Assessing Occupational Safety and Health Training A Literature Review Prepared by: Alexander Cohen, PhD Michael J. Colligan, PhD With Technical Assistance from: Raymond Sinclair Jerry Newman Ronald Schuler June 1998 Disclaimer Mention of company names or products does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC). This document is in the public domain and may be freely copied or reprinted. Copies of this and other NIOSH documents are available from the National Institute for Occupational Safety and Health Publications Dissemination 4676 Columbia Parkway Cincinnati, Ohio 45226-1998 To receive information on other occupational safety and health issues, call 1-800-35-NIOSH (1-800-356-4674), or visit NIOSH Home Page on the World Wide Web at http://www.cdc.gov/niosh Email: [email protected] DHHS (NIOSH) Publication No. 98-145 ii ■ Foreword Occupational safety and health training remains a fundamental element in workplace hazard control pro- grams. As training objectives, recognition of job hazards, learning safe work practices and appreciating other preventive measures are expected to contribute to the goal of reducing occupational risk of injury and disease. This report reviews data found in the literature reflecting the significance of training in meeting these kinds of objectives and outcomes. As will be seen, there is much positive evidence but the results seem very selective and highly qualified. An analysis to identify factors underlying a successful training experience is also presented and does confirm basic principles of learning. Here too, however, important gaps are noted in the available data. The document proceeds to offer an agenda for addressing outstanding needs and ways for strengthening the role that training can play in improving workplace safety and health. The reader audience concerned with these kinds of issues should find this report to be most informative. Linda Rosenstock, M.D., M.P.H. Director, NIOSH ■ iii Abstract ore than 100 Occupational Safety and Health Administration (OSHA) standards for hazard control in the workplace contain requirements for training aimed at reducing risk factors for MMinjury or disease; others limit certain jobs to persons deemed competent by virtue of special training. A literature review was undertaken to assess the merits of such training rules to achieve this objective and to sort out factors of consequence. The review focussed heavily on published reports, pri- marily drawn from the period 1980 through 1996, wherein training was used as an intervention effort to reduce risk of work-related injury and disease. Eighty (80) such reports were found and gave over- whelming evidence to show the merits of training in increasing worker knowledge of job hazards, and in effecting safer work practices and other positive actions in a wide array of worksites. Reports from select surveys and investigations of worker injuries and workplace fatalities were also accessed with many implicating lack of training as a contributing factor to the mishaps. In still other studies, workplace training devoted to first aid instruction showed linkage to reduced worker injury rates, suggesting that even this kind of training has benefits to job safety overall. A critical analysis of the above findings found certain qualifications in viewing training impacts and suc- cesses with regard to current workplace standards. For example, most of the reported training interven- tion studies did not address OSHA training rules per se, and knowledge gain and safe behavior measures were used in many evaluations as opposed to actual injury/disease indicators. Also, in some instances, the training was coupled with other forms of intervention to make attribution difficult. Training deficits noted in some surveys of work injury cases lacked for confirmation and no information was available on the quality of the instruction if given at all. Despite the above reservations and uncertainties, training’s role as a necessary element in developing and maintaining effective hazard control activities remained firmly supported by the available literature. What did emerge from this review and analysis was an appreciation of meaningful training procedures and the recognition of factors both within and beyond the training process that could greatly affect its impact. In this regard, the OSHA voluntary training guidelines were described along with illustrations from the reports to show how the various steps contained within them can be met in realistic ways and have merit in framing an effective program. In addition, factors both within and beyond the training process were assessed for their effects on training outcomes based on data found in the reviewed litera- ture. Variables such as size of training group, length/frequency of training, manner of instruction, and trainer credentials were each shown to be significant determinants to the training process. Equally important were extra-training factors such as goal setting, feedback and motivational incentives along with managerial actions to promote the transfer of learning to the jobsite. Based on the literature review, follow-on efforts to address outstanding issues and needs regarding effec- tive occupational safety and health training were noted. iv ■ Executive Summary This review sought evidence from the literature bearing on two questions: Are occupational safety and health training (OS&H) requirements, as cited in many Federal standards governing workplace condi- tions and operations, effective in reducing work related injury and illness? Does the available evidence show certain training factors or practices to be more important than others in having positive effects on these outcome measures? The literature search focussed on reports of training intervention efforts designed in whole or in part to enhance worker knowledge of workplace hazards, effect behavior changes to ensure compliance with safe work practices, or prompt other actions aimed at reducing the risk of occupational injury or dis- ease. Eighty (80) such reports met criteria for inclusion. They were products of two literature searches. The first search covered the period up to 1993; the second extended the first search through 1996. The included work came mainly from the period 1980 through 1996 and, by intent, addressed five types of hazardous agents. These were: traumatic injury forces, toxic chemicals/materials, harmful physical factors, ergonomic stressors, and biologic/infectious agents as encountered in an array of work set- tings. The search also examined data from select surveys and investigative reports where training fac- tors were either implicated in the etiology of workplace injury or disease incidents or, alternatively, were considered a key element to the success of worksite hazard control programs that showed exem- plary safety and health records. Still another source for information was reports of worksite training directed to other needs (e.g., first aid) but that had apparent positive effects on worksite safety and health indicators as well. With regard to answering the first question, the literature accessed and reviewed in this report offered much direct and indirect evidence to show the benefits of training in establishing safe and healthful working conditions. The intervention studies in particular were especially supportive. Findings here were near unanimous in showing how training can attain objectives such as increased hazard aware- ness among the workers at risk, knowledge of and adoption of safe work practices, and other actions that improve workplace safety and health protection. Data from other types of studies suggested too that lack of required training may have contributed to events where workers were injured or killed. Although affirming the effectiveness of training to meet hazard control objectives, this review also drew attention to some shortcomings in the supportive data. For example, the training intervention work that offered the most positive evidence did not address OSHA training requirements per se. Rather, the training interventions targeted site-specific problems, and while showing success in resolv- ing such problems, i.e., improving safety performance, their exact relationship to OSHA mandated training rules was unclear. Moreover, where studies reported lower injury rates, reduced lost time or medical costs after training, analyses were lacking to show how the improvements could be accounted for by the positive results from training when measured in terms of knowledge gain or behavior indi- cators. One study that attempted such an analysis found that the targeted training could only account for 25% of the observed reduction in injury rate. Also, in some instances, the training was coupled to ■ v other forms of intervention (engineering, ergonomic) so as to make attribution even more difficult. Still another tempering fact was that successful training results appeared greatly influenced by “extra- training” considerations. Management’s role/support of safety training and its transfer to the jobsite, setting goals and providing feedback to motivate use of the knowledge gained, and offering incentives or rewards for reinforcing safe performance all seemed crucial to attaining a positive result. These types of factors are not acknowledged in OSHA training requirements. It is noteworthy that a pro- posed OSHA safety and health program standard does recognize the need