*2.3. The "All the Right Moves" (ARM) Intervention*

The ARM intervention was designed to integrate intervention components into the companies' existing safety and health practices on the sites. The intervention components were first developed and vetted with researchers and construction safety professionals, based on evidence-based organizational interventions and our own studies in the construction industry [4,18,37]. Following this process, the components of the interventions were piloted on commercial construction sites not involved in this trial. Managers and workers from the pilot sites provided qualitative feedback on program components, and the feedback was used to modify the intervention components. The changes were again vetted with these workers to refine the intervention components. This feedback was crucial to ensure intervention-organization fit, worker buy-in, and feasibility of implementing the components.

The ARM intervention contained two main intervention components: (1) the Soft Tissue Injury Prevention Program (StIPP) which focused on improving ergonomics practices at the site and worker level to improve musculoskeletal health; and (2) Health Week, that integrated key messages and provided integrated health coaching opportunities for individual workers to improve ergonomic practices and improved health behaviors (diet, physical activity, and smoking) associated with cardiovascular health. Both of these activities were based on industry safety practices with the ergonomics program using a structure similar to current safety management systems [38], and the health week based on the industry's practice of Safety Week campaigns and training. Refer to Figure 1 for the intervention's logic model.

**Figure 1.** Logic model for the All the Right Moves (ARM) intervention.

*The StIPP intervention component:* This consisted of worksite inspections and feedback, task pre-planning, supervisor training, and worker training implemented for six weeks prior to the health week. The ergonomics-focused program targeted organizational practices and physical job demands by creating a systematic process to control worksite hazards.

Worksite Inspections and Feedback: The inspection process utilized a standardized worksite walkthrough inspection process augmented from an existing safety inspection process adapted from the successful Building Safety for Everyone program [18,36]. Photographs were taken of the injury hazards and ergonomic solutions which could be uploaded through an internet-based platform. The internet-based platform allowed data from all observations in a given date range to be aggregated and a report generated. A pre-intervention worksite inspection was conducted for each site one-week before the intervention activities were launched in order to customize foreman training as well as provide one-on-one training for the safety manager to identify soft tissue injury hazards and ergonomic practices. The walkthrough was conducted by an experienced ergonomist (J.T.D or M.P.G.), who was accompanied by a research assistant and the site safety manager from the general contractor. During the following six-week intervention periods, the safety manager conducted safety inspections on their own documenting their inspections using a custom-made web-based inspection tool. The tool allowed the safety manager to upload observations, including date, location, photo, hazard identified, solutions.

Each week the research team working with the safety manager compiled an inspection report and materials to provide critical feedback to the foreman and to the work crews. Based on our learnings from the Building Safety for Everyone program [18], detailed reports were communicated to foreman at weekly meetings and posters highlighting examples of hazards and solutions from these reports were placed in highly-visible areas around the worksite.

Task pre-planning: In addition to the inspection and feedback, we adapted existing pre-task planning checklists to incorporate soft-tissue injury hazards and the application of ergonomics solutions. These checklists identified task that involved manual materials handling, overhead work, and ground work. Ergonomic solutions included the NIOSH Simple Ergonomics Solutions for Construction Workers [39], as well as various trade specific solutions publicly available, which we compiled in a manual for the safety managers.

Supervisor training: This took place at the start of the intervention to report information from the pre-intervention walkthrough to the site foreman for the subcontractor companies currently on the site. The training curriculum included information about the intervention, programmatic activities, injury hazards and ergonomic solutions identified from the first worksite inspection, and a few basic solutions from the NIOSH Simple Solutions [39], as well as expectations for the duration of the intervention implementation. The training was conducted during a mandatory weekly foreman meeting. Safety managers for each site also received this training, as well as trainings on how to use the web-based worksite inspection tool.

Worker training consisted of an "Ergonomics Toolbox Talk" (i.e., full company break in normal work to discuss an observed safety concern) that consisted of providing a few of the key messages from the supervisor training. The toolbox talk took place at the start of the intervention for workers already on the worksite and during new worker safety orientations, for workers coming onto the site after the initial launch meetings.

Health Week: This health promotion intervention was modeled after the existing safety week in construction (one week each year that is dedicated to raising awareness of workplace safety). The key goal of Health Week was to provide health education through toolbox talks and engage workers in programs to facilitate health behaviors through an opt-in health coaching program. Health Week targeted psychosocial factors and individual health-related behaviors by engaging workers in one-on-one discussions about their health and connecting them with relevant resources to improve their health behaviors. Toolbox talks were held during workers' break times each day of Health Week. Scripts and one-page toolbox cards were developed by the research team and a health promotion consultant, and then vetted with construction companies before being used. Topics included benefits of health coaching, soft tissue injury prevention, smoking cessation, energy balance (diet and physical activity) and a wrap-up session. Free web-based and phone resources were provided for each relevant topic. In addition, resources included free telephone-based health coaching provided by a large health-care organization. For active smokers, nicotine replacement therapy (NRT) (two-week supply) was provided free of charge.

Because of the success of individualized health coaching in construction workers, and prior results demonstrating dynamic workers movement between sites, Health Week encouraged workers to sign up and participate in health coaching program [40,41]. The health coaching program consisted of up to four telephone sessions by a trained health coach at no cost to the worker. The focus of these sessions was soft tissue injury prevention, dietary behaviors, physical activity and smoking cessation. Workers were able to select which of these topics they would receive coaching for. Each day workers were reminded to sign up for health coaching and those who did sign up were put into a lottery to win a USD\$50 gift card to a large hardware-chain store.
