Formative research in occupational health and safety intervention for diverse, underserved worker populations: a homecare worker intervention project.

OBJECTIVE: The increasing numbers of minority, low-income, and contingent workers in the U.S. labor force present new challenges to occupational safety and health interventions. Formative research can be used to help researchers better understand target populations and identify unanticipated barriers to safety changes. The National Institute for Occupational Safety and Health initiated an intervention project to improve health and safety among homecare workers in Alameda County, California. Investigators conducted systematic formative research to gather information to guide intervention development.
METHODS: Various qualitative methods were used including 11 focus groups (conducted in English, Spanish, and Chinese) and 10 key informant interviews. This article focuses on two picture-based focus group activities that explored workers' views on their relationships with consumers and their perceived barriers to interventions.
RESULTS: Findings indicated cultural differences regarding workers' perceptions of their relationships with consumers. Chinese homecare workers mostly focused on respecting elders rather than initiating changes. Some English- and Spanish-speaking workers described efforts to negotiate with consumers. Results also identified workers' perceived barriers to interventions, such as consumers' resistance to changes and lack of resources. These findings played important roles in shaping the intervention materials. For example, given the lack of resources among consumers, the project tried to tap into community-level resources by collaborating with local stakeholders and developing community resource guides.
CONCLUSION: Formative research can be a valuable step to inform the development of occupational health and safety interventions for diverse, underserved worker populations.