Secondary Logo

Value of Social Media in Reaching and Engaging Employers in Total Worker Health

Hudson, Heidi MPH, CHES; Hall, Jennifer EdD, MCHES

Journal of Occupational and Environmental Medicine: December 2013 - Volume 55 - Issue - p S78–S81
doi: 10.1097/JOM.0000000000000035

Objective: To describe the initial use of social media by the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health™ (TWH) Program and the University of Iowa Healthier Workforce Center for Excellence (HWCE) Outreach Program.

Methods: Social media analytics tools and process evaluation methods were used to derive initial insights on the social media strategies used by the NIOSH and the HWCE.

Results: The on-line community size for the NIOSH TWH Program indicated 100% growth in 6 months; however, social media platforms have been slow to gain participation among employers.

Conclusion: The NIOSH TWH Program and the HWCE Outreach Program have found social media tools as an effective way to expand reach, foster engagement, and gain understanding of audience interests around TWH concepts. More needs to be known about how to best use social media to reach and engage target audiences on issues relevant to TWH.

From Total Worker Health (Ms Hudson), National Institute for Occupational Safety and Health, Cincinnati, Ohio; and University of Iowa Healthier Workforce Center for Excellence (Dr Hall), Iowa City, Iowa.

Address correspondence to: Heidi Hudson, MPH, Total Worker Health, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, MS C-27, Cincinnati, OH 45226 (

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

The authors declare no conflicts of interest.

Inexpensive, instant and borderless, social media provides opportunities for health professionals to engage with wider and more diverse audiences and create meaningful ways to share and access scientific health information.1 For government public health initiatives, social media provides the leverage to increase visibility, form collaborations, and establish transparency and trust among broad and diverse audiences.2 Ostensibly, social media offers the power to build social capital and to influence the rate at which workplace safety and health knowledge is diffused and consumed, posing the potential to change health behaviors and the conditions of work and impact health outcomes among workers and in workplaces. Little has been published about how public health organizations use social media and social networking tools to increase awareness of or engage and interact with their stakeholders, especially among worker and employer populations with regard to health protection and health promotion. Much less has been written about the effectiveness to reach, engage, and influence targeted populations, such as employers, with workplace safety and health information via social media and social networking.

Although most government agencies are considered in the early adoption stage on the use of social media, the National Institute for Occupational Safety and Health (NIOSH) has been actively involved in using social and new media for many years.3 In 2007, when the NIOSH launched a Science Blog on its Web site,4 it recognized the leveraging power of social media to transfer workplace safety and health research. In 2009, the NIOSH evaluated its Science Blog and found that it is a useful communication channel to provide workplace safety and health information and expand the Institute's reach to new consumers.5 In addition to the Blog, the NIOSH communicates with stakeholders using four main social media channels: Twitter, Facebook, YouTube, and LinkedIn. As of April 2013, the NIOSH reached more than 200,000 combined followers on Twitter via 13 feeds targeting various industry segments (eg, construction, transportation, and manufacturing); its two Facebook profiles have more than 16,000 combined likes; the NioshSafetyVideos channel on YouTube contains 82 videos viewed annually for more than 142,000 times; and the Total Worker Health Group on LinkedIn has 340 professional members. Each channel provided the NIOSH an opportunity to expand its reach and its opportunities for meaningful interaction for those interested in workplace safety and health.

With the launch of the Total Worker Health™ (TWH) Program in 2011, the NIOSH broadened and attracted a new audience—health promotion professionals—as well as maintained the NIOSH's mainstay of workplace safety and health professionals.6 The broader workplace health and safety audience creates a new avenue in addressing the twenty-first century workforce needs and modernizes the responsibility for promoting safer and healthier workplaces.

The objectives of this article were (1) to describe the initial social media and social networking strategies of the NIOSH TWH Program and the University of Iowa Healthier Workforce Center for Excellence (HWCE) for creating an on-line presence for the concept “Total Worker Health”; (2) to share results and insights from their use of social media tools such as eNewsletters, Facebook, LinkedIn, Twitter, Pinterest, and the NIOSH Science Blog; and, (3) to provide recommendations to organizations interested in using social media to promote the adoption of integrated worker health programs.

Back to Top | Article Outline


Early on in the launch of the NIOSH TWH Program, leadership recognized the potential of social media for leveraging the visibility of TWH and for engaging with a broader stakeholder base, beyond the traditional audience of occupational safety and health professionals. Because of the growing national interest in TWH, the development of a quarterly eNewsletter and the establishment of a social media presence were deemed priority 2011 goals by the NIOSH. As a result, a comprehensive communication and outreach plan and two-phased strategy were established. The TWH Program's goals align with the Institute's communication goals and include the following:

  1. To improve the awareness and recognition of and the NIOSH TWH Program
  2. To disseminate information and research relevant to TWH
  3. To discover, contact, and collaborate with existing and potential partners
  4. To receive feedback from stakeholders and other potential partners

In 2011, phase one of the strategy was launched and included developing the brand identity for the NIOSH TWH Program and a TWH web page. The brand identity included a common law trademark, the tagline, and a design graphic. In 2012, phase two of the strategy was launched and the Program expanded its focus on building an on-line presence for TWH, targeting health protection and health promotion professionals. To build the on-line presence, the Program implemented an integrated social media strategy.

The first part of the strategy was to develop three primary mediums or drivers for content that would engage the interests of the broad and diverse audiences for TWH. The primary content drivers included the NIOSH TWH web page—a quarterly electronic newsletter called TWH in Action!—and case studies that illustrate employer approaches toward integrating health protection and health promotion called Promising Practices for TWH.

The second part of the strategy was to create social networks to share and exchange content, to create dialogue, and to foster partnerships with health protection and health promotion professionals interested in TWH. As a result, the Program created two social networks: @NIOSH_TWH on Twitter and the NIOSH TWH LinkedIn Group. The Program also aimed to further create interest and attract new audiences by working to include their content on other NIOSH channels (ie, NIOSH Science Blog) and third-party channels (ie, radio podcasts, Medscape, and Wikipedia).7–11

The University of Iowa HWCE Outreach Program supports the TWH Program's outreach and communication goals as well as the Center's goals to promote best and promising TWH practices and to serve as a state and national resource center for employee health programs, services, and policy.12 To accomplish this, the HWCE has embraced social media as an integrated communication strategy for engaging target audiences. Overall goals for the Outreach Program's communication plan have been adapted from the five broad purposes of using social media in public health and health promotion to gather market insights, establish brand/presence, disseminate critical information, expand reach, and foster engagement and partnerships.13 They are as follows:

  • Communicate with employers and stakeholders for market insights.
  • Establish the HWCE's presence as a resource center for employee health programs, services, and policy and promote best and promising TWH practices.
  • Disseminate evidence-based information and resources.
  • Expand reach to include employers and stakeholders from diverse sectors.
  • Foster engagement and partnerships with employers and stakeholders.

In 2011, the HWCE Outreach Program worked on building relationships with stakeholders and employers who were part of the Healthier Workforce Learning Network, a statewide distribution list that included more than 1000 key contacts throughout Iowa that were interested in workplace health protection and health promotion. Activities included meetings, committee memberships, surveys, presentations, conferences, and coordinating and hosting the 2012 Total Worker Health™ Symposium in Coralville, Iowa.

The HWCE Outreach Program specifically targets small- and medium-sized businesses and those with limited resources. Smaller businesses often lack the resources that make corporate integrated employee health programs successful and cost-effective. In a 2012 report from the National Small Business Association and Humana, over half of small businesses stated insufficient information availability for introducing health and wellness programs and only one third reported having confidence in their actual ability to help employees manage their well-being.14 By using social media and on-line communication channels, the HWCE is able to gain a more nuanced understanding of their needs and help bridge the information and resource gap they face.

To further engage stakeholders and employers, including health promotion and human resource professionals, the HWCE uses social media as a low-cost integrated communication strategy and engagement tool for employee health programs. Current HWCE activities include sharing information, resources, health tracking tools, promotional materials, and events through on-line channels that employers can use to complement their employee health and safety programs. Communication channels include the HWCE Web site, a monthly Healthier Workforce e-Bulletin, Twitter (@UIHWCE), Facebook (Healthier Workforce Center for Excellence), and an IOWA Total Worker Health Pinterest page.15–19

Back to Top | Article Outline


Using first-level social media metrics recommended by the Federal Social Media Community of Practice, the NIOSH TWH social media strategy was assessed at two points: October 2012 and April 2013.20 The metrics include breadth and direct engagement. Breadth is the most standard social media metric and includes two components: community size (ie, followers, subscribers, and unique visitors to a web page) and community growth (eg, change in the community size). Engagement volume (ie, likes, mentions, retweets, e-mails, and Google alerts) is a component of direct engagement and allows you to identify trends in what your community values, and what elicits engagements in response. In addition, a Google search was collected and compared at two points—June 2011 and May 2013—to estimate the on-line presence of TWH.

The social media strategy of the HWCE Outreach Program used process evaluation methods with formative research uses to monitor levels of audience engagement and gain a better understanding of the information and resource needs of smaller employers. Process evaluation, recommended as an overarching evaluation strategy for social media,13 was most appropriate because it allowed the HWCE to track participant's activity by observing where, what, and how social media and on-line platforms were engaging the target audience, which in turn helped guide current and future social media actions. Audience activity and metrics were observed along a continuum (low, medium, high) to determine engagement levels and considered activity on the HWCE Web site, the e-bulletin, and social media platforms (ie, Pinterest, Twitter, and Facebook). Engagement, a core attribute, if not central purpose in social media,13 assesses the degree and depth of participation that people have around specific topics.21 Low engagement was identified when people viewed content and acknowledged a preference or agreement with posted information (eg, views, clicks, likes, and dislikes). When people shared content and became involved in creating content that could influence others (eg, posts, pins, repins, times a post or link had been shared, and times a newsletter was forwarded/clicked), they demonstrated a medium level of engagement. High engagement was observed when people started participating in off-line activities and interventions as a result of exposure from a social media channel (eg number of people who register for an event, attend off-line events).13

Back to Top | Article Outline


The social media strategy of the NIOSH TWH focused on building an on-line presence for TWH to target health protection and health promotion professionals and to create avenues for expanding reach and stakeholder base. From June 2011 to April 2013, the TWH Program established more than 49,000 subscribers for its quarterly eNewsletter, TWH in Action! In October 2012, the on-line community size for the TWH Program was estimated to be more than 70,000, and in April 2013, the community size was estimated to be more than 140,000. This indicates 100% community growth in 6 months. The engagement volume for the TWH Program from July 2012 to October 2012 was more than 700 and from November 2012 to April 2013 was estimated to be more than 950. In a retroactive Google search of “Total Worker Health” during the month of June 2011, when the NIOSH launched the TWH Program, search results that included references to the NIOSH TWH Program appeared in three pages of up to eight citations per page. In May 2013, when searching “Total Worker Health” on Google, 12 pages of search results referred to activities and outputs derived from the NIOSH TWH Program.

In the first 5 months of expanding the HWCE Web site, more than 15 new web pages were added with more than 20 links to related Web sites and more than 15 direct links to evidence-based resources. Since launching the expanded Web site and the e-bulletin (<1300 subscribers), 200 additional unique visitors have visited the HWCE Web site each month. The Total Worker Health Symposium web page (which includes presentation slides and opening comments from the NIOSH Director, Dr John Howard) has had the highest level of interest among stakeholders with more than 2200 views.22 High interest was also observed (low–medium engagement) on both the Web site and e-bulletin related to incentive-based wellness programs in the workplace—model employer programs/promising practices—and the concept of TWH, respectively.

When analytics and observations from the HWCE Web site, e-bulletin, and social media platforms were combined, the highest levels of engagement occurred among audience members who linked and/or downloaded workplace health and wellness promotional materials (medium engagement), linked to register for webinars or events (medium–high depending on whether they actually participated), or engaged the HWCE in upcoming events (high engagement). HWCE social media platforms (Pinterest, Twitter, and Facebook) have been slow to gain participation among employers and stakeholders; however, initial user's on-line activity has confirmed their desire for information and resources supporting issues relevant to total worker health programs in the workplace. Of the three platforms, the Iowa Total Worker Health Pinterest page has had the highest number of people reached, with the most popular repins (medium engagement) being of evidence-based resources in the form of guides, programs, tools, and promotional materials that support worksite employee health and wellness programs. Twitter has been most successful for understanding employer's challenges and successes, and was achieved through the distribution of a short-on-line employer survey. Audience reach was broadened with the support from the NIOSH Total Worker Health LinkedIn Group and the @NIOSH_TWH Twitter page.

Back to Top | Article Outline


In May 2013, twenty-three months after the TWH Program was announced, the term “Total Worker Health,” its rationale, emerging research, and promising practices regularly appear in social media and on-line through Twitter, LinkedIn, Pinterest, Facebook, eNewsletters, and blogs. This may be indicative that the TWH Program is expanding the stakeholder base for the NIOSH. Much more needs to be known and shared about how to best use social media, particularly among organizations, such as NIOSH, HWCE, and smaller employers. The slow uptake of social media by smaller employers is reportedly not uncommon and will require the NIOSH and the HWCE to work together on their social media ideas and concepts.21

To effectively use social media for engaging employers in TWH, a business case will need to be developed and shared. Privacy issues and other negative perceptions of using social media in the workplace need to be addressed. This includes attention to leading barriers that prevent employers from embracing social media such as lack of knowledge and understanding about social media, failure to accept new ways of thinking, loss of control, fear of the unknown, lack of resources, and difficulty in showing return on investment.23

When the TWH Program first entered social media, much of the time was spent in assessing the value of social media for extending the reach and understanding the potential for an increased stakeholder base. A more comprehensive and coordinated implementation plan combined with a systematic review of the literature on social media approaches for organizational adoption of worker safety, health, and wellness programs is needed to better understand the impact of social media in enhancing TWH Program visibility, fostering stakeholder engagement, and ultimately promoting an integrated approach to workplace health and safety. Coordinated communication goals and measures are needed to understand how the outreach efforts of the NIOSH and the TWH Centers of Excellence, such as HWCE, can effectively reach and engage with target audiences and influence changes in organizational health.

Back to Top | Article Outline


In the initial efforts by the NIOSH TWH Program and HWCE, it has been observed that social media is an effective way to expand reach, build interest, and gather insights about stakeholders' awareness and perceptions of TWH. Although much more needs to be known about how to best use social media to reach and engage with target audiences, some lessons learned can be applied as practical recommendations for other organizations wishing to pursue a similar endeavor. Before developing a strategic communication plan, create a trial period for understanding target audiences—who they are, where they are, what they are interested in, what they want to know more about, and how they like to access information—this information is critical and will guide communication strategies and evaluation plans. When leaning toward committing to creating a social media presence, be willing to start small. It is easy to underestimate the amount of time and resources it takes to understand, build, and engage a community of followers. Create and maintain a tailored, credible, and engaging content strategy. Understand the difference between quantity and quality of engagement as you evaluate your efforts. One hundred followers with 50% interacting are far better than 10,000 followers with no interaction.

Back to Top | Article Outline


1. McNab C. What social media offers to health professionals and citizens. Bull World Health Organ. 2009;87:566–556. Available at
2. Bertot JC, Jaeger PT, Grimes JM. Promoting transparency and accountability through ICTs, social media, and collaborative e-government. Trans Gov People Process Policy. 2012;6:78–91.
3. Thackeray R, Neiger B, Smith A, Van Wagenen S. Adoption and use of social media among public health departments. BMC Public Health. 2012;12:242.
4. Centers for Disease Control and Prevention. NIOSH Science Blog. Available at Published 2007. Accessed October 4, 2013.
5. Sublet V, Spring C, Howard J. Does social media improve communication? Evaluating the NIOSH Science Blog. Am J Ind Med. May 2011;54:384–394.
6. NIOSH. Worker health, totally. NIOSH eNews. Available at Published 2011. Accessed October 4, 2013.
7. NIOSH. Total worker health topic page. Available at Published 2013. Accessed October 4, 2013.
8. NIOSH. TWH in action! quarterly eNewsletter. Available at Published 2012. Accessed October 4, 2013.
9. NIOSH. Promising practices for Total Worker Heath™. Available at Published 2012. Accessed October 4, 2013.
10. Twitter. NIOSH Total Worker Health Twitter. Available at Published 2012.
11. LinkedIn. NIOSH Total Worker Health LinkedIn Group. Available at Published 2012. Accessed October 4, 2013.
12. University of Iowa Healthier Workforce Center of Excellence. Outreach program. Available at Published May 2013. Accessed October 4, 2013.
13. Neiger BL, Thackeray R, Van Wagenen SA, et al. Use of social media in health promotion: purposes, key performance indicators, and evaluation metrics. Health Promot Pract. 2012;13:159–164.
14. National Small Business Association, Human Inc. Workplace wellness programs in small businesses: Impacting the bottom line. 2012. Available at Published 2012. Accessed October 4, 2013.
15. University of Iowa Healthier Workforce Center of Excellence. Mission. Available at Published May 2013. Accessed October 4, 2013.
16. University of Iowa Healthier Workforce Center of Excellence. Healthier Workforce eBulletin. Available at Published May 2013. Accessed October 4, 2013.
17. Twitter. University of Iowa Healthier Workforce Center of Excellence. Available at Published 2012.
18. Facebook. University of Iowa Healthier Workforce Center of Excellence Facebook Page. Available at
19. Pinterest. Iowa Total Worker Health Pinterest Page. Available at Published May 2013.
20. US Government. Social Media for Federal Agencies. Available at Published May 2013. Accessed October 4, 2013.
21. Lovett J. Social Media Metrics Secrets: Do What You Never Thought Possible with Social Media Metrics. Indiana, IN: Wiley Publishing, Inc; 2011.
22. University of Iowa Healthier Workforce Center of Excellence. Presentation slides from Total Worker Health Symposium: safe, healthy, and cost effective solutions. Available at Published May 2013. Accessed October 4, 2013.
23. Silverman M. The social media garden: a digital era research study into social media at work. Available at Published 2012. Accessed October 4, 2013.
Copyright © 2013 by the American College of Occupational and Environmental Medicine