Annals of Occupational Hygiene Advance Access originally published online on July 25, 2008
Annals of Occupational Hygiene 2008 52(7):663-671; doi:10.1093/annhyg/men042
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Workers’ Interpretation of Self-assessment of Exposure
1 Department of Public Health and Clinical Medicine, Occupational Medicine, Umeå University, SE-901 85 Umeå, Sweden
2 Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden
* Author to whom correspondence should be addressed. Tel: +46-90-785-89-55; fax: +46-90-785-24-56; e-mail: anita.p.stromback{at}envmed.umu.se
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ABSTRACT |
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Objectives: The aim was to investigate how workers interpret and act upon results from self-assessment of exposure (SAE).
Methods: Workers in four sawmills in Sweden were supplied with diffusive samplers for measurement of terpenes. Workers received both oral and written instructions about terpenes, their medical effects and how to handle the samplers. Responsibility for sampling was left to the individual worker; written feedback about terpene levels was provided after each measurement. The number of measurements was registered. The workers and supervisors were interviewed about their attitudes, perceived control of their work environment, need for preventive actions and future surveillance of the workplace.
Results: In total, 28 workers performed 100 terpene measurements. At one sawmill, there was a significant association between exposure levels and the number of measurements performed by each worker (
= 0.79, P = 0.03). Contrary to instructions, supervisors played an important role in spontaneous organization of the measurements at each mill. Four measurements revealed terpene concentrations that exceeded the occupational exposure limits, and one preventive action was taken as a consequence of high levels. Seventy percent of the workers could not identify any reason for more measurements. Only 15% considered the measurements as their ‘own’ project, and the rest stated that they participated in order to satisfy the researchers.
Conclusions: Previous studies have shown that workers can perform valid measurements, both select a day and technically perform measurements. This study indicates that this ability is not sufficient to ensure that measurements will be done or that implementing measurements will result in preventive actions. Workers need additional support to take preventive actions and use SAE for ongoing surveillance.
Keywords: participation • self-assessment of exposure • terpenes • theory of planned behavior
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INTRODUCTION |
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Surveillance of workplace chemical exposures includes estimation of exposure levels, interpretation of measurement results and performance of preventive actions when necessary. Exposure measurements are expensive and can be associated with practical difficulties when performed by experts (Balsat et al., 2003). We and others have shown that workers themselves can perform valid measurements (Loomis et al., 1994; Liljelind et al., 2000; Liljelind et al., 2001). Such self-assessment of exposure (SAE) is usually much less expensive than expert measurements. However, little is known about how workers interpret the measurement results and whether they subsequently take rational actions, e.g. repeat measurements if there is high variability or preventive actions if there are high exposure levels.
A theoretical benefit of the SAE method is that workers are empowered with a means to control their working environment risks. Several studies on ergonomics, work safety and health promotion have identified participation and empowerment as key aspects of successful and sustained occupational health and safety interventions (Krause, 1995; Cole and Parker Brown, 1996; Krause, 1997; Hess et al., 2004). Also, the workers’ risk perceptions of the exposure can be a determinant of preventive actions and repeated measurements (Brun, 1994; Stewart-Taylor and Cherrie, 1998; Stave et al., 2007). However, it is uncertain whether SAE actually empowers the worker or if risk perception plays a role in the performance of preventive actions and repeated measurements.
The main objective of this study was to investigate the relationship between measurement frequency, actual exposure concentrations and variation and workers’ propensity to perform exposure measurements. Further, performance of preventive actions as a consequence of exposure concentrations, as well as attitudes, subjective norms, perceived behavior control and future measurement intentions were investigated. In studies like this, where the subject matter is not well studied, a case study design is preferable (Yin, 1984). One further advantage of a case study design is that it enables flexibility in the research agenda. If important results appear during the study, they can be included.
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METHODS |
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This study is an extension of a study by Liljelind et al. (2000) and was conducted in four sawmills. The data were collected by recording measurement frequency and interviewing workers and supervisors.
The cases
In the spring of 1997, six sawmills in the northern Swedish county of Västerbotten were invited to participate in the study. Participation did not result in any costs for the organizations. Four sawmills accepted the invitation. All sawmills were unionized. The measurement phase lasted for about a year. Each sawmill processed different types of wood, but the woods were primarily birch, pine and spruce. Descriptive information about the sawmills is presented in Table 1. The mills were small organizations with approximately the same number of workers in the buildings where all the measurements were taken. The executive managers were also mill supervisors and met daily with the workers in the saw house, except in Sawmill C where the supervising production manager met the workers daily.
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Information to participants and the self-measurement procedure
An occupational hygienist and an occupational psychologist visited each sawmill and gave the workers oral and written instructions. The informational sessions lasted 45–60 min. Workers were trained on how to handle the samplers and informed that they were free to perform measurements when and as often as they liked, i.e. there were no constraints due to specific activities such as cleaning or repairing machines. They were also informed that a single measurement should last for a full work shift (normally 8 h), about the toxic effects of terpenes and the Swedish occupational exposure limit (OEL) for terpenes (150 mg m–3). Further, the workers were informed of the possibility that exposure levels could vary between days, and that repeated measurements had to be taken in order to make a good estimate of average exposure. The only constraint was that measurements should be limited to days when pine was being processed as the highest concentrations of terpenes occur during work with pine. They were also informed that ventilation, cleaning and work routines were important to reduce exposure levels since the amount of terpenes in the air is dependent on the presence of pine wood and dust. The information did not include any specific instructions about hygiene goals as one study aim was to evaluate what, if any, initiatives the workers would take upon receiving measurement results.
Supervisors received similar information at the first visit and were also informed that the decision about when and why to measure should be left to the individual workers.
Diffusive samplers were used (PerkinElmer®). The samplers were available at the workplace from the day after workers were informed about the project. After a measurement, the worker placed the sampler in a preaddressed, stamped envelope and it was sent to a central laboratory for chemical analysis. Results were mailed back to the individual worker within a week after the sampler arrived at the laboratory. The results were presented as a diagram with the worker’s actual and previous measurements, a short comment that exposure levels may vary from day to day, information on the OEL and the telephone number of an occupational hygienist in case the worker had any questions. A more detailed description of the self-measurement procedure, including analytical methods, can be found in Liljelind et al. (2001).
Summaries of measurements were regularly sent to the supervisor. Each supervisor received a diagram showing all measurements in his sawmill, identifying workers by code and not by name, the grand mean for the mill and the OEL (Liljelind et al., 2000).
Measurement frequency
The number of measurements performed and concentration and date for each measurement were recorded for each worker. All telephone questions to the occupational hygienist from the workers and supervisors were also recorded.
Interviews
Workers and supervisors were interviewed on two occasions. Both interviews were semi-structured and included open-ended questions about actions and attitudes toward the SAE program, with particular focus on preventive actions and terpene control. A semi-structured interview was chosen to allow flexibility in the follow-up questions. Examples of questions include one about attitudes: ‘What do you think about SAE?’; one about perceived norms: ‘What made you decide to perform measurements, was it you alone or were you told by someone?’; one about perceived control was ‘Do you know how to take preventive actions?’ and one about behavioral intentions was ‘Can you identify a reason to perform an additional measurement?’. A list of all the structured questions is provided in Appendix.
The first interview was by telephone and took place 2 months after the introduction of SAE. The interview included questions about the implementation of the SAE procedures and the interviewee’s intentions and experiences with the measurements, knowledge of the substance and risks of exposure. The interviewees were asked about their reactions to the measurement results, whether or not they had taken preventive actions in response to the results, and about their control of the work, i.e. if they knew how to take preventive actions.
The second interview was conducted by telephone a year after the measurements started. The interview included questions similar to the first interview and also questions about the importance of the measurements, if the workers considered SAE as something that they controlled, and the reasons for performing additional measurements.
The employers were asked the same questions as the workers, with the exception of the questions about changes in working procedures and control of the work.
On average, an interview lasted 15 min (range 10–25 min). All interviews were recorded and transcribed. Transcribed interviews were analyzed using the content analysis technique (Shadbolt and Burton, 1990; Kvale, 1996). Meaningful units were identified in the text, in this case blocks of sentences. Natural language understanding was the underlying model for segmentation of the text into blocks of sentences and the categorization of these blocks.
Blocks of sentences were analyzed according to a modification of the theory of planned behavior (Fishbein and Ajzen, 1975; Ajzen, 1985; Ajzen, 1991). This theory links stimuli in an individual’s surrounding (in this case, the measurement result) to behavior (preventive actions and future measurements) by a chain of cognitive concepts. First, concept attitudes, perceived norms (a belief that a certain referent person thinks that the individual should or should not perform the behavior in question) and perceived behavioral control are supposed to predict behavioral intention (the person’s decision to act). Next, behavioral intention is supposed to predict behavior. Applied to SAE, the theory states that if workers have positive attitudes toward SAE, perceptions of control over the SAE method and preventive actions and perception of an organizational desire to take action, the workers will perform preventive actions and use SAE in future surveillance as a means to estimate exposure.
The verbal statements were categorized as follows:
- (i)Attitudes, if they concerned beliefs and feelings about SAE.
- (ii)Perceived norms, if the statements were about organized activities and managerial support.
- (iii)Perceived control, if they concerned the possibility and knowledge about how to perform measurements and preventive actions.
- (iv)Behavioral intentions, if they reported intentions to perform further measurements for surveillance.
- (ii)Perceived norms, if the statements were about organized activities and managerial support.
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RESULTS |
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Measurement frequency
In total, 100 measurements were made by 28 workers. Each worker performed at least two measurements. Twenty workers (71%) performed at least three measurements, and eight (29%) performed at least four measurements Table 2. The two workers who performed the most measurements made 11 and 12 measurements, respectively. For more detailed results of the SAE measurements, see Liljelind et al. (2001).
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As one study aim was to investigate whether the average and variation in exposure levels were of importance in the workers’ performance of exposure measurements, the correlation between each workers’ mean level of exposure and number of measurements was calculated. The variation in each worker’s measurements and number of performed measurements were also calculated. In the statistical analyses, the two workers who performed 11 and 12 measurements were excluded. They were excluded because their supervisor assigned responsibility for organizing SAE to these two workers, and therefore the individual initiative for performance of the SAE measurements was diminished.
Over all mills, the Spearman rank correlation coefficient between each worker’s mean exposure level and number of measurements and the coefficient of variance (CV) and the number of measurements were not significant ( = 0.16, P = 0.43 and = 0.24, P = 0.23, respectively).
To test if initial measurements had more influence than later measurements, we also analyzed the relation between the mean and CV of the first two measurements and the number of performed measurements for each worker. There were no significant correlations ( = 0.15, P = 0.45 and = 0.05, P = 0.79, respectively).
When the relation between each worker’s mean and CV of exposure level and the number of performed measurements in each mill was tested, the only significant correlation was the one between each worker’s mean exposure level and number of measurements in Sawmill C ( = 0.79, P = 0.03).
Interviews
Twenty-seven of 28 workers and all supervisors were interviewed on two occasions. The one dropout was due to a long-term illness.
Attitudes.
The attitude among all but four workers and all supervisors was that SAE was interesting, practical and very easy to perform (Table 3). No problems were reported with carrying the samplers. One worker stated, ‘It’s like a pencil, you just put it in your chest pocket’. The workers with negative impressions gave two reasons. One worker reported that he felt negative toward SAE because he had not experienced any negative health effects during his long employment in this industry. His supervisor persuaded him to do measurements and when his first result was 257 mg m–3 (the Swedish OEL is 150 mg m–3), he was startled and measured four additional times. Three workers in another sawmill were also negative toward SAE. They said that for SAE to have an impact, the exposure levels had to be over the OEL or the supervisor would ignore the results.
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When asked about receiving feedback of the results, all but two of the workers thought that it was interesting to get information about exposure levels. Two workers said that as their results were far below the OEL despite their initial perceptions of high exposure and therefore they were not motivated to continue the measurements.
Due to the theoretical interest in risk perception as a determinant of preventive behavior, the workers’ answers to the risk questions are shown separately (Table 3). Two workers thought their terpene exposure implied risk, seven said there was no implied risk and 18 workers did not know if terpene exposure implied risk. Twelve workers thought that exposure to mould, dust and noise were worse than terpene exposure, one worker thought the opposite and the rest of the workers stated that they lacked the knowledge to make a judgment.
Regarding attitudes toward preventive actions, five workers said that preventive actions were not necessary because exposure levels were low. The worker who had the second highest measured level (516 mg m–3) said, ‘I have worked in the mill for over 30 years and I have not felt any symptoms, so I do not react in any special way’. That measurement was the last of four measurements he performed. Thirteen of the workers said that they could not take preventive actions because of lack of control over the work process, and five said that they did not have enough knowledge to take preventive actions. One worker said that mould and dust were a larger problem that ought to be handled first. One worker said that the measurements had brought about preventive actions and that these were necessary due to the exposure levels.
There was no relation between exposure levels and attitudes toward SAE. The sawmill with the lowest exposure concentrations had the largest number of workers with negative attitudes. At the sawmill with the highest exposure concentrations, one of six workers was negative toward SAE, and that worker reported his negative attitude was because of a lack of perceived health effects from terpene exposure.
Perceived norms.
Both workers and supervisors reported some spontaneous, voluntary organization for performing the SAE measurements at each mill (Table 2). When asked what made them measure on a particular day, all workers but one reported that they had measured as a consequence of a reminder or instruction from a colleague or supervisor. One worker who was negative toward SAE stated that his supervisor persuaded him to measure.
The supervisors’ reactions are both surprising and important. All supervisors pointed out the importance of organizational support for measurements. They thought that the workers would have difficulties in performing SAE on their own because of forgetfulness or other priorities such as work tasks. As one supervisor put it, ‘The tubes do not speak for themselves’. One supervisor pushed his workers to perform measurements because he was concerned that after the project finished, workers would falsely accuse him of not permitting measurements.
None of the supervisors mentioned the need for preventive actions as a result of the measurements. One supervisor failed to mention the repair of the heat exchanger during the first interview. In the second interview, he mentioned this repair but did not take credit for it. He said that he had left the entire project to the workers themselves and that this was possible because his mill was a small organization.
Perceived control.
As earlier mentioned, 13 of the workers said that they could not take any preventive actions due to lack of control over the work process and five said that they did not know how to take preventive actions. When asked a follow-up question about perceived control over the work process, 88% of the workers spontaneously reported their perception of lack of control over the work environment for performance of preventive actions or change of the work routines. When asked if SAE was something that the workers were in charge of, 15% of the workers considered SAE as their ‘own’ project; the rest stated that they participated in order to satisfy the researchers. One worker saw SAE as something he controlled in cooperation with the researchers. This was the same worker who said that the preventive actions resulted from the SAE measurements (Table 3).
Preventive actions.
Only one preventive action was taken because of the measurements. In one sawmill, one worker reported in the first interview that they had repaired a heat exchanger in order to increase ventilation. In the follow-up interview, four workers in the same sawmill reported the repair, while the rest did not mention it.
Future surveillance.
Seventy percent of workers could not identify any reasons for additional measurements. They felt that they knew the exposure levels after the study measurements. The remaining 30% noted diverse reasons for additional measurements. These included control of exposure levels, more knowledge of health effects, perceived health effects, warm summer days and expected levels close to the OEL and that the university wanted more measurements (Table 3).
Analyses of dropouts
Supervisors of the two sawmills that did not participate were interviewed about why they had declined. One supervisor reported that he did not want to cause any unnecessary fear or anguish among the workers by introducing SAE. Even if the levels were below the OEL, he was concerned that the measurements might cause anxiety. The other supervisor said that the proposal came to him when he was under stress but that he would have participated if he had more thoroughly understood the project.
One worker did not participate in SAE and reported that this was because he smoked. He thought that if he smoked, the cigarette fumes would ruin the measurement. Furthermore, his coworker did measurements and he thought those results would also be indicative of his exposure.
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DISCUSSION |
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Overall results showed that the workers’ interpretation of SAE was not consistent with rational considerations from a health perspective. Preventive actions as a consequence of high measurements were infrequent and the majority of workers failed to identify reasons for future surveillance.
One surprising and important finding was the supervisors’ action. All four supervisors spontaneously organized the SAE measurements even though this was contrary to instructions. The instructions to both workers and supervisors was that the workers should decide when and how many measurements to perform. Because of the supervisors’ organization of the measurements, the workers’ initiatives were precluded. This is one advantage with using a case study design in areas where the knowledge is limited. The case study design enables the inclusion and examination of unforeseen events during an ongoing study.
We expected that high mean exposure levels and high variation in exposure levels would affect the workers’ risk perception, induce insecurity among the workers and create a norm of performing more measurement for surveillance. In fact, there was no association between mean exposure concentrations and measurement frequency or between the CV and number of measurements. Only in one sawmill, there was a significant correlation between high mean exposure levels and number of measurements. This sawmill had the second highest mean level of exposure and may indicate a weak relationship. The workers at the mill with the lowest mean exposure levels were most negative toward SAE. However, the interviews revealed that the motivation to make the performed measurements was a result of spontaneously organized activity in the mills rather than a decision related to the measurement results themselves. Data supporting this hypothesis are the statements from all but one worker that they measured as a consequence of some form of reminder or instruction from a colleague or supervisor. Thus, the norm to measure as a separate event was not created in this project as a consequence of the measurement results, but rather as a consequence of spontaneous organization of the measurement procedure.
These results also indicate that the workers’ risk perception was not affected by the exposure results. Even though 67% of the workers reported that they lacked knowledge about the risks of terpene exposure, this knowledge gap did not induce insecurity. It is also possible that workers thought the lack of symptoms from terpene exposure implied that the risk associated with terpenes is unimportant.
Although most workers had a positive attitude toward SAE, 88% reported that they had no control over the work process, and 19% said that they did not know how to take preventive actions. Thus, they lacked a perception of behavioral control, which makes the knowledge of high exposure levels an insufficient stimulus for preventive actions. Meta-analyses have shown that the theory of planned behavior is one of the most parsimonious theories in prediction of various social behaviors. This implies that an independent factor must have a strong impact to influence the dependent variable (Hausenblas et al., 1997; Armitage and Conner, 2001). While many of the workers reported that they lacked the control to take preventive actions, the fact that they had a positive attitude toward SAE, got feedback about measurement results, and could perform measurements were insufficient to encourage more measurements.
Furthermore, none of the supervisors mentioned the need for preventive actions based on measurement results. The preventive action in one sawmill was taken as a consequence of the SAE, but it was the result of spontaneous organization in the workgroup and the fact that the supervisor had explicitly left the responsibility for the SAE project to the workers. In another sawmill, where exposure exceeded the OEL on four occasions and reached two-thirds of the OEL an additional 11 times (data not shown, for further information see Liljelind et al., 2001), the supervisor did not mention the need for preventive action. This case indicates that not even a supervisor who received feedback about the workplace exposures could properly translate the results into action.
Management has the authority to make decisions about preventive actions; however, if the management does not view the work environment as unsatisfactory, then the workers have no legitimate power to take necessary preventive actions. In organizations, the supervisors’ beliefs and actions are very important for the implementation of occupational health and safety interventions (Salim, 1982; Glasgow et al. 1990; Cole and Parker Brown, 1996; Krause, 1997). In the theory of planned behavior, perceived subjective norm is defined as ‘a belief that a certain referent person thinks that the individual should or should not perform the behavior in question’. For the workers, a significant referent person is the supervisor. If the supervisors express opinions and act in certain ways, this will influence the workers’ beliefs and actions. In present study, the worker initiated repair of the heat exchanger because the supervisor had left the entire responsibility for the SAE project to the workers. The fact that the supervisors did not see a need for preventive actions even when the OEL was exceeded raises questions about the power of the OEL to serve as a motivating tool in workplace safety. It might be that the supervisors do not interpret the OEL as binding or that they see the Swedish Work Environment Authority as an advisory organization. The workers’ perceptions of lack of control over preventive actions is surprising since they were informed about the importance of cleaning and work routines as a way to reduce exposure. This may be explained by the phenomenon of ‘locus of control’ (Rotter, 1966), i.e. how workers perceive responsibility for performance of preventive actions. If the workers see the control as belonging to the supervisors, they might not even perceive their own behaviors as preventive actions.
The data show that workers had perceptions about level of exposure before they began SAE. Two workers said that they were not motivated to continue the measurements despite their initial perception of high exposures as their results were considerably under the OEL. Also, the worker who had the second highest concentration referred to his lack of symptoms as an indicator of no harm from the exposure. As seen in the present study, such preconceptions can induce unwillingness to perform further measurements.
Taken as a whole, this study indicates that user-friendly methods for self-assessment that can be reliably implemented are insufficient to ensure that SAE programs will be continued and that the gathered information will be effective. This is true even when there is a positive attitude toward self-assessment.
These results should be considered within the context of the present design. Swedish sawmill workers have completed at least 9 years of compulsory education. Given the small population of northern Sweden, the workers in the present study were relatively homogenous in terms of background and lifestyles. Workers with shorter theoretical training may be limited in their ability to interpret the results, while more skilled or trained workers could be more able to interpret the results. Further, all mills are unionized and this might influence the results. For example, workers may perceive safety-related issues as a responsibility of the union rather than the individual.
Workers were aware that management received summaries of all measurements. This may have negatively influenced the workers’ performance of measurements as well as preventive actions. Even though the results were coded to prohibit identifying individuals, the mills are small and supervisors may have been able to identify workers. However, all supervisors stated enthusiasm for SAE and in three of four cases, they identified problems that kept the workers from performing SAE (e.g. forgetfulness). Therefore, they took steps to organize and encourage measurements, indicating to the workers that they saw the importance of SAE. Thus, the risk of a dampening effect of the supervisors’ possible knowledge of individual worker’s measurement results on measurement performance and preventive actions seems small.
This study focused on terpene exposure. Terpenes can be classified as low-risk substances (Slovic, 1987). Thus, our findings may not be valid for a substance of higher toxicity, present in work environments where health problems are readily attributed to the exposure, or for substances associated with greater media coverage.
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CONCLUSION |
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If the goal of SAE is to have valid estimates of the exposure, workers can perform the measurements. However, if the goal is to establish systematic monitoring and preventive actions, then simply letting workers and supervisors to conduct SAE without formal organization is insufficient. Rational interpretation of, and reaction to, SAE requires a higher level of organization. Some avenues worth pursuing may be delegation of a SAE program to a person with more in-depth knowledge (e.g. a safety engineer or occupational hygienist) or more extensive training of workers and supervisors during program implementation.
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FUNDING |
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Swedish Council for Work Life Research (2001-146); Center for Environmental Research (223-1176-00); Swedish National Institute for Working Life.
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APPENDIX |
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Interview questions for workers and supervisors
Attitude
- What do you think about SAE?
- What do you think of the information and instructions about SAE?
- How did you react when you got the measurement results?
- Can you identify any problems in performing SAE?
- What do you think is a greater risk, exposure to terpenes, mould, or wood dust?
- What do you think of the risks with exposure to terpenes?
- What do you know about terpenes?
- Is it necessary to perform preventive actions because of the measurement results?
- What do you think of the information and instructions about SAE?
Perceived norm
- What made you decide to perform a measurement that particular day? Was it you alone or did someone tell you to?
Perceived control
- Do you know how to take preventive actions?
Behavior intentions
- How did you react when you got the measurement results?
Behavior
- Did you take any preventive actions as a consequence of the measurement results?
Questions for workers, added in the second interview.
Attitude
- Did the performance of SAE have any significance for you?
Perceived control
- Who was in charge of the measurements?
Behavioral intentions
- Can you identify a reason for performing additional measurements?
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ACKNOWLEDGEMENTS |
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The work was performed at The Department of Public Health and Clinical Medicine, Occupational Medicine, Umeå University, S-901 85 Umeå, Sweden. The committee of ethics, Umeå University (dnr 97-23) approved the studies. We would like to thank the participating workers and supervisors. We also want to thank Weine Andersson at the Work Environment Inspectorate in Umeå, Drs Kåre Eriksson and Bo Strangert for their support and valuable comments and Mrs Margit Sundgren for her skillful technical assistance.
Received November 15, 2007; in final form May 14, 2008
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