OBJECTIVES: We examined factors regarding help-seeking intentions in terms of the balance between treatment and job content among Japanese employees working for small- and medium-sized enterprises. In doing so, we focused upon a cooperative organizational culture and workers' attitudes toward seeking help from others. METHODS: We conducted a web-based survey on cooperative organizational culture, workers' attitudes toward help-seeking, and job-related factors via a representative sample of Japanese employees in terms of industry and company size. Participants included 3,286 full-time employees aged 20-64 years who had not had a history of sick leave beyond one month or health-related work restrictions. After they were provided a leaflet regarding the balance between treatment and job content - as advocated by the Japanese Ministry of Health, Labour and Welfare - participants were asked to answer their intention of help-seeking in an imaginary situation where they had been diagnosed as having a severe physical illness. We conducted multivariate logistic regression analysis using cooperative organizational culture and workers' attitudes toward help-seeking as explanatory variables, and the intention of help-seeking as the dependent variable, adjusted for relevant job-related and demographic variables. RESULTS: Approximately 75% of participants reported an active intention to seek help regarding the balance between treatment and job content. Those who reported the highest levels of cooperative organizational culture revealed the intention of seeking out help significantly more frequently than those who reported the lowest levels of cooperative organizational culture in the workplace (odds ratio: 1.5, 95% confidence interval: 1.1-1.9). Similarly, those with the highest attitude reported help-seeking intentions significantly more frequently (odds ratio: 1.4, 95% confidence interval: 1.1-1.7). Other job-related factors - such as the presence/absence of consultation desks or occupational health staff - were also significantly associated with the intention to seek help. CONCLUSIONS: Our findings suggest that an increase in awareness of the system regarding the balance between treatment and job content may enhance workers' intention to seek help regarding their health-related issues. After the adjustment of relevant job-related factors, cooperative organizational culture and workers' attitudes toward help-seeking were significantly associated with the intention to seek help. For those who are passive in seeking help regarding their health-related issues despite their awareness of the support system, the enhancement of a cooperative organizational culture, along with a positive attitude toward help-seeking via workplace improvement programs and in-company training, may promote the intention of help-seeking among employees working for small- and medium-sized companies.