An Ecological Approach to the Assessment and Promotion of Hearing Protection Behaviour in the Workplace

Abstract

Background: Noise-induced hearing loss (NIHL) is a common debilitating occupational health problem in New Zealand and globally. In addition to the economic burden arising from compensation and rehabilitation for NIHL, quality of life is diminished. Unfortunately, interventions to prevent NIHL have not produced lasting favourable outcomes. The focus of NIHL prevention has mostly been on individuals at the personal level, which neglects environmental influences. The aim of this research was to understand the personal and environmental factors influencing hearing protection behaviour in workers and to develop an intervention to promote this. The theoretical framework for this study was the Ecological Model for Health Promotion; a planning model that helps identify and target behavioural influences across multiple levels of the social environment. Methods: Semi-structured interviews (Phase 1), cross-sectional survey (Phase 2), and the development and pilot of an intervention (Phase 3) comprised the three phases of this research. The interview phase identified barriers and supports to hearing protection. A short questionnaire was developed based on themes from the interviews and was administered to a large group to allow internal reliability and sub-structure to be investigated. The intervention phase was guided by the Ecological Model and behaviour change theories. Findings: Phases 1 and 2 of the research identified themes and factors that influence hearing protection behaviour. These findings suggested that supports and barriers to hearing protection behaviour are formed by intrapersonal, interpersonal, and organisational level influences as per the Ecological Model. The hearing protection assessment questionnaire was a reliable and valid tool to identify influences of hearing protection behaviour across different levels. Key supports and barriers to hearing protection behaviour were targeted in the development of an intervention programme. The intervention successfully elicited improvements in personal and environmental influences and promoted hearing conservation. Conclusion: The research demonstrated the utility of the ecological model in developing effective interventions aimed at preventing NIHL. This thesis provides insight into multi-level influences for hearing protection behaviour and targeting them to promote hearing health in workplaces.