**2. Materials and Methods**

This study, "Promoting Physical and Mental Health of Caregivers through Transdisciplinary Intervention," was carried out through the Center for the Promotion of Health in the New England Workplace (CPH-NEW), a Total Worker Health®Center for Excellence of the National Institute of Occupational Safety and Health. At the time when this study began, "Total Worker Health" was defined by National Institute of Occupational Safety and Health as "a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance worker health and well-being." The study was approved by the University of Massachusetts Lowell Institutional Review Board (protocol # 06-1403).

#### *2.1. Setting and Sample*

The project occurred within the context of a multi-year partnership with a large, for-profit long-term care company, which operated over 200 nursing facilities in 12 states within the eastern United States. In 2003–2006, the company had initiated a "safe resident handling" program in all of its skilled nursing facilities. Some sites also had HP activities as of 2006, depending on local initiative; a corporate-sponsored wellness program began in 2011.

Within that context, this project component sought to improve the health and safety of nursing home workers by creating participatory teams of non-supervisory workers to address integrated workplace HP and OSH concerns within their own worksites [32]. The teams were started in three skilled nursing facilities in 2008 with the assistance of university researchers. The participatory program was compared with a corporate-initiated wellness program in three other facilities within the same company and geographical region. None of the six facilities had union representation of their workers. We sought to involve all employees, in various job titles and at different organizational levels. Evaluation of program fidelity, impact, and sustainability was based on data from all employees who answered the surveys. Figure 1 provides an outline of the study process and evaluation activities.
