Small manufacturing businesses experience a higher incidence of injuries and illnesses, have access to fewer health and safety resources and receive much less attention from regulatory agencies than their larger counterparts. These businesses are an important sector of the United States economy; nearly 98% of the 5.7 million businesses have fewer than 100 employees and account for 36% of all employment. The goal of this project was to develop and test the effectiveness of written materials in improving small business owners' outcome beliefs, attitudes and intentions toward workplace health and safety. We first developed and assessed a wide variety of written formats (newsletters, magazines, newspapers, brochures, etc.) and styles (case studies, personal stories from owners and workers, cartoons, etc.) through a series of focus groups with small business owners. Results were used to determine which styles and formats are ranked most highly by owners in attractiveness, readability and effectiveness in delivering specific health and safety messages. We then tested the effectiveness of our written materials in a randomized, controlled trial involving owners of small businesses. Owners in control and intervention groups completed a baseline survey of intentions, attitudes and outcome beliefs toward improving health and safety. Owners in the intervention group received six issues of a bi-monthly newsletter. At the end of the year, all study participants were asked to complete a follow-up survey measuring their intentions, attitudes and outcome beliefs. Owners in the intervention group were also asked for their opinions on the specific materials received. The results of our discussions with owners of small manufacturing business owners indicate that design and content are both important features of a newsletter on health and safety. The most important design features are those that assist them in determining whether to read or keep the information. They want content that is relevant to their business, allows comparison and identifies costs and benefits in actual dollar amounts. "Beginning" owners were concerned about and sometimes overwhelmed by the newsletter content. In some cases they expressed anger about the things they were expected to know and do. "Knowledgeable" owners, on the other hand, were generally positive, because they found the content to be a good reminder. Our observations of the interactions between these two types of owners suggest that we should include messages from knowledgeable owners that address the concerns of those just beginning to address workplace health and safety. The results of our intervention study with six issues of a bi-monthly newsletter suggest that it is possible to bring about improvements in small business owners' outcome beliefs and intentions. A large number of the owners reported reading, sharing and keeping the newsletter. Owners' beliefs improved with respect to their employees' health and productivity and the quality of their products. However, they also recognized that improving health and safety takes time and money. It appears, therefore, that we need to expand our message to help owners identify cost-effective ways in which to incorporate health and safety into their business activities. Insurance companies, employers' associations, regulatory agencies and small business assistance programs should be able to apply these results in their efforts to improve health and safety in small businesses. Materials prepared with assistance from small business owners framed in a manner and format appropriate to the audience may be able to bring about improvements in both knowledge and behavioral intentions.
University of Minnesota, School of Public Health, Division of Environmental Health Sciences, Box 807 MMC, 420 Delaware Street SE, Minneapolis MN 55455