The Total Worker Health^® Approach (TWH), developed by the National Institute for Occupational Safety and Health in 2011, champions an approach to worker health, safety, and well-being that goes beyond merely avoiding harms and implementing workplace wellness programs (1) (2). Instead, TWH is notable for its orientation towards robust, holistic strategies, encompassing policies, programs, and practices that integrate the elimination of safety hazards with health promotion activities for the advancement of worker well-being (3). Consequently, among professionals who most commonly adopt these approaches, such as those in occupational safety and health (OSH) professions, new ways of intervening and collaborating have been required to carry out these initiatives (4).

An expanded approach to worker health, safety, and well-being, and broadened collaboration is consistent with the vision of TWH. The program anticipates that its future professionals will help build bridges to many new and diverse partners to take advantage of what the disciplines of those partners can contribute to research and practice in TWH (5). Understanding the current orientation of each discipline is essential to documenting what needs to be done to develop TWH as the interdisciplinary field it was envisioned to be.

Therefore, we conducted a scoping review, focusing primarily on review and summative literature, to understand the landscape of knowledge available across a myriad of fields that can inform and improve the TWH perspective on worker health, safety, and well-being. We also aimed to determine how this knowledge can extend the reach of TWH partnerships beyond traditional collaborators. A scoping review is a type of knowledge synthesis that uses systematic and iterative approaches to identify and synthesize literature on a given topic (6). This current review aggregates literature from various disciplines that have published on topics of worker health, safety, or well-being but may not be formally recognized by the community of TWH researchers and practitioners. Furthermore, we analyze the literature as it relates to the 75 priority issues identified by the TWH program as important for advancing worker well-being (7). We observe the issues that are or can be addressed by a wide range of disciplines and identify gaps in areas that seem to have been addressed only lightly. We also identify priority issues that seem to have minimal input from various disciplines’ literature. As a result of this review, we aim to broaden the scope of available knowledge that can enhance worker well-being within TWH practice by targeting research efforts incorporating a range of relevant disciplines in the short term, and in the longer term, prompting the design of effective interventions using a broadened research agenda for evidence-based practice.

A total of 3,751 references were screened for inclusion, and 384 were retained after meeting inclusion criteria for the scoping review. Of the 384 references, 224 were identified from the librarian’s search of various electronic databases and 160 were identified from other methods, such as from targeted searches and hand searches conducted by research analysts (see PRISMA Supplemental Digital Content, http://links.lww.com/JOM/B900). The types of references represented in the compilation include books (n = 2), book and handbook chapters (n= 180), journal articles (n = 13), single studies (n = 38), review articles (n = 138), and working papers (n = 13). Included references were assigned to 9 disciplines and 26 subdisciplines (9) (see Supplementary Material 1, http://links.lww.com/JOM/B902).

Once disciplinary assignments were made, we tallied the citations of each, resulting in the following: occupational health (OH) had 105 citations, psychology had 103, business administration 61, architecture and design 47, public health 28, economics 18, sociology 15, public policy 6, and social work had 1 (see Figure 1). We also tallied the number of citations according to the 26 subdiscipline assignments; these values are reflected in Figure 2. For details on how subdisciplines were categorized under the disciplines, see Supplemental Digital Content 2 (http://links.lww.com/JOM/B901).

We then assessed the content of each discipline’s body of literature and charted them according to the 75 TWH priority issues (see Table 1). This comparison revealed a variation in the quantity of issues a discipline’s literature addressed. For example, out of 75 TWH issues, literatures from business administration (n = 68, 91%), psychology (n = 51, 68%), and occupational health (n = 47, 63%) addressed the highest number of issues whereas architecture and design (n = 20, 27%) and social work (n = 21, 28%) addressed the fewest. Each TWH issue was addressed by the literature of multiple disciplines, with the number of disciplines per issue ranging from as few as two to as many as eight (see Table 1 column, ‘Number of Disciplines Addressing Each Issue’). The TWH issue categories with the greatest number of disciplines covering its issues were found in the categories ‘Workforce Demographics’ and ‘Community Supports’, both having an average of six disciplines covering issues under these categories. The TWH issue categories with the least number of discipline coverage were ‘Work Arrangements’, ‘Organization of Work’ and ‘Healthy Leadership’, with averages at or below 3.8. Using this framework of TWH issue coverage, we compared each disciplines’ body of literature in relation to the issues covered by OH. We used OH as a reference point because of its predominant representation in the field of practice, demonstrated by courses taught in TWH principles, membership in NIOSH TWH Centers and Affiliates, and Society for Total Worker Health, among others. Disciplines with the most issues in common with OH included business administration, covering 41 of the same issues, psychology with 30 shared issues, and public health sharing 20. Sociology, social work, and economics had the fewest number of issues in common with OH, with 15, 12, and 9 shared issues, respectively.

To understand how proportional the volume of disciplines’ literature was relative to the amount of TWH issue coverage, the research team compared the number of each discipline’s citations in the scoping review database with the quantity of TWH priority issues a discipline’s literature addressed (Figure 1). As expected, the greater the number of citations in the database, the greater the number of TWH issues its literature addressed. For example, OH, psychology, and business administration each have the highest numbers of citations in the database, and each of their literature addresses the greatest number of TWH issues. In contrast, economics, sociology, and social work have lower numbers of citations in our scoping review and cover a narrower range of TWH issues. However, there were a few outlying disciplines where the number of TWH issues did not correspond as linearly. For example, while architecture and design had a higher amount of included literature, the discipline had a lower amount of TWH issues it addressed. Conversely, public policy had a lower amount of included literature yet covered a wide range of TWH issues. A similar comparison was done, grouping each citation by subdiscipline and ascertaining their relationships with TWH priority issues (Figure 2). Among the 26 subdisciplines, the size of its literature was mostly commensurate with the number of issues covered. Yet, there were also several subdisciplines that did not follow that trend. For example, corporate real estate, a subdiscipline with a relatively higher citation count did not cover TWH issues as broadly as other disciplines with similar numbers of citations. The subdisciplines industrial-organizational psychology, management, and human resource management each had lower citation counts, but its literature was relevant to a wider range of TWH issues.

This scoping review seeks to reveal the range of disciplines that can be included within the TWH paradigm, making practitioners within disciplinary frameworks aware of contributions from outside their disciplines and encouraging more collaboration to address complex, interconnected worker health, safety, and well-being issues. Literature generated from a broad search of workplace-related themes revealed there are many more disciplines that can contribute to TWH than are currently recognized by the community of practice. This suggests that a range of literature, beyond traditional OSH and occupational health psychology, could be drawn from to inform TWH practice. Disciplines where this need is especially important include architecture and design, economics, social work, sociology, public policy, and their subdisciplines.

Charting the literature by disciplines and the 75 TWH priority issues revealed there were no issues addressed by a single discipline alone; each issue was covered by at least two disciplines. Identifying opportunities for interdisciplinary alliances may be aided by recognizing disciplines that address common underlying structural problems within a TWH issue category, as expressed in Table 1. Disciplines with literature relevant to a TWH issue category could, in practice, address a component of the issue category in tandem. For example, within the TWH issue category “Compensation and Benefits”, business administration could work on pay and leave policies, while psychology ensures that workloads are equitable and workers are paid properly; public policy would assess compliance with federal and state pay and leave requirements, and social work would ensure workers who need support have access to the resources they need. Thus, interdisciplinary approaches to worker health, safety, and well-being could involve both sequential interventions and direct teaming, requiring continuous contribution on-demand. In addition, data from our analysis in Table 1 is suggestive of other starting points for convening an expanse of potential partners. TWH issue categories with many disciplines covering its issues, such as ‘Workforce Demographics’ and ‘Community Supports’, may point to areas of research and practice where new collaborations are ready to be formed. TWH issue categories where recent advances create an urgent need for multidisciplinary study, such as the ‘Technology’ category, may use this analysis to help extend the areas of inquiry so that issues such as artificial intelligence, robotics, and worker sensors and monitoring can be implemented to the benefit, rather than the detriment, of workers. Finally, the TWH priority areas that this review suggests are not well-covered by disciplines, such as ‘Work Arrangements’ and its component issues, may be indicative of an important need for further research attention.

Grouping the literature by disciplines and comparing their coverage of TWH issues with OH may suggest areas of natural allyship with OH and opportunities for new partnerships, since OH is a discipline that has a significant presence in the research and practice of TWH. The analyses have the potential to build bridges from OH to the formation of interdisciplinary teams focused on the same issues or issue categories. For example, literatures from the disciplines of business administration, psychology, and public health disciplines covered the greatest number of the same TWH issues as OH while sociology, social work, and economics covered the least. This suggests that contributions from the former disciplines may already be engaged in TWH interventions while the latter are not as highly integrated into the TWH paradigm. In addition, disciplines with fewer issues in common with OH, such as sociology, social work and economics, may be areas of greatest opportunity for net increase in TWH knowledge and practice. Example issues that are not covered by OH include “Transportation and Commuting Assistance”, which can be addressed by the field of sociology, “Employee Assistance and Substance Use Disorder Programs” by social work, and “Adequate Wages and Prevention of Wage Theft” by economics.

Expanding TWH approaches to include the knowledge and practice of more disciplines will require new roles, strategies to expertly coordinate contributions, and best practices in convening and managing diverse teams. To accelerate this needed learning and skill development, research funders can create new incentives for TWH researchers and practitioners to work in interdisciplinary teams, particularly in areas in which multiple disciplines can contribute and in those in which one discipline’s research may be isolated from the others. They can also help establish enhanced educational programming to explicitly communicate contributions to TWH across disciplines and accelerate skill development and practice in interdisciplinary teaming. Future studies could analyze evidence of interdisciplinary collaboration in the context of TWH interventions and evaluate the impacts on worker well-being when such collaboration is brought to bear on issues of common interest across disciplines.

We conducted a scoping review primarily focused on summative literature to understand the landscape of knowledge available to address worker health, safety, and well-being using the TWH paradigm and determine how this knowledge can extend the reach of its partnerships. Searching for literature relevant to TWH themes generated a catalog of citations from many disciplines and subdisciplines, including some that may not be formally recognized by the TWH community. We enumerated them here with the intention of broadening the scope of knowledge and communities of practice for the benefit and enhancement of worker well-being. As TWH continues to evolve, it is pertinent to understand the various disciplines and perspectives that form its foundation and identify new disciplines and perspectives that might enrich existing research and practice through collaboration with those with a longer history of involvement in the TWH movement.