Small + Safe + Well: Lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business (Schwatka et al., 2022)

The SSWell study used a randomized design that assigned 97 businesses to either the treatment or the waitlist control condition. For these 97 businesses, 2,785 employees completed a baseline employee survey. This sample included all small businesses in Colorado that already participated in Health Links.  Two thirds of the businesses (66 / 97) were assigned to the treatment condition, which consisted of Health Links plus the TWH leadership program. The remaining one third of businesses (31/97) were assigned to the waitlist control, participating in just Health Links in year one of their participation and Health Links plus the TWH leadership program in year two. 

The study included two analytic samples: a sample of businesses and a sample of employees. To be included in the final analytic sample of businesses, businesses needed to participate in the baseline, year one, and year two assessments, and needed to have at least one employee complete their year one and year two employee survey. Based on these criteria, the final analysis sample included 36 out of the initial 97 businesses. To be included in the analytic sample of employees, employees needed to complete the first- and second-year employee surveys while employed at the same business. Based on these criteria, the final sample included 250 out of the initial 2,785 employees. For the analysis, the treatment group included 13 businesses (and their employees) that received the intervention in year one (including one that was part of the original randomly selected control group). The control group included 23 businesses that were initially waitlisted and then received the intervention in year two (including nine that were originally randomly selected to receive the intervention in year one). On average, the final sample of businesses had around 110 employees and an average baseline TWH score of 46. The final sample of employees were on average 42 years old, majority white (87%), and had been at their current job for five years.   

Data were collected via an online business assessment at baseline and after one year, and via online employee surveys at baseline, one year, and two year follow ups.  The business assessment instrument, the Healthy Workplace Assessment, measures TWH policies across six benchmarks and gives organizations a score between 0 and 97. The questions in the employee survey were developed by the study authors and consisted of questions surrounding a) safety leadership and b) health leadership.  The employee survey included five secondary outcomes: 1) safety climate 2) health climate, 3) safety behavior, 4) health behavior, and 5) wellbeing. Employee surveys were distributed through a primary contact at each business.