Behavioural interventions to promote workers' use of respiratory protective equipment

Background Respiratory hazards are common in the workplace. Depending on the hazard and exposure, the health consequences may include: mild to life‐threatening illnesses from infectious agents, acute effects ranging from respiratory irritation to chronic lung conditions, or even cancer from exposure to chemicals or toxins. Use of respiratory protective equipment (RPE) is an important preventive measure in many occupational settings. RPE only offers protection when worn properly, when removed safely and when it is either replaced or maintained regularly. The effectiveness of behavioural interventions either directed at employers or organisations or directed at individual workers to promote RPE use in workers remains an important unanswered question. Objectives To assess the effects of any behavioural intervention either directed at organisations or at individual workers on observed or self‐reported RPE use in workers when compared to no intervention or an alternative intervention. Search methods We searched the Cochrane Work Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 07), MEDLINE (1980 to 12 August 2016), EMBASE (1980 to 20 August 2016) and CINAHL (1980 to 12 August 2016). Selection criteria We included randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time‐series (ITS) comparing behavioural interventions versus no intervention or any other behavioural intervention to promote RPE use in workers. Data collection and analysis Four authors independently selected relevant studies, assessed risk of bias and extracted data. We contacted investigators to clarify information. We pooled outcome data from included studies where the studies were sufficiently similar. Main results We included 14 studies that evaluated the effect of training and education on RPE use, which involved 2052 participants. The included studies had been conducted with farm, healthcare, production line, office and coke oven workers as well as nursing students and people with mixed occupations. All included studies reported the effects of interventions as use of RPE, as correct use of RPE or as indirect measures of RPE use. We did not find any studies where the intervention was delivered and assessed at the whole organization level or in which the main focus was on positive or negative incentives. We rated the quality of the evidence for all comparisons as low to very low. Training versus no tra