Survey Assessment of Worker Dermal Exposure and Underlying Behavioral Determinants

Abstract

Within the workplace, there is less reliance on engineering controls for dermal exposure protection and more reliance on the worker's motivation and training in use of personal protective equipment. Behavior thus becomes a significant determinant of dermal exposure, and its assessment paramount in examining and understanding factors influencing exposure. The main objectives of this study were to: (i) assess worker knowledge, attitudes, and perceptions (KAP) of workplace dermal hazards using a self-complete questionnaire and to examine KAP associations with behavior and exposure; (ii) compare worker and manager scores to identify potential gaps in KAP between the two groups; (iii) utilize a semiquantitative observational DeRmal Exposure Assessment Methodology (DREAM) to evaluate worker dermal exposure; and (iv) identify potential behavioral factors underlying exposure using DREAM and KAP. Nineteen industries across the Baltimore, Md. and Lancaster, Pa., regions participated in the study including a total of 89 workers and 17 managers. The scales within the KAP questionnaire that served as the outcome measure included knowledge, training, behavior, behavior beliefs, information beliefs, self-efficacy, and overall beliefs. DREAM scores ranged from 0.15 to 545 with a median of 8 and a mean (SD) of 22 (62.5). Whereas worker self-efficacy with respect to PPE use, and the group "workers with 10-20 years of experience" were marginally positively associated with protective behavior (p < 0.08 and p < 0.06, respectively), a question related to barriers to PPE use was negatively associated with precautionary behavior (p < 0.01). Dermal exposure was positively associated with workers in the age group 40-49 years as compared with those less than 40 years of age (OR = 4.86, 95% CI = 0.93, 25.62). There were no statistically significant associations between KAP and DREAM. This is one of the first studies to begin to elucidate worker knowledge, attitudes, and perceptions that underlie behaviors that lead to occupational dermal exposures. Results of the KAP questionnaire can inform strategies to improve awareness and protective practices in the workplace through factors such as increased worker dermal hazard knowledge, well-informed company PPE selection and availability, and improved worker training.

Factors Influencing Oncology Nurses' Use of Hazardous Drug Safe-Handling Precautions

“…The instruments that measured the predictor variables were the Chemotherapy Exposure Knowledge scale, the Barriers to Using PPE scale, a self-efficacy scale, and three items about perceived risk, which were adapted from measures used in studies of dermal chemical exposure in industrial workers (Geer, Curbow, Anna, Lees, & Buckley, 2006;Geer et al, 2007). Content validity (content validity index = 1) was established by three consultants (two with expertise in HD handling and one with expertise in occupational safety and health) using the universal agreement method (Polit, Beck, & Owen, 2007).…”

“…The 12-item Chemotherapy Exposure Knowledge scale (Geer et al, 2007) measures knowledge about HD exposure. Response options are true, false, and don't know.…”

A Pilot Study of Workplace Dermal Exposures to Cypermethrin at a Chemical Manufacturing Plant

“…Cypermethrin was analyzed in pre-and post-shift urine samples. Behavioral determinants of exposure were evaluated through a technician-administered, 115-question KAP survey based on the work of Geer et al (29) During December 2005-January 2006, eight workers were recruited from a chemical plant manufacturing cypermethrin and located in a northeastern U.S. city. Discussions with the plant industrial hygienist (IH) indicated that the potential existed for worker dermal exposure.…”

“…The KAP questionnaire was constructed using dichotomous and Likert-scale responses and shown to have both good face and content validity. (29) In addition to the dermal KAP questions, the survey instrument also included a demographic module to capture age, gender, ethnicity, and household income information. Altogether, the KAP survey contained 115 questions across seven scales: (1) Knowledge, 13 questions; (2) Information Belief, 3 questions;…”

“…We built on their survey methodology by developing and testing a new survey, comprising seven psychosocial scales, to assess workers' dermal knowledge, attitudes, and perceptions (KAP) as underlying behavioral determinants of exposure. (29) The KAP survey was developed from the Health Belief Model premised on the concept that people partake in health protective behavior based on perception of susceptibility (personal vulnerability), severity (likelihood of getting sick), benefits of taking action (outcome expectancy), and barriers (self-efficacy). (30)(31)(32) The current study is intended to demonstrate feasibility and provide range-finding data to inform the design of larger future studies that will assess the factors contributing to potential exposure and to characterize the current practice of hazard control, including the use of personal protective equipment.…”