**1. Introduction**

For many Americans, especially older adults, home care workers (HCWs) are a vital source of daily personal support that facilitates their ability to "age in place." With a growing proportion of aging adults in the US population in coming years, the currently estimated 2.9 million home care and personal care aides is projected to increase by 41% between 2016 and 2026. This growth rate is considerably higher than the 7% average growth for all US occupations [1].

HCWs face job demands that are unique and multi-faceted, and they often lack resources or supports to help them meet such demands [2]. Despite the important service they provide in communities, HCWs remain poorly compensated with a median income of \$23,130 that is considerably lower than the median for all US workers [1]. Nearly half the nation's HCWs rely on low-income tax credits and federal assistance programs to make ends meet [3]. HCWs face a number of physical demands and exposures as they assist older adults with activities of daily living, such as walking and other movements, personal hygiene, dressing, bathing, cooking, and housekeeping. Thus, HCWs often suffer from musculoskeletal strain, are exposed to infectious agents and hazardous chemicals, and are at-risk for puncture injuries from sharps when clients do not discard them properly [4]. Further, because they work alone within the homes of their clients, HCWs lack many occupational safety and health protections that are commonly available for employees in more traditional workplaces (e.g., supervision, environmental safety audits, employer assessment and correction of hazards, co-worker support, safety committees, and safety training) [2]. The degree of worker vulnerability differs for independent contractors compared to those who work for home care agencies, but most all HCWs experience deficits in protections to some degree.

Although HCWs report high satisfaction from the close relationships they develop with clients [4], some home care clients may engage in very challenging behaviors, including verbal and physical aggression. HCWs report incidents of verbal and sexual harassment, which are associated with stress, depression, sleep problems, and burnout [5]. The unique profile of challenges for HCWs points to the critical need for interventions geared toward protecting their safety, health, and well-being.

Research with this socially important workgroup has led to the development of effective interventions to reduce blood and body fluid exposures [6], reduce musculoskeletal pain [7], and improve physical fitness and work ability [8]. Socially supportive group interventions have produced long-term improvements in well-being for family caregivers [9] and improved a range of safety, health, and well-being factors among independent HCWs serving consumer-employers in publicly funded programs in Oregon [10]. In addition to experimentally evaluated programs, there are valuable resources for HCWs developed through participatory methods. For example, the Safe Home Care Project provides resources on safe cleaning and disinfection and on safe practices to reduce risk of injuries from sharps and blood-borne exposures (University of Massachusetts, Lowell, Safe Home Care, n.d. [11]). The Caring for Yourself While Caring for Others handbook (National Institute for Occupational Safety and Health [NIOSH] n.d. [12]) provides a checklist of potentially hazardous work tasks, along with tips and tools for preventing exposures and injuries for each family of tasks. The handbook also addresses communication strategies and workplace stress. Helpful illustrations show workers examples and non-examples of safe practices and tool use, and overall, the book is designed to help facilitate conversations between workers and their clients (or with their family members or workplace supervisors) about improving workplace safety.

#### *1.1. Translating Evidence-Based Interventions into Practice*

In the healthcare domain, Balas and Boren [13] stated that " ... it takes an average of 17 years for research evidence to reach clinical practice" (p. 66). For nine clinical procedures established effective in landmark trials, the authors reported current rates of procedure use between 17.0% to 70.4%. Even in medicine, there are very long time lines to realize variable degrees of adoption.

Typically, an intervention's reach beyond the research setting is limited by constraints such as a lack of funding to facilitate its usability and scalability or the absence of structures or partners to market it to potential adopters. In some cases, an intervention's features may not encourage its transfer to practice (e.g., too complex, costly, or effortful to implement). Moreover, intervention researchers are typically evaluated and rewarded for obtaining competitive grants, conducting innovative and high quality research, and publishing research findings. Occupational incentives are not typically aligned for investigators to adapt, commercialize, market, and disseminate the evidence-based programs they create or study. These types of barriers include the overarching culture of peer review, which tends to emphasize factors related to the internal validity of intervention studies over issues related to external validity (e.g., factors that influence participation, adoption, and implementation). To illustrate, in a review of health promotion intervention research using the widely recognized RE-AIM framework, Bull and colleagues [14] reported that just 25% of studies reported information on adoption, and only 12.5% reported implementation data.

In order to overcome some of these barriers, Harris and colleagues [15] proposed a dissemination framework that addresses the gap between scientists and end users of evidence-based health promotion interventions. Their approach relies on a motivated "disseminator" or intermediary organization to help researchers adapt, market, and disseminate interventions. In their model, researchers and intermediary disseminating organizations form a reciprocal relationship that generates "Dissemination Resources" that are then marketed to end users—primarily by the disseminating organization. The authors provided two examples of interventions that were successfully disseminated through this approach that had reached nearly 2000 employers and community based adopters at the time of the publication.

Systematic reviews of research on the translation of community-based interventions into practice suggest additional facilitators for success. Matthews and colleagues [16] shared that translating physical activity interventions into practice was facilitated by tailoring an intervention to suit the intended adopter, partnering strategically with receptive organizations, and adequately training implementers. In another review, Estabrooks and Glasgow [17] shared that interventions are more translation-friendly if they are perceived by the intended users as being more advantageous than existing practices, compatible with their current needs and values, feasible to deliver and implement, able to be tested for potential adoption, and have demonstrated effectiveness among stakeholders [18].

Other dissemination research highlights the importance of commitment from organizational leaders (including financial support) and the presence of workplace champions. The successful large-scale adoption of the evidence-based Stand Up Australia intervention (disseminated as the BeUpstanding ProgramTM) was attributed by researchers in part to a strong partnership with and timely funding support from the adopter (government, in this case). The authors also reported the importance of packaging the intervention into an online toolkit, and then transferring the toolkit to a workplace champion. The toolkit helped champions by providing practical strategies for making a business case for the intervention, obtaining buy-in from organizational leaders, and how to deliver and evaluate the program [19]. Qualitative research with adopters and non-adopters of the evidence-based PHLAME wellness program for firefighters highlighted the importance of a committed chief and the presence of a workplace wellness champion at adopting fire stations (i.e., the "champ-and-chief" model of adoption) [20].
