Workplace Health Understandings and Processes in Small Businesses: A Systematic Review of the Qualitative Literature

Introduction Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS). Methods The review was conducted as part of a larger mixed-method review and in consultation with stakehold- ers. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative arti- cles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethno- graphic findings synthesis. Results This review finds that SBs have distinctive social relations of work, apprehen- sions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader struc- tures, policies and systems shape the practice of workplace health in SBs. The themes contribute to 'layers of evi- dence' that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels. Conclusions This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social rela- tions can limit workers' and employers' apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcon- tracting) can complicate occupational health responsibili- ties. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interven- tions and improved worker representation.