A Systems-Based Approach for the Prevention of Heat-Associated Kidney Disease in Latin American Workers

Background: The prevalence of chronic kidney disease and other non-communicable diseases in Guatemala has been rising. Recently, chronic kidney disease of non-traditional origin (CKDnt) has been identified among occupational cohorts and linked to heavy workloads in hot environments. Objective: To describe a systems-based community participatory approach to occupational safety and health. Methods: Over the last eight years, academic researchers have partnered with a large agribusiness in Southwest Guatemala to address the health, safety, and well-being concerns of workers, especially in relation to CKDnt. This case study presents the Total Worker Health® approach used to develop, implement, and evaluate interventions to address potential causes of CKDnt. The results of these interventions are presented using the Consolidated Framework for Implementation Research and RE-AIM. Findings: A Total Worker Health (TWH) approach addressing both transactional and transformational organizational behavior change to reduce the incidence of reduced kidney function in this workforce can be successfully implemented. Our findings highlight the need for collaborative approaches to the development and implementation of strategies to adapt to climate change in the workplace. The sustainability of interventions needs constant re-evaluation to adapt to changing contexts. Discussion: This case study illustrates a practical, evidence-based TWH approach to address the immediate impacts of heat stress and nephrotoxins on the kidney health of sugarcane workers in Guatemala. It also illustrates the importance of multi-modal interventions implemented and evaluated in a dissemination and implementation science framework informed by the community that is at risk. The principles underlying our approach may have applicability and generalizability to less extreme circumstances, and beyond those with heat-associated kidney disease.