Total Worker Health® Research Methodology Workshop
March 7-8, 2017 University of Iowa

Purpose: The purpose of the Total Worker Health® (TWH) Research Methodology Workshop is to review current methodological approaches and limitations to TWH-related research and explore methods that have the most promise to advance the scientific evidence base. This workshop will bring together leading research investigators in the field of TWH and other pertinent areas who will collaborate to develop a set of recommendations (promising research methods) to guide the design of TWH studies.

Rationale: This workshop will respond to recommendations put forth by the Independent Panel of the Pathways to Prevention (P2P) workshop, Total Worker Health: What’s Work Got to Do With It? (National Institutes of Health 2015) https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/total-worker-health as well as address several goals in the National Total Worker Health Agenda: http://www.cdc.gov/niosh/docs/2016-114/pdfs/nationaltwhagenda2016-1144-14-16.pdf.

External Planning Panel

NIOSH Planning Panel

Location: The workshop will be held March 7-8, 2017 at the University of Iowa College of Public Health.

Duration: The workshop will begin at 8 am, Tuesday, March 7 (CDT, -5 UCT) and conclude at 3 pm (CDT, -5 UCT), Wednesday, March 8.  A 3 pm conclusion will allow ample time for attendees to catch a 5 pm flight from the Eastern Iowa Airport (CID), a 30 minute drive from the College of Public Health (Travel Information).

Deliverable: A manuscript(s) presenting guidance and recommendations for preferred research methods for TWH studies will be submitted to a peer-reviewed journal (e.g., JOEM special issue, Health Affairs, Annals of Internal Medicine, JOEH).

Background: The goal of the P2P workshop was to “ascertain the scientific evidence related to integrating worksite health promotion with occupational safety and health protection, including factors that influence the effectiveness of an integrated approach (what works and for whom), and develop research recommendations to better understand the effectiveness of integrated interventions.”

Main Findings reported in the Executive Summary:

  • The literature on integrated interventions is sparse, and their effectiveness is unclear.
    • The content, approach to implementation and outcomes are unclear.
  • Nine out of the 15 studies that met methodological inclusion criteria addressed health and safety outcomes (workplace safety, quality of life, physical and psychological well-being, self-rated health, health symptoms, stress) and eleven addressed intermediate health outcomes assumed to have long-term health effects (tobacco cessation, decreased use of alcohol and other drugs, BMI, weight, blood pressure, cholesterol level, physical activity, health eating behaviors, hazardous work exposures, near-miss hazard events).
    • Overall, the strength of evidence about all health and intermediate outcomes was low (reviewers had low confidence that the evidence reflected the true effect).
    • No studies addressed health care utilization or potential harms.
  • The information on intervention development, implementation and outcomes was limited among studies showing benefits.
    • The few studies on scalability highlighted the common feature that workers participated in the planning, design, development and implementation of the intervention.
  • No studies included a formal analysis of possible variation in intervention effectiveness according to the individual, worksite, organizational or community factors.
  • Studies conducted before 2011 were retrofitted to meet the NIOSH definition of TWH.

The panel concluded, “The current state of the science offers insufficient evidence to determine the overall harms or benefits of integrated interventions. In the absence of this evidence it is impossible to describe the characteristics of effective integrated interventions or contextual factors that influence effectiveness.” In spite of this limited evidence, the panel suggested a need for additional research and made specific recommendations, including the need for a core set of measures and outcomes that are incorporated into all integrated studies. These measures should reflect the priorities of the stakeholders and are necessary in order to systematically evaluate the body of evidence.

P2P recommendations being addressed by the workshop:

  • #3: Develop a core set of measures and outcomes that are incorporated into all integrated intervention studies.
  • #6: Expand research and evaluation designs options to include range of rigorous methodologies.

Pre-Workshop Preparation: In order to guide the discussion during the workshop please select and review one or two case studies (including published findings or works in progress) that describe and evaluate a TWH intervention or an occupational safety and health (OSH) or worksite health promotion/well-being (WHP) intervention that you think would inform TWH research. These do not need to have had a positive outcome. These could include studies in large organizations or small and may address a range of outcomes including (health, safety, medical costs, productivity, safety incidents, etc.). The form (here) should be used to guide your review of each case study. Please email your reviews to diane-rohlman@uiowa.edu by March 1, 2017. Case study reviews will be aggregated and a subset of reviews will be used for the discussion of research and evaluation design methodology during the workshop. Outcome measures from the case studies will be compiled and used to guide the discussion of a core set of measures.

The complete 2015 Pathways to Prevention Workshop report can be found at Pathways to Prevention: Total Worker Health®—What’s Work Got to Do With It?

NIOSH’s response to the report can be found at NIOSH Response to the NIH Pathways to Prevention Workshop Recommendations“.