ous research has shown that construction and factory
workers use HPDs only a fraction of the time (18% to
70%) when they should be worn (Lusk, Kerr, & Kauffman,
1998; Lusk, Ronis, & Kerr, 1995). Therefore, it is
essential that workers increase their use of HPDs, thus
assuming personal responsibility for preventing NIHL. As
health professionals, occupational health nurses conduct
audiometric screening tests, provide education to workers
regarding the dangers of loud noise, and assist them in preventing
NIHL.
Although prior research has shown that there is a
strong need to change worker behavior regarding use of
HPDs, the research base regarding occupational behavior
change programs is sparse. In a review of 36 intervention
research studies in occupational health and safety, Goldenhar
and Schulte (1994) noted a number of methodological
problems including lack of a theoretical basis, small sample
size, and inadequate intensity to cause the desired
change. They also noted that most studies were either
quasi-experimental (including nonrandom assignment) or
nonexperimental (lack of a control group). Only one study
was found that investigated hearing protection using a
behavioral intervention (Ewigman, Kivlahan, Hosokawa,
& Horman, 1990). While this intervention did result in
changes in knowledge, attitudes, beliefs, and behaviors
toward use of hearing protection, it lacked a control group
to assess the effect of the intervention. Fishbein and associates
(1991) have noted that theory-based research has the
best potential to enhance the development of successful
new interventions and underscored the need for all behavioral
intervention programs to be guided by a theoretical
framework. However, prior reviews of studies involving
changes in workplace practices (Goldenhar & Schulte,
1994; McAfee & Winn, 1989) have noted that few of the
behaviorally focused intervention studies had a theoretical
basis.
Subsequent to these reviews, Lusk and colleagues
(1999) tested the effectiveness of a theory-based intervention
delivered to groups of workers working in three
trades. Plumber/pipefitters and their trainers showed significant
increases in use of HPDs at the 1-year posttest,
while operating engineers and carpenters did not. However,
mean rate of use was considerably less than the necessary
use (100%) to prevent hearing loss, demonstrating
the need for further behavior change. Building on the intervention
for construction workers, the project described in
this paper developed and tested a tailored theory-based
intervention and a nontailored theory-based intervention
delivered to individuals via computer to increase factory
workers’ use of HPDs. With increasing accessibility and
recent advances in technology, computer-based programs
offer a promising method of presenting behavior change
messages to large groups of workers. Programs can be produced
that combine interesting and relevant video and
graphics with the database capabilities and processing
power of a desktop computer to provide a feasible and
cost-effective approach for behavior-change interventions
to individuals and groups (Eakin, Brady, & Lusk, 2001).
Prior studies using a variety of approaches have shown
the beneficial effects of tailoring behavior change messages
to the individual (Bull, Krueter, & Scharff, 1999; Krueter,
Bull, Clark, & Oswald, 1999; Prochaska, DiClemente,
Velicer, & Rossi, 1993; Strecher, 1999). In the research
project presented here, the intervention was tailored to:
(a) workers’ responses to survey questionnaire items
(perceptions of benefits, barriers, self-efficacy, interpersonal,
and situational factors)
(b) self-reported type of HPD used
(c) perceived hearing ability
(d) self-reported use of HPDs,
thus determining the information they would receive and
making it relevant to them
Program content was based on prior research using the
Health Promotion Model (Pender, 1987) that identified
predictors of hearing protection use among factory and
construction workers (Lusk et al., 1995; Lusk, Kerr, Ronis,
& Eakin, 1999). In addition, Pender’s (1987) Health Promotion
Model and Bandura’s (1986) Social Cognitive Theory
provided the theoretical foundation and guided the
process for creating an individually-tailored, multimedia
program to change workers’ behavior regarding use of
HPDs.
Methods
Design
This study used an experimental design, randomly assigning
subjects in a pretest-posttest control group design
(Campbell & Stanley, 1963) to contrast the effects of three
interventions on factory workers’ use of HPDs. The interventions
were:
1. a tailored intervention, in which workers received
information based on the predictors of HPD use
from the causal model obtained in the original study
of a large group of factory workers (Lusk et al.,
1995), but tailored to each individual’s specific
responses to the survey items
2. a nontailored predictor-based intervention
3. a control intervention
Setting and Subjects
The study site for this program was an aut