Voices Illuminating Solutions for Outdoor Workers' Needs and Safety

This study uses a randomized controlled trial (RCT) design with two parallel arms to evaluate whether combining participatory action research with occupational health education produces greater changes in climate-related attitudes, behaviors, and protective actions compared to occupational health education alone. The study targets outdoor workers and community members across California: San Joaquin Valley, Kings and Monterey Counties, regions where outdoor workers face disproportionate exposure to climate-related health hazards including extreme heat and degraded air quality.

Intervention

The Intervention Group will engage in the "Our Voice photovoice program," a community-based participatory action research methodology developed at Stanford University. Our Voice uses a mobile application called the Discovery Tool, which allows participants to document features of their local environment by taking photos and recording written or audio reflections in real time. The app is available in multiple languages, including English and Spanish. Participants in the Intervention Group will complete three sequential activities:

Discovery Tool Training: a live or pre-recorded individual or small group session (by phone, Zoom, or in-person) led by a Stanford RA, orienting participants to the photovoice approach and app use

Discovery Walk: an independent walk in their home or work neighborhood to document environmental features relevant to climate and health using the Discovery Tool

Community Discovery Meeting: a facilitated approximately 2-hour group meeting held within six weeks of the Discovery Walk, where participants collectively review photos, identify common themes, and discuss community assets and challenges they wish to address

Control Both groups will receive bilingual (English and Spanish) Cal/OSHA educational materials covering heat illness prevention, air quality risks, and protective measures for outdoor workers. The Control Group receives these materials as the sole study intervention. The Intervention Group receives the same materials as part of their Community Discovery Meeting.

Randomization Eligible participants will be randomly assigned in a 1:1 ratio to either the Intervention or Control Group using simple randomization via REDCap.

Inclusion criteria

• Participants must be 18 years or older.
• Participants must be connected to the San Joaquin Valley, Monterey County, or Kings County as either an outdoor worker or community member.
• Participants must have the capacity to verbally consent in English or Spanish
• Participants must have the ability to walk or otherwise move around their community using the Discovery Tool.
• Have a smartphone capable of loading the Discovery Tool OR willingness to use a TracFone provided by the research team

Exclusion criteria

• Inability to consent to the study.
• Unable to navigate the Discovery Tool with reasonable technical guidance from the research team.