Occupational injuries and diseases seriously threaten workers’ health and result in great economic loss [1]. Health and safety training has been adopted as one means for reducing occupational injuries and diseases in the workplace. However, the effects of traditional didactic training programs are usually short lasting and may not be effective in reducing occupational injuries and diseases in the long run. Furthermore, the effectiveness of occupational health and safety training has not been thoroughly evaluated.

 A non-governmental organization in Hong Kong, the Hong Kong Workers’ Health Center, started to introduce participatory training on occupational health and safety (OHS) in China in 2003 [2]. A randomized controlled trial (RCT) was conducted in manufacturing factories in Shenzhen (a special economic region in southern China) to evaluate the effectiveness of participatory approach to OHS training compared to traditional didactic training.

Methods:

Sixty factories (30 pairs) were identified from the factory register in Shenzhen and were paired according to industry, production process and employment size. One of each pair of factories was randomly assigned to the intervention group and the other to the control group. Within each intervention factory, 60 workers were selected and they were then randomly allocated to an intervention group (with participatory training) and a control group (with conventional didactic training). In the control factories, all 60 workers received didactic training. The OHS topics covered were the same in both participatory training and didactic training.

All participating workers completed a baseline questionnaire before training, exploring their knowledge, attitude and practice (KAP) on a number of OHS areas, and experiences of musculoskeletal disorders (MSD) and occupational injuries suffered over the previous 12 months. The KAP assessment was repeated immediately after training, then at 3 and 12 months after training. MSD experiences and occupational injuries were enquired again at the end of the 12-month follow-up.

One way and repeated measure analysis of variance (ANOVA) were used to compare KAP scores at different time points and between the different groups. Chi-square test was used to compare the proportions of workers who reported MSD at baseline and 12 months in the different groups. Chi square test and two proportions Z test were applied to compare the injury incidence rates in the 12 months prior to and after training in the different groups.

Results:

During 2008-2010, 3,479 frontline workers in 60 factories were involved in the trial: 918 workers in intervention groups received participatory training, 907 workers in intervention factories (Control 1) and 1,654 workers in control factories (Control 2) received didactic training as control groups.

The follow-up rates at 3-month and 1-year after training were 71.1% (2,473/3,479) and 60.9% (2,120/3,479) respectively. The average baseline KAP scores of 64.9±15.0, 63.5±14.7 and 78.1±18.0 improved after training significantly (p<0.001) at immediate evaluation (82.7±12.3, 71.9±12.4 and 90.6±12.7), at three month after training (79.6±11.5, 73.9±10.5 and 91.8±9.5) and at one year after training (75.4±12.0, 71.3±10.1 and 88.4±10.7). The mean KAP scores of intervention groups were significantly higher than those of the two control groups after training, but the actual differences were small. There appeared to be a trend for the scores to decline over time, especially for the knowledge score.

There were no statistically significant differences in the overall prevalence of MSD between baseline and one year after training in the different groups. For the specific body parts, prevalence rates of MSD decreased slightly in general one year after training, but the reduction was only significant in the lower extremities (from 16.8% to 9.9%; c² = 13.102, p< 0.001) and wrist/fingers (from 12.9% to 8.3%; c² = 9.433, p=0.002) in the intervention group, and no significant reduction was observed in any body parts in the two control groups.

In the year after training, the person-based and event-based incidence rates of injury in the intervention group reduced from 89.3 per 1,000 workers to 52.1 per 1,000 workers (χ2=6.703, p=0.010) and from 138.3 per 1,000 person-years to 67.0 per 1,000 person-years (Z=4.543, p<0.01), respectively. The person-based and event-based incidence rates of injury in the two control groups also reduced, but the reductions were not statistically significant (p values>0.05). The re-injury rates were 27.1% (13/48) in the intervention group, 46.3% (19/41) in Control1 group and 52.6% (51/97) in Control 2 group. The average cost savings for injury prevention were 110.5 Yuan (US$ 16.7) per worker for participatory training and 35.2 Yuan (US$ 5.3) per worker for didactic training.

Conclusions and Recommendations:

Participatory OHS training was effective in improving KAP on OHS of factory workers, and compared favourably to conventional didactic training. The effects on attitudes and practices seemed to be more sustainable. This form of training also effectively reduced occupational injuries over a period of 12 months. The effectiveness for reducing MSD was less obvious. Preliminary cost-benefit analyses suggested a more favourable return compared to didactic training.

When planning education and training programs on OHS for workers, attention should be given to the approach and methods in addition to the contents and we should do justice to the huge sums of money being spent by doing proper evaluation that will help identify the useful from the less useful or useless. Eliciting the active participation of workers would guarantee success and improve sustainability of the effects on OHS improvements. In view of the trend for decline of KAP over time, repeated training for workers is recommended for sustaining the improvement of KAP on OHS.

Further work in progress:

The original training program package of the Hong Kong Workers’ Health Center included a follow-up to set up a health and safety committee in the factory to sustain the impact of participatory training. This was withheld in the previous RCT in order to evaluate participatory training method per se. The whole program is currently being implemented in a new 3-year project that will cover over 200 factories in Guangdong Province of China and the added value of introducing a health and safety committee for sustainable workplace occupational health and safety improvements will be further evaluated.

References

1. World Health Organization. Declaration on Occupational Health for All. WHO, Geneva, 1994.
2. Yu TS , Liu TY. Improving occupational health and safety through participatory ergonomics in Hong Kong Safety and Health; Beijing2004. p. 296-8.