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HSE Health & Safety
Executive
Enhancing chemical risk control for reducing exposure in the workplace through advanced
risk messaging techniques
Prepared by White Queen Safety Strategies for the Health and Safety Executive 2005
RESEARCH REPORT 354
HSE Health & Safety
Executive
Enhancing chemical risk control for reducing exposure in the workplace through advanced
risk messaging techniques
White Queen Safety Strategies Postbus 712
2130 AS Hoofddorp The Netherlands
Besides legislation, there are various efforts to raise awareness of hazards for those working in particular industries. The current study investigates the possibility of presenting information in the form of 'advanced risk messaging'. This term was coined for this study and is used to mean interactive computer-based methods to deliver risk messages to people potentially exposed to harm.
The aims of the study were to examine both the characteristics of the receivers in their response to risk communication and the effectiveness of providing messages using this medium.
This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.
HSE BOOKS
© Crown copyright 2005
First published 2005
ISBN 0 7176 6128 8
All rights reserved. No part of this publication may bereproduced, stored in a retrieval system, or transmitted inany form or by any means (electronic, mechanical,photocopying, recording or otherwise) without the priorwritten permission of the copyright owner.
Applications for reproduction should be made in writing to:Licensing Division, Her Majesty's Stationery Office, St Clements House, 2-16 Colegate, Norwich NR3 1BQ or by e-mail to [email protected]
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CONTENTSExecutive Summary .................................................................................................................. v
Objectives.............................................................................................................................. vThe "ARM" simulation game................................................................................................ vPilot study ............................................................................................................................ viConclusions.......................................................................................................................... ix
1 INTRODUCTION ............................................................................................................ 11.1 Functional Objectives .............................................................................................. 11.2 Target Population ..................................................................................................... 11.3 Project Organisation and Development History ...................................................... 2
1.3.1 Research work ..................................................................................................... 21.3.2 Programming ....................................................................................................... 31.3.3 Liaison with HSE and HSL ................................................................................. 31.3.4 Birmingham Pilot Studies.................................................................................... 81.3.5 Capitulation ......................................................................................................... 8
2 RISK COMMUNICATION ISSUES ............................................................................... 92.1 The Challenge .......................................................................................................... 92.2 Mental Models ......................................................................................................... 92.3 Regulatory Control And Guidance .........................................................................102.4 Material Safety Data Sheets (MSDS) and other written information about the hazards 10
2.5 Information Technology (IT) ..................................................................................112.6 What Message Should This Project Deliver?..........................................................12
2.6.1 Warnings.............................................................................................................132.6.2 Technical Content...............................................................................................142.6.3 Framing effects ...................................................................................................152.6.4 Order of presentation ..........................................................................................152.6.5 Information Source .............................................................................................152.6.6 Workplace context and Control ..........................................................................162.6.7 Targeting behaviour............................................................................................172.6.8 Changing Behaviour ...........................................................................................18
2.7 Evaluating Message Effectiveness..........................................................................212.8 implications for advanced risk messaging ..............................................................22
3 SOFTWARE DEVELOPMENT STRATEGY ...............................................................253.1 Functionality ...........................................................................................................253.2 ARM development ..................................................................................................25
3.2.1 Phase 1 ................................................................................................................273.2.2 Phase 2 ................................................................................................................273.2.3 Phase 3 ................................................................................................................283.2.4 Phase 4 ................................................................................................................283.2.5 Phase 5 ................................................................................................................283.2.6 Phase 6 ................................................................................................................28
3.3 System Boundary and subsystems FOR ARM-1 ....................................................283.3.1 ARM Subsystems ...............................................................................................283.3.2 ARM Data Flows................................................................................................29
4 CONCEPT DESIGN .......................................................................................................334.1 Introduction.............................................................................................................334.2 Data: "body parts" and their health .........................................................................33
4.2.1 Program flow (scenario, cycles and events). ......................................................345 DETAILED DESIGN ......................................................................................................37
5.1 Introduction.............................................................................................................375.2 ARM-1 ....................................................................................................................375.3 Expert advice: Biomedical Sciences Group ............................................................41
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5.3.1 Exposure identification .......................................................................................415.3.2 Reading the Label ...............................................................................................445.3.3 Protection............................................................................................................455.3.4 Symptoms and what to do...................................................................................49
5.4 Detailed Development Process ...............................................................................575.4.1 Introduction ........................................................................................................575.4.2 Determining the key elements of the message....................................................57
5.5 Measuring the response...........................................................................................655.5.1 Terminology of the output files ..........................................................................655.5.2 Main scoring cycle..............................................................................................655.5.3 Image displays ....................................................................................................665.5.4 Health events ......................................................................................................675.5.5 Stop Working......................................................................................................695.5.6 Holidays..............................................................................................................695.5.7 Compensation .....................................................................................................69
5.6 When the game ends or is quit ................................................................................695.7 Example results .......................................................................................................715.8 Problems and solutions ...........................................................................................73
6 PILOT STUDIES.............................................................................................................776.1 Setting up the studies ..............................................................................................776.2 Sending out the program and getting the results .....................................................776.3 the results ................................................................................................................78
6.3.1 Number of returns...............................................................................................786.3.2 Questionnaire......................................................................................................786.3.3 Actions during play.............................................................................................796.3.4 Why is information never looked at? A post-pilot check ..................................86
7 Summary, conclusions and recommendations.................................................................897.1 Summary of results .................................................................................................897.2 CONCLUSIONS.....................................................................................................897.3 Recommendations for Future work.........................................................................90
8 REFERENCES ................................................................................................................93Annex I: Case studies ...............................................................................................................99ANNEX II: collection of basic data about isocyanates ..........................................................103
II.1 Types of Isocyanates ...................................................................................................103
II.2 Cause and Effect Basics ..............................................................................................103
II.3 MSD sheet.............................................................................................................104
II.4 Exposure routes.....................................................................................................104
II.5 Health Effects........................................................................................................105
II.6 Protection, prevention, best practices....................................................................106
II.7 Environmental Protection Agency, USA: Isocyanate Basics................................108
ANNEX III: INTERPRETING THE RESULTS FILE ..........................................................109
iv
EXECUTIVE SUMMARY
OBJECTIVES
Besides legislation, there are various efforts to raise awareness of hazards for those working
in particular industries. The current study investigates the possibility of presenting
information in the form of 'advanced risk messaging'. This term was coined for this study
and is used to mean interactive computer-based methods to deliver risk messages to people
potentially exposed to harm.
The aims of the study were to examine both the characteristics of the receivers in their
response to risk communication and the effectiveness of providing messages using this
medium.
THE "ARM" SIMULATION GAME
A PC-based simulation game was developed called ARM (Advanced Risk Messenger) which
could provide spray painters in the motor repair industry with information about their working
conditions and the effects on their health. This game allowed players to explore for
information and to manipulate their working environment so that they can see what the effects
are.
The hazard explored was asthma, acquired through exposure to the hazard agent isocyanates.
In the game setting, asthma can be avoided by choosing the full-face air supplied respirator
for breathing protection, a ventilated spray booth and training. There are other incentives
besides health in the game, including making money and having fun (going on holiday). The
player experiences getting older in this context and can even travel back in time if they do not
like the outcome.
Key points taken up from existing understanding about risk messages are as follows:
x Warnings should be simple, clear and effective rather than detailed. It is more
important to initiate the required response than to provide detailed information.
Therefore, detailed information was only provided in ARM if the user requested it.
x Aim for positive framing of messages. Positively framed risk communications are
generally more influential on intentions to act than negatively framed risk
communications. Decision makers also tend to view positive options as gains and
thus become more risk averse. On this basis, ARM used a score system typical of
game play and positive feedback when good control choices are made.
v
x The information source of a message should appear intelligent and credible. This was
made an inherent feature of the program design.
x A risk message needs to take workplace context into account, such as social
pressures, and the degree of control the individual has over the risks. Strategies for
targeting and changing behaviour therefore have to be considered. ARM was
therefore focused on getting across the essential elements of control rather than try to
cover them all.
x Identifying precursors and symptoms or making the target behaviour conspicuous in
the message itself are two such effective strategies in the process of targeting and
changing behaviour. These were therefore used in ARM by relating symptoms to
control choices.
x Effective ways to change behaviour are to change to beliefs and perceptions people
have about the severity of the risk and the potential damage to their health, and to
make the recommended response appear sufficiently beneficial and easy to carry out.
The risk message must be careful to make the situation not seem hopeless, while at
the same time showing the risk to be severe enough to induce action on the part of the
person at risk. ARM avoided hopeless situations and work related death.
x Measures of message effectiveness should be incorporated into the program. ARM
used a simple questionnaire and sophisticated measurement (automatically generated
text files of all the users' actions and the program response over time when operating
the program).
PILOT STUDY
The important results were:
1. The effectiveness of getting people from small auto body shops to respond was very
small. Only 3 volunteers were obtained out of an intended 20 for the Pilot Study.
They played a total of 23 game runs. Even paying volunteers £15 for what was less
than an hour’s work was an inadequate incentive. One problem was considered to be
lack of access to a computer. An estimate was that only 10% of front line workers
had home computers whereas nearly all of them (sample of 30 people) had
Playstations or X-boxes.
2. 23 simulation trials were played. The 3 subjects never sought out detailed
information even though it was only a button click away (there was one exception
where on one run a player looked at the paint warning label). They did however visit
the doctor, visit a specialist for medical checks and check on their exposure
(biofeedback) but only if they had indication of declining health.
3. The targeted behaviour (air supplied respirator, ventilation booth, training) was
achieved for all 3 paint sprayers in the first game played (so, within 5 minutes or
less). In 2 cases the targeted behaviours were selected from the outset. In the other
case the painter sprayer selected the mask for lacquers and enamels.
4. Responses on the questionnaire suggested all three players would be more careful
with spray paints in the future although there was uncertainty as to whether they
vi
would ask for healthier working conditions. Evaluation of ARM as a good teacher
was a "no" from player 1 and a "don’t know" from player 2 and 3.
5. At the beginning of each run the player is advised to read the warning label. In the 23
runs this was done only once, for 12 seconds, which is a long time compared to the 2
or 3 seconds spent looking at other screens such as those showing symptoms. The
implication for advanced risk messaging is that players will not seek out information
when it is passively presented. When information is presented (symptoms, advice
from doctor, biofeedback) this is not looked at for more than 3 seconds. The time
frame for delivering information is really quite short.
6. Ferguson et al (ref (21)) cites literature suggesting that negative frames are more
persuasive for detection behaviours (risk seeking), whilst positive frames are more
persuasive for prevention behaviours (risk aversion). Within the limits of the sparse
data, the ARM simulation supported this, indicating that detection behaviours only
took place when the health message was negatively framed (losses) and that
prevention behaviours continued when messages were positively framed (gains).
Responses to the questionnaire presented at the end of each trial over 3 paint sprayers and 23 trials
Question Frequency of responses of 3 paint sprayers over 23 trials
Yes No Don’t know
Do you think asthma is serious 23 0 0
Is work more important than worrying about health 0 22 1 (player 2)
Will you be more careful with spray paints in the
future?
23 0 0
Do you think ARM is a good teacher? 0 10 13 (player (players 2
1) and 3)
Are you going to ask for healthier working 0 1 22
conditions? (player 1)
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Sample response from first 5 years of the ARM simulation (and end scores) Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
Order of Priority Health, money, Fun, health, Fun, money, long Fun, money, long Long life, fun fun, long life money, long life life, health life, health health, money
Breathing Air supplied Air supplied Respirator for Air supplied Air supplied protection Respirator Respirator lacquers and Respirator Respirator
enamels
Workplace Ventilation booth Ventilation booth Ventilation booth Ventilation booth Ventilation booth
Training Trained Trained Trained Trained Trained
Age | Events
31 Start working Start working Start working Start working Start working
32 7 DAY HOLIDAY
32.1 14 DAY HOL
32.2 5 DAY HOL
32.7 4 DAY HOL
32.8 5 DAY HOL ASTHMAMILD
33 15 DAY HOLIDAY
33.1 ASTHMAMILD
33.3 CLICK ON DOCTOR
5 DAY HOL
("you are fine" not visible)
33.3 SEE SPECIALIST (Told: YOU ARE FINE)
33.8 4 DAY HOL
34 STOP 7 DAY HOLIDAY WORKING
34.1 7 DAY HOL
34.4 5 DAY HOL
34.5 BACK TO WORK Air supplied respirator, booth, trained
34.8 CHANGE CONDITIONS (Air supplied respirator, No booth, Trained
34.9 6 DAY HOLIDAY ASTHMA ATTACK
.......
80.1 DIES OF OLD DIES OF OLD DIES OF OLD DIES OF OLD AGE AGE AGE AGE
Score 1570 2136 1788 1964 2072
Money 95,975 96375 75,100 76,875 44175
Health 1000 1000 800 1000 1000
Fun 100 940 860 950 990
viii
CONCLUSIONS
The ARM simulator provides a means of examining behaviours of people in a virtual
workplace.
A lot of time was spent designing message content and discussing the presentation of
information about asthma, isocyanates, and appropriate workplace conditions, and of
delivering the game play structure. This study suggests that HSE, who are the content experts
in the risk communication process, may spend too much time worrying about the detailed
content of messages when the targeted audience are not interested in the details. More time
could be spent dealing with other hurdles that have to be overcome like how to get the
message to the people who need it. “Advanced” communications probably need to use
currently regularly accessed channels (e.g. TV, Video games). A survey of regularly accessed
channels amongst target populations might be appropriate.
The ARM program delivered a complex message in less than 5 minutes. Even this pilot
system can be seen to have advantages over conventional guidance methods.
The ARM program could be a valuable research tool when it is necessary to measure the
parameters of how a person responds to a message: what they do and for how long, what their
perceptions are and whether they intend to change behaviour.
The pilot program can be downloaded from www.whitequeen.nl.
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x
1 INTRODUCTION
This report presents findings from a research project investigating the possibility of enhancing
chemical risk control for reducing exposure in the workplace through advanced risk
messaging techniques.
In this study the term 'advanced risk messaging' means using interactive computer-based
methods to deliver risk messages to people potentially exposed to harm from the handling of
chemicals in the workplace. The aim was to explore both the characteristics of the receivers
in their response to hazard and risk communications and the effectiveness of providing
messages using this medium.
Using information technology potentially introduces new possibilities of ways and means of
contacting and informing the target population. The concern is to consider better ways of
providing messages that have a positive influence on risk control behaviour in the handling of
chemicals.
1.1 FUNCTIONAL OBJECTIVES
The functional objectives of the advanced risk-messaging prototype to be developed are:
x a PC based messaging system, which uses a virtual reality of chemical handling in
the workplace with which the user can interact;
x a better understanding about presenting effective risk messages and which can reach
the target audience;
x a system which has the potential and the flexibility to be applied to any type of
hazardous chemical used in any workplace and in different communication contexts
(with the product; on the internet; in training; at home; etc.);
x improvement in the chances of correct, full and continuing compliance with the
specific risk control measures required.
The objectives were used to evaluate the effectiveness of the final results of the research.
1.2 TARGET POPULATION
The target population for the research were workers who may experience harm from loss of
risk control. The target group that was finally chosen for the research was limited to small
companies (particularly those with less than 20 employees) with spray painters involved in
motor vehicle repair.
Spray painters are one of the groups who appear to be particularly exposed to chemicals
producing ill-health effects, as reflected in health and safety statistics reported in 1999 (25).
Spray painters had the highest incidence rate of occupational asthma, the most commonly
reported agent group incriminated being isocyanates. Contact dermatitis, accounting for the
majority of cases for skin disorders, was most prevalent in hairdressing and beauty salons.
The high incidence groups included:
x Hairdressing
1
x Dry cleaning
x Nursing
x Farming/fishing/forestry (such as from timber treatments)
x Metal processing (such from oils used in metal cutting)
x Car repair (use of isocyanate paint sprays)
Again , isocyanates were the most commonly cited agents in the three years 2000-2002, (34)
with flour and grain being the second and solder flux/colophony the third most common
agents. The occupations with the highest incidence rate of occupational asthma as reported to
chest physicians were bakers, flour confectioners, spray painters and those in the welding
trades. For each of these occupations the estimated rate was over 20 times the overall rate for
all occupations.
1.3 PROJECT ORGANISATION AND DEVELOPMENT HISTORY
1.3.1 Research work
Dr Linda J. Bellamy of SAVE Consultants in Apeldoorn, The Netherlands, was originally
commissioned to carry out the work. In January 2003 Linda Bellamy continued the work with
White Queen Safety Strategies, The Netherlands.
The project started in June 2000 with the following planned phases:
Phase 1: System description and Plan (Report)
Phase 2: Concept design (Report)
Detailed design (Demonstration disc)
Phase 3: Development report
ARM-1 software (ARM-1 disc)
Phase 4: Pilot studies (Report)
Phase 5: ARM-2 software (ARM-2 disc)
Phase 6: Experimental results (Report + replay disc)
Phase 7: Final study report (Report)
This report is the Phase 7 report. It excludes phases 5 and 6 on the basis of the results of the
Pilot Studies in Phase 4.
The following documents were produced:
(1) Project Proposal, 1999, Ref (3)
(2) Phase 1 Report, December 2000, Ref (4)
(3) Progress Reports 1 and 2, December 2000, Ref (5)
(4) Progress Reports 3 and 4, May 2001, Ref (6)
(5) Phase 2 Report, November 2001, Ref (7) + Phase 2 CD ARM Demo concept,
November 2001
2
(6) Progress Reports 5 and 6, May 2001, Ref (8)
(7) Progress Reports 7 and 8 June 2002, Ref (9)
(8) Progress Reports 9 & 10 December 2002, Ref (11)
(9) Phase 3 ARM-1 Development report November 2002, Ref (10) + Phase 3 CD
ARM-1 prototype November 2002
(10) Progress Report 11 April 2003, Ref (61)
(11) Progress Report 12 June 2003, Ref (62)
(12) Progress Report 13 December 2003, Ref (63)
(13) Progress Report 14 July 8 2004, Ref (64)
1.3.2 Programming
The initial programming of the ARM risk messaging software was carried out by Nico
Vermaas of SAVE Consultants, Apeldoorn, The Netherlands.
This was taken over by Julius Whiston of Whiston Computers Ltd, London in October 2002
prior to the production of the ARM-1 prototype.
The GUI was designed by Linda Bellamy, White Queen BV.
1.3.3 Liaison with HSE and HSL
The liaison officers were as follows: HSE liaison officer 2000: Shelagh Molloy, HDC-SPIN, Rose Court, London. HSE liaison officer 2001- : Dr Marion Evans, HSE, Rose Court, London
Meeting 1: Phase 1 Planning, February 2001
A meeting was held at Rose Court with Dr Evans after the presentation of the Phase 1 report
and the following points agreed:
x individual susceptibilities to hazards are not known and the risk is context specific
so susceptibility will be excluded from the message;
x Uncertainty about causes and health effects is a problem; the messaging software
can have a generally applicable functionality but in the first instance for simplicity it
could be focused on one group: asthma/isocyanate group.
x MSD sheets can be excluded from the study
x Could be advantageous to include the social context
x Could be advantageous to include control measures that are easy to carry out
3
Meeting 2: ARM-1 Prototype Demonstration, November 2001
This meeting was held at Rose Court, London, with the following persons present from HSE:
Marion Evans (Project Officer), Shelagh Molloy, Michael Topping, Andrew Maxey, Judy
Cawte, Sara Wassell, Carol Sullivan, Sara Senior.
Figure 1: Phase 2 First prototype ARMPaintSpray_13nov01 – Opening screen
Figure 2: Phase 2 First prototype ARMPaintSpray_13nov01 – Game play screen
HSE were positive about:
4
x Functional specifications
x Scenario concept which could be enlarged to include more real life choices
HSE were negative about:
x possible outcomes in the game of death or hopeless situations of incurable illness
HSE wanted to include:
x more options to change ones conditions such as reporting to employer (and perhaps
link or reference to COSHH essentials website)
x more options to change health (perhaps the doctor could provide such options)
x realistic choices in use of protective equipment; some people have protective
equipment but won’t wear it
x option to seek compensation
x effects on quality of life (this would be a good goal)
x financial effects
x something that indicates changes in health
x scenario should begin before the user gets sick
Meeting 3, Health and Safety Laboratory, Sheffield, May 2002
The meeting was held at the Health and Safety Laboratory, Biomedical Sciences Group with
Andrew Curran (Head of Biomedical Sciences Group), Kate Jones (Senior Scientist), and
David Fishwick, (Consultant chest physician, Chief medical Officer).
They were shown a new demonstration (Figure 3: Phase 3 First prototype ARM22april2002).
5
Figure 3: Phase 3 First prototype ARM22april2002
The group provided information helpful to targeting key message elements concerning:
x Exposure identification
x Protection, choice of mask, maintenance, spray booth, maintenance, training
x Non-sprayers should not have contact
x Symptoms and what to do
x Key aspects of warning labels
On the basis of their assistance and comments received from HSL on 25 February 2003,
subsequently discussed with Andrew Garrod1 the software was redesigned and a new ARM
prototype produced (see Figure 4).
Meeting 4, HSE, Rose Court: Presentation ARM-1 prototype Phase 3, March 13 2003 (Ref (60)
Present from HSE were: Dr Marion Evans, ARM Project Technical Manager for HSE
(HDDO); Donald Adey (Chemicals Policy Division, Occupational Asthma Project Manager);
Shona Picken (HD, Chemicals Essentials Project); Dave Rickwood (Risk Policy Unit); Chris
Turner (HD, Occupational Asthma); Louise Jones (HD, e-COSHH, marketing and
promotion); Kate Jones (HSL Biomedical Sciences); Andrew Curran (HSL, Head of
Biomedical Sciences Group).
The ARM-1 prototype was presented (see Figure 4).
Andrew Garrod - HM Specialist Inspector (Occupational Hygiene), Health and Safety Executive,
Bootle
6
1
Figure 4: Phase 3 ARM-1 Demo, 14-Nov-02 (ARM-1a)
A number of points were agreed in this meeting:
(1) Changes to enhance the visibility of some of the screen information
(2) Changes to information content and graphics
(3) Requirement to label all pictures
(4) There was some discussion over whether a ventilated spray booth was
absolutely necessary to avoid inhalation of spray but in the end agreed that
although a full faced respirator alone, when properly fitted and used, can
prevent inhalation of spray containing isocyanates 2 this can only be effective
in combination with strict procedures concerning leaving and returning to the
spraying area. It was agreed, therefore, that the message should be to also use
a ventilated spray booth as well as the full face air supplied respirator.
(5) HSE considered that a positive message has a better effect than a negative
one.
(6) The message is aimed at the employee
Meeting of Motor Vehicle Repair Health and Safety Forum in Birmingham Tuesday May th
13 2003
A CD of ARM-1 was sent to J. Powell (Chairman MVRHS Forum) for review and to request
assistance with distributing this in the field. Linda Bellamy, White Queen, offered to give a
2 Linda Bellamy had also discussed this point earlier with person with COSHH/isocyanates expertise:
Andrew Garrod - HM Specialist Inspector (Occupational Hygiene), Health and Safety Executive.
7
presentation at the next meeting in Birmingham in order to get support for finding subjects for
the piloting.
On the basis of comments received from the Chairman, the software was further developed:
x New front page screen tailored to the gamex Explanation of the aims of the game and a ‘How to Play’ tutorial
The Chairman was particularly unhappy about allowing a piece of software into the
workplace that showed a virtual reality workplace where people could enter the workplace
untrained, for example. It was because of the many anxieties that he had that an explanation
and tutorial were developed at short notice.
The presentation of ARM Pilot 1, ready for pilot testing, was made at Birmingham on 13 May
03 to the MVRH&S forum. Following this, a number of people volunteered to take 10 CDs
with the ARM pilot into the industry for piloting with paint sprayers. Stamped addressed
envelopes, a floppy disc for recording results and instructions were included.
Due to the timing of the presentation (last on the agenda, which overran in time), it was not
very easy to explain what to do in just a few minutes or to exchange contact details because
nobody had any time.
Later an additional 11 copies of the ARM Pilot 1 were sent out to be distributed by one of the
volunteers.
As it turned out, of the 20 copies of ARM distributed to paint sprayers, only one paint sprayer
sent back any results. This was received on 26 January 2004 more than 6 months later.
1.3.4 Birmingham Pilot Studies
Following the failure of the MVRHS Forum line of approach, it was decided to subcontract a
person in Birmingham (a university research student) to make direct contact with Birmingham
companies and to offer a financial incentive to paint sprayers for playing the ARM game
(£15). After a lot of work identifying companies and contacting people, only 2 people could
be found who were willing to provide results.
The sum total of subjects was now 3.
1.3.5 Capitulation
After so long struggling to get subjects, and still no results back from the MVRHS volunteer
group there was no point in further developing the software according to the original plan as
there were insufficient data, insufficient willing/able subjects, and no interest from HSE's
MVRHS.
This report:
x describes the process behind the development of the model/software,
x provide the background literature review and thinking,
x describes the software,
x give the analysis of the 3 results from the targeted population, and
x makes conclusions on what this means for risk communication.
8
2 RISK COMMUNICATION ISSUES
2.1 THE CHALLENGE
Identifying and reaching those people working in ill-informed companies or those who,
despite being provided with information, take no action to reduce exposure is considered a
difficult challenge. In this study small companies were approached both indirectly using
volunteer intermediaries from HSE’s Motor Vehicle Repair Health and Safety Forum who
would get the ARM simulation game into the workplace and later by direct contact with small
companies in the Birmingham area. Getting responses proved extremely difficult with a
response rate of less than 10% of individuals approached.
2.2 MENTAL MODELS
Understanding the 'mental models' of people in the workplace who may be exposed to
chemical health risks is considered to be an extremely valuable ingredient to designing
effective messages. The main problem is that, despite the availability of chemical hazard
information, people still ignore, deny or underestimate risks to health in the control of risks
and risk exposure (ref (58)). In some cases, this may be because they have no control over
means of prevention and protection, or they believe this to be the case.
An important question to ask in structuring risk information is what do the recipients need and
want to know about the hazards and their control? If risk information is presented in
confusing ways, it may be ignored, misunderstood, or meaningless. Different messages from
different communication channels may conflict. Circumstances in the workplace may change
over time.
A Health and Safety Laboratory workshop on risk perception and risk communication (37)
identified as fundamental a need to gain insight into the target audience and their perceptions,
attitudes and beliefs, and their mental models that affect their understanding and response to
risk messages. Mental model refers to internalised representations of the world by which the
external world is actively constructed and interpreted through information handling processes,
biases, strategies and other so called cognitive 'tools'. However, models are not always
accurate and there can be errors, uncertainties and misunderstandings amongst both the so-
called lay population as well as the so-called experts.
For the current study the hypothesis was made that there are two groups:
x Risk acceptance group: those who when informed about risks will demonstrate
intent to take measures to avoid them
x Risk denial group: those who when informed about risks will demonstrate intent not
to take measures to avoid them.
The idea was to study:
x Do such groups exist?x What sort of information gathering and action strategies do they have?x Do they understand the message sufficiently to understand how to minimise
exposure to health risks (if not, why not?)
9
x If they do then what are the positive and negative influences on intent to take
measures? (like social context, work demands, mode of information delivery,
information source, availability of measures).
The study of the mental models of subjects is one of the key aims, because this knowledge
would be able to help the design of risk messages about chemical hazards in the future. At
the same time we also want a product, an effective risk messaging system.
2.3 REGULATORY CONTROL AND GUIDANCE
Rather than direct control on people handling chemicals, a good deal of regulatory control is
focused on manufacturers and suppliers of chemicals to provide accurate warning
information, and on managers to assess health and safety risks and provide appropriate risk
reducing measures. Regulations to control risks include for example COSHH, the Control Of
Substances Hazardous to Health Regulations 1999 in Britain (26) with guidance on how the
regulations should work in practice. Examples include the Health and Safety Commission's
guidance on safety data sheets (23) and the Approved Code of Practice on management of
health and safety at work (29).
At another level, there are efforts to raise awareness of hazards for those working in particular
industries such as the HSE publications 'Drycleaners. Are you in control?' or 'Isocyanates;
Health hazards and precautionary measures' or 'Good health is good business' (32). One study
has shown that HSE leaflets can be difficult to read and tend to be negatively framed. (Ref
(21)). For example the following text has a Flesch reading ease score of 25% (where 100% is
the best for understanding):
HSE’s “Isocyanates: Health Hazards and Precautionary Measures” (33) says: "You should
not use RPE [respiratory protective equipment] as your only control measure to achieve
compliance with the MELs [maximum exposure limits]. You should reduce exposure to
isocyanates to a minimum by other means before using RPE. Direct control at source (e.g.
enclosures, extraction hoods, suitable spray guns and work methods etc.) should always be
the primary means in reducing exposure. However, where such control measures are not
reasonably practicable or are found to be inadequate and it is not reasonably practicable to
improve their performance, then suitable personal protective equipment including RPE will be
needed. RPE may also be used, where reasonably practicable, to control exposure to its
lowest level after all other suitable steps have been taken."
One of the conclusions of the HSL workshop (37) was that a more prescriptive approach to
issuing risk information and advice to small companies was preferred over a goal setting
approach. In the current study, irrespective of the approach, getting various HSE experts to
agree on a message that was comprehensive, accurate and acceptable was the hardest part of
the study. This process was described in Section 1.3.3.
2.4 MATERIAL SAFETY DATA SHEETS (MSDS) AND OTHER WRITTEN INFORMATION ABOUT THE HAZARDS
Currently, one of the primary sources of information about hazards in the workplace is the
Material Safety Data Sheet (MSDS) that relies on the receiver being able to understand the
written information and to use this information to determine appropriate risk control
measures. Quite aside from reading difficulties, such information may be too technical,
vague or inferential and cannot take account of the specific risks that might be posed in a
10
2.5
particular workplace. Therefore, one research question is whether it is possible to deliver
hazard and risk information in a form that avoids difficult written text. This document, for
example has (according to the MS Word performed calculation) a Flesch Reading Ease score
of 38% (where 100% is the best for understanding) and a Flesch Kincaid Grade Level score of
12 meaning you have to be at least US 12th grade to understand this. This is comparable to
an MSD sheet according to results given by Ref (48). HSE information leaflets get a score
ranging between 45 and 85 (ref (21)).
The MSD sheet is the only accurate source of information about the hazards for the unique
composition of a specific product. Therefore, this must be provided by the manufacturer and
product supplier. The actual context in which the product is used and the susceptibility of the
user to the hazards determine the actual risks. If a risk messaging system addresses these
other issues as well it needs to be highly context specific and cannot rely only on providing
hazard warnings.
INFORMATION TECHNOLOGY (IT)
The choice to use information technology is an exploratory one. A message delivered by a
computer programme, which allows interactive use in the way the message, is delivered,
could have advantages. A user might be able to explore a 'virtual' workplace without being
actually exposed to risks. The idea of the current study is to develop a system that will be
able to be stored on disk/CD for use in software environments that are accessible at home and
at work for a wide population.
One conclusion of a study carried out by WS Atkins Consultants (57) on people working with
chemical products in small firms was that people who actually had experienced accidents
handling chemicals were more safety conscious. A virtual reality, even a simple one, may be
far better than, as reported in the same study, a manager demonstrating the flammability of
hairspray by igniting it with a cigarette lighter for the benefit of trainees.
Health risks (like asthma or dermatitis) from exposure cannot be demonstrated in the actual
situation.
New technology gives possibilities for interactive learning which can be effective in
providing people with practice in using and applying knowledge in a variety of possible
settings. They can learn to apply exposure prevention standards in current and new situations.
Simulators are used in cases where learning and practice is limited in the real situation
because of the concomitant risks. This ranges from full-scale simulators such as flight
simulators and marine vessel simulators to simple but effective interactive tools based on
manipulation of a much smaller number of variables. For example, in military training, one
can learn how temperature and wind-speed affects the distance and angle travelled by missiles
fired from a cannon by manipulating the variables and observing the effects on performance.
The simulation approach does not have to be complex to be effective.
There is potential for simulation of the control of chemical hazards in workplaces using IT for
the enormous range of chemicals that might be encountered. Learning schemes involving the
virtual chemical workplace already exist.
An example was found on the Internet www.leapoffaith.com as shown in Figure 5 It
includes a comprehensive chemical database, an email link to experts, direct link to MSD
sheets, personalised risk assessment based on exposure and health history, online training
with instant feedback, job specific chemical searches, and administrative tools for managing
chemical data and documenting safety training. This tool, @ware, was primarily developed as
an internet-based program for hazard communication and safety training (42). One of the
11
2.6
investigative findings was that use of the tool significantly increased worker perceptions of
the degree to which they could have control over the use of precautions. The use of
behavioural models for influencing human health behaviours is, says the company, a basis
and framework for program design. Examination of the tool indicated that all its elements
were in written language, and knowledge of the name of the chemicals, or of a specific
product were keys to getting chemical information.
Figure 5 A virtual workplace on the Internet
WHAT MESSAGE SHOULD THIS PROJECT DELIVER?
Should the message delivery in the current project be:
x a warning, or
x a more general informative communication about hazards and avoidance, or
x a safety advisory about target behaviours that could improve health?
There are three related classes of issues all associated with considerable research and theory:
x Risk communication issues, studied mainly in the context of public perceptions of
risk e.g. (37), (40), (41), (56), (57)
12
x Design of warnings (43), (44)
x Use of theoretical models to design behaviour changing communications (2), (17)
Key points are taken up in the sections below.
2.6.1 Warnings
Priorities for risk reduction are generally accepted in Europe as remove the hazard altogether,
combat risks at source (preventive safeguards), protect those at risk, with collective protection
having priority over individual protection, and provide means of mitigating the effects should
the hazard be realised. Such concepts can be found in the EU Framework Directive (59) and
Management of Health and Safety at Work ACOP (29), for example.
Warnings deal with the residual risks, the leftover risks that cannot be removed. The purpose
of a warning is to provide information to those who might be caused harm in a form that
provides them with an opportunity to avoid harm. Warnings are supposed to include four key
elements:
x a standard signal word (like DANGER, WARNING, CAUTION) x statements of the hazardx the potential consequences x how to avoid the hazard
Most communications about the safe handling of hazardous chemicals include almost
unavoidably at some point, in some form or other, a form of warning:
"information about a possible negative consequence - a message that something undesirable
may occur to someone or something as a result of taking (or failing to take) some action" (1).
In (48) it is said that a warning:
“….should appropriately identify specific hazards, the magnitude of the associated risks, and
describe the means by which a person could avoid danger. In essence, its objective is
informed consent or choice behaviour. This is an internationally accepted legal concept that
was highlighted in the Nuremberg war trials, which indicated that a person must consent to a
personal exposure to significant risk and that such a consent must be informed, voluntary,
and revocable" p.4
In fact, this rather legal view perhaps explains the complicated content and poor design of
some means of hazard communication, principally Material Safety Data sheets. In the US, for
example, the primary purpose of the author companies may be to avoid prosecution rather
than to optimise risk communication.
A warning is a form of hazard communication such as:
“WARNING! FLAMMABLE LIQUID AND VAPOUR HARMFUL IF INHALED. CAUSES
EYE IRRITATION. MAY CAUSE SKIN IRRITATION. Keep away from heat sparks and flame. Avoid breathing vapour. Avoid contact with eyes, skin and clothing. Keep container
closed. Use with adequate ventilation. Wash thoroughly after handling.”
[American Cyanamid Company label which also contained first aid instructions]
This was subject to legal questioning:
"......... the labels did not specifically state, for example, that n-Butanol, propylene glycol
methyl ether, styrene, and vinyl toluene may cause central nervous system depression,
including dizziness, headaches, nausea, and other symptoms. Nor did the labels specifically
13
warn that silica and talc may cause lung damage."
(OSHA (47)
Cyanamid's manager of hazard communication gave the opinion that:
"...the statement "Warning! Causes central nervous system depression" is less effective than
"Harmful if inhaled", because the average worker would not comprehend the former phrase
unless it were explained. As to the suggestion that a list of specific CNS effects be given, she
testified that she doubted that the full list would be as effective as "Harmful if inhaled"
because a worker would "not have the tendency to read through all that". Ms Hanavan also
testified that listing only a single CNS symptom, such as "Warning! May cause dizziness"
would not be quite accurate, because it would describe only one of the many things that could
occur...."
(OSHA (47).
The point that seems to arise about warnings is that there is a design conflict between
accuracy of the message (also in a legal sense) and its effectiveness. Do you tell a person all
the dangers and details in a warning or do you give them a single clear message that is going
to motivate the appropriate behaviour? Again this was something that arose in discussions
with HSE. e.g. HSE did not like the character in the ARM game dying from isocyanate
exposure even though this happened in real life scenarios.
2.6.2 Technical Content
Witte (56) says that the amount of information given influences perceptions. Time and space
are limited. This means information has to be selective. The key question then is what
information to select within time and space limitations.
Quite aside from legal perspectives on accuracy, scientific accuracy and level of detail are
controversial issues in relation to theories about message design. This was certainly found in
the current study within discussions with HSE. Technical content of warnings and hazard
communications appear to be issues for which there is no clear predictive model for the
effects on behaviour so discussions focus more on content than how to get the desired effect.
Questions such as “which is better, a less or more detailed scientific statement” also need to
be addressed. For example (39) compare:
"Scientific research has linked long-term PERC exposure to some kinds of cancer in test
animals"
and
"Scientific exposure has linked long-term PERC exposure to liver cancer in mice and leukaemia in rats. Although no evidence has been found concerning cancer in humans, EPA
considers PERC a 'suspected human carcinogen'.”
The answer is not simple because the effects of technical information are confounded with
other variables and simply highlight the interactive nature of variables that may offset each
other in terms of effects. Using test material which varied in technical detail this research
(39) showed that:
x the actual detail level was not perceived by those tested;
x perceived detail significantly correlated with rating the risk as serious;
x perceived detail was not significantly correlated with intention to take measures.
14
This seems to suggest that when deigning a risk message spending time on delivering detailed
technical content is not a good focus. Getting the required behaviour is more important.
2.6.3 Framing effects
How messages are framed has been shown to affect behavioural outcomes. Framing effects
(such as whether messages are framed in terms of gains or losses) can obscure rationality in
the making of decisions. Tversky and Kahneman (53) showed that when choice options are
framed positively, a decision maker tends to perceive them as gains and becomes more risk
averse. In contrast, when the same choice options are framed negatively, a decision maker
tends to perceive them as losses and becomes more risk seeking. In an imagined situation
where a deadly virus is expected to kill 200 people, Tversky and Kahneman found most of
their subjects (72%) favoured a program with the sure thing (200 people saved) as opposed to
1/3 chance that 600 will be saved and a 2/3 chance that no people will be saved when the
choice outcomes were framed in terms of lives saved. When the same choice outcomes were
framed in terms of lives lost, most of the subjects (78%) in another group favoured the
gamble (the probabilistic outcome), 1/3 chance that nobody will die and a 2/3 chance that 600
will die.
Similarly, Witte (56) cites studies indicating that the extent to which patients chose one kind
of therapy over another depended on whether risks were framed as mortalities or survivability
and not on the accuracy of the data.
A recent study for the HSE (21) indicates that on average current HSE leaflets (analysed for
noise and manual handling) contained primarily negatively framed information. Risk
communications (specifically designed for the study) framed as ‘positives’ (the long-term
benefits of adopting safe working practices) were generally more influential on intentions to
act than negative frames for the sample of HSE leaflet(s).
2.6.4 Order of presentation
Presentation order may be crucial for transmitting information when recency or primacy
effects could come into play. Receivers may remember the last things they heard about or
read about more clearly. On the other hand, important information at the beginning of a
message may be focussed on, and better remembered although frightening information at the
beginning may cause 'shutdown' (Witte 1994).
2.6.5 Information Source
The effectiveness of the impact of risk communication has been regarded rather negatively, in
large part attributed to a lack of trust (Slovic, (51); EC TRUSTNET framework (20)).
Much that is addressed in the context of "risk communication" comes from evaluating the
impact on the public, mainly where there is an attempt to persuade people that they are less
vulnerable to risks than they think. Mistrust and lack of confidence in science can give rise to
the rejection of technological developments, eclipsing arguments for benefits.
Theoretical approaches as proposed by Kasperson and others (40) emphasise the
psychological, social, institutional and cultural processes involved as basis for improved risk
communication. Guidance given to risk communicators (such as Committee on Risk
Perception and Communication, (16); Kasperson and Kasperson, (41)) includes:
x emphasis on factors relating to the way risks are described,
x two-way longer term interactions with the target audience,
15
x empowering the receiver to act on the communication, and
x credibility of the source.
According to the workshop on risk perception and risk communication (Health and Safety
Laboratory, (37)), the context in which the message is delivered, such as whether the source
of information is trusted and credible is far more important than the level of knowledge
communicated.
Knowledge and risk perception may be closely linked but it is not clear whether risk
perception directly affects risk related behaviour or whether they are both have a common
underlying factor. The effect of a message can depend on the receiver's opinion of the source
of the message. Positive attributes of the source include credibility, knowledge and
trustworthiness. Positive effects will be greater if the communicator is perceived as similar to
the receiver.
In a study by Bellamy and Geyer for the Fire Research Station, different ''intelligent" fire
warning systems and the traditional bell were investigated in a simulator. The intelligent
message was “Attention. This is an intelligent fire warning system. There is a fire above you
on the ground floor. Evacuate now.” The use of an intelligent fire warning system was
shown both in research simulation (ref (12)) and in the real life context (refs (13)(14)) to
stimulate a fast evacuation response on hearing the warning whereas the traditional alarm
does not.
So, building intelligence and credibility into the source of a message may be very important.
ARM had to be a believable representation of what would happen in real life, an intelligent
simulation rather than a mere game.
2.6.6 Workplace context and Control
Even if a message is well designed for effectiveness it may be modified by the social and
cultural aspects of the workplace context itself. Even if perception of risk and appropriate
behaviour to avoid harm is accurate there may be job related barriers to taking avoidance
action.
For example, supposing the appropriate protective means are not provided or using them are
considered unacceptable (not macho, too time consuming..)? Supposing the mission of the
organisation (profit maximisations) conflicts with appropriate harm avoidance behaviour of
individuals?
Some say that the safety culture of the organisation has to be improved so that the
organisation learns to prioritise and reinforce its commitment to safety.
According to a view proposed by Rasmussen Ref (50):
"..human behaviour in any system is shaped by objectives and constraints which must be
respected by the actors for work performance to be successful. Such objectives and
constraints define the boundary conditions of the work space within which the human actor
can navigate freely. ..........The result very likely will be a systematic migration towards the
boundary of acceptable performance and, when crossing an irreversible boundary, a local
work accident may occur...........performance is likely to be maintained close to the boundary
to loss of control in a kind of 'homeostasis' being controlled by perception of dynamic control
characteristics of the interaction not by an abstract variable such as 'risk', that is, touching
the boundary of loss of control is necessary.......people are running risks, not taking risks, that
is, action is not controlled by conscious or sub conscious risk perception."
16
Rasmussen suggests that increasing the sensitivity of actors to the boundary of loss-of-control
(or in this case, the boundary of exposure to harm) through health and safety campaigns may
be only temporarily effective because it will be acting against the functional pressure of the
work environment. Another approach is to make the boundary visible:
"..it appears to be essential that actors maintain 'contact' with hazards in such a way that they
will be familiar with the boundary of loss of control and will learn to recover."
Whether this concept can be applied to the risks of occupational ill health is an interesting
question since it highlights the enormous difficulty of making the boundary of exposure to
harm visible and whether stepping over that boundary is recoverable.
An actual example illustrates the problem of why risk messaging may be ineffective. In this
case a young woman undertook an extensive training for developing the skills required for
working in beauty salons. When she took up her first job she discovered that she was allergic
to the creams being used, so much so that she had to change her career. This had not been
discovered during training. Only when creams were being used daily with a high frequency
of hand washing did the problem emerge. When questioned about why she could not wear
protective gloves she replied that this was just not possible in that line of work since it
interfered with the process of massaging the creams into the skin of the client. In addition,
many of the other workers apparently experienced allergies to the protective gloves
themselves.
In this case, the person considered had no power to control the risks. So, a risk message may
communicate the risk but still leave the person feeling powerless to take any action.
Strategies for targeting and changing behaviour may therefore be warranted. These are dealt
with in the next sections.
2.6.7 Targeting behaviour
It has been suggested that the target behaviour should be displayed in the message. For
example:
"Had a few drinks? Get a ride."
Similarly, for the current project we might say:
“Using isocyanates? Get an air supply.”
One of the problems with health risks is the intangible and delayed nature of the effects, so
useful things could be:
x Identifying precursors or symptoms
x Making the target behaviour more conspicuous.
For example, voluntary seatbelt wearing doubled in a part of France where seatbelt users were
encouraged to put a bumper sticker on their car that said "I wear my seatbelt. How about
you?" (Wilde (54)).
In the ARM context this might be a sticker on a full face respirator that reads: "I keep my
visor closed. How about you?" in order to prevent exposures from visor lifting to check
painting quality.
17
2.6.8 Changing Behaviour
So, the purpose of communicating about health hazards it to bring about behavioural change
and not to deliver detailed technical accuracy . Risk communication to bring about behaviour
change has been tried in areas relating to eating, exercise, smoking, driver behaviour, condom
use, AIDS, preventive medicine and practices such as screening, and community health issues
in developing countries. Some of the theory involved in the approaches is described below.
Theory of planned behaviour
Ajzen's (2) theory of planned behaviour has been used to examine behavioural intention.
(see also I. Aizen website: http://www-unix.oit.umass.edu/~aizen/tpb.html). The important
elements are:
x Behavioural beliefs giving rise to attitudes towards the behaviour (favourable or
unfavourable), such as beliefs that using hair spray is very harmful to health but
good for hairstyling.
x Normative beliefs giving subjective norms or perceived social pressures, such as
beliefs that important others do not expect protective gloves to be worn in beauty
clinics.
x Perceived behavioural control derived from control beliefs, such as beliefs about
availability of air supplied respirators, or beliefs that use of air supplied respirators
is not up to them.
The more favourable the attitudes and subjective norms and the greater the perceived control,
the stronger the person's intention to perform the behaviour in question. So, given the
availability of control over behaviour through preventive and protective means, influencing
attitudes and norms could enhance their effective use.
In defining the behaviour (that one wants to change), Ajzen uses "TACT" elements = Target,
Action, Context and Time. So, to measure behavioural change it should be defined in the
same way e.g. not lifting (action) visor (target) in a ventilation booth (context) until the spray
has cleared (time). A related question on beliefs might be: "Do you think it is harmful to lift
your visor in a ventilation booth now and again?"
The theory does not indicate what kind of intervention would be most effective, but it is
suggested that an obvious consideration is the room for designated change. If there are beliefs
that lifting the face visor is not very harmful to health, then this might be an indicator of an
area to tackle when there is a lot of room for change.
According to ref (57) this is one of the few theories to offer a systematic approach to the
construction of the content of the message. Say a person believes that protective gloves are
easy to use, but this is not done because clients do not like it and clients are important. Here,
emphasising the value of protective gloves is fairly pointless. Trying to change beliefs about
what clients think or shifting emphasis to a more important other who does think protective
gloves are important could be useful approaches. E.g. the clientele could be made to feel that
it is socially unacceptable to expect the beautician or the hairdresser not to wear protective
gloves.
18
Health Belief Model (HBM)
This model is one of the most commonly used models of health behaviour change (38).
Apparently two major factors influence the likelihood that a person will adopt a
recommended preventive health action.
x Firstly, a person must feel personally threatened by the disease i.e. they must feel
personally susceptible with serious or severe consequences.
x Secondly, they must believe that the benefits of taking preventive action outweigh
the perceived barriers (psychosocial, physical and financial) to preventive action.
The influencing factors of the HBM in promoting preventive behaviours are [Ref (57)]:
(1) Perceived barriers to performing the recommended response
(2) Perceived benefits of performing the recommended response
(3) Perceived susceptibility to a health threat
(4) Perceived severity of a health threat
(5) Cues to action
The combination of perceived susceptibility and severity provide the motivation for action,
and the comparison of perceived benefits to perceived barriers provides the means or pathway
to action. The stronger the perceptions of severity, susceptibility and benefits, and the weaker
the perception of barriers, the greater the likelihood that health-protective actions would be
taken.
Variables (1) to (4 ) are affected by demographics (age, sex, race etc.), experience, and the
cues to action variable (5). The cues to action can be external such as a risk message, or
internal such as symptoms of asthma, for example. The perceptions trigger the decision
making process whereby the barriers and benefits are weighed against each other.
In general, says Witte (57), perceived barriers to health-protective behaviours have been the
strongest predictor of whether or not individuals engage in such behaviours and perceived
severity the weakest predictor.
On the other hand, if people do not feel at risk from a threat or do not feel the threat to be
significant, they simply will ignore information about the threat. Witte (55) focuses on fear
appeals as cues to action. A fear appeal (often used by parents with their children) typically
focuses on a threat by emphasising severity (size of harm) and probability (likelihood of
target audience experiencing the threat), and then emphasises the “efficacy” of the
recommended response. Efficacy is about the effectiveness of the recommended response
(response efficacy) and about how to easily carry out that response (self-efficacy). When
people become motivated to deter the threat and confront the danger this stimulates adaptive
actions that control the danger.
So, if people believe themselves to be vulnerable to serious risk and that they can effectively
do something about it then they will protect themselves. However, if they believe there is
nothing they can do then they deny that they are at risk and may defensively avoid the issue.
19
So, risk messages may seriously backfire if they create fear in cases where means to
protection cannot be taken.
On the other hand, risk messages using the fear approach have been very successful in a
variety of cases from skin cancer prevention to tractor safety (57). Apparently, with only a
little bit of pilot testing, it is easy to determine an audience's existing perceptions of threat and
efficacy and so to target messages to produce high levels of threat and efficacy that should
lead to danger control actions.
Concept Definition Application
Perceived
Susceptibility
One’s opinion of chances of
getting a condition
Define population(s) at risk, risk levels
Personalise risk based on a person’s
features or behavior
Heighten perceived susceptibility if too low
Perceived Severity One’s opinion of how serious a
condition and its sequelae are
Specify consequences of the risk
and the condition
Perceived Benefits One’s opinion of the efficacy of
the advised action to reduce
risk or seriousness of impact
Define action to take:
how, where, when; clarify the positive
effects to be expected
Perceived Barriers One’s opinion of the tangible
and psychological costs of
the advised action
Identify and reduce barriers through
reassurance, incentives, assistance
Cues to Action Strategies to activate “readiness” Provide how-to information, promote
awareness, reminders
Self-Efficacy Confidence in one’s ability
to take action
Provide training, guidance in
performing action
Figure 6 Health Belief Model Definitions and Application (From Ref. 94)
Stages Of Change model
It may be important to know at what stage the target audience is at. For example, is the
audience completely unaware that it is taking risky action, or are they considering possibilities
for change, or are they committed to change but do not how to achieve it? The idea is to
design messages to move people through different stages of change. The five stages are
shown below with recommended applications (The Communication Initiative, 1998)
20
2.7
CONCEPT DEFINITITION APPLICATION
Pre-contemplation Unaware of the problem
hasn’t thought about change
Increase awareness of need for change,
personalize information on risks and
benefits.
Contemplation Thinking about change,
in the near future.
Motivate, encourage to make specific
plans
Decision/Determination Making a plan to change Assist in developing concrete action
plans, setting gradual goals
Action Implementation of specific
action plans
Assist with feedback, problem solving,
social support, reinforcement
Maintenance Continuation of desirable
actions, or repeating periodic
recommended step(s)
Assist in coping, reminders, finding
alternatives, avoiding slips/relapses
(as applies)
Figure 7 Summary of the Stages of Change Model (Ref. 94)
EVALUATING MESSAGE EFFECTIVENESS
Wilde (54) suggests that social-science information on how people respond to mass-messages
has been slow to develop despite engineering advances in mass communications technology.
One problem is the necessary yardstick.
Ultimately, the effectiveness of hazard communication can only be tested against actual
improvements in health. Increased hazard awareness, for example, is not an effective
yardstick, as shown by heavy smokers or drinkers who are no less aware of the hazards than
abstainers or moderate users, says Wilde.
So, yardsticks need to be defined for measuring message effectiveness. These can include
(54):
Attractiveness/effectiveness ratings
a. attractiveness ratings by a subject sample,
b. effectiveness ratings by a subject sample,
c. effectiveness ratings by experts,
d. the number of people exposed to the message,
e. the extent of message recall
Evaluation of change
f. change in knowledge,
g. change in attitudes or behavioural intentions expressed by the recipients,
h. change in self-reported behaviour,
i. change in behaviour observed under laboratory conditions,
j. change in unobtrusively observed behaviour under real-life conditions,
k. change in the ultimate target, that is, improvement against some definition of "health"
or "quality of life"
Anything which is influenced by intervention can be thought of as an outcome measure and
includes (Witte (57)):
Perceptual variables, such as:
21
1. attitudes, beliefs, intentions
2. perceived severity of threat
3. perceived susceptibility to threat
4. perceived response efficacy
5. perceived self efficacy
6. subjective norm
7. perceived barriers
8. fear
9. defensive avoidance.
Non-reactive measures
1. wear and tear of information materials.
Behavioural measures, such as:
1. number of people who accessed the internet site
2. number of pamphlets picked up at a library
3. number of requests for materials
4. amount of time spent on the materials
5. amount of time spent on the internet
The identification of these measures were useful for generating ideas for measuring the results
in the pilot studies for the current research.
2.8 IMPLICATIONS FOR ADVANCED RISK MESSAGING
x Warnings should be simple, clear and effective rather than detailed. It is more
important to initiate the required response than to provide detailed information.
Therefore detailed information was only provided in ARM if the user requested it.
x Aim for positive framing of messages. Positively framed risk communications are
generally more influential on intentions to act than negatively framed risk
communications. Decision makers also tend to view positive options as gains and
thus become more risk averse. On this basis, ARM used a score system typical of
game play and positive feedback when good control choices are made.
x The information source of a message should appear intelligent and credible. This was
made an inherent feature of the program design.
x A risk message needs to take workplace context into account, such as social
pressures, and the degree of control the individual has over the risks. Strategies for
targeting and changing behaviour therefore have to be considered. ARM was
therefore focused on getting across the essential elements of control rather than try to
cover them all.
x Identifying precursors and symptoms or making the target behaviour conspicuous in
the message itself are two such effective strategies in the process of targeting and
changing behaviour. These were therefore used in ARM by relating symptoms to
control choices.
x Effective ways to change behaviour are to change to beliefs and perceptions people
have about the severity of the risk and the potential damage to their health, and to
make the recommended response appear sufficiently beneficial and easy to carry out.
The risk message must be careful to make the situation not seem hopeless, while at
22
x
the same time showing the risk to be severe enough to induce action on the part of the
person at risk. ARM avoided hopeless situations and work related death.
Measures of message effectiveness should be incorporated into the program. ARM
used a simple questionnaire and a sophisticated measurement (automatically
generated text files of all the users actions and the program response over time when
operating the program.
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3 SOFTWARE DEVELOPMENT STRATEGY
3.1 FUNCTIONALITY
The broad functional specification of the ARM system was as follows:
- can be used to investigate the mental models of people showing risk denial or risk
acceptance characteristics and the sources of denial and acceptance;
- provides an interactive system for effectively communicating about chemical hazards
and risks to health and how to manage them in the workplace;
- could be used flexibly to create risk messages in different contexts (different
chemicals, workplaces etc.);
- can measure whether the communication has been effective;
- can be stored on a disk/CD;
- can be use to provide risk messaging on the world wide web;
- can be used to make object links to the www (wherein more information, such as
HSE electronic information over new hazards).
This functionality has to allow the main objectives of the experimental work to be met:
- to test the effectiveness of the risk messaging system in simulated contexts
- measuring understanding: such as how well subjects learn to stay healthy in the
simulation context in comparison with other (competing) goals;
- measuring intent to take measures against exposure in real life
- making comparisons with standard risk communication (such as written message
effectiveness – using real labelling or MSD sheets, for example) or taking before and
after measures;
- to investigate, in relation to performance scores, the mental models of workers
potentially exposed to harmful chemicals in the context of the advanced risk
messaging system, such as:
- their strategies in responding to information
- information seeking
- information denial
- beliefs and choices
To summarise, the software has two functional components:
1. A risk-messaging component
2. A measurement component
3.2 ARM DEVELOPMENT
The name given to the software to be developed was ARM (Advanced Risk Messenger). The
whole study was planned to take place in a number of phases listed below. The ARM-1
version was produced in phase 3 to enable the carrying out of pilot studies in phase 4. The
system was to be refined and improved and implemented in detail on the basis of the results
of phase 4. This revised software, called ARM-2, was to be delivered in phase 5 for testing
in phase 6 (the experimental approach).
Phase 1: System description and Plan (Report)
Phase 2: Concept design (Report)
Detailed design (Demonstration disk)
Phase 3: Development report (Report)
ARM-1 software (ARM-1 disk)
25
Phase 4: Pilot studies (Report) Phase 5: ARM-2 software (ARM-2 disk) Phase 6: Experimental studies (Report + results replay disk) Phase 7: Final study report (Report)
+
and
-
-
CONCEPT DESIGN:
- process model (functions)
- data model (information/data definition)
- implementation model
(programme + data base + technology)
- user model (user interface)
PHASE 1
Reconnaissance
phase: examine
problems and
solutions Plan of
approach
ARM concept
design
specification
demo disk
PHASE 2
Functional design
process
demo/prototype
PHASE 3
Technical design
implementation
PHASE 4
Introduction
and use
acceptance
tests
Choose solution:
- system boundary
- subsystems
ARM -2
programme
- documentation
PHASE 5
Fine tune ARM-1
Results
of pilot
studies
ARM -1
programme
- documentation
PHASE 6
Experimental testing
Figure 8 ARM Software Development
26
3.2.1 Phase 1
This phase took an evolutionary approach to prototyping. The idea was to develop to a pilot
stage that was acceptable to HSE, test this with paint sprayers, and then modify the tool for
the target users according to the pilot results.
3.2.2 Phase 2
This phase was the system analysis for the development of the conceptual model. The concept
specified a risk messaging system involving self-paced, self-directed learning. The concept
was designed to enable subjects to experiment with different settings in virtual reality, and in
the process to witness the possible effects in the virtual world of their actions (such as
changes in health and finances). The concept was not the actual system, but what it would
look like.
The chemical risk simulation had to be designed for the joint functions of both delivering risk
messages in an interactive situation (to get the message across) as well as measuring
behaviour in order to study it for the characteristics of risk-denial and risk-acceptance groups
in their risk control behaviours.
The idea was to have a number of virtual settings for some ‘mimicked’ chemicals, (in this
case isocyanates), and activities, (in this case paint spraying), so that the behaviour in these
settings could be re-run and studied and performance data extracted and evaluated by the
experimenter.
The design process included:
(a) Data model specification. Consideration was given to incorporating things such as:
- specifying the relevant objects (e.g. chemicals, human behaviour, preventive
and protective devices, actors in the setting)
- person properties (e.g. body parts, senses, actions, memories, communications),
- possible involuntary events in using substance (e.g. inhale, come into contact
with, ignite, get splashed by, etc.)
- possible chemical reactions and properties (e.g. physical, perceptible, toxic,
carcinogenic, irritant, corrosive, flammable etc.)
- health effects (e.g. short term, long term, effects on body, visible, invisible,
cumulative, life-span, comfort),
- social effects (e.g. communication, image, peer perceptions, behaviour of
others)
- settings (paint shop, hairdressers, dry cleaners etc.),
- available actions (select, use, touch, look, smell, listen, wait),
- mission measures (time, risk control, health, wealth, image), etc.
(b) Process model specification, which gives the intelligence of the programme (if-then
algorithms, logic schemes, flow schemes). This describes what the programme does,
such as:
- linking sets of behaviours with possible events in using a substance,
- being able to put together a group of chemical reactions and properties and
then linking these to person properties,
27
- linking action choices to outcomes, such as linking use of preventive
measures to health outcomes,
- linking time passing to actions
- controlling event sequences such as providing action choices which determine
the occurrence of subsequent events.
This creates the causal texture of the virtual world.
(c) Level of implementation specification: what the system will ‘look’ like such as:
- level of graphics, sounds, mode of information presentation
- how the person will interact with the system.
.
By the end of phase 2 it was possible to see the concept model on a demonstration disk.
3.2.3 Phase 3
In phase 3 the design agreed in Phase 2 was implemented. Using relevant tools and standards,
the prototype PC based system was developed. This was the ARM-1 (Advanced Risk
Messenger version 1).
3.2.4 Phase 4
Pilot Studies were carried out in phase 4 using the ARM-1 software. The purpose of the pilot
studies was primarily to test the design of the risk messaging such that it could be improved
for the main study. However, due to difficulties in obtaining subjects from the target audience
and the nature of the results, the work was terminated at this point.
3.2.5 Phase 5
The more detailed design or fine-tuning of the advanced risk messaging system was going to
deliver a virtual reality/interactive learning context which had a good chance of making
people aware of the hazards and of overcoming risk denial. The software was to be called
ARM-2. Because Phase 4 was never finally achieved Phase 5 was scrapped.
3.2.6 Phase 6
The experimental phase using ARM-2 was also scrapped.
3.3 SYSTEM BOUNDARY AND SUBSYSTEMS FOR ARM-1
3.3.1 ARM Subsystems
The ARM subsystems are shown in Figure 9
Cause and effect modeller
The experimenter uses the cause and effect modeller to set up, ultimately, how and what
events to present to the target user.
Databases
These contain all the data required for the simulation.
28
Simulator/messaging system
This system delivers a presentation (input) to the target user. The simulator provides the logic
and the messaging system provides the presentation. The properties of the presentation are the
independent variables in the study. These properties have to include factors as shown in the
Application column of Figure 6,
Results
The data generated by a user's interaction with the simulation (output).
Measurement and analysis
The output data are turned into measurements, the dependent variables. These data may be
measures made at different times in the simulation in order to determine if change in the
dependent variables is occurring, that is 'before' and 'after' measures.
Mental models
The deductions about the effects the messaging system on mental processes was to be used to
fine-tune the cause and effect modeller so as to improve the simulation to provide more
effective messages.
3.3.2 ARM Data Flows
The data flows are shown in and Figure 10.
The data items (rectangles) include:
x Events: the message elements. The events will be things that can happen in the
simulation like: release a chemical, present symptoms, show damaged body parts,
give advice, present a set of choices, wear protection, remove chemical, give
information.
x Event presentation. This means an event presented in a particular mode (symbol,
picture, word, sound....).
x World of simulation: Different possible patterns of events in time and space, their
relations given by if-then 'laws' and the possible modes (sound, symbol, picture,
word, video etc.) of presenting the events to the User. For example, 'open bottle'
might be linked to 'fumes come out' if the chemical is volatile and there may be
different ways of showing the same event.
x World of health: These are cause and effect relations ('health laws') between a
number of things which can be used to calculate exposure dose to different body
parts, as well as symptoms and effects on health. The dose will be related to the
properties of the chemical itself, the type of exposure event, the effectiveness of
prevention/protection, and the frequency of exposure. The properties of the
chemical and the type of exposure event can lead to certain symptoms or
impairments of body function. The dose may lead to a particular disease or disorder
of a certain level of severity (health). Symptoms and health effects will also depend
29
on the susceptibility of the user which may in turn be characterised by factors such
as age, sex, previous illness, whether pregnant etc.
x Health: Possible health effects as a result of exposure. This might be per body part,
or an overall score etc.
x Protection: The extent to which the person is protected from exposure
x Measurements: Data which can be extracted from the simulation
The processes (circles) were designed to include:
x Set up world: the configuration of the data - defining data items and their
relationships. These might be based on:
-the chemical and the hazards
-causes and effects in chemical handling - like inhalation causing symptoms
-susceptibility of the user is related to the threat
-risk control strategies (prevention, protection etc.) and equipment (gloves,
ventilators) and their effectiveness (measured as health/symptoms of the user)
-what the user might hear, see, smell, etc. in the workplace
-available actions of the user and what they can act on and who they can talk
to and what they can ask for etc. and what kind of result they will get.
x Run simulation: This process implements the laws and stage manages the whole
simulation.
x Combine: The process that combines an event with a presentation mode.
x Make interface with user: This is the interfacing process which takes the
presentation to the user and gives the user selected event as output data.
x Determine health effects: The process which, using the laws of health and actual
occurrence of an event as input, identifies protection and exposure events and
calculates dose in relation to level of protection, and the health effects (see World
Of Health) to give health data and may give this as output data as an event such as a
symptom event or health score event.
x Analyse (Exp.): This process is carried out by the experimenter by examining the
data measurements and concluding on the mental models of the user. This
information may then be used to improve the set-up of the system.
30
Figure 9 ARM Subsystems
31
World of
Runmode
Simulated
Laws
World of Simulation
Health
Mental Models
Health
Protection level
Measurements
Set up world
Analyse (EXP.)
Combine
Make interface with user
simulation
Determine Health Effects
Event
Event Presentation
Messaging
System
Analyser
Cause and Effect
Modeller
Presentation
event
User- chosen event
Health Effects
Simulation
Health Laws
Health Laws
measurements
Protection
Event
Figure 10 ARM Data Flow Diagram
32
4 CONCEPT DESIGN
4.1 INTRODUCTION
ARM-1 runs a scenario that is chosen by the user. The prototype was based on real scenarios
described in a NIOSH alert document (Annex I). The choice of target population was spray
painters, primarily in autobody shops, using paints that may contain isocyanates, which may
cause asthma, and ultimately could be the cause of death.
Figure 11 shows the data flow of the application. The design is such that in the scenario the
health of body parts will change based on the choices that the user makes. Things in the
scenario will happen depending on the health of the body parts and depending on the choices
made by the user.
The elements that make up the ARM-1 program are:
- Data (body parts and their health)
- Program flow (scenario, cycles and events).
- User-interface (input and output)
4.2 DATA: "BODY PARTS" AND THEIR HEALTH
"Body parts"
"Body parts is a term defined by the programmer. The most important data of the program
during the scenario run are the "body parts". These elements of the program have a value that
can change during the run of the scenario. The user can monitor the change and can take
appropriate action. The value of the body part (its health) has two aspects, a current level and
a degradation. So, health can be at a current level and can degrade at a certain rate.
Results
During the session (in which one or more scenario runs can take place) everything that
happens (which choices where made at what time) is monitored and stored in a result file.
This file can later be used to analyse the behaviour of the user. When the user ends the ARM
session he/she will be asked to e-mail this result file to White Queen by clicking the
appropriate button.
33
User Timer
triggers
step
Next Cycle
Output (continuous)
clicks on buttons(triggers)
triggers triggers
Check Event
Effects
- degradation - degradation - health - health
Messages Output to user
Bodyparts (result file)
Figure 11 Dataflow diagram of the ARM-1 simulator
4.2.1 Program flow (scenario, cycles and events).
Scenario choice
The program starts with a series of screens and/or questionnaires that enable the user to
choose a scenario. The simulator will then run the chosen scenario.
Simulator (cycles and events)
The simulator runs the scenario in cycles. Every cycle represents a fixed amount of time,
usually a 10th of a year but this can change per scenario. In real time the user controls the
duration of cycle. It can be the time in which the program is put on pause by the user or the
speed at which the user wants the scenario to run.
During each cycle a number of events can happen. Events are processes in the scenario that
are started by either the user or the simulator itself.
x The user can start events by button clicks.
x The simulator can start events when a predefined condition is met. This can be a
certain health of a "body part", a certain time or just one event starting another
event.
34
x The events can in their turn change the health level or the speed of health
degradation of body parts.
x At the end of each cycle the effects of the executed events in the current cycle are
determined:- Health effects. The health of body parts is changed according to the
current degradation rates.
x New events can be triggered based on a new health level reached by a body part.
x New events can be triggered based on a time that is reached in the scenario (age).
Program End
After the scenario run there will be a questionnaire and the option to e-mail the results to
White Queen.
35
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36
5 DETAILED DESIGN
5.1 INTRODUCTION
In phase 3 of the development of the Advanced Risk Messenger (ARM) the software program
concept design specified in Phase 2 was implemented. During phase 3 development new ideas
were incorporated into the design. The prototype PC based system is called ARM-1
(Advanced Risk Messenger version 1).
5.2 ARM-1
The Advanced Risk Messenger (ARM) is a tool for communicating the risks and risk controls
to paint sprayers using paints containing isocyanates and others in the workplace who are also
at risk from exposure. Small autobody repair shops are targeted. The risk is occupational
asthma.
Figure 12 The start screen
ARM-1 has developed as a simulation game where it is possible to play the role of Mark who
is a paint sprayer in an autobody shop. The design of ARM-2 which was to follow was to
include Liz who works in Quality Control in another repair shop but who may also be at risk
from inhaling spray containing isocyanates. Details of this scenario, to based on a real case,
were never able to be obtained due to confidentiality.
37
Figure 13 Choosing who to play
38
Figure 14 The simulation screen
39
Figure 15 The introduction screen
40
5.3 EXPERT ADVICE: BIOMEDICAL SCIENCES GROUP
In developing a lot of the key content aspects of ARM-1 some very important information
was acquired from the Health and Safety Laboratory Biomedical Sciences Group in Sheffield:
Dr Andrew Curran (Head) , Dr David Fishwick (Consultant chest physician and Chief
Medical Officer) and Kate Jones (Senior Scientist).
In order to home in on the really important aspects of the message the group helped to
identify key factors by answering the author’s questions about cause and effect relationships
and discussing real live cases of occupational asthma. The results were as follows:
5.3.1 Exposure identification
Biomedical Sciences Group:
Air sampling is complex and does not give an answer about exposure. Urine sampling can be
undertaken before symptoms develop and can then see if protection is working or not.
Biofeedback is best.
ARM:
Biofeedback was built into the simulation:
Ask Kate Jones “Have I
been exposed?”
Figure 16 The player can click on this button to ask Kate Jones about exposure.
41
The player will receive a positive or negative response depending on whether they were
exposed. Clicking on the button when not at work always gives a negative since the urine
sample must be within 2 hours of working. The player can seek more information in the
ARM library:
Figure 17 ARM advice screen "Kate Jones"
The player can contact Kate Jones (who is an actual person) upon quitting the ARM game.
42
Figure 18 One of the ARM quit screens
Figure 19 Clicking on the email button starts the email dialogue
43
5.3.2 Reading the Label
Biomedical Sciences Group:
R42 is the most important thing to be alert to on the label
ARM:
The player is encouraged to read the paint label. The advice screen highlights the importance
of the word Isocyanate, and of R42 and S23.
Figure 20 The player is told what sort of paint Mark is using and can choose to get help in reading the label.
44
5.3.3 Protection
Biomedical Sciences Group:
The key elements of protection are a proper face mask that fits, a properly maintained
ventilation booth and training. Non-sprayers can have contact with isocyanates if the disposal
of the vapour is not properly controlled. Because of paint spray the sprayer often cannot see
through mask so he lifts the visor to see how it is going. Even if spraying has stopped and
there is a ventilated booth there may still be vapour in the booth. ARM:
These 3 elements determine the 3 key working conditions (Good, Average, Bad) which
subsequently affect health.
The relationships for the paint sprayer are:
Supplied air respirator + Ventilation booth + Training = good
Supplied air respirator + Ventilation booth + No training = average
Supplied air respirator + No booth + Training = average
Any other condition = poor
The health value does not degrade for “good”, degrades for “average” and degrades even
faster for “poor”.
If the “Liz” scenario were to be developed in ARM-2 this would be used to give the message
that colleagues can also be affected even if not spraying paint. The operation of the
ventilation booth would be an important factor here.
45
Figure 21 Choice screen for breathing protection and the optional ARM advice which appears if the player clicks on Ask for Information
46
.
Figure 22 Ventilation choice screen and the optional ARM advice, which appears if the player clicks on Ask for Information
47
Figure 23 Training choice screen and the the optional ARM advice which appears if the player clicks on Ask for Information
48
5.3.4 Symptoms and what to do
Biomedical Sciences Group:
Symptoms (in order):
1) Nasal symptoms
2) Chest tightness and wheezing (could be cough but less likely)
3) Improvement on holiday
4) Rest day improvement
5) Intensity and duration increases
6) No rest day improvement but maybe on holiday
7) Medication: Inhale steroid – presenter; beta 2 agonist – reliever
8) Increased reliance on medication
The GP may miss the issue so it is important that the person tell the GP that they think it is
occupational. A clinician is needed for diagnosing. The standard tests are:
x Questionnaire: history and physical examinationx Peak flow monitoring x Bronchial provocation – provoke asthma – non-specific + specific x Skin prick testing x Blood and urine
The patient should tell his/her GP, “I need to see a specialist. I am working with something
known to cause occupational asthma.”
The bottom line for most people is financial loss. Some want to struggle on. In principle, the
employer is obliged to do something but employees are reluctant. For compensation, they
should ask the DSS. They need the diagnosis and to prove they were working with an
asthma-gen.
ARM:
ARM gives the symptoms sequence in ARM advice. The symptoms also appear in the
simulation depending on the health level. A visit to the GP is always possible. The GP
always offers medication and the opportunity to see a specialist, which the player may take up
if he/she chooses. The GP will say the patient is fine if the health level to which a person
could return is the maximum possible. Since this maximum possible health can degrade such
there are lower level maximums representing increasing irreversible damage: first level
maximum and second level maximum. Once the second level is reached, the specialist will
say the patient has asthma.
ARM also deals with obtaining compensation. This is illustrated in Section 5.4.2 under the
message aspect: “Getting occupational asthma is not inevitable or hopeless”.
49
Figure 24 ARM asthma advice
Figure 25 First symptom as it appears in the simulation
50
Figure 26 Second symptom as it appears in the simulation. This symptom often repeats
Figure 27 Later symptom of occupational asthma. In the simulation the patient recovers some health after being in hospital.
51
Figure 28 Severest symptom of occupational asthma as it appears in the simulation
52
Figure 29 Clicking on the Doctor icon can have one of two results
53
Figure 30 Clicking on Specialist can have one of two results
54
Figure 31 ARM advice on what the specialist does
55
Figure 32 ARM information about medicines
56
5.4 DETAILED DEVELOPMENT PROCESS
5.4.1 Introduction
There were a number of difficult aspects of the detailed development of ARM-1.
1. Determining the key elements of the message
2. Measuring the response
3. Problems and solutions
5.4.2 Determining the key elements of the message
Getting occupational asthma is not inevitable or hopeless
The first real demonstrable prototype presented to HSE was based on a real life scenario. In
this instance the person ultimately dies on the way to hospital after having an asthma attack at
the age of 47. However ARM-1 now avoids giving the idea that exposure to isocyanates is
inevitable and hopeless. The simulation achieves this message in the following way:
x Using the correct PPE and training results in no symptoms of asthma and living to a
ripe old age (80). If an incorrect strategy is taken there is always the opportunity to
go back in time and try again
x Work conditions can always be changed at any time and limit further damage to
health if conditions are improved
x It is possible to stop work and get financial compensation provided medical
evidence of occupational illness is obtained.
Figure 33 The main ARM screen also showing the opportunities to change work conditions and to go back in time
57
Figure 34 The opportunity to undertake time travel to avoid possible earlydeath
Figure 35 The time travel interface where it is possible to go back in time a chosen number of years
58
Figure 36 Going on holiday results in an improvement in health if alreadysensitised
Figure 37 Stopping working results in an improvement in health if alreadysensitised but money goes down due to monthly outgoings and no income
59
Figure 38 It is possible to get financial compensation if you have acquired medical evidence of work-related ill health
Figure 39 If when working you apply for and get positive urine tests or during or after giving up work you ask to see a specialist who diagnoses that you
have asthma then this is sufficient evidence for getting compensation later.
60
Figure 40 Even if already suffering from asthma, getting no medical evidence will result in a failure to get financial compensation
Figure 41 Stopping work without compensation can have financial consequences, but it is still possible to travel back in time. Having no money
automatically ends the game
61
Figure 42 ARM advice Compensation. This screen is a copy from the web siteof John Pickering & Partners and was very informative
Figure 43 If all goes well you live to old age
It is possible to have health, wealth, fun and longevity
A scoring system was developed for ARM-1 that takes account of the player’s different
lifestyle preferences. The player’s order of priorities weights numerical values of age, money,
health and fun and gives a total score. The player:
62
x ages by one tenth of a year every cycle (let’s call this an ARM month),
x acquires money every month if working or receiving compensation
x loses money every month if not working and not receiving compensation
x can have fun and improve health (if sick) by going on holiday although this costs
money
x eventually gets unhappy if working without a break
x loses health if exposed to isocyanates
x improves health when on holiday or not working
x has to pay a small amount for medication although this improves health
x has an ended game when health runs out
The scoring system is actually quite subtle and even has aspects built into it which change as
the person gets older. A person may be able to retire early and have enough money to live on
until they reach old age (80). Poor conditions produce much lower score results. Best scores
are generally achieved with good conditions, lots of holidays, and retiring, depending on the
priorities of the player. Going back in time goes back to the conditions the first time the
person was that age e.g. at 76 going back 10 years goes back to the first time the person was
66. It is possible to endlessly go back in time to try to optimize the scoring.
Figure 44 The player chooses the sequence of importance of the four factors
63
Figure 45 Fun, health, age, money (left panel) and total score (top right)
If the player does well he or she gets in the High Scores table
Figure 46 The high score table
64
Isocyanates can cause occupational asthma
The relationship between exposure and isocyanates is shown by delivering symptoms at the
appropriate point of health degradation. Avoidance of exposure can be controlled and
checked for effectiveness. Repeatedly taking medicines will improve health to the possible
maximum but cannot totally cure.
The player should know there are isocyanates in the paint if he/she has checked the paint
label. There is a constant reminder of this every time there is a selection of work conditions
including Change Work Conditions. The various relationships have already been discussed in
section 5.3.4.
5.5 MEASURING THE RESPONSE
5.5.1 Terminology of the output files
Every time the player plays a game the simulator and user events are recorded in a unique text
file with the format “armdat 09 11 2002 00,19,53.txt”. This file is a conversion
of the binary armdat.dat file with the date and time use in the file name. The contents look
like this:
5.5.2 Main scoring cycle
1. There are three components to the score: Money, Health and Fun. When the priorities
are chosen by the player, these components are given a rating of 1.0, 0.8, and 0.6
according to the order in which they are chosen.
Purpose: A person may make choices according to their life priorities. In the game
the persons scoring will be weighted according to his/her priorities, reflecting whether
they are achieving (or not achieving) their life priorities. The position of “Long Life”
does not affect the results because of HSE sensitivity concerning a "death" message
(this variable was discarded from an earlier version but remains in the Quality of Life
list).
2. In the engine of the program (not seen by the player) all three components start at
1000.
3. The age of the person at the start of the game is 31. The player can see their current
age status.
4. Depending on working conditions, the rate at which the various components change
is set.
i) Money (“money” in the output file) is fixed at £15,000 /yr or
£225/cycle. The Player sees his/her current total money status.
ii) Fun (“fun” in the output file) change ranges from -45 to -10
depending on settings. The changes attributable to the various
settings are:
a) 0 for Ventilation booth (“booth” in output file), -10 for no booth
(“no booth”).
b) One of: -10 for Air supplied respirator (“hood” in output file)., -
15 for Paint spray respirator (“gas mask” in output file) , -20 for
65
Dust Mask (“face mask” in output file), -25 for no mask (“no
mask” in output file).
c) 0 for training, -10 for no training.
These three values are added up to get the change in fun per cycle.
iii) Health (“Asthma” in output file) change is set as follows:
a) If there is Air supplied respirator (“hood”), a ventilation booth
(“booth”) and training (“training”), it is 0.
b) If there is a air supplied respirator (“hood”) and training
(“training”), it is -3.
c) If there is an air supplied respirator (“hood”) and a ventilation
booth (“booth”), it is -3.
d) Otherwise it is -6.
5. On each cycle, the components change by the result in step 4.
6. As the person gets older, the value of fun and lungs (in terms of points) increases.
The scale factor is 0.1+(status.Age-31)*0.9/49.
7. To calculate the score the following happens:
i) money is converted to "moneyPoints". This process is done by
(non-linearly) scaling money. £1000 is worth 100 points while
£100,000 is worth 600 points.
ii) age is converted to "agePoints" linearly with being 70 years old
worth 1000 points.
iii) lungs are changed by the scale factor derived in step 6.
iv) fun is changed by the scale factor derived in step 6.
v) all four of the above are multiplied by the respective priorities
given in step 1 and then summed.
vi) because the weighted sum does not start at 0, the initial sum from
the 1st cycle is subtracted from v) to give the actual score.
5.5.3 Image displays
Dependent on the value of “asthma”, the following images are displayed together with a “thermometer” indicator: \
>950 Good health and lungs show a green colour
550 to 950 Average health and lungs show yellow
<550 Bad health and lungs show red
Similarly depending on the value of fun, the following images are displayed:
66
>750 "Happy" face
400 to 750 "Ok" face
<400 "Sad" face
5.5.4 Health events
Health events such as a mild asthma attack occurs when the health value crosses the following
boundaries and is decreasing:
900 mild asthma
attack
800 asthma attack
700 asthma attack
650* asthma attack requiring a hospital stay
500 asthma attack
67
450 prolonged asthma attack
300 asthma attack
<50** fatal asthma attack
* This only occurs the first time the boundary is crossed or if an asthma attack has occurred since the last hospital stay. ** Any value below 50 results in a fatal attack. When the age of the player reaches 80, the person dies a natural death.
Associated with “asthma” is a value called currentMax which starts at 1000 and is used as a
cap on “asthma”. This is intended to reflect the fact that an asthma attack causes permanent
damage to lung capacity which cannot be restored. CurrentMax changes value on the
occurrence one of two events:
1. Asthma attack. This results in currentMax being decreased by 100.
2. A hospital stay. This results in currentMax being set to 700.
When the doctor is consulted, if the “asthma”< currentMax, then asthma is diagnosed.
Otherwise the person is diagnosed as healthy.
When the specialist is consulted, if currentMax<850, then asthma is diagnosed. Otherwise the
person is considered healthy.
68
When Kate Jones is consulted, if the change in “asthma” per cycle is negative, the test is
positive. Otherwise it is negative. If the person has stopped working then the change in
“asthma” just before work was stopped is considered.
Medication: Each time medication is taken, “Money” is decreased by 50 while “Asthma” is
increased by 40(subject to the latter not exceeding currentMax).
5.5.5 Stop Working
If the person stops working, the change in Asthma is set to 1(i.e. slowly getting better) while the change in Money is £-75. The change in Fun is set to 0.5.5.6 Holidays
While the person has more than £500, he can go on holiday. During this time, “Money”
changes by £-100, “Fun” by 40 and “Asthma” by 1. Once Money has fallen below £500, the
person has to go back to work if they are not getting compensation.
5.5.7 Compensation
When the person stops work, he may try to claim compensation. The person is only eligible if
they have seen either the specialist or Kate Jones and have been diagnosed as having asthma
or having been exposed to isocyanates.
If a person wins compensation, they get an initial income of £75/cycle while not working.
This slowly decreases down to £10/cycle.
5.6 WHEN THE GAME ENDS OR IS QUIT
At the end of a game the user is given a questionnaire which they are invited to fill in.
69
Figure 47 Questionnaire
On quitting the program the user is asked to mail the files and offered the opportunity to
receive a test kit for isocyanate exposure.
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5.7
Figure 48 Quit screen
EXAMPLE RESULTS
Details on the interpretation of the results files are shown in Annex III.
Date; Time; Age; Score; Event;
Bodypart; CurrentMax; Health; Change
14-11-2002; 00:14:09; 80.1; 1260; Player: linda;
14-11-2002; 00:14:09; 80.1; 1260; Mark Scenario Chosen;
14-11-2002; 00:14:09; 80.1; 1260; Open Scenario;
Asthma; 1000; 1000; 1; ;
; 0; 0; 0; ;
Money; 10000; 31675; -75; ;
Fun; 1000; 0; 0;
14-11-2002; 00:14:10; 80.1; 1260; Priority: Long Life;
14-11-2002; 00:14:10; 80.1; 1260; Priority: Fun;
14-11-2002; 00:14:11; 80.1; 1260; Priority: Health;
14-11-2002; 00:14:11; 80.1; 1260; Priority: Money;
14-11-2002; 00:14:12; 80.1; 1260; End Paint Panel;
14-11-2002; 00:14:12; 80.1; 1260; Select Hood;
14-11-2002; 00:14:14; 80.1; 1260; Select With Booth;
14-11-2002; 00:14:14; 80.1; 1260; Trained;
14-11-2002; 00:14:14; 80.1; 1260; Close Scenario;
14-11-2002; 00:14:14; 31; 0; Start;
Asthma; 1000; 1000; 0; ;
; 0; 0; 0; ;
Money; 10000; 1000; 225; ;
Fun; 1000; 1000; -10;
14-11-2002; 00:14:16; 31.1; 4; Routine recording;
Asthma; 1000; 1000; 0; ;
71
; 0; 0; 0; ; Money; 10000; 1225; 225; ; Fun; 1000; 990; -10;
The results files contain all the information about what the player does: 14-11-2002; 00:16:33; 74.3; 951; TimeTravelInterface;
Asthma; 700; 630; -6; ;
; 0; 0; 0; ;
Money; 10000; 55825; 225; ;
Fun; 1000; 0; -25;
14-11-2002; 00:16:34; 74.3; 951; BackInTime25Years;
Asthma; 700; 630; -6; ;
; 0; 0; 0; ;
Money; 10000; 55825; 225; ;
Fun; 1000; 0; -25;
What they see: 14-11-2002; 00:16:31; 72.4; 937; Open Doctor: ASTHMA ATTACK;
Asthma; 900; 694; -6; ;
; 0; 0; 0; ;
Money; 10000; 51550; 225; ;
Fun; 1000; 0; -25;
14-11-2002; 00:16:31; 72.4; 937; Close Doctor;
14-11-2002; 00:16:31; 72.4; 937; AsthmaAttack;
Asthma; 800; 694; -6; ;
; 0; 0; 0; ;
Money; 10000; 51550; 225; ;
Fun; 1000; 0; -25;
And what they do: 14-11-2002; 16:24:36; 43.5; 175; Open Advice MEDICINE;
Asthma; 700; 518; -6; ;
; 0; 0; 0; ;
Money; 10000; 26575; 225; ;
Fun; 1000; 0; -35;
14-11-2002; 16:24:37; 43.5; 175; Close Advice MEDICINE;
14-11-2002; 16:24:38; 43.5; 175; Open Advice ASTHMA;
Asthma; 700; 518; -6; ;
; 0; 0; 0; ;
Money; 10000; 26575; 225; ;
Fun; 1000; 0; -35;
14-11-2002; 16:24:38; 43.5; 175; Close Advice ASTHMA;
These data files provide the source of information for analyzing how people are behaving
when confronted with ARM.
At the end of each game or on quitting the player sees a questionnaire. What they fill in is
also recorded in the armdat.txt files such as:
19/12/2003; 12:44:22; 80.1; 2096; 1) Yes;
19/12/2003; 12:44:22; 80.1; 2096; 2) No;
19/12/2003; 12:44:22; 80.1; 2096; 3) Yes;
19/12/2003; 12:44:22; 80.1; 2096; 4) No;
19/12/2003; 12:44:22; 80.1; 2096; 5) Dont Know;
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5.8 PROBLEMS AND SOLUTIONS
One of the biggest problem was the amount of development time required for putting together
the graphics:
x Finding suitable visual representations on the internet e.g. a person wearing an air
supplied respirator and spraying a car, a ventilation booth that looks like a
ventilation booth
x Modifying and combining graphics to fit the message e.g. the development of
asthma symptoms
x This time and difficulty in trying to get the message right was severely
underestimated for this part of the project.
Another very big problem was realism in the simulation. Trying to get health, doctors,
specialists, applying for compensation, money to respond as in the real situation, and getting a
sensible balanced scoring system was fraught with having to repeatedly test evolving ARM
models. Small differences in how the simulation responds can give a the wrong message
from what is intended. For example, it was no mean feat to make it possible to go on holiday
for a realistic length of time, and to build up enough money to retire without it being so much
that retirement at a young age was feasible. In the second stage of ARM-1 development,
having a mathematician doing the programming was exceptionally valuable.
Additional considerations in functionality, such as how the program should run if it were on a
computer in a doctor’s waiting room (and therefore maybe have different players in sequence)
were also met e.g. user fills in a name which appears on the txt file and quitting still leaves the
Start screen visible for the next player.
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Figure 49 All the ARM advice screens in the library took considerable time and effort to develop. Limited visual space meant carefully selecting what goes on
the screen but the screens remained too busy.
Some things have inevitably had to be left out.
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Figure 50 The HSE page from the library gives further information sources.
Pre-pilot tests using young children (hence low reading age) showed that they could play the
game quite easily without any briefing. At this stage the introductory screen showing what
the game is about and the scoring principles (as requested by Chairman of the MVRHS
Forum prior to it being demonstrated) had not been introduced and subjects were more
exploratory than in the pilot results. Post pilot testing suggested a deadening effect of the
game play screen on exploring possibilities.
Although the game rapidly becomes boring (especially in Good conditions), the user starts to
learn very quickly what the essential risk controls are for isocyanate paint spraying. In 10
minutes a child was able to repeat back the details of all the 3 essential elements of mask,
booth and training. A Dutch teenager could specify the correct mask after 5 minutes after
having failed with incorrect ones. So, a high level of language comprehension was not
needed to learn the correct controls. This seemed to give the green light for the pilot studies
to begin.
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6 PILOT STUDIES
6.1 SETTING UP THE STUDIES
20 CDs of ARM Pilot 1 were distributed via the Motor Vehicle Repair Health and Safety
Forum in Birmingham on in May 2003. The CDs were handed out together with a floppy
disk and a stamped addressed envelope for those who have no email. The size of results files
meant that around 10 could fit on a floppy. The first 10 game files were requested whatever
the manner of returning them. The volunteers from the forum distributed the packages in the
vehicle paint spraying industry. It was later checked that this had been done.
Following this a further 20 were sent to a researcher at Birmingham University who was
subcontracted to collect data, offering to pay each subject £ 15 for a set of 10 results. He used
x Letters to individual Companies: No replies
x Advertisements in Local Newspaper: No replies
x Telephoning 20 individual Companies: 3 took CDs
x Visiting 10 local companies and leaving 5 CD’s. On return 2 weeks later no-one
had tried to play.
6.2 SENDING OUT THE PROGRAM AND GETTING THE RESULTS
The ARM-1 exe file must be copied into a directory on the player’s computer. Besides copying the exe file to a directory, at the start of the game Players are prompted toselect a place for their results files:
Figure 51 ARM screen requesting the player to choose a location for the results files
This can be the a: drive if the person wants to record directly onto the floppy.
77
In conclusion, the player would know exactly where all the copied and created files are which
can be safely deleted when the game is over.
Besides having the game on CD it was put on a web site for downloading at
www.whitequeen.nl. The program is around 4MB when zipped which takes a short time to
download.
6.3 THE RESULTS
6.3.1 Number of returns
Only 3 sets of results were returned totalling 23 scenario runs:
x Dec 2003 (Player 1) and March 2004 (Player 2) from the Birmingham paid sample
(10 games each), and
x Jan 2004 (Player 3) from the Motor Vehicle Repair Health and Safety Forum
sample (only 3 games).
x The researcher in Birmingham reported:
“I cannot see any more data coming through as people either are not bothered or find it
boring to play.”
“I asked the paint sprayers / office employees, why they did not play the game. The answer
always came back the same. ‘We just never got round to it,’ or ‘Have not got time.’ The
attitude towards playing the game was very poor. Whether this is a local attitude or
nationwide I do not know. The incentive of £15 did not encourage any progress. It is my
opinion that most people in this profession would rather spend their evenings at home in front
of the TV or in the local pub with friends. The idea of playing a game for research always
gets put to one side. One manager did say that he doubted if most of the staff had home
computers. This I found hard to swallow, so I asked a few friends of mine who work in the
safe making industry in ……. to ask around the factory and find out how many staff had
computers. Out of the thirty or so people that worked there only 5 people had home computers and 2 of those were the management. However most of them had Play stations, or
X-box’s. It may be that any simulation game should be produced for the Play station or X-
Box, rather than a PC. The target audience does not seem to have the equipment to play the
game. Either this or they are simply not interested.”
One of the volunteers at the Motor Vehicle Repair Health and Safety Forum who took the
CDs and who had worked for 25 years in the industry said they were not surprised that no
results came back. He suggested that this was a reflection of how little people care about
health and safety in small enterprises; a motivational problem. He felt that health and safety
only really works where the trade unions are involved and hence bigger organisations, (which
were not the target here).
6.3.2 Questionnaire
There were 23 games played. There was no differences in questionnaire response between the
first game and the last game played for the 3 spray painter players.
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Table 1 Questionnaire responses of 3 paint sprayers
Question Frequency of responses of 3 paint sprayers over 23 trials
Yes No Don’t know
Do you think asthma is serious 23 0 0
Is work more important than worrying about health 0 22 1 (player 2)
Will you be more careful with spray paints in the
future?
23 0 0
Do you think ARM is a good teacher? 0 10 13 (player (players 2
1) and 3)
Are you going to ask for healthier working 0 1 22
conditions? (player 1)
Risk perception: All responses indicated asthma was serious. Importance of health: The majority response was that work was not more important thanhealth. Behaviour change: All responses indicated that the subjects would be more careful with spray paints in the future. ARM as a teacher: ARM was either considered NOT a good teacher (Player 1) or the respondent could not decide (Players 2 and 3). Ask for healthier working conditions: One response was a definite no (may have been amiss key) and the rest were uncertain.
6.3.3 Actions during play
The most notable finding was that no player on any of their runs ever checked for information
using the Ask for information button (with one exception, see next paragraph). Examples
from each of the 3 players are shown in Fout! Verwijzingsbron niet gevonden..
Each of the runs from start (age 31) to end (dying of old age) were played for less than 5
minutes. Choice screens and feedback (doctor, biofeedback etc.) were hardly looked at when
they appeared (for only 2 or 3 seconds before being clicked away). The only exception was
Player 2, run 8. At the “Mark’s paint, look at the label” screen he clicked on Ask for
information and looked at the information screen about the paint label twice, in total for 12
seconds.
Two of the Players did seek medical information and consulted Kate Jones about exposure to
isocyanates where they had previously had declining health indications and/or asthma
symptoms. In the only run where the player contracted asthma he also consulted a specialist,
stopped working and sought and won compensation. This player went on consulting the
doctor on all his subsequent runs.
Of the 23 runs, there was only one case where the subject started with the wrong protection
(player 2, 1st run). Although he chose the Ventilation booth and Trained he selected
Respirator for lacquers and enamels. As a result he was the only one to get asthma. Player 2
in all his subsequent runs (where he had all 3 protection levels) worked, went on holiday, and
had checkups with the doctor. In all other cases the subjects began each run with the Air
79
supplied respirator, the Ventilation Booth and Trained. Player 1 changed conditions part way
through to Respirator for lacquers and enamels but then quickly changed back. He then
checked up for his exposure with Kate Jones and with the doctor. On all other runs he just
worked and went on holiday . Player 3 just worked, went on holiday and retired around 60 on
all his runs.
Table 2 Examples from the 3 players showing range of responses
Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
Order of Health, money, Fun, health, Fun, money, Fun, money, Long life, fun Priority: fun, long life money, long life long life, health long life, health health, money
Breathing Air supplied Air supplied Respirator for Air supplied Air supplied protection: Respirator Respirator lacquers and Respirator Respirator
enamels
Workplace: Ventilation booth Ventilation booth Ventilation booth Ventilation booth
Ventilation booth
Training: Trained Trained Trained Trained Trained
Events
31 Start working Start working Start working Start working Start working
32 7 DAY HOLIDAY
32.1 14 DAY HOL
32.2 5 DAY HOL
32.7 4 DAY HOL
32.8 5 DAY HOL ASTHMAMILD
33 15 DAY HOLIDAY
33.1 ASTHMAMILD
33.3 CLICK ON DOCTOR
5 DAY HOL
("you are fine" not visible)
33.3 SEE SPECIALIST (Told: YOU ARE FINE)
33.8 4 DAY HOL
34 STOP WORKING 7 DAY HOLIDAY
34.1 7 DAY HOL
34.4 5 DAY HOL
34.5 BACK TO WORK Air supplied respirator, booth, trained
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Table 2 cont.
Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
34.8 CHANGE CONDITIONS (Air supplied respirator, No booth, Trained
34.9 6 DAY HOLIDAY ASTHMA ATTACK
35.1 9 DAY HOL 14 DAY HOL
35.2 ASTHMA ATTACK
35.4 4 DAY HOL
35.6 CLICK ON DOCTOR
35.6 SEE SPECIALIST (Told: YOU HAVE ASTHMA)
35.7 6 DAY HOL
35.9 CHANGE CONDITIONS (Air supplied respirator, Booth, Trained
36.5 4 DAY HOL 4 DAY HOL
37 14 DAY HOL
37.2
37.5 5 DAY HOL
37.8 7 DAY HOL
37.9 14 DAY HOL
38.3 3 DAY HOL
38.8 4 DAY HOL
39.1 7 DAY HOLIDAY
39.2
39.4 4 DAY HOL
39.7 5 DAY HOL
40 ASK KATE JONES (Told: NOT recently EXPOSED to isocyanates)
40.1 14 DAY HOL
40.4
41 5 DAY HOL
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Table 2 cont. Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
41.2 7 DAY HOLIDAY
41.6 7 DAY HOL
41.8 16 DAY HOLIDAY
42.3 CHANGE CONDITIONS (respirator for lacquers and enamels, booth, trained)
42.4 8 DAY HOL
42.5 4 DAY HOL
43.1 7 DAY HOLIDAY
43.2 CHANGE CONDITIONS (air supplied respirator, booth, trained)
43.3
43.7 8 DAY HOL
44.1 10 DAY HOL
44.7 7 DAY HOL
44.8 4 DAY HOL
45
45.1 14 DAY HOL
45.2 ASTHMA 4 DAY HOL ATTACK
45.5 CLICK ON CLICK ON DOCTOR DOCTOR
(NOTHING)
45.5 SEE SPECIALIST (Told: YOU HAVE ASTHMA)
45.6 ASK KATE JONES: Told: Not recently exposed to isocyanates
45.8 CLICK ON DOCTOR ("you are fine" not visible)
46.2 4 DAY HOLIDAY
46.3 5 DAY HOL
46.5 5 DAY HOL 7 DAY HOL
46.9
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Table 2 cont. Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
47 3 DAY HOL
47.4 4 DAY HOL
48 3 DAY HOL
48.1 14 DAY HOLIDAY
48.2
48.3 STOP WORKING
48.6 5 DAY HOL
48.8 7 DAY HOL
49 3 DAY HOL
49.3
49.7 BACK TO WORK air supplied respirator, booth, trained
50 3 DAY HOL
50.1 5 DAY HOL 22 DAY HOLIDAY
21 DAY HOL
50.3
50.6 CLICK ON DOCTOR (NOTHING)
50.7
51.1 3 DAY HOL
51.2 4 DAY HOL
52 7 DAY HOL
52.2 3 DAY HOL
52.4 7 DAY HOLIDAY
52.5 27 DAY HOLIDAY
53.1 3 DAY HOL
53.5
53.6
53.8 8 DAY HOL
54.1 3 DAY HOL
55 3 DAY HOL
55.1 STOP WORKING
55.2 ASTHMA 14 DAY HOL ATTACK
56 6 DAY HOL 3 DAY HOL
56.3 ASK KATE JONES: Not exposed
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Table 2 cont. Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
56.5 7 DAY HOL
56.6 Asks for and GETS COMPENSATIO N
56.9 13 DAY HOLIDAY
57 3 DAY HOL
57.1
57.3 BACK TO WORK (Air supplied respirator, Booth, Trained)
57.6
58 3 DAY HOL
58.1 15 DAY HOLIDAY
4 DAY HOL
59 3 DAY HOL
59.5 10 DAY HOL
60.1 7 DAY HOLIDAY
4 DAY HOL
60.3
60.4 12 DAY HOL
60.7
60.8 7 DAY HOL
61 3 DAY HOL
61.1 STOP WORKING
61.2 7 DAY HOLIDAY
61.3 4 DAY HOL
62 5 DAY HOL
62.1 14 DAY HOL
62.7 15 DAY HOLIDAY
62.8
63.1 8 DAY HOLIDAY
63.3 5 DAY HOL
64
64.1 4 DAY HOLIDAY
64.4 7 DAY HOLIDAY
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Table 2 cont. Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
65.1 14 DAY HOLIDAY
14 DAY HOL
65.2 ASTHMA ATTACK
66.2 7 DAY HOL
66.4 7 DAY HOLIDAY
67.3 14 DAY HOLIDAY
67.4
67.6 7 DAY HOL
68 10 DAY HOL
68.1 7 DAY HOL
68.3 7 DAY HOLIDAY
69.1 4 DAY HOL
69.2 7 DAY HOLIDAY
70 14 DAY HOL
70.7 8 DAY HOLIDAY
70.8
71.1 7 DAY HOL
71.9
72
72.2 7 DAY HOLIDAY
72.3 21 DAY HOLIDAY
72.6 14 DAY HOL
72.9 CLICK ON DOCTOR
72.9 SEE SPECIALIST (YOU HAVE ASTHMA)
73.3 4 DAY HOL
73.4 7 DAY HOLIDAY
73.6
73.7 9 DAY HOL
74 5 DAY HOL
74.1
85
Table 2 cont.
Age Player 1, run 1 Player 1 run 6 Player 2, run 1 Player 2 run 2 Player 3, run 1
75.1 14 DAY HOLIDAY
14 DAY HOL
75.3 ASTHMA ATTACK
76.1 7 DAY HOLIDAY
7 DAY HOL
76.5 4 DAY HOL
76.9 10 DAY HOL
77
77.3 4 DAY HOLIDAY
77.6 7 DAY HOL
77.7 CLICK ON DOCTOR (NOTHING)
78 7 DAY HOL
78.7 23 DAY HOLIDAY
79.5 7 DAY HOLIDAY
79.6 17 DAY HOL
79.9
80.1 DIES OF OLD AGE
DIES OF OLD AGE
DIES OF OLD AGE
DIES OF OLD AGE
Score 1570 2136 1788 1964 2072
Money 95,975 96375 75,100 76,875 44175
Health 1000 1000 800 1000 1000
Fun 100 940 860 950 990
6.3.4 Why is information never looked at? A post-pilot check
A number of trials in the pre-pilot phase had resulted in the testers looking at the information
so the pilot results were unexpected. In fact the pre-pilot testers had learned very quickly
about the hazards of spray painting and what to do about it.
As a follow-up check, because of the consistent failure to look at information, it was
considered a good test to get a person to play the game who had a low reading age. To match
the pre-pilot reviews, an 11 year old child was asked to play the game. The results were
identical to those of the 3 paint sprayers, i.e. he never clicked on the Ask for Information
button. He subsequently reported that did not understand the words “exposed” and
“compensation” and yet did not ask for information. He did not understand why health was
declining yet again did not ask for information.
When asked why he never used the Ask for information button he said: “I don’t know why, I
just never do. Normally it just has information I already know. I would look at it if I thought
there might be something there useful in the game.” So, we looked at the Compensation
information sheet. “There you are, it has all this useless information which doesn’t really
answer my question. Just phone numbers”.
86
After looking at some of the other information screens he concluded that the information there was insufficient for him to understand why the correct respirator was indeed the correct one. He said it looked correct because it covered the whole of the face. But why wasn’t it goodenough on its own? And was it the paint causing the asthma? That wasn’t understood either. Again the information was “useless” at answering these specific questions.Was ARM a good teacher? No.
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7 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
7.1 SUMMARY OF RESULTS
1. The effectiveness of getting people from small auto body shops to respond was very
small. Only 3 volunteers were obtained out of an intended 20 for the Pilot Study.
They played a total of 23 game runs. Even paying volunteers £15 for what was less
than an hour’s work was an inadequate incentive. One problem was considered to be
lack of access to a computer. An estimate was that only 10% of front line workers
had home computers whereas nearly all of them (sample of 30 people) had
Playstations or X-boxes.
2. 23 simulation trials were played. The 3 subjects never sought out detailed
information even though it was only a button click away (there was one exception
where on one run a player looked at the paint warning label). They did however visit
the doctor, visit a specialist for medical checks and check on their exposure
(biofeedback) but only if they had indication of declining health.
3. The targeted behaviour (air supplied respirator, ventilation booth, training) was
achieved for all 3 paint sprayers in the first game played (so, within 5 minutes or
less). In 2 cases the targeted behaviours were selected from the outset. In the other
case the painter sprayer selected the mask for lacquers and enamels.
4. Responses on the questionnaire suggested all 3 players would be more careful with
spray paints in the future although there was uncertainty as to whether they would ask
for healthier working conditions. Evaluation of ARM as a good teacher was a "no"
from player 1 and a "don’t know" from player 2 and 3.
5. At the beginning of each run the player is advised to read the warning label. In the 23
runs this was done only once, for 12 seconds, which is a long time compared to the 2
or 3 seconds spent looking at other screens such as those showing symptoms. The
implications for advanced risk messaging is that players will not seek out information
when it is passively presented. When information is presented (symptoms, advice
from doctor, biofeedback) this is not looked at for more than 3 seconds. The time
frame for delivering information is really quite short.
6. Ferguson et al (ref (21)) cites literature suggesting that negative frames are more
persuasive for detection behaviours (risk seeking), whilst positive frames are more
persuasive for prevention behaviours (risk aversion). Within the limits of the data,
the ARM simulation supported this, indicating that detection behaviours only took
place when the health message was negatively framed (losses) and that prevention
behaviours continued when messages were positively framed (gains).
7.2 CONCLUSIONS
The ARM simulator provides a means of examining behaviours of people in a virtual
workplace.
A lot of time was spent designing message content and discussing the presentation of
information about asthma, isocyanates, and appropriate workplace conditions, and of
delivering the game play structure. This study suggests that HSE, who are the content experts
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7.3
in the risk communication process, may spend too much time worrying about the detailed
content of messages when the targeted audience are not interested in the details. More time
could be spent dealing with other hurdles that have to be overcome like how to get the
message to the people who need it. “Advanced” communications probably need to use
currently regularly accessed channels (e.g. TV, Video games). A survey of regularly accessed
channels amongst target populations might be appropriate.
The ARM program delivered a complex message in less than 5 minutes. Even this pilot
system can be seen to have advantages over conventional guidance methods.
The ARM program could be a valuable research tool when it is necessary to measure the
parameters of how a person responds to a message: what they do and for how long and
whether their perception are and whether they intend to change behaviour.
RECOMMENDATIONS FOR FUTURE WORK
1. It was not considered worthwhile at this stage to continue with the detailed design of the
message. The priority should be to identify the target population (where, who) and define
their characteristics so as to be able to specify what the appropriate infrastructure would
be for bringing the risk message to the population. HSE could consider undertaking
studies for the purpose of locating the target populations and finding out what they
currently use which are potential media for communications.
2. If the information behind the message needs to communicated it should be made
adaptable to the target population (e.g. like user defined pages that are currently possible
on some web sites like Amazon books, for example) but it is not clear what role more
detailed information might play in behaviour change.
3. In order to overcome the boredom factor more of the things that are attractive in computer
games could be added. Lots of change is one thing. In addition most games have
“levels” of some sort. One video game player suggested that a future design could put in
different levels that force the player into a certain situation, such that first you have to
play with the worst conditions possible with no training and no ventilation and no
respirator and then work your way up to the best conditions. Finally, there could be a
“level” that tells the person to select the conditions that he has himself at work, and try to
get a high score and then people can more easily compare their own conditions to the
ones they have already had to try out in the game. This player also preferred the earlier
game version (see Figure 2) which gives continuous feedback about lung health.
4. Change is interesting and more compelling. The busy colourful graphic screen that was
designed later actually masked changes. So, more contrasted change and less busy with
images is the recommendation for the risk message. The player said he thought it was
nice when in the earlier version it said things like "You feel a bit dizzy,” or “You feel
fine” or “You earn an average salary.” He thought the later screen design gave
information too passively in the graphics. In addition, contrary to risk message design
advice, the player wanted more variables to play with (eg. different spray guns).
5. The recommendation is, therefore, that any new design should use more help from those
who understand the medium itself (in this case computer gaming) rather than just an
unbalanced emphasis on content.
6. ARM could be used in future research studies to examine behaviour strategies of subjects.
It can identify weaknesses in the message and the results can be used as a basis for
90
making improvements. ARM's flexibility as an "advanced" risk messenger could
appropriately adapt the message to players' responses "online". eg. it can adapt the frame
of the message as it goes along.
7. Some thought could be given to investigating simple behaviour changing campaigns
which have been shown to work in other contexts ( driving behaviour) in the ARM
simulation. The isocyanate equivalent would be along the lines of: "Using isocyanates?
Get an air supply." ,"I keep my visor closed. How about you?". This focuses on
behavioural change as the target rather than imparting knowledge.
8. It is felt that strong and continuous or frequent change as feedback on positive and
negative behaviour is needed in the risk message.
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8 REFERENCES
(1) AYERS, T.J. et al (1989) What is a warning and when will it work? pp. 1-5 in
Laughery, Wogalter and Young (1994).
(2) AJZEN, I. (1985) From intentions to actions: A theory of planned behaviour.
In J. Kuhl & J. Beckman (eds.), Action-control: From cognition to behavior
(pp. 11-39). Heidelberg: Springer.
(3) BELLAMY, L.J. (2000a) Enhancing Chemical Risk Control for Reducing
Exposure in the Workplace through Advanced Risk Messaging Techniques,
Proposal ref 000848-G61, Prepared for: Health and Safety Executive,
Chemicals Policy Division, Strategy and Research, Rose Court, London by
SAVE Consultants Apeldoorn, The Netherlands.
(4) BELLAMY, L.J. (2000b) Reducing Exposure In The Workplace Through
Advanced Risk Messaging (ARM) Phase 1: System description and plan, ref
002047 -G61, December 2000, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
(5) BELLAMY, L.J. (2000c) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Reports 1 and 2, ref.
002054 - G61, December 2000, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
(6) BELLAMY, L.J. (2001a) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Reports 3 and 4, ref.
010795 - G61, May 2001, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
(7) BELLAMY, L.J. (2001b) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Phase 2 Concept design: ARM-1, ref
011598 - G61, November 2001
(8) BELLAMY, L.J. (2001c) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Reports 5 and 6, ref.
011834 - G61, Dec 2001, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
(9) BELLAMY, L.J. (2002a) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Reports 7 and 8, ref.
020784 - G61, June 2002, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
(10) BELLAMY, L.J. (2002b) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, ARM-1 Development Report, ref.
021516-G61, November 2002, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
(11) BELLAMY, L.J. (2002c) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Reports 9 and 10, ref.
021663 -G61, December 2002, SAVE Consultants, PO Box 10466, 7301 GL
Apeldoorn, The Netherlands. HSE RSU Ref: 4106/R64.066
93
(12) BELLAMY, L. and GEYER, T.A.W. ( 1990 ) Experimental programme to
investigate informative fire warning characteristics for motivating fast
evacuation. Prepared for the Fire Research Station. Published by BRE books,
UK, 1990.
(13) BRYAN J. L. (2000) Psychological variables that may affect fire alarm
design. Fire Protection Engineering no. 11
(14) Darlowsmithson (1988) “Equinox – You Want Bells on It?” (TV Broadcast),
London, 1988.
(15) BOTTOMLEY, D. (1998) Health and safety performance in the rubber
industries: incident report analysis. Health and Safety Laboratory Report.
IR/RAS/98/1.
(16) COMMITTEE ON RISK PERCEPTION AND COMMUNICATION (1989)
Improving risk communication. Committee on Risk Perception and
Communication, National Research Council, National Academy Press 1989
(17) THE COMMUNICATION INITIATIVE (1998) Summaries of change
theories and models: www.comminit.com,
www.comminit.com/changetheories.html Director: Warren Feek, 5148
Polson Terrace, Victoria, British Columbia, Canada V8Y 2C4, Phone: 1-
(250)-658-6372 Fax: 1-(250)-658-1728.
(18) DEPARTMENT OF TRADE AND INDUSTRY (1998) A Guide to the
Cosmetic Products (Safety) Regulations. Central Office of Information 6/98.
(19) DEPARTMENT OF EMPLOYMENT, TRAINING, AND INDUSTRIAL
REGULATIONS (1999) Hazardous Substances Case Study No. 5 – A
Workplace Using Spray Paint Edition 3. Queensland Government 5/99.
(20) EUROPEAN COMMISSION (2000) The TRUSTNET framework: a new
perspective on risk governance. Project report for research under R&T
specific programme "Nuclear fission safety 1994-1998". EUR 19150 EN. For
more recent information see http://www.trustnetgovernance.com/index.htm
(21) FERGUSON. E., BIBBY, P.A., LEAVISS, J, & WEYMAN, A. (2003)
Effective design of workplace risk communications. Prepared by School of
Psychology, University of Nottingham, Nottingham NG7 2RD, UK and
Health & Safety Laboratory, Broad Lane, Sheffield S3 7HQ. Health and
Safety Executive Research Report 093, HSE Books, HMSO.
(22) HEALTH AND SAFETY COMMISSION (1999) The Approved guide to
the classification and labelling of substances and preparations dangerous for
supply (Fourth Edition). HSE C80 12/99.
(23) HEALTH AND SAFETY COMMISSION (1993) Safety data sheets for
substances and preparations dangerous for supply, Approved Code of
Practice. HMSO, 1993.
(24) HEALTH AND SAFETY COMMISSION (2000) Safety data sheets for
substances and preparations dangerous for supply (Second Edition),
Approved Code of Practice. HSE C5 07/00.
94
(25) HEALTH AND SAFETY COMMISSION (1999a) Health and safety
statistics 1998/1999. HMSO 1999
(26) HEALTH AND SAFETY COMMISSION (1999b) Control Of Substances
Hazardous to Health, Approved Codes of Practice, HMSO 1999.
(27) HEALTH AND SAFETY COMMISSION (1999) General COSHH ACOP
(Control of substances hazardous to health) and Carcinogens ACOP (Control
of carcinogenic substances) and Biological agents ACOP (Control of
biological agents). HSE C100 3/99.
(28) HEALTH AND SAFETY COMMISSION (2000) General COSHH ACOP
(Control of substances hazardous to health) and Carcinogens ACOP (Control
of carcinogenic substances) and Biological agents ACOP (Control of
biological agents). HSE C50 7/00.
(29) HEALTH AND SAFETY COMMISSION (2000) Management of health and
safety at work. Approved Code of Practice. HMSO 2000.
(30) HEALTH AND SAFETY EXECUTIVE (1995) CHIP 2 for Everyone,
Chemicals (Hazard Information and Packaging for Supply) Regulations 1994.
HSE C100 4/95.
(31) HEALTH AND SAFETY EXECUTIVE (1999) The Complete Idiot’s Guide
to CHIP. INDG18(rev1) 5/99
(32) HEALTH AND SAFETY EXECUTIVE (1998) Good health is good
business. Employers' guide. MISC130 5/98
(33) HEALTH AND SAFETY EXECUTIVE (1999) Isocyanates: Health hazards
and precautionary measures. Guidance note EH16. HSE C35 9/99.
(34) HEALTH AND SAFETY EXECUTIVE (2003) Occupational Health
Statistics Bulletin 2002/03
(35) HEALTH AND SAFETY EXECUTIVE (2000) Occupational Exposure
Limits 2000 EH40/2000. HSE C180 2/2000.
(36) HEALTH AND SAFETY EXECUTIVE (1999) A Step by Step Guide to
COSHH Assessment. HSE C75 11/99.
(37) HEALTH AND SAFETY LABORATORY (1999) Report on proceedings of
the Health Directorate workshop on risk perception and risk communication,
Gatwick, January, 1999. A.K. Weyman, C.J. Kelly & B. Sreenivasan, Report
EWP/99/20.
(38) JANZ, N. K, & BECKER, M.H. (1984) The health belief model: A decade
later. Health Eduction Quarterly, 11, 1-47.
(39) JOHNSON, B.B., SANDMAN, P.M., MILLER, P. (1992) Testing the role of
technical information in public risk perception. RISK: Issues in Health and
Safety, vol3, pp. 341–364 http://www.fplc.edu/risk/vol3/fall/johnson.htm
(40) KASPERSON, R.E., RENN, O., SLOVIC, P. BROWN, H.S., EMEL, J.
GOBLE, R. KASPERSON, J.X., RATICK, S. (1988) The social
95
amplification of risk: A conceptual framework. Risk Analysis, Vol. 8, No.2,
1988.
(41) KASPERSON, R.I., KASPERSON, J.X. (1995) Considerations and
principles for risk communication for industrial accidents. Paper prepared for
OECD workshop on risk assessment and risk communication in the context of
accident prevention, preparedness and response, Paris, 11-14 July 1995.
(42) KROHN, B.R. (2000) @ware: An internet based hazard communication
training application. Paper presented at the Society for Chemical Hazard
Communication Spring Meeting, Seattle, WA, March 2000.
(43) LAUGHERY, K.R., BRELSFORD, J.W. (1991) Receiver characteristics in
safety communications. pp120-124 in Laughery, Wogalter and Young
(1994).
(44) LAUGHERY, K.R., WOGALTER, M.S., YOUNG, S.L. (1994) Human
factors perspectives on warnings. Human Factors and Ergonomics Society
Publications, PO Box 1369, Santa Monica, CA 90406-1369 USA.
(45) VAN ZAKEN EN WERKGELEGENHEID (2000)
Veiligheidsinformatiebladen en werkpleketikettering. Sdu Uitgevers, 2000.
(46) MINISTERIE VAN SOCIALE ZAKEN EN WERKGELEGENHEID (1999)
Toxische stoffen in de houtverwerende industrie. Sdu Uitgevers, 1999.
(47) OSHA [OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION,
US DEPARTMENT OF LABOUR] (1992) OSHA Review Commission
Decisions 02/07/1992 - 86-681 - American Cyanamid Company (Available
on the OSHA website: http://www.osha-slc.gov/REVIEW_data/)
(48) PETERS, A.P., PETERS, B.J. (1999) Warnings, instructions and technical
communications. Lawyers and Judges Publishing Co., Inc., USA.
(49) PETTS, J., McALPINE, S., SADHRA, S., PATTISON, H., MACRAE, S
(n.d.) Development of a methodology to design and evaluate effective risk
messages. University of Birmingham, UK
(50) RASMUSSEN, J. (1994) Risk management, adaptation, and design for safety,
pp.1-36 in B. Brehmer and N.-E. Sahlin (eds), Future Risks and Risk
Management, Kluwer Academic Publishers, Netherlands, 1994.
(51) SLOVIC, P. 1993. Perceived Risk, Trust and Democracy. Risk Analysis.
13(6):675.
(52) TVERSKY, A. AND KAHNEMAN, D (1974), Judgment under uncertainty:
Heuristics and biases, Science 185, 1124–1131.
(53) TVERSKY, A., & KAHNEMAN, D. (1981) The framing of decisions and the
psychology of choice. Science, 1981, 211, 453-458.
(54) WILDE, G.J.S. (1994) Target Risk. Dealing with the danger of death, disease
and damage in everyday decisions. PDE Publications, 1994.
96
(55) WITTE, K. (1992) Putting the fear back into fear appeals: The extended
parallel process model. Communication Monographs, 59, 329-349.
(56) WITTE, K. (1994). The manipulative nature of health communication
research: Ethical issues and guidelines. American Behavioral Scientist, 38,
285-293.
(57) WITTE, K. (1998). Theory based interventions and evaluations of
outreach efforts. Seattle, WA: National Network of Libraries of
Medicine/Pacific Northwest Region (commissioned publication).
(http://www.nnlm.nlm.nih.gov/pnr/eval/witte.html)
(58) WS ATKINS CONSULTANTS LTD (2000) Characteristics of people
working with chemical products in small firms. Prepared for the Health
and Safety Executive, Contract Research Report 278/2000.
(59) EU Framework Directive: Council Directive 89/391 of 12 June 1989
on the introduction of measures to encourage improvements in the
safety and health of workers at work
(60) BELLAMY, L.J. (2003) Minutes of the meeting of 13th
March between
White Queen and HSE, Rose Court, London, Ref. 240404-5.
(61) BELLAMY, L.J. (2003) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Report 11, Doc nr.
030403a-5, April 2003, White Queen, PO Box 712, 2130 AS Hoofddorp, The
Netherlands. HSE RSU Ref: 4106/R64.066
(62) BELLAMY, L.J. (2003) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Report 12, Doc nr.
050603a-5, June 2003, White Queen, PO Box 712, 2130 AS Hoofddorp, The
Netherlands. HSE RSU Ref: 4106/R64.066
(63) BELLAMY, L.J. (2003) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Report 13, Doc nr. 031218-
5, December 2003, White Queen, PO Box 712, 2130 AS Hoofddorp, The
Netherlands. HSE RSU Ref: 4106/R64.066
(64) BELLAMY, L.J. (2004) Reducing Exposure in the Workplace Through
Advanced Risk Messaging Techniques, Progress Report 14, Doc nr. 040708-
5, July 2004, White Queen, PO Box 712, 2130 AS Hoofddorp, The
Netherlands. HSE RSU Ref: 4106/R64.066
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ANNEX I: CASE STUDIES
HSE were unable to provide any case studies because information was confidential and
clearance was not obtained. For this reason case study descriptions in the public domain,
which are very hard to find in sufficient detail, were used.
Preventing Asthma and Death from Diisocyanate Exposure NIOSH ALERT: 1996
DHHS (NIOSH) Publication No. 96-111 /www.cdc.gov/niosh/asthma.html
Case No. 1--Spray Painting (One Death)
A 37-year-old male, self-employed car painter was admitted to the hospital with asthma
symptoms [Fabbri et al. 1988]. These symptoms had first developed 5 years earlier and were
thought to be related to his occupation. He had been working in the same environment for
more than 20 years.
The car painter was diagnosed with occupational asthma induced by isocyanates and advised
to change his job or avoid the use of polyurethane paints. He nevertheless continued to work
as a car painter and used medications such as bronchodilators, cromolyn, and steroids to treat
his asthma.
Six years later, he was wearing a mask and spraying a car with 2-component polyurethane
paint when he developed severe, prolonged asthma. Despite medication, he remained
symptomatic--especially at night. He returned to work, sprayed the polyurethane paint again,
and developed severe asthma requiring emergency treatment. He died in the ambulance en
route to the hospital. The manufacturer reported that the paint contained small amounts of
TDI, and a chemical analysis confirmed the presence of TDI mixed with solvents.
Case No. 2--Highway Spill
Two police officers developed asthma-like illness after a single exposure to TDI in the
immediate vicinity of a tank car that had overturned on the highway [Luo et al. 1990]. After
briefly directing traffic at the accident scene, both officers received medical care for severe
symptoms, including burning eyes, throat irritation, cough, chest tightness, and difficult
breathing. Treatment included steroids and a bronchodilator.
Both police officers developed a chronic bronchospastic disorder after their relatively brief
exposure to high concentrations of TDI. Though considerable improvement has occurred in
both cases, symptoms have persisted for more than 7 years.
Case No. 3--Spray Painting
Occupational asthma was reported in three workers in the paint shops of a large assembly
plant [Seguin et al. 1987]. When co-workers were also examined, six additional workers
showed symptoms of occupational asthma.
Of the nine affected workers (males aged 23 to 59), six had significantly reduced lung
function after an inhalation test using the paint containing isocyanates. The duration of
exposure to isocyanates in the paint shops ranged from 3 to 5 years.
The authors of this study reported a 12% prevalence rate for occupational asthma.
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Case No. 4--Isocyanate Foam Operation (One Death)
A maintenance worker became ill after repairing an MDI foaming system at a plant that
manufactured artificial plants with polyurethane foam bases [NIOSH 1994a]. The worker
later suffered recurrent bouts of respiratory illness (diagnosed as isocyanate- induced HP).
After showing further respiratory symptoms associated with isocyanate exposure, the worker
quit his job but continued to experience coughing and progressive loss of lung function. His
illness was eventually complicated by productive cough, weakness, sweats, muscle aches, and
shortness of breath. Ultimately, he died.
Worksite evaluations found detectable air concentrations of MDI and inadequate ventilation
systems in the foaming areas. Vapors and aerosols were observed rising into the faces of
employees working with the foam. Skin contact with the curing foam was also noted during
the survey.
Case No. 5--Wood Products Manufacturing
Ten workers at an engineered wood products plant developed occupational asthma from
exposure to MDI [NIOSH 1993]. The workers were employed 1 to 8 months at the plant
before their diagnosis of occupational asthma. None of the 10 workers reported pre-existing
asthma.
Respiratory symptoms included chest tightness, wheezing, and coughing at night. Six workers
reported a relationship between symptoms and work: they either reported improved symptoms
while away from work or increased symptoms on their first day back at work. Eight workers
showed declines in lung function over the workweek or over their period of employment, or
they showed increased lung function after treatment with a bronchodilator. Eight workers
showed bronchial sensitivity when tested (methacholine challenge).
All 10 workers reported respiratory symptoms when they were in areas where MDI was used.
The physician who examined the 10 workers recommended that they be removed from areas
with any potential exposure to MDI.
Case No. 6--Coal Mining
Coal miners at a longwall mine complained of illness after exposure to MDI-based
polyurethane rock glues [NIOSH 1994b]. These miners had sprayed glues onto rock strata.
They were supplied with air-purifying respirators (organic vapor cartridges) and chemical-
resistant gloves that were not routinely worn. The exposed miners reported respiratory
difficulties, asthma, shortness of breath, dizziness, headache, sore throat, fatigue, and contact
dermatitis. Company medical records contained nine reports of health problems attributed to
rock glue exposure.
The inappropriate glue-spraying procedure used at this mine was eliminated by the Mine
Safety and Health Administration (MSHA). The manufacturer's instructions specify that the
glues are only to be injected for roof support and that workers are to wear supplied-air
respirators--not air-purifying respirators. Air-purifying respirators are not recommended
because rock glues are eye irritants and have poor warning properties, and because cartridges
for these respirators have no end-of-service indicators for MDI.
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Case No. 7--Isocyanate Roofing Foam
Isocyanate exposure has also occurred at non-industrial worksites such as public schools. The
management of a large metropolitan school district contacted NIOSH for assistance after a
university study documented asthma in 13 of approximately 85 staff members from a middle
school [NIOSH 1994c]. The report further suggested that as many as 34 staff members might
be asthmatic.
NIOSH investigators determined that large quantities of polyurethane foams and isocyanate
coating materials had recently been applied to the school roof on several occasions. School
staff members reported odors during roofing application, suggesting possible exposures to
roofing materials that included isocyanates. Later air sampling during a test pour of the
roofing materials at another location indicated the release of isocyanates during roofing and a
potential for exposure.
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ANNEX II: COLLECTION OF BASIC DATA ABOUT ISOCYANATES
Isocyanates are used in vehicle spray painting. Two-pack spray paints containing isocyanates
are used extensively to paint vehicles. In these paints, isocyanate hardeners or activators
added to liquid resin react to produce a polyurethane film.
II.1 TYPES OF ISOCYANATES
HSE guidance note on isocyanates (Ref 95: HSE 1999)
Aromatics: TDI Toluene diisocyanate (2,4/2,6, -diisocyanato toluene) MDI Methylene bisphenyl diisocyanate (4,4'-diisocyanato diphenyl methane) NDI Napthalene diisocyanate (1,5-diisocyanato-napthalene) Aliphatics:HDI hexamethylene diisocyanate (1,6-diisocyanato-hexane)HMDI - hydrogenated MDI (4,4-diisocyanato-dicyclohexylmethane) IPDI - isophorone diisocyanate (1-isocyanato-3-isocyanatomethyl-3,5,5,-trimethylcyclohexane)
II.2 CAUSE AND EFFECT BASICS
EPA, USA: Isocyanate Basics
Isocyanates, the hardener in clearcoats and many primers, may be extremely hazardous to
humans in very small quantities. Isocyanates are the leading cause of occupational asthma, a
potentially life-threatening disease. Scientists estimate that 5% to 20% of the population may
be allergic (or "sensitized") to isocyanates. Allergic reactions include: itching and watery
eyes, skin rashes, asthma, and other breathing difficulties. Unfortunately, you won't know if
you're allergic to isocyanates until/unless you start experiencing the symptoms—which can
appear at first contact or at any time. Even if you're not allergic to isocyanates, they may still
irritate your skin and lungs, and many years of exposure can lead to permanent lung damage
and respiratory problems. If you are allergic, even tiny amounts of isocyanate can trigger a
severe lung reaction. A sensitized painter or technician cannot work in an auto refinishing
shop without putting his life in jeopardy. What does it all mean? Do everything you can to
limit your exposure to hazardous paint materials. An HVLP spray gun is an important tool for
reducing overspray and painting safely
Canadian centre for occupational health and safety Information alert #54 (1989)
Isocyanates are highly reactive chemical typically found in the hardener of two-part paints
and primers. Isocyanates are present in two forms, monomer and prepolymer. Frequently,
the isocyanate monomer content is indicated in product data information, but this is only a
small fraction of the total unreacted isocyanate present in hardeners.
Both forms of unreacted isocyanate present a risk to health when they enter the air during
paint or primer spraying.
103
II.3 MSD SHEET
Safety data sheets (from Idiots Guide to CHIP)
Suppliers must provide material safety data sheets (MSDs) for dangerous chemicals to the
recipient of the chemicals, but only if the chemicals are to be used in connection with work.
MSDs must give enough information to allow the user to decide how to protect both people at
work and the environment. Among other things, this includes the hazardous properties of the
chemical information on handling and storage, and exposure.
Example
Source: Dutch Chemiekaarten 2000:
TDI Toluene diisocyanate (2,4 -diisocyanato toluene)
CAS-number 584-84-9
R26-36/37/38-40-42/43-52/53
S: (1/2-)23-36/37-45-61
R26=very toxic by inhalation
R36/37/38 = Irritating to eyes, respiratory system and skin
R40 Possible risk of irreversible effects
R42 May cause sensitisation by inhalation
R43 May causes sensitisation by skin contact
R52/53 not applicable (environment)
S(1/2) Keep locked up and out of reach of children
S23 Do not breathe gas/fumes/vapour/spray (appropriate wording by manufacturer)
S36/37 Wear suitable protective clothing and gloves
S45 In case of accident or if you feel unwell seek medical advice immediately (show label
where possible)
S61 not applicable (environment)
May be important to highlight for respiratory sensitizers:
R42 May cause sensitisation by inhalation
II.4 EXPOSURE ROUTES
DHSS NIOSH ALERT 1996 Pub. 96-111 /www.cdc.gov/niosh/asthma.html
Diisocynates:Major route: InhalationOther: May occur through skin contact during handling of liquid isocyanates
Respiratory sensitisers and COSHH www.hse.gov.uk/pubns/indg95.htm:
Event: Inhale
Exposure type: Inhale
Body part: respiratory system
104
II.5 HEALTH EFFECTS
UK HSE: Isocyanates: Health surveillance in motor vehicle repair. Engineering sheet #18
The spraying of two-pack paints containing isocyanates is one of the most important causes of
occupational asthma in the UK. Some people may become sensitised as a result of working
with two-pack spray paints, i.e. they become allergic to isocyanates. In sensitised people, even
minute concentrations of isocyanates can lead to asthma attacks. Asthmatic attacks may occur
immediately or may be delayed for up to 12 hours after exposure, so symptoms may occur
away from work. Fatal cases have been reported but these are rare.
US DHSS NIOSH ALERT 1996 Pub. 96-111:
Health effects TDI and other isocyanates:
1. Irritation
x Powerful irritants to mucous membranes eyes
x Powerful irritants to gastrointestinal tract
x Powerful irritants to respiratory tract
x Respiratory irritation may progress to chemical bronchitis with severe bronchospasm
x Direct skin contact can cause marked inflammation
2. Sensitisation and asthma
x Can sensitise workers, which means they are subject to asthma attacks if exposed
again even at concentrations below recommended exposure limitsx Have been reports of death from severe asthma in sensitised subjects
3. Hypersensitivity pneumonitis (HP)
x Sporadic cases only
x Symptoms of acute HP develop 4 to 6 hrs after exposure
x Symptoms are flu like with fever, muscle aches and headaches and may include dry
cough, chest tightness, difficult breathing.
x Symptoms of chronic HP include progressively difficult breathing, fatigue, weight
loss
4. Cancer
TDI is a potential human carcinogen
Respiratory sensitisers and COSHH (www.hse.gov.uk/pubns/indg95.htm):
x One dose can trigger irreversible allergic reaction. x Sensitisation does not take place immediately. Happens after several months or years
of breathing in sensitiser.
x Once sensitised further exposure (even the tiniest trace) will produce symptoms
x Once sensitised can give permanent damage to lungs and increasingly severe
symptoms.
x Symptoms can continue for years even after exposure has stopped
x Once sensitised other triggers (tobacco smoke, air pollution, cold air) can trigger
symptoms
Symptoms:
x Asthma - attacks of coughing, wheezing and chest tightness
x Rhinitis and conjunctivitis - runny or stuffy nose and watery or prickly eyes
105
Health and Safety Authority, Ireland: An employees guide to occupational asthma:
What symptoms should you look out for?Certain dusts and chemicals, found in the workplace, when breathed in may result in serious chest problems. The symptoms start as
- runny eyes and nose
- itchy eyes and nose
and may develop into the more serious problems of asthma
- breathlessness
- wheezing
- tightness of chest
- coughing
The symptoms do not occur the first time you breathe in the substance. It takes a while for the
allergy to develop - from two months to two years usually. After this, each time you breathe
in even the smallest amounts of the substance, you will get symptoms.
Some people will get symptoms of asthma even when they are no longer exposed to the
substance.
This asthma caused by dusts or chemicals breathed in from the workplace air is called
occupational asthma. The symptoms are often worse at night, or the end of a shift and may
improve over weekends and holidays when you are away from work.
If you develop any of these symptoms you should immediately consult your doctor, or a
doctor with specialised training in occupational medicine.
See your manager
See your safety representative.
Remember:
If you develop occupational asthma you may have breathing difficulties for the rest of your
life.
It is your employer's legal responsibility to ensure you do not develop occupational asthma.
Govt. of Saskatchewan
Direct skin contact with isocyanates: may cause rashes, blistering and reddening of the skin.Repeated skin contact may cause skin sensitization.Eye exposure to airborne isocyanates can cause eye irritation and temporary blurred vision. Direct contact with the eye may cause damage to the cornea.
II.6 PROTECTION, PREVENTION, BEST PRACTICES
General (from numerous sources):
Substitute for less hazardous chemical
Engineering controls: Closed systems and ventilation; Exhaust ventilation for vapours and
particulates;Check equipment every 3 years
Allow booths to clear of spray and vapour after the work cycle is completed
Restrict area to essential workers
Avoid contact by remote operation using automated equipment from control room or room
with separate ventilation
Clothing: PPE of Coveralls, footwear, chemical resistant gloves and goggle, full face shields,
suitable respiratory equipment.
Use respirators for: short duration maintenance and emergencies...self contained BA with full
face piece operated in positive pressure mode or any supplied air respirator with full face
106
piece in positive pressure mode in combination with self contained BA in positive pressure
mode.
Training
Fit testing
Maintenance
Storage
Written Standard of operation
Information: container labelling, MSD sheets, training
Exposure monitoring: Could there be a potential for exposure?
Medical monitoring
HSE: Isocyanates: Health surveillance in motor vehicle repair. Engineering sheet #18
Adequate control when isocyanate paints are used may be achieved by segregating spraying
operations from other activities in a booth or enclosure, from which vapour and spray are
ventilated to a safe place in the open air after adequate filtration. People inside the booth
should wear adequate respiratory protection. Compressed air line breathing apparatus
incorporating a full face mask or visor is normally used. The booth needs to be thoroughly
examined and tested by a competent person at least every 14 months to check that enclosure
and ventilation are effective. Respiratory protective equipment should also be checked at least
every month to ensure it is working properly. Records of such checks and of any repairs
required should be kept.
Interpretation of points from the Guidance
Key data were identified, extracted, shortened and organised from the guidance note on a
level of 4 management priorities. The result is shown below.
1. Do not use isocyanate spray paints if you can use a safe substitute that does not cause
asthma
2. If you do use isocyanate spray paints:
STOP IT GETTING IN THE AIR
STOP IT GETTING ON THE SKIN
STOP IT GETTING ON PERSONAL CLOTHING AND IN FOOD OR
CIGARETTES
CONTROL EMPLOYEES GOING INTO CONTAMINATED AREAS
- follow standards of safe storage
- prevent spills and leaks
- don't use direct from open containers
- keep the area of work with isocyanate paints separated from other work areas
- don't let other employees enter the isocyanate area (put warning signs up to
stay out)
- provide exhaust ventilation/extraction hoods of the work area and make sure
it is always working properly
- use spray guns and work methods which minimise the chance of it getting in
the air
- train workers to use tools and methods properly
- make sure essential workers in the hazardous area are only there when it is
necessary for the job, and that they do other work or take breaks in clean
areas
- get an exposure monitor to check measures are working and use according to
the manufacturer's advice
PROTECT IN AREAS WHERE ISOCYANATE PAINTS ARE STORED OR USED
107
- provide protective work clothes so that personal clothing will not have a
chance to become contaminated in the work area
- provide a changing area so that personal clothing won't be contaminated by
protective clothing
- if there is a chance of a exposure such as leak or spill, or equipment has to be
opened for maintenance, or exposure cannot be prevented during spraying
wear personal protection equipment for skin (chemical protective clothing
and gloves) and lungs (air fed respiratory protection).
- this means you should have the protective equipment available in an
accessible location in or near the working area and ensure that it is always in
working condition and that it fits those who may have to use it.
- provide 'CE' marked respiratory protective equipment, which is essential
when exposures could get above legal limits even for short periods
- maintain RPE in accordance with manufacturer’s instructions
- train workers how to use protective equipment properly
HEALTH CHECKS AND FIRST AID
- send new employees for health checks before they begin
- make regular checks such as by questionnaire on whether employees are
showing relevant symptoms of exposure and keep records of the checks
- stop employees working if they show symptoms of wheezing, coughing,
chest tightness, breathlessness until they have obtained medical advice that
they are fit to return to work
- train employees in how to deliver first aid for casualties and without
becoming contaminated themselves.
As can be seen, quite aside from understanding that isocyanates cause asthma, there are an
enormous number of potential measures that may need to be taken to protect people from
exposure.
This illustrates that the data issues are complex. Any one of the points above could be
followed up in more detail, providing more information. The multidisciplinary nature of the
information requirements, the actual message content and ultimately the 'laws' to be installed
in the simulated world together made the data gathering requirements a formidable task.
II.7 ENVIRONMENTAL PROTECTION AGENCY, USA: ISOCYANATE BASICS
Isocyanates, the hardener in clearcoats and many primers, may be extremely hazardous to
humans in very small quantities. Isocyanates are the leading cause of occupational asthma, a
potentially life-threatening disease. Scientists estimate that 5% to 20% of the population may
be allergic (or "sensitized") to isocyanates. Allergic reactions include:
Itching and watery eyes, skin rashes, asthma, and other breathing difficulties. Unfortunately,
you won't know if you're allergic to isocyanates until/unless you start experiencing the
symptoms—which can appear at first contact or at any time. Even if you're not allergic to
isocyanates, they may still irritate your skin and lungs, and many years of exposure can lead
to permanent lung damage and respiratory problems. If you are allergic, even tiny amounts of
isocyanate can trigger a severe lung reaction. A sensitized painter or technician cannot work
in an auto refinishing shop without putting his life in jeopardy. What does it all mean? Do
everything you can to limit your exposure to hazardous paint materials. An HVLP spray gun
is an important tool for reducing overspray and painting safely.
108
ANNEX III: INTERPRETING THE RESULTS FILE
See Section 5.5 in the Main Report.
One set of column headings shows the Date (actual), Time (Actual), Age (of the person in the simulation), Score (for that game), Event. The events indicate what the person does at a particular cycle time. In the following example the person gives themselves a name, chooses which scenario to play, and sets up the conditions for the game.
Date; Time; Age; Score; Event;
14/11/2003; 14:53:52; 0; 0; Player: Nico;
14/11/2003; 14:53:56; 0; 0; Mark Scenario Chosen;
14/11/2003; 14:53:56; 0; 0; Open Scenario;
14/11/2003; 14:53:57; 0; 0; Priority: Health;
14/11/2003; 14:53:58; 0; 0; Priority: Long Life;
14/11/2003; 14:53:59; 0; 0; Priority: Fun;
14/11/2003; 14:53:59; 0; 0; Priority: Money;
14/11/2003; 14:54:02; 0; 0; Open Advice PAINT;
14/11/2003; 14:54:04; 0; 0; Close Advice PAINT;
14/11/2003; 14:54:04; 0; 0; End Paint Panel;
14/11/2003; 14:54:06; 0; 0; Open Advice PROTECTION;
14/11/2003; 14:54:07; 0; 0; Close Advice PROTECTION;
14/11/2003; 14:54:14; 0; 0; Select Face Mask;
14/11/2003; 14:54:16; 0; 0; Open Advice BOOTH;
14/11/2003; 14:54:17; 0; 0; Close Advice BOOTH;
14/11/2003; 14:54:19; 0; 0; Select With Booth;
14/11/2003; 14:54:21; 0; 0; Open Advice BOOTH;
14/11/2003; 14:54:22; 0; 0; Close Advice BOOTH;
14/11/2003; 14:54:24; 0; 0; Untrained;
14/11/2003; 14:54:24; 0; 0; Close Scenario;
109
In the following example, the results are shown concerning the 3 measured variables of
Health (“Asthma”), Money and Fun.
Date; Time; Age; Score; Event;
Bodypart; Current
Max; Health; Change
14/11/2004; 11:27:37; 31; 0; Start;
Asthma; 1000; 1000; -6; ;
; 0; 0; 0; ;
Money; 10000; 1000; 225; ;
Fun; 1000; 1000; -45;
14/11/2004; 11:27:44;
Asthma; 1000;
; 0; 0; 0; ;
Money; 10000;
Fun; 1000;
31.1; 3; Routine recording;
994; -6; ;
1225; 225; ;
955; -45;
14/11/2004; 11:27:45; 31.2; 6; Routine recording;
Asthma; 1000; 988; -6; ;
; 0; 0; 0; ;
Money; 10000; 1450; 225; ;
Fun; 1000; 910; -45;
……
14/11/2004; 11:27:55;
Asthma; 1000;
; 0; 0; 0; ;
Money; 10000;
Fun; 1000;
32.6; 43; Routine recording;
904; -6; ;
4600; 225; ;
280; -45;
14/11/2004; 11:27:55; 32.7; 45; Open Doctor: ASTHMAMILD;
Asthma; 1000; 898; -6; ;
; 0; 0; 0; ;
Money; 10000; 4825; 225; ;
Fun; 1000; 235; -45;
14/11/2004; 11:27:58; 32.7; 45; Close Doctor;
14/11/2004; 11:27:58;
Asthma; 1000;
; 0; 0; 0; ;
Money; 10000;
Fun; 1000;
32.7; 45; AsthmaMild;
898; -6; ;
4825; 225; ;
235; -45;
110
Meanings of “Event” text (shown in the boxes) as seen in the txt file.
Event:
Priority
;
Open Advice PAINT;
111
Meanings of “Event” text (shown in the boxes) as seen in the txt file/cont.
PAINT;
The paint information screen is opened:
The paint panel next button is clicked
Close
Advice
End Paint Panel;
112
The text in the boxes appears if the person clicks on those buttons
BOOTH
Select Hood
PROTECTION
Select Booth Select No Booth
Open Advice
Select No Mask
Select Face Mask
Select Gas Mask
Open Advice
113
The text in the boxes appears if the person clicks on those buttons
Open Info Form
trained
Open Advice
TRAINING
untrained
114
Info form
Open advice + pic
The text in the box appears upon button click plus the title (pic) as shown according to what
the "pic"is (see next pictures).
'Open
Advice ' +
pic
This is the Info Form:
pic='CREDITS'
115
pic='PROTECTION
pic='BOOTH'
pic='PAINT
'
116
pic='TRAINING'
pic='ASTHMA'
pic='KATEJONES'
117
pic='COMPENSATION'
pic='SPECIALIST’
pic='MEDICINE'
118
Click on Doctor: DoctorFine
Click on Doctor: Asthma
119
Click on doctor:Exposed
Click on doctor:NotExposed
Open doctor: ProlongedAsthma
Open doctor: AsthmaAttack
120
Open doctor: Hospital
AsthmatoHospital
Open doctor:AsthmaMild
121
Open doctor: DeathOld
Deadly asthma
Open doctor: DeathYoung
Doctor: Stop working
Click on compensation: won
122
Click on compensation: lost
Open doctor:
No money
Doctor: Specialist
specialist:you are fine;
See specialist
123
Doctor: Specialist
specialist:you have asthma;
See specialist
Start Holiday
End …day holiday
Time travel
Time travel interface
Back in time….year
124
BackToWork; (returns to choice sequence)
ChangeConditions (returns to choice sequence)
Stop working
125
Printed and published by the Health and Safety ExecutiveC30 1/98
Printed and published by the Health and Safety Executive C1.10 07/05
ISBN 0-7176-6128-8
RR 354
78071 7 661 282£20.00 9
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