. Author manuscript; available in PMC: 2015 Jun 18.

Published in final edited form as: J Occup Environ Med. 2014 Jun;56(6):579–587. doi: 10.1097/JOM.0000000000000171

TABLE 3.

Unique Barriers and Opportunities for Small Businesses

Barriers	Opportunities
Direct cost³	Less bureaucracy, easier implementation
Indirect cost (time, staff, and facility)³²	Employee suggestions incorporated more easily
Lack of employee interest³	Greater personal accountability
Lack of management support³	Potential for teamwork/bonding
Lack of expertise	Higher participation rates³¹ (note: study scored as low rigor)
Uncertain ROI because of less employer-based health insurance³³
Rural setting with less access, or fewer health promotion providers³²
Manager fear of “paternalistic” image²⁹
Difficult to evaluate (expertise, cost to outsource)
Protecting employee privacy, avoid stigmatizing individuals

ROI, return on investment.