Implementation Level and Strategy
Because of the inadequate description of most of the
intervention studies found, it was not possible to characterize
all interventions precisely. Another concern
was the lack of information about the implementation
of the proposed intervention; this incomplete knowledge
makes it impossible to draw firm conclusions
about the potential effectiveness of the intervention.
No information was available about how and to what
extent the legal interventions were implemented at
worksites. No information was given about how employers
and workers were motivated to comply with the
legislation. It could be argued that obligatory legislative
interventions are just organizational interventions used
to commit or compel employers and workers to reduce
the risks for injuries. Lipscomb et al.,15 for example,
stated that informational and educational programs
could accompany legislation. Also, in other health and
workability studies, it is argued that legislation alone is
not powerful enough in today’s society to change
attitudes and behavior in the desired direction.30
Another explanation for not finding an effect could
be that legislation is only gradually introduced and
implemented, and so does not actually interrupt the
time series. Because it is not known how the legislation
was introduced to the field or how well they were
publicized or enforced, there might exist a so-called
gradual diffusion or delayed causation of the intervention.
31 It can be argued that some firms anticipate
forthcoming legislation and others lag behind in their
implementation. Therefore, the exact point of the
intervention can be difficult to determine.
The studies concerning the multifaceted interventions
in the safety campaign28 and the drug-free-workplace
program29 described in more detail the content of their
interventions and their corresponding implementation
strategies. The Spangenberg et al. study28 also provided
information about the familiarity and receptivity of the
safety campaign, but no information was provided with
respect to implemented activities or performance indicators
for the proposed behavior (e.g., good housekeeping).
The use of drug testing in the workplace,
moreover, introduces several ethical and legal complications,
such as the employer’s right to test and the
worker’s right to privacy.
Both multifaceted intervention studies28,29 have used
multiple and continuing intervention methods. Informational
and facilitative strategies that influence the
safety culture at worksites, combined with enforcement
methods such as worksite inspection or mandatory
drug testing, were important activities in these multifaceted
interventions. Other studies (e.g., Neal et al.32)