Total Worker Health® (TWH)

Project Summary Title and Description

Total Worker Health® (TWH)
The purpose of this review is to provide an evidence report that the National Institutes of Health, Office of Disease Prevention, Pathways to Prevention Workshop Program can use to inform a workshop focused on Total Worker Health® (TWH). TWH is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. This review describes the body of evidence evaluating TWH interventions, assesses the benefits and harms of interventions, and highlights research gaps and future research needs.
Authors of Report
Methodology description
Data Sources: We searched MEDLINE®, the Cochrane Library, the Cochrane Central Trials Registry, and PsycINFO from January 1, 1990, to September 21, 2015. Eligible studies included randomized controlled trials (RCTs), nonrandomized trials, prospective cohort studies with a concurrent control group; single-group pre-post studies were also eligible for Key Questions (KQs) describing interventions or identifying contextual factors, research gaps, and future research needs. Review Methods: Pairs of reviewers independently selected, extracted data from, and rated the risk of bias of relevant studies; they graded the strength of evidence (SOE) using established criteria. We synthesized all evidence qualitatively.
All of the report's study data were entered retrospectively to SRDR, via direct file uploading as Excel spreadsheets (one each for Key Questions 1 and 2). For Key Question 1, the uploaded data include the following: Study Design, Arms, Integrated Intervention Details, Baseline Data, Outcome Descriptions, Contextual Factors, and Abbreviations used throughout the data extraction form. For Key Question 2, the uploaded data include the same tabs as the Key Question 1 extraction form, and additionally the following: Continuous Outcome Results Data (only for outcomes eligible for Key Question 2), Binary Outcome Results Data (only for outcomes eligible for Key Question 2), Adverse Events, Risk of Bias ratings, and Abbreviations used throughout the data extraction form. Publication of the final report and PMID are pending. Currently, the Prepublication Draft Report is available online at the AHRQ Effective Health Care Program's website:
Funding Source
This report is based on research conducted by the RTI International–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00008-I_HHSA 2903

Key Questions

1. What populations, work settings, intervention types, and outcomes have been included in studies assessing integrated interventions?
2. What is the effectiveness of integrated interventions for improving the following outcomes, and what are the potential harms? a. Health and safety outcomes (e.g., cardiovascular events or incidence of work-related injuries); b. Intermediate outcomes (e.g., change in blood pressure, tobacco use, or hazardous exposures); c. Utilization outcomes and occupational injury and illness surveillance outcomes (e.g., hospitalizations or measures of workers’ compensation claims); d. Harms (e.g., discrimination or victim blaming)
3. What are the characteristics of effective integrated interventions?
4. What contextual factors have been identified as potential modifiers of effectiveness in studies of integrated interventions?
5. What evidence gaps exist in the body of literature assessing the effectiveness of integrated interventions in terms of the following: populations, work settings, intervention types, outcomes, study designs, research methods, and contextual factors that may modify intervention effectiveness?
6. What are the future research needs?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

MassBuilt: effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers.2009
A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States).2003
Effects of a Dutch work-site wellness-health program: the Brabantia Project.1998
Tai Chi for older nurses: a workplace wellness pilot study.2012
Intervening to improve health indicators among Australian farm families.2009
Integrated health programme: a workplace randomized controlled trial.2009
Tools for health: the efficacy of a tailored intervention targeted for construction laborers.2007
Promoting behavior change among working-class, multiethnic workers: results of the healthy directions--small business study.2005
Health behavior change among office workers: an exploratory study to prevent repetitive strain injuries.2004
Reducing overall health care costs for a city municipality: a real life community based learning model.2004
An intervention to promote appropriate management of allergies in a heavy manufacturing workforce: evaluating health and productivity outcomes.2003
The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study.1998
Intervention in shift scheduling and changes in biomarkers of heart disease in hospital wards.2001
Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme.2002
A new health promotion model for lone workers: results of the Safety & Health Involvement For Truckers (SHIFT) pilot study.2009
Results of a pilot intervention to improve health and safety for health care workers.2013
The COMPASS pilot study: a total worker Health™ intervention for home care workers.2015
Decreased rate of back injuries through a wellness program for offshore petroleum employees.1999
Results of a union-based smoking cessation intervention for apprentice iron workers (United States).2006
The utility of health education among lead workers: the experience of one program.1993
Promoting employee health by integrating health protection, health promotion, and continuous improvement: a longitudinal quasi-experimental intervention study.2015
Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial.
Total Worker Health Intervention Increases Activity of Sedentary Workers.2016
Effects of a Workplace Intervention Targeting Psychosocial Risk Factors on Safety and Health Outcomes.

Downloadable Data Content

  • XLSX Project Data