**3. Results**

In total, we interviewed 18 small business leaders from diverse industries based on the 10 Occupational Safety and Health Administration (OSHA) industry divisions. Industries were represented as follows: (A). Agriculture, Forestry, Fishing, 4; (B). Mining, 1; (C). Construction, 2; (D). Manufacturing, 1; (E). Transportation, Communications, Electric, Gas, Sanitary Services, 2; (G). Retail trade, 1; (H). Finance, Insurance, Real Estate, 1; and (I). Services, 6. About half of the leaders were female (n = 8.44%). Overall, the most common overarching theme discussed was their business, which represented 66% of total codes. Leaders discussed themselves and their employees much less frequently (see Figure 1). In the following sections, we describe each of these three overarching themes by highlighting the top five child codes within each theme. There were no qualitative differences in responses by the gender of the leader.

**Figure 1.** Percent of total codes mentioned by parent code.

#### *3.1. Business*

Small business leaders primarily talked about health, safety and well-being in the context of the business they owned or worked for. The most frequent child codes in a business context, in order from most to least frequently mentioned, included health and safety programs, organizational barriers to doing TWH, gathering employee feedback on health and safety, communicating the importance of health, and program evaluation (see Table 1).



Within this overarching theme, health and safety programs were overwhelmingly referenced the most with leaders mentioning a variety of program elements. The most common element was employee incentives. Most small business leaders either discussed the current use of incentives, or desire to implement incentives to increase employee participation in health and wellness activities.

"We tied it to an incentive program. So we pay out incentives three times a year ... we are one of the few remaining family-owned businesses that still pay full benefits for our 30 management team members and their entire family ... if someone can't participate in one of the platforms that we choose and they can't take and invest that time for themselves and go get a health assessment and be active, that maybe they don't get an incentive".

"For participating in a lot of these activities, just by signing up to do yoga or signing up to give blood, we do random drawings for gift cards ... After the event, we publicize how many people participated and who got the gift card".

Other common, but less frequently mentioned, grand-child codes under health and safety programs included safety and wellness meetings and/or committees as well as health insurance offerings, such as benefits and biometric screenings. Compared to larger businesses, it is not as common for small businesses to offer health insurance benefits to employees, however, a few of the leaders in our study did mention offering these benefits to their white-collar workforce (see quote above under incentives).

"We also conduct monthly safety meetings in the field and all of the employees in the field attend. We do keep attendance at it and we've begun to integrate a variety of things. [There is an] enhanced level awareness and knowledge base at those meetings".

"Through our benefits program ... once a year or twice a year we have the third party come in and do the health assessments where they do the blood pressure, cholesterol levels and readings and it's interesting because you can see the history through the years ... it's just interesting just to see how that changes throughout a period of time".

"We started to, about a year and a half ago, provide some of our more management level positions and some of our full-time employees with health insurance".

It is worth noting that leaders rarely discussed health, safety, and well-being practices from an integrated perspective. Leaders mentioned a variety of program elements from paid time off to job hazard analyses processes, but only one leader mentioned that they took steps to integrate these efforts. Another leader recognized the need for their business to integrate their efforts to protect and promote employee health. However, it was somewhat common for leaders to compare their safety and health promotion programs. About one-third of the leaders mentioned that one program was in better shape than the other.

"We definitely separate health and safety. When we think about safety, we think about workplace accidents only. We don't connect the two, so I think one of the future things I would like to do is find an overlap of them".

Within this overarching theme, leaders also discussed organizational barriers associated with doing TWH. Leaders mentioned barriers such as an offsite workforce (e.g., easier to give office employees resources than field workers), difficulty obtaining employee engagement (e.g., challenge of designing programs that reach employees), and generational differences (e.g., millennials being perceived as unreliable and not working as hard as older generations). However, if they are able to successfully implement programs, some leaders (7% of all business child codes) mentioned some perceived beneficial business outcomes of adopting TWH, including better employee health and improved employee engagement.

Leaders also discussed the ways in which their business communicates health information to their employees and gathers employee feedback on health and safety programs. When discussing health communication, leaders frequently mentioned different modes of communication such as email, newsletters, and postings on wall boards. When discussing the ways in which their business goes about gathering feedback, leaders mentioned surveys, annual performance reviews, direct communication between the safety/wellness committee and employees, near miss injury reporting programs, etc. Some leaders also discussed efforts to evaluate their programs and take action to improve their programs, for example, not only asking for employee feedback, but also taking steps to act upon that feedback.

"Then we have a newsletter that goes out to all of our employees and again, there is something in there about safety, something in there about your health and other things".

"Information that we get through the near-miss program can also show us what employees are looking for and what they're needing and just kind of assessing that and prioritizing that and seeing if there's something that we can do about it".
