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

《平价医疗法案》的一个关键目标是建立一种通过工作场所卫生和保健来预防的国家文化 安全倡议。为了实现这一目标，将循证项目从研究扩大到广泛的方法- 需要大规模传播，以帮助平衡效率和成本。在许多情况下，有压力要 降低纵向扩展成本，但代价是降低计划实施和有效性。扩大规模 牺牲效率但降低成本并惠及更多雇主的方法可能是 可以接受。我们将对有效性和成本权衡以及以下方面的范围和代表性进行建模 当我们扩大基于证据的职业防晒干预措施时，阳光安全工作场所 (SSW)，用于全国分发。这种干预依赖于与经理和内部人员的个人接触。 员工个人培训(SSW-IP)，大大改善了工作场所的防晒安全(即， 政策采纳和员工教育)在随机对照试验中进行。我们将比较现有的- 个人节目交付方法(SSW-IP)到利用互联网的低成本传播方法 技术(SSW-T)，即虚拟会议、社交网络、在线培训和计划材料。目标 研究的目的是：1)评估项目的可达性(数量和代表性)和实施情况 SSW实现的比率(即采用职业防晒政策和提供职业防晒教育)-- IP和SSW-T在国家分配给公共安全和公共工程行业的模型中；2)估计 与SSW-IP和SSW-T相关的成本(即干预成本和诱导雇主成本)，并比较 估计的计划收益(即政策和教育)对成本；以及3)估计影响和成本- SSW-IP和SSW-T在a)工作环境和环境变化的次要结果中的有效性 日晒安全程序和b)工人的日晒安全做法。在一个为期5年的项目中，SSW-T将由 重新设计我们非常有效的SSW-IP方法，以使用最新的网络会议、社交网络和 在线培训技术的传播。实施率(定义为政策采纳率和 与SSW-IP(n=50个雇主)和SSW-T(n=150个雇主)相关的费用 以随机两组前测-后测设计为模型，招募了全国200名雇主样本(即， 消防部门和国家交通部门)。与传统的随机试验不同， 初步分析将具有成本效益，以检验SSW-T可以经济高效地交付的假设 到一组扩展的工作地点，其实施率低于SSW-IP，但基本上 更低的成本。二次分析将比较两个扩大战略的实施率、 按雇主群体(例如，规模和地区)、工作场所环境/程序的变化和员工的费率 防晒安全措施。这些发现将产生巨大的影响，帮助公共卫生从业者选择最好的 扩大循证工作场所健康和安全计划的战略，以实现这一ACA目标。

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. We will model the effectiveness and cost trade-off, along with the extent and representativeness of reach, when scaling up our 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. We 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 our 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.