Studying Total Worker Health: Research Methods and Measures

Experts Seek to Build the Research Base for TWH Approach

Total Worker Health (TWH) is a holistic approach to improving well-being in the American workforce. Recommendations from an expert workshop seeking to strengthen the evidence supporting TWH interventions are presented in a special article in the November 2018 Journal of Occupational and Environmental Medicine.
At the recent workshop, leading researchers met to discuss and outline principles important to building the TWH intervention research base. The lead author of the new report is Sara L. Tamers, PhD, MPH, of the US Centers for Disease Control and Prevention (CDC).
An initiative of the CDC's National Institute for Occupational Safety and Health (NIOSH), the Total Worker Health® approach seeks to integrate traditional occupational safety and health approaches with injury and illness prevention efforts to advance worker well-being. It prioritizes steps to address physical, organizational, and psychosocial factors that can affect worker well-being.

In the new report, workshop participants present recommendations in five areas:
  • Research designs for measuring the effectiveness of TWH programs—addressing the different methodologies, comparison groups, participatory approaches, and data reporting used in studying the impact of TWH interventions.
  • Selection bias, attrition, and unanticipated changes in the work environment—all part of the challenges of conducting research in "real-world" occupational settings.
  • Qualitative and mixed-methods approaches—techniques to make TWH research more actionable by answering "what, why, and how" questions about program effects.
  • Case study designs—despite some disadvantages, case studies can help to explain the complexities of implementing TWH programs in real-life situations.
  • Measures and Outcomes—recommendations toward developing a core set of relevant measures and outcomes for use in TWH studies.
"Although the TWH research base has grown, it is still an emerging field that can benefit from further examination of how current and new research methods can be used to solidify the evidence base and advance the field," Dr. Tamers and coauthors write. They hope their report will contribute to the development of "rigorous, valid methodologic and measurement approaches" to implementing and evaluating TWH approaches to promote worker health, safety, and productivity.
About the Author — Dr. Tamers may be contacted for interviews at
About ACOEM — ACOEM (, an international society of 4,500 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
About JOEM — The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Tamers SL, Goetzel R, Kelly KM, et al. Research methodologies for Total Worker Health®: proceedings from a workshop. J Occup Environ Med. 2018;60(11):968-78.