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Occupational Health and Safety
Health and Safety Training

Mastering Health and Safety Training for a Secure Work Environment

This comprehensive guide covers the essential components of an effective health and safety training program that focuses on the well-being of workers and how this can drive the organization’s productivity and success.

construction builders conducting health and safety training on site

What is Health and Safety Training?

Health and safety training is an educational process that imparts knowledge, skills, and awareness, enabling workers to effectively protect themselves from hazards and promote a safe working environment. Occupational risks do not just pose a danger to employees on the floor. These also have a direct impact on the success and reputation of the company as well. Therefore, everyone involved in the operations—from top executives to third-party suppliers and contractors—should undergo this vital training.

Significance

There are extensive advantages to developing a robust occupational health and safety training program, with positive effects on the workers and the business.

The primary purpose of training is to protect workers from workplace hazards. Fostering a safe and secure working environment through knowledge and skill sharing reduces the likelihood of workplace illnesses and injuries. And because employees feel safe in their surroundings, they become more engaged in their jobs and function at an optimum level.

The company gains from investing in this as well. First of all, injuries and fatalities are expensive. Their hard-earned money would go to hospitalizations, compensations, and legal liabilities. The business could also get fined by regulatory agencies for not paying enough attention to their employees’ well-being. Second, operational productivity will decline, which directly translates to reduced revenues. Last but not least, they could suffer reputational damage, a more long-lasting consequence.

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Key Components

Health and Safety training programs educate employees on identifying, preventing, and mitigating hazards and risks in the workplace. It covers a wide range of topics, greatly depends on the industry, and is delivered in various formats. The topics listed below may be considered the basics, but these are the most vital and applicable to all sectors.

Hazard Identification

Employees should know how to identify potential hazards, like unmaintained or damaged equipment, hazardous materials and environment, and even unsafe behavior or practices. All these could directly result in injury and illness.

Hazard identification is best taught face to face. Classroom-type lectures allow discussions of real-life examples and case studies, particularly when new hazards are observed. But if this is not feasible, interactive workshops will do just as well. But note that open communication and active participation are crucial in this regard.

Risk Assessment

The next step after identifying hazards is assessing the risk. On that account, training managers should include this topic in the program. Risk assessment is defined as the evaluation of the likelihood and gravity of the discovered hazards and prioritizing the control measures and resources required accordingly.

During the training, it’s crucial to focus on systematic methodologies and various tools that can help ensure a thorough risk evaluation, such as the Risk Matrix , Failure Mode and Effects Analysis ( FMEA ), and the Decision Tree. Practical exercises based on real-life scenarios allow participants to assess risks and propose effective control measures on the spot.

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Personal Protective Equipment (PPE)

PPEs are specialized clothing and equipment that act as the final defense against hazards that control measures cannot eliminate. Gloves, goggles, and masks are the most rudimentary and widely utilized across sectors. Task-specific gear in high-risk industries, such as air-supplying respirators for hazardous waste management , UV and infrared safety helmets for welding , and fall restraint harnesses for working at heights, should be available.

Workers should first understand the significance of PPEs and how consistently wearing them can keep them safe. They should also be taught the proper use, storage, check, and maintenance. Employees learn about these better through practical sessions with hands-on demonstrations.

Workplace Ergonomics

Another vital topic to include in the company’s health and safety curriculum is ergonomics , the study of people’s efficiency and safety in their working environment. This subject matter is vital as it minimizes the risk of musculoskeletal injuries caused by repetitive motions and poor posture.

The best way to teach this is through interactive sessions. Workers can learn the proper posture when sitting down or lifting heavy loads, methods to appropriately set up their workstations, and techniques for reducing physical strain. All these should be based on regulatory standards mandates.

Mental Health Awareness

Stress, anxiety, and depression are just as serious as physical injuries. These negatively impact the employee’s confidence at work and the business’s overall productivity. Mental health awareness programs should focus on educating workers about the different kinds of mental health issues and their signs, the significance of reducing stigma, and fostering compassion and support in the work environment.

A simple round-table discussion can facilitate an open and honest conversation about mental health challenges. Experts can share coping strategies by reviewing case studies with the participants and engaging them in role-playing exercises. Most importantly, the company should ascertain that mental health support and resources are made available to anyone who needs it.

Emergency Response Procedures

Employees should know how to effectively respond to emergencies , whether that is a medical incident involving a workmate or unforeseen disasters. Acting swiftly and appropriately saves lives and minimizes damages. HR managers should include the following subject matters in the training curriculum:

Evacuation protocols
Fire safety protocols
Hazardous materials handling
First aid , CPR (Cardiopulmonary Resuscitation), and fundamental medical assistance
Communication and reporting protocols

All these are best taught through drills and simulations. Hands-on training helps employees get familiarized with the situation they might face as well as the emergency equipment they need to utilize.

Compliance with Regulations

Adherence to regulations demonstrates the company’s commitment to safety and quality, consequently increasing stakeholder and consumer trust. Compliance is not just a managerial obligation. Everyone in the organization must take part in this endeavor. And it all starts with education.

Compliance training should emphasize the reason behind these mandates, particularly how they impact the operations and the people involved. The consequences of negligence and outright violations, such as fines and penalties, should also be mentioned. Participants would have a better grasp of the subject by going over real-life case studies instead of narrating the numerous regulations one by one.

Best Practices

Workplace dynamics continuously evolve because of new risks. Safeguarding employees’ health and safety can only be possible when the company adheres to the latest best practices, particularly in training.

Assess Training Needs – The training program should suit the needs, particularly the unique risks, present in the organization. HR and training managers should regularly conduct a thorough workplace assessment and tailor the curriculum based on that.
Engage Employees – Organizations can be successful in achieving a holistic training program when they involve their employees during the planning, development, and evaluation.
Update Curriculum Regularly – Refresher courses are must-haves because new risks emerge, government mandates change, and internal policies adapt. Workers will be more prepared for these changes when they are informed about them.
Evaluate Training Effectiveness – Progress is possible when organizations can measure the success of their initiatives. Evaluation can be done through assessments (e.g., quizzes and return demonstrations), surveys, and feedback sessions .

Create a secure working environment by empowering workers through continuous education. Leverage SafetyCulture’s Training feature to develop a holistic curriculum, conduct thorough training sessions, and ensure maximum impact for the workforce and the entire organization.

Strengthen Health and Safety Through Robust Training with SafetyCulture

Why use safetyculture.

Health and safety training plays a pivotal role in creating a secure working environment . Enriching skills and knowledge ensures employees can operate confidently, thrive in their working environment, and come home safely.

SafetyCulture (formerly iAuditor) , a top-rated mobile-first operations platform, can contribute to fostering a culture of safety within organizations. See how this software solution can be an asset to your health and safety training goals:

Ensure workers get work-related training at their most convenient time by providing bite-sized modules, instructional videos, and short quizzes on any mobile device.
Organize all resources for face-to-face training sessions, such as onboarding, upskilling, and company-wide seminars, by using checklists from the Public Library.
Make data-driven decisions for training changes or improvements using built-in analytics for risk assessments, skill gap analysis, and performance evaluations.
Document training programs, complete with photos and videos, for future stakeholder reviews and compliance reports.
Involve everyone in health and safety training initiatives by using Heads Up to communicate new risks, notifying workers about scheduled seminars, or reminding individuals about their attendance.

Eunice Arcilla Caburao

How Did They Do That? Case Studies on EHS Excellence

While it might be an overused phrase — “no need to reinvent the wheel” — there is a lot to be learned from others who have tackled and found solutions to safety issues that many companies face.

In this vein, the winners of the Campbell Award offer materials including business case studies, teaching notes and case study presentations.

Frist a word about the award, which is a National Safety Council award. Its mission is to “identify and provide evidence-based findings that enable current and future business leaders to effectively advance business vitality through embracing the value of environmental, health and safety management.” The award is supported by a network of Global Partners across five continents.

The Campbell Award recognizes organizations for commendable leadership and excellence in integrating EHS management with business operations systems. The award aims to:

Establish a validated process by which organizations can measure the performance of their EHS operations system against well tested and internationally accepted key performance indicators.
Capture and evaluate the successes and lessons learned through a rigorous systematic review process.
Foster the sharing of leading-edge EHS management systems and best practices for educational purposes worldwide.
Recognize organizations that have EHS well integrated as a key business value and in which measurable achievements in EHS performance are productive and profitable.

Here are some samples (and excerpts) of these case studies:

Johnson & Johnson -- Social Responsibility & Sustainable Competitive Advantages

This business case study starts with the assumption that EHS is a core value — because, for them, it is. Johnson & Johnson’s leaders, however, are aware that this belief is not shared by everyone — including some of its shareholders, who may be more focused on profit margin. By examining the company's credo-based culture and a number of its key EHS initiatives, Johnson & Johnson wanted students to come to understand the myriad ways in which social responsibility offers the company a truly sustainable competitive advantage.

Alcan- Leadership Challenges in Cross-Culture Ventures

This business case study takes a well-developed integrated EHS management system and puts it to the test in an extreme physical and cultural environment. In examining the astonishing results at the Ningxia facility, Alcan leadership wanted students to understand the difference an integrated, transferable system can make. Through this remarkable example, students come to see the value of integration and transfer as it extends not only to the business but the wider community — making the decision they’re faced with at the end of the study even more crucial.

Dow—Inseparability of Safety

“If you can’t do it better, why do it?” These famous words of Dow Chemical Company founder Herbert H. Dow begin the organization’s Campbell Award Case Study. It is this history of innovation, coupled with aspirational goal-setting and world-class expertise, which has enabled Dow to continue to reach and exceed its vision. In this study, readers gain insight into Dow’s transformational goal development process, including a look at incentives, empowerment, risk assessment, leading indicators, and more. Readers have the opportunity to put themselves in the shoes of Dow leadership and ask themselves, “What should we do next?”

More examples can be found here .

There is also a Campbell Institute that was launched from the Campbell Award winners as well as thought-leaders from the National Safety Council. The mission of the Institute is to help organizations achieve and sustain EHS excellence through participation, research and events.

Adrienne Selko | Senior Editor

Email [email protected]

Adrienne Selko is also the senior editor at Material Handling and Logistics and is a former editor of IndustryWeek.

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Case studies.

The Center’s research identifies and explores best practices, which in turn are the foundation for policies, programs, and practices that are implemented by organizations seeking to improve worker health, safety, and well-being. Our case studies provide concise summaries of organizational change implemented using a Total Worker Health ® integrated approach, and are based on the Center’s previous and current research projects.

The Workplace Organizational Health Study The Workplace Organizational Health Study sought to improve the health, safety, and well-being of front-line food service workers by identifying working conditions that could be modified to reduce pain and injuries and improve worker well-being. This case study, developed by the Center, summarizes the implementation of the 2+2 Feedback and Coaching tool, previously used with managers and modified for use with employees. Download the case study

Dartmouth-Hitchcock Medical Center To address rising employee health care expenses, Dartmouth-Hitchcock Medical Center (DHMC) launched an initiative to achieve its vision of the healthiest possible workforce, the foundation of which is an organizational culture that advances employee health, safety, and well-being. This case study, developed by the Center in collaboration with HealthPartners, summarizes the DHMC successful Total Worker Health approach and the resulting beneficial outcomes. Download the case study

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To download this document, please provide the following information. We are required to track downloads as part of the reporting we submit to our funder, NIOSH. We may contact you in the future about your use of this resource and to share news from our Center, but will not share your information with others. Thank you.

EHS Daily Advisor

Practical EHS Tips, News & Advice. Updated Daily.

Why Use Case Studies in Safety Training?

Updated: Jan 18, 2012

Case studies provide many benefits in safety training. They are especially effective for teaching employees about accident causes and prevention.

Case studies are an excellent way to train employees about workplace safety and health issues.

They present information in an engaging and dramatic way that grabs and holds trainees’ interest and attention.
They deal with practical, real-life issues that may actually confront trainees on the job.
They are like a puzzle that must be analyzed and solved, which provides a challenge for trainees and requires them to think rather than just sit and listen.
They are usually compact enough to fit comfortably into an average-length training session.

Accident case studies, in particular, provide a way of:

Focusing on a particular incident, hazard, unsafe act, etc.
Analyzing what happened, why it happened, and how it could have been prevented
Encouraging interaction between trainers and trainees and among trainees

Try OSHA Accident Case Studies and give a boost to your safety training program with real-life case studies of actual industrial accidents from OSHA files. We have a great one on lifting. Get the details.

Enhancing understanding of unsafe acts and conditions
Stimulating trainees to think and solve problems by examining information, considering alternatives, and deciding what the safest course of action would be

Investigative Approach

Like a real workplace accident investigation, an accident case study dissects the events leading up to the accident and helps trainees:

Identify potential hazards
Understand accident causes
Discuss possible preventive measures
Determine the best methods for preventing a similar accident
Generalize the information learned to other safety issues in the workplace
Transfer the analysis, problem-solving, and decision-making skills learned during the case study process to real situations on the job

With all these benefits, it’s easy to see why case studies are a popular format for safety and health training.

Even your most skeptical workers will see what can go wrong and become safety-minded employees with OSHA Accident Case Studies . They’ll learn valuable safety training lessons from real mistakes—but in classroom training meetings instead of on your shop floor. Get more info.

Case Studies Help Prevent Accidents

Want to prevent accidents? Of course you do. That’s why you should try OSHA Accident Case Studies.

Animated, customizable PowerPoint slides tell real-life case studies of actual industrial accidents from OSHA files, complete with accident photos to get workers’ attention and make your safety meetings come alive.

OSHA Accident Case Studies includes 25 meetings on all key safety topics.

Even your most skeptical workers will see what can go wrong and become safety-minded employees. They’ll learn valuable safety training lessons from real mistakes—but in classroom training meetings instead of on your shop floor.

25 case study meetings on key OSHA topics
Customizable visuals and text
Fast moving, animated PowerPoint presentations
Detailed speaker’s notes for every slide
Printable handouts, quizzes, and slides for each topic
Interactive exercises and questions

Safety topics include:

—Back safety —Power tools —Hazard communication —Lockout/tagout —Fire safety —Hearing protection —Confined spaces —Trenching and excavation —HAZWOPER —Ergonomics —And more!

We’ll be happy to make OSHA Accident Case Studies available for a no-cost, no-obligation, 30-day evaluation in your office. Just let us know , and we’ll be pleased to arrange it.

Evaluating Health and Safety Training: A Case Study in Chemical Workers Hazardous Waste Worker Education

Until very recently the effectiveness of training and education in controlling occupational health and safety hazards was largely a matter of faith rather than systematic evaluation (Vojtecky and Berkanovic 1984-85; Wallerstein and Weinger 1992). With the rapid expansion of intensive federally-funded training and education programmes in the past decade in the United States, this has begun to change. Educators and researchers are applying more rigorous approaches to evaluating the actual impact of worker training and education on outcome variables such as accident, illness and injury rates and on intermediate variables such as the ability of workers to identify, handle and resolve hazards in their workplaces. The programme that combines chemical emergency training as well as hazardous waste training of the International Chemical Workers Union Center for Worker Health and Safety Education provides a useful example of a well-designed programme which has incorporated effective evaluation into its mission.

The Center was established in Cincinnati, Ohio, in 1988 under a grant which the International Chemical Workers Union (ICWU) received from the National Institute for Environmental Health Sciences to provide training for hazardous waste and emergency response workers. The Center is a cooperative venture of six industrial unions, a local occupational health centre and a university environmental health department. It adopted an empowerment education approach to training and defines its mission broadly as:

… promoting worker abilities to solve problems and to develop union-based strategies for improving health and safety conditions at the worksite (McQuiston et al. 1994).

To evaluate the programme’s effectiveness in this mission the Center conducted long-term follow-up studies with the workers who went through the programme. This comprehensive evaluation went considerably beyond the typical assessment which is conducted immediately following training, and measures trainees’ short-term retention of information and satisfaction with (or reaction to) the education.

Programme and Audience

The course that was the subject of evaluation is a four or five-day chemical emergency/hazardous waste training programme. Those attending the courses are members of six industrial unions and a smaller number of management personnel from some of the plants represented by the unions. Workers who are exposed to substantial releases of hazardous substances or who work with hazardous waste less proximately are eligible to attend. Each class is limited to 24 students so as to promote discussion. The Center encourages local unions to send three or four workers from each site to the course, believing that a core group of workers is more likely than an individual to work effectively to reduce hazards when they return to the workplace.

The programme has established interrelated long-term and short-term goals:

Long-term goal : for workers to become and remain active participants in determining and improving the health and safety conditions under which they work.

Immediate educational goal : to provide students with relevant tools, problem-solving skills, and the confidence needed to use those tools (McQuiston et al. 1994).

In keeping with these goals, instead of focusing on information recall, the programme takes a “process oriented” training approach which seeks “to build self-reliance that stresses knowing when additional information is needed, where to find it, and how to interpret and use it.” (McQuiston et al. 1994.)

The curriculum includes both classroom and hands-on training. Instructional methods emphasize small group problem-solving activities with the active participation of the workers in the training. The development of the course also employed a participatory process involving rank-and-file safety and health leaders, programme staff and consultants. This group evaluated initial pilot courses and recommended revisions of the curriculum, materials and methods based on extensive discussions with trainees. This formative evaluation is an important step in the evaluation process that takes place during programme development, not at the end of the programme.

The course introduces the participants to a range of reference documents on hazardous materials. Students also develop a “risk chart” for their own facility during the course, which they use to evaluate their plant’s hazards and safety and health programmes. These charts form the basis for action plans which create a bridge between what the students learn at the course and what they decide needs to be implemented back in the workplace.

Evaluation Methodology

The Center conducts anonymous pre-training and post-training knowledge tests of participants to document increased levels of knowledge. However, to determine the long-term effectiveness of the programme the Center uses telephone follow-up interviews of students 12 months after training. One attendee from each local union is interviewed while every manager attendee is interviewed. The survey measures outcomes in five major areas:

students’ ongoing use of resource and reference materials introduced during training
the amount of secondary training, that is, training conducted by participants for co-workers back at the worksite following attendance at the Center course
trainee attempts and successes in obtaining changes in worksite emergency response or hazardous waste programmes, procedures or equipment
post-training improvements in the way spills are handled at the worksite
students' perceptions of training programme effectiveness.

The most recent published results of this evaluation are based on 481 union respondents, each representing a distinct worksite, and 50 management respondents. The response rates to the interviews were 91.9% for union respondents and 61.7% for management.

Results and Implications

Use of resource materials

Of the six major resource materials introduced in the course, all except the risk chart were used by at least 60% of the union and management trainees. The NIOSH Pocket Guide to Chemical Hazards and the Center’s training manual were the most widely used.

Training of co-workers

Almost 80% of the union trainees and 72% of management provided training to co-workers back at the worksite. The average number of co-workers taught (70) and the average length of training (9.7 hours) were substantial. Of special significance was that more than half of the union trainees taught managers at their worksites. Secondary training covered a wide range of topics, including chemical identification, selection and use of personal protective equipment, health effects, emergency response and use of reference materials.

Obtaining worksite improvements

The interviews asked a series of questions related to attempts to improve company programmes, practices and equipment in 11 different areas, including the following seven especially important ones:

health effects training
availability of material safety data sheets
chemical labelling
respirator availability, testing and training
gloves and protective clothing
emergency response
decontamination procedures.

The questions determined whether respondents felt changes were needed and, if so, whether improvements had been made.

In general, union respondents felt greater need for and attempted more improvements than management, although the degree of difference varied with specific areas. Still fairly high percentages of both unions and management reported attempted improvements in most areas. Success rates over the eleven areas ranged from 44 to 90% for unionists and from 76 to 100% for managers.

Spill response

Questions concerning spills and releases were intended to ascertain whether attendance at the course had changed the way spills were handled. Workers and managers reported a total of 342 serious spills in the year following their training. Around 60% of those reporting spills indicated that the spills were handled differently because of the training. More detailed questions were subsequently added to the survey to collect additional qualitative and quantitative data. The evaluation study provides workers’ comments on specific spills and the role the training played in responding to them. Two examples are quoted below:

Following training the proper equipment was issued. Everything was done by the books. We have come a long way since we formed a team. The training was worthwhile. We don’t have to worry about the company, now we can judge for ourselves what we need.

The training helped by informing the safety committee about the chain of command. We are better prepared and coordination through all departments has improved.

Preparedness

The great majority of union and management respondents felt that they are “much better” or “somewhat better” prepared to handle hazardous chemicals and emergencies as a result of the training.

This case illustrates many of the fundamentals of training and education programme design and evaluation. The goals and objectives of the educational programme are explicitly stated. Social action objectives regarding workers’ ability to think and act for themselves and advocate for systemic changes are prominent along with the more immediate knowledge and behaviour objectives. The training methods are chosen with these objectives in mind. The evaluation methods measure the achievement of these objectives by discovering how the trainees applied the material from the course in their own work environments over the long term. They measure training impact on specific outcomes such as spill response and on intermediate variables such as the extent to which training is passed on to other workers and how course participants use resource materials.

Environmental Education and Training: The State of Hazardous Materials Worker Education in the United States

The term environmental education covers a potentially wide range of issues and activities when applied to employees, managers and workplaces. These encompass:

education for general awareness of environmental concerns
education and training toward modifying work practices, processes and materials to reduce the environmental impact of industrial processes on local communities
professional education for engineers and others seeking expertise and careers in environmental fields
education and training of workers in the growing field of environmental abatement, including hazardous waste cleanup, emergency response to spills, releases and other accidents, and asbestos and lead paint remediation.

This article focuses on the state of worker training and education in the United States in the growing environmental remediation field. It is not an exhaustive treatment of environmental education, but rather an illustration of the link between occupational safety and health and the environment and of the changing nature of work in which technical and scientific knowledge has become increasingly important in such traditional “manual” trades as construction. “Training” refers in this context to shorter-term programmes organized and taught by both academic and non-academic institutions. “Education” refers to programmes of formal study at accredited two-year and four-year institutions. Currently a clear career path does not exist for individuals with interest in this field. The development of more defined career paths is one goal of the National Environmental Education and Training Center, Inc. (NEETC) at Indiana University of Pennsylvania. Meanwhile, a wide range of education and training programmes exist at different levels, offered by a variety of academic and non-academic institutions. A survey of the institutions involved in this type of training and education formed the source material for the original report from which this article was adapted (Madelien and Paulson 1995).

Training Programmes

A 1990 study conducted by Wayne State University (Powitz et al. 1990) identified 675 separate and distinct noncredit short courses for hazardous waste worker training at colleges and universities, offering over 2,000 courses nationwide each year. However, this study did not cover some of the primary providers of training, namely community college programmes, US Occupational Safety and Health Administration training programmes and independent firms or contractors. Thus, the Wayne State number could probably be doubled or tripled to estimate the number of noncredit, noncertification course offerings available in the United States today.

The major government-funded training programme in environmental remediation is that of the National Institute for Environmental Health Sciences (NIEHS). This program, established under the Superfund legislation in 1987, provides grants to non-profit organizations with access to appropriate worker populations. Recipients include labour unions; university programmes in labour education/labour studies and public health, health sciences and engineering; community colleges; and non-profit-making safety and health coalitions, known as COSH groups (Committees on Occupational Safety and Health). Many of these organizations operate in regional consortia. The target audiences include:

construction trades workers involved in cleanup of hazardous waste sites
emergency response personnel working for fire and emergency services agencies and industrial plants
transportation workers involved in transporting hazardous materials
hazardous waste treatment, storage and disposal facility workers
wastewater treatment workers.

The NIEHS program has resulted in extensive curriculum and materials development and innovation, which has been characterized by considerable sharing and synergy among grantees. The programme funds a national clearinghouse which maintains a library and curriculum centre and publishes a monthly newsletter.

Other government funded programmes offer short courses targeting hazardous waste industry professionals as opposed to front-line remedial workers. Many of these programmes are housed in university Educational Resource Centers funded by the National Institute for Occupational Safety and Health (NIOSH).

Education Programmes

Community colleges

The broadest change on the hazardous waste education and training landscape in the past few years is the dramatic development of community college programmes and consortia to improve vocational education at the associate’s degree level. Since the 1980s, community colleges have been doing the most organized and extensive curriculum development work in secondary education.

The Department of Energy (DOE) has funded programmes nationwide to provide for a trained workforce at sites where the need has changed from nuclear technicians to hazardous waste clean-up workers. This training is taking place most rigorously at community colleges, many of which have historically provided for personnel needs at specific DOE sites. DOE-funded programmes at community colleges have also given rise to major efforts in curriculum development and consortia for sharing information. Their goals are to establish more consistent and higher standards of training and to provide mobility for the workforce, enabling an individual trained to work at a site in one part of the country to move to another site with minimal retraining requirements.

Several consortia of community colleges are advancing curricula in this area. The Partnership for Environmental Technology Education (PETE) operates in six regions. PETE is working with the University of Northern Iowa to create a world-class network of community college environmental programmes, linked with high schools, that inform and prepare students for entry into these two-year degree programmes. The goals include the development of (1) nationally validated curriculum models, (2) comprehensive professional development programmes and (3) a national clearinghouse for environmental education.

The Hazardous Materials Training and Research Institute (HMTRI) serves the curriculum development, professional development, print and electronic communications needs of 350 colleges with two-year environmental technologies credit programmes. The Institute develops and distributes curricula and materials and implements educational programmes at its own Environmental Training Center at Kirkwood Community College in Iowa, which has extensive classroom, laboratory and simulated field site facilities.

The Center for Occupational Research and Development (CORD) provides national leadership in the US Department of Education’s Tech Prep/Associate Degree initiative. The Tech Prep program requires coordination between secondary and post-secondary institutions to give students a solid foundation for a career pathway and the world of work. This activity has led to the development of several contextual, experiential student texts in basic science and mathematics, which are designed for students to learn new concepts in relationship to existing knowledge and experience.

CORD has also played a significant role in the Clinton administration’s national educational initiative, “Goals 2000: Educate America”. In recognition of the need for qualified entry-level personnel, the initiative provides for the development of occupational skills standards. (“Skills standards” define the knowledge, skills, attitudes and level of ability necessary to successfully function in specific occupations.) Among the 22 skills standards development projects funded under the programme is one for hazardous materials management technology technicians.

Articulation between vocational and baccalaureate programmes

A continuing problem has been the poor linkage between two-year and four-year institutions, which hampers students who wish to enter engineering programmes after completing associate’s (two-year) degrees in hazardous/radioactive waste management. However, a number of community college consortia have begun to address this problem.

The Environmental Technology (ET) consortium is a California community college network that has completed articulation agreements with four four-year colleges. The establishment of a new job classification, “environmental technician”, by the California Environmental Protection Agency provides added incentive for graduates of the ET program to continue their education. An ET certificate represents the entry level requirement for the environmental technician position. Completion of an associate’s degree makes the employee eligible for promotion to the next job level. Further education and work experience allows the worker to progress up the career ladder.

The Waste-management Education and Research Consortium (WERC), a consortium of New Mexico schools, is perhaps the most advanced model which attempts to bridge gaps between vocational and traditional four-year education. Consortium members are the University of New Mexico, the New Mexico Institute of Mining and Technology, New Mexico State University, Navajo Community College, Sandia Laboratory and Los Alamos Laboratories. The approach to curriculum transfer has been an interactive television (ITV) program in distance learning, which takes advantage of the varied strengths of the institutions.

Students enrolled in the environmental programme are required to take 6 hours of courses from the other institutions through distance learning or an offsite semester of coursework. The programme is decidedly inter-disciplinary, combining a minor in hazardous materials/waste management with a major from another department (political science, economics, pre-law, engineering or any of the sciences). The programme is “both broad and narrow” in focus, in that it recognizes a need to develop students with both a broad knowledge base in their field and some specific training in hazardous materials and hazardous waste management. This unique programme couples student participation in realistic applied research and industry-led curriculum development. The courses for the minor are very specific and take advantage of the particularized specialties at each school, but each program, including the associate degree, has a large core requirement in humanities and social sciences.

Another unique feature is the fact that the four-year schools offer two-year associate’s degrees in radioactive and hazardous materials technology. The two-year associate’s degree in environmental science offered at the Navajo Community College includes courses in Navajo history and substantial courses in communications and business, as well as technical courses. A hands-on laboratory has also been developed on the Navajo Community College campus, an unusual feature for a community college and part of the consortium’s commitment to hands-on laboratory learning and technology development/applied research. The WERC member institutions also offer a “non-degree” certificate programme in waste management studies, which seems to be above and beyond the 24-hour and 40-hour courses offered at other colleges. It is for individuals who already have a bachelor’s or graduate degree and who further wish to take advantage of seminars and specialty courses at the universities.

Conclusions

Several significant changes have taken place in the focus of education and training related to the hazardous waste industry in the past few years, in addition to the proliferation of short-course training programmes and traditional engineering programmes. Overall, the Department of Energy seems to have focused education at the community college level on workforce retraining, primarily through the Partnership for Environmental Technology Education (PETE), the Waste-management Education and Research Consortium (WERC) and other consortia like them.

There is a major gap between vocational training and traditional education in the environmental field. Because of this gap, there is not a clear, routine career path for hazardous waste workers, and it is difficult for these workers to advance in industry or government without classic technical degrees. Although inter-departmental options for education at a management level are being established within economics, law and medicine departments which recognize the breadth of the environmental industry, these are still academic-based professional degrees which miss a large part of the available and experienced workforce.

As the environmental clean-up industry matures, the long-term needs of the workforce for more balanced training and education and a well-developed career path become more clear. The large numbers of displaced workers from closed military sites means more people are entering the environmental workforce from other fields, making the demand on union training and placement of displaced workers (both discharged military personnel and displaced civilian personnel) even greater than before. Educational programmes are needed which meet both the needs of personnel entering the industry and of industry itself for a more balanced and better-educated workforce.

Since labour union members are one of the main groups poised to enter the hazardous waste clean-up and environmental remediation field, it would seem that labour studies and industrial relations departments might be logical entities to develop degree programmes that incorporate a hazardous waste/environmental curriculum with development of labour/management skills.

Worker Education and Environmental Improvement

The articles in this chapter have thus far concentrated on training and education regarding workplace hazards. Environmental education serves multiple purposes and is a useful complement to occupational safety and health training. Worker education is a critical and often overlooked aspect of a broad and effective environmental protection strategy. Environmental issues are frequently viewed as purely technological or scientific matters that stand outside the purview of workers. Yet worker knowledge is critical to any effective environmental solutions. Workers are concerned as citizens and as employees about environmental matters because the environment shapes their lives and affects their communities and families. Even when technological solutions are required that use new hardware, software or process approaches, worker commitment and competence are necessary for their effective implementation. This is true for workers whether involved directly in environmental industries and occupations or in other kinds of jobs and industrial sectors.

Worker education can also provide a conceptual foundation to enhance workers’ participation in environmental improvement, health and safety protection, and organizational improvement. The UNEP Industry and Environment Programme notes that “many companies have found that worker involvement in environmental improvement can yield important benefits” (UNEP 1993). The Cornell Work and Environment Initiative (WEI) in a study of US enterprises found that intense worker participation yielded triple the source reduction of technical or external solutions alone and boosted yields of some technological approaches even higher (Bunge et al. 1995).

Worker environmental education comes in a variety of forms. These include trade union awareness and education, occupational training and orientation, connecting environment to workplace health and safety concerns and broad awareness as citizens. Such education occurs in a range of venues including worksites, trade union halls, classrooms and study circles, using both traditional and newer computer-based delivery systems. It is fair to say that workers’ environmental education is an underdeveloped field, especially in comparison with managerial and technical training and school-based environmental education. At the international level, education of front-line workers is often mentioned in passing and is overlooked when it comes to implementation. The European Foundation for the Improvement of Living and Working Conditions has commissioned a series of studies on the educational dimension of environmental protection, and in its next programme of work will directly look at the shop-floor workers and their environmental educational needs.

What follows are several examples gathered through the WEI at Cornell University that illustrate both practice and possibility in worker environmental education.The WEI is a network of managers, trade unionists, environmentalists and government policy officials from 48 countries in all parts of the world, committed to finding ways that workers and the workplace can contribute to environmental solutions. It addresses a wide range of industries from primary extraction to production, service and public-sector enterprises. It provides a means for education and action on environmental matters that seeks to build knowledge at the workplace and in academic institutions that can lead to cleaner and more productive workplaces and better connection between internal and external environments.

Australia: Eco-Skills Modules

The Australian Council of Trade Unions (ACTU) has developed new approaches to workers’ education for the environment that provides both broad social awareness and specific competencies for employment, especially among young workers.

The ACTU has organized an Environment Training Company with a broad mandate to address a variety of sectors but with an initial focus on land management issues. This focus includes teaching ways to handle reclamation work safely and effectively but also ways to assure compatibility with indigenous peoples and natural environments. With input from trade unionists, environmentalists and employers, the training company developed a set of “Eco-Skills” modules to establish basic environmental literacy among workers from an array of industries. These are integrated with a set of skill competencies that are technical, social and safety oriented.

Eco-Skills modules 1 and 2 contain a broad base of environmental information. They are taught alongside other entry-level training programmes. Levels 3 and higher are taught to people who specialize in work focused on reduction of environmental impacts. The first two Eco-Skills modules are composed of two forty-hour sessions. Trainees attain skills through lectures, group problem-solving sessions and practical hands-on techniques. Workers are assessed through written and oral presentations, group work and role plays.

Concepts covered in the sessions include an introduction to the principles of ecologically sustainable development, efficient resource use and cleaner production and environmental management systems. Once Module 1 is completed workers should be able to:

identify the implications of a given lifestyle for long-term sustainability with specific emphasis placed on the learner’s present and future lifestyle
identify ways to reduce the environmental impact of human activities
describe strategies to reduce environmental impacts in a given industry (agriculture, forestry, manufacturing, tourism, leisure, mining)
describe the main features of an Environmental Management System
identify the role of stakeholders in reducing environmental pollution and resource depletion.

Module 2 expands upon these initial objectives and prepares workers to begin applying pollution prevention and resource conservation methods.

Some industries are interested in connecting environmental impact skills and knowledge to their industry standards at every level. Awareness of environmental issues would be reflected in the day-to-day work of all industry workers at all skill levels. An incentive for workers lies in the fact that pay rates are linked to industry standards. The Australian experiment is in its infancy, but it is a clear attempt to work with all parties to develop competency-based activities that lead to increased and safer employment while enhancing environmental performance and awareness.

Linking Occupational Health and Safety and Environmental Training

One of the most active unions in the United States in environmental training is the Laborers International Union of North American (LIUNA). US government regulations require that hazardous-waste abatement workers receive 40 hours of training. The union along with participating contractors have developed an intensive 80-hour course designed to provide potential hazardous-waste workers with greater awareness of safety and the industry. In 1995, over 15,000 workers were trained in lead, asbestos and other hazardous-waste abatement and other environmental remediation work. The Laborers–Associated General Contractors programme has developed 14 environmental remediation courses and associated train-the-trainer programmes to assist nationwide efforts at safe and quality remediation. These are conducted at 32 training sites and four mobile units.

In addition to providing safety and technical training, the programme encourages participants to think about larger environmental issues. As part of their classwork, trainees gather materials from local papers on environmental issues and use this local connection as an opening to discuss broader environmental challenges. This joint environmental training fund employs a full-time equivalent staff of 19 at its central office and spends over US$10 million. The materials and training methods meet high quality standards with extensive use of audio-visual and other training aids, specific competency focus, and quality commitment and assessment built in throughout the curricula. A “learn-at-home” video is used to help meet literacy concerns and environmental and basic literacy training are connected. For those who desire it, six of the courses are transferable into college credit. The programme is active in serving minority communities, and over half of the participants come from minority population groups. Additional programmes are developed in partnership with minority consortiums, public housing projects and other training providers.

The union understands that a great deal of its future membership will come in environmentally related businesses and sees the development of worker education programmes as building the foundation for that growth. While both safety and productivity are better on jobs using trained workers, the union also sees the broader impact:

The most interesting impact environmental training has had on members is their increased respect for chemicals and harmful substances in the workplace and at home. … Awareness is also increasing with respect to the consequences of continued pollution and the cost involved with cleaning up the environment. … The true impact is much greater than just preparing people for work (LIUNA 1995).

In the United States, such hazardous-materials training is also conducted by the Operating Engineers; Painters; Carpenters; Oil, Chemical and Atomic Workers; Chemical Workers Union; Machinists; Teamsters; Ironworkers and Steelworkers.

LIUNA is also working internationally with the Mexican Confederation of Workers (CTM), federal and private training groups and employers to develop training methodologies. The focus is on training Mexican workers in environmental remediation work and construction skills. The Inter-American Partnership for Environmental Education and Training (IPEET) held its first training course for Mexican workers during the summer of 1994 in Mexico City. A number of labour leaders and workers from local industries, including paint manufacturing and metal plating, attended the one-week course on environmental safety and health. Other LIUNA partnerships are being developed in Canada with French editions of the materials and “Canadianization” of the content. The European Institute for Environmental Education and Training is also a partner for similar training in Eastern European and CIS countries.

Zambia: Educational Manual on Occupational Health and Safety

In Zambia, too often occupational health and safety is taken seriously only when there is an incident involving injury or damage to company property. Environmental issues are also ignored by industry. The Manual on Occupational Health and Safety was written in an effort to educate employees and employers on the importance of occupational health and safety issues.

The first chapter of this manual outlines the importance of education at all levels in a company. Supervisors are expected to understand their role in creating safe, healthy working conditions. Workers are taught how maintaining a positive, cooperative attitude relates to their own safety and work environment.

The manual specifically addresses environmental issues, noting that all major towns in Zambia face

threats of increasing environmental damage. In specific, the Zambia Congress of Trade Unions (ZCTU) identified environmental hazards in the mining industry through strip mining and air and water pollution that results from poor practices. Many factories are responsible for air and water pollution because they discharge their waste directly into nearby streams and rivers and allow smoke and fumes to escape unchecked into the atmosphere (ZCTU 1994).

Though many African trade unions are interested in further education on the environment, lack of adequate funding for worker education and the need for materials that link environmental, community and workplace hazards are major barriers.

Employer-Based Worker Environmental Education and Training

Employers, especially larger ones, have extensive environmental education activities. In many cases, these are mandated training linked to occupational or environmental safety requirements. However, an increasing number of companies recognize the power of broad worker education that goes well beyond compliance training. The Royal Dutch/Shell Group of companies have made health, safety and environment (HSE) part of their overall approach to training, and environment is an integral part of all management decisions (Bright and van Lamsweerde 1995). This is a global practice and mandate. One of the company’s goals is to define HSE competencies for appropriate jobs. Worker competence is developed through improved awareness, knowledge and skill. Appropriate training will increase worker awareness and knowledge, and skills will develop as new knowledge is applied. A wide range of delivery techniques helps share and reinforce the environmental message and learning.

At Duquesne Light in the United States, all 3,900 employees were successfully trained “on how the company and its employees actually affect the environment.” William DeLeo, Vice-President of Environmental Affairs said:

To develop a training programme that enabled us to meet out strategic objectives we determined that our employees needed a general awareness of the importance of environmental protection as well as specific technical training relative to their job responsibilities. These two points became the guiding strategy for our environmental education program (Cavanaugh 1994).

Worker and Union-Based Environmental Education Programmes

The Workers’ Education Branch of the ILO has developed a six-booklet set of background materials to spark discussion among trade unionists and others. The booklets address workers and the environment, the workplace and the environment, the community and the environment, world environmental issues, the new bargaining agenda, and provide a guide to resources and a glossary of terms. They provide a broad, insightful and easy-to-read approach that can be used in both developing and industrial countries to discuss topics relevant to workers. The materials are based on specific projects in Asia, the Caribbean and Southern Africa, and can be used as a whole text or can be separated in a study circle format to promote general dialogue.

The ILO in a review of training needs pointed out:

Trade unionists must increase their awareness about environmental concerns in general and the impact their employing firms are having on the environment, including the safety and health of their workers, in particular. Trade unions and their members need to understand environmental issues, the consequences that environmental hazards have on their members and the community at large, and be able to develop sustainable solutions in their negotiations with company management and employers’ organizations. (ILO 1991.)

The European Foundation for the Improvement of Living and Working Conditions has observed:

Local trade unions and other employee representatives are in a particularly difficult situation. They will have the relevant knowledge of the local situation and the workplace but will, in most cases, not be sufficiently specialised in complex environmental and strategic issues.

They will, therefore, be unable to exercise their functions unless they received additional and specialised training. (European Foundation for the Improvement of Living and Working Conditions 1993.)

A number of national unions have urged increased workers’ education on the environment. Included among them is the LO in Sweden, whose 1991 Environmental Programme called both for more education and action at the workplace and for additional study circle material on the environment to promote awareness and learning. The Manufacturing Workers Union in Australia has developed a training course and set of materials to assist the union in providing environmental leadership, including how to address environmental issues through collective bargaining.

Good worker-based environmental education provides both conceptual and technical information to workers that assists them in increasing environmental awareness and in learning concrete ways to change work practices that are damaging to the environment. These programmes also learn from workers at the same time to build on their awareness, reflection and insight about workplace environmental practice.

Workplace environmental education is best done when it is connected to community and global environmental challenges so that workers have a clear idea of how the ways they work are connected to the overall environment and how they can contribute to a cleaner workplace and global ecosystem.

Safety and Health Training of Managers

Following a brief review of the development of educational contributions to worker health and safety and of the first attempts to establish the foundations of management education, this article will address curriculum development. The two career paths along which future senior managers develop will be considered as an issue relevant to the educational needs of managers. The curriculum content for managerial issues will be set forth first, to be followed by that pertinent to an understanding of injury causation.

Education for occupational safety and health has been directed, in the main, to people such as safety managers and occupational physicians, and more recently, to occupational health nurses, ergonomists and hygienists—people who have been appointed to specialist staff positions in organizations.

The advisory roles of these specialists have incorporated tasks such as the administration of pre-employment medical examinations, health surveillance, monitoring employee exposures to a range of hazards and environmental examination. Their activities moreover include contributing to job and task design in order to adjust engineering or administrative controls by way of minimizing if not eliminating (for example) the harmful effects of postural demands or of exposure to toxic hazards.

This specialist-oriented educational approach has tended to ignore the central fact that the provision of safe and healthy workplaces requires an extraordinarily broad scope of operational knowledge necessary to make them a reality. It must be borne in mind that managers carry the responsibility for planning, organizing and controlling work activities in public and private enterprises across all industry sectors.

During the decade of the 1970s many initiatives were taken to offer study programmes at the tertiary level to provide a professional education with practical training for the range of specialist engineers, scientists and health care workers entering the field of occupational safety and health.

In the 1980s it was recognized that the people most directly concerned with occupational safety and health, the managers, the workers themselves and their associations, were the most significant entities in the move to reduce workplace injury and ill health. Legislation in many jurisdictions was introduced to provide education for workers serving on safety committees or as elected safety and health representatives. These changes highlighted for the first time the very limited education and training facilities then available to managers.

An early initiative to address management education

Several steps were taken to overcome this problem. The most widely known is Project Minerva, an initiative of the US National Institute for Occupational Safety and Health (NIOSH), which represented an early effort to inculcate that body of specific managerial skills which is necessary to ensure workplace safety and which “generally exceeds that which is offered through courses in the traditional business curriculum” (NIOSH 1985). Teaching materials intended to address the more urgent safety and health concerns were provided for business schools. The resource guide comprised instructional modules, case studies and a book of readings. Module topics are listed in figure 1.

Figure 1. Modular curriculum content, Project Minerva resource guide.

The Canadian Society of Safety Engineers has recommended this structure to business schools seeking to incorporate occupational safety and health materials into their curricula.

Fundamentals of Managing: General Rather Than Specific Needs

Any job responsibility entails the acquisition of relevant knowledge and appropriate skills in order to discharge it. Responsibility for managing occupational safety and health within any organization will be placed increasingly upon line managers at each level in the job hierarchy. Associated with that responsibility ought to be commensurate accountability and the authority to command the necessary resources. The knowledge and skills needed to discharge this responsibility form the curriculum for occupational safety and health management education.

At first sight, it would seem necessary that a curriculum of this sort be developed with the aim of meeting all the special demands of the whole range of management functions as they relate to such a diversity of positions as office administrator, nurse manager, operations director, supplies and purchasing superintendent, fleet coordinator and even ship’s captain. The curricula need also, perhaps, address the whole range of industries and the occupations found within them. However, experience strongly suggests that this is not so. The necessary skills and knowledge are, in fact, common to all management functions and are more fundamental than those of the specialists. They are operative at the level of basic management expertise. However, not all managers arrive at their position of responsibility by taking similar paths.

Managerial Career Paths

The usual path to a managerial career is through either supervisory or specialist functions. In the former case, career development is dependent on work experience and job knowledge and in the latter it ordinarily presupposes off-the-job college education and postgraduate study, for example as an engineer or nurse manager. Both streams need to develop occupational safety and health (OSH) skills. For the latter this may be done in graduate school.

It is usual today for successful managers to acquire the degree of Master of Business Administration (MBA). For this reason the Minerva Project directed its attention to the 600 or more graduate management schools in the United States. By incorporating into MBA curricula such aspects of occupational safety and health as were determined to be critical for successful management of the field, it was believed that this material would be integrated into the formal studies of middle management.

Given the extremely high rate of technological invention and scientific discovery, undergraduate courses, particularly in engineering and scientific disciplines, have only limited opportunities to integrate broadly-based safety theory and practice into design, process and operation studies.

Since managerial roles begin fairly soon after graduation for those with specialist education, there is a need to provide the knowledge and skills that will support the safety and health responsibility of both specialist and generalist managers.

It is important that an awareness of the content of any curriculum devoted to occupational safety and health objectives among management be promoted among other personnel having related responsibilities. Thus, the training of such key employees as safety and health representatives should be designed to keep them current with such curricular developments.

Curriculum for Managing Occupational Safety and Health

There are two broad classes of knowledge into which the discipline of occupational safety and health falls. One is that relating to the functions and principles of management and the other deals with the nature and proactive control of hazards. The model of curriculum development set forth below will follow this division. Both the supervisory path to management and the specialist path will require their own particular coverage of each of these classes.

The question of what level of complexity and technological detail needs to be provided to students may be determined by the purpose of the course, its length and the intention of the providers regarding subsequent education and skills development. These issues will be addressed in a later section.

Specifically, curricula should address machinery and plant safety, noise, radiation, dust, toxic materials, fire, emergency procedures, medical and first aid arrangements, workplace and employee monitoring, ergonomics, environmental hygiene, workplace design and maintenance and, most importantly, the development of standard operating procedures and training. This last is an essential component of managerial understanding. Not only must tasks and processes be the subject of operator training but the requirement for continuous improvement of people and processes makes training and retraining the most critical step in improving the quality of both. Adult learning theory and practice needs to be applied in the development of the curricular materials that guide this continuing training process.

The functions and principles of management

The fundamental purposes of management embrace the planning, organizing and control of workplace activities. They also embrace the incorporation of practices which maximize opportunities for workforce participation in goal setting, team operation and quality improvement. Furthermore, successful management requires the integration of occupational safety and health into all the organization’s activities.

It is rare for undergraduate programmes, outside those of colleges of business, to cover any of this knowledge. However, it is a most essential component for the specialist practitioners to have incorporated into their undergraduate study.

Organizational framework

The mission statement, strategic plan and structure set up to guide and facilitate the attainment of the organization’s objectives must be understood by the managers to be the basis for their individual activities. Each division of the organization whether it is a hospital, trucking business or coal mine, will in turn have its own goals and structure. Each will reflect the need to achieve organizational goals, and, taken together, will drive the organization towards them.

Policies and procedures

The primary embodiment of an organization’s goals are comprised by policy documents, the guides for individual employees on specific topics. (In some jurisdictions, the publication of an organization’s overall policy is required by law.) These documents ought to include reference to the range of occupational safety and health programmes designed with regard to the activities and processes which occupy the working time of employees. A sample of some general policy statements might include documents on emergency evacuation, fire fighting, purchasing procedures, injury reporting and accident and incident investigation. On the other hand, specific hazards will require their own process-specific policy materials concerning, for example, hazardous substances management, ergonomic interventions or entry into confined spaces.

After establishing policy, an activity preferably carried out with worker representative participation and union involvement, detailed procedures would then be put in place to give effect to them. Again, participative practices will contribute to the wholehearted acceptance of them by the workforce as a valuable contribution to their safety and health.

A safety and health management system is schematically illustrated in figure 2.

Figure 2. A health and safety management system.

Organizational structures defining key roles

The next stage in the management process is to define an organizational structure which characterizes the roles of key people—for example, the chief executive—and professional advisors such as safety advisors, occupational hygienists, the occupational health nurse, the physician and the ergonomist. In order to facilitate their roles, the relationships of these people and elected safety and health representatives (required in some jurisdictions) and worker members of safety committees to the organizational structure need to be explicit.

The planning and organizing functions of management will integrate structures, policies and procedures into the operational activities of the enterprise.

Control activities—establishing processes and goals, determining standards of acceptable achievement and measuring performance against those standards—are the operational steps which bring to realization the intentions of the strategic plan. They also need to be established through co-determination. The tools for control are workplace audits, which may be continuous, frequent, random or formal.

An understanding of these activities is an important component of a management education syllabus, and skills should be developed in carrying them out. Such skills are as essential to the success of an integrated safety and health plan as they are to the discharge of any other management function, whether purchasing or fleet operation.

Organizational development and curriculum

Since the introduction of new organizational structures, new equipment and new materials is occurring at a rapid pace, special attention must be given to the processes of change. The employees who will be affected by these changes can have a deciding influence on their effectiveness and on the efficiency of the work group. An understanding of the psychosocial factors influencing the activities of the organization must be acquired and skills must be developed in using this knowledge to reach organizational objectives. Of particular importance is the delegation of the authority and the accountability of the manager to work groups formed into autonomous or semi-autonomous work teams. The management education curriculum must place at the disposal of its students the tools necessary to carry out their obligation to ensure not only process improvement and quality but the development of the multiple skills and quality awareness of personnel with which the issue of safety is so closely involved.

There are two further components of the management curriculum requiring examination. One of these is the activity of incident investigation and the other, on which the whole of this activity rests, is an understanding of the accident phenomenon.

The accident phenomenon

The work of Derek Viner (1991) in clearly expounding the significance of energy sources as the potential hazards in all workplaces has defined half of the accident equation. In conjunction with Viner’s work, the contribution of Dr. Eric Wigglesworth (1972) in identifying human error, the crucial element in managing workplace safety activities, completes its definition. An emphasis on the process of each damaging occurrence has been shown by Benner (1985) when considering accident investigation methods to be the most productive approach to managing worker safety and health.

Wigglesworth’s visualization of the sequence of events which results in injury, damage and loss appears in figure 3. It highlights the role of nonculpable human error, as well as the essential element of loss of energy containment and the potential for the injury outcome where this occurs.

Figure 3. The error/injury process.

The implications of the model for management become clear when planning for work processes takes account of the behavioural inputs which affect those processes. This is so in particular when the role of design is given its rightful place as the initiating mechanism for both equipment and process development. When planning takes account both of the design of plant and equipment and of the human factors influencing work activity, coordination and control mechanisms can then be implemented to assure containment of the identified hazards.

A model may be used to illustrate the significance of the interaction between the worker, the equipment, tools and machines employed to further the task objectives and the environment within which the activity takes place. The model highlights the need to address factors within all three elements which may contribute to damaging events. Within the workstation environment, which encompasses the thermal, aural and lighting components, among others, the worker interacts with the tools and equipment necessary to get the work done (see figure 4).

Figure 4. Representation of workstation elements relevant to injury causation and control.

Accident investigation and analysis

Accident investigation serves a number of important functions. First, it can be a proactive process, being used in situations where an incident occurs which results in no damage or injury but where there is a potential for harm. Studying the sequence of events can uncover features of the work process which could lead to more serious consequences. Second, one may gain an understanding of the process by which the events unfolded and thus can identify the absence of, or weakness in, process or task design, training, supervision or controls over energy sources. Third, many jurisdictions legally require investigations of certain types of incidents, for example, scaffolding and trench collapses, electrocutions and failures of hoisting equipment. The work of Benner (1985) illustrates well the importance of having a clear understanding of the accident phenomenon and an effective protocol for investigating injury and damage events.

The nature and control of hazards

All injury results from some form of energy exchange. The uncontrolled release of physical, chemical, biological, thermal, or other forms of energy is a source of potential harm to a variety of workers. Containment by suitable engineering and administrative mechanisms is one essential aspect of suitable control. Identifying and evaluating these energy sources is a prerequisite for control.

A management education curriculum would thus contain topics covering a range of activities which includes establishing objectives, planning the work, developing policy and procedures, undertaking organizational change and installing controls over work processes (and specifically the energy sources utilized in carrying out that work), all aimed at injury prevention. While curricula designed for the technical areas of operations need address only fundamental principles, organizations that make use of very hazardous materials or processes must have in their employ a senior member of management with sufficient training in the specific modes of handling, storage and transport of such technology to ensure the safety and health of workers and members of the community.

Larger enterprises and small business

Managers who work in larger organizations employing, say, a hundred or more people usually have one or only a few functional responsibilities and report to a senior manager or a board of directors. They have occupational safety and health responsibility for their own subordinates and act within established policy guidelines. Their educational needs may be addressed by the formal programmes offered in business schools at the undergraduate or graduate level.

On the other hand, the sole managers or partners in small enterprises are less likely to have had graduate education, and, if they have, it is more likely to be of a technological than managerial sort, and it is more difficult to address their needs for the management of occupational health and safety.

Small business needs

Providing training programmes for these managers, who often work very long hours, has represented a difficulty of long standing. Although a number of large legislative jurisdictions have produced guidance booklets setting out minimum performance stands, the more promising approaches are being made available through industry associations, such as the Ontario Industrial Accident Prevention Associations funded by levies placed by the Workers’ Compensation Board upon all businesses in the given industrial sector.

Syllabus Content

A body of knowledge and skills which addresses the needs of managers at the first-line supervisory level, middle management and senior executives is outlined in figure 5 by topic. Individual short-form syllabuses follow in figure 6. These have been collated from the syllabuses of a number of university graduate study programmes.

Figure 5. Syllabus for an OSH study programme.

Figure 6. Short form syllabuses for an OSH study programme.

The needs of first-line supervisors will be met through the acquisition of knowledge and skills covered by those topics that relate to operational demands. The training of senior executives will concentrate on such topics as strategic planning, risk management and compliance matters as well as initiating policy proposals. The allocation of hours for each course of study should reflect student needs.

Management education for occupational safety and health demands an eclectic approach to the broadest range of issues. It shares with quality the imperative of being integrated into every management and worker activity, into every employee’s job description and should be a part of the performance appraisal of all.

Training of Health and Safety Professionals

Categories of Occupational Safety and Health Professionals Requiring Training and Education

The delivery of occupational safety and health services requires a highly-trained and multidisciplinary team. In a few less-developed countries, such a team may not exist, but in the vast majority of countries in the world, experts in different aspects of OSH are usually at least available though not necessarily in sufficient numbers.

The question of who belong to the categories of OSH professionals is fraught with controversy. Usually there is no dispute that occupational physicians, occupational nurses, occupational hygienists and safety professionals (sometimes referred to as safety practitioners) are OSH professionals. However, there are also members of many other disciplines who can make a plausible claim to belonging to the OSH professions. They include those ergonomists, toxicologists, psychologists and others who specialize in the occupational aspects of their subjects. For the purpose of this article, nevertheless, the training of these latter types of personnel will not be discussed, as the main focus of their training is often not on OSH.

Historical Perspective

In most countries, specific OSH training is of fairly recent origin. Until the Second World War, most OSH professionals received little or no formal training in their chosen calling. Few schools of public health or universities provided formal OSH courses, though some such institutions offered OSH as a subject in the context of a wider degree course, usually in public health. Segments of OSH were taught at the postgraduate level for physicians training in disciplines such as dermatology or respiratory medicine. Some engineering aspects of safety, such as machine guarding, were taught in technological and engineering schools. In most countries, even training in individual components of occupational hygiene courses were hard to find before the Second World War. The development of occupational nursing training is even more recent.

In the developed countries, OSH training received a boost during the Second World War, just as OSH services did. The mass mobilization of whole nations for the war effort led to greater emphasis on protecting the health of workers (and therefore their fighting capability or productivity with respect to the manufacturing of more munitions, warplanes, tanks and warships). At the same time, however, wartime conditions and the drafting of both university teachers and students into the armed forces made it extremely difficult to set up formal courses of OSH training. After the Second World War, however, many such courses were established, some with the help of the generous study grants for demobilized servicemen awarded by grateful governments.

After the Second World War, most colonies of European empires achieved independence and embarked upon the path of industrialization to a greater or lesser extent as a means to national development. Before long, such developing countries found themselves confronting the ills of the industrial revolution of nineteenth-century Europe, but within a much telescoped time span and on an unprecedented scale. Occupational accidents and diseases and environmental pollution became rampant. This led to the development of OSH training, although even today there are large variations in the availability of such training in these countries.

Review of Current International Initiatives

International Labour Organization (ILO)

There have been several initiatives of the ILO in recent years which relate to OSH training. Many of them relate to practical training for interventive measures at the worksite. Some other initiatives are carried out in collaboration with national governments (Rantanen and Lehtinen 1991).

Other ILO activities since the 1970s have been carried on largely in developing countries throughout the world. Several such activities relate to the upgrading of training of factory inspectors in countries such as Indonesia, Kenya, the Philippines, Tanzania, Thailand, and Zimbabwe.

The ILO, together with other United Nations agencies such as the United Nations Development Programme, has also assisted in the establishment or upgrading of national institutes of OSH, the training functions of which are usually among their top priorities.

The ILO has also produced several practical monographs which are very useful as training materials for OSH courses (Kogi, Phoon and Thurman 1989).

World Health Organization (WHO)

The WHO has held in recent years a number of important international and regional conferences and workshops on OSH training. In 1981, a conference entitled “Training of Occupational Health Personnel” was held under the auspices of the Regional Office for Europe of the WHO. In the same year, the WHO convoked with the ILO a Joint ILO/WHO Committee on Occupational Health which focused on “educational and training in occupational health, safety and ergonomics” (WHO 1981). That meeting assessed the needs for education and training at different levels, developed policies in education and training and advised on methodology and programmes for education and training (WHO 1988).

In 1988 a WHO Study Group published a report entitled Training and Education in Occupational Health to address particularly the new policies on primary health care strategies adopted by the WHO member states, new needs resulting from technological developments and new approaches to health promotion at work (WHO 1988).

International Commission on Occupational Health (ICOH)

In 1985, the ICOH established a Scientific Committee on Education and Training in Occupational Health. This Committee has organized four international conferences as well as mini-symposia on the subject in the International Congresses on Occupational Health (ICOH 1987). Among the conclusions of the second conference, the need to develop training strategies and training methodologies received prominent mention in the list of priority issues (ICOH 1989).

A main feature of the third conference was the methodology of OSH training, including such functions as learning by participation, problem-based learning and evaluation of courses, teaching and students (ICOH 1991).

Regional initiatives

In different parts of the world, regional bodies have organized training activities in OSH. For example, the Asian Association of Occupational Health, established in 1954, has a Technical Committee in Occupational Health Education which conducts surveys on training of medical students and related subjects.

Types of Professional Programmes

Degree-granting and similar programmes

Probably the prototype of degree-granting and similar programmes is the sort which was developed in schools of public health or equivalent establishments. Higher education for public health is a relatively recent development. In the United States, the first school dedicated to this purpose was established in 1916 as the Institute of Hygiene at Johns Hopkins University. At that time, the overriding public health concerns centred around the communicable diseases. As time went on, education about the prevention and control of man-made hazards and about occupational health drew increasing emphasis in the training programmes of schools of public health (Sheps 1976).

Schools of public health offer OSH courses for a postgraduate diploma or for the degree of Master of Public Health, allowing students to concentrate in occupational health. Usually entry requirements include the possession of a tertiary educational qualification. Some schools insist upon relevant prior experience in OSH as well. The duration of training on a full-time basis is usually one year for the diploma and two years for the Master’s course.

Some of the schools train the different OSH personnel together in core courses, with training in the specific OSH disciplines (e.g., occupational medicine, hygiene or nursing) being offered to students specializing in these areas. This common training is probably a great advantage, as trainees of the different OSH disciplines could develop a greater understanding of each other’s functions and a better experience of team work.

Especially in recent years, schools of medicine, nursing and engineering have offered courses similar to those in schools of public health.

A few universities are offering OSH courses at the basic or undergraduate level. Unlike the traditional OSH tertiary courses, admission to which is usually dependent upon the acquisition of a previous degree, these newer courses admit students who have just graduated from high school. Much controversy still surrounds the merits of this development. Proponents of such courses argue that they produce more OSH professionals in less time and at lower cost. Their opponents argue that OSH practitioners are more effective if they build their OSH training on a basic discipline into which they integrate their special OSH practice, such as occupational medicine or nursing. Knowledge of basic sciences may be acquired at the specialization level if they have not been taught as part of undergraduate training.

Training courses in OSH for physicians vary in their clinical component. The conference, mentioned above, on the training of occupational health personnel organized by the WHO/Regional Office for Europe emphasized that “occupational medicine is fundamentally a clinical skill and its practitioners must be fully competent in clinical medicine”. It must also be stressed that the diagnosis of chemical intoxication among workers is largely clinical, as is the differentiation between “occupational disease” and other diseases and their management (Phoon 1986). It has become, therefore, a worldwide trend to insist upon postings to different clinics as part of the training of the occupational physician. In the United States and Canada, for example, trainees undergo a four-year residency programme which includes a substantial clinical component in such subjects as dermatology and respiratory medicine in addition to the curriculum required for the degree of Master of Public Health or its equivalent.

Formal training for occupational nurses probably varies even more in different parts of the world than that for occupational physicians. These differences hinge on the variations of responsibilities and functions of occupational nurses. Some countries define occupational health nursing as “the application of nursing principles in conserving the health of workers in all occupations. It involves prevention, recognition, and treatment of illness and injury and requires special skills and knowledge in the fields of health education and counselling, environmental health, rehabilitation and human relations” (Kono and Nishida 1991).On the other hand, other countries understand occupational nursing as the role of the nurse in an interdisciplinary occupational health team, who is expected to participate in all the fields of general health management, delivery of health services, environmental control, healthy and safe working procedures and OSH education. A survey in Japan showed, however, that not all the graduates from an occupational nursing staff took part in all these activities. This was probably due to a lack of understanding of the nurse’s role in OSH and to inadequate training in some of the fields (Kono and Nishida 1991).

The discipline of occupational hygiene has been defined by the American Industrial Hygiene Association as the science and art devoted to the recognition, evaluation and control of those environmental factors and stresses, arising in or from the workplace, which may cause sickness, impaired health and well-being, or significant discomfort and inefficiency among workers or among the citizens of the community. Speciality training has also emerged within the general field of occupational hygiene, including that in chemistry, engineering, noise, radiation, air pollution and toxicology.

Curricula for Occupational Safety and Health Personnel

The detailed contents of the curricula for the training of occupational physicians, nurses, hygienists and safety personnel, as recommended by the 1981 Joint ILO/WHO Committee an Occupational Health mentioned above will be represented in the pages to follow. As regards the main subject areas to be taught, the Committee recommends:

organization of occupational safety and health services, their activities, legislation and regulations
occupational medicine
occupational hygiene
occupational safety
work physiology and ergonomics, dealing particularly with the adaptation of work to man, but also with the readjustment of the handicapped to work
occupational psychology, sociology and health education.

According to the profile of the personnel, the educational programmes will go more or less deeply into different subjects to meet the demands of the respective professions, as discussed below for several categories.

It is difficult to comment in detail what should go into the curricula of OSH courses. It is generally agreed that such courses should have a greater input of behavioural sciences than is now the case, but such input should be relevant to the sociocultural milieu of a particular country or region for which a course is designed. Moreover, OSH should not be taught in isolation from the general health services and the community health situation in a given country or region. The fundamentals of management science should be included in OSH curricula to improve the understanding of organizational structures and practices in enterprises as well as to enhance administrative skills of OSH professionals. The art of communication and the ability to conduct an investigation of OSH problems scientifically and to formulate solutions were also recommended for inclusion in all OSH curricula (Phoon 1985b).

Physicians and nurses

All medical students should be taught some occupational health. In some countries, there are separate courses; in others, occupational health is dealt with in such courses as physiology, pharmacology and toxicology, public health, social medicine and internal medicine. Nevertheless, medical students do not, as a rule, acquire sufficient knowledge and skill to allow them to practice occupational health independently, and some postgraduate training in occupational health and safety is necessary. For further specialization in occupational health (e.g., occupational diseases, or even more narrow fields, like occupational neurology or dermatology), postgraduate training programmes should be available. For nurses active in occupational health services, both long-term and short-term courses need to be organized, depending on their range of activities.

Figure 1 lists subjects to be included in specialized postgraduate training for physicians and nurses.

Figure 1. Postgraduate training syllabus for physicians and nurses.

Safety and health engineers and safety officers

The practice of occupational safety is concerned with such failures of materials, machines, processes and structures as may give rise to dangerous situations, including the release of harmful agents. The aim of education in this field is to enable students to foresee danger, both at the planning stage of projects and in existing situations, to quantify the danger and to design measures to combat it. Training in occupational safety involves the student in a substantial study of selected topics from engineering and materials science, particularly those related to mechanical, civil, chemical, electrical and structural engineering.

Separate curricular units would be concerned, for example, with the structure and strength of materials, in mechanical engineering; with forces in structures, in civil engineering; with handling and transportation of chemicals, in chemical engineering; with design standards, protective equipment and the theory of preventive maintenance, in electrical engineering; and with the behaviour of strata, in mining engineering.

Safety engineers, in addition to acquiring a basic knowledge, should also undergo a course of specialization. The 1981 Joint ILO/WHO Committee recommendations for a specialized safety engineering course of study are listed in figure 2.

Figure 2. A syllabus for specialization in safety engineering.

Courses can be either full-time, part-time or “sandwich courses”—in the lattermost case, periods of studying are interspersed with periods of practice. The selection of which courses to take is very much a matter of individual circumstances or preference. This is especially true since many safety practitioners have extensive knowledge gained through on-the-job experience in particular industries. However, within a large community or a country, there should preferably be a large range of choices to cater for all these different needs.

The recent enormous advances in communications technology should enable the greater usage of distance-learning courses which can be delivered both to remote areas of a country or even across national frontiers. Unfortunately, such technology is still quite expensive, and countries or areas which need such distance-learning capabilities most may be the very ones least able to afford them.

Primary health care practitioners

There is a severe shortage of OSH professionals in developing countries. In addition, among primary health care practitioners and health professionals as a whole, there is a tendency to direct their main activities to curative services. This should be counterbalanced with the help of appropriate training to emphasize the great value of instituting preventive measures at the workplace in collaboration with other responsible parties such as workers and managers. This would help, to a certain extent, to alleviate the problems caused by the present shortage of OSH personnel in developing countries (Pupo-Nogueira and Radford 1989).

A number of developing countries have recently embarked on short courses of OSH training for primary health care and public health personnel. There is a wide spectrum of organizations which have undertaken such training. They include national productivity boards (Phoon 1985a), farmers’ associations, national safety councils, national institutes of health, and professional bodies such as medical and nurses’ associations (Cordes and Rea 1989).

A scarcity of OSH professionals affects not only developing countries, but many developed ones as well. In the United States, one response to this problem took the form of a joint report by a preventive medicine and internal medicine study group that recommended that training programmes in internal medicine emphasize controls of hazards in the workplace and in the environment, since most patients seen by internists are members of the workforce. Furthermore, the American Academy of Family Physicians and the American Medical Association have published several monographs on occupational health for the family physician. A study by the American Institute of Medicine reaffirmed the role of the primary care physician in occupational health, outlined the basic skills required and emphasized the need to enhance occupational health activity in basic training and continuing education (Ellington and Lowis 1991). In both developed and developing countries, however, there is still an inadequate number of OSH training programmes for primary health care personnel and an insufficient number of trained personnel.

Multidisciplinary training

Training in the multidisciplinary nature of OSH can be enhanced by making sure that everyone who trains is fully familiar with the roles, activities and areas of concern of the other OSH personnel. In an OSH course in Scotland, for example, members of the different OSH professions participate in the teaching programme. The students are also provided with self-instruction packages designed to give them detailed knowledge of and insight into the different OSH professional areas. Extensive use is also made of experiential learning techniques such as role-playing simulations and participative case studies. For example, students are asked to complete personal checklists on how each particular area of occupational health activity is likely to affect them in their own work situations, and on how they can cooperate effectively with other occupational health professionals.

In the running of a multidisciplinary OSH course, a key element is the mix of learners of different professional backgrounds in the same class. The course material, such as group exercises and essays, must be carefully selected without any bias to a particular discipline. Lecturers must also receive training in the setting of multidisciplinary questions and problems (D’Auria, Hawkins and Kenny 1991).

Continuing Education

In professional education as a whole, there is an increasing awareness of the need for continuing education. In the field of OSH, new knowledge concerning old hazards and new problems arising from changes in technology are developing so rapidly that no OSH practitioner could hope to keep up to date without making a systematic and constant effort to do so.

Continuing education in OSH can be formal or informal, voluntary or obligatory in order to maintain certification. It is essential for every OSH practitioner to keep up with reading the key professional journals, at least in his or her own disciplines. When a new hazard is encountered, it would be very useful to mount a literature search on that subject through a library. If such a library is unavailable, the CIS service of the ILO could be asked to undertake that service instead. Moreover, having continual and direct access to at least a few up-to-date texts on OSH is essential to any kind of OSH practice.

More formal kinds of continuing education could take the form of conferences, workshops, lectures, journal clubs or seminars. Usually tertiary institutions of learning or professional organizations can provide the means of delivery of such programmes. Whenever possible, there should be annual events in which a broader range of views or expertise could be canvassed than is usually available within the framework of a small community or town. Regional or international conferences or seminars can provide extremely useful opportunities for participants, not only to take advantage of the formal programme but also to exchange information with other practitioners or researchers outside the formal sessions.

Nowadays, more and more OSH professional organizations require members to attend a minimum number of continuing education activities as a condition for extension of certification or membership. Usually only the fact of attendance at approved functions is required. Attendance by itself is, of course, no guarantee that the participant has benefited from being present. Alternatives such as subjecting OSH professionals to regular examinations are also fraught with problems. Within a single OSH discipline, there is such a wide diversity of practice even within the same country that it is extremely difficult to devise an examination equitable to all the OSH practitioners concerned.

Self-learning

In every OSH training course there should be emphasis on the need for self-learning and its continuing practice. To this end, training in information retrieval and critical analysis of published literature is imperative. Training on the use of computers to facilitate obtaining of information from the many excellent OSH resources around the world would be also beneficial. Several courses have been developed in recent years to promote self-learning and information management through microcomputers (Koh, Aw and Lun 1992).

Curriculum Development

There is an increasing demand on the part of trainees and the community to ensure that curricula are constantly evaluated and improved. Many modern curricula are competency-based. A series of professional competencies required is first compiled. Since competence may be defined by different groups in different ways, extensive consultations on this matter should be held with faculty members and OSH practitioners (Pochyly 1973). In addition, there is a need for consultations with “consumers” (e.g., students, workers and employers), an inbuilt evaluation programme and well-defined but flexible educational objectives (Phoon 1988). Sometimes the establishment of advisory committees on curriculum or teaching programmes, which normally include faculty and student representatives, but sometimes also involve members of the general community, can provide a useful forum for such consultations.

Infrastructure Development

Infrastructure is often ignored in discussions on OSH training and education. Yet supporting facilities and human resources such as computers, libraries, efficient administrative staff and procedures and safe and convenient access are among the host of infrastructure considerations which could be crucial to the success of training courses. Proper monitoring of students’ progress, counselling and assistance of students with problems, health care of students and their families (where indicated), minding of students’ children, canteen and recreational facilities and provision of lockers or cupboards for the storage of personal possessions of trainees are all important details which should receive careful attention.

Faculty Recruitment and Development

The quality and popularity of a training programme are often vital factors in determining the quality of staff applying for a vacant position. Obviously, other factors such as satisfactory service conditions and opportunities for career and intellectual development are also important.

Careful consideration should be given to job specifications and job requirements. Faculty should have the necessary OSH qualifications, though flexibility should be exercised to allow the recruitment of staff from non-OSH disciplines who may be able to make special contributions to teaching or especially promising applicants who may have the capability but not all the qualifications or experience normally required for the job. Whenever possible, faculty should have practical OSH experience.

After recruitment, it is the responsibility of the leadership and senior members of the school or department to make sure that new staff are given as much encouragement and opportunity to develop as possible. New staff should be inducted into the culture of the organization but also encouraged to express themselves and to participate in decision-making processes related to teaching and research programmes. Feedback should be given to them concerning their teaching performance in a sensitive and constructive manner. Whenever necessary, offers of help to remedy identified limitations should be given. Many departments have found the regular holding of teaching or evaluation workshops for staff to be extremely useful. Cross-postings to industries and sabbatical leave are other important measures for staff development. Some extent of consultancy work, which could be either clinical, worksite or laboratory (depending on the discipline and areas of activity of the faculty member) helps to make academic teaching more practical.

Teaching Venues

Classrooms should be designed and furnished according to appropriate ergonomic principles and equipped with audio-visual aid equipment and video projection facilities. The lighting and acoustics should be satisfactory. Access to an exit should be located in such a way as to minimize the disturbance of an ongoing class.

Proper principles of OSH should be applied to the design and construction of laboratories. Such safety equipment as showers, eye washing facilities, first aid supplies and resuscitation equipment and fume cupboards should be installed or made available where indicated, and laboratories should be bright, airy and odourless.

Venues for field visits should be chosen to provide a wide range of OSH experiences for the trainees. If possible, worksites with different levels of OSH standards should be chosen. However, on no account should the safety or health of trainees be compromised.

Locations for clinical work would very much depend on the nature and level of the training course. In some circumstances, bedside teaching may be indicated to demonstrate the appropriate clinical approach to skills in history taking. In some other circumstances, presentation of cases with or without patients could serve the same purpose.

Examinations and Assessment

The recent trend has been to seek alternatives to administering an all-important and single final examination at the end of a course. Some courses have abolished formal examinations altogether and replaced them with assignments or periodic assessments. Some other courses have a combination of such assignments and assessments, open book examinations and closed book examinations as well. It is nowadays increasingly understood that examinations or assessments are as much measures of the quality of courses and teachers as of the trainees.

A feedback of trainees’ opinions concerning the entire course or components thereof through questionnaires or discussions is invaluable in the evaluation or revision of a course. As far as possible, all courses should be constantly evaluated, at least on an annual basis, and revised if necessary.

Insofar as modes of examination are concerned, essay questions can test organization, integrating ability and writing skills. The precision and validity of essay examinations, however, have been found to be weak. Multiple-choice questions (MCQs) are less subjective, but good ones are difficult to formulate and do not allow a display of practical knowledge. Modified essay questions (MEQs) differ from essays or MCQs in that the candidate is presented with a progressive amount of information about a problem. It avoids cueing by requesting short-answer responses rather than presenting candidates with alternatives from which to choose the appropriate answer. Oral examinations can measure problem-solving skills, professional judgement, communication skills and ability to retain composure under stress. The main difficulty with the oral examination is the potential for so-called “lack of objectivity”. The oral examination can be made more reliable by imposing some structure on it (Verma, Sass-Kortsak and Gaylor 1991). Perhaps the best alternative is to use a battery of these different types of examination rather than to rely on one or two of them only.

Certification and Accreditation

The word certification usually refers to the conferment upon a professional of authorization to practise. Such certification could be conferred by a national board or a college or an institution of practitioners of an OSH discipline. Usually, the OSH professional is given certification only after fulfilling a stipulated period of training in connection with an approved course or positions and also upon passing an examination. In general, such “global certification” is valid for life, unless there is proven professional negligence or misconduct. However, there are other forms of accreditation which require periodic renewal. They include such accreditation as that required in some countries to either conduct special statutory medical examinations or to report on radiographs of asbestos-exposed persons.

Accreditation , on the other hand, refers to the recognition of OSH courses by a national board or professional organization or a scholarship-granting body. Such accreditation should be subject to periodic reappraisal to ensure that courses keep to an appropriate level of currency and effectiveness.

A New Approach to Learning and Training: A Case Study by the ILO-FINNIDA African Safety and Health Project

Abuya : What’s the matter? You look worn out.

Mwangi : I am worn out—and disgusted. I was up half the night getting ready for this lecture I just gave and I don’t think it went very well. I couldn’t get anything out of them—no questions, no enthusiasm. For all I know, they didn’t understand a word I said.

Kariuki : I know what you mean. Last week I was having a terrible time trying to explain chemical safety in Swahili.

Abuya : I don’t think it’s the language. You were probably just talking over their heads. How much technical information do these workers really need to know anyway?

Kariuki : Enough to protect themselves. If we can’t get the point across, we’re just wasting our time. Mwangi, why didn’t you try asking them something or tell a story?

Mwangi : I couldn’t figure out what to do. I know there has to be a better way, but I was never trained in how to do these lectures right.

Abuya : Why all the fuss? Just forget about it! With all the inspections we have to do, who’s got time to worry about training?

The above discussion in an African factory inspectorate, which could take place anywhere, highlights a real problem: how to get the message through in a training session. Using a real problem as a discussion starter (or trigger) is an excellent training technique to identify potential obstacles to training, their causes and potential solutions. We have used this discussion as a role play in our Training of Trainers’ workshops in Kenya and Ethiopia.

The ILO-FINNIDA African Safety and Health Project is part of the ILO’s technical cooperation activities aimed to improve occupational safety and health training and information services in 21 African countries where English is commonly spoken. It is sponsored by FINNIDA, the Finnish International Development Agency. The Project took place from 1991 to 1994 with a budget of US$5 million. One of the main concerns in the implementation of the Project was to determine the most appropriate training approach by which to facilitate high quality learning. In the following case study we will describe the practical implementation of the training approach, the Training the Trainers’ (TOT) course (Weinger 1993).

Development of a New Training Approach

In the past, the training approach in most African factory inspectorates, and also in many technical cooperation projects of the ILO, has been based on randomly selected, isolated topics of occupational safety and health (OSH) which were presented mainly by using lecturing methods. The African Safety and Health Project conducted the first pilot course in TOT in 1992 for 16 participating countries. This course was implemented in two parts, the first part dealing with basic principles of adult education (how people learn, how to establish learning objectives and select teaching contents, how to design the curriculum and select instructional methods and learning activities and how to improve personal teaching skills) and the second part with practical training in OSH based on individual assignments which each participant completed during a four month’s time period following the first part of the course.

The main characteristics of this new approach are participation and action orientation. Our training does not reflect the traditional model of classroom learning where participants are passive recipients of information and the lecture is the dominant instructional method. In addition to its action orientation and participatory training methods, this approach is based on the latest research in modern adult education and takes a cognitive and activity-theoretical view of learning and teaching (Engeström 1994).

On the basis of the experience gained during the pilot course, which was extremely successful, a set of detailed course material was prepared, call the Training of Trainers Package , which consists of two parts, a trainer’s manual and a supply of participants’ handout matter. This package was used as a guideline during planning sessions, attended by from 20 to 25 factory inspectors over a period of ten days, and concerned with establishing national TOT courses in Africa. By the spring of 1994, national TOT courses had been implemented in two African countries, Kenya and Ethiopia.

High Quality Learning

There are four key components of high quality learning.

Motivation for learning . Motivation occurs when participants see the “use-value” of what they are learning. It is stimulated when they can perceive the gap that separates what they know and what they need to know to solve a problem.

Organization of subject matter. The content of learning is too commonly thought of as separate facts stored in the brain like items in boxes on a shelf. In reality, people construct models, or mental pictures, of the world while learning. In promoting cognitive learning, teachers try to organize facts into models for better learning and include explanatory principles or concepts (the “but whys” behind a fact or skill).

Advancing through steps in the learning process . In the learning process, the participant is like an investigator looking for a model by which to understand the subject matter. With the help of the teacher, the participant forms this model, practices using it and evaluates its usefulness. This process can be divided into the following six steps:

orientation
integrating new knowledge (internalization)
application
programme critique
participant evaluation.

Social interaction . The social interaction between participants in a training session is an essential component of learning. In group activities, participants learn from one another.

Planning training for high quality learning

The kind of education aimed at particular skills and competencies is called training . The goal of training is to facilitate high quality learning and it is a process that takes place in a series of steps. It requires careful planning at each stage and each step is equally important. There are many ways of breaking the training into components but from the point of view of the cognitive conception of learning, the task of planning a training course can be analysed into six steps.

Step 1: Conduct a needs assessment (know your audience).

Step 2: Formulate learning objectives.

Step 3: Develop an orientation basis or “road map” for the course.

Step 4: Develop the curriculum, establishing its contents and associated training methods and using a chart to outline your curriculum.

Step 5: Teach the course.

Step 6: Evaluate the course and follow up on the evaluation.

Practical Implementation of National TOT Courses

Based on the above-mentioned training approach and experience from the first pilot course, two national TOT courses were implemented in Africa, the one in Kenya in 1993 and the other in Ethiopia in 1994.

Training needs were based on the work activity of factory inspectors and were determined by means of a pre-workshop questionnaire and a discussion with the course participants about their everyday work and about the kinds of skills and competencies necessary to carry it out (see figure 1). The course has thus been designed primarily for factory inspectors (in our national TOT courses, usually 20 to 25 inspectors participated), but it could be extended to other personnel who may need to carry out safety and health training, such as shop stewards, foremen, and safety and health officers.

Figure 1. Orientation basis for the factory inspector's work activity.

A compilation of course objectives for the national TOT course was assembled step by step in cooperation with the participants, and is given immediately below.

Objectives of the national TOT course

The aims of the training of trainers (TOT) course are as follows:

Increase participants’ understanding of the changing role and tasks of factory inspectors from immediate enforcement to long-term advisory service, including training and consultation.
Increase participants’ understanding of the basic principles of high quality learning and instruction.
Increase participants’ understanding of the variety of skills involved in planning training programmes: identification of training needs, formulation of learning objectives, development of training curricula and materials, selection of appropriate teaching methods, effective presentation and programme evaluation.
Enhance participants’ skills in effective communication for application during inspections and consultation, as well as in formal training sessions.
Facilitate the development of short and long-term training plans in which new instructional practices will be implemented.

Course contents

The key subject areas or curriculum units that guided the implementation of the TOT course in Ethiopia are outlined in figure 2. This outline may also serve as an orientation basis for the whole TOT course.

Figure 2. The key subject areas of the TOT course.

Determining training methods

The external aspect of the teaching method is immediately observable when you step into a classroom. You might observe a lecture, a discussion, group or individual work. However, what you do not see is the most essential aspect of teaching: the kind of mental work being accomplished by the student at any given moment. This is called the internal aspect of the teaching method.

Teaching methods can be divided into three main groups:

Instructional presentation : participant presentations, lectures, demonstrations, audio-visual presentations
Independent assignment : tests or exams, small group activities, assigned reading, use of self-guided learning materials, role plays
Cooperative instruction

Most of the above methods were used in our TOT courses. However, the method one selects depends on the learning objectives one wants to achieve. Each method or learning activity should have a function. These instructional functions , which are the activities of a teacher, correspond with the steps in the learning process described above and can help guide your selection of methods. There follows a list of the nine instructional functions:

preparation
transmitting new knowledge
consolidating what has been taught
practising (development of knowledge into skills)
application (solving new problems with the help of new knowledge)

Planning the curriculum: Charting your course

One of the functions of curriculum or course plan is to assist in guiding and monitoring the teaching and learning process. The curriculum can be divided into two parts, the general and the specific.

The general curriculum gives an overall picture of the course: its goals, objectives, contents, participants and guidelines for their selection, the teaching approach (how the course will be conducted) and the organizational arrangements, such as pre-course tasks. This general curriculum would usually be your course description and a draft programme or list of topics.

A specific curriculum provides detailed information on what one will teach and how one plans to teach it. A written curriculum prepared in chart form will serve as a good outline for designing a curriculum specific enough to serve as a guide in the implementation of the training. Such a chart includes the following categories:

Time : the estimated time needed for each learning activity

Curriculum Units : primary subject areas

Topics : themes within each curriculum unit

Instructional function: the function of each learning activity in helping to achieve your learning objectives

Activities : the steps for conducting each learning activity

Materials : the resources and materials needed for each activity

Instructor : the trainer responsible for each activity (when there are several trainers)

To design the curriculum with the aid of the chart format, follow the steps outlined below. Completed charts are illustrated in connection with a completed curriculum in Weinger 1993.

Specify the primary subject areas of the course (curriculum units) which are based on your objectives and general orientation basis.
List the topics you will cover in each of those areas.
Plan to include as many instructional functions as possible in each subject area in order to advance through all the steps of the learning process.
Choose methods which fulfil each function and estimate the amount of time required. Record the time, topic and function on the chart.
In the activities column, provide guidelines for the instructor on how to conduct the activity. Entries can also include main points to be covered in this session. This column should offer a clear picture of exactly what will occur in the course during this time period.
List the materials, such as worksheets, handouts or equipment required for each activity.
Make sure to include appropriate breaks when designing a cycle of activities.

Evaluating the course and follow-up

The last step in the training process is evaluation and follow-up. Unfortunately, it is a step that is often forgotten, ignored and, sometimes, avoided. Evaluation , or the determination of the degree to which course objectives were met, is an essential component of training. This should include both programme critique (by the course administrators) and participant evaluation .

Participants should have an opportunity to evaluate the external factors of teaching: the instructor’s presentation skills, techniques used, facilities and course organization. The most common evaluation tools are post-course questionnaires and pre- and post-tests.

Follow-up is a necessary support activity in the training process. Follow-up activities should be designed to help the participants apply and transfer what they have learned to their jobs. Examples of follow-up activities for our TOT courses include:

action plans and projects
formal follow-up sessions or workshops

Selection of trainers

Trainers were selected who were familiar with the cognitive learning approach and had good communication skills. During the pilot course in 1992 we used international experts who had been involved in development of this learning approach during the 1980s in Finland. In the national courses we have had a mixture of experts: one international expert, one or two regional experts who had participated in the first pilot course and two to three national resource persons who either had responsibility for training in their own countries or who had participated earlier in this training approach. Whenever it was possible, project personnel also participated.

Discussion and Summary

Factory training needs assessment

The factory visit and subsequent practice teaching are a highlight of the workshop. This training activity was used for workplace training needs assessment (curriculum unit VI A, figure 1). The recommendation here would be to complete the background on theory and methods prior to the visit. In Ethiopia, we scheduled the visit prior to addressing ourselves to the question of teaching methods. While two factories were looked at, we could have extended the time for needs assessment by eliminating one of the factory visits. Thus, visiting groups will visit and focus on only that factory where they will be actually training.

The risk mapping component of the workshop (this is also part of curriculum unit VI A) was even more successful in Ethiopia than in Kenya. The risk maps were incorporated in the practice teaching in the factories and were highly motivating for the workers. In future workshops, we would stress that specific hazards be highlighted wherever they occur, rather than, for example, using a single green symbol to represent any of a variety of physical hazards. In this way, the extent of a particular type of hazard is more clearly reflected.

Training methods

The instructional methods focused on audio-visual techniques and the use of discussion starters. Both were quite successful. In a useful addition to the session on transparencies, the participants were asked to work in groups to develop a transparency of their own on the contents of an assigned article.

Flip charts and brainstorming were new teaching methods for participants. In fact, a flip chart was developed especially for the workshop. In addition to being an excellent training aid, the use of flip charts and “magic markers” is a very inexpensive and practical substitute for the overhead projector, which is unavailable to most inspectors in the developing countries.

Videotaped microteaching

“Microteaching”, or instruction in the classroom focusing on particular local problems, made use of videotape and subsequent critique by fellow participants and resource people, and was very successful. In addition to enhancing the working of external teaching methods, the taping was a good opportunity for comment on areas for improvement in content prior to the factory teaching.

A common error, however, was the failure to link discussion starters and brainstorm activities with the content or message of an activity. The method was perfunctorily executed, and its effect ignored. Other common errors were the use of excessively technical terminology and the failure to make the training relevant to the audience’s needs by using specific workplace examples. But the later presentations in the factory were designed to clearly reflect the criticisms that participants had received the day before.

Practice teaching in the factory

In their evaluation of the practice teaching sessions in the factory, participants were extremely impressed with the use of a variety of teaching methods, including audiovisuals, posters that they developed, flip charts, brainstorming, role plays, “buzz groups” and so on. Most groups also made use of an evaluation questionnaire, a new experience for them. Of particular note was their success in engaging their audiences, after having relied solely on the lecture method in the past. Common areas for improvement were time management and the use of overly technical terms and explanations. In the future, the resource persons should also try to ensure that all groups include the application and evaluation steps in the learning process.

Course planning as a training experience

During these two courses it was possible to observe significant changes in the participants’ understanding of the six steps in high quality learning.

In the last course a section on writing objectives, where each participant writes a series of instructional objectives, was added into the programme. Most participants had never written training objectives and this activity was extremely useful.

As for the use of the curriculum chart in planning, we have seen definite progress among all participants and mastery by some. This area could definitely benefit from more time. In future workshops, we would add an activity where participants use the chart to follow one topic through the learning process, using all of the instructional functions. There is still a tendency to pack the training with content material (topics) and to intersperse, without due consideration of their relevance, the various instructional functions throughout a series of topics. It is also necessary that trainers emphasize those activities that are chosen to accomplish the application step in the learning process, and that they acquire more practice in developing learners’ tasks. Application is a new concept for most and difficult to incorporate in the instructional process.

Finally the use of the term curriculum unit was difficult and sometimes confusing. The simple identification and ordering of relevant topic areas is an adequate beginning. It was also obvious that many other concepts of the cognitive learning approach were difficult, such as the concepts of orientation basis, external and internal factors in learning and teaching, instructional functions and some others.

In summary, we would add more time to the theory and curriculum development sections, as outlined above, and to the planning of future curriculum, which affords the opportunity of observing individual ability to apply the theory.

The ILO-FINNIDA African Safety and Health Project has undertaken a particularly challenging and demanding task: to change our ideas and old practices about learning and training. The problem with talking about learning is that learning has lost its central meaning in contemporary usage. Learning has come to be synonymous with taking in information . However, taking in information is only distantly related to real learning. Through real learning we re-create ourselves. Through real learning we become able to do something we were never able to do before (Senge 1990). This is the message in our Project’s new approach on learning and training.

" DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."

Disability and Work
Worker's Compensation Systems

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Find out what safety training you need.

Osha safety training assessment, osha safety training requirements and best practices.

Workplace Safety

On December 29, 1970, President Richard Nixon signed the Occupational Safety and Health Act of 1970 into law. The following April, the Occupational Safety and Health Administration (OSHA) was formed.

Since then, OSHA has been charged with ensuring “safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.”

As noted in their mission statement, OSHA not only creates safety standards, but they also supply guidelines for meeting these safe conditions. How do you know which OSHA standards apply to you? And how do you receive workplace safety training? We will take you through some of the most common OSHA-related topics to help you maintain OSHA compliance.

Which Industries Do OSHA Regulations Cover?

There are nearly 1,000 OSHA standards, falling under four main categories: Construction, Maritime, Agriculture, and General Industry. Construction includes the most individual safety standards, but most workplaces will find their needs fall under the General Industry umbrella.

When determining which standards you need to enforce, start by considering the potential safety hazards faced by your employees rather than simply looking at your general industry regulations. For instance, if you run a construction company, some employees may need to complete a safety training course on bloodborne pathogens (BBP) in order to administer first aid at job sites. You will not find a bloodborne pathogens regulation in the Construction section; BBP falls under General Industry. Other safety standards, like personal protective equipment (PPE), will be seen across all industries.

OSHA regulations try to cover most potential hazards faced at a worksite. However, when there is not a standard for specific health hazards, employers can fall back on the General Duty Clause of the OSH Act, which requires employers to provide a place of employment that is “free from recognizable hazards that are causing or likely to cause death or serious harm to employees.”

All employers must comply with the General Duty Clause, regardless of whether the workplace is covered by federal OSHA or by a State Plan.

What is an OSHA State Plan?

The federal OSH Act covers most private-sector employees, along with some state and local government employees, throughout the United States and certain U.S. jurisdictions. However, many states and territories enact their own OSHA-approved State Plans , which essentially replace federal OSHA enforcement.

State Plans must set workplace health and safety standards that are “at least as effective as” OSHA standards. Many states adopt standards identical to OSHA but can address possible hazards not covered by federal OSHA standards. Regardless, all State Plans are reviewed, approved, and continually monitored by OSHA. Think of OSHA standards as the foundation and the state plan states can build upon them; adding additional requirements but not requiring less than OSHA standards.

The following table outlines the jurisdictions currently following a State Plan. The seven states listed in bold have State Plans that cover only state and local government worker safety (federal OSHA standards cover private-sector worker safety in these areas) while the rest have a State Plan that covers most private-sector workers and all public-sector workers.

Alaska		Maryland		Puerto Rico	Vermont
Arizona	Indiana		New Mexico	South Carolina	Virginia
California	Iowa	Michigan		Tennessee	Washington
	Kentucky	Minnesota	North Carolina		Wyoming
Hawaii		Nevada	Oregon	Utah

OSHA Training Requirements

Unfortunately, OSHA does not have one consistent standard for addressing safety training. Instead, if there are specific training requirements , they are outlined in the applicable OSHA standard itself.

Some OSHA training requirements include verbiage such as “training” or “instruction,” but OSHA has taken the position that, regardless of the precise language used, all OSHA training must be presented in a manner the employee is capable of understanding.

Generally, employers should understand that if they typically need to communicate with workers at a certain vocabulary level or in a language other than English, safety training materials must be provided in the same manner.

Remember that OSHA training is not comprehensive. Completing training shows the employee has been made aware of potential safety hazards and understands what to do in a dangerous situation. Employees should still receive on-the-job training for a particular role and for the company to ensure they can perform necessary job functions.

OSHA Training Best Practices

When it comes to workplace safety and health, standard training best practices can still be applied. Some of the most used training tips include utilizing engaging content and interactivity, incorporating real-life scenarios, ensuring accessibility for all employees, and assessing employee knowledge as you go.

Engaging and interactive

Keeping learners interested in employee training, especially safety training courses , is often one of the biggest hurdles that trainers encounter. Typical lecture-style training materials tend to lose employees. Incorporating activities, such as in-training questions, means the learners must remain active and engaged during effective safety training.

Incorporating real-life scenarios

No matter the type of training used, it is always easier to grasp the topic at hand when the scenarios are relatable to an employee’s situation. For instance, you may think that a generic training lesson over slips, trips, and falls may be sufficient. But if your employees work in a supermarket and the safety training course only features scenarios occurring on construction sites, it is unlikely to be effective safety training. Relatability always helps with retention.

Accessibility for all employees

When it comes to safety training, it is imperative that all employees receive the training they need, whether they work in an office or out in a field. Ensuring your training materials can be accessed from anywhere at any time means it will be more effective and, ideally, create a safe work environment.

Knowledge assessments

It is easy for employees to sit through a training class simply to check off a required box. However, workplace safety training would be largely useless if employees did not retain any of the information. Offering quiz questions or other forms of assessment both during and after training forces the employees to think about what they learned and prove they understood the material.

OSHA Training Record Requirements

Just like there is not an overarching standard for OSHA training requirements, there is not one simple guideline regarding OSHA training documentation. To determine what training records to maintain, you will need to look up the specific OSHA standards . If a standard has record documentation requirements, they will be listed in the OSHA regulation.

Many safety regulations, like Mechanical Power Presses (1910.217), include verbiage indicating “the employer shall certify that employees have been trained by preparing a certification record.” However, some regulations do outline specific details to be included in the certification.

Another question employers often have is how long training records need to be maintained. Again, this varies by regulation. Some specify a certain number of years, some note that records should be kept for the duration of employment, and others only specify that the most recent certification needs to be maintained.

However, if you are in doubt over what records to maintain, remember that OSHA has offered their own suggestion: “It is a good idea to keep a record of all safety and health training.”

The Consequences of Noncompliance

All employers under the purview of OSHA, whether federally or through a State Plan, are subject to periodic inspections. OSHA inspections can also come about following employee safety complaints. Depending on the type of violation and severity of the danger, or the potential danger, OSHA may issue a citation or fine.

There are six main categories of OSHA violations, five of which result in civil penalties. Penalties for OSHA violations typically increase each year, based on inflation. The specific fines noted below come from the penalty amounts published by OSHA on January 8, 2024.

De Minimis Violations

The least serious of OSHA violations, this category denotes technical violations that have no direct impact on health or safety. OSHA does not issue fines for de minimis infractions, but employers will receive a verbal notification from the OSHA inspector.

Other-than-Serious Violations

A violation related to health or safety but that would not result in serious workplace injuries or death, such as not posting required safety documentation in a work area, is considered “other-than-serious.” The maximum penalty is $16,131 per violation, but inspectors can choose to reduce the fine by as much as 95% or drop the fine altogether, based on things such as the cooperativeness of the owner.

Serious Violations

Just as it sounds, a serious OSHA violation could cause an accident or illness that would most likely result in death or serious physical harm, unless the employer did not or could not have known of the situation. Fines anywhere from $1,190 up to $16,131 are possible per violation.

Willful Violations

This most serious category is reserved for situations when an employer shows complete disregard for employee safety. Fines can range from $11,524 to $161,323 per violation, but if the violation results in an employee death, it becomes a criminal offense and could result in jail time.

Repeated Violation

If OSHA issues a citation or fine and a subsequent inspection reveals an identical or very similar violation, a fine from $11,524 to $161,323 per violation may be issued. However, if the employer contested the original violation and is awaiting a decision from OSHA, inspectors cannot assess a repeated violation.

Failure to Abate Prior Violation

Each violation citation includes a date by which the issue must be resolved. For employers who do not do so on or before the specified date, a fine of up to $16,131 per day beyond the abatement date may be assessed.

In addition to the fines that come with OSHA violations, employers must keep in mind the non-monetary effects of noncompliance. When a company fails to uphold health and safety standards, their customers, partners, and even the public are given reason to see them in a negative light. Reputational damage can result in a loss of sales, layoffs, bankruptcy or worse.

Common OSHA Violations

Each year, OSHA releases a list of the top 10 most-cited violations from the previous fiscal year. The list does not change much from year to year, and many of the listed violations are some of the most easily preventable issues. In 2023, for the 13th year in a row, Fall Protection topped the list.

Here are 2023’s most-cited OSHA violations, along with the corresponding OSHA regulation:

Fall Protection – General Requirements (1926.501)
Hazard Communication (1910.1200)
Ladders (1926.1053)
Scaffolding (1926.451)
Powered Industrial Trucks (1910.178)
Lockout/Tagout (1910.147)
Respiratory Protection (1910.134)
Fall Protection – Training Requirements (1926.503)
Eye and Face Protection (1926.102)
Machine Guarding (1910.212)

Can You Take OSHA Training Online?

As the world around us becomes more digital seemingly every day, it makes sense that employee training would make the switch to digital as well, but how effective are online training materials? Do online training materials meet OSHA training requirements?

When you consider the training best practices mentioned earlier, online safety training can help your safety training program accomplish each of those and more.

An online safety training program makes it easy to insert interactive and engaging material within the content, and these elements can even be tied into knowledge assessments. If your course includes questions or surveys during and after the initial training, employees can demonstrate their newfound knowledge.

A major benefit of online training is that it is easily accessible by employees at any location. Whether you have an office employee taking the course on a desktop computer or an oil worker going through training on a tablet while on the rig, online courses make required, and optional, training courses fully accessible.

Taking OSHA training online could also save your company time and money, as online training does not require a physical classroom setting or bringing an in-person trainer to your jobsite. Employees can complete virtual training from anywhere with internet access.

So, what does OSHA think of online training? While they do believe computer-based training can be highly effective as part of a health and safety training program, they also caution employers to not rely solely on CBT for safety training.

Essentially, OSHA wants to see each employer develop a well-rounded safety training program, not a “set it and forget it” solution. Worker safety is too important. Think of a safety program as a responsive, living entity. Above the baseline policies and safety procedures, there must be a continuous loop of input and responsiveness, from initial training to hazard identification and abatement. Participation is essential.

There are certain job roles or specific OSHA guidelines that may require some in-person training. For instance, anyone can take an online chainsaw safety training course, but until an employee has physically picked up a chainsaw and demonstrated how to safely operate the machinery, they could be considered a liability.

One of the key benefits of online courses is that they afford employers more time for one-on-one or small group live instruction, by handling the knowledge requirements for each training topic efficiently.

OSHA Refresher Training

As is the case with any training, repeating OSHA safety training at regular intervals could help employees stay up to date with safety regulations and further reinforce knowledge of how to follow the OSHA guidelines.

Within OSHA training requirements you will find numerous mentions of “refresher training” or “retraining.” These are meant to advise employers on how often employees are required to be retrained on a topic. Some regulations call for yearly retraining while others only require retraining every three years. Some regulations indicate conditions upon which retraining is warranted. They include:

When worker responsibilities change
New hazard/risk/equipment introduced
Change in assigned duties
Inadequacies in worker’s knowledge or use of procedure
Changes render previous training obsolete
Any situation arises in which retraining appears necessary to ensure safety

A benefit to taking workplace health and safety training online is how easy it is to assign and complete refresher training as often as is needed or as often as you’d like. While some OSHA regulations clearly state retraining frequency or conditions, it is never a bad idea to brush up on safety training materials even when not required.

With nearly 1,000 different OSHA standards and hundreds of specific training requirements, it can be hard for employers to keep track of everything needed for regulatory compliance.

While much of understanding all that is required — or suggested — by OSHA typically means employers must look through specific standards, OSHA does provide an overview of employer responsibilities .

This page lists the General Duty Clause and briefly outlines things such as appropriate signage, how to report fatalities or serious workplace injuries, recordkeeping responsibilities, and more. It also makes it easy to find many important OSHA documents, all linked in one place.

Once you have determined which of OSHA's standards apply to your workplace and the specific training requirements that go along with those regulations, it is time to implement a quality safety training program. See how HSI makes occupational health and safety training easy, no matter your industry, job title or location.

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Case studies

Successful leadership.

There are many benefits to be gained from successful leadership in health and safety, as these case studies show.

Case study - North Staffordshire Combined Healthcare NHS Trust

The board found itself facing service improvement targets. Using new corporate and clinical guidance, it set about taking a 'whole systems' approach to managing corporate risk, giving one of its directors responsibility for the leadership of health and safety for the first time. Health and safety was also made a key item on the board agenda.

This has resulted in a much better integrated health and safety management system that increases the opportunity to identify and manage all corporate risks, and a much more open culture, improving reporting and monitoring. The board actively promotes a culture that gives staff the confidence to report incidents. This has resulted in:

incidence rates reduced by 16% over two years;
insurance premiums reduced by 10%.

Case study - British Sugar

British Sugar had an excellent safety record and was devastated in 2003 when it suffered three fatalities. Although health and safety had always been a business priority, the company recognised that a change in focus was needed to achieve behavioural change. This included:

the CEO assigning health and safety responsibilities to all directors, and monthly reports go to the board;
creating effective working partnerships with employees, trade unions and others;
overseeing a behavioural change programme and audits;
publishing annual health and safety targets, and devising initiatives to meet them.

Results include:

A two thirds reduction in both lost time and minor injury frequency rates over a 10 year period.

much greater understanding by directors of health and safety risks.

Case study – Mid and West Wales Fire and Rescue Service

To give health and safety a high priority, Mid and West Wales Fire and Rescue Service recognised that it was critical for its leadership to demonstrate to its staff that accountability for health and safety was a fundamental element in the success of its overall service delivery. The director of service policy and planning was nominated as the health and safety director for the service in order to clearly define the importance this subject held within the organisation. The director implemented a revised health and safety framework, which included a programme of fire station visits to engage the workforce, and placed a renewed emphasis on improving incident reporting, investigation and monitoring procedures. The service has reported:

£100,000 reduction in insurance liability premiums in one year through improved corporate strategic risk management;
50% reduction in sickness absence through work related injury over a two year period;
50% reduction in injury incidence rate over a three year period.

Case study – Sainsbury's

An external health and safety audit identified a need to develop a unified approach, and also recommended more direction from the board, to develop an effective strategy.

The result was a radical revision of the company's approach, including:

the group human resources director creating a health and safety vision, supported by a plan with targets over three years;
training on health and safety responsibilities was introduced for all board directors.

This has resulted in:

the board providing a role model for health and safety behaviour;
17% reduction in sickness absence;
28% reduction in reportable incidents;
improved morale and pride in working for the company;
raising the profile of health and safety so it is becoming embedded in the culture of the organisation.

When leadership falls short

Many high-profile safety cases over the years have been rooted in failures of leadership. When board members do not lead effectively on health and safety management, the consequences can be severe. These examples mark issues for all boards to consider.

Competent advice, training and supervision

Following the fatal injury of an employee maintaining machinery at a recycling firm employing approximately 30 people, a company director received a 12-month custodial sentence for manslaughter. The machinery was not properly isolated and started up unexpectedly.

An HSE and police investigation revealed there was no safe system of work for maintenance; instruction, training and supervision were inadequate. HSE's investigating principal inspector said: 'Evidence showed that the director chose not to follow the advice of his health and safety adviser and instead adopted a complacent attitude, allowing the standards in his business to fall.'

The managing director of a manufacturing company with around 100 workers was sentenced to 12 months' imprisonment for manslaughter following the death of an employee who became caught in unguarded machinery. The investigation revealed that, had the company adequately maintained guarding around a conveyor, the death would have been avoided.

The judge made clear that whether the managing director was aware of the situation was not the issue: he should have known as this was a long-standing problem. An area manager also received a custodial sentence. The company received a substantial fine and had to pay the prosecution's costs.

Risk assessment

A company and its officers were fined a total of £245,000 and ordered to pay costs of £75,500 at Crown Court in relation to the removal of asbestos. The company employed ten, mostly young, temporary workers; they were not trained or equipped to safely remove the asbestos, nor warned of its risk. The directors were also disqualified from holding any company directorship for two years and one year respectively.

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Health and safety training goes digital and interactive

Case Study – ASDA

Health and Safety training can often be a dry and uninspiring experience. Learners are usually presented with a list of dos and don’ts, paperwork and posters around workplace health and safety practices and procedures, plus anecdotal examples of bad practice in the workplace. It may sometimes feel like nothing could make health and safety training in the workplace engaging, interactive or even enjoyable.

DTS and ASDA recently joined forces to introduce new health and safety learning using DTS’s ‘ Near-Life™ ’ approach to actively engage colleagues.

Health and safety key learning points

The organisations worked closely to develop a course that tackled the key learning points. By asking the question: “what do we really want colleagues to take away from this?” the course development project group was able to address the key areas of change.

That initial question was followed up with: “how would these situations present themselves in store?” and “what are the consequences of not making the right choice in everyday work life?” .

By approaching the learning in this way, DTS and ASDA developed an interactive learning experience that really addressed the key issues and reinforced ASDA’s commitment to health and safety.

Relevant and recognisable

ASDA health and safety training gets digital makeover

To make the learning engaging, a script was developed that brought the learning points to life by using ASDA language and terminology. A combination of professional actors and ASDA colleagues were filmed in a real store to give the scenarios added realism. This made the learning relevant as the setting and language were instantly recognisable.

Using DTS’s Near-Life™ learning approach and interactive game system, a time-sensitive, outcomes-based experience was designed and delivered.

Positive feedback

Initial roll out has been to the ASDA Retail academies, where the learning is being delivered in group settings to gauge response. Early feedback has been positive.

Mike Todd from DTS said,

“We were delighted to have the opportunity to work with ASDA on this very innovative project. We have been able to work closely with the ASDA team to make the training as realistic and relevant as possible. We believe it really demonstrates the value of using interactive video in eLearning.”

Andrew Crowe, Senior Manager Functional Capability added,

“At ASDA we are constantly seeking to improve the learning and development experience for our colleagues. The DTS approach has helped us make our Health and Safety training more relevant and engaging.”

Wider roll out of this cloud-based, elearning solution is planned for early 2019.

Need to find out more? Get in touch with our team.

Innovations in Teamwork for Health Care

Don’t leave teaming up to chance. Create better teamwork through science.

In this course, experts from Harvard Business School and the T.H. Chan School of Public Health teach learners to implement a strategy for organizational teamwork in health care.

What You'll Learn

Health care is a team effort. From the front desk administrators to the nurses, doctors, insurers, and even the patients and their families, there are many people involved in an individual’s care. To deliver quality care in today’s fast-paced environment, practitioners and caregivers must go beyond medical problem-solving and rely on effective collaboration and communication skills.

While other businesses may organize around a functional area or project, allowing team members to learn each other's working styles and strengths over time, health care workers often find themselves in ad hoc scenarios, coordinating with near-strangers on life and death situations. As a leader, how do you encourage trust and meet shared goals when teams are formed quickly? How do you strengthen flexibility and collaboration even as team membership and structures fluctuate across departments?

In Innovations in Teamwork for Health Care, leaders in the field of organizational behavior and teamwork, Amy Edmondson, Professor at Harvard Business School, and Michaela Kerrissey, Assistant Professor at the Harvard T.H. Chan School of Public Health, share their latest research and present their concept of "teaming" as it relates to the health care and life science industries.

In this course, you will explore the complexities of collaboration in dynamic cross-functional teams and its impact on quality of care. You will examine the theory of teaming – where individuals join together to lend their expertise – to appreciate what enables effective teamwork and why teamwork fails; articulate the importance of psychological safety and a joint problem-solving orientation; understand the particular needs of time-limited teams; and rethink the role of hierarchy and leadership in the context of teaming.

You’ll hear firsthand from experts with experience inside and outside the health care industry, from CEO and President of the Cleveland Clinic, Tomislav Mihaljevic, to Andres Sougarret, the engineer who led the miraculous rescue of 33 Chilean miners in 2011.

Ultimately, this course provides you with the tools needed to implement effective teaming strategies for patient-centered care and provides your organization with a framework to empower robust communication, improve efficiency, and elevate patient safety.

The course will be delivered via HBS Online’s course platform and immerse learners in real-world examples from experts at industry-leading organizations. By the end of the course, participants will be able to:

Explore the science of teamwork, focusing on the psychological and sociological aspects of teaming, collaboration, and defining effective outcomes.
Understand the complexity of building trust in ad hoc teams, including how to define purpose, build trust, and navigate interpersonal risks to reach common goals.
Apply communication strategies that encourage psychological safety and create a safe space for all to contribute.
Understand the value in adopting a model of joint problem-solving for patient care.
Identify the distinct needs of time-limited project teams and how to incorporate effective and transparent feedback loops.
Ensure accountability and identify leaders, breaking down hierarchy and encouraging the right person to step up at the right time.
Implement a PDSA (Plan, Do, Study, and Act) framework for your organization.

Continuing Education Credits

In support of improving patient care, Harvard Medical School is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education.

The Harvard Medical School designates this enduring material for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Harvard Medical School is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is approved for 20.00 contact hours. Contact hours are awarded commensurate with participation and completion of the online evaluation and attendance attestation. We suggest claiming your hours within 30 days of the activity date, after this time, the attendance attestation will still be required to claim your hours.

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A free, hard copy of right kind of wrong: the science of failing well for each participant. .

Your Instructors

Amy C. Edmondson is the Novartis Professor of Leadership and Management at Harvard Business School, a chair established to support the study of human interactions that lead to the creation of successful enterprises that contribute to the betterment of society. She has pioneered the concept of psychological safety for over 20 years and was recognized in 2021 as #1 on the Thinkers50 global ranking of management thinkers.

She is the author of Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy (2012), The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth (2018), and Right Kind of Wrong: The Science of Failing Well (2023).

Michaela Kerrissey is an Assistant Professor of Management at the Harvard T.H. Chan School of Public Health. She conducts research on how teams and organizations innovate, integrate, and perform, with a focus on health care. Dr. Kerrissey has authored over 30 publications on these topics and has won numerous best-paper awards, such as from the Academy of Management. She designed the Management Science for a New Era course at Harvard’s School of Public Health. In 2023, she was listed on Thinkers50 Radar, a global listing of top management thinkers.

Real World Case Studies

Affiliations are listed for identification purposes only.

Tomislav Mihaljevic, MD

Learn from the President and CEO of the Cleveland Clinic about how to implement joint problem solving in complex care organizations.

Maya Rupert

Hear from a top political strategist and campaign manager about how she leads within a teaming structure.

Trishan Panch, MD, MPH

Learn from Harvard faculty and founder of Wellframe about the importance of team learning.

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Course Syllabus

Learning requirements: There are no prerequisites required to enroll in this course. In order to earn a Certificate of Completion from Harvard Online and Harvard Business School Online, participants must thoughtfully complete all 5 modules, including satisfactory completion of the associated assignments, by stated deadlines.

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Study the Mining Accident Rescue and Cleveland Clinic cases.
Understand the concept of teaming and how it can be applied to the health care industry.
Brainstorm how to organize with a team to rescue 33 trapped miners.
Analyze the problems solved and new challenges created by organizational structures that were implemented to facilitate teamwork at the Cleveland Clinic.
Outline and analyze an individualized teaming breakdown for your organization.
Study the NASA and Google cases on psychological safety.
Collaborate with team members and leadership to create a space of psychological safety.
Identify the indicators of psychological safety in a group. Analyze data from Project Aristotle’s study of teams at Google.
Consider how past experiences can affect current feelings of psychological safety.
Study the Cleveland Clinic , Boehringer Ingelheim , and Cincinnati Children’s Hospital Medical Center cases.
Implement a joint problem-solving orientation in which team members view problems as shared and solutions as requiring collaboration.
Match different types of diversity in the workplace with the interpersonal boundaries that they imply.
Articulate what you bring to a team and what you might need from others.
Walk down the ladder of inference to get to the root of a problem.
Study the Virginia Mason Medical Center and Institute for Healthcare Improvement cases.
Cultivate an organization where team learning is valued and mobilized for improved performance.
Identify different kinds of work on the process knowledge spectrum.
Brainstorm how a nursing team could learn from an accidental morphine overdose.
Study the cases of Julio Castro's Presidential Campaign and Wellframe .
Practice leadership skills that include coaching, enabling, and ensuring that the right voices are present or represented within the team structure.
Build a leadership workshop for your team using the concepts addressed in this course.
Practice asking meaningful questions as a way to encourage input and express authentic humility.
Learn the difference between confirmatory and exploratory responses.

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Open access
Published: 18 June 2024

Efficacy of multicomponent interventions on injury risk among ice and snow sports participants—a systematic review and meta-analysis

Zhanjiang Fan ORCID: orcid.org/0009-0005-8084-4282 1 , 2 ,
Lanbin Min 1 ,
Wenbin He 1 ,
Yaorong Yang 2 ,
Wen Ma 3 &
Jiayi Yao 4

BMC Sports Science, Medicine and Rehabilitation volume 16 , Article number: 135 ( 2024 ) Cite this article

Metrics details

Ice and snow sports, which are inherently high risk due to their physically demanding nature, pose significant challenges in terms of participant safety. These activities increase the likelihood of injuries, largely due to reduced bodily agility and responsiveness in cold, often unpredictable winter environments. The critical need for effective injury prevention in these sports is emphasized by the considerable impact injuries have on the health of participants, alongside the economic and social costs associated with medical and rehabilitative care. In the context of ice and snow sports environments, applying the E principles of injury prevention to evaluate intervention measures can guide the implementation of future sports safety and other health promotion intervention measures in this field. When well executed, this approach can substantially reduce both the frequency and severity of injuries, thereby significantly enhancing the safety and long-term viability of these challenging sports.

The objective of this study was to rigorously assess and statistically substantiate the efficacy of diverse injury prevention strategies in ice and snow sports, aiming to bolster future safety measures with solid empirical evidence.

Systematic review and meta-analysis.

The overarching aim of this research was to meticulously aggregate and scrutinize a broad spectrum of scholarly literature, focusing on the quantifiable efficacy of diverse, multicomponent intervention strategies in mitigating the incidence of injuries within the realm of ice and snow sports. This endeavour entailed an exhaustive extraction of data from esteemed academic databases, encompassing publications up to September 30, 2023. In pursuit of methodological excellence and analytical rigor, the study employed advanced bias assessment methodologies, notably the AMSTAR 2 and GRADE approaches, alongside sophisticated random-effects statistical modelling. This comprehensive approach was designed to ensure the utmost validity, reliability, and scholarly integrity of the study’s findings.

Fifteen papers, including 9 randomized controlled trials, 3 case‒control studies, and 3 cohort studies with 26,123 participants and 4,382 injuries, were analysed. The findings showed a significant reduction in injury rates through various interventions: overall injury prevention (RR = 0.50, 95% CI 0.42–0.63), educational training (RR = 0.50, 95% CI 0.34–0.73), educational videos (RR = 0.53, 95% CI 0.34–0.81), protective equipment (RR = 0.64, 95% CI 0.46–0.87), and policy changes (RR = 0.28, 95% CI 0.16–0.49). Subgroup analysis revealed potential heterogeneity in compliance ( p = 0.347). Compared to controls, multicomponent interventions effectively reduced injury rates.

This systematic review and meta-analysis demonstrated that multicomponent interventions significantly prevent injuries in ice and snow sports. By applying the E principles of injury prevention and constructing a framework for practical injury prevention research in ice and snow sports, we can gradually shift towards a systemic paradigm for a better understanding of the development and prevention of sports injuries. Moreover, sports injury prevention is a complex and dynamic process. Therefore, high-quality experiments in different scenarios are needed in future research to provide more reliable evidence, offer valuable and relevant prevention information for practitioners and participants, and help formulate more effective preventive measures in practice.

Peer Review reports

Introduction

In the scholarly realm of sports science, the term “ice and snow sports” comprehensively encapsulates a variety of activities conducted on icy and snowy terrains, such as skating, skiing, and other recreational pursuits in these environments. Empirical evidence underscores the significant role of these sports in augmenting adolescent physical health, including their instrumental contribution to mitigating psychological disorders, curbing obesity, forestalling diseases, and fortifying physical fitness [ 1 , 2 , 3 ]. Millions of people participate in ice and snow sports globally, mainly in countries with cold climates and relevant sports facilities, such as North America, Europe, and parts of Asia. According to a report by Snowsports Industries America, the number of winter sports participants in North America was 25.1 million in the 2019–20 season and slightly decreased to 24.6 million in the 2020–21 season. Among a diverse group of participants, only 31% are involved in winter sports, with snowboarding showing higher inclusivity, as 38% of participants come from diverse backgrounds [ 4 ]. China has successfully achieved its goal of “engaging 300 million people in ice and snow sports,” with a national participation number reaching 346 million, a participation rate of 24.56%, and a youth participation rate in ice and snow sports of 15.62%, demonstrating the widespread popularity and rapid development of ice and snow sports in China [ 5 ]. Furthermore, organizations such as the International Ski Federation (FIS), the International Skating Union (ISU), the World Curling Federation (WCF), and the International Olympic Committee (IOC) play key roles in promoting sports, establishing rules, and organizing international competitions [ 6 ]. Numerous organizations and federations have been established worldwide to promote the popularization of ice and snow sports, train athletes, and organize domestic and international competitions and events. The participation in global ice and snow sports is rapidly expanding, especially in China, where the number of participants is continually growing. Sports have expanded from specific regions and seasons to a global scope and all seasons, especially snowboarding and skiing, which are extremely popular among young people and have become fashionable physical activities [ 6 , 7 ].

However, the nature of ice and snow sports includes certain risks, with part of their appeal stemming from the challenge of the natural environment and having a spirit of adventure. The potential injuries associated with these sports are a natural extension of risky behaviours. As the popularity of these sports has increased among young people, data show that from 2001 to 2023, the rates of injury to snowboarders’ heads, necks, and torsos increased by 50%; 14% of injuries occurred in adolescents, accounting for 22% of all injuries; head injuries, especially concussions, have ample epidemiological evidence indicating their significant harm, with approximately 2.5—2.9 deaths per million people in ice and snow sports. Additionally, 85% of injuries were caused by falls, 8% by collisions with others, and 5% by collisions with stationary objects. Although adolescents make up only 12% of all participants, they account for 23% of injuries; these data not only reveal the main causes of injuries but also highlight the importance of preventive measures and the cultivation of safety awareness [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The paradigm of viewing injuries as accidents, coincidental events, or random events is no longer accepted. They are understood to be predictable through causal chains of evidence and are thus considered preventable. This shift is based on the recognition that injuries can be effectively prevented by changing equipment, being aware of environmental conditions, and implementing educational interventions. Therefore, conducting targeted injury prevention interventions is crucial for reducing the risk and severity of sports injuries among participants in ice and snow sports. Moreover, the treatment of sports injuries also results in increased medical and social costs. Therefore, researching and implementing preventive interventions aimed at reducing the risk of injury is of great significance for maximizing the health benefits of participating in ice and snow sports and promoting safe participation [ 15 ].

From 1990 to 2000, research primarily focused on the effectiveness of protective gear, such as helmets [ 11 , 16 , 17 , 18 ], wrist guards, and external joint supports [ 8 , 9 , 19 , 20 ]. Between 2000 and 2010, the number of randomized controlled trials (RCTs) studying injury prevention in ice and snow sports and evaluating the effectiveness of protective measures nearly doubled [ 21 ]. Over the past decade, comprehensive analyses of ice and snow sports injuries have continued to increase. Recent studies have shifted their focus towards educational training programs [ 13 , 22 ], educational videos [ 16 , 23 ], and changes in ice and snow sports policies and regulations [ 10 , 12 , 13 , 14 , 24 , 25 ] to explore the effectiveness of various intervention measures. Although previous reviews and experimental studies have evaluated the efficacy of certain specific programs [ 26 ], the diversity in content, design, target populations, and outcome reporting across different studies has limited the effective utilization of research findings. Meta-analysis can provide more comprehensive evidence in this context. Thus, our research aimed to assess the efficacy of multifaceted intervention programs in reducing injury rates and specific regional injuries, considering various age groups (children, adolescents, adults) and levels of sport participation (amateur, club, elite, mixed).

Despite extensive exploration on this topic, existing research primarily focuses on the effectiveness of individual interventions in reducing the risks associated with ice and snow sports [ 22 , 23 , 24 ]. It has not proposed comprehensive risk prevention strategies from an integrated perspective, which hinders educators, researchers, and ice and snow environment designers from effectively integrating research conclusions into practice. This undoubtedly increases the risk of injury for ice and snow sports participants [ 27 ]. To bridge the gap between theory and practice, researchers typically adopt comprehensive measures to ensure the well-being of individuals and communities [ 28 , 29 ]. The E Principle, a commonly used framework for considering comprehensive measures in the field of injury prevention [ 30 ], integrates education, engineering, and enforcement methods. It systematically considers the effectiveness, credibility, and associated costs of intervention strategies [ 31 , 32 ], promoting the translatability of interventions into applied environments [ 31 ]. Therefore, it is widely regarded as an effective guide for designing and categorizing low-risk strategies [ 30 , 33 ]. In this study, to form a comprehensive prevention strategy for ice and snow sports, the E Principle was employed to shift the focus of injury responsibility from blaming the victim to recognizing the role of other stakeholders (such as organizers, policymakers, built environment designers, equipment manufacturers, and the community at large). By encouraging multi-level collaboration to develop customized risk prevention strategies, we aim to comprehensively reduce injury risks and medical costs. Additionally, using the E Principle to explore preventive measures for ice and snow sports injuries can not only help research propose comprehensive intervention recommendations [ 33 ] but also enhance the experience and well-being of ice and snow sports participants. This further promotes community well-being and advances the overall development of ice and snow sports at regional or national levels [ 34 , 35 ].

Specifically, education involves providing stakeholders with educational information or training to reduce injury risks engineering involves developing products and technologies that can reduce the risk of injury, as well as engineering intervention measures to control the occurrence of injuries in ice and snow environments or designing a safer environment; enforcement includes implementing preventative rules, policies, and regulations to reduce injury risks, including the development and implementation of policies or legislation aimed at reducing or preventing hazardous behaviours; As research has deepened, the extension of the E Principle has expanded to include encouragement and evaluation as the fourth and fifth Es [ 36 , 37 ]. These changes highlight the necessity of considering health promotion and providing injury prevention interventions for all community members, especially those at high risk in ice and snow sports. It also addresses the importance of formally evaluating the three Es interventions, examining the practical impact of their implementation in ice and snow sports injury prevention research. Enforcement promotes safe behaviour through incentive measures, including rewarding individuals or organizations that take safety measures or exhibit safe behaviours; and evaluation involves monitoring, assessing, and reviewing injury prevention plans and strategies to ensure their effectiveness, making adjustments, and demonstrating impact.

This study conducted a rigorous selection and analysis of literature through meta-analysis, systematically reviewing nearly 30 years of related case‒control studies, cohort studies, experimental studies, and quasiexperimental research. The analysis focused on analysing the effectiveness of multicomponent intervention measures, classifying intervention types according to the E principles and covering aspects such as educational training, educational videos, protective equipment, and changes in project policy rules to influence participant injury rates with the aim of providing more comprehensive and effective guidance for injury prevention in ice and snow sports. The study also considered various dimensions, such as age group, type of injury, level of sport, duration of intervention, and type of project, and conducted stratified subgroup analyses to explore the specific impact of intervention measures on injuries among participants in ice and snow sports under these different dimensions.

Search strategy

Within the academic sphere of sports science, with a particular emphasis on the prevention of injuries in ice and snow sports, a comprehensive and systematic literature search was meticulously executed to collate and analyse evidence-based strategies and types of interventions. The authors of this study adhered scrupulously to the methodological protocols delineated in the Cochrane Handbook [ 38 ]. Two researchers embarked on an exhaustive and independent exploration of several prominent databases, including Google Scholar, PubMed, EMBASE, Web of Science, and Sport Discus. This search was characterized by an absence of constraints regarding publication dates, extending up to December 31, 2022. The investigative process encompassed an array of search terms intricately associated with interventions, prevention, and prophylactic measures within the realm of ice sports (such as speed skating, figure skating, ice hockey, and curling) and snow sports (encompassing skiing, snowboarding, cross-country skiing, and alpine skiing). Additionally, the search criteria included terms related to injuries, sports injuries, case studies, RCTs, and the assessment of intervention effectiveness. By employing various permutations and combinations of these keywords, the researchers ensured thorough and expansive coverage of the relevant literature. The search process was continuously updated and refined until September 30, 2023, thereby guaranteeing the inclusion of the most current and pertinent studies in this evolving field of research.

Document recognition

One researcher searched electronic databases and identified a total of 9,756 studies, which were subsequently saved in Zotero. After removing duplicate studies, 7,926 studies remained. An initial screening of titles and abstracts led to the exclusion of 7,767 articles, leaving 159 studies. Following a full-text review of these studies, an additional 145 studies were excluded. Additionally, a manual search of related literature and citation tracking resulted in the inclusion of one more study. Of these, 103 studies were excluded because they did not report specific injury data, and 42 studies did not meet the criteria for RCTs, case‒control studies, or prospective cohort studies. Ultimately, 15 studies were included in the meta-analysis (Fig. 1 ).

Flow chart of the study selection process

Inclusion criteria

In the meticulous process of study selection, two academically qualified researchers independently scrutinized the titles and abstracts of pertinent studies. Each study meeting the following rigorously defined inclusion criteria underwent a comprehensive full-text assessment by these researchers: (1) the study’s central theme was explicitly aligned with the prevention of injuries in the domain of ice and snow sports; (2) the methodological design of the study was structured as either a cohort study, case‒control study, or a randomized or cluster–randomized trial, ensuring a robust and scientifically sound approach; (3) the publication delineated at least one objective and quantifiable outcome, encompassing metrics such as injury rates, the total number of injuries, or the duration of the intervention, to provide measurable insights into the effectiveness of the interventions; and (4) the results presented in the study convincingly demonstrated the efficacy of the interventions in mitigating injury risks in ice and snow sports. In instances of disagreement regarding the eligibility of a specific article, the two researchers engaged in a consensus-building dialogue to resolve any discrepancies. If a consensus remained elusive, a third researcher, equipped with the requisite expertise, was enlisted to provide an adjudicative decision, thereby ensuring the integrity and scholarly rigor of the study selection process.

Exclusion criteria

The criteria for excluding literature were as follows: (1) risk ratios (RRs) or injury rate ratios (RRs) were not provided, or the original data could not be used to calculate the required data (for example, the use of absolute rather than relative injury rates in cohort studies); (2) only mortality rates were reported, without injury rates; (3) only the risks of injuries in ice and snow sports or the factors influencing these injuries were compared; or (4) only other data related to ice and snow sports were reported. In summary, articles that did not provide data allowing for the calculation of risk statistics or that did not provide sufficient data to calculate the injury rate RR were excluded.

Data extraction

The study organized the interventions according to the E principles of injury prevention (education, engineering, and enforcement). The E principles of injury prevention are a commonly used framework in the field of injury prevention and are utilized for conceptualizing and categorizing effective risk reduction strategies [37. Relevant data from each study included in the full texts were extracted with the aim of evaluating the effectiveness of multicomponent interventions in preventing injuries among participants in ice and snow sports. The multicomponent intervention types mainly included the following: (1) education, which involves reducing injury risks by providing educational information or training to stakeholders, including educational training and educational videos; (2) engineering, which involves the development of products and technologies that can reduce the risk of injury, including advancements in protective equipment such as helmets and wrist guards to better prevent injuries during sports; and (3) enforcement, which includes the implementation of preventative rules, policies, and regulations to reduce the risk of injury. The injury rates for the following four types of injuries were analysed separately: (1) head injuries; (2) upper limb injuries; (3) lower limb injuries; and (4) all injuries. Table 1 provides detailed descriptions of the multicomponent interventions and injury categories.

The researchers extracted the characteristics of the participants, the type of sport, the level of sport, the duration of the intervention, and the main outcomes from each article (Table 2 ). The calculations for the meta-analysis were conducted using Collaboration Review Manager 5.1 software. All calculations were based on the primary outcomes of the studies. Data were analysed by calculating risk ratios (RRs), injury rate RRs, or Cox regression RRs [ 39 ]. The calculation of the injury rate RR was as follows: RR = (number of injuries in the intervention group/duration of intervention)/(number of injuries in the control group/duration of intervention). An injury rate RR > 1 was considered to indicate that the intervention effect was not significant or ineffective, while an injury rate RR < 1 was considered to indicate the effectiveness of multifaceted intervention measures in reducing injuries [ 40 ], meaning that an RR of 0.42 corresponded to a 58% reduction in injuries. The injury rate RR with a 95% confidence interval (CI) was used as the measure of effect size for analysis. The inverse variance was used as the statistical method, and the analysis was based on a random-effects model. Statistical heterogeneity was assessed using I 2 and χ2 (Q) values; heterogeneity was considered low for I 2 values between 25 and 50%, moderate for values between 50 and 75%, and high for values ≥ 75% [ 38 ]. Tri-tailed or bi-tailed P values < 0.05 were considered to indicate statistical significance.

Quality evaluation

In accordance with the recommendations of AMSTAR 2 [ 41 ], the credibility of each included experiment was assessed to categorize the studies. Two researchers evaluated each study based on fulfilment of the evaluation criteria, marking them as “yes,” “no,” or “partly yes” for some entries. Depending on the potential impact on the study results, each credibility level was judged as high, moderate, low, or very low. A study was rated as “high” if there were 0 or 1 noncritical items with flaws and “moderate” if there were more than 1 noncritical items with flaws. If there was 1 critical item with flaws with or without noncritical items with flaws, the study credibility was rated as “low.” If there was more than 1 critical item with flaws with or without noncritical items with flaws, the study credibility was rated as “very low.” The two researchers independently reviewed the credibility and resolved any discrepancies through consensus among all researchers. The quality of evidence and the strength of the recommendations were evaluated using the GRADE system [ 42 ]. Researchers considered four key elements of the articles: study design, study quality, consistency, and directness. The criteria for assigning evidence levels were as follows: (1) RCTs were rated as high-level studies; (2) observational studies as moderate-level studies; and (3) other studies as low-level studies. The level was downgraded under the following conditions: (1) poor study quality decreased the level by 1, and very poor study quality decreased the level by 2; (2) poor consistency decreased the level by 1; (3) large uncertainty in directness decreased the level by 1, and very large uncertainty decreased the level by 2; (4) unclear data reporting decreased the level by 1; and (5) high risk of bias decreased the level by 1. The level was upgraded under the following conditions: (1) consistency of two or more pieces of evidence, with significant and low risk of bias, increased the level by 1–2; (2) strong direct evidence, with significant and low risk, increased the level by 2–5, and validity of the evidence increased the level by 2; (3) each increase in the degree of evidence increased the level by 1; and (4) reduction of all potential confounding factors increased the level by 1. Publication bias was assessed through visual inspection of funnel plots and the bi-tailed Egger test [ 43 ]. Finally, the evidence was categorized into four levels: high, moderate, low, and very low. Based on this, a systematic analysis of the literature was conducted, including 9 RCTs, 3 case‒control and case‒crossover studies, and 3 prospective cohort studies, totalling 15 studies with 27 valid data points. Using 12 quality criteria adapted from Furlan [ 44 ], two researchers independently scored the methodological quality (Table 2 ), with the highest score being 11/12, the lowest score being 7/12, and the average score being 8/12.

Publication bias

Based on the studies identified, the funnel plot (Fig. 2 ) showed that the effect sizes were relatively evenly clustered in the upper effective area, suggesting a symmetric distribution. To avoid a single study generating too many effect values and occupying excessive weight, potentially causing bias in the results, this study adopted a method of effect value aggregation for articles containing various conditions. If an experiment reported the effects of multiple interventions and these interventions were not the moderating variables of interest in this study, they were converted into a single effect size. Furthermore, to ensure the independence of effect values, if an experiment reported multiple test results from the same sample, CMA 3.0 was used to combine these effect values before including them in the meta-analysis. Egger’s test was used to confirm asymmetry. The larger the deviation of the intercept from zero was, the more apparent the asymmetry. If the p value of the intercept was equal to or less than 0.1, the asymmetry was considered statistically significant (intercept = -2.08, SE = 0.69, P = 0.003) [ 45 ]. The fail-safe number (Nfs) test criterion was an Nfs value greater than 5 N + 10, with N representing the number of studies. This criterion, as proposed by Rosenthal [ 46 , 47 ], estimates how many unpublished and nonsignificant study samples would be needed to render the current meta-analysis results insignificant. The results showed Nfs = 926, which is greater than 5 × 27 + 10 = 145, indicating that the likelihood of a change in the results of this meta-analysis is minimal. Based on these findings, we concluded that there was no publication bias in the included studies and that the results of the meta-analysis are valid and reliable.

Publication bias funnel plot of the study sample

Through a search, review, and selection of literature, among the 15 studies included in our analysis, we focused only on initial injuries, as repeated results are likely interdependent, potentially leading to bias. According to the E principles of injury prevention, the studies included 6 education-based interventions (3 educational training and information, 3 educational videos), 7 engineering interventions (protective equipment such as helmets and wrist guards), and 2 enforcement interventions (policy and rule changes). The included studies consisted of 5 European RCTs [ 8 , 9 , 13 , 16 , 22 ], 3 Canadian RCTs [ 10 , 20 , 23 ], 1 prospective RCT from the United States [ 19 ], and 3 prospective cohort and case‒control studies from Canada and Switzerland [ 11 , 12 , 14 ]. Additionally, there were 3 prospective cohort studies from Canada [ 17 , 18 , 24 ]. The studies involved a total of 26,123 participants, including both males and females, with an age range covering children (0–12 years), adolescents (13–19 years), and adults (20 years and older). The number of participants in these studies varied from 69 to 6,266 [ 14 , 20 ]. A total of 4,382 injuries were reported across the studies, with intervention durations ranging from 1 week to 144 weeks [ 11 , 19 ]. All interventions were applied at least twice weekly in the intervention groups, while regular training was provided in the control groups. Subgroup analyses were further conducted, including analyses of variables such as age, duration of intervention, level of sport, and type of ice and snow sport. Age, sport level, intervention duration, and ice and snow sports were categorized as follows, respectively: children, adolescents, and adults; elite, club, and amateur; less than or equal to 2 weeks, 8–12 weeks, and more than 12 weeks; and skiing, snowboarding, alpine skiing, and ice hockey.

Evaluating the efficacy of interventions

In the 15 studies included, the overall impact of different interventions on the prevention of injuries in ice and snow sports showed a total injury rate ratio of 0.50 (95% CI 0.41–0.62; I 2 = 76.56%; T 2 = 0.195; p < 0.001) (Fig. 3 ). This indicates that compared to that in the control group, the injury rate in the intervention group was reduced by 50% (1-0.50), meaning that the injury rate in the intervention group was 50% lower than that in the control group. The 95% CI of 0.41–0.62 suggests that at the 95% confidence level, there is a 95% probability that the true injury rate RR lies between 0.41 and 0.62, indicating some degree of uncertainty about this injury rate RR. Importantly, this CI does not include 1, and a p value of < 0.001 signifies that the injury prevention effect is significant, indicating that the injury rate RR in the intervention group is significantly lower than that in the control group (Fig. 3 ). The Q value of 110.91 (df = 26, P < 0.001) highlights variability in the true effect sizes across all studies. The I 2 of 76.56% indicates that approximately 77% of the variance observed in the effects is due to true effects. The T 2 and T values are 0.195 and 0.442, respectively, further emphasizing the heterogeneity observed in the study results.

Results of the meta-analysis

The effectiveness of educational training interventions in reducing injuries in ice and snow sports was studied in 3 experiments involving a total of 1,590 participants [ 10 , 13 , 22 ]. The educational training programs included the ISPAInt program and high-intensity neuromuscular training (NMT) program. The injury rate RR for ice and snow sports participants subjected to educational training interventions was 0.50 (95% CI 0.34–0.73; I 2 = 84.61%; T 2 = 0.223; p < 0.001) (Fig. 4 ). This indicates that educational training interventions can significantly reduce the overall injury rate. Specifically, an RR of 0.50 implies that the injury rate in groups receiving educational training interventions was 50% lower than that in groups without such interventions. The 95% CI of 0.34–0.73 suggests that there is a 95% probability that the true RR lies within this range in similar studies. The I 2 of 84.61% indicates substantial heterogeneity in the results, warranting cautious interpretation. The T 2 value of 0.223 suggests a small variance between different studies, which could be due to differences in study designs, sample sizes, and intervention measures. The p value < 0.001 indicates that the difference in the results is statistically significant. Overall, these results suggest that educational training interventions can reduce the overall injury rate in ice and snow sports. However, the high heterogeneity and variance should be taken into consideration.

Combined effect of multicomponent interventions on the injury rate of participants

In the three included studies on educational video interventions, comprising a total of 3,180 participants [ 16 , 20 , 23 ], the impact of educational video interventions on the risk of injuries among ice and snow sports participants was investigated. The injury rate RR for participants exposed to educational video interventions compared to the control group was 0.53 (95% CI 0.34–0.81; I 2 = 62.72%; T 2 = 0.238; p < 0.001) (Fig. 4 ). This suggests that educational video interventions can significantly reduce the overall injury rate. Specifically, the RR of 0.53 indicates that the injury rate in groups receiving educational video interventions was 47% lower than that in groups without such interventions. The 95% CI of 0.34–0.81 implies that in similar studies, there is a 95% probability that the true RR lies within this range.

The I 2 of 62.72% indicates moderate heterogeneity in the results, while the T 2 of 0.238 suggests a small variance between different studies. The p value < 0.001 indicates that the difference in the results is statistically significant. Overall, these results demonstrate that educational video interventions can effectively reduce the overall injury rate in ice and snow sports.

Engineering

In a total of 7 experiments involving 19,545 participants, the effectiveness of protective equipment in reducing injury risk among ice and snow sports participants was studied. The protective equipment mainly included helmets [ 11 , 14 , 18 ], wrist guards [ 8 , 9 ], and facial protection, including mouth guards [ 17 ]. These participants included alpine skiers, skiers, snowboarders, and ice hockey players. In 5 experiments evaluating head and facial injuries [ 11 , 14 , 17 , 18 , 19 ], involving 13,755 participants, helmets and facial protection, including mouth guards, were found to effectively protect ice and snow athletes from head injuries. In 2 experiments assessing upper limb (wrist and shoulder) injuries, involving a total of 5,790 participants, wrist guards or external joint supports effectively protected against wrist injuries [ 8 , 9 ].

Based on the effectiveness studies of protective equipment across 7 experiments, the interventions collectively reduced injuries to various body parts compared to the controls, with an injury rate RR = 0.64 (95% CI 0.46–0.87; I 2 = 58.13%; T 2 = 0.087; p < 0.01) (Fig. 4 ). This indicates that protective equipment interventions can significantly reduce the overall injury rate. Specifically, the RR of 0.64 suggests that the injury rate after protective equipment interventions was 36% lower than that in groups without these interventions. The 95% CI of 0.46–0.87 implies that there is a 95% probability that the true RR lies within this range in similar studies. The I 2 of 58.13% indicates moderate heterogeneity in the results, while the T 2 of 0.067 suggests a small variance between different studies. The p value of < 0.004 indicates that the difference in the results is statistically significant. Overall, these results demonstrate that interventions involving protective equipment can effectively reduce the overall injury rate in ice and snow sports.

Enforcement

Two prospective cohort studies involving a total of 1,848 participants examined the impact of policy and rule changes on injury risk among ice hockey players [ 10 , 12 ]. Compared to the control group, the injury rate RR for ice hockey players subjected to interventions involving changes in policy and rules was 0.28 (95% CI 0.16–0.49; I 2 = 63.24%; T 2 = 0.152; p < 0.001) (Fig. 4 ). This indicates that interventions involving policy and rule changes can significantly reduce the overall injury rate. Specifically, the RR of 0.28 suggests that the injury rate after such interventions was 72% lower than that in groups without these interventions. The 95% CI of 0.16–0.49 implies that in similar studies, there is a 95% probability that the true RR lies within this range.

The I 2 of 63.24% indicates moderate heterogeneity in the results, while the T 2 of 0.152 suggests a small variance between different studies. The p value < 0.001 indicates that the difference in the results is statistically significant. Overall, these results demonstrate that interventions involving policy and rule changes can effectively reduce the overall injury rate in ice hockey sports.

Subgroup analysis

The subgroup analysis primarily focused on the injury rates among ice and snow sports participants and the results of mixed-effects application of a random model across five moderating variables (Table 3 ). A comparison between subgroups revealed only one significant difference ( p = 0.347). This finding offers insights for interpreting the qualitative sources within our study. On the one hand, this finding can help explain the variance among studies. On the other hand, this finding suggests that elite athletes, through years of training and competition experience, have developed good sports habits. Consequently, intervention measures may not have as significant an impact on elite athletes as they do on athletes in other groups. This lack of a significant impact on elite athletes can be attributed to their already established and effective injury prevention practices and heightened awareness and skill level in their respective sports.

Types of injuries

The subgroup analysis for types of injuries revealed the following: for head injuries, the injury rate RR was 0.51 (95% CI 0.29–0.89; I 2 = 85.04%; T 2 = 0.386; p < 0.01). This indicates a statistically significant reduction in the rate of head injuries as a result of the interventions. For upper limb injuries, the RR was 0.42 (95% CI 0.19–0.94; I 2 = 66.06%; T 2 = 0.374; p < 0.05). This suggests a significant reduction in the rate of upper limb injuries. For lower limb injuries, the RR was 0.41 (95% CI 0.28–0.60; I 2 = 53.65%; T 2 = 0.094; p < 0.001), indicating a significant reduction in lower limb injuries. For injuries to the entire body, the RR was 0.56 (95% CI 0.41–0.77; I 2 = 76.36%; T 2 = 0.208; p < 0.001), which is also statistically significant.

This study revealed that multifaceted intervention measures are more effective for preventing lower and upper limb injuries than for head and overall body injuries (RR = 0.42 vs. 0.51 and 0.56). This differential effectiveness could be related to the specific characteristics of ice and snow sports activities. For example, the nature of these sports might pose greater risks for limb injuries, making interventions targeting these areas particularly effective. The high degree of heterogeneity (I 2 values) also suggests variability in the effect sizes across the studies, which might be attributed to differences in the types of sports, intervention methods, and participant characteristics.

The subgroup analysis by age group revealed the following: For children (< 12 years), the injury rate RR was 0.30 (95% CI 0.23–0.38; I 2 = 0.74%; T 2 = 0.001; p < 0.001). This indicates a significant reduction in injury rates in children as a result of the interventions. For adolescents (12–19 years), the RR was 0.62 (95% CI 0.43–0.89; I 2 = 82.06%; T 2 = 0.134; p < 0.01). This suggests a substantial but less pronounced reduction in injury rates compared to that in children. For adults (≥ 20 years), the RR was 0.68 (95% CI 0.57–0.80; I 2 = 74.71%; T 2 = 0.253; p < 0.01), indicating a significant reduction in injury rates, although the effect is less than that for children.

The analysis revealed that multifaceted intervention measures are more effective for children and adults than for adolescents. This outcome aligns with cognitive development patterns: children, who have lower self-protection awareness, are more susceptible to intervention measures and possess stronger learning capabilities and a greater willingness to accept new practices. Adults, with their rich knowledge and strong self-protection awareness, are also more receptive to interventions. Adolescents, often seeking thrill and adventure, are more likely to indulge in risky behaviour, making them more prone to accidents and injuries during sports activities. The significant heterogeneity (I 2 values) among adolescents and adults suggests variability in the effect sizes across different studies, possibly due to variations in intervention methods, types of sports, and individual characteristics of the participants within these age groups.

Exercise level

The subgroup analysis by exercise level revealed the following: For elite-level athletes, the injury rate RR was 0.78 (95% CI 0.47–1.30; I 2 = 84.6%; T 2 = 0.114; p = 0.347), which is not statistically significant. This suggests that interventions have a less pronounced impact on reducing injuries among elite athletes. For club-level athletes, the RR was 0.46 (95% CI 0.33–0.66; I 2 = 82.13%; T 2 = 0.264; p < 0.001), indicating a significant reduction in injury rates at this level. For amateur-level athletes, the RR was 0.51 (95% CI 0.35–0.75; I 2 = 54.38%; T 2 = 0.126; p < 0.001), also indicating a significant reduction in injury rates. For mixed levels, the overall injury rate RR was 0.45 (95% CI 0.25–0.81; I 2 = 75.89%; T 2 = 0.401; p < 0.01), which is statistically significant.

The analysis indicates that multifaceted intervention measures are most effective for club-level participants, followed by amateur-level athletes, with no significant impact for elite-level athletes. The high heterogeneity (I 2 values) across different levels, especially among elite and club-level athletes, suggests variability in the effect sizes, possibly due to differences in the intensity and nature of the sports activities, the athletes’ experience, and the specific types of interventions used. The lack of a significant impact on elite athletes might be attributed to their high levels of training and awareness and existing injury prevention practices. In contrast, club and amateur athletes might benefit more from interventions due to less exposure to professional training and injury prevention strategies.

Duration of intervention

The subgroup analysis based on the duration of the intervention revealed the following: For interventions lasting ≤ 2 weeks, the injury rate RR was 0.70 (95% CI 0.54–0.91; I 2 = 6.09%; T 2 = 0.009; p < 0.01). This indicates a significant reduction in injury rates for short-term interventions, with minimal heterogeneity among studies. For interventions lasting 8–12 weeks, the RR was 0.49 (95% CI 0.26–0.95; I 2 = 77.81%; T 2 = 0.428; p < 0.05). This suggests a more pronounced reduction in injury rates for medium-term interventions, although with a higher level of heterogeneity. For interventions lasting ≥ 12 weeks, the RR was 0.48 (95% CI 0.37–0.63; I 2 = 81.42%; T 2 = 0.227; p < 0.001). This indicates a significant reduction in injury rates for long-term interventions, again with considerable heterogeneity.

The subgroup analysis of the duration of the intervention shows that medium-term (8–12 weeks) and long-term (≥ 12 weeks) interventions are most effective, followed by short-term (≤ 2 weeks) interventions. The varying effectiveness based on duration suggests that while shorter interventions have an impact, more extended periods of intervention may be more effective in reducing injuries. The high I 2 values for the 8- to 12-week and ≥ 12-week durations indicate substantial heterogeneity, which could be due to variations in the types of interventions implemented, the sports involved, and the specific characteristics of the participants. Despite the heterogeneity, the consistent trend across all durations underscores the overall effectiveness of intervention measures in reducing injury rates in ice and snow sports.

Ice and snow sports

The subgroup analysis based on the type of ice and snow sports revealed the following: For alpine skiing, the injury rate RR was 0.64 (95% CI 0.47–0.86; I 2 = 74.15%; T 2 = 0.136; p < 0.01). This indicates a significant reduction in injury rates in alpine skiing, though with considerable heterogeneity among studies. For skiing/snowboarding, the RR was 0.51 (95% CI 0.34–0.76; I 2 = 66.01%; T 2 = 0.223; p < 0.01). This suggests a significant reduction in injury rates in skiing and snowboarding, with moderate heterogeneity. For ice hockey, the RR was 0.38 (95% CI 0.25–0.57; I 2 = 80.06%; T 2 = 0.258; p < 0.001), indicating a significant reduction in injury rates and the highest effectiveness among the sports analysed, again with considerable heterogeneity.

Our analysis suggests that the efficacy of the interventions varies significantly across different ice and snow sports, with pronounced effectiveness observed in ice hockey compared to alpine skiing, skiing, and snowboarding. This differential impact may be attributed to the inherently intense physical contact and competitive ethos of ice hockey, which render it particularly amenable to the influence of policy and rule changes. The observed high levels of heterogeneity, as reflected in the I 2 values across these sports, indicate a notable variation in the effect sizes. This variability is likely a consequence of several factors, including the distinct nature of each sport, the specific types of interventions implemented, and the unique characteristics of the participant cohorts within each sporting discipline. The analysis further reveals a significant reduction in injury rates across all examined types of ice and snow sports, emphasizing the overarching effectiveness of interventions when they are meticulously tailored to meet the specific needs and inherent risks associated with each sport. This finding underscores the critical importance of developing and implementing bespoke intervention strategies that are finely attuned to the particularities of each sport, thereby optimizing their potential to mitigate injury risks and enhance participant safety. A nuanced approach to intervention design and implementation, cognizant of the unique attributes and demands of each sport, is paramount for effectively reducing injury rates and promoting the health and safety of athletes engaged in these diverse and challenging sporting activities.

This systematic review and meta-analysis, which included 9 RCTs, 3 case‒control studies, and 3 prospective cohort studies, evaluated the effectiveness of intervention measures on overall and specific injuries among participants in ice and snow sports. Excluding the influence of objective factors, such as environmental and regional factors, the measures rooted in each of the E principles of injury prevention (education, engineering, and enforcement) exhibit significant effectiveness in preventing overall and specific injuries among participants in ice and snow sports. The selected interventions based on education, engineering, and enforcement reduce the injury rates in ice and snow sports. Although these results demonstrate the potential of the principles of injury prevention, it is not possible to compare the principles between the groups, as the interventions across the groups did not include the same outcome indicators. Based on the injury rate RRs and 95% CIs, the results demonstrate that the intervention measures effectively reduce the risk of injuries among ice and snow sports participants. The analysis of the impact of multifaceted injury prevention interventions compared to control groups on overall and regional injury risks included I 2 values, p values, RRs, T 2 values at a significance level of P < 0.001, along with the certainty of all primary and secondary outcomes. Despite the significant preventive results indicated by the analysis, potential risks of bias exist. Moreover, most of the results are based on high efficacy.

The significant outcomes suggest that multifaceted interventions are effective in reducing injury risks in ice and snow sports. However, the variability in effects (indicated by I 2 values) and the potential biases underscore the need for cautious interpretation of these findings. The high efficacy reported in most studies emphasizes the importance of such interventions in sports injury prevention but also highlights the necessity for continuous evaluation and potential refinement of these intervention strategies.

Comparison with existing literature

The aim of this study was to assess the effectiveness of multifaceted interventions for the prevention of injuries in ice and snow sports. When analysing the injury rate ratio from this study and comparing it with values reported in previous research, our study included participants of all ages and various skill levels in ice and snow sports (elite, club, amateur, and mixed). The injury rate RR in this study was 0.50 (95% CI 0.41–0.62; I 2 = 76.6%; T 2 = 0.195; p < 0.001), indicating an approximately 50% reduction in injury risk, which is at the upper limit reported in previous systematic reviews. This finding represents a statistically significant and clinically meaningful reduction in the prevention of injuries, similar to the reductions in injury rates reported in previous systematic reviews and meta-analyses. For example, in an educational anterior cruciate ligament (ACL) injury prevention video study, Schoeb et al. found the intervention to be effective in preventing lower limb and knee joint injuries (RR = 0.665 (95% CI 0.485–0.884) p < 0.001, RR = 0.699 (95% CI 0.493–0.989) p < 0.001) [ 22 ]. Lauersen et al. indicated that physical exercise interventions can reduce the risk of acute injuries by 35.3% (RR = 0.65, 95% CI = 0.50–0.84, p < 0.01) [ 39 ], while Hübscher et al. reported that multiple intervention exercises effectively reduced the risk of lower limb injuries (RR = 0.61, 95% CI = 0.49–0.77, p < 0.01) and that balance training alone significantly reduced the risk of ankle sprains (RR = 0.64, 95% CI = 0.46–0.90, p < 0.01) [ 48 ].

A systematic review of early research on the prevention of sports injuries concluded that educational training had a significant impact as a prevention strategy [ 49 ]. Home-based balance training can improve static and dynamic balance and enhance postural control during movement, potentially reducing the risk of injury and possibly improving proprioception and neuromuscular control [ 10 ]. The 50% intervention effectiveness in our study further supports the benefits of educational training, particularly in reducing the risk of lower limb joint injuries. 80% of effective educational training interventions included stability, balance, or coordination components [ 25 ], and 3 experiments with educational training interventions significantly reduced the risk of sports injuries and improved physical capabilities. In previous studies, lower limb injuries, especially ACL injuries, were a prominent issue. In our study, educational training programs primarily based on proprioceptive training significantly prevented lower limb injuries, but further detailed research is needed to determine whether such training can reduce knee injuries. Additionally, compared to the control group, the intervention group showed a lower average 2-week rate for traumatic knee injuries, knee overuse injuries, and lower back overuse injuries [ 13 , 22 , 50 ]. Our findings corroborate Schoeb et al.‘s finding that youth skiers performing the ISPAInt program weekly 0.8 ± 0.6 times had a lower absolute incidence of traumatic and overuse injuries. Westin et al. reported a 45% reduction in ACL injury rates among U18 skiers [ 13 ]. Therefore, high-quality implementation should be based on a partnership between program developers (researchers) and participants. Two experiments studied the impact of high-intensity NMT programs on lower limb injuries [ 10 , 13 ]. Emery et al.‘s study showed protective effects for all injuries (RR = 0.30, 95% CI, 0.19–0.49), lower limb injuries (RR = 0.31, 95% CI, 0.19–0.51), ankle sprains (RR = 0.27, 95% CI, 0.15–0.50), and knee twists (RR = 0.36, 95% CI, 0.13–0.98). Emery et al.‘s RCT showed that adolescents who underwent 12 weeks of high-intensity NMT had significantly lower risks of sports and muscle injuries than did those in the control group, with an RR of 0.82 (95% CI 0.71–0.94; 95% CI 0.58–1.15), although the difference was not significant [ 26 ]. Rahnema et al.‘s quasiexperimental study revealed significant correlations between improvements in balance and agility following 8 weeks of regular training and thrice-weekly core stability training among professional speed skaters ( p < 0.05), indicating a positive impact on dynamic balance and agility [ 51 , 52 ]. This reflects the overall trend in injury prevention research, where external risk factors are uncontrollable, but factors such as cognitive level, physical fitness, muscle strength, sports skills, and abilities can be altered through various combinations of educational interventions. Similarly, NMT is included in educational training interventions. According to the review, NMT is believed to have beneficial effects on joint position sense, stability, and reflexes. NMT is a cost-effective training method that can effectively reduce injury risk without equipment. ISPAInt interventions and strength NMT can effectively reduce overall injuries in ice and snow athletes [ 10 , 22 ]. Interventional experimental studies aimed at strengthening power and improving NMT have not been widely conducted in ice and snow sports. Instead, strength training and NMT have been successfully applied as parts of multifaceted interventions, almost all of which include elements of strength, neuromuscular, balance, and coordination training. This comprehensive educational training program intervention might be the sum of all effective methods. It is challenging to pinpoint which part of the training intervention is the most effective component and which part has no impact on injury risk [ 49 ]. A combination effect might occur, but effective prevention must be based on high compliance with the injury prevention program by participants and organizers [ 53 ].

Educational video interventions have been rated as 65% effective [ 54 , 55 ], which is very similar to the findings of our study. Although our results carry potential biases, our research was based on participants of all ages and varying skill levels and considered differences among subgroups. Our analysis suggests that this type of intervention has significant potential for preventing sports injuries, warranting further research into the effectiveness of educational video interventions. Additionally, the design of broader educational video intervention programs will inevitably increase with greater application, potentially leading to reduced compliance. Our study indicates that efficacy research for multifaceted intervention measures must be based on high-quality RCTs, with further research in randomized trials remaining crucial. For instance, Jørgensen et al. found that showing a 45-minute educational video during long bus trips to ski resorts for beginners, including basic skills and safety requirements, equipment checks, and helmet use, effectively reduced injury risks, especially for collisions and falls [ 16 ]. Ytterstad et al. provided past injury information and technical and safety tips to ski club members through brochures and educational videos, significantly reducing skiing injuries [ 19 ]. Using standardized assessment tools to evaluate injury rates, Priyambada et al. found that the injury risk in the intervention group was similar to that in the control group, with an injury rate of 22.95/100 (95% CI: 17.63–28.26) in the intervention video group and 23.31/100 (95% CI: 16.75–29.87) in the control group. They suggested understanding risky behaviours to optimize the promotion of safe practices and prevent injuries and appropriately incorporating them into injury prevention strategies [ 23 ]. Educational videos were found to effectively increase injury awareness and safety prevention knowledge among children and adolescent skiers, similar to the findings reported by Jørgensen et al. Intervention with snowboarding safety videos and manuals increased safety injury knowledge by 13.6% among Canadian 7th-grade (11–12 years old) students, which is a critical first step as children and adolescents face risks of preventable injuries; additionally, early learning of safety strategies could lead to lifelong safety compliance [ 56 ].

Protective equipment is widely used to prevent injuries among participants in ice and snow sports, but its effectiveness varies. Early review studies have shown that helmet use by skiers can effectively reduce the risk of head injuries [ 9 , 11 , 16 , 19 , 57 , 58 ] and may also help reduce neck and other injuries [ 11 , 40 ], but it could also potentially increase the risk of head or neck injuries [ 59 ]. In ice and snow sports, a mandatory policy of wearing wrist guards implemented among middle school students (12–16 years) significantly decreased wrist injury rates [ 60 ]. However, using wrist guards may increase the risk of injuries to the elbow, upper arm, and shoulder while reducing the risk to the hand, wrist, and forearm [ 18 ], possibly due to the transmission of impact forces along the kinetic chain of the limb.

In our study, 5 out of 7 experiments supported the use of protective equipment (such as helmets, face shields, and mouthguards) to effectively prevent head injuries [ 11 , 14 , 18 , 19 , 61 ]. These participants included alpine skiers, skiers, snowboarders, and ice hockey players. For instance, three case‒control studies reported a reduced risk of head injuries in participants wearing helmets (reductions of 29%, 60%, and 15%, respectively) [ 18 ], and a large study of 1,033 professional ice hockey players revealed that athletes wearing mouthguards had significantly less severe symptoms than those who did not ( p < 0.01) [ 17 ]. In two experiments assessing upper limb (wrist and shoulder) injuries, wrist guards or external joint supports effectively protected ice and snow sports participants from wrist injuries [ 8 , 9 ]. Wrist injuries are common among skiers; hence, wrist protectors with specific designs have been developed and shown significant protective effects [ 9 ]. Rønning et al., by randomly assigning snowboarders to an intervention or control group, found a significant reduction in wrist injuries in the group using wrist guards. While the results show significant preventive effects, potential risks also exist. An undisputed fact is that almost all ice and snow sports venues require participants to wear protective equipment, corroborating our findings. Further data are needed to understand which aspects of protective equipment may carry potential risks.

Additionally, numerous studies on policy and rule changes have confirmed their effectiveness in preventing injuries among ice hockey players [ 12 , 24 , 56 , 62 , 63 ]. For instance, in several studies evaluating the impact of prohibiting body checking, both injuries and penalties decreased, along with a reduction in injury rates. Regnier et al. found that in leagues where body checking was allowed (ages 11–12), players faced a greater risk of severe injuries. In Ontario and Quebec, in leagues allowing body checking (ages 14–15), players had greater injury rates than those in leagues where body checking was not permitted. The increased injury risk in leagues allowing body checking suggests that changes to body checking rules can be beneficial for protecting players. From a player development perspective, introducing body checking at an earlier age can be highly beneficial for the growth of adolescents, eliminating the career risks brought about by injuries [ 62 ]. Black et al. noted that in nonelite Canadian ice hockey games [ 12 ], abolition of the body-checking policy led to a relative reduction of 50% in injury rates and 64% in concussion rates among Alberta’s 11- and 12-year-old ice hockey players [ 14 ], with a threefold decrease in injury and concussion risks [ 12 ]. Slaney noted that mandatory wrist guard wearing in schools can effectively reduce the risk of upper limb fractures. However, the effectiveness of implementing these policies outside the school environment remains unknown [ 60 ].

Therefore, changes in policies and rules fundamentally alter the culture of a sport while maintaining the common interests of stakeholders. These findings corroborate those of our study, suggesting that policy and rule interventions have effective potential for preventing injuries in ice and snow sports. Therefore, it is necessary to develop sports rules and policies encompassing various dimensions to ensure the common interests of stakeholders, which is crucial for ensuring the sustainable development and nurturing of talent in these sports.

The E ’s of ice and snow sports injury prevention

Based on this meta-analysis, which assessed the strength of the evidence for the efficacy of intervention measures, future research needs to consider the “optimal” study design and appropriate analytical tools to achieve this goal. The practical research framework for injury prevention in ice and snow sports refers to a series of steps or measures to prevent injuries during these activities. This framework is built upon an understanding of the context for implementing injury prevention and can provide an evidence base for the effective implementation of interventions, which is essential for advancing injury prevention in ice and snow sports. This task may be challenging and requires addressing many challenges; however, all these challenges are profoundly meaningful. With advances in traditional scientific and analytical methods in sports injury research, we are gradually moving towards a systematic paradigm to better understand the development and prevention of sports injuries [ 33 , 64 , 65 ]. Research on preventing injuries in ice and snow sports should include key information, regardless of the design, including the reasons for employing or not employing certain measures. Indeed, adopting an evidence-based framework for injury prevention in ice and snow sports can result in improved efficacy in real-world settings.

Risk identification

Before initiating any preventive measures, it is crucial to identify the risks and types of injuries that participants may encounter [ 32 ]. This includes understanding the characteristics of ice and snow sports, the conditions of ice and snow sports environments, the skill levels of the participants, and other factors that may lead to injuries.

Risk assessment

After identifying potential risks, the next step is to assess the severity and likelihood of these risks [ 31 , 32 ]. This can be done by analysing past injury data, the physical condition of the participants, and the condition of the equipment, among other factors.

Risk management

Based on the results of the risk assessment, measures that could reduce the risk or severity of sports injuries should be formulated [ 32 ]. While some characteristics, such as age, sex, or a history of injuries, have been shown to affect risk and recovery time, understanding these nonmodifiable risk factors is crucial for guiding interventions and strategies. This may include technical training, using appropriate protective gear, and improving the sports environment, among other measures.

Multicomponent interventions

Providing athletes, coaches, and stakeholders with the necessary education, engineering, enforcement, and encouragement measures will enhance their awareness [ 64 ]and ability to prevent injuries in ice and snow sports. This includes proper sports techniques, methods of using protective equipment, policy support and encouragement measures, and first aid measures in the event of an accident.

Implementation and execution

Evidence-based prevention strategies should be applied to reduce the risk of injuries [ 31 ]. Preventive measures should be implemented to ensure that all participants adhere to relevant safety guidelines and procedures.

Monitoring and evaluation

Specific methods should be developed for planning, analysing, and evaluating the effectiveness of intervention measures [ 31 , 32 , 64 ]. Regular monitoring and evaluation of the effects of preventive measures are critical for making necessary adjustments. This involves collecting and analysing data on the interventions, feedback, and participant satisfaction. This key step of the injury prevention process is very important yet challenging.

This evidence-based framework, through a systematic approach, aims to reduce the risk of injuries in ice and snow sports, ensuring the safety of participants. Implementing this framework requires the collective effort of all participants, including athletes, coaches, organizers, and stakeholders. Monitoring and evaluation are often overlooked. However, evaluating whether intervention measures have successfully reduced the risk of injuries is crucial. This typically means revisiting risk identification to reassess the extent of injuries [ 32 , 66 ]. Ideally, this evaluation process should be a continuous part of the risk identification process, not a completely separate step. Note that these steps do not have to be completed in sequence. Due to often limited resources, adaptation to real-world settings is necessary for the effective use of time and effort. Therefore, this research provides evidence-based strategies and interventions for reducing injury risks and promote health in participants of ice and snow sports.

Strengths and limitations

In the scholarly assessment of literature quality within our study, we adhered to the AMSTAR 2 criteria, a rigorous standard for evaluating research bias. According to this framework, a study is deemed to exhibit a low risk of bias if it fulfils at least 7 out of 7 critical items without major methodological shortcomings. Conversely, studies scoring below 5 or those with significant flaws are classified as having a high risk for bias. In our meta-analysis, only 7 studies were judged as low risk, with 4 rated as moderate risk, 3 as high risk, and 1 as very low risk. This categorization highlights the methodological diversity and potential issues of internal validity in the sampled studies.

Moreover, the issue of external validity is salient. The included studies encompassed a broad spectrum of participants across various age groups and skill levels, potentially limiting the extrapolation of our findings to elite athletic contexts. This limitation underscores the need for future empirical investigations in this area. Notably, the incorporation of case‒control and prospective cohort studies may have attenuated the overall robustness of the evidence. Our subgroup analyses, despite being meticulously conducted, involved variability in intervention approaches, study designs, and participant demographics. Our goal was to collect as much reliable evidence as possible for the prevention of injuries in ice and snow sports through researching practical preventive strategies. This endeavour entailed synthesizing a diverse corpus of data and confronting the inherent complexities of integrating various methodologies and participant cohorts. While this strategy yields an expansive understanding, it also necessitates a nuanced interpretation of the results, considering the varied degrees of bias and potential constraints in generalizing outcomes across different populations and sporting disciplines.

The dynamic and multifaceted nature of sports injury prevention mandates adaptability to real-world contexts and diverse frameworks [ 67 ]. Current research on ice and snow sports injury prevention predominantly addresses scenario-specific solutions, yet there is a burgeoning need to reinforce practical applications. Given the unique and evolving nature of implementation scenarios, strategies tailored to a singular context may not suffice. Future research should pivot towards elucidating the underpinnings of effective methods in dynamic scenarios and identifying key elements that enhance the impact of these interventions. With an emphasis on process-oriented approaches over singular solutions, the focus should be on the comprehensive efficacy of intervention programs and their implementation trajectories. A practical, scalable, and adaptable intervention program, when applied with creativity and flexibility, can provide a robust theoretical and practical foundation for designing and implementing context-specific strategies [ 68 ]. In addition to utilizing the pillars of the three “E”s for strategic interventions, other considerations of these efforts should also focus on the “fourth and fifth E”s, including encouragement, monitoring, and evaluation [ 64 ], to provide coaches, practitioners, and participants with valuable and relevant data in order to help them develop more effective prevention measures in practice. While our study primarily explored the efficacy of multifaceted intervention measures, future research should explore the intrinsic mechanisms and situational applicability of these interventions and concentrate on the intricacies of the injury prevention process. Such an approach will enable the customization of interventions to specific contexts, thereby enhancing their overall effectiveness and applicability.

This study included RCTs, case‒control studies and prospective cohort studies on the prevention of injuries in ice and snow sports. By synthesizing 27 data samples from 15 studies, various intervention measures were found to effectively reduce the injury risk among ice and snow sports participants by 50% (RR = 0.50, 95% CI 0.41–0.62). Multifaceted intervention measures reduced the risk by 48% (RR = 0.52, 95% CI 0.42–0.63), with education, including training, reducing the risk by 50% (RR = 0.50, 95% CI 0.34–0.73), educational videos reducing the risk by 47% (RR = 0.53, 95% CI 0.34–0.81); engineering, including protective equipment, reducing the risk by 36% (RR = 0.64, 95% CI 0.46–0.87), and enforcement, including policy and rule changes, reducing the risk by 72% (RR = 0.28, 95% CI 0.16–0.49). A decrease in injury risk contributes to reducing the subsequent economic costs and social cost‒benefit ratio of treatment.

Recognizing that sports injuries constitute a formidable impediment to the enthusiasm and well-being of participants in ice and snow sports and considering their substantial economic implications, our study’s findings are firmly rooted in evidence-based research. The prevalence of injuries in these sports settings can be effectively mitigated, at least partially, through strategic intervention measures such as comprehensive educational training programs. The proactive promotion and implementation of these evidence-based interventions stand to confer significant additional benefits. Thus, injuries in ice and snow sports can to some extent be prevented through implementation of the E principles, constituting a shift towards a systematic paradigm with greater benefits through vigorous promotion in practice. Therefore, it is essential to promote an evidence-based framework for research on injury prevention in ice and snow sports; participants in ice and snow sports will benefit from such easy-to-implement and cost-effective injury prevention frameworks. The future of these sports is inextricably linked to the development and adoption of interventions that are not only easy to implement but also cost-effective. Such injury prevention programs are crucial for safeguarding the health and fostering the continued participation of athletes, thereby ensuring the sustainable growth and vitality of these sporting disciplines. The integration of these measures into standard practice will not only enhance the safety and enjoyment of participants but also contribute to the overall economic efficiency of these sports by reducing the costs associated with sports-related injuries.

Data availability

Data is provided within the manuscript or supplementary information files.

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Fan, Z., Min, L., He, W. et al. Efficacy of multicomponent interventions on injury risk among ice and snow sports participants—a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 16 , 135 (2024). https://doi.org/10.1186/s13102-024-00921-6

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The state of AI in early 2024: Gen AI adoption spikes and starts to generate value

If 2023 was the year the world discovered generative AI (gen AI) , 2024 is the year organizations truly began using—and deriving business value from—this new technology. In the latest McKinsey Global Survey on AI, 65 percent of respondents report that their organizations are regularly using gen AI, nearly double the percentage from our previous survey just ten months ago. Respondents’ expectations for gen AI’s impact remain as high as they were last year , with three-quarters predicting that gen AI will lead to significant or disruptive change in their industries in the years ahead.

About the authors

This article is a collaborative effort by Alex Singla , Alexander Sukharevsky , Lareina Yee , and Michael Chui , with Bryce Hall , representing views from QuantumBlack, AI by McKinsey, and McKinsey Digital.

Organizations are already seeing material benefits from gen AI use, reporting both cost decreases and revenue jumps in the business units deploying the technology. The survey also provides insights into the kinds of risks presented by gen AI—most notably, inaccuracy—as well as the emerging practices of top performers to mitigate those challenges and capture value.

AI adoption surges

Interest in generative AI has also brightened the spotlight on a broader set of AI capabilities. For the past six years, AI adoption by respondents’ organizations has hovered at about 50 percent. This year, the survey finds that adoption has jumped to 72 percent (Exhibit 1). And the interest is truly global in scope. Our 2023 survey found that AI adoption did not reach 66 percent in any region; however, this year more than two-thirds of respondents in nearly every region say their organizations are using AI. 1 Organizations based in Central and South America are the exception, with 58 percent of respondents working for organizations based in Central and South America reporting AI adoption. Looking by industry, the biggest increase in adoption can be found in professional services. 2 Includes respondents working for organizations focused on human resources, legal services, management consulting, market research, R&D, tax preparation, and training.

Also, responses suggest that companies are now using AI in more parts of the business. Half of respondents say their organizations have adopted AI in two or more business functions, up from less than a third of respondents in 2023 (Exhibit 2).

Gen AI adoption is most common in the functions where it can create the most value

Most respondents now report that their organizations—and they as individuals—are using gen AI. Sixty-five percent of respondents say their organizations are regularly using gen AI in at least one business function, up from one-third last year. The average organization using gen AI is doing so in two functions, most often in marketing and sales and in product and service development—two functions in which previous research determined that gen AI adoption could generate the most value 3 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023. —as well as in IT (Exhibit 3). The biggest increase from 2023 is found in marketing and sales, where reported adoption has more than doubled. Yet across functions, only two use cases, both within marketing and sales, are reported by 15 percent or more of respondents.

Gen AI also is weaving its way into respondents’ personal lives. Compared with 2023, respondents are much more likely to be using gen AI at work and even more likely to be using gen AI both at work and in their personal lives (Exhibit 4). The survey finds upticks in gen AI use across all regions, with the largest increases in Asia–Pacific and Greater China. Respondents at the highest seniority levels, meanwhile, show larger jumps in the use of gen Al tools for work and outside of work compared with their midlevel-management peers. Looking at specific industries, respondents working in energy and materials and in professional services report the largest increase in gen AI use.

Investments in gen AI and analytical AI are beginning to create value

The latest survey also shows how different industries are budgeting for gen AI. Responses suggest that, in many industries, organizations are about equally as likely to be investing more than 5 percent of their digital budgets in gen AI as they are in nongenerative, analytical-AI solutions (Exhibit 5). Yet in most industries, larger shares of respondents report that their organizations spend more than 20 percent on analytical AI than on gen AI. Looking ahead, most respondents—67 percent—expect their organizations to invest more in AI over the next three years.

Where are those investments paying off? For the first time, our latest survey explored the value created by gen AI use by business function. The function in which the largest share of respondents report seeing cost decreases is human resources. Respondents most commonly report meaningful revenue increases (of more than 5 percent) in supply chain and inventory management (Exhibit 6). For analytical AI, respondents most often report seeing cost benefits in service operations—in line with what we found last year —as well as meaningful revenue increases from AI use in marketing and sales.

Inaccuracy: The most recognized and experienced risk of gen AI use

As businesses begin to see the benefits of gen AI, they’re also recognizing the diverse risks associated with the technology. These can range from data management risks such as data privacy, bias, or intellectual property (IP) infringement to model management risks, which tend to focus on inaccurate output or lack of explainability. A third big risk category is security and incorrect use.

Respondents to the latest survey are more likely than they were last year to say their organizations consider inaccuracy and IP infringement to be relevant to their use of gen AI, and about half continue to view cybersecurity as a risk (Exhibit 7).

Conversely, respondents are less likely than they were last year to say their organizations consider workforce and labor displacement to be relevant risks and are not increasing efforts to mitigate them.

In fact, inaccuracy— which can affect use cases across the gen AI value chain , ranging from customer journeys and summarization to coding and creative content—is the only risk that respondents are significantly more likely than last year to say their organizations are actively working to mitigate.

Some organizations have already experienced negative consequences from the use of gen AI, with 44 percent of respondents saying their organizations have experienced at least one consequence (Exhibit 8). Respondents most often report inaccuracy as a risk that has affected their organizations, followed by cybersecurity and explainability.

Our previous research has found that there are several elements of governance that can help in scaling gen AI use responsibly, yet few respondents report having these risk-related practices in place. 4 “ Implementing generative AI with speed and safety ,” McKinsey Quarterly , March 13, 2024. For example, just 18 percent say their organizations have an enterprise-wide council or board with the authority to make decisions involving responsible AI governance, and only one-third say gen AI risk awareness and risk mitigation controls are required skill sets for technical talent.

Bringing gen AI capabilities to bear

The latest survey also sought to understand how, and how quickly, organizations are deploying these new gen AI tools. We have found three archetypes for implementing gen AI solutions : takers use off-the-shelf, publicly available solutions; shapers customize those tools with proprietary data and systems; and makers develop their own foundation models from scratch. 5 “ Technology’s generational moment with generative AI: A CIO and CTO guide ,” McKinsey, July 11, 2023. Across most industries, the survey results suggest that organizations are finding off-the-shelf offerings applicable to their business needs—though many are pursuing opportunities to customize models or even develop their own (Exhibit 9). About half of reported gen AI uses within respondents’ business functions are utilizing off-the-shelf, publicly available models or tools, with little or no customization. Respondents in energy and materials, technology, and media and telecommunications are more likely to report significant customization or tuning of publicly available models or developing their own proprietary models to address specific business needs.

Respondents most often report that their organizations required one to four months from the start of a project to put gen AI into production, though the time it takes varies by business function (Exhibit 10). It also depends upon the approach for acquiring those capabilities. Not surprisingly, reported uses of highly customized or proprietary models are 1.5 times more likely than off-the-shelf, publicly available models to take five months or more to implement.

Gen AI high performers are excelling despite facing challenges

Gen AI is a new technology, and organizations are still early in the journey of pursuing its opportunities and scaling it across functions. So it’s little surprise that only a small subset of respondents (46 out of 876) report that a meaningful share of their organizations’ EBIT can be attributed to their deployment of gen AI. Still, these gen AI leaders are worth examining closely. These, after all, are the early movers, who already attribute more than 10 percent of their organizations’ EBIT to their use of gen AI. Forty-two percent of these high performers say more than 20 percent of their EBIT is attributable to their use of nongenerative, analytical AI, and they span industries and regions—though most are at organizations with less than $1 billion in annual revenue. The AI-related practices at these organizations can offer guidance to those looking to create value from gen AI adoption at their own organizations.

To start, gen AI high performers are using gen AI in more business functions—an average of three functions, while others average two. They, like other organizations, are most likely to use gen AI in marketing and sales and product or service development, but they’re much more likely than others to use gen AI solutions in risk, legal, and compliance; in strategy and corporate finance; and in supply chain and inventory management. They’re more than three times as likely as others to be using gen AI in activities ranging from processing of accounting documents and risk assessment to R&D testing and pricing and promotions. While, overall, about half of reported gen AI applications within business functions are utilizing publicly available models or tools, gen AI high performers are less likely to use those off-the-shelf options than to either implement significantly customized versions of those tools or to develop their own proprietary foundation models.

What else are these high performers doing differently? For one thing, they are paying more attention to gen-AI-related risks. Perhaps because they are further along on their journeys, they are more likely than others to say their organizations have experienced every negative consequence from gen AI we asked about, from cybersecurity and personal privacy to explainability and IP infringement. Given that, they are more likely than others to report that their organizations consider those risks, as well as regulatory compliance, environmental impacts, and political stability, to be relevant to their gen AI use, and they say they take steps to mitigate more risks than others do.

Gen AI high performers are also much more likely to say their organizations follow a set of risk-related best practices (Exhibit 11). For example, they are nearly twice as likely as others to involve the legal function and embed risk reviews early on in the development of gen AI solutions—that is, to “ shift left .” They’re also much more likely than others to employ a wide range of other best practices, from strategy-related practices to those related to scaling.

In addition to experiencing the risks of gen AI adoption, high performers have encountered other challenges that can serve as warnings to others (Exhibit 12). Seventy percent say they have experienced difficulties with data, including defining processes for data governance, developing the ability to quickly integrate data into AI models, and an insufficient amount of training data, highlighting the essential role that data play in capturing value. High performers are also more likely than others to report experiencing challenges with their operating models, such as implementing agile ways of working and effective sprint performance management.

About the research

The online survey was in the field from February 22 to March 5, 2024, and garnered responses from 1,363 participants representing the full range of regions, industries, company sizes, functional specialties, and tenures. Of those respondents, 981 said their organizations had adopted AI in at least one business function, and 878 said their organizations were regularly using gen AI in at least one function. To adjust for differences in response rates, the data are weighted by the contribution of each respondent’s nation to global GDP.

Alex Singla and Alexander Sukharevsky are global coleaders of QuantumBlack, AI by McKinsey, and senior partners in McKinsey’s Chicago and London offices, respectively; Lareina Yee is a senior partner in the Bay Area office, where Michael Chui , a McKinsey Global Institute partner, is a partner; and Bryce Hall is an associate partner in the Washington, DC, office.

They wish to thank Kaitlin Noe, Larry Kanter, Mallika Jhamb, and Shinjini Srivastava for their contributions to this work.

This article was edited by Heather Hanselman, a senior editor in McKinsey’s Atlanta office.

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This paper is in the following e-collection/theme issue:

Published on 18.6.2024 in Vol 26 (2024)

Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review

Authors of this article:

Cécilia Palmier 1, 2 * , MSc ;
Anne-Sophie Rigaud 1, 2 * , Prof Dr Med ;
Toshimi Ogawa 3 , PhD ;
Rainer Wieching 4 , Prof Dr ;
Sébastien Dacunha 1, 2 * , MSc ;
Federico Barbarossa 5 , MEng ;
Vera Stara 5 , PhD ;
Roberta Bevilacqua 5 , MSc ;
Maribel Pino 1, 2 * , PhD

1 Maladie d’Alzheimer, Université de Paris, Paris, France

2 Service de Gériatrie 1 & 2, Hôpital Broca, Assistance Publique - Hôpitaux de Paris, Paris, France

3 Smart-Aging Research Center, Tohoku University, Sendai, Japan

4 Institute for New Media & Information Systems, University of Siegen, Siegen, Germany

5 Scientific Direction, Istituto Nazionale di Ricovero e Cura per Anziani, Ancona, Italy

*these authors contributed equally

Corresponding Author:

Anne-Sophie Rigaud, Prof Dr Med

Service de Gériatrie 1 & 2

Hôpital Broca

Assistance Publique - Hôpitaux de Paris

54 rue Pascal

Paris, 75013

Phone: 33 144083503

Fax:33 144083510

Email: [email protected]

Background: Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent.

Objective: The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults.

Methods: We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation.

Results: In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users’ personal data.

Conclusions: Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals’ quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects.

Introduction

Challenges associated to population aging.

Technological and medical advances have led to a demographic shift in the population, with the number of older adults constantly increasing. According to the United Nations [ 1 ], older adults (aged 60-65 years) will represent 16% of the world’s population in 2050. In addition, life expectancy is increasing, from 64.2 years in 1990 to 72.6 years in 2019, and is expected to reach 77.1 years in 2050 [ 1 ]. However, there is a wide diversity of health conditions among older adults. The health status of older adults is dependent on multiple factors, including nonmodifiable genetic factors and environmental factors, such as lifestyle [ 2 ]. Thus, older adults represent a very heterogeneous population with multiple and diverse needs and desires. With advancing age, the loss of functional independence; frailty; and other health diseases such as cardiovascular problems, cancers, osteoarthritis, osteoporosis, or major neurocognitive disorders may appear [ 3 - 5 ]. Among age-related conditions, major neurocognitive disorders (eg, Alzheimer disease) receive particular attention due to the increasing prevalence of these diseases [ 6 ].

The aging population is not only a public health issue but also a socioeconomic one. To face this challenge, it is important to develop preventive measures to support active and healthy aging and to preserve the independent functioning and quality of life of older adults. The adoption of healthy behaviors can help prevent or delay the onset of pathologies or treat them if detected early [ 7 ].

The Use of Technologies for Older Adults

Preventive health measures can be supported through new technologies, such as robotic coaching solutions (RCSs) that promote healthy aging among older adults [ 8 , 9 ]. RCSs have been defined as personalized systems that continuously monitor the activities and environment of the user and provide them with timely health-related advice and interventions [ 10 - 12 ]. These systems can help users define and achieve different health-oriented goals [ 12 ].

RCSs may encompass artificial intelligence (AI) technologies that can analyze user data, personalize coaching programs, and adapt recommendations based on each individual’s needs [ 1 , 13 - 19 ]. RCSs can involve robots equipped with sensors such as cameras, microphones, or motion sensors to collect real-time data about the user, AI, and programming that enables their interaction with users [ 20 , 21 ]. These technologies are often equipped with voice and visual recognition and learning capabilities [ 20 , 21 ]. They can benefit from advanced natural language processing techniques, which allow for understanding of the user’s input, facilitating natural and effective communication [ 22 ]. RCSs can offer guidance, support, and feedback based on preprogrammed information or real-time data analysis. These data can inform coaching strategies and allow RCSs to provide users with relevant feedback [ 8 ].

RCSs can also encompass a virtual agent, which refers to a computer program or an AI system that interacts with users in a manner that simulates human conversation [ 14 , 18 , 23 ]. A virtual agent is an animated character capable of adopting a social behavior mimicking that of humans to encourage the users to make changes in their habits [ 14 ]. Virtual agents might take the form of a chatbot, voice assistant, or other AI-driven communication system [ 14 ]. Biometric monitoring devices to track physiological data such as heart rate, sleep patterns, or stress levels can also be included in RCSs [ 8 , 20 , 21 ]. These data can contribute to the configuration of personalized coaching plans. RCSs can also encompass advanced data analytics that can process large data sets generated by users’ interactions and behaviors. This functionality helps in identifying patterns, trends, and areas for improvement in coaching strategies [ 24 ]. Integrating Internet-of-Things devices in RCSs can provide additional data points about a user’s environment, lifestyle, or habits, thus contributing to a personalized coaching approach [ 25 ].

Health-oriented RCSs could enable users to lead a healthy lifestyle, by identifying needs and goals and providing appropriate risk predictions and individualized recommendations [ 12 , 26 - 28 ]. There are RCSs dedicated to a particular domain, such as physical activity or motor rehabilitation [ 9 , 16 ]. Others may have the objective of promoting independent and healthy aging [ 29 ].

Promoting active and healthy aging can allow older adults to maintain their independence and continue to live at home [ 4 , 30 ], which is a wish of many [ 3 ]. This intervention could also help to reduce the need for assistance, usually provided by informal caregivers and health professionals [ 4 , 19 , 30 - 33 ]. Furthermore, RCSs could lead to a reduction in individual and collective health care expenses [ 4 , 32 , 34 ] by easing access to health and social care interventions to a wide population, including hard-to-reach (eg, geographically isolated) individuals. However, although the use of health-related RCSs could have many benefits, several ethical issues arise with their development and implementation in human environments [ 3 , 35 - 38 ].

An Ethical Framework for the Use of Technologies for Older Adults

For RCSs to contribute to active and healthy aging, it is important that all the stakeholders (engineers, geriatricians, psychologists, etc) involved in their design and implementation refer to an ethical framework [ 3 , 38 ]. It is also important to inform society (politicians and legal experts) about such an extension of technology in people’s lives (private, professional, medicosocial, and commercial context), so that we can create a legal framework for the use of these technologies. An analysis of the way in which ethical and legal dimensions have been addressed by studies, in the field of RCSs for health care, seems useful to support the key actors in their development and implementation. The growing interest in the ethical questions associated with the use of social and assistive robots is evidenced by the volume of literature reviews [ 3 , 12 , 18 , 31 , 32 , 37 , 39 - 51 ] on the topic.

Now, it appears appropriate to systematically examine this body of work, focusing on the ethical analysis, and provide an overview of the literature. Therefore, we performed a review of the literature on RCSs for older adults using the European Network of Health Technology Assessment (EUnetHTA Core Model; version 3.0) model [ 52 ] for analysis. This Health Technology Assessment (HTA) model makes it possible to assess the intended and unintended consequences of the use of a specific technology regarding multiple domains (eg, technological, ethical, clinical, and organizational), providing methods and concepts for this analysis [ 53 ]. Therefore, HTA is a process that informs decision-making about the introduction of new technologies such as RCSs in health care. It also seems necessary to issue guidelines for the development and implementation of health-oriented RCSs [ 54 ].

The objective of this study was to highlight the main ethical questions and corresponding recommendations linked to the use of RCSs for older adults for engineers, researchers, and health professionals in this field. For this purpose, we conducted a narrative literature review using the ethical dimension of the EUnetHTA Core Model to guide the analysis. To the best of our knowledge, such a study has not been conducted so far.

A thematic analysis of the literature was performed to identify publications that describe RCSs for supporting older adults in health care and prevention and those that address ethical issues and recommendations regarding their development and implementation. The methodology used for the narrative review was inspired by the study by Green et al [ 55 ].

Inclusion and Exclusion Criteria

The review encompassed papers focusing on all populations, with particular attention to older adults. It focused on the concept of RCSs for health, while also incorporating publications discussing other health technologies for older adults if the authors have delved into relevant ethical considerations for their development or implementation.

The context of the review revolved around the use of RCSs (or related technologies), especially for older adults, across diverse living environments such as homes, hospitals, and nursing homes. Publications addressing RCSs and related ethical issues within the health care domain were considered, whereas those focusing solely on technical aspects (eg, AI and deep learning) or those outside the health care domain were excluded.

Various types of publications, including theoretical papers, research studies, and reviews, were included if they offered ethical reflections or recommendations for RCS use in health care. These reflections and recommendations were expected to align with the topics and issues of the ethical dimension of the EUnetHTA Core Model.

All publications, regardless of language (English or French), were eligible if published after 2011. This time frame was chosen considering the technological advancements over the past decade, which may have influenced the evolution of ethical issues and recommendations in the field of remote care systems and related technologies. Textbox 1 summarizes the inclusion and exclusion criteria adopted for the selection of papers in this review.

Inclusion criteria

Types of participants: all populations
Interventions or phenomena of interest: RCSs or other technologies used in health care, if ethical issues are discussed
Context: the use of RCSs in the health care sector
Paper type: all paper types (theoretical papers, research studies, and reviews) that discuss ethical issues
Language: English or French
Date of publication: after 2011

Exclusion criteria

Types of participants: not applicable
Interventions or phenomena of interest: RCSs or all other types of technology outside the health care sector
Context: the use of RCSs in non–health care sectors
Paper type: papers about RCSs and other technologies that are not dealing with ethical issues
Language: all other languages
Date of publication: before 2011

Search Strategy and Study Selection

The review was conducted using the following keywords: “seniors,” “older adults,” “social robots,” “assistive robots,” “assistive technology,” “robots,” “virtual coach,” “e-coaching,” “coaching system,” “coaching device,” “ethics,” and “recommendations.”

The review was performed between August 2021 and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases.

This search allowed us to find 4928 initial publications. Then, secondary research using references from other articles and the same inclusion criteria was conducted. This search allowed us to find 13 additional papers.

In total, 4943 papers were analyzed. The selection of the final publications was performed after reading the title and abstract first and, then, the full article. This selection process helped us to exclude irrelevant papers and duplicates ( Figure 1 ). In total, 0.51% (25/4943) of the papers were included in our review.

Data Analysis Criteria

The selected papers were analyzed using the ethical domain of the EUnetHTA Core Model [ 52 ]. Proper registration of the use of EUnetHTA Core Model for the purpose of this review was made on the HTA Core Model website [ 52 ].

The model was developed for the production and sharing of HTA information, allowing for the support of evidence-based decision-making in health care, but it can also be customized to other research needs. The EUnetHTA Core Model is composed of 9 domains, each including several topics. Each topic also includes different issues (ie, questions that should be considered for the evaluation of health technologies). Thus, the model is structured into 3 levels: domain (level 1), topic (level 2), and issue (level 3). The combination of a domain, topic, and issue is linked to an assessment element ID, which can be identiﬁed using a speciﬁc code for standardization purposes (B0001, B0002, etc).

The main EUnetHTA model domains include the following: (1) health and current use of the technology, (2) description and technical characteristics of the technology, (3) safety, (4) clinical effectiveness, (5) costs and economic evaluation, (6) ethical aspects, (7) organizational aspects, (8) patient and social aspects, and (9) legal aspects.

The ethical domain (level 1) in the EUnetHTA Core Model [ 52 ] includes 5 topics (level 2): “benefit-harm balance,” “autonomy,” “respect for people,” “justice and equity,” and “legislation.” Each of these topics includes several issues (level 3) [ 52 ].

In this study, 2 authors (CP and ASR) independently analyzed the 25 selected articles. First, they read the articles several times to improve familiarity with the ideas addressing the ethical aspects of RCSs. Then, in each publication (methods, results, and discussion sections), they identified segments of data that were relevant or captured an idea linked to the “ethical” domain of the model. A subsequent exploration of the coded data (sentences or set of statements) was performed to get a more precise classification at the topic level (level 2) and at the issue level (level 3). Then, the coding was performed using the HTA nomenclature. The 2 experts (CP and ASR) compared their results. In a few cases, the coding results showed a lack of consensus between the 2 coding authors, which was resolved through a subsequent discussion between them. Interrater correlation was not calculated.

A thematic analysis using the EUnetHTA framework for conducting a literature review has been described in other studies [ 56 , 57 ]. Furthermore, the use of EUnetHTA to perform an ethical analysis of health technologies has already been proposed [ 58 ]. The 25 selected articles were all coded using this methodology. Some authors have previously emphasized the possibility of overlapping issues between topics in the HTA analysis. They have suggested to assess the overlapping issues in the most relevant topic section [ 59 ].

This review was not registered, and a protocol for the review was not prepared.

Selected articles are presented in Multimedia Appendix 1 [ 3 , 12 , 18 , 31 , 32 , 37 - 51 , 60 - 64 ]. For each topic, we have presented our findings in terms of questions and recommendations according to the EUnetHTA Core Model, wherever possible.

Ethical Issues and Recommendations for the Use of New Technologies

This section aims to summarize the ethical analysis performed regarding the use of RCSs with older adults and to provide recommendations for ethical use of these devices. Table 1 presents a synthetic summary of the elements presented in this section.

Topic and ethical issues (European Network of Health Technology Assessment Core Model)		Ethical concerns	Recommendations

	What are the known and estimated benefits and harms for patients when implementing or not implementing the technology?
	What are the benefits and harms of the technology for relatives, other patients, organizations, commercial entities, society, etc?
	Are there any unintended consequences of the technology and its application for patients?

	Is the technology used for individuals who are especially vulnerable?
	Does the implementation or use of the technology affect the patient’s capability and possibility to exercise autonomy?

	Does the implementation or use of the technology affect human dignity?
	Does the technology invade the sphere of privacy of the patient or user?

	How does implementation or withdrawal of the technology affect the distribution of health care resources?
	How are technologies with similar ethical issues treated in the health care system?

	Can the use of the technology pose ethical challenges that have not been considered in the existing legislations and regulations?

Topic 1: Benefit-Harm Balance

RCSs should be developed according to the principles of beneficence (ie, to promote the interest of users) and nonmaleficence (ie, to avoid inflicting harm) [ 39 , 60 , 64 ].

What Are the Known and Estimated Benefits and Harms for Patients When Implementing or Not Implementing the Technology?

Risk of social isolation.

According to Sharkey and Sharkey [ 50 ], technological devices, when used appropriately, could benefit older adults by promoting social interaction and connection with their loved ones [ 4 , 31 , 40 ]. Broadbent et al [ 19 ] have discussed the potential of robots to reduce older adults’ social isolation. However, other authors reported the negative influence of the use of robotic devices on human contact [ 31 , 32 , 65 ]. The use of robots (eg, telepresence robots) to make some cost savings (eg, reducing travel costs and time spent on trips for family and professionals to visit older adults) would reduce face-to-face interactions [ 3 , 36 , 39 , 40 ]. Moreover, according to Körtner [ 47 ], the more people become accustomed to communicating with robots, the less they will be used to communicating with humans. The use of social robots could lead to a reduction of interactions with humans and thus to social isolation and emotional dependence [ 39 ]. However, the influence of technological devices, such as RCSs, on social isolation is still under debate, and the impact of technology would depend on the manner in which it is used.

To avoid exacerbating the users’ social isolation, Portacolone et al [ 38 ] advocate that social robots and similar technologies should be designed with the objective of fostering interactions with other humans, for instance, keeping users informed about the entertainment and socializing activities near their home, connecting them with their loved ones, and so on.

Risk of Deception

Another major risk for users is deception [ 39 , 64 , 66 ]. Portacolone et al [ 38 ] described 3 types of deception that people with neurocognitive disorders may face when interacting with social robotic systems but which may also apply to all users. The first type involves the user’s misconception of what is driving the technological device [ 51 ]. Users may be misled if they think that behind a medical chatbot, there is a real physician who communicates and reads their messages [ 44 ] or, alternatively, if they are not aware that, at some point, there are real humans guiding the technological device [ 38 ]. The second type refers to robotic devices programmed to express feelings or other types of affective communication, which may lead the user to believe that the system’s emotions are authentic. Related to this issue, Körtner [ 47 ] discussed how some older adults may fear that their social robot will forget them during their absence from home. The resemblance with the living in terms of affective behavior (eg, crying, laughing, or expressing concern) can make the user believe that there is a reciprocity between human and robot feelings [ 43 ]. The last type of deception is related to the inadequate interpretations that older adults may have regarding the nature of the robot, for example, thinking that an animal-shaped robot is a real animal or a pet [ 38 ]. Some current developments of social robots tend to make them resemble a living being, in terms of their verbal and nonverbal behaviors [ 34 , 60 ] or by highly anthropomorphizing their design [ 47 ], which may blur the boundary between the real and the artificial [ 45 , 60 ]. These design choices can also impact users’ dignity by infantilizing them as they are led to believe in something that is false [ 50 ].

However, according to some researchers [ 51 , 63 , 64 ], the notion of deception should be considered in terms of the gradation between what is morally acceptable and what is not. Deception would be morally acceptable when it aims to improve a person’s health or quality of life, for example, the use companion robots to calm a person experiencing behavioral disorders linked to dementia [ 51 ].

According to Danaher [ 43 ] and Vandemeulebroucke et al [ 40 ], to avoid deception, it is essential to be transparent to users about the design and operation of devices. As the information given to the participants is the basis for obtaining consent to use the technology, it is essential to offer them documents explaining how the device is built and its advantages and limitations in a clear manner adapted to the user’s knowledge and experience. It is also important to inform users on how to behave with technology [ 12 ]. Researchers should also answer users’ questions, pay attention to their feedback, and use it to improve the device and its documentation [ 60 ]. During experiments with RCSs, it is also important that researchers regularly remind participants of the nature of the technological device to reduce the risk of misinterpretation and to ensure that they still consent to participate in the study [ 38 ].

Biases of Algorithms

An autonomous device does not work without AI or algorithms that allow it to make decisions. However, these technologies are created by humans, and programming biases can be incorporated into them and lead to failures [ 44 ]. A technological device can, for instance, misread a situation and react accordingly, leading to a safety risk for the user [ 18 ]. Thus, it is essential that the researcher scrutinizes the algorithms used in RCSs before their implementation [ 44 ]. Fiske et al [ 44 ] also suggest providing the users with detailed explanations about the algorithms present in the technological device they are using.

What Are the Benefits and Harms of the Technology for Relatives, Other Patients, Organizations, Commercial Entities, Society, Etc?

At the society level, Boada et al [ 39 ] mentioned an ethical consideration related to the ecological impact of robotic devices in the current context of climate crisis and the lack of natural resources. The construction of RCSs requires raw materials, high energy consumption, and the management of their waste. Therefore, it is important for developers to design technologies that consume less energy and can be recycled.

Are There Any Unintended Consequences of the Technology and Its Application for Patients?

Technologies evolving very quickly.

For some older adults, technologies evolve very quickly, which makes it difficult for them to keep up with [ 62 ]. Denning et al [ 67 ] encourage designers to develop products that are intuitive to use or to offer users a simplified training. However, although some technologies are progressing quickly, technological limitations are still present, especially regarding social robotic systems, impacting their performance [ 68 ] and generating frustration among some users [ 69 ].

Unsuitability of Technology

The lack of experience with the technologies and the fact that the systems are not suitable to everyone can reduce the usability and acceptability of RCSs among older adults [ 3 , 60 , 62 ]. Frennert and Östlund [ 62 ] highlighted that some older adults were not confident in their ability to handle a robot because of previous complicated experience with technology. Peek et al [ 70 ] also reported that users had doubts about their ability to use the technology and feared that they would easily forget how to use it. They may also fear false alarms generated by monitoring technologies. For example, a person may decide to sit on the floor, but this behavior can be considered as a fall by the technology, and it could call for an ambulance to be sent to the person’s home in vain [ 70 ].

To promote acceptability and usability of RCSs, it is essential to develop them considering the capabilities, needs, and wishes of various users [ 31 , 47 ]. “User-centered design” approaches should be used for this purpose [ 71 ]. This methodology must be performed in a continuous manner to consider the development, new preferences, and experiences of the users. Technology assessment should also be conducted before deployment in ecological environments to improve the predictability of RCSs and decrease the risk of confusion and accidents [ 40 , 47 ].

Topic 2: Autonomy

According to Anderson and Kamphorst [ 42 ], the notion of autonomy implies the recognition of people, for instance, users of RCSs, as thinking individuals who have their own perspective on matters and are able to judge what is best for them.

Is the Technology Used for Individuals Who Are Especially Vulnerable?

Free and informed consent is a prerequisite for the involvement of an individual in research, regardless of the domain. This aspect is mentioned in numerous codes and declarations such as the Declaration of Helsinki (1964-2008) [ 72 ]. In the context of studies of the use of RCSs, this principle ensures that the person has freely chosen to use a device. However, some older adults, particularly those with cognitive disorders, may have difficulties in understanding and evaluating information related to RCSs and therefore in making appropriate choices [ 3 ]. Moreover, the person may not remember that the RCS is in their environment or how it works [ 38 , 44 ]. The question of how to ensure that the older adult has understood the purpose of RCS and that their choice of using the technology is based solely on their own decision and not that of a relative, caregiver, or institution has also been discussed [ 46 ].

Researchers in the field of RCS should adapt to the cognitive abilities of the populations they work with to facilitate communication and decision-making [ 46 ]. Thus, the observation of the person’s behavior is necessary to identify potential reservations regarding the use of RCSs. When the person is very vulnerable to respond, informed consent could be sought by proxy such as from children, spouse, or partner [ 46 , 64 ]. However, according to Diaz-Orueta et al [ 37 ], the final decision of using RCSs lies with the user. To prevent loss of capacity and to guard against any risk of inducement to participate, advance directives [ 46 , 64 ] or implementation of an advance power of attorney [ 46 ] can be proposed.

Does the Implementation or Use of the Technology Affect the Patient’s Capability and Possibility to Exercise Autonomy?

Dependence on the technology.

Although the main interest of RCSs for older adults is the maintenance of functional independence, it has been claimed that these devices could make people dependent on them. By replacing users in tasks that they can still perform, the use of RCSs could create new forms of vulnerability [ 3 , 31 , 39 , 41 , 51 ].

People could rely entirely on autonomous technological devices, such as RCSs, to guide their behaviors, goals, and actions [ 12 , 73 ]. A questioning of the authenticity of users’ actions has been mentioned by Anderson and Kamphorst [ 42 ]. Users might not feel responsible for the success of their actions if they feel they are completely driven by the guidance of the RCS. People could also develop emotional and psychological feelings toward the technology. This may have negative consequences for the individuals [ 38 , 49 ] and lead to new vulnerabilities [ 39 ].

Loss of Freedom

Another ethical issue relates to the conflict between the user’s safety, encouraged by the technology guidance, and a loss of freedom. The RCS could impose constraints on the user under the pretext that the user’s actions are not good for them [ 39 , 40 , 74 ]. Sharkey and Sharkey [ 50 ] explained that to promote home care, RCS could act as a supervisor (ie, programmed to ensure that no danger is present and, if there is a danger, to implement procedures to stop it and avoid it in the future). For instance, the RCS could prevent the person from eating fatty and high-caloric food because it is harmful to them. To protect users and ensure that they live in good health, individuals using RCSs could end up being deprived of certain actions or being under some type of “house arrest” [ 50 ].

One of the goals of using such RCSs is to support older adults’ independence; therefore, it is essential that developers and researchers in the field take measures to preserve the person’s autonomy [ 75 ]. Furthermore, RCS users must have the opportunity to evaluate and re-evaluate the role given to the device, to assess whether the system is reliable and whether it is serving their interests [ 12 , 42 ].

Creating a New Source of Authority

The use of RCSs could alter human relationships, for example, by creating tensions between older adults and their informal caregivers. Their use could also create some tensions with health care professionals by creating a new source of authority [ 12 ]. Monitoring older adults through RCSs can generate anger in the user, for example, when the device insists that the older adult should take a medication that they do not want to take [ 41 , 75 ].

Topic 3: Respect for Persons

Does the implementation or use of the technology affect human dignity.

Human dignity may be affected by the use of RCSs as these technologies may be perceived as “problem evocators” [ 41 ]. Some RCSs are used to compensate for impaired capacities. However, according to Körtner [ 47 ], their use can make older adults aware of their limitations and lead to negative feelings, anxiety, or exhaustion. RCS use can also lead to a form of stigmatization by making one’s own inabilities visible to others [ 3 , 70 ]. It is important to have positive communication regarding RCSs, to provide a less stigmatizing view of their use.

Does the Technology Invade the Sphere of Privacy of the Patient or User?

To continue living at home, users are increasingly willing to tolerate intrusion in their privacy [ 70 ], but they are not always aware of when and how they are being monitored by RCSs [ 61 ]. Portacolone et al [ 38 ] provided the example of an animal-shaped companion robot, for which the older adults can signal that they no longer wish to interact with it by putting the robot to sleep. However, the animal-shaped robot can record data even when it is sleeping, but users are not always aware of this information. Forgetfulness and the lack of understanding of the device can lead to the risk of manipulation and coercion [ 44 ]. The person who is vulnerable may forget that they are being monitored and reveal personal information [ 50 ].

Technological devices, such as RCSs, must remain under the control of the users [ 47 ]. Users should have the ability to define when and where the device is used—when it collects data—to maintain their privacy, especially in intimate or private care settings.

Security of Data

According to Portacolone et al [ 38 ], remote monitoring technologies are usually controlled by third parties, sometimes even operating in another country, which can lead to cultural biases during the interaction between the older adult and the RCS. This context involves the risk that the person controlling the device (third party) takes advantage of the older adult’s vulnerability to steal their personal information or exposes the user to financial abuse [ 38 ]. Older adults are not always aware or vigilant about the sharing and use of data, which may be personal and sensitive [ 73 ]. Furthermore, RCSs can be connected to internet services that collect, store, and transfer these sensitive data [ 47 ] for commercial use [ 49 , 61 ].

In addition, the use of technologies connected to digital networks involves the risk of hacking and unauthorized surveillance [ 34 , 51 ], which can make people vulnerable [ 62 ]. Denning et al [ 67 ] found that home robots could not only be remotely located and identified but also hacked and controlled. First, users may have either preconceived and erroneous ideas about the capabilities of the device or a lack of knowledge to evaluate the safety, especially regarding data protection [ 3 ]. Second, users do not always configure their technological device correctly or update them [ 67 ].

Encryption or security systems must be put in place to protect users’ personal data captured by the devices at every stage: during collection, storage, transmission, and processing [ 3 ]. Researchers must also give particular attention to data security. In Europe, for instance, researchers and technology providers are required to comply with the General Data Protection Regulation [ 40 , 76 ]. Data collection must be performed legally or approved by the local relevant ethical committees.

To address data security challenges, 3 principles are recommended by Ienca et al [ 46 ] when developing technological devices: transparency, legitimate purpose, and proportionality. Transparency refers to the fact that the user knows that the system is collecting data and has consented to it. The user must also have precise information about when and what type of data are recorded and who has access to them [ 47 ]. Legitimate purpose refers to the notion that the monitoring and collection of data is performed for a specific purpose, (ie, in the best interest of the user or, if applicable, a relative who has consented to it). Finally, the principle of proportionality refers to the fact that the data collected are not disproportionate to the user’s needs.

Topic 4: Justice and Equity

The consequences of the technology implementation on the distribution of health care resources was discussed in the literature.

How Does Implementation or Withdrawal of the Technology Affect the Distribution of Health Care Resources?

Societal pressure.

Socioeconomic issues are also linked to the development and use of RCSs can also be raised. Individual freedom may be hindered by the “incentive” of certain stakeholders or authorities to enforce the use of RCSs [ 37 ]. The use of RCSs and similar systems may also lead to a lesser involvement of relatives, caregivers, and institutions that provide care to older adults and to the reduction of care costs; these perceived economic benefits may pressurize older adults to consent to use these devices [ 40 , 46 ]. It is also possible that older adults may have to agree to use the technological device to receive other health care benefits (eg, aids and subsidies) [ 42 ].

Digital Divide

Different opportunities to access RCSs can result in digital divide, defined by the Organisation for Economic Cooperation and Development [ 77 ] as a gap between those who have access to information and communication technologies and those who do not. This difference can create educational, economic, social, and even health-related disparities among citizens. Some citizens would be able to use these devices and, therefore, could benefit from their advantages, whereas others will not be able to use them and will not enjoy their benefits. The use of technologies in the health care context, through public or private institutions, should be subject to previous authorization by independent ethical committees to ensure that the use of these devices will not harm users in any way.

Inequalities in Resources

Questions about justice, equity, and equality among all citizens also arise [ 12 , 40 , 46 ]. RCSs have relatively high costs [ 64 ] and can generate additional expenses such as an internet subscription [ 3 ] that only a part of the population can afford, and this may be owing to the lack of research allowing to measure the cost-to-benefit ratio of these technologies on health [ 32 ]. It is important to ensure the access to RCSs among different living areas (ie, urban and rural). Therefore, involving municipalities and neighborhood associations seems an interesting way of raising awareness about the opportunities offered by RCSs for older adults and reaching a wider range of people.

To promote justice, equity, and fair distribution, Ienca et al [ 46 ] and Wangmo et al [ 64 ] recommend reducing the development costs of RCSs by promoting an open dissemination of source codes. In addition, RCSs should be distributed in priority to those in greatest need; therefore, measures to ensure access to RCSs under fair conditions should be established [ 51 ]. Joachim [ 78 ] also suggests to cover some of the costs of these health care–oriented technologies through health insurance.

Recommendations have been published by researchers to improve equality of access to technologies, such as using open-source software, providing priority access for individuals with low income, or relying on certain collective financing systems such as retirement or health insurance [ 46 , 51 , 78 ]. Discussions must be conducted among developers, legislators, and private and public organizations to identify viable financing solutions that allow for fair distribution of RCSs.

Replacement of Professionals

Researchers have also reported fears expressed by older adults and caregivers about how the use of technological devices could eliminate care-related jobs or replace humans [ 17 , 34 , 48 , 61 ]. There are also concerns about the use of these technological tools to reduce health care costs by decreasing the number of available health care resources and services, thereby exacerbating social inequalities [ 44 ]. The introduction of health-oriented RCSs requires adapting the contexts of care practices, which may threaten their quality [ 39 ]. Their incorporation into the care work environment can be difficult because the devices are automated and some care situations are unpredictable [ 17 , 62 ]. Furthermore, the gestion of certain tasks by technological devices requires a restructuring of the roles and responsibilities of caregivers [ 39 ]. Fiske et al [ 44 ] highlight that there are currently no recommendations or training to enable health care professionals to adopt RCSs, even though these professionals are increasingly confronted with technological devices in their practice.

The incorporation of RCSs must always be accompanied by a discussion with concerned care professionals regarding the advantages and limits of the technology. Professionals must also be supported in the use of these devices through effective training. Structured training and supervision will contribute to the development of a controlled framework of practice around the use of RCSs and thus avoid potential abuse [ 44 ]. Moreover, to encourage their use among professionals, it is essential to clearly define the role of RCSs as an additional resource for professionals and not a replacement of human care services [ 44 ].

Topic 5: Legislation

The ethical challenges linked to the lack of existing legislations and regulations dedicated to the use of the technology were discussed in the literature.

Can the Use of the Technology Pose Ethical Challenges That Have Not Been Considered in the Existing Legislations and Regulations?

Safety of devices.

The use of RCSs by older adults can result in damage and harm to their environment [ 79 ], especially when the device is still at the prototype stage [ 47 ]. Safety risks linked to the use of RCSs (eg, malfunctioning of the technology and incorrect decisions made by the coaching system) arise when they share a common space with humans and interact with them [ 39 ]. The following questions must be considered: Who is responsible in case of an accident, and who pays for the damages [ 39 , 40 , 48 , 62 , 80 ]? Is it the designer, the device, or the user himself? Currently, the civil code favors the cascade system (ie, first, the liability falls on the designer of the product; then, on the developer; and finally, on the user who has not followed the rules of use) [ 74 ]. However, the more the machine becomes autonomous, the less the existing legal frameworks can answer these questions [ 80 ]. This is a key legal issue regarding the implementation of RCSs in real settings because the person responsible for damage to the user or the environment may incur legal or even penal proceedings.

Damage and prejudice can also be caused by a failure to share authority [ 45 , 49 , 60 ]. Who between the human and the technological device holds the power to make decisions and control a functionality [ 81 ]? According to Grinbaum et al [ 45 ], it is important to specify the circumstances in which the human must take control over the technological device (RCS) and those in which the device should decide autonomously. According to Riek and Howard [ 49 ], it is preferable that in certain cases, the technological device, although autonomous, requires a human validation of its actions to keep the user in control of the device. In addition, Bensoussan and Puigmal [ 80 ] suggested the idea that technological devices must have an emergency stop button, so that the human can switch off the technology at any time.

Regulation of Technology

Currently, there is a gray area between the capabilities of RCSs, the reality of the field, and the regulations in force [ 38 ]. To accompany the researcher during the whole process of development and diffusion of RCSs, an ethical framework should be established [ 18 , 60 ]. Specifically, this can be in the form of an ethical code of conduct illustrating the expectations to all the employees of a company [ 18 ]. The researcher must regularly inform themselves about the ethics to be consistent with the evolution of the regulatory framework [ 60 ]. However, according to Nevejans [ 82 ], these ethical recommendations have no legal value and cannot protect humans from the damage caused by new technologies. Thus, it is necessary to think about a new legal framework to protect the users of RCSs [ 37 ].

The use of technologies, such as RCSs, in the health care field has grown significantly in recent years [ 17 , 18 ]. RCSs are increasingly being used for older adults with the aim of promoting healthy behaviors, quality of life, and well-being. However, the use of RCSs also raises several ethical challenges regarding the cost-to-benefit balance of these new care practices, respect for the autonomy of users, respect for privacy, justice and equity linked to their access, or need for a suitable legal framework. Such challenges could be addressed by establishing relevant recommendations for the development and use of RCSs. Some guidelines regarding the use of robotic systems have been published [ 49 , 83 ]. Moreover, in April 2021, the European Commission unveiled the first legal framework about AI [ 84 ]. However, to the best of our knowledge, no recommendations have been proposed in this field directly linked to an analysis of the literature dealing specifically with these ethical issues and potential solutions to address them.

This narrative review identified 25 articles in which authors highlighted ethical issues and recommendations related to the use of RCSs and similar technologies. The use of the EUnetHTA Core Model for the analysis of these articles made it possible to classify the information retrieved in the publications according to 5 main ethical topics—“benefit-harm balance,” “autonomy,” “respect for persons,” “justice and equity,” and “legislation”—and to provide a detailed analysis of RCS-related ethical issues. Our review also aimed to identify recommendations for better development, diffusion, and use of RCSs by a population of older adults.

Technology devices, such as RCSs, are used with older adults to enable them to live independently; to enhance their quality of life and well-being; and, therefore, to cope with the increasing care demands for older populations. RCSs may be used to encourage a range of health-related goals: physical, cognitive, nutritional, social, and emotional domains. To be effective, RCSs must be able to motivate the user by providing highly personalized care programs [ 85 , 86 ]. However, studies have shown that not all potential target users are included in the development of these devices [ 37 , 87 , 88 ]. Therefore, RCSs design might fail to meet a wide range of users’ needs, capabilities, and wishes. Thus, it is essential to apply “user-centered design” approaches and involve target users with various sociodemographic characteristics and technology experience throughout the development process. A strong involvement of the intended users of these systems in their design process would also improve the quality of the information provided to potential users of RCSs regarding their operation, type of data collected, and potential benefits of the technology. In this way, the involvement of the users would improve the quality of the process of obtaining the consent required from older adults to use the technology.

Another ethical challenge related to the use of RCSs is the fact that their wide implementation for older adults’ care may affect the distribution of health care resources. For instance, it has been found that for some older adults and informal and formal caregivers, the use of RCSs could replace humans in many caregiving tasks, eventually leading to a suppression of jobs or to a degradation of the quality of health care services [ 17 , 34 , 48 , 61 ]. In this regard, the participation of a third person (professional, volunteer, or family member) as a “human coach” could be considered when implementing RCSs in the older adults’ environment. This “human coach” could help build a “chain of trust” by being an intermediary between the RCS and the user. On the one hand, the involvement of a real person in the use of the RCS could reduce the risk of replacement of human assistance by technological assistance. On the other hand, the “human coach” could help enhance the acceptability and usability of the device, while at the same time, reassuring the user and providing recommendations to the developers, so that the RCS is consistent with users’ needs and desires. However, the benefits of involving a “human coach” in the RCS service provision has yet to be evaluated by scientific studies.

According to some studies [ 3 , 39 , 41 , 51 , 65 ], the use of RCSs can have an impact on social relationships, reducing human contact and even altering social relationships by creating tension between older adults and their caregivers. Thus, it would be interesting to identify the repercussions and implications of these devices in older adults’ daily life and in the life of the members of their social environment through new studies. It also seems necessary to evaluate the organizational impact of the implementation of RCSs and to identify potential obstacles to their use in the care professionals’ work context.

Our analysis also confirmed that for RCSs to provide personalized health-related recommendations, the collection of sensitive data is necessary. Data collection in this context also raises several ethical issues. For instance, personal data can be exposed to hacking and misuse. Proper data management, anonymization, and encryption are essential to protect the personal data of RCS users [ 86 ]. In addition, researchers and developers in this field must evaluate RCSs before implementation to ensure that they do not cause physical or moral harm to users. Thus, it has been suggested that stakeholders refer to local and regional regulatory and safety standards to guide their development and use.

Finally, our analysis also discussed how legal and ethical frameworks regarding the use of RCSs need to be adapted to cope with the constant development of new technologies. So far, existing legal frameworks are not yet adequate to respond effectively to the question of liability in case of damage caused by RCSs, particularly because these devices are becoming increasingly autonomous [ 80 ]. The establishment of “operational ethics committees in digital sciences and technologies” could help in the development and conduct of projects in this area [ 60 ]. Guidelines should be established to identify the types of applications and technological devices that require regulatory review and approval [ 44 ]. Research projects and working groups involving users, researchers, and lawyers should be set up to further investigate the legal and ethical issues related to the use of RCSs.

Some countries and regions, such as Europe and Japan have initiated the work of structuring relevant legal and ethical frameworks; however, their orientations and measures may differ culturally [ 78 ]. Future studies in the area of RCSs could consider the influence of cultural and socioeconomic specificities of the contexts of experimentation (countries and regions) regarding the acceptance and use of RCSs by older adults and formal and informal caregivers and regarding the definition of ethical and legal frameworks governing their uses. Therefore, the use of validated and widely applied analysis frameworks, for example, the Western, Educated, Industrialized, Rich and Democratic framework [ 89 ], formulated to measure countries’ commonalities in their approaches to the interpretation of behavioral research findings (eg, regarding technology adoption) could be interesting. The Western, Educated, Industrialized, Rich and Democratic framework [ 89 ] could help not only to explore the differences among countries regarding the validation and adoption of new technologies for older adult care but also to seek greater cultural and demographic diversity in technology research.

This dimension of cross-cultural comparison has received particular attention in the framework of a current international research partnership between Europe and Japan, such as the EU-Japan Virtual Coach for Smart Ageing (e-VITA) project. This project aims to develop a cross-cultural RCS that can be tailored to the needs of healthy older adults to promote aging well. The e-VITA RCS will be made available to older adults in their homes, which raises many of the ethical questions discussed in this paper. Therefore, the study will require the researchers to set up procedures adapted not only to the users but also to the 2 cultures (European and Japanese), respecting the corresponding ethical and legal regulations. Thus, it would be interesting to perform an analysis of the ethical issues raised by users from different countries and cultures within the framework of the e-VITA project.

Limitations

A narrative review of the literature was conducted to provide a nonexhaustive synthesis of the various ethical concerns and recommendations when using RCSs for older adults. This review has some limitations. Only articles in French and English were included. Some articles indicating ethical concerns or recommendations may not have been included when this information was not mentioned in the keywords or abstract.

Conclusions

The use of RCSs in the context of health care, particularly with an older adult population, tends to show many benefits. RCSs have the potential to improve the quality of life of older adults and their independence. When used in an ethical and appropriate manner, RCSs can help improve older adults’ emotions and cognitive and physical abilities and promote social relationships. By helping older adults to continue living at home for as long as possible, the use of health-oriented RCSs could help to address some of the challenges resulting from demographic aging. However, the use of these new health care technologies involves some ethical concerns, with the most cited issues being not only the risk of accidents, lack of reliability, loss of control, risk of deception, and risk of social isolation but also the confidentiality of data and liability in case of safety problems.

Some recommendations have been made in the past regarding the use of social and assistive robotic technologies for older adults, such as considering the opinion of target users; collecting their consent; training the care professionals to use them; and ensuring proper data management, anonymization, and encryption. However, the integration of RCSs in current health practices and, particularly, in the private homes of older adults can be disruptive. It requires the establishment of scalable and adapted ethical and regulatory frameworks that follow the technology progress and the social and digital change of society Thus, studies are needed to identify new ethical concerns arising from the organizational impact of the implementation of RCSs in different contexts, especially in the homes of older adults. The influence of cultural and socioeconomic specificities of the contexts of experimentation (countries and regions) regarding the acceptance and use of RCSs by older adults and formal and informal caregivers is also an area of interest for future studies.

Acknowledgments

This paper is a part of the EU-Japan Virtual Coach for Smart Ageing (e-VITA) project, which aims to develop a robotic coaching system for older adults [ 90 ]. The authors thank the collaborators who made this project possible: European Commission and Assistance Publique–Hôpitaux de Paris (Délégation à la Recherche Clinique et à l’Innovation). This review was based on data collected within the e-Vita project, funded by the European Union H2020 Program (grant 101016453) and the Japanese Ministry of Internal Affairs and Communication (Ministry of Internal Affairs and Communication; grant JPJ000595).

Data Availability

Data sharing is not applicable to this paper as no data sets were generated or analyzed during this review.

Conflicts of Interest

None declared.

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Abbreviations

artificial intelligence

European Network of Health Technology Assessment

EU-Japan Virtual Coach for Smart Ageing

Health Technology Assessment

robotic coaching solution

Edited by A Mavragani; submitted 12.04.23; peer-reviewed by J Sedlakova, S Liu; comments to author 20.08.23; revised version received 22.12.23; accepted 12.03.24; published 18.06.24.

©Cécilia Palmier, Anne-Sophie Rigaud, Toshimi Ogawa, Rainer Wieching, Sébastien Dacunha, Federico Barbarossa, Vera Stara, Roberta Bevilacqua, Maribel Pino. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 18.06.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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CDC developed the SHI in partnership with school administrators and staff, school health experts, parents, and national nongovernmental health and education agencies to:

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Why Use Case Studies in Safety Training?

Case studies provide many benefits in safety training. They are especially effective for teaching employees about accident causes and prevention.

Investigative Approach

Case Studies Help Prevent Accidents

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The Consequences of Noncompliance

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Case studies

Case study - North Staffordshire Combined Healthcare NHS Trust

Case study - British Sugar

Case study – Mid and West Wales Fire and Rescue Service

Case study – Sainsbury's

When leadership falls short

Competent advice, training and supervision

Risk assessment

Health and safety training goes digital and interactive

Case Study – ASDA

Health and safety key learning points

Relevant and recognisable

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Innovations in Teamwork for Health Care

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