Occupational health literacy, injury risk, and temporary work disability: a multicenter cross-sectional study in Turkey

Occupational injuries continue to impose a substantial burden on workers’ health and productivity, particularly in the metal industry. However, the extent to which occupational health literacy (OHL) influences injury occurrence and work disability duration remains unclear. We conducted a multicenter cross-sectional study involving 649 workers from foundry and machinery factories in Turkey in April 2025. Two outcomes were assessed: risk of occupational injury and duration of temporary work disability. Time to first injury among blue-collar men hired after 2020 was analyzed using Cox regression. Lost workdays among all blue-collar men were modeled using negative binomial mixed models, applying a staged modeling approach: Model 1 included demographic and work-related factors, and Model 2 additionally included injury-related variables. During the study period, 205 workers experienced 326 injury events. Among blue-collar men hired after 2020, the one- and three-year injury-free survival rates were 78.4% and 57.4%, respectively. Older age, higher educational attainment, and being single were associated with lower injury risk, whereas foundry work was associated with a higher risk of occupational injury. OHL was not associated with injury risk. In Model 1 of the negative binomial mixed models, higher OHL scores were associated with fewer lost workdays (IRR = 0.98; 95% CI: 0.97–1.00; p = 0.042); this association was attenuated and no longer statistically significant after adjustment for injury-related characteristics in Model 2. Higher OHL was not associated with injury occurrence but may be associated with the duration of temporary work disability following injury. These findings suggest that work disability duration reflects a multifactorial process shaped by both injury-specific characteristics and individual-level factors, with OHL potentially playing a complementary role in post-injury recovery rather than serving as a primary determinant of outcomes. Longitudinal studies are needed to clarify these relationships and inform targeted workplace health interventions.