The integration of occupational safety and health protection with workplace efforts to promote worker health and well-being is a well-established concept, progressively formalized through the CDC-NIOSH Total Worker Health® (TWH) program. This scoping review aimed to map and describe the implementation and evaluation methods used in TWH approaches across occupational settings. Scopus, Web of Science, and PubMed were searched using predefined search strings based on “Total Worker Health” and “Total Worker Health approach”. The original search was conducted in January 2023 and was updated in July 2026 using the same databases and search strategies. Eligible studies were peer-reviewed articles written in English that addressed the application, implementation, assessment, or evaluation of TWH approaches in occupational settings. Sixty studies identified in the original search were fully charted and summarized using descriptive frequency tables. The updated search retained eight additional recent studies, which were reported separately and additionally charted across a focused set of core methodological domains. Across the original corpus and the updated studies, substantial heterogeneity was observed in occupational sectors, study aims, intervention components, assessment methods, analytical approaches, and reporting formats. The main tools used to evaluate TWH aspects and interventions were surveys, questionnaires, interviews, meetings, focus groups, training activities, and mixed-methods evaluations. No single standardized model for implementing or evaluating TWH approaches emerged from the mapped literature; however, more consistent reporting of implementation processes, assessment tools, study populations, and analytical approaches may improve comparability, reproducibility, and transferability across occupational settings.
A Scoping Review on Implementation and Evaluation Methods of Total Worker Health® Approaches
Zellino, C.
;Spinazzè, A.
;Borghi, F.;Boscolo, S.;Carminati, A.;Pagani, E.;Cattaneo, A.Penultimo
;Cavallo, D.Ultimo
2026-01-01
Abstract
The integration of occupational safety and health protection with workplace efforts to promote worker health and well-being is a well-established concept, progressively formalized through the CDC-NIOSH Total Worker Health® (TWH) program. This scoping review aimed to map and describe the implementation and evaluation methods used in TWH approaches across occupational settings. Scopus, Web of Science, and PubMed were searched using predefined search strings based on “Total Worker Health” and “Total Worker Health approach”. The original search was conducted in January 2023 and was updated in July 2026 using the same databases and search strategies. Eligible studies were peer-reviewed articles written in English that addressed the application, implementation, assessment, or evaluation of TWH approaches in occupational settings. Sixty studies identified in the original search were fully charted and summarized using descriptive frequency tables. The updated search retained eight additional recent studies, which were reported separately and additionally charted across a focused set of core methodological domains. Across the original corpus and the updated studies, substantial heterogeneity was observed in occupational sectors, study aims, intervention components, assessment methods, analytical approaches, and reporting formats. The main tools used to evaluate TWH aspects and interventions were surveys, questionnaires, interviews, meetings, focus groups, training activities, and mixed-methods evaluations. No single standardized model for implementing or evaluating TWH approaches emerged from the mapped literature; however, more consistent reporting of implementation processes, assessment tools, study populations, and analytical approaches may improve comparability, reproducibility, and transferability across occupational settings.
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