Journal of Health Literacy

Journal of Health Literacy

Evaluating the Relationship between Health, Safety, and Environment Culture (HSEC) and Occupational Health and Safety Literacy (OHS Literacy): A Comparison of Two Structural Equation Modeling Approaches

Document Type : Original Article

Authors
Farideh Khosravi 1
Seyfollah Gharib 2, 3
Mohaddeseh Nouri 1
Jamshid Jamali 3, 4
Zahra Emrani 3, 5
1 Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Health, Safety, Environment management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
3 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
4 Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
5 Department of Management sciences and health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/jhl.2025.89135.1807
Abstract
Background and Objectives: Health, Safety, and Environment Culture (HSEC) shapes employees’ awareness, attitudes, and behaviors toward occupational risks. Occupational Health and Safety Literacy (OHSL) is a key determinant of accident prevention, well-being, and regulatory compliance. Understanding the HSEC–OHSL relationship is essential for organizational performance and worker safety. Structural Equation Modeling (SEM) offers tools to investigate such relationships; however, researchers face the choice between covariance-based SEM (CB-SEM) and partial least squares SEM (PLS-SEM). By contrasting these approaches, this study contributes to the theoretical understanding of safety culture and literacy and informs methodological decisions in occupational health research.

Materials and Methods: We conducted a cross-sectional survey of personnel at Shahid Hasheminejad Gas Refining Company (Khangiran) (n = 410) using cluster sampling. Instruments included demographic checklists and validated HSEC and OHSL questionnaires. Data were analyzed with PLS-SEM (SmartPLS) and CB-SEM (AMOS) to compare approaches in estimating relationships and underlying factor structures. Model fit, factor loadings, (R2), and predictive relevance were evaluated.

Results:  Mean scores were 78.66 ± 20.73 for HSEC and 74.67 ± 12.94 for OHSL (0–100 scale). Both SEM approaches showed a significant positive association: (rPLS=0.68) and (rCB=0.70). In PLS-SEM, factor loadings were higher than in CB-SEM. Based on loadings and (R2), the most influential OHSL facet was the use of health and safety information; for HSEC, on-the-job training and human factors were prominent. In CB-SEM, the communications factor had the highest loading.

Conclusion: Our findings support a positive HSEC–OHSL interrelationship, contributing to workplace safety and organizational performance. Overall, high levels of HSEC and OHSL suggest a foundation for promoting safe practices and continuous safety-management improvement. Enhancing both culture and literacy may yield synergistic effects for a safer, more productive work environment.
Keywords
Structural Equation Modeling
Partial Least Squares Structural Equation Modeling
Covariance-Based Structural Equation Modeling
Health, Safety, and Environment Culture
Occupational Health and Safety Literacy

Acknowledgements: We would like to thank all the personnel of Shahid Hasheminejad Gas Refining Company (Khangiran) who participated in this study. We would also like to thank the refinery managers who were very cooperative in collecting the data. This project was funded by the Vice-Chancellor for Research of Mashhad University of Medical Sciences (Research Project Code: 4020889).


Availability of Data and Materials: The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request, pending approval by the Mashhad Regional Committee for Medical Research Ethics.


Conflicts of interest: All authors declare that they have no conflict of interest.


Consent for publication: Not applicable.


Ethics Approval and Consent to Participate: Ethical approval was granted by the Ethics Committee of Mashhad University of Medical Sciences, Iran (IR.MUMS.FHMPM.REC.1402.123). All procedures adhered to the Declaration of Helsinki and relevant institutional guidelines. Written informed consent was obtained from all participants. Participants in this study provided informed consent before completing questionnaires.


Funding: This research received funding from the Mashhad University of Medical Science, Iran.


Authors’ Contributions: Farideh Khosravi: Study design, Initial draft, data analysis, data analysis, interpretation of the results, preparation of the final version of the article. Seyfollah Gharib and Mohaddeseh Nouri: questionnaire collection, participation in the draft of the article. Jamshid Jamali: Supervisor this project, Conceptualization, Study design, data analysis, interpretation of the results, final version revision. All authors have approved the final manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

  1. Fernández-Muñiz B, Montes-Peón JM, Vázquez-Ordás CJ. Relation between occupational safety management and firm performance. Safety science. 2009;47(7):980-91. https://doi.org/10.1016/j.ssci.2008.10.022
  2. Molavi Vardanjani R, Rafati M, Zaeimdar M. Assessment of the Function of the Health, Safety and Environmental Management System (HSE) in the Dry Milk Factory of Pegah Shahr E Kord with the Balanced Scorecard Approach. Journal of Environmental Science and Technology. 2020;22(9):115-27.
  3. Mirzaei H. Guide to safety, health and workplace conditions. Training center and Industrial Research of Iran. 2006;27.
  4. Hemmatju Y. Review the safety of workers and its association with events happening in a match factory city of Tabriz. J Tehran Uni Med Sci. 2008;45:654-9.
  5. Kletz TA. An engineer's view of human error: IChemE; 2001.
  6. Cooper D. Improving safety culture: A practical guide: Wiley; 1998.
  7. Abed M. Establishment of mistake acceptance for work safety. Tadbir J. 2009;4:54-7.
  8. DiCuccio MH. The relationship between patient safety culture and patient outcomes. Journal of patient safety. 2015;11(3):135-42. https://doi.org/10.1097/PTS.0000000000000058 PMid:24583952
  9. Nasiri P, Alizade S, Ahmadlu M. Development of an effective safety culture. Publisher Islamic Azad University. Science and Research Branch. 2007:31-40.
  10. Alimohammadi I, Hashemi H, Farshad A, Amini M, Haghi B, Nouri S. Safety culture survey questionnaire detergents and cleaners industries. J Health Safety Work. 2012;1.
  11. Wiegmann DA, von Thaden TL, Gibbons AM. A review of safety culture theory and its potential application to traffic safety. Improving Traffic Safety Culture in the United States. 2007;113:6-7.
  12. Bodur S, Filiz E. A survey on patient safety culture in primary healthcare services in Turkey. International Journal for Quality in Health Care. 2009;21(5):348-55. https://doi.org/10.1093/intqhc/mzp035 PMid:19700779
  13. Pelikan J, Röthlin F, Ganahl K. The European Health Literacy Project, 2009-2012. Ludwig Boltzmann Institut. 2012.
  14. Ozdemir H, Alper Z, Uncu Y, Bilgel N. Health literacy among adults: a study from Turkey. Health education research. 2010;25(3):464-77 https://doi.org/10.1093/her/cyp068 PMid:20080808
  15. Nutbeam D. Health promotion glossary. Health promotion. 1986;1(1):113-27 https://doi.org/10.1093/heapro/1.1.113 PMid:10318625
  16. Lee Y-M, Yu HY, You M-A, Son Y-J. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian. 2017;24(1):11-8. https://doi.org/10.1016/j.colegn.2015.08.003 PMid:29218957
  17. Kim Y, Park J, Park M. Creating a culture of prevention in occupational safety and health practice. Safety and health at work. 2016;7(2):89-96. https://doi.org/10.1016/j.shaw.2016.02.002 PMid:27340594 PMCid:PMC4909854
  18. Rauscher KJ, Myers DJ. Occupational health literacy and work-related injury among US adolescents. International journal of injury control and safety promotion. 2014;21(1):81-9. https://doi.org/10.1080/17457300.2013.792288 PMid:23679156
  19. Lingard HC, Cooke T, Blismas N. Safety climate in conditions of construction subcontracting: a multi‐level analysis. Construction management and economics. 2010;28(8):813-25. https://doi.org/10.1080/01446190903480035
  20. Neal A, Griffin MA. A study of the lagged relationships among safety climate, safety motivation, safety behavior, and accidents at the individual and group levels. Journal of applied psychology. 2006;91(4):946. https://doi.org/10.1037/0021-9010.91.4.946 PMid:16834517
  21. Tabachnick B, Fidell L, Ullman J. Using multivariate statistics (Vol. 5, pp. 544-561). Pearson; 2019.
  22. Boomsma A, Hoogland JJ. The robustness of LISREL modeling revisited. Structural equation models: Present and future A Festschrift in honor of Karl Jöreskog. 2001;2(3):139-68.
  23. Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2023.
  24. Hair JF. A primer on partial least squares structural equation modeling (PLS-SEM): sage; 2014. https://doi.org/10.1108/EBR-10-2013-0128
  25. Suthakorn W, Songkham W, Tantranont K, Srisuphan W, Sakarinkhul P, Dhatsuwan J. Scale Development and Validation to Measure Occupational Health Literacy Among Thai Informal Workers. Safety and health at work. 2020;11(4):526-32. https://doi.org/10.1016/j.shaw.2020.06.003 PMid:33329920 PMCid:PMC7728703
  26. Noori M, Jamali J, Rezvani Z, Gharaee A, Gharib S. Evaluation of the Psychometric Properties of the Persian Version of the Occupational Health and Safety Literacy Questionnaire among Process Industry Workers. J Health Lit. 2024;9(1):53-65.
  27. Gholkhandan MN, Rezvani Z, Jamali J, Gharib S. Evaluation of the Psychometric Properties of the Health, Safety, and Environment (HSE) Culture Questionnaire Based on the Oil and Gas Producers (OGP) Guide in Process Industries. 2023.
  28. Huang W. PLSe: Efficient Estimators and Tests for Partial Least Square. Los Angeles, USA University of California, Los Angeles (UCLA); 2013.
  29. Hair Jr JF, Hult GTM, Ringle CM, Sarstedt M. A primer on partial least squares structural equation modeling (PLS-SEM): Sage publications; 2021. https://doi.org/10.1007/978-3-030-80519-7
  30. Benitez J, Henseler J, Castillo A, Schuberth F. How to perform and report an impactful analysis using partial least squares: Guidelines for confirmatory and explanatory IS research. Information & Management. 2020;57(2):103168. https://doi.org/10.1016/j.im.2019.05.003
  31. Tenenhaus M. Component-based Structural Equation Modelling. Total Qual Manag Bus Excell. 2008;19(7-8):871-86. https://doi.org/10.1080/14783360802159543
  32. Richter NF, Sinkovics RR, Ringle CM, Schlägel C. A critical look at the use of SEM in international business research. International marketing review. 2016;33(3):376-404. https://doi.org/10.1108/IMR-04-2014-0148
  33. Astrachan CB, Patel VK, Wanzenried G. A comparative study of CB-SEM and PLS-SEM for theory development in family firm research. J Fam Bus Strateg. 2014;5(1):116-28. https://doi.org/10.1016/j.jfbs.2013.12.002
  34. Dash G, Paul J. CB-SEM vs PLS-SEM methods for research in social sciences and technology forecasting. Technol Forecast Soc Change. 2021;173:121092. https://doi.org/10.1016/j.techfore.2021.121092
  35. Hair JF. Multivariate data analysis. 2009.
  36. Halvani G, Ebrahimzadeh M, Dehghan M, Fallah H, Mortazavi M. Assessment of factors affecting safety culture in Yazd steel industry workers. Occupational Medicine Quarterly Journal. 2012;4(1):66-72.
  37. Hosseinzadeh K, Mohammadfam I, Soltanzadeh A, Soltanian A. Assessing the Relationship between Safety Culture and Occupational Accidents: A Case Study in a Processing Industry using Structural Equation Modeling. Journal of Occupational Hygiene Engineering. 2023;10(1):25-32. https://doi.org/10.52547/johe.10.1.4
  38. Ozaydin F, Demirci H, Karayurek Y. Relatıonship Between Occupational Accidents of Industrial Workers and Health Literacy and Workplace Safety Climate. Eur Health Liter J. 2021;1:47-57. https://doi.org/10.29228/ehlj.51105
  39. Haghighi M, Alimohammadi I, Zarie F, Yekefalah D. Assessment Health, Safety & Environment Culture in an Oil Refinery Based On Geller Model. Iranian Journal of Health Education and Health Promotion. 2013;1(3):47-56.
  40. Henseler J, editor Assessing and testing the goodness-of-fit of PLS path models. The 3rd Annual Conference of the Dutch/Flemish Classification Society (Vereniging voor Ordinatie en Classificatie-VOC); 2014.
  41. Choi SI. Modeling Students' Satisfaction with English-Medium Instruction : A Comparison of CB-SEM vs. PLS-SEM Approaches. J Lang Sci. 2021;28:207-28. https://doi.org/10.14384/kals.2021.28.3.207
  42. Amaro S, Abrantes JL, Seabra C. Comparing CB-SEM and PLS-SEM results: an empirical example. The Conference for PLS Users (1-7); Sevilla: University of Twente2015 https://doi.org/10.3990/2.357