title: A study of the implementation process of an intervention to prevent work-related skin problems in wet-work occupations.
abstract: OBJECTIVE
  The objective of the present implementation study is to document how an intervention to reduce work-related skin problems by means of implementing an evidence-based skin protection programme in six gut-cleaning departments in swine slaughterhouses was understood, accepted and carried out. The association between the degree of implementation and the reduction of work-related skin problems in each department is examined. The intervention included a top-down strategy with establishment of a management system focusing on skin risks and a bottom-up strategy with participation of a selected group of shop floor workers and the safety representative, as change agents, as well as an empowerment-based educational programme, where the middle management and representatives from the top management also participated.
  
  
  METHODS
  The study design was a randomized controlled intervention study with a 1-year study period. The outcome of the intervention was evaluated by telephone interviews. Data on the implementation process consisted of self-administered questionnaires, focus interviews and compiled written materials. Four indexes referring to the management system and the change agents' intervention activities were constructed. Finally, the Pearson correlation coefficient was used to test the correlation between the degree of implementation and the eczema frequency at 1-year follow-up.
  
  
  RESULTS
  There was a statistically significant association (p < 0.05) between both the index for the combined implementation method and the eczema frequency after 1 year of intervention, and between the activities of the change agents and the eczema frequency. In contrast to this there was only a weak association between the establishment of a formal management system alone and the outcome.
  
  
  CONCLUSIONS
  The study evidences that a combination of a top-down and a bottom-up implementation method is effective to reduce work-related skin problems, and that the process of implementation is a significant determinant of the overall results.
authors.affiliation: National Institute of Occupational Health, Lersø Parkallé 105, 2100, Copenhagen, Denmark. maf@ami.dk
authors.forename: Karen
authors.initials: K
authors.lastname: Mygind
authors.forename: Vilhelm
authors.initials: V
authors.lastname: Borg
authors.forename: Mari-Ann
authors.initials: MA
authors.lastname: Flyvholm
authors.forename: Lea
authors.initials: L
authors.lastname: Sell
authors.forename: Karen Frydendall
authors.initials: KF
authors.lastname: Jepsen
mesh_terms: D000003:Abattoirs; D000818:Animals; D003718:Denmark; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D007422:Intestines; D016273:Occupational Exposure; D016730:Program Development; D012871:Skin Diseases / Q000517:prevention & control*; D013552:Swine