NIOSH Board of Scientific Counselors

Report of the Work Group on Enhancing the Utility of NIOSH Information Products: October 22, 2007

Work Group Members

Board Members:
Scott Schneider - Chair
Mei-Li Lin
Eric Lamar

NIOSH participants:
Max Lum
Paul Schulte
Andrea Okun
Christy Forrester
Fred Blosser
Elaine Cullen

Report

"So many scientists think that once they figure it out, that's all they have to do, and writing it up is just a chore. I never saw it that way; part of the art of any kind of total scholarship is to say it well." -Stephen Jay Gould

"To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications" -Louis Pasteur

NIOSH does a tremendous amount of top quality research to help solve occupational safety and health problems. The ultimate goal of this effort is to reduce workplace fatalities, injuries and illnesses. NIOSH has historically developed a broad range of documents containing occupational health and safety (for example in the 1970s NIOSH produced a whole series of health and safety guides for each industry), however its primary focus was making scientific recommendations, usually in the form of recommended exposure limits (RELs), to OSHA as the basis for new regulations. NIOSH spent its early years developing numerous "criteria documents" with such recommendations. OSHA adopted some of these and created new rules resulting in many lives saved and illnesses prevented, for example recommendations on asbestos and cotton dust. NIOSH played a key role in generating new information from its research efforts and also synthesizing information into a usable form for creating policy. More recently, OSHA has been much less active in the development of new regulations and NIOSH recommendations have become less critical. A new direction was forged to utilize the information NIOSH has developed to create safety and health improvements in the workplace. The emphasis has shifted focus from supporting new regulatory efforts to using social marketing to get the information to key decision makers who will be convinced of the need for change. This change has been reflected more recently in a change in NIOSH's communications strategy, with less effort and emphasis placed on the development of recommended standards and more emphasis on communication products geared towards employers, employees, and the general public. In addition, with the increased use of the Internet, NIOSH has also implemented a dissemination strategy that calls for the release of its communication products on the NIOSH Website as well as in print. The new Institute focus on "research to practice" (r2p) also necessitates a review of how communications and social marketing strategies can play a major role in the implementation and utilization of the scientific information created by NIOSH scientists. This report will examine how the Institute's communications strategy has changed and if and how it could be even more effective.

NIOSH Communications Efforts

NIOSH develops a large variety of communication products and communication vehicles. These range from technical reports and scientific articles in peer reviewed journals to "workplace solutions" documents which are geared more towards a lay audience and summarize a problem and solution for specific types of work or workplaces. Appendix A has a table showing the breadth of NIOSH's communications products. In recent years the emphasis has shifted towards publishing more accessible documents and web publishing. Appendix B lists the most popular (most visited) NIOSH web pages.

Appendix C is a summary of the most popular products requested and distributed in the 2006 and 2007. The NIOSH "Pocket Guide to Chemical Hazards" is far and away the most requested publication, perhaps because of its wide use across many sectors, its synthesis of so much technical information into an accessible format and the fact I has been around as a publication and used for so many years. One possible explanation for its popularity may be that private entities also publish copies and charge $35- $75 a copy making free distribution more attractive. It has been suggested that if NIOSH could charge for hard copies of publications then it might be attractive for web booksellers like Amazon to make it available as well. The Government Printing Office (GPO) charges for government publications. NIOSH should be able to charge small amounts to cover printing and distribution, while continuing to make individual copies(or small quantities) available for free and continue free electronic distribution over the internet. The other popular publications appear to be alerts about hazards (like latex allergies and needlesticks) and are mostly focused on the health care sector.

NIOSH also distributes an electronic newsletter, eNews. As of Sep 26, 2007, there are 24,785 subscribers to NIOSH eNews.

Users Survey

Recently there have been some initial attempts at evaluation of NIOSH communication products and methods of distribution. A recent 2004 survey of four professional associations (AIHA, ASSE, AOEM and AOHN) showed widespread recognition of NIOSH among professionals and, most importantly, high credibility of the scientific information presented. The survey results included several suggestions for future improvements in NIOSH communications. Respondents suggested:

• Packaging or distributing NIOSH publications around common themes (83%)
• Announcing publications on the NIOSH website (81%)
• Creating CDROM collections of publications (69%)
• Publicizing and increasing the circulation of the NIOSH HHE reports (65%)

NIOSH has been doing much more diffusion of documents though the web and its eNews and has been publishing more documents on CDROM since this report was issued. In addition respondents also suggested that NIOSH publish more of the following documents (% recommending):

• Practical applications and guides (checklists, how-to publications) (81%)
• Recommended standards (criteria documents) (72%)
• Booklets for educating workers (67%)
• Booklets for educating owners and managers (55%)
• Case studies (HHEs, fatality investigations) (51%)
• Scientific documents (41%)
• Analytical methods manual (35%)

So clearly, even safety and health professionals see the need for NIOSH to publish more documents for practitioners, employers, and workers (e.g. the non-scientist), as well as continuing to communicate in scientific circles. A similar survey will be conducted soon among trade associations and unions and the original study among the four professional associations will be repeated to see if changes implemented have met the needs of these important customers for NIOSH information. Another area NIOSH needs to explore is how its communications products are meeting the needs of small organizations and businesses that may not have access to professionals and sectors which NIOSH may be less known (e.g. the service sector).

Impact

With the increasing emphasis in NIOSH on Research to Practice and increasing attention being paid to measuring impact by the OMB and recommendations from the National Academies of Sciences reviews, the question arises as to whether NIOSH's communication efforts can be focused to increase their impact and more effectively prevent injuries, illnesses and fatalities. This requires an analysis of how change occurs and how communications can help effect change, in other words a social marketing plan.

We need to ask the following questions:

1. Who should the target audience(s) be?
2. Who has the ability or the authority (and responsibility) to make or influence changes in the workplace that can affect occupational safety and health?
3. What are their concerns or issues? What do they care about? What is on the top of their inbox?
4. What communications channels do they use to get information? Which ones do they trust or listen to?
5. What messages will move them and can create change?
6. What is the best way to deliver those messages, who should deliver them?
7. How will product impact be measured and by whom?

While the focus of NIOSH has traditionally been scientific publications/communications, they may not be reaching the decision makers or be in a language they understand or are motivated by. Scientific journals are often difficult to access, even though they are mostly on line now. They generally require a subscription. The language of scientific publications is also not as accessible to lay readers, such as practitioners.

This analysis needs to be made up front at the early stages of a project design and development. Who should do this work? Developing a marketing/communications plan, is an important issue. Many NIOSH researchers feel that they are not trained to do this work and are pressed for time and money to just get their research accomplished. Generally, they believe the information should be handed off to a communications person to develop such a plan and work with partners on implementation. Others, though, have incorporated such communications and implementation/diffusion efforts into their projects and done extensive work to gain adoption of changes (e.g., some of the agricultural research projects). NIOSH has recently contracted with several professional health communications firms to act as a resource to NIOSH researchers to help them with social marketing efforts.

NIOSH has several different offices that are involved in its health communications effort. There is the Office of Health Communications in the Office of the Director in Washington, the Education and Information Division in Cincinnati and also the r2p office in Cincinnati. It is important for these offices to coordinate their functions and work together to achieve maximum impact and avoid duplication of effort.

Some researchers have very close connections with the industry they are studying, attend trade shows, speak at industry meetings and work with the industry trade press to get information out. Perhaps the best example of this is the mining sector. The mining research and communications program is well funded, has a relatively small sector to work with and has a long history of working with industry and labor representatives to do research and disseminate research findings. It is unclear though how effective this communications effort has been in creating positive changes in the industry. The National Academy of Sciences (NAS) recently reviewed the NIOSH Mining research program and concluded: "The Mining Program should place greater emphasis on outputs preferred by mining operators, miners and other non-technical users." They also added "Much of the responsibility for technology transfer is in the hands of project researchers who cannot be expected to be expert in technology transfer issues involved." They recommended a "more proactive, aggressive, and strategic dissemination agenda… one that is informed by research about the diffusion of new technologies, processes and practices." One avenue to explore is repackaging NIOSH publications (like HHEs) in a given area or sector to make them more accessible. Even technical reports from extramural grantees could be made more accessible by building a repository of them on the NIOSH website. Use of NIOSH materials in training program will help diffuse the information more effectively by multiplying the umber of people reached.

One way that has been suggested to encourage more focus on impact is through holding Division Directors accountable for this effort. They have significant control over what little discretionary budgets they have and can help direct the research program in their Division in this direction. However, NIOSH must decide how best to balance limited resources between the Institute's important research function and its outreach activities (information dissemination, r2p, public health practice).

Partnering

One successful strategy has been to partner with others to translate and communicate the information to new audiences. Two examples of this are the partnership with the National Safety Council on intervention evaluation and with the Laborers' Health and Safety Fund on Internal Traffic Control Plans (ITCP). NIOSH worked with the Institute for Work and Health in Toronto to produce a book: "Guide to Evaluating the Effectiveness of Strategies for Preventing Work Injuries: How to Show Whether a Safety Intervention Really Works." They then gave a small contract to the National Safety Council to develop a workshop based on this book for small employers to encourage them to evaluate safety and health interventions in their workplaces. This workshop has been very popular. Likewise, NIOSH sponsored research (in cooperation with the Laborers' Health and Safety Fund) developed an intervention to reduce backover fatalities among road workers by planning routes through road construction sites to minimize backing up. This concept (called an Internal Traffic Control Plan) was then translated into an accessible booklet by the Fund under a small contract with NIOSH and is will shortly be available through OSHA as part of their Alliance program. Partnering with non-profits to translate NIOSH research for a wider audience could plan an important role in helping increase the effectiveness of NIOSH's communications efforts. Ultimately it may be useful to look at the successful model in the Agricultural Extension Service which brings useful information directly to those who need it and consider if r2p centers should be established around the country. NIOSH should also look at social marketing opportunities with those who have extramural NIOSH funding, like cooperative agreements.

Health Communications Research

One theory about changing behavior is that the main motivation for employers is financial. If we can convince them that a change will save them money, they will make it. As a result, increasing effort has gone into showing "return on investment" for safety and health interventions. NIOSH has economists on staff and they have also been doing such research. It is unclear though how much this strategy will work or in which instances (e.g. small businesses vs. larger businesses). It clearly plays a role in many decisions, but is it the prime motivator or deciding factor?

NIOSH has also been doing research on the effectiveness of various types of messages, particularly the use of story telling to change attitudes and motivate people to make changes. The aim of the NIOSH education and training research program is to better understanding the multiple factors that influence occupational safety and health education and training effectiveness. As part of this research, NIOSH evaluates the audience impact of training programs and their components by investigating: (1) theoretical models gleaned from health promotion, psychology, learning and educational perspectives; (2) the role of attitudes, beliefs, behavioral intentions, and other characteristics of the individual that affect learning and transfer of learning into action; (3) barriers affecting adoption of health and safety behaviors promoted by training; and (4) environmental influences on occupational safety and health training. The results of this effectiveness research are used to improve safety training programs and/or safety training products. Researchers determine the optimal approach or media to be used to communicate and educate audiences about occupational safety and health issues. The effects of these improvements to training programs/products is demonstrated through increased audience awareness of a particular set of health risks, modification of a set of behaviors, development of sound workplace safety practices, or modifications to the work environment.

Rewarding r2p Efforts

The NIOSH Communications Office in the Office of the Director has been holding seminars and discussions across the Institute to figure out how to address these issues and has assigned communications personnel to many Divisions and NORA sector teams to have help ready to assist scientists in their efforts. There are additional barriers to getting research scientists to work on diffusion efforts. Scientists get rewarded with promotions for their scientific publications efforts. They do not get such rewards (other than professional satisfaction) for efforts such as writing articles for the trade press, which is the main source of information for practitioners, or presenting or exhibiting at trade shows.

NORA Sector Councils

One mechanism for improving communications and dissemination is through the NORA sector research councils. Last year NIOSH set up 8 sector research councils with representatives of industry, labor and academia. These councils have been drafting goals for the sectors. They will be a great resource to 1) identify research opportunities and issues, 2) identify the best channels for communication within the sector and 3) strategize on how NIOSH research can be most effectively communicated to create change within that sector.

The NIOSH Review Process

One of the frequent concerns expressed by NIOSH researchers is the long and tedious review process for NIOSH publications (e.g. non-journal articles). It can take years to publish such documents with much of that time taken up with internal review of documents within NIOSH. By the time publication is approved, the information may not be as timely. This process may be aggravated by new requirements from the Office of Management and Budget (OMB) to review data quality before publication. They also complain of the linear nature of the review process. After several internal reviews, it then gets sent for external review and a second or third set of revisions are needed. Having simultaneous reviews might help speed up the process so that all comments can be dealt with at the same time. The NIOSH Office of the Director (OD) has recently implemented an electronic tracking system which will give them much better data on how long reviews are taking and where the hold ups may be. This could help expedite the process, although this system has barely been in place and the results are not yet evident.

The Revolution in Information Technology

The past few years has seen a revolution in information through the Internet. More and more people are getting their information from websites like Wikipedia. YouTube has exploded in the sharing of videos on the Internet. Social networking sites like Facebook or MySpace have made networking easier. Podcasting (audio and video) has become commonplace as there has been a proliferation of MP3 players allowing portability and accessibility of audio and video files. Blogging has become a popular way to democratize information by posting opinions on websites and inviting comments or dialogue. NIOSH is just beginning to take advantage of this. NIOSH has been posting information on Wikipedia and is in the process of starting a blog. Much more could be done to utilize and evaluate the use of social media as an effective marketing tool.

Public Health Campaigns

Europe has had some success in mounting public health campaigns around occupational safety and health issues (see for example the British Health and Safety Executive's campaigns on Falls and the European Union campaigns on Noise and Ergonomics). NIOSH should review the European experience and consider developing its own public health style campaigns in the US around pressing occupational health and safety issues as a way of increasing its impact.