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Abstract
The leading cause of occupational death in small retail establishments—workplace violence—provides an example of how data can be used to document the need for type 2 translational research. First, strategies effective in reducing workplace violence in small retail businesses were identified. Next, the effectiveness of the researched strategies was compared with the types of strategies voluntarily implemented by small businesses. The strongest evidence-based strategies were the least likely to be implemented by businesses, and the relationship between effectiveness and implementation was nearly inverse. For example, cash control policies were found to be effective in 92% of studies, but fewer than 10% of businesses had implemented adequate cash control policies. Surveillance cameras were found to be effective in only 50% of studies, but more than 70% of businesses had implemented them. In the absence of effective translation of knowledge and practice, business owners installed the least effective strategies, often at a higher cost.
- Developmental
- evaluation
- homicide
- occupational
- prevention
- translational research
- workplace violence
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In order to increase the impact of medical and public health research, focus has shifted from basic to translational research.1 Translational research is the process of moving confirmed intervention and prevention strategies into the ‘real’ world, where they benefit patients and communities in a sustainable manner.2 The definition of translational research, while widely debated, has generally divided into three broad types.2–5 The first type is clinical and translates research from bench to bedside, introducing new approaches for prevention, diagnosis and treatment of disease.3 The second type is applied and translates successful interventions to new populations, ensures that interventions are correctly implemented, and identifies sustainable long-term models.2 The third type is the final step in which strategies become diffused throughout a population and are embedded as normal practice.2
The authors propose two conditions that are necessary to establish a compelling need for applied translational research. The first is the availability of evidence-based intervention strategies. The second condition is that the intervention is necessary but has not been appropriately adopted. This condition is met when an effective strategy is needed but has not been introduced into a high-risk population, or when the strategy was not implemented correctly and is therefore not providing the needed benefits. If evidence can substantiate both conditions, there is a need for translational research to identify strategies for successful intervention implementation.
Prevention of violence in the workplace, in particular in small businesses, provides an example of this need for applied translational research. Robberies are the most frequent cause of work-related homicide and one of the leading causes of violent injury among workers, especially in the retail industry.6 7 Small retail businesses have the highest risk of robbery and homicide8 yet may have the least access to information about successful strategies for prevention, even though a substantial body of research has evaluated such strategies and tested them primarily in corporate convenience stores.9
Methods
We demonstrate the need for translational research by first identifying strategies that research has found to be effective in reducing the risk of robbery, and second by measuring the extent to which high-risk small businesses have implemented these strategies. We identified the strategies associated with reduced robbery risk by conducting a thorough review of the literature.9–28 Details of the search strategy are described in a comprehensive literature review published by Casteel and Peek-Asa in 2000,9 with followed the search strategy defined by Beahler et al.29 This search strategy was redone to identify literature published from 1999 to June 2009.
Eighteen studies identified specific strategies for robbery and violence prevention in the retail setting.11–28 Nine strategies that have been examined in multiple studies were included: cash control policies; correct use of safe good lighting; employee training; policies against clerks working alone; good visibility and the use of alarm systems; surveillance cameras and mirrors. The success of each strategy was measured as the proportion of studies that found the strategy to be effective (ie, the number of studies that found the strategy to be effective divided by the number of studies that examined the strategy). This measure does not integrate study quality or study size, but provides a simplistic examination of overall endorsement of the strategies.
The population under consideration for our translational research included 314 small retail businesses in the city of Los Angeles that were randomly selected through an electronic business database. Eligible businesses included convenience store/gas stations, grocery stores, liquor stores, bars and restaurants and motels. Of 937 businesses randomly selected for intervention, 441 (47.1%) participated. On-site surveys were conducted from 1997 to 2000 by trained certified protection professionals to identify strategies that businesses had voluntarily implemented.28 These surveys were conducted to collect baseline information for a larger intervention study. Details of the intervention evaluation are described elsewhere.28–30 Although information was collected on every strategy implemented by the businesses, this analysis focuses on the implementation of the nine evidence-based strategies listed above. Frequency of implementation was measured as the proportion of the 314 businesses that had the strategy in place during the baseline assessment.
Results
Table 1 summarises the nine researched strategies and their association with robbery risk reduction. Figure 1 identifies the discrepancy between the strategies found to be effective and the strategies that were implemented by the businesses. The relationship between the strategies that research has found to be successful and the strategies that businesses had implemented is nearly inverse.
Effectiveness of workplace violence prevention strategies identified by research studies
Successful strategies for reducing robbery in retail businesses compared with the frequency of implementation of these strategies by retail businesses.
For example, 91.7% of studies found that cash control policies were an effective strategy. However, only 9.2% of businesses had adequate cash control policies. The correct use of a safe showed a similar disparity: 85.7% of studies found safes effective but only 13.7% of businesses had this strategy in place. Other strategies that had stronger evidence-based support than implementation included employee training, policies against having a single clerk on duty and good visibility. Good lighting was the only evidence-based strategy that had high implementation by businesses.
On the other hand, security cameras, alarms systems and mirrors were successful strategies in only half or less of the studies, yet more than 70% of businesses had installed cameras and more than half had installed alarm systems or mirrors.
Discussion
A critical gap exists in the translation of successful robbery prevention strategies to the highest risk small businesses. This gap is not based on resources; the businesses were clearly willing to invest in security, as evidenced by the high percentage that had purchased expensive cameras and alarm systems. Rather, this gap is probably driven by lack of information about successful strategies or how to implement them. For example, companies that sell security equipment such as cameras and alarms have aggressive sales programmes that include installation, but they rarely provide information about policy-based approaches such as cash handling. In the absence of effective translation of knowledge and practice, business owners preferentially installed the least effective strategies, often at a higher cost.
This analysis demonstrates the need for research to identify effective ways of translating new strategies into high-risk businesses. However, no formal studies evaluating the impact and outcomes of translation approaches have been conducted. Applied translational research should integrate mixed methods, using qualitative and quantitative approaches to identify the populations at risk and their current knowledge, attitudes and behaviours regarding the new strategies; identify the implementation and diffusion methods most appropriate for introducing the new strategies, and identify the community resources that could provide a sustainable infrastructure for the new strategies.
Several types of organisations could provide a sustainable infrastructure for this programme, including law enforcement agencies, professional business associations and insurance companies. Each of these organisations has access to businesses and could integrate a baseline assessment and recommendations for programme implementation. Each of these organisations also has opportunities to offer incentives to businesses. For example, insurance companies could reduce premiums in compliant businesses because their crime-related insurance claims could go down. Business associations can offer workplace violence prevention information to members as a member benefit, and could include workplace violence as a topic in their trade journals. Each of these organisations has its own barriers to diffusing the programme successfully. For example, many small business owners are sometimes distrustful of police agencies, and strain on municipal budgets reduces the number of officers available to focus on prevention. The highest risk businesses may be unlikely to be members of business organisations, such as the Chamber of Commerce. Translational research can identify and test the most promising integrated approaches to reach the greatest number of high-risk businesses.
What is already known on this subject
Translational research involves moving evidence-based programs into the “real world” and identifying sustainable models for their diffusion into high risk populations.
Evidence-based programs to reduce robbery and related injury and homicide in small retail and service businesses have been available for many years.
Little is known about the extent to which businesses use these approaches.
What this study adds
We identified which elements of an evidence-based workplace violence prevention program were implemented by 314 high-risk businesses.
In the absence of effective translation of knowledge and practice, business owners had installed the least effective strategies, often at a higher cost than the strategies known to be effective.
This brief report provides an example of how the need for translational research can be measured.
Acknowledgments
The authors would like to thank James Grayson, Dawn Gregory and Phillip Smith for their role in collecting on-site business assessments and Adele Bonney for editorial input on this paper.
References
Footnotes
Funding This work was supported by the CDC/NCIPC-funded University of Iowa Injury Prevention Research Center (CDC CCR 703640) and CDC/NIOSH (R01OH009527). The funders were not involved in the design or conduct of this study collection, management, analysis or interpretation of the data, and preparation, review, or approval of the manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.