Project description
The aim of this project was to implement a comprehensive health promotion intervention using mixed methods within a Participatory Action Research (PAR) approach to influence the sun-related attitudes and behaviours of outdoor workers in workplace settings in Queensland, Australia. Recruitment and baseline characteristics are described in detail previously [
14]. Briefly, 14 workplaces were recruited. These included small and large organisations across the rural, building and construction, public and local government sectors in geographically dispersed regions of Queensland. All the organisations employed outdoor workers, defined as individuals who work outdoors for most of the day on at least 5 days per week.
Each workplace nominated a workplace representative as a champion. The champions, with other workers, were invited to participate in the development of a plan for the suite of sun-safe health promotion interventions for the workplace. These plans were referred to as Sun Protection Action Plans and were developed over time in partnership with the research team. They encompassed six domains, as appropriate to, and based on data from, each workplace: policy, structure and environment, Personal Protective Equipment (PPE), education and awareness, role modelling, and skin examinations.
Using the principles and processes of a PAR approach, mixed methods were applied concurrently throughout the development of the Action Plans and data collection stages [
9]. Two preliminary tools were used to engage workers and workplaces, identify the priority given to sun safety within each organisation, and gather a policy baseline. The first was a telephone-based screening tool, comprised of quantitative and qualitative questions about workplace demographics, locations and structures and existing workplace policies and procedures related to sun safety and UVR exposure. A second, more comprehensive situational analysis tool, conducted in person with the representative in each workplace, involved the systematic collection of detailed information about existing workplace sun safety policies, procedures and strategies,
The combination of data from these tools enabled a comprehensive picture of existing sun safety strategies and culture to be developed, to inform the sun safety interventions for each workplace. As the researchers were on-site to conduct the more comprehensive situational analysis, it was prudent to integrate additional research strategies targeting workers. For example, a discussion group with outdoor workers from each site was undertaken. The discussion group was guided by PAR principles to allow the discovery of information grounded in the workers’ realities. The discussion groups involved generating ideas from workers about strategies to promote and increase sun safety practices in their workplace. The discussion was transparent, free-flowing and allowed a ‘heads together’ way of thinking. It valued the workers’ inputs, took advantage of their existing skills, knowledge and resources and stimulated ideas. In most cases, supervisors were excluded from the discussion to allow workers to speak openly. All discussions were documented and transcribed to identify key themes.
Quantitative measures employed as the project developed included 1) the distribution of ultraviolet radiation (UVR) dosimeters to workers to measure their UVR exposure across one working day, and 2) a telephone survey with a sample of the workers from each workplace, to collect information about workers’ demographics, behaviours and attitudes related to sun exposure and protection in the workplace, knowledge of workplace sun protection policy, and perception of their workplaces’ level of support for sun protection. Similar data was collected during the research evaluation stage to allow for pre and post-intervention comparisons. Additional questions about workers’ perception of changes to workplace sun safety protocols were asked.
Working with a diverse team
This project was conducted by a multidisciplinary team of quantitative and qualitative researchers with various expertise in epidemiology, public health, health promotion, health economics, and the social sciences.
The team consisted of eight researches and two professional staff. All researchers held a doctoral degree. Five researchers were quantitative experts, including the Project Lead. The three qualitative methodologists were assigned an equal number of geographically feasible and like workplaces to undertake fieldwork with a Research Assistant. The Project Office consisted of two contracted professional staff – a Project Manager and a Research Assistant. Casual professional support staff was provided when needed, for example, undertaking surveys. Six researchers were located within travelling distance of the project office. One researcher was located in another Australian city and one researcher was located in Canada. The team met once a fortnight in the planning phase, and once a month during fieldwork. Six team members attended in person and two team members attended by Skype. Most team members attended most meetings. Two team members attended meetings irregularly. Each meeting was guided by an agenda developed by the project lead.
Before the project commenced, the research team set the foundation for how they would use mixed methods within the PAR approach to address the research question. The research team needed to collectively define the meaning of mixed methods and PAR to create a common language. This was complicated by the diversity of methodological expertise and experience with PAR as a research approach. Through early discussions, the researchers learnt from each other to achieve an understanding and consensus about what data each method was collecting within the PAR process, and how this information would be useful to all relevant parties: the funding body, the health promotion community, the workers and the workplaces and the skin cancer research community. This was a healthy debate which required researchers from both methodologies to consider the scope and sequence of the research. Once all researchers recognised qualitative and quantitative data would be equally beneficial to the PAR process, methodological bias was overcome to a degree to which the team could work cooperatively.
A methods paper for use by the research team was then drafted by the project manager to outline the selected mixed methods, explain how these would be integrated, and indicate the logical sequence of PAR activities. This paper allowed the research team to conceptualise the mixed methods not as designs, but as a set of interactive parts [
15]. This methods paper was crucial in guiding the research team in applying the principles and processes of PAR in the project.