Long-term impact of worker notification: qualitative assessment of a community-based notification and screening program in Augusta, Georgia.
BACKGROUND
Evaluation of high-risk worker notification programs often focuses on their immediate effectiveness in communicating information to individual workers. This approach leaves unexamined some important social processes that can influence worker notification's impact and public health consequences over time.


METHODS
To explore long-term effects, ethnographic methods were used for qualitative assessment of a community-based program carried out by the National Institute for Occupational Safety and Health (NIOSH) in Augusta, Georgia, during the early 1980s. More than a decade after the original NIOSH intervention, lengthy taped interviews were conducted with 70 members of the notified cohort (chemical workers exposed to beta-naphthylamine (BNA)) and 32 members of their families.


RESULTS
The notified workers expressed extremely positive feelings about having received the risk information. However, for non-obvious and unanticipated reasons, most had failed to implement the notification's primary health advice (annual screening for bladder cancer). Both the workers and their family members reported a number of ongoing concerns related to the program.


CONCLUSIONS
The study findings suggest four strategies, all relatively low in cost, that are likely to increase the long-term public health benefits of worker notifications that rely on individually mailed written materials: (1) in designing worker notifications, take into account the information (accurate or not) that the workers already have, and determine what kind of information they most want and need; (2) define the notification audience broadly to include not only the study cohort but also family members and/or other similarly exposed workers; (3) when notifications recommend secondary disease prevention measures over long time periods, follow up the notification health advice with periodic reminders; (4) inform a wide range of community organizations and service providers (non-medical as well as medical) about the notification, and encourage them to provide appropriate support to the notified workers and their families.
Needleman
Carolyn
C
Bryn Mawr College, 300 Airdale Road, Bryn Mawr, Pennsylvania, USA.
Connally
Lee Barbara
LB
D002617:Chemical Industry; D015331:Cohort Studies; D015991:Epidemiologic Measurements; D005190:Family; D005845:Georgia; D006801:Humans; D008403:Mass Screening; D009314:National Institute for Occupational Safety and Health, U.S.; D009784:Occupational Diseases / Q000517:prevention & control*; D016272:Occupational Health; D018570:Risk Assessment; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000517:prevention & control*