Abstract

Objectives

Enhancing employees’ perceived organizational support (POS) is crucial for organizations, and one effective approach is enhancing supervisors’ POS. However, there is limited research focusing specifically on enhancing supervisors’ POS. We aimed to investigate the influence of occupational health staff’s involvement for supervisors on their POS.

Methods

A prospective cohort study was conducted using an online survey targeting supervisors in various industries across Japan. We assessed supervisors’ POS using 8 effective items of the Japanese version of the Survey of Perceived Organizational Support. Data were collected on the involvement of occupational health staff in providing supervisors with training on workplace health management and guidance on addressing specific subordinates with health concerns. The association between this involvement and POS was assessed through multiple regression analyses.

Results

The study involved 541 supervisors with occupational health staff at their workplace in the final analysis. Training from occupational health staff was significantly associated with an increase in POS at follow-up after adjustment for potential confounders, including demographic variables and POS at baseline. Similarly, guidance from occupational health staff was also significantly associated with increased POS. This effect was particularly notable in small workplaces.

Conclusions

Our study indicates that occupational health staff’s involvement in supporting supervisors can contribute to enhancing supervisors’ POS, especially in small workplaces. These findings suggest that by developing structured systems and establishing specific roles for occupational health staff, organizations may effectively enhance supervisors’ POS.

Key points

What is already known on this topic: Perceived organizational support (POS) is a vital indicator for an organization, as it is associated with factors such as employee work engagement, organizational commitment, and organizational citizenship behaviors. Enhancing supervisors’ POS is one approach to improve employees’ POS; however, there is limited research specifically focusing on enhancing supervisors’ POS.

What this study adds: The involvement of occupational health staff with supervisors, including training on workplace health management and guidance on addressing specific subordinates with health concerns, has the potential to enhance supervisors’ POS. Supervisors are likely seeking organizational support for workplace health management, and providing support that meets their needs could lead to an enhancement in POS.

How this study might affect research, practice, or policy: Organizations should develop a structured system for occupational health staff and establish their role in providing support to supervisors, especially in small workplaces.

Introduction

Enhancing employees’ perceived organizational support (POS) is essential for an organization. POS reflects the extent to which employees believe their organization values their contributions and cares about their well-being.1 Grounded in social exchange theory, employees with higher POS tend to be more motivated to align more closely with organizational objectives.1,2 Previous studies indicate that high POS correlates with increased work engagement, job performance, organizational commitment, and organizational citizenship behaviors, and is inversely related to absenteeism and turnover intentions.3–5 Thus, employees’ POS is a vital indicator for an organization.

One strategy to enhance employees’ POS is to improve their supervisors’ POS.6 According to organizational support theory, supervisors reciprocate the favorable treatment they receive from the organization by extending it to their subordinates. Employees typically view their supervisors as representatives of the organization, entrusted with directing and evaluating the performance of their subordinates. Consequently, these employees interpret supervisor support as indicative of organizational support.7 Shanock and Eisenberger6 reported that supervisors with high POS initially boost employees’ perceived support from their supervisors. This increased perception then leads to enhancements in the employee’s own POS, as well as improvements in their in-role and extra-role performance.

Besides supervisor support, factors such as fair treatment, rewarding expectations, and effective human resources practices also contribute to enhancing POS. The human resource elements include training, development opportunities, and health promotion initiatives.3–5 However, most previous reports focus on lower-level employees, and to our knowledge there is limited research focusing specifically on enhancing supervisors’ POS.

Occupational health physicians and nurses (hereafter referred to as occupational health staff), as health specialists within organizations, provide essential support to supervisors managing their subordinates. These roles, common in the United States, Europe, and Japan, involve more than just health support for employees, such as lifestyle guidance based on medical examinations. Occupational health staff also advise employers and workplace supervisors on aspects of fitness to work considering subordinates’ health. Furthermore, occupational health staff are sometimes consulted by supervisors on addressing specific subordinates with health concerns, and they are expected to provide appropriate responses to these consultations.8–10 Occupational health staff are not only tasked with individual support but also, in some organizations, are required to conduct training for supervisors in supporting the health of subordinates and enhancing the comfort of the workplace environment.11,12

Building on the aforementioned factors enhancing POS, we hypothesized that occupational health staff’s involvement in providing supervisors with training in workplace health management and guidance on addressing specific subordinates with health concerns would enhance supervisors’ POS. We therefore conducted a prospective cohort study to investigate the association between occupational health staff’s involvement with supervisors and supervisors’ POS.

Methods

Study design and participants

This was a prospective cohort study conducted through an online survey, forming part of the Work, Well-being and Safety for Occupational health practice and management II Study (W2S-Ohpm II study). The baseline survey began on March 10, 2023, and concluded on March 14, after reaching the required sample size. The follow-up survey was subsequently conducted among the baseline survey participants from December 13, 2023, to December 26, 2023. This study was approved by the Ethics Committee of the University of Occupational and Environmental Health, Japan (approval numbers: R4-077). All participants provided their informed consent through an online form available on the survey website.

The target population for the survey was registered monitors of Rakuten Insight, Inc. (Tokyo, Japan). Rakuten’s services are used by many people in Japan, with over 100 million IDs issued for using these services.13 Although some individuals may hold multiple IDs, this still indicates a wide reach of Rakuten’s services across Japan. The registered monitors comprised 497 760 individuals at the time of the survey and only these monitors could answer this survey; however, we believe that the sampling did not introduce significant bias for the purpose of representing the standard population of Japan.

Rakuten Insight, Inc. managed the survey operations and communicated to the registered monitors that a certain number of points would be awarded for responding to the questions. Each participant was assigned a unique ID, and only anonymized data were accessible to researchers. We set the target sample size to 10 000 participants according to the respondent number in Japan’s annual occupational safety and health survey.14 The eligible population for the survey was workers in Japan aged 20 or older at the baseline survey. Sampling was conducted considering sex, age, and geographic region based on the actual Japanese workforce to ensure the target population accurately represented workers in Japan.15 Due to the company’s confidential information, no information was available on the initial number of invitations to participate; however, 21 965 registered monitors answered the initial screening questions and participated in the survey. Of these, 10 000 matched the survey’s criteria (worker status, sex, age, and region). We set the following exclusion criteria: unusually large height (>240 cm); unusually heavy weight (>300 kg); clearly incorrect answers; respondents who indicated that they were engaged in work for 0 days or 0 hours; respondents who worked more than 150 h/wk; respondents who provided the same responses for total weekly working hours including overtime hours and for only weekly overtime hours; respondents who answered unusually long 1-way commuting times of 7 hours or more; and respondents who stated that they had 16 or more family members living with them. This procedure resulted in a baseline dataset consisting of 9451 participants, after excluding 549 individuals. We further narrowed the participants to 1646 managerial staff at baseline, excluding nonmanagerial staff, to align with the study’s objectives. In this study, we collectively referred to these managerial staff as "supervisors."

A total of 1161 individuals (71%) participated in the follow-up survey. Because the presence or absence of occupational health staff might potentially influence the study’s primary outcome of interest—supervisors’ POS—we excluded 620 individuals from workplaces without occupational health staff for the follow-up survey. By focusing on workplaces with occupational health staff, we aimed to more accurately assess the impact of their involvement on supervisors’ POS. Ultimately, 541 supervisors were included in the final analysis. Figure 1 illustrates the study flow.

Flow chart of this study.
Figure 1

Flow chart of this study.

Assessment of supervisors’ POS

We assessed supervisors’ POS at baseline and follow-up using the Japanese version of the Survey of Perceived Organizational Support (SPOS-J).1,16 Although various abbreviated versions of the original SPOS have been used based on the research objectives,3 the 8-item version is considered an efficient substitute for the 36-item version and is widely used.17,18 After conducting exploratory and confirmatory factor analyses on the 36-item SPOS-J, item response theory19 was applied to extract an effective 8-item subset for our study (items 3, 7, 9, 10, 17, 21, 23, 25).16 The 8-item subset in both original and Japanese is listed in Table S1. Responses were on a 7-point Likert-type scale, from 0 (strongly disagree) to 6 (strongly agree). We reversed the scoring for negatively phrased items (items 3, 7, 17, 23). Total scores ranged from 0 to 48, with the Cronbach α coefficient being .89 at baseline and .88 at follow-up.

Occupational health staff’s involvement

We assessed occupational health staff’s involvement with supervisors through 2 key activities: “Training on workplace health management for supervisors” and “Guidance for supervisors on addressing specific subordinates with health concerns.” These items were selected as representative of the support that occupational health staff provide to superiors and were chosen to examine 2 main targets: supervisors as a group and supervisors individually. During the follow-up, supervisors were asked about each of the 2 items with the question: “In the past year, have you received any services from occupational health staff (occupational health physicians or nurses) at your organization?” Respondents could choose from the following options: “I have received the service from an occupational health physician,” “I have received the service from an occupational health nurse,” and “Although there are occupational health physicians and nurses, I have never received services from them.” Respondents were allowed to select more than 1 of the first 2 options. The selection of either option was classified as “Yes,” whereas the last option was classified as “No.”

Covariates

Covariates comprised demographics, industry category, and workplace size, all collected at baseline. Demographics encompassed age (continuous), sex (male, female), education (junior high or high school, vocational school or college, and university or graduate school), annual household income (<6.00 million, 6.00-7.99 million, 8.00-9.99 million, 10.00-13.99 million, and ≥14.00 million Japanese yen; the 2023 yearly average exchange rate was 1 US dollar to 140.5 Japanese yen20). For the industry category, participants selected from the 20 categories of Japan’s standard industrial classification.21 Due to the small number of participants in some categories, we grouped them into the following 8 categories for this study: primary industries (agriculture and forestry; fisheries; mining and quarrying of stone); manufacturing and construction; public services and infrastructure (electricity, gas, heat supply, and water; government except elsewhere classified; transport and postal services); information, communication, and finance (information and communications; finance and insurance); commerce and real estate (wholesale and retail trade; real estate and goods rental and leasing); professional services, education, and welfare (scientific research, professional and technical services; education, learning support; medical, healthcare, and welfare); service industries (accommodations, eating and drinking services; living-related and personal services and amusement services; compound services; services not elsewhere classified); industries unable to classify. The workplace size (number of employees) was classified into 3 categories following a previous study22: small (1-99), medium (100-999), and large (≥1000).

Analysis

Multiple regression analyses were used to examine the association between occupational health staff’s involvement (both training and guidance) and POS at follow-up. The coefficients (Β) were estimated after first adjusting for age (continuous) and sex (Model 1), then for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical) (Model 2), and, finally, for POS at baseline (continuous) (Model 3). Furthermore, POS is reported to be affected by workplace size.3 Additionally, according to the Industrial Safety and Health Act, large workplaces with more than 1000 employees are required to contract a full-time occupational health physician, whereas smaller workplaces often have a part-time occupational health physician.23 Given these factors, we considered it important to examine the relationship between occupational health staff’s involvement and supervisors’ POS by stratifying the analysis according to workplace size. We defined statistical significance as a 2-tailed P value of less than .05. All analyses were conducted using Stata Statistical Software (Release 16; StataCorp LLC, College Station, TX, USA).

Results

Table 1 presents the demographics and characteristics of the study participants. The majority of participants were male (92.2%), and a significant portion had advanced educational backgrounds, with 77.6% holding a university or graduate degree. In terms of occupational health staff’s involvement, 195 supervisors (36.0%) received training on workplace health management, and 190 (35.1%) received guidance on addressing specific subordinates with health concerns. Regarding POS scores, the baseline average was 25.9 (SD: 9.0). At follow-up, the average POS slightly increased to 26.7 (SD: 8.5).

Table 1

Participant characteristics, occupational health staff’s involvement, and perceived organizational support scores (n = 541).

Mean (SD)n (%)
Age, mean (SD)52.2 (9.2)
Sex, male499 (92.2)
Education
Junior high or high school68 (12.6)
Vocational school or college53 (9.8)
University or graduate school420 (77.6)
Annual household income (JPY)
<6.00 million78 (14.4)
6.00-7.99 million102 (18.9)
8.00-9.99 million124 (22.9)
10.00-13.99 million135 (25.0)
≥14.00 million102 (18.9)
Industry category
Primary industries3 (0.6)
Manufacturing and construction184 (34.0)
Public services and infrastructure64 (11.8)
Information, communication, and finance73 (13.5)
Commerce and real estate66 (12.2)
Professional services, education, and welfare83 (15.3)
Service industries61 (11.3)
Industries unable to classify7 (1.3)
Workplace size (number of employees)
Small (1-99)255 (47.1)
Medium (100-999)172 (31.8)
Large (≥1000)114 (21.1)
Occupational health staff’s involvement
Training on workplace health management
Yes195 (36.0)
No346 (64.0)
Guidance on addressing specific subordinates with health concerns
Yes190 (35.1)
No351 (64.9)
Perceived organizational support at baseline (range: 0-48), mean (SD)25.9 (9.0)
Perceived organizational support at follow-up (range: 0-48), mean (SD)26.7 (8.5)
Mean (SD)n (%)
Age, mean (SD)52.2 (9.2)
Sex, male499 (92.2)
Education
Junior high or high school68 (12.6)
Vocational school or college53 (9.8)
University or graduate school420 (77.6)
Annual household income (JPY)
<6.00 million78 (14.4)
6.00-7.99 million102 (18.9)
8.00-9.99 million124 (22.9)
10.00-13.99 million135 (25.0)
≥14.00 million102 (18.9)
Industry category
Primary industries3 (0.6)
Manufacturing and construction184 (34.0)
Public services and infrastructure64 (11.8)
Information, communication, and finance73 (13.5)
Commerce and real estate66 (12.2)
Professional services, education, and welfare83 (15.3)
Service industries61 (11.3)
Industries unable to classify7 (1.3)
Workplace size (number of employees)
Small (1-99)255 (47.1)
Medium (100-999)172 (31.8)
Large (≥1000)114 (21.1)
Occupational health staff’s involvement
Training on workplace health management
Yes195 (36.0)
No346 (64.0)
Guidance on addressing specific subordinates with health concerns
Yes190 (35.1)
No351 (64.9)
Perceived organizational support at baseline (range: 0-48), mean (SD)25.9 (9.0)
Perceived organizational support at follow-up (range: 0-48), mean (SD)26.7 (8.5)

Abbreviation: JPY, Japanese yen.

Table 1

Participant characteristics, occupational health staff’s involvement, and perceived organizational support scores (n = 541).

Mean (SD)n (%)
Age, mean (SD)52.2 (9.2)
Sex, male499 (92.2)
Education
Junior high or high school68 (12.6)
Vocational school or college53 (9.8)
University or graduate school420 (77.6)
Annual household income (JPY)
<6.00 million78 (14.4)
6.00-7.99 million102 (18.9)
8.00-9.99 million124 (22.9)
10.00-13.99 million135 (25.0)
≥14.00 million102 (18.9)
Industry category
Primary industries3 (0.6)
Manufacturing and construction184 (34.0)
Public services and infrastructure64 (11.8)
Information, communication, and finance73 (13.5)
Commerce and real estate66 (12.2)
Professional services, education, and welfare83 (15.3)
Service industries61 (11.3)
Industries unable to classify7 (1.3)
Workplace size (number of employees)
Small (1-99)255 (47.1)
Medium (100-999)172 (31.8)
Large (≥1000)114 (21.1)
Occupational health staff’s involvement
Training on workplace health management
Yes195 (36.0)
No346 (64.0)
Guidance on addressing specific subordinates with health concerns
Yes190 (35.1)
No351 (64.9)
Perceived organizational support at baseline (range: 0-48), mean (SD)25.9 (9.0)
Perceived organizational support at follow-up (range: 0-48), mean (SD)26.7 (8.5)
Mean (SD)n (%)
Age, mean (SD)52.2 (9.2)
Sex, male499 (92.2)
Education
Junior high or high school68 (12.6)
Vocational school or college53 (9.8)
University or graduate school420 (77.6)
Annual household income (JPY)
<6.00 million78 (14.4)
6.00-7.99 million102 (18.9)
8.00-9.99 million124 (22.9)
10.00-13.99 million135 (25.0)
≥14.00 million102 (18.9)
Industry category
Primary industries3 (0.6)
Manufacturing and construction184 (34.0)
Public services and infrastructure64 (11.8)
Information, communication, and finance73 (13.5)
Commerce and real estate66 (12.2)
Professional services, education, and welfare83 (15.3)
Service industries61 (11.3)
Industries unable to classify7 (1.3)
Workplace size (number of employees)
Small (1-99)255 (47.1)
Medium (100-999)172 (31.8)
Large (≥1000)114 (21.1)
Occupational health staff’s involvement
Training on workplace health management
Yes195 (36.0)
No346 (64.0)
Guidance on addressing specific subordinates with health concerns
Yes190 (35.1)
No351 (64.9)
Perceived organizational support at baseline (range: 0-48), mean (SD)25.9 (9.0)
Perceived organizational support at follow-up (range: 0-48), mean (SD)26.7 (8.5)

Abbreviation: JPY, Japanese yen.

Table 2 shows the association between training on workplace health management and supervisors’ POS at follow-up. Our analysis revealed that training from occupational health staff was significantly associated with an increase in POS. Specifically, after adjusting for sex and age (Model 1), and subsequently for education, annual household income, industry category, and workplace size (Model 2), the training was found to be significantly correlated with an increase in POS (Β = 3.241, SE = 0.745, P < .001). This association remained significant even after further adjustment for POS at baseline in Model 3 (Β = 2.300, SE = 0.620, P < .001).

Table 2

Training on workplace health management by occupational health staff and supervisors’ perceived organizational support at follow-up.a

Model 1Model 2Model 3
BSEPBSEPBSEP
Training on workplace health management (ref: No)
Yes3.0590.744<.0013.2410.745<.0012.2470.620<.001
Covariates
Age (continuous)0.1900.040<.0010.1620.040<.0010.1090.033.001
Sex (ref: male)
Female4.5251.372.0013.9311.410.0063.2341.166.006
Education (ref: junior high or high school)
Vocational school or college−2.5021.541.105−2.2711.274.075
University or graduate school−0.8361.094.445−0.9550.905.292
Annual household income (ref: <6.00 million)
6.00-7.99 million0.0941.239.940−0.3801.025.711
8.00-9.99 million−2.0381.207.092−1.4600.999.144
10.00-13.99 million0.9181.199.445−0.4640.995.642
≥14.00 million1.8931.272.1370.3981.056.706
Industry category (ref: Manufacturing and construction)
Primary industries3.1234.744.511−0.1213.927.975
Public services and infrastructure−1.1111.186.349−1.6650.981.090
Information, communication, and finance−0.4881.130.666−0.5560.934.552
Commerce and real estate−1.1821.193.322−0.4070.988.680
Professional services, education, and welfare0.5311.116.6340.6000.922.516
Service industries0.0511.237.9670.4051.023.692
Industries unable to classify−3.6833.413.281−1.6002.824.571
Workplace size (ref: small (1-99))
Medium (100-999)−2.1830.834.009−1.0380.693.135
Large (≥1000)−2.5880.983.009−1.9380.814.018
Perceived organizational support at baseline (continuous)0.5170.034<.001
Model 1Model 2Model 3
BSEPBSEPBSEP
Training on workplace health management (ref: No)
Yes3.0590.744<.0013.2410.745<.0012.2470.620<.001
Covariates
Age (continuous)0.1900.040<.0010.1620.040<.0010.1090.033.001
Sex (ref: male)
Female4.5251.372.0013.9311.410.0063.2341.166.006
Education (ref: junior high or high school)
Vocational school or college−2.5021.541.105−2.2711.274.075
University or graduate school−0.8361.094.445−0.9550.905.292
Annual household income (ref: <6.00 million)
6.00-7.99 million0.0941.239.940−0.3801.025.711
8.00-9.99 million−2.0381.207.092−1.4600.999.144
10.00-13.99 million0.9181.199.445−0.4640.995.642
≥14.00 million1.8931.272.1370.3981.056.706
Industry category (ref: Manufacturing and construction)
Primary industries3.1234.744.511−0.1213.927.975
Public services and infrastructure−1.1111.186.349−1.6650.981.090
Information, communication, and finance−0.4881.130.666−0.5560.934.552
Commerce and real estate−1.1821.193.322−0.4070.988.680
Professional services, education, and welfare0.5311.116.6340.6000.922.516
Service industries0.0511.237.9670.4051.023.692
Industries unable to classify−3.6833.413.281−1.6002.824.571
Workplace size (ref: small (1-99))
Medium (100-999)−2.1830.834.009−1.0380.693.135
Large (≥1000)−2.5880.983.009−1.9380.814.018
Perceived organizational support at baseline (continuous)0.5170.034<.001

Abbreviation: B, unstandardized coefficient.

aModel 1: adjusted for age (continuous) and sex. Model 2: Model 1+ additionally adjusted for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical). Model 3: Model 2+ additionally adjusted for perceived organizational support at baseline (continuous). Bold values indicate significant differences.

Table 2

Training on workplace health management by occupational health staff and supervisors’ perceived organizational support at follow-up.a

Model 1Model 2Model 3
BSEPBSEPBSEP
Training on workplace health management (ref: No)
Yes3.0590.744<.0013.2410.745<.0012.2470.620<.001
Covariates
Age (continuous)0.1900.040<.0010.1620.040<.0010.1090.033.001
Sex (ref: male)
Female4.5251.372.0013.9311.410.0063.2341.166.006
Education (ref: junior high or high school)
Vocational school or college−2.5021.541.105−2.2711.274.075
University or graduate school−0.8361.094.445−0.9550.905.292
Annual household income (ref: <6.00 million)
6.00-7.99 million0.0941.239.940−0.3801.025.711
8.00-9.99 million−2.0381.207.092−1.4600.999.144
10.00-13.99 million0.9181.199.445−0.4640.995.642
≥14.00 million1.8931.272.1370.3981.056.706
Industry category (ref: Manufacturing and construction)
Primary industries3.1234.744.511−0.1213.927.975
Public services and infrastructure−1.1111.186.349−1.6650.981.090
Information, communication, and finance−0.4881.130.666−0.5560.934.552
Commerce and real estate−1.1821.193.322−0.4070.988.680
Professional services, education, and welfare0.5311.116.6340.6000.922.516
Service industries0.0511.237.9670.4051.023.692
Industries unable to classify−3.6833.413.281−1.6002.824.571
Workplace size (ref: small (1-99))
Medium (100-999)−2.1830.834.009−1.0380.693.135
Large (≥1000)−2.5880.983.009−1.9380.814.018
Perceived organizational support at baseline (continuous)0.5170.034<.001
Model 1Model 2Model 3
BSEPBSEPBSEP
Training on workplace health management (ref: No)
Yes3.0590.744<.0013.2410.745<.0012.2470.620<.001
Covariates
Age (continuous)0.1900.040<.0010.1620.040<.0010.1090.033.001
Sex (ref: male)
Female4.5251.372.0013.9311.410.0063.2341.166.006
Education (ref: junior high or high school)
Vocational school or college−2.5021.541.105−2.2711.274.075
University or graduate school−0.8361.094.445−0.9550.905.292
Annual household income (ref: <6.00 million)
6.00-7.99 million0.0941.239.940−0.3801.025.711
8.00-9.99 million−2.0381.207.092−1.4600.999.144
10.00-13.99 million0.9181.199.445−0.4640.995.642
≥14.00 million1.8931.272.1370.3981.056.706
Industry category (ref: Manufacturing and construction)
Primary industries3.1234.744.511−0.1213.927.975
Public services and infrastructure−1.1111.186.349−1.6650.981.090
Information, communication, and finance−0.4881.130.666−0.5560.934.552
Commerce and real estate−1.1821.193.322−0.4070.988.680
Professional services, education, and welfare0.5311.116.6340.6000.922.516
Service industries0.0511.237.9670.4051.023.692
Industries unable to classify−3.6833.413.281−1.6002.824.571
Workplace size (ref: small (1-99))
Medium (100-999)−2.1830.834.009−1.0380.693.135
Large (≥1000)−2.5880.983.009−1.9380.814.018
Perceived organizational support at baseline (continuous)0.5170.034<.001

Abbreviation: B, unstandardized coefficient.

aModel 1: adjusted for age (continuous) and sex. Model 2: Model 1+ additionally adjusted for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical). Model 3: Model 2+ additionally adjusted for perceived organizational support at baseline (continuous). Bold values indicate significant differences.

Table 3 also shows a significant association between guidance on addressing specific subordinates with health concerns and an increase in supervisors’ POS at follow-up. In Model 2, the guidance was significantly correlated with an increase in POS (Β = 2.351, SE = 0.756, P = .002). This association persisted even after adjusting for POS at baseline in Model 3 (Β = 1.344, SE = 0.628, P = .033).

Table 3

Guidance on addressing specific subordinates with health concerns by occupational health staff and supervisors’ perceived organizational support at follow-up.a

Model 1Model 2Model 3
BSEPBSEPBSEP
Guidance on addressing subordinates (ref: No)
Yes2.4660.749.0012.3510.756.0021.3440.628.033
Covariates
Age (continuous)0.2000.040<.0010.1740.040<.0010.1180.034<.001
Sex (ref: male)
Female4.3361.381.0023.7841.424.0083.1471.177.008
Education (ref: junior high or high school)
Vocational school or college−2.2921.556.141−2.1471.285.096
University or graduate school−0.7501.105.497−0.9150.913.317
Annual household income (ref: <6.00 million)
6.00-7.99 million0.1901.254.880−0.3561.036.732
8.00-9.99 million−1.5751.218.196−1.1571.006.251
10.00-13.99 million0.8541.210.480−0.5271.004.600
≥14.00 million2.0541.282.1100.4971.064.641
Industry category (ref: Manufacturing and construction)
Primary industries2.4664.811.609−0.4063.979.919
Public services and infrastructure−1.1791.198.325−1.7520.990.077
Information, communication, and finance−0.5131.140.653−0.5800.942.538
Commerce and real estate−1.3061.204.279−0.4790.996.631
Professional services, education, and welfare0.4741.125.6740.5550.930.551
Service industries−0.1431.248.9090.2831.031.784
Industries unable to classify−3.4783.444.313−1.3482.849.636
Workplace size (ref: small (1-99))
Medium (100-999)−2.3100.841.006−1.1070.699.114
Large (≥1000)−2.5820.992.010−1.9070.821.021
Perceived organizational support at baseline (continuous)0.5230.034<.001
Model 1Model 2Model 3
BSEPBSEPBSEP
Guidance on addressing subordinates (ref: No)
Yes2.4660.749.0012.3510.756.0021.3440.628.033
Covariates
Age (continuous)0.2000.040<.0010.1740.040<.0010.1180.034<.001
Sex (ref: male)
Female4.3361.381.0023.7841.424.0083.1471.177.008
Education (ref: junior high or high school)
Vocational school or college−2.2921.556.141−2.1471.285.096
University or graduate school−0.7501.105.497−0.9150.913.317
Annual household income (ref: <6.00 million)
6.00-7.99 million0.1901.254.880−0.3561.036.732
8.00-9.99 million−1.5751.218.196−1.1571.006.251
10.00-13.99 million0.8541.210.480−0.5271.004.600
≥14.00 million2.0541.282.1100.4971.064.641
Industry category (ref: Manufacturing and construction)
Primary industries2.4664.811.609−0.4063.979.919
Public services and infrastructure−1.1791.198.325−1.7520.990.077
Information, communication, and finance−0.5131.140.653−0.5800.942.538
Commerce and real estate−1.3061.204.279−0.4790.996.631
Professional services, education, and welfare0.4741.125.6740.5550.930.551
Service industries−0.1431.248.9090.2831.031.784
Industries unable to classify−3.4783.444.313−1.3482.849.636
Workplace size (ref: small (1-99))
Medium (100-999)−2.3100.841.006−1.1070.699.114
Large (≥1000)−2.5820.992.010−1.9070.821.021
Perceived organizational support at baseline (continuous)0.5230.034<.001

Abbreviation: B, unstandardized coefficient.

aModel 1: adjusted for age (continuous) and sex. Model 2: Model 1+ additionally adjusted for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical). Model 3: Model 2+ additionally adjusted for perceived organizational support at baseline (continuous). Bold values indicate significant differences.

Table 3

Guidance on addressing specific subordinates with health concerns by occupational health staff and supervisors’ perceived organizational support at follow-up.a

Model 1Model 2Model 3
BSEPBSEPBSEP
Guidance on addressing subordinates (ref: No)
Yes2.4660.749.0012.3510.756.0021.3440.628.033
Covariates
Age (continuous)0.2000.040<.0010.1740.040<.0010.1180.034<.001
Sex (ref: male)
Female4.3361.381.0023.7841.424.0083.1471.177.008
Education (ref: junior high or high school)
Vocational school or college−2.2921.556.141−2.1471.285.096
University or graduate school−0.7501.105.497−0.9150.913.317
Annual household income (ref: <6.00 million)
6.00-7.99 million0.1901.254.880−0.3561.036.732
8.00-9.99 million−1.5751.218.196−1.1571.006.251
10.00-13.99 million0.8541.210.480−0.5271.004.600
≥14.00 million2.0541.282.1100.4971.064.641
Industry category (ref: Manufacturing and construction)
Primary industries2.4664.811.609−0.4063.979.919
Public services and infrastructure−1.1791.198.325−1.7520.990.077
Information, communication, and finance−0.5131.140.653−0.5800.942.538
Commerce and real estate−1.3061.204.279−0.4790.996.631
Professional services, education, and welfare0.4741.125.6740.5550.930.551
Service industries−0.1431.248.9090.2831.031.784
Industries unable to classify−3.4783.444.313−1.3482.849.636
Workplace size (ref: small (1-99))
Medium (100-999)−2.3100.841.006−1.1070.699.114
Large (≥1000)−2.5820.992.010−1.9070.821.021
Perceived organizational support at baseline (continuous)0.5230.034<.001
Model 1Model 2Model 3
BSEPBSEPBSEP
Guidance on addressing subordinates (ref: No)
Yes2.4660.749.0012.3510.756.0021.3440.628.033
Covariates
Age (continuous)0.2000.040<.0010.1740.040<.0010.1180.034<.001
Sex (ref: male)
Female4.3361.381.0023.7841.424.0083.1471.177.008
Education (ref: junior high or high school)
Vocational school or college−2.2921.556.141−2.1471.285.096
University or graduate school−0.7501.105.497−0.9150.913.317
Annual household income (ref: <6.00 million)
6.00-7.99 million0.1901.254.880−0.3561.036.732
8.00-9.99 million−1.5751.218.196−1.1571.006.251
10.00-13.99 million0.8541.210.480−0.5271.004.600
≥14.00 million2.0541.282.1100.4971.064.641
Industry category (ref: Manufacturing and construction)
Primary industries2.4664.811.609−0.4063.979.919
Public services and infrastructure−1.1791.198.325−1.7520.990.077
Information, communication, and finance−0.5131.140.653−0.5800.942.538
Commerce and real estate−1.3061.204.279−0.4790.996.631
Professional services, education, and welfare0.4741.125.6740.5550.930.551
Service industries−0.1431.248.9090.2831.031.784
Industries unable to classify−3.4783.444.313−1.3482.849.636
Workplace size (ref: small (1-99))
Medium (100-999)−2.3100.841.006−1.1070.699.114
Large (≥1000)−2.5820.992.010−1.9070.821.021
Perceived organizational support at baseline (continuous)0.5230.034<.001

Abbreviation: B, unstandardized coefficient.

aModel 1: adjusted for age (continuous) and sex. Model 2: Model 1+ additionally adjusted for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical). Model 3: Model 2+ additionally adjusted for perceived organizational support at baseline (continuous). Bold values indicate significant differences.

Table 4 presents the association between occupational health staff’s involvement and supervisors’ POS at follow-up, stratified by workplace size. In small workplaces (1-99), both training and guidance were significantly associated with increased supervisors’ POS even after adjusting POS at baseline in Model 3. However, in medium (100-999) and large workplaces (≥1000), there was no significant association between training or guidance and supervisors’ POS.

Table 4

Occupational health staff’s involvement and supervisors’ perceived organizational support at follow-up stratified by workplace size.a

Model 1Model 2Model 3
BSEPBSEPBSEP
Small workplaces (1-99)
Training on workplace health management (ref: No)
Yes4.4131.115<.0014.3591.150<.0012.7760.987.005
Guidance on addressing subordinates (ref: No)
Yes3.4451.135.0033.1081.175.0092.2000.990.027
Medium workplaces (100-999)
Training on workplace health management (ref: No)
Yes2.9331.309.0262.9571.395.0361.7441.163.136
Guidance on addressing subordinates (ref: No)
Yes2.4371.298.0621.7611.437.2220.1881.201.876
Large workplaces (≥1000)
Training on workplace health management (ref: No)
Yes0.2491.495.8680.9191.461.5311.5641.180.188
Guidance on addressing subordinates (ref: No)
Yes0.6651.498.6581.0791.412.4470.8221.146.475
Model 1Model 2Model 3
BSEPBSEPBSEP
Small workplaces (1-99)
Training on workplace health management (ref: No)
Yes4.4131.115<.0014.3591.150<.0012.7760.987.005
Guidance on addressing subordinates (ref: No)
Yes3.4451.135.0033.1081.175.0092.2000.990.027
Medium workplaces (100-999)
Training on workplace health management (ref: No)
Yes2.9331.309.0262.9571.395.0361.7441.163.136
Guidance on addressing subordinates (ref: No)
Yes2.4371.298.0621.7611.437.2220.1881.201.876
Large workplaces (≥1000)
Training on workplace health management (ref: No)
Yes0.2491.495.8680.9191.461.5311.5641.180.188
Guidance on addressing subordinates (ref: No)
Yes0.6651.498.6581.0791.412.4470.8221.146.475

Abbreviation: B, unstandardized coefficient.

aModel 1: adjusted for age (continuous) and sex. Model 2: Model 1+ additionally adjusted for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical). Model 3: Model 2+ additionally adjusted for perceived organizational support at baseline. Bold values indicate significant differences.

Table 4

Occupational health staff’s involvement and supervisors’ perceived organizational support at follow-up stratified by workplace size.a

Model 1Model 2Model 3
BSEPBSEPBSEP
Small workplaces (1-99)
Training on workplace health management (ref: No)
Yes4.4131.115<.0014.3591.150<.0012.7760.987.005
Guidance on addressing subordinates (ref: No)
Yes3.4451.135.0033.1081.175.0092.2000.990.027
Medium workplaces (100-999)
Training on workplace health management (ref: No)
Yes2.9331.309.0262.9571.395.0361.7441.163.136
Guidance on addressing subordinates (ref: No)
Yes2.4371.298.0621.7611.437.2220.1881.201.876
Large workplaces (≥1000)
Training on workplace health management (ref: No)
Yes0.2491.495.8680.9191.461.5311.5641.180.188
Guidance on addressing subordinates (ref: No)
Yes0.6651.498.6581.0791.412.4470.8221.146.475
Model 1Model 2Model 3
BSEPBSEPBSEP
Small workplaces (1-99)
Training on workplace health management (ref: No)
Yes4.4131.115<.0014.3591.150<.0012.7760.987.005
Guidance on addressing subordinates (ref: No)
Yes3.4451.135.0033.1081.175.0092.2000.990.027
Medium workplaces (100-999)
Training on workplace health management (ref: No)
Yes2.9331.309.0262.9571.395.0361.7441.163.136
Guidance on addressing subordinates (ref: No)
Yes2.4371.298.0621.7611.437.2220.1881.201.876
Large workplaces (≥1000)
Training on workplace health management (ref: No)
Yes0.2491.495.8680.9191.461.5311.5641.180.188
Guidance on addressing subordinates (ref: No)
Yes0.6651.498.6581.0791.412.4470.8221.146.475

Abbreviation: B, unstandardized coefficient.

aModel 1: adjusted for age (continuous) and sex. Model 2: Model 1+ additionally adjusted for education (categorical), annual household income (categorical), industry category (categorical), and workplace size (categorical). Model 3: Model 2+ additionally adjusted for perceived organizational support at baseline. Bold values indicate significant differences.

Discussion

Our study indicated that occupational health staff’s involvement with supervisors, through training on workplace health management and guidance on addressing specific subordinates with health concerns, was associated with an increase in supervisors’ POS. This effect was particularly notable in small workplaces. Our findings suggest that occupational health staff’s involvement in supporting supervisors to effectively manage subordinates’ health can enhance supervisors’ POS, especially in small workplaces.

One plausible reason for this association could be that supervisors require organizational support in areas like training and guidance on workplace health management. The role of supervisors in creating a healthy work environment and supporting employees with health concerns has become increasingly significant.24–26 This is especially true for employee mental health, which is a significant concern in terms of work productivity and employee turnover.27–29 Moreover, there is a growing emphasis on ensuring fitness for work for employees with chronic diseases such as cancer, stroke, and heart disease, enabling them to continue working while receiving treatment.30 As supervisors are increasingly expected to maintain a healthy work environment and address individual health concerns of employees,26 there may be an increasing demand among supervisors for organizational support in the form of these training and guidance provisions. Previous studies have indicated that organizational efforts in health management that meet employee needs can enhance POS.31,32 Consequently, the occupational health staff’s involvement, including training and guidance, might have met supervisors’ needs, potentially leading to an enhancement in their POS.

Organizational efforts to enhance employee well-being through voluntary initiatives, rather than external pressures such as corporate trade union negotiations or government regulations, have been reported to enhance POS.1,3 Occupational health physicians, who are recognized as part of the organization,22 are required by the Industrial Safety and Health Act to carry out monthly workplace patrols, attend health committee meetings, provide advice based on health examination results, and support employees who work long hours.23 In contrast, training on workplace health management and guidance on addressing specific subordinates with health concerns for supervisors are not mandated and may be perceived as voluntary support. Thus, these voluntary efforts may have contributed to the enhancement of supervisors’ POS.

Our findings showed the occupational health staff’s involvement influences supervisors’ POS, especially in small workplaces. This is probably a reflection of whether the contract is full-time or part-time, as the impact of each activity may differ. Part-time occupational health staff working in small workplaces tend to have more limited working hours compared with full-time staff, which often restricts the scope of their activities. In particular, part-time staff in Japan were reported to have shorter working hours compared with their European counterparts. Furthermore, because Japanese staff are predominantly engaged in the above tasks mandated by the Act,23 this substantial workload can impede their ability to allocate time for training in health management and advising on health promotion activities.11,33 Thus, an organization’s decision to allocate time for occupational health staff to engage with supervisors reflects a voluntary initiative, which may have contributed to the enhancement of supervisors’ POS. On the other hand, full-time staff, with their greater working hours and broader scope of activities, are likely to have more involvement with supervisors compared with part-time staff. Consequently, the impact of training and guidance provided by full-time staff might not have been as pronounced. It should also be noted that our study did not examine whether the occupational health staff were full-time or part-time, or their specific working hours. These factors could significantly influence the results and should be addressed in future research.

Our findings indicate that redefining the structure and role of occupational health staff, as health experts, might be necessary to improve supervisors’ POS, especially in small workplaces. With employee health concerns becoming increasingly individualized and encompassing various diseases, occupational health staff emerge as a vital source of organizational support.22 However, a 2022 survey in Japan showed that only a small percentage of people, 8.0% for occupational health physicians and 4.9% for occupational health nurses, selected these professionals as their primary consultation sources for stress-related issues (multiple responses were permitted).14 It is possible that workplace supervisors do not fully recognize occupational health staff as a resource for consultation. This might be due to occupational health staff’s expanding roles and limited availability for health management training and advice.11,33 Therefore, enhancing the structures and roles of occupational health staff could potentially improve supervisors’ POS.

Nonetheless, it is possible that the organizations facilitating occupational health staff’s involvement in this study also provided other forms of organizational support, such as various training programs for supervisors, potentially contributing to the improvement in POS. The influence of supervisor leadership on employee job satisfaction, work engagement, and job performance is well-established.34,35 Therefore, organizations focusing on leadership development might offer various training programs, including those conducted by occupational health staff.36 Because training and other human resources initiatives are recognized as key factors for enhancing POS,3–5 the provision of a broad range of training opportunities for supervisors may have played a significant role in improving POS. Consequently, further research into the extent of additional training provided by organizations is needed.

This study has several strengths. First, although previous research on supervisors’ POS is limited, our study stands out with a larger sample size compared with previous studies on supervisors’ POS.6,37 We successfully recruited supervisors from various industries and workplace sizes, which enhances the generalizability of our findings. Second, this is the first longitudinal study to investigate factors contributing to the improvement of supervisors’ POS, allowing for a better understanding of potential causal relationships.

However, this study has several limitations that must be acknowledged. First, there is a potential for selection bias due to the online survey methodology. We attempted to minimize this bias by selecting our sample in a manner consistent with the actual Japanese workforce.15 Second, our study did not examine variables that could have influenced the results, such as the number of subordinates managed by supervisors, their duration of employment with the organization, and their specific roles within the workplace. For example, supervisors with a greater number of subordinates might encounter more employees with health issues, potentially increasing their need for occupational health staff support. Third, our study did not investigate the specific details and frequency of the training and guidance provided by occupational health staff. Additionally, it should be noted that these evaluations were based on the supervisors’ subjective perceptions, and we did not have detailed information about how the involvement was received. For example, we did not know whether occupational health staff conducted interviews and directly intervened with subordinates who had health concerns before providing guidance to the supervisors. The improvement in supervisors’ POS could possibly be partially attributed to the direct intervention by occupational health staff that resolved the health concerns of the subordinates. Fourth, this study only addressed 2 major questions and did not examine other types of support, such as assistance with improving the work environment or methods for promoting health programs among subordinates. Future research should focus on the content, duration, and frequency of such training and guidance in more detail, investigate other types of support, and include how these involvements are conducted.

In conclusion, our findings indicate that occupational health staff’s involvement in training and guidance for supervisors might contribute to enhancing supervisors’ POS, and this effect was particularly notable in small workplaces. Consequently, organizations should consider establishing systems and defining roles for occupational health staff, enabling them to provide effective support to supervisors. Such efforts are expected to contribute to improved overall employee health and well-being.

Acknowledgments

The current members of the W2S-Ohpm Study, in alphabetical order, are as follows: Akiko Matsuyama, Asumi Yama, Ayaka Yamamoto, Ayana Ogasawara, Hideki Fujiwara, Juri Matsuoka, Kakeru Tsutsumi, Kazufumi Matsuyama, Kenta Moriya, Kiminori Odagami, Koji Mori, Kosuke Sakai, Masako Nagata, Miho Omori, Mika Kawasumi, Mizuho Inagaki, Naoto Ito, Rina Minohara, Shunusuke Inoue, Suo Taira, Takahiro Mori, Tomohisa Nagata (present chairperson of the study group), and Tomoko Sawajima. All members are affiliated with the University of Occupational and Environmental Health, Japan.

This study was approved by the Ethics Committee of the University of Occupational and Environmental Health, Japan (approval numbers: R4-077). All participants provided their informed consent through an online form available on the survey website.

Author contributions

T.N., K.O., and K.M. conceived the study ideas; T.N., K.O., N.P.A., and K.M. collected the data; T.M. designed the analysis, analyzed the data, and wrote the draft of the manuscript. All authors have advised on the data interpretation and have reviewed, edited, and approved the final manuscript.

Funding

This study was supported and partly funded by a research grant from the University of Occupational and Environmental Health, Japan [no grant number]; Japanese Ministry of Health, Labour and Welfare [grant nos. 210 401-01 to K.M. and 20JA1005 to T.N.]; JSPS KAKENHI [grant nos. JP22K10543 and JP19K19471 to T.N.]; Collabo-Health study group [support provided to T.N. and K.M., no grant number], and DAIDO LIFE INSURANCE COMPANY [support provided to K.M., no grant number]. The funders were not involved in the study design, collection, analysis, interpretation of data, writing of the article, or the decision to submit it for publication.

Conflicts of interest

T.N. reports personal fees from BackTech Inc., EWEL Inc., and Sompo Health Support Inc., outside the submitted work. K.M. reports research grants from DAIDO LIFE INSURANCE COMPANY and Komatsu Ltd, scholarship grants from AORC, BackTech Inc., DAIDO LIFE INSURANCE COMPANY, EWEL Inc., iSEQ.Inc., JMA Research Institute Inc., MEDIVA.Inc., SMS Co., Ltd, Sompo Health Support Inc., and T-PEC COPRORATION, and personal fees from BackTech Inc. and Sompo Health Support Inc., outside the submitted work. The other authors declare no conflicts of interest associated with this manuscript.

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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