HSE Health & Safety

Executive

Effective communication of chemical hazard and risk information using a multimedia safety data sheet

Prepared by the University of Aberdeen for the Health and Safety Executive 2003

RESEARCH REPORT 072

HSE Health & Safety

Executive

Effective communication of chemical hazard and risk information using a multimedia safety data sheet

KS Creely 1 , S Leith 2 , MK Graham 3 , HA Cowie 3 , J Hughes 2 , P George 3 and JW Cherrie 1&3

1. Department of Environmental and Occupational MedicineLiberty Safe Work Research Centre, Foresterhill Road

Aberdeen, AB25 2XP

2. West Technical Consultants Park Business Centre, 5 La Belle Place, Glasgow ,G3 7LH

3. Institute of Occupational Medicine8 Roxburgh Place, Edinburgh, EH8 9SU

Workers and managers often do not understand the technical information in safety data sheets (SDSs) and there is therefore doubt about whether they are an effective way of communicating hazard and risk information. Development of a computer multimedia SDS (mmSDS) could provide a more reliable way of communicating essential chemical hazard and risk information. Two mmSDSs were developed, the first covering two similar formaldehyde based embalming fluids and the second covering a solvent-based paint.

Workplace and laboratory studies were undertaken to evaluate the effectiveness of the mmSDS in increasing users’ knowledge of the hazardous substances in the product, as well as their ability to induce appropriate protective behaviour. Subjects received either the mmSDS or the conventional SDS package, which was also presented via computer. Exposure to hazardous substances was monitored pre- and post-intervention and the effect of the interventions on subjects’ knowledge, attitudes and risk perception, was also assessed. In both studies, the populations were small and repeated follow up of the participants was not always possible making it difficult to achieve adequate statistical power to detect the kind of differences hoped to be found between two interventions.

Despite the limitations in both evaluation studies, knowledge of hazards and risks increased for both groups after working through the SDSs. There was little change in the use of personal protective equipment and control measures for both types of SDS in the workplace studies, however use of these measures increased in the laboratory studies with the mmSDS being more effective at promoting change. Cumulative exposures to hazardous substances in the laboratory study also decreased after working through the SDSs. These findings suggest that the mmSDS may be a more effective way of providing chemical safety information in the workplace. However, the impact of this acquired knowledge on behaviour and exposure to chemicals was more pronounced on novice users in the laboratory study and may be restricted by workplace factors. Further research should be undertaken to assess the effectiveness of the mmSDS in workplaces where users have greater control over the use of protective measures.

This report and the work it describes were funded by the Health and Safety Executive. Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

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First published 2003

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CONTENTS

SUMMARY iii

1. INTRODUCTION 1

2. DEVELOPMENT OF MULTIMEDIA SAFETY DATA SHEETS 5

2.1 The project team and remit of design 52.2 Streaming the safety data sheet information 62.3 Introductory video clips 82.4 Incorporating interactivity 82.5 Enhancing the learning process 10

3. EVALUATION STUDY METHODOLOGY 13

3.1 Overview of evaluation studies 133.2 Recruitment of study participants 143.3 Pairing of study candidates 153.4 Monitoring exposure to hazardous substances 153.5 Administering mmSDS and SDS packages 163.6 Questionnaires 173.7 Statistical methods 19

4. WORKPLACE EVALUATION STUDY RESULTS 21

4.1 Participants and company details 214.2 Characteristics of the study population 214.3 Exposure to formaldehyde 224.4 Use of personal protective equipment and workplace

ventilation 244.5 Knowledge 244.6 Previous training 254.7 Subjective assessment of the mmSDS and SDS packages 264.8 Effect of the mmSDS and SDS interventions 28

5. LABORATORY EVALUATION STUDY RESULTS 35

5.1 Study participants 355.2 Characteristics of study population 355.3 Exposure to white spirit 365.4 Use of personal protective equipment (PPE) and work

place ventilation 375.5 Knowledge 375.6 Subjective assessment of the mmSDS and SDS packages 385.7 Effect of the mmSDS and SDS 40

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6. DISCUSSION 49

6.1 Workplace evaluation studies 49 6.2 Laboratory evaluation study 55 6.3 Cost-benefits of using multimedia technology 59

7. CONCLUSION 61

8. ACKNOWLEDGEMENTS 65

9. REFERENCES 67

10. APPENDICES Appendix 1 Appendix 2

Selected screen shots from the mmSDS Copies of proformas used in evaluation studies

73 75

Appendix 3 Embalmers knowledge assessment, attitudes and risk perception questionnaire 93

Appendix 4 Painting knowledge assessment, and risk perception questionnaire 109

Appendix 5

Appendix 6

Example of mmSDS subjective assessment questionnaire Example of SDS subjective assessment

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questionnaire 121

Appendix 7 Summary of subjective opinions for embalming fluid SDS and mmSDS

127

Appendix 8

Appendix 9

Change in cumulative exposure per subject (embalmers) Summary of subjective opinions for the paint SDS and mmSDS packages

129

137 Appendix 10 Change in cumulative exposure per subject

(laboratory study)

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139

SUMMARY

Safety data sheets (SDSs) are used by companies to support risk assessments and also provide information to workers about the hazards and risks of using the products. Workers and managers often do not understand the technical information in SDSs and there is therefore doubt about whether they are an effective way of communicating hazard and risk information. In contrast, studies have shown that training can induce protective behaviour amongst users of hazardous substances, with more effective training being highly interactive. Over the last decade there has been a rapid development in the capability of computer systems to deliver high quality interactive multimedia presentations and these have been shown to increase the effectiveness of training and the speed at which adults learn. Development of a computer multimedia SDS (mmSDS) could provide both a more reliable way of communicating essential chemical hazard and risk information and a more effective way for employers to fulfil their legal obligations with respect to information and training. Two mmSDSs were developed, the first covering two similar formaldehyde based embalming fluids and the second covering a solvent-based paint. Focus group meetings with end-product users were held to obtain opinions regarding the design and content of the mmSDSs. Product manufacturers also collaborated closely.

Workplace and laboratory-based studies were undertaken to evaluate the effectiveness of the mmSDSs in increasing knowledge of the hazardous substances in the product, as well as their ability to induce appropriate protective behaviour in the user. The subjects received either the mmSDS or the conventional SDS package, which was also presented via computer. Subjects’ exposure to hazardous substances was monitored pre- and post-intervention. The effect of the interventions on subjects’ knowledge, attitudes and risk perception, was also assessed. Short­term changes were assessed shortly after the intervention and the evaluation studies were repeated at approximately one month and three to six months later to identify any longer term trends. In both studies, the populations were small and repeated follow-up of participants was not always possible. Due to the study limitations and difficulty in achieving adequate statistical power, the results are suggestive rather than definitive.

Fourteen embalmers participated in the workplace evaluation study. Their average age was 38 years, with a range from 28 to 50 years. Knowledge of hazards and risks increased for both groups of workers after working through the SDS, with a greater increase being observed in those individuals who received the mmSDS. Individuals who used the mmSDS retained this increase in knowledge for a longer period of time. Cumulative exposure to formaldehyde was found to decrease slightly after working through the SDSs, although there were no significant differences between the two packages. In the longer post-intervention studies overall cumulative exposure gradually increased back to pre-intervention levels. There was little change in the use of personal protective equipment and control measures for either type of SDS however this was due, at least in part, to the fact that many subjects used all the protective measures available to them before the intervention.

Twenty-four individuals participated in the laboratory-based study. Their average age was 31.6 years, with a range from 18 to 64 years. None of the participants had previously used the paint product and so knowledge of the hazards and risks increased substantially for both groups of users after working through the SDSs. Use of protective measures improved, with the mmSDS being more effective at promoting positive changes in the wearing of personal protective equipment and hand washing. Cumulative exposures to hazardous substances in the laboratory

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study also decreased after working through the SDSs. These findings suggest that the mmSDS may be a more effective way of providing chemical safety information in the workplace.

The impact of this knowledge acquired from the SDSs on behaviour and exposure to chemicals was more pronounced in novice users in the laboratory study and may be restricted by workplace factors. Changes in behaviour leading to reductions in exposure were not maintained for more than a few months and so continued reinforcement of the message is recommended. Further research should be undertaken to assess the effectiveness of the mmSDS in workplaces where users have greater control over the use of protective measures.

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1. INTRODUCTION

In the European Union (EU), employers have a legal obligation to inform their workers about the hazards and risks associated with using hazardous substances under the requirements of the Chemical Agents Directive (European Communities, 1998). Knowledge of the likely risks should allow employees to take appropriate protective steps and these requirements therefore form part of the employer’s strategy for controlling exposure. Safety Data Sheets (SDSs) play an important part in communicating hazard and risk information about chemicals (HSE, 2000a) in small to medium sized enterprises (SMEs) and they are legally required under Regulation 6 of the Chemicals (Hazard Information and Packaging for Supply) Amendment Regulations 2000 (CHIP 2000).

There is, however, clear evidence to suggest that SDSs are an ineffective way of communicating information, either because they are not read (HSE, 2000a; Pollack-Nelson, 1995; Hatem and Lehton, 1995) or because the information is not properly understood by workers (Anonymous, 1991). Work by Cohen et al (1985) showed that risk communication messages which specifically portrayed technical accuracy and emphasised legal liability had little success. There are several other reasons for the ineffectiveness of SDSs such as familiarity of product type; no immediacy of the hazard and unreality of delayed effects (McDonald, 1998); and poor perception of the hazardous nature of the substance (Godfrey et al, 1983; Wogalter et al, 1986; Friedmann, 1988; Silver et al, 1991). Pollack-Nelson (1995) demonstrated that in cases where an individual is familiar with a product and has already formed an opinion as to its hazardousness, appropriate methods of use, instructions or warnings may often be disregarded. This study also found that individuals were more concerned about the more apparent and immediate hazards associated with, for example, methylene chloride exposure than with long term ill-health effects such as cancer, which typically does not manifest itself until many years after exposure to the hazard. However, probably the most important barrier to effective communication is the complexity of the information to be communicated and the lack of any incentive on the part of suppliers to present the information in a clear easily understood way. Although illiteracy levels are generally low in the UK and most other countries in the EU, many industrial workers may have difficulties with the relatively complex terminology used in SDSs (Samways, 1988). Indeed, in a recent survey by HSE (2000a) two thirds of workers in SMEs were found to have an average reading age of just under 12 years and 5 months.

In contrast to written hazard and risk communication, studies have shown that training is capable of inducing protective behaviour amongst users of hazardous substances. Tan-Wilhelm et al (2000) compared self-protective attitudinal and behavioural responses amongst workers receiving beryllium risk notification instructions including live presentations, question and answer sessions, posters and stickers with controls who did not receive any training. This study demonstrated that workers receiving the training materials reported more positive attitudes towards safety practices and engaged in more protective behaviour, with the study participants also reporting that the live presentations had a significantly stronger influence on self-protective behaviour than the written materials. Hopkins et al (1986) were able to demonstrate that appropriate training could reduce styrene exposure amongst groups of workers manufacturing glass-reinforced plastic products. Videotapes demonstrating and explaining the usefulness of housekeeping conditions and work practice behaviours designed to reduce exposures to styrene were shown during training meetings, with follow up behaviour maintenance programs being used to encourage such work practices. Post training exposures to styrene for all workers were lower than the baseline

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exposure levels with 82-89% reductions in individual workers’ exposure being reported in some instances. There is also evidence that training can have positive indirect effects on management’s introduction of hazard control measures and organisational handling of health and safety issues, with many observed effects also being maintained over several years (Robins et al, 1990). The relative effectiveness of training programmes have been found to be related to their interactive nature, plus the use of visually attractive support materials and appropriate high quality video film (Robins et al, 1990). Work by Desvouges and Smith (1988) and Samways (1988) illustrate the success of risk communication based on audio and visual aids and via interactive teaching such as focus groups. One interesting point from much of the research relates to the importance of the presenter of such messages and Covello (1993) highlighted that physicians are the most trusted and credible sources of information on occupational health and safety matters.

Incorporating more of the benefits of training in the delivery of hazard and risk information rather than just relying on printed material should increase its effectiveness. Multimedia can be defined as “the ability to combine sound, pictures, text and animations in a presentation that users can interact with” (Lawton, 1996). Over the last decade there has been a rapid development in the capability of computer systems to deliver high quality interactive multimedia presentations. There is a plethora of literature that indicates that multimedia materials promote more positive attitudes towards learning and they are being increasingly used in occupational health and safety training. Easy availability, accessibility, low cost of technological resources and the expanding body of research on the role of multimedia in learning have all contributed to this increase in usage (Premkumar et al, 1998). Multimedia systems have been shown in some studies to increase the effectiveness of training (Courtney and Thelen, 1981), with 15-20% increases in learning efficiency being reported compared to conventional methods of instruction (Mehrabi et al, 2000). Multimedia systems have also been shown to increase the speed at which adults learn (Greaves and Heideman, 2000; Goh et al, 1998; Huddock, 1994), with 30% reductions in training times achievable (Cooper and Phillips, 1994). They can therefore provide a cost-effective alternative to conventional training.

The design of effective multimedia presentations has been the subject of much study over recent years, with many articles and books being published. The main design issues have been summarised by Tannenbaum (1998). These include clearly defining the purpose and objectives of the project; analysing the characteristics of the intended audience; keeping the information on the computer screen simple, conveying no more than one major concept at a time and using images and text that enhance and do not detract from the message. Tannenbaum (1998) also includes detail of work undertaken by Mok (1996) who advocates that multimedia packages should be designed so that they behave in a predictable, consistent manner, enabling users to progress through the package at their own pace as well as providing the appropriate level of interactivity. Gould (1990) believes that in order to design good, usable systems, there should be early and continual focus on end users, with regular user testing of the package being undertaken and the system being modified on the basis of these results.

Motivation is another important factor that should be considered when designing multimedia presentations. Ideally users should experience an intrinsic desire to engage in the presentation; being interested in completing the tasks for their own sake rather than because of any value attached to their completion. For meaningful learning to occur it is important to design for intrinsic motivation on the part of its users (Biggs and Moore, 1993). With this view in mind, Stoney and Wild (1998) suggests that multimedia presentations should be designed so that they are pleasing to the eye, easy to learn and use, whilst also being challenging and engaging. They also state that learners should be given control over their learning experience, with the

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appropriate level of interactivity being incorporated so as to engage the user. Interaction is intrinsic to successful, effective instructional practice (Sims, 1997).

This project focuses on the use of SDSs as training and information tools by employers. The aim of the project was to develop computer mmSDSs for two products and test the effectiveness of these in promoting control of exposure to the hazardous substances compared to the conventional SDSs. The generic design of the mmSDS was applied to a solvent-based paint and two similar formaldehyde-based embalming fluids. The main development stages of the packages, outlining the key psychological and design issues that were considered during their production are discussed in Section 2.

For training to be successful, it must increase workers’ assimilation and understanding of the hazards and risks, changing their attitudes, which in turn should lead to the adoption of safer work practices and behaviour. Workplace and laboratory studies were undertaken to evaluate the effectiveness of the multimedia packages in increasing users knowledge of the hazardous substances being used and their ability to induce appropriate protective behaviour. How this compared to the conventional means of communicating such information are also described.

It was hypothesised that, following both of the interventions, there would be a reduction in exposure levels to the hazardous substances being used due to increased product knowledge. Whilst it was also anticipated that the changes induced by both programs would be slowly lost over a period of time, it was thought that the extent of these changes would differ between the two approaches. Those individuals receiving the mmSDS might have lower exposure levels for a longer time interval due to the information being communicated in a more effective manner resulting in long-term attitudinal and behavioural changes. For those individuals receiving the conventional SDS, it was hypothesised that their exposure would quickly increase back to baseline pre-intervention levels, as the information may not have been communicated in a manner that would effectively change their workplace attitudes and behaviour. Repeat evaluation studies will also help identify when refresher training may be necessary.

In summary, the aim of the project was to develop computer mmSDSs for two products and test the effectiveness of these in promoting control of exposure to the hazardous substances compared to the conventional SDSs. The objectives of the study were as follows. • Develop multimedia interactive SDS training tools targeted at end users of hazardous

substances. • To refine the mmSDSs using appropriate selected focus groups. • To test the effectiveness of the mmSDSs in increasing knowledge and inducing appropriate

protective behaviour amongst target workers. • To evaluate which elements of the mmSDSs have the greatest impact on the communication

of information about protective behaviour by workers. • To test the ability of the mmSDSs to reduce workers exposure to hazardous substances

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2. DEVELOPMENT OF MULTIMEDIA SAFETY DATA SHEETS

2.1 THE PROJECT TEAM AND REMIT OF DESIGN

As the development of multimedia projects require a blend of skills and experience (Glushko, 1995), a multidisciplinary team was set up consisting of occupational hygienists, an occupational psychologist, graphic designer and multimedia developers. At key stages during the development of the mmSDS, focus groups of product users were convened to gather opinions regarding the design, content and appropriateness of the mmSDS, with many different ideas being prototyped. Separate focus groups were held for each group of end users, their managers, supervisors and safety representatives to enable a wide range of opinions to be expressed. In response to the feedback and suggestions obtained from these meetings, changes to the design and content of the mmSDS were implemented, ensuring that the finished products were intuitive, understandable and well presented. The product manufacturers also collaborated closely with the team to ensure that the content was technically correct.

For health risk communications to be maximally effective, they must be tailored to the informational needs and characteristics of the target audience (Cohen et al, 1985). It is recognised that before any message is prepared for a given audience, efforts should be made to determine their existing level of knowledge about the hazards in question and factors such as education which could affect their understanding and acceptance of the message to be delivered. Neglecting to consider the characteristics of the intended audience can result in a multimedia package that is pitched to an entirely different audience to that intended, ultimately leading to frustration and non-use of the programme.

Discussions with general employees during the focus group meetings revealed that most were aware of the main hazards associated with the products. However, very few had previous experience wit h computers or multimedia materials, principally because their job did not require the use of such technology. Many of the general employees seemed reluctant and in some instances scared of using computers. Possible reasons for this are:

• awe – as they are not accustomed to using computers they may be afraid that they are unequal to the task;

• fear – they are perhaps afraid that the computer will prove to themselves and their employer that it is superior to them; or

• dissatisfaction – they may want to use the computer but having found previous software or hardware difficult to use they may be reluctant to try again (Greenberg, 1984).

The design of the mmSDS needed to address such attitudes as well as providing a platform for effective learning of the SDS information. It has been reported that people usually retain 10-15% of that which is read, 10-20% of that which is heard and 20-30% of that which is seen. However when audio and video are presented side-by-side, retention of knowledge can increase to 40-50% (Mehrabi et al, 2000). The mmSDSs were therefore designed to be dynamic in nature, with extensive and complex interaction between voiceover, graphics and video clips, reducing the need for users to read text wherever possible. Appendix 1 gives example s of screen shots from the mmSDSs. The package was also designed with the novice computer user in mind, incorporating an intuitive navigational structure and appropriate level of interactivity.

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2.2 STREAMING THE SAFETY DATA SHEET INFORMATION

In the UK, SDSs are required under Regulation 6 of the Chemicals (Hazard Information and Packaging for Supply) Regulations (Amendment) 2000 (CHIP 2000) for substances and preparations dangerous for supply. These documents provide information about the hazards of the substance and the necessary protective measures for safe use at work. The information in SDSs must be provided under sixteen headings including first-aid measures, toxicological information, exposure controls/personal protection and several others (HSC, 1993).

As various sections of the workforce require different levels of information from a SDS, it was considered important that the mmSDS was subdivided into three streams of information to accommodate the differing needs of general employees, safety officers and managers. For the general employees, the information provided in the conventional SDS headings were grouped into seven key topics (Figure 1). For example, information contained in the sections dealing with handling and storage, personal protection and disposal in the conventional SDS were grouped together into the “Controlling exposure” section, whilst information found in the toxicological section of the conventional SDS was placed in the health effects section of the mmSDS. This enabled related information to be grouped in a manner that would be more easily understandable by users who may not be familiar with SDSs.

SDSs are often the most important sources of information for users undertaking risk assessments as required by the Control of Substances Hazardous to Health (COSHH) Regulations 1999 (HSE, 1999a). Additional information concerning risk assessment and implementing appropriate controls was included in the technical and managers information streams (Figure 1). These provide a brief overview of the requirements of the UK COSHH Regulations; appropriate control guidance sheets from COSHH Essentials (HSE, 1999b) as well as advice on where to obtain further information.

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Figure 1: Main sections of mmSDS

MAIN SCREEN Select information stream

General Technical Management user user user

General hazard General hazard General hazard information information information

Health effects Health effects Health effects

Controlling Assessing risk Assessing risk exposure

First aid Controlling Controlling measures exposure exposure

Safe paint Putting Putting disposal / appropriate appropriate transport control in place control in place

Safety data First aid First aid sheet measures measures

Summary Safe paint Safe paint disposal / disposal / transport transport

Safety data sheet

Safety data sheet

Summary Summary

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2.3 INTRODUCTORY VIDEO CLIPS

Users must be motivated to use the multimedia package (Stoney and Wild, 1998); therefore it was essential that the introductory section captured their attention to encourage further exploration. Introductory videos were included for each information stream. These comprised a presenter discussing the key points related to the particular information stream and this was accompanied by appropriate graphics to reinforce the message. The video clips were approximately 2-3 minutes in length, with users being unable to exit the clip so that in the event of the individual choosing not to continue with the multimedia package, they would at least have received the basic information.

Perceived trust, honesty, competence and expertise were issues considered when identifying suitable presenters (Covello, 1993) with the focus group members being asked to consider these factors and suggest suitable presenters. Strong negative responses were offered concerning the use of members of the medical profession to present the package. These attitudes, though surprising, were not entirely unexpected given the media attention that doctors were receiving at the time. The conviction in the UK of Dr. Harold Shipman, a General Practitioner found guilty of murdering 15 women patients and suggested to be responsible for up to 300 murders, was headline news as were reports of a surgeon removing the wrong kidney (Dalrymple , 2000). Age and gender were also issues that the groups had strong opinions about, with the participants being unanimous in their agreement that a male presenter would be better as “they would probably know what they are talking about”. Such sexist attitudes are not unexpected in a male dominated industry where women often receive lower initial ratings in competence and expertise than men (Covello, 1993). The paint spraying focus groups also agreed that they would place greater confidence and trust in a middle-aged presenter.

Despite the focus groups comments, a male physician was chosen to present the general user section of the paint mmSDS. Previous research had shown that doctors are amongst the most trusted and credible sources of information on occupational health issues (Covello, 1993) and it was felt that the groups’ opinions were biased because of the previous press coverage. Other well-respected professionals were chosen to present the remaining information sections. These included a professional occupational hygienist, the former chairman of the Health and Safety Commission and the President of the British Institute of Embalmers.

2.4 INCORPORATING INTERACTIVITY

Several levels of interactivity were incorporated within the multimedia presentations to enhance the learning experience. The developed multimedia packages contain a range of linear and hierarchical navigational structures (Vaughan, 1994), with users being able to navigate both sequentially and along branches of a “tree like” structure through the use of menus (Figure 2). A simple linear navigational structure was used for the preliminary sections of the package to build confidence and relax the user. However, this style of navigation has been found to be ineffective as a learning tool as it provides only “a basic level of control over the pace of delivery or learning” (Interactivity, 1998). A hierarchical structure was therefore used for the main body of information as this provides users with greater control over the direction of their learning.

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Figure 2: Example of the presentations’ navigational structure

Linear navigation structure

etc

Hierarchical navigation structure

General hazard information

Controlling exposureHealth effectsTitle page

Selection of information

stream

User video Instructions Menu

Health effects

Lungs

Question 1

Skin

Question 2

Question 3

Stomach

Eyes

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User interactivity is one of the most powerful classes of interaction in multimedia systems. It includes multiple choice questions where the users are allowed to indicate their level of understanding, with the system being designed to respond with appropriate feedback (Interactivity, 1998). Each of the main mmSDS sections contains a short quiz that users were encouraged to attempt. These act as prompts and self checks to aid the learner in monitoring their comprehension of the material. As positive reinforcement delivered intermittently was found by Skinner (1953) to encourage learning, the responses were made as encouraging as possible, with individuals also being advised to review the information in the section should they answer incorrectly.

Appropriate and intuitive icons were used to enable users to navigate through the package with ease (Figure 3). Users are also provided with instruction on how to navigate through the programme, with the functions of the various buttons being explained. As control is the minimum requirement for successful interactivity (Tannenbaum, 1998), a menu button was incorporated on each page so that the users could always return to the main menu. It was also considered important to ensure that users did not feel obliged or under pressure to view all the multimedia information therefore, after the initial section, they are given the freedom to quit the package.

Figure 3: Screen shot depicting navigation panel

2.5 ENHANCING THE LEARNING PROCESS

As many industrial workers may experience difficulties with the relatively complex terminology used in SDSs (Samways, 1988), narration was to be extensively used within the package to eliminate the need to read lengthy sections of text. The identification of a suitable narrator for the multimedia packages was perhaps one of the most important issues discussed in the focus group meetings. Evidence that accents influence listeners’ perceptions of speakers is well documented. For example, Edwards (1982) discovered that teachers’ evaluations of students are influenced by accents and even when combined with factors such

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as photographs or examples of work carried out by the individual, the importance of accent does not diminish. Berk-Seligson (1984) found that people with non-standard accents were judged as being in a low socio-economic class and vice versa. It has also been suggested that perceptions of people with accents are based on stereotypes held about that ethnic group (Gill, 1994). Such perceptions could in turn affect the credibility of the information being communicated by the narrator due to judgements being made about their expertise and trustworthiness, suggesting that effective communication of information could be compromised if a negative perception of the narrator is formed.

Recordings of various regional accents (both male and female) were played to the participants, as well as the classic “BBC Radio Received Pronunciation” accent, with the groups being asked to comment on the clarity and credibility of the information presented. The “Received Pronunciation” was viewed more favourably in terms of clarity of information, with many participants stating that the individual sounded more authoritative then the others. Several individuals also stated that the accent reminded them of previous health and safety training materials and thought that this too added to the narrator’s credibility.

The decision to have a narrator with no discernible accent was also backed by related literature. Research has established that individuals view people with accents similar to their own more favourably than those with dissimilar accents (Edwards, 1982; Ryan and Sebastian, 1980; McKirnan and Hamayan, 1984). In view of the fact that the developed packages would be ultimately used in companies throughout UK, it was considered unwise to choose a regional accent which some could find off putting, possibility affecting the usability of the package.

Colour is a highly subjective and powerful influence on visual communication, with the choice of colours being a subtle means of gaining acceptance to a multimedia production and avoiding rejection (Tannenbaum, 1998). The choice of colour schemes for the various sections was made with regard to the focus group comments and to guidelines published by the International Organisation for Standards on the use of colour to convey hazard information (ISO, 1984). The colours red and yellow were used in the health effects section for the mmSDSs. This decision was also based on the results of a study by Dunlap et al (1986), who found that in a survey of 1169 subjects, the colours red and yellow received consistently higher perceived hazard ratings than blue, green or white. As the colours orange and yellow are commonly associated with warmth and brightness and are thought to be social, cheerful colours (Grieve, 1991), they were used extensively in the introductory sections of the mmSDS. Focus group members were also shown examples of the various colour schemes for a given section to confirm their suitability.

Although it was intended that text would be kept to a minimum, relying on appropriate photographic, video and graphical footage to convey the message, short sections of text were still required to convey key points. As a typeface can convey a “message about the actual message”, conveying a tone or mood before the reader has comprehended the message (Tannenbaum, 1998), it was important to select a font which was appropriate for the information being presented as well as being easy to read.

The focus groups were shown various styles of text and were asked to identify those that they thought would be suitable for the mmSDS and were easy to read and most pleasing to the eye. With the spray painting focus groups, the Julius font was rated highest in both of these categories as this is a sans serif font, which is generally found to be much easier to read (Tannenbaum, 1998). The embalming focus groups, however, selected serif fonts such as Flexure for titles and Gothic for the main body of text. As serif fonts can add visual character and interest and can guide the reader’s eye through the text (Tannenbaum, 1998) the Flexure

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font was used in the main titles. However, when the Gothic font was incorporated within the package it was found to be virtually incomprehensible and it was decided that the Julius font should again be used. All text was presented in the conventional upper- and lower- case style as this has been found to be both easier and quicker to read than all upper-case text (Helander, 1990; Marcus, 1995). Text boxes were left justified as readability studies have found that this style is the best for ease of reading (Tannenbaum, 1998; Helander, 1990; Marcus, 1995).

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3. EVALUATION STUDY METHODOLOGY

3.1 OVERVIEW OF EVALUATION STUDIES

The aim of this part of the project was to test the effectiveness of the developed mmSDSs in increasing users’ level of knowledge regarding the products and also their ability to induce appropriate protective behaviour, thus reducing users’ exposure to hazardous substances.

Workplace evaluation studies were used to evaluate the embalming fluids package, whilst laboratory based studies were used to evaluate the paint package. The decision to undertake a laboratory-based evaluation of this package was based on difficulties in identifying sufficient users of the paint in the workplace to enable a viable investigation. These problems are discussed more fully in Section 3.2.1.

For each of the evaluation studies, half the study candidates received the mmSDS and the remainder received the conventional SDS. The conventional SDS was also presented on a computer to help ensure that the novelty of using such technology to access information did not confound the comparison.

A total of five evaluation studies were completed where possible and these were as follows:

Study One: Two weeks prior to intervention, baseline information was obtained. Personal exposure to the hazardous substances being used was monitored (Section 3.4) and participants’ existing knowledge, attitudes and risk perception concerning the products was also assessed (Section 3.6.1). Company Safety Climate was assessed in the workplace studies (Section 3.6.3).

Study Two: Study participants received either the mmSDS or the conventional SDS. Participants’ opinions of the packages and details of their previous use of computers were obtained using a subjective assessment questionnaire (Section 3.6.4).

Study Three: As soon as possible after the intervention, participants’ exposure to the hazardous substances used was assessed as were their knowledge, attitudes and risk perception concerning the products used. Individuals’ sense of responsibility for a risk taking decision and its consequences was assessed using a Locus of Control questionnaire (Section 3.6.2).

Study Four: Approximately one month later, participants’ exposure to the hazardous substances used and changes in knowledge, attitudes and risk perception concerning the products used was again assessed to determine if there were any medium term changes after the intervention.

Study Five: Approximately two to six months later (2 months for the laboratory study, six months for the workplace), participants exposure to the hazardous substances used and levels of knowledge, attitudes and risk perception concerning the products used were again assessed. This was to identify any long-term changes after the intervention.

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3.2 RECRUITMENT OF STUDY PARTICIPANTS

3.2.1 Workplace evaluation studies

A large group of funeral homes agreed to participate in the evaluation studies and contact details of embalmers within eighteen funeral homes in the North East of England were supplied. Each embalmer was sent a letter, which introduced the project and requested their help by participating in the studies. Those embalmers interested in participating in the research were asked to complete the short background information questionnaire that accompanied the letter and return it in the stamped addressed envelope provided. Embalmers who completed and returned the questionnaires were then contacted by telephone and provided with further information on what the site visits would involve.

Various measures were taken to recruit suitable spray-painting companies within the North of England to participate in the evaluation studies. The paint manufacturer contacted clients who used the product by telephone to introduce the project and identify those interested in participating in the research. Twenty-one companies were then sent a covering letter and further details of the project, which was then followed up by a telephone call to confirm their interest. When this approach failed to generate a high enough response rate, a leaflet was posted to 38 companies who used similar paint products. This leaflet offered a free on-site review of safety in the use of solvent-based paint products in return for helping with the assessment of the packages. Interested companies were invited to fax back the completed leaflet and were contacted by telephone to provide further information. As the mail shot also generated a low response rate, the remaining companies were contacted by telephone to again determine their interest in the project and possible participation.

Companies were found to be enthusiastic about the project but very poorly resourced in terms of staff and time. Despite the recruitment methods used and a number of incentives being offered such as details of personal monitoring results and results of the safety climate surveys, only seven companies agreed to participate in the evaluation studies. Not only was there a shortfall in the required number of fifteen companies, but there was also the additional problem that only one or two full time spray painters were employed in each of these. After careful consultation, it was decided that laboratory based studies would be used to evaluate the paint mmSDS, with members of the general public asked to use the paint in a controlled environment.

3.2.2 Laboratory evaluation studies

Advertisements were placed in a local newspaper and local university job centre, with a small participation fee and reimbursement of reasonable travelling expenses being offered. Two occupational physicians reviewed the proposed methodology for the laboratory studies for ethical reasons. Pregnant or breast-feeding women were excluded from the study as a precautionary principle. Young persons aged below 17 years and individuals over 65 were also excluded as were those who were asthmatic, suffered from heart disease or any skin complaints such as dermatitis. All potential participants who responded to the adverts were asked to provide details regarding their age, general health and whether they suffered from asthma, heart disease or skin complaints or were pregnant. Information regarding hobbies, pastimes and employment status was also obtained. Those individuals who were interested in participating in the research were forwarded an information sheet, which provided further information on the project. This document was developed in accordance with the guidance given by Central Office for Research Ethics Committees (2000). Potential candidates were then telephoned to confirm that they were still interested in participating in the research and, if so, to arrange their first visit.

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3.3 PAIRING OF STUDY CANDIDATES

As mentioned in Section 3.1, half the study candidates received the mmSDS whilst the remainder received the conventional SDS. Embalmers were matched a priori by style of mortuary from information supplied by the Divisional Manager. Study candidates for the laboratory studies were matched a priori by gender, age and employment status.

3.4 MONITORING EXPOSURE TO HAZARDOUS SUBSTANCES

3.4.1 Tasks monitored

Individuals’ personal exposure to either formaldehyde or paint solvents was monitored both before and several times after receiving the training packages. For the embalmers, exposure was measured during the embalming of non-autopsied cases and included the dilution of embalming fluids, arterial and cavity embalming and disposal of waste fluids at the end of the task. The choice of using control measures such as ventilation and personal protective equipment (PPE) was left to the embalmer to decide, with embalmers initially being instructed to work as they would normally.

In the laboratory-based studies, exposure to white spirit was monitored during a standardised task, which involved pouring, mixing and spraying fixed quantities of paint (to which white spirit was added). The task was carried out in a room that had a door, which could be left open or shut and an extractor fan which could be switched on. Various items of PPE such as gloves and facemasks were available outside the room, as were refreshments and hand washing facilities. Use of safety equipment is influenced by the “cost of compliance”, that is, the amount of effort or expense required too comply. For example, Wolgalter et al (1988, 1989) found that subjects in a chemistry experiment were more likely to comply with instructions to don protective equipment when it was located nearby. Rodriguez (1991) also found that subjects involved in a chemistry experiment were more likely to use protective eye goggles, gloves and a laboratory coat as the effort required to obtain this equipment decreased. As participants may be inclined to wear and use the safety equipment simply because it is readily available, slight obstacles were built into the experiment so that there was a slight “cost of compliance”. For example, gloves, goggles and masks were kept outside the room where the painting was being undertaken and the participant was required to switch on and adjust the extractor fan.

Participants in the laboratory study were provided with both verbal and written instructions on the task and were given the opportunity to ask questions if they were unclear as to what they should do. Both the task and instructions were piloted before commencing the study. These pilot studies involved ensuring that even in the “worst-case”, subjects would not be exposed to unacceptable concentrations of solvent vapours. The choice of whether to use protective measures such as ventilation, facemasks and gloves was left to the study participants. Participants were also video recorded whilst undertaking the tasks.

Cumulative exposure (exposure multiplied by duration) was used as the main index of exposure. This was because the exposure measurements were derived from activities of variable duration. Cumulative exposure is clearly the most appropriate measure of exposure for variable duration tasks (Cherrie, 1996).

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3.4.2 Sampling Equipment

Pumped XAD-2 tubes and SKC 226-118 tubes were used to monitor embalmers’ exposure to formaldehyde. SKC Anasorb CSC (Coconut Shell Charcoal) tubes were used to monitor white spirit exposure during the laboratory studies. The personal sampler was attached to the lapel of the participant and connected to a battery-operated personal sampling pump. The sampling pump was calibrated before and after each monitoring period to give the average flow rate during sampling and one field blank was taken per sampling day.

3.4.3 Proformas and protocols

Protocols were devised to help eliminate variability between studies. Assessment proformas were also devised to enable consistent factual information from the workplace and laboratory studies to be recorded in a systematic manner. Information regarding use of ventilation, PPE and quantities of fluids used were noted as was any other information deemed relevant. A proforma was completed for each monitoring study, with the information obtained complementing the sampling results. Copies of the proformas used are shown in Appendix 2

3.4.4 Analytical methods

Formaldehyde samples were prepared for analysis using a modification of National Institute of Occupational Safety and Health (NIOSH) method 2541 (NIOSH, 1994). Samples were desorbed in 1ml of Toluene containing mesitylene as an internal standard. An aliquot of each sample was analysed by gas chromatography (GC) with a flame ionisation detector. The GC was fitted with a 10 metre DB-1301 capillary column and programmed to heat from 60­1900C. Calibration standards were prepared from known weights of Analar grade chemicals in the desorption solution.

The white spirit samples were prepared for analysis using a modification of Methods of Determination of Hazardous Substances 96 (HSE, 2000b). The samples were desorbed in 2ml of carbon disulphide. An aliquot of each sample was analysed by GC with a flame ionisation detector. The GC was fitted with a 30 metre RH-wax capillary column and programmed to heat from 35-1700C. Calibration standards were prepared from known weights of Analar grade chemicals in the desorption solution.

3.5 ADMINISTERING mmSDS AN D SDS PACKAGES

Subjects received either the SDS or mmSDS, both of which were presented on a laptop computer provided by the researcher. This was set up in a quiet area where individuals could browse through the packages with little distraction. In the workplace evaluation studies, embalmers were allowed to select either of the three information streams in the mmSDS whilst in the laboratory studies, participants were instructed to select the general employee information section. All subjects were informed that they could spend as long as they liked browsing through the package and were given the opportunity to ask questions. They were also informed that they could approach the researcher at any time if they experienced any problems whilst browsing through the package. They were also requested to complete the subjective assessment questionnaire (Section 3.6.4). The amount of time spent browsing though the packages as well as the pages studied was recorded on a log file.

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3.6 QUESTIONNAIRES

Various questionnaires were administered during the evaluation studies to assess the effectiveness of the mmSDSs. All of the questionnaires were piloted before use to ensure that the questions were unambiguous and easily read.

3.6.1 Knowledge assessment, attitudes and risk perception

These questionnaires (Appendices 3 and 4) aimed to assess the impact of both SDSs on the individuals’ level of knowledge of specific health and safety topics contained within the SDS, as well as identify any changes in attitude and risk perception towards the products. They were administered both before and several times after receiving the interventions.

For the data analysis, the total number of questions answered correctly was recorded. Also, the questions were sub-divided into two or three categories for the workplace and laboratory evaluation studies respectively. These were general, health-related and control-related questions (laboratory study only). The number of questions answered correctly in each category by each subject was noted.

Statements to determine the participant’s attitudes towards various aspects of the products, as well as identify possible intentions towards behavioural changes were included, with participants being required to specify how strongly they agreed or disagreed with them on a five point “Likert” scale ranging from "Strongly agree" to "Strongly disagree". Several of these statements were obtained from previous attitude surveys. For example, statements such as “I feel that I have little control over work related risks to my health” and “If a person is exposed to a chemical that can make them ill then that person will probably become ill someday” were adapted from a question set used by Slovic et al (1997). Attitude statements were subdivided into two categories, those being health-related or control-related. Average attitude scores were obtained for each category (negative statements had their score reversed to obtain positive values).

Statements designed to measure the participants risk perception to activities involving the products were included. Participants were required to indicate what they thought the risk of experiencing ill-health effects would be from undertaking the given task using a five point “Likert” scale ranging from “none” to “very high”. Based on the questionnaire responses, individual risk perception was classified as low, medium or high. As there was concern that after the intervention, participants would automatically rate the risk of the activities higher than previously, participants’ general risk perception was also assessed to provide a baseline. The statements in part A of this section originated from the Graveling et al (1987) miners’ study. The statements in part B were derived from Krewski et al (1995) where members of the Canadian population were asked to indicate the degree of health risk they associated with various hazards. As it was thought that the participants’ perception of these ten activities would not change over time, participants’ responses to these statements should remain consistent. Any significant changes in general risk perception could indicate that participants were deliberately rating risk higher throughout as they may consider that it was expected of them and should be addressed.

Lastly, in the workplace evaluation studies, embalmers were also asked to provide details of previous health and safety training they had received as this could influence the impact of the training packages.

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3.6.2 Locus of Control

It was acknowledged that the impact of training material could be strongly influenced by the psychological make-up of those individuals taking part. The Locus of Control questionnaire developed by Rotter (1966) and Rotter, Chance and Phares (1972) was used as it is related to the individual’s sense of responsibility for a risk taking decision and its consequences. It refers to the individual’s perception of the agency controlling the reinforcement that they receive, in essence, the level of control the individual perceives that they have over what happens in their life. If a person perceives themselves to be responsible for the outcome of their actions, they are said to have an internal locus of control i.e. they feel that control is an internal matter related to their own efforts and talents. Those perceiving themselves to be controlled by external factors, which they are unable to influence such as fate, chance and powerful figures of authority, are described as having an external locus of control. The Locus of Control questionnaire consists of 29 paired statements. In each pair, one statement refers to an internal locus of control, whilst the other refers to an external and participants were required to indicate which option they were in most agreement with. This questionnaire was administered on only one occasion, as it was hypothesised that an individual’s locus of control is predetermined and is unlikely to be influenced by training.

3.6.3 Safety Climate

It is recognised that workers’ perception of the prevailing health and safety culture within a company can influence their safety-related behaviour and subsequently their exposure to hazardous substances. For example, if a worker believes that the company does not have a strong commitment towards health and safety, they may have the opinion "Well if they can't be bothered why should I be?" and subsequently may not conduct their work in a safe manner. It was therefore important that participants’ perceptions of factors such as the importance of safety training programs and management attitudes towards safety were identified to determine if these were exerting an effect on the employees’ exposure and also on the effectiveness of the SDSs. The Safety Climate for each of the embalmers’ workplaces was assessed using the full attitude questionnaire developed as part of Loughborough University “Safety Climate Assessment Toolkit” (Cox and Cheyne, 1999).

This questionnaire contains 43 statements designed to measure four broad areas: Organisational context, social environment, individual appreciation and work environment. Respondents were required to indicate on the five point, “Likert Scale”, the extent of their agreement with each of the statements, ranging from “strongly agree” to “strongly disagree”. The questionnaire also included space for respondents to note any additional comments about health and safety that they had. The full attitude questionnaire was administered to as many employees as possible in each site including funeral directors, assistants and clerks. Casual drivers were excluded from the survey. The questionnaires were completed and collected on the same day whenever possible. The questionnaire data was analysed using the methodology described within the toolkit (Part B, pages 92-93). Scores were calculated for each dimension and converted to a 1 to 10 scale. An average of all the dimension scores was obtained, with the safety climate of the company being rated as follows:

• Excellent - average score above 8 • Very good – average score between 7 and 8 • Good – average score between 6 and 7 • Poor - average score between 5 and 6 • Very poor - average score less then 5

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3.6.4 Subjective opinion of mmSDS and SDS packages

Short questionnaires were developed to obtain information regarding the participants’ previous use of computers, both at work and in the home, as well as the participant’s subjective opinions regarding the packages (Appendices 5 and 6). Such information would provide further clues as to the success or failure of the intervention and would be useful in terms of improving the effectiveness of any similar interventions developed in the future.

Respondents were asked in Section A to state whether they use a computer as part of their job and if so how often they use it (e.g. every day, once or twice a week, once every two to three weeks or less than once a month). Respondents were also asked to provide the same information with respect to the use of computers at home. An adaptation of the psychological questions used by Brett (1996) was also included in section A to determine how participants felt about using computers in general. If an individual was not very confident and nervous about using a computer, this could influence the usability and ultimately the effectiveness of the multimedia package. All this information allowed participants to be classified as “very experienced”, “fairly experienced”, “fairly inexperienced” or “very inexperienced” computer users.

Section B is an adaptation and modification of the questionnaire used by Brett (1996) to assess undergraduates’ attitudes towards a multimedia language learning program. The statements in part A were designed to elicit participants’ general attitudes to using the packages, whilst the statements in part B were designed to determine participants’ attitudes to the packages as a learning tool. Open-ended questions were included in part C so participants could indicate what factors they liked or disliked most about the packages.

3.7 STATISTICAL METHODS

The embalmers were initially “paired” a priori by style of mortuary, with each individual of the pair being randomly assigned either the mmSDS or SDS package. Using a one-way analysis of variance, with the initial concentration measurement as the response variable and the style and age of the company site as the explanatory variable, the matching variable was found not to be statistically significant. In addition, not all participants attended the follow-up studies and using a matched analysis would have resulted in a further loss of data. It was therefore decided that it was not necessary to use the matching structure in the analyses. The laboratory study participants were initially paired a priori by age and employment status with each of the pair being randomly assigned either the mmSDS or SDS package. A one-way analysis of variance was performed separately for each of the matching variables. Neither age nor employment status was found to have a significant effect on the initial concentration measurement. It was therefore appropriate not to use the matching structure in the analyses of this study.

The data for the workplace and laboratory studies were analysed separately. Prior to analysis, the data was examined for accuracy and any unusual or invalid values were referred back to the data forms and amended as necessary. Data were described using standard tabular and graphical methods. Statistical analyses were primarily descriptive, because there were relatively few subjects in each data set. The statistic al significance of associations between variables was examined using analysis of variance or regression methods, and one-sample t­tests were used to investigate the significance of individual changes in exposure over time.

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4. WORKPLACE EVALUATION STUDY RESULTS

4.1 PARTICIPANTS AND COMPANY DETAILS

A total of 25 completed questionnaires were returned from 17 funeral homes. The follow up telephone calls revealed that although in some instances several embalmers were employed at a funeral home, it was usual for only one embalmer to undertake the majority of the work or for the work to be alternated between embalmers depending on other work and holiday commitments. It was also common for one employee to travel between sites to undertake embalming duties. It was therefore decided that only one embalmer would be selected from each site to participate in the study. A total of fourteen funeral homes and embalmers participated in the work.

All except one of the embalmers were male, with ages ranging from 28 to 50 (mean age 38 years). Six of the embalmers (42.9%) had been employed for between 1 and 5 years, six (42.9%) for more than 5 but less than 10 years and two (14.3%) for more than 10 years. The divisional manager supplied information about the average number of embalmings undertaken per year per site, and this ranged from 136 to 1091 between sites.

All of the participants completed the first baseline monitoring study, browsed through their allocated package and participated in a monitoring study after receiving the intervention. However, only 10 participants took part in the third monitoring study (6 mmSDS: 4 SDS) and 5 in the final monitoring study (all mmSDS). This was due to a number of factors including holiday commitments and embalmers’ workloads. There were no obvious differences between those individuals that took part in all three studies and those that did not. The length of time between monitoring studies varied from embalmer to embalmer, and the influence of this on the effects of the interventions was examined in the data analysis.

4.2 CHARACTERISTICS OF THE STUDY RESULTS

Each of the study participants was classified according to their safety attitude, risk perception and locus of control. Five of the 14 participants displayed an internal locus of control; one displayed an external locus of control and the remaining 8 subjects displayed ambiguous locus of control traits. Three of the five respondents with internal locus of controls were site managers.

Classification of safety attitude scores was designed so that there were approximately equal numbers of subjects in the low, medium and high groups (see methods section 3.6.1); with those subjects ranked low having a poor attitude. Safety attitude was further subdivided into ‘health’ attitude and ‘control’ attitude with, again, equal numbers allocated to each of the low, medium and high attitude groups. Subjects tended to be classified similarly for both aspects of control; for example all three subjects with low ‘control’ attitude also had low ‘health’ attitude. Where the classifications differed, subjects tended to be classified higher for ‘control’ attitude than for ‘health’ attitude.

Four of the participants had high-risk perception, seven had medium risk perception and three had low risk perception scores. Ten of the subjects were classified in the same category (low, medium and high) for both safety attitude and risk perception. The safety climate at the funeral homes where the embalmers worked were excellent or very good at three sites, good at 10 sites and poor at one.

Each of the participants completed the general risk perception questionnaire prior to training. A total of 10 questions were asked, five were graded on a 5-point scale from no risk (5) to

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very high risk (1) and four were graded on a 4-point scale from almost no risk (4) to high risk (1). One subject scored a total of 30 points, reflecting a low general risk perception, three scored 24 or 25 points, six scored 20-23 points and four scored less than 20 points, reflecting a high general risk perception.

4.3 EXPOSURE TO FORMALDEHYDE

4.3.1 Choice of exposure variable

Exposure to formaldehyde was measured as average concentration (ppm) and duration of exposure. Concentration was multiplied by duration to calculate cumulative exposure for each participant (ppm.minutes). Preliminary analyses of both concentration and cumulative exposure showed similar patterns for each, although cumulative exposure was considered a more relevant measure, as it took account of both the intensity and duration of exposure. All subsequent analyses were therefore carried out for cumulative exposure.

Table 1 summarises the exposure levels for the participants at each of the four monitoring studies. Levels of exposure were very variable between participants at each of the studies. On average, exposure levels were higher at the first and last studies, and lower at the second and third studies. However two of the exposure measurements were unusually high due to arterial spray and leakage during embalming; when these two values were excluded the mean exposures at the four time periods were 43.0, 33.3, 39.6 and 20.1 ppm.minutes, respectively. These differences were not significant statistically.

Table 1 Distribution of cumulative exposure to formaldehyde (ppm.minutes) by

monitoring study

Study no. No of Cumulative exposure to formaldehyde participants Minimum Maximum Mean s.d.

1 14 3.60 196.30 53.94 53.5 2 14 6.24 95.20 33.29 26.7 3 10 4.80 85.50 39.59 28.8 4 5 4.59 187.60 53.62 75.7

Table 2 summarises the percentage change in cumulative exposure at each of the monitoring studies following the interventions.

Table 2 Percentage change in cumulative exposure to formaldehyde by post­

intervention study

Post No of % change intervention participants Minimum Maximum Mean s.d.

study no. 1 14 -79.6 206 -11.4 75 2 10 -91.5 211 9.8 98 3 5 -86.3 174 26.9 103

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4.3.2 Association between exposure levels and workplace factors

The position of the embalmers in relation to the ventilation fan was recorded at each study. Participants could work with the fan on the wall in front of them, to the side of them or behind them; while one subject at the first two studies worked without an extractor fan, but with the window opened at his side. There was no evidence of any difference in individuals’ exposures between extractor fan locations. Similarly average exposure levels were similar in different styles and ages of workplaces.

Among individuals who worked in companies with higher scores for safety climate before intervention, exposure to formaldehyde tended to be higher i.e. the worse the safety climate, the higher the exposure.

4.3.3 Association between exposure levels and working practices

Several aspects of individua l working practices were observed (described in section 3.4.1). These included, for example, the number of injection points made to administer arterial fluids and whether there was any arterial leakage. The association of each working practice and exposure level was examined for measurements made at all monitoring studies. There was some evidence that exposure levels tended to be higher when cavity fluids were injected than on occasions when no cavity fluids were used (average exposure with no cavity flu ids: 7.0 ppm.minutes, with cavity fluids: 48.7 ppm.minutes). Exposures were also higher when arterial spray and leakage occurred during embalming, which happened on three occasions during the study, (average exposure with spray and leakage: 136.5 ppm.minutes, compared to 36.9 ppm.minutes without spray and leakage). Previous research by Bennett et al (1996) also found similar results. Statistical analyses of cumulative exposure therefore took account of these two working practices. No other working practices were associated with cumulative exposure levels.

4.3.4 Association between exposure levels and individual characteristics

There was no association between exposure levels and age of participant, or with the length of time the participant had worked in the industry. Nor was there any association between exposure levels and individuals’ risk perception or safety attitude.

Mean cumulative exposure was 28.9, 67.5 and 68.5 ppm.minutes for the internal, ambiguous and external locus of control categories respectively. There was some evidence therefore that individuals displaying an internal locus of control had lower cumulative exposure levels than those displaying ambiguous and external traits. However, exposure levels were widely distributed within each group and the differences between the groups were not statistically significant.

4.3.5 Association between exposure levels and interventions

Prior to intervention there was no significant difference in exposure levels between subjects who subsequently used the mmSDS package and those who used the SDS package, with a mean exposure for those subsequently using the mmSDS of 51.5 ppm.minutes and for those using the SDS of 56.3 ppm.minutes.

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4.4 USE OF PERSONAL PROTECTIVE EQUIPMENT AND WORKPLACE VENTILATION

The use of PPE prior to the interventions is summarised in Table 3. The majority of participants wore eye protection when embalming. However 50% or fewer wore a mask or arm sleeves. Three subjects wore all four types of protective equipment during embalming, while one subject did not wear any protective equipment. Proportionally more of the group who were subsequently trained using the mmSDS package wore a mask at the pre­intervention study. Although not noted in Table 3, protective gloves and overalls were worn at all times when working in the embalming theatre. In most instances, subjects were wearing all of the PPE that was available to them with only a few subjects neglecting to wear PPE such as face-visors even though they were available in the embalming theatre. It was noted that those individuals who did not wear their face-visor wore spectacles.

Table 3 Use of PPE before training

Participants using equipment Protective Equipment No. %

Mask 7 50 Eye protection 12 86

Waterpro of apron 9 64 Arm sleeves 5 36

All the embalming theatres had extractor fans installed, with replacement air systems also present in several. All except one of the subjects used the available ventilation throughout the embalming period although all the subjects were fully aware of the need to ventilate the embalming theatre and where the extractor fan should ideally be located. The embalmer that did not use the extractor fan stated that this was because the position of the fan (which was located behind him while he was in his normal working position) would draw the formaldehyde vapours across his body thus increasing his exposure. The opening of windows in the embalming theatre is not recommended given the tasks undertaken and the possible ingress of insects. Of the seven participants that worked in a room where there was a window, only one subject opened the window. The embalmer who left the window open reported that the extract systems were not working correctly (it was switched on and his comments were found to be correct) and this was the only means that he had to ventilate the room.

4.5 KNOWLEDGE

The 14 participants were asked 14 questions to test their knowledge of hazardous products. All of the participants got between 5 and 8 of the questions correct at the pre-intervention study. Four subjects got 5 questions correct, three got 6 questions correct, three got 7 questions correct and four got 8 questions correct. When the questions were subdivided into questions about health and general questions, the majority of subjects got one or two health questions correct (11 subjects) and five or six general questions correct (10 subjects). Four subjects got four or fewer general questions correct, while one subject got no health questions correct and two subjects got three health questions correct.

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4.6 PREVIOUS TRAINING

All of the embalmers had previously received health and safety information pertaining to embalming from their employer. Seven (50%) had received this between 6 months and two years ago with the remainder receiving it over two years ago. The questionnaire survey also revealed that the embalmers were informed about health and safety matters through a variety of media and the information covered a variety of topics. Figure 4 shows the different formats of the previous health and safety training. All the embalmers had received the information as part of their qualification course, with half also receiving the information through additional health and safety training sessions and posters or signs within their place of work. The use of respiratory protective equipment (RPE) and ventilation had only been demonstrated to one embalmer.

Figure 4 Format of previous health and safety training related to embalming

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12

10

No. of 8

embalmers 6

4

2

0A B C D E F G

Methods

Key A. Company induction training B. Embalming qualification course C. Additional health and safety training session D. Demonstration on the use of RPE E. Demonstration on how to use ventilation correctly F. Leaflet or information sheet G. Poster / signs on wall

The information provided in this previous training is shown in Figure 5.

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Figure 5 Information in previous health and safety training

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12

10

No. of 8

embalmers 6

4

2

0A B C D E F

Information

Key A. Possible risks to health from using fluids B. How to use ventilation systems properly C. How to use RPE D. How to clean embalming fluid spills properly E. Employers responsibilities for health and safety F. Your responsibility for health and safety

4.7 SUBJECTIVE ASSESSMENT OF THE mmSDS AND SDS PACKAGES

All of the embalmers who browsed through the mmSDS worked through the general employee section. On completion of the training, all 14 participants completed a questionnaire giving their opinions about the package used. A summary of the results is given below, with detailed tables in Appendix 7.

4.7.1 Experience with computers and time spent browsing

No computers were available at the participating sites. However these were introduced to all sites several months after the training packages had been administered. Only one individual used a computer as part of their work but this was their own personal computer. Depending on their use of computers at home, participants were classified as being either “very experienced”, “fairly experienced”, fairly inexperienced” or “very inexperienced” using the information provided in the questionnaire. The amount of time each embalmer spent browsing through the package was recorded and a summary by package and computer experience is shown in Table 4. Those using the mmSDS package tended to have spent, on average, a longer time browsing though the information compared with those using the SDS package, and this was true for subjects with each category of computer experience.

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Table 4 Distribution of time spent browsing by package and computer experience. Each cell

contains number of subjects in cell and mean time (minutes) spent browsing on package.

mmSDS SDS All Computer Experience No. Time No. Time No. Time

Very experienced 1 35.0 2 12.5 3 20.0 Fairly experienced 3 45.7 2 6.0 5 29.8 Fairly inexperienced 2 36.5 1 6.0 3 26.3 Very inexperienced 1 58.0 2 18.0 3 31.3 All 7 43.3 7 11.3 14 27.3

4.7.2 Subjective opinions

Participants were asked whether they agreed or disagreed (on a 5-point “Likert” scale) with twelve statements about the packages, for example, whether the package was easy to use, simple or didn’t teach anything that wasn’t known already (see Appendix 7 tables for details). The only difference found between the packages was that those using the mmSDS were more likely to agree that they would not change their working practices as a result of the package (4 of the 7 subjects) compared with those using the SDS package (0 of the 7 subjects).

All of the participants who were “very experienced” or “very inexperienced” computer users, strongly agreed that their package was useful; while all of the participants who were “fairly experienced” or “fairly inexperienced” agreed that the packages were useful.

The participants were asked to state which aspects they liked and disliked about the packages. Several participants found the mmSDS package, easy to follow and use (3 subjects) “even for those with little experience with computers”, well-presented and laid-out (2) with a good menu (1), being “informative and fun”. However one individual stated that they found the navigation slightly confusing to begin with, although this was quickly overcome once they became used to the package. Participants’ views regarding the content of the mmSDS were, overall, positive. Most participants stated that the mmSDS was interesting (2), informative (3) and refreshed the memory (1) whilst others felt that the information was too basic, stating the obvious at times and should be common practice for experienced embalmers. However, one of these individuals also stated that the package would be useful refresher training. “Controlling exposure, health effects and first aid sections” were rated by two participants as being the best sections in the package and interactive elements such as the ability to work at their own pace; quizzes and video clips were rated highly. One individual stated that they would have liked more video clips included that demonstrated good working practices.

With regards to the SDS package, participants also stated that they found the package was easy to use (2), the information well presented and easy to follow (3), the information useful (3), easily read (2), being clear and precise (1). However, some participants were unhappy with the content of the information, with one stating that there wasn’t enough, another finding the information “long-winded” with “too many directives” and “mind numbing numbers”. One individual also stated that they would have liked to obtain further information about certain sections of the package. One subject who received the SDS became extremely concerned and distressed about the carcinogen information it contained (formaldehyde is a Category 3 carcinogen) and approached the researcher for further information and clarification as they did not understand what this meant.

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As with the mmSDS, participants thought that the package was easy to use, even for an inexperienced computer user, contained useful information and increased awareness. As participants received only the mmSDS or the SDS, it was not possible to determine which intervention was the most preferred.

4.8 EFFECT OF THE mmSDS AND SDS INTERVENTIONS

4.8.1 Immediate effects of the interventions

The study design was that all participants would be re-surveyed one day after they had received the interventions. However, due to circumstances including participants’ workloads and holidays this was not possible. Of the 14 participants, 11 were resurveyed within two weeks of receiving training, while the remaining 3 were resurveyed after 24, 47 and 78 days. It is possible that these longer time periods might have caused the effects of training to be reduced and so the comparisons between assessments made pre-intervention and at the first post-intervention study were analysed for all participants together, and excluding the three participants with longer duration between studies. Results below refer to the full study population; any effects of omitting the three subjects with longer durations are noted in the relevant sections. Other external factors that may have influenced training effects (specifically on exposure measurements) were the use of cavity fluids and the occurrence of arterial spray and leakage (see section 4.3.3) and the influence of these are also discussed. A summary of the main immediate effects of the interventions is given in Section 4.8.1.4.

4.8.1.1 Change in exposure levels

Changes in individual cumulative exposure levels during the study are shown graphically in Appendix 8. Overall, cumulative exposure levels decreased following the interventions for eight of the 14 participants (3 mmSDS and 5 SDS) and increased for five. For the remaining participant, who used the mmSDS, cumulative exposure at the pre-intervention study was very high due to the occurrence of arterial spray and leakage. As expected, cumulative exposure for this subject was much lower at the first post-intervention study where such leakage did not occur, but it is not possible to separate out any potential effect of training on this decrease. Several of the changes, increases and decreases, in exposure were small.

The average decrease in cumulative exposure (excluding the subject where arterial spray occurred) was 12.4 ppm.minutes (7.2% reduction). The average among the six subjects who used the mmSDS package was 1.5 ppm.minutes (16.4% reduction) and among the seven who used the SDS package was 21.6 ppm.minutes (27.5% reduction). The differences between the packages were not statistically significant. Overall, therefore there was a small average change in exposure between the first post-intervention study and the pre-intervention study, which did not vary by package.

Change in exposure immediately after the interventions was not associated with any other factors, such as age, locus of control, experience with computers or number of years spent working in the industry.

4.8.1.2 Change in use of PPE and ventilation

Prior to training half of the study participants (7 subjects) wore a facemask. Following training only one subject changed his use, from wearing a mask too not wearing it. Similarly another subje ct who had previously worn eye protection did not wear it at the first post­intervention study. An additional subject, who had previously worn eye protection all the time at the pre-intervention study, only put it on before injecting arterial fluids at the first

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post-intervention study. As 12 of the 14 participants wore eye protection at the pre­intervention study, there was clearly little opportunity for training to increase its use.

Of the nine subjects who wore a protective apron at the pre-intervention study, one did not wear an apron during the first post-intervention study. One subject, who had not previously worn an apron, did so at the first post-intervention study. He had used the SDS training package. Only five subjects wore arm sleeves at the pre-intervention study. All of these continued to wear arm sleeves after training and one subject, who had not previously worn arm sleeves, wore them at the first post-intervention study (after using the SDS training package).

None of the participants changed their use of windows between the pre-intervention and post­intervention studies. Three of the 14 participants changed their use of an extractor fan between the pre-intervention study and the first post-intervention study. Two of these subjects, both of whom used the mmSDS training package, had an extractor fan switched on throughout the whole of the sampling period at the pre-intervention study. At the first post­intervention study, one of these had an extractor fan switched on during arterial embalming only and the other did not have an extractor fan switched on at all. The remaining subject, who used the SDS package, did not have an extractor fan switched on during the pre­intervention study but had it switched on after embalming at first post-intervention study.

Overall, therefore, there was very little change in the use of PPE and ventilation between the pre-intervention and first post-intervention study.

4.8.1.3 Change in knowledge

Half of the study participants had an increase in the number of questions answered correctly in the knowledge questionnaire. There was some evidence of a difference in increase in knowledge between the two packages, with five of the seven subjects (71%) using the mmSDS package showing an increase in knowledge compared to two of the seven (29%) using the SDS package (p=0.08). Of the remaining seven participants, three had a decrease in the number of questions answered correctly and four had remained at the same level. Increase in knowledge was not associated with age, computer experience, locus of control or length of time worked in the industry.

When the questions on health knowledge and general knowledge were examined separately, only one subject (who used the SDS package) answered fewer health questions correctly compared to four who answered fewer general knowledge questions correctly (1 mmSDS and 3 SDS). For the health questions, seven subjects increased their knowledge level and six remained the same. For the general questions five subjects increased their knowledge and five remained the same.

4.8.1.4 Summary of short-term effects of the interventions

i. There was little difference in average cumulative exposure levels in the study group following use of the SDSs, for either package.

ii. Cumulative exposure levels decreased following the intervention for eight of the 14 participants (3 mmSDS and 5 SDS) and increased for five.

iii. There was little change in the use of PPE or ventilation immediately following training, although most subjects already used the available equipment.

iv. Seven of the 14 participants showed an increase in knowledge level following training; more of these had used the mmSDS package than the conventional SDS package.

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4.8.2 Longer-term effects of the interventions

Two more visits at each workplace were planned following the first post-intervention study. The aim of these studies was to investigate the longer-term effects of the packages. These studies were planned to take place approximately one month and six months after the intervention had taken place. Ten subjects were surveyed in the second post-intervention studies (6 mmSDS and 4 SDS) and only five subjects were surveyed at the third post­intervention study. All of those surveyed at the third post-intervention study had used the mmSDS package.

As for the first post-intervention study, there was some variability in the actual time periods between studies. In particular three of the second post-intervention studies took place more than 50 days after training. As before, results below refer to all ten of the participants in the second post-intervention study, and any effects of omitting the three subjects with longer durations since training noted in the relevant sections. Other external factors that may have influenced training effects (specifically on exposure measurements) were the use of cavity fluids and the occurrence of arterial spray and leakage and the influence of these is also discussed below. A summary of the main longer-term effects of the interventions is given in Section 4.8.2.4.

4.8.2.1 Change in exposure

Individuals’ changes in exposure levels across all studies are shown graphically in Appendix 8. Of the eight subjects who had shown a decrease in exposure immediately following training, seven were re-surveyed. Of these seven participants, only two maintained the decrease (compared to pre-intervention levels); one of these had used the SDS and was resurveyed at the second post-intervention study only, and one had used the mmSDS and was resurveyed at the second and third post-intervention studies. In both cases, exposure levels remained relatively constant across the post-intervention studies.

For the remaining five subjects who had shown an immediate post-intervention decrease in exposure, four participated in the second post-intervention study only. For these four subjects exposure levels at the second post-intervention study had increased following the initial decrease and three were higher than pre-intervention levels, with one approximately the same level as the pre-intervention study. The final subject who had shown an immediate post­intervention decrease participated in both the second and third post-intervention studies and showed a small decrease between the first and second post-intervention studies and then a sharp increase at the third post-intervention study. This exposure level was higher than at the pre-intervention study.

Of the five subjects who had shown an increase at the first post-survey study, only two participated further in the study. Of these, one had the same exposure level at the second as at the first post-intervention study, and then a lower exposure (approximately equal to the pre­intervention study) at the third study. The second participant showed a steep decrease in exposure following the initial increase, to a level slightly lower than at pre-intervention. At the third post-survey study this participant had a very high exposure level, but this was due, at least in part, to the occurrence of arterial spray and leakage during embalming.

After excluding measurements where arterial spray and leakage occurred, the average change between the pre-intervention study and the third study was a decrease of 6.2 ppm.minutes (21% reduction), and between the pre-intervention study and the fourth study was decrease of 0.6 ppm.minutes (47% reduction). Both differences were not statistically significantly different from zero.

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4.8.2.2 Change in PPE

There was little change in the use of PPE between the pre-intervention and second and third post-intervention studies. Of the 10 participants at the second post-intervention study, one used a face mask who had not worn one previously (mmSDS user) and one participant who had previously worn a facemask did not wear one at the second post-intervention study (SDS user). No change in the use of a facemask was seen in the five subjects who participated in the third post-intervention study.

One subject, who had worn eye protection at the pre-intervention study, did not wear it at the second post-intervention study. Use of eye protection at the second post-intervention study was the same as at the pre-intervention study for the other nine participants. At the third post­intervention study, four of the five participants showed no change in use of eye protection, while one wore eye protection at this study for the first time. Two participants changed their use of a waterproof apron between the pre-intervention and second post-intervention study. There was no change in waterproof apron use for the five subjects who participated in the third post-intervention study.

Similarly, one subject who wore arm sleeves during pre-intervention did not wear them at the second post-intervention study (mmSDS) while one subject who did not previously wear arm sleeves, wore them at the second study (SDS). At the third post-intervention study, arm sleeves were not worn by one subject who had worn them at the second post-intervention study but not previously.

None of the ten participants at the second post-intervention study changed their use of windows during embalming. One participant no longer switched the extractor fan on, but had previously done so.

4.8.2.3 Change in knowledge

Of the 10 participants at the second post-intervention study, six showed an increase in the number of questions answered correctly on the knowledge questionnaire compared to pre­intervention levels (2 of the six using the mmSDS package and all four of those using the SDS package). Two showed no change in level of knowledge and two showed a decrease in knowledge (all mmSDS). Of the five participants at the third post-intervention study, three showed higher knowledge levels than at pre-intervention and two showed a decrease in the number of correct answers.

At the second post-intervention study, therefore, knowledge levels for all four SDS users were higher than at the pre-intervention study. However, the patterns across studies for individual subjects were not consistent. One subject increased knowledge levels steadily across the first and second post-intervention studies, one subject had the same levels at the pre-intervention and first study followed by an increase. Another subject showed decreased knowledge at the first study compared to the pre-intervention study followed by an increase and the final subject had an increase between the pre and first-post intervention study followed by a slight decrease from first to second post-intervention studies. There was some evidence that the longer-term increase in knowledge among those using the SDS package was stronger for the health questions than for the general questions.

Results for the subjects who used the mmSDS package showed that only two of the six had higher knowledge levels at the second post-intervention study compared to the pre­intervention study, compared to increased levels in five of the seven subjects at the first post­intervention study. The two subjects with increased knowledge at the second post­intervention study compared to the pre-intervention study had also shown increased

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knowledge immediately following training, and both subjects maintained this increase at the third post-intervention study.

4.8.2.4 Summary of long-term effects of the interventions

i. The long-term effects of training on cumulative exposure levels were negligible for both SDS packages.

ii. There was little change in the use of PPE between the pre-intervention and second and third post-intervention studies.

iii. There was some evidence that the longer-term effects of training on knowledge was stronger for subjects trained using the SDS package.

iv. Among those who received the mmSDS package, there was some evidence that the increase in knowledge immediately following the intervention was maintained by a subset of the participants.

4.8.3 Other effects of the mmSDS and SDS interventions

4.8.3.1 Safety Attitude

Individual safety attitude was recorded as high, medium or low at each study. For most subjects there was little change in attitude over time, with 10 subjects remaining in the same category for the pre- and first post-intervention study and 6 subjects unchanged between the pre- and second post-intervention study.

Among the seven subjects who used the mmSDS, only one showed any increase in safety attitude across time. This subject had ‘medium’ attitude at pre-intervention and at the first post-intervention study, rising to ‘high’ at the second post-intervention study (the last at which he was surveyed). Two subjects maintained the same level of safety attitude across all four-time points. The remaining four subjects all showed some decrease in safety attitude: two remained in the same category for the pre-intervention and first post-intervention study and were lower in the second and third post-intervention studies, and two showed a decrease immediately following training. One of these subjects did not attend any more studies, while for the other the decrease remained at the second and third post-intervention studies.

For the seven subjects who used the SDS package, four maintained the same safety attitude across the three studies attended and one subject had unchanged safety attitude for the two studies in which he participated. The remaining two subjects showed an increase in safety attitude from ‘medium’ to ‘high’ between the pre-intervention and first post-intervention study. Neither of these subjects attended any further studies.

Overall, therefore there was some evidence that users of the mmSDS package were more likely to show a decrease in safety attitude than users of the SDS package. It should be noted however, that three of the SDS subjects had ‘low’ safety attitude at the pre-intervention study compared to only one of the mmSDS subjects. All four of the subjects who started with ‘low’ safety attitude continued to have ‘low’ attitude across all time periods. Decreases in safety attitude were therefore possible only for four of the SDS subjects compared to six of the mmSDS subjects. Increases in safety attitude were more apparent for health attitude questions than for control attitude questions.

4.8.3.2 Risk perception

Individual risk perception was also categorised as low, medium or high at each study. For four subjects (3 mmSDS and 1 SDS) risk perception was unchanged across studies, and for three subjects (2 mmSDS and 1 SDS) it fluctuated up and down by one category across

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studies (e.g. low, medium, low, medium). Among the remaining seven subjects, four showed an overall increase in risk perception. Three of these used the SDS package, two of whom increased from ‘medium’ to ‘high’ perception and one increased from ‘low’ to ‘medium’. One subject used the mmSDS package and showed an increase from ‘medium’ to ‘high’ perception. Finally, three subjects showed a decrease in risk perception across studies, two using the SDS package (one ‘medium’ to ‘low’ and one ‘high’ to ‘medium’) and one using the mmSDS package (‘medium’ to ‘low’).

General risk perception was also found to fluctuate across studies. With the section A statements (Appendix 3), there was some weak evidence of an overall increase in general risk perception though this was not statistically significant. A decrease in average score was taken to represent an increase in risk perception.

Prior to 1st post study: 7 increased perception, 2 same, 5 decreased Prior to 2nd post study: 5 increased perception, 2 same, 3 decreased Prior to 3rd post study: 3 increased perception, 1 same, 1 decreased

With the section B statements (Appendix 3) there was evidence of an increase in general risk perception. The average change in perception for 1st versus pre-intervention being 0.2 (significantly different from 0 using a one-sample t-test; p=0.05) and the average change in perception for 2nd vs pr- intervention being 0.18 (p=0.09).

Prior to 1st post study: 4 increased perception, 1 same, 9 decreased Prior to 2nd post study: 2 increased perception, 2 same, 6 decreased Prior to 3rd post study: 1 increased perception, 1 same, 3 decreased

Closer inspection of the results revealed that overall; individuals with increased product risk perception also had increased general risk perception.

4.8.3.3 Summary of other intervention effects

i. There was some evidence that users of the mmSDS package were more likely to show a decrease in safety attitude than users of the SDS package, although more of the SDS users had low safety attitude pre-intervention.

ii. Increases in safety attitude were more apparent for health attitude questions than for control attitude questions.

iii. Changes in risk perception were slightly more common among SDS than mmSDS users, for both increases and decreases in perception.

iv. Changes in general risk perception occurred across studies. Both increases and decreases in general risk perception was found for individuals with changes in product risk perception.

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5. LABORATORY EVALUATION STUDY RESULTS

5.1 STUDY PARTICIPANTS

A total of 24 subjects participated in the laboratory study. Fourteen (58%) subjects were male, and ten (42%) were female, with ages ranging from 19 to 64 (mean age 35 years) in males and 18 to 38 (mean age 26 years) in females. All 24 participants completed the first baseline monitoring study and browsed through their allocated training package. However, only 22 participants took part in the second monitoring study, 14 in the third and 4 in the final study. At each study, exactly half of the participants had used the mmSDS and half had used the SDS. It was not possible to ascertain why individuals declined to participate in the later studies.

5.2 CHARACTERISTICS OF STUDY POPULATION

Each of the study participants was classified according to their safety attitude, risk perception and locus of control. Six of the 24 participants displayed an internal locus of control, 14 displayed an ambiguous locus of control and the remaining two subjects displayed external locus of control.

Classification of safety attitude scores was designed so that there were approximately equal numbers of subjects in the low, medium and high groups. A low category of safety attitude indicates a poor attitude towards safety and a high category of safety attitude indicates a good attitude towards safety. Safety attitude was further subdivided into ‘health’ attitude and ‘control’ attitude with; again, equal numbers allocated to each of the low, medium and high attitude groups. Subjects tended to be classified higher for ‘control’ attitude than for ‘health’ attitude. For example, of the nine subjects who had low ‘health’ attitude, six had medium ‘control’ attitude and of those eight who had medium ‘health’ attitude, four had high ‘control’ attitude, two had medium and two had low ‘control’ attitude.

Similar to safety attitude, specific risk perception was classified into three categories with approximately equal numbers of subjects in the low, medium and high groups. A low category for specific risk perception indicated that subjects had a high perception of specific risk factors and a high category for specific risks indicated a low perception of specific risk factors. Seven participants had high specific risk perception, twelve had medium specific risk perception and five had low specific risk perception scores. Eight subjects were classified in the same category (low, medium or high) for both safety attitude and specific risk perception. Each of the participants completed a general risk perception questionnaire prior to training. A total of 10 questions were asked, five were graded on a 5-point scale from no risk (5) to very high risk (1) and four were graded on a 4-point scale from almost no risk (4) to high risk (1). One subject scored a total of 34 points, reflecting a low general risk perception, two scored 29 or 30 points, six scored 26-28 points, five scored 25 points, three scored 23 or 24 points, six scored 21 or 22 points and one scored less than 20 points, reflecting a high general risk perception.

Before the interventions, the employment status of the participants was recorded. Fourteen subjects were students (8 mmSDS: 6 SDS) and 10 subjects were unemployed (4 mmSDS: 6 SDS). The practical abilities of the participants was assessed from a background questionnaire administered at recruitment. Four subjects were very practical (1 mmSDS: 3 SDS), ten subjects were fairly practical (6 mmSDS: 4 SDS) and ten subjects were not practical (5 mmSDS: 5 SDS). The background questionnaire also assessed how healthy individuals were at recruitment in terms of their lifestyle and study. Eight subjects were very healthy (5

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mmSDS: 3 SDS), nine subjects were fairly healthy (5 mmSDS: 4 SDS) and seven subjects were not healthy (2 mmSDS: 5 SDS).

5.3 EXPOSURE TO WHITE SPIRIT

5.3.1 Choice of exposure variable

Exposure to white spirit was measured as task average concentration in ppm and duration of exposure in minutes. Concentration was multiplied by duration to calculate cumulative exposure for each participant (ppm.minutes). As cumulative exposure took account of both the intensity and duration of exposure it was decided that it was a more relevant measure than concentration. All subsequent analyses were therefore carried out for cumulative exposure.

Table 5 summarises the exposure levels for the participants at each of the four monitoring studies. As can be seen from Table 5, the mean cumulative exposure shows an immediate

stdecrease at the 1 study after intervention and a further decrease at the 2nd study after intervention. By the 3rd study after intervention, the mean cumulative exposure has increased but it remains lower than at the pre-intervention study. The differences in the exposures across studies were not statistically significant.

Table 5 Distribution of cumulative exposure to white spirit (ppm.minutes) by

monitoring study

Study no. No of Cumulative exposure to white spirits participants Minimum Maximum Mean s.d.

1 24 85 1575 485 342 2 22 37 2096 426 434 3 14 133 909 303 210 4 4 48 675 364 299

Table 6 summarises the percentage change in cumulative exposure at each of the monitoring studies following the interventions.

Table 6 Percentage change in cumulative exposure to white spirit by post-intervention

study

Post No of % change intervention participants Minimum Maximum Mean s.d.

study no. 1 22 -92.5 112.5 -9.7 53.8 2 14 -77.2 273.3 -13.4 101.5 3 4 -91.1 87.4 -38.8 84.9

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5.3.2 Association between exposure levels and individual characteristics

The cumulative exposure prior to intervention showed no associations with any of age, sex, locus of control, practical, healthy, or employment status.

5.3.3 Association between exposure levels and SDS packages

Exposure levels at the pre-intervention study were very similar for subjects using each of the two packages. The mean cumulative exposure for subjects using the mmSDS package was 482 ppm.minutes and for those using the SDS package, the cumulative exposure was 488 ppm.minutes.

5.4 USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) AND WORK-PLACE VENTILATION

The use of PPE prior to the interventions is summarised in Table 7. The majority of participants (63%) wore gloves when painting. However, only 40% wore a mask, either a basic nuisance mask or a 3M half-mask filtering face-piece. Proportionally more of the group who were subsequently trained using the mmSDS package wore either a basic mask or a 3M mask at the pre-intervention study. Of the 15 subjects who wore gloves during the task, eight also wore a mask (4 wore a basic mask and 4 wore a 3M mask),

Table 7 Use of PPE before training

Participants using equipment Protective Equipment No. % Mask Worn 10 40

Basic mask 6 3M mask 4

Gloves 15 63

Six subjects (2 mmSDS: 4 SDS) used general ventilation, three (2 mmSDS: 1 SDS) of whom had the door open throughout the sampling period. Similarly twelve subjects (4 mmSDS: 8 SDS) had the extractor fan switched on, six (3 mmSDS: 3 SDS) of whom switched it on at the start of the sampling period or during mixing. Eight subjects had a drink prior to the task or did not consume any refreshments during the study (2 mmSDS: 6 SDS). Ten subjects (5 mmSDS: 5 SDS) washed their hands after the task, of whom nine used soap and water or baby wipes (4 mmSDS: 5 SDS) and one subject used white spirits (mmSDS).

5.5 KNOWLEDGE

The 24 participants were asked 9 questions to test their health and safety knowledge of the paint product. One subject got none of the questions correct at the pre-intervention study, one subject got 1 correct, five subjects got 2 correct, eight subjects got 3 correct, six subjects got 4 correct, and three subjects got 5 questions correct at the pre-intervention study.

These baseline questions were then subdivided into three questions on each of health, general and control issues. Results for these knowledge subdivisions are shown in Table 8, which shows that pre-intervention knowledge was better for the general questions than for the health or control questions.

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Table 8 Knowledge at pre-intervention study subdivided by health, general and control

questions. Each cell contains number of subjects getting each number of questions correct.

Number of Category questions correct Health General Control

0 12 3 7 1 8 10 11 2 4 9 5 3 0 2 1

5.6 SUBJECTIVE ASSESSMENT OF THE mmSDS AND SDS PACKAGES

On completion of the training, all 24 participants completed a questionnaire giving their opinions about the package. A summary of the results is given below, with detailed tables in Appendix 9.

5.6.1 Experience with computers and time spent browsing

Depending on their use of computers at home, participants were classified as being either “very experienced”, “fairly experienced”, fairly inexperienced” or “very inexperienced” using the information provided in the questionnaire. The amount of time each subject spent browsing through the package was recorded and a summary by package and computer experience is shown in Table 9. It can be seen from this table that those using the mmSDS training package tended to have spent, on average, a longer time browsing through the package than those using the SDS package, and this was true for all levels of computer experience.

Table 9 Distribution of time spent browsing by package and computer experience.

Each cell contains number of subjects in cell and mean time (minutes) spent browsing on package.

mmSDS SDS All Computer Experience No. Time No. Time No. Time

Very experienced 7 35.4 8 12.7 15 23.3 Fairly experienced 2 38.5 - - 2 38.5 Inexperienced 3 51.3 4 15.5 7 30.9 All 12 39.9 12 13.7 24 26.8

5.6.2 Subjective opinions

Participants were asked whether they agreed or disagreed (on a 5-point “Likert” scale) with twelve statements about the training packages, for example, whether the package was easy to use, simple or didn’t teach anything that wasn’t known already (see Appendix 9 for details).

On the whole, subjects using the mmSDS package reported more strongly that the package was interesting, fun and that it was a useful source of information for people who use the paint. The more experienced computer users tended to find it easier to use.

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Those who felt that the package was not enjoyable tended to spend less time using it. Similarly, those who found that the package was fun tended to spend more time using it compared with those who did not. People who strongly agreed that the package was a “useful source of information for people who use the paint” tended to spend more time using the package.

Open-ended questions were included in the questionnaire so participants could indicate what factors they liked and disliked about both the mmSDS and SDS package. With regards to the mmSDS, participants stated that they found it straight forward, simple to use (4), clearly laid out (3), easy to navigate with a menu which was easy to follow (2). Participants also liked the fact that it incorporated a range of media, rating the introductory and painting videos highly, with the voice-over making the package easier to understand. The participants also liked the fact that they had the ability to control the material they viewed and enjoyed the interactive learning approach which helped maintain interest. Participants thought the package contained plenty of useful information (2), was highly informative (2), was not biased in the information it presented and enlightened them on safety and the dangers of using paint.

Three participants stated that there were no aspects of the package that they did not like. However many of the points which were rated positively were also rated negatively by some participants. Whilst many liked the range of media, three individuals did not like the voice­over stating that it became boring, slightly annoying and that the speaker had a patronising tone. Two participants disliked the fact that they could not speed up the package and so complained that it was too slow and long. Although most found the package easy to navigate through, two participants thought that it was easy to exit the package by mistake (and consequently did so) and thought that the point and click sections on the quizzes were not always straightforward. Some individuals also thought that some of the pop-up boxes did not contain enough information (though did not state which) and that more information should be included in the summary. One individual also stated that they would have liked more information about the paint manufacturer. Other comments included that the topics were too dry, the typeface wasn’t comfortable to read and that more music should have been included.

With regards to the SDS, many found the navigation of the package easy to use (7) with the information logically and simply ordered (2) and the layout relative ly easy on the eye. With regards to the actual content, participants thought that the package contained information that was easy to understand, informative, reasonably interesting and useful if intending to use the paint or worked in industry. Many of the media elements incorporated in the preliminary sections of the package were rated highly, with individuals liking the voice-over (3), colour and the fact that instructions on using a mouse were included.

However, there were many aspects of the SDS that were not rated highly. Many thought it contained too much “technical and industry speak” which made it difficult to understand (3) and that it didn’t contain enough information that was user friendly. Whilst some thought that there were “vast tomes of information” with no attempt to break this down into manageable pieces, some felt that more information on substances present in the product was necessary. Two individuals also stated that they would be “put off” using the paint after readings this information

Some individuals provided suggestions on how the package could be improved. These included the inclusion of a map to aid navigation around the pages, changing the print style and layout, the addition of pictures, graphics, video clips and more audio elements, bigger brighter headings, more colour, with important information being highlighted. “The information would be easier to digest if it was presented in a variety of formats”, “should be interactive” .

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5.7 EFFECT OF THE mmSDS AND SDS PACKAGES

5.7.1 Immediate effects of the interventions

The study plan was that all participants would be re-surveyed one day after they had received training. This was not always possible because participants had other commitments. Of the 24 participants, two did not complete any studies after the intervention, 16 were resurveyed within two weeks of receiving the package, three were resurveyed within three weeks of receiving the package and the remaining three subjects were resurveyed after 22, 25 and 56 days. It is possible that these longer time periods might have caused the effects of training to be reduced and so the comparisons between assessments made pre-intervention and at the first intervention studies were analysed for all participants together, and excluding the participant with the longest duration between studies. Results below refer to the full study population; any effects of omitting the subject with longer duration are noted in the relevant sections. A summary of the main immediate effects of the interventions is given in Section 5.7.1.4.

5.7.1.1 Change in exposure levels

Changes in individual cumulative exposure levels during the study are shown graphically in Appendix 10. Overall, cumulative exposure levels decreased following training for fourteen of the 22 participants who attended a second study (6 mmSDS and 8 SDS) and increased for eight subjects. Several of the changes, increases and decreases, in exposure were small. The average change in exposure immediately post-intervention was a decrease of 70 ppm.minutes (9.7% reduction), but this was very variable ranging from an increase in exposure by 744 ppm.minutes to a decrease in exposure by 1123 ppm.minutes. The average change in exposure in the study population was not statistically signific antly different from zero.

Comparisons between results for the two packages showed that the average change in exposure for those using the mmSDS was an increase of 52 ppm.minutes (3.2% increase) and for those using the SDS package was a decrease of 192ppm.minutes (22.6% decrease). This difference between the packages was statistically significant at the 10% level providing some evidence of a greater decrease in exposure for those who used the SDS package, although the result was dependent on one large decrease in exposure from almost 1600 ppm.minutes to around 450 ppm.minutes in one SDS user. If this subject was excluded the difference between the packages was much smaller and no longer statistically significant. Exclusion of the one subject with a long inter-study duration did not affect these results.

There was evidence that decreases in exposure from pre-intervention to first post-intervention studies were higher in those who changed their use of the door, from being shut at pre­intervention to being open at least some of the time at post-intervention. The difference was statistically significant (average change among those who opened door: 175 ppm.minutes decrease, average change for those who did not change door use or who changed from open some of the time to open all of the time: 42 ppm.minutes increase.). These changes do not differ significantly by package.

Change in exposure immediately after training was not associated with locus of control, gender, employment status, experience with computers, practical ability or health. There was some evidence that older subjects showed smaller decreases in exposure immediately post­intervention. There was also a significant association between time spent browsing on the computer and change in exposure; with those who browsed longer showing smaller decreases in exposure. This is consistent with the result of smaller decreases among mmSDS users who had tended to spend more time browsing at the computer.

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5.7.1.2 Change in use of PPE and ventilation

Prior to training only nine of the study participants who participated in the post-intervention study wore a face mask, either throughout the sampling period (3 subjects), during mixing of paint (1 subject) or during spraying of paint only (5 subjects). Following training six subjects changed their use of the facemask, five of which changed in a positive direction. Four subjects, who had not previously worn a facemask, now wore a mask; two throughout the sampling period and two for paint spraying only. One subject who previously only donned a mask during mixing paint now wore one throughout. However, one subject who had previously worn a mask throughout the sampling period now wore it only for paint spraying. Four of the five subjects with positive changes in mask use had used the mmSDS package and one had used the SDS package. The one subject who made a negative change had used the mmSDS package.

At the pre-intervention study 13 participants who attended the second study had worn gloves and nine had not. All thirteen who wore gloves continued to wear them after training. Of the nine subjects who did not wear gloves, five started to wear them immediately after the training. These five comprised three of the five mmSDS users who had not previously worn gloves and one of the four SDS users who did not wear gloves at pre-intervention. Of the five subjects who made positive changes to face mask use and five who made positive changes to glove use, only one made positive changes to both types of protection.

Eight subjects changed their use of general ventilation immediately following training. One subject trained using the SDS package, changed from using ventilation before or during spraying to using it throughout the sampling period. Of the 16 subjects who did not use general ventilation pre-intervention, seven now used it (4 SDS and 3 mmSDS) – four throughout the sampling period and three before or during spraying. Twelve of the 22 participants at the post-intervention study changed their use of the extractor fan. One subject stopped using the fan, who had used it throughout the time period pre-intervention. The other eleven (5 mmSDS and 6 SDS) subjects made positive changes to their use of the extractor fan – five changed from using the fan before or during spraying to using it from the start and six subjects who had not previously used the extractor fan starting using it. Three of these now used the extractor fan from the start of the sampling or during mixing and three now used the fan before or during spraying. Four subjects made positive changes to both general ventilation and use of the extractor fan.

Nine subjects (5 SDS and 4 mmSDS) who attended the post-intervention study had washed their hands using soap or baby wipes at the pre-intervention studies. Of these, three did not wash their hands at the post-intervention study, all of which used the SDS package. Of the 12 subjects who previously did not wash their hands (six from each package) three subjects who were all mmSDS users now washed their hands with soap or wipes. The one subject who washed his hands with white spirit continued to do so. Of the seven subjects (5 SDS, 2 mmSDS) who had refreshments prior to task or not at all during pre-intervention, six changed their actions. Five of these now had refreshments after the task (3 SDS and both of the mmSDS) and one now had refreshments during the task. Only one of the fourteen subjects who had previously had refreshments after the task changed his behaviour to have refreshments before the task or not at all. The one subject who had refreshments during the task at pre-intervention continued to do so.

5.7.1.3 Change in knowledge

There was a general increase in knowledge levels among the 22 participants at the post­intervention study, from an average of 34% of questions correct to an average of 62% of questions correct. Only one subject got fewer questions correct after receiving the

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intervention, two answered the same number of questions correctly and nineteen answered more questions correctly. The increases in knowledge were similar for users of the two packages, and occurred for all three types of questions (health, control and general).

5.7.1.4 Summary of immediate effects of the interventions

i. The average change in exposure immediately after training was not statistically significantly different from zero.

ii. There was some evidence that the decrease in exposure was greater for subjects using the SDS package, but this was strongly influenced by one individual whose exposure decreased by 1123 ppm.minutes.

iii. Decreases in exposure were higher for subjects who used general ventilation after training but not before.

iv. Users of the mmSDS package were more likely to start wearing a facemask or gloves, and were more likely to start washing their hands after training.

v. There was an improvement in the use of general ventilation and the extractor fan, and an improvement in knowledge levels for users of both training packages.

5.7.2 Longer-term effects of the interventions

Two more studies were planned following the first post-intervention study. The aim of these was to investigate the longer-term effects of the packages. These studies were planned to take place approximately one month and two months after the subjects had received the intervention. Fourteen subjects were surveyed in the second post-intervention studies (7 mmSDS and 7 SDS) and only four subjects were surveyed at the third post-intervention studies (2 mmSDS and 2 SDS). A summary of the main longer-term effects of the interventions is given in Section 5.7.2.4.

5.7.2.1 Change in exposure

Individuals’ changes in exposure levels across all studies are shown graphically in Appendix 10. Of the fourteen subjects who had shown a decrease in exposure immediately following training, nine were re-surveyed. Of these nine participants, three showed a continued decrease in exposure, two across two post-intervention studies and one across three post­intervention studies.

All three subjects had used the SDS package. Of the remaining six subjects, five attended only two post-intervention studies and four of these showed increases in exposure between the first and second post-intervention studies. However for all four subjects exposure levels at the second study were still lower than at pre-intervention. The other subject who attended two post-intervention studies showed an increase between the first and second post­intervention study resulting in an exposure higher than that measured pre-intervention (SDS package). The final subject attended three post-intervention studies and showed small increases in exposure between the first and second and between the second and third post­intervention studies, but to levels still substantially lower than at pre-intervention.

Of the eight subjects who had shown an increase in exposure at the first post-intervention study, five participated further in the study. Four of these subjects (3 mmSDS, 1 SDS) showed a decrease in exposure between the first and second post-intervention studies, all to levels lower than measured at pre-intervention, and the only one of these four subjects who attended a third post-intervention study showed a further decrease in exposure between the second and third studies. The final subject (mmSDS) showed a further increase in exposure from the first to second post-intervention studies, followed by a decrease between the second

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and third studies. Exposure levels at the third study were however still higher than at pre­intervention.

Overall, of the 14 subjects who attended two or more post-intervention studies, only two had exposures at their final study that were higher than at pre-intervention. The average change in exposure between pre-intervention and the second post-intervention study was a decrease of 261 ppm.minutes (13.6% reduction) and between pre-intervention and the third post­intervention study was a decrease of 591 ppm.minutes (38.8% reduction). Differences in exposures did not vary significantly between packages.

5.7.2.2 Change in PPE and ventilation

Ten of the fourteen subjects who attended two or more post-intervention studies did not change their use of a mask over time, six did not wear a mask at any study, two wore a mask for spraying paint only and two wore a mask all the time. Two subjects (1 mmSDS and 1 SDS) who did not wear a mask at pre-intervention, but who wore one for paint spraying only at the first post-intervention study, continued to wear it for spraying at the second post­intervention study. Neither of these subjects attended a third post-intervention study. A third subject (mmSDS) who had changed from not wearing a mask pre-intervention to wearing one throughout the first post-intervention study continued to wear a mask throughout the second post-intervention study but only during spraying at the third post-intervention study. The final subject (SDS) had worn a mask only for spraying at the pre-intervention and first post­intervention study but wore one throughout the second post-intervention study.

Four subjects did not wear gloves at any of the studies that they attended and seven subjects wore gloves at all studies. Of the five subjects who had started to wear gloves immediately after training, three attended two or more studies. All three subjects continued to wear gloves at all studies that they attended.

Among the 14 respondents who attended two or more studies, five did not change their use of the extractor fan. Of the twelve subjects who showed an immediate post-intervention positive change in fan use, seven attended further studies. Of these, three maintained the positive change they had made. Two subjects did not use the extractor fan at the second or third post­intervention study having used it from the start at the first post-intervention study and when spraying at pre-intervention. Of the final two subjects, one reverted back at the second post­intervention study to their pre-intervention use of the fan, and the other had a negative change from first to second post-intervention studies and then a positive change again from the second to the third post-intervention study. There were no significant differences between the packages in the types of changes seen.

Eight subjects did not change their use of general ventilation across all studies. Of the eight subjects who had made positive changes in use of ventilation immediately following training, four attended two or more post-intervention studies. All of these subjects maintained their positive change in use of ventilation. The final two subjects (1 mmSDS and 1 SDS) had the door shut during pre-intervention and the first post-intervention study, but had it open throughout the second post-intervention study or opened it during mixing.

Immediately after training three subjects (all SDS) had stopped washing their hands. Two of these attended further studies – one of them continued not to wash their hands and the other washed their hands at both other studies that they attended. Three subjects had started to wash their hands immediately post-intervention and only one of these attended further studies. This subject continued to wash their hands. The one subject who washed their hands with white spirit at the pre-intervention and first post-intervention study also did so at the second post-intervention study. Eight subjects did not change their hand-washing habits between

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studies. Of the remaining three subjects, one washed their hands with water at the pre­intervention, first and third post-intervention studies but did not wash them at the second post­intervention study; one did not wash their hand at the pre-intervention and first post­intervention study, but did so at the second post-intervention study and the third subject washed their hands with water at the pre- and first post-intervention study and then washed them with white spirit at the second post-intervention study.

Two subjects had eaten during the survey at the first post-intervention study, and both of these continued to do so at all studies they attended. Of the five subjects who ate prior to the task or not at all at pre-intervention and after the task at the first post-intervention study, three attended further studies. Of these, two reverted to eating prior to the task or not at all and one continued to eat after the task.

5.7.2.3 Change in knowledge

The overall knowledge scores at the second and third post-intervention studies were statistically significantly higher than the pre-intervention scores, but there were no significant differences between scores at the first, second or third post-intervention studies. This suggests that the increase in knowledge immediately after training was maintained but did not increase significantly over time. There was no difference between the packages in the changes in knowledge between studies.

Of the fourteen subjects at the second post-intervention study, four had lower knowledge scores than at the first post-intervention study (but all were still higher than at pre­intervention), five had identical scores and five had higher scores than at the first post­intervention study. All four subjects who attended the third post-intervention study had the same scores then as at the previous study. Of the twelve subjects who showed an increase in knowledge immediately after training and who attended further studies, four (3 SDS and 1 mmSDS) showed a further increase in knowledge, four (1 SDS and 3 mmSDS) maintained their original increase, and four (2 mmSDS and 2 SDS) showed a subsequent decrease, but to levels still higher than at pre-intervention.

An overall increase in knowledge between the first post-intervention study and the second and third post-intervention studies was evident for the control knowledge questions, particularly for those using the SDS package, five of whom increased their control knowledge between the first and second post-intervention studies compared to only one of those using the mmSDS package.

5.7.2.4 Summary of long-term effects of the interventions

i. On average, cumulative exposures at the second and third post-intervention studies were lower than at pre-intervention, and this decrease was statistically significant for the fourteen participants at the second post-intervention study. Only two subjects had higher exposures at the second or third post-intervention study than at pre­intervention. The decreases in exposure were apparent for users of both packages.

ii. Improvements in the use of PPE and general ventilation immediately following training were maintained at the second and third post-intervention studies.

iii. Improvements in the use of the extractor fan were more variable, but three of the seven subjects who had shown immediate post-intervention effects and who attended further studies maintained these improvements.

iv. The increase in knowledge levels immediately followin g training was maintained, but not significantly increased, at the second and third post-intervention studies; increases in control knowledge were particularly apparent for subjects who used the SDS package.

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5.7.3 Other effects of the mmSDS and SDS packages

5.7.3.1 Safety Attitude

Individual safety attitude was recorded as high, medium or low at each study. For most subjects there was little change in attitude over time, with 14 subjects remaining in the same category for the pre- and first post-intervention study and 6 subjects unchanged between the pre- and second post-intervention study.

Among the eleven subjects who used the mmSDS package and who had data available on safety attitude, three showed an increase in safety attitude across time. One of these three subjects had ‘low’ attitude at pre-intervention, rising to ‘high’ at the first post-intervention study, and falling to ‘medium’ at the second post-intervention study (the last at which they were surveyed). The second of these subjects had ‘medium’ attitude at pre-intervention, rising to ‘high’ at the first post-intervention study and maintaining this ‘high’ level of safety attitude across all post-intervention studies. The remaining subject showed an increase from ‘low’ attitude at pre-intervention to ‘medium’ attitude at the first and second post-intervention study and was not studied beyond this point.

Of the seven mmSDS subjects who showed no initial change in safety attitude, four remained in the same category of safety attitude for the pre-intervention and first post-intervention studies and were not studied further. Two subjects remained in the same category from pre­intervention to the second post-intervention study and then were no longer studied. Only one subject who showed no initia l change was surveyed at all studies and maintained the same level of safety attitude across these four time points.

The remaining subject who used the mmSDS package showed a decrease in safety attitude immediately after training and maintained this lower safety attitude level at the second post­intervention study (the last at which he was studied).

For the eleven subjects who used the conventional SDS package, two showed an increase in safety attitude across time. One of these subjects had ‘low’ attitude at pre-intervention, rising to ‘high’ at the first post-intervention study and maintaining this ‘high’ level of safety attitude at the second post-intervention study (the last at which he was studied). The other subject had ‘medium’ attitude at pre-intervention, rising to ‘high’ at the first post-intervention study and maintaining this ‘high’ level of safety attitude at the second post-intervention study, then decreasing to the original ‘medium’ level of safety attitude at the third post-intervention study.

Seven subjects using the conventional SDS package showed no initial change in safety attitude. Three of these subjects remained in the same category of safety attitude for the pre­intervention and first post-intervention studies and were not studied further. Three subjects remained in the same category from pre-intervention to the second post-intervention study and then were no longer studied. One subject had no data on their safety attitude at the second pre-intervention study; however, this subject had a ‘medium’ attitude at pre­intervention and at the first and third post-intervention studies.

The remaining two subjects who used the SDS package showed a decrease in safety attitude immediately after training. One of which was not surveyed after the first post-intervention study and the other subject maintained the lower level of safety attitude at the second post­intervention study, which was the last time point at which they were studied.

Overall, there is little difference in total safety attitude or control attitude for subjects using the mmSDS package compared to those using the SDS package. Between the pre­

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intervention study and the first post-intervention study, mmSDS users were more likely to have an increase in health attitude compared to SDS users (5 mmSDS, 2 SDS). However, this difference between packages was not maintained throughout the study. The possibility of an increase in safety attitude was slightly more likely in subjects using the SDS package compared to subjects using the mmSDS package for questions on overall safety attitude (7 mmSDS, 9 SDS) and for health attitude (7 mmSDS, 10 SDS) than for questions on control attitude (9 mmSDS, 8 SDS).

5.7.3.2 Risk perception

Individual risk perception was also categorised as low, medium or high at each study, where a low score indicated a high perception of specific risk factors and a high score indicated a low perception of specific risks.

Four of the 11 subjects using the mmSDS package showed an improvement in their specific risk perception scores immediately after training. One of these subjects was not studied beyond the first post-intervention study. At the second post-intervention study, one subject returned to the specific risk perception score obtained prior to training and was not studied beyond this time point. A vast improvement in specific risk perception score was observed for one subject immediately after training with a change from ‘high’ to ‘low’, however, this subject then showed a worsening in specific risk perception score at the second post­intervention study with a ‘medium’ risk perception score. This was the last point at which this subject was studied. The remaining subject showed a slight improvement in risk perception score from pre-intervention to the first post-intervention study and showed a further improvement between the first and second post-intervention studies (from ‘high’ to ‘medium’ to ‘low’) and was not studied further.

No change in specific risk perception immediately after training was observed for four of the 11 subjects using the mmSDS package. Two of these four subjects were not studied after the first post-intervention study. One of the four subjects maintained the same level of risk perception from the pre-intervention study until the second post-intervention study (the last point at which they were studied). The remaining subject had a worsening in specific risk perception from ‘medium’ to ‘high’ between the first and second post-intervention study and maintained this ‘high’ risk perception at the third post-intervention study.

Three of the eleven subjects using the mmSDS package showed a worsening in specific risk perception immediately after training from ‘low’ to ‘medium’ risk perception. No further studies were made after the first post-intervention study for one of these three subjects. Another of these three subjects maintained this ‘medium’ level of risk perception at the second post-intervention study (the last point at which they were studied). For the remaining subject, the ‘medium’ level of risk perception was maintained at the second post-intervention study and then this subject showed an improvement in their risk perception, returning to their original ‘low’ level at the third post-intervention study.

Of the eleven subjects using the SDS package, six had an improvement in specific risk perception immediately after training from ‘medium’ to ‘low’. Two of these six had no further studies after the first post-intervention study. At the second post-intervention study, two subje cts had a subsequent worsening in risk perception (one from ‘low’ back to ‘medium’ and one from ‘low’ to ‘high’. A further subject maintained their improvement in risk perception at the second study (the last point at which they were surveyed). For the remaining subject, risk perception fluctuated up and down by one category across studies from ‘medium’ to ‘low’ to ‘medium’ to ‘low’.

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Four SDS users showed no change in specific risk perception immediately after training, one of who was only surveyed once after training at the first post-intervention study. A further two subjects retained the same level of risk perception until their final study, which was at the second post-intervention study (one ‘low’ and one ‘medium’). After the first post­intervention study, one subject showed an improvement in risk perception from ‘medium’ to ‘low’ at the second post-intervention study and at the third post-intervention study showed a worsening in risk perception from ‘low’ to ‘high’. Only one of the eleven SDS users showed an immediate worsening in risk perception after training from ‘medium’ to ‘high’. This subject participated no further in this study.

Overall, subjects using the mmSDS package were slightly less likely than those using the conventional SDS package to have shown an improvement in specific risk perception immediately after training (4 mmSDS, 6 SDS). This difference between packages did not continue throughout the study. Half of the subjects (3 mmSDS, 9 SDS) have shown either an improvement or a worsening in risk perception score immediately after training. For five (3 mmSDS, 2 SDS) of the 24 subjects, only a worsening in risk perception score was possible and for seven subjects (6 mmSDS, 1 SDS) only an improvement in risk perception score was possible immediately after training.

5.7.3.3 General risk perception

Changes in general risk perception were also noted as any significant changes could indicate that participants were rating risk differently as they felt that was expected of them and could influence any changes observed in specific risk perception.

A decrease in general risk perception score was taken to represent an increase in risk perception. With the section B statements, there was no statistically significant difference in change in risk perception with most subjects rating risk the same.

Section B – Change in category of risk perception: stPrior to intervention to 1 post-intervention: 3 increased perception, 13 same, 6

decreased Prior to intervention to 2nd post-intervention: 2 increased perception, 9 same, 3 decreased Prior to intervention to 3rd post-intervention: 1 increased perception, 2 same, 1 decreased

Average change in total score pre vs 1st was 0.32 (not significantly different from 0). Average change in total score pre vs 2nd was 0.57 (not significantly different from 0).

With the section C statement there was some evidence of an increase in general risk perception, with the average change in total score for pre vs 1st post-intervention being 0.64 (significantly different from 0 at the 3% level). However, there was no difference in average total score between pre and 2nd post-intervention.

Section C – Change in category of risk perception: stPrior to intervention to 1 post-intervention: 5 increased perception, 10 same, 7

decreased Prior to intervention to 2nd post-intervention: 2 increased perception, 8 same, 4 decreased Prior to intervention to 3rd post-intervention: 1 increased perception, 1 same, 2 decreased

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5.7.3.4 Summary of other intervention effects

i. There were few changes in safety attitude across studies. Without taking general risk perception into account, there was some indication that users of the SDS package were more likely to show an increase in specific risk perception immediately after training. However this result does not hold across all studies.

ii. Generally those subjects who showed an increase in their specific risk perception tended not to show increase in general risk perception

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6. DISCUSSION

6.1 WORKPLACE EVALUATION STUDIES

6.1.1 Introduction

SDSs are used primarily as risk assessment tools and play an important part in communicating hazard and risk information about chemicals to workers, particularly in SMEs. This project focussed on the use of SDS as training and information tools, providing workers with information on how to use and handle hazardous substances safely. For training to be successful it must increase workers assimilation and understanding of the hazards and risks associated with using the products and change their attitudes, which in turn should lead to the adoption of safer work practices and working behaviour.

It is acknowledged that there are several limitations to the study. Funeral homes volunteered to participate in the study by returning completed background questionnaires and the funeral director who undertook the majority of the embalming activities was chosen as the study candidate from each site. This method of recruitment almost certainly resulted in selection bias in that the individuals and funeral homes who volunteered to participate may have been more health and safety conscious that those that did not. Such bias may influence the detection of any post-intervention differences, for example, if the embalmer is already undertaking all the necessary precautions prior to the intervention, then there would be very little scope for any improvements to be detected post-intervention. It is therefore felt that the results may underestimate some of the potential effects of SDS information in general. Also, the embalmers were aware of an ongoing refurbishment of funeral homes within the organisation and this may have influenced their behaviour and responses. Participants’ behaviour and responses may also have been inf luenced by the presence of the researcher and could have resulted in positive or negative bias depending on workers interpretation of the study activities (Skov and Kristensen, 1996).

It was not possible to undertake all three post-intervention studies with all of the embalmers due to other workload and holiday commitments. Despite many attempts, it was only possible to conduct three post-intervention studies with five embalmers, all of whom had received the mmSDS. This clearly affects the interpretation and generalisation of the findings and it was not possible to conduct any long-term post-intervention comparisons between the two packages. It was also originally intended to undertake the post-intervention studies at time intervals of one day, one month and six months after the interventions however this was not always practical because of the difficulties in organising access to the embalmers. For the first post-intervention study, only 11 were resurveyed within two weeks of receiving the training, with the remaining 3 resurveyed after 24, 47 and 78 days, with similar trends being observed for the lag periods for the longer post-intervention studies. The analysis was undertaken for both the full study population and repeated with the subjects with longer lag periods omitted and no differences were observed. However, it is still possible that training effects may have been missed and by the time the sites were resurveyed, these effects were reduced or disappeared.

Lastly, the study population consisted of only 14 embalmers (7 for each package). Clearly the sample size makes it difficult to achieve adequate statistical power to detect the kinds of differences one might hope to find between two interventions.

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6.1.2 Safety climate and locus of control

Baseline information was obtained about the study candidates and their place of work before administering the interventions. This information included monitoring their exposure to formaldehyde, observing use of protective measures, assessing knowledge, risk perception and attitudes towards the embalming fluids used to determine what effect, if any, the interventions exerted on these variables. It was also recognised that the safety climate and locus of control of the subjects may influence these variables and influence the effectiveness of the training interventions.

The baseline safety climate surveys revealed that only one site had a poor safety climate. Interestingly we found that, as the individual score for safety climate became lower, cumulative exposure to formaldehyde tended to increase i.e. the lower the ranking of the safety climate, the higher the exposure. Employees at those sites with lower ranking safety climates tended to feel that there were not always enough people or time to do the job safely and that safety was not as important as production. Such views could result in the embalmer feeling that they had to work quicker and “cut corners” in order to keep up with the workload, which would explain their higher cumulative exposures. This finding agrees with the published literature on this topic . For example, Gershon et al (2000) found that management attitude towards safety was the most significant factor in enhancing employee compliance and reducing exposure incidence to blood-borne pathogens. However, changes in cumulative exposure after the training interventions were found not to be associated with safety climate.

It was also acknowledged that the impact of the SDSs could be strongly influenced by the psychological make-up of those individuals taking part. Locus of Control is related to the individuals’ sense of responsibility for a risk taking decision and its consequences (Rotter, 1966; Rotter et al 1972). If a person perceives themselves to be responsible for the outcome of their actions, they are said to have an internal locus of control i.e. they feel that control is an internal matter related to their own efforts and talents. Those perceiving themselves to be controlled by external factors, which they are unable to control, such as fate, chance and powerful figures of authority, are described as having an external locus of control. Not only are individuals with external locus of control less able to make an objective assessment about their risk-taking behaviour, there is also reason to suspect that they are less likely to adopt safer practices than those with an internal locus of control. Crisp and Baker (1995) cite a number of studies concerned with sexually transmitted diseases and sexual practices which reinforces this suspicion.

There was some evidence that subjects displaying an internal locus of control had lower cumulative exposure levels in the baseline surveys than the other subjects. However, the differences between the groups were not statistically significant. It was also interesting to note that the three site managers in the data set all had internal locus of controls although there was no association between job title and cumulative exposure. Reviews of the published literature suggest that an internal locus of control is positively associated with belief in the ability to learn and improve skills (Spector, 1982). By implication, those with a positive belief in their ability to learn are more likely to be motivated and strive for greater autonomy. However, any changes observed after the interventions were not found to be associated with locus of control.

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6.1.3 Effectiveness of the embalming fluid mmSDS package

6.1.3.1 Changes in product knowledge

Changes in knowledge were assessed by questionnaire. In the first post-intervention study, five of the seven subjects receiving the mmSDS showed an increase in knowledge compared to two of the seven receiving the package. This difference was statistically significant at the 10% level and suggests that the mmSDS is indeed a more effective way of communicating hazard and risk information than the SDS. This increase in knowledge was not associated with other variables such as age and locus of control. It was also interesting to note that the three individuals who answered fewer questions correctly post-intervention (albeit only slightly fewer), all received the SDS. These findings would appear to agree with the published literature concerning multimedia -training tools and SDS as previously discussed in Section 1, as well as the subjects’ comments on the packages.

Knowledge was still found to have increased at the second post-intervention study compared to pre-intervention. However, whilst the mmSDS subjects showed an increase in knowledge compared to the SDS at the first post-intervention, the reverse was true in the second post­intervention. The remaining four SDS subjects level of knowledge was higher than post­intervention levels whilst only two of the six mmSDS were found to have higher levels. Closer inspection of one of the mmSDS subjects where knowledge had decreased showed that their level of knowledge had initially increased in the first post-intervention study. This was also found to be the case for one of the subjects where their level of knowledge was found to be the same as post-intervention. It was also noted that for the three of the five mmSDS users in the third post-intervention their level of knowledge was higher than baseline.

Conventional wisdom tells us that following training; knowledge should firstly increase and although it will gradually be lost over time, should plateau at a level higher than what it was originally. The results of the mmSDS subjects appear to support this notion, with the increases in knowledge gained being either lost or flattening off over time. The results for the SDS users are unexpected and difficult to account for as three of the four subjects’ knowledge was found to increase over time. It is possible that these embalmers may have received supplementary health and safety information or training from their employer between the first and second post-intervention studies although none of the subjects acknowledged this in the questionnaire. Workers responses to risks can generally be classified into three categories. These are denial, acceptance and activism (Recchia, 1999). It may also be possible that these four individuals are “activists” and that after receiving the initial training and perhaps not fully understanding it, they have actively taken steps to locate further information. Without questioning the individuals it is not possible to explore this hypothesis further and as no SDS subjects took part in the final post-intervention study, it was also not possible to see whether this increase in knowledge was maintained. On the basis of the medium-term results it would appear that the conventional SDS may be more effective at increasing and maintaining knowledge although the reasons cannot be readily explained.

Overall the results suggest that the mmSDS is more effective in the short term at increasing knowledge with these increases either flattening off or gradually being lost over time. As the individual lag times between studies were variable it was not possible to indicate when refresher training should be conducted. However, it has been suggested that measuring users’ knowledge related to the hazardous substances is an insufficient indicator of program effectiveness and behavioural change (Weidner, 2000), so changes in more influential traits such as attitudes and risk perception were also assessed.

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6.1.3.2 Attitudinal changes

Attitudes are important concepts that help people to understand their social world. They help us define how we perceive and think about others, as well as how we behave toward them. A widely accepted definition of an attitude is offered by Judd, Ryan, & Parke, (1991). They believe that attitudes can be viewed as "evaluations of various objects that are stored in memory". According to the tri-component model, an attitude includes affect (a feeling), cognition (a thought), and behaviour (an action).

Attitudes are built upon the beliefs that are held about the attitude object and are formed in a complex manner. Most psychologists concur that attitudes are learned through experiences, conditioning, and socialisation. Specifically, attitudes can be acquired from others (i.e. social learning) as well as being acquired via direct experience. Social Learning, often referred to as "socialisation" refers to the gradual acquisition of language, attitudes, and other socially approved values through reinforcement, observation, and other learning processes. This implies that one's interaction with others, such as parents, teachers, peers, relatives, newspapers, books, television and religious groups can affect our attitudes toward various objects. Attitudes can also be acquired from the mere exposure to a particular object. Such direct experience, repeated over time, often results in a preference for that object when compared to objects less often encountered. For example, when asked to choose a preference for the way a task should be completed, most workers will select the method with which they are most familiar. It was hypothesised that following the SDSs, individuals attitudes towards the hazardous substances would change due to increased product knowledge. The results from the knowledge questionnaire would suggest that if this were the case, changes in attitudes would be observed for mmSDS users in the first post-intervention, whilst changes would be more evident in the SDS users in the second post-intervention.

Overall there was little change in measured attitude between the pre- and post-intervention studies with 10 subjects remaining unchanged between the pre and first post-intervention study and 6 unchanged between the pre- and second post-intervention study. It was perhaps presumptuous to assume that a one off intervention would change workers attitudes given that attitudes are relatively enduring, formed in a complex manner and that they cannot be changed by a one off campaign (HSE, 1993; Recchia, 1999). Given that the majority of the subjects had worked as embalmers for several years, had received previous health and safety training and worked in funeral homes mostly with strong safety climates, attitudes would already have been fairly well formed. Recchia (1999) claims that dramatic changes in attitudes will only take place in situations where beliefs and values that underlie the particular attitudes are relatively trivial or new, rather than well established. This was evident by the responses obtained from the subject who was concerned about the cancer risk associated with formaldehyde. This individual was unaware of the carcinogen classification and in the pre­intervention study disagreed with the statement “Despite what the scientists say, I think formaldehyde can cause cancer in humans”. In both of the post-intervention studies this individual participated in, he strongly agreed with this statement.

6.1.3.3 Changes in Risk perception

The study of risk and peoples’ reactions to it has been a topic of empirical investigation and philosophical debate for several decades now. “From the perspective of a social scientist, risk perception involves peoples’ beliefs, attitudes, judgements and feelings as well as the wider social or cultural values and dispositions that people adopt towards hazards and their benefits” (Pidgeon et al, 1992). This recognises that perceptions of risk are not only multidimensional in terms of the range of qualitative variables which lay people consider salient but are, to

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some extent, socially and culturally defined. There are many factors that affect the way in which individuals form risk perceptions. These include:

• Individuals’ personality; • Health status and age; • Training / knowledge / skills; • Past experience; • Culture and background; • Particular stimuli and • whether the risk is voluntary, familiar, controlled by the individual, chronic, natural, fair,

detectable and memorable (Fernandez et al, 2000; Millward, 2000; HSL, 1999; LaGrega et al, 1994).

Changes in risk perception following the interventions were slightly more common among SDS than mmSDS users, for both increases and decreases in perception although there were no significant differences between the packages. However, changes in general risk perception were also noted. It was originally thought that the SDS packages would change users’ perceptions of the hazardous substances used because of the new health and safety information. It appears unlikely that this occurred given that changes in their general risk perception occurred as well. As mentioned earlier many factors affect the way in which individuals form risk perceptions. Referring back to the baseline characteristics of the study population, the subjects were very experienced and had mostly been working within sites with good safety climates for many years. Perceptions would have already been formed, whether or not these are correct or not and as with attitudes, it is thought unlikely that a one off intervention would be able to influence these.

6.1.3.4 Behavioural changes

The ultimate goal of any health and safety intervention is to change workers behaviour whilst using hazardous substances and ultimately reduce their exposure. Workers’ behaviour and use of control measures were observed during the post-intervention studies. Overall there was little change in the use of PPE and ventilation after the interventions which is probably due to the fact that the majority of the subjects were using all the protective measures available to them and there was little opportunity for any improvements to be made by them. In instances where users were wearing items of PPE pre-intervention that were not worn post-training, this may have been due to the presence of the researcher. As previously mentioned, participants’ behaviour and responses may be influenced by the presence of the researcher both positively and negatively. It is possible that during the initial study, some embalmers may have worn items of PPE that they would not normally wear in the hope of giving a good impression. In one instance, a work colleague informed the researcher that the embalmer, who had worn a facemask, would not normally do so. It is also possible that post-training, embalmers were more comfortable with the presence of the researcher and worked as they would normally. With regards to the use of ventilation, the embalmer who did not switch on the extractor fan was aware that it didn’t work and ventilated the theatre by opening the window. The embalmer who also decided to switch on the fan after embalming but did not use the fan earlier only did so because of unpleasant odours. It is probable that the packages were unable to influence workplace behaviour, because it was being influenced by other workplace factors such as safety climate that already had a great impact on the subjects.

Although overall the subjects’ knowledge of the products used had increased and some small, changes in health related attitudes occurred, behaviour measures did not change. Changing behaviour is difficult and simply informing individuals that they are at risk from a hazard is rarely sufficient to change behaviour (Marteau and Lerman, 2001). There are many theories

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available which attempt to explain and predict preventative health behaviour. The most commonly used are the value expectancy models of which the best known and most influential are the Theory of Reasoned Action (Fishbein and Ajzen, 1975), Theory of Planned Behaviour (Ajzen, 1991) and the Health Belief Model (Jaz and Becker, 1984). Weinstein (1993) argues that value expectancy models have four characteristics in common. These are:

1. Motivation for self-protective behaviour arises from anticipation of negative consequences and desire to minimise these outcomes.

2. Impact of anticipated negative outcome on motivation depends on beliefs about likelihood of outcome will occur.

3. Motivation to act arises from expectation that action will decrease the likelihood or severity of harm.

4. Expected benefits of particular action must be weighed against expected costs of taking action.

DeJoys’ (1996) critical review of the applicability of theoretical models of health behaviour to workplace self-protective behaviour discusses several constructs within these models that are relevant to workplace self–protective behaviour. These include threat-related beliefs, self­efficacy, response efficacy, barriers and normative expectation. It has been suggested that barriers or costs are the single best predictor of health behaviour with research on the use of PPE showing that job related barriers are often the major factor in non-compliance. As the safety climates at all of the sites bar one were rated good or higher, with subjects appearing confident in their ability to use the protective measures and the effectiveness of these in protecting them, it is not surprising that all the available self protective measures were being used.

6.1.3.5 Changes in cumulative exposure

We hypothesised that, following both of the interventions, there would be a reduction in exposure levels to the hazardous substances being used due to changes in behaviour. Despite the lack of change in overt behaviour the cumulative exposure decreased for eight of the fourteen participants in the first post-intervention study. The average changes in cumulative exposure between pre- and the first post-intervention study were small, approximately 7.2% overall. We also believed that those subjects receiving the mmSDS package would display lower cumulative exposures after the intervention than those receiving the SDS due to the information being communicated in a more effective manner. Although mmSDS subjects appeared to display greater levels of knowledge than the SDS users post-intervention, the difference in cumulative exposure between the two packages was not statistically significant. Although several of the changes in cumulative exposure were small and few overt behavioural changes were observed which could account for the changes, it was possible that the interventions were promoting a training effect. It is possible that the subjects were making very small changes to their working behaviour and taking more care when using the fluids, which could account for the fluctuations in exposure. Indeed, small changes in the workers posture or pattern of movements around the workplace can lead to variations in exposure (Kromhout et al, 1993; Cherrie et al, 1994).

It was also originally thought that those individuals receiving the mmSDS would have lower exposure levels for a longer time interval than those receiving the SDS. Although technically there was an overall decrease in cumulative exposure at the first post-intervention, there were no significant differences between the two packages. However some interesting trends in changes in cumulative exposure (albeit very small) were observed for the two packages. Technically four of the six mmSDS subjects’ cumulative exposure were lower than pre­intervention during the second post-intervention study whilst only one of the four SDS subjects had a lower exposure. The remaining SDS subjects, all of whom had decreases in

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cumulative exposure at the first post assessment, had exposures which were greater than those observed pre-intervention. Indeed the cumulative exposure for the SDS subject which was lower than pre-intervention was slightly higher than that observed during the first post­training. For the four mmSDS subjects with lower cumulative exposures, it was also noted that these were lower than the first post-intervention study and tended to increase again in the last. There is a suggestion that the mmSDS could be promoting a long-term change in cumulative exposure possibly due to subjects continuing to make small changes to the way they work and use the fluids. The findings also suggest that this effect was gradually being lost over time as subjects reverted back to their old working habits.

6.2 LABORATORY EVALUATION STUDY

6.2.1 Introduction

Volunteers from the general public, instead of spray painters, as originally intended, undertook this work. This was due to an insufficient number of companies agreeing to participate in the study. The multimedia package was developed with spray painters in mind, using the comments from focus groups consisting of this target population. The characteristics of the target population are very different from that of the study population and this may have affected the results. However, we felt it was acceptable to view all the subjects as “novices” given that none had spray painted or used paints in a professional capacity previously.

There was a high dropout rate, with many of the participants failing to return for the repeat post-intervention studies. This meant that it was not possible to conduct all three post­intervention studies with all of the participants. There may be a bias in that the individuals who participated in the later studies were different in some way to those that dropped out. However, it was not possible to ascertain why individuals dropped out of the study. It was also originally intended to undertake the post-intervention studies at time intervals of one day, one month and two months after intervention however this was not always possible. As with the workplace studies, the analysis was undertaken for both the full study population and repeated with the subjects with longer lag periods omitted and no differences were observed.

Laboratory investigations that observe compliance behaviour always run the risk of introducing biases. In particular, subjects might assume that since they are participating in an experiment, they will not be exposed to danger and so do not need to take any precautionary actions (Hatem and Lehton, 1995). This is a difficult bias to resolve. However steps were taken to minimise this problem by emphasising that the participants were in control of the experiment and they could take whatever action they wished.

Lastly, the study population consisted of only 24 volunteers (12 for each package). Clearly the sample size was small, making it more difficult to achieve adequate statistical power to detect the kinds of differences one might hope to find between the two interventions.

6.2.2 Effectiveness of the paint mmSDS package

6.2.2.1 Changes in product knowledge

None of the subjects had ever spray-painted or used paints in a professional capacity. For ethical reasons prior to undertaking the study, all participants were provided with basic information on the potential health effects associated with the paint. The paint tin had a label that provided information on how to use the product safely but this was read by only one individual. The average number of questions about hazards and risks answered correctly pre­intervention was 34%. We believed that both of the SDSs would produce large increases in

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participants’ knowledge given that they had not received any information from other sources and the information was new. It was also hypothesised that the mmSDS package would induce larger increases in knowledge given that the information was being communicated in a more effective manner. The first point was shown to be correct as nineteen of the remaining 22 participants answered more questions correctly and overall, the number of questions answered correctly was found to nearly double. However, there was no statistically significant difference in the increase in knowledge between the two packages.

The immediate increase in knowledge was also maintained over time, with overall knowledge scores still being significantly higher at the second and third post-intervention scores compared to pre-intervention. However, there were still no significant differences between the two packages. The fact that knowledge did not increase overall between the post intervention studies was not unexpected given that conventional wisdom suggests that following training, knowledge should increase and then gradually be lost. It was encouraging to find that knowledge was still significantly higher at the longer post-intervention studies and on the basis of the results, it would appear that both of the SDSs are effective at increasing and maintaining knowledge over the longer time periods i.e. up to a few months. In some individuals it was found that knowledge was slowly decreasing over time but that it did not return to that recorded at pre-intervention level. It would have been useful to conduct further studies at longer time periods to track the changes in knowledge and establish when retraining would be necessary.

It was noted that some subjects answered more questions correctly at the second post-training study than the first. These were mostly SDS subjects answering more control knowledge questions correctly. It is not clear why this occurred.

6.2.2.2 Attitudinal changes

As with the embalmers, we hypothesised that following the interventions, individuals’ attitudes towards the hazardous substances would change due to the increased product knowledge. The results from the knowledge assessment questionnaires suggest that any changes in attitude should be noted for both SDS and mmSDS users but that no differences between the packages would be found.

As previously mentioned in Section 6.1.3.2, attitudes are built in a complex manner and are learned from a variety of sources. As the subjects were “novice” spray painters, undertaking a task that was new and had little interaction or reinforcement from peers or relatives it was thought that their attitudes towards using the paint would be new, not very well formed and therefore subject to change upon receipt of additional information.

However, for most subjects there was little change in attitude over time. There was also little difference in total safety attitude or control attitude for subjects using the mmSDS package compared to those using the conventional package. Although some slight differences were noted between the packages, these were not statistically significant and it is questionable as to whether they can be attributed to the SDSs, particularly given that there were not associated with changes in knowledge. Again, as suggested for the workplace evaluation study, the interventions were administered on only one occasion and lasted for only a short period of time. It may be that repeated administration of the information over a period of time would be necessary before any significant changes in attitude occur. Also, simply giving someone information, even assuming that they think about it and accept the information, may be insufficient to alter their feeling (HSE, 1993).

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6.2.2.3 Changes in risk perception

There was some indication that users of the SDS were more likely to show an increase in specific risk perception immediately after training. In addition, these individuals generally did not show an increase in general risk perception. These findings suggest that a training effect may have occurred, rather than the individual simply ranking everything higher as they felt that might have been expected of them. As discussed earlier in Section 6.1.3.3, there are many factors that can affect how individuals form perceptions. Knowledge acquisition is a key factor and although further analysis of the data revealed there were no associations between knowledge and risk perception, it may be possible that this has played a role. Closer inspection of the statements revealed that whilst only two SDS subjects thought the risk of experiencing ill-health effects was very high when spraying paint in an unventilated area before the intervention, five thought so afterwards. We hypothesised that there should be a causal association between workers perceptions of the risks from handling hazardous substances, their behaviour while working and their consequent exposure. On the basis of these findings and if such an association exists, it would be expected that the SDS users would show greater positive behavioural changes and greater decreases in cumulative exposure than the mmSDS users due to their increased risk perception.

6.2.2.4 Behavioural changes

As overall knowledge was found to substantially increase following the interventions and there was scope for improvements in protective behaviour to be observed, it was thought that significant positive changes would occur after training. This was indeed found to be the case with increases in the use of protective equipment, ventilation and hand washing being recorded in the first post-intervention study. In this study, the mmSDS had more positive changes in the use of masks, gloves and hand washing than the SDS package did. It is possible that the mmSDS was more effective at communicating the need for users to wear masks and gloves whilst using the paint as it showed pictures which the individuals could easily relate to.

Longer-term behavioural changes were also evident regarding PPE usage, with all of the remaining subjects who had posit ively changed their behaviour after the interventions continuing to do so. Positive behavioural changes were also maintained regarding venting the room by opening the door. The maintenance of these positive changes infers that both packages are capable of promoting long-term behavioural changes. The use of the extractor fan in the follow up studies was less clear, with some subjects maintaining the improvements made and others reverting back to their pre-intervention behaviour. There are several possible reasons why this may have occurred. Firstly, it is possible that subjects were choosing to ventilate the room through opening the door rather than the fan, given that further improvements in general ventilation were noted in the second post-intervention study. Secondly, it may have been that the “cost of compliance” for using the fan was too great as individuals were required to switch on the fan and use step ladders to adjust the face opening to increase the airflow. Simply opening the door would be much easier. Thirdly, familiarity is said to operate at the level of personal experience, suggesting that, in the absence of negative outcomes, it can lead to decreased levels of caution (HSL, 1999). It may be possible that subjects were getting used to the task and, after experiencing no side effects in previous studies, may have felt that there was no need to use the additional measure. The variability in hand washing may be due to glove usage as there was a weak association that when gloves were worn, hands were not washed.

It was noticed that for one subject, no changes in behaviour were observed at any point after receiving the mmSDS. This individual continued not to wear any PPE or ventilate the room, washed hands with white spirits and ate during the task. It was interesting to note that this

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person was one of the two participants with external locus of controls and was the one individual who actually answered fewer questions correctly post-intervention. It would appear that this individual was somehow different from the rest of the study population and can be used to illustrate some general points. As mentioned previously, individuals with external locus of controls may perceive themselves as being controlled by figures of authority. It is possible that this person perceived the researcher as an authority figure and given that they did not instruct the subject to use the control measures, instead leaving it for them to decide, may have felt no need to do so. Previous research also suggests that locus of control can be used as a predictor of users’ attitudes towards computers, with internal locus of controls holding more positive computer related attitudes than others (Katz, 1994; Coovert and Goldstein, 1980). Closer inspection of this partic ipants’ subjective opinions of the mmSDS found that they responded negatively to virtually all aspects of the package, strongly agreeing that the package was a waste of time and that it would not make them change the way they worked. Given the fact that they disliked the package, and felt that it was not useful to them, it is thought that there was no motivation for them to work through the information other than receiving their participation fee. Participants must be intrinsically motivated if meaningful learning is to occur (Biggs and Moore, 1993) and this could very well explain why no increase in knowledge was found post-intervention and no behavioural changes were observed. Lastly, Ross and Schultz (1999) found that computer aided instruction (CAI) may not be the most appropriate method of learning for all students. They state that learning styles consist of “distinctive behaviours which serve as indicators of how a person learns from and adapts to his environment” and found that some styles responded better to CAI than others. Although learning styles were not assessed in this study, it may be possible that this subject did not respond well to the mmSDS given their learning style and would have responded better to some other form of information provision.

6.2.2.5 Changes in cumulative exposure

As before, it was hypothesised that, following both of the interventions, there would be a reduction in cumulative exposure levels due to increased product knowledge and changes in behaviour. Despite increased knowledge and observable behavioural changes, the average change in exposure for the study population was found not to be statistically significant. This was surprising given that training effects were seen on use of ventilation and the fan for both packages. There was also evidence to suggest that decreases in exposure were statistically significantly higher for those that changed their use of the door from being shut to open some of the time. There was evidence to suggest that the decreases in exposure was greater for subjects using the SDS package, but this was strongly influenced by one individual. Closer inspection of this individual revealed large behavioural changes that explain this dramatic decrease in exposure. Whilst during the pre-intervention study this individual only opened the door briefly to ask a question and switched the fan on half way though spraying, in the post-intervention study they ventilated the room and had the fan switched on throughout. Although it was hypothesised that there may be a causal association between risk perception and cumulative exposure, no association was found.

It was believed that any changes in cumulative exposure induced by the programs would be slowly lost over a period of time. It was also thought that the extent of these changes would differ between the two approaches. As little change was evident after the first post­intervention study, it was thought unlikely that any other significant changes would be noted in the subsequent studies. Howeve r, on average, cumulative exposures at the second and third post-intervention studies were lower than at pre-intervention, and this decrease was statistically significant for the fourteen participants at the second post-intervention study. The decreases in exposure were apparent for users of both packages. This finding was probably due to individuals switching on the fan and opening the door earlier in the task thus ventilating the room more efficiently. Indeed, this was found to be the case in several

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instances. Possible reasons for this change may be due to subjects developing positive opinions about ventilating the room, finding that the use of ventilation helped to make the painting area more pleasant to work in, thus deciding to use it earlier. It is also possible that a practice effect was occurring, with the subjects becoming more used to the task, and what was expected of them.

It was noted that some subjects, who had experienced a decrease in exposure at the first post­intervention study, had cumulative exposure levels that were gradually increasing over time although remaining below pre-intervention levels. This suggests that, for some people at least, the training effects of the packages may gradually be being lost. It was also interesting to note that there was some evidence that older subjects showed smaller decreases in exposure immediately post-intervention. This was probably linked to behavioural changes and evidence that those who positively changed their use of the door to ventilate the room were on average, slightly younger. It may be that the older subjects had more experience of using paint products and having suffered no adverse health effects in the past, continued to use the products in the manner they would normally. Unsafe working is not based on reasoned behaviour but merely becomes a habit or routine (DeJoy, 1996). Similar findings were found in Hatem and Lehtons’ (1995) study, which concluded that the lack of compliance with protective measures when using a glue was due to subjects using potentially faulty rules developed from past experiences of using the product.

6.3 COST - BENEFITS OF USING MULTIMEDIA TECHNOLOGY

There is a plethora of literature, which indicates that multimedia materials promote more positive attitudes towards learning and are being increasingly used in occupational health and safety training. This research has focussed primarily on the use of SDS as information tools for employees, developing multimedia packages to present this information in a more effective manner. Overall the results suggest that the mmSDS was at least as effective as the SDS package in communicating hazard and risk information and was found to significantly increase knowledge in the workplace evaluation studies over the SDS. The ultimate goal of any health and safety intervention is to reduce exposure. Although the embalming fluid mmSDS was unable to do this due to workplace constraints, the paint mmSDS was found to promote more positive behavioural changes than the SDS. Taking into account the many limitations of the studies, these finding are important and suggest that mmSDS may indeed be a more effective method for communicating SDS information within industry.

The subjects’ responses in the subjective assessment questionnaires also suggested that the mmSDS was the more preferred information provision in both studies. As subjects were only trained using one of the SDS packages and did not know about the existence of the other; their judgements were based only on their experience of the one particular program. It is recognised that there are cost ramifications for industry in implementing and using such tools and it is important to discuss some of the costs and benefits associated with them.

Koegel-Buford (1994) reported that there were a number of barriers to the widespread use and success of multimedia authoring systems. These included cost of acquisition, development and delivery of multimedia, difficulties with production quality and ease of use of tools. Although these comments may have been true in 1994, substantial advances have helped make them more easily available, accessible, with cheaper computers and user–friendly authoring systems (Premkumar et al, 1998). Takula (1993), although discussing the use of CD-ROM technology within developing countries, raises an important issue in that it is more difficult to modify information within CD-ROMs compared to paper products and that this would require technical assistance. However Rosser et al (2000) argues to one of the perceived benefits of computer assisted instruction is that software can be quickly and

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economically adjusted to advances in knowledge and training. Providing the company has access to skills to do this it should not present a problem.

Considering the costs associated with traditional training such as trainers’ salaries, travel and accommodation (Tyman, 1993) and that multimedia systems have been shown to increase the speed at which adults learn (Greaves and Heideman, 2000; Goh et al, 1998; Huddock, 1994), multimedia is usually less expensive over time. Perhaps the greatest benefit to the employer and employees of using multimedia -training tools is the flexibility they provide in terms of allowing users to pursue training at times that are convenient for them. With regards to the embalmers, variable workloads meant that it was often difficult to arrange studies and their time was often very limited. Multimedia CD-ROMs would provide users with the ability to progress through the material at their own pace at times convenient for them.

The most serious obstacle in the use of multimedia as training tools is the need to integrate computer technology within workplaces. Indeed when the study commenced, none of the funeral homes surveyed had computers. However, research suggests that this obstacle is quickly being overcome. In the fifth series of International Benchmarking Studies by the Department of Trade and Industry (DTI, 2001) aimed at “measuring the UK's progress towards the information age”, it was found that the Government's target of 1.5 million micro, small and medium-sized businesses going online by 2002 has already been exceeded. The proportion of businesses with access to the Internet is now at 94% in the UK. Looking at this figure in greater depth, 91% of small businesses (less than 49 employees) and 76% of micro businesses (less than 10 employees) have access to the Internet, with the percentages rising yearly. It safe to assume that the vast majority of these businesses will have computers with CD-ROM capabilities, indeed in a previous survey which found that 91% of businesses had computers, 73% of these had a CD-ROM (ISI, 1998). It was also noted that all the funeral homes surveyed now have computers installed, which have CD-ROM and Internet access. As computers can also be used for many other purposes such as word processing and budget preparation, this would also help justify the initial expenditure to any company.

The use of multimedia as a training tool is expanding at a rapid rate and more and more information is being disseminated over the Internet. As mentioned earlier, a large percentage of businesses are already connected to the Internet and this offers many advantages in that information can be accessed quickly and easily and can simply be exploited for training purposes. It is important to be aware that training and information needs are changing and steps should be taken to exploit information technology for the benefit of product manufacturers and employees alike.

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7. CONCLUSION

Employers have a legal obligation to inform their workers about the hazards and risks associated with using hazardous substances and SDSs play an important part in communicating this information to employees, particularly within small to medium sized enterprises. There is however, clear evidence to suggest that SDSs are an ineffective way of communicating information to employees. This gives cause for concern given that knowledge of likely risks associated with the products being used should allow employees to take appropriate protective steps when working. If they are not able to understand or read this information, then there is reason to believe that they will not be able to adopt the appropriate protective measures. In contrast to written hazard and risk communication, studies have shown that training is capable of inducing protective behaviour amongst users of hazardous substances, with the relative effectiveness of training programmes being related to their interactive nature, plus the use of visually attractive support materials.

This project focussed on the use of SDSs as information provision by employers. The aim of the project was to develop mmSDS for two products, which it was hoped would provide a more reliable way of communicating essential chemical hazard and risk information to workers and a more effective way for employers to fulfil their legal obligations with respect to information and training. The main hypotheses being tested in the experimental studies were that following the intervention, knowledge would increase and that this would change attitudes and risk perception towards the products resulting in positive behavioural changes, which would ultimately bring about reductions in personal exposure to the hazardous substances. It was also anticipated that the changes induced by both programs would be slowly lost over a period of time and that the extent of these changes would differ between the two approaches. Despite the many limitations of both the workplace and the laboratory evaluation studies, the results were encouraging.

In terms of increasing knowledge, the mmSDS was initially found to be more effective than the SDS in the workplace evaluation studies, with these increases either being gradually lost or flattening off over time. In the laboratory studies involving novice users, the number of questions answered correctly was found to nearly double post training although there were no statistically significant differences between the two packages. The increase in knowledge was also found to be maintained over time, with overall knowledge scores still being significantly higher at the second and third post intervention studies compared to pre-intervention, although aga in there were no significant differences between the two packages. Overall the results suggest that the mmSDSs were probably slightly better than the conventional SDS packages in communicating hazard and risk information in the workplace. It was also encouraging to find that knowledge was still significantly higher at the longer post intervention periods for both packages.

Although significant increases in knowledge occurred after receiving the packages, there was little change in subjects’ attitudes towards the hazardous substances. However, it was perhaps presumptuous to assume that browsing though either one of these multimedia packages, for on average 11-45 minutes, would change the subjects’ attitudes given that attitudes are relatively enduring, formed in a complex manner and evidence suggests that they cannot be changed by a one off campaign. It may be that repeated access to the information over a period of time would be necessary before any significant changes in attitude would occur and that simply giving someone information may be insufficient to alter their views. Similar findings were seen for changes in risk perception, although there was some indication that users of the SDS package in the laboratory study were more likely to show an increase in specific risk perception immediately after training. However there were no associations

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between knowledge, risk perception and cumulative exposure and this increase in risk perception was not maintained over the post intervention studies.

Although no major changes in attitude and risk perception were noted, we were most interested in changing workers’ behaviour whilst using hazardous substances and ultimately reducing their exposure. In the workplace evaluation studies, little change in behaviour was observed after the interventions. However, this was probably due to the fact that the majority of the subjects were already using all the available protective measures and that there was little opportunity for any improvement. Given that there was little scope for behavioural changes, it was not surprising that there were no statistically significant changes in cumulative exposure after receiving the packages. Nevertheless, this data suggests that transitory reductions in average exposure of about 20% might be expected from viewing hazard and risk information in a SDS. In this study, it was thought possible that the changes in exposure were due to very small changes in the workers behaviour and more care being taken when using the fluids.

The results for the laboratory studies were encouraging. Increases in the use of protective equipment, ventilation and hand washing were recorded in the first post intervention study, with the mmSDS package inducing more positive changes in the use of masks, gloves and hand washing than the SDS package. It was also found that both packages were capable of promoting long-term positive behavioural changes. These are important findings given that previous research suggests that changing behaviour is very difficult and simply informing individuals that they are at risk from a hazard is rarely sufficient to change behaviour. Despite increased knowledge and observable behavioural changes, the average change in exposure for the laboratory study population was found not to be statistically different in the first post intervention. Cumulative exposures at the second and third post-intervention studies were lower than at pre-intervention and decreases were apparent for users of both packages. This finding was probably due to individuals switching on the fan and opening the door earlier in the task thus ventilating the room more efficiently. Although there were no significant differences in exposure between the two packages, it is thought that the mmSDS subjects total exposure (including dermal exposure) to the paint solvent would be less given that the information promoted more positive changes in the wearing of masks and gloves than the SDS package.

Taking into account the many limitations of the studies, these finding are encouraging and suggest that mmSDS may indeed be an effective method for communicating SDS information within industry. The subjects’ responses in the subjective assessment questionnaires also suggested that the mmSDS was the more preferred way of obtaining information in both studies. As previously discussed, it is possible that training effects may have been missed or reduced due to longer time periods between the interventions and reassessment for some subjects and that the packages may actually have been more effective than our data suggests. It would be valuable to evaluate the packages further within more static populations so that reassessment could be undertaken at distinct time points to help determine whether this is indeed the case.

As the lag times between measurements were variable, it was not possible to clearly indicate when refresher training should be conducted. Further studies at distinct time points would also help address this question. It is also important to again emphasise that the characteristics of the subjects used in the studies were very different, with the embalmers being well educated and trained in the use of chemicals in their jobs and the general public essentially “novice” users of the chemicals. This may well have influenced the results obtained and it would be valuable to evaluate such tools within SMEs with employees more typical of the general working population. Lastly, the developed mmSDS packages also had two other streams of information (technical and management) that were not assessed as part of this

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research. It would be useful to develop these sections further, ultimately evaluating the effectiveness of the mmSDS as a management and risk assessment tool and determining whether the mmSDS is more effective than the conventional SDS at promoting control of exposure to hazardous substances from a more senior level in organisations. The use of multimedia technology is ever increasing and there is tremendous scope for it to be utilised in occupational health and safety. There is a clear need for hazard and risk information in SDS to be communicated in a more effective manner to all sections of the workforce and the concept of mmSDS should be explored further.

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8. ACKNOWLEDGEMENTS

The authors wish to thank the following companies and organisations for their help throughout this research project. Firwood Paints Company, The Dodge Company, British Institute of Embalmers, P.B. Wright Funeral Directors, Stephen Clark Fabrications and Wayne Autocourt. We would also like to thank all those that took part in the focus groups and evaluation studies. Lastly, we would also like to thank Dr. Kathryn Mearns, University of Aberdeen and all the Institute of Occupational Medicine staff for their support, help and advice throughout the research.

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APPENDIX 1

Selected screen shots from the mmSDS

73

74

APPENDIX 2 (A)

Effective Communication of Hazard and Risk Information

Embalmers Assessment Proforma

A. General Information

1. Employee name :

2. Employee code: E0 /

3. Date of visit: / /

4. Company details:

5. Company Code:

6. Purpose of visit

Name:

Address:

Postcode:

Telephone number:

E0 /

Tick one box 1. Initial visit � 2. Day after receiving MM-SDS / SDS � 3. One month after receiving MM-SDS / SDS � 4. Five months after receiving MM-SDS / SDS �

75

B. Sampler information

1. Sample code:

2. Monitoring details

Time Flow rate (ml) Start

End

Total sampling time = mins Average flow rate = ml

3. Any problems with monitoring equipment?

Yes � Provide details:

No � (In the event that more than one sample is to be obtained on each visit, a separate assessment proforma will be completed).

4. Blank code

(Information to be completed after visit)

5. Date sample submitted to lab

6. Date sample analysed

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C. Control measures

N.B. Check individual is ready to start activity before recording details

1. Personal protective equipment

Worn Y / N

Type and condition

Worn correctly? Y/N

Removed? Y/N

*Provide details

Face mask

Gloves

Eye protection

Overalls

Gown

Waterproof apron

Waterproof arm sleeves

Other (specify)

Note: * provide details i.e. reasons for removal, how the item was removed, how long the item was removed for, measures taken before donning again etc.

Were any items of PPE not worn at start of activity subsequently donned during sampling period?

Yes � Provide details:

No �

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Were the following items of PPE cleaned after use?

( Yes/No ) *Provide details Face mask

Gloves

Eye protection

Overalls

Gown

Waterproof apron

Waterproof arm sleeves

Other (specify)

Note * i.e. how were the items cleaned, were they cleaned before or after removal etc.

Storage of PPE during lunch / tea breaks.

Provide details:

Storage of PPE at the end of shift.

Provide details:

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2. Use of Barrier cream

Was barrier cream:

Yes No If yes, provide details Applied before donning gloves / working with fluids? � � During embalming activity? � � After embalming activity? � �

3. General Ventilation

Show location of windows, doors, LEV systems in relation to main embalming activities.

Are there any windows in the embalming theatre?

Yes � No � If yes, were these opened during the sampling period?

Yes � Provide details:

No �

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� �

� �� �� �

4. Local exhaust ventilation

Is there a LEV system in the embalming theatre?

Yes � No �

If yes, provide details (i.e. description and condition):

Did the participant:

Yes No Switch on the LEV system at any time during sampling period?

If yes, did they switch on LEV system before using the fluids?

Or, did they switch on the LEV system just before embalming?

Or, did they switch on the LEV system at some other point during the sampling period (give details).

If used, did the participant switch off the LEV system at any time during the sampling period?

Yes � Provide details i.e. duration, reason why?

No �

5. Hand washing

Did the participant wash their hands at any point during the sampling period?

Yes � *Provide details:

No � *i.e. reason for washing hands and whether soap was used

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D. Information regarding deceased

Age :

Sex:

Estimated weight:

Elapsed time between death and embalming (days):

Condition of remains:

Purge � Rigor mortis � Dropsical � Jaundiced � Discoloration � Tissue Gas � Emaciated � Decomposed � Skin slip � Oedema � Body refrigerated �

E. Arterial embalming

Diluting fluid:

Start time Finishing time Name of fluid Amounts of fluid used (amount of concentrate and water used)

Total amount of fluid diluted

Describe methods used to dilute arterial fluid (i.e. use of ventilation systems and PPE:

Did any spills or splashes occur during dilution of fluids?

Yes � Provide details i.e. severity, how they were cleaned up etc.

No �

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Embalming techniques:

Arteries injected Veins drained

Start time: Finish time: Start time: Finish time:

Carotid R L Jugular R L Subclavian R L Axillary R L Axillary R L Iliac R L Brachial R L Femoral R L Iliac R L Femoral R L Radial R L Ulnar R L Injection intermittent yes / no Drainage intermittent yes / no Injection continuous yes / no Drainage continuous yes / no

Total amount of fluid injected = Total amount of fluid drained =

Did any spills or splashes occur during injection and drainage process?

Yes � Provide details i.e. severity, how they were cleaned up etc.

No �

F. Aspiration

Start time: Finish time:

Did any spills or splashes occur during aspiration?

Yes � Provide details i.e. severity, how they were cleaned up etc.

No �

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G. Cavity embalming

Name of fluid:

Standard Index of fluid:

Quantity of fluid used:

Start time Finish time

Where cavities treated immediately after injection?

Yes �No � If delayed, how long?

Describe technique:

How is incision closed?

Suture � Trocar button �

Did any spills or splashes occur during cavity treatment?

Yes � Provide details i.e. severity, how they were cleaned up etc.

No �

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H. Housekeeping

Give details of level of housekeeping in area (i.e. replacement of lids on containers, prompt disposal of fluid-soaked clothes etc…)

I. Disposal of waste fluids

Give details of techniques used to dispose of waste fluids (i.e. use of control measures)

J. Information on eating, drinking and smoking habits during visit

Time Event (E, D or S)

Where? (E.T or D.A)

Hands washed? Yes / No

PPE removed? Yes / No

Note: E = Eating, D = Drinking, S = Smoking E.T. = Embalming Theatre, D.A = Designated area

K. Storage of embalming fluid containers

Provide details on the fluid storage area.

84

L. Incidents

Give details of events not otherwise described.

Time Details

85

86

APPENDIX 2 (B)

Laboratory Study Spray Painting and the General Public Proforma

A. General Information

1. Participant name

2. Participant Code

3. Date of visit 4. Tape Number

5. Monitoring Visit (Tick one box)

/ /

1 2 3 4

� � � �

B. Sampler information

1. Sample code:

2. Monitoring details

Time Flow rate (ml) Start

End

Total sampling time = mins Average flow rate = ml

3. Blank code:

4. Any problems with monitoring equipment?

Yes � Provide details:

No �

87

C. Control Measures

N.B. Participant must wear overalls, overshoes and safety glasses

1. Personal protective equipment worn at start of sampling period

Worn ( Y / N )

Removed during sampling period

(Y/N)

*Provide details

Face mask (standard provided at DIY shops) Face mask (3M)

Safety glasses

Safety goggles

Disposable gloves

Note: * Provide details i.e. reason for removal, how the item was removed, measures taken before donned again etc.

2. Were any items of PPE not worn at start of activity subsequently donned during sampling period?

Yes � Provide details:

No � 3. Did individual ask for help in selecting PPE / donning PPE?

Yes � Provide details of questions asked and responses given:

No �

88

� �

� �� �� �

� �

4. Use of LEV system

Did the participant:

Yes No Switch on the LEV system at any time during sampling period?

If yes, did they switch on LEV system before using the paint product?

Or, did they switch on the LEV system just before spray painting?

Or, did they switch on the LEV system at some other point during the sampling period (give details).

If used, did the participant switch off the LEV system at any time during the painting activity?

Yes � Provide details:

No �

If used, did the participant:

Yes No Adjust the LEV system at any time during sampling period?

If yes, give details of time and task undertaken when system was adjusted.

If yes, which direction (and how many turns) did they adjust the face of the fan?

If LEV system was used, provide diagram of individuals working position in relation to extract fan.

89

� �

� �� �� �

5. Use of natural ventilation

Did the participant:

Yes No Open the door at any time during sampling period?

If yes, did they open the door before using the paint product?

Or, did they open the door just before spray painting?

Or, did they open the door at some other point during the sampling period (give details).

If opened, did the participant close the door at any time during the painting activity?

Yes � Provide details:

No �

If opened, provide diagram of individuals working position in relation to the door.

6. Hand washing

Did the participant wash their hands at any point during the sampling period?

Yes � *Provide details:

No � *i.e. reason for washing hands and whether soap was used

7. Did the participant eat or drink any of the refreshments provided?

Yes � *Provide details:

No �

90

D. Painting Activity

1. Breakdown of activities

Start time End time Total duration (mins) Decanting / mixing paint Spray painting

2. Did participant replace the lid after decanting the solvent?

Yes �No �

3. Did participant replace the lid after decanting the paint?

Yes �No �

4. Assessment of participant’s mixing technique (tick appropriate box).

Good � (Very controlled technique, no spillage)

Fair � (Quite controlled, little spillage)

Poor � (Very messy worker, lot of spillage)

5. Assessment of participants spray technique (tick appropriate box).

Good � (Very controlled technique and very little over spray)

Fair � (Quite controlled, some over spray)

Poor � (Very messy worker, lots of over spray)

6. Paint spills

Did any paint spills occur during the visit?

No �Yes � Provide details i.e. severity, how they were cleaned up etc.

:

91

7. Quantities of liquids used

Liquid Start (ml) End (ml) Quantity used (ml)

Water 500

White spirit 250

8. Amount of paint mixture remaining in spray gun =

E. Temperature and humidity of room..

Start End Average Temperature

Humidity

F. Details of events, comments, questions not otherwise described.

Time Details

92

APPENDIX 3

EMBALMERS KNOWLEDGE ASSESSMENT, ATTITUDES AND RISK PERCEPTION QUESTIONNAIRE

Research project carried out by the University of Aberdeen and Institute of Occupational Medicine on behalf of the Health

and Safety Executive

Questionnaire

The University of Aberdeen and the Institute of Occupational Medicine, Edinburgh, are carrying out a number of surveys in companies that are involved in embalming.

The purpose of this survey is to find out how much you know about the hazards and risks associated with using Standard Arterial (Index 26) and Cavity (Index 24) embalming fluids, as well as helping us understand more about your work. (These are fluids that you either use, or are similar to those that you frequently use at work).

We would be grateful if you would take the time to fill in this questionnaire which should take about 25 to 30 minutes to complete. The questionnaire is split into six sections, with guidance being given on how to complete the questions in each section. Please attempt to answer ALL the questions and avoid discussing your answers with your work colleagues.

All responses will be treated in strictest confidence and will only be seen by members of the research team. Your employer will not see your responses.

Once completed, please place the questionnaire in the envelope provided and return it to the researcher.

93

Section A - Knowledge

Instructions

Please read each of the following statements carefully and tick the answer(s) that you think are correct. If you are unsure or do not know the answer, tick the “Do not know” box. Please tick only one box for each question, unless otherwise indicated.

Questions

1. Standard Arterial and Standard Cavity fluids can harm your body by …

(please tick all those that apply)

a. Being breathed in by the lungs � b. Being accidentally swallowed � c. Through contact with your skin � d. Through contact with your eyes � e. Do not know �

2. Both Standard Arterial and Cavity embalming fluids contain a substance called formaldehyde. What are the possible risks to health associated with this substance?

(please tick all those that apply)

a. It can cause occupational asthma � b. It may cause sensitisation by skin contact � c. It can be toxic if swallowed � d. It can cause cancer in humans � e. Do not know �

3. Both Standard Arterial and Cavity embalming fluids contain a substance called methanol. What are the possible risks to health associated with this substance?

(please tick all those that apply)

a. It can cause occupational asthma � b. It may cause sensitisation by skin contact � c. It can be toxic if swallowed � d. It can cause cancer in humans � e. Do not know �

94

4. Standard Arterial and Cavity bottles should be stored in warm, sunny areas.

True � False � Do not know �

5. Standard Arterial and Cavity fluids are dangerous to the environment.

True � False � Do not know �

6. The most effective way of controlling your exposure to embalming fluid vapours is by ventilating the embalming theatre.

True � False � Do not know �

7. Standard Cavity fluid is not flammable.

True � False � Do not know �

8. Maximum Exposure Limits are the concentrations of a hazardous substance (averaged over 8hr and 15min time periods) which are not thought to be a risk to workers health.

True � False � Do not know �

95

9. Which of the following will release formaldehyde vapours into the air?

(please tick all those that apply)

a. Fluid soaked cloths and sponges � b. Open fluid bottles � c. Embalming fluid spills � d. Using glass pressure jars to administer arterial �

fluids which have cracked seals e. Do not know �

10. Which of the following are possible symptoms of being exposed to high levels of embalming fluid vapours?

(please tick all those that apply)

a. Headaches � b. Tiredness � c. Vomiting � d. Sore eyes � e. Do not know �

11. What action should you take if someone accidentally swallowed large amounts of concentrated Standard Arterial or Cavity fluid?

(please tick all those that apply)

a. Seek medical attention straight away � b. Move them to an area with fresh air � c. Ensure that they do not drink water or any other fluids � d. Encourage the individual to vomit as quickly as possible � e. Do not know �

Please turn to next page

96

Section B - Knowledge

Instructions

This section contains four multiple-choice questions. Please read each question carefully and tick the answer that you think is correct. If you are unsure or do not know the answer, tick the “do not know” box. Please tick only one box for each question.

Questions

1. Standard Arterial and Cavity have been assigned several risk phrases that provide information on how these fluids can affect the body. What does the risk phrase R21 mean?

a. The embalming fluid vapours are toxic if breathed into the lungs. � b. The embalming fluids can irritate the eyes. � c. The fluids can cause burns. � d. The fluids are harmful when in contact with the skin. � e. Do not know. �

2. The hazard symbol is displayed on Standard Arterial and Standard Cavity fluid bottles. Does this mean that these fluids are,

a. Dangerous to the environment � b. Corrosive � c. Harmful or an irritant � d. Toxic � e. Do not know. �

3. Which of the following statements is NOT true regarding skin contact with concentrated Standard Arterial and Cavity embalming fluids?

a. Repeated contact with these fluids can dry out your skin. � b. The substances found in these fluids cannot be absorbed through �

intact skin. c. Some individuals can experience an allergic reaction if their �

skin comes into contact with these products. d. Contact with concentrated fluids can burn your skin. � e. Do not know. �

97

Section C – Attitudes to embalming fluid hazards and safety

Instructions

Please read each of the statements on the following pages carefully and tick the box that most closely matches your opinion.

Please tick only one box for each question.

Please turn to next page.

98

Strongly Agree Neither agree Disagree Strongly agree or disagree disagree

1. I am more concerned with the health risks associated with handling � � � � � cases than those associated with embalming fluids.

2. I see no reason why I can’t eat, drink or smoke in the embalming � � � � � theatre.

3. I don’t worry if I occasionally suffer headaches or sore eyes when � � � � � embalming, its just part of the job.

4. Safety is at the forefront of my mind when working with embalming � � � � � fluids.

5. I always take care to look after my personal protective equipment � � � � � properly.

6. Using ventilation systems can be more trouble than they are worth. � � � � � 7. Despite what the scientists say, I think formaldehyde can cause � � � � � cancer in humans.

8. People worry more than is necessary about the hazards associated � � � � � with using formaldehyde based embalming fluids.

9. Given the opportunity, I would use further measures to help protect � � � � � my health when using embalming fluids.

10. If a person is exposed to a chemical that can make them ill then that � � � � � person will probably become ill someday.

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Strongly Agree Neither agree Disagree Strongly agree or disagree disagree

11. I think the risks associated with embalming fluids are sufficiently � � � � � controlled in my workplace.

12. I find that my personal protective equipment is often uncomfortable. � � � � �

13. If I experienced headaches and felt sick whilst using embalming � � � � � fluids, I would report it straight away to my employer.

14. My employer doesn’t do enough to protect my health and safety. � � � � �

15. I can help protect my health and safety when using embalming fluids � � � � � by making slight changes to the way I work.

16. Accidentally mixing formaldehyde based fluids and bleach together � � � � � would not worry me.

17. always make sure that the ventilation system is switched on � � � � � whenever I am using embalming fluids

18. I think embalming fluids are safe as long as they are handled and � � � � � used in the correct manner.

19. I feel that I have little control over work related risks to my health. � � � � �

20. It is easy to incorporate safe working practices when embalming. � � � � �

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Section D – Risk perception

This section contains nine statements, each detailing an activity involving the use of Standard Arterial or Standard Cavity embalming fluids.

For each of the activities, we would like you to indicate, by ticking the appropriate box, what you think the risk of the embalmer experiencing ill-health effects would be.

For each of the activities you should assume the following: • There is only one embalmer working in the embalming theatre. • All windows and doors are shut unless otherwise indicated. • The embalming theatre has a local exhaust ventilation system. This is switched on

and working correctly unless otherwise stated. • The embalmer is no t wearing any respiratory protective equipment unless

otherwise stated.

Please tick only one box for each statement.

Please turn to the next page

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Activities Risk of individual experiencing ill-health effects

None Low Medium High Very high 1. Using a cavity injector that is leaking.

2. In the event of an embalming fluid spill, drenching spill area immediately with lots of water.

3. Leaving Standard Arterial and Cavity bottles open and embalming fluid soaked cloths and sponges lying in the work area whilst carrying out other tasks.

4. Leaving viscera soaking in an open bucket containing Standard Cavity fluid.

5. Carrying out embalming activities without switching on the local exhaust ventilation system.

6. Using glass pressure vessels with seals that are cracked and damaged.

7. Carrying out embalming activities whilst using a local exhaust ventilation system that has its extraction point near the ceiling.

8. Diluting Standard Arterial embalming fluid whilst not wearing Protective gloves.

9. Wearing a cartridge respirator when embalming which has never been stored correctly during lunch breaks and over-night.

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� � � � � � � � � � � � � � � � � � � �

Section E – General risk perception

This section is split into two parts.

Part A contains five statements that describe activities that do not involve using embalming products. For each of these activities, please indicate, by ticking the appropriate box, what you think the risk of an individual experiencing an accident or ill-health effects would be.

Please tick only one box for each statement.

Activity Risk of an accident / ill-health effects occurring

None Low Medium High Very high 1. Using an electric fire in the

bathroom.

2. Driving a car when just over the legal drink limit.

3. Smoking a single cigarette.

4. Working up a ladder without someone in support at the bottom.

5. Smoking 20 cigarettes a day all their adult life.

For Part B, please indicate, by ticking the appropriate box, what you think the risk to health for the average person in Great Britain is from the following hazards.

Please tick only one box for each statement

Hazard Almost Slight Moderate High no risk

1. Prescription drugs

2. Drinking alcohol

3. Bottled water

4. Depletion of the ozone layer

5. Cigarette smoking

Section F – Organisational Issues

This section contains five questions. Please read each question carefully and tick the appropriate number of boxes.

Questions

1. Have you had any health and safety information about embalming from your current employer?

(please tick one box) Yes � Go to question 2

No � Go to question 5

2. If yes, what format did this take? (please tick all those that apply)

a. Company induction training � b. During embalming qualification course � b. Additional health and safety training session � c. A demonstration on how to use respiratory protective equipment � (i.e. masks) correctly.d. A demonstration on how to use ventilation systems correctly � e. A leaflet or information sheet � f. Posters / signs on the wall �

3. Did this information include any of the following? (please tick all those that apply)

a. The possible risks to health from using embalming fluids � b. How to use ventilation systems properly � c. How to use respiratory protective equipment properly � d. How to clean up embalming fluid spills properly � e. Employers responsibilities for your health and safety � f. Your responsibilities for health and safety �

4. How long ago did you receive the information? (please tick one box)

a. Less than 6 months ago � b. Between 6 months and 2 years ago � c. More than 2 years ago �

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5. Have you had any health and safety training or guidance on embalming in a previous job?

(please tick one box) Yes � No �

Please turn to the next page.

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Section G - Personal

To help us in our research, please enter the following information in the spaces provided below.

1. Name_________________________________________________

2. Age ____________

3. Gender Male � Female �

4. Company______________________________________________

5. Job title_______________________________________________

6. How long have you worked as an embalmer with this company? (please tick one box)

a) Up to one year � b) More than one year but less than 5 � c) More than 5 years but less than 10 � d) More than 10 years but less than 20 � c) More than 20 years �

7. Do you currently smoke tobacco products i.e. cigarettes? (please tick one box)

Yes, every day � Yes but only occasionally � No �

If yes, how many cigarettes, on average, do you smoke per day? ________________

If no, are you an ex-smoker? (please tick one box)

Yes � No �

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8. Do you drink alcoholic drinks? (please tick one box)

Yes � No �

If yes, how often do you drink alcohol? (please tick one box)

Every day Once or twice a week

Once every two to three weeks

Less than once a month

� � � �

Thank you for taking the time to complete this questionnaire. Please return the questionnaire to the researcher in the envelope provided.

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108

APPENDIX 4

Painting Knowledge Assessment and Risk Perception Questionnaire

Department of Environmental and Occupational Medicine

Spray painting and the general public

Participant number: Date: / /

Knowledge and risk perception questionnaire

The purpose of this questionnaire is to find out how much you know about the hazards and risks associated with using Firglo 700, the paint product that the University of Aberdeen is testing.

We would be grateful if you would take the time to fill in this questionnaire which should take about 15 minutes to complete. This questionnaire is split into four sections, with guidance being given on how to complete the questions in each.

Please attempt to answer ALL the questions. All responses will be treated in strictest confidence and will only be seen by members of the research team.

Once completed, please return the questionnaire to the researcher.

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Section A - Knowledge

Instructions

Please read each of the following statements carefully and tick the answer that you think is correct. If you are unsure or do not know the answer, tick the “Do not know” box. Please tick only one box for each question, unless otherwise indicated.

1. Firglo 700 can be hazardous to health if it is not used and handled correctly.

True � False � Do not know �

2. If you accidentally swallowed Firglo 700 paint, you should try to vomit it up as quickly as possible.

True � False � Do not know �

3. You don’t have to wear safety glasses when spray painting with Firglo 700.

True � False � Do not know �

4. Firglo 700 paint is not flammable.

True � False � Do not know �

5. It is perfectly safe to spray paint whilst standing between the object being painted and the air extraction point.

True � False � Do not know �

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6. By which of the following routes, if any, could Firglo 700 enter the body? (please tick those that apply)

a. By being breathed in by the lungs � b. By being accidentally swallowed � c. By passing through cut or grazed skin � d. By passing through intact skin � e. None of these routes �

7. What protective clothing, if any, do you think is necessary to be worn when spraying Firglo 700 paint?

(please tick those that apply)

a. Eye protection i.e. goggles or safety glasses � b. Face mask � c. Rubber gloves � d. Boiler suit � e. It is not necessary to wear protective clothing �

8. Which of the following are symptoms of breathing in high levels of paints?

(please tick those that apply)

a. Headaches � b. Dizziness � c. Vomiting � d. Tiredness � e. Do not know. �

9. The symbol � is displayed on Firglo 700 paint tins. This means the paint is:

a. Dangerous to the environment � b. Corrosive � c. Harmful or an irritant � d. Toxic � e. Do not know. �

Please turn to next page

111

Section B – Attitudes to paint hazards and safety

Instructions

Please read each of the statements on the following pages carefully and tick the box that most closely matches your opinion.

Please tick only one box for each question.

Please turn to next page.

112

Strongly Agree Neither agree Disagree Strongly agree or disagree disagree

1. I see no reason why I can’t eat, drink or smoke in the paint spraying or � � � � � surrounding areas.

2. I don’t worry if I occasionally feel dizzy or suffer headaches when using � � � � � paints.

3. If a person is exposed to a chemical that can make them ill then that � � � � � person will probably become ill someday.

4. I always take care to ventilate areas where painting activities are being � � � � � carried out.

5. I think Firglo 700 paint is safe as long as it is handled and used in the � � � � � correct manner

6. There is no need to use protective measures if I am only paint spraying for � � � � � a short period of time.

7. I am troubled by the possibility of skin contact with the paint. � � � � �

8. I am worried that using paints may cause cancer. � � � � �

9. I would not be worried about using this paint in a poorly ventilated area. � � � � �

10. I am worried that using paint may harm my health in some way. � � � � �

� � � � � � � � � � � � � � �

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� � � � �

� � � � �

� � � � �

Section C – Risk perception

1. Detailed below is a list of activities involving the use of Firglo 700 paint.

For each of these activities, we would like you to indicate, by ticking the appropriate box, what you think the risk of experiencing ill-health effects would be.

Please tick only one box for each statement

Activity Risk of ill-health effects occurring None Low Medium High Very high

1. Spray painting in a well-ventilated area without a face-mask 2. Wearing protective gloves whilst

handling and using paints. 4. Leaving paint tins open whilst

carrying out other, non-painting tasks in the area.

5. Spray painting in an area where no doors/windows are open

2. Detailed below are five statements that describe activities that do not involve using paints.

For each of these activities, please indicate, by ticking the appropriate box, what you think the risk of an individual experiencing an accident or ill-health effects would be.

Please tick only one box for each statement.

Activity Risk of an accident / ill-health effects occurring None Low Medium High Very high

1. Using an electric fire in the bathroom.

2. Driving a car when just over the legal drink limit.

3. Smoking a single cigarette.

4. Working up a ladder with someone in support at the bottom.

5. Smoking 20 cigarettes a day all their adult life.

114

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3. For the following statements, please indicate, by ticking the appropriate box, what you think the risk to health for the average person in Great Britain is from the following hazards.

Please tick only one box for each statement

Hazard Almost Slight Moderate High no risk

1. Prescription drugs

2. Drinking alcohol

3. Bottled water

4. Depletion of the ozone layer

5. Cigarette smoking

Please turn to next page

115

Section D - Personal

To further help us in our research, we would be grateful if you could answer the following questions in the spaces provided.

1. Do you currently smoke tobacco products i.e. cigarettes? (please tick one box)

Yes, every day � Yes but only occasionally � No �

If yes, how many cigarettes, on average, do you smoke per day? _________________

If no, are you an ex-smoker? (please tick one box)

Yes � No �

2. Do you drink alcoholic drinks? (please tick one box)

Yes � No �

If yes, how often do you drink alcohol?

Every day Once or twice a Once every two to Less than once a week three weeks month

� � � �

Thank you for completing this questionnaire. Please return it to the researcher

116

APPENDIX 5

EXAMPLE OF mmSDS SUBJECTIVE ASSESSMENT QUESTIONNAIRE

Department of Environmental and Occupational Medicine

Spray painting and the general public

Participant number: Date: / /

Questionnaire

Now that you have browsed through “Firglo 700 – Interactive Safety Data”, we would like to find out your thoughts on the computer program.

We would be grateful if you would take the time to fill in this questionnaire which should take about 5 to 10 minutes to complete. Guidance is given on how to complete each question. Please attempt to answer ALL the questions.

All responses will be treated in strictest confidence and will only be seen by members of the research team.

Once completed, please return the questionnaire to the researcher.

117

� � � �

� � � �

Section A – Use of computers

1. Do you have a computer at home?

(please tick one box) Yes � Go to question 2

No � Go to question 3

2. If yes, how often do you use the computer? (please tick one box)

Every day Once or twice a Once every two to Less than once a week three weeks month

3. In your last or present employment, did / do you use a computer as part of your job? (Students – please note down your use of computers at University).

(please tick one box) Yes � Go to question 4

No � Go to question 5

4. If yes, how often did / do you use the computer? (please tick one box)

Every day Once or twice a Once every two to Less than once a week three weeks month

5. How do you feel about using computers? (circle a number on the scale of 1–5)

Confident 1 2 Relaxed 1 2 Good at it 1 2

3 4 5 Not confident 3 4 5 Nervous 3 4 5 Bad at it

Please turn to next page

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� � � � �

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Section B – Comments on “Firglo 700 – Interactive Safety Data”

a. Please read each of the statements carefully and tick the box that most closely matches your opinion. Please tick only one box for each statement.

“I found “Firglo 700 – Interactive Safety Data” ……………….

Strongly Agree Neither Disagree Strongly agree agree nor disagree

disagree Easy

A waste of time

Not enjoyable

Interesting

Fun

Boring

Simple

Useful

Difficult

Complicated

b. Please read each of the statements carefully and tick the box that most closely matches your opinion. Please tick only one box for each statement.

“Firglo 700 – Interactive Safety Data” …

Strongly Agree Neither Disagree Strongly agree agree nor disagree

disagree Included advice on using paints that I can actually use.

Would be a useful source of information for people who use the paint.

Made me more aware of the risks associated with using the paint.

Won’t make me change the way I use the paint product.

119

c. Please write in the spaces below, three things that you liked about “Firglo 700 – Interactive Safety Data”.

1. _________________________________________________

2. ________________________________________________

3. _________________________________________________

d. Please write in the spaces below, three things that you disliked about “Firglo 700 – Interactive Safety Data”.

1. _________________________________________________

2. _________________________________________________

3. _________________________________________________

Thank you for taking the time to complete this questionnaire. Please return the questionnaire to the researcher.

120

APPENDIX 6

EXAMPLE OF SDS SUBJECTIVE ASSESSMENT QUESTIONNAIRE

Research project carried out by the University of Aberdeen and Institute of Occupational Medicine

Safety Data Sheet for Dodge Standard Arterial and Standard Cavity Embalming products

The University of Aberdeen and the Institute of Occupational Medicine, Edinburgh, are carrying out a number of surveys in companies that are involved in embalming.

Now that you have browsed through “Safety Data Sheet for Dodge Standard Arterial and Standard Cavity embalming products”, we would like to find out your thoughts on the package.

We would be grateful if you would take the time to fill in this questionnaire, which should take about 5 minutes to complete. Guidance is given on how to complete each question. Please attempt to answer ALL the questions.

All responses will be treated in strictest confidence and will only be seen by members of the research team. Your employer will not see your responses.

Once completed, please return the questionnaire to the researcher in the envelope provided.

121

� � � �

� � � �

Section A – Use of computers

1. Do you use a computer as part of your job?

(please tick one box) Yes � Go to question 2

No � Go to question 3

2. If yes, how often do you use the computer at work? (please tick one box)

Every day Once or twice a Once every two to Less than once a week three weeks month

3. Do you have a computer at home?

(please tick one box) Yes � Go to question 4

No � Go to question 5

4. If yes, how often do you use the computer? (please tick one box)

Every day Once or twice a Once every two to Less than once a week three weeks month

5. How do you feel about using computers? (circle a number on the scale of 1–5)

Confident 1 2 Relaxed 1 2 Good at it 1 2

3 4 5 Not confident 3 4 5 Nervous 3 4 5 Bad at it

Please turn to next page

122

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Section B – Comments on computer package

a. Please read each of the statements carefully and tick the box that most closely matches your opinion. Please tick only one box for each statement.

“I found “Safety Data Sheet for Dodge Standard Arterial and Standard Cavity embalming products” …

Strongly Agree Neither Disagree Strongly agree agree nor disagree

disagree easy to use

a waste of time

not enjoyable

interesting

fun

boring

simple

Useful

b. Please read each of the statements carefully and tick the box that most closely matches your opinion. Please tick only one box for each statement.

“Safety Data Sheet for Dodge Standard Arterial and Standard Cavity embalming products” ……………….

Strongly Agree Neither Disagree Strongly agree agree nor disagree

disagree Included advice on using embalming fluids that I can actually use.

hasn’t taught me anything that I didn’t know already.

made me more aware of the risks associated with using these fluids.

won’t make me change the way that I work.

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________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

c. Please write in the spaces below, three things that you liked about “Safety Data Sheet for Dodge Standard Arterial and Standard Cavity embalming products".

1. _________________________________________________

2. ________________________________________________

3. _________________________________________________

d. Please write in the spaces below, three things that you disliked about “Safety Data Sheet for Dodge Standard Arterial and Standard Cavity embalming products".

1. _________________________________________________

2. _________________________________________________

3. _________________________________________________

e. Do you have any other comments about the computer program “Safety Data Sheet for Dodge Standard Arterial and Standard Cavity embalming products”?

Please turn to next page

124

Section C - Personal

To help us in our research, please enter the following information in the spaces provided below.

Name_________________________________________________

Age ___________

Gender Male � Female�

Company______________________________________________

Job title_______________________________________________

Thank you for taking the time to complete this questionnaire. Please return the questionnaire to the researcher in the envelope provided.

125

126

Appendix 7:

Summary of subjective opinions for the embalming fluid mmSDS and SDS packages

Table 1: Subjects responses after receiving the mmSDS package

mmSDS Statement 1 2 3 4 5 6 7 8 9 10 11 12

n n n n n n n n n n n n Strongly disagree

1 2 1

Disagree 6 5 4 4 2

Neither 4 1 2 1 1

Agree 3 5 3 1 7 5 5 1 6 4

Strongly agree 4 2 2 2

Table 2: Subjects responses after receiving the SDS package

SDS Statement 1 2 3 4 5 6 7 8 9 10 11 12

n n n n n n n n n n n n Strongly disagree

4 2 1 1

Disagree 3 2 1 3 1 2 2 2

Neither 3 1 5 3 3 5

Agree 4 4 1 5 3 3 1 7

Strongly agree 3 2 1 4 2

n = number of responses

I found “name of package”…

Statements 1. easy to use 2. a waste of time 3. not enjoyable 4. interesting 5. fun 6. boring 7. simple

127

8. useful 9. included advice on embalming fluids that I can actually use 10. hasn’t taught me anything that I didn’t know already 11. made me more aware of the risks associated with using these fluids 12. won’t make me change the way that I work

128

Appendix 8:

Changes in cumulative exposure per subject (embalmers)

Figure 8.1: Cumulative exposure by visit for subject 1

Figure 8.2: Cumulative exposure by visit for subject 2

129

Figure 8.3: Cumulative exposure by visit for subject 3

Figure 8.4: Cumulative exposure by visit for subject 4

Figure 8.5: Cumulative exposure by visit for subject 5

130

Figure 8.6: Cumulative exposure by visit for subject 6

Figure 8.7: Cumulative exposure by visit for subject 7

131

Figure 8.8: Cumulative exposure by visit for subject 8

Figure 8.9: Cumulative exposure by visit for subject 9

132

Figure 8.10: Cumulative exposure by visit for subject 10

Figure 8.11: Cumulative exposure by visit for subject 11

133

Figure 8.12: Cumulative exposure by visit for subject 12

134

Figure 8.13: Cumulative exposure by visit for subject 13

Figure 8.14: Cumulative exposure by visit for subject 14

135

136

Appendix 9:

Summary of subjective opinions for the paint mmSDS and SDS packages

Table 1: Subjects responses after receiving the mmSDS package

mmSDS Statement 1 2 3 4 5 6 7 8 9 10 11 12 13 14

n n n n n n n n n n n n n n Strongly disagree 6 2 1 6 4 1 2

Disagree 5 4 2 6 1 6 7 6

Neither 1 6 3 7 3 1 1 3 2

Agree 5 1 8 1 3 7 7 6 5 9 1

Strongly agree 6 1 1 3 5 2 7 3 1

Table 2: Subjective responses after receiving the SDS package

SDS Statement 1 2 3 4 5 6 7 8 9 10 11 12 13 14

n n n n n n n n n n n n n n Strongly disagree 1 1 1 3 1 6 5 1 1

Disagree 1 8 1 2 6 2 2 2 3 2 2 1 7

Neither 2 6 4 3 4 1 2 2 1 1

Agree 3 1 4 5 5 5 6 3 3 4 8 8 2

Strongly agree 7 1 1 3 2 4 2 4 2

n = number of responses

Statements

I found “name of package ”…

1. Easy 2. A waste of time 3. Not enjoyable 4. Interesting 5. Fun

137

6. Boring 7. Simple 8. Useful 9. Difficult 10. Complicated 11. Included advice on using paints that I can actually use 12. Would be a useful source of information for people who use the paint 13. Made me more aware of the risks associated with using this paint 14. Won’t make me change the way that I use paint products

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Appendix 10:

Changes in cumulative exposure per subject (laboratory study)

Figure 10.1: Cumulative exposure by visit for subject 1

Figure 10.2: Cumulative exposure by visit for subject 2

139

Figure 10.3: Cumulative exposure by visit for subject 3

Figure 10.4: Cumulative exposure by visit for subject 4

Figure 10.5: Cumulative exposure by visit for subject 5

140

Figure 10.6: Cumulative exposure by visit for subject 6

Figure 10.7: Cumulative exposure by visit for subject 7

141

Figure 10.8: Cumulative exposure by visit for subject 8

Figure 10.9: Cumulative exposure by visit for subject 9

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Figure 10.10: Cumulative exposure by visit for subject 10

Figure 10.11: Cumulative exposure by visit for subject 11

Figure 10.12: Cumulative exposure by visit for subject 12

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Figure 10.13: Cumulative exposure by visit for subject 13

Figure 10.14: Cumulative exposure by visit for subject 14

144

Figure 10.15: Cumulative exposure by visit for subject 15

Figure 10.16: Cumulative exposure by visit for subject 16

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Figure 10.17: Cumulative exposure by visit for subject 17

Figure 10.18: Cumulative exposure by visit for subject 18

146

Figure 10.19: Cumulative exposure by visit for subject 19

Figure 10.20: Cumulative exposure by visit for subject 20

Figure 10.21: Cumulative exposure by visit for subject 21

147

Figure 10.22: Cumulative exposure by visit for subject 22

Figure 10.23: Cumulative exposure by visit for subject 23

148

Figure 10.24: Cumulative exposure by visit for subject 24

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Printed and published by the Health and Safety ExecutiveC30 1/98

Printed and published by the Health and Safety Executive C1.25 02/03

ISBN 0-7176-2618-0

RR 072

780717626182£30.00 9

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