Silicosis is an incurable, potentially life-threatening, form of fibrotic lung disease caused by inhalation of respirable crystalline silica (RCS) [1]. The disease has been recognized globally for over 100 years, and lung disease screening is recommended for high-risk industries, including mining and construction [2]. Cases of silicosis were identified in 2010 among workers in the stone benchtop (countertop) industry (SBI) working with artificial stone (AS; Textbox 1) [3-12]. Subsequently, a number of cases of artificial stone-associated silicosis were diagnosed in Australia [3,13]. AS has a very high crystalline silica content, often over 90% [14]. Processing AS by drilling, polishing, cutting, or grinding generates fine particles of dust containing RCS, which can cause silicosis when inhaled [15].

An investigation of the effects of RCS exposure in the SBI was commissioned by the Victorian regulator, WorkSafe Victoria [16], and developed into a screening program by Monash University. It included (1) exposure assessment from a detailed occupational history; (2) collection of respiratory symptoms; (3) recording of investigations including spirometry, chest x-ray, and high-resolution CT of the chest; (4) screening for comorbidities associated with silica exposure, including autoimmune diseases and tuberculosis [4,17]; and (5) a mental health instrument.

The initial paper-based questionnaire was developed by a multidisciplinary team, including respiratory physicians, an occupational hygienist, and occupational physicians [16]. Simplicity was prioritized, as many industry workers were born outside Australia and spoke English as an additional language [18].

Up to 6 jobs in the SBI could be recorded in the occupational history. The proportion of time spent on specified tasks in each job and the proportion of time spent on dry cutting of stone and working near someone doing dry cutting were recorded. Exposure control measures (ventilation and respirator use) were identified for each job. Other information collected included the country, start and (if relevant) finish date; days per week worked; number of people in the organization; and type of stone predominantly worked with (AS or natural stone). Other silica-associated occupations (eg, mining, quarrying) and any non-occupational activities that involved dust exposure (including hobbies and home repairs, eg, tiling, plastering) were also recorded.

Data were collected from multiple users, including respiratory physicians, multidisciplinary team, workers, and administrative staff, and capture all the elements listed earlier. The data were cleaned and entered into an electronic data capture tool (EDCT) held on the secure REDCap platform [19,20]. The data were used for both clinical and research purposes. In 2021, screening was centralized and carried out at a single site, which led to a need for direct data entry to the EDCT by the worker.

Exposure calculations from the occupational data have been used to identify roles within the SBI with greater RCS exposure, such as factory machinists and installers, and that exposure intensity and cumulative exposure were associated with dyspnea and radiological abnormalities consistent with silicosis [21]. The screening program data has also been used to describe the numbers of cases of silicosis diagnosed to date [18], the rates and determinants of psychological distress, and the psychometric properties of the mental health instrument [22,23].

The aim of this study was to describe the development of the EDCT, present its refined content, and describe the results of an audit of its clinical utility undertaken with a sample of workers.

The demographics of the workers are presented in Table 1. Most participants were male, and they covered a range of ages and years of employment in the SBI. They included machinists, installers, and office workers.

All participants were asked to report about their comprehension of an introductory statement, and one worker commented that it took a while to read and understand, and did not feel like he understood it fully. All workers reported that they comprehended what was meant by “dry work.” When asked about tasks that exposed them to dust that were not already listed on the EDCT, 2 workers identified new relevant tasks: emptying bins containing benchtop fragments and cleaning of the final benchtop product, onto which the dust-containing water used in wet cutting had dried. In total, 4 workers reported that their ventilation option was not included in the list on the EDCT, nor was it pictured. However, after discussion, the alternative options they were describing were “air conditioning,” “garage door,” “no ventilation,” and “ventilation in the wall,” all of which were listed.

For respirators, 14 workers identified the type they used from the descriptions and pictures in the EDCT, and the only worker that did not see their device described use of one similar to that depicted. Of 8 workers who were asked if they could easily remember and estimate the percentage of time they spent wearing a respirator, 7 responded in the affirmative. One worker had worn his respirator for 6 hours out of an 8-hour shift (approximately 75%), but had estimated that he wore it for 35% of the day. One worker commented that he wore his respirator all day, regardless of the task, whilst another pointed out that each job was different, with some jobs being “perfect” (ie, not requiring any adjustments), whereas others required adjustments onsite, adding to the difficulty of responding to this question accurately.

If a worker reported dry cutting in their current job, they were asked whether or not practices around dry cutting had changed (this was because dry cutting without suitable protection had been officially banned recently in Australia). Of the 11 workers who completed this question, 10 understood the question and were able to complete it accurately, but one worker expressed some confusion around the wording of the question. Workers also described measures other than ventilation and respirators that their employer had introduced including changing clothes at work and using water systems for dust suppression when loading stone.

Subsequently, modifications were made to improve accessibility for the workers: simplification of the language used in descriptive statements and instructions, modification of the color scheme to improve readability, and addition of commonly reported responses (eg, “home maintenance,” “tiling,” and “plastering”) as a prompt on the non-occupational (eg, hobby) dust exposure history section. One of the simplified statements was an introductory statement that defined “dry work” (Figure 3). An image accompanied the text with examples of dry and wet cutting [26]:

The current version of the Occupational Silica Exposure Assessment Tool from the EDCT is presented in Multimedia Appendix 1.

This study has presented the development, comprehension, utility, and refinement of the OSEAT, a purpose-built EDCT for use among SBI workers undergoing assessment for silicosis that included input from workers and has the capacity for modification and use within other silica-exposed occupational settings.