Small business Total Worker Health: A conceptual and methodological approach to facilitating organizational change

The Role of Wellness Climate in Small Business Health Promotion and Employee Wellbeing

Wellness involves physical, emotional, behavioral, social, and spiritual dimensions. A climate for wellness exists at both the psychological and organizational levels, consisting of individual and shared perceptions of policies, structures, and managerial behavior that support or promote employee wellbeing. This study explored the associations between psychological and organizational wellness climate and the effectiveness of a team health promotion training on employees' perceived physical and mental wellbeing and substance use. Employees from 45 small businesses completed self-report measures of wellness climate, wellbeing, positive unwinding behavior, work-family conflict, job stress, drug use, and alcohol use, assessed before, and one and six months after, attending either of two types of onsite health promotion training. Team Awareness training targeted improvements in the social climate at work. Healthy Choices training targeted individual health behavior. A control group did not receive training until after the study. Businesses were randomly assigned to conditions and data were analyzed using multi-level modeling. Models that included wellness climate as a mediator fit the data significantly better than models without climate as a mediator. Team Awareness participants showed greater improvements in wellness climate and wellbeing compared to the control group. Healthy Choices participants showed no changes in climate and no mediation effects of climate. Health promotion efforts may be enhanced by including wellness climate as a target in program design at multiple levels.

Methods to improve the translation of evidence-based interventions: A primer on dissemination and implementation science for occupational safety and health researchers and practitioners

Objective

A limited focus on dissemination and implementation (D&I) science has hindered the uptake of evidence-based interventions (EBIs) that reduce workplace morbidity and mortality. D&I science methods can be used in the occupational safety and health (OSH) field to advance the adoption, implementation, and sustainment of EBIs for complex workplaces. These approaches should be responsive to contextual factors, including the needs of partners and beneficiaries (such as employers, employees, and intermediaries).

Methods

By synthesizing seminal literature and texts and leveraging our collective knowledge as D&I science and/or OSH researchers, we developed a D&I science primer for OSH. First, we provide an overview of common D&I terminology and concepts. Second, we describe several key and evolving issues in D&I science: balancing adaptation with intervention fidelity and specifying implementation outcomes and strategies. Next, we review D&I theories, models, and frameworks and offer examples for applying these to OSH research. We also discuss widely used D&I research designs, methods, and measures. Finally, we discuss future directions for D&I science application to OSH and provide resources for further exploration.

Results

We compiled a D&I science primer for OSH appropriate for practitioners and evaluators, especially those newer to the field.

Conclusion

This article fills a gap in the OSH research by providing an overview of D&I science to enhance understanding of key concepts, issues, models, designs, methods and measures for the translation into practice of effective OSH interventions to advance the safety, health and well-being of workers.

Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business

BACKGROUND

Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health ("TWH") leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later.

METHODS

The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest.

RESULTS

Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes.

CONCLUSIONS

This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business.

TRIAL REGISTRATION

The trial was retrospectively registered with ClinicalTrials.gov ( ID U19OH011227 ).

Latin American Agricultural Workers' Job Demands and Resources and the Association With Health Behaviors at Work and Overall Health

In the present study, we describe the job demands and job resources (JD-R) experienced by agricultural workers in three Latin American countries and their relationship to proactive health behaviors at work and overall health. Following previous research on the JD-R model, we hypothesized that job demands (H1) would be negatively related to agricultural workers' self-reported overall health. On the other hand, we hypothesized that job resources (H2) would be positively related to agricultural workers' overall health. Furthermore, we hypothesized (H3) that workers' engagement in jobsite health promotion practices via their proactive health behaviors at work would partially mediate the relationship between workers' job resources and job demands and overall health. We also had a research question (R1) about whether there were differences by type of job held. The sample of workers who participated in this study (N = 1,861) worked in Mexico, Guatemala, and Nicaragua for one large agribusiness that produces sugar cane. They worked in two distinct areas: company administration and agricultural operations. We administered employee health and safety culture surveys using survey methods tailored to meet the needs of both types of workers. Stratified path analysis models were used to test study hypotheses. In general, we found support for hypotheses 1 and 2. For example, operations workers reported more physically demanding jobs and administrative workers reported more work-related stress. Regardless, the existence of high job demands was associated with poorer overall health amongst both types of workers. We found that workers in more health-supportive work environments perform more proactive health behaviors at work, regardless of their role within the organization. However, hypothesis 3 was not supported as proactive health behaviors at work was not associated with overall health. We discuss future research needs in terms of evaluating these hypotheses amongst workers employed by small- and medium-sized agribusinesses as well as those in the informal economy in Latin America. We also discuss important implications for agribusinesses seeking to develop health promotion programs that meet the needs of all workers.

Leveraging an Implementation Science Framework to Measure the Impact of Efforts to Scale Out a Total Worker Health® Intervention to Employers

The role of dissemination and implementation (D&I) science is critical to the translation of Total Worker Health^® into practice and to the success of interventions in addressing current and future implications for worker safety, health, and well-being. D&I frameworks can guide researchers to design Total Worker Health (“TWH”) delivery approaches that use flexible implementation strategies to implement the core components of programs for employers with varying contextual factors, including small/mid/large-sized businesses and different industry types. To date, there have been very few examples of applying implementation frameworks for the translation and delivery of interventions into organizational settings that require adoption and implementation at the business level to benefit the working individuals. We present a TWH case study, Health Links™, to illustrate an approach to applying an existing implementation framework, RE-AIM, to plan, design, build, and then evaluate TWH implementation strategies. Our case study also highlights key concepts for scaling-out TWH evidence-based interventions where they are implemented in new workplace settings, new delivery systems, or both. Our example provides strong support of key implementation planning constructs including early and consistent stakeholder engagement, tailored messaging and marketing, flexibility, and adaptations in implementation strategies to maximize adoption, implementation, and maintenance among participating businesses.

A pilot study of changes in Total Worker Health® policies and programs and associated changes in safety and health climates in small business

BACKGROUND

There is little longitudinal research on whether changes to Total Worker Health® (TWH) policies and programs are associated with changes in health climate and safety climate. We hypothesize that as TWH policies and programs change, employees will report changes in safety climate and health climate from baseline to 1 year.

METHODS

Twenty-five diverse small businesses and their employees participated in assessments completed approximately 1 year apart. The exposures of interest, TWH policies and programs, were measured using the business-level Healthy Workplace Assessment™ which collects information on six benchmarks. The outcomes of interest, employee perceptions of safety climate and health climate, were measured via an employee survey. We employed paired t-tests and simple linear regression to assess change over a 1-year period.

RESULTS

The mean Healthy Workplace Assessment overall score changed by 11.3 points (SD = 11.8) from baseline to Year 1. From baseline to Year 1, the mean scores of each benchmark changed in a positive direction within this sample. The mean safety climate score and health climate score changed by +0.1 points (SD = 0.2) and +0.1 points (SD = 6.4) from baseline to Year 1, respectively. The associations between changes in the overall Healthy Workplace Assessment score and health climate and safety climate scores were negligible [β = 0.01 (95% confidence interval [CI]: 0.002, 0.02), and β = 0.01 (95% CI: 0.002, 0.02), respectively].

CONCLUSION

Our study suggests that when small businesses improve upon their TWH policies and programs they experience marginal measurable improvements in employee perceptions of their workplace safety climate and health climate.

Attitudes of Company Executives toward a Comprehensive Workplace Health Management-Results of an Exploratory Cross-Sectional Study in Germany

Workplace health management (WHM) in Germany aims at maintaining and increasing the health and well-being of employees. Little is known about company executives’ attitudes toward WHM. To gain more insight, we conducted a large-scale survey in companies in the German county of Reutlingen in 2017. We sent a standardized questionnaire to 906 companies, containing inter alia 26 self-constructed declarative statements depicting company executives’ opinions on various WHM aspects; 222 questionnaires could be evaluated. By exploratory factor analysis we assigned the 26 items to six factors reflecting different attitudes toward WHM. Factor values were standardized to a scale from 0 to 10. The attitude ‘positive view of general health services in the company’, for example, achieved by far the lowest mean agreement (3.3 points). For the attitude ‘general skepticism toward WHM’, agreement and disagreement were balanced (5.0 points). Using multiple regression analyses, we searched for variables that could partially explain respondents’ agreement with attitudes. In conclusion, a general WHM skepticism was widespread, but not dominant. The idea that general health services should be offered in companies was predominantly rejected. Older respondents and respondents from smaller companies and craft enterprises were more skeptical than average about WHM and its possible extensions.

Total Worker Health® and Small Business Employee Perceptions of Health Climate, Safety Climate, and Well-Being during COVID-19

The COVID-19 pandemic created workplace challenges for employee safety and health, especially in small enterprises. We used linear mixed-effects regression to examine changes in health climate, safety climate, and worker well-being, prior to the pandemic and at two timepoints during it. We also examined whether employees at organizations that had received a TWH leadership development intervention prior to COVID-19 would better maintain pre-pandemic perceptions of climates and well-being. The final study cohort consisted of 261 employees from 31 organizations. No differences were observed in mean outcome scores between the leadership intervention groups at any of the survey timepoints. We combined intervention groups to examine the difference across timepoints. Perceptions of health and safety climates remained stable across all timepoints. However, employee well-being scores declined between the pre-pandemic period and subsequent COVID-19 timepoints. These findings suggest that while small organizations continued to be viewed as supporting employees' health and safety over the course of the pandemic, well-being scores declined, indicating that other factors contributed to decreased well-being. The findings from this study have implications for small business leaders as they navigate the impact of the COVID-19 pandemic on the health, safety, and well-being on their organizations and employees.

Cardiovascular Health Research in the Workplace: A Workshop Report

Heart disease and stroke are the first and fifth leading causes of death in the United States, respectively. Employers have a unique opportunity to promote cardiovascular health, because >60% of US adults are employed, and most spend half of their waking hours at work. Despite the scope of the opportunity, <1 in 5 businesses implement evidence-based, comprehensive workplace health programs, policies, and practices. Integrated, systems-based workplace health approaches that harness data science and technology may have the potential to reach more employees and be cost-effective for employers. To evaluate the role of the workplace in promoting cardiovascular health across the lifespan, the National Heart, Lung, and Blood Institute, the National Institute for Occupational Safety and Health, and the American Heart Association convened a workshop on March 7, 2019, to share best practices, and to discuss current evidence and knowledge gaps, practical application, and dissemination of the evidence, and the need for innovation in workplace health research and practice. This report presents the broad themes discussed at the workshop and considerations for promoting worker cardiovascular health, including opportunities for future research.

Impact of Advising on Total Worker Health Implementation

OBJECTIVE

Little is understood about the mechanisms for improving the adoption and implementation of Total Worker Health® (TWH) in workplace settings. The primary objective of this study was to identify whether the delivery of TWH advising is associated with subsequent changes in TWH in small-to-medium sized businesses.

METHODS

We conducted a longitudinal study of a TWH intervention in 200 organizations completing Health Links Healthy Workplace Assessments™ between October 2016 and December 2019. Organizations were offered consultation via telephonic and live web-based advising sessions.

RESULTS

Organizations exhibited non-significant albeit positive change in assessment scores from baseline to assessment 2. Businesses receiving advising showed significant score improvements from assessment 2 to 3, versus those without advising.

CONCLUSIONS

TWH consultation may enhance adoption of organizational behaviors that promote worker health, safety, and well-being over time.

A mixed-method approach to tailor the implementation of a participatory Total Worker Health® program

Purpose –

Total Worker Health^® (TWH) programs, which represent a holistic approach for advancing worker safety, health and well-being, require an employer to adapt programmatic coordination and employee involvement in program design and delivery. Organizational readiness for such measures requires competencies in leadership, communication, subject expertise and worker participation. In the absence of documented methods for TWH readiness assessment, the authors developed a process to prospectively identify implementation facilitators and barriers that may be used to strengthen organizational competencies and optimize the organizational "fit" in advance.

Design/methodology/approach –

The mixed-method baseline assessment instruments comprised an online organizational readiness survey and a key leader interview; these were administered with key organizational and labor leaders in five US healthcare facilities. Findings about organizational resources, skills available and potential implementation barriers were summarized in a stakeholder feedback report and used to strengthen readiness and tailor implementation to the organizational context.

Findings –

The research team was able to leverage organizational strengths such as leaders' commitment and willingness to address nontraditional safety topics to establish new worker-led design teams. Information about program barriers (staff time and communication) enabled the research team to respond with proactive tailoring strategies such as training on participant roles, extending team recruitment time and providing program communication tools and coaching.

Originality/value –

A new method has been developed for prospective organizational readiness assessment to implement a participatory TWH program. The authors illustrate its ability to identify relevant organizational features to guide institutional preparation and tailor program implementation.

How does Organizational Climate Motivate Employee Safe and Healthy Behavior in Small Business?: A Self-Determination Theory Perspective

OBJECTIVE

This study evaluates the motivational processes between employee occupational safety and health climates and behaviors using the Theory of Self-Determination in a sample of diverse small businesses.

METHODS

We used cross-sectional data to assess whether employee safety/health intrinsic, identified, and external motives mediate the relationship between safety/health climate and behavior.

RESULTS

All three types of motivation mediated the relationship between safety and health climates and behaviors.

CONCLUSION

Small businesses seeking to engage employees in Total Worker Health efforts should build strong safety and health climates because of their influence on employees' motivation to participate in health promoting and health protective programs.

Profiles of total worker health® in United States small businesses

BACKGROUND

The Total Worker Health® (TWH) approach is a best practice method to protect and promote worker safety, health, and well-being. Central to this approach is leadership support and health and safety climates that support day-to-day use of health and safety policies and programs. There is some research that supports these relationships, but there is limited research amongst small businesses. Furthermore, it remains to be shown what role TWH business strategies, as reflected by organizational policies and programs, play in this process. The purpose of this study is to characterize small businesses by their organizations' TWH approach and assess the relationship of these approaches to employee health and safety behaviors.

METHODS

We utilized cross-sectional data from 97 businesses participating in the Small+Safe+Well study. We collected data using a business assessment tool, Healthy Workplace Assessment™, and an employee assessment tool, Employee Health and Safety Culture Survey. We used latent profile analysis at the business level to identify subgroups of businesses based on a set of characteristics from these assessments. Linear regression analysis at the employee level was used to determine profile association with employee safety and health behaviors.

RESULTS

There were two profiles characterized by the lowest (33% of all businesses) and highest (9%) levels of the indicators. There were also two profiles with higher scores on two of the different foci on either TWH business strategies (27%) or leadership and climate (31%). Employees working for a business with a profile that focused on leadership and climate, in addition to having a business strategy, reported the best safety and health behaviors.

CONCLUSIONS

Our study demonstrates that employee engagement in TWH will be highest when businesses have a strategy for how they implement a TWH approach and when they demonstrate leadership commitment to these strategies and foster positive safety and health climates. Our results offer suggestions on how to use TWH assessments to develop interventions for small businesses. More research is needed to understand whether small businesses can improve upon their profile overtime, whether these changes depend on contextual factors, and whether TWH interventions can help them improve their profile.

Evaluation of a Total Worker Health® leadership program for small business leaders

Leaders play a critical role in the development and execution of Total Worker Health (TWH). Small businesses, in particular, can benefit from strong leadership support for TWH as the burden of work-related injury, illness and fatality, as well as poor health and well-being is high in this population. In the present study, we conducted a program evaluation of a TWH leadership development program for small business leaders using the RE-AIM framework. The goal of the program was to help change leaders' behaviors around health, safety and well-being practices following the theory of transformational leadership. Two leaders from each business participated in pre-training activities on their own, a 6-hour in-person training, and three months of access to virtual training transfer activities, including coaching and goal tracking. Our results suggest that the TWH leadership development program is effective at improving leaders' self-reported TWH leadership practices and that the in-person training was implemented successfully. However, leaders did not report improvements in their personal health and in fact reported increased levels of work stress after the program. We also observed some challenges when implementing our training transfer strategies. Our study suggests that leaders may benefit from attending TWH leadership trainings alongside other colleagues in their organization to facilitate a shared vision and goals for TWH in their organization. As a next step, it will be important to determine the program's effectiveness in changing business TWH policies and practices, employee perceptions of TWH and leadership, and employee health and safety outcomes.

International Total Worker Health: Applicability to Agribusiness in Latin America

Total Worker Health^® (TWH) is a framework for integrating worker and workplace safety, health, and well-being, which has achieved success in European and US settings. However, the framework has not been implemented in Latin America or in agricultural sectors, leaving large and vulnerable populations underrepresented in the implementation and evaluation of these strategies to improve safety and promote health and well-being. This study presents a case study of how a TWH approach can be applied to a multinational Latin American agribusiness. We describe the process and adaptation strategy for conducting a TWH assessment at multiple organizational levels and in multiple countries. We follow this with a description of a TWH leadership training that was conducted based on the results of the assessment. Finally, we describe our methods to make corporate recommendations for TWH policies and programs that were informed by the TWH assessment and leadership trainings. With this case study we aim to demonstrate the importance and feasibility of conducting TWH in Latin America.

The Importance of Small Business Safety and Health Climates During COVID-19

OBJECTIVE

This study examines employee perceptions of safety and health climates for well-being during the COVID-19 pandemic in a sample of small businesses.

METHODS

We evaluated changes to employees' work and home life resulting from COVID-19 and perceptions of safety and health climates. Cross-sectional relationships were assessed using multivariable linear regression models for a sample of 491 employees from 30 small businesses in Colorado in May 2020.

RESULTS

Employee perceptions of safety and health climates were significantly related to their self-reported well-being during the first wave of COVID-19, even when there were changes to childcare, the ability to work, and limited social contacts.

CONCLUSION

Safety and health climates may influence employee well-being even when other disruptions occur, suggesting that during emergencies, small businesses with strong climates may be better prepared to maintain employee well-being.

Health Links™ Assessment of Total Worker Health® Practices as Indicators of Organizational Behavior in Small Business

OBJECTIVE

The aim of this study was to conduct a cross-sectional assessment of the adoption of Total Worker Health (TWH) policies and practices by business size and evaluate extent and alignment of their safety and health.

METHODS

We conducted an analysis of 382 businesses that completed the Health Links Assessment. We measured organizational adoption of TWH across six benchmarks: organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation.

RESULTS

Benchmark scores were significantly associated with business size. Larger businesses were more likely to score higher across each benchmark.

CONCLUSION

Small businesses are implementing TWH in a variety of ways and the level of implementation differs by business size. Practical interventions as well as dissemination and implementation research should take business size into account to ensure that TWH is both effective and sustainable in meeting the needs of employees.

Critical realism and constructivism: merging research paradigms for a deeper qualitative study

Purpose

Traditional approaches in qualitative research have adopted one research paradigm linked to an established typology. This paper addresses the unconventional application of two research paradigms in one study. A critical realist approach was used to augment a constructivist analysis of data in a research project seeking to explore the meaning that managers in small to medium enterprises (SMEs) attach to hazard identification, the construction of a hazard profile reflective of the business and its use in assisting to manage hazards within the SME's safety management system framework. Critical realism offered a complementary but essential framework to explore causal mechanisms that led to a deeper understanding of the findings by searching for the processes and causality that lay beneath the social and organizational phenomena observed.

Design/methodology/approach

This paper compares the two research paradigms in order to seek junctures and apply them to a research project. Analytical tools applied to each research paradigm within the project are presented, followed by a new multiparadigm conceptual model that integrates critical realism and constructivism, providing an original contribution of knowledge to this field of qualitative research.

Findings

The adoption of a multiparadigm model enabled not only the interpretation of social phenomena but also the determination of its causality, enabling a more insightful answering of the research question and leading to a deeper insight into the phenomenology that was studied. This research approach widens the boundaries of qualitative inquiry within organizational research by promoting strategies that challenge more traditionally anchored research typologies, and consequently contributes to better research outcomes.

Research limitations/implications

This study was conducted across four organizations. Similar research is encouraged across a greater number of case studies to validate the process of using a constructivist and critical realist paradigm to gain a more insightful understanding of events and their causality.

Practical implications

The comparison of two research paradigms and consequent provision of a conceptual model (Figure 3) provides potential for the development of further multiparadigm models for research projects within the field of organizational management.

Social implications

This paper has the potential to promote engagement and collaboration between research scholars seeking to explore the use of multiple research paradigms.

Originality/value

Such an approach has not previously been widely discussed or adopted to examine qualitative data, and advances theory in qualitative research. The application of two research paradigms using such an approach can be applied to businesses in a number of different contexts to gain a more insightful understanding of research participant perspectives, observable events arising from those perspectives and their associated causality.

Results of caring and reaching for health (CARE): a cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff

BACKGROUND

Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers' physical activity (primary outcome), other health behaviors, and their workplace health environment.

METHODS

Eligible child care centers, defined as being in operation for at least 2 years and employing at least four staff, were enrolled into CARE's cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers' physical activity was assessed with accelerometers, worn for 7 days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes.

RESULTS

Participants included 553 child care workers representing 56 centers (HL = 250 staff/28 centers, HF = 303 staff/28 centers). At 6 months, moderate-to-vigorous physical activity declined slightly in both arms (- 1.3 min/day, 95% CI: - 3.0, 0.3 in HL; - 1.9 min/day, 95% CI: - 3.3, - 0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons.

CONCLUSIONS

While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers.

TRIAL REGISTRATION

Care2BWell: Worksite Wellness for Child Care (NCT02381938).

Models for Developing Community Organizations to Reinforce Health Management in Small Businesses

The incidence of occupational diseases in small businesses is higher than in big ones, and this fact puts the former in need of a healthcare management model they can administer. This study established a model based on community organizational development theory to reinforce worker empowerment for healthcare in small businesses, focusing on health centers for workers (HCFW). The researchers surveyed 408 workers at 39 small businesses in the B region of South Korea, according to the characteristics of business sites, general characteristics of workers, and elements of community organizational development theory, and analyzed their results with a structural equation. The research period was September, 2015. Five concepts were examined: empowerment in healthcare, community capacity, participation and relevance, critical consciousness, and issue selection. The results revealed that greater community capacity led to greater participation and relevance (γ = 0.39) and empowerment in healthcare (γ = 0.25), while greater participation and relevance led to greater empowerment in healthcare (γ = 0.76). In addition, greater critical consciousness led to greater participation and relevance (γ = 0.12). Finally, greater community capacity led to greater issues selection (γ = 0.56), which in turn led to greater participation and relevance (γ = 0.25). The study makes proposals for directions of health centers for workers and community networks. Confirmation of this model for worker empowerment suggests several directions to HCFW in relation to workers and community networks.

Total Worker Health Leadership and Business Strategies Are Related to Safety and Health Climates in Small Business

The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates.

Small Business Employees' Perceptions of Leadership Are Associated With Safety and Health Climates and Their Own Behaviors

OBJECTIVE

Leadership is an important factor in creating a safe and healthy work environment. Little is known about its influence in small organizations. This study assessed the relationship between leadership, climate, and employee behavior in organizations with less than 500 employees.

METHODS

We examined organizational factors and worker perceptions of leadership and safety/health behaviors in an analysis of 1271 employees in 53 Colorado small organizations. Cross-sectional relationships were assessed using multivariable linear regression models.

RESULTS

Perceived leadership commitment to safety was associated with safety climate (β = 0.67) and safety behaviors among employees (β = 0.45). Perceived leadership commitment to worksite wellness was associated with health climate (β = 0.66) and health behaviors (β = 0.42).

CONCLUSIONS

Leadership plays an important role in creating a positive work environment around safety and health.

Components of an Occupational Safety and Health Communication Research Strategy for Small- and Medium-Sized Enterprises

The majority of the global labor force works in firms with fewer than 50 employees; firms with fewer than 250 employees make up 99% of workplaces. Even so, the lack of extensive or comprehensive research has failed to focus on occupational safety and health communication to these small- and medium-sized enterprises (SMEs). Given that the magnitude of all occupational safety and health (OSH) morbidity, mortality, and injury disproportionately occurs in businesses with fewer than 250 employees, efforts to communicate with employers to engage in preventative occupational safety and health efforts merit attention. This article provides an overview of important components that should be considered in developing an occupational safety and health (OSH) communication research strategy targeting SMEs. Such a strategy should raise awareness about the diversity and complexity of SMEs and the challenges of targeting OSH communication toward this diverse group. Companies of differing sizes (e.g. 5, 50, 500 employees) likely require differing communication approaches. Communication strategies will benefit from deconstructing the term 'small business' into smaller, more homogenous categories that might require approaches. Theory-based research assessing barriers, message content, channels, reach, reception, motivation, and intention to act serve as the foundation for developing a comprehensive research framework. Attention to this type of research by investigators is warranted and should be encouraged and supported. There would also be value in developing national and international strategies for research on communication with small businesses.

Total Worker Health: A Small Business Leader Perspective

Total Worker Health® (TWH) frameworks call for attention to organizational leadership in the implementation and effectiveness of TWH approaches. It is especially important to study this within in the small business environment where employees face significant health, safety, and well-being concerns and employers face barriers to addressing these concerns. The purpose of this study was to gain a better understanding of how small business leaders perceive employee health, safety, and well-being in the context of their own actions. We conducted semi-structured interviews with 18 small business senior leaders and used a qualitative coding approach to analyze the transcripts to determine the frequency with which leaders discussed each code. When we asked leaders about their leadership practices for health, safety, and well-being, leaders reflected upon their business (65%), themselves (28%), and their employees (7%). Leaders rarely discussed the ways in which they integrate health, safety, and well-being. The interviews demonstrate that small business leaders care about the health of their employees, but because of the perceived value to their business, not to employees or themselves. Thus, they may lack the knowledge and skills to be successful TWH leaders. The present study supports a need for continued small business TWH leadership research.

Conference Summary Understanding Small Enterprises Conference, 25-27 October 2017

Objectives

The specific objectives of the 2017 Understanding Small Enterprises Conference were to: (i) identify successful strategies for overcoming occupational safety and health (OS&H) barriers in small and medium-sized enterprises (SMEs); (ii) disseminate best practices to research and business communities; (iii) build collaborations between different stakeholders including researchers, insurers, small enterprises, government agencies; and (iv) better inform OS&H research relevant to SMEs.

Methods

A two and a half day international conference was organized, building upon three previously successful iterations. This conference brought together researchers, practitioners, and other stakeholders from 16 countries to share best practices and emerging strategies for improving OS&H in SMEs.

Findings

Cross-cutting themes that emerged at the conference centered around: 1) stakeholder and intermediary involvement; 2) what occupational health and safety looks like across different industries; 3) intervention programs (tools and resources); 4) precarious and vulnerable work and the informal sector; and 5) Total Worker Health® in SMEs.

Conclusion

A number of innovative initiatives were shared at the conference. Researchers must build collaborations involving a variety of stakeholder groups to ensure that OS&H solutions are successful in SMEs. Future OS&H research should continue to build upon the successful work of the 2017 Understanding Small Enterprises Conference.