Healthcare provided in the home is increasing, resulting in a greater number of professional caregivers providing in-home services for ill and disabled persons. The number of home health aides is expected to increase dramatically. The unique physical environment of each home results in challenges to worker safety and health. Sixty percent of all injuries experienced by home health aides occurred inside patient homes, and were due to patient handling tasks, medical devices, equipment, and other environmental factors. Given the increase in health care provided in homes, and the hazards faced by home healthcare workers, it is critical that workers across disciplines have the ability to identify, assess, and respond to home hazards. The proposed project will (1) Develop a virtual simulation training system (VSTS), using an interdisciplinary, participatory design approach;(2) Assess the usability, usefulness, and desirability of the VSTS across multiple professional disciplines;and (3) Evaluate the efficacy of the VSTS in preparing home healthcare professionals to recognize, assess, and respond to hazards in the home health environment using appropriate risk perception and decision-making processes. The project will use an iterative, participatory design approach to develop the VSTS and a randomized design to determine its efficacy for training home healthcare professionals (Home Health Aides, Nurses, Occupational Therapists and Physical Therapists). The VSTS will contain a Training Environment (TE) and an Evaluation Environment (EE). The TE will provide training in hazard identification, assessment, and response as well as training in risk assessment and decision-making. The EE will allow an assessment of an individual's ability to identify, assess, and respond to hazards appropriately, as well as an assessment of the decision- making processes used to evaluate risks in the home. To develop the VSTS, we will recruit 90 participants representing seven professions involved with the provision in home healthcare (nurses, home health aides, occupational therapists, physical therapists, agency educators, nurse managers, and health and safety experts). These professionals will participate in focus groups, interviews and, ultimately, VSTS testing to ensure development of a relevant, accessible, and comprehensive training program. To test the efficacy of the training, we will recruit 90 additional participants who will be randomly assigned to either the training (TE) or the control condition. Differences in performance and risk assessment will be evaluated through descriptive and inferential statistical analysis, as well as qualitative, """"""""think aloud"""""""" techniques. Unique to this study is the use of virtual simulation as a training technique, a participatory design approach, and the integration of decision making and risk perception measures into the training and evaluation. The impact of this work will be the development of a broadly available, easily disseminated, and accessible health and safety training system for home healthcare workers across multiple disciplines.

Public Health Relevance

The demand for home healthcare services is rapidly increasing. This has resulted in a need for trained home healthcare professionals to care for and support ill and disabled persons in their personal residences. However, home healthcare workers are at serious and substantial risk for work-related injury and illness associated with providing healthcare services in the challenging and variable home environment. This project will develop, test, and evaluate a virtual simulation training system designed to train home healthcare professionals in the identification of, assessment of, and response to health and safety hazards in the home. This project has the potential to translate into reductions in the burden of substantial occupational injury and illness among this large population of workers.

National Institute of Health (NIH)
National Institute for Occupational Safety and Health (NIOSH)
Research Project (R01)
Project #
Application #
Study Section
Safety and Occupational Health Study Section (SOH)
Program Officer
Frederick, Linda J
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Louisville
United States
Zip Code
Polivka, Barbara J; Anderson, Sarah; Lavender, Steve A et al. (2018) Efficacy and Usability of a Virtual Simulation Training System for Health and Safety Hazards Encountered by Healthcare Workers. Games Health J :
Wills, Celia E; Polivka, Barbara J; Darragh, Amy et al. (2016) ""Making Do"" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards. West J Nurs Res 38:411-26
Darragh, Amy R; Lavender, Steve; Polivka, Barbara et al. (2016) Gaming Simulation as Health and Safety Training for Home Healthcare Workers. Clin Simul Nurs 12:328-335
Polivka, Barbara J; Wills, Celia E; Darragh, Amy et al. (2015) Environmental Health and Safety Hazards Experienced by Home Health Care Providers: A Room-by-Room Analysis. Workplace Health Saf 63:512-22; quiz 523