DOI: 10.3886/e239959v1
title: Efficacy of the SAFE Program to Promote Preventative Behaviors for Infectious Airborne Diseases and Improve Well-Being for Individuals with Autism Spectrum Disorders in the Workplace United States, 2021-2024.

description: The purpose of this research study was to determine if the SAFE program increases perceived safety and well-being in the workplace and increases individual knowledge of actionable behaviors to prevent transmission of infectious airborne diseases (IAD) in the workplace for Autistic people. This study compared differences in three groups in perceived knowledge and actionable behaviors to prevent the transmission of airborne diseases, self-advocacy, and self-efficacy. In this pilot study to determine proof of concept and feasibility, participants were randomized in blocks into one of three arms: 1) SAFE Program delivered by a peer interventionist; 2) SAFE Program delivered by employment services staff/educators; and 3) employment services as usual. Participants assigned to the services as the control group continued with their current employment services and supports without the integration of the SAFE program components. Participants assigned to the intervention arms of the study continued to receive their employment services with the SAFE program integrated over four weeks. Outcome measures were administered before the start of the intervention (pre-test), after the four-week intervention period (post-test 1), and once again one month post-intervention (post-test 2) to measure retention. Data was collected from 10/24/2023 to 4/30/2024.
description: Response Rates: There were 69 individuals screened eligible for the study. One individual declined to consent to the study. 68 participants were enrolled in the study. One participant withdrew from the study before providing any survey data. A total of 67 participants completed pre-test surveys. 66 participants completed the intervention, first post-test data collection, and second post-test data collection (98%).
description: Presence of Common Scales: <b>Descriptive Data.</b> The research team collected demographic data including age; gender; ethnicity; education; and primary/secondary diagnoses. <br><b>Primary Outcome Measures:</b><b> </b><br><b>Airborne Infectious Disease Knowledge Survey</b> (completed pretest, post-test 1, post-test 2). This survey assessed both knowledge and actionable behaviors that participants exhibit to prevent IADs. The items for the tool were developed from recommendations provided by the Centers for Disease Control and Prevention to reduce exposure to IADs, including use of personal protective equipment, personal hygiene, and social distancing. The 16-item assessment includes administrator observations during an interview (6 items) and questions completed by the participant (10 items). <br><b>Workplace Health and Safety Self-Advocacy Scale (WHSSS)</b> (completed pre-test, post-test 1, post-test 2). This measure was adapted from employment-centered items on the Self-Determination and Self-Advocacy Questionnaire, which assesses the degree of self-advocacy in the workplace as reported by staff and self-reported by participants. The modified WHSSS has five questions and was used to assess the skills used to advocate for preventative practices for IADs in the workplace and the degree to which the person uses these skills. <b>Secondary Outcomes:</b><b> </b><b>PROMIS General Self-Efficacy Item Bank</b> (completed pre-test, post-test 1, post-test 2). This measure was used to assess participants’ belief in their capacity to manage daily stressors and have control over meaningful events. The measure consists of ten items that assess the extent to which respondents believed in their ability to solve problems. Sample items were “I can always manage to solve difficult problems if I try hard”, “Thanks to my resourcefulness, I know how to handle unforeseen situations”, and “I can usually handle whatever comes my way”. <b>The PROMIS General Self-Efficacy</b><b> </b>(completed pre-test, post-test 1, post-test 2). This measure allows for comparisons across populations and demonstrates strong internal consistency reliability (Cronbach’s α = .94) and good validity, supported by confirmatory factor analysis (CFI = .987, TLI = .984, RMSEA = .090). <b>VocFit Safety Subscale</b> (completed pre-test, post-test 1, post-test 2). The VocFit is an assessment tool used to measure the best fit for a worker with a job. The VocFit safety subscale consists of eight questions, asking to what degree the participant demonstrates the ability to engage in safety protocols at their employment. The VocFit is a valid and reliable measure for assessing workplace adaptability. It demonstrates high internal consistency, with an ordinal alpha reliability coefficient of ≥ .86. <b>NIH Toolbox Item Bank/Fixed Form v2.0 – Perceived Stress (Ages 18+)</b> (completed pre-test, post-test 1, post-test 2). This self-report measure has 10 items and was used to assess “perceptions about the nature of events and their relationship to the values and perceived coping resources of an individual” of participants. The Perceived Stress Measure demonstrates good reliability, with Cronbach’s alpha values reported as high as 0.89, and has shown strong evidence of validity. <b>PROMIS Item Bank v1.0 – Anxiety Short Form 8. (Ages 18+) </b>(completed pre-test, post-test 1, post-test 2). This self–report measure has eight items and was used to assess anxiety of participants. The Anxiety Short Form measure demonstrates strong convergent validity, with a correlation of 0.69, and excellent internal consistency, with a Cronbach’s alpha of 0.93 (39). <b>Feasibility and Acceptability Measures.</b> To assess the feasibility and acceptability of the SAFE program, participants were asked to complete 3 short surveys. Participants were also asked to share things they enjoyed and did not enjoy about the SAFE program. <b>The SAFE Evaluation</b><b> </b>(completed post-test 1). The SAFE Evaluation included six questions regarding the degree to which participants felt the SAFE program increased their knowledge of infectious airborne diseases, how the diseases spread, how to protect themselves at work and in the community, and how to ask for help and manage stress and anxiety relative to infectious airborne disease. <b>The Acceptability of Intervention Measure (AIM)</b> (completed post-test 1). The AIM included four items that addressed how much the participant agreed with the acceptability of the SAFE Program. These items include questions such as, “I like the SAFE program,” with a 5-point response scale ranging from strongly disagree to strongly agree. The AIM has demonstrated good reliability, validity, and responsiveness. <b>The Feasibility of Intervention Measure (FIM)</b> (completed post-test 1). The FIM included four items that addressed how much the participants agreed with the feasibility of the SAFE Program. These items include questions such as, “The SAFE program seems possible,” with a 5-point response scale ranging from strongly disagree to strongly agree. Evidence supports the FIM as a reliable, valid, and responsive tool for assessing feasibility.
description: Participants were a convenience sample recruited through community partner organizations that provide transition services for autistic adults.
description: Adults with Autism Spectrum Disorder (ASD) who receive employment services and are working 10+ hours per week. .
description: face-to-face interview; web-based survey; SAFE Program Webpage on the REACH Collective Website - https://sites.temple.edu/reachlabtemple/safe-social-distancing-and-advocacy-for-personal-protective-equipment-and-employment/