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AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 58:838–848 (2015)

Triage for Action: Systematic Assessment and


Dissemination of Construction Health and
Safety Research

1 2 3
Robin Baker, MPH, Charlotte Chang, DrPH, Jessica Bunting, MS, and Eileen Betit, MS3

Background Research translation too often relies on passive methods that fail to reach
those who can impact the workplace. The need for better research to practice (r2p)
approaches is especially pressing in construction, where a disproportionate number of
workers suffer serious injury illness.
Methods A triage process was designed and used to systematically review completed
research, assess r2p readiness, establish priorities, and launch dissemination follow-up
efforts. A mixed quantitative and qualitative approach was used.
Results The process proved effective in ensuring that significant findings and evidence-
based solutions are disseminated actively. Key factors emerged in the selection of follow-
up priorities, including availability of partners able to reach end users, windows of
opportunity, and cross-cutting approaches that can benefit multiple dissemination efforts.
Conclusions Use of a systematic triage process may have an important role to play in
building r2p capacity in construction safety and health. Am. J. Ind. Med. 58:838–848,
2015. © 2015 Wiley Periodicals, Inc.

KEY WORDS: construction health and safety; dissemination; triage tool; research to
practice; promotion of evidence-based practices

INTRODUCTION spread of innovations is unplanned, informal, decentralized,


and largely horizontal or mediated by peers,” rather than
There has been increasing attention to the problem of more active and intentional dissemination involving
inadequate dissemination of research findings in the “planned efforts to persuade target groups to adopt an
construction industry [National Research Council and innovation” [Greenhalgh et al., 2004]. The need for better
Institute of Medicine 2009; Gillen, 2010]. Evidence-based movement from health and safety research findings to
interventions have been developed that could prevent deaths, effective practice is especially pressing in construction,
injuries, and illnesses, yet all too often research that has been where a disproportionate number of workers are killed,
published in the peer-reviewed literature fails to get into the injured, and made ill each year in the U.S. [Waehrer et al.,
hands of those who need to take action on the findings. A 2007; Dong et al., 2012; Swuste et al., 2012].
reliance on “passive” diffusion of solutions in which “the In 2010, the National Institute for Occupational Safety
and Health (NIOSH) funded an intensive “research to
practice” (“r2p”) initiative as a supplement to its National
1
Center for Occupational and Environmental Health, UC Berkeley, Berkeley, California Construction Center (the Center) program at CPWR—The
2
Labor Occupational Health Program, University of California, Berkeley, California Center for Construction Research and Training. The r2p
3
r2p, CPWR^The Center for Construction Research and Training, Silver Spring, initiative centered on three main areas of focus: actively
Maryland

Correspondence to: Robin Baker, MPH, Center for Occupational and Environmental disseminating research findings from its funded projects,
Health, UC Berkeley, Berkeley, California. E-mail: rbaker@berkeley.edu supporting and studying health and safety partnerships in
construction, and developing r2p tools and resources.
Accepted 28 April 2015
DOI 10.1002/ajim.22477. Published online 26 May 2015 in Wiley Online Library For the purpose of this initiative, r2p was defined as
(wileyonlinelibrary.com). systematic efforts to promote the broad-based application of

ß 2015 Wiley Periodicals, Inc.


Construction Health and Safety Research Triage 839

evidence-based interventions to improve health and safety the Center’s 2004–2009 grant period to assess and prioritize
practices in the construction industry. This was conceived as important findings for broader transfer and to ensure further
a process or “pathway” for ensuring that research on hazards translation and dissemination of those findings. The Center
leads to research on solutions, and that evidence-based leads a research consortium made up of health and safety
solutions are then actively translated, disseminated, adopted, investigators at major universities throughout the country,
and implemented. Translation was understood to involve and supports up to 20 studies during each five-year
making solutions and information accessible and packaging cooperative agreement specifically designed to identify
them in ways that will effectively reach end users, with problems and solutions in construction safety and health.
dissemination involving actively communicating and pro- Investigators submit regular progress and final reports
viding support to intermediaries and end-users who will identifying findings, outputs, and dissemination conducted.
ultimately adopt and implement them. Yet in the past, a systematic approach did not exist for
Our concept of r2p also included an emphasis on the assessing r2p activities conducted, readiness for further
critical need for “practice to research” (“p2r”) in which dissemination, or need for additional support or follow-up.
construction stakeholders in the field (e.g., workers, The triage project involved evaluating the research
contractors, unions, manufacturers) inform each stage of products and/or findings produced by each consortium
the research process from problem identification to transla- member, helping to identify promising ways to package and
tion, dissemination, and implementation of findings. To promote them to target audiences, prompting investigators to
promote the two-way process whereby research informs consider a range of translation and dissemination strategies,
practice and practice informs research, the r2p initiative and supporting additional dissemination efforts, when
included a focus on the development of multi-stakeholder warranted, by providing additional funding and/or technical
partnerships which engage critical intermediary organiza- support. Aims for the triage project were (i) to develop a
tions that are able to reach and influence target populations practical way to systematically review the results of
and end users. construction safety and health research in order to identify
The r2p initiative was influenced by several conceptual research translation and dissemination priorities, and (ii) to
frameworks and models related to dissemination and enhance research to practice through the process of review,
implementation and knowledge transfer. In their call for prioritization, and dissemination follow-up. Below, we
the development of marketing and distribution systems in describe the process for developing the “triage tool” and
public health, Kreuter and Bernhardt [2009] identified key review protocol, the findings from the triage of research
r2p functions present in other industries that take products of projects, as well as the follow-up dissemination enhancement
research to the public, including consumer goods, biomedi- efforts that resulted.
cine, and education. Such functions included market research
and strategy, inventory management, training and technical
METHODS
assistance, customer and product support, coordination, and
evaluation. Knowledge Transfer and Exchange models
A triage tool was developed to identify innovations of the
[Institute for Work & Health 2006] highlight “push” factors
highest priority for further dissemination and adoption, as well
in which researchers actively disseminate findings to key
as opportunities to more broadly share key findings or promote
audiences, “pull” factors in which potential users of research
additionalresearchinpromisingareas.TheCentersubsequently
seek out information and solutions to address issues they
offered support to six high priority r2p efforts identified through
face, and the creation of “exchange” relationships that
the review. Additional projects were offered other types of r2p
facilitate the application of research among end-users and the
support, such as assistance with communications products or
generation of research more relevant to the real world. The
linkage with industry stakeholders.
RE-AIM model [Glasgow et al., 1999] emphasized the
The triage process was implemented in stages: (i)
combination of audience reach, effectiveness of interven-
designing the tool and triage protocol; (ii) conducting an
tions, and the extent of adoption, implementation, and
initial set of project reviews; (iii) providing follow-up
maintenance as the key components of public health impact.
support to three r2p efforts, (iv) revising the tool; (v)
The r2p initiative’s focus on developing dissemination and
completing the remaining reviews; (vi) analyzing all
implementation infrastructure in construction health
reviews; and (vii) providing follow-up support to three
and safety, the need to engage both push and pull factors
additional efforts.
and support the development of multi-stakeholder partner-
ships for knowledge transfer and exchange, as well as ways of
conceptualizing r2p outcomes were guided by these models. Triage Tool Development
In this article, we focus on the “triage project,” one
element of the Center’s r2p initiative. Triage involved To develop the triage tool, the r2p research team drew on
the systematic review of research projects completed during a combination of expert opinion and existing research
840 Baker et al.

translation models. We worked with the Center’s Technical implemented on worksites. For “achievability,” the fourth
Advisory Board (TAB) to identify key criteria for prioritizing domain, reviewers were asked to consider questions related
dissemination efforts. A variety of frameworks and tools to the challenges of the proposed change; whether the
such as RE-AIM [Glasgow et al., 1999], Knowledge Transfer intervention was readily available; anticipated barriers; costs
and Exchange [Institute for Work & Health 2006], and to potential adopters; and the extent to which the intervention
Cochrane Systematic Reviews [Higgins and Green, could be “packaged” with other interventions. Reviewers
2011] were considered. The initial draft was presented to also were encouraged to consider concepts from the theory of
key construction and research audiences for input, including “diffusion of innovations” such as relative advantage,
the TAB, the Center’s research consortium, the National compatibility, complexity, trial-ability, and observability
Occupational Research Agenda (NORA) Construction [Rogers, 1995]. The fifth domain, “high priority areas,”
Sector Council (a partnership program sponsored by NIOSH asked reviewers to indicate if the project addressed a hazard
to establish and promote research priorities), North or health effect that is of special importance or makes a
America’s Building Trades Union’s Safety and Health unique and significant contribution, such as addressing
Committee, and a newly formed OSHA/NIOSH/CPWR serious health disparities, focusing on areas that remain
interagency r2p Working Group. largely unaddressed, representing a major gap in construc-
The initial version of the triage tool started with tion health and safety, or presenting an opportunity to make
background sections identifying the project, lead investi- an “upstream” change at an industry-wide or societal level.
gators, NORA priorities addressed, study type, major A sixth “summary score” asked reviewers to provide
findings, major outputs or products, dissemination already their assessment, again on a scale of 1 to 5, of the overall
conducted, and key audiences. The form then used a skip priority the project should have for additional r2p support
pattern based on whether or not the research had resulted in from the organization. This was not intended to be an average
specific interventions (evidence-based tools, equipment, or of the previous scores, but rather as an overall assessment of
programs). For research without specific interventions (e.g., a project’s r2p readiness. For example, a project with a low
surveillance studies), reviewers completed a section on score in terms of potential impact and reach might still be
recommended next steps to continue to move the research rated highly overall if it offered a highly effective
along the r2p process, such as further communication of intervention that would be relatively simple to implement.
results to target audiences, further definition or characteriza- Reviewers were asked to provide detailed comments on their
tion of the problem, or the development and testing of rationale in weighting the importance of the different
prevention strategies or interventions. domains for this summary score, which, along with notes
For research projects that had resulted in interventions, for each of the previous domains, would serve as the record
reviewers completed two additional sections —a section to for how triage decisions were made.
rate r2p readiness and one to describe initial dissemination In the final section for all projects at the intervention
steps. In order to address the range of considerations that may stage, reviewers were asked to suggest methods of
be important in dissemination and implementation efforts dissemination for the project, including education/training,
[Colditz and Brownson, 2012; Proctor and Brownson, 2012], outreach/marketing, policy development, technology trans-
we built multiple dimensions into the assessment of “r2p fer, coalition-building, communication products, and/or
readiness,” including, but not limited to, intervention other strategies. This section asked for suggestions of
efficacy, which has traditionally been the standard for possible partners, potential evaluation measures, other
considering the value of research. Ultimately five domains factors that could help or hinder r2p efforts, and recom-
were selected for inclusion in the triage tool for rating r2p mended actions or immediate next steps.
readiness, with a scoring scale from 1 (lowest) to 5 (highest). To assist reviewers in completing the triage form and in
The first domain, “strength of findings,” asked order to enhance consistency in interpretation of items, a
reviewers to consider factors such as research design, guidance document and detailed “mouse over” explanations
evidence of efficacy, effect size, and consistency with other and examples were created.
evidence or experience in the field. For the second domain, Following the review of the first 10 projects, the tool
“impact and reach,” reviewers took into account the underwent a final round of revision. Only one major change
severity of the problem addressed as well as the scope of the resulted, which reflected user interest in more explicitly
problem in terms of numbers of affected workers, trades, acknowledging differences in dissemination goals for
and/or construction sectors. The third domain, “potential for projects that result in specific interventions and those that
effective partnerships,” asked reviewers to evaluate the do not (such as epidemiologic research). For clarity, two
extent to which there were promising partners that could separate versions of the tool were created for “intervention
collaborate to carry out the next steps, since a lack of stage research” and “pre-intervention stage research.”
industry-based partners can often keep even highly effective Of the 17 projects reviewed, 12 were at the intervention
solutions from successfully being disseminated and stage and five were at the pre-intervention stage. The mix of
Construction Health and Safety Research Triage 841

projects was a function of the pool of research projects categories for products such as factsheets, websites, and
solicited and included in the Center’s consortium. In the early videos; and (v) Partner codes—two categories including
years of the Center’s 25-year history, the research emphasis current research partners and potential r2p partners.
was aimed at gaps in defining the problems in the industry. As The list of codes was applied to the summary triage
this area of research grew over time and hazards became forms for each project in the areas of: dissemination already
better defined, the Center shifted its emphasis toward more conducted; further dissemination needed; and project
solutions-oriented research within the consortium. commonalities, differences, and cross-cutting themes and
issues. Each response or comment on the form was assigned
all applicable codes. After coding was completed, we
Research Reviews
examined data organized by code and by each area
mentioned above (e.g., dissemination already conducted).
Each completed research project was discussed on a
conference call, using the triage form (http://www.cpwr.com/
research/r2p-tools-and-resources) as the discussion guide. RESULTS
Reviewers included the project’s lead investigator (and other
members of the research team at the discretion of the The results include: (i) the findings of the systematic
principal investigator), the Center’s project officer who was review of the research projects, including patterns of
responsible for project oversight, and a member of the dissemination strategies and prioritization of r2p follow-up
Center’s r2p research team. Prior to the call, previously- stemming from the review process; and (ii) the follow-up
submitted progress and final reports were used to fill in as dissemination projects identified and carried out based on the
much of the background sections of the tool as possible. The reviews.
draft was shared with all reviewers, and each reviewer
completed the form individually prior to the conference call.
These calls allowed project investigators to update or Triage Analysis Results
correct information about materials created or dissemination Project ratings
undertaken since the final report was submitted and to offer
additional context or clarification. It was also a chance for r2p Table I shows scores for the 12 intervention projects,
team members and program officers to ask questions and with summary scores ranging from 2.7 to 5.0, and with scores
contribute their knowledge about dissemination strategies being fairly close across raters. Only one project had highly
and resources. Each reviewer returned a final individually- divergent summary scores (with a standard deviation of more
completed triage tool to the r2p research team after the than two). Numerical scores tended to be on the higher end of
discussion. Calls typically lasted one to one and a half hours. the scale with 9 of the 12 projects receiving summary scores
of 4 or higher. The highest scoring domains overall were
Analysis of Research Reviews “potential impact” and “high priority area.” The domain with
the highest correlation to a high summary score was
The r2p research team consolidated scores and “partnership potential.”
recommendations of the three different reviewers to create Project ratings were categorized into “top,” “middle,”
one master triage form, or summary report, for each research and “bottom” tiers. The top tier included the three projects
project to be used in analysis. Quantitative and qualitative that received summary scores of “5,” indicating that all
analyses were undertaken with intervention-stage projects. reviewers had unanimously given them the highest possible
For non-intervention projects, only qualitative approaches score. The middle tier included six projects that received
were used. For each intervention-stage project, mean scores scores ranging from 4.0 to 4.8, while the bottom tier included
and standard deviations for each of the six priority rating three projects receiving mean scores below 4.0, indicating a
areas (the five domains and summary score) were generated, lower level of readiness for dissemination.
and the ranges of all three raters’ scores were noted.
ATLAS.ti software was used in qualitative analysis of Dissemination strategies
all 17 triage summaries. We generated lists of codes in
five “families”: (i) audience codes—17 distinct terms or Qualitative analysis revealed patterns in dissemination
categories such as apprenticeship programs, residential strategies. As expected, the most universal form of
contractors, and doctors; (ii) dissemination channel codes dissemination that already had been undertaken by research-
—12 terms or categories such as peer-reviewed journals and ers was publication in the scientific literature. Broader
mass media; (iii) dissemination method codes—15 terms or dissemination strategies employed most frequently included
categories such as training, marketing, technology transfer, conducting presentations to and writing articles for con-
and coalition building; (iv) Output codes—16 terms or struction audiences such as trade associations and labor
842 Baker et al.

TABLE I. Mean and Standard Deviation Scores of Projects by Dimension

C1: strength of findings C2: potential impact C3: partnerships C4: achievability C5: high priority area C6: summary
Project name Mean St.D. Mean St.D. Mean St.D. Mean St.D. Mean St.D. Mean St.D.
Masonry ergonomics 4.67 0.58 4.67 0.58 5.00 0.00 4.33 0.58 5.00 0.00 5.00 0.00
Latino worker safety 4.00 0.00 4.67 0.58 4.67 0.58 4.67 0.58 4.67 0.58 5.00 0.00
Silica and noise 4.67 0.58 4.50 0.71 4.50 0.71 4.00 1.00 5.00 0.00 5.00 0.00
Overhead drilling 4.67 0.58 3.67 0.58 4.67 0.58 3.67 0.58 5.00 0.00 4.67 0.58
Nail guns 5.00 0.00 4.00 0.00 3.67 1.15 4.33 0.58 4.00 1.00 4.67 0.58
Fall prevention education 3.00 0.00 4.33 0.58 4.67 0.58 4.33 0.58 3.67 1.15 4.33 0.58
Safety culture 3.00 0.00 4.33 0.58 2.67 0.58 2.67 0.58 5.00 0.00 4.00 1.00
Residential falls 3.33 0.58 4.00 0.00 4.00 1.00 3.00 0.00 4.67 0.58 4.00 1.00
Ladder falls 3.33 0.58 4.33 0.58 3.67 0.58 3.67 0.58 4.33 0.58 4.00 0.00
Electrical inspections 3.00 1.00 4.33 1.15 3.33 1.53 4.33 0.58 4.67 0.58 3.67 1.15
Leading edge 3.00 1.00 4.33 0.58 3.67 0.58 3.67 0.58 4.33 0.58 3.33 0.58
Ergo diffusion 3.33 0.58 3.33 1.15 1.67 0.58 2.67 2.08 3.33 0.58 2.67 2.08
Overall 3.75 0.91 4.20 0.68 3.83 1.15 3.78 0.96 4.44 0.75 4.19 1.01

organizations (16 projects), making information or a solution critical to reaching and influencing the ultimate target
available online for download (nine projects), presentations populations (construction contractors and workers). The
at professional meetings (eight projects), and seeking to desired partners identified most frequently were OSHA or
incorporate findings or a solution into education or training other government agencies (seven projects), manufacturers
such as apprenticeship or career technical education (four projects), unions and apprenticeship programs (four
programs (eight projects). Other dissemination strategies projects), an existing national fall prevention campaign
that were often employed included distributing materials or (three projects), and big box stores or other suppliers (three
findings to research partners (seven projects) and developing projects).
communications products such as factsheets, hazard alert
cards, and stories of impact (seven projects). Cross-cutting issues
Dissemination strategies that had been employed the
least included engaging in policy discussions or efforts (two In the process of identifying promising project-specific
projects), technology transfer (two projects), mass media r2p opportunities, strong cross-cutting themes and topics
communications (one project), and social media communi- emerged, such as the challenges of technology transfer,
cations (one project). incorporating evidence-based practices into established
For the 12 intervention stage projects, reviewers made educational or training programs, reaching workers and
recommendations for further dissemination methods. Those contractors in the residential construction sector, and the
most often suggested by reviewers included developing and central role of safety culture in promoting health and safety
distributing additional communications products (12 proj- on construction work sites.
ects), outreach/marketing (11 projects), education/training
(10 projects), coalition-building (10 projects), policy Follow-Up r2p Projects Identified
development (eight projects), and technology transfer efforts
(four projects). As Figure 1 illustrates, we considered numerical scores
For the five non-intervention stage projects, reviewers and cross-cutting themes, as well as windows of opportunity,
recommended a range of next steps other than broad in the selection of follow-up r2p efforts for further
distribution, including communication of results to specific investment. Scores were used primarily to ensure that all
target audiences (four projects), developing prevention high-scoring research projects moved forward toward real-
strategies or interventions (four projects), and/or further world application. The review revealed that all three of the
characterization of the problem (three projects). top-tier projects and many of the middle tier projects already
had received next stage support as funded projects in the
Potential partnerships 2009–2014 cooperative agreement (seven projects), through
the Center’s small studies mechanism (two projects), and/or
Project reviewers identified existing and potential through other external efforts and funders (three projects).
partners to involve in future efforts. Partners were seen as This narrowed the field of specific projects still in need of r2p
Construction Health and Safety Research Triage 843

The first three follow-up efforts were selected prior to


completing the review of all the projects. Reviews required
substantial lead time to schedule and were time-consuming
to conduct and analyze. In order to launch clearly promising
follow-up efforts in a timely fashion, a first set of decisions
on follow-up projects took place at the mid-point of the triage
review process. All three initial follow-up efforts stemmed
from projects that had yielded high priority rankings in the
triage reviews, and afforded unique and timely opportunities
to take action together with likely or already-involved
partners. The remaining three follow-up efforts were selected
after all 17 projects had undergone triage review.
The recently formed OSHA/NIOSH/CPWR r2p Work-
ing Group played a critical role in the selection and
implementation of follow-up dissemination projects emerg-
ing from the triage process. The joint Working Group
reviewed potential projects, provided input on priority areas
of interest, and identified those that offered opportunities to
collaborate and build r2p capacity in all three organizations.
The group worked together to develop a dissemination
planning template to provide a thorough, strategic, and
consistent approach across dissemination efforts.

FIGURE1. Selection process for r2p follow-up projects.


Implementation of r2p Follow-Up
support and led to the consideration of follow-up projects Projects
focusing on cross-cutting r2p strategies, many of which built
upon and added to a substantial existing evidence base (e.g., The Nail Gun Safety project resulted from one of the
hazards of silica exposure), and had the potential to advance CPWR-funded studies [Lipscomb et al., 2010, 2011], which
the development of dissemination mechanisms for both identified a clear hazard and relatively simple solutions.
current and future research. Drawing on a synthesis of NIOSH and OSHA agreed to develop and release a joint
research, rather than on a single research project alone, Nail Gun Guidance Document [OSHA/NIOSH, 2011] for
strengthened our confidence in the readiness of information construction contractors, and all three organizations engaged
and interventions for dissemination. Unique opportunities in a coordinated effort to actively disseminate the document.
also influenced the selection of follow-up projects. These This resulted in a concentrated campaign to reach nail
included, for example, NORA Construction Sector Council gun purchasers and users through intermediary organizations
plans, proposed OSHA rulemaking, and intended release of a and publications. This effort involved a press release
joint NIOSH-OSHA guidance document. announcing the new government resource and included
The following six projects were selected based on priority personalized email communications to key constituents,
rating scores, recommended dissemination methods, sug- use of social media, and other active marketing. Results
gested next steps, available partners, resources needed, and included major exposure through industry publications and
gaps in research dissemination. Opportunities for synergy websites and a high volume of downloads. The campaign
across dissemination efforts and the ability to address cross- helped drive traffic to a user-friendly website created by the
cutting themes led to the selection of dissemination projects original research team and featuring valuable information
that were related to more than one specific research project in and additional resources (http://www.nailgunfacts.org). In
most cases. addition to resulting in broad dissemination of important
▓Round One r2p Follow-Up Projects safety information, this first joint effort contributed
▓▓Nail Gun Safety substantially to improved dissemination capacity in all three
▓▓Silica Safety organizations.
▓▓Technology Transfer The Silica Safety project was based on the identified
▓Round Two r2p Follow-Up Projects need to improve awareness of available solutions to control
▓▓Safety Culture/Climate silica dust in construction work stemming from two of
▓▓Reaching Residential Contractors the triaged projects. It was anticipated that OSHAwas ready to
▓▓Career Technical Education announce new rule making activity for silica exposure,
844 Baker et al.

making it a particularly opportune time to promote awareness resource materials on best practices also resulted [CPWR,
of evidence-based solutions. The resulting dissemination 2014,b].
project involved the development, testing, and promotion of a The challenge of Reaching Residential Contractors
“one-stop” website for information and resources related to was another issue that arose in the review of several research
silica safety (http://www.silica-safe.org). Based on input from projects, and had also been selected as a priority issue by the
the major target groups (construction contractors and trades NORA Construction Sector Council. The follow-up effort
people), the site was designed to provide a practical tool for was again undertaken as a joint project of the r2p Working
developing a written silica exposure control plan, customized Group, which was already engaged in related work through
to the particular construction job and drawing on the best the joint national social marketing campaign, “Safety Pays,
available evidence. The site received more than 12,000 visits Falls Cost” (http://stopconstructionfalls.com). The r2p
in the first year, with much of the traffic driven by a support for this area involved conducting a literature review
combination of an active outreach campaign and referrals and environmental scan to identify promising approaches for
from OSHA and industry websites. In addition, OSHA listed reaching the residential sector [Chapman, 2013], as well as a
the CPWR website as one of just six technical resources on its survey project to collect experiences that were not captured
“Crystalline Silica Rulemaking” online resource. The website in the literature. The survey report [CPWR, 2015] shares
was referenced during testimony during the rule-making lessons learned from health and safety researchers, insights
hearings, discussed in supporting comments and briefs, and into the social and professional networks of residential
submitted as evidence in support of the feasibility of reducing contractors, and suggested areas for further exploration in
silica exposures through the use of safer equipment and work terms of impacting health and safety practices in this hard-to-
practices. It has also been used as a vehicle to disseminate reach population.
related research information and other interventions devel- Finally, the follow-up project on Career and Technical
oped by safety and health researchers. Education (CTE) was identified as a result of 10 different
The Technology Transfer effort grew out of the project reviews in which the researchers hoped to dissemi-
dissemination lessons of a research consortium project that nate their results through existing training programs. While
developed and then sought to take to market an overhead the Center has extensive experience and connections in
drilling device [Rempel et al., 2010a,b]. The challenges formal apprenticeship programs, little was known about
faced by this research team resonated with other researchers’ health and safety training in construction CTE programs,
frustration with the slow and sometimes seemingly impene- which are typically based in community colleges and high
trable process of making safety innovations available on the schools, and represent an important dissemination setting for
market. This project involved a “Construction Industry reaching thousands of workers who enter the construction
Technology Transfer Symposium” held in May 2012 that industry each year. A report was commissioned [Bush and
explored gaps in understanding of the process, ways that Andrews, 2013] that describes what is known about the
researchers could better partner with manufacturers, and how current state of occupational safety and health training in
researchers could create more effective technology transfer construction CTE programs and recommendations for
plans for their interventions, drawing on both successful and partnering with CTE organizations in order to create
unsuccessful case examples of commercializing innovations. pathways for dissemination of new, evidence-based learning
Recommendations for building and sustaining technology materials. As a result of this initial assessment, a new study
transfer in the construction industry were documented in a was initiated recently to systematically assess and character-
symposium report [CPWR, 2012], and a practical patent and ize the elements of effective health and safety education in
licensing guide for health and safety researchers was post-secondary construction CTE programs nationally.
developed [CPWR, 2014a].
Safety Culture and Climate was the subject of several
research projects that were reviewed and the triage process DISCUSSION
identified the need to bring together lessons and resources
across these different projects and identify unmet research The r2p triage project involved the development and
and dissemination needs. The Center partnered with the application of a systematic approach to ensure that promising
NORA Construction Sector Council for this follow-up effort, safety and health findings and solutions from the Center
as they had independently identified safety culture and safety continue along the research to practice pathway, and to
climate as important areas considered “ready for impact” ultimately better protect workers from injury and illness on
[NORA Construction Sector Council, 2008]. This r2p the job. The project addressed two of Kreuter and
follow-up project included a literature review [Hecker and Bernhardt’s [2009] recommended action steps for adopting
Goldenhar, 2014] and a national symposium to identify best a marketing and distribution perspective on dissemination
practices and recommendations based on current evidence and implementation in public health: one which called for all
and experience in the field [CPWR, 2014b]. Additional appropriate proven programs to be distributed, and not
Construction Health and Safety Research Triage 845

simply those whose researchers or developers happen to be activities, require a distinct assessment process to determine
dissemination-oriented; and another which called for how to move the results forward. More attention may be
marketers and public health practitioners to work together needed to explore the unique r2p needs of non-intervention
to modify programs, package them appropriately, and research that is not yet ready for broad dissemination, but that
present them to users in a way that facilitates ease of use. still needs to be communicated to key audiences and moved
The application of the triage tool provided a useful to the next phases of development in order to make an
standardized approach to the review process and revealed impact.
that even though significant research translation and
dissemination already had taken place prior to the review, Researcher engagement
important gaps and opportunities remained. Many follow-up
projects were selected to further explore r2p strategies that Engaging researchers in the review of their completed
cut across multiple projects and had the potential to improve projects presented both advantages and challenges. Re-
dissemination knowledge and experience for current and searchers’ scientific training has typically not included r2p
future research. In addition, the resulting dissemination concepts, terminology, and strategies [Kreuter & Bernhardt,
projects helped build r2p capacity in construction safety and 2009]. During the triage process, researchers expressed
health across three key organizations—OSHA, NIOSH, and concern that they would be expected to become “communi-
the Center. Lessons learned about assessing r2p readiness cation experts,” engage in dissemination work even though
and selecting follow-up projects as well as limitations to the their funding had ended, and/or do a great deal of additional
project are discussed below. paperwork. It was critical to the success of the triage process
that we were able to address these concerns by minimizing
the work involved in the process and providing r2p expertise
Assessing r2p Readiness
and resources, rather than creating a mandate for researchers
Using qualitative and quantitative to carry out the follow-up work themselves.
approaches in assessment While scheduling the conference calls to conduct the
reviews was labor-intensive, in the end we did achieve 100%
The triage tool and assessment process evolved to be participation. The researchers were able to provide context
strongly qualitative in nature as the complexity of weighing and clarification on the details of their research, findings, and
the different dimensions of r2p readiness became clearer. dissemination efforts, and most reported that, despite some
Numerical ratings provided a standard way of comparing initial reluctance, the group process was valuable for
different readiness dimensions and reviewer assessments thinking through dissemination readiness and opportunities.
within and between projects, yet accompanying notes with Researchers showed remarkable thoughtfulness and willing-
detailed rationale for the ratings were critical to interpreting ness to critically assess the strength of their findings and their
the scores and leaving a record of our decision-making and potential contributions to practice.
how we engaged in the triage process. Similarly, we chose to Critical to researcher engagement was the presence of
use a summary score that reflected each reviewer’s synthesis r2p support systems that had been put in place in advance
and balancing of the different dimensions of each project. As through the Center’s dedicated communications and dissem-
we were developing and piloting the tool and process, we ination efforts, as well as funding resources, including small
decided a more flexible approach would be more appropriate study opportunities to explore and test dissemination
than averaging the ratings or applying a standard weighting approaches. This points to the need for strong institutional
formula. We instead relied on reviewers’ experienced in support and commitment of organizational resources for an
construction, health, and safety, and r2p to document their r2p initiative such as the triage project to be successful.
reasoning behind their scoring in detail and to provide
additional commentary on important r2p priorities related to
Selection of Follow-Up Projects
the projects.
Flexible and strategic selection of
Different types of research require follow-up projects
different assessment and r2p
approaches The selection of follow-up r2p projects was originally
intended to rely more heavily on the numerical scores
The triage process was most effective for assessing and coming out of the triage review process. However, several
supporting research projects that had resulted in specific factors led to the use of a more flexible and opportunistic
interventions—evidence-based tools, equipment, and prac- approach. The r2p research team discovered that work on the
tices. Non-intervention-oriented research projects, such as highest-priority projects was already continuing, having
those involving surveillance or exposure assessment been supported through a variety of mechanisms. Yet
846 Baker et al.

researchers tended to rely on more familiar dissemination Credible partners with established relationships with these
strategies such as writing articles, presentations to profes- audiences were therefore essential in all of the projects
sional associations, and, in some cases, developing transla- selected for r2p follow-up.
tional materials without a specific audience or dissemination Although a different kind of partnership, the r2p
strategy in mind. This led to a focus on how to better engage Working Group brought together the experiences, energy,
in and promote broader “out of the comfort zone” and resources of three influential institutions in construc-
dissemination strategies—that is drawing on a wider range tion health and safety to support and implement follow-up
of options, ranging from use of social media and social projects. The group played a pivotal role in the triage
marketing to advancing policy proposals. process in carrying out and executing dissemination plans.
In addition, the differentiation between project scores While the Working Group was a unique collaboration of
was less pronounced than anticipated. Research projects had health and safety-focused government organizations, the
been screened carefully before inclusion in the Center’s experience more broadly suggests the importance of not
research consortium proposal, with an emphasis on projects only partners with access to target populations, but also
with high potential for improving construction safety and partners with an explicit focus on dissemination and the
health. This resulted in high triage scores overall, and ability to bring different and necessary resources to the
particularly in terms of being in high-priority areas and table.
having potential for impact.
Strong cross-cutting issues and themes emerged, which
Limitations
suggested that some of the potentially most useful invest-
ments may be made in areas that benefit multiple projects
One limitation of this triage effort was the inclusion of
and/or develop dissemination capacity for future efforts. The
only a discrete set of studies conducted by members of the
emergence of these cross-cutting themes from the triage
Center’s research consortium. Its group of investigators may
process additionally demonstrated the benefits of being
be unusually motivated to think about r2p issues, given the
able to review a set of projects together as a group. Without
rigorous screening process employed by the Center in
the ability to compare across projects, some important
selecting proposals to include in its consortium and a
opportunities to build r2p knowledge, capacity, and
corresponding emphasis on projects that are likely to have a
infrastructure in construction health and safety may have
significant impact on improving health and safety in the
been missed.
construction industry. The triage process, which included
Finally, the need to be “opportunistic” became increas-
filling out forms, scheduling and holding conference call
ingly apparent in the early stages of the triage review process.
discussions, analysis, and subsequent decision-making,
OSHA’s rulemaking process, a new OSHA/NIOSH/CPWR
required substantial investments of time. It may be
joint r2p Working Group ready to take on follow-up projects,
challenging to replicate this level of support and commitment
and broad interest in technology transfer presented oppor-
to the process with other groups of researchers and in the
tunities and momentum to advance r2p in construction health
absence of a dedicated r2p staff.
and safety. Seizing windows of opportunity can be
The triage process also involved a degree of subjectivity
particularly effective in promoting dissemination, as has
in each reviewer’s assessment of the projects, including
been noted by other authors [Kingdon, 1995; Dearing, 2008;
providing a summary score based on her/his perception of
Minkler et al., 2014].
r2p readiness dimensions. To account for this, reviewers
were asked to describe and make explicit their rationale for
The critical role of partnership
their scoring and prioritization.
The evaluation of the follow-up dissemination efforts
The importance of partnership in advancing r2p became
was limited to process evaluation measures, such as the
evident throughout the triage process. The partnership
number of translational products developed, the extent of the
domain had one of the strongest relationships with summary
distribution efforts, and the numbers reached (e.g. number of
scores and follow-up projects tended to focus on efforts that
downloads). Outcome evaluation was beyond the scope of
could enhance partnership opportunities. The planning
this effort.
process for each dissemination effort required that we
identify effective intermediary groups that could best reach
and influence the end users who ultimately need to adopt and CONCLUSION AND NEXT STEPS
implement the proposed innovation. In many cases these
final decision-makers are construction contractors and Information from the triage effort has helped to inform
workers who are not easily reached and can be resistant to the priorities of the National Construction Center and to carry
changes in tools or practices [National Research Council and out dissemination in a more systematic way. The Center will
Institute of Medicine, 2009; Gillen and Gittleman, 2010]. seek to expand and refine its r2p triage initiative in the next
Construction Health and Safety Research Triage 847

five-year funding cycle (which began in 2014). In addition to Acknowledgements


repeating the triage review process with newly completed
research projects, further exploration will focus on three The research was made possible by CPWR – The
areas: Center for Construction Research and Training through
cooperative agreement U60-OH009762 from the National
1. Effective follow-up for research that does not result in Institute of Occupational Safety and Health (NIOSH). Its
evidence-based solutions ready for broad dissemina- contents are solely the responsibility of the authors and do
tion. As discussed earlier, The Center’s pool of research not necessarily represent the official views of CPWR or
projects is weighted toward intervention research that is NIOSH.
more likely to be ready for broad dissemination.
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