Abstract
BackgroundWorksite health promotion (WHP) initiatives are increasingly seen as having potential for large-scale health gains. While health insurance premiums are directly linked to workplaces in the USA, other countries with universal health coverage, have less incentive to implement WHP programs. Size of the business is an important consideration with small worksites less likely to implement WHP programs. The aim of this study was to identify key intervention points and to provide policy makers with evidence for targeted interventions.MethodsThe worksites (n = 218) of randomly selected, working participants, aged between 30 and 65 years, in two South Australian cohort studies were surveyed to assess the practices, beliefs, and attitudes regarding WHP. A survey was sent electronically or by mail to management within each business.ResultsSmaller businesses (<20 employees) had less current health promotion activies (mean 1.0) compared to medium size businesses (20–200 employees – mean 2.4) and large businesses (200+ employees – mean 2.9). Management in small businesses were less likely (31.0 %) to believe that health promotion belonged in the workplace (compared to 55.7 % of medium businesses and 73.9 % of large businesses) although half of small businesses did not know or were undecided (compared to 36.4 and 21.6 % of medium and large businesses). In total, 85.0 % of smaller businesses believed the health promotion activities currently employed in the worksite were effective (compared to 89.2 % of medium businesses and 83.1 % of large businesses). Time and funding were the most cited responses to the challenges to implementing health promoting strategies regardless of business size. Small businesses ranked morale and work/life balance the highest among a range of health promotion activities that were important for their workplace while work-related injury was the highest ranked consideration for large businesses.ConclusionThis study found that smaller workplaces had many barriers, beliefs and challenges regarding WHP. Often small businesses find health promotion activities a luxury and not a serious focus of their activities although this study found that once a health promoting strategy was employed, the perceived effectiveness of the activities were high for all business regardless of size. Tailored low-cost programs, tax incentives, re-orientation of work practices and management support are required so that the proportion of small businesses that have WHP initiatives is increased.
Highlights
Worksite health promotion (WHP) initiatives are increasingly seen as having potential for large-scale health gains
Small businesses were less likely to have occupational health and safety (OHS) agenda items and large businesses were less likely to have staff wellbeing discussed at management meetings
The mean number of health promotion activities undertaken by business size was 1 for small businesses, 2.4 for medium businesses and 2.9 for large businesses
Summary
Worksite health promotion (WHP) initiatives are increasingly seen as having potential for large-scale health gains. Evidence suggests smaller firms are less likely to have successfully initiated health promotion interventions [10, 13,14,15,16] compared to the larger workplaces who have the benefits of economies of scale and additional resources [13]. The research indicates that implementation of WHP decreases as the size of the workplace decreases [17] with the most cited barriers for smaller workplaces being lack of interest from workers, lack of knowledge, program costs, lack of appropriate level of resources and lack of support from management [10, 14, 16]. While the most popular WHP initiatives include assistance with smoking cessation, increasing physical activity, improving nutrition, stress management and reduction, weight management, and responsible alcohol intake, the uptake vary by size of workplace
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