Using Technology to Scale-Up an Occupational Sun Protection Policy Program

A key goal in the Affordable Care Act is building a national culture of prevention through
workplace health and safety initiatives. To achieve this goal, methods for scaling up
evidence-based programs from research to wide-scale dissemination are needed to help balance
effectiveness and cost. In many cases, there are pressures to reduce scale-up costs but at
the expense of lower program implementation and effectiveness. A scale-up method that
sacrifices effectiveness but reduces costs and reaches a larger number of employers may be
acceptable. The investigators will model the effectiveness and cost trade-off, along with the
extent and representativeness of reach, when scaling up the evidence-based occupational sun
protection intervention, Sun Safe Workplaces (SSW), for national distribution. The
intervention, which relies on personal contact with managers and in-person employee training
(SSW-IP), created large improvements in comprehensive workplace sun safety (i.e., policy
adoption and employee education) in a randomized controlled trial. The investigators will
compare the existing in-person program delivery methods (SSW-IP) to a lower-cost
dissemination method that utilizes Internet technology (SSW-T), i.e., virtual meetings,
social networking, online training, and program materials. The aims of the research are to:
1) estimate the program reach (number and representativeness) and implementation rates (i.e.,
adoption of policies and delivery of education on occupational sun protection) achieved by
the SSW-IP and SSW-T in a model of national distribution to public safety and public works
industries; 2) estimate the costs associated with the SSW-IP and SSW-T (i.e., intervention
costs and induced employer costs) and compare the estimated program benefits (i.e., policy
and education) to cost; and 3) estimate the effect and cost-effectiveness of SSW-IP and SSW-T
in secondary outcomes of a) changes in workplace environments and procedures for sun safety
and b) workers' sun safety practices. In a 5-year project, SSW-T will be created by
redesigning the very effective SSW-IP methods to use the latest web conferencing, social
networking, and online training technology for dissemination. The implementation rates
(defined as policy adoption and education delivery) and costs associated with SSW-IP (n=50
employers) and SSW-T (n=150 employers) will be modeled in a randomized two-group
pretest-posttest design, enrolling a national sample of 200 employers (i.e., firefighting
departments and state departments of transportation). Unlike traditional randomized trials,
the primary analysis will be of cost effectiveness to test the hypothesis that SSW-T can be
delivered cost-effectively to an expanded group of worksites producing a lower implementation
rate than SSW-IP but at substantially lower cost. Secondary analyses will compare the two
scale-up strategies on implementation rate, differences in rate by employer groups (e.g.,
size and region), changes to workplace environment/procedures, and employee sun safety
practices. The findings will have high impact by helping public health practitioners select
the best strategy for scaling up evidence-based workplace health and safety programs to
achieve this ACA goal.

Inclusion Criteria:

- Fire Departments and State DOTs in the United States, agreeing to participate,
providing written policies at pretest and having at least 6 managers and 50 workers
complete the pretest.

- Being a senior manager of a fire department or state DOT located in the United States.
Criteria include a) being in a senior management position; b) responsible for
work-site safety/health policy and education; c) consenting to participate, and d)
completing the pretest. This includes city/county managers, human resources directors,
risk managers, and managers of facilities, fire, roads and transportation departments

- Being an employee of a fire department or state DOT located in the United States.
Criteria includes a) being employed part/full-time at the employer, b) working at
least part of daytime hours outdoors, c) consenting to participate, and d) completing
the pretest survey.

Exclusion Criteria:

- Prior participation in the Sun Safe Workplaces program