Table 3 Strategies to address barriers to heat-related illness prevention and treatment identified during participatory focus groups

Behaviors reflecting cultural beliefs

Add the following information to train-the-trainer HRI educational materials:

Education/workplace & individual

E.g. Avoidance of certain HRI treatments

1) a review of the potential role of cultural beliefs, such as beliefs related to cooling treatments after heat exposure, in the prevention and treatment of HRI;

2) recommendations for trainers to identify and, if present, acknowledge the role of cultural beliefs in a non-judgmental and respectful manner;

3) an explanation of rapid cooling treatments for workers with heat stroke;

4) recommendations for trainers to involve workers in developing effective and culturally acceptable strategies for treating workers with heat stroke

Competing health priorities

E.g. Weight loss (via sweating); Back injury prevention

Direct workers to community-based obesity prevention and fitness programs, if available, or integrate elements of such programs into workplace health promotion activities.

Health promotion/ community & workplace

Competing workplace hazards & controls

E.g. Non-breathable chemical resistant suits for pesticide handlers;

Develop and use more breathable chemical-resistant suits;

Personal protective equipment/workplace

Prevention of ultraviolet light (UV) exposure

Enhance UV protection of light-colored, breathable clothing by frequent laundering with ultraviolet absorbent agents, or use clothing with pre-integrated UV protection;

Encourage sunscreen use during worker HRI training

Education/individual

Hydration & workplace factors

E.g. Inadequate hydration due to lost wages from taking breaks among piece rate workers, negative reactions from supervisors regarding water breaks, lack of nearby bathroom facilities;

Implement a standardized system of water break reminders at reasonable intervals on days with high heat/humidity;

Administrative/ workplace

Implement salaried or hourly payment schemes instead of piece rate;

Locate bathroom facilities close to workers;

Water does not appear clear and is not changed regularly;

Adhere to basic field sanitation requirements (drinking water is provided in a closable container, is clearly labelled as such in a language that workers can understand, is readily accessible to workers, has a tap, is suitably cool, and containers are refilled regularly);

Water is located in opaque containers, near bathrooms (perceived as contaminated);

Locate water away from restrooms (but near workers) in non-opaque containers;

Arrange for an employee to deliver water to workers at regular intervals using an all-terrain or other vehicle;

Energy drinks preferred to increase alertness and productivity

Provide preferred, recommended beverages; Include information on sleep hygiene and fatigue mitigation in health promotion activities

Health promotion/ community & workplace

Other workplace factors

E.g. Lack of shade

Add workplace shade requirements to regulations, if not already included

Engineering (shade)/ societal