Abstract
BackgroundNumerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). Research primarily focused on the effectiveness of these WHPPs. Whereas process evaluations provide essential information necessary to improve large scale implementation across other settings. Therefore, this review aims to: (1) further our understanding of the quality of process evaluations alongside effect evaluations for WHPPs, (2) identify barriers/facilitators affecting implementation, and (3) explore the relationship between effectiveness and the implementation process.MethodsPubmed, EMBASE, PsycINFO, and Cochrane (controlled trials) were searched from 2000 to July 2012 for peer-reviewed (randomized) controlled trials published in English reporting on both the effectiveness and the implementation process of a WHPP focusing on physical activity, smoking cessation, alcohol use, healthy diet and/or relaxation at work, targeting employees aged 18-65 years.ResultsOf the 307 effect evaluations identified, twenty-two (7.2%) published an additional process evaluation and were included in this review. The results showed that eight of those studies based their process evaluation on a theoretical framework. The methodological quality of nine process evaluations was good. The most frequently reported process components were dose delivered and dose received. Over 50 different implementation barriers/facilitators were identified. The most frequently reported facilitator was strong management support. Lack of resources was the most frequently reported barrier. Seven studies examined the link between implementation and effectiveness. In general a positive association was found between fidelity, dose and the primary outcome of the program.ConclusionsProcess evaluations are not systematically performed alongside effectiveness studies for WHPPs. The quality of the process evaluations is mostly poor to average, resulting in a lack of systematically measured barriers/facilitators. The narrow focus on implementation makes it difficult to explore the relationship between effectiveness and implementation. Furthermore, the operationalisation of process components varied between studies, indicating a need for consensus about defining and operationalising process components.
Highlights
Numerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle
Literature search and study selection For this systematic review, peer-reviewed studies were eligible for inclusion when they reported an effect evaluation as well as a process evaluation for a worksite health promotion intervention focusing on stimulating a healthy lifestyle published in English between 2000 and July 2012
Step 1: a literature search was in the online databases Pubmed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled trials for peer-reviewed Worksite health promotion program (WHPP) effect evaluations published in English from 2000 to July 2012
Summary
Numerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). In order to change employees’ health and lifestyle, programs need to work as intended (and avoid theory failure) They must be effectively transferred from research to practice and be maintained over time [9]. Research starts to recognize the importance of evaluating different implementation outcomes (such as recruitment, dose delivered, dose received, fidelity, satisfaction, and maintenance) and the contextual factors that hinder or facilitate the implementation of a WHPP [11,12,13,14]. Since WHPPs are often comprehensive interventions with multiple components, it is difficult to determine the overall level of implementation and investigate which specific intervention components have been successful [14,16]
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