The goal for this multidisciplinary randomized controlled trial (RCT) is to actively and meaningfully engage outdoor workers (can include agricultural workers, construction workers, landscaping, wildland firefighters, fire cleanup crews, etc.) and community members in describing the impact of climate change on their lives and working conditions in San Joaquin Valley, Kings County, and Monterey County. Participants will be randomly assigned to one of two study arms: (1) the Intervention Group, which will receive bilingual (Spanish and English) Cal/OSHA educational materials and engage in the Our Voice participatory action research (photovoice) method using a bilingual (Spanish and English) mobile application, or (2) the Control Group, which will only receive bilingual (Spanish and English) Cal/OSHA educational materials. Core outcomes will be measured identically across both groups to allow direct comparison of the two approaches. Using the "Our Voice participatory action research method" and Cal/OSHA educational materials, the investigators will learn about participants' attitudes, behaviors, and actions in response to changing climate in the counties and evaluate whether the education and photovoice approach is more impactful than traditional didactic Cal/Osha education only.
This study uses a randomized controlled trial (RCT) design with two parallel arms to evaluate whether combining participatory action research with occupational health education produces greater changes in climate-related attitudes, behaviors, and protective actions compared to occupational health education alone. The study targets outdoor workers and community members across California: San Joaquin Valley, Kings and Monterey Counties, regions where outdoor workers face disproportionate exposure to climate-related health hazards including extreme heat and degraded air quality. Intervention The Intervention Group will engage in the "Our Voice photovoice program," a community-based participatory action research methodology developed at Stanford University. Our Voice uses a mobile application called the Discovery Tool, which allows participants to document features of their local environment by taking photos and recording written or audio reflections in real time. The app is available in multiple languages, including English and Spanish. Participants in the Intervention Group will complete three sequential activities: Discovery Tool Training: a live or pre-recorded individual or small group session (by phone, Zoom, or in-person) led by a Stanford RA, orienting participants to the photovoice approach and app use Discovery Walk: an independent walk in their home or work neighborhood to document environmental features relevant to climate and health using the Discovery Tool Community Discovery Meeting: a facilitated approximately 2-hour group meeting held within six weeks of the Discovery Walk, where participants collectively review photos, identify common themes, and discuss community assets and challenges they wish to address Control Both groups will receive bilingual (English and Spanish) Cal/OSHA educational materials covering heat illness prevention, air quality risks, and protective measures for outdoor workers. The Control Group receives these materials as the sole study intervention. The Intervention Group receives the same materials as part of their Community Discovery Meeting. Randomization Eligible participants will be randomly assigned in a 1:1 ratio to either the Intervention or Control Group using simple randomization via REDCap.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE
Enrollment
50
Participants will receive Cal/OSHA educational materials covering heat and air quality risks for outdoor workers \[will insert more info (how often, method etc once MP revises protocol\].
Participants will engage in the full Our Voice photovoice program, including training on the Discovery Tool, a Discovery Walk, attendance at a Community Discovery Meeting, and receive the same Cal/OSHA educational materials \[will insert more info (how often, method etc once MP revises protocol\].
Stanford University
Stanford, California, United States
RECRUITINGChange in self-efficacy as assessed by the Individual Community-Related Empowerment (ICRE) Scale.
Each participant will complete the Individual Community-Related Empowerment (ICRE) at baseline, immediately after the intervention photovoice activity or control education activity, and 6 months. The ICRE Scale is an 18-item measure of empowerment capturing the following five dimensions: self-efficacy (personal confidence in capacity to change one's community), intention (desire to engage with or for the community), participation (actual community involvement), motivation (beliefs surrounding community engagement), and critical awareness (perceived seriousness of community issues). Response options are on a five point rating scale ranging from 1 = "strongly agree" (the most favorable perception) to 5= "strongly disagree" (the most unfavorable perception). Lower raw scores indicate greater empowerment.
Time frame: Change in self-efficacy from baseline to immediately after the intervention photovoice activity or control education activity and at 6 months
Change in social cohesion and collective efficacy as assessed by the Social Cohesion and Self-Efficacy scale.
Each participant will complete the Social Cohesion and Self-Efficacy scale at baseline, immediately after the intervention photovoice activity or control education activity, and 6 months. The scale includes 6 questions answered on a five point rating scale ranging from 1 = "strongly disagree" (the least favorable perception) to 5= "strongly agree" (the most favorable perception). Higher scores indicate greater social cohesion and self-efficacy.
Time frame: Change in social cohesion and collective efficacy from baseline to immediately after the intervention photovoice activity or control education activity and 6 months
Change in climate change hope and agency as assessed by the Climate Change Hope Scale (CCHS).
Each participant will complete the CCHS at baseline, immediately after the intervention photovoice activity or control education activity, and 6 months. The scale consists of 11 statements to which participants respond to on an 8-point scale. The scale goes from -3 (strongly disagree) to 0 (neutral) to 3 (strongly agree) and one last choice of X which means "I do not think climate is changing." Higher scores indicate greater hope.
Time frame: Change in climate change hope and agency from baseline to immediately after the intervention photovoice activity or control education activity and 6 months
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