Stakeholder evaluation of an online program to promote physical activity and workplace safety for individuals with disability

https://doi.org/10.1016/j.evalprogplan.2017.03.005Get rights and content

Highlights

  • There is a need to improve workplace safety and health promotion efforts for individuals with a disability (IWD).

  • Researchers developed an online physical activity and workplace safety program for IWD.

  • Recruitment and feedback of stakeholders evaluated the efficacy of such a program.

  • Identification of challenges and recommendations for programs for IWD can promote future programs.

Abstract

Individuals with disabilities face increasing health and employment disparities, including increased risk of morbidity and mortality and decreased earnings, occupational roles, and greater risk of injury at work. Thus, there is a need to improve workplace safety and health promotion efforts for people with disability. The purpose of this study was to obtain stakeholder feedback about an online program, Be Active, Work Safe, which was developed to increase the physical activity and workplace safety practices of individuals with disability. Eight stakeholders (content experts and individuals with disability) evaluated the 8-week online program and provided feedback on accessibility, usability, and content using quantitative and qualitative approaches. Stakeholders suggested changes to the organization, layout and accessibility, and content. This included making a stronger connection between the physical activity and workplace safety components of the program, broadening content to apply to individuals in different vocational fields, and reducing the number of participant assessments. Engaging stakeholders in the development of health promotion programs is critical to ensure the unique issues of the population are addressed and facilitate engagement in the program. Feedback provided by stakeholders improved the program and provided insight on barriers for adoption of the program.

Introduction

There are approximately 57 million people in the United States living with a disability and approximately half are of working age (18–64 years old) (Stoddard, 2014). Despite this growing number, the employment rate of these individuals is only 33.9%, compared to 74.2% of the general population (Stoddard, 2014). Employment disparities have been identified for people with a disability who are employed disproportionately at entry level occupations and are underemployed, resulting in lower wages and less job security and stability (Kaye, 2009). Moreover, individuals with a disability who are employed typically face a greater number of job-related risks (e.g., entry level jobs, lack of proper training, exposure to hazardous working conditions) when compared to the general population (Kaye, 2009). These job risks can subsequently result in a regression in the rehabilitation process (Fitzmaurice, Kanarek, & Fitzgerald, 2011). The impact of increased job-related risks of people with a disability is further compounded by the fact that many of these individuals are at greater risk of chronic conditions (e.g., heart disease, diabetes) and engage in poor lifestyle behaviors (e.g., smoking, physical inactivity) (Dixon-Ibarra and Horner-Johnson, 2014, Fitzmaurice et al., 2011; Rimmer, Chen, McCubbin, Drum, & Peterson, 2010).

One health behavior that has been shown to improve health outcomes, overall wellness, and decrease injuries is physical activity. Despite the benefits of physical activity, individuals with disability are typically less active than the general population (US Department of Health and Human Services [USDHHS], 2000). Benefits of physical activity, such as improved strength and cardiorespiratory fitness, could also extend to the workplace.

The National Institute for Occupational Safety and Health (NIOSH) Total Worker Health (TWH™) Program aims to integrate occupational safety and health protection with health promotion. This integration increases the potential for reducing injury, illness, and disability absenteeism rates based on reduction of individual worker health risks (Schill & Chosewood, 2013). Anger et al. (2015) reviewed TWH™ intervention studies, which were limited, and found that integrated programs improved risk factor outcomes for injuries and chronic disease.

There is a need to address the workplace safety and health promotion needs of people with a disability, however, there are a limited number of programs available. A report by the NIOSH (Dewey, 2006) identified a gap in occupational health and safety training for workers with developmental disabilities. In response, a training curriculum, Staying Safe at Work, was developed and disseminated (Dewey, 2011). There are also a limited number of health promotion programs available for people with a disability (Drum et al., 2009). For example, a series of audits of the physical activity literature demonstrated that less than 10% of all publications examined the effectiveness of health promotion interventions for people with traumatic brain injury, stroke, spinal cord injury, multiple sclerosis, and spina bifida (Cleveland, Driver, Swank, & Shearin, 2014; Dixon-Ibarra, Vanderbom, Dugala, & Driver, 2014; Nery, Driver, & Vanderbom, 2013; Pawlowski, Dixon-Ibarra, & Driver, 2013; Vanderbom, Driver, & Nery-Hurwit, 2014). If workplace safety and health promotion needs of people with a disability are to be met, it is critical that evidence-based programs exist. Based on NIOSH’s TWH™ initiative, training in basic workplace safety skills for individuals with disabilities can be integrated with health promotion efforts to address more than one dimension of worker health (NIOSH, 2012).

For this project we developed a program called Be Active, Work Safe (BAWS). BAWS is an eight-week online informational and social-behavioral intervention designed to promote the physical activity and workplace safety behaviors of people with a disability. Thus, the purposes of this paper are to: (1) describe the content and development of the BAWS program, and (2) detail the feedback provided by a group of stakeholders on the content and usability of the program.

Section snippets

Program content

The content of BAWS was adapted from two existing, evidence-based, in-person interventions. The physical activity program content was adapted from the Physical Activity Centered Education program (Driver, Irwin, Woolsey, & Warren, 2013; Driver & Woolsey, 2016), which was originally developed for people with a brain injury. The workplace safety material was adapted from Staying Safe at Work (Dewey, 2011), developed for people with developmental disabilities. Merging the content into BAWS

Results

Three individuals with a disability and six experts distributed evenly in the fields of physical activity promotion (n = 2), vocational rehabilitation (n = 2), and workplace health and safety (n = 2) completed the program evaluation. One woman and two men with a disability reviewed the program. All reported having a physical disability, were 20 to 36 years old, and were white, African American, and Asian American. Experts included four women and two men between 34 and 66 years old who were all white,

Discussion

The aims of this manuscript were to describe the development of BAWS and present feedback from content experts and individuals with disability. Since only one type of disability (physical) was represented in the stakeholder review, this review may be limited in scope. However, comments from stakeholders were generally positive and constructive.

Feedback was used to revise the program to improve the content, organization, and accessibility for users. The main modifications included the provision

Conclusion: lessons learned

Several important lessons were learned during the process of transforming curriculum to an online setting and the evaluation process. While we recognized that including stakeholders in all stages of program development, implementation, and evaluation would be key to program success (Drum et al., 2009), we faced challenges to recruit people with a disability for evaluation and input. Involvement in the early stages of development is critical to foster engagement in the later stages. Therefore,

Conflict of interest statement

The authors have no conflicts of interest to declare. This manuscript has not been submitted to another journal.

Funding

The contents of this manuscript were developed under a grant U19OH010154-03 from the National Institute of Occupational Safety and Health through the Oregon Healthy Workforce Center.

Acknowledgements

The authors would like to thank David Grim, Matthew Durbin, and Nathan Ketelhut for their time and creativity with constructing the Be Active, Work Safe website.

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