Marie-Anne S. Rosemberg, PhD, MN, RN, FAAOHN, University of Michigan; Aurora B. Le, PhD, MPH, CSP, CPH, University of Michigan; Lauren Ward, MPHTM, University of Michigan; Carol Shannon, MA, MPH, University of Michigan

Nail salon workers (NSW) are an underrepresented and hardly reached population. They are exposed to a myriad of hazards at work. However, we lack information about existing interventions targeting the health and wellbeing of this at-risk group of workers. The purpose of this project was to conduct a scoping review to identify and appraise existing interventions to promote health among NSW

NSW are primarily foreign-born women who face various forms of occupational hazards leading to disparities such as alarming exposures to chemical hazards and bloodborne pathogens, aggression from clients, and little access to and utilization of resources. These various forms of occupational hazards are strongly associated with negative respiratory, dermatological, carcinogenic, and reproductive outcomes. Yet we continue to lack knowledge of endeavors that aim to promote the health and wellbeing of this high-risk worker population. Without well-designed, culturally-appropriate interventions, nail salon workers will continue to experience elevated rates of illness, injury, and chronic chemical exposures.

Arskey and O’Malley’s five-step framework on reviews guided this project. The steps were: (1) identification of the research question, (2) identification of all relevant studies, (3) selection of studies suited to the research question, (4) charting of the data obtained from the search, and (5) summarization and reporting of the results. For step one, our research question was: Are there any studies aimed at improving the health and wellbeing of NSW? Our sub-questions were: What are the key components of these interventions? What were the key outcomes? For step two, we partnered with an experienced health sciences librarian health sciences library informationist to identify and compile potentially relevant studies through the database search strategy. The databases MEDLINE, EMBASE, Scopus, CINAHL, and Web of Science were searched. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart was used to capture the inclusion protocol. The original search yielded 394 references before deduplication. Abstracts were independently assessed by two research team members. Disagreements between the initial two reviewers were resolved by a third reviewer. Thirty-seven full-text articles were reviewed for relevance to the research question. After applying our exclusion criteria (e.g., not in English, and not focused on nail salon workers) five articles remained; two were products of the same study leaving four unique interventions.

Four US-based interventions were identified with varying study designs (i.e., one randomized-controlled trial, one quasi-experimental and two cross-sectional). About 424 participants were recruited through cosmetology schools and 34 from nail salons. None of the articles explicitly mentioned the inclusion of community stakeholders in the development of their respective interventions but one intervention did use a community-based organization for recruitment. The majority of participants were female between the ages of 23 and 58. A quarter of the cosmetology school trainees were high school students. Two interventions took the train the trainer approach where the nail salon owners received the interventions and they then trained the workers on best practices to reduce chemicals. Participating salon owners were generally female and of Vietnamese descent. Most participants had attended some high school or completed high school.

Interventions focused on several health outcomes including ergonomics and physical hazards, infection prevention, and chemical exposures. Mode of delivery varied from pamphlet distribution and inspections to full-day training sessions. Interventions were evaluated via pre- and post-tests and infractions frequency. Maximum follow-up time was 8 months.

Outcomes included increased knowledge on exposures, fewer infractions, increased adherence to infection control practices and use of personal protective equipment, and behavior and attitude changes. There were statistically significant improvements in reported health behaviors surrounding chemical hazard awareness (e.g. reading product labels), as well as outdoor breaks during work. There were no statistically significant changes in chemical levels in salon air, though there was some reported decrease in nose, throat, and skin irritation.

There is a need for culturally sensitive interventions to improve health and wellbeing among nail salon workers. That two of the four interventions targeted nail technician trainees and their instructors indicates the potential of early interventions before the workers officially start in the industry. This scoping literature review sheds light on the current state of peer-reviewed, published interventions targeting the health of nail salon workers, an overlooked and vulnerable worker population. Future interventions could implement a Total Worker Health approach to address psychosocial stressors (e.g., work-life balance, resource access) and factors beyond the workplace affecting NSW’s’ health and wellbeing.

To our knowledge, this is the first review of its kind aimed to identify interventions specifically targeting health among NSW. This scoping review underscores the need for effective interventions and programs aimed to promote the health and wellbeing of NSW. This work will guide future intervention studies not only among this specific worker population, but also other worker groups with similar characteristics (e.g., predominantly women, racial/ethnicity minority groups, immigrations) and facing similar exposures.

Tags: Best Practices in Creating Healthy Workplaces, Education and Training Interventions in Occupational Safety and Health, Interventions in the Workplace, Literature review, r2p2r: Research-to-Practice-to-Research, Services