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Many employers invest in Total Worker Health® (TWH) programs but struggle to engage employees in them—even when they offer incentives for participation. Findings from our recent study, in collaboration with Clemson University, published in the Journal of Environmental and Occupational Health, show that employers looking to increase employee engagement should first focus on how their organization demonstrates its commitment to TWH through leadership, values, and practices. 

Using data from the Small+Safe+Well (SSWell) Study, our team looked at 36 small businesses representing 1,052 employees implementing different levels of TWH. The study aimed to understand employee perspectives on how much their organization valued and was committed to their safety, health, and well-being. Dr. Natalie Schwatka, the study’s lead author, says, “We know these perceptions are related to employee engagement, but what we did not know was how they were related. That’s where motivation comes into play.” 

If you are an employer, you might be asking yourself, “My business has a TWH program. Isn’t that enough of a demonstration of commitment?” The answer is yes…and no. Employees make judgment calls about their organization’s commitment by observing whether TWH programs are supported by management; given adequate resources; based on employee input; and continually improved. These observations make up what are called “safety and health climates.” These climates are a snapshot of a business’s health and safety culture at one point in time. 

We find that motivation is the key link between safety and health climates and employee participation in TWH programs. Take a look at the process illustrated below. As you think about what motivates you personally, consider how your organization shows that it cares about health and safety and how that impacts you.



Interestingly, we find that three kinds of motivation are at play here:  

1. External motivation – “I do it because I have to”
2. Identified motivation – “I do it because I know it’s good for me”
3. Intrinsic motivation – “I do it because it’s interesting to me” 

When your organization decides to improve safety and health climates, it is influencing each kind of motivation. Importantly, it is influencing intrinsic motivation, which is thought to be the most powerful kind of motivation. It represents an internally driven reason that causes an employee to engage in TWH programs. 

What does this mean for your business or your TWH practice? Based on our study’s findings, we recommend the following steps:   

1. Conduct an employee survey. Assess your company’s safety and health climates through an employee survey to learn whether they perceive a commitment to safety and health. *Businesses enrolled in Health Links™ Premium Plan can access our validated employee health and safety culture survey.   

2. Explore creative ways to increase engagement. Think beyond the use of incentives as they do not have a lasting impact on behavior and can actually decrease engagement when removed. Make sure management actively participate in your programs. Get feedback from diverse groups of employees. Consider not only what they need but what they want. When employees have a say in the programs, they will feel a greater sense of ownership of them.  

Written by Natalie Schwatka, PhD, Assistant Professor at the Colorado School of Public Health and leader researcher at the Center for Health, Work & Environment.