Effectiveness of Toolbox Talks as a Workplace Safety Intervention in the United States: A Scoping Review

Response to Reviewer 1 Comments

1. Summary

We appreciate the reviewer’s thorough and thoughtful evaluation of our manuscript. We have carefully considered each comment and made revisions accordingly to strengthen the clarity, structure, and depth of our analysis. Below we provide point-by-point responses and describe how the manuscript has been revised to address these concerns.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Can be improved

See responses below.

Is the research design appropriate?

Must be improved

See responses below

Are the methods adequately described?

Can be improved

See responses below

Are the results clearly presented?

Must be improved

See responses below

Are the conclusions supported by the results?

Must be improved

See responses below

3. Point-by-point response to Comments and Suggestions for Authors

Reviewer Comments 1: You might ask what it looks like in industries other than construction.

Response 1:  Thank you for this comment. In the Introduction section (1.1. Toolbox Talks) we included a range of other high-risk industries/occupations/users of Toolbox Talks, their wide accessibility on the internet.

Comments 2: It is also interesting whether the methodology of such activities affects their effectiveness. The authors do not pay enough attention to this issue. I would propose to expand this issue a little.

Response 2: We agree that knowing whether the methodology of activities plays a role in the effectiveness of TBTs. In response, we have expanded the Discussion section to directly address how intervention characteristics including participatory delivery methods, narrative formats, digital tools, and supervisor involvement either enhance or limit effectiveness. This is now supported by citations to studies that used these specific approaches (e.g., Kaskutas et al., 2016a; Eggerth et al., 2018).

Reviewer Comment 3:To sum up, the work is very limited, which may cause the reader to fail to identify the essence of the issue. One gets the impression that many threads are touched upon without being explained in detail. It requires expansion and detail.

Response 3: We appreciate this critique. The qualitative nature of this scoping review did pose analytical challenges, which we point out in the limitations section. Additionally, the intent to include a narrative synthesis in the scoping review (although not required per PRISMA) was meant to provide more in-depth analysis across studies and highlight key findings more cohesively. Nevertheless, we have worked to revise the manuscript to provide clearer organization and narrative flow. In particular:

• We clarified the research aim and questions in the Introduction.
• In the Results section, we improved transitions between sections 3.2 to 3.3 by including statements to be more interpretive and solution oriented by the authors.  In our statements, we provide thematic closure to the effectiveness of TBT findings and set up the reader to understand why the next section on challenges is necessary.
• In the Discussion section, we carefully revised the content to ensure it was data driven and relevant to the literature we reviewed.

Reviewer Comment 4: No clearly formulated research thesis has been indicated, although it seems obvious. It is a literature analysis, but I would suggest specifying the area of the search.

Response 4: Thank you for pointing this out. In response, we incorporated and explicitly stated the i) study objectives, listing three specific research questions in the Introduction as stated below;

Research questions guiding this review are as follows:

1. What is the reported effectiveness of Toolbox Talks as an occupational safety intervention?
2. What challenges and barriers are associated with their implementation?
3. What best practices and delivery methods improve their impact?

In addition, we added 2 theoretical frameworks in the Introduction section to guide the interpretation of TBT effectiveness by explaining the cognitive and motivational mechanisms, specifically, how adult learning principles and perceived risk influence worker engagement, knowledge retention, and behavioral change.

Reviewer Comment 5: A more detailed description of the methodology presented in Figure A1, paying attention to limitations and factors interfering with finding the requested applications.

Response 5: Thank you for noting this. We have revised the Methods section to offer more explanation of our screening and selection process. This includes:

·        Revision to the Methods section providing detailed description of the study search using PRISMA-ScR guidelines.

·        Revision to the Limitations section providing clarification and details of inconsistent terminology of search terms across sectors and database indexing as limitations.

Reviewer Comment 6: In many chapters (this is how I treat issues covered by separate points) it is difficult to determine what the authors wanted to point. I have the impression that these are rather some reflections. This requires some sorting out.

Response 6: The qualitative nature and overlap of effectiveness categories created challenges for developing a narrative synthesis and may appear to include reflections as part of the findings. However, we carefully reviewed the Results section and revised this section to ensure the information presented clearly stems from the content of the studies and are reported as data-driven findings. We also organized this section by using the reviewers suggestion by addressing these as separate points in the Results section.

Reviewer Comment 7: The results presented may be very important as preliminary research, but even in this form they should be organized.

Response 7: Again, we appreciate the reviewer’s comment and agree this section was a bit muddled. After careful review we re-organized and revised sections within Results by reorganizing Table 1, listing the “Effectiveness Categories” in the first column so that it is organized by Effectiveness Domain. We also used separated the “Effectiveness Categories” so that the result are more organized when describing the results.  We reorganized the Introduction section by rearranging content. More specifically, we first define and describe Toolbox Talks in the context of origin and purpose. Next in Section 1.2 we discuss the “Significance of TBTs,” followed by 1.3 Theoretical Framework, and then 1.4 Objectives and research questions. The  Discussion section so that the introductory section is clear and logically organized.  

Reviewer Comment 8: The literature has been selected correctly. Its scope is sufficient.

Response 8: Thank you for this positive evaluation and are pleased that the scope and selection of literature met the reviewer’s standards.

4. Reviewer Point 1: Comments on the Quality of English Language: I am not qualified to assess the quality of the English language used.

Response to Comments on the Quality of English Language. N/A

5. Additional clarifications

Response to Reviewer 2 Comments

Response to Reviewer 3 Comments

1. Summary

We sincerely thank Reviewer #3 for the thoughtful and encouraging feedback on our manuscript, "Toolbox Talks in the United States: A Scoping Review of Effectiveness, Challenges and Best Practices." We appreciate your suggestions to broaden the scope and clarity of the paper and have incorporated each point as detailed below.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Yes

See responses below.

Is the research design appropriate?

Yes

See responses below

Are the methods adequately described?

Yes

See responses below

Are the results clearly presented?

Yes

See responses below

Are the conclusions supported by the results?

Yes

See responses below

1.                Point-by-point response to comments and Suggestions for Authors

Reviewer Comments 1: Lines 40–42 – It is worth noting that similar results are found in Europe and Canada, and references can be found from the Workers Compensation reports of those regions/countries. Mentioning this would broaden the application of the work.

Response 1: Thank you for this helpful suggestion. We have added a brief mention in the Introduction to acknowledge that similar workplace injury and fatality trends have been documented in other countries such as Canada and across Europe. This addition broadens the context while maintaining our U.S.-specific focus for analysis.

Reviewer Comments 2: Line 47 – The term "Toolbox Talk" is introduced. In Line 131 – "Tailgate Talks" was also searched. Different groups use Toolbox Talks or Tailgate Talks – they are the same thing. I would introduce that thought into Line 47.

Response 2: Agree. The text at Line 47 has been revised to include “or Tailgate Talks” to clarify that Toolbox Talks and Tailgate Talks are synonymous terms used interchangeably.

Reviewers Comments 3. Line 75 – Add "29CFR" before the section references – not everyone realizes it is a U.S. Federal Regulation.

Response 3: Thank you for the reminder. We have added "29 CFR" before all cited OSHA regulatory sections in the manuscript (e.g., 29 CFR 1926.21(b)(2)) to ensure readers unfamiliar with U.S. regulations recognize these as federal occupational safety standards.

Comments 4. You may wish to add in S5 – Conclusions – that the Process Industries include “Safety Moment” as the first agenda item in all meetings. This is a Toolbox Talk – for people working in offices – and it targets SAB primarily.

Response 4.  Nice point. We have included this in the Conclusion section, acknowledging that “Safety Moments” function as a form of Toolbox Talk. This practice emphasizes Safety Attitudes and Beliefs and illustrates how TBT principles are applied beyond traditional field-based settings.

4. Response to Comments on the Quality of English Language

Point 1:

Response 1: n/a

5. Additional clarifications

n/a

1. Summary

We appreciate the reviewer’s thorough and thoughtful evaluation of our manuscript. We have carefully considered each comment and made revisions accordingly to strengthen the clarity, structure, and depth of our analysis. Below we provide point-by-point responses and describe how the manuscript has been revised to address these concerns.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Can be improved

See responses below.

Is the research design appropriate?

Can be improved

See responses below

Are the methods adequately described?

Can be improved

See responses below

Are the results clearly presented?

Can be improved

See responses below

Are the conclusions supported by the results?

Must be improved

See responses below

3. Point-by-point response to Comments and Suggestions for Authors

 Reviewer Overall Comments 1: The answers provided do not constitute an exhaustive explanation of my reservations. The work has been corrected, but the comments made in the previous assessment should be reviewed again.

Response to Overall Comments 1:  Thank you for your continued feedback. We have carefully revisited all comments from both rounds of review and have made additional revisions throughout the manuscript in each of the sections mentioned to more fully address your concerns. We have highlighted these areas in yellow. We are hopeful that the changes and expanded explanations meet your expectations and strengthen the overall quality of this work.

Comments 2: Introduction – Can be improved.

Response 2: Thank you for your feedback. We have revised the Introduction to provide clearer context, added relevant references, and strengthened the rationale for the review by more explicitly identifying gaps in the literature and aligning with the study objectives.

Reviewer Comment 3: Research Design – Can be improved.

Response 3: Thank you for the comment. We have improved the Research Design by clarifying the rationale for using a scoping review design, aligned it with PRISMA-ScR guidelines, and explained its suitability for addressing the study’s broad and exploratory research questions.

Reviewer Comment 4: Methods – Can be improved.

Response 4: Thank you for the comment. The Methods section has been revised for greater clarity and detail, including expanded descriptions of the eligibility criteria, search strategy, data charting process, and outcome categorization to improve transparency and reproducibility.

Reviewer Comment 5:  Results – Can be improved.

Response 5: Thank you for the comment. The Results section has been refined for improved clarity and organization, with more structured summaries of effectiveness outcomes across domains and clearer alignment with the study’s research questions and tables.

Reviewer Comment 6: Conclusions – Must be improved.

Response 6: Thank you for the comment. The Conclusion has been revised to better reflect the study’s key findings and align with the effectiveness outcome domains. We clarified the practical implications of TBTs, emphasized the importance of addressing implementation barriers, and strengthened the final statement by specifying future research needs, including optimal delivery methods, long-term impact assessments, and standardized outcome measures.