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Oral Session 3 – Intervention studies

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O3.1 EVALUATION OF HIV PEER EDUCATION IN A SOUTH AFRICAN WORKPLACE

J. Myers, N. Sloan.School of Public Health and Family Medicine, University of Cape Town, South Africa

Introduction: In 1997, a South African national retail group operating two companies initiated an HIV/AIDS peer education programme for its employees, aimed at addressing the growing epidemic. This, along with a number of similar initiatives in industry, had never been evaluated.

Methods: A cross sectional study of employees was conducted in 2001 to determine (a) the level of HIV/AIDS knowledge; (b) attitudes towards people living with HIV/AIDS; (c) perceived self risk of acquiring HIV infection; and (d) use of condoms (provided free). Questionnaires were completed in the vernacular during in store training sessions in three geographical regions (Gauteng, Western Cape, and Eastern Cape/KwaZulu-Natal) in 2001.

Results: In store training sessions given by peer educators to their colleagues had no significant impact on any of the four main study outcomes. Multivariate logistic regression showed that very little of the variance in any of the four main outcomes was explained by potential determinants of interest. Regarding HIV knowledge, 8% of variance was explained by geographical area, level of education, whether or not participants were managers, and if they were peer educators. Of the total number of subjects, 59% had a good knowledge score (mean 13.6, maximum 17). Regarding variance in attitude towards people with HIV/AIDS, 6% was explained by company, geographical area, level of education, whether or not participants were managers, and if they were peer educators; 62% had a positive attitude towards people with HIV/AIDS. Regarding risk, 7% of variance was explained by age, sex, company, geographical area, and relationship status. The majority of participants thought they were at low risk of acquiring HIV (mean 2.5, maximum 10). For condom use, 17% of variance was explained by age, sex, company, geographical area, relationship/marital status, and whether or not participants were permanent or casual employees; 34% used condoms frequently.

Conclusions: This HIV peer education programme is ineffective and wasteful of resources. The symbolic value of this inexpensive programme seeming to indicate action contrasts with the absence of a more costly comprehensive and effective AIDS care programme, including antiretrovirals, as part of health insurance. The private sector has been as tardy as the public sector in effectively addressing the epidemic.

O3.2 IMPACT OF TRAINING IN THE MANAGEMENT OF AGGRESSION ON INCIDENT RATES AND PERCEPTIONS OF STAFF

E. R. Waclawski, L. Bell, J. Leyden.Occupational Health Service, NHS Argyll and Clyde, Paisley, UK

Objective: To investigate the benefit of training in reporting of incidents and any benefit in confidence and anxiety when dealing with incidents.

Methods: The training records for management of aggression from April 1999 to March 2001 and the incidents recorded in April 2000 to March 2003 were linked to give rates of incidents for verbal abuse and physical aggression for trained and untrained staff. A survey of staff was undertaken to investigate the effect of training on anxiety and confidence, and further training needs, by means of a questionnaire.

Results: The total number of employees was 1800. Of these, 243 were trained, and 1557 untrained in the 2 year period. There were 164 incidents of verbal abuse and 247 of physical abuse recorded for the 2 years under study. For the trained staff, 44 verbal and 74 physical abuse incidents were recorded. The annual rates of reported verbal incidents for all (4.6/100), trained (9.0/100), and untrained staff (3.9/100) and physical incidents for all (6.9/100, trained (15.2/100), and untrained (5.6/100) staff indicated higher rates for trained staff. The difference in rates between trained and untrained staff for verbal incidents (5.1/100; 95% confidence interval (CI) 2.0 to 9.5) and physical incidents (9.6/100; 5.5 to 14.8) indicate that trained staff had a significantly higher rate of reporting of verbal and physical incidents compared with untrained staff. Prior to having been trained, the trained staff only reported 14 physical and 16 verbal incidents (1999 to 2001), suggesting a change in behaviour following training. In the questionnaire responses, 55% of staff who had attended training indicated that it had changed their reporting behaviour. An increased awareness of violence and aggression was also identified from the responses. The training appeared to have a positive impact in reducing anxiety dealing with violence and aggression in 67% of respondents and improved staff confidence in 81% of respondents. It also resulted in improved breakaway and restraint techniques in 75% of trained staff, but 12% considered that after training they were more likely to cause injury to patients.

Conclusions: The effect of training on incident reporting will require to be considered when studying this topic or setting targets for reductions in incident rates at work.

O3.3 MANAGEMENT OF OCCUPATIONAL HEALTH HAZARDS OF FARM WOMEN THROUGH EDUCATIONAL INTERVENTION

S. Singh, S. Sinwal.Department of FRM, College of Home Science, MPUAT, Udaipur, India

Introduction: Health is fundamental to the national progress in any sphere. The general health of the people is also related to the occupation in which they are engaged. Women make up 46% of the total agriculture workforce in India and face debilitating health hazards. The present study was an effort to assess the occupational health hazards of women farmers and to design an educational package for intervention to generate awareness for minimising these hazards.

Methods: A scale developed by us in 2004 was used for assessment of hazard proneness of women farmers in agriculture. As the vast majority of respondents was found to be prone to high risk of hazards and were also illiterate and ignorant of safe work practices, an educational package in the form of a video compact disc (VCD) was developed to promote health and safety in agriculture.

Results: The analysis of responses on scale revealed that the majority of subjects (74%) had a high incidence of being prone to hazards. The effectiveness of the self developed educational package was tested by assessing the gain in knowledge of the respondents by exposure to the VCD. For this purpose pre- and post-experimental analysis was carried out. An overall view of the before and after knowledge scores and the significant paired t test values (45.36, significant at the 1% level) emphatically expressed the effectiveness of the package in imparting knowledge of causes and the corresponding remedial measures in minimising occupational health hazards in agriculture to the selected sample group.

Conclusion: The findings of this study should guide government, policymakers, implementers, non-governmental organisations and social workers to take preventive/remedial measures to enhance the work status of women.

O3.4 IS SMOKING CESSATION ENOUGH IN THE PREVENTION OF OCCUPATIONAL ALLERGY?

D. Rees1, N. Mansoor1, D. Bartie1, M. Jeebhay2, F. Fox3.1National Institute for Occupational Health, Johannesburg, South Africa; 2School of Public Health and Family Medicine, University of Cape Town, South Africa; 3Mondi Ltd, Johannesburg, South Africa

Introduction: Smoking inconsistently increases the risk of sensitisation to occupational allergens, but is important in some settings, usually when the exposure is to high molecular weight agents. The intensity of exposure and atopy may modify the risk of sensitisation in smokers. This paper presents findings on the effect of smoking on sensitisation to occupational allergens from four concurrent recent South African occupational allergy studies.

Methods: One cohort study in a soybean plant (n = 115 workers) and three cross sectional studies were carried out in a maize processing plant (n = 74), a fish processing plant (n = 513), and a pine sawmill (n = 96), to identify sensitisation to the respective workplace allergens. Smoking history was ascertained by questionnaire and atopic status, and occupational sensitisation by skin prick tests (positive test  =  3 mm > negative control; atopic  =  positive to at least one common aeroallergen).

Results: Atopic smoking workers were a relatively large part of the workforces (14–22%) and invariably had the highest proportion of sensitised subjects, as shown in table 1. Interaction with atopy is suggested in some settings. There were 22 “excess” sensitised workers out of a total of 115 in the four workplaces.

Table 1

 Number of sensitized workers in different industries

Conclusions: the smoking effect was inconsistent but substantial in atopic workers. Controlling allergen exposure and prohibiting smoking may markedly reduce sensitisation in these settings. The immediacy of sensitisation may be an inducement for discouragement of smoking during vocational training and at work.

O3.5 HEALTHY WORKPLACES IN THE HEALTHCARE SECTOR: PARTICIPATORY ERGONOMICS IN AN ONGOING INTERVENTIONS STUDY AT A DANISH HOSPITAL

N. Fallentin1, M. Söderfeldt2.1National Institute of Occupational Health, Copenhagen, Denmark; 2Malmo University, Sweden

Introduction: Healthcare is one of the major employment sectors in Europe with a significant proportion employed in hospitals. At the same time, the sector is characterised by a preponderance of working environment problems such as accidents, musculoskeletal disorders, violence at work, and shift work.

Objective: In order to provide practical tools for the improvement of working conditions at Danish hospitals, a governmental research programme was initiated.

Methods: As part of this programme, the present interventions study was started in the orthopaedic and psychiatric ward at a Copenhagen city hospital in 2002. Working environment problems at the two wards were assessed in a questionnaire based survey. Based on the survey, a controlled trial was conducted by assigning subunits in the two wards, with a high similarity in exposure conditions, as either the intervention or the control group. Interventions were planned, initiated, and surveyed by participatory ergonomics teams. Pre-intervention exposure levels were measured using a combination of selfreported data and recordings of ergonomic exposures (back postures measured by inclinometers) and biomarkers of psychosocial exposure, such as urinary catecholamines.

Results: The initial questionnaire (591 participants and a response rate of 79%) revealed distinct and different profiles at the two wards. The orthopaedic ward had a high frequency of strenuous working postures, a high back load (Hollmann physical exposure index 22.4), and associated back problems, while the psychiatric ward exhibited a limited physical workload (index value 12.4), but major psychosocial problems, mainly in the form of workplace violence. Interventions at the orthopaedic ward thus focused at ergonomic patient handling issues, using a combination of mechanical lifting devices and supervised training, while the psychiatric ward introduced a number of measures to combat violence at work, such as staff training and modification of the work organisation and physical workplace environment.

Conclusion: Post-intervention measurements (second questionnaire and direct exposure measurements) will be conducted towards the end of 2004. The results are expected to improve the quality of evidence based guidance to support working environment initiatives at Danish hospitals.

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