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Cultural appropriateness in randomized controlled trials (RCTs) aimed at reducing pesticide exposure among farmers and farmworkers: a systematic review

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International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

Objective

The widespread use of pesticides poses serious health hazards to farmers and their families. Some evidence shows that culturally sensitive interventions could be associated with improved outcomes; however, little is known about the effectiveness of cultural adaptations in interventions among farmers and farmworkers. Therefore, the purpose of this study was to summarize strategies used in the cultural adaptation interventions addressing the reduction of pesticide exposure in farmers and farmworkers, as well as assessing the effects of these strategies.

Methods

A comprehensive systematic literature search was conducted on PubMed, Embase, Clarivate Web of Science, Scopus, NIOSHTIC, Agricola, Agris, as well as reference lists to identify randomized controlled trials (RCTs) published in English from January 2000 until March 2022. Data were extracted to examine the characteristics of interventions in terms of the cultural adaptation strategies and their effectiveness by two independent reviewers.

Results

Eleven articles from ten trials met the inclusion criteria. The majority of studies were conducted in the USA (n = 7) and were ranked as poor quality (n = 5). Four of the ten studies were rated moderate, and six were rated weak. The socio-cultural and constituent-involving strategies were the most commonly reported across the included studies, followed by linguistic strategy. Six studies (seven articles) were tailored for subgroups or individuals. Overall, 8 of 10 studies reported significant changes in whole and some outcomes in the intervention groups over controls. Seven studies received moderate cultural adaptation scores which may reflect the moderate effectiveness of the interventions.

Conclusion

Our review underscored the paucity and low quality of existing studies investigating the culturally adapted interventions in reducing farmers’ and farmworkers’ pesticide exposure. Future high-quality culturally sensitive studies could increase our knowledge regarding the culture’s role in reducing pesticide exposure in farmers and farmworkers.

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Abbreviations

RCTs:

Randomized controlled trials

USA:

United States of America

FFS:

Farmer field schools

PRISMA:

Preferred reporting items for systematic reviews and meta-analysis

PICOS:

Population, intervention, comparison, outcome, study type

EBP:

Evidence-based practice

CCRBT:

Cochrane collaboration risk of bias tool

CAB:

Community advisor board

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Acknowledgements

This project has been approved by the Research and Technology Deputy of Hamadan University of Medical Sciences.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Hamadan University of Medical Sciences [reference number: 9511126847].

Author information

Authors and Affiliations

  1. Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

    Akram Karimi-Shahanjarini & Maryam Afshari

  2. Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

    Akram Karimi-Shahanjarini & Maryam Afshari

  3. Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

    Fereshteh Besharati

Authors
  1. Akram Karimi-Shahanjarini
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  2. Maryam Afshari
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  3. Fereshteh Besharati
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Contributions

A.K-Sh and MA designed the study. A.K-Sh and MA collected the data, contributed to the data analysis and interpretation and wrote the first draft of the article. FB and MA were responsible for the data analysis and interpretation. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Maryam Afshari.

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Appendix A

Appendix A

The first line: for the farmer and farm workers

Agricultur* (Topic) OR agriculture (Topic) OR farm (Topic) OR farms (Topic) OR farmer* (Topic) OR farming (Topic) OR "farm worker" (Topic) OR "farm workers" (Topic) OR "farmworker" (Topic) OR "farmworkers" (Topic) OR ranch* (Topic) OR dairy (Topic) OR dairying (Topic) OR dairies (Topic) OR greenhous* (Topic) OR orchard* (Topic) OR livestock* (Topic) OR "live stock" (Topic) OR "live stocks" (Topic) OR "animal confinement" (Topic) OR "farm animal" (Topic) OR "crop production" (Topic) OR harvesting (Topic) OR horticultur* (Topic) OR horticulture (Topic) OR agronom* (Topic) OR mix* (Topic) OR cattle (Topic) OR animals (Topic) OR work (Topic) OR occupation (Topic) OR gardening (Topic) OR "crops, agricultural" (Topic) OR "agricultural workers” diseases" (Topic) OR gardener (Topic) OR "agricultural worker" (Topic) OR "fruit grower" (Topic) OR orchardist (Topic) OR grower (Topic) OR cultivator (Topic) OR planter (Topic).

The second line: for the pesticide

Pesticid* (Topic) OR pesticides (Topic) OR fungicid* (Topic) OR herbicid* (Topic) OR organophosphate (Topic) OR biocides (Topic) OR herbicide (Topic) OR insecticid* (Topic) OR carbamat* (Topic) OR carbamates (Topic) OR pyrethrins (Topic) OR molluscacid* (Topic) OR rodenticid* (Topic) OR poison* (Topic) OR "pesticide exposure" (Topic) OR fungicide (Topic) OR fumigant (Topic).

The third line: for the intervention and program

Intervention (Topic) OR effect* (Topic) OR "personal protective equipment" (Topic) OR "safety behavior" (Topic) OR safety (Topic) OR prevention (Topic) OR glove (Topic) OR mask (Topic) OR boots (Topic) OR control* (Topic) OR protect (Topic) OR evaluation* (Topic) OR program* (Topic) OR training (Topic) OR "educational program" (Topic).

The fourth line: for the types of studies

Trial (Topic) OR "randomized controlled trial" (Topic) OR "cluster-randomized controlled trial" (Topic) OR "cluster-randomized controlled trials" (Topic) OR "controlled clinical trial" (Topic) OR "randomized controlled trials" (Topic) OR "random allocation" (Topic) OR "double-blind method" (Topic) OR "single-blind method" (Topic) OR "clinical trial" (Topic) OR "clinical trials" (Topic) OR singl* (Topic) OR doubl* (Topic) OR trebl* (Topic) OR tripl* (Topic) OR mask* (Topic) OR blind* (Topic) OR "latin square" (Topic) OR placebos (Topic) OR placebo* (Topic) OR random* (Topic) OR "research design" (Topic) OR "comparative study" (Topic) OR "evaluation studies" (Topic) OR "follow up studies" (Topic) OR "prospective studies" (Topic) OR "cross-over studies" (Topic) OR control* (Topic) OR prospectiv* (Topic) OR volunteer* (Topic) OR human (Topic) NOT animal (Topic).

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Karimi-Shahanjarini, A., Afshari, M. & Besharati, F. Cultural appropriateness in randomized controlled trials (RCTs) aimed at reducing pesticide exposure among farmers and farmworkers: a systematic review. Int Arch Occup Environ Health 96, 27–44 (2023). https://doi.org/10.1007/s00420-022-01880-6

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