Safety and Health Education to Aging Farmers and Scarce Resources, What are the Implications?

1. Chike Anyaegbunam, Ph.D. SE Center for Agric. Health and Injury Prevention University of Kentucky Safety and Health Education to Aging Farmers and Scarce Resources, What are the Implications?

2. Who’s Chike?

3. Chike Anyaegbunam, National Director, Community-based Social Marketing Programs for Tractor Safety in the U.S.

4. The Social Marketing Project:A Description • A 24-month national research project funded by CDC/NIOSH to initiate the incremental development of a community-based social marketing program for the promotion of selected aspects of the National Agricultural Tractor Safety Initiative. • Based on community trials carried out by Dr. Cole et al in four Kentucky counties.

5. Social Marketing Project: Goals Engage grassroots farm community members in … • the refinement of the Initiative and its recommendations, • identifying the most influential local media and communication channels for promoting the Initiative, and • developing and pretesting a prototype social marketing toolkit for promoting selected aspects of the Initiative.

6. Social Marketing Project:Participating Universities/Centers • University of Kentucky • University of Texas • East Carolina University • Colorado State University • University of Washington • University of California, Davis • Northeast Agric. Center, NY • National Farm Medicine Center, WI • CDC/NIOSH Health Communication Unit

7. Project Design and Method • Thirty-two focus groups totaling 288 participants in eight geographically diverse states used to interact with farm communities during the project. • Focus group participants were selected from principal farm operators, farm managers, farm women, and those who provide business, social, and professional services to farmers (Cooperative Extension, equipment dealers, insurance, health care, financial, farm supply. etc.). • 8-10 participants in each focus group. • Project approved by participating universities’ IRBs

8. Phase I:Year I ACTIVITIES Formative Research: • Secondary information gathering and analysis • Communication audit • Design/pretest discussion guide • Development of prototype campaign toolkit • Workshop #1 • Conduct focus groups • Transcription

9. Phase I: Year II ACTIVITIES • Transcription • Data analysis - constant comparative analysis + NVivo 7 • Focus group report and recommendations • Campaign toolkit revision • Workshop #2 • Community meetings • Project report • Disseminate report

10. Phase II:National Tractor Safety Campaign Design and Implementation • Campaign strategy design • Development of themes, messages, materials, partnerships, special events and activities • Pilot testing and revision • Implementation and monitoring • Evaluation

11. COLLABORATION + KNOWLEDGE DEVELOPMENT + CAPACITY BUILDING = CAMPAIGN PLATFORM • Stakeholder Support: • Regional • National Tractor Overturn & Roadway Crashes (2) Cost of Injuries & Fatalities (2, 3 & 7) Great Lakes (1) Great Plains (2) • Recommendations: • Programs • Policies • Resources Surveillance Data High Plains (3) Model Vehicle Code for Tractors (1) Changes in ROPS Standards (3) National Children’s Center (4) NATIONAL TRACTOR SAFETY CAMPAIGN • Recommendations: • Marketing • Publicity Northeast (5) Current Standards Review • Recommendations: • Interventions • Standards Pacific Northwest (6) Incentives for ROPS Retrofitting (2&4) ROPS Intervention Effectiveness (2, 4 & 5) Southeast (7) • Theoretical Support: • Human Behavior • Engineering Prevention/Intervention Options Southern Coastal (8) Southwest (9) Social Marketing Programs (1, 3 ,5, 6, 7, 8, 9 & 10) Community/Partners (1&6) Western (10) Social Marketing/Community LONG TERM GOAL NIOSH & AG CENTER PARTNERSHIPS PROJECTS PROCESS OUTCOMES

12. COLLABORATION + KNOWLEDGE DEVELOPMENT + CAPACITY BUILDING = CAMPAIGN PLATFORM • Stakeholder Support: • Regional • National Tractor Overturn & Roadway Crashes (2) Cost of Injuries & Fatalities (2, 3 & 7) Great Lakes (1) Great Plains (2) • Recommendations: • Programs • Policies • Resources Surveillance Data High Plains (3) Model Vehicle Code for Tractors (1) Changes in ROPS Standards (3) National Children’s Center (4) NATIONAL TRACTOR SAFETY CAMPAIGN • Recommendations: • Marketing • Publicity Northeast (5) Current Standards Review • Recommendations: • Interventions • Standards Pacific Northwest (6) Incentives for ROPS Retrofitting (2&4) ROPS Intervention Effectiveness (2, 4 & 5) Southeast (7) • Theoretical Support: • Human Behavior • Engineering Prevention/Intervention Options Southern Coastal (8) Southwest (9) Social Marketing Programs (1, 3 ,5, 6, 7, 8, 9 & 10) Community/Partners (1&6) Western (10) Social Marketing/Community LONG TERM GOAL NIOSH & AG CENTER PARTNERSHIPS PROJECTS PROCESS OUTCOMES

13. Local and International Projects 1979 - preset

14. Focus Group Session in Kentucky

15. Focus group with Ovahimba women, Northern Namibia

16. Overview • Aging American farmers: a “special population” with unique health and safety education needs • Health education and communication approaches for promoting agricultural safety and injury prevention • Engaging older farmers in community-based participatory research and health marketing programs - What are the implications?

17. Aging American farmers as a “special population” Older farmers are a “special needs population that needs recognition and attention.” However, they have been underrepresented within the research literature dealing with Farm Health and Safety. Hernandez-Peck (2001) NORA News (2003)

18. Aging American farmers as a “special population at risk” Unlike the rest of the population, farmers tend to remain in farming beyond the normal retirement age. It is not surprising to see farmers in their 70s still farming full-time. Hernandez-Peck (2001) Nora News (2003)

19. Age-related Risks Aged, or “senior” farmers, like most agricultural workers, are at risk of sustaining serious injuries. Senior farmers, however, may be at additional risk due to normal physical and sensory deficits associated with aging. Whitman & Field (1995)

20. Physical Conditions Conditions frequently associated with age (i.e., arthritis, limited vision and hearing, and depression) potentially make the demands of daily farming extremely dangerous for the older farmer Hernandez-Peck (2001) Use of prescription drugs.

21. Risks that increase older farmers’ susceptibility to injury • Sensory loss • Loss in muscle and skeletal strength • Slower reaction time • More rapid fatigue • Reduced ability to handle such tasks as operating agricultural machinery under time stress • Automatic, rather than attentive, behaviors (due to the farmer having performed the task so many times in the past) Dan Lago (1999)

22. Psychographics • Older farmers enjoy their work. It gives them a sense of accomplishment and cannot be extricated from their heritage and culture. • Older farmers have been described as unwilling to recognize or accept their physical limitations. • Older farmers may be willing to acknowledge, for instance, that a risk of tractor-related injury exists, but believe the likelihood of an injury occurring to them personally is small. • Older farmers tend to have a high level of confidence in their own abilities and often believe that they possess the ability to prevent serious tractor and machinery-related injuries, for instance. • Older farmers may not think there's anything new to learn, and habits are hard to break. • Fatalistic beliefs

23. Aging and limited-resource farmers Limited-resource farmers often belong to socially disadvantaged groups whose members have been subjected to racial or ethnic prejudice because of their identity as members of a group without regard to their individual qualities. Those groups include African Americans, American Indians or Alaskan natives, Hispanics, and Asians or Pacific Islanders. Women have also been added to the list of socially disadvantaged farm operators. USDA (1997) Risks? Research Studies?

24. Fatal occupational injury rates in the agriculture, forestry, and fishing industry and the private sector by age, 1992–2001 (Sources: BLS [2002a]; Myers [2003].)

25. Need for Targeted Interventions A need exists for intervention efforts geared toward enhancing awareness of agricultural related hazards, fostering positive attitudes concerning injury prevention strategies, and encouraging safer work practices among older farmers and resource-poor farmers. Whitman & Field (1995) Excellent tactical efforts/suggestions exist: • John Myers et al (1999) • Dan Lago (1999) • Kansas: Measuring reaction time of older farmers at displays; older people were amazed at how many seconds it took them to react, often a major cause of accidents among senior farmers (1997). Integrated Strategic Efforts • NYCAM Social Marketing Campaign • Canadian Agric. Safety assoc.

28. Selling Safety to Farmers • Safety advocacy bore fruits because of 2nd World War • Research by farm safety specialists into the nature of the farm accident problem • Dissemination of their solutions through an organizational network of governmental and private institutions • Education increased farmer’s dependence on the expert for safety information Oden (2005)

29. Health Education/Communication:Definitions • Health education: A continuing process of informing people how to achieve and maintain good health; of motivating them to do so; and of promoting environmental and lifestyle changes to facilitate their objective. • Health communication: The study and use of communication strategies to inform and influence individual and community decisions that enhance health. It links the domains of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health.

30. Social Marketing:Definition Social marketing involves “the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society.” Andreasen, (1995)

31. Strategic communication and community engagement • Emergence of an unprecedented sense of empowerment among organizations’ internal and external stakeholders • Adding the horizontal axis of communication to the traditional one-way top-down or center-out and bottom-up models Beltran, 1979 The 3-D Communication Approach 2007

32. From Selling to Marketing Agric. Health and Safety • Typically, top-down safety and health education/communication programs have had little effect on lowering farm injury rates • Farmers and farm community members do not buy into the safety practices for a variety of reasons. • A more effective way to develop attitudes that support the adoption of safety practices is for researchers and members of the farming community to engage in dialogueMurphy (2003) Cole (1997)

33. What is Dialogue? • Jürgen Habermas: System and Lifeworld Spheres • James Carey: Transmission vs. Ritual Models • Hans-Georg Gadamer: Co-creation of meaning in conversation • James Grunig: From press agentry/publicity to two-way symmetrical models of public relations • Everett Rogers: The Passing of the Dominant Paradigm - From top-down to participatory communication

34. What is Dialogue? (2) • Bruner and Cole: Construction of Reality through Narratives and Storytelling • Freire: Dialogue and conscientization through problem posing and use of picture and audio codes as triggers • Green, Israel, and Anyaegbunam et al: Community Based Participatory Research/ Participatory Communication Research • Kotler, Zaltman, Andreasen and CDC: Social Marketing and Prevention/Health Marketing

37. From Selling to Marketing Agric. Health and Safety(2) Approaches in the field of health education and communication have evolved over the years from dictating the way that information is to be conveyed from the top-down, to strategies that favor learning from and listening to the needs and desires of the target audience themselves, and building the program from there.

38. From Selling to Marketing Agric. Health and Safety(3) Innovative health promotion practice includes community partnerships that focus on both individuals and communities at risk. Interventions directed at individual behaviors alone, without also influencing the social, cultural, economic, and political levels that shape behavior, do not have as great an impact on health status.

39. Marketing Agric. Safety and Health to Farmers Understanding the demographics and psychographics, including beliefs, perceptions, values, norms, lifestyles and concerns of an agricultural population is one of the first and most important steps in assessing its health and safety needs. It is also a fundamental precursor to planning effective programs to prevent occupational injury and improve health among the population.

40. Health Marketing Health Marketing involves creating, communicating, and delivering health information and interventions using customer-centered and science-based strategies to protect and promote the health of diverse populations. (CDC, 2005)

41. What is Health Marketing? • A transdisciplinary practice that integrates traditional marketing field with public health research, social marketing, health education and communication theories and practice • It promotes the use of marketing research to educate, motivate and inform the public on health messages • It is a complex framework that provides guidance for designing health interventions, campaigns, communications, and research projects • A broad range of strategies and techniques that can be used to create synergy among public health research, communication messages and health behaviors.

42. Why a transdisciplinary approach? Injury prevention needs to be conceptualized broadly enough that it can subsume a wide variety of specific scientific theories and the insights derived from research in a variety of disciplines. Moreover, a broad conception of injury prevention enables several programming difficulties to be overcome. Many programs provide services potentially relevant to prevention but with no demonstrated connection to injury prevention. Thinking contextually allows these undertakings to be considered as resources to the prevention effort. Preventing Neurotrauma: A Casebook of Evidence Based Practices Richard Volpe and John Lewko 2004

43. Health Marketing Basics • The offer, its competitive cost and benefits induce prospective consumers to purchase or adopt product, idea or service • Self-interest: The invisible guiding hand that ensures the efficiency of the marketplace • Consumer research: Used by marketers to identify the ways in which prospective consumers define their self-interest • 4Ps of Marketing: Product, price, place, promotion + partnership = the marketing mix

44. Uses of the health marketing approach • Consumer Research + needs assessment • Building sustainable distribution channels • Improving products and product selection and reducing product price • Developing and testing products that specifically respond to consumer and distributor preferences

45. Community-based Participatory Research (CBPR) Collaborative partnership approaches to actively involve participants in all phases of the research process from problem identification through adoption and dissemination of results. Recognizes the community as an integral partner in the research endeavor; the knowledge and experiences of community members are incorporated into the research process to ensure acceptance and improve community health. Recognizes that behavior and health are influenced by individual attributes as well as the conditions under which they live - the ecological models of health

46. CBPR and Health Marketing: A Basic Process • Research • Action Planning • Communication/Implementation • Evaluation *All phases carried out by transdisciplinary team + the community

47. Conclusion • Commercial marketing gave us the consumption of tobacco, alcohol and excess calories. • Health marketing can help us improve the occupational health and safety of farmers, especially, resource-poor and older farmers. • What are the implications of taking this road to agric. health and safety promotion among resource-poor and older farmers? Thank you