A well-functioning systematic occupational safety and health management is beneficial for both individuals and organizations, and employee motivation seems to be crucial for positive outcomes. Occupational safety and health issues are a major concern for the Swedish equine sector since the work environment in horse stables is known to be characterized by low mechanization, high physical workloads, and high injury risks. The purpose of this study was to gain an increased understanding of how systematic occupational safety and health management is performed and which factors that influence motivation for occupational safety and health improvements in the Swedish equine sector. An explanatory sequential mixed-methods study, based on quantitative data from questionnaires and qualitative data from semi-structured interviews, was conducted. Various statistical analyses were performed to obtain quantitative data and an abductive applied thematic analysis was applied for the qualitative data. The results indicate that both intrinsic motivators, i.e. attitudes, values, and influence, as well as contextual factors such as motivational management, occupational culture, and workplace resources, influence compliance in systematic occupational safety and health management and participation in occupational safety and health improvements, which in turn affect workplace outcomes regarding safety and health. The positive relationship found between an implemented and functioning systematic occupational safety and health management and employee motivation for occupational safety and health improvements indicate the importance of employee involvement and participation. Understanding the motivational factors for occupational safety and health improvements from an employee perspective is an important step to creating healthy and sustainable workplaces.