Work is a well-established determinant of health [1,2] and can positively influence individuals’ health and well-being when performed under favorable conditions [3]. In addition to providing financial security, work can offer social recognition, meaningful social connections, and protection against the decline of certain functional capacities [4-6]. Conversely, adverse working conditions and occupational injuries, whether physical or psychological, can undermine quality of life and reduce participation in the labor force [7]. Beyond their consequences for individuals, occupational injuries also have organizational repercussions, including increased absenteeism [8] and decreased workplace performance [9]. For over 3 decades, the scientific community and various stakeholders (eg, work organizations, governments, and health care professionals) have devoted sustained attention to preventing occupational injuries [10,11]. Yet, prevention remains a highly relevant issue due to the emergence of new challenges in today’s evolving world of work [12-14]. Indeed, contemporary work environments are being reshaped by structural changes such as labor shortages, pandemic-related disruptions, the rapid rise of telework, and the integration of AI [15-17]. These transformations have altered how work is performed and may heighten occupational risks (eg, increased workload due to staff shortages, anxiety related to fears of technological replacement). They also complicate the management of risk consequences, particularly the adaptation of return-to-work processes following periods of absence [17-19]. Traditional prevention strategies, while valuable, often fall short in addressing these emerging challenges [15,19-21]. Organizations therefore stand to benefit from innovative prevention approaches to sustain workers’ health and well-being. In this context, the paper outlines a study protocol for the development of an assessment tool to support organizations in adopting a new prevention approach known as integrative prevention at work.

The need for more effective prevention approaches becomes even more pressing in light of the rising number of occupational injuries observed globally. In the province of Quebec (Canada), the Workers’ Compensation Board reported a 56.6% increase in occupational injury cases between 2018 and 2022, despite the numerous prevention efforts already implemented in workplaces [22]. In the United States, the Bureau of Labor Statistics recorded 2.8 million nonfatal injuries and illnesses in the private sector in 2022, an increase of 7.5% compared to 2021 [23]. A similar trend was observed in the European Union, where in 2021, 2.88 million nonfatal work accidents resulting in at least 4 calendar days of absence were reported, representing a 5.5% increase from the previous year [24]. These figures highlight the need to adapt and improve preventive actions to reduce both the incidence and consequences of occupational injuries. The importance of improved prevention is further underscored by the human costs such as the pain and distress experienced by injured workers [25]. In Quebec, human costs represent 61% of the total burden associated with occupational injuries [25,26]. The financial repercussions are also considerable. In the United States, occupational injuries cost an estimated US $167 billion in 2021 [27]. As for the European Union, the estimated annual cost of work-related accidents and illnesses reaches approximately €476 billion (US $534.7 billion) [28]. Similarly high costs are reported in other industrialized countries such as Australia (Aus $28.60 billion [US $20.10 billion]) [29] and Great Britain (£20.70 billion [US $27.70 billion]) [30]. Currency conversions were calculated using the European Central Bank reference exchange rates published on October 21, 2026: €1=US $1.12, Aus $1=US $0.70, and £1=US $1.34. These statistics demonstrate that the consequences of occupational injuries extend far beyond individual workers, impacting organizations and society as a whole.

Traditionally, the continuum of prevention for occupational injuries and prolonged incapacity at work has been structured along 3 levels: primary, secondary, and tertiary prevention [31]. Primary prevention concerns actions that aim to prevent the occurrence of an occupational injury. These interventions often involve modifications to the work environment to reduce risks and hazards, thereby benefiting the entire workforce [32-34]. Secondary prevention aims to halt or delay the progression of an occupational injury and to mitigate its consequences. This level primarily targets individual workers and includes actions such as early detection and intervention following exposure [32-34]. Tertiary prevention aims to minimize the risk of relapse and chronicity after an occupational injury [32]. Interventions at this level include rehabilitation, effective return-to-work processes, and strategies to prevent recurrences or the deterioration of workers’ health [32,33]. Some authors also suggest considering health promotion as a part of this continuum [35,36]. Such initiatives aim to empower workers to take greater control over their health and well-being, for example, by providing healthy food options in workplace cafeterias or by creating supportive environments that foster an active lifestyle. Occupational health prevention and promotion requires the involvement of multiple stakeholders, including those from the health care system (eg, rehabilitation professionals, nurses, physicians, and ergonomists), the workplace (eg, managers, workers, and unions), and the insurance sector (eg, public or private insurers) [37-39]. While valuable, these approaches often remain fragmented, with limited coordination across stakeholders [37,38]. As a result, several scholars have called for a more comprehensive and integrated approach that would benefit both organizations and workers [13,32,40,41].

In recent years, integrative prevention at work has emerged as a promising and contemporary avenue to address the prevention of occupational injuries and prolonged incapacity at work. This approach is grounded in a philosophy that promotes the coordination of prevention actions among stakeholders and the removal of boundaries between the traditionally distinct levels of prevention (ie, primary, secondary, and tertiary) [32,33,40-43]. This holistic approach has attracted growing interest across various sectors, including the scientific community [44], due to its potential to produce significant positive impacts, not only for workers, but also for organizations and society at large, including financial benefits [45-47]. To clarify the concept of integrative prevention at work and identify its operational characteristics, our team conducted a research project divided into 2 phases. In the first phase, we carried out a concept analysis following Walker and Avant’s method [48], using a meta-narrative review to examine publications addressing the integration of prevention activities across the prevention continuum for occupational injuries and prolonged incapacity at work [41]. This 5-step systematic process involved identifying, extracting, and synthesizing information on the attributes, antecedents, outcomes, and contextual factors of integrative prevention at work across the literature, which were used to develop a preliminary conceptualization. In the second phase, we collected qualitative data based on the experiential knowledge of key stakeholders involved in the prevention continuum for occupational injuries and prolonged incapacity at work. This qualitative phase aimed to enrich and refine the preliminary conceptualization, ensuring that it more accurately reflects organizational realities and practice settings [49]. The findings from both phases enabled us to propose a comprehensive conceptualization of integrative prevention at work, illustrated in Figure 1.

According to our findings, integrative prevention at work is characterized by the actualization of 5 key characteristics, referred to as attributes (ie, the manifestation of the approach in reality) [49]. These attributes are: (1) a holistic vision of health, considering workers’ physical and mental health, as well as their overall well-being, as interconnected dimensions; (2) a common understanding of the purpose of integrative prevention, referring to a shared view among stakeholders of what integrative prevention aims to achieve; (3) communication between stakeholders, involving the exchange of information, knowledge, and perspectives among all stakeholders; (4) collaboration between stakeholders, involving working together to address prevention needs by sharing expertise, responsibilities, and resources; and (5) coordination of preventive actions, aligning preventive actions across stakeholders and levels of prevention to ensure that they complement rather than conflict with one another. The implementation of these attributes within a work context could lead to outcomes (ie, characteristics that emerge from or are influenced by the approach) such as process improvement, financial benefits, positive work climate, decrease in risks and issues, and health maintenance [49]. However, antecedents (ie, characteristics that precede the approach) are required beforehand to be able to actualize attributes and generate outcomes. Organizations and individuals need to be disposed, stakeholders need knowledge, and a relationship must exist between them.

All attributes, antecedents, and outcomes must be implemented according to a particular context, which is part of an ongoing process of change [41,49]. In fact, integrative prevention at work can be seen as a dynamic and systemic process. More precisely, the attributes are closely connected and reinforce each other, helping to create an organizational culture of prevention. For example, communication without collaboration, or coordination without a shared vision, is unlikely to produce lasting effects. What matters is the way the attributes work together to embed prevention in everyday practices and relationships. This conceptualization of integrative prevention at work provides a clear and structured description of the approach, thus enabling its operationalization in real-world contexts [50]. Our work has also highlighted the need for practical means such as operational tools, to support the transformation of prevention practices [41]. Despite this growing interest, no existing assessment tool currently measures all 5 attributes of integrative prevention at work on a unified scale [51]. Developing such a tool could serve as a valuable resource for organizations interested in adopting this approach [51].

The adoption of integrative prevention at work would be particularly relevant in the health and social services sector, as it faces significant challenges related to occupational health and injury prevention. In Quebec (Canada), for instance, the number of occupational injury cases in this sector increased by 311% between 2019 and 2023 [52,53]. In 2022, nursing professionals accounted for nearly 10% of all occupational injuries across all sectors in the province, a figure that rose to 19% among support staff in the health and social services sector [52]. A similar trend is observed in the United States, where the education and health services sector recorded the highest number of nonfatal injuries and illnesses in 2021 (including COVID cases) [54]. Likewise, in Europe, the health and social care sector is recognized as a high-risk sector [55]. These statistics can be explained by the various challenges faced by health care workers in recent years such as the COVID-19 pandemic. In addition to the contemporary challenges affecting all workers in today’s evolving world of work, health care professionals are especially vulnerable to psychological risks such as burnout [56,57] and are more likely to experience anxiety and other mental health concerns [58,59]. They are also at higher risk of musculoskeletal injuries due to physically demanding tasks such as patient lifting and transfer activities [60]. Moreover, this sector faces significant staff turnover [61]. Given these challenges, the implementation of integrative prevention at work appears relevant in health care organizations. Furthermore, the health and social services sector has demonstrated openness to initiatives focused on occupational health and work disability management (eg, [62,63]). In recent years, several organizations in this sector in Canada and the United States have increasingly turned toward integrative prevention approaches. Many have participated in research projects aimed at maintaining and improving health, security, and well-being at work [64-66], illustrating their growing interest in and need for such approaches. For example, a program called Prevention and Early Active Return-to-Work Safely (PEARS) was implemented in a large Canadian hospital (in British Columbia). The goal of this pilot project was to integrate secondary prevention actions into an existing primary prevention program. These initiatives specifically targeted musculoskeletal injury prevention. Despite low worker participation in this pilot program, the results supported the idea that coordinating primary and secondary prevention efforts is more effective at reducing disability than implementing them separately [65,66]. In the United States, a total worker health (TWH) initiative called the live well/work well (LWWW) was implemented across a large health care organization, including hospitals and medical centers. A TWH approach is defined as “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness-prevention efforts to advance worker well-being” [67]. Implementation of the LWWW program in medical centers and hospitals led to several benefits reported by participants, including workers feeling that their health and safety were protected by their organization, as well as improvements in lifestyle scores over a 3-year period. Considering these examples of initiatives, mostly compatible with our conceptualization of integrative prevention at work, implementing such an approach could serve as a promising solution for organizations in the health and social services sector. An assessment tool could support such organizations in the early stages of implementation and provide continued benefits throughout the change process.

To gain a comprehensive overview of the assessment tools currently available, our research team conducted a scoping review to identify and describe tools assessing one or more attributes of integrative prevention at work [51]. However, none of them assess all 5 attributes using a unified scale, which poses a challenge for the operationalization of this approach in organizations [51]. To address this gap, it is necessary to develop an assessment tool that would encompass all the attributes of integrative prevention at work on a unified scale. Such a tool would facilitate the implementation of this innovative prevention approach across diverse organizational contexts. According to Pronk et al [68], emerging approaches like integrative prevention at work necessitate tools that can assess their defining characteristics and measure their level of implementation. Even before the implementation process begins, an assessment tool can be used to establish a baseline within an organization, which can then serve as a reference point throughout the implementation journey [68]. Beyond this initial purpose, the tool could also serve as a practical guide for stakeholders by supporting the progressive integration of the approach’s defining characteristics into their specific contexts [33] and by enabling the monitoring of implementation progress over time [47,69,70]. Additionally, interpreting the results of the assessment tool in light of the approach’s characteristics could help organizations determine future objectives [68,70] and identify necessary organizational changes [71]. In this way, the tool could contribute to a continuous improvement process by helping organizations identify areas for improvement, set priorities, and guide the ongoing development of prevention practices. Beyond measurement, an assessment tool could also foster dialogue and reinforce stakeholder engagement in the prevention process [72], all of which are key attributes of integrative prevention at work [41,49].

Given that organizations are continuously confronted with emerging challenges [12-14] and that traditional means of prevention are no longer sufficient to address these complex issues [15,19-21], organizations would benefit from adopting new approaches to maintain workers’ health and well-being, such as integrative prevention at work [32,33,40-42,73]. Although recent studies have identified the defining key characteristics of integrative prevention at work [41,49], no assessment tool currently exists to evaluate them within organizations. This gap represents a key operational challenge [41].

In the health and social services sector, where challenges related to occupational injuries and prolonged incapacity at work are particularly acute (eg, [60,74,75]), organizations have demonstrated a particular openness and responsiveness to initiatives aimed at improving health, safety, and well-being in the workplace (eg, [62,63]). Given these considerations, developing an assessment tool to support the assessment of the attributes of integrative prevention at work represents a promising solution to facilitate the implementation of this approach in this sector.

This project aims to develop an assessment tool for evaluating the attributes of integrative prevention at work within the health and social services sector. More specifically, the project aims to: (1) generate items, rating scales, and instructions; (2) validate the content of the tool; (3) pretest the tool in organizational settings; and (4) evaluate its psychometric properties.

This project will use a methodological study design to develop an assessment tool [76-78], and will be carried out in 4 distinct phases, as illustrated in Figure 2. Since an assessment tool must be developed with careful consideration for the language and cultural context of its intended users [76], the tool to assess the attributes of integrative prevention at work will initially be developed in French, given that most health and social services institutions in Quebec operate primarily in this language.

A pretest will be conducted to pursue two main objectives: (1) to ensure that the tool is well understood and appropriately interpreted by its intended users [91-93], and (2) to assess its acceptability, applicability, and transferability [94-96]. Based on cognitive interviewing, this phase will help identify potential shortcomings in the tool that could lead to response errors among users [91,97-100]. Moreover, including an assessment of applicability and transferability at this stage allows for a comprehensive understanding of both the tool itself and the conditions under which it can be effectively used across various organizational settings, which is particularly relevant for public health initiatives such as this one [82,94].

Psychometric properties of the tool, namely factorial validity and internal consistency, will be evaluated.

The study received ethical approval from the Human Research Ethics Committee of the University of Quebec in Trois-Rivières (CER-25-320-07.14).

This is the first protocol to operationalize the recently conceptualized approach of integrative prevention at work through the development of a validated assessment tool. Several findings are expected and will contribute to the advancement of knowledge from organizational and research perspectives. Future directions are also discussed, as well as study strengths and limitations.

From an organizational perspective, this research project will provide the first assessment tool capable of evaluating all the attributes of integrative prevention at work on a unified scale. It will also be the first tool aligned with the most recent conceptualization of integrative prevention at work. Building on gaps identified in the existing literature, this tool uniquely integrates the 5 attributes of integrative prevention at work within a single assessment tool [51]. In addition, the psychometric properties of the tool will be evaluated and made available, an aspect rarely reported for comparable tools [51]. The tool offers organizations a simple, contextually adaptable resource that allows them to initiate necessary changes to implement an integrative prevention at work approach and to more accurately identify their strengths and weaknesses in prevention practices. Its development is grounded in the recognition that previous initiatives in the health and social services sector, namely PEARS in Canada and LWWW in the United States, have highlighted the relevance and potential benefits of integrative prevention approaches, as well as the sector’s growing interest in such approaches. This tool provides a structured way to assess and monitor these kinds of approaches, supporting organizations in their adoption and ongoing refinement, thereby helping to address some implementation challenges observed in those initiatives. In fact, given the dynamic nature of integrative prevention at work, the assessment tool may be administered at multiple time points to monitor implementation progress and changes in prevention practices over time. In the long term, this tool is expected to support the development of comprehensive and coordinated prevention practices within organizations, facilitating the transition from isolated initiatives to integrated approaches. Implementation initially focuses on health and social services organizations in Quebec, where the needs for integrative prevention approaches are particularly pressing. However, the tool also has potential for adaptation and application in other health and social services sectors nationally and internationally, as well as in other sectors of activity, providing a scalable resource for diverse organizations. In other words, this assessment tool represents a concrete and innovative deliverable that can be readily used by stakeholders to facilitate the implementation and monitoring of a promising prevention approach. The 5 attributes will initially be interpreted separately to examine the frequency with which each attribute is manifested within an organizational context. Taken together, the 5 attributes may provide an overall understanding of the frequency with which integrative prevention at work is manifested within an organization. However, a single overall score will not be assumed unless its theoretical and empirical justification is supported by the psychometric evaluation. If supported, such a score would be intended to inform continuous improvement within each organization. The assessment tool is therefore intended primarily to support reflection and the development of better preventive practices. As similar tools have demonstrated, we expect that this tool will facilitate communication and collaboration between stakeholders [124-126], and even empower them by enhancing their agency and control over preventive practices in their workplaces [125,127].

From a research perspective, this study contributes to advancing knowledge on the prevention continuum in occupational health. Specifically, it is expected to generate empirical evidence supporting the integrative prevention at work approach and to deepen our understanding of its implementation. In doing so, it will clarify key conceptual dimensions, respond to the need for empirical data highlighted by the scientific community [40], and thus provide a methodological foundation for future studies. Furthermore, the development and validation of this tool address a gap previously identified in the literature [41,51].

This project will offer an operational tool to facilitate the implementation of integrative prevention at work and to assess the frequency with which its 5 attributes are manifested within the health and social services organizations. The tool could serve as a foundation for the development of a training workshop focused on its use. This workshop would be intended for its target users, namely professionals working in health and social services organizations who are involved in tasks related to the prevention of occupational injuries or the support of return-to-work processes for workers who have experienced a period of absence in this sector. To support the dissemination of findings and usage guidelines, we also plan to develop a summary document highlighting key information, which will be distributed throughout the health and social services sector in Quebec, Canada. Partnerships with various occupational health organizations and key stakeholders (eg, decision-makers in the targeted sector) are also being pursued to facilitate the implementation of this tool in organizational settings.

We also plan to disseminate content through social media and participate in podcasts to communicate our findings to a broader audience. In particular, a blog dedicated to various themes related to integrative prevention at work will be developed and promoted across different digital platforms. By using a variety of accessible and engaging knowledge translation formats tailored to diverse preferences, we hope to reach a broader audience while accounting for individual preferences and diversity.

For the scientific community, through the publication of open-access scientific papers, as well as participation in conferences, this project will provide empirical evidence on integrative prevention at work. This research project will also pave the way for future research. Additional psychometric properties could be explored in future studies (eg, test-retest reliability). Moreover, the project could lead to the transcultural validation of the tool in English or other languages, expanding its applicability to contexts beyond the one outlined here.

To our knowledge, this study presents the protocol for the first assessment tool capable of evaluating all 5 attributes of integrative prevention at work using a unified scale. The development and validation of such a tool will fill a gap in the current literature regarding the need for a tool to operationalize this concept within organizations [14,51]. The methodological study is described in detail to ensure scientific rigor and replicability in future studies [77]. The validation processes outlined in this protocol aim to provide a tool tailored to organizations in the health and social services sector in Quebec, Canada, offering them a concrete and practical deliverable. Nevertheless, the transferability of the results to other contexts cannot be guaranteed. Further methodological limitations can be anticipated, one of which concerns the sample size in phase 4, required for conducting factorial analysis. Although we plan to follow the recommended ratio of 5 participants per item [106-108,111], this remains a minimal threshold. As noted in the methodological section, our sample size could be as small as 75 participants. However, several authors recommend not only considering the participant-to-item ratio, but also ensuring a minimum sample size of 100 participants [117], or even between 200 and 500 participants for more robust and reliable results [128]. We aim to recruit as many participants as possible to meet these higher thresholds. However, for feasibility reasons, we may only be able to meet the minimal recommended ratio. While this would not invalidate the results, since many published studies have conducted factorial analyses with relatively small samples [108], it would nonetheless be advisable to replicate these analyses with larger samples in future research in order to draw stronger conclusions. Moreover, because this manuscript presents a study protocol, certain analytical decisions will be informed by the results of the psychometric evaluation. For example, the calculation of a potential overall score will depend on the factorial structure identified during phase 4 and on whether such a score is theoretically and empirically justified. Similarly, procedures for handling missing data will be selected in accordance with methodological recommendations and the psychometric characteristics of the final version of the assessment tool. Finally, a limitation of the assessment tool is that it focuses on the 5 defining attributes of integrative prevention at work and therefore does not provide a comprehensive assessment of the entire conceptual model, including its antecedents, outcomes, and contextual factors. However, it provides a starting point for assessing the frequency with which attributes of integrative prevention at work are manifested within organizations.

This paper presents a research protocol designed to develop and validate a tool for assessing the 5 attributes of integrative prevention at work, using a 4-phase methodological study design. This tool will support the operationalization of integrative prevention in health and social services organizations in Quebec, Canada. The project is expected to generate multiple benefits from clinical, organizational, societal, and research perspectives. By providing organizations and stakeholders with a concrete means to evaluate and strengthen their preventive practices, this tool may foster a cultural shift toward more sustainable and integrative approaches to occupational health. In addition to contributing to the advancement of knowledge in the field of the continuum of prevention for occupational injuries and prolonged incapacity at work, the tool could also serve as a model for future tool developments in other sectors, thereby promoting the broader adoption of integrative prevention approaches.