Safety Science 115 (2019) 376–392

Contents lists available at ScienceDirect

Safety Science
journal homepage: www.elsevier.com/locate/safety

Review

Evaluating the effectiveness of workplace interventions in improving safety T

culture: A systematic review
Mohammed Aburumman , Sharon Newnam, Brian Fildes
⁎

Monash University Accident Research Centre (MUARC), Monash University, Victoria, Australia

ARTICLE INFO ABSTRACT

Keywords: Purpose: Recent studies have called for the translation of theoretical research in safety culture into intervention
Systematic review efforts that can guide organisations in improving their workplace safety culture. The aim of this systematic
Safety culture review is to identify and evaluate the effectiveness of workplace interventions in improving safety culture. The
Safety climate current study further aims to identify intervention types and target levels, and evaluate their influence on the
Organizational psychology
success of the intervention.
Occupational safety
Methods: Six online databases were searched for workplace intervention studies that evaluated pre- and post-
Intervention
measurements of safety culture. Data were then extracted from the identified studies, and a methodological
quality assessment was undertaken to determine the strength of evidence.
Results: 23 peer-reviewed studies were included in this review. Overall, the majority of the studies had a positive
impact on safety culture. The most successful types of interventions were those related to the importance of
safety, leadership style and behavioural monitoring. No significant differences in safety culture outcomes were
observed between interventions targeted at the individual, work-group or organisational levels. However, these
findings should be interpreted with caution due to the overall weak methodological quality of the included
studies.
Conclusions: The results of this review are inconclusive due to the susceptible designs employed by a majority of
the studies. Further high-quality experimental research is needed to determine the effectiveness of workplace
interventions in improving safety culture.

1. Introduction Hence, it is essential for employers to develop an understanding of the

Workplace accidents affect organisations all over the world and can
cause irreversible damage to the assets, resources and reputation of the
affected organisations. Over the past year alone, 178 work-related
fatalities were reported in Australia (Safe Work Australia, 2017). Sig-
nificant figures of work-related fatalities have also been reported in-
ternationally, with recent annual figures showing 4836 cases reported
in the US (U.S. Bureau of Labor Statistics, 2016) and 144 cases in the
UK (Health and Safety Executive, 2016). These statistics highlight the
global social impact of workplace accidents.
The impact of workplace injuries and fatalities not only affects the
injured worker. Impacts have also been identified within the commu-
nity (i.e. family members and friends), workplace (i.e. work colleagues
and employers) and broader society (Newnam et al., 2014). Safe Work
Australia (2015) has estimated the total economic burden of workplace
accidents on the 2012–13 financial year at AUD 61.8 billion, which
roughly amounts to 4.1% of Australia’s GDP over that same period.
determinants of workplace accidents in order to establish active con-
trols that are capable of preventing accidents, or at the very least mi-
tigating their effects.
1.1. Safety culture
Investigations into major industrial accidents such as Piper Alpha,
Chernobyl, Bhopal and the Challenger space shuttle have associated
causal factors to a “poor” safety culture or safety climate within the
workplace (Cox and Flin, 1998; Mearns et al., 2001; Reason, 1998).
Safety culture, in one of its many definitions in the literature, is com-
monly described as the “shared values (i.e. what is important) and
beliefs (i.e. how things work) that interact with an organisation’s
structures and control systems to produce behavioural norms (i.e. the
way we do things around here)” (Reason, 1998, p. 294; Uttal, 1983).
Safety Climate, on the other hand, is viewed as a surface-level image of
the state of safety culture (e.g. safety attitudes) at a given point in time

⁎
Corresponding author at: Monash University Accident Research Centre (MUARC), Building 70, Monash University, Clayton, VIC 3800, Australia.
E-mail address: mohammed.aburumman@monash.edu (M. Aburumman).

https://doi.org/10.1016/j.ssci.2019.02.027
Received 18 December 2017; Received in revised form 23 January 2019; Accepted 21 February 2019
Available online 28 February 2019
0925-7535/ © 2019 Elsevier Ltd. All rights reserved.
M. Aburumman, et al.
(Cox and Flin, 1998; Flin et al., 2000; Guldenmund, 2000). Despite the
differences in defining these concepts, many studies have shown that
both safety culture and safety climate play a key role in predicting
workplace accidents (Clarke, 2006; Cooper, 2000; Hofmann and
Stetzer, 1996; Mearns et al., 2003; Zohar, 2000). Thus, both terms will
be referred to as “safety culture” throughout this paper, with the ex-
ception of cases when reference is being made to the specific termi-
nology used by the cited literature.
Reason (1998) suggests that safety culture plays a key role in a
workplace incident. Primarily, a workplace with a poor safety culture
fosters an environment where errors are more frequently made, and
violations are increasingly tolerated. This, in turn, exposes weaknesses
resulting from active and latent failures within the system. Moreover, a
workplace with a poor safety culture could be characterised by its
management’s failure to acknowledge, or address, the gaps within their
safety systems. As a result, these weaknesses linger, and possibly
worsen, over a long duration of time. Thus, increasing the likelihood of
a potential harmful event to occur, possibly resulting in injury and/or
death. Based on this understanding, an “ideal” safety culture has been
conceptualised as “the ‘engine’ that drives the system towards the goal
of sustaining the maximum resistance towards its operational hazards”
(Reason, 1998, p. 294). In practice, this means that safety culture has
significant predictive value for prevention efforts in the Occupational
Health and Safety (OHS) setting.
Notwithstanding the theoretical importance of the safety culture
concept, recent studies have called for the translation of this research
into intervention efforts that can guide organisations in improving their
workplace safety culture (Leitão and Greiner, 2016; Newnam et al.,
2016; Vu and De Cieri, 2016). Several notable publications have at-
tempted to translate safety culture theory into intervention research
within the workplace safety culture context (Zohar, 2002; Zohar and
Luria, 2003). Furthermore, previous systematic reviews have been
conducted to evaluate OHS management systems interventions (Robson
et al., 2007), patient safety culture improvement strategies (Morello
et al., 2013) and active behavioural change safety interventions
(Mullan et al., 2015). However, there have been no systematic reviews
undertaken to date that have attempted to evaluate workplace inter-
vention studies that were aimed at improving workplace safety culture.
Therefore, the current study aims to identify, and evaluate the effec-
tiveness of, all workplace intervention studies that have been carried
out to date, which have been targeted at improving safety culture.
Much of the workplace safety intervention research has traditionally
been directed at the individual worker level (Goldenhar and Schulte,
1996; Newnam and Watson, 2011). This approach is very reductionist
focused and assumes the worker is to blame for incidents (Newnam and
Goode, 2015; Rasmussen, 1997). To optimise the effectiveness of
workplace safety interventions, a greater focus should be given to the
development and implementation of safety initiatives at the broader
organisational context (Hale et al., 2010; Hofmann et al., 1995). This
argument is consistent with the theoretical underpinnings of safety
culture, which align the concept at the group and organisational levels
(Zohar, 2000; Zohar and Luria, 2005). Thus, the current study also aims
to identify the target levels (i.e. organisation, work group or individual)
of these interventions, and evaluate the influence of the target level on
the effectiveness of the interventions.
Of further interest is the contribution of the type of workplace in-
tervention in improving safety culture. The type of intervention refers
to the components of the workplace safety culture targeted by the in-
tervention. One of the most researched areas of workplace safety in-
terventions is individual worker safety training (Hofmann et al., 2017).
This approach to safety culture improvement is seen as rather limited,
since safety culture theory emphasises the role of management’s com-
mitment to safety (Flin et al., 2000; Leitão and Greiner, 2016; Seo et al.,
2004; Vu and De Cieri, 2015) and supervisory safety actions (Hofmann
et al., 2017; Zohar, 2002; Zohar and Luria, 2003) in influencing the
workforce’s safety culture perceptions. Hence, the current study further
377
Safety Science 115 (2019) 376–392
aims to categorise the types of interventions identified in this review,
and evaluate the influence of the intervention type on the effectiveness
of the interventions. This component of the current study will be guided
by the use of an adapted conceptual framework developed by Hale et al.
(2010).
1.2. Theoretical framework
Originally developed as a safety management framework by Hale
(2003), the framework was later adapted to categorise safety manage-
ment and culture interventions (Hale et al., 2010). In this adapted
framework, safety management is conceptualised at three distinct le-
vels: the societal (e.g. regulations), organisational (e.g. safety man-
agement system), group and individual levels (e.g. resources and con-
trols). These levels are supported by monitoring, feedback and learning
systems (e.g. inspections and audits) as well as the design and main-
tenance factors in the workplace (e.g. safety controls), all of which
influence the overall output of the system (e.g. safety performance).
Beyond the main elements of the framework, the element of safety
management system was broken down into two sub-elements, which
are general and culture and motivation, while the element of resources
and control was broken down into six sub-elements, which are general,
procedures and goals, competence, availability, motivation and commu-
nication. These elements and sub-elements of the framework were then
used by Hale et al. (2010) to classify organisational factors that have
been linked to safety performance (Hale and Hovden, 1998) and injury
rates (Shannon et al., 1997) under the adapted framework. The ele-
ments and sub-elements of this framework, as well as the organisational
factors, will be used to categorise the interventions identified in this
review into category (i.e. element or sub-element) and type (i.e. orga-
nisational factor). An illustration of the adapted framework, including
the classification of organisational factors under each element and sub-
element of the framework, is shown in Fig. 1.
1.3. Study aims
The primary aim of the current study is to conduct a systematic
review to identify and evaluate the effectiveness of workplace inter-
ventions targeted at improving workplace safety culture. The secondary
aims of the current study are to identify and categorise these workplace
intervention studies by target level (i.e. workplace population) and
intervention type (Hale et al., 2010) to assess their relationship with
improvements in outcomes (i.e. safety culture levels). To fulfil these
aims, the identified studies will be evaluated based on their impacts on
safety culture as well as the methodological quality of the studies to
determine the overall effectiveness of the studies. In summary, the goal
of this research is to identify successful examples of translational re-
search in safety culture, as well as to establish the type and target level
of interventions that are most effective in improving safety culture le-
vels, thereby facilitating the adoption of safety culture research into
industry programmes that would ultimately guide workplaces in re-
ducing workplace injury and death.
2. Methods
2.1. Search strategy
The search strategy aimed to identify published studies that have
investigated the link between workplace interventions and their effects
on safety culture. To do so, six online databases (Business Source
Complete, Ovid MEDLINE, PsycINFO, ProQuest, EMBASE and Scopus)
were included in the search. Search terms were mapped to MESH terms
and subheadings where applicable, and grouped together using Boolean
operators. Some of the terms used included intervention, promotion,
programme, safety culture, safety climate, workplace, occupational, and
industrial. The full search strategy is provided in Appendix A.
M. Aburumman, et al.
Fig. 1. Adapted safety management framework for classification of safety culture interventions (Hale et al., 2010).
The search was limited to peer-reviewed articles that were pub-
lished in English. Reference lists of included articles were also hand
searched to identify additional studies that met the search criteria but
did not appear in the search results.
2.2. Inclusion and exclusion criteria
Articles were included if they (1) described one or more interven-
tions, (2) were implemented in an occupational setting, and (3) mea-
sured safety culture or safety climate as an outcome.
Articles were excluded if they (1) were not peer-reviewed articles,
(2) were not carried in an occupational setting, or consisted of a non-
working study population (e.g. minors), and (3) did not evaluate pre-
and post- measurements of safety culture or climate as an outcome.
Studies not targeted at improving employee safety culture (e.g. patient
safety) were excluded. Articles that were not available in full-text were
also excluded at the final review stage.
Articles obtained through the database search were initially sear-
ched for duplicates. The articles were then screened using Ulrichsweb to
identify non-refereed journals. Following this process, the remaining
articles were screened by title and abstract to establish whether or not
they met the inclusion and exclusion criteria. The screening of all ar-
ticles was carried out by the first author (MA), with the second author
(SN) conducting a confirmatory screening of 50% of the articles. Results
were then compared and any disagreements that occurred were re-
solved through discussions. Finally, articles that were assessed as eli-
gible for full-text review were retrieved and thoroughly reviewed
against the inclusion and exclusion criteria by the first author (MA),
with the second author (SN) conducting a confirmatory review of 50%
of the articles.
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Safety Science 115 (2019) 376–392
2.3. Quality assessment
Articles that were included in the systematic review were assessed for
methodological quality using the Downs and Black (1998) quality as-
sessment checklist. The checklist contains 27 questions related to the
quality of reporting, external validity, internal validity (bias and con-
founding), and the power of detection. One of the 27 questions (i.e.
question 8 regarding adverse events) was omitted due to its non-ap-
plicability to the nature of workplace safety research. A further question
(i.e. question 27) was modified from calculating whether the study had
sufficient power to detect a clinically important effect on a scale of 0 to 5
(maximum score of 5), to whether a power or sample size calculation was
included in the article (Yes = 1, No = 0, maximum score of 1). As a
result, the maximum total score was reduced from 32 points to 27 points.
The scoring was conducted by one of the authors (MA) and con-
firmed by the second author (SN). Any disagreements that occurred
were resolved through discussions. A quality rating criteria previously
used by O’Connor et al. (2015) was implemented for evaluating the
quality of the studies as excellent, good, fair and poor. Because
O’Connor et al. (2015) criteria evaluated against a maximum total score
of 28 compared to our maximum total score of 27, one point was
subtracted from their rating criteria. Hence, a score of 23 or higher was
rated as excellent, 18 to 22 as good, 13 to 17 as fair, and 12 or less as
poor.
The quality assessment was not applied as an exclusion criterion,
but was used to draw conclusions about the level of evidence available.
2.4. Data extraction
A range of quantitative and qualitative data were extracted from the
included studies into a table format. Quantitative data included sample
M. Aburumman, et al.
Fig. 2. Flow diagram of search results and study selection process using the PRISMA template (Liberati et al., 2009).
size, follow-up duration and quality score. Qualitative data included
study setting, study design, interventions implemented, outcome mea-
sures, statistical methods, results and study limitations. A meta-analysis
was not feasible due to the wide range of study designs, outcome
measures and statistical methods employed by the studies.
3. Results
3.1. Study selection
The literature search strategy was executed in April 2017 and yielded
1855 articles. After removing duplicates and screening the titles and ab-
stracts of the remaining articles against the inclusion and exclusion criteria,
51 articles were assessed as eligible for full-text review. The full-text review
identified 23 articles as eligible for inclusion in the systematic review. A
flow diagram of the study selection process is provided in Fig. 2.
3.2. Study characteristics
The reported study sample sizes ranged from 50 to 6867, with a
total of five studies reporting a sample size of less than 100. Follow up
duration between administering pre- and post-test measurements of
safety culture (or safety climate) ranged from one month to 42 months,
with eight studies reporting follow-up periods of six months or less. The
studies were carried out in various industrial settings, namely manu-
facturing4-8,14-16,18-19,23 (n = 11 studies), construction10-12,20 (n = 4
studies), utilities1-2 (n = 2 studies), forestry21 (n = 1 study), health-
care9 (n = 1 study), maintenance3 (n = 1 study), transportation22
(n = 1 study), with the remaining two studies covering multiple
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Safety Science 115 (2019) 376–392
industries ranging from manufacturing to retail13,17. The studies were
carried out in Denmark6-8,11,14-15,18 (n = 7 studies), the United
States1,5,10,19,22 (n = 5 studies), Israel3-4,16 (n = 3 studies), Sweden20-21
(n = 2 studies), Australia17 (n = 1 study), Canada9 (n = 1 study),
China12 (n = 1 study), Iran23 (n = 1 study), Poland13 (n = 1 study),
and the United Kingdom2 (n = 1 study).
Five (22%) studies employed a true experimental design1,9,14,16-17.
These designs were either pretest–posttest control group, cluster randomised
trial, or randomised matched pairs. Six (26%) studies employed a quasi-
randomised design3,11,13,18,20,23, and were classified as either nonequivalent
pretest–posttest control group or multiple time series. Nine (39%) studies
employed a pre-experimental design2,4-7,10,15,21-22, and were all classified as
one group pretest-posttest. The remaining three (13%) studies employed an
observational design8,12,19, and were classified as either longitudinal or re-
peated cross-sectional studies. Among the most used outcome measures
were variations of the Danish Safety Culture Questionnaire8,11,14,18 (Nielsen
and Mikkelsen, 2007) (n = 4 studies), Zohar’s (2000) safety climate scale3-
4,21
(n = 3 studies), and Zohar’s (1980) safety climate scale5,9 (n = 2 stu-
dies). The outcome measures used by the remaining studies are listed in
Table 1.
Utilising Hale et al. (2010) adapted framework, the interventions from
each study were categorised into a maximum of two categories and types.
The categories were based on the elements and sub-elements of the adapted
framework, while the types were based on the organisational factors under
each element or sub-element of the framework. The categories covered were
motivation (M)1-4,6,11,14-16,18,20,22-23 (n = 13 studies), competence (C)1-2,9-
10,13,19,21,23
(n = 8 studies), safety management system - culture/motivation
(SMS-C/M)7-9,14,21-22 (n = 6 studies), safety management system - general
(SMS-G)7-8,15 (n = 3 studies), monitoring, feedback and learning systems
 Table 1
Overview of included articles.
Author (year) Country Sample Size Setting Design Follow-up Interventions Outcome Measure Statistical Results Limitations
(months) Analysis

1
M. Aburumman, et al.

Basen-Engquist USA 6867 Utilities (Natural gas & Experimental 33 to 36 Health promotion Own organisational health Repeated No significant change in • Newly developed
et al. electrical) (n = 40 (randomised programme: & safety climate scale (6 measures safety climate scale (needs
(1998) worksites) matched pairs) • Promotional and items corresponding to Analysis of further validity
awareness materials and safety climate) Variance and reliability
activities (ANOVA) testing)
• Self-assessments of risk • Participants &
behaviour researchers were
• Self-help materials to help not blinded
people build the skills
needed to adopt healthy
behaviours
• Direct education for
smoking cessation or
dietary change offered
through multisession
support groups or classes
2
Harvey et al. UK T0a (4 1 7), T1b Utilities (Nuclear Pre-experimental 16 • One day training Safety Culture Attitudes Mann-Whitney Only managers showed a • No control group
(2001) (4 8 0) plant) (n = 1) (one group workshop in teams of scale (Harvey et al., 2002) test and two- significant change in two • Single
pretest–posttest) people working together (60 items) way ANOVA of six safety culture factors organisation
• Raise general awareness (1-perceived management
of safety issues and safety style and communication;
behaviours and give 2- complacency)
employees the opportunity
to provide feedback on

380
what they felt was right or
wrong in their work areas
• Follow up with feedback
sheets to highlight the
issues and suggested
actions to be taken
3
Zohar (2002) Israel 426 (381 Maintenance (n = 1) Quasi-experimental 6 • Weekly personal feedback Shortened safety climate Repeated Significant increase in • Quasi-
workers + 45 (nonequivalent to supervisors concerning Scale (Zohar, 2000) (10 measures measured safety sub- randomisation
supervisors) pretest–posttest frequency of safety-related items) ANOVA climate scores for the • Single
control group) interactions with intervention group organisation
subordinates • Exact safety
• Communication of (high) climate scores
safety priority from direct were not reported
superiors (i.e. section
managers)
(continued on next page)
Safety Science 115 (2019) 376–392
 Table 1 (continued)

Author (year) Country Sample Size Setting Design Follow-up Interventions Outcome Measure Statistical Results Limitations
(months) Analysis

4
Zohar and Israel 134 (121 Manufacturing (Oil Pre-experimental 6 • Bi-weekly personal Shortened safety climate Paired t-test Significant increase in • No control group
M. Aburumman, et al.

Luria workers + 13 refinery) (n = 1) (one group feedback to shop-floor scale (Zohar, 2000) (10 measured safety sub- • Single
(2003) supervisors) pretest–posttest) supervisors (level-1 items) climate scores organisation
managers) and their • Exact safety
immediate superiors (level- climate scores
2 managers) concerning were not reported
the cumulative frequencies
of reported safety-related
interactions between
supervisor and
subordinates
• Level-2 managers
instructed to inform each
supervisor of his/her
relative position (i.e. by
comparison to the other
supervisors) on a bi-weekly
basis, and to communicate
approval or disapproval
depending on this
information
• Senior level-3 managers
received summarised
information during
scheduled management

381
meetings throughout the
intervention
5
Cooper and USA T0 (3 7 4), T1 (1 8 7) Manufacturing Pre-experimental 12 Behavioural safety Modified Zohar (1980) t-test Significant increase in six • No control group
Phillips (Packaging production (one group initiative: safety climate scale (50 of the seven measured • Single
(2004) plant) (n = 1) pretest–posttest) • Behavioural safety items) (Cooper and safety sub-climate scores organisation
checklist Phillips, 1994)
• Observers from each
workgroup
6
Nielsen et al. Denmark 359 Manufacturing (Metal Pre-experimental 24 Incident reporting scheme: Modified safety climate Independent Significant increase in • No control group
(2006) plant) (n = 2) (one group • Reporting minor incidents scale (Seppala, 1992) (17 sample t-test safety climate scores at
pretest–posttest) (MI’s) and near misses items) plant B (plant A came very
(NM’s) in addition to the close to significance at
mandatory lost time p = 0.0502)
incidents (LTI’s)
• Detailed description of
the reported incident and
suggestions for preventive
measures – and if possible
preventive action(s) taken
immediately
• Reported incidents were
analysed on a continuous
basis and information
about accident patterns
was fed back to the
workers through their
supervisors and used by the
safety committee to set up
preventive measures
Safety Science 115 (2019) 376–392

(continued on next page)

 Table 1 (continued)

Author (year) Country Sample Size Setting Design Follow-up Interventions Outcome Measure Statistical Results Limitations
(months) Analysis

7
Rasmussen Denmark 722 Manufacturing (Wind Pre-experimental 42 New initiatives and Safety climate scale Linear Significant increase in • No control group
M. Aburumman, et al.

et al. (326Ec + 396Cd) turbine blades) (n = 2) (one group solutions were tested for (Ojanen et al., 1988) regression safety climate scores for • Comparison
(2006) pretest–posttest) feasibility in pilot projects the intervention group group scores were
before full-scale not reported
implementation, which • Exact safety
was coordinated with the climate scores
company’s existing safety were not reported
committee and
environmental department.
Themes included:
• Chemical products
• Personal protective
equipment (PPE)
• New safety instructions
for chemical and physical
hazards
• Video recordings
• Education and learning
• Employee courses
• Proactive safety
organisation
• Information and
communication
• Occupational medical and
dermatological

382
examination
• Accident and injury
registration system
• Safety rounds
• Team production
8
Nielsen et al. Denmark 517 Manufacturing (Wind Observational 12 Natural intervention: Danish Safety Culture t-test Improvements in five of • Natural
(2008) turbine blades) (n = 2) (longitudinal) • Intervention from Questionnaire (Mikkelsen the six safety culture intervention (no
Rasmussen et al. (2006) and Nielsen, Unpublished) subscales at plant B control over
was transferred to plant B (21 items) (intervention) but none intervention)
(control group) were statistically • Due to
significant observational
nature of study, it
is difficult to infer
causal
relationships
9
Mullen and Canada 169 (115 Healthcare (n = 21) Experimental 3.5 • General transformational Shortened safety climate Multivariate Increase in safety climate • Participants &
Kelloway workers + 54 (pretest–posttest leadership training: half scale (Zohar, 1980) (10 analysis of for intervention groups researchers were
(2009) leaders) control group) day group-based training items) covariance over control group (no not blinded
workshop for managers; or (MANCOVA) significant differences
• Specific transformational between both intervention
leadership training: half- groups)
day group-based training
workshop for managers
10
Sokas et al. USA 84 Construction (n = 2) Pre-experimental 3 10-hour OSHA (US) hazard Modified and translated Paired t-test No significant • No control group
(2009) (one group awareness training NIOSH Safety Climate improvement in safety
pretest–posttest) programme Scale (Jorgensen et al., climate between pre- and
2007) post- measurements
(continued on next page)
Safety Science 115 (2019) 376–392
 Table 1 (continued)

Author (year) Country Sample Size Setting Design Follow-up Interventions Outcome Measure Statistical Results Limitations
(months) Analysis

11
Kines et al. Denmark T0 (53), T1 (52) Construction (n = 2) Quasi-experimental 3.5 to 9.5 Bi-weekly coaching and Modified Danish Safety Linear No overall significant • Not randomised
M. Aburumman, et al.

(2010) (nonequivalent feedback of construction Culture Questionnaire regression change in safety culture. • Small sample size
pretest–posttest site foremen regarding (Nielsen and Mikkelsen, One of the two
control group) daily verbal safety 2007) (27 items) intervention groups
exchange with workers showed a significant
positive change in the
worker attention to safety
dimension (1 of 7
dimensions).
12
Zhou et al. China T0 (5 4 3), T1 (4 0 4) Construction (n = 1) Observational 36 Natural interventions: Modified Health and Independent Significant improvements • Natural
(2011) (repeated cross- • Changes in regulations Safety Climate Survey sample t-test in all four safety climate intervention (no
sectional) and organisational Tool (HSE UK) (Zhou subscales control over
practices et al., 2008) (31 items) intervention)
• Due to
observational
nature of study, it
is difficult to infer
causal
relationships
• Single
organisation
13
Pecillo (2012) Poland 50 Various (Construction, Quasi-experimental 6 to 10 • Training and CIOP-PIB Safety Culture ANOVA and Significant increase in • Not randomised
manufacturing, (multiple time consultations Questionnaire (Milczarek, paired t-test various safety culture • Small sample size
maintenance) (n = 4) series) • Observing and registering 2002) subscales at intervention
unsafe behaviour companies

383
14
Kines et al. Denmark T0 (83E + 92C), T1 Manufacturing (Metal Experimental 4 to 6 Four dialogue meetings Modified Danish Safety t-test significant increases on six • Participants &
(2013) (68E + 71C) industry enterprises) (pretest–posttest between an on-site Culture Questionnaire of the eight factors, researchers were
(n = 14) control group) research team member(s) (Nielsen and Mikkelsen, whereas comparison not blinded
and the owner/manager, 2007) groups showed significant
and at least two owner/ increase from baseline to
manager led dialogue follow-up on only one
meetings with the workers factor (i.e. safety
to: participation)
• gain commitment from
the leader
• reflect on their leadership
role
• prioritise safety
• increase safety
communication
• identify safety problems
• establish remediation
activities and priorities
• initiate tangible safety
activities
• follow up and evaluate
the activities
(continued on next page)
Safety Science 115 (2019) 376–392
 Table 1 (continued)

Author (year) Country Sample Size Setting Design Follow-up Interventions Outcome Measure Statistical Results Limitations
(months) Analysis

15
Nielsen Denmark 169 Manufacturing Pre-experimental 23 Health & safety committee: Multiple subscales from Paired t-test Significant improvement • No control group
M. Aburumman, et al.

(2014) (Industrial lifts) (one group • monthly meetings various safety climate on six of the nine safety • Single
(n = 1) pretest–posttest) • introduce additional scales culture subscales organisation
members
• new task of analysing
accidents
Health & safety
organisation:
• Discuss safety
performance and produce
action plans
• Distribute minutes of
safety meetings
• safety column in in-house
magazine
• safety on the agenda of
other non-safety meetings
and part of daily
supervisor-worker
interactions
Safety representatives:
• Introduce safety themes
16
Zohar and Israel 342 (175E + 167C) Manufacturing (Metal) Experimental 6.5 Individual feedback to help Safety climate scale Linear mixed Significant increase in • Participants &
Polachek (n = 1) (pretest–posttest supervisors increase the (Zohar and Luria, 2005) models safety climate for researchers were
(2014) control group) importance of their safety (16 items) intervention group over not blinded

384
messages during daily control group • Single
communication with organisation
workers
17
Doda et al. Australia 242 (133E + 109C) Various Experimental 12 Implementation of Modified safety climate McNemar test No significant changes in • Exact safety
(2015) (Manufacturing, (cluster-randomised standard and tailored questionnaire (Cox and and Wilcoxon's overall safety climate in climate scores
maintenance, pretest–posttest ergonomics Cheyne, 2000) test both groups. However, a were not reported
healthcare, control group) recommendations significant decrease in one
transportation, retail, safety climate factor for
professional services the control group and two
and other services) safety climate factors for
(n = 21) the intervention group
were recorded.
18
Nielsen et al. Denmark 105 Manufacturing (Metal Quasi-experimental 6 • Short workshop with the Modified Danish Safety t-test, one-way Significant increase in all • Not randomised
(2015) & wood processing) (nonequivalent enterprises’ safety Culture Questionnaire ANOVA three safety culture
(n = 4) pretest–posttest organisation with focus on (Nielsen and Mikkelsen, subscales for one of the
control group) the safety organisation’s 2007) two intervention groups
performance and significant decrease in
• Workshop where workers two of the three safety
and supervisors discussed culture subscales for one
safety issues identified at of the two control groups
baseline
• Short workshop on safety
management and
leadership followed by a
number of individual safety
coaching sessions with
supervisors
(continued on next page)
Safety Science 115 (2019) 376–392
 Table 1 (continued)

Author (year) Country Sample Size Setting Design Follow-up Interventions Outcome Measure Statistical Results Limitations
(months) Analysis

19
Evanoff et al. USA T0 (1018), T1 Manufacturing Observational 12 to 27 Revision of apprentice fall Apprentice survey t-test Significant increase in • Due to
M. Aburumman, et al.

(2016) (1273) (Carpentry) (repeated cross- prevention curriculum to (Kaskutas et al., 2010) safety climate observational
sectional) include new training incl. safety climate items nature of study, it
content and new hands-on/ is difficult to infer
participatory training causal
methods relationships
20
Pousette and Sweden 51 (24E + 27C) Construction (n = 1) Quasi-experimental 1 to 4.5 Four-hour education in Shortened Nordic Safety ANOVA for Significant decrease in one • Not randomised
Törner (nonequivalent planning and performing Climate Questionnaire dependent of the two safety climate • Small sample size
(2016) pretest–posttest structured work (NOSACQ-50), (Kines measures subscales in all • Single
control group) preparation meetings, and et al., 2011) (19 items) intervention groups along organisation
support in performing such with a significant increase
meetings with regular in all control groups on
intervals the same subscale
21
von Thiele Sweden 212 Forestry (n = 1) Pre-experimental 16 20 days of education and Modified shortened safety Repeated Significant improvement • No control group
Schwarz (one group practical leadership climate scale (Zohar, measures in both safety climate • Single
et al. pretest–posttest) training 2000) (10 items) ANOVA subscales organisation
(2016)
22
Zuschlag et al. USA T0 (179 Transportation (Rail) Pre-experimental 28 Clear Signal for Action Labour–management Two-by-two Significant improvement • No control group
(2016) workers + 16 (n = 1) (one group (CSA) safety culture relations Scale ANOVA in safety culture subscale • Single
managers), T1 (86 pretest–posttest) intervention: (Dastmalchian et al., for both workers and organisation
workers + 26 • Peer-to-peer feedback 1989) (6 items for safety managers
managers) (PPF): workers observe culture)
each other, and exchange
feedback about the safety
of their behaviour,

385
conditions, and
organisational factors
• Continuous improvement
(CI): workers and managers
cooperatively gather and
analyse data to identify
systemic causes of
observed at-risk behaviours
and conditions, and then
implement corrective
actions to address the
causes
• Safety-leadership
development: managers are
trained to promote
proactive safety practices
such as PPF and CI
23
Haghighi Iran 90 (45E + 45C) Manufacturing (Oil Quasi-experimental 3 Safety Culture Promotion Own scale (Safety Culture- Paired t-test Significant improvement • Newly developed
et al. refinery) (n = 1) (nonequivalent Intervention Programme: related Cognitive Factors in all four safety culture scale, needs
(2017) pretest–posttest • Safety culture education Questionnaire [SCCFQ]) subscales for the further validity
control group) programme experimental group, and reliability
• Safety culture promotion compared with a testing
programme significant increase in one • Not randomised
subscale for the control • Small sample size
group • Single
organisation

a
T0 refers to the baseline measurement (pre-intervention).
b
T1 refers to the follow-up measurement (post-intervention).
c
Safety Science 115 (2019) 376–392

E refers to the experimental group.

d
C refers to the control group.
M. Aburumman, et al. Safety Science 115 (2019) 376–392

Table 2
Classification of intervention type and intervention level for individual studies using the Hale et al. (2010) adapted framework (refer to Fig. 1).
Author (year) Intervention Type Intervention Level

1
Basen-Engquist et al. (1998) • Motivation (M): Health and Safety promotion Organisation
• Competence (C): Training
2
Harvey et al. (2001) • Competence (C): Training Group
• Motivation (M): Workforce participation
3
Zohar (2002) • Motivation (M): Supervisor commitment Group
• Motivation (M): Importance of safety
4
Zohar and Luria (2003) • Motivation (M): Supervisor commitment Group
• Motivation (M): Importance of safety
5
Cooper and Phillips (2004) Monitoring, feedback and learning system (MFL): Behavioural monitoring Group
6
Nielsen et al. (2006) • Monitoring, feedback and learning system (MFL): Incident/accident analysis Organisation
• Motivation (M): Importance of safety
7
Rasmussen et al. (2006) • Safety management system - general (SMS-G): Safety committee Organisation
• Safety management system - culture/motivation (SMS-C/M): Top management commitment
8
Nielsen et al. (2008) • Safety management system - general (SMS-G): Safety committee Organisation
• Safety management system - culture/motivation (SMS-C/M): Top management commitment
9
Mullen and Kelloway (2009) • Competence (C): Training Individual (Managers)
• Safety management system - culture/motivation (SMS-C/M): Leadership style
10
Sokas et al. (2009) Competence (C): Training Individual (Workers)
11
Kines et al. (2010) Motivation (M): Supervisor commitment Group
12
Zhou et al. (2011) Societal (S): External Pressure Organisation
13
Pecillo (2012) • Monitoring, feedback and learning system (MFL): Behavioural monitoring Group
• Competence (C): Training
14
Kines et al. (2013) • Safety management system - culture/motivation (SMS-C/M): Top management commitment Group
• Motivation (M): Importance of safety
15
Nielsen (2014) • Safety management system - general (SMS-G): Safety committee Organisation
• Motivation (M): Importance of safety
16
Zohar and Polachek (2014) Motivation (M): Supervisor commitment Group
17
Doda et al. (2015) Design and maintenance of technology (D&M): Ergonomics Group
18
Nielsen et al. (2015) • Motivation (M): Supervisor commitment Organisation
• Motivation (M): Workforce participation
19
Evanoff et al. (2016) Competence (C): Training Individual (Workers)
20
Pousette and Törner (2016) Motivation (M): Supervisor commitment Group
21
von Thiele Schwarz et al. (2016) • Competence (C): Training Individual (Managers)
• Safety management system - culture/motivation (SMS-C/M): Leadership style
22
Zuschlag et al. (2016) • Motivation (M): Workforce participation Group
• Safety management system - culture/motivation (SMS-C/M): Top management commitment
23
Haghighi et al. (2017) • Motivation (M): Health and Safety promotion Organisation
• Competence (C): Training

(MFL)5-6,13 (n = 3 studies), societal (S)12 (n = 1 study) and design and
maintenance of technology (D&M)17 (n = 1 study). The intervention types
covered were training1-2,9-10,13,19,21,23 (n = 8 studies), supervisor commit-
ment3-4,11,16,18,20 (n = 6 studies), importance of safety3-4,6,14-15 (n = 5 stu-
dies), top management commitment7-8,14,22 (n = 4 studies), workforce partici-
pation2,18,22 (n = 3 studies), safety committee7-8,15 (n = 3 studies), leadership
style9,21 (n = 2 studies), behavioural monitoring5,13 (n = 2 studies), health and
safety promotion1,23 (n = 2 studies), external pressure12 (n = 1 study), in-
cident/accident analysis6 (n = 1 study) and ergonomics17 (n = 1 study).
Furthermore, the interventions were mostly targeted at the work group-
level2-5,11,13-14,16-17,20,22 (n = 11 studies), followed by the organisational-
level1,6-8,12,15,18,23 (n = 8 studies), while the individual-level9-10,19,21 (n = 4
studies) was the least targeted. The classifications of intervention type and
target level for individual studies are listed in Table 2.
3.3. Quality of individual studies
random variability in the data, and lack of reporting on actual prob-
ability values for outcomes. A summary of the quality scoring of in-
dividual studies is provided in Table 3.
3.4. Outcomes of individual studies
3.4.1. Overview of outcomes
Of the 23 studies evaluated, 16 (69%) studies found statistically sig-
nificant increases in the post-test safety culture scores in the intervention
groups3-7,9,12-16,18-19,21-23. In the remaining seven studies, three (13%) stu-
dies found no statistically significant changes in safety culture scores fol-
lowing the interventions1,8,10. Two (9%) studies found minor partial sta-
tistically significant improvements in the safety culture subscales2,11. Two
(9%) studies found a partial statistically significant decrease in some of the
safety culture subscales following the interventions17,20.

Using the methodological quality assessment criteria in Section 2.3,

none of the 23 articles included in the systematic review were rated as
excellent quality. Five (22%) studies were rated as good1,9,14,16,20, 15
(65%) were rated as fair2-3,5-6,8,10-12,15,17-19,21-23, and three (13%) were
rated as poor4,7,13.
One of the most common issues in the methodological quality of the
studies was the lack of blinding of both participants and researchers;
this was evidenced in only one study17. Furthermore, only one study
was able to demonstrate that a power or sample size calculation was
carried out16. Other widely common issues were the lack of randomi-
sation of subjects into intervention and control groups, lack of reporting
on characteristics of participants lost to follow-up, lack of reporting on
3.4.2. Effect of study quality on outcomes
Of the 23 assessed studies, three (60%) of the five studies rated as
having good methodological quality found statistically significant im-
provements in safety culture9,14,16. 12 (80%) of the 15 studies rated as
fair found statistically significant improvements or minor partial sta-
tistically significant improvements in safety culture2-3,5-6,11-12,15,18-19,21-
23
. Three (100%) of the remaining three studies rated as poor found
statistically significant improvements in safety culture4,7,13. These re-
sults lead us to believe that the increased rigour implemented by higher
quality studies, in an effort to reduce the risk of bias and confounding,
may have led to more objective evaluations of the interventions.

386
M. Aburumman, et al. Safety Science 115 (2019) 376–392

Table 3
Summary of the quality assessment results using the Downs and Black (1998) quality assessment checklist.
Questions

1 2 3 4 5 6 7 9e 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Score %

1
Basen-Engquist et al. (1998) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 0 22 81.5%
2
Harvey et al. (2001) 1 1 0 1 0 1 1 1 1 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 1 0 14 51.9%
3
Zohar (2002) 1 1 1 1 0 0 0 0 0 1 0 1 0 0 1 1 1 1 1 1 1 0 0 0 0 0 13 48.1%
4
Zohar and Luria (2003) 0 1 1 1 0 0 0 1 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 1 0 11 40.7%
5
Cooper and Phillips (2004) 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 1 0 16 59.3%
6
Nielsen et al. (2006) 1 1 1 1 1 1 0 0 0 1 0 1 0 0 1 1 1 0 1 0 1 0 0 0 1 0 14 51.9%
7
Rasmussen et al. (2006) 1 1 0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 1 0 0 0 0 1 0 8 25.9%
8
Nielsen et al. (2008) 1 1 0 1 2 1 0 0 0 1 0 1 0 0 1 1 1 0 1 1 1 0 0 1 1 0 16 59.3%
9
Mullen and Kelloway (2009) 1 1 1 1 1 1 1 0 0 1 0 1 0 0 1 1 1 1 1 1 1 1 0 1 1 0 19 70.4%
10
Sokas et al. (2009) 1 1 1 1 2 1 0 1 1 0 1 0 0 0 1 1 1 0 1 0 0 0 0 1 1 0 16 59.3%
11
Kines et al. (2011) 1 1 0 1 0 1 1 0 1 0 0 1 0 0 1 0 1 1 1 1 1 0 0 0 1 0 14 51.9%
12
Zhou et al. (2011) 1 1 1 0 1 1 1 0 1 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 1 0 14 51.9%
13
Pecillo (2012) 1 1 0 1 0 1 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 8 29.6%
14
Kines et al. (2013) 1 1 0 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 0 21 77.8%
15
Nielsen (2014) 1 1 1 1 1 1 0 1 0 1 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 14 51.9%
16
Zohar and Polachek (2014) 1 1 1 1 0 1 1 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 21 77.8%
17
Doda et al. (2015) 1 1 1 1 1 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 0 17 63.0%
18
Nielsen et al. (2015) 1 1 1 1 1 1 0 0 0 0 1 0 1 0 1 0 1 1 1 0 0 0 1 0 1 0 14 51.9%
19
Evanoff et al. (2016) 1 1 1 1 1 1 1 0 1 1 1 1 0 0 1 1 1 1 1 0 0 0 0 0 1 0 17 63.0%
20
Pousette and Törner (2016) 1 1 1 1 1 1 1 0 1 1 1 1 0 0 1 0 1 1 1 1 1 0 0 1 1 0 19 70.4%
21
von Thiele Schwarz et al. (2016) 1 1 1 1 1 1 1 0 1 1 1 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 15 55.6%
22
Zuschlag et al. (2016) 1 1 0 1 0 1 0 0 1 1 1 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 13 48.1%
23
Hofmann et al. (2017) 1 1 1 1 1 1 1 1 1 0 0 1 0 0 1 1 1 1 0 1 1 0 0 0 1 0 17 63.0%

e
Question no. 8 was omitted as it was deemed not applicable to the studies assessed.

3.4.3. Effect of intervention type on outcome
The effectiveness of the intervention categories, types and levels
were evaluated based on two criterions. First, the effectiveness was
measured in terms of statistically significant improvements in safety
culture following the intervention. Second, the effectiveness was eval-
uated through the level of evidence to support these outcomes, in the
form of Average Study Quality (ASQ) score (Welp and Manser, 2016).
The ASQ is, simply put, the combined mean of quality scores for studies
in a specific intervention category, type or level. For example, if three
studies were included under a specific category with individual quality
ratings of 50%, 60% and 70% respectively, then the ASQ for this ca-
tegory would be 60%, corresponding to a quality rating of fair (based on
the methodological quality assessment criteria in Section 2.3).
Based on the intervention categories and types used to classify the
interventions as detailed in Table 2, the most effective intervention
types, in terms of number of studies that found statistically significant
improvements in safety culture as well as the level of evidence to
support these outcomes, were leadership style9,21 (n = 2 of 2 studies;
ASQ = 63.0% [fair]), importance of safety3-4,6,14-15 (n = 5 of 5 studies;
ASQ = 54.1% [fair]), external pressure12 (n = 1 of 1 study;
ASQ = 51.9% [fair]), incident/accident analysis6 (n = 1 of 1 study;
ASQ = 51.9% [fair]) and behavioural monitoring5,13 (n = 2 of 2 studies;
ASQ = 44.4% [poor]). Other sub-categories that were often found ef-
fective were top management commitment7,14,22 (n = 3 of 4 studies;
ASQ = 50.6% [fair]), training9,13,19,21,23 (n = 5 of 8 studies;
ASQ = 56.3% [fair]), supervisor commitment3-4,16,18 (n = 4 of 6 studies;
ASQ = 54.6% [fair]), workforce participation18,22 (n = 2 of 3 studies;
ASQ = 50.0% [fair]), and safety committee7,15 (n = 2 of 3 studies;
ASQ = 38.9% [poor]). Only one of the two studies using health and
safety promotion interventions found statistically significant improve-
ments in safety culture23 (ASQ = 63.0% [fair]), while the single study
using ergonomics as an intervention had a minor negative effect on
safety culture17.
Category-wise, the most effective categories were societal (S)12
(n = 1 of 1 study; ASQ = 51.9% [fair]) and monitoring, feedback and
learning systems (MFL)5-6,13 (n = 3 of 3 studies; ASQ = 46.9% [poor])
interventions. These were followed by safety management system - cul-
ture/motivation (SMS-C/M)7,9,14,21-22 (n = 5 of 6 studies; ASQ = 55.6%
[fair]), competence (C)9,13,19,21,23 (n = 5 of 8 studies; ASQ = 56.3%
[fair]), motivation (M)3-4,6,14-16,18,22-23 (n = 9 of 13 studies;
ASQ = 56.8% [fair]), and safety management system - general (SMS-
G)7,15 (n = 2 of 3 studies; ASQ = 38.9% [poor]). The single study ca-
tegorised under design and maintenance of technology (D&M) did not
have a positive effect on safety culture17.
3.4.4. Effect of intervention level on outcomes
Six (75%) of the eight organisational-level interventions found
statistically significant improvements in safety culture6-7,12,15,18,23,
with an ASQ of 49.4% (fair). Seven (64%) of the 11 group-level inter-
ventions found statistically significant improvements in safety culture3-
5,13-14,16,22
, with an ASQ of 54.5% (fair). Three (75%) of the four in-
dividual-level interventions found statistically significant improve-
ments in safety culture9,19,21, with an ASQ of 63.0% (fair). These results
are somewhat similar, with the group-level interventions having a
slight disadvantage in terms of positive outcomes. This effect is, how-
ever, negated if the studies (n = 2) that found only minor partial sig-
nificant improvements in safety culture were included2,11. This leads us
to believe that the effect of the intervention level on outcomes is in-
conclusive, in part due to the small sample of studies evaluated for each
level and the level of evidence available rating as fair on average.
4. Discussion
The primary aim of the current study was to conduct a systematic
review to identify workplace interventions that have sought to enhance
safety culture and evaluate the extent of their effect on the workforce’s
safety culture. The current review identified 23 studies that served as
exemplars of the translation of safety culture theory into intervention
efforts which can guide workplaces in improving their safety culture.
Overall, the majority of the interventions included in our review were
found to be effective and resulted in a positive impact on safety culture
post-intervention. However, this finding should be tempered con-
sidering the majority of the studies included in the review were assessed
as having susceptible methodological quality.
The second aim of the current study was to identify the target levels
(i.e. organisation, work group or individual) of these interventions, and

387
M. Aburumman, et al.
evaluate the influence of the target level on the effectiveness of the
interventions. The majority of the interventions were found to be tar-
geted at the work group-level, followed by the organisational-level,
while the individual-level was the least targeted. This finding is con-
sistent with the theoretical foundations of safety culture which align the
concept at the group and organisational levels (Hofmann and Stetzer,
1996; Zohar, 1980, 2000). In terms of the effectiveness of targeted in-
tervention levels, the current study did not find substantial variation in
impacts on safety culture outcomes between individual, work group or
organisational level interventions.
The third aim of the current study was to categorise these inter-
ventions based on Hale et al. (2010) adapted framework and evaluate
the influence of the intervention type on the effectiveness of the in-
terventions. The majority of the interventions were found to be of a
motivational nature, while safety training was the most often employed
type of intervention. In terms of effectiveness of the type of interven-
tion, there were differences noted between the various types of inter-
ventions included in this review. The most seemingly effective types of
interventions (based on intervention types used in more than a single
study) were those focused on management’s emphasis on the im-
portance of safety, management’s leadership style and the im-
plementation of behavioural monitoring programmes. Other highly
effective types of interventions included those targeting top manage-
ment and supervisory commitment, training of workers and managers,
workers’ involvement and participation in safety, and the activities of
safety committees. These findings are consistent with theoretical re-
search in safety culture. That is, past systematic reviews of safety cul-
ture assessment tools have found that amongst the most frequently
hypothesised sub-dimensions of safety culture are those relating to
management commitment (Flin et al., 2000; Leitão and Greiner, 2016;
Seo et al., 2004; Vu and De Cieri, 2015), workers’ involvement in safety
(Leitão and Greiner, 2016; Seo et al., 2004; Vu and De Cieri, 2015),
competence levels (Flin et al., 2000; Leitão and Greiner, 2016; Seo
et al., 2004), safety communication (Leitão and Greiner, 2016; Vu and
De Cieri, 2015) and work pressure (Flin et al., 2000; Seo et al., 2004).
5. Limitations, implications and recommendations for future
research
The findings from this study should be interpreted with caution for a
number of reasons.
First, the systematic review only included studies published in peer-
reviewed journals. Although this was done in an attempt to ensure a
high quality of evidence and reported findings, this criterion excluded a
number of potentially valuable studies and best practices from gov-
ernment or industry reports and grey or unpublished literature.
Furthermore, due to the wide variations in study designs, outcome
measures and statistical methods employed by the studies included in
this review, it was not possible to conduct a meta-analysis. A meta-
analysis would have provided a more objective evaluation of the effects
by looking at the effect size, beyond just the measure of frequency and
study quality.
Second, the majority of the studies were assessed as having fairly
weak methodological quality, with no single study rating as excellent.
Moreover, when evaluating the effectiveness of intervention type and
target level, the level of evidence was on average rated fair to poor.
Hence, the findings should wisely be viewed as inconclusive. These
quality ratings mean that the majority of the studies were exposed to a
high risk of bias and threats to their internal validity, primarily due to
the lack of true experimental designs employed in the studies (Shannon
et al., 1999). This was often due to the lack of randomisation of subjects
into intervention and control groups. This is, however, a topic for de-
bate since it may be viewed as unethical to exclude subjects from in-
terventions that could possibly impact their personal safety and well-
being. One way of overcoming this is by reciprocating the interventions
at the control groups following the initial study (Nielsen et al., 2008;
388
Safety Science 115 (2019) 376–392
Rasmussen et al., 2006). This may, yet again, prove to be difficult due
to financial constraints that are often existent in research studies.
Third, positive outcomes were most prevalent in studies where the
methodological quality was rated as poor, and least prevalent in studies
where the methodological quality was rated as good. This could possibly
be explained by the more rigorous studies employing designs and
methods that sought to reduce the risk of bias, hence, resulting in a
more objective outcome. Furthermore, despite the general lack of ran-
domisation in the studies that utilised a control group, where rando-
misation occurred, it was primarily performed in a cluster format. This
means that the unit of randomisation was the organisation, work site or
work group, and not the individual. Hence, it is often difficult to blind
the intervention and control groups from their assignment (Donner and
Klar, 2004). Cluster randomisation is, however, a limitation of work-
place safety research, as it is often not practicable to carry out rando-
misation of individuals in the workplace.
Fourth, the studies varied broadly in terms of follow-up duration
(1–42 months), with several studies reporting a follow-up duration of
six months or less. It is possible that the shorter follow-up durations
may have only captured a short-term transient shift in safety culture
that may or may not have been sustained for the long term. It would be
beneficial for future studies to employ a time-series design over longer
durations to identify trends in safety culture before, during and after an
intervention.
Fifth, many of the studies were classified under more than a single
intervention type, though this was limited to a maximum of two for the
purpose of analysis. This meant that it was difficult to isolate the effects
of specific aspects of these multi-faceted interventions. This issue is
further compounded by the small number of studies evaluated under
each intervention type. Hence, it is unwise to draw conclusions about
the causal relationships between these intervention types and out-
comes. Moreover, the adapted Hale et al. (2010) framework, though
useful for the purpose of breaking down the interventions to allow for
further analysis, was limiting in terms of accurately labelling the in-
terventions. An example is the organisational factors grouped under
motivation and communication, where it could be argued that many
factors classified under motivation belong to communication and vice
versa. This was evident in other categories as well. For this reason, it
would be advocated that the framework is further adapted and vali-
dated for use in classifying organisational safety interventions.
Sixth, the evaluation criteria of the studies were limited. The ma-
jority of studies focused solely on the effects of the intervention and its
relationship with safety culture scores. This is a limitation as recent
developments in organisational intervention literature have highlighted
the importance of evaluating the process and impacts of an interven-
tion, in addition to the effects (Nielsen and Abildgaard, 2013; Nielsen
and Randall, 2013). A process evaluation aims to understand if the
intervention was delivered as intended and includes the assessment of
factors such as consistency in delivery, participation rate, and engage-
ment with the programme. These factors are important to consider so as
to control for any extraneous variables that may impact on intervention
effectiveness. An evaluation of the impact of interventions is also im-
portant. This evaluation may be achieved by establishing intermediate
(e.g. changes in participants’ attitudes or behaviours) and indirect in-
dicators (e.g. changes in organisational strategies to deal with arising
safety issues) beyond just the intended outcomes or effects (e.g. changes
in safety culture or safety performance) (Nielsen and Randall, 2013).
Thus, it is recommended that future safety culture intervention studies
utilise a comprehensive intervention evaluation framework, including
process, impact and outcome evaluation measures to investigate the
influence on direct and indirect outcomes.
Seventh, the effectiveness of interventions may be limited by the
dynamic variables present within the studied populations. For example,
a population with a high level of safety awareness and an established
safety management system may not be significantly affected by a simple
training or safety management system-related intervention, but could
M. Aburumman, et al. Safety Science 115 (2019) 376–392

be significantly affected by a communication-related intervention such 6. Conclusions

as worker involvement and participation. Hence, it is constructive that
interventions are conducted as a result of a diagnostic process of the
targeted population prior to the development of the intervention(s).
Equally as important, recent developments in research have pointed out
that the contextual variables of the intervention can have a great effect
on the outcomes of the intervention. It has been argued that to achieve
effective workplace safety intervention outcomes, individualised in-
terventions need to be coupled with broader organisational interven-
tions that involve the highest levels of management in an active and
visible role (Hale et al., 2010). Moreover, research suggests that the
“energy level” exerted by the intervention coordinator (often the safety
professional within an organisation) is directly related to the success of
an intervention (Hale et al., 2010).
Finally, the findings from this study provide theoretical and prac-
tical implications. From a theoretical perspective, the findings of this
study confirm that the conceptual foundations of safety culture remain
unclear, partly due to the focus of safety culture intervention studies on
multi-faceted interventions that target distinct and varying aspects of
behavioural change (e.g. attitudes, norms, perceptions). This makes it
challenging to isolate the element(s) of safety culture that have the
strongest and most direct relationship to behavioural change. To
overcome this limitation, future research needs to identify the me-
chanisms directing change in behaviour. This conclusion has implica-
tions for the development of policy and practice relevant to cultural
change. Practically speaking, safety practitioners may find the frame-
work utilised in this study to be helpful in guiding the implementation
of safety interventions at their workplace. The findings from the study
could be particularly helpful in identifying safety interventions targeted
towards improving workplace safety culture that may prove to be more
effective to trial at the workplace based on previous literature.
This systematic review is, to our knowledge, the first review to
evaluate the effects of workplace interventions on safety culture, as well
as to evaluate the influence of intervention type and target level on
safety culture outcomes. Most of the intervention studies included in
this review found a positive impact on safety culture. Moreover, the
most effective types of interventions were those focused on manage-
ment’s emphasis on the importance of safety, management’s leadership
style and the implementation of behavioural monitoring programmes.
Furthermore, the effectiveness of interventions targeted at the in-
dividual, work group or organisational level were similar in terms of
their positive impacts on safety culture. However, these findings were
limited and inconclusive due to the studies’ generally weak methodo-
logical quality, which demonstrates the need for further high-quality
experimental research in the area of workplace safety culture inter-
ventions. It is important that future safety culture intervention efforts
address the inconsistencies identified in the current study to enable the
adoption and replication of safety culture interventions in industry,
helping achieve reductions in workplace injuries and fatalities in order
to create safer work environments.
Acknowledgement
This research was supported through an Australian Government
“Research Training Program” scholarship.
Declarations of interest
None.

Appendix A. Search criteria

Business Source Complete

1 DE “INDUSTRIAL safety”
2 DE “CORPORATE culture”
3 culture
4 climate
5 safety
6 3 OR 4
7 1 AND 6
8 2 AND 5
9 7 OR 8
10 interven* OR promot* OR program*
11 9 AND 10
12 limit 11 to (scholarly peer reviewed journals AND English)

EMBASE

1 occupational safety/
2 climate.mp.
3 culture.mp.
4 2 or 3
5 1 and 4
6 (interven* or promot* or program*).mp.
7 5 and 6
8 limit 7 to (English and journal)

Ovid MEDLINE

1 Safety Management/
2 climate.mp.
3 culture.mp.
4 2 or 3
5 1 and 4
6 (interven* or promot* or program*).mp.
7 5 and 6

389
M. Aburumman, et al. Safety Science 115 (2019) 376–392

8 Patient Safety/
9 7 not 8
10 limit 9 to (English and journal article)

ProQuest

1 MESH (Safety Management)

2 all(culture)
3 all(climate)
4 all(interven*) OR all(promot*) OR all(program*)
5 2 OR 3
6 1 AND 5
7 6 AND 4
8 Limit 7 to (English language)
9 Limit 8 to (peer reviewed)
10 Limit 9 to (scholarly journals)

PsycINFO

1 Safety/ or Occupational Safety/

2 Organizational Climate/
3 Patient Safety/
4 culture.mp.
5 climate.mp.
6 safety.mp.
7 4 or 5
8 1 and 7
9 2 and 6
10 “safety culture”.mp.
11 “safety climate”.mp.
12 8 or 9 or 10 or 11
13 interven*.mp.
14 promot*.mp.
15 program*.mp.
16 13 or 14 or 15
17 12 and 16
18 17 not 3
19 limit 18 to (all journals and English language)

Scopus

((KEY(“safety culture”)) OR
(KEY(“safety climate”))) AND
(TITLE-ABS-KEY(interven* OR
promot* OR program*)) AND
(EXCLUDE(SUBJAREA, “MEDI”))
AND (LIMIT-TO(SRCTYPE, “j”))
AND (LIMIT-TO(LANGUAGE,
“English

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