26
For example, if a review addressing the impact of relevant cultural factors on OA was found that was conducted in the early
1990’s, any research conducted since that date would then form the focus of searches looking at the relationship between OA and
organisational culture.
16
Societal/Non work factors
(not represented on figure)
Diagnostic consensus
Family support/understanding
Access to primary/secondary care
Social Inequality/Health
Inequality
Public Health
Costs
Organisation –“hard”
variables
Organisation –
“soft” factors
Job
Me
Potential “Hard” Organisational
Factors
•
•
•
•
•
•
•
•
•
•
•
Figure 3: Breakdown
of psychosocial and
other organisational
influences on
occupational asthma
(based on the HSG48)
•
•
Occupational health policy
Occupational health provision
Occupational health procedures
Occupational health diagnosis
Risk assessments
Redeployment policy/potential
Resource (economic and staff)
constraints
Primary Intervention
Secondary Intervention
Tertiary Intervention
Liaison with stakeholders
/primary/secondary routes
Employment Status
Supply Chain
Potential individual ‘me’ factors
Potential ‘Soft’ Organisational Factors:
Cognitive
• Risk perception/appraisal/resignation
• Health Beliefs
• Attitudes to behaviour
• Expectations
• Comprehension/understanding/memory
• Values
• Motivation
• Self-Efficacy/Locus of Control
• Personality
• Awareness
• Familiarity/Experience
• Decision Making
Communication
• Risk communication, strategy, media and availability
• Management approach/style
• Communication structures
• Training
Organisation Attitudes
•
•
•
•
•
•
Health and safety culture
Health and safety climate
Peer and management attitudes
Reference norms
Support
Relationships (inc. stigma)
Behavioural
• Health behaviours/coping strategies
• Habitual behaviours/routines/Conditioning
• Skill acquisition
• Non-compliance
• Poor work practices
Current/past practices
•
•
•
Track record
OA incidence/prevalence rates
Changing working patterns
Environmental
•
•
Emotional
• Fear (e.g. of economic consequences)
• Emotional consequences (anxiety and
depression).
• Stress as a (reaction or cause).
• Satisfaction
• Morality
Sick building syndrome
Environmental tobacco smoke
Potential “job” factors:
•
•
•
•
•
•
Usability of PPE/RPE
Design of PPE/RPE (including aesthetics/comfort)
Selection/Issue of PPE/RPE
Task (duration, complexity)
Person task fit
Use of engineering controls
Condition
• Symptom severity, intermittency and
reversibility
• Disabling effects
17
Sources: For this phase the following sources were used:
Websites (see section 6 for full list)
Academic Databases
•
•
•
•
•
•
•
•
Medline/Pubmed
Science Direct
Psychinfo
CINAHL
PROQUEST
Web of Science
Cochrane
Database of Abstracts of Review
Effectiveness (DARE)
• NHS Economic Evaluation (NEE)
2.1.2
•
•
•
•
•
•
•
•
•
•
•
HSE (and links)
AOHHN
BMJ
Journal of Occupational Medicine
Journal
of
Occupational
and
Environmental Medicine
Asthma.org
British Occupational Health Research
Foundation
British Lung Foundation
COSHH Essentials
British Occupational Hygiene Society.
British Thoracic Society.
HSE/HSL Research Phase
Aim: To focus on identifying relevant research commissioned by HSE or undertaken by HSL
within the last 10 years which provided, either through direct investigation or incidentally as
an explanation for an observation, (a) psychosocial explanations for exposure to a substance
hazardous to health, (b) diagnostic barriers specific to occupational health care, or (c)
organisational contributors to health risks.
Strategy: Literature was derived from two main sources:
(a) Key members from various HSL sections (e.g. Medical Unit, Biological Monitoring,
Health Effects, Personal Protective Equipment, Risk Assessment, Ergonomics, Work
Psychology, Exposure Monitoring, Field Measurement, and Inorganics and Fibres) were
approached to:
• Firstly, identify relevant research they were aware of that had been conducted
by either themselves or section colleagues that could inform the research aims,
and,
• Secondly, on the basis of their experience, discuss the psychosocial factors that
might apply as a source of anecdotal evidence.
(b) HSL and HSE intranet websites.
Inclusion criteria: As described in section 2.1, the degree of inclusiveness varied for each of
the psychosocial layers (see figure 3). Those providing psychosocial or organisational related
explanations for observations, or that directly investigated a psychosocial risk factor, were
then coded for inclusion within the review (see section 2.2). For example:
• Individual factors: Searches focused on any work conducted since 1999/2000
concerning exposure to occupational asthma and contact skin dermatitis health risks,
or work addressing management and prognosis of these conditions once symptoms
had arisen. General literature reviews conducted by HSL of psychological risk factors
such as risk perception were also included.
18
• Immediate work environment: Any work undertaken in the last 10 years (since 1995)
alluding to attitudes surrounding PPE usage and hygiene control usage for respiratory
and dermal hazards.
• “Soft” organisational factors: Any work concerning communication, training or
cultural (including health and safety culture) influences on occupational health risks.
• “Hard” organisational factors: Any work conducted since 1995 concerning barriers
associated with occupational health provision, supply chain barriers, health
surveillance, rehabilitation or redeployment policy or risk assessment for occupational
health risks.
2.1.3
External/Public Domain Searches
Aim: To complement findings from preceding stages by conducting tailored searches
targeting specific psychosocial and organisational factors surrounding occupational asthma
and asthma development, prevention and management. This phase focused on public domain
databases to ensure the review adequately represented contemporary findings for each
psychosocial theme addressed.
Strategy: The precise strategy varied for each ‘psychosocial’ layer is as follows:
Individual Factors: Having previously discovered a number of general literature reviews from
2000/01 covering the psychology of asthma, corresponding searches focused on work
undertaken since 2000. Searches centred on occupational asthma, occupational dermatitis,
and asthma and, where necessary, other respiratory disorders, since each can arise from
behavioural non-compliance with exposure prevention measures. Non-work related asthma
was included in this level since it was assumed that corresponding behavioural, cognitive and
emotional antecedents or consequences would not differ widely from occupational asthma.
Accordingly, search terms were expressed utilising the following format (utilising Boolean
expressions):
a)
Cognitive (from 2000 to present)
e.g. [risk perception OR appraisal] AND [occupation* asthma OR occupation*dermatitis OR asthma]
e.g. [beliefs OR attitude* OR knowledge OR motivation OR cost-benefit OR awareness] AND
[occupation* asthma OR occupation*dermatitis OR asthma]
e.g. [illness representation OR symptom perception OR illness perception OR expect*] AND
[occupation* asthma OR occupation*dermatitis OR asthma]
e.g. [complacency OR denial OR fatalism OR resignation OR acceptance] AND [occupation* asthma
OR occupation*dermatitis OR asthma]
e.g. [decision making OR familiarity OR latency] AND [occupation* asthma OR
occupation*dermatitis OR asthma]
e.g. [control OR locus of control OR self-efficacy OR responsibility OR perceived control] AND
[occupation* asthma OR occupation*dermatitis OR asthma]
e.g. [personality] AND [occupation* asthma OR occupation*dermatitis OR asthma]
b)
Behaviours (from 2000 to present)
e.g. [behav*r OR habit OR habitual OR compliance OR work practice* OR skill] AND [occupation*
asthma]
c)
Emotion (from 2000 to present)
e.g. [emotion* OR fear OR stress OR anxiety OR depression OR moral*] AND [occupation* asthma
OR occupation*dermatitis OR asthma]
d)
Condition (from 2000 to present)
e.g. [perception] AND [severity OR intermittency OR reversibility OR consequences OR disabil* OR
duration] AND [occupation* asthma OR occupation*dermatitis OR asthma]
19
Immediate work environment: Lack of empirical formal investigation, for example into
attitudes to PPE usage and hygiene control measures, during phase 2 warranted extending the
time frame to cover the past 10 years for job related factors. Searches focused on
occupational asthma, other respiratory conditions and occupational dermatitis to a lesser
extent due to its different PPE requirements. Research providing psychosocial explanations
for non-compliance with industrial hygiene based control measures represented the broadest
inclusion criteria. Corresponding search terms included (utilising Boolean expressions):
a) PPE (from 1995 to present)
e.g. [PPE OR personal protective equipment OR RPE OR respiratory protective equipment]
AND [occupation* asthma OR (other respiratory conditions, e.g. COPD, asbestosis)]
e.g. [PPE OR personal protective equipment OR RPE OR respiratory protective equipment]
AND [occupation* asthma OR (other respiratory conditions, e.g. COPD, asbestosis)] AND
[attitudes OR beliefs OR perception]
b) Task (from 1995 to present)
e.g. [task] AND occupation* asthma OR (other respiratory conditions, e.g. COPD, asbestosis)]
AND [Design OR use*)
c)
Occupational Hygiene (from 1995 to present)
e.g. [control* OR hierarchy of control* OR industry* hygiene OR occupation* hygiene OR
inspect*] AND [occupation* asthma OR (other respiratory conditions, e.g. COPD, asbestosis)]
e.g. [control* OR hierarchy of control* OR industry* hygiene OR occupation* hygiene OR
inspect*] AND [occupation* asthma OR (other respiratory conditions, e.g. COPD, asbestosis]
AND [attitudes OR beliefs OR perception]
“Soft” Organisational Factors: Any barriers or contributors operating at the soft
organisational level are likely to have read across for a range of occupational health hazards.
Consequently, search terms addressing this level related to occupational health in general, and
centred on research undertaken since 1995, again to optimise inclusiveness. Since this level
comprised management style and culture, grey literature such as magazine articles from
health and safety publications, trade associations or trade unions were also considered.
Searches were structured as follows:
a) Communication (from 1995 to present)
e.g. [risk commun* and communication OR strategy OR media OR structure OR approach*]
AND [occupation* asthma OR occupation* dermatitis OR Occupation* health OR
occupation* disease OR health and safety]
b) Attitudes (from 1995 to present)
e.g. [organ* culture OR organ* climate OR health and safety culture OR health and safety
climate OR attitudes OR norms] AND [occupation* asthma OR occupation* dermatitis OR
Occupation* health OR occupation* disease OR health and safety]
c) Current/Past Practices (no date limit)
e.g. [reputation OR organ* change] AND [occupation* asthma OR occupation* dermatitis
OR Occupation* health OR occupation* disease OR health and safety]
d) Environmental (from 1995 to present)
e.g. [sick building OR air OR smok*] AND [occupation* asthma OR occupation* dermatitis
OR Occupation* health OR occupation* disease OR health and safety]
20
“Hard” Organisational Factors: With the exception of barriers associated with primary (e.g.
screening, substitution, engineering and administrative solutions), secondary (e.g. health
surveillance) and tertiary interventions27 (rehabilitation and redeployment practices),
corresponding searches accommodated occupational health in general. Again, a read across
between OA and other occupational diseases was anticipated where barriers concerned access
to occupational health policy and provision, the supply chain, and resource restrictions.
Conversely, intervention searches centred on occupational asthma, occupational dermatitis
and other respiratory conditions. Each shares a common aetiology in terms of behavioural
non-compliance with exposure precautions. Date limits applied depending on the availability
of relevant literature and the likelihood of having being affected by the SH2 launch.
a)
Occupational Health (from 2000, i.e. since SH2 launch)
e.g. [occupation* health provision OR diagnosis] AND [occupation* asthma OR
occupation* dermatitis OR occupation* disease] AND [barriers OR access OR availability]
b)
Rehabilitation (no date limit)
e.g. [rehabilitation OR redeployment] AND [occupation* asthma OR occupation* dermatitis
OR (other respiratory conditions, e.g. COPD, asbestosis) ]
c)
Interventions (from 1990 to present)
e.g. [interven* OR training OR prevent* OR education OR manag*] AND [occupation*
asthma OR occupation* dermatitis OR (other respiratory conditions, e.g. COPD,
asbestosis)]
d)
Supply Chain/Stakeholder Links (no date limit)
e.g. [supply chain OR trade associations OR trade OR trade unions OR network OR liaison]
AND occupation* asthma OR occupation* dermatitis OR occupational health OR
occupational disease (other respiratory conditions, e.g. COPD, asbestosis)]
Societal Factors: Since this level is intended to capture the interactions between societal and
workplace influence on OA occurrence, it was decided to include non-work related asthma
within corresponding searches addressing, for example, family support and socio-economic
status (SES). No restrictions were placed on the occupational diseases relating to medicallegal barriers given the paucity of work in this area. With the exception of support, no date
restrictions were applied.
a)
SES (no date limit)
e.g. [SES OR socio economic status OR inequal* OR quality of life] AND [occupation*
asthma OR asthma]
b)
Medical Legal (no date limit)
e.g. [legal OR litigation OR medico-legal OR compensation] AND [occupation* asthma
OR asthma OR occupational health OR occupational disease]
c)
Support (from 1995 to present)
e.g. [family OR social OR peer OR work OR colleague OR supervisor OR manag*] AND
[support] AND [occupation* asthma OR asthma]
Sources: Public domain searches were conducted with the assistance of HSE’s Information
Services’ search team. Databases covered comprised Assia, Ebsco table of contents, Ebsco
27
See Glossary for definition
21
business science corporate, Embase, Ergonomics Abstracts, Excerpta, Healsafe, IBSS,
Medline, Oshrom, Oshplus, Psycinfo. Social Scisearch, Social Science Citation Index, and
Sociological Abstracts.
2.2
DATA EXTRACTION AND CODING
Articles fulfilling the inclusion criteria were then subjected to data extraction. Data was
extracted for the following areas:
•
•
•
•
•
•
•
•
•
•
Article type (e.g. news article, commissioned report, incident investigation,
interview, study, literature review, other)
Design type (e.g. controlled study, survey, case study, observation).
Cross sectional, retrospective or prospective
Sample size
Job Type
Agent/COSHH substance
Industry Sector: (e.g. agriculture, catering/hospitality, construction,
chemicals, engineering, food manufacture, haulage, health services, local
government, MVR, surface engineering, waste management)
Organisational size
Stakeholder type
Psychosocial factor(s) documented, its role as either contributor to OA or
intervention barrier, and detail on its implication for OA development,
prevention and/or symptom management
Labels for the various psychosocial factors identified were kept consistent across all the
articles examined. However, their respective grouping under related themes were revised and
consolidated at key stages during the review (for example, between search phases) in order to
keep the complexity of the emerging themes to a minimum.
2.3
EVIDENCE WEIGHTING
Since this was a critical rather than systematic review, criteria were drawn up in order to
weight the quality of evidence underpinning the psychosocial themes identified. Weighting
criteria are specified in figure 4 below, and are based on a combination of study type and
consistency of findings. The criterion used was selected on the basis of it being able to
accommodate the diversity of literature and article types encompassed within this review. The
heterogeneity of the psychosocial variables considered rendered a purely systematic
methodology impractical within the project’s timescale and budget. Rather, every effort was
made to ensure the approach used was as methodological and as pragmatic as possible given
the complexity of the relationships addressed.
22
Very Strong
Evidence
Strong Evidence
Underlying evidence is generally consistent
and includes findings from a series (two or
more) of cross sectional studies without
control groups.
Underlying evidence may contain some
inconsistencies, and/or includes evidence
from one cross sectional surveys, and/or a
series (two or more) of descriptive reviews
and/or a series (two or more) of case studies.
Moderate
Evidence
Limited
Evidence
Weak Scientific
Evidence
2.4
•
•
Figure 4: Quality Criteria28
Strong evidence + more than 10 articles
included within that factor
Underlying evidence is generally consistent
and includes findings from systematic/critical
reviews and/or more than one scientific study
with either control group comparisons and/or
a longitudinal design.
Underlying evidence is reliant on expert
opinion (e.g. editorial letters), single case
study, and opinion, and/or anecdotal
examples.
Strong evidence
More than 10 articles
Control group
comparisons, systematic
consideration of
evidence, longitudinal
studies, randomised
controlled trials (RCTs)
Series of cross sectional
studies
No control groups
Single cross sectional
study
Series of case studies
Series (two or more) of
descriptive reviews
Single descriptive review
Single case study
Anecdotal evidence
Expert Opinions
ARTICLES
99 HSE/HSL articles fulfilled the inclusion criteria.
368 public domain articles fulfilled the inclusion criteria.
28
Adapted from the Royal College of General Practitioners (RGCP) system used within the BOHRF (2005) Evidence based
guidelines for the prevention, identification, and management of OA.
23
3
SUMMARY OF RESULTS
For each of the psychosocial ‘variables’ uncovered by this review, related evidence strength is
given in brackets following first mention of that factor. Corresponding variables are separated
into OA contributors, OA diagnostic barriers and OA management barriers. Some variables
fall under one or more of these distinctions. Full details of the results from the articles
reviewed can be found in appendix 2: Main Review and details of the references used can be
found in appendix 3: Tables of Psychosocial Factors References.
3.1
CONTRIBUTORS
3.1.1
Individual
Individual ‘psychosocial’ risk factors that exacerbate the likelihood of OA development can
be divided into cognitive (thought-related), personality, emotional and behavioural categories.
Cognitive predictors:
The accuracy of a workers’ appraisal of the degree of risk presented by an asthmagen can be
undermined by risk perception biases, risk knowledge and comprehension ability:
•
•
Risk perception biases: Those risk perception biases that may have a significant role
in underestimating perceived risk included OA latency (strong), hazard familiarity
(strong) and misperception of OA severity (very strong). Thus, the prospect of an
uncertain and potentially distant health threat such as occupational asthma does not
appear to act as a powerful compliance incentive. Likewise, hazard familiarity,
generated by associations of asthmagens such as flour or grain with safe domestic
use, could give rise to a false sense of security. Underestimation of health
ramifications associated with OA will produce a similar effect. Misunderstanding of
hazard characteristics (moderate) may similarly undermine risk appraisals. This can
be attributed to the transparency and insidious nature of asthmagen exposure, and
consequent underestimation of clearance times and dispersal zones. Assumptions of
PPE invincibility (moderate), of others being at greater risk (social comparison bias,
limited), and that working in the private sector (limited) automatically mitigates risk
also emerged as possible distorters. Within the broader literature domain, a tendency
to construe risk according to isolated events rather than and accumulation of exposure
(accumulation bias, limited) will undoubtedly apply to workers exposed to OA
hazards.
Knowledge: Inadequate knowledge of risks (very strong) in general, as characterised
by broad and unspecified risk interpretations, as well as difficulties in differentiating
risks from hazards and in identifying the circumstances under which risk arises, could
substantially undermine workers’ risk appraisal. Also, imprecise knowledge of
potential long term health effects (strong) that asthmagen exposure can bring about,
along with poor knowledge of controls29, in terms of what they are, why and how
they work (control knowledge, moderate), have been identified as predictors of noncompliance with exposure precautions. A further body of evidence demonstrates that
knowledge, be it of risks, health consequences or controls, is insufficient for
guaranteeing behavioural compliance with control measures (behaviour link,
moderate). Comprehension, or the ability to learn guidance, emerged as a significant
predictor for asthmatic medication compliance. Although no direct evidence for the
role of intelligence levels in predicting exposures was found, difficulties in
29
The term control is used in its broadest sense, and refers to regulations as well as engineering, administrative or PPE solutions,
and hierarchy of control principles for exposure reduction.
24
understanding risk information, and learning disabilities, in particular, must
inevitably exacerbate exposure risk.
Workers’ actual decision to avoid risk may be contingent upon the cost-benefit interpretations
(moderate) they make. This in turn will be influenced by the availability of controls,
acceptance that controls work, acceptance of responsibility, health beliefs and attitudes,
perceived control over hazards and sense of self-efficacy.
•
•
•
•
Compliance decisions can be considered a product of the cost-benefit judgements
(moderate) workers make of risk control measures. In this context, costs are used in
this broadest sense and can refer to financial, efficiency, time or ‘self-esteem’ losses.
Where the perceived costs outweigh perceived benefits, asthmagen exposure may
continue unchecked. Other ‘cost’ considerations that might be perceived to outweigh
the benefits of adopting a risk aversive approach include productivity interference
(productivity costs, strong), task interference (goal directedness, moderate), usage
difficulties, communication obstruction and discomfort.
Comparison of differences between lay persons and experts (availability, moderate)
in the way risk decisions are made reveal poor agreement, and a tendency for ‘lay
person’ judgements to be swayed by available production processes and risk
information sources, such as suppliers, as opposed to applying COSHH guidelines
‘by the book’.
Regardless of their availability, evidence implies that workers must accept (control
acceptance, strong) that controls work if they are to consistently use them.
Employees must also believe themselves personally susceptible to the adverse
consequences of OA (health beliefs, moderate).
Mixed evidence emerged for the role that workers’ perceptions of the amount of
control they have over hazard exposure has upon compliance. Such ‘perceived hazard
control’ (limited) could increase compliance by encouraging workers to become more
engaged in tasks or reduce compliance by over-inflating a sense of risk immunity. A
related concept, workers’ ‘self-efficacy’ (moderate), referring to personal beliefs
about possessing the necessary skills for controlling exposure, can also represent an
important compliance determinant. Ambiguity surrounding workers’ perceived
responsibility (moderate) to protecting themselves against OA hazards and an
assumption that responsibility fully resides with line management might similarly
jeopardise exposure control.
A decision to ignore risks may be based on the presence of a fatalistic attitude (very strong) or
complacency (moderate). Fatalism represents a resignation to the risks faced and consequent
inertia in controlling those risks. It is more likely to occur where workers feel that they have
no option but to work with asthmagens, as can happen in SMEs where control resources are
more limited. Related to perceived control, complacency corresponds to an assumption of
‘risk immunity’ and appears directly proportional to length of experience unhampered by
adverse exposure events.
Personality:
High sensation seeking personality traits (moderate) can predispose exposure risk, as can a
general tendency to engage in risk taking behaviour, regardless of context.
Emotions:
Potential emotion related contributors to OA development include employer fear of
enforcement and experience of work-related stress and its overlap with non-work stress
sources. Employers’ fear of enforcement (moderate), particularly amongst SMEs, can mediate
25
OA exposure risk through employers failing to acquire appropriate risk information from
HSE. The role of stress (limited), stemming from work demands, intensity and control, in
precipitating OA development is unclear. Stress possibly increases OA susceptibility through
modulating immunity.
Behaviour:
Health behaviour and associated conditions such as smoking (very strong) and obesity
(strong) are recognised risk factors for OA. Smoking combined with exposure to work-related
asthmagens may have a manifold affect on OA susceptibility. Based on research from cancer
and cardiac health care, ‘monitoring’ or ‘blunting’ coping styles (strong), respectively
referring to a tendency to actively seek or avoid risk information to deal with a health threat,
may also mediate also OA susceptibility. For example, ‘blunters’ may deliberately ignore
risk communication.
Regardless of any intention to adopt more risk averse strategies, compliance may nonetheless
be thwarted by entrenched habits (strong) or difficulties in sustaining concentration over time
(limited). Safety-related research on sustained concentration, or vigilance, demonstrates that
it can be undermined by boredom, poor hydration, low carbohydrate levels within the blood
stream, low arousal levels (see figure 5), environmental distracters, and shift patterns/points in
the shift, such as between the second and fourth hours or during post lunch dips. Sustained
compliance will be contingent upon line management using reinforcement (moderate),
through summative (praising the outcome) or formative (advising on further skill
enhancement) feedback that is timely, perceived as important, and predictable. Examples of
non-compliant behaviour by sector are listed in table 1. This should demonstrate how
peripheral tasks, such as sweeping up, or transferral of hazards into and out of storage, and
reflexive actions such as ‘catching drips,’ should be factored into risk assessment.
Figure 5: The Yerkes-Dodson law demonstrating an inverted ‘u’ relationship between task
performance and arousal levels (1908, taken from Whitlock, 2002)
26
Table 1: Examples of non-compliant behaviour by sector
Overall
Factor
Task
Specific
Factor
Stage
of OA
Metal Work / 1,2,4
Soldering
1,2,4
Wood
working
1,2,4
1,2,4
1,2,4
1,2,4
Paint spraying 1,2,4
/ Isocyanate
1,2
Article
mentioned in
Pengelly et al
(1998)
Evidence Quality
Cross sectional survey and site
visits. 26 sites / 239 samples
Park (2001)
Case control study of 8
automotive plants.
N = all workers employed for at
least 6 months between 1967 and
1993.
Dilworth (2000) Cross sectional survey and
sampling. 47 sites / 386 samples
Rosen et al
(2005)
Descriptive review
Agent/Condition/
Generic
Comments
Rosin based
solder flux fume
Solderers in assembly and PCB production have more exposures below detection limit (due to
more LEV and easier accessibility of work piece) compared to solderers in repair work who
have higher short-term exposures (due to less LEV and limited accessibility so have to work
closer to work piece).
Hard metal dusts
(e.g.
cobalt/tungsten
carbide)
Asthma incidence increased in tool grinding - mean tool grinding cumulative measures were
greater for asthma cases. For welding, asthma cases had similar or smaller mean exposures as
controls.
Wood dust
High exposures came from particular wood working processes: multitasking, sanding, circular
sawing, routing
Generic
VEM can show relative importance of type of task on total exposure, e.g. more than half
exposure due to a metal rolling task or greatest contribution to exposure during wood working
routing with a hand held power tool.
Stewart-Taylor Cross sectional survey. N = 17 Asbestos/amosite Clear association of higher cumulative exposures when workers used power tools compared to
and Cherrie
workers (6 teams).
but issues may
manual methods (7 times higher). Careful bagging was shown to reduce exposures by a
(1998)
apply
smaller margin (approx half). Such findings re power tools may apply to asthma risk
industries such as woodworking.
Brosseau et al
PRECEDE-PROCEED model to Wood dust
Planning committee members described the most important barriers to using dust controls to
(2002)
develop intervention study. Used
be difficulties with maneuvering hand-held sanders around bulky pieces. Planning committee
planning committee (N = 10),
was also aware in general of operations causing the highest levels of dust (sanding and routing
pilot study of monitoring and
with hand-held powered tools).
observation (N = 5) and focus
groups (N = 6 workers/3 owners)
Roff et al (2003) Sampling and Observation. 41 N-methyl
Dermal exposure to hands was significant during wiping and dipping tasks. Small scale
samples / 28 subjects
pyrrolidone (not manual dipping had much higher exposure - therefore type of task can impact on exposure.
sure if OA agent)
Talini et al
Questionnaire survey and testing. Isocyanates, wood Prevalences of attacks of shortness of breath with wheezing and dyspnea were higher in spray
(1998) - abstract 296 furniture workers
dust
painters (13.5% and 11.5%) than in wood workers (7.7% and 6.3%) or assemblers (control
group; 1.6% and 1.6%). Asthma like symptoms found in 13.3% of spray painters but only
10% of woodworkers and 4% of assemblers.
27
Bakeries
1,2
Sennbro et al
(2004)
Personal air monitoring survey Diisocyanates or
for exposure to isocyanates. N = polyurethane or
111 workers / 223 samples.
both
On average, the personal exposure levels in the different types of manufacturing tasks were in
decreasing order: continuous foaming > flame lamination > moulding >> low or no heating
processes.
1,2
Redlich et al
(2002)
1 year follow up of SPRAY
Hexamethylene
survey to investigate exposure of diisocyanate
autobody shop workers (N = 45) (HDI)
There were more painters and technicians than office workers who reported work-related
asthma-like symptoms.
1,2,4
Brooks (1995)
Descriptive Review
Asthma
1,2,4
Bulat et al
(2004)
Exposure sampling from 70
bakeries in Belgium (N = 411
samples)
Exposure levels in traditional bakeries (job tasks not clearly divided and automation poor smaller bakeries?) seem to be higher than in industrial bakeries (degree of automation and
clear division of job tasks - larger bakeries?).
1,2,4
Smith (2004) abstract
Evaluation of in house
respiratory health surveillance
programme
Inhalable dust,
wheat flour and
alpha-amylase
allergens
Asthma
1,2
Liss et al (2003) Questionnaire mail survey (1110
- abstract
medical radiation technologists
(MRTs) and 1523
physiotherapists)
Hoppin et al
Cross sectional questionnaire and
(2004)
exposure sampling study
Cohort of 20,898 farmers
Various
chemicals, e.g.
glutaraldehyde
Prevalence of reporting 3 or more respiratory symptoms, 2 or more work-related and 3 or
more work-related respiratory symptoms in the past 12 months was more frequent among
MRTs - mostly associated with unusual tasks than routine tasks.
Respiratory
irritants, e.g.
diesel, solvents,
welding fumes
Driving diesel tractors, exposure to solvents resulting from cleaning or painting tasks, hand
picking crops and using natural fertilizer were factors associated with increased odds of
wheeze - not OA.
1,2
1,2,4
Healthcare
Farming /
1,2,4
Crop Workers
For certain types of jobs or industrial operations, asthma is noted to develop in an
exceptionally high percentage of persons exposed, e.g. spray painting.
Elms et al (2003) Cross sectional survey and
Flour dust and
Mixers and weighers from large bakeries had the highest exposures to both inhalable dust and
sample testing. 117 samples / 22 enzymes
fungal alpha amylase. 63% of individuals exceeding MEL were weighers and mixers. Target
orgs
these job categories for control measures.
Burstyn et al
Exposure sampling and
Wheat antigen
Tasks such as weighing, pouring, and operating dough brakers or horizontal mixers increased
(1998)
observation from 96 bakery
and fungal alpha- flour antigen exposure while packing and decorating resulted in lower exposures. Croissant,
workers in 7 different small or
amylase.
puff pastry and bread bun production lines were associated with increased exposure, while
medium sized bakeries in
cake production and substitution of dusting with divider oil were associated with decreased
Canada.
exposure. Exposure levels can be reduced by automation or alteration of tasks requiring
pouring of flour and changes to types of product manufactured.
28
Over the 10-year period of surveillance, the incidence of symptomatic sensitisation in the
bread-baking sector (2240 per million employees per annum) was greater than for other flour
using groups (330 per million employees per annum).
Detergent /
Cleaning
Hairdressing
1,2,4
Holness and
Nethercott
(1995)
1,2,4
Danuser et al
Epidemiological questionnaire
(2001) -abstract study. N = 1542 Swiss farmers.
1,2,4
Monso (2004) abstract
1,2,4
Vanhanen (2000) 40 workers and 36 non-exposed
- abstract
workers subjected to skin prick
and RAST tests
1,2,4
Zock et al (2001) Spanish part of the European
- abstract
Community Respiratory Health
Survey, using telephone
interviews. N = 67 indoor
cleaners.
1,2,4
Albin et al
Postal questionnaire of female
Asthma
(2002) - abstract hairdressers from vocational
schools in Sweden and referents
from general population.
The hairdressers most often performing hair bleaching treatments or using hair spray had,
compared with most infrequent users, a lightly but not significantly higher incidence of
asthma.
1,2,4
Hollund et al
Questionnaire survey in Norway. Hairdressing
(2001) - abstract N = 100 hairdressers (91%
chemicals
response), 95 office workers
(84% response) and population
based control group.
Compared with the population control group, hairdressers younger than 30 and older than 40
reported more symptoms such as breathlessness in the past year. Hairdressers over 40
reported significantly more symptoms such as wheezing and breathlessness than office
workers. Older hairdressers reported symptoms more often than younger hairdressers.
Karjalainen et al All Finnish male construction
Asthma
(2002) - abstract workers and all administrative
workers were followed through a
register 1986-1998.
Risk of asthma was increased in nearly all construction occupations but it was highest among
welders and flame cutters, asphalt roofing workers, plumbers and bricklayers and tile setters.
Construction 1,2,4
Questionnaire surveys of 606
pork producers and 53 hog
confinement farmers and 43
control farmers. Follow up 6
years later with 36 hog farmers
and 32 controls.
Bronchial challenge tests in
greenhouse growers
Farm dusts and
gases
The most common activities associated with RPE use were feeding and working in the barns both tasks tend to generate more dust.
Re Bronchitis but Poultry farmers experienced the highest symptom rates. Chronic bronchitis was increased in
issues may apply crop farmers. Over 4 hours per day spent in animal confinement buildings more than doubled
the risk for chronic bronchitis.
Pollens, moulds, Cultivation of greenhouse crops may cause occupational asthma through sensitisation to
Tetranychus
workplace pollens, moulds and Tetranychus urticae allergens. Skin testing identifies
urticae allergens sensitisation to these allergens in one third of workers and more than one fifth will develop
OA.
Enzymes Occasional peak values up to 80 ng/m3 were detected in the packing and maintenance tasks
protease
and high values of >1ug/m3 in the mixing area
Asthma
29
Asthma risk of Spanish cleaners is primarily related to the cleaning of private homes and may
be explained by use of sprays and other products in kitchen cleaning and furniture polishing.
3.1.2
Job
Job related variables mediating OA risk include emergency situations (weak), PPE
availability, design and comfort, usage extent, age, effectiveness, maintenance and associated
record keeping, as well as ventilation control ease of use and maintenance. PPE availability
(very strong), in terms of supply and location has, unsurprisingly, been identified amongst the
most important compliance predictors. So too has PPE design and comfort (very strong).
Underpinning evidence consistently demonstrated how PPE’s possible interference with task
performance, manual dexterity, communication, and creation of discomfort through poor fit,
and heat, can deter appropriate usage. ‘Image concerns’ and religious based ‘dress’
requirements were offered as explanations of non-compliance in only a few instances. Poor
cleaning and maintenance practices (very strong) in accordance with manufacturer guidelines
and poor record keeping of PPE issue and maintenance (limited) can lead to PPE being used
well beyond its expiry date (duration, moderate). Curiously, research on PPE effectiveness
(strong) demonstrated increased prevalence of respiratory symptoms amongst more frequent
and prolonged users within the farming industry. Over reliance on PPE at the expense of other
controls, and an assumption of ‘PPE invincibility’, and difficulties in wearing PPE
appropriately due to vigorous activity, could explain such anomalies. Control ease of use
(strong), such as the location of switches, bulkiness or weight and consequent fatiguing
effects, and associated maintenance checks (moderate) also emerged as risk factors. Examples
of variation of exposure by job-related tasks are detailed in table 2 below. Again such
variations need to be taken into account for psychosocial risk assessments.
30
Table 2: Examples of variation of exposure by job-related tasks
Overall / Specific
Factor
Work Practices
Compliance/Poor
practices
Stage of
OA
Article mentioned in
Evidence Quality
Agent/Condition/Generic
1,2,4
Liu et al (2000)
Case studies - 3 auto
body shops examined
and sampled.
Isocyanates.
More
re skin disease but issues may
apply to respiratory
sensitization and asthma.
Cross sectional survey Flour dust and enzymes
and sample testing.
117 samples / 22 orgs
Cross sectional survey Wood dust
and sampling. 47 sites
/ 386 samples
Cross sectional survey Flour dust
and dust sampling. 55
bakeries
1,2,4
Elms et al (2003)
1,2,4
Dilworth (2000)
1,2,4
Elms et al (2004)
1,2,4
Roff et al (2003)
Sampling and
Observation. 41
samples / 28 orgs
N-methyl pyrrolidone (not
sure if OA agent)
1,2,4
Chambers, Sandys and
Piney (2005)
Isocyanates
1,2,4
Avory and Coggon
(1994)
Case study of 1
company. Site visit
and interviews (4
sprayers and 1
manager, plus 28
monitoring samples).
Interview survey.
N = 84 agricultural
workers / 79 farms
1,2,4
Roghmann et al (2003) abstract
Pesticides - but issues may
apply
Observational study of Re hand disinfection but
workers in 2 intensive issues may apply
care units
31
Comments
Good workplace hygiene and work practices may significantly
reduce environmental surface contamination and skin exposure,
e.g. preventing hardeners and paints from collecting on
workbench surfaces.
Improved working practices needed, e.g. NOT manually folding
empty flour improver bags for disposal and creating visible dust
clouds.
Brush cleaning of wood dust witnessed at 96% of sites, even
though 79% had vacuum
Despite 80% of bakeries reporting that they understand that
flour dust is a respiratory sensitiser, most bakeries still
undertook inappropriate work practices such as flour dusting by
hand and dry brush cleaning.
At smaller dipping for paint stripping premises some poor work
practices seen - a worker cupped their gloved hand to catch
drips while carrying items to the sink and this spread
contamination to the taps.
Some samples from manager had evidence of exposure
suggesting that some spraying in the open workshop has taken
place or that the manager entered the booth unprotected during
spraying or before clearance.
Compliance was lower for following manufacturers
recommendations about disposal of containers. Only 14% said
they disposed of containers as instructed. Compliance was more
consistent for using and application, mixing, and cleaning.
589 opportunities for hand disinfection were recorded in 40
hours of observation. Overall compliance was only 22%. Only
4.8% of workers appropriately complied with disinfection when
hands were exposed to multiple body sites. Glove use increases
compliance.
1,2,4
White and Benjamin
(2003)
1,2,4
Pengelly et al (1998)
1,2,4
O’Hara and Dickety
(2000)
Descriptive Review
Generic
Suppliers need to assess H&S knowledge at client end as the
supplier (transporter) may be more used to dealing with hazards
than the occasional receiver, e.g. driver/supplier has full PPE,
unloader does not.
Cross sectional survey Rosin based solder flux fume Position adopted by workers relative to fume affects exposure.
and site visits. 26 sites
E.g. high result found when solderer leaning over workplace
/ 239 samples
and placing breathing zone closer to fume.
12 case studies and
Generic
Examples of poor work practices include:
literature review
Taking drinks into the exposure area because it is easier.
Worker observed sweeping dust using no protective clothing or
equipment and switched off the extraction.
Cleaning
paint guns without wearing mask, despite knowing they should.
32
3.1.3
Organisational
‘Soft’ organisational OA contributors can be grouped under communication, attitudinal and
work organisation variables.
Communication risk factors:
Exposure risk appears highly dependent on the quality of risk awareness and control training
received (training benefits, moderate). According to the literature reviewed, training was
deemed more effective when provided prior to commencing a job and repeated throughout
(delivery, strong), or indeed when provided during early vocational training (moderate) as a
way of instilling positive health and safety attitudes at career inception. Risk assessment
training (strong), control usage training (strong), and training provision within SMEs
(moderate), was generally found wanting. Evidence cited training within SMEs in the
woodworking and chemical industries as occurring on an ‘on the job’ or ‘sitting with Nelly’
basis, perhaps on an assumption that experience equates to training competence. Training
managers in feedback and reinforcement techniques offers a potential means of improving
compliance (managers, limited). Specific sectors within which training provision
inadequacies were identified included agriculture, baking, woodworking and chemical
industries. As part of training delivery, risk communication was recognised as more effective
where:
•
•
•
•
•
•
Efforts were made to make it as accessible (moderate) as possible,
It is pitched in industry relevant (moderate) phraseology,
It is conveyed via multi-media techniques (moderate),
It combines text with illustration,
Provided by a credible and trustworthy source (moderate),
It is consistent (moderate) and tailored to audience needs (limited).
Risk learning was typically acquired by word of mouth, with written information often left
unread (preferences, moderate). The usability (very strong) of risk communication was
improved where expressed in simple, concise, visual, explicit and prescriptive terms.
Consequently, Safety Data Sheets (SDS) were often criticised as too technical. HSE tended to
be under-used (source, strong) as an information source, with SMEs in particular acquiring
information via less reliable sources such as supply chains and mail shots from commercial
organisations.
Attitudinal risk factors:
Attitudinal factors occurring at the organisational level mirror implicit organisational norms
and beliefs. For the purpose of this review, attitudinal-related risk factors for OA can be subdivided into support/social norm and health and safety climate and organisational culture.
• Support/Social Norms
The amount of social support (support quantity, strong) encountered at work can predict
compliance intentions. This underscores the necessity of constructive supervisory
support. Where prevailing ‘social’ norms adopted by colleagues dictate a dismissive
attitude to occupational health (frame of reference, moderate), peer pressure (strong) can
prove a powerful compliance deterrent.
• H&S Climate
Safety climate refers to the attitudes towards safety within an organisation whilst safety
culture concerns the underlying beliefs and convictions of those attitudes or the prevailing
values of the social group (Guldenmund 2000, in Gadd and Collins 2002). Both embody
an organisation’s attitude to safety and, by implication, occupational health. A need for
33
improved safety climate (moderate) was documented. Accordingly, safety climate
attitudes are conveyed via behaviour relating to leadership style/management approach
(very strong), line management as role models (strong), providing consistent messages
(limited) and harnessing worker commitment (very strong). A positive occupational
health climate is reflected in honest reporting (strong) of occupational health related
statistics, an organisations’ reputation and the relative importance attached to
occupational health compared with safety and productivity considerations. In terms of
priorities, occupational health (moderate) and, to a lesser extent, safety (moderate) are
widely considered by employers to conflict with productivity (very strong). A positive
occupational health climate is thus contingent on managers of all levels responding
quickly to occupational health related suggestions, meeting with staff to discuss health
and safety concerns, planning maintenace episodes, involving staff, unions and health and
safety advisers in occupational health risk control decisions, and acting as consistent role
models, for example, by always wearing PPE in hazardous areas. Internal perceptions of
safety climate were found to vary between managers and frontline staff, with the latter
holding the more negative perception (peer/management discrepancy, strong), be more
positive where training was provided (moderate) and unions were involved in
occupational health decisions (limited), and have an inverse relationship with job tenure
(moderate). Amongst the literature reviewed, SMEs (limited) were rated as possessing
both positive and negative safety climates.
• Organisational Culture
Organisational culture30 is distinct from safety culture, in that it is possible to have a
positive and supportive organisational, yet negative safety culture. Nonetheless, it appears
that the two can interact to exacerbate exposure risk. For example, a blame culture
(limited) could suppress exposure incident reporting and block upwards risk
communication. A macho culture (strong) encourages complacency and potential ridicule
of workers endeavouring to adopt more risk ‘averse’ behaviours. The presence of subcultures (moderate) varying between teams or organisational levels can also hinder
uniform conformity to control measures.
Work Organisation:
The impact that shift patterns (duration and time of day) (moderate) have on exposure
‘opportunity’ should also be encompassed by risk assessments.
Hard organisational factors:
Facets of an organisations’ policies, procedures and resources (‘hard’ organisational factors)
mediating exposure risk can be sub-divided under prevention practices, occupational health
provision, liaison and resources.
• Prevention Practices
Usage of a number of OA sensitisers or irritants (exposure complexity, limited) can
complicate intervention effectiveness. The most preferred solution for eliminating risk,
substitution (moderate), can be thwarted by preference for more familiar engineering
solutions, inadequate risk assessment of alternatives, and cost. Inconsistent evidence was
found for the role of formal performance or safety incentives (limited) on reducing
occupational health risks. Safety incentive schemes rewarding absence of incidents can fail
through facilitating report suppression and peer isolation within blame cultures. The same
may be true of schemes based on ‘exposure’ incidents. Performance incentives or schemes
such as ‘piece meal’ work practices and bonuses undermine health and safety through their
exclusive focus on productivity considerations. Incentives provided on a group basis may also
have limited impact because of their diluted meaning for individuals. Other literature cited a
30
See Glossary for definition
34
combination of incentives, based on reward, social recognition and feedback parameters, to
exert a synergistic (multiplicative) effect on performance. More effective interventions
(efficacy, very strong) tended to observe hierarchy of control principles. Preventative
interventions are generally considered most effective where:
• Employees understand the physiological effects,
• Hazard levels are the highest,
• Hazard levels are constant,
• Process conditions are unchanging,
• Associated jobs and tasks are routine,
• Employees are actively involved in hazardous tasks,
• Management demonstrate commitment,
• Where there is positive attitudes from peer groups,
• They engender self-efficacy.
• Occupational Health Provision
Widespread use of prospective health surveillance (very strong) was frequently
recommended. Exposure limits (limited) were widely recognised as having limited
effectiveness. Inadequate occupational health provision (very strong) and availability of
occupational health policy (moderate) within SMEs was frequently observed.
• Liaison
To coordinate efforts on OA prevention and risk communication, improved liaison (moderate)
between employers, trade associations, other local business, trade unions, suppliers and large
commercial organisations was recommended. Supply chain length can undermine the
reliability of the health and safety information they provide (weak). Weak points can arise at
the transaction point between front line supplier and receiver (weak), during storage (weak)
and from employing casual staff (limited). See figure 6 as a demonstration of stakeholders
who could be involved within improved liaison.
• Resources
Financial (moderate), health and safety staff provision (moderate) and time (moderate) thwart
usage of preventative measures. Unsurprisingly, developing preventative interventions
appeared easier for larger firms (moderate).
Figure 6: Key stakeholders who could be involved in workplace interventions to prevent
occupational asthma (source: Curran and Fishwick, 2003b)
HSE
Insurance
THE WORKPLACE
Occupational
Health
Provider
Company
Trade
Workers
Specialist
Physician
Association
Occupational
Asthma
Sufferer
The Supply
Chain
Trade
Unions
35
Solicitor
Primary Care
Physician
3.1.4
External
Inadequate (very strong) or dysfunctional (moderate) family or social support can predispose
asthma risk. Asthma risks are greater for those with poorer employment and income prospects
(very strong). Similarly, strong evidence implies socio-economic status as an asthma risk
factor, with prevalence rates being higher amongst people living in poorer housing and
possessing a lower income (very strong). Increased smoking prevalence, poorer education and
tendency to enter ‘asthmagenic’ jobs could potentially mediate the relationship between SES
and asthma. Gender’s (limited) role as risk factor appears more ambiguous. Some, but not all
research, demonstrates females at greater risk. Relative to other ethnic groupings, some
evidence (limited) suggests Afro-Caribbeans and Asians may be at greater risk. Again, SES
may mediate this observation. Limited profiling of asthma by public health campaigns
(limited) and employer ambiguity over the legal exposure minimum (strong) could contribute
to asthma prevalence.
3.1.5
Model
The model in figure 7 provides an explanatory framework31 for organising identified
psychosocial contributors to occupational asthma. Only those risk factors receiving very
strong (vs), strong (s), or moderate (m) evidence based quality ratings are listed in the model.
The model is broadly divided into individual, job-related, organisational and external layers
that either directly or indirectly influence compliance. Individual factors predispose
compliance. Accordingly, initial hazard identification and risk appraisals (stage 1) may be
distorted by risk perception biases and risk knowledge and comprehension. The decision
(stage 2) to respond to the OA risk that is perceived (from stage 1) is contingent on the costbenefit interpretations made, which in turn may be affected by control acceptance, attitudes to
risk, self-efficacy and assumed responsibility, or fear of enforcement. Cost-benefit
interpretations will also assimilate environmental based information such as PPE availability
and control usability. Perceived control is also included within the model since, in principle, it
should factor heavily in determining whether employees feel their actions will make a
difference to risk. From the cost-benefit judgement an intention to avoid or ignore risks then
arises (stage 3). Intention in itself does not guarantee ‘congruent’ behaviour (stage 4). Latent
individual factors that may block intention include existing work habits and vigilance levels.
Other ‘latent’ individual factors, such as impulsive personality traits, and health behaviours
may have an indirect effect upon each of the stages 1-4.
The extent to which an intention to comply (stage 3) is realised is contingent on ‘enablers’
that operate in the immediate environment. PPE/control availability, design, maintenance and
ease of use and job hindrances or stressors can be regarded as such ‘enablers’.
Other organisational and external based factors exert an indirect influence and can loosely be
regarded as reinforcers of compliance behaviour, potentially affecting all of the individual
based stages. Health and safety climate, mediated by leadership style and worker involvement
have a potent influence, as will training and risk communication practices, and occupational
health provision. From outside the organisation, external support and socio economic factors
can also conspire to determine OA risk.
The relationships between stages 1 to 4 are portrayed as one way since these concern a
decision making sequence in which output from one stage informs the next. Corresponding
circles overlap to demonstrate how the content of each is not necessarily mutually exclusive.
31
Note: This model is intended to profile how the psychosocial and organisation risk factors identified might interact in
predilecting OA risk and is an adaptation of DeJoy’s (1996) worker self-protection model. This model was chosen because it is
draws on various contemporary evidence-based health behaviour prediction theories and applies them to occupational hazards,
and because of the intuitive explanatory-power it offers (see DeJoy et al, 1996 for further information). It has not been subjected
to empirical testing.
36
For example, risk perception biases stemming from OA latency will also figure strongly in
cost-benefit appraisals. However, the relationship between each stage and the environment are
bi-directional, reflecting how compliance is contingent upon the interaction between the
employee and their environment. The principles underpinning the model could equally be
applied to exposure reduction decisions applied by worker and manager alike.
37
Figure 7: Psychosocial Contributors to Occupational Asthma (adapting DeJoy’s (1986) Stage Model of Workplace Self-Protective Behaviour)
Personal experience / job tenure (m)
Impulsiveness (m)
Stress (m)
Asthmagen
Immediate
Environment
‘Soft’ Organisational
Stage 1: Risk Appraisal
Risk perception:
Latency (s)
Familiarity (s)
Anticipated severity (s)
PPE invincibility (m)
Knowledge:
Risks (vs)
Health consequences (s)
Controls (m)
Health Behaviour (vs)
Coping Style (s)
Concentration
Habits (s)
Latent Individual Factors
Stage 2: Decision Making
Cost benefit appraisal (m)
Availability (lay vs expert) (m)
Control acceptance (s)
Attitudes to risk (m)
Complacency (m)/fatalism (vs)
Self-efficacy (m)
Responsibility (m)
Fear of enforcement (m)
Perceived control of hazard (l)
Stage 3: Intention
to avoid or ignore risk
Stage 4: Behaviour
Compliance/risk Aversion
Exposure/ Risk Taking
Job: PPE (availability (vs), design/comfort (vs), maintenance (vs), Control ease of use (s), Control maintenance (m),
Hard Organisational
Communication/Training: Training (availability, (s), control use (s), risk assessment (s), management feedback (m)), Risk communication (accessibility (s),
relevance (m), usability (vs), credibility (m).
Attitudes: Support (s), norms (m), peer pressure (s), health and safety culture (leadership (vs), worker commitment (vs), productivity conflict (vs), macho culture
(s), sub-cultures (m))
Overlook substitution (m), health surveillance (vs), occupational health provision (vs), occupational health policy (m), Resources (finance (m), staff (m), time (m)
External/Societal
Support (vs), SES (vs)
38
3.2
DIAGNOSTIC BARRIERS
3.2.1
Individual
In the absence of any health surveillance, a decision to seek diagnosis will be contingent upon
workers perceiving symptoms to be of sufficient severity to warrant medical help. Symptom
perception will be dependent on the reliability of their pre-existing knowledge of the health
effects of OA morbidity (health consequences knowledge, strong). Perception inaccuracy is
common even among asthmatics (perception inaccuracy, very strong). Misattribution can
stem from confusing anxiety-induced dyspnea (misattribution: stress, limited), or through a
‘classical conditioning’ of symptoms (conditioning, strong). As such, an expectation that
symptoms may arise can induce greater symptom reporting that is independent of underlying
pathology. Workers who know they are sensitised, but are as yet asymptomatic, may be
particularly susceptible to symptom misattribution, although no studies were found
investigating symptom appraisal amongst individuals falling into this category.
Environmental distracters can also interfere with the ability to read symptoms (environmental
distracters, limited). Symptom appraisal will also be contingent on symptom severity (very
strong), intermittency (limited), reversibility (limited), variability (limited) and speed of onset
(symptom onset, weak). Accordingly, symptoms that are more severe, more frequent and less
variable are more likely to compel the employee to take advice.
The actual decision to go through the diagnostic process can also be framed as a cost-benefit
judgement (cost-benefit, moderate). The literature reviewed suggests that this judgement may
be swayed by unwillingness to relinquish control for the condition to medical care (perceived
control of condition, very strong), beliefs about the efficacy of OA treatment and the longterm impact of OA on health (health beliefs, moderate), fears of treatment dependency
(strong) and interference with life goals (goal directedness, moderate). Above all, it will be
biased by a seemingly justified fear in potential loss of income once the employer becomes
aware of the diagnosis (fear of economic consequences/confidentiality breach, very strong).
Such fears are justified by substantially reducing ‘workability’ (strong), reduced quality of
life (strong), limited retraining (strong) or redeployment (strong) options with the same
employer and poor employment prospects ratings amongst asthma sufferers (economic
prospects, very strong). Any anxiety (anxiety, limited) following on from symptom
manifestation can either impede diagnosis access by clouding judgement, or motivate the
employee to gain a diagnosis and comply with treatment. Symptom denial (OA denial, very
strong), and related avoidant coping strategies (coping strategy, strong) may be adopted by
workers preferring to avoid medical help due to what they perceive as unacceptable overall
costs to their livelihood.
3.2.2
Organisational
A ‘safety’ culture within which productivity is prioritised over occupational health
(conflicting priorities, very strong) will thwart diagnostic intentions. Other diagnostic barriers
occurring at the organisation/administrative level concern occupational health provision. A
widespread shortfall in health surveillance (very strong) availability prevents early diagnosis.
Employees’ fear of the economic ramifications implicated by OA can also potentially
undermine honest reporting (honesty, limited) within health surveillance questionnaires and
during any diagnostic consultation. Inadequate specificity and sensitivity (techniques, very
strong) amongst diagnostic tests and testing comprehensiveness (limited) also thwarts reliable
diagnosis. So too does lack of consensus on how to diagnose OA (diagnostic consensus,
strong), difficulties in isolating work-related causes (causal uncertainty, very strong) and
protracted referral routes (referral route, strong). Referral delays stem from inadequate
availability of OH provision (OH usage, very strong), under-resourcing within those OH
services that are available (OH resources, limited), forcing them to take a reactive approach
(approach, strong), and a related tendency for workers to initially seek a diagnosis via
39
primary care. Possibly due to a low profile of occupational medicine within mainstream
medical training, evidence implies that general practitioners are inadequately equipped for
making a prompt OA diagnosis (primary care competency, very strong).
3.2.3
Societal
Both employers’ and employees’ economic-based fears associated with OA diagnosis
seemingly have their routes in the compensation system. For the employee (employee
(dis)incentives, very strong), sub-salary reward sums, the potential of claims rejection due to
difficulties in proving employer negligence, lengthy claim processes, removal from the job as
the claim proceeds, and difficulties accessing experienced lawyers can collectively deter
employees from seeking compensation. If the threat of having to compensate occupational
health problems is meant to act as an incentive for employers to adopt better preventative
practices, then some evidence suggests that the system fails in this regard (employer
(dis)incentives, limited). Diagnosis ambiguity can make it easier for employers to contest
claim legitimacy and the costs of compensation may be less than that of preventative
measures. Underhand practices, such as threatening to sack employers, concealing
occupational disease records, and placing employees on long-term sick might be adopted in
order to circumvent compensation payouts (employer based costs, strong), as well as prevent
a claim record blemishing an organisation’s reputation and contractual eligibility.32
Difficulties in making a reliable diagnosis and consequent credibility risks can also make
clinicians reluctant to engage in the claims process (clinician disincentive, limited).
Other societal related barriers conspiring against early diagnosis include reluctance to acquire
the stigma of poor health (stigma, moderate), support (very strong) and being male (limited).
3.2.4
Model
The effect of diagnostic barriers on employees’ intentions to access appropriate medical
advice can also be explained by applying DeJoy’s (1996) worker self-protective behaviour
model (see figure 8). As with the other models, with the exception of stress caused
misattribution, anxiety, honest reporting, test comprehensiveness, employer compensastion
(dis)incentive and gender, only variables achieving moderate (m), strong (s) or very strong
(vs) quality ratings are listed within the model. Responding to initial symptom manifestation
will be contingent upon symptom perception and attribution processes (stage 1). These will be
mediated by pre-existing knowledge of OA, environmental distracters, symptom severity and
possible symptom misattribution. If symptoms are appraised to be of sufficient severity to
warrant a diagnosis (stage 2), the decision to seek diagnosis or respond honestly to health
surveillance testing will rest upon the relative cost judgements made. Apparently justified
economic-based fears of potential job loss and poor subsequent employment, redeployment or
retraining prospects are likely to weigh in favour of avoiding earlier diagnosis. Even if an
intention is formed to seek a diagnosis (stage 3), organisational factors, such as a poor health
and safety climate, prioritisation of productivity over occupational health concerns, poor
access to occupational health provision and diagnostic uncertainty can block such intentions.
Compensation system drawbacks, in particular, may reinforce employee and employer
reluctance to engage in the claim process.
32
It was not possible to discern the extent of such practices from the available literature.
40
Figure 8: Diagnostic Barriers for Occupational Asthma (adapting DeJoy’s (1986) Stage Model of Workplace Self-Protective Behaviour)
Stage 1: Symptom Perception
Symptom
Inaccuracy (vs)
Misattribution: conditioning (s),
stress (l)
Symptom severity (vs)
Knowledge:
Health consequences (s)
Soft
Organisational
Hard
Organisational
Stage 2: Decision Making
Cost benefit appraisal (m)
Perceived control (vs)
Goal directedness (m)
Health beliefs (m)
Economic / confidentiality fears
(vs)
Anxiety (l)
Stage 3: Intention
Obtain diagnosis
OA/symptom denial (vs)
Stage 4: Behaviour
Seek diagnosis
Coping strategies (s)
Honest reporting (l)
Workability (s)
Quality of life (s)
Attitudinal: Health and safety climate (productivity vs occupational health) (vs);
Occupational health provision: Health surveillance (vs), OH policy (m) OH usage (vs), OH reactive approach, Testing
reliability (s), testing comprehensiveness (l), diagnostic consensus (s), referral route (s), causal uncertainty (vs), primary
care competency (vs).
External/Societal Employee compensation (dis)incentive (vs), employer compensation (dis)incentive (l), gender (l), support (vs),
employment prospects (vs)
41
3.3
OCCUPATIONAL ASTHMA MANAGEMENT BARRIERS (TERTIARY
INTERVENTIONS).
3.3.1
Individual
Literature demonstrates poor compliance with OA treatment and management regimes as a
common occurrence (non-adherence, very strong) and a risk factor for accident and emergency
visits, fatal asthma attacks and an overall worse prognosis (risk factor, strong). Due to its
immediate benefits, reliance on symptom relief as opposed to controller medication (immediacy
of relief, strong), regime complexity (moderate), and difficulties in reliably undertaking peak
flow monitoring (monitoring, limited) typify compliance challenges encountered by OA
sufferers. Improved self-management training is a widely reported need (self-management
training need, very strong). Tailored self-management plans and personalised prompts are
recommended as solutions for improving compliance (solutions, strong). Any worksite asthma
management programmes will have to limit the impact of OA on ‘workability’ (workability,
strong) and quality of life (strong). Curiously, quality of life ratings have been found to be
worst amongst OA sufferers than controls with equitable underlying pathology. Asthma may
therefore be perceived as less adverse when it arises from circumstances where the individual
had more voluntary control over exposure. This is more likely to apply to non-work related
exposure.
Individual cognitive factors that act as diagnostic barriers can also hamper OA management.
Accordingly, knowledge of long-term health consequences associated with OA (health
consequences, strong), environmental distracters (limited), misattributions stemming from stress
(limited) or ‘symptom expectations’ (conditioning, strong) may undermine workers’ ability to
read and respond appropriately to their symptoms. This ability is also likely to be moderated by
symptom severity (very strong), intermittency (limited), reversibility (limited), and variability
(limited). Hence, tertiary interventions aiming to improve an asthmatic sufferer’s ability to
remain at work should not overlook employees with mild and highly intermittent symptoms.
Through absence of symptom prompts, asthmatics with less severe and more intermittent
symptoms are recognised as having more difficulty in adhering to treatment regimes. Failure to
monitor their asthma management may therefore lead to a subtle deterioration in their work
capacity over time. Comprehension ability represents a significant risk factor for treatment noncompliance (comprehension, strong). Tertiary interventions will thus also need to make every
effort to accommodate workers’ comprehension level, and also improve their sense of perceived
control over the condition (perceived control over condition, very strong). Otherwise, denial of
OA severity (OA denial, very strong) and resultant non-adherence may arise. Development of a
diverse selection of coping strategies, encompassing problem focussed (tackling the stressor at
source) and emotion focussed (tackling the stress response) techniques, may enhance workers’
perceived control over their condition. Some evidence implies that adherence to such asthma
management programmes will be more likely amongst workers who believe their condition is
controllable, as well as long term (illness representations, limited).
Emotional variables that can potentially undermine the efficacy of OA management include
stress (limited), panic (limited), anxiety (limited) and depression (very strong). Adherence is
more likely to fail when experiencing multiple stressors or when depression, engendered by a
low sense of perceived control over the condition, creates a sense of learned helplessness and
consequent neglect. Anxiety appears to either motivate or hamper treatment compliance (see
section 3.2.1). Panic is cited as over-represented amongst asthmatics and associated with
increased morbidity. The respiratory symptoms brought about by panic can potentially interfere
with accurate symptom perception and response to asthma attacks. More severe mental health
problems are also linked with poor compliance.
42
3.3.2
Organisational
Within the immediate work environment, environmental tobacco smoke (ETS, strong) can
precipitate worsened asthma severity. Likewise, a history of asthma can predispose workers to
the effects of sick building syndrome (SBS, strong). Associated with work conditions
characterised by, for example, poor ventilation, low control over workload, high ETS, low
management commitment and low pay, SBS represents a group of mucosal, skin and lethargy
symptoms that is temporarily related to particular buildings.
For asthmatics unable to continue working within the same working environment, limited
redeployment (strong) or retraining opportunities (strong) renders it very difficult for OA
sufferers to continue employment without jeopardising their long-term prognosis. Where
relocation is viable, care must be taken to ensure risk assessments encompass other asthmagens
or sensitisers that may arise within the new work environment. Since early initiation of
retraining and redeployment can limit the length and extent of disability associated with OA,
expansion of such options would potentially improve the long term ‘workability’ of people with
OA.
Return to work (RTW) or rehabilitation programmes generally appear more effective if
conducted on a case management basis (rehabilitation, strong). Light duty assignment, reduced
hours and, where viable, modified or upgraded equipment, can facilitate a staged return. Work
characteristics, such as physical demands, worker control, length of hours worked, job-related
stressors and peer support will also need to be reviewed during the rehabilitation process. Where
published, in-house worksite management programmes (OA management programmes, strong)
encompassing, for example, trigger recognition, medication use and care of equipment, and lung
function monitoring have been found to be effective in overcoming knowledge and behavioural
barriers, and improving treatment compliance amongst workers with pre-existing and workrelated asthma. Safety climate, and the relative prioritisation of occupational health are likely to
have a strong role in rehabilitation availability and success (conflicting priorities, very strong).
Psychological techniques, such as relaxation and stress management, can provide a useful
adjunct to mainstream medical treatment. However, their precise efficacy has yet to be
established (psychological rehabilitation techniques, limited).
In addition to occupational health care availability, facets of medical care key to successful OA
management include physician competency (specialist expertise, moderate and primary care
competency, very strong), as a way of fostering patient confidence in the quality of care they
receive, and physician communication skills (relationship, very strong). Clear, supportive
communication that enhances patients’ expectations through providing a balanced portrayal of
the consequences of OA is, according to the literature, more likely to engage an individual’s
active management of OA.
3.3.3
Societal
Whilst support is positively related to improved prognosis amongst asthmatics (external support
quantity, very strong), over-exaggerated support by friends and employees may stifle any sense
of control the asthma sufferers may have over their condition (external support quality,
moderate). Financing prescriptions can deter sufferers from rigidly following treatment
guidelines (medication costs, strong). Non-adherent sufferers ironically incur greater costs to the
health care system through emergency care. Most of the direct and hidden economic burden of
OA appears to be bourn by the employer (employer costs, strong), through sickness, reduced
productivity and compensation claims. This can account for their apparent reticence to realise
OA risks.
43
3.3.4
Model
Potential barriers undermining the effectiveness of OA management can also be summarised
using DeJoy’s (1996) self-protection model (see figure 9). As with the other models, with the
exception of individual illness representation factors, stress caused misattribution and anxiety,
only variables achieving moderate (m), strong (s) or very strong (vs) quality ratings are listed
within the model. Symptom management is a function of the ability to perceive symptoms
accurately (stage 1), and discriminate them from other potential causes such as panic, stress or
symptom conditioning. The subsequent decision to rigidly adhere to treatment may also rest on
a cost-benefit judgement. Prescription costs, motives to obtain immediate relief, regime
complexity, and poor perceived control over the condition may sway the decision in favour of
non-compliance and subsequent OA denial (stage 3). Latent individual factors, such as
comprehension levels and coping resources may also moderate stages 1 to 4. The quality of
support received from the immediate work environment, as an indicator of safety culture, from
physicians, or by friends and family act as environmental-based factors that can reinforce or
undermine any compliance intentions. Optimising quality of life and workability amongst OA
sufferers will depend, in particular, on the redeployment, retraining and rehabilitation practices
made available.
44
Figure 9: OA Management Barriers for Occupational Asthma (adapting DeJoy’s (1986) Stage Model of Workplace Self-Protective Behaviour)
Latent Individual Factors:
Comprehension levels (s)
Coping strategies (s)
Illness representations (Cause, control and durability) (l)
Stage 1: Symptom Perception
Symptom
Inaccuracy (vs)
Misattribution: conditioning (s),
stress/panic (l),
Symptom severity (vs)
Knowledge:
Health consequences (s)
Soft
Organisational
Hard
Organisational
Stage 2: Decision Making
Cost benefit appraisal (m)
Immediacy of relief (s)
Regime complexity (m)
Economic / confidentiality fears
(vs)
Anxiety (l)
Depression (vs)
Stage 3: Intention
Manage/ignore symptoms /
OA Denial
(vs)
Stage 4: Behaviour
Treatment compliance
Symptom Management
Workability (s)
Quality of life (s)
Attitudinal: Health and safety climate (productivity vs occupational health) (vs);
Human Resource Practices: Redeployment (s), retraining (s), rehabilitation practices (s).
Occupational health provision: Specialist expertise (m), Physician communication skills (vs), primary care competency
(vs)
External/Societal Support quality (m), Medication costs (s), employer costs (s)
45
3.4
VARIATIONS BY ORGANISATIONAL SIZE
No hard and fast rules were observed for how psychosocial barriers varied according to
organisational size. This is underlined by inconsistencies within the literature concerning the
presence or absence of positive safety climates within smaller organisations. Therefore, it
cannot be concluded with any confidence that an organisation of a certain size will display
certain psychosocial attributes. Nonetheless, some broad trends were identified that could
loosely be applied to differentiating micro, small and medium companies from larger
organisations.
In general, evidence suggests smaller companies are less aware of occupational health risks with
workers at the front line least so. Formal risk communication tends to be more effective in
reaching larger organisations and is sometimes assumed by smaller companies to preclude them
on account of their size. Isolation from formal risk information sources means that smaller
organisations have less opportunity to counter their reluctance to approach HSE in case it leads
to enforcement action. Consequently, enforcement fears appear more predominant amongst
smaller organisations. Resource limitations experienced by smaller organisations could account
for their difficulties in funding health and safety representation in house, offering health
surveillance and adequate occupational health provision to their employees, and investing in
effective engineering or PPE solutions. Resultant constraints in employees’ ability to control
risk and limited redeployment and retraining options may leave them little option other than to
adopt a fatalistic attitude to the risks they face.
3.5
VARIATIONS BY INDUSTRY SECTOR
Variations of psychosocial factors according to the main UK industry sectors within which OA
arises is outlined within appendix 3. Summaries of those sectors that are better described within
the literature are provided in the discussion. Sectors are described according to:
•
•
•
•
•
•
Population size.
Gender mix. This is included on the basis of tentative evidence implying females as
more susceptible to OA and more receptive to compliance requirements.
Age profile. Habits are more likely to become entrenched with age. Providing an
overview of the ageing demographic within a given sector would reflect the amount of
effort required for changing habits.
Attitudinal dimensions of safety culture. For the purpose of this review, attitudes are
differentiated according to ‘don’t know the risks’, ‘aware of the risk but unsure if they
are applicable’, ‘aware but are taking not action’, ‘aware and will act sometime,’ ‘aware
and acting’. Prochaske and Diclemente’s (1984) stages of change model (see figure 11)
loosely translate onto these attitudinal distinctions.
Peer contact/networking. This indicates the different sources of potential health and
safety ‘influencers’ operating within a given sector and who in turn HSE needs to target
to encourage improved compliance within their target audience.
Resource constraints (knowledge, financial and time). This should indicate the sectors
relative readiness to take up good practice recommendations.
46
4
DISCUSSION
Those psychosocial variables identified within this review as receiving strong or very strong
ratings enable the following key messages to be made for OA prevention.
•
•
•
•
•
•
•
•
•
•
The latency of OA renders the uncertain health threat it may present as a weak incentive for
preventing asthmagen exposure.
Hazard familiarity and poor appreciation of the chronic health effects associated with OA
also hamper accurate risk perception.
Nonetheless, accurate awareness of risk is not enough for ensuring compliance.
Poor access to risk control measures, such as local exhaust ventilation (LEV) and PPE, in
terms of their availability and location, makes any positive intentions workers or managers
have to improve compliance negligible.
Regardless of their availability, employees must believe that controls will work if they are
to use them appropriately.
Similarly, repeated skills based training encompassing risk assessment and control use is
essential for optimising compliance.
Risk communication must be ‘useable’, credible and perceived as personally relevant for it
to have any motivating effect.
Demonstrable commitment by managers to occupational health, supervisory support and
inclusion of staff within occupational health-related decisions is an important prerequisite
for compliance.
Peer pressure mirroring a culture that is dismissive of occupational health concerns can act a
powerful deterrent to compliance.
Maintaining occupational health needs to be considered as integral to, and not at odds with,
organisational productivity if a positive ‘health climate’ is to be instilled.
For overcoming diagnostic barriers, the more salient psychosocial barriers imply:
•
•
Mitigating seemingly justified fears of adverse economic consequences following a positive
OA diagnosis, held by employee and employer alike, is crucial to encouraging earlier
diagnosis.
Improved access to OH provision, accompanying health surveillance, and alleviating
diagnostic uncertainty is also pivotal to encouraging earlier diagnosis.
Retaining more workers with OA in work is contingent on:
•
•
•
4.1
Wider and more diverse retraining and redeployment opportunities being made available.
Improving workers ability to read and respond to their symptoms appropriately.
Competent physician support.
CAVEATS
Before accepting the main findings of this review as entirely watertight, certain caveats related
to the underpinning methodology should be noted.
The quality rating system is an adaptation of the Royal College of General Practitioners (RGCP)
system used within BOHRF (2005) “Evidence based guidelines for the prevention,
identification, and management of OA.” It is therefore based on the methodological rigour
employed by studies contributing to this review. Inclusion of an eclectic mix of evidence types,
ranging from case studies and descriptive reviews to prospective investigations using control
47
group comparison, meant that it was not possible to factor sample size into the quality ratings.
Broadening the criteria to encompass numbers of studies relating to a theme may have lent
undue complexity. The limited criteria upon which the quality grading is based means that
resultant ratings are best regarded as ‘rules of thumb’ for differentiating the strength of evidence
underpinning each psychosocial variable identified.
As a result, absence of a strong evidence base does not necessarily mean that the corresponding
relationship is weak. In some instances it may simply reflect a paucity of research in this area.
Corresponding knowledge gaps are provided within section 4.2.
The themes or psychosocial variables under which evidence is grouped cannot consistently be
considered mutually exclusive. Inevitably there will be some overlap, for example, between
knowledge of health consequences and health beliefs, or social support, norms and peer
pressure. Consequently, no pretence is made that all of the variables identified will possess
scientifically verifiable ‘construct validity’. Rather, they provided an intuitive means for
organising the disparate array of factors exposed by this review and were arrived at by
discussion between two evidence reviewers.
As a result, some of the variables such as ‘employee disincentives [for making compensation
claims]’ can cover a mix of factors. To separate such factors out may have created excessive
fragmentation.
4.2
KNOWLEDGE GAPS/WEAKNESSES
This review has endeavoured to provide a comprehensive account of psychosocial contributors
to occupational asthma, and barriers to diagnosis and OA management. Lower quality ratings
allocated to some of the factors identified may reflect a paucity of research in that area rather
than strength of relationship. In particular, apparent ‘knowledge gaps were identified for the role
of
•
•
•
•
•
•
lapses in concentration in exacerbating exposure risk for occupational health hazards. The
majority of vigilance related research appears to revolve around major safety hazards and
fatigue, the relevance of which to occupational health hazards had to be extrapolated rather
than reproduced.
any symptom perception processes differentiating sensitised and asymptomatic employees
from symptomatic employees. Related conclusions have to be drawn from general symptom
perception research. Accordingly, sensitised and asymptomatic workers, who are aware of
their sensitised status, may be more susceptible to symptom misattribution but, equally,
more motivated to use precautionary measures than non-sensitised workers. Conversely,
they may be less motivated than symptomatic employees.
illness representations for occupational asthma in mediating OA management.
the supply chain in mitigating or increasing OA risk. Corresponding evidence was based
mainly on a limited number of generic literature reviews.
preventative behavioural or psychosocial interventions in reducing OA risks. Few
preventative behavioural change studies were identified, and those few that were revolved
around training interventions.
sub-cultures operating at a team level in distorting a cohesive organisational approach to
occupational disease prevention and management.
Nonetheless, this review is based on a comprehensive evidence base derived from inclusion
criteria that prioritises relevance to occupational asthma. Thus, despite the knowledge gaps and
caveats raised, it provides a sufficiently robust platform for guiding both intervention and
48
research recommendations. Moreover, the psychosocial barriers identified in this review, at face
value will have read across to other occupational diseases arising from behavioural noncompliance with dermal or respiratory health hazards. Equally, these recommendations should
also translate to these other occupational diseases.
4.3
INTERVENTION RECOMMENDATIONS
4.3.1
Prevention
The following psychosocial based recommendations for preventing asthmagen exposure are
based on current research consensus on the optimal ways for changing behaviour to improve
health (Bennett, Conner, and Godin, 2004; Michie, 2005; Michie and Abraham, 2004; Michie
and Johnston, 2004; Norman, Abraham, and Conner, 2000). The health behaviour prediction
models underpinning such research are increasingly being applied to health and safety issues
(e.g. Beatty and Beatty, 2004; Johnson and Hall, 2005; Perez-Floriano, 2001; Petrea, 2001;
Sheeran and Silverman, 2003). According to this consensus, compliance with health and safety
guidelines is contingent on:
1. The formation of attitudes that positively favour self-protective health behaviour. In this
context, attitudes comprise a combination of beliefs about anticipated consequences of
self-protective behaviour and the importance the individual attaches to those outcomes
(Conner and Abraham, 2001; Norman, Abraham and Conner, 2000). Thus, where
individuals perceive themselves as personally susceptible (perceived susceptibility) to
the health effects of not engaging in protective actions and anticipate those
consequences as adverse (perceived severity), they will be more inclined to follow
health and safety guidelines (Fleming, Lardner et al, 2002; Terrell, 1984).
2. Perceiving the benefits of self-protective behaviour to outweigh the costs. Even when
workers perceive a genuine personal health threat, they are not likely to follow guidance
if they believe the personal ‘costs’33 of doing so to outweigh the benefits (Bennett and
Murphy, 1997). From a behaviourist perspective such cost-benefit interpretation is
likely to be skewed by the immediacy of perceived consequences, in which case the
discomfort of wearing PPE and task interference will carry more weight in determining
PPE usage than the long term consequences of an uncertain health risk (Fleming,
Lardner et al, 2002; Terrell, 1984).
3. Creating a sense of ‘anticipated regret’. Manipulating emotions by highlighting the
sense of regret and remorse the individual may feel by failing to observe health
precautions has been found to reinforce the intention to engage in self-protective
behaviour (Conner and Abraham, 2001; Norman, Abraham and Conner, 2000).
4. Instilling ‘compliant’ social norms. Work-related social norms, as reflected in
colleagues’ and managers’ behaviour and attitudes to health risk, must be such that
signals following guidelines and avoiding health risks is important (see figure 10,
Azjen, 1985; Conner and Abraham, 2001).
5. Ensuring employees’ sense of perceived control. Employees must feel that they are able
to avoid risk (Berry, 2004) both in terms of:
a. Their believing that they possess the necessary skills, training and competency,
or self-efficacy, to do so (DeJoy, 1996),
b. Their work environment, through provision of appropriate resources and
support, instilling a belief that any self-protective actions that they do take will
be effective in reducing risk (response efficacy) (DeJoy, 1996).
6. Avoiding denial. Endeavours to raise risk awareness without furnishing employees with
the necessary skills (self-efficacy) or a facilitating work environment (response
33
In this context, costs can be psychological, social, or financial.
49
efficacy), as defined by prevailing attitudes and resources, is likely to fail. As a coping
strategy, workers may deny risks where they perceive themselves to have no option
other than to be exposed to those risks (Berry, 2004). Table 3 below demonstrates how
risk communication can be modified to accommodate individuals who prefer to avoid
detailed risk information (‘blunters’)
Table 3: Accommodating monitor and blunter coping styles: examples from
mammography screening
Monitor Message
Blunter Message
The key to finding breast cancer is early
detection, and the key to early detection is getting
regular screening mammograms. Cancers found
with mammograms are usually smaller than
cancers that can be felt, and they are less likely to
have spread. For some women, early detection
may prevent the need to remove the entire breast
or receive chemotherapy. Regularly scheduled
screening mammograms, together with clinical
breast exams, offer the best chance of finding and
treating breast cancer early.
There is no reason for you to take unnecessary
chances with your health. Early detection is your
best protection. Regular mammography reduces
mortality from breast cancer by up to 30%, so
schedule a mammogram today.
Source: Williams-Piehota et al (2005)
The key to finding breast cancer is early detection,
and the key to early detection is getting regular
screening mammograms. Breast cancer can be
detected early with mammography, long before
lumps can be felt by hand.
Early detection is your best protection.
mammogram. It can save your life!
Get a
7. Planning behaviour in detail. The translation of an intention to change behaviour
(Conner and Abraham, 2001) into actual behaviour change is improved substantially by
planning, and specifying the desired behaviour in detail. This involves specifying what
it involves, whom it applies to, when it should be undertaken (Michie and Johnston,
2005), and the formation of similarly detailed contingency plans to address potential
behavioural barriers that might arise (Golwitzer, 1993; Michie and Johnston, 2004;
Sheeran and Silverman, 2003; Schwartzer, 1992). Otherwise, the intention to change,
as created by risk knowledge, positive attitudes and beliefs, self-efficacy, and a
facilitating work environment (as outlined by the Theory of Planned Behaviour, see
figure 10) are not sufficient for guaranteeing actual behaviour change. Similarly, from a
behavioural perspective, all the antecedents predisposing behaviour change, in terms of
resources, attitudes, knowledge and skill, are again necessary but not sufficient for
ensuring a change in approach (Fleming, Lardner et al, 2002).
8. Reinforcing compliant behaviour to ensure its sustainability. Immediate, predictable
and positive34 reinforcement of compliant behaviour using methods perceived as
important by employees, such as verbal praise and recognition by a respected
supervisor, is more likely to guarantee sustained self-protective actions (Fleming,
Lardner et al, 2002).
9. Tailoring interventions to the stage of change. According to the stage perspectives of
behaviour change widely used in health promotion (Bunton, et al, 2000; Weinstein,
34
Positive reinforcers increase target behaviour by giving ‘something that is wanted’ following a behaviour, and is more likely to
yield optimal performance. This differs from negative reinforcers, which increases target behaviour through the avoidance of an
event that is not wanted (such as criticism), and tends to give rise to satisfactory, but not exemplary, or motivated performance.
Conversely, punishment reduces target behaviour by delivering an undesirable event or sanction following the behaviour in
questions (e.g. docking pay, or a ‘telling off’).
50
Rothman and Sutton, 1998; Whitelaw et al, 2000; see figure 11 for Prochaska and
Diclemente’s (1984) Theory of Transactional Behaviour) interventions must be tailored
to the individual or organisation state of preparedness to engage in change.
Consequently, knowledge and risk communication interventions have salience in
encouraging ‘contemplation’ of change, while planning based interventions (see figure
11) have more relevance to ‘implementation’ stages, and ‘reinforcement’ becomes
essential for ‘sustained’ change.
51
Attitude
Subjective Norm
Intention
Behaviour
Perceived
behavioural
Control
Figure 10: Health Behaviour Prediction: The Theory of Planned Behaviour
(e.g. Azjen, 1985)
Description: The Theory of Planned Behaviour (TPB) (Azjen, 1985) endeavours to provide a simplistic model of the decision
making determinants of behaviour (Conner and Abraham, 2001; Norman, Abraham and Conner, 2000). The TPB posits that an
individual’s intention to act in a certain way and sense of control over his/her environment are the most immediate pre-cursors of
behaviour. The model then describes intention to stem from:
Attitudes: (to the behaviour): Comprising of beliefs about the possible consequences of a given behaviour and evaluation of
whether that outcome is important (e.g. “if I don’t smoke my health will improve, which is important to me”).
Subjective norms: Comprising of perceptions of any social norms or pressures to perform a given behaviour combined with an
evaluation of importance (e.g. “my family would prefer it if I ate a healthier diet, and what they think is important”).
Perceived behavioural control (PB): Referring to the extent the individual believes they are in full control over their behaviour,
based on internal control factors, (e.g. abilities) and external control factors (e.g. environmental barriers) (e.g. “I could give up
smoking but it’s hard when everyone lights up in the pub”).
52
Precontemplation:
Not intending to make any changes
e.g. I enjoy smoking too much to give up
Contemplation:
Considering a change
e.g. (following health campaign) – perhaps I should give
up
Preparation:
Making small changes
e.g. planning how, reducing number smoked
Action:
Actively engaging in a new behaviour
e.g. quitting smoking altogether
Maintenance:
Sustaining the change over time
e.g. Staying ‘stopped’
Figure 11: Prochaska and DiClemente (1984) Transtheoretical Model of Change (‘Stages of
Change’).
Description: Prochaska and Diclementes’ (1984) transtheoretical model (TTM) depicts the stages people pass through when
undertaking behavioural change. When in precontemplation, change is not considered. During contemplation, preliminary
considerations of the need to change are made at a remote, often non-committal, level. The individual then engages in preparation,
whereby they actively plan for the implementation that occurs in the action stage. The subsequent maintenance stage reflects efforts
in sustaining change over time. The model is cyclical and bi-directional, in that individuals engaged in behavioural change can start
at any stage in the model and relapse back to earlier stages (Conner and Norman, 1996).
Specific recommendations for the application of these principles to mitigating the effects of
psychosocial contributors to OA development are provided in appendix 1. The model depicted
in figure 12 provides an overview of how recommendations link together and can guide the
sequence by which they should be considered. Based on a risk assessment approach, the
principles underpinning this model are intended to be applicable to staff of all grades. In
keeping with regulation 7 of Control of Substances Hazardous to Health (COSHH), this
framework is based on the assumption that either substitution, engineering and administration
solutions are, in the main, sought first for psychosocial barriers, and that ‘psychosocial’
solutions are produced for any residual risk. Notwithstanding the hierarchy of controls
approach, table 5 also demonstrates how these recommendations integrate with COSHH
principles compliance. The approach outlined in figure 12 is also based on the premise that the
relative contribution of psychosocial risk factors will vary between organisations; even those
that fall within the same industry sector and share the same size characteristics (Boocock and
53
Weyman, 1998). Hence, solutions for their prevention will have to be determined at a local level
if they are to achieve optimal effectiveness, with input from occupational health expertise where
necessary. The approach therefore resembles the risk assessment methodology used within
HSE’s management standards for stress.
4.3.1.1
A risk assessment framework for determining psychosocial
interventions:
The framework starts with HSE making a decision about the population of workers at risk of
OA (stage 1) it wishes to target with preventative strategies, potentially based on need and the
size of population to be accessed. Industry sector characteristics such as age and gender
demographics, predominant organisation size profiles, health and safety culture, extent of
‘network links’ with supply chains, trade associations, trade unions etc, industry prospects, and
usage of temporary/casual workers can help inform this decision (see appendix 3 for other
industry characteristics that can help inform the target population).
Organisations falling within the targeted populations then need to conduct ‘psychosocial’ risk
assessments in consultation with their staff and utilising HSE expertise where necessary. In
keeping with the 5-step approach, the risk assessment will comprise hazard identification,
identifying those at greatest risk of exposure, risk evaluation, prescribing actions, recording
findings, monitoring and review:
Hazard/Risk identification: Risk assessment tools can be developed in house, or be based on
externally generated tools such as DeJoy’s (2000) behavioural diagnostic questionnaires, or
utilise antecedent, behaviour and consequences (ABC) charts as outlined by Fleming and
Larder35, et al, (2002) (see recommendation 1 of table 7 in appendix 1). Qualitative based
techniques, such as focus groups and interviews, can be used to provide more contextual detail
on the risk factors uncovered by more quantitative tools, and provide some triangulation of
evidence. Usage of Likert scales within quantitative measures, combined with exposure
biomarkers and qualitative feedback would allow interpretation of the risk each hazard presents
to be made.
Identifying who is at risk: Analysis of psychosocial risk data by group should enable
identification of workers most susceptible to developing OA according to psychosocial
precursors combined with actual exposure indicators.
Action: Actual intervention choice can be guided by Prochaske and Diclemente’s (1984) stages
of change approach (see figure 10), and therefore be based on workers overall receptiveness to
change. Thus where:
•
•
Workers are deemed to possess insufficient knowledge of asthmagen risks and
consequences, training addressing these knowledge gaps should be provided (see
recommendations 2 and 3 of table 7 in appendix 1) to encourage ‘contemplation’ of
risks.
Where problems reside mainly with attitudes towards risks, health beliefs and risk
perceptions, interventions should be targeted at providing persuasive risk
communication in a way that encourages employees and employers to construe the
35
Antecedents refer to factors that contribute to a given behaviour. They are considered necessary but not sufficient for behavioural
change. Consequences relate to events that influence the likelihood of that behaviour being repeated, either through punishment or
reinforcement. ABC charts tend to skew consideration of behavioural precursors to more proximate factors. Consequently, division
of antecedents into personal, job, work environment and external layers may force a more rigorous consideration of events building
up to compliance.
54
•
•
•
•
costs of non-compliance to outweigh the benefits (see recommendations 8 to 22 of
table 7 in appendix 1).
Managers may also need to reconsider their health and safety climate based
interventions (see recommendations 30 to 32 of table 7 in appendix 1) through
reviewing their leadership style and recruiting peer leaders as a means of changing
attitudes.
However, knowledge or attitude based interventions will have limited effectiveness
where workers believe that they (a) lack ‘self efficacy’ and do not have sufficient skills
based training to follow compliance guidelines and apply their knowledge, (b) they
doubt control effectiveness, or (c) they do not have the necessary work resources (e.g.
availability of PPE or engineering controls) to put into practice any intentions they
have developed to use controls appropriately. In these instances, skills based training
(see recommendations 5 to 7 of table 7 in appendix 1), interventions encouraging
acceptance of control measure effectiveness such as video monitoring and biomarker
feedback, (see recommendations 8 and 9 of table 7 in appendix 1) or a stock take of
control provision, usability and accessibility (see recommendation 42 of table 7 in
appendix 1) will need to be undertaken.
To actually implement change, interventions will need to focus on specifying
compliance behaviour in detail, encompassing a description of what the actual
behaviour entails, who it involves, when and under what circumstances it should be
implemented (see recommendation 23 of table 7 in appendix 1) and include
contingency plans for compliance challenges such as pressurised working or
concentration dips. Work reorganisation, goal setting, recruitment of informal peer
leaders and peer or supervisor observation could also facilitate implementation of
change (see recommendations 23 to 28 of table 7 in appendix 1).
Sustained change often fails due to lack of reinforcement. Therefore, formal or
informal incentives will then need to be considered to ensure sustained compliance
feedback (see recommendations 29 of table 7 in appendix 1). This may necessitate
managers being trained in constructive feedback techniques.
Note that none of the stages outlined within figure 12 are mutually exclusive. Interventions
addressing health and safety culture will also affect self-efficacy, for example, and interventions
affecting knowledge will also affect implementation-based interventions. The central tenet of
this framework for guiding interventions is that the success of interventions addressing any one
stage will be contingent on needs relating to earlier stages having already been addressed. For
example, if staff, supervisors or managers do not adequately perceive risk, any supervised
planning they undertake to mitigate risks will not work. Moreover, due to the distal prospects of
the health threat associated with OA, the framework presented in figure 12 still needs to be
backed up by the realistic threat of enforcement or sanctions (see recommendation 45 of table 7
in appendix 1). This ensures that for the employers, the costs of non-compliance significantly
outweigh any benefits (COI reference).
Evaluation (Monitoring and Review): Intervention effectiveness can be gauged using a
combination of exposure indicators and psychosocial measures to provide triangulation of data.
Provided alternative explanations occurring over the course of the intervention are taken into
account (such as any changes in industrial hygiene practices, substitution or introduction of new
controls), collection of ‘biopsychosocial’ and exposure monitoring data should enable the
effects of modified psychosocial risk factors upon exposure variables to be more readily
delineated. More reliable pre and post intervention comparison will require the same techniques
used during the initial risk assessment to be reissued at post intervention stages and during
ongoing monitoring. However, at the post intervention stage, addition of specific measures
bespoke to the most salient psychosocial risk factors identified at pre-intervention stages would
facilitate greater exploration of their role. To provide a richer and more reliable body of
55
evidence, it is recommended that both quantitative and qualitative measures be used for gauging
psychosocial risk factors. Example options are listed in table 4 below.
Table 4: Suggested Outcomes for Evaluation OA Prevention Effectiveness
Outcome
Example Measures
Rationale
Generic Psychosocial
Risk Factors
Quantitative: Adaptation of the
Behavioural Diagnostic Questionnaire
(DeJoy, 2000).
Qualitative: ABC charts, observation (e.g.
comparing frequency of non-compliant
behaviour), focus group opinion.
Specific sub-scales from generic
measures, accompanied, where available,
by other risk factor measures. E.g.
Health and Safety Climate Tool: (HSE,
1997, Weyman and Milnes, 2001)
Risk Taking Personality: e.g. The Barrett
Impulsiveness Scale (Patton, Stanford and
Barratt, 1995).
Social Support: e.g. Caplan et al, 1980,
peer, supervisor and relationship support
scale.
Monitor/blunting style.
Locus of control.
Reissue psychosocial based
measure used in the initial
risk assessment for more
reliable pre-post and followup intervention comparisons.
Air monitoring/skin
exposure indicators
Quantitative: air sampling, air borne
levels in work place, surface/skin
contamination, air velocities in, near local
exhaust ventilation (LEV) systems.
Qualitative: Observation, assisted
observation (tyndall illumination for fine
aerosols)
Taken at pre, post and followup intervention stages.
Enables measurement of any
covariance between
psychosocial risk factors &
primary pre-absorptions
exposure indicators
Biological
monitoring/health
surveillance
Skin Prick/RAST tests for IgE (for Low
Molecular Weight [LMW] sensitisers)
Respiratory/sensitisation symptom
incident rate.
OA incident/prevalence rate.
Taken at pre, post and followup intervention stages.
Enables measurement of any
covariance between
psychosocial risk factors, and
biomarker ‘post absorption’
indicators.
Specific Psychosocial
Risk Factors
56
For exploring selected
psychosocial factors that
emerged as presenting the
greatest risk during the risk
assessment stage.
Figure 12: Risk Assessment Framework Incorporating Psychosocial Solutions Preventing
Occupational Asthma
Identify Target Population
Need and population size
Industry
Characteristics
HSE
•
•
•
Company/
HSE
consultation
•
•
•
Maintenance
PreparationImplementation
Contemplationpreparation
Precontemplation Contemplation
Stage (see pg 53)
Initial Psychosocial Risk Assessment
Psychosocial Hazard Assessment (e.g. behavioural diagnostic
questionnaires, ABC charts or qualitative methods)
Risk evaluation (incorporating exposure indicators and Likert
scales of psychosocial factors)
Exposure indicators (e.g. exposure monitoring and health
surveillance).
Solution Generation
Tailor to needs identified in psychosocial risk assessment and extent to which
workforce is receptive and accepts the need for compliance improvement (refer
to figure 10 for the stages of change model).
Take into account recipients’ comprehension level, credibility of source, training
competency and relevance to work place context.
Generate solutions with ongoing consultation and involvement.
Need
Solution
Knowledge of risk, consequences
and controls.
Risk perception biases.
Negative attitudes to compliance.
Ignoring risks.
Self-efficacy.
Control acceptance.
Perceived control.
Control/precaution accessibility,
usability and availability.
Translation of compliance
intentions into action (behaviour
link).
Knowledge-based training interventions.
Persuasive risk communication
(conveying personally relevant noncompliance costs to self and family),
health and safety climate interventions.
Skills-based training.
Control acceptance (biomarker feedback
& video monitoring).
Work organisation/reorganisation.
Stock-take of control provision,
usability, effectiveness, ‘use by dates’,
location relative to hazards, recruiting
informal leaders.
Preparation/detail contingency planning
“when x situation arises I will do y” and
contingency.
Instilling habitual behaviour.
Goal setting.
Manipulating peer pressure.
Reinforcement/recognition.
Performance appraisals.
Incentive schemes.
Observation
Change sustainment.
Evaluation
57
4.3.1.2
Integration with COSHH principles:
Table 5 lists psychosocial influences that can potentially affect compliance with COSHH
principles. Whilst each of the preventative psychosocial barriers identified by this review can
have either direct or indirect impact upon their application, particularly principle g, those listed
in table 5 concern barriers that may require particular consideration. These either affect all
principles or have particular importance to at least one. Those prerequisites for compliance with
all principles include:
•
•
•
•
•
An accurate knowledge of risks. Corresponding knowledge-based training should
include distinction between hazards and risk, asthmagen types, sensitiser or irritant
role, clearance times, exposure variation by task, work exposure limit (WEL), exposure
variation by task and the role of personal hygiene in mitigating exposure risk, to
encourage in depth understanding.
Absence of perceptual biases. Risk communication intended to correct latency,
familiarity and accumulation biases must be conveyed in such a way that managers,
and workers alike realistically perceive workers as susceptible to OA, and that the
short, medium and long term costs of non-compliance outweigh the perceived benefits
of non-compliance according to financial, productivity, ‘workability’ and health
variables. Video monitoring demonstrating exposure in real time, biomarker feedback
aligned with behavioural observations of compliance, case studies from OA sufferers,
and business cases demonstrating the productivity gains of ‘good practice’, can be used
to bolster persuasiveness of risk communication. To balance developing personally
relevant messages with avoiding costs incurred by individually tailored interventions,
these techniques could be based on ‘employee types’ rather than individuals.
Employee ‘type’ could be based on employees sharing:
equitable job tasks,
exposure to the same asthmagenic hazards,
access to similar control measures,
demographic characteristics such as age, gender and socio-economic status
(SES),
similar organisational cultures.
Occupational health and productivity on equal footing: Parity between occupational
health and productivity could be encouraged by integrating compliance variables into
any performance incentive schemes, ensuring mission, policy and procedural
statements reflect occupational health as integral to organisational performance, and
creating business cases demonstrating productivity gains accrued through good
practices in occupational health.
Providing skills based training. Employees’ confidence in their adherence ability will
be bolstered by effective skills training. Accordingly, training must be delivered by a
credible source, avoid the assumption that experience equates to training competence,
be construed as relevant to the job, give accurate advice, avoid unnecessary jargon and
acronyms, and be tailored to recipient needs. In particular, it should accommodate
recipients’ comprehension levels, given the latters’ role as a strong predictor of
treatment adherence amongst asthma sufferers.
Creating a positive health and safety climate: Demonstrable commitment by managers
to occupational health, conveyed by meeting staff to discuss health concerns; involving
staff in substance, equipment, control and personal protective equipment (PPE) design
and/or choice; acting as good practice role models through wearing PPE when exposed
to hazards; and ensuring line management consistency in violation reprimands, should
facilitate a collective commitment to occupational health considerations.
58
Table 5: Integration of psychosocial considerations into principles of good practice for the control of exposure to substances hazardous to health*
Psychosocial barriers requiring specific consideration
Psychosocial barriers (common to all principles)
(a)
Design and operate processes and activities to
•
Knowledge (risks, controls) (rec. 2, 3,
•
Cost-benefit interpretations (rec. 5, skills training)
minimise emission, release and spread of substances
knowledge training, and rec. 4-7, skills
•
Lay versus expert decision making (rec. 21, risk communication
hazardous to health.
training)
provider, and rec. 22, accessibility, utilisation of supply chain)
•
Risk Perception biases (rec. 8-22, risk
(b)
Take into account all relevant routes of exposure –
communication)
inhalation, skin absorption and ingestion – when
•
Knowledge of health consequences (rec. 3, knowledge training
developing control measures.
•
Conflicting priorities (rec. 38, and 40)
including exposure route illustrations, reference)
•
Health and Safety Climate (rec. 30–32,
•
Peripheral tasks/reflexive actions (rec. 4, risk assessment training, and
leadership)
rec. 2, knowledge of exposure routes, who is at risk)
•
Resource limitations (rec. 11, business
(c)
Control exposure by measures that are
•
Cost benefit interpretations (rec. 8 to 11, persuasive risk
case, rec. 38, conflicting priorities)
proportionate to the health risk.
communication)
•
Training (rec. 2 to 22, Knowledge &
•
Ignoring risks (rec. 8 to 11, persuasive risk communication, rec. 6,
skills training and risk communication)
skills training to counteract denial created by lack of self efficacy)
•
Control acceptance (rec. 8, video monitoring, rec. 9, observation and
biomarker feedback)
•
Fear of enforcement, preventing access to control advice (rec. 21 and
proactive inspector input, rec. 44, positive success stories of inspector
input)
(d)
Choose the most effective and reliable control option
•
Lay versus expert decision-making (rec. 21, risk communication
which minimises the escape and spread of substance
provider, and rec. 22, accessibility, utilisation of supply chain)
hazardous to health.
•
Cost-benefit interpretations (rec. 8 to 11, persuasive risk
communication)
•
Risk taking responsibility (screening/selection criteria)
•
Control acceptance (rec. 8, video monitoring, rec. 9, observation and
biomarker feedback)
•
Control accessibility/availability (rec. 42)
•
Concentration, distraction
(e)
Where adequate control of exposure cannot be
•
PPE invincibility assumption (rec. 8, video monitoring, rec. 9,
achieved by other means, provide, in combination
observation and biomarker feedback)
with other control measures, suitable personal
protective equipment.
(f)
Check and review regularly all elements of control
•
Responsibility (rec. 39, human resource management)
measures for their continuing effectiveness.
•
Resource – time availability (rec. 28, habit)
(g)
Inform and train all employees on the hazards and
•
Denial of risk/self efficacy (rec. 4-7, Skills training, 8-11 risk
risks from the substances with which they work and
communication)
the use of control measures developed to minimise
•
Comprehension (rec. 8 to 11, persuasive risk communication, rec. 6,
the risks.
skills training to counteract denial created by lack of self efficacy) (rec.
42)
•
Peer pressure: (rec. 26)
(h)
Ensure that the introduction of control measures
does not increase the overall risk to health and
safety.
•
•
Substitution (rec. 43)
Control accessibility/availability
59
*Recommendation numbers refer to those listed in table 7 in appendix 1 (preventative recommendations)
Principle specific considerations comprise:
•
Principle a and d: Both process design and operation (principle a) and control
choice (principle d) will need to take into account the immediate cost-benefit
interpretations made by operators when using them, so that their perceived benefits
serve to reinforce correct usage. Costs, in terms of task interference, consequent
performance interference, discomfort, time taken to apply, accessibility, values
conflict, and ease of use must therefore be minimised so that they do not exceed any
benefits gained from praise, recognition, financial incentives, avoidance of
sanctions, and controlling health risks. Equipment and control design and choice
will also need to accommodate possible dips in concentration and therefore
designed to minimise the conscious effort required in their application. Similarly,
both principles will be affected by lay and expert differences in control decisionmaking, where non-expert ‘employers’ choices are more likely to be swayed by
processes and substances already in place, and utilise available advice rather that
proactively seek expert sources. This suggests active promotion by HSE of the
COSHH essentials route map for SMES/non-professionals as necessary (see figure
1). It also suggests that HSE may need to intervene in ensuring that the advice
accessed by ‘non-professionals’ is kept up to date and accurate, through, for
example, inspectors training front-line substance and equipment suppliers in risk
awareness, COSHH essentials, optimal risk control and communication techniques.
Such training may also require direct input from the manufacturer to mitigate risk
distortion created by long supply chains. Where not in place, encouraging
acceptance of controls is particularly important. In which case, video monitoring
and exposure biomarker feedback tailored to ‘employee type’ observations may
provide powerful means of improving acceptance. Potential ‘risk takers’ should also
be excluded from control design and choice, ideally, during the recruitment phase.
•
Principle b: Models illustrating exposure pathways should enhance understanding
of exposure routes training provides. Such knowledge will need to encompass
variation of exposure risk by task, including that associated with less obvious
supporting activities such as sweeping, laundry, and transferral into and out of
storage. It should also accommodate familiarity perceptual biases, such as that flour
is harmless because it goes into food, and risks generated by reflexive behaviour,
such as using a hand to catch a drip, or raising a visor to check quality of work.
•
Principle c: Cost benefit interpretations and control acceptance also applies to
principle c in the same manner as a and d. Denial of risks may also be a particular
problem in ensuring controls are proportionate to health risks. To prevent denial
being generated as a means of coping with a perception of ‘unpreventable’ risk and
associated risk perception biases, ‘persuasive risk communication techniques’ need
to be accompanied by appropriate skills training in control usage and ensuring
control accessibility. Fear of enforcement may deter employers from seeking advice
from HSE that informs a ‘proportional’ judgement. Promotion of a more proactive
inspector role accompanied by positive success stories of their having mitigated
occupational health risk, and increasing the number of expert advice outlets via
suppliers, trade associations, journals, trade fairs, and insurers could help ensure
such fear is perceived as unfounded.
•
Principle e: Over reliance on PPE, reinforced by an assumption of PPE
invincibility, could be counteracted by video visualisation or biomarker feedback
techniques, due to their providing graphic evidence that PPE does not fully block
60
exposure. Again, to minimise financial costs, such feedback could be provided on
an employee type basis.
•
Principle f: Checking procedures may be amongst the first guidelines to fall victim
to time pressures. Every effort should be taken to ensure checking procedures
become a habit, through their development as a routine, periodically monitored by a
supervisor, and that responsibilities for who should undertake them are clearly
specified and communicated.
•
Principle g: Skills-based training will be more readily sustained if given as ‘hands
on’ under qualified supervision before it is applied alone ‘in situ’. Peer or
supervisor observation proceeded by ‘formative’ and ‘summative’ feedback should
enable more rapid skill advancement, and increase the prospect that compliant
behaviour will be repeated. Targeting peer pressure by recruiting informal peer
leaders to model compliant behaviour may be a powerful means of instilling
COSHH compliance as a ‘social’ norm.
•
Principle h: Knowledge-based training and advice sources provided by HSE or
supply chains may need to accommodate and anticipate risk information for
alternative substances where substitution is necessary and ensure its price be
considered against the wider context of occupational health.
4.3.1.3
Integration with Health and Safety Management Systems (HSG65)
The preventative recommendations listed in table 7 in appendix 1 integrate with the policy,
organisational (competency, co-operation, communication and control) planning, audit and
review components advocated within HSE’s ‘Successful Health and Safety Management’ guide
as follows:
Policy: Policy-related recommendations comprise integrating good occupational health
practices as a facet of organisational performance, for example, through inclusion within
incentive and performance monitoring schemes. Schemes based purely on productivity variables
or incident/symptom absence should be avoided due to their encouraging productivity to take
priority over occupational health and encouraging report suppression. Human resource
management policy also needs to incorporate opportunities for raising occupational health risk
and control awareness during recruitment, induction, performance appraisal, and within health
and safety and first aid training. Occupational health policy should convey how occupational
support can be accessed, and under what terms. A possible shared ‘behavioural’ aetiology
between occupational diseases arising from non-compliance with guidelines for dermal or
respiratory hazards also warrants developing shared behavioural solutions as a way of
optimising cost-effectiveness.
Organisation (Control): Harnessing control over the workforces’ adherence to OA risk control
measures can be facilitated by managers, supervisors, and front line staff being clear on what
their responsibilities to risk control are. Care should be taken to ensure that responsibility cannot
be shifted to another party; for example, front line staff assume that the responsibility for
exposure minimisation lies with managers. Otherwise, they may develop an ‘external locus of
control’ and feel less motivated to take personal responsibility for their own occupational
health. It is essential that ‘control’ be maintained over the availability, accessibility, usability,
monitoring and updating of protective equipment such as LEV and PPE. This is an important
signal of an organisation’s prevailing health and safety culture. Control can also be exercised
through peers and line management from time to time monitoring ‘good practice’ behaviour
amongst colleagues. This applies as much to senior managers observing ‘role model
61
consistency’ amongst their colleagues as it does to supervisors monitoring ‘operator’
compliance.
Organisation (Internal Co-operation): Organisation wide commitment to reducing OA risk can
be garnered through managers acting as ‘health’ conscious role models by responding quickly to
health concerns, consistently complying with precautionary measures when exposed to hazards
themselves, active participation in health and safety related meetings, and precaution choice and
control decisions. Front line staff representation and inclusion of occupational health, industrial
hygiene and health and safety expertise will also be key to generating effective decisions
surrounding control design and choice and fostering organisational commitment. Recruitment of
appropriate informal peer leaders as role models of good practice ‘compliant’ behaviour could
provide a powerful means of yielding a ‘snow ball’ effect amongst colleagues provided they are
then not perceived as management ‘lackeys’.
Organisation (Competency): Risk awareness training, along with tailored skills-based training
in risk assessment, substance substitution, process design, control/equipment choice, storage,
monitoring and availability should improve the workforces’ collective competency in
minimising asthmagen exposure. Providing managers, and supervisors with training in
constructive summative and formative feedback skills should help in perpetuating workforce
competency by reinforcing good practice.
Organisation (Communication): Video monitoring, case studies, observations aligned with
biomarker feedback may provide mechanisms for delivering risk communication messages that
are perceived as personally relevant by workers directly exposed to asthma hazards. Business
cases, depicting the long-term financial gains of effective control may make employers more
receptive to the need for risk control. Risk communication messages are likely to have more
impact where they:
•
•
•
•
•
•
•
stem from an accessible, credible source;
are pitched in non-jargonistic, non technical terms and are perceived as relevant;
are conveyed using multimedia, prompts and reminders, the content and position, of
which is periodically altered to limit habituation;
accommodate different coping styles by offering more in depth risk information as an
option rather than default;
avoid fear-generated denial by sign posting how risk can be avoided as well as why it
should be avoided;
spell out the consequences of non-compliance for dependents as well as themselves;
recruit the assistance of family and peers in conveying risk messages.
Risk communication via suppliers (see section 4.3.4), trained by HSE and manufacturers, trade
associations/unions, college vocational courses, trade specific journals and websites reduce
reliance upon employers and employees proactively seeking information themselves.
Planning/Implementation: Highly specified guidelines, pre-emptive planning, encouraged by
prompt cards, that encourage employees to think in detail about how, when, and with what they
need to take action to avoid risk during any one shift and goal setting should increase the
likelihood of behavioural compliance. Work reorganisation, in terms of increasing PPE
accessibility, reviewing workload, work pacing and offering job rotation as a means of
preventing boredom from undermining risk vigilance, could minimise the impact of job-related
hindrances upon compliance.
62
Measurement: Table 4 (above) contains suggestions for evaluating prevention effectiveness.
Health surveillance outcomes can be classified as reactive measures, whereas air monitoring and
psychosocial measures can be categorised as active monitoring
Review: Including improved compliance as a goal for review within performance appraisals
offers a means of reviewing prevention measures on an individual level. Organisation wide
review may be facilitated by industry level partnership, and HSE guidelines accommodating a
tendency amongst SMEs to choose control on the basis of available processes, substances and
advice rather than first principles.
4.3.2
Secondary Intervention: Diagnosis
Recommendations for overcoming diagnostic barriers are detailed in table 8 in appendix 1.
These are chiefly geared towards encouraging earlier diagnosis and overcoming the deterrent
effects that anticipated income loss has for employees/employers gaining a positive diagnosis of
OA.
Earlier diagnosis can be facilitated by raising prospective symptom awareness amongst ‘OA at
risk’ employees, as defined by high asthmagen exposure levels or sensitisation. Following their
initial manifestation, symptom monitoring prompt cards, maintaining records of symptom
patterns away from and at work, and feeding back individual health surveillance results, could
promote awareness, as might recruitment of family and colleagues as additional symptom
monitors. To prevent symptom misattribution, at risk employees should also be informed of the
role of stress and panic in creating dyspnea, and hyperventilation that can be falsely interpreted
as an asthma attack (see section 4.3.5 for OH provision suggestions amongst SMEs). Active
promotion of OA referral routes and availability, for example during health promotion
initiatives, could also enhance more prompt diagnosis.
As with the Quebec example for isocyanate asthma (Tarlo and Liss, 2002), recompensing salary
loss at a level just short of the full salary rate may help nullify the effects that employees’
anticipated income loss has on delaying diagnosis. Matching the full salary may undermine
employees’ motivation to engage in self-protective behaviour. However, achieving a 90% level
through compensation claims against the employer will undoubtedly be unwelcome, and
reinforce any tendency by employers to suppress OA reporting or unfairly dismiss symptomatic
employees. A solution may be for the state to fund retraining or redeployment initiatives, and
for the employer to only pay out once such options are fully exhausted or permanent disability
is diagnosed. To optimise retraining and redeployment opportunities a national ‘job bank’ for
workers unable to continue in their current job due to occupational-generated health impairment
could be set up. Such a ‘job bank’ could target SMEs in particular, which are less likely to be
able to offer such opportunities ‘in house’. Indeed, promoting this scheme to SMEs could be
one of the tasks undertaken by HSE’s forthcoming national Workplace Health Direct Initiative.
Increasing the transparency of confidentiality boundaries surrounding OH provider consultation,
particularly the circumstances under which employers are notified of diagnosis results, may also
help reduce employees’ apprehensions, as might HSE making a list of available lawyers with
proven experience in occupational provision.
Developing business cases contrasting the costs of late with earlier diagnosis could stem
employers’ fears over the economic ramifications of an OA sentinel event. Costs could also be
expressed in terms of the effects that negligence claims could have on their reputation. Ensuring
that all state-funded retraining or redeployment schemes are explored first before the employee
is entitled to make a claim against their employer could help reduce the economic implications
of OA diagnosis for employers. Insurance premiums could also be levied according to OH
provision as well as risk control measures, as a way of encouraging employers to offer greater
63
OH support. Other recommendations for encouraging earlier diagnosis are listed in table 8 in
appendix 1.
4.3.3
Tertiary Interventions: Retention at Work/Return to Work
Ideally, the return to work ‘passage’ can be made smoother and more effective by conducting
preliminary needs assessments on a case management basis and making workplace
modifications, for example, to work pacing, increasing employee control over their workload,
and scheduling of rest breaks, accordingly. A graded reintroduction to former work hours and
tasks may help the employee and may provide a more reliable way of allowing the employee to
regain their confidence.
Retraining and redeployment options for enabling retention at work have already been
discussed. Given the particular challenges associated with adhering to treatment regimes, with
support from OH providers or GPs, self-management plans, tailoring to employees’ medication
schedule and including symptom-monitoring prompts (see recommendation 8 and 9 within table
9 in appendix 1) could help them avoid unnecessary exposure to asthmagens by promoting their
ongoing awareness of how their actions can exacerbate symptom severity. Provision of worksite educational interventions may be viable for companies with a large number of asthma
sufferers. Such interventions may have to be funded on a cross-SME basis for smaller
organisations (see section 4.3.5). Any educational programmes should also include problem
solving and emotion focussed coping strategies amongst the self-management skills it aims to
convey. A full and detailed list of tertiary interventions is given in table 9 in appendix 1.
Recommended outcome criteria for evaluating the effectiveness of retention at work and
rehabilitation interventions for sensitised employees or those with OA, are outlined in table 6.
Table 6: Suggested Outcomes for Evaluation of Retention/Rehabilitation Effectiveness
Outcome
Medical
Outcomes
Health
Surveillance
Work
Outcomes
Example Measures
Rationale
Hospital admissions
Emergency room visits
Unscheduled GP visits
Use of rescue or reliever medications
OA incident/prevalence rate
Forced Expiratory Volume in a second (FEV1)
Peak Expiratory Flow (PEF)
Skin Prick/RAST tests for IgE (for LMW sensitisers)
Respiratory/sensitisation symptom incident rate
Symptoms scores
Peak/flow diary
Sickness absenteeism
Objective indicators.
Triangulation of outcome
data.
Objective indicators.
Triangulation of outcome
data.
Work cost
Triangulation of outcome
data
Gauges perceived success
of outcomes. Predicts
long-term ability to
remain at work.
Triangulation of outcome
data.
Quality of Life (Asthma Related Quality of Life, Utility
Scales, Juniper, 1999)
Asthma knowledge questionnaires
Anxiety (State-trait anxiety inventory, Speilberger,
1970)
Coping (e.g. Respiratory Illness Questionnaire,
Staudenmayer, 1978)
Health Locus of Control (Health locus of control scale,
Wallston, 1976)
* Cited references provided in Hayes et al (2004) and Fleming, Pagliari, Churchill, McKean, Shuldman (2004).
Psychosocial
Outcomes*
64
4.3.4
Intervention providers
Review findings imply that intervention provision should meet certain criteria in order to
achieve optimal cost-effectiveness. It must:
be readily accessible,
reduce any need to proactively seek information,
be credible, and convey up-to-date, relevant and accurate advice,
be tailored to its target audience needs and receptiveness to change,
ensure that enforcement fears are not aroused,
As quality control, the advisor training and monitoring would have to be overseen by HSE,
through inspectors. Training would encompass risk knowledge, skills training in
equipment/control design, usage, monitoring and storage, and communication skills. Contingent
on suitable training, eligible advisors fulfilling the above criteria could include front line
occupational suppliers, business advisors (such as the Chambers of Commerce), insurance
representatives, trade associations and trade union officials. Suppliers’ advice will inevitably be
bespoke to their particular product, so it may need to be complemented by impartial sources
such as HSE or trade associations. Supplier training will also require input from the original
manufacturer to circumvent message distortion created by lengthy supply chains. A
requirement of having undergone HSE approved training in risk control advice could be
included in the procurement arrangements set up between supplier and user.
Early
development of risk averse attitudes could also be instilled on college vocational training
courses and apprenticeships, rather than during secondary education, to ensure messages are
relevant to the career recipients intend to pursue. Written risk communication avenues fulfilling
the above criteria include trade journals, trade specific web sites, and trade union publications.
Accessing more remote populations, such as farmers, motor vehicle repair (MVR) workers and
carpenters, may require utilising occasions (such as markets in the case of the agriculture sector,
trade fairs, trade conventions, exhibitions, or even chambers of commerce dinners) at which the
target population periodically congregate. This may provide an opportunity for promoting
occupational health messages. Safety & Health Awareness Days (SHADs) to some extent fulfil
this role; however, they may suffer a self-selection bias amongst attendees towards more health
and safety conscious workers and employers. For such populations, risk communication may
have to recruit the aid of significant others, such as spouses, to influence the target audience.
4.3.5
Resource limitations
Invariably, resource limitations present a particular problem for SMEs in OA prevention,
diagnosis and rehabilitation. These problems could potentially be overcome by developing
shared resources across SMEs, preferably at a local, sector specific level, to set up the
following.
•
•
‘Think tank’ partnerships: Akin to ‘good neighbourhood schemes’ management and
employee representatives from local SMEs, could form partnerships for the purpose of
sharing ideas and knowledge on cost-effective measures for reducing OA risk (Brosseau et
al, 2002). As an incentive, membership to such schemes could be included amongst the
criteria for determining insurance premiums.
A shared health and safety champion: Where full time employment of an ‘in house’ health
and safety officer is not possible, a health and safety champion could be recruited from
within the workforce of one of the organisations participating in the scheme to act as a full
time health and safety champion across all SME participants. Funding the salary could be
shared accordingly. The ‘champion’s’ role would be to train colleagues in risk awareness,
65
•
and control measures for all occupational health risks. Their advantage would be that they
would be able to speak their recipients’ language and have, themselves, first hand
experience of compliance challenges.
Shared occupational health provision: Local SMEs could also jointly set up a shared
contract with a local occupational health provider or regional advisory service to split the
costs of surveillance and consultation between them.
Advice pertaining to each of the above could also be provided by HSE’s planned Workplace
Health Direct resource.
4.3.6
Industry Sector Considerations
The summary industry sector profiles that follow also contain recommendations based on the
principles portrayed in figure 12 (risk assessment framework diagram). These recommendations
are based on the particular psychosocial characteristics defining that sector (see section 3.5).
Since most of the safety cultures identified revolve around inadequate risk awareness or
awareness accompanied by inertia corresponding recommendations concern awareness raising
and persuasive risk communication. Had cultures reflected ‘an intention to act sometime’ the
focus would have been placed on planning and reinforcement based interventions.
Agriculture
•
Brief evidence suggested that the agriculture sector has a safety culture based on awareness of risks but
taking no action (e.g. compliance with PPE lower than recommended or belief that if exposed in early
life asthma incidence is lower).
• The main peer contacts that the agriculture sector appeared to use included trade associations/journals
(e.g. the farming press) and the family (e.g. spouse influence in family businesses). Suppliers appeared
to be less in use by the agriculture sector in that only a small percentage reported getting H&S
information from suppliers and some evidence regarding not following manufacturer instructions/labels
was apparent. Contact with regulators also did not appear to have a great influence on the agriculture
sector.
• Brief evidence suggested that agriculture industry prospects and interest in the H&S of these
populations are decreasing, due to decreasing numbers employed in farming.
• The resource limitations that were evident in the agriculture sector included time (barrier to change and
little time to read H&S information), money (barrier to change and obtaining H&S information) and
knowledge (higher knowledge leads to increasing safe behaviours).
• There was very limited evidence on the training practices in the agriculture sector but brief evidence
suggested that more formal training (e.g. in the use of pesticides) was needed, as this was associated
with more frequent use of PPE.
Recommendations :
• Persuasive risk communication (recs. 8,9,10,11, table 7 in appendix 1) to move the safety culture to a
risk contemplation stage.
• Include spouses within risk communication target audience. Use trade journals for promoting risk
messages (rec. 18, 22, table 7 in appendix 1).
• Develop businesses cases demonstrating performance benefits of health hazard control and help
motivate an industry apparently in decline. Emphasise potential ramifications of poor risk control to
dependents (rec. 11, table 7 in appendix 1).
• Increase risk awareness education within agriculture training colleges (rec. 11, table 7 in appendix 1).
Use markets, or convene SHADs to promote risk messages. Emphasise strategies for improving control
availability/accessibility (rec. 42, table 7 in appendix 1).
66
Food Manufacture / Bakeries
•
Some evidence suggested that the food manufacture sector has a safety culture where they either do not
know the risks (e.g. not aware of exposure limits or hazards) or are aware but taking no action (e.g.
bakeries still undertaking inappropriate work practices such as hand dusting, dry brush cleaning, manually
folding empty flour bags, not using RPE/LEV despite knowing the hazard of flour dust. Also, there
appeared to be an element of resignation of risk (‘part of the job’), fear of disclosure, and a reactive
approach to H&S).
• The main peer contact that was evident for the food manufacture sector was colleagues (e.g. the
importance of safety reps, support and management commitment). Trade associations/journals were
thought to have diminished in the bakery industry and information use appeared to be limited and
determined by legal requirements and fear of litigation.
• There appeared to be mixed evidence for the size profile of the food manufacture sector. Some evidence
points to exposure levels being higher in traditional bakeries (smaller) than industrial bakeries (larger)
while other evidence suggested that staff at larger bakeries had the highest exposures and bakers
perceived that flour dust is a hazard for larger bakeries. Evidence also highlighted the need for health
surveillance in small bakeries.
• Resource limitations evident in the food manufacture sector included time (e.g. no time to read H&S
information), money (e.g. costs of substitution, turnover and litigation), and knowledge (e.g. not aware of
exposure limits or hazards).
• There was some evidence that training practices in the food manufacture sector were mostly college
based and that hypersensitivity/asthma symptoms can develop during vocational training, especially
where instructors do not accept control measures/PPE and a macho culture prevails. More in-house
formal training or ‘on the job’ training (e.g. on flour dust, RPE, LEV) was limited.
Recommendations:
• Focus on increasing knowledge of risks and control measures (recs. 2&3, table 7 in appendix 1) and
persuasive risk communication (recs. 8, 9, 10, 11, table 7 in appendix 1) to engage safety culture in risk
contemplation. Ensure this is accompanied by skills-based training (recs. 4,5,6, table 7 in appendix 1),
and improving control accessibility (recs. 42, table 7 in appendix 1), to overcome adoption of fatalistic
attitudes created poor perceived control.
• Recruit informal peer leaders to exert positive pressure (recs. 26, table 7 in appendix 1) that conforms to
compliance good practice.
• Encourage a shared OH resource between local bakeries (see paragraph 4.3.5) to create increased
health surveillance.
• Develop business cases demonstrating performance benefits of health hazard control. Emphasise
potential ramifications of poor risk control to dependents (rec. 11, table 7 in appendix 1).
• Increase risk awareness education within catering training. Screen and train in-house trainers in risk
communication techniques (recs. 8 to 19, table 7 in appendix 1) via inspectors.
67
Woodworking
•
Some evidence suggested that the wood manufacture sector has a safety culture where they either do
not know the risks (e.g. exceeding exposure limit, few COSHH assessments or hazards seen more as
inconvenience than serious risk) or are aware but taking no action (e.g. poor work practices such as
brush cleaning of wood dust, little use of RPE, little health surveillance, little acceptance of controls due
to lack of ease of use, risk resignation (‘part of the job’) or reactive approach to H&S).
• The main peer contacts that were evident in the wood manufacture sector were colleagues (e.g. prefer
‘word of mouth’ communication and learning from others), customers (e.g. feel that the H&S onus is on
the client) and reliance on less knowledgeable suppliers. Trade associations/journals were thought to
have diminished in the woodworking industry and smaller woodworking shops were isolated from peers
by not participating in trade associations/professional organisations. Use of information in the wood
manufacture sector was limited and appeared to be determined by legal requirements and fear of
inspection.
• Brief evidence on size profile suggested that small woodworking shops needed better information
awareness and recognition that some controls may be too expensive for them.
• Resource limitations evident in the wood manufacture sector included time (e.g. no time to read H&S
information or attend training), money (e.g. barrier to training, ability to afford dust controls etc) and
knowledge (e.g. incorrect knowledge of RPE use).
• Training practices in the wood manufacture sector appeared to be mainly ‘on the job’ (e.g. poor or
patchy training/instruction, not perceived as proper training and potentially lacking quality, and reliance
on user experience) or college based.
Recommendations:
• Focus on increasing knowledge of risks and control measures (recs. 2&3, table 7 in appendix 1) and
persuasive risk communication (recs. 8, 9, 10, 11, table 7 in appendix 1) to engage safety culture in risk
contemplation.
• Recruit informal peer leaders to exert positive pressure (recs. 26, table 7 in appendix 1) that conforms
to compliance good practice.
• Since woodworking companies tend to be small, utilise a health and safety champion to improve
compliance practices within local woodworking shops (see paragraph. 4.3.5).
• Discourage performance incentives that exclusively focus on productivity at the expense of occupational
health (rec. 40, table 7 in appendix 1).
• Develop businesses cases demonstrating performance benefits of health hazard control. Emphasise
potential ramifications of poor risk control to dependents (rec. 11, table 7 in appendix 1).
• Screen and train in-house trainers in risk communication techniques (recs. 8 to 19, table 7 in appendix
1) via inspectors.
68
MVR and Manufacture
•
Evidence suggested that the motor vehicle repair and manufacture sector has a safety culture mainly
defined by not knowing the risks (e.g. not knowing isocyanate danger, perceive water based product as
safe, managers exposed, limited COSHH or SDS knowledge) or being aware but taking no action (e.g.
risk resignation (‘part of the job’), over familiarity with information, poor PPE/RPE/controls use or
reactive approach to H&S). There was brief evidence of some companies with health surveillance having
better OA outcomes and MVR SHAD events raising awareness and encouraging action, suggesting that
some companies are aware and acting sometimes.
• The main peer contact that was evident in the MVR sector was suppliers (e.g. reliance on suppliers for
information or risk reduction largely driven by external influence). However, labelling and SDS from
suppliers were reported as difficult to understand. Colleague contact was limited in that manager to shop
floor communication was reported as poor. Trade associations/journals were thought to have diminished
in the MVR sector and use of information in the MVR sector appeared to be limited and determined by
legal requirements and fear of inspection/enforcement/litigation.
• Evidence for size profile showed that small companies are limited in that they are unlikely to have
specialist H&S staff or plentiful time, need simpler and more cost effective measures and found SDS too
technical or not applicable to small companies. Only larger companies will have significant occupational
health provision and redeployment.
• Resource limitations evident in the MVR sector included time (e.g. no time to read/use H&S
information), money (e.g. cost was a main determinant of using information to take action or choosing
paint products), knowledge (e.g. not knowing isocyanate danger or effects, poor PPE knowledge, and
COSHH/OEL and hazards vs. risks knowledge limited) and incentives (e.g. ‘piece work’ negative
incentive to rush jobs to increase earnings).
• Training practices in the MVR sector appeared to be mainly ‘on the job’ by more experienced staff,
which may involve issues such as conveying bad habits.
Recommendations:
• Focus on increasing knowledge of risks and control measures (recs. 2&3, table 7 in appendix 1) and
persuasive risk communication (recs. 8, 9, 10, 11, table 7 in appendix 1) to engage safety culture in risk
contemplation.
• Encourage a shared OH resource between local MVR body shops (see paragraph 4.3.5) to create
increased health surveillance.
• Utilise a health and safety champion to improve compliance practices within small local MVR body shops
(see paragraph. 4.3.5).
• Train front-line suppliers in risk communication techniques (rec. 21, recs. 8 to 19, table 7 in appendix 1).
• Discourage performance incentives that exclusively focus on productivity at the expense of occupational
health (rec. 40, table 7 in appendix 1).
• Develop business cases demonstrating performance benefits of health hazard control. Emphasise
potential ramifications of poor risk control to dependents (rec. 11, table 7 in appendix 1).
• Screen and train in-house trainers in risk communication techniques (recs. 8 to 19, table 7 in appendix 1)
via inspectors.
69
4.4
RESEARCH RECOMMENDATIONS
More active research needs to be undertaken to verify the extent to which the findings of this
review accurately reflect the realities of workplaces exposed to asthma-related hazards.
•
As a starting point, to clarify the relative contribution the psychosocial risk factors have on
exacerbating OA likelihood, studies designed to compare the behavioural profiles
differentiating sensitised from non-sensitised workers could be undertaken. To enable a
reliable comparison, asthmagen type, job type, training and experience will have to be
controlled, possibly through counterbalancing. Conducting the comparison between
employees working for the same organisation would mean that the investigation would
focus on the immediate behavioural antecedents of non-compliance. Wider organisational
variables would be consistent across the two groups. Conversely, comparison of
psychosocial variables distinguishing companies with high and low occupational asthma
incidence rates would allow exploration of the role played by organisational factors.
Ensuring that respective organisations are of the same size, and fall within the same industry
sector would limit the potential array of confounding explanations. Data could be collected
via a behavioural diagnostic questionnaire, such as that developed by DeJoy (2000),
combined with peer and supervisory observations, interviews or focus groups to achieve
some triangulation within the evidence derived. Using managers of all levels, as well as
front line staff would create a more robust body of evidence, and enable perceptions
between the two groups to be contrasted. Conducting this research on a sector-by-sector
basis would allow HSE to become more in tune with the audience characteristics to which it
is endeavouring to tailor risk communication.
•
Findings derived from this review and any ‘primary’ research could be used by HSE as the
basis for developing a psychosocial risk assessment or ‘diagnostic tool’ for occupational
health hazards. This initial tool would have to undergo empirical and usability testing on
diverse pilot samples to gauge its transferability. As with the stress tool developed as part of
HSE’s management standards for stress, employers could then have the option of using a
generic tool supplied by HSE, or develop ‘in-house’ methods for exposing psychosocial risk
factors.
•
If the risk assessment framework recommendations for OA prevention are to be taken up,
pilot trials of their application to companies from across the industry sector within which
OA arises would have to undertaken. Their effectiveness could be established by comparing
their exposure outcomes (see table 4) and OA disease rates before and after interventions
with organisations of the same size and belonging to the same industry sector.
•
To support uptake of the preventative recommendations made, HSE could also develop
some of the supporting tools, such as building up a body of business cases, case studies,
video monitoring examples, and biomarker feedback examples, bespoke to different
employee types that employers can then ‘pick and choose’ from according to the particular
needs they identify amongst employees.
•
From amongst the knowledge gaps identified, priority should be placed on investigating the
effects of concentration lapses on exposure risks. This could be done, for example, by
observing the number of compliance violations made as a shift progresses.
70
5
5.1
BIBLIOGRAPHY
HSE / HSL LITERATURE
Adisesh, A., Meyer, J.D., Cherry, N.M. (2002). Prognosis and work absence due to
occupational contact dermatitis. Outcome of cases reported to EPIDERM. Contact Dermatitis,
46, 273-279.
Alston, S., Powell, L., Stroud, P., Brown, R.C. (1997). A workplace study of the use and
maintenance of respiratory protective equipment against Vapour. ISRP Journal, 15 (2), 24-35.
Anees, W., Huggins, V., Blainey, D., Pantin, C., Robertson, K., and Burge, S. (2002).
Evaluation of an expert system for the interpretation of serial peak expiratory flow
measurements in the diagnosis of occupational asthma in a field trial. The grain dust study.
HSE CRR 450/2002. HSE Books: Sudbury.
Beaumont, D., Tate, P., Curran, A.D., Fishwick, D. (2002). Natural rubber latex aeroallergen
exposure. Annals of Occupational Hygiene, 46, 645-646.
Benjamin K, Beswick J, Smith P, Sreenivasan B & Travis K (2002) Review of Training
Provided to Asbestos Removal Workers. HSL report WPS/02/06
Bolsover, J.A. and Parker, C.J. (2002). Summary of BA incidents investigated by the Health
and Safety Laboratory, January 1998 to February 2002. HSL Report PE/02/09. RESTRICTED
Boocock, M. and Weyman, A. (1998). The relative importance of risk factors in controlling
musculoskeletal disorders. HSL Report EWP/98/37. RESTRICTED
Boocock, M., Weyman, A., Riley, D. (1998). The relative importance of risk factors in
controlling musculoskeletal disorders - a study of sewing machinists. HSL Report EWP/98/36.
RESTRICTED
Bottomley, D. and Trainor, M. (1999). Health and safety performance in the rubber industries:
the role of safety culture, safety management and technological risk. HSL Report RAS/99/3.
RESTRICTED
Bradshaw, L., Davies, J., Curran, A., Fishwick, D (2004). A qualitative study of work related
asthma symptoms and attitudes to the workplace. SJWEH. (Paper submitted)
Bradshaw, L.M., Curran, A.D., Eskin, F., Fishwick, D. (2001). Provision and perception of
occupational health in small and medium sized enterprises in Sheffield, UK. Occupational
Medicine, 51, no 1, 39-44.
Brown, R.C. (1995). Protection against dust by respirators.
Occupational Safety and Ergonomics, 1 (1), 17-35.
International Journal of
Brown, T. and Rushton, L. (2003). Development of risk reduction strategies for the prevention
of dermatitis in the UK printing industry. HSE RR158. HSE Books: Sudbury.
Burdett, G. and Bard, D. (2003). Pilot study on the exposure of maintenance workers
(Industrial Plumbers) to asbestos. Final Report. HSL Report MF/2003/15. RESTRICTED
71
Carruthers, G., Hooker, S. Foxon, D. (2004). Case studies demonstrating behaviour change
driven (primarily) by public health campaigns. COI Communications Research Unit, HSE.
Chambers, H., Sandys, V., Piney, M. (2005). Effectiveness of control measures during use of
isocyanate containing paints in motor vehicle repair at Hartwells. HSL Report OH/2005/02.
RESTRICTED
Chambers, H., Weyman, A, Keen, C (2002) Identification of reasons for failure of control
strategies. HSL Report. FSSU/02/02
Cocker, J., Rawson, B., Wheeler, J., Penney, M., Sams, C. (2003). Internal contamination of
gloves: Routes and consequences. HSL Report IR/ECO/02/17. RESTRICTED
Collins, A. (2003). Health and safety in the rubber industry: A guide to training. HSL Report
RAS/03/13
Creely, K.S., Leith, S., Graham, M.K., Cowie, H.A., Hughes, J., George, P., Cherrie, J.W.
(2003). Effective communication of chemical hazard and risk information using a multimedia
safety data sheet. HSE RR072. HSE Books: Sudbury.
Curran, A. and Fishwick, D. (2003a). Occupational Asthma Research Issues: Report from an
HSE Workshop 6-7 January 2003. HSL Report MU/03/01
Curran, A.D. and Fishwick, D. (2003b). Occupational asthma: research, change and the 30%
target. Annals of Occupational Hygiene, August, 47 (6), 433-6.
Daunton, B. and Bagon, D.A. (2003). The effectiveness of control measures for isocyanates in
motor vehicle repair. HSL Report FSSU/2003/04. RESTRICTED
Devereux, J., Rydstedt, L., Kelly, V., Weston, P., Buckle, P. (2004). The role of work stress and
psychological factors upon the development of musculoskeletal complaints. HSE RR273. HSE
Books: Sudbury.
Dilworth, M. (2000). Wood dust survey 1999/2000. FINAL REPORT
Elms, J., Beckett, P., Griffin, P., Evans, P., Sams, C., Roff, M., Curran, A.D. (2003). Job
categories and their effect on exposure to fungal alpha-amylase and inhalable dust in the UK
baking industry. AIHA Journal, 64(4), 467-71.
Elms, J., Bradshaw, L., Fishwick, D., Evans, G. and Curran, A. (2005). An Evaluation of the
Sheffield Occupational Health Group. Health and Safety Laboratory
Short report for
submission to Occupational Medicine.
Elms, J., Fishwick, D., Walker, J., Rawbone, R., Jeffrey, P., Griffin, P., Gibson, M., Curran,
A.D. (2003). Prevalence of sensitization to cellulase and xylanase in bakery workers.
Occupational and Environmental Medicine, 60(10), 802-804.
Elms, J., O'Hara, R., Pickvance, S., Fishwick, D., Hazell, M., Frank, T., Marlow, P., Henson,
M., Harvey, P., Evans, G., Curran, A.D. (2003). The profile of patients' occupational health in
primary care. HSL Report HEF/03/10
Elms, J., Robinson, E. and Rahman, S. (2004). Exposure to Flour Dust in UK Bakeries and
Current Use of Control Measures. HSL Report HEF/04/01
72
Fishwick, D, Curran, A.D. (1999). Diseases at work: assessing occupational respiratory illness.
Respiratory Disease in Practice, 16, 11-13.
Fishwick, D., Allan, L.J., Wright, A., Curran, A.D. (2001). Assessment of exposure to organic
dust in a hemp processing plant. Annals of Occupational Hygiene, 45, 577-583.
Fishwick, D., Bradshaw, L., Curran, A. and Davies, J. (2003).
Occupational Asthma: A National Study. HSL Report MU/03/02
Routes of Referral for
Fishwick, D., Elms, J., Curran, AD. (2005). Re: Preventing baker's asthma: an alternative
strategy. Occupational Medicine, 55(1), 72, Jan.
Fleming, M. and Lardner, R. (2002). Strategies to promote safe behaviour as part of a health
and safety management system. HSE CRR 2002/430. HSE Books: Sudbury.
Gadd, S. and Collins, A.M. (2002). Safety Culture: A review of the literature. HSL Report
RAS/02/04
Gadd, S., Keeley, D., Balmforth, H. (2003). Good practice and pitfalls in Risk Assessment.
HSL Report RAS/03/02
Gadd, S., O'Hara, R., Dickety, N., Weyman, A. (2000). Good practice by SMEs in assessing
workplace risks: Final Report. HSL Report RAS/00/12
Griffin, P., Fishwick, D., Elms, J., Curran, A.D. (2001). Respiratory symptoms and wheat flour
exposure: a study of flour millers (letter). Occupational Medicine, 51, 25-27.
Griffin, P., Jeffrey, P., Gibson, M., Barber, C., Curran, A.D. (1999). Respiratory symptoms,
sensitization and dust exposure in small bakeries (letter). Occupational Medicine, 49, 569-570.
Health and Safety Executive (1997). Health and Safety Climate Tool. HSE Books: Sudbury
Horbury, C. and Hurst, N. (1997). Assessment of safety culture and human factors issues within
CHID. HSL Report RAS/98/3. RESTRICTED
Howe, A. and Simpson, P. (2002). Survey of Provision of Training for Welders. Draft Report.
HSL Report ECO/02/05
Hoyle, J., Cherry, N., Pickering, CAC., Burgess, G., Smedley, J., Dippnall, M. and Niven, RM.
(2002). Occupational lung disease on ferrous foundry workers. HSE RR 022. HSE Books:
Sudbury.
Hughson, G.W., Mulholland, R.E., Cowie, H.A. (2002). Behavioural studies on people’s
attitudes to the wearing of hearing protection. HSE RR028. HSE Books: Sudbury.
Hutchinson, C., Dorsett, J., Watson, A., Kilpatrick, A., Reitgassl, F., Hegarty, B., Waters, K.
(2005). Tobacco Control: How the integration of advertisers made advertising more powerful
than word of mouth. COI Communications Research Unit, HSE
Jackson, C.A. (2004). The evaluation of occupational health advice in primary health care. HSE
RR242. HSE Books: Sudbury.
Jeffrey, P., Griffin, P. (1999). Small bakeries, a cross-sectional study of respiratory symptoms,
sensitization and dust exposure. Occupational Medicine, 49, (4), 237-241.
73
Jones, K., Cocker, J., Dodd, L.J., Fraser, I. (2003). Factors affecting the extent of dermal
absorption of solvent vapours: a human volunteer study. Annals of Occupational Hygiene,
47(2), 145-150.
Kenny, L. (2003). Commentary: Scientific Principles and Pragmatic Solutions for the
Measurement of Exposure to Inhalable Dust. Annals of Occupational Hygiene, 47, 437-440.
Kenny, L.C., Hurley, F., Warren, N.D. (2002). Estimation of the risk of contracting
pneumoconiosis in the UK coal mining industry. Annals of Occupational Hygiene, 46(1), 257260.
Levin, J.O., Brown, R.H., Ennals, R., Lindahl, R., Ostin, A. (2000). Isocyanates: measurement
methodology, exposure and effects. Journal of Environmental Monitoring, 2, 18N-20N.
Llewellyn, D., Mullen, D., Farley-Way, M. (no date). A pilot study of farmers' use of
computers and preferred communication channels for health and safety information. HSE,
Control Implementation Strategy Section, FOD CSD3A.
Lunt, J. and Corbett, E. (2005). Sustaining attention in Train Driving: Learning from strategies
applied in sport. HSL Report WPS/04/13
Meldrum, M., Rawbone, R., Curran, AD., Fishwick, D. (2005). The role of occupation in the
development of chronic obstructive pulmonary disease (COPD).
Occupational and
Environmental Medicine, Apr, 62(4), 212-4.
Miller, B.G., Graham, M.K., Creely, K.S., Cowie, H.A., Soutar, C.A. (2003). Questionnaire
Predictors of Asthma and Occupational Asthma. HSE RR164. HSE Books: Sudbury.
Milnes, E. (2001). Analysis of Risk Assessments gathered during WCO Survey of Manual
Handling Incidents. HSL Report ERG/01/09.
O’Hara, R. and Dickety (2000) Communicating Health and Safety Information in Small Firms
Using Chemicals. HSL Report RAS/00/16. RESTRICTED
O'Hara, R. (2005). Evaluation of four pilot Safety and Health Awareness Days (SHADs) for
motor vehicle paint sprayers - DRAFT COPY. HSL Report RAS/05/DRAFT
O'Hara, R. and Elms, J. (2004). Securing Health Occupations Together Workshop,
Occupational Health in Primary Care, Bradford Workshop, October 2004.
Pengelly, I., Groves, J., Simpson, A., Northage, C. (1998). Workplace exposure to rosin-based
solder flux fume during hand soldering. Annals of Occupational Hygiene, 42 (5), 295-302.
Pilkington, A., Graham, M.K., Cowie, H.A., Mulholland, R.E., Dempsey, S., Melrose, A.S.,
Hutchinson, P.A. (2002). Survey of the use of occupational health support. HSE CRR445/2002.
HSE Books: Sudbury.
Piney, M. (2000). Controlling isocyanate exposure and release at Hartwell's (Newport) Ltd.
HSE FOD Wales and West Regional Specialist Group Report. RESTRICTED
Raw, G.J. (1992). Sick buillding syndrome: a review of the evidence on causes and solutions.
Building Research Establishment, Garston, Watford for the HSE, CR74/92. RESTRICTED
74
Redmayne, A.C., Wake, D., Brown, R.C., Crook, B. (1997). Measurement of the degree of
protection afforded by respiratory protective equipment against microbiological aerosols.
Annals of Occupational Hygiene, 41, (S1), 636-640.
Reetoo, K.N., Macdonald E.B., Harrington, J.M. (2004). Competencies required of occupational
health physicians. HSE RR247. HSE Books: Sudbury.
Robertson, V. and Stewart, T. (2004). Risk perception in relation to musculoskeletal disorders
(MSDs). HSE RR284. HSE Books: Sudbury.
Roff, M., Warren, N., Cocker, J., Akrill, P., Bagon, D. (2003). Workplace respiratory, dermal
and systemic exposure to N-methyl pyrrolidone in the UK. HSL Report HSL/ECO/2003/04.
RESTRICTED
Rosen, G., Andersson, I.M., Walsh, P.T., Clark, R.D.R., Saamanen, A., Heinonen, K., Riipinen,
H., and Paakkonen, R. (2005). A review of video exposure monitoring as an occupational
hygiene tool. Annals of Occupational Hygiene, 49(3), 201-217.
Shearn, P. (2005). Workforce Participation in Occupational Health & Safety Management at
FMC Technology Ltd, Dunfermline. HSL Report ERG/05/04 (Draft)
Smith, A., McNamara, R., Wellens, B. (2004). Combined effects of occupational health
hazards. HSE RR287. HSE Books: Sudbury.
Sreenivasan B & Phelps C (2001) Asbestos Workers and their Perceptions of Risk. HSL Report
WPS/01/02. RESTRICTED
Strutt, S. and Bird, C. (2004). Micro Firms Research: By Sector. Debrief Presentation. The
Marketing Works / Health and Safety Executive.
Topping, M. (2001). Occupational exposure limits for chemicals.
Environmental Medicine, 58, 2, p. 138-44, Feb.
Occupational and
Trainor, M., Weyman, A., Anderson, M. (1998). Assessment of the application of risk
assessment in the UK mining industry (main report). HSL Report RAS/98/5, EWPS/98/33.
RESTRICTED
Trainor, M., Wright, S., O'Hara, R., Dickety, N. (2002). Risk assessment: The extent of
adoption by industry. (R71.043) HSL Report RAS/02/12
Tylee, B. and Bard, D. (2004). Survey on the provision of equipment available for asbestos
removal work in flammable or hazardous environment.
HSL Report MF/2004/05.
RESTRICTED
Ujah, E.U., Bradshaw, L., Fishwick, D., Curran, A.D. (2004). An evaluation of occupational
health services within the NHS in London. Occupational Medicine, 54(3), 159-64.
Walsh PT, Clark RDR., Flaherty S, Gentry S J (2000). Computer-aided video exposure
monitoring. Applied Occupational and Environmental Hygiene, 15, 48-56.
Walsh PT., Clark RDR, Flaherty S, Plant I. (2002). Monitoring exposure to solvent vapour in
the workplace using a video-visualization technique. Noise and Health, 4, 1-7.
75
Weyman, A. (1988). Risk perception and risk taking behaviour at work - A review of literature.
HSL Report EWPS/98/23
Weyman, A. (1997). Psychosocial determinants of work related upper limb disorder
(WRULDS). A review of literature. HSL Report EWP/97/07
Weyman, A. (1998) Investigation into factors which underlie Risk Taking Behaviour at
Stillingfleet Combined Mine. HSL Report EWP/98/39. RESTRICTED
Weyman, A. (1999). The effects of job (In)security and safety incentive schemes on accident
reporting rates and levels of risk taking behaviour. HSL Report EWPS/98/22
Weyman, A. and Goddard, H. (1996). Evaluation of the Asbestos awareness campaign. HSL
Report EWP/96/25. RESTRICTED
Weyman, A. and Marlow, P. (2004). Benchmarking manual handling performance in the
offshore industry (managers and supervisors). HSL Report ERG/04/04
Weyman, A. and Milnes, E. (2001). Benchmarking Manual Handling Performance in the
Chemicals Industry. HSL Report ERG/01/08
Weyman, A. and Shearn, P. (2004). Teaching practice in risk education for 5-16 year olds. HSL
Report ERG/03/04.
Weyman, A., Kelly, C.J., Sreenivasan, B. (1999). Report on the proceeding of the Health
Directorate Workshop on Risk Perception & Risk Communication. HSL Report EWP/99/20
Weyman, A.K. and Anderson, M. (1996). Factor analysis of HSEs safety culture measure
applied in three deep coal mines. HSL Report EWP/96/20. RESTRICTED
Weyman, A.K. and Kelly, C.J. (no date). Risk perception and risk communication: A review of
literature. Health and Safety Laboratory.
Weyman, A. (1988). Risk perception and risk taking behaviour at work - A review of literature.
HSL Report EWPS/98/23.
Weyman, A.K., Jackson, J.A., Hawkins, M.J. (2003). Slip and trip human factors scoping study
- Development of safety performance measures. HSL Report ERG/03/06
Wheeler, J. (2001). Short report/letter on PXRF measurements made at CEL Ltd. HSL
Wheeler, J., Sams, C., Bladwin, P. (1999). Sources of lead exposure in the battery industry.
HSL Report IR/A/99/02.
White, J and Benjamin, K. (2003). Occupational health in the supply chain: A literature review.
HSL Report WPS/03/06
Williams, N.R., Jones, K, Cocker, J (1999). Biological monitoring to assess exposure from use
of isocyanates in motor vehicle repair. Occupational Environmental Medicine, 56: 598-601
Worsell, N., Chambers, C., Beswick, J., Heritage, L., Wu, B. (2001). Availability, quality and
standards of training for woodworking operators and supervisors. HSL Report RAS/01/01
76
Wright, S. and Collins, A. (2002). The 5S Technique: A risk management perspective.
(JS4000989) HSL Report RAS/02/09.
Wright, M., Marsden,S., Cudmore, S., Beardwell, C., Pennie, D. (2005). Evaluation of EPS:
Inspectors' survey responses. HSE Research Report - DRAFT. HSE Books: Sudbury
5.2
EXTERNAL LITERATURE
Aalto, A.M., Harkapaa, K., Aro, A.R. and Rissanen, P. (2002). Ways of coping with asthma in
everyday life: Validation of the Asthma Specific Coping Scale. Journal of Psychosomatic
Research, 53 (6): 1061-1069, Dec.
Abba, K., Clarke, S. and Cousins, R. (2004). Assessment of the potential effects of population
changes in attitudes, awareness and beliefs on self-reporting of occupational ill-health.
Occupational Medicine, 54, p. 238-244.
Aboussafy, D. and Morley, A. (2002). Stress, coping, self-efficacy and asthma control: Clinic,
diary and laboratory studies. Dissertation Abstracts International: Section B: The Sciences &
Engineering, 62, no. 12-B, p. 6015.
Adams, R.J., Boath, K., Homan, S., Campbell, D.A. and Ruffin, R.E. (2001). A randomized trial
of peak-flow and symptom-based action plans in adults with moderate-to-severe asthma.
Respirology, 6, no. 4, p. 297-304, Dec.
Adams, R.J., Wilson, D., Smith-Brian, J. and Ruffin, R.E. (2004). Impact of coping and
socioeconomic factors on quality of life in adults with asthma. Respirology, 9, 1, p. 87-95, Mar.
Agius, R.M., Davison, A.G., Hawkins, E.R. and Newman-Taylor, A.J. (1994). Occupational
asthma in salbutamol process workers. Occupational and Environmental Medicine, 51, no. 6, p.
397-9, Jun.
Agner, T. and Held, E. (2002). Skin protection programmes. Contact Dermatitis, 47, n. 5, Nov.,
p. 253-256.
Akpinar, E.M. and Elci, O.C. (2002). Importance of work intensity on respiratory problems in
hairdressers. Occupational and Environmental Medicine, 59, 9, 649-650.
Albin, M., Rylander, L., Mikoczy, Z., Lillienberg, L., Hoeglund, A.D., Brisman, J., Toren, K.,
Meding, B., Diab, K.K. and Nielson, J. (2002). Incidence of asthma in female Swedish
hairdressers. Occupational and Environmental Medicine, 59, 2, p. 119-123.
Alexopoulos, E.C. and Burdorf, A. (2001). Prognostic factors for respiratory sickness absence
and return to work among blue collar workers and office personnel. Occupational and
Environmental Medicine, 58, 4, p. 246-252, Apr.
Ameille, J., Pairon, J.C., Bayeux, M.C., Brochard, P., Choudat, D., Conso, F., Devienne, A.,
Garnier, R. and Iwatsubo, Y. (1997). Consequences of occupational asthma on employment
and financial status: a follow up study. European Respiratory Journal, 10, 55-58.
Anonymous (2000). What observation skills are required for behavioural safety initiatives.
Training Solutions for Health and Safety, no. 12, p. 16-19, Jan/Feb.
77
Anonymous (2001). Airway allergy and worklife. Scandinavian Journal of Work Environment
and Health, 27, 6, p. 422-425, Dec.
Anonymous (2002). NHS Trust fined after employee contracts asthma from chemical. Safety
Management, March, 16.
Anonymous. (2002). Employers' asthma wake up call. Occupational Health. 54, no.3, 7, Mar.
Anonymous. (2002). Occupational health. Safety Management. Dec. 2002, 32-34,36,38,40-42.
Atherly, A., Nurmagambetov, T. and Willaims, S. (2005). Direct and indirect cost of asthma in
an employer population. Value in Health, 8, no 3, May-Jun, pp 259-260.
Avory G. and Coggon D. (1994) Determinants of safe working behaviour in farmers when
working with pesticides. Occupational Medicine, 44: 236-238.
Axon, E.J., Beach, J.R. and Burge P.S. (1995). A comparison of some of the characteristics of
patients with occupational and non-occupational asthma. Occupational Medicine, 45, 109-111,
Apr.
Azjen (1985). Intentions to action: a theory of planned behaviour, In Kuhl J and Beckman J
(eds). Action Control: from cognitions to behaviours. New York, Springer Verlag.
Baggs, J. and Silverstein, B. (2003). Workplace health and safety regulations: Impact of
enforcement and consultation on workers' compensation claims rates in Washington State.
American Journal of Industrial Medicine, 43, no.5, 483-494, May.
Bardana, E.J. Jr. (2003). Occupational asthma. Annals of Allergy, Asthma and Immunology, 90,
Iss 5, p. 1, May.
Barnes, P.J. and Woolcock, A.J. (1998). Difficult asthma. European Respiratory Journal, 12, 5,
1209-1218.
Barr, R.G., Somers, S.C., Speizer, F.E. and Camargo, C.A. (2002). Patient factors and
medication guideline adherence among older women with asthma. Archives of Internal
Medicine, 162, 15, p. 1761-8.
Bar-Tal, Y. (1994). Monitoring, blunting, and the ability to achieve cognitive structure. Anxiety,
Stress and Coping: An International Journal, 6 (4): 265-274, Feb.
Barton, C., Clarke, D., Sulaiman, N. and Abramson, M (2003). Coping as a mediator of
psychosocial impediments to optimal management and control of asthma. Respiratory
Medicine, 97, 7, 747-761.
Basagana, X.; Sunyer, J.; Kogevinas, M.; Zock, J.P.; Duran-Tauleria, E.; Jarvis, D.; Burney, P.
and Anto, J.M. (2004). Socioeconomic status and asthma prevalence in young adults : The
European community respiratory health survey. American Journal of Epidemiology, 160, no. 2
(July 15, 2004). p. 178-188.
Bauer, A.; Kelterer, D.; Bartsch, R.; Pearson, J.; Stadeler, M.; Kleesz, P.; Elsner, P.; Williams,
H. (2002). Skin protection in bakers' apprentices. Contact Dermatitis; 46, No.2, p.81-85, Feb.
78
Baur, X., Stahlkopf, H. and Merget, R. (1998). Prevention of occupational asthma including
medical surveillance. American Journal of Industrial Medicine, 34, no. 6, p. 632-9, Dec.
Beatty, P.C. & Beatty, S.F. (2004) Anaesthetists’ intentions to violate safety guidelines.
Anaesthesia. 59. 528-540.
Beck, B.J. (1997). Non-financial barriers to access to health care and their impact on
hospitalisation for asthma. Dissertation Abstracts International Section A: Humanities and
Social Sciences, 58, 3-A, p. 1107, Sep.
Bender, B.G. and Creer, T.L. (2002). Asthma. In Antoni, Michael H and Christensen, Alan J
(Eds). Chronic physical disorders: Behavioural medicine’s perspective (pp. 244-267). The
Blackwell series in health psychology and behavioural medicine. Malden, MA, US: Blackwell
Publishers.
Bernacki, E.J. and Guidera, J.A. (1998). The effect of managed care on surgical rates among
individuals filing for workers' compensation. Journal of Occupational and Environmental
Medicine, 40, no.7, 623-631, July.
Bernstein, D., Karnani, R., Biagini, R. Berstein, C., Murphy, K., Berendts, B., Bernstein, J. and
Bernstein, I. (2003). Clinical and occupational outcomes in health care workers with natural
rubber latex allergy. Annals of Allergy, Asthma and Immunology, 90, 2, p. 209-213, Feb.
Bernstein, D.I. (2002). Management of natural rubber latex allergy. The Journal of Allergy and
Clinical Immunology, 110, no. 2 Suppl, p. S111-6, Aug.
Bernstein, I.L., Keskinen, H. and Malo, J.L. (1999). Medicolegal and compensation aspects. In
Bernstein, I.L., Chan-Yeung, M., Malo, J.L., and Bernstein, D.I. (Eds). Asthma in the
Workplace (2nd edition, revised and expanded). Marcel Dekker Inc: USA.
Berntsson, L. and Ringsberg, K.C. (2003). Correlation between perceived symptoms, self-rated
health and coping strategies in patients with asthma-like symptoms but negative asthma tests.
Psychology, Health and Medicine, 8 (3): 305-315, Aug.
Berry, D. C. (2004) Risk, Communication and Health Psychology. Maidenhead. OU Press.
Biddle, J.; Roberts, K.; Rosenman, K.D. and Welch, E.M. (1998). What percentage of workers
with work-related illnesses receive workers' compensation benefits? Journal of Occupational
and Environmental Medicine, 40(4): 325-331, Apr.
Binks, S.P. (2003). Occupational toxicology and the control of exposure to pharmaceutical
agents at work. Occupational Medicine, 53, No. 6, 363-370, Sept.
Blanc, P.D., Trupin, L., Eisner, M., Earnest, G., Katz, P.P., Israel, L. and Yelin, E.H. (2001).
The work impact of asthma and rhinitis: Findings from a populations based survey. Journal of
Clinical Epidemiology, 54, 6, p. 610-618.
BOHRF (2004). Guidelines for the prevention, identification and management of occupational
asthma: Evidence review and recommendations. British Occupational Health Research
Foundation, London.
Boorman, S. (2004). Allergic to work? The Safety and Health Practitioner, September 2004, p.
38-40.
79
Boot, C.R.; Van der Gulden, J.W.; Orbon, K.H.; Vercoulen, J.H.; Akkermans, R.; Van Weel, C.
and Folgering, H.T. (2004). Asthma and chronic obstructive pulmonary disease: differences
between workers with and without sick leave. International Archives of Occupational and
Environmental Health, 77, no. 5, pp.357-362.
Bosley, C.M., Fosbury, J.A. and Cochrane, G.M. (1995). The psychological factors associated
with poor compliance with treatment in asthma. European Respiratory Journal, 8, n6, p.899904, Jun.
Boss, L.P., Evans, D., Ramos-Bonoan, C., Liao, W., Taggart, V. and Redd, S.C. (2005).
Ensuring a scientific basis for community interventions for asthma. International Journal of
Hygiene and Environmental Health, 208, 1-2, p. 21-25.
Bresnitz, E.A., Beckett, W., Chan-Yeung, M., Craig, T., Gilman, M., Harber, P., Lindell, K.,
Martinez, K., Petsonk, L., Rand, C. and West, B. (2004). Guidelines for assessing and
managing asthma risk at work, school, and recreation. American Journal of Respiratory and
Critical Care Medicine, 169(7): 873-881, Apr.
Bright, P. and Burge, P.S. (1996). The diagnosis of occupational asthma from serial
measurements of lung function at and away from work. Thorax, 51, 8, p. 857-863.
Briner. R.B. (2000). Relationships between work environments, psychological environments
and psychological well-being. Occupational Medicine, 50, Issue 5 299-303.
British guideline on the management of asthma. Thorax, 2003, 58, Suppl 1., 1-94.
Brooks, S. (1995). Occupational asthma. Toxicology Letters, 82/83, pages 39-45.
Brosseau, L.M. and Parker, D.L. (2002). Designing intervention effectiveness studies for
occupational health and safety: The Minnesota wood dust study. American Journal of Industrial
Medicine, 41, no.1, 54-61, Jan.
Brown, S.L. and Bedi, G. (2001). The relationship between coping style and affect in
recovering cardiac patients. Current Research in Social Psychology, 6 (11): May.
Brown, T. (2004). Strategies for prevention: occupational contact dermatitis. Occupational
Medicine, 54, no. 7, pp. 450-457.
Bucknall, CE., Slack, R., Godley, CC., Mackay, TW. and Wright, SC (1999). Scottish
confidential inquiry into asthma deaths (SCIAD), 1994-6. Thorax, 54, 11, 978-984.
Bulat, P., Myny, K., Braeckman, L., Van Sprundel, M., Kusters, E., Doekes, G., Possel, K.,
Droste, J., and Vanhoorne, M. (2004). Exposure to inhalable dust, wheat flour and amylase
allergens in industrial and traditional bakeries. Annals of Occupational Hygiene, 48, No 1, p.
57-63.
Bunton, R., Baldwin, S., Flynn, D. & Whitefellow, S. (2000) The ‘stages of change’ model in
health promotion: Science and Ideology. Critical Public Health. Vol. 10, No. 1.
Burge, P.S. (1997). The management of occupational asthma and hyperreactive airways disease
in the workplace. In H.A. Waldron and C. Edling. (Eds.) Occupational Health Practice.
Butterworth-Heinemann; Oxford.
80
Burge, PS., Pantin, CF., Newton, DT, Gannon, PF., Bright, P., Belcher, J., McCoach, J.,
Baldwin, DR. and Burge, CB. (1999). Development of an expert system for the interpretation
of serial peak expiratory flow measurements in the diagnosis of occupational asthma. Midlands
Thoracic Society Research Group. Occupational Environmental Medicine, 56(11), 758-64,
Nov.
Burge, S. (2004). Sick building syndrome. Occupational and Environmental Medicine, 61,
185-190.
Burgess, J.L.; Kovalchick, D.F., Lymp, J.F., Kyes, K.B., Robertson, W.O. and Brodkin, C.A.
(2001). Risk factors for adverse health effects following hazardous materials incidents. Journal
of Occupational and Environmental Medicine, 43, n. 6, p. 558-566, Jun.
Burstyn, I.; Teschke, K.; Bartlett, K. and Kennedy, S.M. (1998). Determinants of wheat antigen
and fungal alpha-amylase exposure in bakeries. American Industrial Hygiene Association
Journal, 59, no. 5, p. 313-320, May.
Burton, W.N.; Connerty, C.M., Schultz, A.B., Chen, C.Y. and Edington, D.W. (2001). Bank
One's worksite based asthma disease management program. Journal of Occupational and
Environmental Medicine, 43, n. 2, p. 75-82, Feb.
Byer, B. and Myers, L.B. (2000). Psychological correlates of adherence to medication in
asthma. Psychology, Health and Medicine, 5 (4), p. 389-393, November.
Byrns, G.E., Palatianos, K.H.C., Shands, L.A., Fennelley, K.P., McCammon, C.S., Boudreau,
A.Y., Breysse, P.N. and Mitchell, C.S. (2000). Chemical hazards in radiology. Applied
Occupational and Environmental Hygiene, 15, no. 2, p. 203-208, Feb.
Campbell, D.A. (1998). Psychosocial factors in asthma mortality. Clinical Asthma Reviews, 2,
1, 31-35.
Cannon, J., Cullinan, P. and Newman Taylor, A. (1995). Consequences of occupational asthma.
British Medical Journal, 311: 602-603.
Caplan, R.D., Cobb, S., French, J.R.P. Jr, Van Harrison, R., & Pinneau, S.R., Jr. (1980). Job
demands and work health: Main effects and occupational differences. University of Michigan,
Institute for Social Research: Ann Arbor.
Caress, A.L., Beaver, K., Luker, K., Campbell, M. and Woodcock, A. (2005). Involvement in
treatment decisions: What do adults with asthma want and what do they get? Results of a cross
sectional survey. Thorax, 60, 3, p. 199-205.
Carpentier, R.M.C., Ouellet, F., Simard, M. and Marchand, A. (1998). Worker support for joint
health and safety committees: A psychodynamic analysis. Travail Human, 61, 2, pp 171-185,
Jun.
Carroll, P. and Wachs, J.E. (2004). Managing asthma in the workplace: an overview for
occupational health nurses. AAOHN Journal, 52, no. 11, p. 481-9, Nov
Cartier A. (2003). Diagnosing occupational asthma.
International, 15(5), p. 197-202, Sept-Oct.
81
Allergy & Clinical Immunology
Cates, C. (1995). Extracts from "Clinical Evidence": Chronic asthma. British Medical Journal,
323: 976-979.
Chao, H.J.; Schwartz, J.; Milton, D.K. and Burge, H.A. (2003) Work environment and workers'
health in four large office buildings. Environmental Health Perspectives, 111, no. 9, p. 12421248, July.
Chappell, D.W. (1995). Win with Team Safety. Safety and Health, 151, no.2, 68-70, Feb.
Chen, J.T., Krieger, N., Van Den Eeden, S.K. and Quesenberry, C.P. (2002). Different slopes
for different folks: Socioeconomic and racial/ethnic disparities in asthma and hay fever among
173,859 US men and women. Environmental Health Perspectives, 110, suppl 2, p. 211-216.
Chetta, A., Castagnaro, A., Foresi, A., Donno, M.D., Pisi, G., Malorgio, R. and Olivieri, D.
(2003). Assessment of breathlessness perception by Borg scale in asthmatic patients:
Reproducibility and applicability to different stimuli. Journal of Asthma, 40 (3): 323-329, May.
Cheyne, A., Tomas, J.M., Cox, S. and Oliver, A. (2003). Perceptions of safety climate at
different employment levels. Work and Stress, 17, 1, pp 21-37, Jan-Mar.
Conner, M & Norman, P (1996). Predicting Health Behaviour. Buckingham. Open University
Press.
Conner, M. & Abraham, C. (2001) Conscientiousness and the theory of planned behaviour:
toward a more complete model of the antecedents of intentions and behaviour. Personality and
Social Psychology Bulletin. 27 (11) 1547-61
Conner, P.R. (2002). Experience with early detection of toluene diisocyanate-associated
occupational asthma. Applied Occupational and Environmental Hygiene, 17, no. 12, p. 856862, Dec.
Cooper, M.D., Makin, P.J., Phillips, R.A. and Sutherland, V.J. (1993). Safety Climate:
Perceptions of the working environment. Courtaulds Cellophane, Bridgwater. Centre for
Business Psychology, University of Manchester Institute of Science and Technology,
Manchester, UK.
Coppieters, Y. and Piette, D. (2004). Targeting pupils at risk of occupational asthma. Patient
Education and Counselling, 55, (1), p. 136-141, October.
Coppieters, Y., Parent, F. and Piette, D. (2003). Development and evaluation of the use of an
interactive CD-ROM for students at risk of disease related to occupational hazards: The case of
asthma. Promotion and Education, 10, 2, p. 89-93. (French).
Corbridge, S.J. and Corbridge, T.C. (2003). Occupational asthma - Part II. AAOHN Journal, 51,
Iss 11, p. 455, November.
Covello, V.T. (1997). Risk communication. In H.A. Waldron and C. Edling. (Eds.)
Occupational Health Practice. Butterworth-Heinemann; Oxford.
Creer, T.L. and Levstek, D.A. (2001). Respiratory disorders. In DW Johnston and M Johnston
(Eds.) Health Psychology: Comprehensive Clinical Psychology, Volume 8, Pergamon.
82
Cullinan, P., Tarlo, S. and Nemery, B. (2003). The prevention of occupational asthma.
European Respiratory Journal, 22 (5), p. 853-60, Nov.
Cutter, J. and Jordan, S. (2004). Uptake of guidelines to avoid and report exposure to blood and
body fluids. Journal of Advanced Nursing, 46 (4), pp.441-452, May.
Danuser, B., Weber, C., Kuenzli, N., Schlinder, C. and Nowak, D. (2001). Respiratory
symptoms in Swiss farmers: An epidemiological study of risk factors. American Journal of
Industrial Medicine, 39, 4, p. 410-418.
Davidson, M.J.F. (1995). ABC of work related disorders: Legal aspects. British Medical
Journal; 313: 1136-1140.
De Bono, J. and Hudsmith, L. (1999). Occupational asthma: A community based study.
Occupational Medicine, 49, 217-219. May 1999.
De Joy, D.M. (1996) Theoretical Models of Health Behaviour and Workplace Self-Protective
Behaviour. Journal of Safety Research. Vol 27, No. “ 61-72
De Meer, G., Kerkhof, M., Kromhout, H., Schouten, J.P. and Heederik, D. (2004). Interaction of
atopy and smoking on respiratory effects of occupational dust exposure: A general populationbased study. Environmental Health, Vol/Iss/Pg. 3/-, 02 Jun 2004.
De Peuter, S., Van Diest, I., Lemaigre, V., Verleden, G., Demedts, M. and Van den Bergh, O
(2004). Dyspnea: The role of psychological processes. Clinical Psychology Review, 24, 5,
557-581.
De Peuter, S., Van-Diest, I., Lemaigre, V., Li, W., Verleden, G., Demedts, M. and Van-denBergh, O. (2005). Can Subjective Asthma Symptoms Be Learned? Psychosomatic Medicine,
67 (3): 454-461, May-Jun.
De Vries H. and Lechner L. (2000) Motives for protective behaviour against carcinogenic
substances in the workplace: A pilot study among Dutch workers. Journal of Occupational &
Environmental Medicine, 42(1): 88-95.
Dedhia, H.V., Rando, R.J. and Banks, D.E. (2000). Can we protect workers from developing
the adverse respiratory effects of isocyanate exposure? Occupational Medicine: State of the art
reviews, 15, 2, p. 399-409, Apr-June.
DeJoy, D.M.; Searcy, C.A.; Murphy, L.R.; Gershon, R.R.M. (2000). Behavioral-diagnostic
analysis of compliance with universal precautions among nurses. Journal of Occupational
Health Psychology, 5, no. 1, p. 127-141, Jan.
De-Ridder, D. and Schreurs, K. (2001). Developing interventions for chronically ill patients: Is
coping a helpful concept? Clinical Psychology Review, 21 (2): 205-240, March.
Derk, S.J. and Henneberger, P.K. (2003). The association between workplace exacerbation of
asthma and quality of life. American Journal of Respiratory and Critical Care Medicine, 2003
International Conference, The American Thoracic Society, Seattle, WA, May 16-21, 2003
Di Blasi, Z., Harkness, E., Ernst, E., Georgiou, A. and Kleijnen, J. (2001). Influence of context
effects on health outcomes: A systematic review. The Lancet, 357, 10, p. 757-762, March.
83
Dolinski, D. and Nawrat, R. (1998). "Fear-then-Relief" procedure for producing compliance:
Beware when the danger is over. Journal of Experimental Social Psychology, 34, Issue 1,
January, p. 27-50.
Douglas, J.D.M. (2005). If you want to cure their asthma, ask about their job. Primary Care
Respiratory Journal, 14, 2, 65-71.
Douglass, J., Aroni, R., Goeman, D., Stewart, K., Sawyer, S. Thien, F. and Abramson, M.
(1995). A qualitative study of action plans for asthma. British Medical Journal; 324: 1003.
Eisen, E.A., Holcroft, C.A., Greaves, I.A., Wegman, D.H., Woskie, S.R. and Monson, R.R.
(1997). A strategy to reduce healthy worker effect in a cross-sectional study of asthma and
metalworking fluids. American Journal of Industrial Medicine, 31, 6, 671-677.
Eisner, M.D., Yelin, E.H., Trupin, L. and Blanc, P.D. (2002). Influence of chronic respiratory
conditions on health status and work disability. American Journal of Public Health, 92, 9, p.
1506-1513, Sept.
Eisner, M.D.; Yelin, E.H.; Henke, J.; Shiboski, S.C. and Blanc, P.D. (1998). Environmental
tobacco smoke and adult asthma. The impact of changing exposure status on health outcomes.
American Journal of Respiratory and Critical Care Medicine, 158(1): 1-6, July.
Erickson, S.R. and Kirking, D.M. (2002). A cross-sectional analysis of work-related outcomes
in adults with asthma. Annals of Allergy, Asthma and Immunology, 88, 3, p. 292-300.
Erickson, S.R. and Kirking, D.M. (2004). Variation in the distribution of patient-reported
outcomes based on different definitions of defining asthma severity. Current Medical Research
and Opinion, 20, 12, 1863-1872.
Erkinjuntti-Pekkanen, R.; Slater, T.; Cheng, S.; Fishwick, D.; Bradshaw, L.; Kimbell-Dunn, M.;
Dronfield, L. and Pearce, N. (1999). Two years follow up of pulmonary values among welders
in New Zealand. Occupational and Environmental Medicine, 56, No.5, p.328-333, May.
Ettinger, A., Reed, M. and Cramer, J. (2004). Depression and comorbidity in community based
patients with epilepsy or asthma. Neurology, 63, 6, p. 1008-1014.
Evans, W. (1996). Occupational asthma - A lawyer's view. Journal of the Royal Society of
Health, 116, 4, 229-231.
Falliers, C.J. (1987). Preoccupational asthma. Journal of Asthma, 24(3), p. 149-51.
Feldman, J.M., Lehrer, P.M., Hochron, S.M. and Schwartz, G.E. (2002). Defensiveness and
individual response stereotypy in asthma. Psychosomatic Medicine, 64, 2, p. 294-301, MarApr.
Fell-Carlson, D. (2004). Rewarding safe behaviour. Strategies for Change. AAOHN Journal,
52 (12), 521-527.
Fischer, F.M., Morata, T.C., Latorre, M.doR., Krieg, E.F., Fiorini, A.C., Colacioppo, S.,
Gozzoli, L., Padrao, M.A., Zavariz, C., Lieber, R., Wallingford, K.M. and Cesar, C.L. (2001).
Effects of environmental and organizational factors on the health of shiftworkers of a printing
company. Journal of Occupational and Environmental Medicine, 43, no. 10, p. 882-9, Oct.
84
Fishwick, D., D’Souza, W. and Beasley, R. (1997). The asthma self-management plan of care:
What does it mean, how is it done, does it work, what models are available, what do patients
want and who needs it? Patient Education and Counselling, 32 (Suupl 1), p. S21-S33, Dec.
Fleming, S.L., Pagliari, C., Churchill, R., McKean, M. and Shuldham, C.M. (2003).
Psychotherapeutic interventions for adults with asthma. The Cochrane Database of Systematic
Reviews 2003, Issue 4, Art. No. CD002982.pub2.
Forrest, J. (2001). A-Z of personal protection: Against the grain. Health and Safety at Work,
23, 9, 47, Sept.
Frew, A.J. (2003). What can we learn about asthma from studying occupational asthma? Annals
of Allergy, Asthma and Immunology, 90, Iss 5, p. 7, May.
Frew, A.J. (2004). Advances in environmental and occupational diseases 2003. Journal of
Allergy and Clinical Immunology, 113 (6), p. 1161-6, June.
Friedman-Jimenez, G.; Beckett, W.S.; Szeinuk, J. and Petsonk, E.L. (2000). Clinical evaluation,
management, and prevention of work-related asthma. American Journal of Industrial Medicine,
37, no. 1, pp. 121-141.
Galdi, E. and Moscato, G. (2002). Prevention of occupational asthma. Monaldi Archives for
Chest Disease, 57, 3-4, p. 211-2, Jun-Aug.
Gallant, M.P. (2003). The influence of social support on chronic illness self-management: A
review and directions for research. Health Education and Behavior, 30 (2): 170-195, Apr.
Gannon, P.F.G., Weir, D.C., Robertson, A.S. and Burge, P.S. (1993). Health, employment and
financial outcomes in workers with occupational asthma. British Journal of Industrial
Medicine, 50, 491-496.
Garcia, A.M.; Boix, P. and Canosa, C. (2004). Why do workers behave unsafely at work?:
Determinants of safe work practices in industrial workers. Occupational and Environmental
Medicine, 61, no. 3, p. 239-246, Mar.
Gassert, T.H., Hu, H., Kelsey, K.T. and Christiani, D.C. (1998). Long term health and
employment outcomes of occupational asthma and their determinants. Journal of Occupational
and Environmental Medicine, 40, 5, p. 481-91, May.
Gautrin, D., Newman-Taylor, A.J., Nordman, H. and Malo, J.L. (2003). Controversies in
epidemiology of occupational asthma. European Respiratory Journal, 22 (3), p. 551-9, Sept.
Geller, E.S., Perdue, S.R. and French, A. (2004). Behaviour-based safety coaching. 10
guidelines for successful application. Professional Safety, July 2004, p. 42-49.
Gershon, R.R.M.; Karkashian, C.D.; Grosch, J.W.; Murphy, L.R.; Escamilla-Cejudo, A.;
Flanagan, P.A.; Bernacki, E.; Kasting, C. and Martin, L. (2000). Hospital safety climate and its
relationship with safe work practices and workplace exposure incidents. American Journal of
Infection Control, 28, no. 3, p. 211-221, June.
Giardino, N.D., Schmaling, K.B. and Afari, N. (2002). Relationship Satisfaction Moderates the
Association Between Catastrophic Cognitions and Asthma Symptoms. Journal of Asthma, 39
(8): 749-756, Dec.
85
Gibson, P.G., Powell, H., Coughlan, J., Wilson, A.J., Abramson, M., Haywood, P., Bauman, A.,
Hensley, M.J. and Walters, E.H. (2002). Self-management education and regular practitioner
review for adults with asthma. The Cochrane Database of Systematic Reviews 2002, Issue 3,
Art. No. CD001117.
Gillen, M., Baltz, D., Gassel, M., Kirsch, Luz., and Vaccaro, D. (2002). Perceived safety
climate, job demands, and coworker support among union and nonunion injured construction
workers. Journal of Safety Research, 33, no. 1, p. 33-51.
Girard, F., Chaboillez, S., Cartier, A., Cote, J. (2004). An effective strategy for diagnosing
occupational asthma: Use of induced sputum. American Journal of Respiratory and Critical
Care Medicine, 170, Iss 8, p. 845, October.
Godin, G.; Naccache, H. and Morel, S. (2000). Determinants of nurses' adherence to universal
precautions for venipunctures. American Journal of Infection Control, 28, n. 5, p. 359-364, Oct.
Goe, S.K., Henneberger, P.K., Reilly, M.J., Rosenman, K.D., Schill, D.P., Valiante, D., Flattery,
J., Harrison, R., Davis, L., Tumpowsky, C. and Filios, M.S. (2004). A descriptive study of work
aggravated asthma. Occupational and Environmental Medicine, 61 (6), p. 512-517, June.
Goldenhar, L.M., Williamson, L.J. and Swanson, N.G. (2003). Modelling relationships
between job stressors and injury and near-miss outcomes for construction labourers. Work and
Stress, 17, No 3, 218-240, Jul-Sept.
Gordon, SB., Curran, AD., Murphy, J., Sillitoe, C., Lee, G., Wiley, K. and Morice, A.H. (1997).
Screening questionnaires for bakers asthma - are they worth the effort? Occupational Medicine,
47, 361-366.
Gorski, P., Kolacinska, B. and Wittczak, T. (1999). Analysis of the clinical state of patients
with occupational asthma following cessation of exposure to allergens. Occupational Medicine,
49, 285-289, Jul.
Gray JR. (2004). Worrying practices in disinfectant procedures. British Journal of Nursing;
13(1); p. 10; Jan 8-21.
Green, E., Courage, C. and Rushton, L (2003). Reducing domestic exposure to environmental
tobacco smoke: a review of attitudes and behaviours. Journal of the Royal Society for the
Promotion of Health, 123, 1, 46-51.
Green-McKenzie, J.; Rainer, S.; Behrman, A. and Emmett, E. (2002). Effect of a health care
management initiative on reducing workers' compensation costs. Journal of Occupational and
Environmental Medicine, 44, no. 12, p. 1100-1105, Dec.
Gregerson, M.B. (2000). The curious 2000-year case of asthma. Psychosomatic Medicine, 62, 6,
816-827.
Griffiths, C., Kaur, G., Gantley, M., Feder, G., Hillier, S., Goddard, J. and Packe, G. (2001).
Influences on hospital admission for asthma in South Asian and white adults: Qualitative
interview study. British Medical Journal, 323, p.1-8.
Gwynn, R. (2004). Risk factors for asthma in US adults: Results from the 2000 behavioural risk
factor surveillance system. Journal of Asthma, 41 (1), p. 91-98, February.
86
Hable, P., Taveira, A.D. andKarsh, B.T. (2002). Investigations of the relationship between
workers' perceptions and compliance with standard safety precuations in a rural hospital.
Proceedings of the 46th Annual Meeting of the Human Factors and Ergonomics Society,
Baltimore, Maryland, Sept30-Oct4 2002.
Hagberg, M. (2001). X-2001 - Exposure assessment in epidemiology and practice. Stockholm,
National Institute for Working Life, 2001 515pp.
Haines, V.Y., Merrheim, G. and Roy, M. (2001). Understanding reactions to safety incentives.
Journal of Safety Research, 32, 1, pp 17-30.
Hancox, R.J., Milne, B.J., Taylor, D.R., Greene, J.M., Cowan, J.O., Flannery, E.M., Herbison,
G.P., McLachlan, C.R., Poulton, R. and Sears, M.R. (2004). Relationship between
socioeconomic status and asthma: A longitudinal cohort study. Thorax, 59, 5, p. 376-80.
Hand, C.H. and Adams, M. (2002). How do attitudes to illness and treatment compare with
self-reported behaviour in predicting inhaler use in asthma? Primary Care Respiratory Journal,
11(1), 9-12.
Harber, P. (1996). Decreasing Work Disability from Asthma. Western Journal of Medicine,
165, No. 3, pages 142-143.
Harbison, S.A. (no date). Assessment of safety culture by regulatory bodies - UK view. HM
Nuclear Installations Inspectorate.
Hardie, G.E., Gold, W.M., Janson, S., Carrieri-Kohlman, V. and Boushey, H.A. (2002).
Understanding how asthmatics perceive symptom distress during a methacholine challenge.
Journal of Asthma, 39 (7): 611-618, Oct.
Harrison, B.D. (1998). Psychosocial aspects of asthma in adults. Thorax, 53 (6), p: 519-25, Jun.
Haynes, R.B., McDonald, H., Garg, A.X. and Montague, P. (2002). Interventions for helping
patients to follow prescriptions for medications. The Cochrane Database of Systematic Reviews
2002, Issue 2, Art. No. CD000011
Hegde, S.C., Shah, P.B. and Mahashur, A.A. (2002). Awareness regarding occupational asthma
amongst general practitioners - A critical evaluation. Indian Journal of Occupational and
Environmental Medicine, 6, 1, 16-20.
Hendrick, D.J. (1994). Management of occupational asthma. The European Respiratory
Journal, 7, no. 5, p. 961-8.
Henley, K. (1996). Indoor air quality and asthma.
Sep.
Occupational Health, 48, no.9, 314-315,
Hesselink, A.E., Penninx, B.W.J.H., Schlosser, M.A.G., Wijnhoven, H.A.H., Van-der-Windt,
D.A.W.M., Kriegsman, D.M.W. and Van-Eijk, J.Th.M. (2004). The role of coping resources
and coping style in quality of life of patients with asthma or COPD. Quality of Life Research:
An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 13
(2): 509-518, March.
87
Hnizdo, E. and Sylvain, D. (2003). Health hazard evaluation report: HETA 2000-0096-2876,
ChemDesign Corporation, Fitchburg, Massachusetts. National Institute for Occupational Safety
and Health.
Hofmann, D.A. and Morgeson, F.P. (2004). The role of leadership in safety. In J. Barling and
M.R. Frone (Eds.). The Psychology of Workplace Safety. American Psychological Association:
Washington, DC.
Hollund, B.E., Moen, B.E., Lygre, S.H., Florvaag, E. and Omenaas, E. (2001). Prevalence of
airway symptoms among hairdressers in Bergen, Norway. Occupational and Environmental
Medicine, 58, 12, p. 780-785.
Holness, D.L. and Nethercott, J.R. (1995). The use of respiratory protective equipment and
respiratory outcomes in hog farmers. In H.H. McDuffie, J.A. Dosman, K.M. Semchuk, S.A.
Olenchock, and A. Senthilselvan, (Eds). Agricultural Health and Safety. Workplace,
Environment, Sustainability. CRC Press Inc., Boca Raton, pages 551-555.
Hopkins, A. (1998). Does compensation have a role in injury prevention? In Anne-Marie Feyer
and Ann Williamson (Eds.) Occupational injury: risk, prevention and intervention. London,
U.K.: Taylor & Francis, 1998. Ch. 20, p.263-270
Hoppin, J.A.; Umbach, D.M. and London, S.J. (2004). Diesel exhaust, solvents, and other
occupational exposures as risk factors for wheeze among farmers. American Journal of
Respiratory and Critical Care Medicine, 169, n. 12, p. 1308-1313, Jun.
Horne, R. and Weinman, J. (2002). Self-regulation and self management in asthma: Exploring
the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer
medication. Psychology and Health, 17 (1), p. 17-32, February.
Hunt, P.; Herrick, R.; Marx, A.; Sama, S.; Milton, D.; Hallock, M.; Pechter, E.; Boylstein, R.
and Dieffenbach, A. (2002). Exposure assessment for respiratory sensitizers and irritants:
Expert assessment versus subject assessment of exposure based on telephone questionnaire
responses in an HMO-based study of occupational asthma. American Industrial Hygiene
Conference and Expo Proceedings. http://www.aiha.org/aihce02/handouts.htm.
Hurwitz, E.L. (2003). Do asthma and physical inactivity influence the associations of personal
and job stressors with perceived stress and depression? Findings from the 1998-1999 California
Work and Health Survey. Annals of Epidemiology, 13, 5, p. 358-368.
Inman, C.; Lewis, V.; Jackson, L.; Landsittel, D. and Blanciforti, L. (2002). Theoretically-based
eye injury prevention messages: working with carpenters. Best Practices in Occupational Safety
and Health, Education, Training, and Communication: Ideas That Sizzle, 6th International
Conference, Scientific Committee on Education and Training in Occupational Health, ICOH, In
Cooperation with The International Communication Network, ICOH, Baltimore, Maryland,
USA, October 28-30, 2002
Innes, N.J., Reid, A., Halstead, J., Watkin, S.W. and Harrison, B.D. (1998). Psychosocial risk
factors in near-fatal asthma and in asthma deaths. Journal of the Royal College of Physicians
of London, 32 (5), P: 430-4, sep-Oct.
Jaakkola, M.S., Piipari, R., Jaakkola, N. and Jaakkola, J.J.K. (2003). Environmental tobacco
smoke and adult onset asthma: A population based incident case-control study. American
Journal of Public Health, 93, 12, p. 2055-2060.
88
Jeebhay, M.F., Lopata, A.L. and Robins, T.G. (2000). Seafood processing in South Africa: A
study of working practices, occupational health services and allergic health problems in the
industry. Occupational Medicine, 50, 6, p. 406-13.
Jensen, L.K. and Kofoed, L.B. (2002). Musculoskeletal Disorders Among Floor Layers: Is
Prevention Possible? Applied Occupational & Environmental Hygiene, 17, no. 11, pp. 797-806.
Jessop, D.C. and Rutter, D.R. (2003). Adherence to asthma medications: The role of illness
representation. Psychology and Health, 18, (5), p. 595-612, October.
Johnson, S.E. & Hall, A. (2005) The prediction of safe lifting behaviour: an application of the
theory of planned behaviour. Journal of Safety Research. 36. 63-73.
Juniper, E.F. (1999). Health-related quality of life in asthma. Current Opinion in Pulmonary
Medicine, 5(2), p. 105-10, March.
Kamal, K. and Miller, L.A. (2004). Psychosocial factors and asthma. American Journal of
Respiratory and Critical Care Medicine, 169 (11), p: 1253, Jun.
Kaptein, A.A., Scharloo, M., Helder, D.I., Kleijn, W.C., Van Korlaar, I.M. and Woertman, M.
(2003). Representations of chronic illness. In H. Leventhal and L. Cameron (Eds). The Selfregulation of Health and Illness Behaviour. New York: Routledge.
Karjalainen, A., Martikainen, R., Oksa, P., Saarinen, K. and Uitti, J. (2002). Incidence of
asthma among Finnish construction workers. Journal of Occupational and Environmental
Medicine, 44, 8, p. 752-7, Aug.
Katz, P.P.; Eisner, M.D.; Yelin, E.H.; Earnest, G.; San-Pedro; and Blanc, P.D. (2002).
Prevalence of depressive symptoms among adults with asthma. American Journal of
Respiratory and Critical Care Medicine, 2002 International Conference, The American Thoracic
Society, Atlanta Georgia, May 17-22, 2002.
Katz, P.P.; Yelin, E.H.; Eisner, M.D. and Blanc, P.D. (2003). Function and the development of
depressive symptoms among adults with asthma. American Journal of Respiratory and Critical
Care Medicine, 2003 International Conference, The American Thoracic Society, Seattle, WA,
May 16-21, 2003.
Kemple, T. and Rogers, C. (2003). A mailed personalised self-management plan improves
attendance and increases patients' understanding of asthma. Primary Care Respiratory Journal,
12(4), 110-114.
Kennedy, S.M., Le Moual, N., Choudat, D. and Kauffmann, F. (2000). Development of an
asthma specific job exposure matrix and its application in the epidemiological study of genetics
and environment in asthma (EGEA). Occupational and Environmental Medicine, 57, 9, 635641.
Kim, L.E.; Jeffe, D.B. and Evanoff, B.A. (2001). Improved compliance with universal
precautions in the operating room following an educational intervention. Infection Control and
Hospital Epidemiology; 22, n. 8, p. 522-524, Aug.
King, M.E., Mannino, D.M. and Holguin, F. (2004). Risk factors for asthma incidence: A
review of recent prospective evidence. Panminerva Medicine, 46(2), p. 97-110, June.
89
Kolbe, J. (1999). Asthma education, action plans, psychosocial issues and adherence. Canadian
Respiratory Journal, 6 (3), p: 273-80, May-Jun.
Krause, N. and Lund, T. (2004). Returning to work after occupational injury. In J. Barling and
M.R. Frone (Eds.). The Psychology of Workplace Safety. American Psychological Association:
Washington, DC.
Kronander, U.N., Falkenberg, M. and Olle, Z. (2004). Prevalence and incidence of asthma
related to waist circumference and BMI in a Swedish community sample. Respiratory
Medicine, 98, 11, p. 1108-1116.
Kuschner, W.G.; Chitkara, R.K. and Sarinas, P.S.A. (1998). Occupational asthma: Practical
points for diagnosis and management. Western Journal of Medicine, 169(6); p. 342-50, Dec.
Kyes, K.B.; Wickizer, T.M. and Franklin, G. (2003). Employer satisfaction with workers'
compensation health care: Results of the Washington State workers' compensation managed
care pilot. Journal of Occupational and Environmental Medicine, 45, no. 3, p. 234-240, Mar.
Lad, T. (2003). Occupational asthma in health care professionals. Occupational Health and
Safety, 72, 9, p. 190, September.
Lahtinen, M., Huuhtanen, P., Vahamaki, K., Kahkonen, E., Mussalo-Rauhamaa, H., and
Reijula, K. (2004). Good practices in managing work-related indoor air problems: A
psychosocial perspective. American Journal of Industrial Medicine, 46, 71-85.
Larbanois, A., Jamart, J., Delwiche, J.P. and Vandenplas, O. (2002). Socioeconomic outcome of
subjects experiencing asthma symptoms at work. European Respiratory Journal, 19, 6, p. 11071113.
Lardner, R., Miles, B. and Fleming, M. (2000). Safer behaviour at work. The Chemical
Engineer, January 2000, p. 23-25, www.keilcentre.co.uk/downloads/behaviour2.pdf
Le Moual, N., Kennedy, S.M. and Kauffmann, F.(2004). Occupational exposures and asthma in
14,000 adults from the general population. American Journal of Epidemiology, 160, 11, 11081116, Dec.
Leffler, C.T. and Milton, D.K. (1999). Occupational asthma and contact dermatitis in a spray
painter after introduction of an aziridine cross-linker. Environmental Health Perspectives, 107,
7, p. 599-601, Jul.
Lehrer, P., Feldman, J., Giardino, N., Song, H.S. and Schmaling, K. (2002). Psychological
aspects of asthma. Journal of Consulting and Clinical Psychology, 70 (3), p. 691-711, June.
Levin, S.; Herbert, R.; Skloot, G.; Szeinuk, J.; Teirstein, A.; Fischler, D.; Milek, D.; Piligian,
G.; Wilk-Rivard, E. and Moline, J. (2002). Health effects of World Trade Center site workers.
American Journal of Industrial Medicine, 42, no. 6, p. 545-547, Dec.
Ley, R., Timmons, B., Kotses, H., Harver, A., Wientjes, CJE (1996). Highlights of the annual
meeting of the international society for the advancement of respiratory psychophysiology and
the 14th international symposium on respiratory psychophysiology. Biofeedback and SelfRegulation, 21, 3, 241-260.
90
Lincoln, A.E., Feuerstein, M., Shaw, W.S. and Miller, V.I. (2002). Impact of case manager
training on worksite accommodations in workers' compensation claimants with upper extremity
disorders. Journal of Occupational and Environmental Medicine, 44, no.3, 237-245, Mar.
Ling, T.C. and Coulson, I.H. (2002). What do trainee hairdressers know about hand dermatitis?
Contact Dermatitis, 47, 4, p. 227-231.
Liss, G.M.; Tarlo, S.M. (2001). Natural rubber latex-related occupational asthma: Association
with interventions and glove changes over time. American Journal of Industrial Medicine, 40,
no. 4, pp. 347-353.
Liss, G.M.; Tarlo, S.M.; Doherty, J.; Purdham, J.; Greene, J.; McCaskell, L. and Kerr, M.
(2003). Physician diagnosed asthma, respiratory symptoms, and associations with workplace
tasks among radiographers in Ontario, Canada. Occupational and Environmental Medicine, 60,
no. 4, p. 254-261, Apr.
Liu, Y.; Sparer, J.; Woskie, S.R.; Cullen, M.R.; Chung, J.S.; Holm, C.T. and Redlich, C.A.
(2000). Qualitative assessment of isocyanate skin exposure in auto body shops: A pilot study.
American Journal of Industrial Medicine, 37, no. 3, p. 265-274, Mar.
Lombardo, L.J. and Balmes, J.R. (2000). Occupational asthma: A review. Environmental
Health Perspectives, 108, 697-704 Suppl 4. Aug 2000.
Lucas, D.O.; Zimmer, L.O.; Paul, J.E.; Jones, D.; Slatko, G.; Liao, W. and Lashley, J. (2001).
Two-year results from the asthma self-management program: Long-term impact on health care
services, costs, functional status, and productivity. Journal of Asthma, 38, no. 4, p. 321-330.
Lymer, U., Richt, B and Isaksson, B. (2004). Blood exposure: factors promoting health care
workers' compliance with guidelines in connection with risk. Journal of Clinical Nursing, 13
(5), pp.547-554, Jul.
Lynch, J., Smith, G.D., Hillemeier, M., Shaw, M., Raghunathan, T. and Kaplan, G. (????).
Income inequality, the psychosocial environment, and health: Comparisons of wealthy nations.
The Lancet, 358, Is 9277, p. 194.
MacIntosh, M. and Gough, R. (1998). The impact of workplace change on occupational health
and safety: A study of four manufacturing plants. Human Factors, Ergonomics and
Manufacturing, 8, no. 2, pp. 155-175.
Mackenbach, J.P. and Bakker, M.J. (2003). Tackling socioeconomic inequalities in health:
Analysis of European experiences (for the European Network on Interventions and Policies to
Reduce Inequalities in Health*). The Lancet, 362, Is. 9393, p. 1409.
Mackmurdo, R. (2002). Risk Watch: Effective employee involvement. Occupational Safety and
Health, 32, no.5, 12-14, May.
Madan I. (1996). ABC of work related disorders: occupational asthma and other respiratory
diseases. British Medical Journal, 313(7052); p. 291-4, Aug.
Makinen, S., Suominen, T. and Lauri, S. (2000). Self care in adults with asthma: How they
cope. Journal of Clinical Nursing, 9, 4, p. 557-565, Jul.
91
Malo, J.L. (2002). Occupational asthma: What have we learned in the past 10 years and
what should we learn next? Monaldi Archives for Chest Disease, 57, 2, 123-126.
Malo, J.L., Dewitte, J.D., Cartier, A., Ghezzo, H., L'Archeveque, J., Boulet, L., Cote, J., Bedard,
G., Boucher, S., Champagne, F., Tessier, G. and Contandriopoulos, A.P. (1993). The Quebec
system of indemnification for occupational asthma. Description, efficacy and costs. Rev. Mal.
Respir, 10, 313-23.
Malo, J.L., Lemiere, C., Gautrin, D. and Labrecque, M. (2004). Occupational asthma. Current
Opinion in Pulmonary Medicine, 10 (1), p. 57-61, January.
Malo, J.L.; Boulet, L.P.; Dewitte, J.D.; Cartier, A.; L'Archeveque, J.; Cote, J.; Bedard, G.;
Boucher, S.; Champagne, F.; Tessier, G.; Contandriopoulos, A.P.; Juniper, E.F. and Guyatt,
G.H. (1993). Quality of life of subjects with occupational asthma. Journal of Allergy and
Clinical Immunology, 91, No. 6, pages 1121-1127.
Mancuso, C.A.; Rincon, M. and Charlson, M.E. (2003). Adverse work outcomes and events
attributed to asthma. American Journal of Industrial Medicine, 44, no. 3, p. 236-245, Sept.
Marabini, A., Siracusa, A., Stopponi, R., Tacconi, C. and Abbritti, G. (2003). Outcome of
occupational asthma in patients with continuous exposure: A 3-year longitudinal study during
pharmacologic treatment. Chest, 124, Iss 6, p. 2372, December.
Mardis, A.L. and Pratt, S.G. (2003). NIOSH alert: Preventing deaths, injuries and illnesses of
young workers. National Institute of Occupational Safety and Health.
Marks, G.B., Jalaludin, B.B., Williamson, M., Atkin, N.L. and Bauman, A. (2000). Use of
preventer medications and written asthma management plans among adults with asthma in New
South Wales. NSW Health Department Asthma Data Working Group. The Medical Journal of
Australia, 173, 8, p. 407-10.
McGann, E.F. (2000). The relationship of denial of illness and compliance with inhaled
preventative medications in adults with asthma. Dissertation Abstracts International: Section B:
The Sciences and Engineering, 61, 4-B, p. 1873.
McGee, B.K. (2004). Organizational culture and behavioural issues affecting workplace safety.
Dissertation Abstracts International: Section B: The Sciences and Engineering, 65, 6-B, p. 3207.
McGhan, S.L., Cicutto, L.C. and Befus, A.D. (2005). Advances in development and evaluation
of asthma education programs. Current Opinion in Pulmonary Medicine, 11, 1, 61-68.
Meijer, A.M., Griffioen, R.W., Van-Nierop, J.C. and Oppenheimer, L. (1995). Intractable or
uncontrolled asthma: psychosocial factors. The Journal of Asthma, 32 (4), p. 265-74.
Meijer, E., Grobbee, D.E. and Heederik, D. (2002). Detection of workers sensitised to high
molecular weight allergens: A diagnostic study in laboratory animal workers. Occupational and
Environmental Medicine, 59, 3, p. 189-95.
Mendelson, M.B., Catano, V.M. and Kelloway, K. (2000). Role of stress and social support in
sick building syndrome. Work and Stress, 14, 2, p. 137-155, Apr-June.
92
Meredith, S.K., Bugler, J. and Clark, R.L. (2000). Isocyanate exposure and occupational
asthma: a case-referent study. Occupational and Environmental Medicine, 57; No. 12; 830-836,
December.
Merget, R.; Caspari, C.; Dierkes-Globisch, A.; Kulzer, R.; Breitstadt, R.; Kniffka, A.; Degens,
P. and Schultze-Werninghaus, G. (2001). Effectiveness of a medical surveillance program for
the prevention of occupational asthma caused by platinum salts: A nested case-control study.
Journal of Allergy and Clinical Immunology, 107, no. 4, pp. 707-712.
Mihalas, L.S. (1999). An approach to the diagnosis of occupational asthma. Annals of Allergy,
Asthma, & Immunology, 83(6 part 2), p. 577-82, Dec.
Milton, D.K., Solomon, G.M., Rosiello, R.A. and Herrick, R.F. (1998). Risk and incidence of
asthma attributable to occupational exposure among HMO members. American Journal of
Industrial Medicine, 33, 1, p. 1-10.
Moffat, M., Cleland, J., Price, D., Van der Molen, T. (2002). General practitioners'
understanding of severe and difficult asthma: A qualitative study. Primary Care Respiratory
Journal, 11(3), 99-102.
Monso, E. (2004). Occupational asthma in greenhouse workers. Current Opinion in Pulmonary
Medicine, 10, 2, p. 147-50, Mar.
Moscato, G., Dellabianca, A., Maestrelli, P., Paggiaro, P., Romano, C., De-Zotti, R., Marabini,
A., Voltolini, S., Crippa, M., Previdi, M., Brame, B., Benzon, R. and Siracusa, A. (2002).
Features and severity of occupational asthma upon diagnosis: An Italian multicentre case
review. Allergy, 57, 3, p. 236-42, Mar.
Moscato, G., Dellbianca, A., Perfetti, L., Brame, B., Galdi, E., Niniano, R. and Paggiaro, P.
(1999). Occupational asthma: A longitudinal study on the clinical and socioeconomic outcome
after diagnosis. Chest, 115, 1, p. 249-256.
Moscato, G., Malo, J.L. and Bernstein, D. (2003). Diagnosing occupational asthma: how, how
much, how far? The European Respiratory Journal, 21, no. 5, p. 879-85, May.
Munoz, X., Cruz, M.J., Orriols, R., Bravo, C., Espuga, M. and Morell, F. (2003). Occupational
asthma due to persulfate salts: Diagnosis and follow up. Chest, 123, 6, p. 2124-9, Jun.
Muris, P., De-Jong, P.J., Merckelbach, H. and Van-Zuuren, F.J. (1994). Effects of imposed
monitoring and blunting strategies on emotional reactivity. Anxiety, Stress and Coping: An
International Journal, 7 (1): 53-65, May.
Murphy, E., Harrison, J. and Beach J. (2002). Implementation of statutory occupational
respiratory health surveillance. Occupational Medicine, 52, 8, p. 497-502.
Nathell, L. (2005). Effects on sick leave of an inpatient rehabilitation programme for asthmatics
in a randomised trial. Scandinavian Journal of Public Health,33, 1, p. 57-64.
Nayebzadeh, A. and Dufresne, A. (1999). Evaluation of exposure to methyl methacrylate among
dental laboratory technicians. American Industrial Hygiene Association Journal, 60, 5, p. 625628, Sep-Oct.
93
Neal, A. and Griffin, M.A. (2004). Safety climate and safety at work. In J. Barling and M.R.
Frone (Eds.). The Psychology of Workplace Safety. American Psychological Association:
Washington, DC.
Nelson, D.A. (2001). Self direction and coping in adults with asthma. Dissertation Abstracts
International Section A: Humanities and Social Sciences, 61, 9-A, p. 3440.
Newman-Taylor, A. (2002). Asthma and work. The Colt Lecture, delivered at the 9th
international symposium on inhaled particles, Cambridge, September 2001. Annals of
Occupational Hygiene, 46 (7), p 563-574.
Nicholson, P.J., Cullinan, P., Newman-Taylor, A., Burge, P.S. and Boyle, C. (2005). Evidence
based guidelines for the prevention, identification and management of occupational asthma.
(BOHRF 2005). Occupational Environmental Medicine, 62, 290-299.
Niemeier, V., Nippesen, M., Kupfer, J., Schill, W.B. and Gieler, U. (2002). Psychological
factors associated with hand dermatoses: Which subgroup needs additional psychological care?
British Journal of Dermatology, 146, 6, p. 1031-1037.
Niven, R.M. and Pickering, C.A. (1999). Is atopy and smoking important in the workplace?
Occupational Medicine, 49, no. 3, p. 197-200, Apr.
Noiesen, E., Larsen, K. and Agner, T. (2004). Compliance in contact allergy with focus on
cosmetic labelling: A qualitative research project. Contact Dermatitis, 51, 4, p. 189-95.
Norman, P, Abraham, c and Conner, M (2000). Understanding and Changing Health behaviour,
Harwood Academic Publishers, Australia
Nouwen, A.; Freeston, M.H.; Labbe, R. and Boulet, L.P. (1999). Psychological factors
associated with emergency room visits among asthmatic patients. Behavior Modification, 23,
no. 2, p. 217-233, Apr.
Obase, Y., Shimoda, T., Mitsuta, K., Matsuse, H. and Kohno, S. (2000). Two patients with
occupational asthma who returned to work with dust respirators. Occupational and
Environmental Medicine, 57, 1, p. 62-64, Jan.
Oliver, L.C., Miracle-McMahill, H., Littman, A.B., Oakes, J.M. and Gaita, R.R. (2001).
Respiratory symptoms and lung function in workers in heavy and highway construction: A cross
sectional study. American Journal of Industrial Medicine, 40, 1, p. 73-86.
O'Neill, R. (1995). Asthma at work: causes, effects and what to do about them. Sheffield
Occupational Health Project, Sheffield, 1995, 133pp.
Osborne, S. (2003). Influences on compliance with standard precautions among operating room
nurses. American Journal of Infection Control, 31, 7, p. 415-423, Nov.
Packham, C. (2002). Controlling the itch. Occupational Health, 54, n. 5, p. 26-29, May.
Park, R.M. (2001). Medical insurance claims and surveillance for occupational disease: analysis
of respiratory, cardiac, and cancer outcomes in auto industry tool grinding operations. Journal of
Occupational and Environmental Medicine, 43, no. 4, p. 335-346, Apr.
94
Patterson, M., Warr, P. and West, M. (2004). Organizational climate and company
productivity: The role of employee affect and employee level. Journal of Occupational and
Organizational Psychology, 77, 193-216.
Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt
Impulsiveness Scale. Journal of Clinical Psychology, 51, 768–774.
Perez-Floriano, L.R. (2001) Hazard information, risk perception, cultural values, and safety
compliance: A comparison of Canada, Mexico, and the United States.
Perry, M. J., Marbella, A. and Layde, P.M. (2000). Association of pesticide safety knowledge
with beliefs and intentions among farm pesticide applicators. Journal of Occupational &
Environmental Medicine, 42(2): 187-193.
Petersson, L.M., Nordin, K., Glimelius, B., Brekkan, E., Sjoden, P.O., and Berglund, G. (2002).
Differential effects of cancer rehabilitation depending on diagnosis and patients' cognitive
coping style. Psychosomatic Medicine, 64 (6): 971-980, Nov-Dec.
Petrea, R.E. (2001) The theory of planned behaviour: use and application in targeting
agricultural safety and health interventions. Journal of Agricultural Safety and Health. 7. 7-19.
Petrie, K.J; Broadbent, E. and Meechan, G. (2003). Self-regulatory interventions for improving
the management of chronic illness. In Leventhal, Howard (Ed), Cameron, Linda D (Ed), The
self-regulation of health and illness behaviour. (pp.257-277). New York, US: Routledge.
Piirainen, H., Rasanen, K. and Kivimaki, M. (2003). Organizational climate, perceived workrelated symptoms and sickness absence: A population based survey. Journal of Occupational
and Environmental Medicine, 45, no 2, 175-184.
Piirila, P.L., Keskinen, H.M., Luukkonen, R., Salo, S.P., Tuppurainen, M. and Nordman, H.
(2005). Work, unemployment and life satisfaction among patients with diisocyanate induced
asthma - A prospective study. Journal of Occupational Health, 47, 2, 112-118.
Poonai, N., Van-Diepen, S., Bharatha, A., Manduch, M., Deklaj, T. and Tarlo, S.M. (2005).
Barriers to diagnosis of occupational asthma in Ontario. Canadian Journal of Public Health, 96,
no. 3, p.230-3, May-Jun.
Powell, H. and Gibson, P.G. (2002). Options for self-management education for adults with
asthma. The Cochrane Database of Systematic Reviews 2002, Issue 3, Art. No. CD004107.
Probst, T.M. (2004). Safety and insecurity: Exploring the moderating effect of organizational
safety climate. Journal of Occupational Health Psychology, 9, no 1, 3-10.
Prochaska J.O. and DiClemente C.C. (1984) The Transtheoretical Approach: Crossing
Traditional Boundaries of Change. Homewood IL, Irwin J In Conner and Norman (eds) (1995)
Predicting Health Behaviour. Buckingham, OU Press.
Rabatin, J.T. and Cowl, C.T. (2001). A guide to the diagnosis and treatment of occupational
asthma. Mayo Clin Proc, 76(6), p. 633-40, June.
Ram, F.S.F. (2003). Primary care management of asthma using written management plans and
asthma clinics: evidence of effectiveness from recent Cochrane systematic reviews. Primary
Care Respiratory Journal, 12(1), 21-24.
95
Rand, C.S. and Butz, A.M. (1998). Psychosocial and behavioral risk factors in asthma
management. Seminars in Respiratory and Critical Care Medicine, 19, 6, 603-611.
Redlich, C.A. and Anwar, M.S. (1998). Occupational asthma: Keys to diagnosis and
management. Journal of Respiratory Diseases, 19, 6, 508-519.
Redlich, C.A.; Stowe, M.H. and Coren, B.A. (2002). Diisocyanate exposed autobody shop
workers: A one year follow-up. American Journal of Industrial Medicine, 42, n. 6, p. 511-518,
Dec.
Reijula, K. (1999). Something in the air. Work Health Safety. 30-31.
Rick, J. and Briner, R.B. (2000). Psychosocial risk assessment: Problems and prospects.
Occupational Medicine, 50, 5, 310-314.
Rietveld, S (1998). Symptom perception in asthma: A multidisciplinary review. Journal of
Asthma, 35 (2): 137-146.
Rietveld, S. and Brosschot, J.F. (1999). Current perspectives on symptom perception in asthma:
A biomedical and psychological review. International Journal of Behavioural Medicine, 6, 2,
120-134.
Rietveld, S., Everaerd, W. and Creer, T.L. (2000). Stress-induced asthma: A review of research
and potential mechanisms. Clinical and Experimental Allergy. 30, no.8, 1058-1066, Aug.
Rietveld, S., Prins, P.J.M. and Colland, V.T. (2001). Accuracy of symptom perception in
asthma and illness severity. Children's Health Care, 30 (1): 27-41, Mar.
Rietvelt, S. and Houtveen, J.H. (2004). Acquired sensitivity to relevant physiological activity in
patients with chronic health problems. Behaviour Research and Therapy, 42 (2): 137-153, Feb.
Rischitelli, D.G. (1999). A workers' compensation primer.
Immunology, 83, no. 6 Pt 2, p. 614-7, Dec.
Annals of Allergy, Asthma &
Ritz, T. and Roth, W.T. (2003). Behavioral Interventions in asthma: Breathing training.
Behavior Modification, 27, 5, 710-730, Oct.
Ritz, T. and Steptoe, A. (2000). Emotion and pulmonary function in asthma: Reactivity in the
field and relationship with laboratory induction of emotion. Psychosomatic Medicine, 62, 6, p.
808-815, Nov-Dec.
Roberts, J.L., Jansen, S., Gillen, M., Flattery, J. and Harrison, R. (2004). Processes of care for
individuals with work-related asthma. Treatment characteristics and impact of asthma on work.
AAOHN Journal, 52, 8, P. 327-337.
Rodrigo, G.J., Rodrigo, C. and Hall, J.B. (2004). Acute asthma in adults – A review. Chest,
125 (3), 1081-1102, March.
Roed, K. and Zhang, T. (2003). Does unemployment compensation affect unemployment
duration? Economic Journal, 113, n. 484, p. 190-206, Jan.
96
Roelofs, C.R., Barbeau, E.M., Ellenbecker, M.J. and Moure-Eraso, R. (2003). Prevention
strategies in industrial hygiene: A critical literature review. American Industrial Hygiene
Association Journal, 64, 62-67.
Roghman, M.C., Kim, P.W., Perencevich, E.N. and Harris, A.D. (2003). Rates of hand
disinfection associated with glove use, patient isolation and changes between exposure to
various body sites. American Journal of Infection Control, 31, 2, p. 97-103.
Romano-Woodward, D. (2004). Take a fresh breath. Occupational Health, 56, Iss 10, p. 16,
October.
Rosenthal, J. and Forst, L. (2001). Health hazards of photography. Occupational medicine: state
of the art reviews, 16, no. 4, p. 577-582, Oct/Dec.
Ross, D.J. and McDonald, J.C. (1998). Health and employment after a diagnosis of
occupational asthma: A descriptive study. Occupational Medicine, 48, 219-225, May.
Roy, M. (2003). Self-directed workteams and safety: a winning combination? Safety Science,
41, no. 4, pp. 359-376.
Runeson, R. Norback, D. and Stattin, H. (2003). Symptoms and sense of coherence – A follow
up study of personnel from workplace buildings with indoor air problems. International
Archives of Occupational and Environmental Health, 76(1), p. 29-38, February.
Sadhra, S., Petts, J., McAlpine, S., Pattison, H. and MacRae, S. (2002). Workers' understanding
of chemical risks: Electroplating case study. Occupational Environmental Medicine, 59(10):
689-95.
Salazar, M.K., Connon, C., Takaro, T.K., Beaudet, N. and Barnhart, S. (2001). An evaluation
of factors affecting hazardous waste workers’ use of respiratory protective equipment. American
Journal of Industrial Hygiene, 62, 236-245.
Salminen, S. (1997). Risk taking, attributions and serious occupational accidents. Finnish
Institute of Occupational Health, Helsinki, Finalnd, People and Work Research Reports 13.
Sansom, A. (2005). Upstanding Behaviour. Safety and Health Practitioner, April 2005.
Sarlo, K. (2003). Control of occupational asthma and allergy in the detergent industry. Annals
of Allergy, Asthma and Immunology, 90, 5, p. 32, May.
Sauni, R., Oksa, P., Vattulainen, K., Uitti, J., Palmroos, P. and Roto, P. (2001). Effects of
asthma on the quality of life and employment of construction workers. Occupational Medicine,
51, 3, p. 163-167, May.
Schmaling, K.B., Lehrer, P.M., Feldman, J.M. and Giardino, N.D. (2003). Asthma. In Nezu,
C.M., Nezu, A.M. (Eds). Handbook of Psychology: Health Psychology, Volume 9 (pp. 99120). New York: John Wiley and Sons.
Schmaling, K.B.; McKnight, P.E. and Afari, N. (2002). A prospective study of the
relationship of mood and stress to pulmonary function among patients with asthma. Journal of
Asthma, 39, no. 6, p. 501-510, Sep.
97
Schwartzer, R. (1992) Self-efficacy in the adoption and maintenance of health behaviours:
Theoretical approaches and a new model, in R. Schwarzer (ed.) Self Efficacy: Thought control
of Action, pp. 217-243. Washington, DC: Hemisphere.
Schweigert, M.K.; Mackenzie, D.P. and Sarlo, K. (2000). Occupational asthma and allergy
associated with the use of enzymes in the detergent industry: A review of the epidemiology,
toxicology and methods of prevention. Clinical and Experimental Allergy, 30, no. 11, p. 15111518, Nov.
Sennbro, C.J.; Lindh, C.H.; Ostin, A.; Welinder, H.; Jonsson, B.A.G. and Tinnerberg, H.
(2004). A Survey of Airborne Isocyanate Exposure in 13 Swedish Polyurethane Industries.
Annals of Occupational Hygiene, 48, No 5, p. 405-414.
Sheeran, P. & Silverman, M. (2003) Evaluation of three interventions to promote workplace
health and safety: evidence for the utility of implementation intentions. Social Science and
Medicine. 56 2153-2163.
Sim, M. (2003). The continuing challenge to reduce the burden of occupational asthma.
Occupational and Environmental Medicine, 60, 10, p. 713, October.
Sinclair, R.R. and Tetrick, L.E. (2004). Pay and benefits: The role of compensation systems in
workplace safety. In J. Barling and M.R. Frone (Eds.). The Psychology of Workplace Safety.
American Psychological Association: Washington, DC.
Siriruttanapruk, S. and Burge, P.S. (1997). The impact of the COSHH regulations on workers
with occupational asthma. Occupational Medicine, 47, 101-104, Feb.
Slater, T., Erkinjuntti-Pekkanen, R., Fishwick, D., Bradshaw, L., Pearce, N., Armstrong, H. and
McLean, D. (2000). Changes in work practice after a respiratory health surveillance among
welders in New Zealand. New Zealand Medical Journal, 28, 305-8.
Smit, I. and Schabracq, M. (1998). Team cultures, stress and health. Stress Med, 14, no. 1, pp.
13-19.
Smith, A. and Nicholson, K. (2001). Psychosocial factors, respiratory viruses and exacerbation
of asthma. Psychoneuroendocrinology, 26(4), 411-420.
Smith, B. (1989). Workshop paper no. 6: Worker attitudes to practices in the aluminium
industry. Journal of Occupational Health and Safety Australia and New Zealand, 5, 5, p. 429431, Oct.
Smith, T.A. (2004). Preventing baker's asthma: An alternative strategy. Occupational Medicine,
54, 1, p. 21-27.
Smyth, J.M., Soefer, M.H., Hurewitz, A., Kliment, A. and Stone, A.A. (1999). Daily
psychosocial factors predict levels and diurnal cycles of asthma symptomatology and peak flow.
Journal of Behavioral Medicine, 22 (2), p. 179-93, Apr.
Snashall, D. (2003). Occupational asthma. Occupational and Environmental Medicine, 60, Iss
10, p. 711, October.
Sorensen, G., Stoddard, A.M., LaMontagne, A.D., Emmons, K., Hunt, M.K., Youngstrom, R.,
McLellan, and Christiani, D.C. (2002). A comprehensive worksite cancer prevention
98
intervention: Behaviour change results from a randomized controlled trial (United States).
Cancer Causes and Control, 13, p. 493-502.
Soriano, J.B., Rabe, K.F. and Vermeire, P.A. (2003). Predictors of poor asthma control in
European adults. Journal of Asthma, 40 (7), p. 803-813, October.
Soyseth, V., Kongerud, J., Aalen, O.O., Botten, G. and Boe, J. (1995). Bronchial
responsiveness decreases in relocated aluminium potroom workers compared with workers who
continue their potroom exposure. International Archives of Occupational and Environmental
Health, 67, 1, p. 53-57.
Stajkovic, A.D. and Luthans, F. (2003). Behavioural management and task performance in
organisations: Conceptual background, meta-analysis and test of alternative models. Personnel
Psychology, 56, p. 155-194.
Stenton, S.C., Sandhu, P.S. and Hendrick, D.J. (1995). Industrial injury benefit for occupational
asthma in north east of England. British Medical Journal, 310: 1299-1300.
Stewart-Taylor A. and Cherrie J.W. (1998). Does risk perception affect behaviour and
exposure? A pilot study amongst asbestos workers. Annals of Occupational Hygiene, 42: 565569.
Sturdy, P.M., Victor, C.R., Anderson, H.R., Bland, J.M., Butland, B.K., Harrison, B.D.W.,
Peckitt, C. and Taylor, J.C. (2002). Psychological, social and health behaviour risk factors for
deaths certified as asthma: A national case-control study. Thorax, 57 (12), P: 1034-9, Dec.
Taivainen, A.I., Tukiainen, H.O., Terho, E.O. and Husman, K.R. (1998). Powered dust
respirator helmets in the prevention of occupational asthma among farmers. Scandinavian
Journal of Work Environment & Health, 24, no. 6, p. 503-7, Dec.
Talini, D.; Monteverdi, A.; Benvenuti, A.; Petrozzino, M.; Di-Pede, F.; Lemmi, M.; Carletti, A.;
Macchioni, P.; Serretti, N.; Viegi, G. and Paggiaro, P. (1998). Asthma-like symptoms, atopy,
and bronchial responsiveness in furniture workers. Occupational and Environmental Medicine,
55, no. 11, p. 786-791, Nov.
Tarlo, S.M. (1999). Occupational allergies and asthma. Canadian Family Physician, 45, 15161522.
Tarlo, S.M. and Liss, G.M. (2001). Can medical surveillance measures improve the outcome of
occupational asthma? The Journal of Allergy and Clinical Immunology, 107, no. 4, p. 583-5,
Apr.
Tarlo, S.M. and Liss, G.M. (2002). Diisocyanate-induced asthma: Diagnosis, prognosis and
effects of medical surveillance measures. Applied Occupational and Environmental Hygiene,
17(12), 902-908.
Tarlo, S.M. and Liss, G.M. (2003). Occupational asthma: An approach to diagnosis and
management. Canadian Medical Association Journal, 168(7); p. 867-71, Apr.
Tarlo, S.M., Banks, D., Liss, G. and Broder, I. (1997). Outcome determinants for isocyanate
induced occupational asthma among compensation claimants. Occupational and Environmental
Medicine, 54, 1, p. 756-761.
99
Tarlo, S.M., Liss, G.M. and Yeung, K.S. (2002). Changes in rates and severity of compensation
claims for asthma due to diisocyanates: A possible effect of medical surveillance measures.
Occupational and Environmental Medicine, 59, n. 1, p. 58-62, Jan.
Taylor, L. and Morgan, D. (1995). The hidden cost: A national asthma campaign investigation
into severe asthma. National Asthma Campaign: London.
Terrell, P.G. (1984). How to increase worker acceptance of respirators. Professional Safety,
29(10): 15-20.
Teschke, K., Chow, Y. and Brauer, M. (2002). Exposures and their determinants in radiographic
film processing. American Industrial Hygiene Association Journal, 63, 1, p. 11-21, Jan-Feb.
Theorell, T. (1997). Psychosocial factors in the work environment - an occupational medicine
perspective. In H.A. Waldron and C. Edling. (Eds.) Occupational Health Practice. ButterworthHeinemann; Oxford.
Tilles, S.A. and Jerath-Tatum, A. (2003). Differential diagnosis of occupational asthma.
Immunology and Allergy Clinics of North America, 23, 2, 167-176.
Toren, K. and Sterner, T. (2003). How to promote prevention:economic incentives or legal
regulations or both? Scandinavian Journal of Work, Environment and Health, 29, no. 3, p. 239245, June.
Trim, J.C.; Adams, D. and Elliott, T.S.J. (2003). Healthcare workers' knowledge of inoculation
injuries and glove use. British Journal of Nursing, 12 (4), p.215-21, Feb-Mar.
Uldry, C. and Leuenberger, P. (2000). Compliance, psychosocial factors and patient education
in difficult or therapy-resistant asthma. European Respiratory Review, 10, 69, 97-101.
Vamos M. and Kolbe J. (1999). Psychological factors in severe chronic asthma. Australian &
New Zealand Journal of Psychiatry, 33, no. 4, p. 538-544, Aug.
Van Ganse, E., Mork, A.C., Osman, L.M., Vermeire, P., Laforest, L., Marrel, A. and Stahl, E.
(2003). Factors affecting adherence to asthma treatment: patient and physician perspectives.
Primary Care Respiratory Journal, 12(2), 46-51.
Vandenplas, O., Binard-Van Cangh, F., Brumagne, A., Caroyer, J.M., Thimpont, J., Sohy, C.,
Larbanois, A. and Jamart, J. (2001). Occupational asthma in symptomatic workers exposed to
natural rubber latex: Evaluation of diagnostic procedures. Journal of Allergy and Clinical
Immunology, 107, 3, pt 1, p. 542-547.
Vandenplas, O., Jamart, J., Delwiche, J.P., Evrard, G. and Larbanois, A. (2002). Occupational
asthma caused by natural rubber latex: Outcome according to cessation or reduction of
exposure. Journal of Allergy and Clinical Immunology, 109, 1, p. 125-130, Jan.
Vandenplas, O., Larbanois, A. and Jamart, J. (2002). Socio-economic consequences of
occupational asthma in Belgium. Medecine du travail / Arbeidsgezondheitszorg & Ergonomie,
39, 1, p. 5-12.
Vandenplas, O., Toren, K. and Blanc, P.D. (2003). Health and socio-economic impact of workrelated asthma. European Respiratory Journal, 22 (4), p. 689-97, October.
100
Vanhanen, M., Tuomi, T., Tiikkainen, U., Tupasela, O., Voutilainen, R. and Nordman, H.
(2000). Risk of enzyme allergy in the detergent industry. Occupational and Environmental
Medicine, 57, 2, p. 121-125, Feb.
Venables, K.M., Davison, A.G. and Newman-Taylor, A.J. (1989).
occupational asthma. Respiratory Medicine, 83(5), p. 437-40, September.
Consequences of
Vigo, P.G. and Grayson, M.H. (2005). Occupational exposures as triggers of asthma.
Immunology and Allergy Clinics of North America, 25, no. 1, p. 191-205, Feb.
Wagner, G.R. and Wegman, D.H. (1998). Occupational Asthma: Prevention by Definition.
American Journal of Industrial Medicine,33(5): 427-429, Dec.
Wallen, E.S. and Mulloy, K.B. (2005). Computer based safety training: An investigation of
methods. Occupational and Environmental Medicine, 62, 4, p. 257-262.
Walpole, O. (2001). Dusty Answer. Occupational Health, 53, no.5, 24-26, May.
Walusiak, J.; Palczynski, C.; Hanke, W.; Wittczak, T.; Krakowiak, A. and Gorski, P. (2002).
The risk factors of occupational hypersensitivity in apprentice bakers - The predictive value of
atopy markers. International Archives of Occupational and Environmental Health, 75, no. s01,
pp.117-121.
Weaver, J.L.; Gerber, T.N.; Hancock, P.A. and Ganey, H.C.N. (2003). Individual differences in
behavioral compliance to warnings representing varying degrees of threat. International Journal
of Occupational Safety and Ergonomics, 9, No.2, p.149-160.
Weinstein, N.D., Rothman, A.J. & Sutton, S.R. (1998) Stage Theories of Health Behaviour:
Conceptual and Methodological Issues. Health Psychology. Vol 17, No. 3, 290-299.
White, M.C., Baker, E.L., Larson, M.B. and Wolford, R. (1988) The role of personal beliefs and
social influences as determinants of respirator use among construction painters. Scandinavian
Journal of Work Environment and Health, 14(4): 239-245.
Whitelaw, S., Baldwin, S., Bunton, R. & Flynn, D. (2000) The status of evidence and outcomes
in the Stages of Change research. Health Education Research Theory and Practice. Vol 15, No.
6, 707-718.
Williams, J. (1997). Assessing and reducing the likelihood of violation behaviour - A
preliminary investigation. Paper presented at Institution of Nuclear Engineers' conference
COPSA, 9 October 1997.
Williams, N. (2003). Asthma and the workplace. Practice Nurse, 25(7); p.14, 16, 19, Apr.
Williams-Piehota, P., Pizarro, J., Schneider, T.R., Mowad, L. and Salovey, P. (2005). Matching
Health Messages to Monitor-Blunter Coping Styles to Motivate Screening Mammography.
Health Psychology, 24 (1): 58-67, Jan.
Wong, R.H., Chien, H.L., Luh, D.L., Lin, W.H., Wang, Y.C. and Cho, C.Y. (2005), Correlation
between chemical safety knowledge and personal attitudes among Taiwanese hairdressing
students. American Journal of Industrial Medicine, 47: 45-53.
101
Woskie, S.R.; Sparer, J.; Gore, R.J.; Stowe, M.; Bello, D.; Liu, Y.; Youngs, F.; Redlich, C.;
Eisen, E. and Cullen, M. (2004). Determinants of isocyanate exposures in auto body repair and
refinishing shops. Annals of Occupational Hygiene, 48, No 5, p. 393-403.
Wright, R.J., Rodriguez, M. and Cohen, S. (1998). Review of psychosocial stress and asthma:
An integrated biopsychosocial approach. Thorax, 53 (12), 1066-1074, Dec.
Wu, A.W., Young, Y., Skinner, E.A., Diette, G.B., Huber, M., Peres, A. and Steinwachs, D.
(2001). Quality of care and outcomes of adults with asthma treated by specialists and
generalists in managed care. Archives of Internal Medicine, 161, 21, p. 2554-60.
Zeitlin, L.R. (1995). Organizational downsizing and stress-related illness. International Journal
of Stress Management, 2 (4), p. 207-219, October.
Zimmer, L.O., Almond, M.J., Jones, D., Lucas, D.O., Stern, J., Broxton, B., Santry, M.,
Lashley, J. and Donohue, J.F. (2000). One-year outcomes from a computer based disease
management program: The individualised asthma care training program (IACTrho). Disease
Management, 3, 2, p. 65-73.
Zock, J.P., Brederode, D. and Heederik, D. (1998). Between and within observer agreement for
expert judgement of peak flow graphs from a working population. Journal of Occupational and
Environmental Medicine, 40, 11, p. 969-72, Nov.
Zock, J.P., Kogevinas, M., Sunyer, J., Almar, E., Muniozguren, N., Payo, F., Sanchez, J.L. and
Anto, J.M. (2001). Asthma risk, cleaning activities and use of specific cleaning products among
Spanish indoor cleaners. Scandinavian Journal of Work, Environment and Health, 27, 1, p. 7681.
Zohar, D. (2002). The effects of leadership dimensions, safety climate, and assigned priorities
on minor injuries in work groups. Journal of Organizational Behavior; 23 (1), p.75-92, Feb.
102
6
6.1
GLOSSARY, ACRONYMS AND WEBSITES
GLOSSARY
Alexithymia:
Difficulty in labelling and expressing emotions.
Allergic:
Sensitised to a substance caused by a reaction from the immune system. There is a gap between
exposure and symptoms.
Asthmagens:
Agents that cause occupational asthma in people who did not have it before.
Atopy:
An allergic reaction with strong family tendencies.
Behaviour:
This refers to observable physical actions, gestures/reactions, in short any measurable response
of a person. In the context of occupational asthma the behaviour acts as a mediator of other
psychosocial factors on occupational asthma susceptibility.
Bronchitis:
Inflammation of one or more bronchi, usually secondary to infection.
Cognitions:
Mental information processing factors such as perceptions, appraisals, reasoning, beliefs,
expectations, decision-making and problem solving.
Controller Medication:
Exert anti-inflammatory effects and include long-term inhaled or oral forms. Used with severepersistent asthma.
Chronic Obstructive Pulmonary Disorder:
A progressive disease process that most commonly results from smoking. COPD is
characterised by difficulty breathing, wheezing and a chronic cough.
Diagnosis:
The confirmation of presence/absence of a disease from an asymptomatic patient.
Dyspnea:
Shortness of breath, difficult or laboured breathing.
Extrinsic asthma:
Immune mediated response to an external trigger (most common).
FEV1:
Volume of air exhaled during the first minute of a forced expiratory manoeuvre from full vital
capacity (FVC).
Hypercapnia:
Excessive carbon dioxide.
103
Hypoxia:
Lack of oxygen reaching vital tissues such as heart and brain.
Immunoglubulin E
Otherwise known as IgE, this is a specific antibody, the reactivity of which is linked to
hypersensitivity.
Immunologic Occupational Asthma:
This is where there is a time delay between exposure to a respiratory sensitizer and the
development of symptoms. Encompasses occupational asthma formerly classified as RADS and
irritant-induced asthma involving multiple lower-concentration levels.
Incidence:
Number or rate of new cases over a period.
Intrinsic asthma:
Usually associated with a family history of the disease.
Irritant:
Airway dysfunction caused by a reaction to a substance, which does not involve the immune
system. Symptoms develop within a few hours of exposure.
Local exhaust ventilation:
A ventilation system that captures and removes air contaminants at the point they are being
produced before they escape into the workroom air. The system consists of hoods, ductwork, a
fan and possibly an air-cleaning device.
Non-immunologic Occupational Asthma:
Typically occurs within a few hours of high concentration exposure to an irritant at work.
Occupational asthma:
Asthma that is caused by exposure to substances at work. Occupational asthma is caused by
workers breathing in substances at work that produce a hypersensitive state in the airways - the
small tubes that carry air in and out of the lungs - and trigger a subsequent response in them.
Not everyone who becomes sensitised goes on to get the clinical disease but once the lungs
become hypersensitive further exposure to the substance, even at quite low levels, may provoke
an attack.
Operational definition of Occupational Asthma (taken from Lombardo and Balmes, 2000).
Variable airflow limitation and/or airway hyperresponsiveness due to exposure to a specific
agent or conditions in a particular work environment and not to stimuli encountered outside the
work place. This definition contains no reference to causal mechanisms and therefore
encompasses work related airway obstruction due to (1) antigen-induced hypersensitivity
reactions, pharmacological effects, non-specific inflammatory processes, and direct airway
irritation.
Organisation Climate:
Current expectations, impressions and feelings and work units/teams/groups have within an
organisation, that in turn effects their relationships with line management, with one another and
with work units.
104
Organisation Culture:
“The way we do things around here”. Culture refers to the collection of overt and covert rules,
values, norms and principles that are enduring, and guide the organisation. Culture is rooted in
the history of the organisation, and often reflected in an organisation’s language and internal
jargon.
Pathogenesis:
The origin and development of disease.
Peak Flow:
Maximum flow of exhaled air during a forced expiratory manoeuvre from full vital capacity
(FVC).
Prevalence:
Numbers or percentage of a population who have the condition.
Primary Interventions:
Interventions that aim to prevent the onset of disease often by reducing or eliminating exposure
to the agent in the workplace.
Psychosocial:
In this context psychosocial refers to all psychological and social factors that play a role in the
development of occupational asthma. Psychological aspects therefore cover cognitions
(information processing factors), emotional as well as behavioural factors. Social aspects
include those factors in the external environment that interact with psychological factors in a
way that affects susceptibility to occupational asthma. They therefore include work
relationships, managerial style, work place communication, health and safety climate, health
and safety culture, and influence of occupational health practitioners.
Randomised controlled trials:
A clinical trial that involves at least one test treatment and one control treatment, concurrent
enrolment and follow-up of the test and control treated groups, and in which the treatments to be
administered are selected by a random process, such as the use of a random-numbers table.
Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days
of the week, medical record numbers, or other such pseudo or quasi-random processes, are not
truly randomised and a trial employing any of these techniques for patient assignment is
designated simply a controlled clinical trial.
Reactive airways dysfunction syndrome (RADS):
Asthma symptoms and airway hyper-responsiveness that develop promptly after short-term,
high-intensity inhalation exposure to irritant materials (non-immunologic).
Reliever Medication:
Reverses acute bronchoconstriction, e.g. short-acting beta-2 agonists.
intermittent and severe-persistent asthma.
Used with mild-
Screening:
The detection of disease in an asymptomatic and unselected population.
Secondary Interventions:
Aims to detect disease at an early or pre-symptomatic stage, for example by health surveillance.
105
Sensitisation:
Development of allergy after exposure to even a small amount of an asthmagen.
Sensitivity:
Ability to rule out other conditions.
Specificity:
Ability to detect a given condition.
Stakeholders:
Anyone who has a stake i.e. an interest, a right (legal, moral) or ownership: shareholders,
customers, suppliers, employees, communities, etc
Triggers:
Agents that can set off an asthma attack.
Tertiary Intervention:
Aims to prevent worsening of symptoms by early recognition and early removal form exposure.
Work-related/aggravated/Pre-existing asthma:
Asthma that the employee has, perhaps since childhood, worsened by workplace exposure.
Work-related asthma is broader and includes substances in the workplace that irritate the
airways of individuals with pre-existing (eg childhood) asthma. Respiratory irritants may
provoke attacks in those with occupational asthma or pre-existing asthma of non-occupational
origin. Examples include chlorine, general dust and even cold air. In this case, the individual
does not become sensitised to that specific agent, but the attack is still work-related.
106
6.2
AA
ACOP
BOHRF
COI
COPD
COSHH
FEV1
HMW
HSE
HSL
IgE
IVC
LEV
LMW
MEL
NRL
OA
OCD
ODIN
OEG
OES
PEF
PEFR
PPE
RADS
RAST
RCT
RPE
RUDS
SENSOR
SIC
SIOA
SOLACE
SPT
SWORD
TDI
ACRONYMS
Acute Asthma
Approve Code of Practice
British Occupational Health Research Foundation
Central Office of Information
Chronic Obstructive Pulmonary Disorder
Control of Substances Hazardous to Health
Forced expiratory volume in 1 sec
High Molecular Weight
Health and Safety Executive
Health and Safety Laboratory
Immunoglubulin E
Individually Ventilated Cage
Local Exhaust Ventilation
Low Molecular Weight
Maximum Exposure Limit
Natural Rubber Latex
Occupational Asthma
Occupational Contact Dermatitis
Occupational Disease Intelligence Network (UK)
Occupational Exposure Guideline
Occupational Exposure Standard
Peak Expiratory Flow
Peak Expiratory Flow Rates
Personal Protective Equipment
Reactive Airways Dysfunction Syndrome
Radio-allergosorbent Testing
Randomised Controlled Trial
Respiratory Protective Equipment
Reactive Upper-Airways Dysfunction Syndrome
Sentinel Health Notification System for Occupational Risk (US)
Specific Inhalation Challenge
Sensitiser Induced Occupational Asthma
Society of Local Authority Chief Executives and Senior Managers
Skin Prick Tests
Surveillance of Work and Occupational Respiratory Disease
Toluene Diisocyanate Induced (asthma)
107
6.3
POSSIBLE RELEVANT OCCUPATIONAL ASTHMA WEBSITES
Allergy UK. http://www.allergyuk.org/
AllRefer. http://www.allrefer.com/
Amicus Trade Union. http://www.amicustheunion.org/
Asthma.org. http://www.asthma.org.uk/
Asthma: A Prairie Health works Special.
http://www.prairiepublic.org/features/healthworks/asthma/index.htm
BBC website asthma pages. http://www.bbc.co.uk/health/conditions/asthma/
British Lung Foundation. http://www.britishlungfoundation.com/
British Medical Journal. http://bmj.bmjjournals.com/
British Occupational Health Research Foundation. http://www.bohrf.org.uk/
British Occupational Hygiene Society. http://www.bohs.org/
British Thoracic Society. http://www.brit-thoracic.org.uk/
Centre for Occupational and Environmental Health, University of Manchester.
http://www.coeh.man.ac.uk/thor/
Chartered Institute of Environmental Health. http://www.cieh.org/
Chemical Industries Association. http://www.cia.org.uk/newsite/
Clean Air Award (Roy Castle) website. http://www.cleanairaward.org.uk/
Cochrane Library. http://www.cochrane.org/reviews/index.htm
COSSH Essentials. http://www.coshh-essentials.org.uk/
Department of Health. http://www.dh.gov.uk/Home/fs/en
Environment Agency. http://www.environment-agency.gov.uk/
European Academy of Occupational Health Psychology. http://www.ea-ohp.org/
General Practice Airways Group. http://www.gpiag.org/
Global Initiative for Asthma. http://www.ginasthma.com/
HSE Latex website. http://www.hse.gov.uk/latex/index.htm
108
HSE website asthma pages. http://www.hse.gov.uk/asthma/
Industrial Injuries Advisory Council (IIAC). http://www.iiac.org.uk/
Institute of Occupational Medicine. http://www.iom-world.org/
Institution of Occupational Safety and Health (IOSH). http://www.iosh.co.uk/
Lancet. http://www.thelancet.com/
National Institute for Occupational Safety and Health (NIOSH).
http://www.cdc.gov/niosh/homepage.html
NHS Direct. http://www.nhsdirect.nhs.uk/
NHS. http://www.nhs.uk/
OASYS. http://www.occupationalasthma.com/
Occupational Safety and Health Administration (OSHA). http://www.oshaslc.gov/SLTC/occupationalasthma/
OMNI. http://www.omni.ac.uk/
Professional Organisations in Occupational Safety and Health (POOSH).
http://www.poosh.org/
PubMed. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
Society of Occupational Medicine. http://som-old.foxsoft.net/
Trades Union Congress. http://www.tuc.org.uk/
Unison Trade Union. http://www.unison.org.uk/safety/
World Health Organisation. http://www.who.int/en/
109
7
7.1
APPENDIX 1: RECOMMENDATION TABLES
7.1.1
Solutions for Exposure Prevention
APPENDICES
N
o
Barrier / Contributor
Rationale
Examples
Predisposers:
Knowledge, risk
perception, cost benefit
interpretations, beliefs re:
health and economic
consequence, selfefficacy, response
efficacy/acceptance of
controls, comprehension
ability. Enablers:
Training quality,
availability of PPE and
controls, work
organisation.
Reinforcers: norms, peer
pressure, health and
safety climate,
communication
practices.
Psychosocial based risk
assessment: Undertake baseline
risk assessment of psychosocial
risk factors predicting exposure,
potentially using the PRECEDE
(predisposers, enablers, and
reinforcing) model to
differentiate their roles, and
provide a framework for
tailoring interventions. The
assessment could then be used
to evaluate intervention
effectiveness at post
intervention and follow-up or to
monitor psychosocial risk
factors.
Company-generated or
using a tool designed by
HSE, e.g. based on
Dejoy's (2000)
behavioural diagnostic
tool or ABC charts
(antecedents, behaviours,
consequences).
1
110
Industry sector
caveats
Organisation
size caveats
Blame cultures
operating in
some sectors
may prevent
honest reporting.
Reduce by
ensuring
employees from
all organisation
levels
participate.
SMEs may
need additional
support,
provided by
inspectors or
workplace
health direct.
POPMAR
(HSG65) /
COSHH relevance
Planning
Identify COSHH
risk factors.
Provider (P)
/ Receiver
(R)
P: Workplace management
R: All workplace personnel
Intervention
Risk assessment
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Knowledge of risks, risk
perception biases.
Knowledge training (a) Risk:
To increase compliance,
recollection likelihood, correct
risk perception inaccuracies,
enable more accurate risk
assessments, and deepen that
knowledge through inclusion of
exposure routes (Zubric, 2005).
Include the distinction
between hazards and
risk, asthmagen types,
exposure routes,
clearance times,
exposure variation by
task (e.g. including less
obvious activities such as
cleaning, sweeping up),
reflexive behaviour (e.g.
catching hazardous
'drips', lifting visor to
check work quality),
accumulation,
familiarity, and latency
biases as well as the role
of personal hygiene.
Knowledge of risks,
consequences, costbenefit perceptions.
Knowledge training (b)
Consequences: To increase the
likelihood that the costs of noncompliance will be perceived to
outweigh the benefits.
Inclusion of implications for
dependents is likely to reinforce
the costs.
Provide an evidencebased portrayal of
potential health,
workability and
economic costs 'to self
and dependents /
'significant' others in
terms of 'typical' and
worst case scenarios.
Training
Examples
3
111
Industry sector
caveats
Particularly
important for
sectors with
evidence of
insufficient risk
knowledge, such
as welding and
baking and
exposed to
multiple
asthmagens, e.g.
agriculture,
cleaning, health
services,
welding.
Organisation
size caveats
POPMAR
(HSG65) /
COSHH relevance
Organisation
(competence)
COSHH principles:
a, b, g.
Organisation
(competence)
COSHH principles
a, b, g.
Provider (P)
/ Receiver
(R)
P: HSE inspectors,
workplace H&S advisors,
supervisors
R: All workplace
personnel
Rationale
P: HSE inspectors, workplace H&S advisors,
supervisors
R: All workplace personnel
2
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
Intervention
Rationale
Examples
4
Knowledge of risks (risk
assessment), risk
perception biases and RA
difficulty assumption,
behaviour link.
Skills training (a) Risk
Assessments: To increase
knowledge of risks, relationship
with different task, who is at
risk, and by using own
workplace as an example,
increase likelihood of training
being converted into actual
practice. Training should take
into account risk perception
biases.
5S approach, hands on
training using own
workplace as example
source.
5
User cost-benefit tradeoff. Staff commitment.
Skills training (b)
Control/precaution design
(Controls referring to
engineering solutions or
PPE): Design controls so that
the consequences of
following/using controls
reinforce compliant behaviour,
take into account the costbenefit judgements operators
may make when following
controls, and the tendency to
base control decision on
existing processes and
accessible information sources.
Minimise potential
perceived costs by
reducing the time taken
to apply/use the controls,
hassle in usage,
discomfort (smell,
breathing, fit), task
interference, distracting
effects, communication
interference, and
increasing ease of use,
availability and
accessibility. Involve
potential users as well as
health and safety experts
in design. Avoid PPE
being considered a longterm solution.
112
Industry sector
caveats
Organisation
size caveats
Will require
sector-specific
intelligence of
cost-benefit
interpretations.
Where working
under pressure to
meet targets e.g.
contract cleaning
or
manufacturing,
emphasis will
need to be on
minimising the
time it takes to
apply controls.
Resource
limitations may
mean SMEs are
guided by
processes and
controls already
in use as well
as the financial
costs of
controls.
Correct
assumptions
that experience
equates to good
practice in
requiring more
experienced
staff to provide
compliance
training.
POPMAR
(HSG65) /
COSHH relevance
Organisation
(competence)
All COSHH
principles.
Provider (P)
/ Receiver
(R)
Organisation
(competence)
COSHH principles:
c, d, g.
P: HSE inspectors, workplace
H&S advisors, supervisors
R: All workplace personnel
Barrier / Contributor
P: HSE inspectors, manufacturers, workplace H&S
advisors
R: Workplace front line personnel
N
o
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
6
Self-efficacy, acceptance
of controls.
Skills training (c) Usage:
Requires repeated 'hands on'
practice in control usage under
supervision conditions in order
to increase likelihood of correct
usage "in situ". Where
possible provide
evidence/feedback during
training of the impact that
correct control usage has on
exposure levels.
PPE fit testing, smoke
tests, video visualisation.
7
Habit.
Skills training (d) Control
monitoring, storage and
replacement. Instil as a routine
and combine with periodic
supervisor checks to increase
likelihood of uptake.
Schedule at
regular/routine intervals.
Include random
supervisory checks.
8
Cost-benefit
interpretations, ignoring
risk.
Option: Feedback real time,
personally relevant and
demonstrable evidence of
exposure.
Video visualisation by
employee type.
113
Industry sector
caveats
Deliver by
supplier (HSE
trained), more
likely to be
perceived as an
expert.
Organisation
size caveats
As above.
Cross SME
resource.
POPMAR
(HSG65) /
COSHH relevance
Organisation
(competence).
Organisation
(competence).
Not viable for all
asthmagens (e.g.
latex).
HSE develop
'employee type'
examples to
minimise costs.
Organisation
(communication)
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: HSE, supply
chain
R: All workplace
personnel
Examples
P: HSE inspectors,
workplace H&S
advisors
R: Workplace front
line personnel
Rationale
P: HSE inspectors, workplace
H&S advisors
R: Workplace front line
personnel
Barrier / Contributor
Risk
communication:
a) persuasion
Intervention
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
Examples
9
Cost-benefit
interpretations, ignoring
risk.
Option: Feedback personally
relevant demonstrable evidence
of exposure.
Observation case studies
and biomarker feedback
by employee type (case
studies of noncompliance observations
and resultant biomarker
profile).
HSE develop
'employee type'
examples to
minimise costs.
POPMAR
(HSG65) /
COSHH relevance
Organisation
(communication)
COSHH principle
g.
10
Cost-benefit
interpretations, ignoring
risk.
Option: Provide personally
relevant demonstrable evidence
of exposure risk. Encourage a
sense of 'anticipated regret'
(Armitage & Conner, 2001).
Case studies and OA
'sufferer' testimonies by
employee type
HSE develop
'employee type'
examples to
minimise costs.
Organisation
(communication)
COSHH principle
g.
11
Long-term employer
cost-benefit assumptions,
ignoring risk, perceived
control, self efficacy.
Option: Business case for
employers.
Profile evidence-based
costs (lost productivity,
compensation claims,
sickness rates, staff
commitment) of noncompliance relative to
compliance (control,
equipment, product
substitution/reformulatio
n and morale).
Organisation
(communication)
All COSHH
principles.
P: HSE
R: All workplace personnel
Intervention
114
Industry sector
caveats
Organisation
size caveats
P: HSE, supply chain,
senior management, H&S
advisors
R: Workplace front line
personnel
Rationale
P: HSE
R: All
workplace
personnel
Provider (P)
/ Receiver
(R)
Barrier / Contributor
N
o
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Risk communication: b)
source
Risk communication: c) Content
Examples
Industry sector
caveats
Credibility, acceptance
of controls.
Credibility: Communication
must be evidence-based, up-todate, accurate, honest and
perceived as being produced by
a source that is expert in
industry-sector specific H&S
issues for it to be considered
credible.
HSE inspectors, H&S
champion, involvement
of H&S experts and
involve staff in
development.
Involve sector
and specialist
inspectors in
development.
Denial, Self-Efficacy.
Denial: Avoid fear-generated
denial (Berry, 2004) by
ensuring risk communication
not just explains why
compliance is important but
how exposure can be avoided.
Raising awareness of risk must
be backed up by skills training
where employees do not feel
they have the necessary skills or
equipment to avoid risk;
otherwise the risk may be
ignored.
Communication
signposts guidance/inhouse policy/procedures
and/or instructions
(Cummings, 2005).
Important where
there is evidence
of "aware of
risks, but not
acting" e.g.
agriculture and
baking.
115
Organisation
size caveats
Reduce costs
by using SME
'shared' H&S
champion for
delivery,
utilising verbal
culture.
POPMAR
(HSG65) /
COSHH relevance
Organisation
(communication)
COSHH principle
g.
Implementation
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: HSE, supply chain, trade unions,
H&S consultants, workplace H&S
advisors
R: All workplace personnel
13
Rationale
P: HSE, supply chain, trade
unions, H&S consultants,
workplace H&S advisors
R: All workplace personnel
12
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Rationale
Examples
Habituation/Scheduling: To
limit habituation to risk
communication,
employers/employees will need
to be routinely reminded of the
risk, using, if possible, different
ways of phrasing and presenting
the message over time.
Produce a range of
posters conveying the
same message
Reposition prompts/cues
from time to time (still
ensuring they are visible,
and at exposure points).
Involve operators in
location choice. Seek
novel communication
options such as screen
savers and pod casts.
15
Acceptance,
comprehension.
Relevance: Increase the
likelihood of acceptance by
making the communication
(regarding risks, legislation and
controls) as sector-specific as
possible, avoiding technical
jargon, using up-to-date, timely
and accurate evidence based
material. Tailor to audience
characteristics (Cummings,
2005).
Actively involve
operators, inspectors
with sector specialist
knowledge in the
development of risk
communication e.g. of
Safety Data Sheets.
Incorporate
experiences/testimonies
of OA sufferers.
116
Larger
companies may
be able to
resource risk
communication
options. Sector
specific risk
communication
options for
SMES may
need to be
provided by
HSE.
POPMAR
(HSG65) /
COSHH relevance
Implementation
COSHH principle
g.
Implementation
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: HSE, supply chain
R: All workplace personnel
Habituation.
Organisation
size caveats
P: HSE, supply chain, trade unions,
H&S consultants, workplace H&S
advisors
R: All workplace personnel
14
Industry sector
caveats
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Rationale
Examples
Comprehendability: Ensure all
workers exposed to asthma risk
easily comprehend
communication. Encourage
understanding by facilitating
interactive learning.
Use simple, wellstructured and concise
phraseology reinforced
by illustrations, (e.g.
graphs and images)
(Cummings, 2005).
Complex material must
be backed up by written
communication to reduce
reliance on memory.
Utilize interactive
learning methods, such
as sector-specific website quizzes to encourage
interactive learning.
17
Coping Style.
Coping Style: To accommodate
monitoring and blunting styles
offer more in depth risk
information as an option rather
than as default.
"Front line" risk
information to be kept as
brief, factual and
succinct as possible.
Signposts to more in
depth information, e.g. as
links within website or
references within written
literature.
117
POPMAR
(HSG65) /
COSHH relevance
Implementation
COSHH principle
g.
Implementation
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: HSE, supply chain,
workplace senior management,
workplace H&S advisors
R: All workplace personnel
Comprehension.
Organisation
size caveats
P: HSE, supply chain, workplace senior
management, workplace H&S advisors
R: All workplace personnel
16
Industry sector
caveats
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Rationale
Examples
Industry sector
caveats
Influence: Target risk
communication at ‘influencers’
as well as workers at risk of OA
to optimise the persuasion
opportunities.
Consider non-work as
well as work
'influencers'.
For isolated
workers, e.g.
within
agriculture
consider
targeting spouses
(Llewellyn,
2005).
19
Cost-benefit
interpretations.
Integrate with health
promotion: Integration of work
site health protection with
general health promotion may
emphasise risk magnitude, for
example, for smokers exposed
to OA risk (e.g. Sorenson et al,
2002).
Combine health
promotion and
occupational health
protection strategies.
Incorporation
may be easier for
sectors with
national
occupational
well being
initiatives such
as NHS Working
Lives
(http://www.nhse
mployers.org/Em
ployerExcellence
/improving_work
ing_lives.asp).
118
Potential
consideration of
HSE's
Workplace
Health Direct to
access SMEs.
Policy /
Implementation
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: OH resource, workplace senior
management, workplace H&S advisors
R: All workplace personnel, family
Internal and external
support quality.
POPMAR
(HSG65) /
COSHH relevance
Implementation
COSHH principle
g.
P: HSE
R: Spouse, parents
18
Organisation
size caveats
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Examples
Media: Accommodate different
learning styles and preferences,
and optimise the possibility of
risk communication being
seen/heard by using
multimedia.
Computers: websites,
screen savers, emails.
hand written instructions
/ guidance, posters.
TV: advertisements in
soap opera slots.
Risk communication: d) delivery
Comprehension,
accessibility,
concentration,
habituation.
Rationale
119
Industry sector
caveats
Organisation
size caveats
Evidence that the
following sectors
may prefer
emphasis on oral
communication
of risk
information:
Agriculture
(Llewellyn,
2005), wood working (Strutt
& Bird, 2004),
and small
chemical firms
(O'Hara et al,
2000).
Emphasise faceto-face training,
briefings, and
recruitment of
peer leaders (see
recommendation
26) for these
sectors.
Utilise nonverbal culture
of SMEs,
through, for
example
encouraging a
peer "H&S"
champion to
deliver
message. Must
be backed up
by written
communication
where advice is
complex.
POPMAR
(HSG65) /
COSHH relevance
Implementation
All COSHH
principles.
Provider (P)
/ Receiver
(R)
P: HSE, supply chain, external H&S consultants, workplace H&S
advisors, OH resources
R: All workplace personnel
20
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Ensure local "H&S
champions",
occupational supply
chain providers, H&S
reps, trade union
officials, in house
"trainers” and vocational
course providers, are
trained in risk
communication skills.
Inspectors could provide
training.
Props and prompts in
screen savers, pod casts.
Locate prompts (e.g. free
stickers, posters, mouse
mats (Cummings et al,
2005)), and signs in
visible, frequently
accessed locations,
particularly 'exposure
relevant' positions such
as within booths, at work
stations or on the inside
of first aid box covers.
Encourage suppliers to
provide copies of
instructions for
distribution amongst the
workforce, rather than a
single set (Vaughan,
2005).
21
Fear of enforcement,
accessibility, resources.
Provider: Reduce risk
communication avoidance
based on fears of attracting
HSE's 'attention'. Ensure
provider is a competent
communicator that is respected
and accepted by recipients. (See
recommendation 13).
22
Access.
Accessibility: Risk
communication needs to be
readily accessible, and not
overly reliant on
employers/employees
proactively seeking information
on exposure control.
120
Industry sector
caveats
Utilise tradespecific
publications,
occasions or
websites (e.g.
trade fairs) for
articles and
promotion
/marketing
materials (e.g. to
promote
SHADS).
Organisation
size caveats
Focus on local
H&S
champions;
creating a
climate of peer
pressure that
favours
compliance,
and
occupational
supply chain
providers.
Improve access
to SMEs for
example; by
including OA
risk information
within business
start up packs
(Cummings,
2005),
incorporation in
Chambers of
Commerce
advice and
services, via
SHADS, and
incorporation
into services
offered by
occupational
suppliers.
POPMAR
(HSG65) /
COSHH relevance
All COSHH
principles.
Implementation
All COSHH
principles.
Provider (P)
/ Receiver
(R)
P: HSE, trade unions, trade associations, H&S
consultancies
R: All workplace personnel
Examples
P: Supply chains, trade unions,
trade associations, H&S
consultancies
R: All workplace personnel
Rationale
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Behaviour link, coping
strategies.
Planning: Increase employees
risk awareness, and likelihood
that they will adhere to
compliance guidelines, consider
in advance of each shift the
hazards they are working with,
checking controls are in place,
and consider how they might
deal with factors that might
hinder their vigilance, such as
lulls in concentration, additional
work load, staff shortages etc.
Pre-shift prompt card:
Include questions such as
"What hazards am I
working with today?
How could this affect my
health? What precautions
/ controls are in place?
What could get in the
way of my using
precautions/controls,
appropriately? When
might my concentration
lapse? What is the WEL
limit? Where can I get
more information from?”
Appraisals/supervision:
Incorporate the above
level of planning into
supervisions and staff
appraisals.
Stress, concentration,
perceived control, selfefficacy, work patterns,
coping strategies.
Work Organisation: Review
work organisation in order to
reduce job related hindrances.
Follow HSE’s
management standards
for stress, review work
load, pacing,
ergonomics, review shift
patterns, and consider
job enrichment or
rotation as way of
reducing boredom
effects.
Planning / Implementation
Examples
24
121
Industry sector
caveats
Organisation
size caveats
POPMAR
(HSG65) /
COSHH relevance
Implementation
All COSHH
principles.
Implementation
All COSHH
principles.
Provider (P)
/ Receiver
(R)
P: Workplace supervisors,
H&S advisors
R: Workplace front line
personnel
Rationale
P: HSE inspectors, workplace H&S advisors, supervisors
R: Workplace front line personnel
23
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Rationale
Examples
Industry sector
caveats
Organisation
size caveats
Goal Setting: Develop
compliance-related goals to
motivate compliance.
Set during the appraisal,
and monitor goal
accomplishment over
time (by peers, line
management). Goals
could include selfchecking compliance on
a regular basis, keeping
within a fixed percentage
below work exposure
limits (WEL), and
attending compliance
training, the number of
staff to have received
compliance training etc.
May be less
applicable in
micro
businesses or
sole trader
operations
where goals are
more likely to
be selfgenerated and
not imposed by
a management
hierarchy.
26
Behaviour link, peer
pressure, self-efficacy,
perceived control,
attitudes, health and
safety culture.
Peer pressure: Recruit
informal workplace peer leaders
as role models for good practice
compliant behaviours. Ensure
they are not perceived as a
management lackey (e.g. De
Vries, 2000).
Focus risk
communication. Avoid
offering material
incentives to peer leaders
should their actions be
construed as insincere.
May be less
applicable in
micro
businesses or
sole-trader
operations.
122
Implementation
COSHH principle
g.
P: HSE inspectors, workplace senior
management, supervisors
R: All workplace personnel
Motivation,
concentration, behaviour
link.
Provider (P)
/ Receiver
(R)
P: Workplace
senior management,
supervisors
R: Workplace
informal peer
25
POPMAR
(HSG65) /
COSHH relevance
Implementation
COSHH principle
g.
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Examples
27
Peer pressure, health and
safety culture/climate,
ignoring risks.
Observation (peer or
supervisory): Provides real
time observation of behavioural
compliance and formative
feedback on compliance
effectiveness with view to
improvement.
Peer or supervisory,
incorporating using a
best practice template as
a benchmark.
28
Concentration, behaviour
link, habit.
Habit: Create conditions in
which compliant behaviour
becomes a habit rather than
context or exposure level
dependent.
Wear PPE all the time
rather than when
working with
asthmagens, have LEV
operating all the time.
Monitoring. Ensuring
good practice is adopted
from the induction stage.
123
Industry sector
caveats
Organisation
size caveats
Less likely to
work in
organisations
within industry
sectors within
which blame or
macho cultures
prevail, e.g.
baking (Bauer et
al, 2002).
May increase
compliance
costs through
increased
usage. Less
viable for
SMEs.
POPMAR
(HSG65) /
COSHH relevance
Implementation
COSHH principle
g.
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: Workplace senior
management, supervisors,
H&S advisors
R: Workplace front line
personnel
Rationale
P: Workplace senior
management, supervisors,
H&S advisors
R: Workplace front line
personnel
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Reinforcement /
Sustainability
Behaviour link,
sustainability.
Rationale
Reinforcements: Ensure
compliant behaviour is
sustained through timely,
meaningful and predictable
positive reinforcement.
Essential and often forgotten
(see incentives recommendation
40).
Examples
Positively reinforce
compliant behaviour
through verbal and
written feedback
provided impromptu or
on scheduled occasions.
Incorporate into
appraisals and other
scheduled supervisory
meetings.
124
Industry sector
caveats
More likely to
work in sectors
operating open
and transparent
communication
practices,
otherwise
feedback may be
interpreted as
motivated by a
hidden agenda.
Organisation
size caveats
POPMAR
(HSG65) /
COSHH relevance
Organising
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: Workplace supervisors
R: Workplace front line
personnel
29
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Health and safety
culture/climate.
Leadership: Demonstrable
management commitment (at
all levels) is essential for
creating positive attitudes
towards reducing OA risk (e.g.
Collins, 2003) and fostering
trust amongst employees.
Behaviours reflective of
a 'caring' leadership
include: Meeting staff to
discuss occupational
health hazards,
responding quickly to
occupational health
hazards or incidents
(Fleming, Lardner et al,
2002). Senior
management taking part
in accident/incident
investigations, taking
part in H&S committee
meetings, participating in
H&S audits, discussing
H&S alongside
production issues,
spending equal time
discussing production
and H&S issues.
(Collins, 2003).
Health and safety
culture/climate.
Role Models/ Consistency:
Managers need to act as
consistent role models, both
across time and between levels
to prevent sending mixed
messages.
Management consistently
intervening when they
witness violations of
rules and wearing
appropriate PPE when on
the shop floor, and
backup supervisors
condemnation of any
violation.
Leadership / Management
Examples
31
125
Industry sector
caveats
Organisation
size caveats
POPMAR
(HSG65) /
COSHH relevance
Organising
COSHH principle
g.
Organising
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: Workplace senior
management
R: Workplace front
line personnel
Rationale
P: Workplace senior management
R: Workplace front line personnel
30
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Rationale
Examples
33
Knowledge of risks,
behavioural link.
Biopsychosocial surveillance:
Include surveillance of
psychosocial risk factors to
monitor covariance with
biological/exposure monitoring
variables to evaluate any causal
relationship.
Prospective: Optimise risk
management by conducting
prospective rather than reactive
(to sentinel event) health
surveillance. Focus resources
on areas/individuals with
unacceptable exposure levels.
Use a
psychosocial/behavioural
diagnostic tool with
proven psychometric
properties (reliability,
validity).
Integration
with health
surveillance
Membership to H&S
decision-making teams.
Development of selfdirected teams in which
teams take their own
decisions (with
management support)
regarding workplace
layout, work
organisation,
maintenance of accident
and incident records,
monitoring, and
compliance training
(Roy, 2003). Involve
staff in design and
selection of PPE.
34
126
Less likely to
be resourced by
individual
SMEs. Shared
resource within
a local
partnership.
Less likely to
be resourced by
individual
SMEs. Shared
resource within
a local
partnership.
Provider (P)
/ Receiver
(R)
Planning
All COSHH
principles.
Planning.
P: OH resource
R: All workplace
personnel
Staff involvement /
commitment: Actively involve
front line staff, trade unions and
occupational health experts in
the development of risk
reduction strategies and
controls. This should improve
compliance rates through
allowing staff to own decisions,
promote risk awareness and
increases the likelihood of
solution effectiveness.
POPMAR
(HSG65) /
COSHH relevance
Organising.
P: OH resource
R: All workplace
personnel
Health and safety
culture/climate.
Organisation
size caveats
P: Workplace senior management
R: Workplace H&S advisors, employee
representatives
32
Industry sector
caveats
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
Rationale
Employee biomarker
feedback: Provide at risk
employees, particularly those
sensitised, with regular
biomarker feedback on a
confidential basis so that they
can regulate their compliance
behaviour and retain increased
symptom awareness.
36
Knowledge of risk,
exposure routes and
behaviour link.
Team health surveillance:
Provide managers with team
average health surveillance
results so that they can modify
engineering, administrative,
PPE provision, or employee's
compliance behaviour
accordingly, according to the
teams exposure context.
Feedback must be anonymous
to prevent individuals being
subject to unfair treatment.
Should also promote their
awareness for the need of
adequate OH provision.
37
Organisation
size caveats
IgE feedback for LMW
asthmagens.
Cross SME
resourcing.
Honest Reporting: See
diagnostic solutions table,
recommendations (e.g. 1, 5, 10,
11, 12, 13, 14).
127
POPMAR
(HSG65) /
COSHH relevance
Planning
Implementation
COSHH principle
g.
Planning
Implementation
COSHH principle
g.
Provider (P)
/ Receiver
(R)
P: OH resource
R: Workplace supervisors
Knowledge of risk,
exposure routes and
motivation.
Industry sector
caveats
P: OH resource
R: All workplace
personnel
35
Examples
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Integration with administrative / policy
solutions
Health and safety
culture/climate.
Rationale
Conflicting priorities: Ensure
policy statements and
procedures convey occupational
health as having equal priority
to organisation performance as
way of driving a positive health
and safety climate.
Examples
HSE produce business
cases for employers
demonstrating the cost
benefits of effective
occupational health
management for the
organisations overall
performance. Avoid
performance incentives
that are exclusively
based on productivity
such as piecemeal
working and
performance bonuses
(see recommendation
11).
128
Industry sector
caveats
Business case by
industry sector
type.
Organisation
size caveats
Business case
by
organisational
size.
POPMAR
(HSG65) /
COSHH relevance
Policy
All COSHH
principles.
Provider (P)
/ Receiver
(R)
P: Workplace senior management, human
resource function
R: Workplace front line personnel
38
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Barrier / Contributor
Rationale
Examples
Health and safety
culture/climate,
perceived control,
motivation, self-efficacy,
communication,
accountability,
responsibility.
Human Resource
Management: Ensure human
resource practices build in risk
communication/awareness
raising and compliance training
opportunities. Ensure
responsibilities towards OA risk
prevention are clearly
delineated within job
descriptions and that these
responsibilities apply to all
organisational layers.
(a) Selection - avoid
recruiting "risk takers".
(b) Induction - raise risk
awareness. (c) Health
and safety training/first
aid training - Increase
profile of occupational
health issues. (d)
Performance appraisals raise risk awareness,
offer compliance training
where necessary, and
reinforce good practice.
(e) Front line
representation in
decision making (see
leadership/management
recommendation 32).
129
Industry sector
caveats
Organisation
size caveats
POPMAR
(HSG65) /
COSHH relevance
Provider (P)
/ Receiver
(R)
P: Workplace human resource function
R: All workplace personnel
39
Intervention
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Motivation, behaviour
link.
Rationale
Examples
Incentives: Create a synergistic
(multiplicative effect) in
reinforcing compliant behaviour
by providing a combination of
incentives (financial,
recognition, and feedback).
Ensure the link between
compliant behaviours and
incentive provision is clear and
'individually owned" (Weyman,
1999). Avoid incident or
symptom based incentive
schemes since these may
encourage report suppression.
Recognition: Career
progression, training
opportunities, staff
appraisal systems.
Financial: Bonuses,
Feedback: Verbal,
handwritten. Reinforce
for evidence of
compliance (e.g. keeping
exposure levels at a fixed
percentage below WEL)
rather than noncompliance since the
latter may encourage
report suppression.
Integration: Optimise costeffectiveness by developing
psychosocial strategies
transferable to other
occupational health risks.
Recommended strategies
should have read across
to other respiratory and
dermal health hazards.
130
Industry sector
caveats
Organisation
size caveats
Particularly
applicable to
sectors where
performance
targets may be
based on volume
of work, or in
which
pressurised
working is
routine, such as
cleaning, food
production.
Options are
likely to be
limited within
smaller
organisations.
Emphasise
verbal feedback
as way of
affecting health
and safety
culture.
POPMAR
(HSG65) /
COSHH relevance
Policy
COSHH principle
g.
Policy
All COSHH
principles.
Provider (P)
/ Receiver
(R)
P: Workplace
senior management
R: All workplace
personnel
41
Barrier / Contributor
P: Workplace senior management
R: All workplace personnel
40
Intervention
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Integration with engineering solutions
Substitution
Examples
Perceived control, self
efficacy, health and
safety culture, climate.
Availability: Accessibility is
important to ensure employee
intentions to comply with
control measures are not
thwarted, and reinforce a
positive health and safety
climate. Employers must
ensure ongoing availability and
accessibility of control
measures including PPE.
Regularly monitor PPE
stocks and expiry dates,
locate near to
workstations, and
exposure points/areas.
Ensure regular
maintenance and
usability checks of
control equipment such
as LEV.
Knowledge of risks.
Risk Assessment: Ensure the
potential occupational health
risks of substitution options are
known.
Utilise occupational
supply chain to convey
this information.
131
Industry sector
caveats
Organisation
size caveats
POPMAR
(HSG65) /
COSHH relevance
May be more
difficult where
workspaces
encompass large
areas, such as
agriculture.
Encourage
workers to
habitually take
PPE with them
as well as store
at high exposure
areas.
Accessibility
particularly
important for
when working
under stress/high
pressure.
Provider (P)
/ Receiver
(R)
Organisation
(competence)
COSHH principles
a, b, g.
P: Supply
chain
R: All
workplace
H&S advisors
43
Rationale
P: Workplace senior management, supervisors
R: All workplace personnel
42
Barrier / Contributor
TABLE 7: SOLUTIONS FOR EXPOSURE PREVENTION
N
o
Intervention
Barrier / Contributor
External solutions
Cost-benefit
interpretations.
Industry sector
caveats
Organisation
size caveats
Industry level partnerships:
Set consistent sector-wide
occupational health standards
and strategies as means of
sharing resources and solutions.
Governance schemes
(Ballard, 2005) - sector
level partnerships
between employers,
unions, suppliers and
government.
Set up within
sector local
industry
partnerships to
share thinking
and
occupational
health
management
resources, c.f
good
neighbourhood
schemes.
Enforcement: The threat of
enforcement/legislation for
persistent non-compliance with
WEL standards or high
incidence rates must be
sustained and perceived as
realistic if the employer are to
construe the costs of noncompliance to outweigh the
benefits. This is particularly
important given that the latency
of occupational health risks
associated with OA is likely to
act as weak compliance
incentive for the employer.
Modify/replace the
Enforcement
Management Model to
better accommodate
latent and 'insidious'
occupational health risks.
Avoid
reinforcing
perceptions of
HSE's role as
exclusive to
enforcement in
SMEs. Promote
positive success
stories
(Cummings,
2005).
132
POPMAR
(HSG65) /
COSHH relevance
Policy
All COSHH
principles.
Policy
All COSHH
principles.
Provider (P)
/ Receiver
(R)
P: HSE inspectors
R: Employers
45
Examples
P: HSE
R: Employers, government, unions,
suppliers
44
Rationale
7.1.2
Solutions for Diagnostic Barriers
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Risk assessment
Intervention
Examples
Diagnostic Barriers: Evaluate
extent to which psychosocial
factors (e.g. fear of economic
consequences) deter honest health
surveillance reporting and delayed
diagnosis.
Focus groups, ABC charts.
Symptom perception,
illness representations.
Symptom Awareness: Educate
'OA' at risk employees (defined by
working in at risk jobs and/or
sensitisation) in the signs and
symptoms of OA so that they can
seek an early diagnosis when
corresponding respiratory or
sensitisation symptoms arise.
Include education on misattribution
of dyspnea or hyperventilation
symptoms to prevent exacerbation
of any stress reactions and
unnecessary self-referrals.
'Pocket size' symptom
monitoring prompt cards that
draw attention to any symptom
manifestation away from work,
particularly when on holiday.
Work site combined health
promotion/health protection
programmes. Inclusion in risk
communication provided at
induction, performance appraisal,
health surveillance and OH
checks.
Internal and external
quantity and quality of
support.
Family/Colleagues Involvement:
Include family and colleagues of at
risk workers in symptom
awareness education.
Encourage at risk workers to
inform family/colleagues where
appropriate.
Education
Fear of economic
consequences, costbenefit interpretations,
honesty.
133
Industry
sector caveats
Blame
cultures may
prevent honest
responding.
Organisation
size caveats
Integrate in
sectors
operating
existing
employee well
being
initiatives
such as the
NHS.
Potentially
resourced by
HSE for SMEs.
Provider
(P)/Receiver (R)
P: OH
resources
R: OA at risk
employees
3
Rationale
P: OH resources
R: OA at risk employees
2
Barrier / Contributor
P: OH resource, H&S
advisor, senior
management,
supervisors
R: All workplace
personnel
N
o
1
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Diagnostic barriers,
symptom perception,
illness representation.
Recording: Encourage employees
to maintain records of a symptom
manifestation to bolster their
eligibility for compensation.
Symptom diaries (kept brief,
recording symptoms, timing,
substance exposure (duration and
agent).
Employer cost-benefit
interpretations, fear of
enforcement/undermined
reputation, honesty.
Employer business case: Create a
business case for employers
demonstrating the relative costs of
early intervention versus late/no
intervention for sentinel OA events
or suspect OA cases.
Compare costs in terms of lost
productivity, compensation
claims, sickness rates, turnover
rates and replacement
6
Employee diagnostic
fears and cost-benefit
interpretations, honesty.
Compare costs in terms of
economic, workability, quality of
life variables for self and family.
7
Knowledge of risk,
exposure routes and
motivation.
Employee case studies: Provide at
risk employees case studies
demonstrating the short, medium
and long-term personal costs of
delayed diagnosis relative to early
diagnosis to instil intentions to seek
early diagnosis. Promote positive
cases of successful OA
rehabilitation following earlier
diagnosis.
Employee Health Surveillance:
Provide at risk employees,
particularly those sensitised, with
regular biomarker feedback on a
confidential basis so that they can
regulate their compliance
behaviour and retain increased
symptom awareness.
IgE feedback for LMW
asthmagens
134
Risk communication:
(a) persuasion
Industry
sector caveats
Organisation
size caveats
Provider
(P)/Receiver (R)
Produce
business cases
for each of the
industry
sectors in
which OA
arises to
increase
perceived
relevance.
Produce case
studies for
each of the
industry
sectors in
which OA
arises to
increase
perceived
relevance.
Produce for a
combination of
industry sector
by
organisational
size to increase
perceived
relevance.
Produce for a
combination of
industry sector
by
organisational
size to increase
perceived
relevance.
P: OH resources
R: OA at risk
employees
Examples
P: OH resources
R: OA at risk employees
Rationale
5
Barrier / Contributor
P: OH resources
R: OA at risk employees
Intervention
P: OH
resources
R: OA at
risk
employees
N
o
4
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Intervention
Barrier / Contributor
Knowledge of risk,
exposure routes and
behaviour link.
Fear of economic
consequences, cost
benefit interpretations,
honesty.
Employee inducement
1
0
Amount: Counteract fears of
anticipated income loss following a
positive diagnosis of OA by setting
benefit/compensation rates just
below full net pay. Full pay may
engender learned helplessness
(Sinclair and Tetrick, 2004).
Industry
sector caveats
Organisation
size caveats
Cross SME
resourcing.
Promotion of
Workplace
Health Direct
by HSE.
Promotion by employers at
induction and during appraisals,
promoted via HSE website, and
regional occupational advisory
services and primary care.
Cross SME
resourcing.
Promotion of
Workplace
Health Direct
by HSE.
E.g. Quebec's compensation
system, amounting to 90% net
wage.
Partial/full state
funding/grading
according to
company size
to
accommodate
SME resource
limitation.
135
Provider
(P)/Receiver (R)
P: DWP employment
agencies
R: All workplace
personnel
Self-efficacy
Some limited OH access.
Team health surveillance:
Provide managers with team
average health surveillance results
so that they can modify
engineering, administrative, PPE
provision, or employees’
compliance behaviour accordingly,
according to the team’s exposure
context. Feedback must be
anonymous to prevent individuals
being subject to unfair treatment.
Should also promote their
awareness for the need of adequate
OH provision.
OH access: For case studies
(recommendations 5&6) to be
effective, employees will need to
know how to access OH provision.
Examples
P: State
R: All workplace
personnel
9
Rationale
P: OH resources
R: Workplace supervisors
N
o
8
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Intervention
Barrier / Contributor
Fear of economic
consequences, cost
benefit interpretations,
honesty.
Redeployment and retraining:
Counteract anticipated income; job
and disability fears by ensuring
realistic redeployment and
retraining opportunities are made
available that are appropriate to
functioning capacity/'workability'.
Coordinated on a national basis
as a 'job bank' or 'retraining
agency ' for all occupational
health conditions. Establish a
network of links with employers
to optimise retraining
opportunities. Will require state
funding.
1
2
Fear of economic
consequences, cost
benefit interpretations,
honesty.
Health and Safety Climate:
Foster a work environment that
conveys concern over occupational
health and encourages a proactive
approach to occupational health
management.
Prevention recommendations
30,31,32.
1
3
Fear of economic
consequences, fear of
confidentiality breaches,
OH provision, honesty.
OH Transparency: Ensure
employees are clear on the
confidentiality boundaries
surrounding consultation with
occupational health
provision/primary care, and
circumstances under which
employers are made aware of OA
diagnosis.
Industry
sector caveats
Organisation
size caveats
Provider
(P)/Receiver (R)
P: OH resoures,
workplace human
resource function
R: OA employees
Examples
P: Workplace
senior
management
R: All workplace
personnel
Rationale
P: DWP employment
agencies
R: All workplace
personnel
N
o
1
1
136
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Intervention
Employer inducement
Examples
Industry
sector caveats
Organisation
size caveats
Inclusion
within HSE's
Workplace
Health Direct.
Provider
(P)/Receiver (R)
Medico legal barriers,
cost benefit
interpretations, honesty.
Lawyers: Increase accessibility of
employees to lawyers experienced
in occupational health
compensation.
HSE set up a list of 'vetted'
lawyers.
Employer fear of
economic consequences,
cost benefit
interpretations.
Last resort: Employer
compensation pay outs needs to be
undertaken as a last resort
following (a) medical verification
of permanent disability, or (b) full
exploration of state funding
redeployment and retraining
options where permanent disability
does not apply, to limit the extent
to which fear of compensation payouts and raised premiums
encourages employers to
manipulate OA reporting figures or
engage in unfair dismissal.
Modification of common law
compensation (O'Neill, 1995).
Particularly
relevant to
underresourced
SMEs.
Employer fear of
economic consequences,
cost benefit
interpretations.
State contribution: Retraining and
rehabilitation options will need
state funding to prevent any limited
availability due to employers'
reluctance to fund such initiatives.
See recommendation 11.
Particularly
relevant to
underresourced
SMEs.
P: State
R: OA employees
1
6
Rationale
P: OH resources, workplace human
resource function
R: OA employees
1
5
Barrier / Contributor
137
P: OH resources,
workplace human
resource function
R: OA employees
N
o
1
4
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Intervention
Insurance premiums: Vary
premiums according to risk taking
practices (including those
addressing psychosocial risk
factors) and quality of OH
provision to create an incentive for
employers to utilise risk control
measures and improve OH
provision.
OA diagnosis.
OH Availability: Increase OA
diagnostic speed and accuracy by
increasing national OH provision.
OA diagnosis.
OH medical knowledge: Increase
competency in diagnosis of
occupational diseases within
primary care.
Diagnosis
Employer fear of
economic consequences,
reinforcement /
sustainability.
Examples
Industry
sector caveats
Organisation
size caveats
Provider
(P)/Receiver (R)
Increase OH emphasis within
medical and nurse training.
Produced occupational disease
diagnostic guidelines for GPs.
Encourage availability of OH
expert GP within partnership
practices.
138
Cross SME
shared
resource.
Inclusion
within HSE's
Workplace
Health Direct.
Cross SME
shared
resource.
Inclusion
within HSE's
Workplace
Health Direct.
P: OH resource/GP
liaison, medical training
personnel
R: Medical trainees
1
9
Rationale
P: HSE
R All workplace
personnel
1
8
Barrier / Contributor
P: Insurers, HSE
R: Employers
N
o
1
7
TABLE 8: SOLUTIONS FOR DIAGNOSTIC BARRIERS
Intervention
Barrier / Contributor
Rationale
Examples
Pre-empting: Encourage at risk
employees to inform GPs that they
work in asthmagenic occupations
or are sensitised.
Industry
sector caveats
Organisation
size caveats
Provider
(P)/Receiver (R)
P: OA employees
R: Primary care
N
o
2
0
139
7.1.3
Solutions for Rehabilitation/Retention at Work Barriers
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
Intervention
Barrier / Contributor
Needs assessment
Job characteristics,
symptom perception,
health beliefs, health and
safety climate, support,
conflicting health and
safety priorities, stress.
Rationale
Needs assessment: Conduct
a risk assessment of
psychosocial and work
environment and work
organisation factors
facilitating or impeding
return/retention at work for
OA sensitised/OA
symptomatic employee. Use
results as a guide for case
management related
interventions.
Examples
Encompass, for example, peer
support, family support, health and
safety climate variables, access to
PPE and engineering controls,
usability of PPE and engineering
controls, competency in usage of
controls, training needs, work tasks
(tempo and scheduling, exposure
variables (agents and duration),
fatigue/distraction effects, work
load), and symptom appraisals.
140
Industry sector
caveats
May be
perceived as less
important for
sectors
employing low
skilled casual or
temporary
workers, such as
agriculture (e.g.
fruit picking) or
cleaning
contractors. May
also be perceived
as less important
where sectors
experience
favourable job
market
conditions, in
which sectorspecific skills are
available within
the job market.
Organisation
size caveats
May be
perceived as
less
appropriate
for SMEs.
Cross-SME
resourcing.
Provider (P) /
Receiver (R)
P: Workplace supervisors
R: OA employees
N
o
1
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
Intervention
Barrier / Contributor
Workplace modifications:
In accordance with needs
assessment findings, modify
work context to allow the
employed to retain a useful
contribution to organisation
productivity.
Examples
Modification options: Work tempo,
rest breaks, employee control over
workload, PPE availability,
upgrading, control access &
usability, consider job
enrichment/rotation as means of
reducing overall exposure.
Workplace Intervention
Job characteristics,
symptom perception,
health beliefs, health and
safety climate, support,
conflicting health and
safety priorities, stress.
Rationale
141
Industry sector
caveats
May be
perceived as less
important for
sectors
employing low
skilled casual or
temporary
workers, such as
agriculture (e.g.
fruit picking) or
cleaning
contractors. May
also be perceived
as less important
where sectors
experience
favourable job
market
conditions, in
which sectorspecific skills are
available within
the job market.
Organisation
size caveats
Inclusion
within
Workplace
Health Direct
advice.
Provider (P) /
Receiver (R)
P: Workplace supervisors
R: Returning to work (RTW) employees
N
o
2
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
Intervention
Barrier / Contributor
Rationale
Examples
Informing 'responsible'
team colleagues: Recruit
support from colleagues in
facilitating retention and
return to work, particularly
informal peer leaders. Ensure
support provided is not
disempowering.
Ensure colleagues are trained in
responding appropriately to asthma
attacks. Team supervisor advise
team on support needed and any
involvement they may have in
workplace modifications.
142
Industry sector
caveats
Contingent on a
supportive,
positive health
and safety
climate having
been created.
Organisation
size caveats
Less
applicable to
sole
traders/micro
businesses.
Provider (P) /
Receiver (R)
P: Workplace responsible
colleagues
R: Returning to work
(RTW) employees
N
o
3
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
Intervention
Barrier / Contributor
Rationale
Examples
Fatigue, stress, perceived
control.
Gradation: Allow reduced
hour and graded return to
work options (where hours
worked and task demands
gradually increase over time)
for OA sufferers returning to
work.
May need to create business case
demonstrating the benefits of case
management (including
paced/graded return to work, and
workplace modifications) to
encourage employers to make these
changes.
143
Industry sector
caveats
May be
perceived as less
important for
sectors
employing low
skilled casual or
temporary
workers, such as
agriculture (e.g.
fruit picking) or
cleaning
contractors. May
also be perceived
as less important
where sectors
experience
favourable job
market
conditions, in
which sectorspecific skills are
available within
the job market.
Organisation
size caveats
Inclusion
within
Workplace
Health Direct
advice. Cross
SME support.
Provider (P) /
Receiver (R)
P: Workplace supervisors
R: Returning to work (RTW) employees
N
o
4
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
Intervention
Barrier / Contributor
Rationale
Examples
Self-efficacy, perceived
control, health and safety
climate.
Education: Where viable
(e.g. a large proportion of the
workforce are known to
possess asthma, albeit OA,
work aggravated, or preexisting) provide work site
asthma education
programmes. Focus in
particular on encouraging
compliance with controller
medication (e.g. Edington,
2001).
Include asthma causes, trigger
recognition, asthma monitoring, use
and care of medication, peak flow
meters, nebulizers metered dose
inhalers, symptom perception and
misattributions.
6
Multi-disciplinary
Expertise: Draw on multidisciplinary advice from
occupational health
physicians/nurses, industrial
hygienists and psychologists
in forming return to work
advice.
Provider (P) /
Receiver (R)
Job bank for
SMEs.
Redeployment/Retraining:
See recommendation 11 of
diagnostic barriers.
Intervention
effectiveness.
Organisation
size caveats
May be more
amenable to
large
companies
with wellresourced OH
provision, e.g.
health
services.
Inclusion
within
Workplace
Health Direct
advice. Cross
SME
resourcing
option.
HSE compile case examples.
144
P: HSE
R:OA employees
7
Industry sector
caveats
P: OH resource
R:OA employees
N
o
5
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
9
Organisation
size caveats
Provider (P) /
Receiver (R)
Examples
Self-management
challenges.
Tailored written selfmanagement plans: Improve
workers medication
compliance by ensuring that
employees have tailored
written self-management
plans, together with regular
self-monitoring and review.
Plans should include advice on
when and how to modify
medication in response to
worsening asthma, and how to
access medical system in response
to a worsening condition. It could
also contain a checklist scheduling
intake of controller medication.
Copies (contingent on employee
consent) could be made available to
workplace employees.
Self-management
challenges.
Prompts: Provide OA
employees with written
prompts, checked from time
to time by their supervisor, of
medication usage, PPE usage,
agents exposed to, symptom
severity, intermittency,
variability, reversibility, and
work conditions.
Inclusion in self-management plans
(see recommendation 8 above).
Prompts can include "Have I taken
my medication? What agents have I
been working with? How much
exposure have I had? Have I taken
any unnecessary risks? How much
have I been exposed? Am I using
controls/PPE appropriately, does it
need replacing? Provided as a credit
card or in a visible position at
workstations.
Self Management
Barrier / Contributor
Industry sector
caveats
Rationale
P: OH resource, workplace
supervisors
R:OA employees
Intervention
P: OH resource, workplace
supervisors
R:OA employees
N
o
8
145
TABLE 9: SOLUTIONS FOR REHABILITATION/RETENTION AT WORK BARRIERS (SECONDARY AND TERTIARY INTERVENTIONS)
Intervention
Barrier / Contributor
Self-management
challenges.
Rationale
Examples
Coping Strategies: Include
coping strategies within work
site training programmes,
reflecting current thinking
that a combination of problem
focused (tackling problems at
their source) and emotion
focused training (tackling the
response) is regarded as the
most effective for dealing
with the stressors associated
with chronic illness.
Train in problem focussed (problem
solving, self-management, and
lifestyle changes) and emotive
focussed (relaxation, panic attack
control, and distraction) techniques.
1
1
Health Surveillance: See
recommendation 7/8 of
diagnostic barrier
recommendations.
1
2
Informing family: See
recommendation 3 of
diagnostic barrier
recommendations.
146
Industry sector
caveats
Organisation
size caveats
Provider (P) /
Receiver (R)
P: OH resource
R:OA employees
N
o
1
0
7.2
APPENDIX 2: MAIN REVIEW
7.2.1
Individual: Cognitive
7.2.1.1
Symptom Perception
Inaccuracy
Inaccuracy
Role
Evidence Strength
Diagnostic and OA management barrier
Very strong
Inaccurate perception of asthma symptoms is common place (De Peuter et al, 2004; Rietveld,
1998), is often not proportional to the severity of underlying patho-physiology or objective
measures (Bender & Creer, 2002; Creer & Levstek, 2001; De Peuter et al, 2004; Petrie et al,
2003), can be distorted by the negative emotions it arouses (Bender & Creer, 2002; Rietveld &
Brosschot, 1999), and can give rise to poor treatment compliance (Barnes & Woolcock, 1998;
Lehrer et al, 2002; Rodrigo et al, 2004; Schmaling et al, 2003). It also delays seeking help
(Fishwick et al, 1997; Innes et al, 1998; Nouwen et al, 1999), and is a risk factor for fatal
asthma attacks (Rand & Butz, 1998). Due to operation of defence mechanisms, improved
knowledge does not always improve perception accuracy (De Peuter et al, 2004; Rietveld,
1998). Increased publicity surrounding health conditions can give rise to an increase in either
accurate or misattributed symptom perception (Abba et al, 2004).
Causes of symptom misattribution
Misattribution: Stress
Role
Evidence Strength
Diagnostic and OA management barrier
Limited
Misattribution:
Conditioning
Role
Evidence Strength
Diagnostic and OA management barrier
Strong
Symptom misattribution can stem from stress and anxiety, which can serve as a distracter and
blunt symptom perception, or exacerbate tendency to label breathing related symptoms, or
dyspnoea, as asthma despite absence of underlying broncho-constriction (Rietveld et al, 2000;
Rietveld et al, 2001; Rietvelt & Houtveen, 2004). Conversely, broncho-constriction can
sometimes arise without manifest breathing problems, again creating symptom underestimation.
Asthma sufferers can fall into a vicious hyperventilation cycle in which stress-related increases
in breathing rate and depth is interpreted as an asthma attack, which then precipitates
hyperventilation. Other evidence suggests symptom perception as susceptible to classical
conditioning (De Peuter et al, 2004), in which the expectation that symptoms will arise, for
example, following exercise, or presentation of a placebo challenge, gives rise to increased
symptom reporting (Rietveld & Brosschot, 1999). Symptom misattribution may also have
particular relevance to workers who know they are sensitised, but do not as yet display
clinically manifest symptoms. Through a raised expectation, they may be susceptible to
misinterpreting benign symptoms as asthmatic, or, when under stress, fail to notice genuine
signs.
147
Distractors
Distractors
Role
Evidence Strength
Environmental noise and
potentially presenting a
environments (De Peuter
Rietveld, 1998). For such
align.
Diagnostic and OA management barrier
Limited
distractors can also undermine ability to read their symptoms,
challenge to asthmatic workers operating in high stimulation
et al, 2004; Nouwen et al, 1999; Rietveld & Brosschot, 1999;
reasons, subjective and objective symptom measures do not always
Illness Representations
Illness Representations Role
Evidence Strength
Diagnostic and OA management barrier
Limited
The ‘illness’ beliefs, or mental representation sufferers attribute to asthma may determine
compliance, for example, individuals who believed their asthma could be cured/controlled, or
last a long time, were more likely to adhere. Those who believed asthma was caused by external
causes were less likely to adhere. Individuals who believed their asthma would last a long time
were more likely to intend to adhere (Jessop & Rutter, 2003).
Interaction with symptom characteristics
Symptom severity
Role
Evidence Strength
Diagnostic and OA management barrier
Very strong
Symptom Intermittency
Role
Evidence Strength
Diagnostic and OA management barrier
Limited
Symptom Variability
Role
Evidence Strength
Diagnostic and OA management barrier
Limited
Symptom Reversibility
Role
Evidence Strength
Diagnostic and OA management barrier
Limited
Symptom severity can affect accurate symptom perception and consequent medication usage.
Symptom severity is directly proportional to adherence, meaning that those with less severe
symptoms are less likely to adhere to treatment regimes (Bucknall et al, 1999; Hand & Adams,
2002; Hardie et al, 2002; Lehrer et al, 2002; Soriano et al, 2003; Taylor & Morgan, 1995). It
also has a positive relationship with quality of life (Erickson & Kirking, 2004). Some evidence
suggests the threshold by which users deem it necessary to take medication can be higher than
medically advised (Hardie et al, 2002). Symptom intermittency, variability, and reversibility can
also create problems in determining appropriate treatment but can also interfere with sufferer
readiness to deal with an attack (Bender & Creer, 2002; Byer & Myers, 2000; Creer & Levstek,
2001; De Peuter et al, 2004; Rietveld, 1998).
148
7.2.1.2
Risk Perception
General: Risk perception varies between individuals (Covello, 1997; Weyman & Kelly, no
date), is influenced by experience and their salience within memory (Trainor, Weyman &
Anderson, 1998), and can be inconsistent with behaviour (McGee, 2004). Underestimations of
risk act can act as a barrier to self-protective behaviour (Bradshaw et al, 2005), for example, in
order to justify riskier behaviour, such as using power rather than hand tools to remove asbestos
(Stewart-Taylor & Cherrie 1998). Precaution uptake is more likely where the risk is perceived
as more severe (Cutter & Jordan, 2004).
Specific Risks
Latency
Role
Evidence Strength
Contributor/Prevention Barrier
Strong
Familiarity
Role
Evidence Strength
Contributor/Prevention Barrier
Strong
PPE Invincibility
Role
Evidence Strength
Contributor/Prevention Barrier
Moderate
Hazard
Characteristics
Role
Evidence Strength
Contributor/Prevention Barrier
Moderate
Health consequences
Role
Evidence Strength
Contributor/Prevention Barrier
Strong
Social comparison
Role
Evidence Strength
Contributor/Prevention Barrier
Limited
Accumulation
Role
Evidence Strength
Contributor/Prevention Barrier
Limited
Previous experience of Role
health effect
Evidence Strength
Contributor/Prevention Barrier
Moderate
Role
Evidence Strength
Contributor/Prevention Barrier
Limited
Public/private sector
149
Various perceptual biases may directly increase vulnerability to OA through undermining risk
perception, giving rise to less cautious use of controls. The latency of OA health risk emerged
as a widely cited determinant of risk underestimation (Benjamin et al, 2002; BOHRF, 2004;
Covello, 1997; Creely et al, 2003; Hughson et al, 2002; Meldrum et al, 2005; Robertson &
Stewart, 2004; Salazar et al, 2001; Weyman & Kelly, 1999; Weyman et al, 1999). Hazard
familiarity due to associations with safe domestic use or consumption (such as flour, egg
albumen, grains or diluting isocyanate paint with water) can also lead to risk underestimation
(Creely et al, 2003; Covello, 1997; Lymer & Isaksson, 2004; O'Hara & Dickety, 2000; Sadhra et
al, 2002; Trainor, Weyman & Anderson, 1998; Weyman & Kelly, 1999; Weyman, 1998), as
well as misunderstanding of the chronic ill health implications of occupational asthma (Alston
et al, 1997; Devereux et al, 2004; Kemple & Rogers, 2003; Llewellyn et al, no date; Trainor,
Weyman & Anderson, 1998) and a tendency to judge risks according to isolated events.
Cumulative risk, generated by repeated exposure to the same hazard, tends to be misjudged
(Berry, 2004; Weyman & Kelly, no date). An assumption that others are at greatest risk
(Weyman & Kelly, no date; Weyman et al, 1999), and that PPE provides full protection (Alston
et al, 1997; Brown & Rushton, 2003; Gadd & Collins, 2002; Redmayne et al, 1997; Sadhra et
al, 2002; Vaughan, 2005) could also give rise to less cautious behaviour. Hazard characteristics
also appear to modify risk perception (Alston et al, 1997; Chambers, Sandys & Piney, 2005;
Cullinan et al, 2003; Falliers, 1987; O'Hara & Dickety, 2000; Pengelly et al, 1998; Weyman &
Kelly, no date). Manmade hazards and machinery or equipment tend to be attributed greater
risk. Conversely, chemicals, and associated clearance times and size of hazardous zones, tend to
be underestimated due to the insidious and less visible nature of most asthmagenic hazards.
Pengelly et al’s (1998) survey of 26 companies using rosin based solder flux fume demonstrates
how hazard visibility influences behaviour. Whilst some companies used LEV for all soldering
operations, others only used it for jobs producing the most fumes. A survey of RPE use amongst
workers exposed to vapour found that reasons given for removing RPE too early, such as it
being removed for a short period when having stopped working and because workers were away
from hazard (Alston et al, 1997; Jones, 2003) reflects how inaccurate perceptions of hazard
clearance times and dispersions can unnecessarily exacerbate exposure. Previous direct or
vicarious experience of having succumbed to health risks, on the whole, appears to instil more
realising risk perceptions (Barton et al, 2003; Cutter & Jordan, 2004; O'Hara & Dickety, 2000;
Robertson & Stewart, 2004; Strutt & Bird 2004; Worsell et al, 2001). However, prior exposure
to health consequences can also generate poorer compliance, due to it providing verification that
compliance efforts do not work (Dejoy et al, 2000; Weyman et al, 1999; Vaughan, 2005).
Employment within the private sector may also give risk to greater risk taking (Teschke et al,
2002). Compared to public sector hospitals radiographers in private clinics spent more time in
the processing areas exposed to chemicals in x-ray developer and fixer solutions (Teschke et al,
2002).
7.2.1.3
Knowledge
Treatment Knowledge
Treatment Knowledge
Role
Evidence Strength
OA management barrier
Very strong
Inadequate understanding amongst asthma sufferers of treatment demands and requirements was
cited by 11 studies, and found to be predictive of poor compliance and emergency hospital visits
(Bender et al, 2002; Boorman, 2004; Byer & Myers, 2000; Burton et al, 2001; Campbell, 1998;
De Peuter et al, 2004; Falliers, 1987; Innes et al 1998; Lad, 2003; Lombardo & Balmes, 2004;
Moffat et al, 2002; Nouwen et al, 1999; Petrie et al, 2003; Soriano et al, 2003; Uldry &
150
Leuenberger, 2000; Vamos & Kolbe, 1999). Overuse of reliever medication, and under reliance
upon controller medication, was listed as a particular problem (Burton et al, 2001).
Recommendations were made for improving awareness at the time of diagnosis (Bender et al,
2002), of the pace and course of the condition and its implications for treatment management
(Petrie et al, 2003), the distinction between general and episode management, and of lung
function monitoring (De Peuter et al, 2004; Soriano et al, 2003) as part of self-management
requirements.
Condition/health effects knowledge
Condition/health
effects knowledge
Role
Evidence Strength
OA Contributor/OA management barrier
Strong
Knowledge of the OA condition, as well as treatment understanding, is also a recognised
predictor, not just of treatment compliance but also of sufferer’s acceptance of the asthma
identity (Barton et al, 2003; Brown & Rushton, 2003; Lucas et al, 2001; Petrie et al, 2003; Van
Ganse et al, 2003). Packham (2002) ascribe how inadequate knowledge of the skin damage
associated with occupational dermatitis can contribute to occupational skin dermatitis, implying
that raising knowledge of the health consequences associated with a condition may act as a
deterrent to its development. A UK survey of occupational health risk awareness within 4950
companies by Pilkington et al (2002) found inadequate comprehension of the potential health
effects of the hazards which they work with as widespread. Similar findings were apparent in
other studies of workers using chromium (Sadhra et al, 2002), printing chemicals (Brown &
Rushton, 2003), and wood dust (Brosseau et al, 2002). Knowledge of long-term health effects of
occupational health hazards, in particular, has also been found wanting (Sadhra et al, 2002).
Although conducted in Taiwan, a cross-sectional survey of 163 hairdressing students by Wong
et al (2005) similarly found those possessing poor understanding of the health hazards with
which they worked notably had poor perception of long-term harm and a sense of
invulnerability. This highlights potential merit in including vocational training awareness
amongst the target populations for raising risk awareness.
Risk Knowledge
Risk Knowledge
Role
Evidence Strength
OA contributor
Very strong
Nineteen studies were uncovered describing knowledge of occupational health risks as
insufficient, potentially giving rise to complacency. To illustrate, a survey of farmers
appreciation of pesticide health hazards found those with more accurate knowledge were more
likely to report intention to seek pesticide safety information; less likely to report being too busy
for RPE/PPE; and more likely to disagree with the idea that exposure is not harmful (Perry et al,
2000). Other workers where studies uncovered insufficient awareness of OA risks included
carpenters, bakers, hairdressers, MVR workers, chromium workers and paint sprayers using
surface coating metal products within SMEs. Those facets of risk awareness that were
highlighted as inadequate included broad and unspecified interpretations of risk, difficulties in
discriminating risks from hazards, misunderstanding of clearance times and zones, and isolating
when and where exposure arises. Managers and front line staff in SMEs have, in different
studies, been labelled as possessing the weakest knowledge.
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Control Knowledge
Control Knowledge
Role
Evidence Strength
OA contributor
Moderate
Five studies specified aspects of respiratory hazard control measures where knowledge was
found wanting (Alston et al, 1997; Chambers, Weyman & Keen, 2002; Elms et al, 2004; Toren
& Sterner, 2003; Wong et al, 2005). For two, this concerned RPE fit testing (Alston et al, 1997;
Wong et al, 2005), and an assumption that adjusting straps amounted to appropriate remedial
measures. Two highlighted inadequate knowledge of exposure limits, one in bakeries (Elms et
al, 2004), and the other for the chemical industry in general (Toren & Sterner, 2003). Wong et al
(2005) observed hairdressers failure to take into account air conditions when using chemicals as
a reflection of poor control knowledge. A study assessing COSHH awareness amongst 25
studies using metal surface coating paint products rated just 22% to have good knowledge of
COSHH requirements (Chambers, Weyman & Keen, 2002).
Behaviour Prediction
Behaviour Prediction
Role
Evidence Strength
OA contributor
Moderate
Three general literature sources covered by this review recounted knowledge as insufficient for
encouraging behaviour change, and for behaviour change to occur very slowly (Carruthers et al,
2004; Kolbe, 1999; Uldry & Leuenberger, 2000). Carruthers et al’s (2004) article from the
Central Office of Information (COI) profiles the effectiveness of various government health
campaigns. Observations that only 34% of smokers, who had seen adverts from the Department
of Health’s Tobacco Education Campaign encouraging people not to smoke around children,
claimed to have either given up or restrict their smoking as a result, demonstrates how
knowledge of health risks does not change behaviour. Similarly, McGhan et al (2005) describes
treatment knowledge as insufficient for guaranteeing treatment compliance. Three other studies
demonstrate how understanding of the health risks associated with dermal hazards (Ling &
Coulson, 2002), blood borne pathogens (Lymer & Isaksson, 2004), and welding (Slater et al,
2000) did not increase compliance with safer working practices such as increased use of hand
creams for dermatitis prevention. In particular, a two year follow up study of LEV and RPE
amongst 62 workers within New Zealand welding companies, following improved health
surveillance feedback, found just half of the welding sites to have changed their LEV where
deemed necessary, and 23% of welders made no change to using RPE (Slater et al, 2000).
Again, this highlights how information alone is insufficient for preventing exposure.
Organisation size
A cross-sector survey of micro-firm knowledge of health and safety risks found that smaller
companies assumed that flour dust hazard information to be aimed at larger bakers (Strutt &
Bird, 2004). A UK survey of hazard awareness within 18 companies possessing noisy working
environments found large companies had higher knowledge levels (44%) than medium (31%) or
small (25%) companies. Although based on noise, this example demonstrates how occupational
knowledge can vary according to organisation size (Hughson et al, 2002).
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7.2.1.4
Individual: Comprehension
Comprehension as a Role
risk factor
Evidence Strength
Role
Learning Difficulties
Evidence Strength
Role
Memory
Evidence Strength
OA Contributor/OA Management barrier
Strong
OA Contributor/OA Management barrier
Limited
OA Contributor/OA Management barrier
Strong
Eight studies highlighted comprehension ability as a major predictor of poorer prognosis for
people with asthma (Bender & Creer, 2002; Marabini et al, 2003; Schmaling et al, 2003;
Soriano et al, 2003; Sturdy et al, 2002; Thorax, 2003). Ability to understand OA may
particularly affect OA sufferer’s ability to distinguish somatic from asthmatic symptoms
(Schmaling et al, 2003). Learning difficulties, in particular, has been identified as a risk factor
for brittle asthma (Harrison, 1998; Lombardo & Balmes, 2000). Similarly, forgetfulness has
been identified as a risk factor for both treatment and control compliance failures (Bradshaw et
al, 2005; Brosseau et al, 2002; Hughson et al, 2002; Jackson, 2004; Moffat et al, 2002; Uldry &
Leuenberger, 2000). For example, employees may increase their exposure by simply forgetting
to switch extractor fans on (Brosseau et al, 2002). Some GPs consider forgetfulness to be a sign
of poor motivation to comply with treatment regimes (Moffat et al, 2002). Written selfmanagement treatment plans have been recommended as a means of circumventing
forgetfulness (Bradshaw et al, 2005). Minimising reliance on memory thus represents a criterion
for any solution endeavouring to overcome psychosocial explanations for non-compliance.
7.2.1.5
Individual: Ignoring Known Risks
OA denial
OA Denial
Role
Evidence Strength
OA management
Very strong
An expansive range of literature documented denial of OA severity, once acquired, as
commonplace, and to be a predictor of fatal asthma attacks, poor self-management strategies,
and to give rise to an overuse of reliever, and under use of preventative medication (Adams et
al, 2001; Barton et al, 2003; Bucknall et al, 1999; Campbell, 1998; De Peuter et al, 2004;
Harrison, 1998; Innes et al, 1998; Kamal & Miller, 2004; Kolbe, 1999; Mcgann, 2000; Moffat
et al, 2002; Rietveld & Brosschot, 1999; Thorax, 2003; Uldry & Leuenberger, 2000; Van Ganse
et al, 2003).
Fatalism
Fatalism
Role
Evidence Strength
OA contributor
Very strong
‘It [risk] goes with the territory’ or ‘it’s part and parcel of the job’ attitudes (Brown % Rushton,
2003; Cutter & Jordan, 2004; Hughson et al, 2002; Jackson, 2004; Lymer & Isaksson, 2004;
O'Hara & Dickety, 2000; Rosen et al, 2005; Strutt & Bird, 2004; Weyman, 1998; Wright &
Collins, 2002; Worsell et al, 2001) were documented as arising within printing (Brown &
Rushton, 2003), wood working, (Strutt & Bird, 2004; Worsell et al, 2001), amongst small firms
using chemical hazards (O’Hara & Dickety, 2000), using isocyanates, flour dust, and bleaches
153
(Strutt & Bird, 2004) and clinical staff exposed to blood borne pathogens (Cutter & Jordan,
2004; Lymer & Isaksson, 2004).
Complacency
Complacency
Role
Evidence Strength
OA contributor
Moderate
Complacency to hazards, as reflected in behaviour demonstrating workers to believe themselves
as impervious to risk, is posited as directly proportional to job tenure, and experience in a job
(Benjamin et al, 2002; Brown & Rushton, 2003; Jones, 2004; Sadhra et al, 2002; Soriano et al,
2003; Strutt & Bird, 2004; Trainor et al, 2002). Complacency was documented as arising within
the printing industry (Brown & Rushton, 2003), paint industry (Jones, 2004) and amongst
chromium workers (Sadhra et al, 2002).
7.2.1.6
Individual: Decision Making
Lay versus expert judgement
Lay vs expert
Role
Evidence Strength
OA contributor
Moderate
Poor agreement between lay and expert risk judgments has been found by Hunt et al (2002) in
terms of dust exposure assessment, with lay people tending to overestimate exposure extent, and
by Sadhra et al (2002) when comparing expert’s perceptions of chromium platers’ compliance
practices with that of managers and operators themselves. In general, experts rated compliance
more negatively, for example, stating that 15% of platers use labels and Safety Data Sheets
(SDS), compared with ratings of 84% of managers and 76% by operators themselves. Such
results imply a bias towards positively rather than objectively rating one’s own practices. In
one study comparing lay with expert decision making amongst SME’s engagement in surface
coating metal products (paint), non-experts tended to base control choices with existing
processes, rather than substance, as a starting point, and utilise information in a haphazard
sequence, with preference towards available sources, rather than follow a linear decisionmaking sequence as espoused with HSE’s earlier versions of the COSHH principles (Weyman,
Chambers & Keen, 2002). Although yet to be generalised to other industry types, these findings
profile what might intuitively be expected to be arising within organisations and industry sectors
detached from HSE, whose control choices are driven by expediency and cost rather than risk.
Cost-benefit trade off
Cost benefit trade off
Role
Evidence Strength
OA contributor/ Diagnostic barriers
Moderate
Risk taking behaviour, in general, can be construed as a trade-off between the perceived costs
and benefits of avoiding risks, for employers and employees alike (De Vries & Lechner, 2000;
O'Hara & Dickety, 2000; Weyman & Kelly, 1999; Weyman, 1998; Weyman et al, 1999). For
example, a series of case studies of small firms using chemicals (O’Hara & Dickety, 2000)
encountered examples of workers drinking tea within exposure zones. In this instance, going to
a different area may have been considered too costly. Similarly, De Vries and Lechner (2000)
found non-compliant Dutch laboratory workers exposed to carcinogenic risk factors perceived
fewer benefits and encountered more barriers to complying with safety recommendations.
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Health beliefs / Attitudes
Health beliefs/attitudes Role
Evidence Strength
OA contributor/OA management
Moderate
Attitudes differ from beliefs in that attitudes contain a valency component. This means that
individuals make a judgement about how much the perceived consequence of an action actually
matters to them (Azjen, 1988). Health beliefs regarding the course, duration and severity of
asthma have been identified as a predictor of treatment adherence, condition acceptance, asthma
morbidity and health care utilisation (Barton et al, 2003; Byer & Myers, 2000; Green et al,
1998; Harrison, 1998; Petrie et al, 2003; Rand & Butz, 1998; Schmaling et al, 2003). Instilling
beliefs that medication works is thus an important component of OA management, as well as
creating a more adaptive attitude to the hazard (De Vries & Lechner, 2000). Similarly, De Vries
and Lechner (2000) found attitudes to health to correlate significantly with future intention to
always use personal safety equipment as well as with current behaviour. Indeed frequent users
of PPE were more positive on attitudes to safety. The most important determinant seemed to be
subjects approach to safety in other situations. Attitudes towards compliance may also be a
reflection of wider attitudes towards health hazards. For example, a survey of PPE usage
amongst agriculture workers found those who follow instructions when buying household
appliances are more than four times as likely to read label of pesticides and twice as likely to
read PPE instructions (Avory & Coggon, 1994). Inclusion of risk attitudes, and creating positive
attitudes regarding the effectiveness of control measures, thus potentially offers two other
potential avenues for reducing exposure.
Acceptance
Acceptance
Role
Evidence Strength
OA contributor
Strong
Three studies claimed accepting control effectiveness as an important contributor to compliance
(Alston et al, 1997; Bauer et al, 2002; Taylor & Morgan, 1995), which can be facilitated by
appropriate training (Bauer et al, 2002), or undermined by failing to include workers in control
choice, such as PPE (Alston et al, 1997).
Perceived control over risk
Perceived control: risk
Role
Evidence Strength
OA contributor
Limited
In general, people are more concerned, and become more cautious, about risks they perceive
outside their control (Covello, 1997). Within the work context, the review literature suggests
that increased perceived control or internal locus of control can exacerbate exposure likelihood
by creating complacency, progressively undermining workers sense of vulnerability over time
(Robertson & Stewart, 2004; Trainor, Weyman & Anderson, 1998; Weyman & Kelly, no date;
Weyman, 1997; Weyman et al, 1999; Weyman, 1998). For example, Sadhra et al (2002) found
experienced electroplaters to over-estimate their ability to avoid exposure to chromium acid and
to place excessive faith in their own experience. Conversely, other studies imply perceived
control to mitigate exposure risk by encouraging workers to become more engaged in their tasks
(Creely et al, 2003; Godin et al, 2000; Neal & Griffin, 2004).
155
Perceived control over condition
Perceived
condition
control: Role
Evidence Strength
OA management barrier
Very strong
Evidence for the impact of perceived control over asthma, once developed, is less ambiguous.
Unpredictable asthma attacks can undermine the individual’s perceived control over their
condition, and engender some degree of learned helplessness (Byer & Myers, 2000; Creer &
Levstek, 2001; Hand & Adams, 2002; Lehrer et al, 2002; Nouwen et al, 1999; Rietveld, 1998;
Van Ganse et al, 2003; Wright et al, 1998). This, in turn can give rise to individual’s neglecting
their medication, and relying on more avoidant coping strategies such as denial (Barton et al,
2003). In a similar vein, patients may also delay seeking medical care for their condition
because of unwillingness to give up control to others (Rand & Butz, 1998). For musculoskeletal
disorders (MSD), Weyman (1997) recognised limited control over work activities as also
restricting employee’s ability to manage their condition effectively. The same may be true for
OA.
Risk related self-efficacy
Self efficacy: risk
Role
Evidence Strength
OA contributor
Moderate
Self-efficacy refers to the individual’s belief that they possess the necessary skills for
controlling risk. Bender and Creer (2002) describe self-efficacy as key to adherence. Selfefficacy has been identified as a statistically significant predictor of both the intention to use
controls, as well as actual usage (De Vries & Lechner, 2000; Godin et al, 2000). Other studies
claim that self-efficacy can be improved by skills-based training (Creer & Levstek, 2001),
undermined by mechanical measures (Ley et al; 1996), and can compel voluntary exposure
(Weyman & Kelly, no date).
Condition-related self-efficacy
Self efficacy: condition
Role
Evidence Strength
OA management barrier
Strong
Akin to perceived control, poor self-efficacy has been linked to poor treatment adherence, and a
restriction of quality of life and corresponding lifestyle choices (Aalto et al, 2002; Aboussafy et
al, 2000; Adams et al, 2001; Barton et al, 2003; Burton et al, 2001; Gallant, 2003; Griffiths et al,
2001; Hesselink et al, 2004; Jackson, 2004; Lucas et al, 2001; McGhan et al, 2005; Moffat et al,
2002; Nouwen et al, 1999; Van Ganse et al, 2003).
Perceived Responsibility
Perceived
responsibility
Role
Evidence Strength
OA contributor
Moderate
Two studies highlighted worker’s failure to observe their health and safety responsibilities, one
from their not being made aware by management (Alston et al, 1997), the second, through
displacing responsibility on to the client (Strutt & Bird, 2004).
156
7.2.1.7
Motivation
Motivation:
Role
Evidence Strength
OA contributor
Strong
Motivation is identified as a prerequisite of control compliance (Creely et al, 2003), treatment
compliance (Creer & Levstek, 2001; Gwynn, 2004; Levin et al, 2002; Rodrigo et al, 2004) and
receptiveness to training (Benjamin et al, 2002; Creely et al, 2003). Falliers (1987) advocated
minimising reliance on motivation in treatment regimes.
7.2.1.8
Personality
taking Role
Evidence Strength
Role
Negative affectivity
Evidence Strength
Role
Psychiatric disorders
Evidence Strength
OA contributor/diagnostic barrier
Moderate
OA management barrier
Strong
OA management barrier
Strong
Risk
Personality
Risk taking personalities, associated with high sensation seeking, and neuroticism personality
traits (Neal & Griffin, 2004), unsurprisingly, has been linked with increased exposure (Dejoy et
al, 2000; Falliers, 1987; Salminen, 1997; Weyman & Kelly, no date). Conversely, defensive
personality types (Feldman et al, 2002; Harrison, 1998; Lehrer et al, 2002) potentially render
diagnosis more difficult, whilst inflexible personality types are less able to adjust to the
demands of OA. Likewise, negative affectivity (tendency to view experiences from a negative
perspective) (Creer & Levstek, 2001; Smith & Nicholson, 2001) and psychiatric disorders
(Barnes & Woolcock, 1998; Bender & Creer, 2002; Bucknall et al, 1999; Campbell, 1998;
Harrison, 1998; Petrie et al, 2003; Rodrigo et al, 2004; Sturdy et al, 2002; Thorax, 2003) have
also been related to OA treatment non-compliance.
7.2.2
Individual: Emotional
7.2.2.1
Fear of economic consequences
Fear of economic / Role
confidentiality
Evidence Strength
consequences
Diagnostic barriers
Very strong
Employees’ fears of the economic repercussions that may proceed their employers discovering
that they are positively diagnosed with OA appears a powerful motivator for symptom
concealment and non-disclosure (Axon et al, 1995; Bernstein, 2002; BOHRF, 2005; Bradshaw
et al, 2005; Bradshaw et al, 2001; Bucknall et al, 1999; Cannon et al, 1995; Creer & Levstek,
2001; Cullinan et al, 2003; Curran & Fishwick, 2003; Devereux et al, 2004; Elms et al, 2003;
Fishwick et al, 2003; Gannon et al, 1993; Gordon et al, 1997; Hoyle et al , 2002; Mancuso et al,
2003; Mihalas, 1999; O'Neill, 1995; Rabatin & Cowl, 2001; Reetoo et al, 2004; RomanoWoodward, 2004; Ross & McDonald, 1998; Snashall, 2003; Venables et al, 1989; Vigo &
Grayson, 2005; Weyman, 1999; Weyman, 1998). Such fears stem from perceiving employers
as prejudiced against disease (Venables et al, 1989), and consequent threat of job loss (Bucknall
157
et al, 1999; Reetoo et al, 2004), reduced earnings (Gannon et al, 1993) and poor job prospects
(Bradshaw et al, 2005; Devereux et al, 2004; Reetoo et al, 2004; Venables et al, 1989). For
example, BOHRF’s (2005) systematic review reported one third of OA sufferers as unemployed
6-months post diagnosis. Such fears apparently force many symptomatic employees to remain
in asthmagenic jobs. A longitudinal survey by Bradshaw (2005) of 77 referrals to 6 respiratory
specialist centres revealed 36% of those diagnosed with OA to still be in the same job at 12
months follow-up. Concerns of confidentiality breaches, and ambiguity over the circumstances
under which physicians inform employers of a diagnosis can serve to reinforce this fear
(Bradshaw et al, 2005; Bradshaw et al, 2001; Elms et al, 2003; Fishwick et al, 2003; Reetoo et
al, 2004).
7.2.2.2
Treatment dependency fears
Treatment dependency Role
fears
Evidence Strength
Diagnostic/management barriers
Strong
Reluctance to become dependent upon treatment was frequently cited as undermining treatment
compliance (Bosley et al, 1995; Horne & Weinman, 2002; Moffat et al, 2002; Soriano et al,
2003; Taylor & Morgan, 1995; Uldry & Leuenberger, 2000; Van Ganse et al, 2003).
7.2.2.3
Enforcement Fears
Enforcement fears
Role
Evidence Strength
Diagnostic/management barriers
Moderate
Employers may inadvertently accentuate exposure risk by avoiding using HSE’s resources due
to fears of triggering enforcement action (Chambers, Weyman & Keen, 2002; Llewellyn et al,
no date; O'Hara & Dickety, 2000; Reetoo et al, 2004; Sadhra et al, 2002; Weyman et al, 1999;
Worsell et al, 2001). This may be particularly the case amongst smaller organisations
(Chambers, Weyman & Keen, 2002; Llewellyn et al, no date; O'Hara & Dickety, 2000; Reetoo
et al, 2004; Sadhra et al, 2002). However, a recent HSE survey of inspectors’ enforcement
practices revealed the minority of actions to be health related (Wright et al, 1995). Conversely,
Carruthers et al (2004) describe the threat of enforcement as beneficial in ensuring the perceived
consequences of non-compliance by enforcers outweigh any benefits. Similarly, in the safety
context, Hopkins (1998) and Baggs and Silverstein (2003) found enforcement inspections
effective in reducing accidents and claim rates respectively. Collectively, this evidence implies
that enforcement fear can either increase risk by deterring poorer resourced employers from
utilising health and safety expertise, or decrease risk by encouraging employers to improve
preventative practices.
7.2.2.4
Non-work
stress
Non-work related stress
related Role
Evidence Strength
OA contributor
Moderate
Non-work related stress, stemming from domestic sources, relationships, bereavement or
complex lifestyles has been identified as positive predictors of fatal/near fatal asthma attacks
(Innes et al, 1998; Thorax, 2003), brittle asthma (Harrison, 1998), poorer pulmonary functioning
158
(Schmaling et al, 2002), symptom frequency (Aboussafy et al, 2000), and poorer treatment
adherence (Barton et al, 2003; Bender & Creer, 2002; Kolbe, 1999; Moffat et al, 2002;
Niemeier et al, 2002; Van Ganse et al, 2003).
7.2.2.5
Work-related stress
Work related stress
Role
Evidence Strength
OA contributor
Moderate
Three articles implicate work-related stress, generated by downsizing, declining job
opportunities (Zeitlin, 1995), work intensity, work duration, working conditions (Akpinar &
Elci, 2002), and tense organisational climates (Piirainen et al, 2003) as potential risk factors for
occupational asthma. One study suggests a bi-directional relationship, where increased
prevalence of asthma may contribute to greater stress perception (Hurwitz, 2003).
7.2.2.6
Stress
cause
Stress as a potential cause
as
potential Role
Evidence Strength
OA contributor
Limited
Despite a widespread assumption held by many patients that stress causes asthma, the evidence
for stress-induced asthma remains equivocal, and thwarted by methodological shortcomings in
associated investigations (Lahtinen et al, 2004; Rietveld et al, 2000; Wright et al, 1998).
Hypothesised causal mechanisms included undermined immunity, an increasing sensitivity to
physical, chemical or biological hazards, or stress-related increases in breathing rate and depth
(Lahtinen et al, 2004; Reitveld, 2000; Wright et al, 1998). The experience of stress may also
predispose asthmatic employees to evaluate respiratory symptoms as asthmatic (Reitveld,
2000).
7.2.2.7
Stress as
trigger
Stress as a potential trigger
potential Role
Evidence Strength
OA Management Barriers
Limited
Stress is recognised as a potential trigger of asthma attacks through precipitating bronchoconstriction (Barnes & Woolcock, 1998; Lehrer et al, 2002; Reijula, 1997; Rodrigo et al, 2004;
Smyth et al, 1999).
7.2.2.8
Panic
Panic
Role
Evidence Strength
OA Management Barriers
Limited
Panic tends to be over-represented amongst the asthma population (Lehrer et al, 2002),
and has been associated with increased asthma morbidity, poorer treatment adherence,
increased health care utilisation, possibly through interfering with accurate symptom
159
perception (Creer & Levstek, 2001; Nouwen et al, 1999; Rand & Butz, 1998; Rietveld,
1998; Schmaling et al, 2003).
7.2.2.9
Anxiety:
Role
Evidence Strength
Anxiety
OA Management Barriers
Limited
The relationship between anxiety and asthma appears conflicting. A body of evidence
implicates anxiety in non-adherence and poor treatment outcomes (Adams et al, 2001; Barnes &
Woolcock, 1998; Barton et al, 2003; De Peuter et al, 2004; Innes et al, 1998; Kamal & Miller,
2004; Kolbe, 1999; Lehrer et al, 2002; Nouwen et al, 1999; Rietveld et al, 2000; Rietveld, 1998;
Rodrigo et al, 2004; Schmaling et al, 2003; Schmaling et al, 2002; Smyth et al, 1999; Vamos &
Kolbe, 1999; Van Ganse et al, 2003), possibly by impairing the OA sufferer’s ability to acquire
condition knowledge and make appropriate decisions (Taylor & Morgan, 1995). Elsewhere,
anxiety has been attributed as a motivator increasing likelihood of treatment compliance (Sturdy
et al, 2002; Van Ganse et al, 2003). Other research cites anxiety as linked with self-reported,
but not objective indicators of asthma severity (De Peuter et al, 2004; Uldry & Leuenberger,
2000). Literature describes anxiety as a consequence of having asthma. Its role as a potential
antecedent is not clearly delineated.
7.2.2.10
Depression
Role
Evidence Strength
Depression
OA Management Barriers
Very strong
As with anxiety, depression is also common amongst asthmatics. It too is associated with poorer
treatment compliance, and poorer treatment outcomes (Barnes & Woolcock, 1998; De Peuter et
al, 2004; Kamal & Miller, 2004; Katz et al, 2003; Katz et al, 2002; Kolbe, 1999; Rand & Butz,
1998; Rietveld, 1998; Rodrigo et al, 2004; Smyth et al, 1999; Vamos & Kolbe, 1999). For
example, a survey by Bosley et al (1995) found depression rates significantly higher amongst
treatment non-compliant than compliant asthma sufferers. Depression may mediate compliance
via self-efficacy and motivation. Poor symptom control is likely to undermine self-efficacy and
reinforce any depressed state as a result. Depression in turn can then act as de-motivatory
influence on subsequent compliance.
7.2.2.11
Negative Mood States
Negative Mood States
Role
Evidence Strength
OA Management Barriers
Very strong
Other studies describe negative mood states in general as interfering with accurate symptom
perception, condition management, and contributing to diminished PEF (Barnes & Woolcock,
1998; De Peuter et al, 2004; Kamal & Miller, 2004; Kolbe, 1999; Nouwen et al, 1999; Rietveld,
1998; Rietveld et al, 2000; Ritz & Steptoe, 2000; Rodrigo et al, 2004; Schmaling et al, 2003;
Smyth et al, 1999; Vamos & Kolbe, 1999). Reitveld et al (2000) highlights the potential bidirectional relationship between mood and symptoms severity, reasoning that mood may limit
PEF, but PEF may also affect mood.
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7.2.3
Individual: Behavioural
7.2.3.1
Coping Behaviours
Smoking
Role
Evidence Strength
OA Management
Very strong
Smoking is a well-recognised risk factor for asthma. It is also a recognised risk factor for OA
(Brooks, 1995; Mihalas, 1999). For those pre-existing smokers working in ‘asthmagenic
occupations’, smoking may directly induce non-specific bronchial hyper-reactivity. This may in
turn increase the risk of hyper-reactivity to inhaled allergens and irritant chemicals (Campbell,
1998; Douglas, 2005; Gwynn, 2004; Harrison, 1998; Hoyle et al, 2002; Innes et al, 1998; King
et al, 2004; Ross & MacDonald, 1998; Thorax, 2003). Niven and Pickering (1999) purport
smoking to reduce the latent interval between symptom manifestation and exposure to HMW
allergens. Similarly, Vigo and Grayson (2005) cite evidence suggesting cigarette smokers have
four to six times higher risk of OA upon exposure to platinum salts, laboratory animals or acid
anhydrides, relative to non-smokers. Smoking is also implicated as contributing to poor selfmanagement of asthma (Barr et al, 2002; Meredith et al, 2000; Moffat et al, 2002), and to failure
to consistently use respirators (White et al, 1988).
Obesity
Role
Evidence Strength
OA Management
Strong
A higher body mass index (BMI), and overeating, is also a recognised risk factor of asthma
(Bucknall et al, 1999; Burgess et al, 2001; Campbell, 1998; Harrison, 1998; Moffat et al, 2002;
Rand & Butz, 1998; Smith & Nicholson, 2001; Thorax, 2003; Uldry & Leuenberger, 2000).
Drug/Alcohol Abuse
Role
Evidence Strength
OA Management
Strong
Alcohol and substance abuse can contribute to asthma morbidity and mortality by impeding
effective asthma management, either directly through exacerbating symptoms, or indirectly by
masking symptoms leading to treatment delay (Adams et al, 2004; Barton et al, 2003; Creely et
al, 2003; De Ridder & Schreurs, 2001; Hesselink et al, 2004; Kamal & Miller, 2004; Makinen et
al, 2000; Nelson, 2001; Schmaling et al, 2003; Wright et al, 1998).
Coping Styles
Role
Evidence Strength
OA Management
Strong
Avoidant and emotion focused coping styles have been linked with poorer quality of life
amongst asthmatics, for example, by producing delays in the speed by which medical assistance
is sought (Adams et al, 2004; Barton et al, 2003; Creely et al, 2003; Hesselink et al, 2004;
Kamal & Miller, 2004; Makinen et al, 2000; Nelson, 2001; Schmaling et al, 2003; Wright et al,
161
1998). General coping literature posits a broad coping skills repertoire, comprising problem
solving and emotion focused strategies (such as relaxation), as being the most effective for
contending with the stressors presented by chronic health conditions (De Ridder & Schreurs,
2001). For example, emotion focused strategies may be more effective where problems are
irreconcilable.
Monitors and Blunters
Role
Evidence Strength
OA Management
Strong
A sub-set of coping literature based on research conducted within cancer and cardiac care
differentiates two different coping styles according to the extent to which risk information is
processed (Bar-Tal, 1994; Brown & Bedi, 2001; Muris et al, 1994; Petersson et al, 2002;
Williams-Piehota et al, 2005). Accordingly, ‘monitors’ refers to individuals who actively seek
out further risk information, whereas ‘blunters’ prefer to avoid threatening information in order
to minimise the distress it may generate. As a result, ‘blunters’ may fail to engage in ‘healthier’
behaviours. Related research has found risk communication to be more persuasive for ‘blunters’
if presented in factual and concise terms. Conversely, further elaboration of health risks is
necessary to motivate ‘monitors’.
7.2.3.2
Self-Management Challenges
Self management as a Role
risk factor
Evidence Strength
Role
Immediacy of relief
Evidence Strength
Role
Regime complexity
Evidence Strength
Role
Asymptomatic
Evidence Strength
OA Management
Strong
OA Management
Strong
OA Management
Moderate
OA Management
Limited
Role
Evidence Strength
Role
Evidence Strength
Role
Evidence Strength
Role
Evidence Strength
Role
Evidence Strength
OA Management
Limited
OA Management
Strong
OA Management
Very strong
OA Management
Very strong
OA Management
Strong
Monitoring
Appointments/self
discharge
Regime adherence
Training Need
Solutions
Poor compliance with treatment recommendations represents a risk factor for fatal or near fatal
asthma (Adams et al, 2001; Bosley et al, 1995; Byer & Myers, 2000; Kamal & Miller, 2004;
Taylor & Morgan, 1995; Thorax, 2003; Uldry & Leuenberger, 2000; Wright et al, 1998).
However, compliance difficulties appear widespread (Barton et al, 2003; Bender et al, 2000;
162
Bresnitz et al, 2004; Campbell, 1998; Creer & Levstek, 2001; De Peuter et al, 2004; Fishwick et
al, 1997; Gibson et al, 2002; Hand & Adams, 2002; Harrison, 1998; Haynes et al, 2002; Innes et
al, 1998; Ley et al, 1996; Lucas et al, 2001; Nouwen et al, 1999; Petrie et al, 2003; Ram, 2003;
Rand & Butz, 1998; Sarlo, 2003; Schmaling et al, 2003; Taylor & Morgan, 1995; Thorax, 2003;
Zimmer et al, 2000). Such difficulties are reflected in non-attendance for medical appointments,
and failure to reliably monitor peak flows. Compliance difficulties can be attributed to regime
complexity, for example, having to use two or more different types of medication several times
a day (Creer & Levstek, 2001; Fishwick et al, 1997; Kolbe, 1999; Taylor & Morgan, 1995; Van
Ganse et al, 2003). Being largely without symptoms has also been identified as a risk factor of
non-compliance. A tendency for sufferers to overuse reliever medication at the expense of
controller medication has been attributed to preference for immediate symptom relief (Barnes &
Woolcock, 1998; Bender & Creer, 2002; Bucknall et al, 1999; Burton et al, 2001; Creer &
Levstek, 2001; Marks et al, 2000; Schmaling et al, 2003). Recommendations for improved selfmanagement are widespread within the literature. In particular, personalised written action
plans, detailing medication schedules, and emergency contacts have been found to improve
compliance rates. For example, a systematic review of self-management programmes by Powell
and Gibson (2004) revealed optimal self-management and optimisation of asthma control to be
accomplished with the aid of written action plans combined with regular medical reviews.
7.2.3.3
Behavioural Non-Compliance
Non compliance
Working position
Poor hygiene
Poor practice
Role
Evidence Strength
Role
Evidence Strength
Role
Evidence Strength
OA Contributors
Moderate
OA Contributors
Moderate
OA Contributors
Moderate
Role
Evidence Strength
OA Contributors
Moderate
Six studies describe behavioural non-compliance as arising despite the availability of health and
safety guidelines or risk assessments (Bender & Creer, 2002; Elms et al, 2004; Gershon et al,
2000; Goldenhar et al, 2003; Newman-Taylor, 2002; Trainor et al, 2002). Specific examples of
non-compliance include:
•
•
•
Adopting inappropriate working positions, for example, working too closely to solder
fumes so that the breathing zone and fumes overlap (Pengelly et al, 2005), working
too closely to printing chemicals (Brown & Rushton, 2003), and failing to maintain
the correct spray-away distance in MVR workshops (Liu et al, 2000).
Poor personal hygiene and cleanliness, for example, by failing to wash hands or
change overalls before entering the canteen (Wheeler et al, 2004), disinfecting hands
when required within intensive care units (Roghman et al, 2003), and maintaining a
clean and tidy workplace (Gershon et al, 2000). Within Gershon et al’s (2000) cross
sectional-survey of American hospital workers exposed to blood-borne pathogens,
those who rated their worksite as clean and tidy were 3 times more likely to report
adherence with health and safety guidelines. Reliance on self-report measures will
undermine the reliability of these findings.
Undertaking peripheral tasks: Evidence suggests that workers may adopt more lax
work practices for tasks that support the main function of their job. These also relate
163
to cleaning and tidying, for example, in allowing isocyanate-based paint hardeners
and paints to collect on workplace surfaces (Liu et al, 2000), folding flour bags (Elms
et al, 2003), disposing of pesticide containers by agricultural workers (Avory &
Coggon, 1994), brush cleaning rather than vacuum cleaning wood dust (Dilworth,
2000) or flour dust (Elms et al, 2004), despite the availability of vacuums, and
sweeping up without putting the extractor fan on (O Hara & Dickety, 2000).
Reflexive behaviours: Seemingly, reflexive behaviours can also increase exposure
risk, for example, by cupping the hands to catch paint drips (Roff et al, 2003), reentering a paint booth during clearance times (Chambers et al, 2005), or lifting a visor
to check paint quality.
Food consumption: Examples were encountered of workers eating and drinking
within the exposure areas (O Hara & Dickety, 2000), perhaps because it is more
expedient, or through absence of a canteen.
•
•
7.2.3.4
Habitual Behaviours:
Role
Evidence Strength
OA Contributors
Strong
Literature indicates pre-existing habits as presenting a significant barrier to behavioural change,
the extent of which appears proportional to experience, with older workers finding it more
difficult to change their work patterns (Brosseau et al, 2002; Byer & Myers, 2000; Creely et al,
2003; Hughson et al, 2002; Jensen & Kofoed, 2002; Llewellyn et al, no date; Trainor et al,
2002; Trainor, Weyman & Anderson, 1998; Wright & Collins, 2002). Training aimed at
changing workplace practices, if not repeated, can be short-lived due to gradual reversion to old
habits over time (Creely et al, 2003). Applying old habits to solve problems can also hamper the
speed by which that problem is resolved (Trainor, Weyman & Anderson, 1998). Conversely,
Hughson (2002) demonstrates how behaviour can be shaped so that good practice behaviours
become a habit, in this instance, by encouraging employees to wear ear defenders all the time,
independent of local noise levels.
7.2.3.5
Behavioural Change:
Evaluation
Role
Evidence Strength
OA Management
Weak
A review of public health campaigns by the Central Office of Information (COI) (Carruthers et
al, 2004) highlights difficulties in evaluating the effectiveness of interventions aimed at
population-based behaviour change. These stem from:
•
•
•
The slow nature of behavioural change.
Having to rely on indirect indicators that better capture intentions than actual change,
such as self-report attitudinal measures or helpline usage, and
Difficulties in conducting controlled evaluations, isolating causal influences, and the
relative impact of intervention components such as advertising.
164
Sustainability
Role
Evidence Strength
OA Management
Limited
According to a literature review of safety culture, sustained compliance with risk assessment
recommendations represents the most difficult stage of the risk assessment process (Wright &
Collins, 2002).
Reinforcement
Role
Evidence Strength
OA Management
Strong
Six studies emphasise the importance of feedback in encouraging sustained compliance (Dejoy
et al, 2000; Gadd & Collins, 2002; Gershon et al, 2000; Hofmann & Morgeson, 2004; Rosen et
al, 2005 Stajkovic, 2003, cited in Fell-Carlson, 2004). Informal feedback and prompts, given at
the point-of-use, by supervisors, appears more effective in enhancing compliance than formal
feedback systems (Dejoy et al, 2000; Gershon et al, 2000). Rosen et al (2005) advocate video
exposure monitoring (VEM), which simultaneously videos worker’s behaviour and provides
real-time feedback of associated exposure levels. They describe VEM as potentially providing a
powerful compliance motivator. Evaluation of its potential motivating effectiveness has yet to
be undertaken.
7.2.3.6
Consequences
‘Workability’
Role
Evidence Strength
OA Management
Strong
Asthma is cited as undermining ability to work, or be perceived as such by others (Boot et al,
2004; Eisner et al, 2002; Larbanois et al, 2002; Mancuso et al, 2003; Sauni et al, 2001; and
Vandenplas et al, 2002). According to Sauni et al (2001) asthmatic construction workers
evaluate their ‘workability’ and general health as significantly worse than non-asthmatics, often
having undertaken less strenuous tasks, or changed their occupation. Taking sick leave can
provide one method for coping with work demands (Boot et al, 2004). Removal or reduction of
exposure sources can reduce its disabling effects. Vandenplas et al (2002) advise that a
reduction of exposure to latex should be considered a reasonably safe alternative to exposure
removal due to it having fewer socio-economic consequences.
Quality of life
Role
Evidence Strength
OA Management
Strong
Assessments of OA sufferer’s quality of life (QOL) ratings using generic or asthma-specific
QOL tools demonstrate them as significantly worse than controls (Derk & Henneberger, 2003),
for example, in terms of coping with symptoms, limitation of activities, and emotional
dysfunction (Malo et al, 1993). Such ratings appear proportional to symptom severity (Malo et
al, 1993) or frequency (Berntsson & Ringsberg, 2003), although Juniper (1999) describes OA
165
sufferers as having worse QOL ratings than non-OA sufferers with similar clinical severity.
Attributing the cause of asthma to work as opposed to more voluntary exposure may therefore
inflate sufferer’s perceptions of its adverse effects. Amongst Finnish diisocyanates sufferers
(N=213) (Piirilae et al, 2005), the reasons underpinning dissatisfaction with QOL was
associated with coping with symptoms 57%, unemployment 25%, poor economics 12.5%, low
compensation 8%, and a new job 3%. Taylor and Morgan (1995) found the impact of asthma
upon QOL to also extend to the sufferer’s family, in terms of social and leisure activities,
mobility, control, and planning as well as quality of relationships. According to Aalto et al
(2002) improved physical health can reduce effects of asthma upon lifestyle restrictions.
7.2.4
Job
7.2.4.1
Emergencies:
Mistakes
Moral Dilemma
Role
Evidence Strength
Role
Evidence Strength
OA Contributor
Limited
OA Contributor
Weak
Factors arising from the immediate work environment that jeopardize compliance include
emergencies, in which, for example, the life of a colleague is under immediate threat. The
urgency of the situation may force workers to make mistakes, and fail to use controls
appropriately, such as not using RPE during the 9/11 episode (Levin et al, 2002). Likewise,
pressure stemming from the moral dilemma to help can force workers to put themselves at risk
in order to help their colleague. In these instances delay generated by putting on appropriate
PPE, or having to stand by, may be construed as unacceptable (Vaughan, 2005).
7.2.4.2
PPE/RPE (Controls):
Supply/Selection
Supply/Selection
Role
Evidence Strength
OA Contributor
Very strong
Failure by employers to make appropriate PPE available to employees was often encountered
within the literature. This applies both to whether PPE is supplied (Cutter & Jordan, 2004;
Dejoy et al, 2000; Elms et al, 2004; Fishwick et al, 2003; Lymer & Isaksson, 2004; Robertson &
Stewart, 2004; Trim et al, 2003; White et al, 1988), or whether the PPE that is supplied is
actually suitable for the task (Alston et al, 1997; Bresnitz et al, 2004; Brown & Rushton, 2003;
Hughson et al, 2002; Roff et al, 2003). Elms et al (2004) reported just 42% of bakeries
providing RPE, whereas Fishwick et al (2003) identified just 67% of workers referred to
specialist respiratory centres as having been provided with appropriate PPE. According to
Lymer and Iskasson (2004) availability refers to both the volume of PPE that is ordered, and its
positioning within the workplace. Robertson and Stewart (2004) suggest that PPE supply should
become mandatory.
166
Design/Fit
Design/Fit
Role
Evidence Strength
OA Contributor
Very strong
Poor design and fit of PPE also appears to play a significant role in undermining PPE use
(Alston et al, 1997; BOHRF, 2004; Bolsover & Parker, 2002; Bresnitz et al, 2004; Brown &
Rushton, 2003; Chambers, Sandys & Piney, 2005; Fishwick et al, 2003; Hughson et al, 2002;
Lombardo & Balmes, 2000; Lymer & Isaksson, 2004; Redmayne et al, 1997; Roff et al, 2003;
Salazar et al, 2001; Strutt & Bird, 2004; Vaughan, 2005; White et al, 1988). Poor design can
mean that PPE affects tactile dexterity (Hughson et al, 2002; Strutt & Bird, 2004; Vaughan,
2005), breathing (White et al, 1988), communication (White et al, 1988; Trim et al, 2003),
thermal comfort (Alston et al, 1997; Vaughan, 2005), task performance and general discomfort
(Brown & Rushton, 2003; Dilworth, 2000; Lymer & Isaksson, 2004; Redmayne et al, 1997;
Roff et al, 2003). For workers with specific religious backgrounds, PPE requirements can
conflict with religious-based dress requirements (Vaughan, 2005). More widespread fit testing
was frequently cited as a recommendation (BOHRF, 2004; Bresnitz et al, 2004; Dilworth, 2000;
Lombardo & Balmes, 2000). Indeed a review of breathing apparatus incidents by Bolsover and
Parker (2002) attributes 28% to design problems.
Usage
Usage
Role
Evidence Strength
OA Contributor
Very strong
Where PPE is made available, design and comfort shortcomings means that PPE is often unused
or misused (Alston et al, 1997; BOHRF, 2004; Bolsover & Parker, 2002; Bresnitz et al, 2004;
Brown & Rushton, 2003; Lombardo & Balmes, 2000; Vaughan, 2005). Examples of misuse
include wearing respirators upside down, contaminating PPE on removal, or cutting the fingers
off gloves to improve dexterity. A two-year longitudinal New Zealand survey by ErkinjunttiPekkanen et al (1999) demonstrated how the forced vital capacity (FVC) and forced expiratory
volume in one second (FEV1) had a greater annual decline amongst welders not wearing RPE
relative to those using PPE.
Maintenance
Maintenance
Role
Evidence Strength
OA Contributor
Very strong
Surveys within companies using isocyanates (Levin et al, 2000), chemical vapours (Alston et al,
1997), and printing chemicals (Brown & Rushton, 2003) found a dearth of regular PPE
inspection and maintenance programmes. More generic reviews of PPE maintenance practices
also describe such practices as wanting (BOHRF, 2004; Bresnitz et al, 2004; Lombardo &
Balmes, 2000; Vaughan, 2005). As a result PPE can often be used that is in poor condition, or
beyond its expiry date (Vaughan, 2005). To this end Bolsover and Parkers’s survey (2002)
found 54% of breathing apparatus accidents to stem from poor maintenance and cleaning.
167
Storage
Storage
Role
Evidence Strength
OA Contributor
Moderate
Examples of poor PPE storage was encountered within surveys of paint workshops, wood dust
workshops, printers and workplaces exposed to chemical vapour. According to Alston et al
(1997) poor storage refers to keeping PPE in locations where it remains exposed to hazards
(Alston et al, 1997; Brown & Rushton, 2003; Chambers, Weyman & Keen, 2002; Dilworth,
2000; Levin et al, 2000). Alston et al highlights many companies in which staff are exposed to
vapour (31% of those surveyed) to store RPE inappropriately despite being provided with
properly designated storage.
Duration
Duration
Role
Evidence Strength
OA Contributor
Moderate
Dilworth’s (2000) wood dust survey found 74% of wood working staff to only wear PPE for the
duration of a dusty task; the remainder wore RPE for the duration of the shift. If generalisable to
other settings this suggests PPE use as task-specific, which may undermine the development of
PPE use as a habit. Interestingly, Salazar et al’s (2001) survey of RPE use amongst American
waste workers found more frequent users to negatively rate the comfort of RPE design.
Frequent and more prolonged use of RPE may make its limitations more salient to the user.
Record Keeping
Record Keeping
Role
Evidence Strength
OA Contributor
Limited
Only one study was found that documented the extent of PPE record keeping. Of 11
organisations within which workers were exposed to chemical vapours, the majority did not
keep any records of PPE issuing and maintenance (Alston et al, 1997). This limited evidence
base does not allow judgements of the extent of PPE record keeping within the wider UK
industry.
Effectiveness
Effectiveness
Role
Evidence Strength
OA Contributor
Strong
Studies evaluating the effectiveness of PPE generally find it not to offer full protection to
dermal or respiratory hazards. This applies to RPE in relation to OA (BOHRF, 2005; Forrest,
2001; Hnizdo & Sylvain, 2003; Holness & Nethercott, 1995; Obase et al, 2000; O'Hara &
Dickety, 2000; Taivainen et al, 1998), and gloves in relation to dermatitis (Brown, 2004; Liu et
al, 2000). The systematic review undertaken by the British Occupational Hygiene Research
Foundation in 2005 concluded air fed helmets to improve the symptoms in some OA workers,
but not consistently. This counteracts the widespread assumption of PPE invincibility
apparently held by many employees (see section 1.1.1.2).
168
7.2.4.3
Ventilation/Controls:
Need
Need
Role
Evidence Strength
OA Contributor
Moderate
Improved ventilation was recommended within printing (Rosenthal & Forst, 2001), radiography
(Teschke et al, 2002), dental laboratories (Nayebzadeh & Dufresne, 1999), New Zealand
welding organisations (Erkinjuntti-Pekkanen et al, 1999) and chemical manufacturing
companies (Hnizdo & Sylvain, 2003). The extent to which these surveys are representative of
corresponding UK industry sectors cannot be discerned.
Design
Design
Role
Evidence Strength
OA Contributor
Moderate
Two studies highlight appropriate ventilation control design as not just important for optimising
fume capture, but as necessary for instilling acceptance amongst employees regarding control
effectiveness (Brosseau et al, 2002; Pengelly et al, 1998). Design drawbacks can include
switches difficult to reach, bulky filters, controls that are tiring and difficult to use, hoses that
get in the way, reliance on workers to open and shut blast gates, and time required to use the
control (Brosseau et al, 2002).
Maintenance
Maintenance
Role
Evidence Strength
OA Contributor
Moderate
As with PPE maintenance, seven studies reported shortcomings in the prevalence of
maintenance programmes for ventilation control. This applied to soldering, (Pengelly et al,
1998), paint workshops (Chambers, Sandys & Piney, 2005), surface coating metal products
enterprises (Chambers, Weyman & Keen, 2002), Canadian wood working (Brosseau et al, 2002;
Dilworth, 2000), and baking (Elms et al, 2004). Again, these examples are only illustrative; they
do not indicate the full extent of poor ventilation control maintenance practices within the
British Industry.
Tasks: Sector specific tasks associated with greater asthmagen exposure are profiled within
table 2 of the main body of the report.
169
7.2.5
Soft Organisational: Environmental
7.2.5.1
Air Quality:
Environmental Tobacco Smoke
Environmental
Tobacco Smoke
Role
Evidence Strength
OA Contributor
Strong
Research demonstrates environmental tobacco smoke (ETS) to increase the risk of asthma
(Eisner et al, 1998; Green et al, 2003; Henley, 1996; King et al, 2004; Jaakkola et al, 2003;
Niven & Pickering, 1999). A review of earlier research by Niven and Pickering (1999)
concluded that there was no convincing evidence/data to support an inducing effect of ETS on
asthma in adults, but warned that it was still unwise to continue exposure of employees to ETS.
A more recent large-scale case control study by Jaakkola et al (2003) concluded cumulative
exposure over a lifetime to be proportional to asthma risk.
Sick Building Syndrome
Sick
Syndrome
Building Role
Evidence Strength
OA Contributor
Strong
Sick Building Syndrome (SBS) is a phenomenon whereby employees experience a range of
symptoms when in specific buildings (Burge, 2004; Raw, 1992). Symptoms typically include
irritation of the eyes, nose, throat and skin, together with headache, lethargy, irritability and lack
of concentration (Burge, 2004; Chao et al, 2003; Henley, 1996; Mendelson et al, 2000; Raw,
1992; Runeson et al, 2003). Research implies a history of asthma as positively associated with
non-specific SBS. Asthmatics appear more sensitive to building environments and experience
SBS with more frequency than non-asthmatics (Chao et al, 2003; Henley, 1996; Mendelson et
al, 2000; Runeson et al, 2003). Indeed, Henley (1996) attributes SBS as a cause of OA, although
Mendelson et al (2000) implicate the moderating effect of work stressors. In their study,
employees experiencing higher levels of role conflict, role overload, organisational stress and
lower levels of organisational support predicted poor air quality reporting. Maintaining clean
and uncrowded environments and improved ventilation and humidity levels are included
amongst the controls recommended for SBS (Chao et al, 2003; Henley, 1996).
7.2.6
Soft Organisational: Attitudes and Support
7.2.6.1
Organisational Support:
Quantity: OA management
Support: Quantity – Role
OA management
Evidence Strength
OA Management Barrier
Strong
A broad body of generic research into asthma demonstrates supportive relationships as
predictive of improved asthma self-management (Creer & Levstek, 2001; Devereux et al, 2004;
Innes et al, 1998; Kolbe, 1999; Schmaling et al, 1998; Strutt & Bird, 2004; Uldry &
Leuenberger, 2000; Vamos & Kolbe, 1999; Wright et al, 1998). No direct work was uncovered
exploring the role that social support has in influencing the management of occupational
170
asthma, although it is perhaps safe to assume work-based support from line managers and peers
to facilitate the OA sufferer’s management of their condition.
Quantity: Non-Compliance
Support: Quantity – Role
non-compliance
Evidence Strength
OA Contributor
Moderate
Other occupational specific research addressing related conditions demonstrate non-compliant
workers exposed to carcinogens (De Vries & Lechner, 2000), or incurring injury (Gillen et al,
2002) to operate in less supportive environments.
Quality
Support: Quality
Role
Evidence Strength
OA Management
Moderate
Regardless of the quantity of support received, the quality of support appears a significant
determinant of successful asthma management (Gregerson, 2000; Krause & Lund, 2004;
Lahtinen et al, 2004; Shearn, 2005; Smyth et al, 1999; Wright et al, 1998). For example, support
that equates to ‘smothering’ can be disempowering and encourage over-dependency (Wright et
al, 1998). Krause and Lund’s (2004) generic review on return to work (RTW) programmes
implies appropriate co-worker cooperation, for example, in ensuring OA sufferers monitor their
symptoms, to benefit the rehabilitation process.
Source
Support: Source
Role
Evidence Strength
OA Contributor/ Management
Limited
As well as co-workers, literature from work-related upper limb disorders and blood borne
pathogens reflects support from line management and ‘informal peer leaders’ as necessary for
encouraging compliance and managing symptoms (Lymer & Isaksson, 2004; Weyman, 1997).
Stress Buffer
Stress buffer
Role
Evidence Strength
OA Management
Limited
Two descriptive reviews postulate that social support may moderate stress generated by asthma
symptoms by altering symptom and coping perceptions (Kolbe, 1999; Wright et al, 1998).
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7.2.6.2
Health and Safety Culture/Climate:
Consistency
Consistency
Role
Evidence Strength
OA Contributor
Limited
Inconsistent messages concerning the importance of occupational health, through failure to
consistently enforce examples of non-compliance or contradiction with performance messages,
can contribute to non-compliance (Gadd & Collins, 2002; Jackson, 2004; Lardner et al, 2000).
Management Commitment/Approach
Management
Commitment
Role
Evidence Strength
OA Contributor
Very Strong
A substantial body of evidence emphasises visible management commitment, particularly at the
senior executive level, as an essential pre-requisite for compliance and reduced risk-taking
behaviour (Alston et al, 1997; Collins, 2003; Creely et al, 2003; Fell-Carlson, 2004; Gadd &
Collins, 2002; Gershon et al, 2000; Lymer & Isaksson, 2004; Roy, 2003; Shearn, 2005; Sinclair
& Tetrick, 2004; Trainor et al, 1998; Weyman, 1999; Weyman & Anderson, 1996; Wright et al,
2005; Wright & Collins, 2002). Organisational signs of inadequate management commitment
to occupational health include:
•
•
•
•
•
•
•
Inappropriate work practices (Elms et al, 2004);
Underestimations of duration of RPE usage within the workforce (Alston et al, 1997)
Poor availability of health and safety training (Weyman & Milnes, 2001; Weyman &
Marlow, 2004);
Distrust in managerial health and safety competence (Weyman & Kelly, no date);
Tendency to take a reactive approach to health and safety issues (Brown & Rushton,
2003; Fell-Carson, 2004; Milnes, 2001; Robertson & Stewart, 2004; Roff et al, 2003;
Salazar et al, 2001; Strutt & Bird, 2004; Worsell et al, 2001).
Negative attitudes amongst staff towards health and safety (Garcia et al; 2004; Salazar et
al, 2001; Smith et al, 1989), and, ultimately
Outbreaks of asthma (Cullinan et al, 2003).
Examples of management behaviours that reflect a commitment to health and safety include
meeting employees frequently to discuss health and safety issues, responding quickly to safety
suggestions made by employees (Fleming & Lardner, 2002; Chappell, 1995), inclusion of
workers on health and safety committees (Carpentier-Roy et al, 1998), coaching employees who
commit ‘unsafe acts’ (Chappell et al, 1995), rapid uptake of risk assessments (Trainor et al,
2002) and demonstrating fairness and support (Hofmann & Moregeson, 2004; Neal & Griffin,
2004).
172
Worker Involvement
Worker Involvement
Role
Evidence Strength
OA Contributor
Very Strong
Involving operational staff in occupational health decisions is widely implicated as beneficial
for improving their awareness of health and safety issues (Shearn, 2005), motivating
compliance (Cutter & Jordan, 2004; Fell-Carlson, 2004) by offering workers a greater sense of
control over their environment (Jackson 2004; MacIntosh & Gough, 1998; Roy, 2003; Trainor,
Weyman & Anderson, 1998), and increasing worker acceptance of decisions (Inman et al,
2002). Through tapping into worker’s ‘local’ knowledge, their contribution to health and safety
decisions also improve the accuracy, viability, completeness, and effectiveness of risk
assessments and related decisions (Agner & Held, 2002; Chappell, 1995; Inman et al, 2002;
Mackmurdo, 2002; Neal & Griffin, 2004; Trainor, Weyman & Anderson, 1998; Weyman &
Kelly, no date). Their involvement should encompass planning, implementation and evaluation
(Gadd et al, 2000; Lahtinen et al, 2004; Trainor, Weyman & Anderson, 1998), and be
supplemented by trade union representation (Trainor et al, 2002).
Role Models
Role Models
Role
Evidence Strength
OA Contributor
Strong
Management “leading by example”, for instance, by always wearing appropriate PPE when in
exposure areas, is also widely documented as an aspect of health and safety culture that
reinforces behavioural compliance (Brown & Rushton, 2003; Collins, 2003; Fell-Carlson, 2004;
Hughson et al, 2002; Vaughan, 2005; Williams, 1997).
Conflicting Priorities – productivity
Conflicting priorities - Role
productivity
Evidence Strength
OA Contributor
Very Strong
According to Bradshaw et al (2005); Brown and Rushton (2003); Elms et al (2003); Gadd and
Collins (2002); Hughson et al (2002); Osborne (2003); Trainor, Weyman and Anderson (1998);
Weyman (1998); and White and Benjamin (2003) health and safety requirements are often
perceived by employers and employees to conflict with productivity objectives. As a result,
performance targets are therefore prioritised over health and safety concerns, through, for
example, rushing and taking risks in order to meet deadlines or orders.
Conflicting Priorities - safety
Conflicting priorities - Role
safety
Evidence Strength
OA Contributor
Moderate
Occupational health appears to take second place behind safety in many organisations
(Bradshaw et al, 2001; Brosseau et al, 2002; Pilkington et al, 2002; Strutt & Bird, 2004), and
can be seen by employers more as a financial burden rather than benefit (Pilkington et al, 2002).
This is likely to be reinforced due to the intangible and often latent nature of health threats,
173
which would explain why health conditions with larger latency intervals are allocated still less
importance (Bradshaw et al, 2005).
Peer-Management Discrepancy
Peer-Management
Discrepancy
Role
Evidence Strength
OA Contributor
Strong
A shared perception between management and staff concerning the importance of health and
safety is regarded within the literature as a sign of a positive health and safety climate
(Harbison, no date). This underscores the need for any behavioural intervention targeting
‘asthmagenic’ organisations to take separate opinions of staff and management (Brown &
Rushton, 2003; Hughson et al, 2002).
Organisational Size
Organisational
size Role
and safety climate
Evidence Strength
OA Contributor
Limited
Mixed evidence emerged for the relationship between organisational size and health and safety
climate ratings. Smaller organisations have produced higher health and safety climate scores
within the chemical industry (Weyman & Marlow, 2004) and offshore (Weyman & Milnes,
2001) but, elsewhere have been evaluated to produce significantly lower scores than larger
organisations (Garcia et al, 2004). Smaller organisations cannot therefore be assumed to possess
poorer attitudes to occupational health.
Training
Training
Role
Evidence Strength
OA Contributor
Moderate
Perceptions of safety climate have been found to be more positive amongst staff where they
have received health and safety training (Weyman & Marlow, 2004; Weyman & Milnes, 2001).
Improvement Need
Improvement Need
Role
Evidence Strength
OA contributor
Moderate
General improvements in health and safety culture were called for within seven papers (Dejoy et
al, 2000; Fishwick & Curran, 1999; O'Hara & Elms, 2004; Robertson & Stewart, 2004; Shearn,
2005; Weyman & Anderson, 1996; Wright & Collins, 2002). These included health care (Dejoy
et al, 2000; O'Hara & Elms, 2004), technology (Shearn, 2005) and mining settings (Wright &
Collins, 2002). Specific improvements that were called for included a greater engraining of risk
assessment principles within the safety culture (O'Hara & Elms, 2004), more open
communication and freedom to talk (Fishwick & Curran, 1999), and providing an appropriate
number of procedures and rules that can be more readily followed (Weyman & Anderson,
1996).
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Under-Reporting
Under-Reporting
Role
Evidence Strength
OA contributor
Strong
Occupational disease in general, and occupational asthma in particular, is acknowledged within
the literature as widely under-reported (BOHRF, 2004; Cutter & Jordan, 2004; Leffler &
Milton, 1999; Lymer & Isaksson, 2004; Trainor et al, 2002; Trim et al, 2003). Tendency to
under-report could be regarded as a symptom of poor health and safety cultures.
Reputation
Reputation
Role
Evidence Strength
OA contributor
Weak
A review of safety culture by Gadd and Collins (2002) identified fear of loss of company
reputation as the main factor motivating companies to initiate health and safety improvements.
Blame Culture
Blame Culture
Role
Evidence Strength
OA contributor
Limited
Tendency to underreport safety accidents and incidents, and by implication occupational
disease, has been documented within organisational cultures in which a blame culture prevails.
As a result management may become out of touch with the extent of exposure to occupational
health hazards arising within their workforce (Gadd & Collins, 2002; Harbison, no date;
Weyman et al, 1999).
Learning Culture
Learning Culture
Role
Evidence Strength
OA contributor
Weak
Possession of an organisation learning culture is seen as key to the development of an effective
health and safety culture. Features of a poor learning culture included failure to use new
information, failure to change behaviour in the light of experience, poor organisational memory,
poor uncoordinated responses to error, omission of health and safety checks, and failure to share
knowledge (Harbison, no date).
Macho Culture
Macho Culture
Role
Evidence Strength
OA contributor
Strong
Intuitively, dominance of a macho culture can be construed as a potential compliance barrier
through staff avoiding work practices that reflect ‘vulnerability’ such as wearing PPE. A study
of glove use amongst bakers found instructors to make fun of apprentices for wearing gloves
during wet working and cleaning (Bauer et al, 2002).
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Subcultures
Role
Evidence Strength
Subcultures
OA contributor
Moderate
Behavioural change interventions will need to take into account that ‘sub-cultures’ can operate
within different layers of the organisational hierarchy, and between teams and units, particularly
within larger organisations comprising a number of branches (Cheyne et al, 2003; Smit &
Schabracq, 1998).
Job Tenure
Role
Evidence Strength
Job Tenure
OA contributor
Moderate
Evidence for role of job tenure on exposure risk appears more mixed. Compliance with
universal precautions within doctors has been found more common amongst younger doctors
than those with over 20 years of experience (Cutter & Jordan, 2004). Elsewhere, accident risk
has been judged highest amongst employees with less than 1 year in post (Salminen et al, 1997).
Cooper et al (1993) found job tenure and negative safety climate perceptions as inversely related
within workers of a cellophane manufacturer.
Experience
Role
Evidence Strength
Experience
OA contributor
Limited
In Cooper et al’s (1993) study, workers who had sustained some form of injury within the
previous five years also rated safety climate as more negative.
Union Involvement
Union involvement
Role
Evidence Strength
OA contributor
Limited
Two studies from within the construction (Gillen et al, 2002) and manufacturing industry
sectors (MacIntosh & Gough, 1998) reveal a significant positive correlation between safety
climate scores and union status.
7.2.6.3
Organisational Norms:
Peer pressure
Peer Pressure
Role
Evidence Strength
OA contributor
Strong
Peer pressure, or the attitudes colleagues convey towards compliance, appears to be a powerful
determinant of compliance behaviour, particularly in relation to wearing PPE (De Vries &
Lechner, 2000; Fell-Carlson, 2004; Hughson et al, 2002; Roy, 2003; Salazar et al, 2001;
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Weyman, 1999; Weyman & Kelly, no date; Weyman, 1998; White et al, 1988; Wong et al,
2005). The influence of peers was found to be the most significant predictor of PPE usage from
a survey of behavioural compliance predictors amongst Dutch employees exposed to
carcinogenic hazards (De Vries & Lechner, 2000).
Frames of Reference
Frame of Reference
Role
Evidence Strength
OA contributor
Moderate
Similar to peer pressure, group norms, refers to social expectations within teams or
organisations about the type and extent of compliance behaviours that should be adopted by its
members. Such norms have been described as acting as reference points that employees used to
guide their risk taking behaviour (Godin et al, 2000; Trainor, Weyman & Anderson, 1998;
Weyman et al, 1999).
7.2.7
Soft Organisational: Communication
7.2.7.1
Training:
Training Aids
Training Aids
Role
Evidence Strength
OA contributor
Weak
Information generated by the video monitoring technique has been recommended as providing a
powerful educational and training tool on risk assessments and good or bad work practices for
workers, managers and health and safety practitioners (Walsh et al, 2002).
Training Delivery/Timing
Training
Delivery/Timing
Role
Evidence Strength
OA contributor
Strong
According to Brown and Rushton (2003) and Pilkington (2002), health and safety related
training should be conducted at the induction stage and repeated on a regular basis. To optimise
learning, there appears to be consensus within the literature that training should comprise
multiple media formats to encourage behavioural change (Coppieters et al, 2003; McGhan et al,
2005; Wallen & Mulloy, 2005), for example, by utilising individual and group sessions,
handouts and booklets, websites, electronic learning packages, and combine text with pictorial
information. It should also be interactive, comprise practical elements (Benjamin et al, 2002,
Llewellyn et al, no date), and be provided by a trusted, credible and expert source (Creely et al,
2003, Wong et al, 2005), ideally on a face-to-face basis (Robertson & Stewart, 2004).
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Risk Assessment
Risk Assessment
Role
Evidence Strength
OA contributor
Strong
Improved training in risk assessment was called for within 10 papers (De Vries & Lechner,
2000; Fell-Carlson, 2004; Hughson et al, 2002; Roy, 2003; Salazar et al, 2001; Weyman &
Kelly, no date; Weyman, 1999; Weyman, 1998; White et al, 1988; Wong et al, 2005), including
workers exposed to glutaraldehyde (Anonymous, 2002), isocyanates (Chambers, Sandys &
Piney, 2005) and welding fumes (Howe & Simpson, 2005).
Controls / PPE and RPE
Controls/PPE & RPE
Role
Evidence Strength
OA contributor
Strong
Calls for improved training in PPE/RPE and control usage was cited by 9 studies (Alston et al,
1997; Binks, 2003; Bresnitz et al, 2004; Brown, 2004; Dejoy et al, 2000; Dilworth, 2000;
Lincoln et al, 2002; Packham, 2002; Pengelly et al, 1998) and applies to managers as well as
operational staff (Alston et al, 1997). According to Pengelly et al (1998) such training should
encompass design, positioning and maintenance of local exhaust ventilation (LEV). PPE
training should not overlook simple highly specific behavioural procedures, such as removal of
gloves (Packham, 2002). PPE training may have secondary benefits beyond actually reducing
exposure. It may also enhance employee’s perceptions of their employer’s ability to protect their
health (Dejoy et al, 2000).
Organisation size
Organisation Size
Role
Evidence Strength
OA contributor
Moderate
Occupational health related training appears to be less prevalent amongst smaller organisations
(Bradshaw et al, 2001; O'Hara & Dickety, 2000; Worsell et al, 2001), although this cannot be
regarded as a universal rule. A survey by Bradshaw et al (2001) revealed 17.9% of 28 small and
medium sized enterprises to provide occupational health training. On-the-job training in
compliance provided by more experienced staff, irrespective of their training competency,
appears more common place amongst smaller companies. A survey of the availability, quality
and standards of training for 59 woodworking operators and supervisors found supervisory
training as varied or absent (Worsell et al, 2001).
Sectors
Specific sectors or job types within which improved occupational health related training was
recommended included young farmers (Llewellyn et al, no date), bakeries (Elms et al, 2004)
and the rubber industry (Collins, 2003).
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Management
Management
Role
Evidence Strength
OA contributor
Limited
Three articles identify management training in health and safety as wanting (Gadd & Collins,
2002; Hofmann & Morgeson, 2004; Neal & Griffin, 2004). Neal and Griffin (2004) describe
management training in feedback and goal setting techniques as reducing health and safety
incidents.
Training Benefits
Training benefits
Role
Evidence Strength
OA contributor
Moderate
Provision of health and safety training can raise employee commitment (Gadd & Collins, 2002);
employee’s perceptions of the prevailing safety climate (Weyman & Marlow, 2004; Weyman &
Milnes, 2001); frequency of PPE usage (Avory & Coggon, 1994); and reduce exposure
incidents (Gershon et al, 2000).
Schooling/Vocational Training
Schooling/Vocational
Training
Role
Evidence Strength
OA contributor
Moderate
Preliminary signs of asthma have been found in trainees undertaking vocational training for
high asthma risk industries. For example, a survey by Coppieters and Piette (2004) reveals
12.6% of baker trainees and 14.1% of hairdresser trainees to manifest clinical signs of OA.
Likewise, within bakeries, Walusiak et al (2002) found the rate of positive skin prick tests for at
least one allergen to increase from 17.9% to 24.4% after one year of vocational training. Such
findings have given rise to calls for increased health and safety training within training colleges
and indeed schools. However, a series of 7 case studies of risk education within schools,
conducted by Weyman and Shearn (2004), identified awareness and understanding of the need
to teach young people about risk assessment and controls as low or effectively absent.
Conversely, a review by Brown (2004) describes health education during apprenticeship or
initial training to be an effective tool in primary, secondary and tertiary intervention.
7.2.7.2
Risk Communication:
Accessibility
Accessibility
Role
Evidence Strength
OA contributor
Moderate
Worker isolation, as encountered in farming (Llewellyn et al, no date), woodworking (Dilworth,
2000), and photography (Rosenthal & Forst, 2001), is recognised as thwarting access to risk
communication. So too does widely spread employees or hierarchical organisation structure,
with accurate risk information failing to cascade to all employees or down from management to
shop floor staff (Lardner et al, 2000; O'Hara & Dickety, 2000). Even where provided, written
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risk communication, particularly safety data sheets, can often be ignored or read as a one-off.
Postal information is seen as ‘junk’ (Alston et al, 1997; Avory & Coggon, 1994; Strutt & Bird,
2004). Three case studies investigating the extent of adoption of risk assessment within UK
industry revealed companies as unaware of the HSE info line (Trainor et al, 2002).
Need
Role
Evidence Strength
Need
OA contributor
Very Strong
Thirteen studies highlighted a need for improved risk communication, not just between
organisational layers, but also between co-workers (Bradshaw et al, 2001; Chambers, Sandys &
Piney, 2005; Dejoy et al, 2000; Gadd et al, 2000; Hughson et al, 2002; Lahtinen et al, 2004;
Levin et al, 2000; Pilkington et al, 2002; Reijula, 1997; Rosen et al, 2005; Shearn, 2005;
Weyman & Kelly, no date; Worsell et al, 2001). Bradshaw et al’s (2001) survey of occupational
health perceptions with 28 small and medium sized organisations found only 28.5% provided
leaflets/posters and only 14.2% had provided speakers or videos on health issues at work.
Chambers et al (2005) recommend that paint sprayers should communicate with each other
regarding what stage of clearance the booth is at to ensure people enter safely. Translation of
risk communication into a form that is easily digested by front line staff is strongly advocated
(Gadd et al, 2000). Shearn (2005) also calls for direct encouragement of informal
communication networks as a channel for promoting risk awareness.
Solutions (multi-faceted)
Solutions
Role
Evidence Strength
OA contributor
Strong
Communication process theory stipulates the success of risk communication as dependant on
the sender characteristics, receiver characteristics, and ensuring the message is matched to
receiver’s needs, is based on scientific knowledge, and takes account of how people interpret
information according to text structure, realities of the risk environment and basic understanding
of exposure and effects (Weyman & Kelly, no date). Weyman and Kelly (no date) advise that
risk communication should not highlight or marginalize particular groups as this may cause the
wider public to perceive less risk to themselves. Message reinforcement has also been
highlighted as important for ensuring sustained change (Creely et al, 2003; Hughson et al,
2002), and is exemplified in Kolbe’s (1999) advice that risk communication needs to comply
with the 4 Rs: relevance, realistic, readily available, reinforced. Proposed mechanisms for
improving risk communication include VEM (Rosen et al, 2005; Walsh et al, 2002) and Safety
and Health Awareness Days (SHADs). O’Hara’s (2005) evaluation of an MVR SHAD found it:
•
•
•
Raised knowledge of the use of effective control measures (e.g. knowing how to check
if spray booth extraction is working increased from 29 to 68%)
Raised levels of awareness of hazards and risk control measures (e.g. 92% said the
event improved awareness of health risks)
Decreased levels of confidence that employers were not meeting H&S regulations (from
70% to 59%), indicating improved awareness of regulations, controls etc.
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Consistency
Consistency
Role
Evidence Strength
OA contributor
Moderate
Inconsistency in the health messages conveyed by management has been identified as an
exposure risk factor (Covello, 1997; Robertson & Stewart, 2004; Trainor, Weyman &
Anderson, 1998). Covello et al (1997) add that new information is only perceived as reliable if
it conforms to pre-existing beliefs.
Preferences
Preferences
Role
Evidence Strength
OA contributor
Moderate
Word-of-mouth appears to be the preferred source of risk communication within small
organisations (O’Hara & Dickety, 2000; Robertson & Stewart, 2004; Strutt & Bird, 2004).
Equally, it also appears the least trusted (Robertson & Stewart, 2004; Strutt & Bird, 2004).
Llewellyn et al’s (no date) survey of communication preferences amongst farmers found the
majority (88%) felt it was important to use a range of methods for conveying health and safety
information. Smaller organisations may also perceive written communication as less applicable
to themselves, due to their being too onerous to implement (O Hara & Dickety, 2000).
Media/Delivery
Media/Delivery
Role
Evidence Strength
OA contributor
Moderate
The medium by which risk communication is delivered is regarded as an important component
of risk communication (Sadhra et al, 2002). According to the literature, knowledge of risk no
longer appears restricted to experience and communication. Instead it is increasingly gained
from the mass media (Covello, 1997; Lymer & Isaksson, 2004). The powerful effect exerted by
the mass media is not without its pitfalls. Through ‘dramatising risks’ that have ‘story’ value, it
can give rise to public overestimation of the risks portrayed, reinforce perceptions that risks
apply to others, and engender distrust in the reliability of information provided (Covello et al,
1997). As emphasised by Vaughan (2005), the only time PPE users see PPE used is on the
television, and often these prove to be poor examples.
Relevance
Relevance
Role
Evidence Strength
OA contributor
Moderate
Risk communication that is perceived as personally relevant is likely to be the most persuasive
(Covello, 1997; Lardner et al, 2000). Making it as sector-specific and prescriptive as possible is
suggested in order to stimulate behavioural change (Gadd et al, 2000; Lardner et al, 2000;
Llewellyn et al, no date; Pilkington et al, 2002; Strutt & Bird, 2004; Trainor et al, 2002;
Weyman et al, 1999).
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Company size
Company size
Role
Evidence Strength
OA contributor
Limited
A survey by Hughson et al (2002) of noise risk communication amongst 19 companies found
larger companies (81%) as most likely to have received information, followed by small (50%)
and medium (44%) companies. No other studies were found evaluating risk communication
extent by organisation size.
Usability
Usability
Role
Evidence Strength
OA contributor
Very Strong
Risk communication that is expressed in simple, concise terms, that utilises pictures and graphs
as well as text, that avoids technical jargon, that avoids quantitative probability risk statements,
and that is legible, visible and short is more likely to be applied (Brown & Rushton, 2003;
Creely et al, 2003; Covello, 1997; Levin et al, 2002; Weyman et al, 1999; Wright & Collins,
2002). Safety data sheets (SDS) have been criticised for being too technical, too complex, too
generic and therefore difficult to translate to the worker’s context (Binks, 2003, Bresnitz et al,
2004; Chambers, Weyman & Keen, 2002; Packham, 2002; O’Hara & Dickety, 2000; Sadhra et
al, 2000). Consequently they are open to misinterpretation (Rabatin & Cowl, 2001; White &
Benjamin, 2003) and can force reliance on verbal communication (O’Hara & Dickety, 2000).
Likewise, labels can obstruct risk communication through being too small, positioned in less
obvious locations, for example, on the back of a tin, and using the chemical name that workers
may not understand (Chambers, Sandys & Piney, 2005; Noiesen et al, 2004). The problems this
can produce range from being unable to recognise chemical names to doubting the accuracy of
the ingredient labelling (Noiesen et al, 2004).
Source
Source
Role
Evidence Strength
OA contributor
Strong
HSE does not appear to be the main source of health and safety information, particularly for
smaller companies (Chambers, Weyman & Keen, 2002; Jackson, 2004; O'Hara & Dickety,
2000; Pilkington et al, 2002; Trainor et al, 2002; Weyman & Kelly, no date). Instead, informal
or accessible networks tend to be used, such as suppliers, or commercial mail shots. In such
instances source choice is therefore geared towards saliency and familiarity rather than the
accuracy (Chambers, Weyman & Keen, 2002).
Credibility
Credibility
Role
Evidence Strength
OA contributor
Moderate
The credibility, or trustworthiness, of the risk communication source appears pivotal in
engaging the target audience (Covello, 1997; Jensen & Kofoed, 2002; Sadhra et al, 2002;
Weyman et al, 1999). According to Covello (1997), numerous studies have found that scientists
182
and officials in industry and government often lack trust and credibility, based on beliefs that
they are insensitive to public concerns and perceptions, unwilling to acknowledge problems,
share information or allow meaningful public participation, and lack skills needed to
communicate effectively. Covello (1997) advises that trust and credibility can be obtained by
stating credentials, disclosing information as soon as possible, avoiding minimising or
exaggerating the risk, sharing information, discussing uncertainties and weaknesses, and by coordinating and collaborating with other credible sources.
Audience
Role
Evidence Strength
Audience
OA contributor
Limited
Tailoring risk communication to audience needs is also considered crucial to message
acceptance, and requires audience involvement in the development of a tailored message
(Covello, 1997; Sadhra et al, 2002). Note that the limited evidence base assigned to this theme
stems from its basis on mainly expert opinion.
7.2.8
Soft Organisational: Work Patterns
7.2.8.1
Shift Patterns:
Shift Patterns
Role
Evidence Strength
OA contributor
Moderate
It is important to remain vigilant to any impact work pattern changes can have on exposure
(Devereux et al, 2004; Godin et al, 2000; Kenny, 2002). For example increasing working hours
can lead to concern of increasing cumulative exposures (Kenny, 2002).
7.2.8.2
Resistance
Resistance:
Role
Evidence Strength
OA contributor
Limited
Any change implicated by a risk assessment may meet resistance within the workforce due to
lack of time to implement changes and natural preferences to adhere to the status quo (Roelofs
et al, 2003; Trainor et al, 2002).
7.2.9
Hard Organisational Factors
7.2.9.1
General Interventions:
The following factors represent barriers that might undermine the effectiveness of evaluating
OA interventions. They do not represent OA barriers per se.
Evaluation
According to Roelofs et al (2003), occupational health interventions are under-evaluated, or
evaluated using questionable methodology.
183
Healthy worker effect
Longitudinal evaluations of interventions will need to take into account attrition bias created by
healthy worker effects, in so far that OA sufferers with more severe symptoms may be forced to
leave work. Follow-up assessments may therefore be skewed towards OA sufferers with less
severe symptoms (Brooks, 1995; Eisen et al, 1997; Oliver et al, 2001; O'Neill, 1995; Redlich et
al, 2002).
HSE Targets
A critique of HSE’s approach to OA states that prevention should not target the main causes on
the premise that all reasonable efforts will have already been undertaken to address them (Sim,
2003). Rather, Sim (2003) advocates directing resources at less common causes in order to
reduce prevalence rates.
Exposure Complexity
Exposure to multiple OA sensitisers or irritants may also undermine intervention evaluations
(Brown & Rushton, 2003).
Practicality
The practical issues implicated by implementing an intervention can present a powerful
disincentive. Only one document was found citing this (Llewellyn et al, no date). Intuitively,
this must represent a common problem.
Efficacy
Self-report measures from cross-sectional evaluations of educational interventions aimed at
improving compliance with hearing protection (Hughson et al, 2002) or universal precautions
with blood and body fluid exposure (Cutter & Jordan; 2004; Kim et al, 2001) tends to
demonstrate immediate improvement in hazard and control awareness. However, evidence for
translation of such awareness into practice appears to be less consistent (Agner & Held, 2002;
Cutter & Jordan, 2004). For example, Cutter and Jordan’s (2004) study still found high levels of
non-compliance amongst US health care workers despite their participation in an educational
programme. Just over 63% admitted to basing their compliance judgements on factors other
than that learnt on the program. What these other factors might be, they do not expand on.
Aimed at 280 managers and operators, Hughson et al’s (2002) study concluded, from their
hearing protection intervention, that the training conditions necessary for behaviour is
contingent on:
•
•
•
•
•
•
•
•
•
•
The creation of habitual behaviour (e.g. PPE always worn regardless of
exposure levels)
Provision of task specific positive reinforcement by managers to encourage
sustained changes (Creely et al, 2003)
Management acting as good role models
Positive peer pressure in favour of compliance
Conveying the health effects of non-compliance
Multi-media training
Case examples in order to make the training content more meaningful
Employee involvement (e.g. in choice of PPE)
Refresher courses
Tool-box training.
Lardner et al (2000) warn that ‘off-the-shelf’, as opposed to tailored, training will have limited
effectiveness due to it not accommodating training needs. They also advise that behavioural
interventions undertaken in organisations where blame cultures prevail, will have limited
184
effectiveness due to them being perceived as part of that blame culture. They also suggest that
any organisational intervention pitched at widespread behavioural change must avoid creating
the expectation of short-term results. A review of safety-based behavioural change
modifications by Lardner et al (2000) emphasises behavioural transformations as having longterm projections.
The timing of health education training may be important. Health education undertaken during
apprenticeship or initial training has been shown to be an effective tool in primary, secondary
and tertiary prevention (Brown, 2004). Interventions in which educational training is integrated
into a wider prevention package, appear more effective. For example, Proctor and Gambles
Industrial Hygiene programme comprising improved engineering controls, product
reformulations, exposure limits, air monitoring, as well as employee education/training yielded
a statistically significant drop in the number of sensitised workers and rate of sensitisation
(Schweigert et al, 2000). A retrospective survey of latex-related asthma claim cases and
interventions conducted in Ontario, Canada, found that increasing recognition of latex asthma,
introducing gloves with reduced powder, as well as other latex exposure reduction interventions
such as education and voluntary medical surveillance, was temporally associated with declines
in the number of cases of latex OA and possibly declines in the prevalence of sensitisation to
latex (Liss & Tarlo, 1998). Although aimed at safety rather than occupational health, Hopkins
(1998) describes the potential value of proactive inspector involvement in intervention design
within Australian companies. Through seeking employers and worker cooperation, conducting
a safety audit, drawing up action plans with employers, and conducting site visits once a month,
employers began spending approximately a million dollars on safety measures and the success
of the programme showed a reduction in annual accidents by 80% and accident rate by nearly
90%. No other evaluations of proactive inspector involvement were found. The heterogeneous
nature of these studies renders weighting their collective effectiveness somewhat meaningless.
7.2.9.2
Primary Interventions:
The following barriers apply to interventions intended to prevent exposure.
Screening
Avoid Screening
Role
Evidence Strength
OA prevention barrier
Very Strong
Screening criteria pitched at identifying atopic or sensitised employees are regarded as too
poorly discriminating to provide a sound or ethical basis for dismissal or employment
(Anonymous, 2001; Baur et al, 1998; BOHRF, 2004; BOHRF, 2005; Boorman, 2004; Brooks,
1995; Brown & Rushton, 2003; Douglas, 2005; Evans, 1996; Hendrick, 1994; Niven &
Pickering, 1999; O'Neill, 1995; Schweigert et al, 2000; Tarlo & Liss, 2001).
Recruitment
H&S in recruitment
Role
Evidence Strength
OA prevention barrier
Weak
One study described providing information on health and safety expectations at the time of hire
and recruitment, for example, within job descriptions, as effective for improving compliance
(Fell-Carlson, 2004).
185
Familiarity barrier / Preference for engineering
Familiarity/Preference
for engineering
Role
Evidence Strength
OA prevention barrier
Weak
Occupational hygienists and employers are purported to prefer engineering solutions over
removing the hazard because they are more familiar and part of occupational hygiene training
(Roelofs et al, 2003).
Substitution barriers
Substitution
Role
Evidence Strength
OA prevention barrier
Moderate
Technical and cost concerns appear more powerful in determining substitution choices rather
than risk control (Chambers, Weyman & Keen, 2002; Elms et al, 2004; O'Neill, 1995). For
example, a survey of manager attitudes to substitution amongst 55 bakeries found that 59% of
companies reported that they would consider changing to liquid/paste formula, but envisaged
that there would be technical and cost barriers with this substitution (Elms et al, 2004). O’Neill
(1995) claims that shifts to safer substances and processes are rare.
Incentive/Rewarding Schemes
Reward Schemes
Role
Evidence Strength
OA prevention barrier
Limited
A prospective psychosocial survey of 3139 employees at risk of stress and MSDs identified
failure to reward compliant behaviour to be associated with greater reporting of MSDs
(Devereux et al, 2004). In this context rewards can refer to feedback, monetary incentive, or
social recognition schemes intended to motivate compliant behaviour. Their effectiveness
appears to have been evaluated in the context of health as opposed to safety, and has produced
mixed findings. Bonus based or outcomes based incentive schemes that reward absence of
incidence appear to be unpopular amongst workers and managers (Sinclair & Tetrick, 2004;
Weyman, 1998). Workers who do not receive outcome contingent pay rewards may blame
external causes for the non-compliance rather than re-evaluate their own behaviour, perceive
bonuses as a threat to their guaranteed income, construe them to reinforce a blame culture, and
become competitive with workers belonging to other teams so creating a "we versus them"
mentality. As a result, injury and outcome-based incentives may lead to under-reporting of
illnesses and injuries and "presenteeism" amongst workers who should be off sick. This may
stem from workers not wanting to be blamed for affecting the compensation received by their
team by their peers or management (Fell-Carlson, 2004; Sinclair & Tetrick, 2004; Weyman,
1998). Reward schemes that target teams can also fail to motivate because they make it more
difficult for individuals to isolate their relative role in a success (Weyman, 1999). Schemes
based on withdrawing rewards following an incident are less likely to work than those that
positively reinforce desirable behaviour (Weyman, 1999). A survey of 329 aluminium workers
concluded safety incentive programs to be effective and receive more positive reactions when
they are implemented in settings with positive supervisor-subordinate relationships, good
organisational support and within interdependent teams that share safety norms (Haines et al,
2001). Using financial and social rewards in combination with feedback, rather than in isolation,
can, according to Fell-Carlson (2004), produce a ‘synergistic’ (Stajkovic, 2003, cited in FellCarlson, 2004), or multiplicative effect on performance. This meta-analytic review found
behavioural change as 26.8 times more likely when feedback was added to a system of
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monetary reward and recognition. Likewise, a review by Hofmann and Morgeson (2004)
described that supervisors who actively monitor and reward safety workers performance
encourage more widespread safety related behaviour amongst workers.
Performance schemes that reward operational performance at the exclusion of health and safety
considerations are detrimental to health and safety. For example, rewarding ‘piece work’
encourages workers to take safety short cuts in order to complete a job in a shorter time than
allocated (Chambers, Sandy & Piney, 2005).
7.2.9.3
Secondary Interventions:
The following barriers concern interventions intended to manage exposure.
Exposure limits
Exposure Limits
Role
Evidence Strength
OA prevention/management barrier
Limited
Between individual variations in the asthmagen exposure level necessary for creating
sensitisation has provided long-standing difficulties in setting and reinforcing exposure limits
(Cullinan et al, 2003; Dedhia et al, 2000). Curran and Fishwick (2003) describe them as largely
ineffective within SMEs. Dilworth’s (2000) wood dust survey found 66% of 47 sites to exceed
the maximum exposure limit (MEL). Employers have been documented as finding the former
Occupational Exposure Standard (OES) system as difficult to understand, and insufficiently
comprehensive (Topping, 2001). This theme is allocated a limited weighting due to its basis on
descriptive reviews.
SWORD
SWORD
Role
Evidence Strength
OA prevention/management barrier
Limited
Factors undermining the reliability of the UK’s Survey of Work and Occupational Respiratory
Disease (SWORD) scheme as an indicator of OA prevalence include its exclusion of primary
care data, reliance on the motivation to report by specialist physicians, and limited awareness of
OA as a condition (Baur et al, 1998; Burge, 1997; Curran & Fishwick, 2003; Davidson, 1996;
De Bono & Hudsmith, 1999; Evans, 1996; Hendrick, 1994; O'Neill, 1995). This theme is
allocated a limited weighting due to its basis on expert opinion.
Health Surveillance
Health surveillance
Role
Evidence Strength
OA prevention/management barrier
Very Strong
According to BOHRF’s (2005) systematic review, health surveillance enables detection of
disease at an earlier stage and provides improved prognostic outcome for workers included in
health surveillance programmes (Baur et al, 1998; BOHRF, 2005; BOHRF, 2004; Bradshaw et
al, 2005; Bradshaw et al, 2001; Bresnitz et al, 2004; Brown & Rushton, 2003; Cullinan et al,
2003; Dilworth, 2000; Fishwick et al, 2003; Innes et al, 1998; Jeffrey et al, 1999; Merget et al,
2001; Murphy et al, 2002; Sim, 2003; Smith, 2004; Tarlo & Liss, 2002; Tarlo et al, 2002; Tarlo
& Liss, 2001). An evaluation of an in-house health surveillance programme (Smith, 2004)
demonstrates preventative benefits, for example, an overall reduction in the incidence of new
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cases of symptomatic sensitisation from 2085 per million employees per year in the first 5 years
of the surveillance programme to 405 in the subsequent 5 years. Baur et al (1998) states that
surveillance programmes should be mandatory for workplaces with a high asthma incidence
(more than 200% than that of the general population). Health surveillance availability appears
patchy. Bradshaw et al’s (2001) survey of surveillance provision in 29 SMEs found a small
percentage of health surveillance tests (e.g. lung function testing, dust monitoring, periodic
health checks only by 14.2%; COSHH assessments/risk assessments only by 32%; and allergy
surveillance only by 10.7%).
Over-reliance
Over-reliance
Role
Evidence Strength
OA prevention/management barrier
Weak
Sarlo (2003) describes a general over-reliance on secondary controls.
Worker Compliance
Worker-compliance
Role
Evidence Strength
OA prevention/management barrier
Moderate
Four studies describe secondary interventions as unreliable due to their reliance on worker
compliance, for example in wearing PPE (Bresnitz et al, 2004; Cutter & Jordan, 2004; Roelofs
et al, 2003; Trim et al, 2003).
Biomarker feedback
Biomarker feedback
Role
Evidence Strength
OA prevention/management barrier
Weak
Two case studies by Jones (2004) demonstrate how feeding individuals’ biomarker results to
individuals as evidence of their exposure can force improvement in work practices and change
behaviour. Wider evaluation of the potential value of biomarker feedback as a behavioural
change mechanism is needed.
7.2.9.4
Tertiary Interventions:
The following barriers relate to interventions intended to treat or manage exposure outcomes.
Redeployment
Redeployment
Role
Evidence Strength
OA management barrier
Strong
Difficulty in finding redeployment options that either removes or reduces exposure to
acceptable levels is widely reported (Adisesh et al, 2002; BOHRF, 2005; BOHRF, 2004;
Conner, 2002; Curran & Fishwick, 2003; Marabini et al, 2003; Soyseth et al, 1995; Tarlo et al,
1997; Vaughan, 2005). Larger employers with multiple sites appear to encounter fewer
problems (Conner, 2002).
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Return to work
Return to work
Role
Evidence Strength
OA management barrier
Strong
Evaluations of US case management based return to work (RTW) programs demonstrate them
as effective in improving communication between case managers and physicians and reducing
claims frequency (Bernacki & Guidera, 1998; Lincoln et al, 2002). Training in semi-structured
interviewing, problem solving techniques, self-report ergonomic assessment, and worksite
ergonomic assessment has been found to improve case management effectiveness. General
return to work programs that encompass light duty assignment, reduced hours and modified
equipment have all have been found significant and independent predictors of successful RTW
(Krause & Lund, 2004; Green-Mckenzie et al, 2002; Nathell, 2005). In particular, equipment
modification can double RTW rates and cut lost workdays in half (Krause & Lund, 2004).
However, Curran and Fishwick (2003) state there to be little financial support for return to work
programs for OA suffers. Barriers that can hamper return to work include high physical
demands; low worker control; long working hours; high psychological demands; monotonous
work; low skill discretion; high job stress; low support; job dissatisfaction; and low job
seniority. Other potential barriers to RTW could include advancing age; weak job protection and
problematic relations and communications with employer and other employees. Fear of job loss
and financial strain can promote RTW before the worker is ready (Krause & Lund, 2004).
Retraining
Retraining
Role
Evidence Strength
OA management barrier
Strong
Earlier initiation of vocational training can substantially reduce the extent of occupational
disability created by OA (BOHRF, 2005; Harber, 1996).
Rehabilitation Techniques
Rehabilitation
Techniques
Role
Evidence Strength
OA management barrier
Limited
Counselling and cognitive-behavioural techniques, such as written exercises, stress
management, cognitive challenging, relaxation exercises, EMG biofeedback, yoga, and
hypnosis appear to be beneficial in improving health outcomes for asthmatics (Bucknall et al,
1999; Kamal & Miller, 2004; Petrie et al, 2003; Schmaling et al, 2003). However heterogeneity
of outcome measures, contamination between intervention techniques and difficulties in
recruiting sufficient participants makes it difficult to systematically evaluate their relative
effectiveness (Fleming et al, 2003).
189
Asthma Management Programmes
Asthma education
Written action plans
Role
Evidence Strength
Role
Evidence Strength
OA management barrier
Strong
OA management barrier
Strong
Asthma education programs appear dogged by compliance problems (see section 1.1.3.2). More
successful ones include a worksite asthma management programme undertaken in a US bank
(Burton et al, 2004). Asthmatic employees underwent five hourly sessions run by a nurse
specialist covering:
•
•
•
•
Understanding asthma (trigger recognition, warning signs of impending
attacks),
Getting the most from medication (use and care of equipment, peak flow
meters, nebulizers, metered dose inhalers),
Asthma triggers,
Asthma monitoring and management (e.g. keeping asthma diaries).
This produced significant improvements at 12 months in asthma related sickness absence,
nocturnal awakening, overuse of reliever medication, possession of written treatment plan, and
self-report measures of symptom severity. An evaluation of a knowledge based disease
management programme aimed at improving patients’ awareness also produced improvements
in patients’ knowledge of asthma and asthma care at one-year follow-up (Lucas et al, 2003).
McGhan et al (2005) outline the key psychological components within asthma education
programmes that are required for encouraging behavioural change. These include:
•
•
•
•
•
•
Tailoring education to the sufferers level of self-efficacy,
Encouraging positive outcome expectations,
Providing positive role models (case examples of effective asthmamanagement) and role playing,
Cognitive restructuring for ill informed beliefs,
Biomarker feedback, and
Problem focused rather than palliative coping strategies
The most effective tool for supporting effective self-management appears to be tailored written
action plans. Individualised written action plans, providing guidance on how to adjust treatment
according to symptom exacerbations, when to seek medical assistance and from where
(Fishwick et al, 1997; Powell & Gibson, 2004; Ram, 2003) better enable asthmatics to selfregulate their condition (McGhan et al, 2005). A systematic review by Powell and Gibson
(2004) found optimal self-management of asthma to be accomplished by either self-adjustment
of medications with the aid of a written action plan or by regular medical review. Of the two,
tailored written action plans were judged preferable due to their being less resource intensive.
Likewise, Haynes et al (2002) calls for simple self-management solutions.
Kemple and Rogers (2003) evaluated the effectiveness of prompts (emailing patients with
appointment reminders and providing partially completed self management plans). Such
prompts had a moderate effect in increasing the number of people reviewing their care with a
doctor.
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7.2.9.5
Diagnostic Barriers
Consensus
Consensus
Role
Evidence Strength
OA diagnosis barrier
Strong
A lack of consensus in the practices by which OA is diagnosed represents a significant barrier to
early OA diagnosis, resulting for calls to unify national standards (Anees et al, 2002; Axon et al,
1995; Cullinan et al, 2003; Curran & Fishwick, 2003; Fishwick et al, 2003; Miller et al, 2003;
Moffat et al, 2002). Efforts are underway to harmonise diagnostic standards.
Referral routes/delay
Referral routes
Role
Evidence Strength
OA diagnosis barrier
Strong
Delayed diagnosis and prolonged referral routes are widely documented (Curran & Fishwick,
2003; Fishwick et al, 2003; Gannon et al, 1993; Liss & Tarlo, 2001; Munoz et al, 2003; Poonai
et al, 2005; Vandenplas et al, 2003). For example, Fishwick et al (2003) found the mean referral
time from symptom onset to specialist consultation to be 4 years (N=77), with a maximum of 27
years. Similarly, Poonai et al (2005) calculated the mean diagnostic duration as 3.4 years
amongst 42 patients. On average, patients waited 8 months before discussing the work relation
of symptoms with a physician. Reasons given for this delay included failure of primary care
physicians to inquire about work-relatedness of symptoms (41.5%), fear of losing work time
(37.5%), or delays related to investigations (e.g. employer refusal to allow work trial, 33.3%).
Lower SES (lower education and lower household income) was also related to delayed
diagnosis, possibly due to worse knowledge or confidence in finding other work, or costs of
treatment, preventing people from seeking treatment. Vandenplas et al (2003) states that
diagnostic procedures should be made more accessible by specialist diagnosis centres or by
training more physicians to have specific expertise in this area.
Techniques
Techniques
Role
Evidence Strength
OA diagnosis barrier
Very Strong
Inadequate sensitivity and specificity amongst the range of asthma diagnostic techniques
appears to undermine the speed and reliability of diagnosis (Anees et al, 2002; Axon et al, 1995;
BOHRF, 2005; BOHRF, 2004; Bresnitz et al, 2004; Bright & Burge, 1996; Cartier, 2003;
Girard et al, 2004; Gordon et al, 1997; Hegde et al, 2002; Lad, 2003; Lombardo & Balmes,
2000; Malo et al, 1993; Meijer et al, 2002; Mihalas, 1999; Miller et al, 2003; Moscato et al,
2003; Rabatin & Cowl, 2001; Redlich & Anwar, 1998; Tarlo & Liss, 2003; Tarlo & Liss, 2002;
Tarlo & Liss, 2001; Tilles & Jerath-Tatum, 2003; Snashall, 2003; Vandenplas et al, 2001; Vigo
& Grayson, 2005; Zock et al, 1998). Questions addressing improvement of symptoms away
from work appears to have the most discriminative value (BOHRF, 2005; BOHRF 2004).
191
Cause Uncertainty
Cause uncertainty
Role
Evidence Strength
OA diagnosis barrier
Very Strong
Difficulties in differentiating work from non-work causes, workers misattributing symptoms
arising outside work to domestic origins, and ruling out ‘asthma masqueraders’ such as COPD,
farmers’ lung, and pneumonocosis, also thwart the diagnostic process for OA (Anonymous,
2002; Axon et al, 1995; Bright & Burge, 1996; Burge, 1997; Cartier, 2003; De Bono &
Hudsmith, 1999; Evans, 1996; Fishwick et al, 2003; Fishwick & Curran, 1999; Hendrick, 1994;
Moscato et al, 2003; Packham, 2002; Rabatin & Cowl, 2001; Redlich & Anwar, 1998; Tarlo &
Liss, 2003; Tilles & Jerath-Tatum, 2003; Vigo & Grayson, 2005; White & Benjamin, 2003).
Testing comprehensiveness
Testing
comprehensiveness
Role
Evidence Strength
OA diagnosis barrier
Limited
Ensuring diagnostic testing encompasses all potential respiratory related agents is recommended
by Conner (2002); Elms et al (2003a); Elms et al (2003b); Fishwick et al (2005); and Tarlo and
Liss (2003) in order to improve diagnostic accuracy. For example, for bakery flour and
additives, Fishwick et al (2005) advise that it is important to measure specific IgE to an
exhaustive list of known allergens, including commonly encountered allergens such as wheat
flour and fungal alpha-amylase as well as less common agents such as rye, barley, oats, storage
mites, or other enzymes such as cellulase, xylanase etc.
Honesty
Honesty
Role
Evidence Strength
OA diagnosis barrier
Limited
Not all workers will readily admit to symptoms, particularly if these threaten continuing
employment. According to Curran and Fishwick (2003); Gordon et al (1997); Griffin et al
(2001); Hendrick (1994); and Moscato et al (2003) this will effect honest and realistic
responding to health surveillance questionnaires, although the underlying evidence supporting
this conjecture is based on expert opinion and reviews, and just one empirical investigation
(Gordon et al, 1997).
Fear (Economic /Confidentiality)
Fear
Role
Evidence Strength
OA diagnosis barrier
Very Strong
Fear of dismissal, consequent income loss, and poorer career prospects appears to act as a potent
deterrent to employees seeking a diagnosis (Axon et al, 1995; Bernstein, 2002; BOHRF, 2005;
Bradshaw et al, 2005; Bucknall et al, 1999; Cannon et al, 1995; Creer & Levstek, 2001;
Cullinan et al, 2003; Curran & Fishwick, 2003; Devereux et al, 2004; Gadd et al, 2000; Gannon
et al, 1993; Gordon et al, 1997; Hoyle et al, 2002; Lahtinen et al, 2004; Mancuso et al, 2003;
Mihalas, 1999; O'Neill, 1995; Pilkington et al, 2002; Rabatin & Cowl, 2001; Reetoo et al, 2004;
Romano-Woodward, 2004; Rosen et al, 2005; Ross & McDonald, 1998; Snashall, 2003;
192
Stenton et al, 1995; Trainor et al, 2002; Venables et al, 1989; Vigo & Grayson, 2005; Weyman,
1999; Weyman, 1998). This means that OA workers remain exposed to asthmagens. For
example, from Bradshaw et al’s (2005) study of 97 workers referred to specialist respiratory
centres, of those diagnosed with OA, 36% were still working in the job. Of those who had not
previously been diagnosed, 47% stayed in same job.
Related concerns that employees have over the confidentiality parameters surrounding the
diagnostic consultation, and their employers being informed of a positive diagnosis, appears to
reinforce their reticence over obtaining medical help (Bradshaw et al, 2005; Bradshaw et al,
2001; Elms et al, 2003; Fishwick et al, 2003; Reetoo et al, 2004). Bradshaw et al (2005) call for
the complex communication between employers, workers, healthcare workers and legislators to
be more transparent and consistent.
7.2.9.6
Liaison:
Coordination-Collaboration
CoordinationCollaboration
Role
Evidence Strength
OA contributor
Moderate
To improve the overall management of occupational health, improved intra-organisation and
inter-organisation liaison is advocated by the literature. Lahtinen et al (2004) call for greater
collaboration between management, employees, H&S personnel and occupational health
professionals. Others (Curran & Fishwick, 2003; Gadd et al, 2000; Pilkington et al, 2002; Rosen
et al, 2005; Trainor et al, 2002; Stenton et al, 1995) recommend the formation of stronger
networks between trade associations, local business, commercial organisations, suppliers and
insurance companies. In a similar vein, a survey of occupational health provision within 4950
companies found 26% as willing to share occupational health services, the majority of these
being SMEs.
Trade Associations
Trade Associations
Role
Evidence Strength
OA contributor
Moderate
Some authors were of the opinion that trade association membership now represents a "badge"
of credibility, and that their strength has diminished (Strutt & Bird, 2004; Brosseau et al, 2002)
7.2.9.7
Resources:
Cost
Cost
Role
Evidence Strength
OA contributor
Moderate
Cost concerns are cited within the literature as preventing choice of appropriate PPE (Alston et
al, 1997), product substitution for safer alternatives (Chambers et al, 2002), occupational health
provision (Bradshaw et al, 2001; O’ Hara & Elms, 2004; Pilkington et al, 2002), training
(Worsell et al, 2001), use of video exposure monitoring to overcome psychosocial barriers
(Rosen et al, 2003), and implementing preventative interventions (Brown & Rushton, 2003;
193
O’Hara, 2005). An air sampling survey of 33 UK workshops using isocyanates found body shop
annual income as the most important determinant for workplace background exposure (Woskie
et al, 2004).
Staff
Staff
Role
Evidence Strength
OA contributor
Weak
A series of 10 case studies by Wright and Collins (2002), assessing implementation of the 5S
technique for risk management (a method for establishing and maintaining a quality working
environment within an organisation), documented many companies as not having a large
enough workforce to dedicate to the implementation of the 5S technique.
Health and Safety Staff
Health
Staff
and
Safety Role
Evidence Strength
OA contributor A Contribution
Moderate
Bakeries possessing safety representatives have been found as more likely to have training in
flour dust, knowledge of exposure limits, and to have completed COSHH assessments (Elms et
al, 2004). Printing companies (Brown & Rushton, 2003) and smaller chromium-plating
companies (Sadhra et al, 2004) respectively have been documented as possessing too few safety
representatives. Although this evidence implicates smaller companies to be disadvantaged
through not having enough dedicated health and safety staff, the evidence base is not extensive
enough to allow broad generalisations.
Time
Time
Role
Evidence Strength
OA contributor
Moderate
Time restrictions were cited as substantially undermining compliance with health and safety
requirements through:
•
•
•
•
•
•
Preventing attendance at health and safety training (Collins, 2003; Rosen et al, 2005;
Worsell et al, 2001)
Preventing application of new knowledge gained in health and safety promotion exercises
such as Safety and Health Awareness Days (O’ Hara, 2005),
Preventing health and safety training delivery within schools (Weyman & Shearn, 2004)
Thwarting implementation of risk assessment recommendations (Gadd et al, 2003; Trainor
et al, 2002; Wright & Collins, 2002),
Preventing employers and employees from keeping up to date with health and safety
guidance and information (Llewellyn et al, no date; Shearn, 2005; Strutt & Bird, 2004).
Extending the time to undertake tasks and conflicting with productivity requirements
(Cutter & Jordan, 2004; Llewellyn et al, no date; Lymer & Isaksson, 2004; Trainor,
Weyman & Anderson, 1998).
According to Cutter and Jordan (2004), US universal precautions guidance for blood borne
pathogen exposure fails to accommodate the time constraints operating within health care.
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Non-compliance
Non-compliance
Role
Evidence Strength
OA Contributor
Moderate
Monetary restrictions inevitably undermine compliance by limiting the availability and access to
appropriate engineering and PPE controls (Conner, 2002; Cutter & Jordan, 2004; Strutt & Bird,
2004; Trainor, Weyman & Anderson, 1998; Weyman & Kelly, no date).
Company size
Company Size
Role
Evidence Strength
OA Contributor
Moderate
Literature reflects the resource implications of health and safety compliance as being easier for
larger firms to accommodate (Bresnitz et al, 2004; Chambers, Weyman & Keen, 2002; Cullinan
et al, 2003; Hughson et al, 2002; Jeebhay et al, 2000; Levin et al, 2000; Ross & McDonald,
1998; Sim, 2003). As a result, smaller companies are less likely to undertake airborne exposure
monitoring (Levin et al, 2000), relocate at risk employees to lower exposure areas (Ross &
McDonald, 1998), provide access to occupational provision (Jeebhay et al, 2000; Ross &
McDonald, 1998), and more likely to rely on PPE (Hughson et al, 2002). Larger companies are
more likely to make sizeable investments, for example, in local exhaust ventilation, to
accommodate a single employee (Bresnitz et al, 2004).
7.2.9.8
Occupational Health Provision:
Resource
Resource
Role
OA Contributor/Diagnosis/Management
barrier
Limited
Evidence Strength
Nationwide shortfalls in occupational health resources means that reactive as opposed to
proactive services tend to be offered (Ujah et al, 2004), and that time consuming services tend to
be dropped (Schmaling et al, 2003). A survey of OH provision within 17 NHS trusts found 87%
of OH managers to provide a reactive service only due to lack of staff and 94% of departments
to consider themselves short of staff (Ujah et al, 2004).
Usage
Usage
Role
OA Contributor/Diagnosis/Management
barrier
Very Strong
Evidence Strength
Access to occupational health provision within UK companies is limited (Anonymous, 2002;
Bradshaw et al, 2005; Bradshaw et al, 2001; Brown, 2004; Brown & Rushton, 2003; Jackson,
2004; Jeebhay et al, 2000; O'Hara & Elms, 2004; Pilkington et al, 2002; Reetoo et al, 2004;
White & Benjamin, 2003). Brown (2004) reports that under 15% of all UK companies provide
some sort of OH services. Likewise, Bradshaw et al’s (2005) survey of OA referrals to six
195
expert respiratory centres found a quarter to come from worksites with no form of occupational
health input. Provision appears particularly poor amongst smaller organisations, with 48% of
small, compared with 9% of larger organisations claiming to have little or no access to OH
support services in a survey conducted by Reetoo et al (2004). Brown and Rushton (2003) call
for greater promotion of ‘NHS Plus’ to SMEs following a needs-based assessment.
Specialist Care Competency
Specialist
competency
care Role
OA Contributor/Diagnosis/Management
barrier
Moderate
Evidence Strength
Training in occupational medicine received by staff employed within occupational health
departments was cited as inadequate by seven articles (Bradshaw et al, 2001; Bresnitz et al,
2004; Douglas, 2005; Horne & Weinman, 2002; McGhan et al, 2005; Schmaling et al, 2003;
Ujah et al, 2004).
Weaknesses in Approach
Weaknesses
Approach
in Role
OA Contributor/Diagnosis/Management
barrier
Strong
Evidence Strength
The approach adopted by occupational health departments has been criticised for being too
reactive (O'Hara & Elms, 2004; Reetoo et al, 2004), too inconsistent across services (Soriano et
al, 2003; Ujah et al, 2004), and failing to tailor advice to the needs of smaller organisations
(Reetoo et al, 2004).
Relationships/Communication
Relationship/Communication
Role
Evidence Strength
OA Management
Very Strong
Communication skills are increasingly being recognised as a key physician competency (Petrie
et al, 2003; Reetoo et al, 2004). Poor communication between physician and patient can arise
from the absence of a ‘shared language’ (Uldry & Leuenberger, 2000), shared goals (Thorax,
2003), shared health beliefs (Rand & Butz, 1998) and rushed consultations (Caress et al, 2005).
This can reduce patients’ motivation to take active control over their asthma (Van Ganse et al,
2003), undermine their understanding of medication (McGhan et al, 2005), discourage them
from approaching physicians (Reetoo et al, 2004), contribute to treatment non-compliance
(Kolbe, 1999; Taylor & Morgan, 1995; Vamos & Kolbe, 1999), and result in the physician
blaming the patient for treatment failure rather than reviewing the way in which they convey
advice (Creer & Levstek, 2001). Asthma management programmes have been found to yield
significant improvements in communication between patient and provider in terms of
medication, therapy decisions, and action plans (Burton et al, 2001). Enhancing patients’
expectations through positive communication (Di Blasi et al, 2001), encompassing what can be
done to control a condition; adopting a warm, reassuring manner (Di Blasi et al, 2001); viewing
the relationship as a partnership in which expectations are negotiated (Uldry & Leuenberger,
2000); and allowing for adequate time during the consultation, have all been advocated as
196
solutions for improving communication between patient and physician. Bresnitz et al (2004)
offers advice on communication between the physician and employer. They recommend that
communications between the healthcare provider, the patient/representative and workplace
safety personnel should be initiated with care and always with patients concurrence to avoid
conflict and retaliation situations.
Benefits
OH benefits
Role
Evidence Strength
OA Management
Limited
Various evaluations of OH advice have found it to reduce hazard exposure 4-6 months postindividual advice and increase awareness of health and safety issues. A randomised control trial
conducted by Jackson (2004) provided evidence questioning the efficacy of OH advice in
improving patients’ ability to cope with symptoms. Twenty four percent of participants said OH
advice interviews helped "a little", and 25% claimed it to have provided "no help at all".
7.2.9.9
Occupational Health Policy:
Existence/Usage
Existence/Usage
Role
Evidence Strength
OA Prevention
Moderate
Written company occupational health policies appear few and far between (Bradshaw et al,
2001; Bresnitz et al, 2004; Brown & Rushton, 2003; Ujah et al, 2004). For example, Ujah et al
(2004) revealed 12 of 17 NHS Trusts to be without an occupational health policy. Once again,
their absence also seems commonplace amongst smaller organisations. Five out of 18 SMEs
within Bradshaw et al’s (2001) survey did not have an occupational health policy.
Eating/Rest Policy
Eating/Rest policy
Role
Evidence Strength
OA Prevention
Limited
Dilworth (2000) demonstrated that 70% of 47 woodworking sites have no policy for
consumption of food, and 36% no separate rest area. Although this limited evidence base does
not allow generalisations to industry at large, absence of such policies may encourage workers
to consume food and drink within exposure zones.
Risk/COSHH Assessment Need
Risk/COSHH Assessment Need
Role
Evidence Strength
OA Prevention
Strong
COSHH assessments do not appear to be consistently used by companies falling within the
woodworking (Dilworth, 2000) and bakery (Elms et al, 2004) sectors. Bradshaw et al (2005)
found 43% of the companies from which OA patients originated to be, according to the workers,
without a COSHH assessment. Reliance on worker reports may undermine the accuracy of this
finding. Problems in following a reliable risk assessment approach also appear commonplace
(Bradshaw et al, 2005; Dilworth, 2000; Elms et al, 2004; Gadd et al, 2003; Milnes, 2001;
197
Weyman & Milnes, 2001; Weyman & Marlow, 2004; Ujah et al, 2004). Common risk
assessment pitfalls include not being sufficiently specific, failure to identify all hazards, or to
fully consider all outcomes, or to utilise RA results, and to link RA results with controls (Gadd
et al, 2003; Milnes, 2001).
7.2.9.10
Occupational Health Referrals:
Route
Route
Role
Evidence Strength
OA Prevention
Strong
Tendency for workers to approach their GP (Bradshaw et al, 2005; Fishwick et al, 2003) when
respiratory symptoms first manifest and subsequent delays in onwards referral to secondary care
or occupational health typically prolong the referral process for OA sufferers. Obstacles to
improved use of occupational health care stem from time constraints, lack of professional
training, lack of referral routes (Elms et al, 2003) and lack of awareness regarding referral
routes (O’Hara & Elms, 2004). A survey of 295 GPs found 88% to agree that long waiting lists
for secondary referrals can prevent patients from returning to work earlier (Elms et al, 2003).
Calls for greater collaboration and sharing of information between primary care, OH
professionals and H&S specialists are regarded as central to effectively addressing OH (O’Hara
& Elms, 2004).
Primary Care Competency in Occupational Health
Primary Care Competency
Role
Evidence Strength
OA Prevention
Very strong
Twenty articles highlighted GPs’ limited knowledge of occupational health as giving rise to
misdiagnosis or a delay in the diagnosis of OA (Bender & Creer, 2002; Bucknall et al, 1999; De
Bono & Hudsmith, 1999; Elms et al, 2003; Fishwick et al, 2003; Harrison, 1998; Hegde et al,
2002; Jackson, 2004; Mihalas, 1999; Miller et al, 2003; Milton et al, 1998; O'Hara & Elms,
2004; O'Neill, 1995; Pilkington et al, 2002; Poonai et al, 2005; Reetoo et al, 2004; Schmaling et
al, 1998; Taylor & Morgan, 1995; Walpole, 2001; Wu et al, 2001). Inadequate coverage of
occupational medicine within mainstream medical training is cited as the main cause (Elms et
al, 2003; Jackson, 2004; Pilkington et al, 2002). Delays mainly stem from GPs failing to
investigate work-relatedness (Elms et al, 2003; Mihalas, 1999; Poonai et al, 2005). A diverse
employment history can also make it difficult for GPs to make associations between exposure
and symptoms (De Bono & Hudsmith, 1999). The MED 3 sickness certificate is thought to be
inadequate for communicating fitness to work with employers (Elms et al, 2003; O’Hara &
Elms, 2004).
7.2.9.11
Supply chain:
Communication
Communication
Role
Evidence Strength
198
OA Prevention
Limited
Recommendations for encouraging suppliers, for example, PPE manufacturers, to take on a role
in providing health and safety advice is made by two studies (Brown & Rushton, 2003; White &
Benjamin, 2003).
Company size
Company size
Role
Evidence Strength
OA Prevention
Limited
Larger companies are assumed by smaller organisations to possess stronger health and safety
expertise but can fail to communicate risks to smaller organisations (O'Hara & Dickety, 2000).
Likewise, increased emphasis on H&S procurement expectations may squeeze small SMEs out
of the supply chain (White & Benjamin, 2003). Collectively, these influences may diminish the
quality of any health and safety advice that can be provided by SMEs.
Storage
Storage
Role
Evidence Strength
OA Prevention
Weak
Storage arrangements need to consider the effects of lighting, ventilation, bursting containers,
escape routes, storage design, manufacture, testing and operation of storage equipment on
exposure risk (White & Benjamin, 2003).
Chain Length
Chain Length
Role
Evidence Strength
OA Prevention
Weak
Multiple suppliers in the supply chain increase the susceptibility to substandard practices and
therefore requires more planning (White & Benjamin, 2003).
Transactions
Transactions
Role
Evidence Strength
OA Prevention
Weak
Before making a delivery suppliers should assess the H&S knowledge at the client end since the
supplier (e.g. transporter) may be more used to dealing with hazards than the occasional
receiver, and therefore possess the necessary equipment and PPE that is proportionate to the
hazard (White & Benjamin, 2003).
Contractors
Contractors
Role
Evidence Strength
OA Prevention
Limited
Whilst the use of contractors may be increasing, some evidence suggests that contractors are
more likely to engage in risk taking behaviour (Weyman & Kelly, no date). For casual workers
in the supply chain this may be due to their being consulted less on H&S, having less access to
199
H&S training, having less influence, and potential language or comprehension difficulty barriers
(White & Benjamin, 2003).
Reliance
Reliance
Role
Evidence Strength
OA Prevention
Limited
Eight articles describe suppliers as being the main source of health and safety information for
most companies (Alston et al, 1997; Brosseau et al, 2002; Curran & Fishwick, 2003; Llewellyn
et al, no date; O'Hara, 2005; Strutt & Bird, 2004; Toren & Sterner, 2003; White & Benjamin,
2003). For example, O’Hara’s (2005) evaluation of a SHAD workshop for MVR companies
found 51% to report relying on suppliers. However, reliance appears to vary between sectors.
Some degree of reliance was reported within agriculture (Llewellyn et al, no date); paint
workshops (Strutt & Bird, 2004, O’Hara, 2005), woodworking (Brosseau et al, 2005); and
hairdressing (Strutt & Bird, 2004).
7.2.10
Societal/External
7.2.10.1
Support:
Access
Access
Role
Evidence Strength
OA Management
Very Strong
Poor access to support from friends and family has been identified as a risk factor for fatal/near
fatal asthma (Bucknall et al, 1993; Thorax, 2003), brittle asthma (Harrison, 1998), more
frequent asthma episodes (Smith & Nicholson, 2001), impaired self-management (Barton et al,
2003; Gallant, 2003; Rand & Butz, 1998; Uldry & Leuenbergr, 2000), hospitalisations (Beck,
1997), restricted lifestyles and ‘asthma worry’ (Aalto et al, 2002). Social support may buffer the
stressors generated by asthma management, by increasing patients’ willingness to actively
manage their condition (Van Ganse et al, 2003), and reducing the sense of powerlessness that
asthma can create (Makinen et al, 2000). Some asthma educational programs deliberately target
improving family support (McGhan et al, 2005). Equally, high symptom frequency may
motivate sufferers to seek out support (Bernstonn & Ringsberg, 2003).
Quality
Quality of Support
Role
Evidence Strength
OA Management
Moderate
The quality of the support received also appears significant to successful OA management.
Dysfunctional family support appears to be associated with poorer asthma outcomes (Barton et
al, 2003; Bender & Creer, 2002; Giardino et al, 2002; Green et al, 2003; Gregerson, 2000; Innes
et al, 1998; Meijer et al, 1995; Rand & Butz, 1998; Schmaling et al, 2003; Schmaling et al,
2002; Vamos & Kolbe, 1999; Wright et al, 1998). It may exert its effect directly through
increasing stress, or indirectly through providing the sufferer with poor methods of coping.
Exaggerated support by parents encourages the sufferer to worry excessively about physical
sensitisations (Bender & Creer, 2002; De Peuter et al, 2004).
200
Source
Support Source
Role
Evidence Strength
OA Prevention
Limited
Within some sectors, sources of support may provide a useful channel for conveying risk
information. For example, within the agriculture sector, Llewellyn et al (no date) suggests
spouses as having a potentially useful role in promoting health and safety messages within the
family business.
Stigma/Fear
Role
Evidence Strength
Stigma/Fear
OA Prevention
Moderate
The perceived social stigma of having a chronic illness such as asthma may encourage illness
denial amongst sufferers, undermine their self efficacy, and may lead to hesitation in seeking
medical care (Campbell, 1998; Creer & Levstek, 2001; Gallant, 2003; Kolbe, 1999; Moffat et
al, 2002; Rand & Butz, 1998; Taylor & Morgan, 1995; Vamos & Kolbe, 1999).
7.2.10.2
Social Inequality:
Employment/Income Prospects
Employment/Income Prospects
Role
Evidence Strength
OA Management
Very Strong
A challenge to removal of workers from OA causal agents is that this would be unduly
restrictive of workers' occupational options, including loss of flexibility and opportunity. Thirtythree articles described OA workers as incurring a severe loss in their job income following
expose cessation (Adams et al, 2004; Agner & Held, 2002; Ameille et al, 1997; Baur et al,
1998; Bernstein et al, 2003; Bernstein, 2002; Blanc et al, 2001; BOHRF, 2004; Boorman, 2004;
Bresnitz et al, 2004; Burge, 1997; Conner, 2002; Douglas, 2005; Gassert et al, 1998; Hendrick,
1994; Kolbe, 1999; Larbanois et al, 2002; Lombardo & Balmes, 2000; Malo et al, 1993;
Mancuso et al, 2003; Marabini et al, 2003; Moscato et al, 1999; Newman-Taylor, 2002; O'Neill,
1995; Piirilae et al, 2005; Poonai et al, 2005; Sinclair & Tetrick, 2004; Sturdy et al, 2002;
Taylor & Morgan, 1995; Thorax, 2003; Vandenplas et al, 2003; Vandenplas et al, 2002; Vigo &
Grayson, 2005).
Recently, Vandenplas et al (2003) describe 25-38% of OA sufferers to experience prolonged
work disruption and 42-78% report substantial loss of income. It also appears that the financial
consequences of OA are consistently more pronounced in workers who avoid rather than reduce
further exposure. A survey of 36 subjects with latex induced asthma found 62% of those whose
exposure to latex had ceased were associated with income loss compared to 30% with a
reduction in exposure (Vandenplas et al, 2002). Implicit within the financial losses is the
reduced job mobility resulting from a need to avoid further exposure (Agner & Held, 2002;
Ameille et al, 1997; Baur et al, 1998; Blanc et al, 2001; BOHRF, 2004; Boorman, 2004;
Bresnitz et al, 2004; Gassert et al, 1998; Hendrick, 1994; Lombardo & Balmes, 2000; Malo et
al, 1993; Marabini et al, 2003; Newman-Taylor, 2002; Piirilae et al, 2005; Poonai et al, 2005;
201
Sturdy et al, 2002; Thorax, 2003; Vandenplas et al, 2003). According to Newman-Taylor
(2002), 57% of ‘dismissed’ OA workers report difficulty in finding alternative employment.
These restrictions appear compounded for employees within SMEs due to difficulties in being
redeployed within the same company (Ameille et al, 1997).
Socio Economic Status
Socio Economic Status
Role
Evidence Strength
OA Contributor
Very Strong
Lower socio economic status has been identified as a risk factor for asthma severity
(Gregerson, 2000; Gwynn, 2004; Harrison, 1998; Taylor & Morgan, 1995), asthma morbidity
(Gregerson, 2000; Innes et al, 1998; Kamal & Miller, 2004), mortality (Harrison, 1998; Innes et
al, 1998; Rodrigo et al, 2004; Taylor & Morgan, 1995), prevalence (Basagana et al, 2004;
Schmaling et al, 2003), motivation (Green et al, 2003), poorer medication compliance (Barr et
al, 2002; Barton et al, 2003; Bender & Creer, 2002; Mcgann, 2000; Meijer et al, 1995; Moffat et
al, 2002; Schmaling et al, 2003; Soriano et al, 2003; Van Ganse et al, 2003), hospitalisation
(Beck, 1997; Nouwen et al, 1999), delayed diagnosis (Poonai et al, 2005), and absenteeism
(Alexopoulos & Burdorf, 2001). Possible mediators of this effect include decreased perceived
control (Wright et al, 1998) and social support (Wright et al, 1998), lower education level
(Basagana et al, 2004; Chen et al, 2002; Gassert et al, 1998; Schmaling et al, 2003; Soriano et
al, 2003; Uldry & Leuenberger, 2000; Vandenplas et al, 2002), and limited employment
flexibility (Cannon et al, 1995; Newman-Taylor, 2002). Higher SES groups find it easier to
diversify into related careers. Green et al (2003) describes disadvantaged groups as least likely
to change their behaviour.
Gender
Gender
Role
Evidence Strength
OA Contributor
Limited
With one exception (Liss et al, 2003), the majority of evidence suggests being female to be a
risk factor for asthma onset (Barton et al, 2003; Basagana et al, 2004; Gassert et al, 1998;
Gregerson, 2000; Gwynn, 2004; King et al, 2004; Schmaling et al, 2003; Smith & Nicholson,
2001). Females also seem more likely to comply with medication requirements (Gershon et al,
2000; Jessop & Rutter, 2003; Makinen et al, 2000; Schmaling et al, 2003; Van Ganse et al,
2003).
Age
Age
Role
Evidence Strength
OA Contributor
Limited
Two studies cite younger workers as less susceptible to health hazard exposure due to greater
willingness to comply with precautions. Older workers may be more complacent (Gershon et al,
2000; Kim et al, 2001). Hoyle et al (2002) found older workers above the median age of 44 as
less likely to report symptoms, whilst Gannon et al (1993) describe older workers as more
likely to remain in their job due to difficulties in finding other work. Equally, younger workers
may be more susceptible to exposure through inexperience (Mardis & Pratt, 2003). The
relationship between age and OA development is thus unclear. However, older workers do
202
appear more inclined to comply with treatment regime requirements (Jessop & Rutter, 2003;
Schmaling et al, 2003; Van Ganse et al, 2003).
Ethnicity
Role
Evidence Strength
Ethnicity
OA Contributor
Limited
Tentative evidence implies that Caucasians have better asthma outcomes within English
speaking countries (Schmaling et al, 2003). People of South Asian origin have been found to
have less access, less confidence and less familiarity, understanding and compliance with their
treatment regime requirements (Hoyle et al, 2002). Afro-Caribbean people are also more likely
to report asthma (Chen et al, 2002). One study cites Afro-Caribbean and Asian people to have
been associated with increased hospital admission relative to whites (Taylor & Morgan, 1995).
Such outcomes may be mediated by language difficulties.
7.2.10.3
Medicolegal Aspects:
(Dis)incentives to Claim
(Dis)incentives to Claim
Role
Evidence Strength
OA Contributor
Very Strong
Employee reluctance to claim appears commonplace (Biddle et al, 1998; Bradshaw et al, 2005,
Davidson, 1996; Stenton et al, 1995). Factors that dissuade OA sufferers from claiming include
limited offset of income by award indemnities (Bernstein et al, 1999; Cannon et al, 1995;
Gannon et al, 1993; Malo et al, 1993; Vandenplas et al, 2002; 2003), the protracted claims
process (Burge, 1997; Tarlo, 1999), difficulties in establishing an occupational cause (Bernstein
et al, 1999; Hopkins, 1998), high rejection rates (O’ Neill, 1995; Sinclair & Tetrick, 2004;
Taylor & Morgan, 1995), and fear of job insecurity. Restriction of entitlement within the UK to
a predetermined list of agents (Brooks, 1995; O’Neill, 1995), and limited access to lawyers with
experience in the occupational health claims process (O’ Neill, 1995) can also stack the odds
against a successful claim.
Bernstein et al (1999) compares compensation systems operating within different countries.
Within Belgium, compensation due to occupational disease is separated from accidents, and
therefore removes the controversy between employer and workers regarding the aetiology,
diagnosis and pre-existing conditions. For Finland, insurance companies meet the costs for
diagnosis investigation and several types of compensation are offered. A two-tier system for
determining compensation costs is operated within Canada. Level 1 covers income indemnity
and complete costs of rehabilitation and where eligible, level 2 provides permanent disability
indemnity 2 years following the end of exposure.
(Dis)incentive to Return to Work
Disincentives to Return to
Work
Role
Evidence Strength
OA Contributor
Moderate
Warnings against increasing compensation indemnity (even marginally) include reducing the
incentive for workers to seek alternative employment, and encouraging “learned helplessness”
amongst those who are compensated (Adisesh et al, 2002; Hopkins, 1998; Roed & Zhang, 2003;
Sinclair & Tetrick, 2004). Equally, a survey of workers awaiting medicolegal assessment for
203
occupational dermatitis found them 4 times as likely to have been off work compared to those
not awaiting assessment (Adisesh et al, 2002). This may reflect workers’ reluctance to return to
work whilst compensation issues are outstanding.
Employer Dis(incentive)
Employer (dis)incentive
Role
Evidence Strength
OA Contributor
Limited
Compensation payment by the Department of Work and Pensions (DWP), where undertaken,
has been described as undermining the extent to which the compensation acts as an incentive for
employers to improve their health and safety (Bernstein et al, 1999; Davidson, 1996; Goe et al,
2004; Hopkins, 1998; Kyes et al, 2003; Toren & Sterner, 2003).
Clinician Dis(incentive)
Clinician (dis)incentive
Role
Evidence Strength
OA Contributor
Limited
Lack of consensus on how to diagnose occupational asthma, and consequent risk that the expert
opinion offered by physicians may be seen to be unduly influenced by their personal opinion,
can deter physicians from making a diagnosis of OA and getting involved in compensation
claims (Burge, 1997; Rabatin & Cowl, (2000); Rischitelli, 1999).
7.2.10.4
Costs:
Medication
Medication
Role
Evidence Strength
OA Contributor
Strong
Where not exempt from prescription charges, the cost of medication can negatively affect
compliance amongst asthmatics (Kolbe, 1999; Moscato et al, 1999; Taylor & Morgan, 1995;
Uldry & Leuenberger, 2000).
Hidden Costs
Hidden Costs
Role
Evidence Strength
OA Contributor
Weak
The hidden costs in non-adherence can encompass emergency costs. Adherent patients incur
direct costs through medication and medical visits while non-adherent persons incur higher
indirect costs through emergency visits (Schmaling et al, 2003).
Need
Need
Role
Evidence Strength
204
OA Contributor
Weak
According to Curran and Fishwick (2003) non-health care costs are underestimated and greater
understanding of hidden costs is required.
H&S Compliance
H&S Compliance
Role
Evidence Strength
OA Contributor
Limited
Llewellyn et al’s (no date) survey of 103 farmers’ opinions towards risk communication found
that 95% believed that health and safety information should be free. Cost was found to be one of
the most frequently cited barriers to change and compliance.
Personal Costs
Personal Costs
Role
Evidence Strength
OA Contributor
Moderate
In addition to potential job loss or change, personal costs can stem from medical care, loss of
pay for periods off work, transport costs and increased insurance premiums (Malo et al, 1993).
A survey of 88 asthma patients found 73% incurred extra costs, 42% were unable to afford
items needed to control asthma, 67% cited increased transport costs due to asthma and 9%
wanted more financial support. Similarly, a survey of 1020 National Asthma Campaign
members found 54% to have incurred additional costs, 29% as unable to afford items needed,
6% to have been turned down for life insurance, and 9% to have found their insurance
premiums to have increased (Taylor & Morgan, 1995).
Employer Costs
Employer Costs
Role
Evidence Strength
OA Contributor
Strong
Costs incurred to the employer by occupational asthma stem from litigation, staff replacement
and retraining costs, paid absenteeism, worker productivity, and insurance premiums (Atherly et
al, 2005; Brosseau et al, 2002; Burge, 1997; Burgess et al, 2001; Burton et al, 2001; GreenMcKenzie et al, 2002; Jeffrey et al, 1999; Liss & Tarlo, 2001; Malo et al, 1993). No UK studies
were found calculating these costs.
Societal Costs
Societal Costs
Role
Evidence Strength
OA Contributor
Limited
Society bears the costs of OA through health care and social security benefits (Jeffrey et al,
1999). Again no studies were found that calculated these costs.
205
7.2.10.5
Public Health:
Disease Profile
Disease profile
Role
Evidence Strength
OA Contributor
Limited
Public health campaigns have recently been criticised for not providing asthma a high enough
profile (Brown, 2004; Cullinan et al, 2003; Friedman et al, 2000).
7.2.10.6
Regulations:
Legal Minimum
Legal Minimum
Role
Evidence Strength
OA Contributor
Strong
The main driver for companies to provide health and safety measures is their legal obligation
(Hughson et al, 2002; Strutt & Bird, 2004; Trainor et al, 2002). For SMEs, this can mean that
they provide the legal minimum, but nothing more (Bradshaw et al, 2001). This emphasises the
importance of enforcement in ensuring the costs of non-compliance outweigh any benefits.
Clarity
Clarity
Role
Evidence Strength
OA Contributor
Strong
Bradshaw et al’s (2005) qualitative longitudinal study of 97 workers referred to six national
respiratory centres describes that confusion exists amongst workers and employers about the
best actions to comply with legislation.
206
7.3
APPENDIX 3: TABLES OF PSYCHOSOCIAL FACTORS REFERENCES
7.3.1
Individual Cognitive
Overall Factor
Specific Factors Evidence
Identified
Weighting
Risk Perception General
Stage
of OA
1,2,4
Bradshaw et al (2004)
1,2,4
1,2,4
Weyman and Kelly (???)
Fischer et al (2001)
1,2,4
1,2,4
1,2,4
Trainor, Weyman and
Anderson (1998)
Stewart-Taylor and Cherrie
(1998)
McGee (2004) - abstract
Cutter and Jordan (2004)
1,2,4
1,2,4
1 and 2
1,2,4
1,2,4
Covello (1997)
Weyman and Kelly (???)
BOHRF (2004)
Weyman and Kelly (???)
Hughson et al (2002)
1,2,4
Weyman et al (1999)
1,2,4
Benjamin et al (2002)
1,2,4
Creely et al (2003)
1,2,4
1,2,4
Robertson and Stewart
(2004)
Salazar et al (2001)
1,2,4
1,2,4
Meldrum et al (2005)
Covello (1997)
1,2,4
Latency
Strong
Reviews Mentioned in
Evidence Quality
Agent / Condition / Generic
Longitudinal (2 and 12 months) qualitative survey/interviews. 97
Asthma
workers from 6 National centres (92 follow up)
Literature Review - theoretical
Generic
Cross sectional questionnaire survey of shiftworkers in a printing
Solvent mixtures - toluene, ethanol, ethyl
company. N = 124.
acetate
Cross sectional case studies involving interviews and focus groups. 3 Re Mines but issues may apply
case studies.
Cross sectional survey. N = 17 workers (6 teams).
Asbestos/amosite but issues may apply
Quantitative survey questionnaire study of NCTR safety staff. N ??
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Book chapter
Literature Review - theoretical
Systematic Review
Literature Review - theoretical
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 18 companies / 280 ques. Phase 2: 4
companies / 21 ques
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Cross sectional questionnaire/interview survey. 24 training providers /
22 workers
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Questionnaire (N = 200) and focus group (N = 33) survey and
literature review
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Editorial/Expert Review
Book chapter
207
Generic
Blood and body fluid exposures - but
issues may apply
Generic
Generic
Asthma
Generic
Re Noise but issues may apply
Generic
Re Asbestos but issues may apply
Formaldehyde / White Spirit
Re MSDs but issues may apply
Generic
Re COPD but issues may apply
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Familiarity
Strong
Stage
of OA
4
1,2,4
1,2,4
Fishwick et al (1997)
Weyman and Kelly (???)
Creely et al (2003)
1,2,4
1,2,4
1,2,4
Sadhra et al (2002)
O'Hara and Dickety (2000)
Weyman (1998)
1,2,4
Trainor, Weyman and
Anderson (1998)
Lymer and Isaksson (2004)
1,2,4
PPE invincibility
Social
comparison
Experience
Reviews Mentioned in
1,2,4
Moderate 1,2,4
1,2,4
1,2,4
Covello (1997)
Vaughan (2005)
Gadd and Collins (2002)
Redmayne et al (1997)
1,2,4
1,2,4
Alston et al (1997)
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Alston et al (1997)
Vaughan (2005)
Gadd and Collins (2002)
Sadhra et al (2002)
Vaughan (2005)
Weyman et al (1999)
1,2,4
Moderate 1,2,4
1,2,4
Weyman and Kelly (???)
Robertson and Stewart
(2004)
Strutt and Bird (2004)
1,2,4
Vaughan (2005)
Limited
Evidence Quality
Descriptive Review
Literature Review - theoretical
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Survey and workshop. N = 21 interviews and 84 questionnaires
12 case studies and literature review
Cross sectional study. Focus groups informed questionnaire survey analysed by factor analysis
Cross sectional case studies involving interviews and focus groups. 3
case studies.
Qualitative interview study in Sweden. N = 15 (9 nurses and 6
nursing assistants)
Book chapter
Anecdotal conversation
Literature Review - descriptive
Cross sectional biological testing of RPE
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
Cross sectional survey and interviews. 11 orgs / 45 users
Anecdotal conversation
Literature Review - descriptive
Survey and workshop. N = 21 interviews and 84 questionnaires
Anecdotal email conversation
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Literature Review - theoretical
Questionnaire (N = 200) and focus group (N = 33) survey and
literature review
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Anecdotal conversation
208
Agent / Condition / Generic
Asthma
Generic
Formaldehyde / White Spirit
Chromium plating chemicals
Generic
Re Mines but issues may apply
Re Mines but issues may apply
Blood borne pathogens - but issues may
apply
Generic
Generic
Generic
Microbiological (bacterial and
bacteriophage) aerosols
Vapour
Agent: Printing chemicals. Re OCD but
issues may apply
Vapour
Generic
Generic
Chromium plating chemicals
Generic
Generic
Generic
Re MSDs but issues may apply
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Health /
Disability
Consequences
Hazard
Characteristics
(e.g. clearance
time, quantity,
manmade vs
natural,
environment vs
occ health)
Strong
Moderate
Employer Sector
Limited
Accumulation
Limited
Stage
of OA
Reviews Mentioned in
1,2,4
Weyman et al (1999)
1,2,4
Worsell et al (2001)
1,2,4
4
1,2,4
O'Hara and Dickety (2000)
Barton et al (2003)
Dejoy et al (2000)
Evidence Quality
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Cross sectional survey using focus groups and telephone interviews
(N = 51 recruitment / N = 8 Wood Ind Reps)
12 case studies and literature review
Descriptive Review
Study using PRECEDE model to examine factors related to
compliance with precautions. Part of a survey study. N = 902 nurses
1,2,4
Cutter and Jordan (2004)
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
1,2,4
Alston et al (1997)
Cross sectional survey and interviews. 11 orgs / 45 users
1,2,4
Weyman and Kelly (???)
Literature Review - theoretical
1,2
Devereux et al (2004)
Cross sectional survey and prospective cohort study. Sample 3139
1,2,4
Llewellyn et al (????)
Cross sectional survey. 103 questionnaires
4
Kemple and Rogers (2003) Longitudinal single blinded randomised controlled trial. N = 241
adults with asthma and prescribed inhalers
1,2,4
Trainor, Weyman and
Cross sectional case studies involving interviews and focus groups. 3
Anderson (1998)
case studies.
4
Falliers (1987)
Editorial/Expert Review
1,2,4
Weyman and Kelly (???)
Literature Review - theoretical
1,2,4
Pengelly et al (1998)
Cross sectional survey and site visits. 26 sites / 239 samples
1,2,4
Weyman and Kelly (???)
Literature Review - theoretical
1 and 2 Cullinan et al (2003)
Descriptive Review
1,2,4
O'Hara and Dickety (2000) 12 case studies and literature review
1,2,4
Chambers, Sandys and Piney Case study of 1 company. Site visit and interviews (4 sprayers and 1
(2005)
manager, plus 28 monitoring samples).
1,2,4
Alston et al (1997)
Cross sectional survey and interviews. 11 orgs / 45 users
1,2,4
Jones et al (2003)
Exposure testing of PPE. N = 4 volunteers exposed on 9 occasions
1,2,4
Teschke et al (2002) Studied radiographers working in hospitals / healthcare centres or
abstract
private clinics - details unknown from abstract
1,2,4
4
1,2,4
Weyman and Kelly (???)
Weyman and Kelly (???)
Berry, 2004
Literature Review - theoretical
Literature Review - theoretical
Book chapter
209
Agent / Condition / Generic
Generic
More re accidents but some ref to wood
dust
Generic
Asthma
Blood borne pathogens - but issues may
apply
Blood and body fluid exposures - but
issues may apply
Vapour
Generic
Stress and MSDs - may apply to asthma
Agriculture agents but not specific
Asthma
Re Mines but issues may apply
Asthma
Generic
Rosin based solder flux fume
Generic
Asthma
Generic
Isocyanates
Vapour
Vapour
X-ray developer/fixer solution chemicals
- glutaraldehyde, acetic acid, sulphur
dioxide.
Generic
Generic
Generic
Overall Factor
Symptom
perception /
awareness /
repression
Specific Factors Evidence
Identified
Weighting
Inaccuracy
Environmental
Distractors
Stage
of OA
Very strong 2 and 4
4
4
4
4
4
4
2,3,4
4
4
4
4
4
4
4
4
4
4
Limited
Reviews Mentioned in
Evidence Quality
Agent / Condition / Generic
Descriptive Review
Book Chapter
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Matched subjects study
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Asthma
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
1,2,4
4
4
Rietveld (1998)
Petrie et al (2003)
Bender and Creer (2002)
De Peuter et al (2004)
Lehrer et al (2002)
Schmaling et al (2003)
Rand and Butz (1998)
Creer and Levstek (2001)
De Peuter et al (2004)
Rodrigo et al (2004)
Barnes and Woolcock (1998)
Bender and Creer (2002)
Innes et al (1998)
Nouwen et al (1999)
Fishwick et al (1997)
Rietveld (1998)
De Peuter et al (2004)
Rietveld and Brosschot
(1999)
Abba et al (2004)
Chetta et al (2003)
Horne and Weinman (2002)
Descriptive Review
Prospective laboratory study. N = 22 patients.
Cross sectional questionnaire survey of community based asthma
patients. N = 100.
Generic
Asthma
Asthma
4
Gorski et al (1999)
Follow up study of 56 subjects with OA examined 1-6 months after
removal and 36 or 48 months later. Using questionnaire and testing
Bakery allergens
4
4
4
4
Rietveld (1998)
De Peuter et al (2004)
Nouwen et al (1999)
Rietveld and Brosschot
(1999)
Descriptive Review
Descriptive Review
Matched subjects study
Descriptive Review
Asthma
Asthma
Asthma
Asthma
210
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
Reviews Mentioned in
Evidence Quality
Misattribution
Causes - Stress
Limited
1,2,4
4
Rietveld et al (2000)
Rietvelt and Houtveen
(2004)
Misattribution
Causes Conditioning
Strong
4
4
4
Rietveld and Brosschot
(1999)
De Peuter et al (2005)
Rietveld et al (2001)
Illness
Representation
Symptom
Severity
Limited
4
Jessop and Rutter (2003)
Questionnaire survey. N = 330 individuals from 1 health centre.
Asthma
Thorax (2003)
Lehrer et al (2002)
Harrison (1998)
Adisesh et al (2002)
Bucknall et al (1999)
Soriano et al (2003)
Creer and Levstek (2001)
Hand and Adams (2002)
Erickson and Kirking (2002)
- abstract
Erickson and Kirking (2004)
Guidance
Descriptive Review
Descriptive Review
Cross sectional survey. 510 reporting physicians (response rate 71%)
Medical records review
Large European Survey
Descriptive Review
3 month Longitudinal Questionnaire Survey. N = 44 patients
Cross sectional mail survey of 369 adults in US managed care
organisation
Cross sectional mail survey of 603 adults in US managed care
organisation
Review of medical records in Italy. N = 197 subjects.
Asthma
Asthma
Asthma
Dermatitis but issues may apply
Asthma
Asthma
Generic
Asthma
Asthma
Cross sectional study. N = 32 (16 per group) African Americans and
Caucasians.
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Questionnaire Study
Asthma
Very strong 4
4
1,2,4
4
4
4
4
4
4
4
4
Symptom
Intermittency
Limited
Symptom
Reversibility
Limited
4
Moscato et al (2002) abstract
Hardie et al (2002)
4
Taylor and Morgan (1995)
4
4
4
4
4
Bender and Creer (2002)
Creer and Levstek (2001)
Bender and Creer (2002)
Bender and Creer (2002)
Byer and Myers (2000)
Descriptive Review
Experiment (3 conditions and ques/lung testing).
N = 19 women with severe asthma, 18 with somatization like
characteristics and 18 controls (N = 55).
Descriptive Review
Agent / Condition / Generic
Asthma
Generic
Asthma
Case control lab study. N = 20 cases and 20 controls
Asthma
Two Experiments. 1: 30 children/adolescents doing provocation test. Re children but issues may apply
2: 60 children with asthma and 30 without perform physical exercise.
211
Asthma
Variety mentioned
Asthma - but not necessarily OA
Asthma
Generic
Asthma
Asthma
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Symptom
Variability
Symptom Onset
Limited
Weak
Stage
of OA
3 and 4
4
4
4
1,2,4
Hughson et al (2002)
4
Bradshaw et al (2004)
4
1,2,4
Moffat et al (2002)
Brosseau et al (2002)
4
1,2,4
Petrie et al (2003)
Pilkington et al (2002)
Book Chapter
Generic
Cross sectional telephone interview survey and some follow up. 4950 Generic
companies and 50 face to face follow up interviews
1,2,4
Sadhra et al (2002)
Survey and workshop. N = 21 interviews and 84 questionnaires
Learning
Difficulties
Limited
4
4
1,2,4
4
4
4
4
4
4
Memory
Strong
1,2
4
Strong
Agent / Condition / Generic
1,2,4
Strong
Of Condition /
Health
Consequences
Evidence Quality
De Peuter et al (2004)
Bender and Creer (2002)
Rietveld (1998)
Rietveld and Brosschot
(1999)
Thorax (2003)
Marabini et al (2003)
Sturdy et al (2002)
Thorax (2003)
Bender and Creer (2002)
Soriano et al (2003)
Schmaling et al (2003)
Griffiths et al (2001)
Lombardo and Balmes
(2000)
Harrison (1998)
Uldry and Leuenberger
(2000)
Jackson (2004)
Comprehension / Risk Factor
Understanding
Knowledge
Reviews Mentioned in
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Asthma
Asthma
Asthma
Asthma
Guidance
Longitudinal study
Case control study
Guidance
Descriptive Review
Large European Survey
Descriptive Review
Qual Interview study
Descriptive Review
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Descriptive Review
Descriptive Review
Asthma
Asthma
Randomised control trial design study and survey. 139 participants
(77 Immediate advice group / 62 delayed advice group)
Generic
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 18 companies / 280 ques. Phase 2: 4
companies / 21 ques
Longitudinal (2 and 12 months) qualitative survey/interviews. 97
workers from 6 National centres (92 follow up)
Interview survey with 13 GPs
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Re Noise but issues may apply
212
Asthma
Asthma
Wood dust
Chromium plating chemicals
Overall Factor
Specific Factors Evidence
Identified
Weighting
Behaviour Link
Of Controls /
PPE (including
exposure limits)
Moderate
Moderate
Stage
of OA
Reviews Mentioned in
Evidence Quality
1,2,4
1,2,4
Wong et al (2005)
Brosseau et al (2002)
Cross sectional interview survey. N = 163 hairdressing students
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
Descriptive Review and Interviews with 12 physicians and 46 patients
Brief descriptive review
Descriptive Review
Evaluation of Asthma Self Management Programme - 2 year follow
up survey. N = 110
Descriptive Review
1,2,4
Brown and Rushton (2003)
4
1,2,4
4
4
Van Ganse et al (2003)
Packham (2002)
Barton et al (2003)
Lucas et al (2001)
4
4
1,2,4
Uldry and Leuenberger
(2000)
Kolbe (1999)
Carruthers et al (2004)
4
Slater et al (2000)
4
1,2,4
McGhan et al (2005)
Lymer and Isaksson (2004)
1,2,4
1,2,4
Ling and Coulson (2002) abstract
Trim et al (2003)
1,2,4
1,2,4
4
1,2,4
1,2,4
Alston et al (1997)
Elms et al (2004)
Toren and Sterner (2003)
Wong et al (2005)
Trim et al (2003)
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional survey and dust sampling. 55 Bakeries
Descriptive Review
Cross sectional interview survey. N = 163 hairdressing students
Questionnaire survey. N = 200 health care workers
1,2
Chambers, Weyman and
Keen (2002)
Cross sectional site visits/interviews. N = 25
Agent / Condition / Generic
Generic
Wood dust
Agent: Printing chemicals. Re OCD but
issues may apply
Asthma
Re Dermatitis but issues may apply
Asthma
Asthma
Asthma
Descriptive Review
Descriptive Review by COI (of effectiveness of public health
advertising campaigns)
A two year follow up of 54 welders and 38 non-welders in 8 New
Zealand welding sites, using questionnaire and pulmonary function
testing
Descriptive Review
Qualitative interview study in Sweden. N = 15 (9 nurses and 6
nursing assistants)
UK Questionnaire survey. N = 121 trainee hairdressers
Asthma
Generic
Questionnaire survey. N = 200 health care workers
Blood borne pathogens - but issues may
apply
Vapour
Flour dust
Generic
Generic
Blood borne pathogens - but issues may
apply
Surface coating metal products (paint)
213
Welding agents
Asthma
Blood borne pathogens - but issues may
apply
Re Dermatitis but issues may apply
Overall Factor
Specific Factors Evidence
Identified
Weighting
Of Risks
Stage
of OA
Very strong 1,2,4
Creely et al (2003)
1,2,4
Weyman et al (1999)
1,2,4
1,2,4
Rosen et al (2005)
Strutt and Bird (2004)
1,2
1,2,4
Chambers, Weyman and
Keen (2002)
Robertson and Stewart
(2004)
Brown and Rushton (2003)
1,2,4
Strutt and Bird (2004)
4
Fishwick et al (2003)
1,2,4
1,2,4
1.2.4
Evidence Quality
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Descriptive review
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Cross sectional site visits/interviews. N = 25
Agent / Condition / Generic
Formaldehyde / White Spirit
Generic
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Surface coating metal products (paint)
Questionnaire (N = 200) and focus group (N = 33) survey and
literature review.
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Re MSDs but issues may apply
Sadhra et al (2002)
Chambers, Sandys and Piney
(2005)
Trainor, Weyman and
Anderson (1998)
Siriruttanapruk and Burge
(1997)
Survey and workshop. N = 21 interviews and 84 questionnaires
Case study of 1 company. Site visit and interviews (4 sprayers and 1
manager, plus 28 monitoring samples).
Cross sectional case studies involving interviews and focus groups. 3
case studies.
Questionnaire survey of impact of COSHH Regs. N = 100 patients of
occupational lung disease clinic
Chromium plating chemicals
Isocyanates
1,2,4
Perry et al (2000)
Cross sectional telephone interview study with 164 farmers
1,2,4
1,2,4
Wong et al (2005)
Trim et al (2003)
Cross sectional interview survey. N = 163 hairdressing students
Questionnaire survey. N = 200 health care workers
1,2,4
Ling and Coulson (2002) abstract
Soriano et al (2003)
Uldry and Leuenberger
(2000)
Innes et al (1998)
UK Questionnaire survey. N = 121 trainee hairdressers
Pesticide - not sure if really asthma agent
but issues may apply
Generic
Blood borne pathogens - but issues may
apply
Re Dermatitis but issues may apply
Large European Survey
Descriptive Review
Asthma
Asthma
Descriptive Review
Asthma
1,2,4
1,2,4
Of treatment
Reviews Mentioned in
Very strong 4
4
4
214
Agent: Printing chemicals. Re OCD but
issues may apply
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Asthma
Re Mines but issues may apply
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
4
4
4
4
Company Size
Decision Making Lay Vs Expert
4
4
4
4
4
1,2,4
4
Falliers (1987)
Moffat et al (2002)
Campbell (1998)
Lombardo and Balmes
(2004)
Lad (2003) – themes info
Boorman (2004) – themes
Petrie et al (2003)
Bender et al (2002)
De Peuter et al (2004)
Soriano et al (2003)
Vamos and Kolbe (1999)
Nouwen et al (1999)
Byer and Myers (2000)
Elms et al (2004)
Burton et al (2001)
1,2,4
Strutt and Bird (2004)
1,2,4
Hughson et al (2002)
Moderate 1,2
1,2
1,2,4
Cost Benefit
Trade Off
Moderate
Reviews Mentioned in
1,2,4
1,2,4
Weyman, Chambers and
Keen (2002)
Chambers, Weyman and
Keen (2002)
Sadhra et al (2002)
Hunt et al (2002) - abstract
Weyman and Kelly (???)
Weyman et al (1999)
Evidence Quality
Agent / Condition / Generic
Editorial/Expert Review
Interview survey with 13 GPs
Descriptive Review
Descriptive Review
Asthma
Asthma
Asthma
Asthma
Descriptive Review
Magazine Article
Book Chapter
Descriptive Review
Descriptive Review
Large European Survey
Study
Matched subjects study
Questionnaire Study
Cross sectional survey and dust sampling. 55 Bakeries
Longitudinal evaluation of asthma management programme at 1 large
company. N = 41 participants completing ATAQ questionnaire,
followed up at 2, 4 and 12 months.
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 18 companies / 280 ques. Phase 2: 4
companies / 21 ques
Cross sectional observations, site visits and interviews. 25 site visits
Asthma
Generic
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Flour dust
Asthma
Cross sectional site visits/interviews. N = 25
Surface coating metal products (paint)
Survey and workshop. N = 21 interviews and 84 questionnaires
Telephone questionnaire survey as part of ongoing case-control study
of adult onset asthma. 611 jobs held by 93 cases and 372 controls
were evaluated by an expert panel of 6 industrial hygienists
Literature Review - theoretical
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Chromium plating chemicals
Generic
215
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Re Noise but issues may apply
Surface coating metal products (paint)
Generic
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
1,2,4
1,2,4
1,2,4
Health beliefs /
Attitudes
Moderate
4
4
4
4
1,2,4
4
4
1,2,4
1,2,4
1,2,4
Acceptance
Strong
4
1,2,4
1,2,4
4
Perceived
Control of
Hazard
Limited
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Reviews Mentioned in
Evidence Quality
O'Hara and Dickety (2000)
Weyman (1998)
12 case studies and literature review
Cross sectional study. Focus groups informed questionnaire survey
- analysed by factor analysis
De Vries and Lechner (2000) Cross sectional questionnaire survey of lab/mechanical workers.
N = 164 workers / 4 worksites
Green et al (1998)
Descriptive Review
Petrie et al (2003)
Book Chapter
Rand and Butz (1998)
Descriptive Review
Byer and Myers (2000)
Questionnaire Study
Harrison (1998)
Descriptive Review
Schmaling et al (2003)
Descriptive Review
Kaptein et al (2003)
Descriptive Review/Book Chapter
Weyman et al (1999)
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Avory and Coggon (1994)
Interview survey. N = 84 agricultural workers / 79 farms
De Vries and Lechner (2000) Cross sectional questionnaire survey of lab/mechanical workers.
N = 164 workers / 4 worksites
Barton et al (2003)
Descriptive Review
Alston et al (1997)
Cross sectional survey and interviews. 11 orgs / 45 users
Bauer et al (2002)
Case control intervention study. Skin protection group trained in
protection measures (N = 39) and control group (N = 55), with 4
monthly follow up interviews
Taylor and Morgan (1995)
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Creely et al (2003)
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Robertson and Stewart
Questionnaire (N = 200) and focus group (N = 33) survey and
(2004)
literature review
Weyman et al (1999)
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Weyman (1998)
Cross sectional study. Focus groups informed questionnaire survey
- analysed by factor analysis
Trainor, Weyman and
Cross sectional case studies involving interviews and focus groups. 3
Anderson (1998)
case studies.
Sadhra et al (2002)
Survey and workshop. N = 21 interviews and 84 questionnaires
216
Agent / Condition / Generic
Generic
Re Mines but issues may apply
Re Cancer but issues may apply?
Generic
Generic
Asthma
Asthma
Asthma
Asthma
Generic
Generic
Pesticides - but issues may apply
Re Cancer but issues may apply?
Asthma
Vapour
Bakery / food processing agents
Re Skin protection - but issues may apply
Asthma - but not necessarily OA
Formaldehyde / White Spirit
Re MSDs but issues may apply
Generic
Re Mines but issues may apply
Re Mines but issues may apply
Chromium plating chemicals
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
1,2,4
1,2,4
Perceived
Control of
Condition
Self Efficacy of
Hazard
1,2,4
1,2,4
1,2,4
Very strong 4
4
4
4
4
4
4
4
4
4
4
Moderate 4
4
4
1,2,4
1,2,4
Self Efficacy of
Condition
Strong
1,2,4
4
4
4
1,2,4
4
4
Reviews Mentioned in
Godin et al (2000)
Evidence Quality
Questionnaire survey at baseline and 3 months. N = 156 registered
nurses
Review of accidents after 99 serious accidents in Finland
Agent / Condition / Generic
Blood borne pathogens - but issues may
apply
Salminen (1997) - abstract
More re safety and accidents but issues
may apply
Covello (1997)
Book chapter
Generic
Weyman and Kelly (???)
Literature Review - theoretical
Generic
Neal and Griffin (2004)
Book chapter
Generic
Rietveld (1998)
Descriptive Review
Asthma
Nouwen et al (1999)
Matched subjects study
Asthma
Byer and Myers (2000)
Questionnaire Study
Asthma
Creer and Levstek (2001)
Descriptive Review
Generic
Lehrer et al (2002)
Descriptive Review
Asthma
Wright et al (1998)
Descriptive Review
Asthma
Rand and Butz (1998)
Descriptive Review
Asthma
Weyman (1997)
Literature Review
Re WRULDS but issues may apply
Hand and Adams (2002)
3 month Longitudinal Questionnaire Survey. N = 44 patients
Asthma
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients Asthma
Barton et al (2003)
Descriptive Review
Asthma
Ley et al (1996) – themes
Conference Report
Generic
Bender and Creer (2002)
Descriptive Review
Asthma
Creer and Levstek (2001)
Descriptive Review
Generic
De Vries and Lechner (2000) Cross sectional questionnaire survey of lab/mechanical workers.
Re Cancer but issues may apply?
N = 164 workers / 4 worksites
Godin et al (2000)
Questionnaire survey at baseline and 3 months. N = 156 registered
Blood borne pathogens - but issues may
nurses
apply
Weyman and Kelly (???)
Literature Review - theoretical
Generic
Frew (2003) – themes
Descriptive Review
Asthma
Nouwen et al (1999)
Matched subjects study
Asthma
Griffiths et al (2001)
Qual Interview study
Asthma
Jackson (2004)
Randomised control trial design study and survey. 139 participants
Generic
(77 Immediate advice group / 62 Delayed advice group)
Moffat et al (2002)
Interview survey with 13 GPs
Asthma
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients Asthma
217
Overall Factor
Specific Factors Evidence
Identified
Weighting
Perceived
Responsibilities
Ignoring Known OA Denial
Risks
Moderate
Stage
of OA
Reviews Mentioned in
4
Aboussafy et al (2000)
4
Burton et al (2001)
4
4
Barton et al (2003)
Lucas et al (2001)
4
1,2,4
McGhan et al (2005)
Adams et al (2001)
4
Aalto et al (2002)
4
Hesselink et al (2004)
4
Gallant (2003)
1,2,4
1,2,4
Alston et al (1997)
Strutt and Bird (2004)
Very strong 4
1,2,4
4
4
4
4
4
4
4
4
1,2
Evidence Quality
Program of research, including literature review, clinic visit study,
longitudinal daily diary study and laboratory study. Only from
abstract and no sample details given
Longitudinal evaluation of asthma management programme at 1 large
company. N = 41 participants completing ATAQ questionnaire,
followed up at 2, 4 and 12 months.
Descriptive Review
Evaluation of Asthma Self Management Programme - 2 year follow
up survey. N = 110
Descriptive Review
Prospective Randomised Controlled Trial in Australia. N = 134 adults
with asthma
Questionnaire validation study. N = 3464 persons with drug treated
asthma, 278 brief rehabilitation participants and 316 comprehensive
rehab participants.
Cross sectional study using interviews, questionnaire and lung testing
in Holland. N = 220 asthma patients and 53 COPD patients.
Descriptive Review
Cross sectional survey and interviews. 11 orgs/45 users
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Green et al (1998)
Descriptive Review
Weyman and Shearn (2004) Case studies - 7 schools / 51 staff
Thorax (2003)
Guidance
Campbell (1998)
Descriptive Review
De Peuter et al (2004)
Descriptive Review
Innes et al (1998)
Descriptive Review
Bucknall et al (1999)
Medical records review
Uldry and Leuenberger
Descriptive Review
(2000)
Kamal and Miller (2004)
Letter
Kolbe (1999)
Descriptive Review
Harrison (1998)
Descriptive Review
218
Agent / Condition / Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
More evidence re diabetes but issues may
apply
Vapour
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
4
4
1,2,4
4
4
Green et al (2003)
Campbell (1998)
Trainor, Weyman and
Anderson (1998)
Moffat et al (2002)
Van Ganse et al (2003)
Rietveld and Brosschot
(1999)
Barton et al (2003)
Mcgann (2000) - abstract
1,2,4
Adams et al (2001)
4
4
4
Fatalism /
Acceptance /
Resignation
Reviews Mentioned in
Very strong 1,2,4
1,2,4
Jackson (2004)
Hughson et al (2002)
1,2,4
Brown and Rushton (2003)
1,2,4
Strutt and Bird (2004)
1,2,4
1,2,4
1,2,4
Wright and Collins (2002)
Rosen et al (2005)
Worsell et al (2001)
1,2,4
1,2,4
O'Hara and Dickety (2000)
Weyman (1998)
1,2,4
Lymer and Isaksson (2004)
1,2,4
Cutter and Jordan (2004)
Evidence Quality
Descriptive Review
Descriptive Review
Cross sectional case studies involving interviews and focus groups. 3
case studies.
Interview survey with 13 GPs
Descriptive Review and Interviews with 12 physicians and 46 patients
Descriptive Review
Agent / Condition / Generic
Generic
Asthma
Re Mines but issues may apply
Asthma
Asthma
Asthma
Descriptive Review
Longitudinal exploratory study. N = 51 adults with asthma taking
inhaled medication
Prospective Randomised Controlled Trial in Australia. N = 134 adults
with asthma
1 Case study section of report
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 18 companies / 280 ques. Phase 2: 4
companies / 21 ques
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
Asthma
Asthma
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Case studies and Review - 10 case studies
Descriptive review
Cross sectional survey using focus groups and telephone interviews
(recruitment 51 and wood ind reps 8)
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Generic
More re accidents but some ref to wood
dust
12 case studies and literature review
Cross sectional study. Focus groups informed questionnaire survey analysed by factor analysis
Qualitative interview study in Sweden. N = 15 (9 nurses and 6
nursing assistants)
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Generic
Re Mines but issues may apply
219
Asthma
Generic
Re Noise but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
Blood borne pathogens - but issues may
apply
Blood and body fluid exposures - but
issues may apply
Overall Factor
Specific Factors Evidence
Identified
Weighting
Complacency
Goal
Directedness
Moderate
Moderate
Stage
of OA
1,2,4
1,2,4
Trainor et al (2002)
Brown and Rushton (2003)
4
1,2
1,2,4
Soriano et al (2003)
Jones (2004)
Benjamin et al (2002)
1,2,4
Strutt and Bird (2004)
1,2,4
Sadhra et al (2002)
1 and 2 Rosenthal and Forst (2001)
1,2,4
Weyman (1998)
1,2,4
Habituation
Motivation
Personality
Risk Factor
Reviews Mentioned in
Limited
1,2,4
4
Strong
4
4
4
4
1,2
1,2,4
Trainor, Weyman and
Anderson (1998)
Sadhra et al (2002)
Rietveld and Brosschot
(1999)
Rodrigo et al (2004)
Falliers (1987)
Creer and Levstek (2001)
Levin et al (2002)
Gwynn (2004)
Creely et al (2003)
1,2,4
Benjamin et al (2002)
Moderate 4
1,2
1,2
1,2,4
1,2,4
Innes et al (1998)
Lehrer et al (2002)
Harrison (1998)
Weyman and Kelly (???)
Robertson and Stewart
(2004)
Evidence Quality
Agent / Condition / Generic
Cross sectional case study interviews and review - 3 companies
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
Large European Survey
1 Case example - sent by email
Cross sectional questionnaire/interview survey. 24 training providers
and 22 workers
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Survey and workshop. N = 21 interviews and 84 questionnaires
Descriptive Review
Cross sectional study. Focus groups informed questionnaire survey analysed by factor analysis
Cross sectional case studies involving interviews and focus groups. 3
case studies.
Survey and workshop. N = 21 interviews and 84 questionnaires
Descriptive Review
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Descriptive Review
Editorial/Expert Review
Descriptive Review
Pilot questionnaire study
Large telephone survey
Longitudinal workplace (N=14) and laboratory controlled (N = 24)
studies
Cross sectional questionnaire/interview survey. 24 training providers
and 22 workers
Descriptive Review
Descriptive Review
Descriptive Review
Literature Review - theoretical
Questionnaire (N = 200) and focus group (N = 33) survey and
literature review
220
Asthma
Isocyanate
Re Asbestos but issues may apply
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Chromium plating chemicals
Generic
Re Mines but issues may apply
Re Mines but issues may apply
Chromium plating chemicals
Asthma
Asthma
Asthma
Generic
Generic
Asthma
Formaldehyde / White Spirit
Re Asbestos but issues may apply
Asthma
Asthma
Asthma
Generic
Re MSDs but issues may apply
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
4
4
1,2,4
1,2,4
1,2,4
Psychiatric
Disorders
Strong
Negative
Affectivity
Strong
Concentration (also see distraction
under symptom perception)
Limited
1,2,4
4
1,2,4
1,2,4
1,2,4
4
4
4
1,2,4
1,2
4
4
1,2,4
4
1,2,4
Reviews Mentioned in
Falliers (1987)
Feldman et al (2002) abstract
Salminen (1997) - abstract
Evidence Quality
Editorial/Expert Review
Study - 22 defensive and 66 non defensive subjects exposed to lab
tasks.
Review of accidents after 99 serious accidents in Finland
Agent / Condition / Generic
Asthma
Asthma
More re safety and accidents but issues
may apply
Dejoy et al (2000)
Study using PRECEDE model to examine factors related to
Blood borne pathogens - but issues may
compliance with precautions. Part of a survey study. N = 902 nurses apply
Weaver et al (2003)
Laboratory based experiment, questionnaire survey and observation. Generic
N = 112 college students.
Neal and Griffin (2004)
Book chapter
Generic
Thorax (2003)
Guidance
Asthma
Campbell (1998)
Descriptive Review
Asthma
Bucknall et al (1999)
Medical records review
Asthma
Rodrigo et al (2004)
Descriptive Review
Asthma
Barnes and Woolcock (1998) Descriptive Review
Asthma
Petrie et al (2003)
Book Chapter
Generic
Bender and Creer (2002)
Descriptive Review
Asthma
Sturdy et al (2002)
Case control study
Asthma
Harrison (1998)
Descriptive Review
Asthma
Creer and Levstek (2001)
Descriptive Review
Generic
Smith and Nicholson (2001) Longitudinal Questionnaire Survey
Asthma
Neal and Griffin (2004)
Book chapter
Generic
Dolinski and Nawrat (1998) 5 experiments (4 field studies and 1 laboratory).
Generic
Lunt and Corbett (2005)
Descriptive Review
Generic
221
7.3.2
Overall Factor
Coping
Behaviours
Individual Behavioural
Specific Factors Evidence Stage
Identified
Weighting of OA
Smoking
Very strong 1 and 2
1 and 2
1,2
4
4
1,2,
4
4
2,3,4
Reviews Mentioned in
Thorax (2003)
King et al (2004) – themes
Gwynn (2004)
Innes et al (1998)
Campbell (1998)
Harrison (1998)
Smith and Nicholson (2001)
Rand and Butz (1998)
Hoyle et al (2002)
3
4
1,2
1,2,4
1,2,4
1,2,4
4
1,2,4
Mihalas (1999)
Moffat et al (2002)
Ross and McDonald (1998)
Brooks (1995)
Meldrum et al (2005)
White et al (1988)
Barr et al (2002) - abstract
De Meer et al (2004)
1,2,4
1,2,4
Vigo and Grayson (2005)
Meredith et al (2000)
1,2,4
1,2,4
Obesity
Strong
Douglas (2005)
Niven and Pickering (1999)
Thorax (2003)
1 and 2 King et al (2004) – themes
1,2
Gwynn (2004)
1,2,4
Basagana et al (2004)
1,2
Drug / alcohol
abuse
Strong
Kronander et al (2004) abstract
1,2
Thorax (2003)
1 and 2 Campbell (1998)
1,2
Bucknall et al (1999)
Evidence Quality
Agent / Condition / Generic
Guidance
Systematic Review
Large telephone survey
Descriptive review
Descriptive review
Descriptive Review
Longitudinal Ques Survey
Descriptive Review
Cross sectional controlled study, survey and sampling.
911 men in 10 foundries (509 exposed / 402 non exposed)
Descriptive Review
Interview survey with 13 GPs
Questionnaire Survey of 1317 cases / 312 physicians
Descriptive Review
Editorial/Expert Review
Cross sectional questionnaire survey. N = 169 painters
Participants from Nurses Health Study. N = 5107.
European population based survey and lung testing in Holland.
N = 1906 participants.
Descriptive Review
Case referent study in 2 manufacturing companies. N = 27 cases and
51 references in company A. N = 7 cases and 12 referents in
company B.
Descriptive Review
Brief descriptive review
Guidance
Systematic Review
Large telephone survey
Cross sectional interview study including 10,971 subjects aged 20 to
44 from general population
Population study from South Sweden.
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Isocyanates, amines, aldehydes, furfuryl
alcohol
Variety mentioned
Asthma
Asthma
Asthma
Re COPD but issues may apply
Generic
Asthma
Mineral dust (but bronchitis not asthma)
Guidance
Descriptive review
Medical records review
Asthma
Asthma
Asthma
222
Variety mentioned
Isocyanate
Variety mentioned
Generic but mentions asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Coping Style
Strong
Stage
Reviews Mentioned in
of OA
4
Uldry and Leuenberger
(2000)
4
Burgess et al (2001)
1,2
4
4
4
4
4
4
1,2,4
4
4
4
4
4
4
Monitors and
Blunters
Strong
4
4
4
4
4
Self Management Risk Factor
/ Treatment
Compliance
Difficulties
Strong
4
4
4
4
4
Evidence Quality
Descriptive Review
Prospective Study. 202 subjects in 87 incidents surveyed by
telephone.
Harrison (1998)
Descriptive Review
Smith and Nicholson (2001) Longitudinal Ques Survey
Rand and Butz (1998)
Descriptive Review
Moffat et al (2002)
Interview survey with 13 GPs
Kamal and Miller (2004)
Letter
Wright et al (1998)
Descriptive Review
Schmaling et al (2003)
Descriptive Review
Creely et al (2003)
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies.
Barton et al (2003)
Descriptive Review
Hesselink et al (2004)
Cross sectional study using interviews, questionnaire and lung testing
in Holland. N = 220 asthma patients and 53 COPD patients.
Adams et al (2004) - abstract Longitundinal questionnaire survey study of adult patients. N = 293
baseline and 232 at 12 months.
Nelson (2001) - abstract
Interview study. N = 80 adults with asthma.
Makinen et al (2000) Questionnaire survey in Finland. N = 130.
abstract
De Ridder and Schreurs
Descriptive Review
(2001)
Williams-Piehota et al (2005) Longitudinal survey /experiment with monitor and blunter conditions.
N = 190 women.
Brown and Bedi (2001)
Questionnaire study. N = 80 (60 males / 20 females).
Muris et al (1994)
Experiment using questionnaires and physiological assessment. N =
40 students.
Petersson et al (2002)
Randomised prospective questionnaire study. N = 325
Bar-Tal (1994)
Questionnaire study in Israel. N = 77.
Thorax (2003)
Byer and Myers (2000)
Wright et al (1998)
Uldry and Leuenberger
(2000)
Kamal and Miller (2004)
Agent / Condition / Generic
Asthma
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Formaldehyde / White Spirit
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Breast cancer screening but issues may
apply
Cardiac patients but issues may apply
Generic
Guidance
Questionnaire Study
Descriptive Review
Descriptive Review
Cancer but issues may apply
Rheumatoid arthritis patients but issues
may apply
Asthma
Asthma
Asthma
Asthma
Letter
Asthma
223
Overall Factor
Specific Factors Evidence
Identified
Weighting
Immediacy of
Relief
Strong
Stage
Reviews Mentioned in
of OA
1,2,4
Adams et al (2001)
4
Bosley et al (1995)
4
Taylor and Morgan (1995)
4
Creer and Levstek (2001) –
themes
Barnes and Woolcock (1998)
Bucknall et al (1999)
Schmaling et al (2003)
Bender and Creer (2002)
Burton et al (2001)
4
4
4
4
4
Moderate
Asthma
Asthma
Asthma - but not necessarily OA
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
4
4
4
4
4
Taylor and Morgan (1995)
Asthma - but not necessarily OA
Asymptomatic
Limited
4
4
Bender and Creer (2002)
Bernstein (2002)
Monitoring
Limited
4
4
4
3
Thorax (2003)
Bucknall et al (1999)
Kolbe (1999)
Jeffrey et al (1999)
Appointments /
Self discharge
Strong
Regime
Adherence
Prospective Randomised Controlled Trial in Australia.
N = 134 adults with asthma
Prospective questionnaire/interview study. N = 102 patients (72
completed)
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Book Chapter
Agent / Condition / Generic
Descriptive Review
Medical Records Review
Descriptive Review
Descriptive Review
Longitudinal evaluation of asthma management programme at 1 large
company. N = 41 participants completing ATAQ questionnaire,
followed up at 2, 4 and 12 months.
Marks et al (2000) - abstract Cross sectional survey by telephone interview in Australia
N = 1372 adults with asthma.
Kolbe (1999)
Descriptive Review
Creer and Levstek (2001)
Descriptive Review
Fishwick et al (1997)
Descriptive Review
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients
4
Regime
complexity
Evidence Quality
4
4
4
Very strong 1,2,4
4
Thorax (2003)
Sturdy et al (2002)
Harrison (1998)
Harrison (1998)
Rand and Butz (1998)
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Descriptive Review
Case study and questionnaire survey. Ques N = 58 health care
workers (HCWs)
Guidance
Medical records review
Descriptive Review
Cross sectional survey and dust sampling. 224 individuals / 18
bakeries
Guidance
Case control study
Descriptive Review
Descriptive Review
Descriptive Review
224
Asthma
Asthma
Generic
Asthma
Asthma
Asthma
Natural rubber latex (NRL)
Asthma
Asthma
Asthma
Flour dust
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
4
4
4
4
1,2,4
4
4
4
4
4
4
Self
Management
Training Need
Very strong 4
4
4
4
4
4
4
4
4
4
4
Solutions
Strong
1,2,4
4
4
4
4
1,2,4
4
4
Reviews Mentioned in
Campbell (1998)
Petrie et al (2003)
Sarlo (2003) – themes
Nouwen et al (1999)
Innes et al (1998)
Creer and Levstek (2001)
Fishwick et al (1997)
Rand and Butz (1998)
Hand and Adams (2002)
Barton et al (2003)
Haynes et al (2002)
Taylor and Morgan (1995)
Evidence Quality
Descriptive Review
Book Chapter
Matched subjects study
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
3 month Longitudinal Questionnaire Survey. N = 44 patients
Descriptive Review
Systematic Review of RCT studies.
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Thorax (2003)
Guidance
Bender et al (2000)
Descriptive Review
Ley et al (1996) – themes
Book Chapter
Petrie et al (2003)
Book Chapter
Bender et al (2000)
Descriptive Review
Ley et al (1996) – themes
Conference Report
De Peuter et al (2004)
Descriptive Review
Creer and Levstek (2001)
Descriptive Review
Schmaling et al (2003)
Descriptive Review
Lucas et al (2001)
Evaluation of Asthma Self-Management Programme - 2 year follow
up survey. N = 110
Zimmer et al (2000) Longitudinal trial of "Individualised Asthma Care Training program"
abstract
(IACTrho). N = 40 providing baseline and 12 month data.
Bresnitz et al (2004)
Descriptive Review
Gibson et al (2002)
Systematic Review
Ram (2003)
Review of Cochrane systematic reviews
Kemple and Rogers (2003) Longitudinal single blinded RCT. N = 241 adults with asthma
inhalers
McGhan et al (2005)
Descriptive Review
Adams et al (2001)
Prospective Randomised Controlled Trial in Australia.
N = 134 adults with asthma
Powell and Gibson (2004)
Systematic Review
Dolinski and Nawrat (1998) 5 experiments (4 field studies and 1 laboratory)
225
Agent / Condition / Generic
Asthma
Generic
Asthma
Asthma
Asthma
Generic
Asthma
Asthma
Asthma
Asthma
Generic
Asthma - but not necessarily OA
Asthma
Asthma
Generic
Generic
Asthma
Generic
Asthma
Generic
Asthma
Asthma
Asthma
Variety mentioned
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Overall Factor
Specific Factors Evidence Stage
Identified
Weighting of OA
Work Practices / Non-compliance Moderate 4
Controls
1,2,4
Compliance
1,2,4
1,2,4
1,2,4
Working
position
Poor Hygiene
Poor behaviours
/ practices
Moderate
Habits
Bender and Creer (2002)
Newman-Taylor (2002)
Elms et al (2004)
Trainor et al (2002)
Goldenhar et al (2003)
1,2,4
Gershon et al (2000)
1,2,4
1,2,4
Pengelly et al (1998)
Brown and Rushton (2003)
1,2,4
Moderate 1,2,4
1,2,4
Liu et al (2000)
Wheeler et al (2004)
Gershon et al (2000)
Moderate
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Liu et al (2000)
Elms et al (2003)
Dilworth (2000)
Elms et al (2004)
Roff et al (2003)
1,2,4
4
1,2,4
Chambers, Sandys and Piney
(2005)
Avory and Coggon (1994)
O'Hara and Dickety (2000)
Roghmann et al (2003) abstract
Byer and Myers (2000)
Creely et al (2003)
1,2,4
1,2,4
1,2,4
1,2,4
Llewellyn et al (????)
Trainor et al (2002)
Wright and Collins (2002)
Hughson et al (2002)
1,2,4
1,2,4
1,2,4
Habitual
Behaviours /
Routines
Reviews Mentioned in
Strong
Evidence Quality
Descriptive review
Descriptive Review
Cross sectional survey and dust sampling. 55 bakeries
Cross sectional case study interviews and review - 3 companies
Cross sectional questionnaire survey / telephone interviews. N = 408
respondents
Study to develop hospital safety climate tool. Cross sectional survey
testing questionnaire on 789 hospital based health care staff
Cross sectional survey and site visits. 26 sites / 239 samples
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
Case studies - 3 auto body shops examined and sampled.
Field study and measurements. 4 factories / 53 workers
Study to develop hospital safety climate tool. Cross sectional survey
testing questionnaire on 789 hospital based health care staff
Case studies - 3 auto body shops examined and sampled.
Cross sectional survey and sample testing. 117 samples / 22 orgs
Cross sectional survey and sampling. 47 sites / 386 samples
Cross sectional survey and dust sampling. 55 bakeries
Sampling and Observation. 41 samples / 28 orgs
Case study of 1 company. Site visit and interviews (4 sprayers and 1
manager, plus 28 monitoring samples).
Interview survey. N = 84 agricultural workers / 79 farms
12 case studies and literature review
Observational study of workers in 2 intensive care units
Questionnaire Study
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Cross sectional survey. 103 questionnaires
Cross sectional case study interviews and review - 3 companies
Case studies and Review - 10 case studies
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies / 280 ques. Phase 2: 4
companies / 21 ques
226
Agent / Condition / Generic
Asthma
Asthma
Flour dust
Generic
Generic
Blood borne pathogens - but issues may
apply
Rosin based solder flux fume
Agent: Printing chemicals. Re OCD but
issues may apply
Isocyanates
Lead - not sure if OA agent
Blood borne pathogens - but issues may
apply
Isocyanates
Flour dust and enzymes
Wood dust
Flour dust
N-methyl pyrrolidone (not sure if OA
agent)
Isocyanates
Pesticides - but issues may apply
Generic
Re hand disinfection but issues may apply
Asthma
Formaldehyde / White Spirit
Agriculture agents but not specific
Generic
Generic
Re Noise but issues may apply
Overall Factor
Behavioural
Change
Consequences
Specific Factors Evidence
Identified
Weighting
Sustainability
Reinforcement
Stage
Reviews Mentioned in
of OA
1,2,4
Trainor, Weyman and
Anderson (1998)
1,2,4
Brosseau et al (2002)
1,2,4
Jensen and Kofoed (2002)
Limited 1,2,4
Moderate 1,2,4
1,2,4
1,2,4
Wright and Collins (2002)
Gadd and Collins (2002)
Rosen et al (2005)
Dejoy et al (2000)
1,2,4
Gershon et al (2000)
1,2,4
Hofmann and Morgeson
(2004)
Carruthers et al (2004)
Evaluation
Weak
1,2
Workability
Strong
4
4
4
4
4
4
Quality of Life
Strong
4
4
Evidence Quality
Agent / Condition / Generic
Cross sectional case studies involving interviews and focus groups. 3 Re Mines but issues may apply
case studies.
Using PRECEDE-PROCEED model to develop intervention study.
Wood dust
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Questionnaire and interview study. N = 102 floor layers and 180
Re MSDs but issues may apply
apprentice layers. Ints N = 88 floor layers and 16 key persons.
Case studies and Review - 10 case studies
Literature Review - descriptive
Descriptive review
Study using PRECEDE model to examine factors related to
compliance with precautions. Part of a survey study. N = 902 nurses
Study to develop hospital safety climate tool. Cross sectional survey
testing questionnaire on 789 hospital based health care staff
Book chapter
Descriptive Review by COI (of effectiveness of public health
advertising campaigns)
Mancuso et al (2003)
Questionnaire study. 196 patients in an urban practice completed
standardised major and minor life events scales
Eisner et al (2002) - abstract Study using data from a population based sample of 3805 California
adults.
Vandenplas et al (2002) Questionnaire and measurement study of 36 subjects with latex
abstract
induced asthma after a median follow up of 56 months.
Sauni et al (2001) - abstract Questionnaire study of construction workers. N = 76 asthmatics and
144 non-asthmatics
Boot et al (2004)
Cross sectional questionnaire and lung function testing.
N = 118 asthma participants and N = 71 COPD in Holland.
Larbanois et al (2002) Longitudinal survey study. N = 157 (86 OA / 71 not).
abstract
Derk and Henneberger
Analysis of preliminary data from baseline phase of WEA study using
(2003) - abstract
telephone questionnaire and Asthma Quality of Life Questionnaire
(AQLQ). 332 participants employed and 79 experiences WEA.
Juniper (1999)
Descriptive Review
227
Generic
Generic
Generic
Blood borne pathogens - but issues may
apply
Blood borne pathogens - but issues may
apply
Generic
Generic
Asthma
Generic
Latex
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
7.3.3
Overall Factor
Fear
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
of OA
4
Malo et al (1993)
(same in Malo et al 93
Quebec Compensation)
1,2,4
Brown (2004)
4
Piirilae et al (2005)
4
Aalto et al (2002)
4
Berntsson and Ringsberg
(2003)
4
Taylor and Morgan (1995)
Evidence Quality
Agent / Condition / Generic
Prospective Case control study, using asthma QOL Questionnaire.
N = 134 subjects with OA. N = 91 matched controls
Asthma
Descriptive Review
Prospective questionnaire survey and clinical testing in Finland.
N = 213 asthma patients and N = 120 controls
Questionnaire validation study. N = 3464 persons with drug treated
asthma, 278 brief rehabilitation participants and 316 comprehensive
rehab participants.
Questionnaire study. N = 32 patients.
Dermatitis - but issues may apply
Diisocyanates
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Asthma
Re 'sensory hyperreactivity' disorder with
asthma like symptoms but negative asthma
tests, but issues may apply
Asthma - but not necessarily OA
Individual Emotional
Specific Factors Evidence
Identified
Weighting
Stage
of OA
Economic (detail in Hard Org / Diag
Barriers)
Confidentiality (detail in Hard Org /
Diag Barriers)
Treatment
Strong
4
Dependency
4
Enforcement
Moderate
Reviews Mentioned in
4
4
4
Soriano et al (2003)
Uldry and Leuenberger
(2000)
Moffat et al (2002)
Van Ganse et al (2003)
Horne and Weinman (2002)
4
Bosley et al (1995)
4
Taylor and Morgan (1995)
1,2,4
Llewellyn et al (????)
Evidence Quality
Agent / Condition / Generic
Large European Survey
Descriptive Review
Asthma
Asthma
Interview survey with 13 GPs
Descriptive Review and Interviews with 12 physicians and 46 patients
Cross sectional questionnaire survey of community based asthma
patients. N = 100.
Prospective questionnaire/interview study. N = 102 patients (72
completed)
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Asthma
Asthma
Asthma
Cross sectional survey. 103 questionnaires
Agriculture agents but not specific
228
Asthma
Asthma - but not necessarily OA
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
Cross sectional site visits/interviews. 25 site visits
Surface coating metal products (paint)
1,2,4
Reetoo et al (2004)
Generic
1,2,4
Weyman et al (1999)
1,2,4
Worsell et al (2001)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Cross sectional survey using focus groups and telephone interviews (N
= 51 during recruitment / N = 8 wood ind reps)
1,2,4
1,2,4
1,2,4
1,2,4
Llewellyn et al (????)
Sadhra et al (2002)
O'Hara and Dickety (2000)
Wright et al (2005) - DRAFT
1,2,4
1,2,4
Moderate 4
1,2
4
4
4
4
4
Work
Agent / Condition / Generic
Chambers, Weyman and
Keen (2002)
3, 4
Non-Work
Evidence Quality
1,2
1,2
Stress
Reviews Mentioned in
Moderate 3,4
1,2
Cross sectional survey. 103 ques
Survey and workshop. N = 21 interviews and 84 questionnaires
12 case studies and literature review
Questionnaire survey of LA (N = 399) and HSE (N = 156)
inspectors. N = 555.
Carruthers et al (2004)
Descriptive Review by COI (of effectiveness of public health
advertising campaigns)
Gordon et al (1997)
Questionnaire study - screening questionnaire / interviews and
questionnaire attitude survey. 1994 N = 335 / 1995 N = 341 / attitude
survey N = 50 ques and 50 ints).
Hopkins (1998)
Descriptive Review
Baggs and Silverstein (2003) Repeated measures study of compensation claims rates with
enforcement or consultation pre, baseline and post. N = 8929
accounts.
Thorax (2003)
Guidance
Harrison (1998)
Descriptive Review
Innes et al (1998)
Descriptive Review
Schmaling et al (2002)
Questionnaire and daily records of pulmonary function by patients. N
= 32 patients
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients
Aboussafy et al (2000)
Program of research, including literature review, clinic visit study,
longitudinal daily diary study and laboratory study. Only from
abstract and no sample details given
Barton et al (2003)
Descriptive Review
Weyman (1997)
Zeitlin (1995)
Literature Review
Review of Illness Reports. N = 22,763 reports
229
Generic
More re accidents but some ref to wood
dust
Agriculture agents but not specific
Chromium plating chemicals
Generic
Generic
Generic
Flour
Generic
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Re WRULDS but issues may apply
Stress related illness (inc. asthma)
Overall Factor
Emotions
Specific Factors Evidence
Identified
Weighting
Stress Role Cause
Limited
Stress Role Trigger
Limited
Panic
Limited
Anxiety
Limited
Stage
of OA
Reviews Mentioned in
Evidence Quality
Agent / Condition / Generic
1,2,4
Akpinar and Elci (2002) abstract
Expert Opinion
1,2,4
Piirainen et al (2003)
Population based survey using telephone interviews.
= 2156 interviewees in 1997 and N = 2053 interviewees in 2000
4
1,2,4
1,2,4
Hurwitz (2003) - abstract
Wright et al (1998)
Lahtinen et al (2004)
Data from California Work and Health Survey. N = 2902.
Descriptive Review
Collective case study (N=15) using quant questionnaires and qual
interviews (triangulation of data)
Generic
Asthma
Generic
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Study
Magazine Article
Descriptive Review
Descriptive Review
Interview survey with 13 GPs
Cross sectional questionnaire study. N = 101 hand dermatosis
patients.
Descriptive Review
Descriptive Review
Matched subjects study
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Study
Letter
Study
Descriptive Review
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Asthma
Asthma
Asthma
Dermatitis but issues may apply
1,2,4
2?
Rietveld et al (2000)
Rodrigo et al (2004)
Barnes and Woolcock (1998)
1,2,4
Lehrer et al (2002)
4
Smyth et al (1999)
1,2, 4? Reijula (1997)
4
Bender and Creer (2002)
4
Kolbe (1999)
4
Moffat et al (2002)
4
Niemeier et al (2002) abstract
4
Creer and Levstek (2001)
4
Lehrer et al (2002)
4
Nouwen et al (1999)
4
Schmaling et al (2003)
4
Rietveld (1998)
4
Rand and Butz (1998)
4
Rietveld (1998)
4
De Peuter et al (2004)
4
Rodrigo et al (2004)
4
Barnes and Woolcock (1998)
4
Vamos and Kolbe (1999)
4
Kamal and Miller (2004)
4
Smyth et al (1999)
4
Kolbe (1999)
230
Asthma
N Generic
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
4
4
4
4
4
4
4
4
1,2
4
4
4
1,2,4
4
1,2,4
4
1,2,4
4
Depression
Very strong 4
4
4
4
4
4
4
4
4
4
Reviews Mentioned in
Rand and Butz (1998)
De Peuter et al (2004)
Uldry and Leuenberger
(2000)
Innes et al (1998)
Kolbe (1999)
Nouwen et al (1999)
Vamos and Kolbe (1999)
Lehrer et al (2002)
Sturdy et al (2002)
Wright et al (1998)
Schmaling et al (2003)
Schmaling et al (2002)
Evidence Quality
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Matched subjects study
Study
Descriptive Review
Case control study
Descriptive Review
Descriptive Review
Questionnaire and daily records of pulmonary function by patients. N
= 32 patients
Fischer et al (2001)
Cross sectional questionnaire survey of shiftworkers in a printing
company. N = 124.
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients
Rietveld et al (2000)
Descriptive Review
Barton et al (2003)
Descriptive Review
Adams et al (2001)
Prospective Randomised Controlled Trial in Australia.
N = 134 adults with asthma
Taylor and Morgan (1995)
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Katz et al (2003) 2 studies
Abstracts
Katz et al (2002) - abstract
Analysis of cross sectional data from ongoing telephone survey of
adults with asthma. N = 439.
Rietveld (1998)
Descriptive Review
De Peuter et al (2004)
Descriptive Review
Rodrigo et al (2004)
Descriptive Review
Barnes and Woolcock (1998) Descriptive Review
Vamos and Kolbe (1999)
Study
Kamal and Miller (2004)
Letter
Smyth et al (1999)
Study
Kolbe (1999)
Descriptive Review
231
Agent / Condition / Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Solvent mixtures - toluene, ethanol, ethyl
acetate
Asthma
Asthma
Asthma
Asthma
Asthma - but not necessarily OA
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
4
4
4
4
4
4
4
1,2
4
4
1,2,4
4
4
4
4
4
Other Negative
Emotion
Very strong 4
4
4
4
4
4
4
4
4
4
4
Reviews Mentioned in
Rand and Butz (1998)
De Peuter et al (2004)
Uldry and Leuenberger
(2000)
Innes et al (1998)
Nouwen et al (1999)
Wright et al (1998)
Schmaling et al (2003)
Devereux et al (2004)
Evidence Quality
Agent / Condition / Generic
Descriptive Review
Descriptive Review
Descriptive Review
Asthma
Asthma
Asthma
Descriptive Review
Matched subjects study
Descriptive Review
Descriptive Review
Cross sectional survey and prospective cohort study. Sample 3139
Asthma
Asthma
Asthma
Asthma
Stress and MSDs - but may apply to
asthma
Generic
Eisner et al (2002) - abstract Study using data from a population based sample of 3805 California
adults.
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients
Rietveld et al (2000)
Descriptive Review
Barton et al (2003)
Descriptive Review
Ettinger et al (2004) Mailed questionnaire survey. N = 395 asthma and 362 control
abstract
subjects.
Hurwitz (2003) - abstract
Data from California Work and Health Survey. N = 2902.
Bosley et al (1995)
Prospective questionnaire/interview study. N = 102 patients (72
completed)
Taylor and Morgan (1995)
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Schmaling et al (2003)
Descriptive Review
Rietveld (1998)
Descriptive Review
De Peuter et al (2004)
Descriptive Review
Rodrigo et al (2004)
Descriptive Review
Barnes and Woolcock (1998) Descriptive Review
Vamos and Kolbe (1999)
Study
Kamal and Miller (2004)
Letter
Smyth et al (1999)
Study
Kolbe (1999)
Descriptive Review
Schmaling et al (2003)
Descriptive Review
Nouwen et al (1999)
Matched subjects study
232
Asthma
Asthma
Asthma
Asthma
Generic
Asthma
Asthma - but not necessarily OA
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
7.3.4
Specific Factors Evidence
Identified
Weighting
Stage
of OA
Reviews Mentioned in
Evidence Quality
1,2
Devereux et al (2004)
Cross sectional survey and prospective cohort study. Sample 3139
1,2,4
4
Rietveld et al (2000)
Ritz and Steptoe (2000) abstract
Descriptive Review
Laboratory study inducing emotion. N = 20 asthmatics and 20 non
asthmatic controls.
Agent / Condition / Generic
Stress and MSDs - but may apply to
asthma
Asthma
Asthma
Job Factors
Overall Factor
Specific Factors Evidence Stage
Reviews Mentioned in
Identified
Weighting of OA
Emergency Tasks Mistakes (rule
Limited 1,2,4
Levin et al (2002)
based)
Moral Dilemma
Weak
1,2,4
Vaughan (2005)
PPE / RPE
Supply/Selection Very Strong 1,2,4
Fishwick et al (2003)
(Controls)
1.2.4
4
1,2,4
1,2,4
Robertson and Stewart
(2004)
Elms et al (2004)
Alston et al (1997)
Hughson et al (2002)
1,2,4
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Roff et al (2003)
White et al (1988)
Trim et al (2003)
Bresnitz et al (2004)
Dejoy et al (2000)
1,2,4
Lymer and Isaksson (2004)
1,2,4
Cutter and Jordan (2004)
Evidence Quality
Agent / Condition / Generic
Pilot questionnaire study
Generic
Anecdotal conversation
Prospective Survey (N = 97 interviews / 77 re-interviewed) and
Retrospective Case Study (N = 17 case notes).
Purpose
developed ques. 6 respiratory specialist centres
Questionnaire (N = 200) and focus group (N = 33) survey and
literature review
Cross sectional survey and dust sampling. 55 bakeries
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies / 280 ques. Phase 2: 4
companies / 21 ques
Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Sampling and Observation. 41 samples / 28 subjects
Cross sectional questionnaire survey. N = 169 painters
Questionnaire survey. N = 200 health care workers
Descriptive Review
Study using PRECEDE model to examine factors related to
compliance with precautions. Part of survey study. N = 902 nurses
Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing
assistants)
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Generic
Asthma
233
Re MSDs but issues may apply
Flour dust
Vapour
Re Noise but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
N-methyl pyrrolidone (not sure OA agent)
Generic
Blood borne pathogens - issues may apply
Variety mentioned
Blood borne pathogens - but issues may
apply
Blood borne pathogens - but issues may
apply
Blood and body fluid exposures - but
issues may apply
Overall Factor
Specific Factors Evidence Stage
Reviews Mentioned in
Identified
Weighting of OA
Design (Comfort Very Strong 1,2,4
Fishwick et al (2003)
/ Fit)
1,2,4
1,2,4
Alston et al (1997)
Hughson et al (2002)
1,2,4
Brown and Rushton (2003)
1,2,4
Strutt and Bird (2004)
1,2,4
1,2,4
Vaughan (2005)
Redmayne et al (1997)
1,2,4
1,2,4
Alston et al (1997)
Brown and Rushton (2003)
1,2,4
Roff et al (2003)
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Vaughan (2005)
Dilworth (2000)
BOHRF (2004)
HSE Free Leaflets – themes
Lombardo and Balmes
(2000) – themes
Salazar et al (2001)
1,2,4
Evidence Quality
Prospective Survey (N = 97 interviews / 77 re-interviewed) and
Retrospective Case Study (N = 17 case notes). Purpose developed
ques. 6 respiratory specialist centres
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies / 280 ques. Phase 2: 4
companies / 21 ques
Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Anecdotal conversation
Cross sectional biological testing of RPE
1,2,4
1,2,4
1,2,4
Bresnitz et al (2004)
1,2,4
1,2,4
Asthma
Vapour
Re Noise but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Microbiological (bacterial and
bacteriophage) aerosols
Cross sectional survey and interviews. 11 orgs / 45 users
Vapour
Cross sectional observation (N = 21 companies) and focus groups (N = Agent: Printing chemicals. Re OCD but
35 participants) and literature review.
Also pilot issues may apply
testing of interventions using ques/interviews (N = 8 companies)
Sampling and Observation. 41 samples / 28 subjects
N-methyl pyrrolidone (not sure if OA
agent)
Anecdotal conversation
Generic
Cross sectional survey and sampling. 47 sites / 386 samples
Wood dust
Systematic Review
Asthma
Guidance
Generic
Descriptive Review
Asthma
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Salazar et al (2001)
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Bolsover and Parker (2002) Review of breathing apparatus incidents
Chambers, Sandys and Piney Case study of 1 company. Site visit and interviews (4 sprayers and 1
(2005)
manager, plus 28 monitoring samples).
White et al (1988)
Cross sectional questionnaire survey.
N = 169 painters
Trim et al (2003)
Questionnaire survey. N = 200 health care workers
1,2,4
Agent / Condition / Generic
Descriptive Review
234
Generic
Generic
Generic
Isocyanates
Generic
Blood borne pathogens - but issues may
apply
Variety mentioned
Overall Factor
Specific Factors Evidence
Identified
Weighting
Usage
Stage
Reviews Mentioned in
of OA
1,2,4
Lymer and Isaksson (2004)
1,2,4
Very Strong 1,2,4
1,2
Evidence Quality
Agent / Condition / Generic
Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing
assistants)
Descriptive Review
Workshop report
Cross sectional site visits/interviews. 25 site visits
Blood borne pathogens - but issues may
apply
Generic but mentions OA
Isocyanates
Surface coating metal products (paint)
Cross sectional survey and sampling. 47 sites / 386 samples
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies / 280 ques. Phase 2: 4
companies / 21 ques
Case study section of report. 1 case study
Field study and measurements. 4 factories / 53 workers
Cross sectional survey/interviews - quantitative and qualitative data.
N = 28 managers
Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Systematic Review
Guidance
Descriptive Review
Wood dust
Re Noise but issues may apply
1,2,4
1,2,4
Binks (2003)
Levin et al (2000)
Chambers, Weyman and
Keen (2002)
Dilworth (2000)
Hughson et al (2002)
1,2,4
1,2,4
1,2,4
Jackson (2004)
Wheeler et al (2004)
Bradshaw et al (2001)
1,2,4
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
1,2,4
BOHRF (2004)
HSE Free Leaflets – themes
Lombardo and Balmes
(2000) – themes
Salazar et al (2001)
1,2,4
Salazar et al (2001)
1,2,4
1,2,4
1,2,4
Bolsover and Parker (2002)
Terrell (1984)
Erkinjuntti-Pekkanen et al
(1999)
1,2,4
1,2,4
1,2,4
White et al (1988)
Avory and Coggon (1994)
Hable et al (2002) - abstract
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Review of breathing apparatus incidents
Descriptive Review
A two year follow up of 54 welders and 38 non-welders in 8 New
Zealand welding sites, using questionnaire and pulmonary function
testing
Cross sectional questionnaire survey. N = 169 painters
Interview survey. N = 84 agricultural workers / 79 farms
Questionnaire survey. N = 174 health care workers
1,2,4
Trim et al (2003)
Questionnaire survey. N = 200 health care workers
1,2,4
1,2,4
Bresnitz et al (2004)
Brown (2004)
Descriptive Review
Descriptive Review
235
Generic
Lead - not sure if OA agent
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Asthma
Generic
Asthma
Generic
Generic
Generic
Generic
Welding agents
Generic
Pesticides - but issues may apply
Blood borne pathogens - but issues may
apply.
Blood borne pathogens - but issues may
apply
Variety mentioned
Dermatitis - but issues may apply
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
of OA
1,2,4
Cutter and Jordan (2004)
1,2,4
Maintenance
Storage
1,2,4
Very Strong 1,2,4
1,2,4
1,2,4
Record Keeping
Effectiveness
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
1,2,4
Vaughan (2005)
BOHRF (2004)
HSE Free Leaflets – themes
Lombardo and Balmes
(2000) – themes
Alston et al (1997)
Bolsover and Parker (2002)
Bresnitz et al (2004)
Levin et al (2000)
Chambers, Weyman and
Keen (2002)
Dilworth (2000)
Alston et al (1997)
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
Moderate 1,2,4
1,2
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Case studies. N = 2
Descriptive Review
Workshop report
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies / 280 ques. Phase 2: 4
companies / 21 ques
Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review.
Also pilot
testing of interventions using ques/interviews (N = 8 companies)
Anecdotal conversation
Systematic Review
Guidance
Descriptive Review
Blood and body fluid exposures - but
issues may apply
Asthma and salbutamol in pharmaceutical
industry
Generic but mentions OA
Isocyanates
Vapour
Re Noise but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
Generic
Asthma
Generic
Asthma
Vapour
Generic
Variety mentioned
Isocyanates
Surface coating metal products (paint)
Wood dust
Vapour
Agent: Printing chemicals. Re OCD but
issues may apply
1,2,4
1,2,4
1,2,4
1,2,4
Bresnitz et al (2004)
Alston et al (1997)
BOHRF (2005)
Liu et al (2000)
1,2,4
Forrest (2001) - abstract
No details - magazine article??
Dilworth (2000)
Salazar et al (2001)
Agent / Condition / Generic
Cross sectional survey and interviews. 11 orgs / 45 users
Review of breathing apparatus incidents
Descriptive Review
Workshop report
Cross sectional site visits/interviews. 25 site visits
Cross sectional survey and sampling. 47 sites / 386 samples
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review.
Also pilot
testing of interventions using ques/interviews (N = 8 companies)
Cross sectional survey and sampling. 47 sites / 386 samples
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Descriptive Review
Cross sectional survey and interviews. 11 orgs / 45 users
Systematic Review
Case studies - 3 auto body shops examined and sampled.
Moderate 1,2,4
1,2,4
Limited
Strong
Binks (2003)
Levin et al (2000)
Alston et al (1997)
Hughson et al (2002)
1,2,4
1,2,4
1,2,4
1,2,4
Duration
Agius et al (1994)
Evidence Quality
236
Wood dust
Generic
Variety mentioned
Vapour
Asthma
Isocyanates. More re skin disease but
issues may apply
Generic
Overall Factor
Ventilation /
Controls
Specific Factors Evidence
Identified
Weighting
Need
Stage
Reviews Mentioned in
of OA
1,2,4
Hnizdo and Sylvain (2003) abstract
1,2,4
Holness and Nethercott
(1995)
1,2,4
1,2,4
O'Hara and Dickety (2000)
Obase et al (2000) - abstract
1,2,4
Taivainen et al (1998)
1,2,4
Moderate 4
1,2,4
1,2,4
1,2,4
1,2,4
Design
Maintenance
Brown (2004)
Rosenthal and Forst (2001)
Teschke et al (2002) abstract
Nayebzadeh and Dufresne
(1999) - abstract
Erkinjuntti-Pekkanen et al
(1999)
Evidence Quality
1 company including site visit, sampling, employee survey (N = 45)
and employee testing
Questionnaire surveys of 606 pork producers and 53 hog confinement
farmers and 43 control farmers. Follow up 6 years later with 36 hog
farmers and 32 controls.
12 case studies and literature review
Pulmonary function testing study, before and after work and for 14
hours. N = 2 patients with and without respirator.
Prospective (1 year) symptom and PEF monitoring study.
N=
33 asthmatic agriculture workers/farmers
Descriptive Review
Descriptive review
Studied radiographers working in hospitals / healthcare centres or
private clinics - details unknown from abstract
Industrial hygiene survey in 2 dental laboratories
A two year follow up of 54 welders and 38 non-welders in 8 New
Zealand welding sites, using questionnaire and pulmonary function
testing
Hnizdo and Sylvain (2003) - 1 company including site visit, sampling, employee survey (N = 45)
abstract
and employee testing
Agent / Condition / Generic
AMT and DE-498
Farm dusts and gases
Generic
Asthma
Agricultural agents (cow dander or grains)
Dermatitis - but issues may apply
Generic
Chemicals in x-ray developer and fixer
solutions - glutaraldehyde, acetic acid,
sulpher dioxide.
Methyl methcrylate vapour and acrylic
dust
Welding agents
AMT and DE-498
Moderate 1,2,4
Pengelly et al (1998)
Cross sectional survey and site visits. 26 sites / 239 samples
Rosin based solder flux fume
1,2,4
Brosseau et al (2002)
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Wood dust
Pengelly et al (1998)
Chambers, Weyman and
Keen (2002)
Dilworth (2000)
Elms et al (2004)
Chambers, Sandys and Piney
(2005)
Cross sectional survey and site visits. 26 sites / 239 samples
Cross sectional site visits/interviews. 25 site visits
Rosin based solder flux fume
Surface coating metal products (paint)
Moderate 1,2,4
1,2
1,2,4
4
1,2,4
Cross sectional survey and sampling. 47 sites / 386 samples
Wood dust
Cross sectional survey and dust sampling. 55 bakeries
Flour dust
Case study of 1 company. Site visit and interviews (4 sprayers and 1 Isocyanates
manager, plus 28 monitoring samples).
237
Overall Factor
Task
Specific Factors Evidence
Identified
Weighting
Metal Work /
Soldering
Woodworking
Strong
Stage
Reviews Mentioned in
of OA
1,2,4
Brosseau et al (2002)
1,2,4
Lymer and Isaksson (2004)
1,2,4
1,2,4
Pengelly et al (1998)
Park (2001)
Moderate 1,2,4
1,2,4
1,2,4
1,2,4
Paint spraying /
Isocyanates
Bakeries
Healthcare
Farming / Crop
Workers
Moderate 1,2,4
Roff et al (2003)
1,2
1,2
Talini et al (1998) - abstract
Sennbro et al (2004)
1,2
Redlich et al (2002)
1,2,4
Moderate 1,2
1,2,4
Limited
Dilworth (2000)
Rosen et al (2005)
Stewart-Taylor and Cherrie
(1998)
Brosseau et al (2002)
Brooks (1995)
Elms et al (2003)
Burstyn et al (1998)
1,2,4
Bulat et al (2004)
1,2,4
1,2
Smith (2004) - abstract
Liss et al (2003) - abstract
Moderate 1,2,4
1,2,4
Hoppin et al (2004)
Holness and Nethercott
(1995)
Evidence Quality
Agent / Condition / Generic
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing
assistants)
Cross sectional survey and site visits. 26 sites / 239 samples
Case control study of 8 automotive plants. N = all workers employed
for at least 6 months between 1967 to 1993.
Cross sectional survey and sampling. 47 sites / 386 samples
Descriptive review
Cross sectional survey. N = 17 workers (6 teams).
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Sampling and Observation. 41 samples / 28 subjects
Wood dust
Blood borne pathogens - but issues may
apply
Rosin based solder flux fume
Hard metal dusts (e.g. cobalt/tungsten
carbide)
Wood dust
Generic
Asbestos/amosite but issues may apply
Wood dust
N-methyl pyrrolidone (not sure if OA
agent)
Isocyanates, wood dust
N = Diisocyanates or polyurethane or both
Questionnaire survey and testing. 296 furniture workers
Personal air monitoring survey for exposure to isocyanates.
111 workers / 223 samples.
1 year follow up of the Survey of Painters and Repairers of Auto
Bodies by Yale (SPRAY) to investigate exposure of autobody shop
workers (N = 45) over time - using questionnaire and sampling
Descriptive Review
Cross sectional survey and sample testing. 117 samples / 22 orgs
Exposure sampling and observation from 96 bakery workers in 7
different small or medium sized bakeries in Canada.
Exposure sampling from 70 bakeries in Belgium (N = 411 samples)
Hexamethylene diisocyanate (HDI)
Asthma
Flour dust and enzymes
Wheat antigen and fungal alpha-amylase.
Inhalable dust, wheat flour and alphaamylase allergens
Asthma
Various chemicals, e.g. glutaraldehyde
Evaluation of in house respiratory health surveillance programme
Questionnaire mail survey (1110 medical radiation technologists
(MRTs) and 1523 physiotherapists)
Cross sectional questionnaire and exposure sampling study
Respiratory irritants, e.g. diesel, solvents,
Cohort of 20,898 farmers
welding fumes
Questionnaire surveys of 606 pork producers and 53 hog confinement Farm dusts and gases
farmers and 43 control farmers. Follow up 6 years later with 36 hog
farmers and 32 controls.
238
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
Evidence Quality
of OA
1,2,4
Danuser et al (2001) -abstract Epidemiological questionnaire study. N = 1542 Swiss farmers.
1,2,4
Detergent /
Cleaning
Hairdressing
Construction
7.3.5
Overall Factor
Air quality
Monso (2004) - abstract
Bronchial challenge tests in greenhouse growers
Moderate 1,2,4
Vanhanen (2000) - abstract
1,2,4
Zock et al (2001) - abstract
Moderate 1,2,4
Albin et al (2002) - abstract
40 workers and 36 non-exposed workers subjected to skin prick and
RAST tests
Spanish part of the European Community Respiratory Health Survey,
using telephone interviews. N = 67 indoor cleaners.
Postal questionnaire of female hairdressers from vocational schools in
Sweden and referents from general population.
Questionnaire survey in Norway. N = 100 hairdressers (91%
response), 95 office workers (84% response) and population based
control group.
All Finnish male construction workers and all administrative workers
were followed through a register 1986-1998.
Limited
1,2,4
Hollund et al (2001) abstract
1,2,4
Karjalainen et al (2002) abstract
Agent / Condition / Generic
Re Bronchitis but issues may apply
Pollens, moulds, Tetranychus urticae
allergens
Enzymes - protease
Asthma
Asthma
Hairdressing chemicals
Asthma
Soft Organisational Environmental
Specific Factors Evidence Stage
Reviews Mentioned in
Identified
Weighting of OA
ETS
Strong
1 and 2 King et al (2004)
4
Green et al (2003)
1,2,4
Eisner et al (1998)
1,2
Sick Building
Syndrome*
Strong
1,2,4
1,2,4
Jaakkola et al (2003) abstract
Henley (1996)
Niven and Pickering (1999)
1,2,4
1,2,4
1,2,4
Raw (1992)
Burge (2004)
Chao et al (2003)
1,2,4
Runeson et al (2003)
Evidence Quality
Agent / Condition / Generic
Systematic Review
Descriptive Review
Prospective cohort study of 451 nonsmoking adults with asthma over
18 months.
Population based case control study. N = 521 cases and 932 controls.
Asthma
Brief descriptive review
Brief descriptive review
Asthma and ETS
Generic but mentions asthma
Descriptive Review
Descriptive Review
Longitudinal questionnaire survey and environmental sampling over 1
year. N = 98 participants.
Longitudinal and cross sectional cohort study using questionnaires and
exposure measurements. N = 194 participants
SBS - but issues may apply
SBS - but issues may apply
SBS - but issues may apply
239
Asthma
Generic
Environmental Tobacco Smoke
SBS - but issues may apply
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
of OA
1,2,4
Mendelson et al (2000) abstract
1,2,4
7.3.6
Overall Factor
Internal Support
Henley (1996)
Evidence Quality
Agent / Condition / Generic
Examined differences in stress, support and symptoms reported by
hospital personnel working in kjnown SBS sites in Halifax, Nova
Scotia (N = 297) with controls in SBS free settings (N = 228)
SBS - but issues may apply
Brief descriptive review
Asthma and SBS
Soft Organisational Attitudes
Specific Factors Evidence Stage
Identified
Weighting of OA
Quality
Moderate 4
4
4
1,2,4
Quantity for
hazards
Moderate
Source
Strong
Limited
Evidence Quality
4
4
1,2
Descriptive review
Descriptive Review
Study
Collective case study (N=15) using quant questionnaires and qual
interviews (triangulation of data)
Shearn (2005)
Case study. 1 company / 7 interviews
Krause and Lund (2004)
Book chapter
De Vries and Lechner (2000) Cross sectional questionnaire survey of lab/mechanical workers.
N
= 164 workers / 4 worksites
Gillen et al (2002)
Cross sectional questionnaire / telephone interview study.
N
= 255 construction workers
Vamos and Kolbe (1999)
Study
Kolbe (1999)
Descriptive Review
Wright et al (1998)
Descriptive review
Schmaling et al (1998)
Descriptive review
Uldry and Leuenberger
Descriptive Review
(2000)
Innes et al (1998)
Descriptive Review
Creer and Levstek (2001)
Descriptive Review
Devereux et al (2004)
Cross sectional survey and prospective cohort study. Sample 3139
1,2,4
Strutt and Bird (2004)
1,2,4
1,2,4
Weyman (1997)
Lymer and Isaksson (2004)
1,2,4
4
1,2,4
1,2,4
Quantity for OA
management
Reviews Mentioned in
4
4
4
4
4
Wright et al (1998)
Gregerson (2000)
Smyth et al (1999)
Lahtinen et al (2004)
Agent / Condition / Generic
Asthma
Asthma
Asthma
Generic
Generic
Generic / Injury
Re Cancer but issues may apply?
More re injury but issues may apply
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Stress and MSDs - but may apply to
asthma
Interviews and focus groups with 4 industry sectors. 8 interviews and Isocyanates, flour dust, wood dust,
4 focus groups
ingredients in bleaches, perms etc
Literature Review
Re WRULDS but issues may apply
Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing Blood borne pathogens - but issues may
assistants)
apply
240
Overall Factor
H&S Culture /
Climate
Specific Factors Evidence Stage
Identified
Weighting of OA
Stress buffer
Limited 4
4
Consistency
Limited 1,2,4
1,2,4
4
Management
Very Strong 1,2,4
Commitment /
1,2,4
Approach
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Reviews Mentioned in
Evidence Quality
Descriptive review
Descriptive Review
Case study section of report. 1 case study
Literature Review - descriptive
Descriptive Review
Cross sectional survey and interviews. 11 orgs / 45 users
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Elms et al (2004)
Cross sectional survey and dust sampling. 55 bakeries
Gadd and Collins (2002)
Literature Review - descriptive
Collins (2003)
Site visits and literature review. 6 companies
Weyman (1999)
Literature Review
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
Weyman et al (1999)
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
1,2,4
Wright and Collins (2002)
Case studies and Review. 10 case studies
1,2,4
Shearn (2005)
Case study (1 company / 7 interviews)
1,2,4
1) Weyman & Milnes (2001) Cross sectional questionnaire surveys. Study 1) 215 ques
2) Weyman & Marlow 2004 Study 2) 347 ques
1 and 2 Cullinan et al (2003)
Descriptive Review
1,2,4
Lahtinen et al (2004)
Collective case study (N=15) using quant questionnaires and qual
interviews (triangulation of data)
1,2,4
Weyman and Kelly (???)
Literature Review - theoretical
1,2,4
Robertson and Stewart
Questionnaire (N = 200) and focus group (N = 33) survey and
(2004)
literature review
1,2,4
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review.
Also pilot
testing of interventions using ques/interviews (N = 8 companies)
1,2,4
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
1,2,4
Wright and Collins (2002)
Case studies and Review. 10 case studies
1,2
Milnes (2001)
Review of 61 risk assessments
1,2,4
Worsell et al (2001)
Cross sectional survey using focus groups and telephone interviews.
N = 51 during recruitment and N = 8 wood reps
1,2,4
Roff et al (2003)
Sampling and Observation. 41 samples / 28 subjects
1,2,4
Wright et al (1998)
Kolbe (1999)
Jackson (2004)
Gadd and Collins (2002)
Lardner et al (2000)
Alston et al (1997)
Creely et al (2003)
Salazar et al (2001)
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
241
Agent / Condition / Generic
Asthma
Asthma
Generic
Generic
Generic
Vapour
Formaldehyde / White Spirit
Flour dust
Generic
Agents relevant to rubber industry
Generic
Generic
Generic
Generic
Generic
Re Manual Handling but issues may apply
Asthma
Generic
Generic
Re MSDs but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Re Manual Handling but issues may apply
More re accidents but some ref to wood
dust
N-methyl pyrrolidone (not sure if OA
agent)
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
of OA
1,2,4
Fell-Carlson (2004)
1,2,4
Harbison (????)
1,2,4
Garcia et al (2004)
Descriptive review
Descriptive review
Cross sectional survey of production workers in pottery industry in
Spain. N = 734 production workers interviewed and completed safety
climate index (SCI)
Cross sectional study. Focus groups informed questionnaire survey analysed by factor analysis
Cross sectional case studies involving interviews and focus groups. 3
case studies.
Cross sectional questionnaire survey. N = 1621 individuals / 3 mines.
1,2,4
Weyman (1998)
1,2,4
Trainor, Weyman and
Anderson (1998)
Weyman and Anderson
(1996)
Wright et al (2005) - DRAFT Questionnaire survey of LA (N = 399) and HSE (N = 156) inspectors.
N = 555.
Gershon et al (2000)
Study to develop hospital safety climate tool. Cross sectional survey
testing questionnaire on 789 hospital based health care staff
Smith (1989) - abstract
Workshop paper
Roy (2003)
Qualitative exploratory research of Self Directed Work Teams
(SDWT) - multiple case studies/ints. N = 12 manufacturing factories
in Canada (N = 60 interviews)
Lymer and Isaksson (2004) Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing
assistants)
Fleming and Lardner (2002) Descriptive Review
Lardner et al (2000)
Descriptive Review
Carpentier-Roy et al (1998) Qualitative interview study with 7 H&S committees and 20 groups of
workers.
Chappell (1995)
Brief magazine article
Sinclair and Tetrick (2004) Book chapter
Hofmann and Morgeson
Book chapter
(2004)
Neal and Griffin (2004)
Book chapter
Shearn (2005)
Case study (1 company / 7 interviews)
Wright and Collins (2002)
Case studies and Review - 10 case studies
Lahtinen et al (2004)
Collective case study (N=15) using quant questionnaires and qual
interviews (triangulation of data)
Jackson (2004)
Randomised control trial design study and survey. 139 participants
(77 immediate advice group / 62 delayed advice group)
Gadd et al (2000)
Review and Interviews. 24 SMEs
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
4
1,2,4
1,2,4
1,2,4
1,2,4
Worker
Commitment /
Involvement
Evidence Quality
1,2,4
Very Strong 1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
242
Agent / Condition / Generic
Generic
Generic
Generic
Re Mines but issues may apply
Re Mines but issues may apply
Re Mines but issues may apply
Generic
Blood borne pathogens - but issues may
apply
Aluminium smelting dusts and fumes
Generic
Blood borne pathogens - but issues may
apply
Generic
Generic
Generic
Generic (but more re safety than health)
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
of OA
1,2,
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Weyman and Kelly (???)
Gadd et al (2003)
Fell-Carlson (2004)
Harbison (????)
Trainor, Weyman and
Anderson (1998)
Inman et al (2002) - abstract
4
1,2,4
Agner and Held (2002)
Cutter and Jordan (2004)
4
1,2,4
Role Models
Strong
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Conflicting
Priorities - safety
Moderate
Reviews Mentioned in
1,2,4
1,2,4
1,2,4
1,2
1,2,4
1,2,4
Evidence Quality
Agent / Condition / Generic
Literature Review - theoretical
Generic
Brief literature review and case studies. 26 case studies
Generic
Descriptive review
Generic
Descriptive review
Generic
Cross sectional case studies involving interviews and focus groups. 3 Re Mines but issues may apply
case studies.
Focus group/survey study on carpenters safety eye wear usage
Re eye injury but issues may apply
Descriptive Review
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Lardner et al (2000)
Descriptive Review
Roy (2003)
Qualitative exploratory research of Self Directed Work Teams
(SDWT) - multiple case studies/ints. N = 12 manufacturing factories
in Canada (N = 60 interviews)
MacIntosh and Gough (1998) Case studies. N = 4 manufacturing companies in Australia.
Mackmurdo (2002)
Brief descriptive review
Chappell (1995)
Brief magazine article
Neal and Griffin (2004)
Book chapter
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Collins (2003)
Site visits and literature review. 6 companies
Vaughan (2005)
Anecdotal conversation
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Fell-Carlson (2004)
Descriptive review
Williams (1997)
Conference presentation paper
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Pilkington et al (2002)
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Bradshaw et al (2001)
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
Pilkington et al (2002)
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
243
Re skin protection but issues may apply
Blood and body fluid exposures - but
issues may apply
Generic
Generic
Generic
Generic
Generic (but more re safety than health)
Generic
Re Noise but issues may apply
Agents relevant to rubber industry
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Generic
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Generic
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Conflicting
Priorities productivity
Stage
Reviews Mentioned in
of OA
1,2,4
Brosseau et al (2002)
Very Strong 1,2,4
1,2,4
Bradshaw et al (2005)
1,2,4
1,2,4
White and Benjamin (2003)
Hughson et al (2002)
1,2,4
Brown and Rushton (2003)
1,2,4
3
Gadd and Collins (2002)
Elms et al (2003)
1,2,4
Osborne (2003) - abstract
Asthma
Generic
Re Noise but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
Generic
Asthma
Weyman and Marlow (2004) Cross sectional questionnaire survey. Study 2) 347 ques
1,2,4
1,2,4
1,2,4
Limited
Formaldehyde / White Spirit
1,2,4
1,2,4
Organisation
Size
Wood dust
1,2,4
1,2,4
1,2,4
Strong
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Longitudinal (2 and 12 months) qualitative survey/interviews. 97
workers from 6 national centres (92 follow up)
Descriptive Review
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Literature Review - descriptive
Qual and quant survey (triangulation of evidence). Qual focus groups
22 GPs, 25 nurses, 24 practice mgrs. Quant survey 295 GPs
Agent / Condition / Generic
Re Bloodborne infection, e.g. Hepatitis B,
Hepatitis C, HIV - but issues may apply
Weyman (1998)
Cross sectional study. Focus groups informed questionnaire survey - Re Mines but issues may apply
analysed by factor analysis
Trainor, Weyman and
Cross sectional case studies involving interviews and focus groups. 3 Re Mines but issues may apply
Anderson (1998)
case studies.
Gillen et al (2002)
Cross sectional questionnaire / telephone interview study.
More re injury but issues may apply
N = 255 construction workers
Sinclair and Tetrick (2004) Book chapter
Generic
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases (Phase 2
Re Noise but issues may apply
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N = Agent: Printing chemicals. Re OCD but
35 participants) and literature review. Also pilot testing of
issues may apply
interventions using ques/interviews (N = 8 companies)
Harbison (????)
Descriptive review
Generic
Weyman and Milnes (2001) Cross sectional questionnaire survey. Study 1) 215 questionnaire
Re Manual Handling but issues may apply
1,2,4
Peer/Mgt
Discrepancy
Creely et al (2003)
Evidence Quality
Questionnaire survey to nurses in Australia
244
Re Manual Handling but issues may apply
Overall Factor
Specific Factors Evidence
Identified
Weighting
Training
Moderate
Need
Moderate
Stage
Reviews Mentioned in
of OA
1,2,4
Garcia et al (2004)
1,2,4
1,2,4
1,2,4
1,2,4
1.2.4
1,2,4
3
1,2,4
1,2,4
Under-reporting
Strong
3?
3
3
1,2,4
1,2,4
Cross sectional survey of production workers in pottery industry in
Spain. N = 734 production workers interviewed and completed safety
climate index (SCI)
Weyman and Milnes (2001) Cross sectional questionnaire survey. Study 1) 215 questionnaire
Weyman and Marlow (2004) Cross sectional questionnaire survey. Study 2) 347 questionnaire
O'Hara and Elms (2004)
Brief workshop report / expert opinion
Wright and Collins (2002)
Case studies and Review. 10 case studies
Robertson and Stewart
Questionnaire (N = 200) and focus group (N = 33) survey and
(2004)
literature review
Shearn (2005)
Case study - 1 company/7 interviews
Fishwick and Curran (1999) Magazine article
Weyman and Anderson
Cross sectional questionnaire survey. N = 1621 individuals / 3 mines.
(1996)
Dejoy et al (2000)
Study using PRECEDE model to examine factors related to
compliance with precautions. Part of survey study. N = 902 nurses
1,2,4
Bender and Creer (2002)
BOHRF (2004)
Boorman (2004) - themes
Trainor et al 2002
Weyman and Anderson
(1996)
Leffler and Milton (1999) abstract
Trim et al (2003)
1,2,4
Lymer and Isaksson (2004)
1,2,4
Cutter and Jordan (2004)
1,2,4
Evidence Quality
Reputation
Benefits
Weak
Limited
1,2,4
1,2,4
Gadd and Collins (2002)
Probst (2004)
Blame Culture
Limited
1,2,4
1,2,4
Gadd and Collins (2002)
Weyman et al (1999)
1,2,4
Harbison (????)
Agent / Condition / Generic
Generic
Re Manual Handling but issues may apply
Re Manual Handling but issues may apply
Generic
Generic
Re MSDs but issues may apply
Generic
Generic
Re Mines but issues may apply
Blood borne pathogens - but issues may
apply
Descriptive Review
Systematic Review
Magazine article
Cross sectional case study interviews and review. 3 companies
Cross sectional questionnaire survey. N = 1621 individuals / 3 mines.
Asthma
Asthma
Generic
Generic
Re Mines but issues may apply
Case study
Isocyanates, alkyd resins and chromates
Questionnaire survey. N = 200 health care workers
Blood borne pathogens - but issues may
apply
Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing Blood borne pathogens - but issues may
assistants)
apply
Cross sectional Questionnaire Survey of 200 health care workers (90 Blood and body fluid exposures - but
surgeons, 52 theatre nurses and 58 midwives)
issues may apply
Literature Review - descriptive
Generic
Cross sectional questionnaire survey. N = 136 manufacturing
Generic
employees
Literature Review - descriptive
Generic
Descriptive/theoretical Review and Workshop Discussions/Expert
Generic
Opinion
Descriptive review
Generic
245
Overall Factor
Specific Factors Evidence Stage
Reviews Mentioned in
Identified
Weighting of OA
Learning Culture
Weak
1,2,4
Harbison (????)
Macho Culture
Strong
1,2,4
Bauer et al (2002)
Subcultures
Moderate
1,2,4
Generic
1,2,4
1,2,4
Weyman and Kelly (???)
Hughson et al (2002)
Generic
Re Noise but issues may apply
1,2,4
Moderate
1,2,4
1,2,4
Norms
Experience
Limited
Unions
Limited
Peer Pressure
Strong
Agent / Condition / Generic
Descriptive review
Case control intervention study. Skin protection group trained in
protection measures (N = 39) and control group (N = 55), with 4
monthly follow up interviews
Cheyne et al (2003)
Questionnaire survey in manufacturing organisations. N = 967
employees, 123 first line supervisors and 97 managers.
Smit and Schabracq (1998) Interview study. N = 6 middle management teams (3 research, 3
manuf). N = 61 people.
Cooper et al (1993)
Cross sectional questionnaire survey. N = 374 respondents.
Specific to Courtaulds Cellophane, Bridgwater (poss restricted ?).
Salminen (1997) - abstract
Review of accidents after 99 serious accidents in Finland
Cutter and Jordan (2004)
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Cooper et al (1993)
Cross sectional questionnaire survey. N = 374 respondents.
Specific to Courtaulds Cellophane, Bridgwater (poss restricted ?).
Gillen et al (2002)
Cross sectional questionnaire / telephone interview study.
N = 255 construction workers
MacIntosh and Gough (1998) Case studies. N = 4 manufacturing companies in Australia.
1,2,4
Job Tenure
Evidence Quality
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Literature Review - theoretical
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Weyman (1999)
Literature Review
Salazar et al (2001)
Cross sectional questionnaire / interview survey.
N = 255 respondents / 28 interviews
Fell-Carlson (2004)
Descriptive review
Weyman (1998)
Cross sectional study. Focus groups informed questionnaire survey analysed by factor analysis
Wong et al (2005)
Cross sectional interview survey. N = 163 hairdressing students
White et al (1988)
Cross sectional questionnaire survey. N = 169 painters
De Vries and Lechner (2000) Cross sectional questionnaire survey of lab/mechanical workers.
N
= 164 workers / 4 worksites
Roy (2003)
Qualitative exploratory research of Self Directed Work Teams
(SDWT) - multiple case studies/ints. N = 12 manufacturing factories
in Canada (N = 60 interviews)
246
Generic
Bakery / food processing agents
Re Skin protection - but issues may apply
Generic
Re stress but issues may apply
Generic
Re safety/accidents but may apply
Blood and body fluid exposures - but
issues may apply
Generic
More re injury but issues may apply
Generic
Generic
Generic
Re Mines but issues may apply
Generic
Generic
Re Cancer but issues may apply?
Generic
Overall Factor
7.3.7
Overall Factor
Training
Specific Factors Evidence Stage
Reviews Mentioned in
Identified
Weighting of OA
Frames of
Moderate 1,2,4
Weyman et al (1999)
Reference
1,2,4
Trainor, Weyman and
Anderson (1998)
1,2,4
Godin et al (2000)
Evidence Quality
Agent / Condition / Generic
Descriptive/theoretical Review and Workshop/Expert Opinion
Generic
Cross sectional case studies involving interviews and focus groups. 3 Re Mines but issues may apply
case studies.
Blood borne pathogens - but issues may
Questionnaire survey at baseline and 3 months. N = 156 registered
nurses
apply
Soft Organisational Communication
Specific Factors Evidence
Stage
Reviews Mentioned in
Identified
Weighting of OA
Training Aids
Weak
1,2,4
Walsh et al (2002)
Delivery /
Strong
1,2,4
Pilkington et al (2002)
Timing
1,2,4
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Risk Assessment
/ Health & Safety
Strong
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Evidence Quality
Evaluation of video monitoring technique
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Cross sectional observation (N = 21) and focus groups (N = 35) and
literature review.
Also pilot testing of interventions using
ques/interviews (N = 8)
Benjamin et al (2002)
Cross sectional questionnaire/interview survey. 24 training providers
and 22 asbestos workers
Creely et al (2003)
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Robertson and Stewart
Questionnaire (N = 200) and focus group (N = 33) survey and
(2004)
literature review
Llewellyn et al (????)
Cross sectional survey. 103 questionnaires
Wong et al (2005)
Cross sectional interview survey. N = 163 hairdressing students
Wallen and Mulloy (2005) - 3 versions of computer based respirator training module evaluated
abstract
with manufacturing workers.
Coppieters et al (2003) Questionnaire and group discussion study evaluating CD-ROM tool.
abstract
N = 113 students
McGhan et al (2005)
Descriptive Review
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Gadd et al (2000)
Review and Interviews. 24 SMEs
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
Wright and Collins (2002) Case studies and Review. 10 case studies
247
Agent / Condition / Generic
Tetrachloroethene (dry cleaning)
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Re Asbestos but issues may apply
Formaldehyde / White Spirit
Re MSDs but issues may apply
Agriculture agents but not specific
Generic
Generic
Hairdresser, carpentry or baker
Asthma
Re Noise but issues may apply
Generic
Generic
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
of OA
1,2,4
Pilkington et al (2002)
1,2
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Milnes (2001)
Anonymous (2002) abstract
Chambers, Sandys and
Piney (2005)
Trainor, Weyman and
Anderson (1998)
Howe and Simpson (2005) DRAFT
Pengelly et al (1998)
Alston et al (1997)
Dilworth (2000)
Packham (2002)
Lincoln et al (2002)
1,2,4
1,2,4
Bresnitz et al (2004)
Dejoy et al (2000)
1,2,4
1,2,4
1,2,4
Brown (2004)
Binks (2003)
Bradshaw et al (2001)
1,2,4
1,2,4
1,2,4
Controls / PPE
and RPE
Company Size
Strong
Moderate
Management
Moderate
Limited
Agent / Condition / Generic
Cross sectional telephone interview survey and some follow up. 4950 Generic
companies and 50 face to face follow up interviews
Review of 61 risk assessments
Re Manual Handling but issues may apply
Case study from magazine article
Glutaraldehyde
Case study of 1 company. Site visit and interviews (4 sprayers and 1
manager, plus 28 monitoring samples).
Cross sectional case studies involving interviews and focus groups. 3
case studies.
Internet search of training courses and telephone survey of training
providers (N = 16)
Cross sectional survey and site visits. 26 sites and 239 samples
Cross sectional survey and interviews. 11 orgs / 45 users
Cross sectional survey and sampling. 47 sites / 386 samples
Brief descriptive review
Prospective RCT / Case-control evaluation of 2-day training
programme for nurse compensation case managers.
N = 101 claimants (53 trained group / 48 non-trained group)
Descriptive Review
Study using PRECEDE model to examine factors related to
compliance with precautions. Part of survey study. N = 902 nurses
Isocyanates
Re Mines but issues may apply
Welding fume
Rosin based solder flux fume
Vapour
Wood dust
Re Dermatitis but issues may apply
Upper extremity disorders but issues may
apply
Variety mentioned
Blood borne pathogens - but issues may
apply
Dermatitis - but issues may apply
Generic but mentions OA
Generic
1,2
Descriptive Review
Descriptive Review
Cross sectional survey/interviews - quantitative and qualitative data.
28 mgrs
Worsell et al (2001)
Cross sectional survey using focus groups and telephone interviews (N
= 51 during recruitment and N = 8 wood reps)
O'Hara and Dickety (2000) 12 case studies and literature review
1,2,4
1,2,4
1,2,4
1,2,4
Llewellyn et al (????)
Elms et al (2004)
Collins (2003)
Gadd and Collins (2002)
Cross sectional survey. 103 ques
Cross sectional survey and dust sampling. 55 bakeries
Site visits and literature review. 6 companies
Literature Review – descriptive
Agriculture agents but not specific
Flour dust
Agents relevant to rubber industry
Generic
1,2,4
Hofmann and Morgeson
(2004)
Neal and Griffin (2004)
Book chapter
Generic
Book chapter
Generic
1,2,4
Sector
Evidence Quality
1,2,4
248
More re accidents but some ref to wood
dust
Generic
Overall Factor
Specific Factors Evidence
Stage
Reviews Mentioned in
Identified
Weighting of OA
Training Benefits Moderate 1,2,4
Shearn (2005)
1,2,4
1) Weyman & Milnes 2001
2) Weyman & Marlow 2004
4
Ram (2003)
1,2,4
Avory and Coggon (1994)
1,2,4
Gershon et al (2000)
Schooling /
Vocational
training
Moderate
1,2,4
1,2,4
1,2,4
Risk
Communication /
Information
Access
Moderate
1,2,4
4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Need
1,2,4
1,2,4
4
1,2,4
Very strong 4
1,2,4
1,2,4
Evidence Quality
Agent / Condition / Generic
Case study. 1 company / 7 interviews
Cross sectional questionnaire surveys.
1) 215 questionnaires. 2) 347 questionnaires
Review of Cochrane systematic reviews
Interview survey. N = 84 agricultural workers / 79 farms
Study to develop hospital safety climate tool. Cross sectional survey
testing questionnaire on 789 hospital based health care staff
Weyman and Shearn (2004) Case studies. 7 schools / 51 staff
Generic
Re Manual Handling but issues may apply
Coppieters and Piette
(2004)
Walusiak et al (2002)
High risk occupations included
hairdressing, wood working and bakery.
Bakery dust and flour
Asthma
Pesticides - but issues may apply
Blood borne pathogens - but issues may
apply
Generic
Cross sectional questionnaire study of pupils attending training in high
asthma risk occupations compared with low risk ones.
N = 533.
Questionnaire survey and skin prick testing. N = 357 apprentice
bakers from Poland before and after a year of vocational training
Brown (2004)
Descriptive Review
Rosenthal and Forst (2001) Descriptive Review
Llewellyn et al (????)
Cross sectional survey. 103 ques
Dilworth (2000)
Cross sectional survey and sampling. 47 sites / 386 samples
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups.
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
Alston et al (1997)
Cross sectional survey and interviews. 11 orgs/45 users
O'Hara and Dickety (2000) 12 case studies and literature review
Dermatitis - but issues may apply
Generic
Agriculture agents but not specific
Wood dust
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Vapour
Generic
Avory and Coggon (1994)
Bresnitz et al (2004)
Lardner et al (2000)
Covello (1997)
Reijula (1997)
Levin et al (2000)
Pilkington et al (2002)
Pesticides - but issues may apply
Variety mentioned
Generic
Generic
Generic
Isocyanates
Generic
1,2,4
Hughson et al (2002)
1,2,4
1,2,4
1,2,4
Gadd et al (2000)
Shearn (2005)
Rosen et al (2005)
Interview survey. N = 84 agricultural workers / 79 farms
Descriptive Review
Descriptive Review
Book chapter
Magazine Article
Workshop Report
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Review and Interviews. 24 SMEs
Case study. 1 company / 7 interviews
Descriptive review
249
Re Noise but issues may apply
Generic
Generic
Generic
Overall Factor
Specific Factors Evidence
Identified
Weighting
Stage
Reviews Mentioned in
of OA
1,2,4
Bradshaw et al (2001)
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Solutions
Strong
1,2,4
1,2,4
1,2,4
1,2,4
Consistency
Moderate
1,2,4
1,2,4
4
1,2,4
1,2,4
Preferences
Moderate
1,2,4
1,2,4
1,2,4
1,2,4
Media / Delivery
Moderate
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Evidence Quality
Cross sectional survey/interviews - quantitative and qualitative data.
28 mgrs
Worsell et al (2001)
Cross sectional survey using focus groups and telephone interviews.
N = 51 during recruitment / N = 8 wood reps
Weyman and Kelly (???)
Literature Review - theoretical
Lahtinen et al (2004)
Collective case study (N=15) using quant questionnaires and qual
interviews (triangulation of data)
Chambers, Sandys and
Case study of 1 company. Site visit and interviews (4 sprayers and 1
Piney (2005)
manager, plus 28 monitoring samples).
Dejoy et al (2000)
Study using PRECEDE model to examine factors related to
compliance with precautions. Part of survey study. N = 902 nurses
Weyman and Kelly (???)
Literature Review - theoretical
Creely et al (2003)
Longitudinal workplace (N = 14) and laboratory controlled
(N =
24) studies
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
O'Hara (2005)
Cross sectional questionnaire survey - pre and post intervention
design. 233 ques at baseline and 215 ques at post intervention
Rosen et al (2005)
Descriptive review
Walsh et al (2002)
Evaluation of video monitoring technique
Kolbe (1999)
Descriptive Review
Robertson and Stewart
Questionnaire (N = 200) and focus group (N = 33) survey and
(2004)
literature review
Trainor, Weyman and
Cross sectional case studies involving interviews and focus groups. 3
Anderson (1998)
case studies.
Covello (1997)
Book chapter
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups.
Llewellyn et al (????)
Cross sectional survey. 103 ques
Robertson and Stewart
Questionnaire (N = 200) and focus group (N = 33) survey and
(2004)
literature review
Weyman and Kelly (???)
Literature Review - theoretical
Vaughan (2005)
Anecdotal conversation
Sadhra et al (2002)
Survey and workshop. N = 21 interviews and 84 questionnaires
Lymer and Isaksson (2004) Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing
assistants)
Covello (1997)
Book chapter
250
Agent / Condition / Generic
Generic
More re accidents but some ref to wood
dust
Generic
Generic
Isocyanates
Blood borne pathogens - but issues may
apply
Generic
Formaldehyde
White Spirit
Re Noise but issues may apply
Isocyanates
Generic
Tetrachloroethene (dry cleaning)
Asthma
Re MSDs but issues may apply
Re Mines but issues may apply
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Agriculture agents but not specific
Re MSDs but issues may apply
Generic
Generic
Chromium plating chemicals
Blood borne pathogens - but issues may
apply
Generic
Overall Factor
Specific Factors Evidence
Stage
Reviews Mentioned in
Identified
Weighting of OA
Relevance
Moderate 1,2,4
Pilkington et al (2002)
1,2,4
1,2,4
1,2,4
1,2,4
Company Size
Usability
1,2,4
1,2,4
4
1,2,4
1,2,4
Very strong 1,2,4
1,2,4
1,2,4
1,2,4
1,2
1,2,4
1,2,4
4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Evidence Quality
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups.
Gadd et al (2000)
Review and Interviews. 24 SMEs
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
Weyman et al (1999)
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Llewellyn et al (????)
Cross sectional survey. 103 ques
Sadhra et al (2002)
Survey and workshop. N = 21 interviews and 84 questionnaires
Lardner et al (2000)
Descriptive Review
Covello (1997)
Book chapter
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups.
Vaughan (2005)
Anecdotal conversation
White and Benjamin (2003) Descriptive Review
Chambers, Weyman and
Cross sectional site visits/interviews. 25 sites
Keen (2002)
Creely et al (2003)
Longitudinal workplace (N = 14) and laboratory controlled (N = 24)
studies
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
Burgess et al (2001)
Prospective Study
Wright and Collins (2002) Case studies and Review - 10 case studies
Weyman et al (1999)
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Levin et al (2002)
Pilot questionnaire study
Sadhra et al (2002)
Survey and workshop. N = 21 interviews and 84 questionnaires
O'Hara and Dickety (2000) 12 case studies and literature review
Chambers, Sandys and
Piney (2005)
Packham (2002)
Agent / Condition / Generic
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Generic
Generic
Agriculture agents but not specific
Chromium plating chemicals
Generic
Generic
Re Noise but issues may apply
Agent: Printing chemicals. Re OCD but
issues may apply
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Generic
Surface coating metal products (paint)
Formaldehyde / White Spirit
Generic
Generic
Generic
Generic
Generic
Chromium plating chemicals
Generic
Case study of 1 company. Site visit and interviews (4 sprayers and 1 Isocyanates
manager, plus 28 monitoring samples).
Brief descriptive review
Re Dermatitis but issues may apply
251
Overall Factor
Specific Factors Evidence
Identified
Weighting
Source
Strong
Stage
Reviews Mentioned in
of OA
1,2,4
Rabatin and Cowl (2001)
1,2,4
Noiesen et al (2004) abstract
1,2,4
Bresnitz et al (2004)
1,2,4
Binks (2003)
1,2,4
Covello (1997)
1,2,4
O'Neill (1995)
1,2
Chambers, Weyman and
Keen (2002)
1,2,4
Pilkington et al (2002)
Audience
7.3.8
Overall Factor
Change
Moderate
Limited
Agent / Condition / Generic
Descriptive Review
Qualitative interview and observational study. N = 8 women
Variety mentioned
Re Dermatitis but issues may apply
Descriptive Review
Descriptive Review
Book chapter
Book chapter
Cross sectional site visits/interviews. 25 sites
Variety mentioned
Generic but mentions OA
Generic
Asthma
Surface coating metal products (paint)
Generic
1,2,4
1,2,4
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Weyman and Kelly (???)
Literature Review - theoretical
Jackson (2004)
Randomised control trial design study and survey. 139 participants
(77 Immediate advice group / 62 delayed advice group)
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
O'Hara and Dickety (2000) 12 case studies and literature review
1,2,4
Weyman et al (1999)
Generic
1,2,4
1,2,4
Sadhra et al (2002)
Jensen and Kofoed (2002)
1,2,4
1,2,4
1,2,4
Covello (1997)
Sadhra et al (2002)
Covello (1997)
1,2,4
1,2,4
Credibility
Evidence Quality
Descriptive/theoretical Review and Workshop Discussions/Expert
Opinion
Survey and workshop. N = 21 interviews and 84 questionnaires
Questionnaire and interview study. N = 102 floor layers and 180
apprentice layers. Ints N = 88 floor layers and 16 key persons.
Book chapter
Survey and workshop. N = 21 interviews and 84 questionnaires
Book chapter
Generic
Generic
Generic
Generic
Chromium plating chemicals
Re MSDs but issues may apply
Generic
Chromium plating chemicals
Generic
Soft Organisational Work Patterns
Specific Factors
Identified
Hours/Shifts
Resistance
Evidence
Weighting
Moderate
Limited
Stage
of OA
Study Mentioned in
Evidence Quality
Agent / Condition / Generic
1,2
Kenny et al (2002)
Regulations impact / Risk estimation report
Coal dust
1,2
Devereux et al (2004)
Cross sectional survey and prospective cohort study. Sample 3139
1,2,4
Godin et al (2000)
1,2,4
Trainor et al (2002)
Questionnaire survey at baseline and 3 months. N = 156 registered
nurses
Cross sectional case study interviews and review. 3 companies
Stress and MSDs - but may apply to
asthma
Blood borne pathogens - but issues may
apply
Generic
252
7.3.9
Overall Factor
General
Intervention
Hard Organisational
Specific Factors
Identified
Evaluation
Healthy Worker
Effect
Evidence
Weighting
Moderate
Stage
Reviews Mentioned in
of OA
1,2,4
Roelofs et al (2003)
4
Redlich et al (2002)
4
1,2,4
Descriptive Review
1 year follow up of the Survey of Painters and Repairers of Auto
Bodies by Yale (SPRAY) to investigate exposure of autobody shop
workers (N = 45) over time - using questionnaire and sampling
Brooks (1995)
Descriptive Review
Oliver et al (2001) Cross sectional study of lung function testing and symptom self
abstract
reports in construction workers. N = 389 workers.
Eisen et al (1997)
Reanalysis of cross sectional survey of asthma. N = 1788
autoworkers
O'Neill (1995)
Book chapter
Sim (2003) – themes
Expert Opinion
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Llewellyn et al (????)
Cross sectional survey. 103 questionnaires
Henley (1996)
Brief descriptive review
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies/280 ques. Phase 2: 4
companies/21 ques
Kim et al (2001)
Pre/Post Study of educational intervention in USA - observation at
baseline and 1 and 2 years post intervention.
N=
103 (1997) / 66 (1998).
Agner and Held (2002)
Descriptive Review
Schweigert et al (2000)
Descriptive Review
1,2,4
Liss and Tarlo (2001)
1,2,4
1,2,4
1,2,4
Hopkins (1998)
Brown (2004)
Cutter and Jordan (2004)
4
4
Lardner et al (2000)
Lardner et al (2000)
4
Boss et al (2005) - abstract Review of interventions and preparation for implementation.
4
4
4
Targets
Exposure
Complexity
Practicality
Lacking action
Efficacy
Weak
Limited
Evidence Quality
4
4
1,2,4
Limited
1,2,4
Weak
1,2,4
Very Strong 1,2,4
1,2,4
Review of asthma claim cases and interventions included in Ontario,
Canada
Descriptive Review
Descriptive Review
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Descriptive Review
Descriptive Review
253
Agent / Condition / Generic
Generic
Hexamethylene diisocyanate (HDI)
Asthma
Generic
Metal working fluids
Asthma
Asthma
Agent: Printing chemicals. Re OCD but
issues may apply
Agriculture agents but not specific
Asthma
Re Noise but issues may apply
Blood and body fluid exposures - but
issues may apply
Re skin protection but issues may apply
Enzymes (proteases, amylases, lipases,
cellulases)
Latex
Generic
Dermatitis - but issues may apply
Blood and body fluid exposures - but
issues may apply
Generic
Generic
Asthma
Overall Factor
Primary
Intervention
Specific Factors Evidence
Stage
Reviews Mentioned in
Evidence Quality
Identified
Weighting of OA
Screening
Very Strong 1 and 2 BOHRF (2004)
Systematic Review
1,2
Boorman (2004) – themes Magazine Article
1,2,4
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
1,2,3
BOHRF (2005)
Systematic Review
1,2,4
Brooks (1995)
Descriptive Review
1,2,4
Anonymous (2001) Workshop report
abstract
1,2,4
Hendrick (1994)
Descriptive Review
1,2,4
Schweigert et al (2000)
Descriptive Review
Recruitment
Familiarity
Barriers
Status Quo
Substitution
Barriers
Incentives /
reward
Weak
Weak
Weak
Moderate
Limited
Agent / Condition / Generic
Asthma
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Asthma
Asthma
Generic
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Baur et al (1998)
Tarlo and Liss (2001)
Douglas (2005)
Evans (1996)
Niven and Pickering (1999)
O'Neill (1995)
Fell-Carlson (2004)
Roelofs et al (2003)
Descriptive Review
Editorial
Descriptive Review
Brief editorial/review
Brief descriptive review
Book chapter
Descriptive review
Descriptive Review
Asthma
Enzymes (proteases, amylases, lipases,
cellulases)
Variety mentioned
Asthma
Variety mentioned
Asthma
Generic but mentions asthma
Asthma
Generic
Generic
1,2
1,2,4
1,2,4
Roelofs et al (2003)
Elms et al (2004)
Chambers, Weyman and
Keen (2002)
O'Neill (1995)
Roelofs et al (2003)
Devereux et al (2004)
Weyman 1999
Fell-Carlson (2004)
Weyman (1998)
Chambers, Sandys and
Piney (2005)
Haines et al (2001)
Descriptive Review
Cross sectional survey and dust sampling. 55 bakeries
Cross sectional site visits/interviews. 25 site visits
Generic
Flour dust
Surface coating metal products (paint)
1,2,4
1,2,4
1,2
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
Book chapter
Descriptive Review
Cross sectional survey and prospective cohort study. Sample 3139
Literature Review
Descriptive review
Cross sectional study. Focus groups informed questionnaire survey
Case study of 1 company. Site visit and interviews (4 sprayers and 1
manager, plus 28 monitoring samples).
Cross sectional questionnaire survey. N = 329 team members at an
aluminium production plant.
Sinclair and Tetrick (2004) Book chapter
Hofmann and Morgeson
Book chapter
(2004)
254
Asthma
Generic
Stress and MSDs - may apply to asthma
Generic
Generic
Re Mines but issues may apply
Isocyanates
Generic
Generic
Generic
Overall Factor
Secondary
Intervention
Specific Factors
Identified
Exposure limits
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Limited
4
Curran & Fishwick (2003)
4
Cullinan et al (2003) –
themes
1,2,4
Dilworth (2000)
1,2,4
Topping (2001) - abstract
1,2,4
Galdi and Moscato (2002) abstract
1,2,4
Schweigert et al (2000)
1,2,4
SWORD
Limited
4
4
4
4
Dedhia et al (2000) abstract
Curran & Fishwick (2003)
Davidson (1996)
Curran and Fishwick
(2003)
De Bono and Hudsmith
(1999)
Baur et al (1998)
Hendrick (1994)
Evans (1996)
Burge (1997)
O'Neill (1995)
BOHRF (2004) (themes)
Tarlo and Liss (2002) –
themes
Cullinan et al (2003)
Sim (2003) – themes
Innes et al (1998)
Fishwick et al (2003)
1,2,4
1,2,4
Dilworth (2000)
Bradshaw et al (2001)
4
Jeffrey et al (1999)
1,2,4
Bradshaw et al (2005)
4
4
3
3
Health
surveillance
4
1,2,4
1,2,4
4
4
Very Strong 4
4
Evidence Quality
Agent / Condition / Generic
Expert Opinion
Descriptive Review
Asthma
Asthma
Cross sectional survey and sampling. 47 sites / 386 samples
Descriptive Review
Descriptive Review
Wood dust
Generic
Asthma
Descriptive Review
Descriptive Review
Enzymes (proteases, amylases, lipases,
cellulases)
Isocyanate
Expert Opinion
Descriptive Review
Workshop recommendations
Asthma
Generic
Asthma
Descriptive Review of 182 GP notes of adult onset asthma patients
Variety mentioned
Descriptive Review
Descriptive Review
Brief editorial/review
Book Chapter
Book chapter
Systematic Review
Evaluation
Variety mentioned
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Descriptive Review
Review
Descriptive Review
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Cross sectional survey and sampling. 47 sites / 386 samples
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
Cross sectional survey and dust sampling. 224 individuals / 18
bakeries
Longitudinal (2 and 12 months) qualitative survey/interviews.
97 workers from 6 national centres (92 follow up)
Asthma
Asthma
Asthma
Asthma
255
Wood dust
Generic
Flour dust
Asthma
Overall Factor
Specific Factors
Identified
Over-reliance
Worker
Compliance
Evidence
Weighting
Weak
Moderate
Stage
Reviews Mentioned in
Evidence Quality
of OA
1,2,4
Brown and Rushton (2003) Cross sectional observation and focus groups and literature review.
Also pilot testing of interventions using ques/interviews.
Obs = 21 companies. FGps = 35 participants. Intv Test = 8 companies
1,2
BOHRF (2005)
Systematic Review
1,2,4
Merget et al (2001)
Nested case control study, using questionnaire, interview and skin
prick tests. 14 workers / 42 Controls.
1,2,4
Baur et al (1998)
Descriptive Review
1,2,4
Tarlo and Liss (2001)
Editorial
1,2,4
Tarlo et al (2002)
Retrospective review of OA claims by Ontario Workers Compensation
Board (WCB) between 1980 and 1993. N = 844 new claims
1,2,4
Bresnitz et al (2004)
Descriptive Review
1,2,4
Murphy et al (2002) Audit and review of health surveillance programme and OH
abstract
records/RAs.
1,2,4
Smith (2004) - abstract
Evaluation of in house respiratory health surveillance programme
1,2,4
Sarlo (2003) – themes
Descriptive review
1,2,4
Roelofs et al (2003)
Descriptive Review
1,2,4
Trim et al (2003)
Questionnaire survey. N = 200 health care workers
1,2,4
1,2,4
Tertiary
Intervention
Bio' Feedback
Redeployment
Weak
Strong
Rehabilitation
(RTW)
Strong
1,2
4
4
4
4
4
4
4
4
4
4
4
4
4
Bresnitz et al (2004)
Cutter and Jordan (2004)
Descriptive Review
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Jones (2004)
Case examples - sent by email. 2 case examples.
Curran & Fishwick (2003) Expert Opinion
BOHRF (2004)
Systematic Review
Marabini et al (2003)
Longitudinal study
Adisesh et al (2002)
Cross sectional survey. 510 reporting physicians
Vaughan (2005)
Anecdotal conversation
BOHRF (2005)
Systematic Review
Conner (2002)
Case study of one large company in USA
Soyseth et al (1995) 2 year case control study. N = 12 who were relocated and 26 who
abstract
stayed in original work environments.
Tarlo et al (1997) - abstract Review of OA claims. N = 609.
Curran & Fishwick (2003) Expert Opinion
Krause and Lund (2004)
Book chapter
Krause and Lund (2004)
Book chapter
Nathell (2005) - abstract
Longitudinal randomised evaluation of rehabilitation programme. N =
197.
256
Agent / Condition / Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Asthma
Platinum salt
Variety mentioned
Asthma
Isocyanates - but also variety mentioned
Variety mentioned
Generic
Asthma
Asthma
Generic
Blood borne pathogens - but issues may
apply
Variety mentioned
Blood and body fluid exposures - but
issues may apply
MbOCA Solvent
Asthma
Asthma
Asthma
Dermatitis - but issues may apply
Generic
Asthma
Toluene Diisocyanate (TDI)
Aluminium potroom asthma
Isocyanates
Asthma
Generic / Injury
Generic / Injury
Asthma
Overall Factor
Diagnostic
Barriers
Specific Factors
Identified
Evidence
Weighting
Rehabilitation
Techniques
Limited
Retraining
Strong
OA Management
Programmes:
Asthma
Education
Strong
OA Management
Programmes:
Written Action
Plans
Strong
Consensus
Stage
Reviews Mentioned in
of OA
4
Green-McKenzie et al
(2002)
4
Bernacki and Guidera
(1998)
1,2,4
Lincoln et al (2002)
4
4
4
4
4
4
4
4
4
4
Strong
4
4
4
4
4
4
3
3
3
3
3
4
Evidence Quality
Pre/Post intervention study of hospital workers. N ~ 6000.
Pre/Post analysis of managed care compensation programme.
All claims 1990-1997 reviewed.
Prospective RCT / Case-control evaluation of 2-day training
programme for nurse compensation case managers.
N = 101 claimants (53 trained group / 48 non-trained group)
Kamal and Miller (2004)
Letter
Petrie et al (2003)
Book Chapter
Schmaling et al (2003)
Descriptive Review
Bucknall et al (1999)
Medical records review
Fishwick et al (1997)
Descriptive Review
Fleming et al (2003)
Systematic Review
BOHRF (2005)
Systematic Review
Harber (1996)
Editorial letter/Epitome
Burton et al (2001)
Longitudinal evaluation of asthma management programme at 1 large
(also referenced in various company. N = 41 participants completing ATAQ questionnaire,
other specific categories) followed up at 2, 4 and 12 months.
Lucas et al (2001)
Evaluation of Asthma Self-Management Programme - 2 year follow
(also referenced in various up survey. N = 110
other specific categories)
McGhan et al (2005)
Descriptive Review
Ram (2003)
Review of Cochrane systematic reviews
Powell and Gibson (2004) Systematic Review
Kemple and Rogers (2003) Longitudinal single blinded randomised controlled trial. N = 241
adults with asthma and prescribed inhalers
Haynes et al (2002)
Systematic Review
Fishwick et al (1997)
Descriptive Review
Curran & Fishwick (2003) Expert Opinion
Fishwick et al (2003)
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Curran and Fishwick
Workshop recommendations
(2003)
Anees et al (2002)
2 studies: 1: Cross sectional study (104 workers)
2: Longitudinal field study (228 workers)
Miller et al (2003)
Review and re-analysis of postal survey data set. 11941 in data set
Cullinan et al (2003)
Descriptive Review
257
Agent / Condition / Generic
Generic
More re injury and surgical workers but
issues may apply
Upper extremity disorders but issues may
apply
Asthma
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Grain
Asthma
Asthma
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
1,2
Fishwick et al (2003)
4
3
Route / Delay
Strong
3
3
3
3
3
3
Techniques
3
Very Strong 3
3
3
3
3
3
3
3
3
Evidence Quality
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case studies). Purpose developed ques
Moffat et al (2002)
Interview survey with 13 GPs
Axon et al (1995)
Questionnaire survey. N = 26 patients with OA and 29 patients with
non-occupational asthma.
Curran & Fishwick (2003) Expert Opinion
Fishwick et al (2003)
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Poonai et al (2005)
Structured telephone questionnaire survey with patients fulfilling OA
criteria (N = 42).
Gannon et al (1993)
Questionnaire survey - follow up study of workers with OA (diagnosis
1 year earlier). N = 112
Munoz et al (2003) Longitudinal study and testing of 8 patients with OA.
abstract
Liss and Tarlo (2001)
Review of asthma claim cases and interventions included in Ontario,
Canada
Vandenplas et al (2003)
Descriptive Review
BOHRF (2004)
Systematic Review
Miller et al (2003)
Review and re-analysis of postal survey data set. 11941 in data set
Anees et al (2002)
2 studies: 1: Cross sectional study (104 workers)
2: Longitudinal field study (228 workers)
BOHRF (2004)
Systematic Review
Lad (2003) - themes
Descriptive Review
Snashall (2003) - themes
Descriptive Review
Tarlo and Liss (2002) Evaluation
themes
Lombardo and Balmes
Descriptive Review
(2000) - themes
Girard et al (2004) –
Study
themes info
BOHRF (2005)
Systematic Review
Tarlo and Liss (2003)
Descriptive Review
Mihalas (1999)
Descriptive Review
Cartier (2003)
Descriptive Review
Gordon et al (1997)
Questionnaire study - screening questionnaire / interviews and
questionnaire attitude survey. 1994 N = 335 / 1995 N = 341 / attitude
survey N = 50 ques and 50 ints).
258
Agent / Condition / Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Variety mentioned
Persulfate salts
Latex
Asthma
Asthma
Asthma
Grain
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Variety mentioned
Variety mentioned
Asthma
Flour
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
3
Axon et al (1995)
Questionnaire survey. N = 26 patients with OA and 29 patients with
non-occupational asthma.
Review and questionnaire study of Quebec Compensation System.
N = 134 subjects and 91 controls
Descriptive Review
Questionnaire and testing study. N = 472 workers in first part and N =
79 workers in second part
Descriptive Review
3
Malo et al (1993)
3
3
Rabatin and Cowl (2001)
Meijer et al (2002) abstract
Bright and Burge (1996) abstract
Zock et al (1998) - abstract Study of expert agreement of peak flow graphs. N = 49 potato
processing workers.
Tarlo and Liss (2001)
Editorial
Bresnitz et al (2004)
Descriptive Review
Tilles and Jerath-Tatum
Descriptive Review
(2003)
Moscato et al (2003)
Descriptive Review
Vigo and Grayson (2005) Descriptive Review
Hegde et al (2002)
Questionnaire/interview study. N = 150 Indian general practitioners.
Redlich and Anwar (1998) Descriptive Review
Vandenplas et al (2001) - Diagnostic investigation of patients. N = 45.
abstract
Fishwick and Curran
Magazine Article
(1999)
White and Benjamin (2003) Descriptive Review
Fishwick et al (2003)
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Tarlo and Liss (2003)
Descriptive Review
Cartier (2003)
Descriptive Review
Axon et al (1995)
Questionnaire survey. N = 26 patients with OA and 29 patients with
non-occupational asthma.
De Bono and Hudsmith
Review of 182 GP notes of adult onset asthma patients
(1999)
Packham (2002)
Brief descriptive review
Anonymous (2002)
Descriptive Review
Rabatin and Cowl (2001) Descriptive Review
Bright and Burge (1996) - Descriptive Review
abstract
3
3
3
3
3
3
3
3
3
3
Cause
uncertainty
Evidence Quality
Very Strong 3
3
3
3
3,4
3
3
3
3
3
3
259
Agent / Condition / Generic
Asthma
Variety mentioned
Variety mentioned
Laboratory animals
Asthma
Asthma
Asthma
Variety mentioned
Variety mentioned
Asthma
Variety mentioned
Asthma
Asthma - Variety of agents mentioned
Asthma
Generic
Generic
Asthma
Variety mentioned
Asthma
Asthma
Variety mentioned
Re Dermatitis but issues may apply
Asthma
Variety mentioned
Asthma
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
3
Tilles and Jerath-Tatum
(2003)
3
Moscato et al (2003)
3
Vigo and Grayson (2005)
3
Hendrick (1994)
3
Evans (1996)
3
Redlich and Anwar (1998)
3
Burge (1997)
1,2,3
Elms et al (2003)
3,4
Elms et al (2003)
Evidence Quality
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Brief editorial/review
Descriptive Review
Book Chapter
Test
Limited
Serum sample investigations. 135 samples
comprehensiveCross sectional survey and sample testing. 117 samples / 22
ness
organisations
3
Tarlo and Liss (2003)
Descriptive Review
3
Conner (2002)
Case study of one large company in USA
3
Fishwick et al (2005)
Letter to Editor
Honesty
Limited
3,4
Curran and Fishwick 2003 Workshop recommendations
2,3,4
Griffin et al (2001)
Letter to Editor
3
Gordon et al (1997)
Questionnaire study - screening questionnaire / interviews and
questionnaire attitude survey. 1994 N = 335 / 1995 N = 341 / attitude
survey N = 50 ques and 50 ints).
3
Moscato et al (2003)
Descriptive Review
3
Hendrick (1994)
Descriptive Review
Fear (Economic / Very Strong 3
Curran & Fishwick (2003) Expert Opinion
Confidentiality)
3
Snashall (2003) – themes Review
Overlaps with
3
Romano-Woodward (2004) Review
Emotion
– themes
4
Bucknall et al (1999)
Medical records review
4
Cullinan et al (2003)
Descriptive Review
4
Venables et al (1989)
Questionnaire Study
3 and 4 Creer and Levstek (2001) Descriptive Review
2,3,4
Hoyle et al (2002)
Cross sectional controlled study, survey and sampling. 911 men 9 in
10 foundries (509 exposed group / 402 non-exposed group)
4
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
1,2
Devereux et al (2004)
Cross sectional survey and prospective cohort study. Sample 3139
1,2,4
3,4
Weyman (1999)
Bradshaw et al (2005)
Literature Review
Longitudinal (2 and 12 months) qualitative survey/interviews.
97 workers from 6 national centres (92 follow up)
260
Agent / Condition / Generic
Variety mentioned
Asthma
Variety mentioned
Asthma
Asthma
Asthma - Variety of agents mentioned
Asthma
Wheat and enzymes
Flour and enzymes
Variety mentioned
Toluene Diisocyanate (TDI)
Bakery flour and additives
Asthma
Wheat flour
Flour
Asthma
Asthma
Asthma
Asthma
Generic
Asthma
Asthma
Asthma
Generic
Isocyanates, amines, aldehydes, furfuryl
alcohol
Generic
Stress and MSDs - but may apply to
asthma
Generic
Asthma
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
3
Fishwick et al (2003)
3,4
3,4
4
4
1,2,4
3,4
3
4
1,2,4
3
4
4
4
4
4
4
Evidence Quality
Prospective Survey (N = 97 interviews / 77 re-interviewed) and
Retrospective Case Study (N = 17 case notes). Purpose developed
ques. 6 respiratory specialist centres
Bradshaw et al (2005)
Longitudinal (2 and 12 months) qualitative survey/interviews.
97 workers from 6 national centres (92 follow up)
Bradshaw et al (2001)
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
Elms et al (2003)
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Bradshaw et al (2005)
Longitudinal (2 and 12 months) qualitative survey/interviews. 97
workers from 6 national centres (92 follow up)
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
BOHRF (2005)
Systematic Review
Mihalas (1999)
Descriptive Review
Mancuso et al (2003) Questionnaire study. 196 patients in an urban practice completed
abstract
standardised major and minor life events scales
Weyman (1998)
Cross sectional study. Focus groups informed questionnaire survey analysed by factor analysis
Gordon et al (1997)
Questionnaire study - screening questionnaire / interviews and
questionnaire attitude survey. 1994 N = 335 / 1995 N = 341 / attitude
survey N = 50 ques and 50 ints).
Cannon et al (1995)
Questionnaire Survey. N = 225 (113 OA, 37 WRA, 75 unrelated to
work)
Axon et al (1995)
Questionnaire survey. N = 26 patients with OA and 29 patients with
non-occupational asthma.
Ross and McDonald (1998) Questionnaire Survey of 1317 cases / 312 physicians
Gannon et al (1993)
Questionnaire survey - follow up study of workers with OA (diagnosis
1 year earlier). N = 112
Rabatin and Cowl (2001) Descriptive Review
Bernstein (2002)
Case study and questionnaire survey. Ques N = 58 health care
workers (HCWs)
Agent / Condition / Generic
Asthma
Asthma
Generic
Asthma
Asthma
Generic
Asthma
Variety mentioned
Asthma
Re Mines but issues may apply
Flour
Asthma
Asthma
Asthma
Variety mentioned
Variety mentioned
Natural rubber latex (NRL)
3
Vigo and Grayson (2005)
Descriptive Review
Variety mentioned
1,2,4
O'Neill (1995)
Book chapter
Asthma
261
Overall Factor
Liaison
Specific Factors
Identified
Co-ordination /
Collaboration
Trade
Associations
Resources
Financial
Staff
H&S Staff
Evidence
Stage
Reviews Mentioned in
Evidence Quality
Weighting of OA
Moderate 4
Curran & Fishwick (2003) Expert Opinion
4
Stenton et al (1995)
Letter
1,2,4
Lahtinen et al (2004)
Collective case study (N=15) using quant questionnaires and qual
interviews (triangulation of data)
1,2,4
Gadd et al (2000)
Review and Interviews. 24 SMEs
1,2,4
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
1,2,4
Rosen et al (2005)
Descriptive review
1,2,4
Pilkington et al (2002)
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Moderate 1,2,4
Strutt and Bird (2004)
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
1,2,4
Brosseau et al (2002)
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Moderate 1,2,4
Alston et al (1997)
Cross sectional survey and interviews. 11 orgs / 45 users
1,2
Chambers, Weyman and
Cross sectional site visits/interviews. 25 site visits
Keen (2002)
1,2,4
Pilkington et al (2002)
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
4
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
1,2,4
Bradshaw et al (2001)
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
1,2,4
O'Hara (2005)
Cross sectional questionnaire survey - pre and post intervention
design. 233 questionnaires baseline and 215 questionnaires post
intervention
3
O'Hara and Elms (2004)
Brief workshop report / expert opinion
1,2,4
Rosen et al (2005)
Descriptive review
1,2,4
Worsell et al (2001)
Cross sectional survey using focus groups and telephone interviews (N
= 51 during recruitment / N = 8 wood ind. Reps)
1,2,4
Woskie et al (2004)
Air sampling measurements. N = 380 measurements, 33 body shops.
Weak
1,2,4
Wright and Collins (2002) Case studies and Review. 10 case studies
Moderate 1,2,4
Elms et al (2004)
Cross sectional survey and dust sampling. 55 bakeries
1,2,4
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
1,2,4
Sadhra et al (2002)
Survey and workshop. N = 21 interviews and 84 questionnaires
262
Agent / Condition / Generic
Asthma
Asthma
Generic
Generic
Generic
Generic
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Wood dust
Vapour
Surface coating metal products (paint)
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Generic
Isocyanates
Generic
Generic
More re accidents but some ref to wood
dust
Isocyanates
Generic
Flour dust
Agent: Printing chemicals. Re OCD but
issues may apply
Chromium plating chemicals
Overall Factor
Specific Factors
Identified
Time
Company Size
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Moderate 1,2,4
Llewellyn et al (????)
1,2,4
Strutt and Bird (2004)
Moderate
Evidence Quality
Cross sectional survey. 103 questionnaires
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
1,2,4
O'Hara (2005)
Cross sectional questionnaire survey - pre and post intervention
design. 233 questionnaires baseline and 215 questionnaires post
intervention
1,2,4
Collins (2003)
Site visits and literature review. 6 companies
1,2,4
Gadd et al (2000)
Review and Interviews. 24 SMEs
1,2,4
Trainor et al (2002)
Cross sectional case study interviews and review. 3 companies
1,2,4
Wright and Collins (2002) Case studies and Review. 10 case studies
1,2,4
Weyman and Shearn (2004) Case studies. 7 schools / 51 staff
1,2,4
Shearn (2005)
Case study. 1 company / 7 interviews
1,2,4
Rosen et al (2005)
Descriptive review
1,2,4
Worsell et al (2001)
Cross sectional survey using focus groups and telephone interviews (N
= 51 during recruitment / N = 8 wood ind. Reps)
1,2,4
Trainor, Weyman and
Cross sectional case studies involving interviews and focus groups. 3
Anderson (1998)
case studies.
1,2,4
Lymer and Isaksson (2004) Qualitative interview study in Sweden. N = 15 (9 nurses and 6 nursing
assistants)
1,2,4
Cutter and Jordan (2004)
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
4
Sim (2003) – themes
Review
1 and 2 Cullinan et al (2003)
Descriptive Review
1,2,4
Levin et al (2000)
Workshop report
1,2,4
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases. Phase 1: 19
companies / 280 ques. Phase 2: 4 companies / 21 ques.
Agent / Condition / Generic
Agriculture agents but not specific
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Isocyanates
Agents relevant to rubber industry
Generic
Generic
Generic
Generic
Generic
Generic
More re accidents but some ref to wood
dust
Re Mines but issues may apply
Blood borne pathogens - but issues may
apply
Blood and body fluid exposures - but
issues may apply
Asthma
Asthma
Isocyanates
Re Noise but issues may apply
1,2,4
Hughson et al (2002)
Cross sectional and longitudinal survey in two phases. Phase 1: 19
companies / 280 ques. Phase 2: 4 companies / 21 ques.
Re Noise but issues may apply
1,2
Chambers, Weyman and
Keen (2002)
Hughson et al (2002)
Cross sectional site visits/interviews. 25 site visits
Surface coating metal products (paint)
Cross sectional and longitudinal survey in two phases. Phase 1: 19
companies / 280 ques. Phase 2: 4 companies / 21 ques.
Re Noise but issues may apply
Questionnaire Survey of 1317 cases / 312 physicians
Descriptive Review
Cross sectional postal questionnaire study. N = 41 workplaces in
South Africa
Asthma
Variety mentioned
Seafood processing but issues may apply
1,2,4
4
1,2,4
1,2,4
Ross and McDonald (1998)
Bresnitz et al (2004)
Jeebhay et al (2000) abstract
263
Overall Factor
Specific Factors
Identified
Non compliance
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Moderate 1,2,4
Weyman and Kelly (???)
1,2,4
Strutt and Bird (2004)
Agent / Condition / Generic
1,2,4
Literature Review - theoretical
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Trainor, Weyman and
Cross sectional case studies involving interviews and focus groups. 3
Anderson (1998)
case studies.
Conner (2002)
Case study of one large company in USA
Cutter and Jordan (2004)
Cross sectional Questionnaire Survey of 200 health care workers (90
surgeons, 52 theatre nurses and 58 midwives)
Schmaling et al (2003)
Descriptive Review
Ujah et al (2004)
Cross sectional survey/interviews. 17 NHS trusts (100% response)
Bradshaw et al (2001)
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
O'Hara and Elms (2004)
Brief workshop report / expert opinion
Jackson (2004)
Randomised control trial design study and survey. 139 participants
(77 immediate advice group / 62 delayed advice group)
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Pilkington et al (2002)
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Bradshaw et al (2005)
Longitudinal (2 and 12 months) qualitative survey/interviews.
97 workers from 6 national centres (92 follow up)
White and Benjamin (2003) Descriptive Review
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Jackson (2004)
Randomised control trial design study and survey. 139 participants
(77 Immediate advice group / 62 delayed advice group)
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Anonymous (2002)
Descriptive Review
1,2,4
Brown (2004)
Descriptive Review
Dermatitis - but issues may apply
1,2,4
Jeebhay et al (2000) abstract
Cross sectional postal questionnaire study. N = 41 workplaces in
South Africa
Seafood processing but issues may apply
1,2,4
4
1,2,4
Occupational Resource
Health Provision
Usage
Evidence Quality
Limited
4
1-4?
Very Strong 1,2,4
3, 4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
264
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Re Mines but issues may apply
Toluene Diisocyanate (TDI)
Blood and body fluid exposures - but
issues may apply
Asthma
Generic
Generic
Generic
Generic
Generic
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Asthma
Generic
Generic
Generic
Generic
Asthma
Overall Factor
Specific Factors
Identified
Specialist
Expertise
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Moderate 4
Schmaling et al (2003)
1-4?
Ujah et al (2004)
1,2,4
Bradshaw et al (2001)
4
Approach
Strong
3,4
4
4
1-4?
3, 4
1,2,4
4
4
Relationships /
Communication
Very Strong 4
4
4
4
4
4
4
1,2,4
1,2,4
4
4
4
4
4
Evidence Quality
Descriptive Review
Cross sectional survey/interviews. 17 NHS trusts (100% response)
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
Horne and Weinman (2002) Cross sectional questionnaire survey of community based asthma
patients. N = 100.
Douglas (2005)
Descriptive Review
McGhan et al (2005)
Descriptive Review
Bresnitz et al (2004)
Descriptive Review
Ujah et al (2004)
Cross sectional survey/interviews. 17 NHS trusts (100% response)
O'Hara and Elms (2004)
Brief workshop report / expert opinion
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Soriano et al (2003)
Large European Survey
Sorensen et al (2002)
Randomised controlled designed surveys. N = 9019 at baseline and
7327 final.
Petrie et al (2003)
Book Chapter
Rand and Butz (1998)
Descriptive Review
Thorax (2003)
Guidance
Uldry and Leuenberger
Descriptive review
(2000)
Vamos and Kolbe (1999) Study
Kolbe (1999)
Descriptive Review
Uldry and Leuenberger
Descriptive Review
(2000)
Creer and Levstek (2001) Descriptive Review
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Reetoo et al (2004)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients
Di Blasi et al (2001)
Systematic Review of 25 eligible RCTs
Burton et al (2001)
Longitudinal evaluation of asthma management programme at 1 large
company. N = 41 participants completing ATAQ questionnaire,
followed up at 2, 4 and 12 months.
McGhan et al (2005)
Descriptive Review
Bresnitz et al (2004)
Descriptive Review
265
Agent / Condition / Generic
Asthma
Generic
Generic
Asthma
Variety mentioned
Asthma
Variety mentioned
Generic
Generic
Generic
Asthma
Cancer but issues may apply
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Generic
Generic
Asthma
Generic
Asthma
Asthma
Variety mentioned
Overall Factor
Specific Factors
Identified
Benefits
Occupational
Health Policy
Existence/Usage
Eating/Rest
policy
Risk assessment
need
OH Referrals
Route
Evidence
Weighting
Limited
Moderate
Limited
Strong
Strong
Stage
Reviews Mentioned in
Evidence Quality
of OA
4
Caress et al (2005) Cross sectional survey. N = 230.
abstract
4
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
1,2,4
Jackson (2004)
Randomised control trial design study and survey. 139 participants
(77 immediate advice group / 62 delayed advice group)
1,2,4
Jackson (2004)
Randomised control trial design study and survey
1,2,4
Jackson (2004)
Randomised control trial design study and survey. 139 participants
(77 Immediate advice group / 62 delayed advice group)
1,2,4
Elms et al (???)
Survey evaluation of Occupational Health Development Group. 159
respondents
4
Ross and McDonald (1998) Questionnaire Survey of 1317 cases / 312 physicians
1-4?
Ujah et al (2004)
Cross sectional survey/interviews. 17 NHS trusts (100% response)
1,2,4
Brown and Rushton (2003) Cross sectional observation (N = 21 companies) and focus groups (N =
35 participants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
1,2,4
Bradshaw et al (2001)
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
4
Bresnitz et al (2004)
Descriptive Review
1,2,4
Dilworth (2000)
Cross sectional survey and sampling. 47 sites / 386 samples
1-4?
1,2,4
1,2,4
1,2,4
1,2,4
Ujah et al (2004)
Elms et al (2004)
Dilworth (2000)
Gadd et al (2003)
Bradshaw et al (2005)
1,2
1,2,4
3
Milnes (2001)
1) Weyman and Milnes
(2001) 2) Weyman and
Marlow (2004)
Fishwick et al (2003)
1,2
Fishwick et al (2003)
3, 4
O'Hara and Elms (2004)
Agent / Condition / Generic
Asthma
Asthma - but not necessarily OA
Generic
Generic
Generic
Generic
Asthma
Generic
Agent: Printing chemicals. Re OCD but
issues may apply
Generic
Variety mentioned
Wood dust
Cross sectional survey/interviews. 17 NHS trusts (100% response)
Cross sectional survey and dust sampling. 55 bakeries
Cross sectional survey and sampling. 47 sites / 386 samples
Brief literature review and case studies. 26 case studies
Longitudinal (2 and 12 months) qualitative survey/interviews.
97 workers from 6 national centres (92 follow up)
Review of 61 risk assessments
Cross sectional questionnaire surveys. 1) 215 questionnaires / 2) 347
questionnaires
Generic
Flour dust
Wood dust
Generic
Asthma
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Brief workshop report / expert opinion
Asthma
266
Re Manual Handling but issues may apply
Re Manual Handling but issues may apply
Asthma
Generic
Overall Factor
Specific Factors
Identified
Primary Care
Competency in
OH
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
1,2,3,4 Elms et al (2003)
3
Elms et al (2003)
3
Fishwick et al (2003)
3
3,4
O'Hara and Elms (2004)
Bradshaw et al (2005)
3
Very Strong 4
3
O'Hara and Elms (2004)
Bender and Creer (2002)
Fishwick et al (2003)
3
3
O'Hara and Elms (2004)
Elms et al (2003)
3
Elms et al (2003)
1,2,4
Jackson (2004)
1,2,4
Reetoo et al (2004)
1,2,4
Pilkington et al (2002)
3
Elms et al (2003)
1,2,3,4 Jackson (2004)
3
3,4
Miller et al (2003)
Elms et al (2003)
3, 4
O'Hara and Elms (2004)
Evidence Quality
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Brief workshop report / expert opinion
Longitudinal (2 and 12 months) qualitative survey/interviews.
97 workers from 6 national centres (92 follow up)
Brief workshop report / expert opinion
Descriptive Review
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case studies). Purpose developed ques
Brief workshop report / expert opinion
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Randomised control trial design study and survey. 139 participants
(77 immediate advice group / 62 delayed advice group)
Delphi survey (CATI and postal). Round 1 744 responses / Round 2
652 responses
Cross sectional telephone interview survey and some follow up. 4950
companies and 50 face to face follow up interviews
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Randomised control trial design study and survey. 139 participants
(77 immediate advice group / 62 delayed advice group)
Review and re-analysis of postal survey data set. 11941 in data set
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Brief workshop report / expert opinion
267
Agent / Condition / Generic
Asthma
Asthma
Asthma
Generic
Asthma
Generic
Asthma
Asthma
Generic
Asthma
Asthma
Generic
Generic
Generic
Asthma
Generic
Asthma
Asthma
Generic
Overall Factor
Supply Chain
Specific Factors
Identified
Communication
Evidence
Weighting
Limited
Company Size
Limited
Storage
Chain Length
Transactions
Contracted Staff
Weak
Weak
Weak
Limited
Reliance
Limited
Stage
Reviews Mentioned in
of OA
3
Elms et al (2003)
3
Elms et al (2003)
4
4
1,2,4
4
3
3
4
3
Bucknall et al (1999)
Bender and Creer (2002)
Harrison (1998)
Schmaling et al (1998)
Mihalas (1999)
De Bono & Hudsmith (99)
Wu et al (2001) - abstract
Poonai et al (2005)
3
3,4
3,4
1,2,4
4
Walpole (2001)
Hegde et al (2002)
Milton et al (1998) abstract
O'Neill (1995)
Taylor and Morgan (1995)
1,2,4
Brown and Rushton (2003)
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2,4
1,2
1,2,4
White and Benjamin (2003)
White and Benjamin (2003)
White and Benjamin (2003)
O'Hara and Dickety (2000)
White and Benjamin (2003)
White and Benjamin (2003)
White and Benjamin (2003)
Weyman (1999)
White and Benjamin (2003)
White and Benjamin (2003)
White and Benjamin (2003)
Curran and Fishwick 2003
Alston et al (1997)
Evidence Quality
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Qual and quant survey (triangulation of evidence).
Qual
focus groups 22 GPs, 25 nurses, 24 practice mgrs.
Quant
survey 295 GPs
Medical records review
Descriptive Review
Descriptive Review
Descriptive review
Descriptive Review
Descriptive Review: 182 GP notes of adult onset asthma patients
USA mail survey: 1954 patients / 1078 corresponding physicians.
Structured telephone questionnaire survey with patients fulfilling OA
criteria (N = 42).
Review and simple questionnaire study. N not given.
Questionnaire/interview study. N = 150 Indian general practitioners.
Prospective cohort study. N = 79,204 health maintenance organisation
members.
Book chapter
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members)
Cross sectional observation (N = 21 companies) and focus groups (N =
35 partcicpants) and literature review. Also pilot testing of
interventions using ques/interviews (N = 8 companies)
Descriptive Review
Descriptive Review
Descriptive Review
12 case studies and literature review
Descriptive Review
Descriptive Review
Descriptive Review
Literature Review
Descriptive Review
Descriptive Review
Descriptive Review
Workshop recommendations
Cross sectional survey and interviews. 11 orgs / 45 users
268
Agent / Condition / Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Variety mentioned
Variety mentioned
Asthma
Asthma
Bakery flour, grains and enzymes
Asthma
Asthma
Asthma
Asthma - but not necessarily OA
Agent: Printing chemicals. Re OCD but
issues may apply
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Generic
Asthma
Vapour
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
1,2,4
Llewellyn et al (????)
1,2,4
Strutt and Bird (2004)
1,2,4
1,2,4
4
1,2,4
7.3.10
Evidence Quality
Cross sectional survey. 103 questionnaires
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
O'Hara (2005)
Cross sectional questionnaire survey - pre and post intervention. 233
questionnaires baseline and 215 ques post intervention
White and Benjamin (2003) Descriptive Review
Toren and Sterner (2003) Descriptive Review
Brosseau et al (2002)
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Agent / Condition / Generic
Agriculture agents but not specific
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Isocyanates
Generic
Generic
Wood dust
External / Societal
Overall Factor
Specific Factors Evidence
Stage
Reviews Mentioned in
Identified
Weighting of OA
Thorax (2003)
External support Access/Quantity Very Strong 4
4
Bucknall et al (1999)
4
Uldry and Leuenberger
(2000)
1,2
Harrison (1998)
4
Vamos and Kolbe (1999)
4
Nouwen et al (1999)
4
Smith and Nicholson
(2001)
4
Rand and Butz (1998)
4
Van Ganse et al (2003)
4
Tarlo (1999)
4
Barton et al (2003)
4
McGhan et al (2005)
4
Aalto et al (2002)
4
Berntsson and Ringsberg
(2003)
Evidence Quality
Agent / Condition / Generic
Guidance
Medical records review
Descriptive Review
Asthma
Asthma
Asthma
Descriptive Review
Study
Matched subjects study
Longitudinal Questionnaire Survey
Asthma
Asthma
Asthma
Asthma
Descriptive Review
Descriptive Review and Interviews with 12 physicians and 46 patients
Descriptive Review
Descriptive Review
Descriptive Review
Questionnaire validation study. N = 3464 persons with drug treated
asthma, 278 brief rehabilitation participants and 316 comprehensive
rehab participants.
Asthma
Asthma
Variety mentioned
Asthma
Asthma
Asthma
Questionnaire study. N = 32 patients.
Re 'sensory hyperreactivity' disorder with
asthma like symptoms but negative
asthma tests, but may apply
269
Overall Factor
Specific Factors
Identified
Quality
Source
Stigma/Fear
Evidence
Weighting
Moderate
Limited
Moderate
Stage
Reviews Mentioned in
of OA
4
Gallant (2003)
Evidence Quality
Agent / Condition / Generic
Descriptive Review
4
4
Interview study in US. N not in abstract.
Questionnaire survey in Finland. N = 130.
More evidence re diabetes but issues may
apply
Asthma
Asthma
Descriptive Review
Descriptive Review
Descriptive Review
Abstract
Generic
Asthma
Asthma
Asthma
4
4
4
4
4
Beck (1997) - abstract
Makinen et al (2000) abstract
Green et al (2003)
Gregerson (2000)
Wright et al (1998)
Barton et al (2003) (with
Katz et al info)
Schmaling et al (2003)
Meijer et al (1995)
Innes et al (1998)
Rand and Butz (1998)
Schmaling et al (2002)
4
4
Barton et al (2003)
Giardino et al (2002)
4
4
1,2,4
De Peuter et al (2004)
Bender and Creer (2002)
Llewellyn et al (????)
Descriptive Review
Asthma
Study (1 + replication)
Asthma
Descriptive Review
Asthma
Descriptive Review
Asthma
Questionnaire and daily records of pulmonary function by patients. N Asthma
= 32 patients
Descriptive Review
Asthma
Questionnaire and lung testing study. N = 50 couples, where one
Asthma
partner has asthma
Descriptive Review
Asthma
Descriptive Review
Asthma
Cross sectional survey. 103 ques
Agriculture agents but not specific
4
4
4
4
4
4
Campbell (1998)
Vamos and Kolbe (1999)
Kolbe (1999)
Creer and Levstek (2001)
Rand and Butz (1998)
Moffat et al (2002)
Descriptive Review
Study
Descriptive Review
Descriptive Review
Descriptive Review
Interview survey with 13 GPs
Asthma
Asthma
Asthma
Generic
Asthma
Asthma
4
Gallant (2003)
Descriptive Review
More evidence re diabetes but issues may
apply
4
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
4
4
4
4
270
Asthma - but not necessarily OA
Overall Factor
Specific Factors Evidence
Stage
Identified
Weighting of OA
Very Strong 1,2,4
Social inequality Employment /
Income
1,2,4
prospects
1,2,4
1,2,4
4
1,2,4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
Reviews Mentioned in
Thorax (2003)
Boorman (2004)
BOHRF (2004)
Lombardo and Balmes
(2000) – themes
Marabini et al (2003) –
themes
Sturdy et al (2002)
Newman-Taylor (2002)
Kolbe (1999)
Vandenplas et al (2002) abstract
Ameille et al (1997)
Evidence Quality
Agent / Condition / Generic
Guidance
Descriptive Review
Systematic Review
Descriptive Review
Asthma
Generic
Asthma
Asthma
Study
Asthma
Case control study
Descriptive Review
Descriptive Review
Questionnaire and measurement study of 36 subjects with latex
induced asthma after a median follow up of 56 months.
Questionnaire/telephone survey average 3.1 years after diagnosis.
N = 209 patients
Conner (2002)
Case study of one large company in USA
Malo et al (1993)
Review and questionnaire study of Quebec Compensation System. N
= 134 subjects
Piirilae et al (2005)
Prospective questionnaire survey and clinical testing in Finland.
N = 213 asthma patients and N = 120 controls
Blanc et al (2001) - abstract Population interview survey of adults in California. N = 125 adults
with asthma and 175 adults with rhinitis.
Gassert et al (1998) Case series using interviews at follow up (31 +/- 15 months after
abstract
removal). N = 55 OA patients
Hendrick (1994)
Descriptive Review
Agner and Held (2002)
Descriptive Review
Baur et al (1998)
Descriptive Review
Bresnitz et al (2004)
Descriptive Review
Mancuso et al (2003)
Questionnaire study. 196 patients in an urban practice completed
standardised major and minor life events scales
Bernstein (2002)
Case study and questionnaire survey. Ques N = 58 health care
workers (HCWs)
Vigo and Grayson (2005) Descriptive Review
Vandenplas et al (2003)
Descriptive Review
Douglas (2005)
Descriptive Review
271
Asthma
Asthma
Asthma
Latex
Variety mentioned, e.g. flour, isocyanates
most frequent
Toluene Diisocyanate (TDI)
Variety mentioned
Diisocyanates
Asthma
Asthma
Asthma
Re skin protection but issues may apply
Variety mentioned
Variety mentioned
Asthma
Natural rubber latex (NRL)
Variety mentioned
Asthma
Variety mentioned
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
4
Poonai et al (2005)
4
4
4
4
4
4
4
4
SES
Very Strong 4
4
1,2
1,2,4
1,2
4
4
4
4
4
4
4
1,2
4
1,2,4
4
4
1,2,4
Evidence Quality
Structured telephone questionnaire survey with patients fulfilling OA
criteria (N = 42).
Burge (1997)
Book Chapter
Sinclair and Tetrick (2004) Book chapter
Adams et al (2004) Longitundinal questionnaire survey study of adult patients.
N=
abstract
293 baseline and 232 at 12 months.
Larbanois et al (2002) Longitudinal survey study. N = 157 (86 OA / 71 not).
abstract
Moscato et al (1999) Longitudinal diary and clinical testing study. N = 25 OA patients.
abstract
O'Neill (1995)
Book chapter
Bernstein et al (2003) Retrospective questionnaire evaluation of outcomes in health care
abstract
workers. N = 67 HCWs
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members)
Green et al (2003)
Rodrigo et al (2004)
Harrison (1998)
Gwynn (2004)
Gregerson (2000)
Bender and Creer (2002)
Soriano et al (2003)
Uldry and Leuenberger
(2000)
Kamal and Miller (2004)
Meijer et al (1995)
Nouwen et al (1999)
Wright et al (1998)
Schmaling et al (2003)
Innes et al (1998)
Newman-Taylor (2002)
Harrison (1998)
Schmaling et al (2003)
Robertson and Stewart
(2004)
Agent / Condition / Generic
Asthma
Asthma
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma - but not necessarily OA
Descriptive Review
Descriptive Review
Descriptive Review
Large telephone survey
Descriptive Review
Descriptive Review
Large European Survey
Descriptive Review
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Letter
Studies (1 +replication)
Matched subjects study
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Descriptive Review
Questionnaire (N = 200) and focus group (N = 33 participants) survey
and literature review
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Re MSDs but issues may apply
272
Overall Factor
Demographics
Specific Factors
Identified
Gender
Evidence
Weighting
Limited
Stage
Reviews Mentioned in
of OA
1,2,4
Basagana et al (2004)
Evidence Quality
Cross sectional interview study including 10,971 subjects aged 20 to
44 from general population
4
Vandenplas et al (2002) - Examination of SES of 86 subjects with OA with follow up median of
abstract
43 months after diagnosis
4
Moffat et al (2002)
Interview survey with 13 GPs
4
Van Ganse et al (2003)
Descriptive Review and Interviews with 12 physicians and 46 patients
4
Cannon et al (1995)
Questionnaire Survey. N = 225 (113 OA, 37 WRA, 75 unrelated)
4
Barton et al (2003)
Descriptive Review
4
Mcgann (2000) - abstract Longitudinal exploratory study. N = 51 adults with asthma taking
inhaled medication
4
Barr et al (2002) - abstract Participants from Nurses Health Study. N = 5107.
1,2,4
Chen et al (2002) - abstract Population based study of 173,859 men and women in US Health
Plan.
4
Gassert et al (1998) Case series using interviews at follow up (31 +/- 15 months after
abstract
removal). N = 55 OA patients
3
Poonai et al (2005)
Structured telephone questionnaire survey with patients fulfilling OA
criteria (N = 42).
4
Beck (1997) - abstract
Interview study in US. N not in abstract.
4
Alexopoulos and Burdorf Longitudinal interview study over 2 years. N = 251 blue and white
(2001) - abstract
collar workers.
4
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members)
4
Green et al (2003)
Descriptive Review
1 and 2 King et al (2004)
Systematic Review
1 and 2 Gregerson (2000)
Descriptive Review
1,2
Gwynn (2004)
Large telephone survey
4
Soriano et al (2003)
Large European Survey
4
Venables et al (1989)
Questionnaire Study
1,2
Schmaling et al (2003)
Descriptive Review
4
Barton et al (2003) (with
Abstract
Katz et al info)
4
Smith and Nicholson
Longitudinal Questionnaire Survey
(2001)
4
Schmaling et al (2003)
Descriptive Review
273
Agent / Condition / Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Generic
Asthma - but not necessarily OA
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
Overall Factor
Specific Factors
Identified
Evidence
Weighting
Stage
Reviews Mentioned in
of OA
1,2
Devereux et al (2004)
1,2,4
1,2
Robertson and Stewart
(2004)
Liss et al (2003) - abstract
4
1,2,4
Van Ganse et al (2003)
Basagana et al (2004)
4
1,2,4
Jessop and Rutter (2003)
Gassert et al (1998) abstract
Gershon et al (2000)
1,2,4
4
Age
Limited
4
2,3,4
1,2,4
4
4
4
Makinen et al (2000) abstract
Schmaling et al (2003)
Hoyle et al (2002)
Mardis and Pratt (2003) abstract
Van Ganse et al (2003)
Gannon et al (1993)
Evidence Quality
Agent / Condition / Generic
Cross sectional survey and prospective cohort study. Sample 3139
Stress and MSDs - but may apply to
asthma
Questionnaire (N = 200) and focus group (N = 33 participants) survey Re MSDs but issues may apply
and literature review
Questionnaire mail survey (1110 medical radiation technologists
Various chemicals, e.g. glutaraldehyde
(MRTs) and 1523 physiotherapists)
Descriptive Review and Interviews with 12 physicians and 46 patients Asthma
Cross sectional interview study including 10,971 subjects aged 20 to Asthma
44 from general population
Questionnaire survey. N = 330 individuals from 1 health centre.
Asthma
Case series using interviews at follow up (31 +/- 15 months after
Asthma
removal). N = 55 OA patients
Study to develop hospital safety climate tool. Cross sectional survey Blood borne pathogens - but issues may
testing questionnaire on 789 hospital health care staff
apply
Questionnaire survey in Finland. N = 130.
Asthma
Descriptive Review
Cross sectional controlled study, survey and sampling. 911 men in 10
foundries (509 exposed group / 402 non-exposed group)
Descriptive Review
Asthma
Isocyanates, amines, aldehydes, furfuryl
alcohol
Generic
Descriptive Review and Interviews with 12 physicians and 46 patients Asthma
Questionnaire survey - follow up study of workers with OA (diagnosis Variety mentioned
1 year earlier). N = 112
Descriptive Review
Asthma
4
4
1,2,4
Rietveld and Brosschot
(1999)
Jessop and Rutter (2003)
Questionnaire survey. N = 330 individuals from 1 health centre.
Barr et al (2002) - abstract Participants from Nurses Health Study. N = 5107.
Salminen (1997) - abstract Review of accidents after 99 serious accidents in Finland
1,2,4
Kim et al (2001)
1,2,4
Gershon et al (2000)
Asthma
Asthma
More re safety and accidents but issues
may apply
Pre/Post Study of educational intervention in USA - observation at
Blood and body fluid exposures - but
baseline and 1 and 2 years post intervention.
N = issues may apply
103 (1997) / 66 (1998).
Study to develop hospital safety climate tool. Cross sectional survey
testing questionnaire on 789 hospital health care staff
274
Blood borne pathogens - but issues may
apply
Overall Factor
Specific Factors
Identified
Ethnicity
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Limited
4
Griffiths et al (2001)
4
Schmaling et al (2003)
2,3,4
Hoyle et al (2002)
1,2,4
4
Medicolegal
Aspects
(Dis)Incentive to Very Strong 4
Claim
4
4
1,2
4
4
3,4
4
4
4
4
4
4
4
4
4
4
4
4
4
Evidence Quality
Qual Interview Study
Descriptive Review
Cross sectional controlled study, survey and sampling. 911 men in 10
foundries (509 exposed group / 402 non-exposed group)
Chen et al (2002) - abstract Population based study of 173,859 men and women in US Health
Plan.
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members
Stenton et al (1995)
Letter
Davidson (1996)
Descriptive Review
Davidson (1996)
Descriptive Review
Fishwick et al (2003)
Prospective Survey (97 interviews / 77 re-interviewed) and
Retrospective Case Study (17 case notes). Purpose developed ques
Bradshaw et al (2005)
Longitudinal (2 and 12 months) qualitative survey/interviews. 97
workers from 6 National Centres (92 follow up)
Vandenplas et al (2002) - Examination of SES of 86 subjects with OA with follow up median of
abstract
43 months after diagnosis
Bernstein et al (1999)
Book Chapter Review (re USA/Europe, not UK)
Cannon et al (1995)
Questionnaire Survey. N = 225 (113 OA, 37 WRA, 75 unrelated)
Gannon et al (1993)
Questionnaire survey - follow up study of workers with OA (diagnosis
1 year earlier). N = 112
Brooks (1995)
Descriptive Review
Malo et al (1993)
Review and questionnaire study of Quebec Compensation System. N
= 134 subjects and 91 controls
Tarlo (1999)
Descriptive Review
Bernstein et al (1999)
Book Chapter Review (re USA/Europe, not UK)
Bernacki and Guidera
Pre/Post analysis of managed care compensation programme.
(1998)
All claims 1990-1997 reviewed.
Hopkins (1998)
Descriptive Review
Biddle et al (1998)
Analysis of database of individuals filing for compensation.
N = 29,558 individuals
Vandenplas et al (2003)
Descriptive Review
Burge (1997)
Book Chapter
Sinclair and Tetrick (2004) Book chapter
O'Neill (1995)
Book chapter
275
Agent / Condition / Generic
Asthma
Asthma
Isocyanates, amines, aldehydes, furfuryl
alcohol
Asthma
Asthma - but not necessarily OA
Asthma
Generic
Generic
Asthma
Asthma
Asthma
Asthma
Asthma
Variety mentioned
Asthma
Variety mentioned
Variety mentioned
Asthma
More re injury and surgical workers but
issues may apply
Generic
Generic
Asthma
Asthma
Generic
Asthma
Overall Factor
Specific Factors
Identified
(Dis)Incentive to
RTW
Employer
(Dis)Incentive
Costs
Evidence
Weighting
Moderate
Limited
Clinician
(Dis)Incentive
Limited
Medication
Strong
Stage
Reviews Mentioned in
Evidence Quality
of OA
4
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members)
4
Adisesh et al (2002)
Cross sectional survey. 510 reporting physicians
Dermatitis - but issues may apply
4
Hopkins (1998)
Generic
4
Roed and Zhang (2003)
4
4
4
Davidson (1996)
Goe et al (2004) - abstract
4
4
4
Bernstein et al (1999)
Toren and Sterner (2003)
Kyes et al (2003)
4
4
4
4
Hopkins (1998)
Rabatin and Cowl (2001)
Rischitelli (1999)
Burge (1997)
4
Uldry and Leuenberger
(2000)
Kolbe (1999)
Moscato et al (1999) abstract
Taylor and Morgan (1995)
4
Weak
Weak
Asthma - but not necessarily OA
Analysis of dataset of Norwegian unemployment spells during 1990s. General unemployment, not necessarily
N = approx 100,000 individuals
ill-health unemployment but issues may
apply
Sinclair and Tetrick (2004) Book chapter
Generic
4
4
Hidden Costs
Need
Descriptive Review
Agent / Condition / Generic
4
4
4
Schmaling et al (2003)
Curran and Fishwick
(2003)
Curran and Fishwick
(2003)
Descriptive Review
Compared WAA and NOA cases reported to NIOSH from 4 SENSOR
surveillance programmes in USA. N = 210 WAA cases and 891
NOA cases
Book Chapter Review (re USA/Europe, not UK)
Descriptive Review
Telephone survey to evaluate managed care pilot (MCP).
N = 243 employers (97 intervention / 146 comparison).
Descriptive Review
Descriptive Review
Brief descriptive review
Book Chapter
Generic
Variety mentioned
Generic
Asthma
Descriptive Review
Asthma
Descriptive Review
Longitudinal diary and clinical testing study. N = 25 OA patients.
Asthma
Asthma
Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members)
Descriptive Review
Expert Opinion
Asthma - but not necessarily OA
Asthma
Asthma
Workshop recommendations
Asthma
276
Generic
Diisocyanates / inorganic and mineral
dusts.
Asthma
Generic
Generic
Overall Factor
Specific Factors
Identified
H&S compliance
Personal
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Limited
1,2,4
Llewellyn et al (????)
Moderate 4
Jeffrey et al (1999)
4
4
Employer
Strong
4
4
4
4
4
4
4
1,2,4
Societal
Limited
4
4
4
Public Health
Disease profile
Limited
4
1,2,4
1,2,4
Evidence Quality
Cross sectional survey. 103 ques
Cross sectional survey and dust sampling. 224 individuals / 18
bakeries
Malo et al (1993)
Review and questionnaire study of Quebec Compensation System. N =
134 subjects and 91 controls
Taylor and Morgan (1995) Descriptive Review and 2 questionnaire surveys (N = 88 people with
severe asthma and N = 1020 NAC members)
Burgess et al (2001)
Prospective Study
Jeffrey et al (1999)
Cross sectional survey and dust sampling. 224 individuals / 18
bakeries
Burton et al (2001)
Longitudinal evaluation of asthma management programme at 1 large
company. N = 41 participants completing ATAQ questionnaire,
followed up at 2, 4 and 12 months.
Atherly et al (2005) Review of 2001 Medstat-Marketscan claims database.
abstract
Sample included 31,067 people with asthma and 385,883 people
without.
Malo et al (1993)
Review and questionnaire study of Quebec Compensation System. N
= 134 subjects and 91 controls
Green-McKenzie et al
Pre/Post intervention study of hospital workers. N ~ 6000.
(2002)
Liss and Tarlo (2001)
Review of asthma claim cases and interventions included in Ontario,
Canada
Brosseau et al (2002)
Using PRECEDE-PROCEED model to develop intervention study.
Used planning committee (N = 10), pilot study of monitoring and
observation (N = 5) and focus groups (N = 6 workers/3 owners)
Burge (1997)
Book Chapter
Jeffrey et al (1999)
Cross sectional survey and dust sampling. 224 individuals / 18
bakeries
Curran and Fishwick
Workshop recommendations
(2003)
Cullinan et al (2003)
Descriptive Review
Brown (2004)
Descriptive Review
Friedman et al (2000) Descriptive Review
abstract
277
Agent / Condition / Generic
Agriculture agents but not specific
Flour dust
Variety mentioned
Asthma - but not necessarily OA
Generic
Flour dust
Asthma
Asthma
Variety mentioned
Generic
Latex
Wood dust
Asthma
Flour dust
Asthma
Asthma
Dermatitis - but issues may apply
Asthma
Overall Factor
Regulations
Specific Factors
Identified
Legal Minimum
Clarity
Evidence
Stage
Reviews Mentioned in
Weighting of OA
Strong
1,2,4
Hughson et al (2002)
Strong
1,2,4
Bradshaw et al (2001)
1,2,4
Strutt and Bird (2004)
1,2,4
1,2,4
Trainor et al (2002)
Bradshaw et al (2005)
Evidence Quality
Cross sectional and longitudinal survey in two phases (Phase 2
intervention study). Phase 1: 19 companies / 280 ques. Phase 2: 4
companies / 21 ques
Cross sectional survey/interviews - quantitative and qualitative data.
28 managers interviewed
Interviews and focus groups with 4 industry sectors. 8 interviews and
4 focus groups
Cross sectional case study interviews and review. 3 companies
Longitudinal (2 and 12 months) qualitative survey/interviews. 97
workers from 6 National Centres (92 follow up)
278
Agent / Condition / Generic
Re Noise but issues may apply
Generic
Isocyanates, flour dust, wood dust,
ingredients in bleaches, perms etc
Generic
Asthma
7.4
APPENDIX 4: INDUSTRY SECTOR CHARACTERISTICS EVIDENCE
7.4.1
Agriculture and Food Manufacture
INDUSTRY CHARACTERISTICS
Rating:
High: Highly
Applicable
Medium:
Moderately
Applicable
Low: Less
Applicable
Lowest: Least
Applicable
Population size
Average 20022004
Gender mix
Male (AllAverage 20022004)
Female (AllAverage 20022004)
Age profile
Flat
Young
Middle aged
Ageing
Old
Agriculture
Agriculture
Evidence
Manufacture
of food
products and
beverages
330,349
427,014
253,424
282,152
76,925
144,862
High
Low
Medium
High
Medium
279
Mfg.food
Evidence
INDUSTRY CHARACTERISTICS
Safety culture
Don’t know the
risks
Aware of risks but
unsure if
applicable?
Aware, but are
taking no action
Aware, and will
act sometime
Aware and acting
Agriculture
High
High
Lowest
Medium
Medium
Despite 80% of bakeries reporting they understand
flour dust is a respiratory sensitiser, most bakeries still
undertook inappropriate work practices: flour dusting
by hand and dry brush cleaning. Only 42% of bakeries
provided employees with RPE. Only 3 of 13 carried
out examinations of LEV. May suggest employees
ignoring advice (Elms et al, 2004). Improved working
practices needed, e.g. NOT manually folding empty
flour bags for disposal and creating visible dust clouds
(Elms et al, 2003).
Individuals may give incorrect information/conceal
symptoms for fear of job consequences/loss of income
(Griffin et al, 2001) (Gordon et al, 1997).
Bakery workers thought risk particular to their
industry was "part of the job" (Strutt and Bird, 2004).
Reactive approach to H&S - only search for
information if incident comes up - pot
Risk communication could be obstructed by the
"agriculture asthma paradox" whereby exposure
in early life reduces the incidence of asthma, but
adult exposures on a farm are known to cause
OA. Could be explained by the difference
between atopy and non- atopy asthma. Early
farm exposures, especially those in the first year
of life, reduce the incidence of atopic asthma (a
reflection of the "hygiene hypothesis") and
exposures later in life increase the risk of nonatopic asthma (Schenker, 2005). Lower
prevalence of asthma in farmers could be
attributed to the healthy worker effect.
Compliance was lower for following
manufacturers recommendations about PPE.
88% admit never wearing protective boots.
(Avory & Coggon, 1998)
Low
Low
280
Mfg.food
Only 27% bakeries were aware of MEL and STEL
standards for flour dust, despite trade/bakery
information. (Elms et al, 2004).
Only 26% of bakeries had assessed hazards/risks and
completed COSHH assessment. Only half of these
identified need for health surveillance (Elms et al,
2004).
Some bakers did not seem aware of hazards for
asthma and dismissed it as unlikely (Strutt and Bird,
2004)
INDUSTRY CHARACTERISTICS
Peer contact
Colleagues
Competitors
Customers
Trades Unions
Trade Assocs /
Journal
Agriculture
Mfg.food
Bakeries with safety reps more likely to have training
on flour dust, knowledge of limits and completed
COSHH assessments - safety reps needed (Elms et al,
2004).
Minimal support may be barrier to change (Strutt and
Bird, 2004).
Undertaking inappropriate work practices may suggest
management overlooking unsafe practices (Elms et al,
2004)
Low
Low
Medium
82% of respondents obtain information from the
farming press, I.e. trade journals (Llewellyn et al,
no date)
Suppliers
Lowest
Family influence
High
Only 30% of sample got H&S information from
suppliers (Llewellyn et al (no date).
Compliance was low for following
manufacturers recommendations about disposal
of containers. Only 14% said they disposed of
containers as instructed (Avory and Coggon,
1994). Only 38% of subjects said they always
read all of the manufacturers label when using a
product/chemical for the first time (Avory and
Coggon, 1994).
Spouses have a key role in promoting H&S in
family businesses.
Also, thought of LT disability for family may
encourage change (Llewellyn et al (no date).
281
Medium
Trade association membership mostly viewed as a
"badge" of credibility. Strength of trade associations
in bakeries thought to have diminished (Strutt and
Bird, 2004)
INDUSTRY CHARACTERISTICS
Regulator e.g. LA,
EA, HSE
Size profile
Micro
Small
Agriculture
Fear of enforcement action may encourage
change - but this only mentioned by couple of
people. Opinion on best way for HSE to work
divided (I.e. prosecute/fine more or use common
sense approach (Llewellyn et al, no date).
Potential barriers are difficulties in obtaining
H&S information (only half obtain it from HSE
guidance), getting right sort of information or
difficulties in readily identifying information that
applies to the company. Also discrepancy in
responses as to whether HSE website best place
to access computer based guidance (Llewellyn et
al, no date)
High
Medium
High
Medium
Low
Lowest
Medium
Large
TREND - towards
High
Micro
Small
282
Mfg.food
Some bakery respondents said their information use
had stemmed from legal requirements (Strutt and
Bird, 2004).
If diagnosed, employers fear risk of litigation (Gordon
et al, 1997).
Some respondents mentioned product
packaging/COSHH but admit would not read more
than once or never even refer to it. Info in post seen
as junk. Ignorance / not accessing formal information
- rely on common sense/experience (Strutt and Bird,
2004).
Need sector specific information to aid understanding
and remove complacency (Strutt and Bird, 2004).
Need to institute health surveillance, especially in
small bakeries where levels of allergen exposure was
found to be higher (Jeffrey et al, 1999)
Exposure levels in traditional bakeries (job tasks not
clearly divided and automation poor - smaller
bakeries?) seem to be higher than in industrial
bakeries (degree of automation and clear division of
job tasks - larger bakeries?) (Bulat et al, 2004)
Mixers and weighers from large bakeries had the
highest exposures to both inhalable dust and fungal
alpha amylase. 63% of individuals exceeding MEL
were weighers and mixers (Elms et al, 2003).
Bakers thought flour dust hazard aimed at larger
bakers (Strutt and Bird, 2004)
INDUSTRY CHARACTERISTICS
Industry prospects
Increasing
Static
Decreasing
Resource limitations
Agriculture
High
Medium
Time
Medium
Money
High
Knowledge
Low
Mfg.food
Medium
High
Schenker (2005) General interest in the health of
farming populations has diminished as the
percentage of the population farming has
declined in developed countries, now as low as
less than 2% in man
Second most frequently cited barrier to change in
agriculture industry - time to make change and
task taking longer after change. Also 26% feel
they don't have time to read H&S information
(Llewellyn et al, no date)
94% farmers thought H&S information should be
free. Cost most frequently cited barrier to
change. Thought of economic consequences for
business and cost-benefits may encourage change
(Llewellyn et al (no date)
Farmers higher in knowledge were more likely to
report intention to seek pesticide (not strictly
asthma agent but issues may apply) safety
information; less likely to report being too busy
for RPE/PPE; more likely to disagree with the
idea that exposure is not harmful; and report
higher self efficacy/confidence to prevent
exposure to themselves and their family and to
use PPE correctly. Implies increasing knowledge
leads to increasing safe behaviours.
Those with less than optimal knowledge scores
had a lower frequency of correct responses suggests gaps in safety knowledge (Perry et al,
2000)
High
Medium
Low
Tools
Incentives
283
Some bakery respondents felt there was no time to
read trade publications / look at websites etc (Strutt
and Bird, 2004)
59% of companies reporting they would consider
changing to liquid/paste formula envisaged that there
would be technical and cost barriers with this
substitution (Elms et al, 2004).
Costs can be significant - For employer there is loss of
workers and potential litigation (Jeffrey et al, 1999)
Only 27% bakeries were aware of MEL and STEL
standards for flour dust, despite trade/bakery
information. (Elms et al, 2004).
Some bakers did not seem aware of hazards for
asthma and dismissed it as unlikely (Strutt and Bird,
2004).
Undertaking inappropriate work practices may suggest
limited knowledge of good working practices (Elms et
al, 2004)
Minimal resources in bakeries may be barrier to
change (Strutt and Bird, 2004)
INDUSTRY CHARACTERISTICS
Training practices
On the job
College
Older
Younger
External
e.g. contract staff
Manager
Staff
Casual / Student
High
Formal training in use of pesticides associated
with more frequent use of PPE (Avory and
Coggon, 1994)
In-house formal
Casual workers
Ethnic origin profile
Low - medium - high
Medium = ~7%
Agriculture
Better examples of practical solutions may
encourage change (Llewellyn et al, no date)
Yes
Low
Low
Mid
Medium
No
Low
Mid
284
Mfg.food
Identifying simple ways to educate employees about
correct control usage, e.g. LEV is needed (Elms et al,
2004).
12.6% of bakers declared having suffered from
asthma and 21.4% bakers had wheezing. This shows
preliminary signs of asthma in pupils before entering
their active life and therefore suggests justification of
primary intervention at the vocational training level
(Coppieters and Piette, 2004).
After a year of vocational training, the rate of SPTs
positive for at least one allergen increased from 17.9%
to 24.4% (occupational allergens 2 to 8%)
Hypersensitivity to occupational allergens develops
during vocational training (Walusiak et al, 2002).
One main obstacle concerning glove use by the
apprentices was the low acceptance of gloves by their
instructors at the workplace - serious attempts have to
be made to combat the 'macho culture' in bakeries and
foster a preventative environment (Bauer et al, 2002)
Only 40% of bakery companies had some form of
training on flour dust for employees joining. Also,
only 13 companies provided RPE training (Elms et al,
2004)
7.4.2
Wood Manufacture and Motor Vehicle Manufacture/Repair
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
High: Highly
Applicable
Medium:
Manufacture of
Moderately
wood & wood
Applicable
Rating:
products / of
Low:
Less
furniture
Applicable
Lowest:
Least
Applicable
291,511
Population Average
size
2002-2004
225,373
Gender mix Male (AllAverage
2002-2004)
66,138
Female (AllAverage
2002-2004)
Age profile
Flat
High
Young
Middle aged
Medium
Ageing
Old
Low
Mfg.MV
Evidence
Manufacture
of Motor
Vehicles,
Trailers and
Semi-trailers
M.V.R.
Evidence
Sale,
maintenance
and repair
275,895
549,236
238,658
443,941
37,237
105,294
High
High
Medium
285
Medium
Evidence
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Brush cleaning of wood dust
Safety
Don’t know
witnessed at 96% of sites, even
culture
the risks
though 79% had vacuum
(Dilworth, 2000).
66% of sites / 27.2% samples
exceeded MEL (but decreased
from previous survey). Only
34% of sites could produce
written COSHH assessment
(Dilworth, 2000). At 76% of
sites using RPE, RPE only worn
for duration of dusty task. Only
24% of sites wore RPE for whole
work shift (Dilworth, 2000).
Carpenters thought chemical
hazards more of inconvenience
than anything more serious
(Strutt and Bird, 2004).
Aware of
risks but
unsure if
applicable?
High
Mfg.MV
M.V.R.
Sadhra et al (2002). West
Midlands chromium plating firms
(chosen because most shops
employ less than 20 people. Good
knowledge of acute health effects
based primarily on experience, not
able to distinguish hazards from
risks, difficulties in articulating the
effects of chemicals and how
exposure might occur. Some did
not understand key terms used in
SDS. Low response rate from
small companies. Compounded by
lower literary levels in workers.
Response rate undermined by
work and time pressures as well,
Potential barriers are avoidance as
a coping strategy - hay, workers
had faith in their own experience
and ability to control (internal
locus of control). MVR
respondent did not know dangers
of isocyanates (Strutt & Bird,
2004)
Low
286
High
Medium
Speculated that one sprayer with
high exposures may have been
because they were using mostly
water based products and may have
perceived the risk of isocyanate as
not as high as other products and so
may have altered his behaviour i.e. did not know the risk of water
based product. Also, managers
exposed suggesting spraying in the
open workshop or that the manager
entered the booth unprotected
during spraying or before
clearance. (Chambers, Sandys and
Piney, 2005).
RPE not always worn in other
tasks, e.g. mixing paint away from
extraction (Alston et al, 1997).
44% of companies had suitable
written COSHH assessments; 3
companies had no knowledge of
COSHH. Only 22% of companies
rated as having good knowledge
(Chambers, Weyman and Keen,
2002).
MVR respondent did not know
dangers of isocyanates (Strutt and
Bird, 2004).
INDUSTRY
Manfg.wood/ furn
Mfg.MV
CHARACTERISTICS
Health surveillance programme in
There is an element of resignation
Aware, but
place at only 13% of sites. No
of risk. For example, "part and
are taking
sites had RPE face fitting
parcel of the job", "fumes aren't as
no action
programmes. 50% of sites
bad as in previous job", "but
inadequate storage. Many sites
machines make dust, that's a fact
did not conduct checks of LEV
of life", "you just go out and get
(Dilworth, 2000).
some fresh air". (O' Hara and
Employees noted ease of use was
Dickety, 2000).
an important factor in the
Over-familiarity with warnings /
acceptance of ventilation
labels / information when using
controls. For example, switches
chromium plating chemicals
difficult to reach, bag filters
possibly leads to it being less
bulky and difficult to use, hoses
attended to / Becoming overget in the way, people too lazy to
familiar so that the presence of
open and shut blast gates,
SDS undermines its effectiveness.
cleaning with vacuums is time
(Sadhra et al, 2002)
consuming using a broom is
faster etc etc (Brosseau et al,
2002).
Carpentry workers thought
risk/hazard was "part of the job"
(Strutt and Bird, 2004).
Widespread acceptance of the
status quo in woodworking
industry (Worsell et al, 2001).
Reactive approach to H&S - only
search for information if incident
comes up - potential barrier to
prevention (Strutt and Bird, 2004)
287
M.V.R.
Low
MVR supposed to wear goggles,
gloves etc when mixing paint but
cannot hold mixer with gloves on may be similar attitudes to RPE
(Strutt and Bird, 2004)
Inappropriate storage of PPE
(Chambers, Weyman and Keen,
2002).
MVR workers thought risk/hazard
particular to their industry was
"part of the job" (Strutt and Bird,
2004).
Worker observed sweeping dust
using no protective clothing or
equipment and switched off the
extraction. Or cleaning paint guns
without wearing mask, despite
knowing they should (O'Hara and
Dickety, 2000).
Reactive approach to H&S - only
search for information if incident
comes up - potential barrier to
prevention (Strutt and Bird, 2004)
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Medium
Aware, and
will act
sometime
Aware and
acting
Mfg.MV
M.V.R.
High
Medium
288
At companies with isocyanate OA
and at which medical surveillance
programmes were in place, there
was a shorter duration of symptoms
and tendency to better outcomes
versus those from companies
without a programme (Tarlo and
Liss, 2001).
MVR SHAD event increased levels
of awareness and encouraged
participants to take action (as long
as time and cost did not prevent
them) (O'Hara, 2005).
Lowest
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Carpenters prefer "word of
Peer
Colleagues
mouth" communication of risk
contact
and learning from others
experience. But potential
contributor/barrier as may be
getting wrong
information/learning bad habits
etc and there is no authority to
such communication (Strutt and
Bird, 2004).
Minimal support may be barrier
to change (Strutt and Bird, 2004)
Competitors
Customers
Low
Trades
Unions
Medium
Mfg.MV
M.V.R.
Low
Low
Carpenters ignored personal
responsibility - instead feeling
that the H&S onus was on the
clients they worked for (Strutt
and Bird, 2004)
High
289
Manager to shopfloor
communication poor - shopfloor
staff often don't get to see safety
data sheets and never ask to see
them, especially in SMEs (O'Hara
and Dickety, 2000).
Sprayers should communicate with
each other regarding what stage of
clearance the booth is at to ensure
people enter safely (Chambers,
Sandys and Piney, 2005).
Minimal support may be barrier to
change (Strutt and Bird, 2004)
High
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
High
Trade association membership
Trade
mostly viewed as a "badge" of
Assocs /
credibility. Strength of trade
Journal
associations in carpentry thought
to have diminished (Strutt and
Bird, 2004).
Some planning committee
members thought that most
owners of small woodworking
shops are isolated from their
peers and do not participate in
trade associations or other
professional organisations
(Brosseau et al, 2002)
Some planning committee
Suppliers
members thought that
competition between
woodworking shops causes
owners to rely on equipment
suppliers for information about
the best methods of dust control,
and suppliers are not always
knowledgeable about dust
collection systems and their
proper design (Brosseau et al,
2002)
Mfg.MV
M.V.R.
Lowest
Low
Trade association membership
mostly viewed as a "badge" of
credibility. Srength of trade
associations in motor vehicle repair
thought to have diminished (Strutt
and Bird, 2004)
Medium
Evidence of substance substitution
in surface coating industry based
on a desire for risk reduction
largely absent - driven more by
external influence (e.g. by
suppliers) (Chambers, Weyman
and Keen, 2002) Suppliers
identified as source of information
by 51% so some reliance on
suppliers (O'Hara, 2005).
Labelling on isocyanate containing
products does not make it easy for
sprayers to recognise that paints
contain isocyanates, e.g. labelling
on tins are very small and on the
back. Also using the chemical
name does not make it immediately
obvious to the sprayer (Chambers,
Sandys and Piney, 2005)
Deficiencies understanding
technical terms in SDSs. New risk
information and lay language
needed. 19% never used SDSs
(but some had reading/literacy
problems) (Sadhra et al, 2002)
290
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Family
influence
Regulator eg
LA, EA,
HSE
Mfg.MV
Some carpentry respondents said
their information use had
stemmed from legal requirements
(Strutt and Bird, 2004).
Fear that if asked HSE questions
that showed they were not up to
speed it would trigger an
inspection - awareness of HSE
advisory role needs to be
increased (Worsell et al, 2001).
64% of sites had no copies of
HSE information - problems with
access? (Dilworth, 2000).
Some respondents mentioned
product packaging/COSHH but
admit would not read more than
once or never even refer to it.
Info in post seen as junk.
Ignorance / not accessing formal
information - rely on common
sense/experience (Strutt and Bird,
2004).
Need sector specific information
to aid understanding and remove
complacency (Strutt and Bird,
2004).
Medium
291
M.V.R.
Fear of enforcement in smaller
chromium plating companies therefore become isolated from
HSE and guidance (Sadhra et al,
2002)
Lowest
Some motor vehicle repair
respondents said their information
use had stemmed from legal
requirements (Strutt and Bird,
2004).
Fear of litigation/HSE visit and
perception of HSE as "nit-picky"
acts as barrier to liaison with HSE
(Chambers, Weyman and Keen,
2002).
Some respondents mentioned
product packaging/COSHH but
admit would not read more than
once or never even refer to it. Info
in post seen as junk. Ignorance /
not accessing formal information rely on common sense/experience
(Strutt and Bird, 2004).
Prior to MVR SHAD event, only
19% of attendees had seen HSE
guidance on isocyanates in MVR
(O'Hara, 2005).
Need sector specific information to
aid understanding and remove
complacency (Strutt and Bird,
2004).
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Medium
Size profile
Micro
High
Employees in the focus groups
Small
noted that it is expensive to run
the central dust collector all the
time or that controls are too
expensive for small shops
(Brosseau et al, 2002).
Small companies not aware of
HSE ACOP/guidance and those
that knew about it were
unfamiliar with its contents - so
better awareness of information
needed (Worsell et al, 2001)
Medium
Mfg.MV
M.V.R.
Low
High
High
Medium
Low
292
Most have less than 20 employees
(Sadhra et al, 2002). Smaller
companies using chromium plating
chemicals are unlikely to have
specialist H&S staff (Sadhra et al,
2002)
Need simpler more cost effective
methods for determining airborne
isocyanate to facilitate monitoring
by SMEs (Levin et al, 2000).
Poorer rating paint coating
companies tended to be smaller
with a larger range of demands on
their time (Chambers, Weyman and
Keen, 2002).
Safety data information rarely refer
to small companies and SMEs
found them difficult / too technical
language (Chambers, Weyman and
Keen, 2002).
Need simpler more cost effective
methods for determining airborne
isocyanate to facilitate monitoring
by SMEs (Levin et al, 2000)
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Large
Industry
prospects
TREND towards
Increasing
Static
Decreasing
Mfg.MV
M.V.R.
Medium
Small
Small
High
Medium
Medium
High
293
Case study of large company using
TDI found that this company funds
a significant occupational health
infrastructure but similar resources
are not always available, e.g.
smaller companies without on site
occupational health etc (Connor,
2002).
Also, in larger companies such as
the one examined in this article it is
easier for workers with OA to be
reassigned jobs away from TDI but
this is not always the case,
especially for workers at smaller,
single process plants (Connor,
2002).
Flat
Medium
High
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Some carpentry respondents felt
Resource
Time
there was no time to read trade
limitations
publications / look at websites etc
(Strutt and Bird, 2004). Having
time to attend was another
problem in wood industry unwilling to participate as do not
want to delay earning wages
(Worsell et al, 2001).
Money
Medium
Main barrier to training in wood
industry - budgets and scope for
lost production for management
of H&S and training are limited
(Worsell et al 2001).
Planning committee members
described the most important
barriers to using dust controls to
be difficulties with affording
central dust collectors, sanding
booths, downdraft tables and
other similar effective but
expensive controls. Employees
in the focus groups also noted
that it is expensive to run the
central dust collector all the time
or that controls are too expensive
for small shops (Brosseau et al,
2002)
Mfg.MV
M.V.R.
High
High
Medium
Medium
294
Some motor vehicle repair
respondents felt there was no time
to read trade publications / look at
websites etc (Strutt and Bird,
2004).
When asked to identify anything
that might prevent participants
using the information in the MVR
SHAD event to take action at work,
time was a main barrier cited
(O'Hara, 2005).
Choice of paint products influenced
by customer specifications and
cost, not H&S. (Chambers,
Weyman and Keen, 2002)
When asked to identify anything
that might prevent participants
using the information in the MVR
SHAD event to take action at work,
costs was a main barrier cited
(O'Hara, 2005).
Body shop annual income was the
most important determinant for
workplace background exposure
(e.g. office and other areas adjacent
to spray. Higher income/larger
volume = less exposure) and for
sanding operations (Higher
income/larger volume = more
exposure) (Woskie et al, 2004)
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
High
Incorrect use of RPE (with facial
Knowledge
hair, upside down etc) at many
sites (Dilworth, 2000).
Employees discussed the need for
increased awareness of potential
health effects (Brosseau et al,
2002)
Tools
Mfg.MV
Medium
Minimal resources in carpentry
may be barrier to change (Strutt
and Bird, 2004)
M.V.R.
Understanding of hazards and risks
not differentiated (Sadhra et al,
2002).
Understanding of long term /
chronic effects of chromium
plating chemical exposure
incomplete (Sadhra et al, 2002)
Low
295
Poor PPE usage - reflect lack of
user knowledge (e.g. spraying
overalls, working too close, poor
condition/standard of PPE, wearing
with stubble etc) (Chambers,
Weyman and Keen, 2002).
COSHH knowledge limited: 44%
of companies had suitable written
COSHH assessments; 3 companies
had no knowledge of COSHH.
OEL knowledge limited: only 22%
of companies rated as having good
knowledge. Shop floor operatives
unaware of COSHH and OEL knowing what protects and how
needed (Chambers, Weyman and
Keen, 2002).
MVR respondent did not know
dangers of isocyanates (Strutt and
Bird, 2004)
Minimal resources in motor vehicle
repair may be barrier to change
(Strutt and Bird, 2004)
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
Low
Incentives
Mfg.MV
M.V.R.
Sprayers doing "piece work" so
that if a job is finished in a shorter
time than allocated, they are still
paid for the full amount and can
use the saved time to do another
job and increase their earnings.
This may be a negative incentive to
rush jobs, not take caution, not
maintain RPE or conduct checks
etc so as to do as many jobs as
possible and earn as much as
possible (Chambers, Sandys and
Piney, 2005)
296
INDUSTRY
Manfg.wood/ furn
Mfg.MV
CHARACTERISTICS
Low
Sadhra et al (2002) New workers
Medium
Some carpenters felt H&S simply
Training On the job
learn from senior platers "on the
down to user experience (Strutt
practices
and Bird, 2004).
job" - need to include ability to
Training and instruction on
learn from mistakes as selection
correct use of RPE at only 3 of 40
criterias.
sites. Only 1 site kept records
Less workers than experts (74% vs
(Dilworth, 2000).
92%) believe they can learn from
Training, especially in smaller
others. Experts see formal training
organisations was found to be
better / chromium platers see on
quite poor with improvements
the job training better.
needed.
For example, training in
micro/smaller businesses
appeared patchy and more likely
to rely on on-the-job training this was not perceived by
operators as proper training, may
not cover H&S in sufficient detail
and may be poor quality due to
colleagues lacking knowledge or
passing on bad habits (Worsell et
al 2001)
297
M.V.R.
Older
SMEs often have on-the-job
training by more experienced staff
- who may be conveying bad habits
(O'Hara and Dickety, 2000)
INDUSTRY
Manfg.wood/ furn
CHARACTERISTICS
High
62% in high-risk professions of
College
OA are conscious of occupational
risks related to their work (52%
in low risk professions).
This shows preliminary signs of
asthma in pupils before entering
their active life and therefore
suggests justification of primary
intervention at the vocational
training level (Coppieters and
Piette, 2004)
Casual
workers
Ethnic
origin
profile
Low medium high
medium =
~7%
In-house
formal
External
eg contract
staff
Manager
Staff
Mfg.MV
High
M.V.R.
Howe & Simpson (2005) No legal
requirement for formal training
operations. Until 15 years ago the
majority of welders undertook
lengthy apprenticeship, learning all
aspects of training over a number
of years. Now more common to
learn one or two methods via a
college course or on short courses
undertaken on the job. All welders
have to hold a valid certificate to
carry out the specific type of
welding (BS EN 287-1:2004, need
recertification every year. Focuses
on quality and suggests safety as a
topic for inclusion of knowledge
tests
Younger
Medium
Supplier
No
Lowest
No
No
Low
Low
Low
Med
Med
Mid
Casual /
Student
298