Worldwide, occupational diseases and injuries frequently occur and are consequences of
exposures exceeding biological tolerances of humans. The burden of occupational diseases
and injuries is high, especially in the construction industry [1,2]. Construction workers are
frequently exposed to various types of injury-inducing hazards, especially falling from
heights [3]. In principle, occupational diseases [4-6] and occupational injuries can be
prevented by means of control measures at worksites.
In the construction industry – as in many other industrial sectors – the majority of control
measures are not evaluated in terms of reductions in injuries [7,8]. The reality in daily
practice is that work-related injuries occur too infrequently to set up (randomized) controlled
intervention studies with injuries as primary outcome measure. In addition, it is difficult and
costly to effectively intervene across a large enough construction population. The present
randomized controlled intervention study focuses on a more frequently occurring outcome
measure like safety violations in the construction industry, accompanied by process measures
to get insight in the implementation to evaluate the effect of two strategies.
According to the labor inspectorate (personal communication), more than 80% of Dutch
construction sites violate safety regulations for working from heights, while 14% of the
construction workers report that unsafe situations prevail at work [9]. Safety measures should
be applied to reduce work-related fatal and non-fatal fall injuries. To increase compliance
with safety regulations, employers and workers need to select, implement and monitor safety
measures. To facilitate this behavioral change [10], stimulating knowledge awareness (e.g.
Leeman et al. [11]) and personalized feedback (e.g. Diclemente et al. [12] ) are behavior
change techniques that are frequently advocated.
For this study, two behavior change strategies have been developed to reduce the number of
safety violations concerning the installation and use of rolling scaffolds, ladders and stairs, in
addition to the announcement of safety inspections by the labor inspectorate. These strategies
are based on aspects of awareness-raising and personalized feedback and consist of 1) faceto-
face contacts with safety consultants and 2) direct mail with internet links.