Author's School

School of Medicine


Author's Department/Program

Rehabilitation and Participation Science


English (en)

Date of Award

Spring 5-15-2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Bradley A. Evanoff

Committee Members

Chih-Hung Chang, Lisa T. Connor, Ann Marie Dale, Erin R. Foster, Rachel G. Tabak


The chronic disease burden among American workers leads to substantial expenditures on healthcare, lost productivity at work, and reduced quality of life. Workers from communities of lower socioeconomic status (SES) shoulder a disproportionate burden of chronic diseases and costs. A promising strategy for addressing this population health burden is to develop and implement participatory worker health promotion interventions in workplaces. Part of this effort to develop and implement these programs entails improving the quality of evaluation tools and approaches. Thus, we completed a series of secondary analyses of a large participatory worker health promotion program trial called Working For You. Our first aim was to explore the structural and content validity of the Multifaceted Organizational Health Climate Assessment (MOHCA), a measure of organizational health climate not previously tested in low SES populations. We found that the MOCHA generates valid and reliable scores of participants’ perceived organizational health climate among a low SES population. Importantly, we found that in our lower SES worker population, model fit was better when the MOCHA organizational climate scale was divided into two subscales, including a novel organizational responsiveness subscale that may represent a unique facet of organizational health climate and inform other work. Our second aim was to develop a program logic model and demonstrate the utility of a new process measure of implementation quality called the Process Evaluation Rating Sheet (PERS) in our sample of workers of lower SES. Included in this aim was the demonstration that our Modified PERS demonstrated associations between implementation quality and program efficacy. Our third aim was to establish an association between upstream organizational health climate and perceived organizational support with downstream health behaviors, namely use of workplace health supports. We demonstrated an association between organizational health climate and use of workplace health supports, and found that use of instrumental and informational health supports differed by age and race. These aims together contributed evidence for the utility of current tools and approaches to evaluate and implement participatory worker health promotion programs among lower SES and minoritized workers.