Show and tell: Visual symbols inform vulnerable workers about MSDs

Visual symbols or pictograms, along with training, are a promising approach to protect vulnerable workers from musculoskeletal disorders, according to a collaborative evaluation involving the Institute for Work & Health.

Published: July 26, 2012

A novel method to safeguard vulnerable workers from musculoskeletal disorders (MSDs) is showing promise. This is the take-away message from a pilot evaluation of pictograms, or visual symbols, by the Institute for Work & Health (IWH) and Workplace Safety & Prevention Services (WSPS), an Ontario health and safety association serving the manufacturing, services and agricultural sectors.

These two organizations worked together to assess the effectiveness of pictograms and corresponding safety training for workers in prep kitchens. MSDs were selected because they account for 30 per cent of long-term claims, 53 per cent of lost-time days and 49 per cent of benefit costs in Ontario’s service sector.

The project, funded by Ontario’s Workplace Safety and Insurance Board (WSIB), was described as “groundbreaking” by WSPS Innovation and Knowledge Solutions Manager Kimberly Grant, co-principal investigator, when it was first getting off the ground (see At Work, Spring 2010). Two years later, the results are positive. The pictograms led to an increase in knowledge about MSDs among prep kitchen employees and a decrease in risk-related work practices—effectively confirming that the use of pictograms within a health and safety context is a good idea.

Because pictograms use a universal language, they are particularly helpful in explaining prohibited or desired actions to workers for whom English is a second language or those with low literacy skills. The pictogram approach has proven to be a successful way to share important messages across various barriers, including culture, language, age and education, says IWH Senior Scientist Dr. Ben Amick, co-principal investigator.

Creating a universal language

In the project’s first phase, pictogram prototypes were created and tested with an ergonomics advisory committee and prep kitchen workers. Hazard and control pictograms were developed for four task-specific MSD risks: chopping, handling large containers of food to be prepped, moving prepped food to the cooking area, and reaching for stored materials.

In conjunction with the pictograms, a training program was also developed at a Grade 6 reading level. For both employees and managers, the training goals were:

  • to identify MSD hazards;
  • to explain what can be done to reduce the risk of being hurt;
  • to talk about where to get help at work; and
  • to talk about ways to avoid injury.

For managers, the training objectives also included where and how to place the pictograms and how to provide coaching and support for workers.

Evaluating the pictograms

To assess the effectiveness of the pictograms, IWH and WSPS recruited seven kitchens where observations were conducted over three months. The following measurement tools were used, which were adapted by IWH from previously validated tools and methods:

  • a daily symptom survey with a body map containing nine body parts identified with and connected to a pain/discomfort scale, which was completed by workers;
  • observational assessments in which an observer recorded whether participants were engaged in risky behaviour; and
  • a 14-item knowledge test, which was completed by workers immediately before and after their training session.

The goal of the evaluation was to assess the changes in knowledge among prep kitchen staff, their MSD risk practices, and their pain and discomfort reports after having received MSD and pictogram-specific training, and having the pictograms posted in their work areas.

Challenges included participants having a limited understanding of the study’s purpose and the consent form, and low trust and high turnover rates in prep kitchen work. Additionally, since the employee training was 60 minutes and the manager training was 90 minutes, both parties did not always have time to complete the training.

Workplace attitudes were also a hurdle. This is not a workplace culture that readily admits to pain and discomfort. Injuries are often seen as a badge of honour, says IWH Research Coordinator Trevor King, who was responsible for the observations and played a key role in the evaluation. Fear of job loss or creating a poor relationship with management and/or co-workers may have also influenced behaviour.

Pictograms “a promising intervention”

Despite the challenges, the evaluation confirmed that the pictograms had a positive effect. We found a decreased risk related to work-specific practices (chopping and general handling) and an increase in MSD- and pictogram-related knowledge, although pain/discomfort was not improved, says Amick. It was encouraging to see pictograms, with corresponding training, as a promising intervention.

For more information, see the slides from an IWH plenary on the topic: