Proposed Framework for Developing and Evaluating Total Worker Health® Education and Training Programs

A constantly changing work environment and a shortage of occupational safety and health (OSH) professionals may bring new challenges to the field. Some OSH professionals will be asked to perform roles they are not formally trained in nor have the expertise needed to fully address evolving hazards and implement necessary interventions.[1] [2] [3] To be successful these professionals will need to have an expanded set of knowledge, skills, and abilities (KSAs) that shifts expertise from a specific discipline to expertise that is cross-disciplinary, multifaceted and integrated. One way to address this challenge is through the holistic Total Worker Health^®  approach. A recently published article discusses a framework to develop and evaluate Total Worker Health (TWH) education and training programs with the changing needs of current and future OSH professionals in mind.

Total Worker Health

In 2003, NIOSH launched the first federal research-based, workforce initiative to integrate OSH with the policies, programs and practices that protect and advance the overall well-being of workers in a comprehensive way, both on and off the job.[4]  NIOSH defines TWH as policies, programs, and practices that integrate protection from work-related safety and health hazards with the promotion of injury and illness prevention efforts to advance worker well-being. Over the past two decades, the TWH approach emerged as an increasingly applied discipline that offers transdisciplinary, holistic perspectives and expanded approaches to occupational safety, health, and well-being issues associated with work and non-work environments.[5]

The field of TWH has grown to include the development of academic, nonprofit and government programs focused on TWH education and training; TWH-related job descriptions and positions;[6] and the development of a TWH professional society, the Society for Total Worker Health.[7] Some academic institutions now offer training and certificate programs or degrees in TWH;[8] several TWH Affiliates are adopting the approach in their educational programs;[9] and examples of the application of TWH concepts and findings are illustrated in numerous research, practical applications, health hazard evaluations, tools, and publications.[10]

From 2014 to 2020, six broad core competencies for educating and training professionals entering the field of TWH were proposed, evolved, shared with key audiences, and finally presented in a 2020 Journal of Occupational and Environmental Medicine (JOEM) article.[11] The new 2024 JOEM article featured here provides examples of specific KSAs for each TWH core competency that would enable OSH and allied professionals to successfully perform a specific job or task (Appendix A).

KSAs by Core Competency

(further detail available in the article)

1. Subject Matter Expertise

• Technical and public health knowledge: occupational safety and health, health promotion, organization of work, business, and health service
• Risk/Needs assessment, analysis and decision making
• Surveillance and research methods and analysis
• Reading, interpretation, and practical application of research studies
• Applied public health practices, approaches, and interventions

2. Promotion and Engagement

• Ethics and worker representation
• Diversity and cultural awareness
• Social and community determinants of health
• Training and education skills

3. Program Planning and Development, Implementation and Evaluation

• Public health programs and resources planning
• Implement effective processes, practices/policy guidelines
• Evaluation plan, methods, and resources

4. Communication and Marketing

• Health, safety, and well-being literacy and behaviors
• Health communication strategies and teamwork
• Evaluation of communication and marketing efforts

5. Leadership and Management

• Health systems and healthcare navigation
• Strategic planning and leadership
• Laws, standards, policy, and regulations
• Multidisciplinary/cross-functional teams

6. Partnership Building and Coordination

• Participatory, collaborative, transdisciplinary, cross-functional teams, and partnership
• Resource identification, work-place design, and organizational culture
• Transdisciplinary, interdisciplinary, and integrated interventions and programs
• Solution design combining worksite safety, health promotion, and worksite wellness concepts
• Measurement and evaluation tools

The article also describes a TWH Education and Training Logic Model and proposes the combined use of two models as a framework for evaluating TWH education and training programs: the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) and Kirkpatrick models. The logic model seeks to provide examples of measurable inputs, activities, outputs, outcomes, and future impact for developing and evaluating TWH education and training programs. The ADDIE and Kirkpatrick models may aid institutions in creating a standardized process for TWH education and training planning and evaluation efforts. To briefly describe both approaches, the ADDIE model is comprehensive and provides a framework for developing and implementing education and training programs, and an evaluation component. The Kirkpatrick Model focuses on evaluating education and training programs with an emphasis on effectiveness and outcomes. Integrating these proposed components into public health practice can guide and enhance TWH workforce development planning, education, and training. These tools can also be used to develop a TWH curriculum, evaluate efforts, and prepare for future accreditation.

The proposed set of KSAs and framework for developing and evaluating TWH education or training programs may inform future pilot testing by academic and other training programs and help to standardize practices across the discipline.

If you are engaged in TWH education efforts or seek to gain new skills within your organization related to TWH, we welcome your inputs and recommendations in the comment section below.

Tat’Yana A. Kenigsberg, MPH, is an Epidemiologist in the National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion at CDC.

Adele M. Childress, PhD; (retired) formerly worked in the NIOSH Office for Total Worker Health at CDC.

Donjanea Fletcher Williams, EdD; is a Health Scientist National Center for Injury Prevention and Control at CDC

Maria Lioce, MD; is a Health Scientist in the NIOSH Office of Extramural Programs at CDC.

L. Casey Chosewood, MD, MPH, is Director of the NIOSH Office for Total Worker Health at CDC.

References

[1] World Economic Forum. Global Challenge Insight Report – The future of jobs: Employment, skills and workforce strategy for the fourth industrial revolution. 2016. Available at: https://www3.weforum.org/docs/WEF_Future_of_Jobs.pdf. Accessed April 17, 2023.

[2] Rainie L, Anderson J. The Future of Jobs and Jobs Training. May 3, 2017. Available at: http://www.pewinternet.org/2017/05/03/the-future-of-jobs-and-jobs-training/. Accessed April 17, 2023.

[3] Rosenstock L, Helsing K, Rimer BK. Public Health Education in the United States: Then and Now. Public Health Reviews. 2011; 33:39-65

[4] NIOSH Total Worker Health. History of Total Worker Health. August 10, 2020. Available at: https://www.cdc.gov/niosh/TWH/history.html. Accessed April 17, 2023.

[5] Tamers SL, Chosewood LC, Childress A, Hudson H, Nigam J, Chang CC. Total Worker Health® 2014-2018: The Novel Approach to Worker Safety, Health, and Well-Being Evolves. Int J Environ Res Public Health. 2019 Jan 24;16(3):321. doi: 10.3390/ijerph16030321. PMID: 30682773; PMCID: PMC6388217.

[6]  SHRM. Available at: https://shrm.org/. Accessed April 17, 2023.

[7] Society for TWH. Available at: https://twhsociety.org/. Accessed April 17, 2023.

[8] NIOSH. Graduate Training, Certification Programs & Degree Programs. August 4, 2021. Available at: https://www.cdc.gov/niosh/twh/certificateprograms.html. Accessed April 17, 2023.

[9] NIOSH. NIOSH Total Worker Health® Affiliate Program. March 15, 2023. Available at: https://www.cdc.gov/niosh/twh/affiliate.html. Accessed April 17, 2023.

[10] NIOSH. Publications and Reports. December 8, 2022. Available at: https://www.cdc.gov/niosh/twh/publications.html. Accessed April 17, 2023.

[11] Newman LS, Scott JG, Childress A, Linnan L, Newhall WJ, McLellan DL, et al. Education and training to build capacity in Total Worker Health®: Proposed competencies for an emerging field. J Occ Med. 2020; 62:8, e384