Evaluating the Effectiveness of Participatory Training for Occupational Health and Safety Improvements---A Randomized Controlle Trial with One-year Follow-up in China

Objectives: To find out whether participatory training is effective in improving occupational health and safety (OHS); to see if participatory training is more effective than didactic training in improving OHS; and to document whether participatory training has a better cost-benefit ratio than didactic training.;Methods: A randomized controlled trial (RCT) was conducted among frontline workers in Shenzhen, China from June 2008 to May 2010. The impact of the training programs was assessed with knowledge attitude and practice (KAP), experiences in work-related injury, sick leave and musculoskeletal disorder (MSD) at baseline and one year after training. Chi square test and two-proportion Z test were applied to compare the occurrence of injury, sick leave and MSD in different groups.;Results: 918 intervention workers received participatory training and 2,561 control workers received didactic training. The follow up rates at three-month and one-year after training were 71.1% (2,473/3,479) and 56.3% (1,321/2,347), respectively.;The average baseline KAP scores of 64.9+/-15.0, 63.5+/-14.7 and 78.1+/-18.0 improved significantly at immediate evaluation (82.7+/-12.3, 71.9+/-12.4 and 90.6+/-12.7), at three months (79.3+/-11.5, 73.9+/-10.6 and 91.7+/-9.6), and at one-year after training (76.7+/-12.1, 72.0+/-10.3 and 88.9+/-10.8) in three groups.;In the year after training, the incidence rates of injury events reduced from 144.5 per 1,000 person-years to 73.5 per 1,000 person-years (Z=3.199, p<0.001) in intervention group. No statistical significances were found for injury reduction in control groups. The proportions of workers taking sick leave reduced from 32.0% to 24.6% in intervention group (chi²=5.609, p=0.018), but didn't reduce significantly in control groups (p>0.05). The MSD prevalence rates didn't reduce significantly in intervention and control groups (p>0.05).;The cost-benefit ratios were 1:1.20 for participatory training and 1:1.06 for didactic training if the cost savings were calculated with median costs and workdays lost. The cost-benefit ratios were 1:2.36 for participatory training and 1:1.97 for didactic training if the cost savings were calculated with mean costs and workdays lost.;Conclusions: Participatory training was more effective in improving KAP scores than didactic training. Participatory training could reduce occurrence of injury and sick leave, but not MSD at one year follow up. The cost-benefit ratio of participatory training was better compared to didactic training. The participatory training could be recommended for training frontline workers.;Keywords: Frontline worker, Participatory training, Occupational health and safety, Randomized controlled trial, Evaluation...