AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 58:838–848 (2015)

Triage for Action: Systematic Assessment and

Dissemination of Construction Health and
Safety Research

1 2 3
Robin Baker, MPH, Charlotte Chang, DrPH, Jessica Bunting, MS, and Eileen Betit, MS3

Background Research translation too often relies on passive methods that fail to reach
those who can impact the workplace. The need for better research to practice (r2p)
approaches is especially pressing in construction, where a disproportionate number of
workers suffer serious injury illness.
Methods A triage process was designed and used to systematically review completed
research, assess r2p readiness, establish priorities, and launch dissemination follow-up
efforts. A mixed quantitative and qualitative approach was used.
Results The process proved effective in ensuring that significant findings and evidence-
based solutions are disseminated actively. Key factors emerged in the selection of follow-
up priorities, including availability of partners able to reach end users, windows of
opportunity, and cross-cutting approaches that can benefit multiple dissemination efforts.
Conclusions Use of a systematic triage process may have an important role to play in
building r2p capacity in construction safety and health. Am. J. Ind. Med. 58:838–848,
2015. © 2015 Wiley Periodicals, Inc.

KEY WORDS: construction health and safety; dissemination; triage tool; research to
practice; promotion of evidence-based practices

INTRODUCTION spread of innovations is unplanned, informal, decentralized,

There has been increasing attention to the problem of
inadequate dissemination of research findings in the
construction industry [National Research Council and
Institute of Medicine 2009; Gillen, 2010]. Evidence-based
interventions have been developed that could prevent deaths,
injuries, and illnesses, yet all too often research that has been
published in the peer-reviewed literature fails to get into the
hands of those who need to take action on the findings. A
reliance on “passive” diffusion of solutions in which “the
1
Center for Occupational and Environmental Health, UC Berkeley, Berkeley, California
2
Labor Occupational Health Program, University of California, Berkeley, California
3
r2p, CPWR^The Center for Construction Research and Training, Silver Spring,
Maryland

Correspondence to: Robin Baker, MPH, Center for Occupational and Environmental
Health, UC Berkeley, Berkeley, California. E-mail: rbaker@berkeley.edu
Accepted 28 April 2015
DOI 10.1002/ajim.22477. Published online 26 May 2015 in Wiley Online Library
(wileyonlinelibrary.com).
and largely horizontal or mediated by peers,” rather than
more active and intentional dissemination involving
“planned efforts to persuade target groups to adopt an
innovation” [Greenhalgh et al., 2004]. The need for better
movement from health and safety research findings to
effective practice is especially pressing in construction,
where a disproportionate number of workers are killed,
injured, and made ill each year in the U.S. [Waehrer et al.,
2007; Dong et al., 2012; Swuste et al., 2012].
In 2010, the National Institute for Occupational Safety
and Health (NIOSH) funded an intensive “research to
practice” (“r2p”) initiative as a supplement to its National
Construction Center (the Center) program at CPWR—The
Center for Construction Research and Training. The r2p
initiative centered on three main areas of focus: actively
disseminating research findings from its funded projects,
supporting and studying health and safety partnerships in
construction, and developing r2p tools and resources.
For the purpose of this initiative, r2p was defined as
systematic efforts to promote the broad-based application of

ß 2015 Wiley Periodicals, Inc.

 Construction Health and Safety Research Triage
evidence-based interventions to improve health and safety
practices in the construction industry. This was conceived as
a process or “pathway” for ensuring that research on hazards
leads to research on solutions, and that evidence-based
solutions are then actively translated, disseminated, adopted,
and implemented. Translation was understood to involve
making solutions and information accessible and packaging
them in ways that will effectively reach end users, with
dissemination involving actively communicating and pro-
viding support to intermediaries and end-users who will
ultimately adopt and implement them.
Our concept of r2p also included an emphasis on the
critical need for “practice to research” (“p2r”) in which
construction stakeholders in the field (e.g., workers,
contractors, unions, manufacturers) inform each stage of
the research process from problem identification to transla-
tion, dissemination, and implementation of findings. To
promote the two-way process whereby research informs
practice and practice informs research, the r2p initiative
included a focus on the development of multi-stakeholder
partnerships which engage critical intermediary organiza-
tions that are able to reach and influence target populations
and end users.
The r2p initiative was influenced by several conceptual
frameworks and models related to dissemination and
implementation and knowledge transfer. In their call for
the development of marketing and distribution systems in
public health, Kreuter and Bernhardt [2009] identified key
r2p functions present in other industries that take products of
research to the public, including consumer goods, biomedi-
cine, and education. Such functions included market research
and strategy, inventory management, training and technical
assistance, customer and product support, coordination, and
evaluation. Knowledge Transfer and Exchange models
[Institute for Work & Health 2006] highlight “push” factors
in which researchers actively disseminate findings to key
audiences, “pull” factors in which potential users of research
seek out information and solutions to address issues they
face, and the creation of “exchange” relationships that
facilitate the application of research among end-users and the
generation of research more relevant to the real world. The
RE-AIM model [Glasgow et al., 1999] emphasized the
combination of audience reach, effectiveness of interven-
tions, and the extent of adoption, implementation, and
maintenance as the key components of public health impact.
The r2p initiative’s focus on developing dissemination and
implementation infrastructure in construction health
and safety, the need to engage both push and pull factors
and support the development of multi-stakeholder partner-
ships for knowledge transfer and exchange, as well as ways of
conceptualizing r2p outcomes were guided by these models.
In this article, we focus on the “triage project,” one
element of the Center’s r2p initiative. Triage involved
the systematic review of research projects completed during
839
the Center’s 2004–2009 grant period to assess and prioritize
important findings for broader transfer and to ensure further
translation and dissemination of those findings. The Center
leads a research consortium made up of health and safety
investigators at major universities throughout the country,
and supports up to 20 studies during each five-year
cooperative agreement specifically designed to identify
problems and solutions in construction safety and health.
Investigators submit regular progress and final reports
identifying findings, outputs, and dissemination conducted.
Yet in the past, a systematic approach did not exist for
assessing r2p activities conducted, readiness for further
dissemination, or need for additional support or follow-up.
The triage project involved evaluating the research
products and/or findings produced by each consortium
member, helping to identify promising ways to package and
promote them to target audiences, prompting investigators to
consider a range of translation and dissemination strategies,
and supporting additional dissemination efforts, when
warranted, by providing additional funding and/or technical
support. Aims for the triage project were (i) to develop a
practical way to systematically review the results of
construction safety and health research in order to identify
research translation and dissemination priorities, and (ii) to
enhance research to practice through the process of review,
prioritization, and dissemination follow-up. Below, we
describe the process for developing the “triage tool” and
review protocol, the findings from the triage of research
projects, as well as the follow-up dissemination enhancement
efforts that resulted.
METHODS
A triage tool was developed to identify innovations of the
highest priority for further dissemination and adoption, as well
as opportunities to more broadly share key findings or promote
additionalresearchinpromisingareas.TheCentersubsequently
offered support to six high priority r2p efforts identified through
the review. Additional projects were offered other types of r2p
support, such as assistance with communications products or
linkage with industry stakeholders.
The triage process was implemented in stages: (i)
designing the tool and triage protocol; (ii) conducting an
initial set of project reviews; (iii) providing follow-up
support to three r2p efforts, (iv) revising the tool; (v)
completing the remaining reviews; (vi) analyzing all
reviews; and (vii) providing follow-up support to three
additional efforts.
Triage Tool Development
To develop the triage tool, the r2p research team drew on
a combination of expert opinion and existing research
840 Baker et al.
translation models. We worked with the Center’s Technical
Advisory Board (TAB) to identify key criteria for prioritizing
dissemination efforts. A variety of frameworks and tools
such as RE-AIM [Glasgow et al., 1999], Knowledge Transfer
and Exchange [Institute for Work & Health 2006], and
Cochrane Systematic Reviews [Higgins and Green,
2011] were considered. The initial draft was presented to
key construction and research audiences for input, including
the TAB, the Center’s research consortium, the National
Occupational Research Agenda (NORA) Construction
Sector Council (a partnership program sponsored by NIOSH
to establish and promote research priorities), North
America’s Building Trades Union’s Safety and Health
Committee, and a newly formed OSHA/NIOSH/CPWR
interagency r2p Working Group.
The initial version of the triage tool started with
background sections identifying the project, lead investi-
gators, NORA priorities addressed, study type, major
findings, major outputs or products, dissemination already
conducted, and key audiences. The form then used a skip
pattern based on whether or not the research had resulted in
specific interventions (evidence-based tools, equipment, or
programs). For research without specific interventions (e.g.,
surveillance studies), reviewers completed a section on
recommended next steps to continue to move the research
along the r2p process, such as further communication of
results to target audiences, further definition or characteriza-
tion of the problem, or the development and testing of
prevention strategies or interventions.
For research projects that had resulted in interventions,
reviewers completed two additional sections —a section to
rate r2p readiness and one to describe initial dissemination
steps. In order to address the range of considerations that may
be important in dissemination and implementation efforts
[Colditz and Brownson, 2012; Proctor and Brownson, 2012],
we built multiple dimensions into the assessment of “r2p
readiness,” including, but not limited to, intervention
efficacy, which has traditionally been the standard for
considering the value of research. Ultimately five domains
were selected for inclusion in the triage tool for rating r2p
readiness, with a scoring scale from 1 (lowest) to 5 (highest).
The first domain, “strength of findings,” asked
reviewers to consider factors such as research design,
evidence of efficacy, effect size, and consistency with other
evidence or experience in the field. For the second domain,
“impact and reach,” reviewers took into account the
severity of the problem addressed as well as the scope of the
problem in terms of numbers of affected workers, trades,
and/or construction sectors. The third domain, “potential for
effective partnerships,” asked reviewers to evaluate the
extent to which there were promising partners that could
collaborate to carry out the next steps, since a lack of
industry-based partners can often keep even highly effective
solutions from successfully being disseminated and
implemented on worksites. For “achievability,” the fourth
domain, reviewers were asked to consider questions related
to the challenges of the proposed change; whether the
intervention was readily available; anticipated barriers; costs
to potential adopters; and the extent to which the intervention
could be “packaged” with other interventions. Reviewers
also were encouraged to consider concepts from the theory of
“diffusion of innovations” such as relative advantage,
compatibility, complexity, trial-ability, and observability
[Rogers, 1995]. The fifth domain, “high priority areas,”
asked reviewers to indicate if the project addressed a hazard
or health effect that is of special importance or makes a
unique and significant contribution, such as addressing
serious health disparities, focusing on areas that remain
largely unaddressed, representing a major gap in construc-
tion health and safety, or presenting an opportunity to make
an “upstream” change at an industry-wide or societal level.
A sixth “summary score” asked reviewers to provide
their assessment, again on a scale of 1 to 5, of the overall
priority the project should have for additional r2p support
from the organization. This was not intended to be an average
of the previous scores, but rather as an overall assessment of
a project’s r2p readiness. For example, a project with a low
score in terms of potential impact and reach might still be
rated highly overall if it offered a highly effective
intervention that would be relatively simple to implement.
Reviewers were asked to provide detailed comments on their
rationale in weighting the importance of the different
domains for this summary score, which, along with notes
for each of the previous domains, would serve as the record
for how triage decisions were made.
In the final section for all projects at the intervention
stage, reviewers were asked to suggest methods of
dissemination for the project, including education/training,
outreach/marketing, policy development, technology trans-
fer, coalition-building, communication products, and/or
other strategies. This section asked for suggestions of
possible partners, potential evaluation measures, other
factors that could help or hinder r2p efforts, and recom-
mended actions or immediate next steps.
To assist reviewers in completing the triage form and in
order to enhance consistency in interpretation of items, a
guidance document and detailed “mouse over” explanations
and examples were created.
Following the review of the first 10 projects, the tool
underwent a final round of revision. Only one major change
resulted, which reflected user interest in more explicitly
acknowledging differences in dissemination goals for
projects that result in specific interventions and those that
do not (such as epidemiologic research). For clarity, two
separate versions of the tool were created for “intervention
stage research” and “pre-intervention stage research.”
Of the 17 projects reviewed, 12 were at the intervention
stage and five were at the pre-intervention stage. The mix of
 Construction Health and Safety Research Triage
projects was a function of the pool of research projects
solicited and included in the Center’s consortium. In the early
years of the Center’s 25-year history, the research emphasis
was aimed at gaps in defining the problems in the industry. As
this area of research grew over time and hazards became
better defined, the Center shifted its emphasis toward more
solutions-oriented research within the consortium.
Research Reviews
Each completed research project was discussed on a
conference call, using the triage form (http://www.cpwr.com/
research/r2p-tools-and-resources) as the discussion guide.
Reviewers included the project’s lead investigator (and other
members of the research team at the discretion of the
principal investigator), the Center’s project officer who was
responsible for project oversight, and a member of the
Center’s r2p research team. Prior to the call, previously-
submitted progress and final reports were used to fill in as
much of the background sections of the tool as possible. The
draft was shared with all reviewers, and each reviewer
completed the form individually prior to the conference call.
These calls allowed project investigators to update or
correct information about materials created or dissemination
undertaken since the final report was submitted and to offer
additional context or clarification. It was also a chance for r2p
team members and program officers to ask questions and
contribute their knowledge about dissemination strategies
and resources. Each reviewer returned a final individually-
completed triage tool to the r2p research team after the
discussion. Calls typically lasted one to one and a half hours.
Analysis of Research Reviews
The r2p research team consolidated scores and
recommendations of the three different reviewers to create
one master triage form, or summary report, for each research
project to be used in analysis. Quantitative and qualitative
analyses were undertaken with intervention-stage projects.
For non-intervention projects, only qualitative approaches
were used. For each intervention-stage project, mean scores
and standard deviations for each of the six priority rating
areas (the five domains and summary score) were generated,
and the ranges of all three raters’ scores were noted.
ATLAS.ti software was used in qualitative analysis of
all 17 triage summaries. We generated lists of codes in
five “families”: (i) audience codes—17 distinct terms or
categories such as apprenticeship programs, residential
contractors, and doctors; (ii) dissemination channel codes
—12 terms or categories such as peer-reviewed journals and
mass media; (iii) dissemination method codes—15 terms or
categories such as training, marketing, technology transfer,
and coalition building; (iv) Output codes—16 terms or
841
categories for products such as factsheets, websites, and
videos; and (v) Partner codes—two categories including
current research partners and potential r2p partners.
The list of codes was applied to the summary triage
forms for each project in the areas of: dissemination already
conducted; further dissemination needed; and project
commonalities, differences, and cross-cutting themes and
issues. Each response or comment on the form was assigned
all applicable codes. After coding was completed, we
examined data organized by code and by each area
mentioned above (e.g., dissemination already conducted).
RESULTS
The results include: (i) the findings of the systematic
review of the research projects, including patterns of
dissemination strategies and prioritization of r2p follow-up
stemming from the review process; and (ii) the follow-up
dissemination projects identified and carried out based on the
reviews.
Triage Analysis Results
Project ratings
Table I shows scores for the 12 intervention projects,
with summary scores ranging from 2.7 to 5.0, and with scores
being fairly close across raters. Only one project had highly
divergent summary scores (with a standard deviation of more
than two). Numerical scores tended to be on the higher end of
the scale with 9 of the 12 projects receiving summary scores
of 4 or higher. The highest scoring domains overall were
“potential impact” and “high priority area.” The domain with
the highest correlation to a high summary score was
“partnership potential.”
Project ratings were categorized into “top,” “middle,”
and “bottom” tiers. The top tier included the three projects
that received summary scores of “5,” indicating that all
reviewers had unanimously given them the highest possible
score. The middle tier included six projects that received
scores ranging from 4.0 to 4.8, while the bottom tier included
three projects receiving mean scores below 4.0, indicating a
lower level of readiness for dissemination.
Dissemination strategies
Qualitative analysis revealed patterns in dissemination
strategies. As expected, the most universal form of
dissemination that already had been undertaken by research-
ers was publication in the scientific literature. Broader
dissemination strategies employed most frequently included
conducting presentations to and writing articles for con-
struction audiences such as trade associations and labor
842 Baker et al.

TABLE I. Mean and Standard Deviation Scores of Projects by Dimension

C1: strength of findings C2: potential impact C3: partnerships C4: achievability C5: high priority area C6: summary
Project name Mean St.D. Mean St.D. Mean St.D. Mean St.D. Mean St.D. Mean St.D.
Masonry ergonomics 4.67 0.58 4.67 0.58 5.00 0.00 4.33 0.58 5.00 0.00 5.00 0.00
Latino worker safety 4.00 0.00 4.67 0.58 4.67 0.58 4.67 0.58 4.67 0.58 5.00 0.00
Silica and noise 4.67 0.58 4.50 0.71 4.50 0.71 4.00 1.00 5.00 0.00 5.00 0.00
Overhead drilling 4.67 0.58 3.67 0.58 4.67 0.58 3.67 0.58 5.00 0.00 4.67 0.58
Nail guns 5.00 0.00 4.00 0.00 3.67 1.15 4.33 0.58 4.00 1.00 4.67 0.58
Fall prevention education 3.00 0.00 4.33 0.58 4.67 0.58 4.33 0.58 3.67 1.15 4.33 0.58
Safety culture 3.00 0.00 4.33 0.58 2.67 0.58 2.67 0.58 5.00 0.00 4.00 1.00
Residential falls 3.33 0.58 4.00 0.00 4.00 1.00 3.00 0.00 4.67 0.58 4.00 1.00
Ladder falls 3.33 0.58 4.33 0.58 3.67 0.58 3.67 0.58 4.33 0.58 4.00 0.00
Electrical inspections 3.00 1.00 4.33 1.15 3.33 1.53 4.33 0.58 4.67 0.58 3.67 1.15
Leading edge 3.00 1.00 4.33 0.58 3.67 0.58 3.67 0.58 4.33 0.58 3.33 0.58
Ergo diffusion 3.33 0.58 3.33 1.15 1.67 0.58 2.67 2.08 3.33 0.58 2.67 2.08
Overall 3.75 0.91 4.20 0.68 3.83 1.15 3.78 0.96 4.44 0.75 4.19 1.01

organizations (16 projects), making information or a solution
available online for download (nine projects), presentations
at professional meetings (eight projects), and seeking to
incorporate findings or a solution into education or training
such as apprenticeship or career technical education
programs (eight projects). Other dissemination strategies
that were often employed included distributing materials or
findings to research partners (seven projects) and developing
communications products such as factsheets, hazard alert
cards, and stories of impact (seven projects).
Dissemination strategies that had been employed the
least included engaging in policy discussions or efforts (two
projects), technology transfer (two projects), mass media
communications (one project), and social media communi-
cations (one project).
For the 12 intervention stage projects, reviewers made
recommendations for further dissemination methods. Those
most often suggested by reviewers included developing and
distributing additional communications products (12 proj-
ects), outreach/marketing (11 projects), education/training
(10 projects), coalition-building (10 projects), policy
development (eight projects), and technology transfer efforts
(four projects).
For the five non-intervention stage projects, reviewers
recommended a range of next steps other than broad
distribution, including communication of results to specific
target audiences (four projects), developing prevention
strategies or interventions (four projects), and/or further
characterization of the problem (three projects).
Potential partnerships
Project reviewers identified existing and potential
partners to involve in future efforts. Partners were seen as
critical to reaching and influencing the ultimate target
populations (construction contractors and workers). The
desired partners identified most frequently were OSHA or
other government agencies (seven projects), manufacturers
(four projects), unions and apprenticeship programs (four
projects), an existing national fall prevention campaign
(three projects), and big box stores or other suppliers (three
projects).
Cross-cutting issues
In the process of identifying promising project-specific
r2p opportunities, strong cross-cutting themes and topics
emerged, such as the challenges of technology transfer,
incorporating evidence-based practices into established
educational or training programs, reaching workers and
contractors in the residential construction sector, and the
central role of safety culture in promoting health and safety
on construction work sites.
Follow-Up r2p Projects Identified
As Figure 1 illustrates, we considered numerical scores
and cross-cutting themes, as well as windows of opportunity,
in the selection of follow-up r2p efforts for further
investment. Scores were used primarily to ensure that all
high-scoring research projects moved forward toward real-
world application. The review revealed that all three of the
top-tier projects and many of the middle tier projects already
had received next stage support as funded projects in the
2009–2014 cooperative agreement (seven projects), through
the Center’s small studies mechanism (two projects), and/or
through other external efforts and funders (three projects).
This narrowed the field of specific projects still in need of r2p
 Construction Health and Safety Research Triage
FIGURE1. Selection process for r2p follow-up projects.
support and led to the consideration of follow-up projects
focusing on cross-cutting r2p strategies, many of which built
upon and added to a substantial existing evidence base (e.g.,
hazards of silica exposure), and had the potential to advance
the development of dissemination mechanisms for both
current and future research. Drawing on a synthesis of
research, rather than on a single research project alone,
strengthened our confidence in the readiness of information
and interventions for dissemination. Unique opportunities
also influenced the selection of follow-up projects. These
included, for example, NORA Construction Sector Council
plans, proposed OSHA rulemaking, and intended release of a
joint NIOSH-OSHA guidance document.
The following six projects were selected based on priority
rating scores, recommended dissemination methods, sug-
gested next steps, available partners, resources needed, and
gaps in research dissemination. Opportunities for synergy
across dissemination efforts and the ability to address cross-
cutting themes led to the selection of dissemination projects
that were related to more than one specific research project in
most cases.
▓Round One r2p Follow-Up Projects
▓▓Nail Gun Safety
▓▓Silica Safety
▓▓Technology Transfer
▓Round Two r2p Follow-Up Projects
▓▓Safety Culture/Climate
▓▓Reaching Residential Contractors
▓▓Career Technical Education
843
The first three follow-up efforts were selected prior to
completing the review of all the projects. Reviews required
substantial lead time to schedule and were time-consuming
to conduct and analyze. In order to launch clearly promising
follow-up efforts in a timely fashion, a first set of decisions
on follow-up projects took place at the mid-point of the triage
review process. All three initial follow-up efforts stemmed
from projects that had yielded high priority rankings in the
triage reviews, and afforded unique and timely opportunities
to take action together with likely or already-involved
partners. The remaining three follow-up efforts were selected
after all 17 projects had undergone triage review.
The recently formed OSHA/NIOSH/CPWR r2p Work-
ing Group played a critical role in the selection and
implementation of follow-up dissemination projects emerg-
ing from the triage process. The joint Working Group
reviewed potential projects, provided input on priority areas
of interest, and identified those that offered opportunities to
collaborate and build r2p capacity in all three organizations.
The group worked together to develop a dissemination
planning template to provide a thorough, strategic, and
consistent approach across dissemination efforts.
Implementation of r2p Follow-Up
Projects
The Nail Gun Safety project resulted from one of the
CPWR-funded studies [Lipscomb et al., 2010, 2011], which
identified a clear hazard and relatively simple solutions.
NIOSH and OSHA agreed to develop and release a joint
Nail Gun Guidance Document [OSHA/NIOSH, 2011] for
construction contractors, and all three organizations engaged
in a coordinated effort to actively disseminate the document.
This resulted in a concentrated campaign to reach nail
gun purchasers and users through intermediary organizations
and publications. This effort involved a press release
announcing the new government resource and included
personalized email communications to key constituents,
use of social media, and other active marketing. Results
included major exposure through industry publications and
websites and a high volume of downloads. The campaign
helped drive traffic to a user-friendly website created by the
original research team and featuring valuable information
and additional resources (http://www.nailgunfacts.org). In
addition to resulting in broad dissemination of important
safety information, this first joint effort contributed
substantially to improved dissemination capacity in all three
organizations.
The Silica Safety project was based on the identified
need to improve awareness of available solutions to control
silica dust in construction work stemming from two of
the triaged projects. It was anticipated that OSHAwas ready to
announce new rule making activity for silica exposure,
844 Baker et al.
making it a particularly opportune time to promote awareness
of evidence-based solutions. The resulting dissemination
project involved the development, testing, and promotion of a
“one-stop” website for information and resources related to
silica safety (http://www.silica-safe.org). Based on input from
the major target groups (construction contractors and trades
people), the site was designed to provide a practical tool for
developing a written silica exposure control plan, customized
to the particular construction job and drawing on the best
available evidence. The site received more than 12,000 visits
in the first year, with much of the traffic driven by a
combination of an active outreach campaign and referrals
from OSHA and industry websites. In addition, OSHA listed
the CPWR website as one of just six technical resources on its
“Crystalline Silica Rulemaking” online resource. The website
was referenced during testimony during the rule-making
hearings, discussed in supporting comments and briefs, and
submitted as evidence in support of the feasibility of reducing
silica exposures through the use of safer equipment and work
practices. It has also been used as a vehicle to disseminate
related research information and other interventions devel-
oped by safety and health researchers.
The Technology Transfer effort grew out of the
dissemination lessons of a research consortium project that
developed and then sought to take to market an overhead
drilling device [Rempel et al., 2010a,b]. The challenges
faced by this research team resonated with other researchers’
frustration with the slow and sometimes seemingly impene-
trable process of making safety innovations available on the
market. This project involved a “Construction Industry
Technology Transfer Symposium” held in May 2012 that
explored gaps in understanding of the process, ways that
researchers could better partner with manufacturers, and how
researchers could create more effective technology transfer
plans for their interventions, drawing on both successful and
unsuccessful case examples of commercializing innovations.
Recommendations for building and sustaining technology
transfer in the construction industry were documented in a
symposium report [CPWR, 2012], and a practical patent and
licensing guide for health and safety researchers was
developed [CPWR, 2014a].
Safety Culture and Climate was the subject of several
research projects that were reviewed and the triage process
identified the need to bring together lessons and resources
across these different projects and identify unmet research
and dissemination needs. The Center partnered with the
NORA Construction Sector Council for this follow-up effort,
as they had independently identified safety culture and safety
climate as important areas considered “ready for impact”
[NORA Construction Sector Council, 2008]. This r2p
follow-up project included a literature review [Hecker and
Goldenhar, 2014] and a national symposium to identify best
practices and recommendations based on current evidence
and experience in the field [CPWR, 2014b]. Additional
resource materials on best practices also resulted [CPWR,
2014,b].
The challenge of Reaching Residential Contractors
was another issue that arose in the review of several research
projects, and had also been selected as a priority issue by the
NORA Construction Sector Council. The follow-up effort
was again undertaken as a joint project of the r2p Working
Group, which was already engaged in related work through
the joint national social marketing campaign, “Safety Pays,
Falls Cost” (http://stopconstructionfalls.com). The r2p
support for this area involved conducting a literature review
and environmental scan to identify promising approaches for
reaching the residential sector [Chapman, 2013], as well as a
survey project to collect experiences that were not captured
in the literature. The survey report [CPWR, 2015] shares
lessons learned from health and safety researchers, insights
into the social and professional networks of residential
contractors, and suggested areas for further exploration in
terms of impacting health and safety practices in this hard-to-
reach population.
Finally, the follow-up project on Career and Technical
Education (CTE) was identified as a result of 10 different
project reviews in which the researchers hoped to dissemi-
nate their results through existing training programs. While
the Center has extensive experience and connections in
formal apprenticeship programs, little was known about
health and safety training in construction CTE programs,
which are typically based in community colleges and high
schools, and represent an important dissemination setting for
reaching thousands of workers who enter the construction
industry each year. A report was commissioned [Bush and
Andrews, 2013] that describes what is known about the
current state of occupational safety and health training in
construction CTE programs and recommendations for
partnering with CTE organizations in order to create
pathways for dissemination of new, evidence-based learning
materials. As a result of this initial assessment, a new study
was initiated recently to systematically assess and character-
ize the elements of effective health and safety education in
post-secondary construction CTE programs nationally.
DISCUSSION
The r2p triage project involved the development and
application of a systematic approach to ensure that promising
safety and health findings and solutions from the Center
continue along the research to practice pathway, and to
ultimately better protect workers from injury and illness on
the job. The project addressed two of Kreuter and
Bernhardt’s [2009] recommended action steps for adopting
a marketing and distribution perspective on dissemination
and implementation in public health: one which called for all
appropriate proven programs to be distributed, and not
 Construction Health and Safety Research Triage
simply those whose researchers or developers happen to be
dissemination-oriented; and another which called for
marketers and public health practitioners to work together
to modify programs, package them appropriately, and
present them to users in a way that facilitates ease of use.
The application of the triage tool provided a useful
standardized approach to the review process and revealed
that even though significant research translation and
dissemination already had taken place prior to the review,
important gaps and opportunities remained. Many follow-up
projects were selected to further explore r2p strategies that
cut across multiple projects and had the potential to improve
dissemination knowledge and experience for current and
future research. In addition, the resulting dissemination
projects helped build r2p capacity in construction safety and
health across three key organizations—OSHA, NIOSH, and
the Center. Lessons learned about assessing r2p readiness
and selecting follow-up projects as well as limitations to the
project are discussed below.
Assessing r2p Readiness
Using qualitative and quantitative
approaches in assessment
The triage tool and assessment process evolved to be
strongly qualitative in nature as the complexity of weighing
the different dimensions of r2p readiness became clearer.
Numerical ratings provided a standard way of comparing
different readiness dimensions and reviewer assessments
within and between projects, yet accompanying notes with
detailed rationale for the ratings were critical to interpreting
the scores and leaving a record of our decision-making and
how we engaged in the triage process. Similarly, we chose to
use a summary score that reflected each reviewer’s synthesis
and balancing of the different dimensions of each project. As
we were developing and piloting the tool and process, we
decided a more flexible approach would be more appropriate
than averaging the ratings or applying a standard weighting
formula. We instead relied on reviewers’ experienced in
construction, health, and safety, and r2p to document their
reasoning behind their scoring in detail and to provide
additional commentary on important r2p priorities related to
the projects.
Different types of research require
different assessment and r2p
approaches
The triage process was most effective for assessing and
supporting research projects that had resulted in specific
interventions—evidence-based tools, equipment, and prac-
tices. Non-intervention-oriented research projects, such as
those involving surveillance or exposure assessment
845
activities, require a distinct assessment process to determine
how to move the results forward. More attention may be
needed to explore the unique r2p needs of non-intervention
research that is not yet ready for broad dissemination, but that
still needs to be communicated to key audiences and moved
to the next phases of development in order to make an
impact.
Researcher engagement
Engaging researchers in the review of their completed
projects presented both advantages and challenges. Re-
searchers’ scientific training has typically not included r2p
concepts, terminology, and strategies [Kreuter & Bernhardt,
2009]. During the triage process, researchers expressed
concern that they would be expected to become “communi-
cation experts,” engage in dissemination work even though
their funding had ended, and/or do a great deal of additional
paperwork. It was critical to the success of the triage process
that we were able to address these concerns by minimizing
the work involved in the process and providing r2p expertise
and resources, rather than creating a mandate for researchers
to carry out the follow-up work themselves.
While scheduling the conference calls to conduct the
reviews was labor-intensive, in the end we did achieve 100%
participation. The researchers were able to provide context
and clarification on the details of their research, findings, and
dissemination efforts, and most reported that, despite some
initial reluctance, the group process was valuable for
thinking through dissemination readiness and opportunities.
Researchers showed remarkable thoughtfulness and willing-
ness to critically assess the strength of their findings and their
potential contributions to practice.
Critical to researcher engagement was the presence of
r2p support systems that had been put in place in advance
through the Center’s dedicated communications and dissem-
ination efforts, as well as funding resources, including small
study opportunities to explore and test dissemination
approaches. This points to the need for strong institutional
support and commitment of organizational resources for an
r2p initiative such as the triage project to be successful.
Selection of Follow-Up Projects
Flexible and strategic selection of
follow-up projects
The selection of follow-up r2p projects was originally
intended to rely more heavily on the numerical scores
coming out of the triage review process. However, several
factors led to the use of a more flexible and opportunistic
approach. The r2p research team discovered that work on the
highest-priority projects was already continuing, having
been supported through a variety of mechanisms. Yet
846 Baker et al.
researchers tended to rely on more familiar dissemination
strategies such as writing articles, presentations to profes-
sional associations, and, in some cases, developing transla-
tional materials without a specific audience or dissemination
strategy in mind. This led to a focus on how to better engage
in and promote broader “out of the comfort zone”
dissemination strategies—that is drawing on a wider range
of options, ranging from use of social media and social
marketing to advancing policy proposals.
In addition, the differentiation between project scores
was less pronounced than anticipated. Research projects had
been screened carefully before inclusion in the Center’s
research consortium proposal, with an emphasis on projects
with high potential for improving construction safety and
health. This resulted in high triage scores overall, and
particularly in terms of being in high-priority areas and
having potential for impact.
Strong cross-cutting issues and themes emerged, which
suggested that some of the potentially most useful invest-
ments may be made in areas that benefit multiple projects
and/or develop dissemination capacity for future efforts. The
emergence of these cross-cutting themes from the triage
process additionally demonstrated the benefits of being
able to review a set of projects together as a group. Without
the ability to compare across projects, some important
opportunities to build r2p knowledge, capacity, and
infrastructure in construction health and safety may have
been missed.
Finally, the need to be “opportunistic” became increas-
ingly apparent in the early stages of the triage review process.
OSHA’s rulemaking process, a new OSHA/NIOSH/CPWR
joint r2p Working Group ready to take on follow-up projects,
and broad interest in technology transfer presented oppor-
tunities and momentum to advance r2p in construction health
and safety. Seizing windows of opportunity can be
particularly effective in promoting dissemination, as has
been noted by other authors [Kingdon, 1995; Dearing, 2008;
Minkler et al., 2014].
The critical role of partnership
The importance of partnership in advancing r2p became
evident throughout the triage process. The partnership
domain had one of the strongest relationships with summary
scores and follow-up projects tended to focus on efforts that
could enhance partnership opportunities. The planning
process for each dissemination effort required that we
identify effective intermediary groups that could best reach
and influence the end users who ultimately need to adopt and
implement the proposed innovation. In many cases these
final decision-makers are construction contractors and
workers who are not easily reached and can be resistant to
changes in tools or practices [National Research Council and
Institute of Medicine, 2009; Gillen and Gittleman, 2010].
Credible partners with established relationships with these
audiences were therefore essential in all of the projects
selected for r2p follow-up.
Although a different kind of partnership, the r2p
Working Group brought together the experiences, energy,
and resources of three influential institutions in construc-
tion health and safety to support and implement follow-up
projects. The group played a pivotal role in the triage
process in carrying out and executing dissemination plans.
While the Working Group was a unique collaboration of
health and safety-focused government organizations, the
experience more broadly suggests the importance of not
only partners with access to target populations, but also
partners with an explicit focus on dissemination and the
ability to bring different and necessary resources to the
table.
Limitations
One limitation of this triage effort was the inclusion of
only a discrete set of studies conducted by members of the
Center’s research consortium. Its group of investigators may
be unusually motivated to think about r2p issues, given the
rigorous screening process employed by the Center in
selecting proposals to include in its consortium and a
corresponding emphasis on projects that are likely to have a
significant impact on improving health and safety in the
construction industry. The triage process, which included
filling out forms, scheduling and holding conference call
discussions, analysis, and subsequent decision-making,
required substantial investments of time. It may be
challenging to replicate this level of support and commitment
to the process with other groups of researchers and in the
absence of a dedicated r2p staff.
The triage process also involved a degree of subjectivity
in each reviewer’s assessment of the projects, including
providing a summary score based on her/his perception of
r2p readiness dimensions. To account for this, reviewers
were asked to describe and make explicit their rationale for
their scoring and prioritization.
The evaluation of the follow-up dissemination efforts
was limited to process evaluation measures, such as the
number of translational products developed, the extent of the
distribution efforts, and the numbers reached (e.g. number of
downloads). Outcome evaluation was beyond the scope of
this effort.
CONCLUSION AND NEXT STEPS
Information from the triage effort has helped to inform
the priorities of the National Construction Center and to carry
out dissemination in a more systematic way. The Center will
seek to expand and refine its r2p triage initiative in the next
 Construction Health and Safety Research Triage
five-year funding cycle (which began in 2014). In addition to
repeating the triage review process with newly completed
research projects, further exploration will focus on three
areas:
1. Effective follow-up for research that does not result in
evidence-based solutions ready for broad dissemina-
tion. As discussed earlier, The Center’s pool of research
projects is weighted toward intervention research that is
more likely to be ready for broad dissemination.
However, an equally important part of r2p is the
advancement of research along the “r2p pathway”—that
is, from problem identification, to characterization, to
controls research. More work is needed to assist
researchers in sharing critical results with those who
may be in a position to fund, conduct and/or advocate for
“next stage” research.
2. Defining feasible metrics to assess the impact of
enhanced dissemination efforts. While we may be
able to document that broad dissemination has taken
place, and that we have enhanced our capacity to do such
outreach, it is far more challenging (and costly) to
measure changes in the adoption and implementation of
the interventions in the field (i.e., in practice). Yet
adoption, implementation, and maintenance are clearly
critical outcomes in r2p efforts. This is a developing area
in dissemination and implementation science [Proctor
et al., 2012], and additional capacity building and
resources for supporting and measuring change in these
phases will be needed for research teams, dissemination
partners, and evaluators.
3. Earlier engagement with research teams. The Center has
instituted an r2p “road map” process to aid researchers in
their thinking early on about how their results may be
shared and applied, with a particular emphasis on
helping to identify dissemination partners and engaging
potential end users earlier in the research process. An
“r2p roadmap” tool (http://www.cpwr.com/sites/default/
files/Roadmap%20and%20Worksheet%20FINAL.pdf)
already has been developed and pilot tested. The process
was initiated with research teams in the current cycle and
will continue to be implemented throughout the next five
years. The roadmap process has familiarized researchers
with r2p concepts and will provide opportunities for
prospective planning and reflection on a regular basis
throughout the study periods.
Finally, we have found it important to develop an
approach to r2p that is tailored specifically to the construc-
tion industry, with its unique and complex set of players who
influence health and safety practices. At the same time, we
believe that the basic approach to “triaging” research results
can be adapted and, if supported with institutional resources,
may well prove useful for r2p efforts in other sectors.
847
Acknowledgements
The research was made possible by CPWR – The
Center for Construction Research and Training through
cooperative agreement U60-OH009762 from the National
Institute of Occupational Safety and Health (NIOSH). Its
contents are solely the responsibility of the authors and do
not necessarily represent the official views of CPWR or
NIOSH.
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