Elsevier

Applied Ergonomics

Volume 53, Part A, March 2016, Pages 169-180
Applied Ergonomics

Participatory action research in corrections: The HITEC 2 program

https://doi.org/10.1016/j.apergo.2015.09.011Get rights and content

Highlights

  • A participatory action research project implemented with correctional officers is described.

  • We examine 2 different participatory approaches that use the IDEAS tool.

  • Outcomes are varied based on intervention theme and implementation.

Abstract

Background

HITEC 2 (Health Improvement through Employee Control 2) is the follow-up to HITEC, a participatory action research (PAR) program that integrates health and work conditions interventions designed by the workforce. HITEC 2 compares intervention programs between two correctional sites, one using a pure workforce level design team and the other using a more structured and time delineated labor-management kaizen effectiveness team.

Methods

HITEC 2 utilizes a seven step participatory Intervention Design and Analysis Scorecard (IDEAS) for planning interventions. Consistent with PAR, process and intervention efficacy measures are developed and administered through workforce representation.

Results

Participation levels, robustness of participatory structures and sophistication of interventions have increased at each measured interval. Health comparisons between 2008 and 2013 showed increased hypertension, static weight maintenance, and increased ‘readiness to change’.

Conclusions

The PAR approaches are robust and sustained. Their long-term effectiveness in this population is not yet clear.

Introduction

There are more than half a million COs1 in the United States. Although there is a general paucity of occupational safety and health literature on this population, the prevailing evidence is that corrections is associated with high rates of psychological distress and musculoskeletal and cardiovascular disease risk (Tiesman et al., 2010). Associated contextual risk factors include physical danger, low autonomy, and work-family conflict (Bourbonnais et al., 2007, Schaufeli and Peeters, 2000). HITEC2 1 (2006–2011) and HITEC2 2 (2012-present) is an intervention research program initiated with the Connecticut Department of Correction. It features an integration of preventive occupational health, directed to the physical and organizational work environment, with workplace health promotion (WHP) (Punnett et al., 2009).

Because the methods employed in HITEC2 2 are an evolution within an ongoing study, its design can be appreciated through an overview. The HITEC2 1 approach entailed comparison of an administratively conceived ergonomics and WHP/best practices or professional program at one corrections facility with an intervention program entirely directed by a CO1 dominated DT3 at a second corrections facility. The DT3 was internally generated from the workforce, and adhered to principles of participatory action research (PAR) (Henning et al., 2009, Punnett et al., 2013). In HITEC2 1, health outcomes were measured by survey, focus groups and interviews, by physiologic function and performance testing, and by a standardized Health Risk Appraisal (HRA). The WHP/best practices prison facility (Site A) and the DT3 represented prison facility (Site B) were selected from 19 candidate prisons on the basis of comparable size, security level, staffing, physical plant, and from a preliminary survey of supervisors. The supervisor survey aided site selection by identifying inter-site congruence, particularly around measures of openness to interventions and ‘readiness to change’.

In HITEC2 1, the WHP/best practices prison facility (Site A) had limited success: attendance was modest at individual health coaching, weight loss, and chronic disease prevention classes, and participation in a labor-management advisory committee was sparse. At Site B, the DT3 met regularly 1–2 times per month on protected work time, and conducted its own surveys and recruitments. Innovative DT3 programs included improved inter-officer conduct (civility program), footwear revision, and DT3-directed weight loss configured to work schedules. A clear differential in health outcomes between the two sites for participants engaged continuously from 2008 to 2013 was not readily obvious.

There were other important findings from HITEC2 1 that informed HITEC2 2. Serious emotional health problems among COs1 were widespread with ominous indicators appearing in the first years of employment (Obidoa et al., 2011). Approximately one third (31%) had scores of 10 or more on the Center for Epidemiologic Studies Depression Scale (CES-D) an indication of the presence of significant depressive symptoms (Radloff, 1977), and work-family conflict was identified in the majority of respondents. A high prevalence of obesity also appeared to emerge early in work tenure (Fig. 1). Fig. 1 also suggests that the obese pattern is persistent, changing little over the 20–25 year career of a CO.1 Perhaps more striking are the findings on hypertension which are presented in Fig. 2. In the US male population, hypertension is an age related disorder with prevalence accumulating progressively between the 3rd and 4th decades. Contrarily, in COs,1 hypertension follows the pattern of early presentation in work life, being elevated between the ages of 20–34, compared with national rates, and remaining high in subsequent working years.

The participatory interventions at Site B proved feasible and were superior to the WHP/best practices approach at Site A in terms of efficacy and workforce engagement and participation levels. HITEC2 2 incorporated these outcomes by replacing the more top-down professional interventions at Site A with a task driven successor based on joint labor-management KET.4 The KET4 construction was borrowed from industrial experience (Glover et al., 2011, Farris et al., 2009). To better understand the KET4 composition, its internal process and its differentiation from the pure workforce directed DT3 at Site B, it is useful to review the HITEC2 governance and action process. In PAR, study structure and outcomes are developed within the study process, and the study population is a party to design and execution (Reason and Bradbury, 2001, Small, 1995). Recognized strengths of PAR include incorporation of worker knowledge of hazards and feasibility of interventions, and a high potential for workforce participation, effectiveness and sustainability (Small, 1995). Major obstacles include maintaining consistency of scientific design and endpoints. HITEC's2 operational governance has followed PAR principles, involving the DT3 at Site B, Facility Specific Steering Committee at both sites, and a Study Wide Steering Committee consisting of Department of Correction administrators, site managers (wardens and deputies) and labor union representatives. The Facility Specific Steering Committee provides oversight and feasibility assessment at the facility level. The Study Wide Steering Committee has decision making authority over most study programmatics, but with critical exceptions. These exclusions, which remain within the authority of the research team, involve human subjects and data protection, the conduct of testing and evaluation, and adherence to specific ‘study metrics’ which are essential to scientific design and evaluation of effectiveness. The role of the Study Wide Steering Committee was critical in the evolution of HITEC2 1 into HITEC2 2. The Study Wide Steering Committee requested that the research team replace the top-down WHP/best practices approach at Site A with a more participatory format. The result was the restructuring of intervention planning at Site A. The top-down or administrative best practices approach was replaced with a multi-level participatory form, translated from manufacturing, called a kaizen effectiveness team. The organizational structure of HITEC2 2 is presented in the following Methods section and is introduced here for orientation as Fig. 3.

The lack of applicability of several commonly used survey instruments covering job strain, stress, and work-family conflict was another important finding from HITEC2 1 (Obidoa et al., 2011). Mental health was evaluated both by the Mental Component Score of the Short Form 12 (SF-12) (Ware et al., 2002, Obidoa et al., 2010) and the Center for Epidemiological Studies Depression (CES-D) scale (Radloff, 1977). Focus groups substantiated high levels of depression and bi-directional influences of work-family conflict (WFC). Focus groups and physical testing identified deficits in health, but physical and emotional scores on the SF-12 equaled or exceeded national averages and were correlated only weakly with elevated depression (r < 0.20). Neither the Job Content Questionnaire subscales nor the HRA were associated with the depression scores. The limitations of the SF-12 for longitudinal tracking of employed populations has been noted (Obidoa et al., 2010), but the discordance between reduced physical performance and self-assessed capacity was unanticipated. Similar problems with the bluntness of conventional survey instruments when translated into corrections was noted by Schaufeli and Peeters (2000) in their review of CO1 health. The HITEC2 2 survey was modified, accordingly, by introducing more ‘concrete’ questions on health status.

Section snippets

Kaizen effectiveness team and design team

The involvement of study population representatives in selection of outcome measures introduces two potential problems. First, differences in the content of interventions can weaken inter-group comparisons of effectiveness. Second, participant-selected outcome measures may differ from parameters that are either more effectively measured or preferred by the study team. In HITEC2 2, the problem is approached through a mixed methods approach.

In order to remain consistent with the PAR approach

Results

Results to date fall into two categories: 1) the activity of both the KET4 or DT3 determined by their own and external evaluation criteria, and 2) health outcomes provided at baseline of HITEC2 2 (Year 7 of HITEC2). This is a practical division. While the baseline health data can be compared to HITEC2 1, either as a repeated cross-section or as a prospectively followed inception cohort, the follow-up ‘study metric’ data is not yet available. Accordingly, HITEC2 2 efficacy can be evaluated at

Discussion

This current and second phase of intervention research in corrections began with uncertainties. A primary concern was that the KET4 and DT3 approaches were insufficiently dissimilar and would decant into a convergent intervention program. Another concern was that the KET,4 with its emphasis on shorter-term measurable outcomes, would too naturally align with the Connecticut Department of Correction culture of problem-directed initiatives, such as lock downs for weapon and drug searches. This

Conclusions

The PAR approaches for workplace intervention planning and implementation within corrections are robust and sustained. Innovative personal health and work organization programs have been introduced in key areas. Their long-term effectiveness in an increasingly stressed population is not yet clear.

Acknowledgments

This publication was supported by grant number 1U19OH008857 from the National Institute for Occupational Safety and Health (NIOSH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH.

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