Health Toolkit Research Articles

Screening for Mental Health Problems in Pediatric Primary Care.

Systematic mental health screening is a recommended but controversial process in the pediatricians' behavioral health tool kit. Although the American Academy of Pediatrics and other organizations promote routine behavioral health screening, implementing an effective and sustainable screening program can be challenging. We discuss the rationale for and barriers to screening in pediatric settings, identify accessible validated tools that can be easily incorporated into practice, and suggest a practical strategy for implementing a more accurate screening system for common mental health concerns in pediatric primary care. [Pediatr Ann. 2020;49(10):e421-e425.].

Oral health promotion apps: an assessment of message and behaviour change potential.

Oral health worldwide needs improving: untreated dental caries is the most common health condition affecting people globally. Mobile applications (apps) have potential to provide preventative oral health interventions. This study aimed to investigate the quality of available oral health promotion apps, assessing information provided and the barriers to oral health addressed using psychological frameworks. A content assessment of oral health promotion apps targeted at adults in the UK iTunes store was conducted. The quality of 22 apps was assessed against 3 objective indices derived from the Delivering Better Oral Health toolkit, Theoretical Domains Framework and Behaviour Change Technique Taxonomy. Index scores were calculated and descriptive analyses were completed. On average, four Delivering Better Oral Health messages, seven Theoretical Domains Framework components and eight Behaviour Change Technique Taxonomy components were addressed per app. The most common components were: 'take at least two minutes to brush' for the Delivering Better Oral Health index, 'goals' and 'intentions' for the Theoretical Domains Framework index and 'goal setting (behaviour)' for the Behaviour Change Technique Taxonomy index. The quality of information available in oral health apps requires improvement with the majority addressing only a few barriers to oral health. Currently, there is no recognized scale for evaluating oral health apps: this study provides a suggested method for future app evaluation. There is opportunity for a new app to be created based on health behaviour change theory which includes all the Delivering Better Oral Health messages.

30.K. Round table: What is and what is not HIA; expectations and realities

Abstract Health impact assessment as a public health tool to contribute to development of healthy public policy and later health in all policies approach entered public health practice, research, education and policy at the end of 1990'. During last 20 years the methodology spread around the globe, tools and guidelines have been developed, potential collaboration with other impact assessments discussed or even legally mandated. A quick search in PubMed using a MESH keyword “Health impact assessment” conducted in January 21, 2020 yielded 628 publications in time period of 2010-2019. Reading the abstract of last 100 from 2019 and partially 2018 based on first authors, manuscripts came from 31 countries of all five continents, USA being the most frequent contributor. This quick search revealed also substantial heterogeneity of the use of term; epidemiological studies, often environmental epidemiological ones, health care intervention evaluation studies, methodological development studies, general evaluation studies are often using health impact assessment label. Out of 100 abstracts, 14 seemed to be in-line with description of HIA by Gothenburg consensus paper, the basic document of HIA. On one hand, this is very positive showing the wide possibilities of use of HIA. On other hand however, it is hazardous as it could lead to misunderstandings and consequently to decreased interest for the methodology. With this regard it shall be noted that after a plateau in number of publications between 2014-2017, there seems to be a consistent decline of new research papers addressing using HIA. Looking at one database only can be a limitation of course. The aim of this round table workshop is to discuss where to go with HIA during coming years, identify potential facilitators for broader implementation and use of the methodology. After introductory presentation by workshop coordinators, five presentations will discuss potential facilitators such as common language and expectations, implementation and place of HIA within public health toolkit, capacity building and recent opportunities such as health in EIA and the SDG's. The final part of the round table will be as general discussion with involvement of the audience facilitated by workshop organizer. Key messages HIA is used for different purposes, not only the one described by Gothenburg consensus paper. There is a substantial heterogeneity in use of HIA influenced by language, implementation method, available capacities and motivation.

Beyond Mobile Apps: A Survey of Technologies for Mental Well-Being

Mental health problems are on the rise globally and strain national health systems worldwide. Mental disorders are closely associated with fear of stigma, structural barriers such as financial burden, and lack of available services and resources which often prohibit the delivery of frequent clinical advice and monitoring. Technologies for mental well-being exhibit a range of attractive properties, which facilitate the delivery of state-of-the-art clinical monitoring. This review article provides an overview of traditional techniques followed by their technological alternatives, sensing devices, behaviour changing tools, and feedback interfaces. The challenges presented by these technologies are then discussed with data collection, privacy, and battery life being some of the key issues which need to be carefully considered for the successful deployment of mental health toolkits. Finally, the opportunities this growing research area presents are discussed including the use of portable tangible interfaces combining sensing and feedback technologies. Capitalising on the data these ubiquitous devices can record, state of the art machine learning algorithms can lead to the development of robust clinical decision support tools towards diagnosis and improvement of mental well-being delivery in real-time.

Adapting a health behavioral change and psychosocial toolkit to the context of physical disabilities: Lessons learned from disabled women with young children

BackgroundMothers with physical disabilities (MPDs) face the behavioral and psychosocial changes of the motherhood transition with fewer resources, additional barriers, and higher risks than nondisabled mothers. In this study we sought guidance from MPDs on adaptations needed to a health promotion toolkit for behavioral and psychosocial health that was originally developed for nondisabled, primarily low-income, women. ObjectiveTo identify general themes for adaptations that would increase the suitability of the toolkit for MPDs. Methods11 MPDs were interviewed by videoconferencing in a mixed-methods study about their perspectives on improving relevance of the existing toolkit for this population. The toolkit contained three components: assessment scale, feedback template on assessment results, and a decision aid related to behavior change. Interviews were analyzed using qualitative content analysis. ResultsNine themes for improving suitability of the toolkit for MPDs were identified. Themes covered: Using non-judgment language; including strengths, not just risks; using exercise items applicable to persons with physical disabilities; being aware that functional ability was the key body image concern; considering motivational stages of behavioral change; providing choice in goal-setting for change; including suggestions for social support; identifying resources for health and adaptive parenting; and making health promotion resources available in alternative platforms (paper, electronic). ConclusionsThe MPDs’ feedback revealed ways that our toolkit for behavioral and psychosocial health could be improved to be inclusive of MPDs. The participatory methods utilized here are also recommended in designing new or revising existing materials aimed at enhancing health promotion for people with disabilities.

Implementation of a behavioural change intervention to enhance oral health behaviours in elite athletes: a feasibility study

BackgroundPoor oral health of elite athletes is common and is associated with negative performance impacts. There is a need for oral health promotion strategies that are effective within the elite...

Addressing cognitive health in coordinated specialty care for early psychosis: Real-world perspectives.

Addressing cognitive health during the early phase of psychosis has the potential to enhance recovery outcomes, yet methods to assess and treat cognitive problems are not a systematic part of Coordinated Specialty Care (CSC) in the United States. We sought to understand how CSC providers perceive cognitive health and gauge the acceptability and appropriateness of cognitive interventions to inform the development and implementation of a cognitive health toolkit for OnTrackNY, a CSC program. Electronic surveys were sent to clinicians from 22 OnTrackNY teams. One unstructured and 10 structured questions assessed knowledge and beliefs about cognition, current cognitive health practices, the likelihood of adopting new practices, perceived facilitators, and barriers to assessing and treating cognitive health. Fifty-three clinicians responded. Clinicians identified a range of terms associated with cognitive impairment with specific neurocognitive deficits cited most frequently. The majority perceived the evidence for cognitive impairment at the time of first episode to be moderate to strong, that specific interventions for cognition are warranted, and that there is a significant link between cognition and community functioning. While current practices vary, 88% indicated a high likelihood of integrating tools to address cognitive problems if provided. Compensatory approaches to aid cognitive functioning were viewed most favourably. Results suggest that addressing cognitive health is acceptable and appropriate for OnTrackNY but there is a need for systematic training to integrate empirically supported interventions with existing recovery-oriented practices. Piloting a cognitive health toolkit will inform the potential uptake of assessment and treatment practices more broadly.

The Diabetes and Emotional Health Handbook and Toolkit for Health Professionals Supporting Adults With Type 1 and Type 2 Diabetes: Formative Evaluation.

BackgroundHealth professionals have expressed unmet needs, including lacking the skills, confidence, training, and resources needed to properly attend to the psychological needs of people with diabetes.ObjectiveInformed by needs assessments, this study aimed to develop practical, evidence-based resources to support health professionals to address the emotional needs of adults with type 1 or type 2 diabetes.MethodsWe developed a new handbook and toolkit informed by formative evaluation, including literature reviews, stakeholder consultation and review, and a qualitative study. In the qualitative study, health professionals participated in interviews after reading sections of the handbook and toolkit.ResultsThe literature review uncovered that psychological problems are common among adults with diabetes, but health professionals lack resources to provide related support. We planned and drafted resources to fill this unmet need, guided by stakeholder consultation and an Expert Reference Group (ERG). Before finalizing the resources, we implemented feedback received from stakeholders (ERG, health professionals, academics, and people with diabetes). The resulting resources were the practical, evidence-based Diabetes and Emotional Health handbook and toolkit. A total of 19 health professionals took part in the qualitative study about the handbook and toolkit. They viewed the resources favorably, felt empowered to support people with diabetes experiencing psychological problems, and felt motivated to share the resources with others. Some gave examples of how they had used the handbook in clinical practice. A perceived highlight was the inclusion of a process model outlining 7 steps for identifying and supporting people with emotional problems: the 7 A’s model. With funding from the National Diabetes Services Scheme (NDSS), more than 2400 copies of Diabetes and Emotional Health have been distributed. It is freely available on the Web. The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia.ConclusionsThe new evidence-based resources are perceived by stakeholders as effective aids to assist health professionals in providing emotional support to adults with diabetes. The 7 A’s model may have clinical utility for routine monitoring of other psychological and health-related problems, as part of person-centered clinical care.

Developing Children's Oral Health Assessment Toolkits Using Machine Learning Algorithm.

Evaluating children's oral health status and treatment needs is challenging. We aim to build oral health assessment toolkits to predict Children's Oral Health Status Index (COHSI) score and referral for treatment needs (RFTN) of oral health. Parent and Child toolkits consist of short-form survey items (12 for children and 8 for parents) with and without children's demographic information (7 questions) to predict the child's oral health status and need for treatment. Data were collected from 12 dental practices in Los Angeles County from 2015 to 2016. We predicted COHSI score and RFTN using random Bootstrap samples with manually introduced Gaussian noise together with machine learning algorithms, such as Extreme Gradient Boosting and Naive Bayesian algorithms (using R). The toolkits predicted the probability of treatment needs and the COHSI score with percentile (ranking). The performance of the toolkits was evaluated internally and externally by residual mean square error (RMSE), correlation, sensitivity and specificity. The toolkits were developed based on survey responses from 545 families with children aged 2 to 17 y. The sensitivity and specificity for predicting RFTN were 93% and 49% respectively with the external data. The correlation(s) between predicted and clinically determined COHSI was 0.88 (and 0.91 for its percentile). The RMSEs of the COHSI toolkit were 4.2 for COHSI (and 1.3 for its percentile). Survey responses from children and their parents/guardians are predictive for clinical outcomes. The toolkits can be used by oral health programs at baseline among school populations. The toolkits can also be used to quantify differences between pre- and post-dental care program implementation. The toolkits' predicted oral health scores can be used to stratify samples in oral health research. This study creates the oral health toolkits that combine self- and proxy- reported short forms with children's demographic characteristics to predict children's oral health and treatment needs using Machine Learning algorithms. The toolkits can be used by oral health programs at baseline among school populations to quantify differences between pre and post dental care program implementation. The toolkits can also be used to stratify samples according to the treatment needs and oral health status.

Mindfulness-Based Program Embedded Within the Existing Curriculum Improves Executive Functioning and Behavior in Young Children: A Waitlist Controlled Trial.

There is a growing evidence base for mindfulness-based interventions in educational settings. Notably, there has been little investigation of the potential benefits of classroom-based mindfulness programs in children in the early school years (Preparatory/Kindergarten, Grades 1 and 2) despite early childhood being a period characterized by the development of self-regulation and executive functions. The present study investigated the effects of a mindfulness program that was embedded within a school curriculum. This waitlist controlled trial investigated the effects of a mindfulness program, CalmSpace, delivered by classroom teachers across two school terms. A total of 55 students, Mage = 76.4 months, SD = 8.62, were allocated to participate in CalmSpace in Terms 3 and 4. Thirty-six students in the waitlist control condition, Mage = 80.53 months, SD = 13.04, participated in the intervention in Term 4. The start of Term 3 served as baseline (Time 1), and measures were obtained at the end of Term 3 (Time 2) and the end of Term 4 (Time 3). Direct measures of executive functioning using the Flanker Inhibitory Control and Attention Test (Flanker Task) and Dimensional Change Card Sort Task (DCCS) from the National Institute of Health Toolkit were obtained. Teachers’ report of children’s behavior was also obtained using the Strengths and Difficulties Questionnaire (Teacher version) at the beginning and at the end of Term 3, and at the end of Term 4. Children who received the CalmSpace program showed improvements on the DCCS relative to waitlist control at Time 2 (Cohen’s d = 0.48) and Time 3 (Cohen’s d = 1.10). Similar results were found on the Flanker Task with greater improvements found at Time 2 (Cohen’s d = 0.77) and Time 3 (Cohen’s d = 1.33). Teachers reported improvements for those receiving CalmSpace at Time 2 on total SDQ scores, Emotional Symptoms, Conduct Problems, Hyperactivity/Attention (Cohen’s d = 0.32, 0.14, 0.46, 0.30, 0.33, and 0.53, respectively) compared to waitlist control and at Time 3 (Cohen’s d = 0.85, 0.37, 0.48, and 0.90, respectively). The findings demonstrate that implementing the CalmSpace program can lead to improvements in EF and attention for young children. Despite limitations, this study provides promising evidence that the inclusion of focused, targeted mindfulness activities throughout the day may represent a value-added component to the regular school curriculum that can result in benefits for the students.

IP037. Patient Reported Outcomes of Vascular Interventions and Disease on Health-Related Quality of Life: Preliminary Results

The impact of illness on quality of life(QOL) and its assessment continues to be increasingly recognized in patient care. Vascular disease, chronic and often debilitating, impacts patient's QOL before and after treatment. This study aimed to prospectively assess the impact of abdominal aortic aneurysm and accompanying vascular disease on patient's physical functioning, emotional and social well-being before and after surgical intervention, and compare our subset to a national average score. Patients treated in the outpatient clinic setting were approached for participation in PROVIDE HQL. The Patient Reported Outcomes Measurement Information System (PROMIS), a validated National Institutes of Health toolkit was used. Patients completed the PROMIS-57 Profile V2.0, PROMIS-Sexual Function Profile V1.0, and PROMIS-SF V1.1 Global Health questionnaires before aortic intervention, 1 month and 1 year after the intervention. A linear regression model was built to associate domain scores and length of hospital stay after the intervention. Twenty-one patients completed baseline PROMIS questionnaire to vascular intervention. Fifteen patients (76.2%) were male, with all 21 patients being white, and not identifying as Hispanic or Latino. The majority of patients presented for AAA repair (57% endovascular vs 43% open repair). Major comorbidities included hypertension (95.2%), prior tobacco use (66.7%), and coronary artery disease (57.%). Average length of stay after the intervention was 6.5 days. Thirty day all-cause readmission rate was 10%. Baseline global mental health scores ranged from very good (19%), to good (52%), to fair (29%). Baseline physical health scores ranged from good (29%), to fair (67%) to poor (5%), which is somewhat lower than national baseline for patients of similar age. At the 90% significance level, PROMIS domain scores significantly associated with length of stay included PROMIS-57 Physical Function and PROMIS-57 Anxiety/Fear. Patient self-reported QOL is important to understanding baseline for evaluation after vascular intervention. Consistent follow-up is needed at one month and 1 year after the intervention to monitor patient's return to or deviation from baseline levels. Ongoing research efforts in our outpatient clinic aim to complete this assessment.

Healthworlds, Cultural Health Toolkits, and Choice: How Acculturation Affects Patients' Views of Prescription Drugs and Prescription Drug Advertising.

How do minorities differ from Whites in their interactions with the broader consumeristic health culture in the United States? We explore this question by investigating the role that acculturation plays in minority and White patients' views of prescription drugs and the direct-to-consumer advertising (DTCA) of prescription drugs. Drawing on data from six race-based focus groups, we find that patients' views of prescription drugs affect their responses to DTCA. While both minorities and Whites value the information they receive from DTCA, level of acculturation predicts how minorities use the information they receive from DTCA. Less acculturated minorities have healthworlds and cultural health toolkits that are not narrowly focused on prescription drugs. This results in skepticism on the part of less acculturated minorities toward pharmaceuticals as treatment options. In this article, we argue that researchers must consider the role acculturation plays in explaining patients' health dispositions and their consumeristic health orientations.

An audit investigating the management of diabetic patients in general practice, in relation to periodontal health

Research has found a close relationship between the disease progression of diabetes and periodontitis. The aim of this audit is to determine the compliance of general dental practitioners (GDPs) with recommendations from the Delivering Better Oral Health toolkit (2014) for the management of diabetic patients. The final section of this article discusses the factors that affect the prognosis of immediate natural tooth bridges. Providing information on prognosis is an important part of the consent process; this includes patient factors and clinician factors. CPD/Clinical Relevance: There is evidence of a bi-directional relationship between diabetes and periodontitis.

Deficits in executive function and suppression of default mode network in obesity.

Although nutritional and metabolic factors are well established in obesity, neurocognitive determinants are less understood. Using data from the Human Connectome Project, this study concurrently investigated neurocognitive performance, neural activation during a working memory task, and cortical brain morphometry in relation to obesity in a group of young adults, 22-35 years old. Using a case-control design, obese individuals (n = 243, body mass index [BMI] ≥ 30 kg/m2) were compared to a control group of lean BMI individuals (n = 469, BMI = 18-24.9 kg/m2). Performance tests comprised a battery of behavioral neurocognitive assessments. Neural activity was measured as blood-oxygenation-level-dependent (BOLD) activity during an N-Back task using functional magnetic resonance imaging (fMRI). Cortical morphometry included indices of volume, thickness, and surface area. Relative to the control group, the obese group exhibited significantly worse performance in terms of the National Institutes of Health Toolkit (NIH) 9-Hole Peg Board, Penn Working Memory Test, Delay Discounting, Penn Progressive Matrices, NIH Picture Vocabulary Test, Dimensional Change Card Sort Test and the in-scanner N-Back working memory test (FDR-corrected ps<0.05;ds = 0.231-0.405). The obese group also exhibited significantly greater BOLD activation in N-Back task-negative regions, including the ventromedial prefrontal cortex, posterior cingulate, and right precentral gyrus (FDR-corrected ps<0.05). Supplemental functional connectivity analyses provided evidence that the implicated regions were part of the default mode network. Significant differences in morphometry were present in the medial orbitofrontal cortex, rostral anterior cingulate cortex, inferior and superior parietal gyri, and temporal pole (FDR-corrected p<0.001). A data-driven integrative model classified 73.8% of participants correctly. This multimodal investigation suggests diverse aspects of neurocognition are associated with obesity, particularly implicating deficits in executive function and ineffective suppression of the default mode network.

Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health.

The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit's acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.

A study of oral health prevention behaviours for patients with early stage dementia.

Background Thorough dental prevention provided at the diagnosis of early stage dementia may be able to reduce the risk of dental disease before the associated cognitive decline takes hold.Method A questionnaire was used to see how many patients with a recent diagnosis of dementia were registered with a dentist and if they were accessing preventative dental care. The questionnaire was administered to patients attending Memory Assessment Services (MAS), approximately ten weeks after initial diagnosis. A similar questionnaire was conducted among MAS staff providing insight into their own personal dental care knowledge and behaviours.Results The total number of participants in the study was 51. Eighty percent were currently registered or seen regularly by a dentist. About half of all patients attended for regular hygienist sessions. Most patients did not receive dietary advice or oral hygiene instruction, nor were offered additional fluoride supplementation.Conclusion There was clearly scope for improving oral health education and prevention for dementia patients. MAS nurses were aware of the need for good oral health for themselves and for their patients, however, weren't aware of the current best evidence for prevention as prescribed by the Delivering Better Oral Health toolkit.

How is the Lives Saved Tool (LiST) used in the global health community? Results of a mixed-methods LiST user study

BackgroundThe Lives Saved Tool (LiST) is a computer-based model that estimates the impact of scaling up key interventions to improve maternal, newborn and child health. Initially developed to inform the Lancet Child Survival Series of 2003, the functionality and scope of LiST have been expanded greatly over the past 10 years. This study sought to “take stock” of how LiST is now being used and for what purposes.MethodsWe conducted a quantitative survey of LiST users, qualitative interviews with a smaller sample of LiST users and members of the LiST team at Johns Hopkins University, and a literature review of studies involving LiST analyses.ResultsLiST is being used by donors, international organizations, governments, NGOs and academic institutions to assist program evaluation, inform strategic planning and evidenced-based decision-making, and advocate for high-impact interventions. Some organizations have integrated LiST into internal workflows and built in-house capacity for using LiST, while other organizations rely on the LiST team for support and to outsource analyses. In addition to being a popular stand-alone software, LiST is used as a calculation engine for other applications.ConclusionsThe Lives Saved Tool has been reported to be a useful model in maternal, newborn, and child health. With continued commitment, LiST should remain as a part of the international health toolkit used to assess maternal, newborn and child health programs.

Advancing the conversation: next steps for lesbian, gay, bisexual, trans, and queer (LGBTQ) health sciences librarianship

In recent years, librarians in various sectors have been moving forward a conversation on the distinct information needs and information-seeking behavior of our lesbian, gay, bisexual, trans, and queer (LGBTQ) patrons and how well the profession recognizes and meets those needs. Health sciences librarianship has been slower than other areas of the profession in creating an evidence base covering the needs of its LGBTQ patrons, with, until recently, only very limited literature on this subject. LGBTQ health sciences librarianship is now starting to attract new interest, with librarians working together to bring this emerging specialization to the attention of the broader professional community. In this paper, the authors report on a dedicated panel discussion that took place at the 2016 joint annual meeting of the Medical Library Association and Canadian Health Libraries Association/Association des bibliothèques de la santé du Canada in Toronto, Ontario, Canada; discuss subsequent reflections; and highlight the emerging role for health sciences librarians in providing culturally competent services to the LGBTQ population. Recommendations are also provided for establishing a tool kit for LGBTQ health sciences librarianship from which librarians can draw. We conclude by highlighting the importance of critically reflective practice in health sciences librarianship in the context of LGBTQ health information.

Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education.

Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.

Field tests of a participatory ergonomics toolkit for Total Worker Health

Growing interest in Total Worker Health® (TWH) programs to advance worker safety, health and well-being motivated development of a toolkit to guide their implementation. Iterative design of a program toolkit occurred in which participatory ergonomics (PE) served as the primary basis to plan integrated TWH interventions in four diverse organizations. The toolkit provided start-up guides for committee formation and training, and a structured PE process for generating integrated TWH interventions. Process data from program facilitators and participants throughout program implementation were used for iterative toolkit design. Program success depended on organizational commitment to regular design team meetings with a trained facilitator, the availability of subject matter experts on ergonomics and health to support the design process, and retraining whenever committee turnover occurred. A two committee structure (employee Design Team, management Steering Committee) provided advantages over a single, multilevel committee structure, and enhanced the planning, communication, and teamwork skills of participants.