Several studies have examined the factors influencing workers to use, or not use, hearing protection on the job. A few studies have examined psychosocial factors, including the role of family members in encouraging use of protective equipment or other types of health-related.behaviors.
Sally Lusk, RN, and fellow researchers at the University of Michigan have done several studies on hearing protection the construction and automotive industries and have developed and evaluated training materials. They used Pender's Health Promotion Model (Pender, 1987) to identify predictive factors for the use of hearing protection by construction workers (Lusk, Kerr et. al., 1999; Lusk, Hong et al., 1999) and developed videotapes to target the identified factors. Those who used hearing protection devices (HPDs) regularly perceived benefits, had the HPDs available, were in workplaces that encouraged use, and received interpersonal support for using hearing protection. Interpersonal support included perceptions of praise or encouragement for wearing hearing protection from friends, family members, supervisors, and co-workers. The videotapes were based on two of these factors: on barriers to use, for example "Hearing protection keeps me from hearing what I want to hear," and on interpersonal modeling, particularly the supervisor's use of hearing protection and a demonstration of how to use ear plugs.
In another study, Lusk, Kerr et. al., (1998) found significant differences by construction trade groups, age, and years of employment in the trade, but not by education level, noise exposure, or hearing loss. Operating engineers were the most likely to use HPDs and carpenters least likely. Workers 30 years and older and those with 12 or more years of employment in the trade were most likely to use hearing protection. The authors recommended tailoring training programs to specific groups.
Luskıs team used the Health Promotion Model (Pender, 1987) conceptually to explain variance in use of hearing protection and to examine the factors influencing this behavior. (Lusk, Ronis et al., 1995). They administered a questionnaire to 504 blue-collar workers at three Midwestern manufacturing plants where noise levels exceeded 85 dB. One unexpected finding was that the workers who felt most in control of their health care decisions were less likely to use hearing protection. Other findings were not as surprising: Hearing protection use increased with greater self-efficacy (belief that one could successfully use hearing protection) and perceived benefits or value of use. Use decreased with greater perceived barriers, such as the fear of missing warning sounds.
Samuel Melamed and colleagues studied Israeli industrial workers to identify what motivates some to use HPDs. The three strongest predictors were self-efficacy, perceived susceptibility (the person's estimation of his or her vulnerability to the effects of noise), and noise annoyance. Actual hearing loss was not powerful enough to convince workers to further conserve their hearing. Workers were asked about family support, and 64 percent reported not discussing HPD use with their families; only 7 percent said their spouse encouraged HPD use.
Kelly et. al. looked at social network factors in motivating workers to make behavior changes regarding smoking, eating, stress-reduction, seat-belt use, and exercise. Support of family and others was not a strong predictor of motivation or behavior change, though the effect was most pronounced for smoking and seat-belt use. The authors noted that the intervention (physician prescription and instructional materials) may have been too brief, and a postulated that a longer intervention period (maybe four weeks) or more interpersonal contact might have strengthened the role of family support.
A family concern the desire for healthy children was found to be an important factor influencing construction painters to wear respirators (White et. al, 1988). The strongest factor in respirator use was found to be concern about chemical effects on reproduction. Nonusers often thought others would find them foolish. This study concluded that respirator use is a social behavior and that the perceived attitudes of others in the workplace influence respirator use (family influence wasn't studied). This study suggested including supervisors, management, and union representatives in the target audience for intervention programs.
A Dutch study (de Vries et. al.) looked at the use of protective equipment among industrial workers exposed to carcinogenic substances. Frequent users reported more positive social support from colleagues, bosses, and spouses than did non-frequent users. The most significant predictor was modeling: if colleagues used their personal safety equipment more often, the respondents would use theirs. Although it wasn't as strong a predictor, support from spouses seemed to play a role as well. The authors suggested that interventions should not only be targeted to work sites, but also to the spouses of workers.
Spousal support was found to be a factor in two studies of workplace health promotion among blue-collar workers (Alexy 1990, Bagwell and Bush 2000). Alexy found that support from coworkers, spouse, or supervisor were important factors for participants in a workplace exercise program. Bagwell and Bush found workplace health promotion programs to be more successful when workers and their spouses were involved in the design. Bertera (1990) studied the cost-effectiveness of a health promotion program that included a bimonthly health and fitness magazine targeted to family members as well as employees. He found the program cost-effective and suggested a need to reach spouses. An earlier study by Heinzelmann and Bagley (1970) studied participation in an employee exercise program by sedentary male university employees. They found that 80 percent of the men whose wivesı attitudes toward the exercise program were positive had good adherence, compared with 40 percent of the men whose wivesı attitudes were neutral or negative.
REFERENCES
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Bertera RL. (1990). The effects of workplace health promotion on absenteeism and employment costs in a large industrial population. Am J Public Health. 1990 Sep;80(9):1101-5.
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Heinzelmann F, Bagley RW. (1970). Response to physical activity programs and their effects on health behavior. Public Health Rep. 1970 Oct;85(10):905-11.
Kelly RB, Zyzanski SJ, Alemagno SA. (1991). Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy. Soc Sci Med. 1991;32(3):311-320.
Lusk SL, Ronis DL, Kerr MJ. (1995). Predictors of hearing protection use among workers: implications for training programs. Hum Factors. 1995 Sep;37(3):635-40.
Lusk SL, Kerr MJ, Kauffman SA. (1998). Use of hearing protection and perceptions of noise exposure and hearing loss among construction workers. Am Ind Hyg Assoc J. 1998 Jul;59(7):466-470.
Lusk SL, Kerr MJ, Ronis DL, Eakin BL. (1999). Applying the health promotion model to development of a worksite intervention. Am J Health Promot. 1999 Mar-Apr;13(4):219-227.
Lusk SL, Hong OS, Ronis DL, Eakin BL, Kerr MJ, Early MR. (1999). Effectiveness of an intervention to increase construction workers' use of hearing protection. Hum Factors. 1999 Sep;41(3):487-494.
Melamed S, Rabinowitz S, Feiner M, Weisberg E, Ribak J. (1996). Usefulness of the protection motivation theory in explaining hearing protection device use among male industrial workers. Health Psychol. 1996 May;15(3):209-215.
Pender NJ (1987). Health promotion in nursing practice. Norwalk, Conn.: Appleton & Lange.
White MC, Baker EL, Larson MB, Wolford R. (1988). The role of personal beliefs and social influences as determinants of respirator use among construction painters. Scand J Work Environ Health. 1988 Aug;14(4):239-45.
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