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Abstract
Background: Basic occupational health services (BOHS) promote workplace health through participatory approaches that integrate informal workers into primary care-based occupational health systems. However, participation remains low, and limited research explains why engagement readiness does not necessarily improve despite increased knowledge.
Objective: This study examined the direct and indirect effects of BOHS-based health promotion on informal tourism workers’ readiness to participate, assessed the mediating role of knowledge, and identified barriers to the transition from knowledge to preparedness.
Methods: A mixed-methods, sequential, explanatory design was used. The quantitative phase involved a survey of 222 informal tourism workers, analyzed using partial least squares structural equation modeling. The qualitative phase consisted of in-depth interviews and focus group discussions conducted to explain and contextualize the quantitative results.
Results: Health promotion significantly increased readiness to participate (p<0.05;f²=0.480) and knowledge (p<0.05;f²=0.304) . However, knowledge did not mediate the relationship between health promotion and readiness (p=0.186;f²=0.001) . Qualitative findings showed that income insecurity, irregular schedules, limited managerial and institutional support, and weak follow-up mechanisms constrained workers’ ability to transform knowledge into readiness.
Conclusion: Health promotion influences readiness primarily through relational, motivational, and contextual mechanisms rather than cognitive acquisition alone. These findings highlight the need for adaptive and participatory BOHS strategies that address structural and social barriers. For effective implementation, BOHS implementers and primary health centers should incorporate flexible scheduling, continuous mentoring, and participatory leadership into routine practice. Embedding BOHS activities within workers’ social and organizational environments can strengthen sustained participation and promote more equitable and resilient occupational health systems.
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article Type: Research Article
EUR J SUSTAIN DEV RES, Volume 10, Issue 3, 2026, Article No: em0406
https://doi.org/10.29333/ejosdr/18566
Publication date: 01 Jul 2026
Online publication date: 16 May 2026
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