Implementing and evaluating novel safety training methods for construction sector workers: Results of a randomized controlled trial

Introduction: The construction industry is regarded as one of the most unsafe occupational fields worldwide. Despite general agreement that safety training is an important factor in preventing accidents in the construction sector, more studies are needed to identify effective training methods. To address the current research gap, this study evaluated the impact of novel, participatory safety training methods on construction workers’ safety competencies. Specifically, we assessed the efficacy of an immersive virtual reality (VR)-based safety training program and a participatory human factors safety training program (HFST) in construction industry workplaces. Method: In 2019, 119 construction sector workers from eight workplaces participated in a randomized controlled trial conducted in Finland. All the study participants were assessed using questionnaires at baseline, immediately after the intervention and at one-month follow-up. We applied generalized linear mixed modeling for statistical analysis. Results: Compared to lecture-based safety training, VR-based safety training showed a stronger impact on safety motivation, self-efficacy and safety-related outcome expectancies. In addition, the construction sector workers who participated in the VR-based safety training showed a greater increase in self-reported safety performance at one-month follow-up. Contrary to our study hypotheses, we found no significant differences between the study outcomes in terms of study participants in the HFST training condition and the comparison condition without HFST training. Conclusion: Our study indicates that VR technology as a safety training tool has potential to increase safety competencies and foster motivational change in terms of the safety performance of construction sector workers. In the future, the efficacy of participatory human factors safety training should be studied further using a version that targets both managerial and employee levels and is implemented in a longer format. Practical implications: Safety training in virtual reality provides a promising alternative to passive learning methods. Its motivating effect complements other safety training activities.     

First aid training in secondary schools: A comparative study and implementation considerations

Introduction: School-based first aid training has benefits for adolescents with an opportunity to increase health and safety knowledge relating to injury and cardiac arrest. Method: Using a quasi-experimental design we evaluated differences among students (M_age = 13.46 years, 55% female) taught first aid through the Skills for Preventing Injury in Youth (SPIY) program (n = 1942), treatment-as-usual school-based first aid training (n = 675), and students who did not receive first aid training (n = 489). Results: Results showed significant differences in self-reported knowledge scores at twelve-month follow-up (controlling for baseline knowledge). Students in the SPIY group and the treatment-as-usual first aid group had higher total scores than the control group. Teachers and students reported positive perceptions to first aid study, in particular the interactive delivery and scenarios for contextualizing information. Practical Applications: The study provides support for the retention of first aid knowledge up to 12-months and thus the inclusion and feasibility of first aid training in secondary school curriculum.     

Making safety training stickier: A richer model of safety training engagement and transfer

Introduction: Compared to other types of occupational training, safety training suffers from several unique challenges that potentially impair the engagement of learners and their subsequent application or “transfer” of knowledge and skills upon returning to the job. However, existing research on safety training tends to focus on specific factors in isolation, such as design features and social support. The aim of this research is to develop an overarching theoretical framework that integrates factors contributing to training engagement and transfer. Method: We conducted a comprehensive qualitative review of safety training research that was published between 2010 and 2020. We searched Web of Science, Scopus, and Google Scholar, yielding 147 articles, and 38 were included. We content analyzed article summaries to arrive at core themes and combined them with contemporary models of general occupational training to develop a rich model of safety training engagement and transfer. Results: We propose that training engagement is a combination of pre-training factors such as individual, organizational, and contextual factors, that interact with design and delivery factors. Safety training engagement is conceptualized as a three-component psychological state: affective, cognitive, and behavioral. Organizations should prioritize pre-training readiness modules to address existing attitudes and beliefs, optimize the safety training transfer climate, and critically reflect on their strategy to design and deliver safety training so that engagement is maximized. Conclusions: There are practical factors that organizations can use before training (e.g., tailoring training to employees’ characteristics), during training (e.g., ensuring trainer credibility and use of adult learning principles), and after training (e.g., integrating learned concepts into systems). Practical Applications: For safety training to ‘stick,’ workers should be affectively, cognitively, and behaviorally engaged in learning, which will result in new knowledge and skills, improvements in attitudes, and new safety behaviors in the workplace. To enable engagement, practitioners must apply adult learning principles, make the training relevant, and tailor the training to the job and individual needs. After training, ensure concepts are embedded and aligned with existing systems and routines to promote transfer.     

Evaluation of driver performance with a prototype cyber physical mid-block crossing advanced warning system

Introduction: Using connected vehicle technologies, pedestrian to vehicle (P2V) communication applications can be installed on smart devices allowing pedestrians to communicate with drivers by broadcasting discrete safety messages, received by drivers in-vehicle, as an alternative to expensive fixed-location physical safety infrastructure. Method: This study consists of designing, developing, and deploying an entirely cyber-physical P2V communication system within the cellular vehicle to everything (C-V2X) environment at a mid-block crosswalk to analyze drivers’ reactions to in-vehicle advanced warning messages, the impacts of the advanced warning messages on driver awareness, and drivers’ acceptance of this technology. Results: In testing human subjects with, and without, advanced warning messages upon approaching a mid-block crosswalk, driver reaction, acceptance, speed, eye tracking data, and demographic data were collected. Through an odds ratio comparison, it was found that drivers were at least 2.44 times more likely to stop for the pedestrian with the warning than without during the day, and at least 1.79 times more likely during the night. Furthermore, through binary logistic regression analysis, it was found that driver age, time of the day, and the presence of the advanced warning message all had strong, significant impacts with a confidence value of at least 98% (p < 0.02) on the rate at which drivers stopped for the pedestrian. Conclusions: The results from this study indicate that the advanced warning message sent within the C-V2X had a strong, positive impact on driver behavior and understanding of pedestrian intent. Practical Applications: Pedestrian crashes and fatality rates at mid-block crossings continue to increase over the years. Connected vehicle technology utilizing smart devices can be used as a means for communications between pedestrians and drivers to deliver safety messages. State and local city planners should consider geofencing designated mid-block crossings at which this technology operates to increase pedestrian safety and driver awareness.     

Leadership skills for strengthening jobsite safety climate

Introduction: Construction foremen may lack the leadership skills needed to create a strong jobsite safety climate. Many construction companies address this by sending their lead workers to the OSHA 30-h course; however the course does not include a leadership training module. This article describes the development and pilot testing of such a module and evaluation surveys designed to address this training gap. Methods: A 17-member curriculum development team, numerous subject matter experts, and an instructional design company helped us develop a comprehensive set of teaching resources and a set of survey instruments for evaluating the materials' effectiveness on improving safety leadership and safety climate. All materials and surveys were pilot tested with representative members of the target population. Results: Pilot surveys showed high reliability and data collected on the resulting Foundations for Safety Leadership (FSL) module indicated that the majority of foremen thought the training was helpful or valuable, particularly the discussion questions. The majority said they intended to use the skills on the jobsite. With the exception of the role-play activities, the trainers rated highly all other components, especially the videos and discussion questions. Modifications were made to the training materials and surveys based on pilot test findings. The most important result of the development and pilot testing efforts is that the OSHA Training Institute (OTI) included the FSL as an elective in the OSHA 30-h course. Conclusions: The FSL module fills a needed skills gap by providing safety leadership training to all foremen who might otherwise not have access to it through their company or union. The continued success of the FSL training will be ensured by dissemination via the OSHA 30-h course, an established nationwide safety training program. Practical applications: The FSL training module has already been widely accepted by the construction industry as a useful approach for providing construction foremen/See new abstract lead workers with the knowledge and skills they need to become more effective jobsite safety leaders.     

Linking emotional intelligence to safety performance: The roles of situational awareness and safety training

Introduction: Safety outcomes in the workplace require individual employees to perform (behave) safely in everyday duties. While the literature suggests that emotional management capabilities or traits can be positively related to individual performance in certain conditions, it is not clear how they can influence safety-related performance in high-risk work contexts. Drawing upon trait activation theory, this paper aims to examine when emotional intelligence (EI) benefits employees’ safety performance. We propose that when employees receive inadequate safety training, EI is more likely to trigger their situational awareness and consequently promote their safety performance. Method: We collected time-lagged data from 133 full-time airplane pilots working in commercial aviation industry. Hierarchical moderated regression analysis was conducted to test the moderating effect of safety training inadequacy on the EI–situational awareness relationship. The moderated mediation model, which involves conditional indirect effects of EI on safety performance via situational awareness across different levels of safety training inadequacy, was tested using the PROCESS-based bootstrap confidence interval. Results: Safety training inadequacy negatively moderated the relationship between EI and situational awareness, such that EI was significantly related to situational awareness only when safety training inadequacy was more salient. The more inadequate safety training was, the greater the indirect effect of EI on safety performance via situational awareness was. Conclusions: Inadequate safety training, as a negative situational cue, can activate individuals’ EI to drive their safety-related cognitions (e.g., situational awareness) and behaviors. Effective safety training may be able to complement employees’ low EI in shaping their situational awareness and safety behaviors. Practical Applications: Aviation managers should monitor the adequacy and effectiveness of safety training; this could make pilots’ situational awareness and safety performance depend less on personal attributes (e.g., EI), which organizations are less able to control. When training capacity is temporarily limited, priority might be given to those with low EI.     

Safer than the average human driver (who is less safe than me)? Examining a popular safety benchmark for self-driving cars

Although the level of safety required before drivers will accept self-driving cars is not clear, the criterion of being safer than a human driver has become pervasive in the discourse on vehicle automation. This criterion actually means “safer than the average human driver,” because it is necessarily defined with respect to population-level data. At the level of individual risk assessment, a body of research has shown that most drivers perceive themselves to be safer than the average driver (the better-than-average effect). Method: Using an online sample, this study examined U.S. drivers’ ratings of their own ability to drive safely and their desired level of safety for self-driving vehicles. Results: This study replicated the better-than average effect and showed that most drivers stated a desire for self-driving cars that are safer than their own perceived ability to drive safely before they would: (1) feel reasonably safe riding in a self-driving vehicle; (2) buy a self-driving vehicle, all other things (cost, etc.) being equal; and (3) allow self-driving vehicles on public roads. Conclusions: Since most drivers believe they are better than average drivers, the benchmark of achieving automation that is safer than a human driver (on average) may not represent acceptably safe performance of self-driving cars for most drivers. Practical applications: If perceived level of safety is an important contributor to acceptance of self-driving vehicles, the popular “safer than a human driver” benchmark may not be adequate for widespread acceptance.     

Change in frontline supervisors’ safety leadership practices after participating in a leadership training program: Does company size matter?

Introduction: The majority of construction companies are small businesses and small business often lack the resources needed to ensure that their supervisors have the safety leadership skills to build and maintain a strong jobsite safety climate. The Foundations for Safety Leadership (FSL) training program was designed to provide frontline leaders in all sized companies with safety leadership skills. This paper examines the impact of the FSL training by size of business. Methods: Leaders, defined as foremen or other frontline supervisors, from small, medium, and large construction companies were recruited to participate in a study to evaluate the degree to which the FSL changed their understanding and use of the leadership skills, safety practices and crew reporting of safety-related conditions. We used linear mixed modeling methods to analyze pre-post training survey data. Results: Prior to the training, leaders from small and medium sized companies reported using safety leadership skills less frequently than those from large ones. After the training, regardless of business size, we observed that the FSL training improved leaders understanding of safety leadership skills from immediately before to immediately after the training. Additionally, leaders reported greater use of safety leadership skills, safety practices, and crew reporting of safety-related conditions from before to two-weeks after the training. However, those from small and medium sized companies reported the greatest improvement in their use of safety leadership skills. Conclusions: The FSL training improves safety leadership outcomes regardless of the size company for which the leader worked. However, the FSL may be even more effective at improving the safety leadership skills of leaders working for smaller sized construction companies or those with lower baseline levels of safety leadership skills. Practical applications: The majority of construction companies employ a small number of employees and therefore may not have the resources to provide their frontline leaders with the leadership training they need to be effective leaders who can create a strong jobsite safety climate. The Foundations for Safety Leadership (FSL) training can help fill this gap.     

Adolescents' perspectives on distracted driving legislation

Purpose: Distracted driving is a growing global epidemic, with adolescent drivers reporting frequent engagement in distracted driving behaviors. Public health initiatives and legislative efforts designed to decrease the prevalence of these unwanted driving behaviors have demonstrated small, but significant reductions in crash risk. Non-compliance is a known problem among drivers of all ages, but may be especially problematic for novice, adolescent drivers. Using a construct from the Health Belief Model, the relations between demographic factors, perceived threat to safety, and peer influences were investigated with adolescents' support for three types of distracted driving legislation regarding: (a) reading or sending text messages/emails while driving; (b) hand-held cell phone use while driving; and (c) using non-driving-related-in-vehicle (NDIV) technology while driving. Investigating adolescents' perceptions provides an opportunity to understand distracted driving enforcement and legislation. Methods: Three hundred and seventy-nine adolescents aged 15–19 (M = 16.12, SD = 0.56) were recruited from public high schools. Demographics, perceptions, and support regarding distracted driving were assessed using self-report surveys. Statistical analyses included bivariate correlations and adjusted odds ratios to investigate influences of adolescent support for distracted driving legislation. Results:Female adolescents were at 2 times greater odds of supporting a law against texting/emailing while driving compared to male adolescents. Greater perceived threat to safety was associated with all three types of distracted driving legislation (aOR = 1.10, 1.33). Minimal association was found with peer influences. Conclusions: Perceived threat to safety and gender were associated with legislative support in adolescents. Practical application: Interventions and public health campaigns that incorporate elements related to perceived threat may be more successful with female adolescent drivers than male adolescents. Future experimental research will help to determine what factors affect adolescents' perspectives on distracted driving to promote compliance with related legislation.     

Older driver training programs: A systematic review of evidence aimed at improving behind-the-wheel performance

IntroductionAge- and health-related changes, alongside declines in driving confidence and on-road exposure, have been implicated in crashes involving older drivers. Interventions aimed at improving behind-the-wheel behavior are diverse and their associated impact remains unclear. This systematic review examined evidence on older driver training with respect to (1) road safety knowledge; (2) self-perceived changes in driving abilities; and (3) behind-the-wheel performance. Method Nine databases were searched for English-language articles describing randomized controlled trials (RCTs) and non-RCTs of driver training interventions aimed at those aged 55+ who did not have medical or other impairments that precluded licensure. Quality appraisals were conducted using Cochrane’s Risk of Bias Tool (RoB) and Risk Of Bias In Non-randomized Studies – of Interventions tool (ROBINS – I). [PROSPERO; registration no. CRD42018087366]. Results Twenty-five RCTs and eight non-RCTs met the inclusion criteria. Interventions varied in their design and delivery where classroom-based education, or a combination of classroom-based education with on-road feedback, improved road safety knowledge. Training tailored to individual participants was found to improve self-perceived and behind-the-wheel outcomes, including crashes. Conclusions Interventions comprised of tailored training can improve knowledge of road safety, changes to self-perception of driving abilities, and improved behind-the-wheel performance of older drivers. Future research should compare modes of training delivery for this driver population to determine the optimal combinations of off- and/or on-road training. Practical applications Training programs aimed at older drivers should be supported by theory and research evidence. By conducting comparative trials with a sufficient sample size alongside well-defined outcomes that are designed in accordance with reporting guidelines, the most effective approaches for training older drivers will be identified.     

Bicyclist injury severity in traffic crashes: A spatial approach for geo-referenced crash data to uncover non-stationary correlates

Introduction: Bicyclists are among vulnerable road users with their safety a key concern. This study generates new knowledge about their safety by applying a spatial modeling approach to uncover non-stationary correlates of bicyclist injury severity in traffic crashes. Method: The approach is Geographically Weighted Ordinal Logistic Regression (GWOLR), extended from the regular Ordered Logistic Regression (OLR) by incorporating the spatial perspective of traffic crashes. The GWOLR modeling approach allows the relationships between injury severity and its contributing factors to vary across the spatial domain, to account for the spatial heterogeneity. This approach makes use of geo-referenced data. This study explored more than 7,000 geo-referenced bicycle--motor-vehicle crashes in North Carolina. Results: This study performed a series of non-stationarity tests to identify local relationships that vary substantially across the spatial domain. These local relationships are related to the bicyclist (bicyclist age, bicyclist behavior, bicyclist intoxication, bicycle direction, bicycle position), motorist (driver age, driver intoxication, driver behavior, vehicle speed, vehicle type) and traffic (traffic volume). Conclusions: Results from the regular OLR are in general consistent with previous findings. For example, an increased bicyclist injury severity is associated with older bicyclists, bicyclist being intoxicated, and higher motor-vehicle speeds. Results from the GWOLR show local (rather than global) relationships between contributing factors and bicyclist injury severity. Practical Applications: Researchers and practitioners may use GWOLR to prioritize cycling safety countermeasures for specific regions. For example, GWOLR modeling estimates in the study highlighted the west part (from Charlotte to Asheville) of North Carolina for increased bicyclist injury severity due to the intoxication of road users including both bicyclists and drivers. Therefore, if a countermeasure is concerned with the road user intoxication, there may be a priority for the region from Charlotte to Asheville (relative to other areas in North Carolina).     

Digital screen use for a road safety campaign message was not associated with road safety awareness of passers-by: A quasi-experimental study

Introduction: Recent evidence suggests fatality risks for cyclists may be increasing in Britain. Understanding how to increase levels of cycling while keeping risk low is paramount. Educating drivers about cyclists may help with road safety, and mass-media messaging is a possible avenue, potentially utilizing digital displays screens in public areas. However, no studies have examined the use of these screens for road safety campaigns. Methods: A quasi-experiment was conducted to examine if digital screens may be effective to raise awareness of a campaign message and encourage recall of car drivers. A digital campaign image was selected that encouraged car drivers and cyclists to ‘look out for each other,’ and stated than 80% of cyclists owned a driving license. Views and knowledge on driver priorities around cyclists were examined before (control) and after campaign exposure (intervention), and tested using regression modelling. Results: 364 people were interviewed over five days. Those interviewed on intervention days were more likely to rank ‘Look out for cyclists’ as being more important compared to those interviewed on control days (OR 1.20), but this was not statistically significant (p = 0.355). Those who said they had seen the image did not rank ‘Look out for cyclists’ higher than those who said they had not seen it (p = 0.778). The disparity between reported and displayed percentage of cyclists with a driving license did not differ between intervention and control days, but was 8% higher amongst those who claimed to have seen the image (p = 0.026). Conclusions: We did not find strong evidence that use of an image on digital screens increased public awareness or recall of a casualty reduction campaign message. Work is needed to investigate the effects of longer-term exposure to road safety images. Practical Applications: Short-term use of digital signage is not recommended for raising awareness of road safety campaigns.     

How do organizational practices relate to perceived system safety effectiveness? Perceptions of safety climate and co-worker commitment to safety as workplace safety signals

Introduction: Integrating safety climate research with signaling theory, we propose that individual perceptions of safety climate signal the importance of safety in the organization. Specifically, we expect that three work-related organizational practices (training effectiveness, procedure effectiveness, and work pressure) relate to the broader risk control system in the workplace via individual perceptions of safety climate as a broad management signal. Further, we expect this broad management signal interacts with a local environmental signal (co-worker commitment to safety) to amplify or diminish perceived system safety effectiveness. Method: In a field study of oil and gas workers (N = 219; Study 1), we used mediation modeling to determine the relationships between work-related organizational practices, perceived safety climate, and perceived safety system effectiveness. In a field study of railway construction workers (N = 131; Study 2), we used moderated mediation modeling to explore the conditional role of co-worker commitment to safety. Results: We found that training effectiveness, procedure effectiveness, and work pressure predicted perceived system safety effectiveness indirectly via perceived safety climate (Studies 1 and 2) and that these indirect paths are influenced by co-worker commitment to safety (Study 2). Conclusions: Findings suggest that perceived safety climate is driven in part by work practices, and that perceived safety climate (from managers) and co-worker commitment to safety (from the local environment) interact to shape workplace safety system effectiveness. Practical applications: The insight that training, procedures, and work pressure are meaningful predictors of perceived safety climate as a signal suggests that organizations should be cognizant of the quality of work-related practices for safety. The insight we offer on the competing versus complimentary nature of managerial safety signals (perceived safety climate) and co-worker safety signals (co-worker commitment to safety) could also be used by safety personnel to develop safety interventions directed in both areas.     

A training intervention to improve frontline construction leaders' safety leadership practices and overall jobsite safety climate

Introduction: The 2.5 h Foundations for Safety Leadership (FSL) training program teaches construction supervisors the leadership skills they need to strengthen jobsite safety climate and reduce adverse safety-related outcomes. Methods: Using a quasi-experimental prospective switching replications study design, we examined (1) if FSL-trained jobsite safety leaders would report improved understanding and practice of the FSL leadership skills, safety practices and crew reporting of safety related conditions, and (2) if their crew perceived a change in (a) their supervisors' practices, (b) their own safety practices and reporting of safety-related conditions, and (c) overall jobsite safety climate. Twenty construction sub-contracting companies were recruited and randomly assigned to either an early or lagged-control training group. Participating supervisors and workers completed surveys at multiple time points before and after the FSL training. We used linear mixed modeling to test changes over time. Results: Only supervisors in the early group reported a statistically significant improvement in their understanding and practice of the leadership skills as well as safety practices from before to 2- and 4-weeks post-training. Overall, no significant change was detected in crew-reported outcomes from before to after their supervisors' participated in the FSL training. Conclusions: These results provide evidence that the FSL training can, at least in the short-term, improve construction frontline leaders' jobsite leadership skills. Future research could include an evaluation of FSL refresher activities and a longer-term follow-up. Practical applications: The Foundations for Safety Leadership (FSL) program fills an identified need for construction frontline supervisors to learn and practice critical safety leadership skills on the jobsite. It has already reached over 60,000 leaders and has the potential to reach over 100,000 each year during either an OSHA 30-h or a stand-alone course.     

An application of a modified theory of planned behavior model to investigate adolescents’ job safety knowledge,norms, attitude and intention to enact workplace safety and health skills

Introduction: For many reasons, including a lack of adequate safety training and education, U.S. adolescents experience a higher rate of job-related injury compared to adult workers. Widely used social-psychological theories in public health research and practice, such as the theory of planned behavior, may provide guidance for developing and evaluating school-based interventions to prepare adolescents for workplace hazards and risks. Method: Using a structural equation modeling approach, the current study explores whether a modified theory of planned behavior model provides insight on 1,748 eighth graders’ occupational safety and health (OSH) attitude, subjective norm, self-efficacy and behavioral intention, before and after receiving instruction on a free, national young worker safety and health curriculum. Reliability estimates for the measures were produced and direct and indirect associations between knowledge and other model constructs assessed. Results: Overall, the findings align with the theory of planned behavior. The structural equation model adequately fit the data; most path coefficients are statistically significant and knowledge has indirect effects on behavioral intention. Confirmatory factor analyses suggest that the knowledge, attitude, self-efficacy, and behavioral intention measures each reflect a unique dimension (reliability estimates ≥0.86), while the subjective norm measure did not perform adequately. Conclusion: The findings presented provide support for using behavioral theory (specifically a modified theory of planned behavior) to investigate adolescents’ knowledge, perceptions, and behavioral intention to engage in safe and healthful activities at work, an understanding of which may contribute to reducing the downstream burden of injury on this vulnerable population—the future workforce. Practical application: Health behavior theories, commonly used in the social and behavioral sciences, have utility and provide guidance for developing and evaluating OSH interventions, including those aimed at preventing injuries and promoting the health and safety of adolescent workers in the U.S., who are injured at higher rates than are adults.     

Exploring safety knowledge sharing among experienced and novice workers

Introduction: This paper investigates how members of a culinary and hospitality arts program generate, share, and learn safety knowledge via social and identity mechanisms. Method: We conducted semi-structured interviews with 20 participants of varying roles and experience (i.e., students, culinary instructors, and restaurant chefs) in the culinary and hospitality arts program at a large polytechnic in western Canada. Results: The emergent themes from these interviews indicated that the circulation of safety knowledge relied on the interaction among individuals with various levels of experience, such that those who were more experienced in the culinary arts were able to share safety knowledge with novices, who had less experience. Comparing safety knowledge gleaned from within the school against that gleaned from within the industry highlighted differences between the construction of safety in the two contexts. Notably, many aspects of safety knowledge are not learned in school and those that are may not apply in the industry context. We found that safety knowledge was shared through informal means such as storytelling, a process that allowed members to come to a deep, collective understanding of what safety meant, which they often labeled “common sense.” Conclusion: We found that safety knowledge was a currency through which participants achieved legitimacy, generated through continual practical accomplishment of the work in interaction with others. Practical Applications: Our findings provide novel insights into how safety knowledge is shared, and we discuss the implications of these findings for classroom, work-based learning, and other forms of curricula.     

Improving workplace safety by thinking about what might have been: A first look at the role of counterfactual thinking

Introduction: Information processing theories of workplace safety suggest that cognition is an antecedent of safety behavior. However, little research has directly tested cognitive factors as predictors of workplace safety within organizational psychology and behavior research. Counterfactuals (cognitions about “what might have been”) can be functional when they consist of characteristics (e.g., “upward’ – focusing on better outcomes) that alter behavior in a manner consistent with those outcomes. This field study aimed to examine the influence of counterfactual thinking on safety behavior and explanatory mechanisms and boundary conditions of that relationship. Method: A sample of 240 medical providers from a hospital in China responded to three surveys over a four-month time frame. Results: Results showed that upward counterfactuals were positively related to supervisor ratings of safety compliance and participation. These relationships were mediated by safety knowledge but not by safety motivation. Upward counterfactuals were more strongly related to safety behavior and knowledge than downward counterfactuals. As expected, safety locus of control strengthened the mediating effects of safety knowledge on the relationship between upward counterfactuals and safety behavior. Conclusions and Practical Applications: The findings demonstrated that counterfactual thinking is positively associated with safety behavior and knowledge, thus expanding the variables related to workplace safety and laying some initial groundwork for new safety interventions incorporating counterfactual thinking.     

Safety evaluation of drowsy driving advisory system: Alabama case study

Introduction: The present study discusses roles, characteristics, and safety assessment of a drowsy driving advisory (DDA) system, implemented on rural interstates of Alabama. The DDA system is an engineering countermeasure designed to reduce the likelihood of drowsy driving crashes. It consists of a series of roadside signs with warning and advisory messages for drowsy drivers. The DDA system was implemented upstream of rural rest areas based on a comprehensive crash analysis. Method: A post-implementation study was conducted three years after the DDA system implementation to assess its safety effects. An empirical bayes (EB) method along with predictive methods of the Highway Safety Manual was used in the safety assessment. To overcome the underreported issue of drowsy driving crashes in the crash analysis, the present study used a concept called, expanded definition of drowsy driving (EDD) crashes. Result: The analysis found that the DDA system could reduce total and EDD crashes by 64% and 49%, respectively. It is important to note that such huge crash reduction effects are due to a combined effect of both rest areas and the DDA system, not because of a single treatment. The safety effect of a rest area itself, without considering the effect of the DDA system, was also investigated. Results show that total and EDD crashes would increase about 12–45% and 5–33%, respectively if there is no presence of a rest area. Conclusion: Our findings conclude that the DDA system could significantly reduce both total and drowsy driving crashes when it cooperates with a rest area facility. Practical Application: The findings also provide the guidance of using the DDA system on high-speed roads as a safety countermeasure of drowsy driving crashes. Readers can find details of the DDA system used in this study with its layout, dimension, and roadside safety messages.     

Effectiveness of the CDC HEADS UP online training on healthcare providers’ mTBI knowledge and self-efficacy

Background: Many healthcare providers do not consistently implement recommendations contained in clinical guidelines on mild traumatic brain injury (mTBI). As such, the Centers for Disease Control and Prevention (CDC) created the HEADS UP to Healthcare Providers online training to promote uptake of five key recommendations in the CDC Pediatric mTBI Guideline. Methods: Using data from modules in the CDC HEADS UP to Healthcare Providers online training, healthcare providers’ self-reported knowledge and self-efficacy prior to and immediately following completion of the training was analyzed. Results: Improvements for 8 out of the 10 knowledge questions had a high level of practical significance. The knowledge question with the highest level of practical significance pre- to post-test improvement was for the key guideline recommendation on neuroimaging (pre-test correct: 70.2%; post-test correct: 87.8%; (p < 0.0001, Cohen’s g = 0.39). Four out of the six questions had a self-efficacy level increase of a high level of practical significance (r > 0.50) between the pre- and post-tests. The self-efficacy question with pre- to post-test improvement with the highest level of practical significance was “I am confident in my ability to manage the return to sports progression for my patients” (p < 0.001; r = 0.54). Conclusions: The HEADS UP to Healthcare Providers online training led to significant improvements in knowledge and self-efficacy related to mTBI diagnosis and management. Expanded use of this training among healthcare providers who commonly provide care for pediatric patients with mTBI may be beneficial. Practical Applications: This study highlights several factors guideline developers may take into consideration when creating an implementation tool, such as using health behavior theories, working with partners and key stakeholders, and focusing on digital-based tools.     

Assessment of HEADS UP online training as an educational intervention for sports officials/athletic trainers

Background: Sports- and recreation-related concussions are a common injury among children. Sports officials (SOs) and athletic trainers (ATs) are integral to setting the stage for safe play and managing concussions when they occur, and significant numbers of both groups have completed the Centers for Disease Control and Prevention’s HEADS UP online concussion training course. However, the utility of the course for these audiences has not been assessed. We hypothesized that sports officials’ and athletic trainers’ concussion-related knowledge, attitudes, and behavioral intentions will improve from pre- and post-test after completing CDC’s HEADS UP online concussion training course. Method: Respondents’ concussion-related knowledge, attitudes, and behavioral intentions were assessed both before and after taking the training course. Differences between pre- and post-test scores were calculated based on the Wilcoxon Signed Rank Test Z-score or McNemar’s test. Effect sizes were interpreted. Results: The SOs and ATs who participated in the HEADS UP online training had a high level of concussion knowledge before taking the course: 90% or more of respondents could identify the correct response for at least seven of the 13 knowledge questions in the pre-test. Still, the course was effective at improving the respondents’ knowledge about return-to-play protocols and concussion reporting. Further, SOs and ATs demonstrated improvement in their concussion-related attitudes and behavioral intentions between the pre- and post-test. Conclusion: SOs’ and ATs’ concussion knowledge, attitudes, and behavioral intentions improved immediately following completion of the CDC HEADS UP online training. Future research could also focus on the long-term retention of this type of training. Practical Applications: This study provides insight into how to better focus concussion-related educational programs to fit SOs’ and ATs’ needs.