Safety Science 108 (2018) 286–291

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

The effect of active and passive occupational health and safety (OHS) T
training on OHS awareness and empowerment to participate in injury
prevention among workers in Ontario and British Columbia (Canada)
⁎
Astrid M. Konijna, A. Morgan Layb, Cécile R.L. Boota, Peter M. Smithb,c,d,
a
VU University Medical Center, Department of Public and Occupational Health, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
b
Institute for Work & Health, 481 University Avenue, Toronto, Ontario M5G 2E9, Canada
c
Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
d
Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: To investigate whether differences in methods of Occupational Health and Safety (OHS) awareness
Occupational health & safety training result in differences in worker awareness of rights and responsibilities and worker empowerment to
Injury prevention participate in injury prevention.
Canada Methods: Repeated cross-sectional surveys were conducted on 3911 working adults employed in two Canadian
Workplace hazards
provinces – British Columbia and Ontario. Participants were asked if they had participated in OHS awareness
Training outcomes
training in the preceding 12 months. Using information on type of training received respondents were grouped
into those receiving active and passive training. Adequacy of awareness of workplace hazards and empowerment
to participate in injury prevention were measured by six and five statements respectively. Multivariable logistic
regressions examined association between type of training and awareness and empowerment outcomes.
Results: In multivariable models workers who reported receiving OHS awareness training reported higher levels
of OHS awareness compared to those who did not receive training, with the relationship being stronger for active
training (OR = 2.87, 1.96–4.21), and active and passive training (OR = 2.22, 1.66–2.98), compared to passive
only training (OR = 1.52, 1.16–1.99). Only combined active and passive training was associated with higher
empowerment (OR = 1.70, 1.33–2.17), with estimates for other types of training being close to the null.
Conclusion: Exposure to OHS awareness training is associated with higher OHS awareness among workers in a
broad range of occupations. Mode of training is important, with more active training associated with stronger
impacts on awareness than passive training methods.

1. Introduction
Work-related injury1 is an important public health problem. Glob-
ally, 2.3 million occupational fatalities are reported each year and
many more millions of workers experience non-fatal work-related in-
juries (International Labour Organization, 2014). The global economic
and societal burden of injuries arising from work is substantial: the
International Labour Organization (ILO) has estimated an annual four
percent loss in global gross domestic product, or approximately US$ 2.8
trillion of direct and indirect costs annually (International Labour
Organization, 2013).
As a result, in many developed economies legislative and/or reg-
ulative requirements are in place that require certain occupational
health and safety (OHS) programs to be implemented to reduce the risk
of work-related injury. Despite the high prevalence of worker training
as a primary prevention activity there is limited research evidence on
the effectiveness of training. One of the most recent systematic reviews
in this area concluded that OHS training positively impacts behaviors in
the workplace, but there was insufficient evidence to make conclusions
about the effectiveness of training on knowledge, attitudes and OHS
outcomes (Robson et al., 2012).
In addition to OHS training in the recognition and control of
workplace hazards, many jurisdictions require employers to inform
workers of their basic rights and responsibilities under OHS legislation.
In July 2014 the Canadian province of Ontario (ON) introduced man-
datory awareness training for all workers and supervisors (Expert

⁎
Corresponding author at: Institute for Work & Health, 481 University Avenue, Toronto, Ontario M5G 2E9, Canada.
E-mail address: psmith@iwh.on.ca (P.M. Smith).
1
Throughout this paper the terms ‘‘injury’’ and ‘‘injuries’’ will be used to refer to both injury/injuries and illness/illnesses.

https://doi.org/10.1016/j.ssci.2017.12.026
Received 2 October 2017; Received in revised form 14 December 2017; Accepted 20 December 2017
Available online 23 December 2017
0925-7535/ © 2018 Elsevier Ltd. All rights reserved.
A.M. Konijn et al.
Advisory Panel on Occupational Health and Safety, 2010). This man-
datory program for employees includes a set of educational elements
that informs workers about their duties and rights at the workplace,
right-to-know laws, frequent hazards, the roles of important OHS par-
ties, and occupational illness (Ontario Ministry of Labour, 2014). It was
thought that participation in mandatory awareness training would in-
crease worker and supervisor knowledge of basic rights and responsi-
bilities and will ultimately prevent workplace injuries (Expert Advisory
Panel on Occupational Health and Safety, 2010). A recent study de-
monstrated lower rates of physical- and mental injuries and injuries
requiring medical attention among workers with adequate awareness
and/or empowerment (Lay et al., 2017).
The purpose of this paper was to examine the impact of awareness
training on worker OHS awareness and empowerment to participate in
injury prevention. Specifically we wanted to examine the relationship
between receiving training, and the type of training received, and self-
reported adequacy of awareness and empowerment. A secondary ob-
jective was to examine if there were differences in the relationship
between training and awareness and empowerment outcomes in a
province where training was mandatory (ON), compared to a province
where no similar province-wide program of mandatory training had
been introduced (British Columbia, BC).
Our hypotheses were as follows. We expected differences in the type
of training received and awareness and empowerment outcomes, with
more active modes of training, such as workshops or instructor led
training, having a stronger impact compared to passive modes of
training, such as on-line courses or workbooks (Aguinis and Kraiger,
2009; Burke and Hutchins, 2007; Burke et al., 2006). We also expected
different impacts of training on awareness and empowerment out-
comes. In line with the conceptual model of Robson (Robson et al.,
2012) we anticipated that the strongest impact of training would be on
awareness, given that awareness is the first step of enabling change in
health enhancing behaviors (Hiatt, 2006), and that the determinants of
empowerment to participate in injury prevention are more complex
than simply the provision of knowledge (Spreitzer, 1995). Finally, we
expected differences in the jurisdictional context in which training is
administered. This hypotheses did not have a specific direction of effect
as it is unknown whether making training mandatory would lead to
increased effectiveness (as training could be provided to workers who
may not normally receive training), or less effectiveness (as minimal
mandatory aspects of training may be provided rather than more
comprehensive programs).
2. Methods and materials
2.1. Study population
As part of an ongoing research program to assess the impacts of
awareness training, cross-sectional surveys were conducted in April and
October 2015 on working adults employed at least 15 h a week at firms
with five or more workers in BC and ON. In April 2015, a sample of
1962 working adults completed the survey and in October 2015 the
sample consisted of 1949 workers (Total N for both surveys = 3911).
The majority of these respondents were recruited by email or telephone
from an existing panel of approximately 90,000 Canadians, who had
agreed to participate in intermittent surveys. A smaller sample was
recruited by a commercial survey provider using Random Digit Dialing
(RDD). Response rates for information collected from the research
panel and using RDD were 21.9%, and 10.7% respectively. Approval
was granted by University of Toronto Health Sciences Research Ethics
Board.
2.2. Main independent variable: OHS awareness training
Survey questions were included about whether participants had
participated in OHS awareness training in the preceding 12 months
287
Safety Science 108 (2018) 286–291
(yes/no), the mode of the training (workshops, online training, work-
books, or external training). Information was also collected on the
source of the training (their employer, a government agency, or an
external provider). Respondents could indicate multiple options for
how they received training and from whom.
Using these responses we classified respondents into one of the
following four training groups: respondents who did not receive
training; respondents who received only passive training (online
training or workbooks); respondents who received only active training
(workshops or external training); and respondents who received both
passive and active training. This grouping recognizes the potential for
different impacts of instructor led (active) versus non-instructor-led
(passive) training (Aguinis and Kraiger, 2009; Burke and Hutchins,
2007; Burke et al., 2006).
2.3. Main outcome: OHS awareness and empowerment
OHS awareness and empowerment were measured using a 27-
question survey tool consisting of four dimensions of OHS vulnerability
(Smith et al., 2015). Adequacy of awareness was measured by responses
to six statements about worker awareness of hazards and knowledge of
their rights and responsibilities. Adequacy of a worker’s empowerment
to ask questions and raise concerns about health and safety at work was
measured using five statements. Respondents were considered to have
adequate access to awareness or empowerment if they had agreed
(Strongly agree or Agree) with all statements in that section, resulting
in a dichotomous variable. A list of the questions used to measure
adequate awareness and empowerment is provided in Table 1.
2.4. Potential confounders
A variety of covariates were included into analytical models based
on previous literature. The demographics included age (< 30 years,
30–39 years, 40–49 years, 50–59 years, and ≥60 years), gender (male
vs. female), and location of birth (Canada vs. other). Other covariates
were province of residence (BC vs. ON), workplace size (5–19 em-
ployees, 20–99 employees, 100–499 employees, and ≥500 employees),
exposure to hazards, and adequacy of workplace policy and procedures.
Exposure to hazards was measured by nine questions, asking partici-
pants to indicate on a seven-point response scale how often they ex-
perienced hazards, ranging from never to every day. Workers were
considered as exposed to hazards if they had experienced two or more
hazards at least weekly, or if they were exposed at least weekly to:
lifting 20 kg more than ten times a day; working more than two meters
Table 1
Questions used to measure adequacy of awareness and empowerment.
Awareness: at my workplace…
I am clear about my rights and responsibilities in relation to workplace health and
safety
I am clear about my employers’ rights and responsibilities in relation to workplace
health and safety
I know how to perform my job in a safe manner
If I became aware of a health or safety hazard in my workplace, I know who (at my
workplace) I would report it to
I have the knowledge to assist in responding to any health and safety concerns at my
workplace
I know what the necessary precautions are that I should take while doing my job
Empowerment: at my workplace…
I feel free to voice concerns or make suggestions about workplace health and safety at
my job
If I notice a workplace hazard, I would point it out to management
I know that I can stop work if I think something is unsafe and management will not
give me a hard time
If my work environment was unsafe I would not say anything, and hope that the
situation eventually improves
I have enough time to complete my work tasks safely
A.M. Konijn et al. Safety Science 108 (2018) 286–291

Table 2
Distribution of awareness training types across outcome and study covariates (N = 2704). All estimates are weighted to reflect the Canadian Labour Force Survey.

N of sample % of sample Awareness training received p-Value for diff (chisq)

None Passive only Active only Passive and Active

Overall 2704 100% 42% 21% 12% 25%

Adequate Awareness
Yes 2047 76% 35% 22% 14% 29% < .001
No 657 24% 63% 18% 6% 13%

Adequate Empowerment
Yes 1771 65% 37% 20% 12% 30% < .001
No 933 35% 50% 21% 11% 17%

Province
Ontario 2040 75% 38% 24% 11% 27% < .001
British Columbia 664 25% 52% 12% 15% 21%

Age
< 30 years 714 26% 51% 18% 10% 20% < .001
30–39 years 592 22% 42% 20% 13% 25%
40–49 years 591 22% 39% 22% 12% 27%
50–59 years 577 21% 35% 22% 14% 29%
60+ years 231 9% 38% 22% 13% 27%

Gender
Male 1355 50% 41% 17% 12% 30% < .001
Female 1349 50% 43% 24% 12% 21%

Location of birth
Canada 2319 86% 41% 22% 12% 25% 0.10
Outside Canada 385 14% 44% 16% 13% 27%

Workplace size
5–19 employees 531 20% 56% 16% 11% 17% < .001
20–99 employees 880 33% 42% 21% 11% 27%
100–499 employees 714 26% 30% 24% 16% 30%
500+ employees 579 21% 44% 22% 10% 24%

Exposed to hazards
Yes 1415 52% 39% 19% 13% 30% < .001
No 1289 48% 45% 23% 12% 20%

Adequate workplace policy and procedures

Yes 1570 58% 28% 23% 15% 34% < .001
No 1134 42% 61% 17% 9% 13%

above the ground; bullying or harassment; or hazardous substances.
Given the crude nature of this measure of hazard exposure (exposed/
not exposed) we also examined models using alternate operalisations of
hazard exposure: number of hazards exposed to on an annual basis; and
the number of hazards exposed to on a weekly basis. These different
definitions of hazard exposure did not change the main findings of our
analyses, and as such we present the model with the most parsimonious
hazard exposure method (exposed/not exposed) in this paper (other
results available from the authors on request). Adequacy of policy and
procedures was measured by responses to seven statements about the
existence and implementation of workplace policies and procedures
that create a safe work environment. Individuals who agreed with all
statements were categorized as having adequate access to protective
policies and procedures, others were considered to have inadequate
access. Further information on these measures, and a description of the
items have been previously published elsewhere (Lay et al., 2016;
Smith et al., 2015).
2.5. Data analysis
The original sample of respondents in Ontario and British Columbia
totaled 3911 across both time points. A total of 577 participants com-
pleted the questionnaire at both time points. Their responses to the first
time point were removed from the sample to avoid duplicates. From the
remaining 3334 individuals, observations where a single response on
questions within the policy and procedures-, awareness-, or empower-
ment dimensions was missing, the item value was replaced with the
mean of their other responses for that person within each dimension.
Values were imputed for 287 policy and procedure statements, 82
awareness-related statements and 121 empowerment statements.
After imputation, 491 participants were removed from the sample
because they were missing responses to two or more awareness or
empowerment questions, or questions on policies and procedures. An
additional 139 participants were missing responses for one or more of
the other study covariates. This left a remaining sample of 2704 par-
ticipants for this study (81% of the eligible sample). Among the 2704
participants in the study, 30 participants indicated they had completed
awareness training in the last 12 months but they did not indicate
which specific type of training they had completed. These respondents
were considered to have not completed training. Workers were also
classified as having not received training if responded that they did not
know if they had been trained or not (n = 24).
Initial analyses included basic descriptive statistics on the sample,
including the distribution of the outcome and study covariates across
the proportion of individuals who received training. A series of logistic
regression models were then used to examine the relationship between
receiving training and the outcomes of adequate awareness and em-
powerment. The first set of models (Model 1) included demographic
variables including age, gender, and location of birth as well as pro-
vince of residence. The second set of models (Model 2) additionally
included workplace size, exposure to hazards, and policy and procedure
adequacy. To examine if the relationship between training and aware-
ness and empowerment differed across provinces, we included a mul-
tiplicative interaction term between province of residence and

288
A.M. Konijn et al.
participation in training. As this estimate was not statistically sig-
nificant the interaction term was removed from the models, and pro-
vince was included as a covariate in all analyses.
For all analyses we developed analytical survey weights so that our
sample reflected the age, sex and provincial distribution within the full
ON and BC labour markets. These weights were developed using the
Canadian Labour Force Survey data files (Statistics Canada, 2013) and
were assigned to each respondent based on their age, gender and pro-
vince of residence. No substantive differences in model estimates or
conclusions were present between weighted and unweighted analyses.
All analyses were conducted in SAS Version 9.3 (The SAS Institute,
2011).
3. Results
Table 2 presents descriptive information of awareness training
across our study outcomes and covariates of interest. Overall 42% of
our sample reported not receiving any awareness training, 21% re-
ceiving only passive training, 12% receiving only active training, and
25% receiving both active and passive training. Differences in the dis-
tribution of training were observed across outcomes and all covariates,
with the exception of location of birth. Respondents with adequate
awareness, adequate empowerment, residing in ON, exposed to hazards
at work and working for an employer with adequate policies and pro-
cedures were more likely to receive training in general. Younger re-
spondents and those in small workplaces (5–19 employees) were less
likely to have received training in general. Although levels of training
provision were similar among men and women (59% versus 57%),
there were differences in the types of training received with women
more likely to receive passive training, and men active training.
Table 3 presents the types of training received within the passive
and active training categories. The majority of passive training was
online training compared to workbook training. The majority of active
training was a workshop conducted by the respondent’s employer.
Table 4 presents the odds ratios for adequate awareness and ade-
quate empowerment by groups of active and passive training. All
training type combinations were associated with greater likelihood of
adequate awareness, with estimates attenuating after adjustment for
workplace size, hazard exposure and adequacy of workplace policies
and procedures. Active training was more strongly associated with
adequate awareness than passive training in both models, although
estimates for active and passive training were slightly lower than those
for active training alone.
We observed a graded relationship between type of training and the
outcome of adequate empowerment, with the strongest estimate asso-
ciated with receiving both active and passive types of training. After
adjustment for workplace characteristics only the receipt of both active
and passive training was associated with adequate empowerment, with
no significant differences observed between receiving passive or active
training in isolation and adequate empowerment, compared to re-
ceiving no training.
Table 3
Type of passive and training provided. Only respondents who received training
(N = 1246 for passive training; N = 1013 for active training).
N %
Passive training
Online training only 536 43%
Workbook training only 384 31%
Online and workbook 327 26%
Active training
Workshop only 650 64%
External training only 107 11%
Workshop and external 256 25%
289
Safety Science 108 (2018) 286–291
4. Discussion
While training has been put forward as one mechanism to increase
OHS awareness and empowerment there is relatively little evidence to
support or refute its effectiveness. In this study we sought to examine
three hypotheses regarding types of training and levels of OHS aware-
ness and empowerment to participate in injury prevention. As hy-
pothesized we observed that active training (workshops and external
training courses) had stronger associations with awareness than passive
modes of training (online training and workbooks). In line with our
second hypothesis, we observed weaker associations with training and
empowerment than we did for awareness, with only one significant
association between a combination of passive and active training and
higher empowerment, compared to not receiving any training. Our
third hypothesis was that the effects of training would differ across
provinces, mainly due to the mandatory requirement of training in ON
compared to BC. This hypothesis was not confirmed, with no differ-
ences in the impact of training on either awareness or empowerment
observed across provinces.
Several strengths and limitations need to be considered when in-
terpreting the study findings. A strength of this study is the large sample
size that has been recruited across a variety of industry and occupa-
tional groups in ON and BC. However, we caution generalizing our
findings to the entire labour force in each of these provinces as young
workers were underrepresented and self-employed workers and those in
small businesses are not included in our sampling frame. In addition,
we had a low response rate to both modes of data collection. We at-
tempted to address concerns regarding external validity of our sample
through weighting the estimates to reflect the age, sex and provincial
distribution of the Canadian Labour Force Survey. However, for this
approach to fully address these limitations requires the assumption that
respondents within each age by gender by provincial group are a
random sample of all workers within each of these groups, which while
untestable, is unlikely. Ideally, to examine the impact of training on our
outcomes respondents would be randomized to receive each type of
training versus not receiving training. Unfortunately, this type of study
design is not always viable, in particular within a context where
training provision is mandatory. We have been able to adjust for dif-
ferences in other characteristics of respondents who received and did
not receive training, including important factors such as hazard ex-
posure and policy and procedure adequacy. Being able to adjust our
models for the confounding effects of hazard exposure and the strength
of OHS policies and procedures in the workplace has allowed us to more
fully isolate the relationship between awareness training and our out-
comes. Additionally, we had the ability to compare the impact of
training between two different jurisdictions. Unlike previous studies
that focused on a single jurisdiction (Geldart et al., 2010) data from BC
and ON allow for a discussion of the impact of training within pro-
vincial contexts that differ in relation as to whether training is man-
datory for the entire labour market or not. In addition, we were able to
compare the effectiveness of different modes of training on two out-
comes that have been shown to be reliable and valid (Smith et al.,
2015). However, our categorization of training could have been further
improved by having information on the length of the training under-
taken and the compliance with the type of training. Finally, all mea-
sures used in this study are self-reported, and the data collection is
cross-sectional. As a result we are not able to infer a causal relationship
between our exposure and outcomes, and it is possible that common-
method bias has led to spurious associations being observed.
Our results extend previous research demonstrating that sector- and
hazard-specific OHS training positively changes behaviors in the
workplace (Robson et al., 2012), increases worker willingness and self-
efficacy to make improvements regarding OHS (Becker and Morawetz,
2004), and increases worker ability to be attentive of workplace ha-
zards (Duffy, 2003). The results concerning the increased association
between active training and each of our outcomes compared to passive
A.M. Konijn et al. Safety Science 108 (2018) 286–291

Table 4
Adjusted odds ratios (OR) for different types of training on adequate awareness and empowerment among workers in Ontario and British Columbia (N = 2704). All estimates are
weighted to reflect the employed labour market population in Ontario and British Columbia. [CI = 95% confidence interval].

Adequate Awareness Adequate Empowerment

Model One Model Two Model One Model Two

OR 95% CI OR 95% CI OR 95% CI OR 95% CI

Type of training
None ref ref ref ref
Passive Only 2.15 1.69–2.73 1.52 1.16–1.99 1.24 1.00–1.53 0.93 0.74–1.18
Active Only 4.08 2.85–5.82 2.87 1.96–4.21 1.41 1.09–1.84 1.05 0.79–1.40
Passive & Active 3.86 2.98–5.01 2.22 1.66–2.98 2.27 1.83–2.81 1.70 1.33–2.17

Model One: Adjustment for province of residence, age group, gender, location of birth.
Model Two: Additional adjustment for workplace size, hazard exposure and adequacy of workplace policy and procedures.

training are consistent with the framework of Burke and colleagues
(Burke et al., 2006). Under this framework more engaging techniques
that include high levels of involvement among workers (such as
workshops) are more effective on training outcomes compared to ap-
proaches with minimal engagement (such as workbooks or online
training) (Burke et al., 2006; Mylett and Stubbs, 2006).
One of the more interesting findings from our study was the impact
of participating in both active and passive training on awareness and
empowerment outcomes. Of those respondents who completed training,
43% completed both active and passive types of training (25% of our
entire sample). Compared to workers who reported receiving no
training, completing both types of training led to a slightly lower effect
on awareness than completing only active training. However, for em-
powerment we observed a statistically significant higher level of em-
powerment only among respondents who had participated in both types
of training. Participation in both types of training may reflect a greater
organizational commitment to other aspects of OHS, thus explaining
why this combination of training is more impactful on empowerment
than it appears to be on awareness, although our analyses have adjusted
for workplace policies and procedures. Future research should look into
these combinations to determine whether certain training modes are
associated with more positive OHS outcomes. In addition, it is im-
portant to better understand the relationships with improvements in
OHS awareness and empowerment and subsequent improvements in
safety behavior and reductions in injury rates using longitudinal study
designs.
In conclusion, our study emphasizes the importance of training in-
terventions in workplaces to positively influence worker awareness and
empowerment to participate in injury prevention activities. Based on
the results, we suggest health and safety policy-makers in Canada and
elsewhere provide general awareness training in addition to any sector-
or hazard specific OHS training. Training types with high involvement
of workers should be promoted and preferred over training types with
medium or low involvement, although respondents who only complete
more passive modes of training do report higher awareness than re-
spondents who do not complete any training at all. The association
between mandatory awareness training and awareness and empower-
ment (in ON) did not significantly differ from non-mandatory training
(in BC). While provincial training requirement did not guarantee the
provision of OHS awareness training across ON (only 62% of the
Ontarian workers reported receiving awareness training), a regulatory
mandate to provide awareness training should continue to be con-
sidered as we see that the proportion of workers receiving training is
significantly higher in ON compared to BC.
Further understanding of the impacts and effectiveness of awareness
training would benefit from both longitudinal studies (to obtain in-
formation about the duration of the effect of awareness training) as well
as the use of measures that assess knowledge levels alongside the self-
reported awareness measures used in this study.
Funding
This work was supported through a Canadian Institutes of Health
Research (CIHR) Population Health Intervention Research Operating
Grant [#201409GIR, 2015-2017]. Peter Smith is supported by a
Research Chair in Gender, Work & Health from CIHR [#201210CGW,
2013-2018].
Authors' contributions to the study
All authors were involved in the development of the research
question. PS and ML facilitated the collection of the study data. AK
conducted the analyses. All authors were involved in the interpretation
of the study findings. AK wrote the initial version of the manuscript. All
authors provided feedback and contributed to the final version of the
paper.
Conflicts of interest
None.
Appendix A. Supplementary material
Supplementary data associated with this article can be found, in the
online version, at http://dx.doi.org/10.1016/j.ssci.2017.12.026.
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