Agricultural Disability Awareness and Risk Education (AgDARE)
Deborah B. Reed, RN, PhD, Pamela S. Kidd, PhD, FAAN, Mary Kaye Rayens, PhD, Susan Westneat, MA, Tim Struttman, MSPH, Steven R. Browning, PhD
This four-year intervention developed, implemented, and evaluated a novel farm injury prevention program for high school agriculture students emphasizing disability awareness and utilizing both narrative and physical simulation exercises. Recognizing that the emotional and cognitive development of adolescents often hinders their responsiveness to information on mortality risk, the AgDARE curriculum uses the concept of disability to teach farm safety. Studies suggest that teens are less likely to react to a threat of injury or death but are more inclined to avoid disability, disfigurement, and a change in body image. Reaching more than 1,100 students in three states -- Kentucky, Iowa, and Mississippi -- the AgDARE project aimed to
- increase vocational agriculture students’ knowledge of the long-term consequences of cumulative and catastrophic agricultural-related injury
- enrich students’ understanding of the economic and personal costs associated with injury and trauma resulting in permanent disability
- develop attitudes in vocational agriculture students that support safety behaviors
- encourage and empower students to adopt specific injury prevention strategies while performing farm tasks
- increase vocational agriculture teachers’ resources for providing agricultural safety education
- examine the generalizability of simulations across culturally diverse communities in different geographical regions with different types of agricultural production
NIOSH has estimated that more than 70 Americans younger than age 18 die on the job each year. Thousands more are injured. The magnitude of agriculture work-related injury for adolescents is unknown, since 95% of U.S. farms are exempt from OSHA reporting standards; however, the estimate for agricultural injury deaths for children is 104 annually (Rivara, 1997). This project focused on the 346,000 farm adolescents aged 14 and over, the group at highest risk for agricultural work injury. Although death rates from child and adolescent agricultural injuries have fallen between 39% and 43% in the past ten years, injury rates have risen 10.7% (Rivara, 1997; NIOSH, 2001). Survival after injury is not synonymous with recovery; injured youth may suffer life-long consequences in the form of permanent disability (Reed & Claunch, 2000). Rural adolescents frequently take agriculture classes in their schools. The role of agriculture education in public schools across the United States has been to equip young persons for employment in production agriculture. While instructions regarding general safety rules are in place in the classroom, there is no structured agricultural safety education in the agriculture curriculum. Instead, each agricultural education teacher may choose how safety messages are delivered. This approach severely limits effective evaluation of safety instruction. The AgDARE project thus provided a field evaluation of a novel instructional method to deliver safety instruction for adolescents. Prevention programs often ignore the acquisition of permanent disabilities among farm youth. Rather, mortality prevention is usually emphasized, even though this concept is incongruent with the developmental capacity of many youth (i.e., who tend to be concrete operators versus abstract thinkers). The goal of the AgDARE project was to develop and test the effectiveness of a novel farm injury prevention program for high school agriculture students.
The AgDARE project was implemented in two phases over a four-year period. Phase I consisted of instrument and intervention development. The intervention consisted of four reality-based, latent-image (narrative) simulation exercises that focused on prevention of amputations, spinal cord injuries, noise-induced hearing loss, and hypersensitivity pneumonitis or "Farmer’s lung." Four simulated work exercises (physical simulations) that focused on the same prevention strategies were also developed and tested. The simulations were designed to emphasize the life-long occupational consequences of permanent disabling conditions. The simulation topics were selected based on the existing literature, case-based data from AgrAbility, and focus groups held with agriculture teachers and students. Phase II consisted of intervention dissemination and evaluation.
The narrative and physical simulations were developed with focus groups of farm youth participating in the process. A quasi-experimental cross-over design was used to test the intervention in Phase II. Schools were selected based on location, commodity, and regional similarities. Schools within each geographic region were then randomly assigned to one of two intervention groups or to the control group. Students in the intervention groups completed a demographic survey, Farm Safety Attitude (FSA) Instrument and Stages of Change (SOC) Instrument immediately before the intervention. Each student completed an evaluation of the individual simulation unit immediately following the unit. At the end of the semester or at the end of the academic year (depending on the school year structure), students were given the second intervention and they completed post FSA and post SOC tests. Students in the control group completed demographic surveys, pre FSA and pre SOC tests, and post FSA and SOC tests within the same time-frame as students in the treatment groups. No other activities were conducted with control schools. One year after the intervention, farm visits were made to 29 students who completed the AgDARE intervention and currently did farm work to assess their work behavior.
The AgDARE intervention tested the following hypotheses:
- Students who completed AgDARE would demonstrate greater knowledge of long-term consequences of agricultural-related injury compared with students in the control group.
- Students who completed AgDARE would demonstrate greater knowledge of personal and economic costs resulting from permanent disabilities compared with students in the control group.
- Students who completed AgDARE would demonstrate greater use of injury prevention strategies while performing farm tasks compared with students in the control group.
A cohort of 1,138 high school agriculture students in Kentucky, Iowa and Mississippi participated in the study. The treatment groups consisted of 591 students in 14 schools. Of these students, 373 completed at least two narrative and two physical simulations that focused on the same disabilities. Students in the control group (N=547) were enrolled in 7 schools. 417 control students had complete data sets. Seventy-five percent (N= 590) of the full sample with complete data sets reported they had farm work experience. Twenty-nine students who completed at least two matched units of AgDARE (physical and narrative simulations focused on the same disabilities) and who reported they lived and worked on farms participated in farm visits approximately one year after their AgDARE class instruction.
The narratives served as mental models that directed the students’ attitudes, judgments, decisions, and behavior. Physical simulations incorporated all the senses in the learning experience, exerting influence on decisions about behavior, based not only on mental models but on physical response. 616 students completed both the narrative and physical simulations for each of the four units. The use of both narrative and physical simulations helped to assure that all participants, regardless of their cognitive development, were able to learn from the situation.
A farm safety attitude questionnaire was completed in class prior to the intervention. Students completed the post test after the second class visit. Control schools were administered the questionnaire over the course length. Analyses reveal a significant difference in scores for students who completed AgDARE. No change was noted for control students. Students who completed both narrative and physical components demonstrated the greatest change. There was no difference by sequence of presentation (narrative first vs. physical first).
Students and teachers were highly receptive to the AgDARE curriculum. Of the 29 students randomly sampled who completed AgDARE and received farm visits one year later, 86% had made safety related changes in their farm work. Eighty-seven percent of these changes related directly to injury prevention strategies taught through AgDARE. Students reported that the other changes were made because they now thought more about safety while doing farm work.
Products that emerged from the project are listed in part below and include the AgDARE curriculum notebook and supporting classroom materials, online instructional materials (including Spanish translations of several narrative simulations), refereed journal articles, professional paper presentations at regional and national conferences, and data files. The AgDARE curriculum was developed with input from teachers and students in all three participating states. The curriculum consists of four stand-alone units:
- spinal cord injury
- hearing loss, and
- hypersensitivity pneumonitis
Each unit addresses specific Kentucky Education Reform Act (KERA) goals.
The AgDARE project staff has continued to work with AgrAbility, Farm Safety 4 Just Kids, and other groups in developing new educational materials based on the AgDARE model. For example, under the direction of Dr. Brian Day of NIOSH, the “Ben Can’t Breathe” narrative was adapted and used as a template for development of a similar simulation for construction workers.
The AgDare project was an r2p effort built upon many years of farming-related injury surveillance and epidemiology, as well as many years of applied human learning and instructional systems design.
Products, presentations, and publications
Reed, D.B., et al (2000). The AgDare Curriculum Notebook. The notebook is a 3-inch binder with detailed instructions on how to implement the safety curriculum, references and resource listings, and evaluation materials. Each section includes lesson plans and specific objectives. The 7-minute hearing loss video accompanies the binder. Copies of the curriculum and notebook have been duplicated and distributed in more than 25 states.
Cole, H.P. & Mazur, J. (2001). The AgDare Curriculum Guide. A web-based version of the narrative and physical simulations that includes teacher guidelines, supplemental activities, posters, fact sheets, and references. The web-based versions include sound and illustrations and may be toggled between English and Spanish: Jim in a Jam (Artruro en Apuros), Ben Can’t Breathe (Pulmòn del Granjero), What Happened to Bob, Sound Advice throughout the Years (Pérdida De Oído)
Reed, D.B. (2000, October). Invited presentation to the National FFA Convention. Louisville, KY. This event is the largest annual convention of agricultural educators and students, drawing more than 50,000 participants. In less than one-half day, all print copies of the curriculum were distributed at this event and a waiting list for reprints was generated.
Reed, D. (2001, October). Second invited presentation to National FFA Convention. Louisville, KY. Reed, D.B. & Kidd P.S. (2004). Collaboration between nurses and agricultural teachers to prevent adolescent agricultural injuries: The agricultural disability awareness and risk education model. Public Health Nurs 21,4, 323-330.
Reed, D.B., Kidd, P.S., Westneat, S., & Rayens, M.K. (2001). Agricultural disability awareness and risk education (AgDARE) for high school students. Inj Prev 7 (Suppl 1), i59-63.
Reed, D.B. & Claunch D.T. (2000). Nonfatal farm injury incidence and disability to children. Am J Prev Med 18(4 Suppl), 70-79. Review.