Table 2. Adaptation process: Core steps for translation.

Conduct formative research to assess the local context, culture and existing resources	Summarize formative research findings	Adapt WellWorks intervention components based on formative research	Pilot test and finalize core intervention components
Review national legislation and worksite policies related to worker safety and health Conduct focus groups and interviews with the intended audience Key informant interviews with government, safety consultants and employers – to assess employer attitudes toward worker health and strategies to engage employers around OSH Focus groups with employees – to explore social context of workers’ lives influencing tobacco use and OSH Conduct direct observations of participating worksites – to understand worksite layout, workplace flow, and places to deliver the intervention	Legislation and workplace policies The Factories Act defines maximum permissible limits for some chemicals, and requires periodic monitoring of the work environment and pre-employment and periodic screening for workers employed in enterprises using processes defined as “hazardous” under the Act. Compliance is often inadequate due to insufficient infrastructure, few trained personnel, and scarce resources devoted to inspections and enforcement. The Act requires companies to have annual safety training sessions There is also a required annual Safety Week Key Informant Interviews OSH relies considerably on secondary prevention through medical screening as well as treatment of injury, rather than primary prevention and control of hazards On-site medical care was a major component of OSH Safety officers had additional responsibilities that made use of their engineering training, limiting the time available for safety issues Considerable reliance on the use of PPE Few sites reported using engineering controls such as protective hoods for ventilation. In the case of fumes and related bad odors, job rotation was used to limit exposure duration Management expressed concern that program for workers should not impact production Focus groups with employees Working rotating and night shifts and long hour were common, and there were challenges to stay awake with frequent schedule changes Workers reported using tobacco during night shifts to stay awake, or to work faster to increase production Workers noted stressors on the job included dealing with potential hazards, such as needing to be alert when handling dangerous chemicals or dealing safely with mechanical equipment. Many workers reported that they used tobacco in response to stressors on the job Direct observations Little evidence that safety inspections were conducted regularly, even though by law worksites are required to be inspected by the Directorate of Industrial Safety and Hygiene annually No evidence of tobacco control programs	Joint worker-management participation Create worker/manager committees Build on existing health and safety committees Interventions targeting the worksite organization and environment Adopt pro-active preventive approach beyond legally proscribed standards for OSH to protect worker health Engage industrial hygienist to conduct walk-through assessments of exposure and OSH programs Provide consultations and technical assistance to management to: Reduce workers’ exposures to hazardous substances used in work process Focus on hierarchy of controls, starting with upstream strategies for materials and process substitution, engineering controls. Include recommendations for observable improvements to encourage worker engagement Emphasize importance of management commitment, employee participation, hazard analysis, hazard prevention and control, and training and education. Provide consultations to support implementation of tobacco control policies Interventions for individual workers Provide intervention activities to address both exposure to hazardous substances and health behaviors Include comprehensive program content and coordinated messages acknowledging the additive and synergistic effects of exposures to worksite hazards and individual health and safety behaviors Incorporate OSH messages into tobacco control programming and tobacco control messages into OSH programs	Joint worker-management participation Engage member of management/administration staff to assist with scheduling and promoting events and coordinate consultations with management Engage a program committee in program planning and implementation Interventions targeting the worksite organization and environment Conduct an industrial hygiene walk-through using a standardized assessment based on an adoption of a Bureau of Indian Standards checklist Based on the walkthrough, have the industrial hygienist present a brief written report to management, summarizing findings and recommending changes to reduce exposures to hazards in the work environment Provide consultation and technical assistance on the adoption, implementation, and enforcement of worksite tobacco control policies Interventions for individual workers Provide intervention activities to address both exposure to hazardous substances and health behaviors Include comprehensive program content and coordinated messages acknowledging the additive and synergistic effects of exposures to worksite hazards and individual health and safety behaviors Incorporate OSH messages into tobacco control programming tobacco control messages into OSH programs Use “success stories” to build a supportive work culture around tobacco control and OSH Provide alternative strategies to use tobacco to stay awake on the job Conduct health education sessions related to the risks associated with tobacco use and provide supports for quitting