Inputs: Emerging Issues
Preliminary Programmatic Ideas
Four methodological ideas are being examined as objects of interest in the development of the NIOSH Cross-Sector Program for Musculoskeletal Disorders (MSDs).
New forms and objects of surveillance
A longstanding foundation of public health practice, surveillance activities identifies important impacts of health and injury status in the population. For MSDs the value of information already collected for other purposes at the level of State government and the insurance industry may provide important new insights and more accurate data regarding increasing or decreasing trends associated with MSDs. Continued developments in surveillance methods will be increasingly important as worker demographics and workplace practices evolve and change.
Objective measurements of exposure and outcomes
As a direct extension of recommendations from the 2001 report of the National Academies, this idea focuses on the need to move from subjective evaluations of exposure and injury to more objective measures of exposure and outcomes for a better understanding of causality. Such measurement systems would have far reaching objectives not only in establishing causality but also better measurements of exposure and injury to be used in practical evaluations of workplace hazards and clinical outcomes.
Intervention effectiveness at the enterprise level
The final step in the application of the scientific method to understand and intervene for the benefit of individuals and their communities, the effectiveness of intervention strategies—be they clinical or public health—has long been a major challenge of public health sciences. Compounding this challenge is the joint relation between metrics that describe impact on people and metrics that measure financial or economic impacts. A significant opportunity exists to develop research activities that effectively combine both metrics to measure the impact of intervention strategies to reduce MSDs, and to do so at a level whereby workers and employers are most likely to effectively interact to produce change—the company or enterprise level.
The growth and increasing popularity of interventions designed to encourage behavior change (e.g., using feedback, rewards and incentives, or disciplinary actions) have given rise to a growing demand for authoritative information about the efficacy of behavioral approaches for reducing occupational injuries and illness, including MSDs. Moreover, the success of these approaches depends on factors that exist beyond the employee level. Characteristics of the safety culture, for example, or economic factors that pit safety concerns against goals for profit and productivity can either support or impede intervention effectiveness. More research is needed to identify the critical features and best practices associated with these approaches and to evaluate the role of behavioral intervention strategies in improving the effectiveness of other interventions (e.g., training, education, engineering controls, administrative controls, and personal protective equipment).
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