Occupational Health Science

, Volume 2, Issue 1, pp 25–41 | Cite as

Small Business Total Worker Health: a Conceptual and Methodological Approach to Facilitating Organizational Change

  • Natalie V. Schwatka
  • Liliana Tenney
  • Miranda J. Dally
  • Joshua Scott
  • Carol E. Brown
  • David Weitzenkamp
  • Erin Shore
  • Lee S. Newman
Original Research Article


Nearly half of Americans are employed by small businesses, and future projections suggest that the number of those employed by small businesses will rise. Despite this, there is relatively little small business intervention research on the integration of health protection and health promotion, known as Total Worker Health® (TWH). We first discuss the importance of studying small businesses in TWH research and practice. Second, we describe an example of a small business TWH intervention, Health Links™ plus TWH owner/senior manager leadership training, that we are evaluating via the Small+Safe+Well (SSWell) study. Key features of the intervention and the SSWell study include attention to multi-level influences on worker health, safety and well-being; organizational change; and dissemination and implementation science strategies via the RE-AIM model. We offer several considerations for future small business TWH research and practice both in terms of the small business context as well as intervention development and evaluation. Our goal is to provide TWH researchers and practitioners with a framework and an example of how to approach small business TWH interventions. Ultimately, through the SSWell study, we aim to provide small businesses with strong evidence to support the use of TWH strategies that are practical, effective and sustainable.


Occupational health intervention Organizational climate Health promotion Worker safety Occupational health and safety Dissemination and implementation science 



This publication was supported by the Cooperative Agreement number, 1 U19 OH 011227, funded by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Compliance with Ethical Standards

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Natalie V. Schwatka
    • 1
  • Liliana Tenney
    • 1
  • Miranda J. Dally
    • 1
  • Joshua Scott
    • 1
  • Carol E. Brown
    • 1
  • David Weitzenkamp
    • 2
  • Erin Shore
    • 1
  • Lee S. Newman
    • 1
    • 3
  1. 1.Center for Health, Work & Environment and Department of Environmental & Occupational Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Center for Health, Work & Environment and Department of Biostatistics and Informatics, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraUSA
  3. 3.Department of Epidemiology, Colorado School of Public Health, Department of Medicine, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraUSA

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