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

《平价医疗法案》的一个关键目标是通过工作场所的健康和保健， 安全举措。为了实现这一目标，扩大从研究到广泛的循证方案的方法， 需要规模传播，以帮助平衡效率和成本。在许多情况下， 降低扩大规模的成本，但以降低计划的执行和效率为代价。纵向扩展 一种牺牲效率但降低成本并覆盖更多雇主的方法可能是 可以接受的我们将对有效性和成本权衡进行建模，同时沿着 当我们扩大以证据为基础的职业防晒干预措施时， (SSW)，供全国发行。这种干预依赖于与管理人员的个人接触， 个人员工培训（SSW-IP），创造了全面的工作场所阳光安全的巨大改善（即， 政策采纳和员工教育）的随机对照试验。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 研究的主要目的是：1）估计项目的覆盖范围（数量和代表性）和实施情况 费率（即，通过有关职业防晒的政策和提供有关职业防晒的教育）， IP和SSW-T在公共安全和公共工程行业的国家分布模型中; 2）估计 与SSW-IP和SSW-T相关联的成本（即，干预成本和诱导雇主成本），并比较 估计的计划收益（即，（三）成本与效益;（四）成本与效益。 SSW-IP和SSW-T在以下次要结果中的有效性：a）工作场所环境的变化， 日照安全程序和B）工人的日照安全实践。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， 在线培训技术的传播。执行率（定义为政策通过率和 教育交付）以及与SSW-IP（n=50名雇主）和SSW-T（n=150名雇主）相关的费用， 在随机两组前测-后测设计中建模，招募了200名雇主的全国样本（即， 消防部门和州交通部门）。与传统的随机试验不同， 主要分析将是成本效益，以检验SSW-T能够以成本效益的方式交付的假设 扩大了一组工作地点，其执行率低于SSW-IP，但 更低的成本二次分析将比较两种扩大战略在执行率、 按雇主群体分列的费率（例如，规模和区域）、工作场所环境/程序的变化以及员工 阳光安全实践这些发现将通过帮助公共卫生从业者选择最佳方案来产生重大影响。 扩大以证据为基础的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.