Comprehensive Worksite Health Promotion Program Research Articles

Cost-effectiveness and cost-benefit of worksite health promotion programs in Europe: a systematic review.

The aim of this study was to assess the evidence regarding economic evaluations of worksite health promotion programs in Europe. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search, study selection, data extraction and quality appraisal were performed independently by two researchers. Full economic evaluations of worksite health promotion programs carried out in a European workplace were included. From 1728 search results, 39 articles describing 37 studies were included. Regarding methodological quality, 9 studies were rated as strong, 15 as moderate and 15 as weak. Six of the studies fulfilled the minimum standard for health economic evaluations. Worksite health promotion was applied in many different forms for a wide range of settings. Cost-effectiveness, cost-benefit and cost-utility analyses were performed from different perspectives. Effects on health outcomes tended to be small and uncertain. Only 9 out of 21 cost-benefit analyses reported a financial benefit and 10 out of 23 cost-effectiveness analyses concluded that the intervention was cost-effective. Two out of eight cost-utility analyses were found to be cost-effective. Productivity loss accounted for more than 85% of the total costs and thus, was the main cost driver in the analyses. Due to considerable heterogeneity, no specific type of intervention could be identified to be particularly effective and the economic value of worksite health promotion remains uncertain. Further studies, investigating comprehensive worksite health promotion programs are needed to provide evidence on their efficiency. Guidelines to perform economic evaluations in the field of worksite health promotion, especially for valuation of productivity loss, are required.

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program.

To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.

Estimating the return on investment from a health risk management program offered to small Colorado-based employers.

To determine whether changes in health risks for workers in small businesses can produce medical and productivity cost savings. A 1-year pre- and posttest study tracked changes in 10 modifiable health risks for 2458 workers at 121 Colorado businesses that participated in a comprehensive worksite health promotion program. Risk reductions were entered into a return-on-investment (ROI) simulation model. Reductions were recorded in 10 risk factors examined, including obesity (-2.0%), poor eating habits (-5.8%), poor physical activity (-6.5%), tobacco use (-1.3%), high alcohol consumption (-1.7%), high stress (-3.5%), depression (-2.3%), high blood pressure (-0.3%), high total cholesterol (-0.9%), and high blood glucose (-0.2%). The ROI model estimated medical and productivity savings of $2.03 for every $1.00 invested. Pooled data suggest that small businesses can realize a positive ROI from effective risk reduction programs.

Non-Communicable Disease Prevention and Worksite Health Promotion Programs: A Brief Review

Introduction: Non-communicable diseases (NCD’s) accounted for nearly two-thirds of global deaths in 2008. The aim of this literature review is to examine current evidence for the role of worksite health promotion programs’ role in the prevention of NCD’s. The prevalence of risk factors for NCD’s among employees and the clustering of risk behaviors among employees will be discussed. In addition, the role of health risk appraisals as an entry for worksite health promotion programs is discussed. Methods: The search strategy included using Pub Med to find relevant manuscripts. Manuscripts that were published within the last 10 years, as well as systematic reviews and meta-analyses were given priority due to the limited scope of this review. Results: Worksite health promotion programs have been shown to result in economic benefits both for the employer and employee. In addition to the economic benefits, previous research has shown that worksite health promotion programs are effective in reducing the risk for NCD’s among employees. Comprehensive worksite health promotion programs which include tailoring the program according to the company’s and employees’ needs have been found to be most effective. In addition, worksite intervention programs that have had the greatest impact on improving employee health were those targeting the employees at highest risk for NCD’s. The Health Risk Assessment (HRA) is one of the most frequently implemented worksite health promotion programs and has been implemented in more than 50% of large companies in the USA by 2004. The HRA is beneficial to identify employees who might be at increased risk for NCD, and could be considered as the first step towards improved health. Conclusion: Worksite health promotion programs have the potential to play a role in reducing the prevalence of NCD’s and their risk factors and both health and economic benefits.

Impact of Financial Incentives on Behavior Change Program Participation and Risk Reduction in Worksite Health Promotion

To examine the impact of financial incentives on behavior change program registration, completion, and risk improvement rates. Retrospective cohort study conducted to observe the relationship between financial incentives and behavior change program registration, completion, and risk improvement rates. Large public- or private-sector employers. Twenty-four organizations (n = 511,060 eligible employees) that offered comprehensive worksite health promotion (WHP) programs. Financial incentives offered for completion of a behavior change program as part of a WHP program. Behavior change program registration and completion data were obtained from standard reports. Company-level risk change was calculated from the average per-person number of risks on baseline and follow-up health risk assessments. Incentive design was determined from questionnaires completed by WHP program managers. Average registration rates, program completion rates, and risk improvement rates were compared using t-tests for companies that did versus did not offer incentives. Comparisons were also made between companies with incentives of less than $100 and those with incentives of $100 or more. Correlations between incentive value and outcome variables were assessed using Pearson correlations. Companies that offered incentives had significantly higher health coaching completion rates than companies not offering an incentive (82.9% vs. 76.4%, respectively, p = .017) but there was no significant association with registration (p = .384) or risk improvement rates (p = .242). Incentive values were not significantly associated with risk improvement rates (p = .240). Offering incentives for completing behavior change programs may increase completion rates, but increased health improvement does not necessarily follow.

Health Benefits of an Active Weight Loss Module in a Multicomponent Worksite Health Promotion Program

PURPOSE: To discover the effects of an active weight loss (AWL) module in a comprehensive worksite health promotion (WHP) program for employees beyond the age 40. METHODS: 180 subjects (m: 70.6%; f: 29.4%; age: 47.5 ± 6.3) out of 660 employees from a Swiss insurance company enrolled in a modular 3-month program. This WHP program included 8 intervention categories such as "exercise", "nutrition" and "relaxation" with multiple offerings. Participants had to select at least one offering from each of the 8 categories. AWL, in the nutrition category, included 8 behavioral and nutritional education lessons and independent training in the fitness center 2/week. In a randomized delayed treatment design 12 health and fitness variables, including body composition analysis (% of body fat (%BF)), body mass index in kg/m2 (BMI) and waist hip ratio (WHR) were measured at baseline, 3 (end of program), 6 and 9 months post-baseline to assess potency of the intervention modules. Analyses were made with SPSS 15.0. RESULTS: 33 (P-AWL) (m: 66.7%; f: 33.3%; age: 47.1 ± 6.0) out of 158 subjects who completed the study chose the AWL module. The remaining 125 subjects (OTHERS) (m: 72.8%; f: 27.2%; age: 47.3 ± 6.3) did not select the AWL. At baseline P-AWL had significant higher mean values than OTHERS in %BF, BMI and WHR. Both groups showed a significant decrease in all 3 variables between baseline and 3 months post-baseline (end of program). For P-AWL the decrease in BMI (baseline - 28.7 ± 4.3 vs. 3-months - 27.8 ± 3.6 vs. 9-months - 27.9 ± 3.8), %BF (28.0 ± 6.9 vs. 26.9 ± 7.1 vs. 27.7 ± 7.1) and WHR (.89 ± .10 vs. .87 ± .09 vs. .88 ± .10) lasted until the 9 months measurement contrary to OTHERS (BMI: 24.8 ± 3.2 vs. 24.7 ± 3.2 vs. 24.7 ± 3.4; %BF: 22.1 ± 8.0 vs. 22.5 ± 8.1 vs. 23.0 ± 8.1 and WHR: .85 ± .07 vs. .85 ± .08 vs. .85 ± .08). The two-way (group*time) ANOVA with repeated measures showed a significant decrease over time in the P-AWL group compared to the OTHERS group in BMI (p<0.00), %BF (p<0.03) and WHR (p<0.01). CONCLUSION: The subjects who chose AWL, a combination of behavioral and nutritional education and exercise, had greater and lasting health benefits compared to those who did not choose this module. A recommendation of the ideal WHP module combination to maximize health effects is currently being developed.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

Implementation and Outcomes of a Comprehensive Worksite Health Promotion Program

This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p=0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization’s perspective, program implementation was very successful. This study’s results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.

Results of the 2004 National Worksite Health Promotion Survey

We examined worksite health promotion programs, policies, and services to monitor the achievement of the Healthy People 2010 worksite-related goal of 75% of worksites offering a comprehensive worksite health promotion program. We conducted a nationally representative, cross-sectional telephone survey of worksite health promotion programs stratified by worksite size and industry type. Techniques appropriate for analyzing complex surveys were used to compute point estimates, confidence intervals, and multivariate statistics. Worksites with more than 750 employees consistently offered more programs, policies, and services than did smaller worksites. Only 6.9% of responding worksites offered a comprehensive worksite health promotion program. Sites with a staff person dedicated to and responsible for health promotion were significantly more likely to offer a comprehensive program, and sites in the agriculture and mining or financial services sector were significantly less likely than those in other industry sectors to offer such a program. Increasing the number, quality, and types of health promotion programs at worksites, especially smaller worksites, remains an important public health goal.

Evaluating A Comprehensive Worksite Health Promotion Program For Older Employees

Evaluating A Comprehensive Worksite Health Promotion Program For Older Employees

Worksite-based research and initiatives to increase fruit and vegetable consumption

Background. Worksite initiatives to promote increased consumption of fruits and vegetables include a wide range of programs. Some initiatives focus on the physical and informational environments, with the dual aim of increasing the availability of healthful food options and providing education and support through point-of-choice labeling and signage. Methods. Authors reviewed recent literature on comprehensive worksite health promotion programs that have addressed some type of environmental/organizational intervention to increase fruit/vegetable consumption. Results. This review revealed that environmental/organizational initiatives rely on management commitment, supervisory support, and supportive organizational structures to sustain policy efforts over time. Program effectiveness is enhanced when they are based on social ecological approaches; include worker participation in program planning and implementation (e.g. employee advisory boards and peer-delivered interventions); address multiple (vs. single) risk factors for change; and integrate workers' broader social context (e.g. families, neighborhoods, etc.). Conclusions. Priorities for future worksite-based interventions include identifying and reducing barriers to organizational and environmental change, addressing social disparities in fruit and vegetable consumption, addressing social contextual factors driving behaviors, and building expanded networks of community partnerships. Future research is needed to identify key policy and program components that will yield meaningful increases in fruit and vegetable consumption; barriers/facilitators of organizational and environmental change within worksites; effective community-based participatory methods; and methods to disseminate cost-effective interventions for all worksites.

Examination of risk status transitions among active employees in a comprehensive worksite health promotion program.

Most worksite health promotion programs are designed to effect risk reduction. Net changes in the prevalence of health behaviors are a combination of individuals who reduce to low-risk and those who become high-risk. It is the purpose of this study to examine overall risk status transitions, between low-risk (0-2 risks); medium-risk (3-4 risks); and high-risk (5 or more risks), within a comprehensive worksite health promotion program over the first year of the program (short-term) and after 5 years (long-term). Significant increases were demonstrated in the numbers of individuals who transitioned to lower risk status. Nearly half (0 percentage points) of the net reduction to low-risk status (+10.4 percentage points) occurred during the first year of the program. The design of health promotion programs may need to be adjusted from risk reduction in the short-term to programs that maximize retention of individuals within low-risk categories over the long-term. This program design would maximize the opportunity to obtain initial risk reduction during the first years of the program and then maximize the opportunity to maintain low-risk status in the long-term.

The impact of worksite-based health risk appraisal on health-related outcomes: a review of the literature.

To provide a brief history of the development and evolution of health risk appraisal (HRA) and to review studies published in peer-reviewed journals that address the impact of worksite-based HRA on health-related outcomes. The Centers for Disease Control and Prevention conducted the primary literature search, identifying seven articles through a bibliographic search of major health databases, manual search of specific journals, and reference list search. We identified four additional studies from our personal experience and our manual search of previous reviews. Several studies reported positive changes in seat-belt use and self-reported physical activity associated with HRA participation, and changes in other health-related outcomes after HRA participation were also reported. Evidence supporting causal inference is lacking, however, because of the many threats to internal validity in studies completed to date. Almost no research has addressed the impact of HRA on health-related outcomes in the early "prebehavioral" stages of the change process, despite the theoretical and applied focus of HRA on these types of outcomes. On the basis of the small number of studies in the literature, evidence is weak regarding the impact of HRA itself on health-related outcomes. There is suggestive evidence for the effectiveness of HRA when it is used in a comprehensive worksite health promotion program. Future research should focus on the impact of HRA on variables in the early stages of the change process, such as awareness and commitment, rather than on behavioral outcomes. Research should also address specific characteristics of HRA instruments and implementation approaches.

A Randomized Trial of the IMPACT Worksite Cholesterol Reduction Program

To evaluate the incremental effectiveness of a worksite cholesterol control management program when added to an established, comprehensive health promotion program at the worksite, we conducted a randomized, controlled trial including both blue- and white-collar employees at four geographically dispersed worksites. One hundred twenty-seven employees with serum cholesterol levels of 240 mg/dL or greater were assigned to receive an enhanced intervention program (the IMPACT program) while 125 were assigned to a regular screening and referral group, which included a comprehensive worksite health promotion program. One hundred eighteen program and 116 control subjects had one-year follow-up measures recorded. We used venipuncture specimens to obtain standardized baseline and follow-up cholesterol measures. Program subjects experienced a mean decline of 16.6 mg/dL as compared to a decline of 10.0 mg/dL in control subjects. The crude intergroup difference was 6.6 mg/dL (95% confidence internal [CI] = 1.1, 14.3), while the adjusted difference was 6.9 mg/dL (95% CI = 0.5, 14.3). Neither difference was significant at the .05 level. The percentage of program subjects who reduced their cholesterol level to below 240 mg/dL (36%) was significantly greater than the corresponding percentage among control subjects (21%). The enhanced worksite cholesterol control program provided incremental benefit in the percentage of individuals with elevated cholesterol in a population already exposed to a comprehensive worksite health promotion program that includes regular cholesterol screening, referral, and education activities.

Impact of Worksite Health Promotion on Health Care Costs and Utilization

This study explores the relationship between exposure to a comprehensive worksite health promotion program and health care costs and utilization. The experience of two groups of Johnson & Johnson employees (N = 5192 and N = 3259) exposed to Live for Life, a comprehensive program of health screens, life-style improvement programs, and worksite changes to support healthier life-styles, was compared with that of a control group (N = 2955) over a five-year period. To account for baseline differences, analyses of covariance produced adjusted means for inpatient hospital costs, admissions, hospital days, outpatient costs, and other health costs. Mean annual inpatient cost increases were $43 and $42 for two Live for Life groups vs $76 for the non-Live for Life group. Live for Life groups also had lower rates of increase in hospital days and admissions. No significant differences were found for outpatient or other health care costs.

Health promotion for educators: Impact on absenteeism

The impact of a comprehensive worksite health promotion program on employee absenteeism in a large metropolitan school district was evaluated. Participants in the program ( n = 3,846) did not differ from nonparticipants ( n = 8,290) in age or sex distributions. Program participants improved their physical fitness, body composition, coronary risk factors, and overall feeling of well-being. Absenteeism was determined for the study year and for the previous year from records in the district personnel office. Absenteeism differences were evaluated by analysis of covariance by using age, sex, ethnic group, and the previous year's absenteeism as covariates. Participants who completed the health promotion program had an average of 1.25 days less absenteeism ( P < 0.0001) during the study year than nonparticipants. Regression analyses indicated that improvement in physical fitness was associated with less absenteeism. The results suggest that a reduction in absenteeism due to the health promotion program was possibly associated with an improvement in physical fitness.