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Journal of Agromedicine
ISSN: 1059-924X (Print) 1545-0813 (Online) Journal homepage: http://www.tandfonline.com/loi/wagr20
Using the Socio-Ecological Model to Frame
Agricultural Safety and Health Interventions
Barbara C. Lee, Casper Bendixsen, Amy K. Liebman & Susan S. Gallagher
To cite this article: Barbara C. Lee, Casper Bendixsen, Amy K. Liebman & Susan S. Gallagher
(2017) Using the Socio-Ecological Model to Frame Agricultural Safety and Health Interventions,
Journal of Agromedicine, 22:4, 298-303, DOI: 10.1080/1059924X.2017.1356780
To link to this article: http://dx.doi.org/10.1080/1059924X.2017.1356780
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COMMENTARIES
Using the Socio-Ecological Model to Frame Agricultural Safety and Health
Interventions
Barbara C. Lee
a
, Casper Bendixsen
a
, Amy K. Liebman
b
, and Susan S. Gallagher
c
a
National Children’s Center for Rural and Agricultural Health and Safety, Marshfield Clinic, Marshfield, Wisconsin, USA;
b
Environmental and
Occupational Health, Migrant Clinicians Network, Salisbury, Maryland, USA;
c
Public Health and Community Medicine, Tufts University School
of Medicine, Boston, Massachusetts, USA
ABSTRACT
The Socio-Ecological Model (SEM) is a conceptual framework depicting spheres of influence over
human behavior that has been applied in public health settings for nearly five decades. Core
principles of all variations of the SEM are the multiple influences over an individual’s behaviors,
the interactions of those influences, and the multilevel approaches that can be applied to
interventions intended to modify behaviors. A project team modified the standard SEM to address
interventions for protecting children from agricultural disease and injury. The modified SEM
placed the “child in the farm environment”at the core with five interrelated levels (spheres) of
influence over the child. This framework provides guidance on how a multifaceted, multilevel
intervention can maximize the potential for impact on behaviors and decisions made by parents/
adults responsible for the safety of children on farms. An example of how this model could work
to safeguard youth operating tractors is provided.
KEYWORDS
Agriculture; safety; socio-
ecological model; theory
Background
Occupational safety and health advocates are con-
stantly searching for strategies that offer sustain-
able interventions that reduce risks of injury and
disease. These strategies are often based on educa-
tion, engineering, environmental, and/or enforce-
ment approaches. To strengthen and potentially
measure their impact, they can be based on prin-
ciples of safety and hygiene, past experience, and
sometimes a theoretical model. Agricultural safety
and health interventions have lagged behind other
occupational safety and public health approaches
but increasingly are adopting evidence-based stra-
tegies guided by theories and models that have
demonstrated success in changing unsafe tradi-
tions into safe behaviors. This paper describes
how a well-known public health model has been
modified for agricultural safety and health to mul-
tiply and maximize the impact of agricultural
safety interventions.
Introduced in the 1970s, the Socio-Ecological
Model (SEM) is a broad-based conceptual model
depicting basic ecological principles of human
behavior.
1
The SEM has undergone numerous
updates and modifications for different
applications.
2
The World Health Organization and
U.S. Centers for Disease Control and Prevention
are among the many users of this model, which
illustrates multiple dimensions and complex
human interactions that influence behaviors.
3,4
At
the core of the model is an individual whose beha-
vior is the primary interest. A figure of enlarging
circles added above the core individual demon-
strates how spheres of increasing influence have
higher degrees of impact on individual behavior
(Figure 1). The next level of influence is his/her
interpersonal relationships such as relatives, peer
groups, or healthcare providers. Following this is
the organizational level, which includes organiza-
tions, schools, churches, and workplaces. Next is
the community level, which represents relationships
between organizations. Finally, at the outer sphere
of the figure, is the public policy level that includes
federal/state regulations with enforcement options.
Terminology for the middle levels of the model is
CONTACT Barbara C. Lee lee.barbara@mcrf.mfldclin.edu National Children’s Center for Rural and Agricultural Health and Safety, Marshfield Clinic,
1000 N. Oak Avenue, Marshfield, WI 54449, USA.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wagr.
JOURNAL OF AGROMEDICINE
2017, VOL. 22, NO. 4, 298–303
https://doi.org/10.1080/1059924X.2017.1356780
© 2017 Taylor & Francis
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typically altered depending on the user’sneedsand
the model’s application.
In an extensive review of various ecological
models of health behaviors published in 2008,
authors explain that the core principles of an eco-
logical model are: (1) there are multiple influences
on an individual’s behaviors, including factors at
the intrapersonal level, interpersonal level, with
increasing influence at levels of organization, com-
munity, and public policy; (2) influences interact
across these different levels or spheres of influence;
(3) use of this model should be applied to specific
behaviors; and (4) multilevel approaches can be
the most effective interventions for changing
behaviors.
5
The evolution of the SEM is based in
part on five different theories explaining human
behavior, dating from 1951 to 2006, as well as
eight different theories used to guide behavior
change, dating from 1953 to 2005. The influence
of different theorists and their applications of con-
ceptual models over time can explain both the
strength and the various visual depictions of the
SEM for different audiences.
Modified model
In 1996, the National Institute for Occupational
Safety and Health (NIOSH) launched its National
Childhood Agricultural Injury Prevention
Initiative.
6
As a component of that initiative, the
National Children’s Center for Rural and
Agricultural Health and Safety (NCCRAHS) was
established to link public and private sector initia-
tives based upon a national plan of action.
7
In
2014, with two decades of experience, the
NCCRAHS wanted to base its current and future
endeavors on a theoretical model that would max-
imize potential impacts. The SEM was chosen as a
logical fit for the center’s theme of strengthening
public-private partnerships to address childhood
agricultural injury prevention.
8
The model has
long-standing acceptance by public health agen-
cies, and it has applications in multiple settings
on topics ranging from adding positive nutritional
habits and physical activity to avoiding risky prac-
tices such as smoking and unsafe sex. To the best
of our knowledge, the SEM had not specifically
and proactively been applied in agricultural safety
and health interventions or program evaluations,
nor has it been modified in any specific way to
address the well-being of children.
A comprehensive review of childhood agricul-
tural safety interventions conducted by Gallagher
in 2012
9
assessed 26 peer-reviewed studies that
reported the effectiveness of childhood farm safety
interventions. It was determined that most inter-
ventions focused on the individual level of the
SEM and typically used education as the primary
strategy to increase knowledge and influence beha-
vior change. Based upon these findings, the author
provided eight recommendations for the future,
framed around the principles of the SEM, such as
multilevel partnerships; repeated interventions;
approaches beyond education (e.g., engineering,
policy); diversity in funding; and sustained, wide-
spread dissemination.
9
A planning team at the NCCRAHS reviewed
literature and versions of the SEM and discussed
the impact of the spheres of influence relevant to
the political, social, and individual environment
affiliated with agricultural communities. The
team incorporated concepts from non-agricultural
projects including experiences using the model for
low-income workers.
Our modified version of the SEM (Figure 2)
placed the “child in the farm environment”at the
core of the figure, with the knowledge that a child
(up to 18 years) who lives, visits, or works on a
farm is not in a position to change safety practices
Figure 1. Socio-ecological model: framework for prevention,
centers for disease control. Available from the Centers for
Disease Control and Prevention (CDC). http://www.cdc.gov/vio
lenceprevention/overview/social-ecologicalmodel.html.
4
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him/herself. Rather, the focus of interventions is to
influence the behaviors of those adults who have
the authority and knowledge to reduce the risk of
injury and disease affecting children. We believe
that all children deserve equal protection from
preventable disease and injury, and adults hold
full responsibility for safeguarding children under
their care.
At the model’s core is the child under the
influence and protection of the adult(s). There
are five spheres with interrelated-levels of influ-
ence over the child. The adult sphere includes
parents, guardian, farm owners, employers, and
any other individual(s) who may have responsi-
bility for youth in the agricultural production site
or a farm homestead. The next level of influence
is interpersonal—this includes persons with close
relationship to the immediate family such as rela-
tives, friends, and peer groups. It can also include
health care providers and child care providers
who regularly interact with the family. At the
third sphere above the child is the community
level, which can include local businesses such as
farm cooperatives and community-based organi-
zations such as FFA chapters, schools, faith-based
groups/churches, and child care centers. At a
higher level of influence are institutions and orga-
nizations that span beyond the local region. This
includes agricultural companies such as property/
casualty insurance providers, trade associations,
agribusinesses that set standards and guidelines
for purchasing agricultural products, national/
international trade agreements, bankers and lend-
ing agencies, and national media that influence
public opinion. The highest level of influence is
policy. For the most part, this represents federal
and state regulations regarding the role of youth
in agricultural work. It can also represent issues
such as immigration, federal/state workers com-
pensation laws, and Occupational Safety and
Health Administration (OSHA) enforcement
standards.
Degrees of influence of the various spheres are
subject to many factors. Each superordinate level
influences the subordinate level. For example, a
public policy may influence a community program
that influences an adult to make responsible deci-
sions regarding work assigned to a child living on
a farm.
When applying this modified SEM concept to
agricultural safety and health interventions, the
ideal approach is to have an interrelational link
that crosses through as many spheres as possible.
We have solid evidence from interventions in non-
agricultural settings that a multilevel approach
with repeated interventions has the greatest like-
lihood of achieving the desired outcome. For
example, a 2014 report described how the SEM
was used in a multilevel intervention to reduce
health inequities among low-income workers.
10
Another example is an assessment to propose
community outreach interventions to improve
Figure 2. Socio-ecological model modified to address agricultural safety and health interventions.
300 B. C. LEE ET AL.
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fruit and vegetable intake among inner-city
African Americans. Literature was reviewed on
past interventions addressing this topic. Relevant
interventions were categorized by SEM level then,
based upon intervention effectiveness, and recom-
mendations for a multifaceted community-based
approach became the basis and rationale for “Best
Practices”ecological nutritional programs for
African Americans.
11
Applying the SEM for agricultural safety
What would an ideal intervention based on this
SEM concept look like? For explanatory purposes,
consider an unsafe practice that puts youth at high
risk of an agriculture-related injury. What is the
desired behavior change? And what approach
could be used at multiple levels to influence the
adults that bear primary responsibility for youth
involved in that unsafe practice?
Agricultural safety
Equipment manufacturers and safety professionals
recommend that all tractors used for production
activities include basic safety principles of seatbelts
and Rollover Protection Structures (ROPS). It has
been shown that this safety standard of a tractor
being equipped with a seatbelt and ROPS (or
enclosed cab) can virtually eliminate tractor-
related fatalities when the operator appropriately
uses these safety features.
12,13
Burden
For youth working in agriculture, tractors are the
leading cause of death. An analysis of occupational
fatality cases from 2001 to 2013 among U.S. work-
ers under the age of 18 revealed that of the 406
recorded fatalities across all occupations, about
50% of deaths occurred in agricultural jobs, of
which nearly all were associated with transporta-
tion and equipment.
14
Young workers are often
asked to operate tractors that do not meet safety
standards, because the older unsafe tractors may
be smaller, less expensive, and less complicated to
operate, and farm owners do not want young
people operating their high-powered, expensive
equipment. There are no child labor regulations
that mandate safety standards of tractors operated
by youth. Further, in the United States, family
farms are exempt from child labor in agriculture
regulations. In occupational settings, the parent or
work supervisor bears responsibility for ensuring
that a young worker is safeguarded. However,
agricultural work activities can be complicated,
making close supervision and oversight difficult
to maintain, especially when workers are doing
field operations with tractors and trailed
implements.
Solution
To minimize the toll of serious injuries and deaths
among young workers in agriculture, a solution
would be to ensure that youth (14–18 years) who
are assigned agricultural work involving tractor
operations be allowed only to operate tractors
equipped with ROPS, and that these youth be
required to wear the tractor seatbelt at all times.
Implementing this solution would entail a multi-
level, integrated approach that alters long-standing
practices and might challenge family and/or cul-
tural traditions. Applying the SEM to a multilevel,
integrated intervention would involve each sphere
of influence approaching the problem from a dif-
ferent angle, but all with the same desired outcome
of improving safety.
The scenario below (Table 1) describes an inter-
vention, based on the SEM, of a national-level
campaign to “Safeguard youth operating tractors.”
The scenario above is an idealistic picture of how
the SEM could work, involving entities at all levels
of the SEM, and proposing they would agree and
engage in a unified way. Realistically, this would be
time and resource intensive and difficult to exe-
cute. But undoubtedly, if this scenario were set
into operation, there could be a profound change
that would drastically reduce the toll of injuries
and deaths to youth operating tractors.
Implications
Putting the SEM into practice in agriculture is
possible. Over the past five decades, much has
been learned about the etiology of farm injuries
through data on the incidence of injuries and
details on changing trends in types of injuries.
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Our biggest challenge moving forward is
improving safety interventions and taking
approaches that will have the biggest impact on
reducing the toll of injuries. These multilevel
and interrelated interventions have the potential
of shifting the “culture”of agriculture to have a
greater emphasis on and respect for a “safety
culture”in agriculture. It also broadens the gen-
eral public’s perspective on the issue, rather than
solely relying on direct interventions by parents
or policy-level changes. The diversity of indivi-
duals and organizations involved strengthens the
capacity to change practices, resulting in lives
saved.
Conclusions
Public health demonstration programs have shown
us the SEM is a strong and effective way to change
individual behaviors by influencing those beha-
viors at multiple levels. We propose to modify
the SEM for application in agricultural safety and
health promotion programs. As this model is
applied, evaluated, and improved over time, our
hope is to have a measurable and sustained
improvement in safe practices that create a true
culture of safety in agriculture.
Funding
Efforts toward developing this dedicated issue of the Journal
of Agromedicine with a focus on the Socio-Ecological Model
were funded in part by the National Institute for
Occupational Safety and Health via the National Children’s
Center for Rural and Agricultural Health and Safety (NIOSH
2U54OH009568) and the National Farm Medicine Center.
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Table 1. An intervention, based on the SEM, of a national-level campaign to “Safeguard youth operating tractors.”
Policy Federal child labor laws in agriculture would be changed to set a minimum age of 16 years to operate tractors on
public roads and 14 years to operate tractors on private land. The family farm exemption would be eliminated.
Federal and state OSHA would establish minimum age limits for all safety standards and would require workers
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