Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries

Objectives: To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs). Methods: This study—conducted in 22 manufacturing worksites in Mumbai, India—adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation. Results: While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist’s reports. Conclusion: India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers’ experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them.