Table 3.

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

Potential barriers	Proposed strategies to address barriers*	Strategy type/scope
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

HRI, heat-related illness; UV, ultraviolet.

*Employers and workers should be involved in the discussion and development of acceptable interventions to prevent HRI.