Despite extensive research on health in working life, few studies focus on this issue from the perspective of managers in small-scale enterprises (SSEs). To gain deeper knowledge of managers’ perceptions and strategies for dealing with workplace health management, 13 Norwegian and Swedish SSE managers were interviewed after participating in a workplace health development project. The methodical approach was based on Grounded Theory with a constructivist orientation. The main theme that emerged was ‘ambiguity in workplace health management and maintaining the business’, which was related to the categories ‘internal workplace settings’, ‘workplace surroundings’, and ‘leadership strategies’. The managers experienced ambiguity due to internal and external demands. These requirements were linked to the core challenges in dealing with multitasking leadership, financial decision-making, labour legislation, staff development and maintaining business. However, the managers developed new skills and competence and thereby a more reflexive approach and readiness to create a health-promoting workplace from being part of a development project. The implications are that managers in SSEs need to exchange experiences and discuss workplace health issues with other managers in networks. It is also important that occupational health services and social and welfare organizations use tailor-made models and strategies for supporting SSEs.
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