Worksite Health Promotion Programs Research Articles

Economic benefit of the PHLAME wellness programme on firefighter injury

Work-related injuries and illness are prevalent and costly. Firefighting is especially hazardous and many firefighters sustain work-related injuries. Workplace health promotion programmes have shown positive return on investment (ROI). Little is known about how similar programmes would impact injury and cost among firefighters. To evaluate the impact of a workplace health promotion intervention on workers' compensation (WC) claims and medical costs among Oregon fire departments participating in the PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) health promotion programme compared with Oregon fire departments not participating in PHLAME. Data from firefighters from four large urban fire departments in Oregon were evaluated using a retrospective quasi-experimental study design. Outcomes were (i) total annual firefighter WC claims, (ii) total annual incurred medical costs prior to and after implementation of the PHLAME firefighter worksite health promotion programme (iii) and an ROI analysis. Data were obtained from 1369 firefighters (mean age of 42 years, 91% white, 93% male). WC claims (P < 0.001) and medical costs (P < 0.01) were significantly lower among PHLAME fire departments compared with Oregon fire departments not participating in the programme. Fire departments participating in the PHLAME TEAM programme demonstrated a positive ROI of 4.61-1.00 (TEAM is used to indicate the 12-session peer-led health promotion programme). Fire department WC claims and medical costs were reduced after implementation of the PHLAME workplace health promotion programme. This is a low cost, team-based, peer-led, wellness programme that may provide a feasible, cost-effective means to reduce firefighter injury and illness rates.

Mindfulness Interventions to Reduce Stress among Nursing Personnel

Workplace stress within health care settings is rampant and predicted to increase in coming years. The profound effects of workplace stress on the health and safety of nursing personnel and the financial impact on organizations are well documented. Although organizational modification can reduce some sources of stress, several unique stress-producing factors inherent in the work of nursing personnel are immutable to such approaches. Mindfulness training, an evidence-based approach to increase situational awareness and positive responses to stressful situations, is an inexpensive strategy to reduce stress and improve the quality of nurses' work lives. Several approaches to training, such as mindfulness-based stress reduction, can be tailored to health care settings. Considerations for occupational health nurses in incorporating mindfulness training as an aspect of a comprehensive work site health promotion program for nursing and other hospital personnel are discussed.

Sitting on Stability Balls: Biomechanics Evaluation in a Workplace Setting

Use of a stability ball alone and stability ball chair were evaluated in the Veterans Health Administration as possible alternatives to incorporate with regular office chair use. The evaluation of stability ball use was conducted under the auspices of a work site health promotion program as a cross-over trial with participants rotating through use of the stability ball, stability ball chair, and regular office chair on a monthly basis for a total duration of 3 months. Rotations on regular office chairs served as the control. Three medical facilities participated. A total of 193 employees completed a baseline questionnaire; 159 completed at least one post-rotation questionnaire. Self-reported measures included perceived posture when sitting, perceptions of overall balance, energy levels, job performance, safety, and pain. Use was associated with improvements in perceived posture (p < 0.0001) and energy levels (p = 0.007) for stability ball users compared with the office chair control, and improvements in perceived posture (p < 0.0001) and overall balance (p = 0.05) for stability ball chair users compared with the control. Use of stability balls at work decreases the likelihood of reporting pain from regular office chair use from approximately 45% to 21%. Alternatively, a high number of participants reported pain with use of the stability ball alone and stability ball chair, 42% and 45%, respectively. The perceived risks and benefits of stability ball use should be weighed when incorporating use. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplementary resource: Post-Active Sitting Device Questionnaire]

Effectiveness of Worksite Interventions to Increase Influenza Vaccination Rates Among Employees and Families

To increase influenza vaccination rates among industrial employees and their families through a campaign at a large corporation. This prospective, multisite study used employee surveys and claims data to evaluate an evidence-based worksite vaccination program. Vaccination rates among insured employees and dependents (N = 13,520) increased significantly after the intervention (P < 0.001). More than 90% of vaccinated employees received vaccine at employer-sponsored events. There was a strong association between employee and family vaccination status. Primary reasons for receiving the vaccine were economic (free 84%; convenient 80%; avoid absenteeism 82%), rather than health-related. Knowledge was associated with vaccination, but customized education did not change beliefs. Worksite programs can demonstrably increase vaccination rates among industrial employees and families. Consideration should be given to repositioning vaccination from medical treatment to community initiatives offered with other worksite health promotion programs.

Workplace dietary improvement initiatives ought not to be discouraged by modest returns from low-intensity interventions

We would like to thank Maes and colleagues for their timely and comprehensive summary of European-based studies on the effectiveness of workplace-based interventions to promote healthy eating.1 Their broad inclusion in particular, of a wide range of study designs and efforts to grade both study reporting and intervention quality are to be commended. However, they may be doing their own efforts a disservice, in that their discussion and conclusions seem overly cautious and conservative. For example, the results cited include: Given the widely acknowledged difficulties around implementing sustainable dietary behaviour change, we feel that the review as presented should be considered as encouragement for further workplace-based interventions, aimed at improving dietary quality. Another recent review not restricted to European-only studies also found that worksite health promotion programmes …

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.

The Influence of Worksite and Employee Variables on Employee Engagement in Telephonic Health Coaching Programs: A Retrospective Multivariate Analysis

This study assessed 11 determinants of health coaching program participation. A cross-sectional study design used secondary data to assess the role of six employee-level and five worksite-level variables on telephone-based coaching enrollment, active participation, and completion. Data was provided by a national provider of worksite health promotion program services for employers. A random sample of 34,291 employees from 52 companies was selected for inclusion in the study. Survey-based measures included age, gender, job type, health risk status, tobacco risk, social support, financial incentives, comprehensive communications, senior leadership support, cultural support, and comprehensive program design. Gender-stratified multivariate logistic regression models were applied using backwards elimination procedures to yield parsimonious prediction models for each of the dependent variables. Employees were more likely to enroll in coaching programs if they were older, female, and in poorer health, and if they were at worksites with fewer environmental supports for health, clear financial incentives for participation in coaching, more comprehensive communications, and more comprehensive programs. Once employees were enrolled, program completion was greater among those who were older, did not use tobacco, worked at a company with strong communications, and had fewer environmental supports for health. Both worksite-level and employee-level factors have significant influences on health coaching engagement, and there are gender differences in the strength of these predictors.

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.

Steps that count! The development of a pedometer-based health promotion intervention in an employed, health insured South African population.

BackgroundPhysical activity (PA) has been identified as a central component in the promotion of health. PA programs can provide a low cost intervention opportunity, encouraging PA behavioral change while worksites have been shown to be an appropriate setting for implementing such health promotion programs. Along with these trends, there has been an emergence of the use of pedometers as a self-monitoring and motivational aid for PA.This study determines the effectiveness of a worksite health promotion program comprising of a 10-week, pedometer-based intervention (“Steps that Count!”), and individualized email-based feedback to effect PA behavioral change.MethodsThe study is a randomized controlled trial in a worksite setting, using pedometers and individualized email-based feedback to increase steps per day (steps/d). Participant selection will be based on attendance at a corporate wellness event and information obtained, following the completion of a Health Risk Appraisal (HRA), in keeping with inclusion criteria for the study. All participants will, at week 1 (pre-intervention), be provided with a blinded pedometer to assess baseline levels of PA. Participants will be provided with feedback on pedometer data and identify strategies to improve daily PA towards current PA recommendations. Participants will thereafter be randomly assigned to the intervention group (INT) or control group (CTL). The INT will subsequently wear an un-blinded pedometer for 10 consecutive weeks.Individualized feedback messages based on average steps per day, derived from pedometer data (INT) and general supportive/motivational messages (INT+CTL), will be provided via bi-weekly e-mails; blinded pedometer-wear will be conducted at week 12 (post-intervention: INT+CTL).DiscussionThe purpose of this paper is to outline the rationale behind, and the development of, an intervention aimed at improving ambulatory PA through pedometer use, combined with regular, individualized, email-based feedback. Pedometer-measured PA and individualized feedback may be a practical and easily applied intervention.Trial registrationNumber: DOH-27-0112-3951

Making Healthy Behaviors the Easy Choice for Employees

As employers look for ways to reduce rising health care costs, worksite health promotion interventions are increasingly being used to improve employee health behaviors. An alternative approach to traditional worksite health promotion programs is the implementation of environmental and/or policy changes to encourage employees to adopt healthier behaviors. This review examines the evidence for the effectiveness of worksite health promotion programs using environmental and/or policy changes either alone or in combination with individually focused health behavior change strategies. A review of the relevant literature, published between 1995 and 2010, identified 27 studies that met all inclusion criteria. Limited evidence was found for the effectiveness of environmental and/or policy changes alone (n = 11) to change employee behavior, but more promising results were identified with multicomponent interventions (n = 16). There is a strong need for improvement in the design and evaluation of future health promotion programs focusing solely on environmental and/or policy changes at the worksite.

Measuring Worksite Health Promotion Programs: an application of Structural Equation Modeling with ordinal data

This paper presents a model for measuring the outcome of Worksite Health Promotion Programs through an application of Structural Equation Modeling with ordinal data. We model the function "being healthy" as a vector comprised of three latent or unobservable variables: Health Status, Lifestyle and Stress. Each variable can be measured only indirectly through a set of manifest or observable ordinal indicators. The objective is to derive and analyze the distributions, and changes in distributions over time, of the latent variables on an individual level. The model is analyzed empirically on data from three large Swedish manufacturing firms.

Cost-Effectiveness of Health Risk Reduction After Lifestyle Education in the Small Workplace

IntroductionInvestigations suggest that worksite health promotions in large companies decrease employer health costs and the risk for chronic disease. However, evidence of the success of such programs in small organizations is lacking. The purpose of this study was to determine whether a worksite health promotion program improves health risk and is cost-effective for a small employer.MethodsIntervention (n = 29) and comparison (n = 31) participants from a 172-employee organization underwent health screening of risk factors for coronary heart disease at baseline (fall 2006) and at 12 months (fall 2007). The intervention group attended lifestyle education videoconferences and reported physical activity. We used the Framingham Risk Score to calculate risk of coronary heart disease. To calculate cost-effectiveness, we used direct employer costs of the program divided by either the relative reduction in low-density lipoprotein cholesterol or the absolute change in coronary heart disease risk.ResultsAt 12 months, low-density lipoprotein cholesterol, total cholesterol, and number of metabolic syndrome markers were significantly higher in the comparison group than in the intervention group. Total cholesterol was significantly lower at 12 months than at baseline in the intervention group. Waist circumference and number of metabolic syndrome markers increased significantly from baseline in the comparison group. Cost-effectiveness of the intervention was $10.17 per percentage-point reduction of low-density lipoprotein cholesterol and $454.23 per point reduction in coronary heart disease risk.ConclusionThis study demonstrated the cost-effectiveness in a small organization of a worksite health promotion that improved low-density lipoproteins and coronary heart disease risk in participating employees.

Impact of a Web-Based Worksite Health Promotion Program on Absenteeism

To evaluate the effect of participation in a comprehensive, Web-based worksite health promotion program on absenteeism. Study population consists of Dutch workers employed at a large financial services company. Linear regression was used to assess the impact of program attendance on the difference between baseline and follow-up absenteeism rates, controlling for gender, age, job level, years of employment, and noncompletion of the program. Data from 20,797 individuals were analyzed; 3826 individuals enrolled in the program during the study period. A 20.3% reduction in absenteeism was shown among program attendees compared with nonparticipants during a median follow-up period of 23.3 months. Participating in the worksite health promotion program led to an immediate reduction in absenteeism. Improved psychological well-being, increased exercise, and weight reduction are possible pathways toward this reduction.

Initial and Sustained Participation in an Internet-delivered Long-term Worksite Health Promotion Program on Physical Activity and Nutrition

BackgroundDeterminants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users.ObjectiveIn this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied.MethodsDeterminants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website.ResultsComplete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85).ConclusionsModest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program.Trial RegistrationISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353

Meta-Evaluation of Worksite Health Promotion Economic Return Studies: 2012 Update

Two earlier editions of The Art of Health Promotion reported formal meta-evaluations of economic return studies of worksite health promotion programs. These meta-evaluations were among the most popular articles in our publishing history because practitioners, scientists, and employers continue to seek evidence on the economic effectiveness of workplace health promotion. The 2003 report examined 42 peer-reviewed journal articles that met the inclusion criteria, and the 2005 report examined 56 peer-reviewed journal articles. This 2012 update examines 10 additional studies that met the same set of inclusion criteria; four of the weaker studies were dropped, resulting in a total of 62 studies in this report. The meta-evaluation method used here is the same as used in the earlier reports and has been adapted from use with other preventive health programs, providing an overall summary and individual look at the quality of the peer reviewed articles that comprise the current scientific evidence of economic return for worksite health promotion and wellness programs. The term ‘‘meta-evaluation’’ as used in this article is defined as the application of a systematic review process to a set of evaluation studies with a similar purpose in order to determine their respective quality and to summarize their primary findings. It applies the formal meta-evaluation review process and methodology developed and refined by Windsor and Orleans and further modified by Boyd and Windsor to studies of multi-component worksite health promotion programs as defined by Heaney. This report include excerpts from the book Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, seventh edition, revised and expanded in December of 2011, which applies the same methodology. This edition of The Art of Health Promotion addresses the following topics:

Cost-effectiveness of a long-term Internet-delivered worksite health promotion programme on physical activity and nutrition: a cluster randomized controlled trial.

This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the unit of randomization. The intervention was compared with a standard programme consisting of a physical health check with face-to-face advice and personal feedback on a website. The intervention consisted of several additional website functionalities: action-oriented feedback, self-monitoring, possibility to ask questions and monthly e-mail messages. Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake. Secondary outcomes were self-perceived health, obesity, elevated blood pressure, elevated cholesterol level and maximum oxygen uptake. Direct and indirect costs were calculated from a societal perspective, and a process evaluation was performed. Of the 924 participants, 72% participated in the first and 60% in the second follow-up. No statistically significant differences were found on primary and secondary outcomes, nor on costs. Average direct costs per participant over the 2-year period were €376, and average indirect costs were €9476. In conclusion, no additional benefits were found in effects or cost savings. Therefore, the programme in its current form cannot be recommended for implementation.

Finding a Fit With Fitness: Applying Intentional Change Theory in Worksite Health Promotion Programming

This article presents evidence on the effectiveness of worksite health promotion programs and the correspondingly low participation rates in such programs. To address this gap, Boyatzis's Intentional Change Theory (ICT) is offered as an integrative theory for increasing good health practices. Generally accepted health promotion guidelines are applied to each of the five discoveries of ICT to assist employees in finding their own fit with fitness and thus increase their individual participation in health promotion. To explain the differing contexts for ICT engagement, complexity theory is used to contrast the Positive Emotional Attractor (PEA) and the Negative Emotional Attractor (NEA). The physiological changes that occur when people are in either the PEA or NEA condition are also identified. Last, the elements of each condition are examined, the health promotion applications for each of ICT's five discoveries are summarized, and specific employee actions for each discovery that ignite sustained, desired change are identified.

Reductions in Employee Productivity Impairment Observed After Implementation of Web-Based Worksite Health Promotion Programs

To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

Assessing quality of a worksite health promotion programme from participants’ views: findings from a qualitative study in Malaysia

Background An assessment of the process and outcomes of a health promotion programme is necessary for the continuous improvement of a programme. Objective To explore the participants’ perceptions of the quality and effectiveness of the ‘Love Your Heart Programme’. Design A qualitative study using semi-structured interviews with a purposive sample of participants of the ‘Love Your Heart’ programme. Interviews were based on an interview guide that grouped questions into four main subgroups: structure, process, immediate outcomes and impact. The interviews were audio-recorded, transcribed verbatim and analysed using the principles of grounded theory. Results A total of 17 interviews were conducted. The participants were satisfied with the structural aspects of the programme. Different opinions arose regarding the ideal frequency and duration of the programme. The content of the seminars was thought to be too general. There was also a lack of interest in the ‘Road to a Healthy Heart’ booklet. All of the respondents had positive opinions about the communication skills and attitude of the health educator. The potential advantages and disadvantages of participating in the programme were discussed. Finally, the respondents expressed their satisfaction with the programme and the impact it had on them. Discussion and conclusions In general, the participants who were interviewed held the programme, and the health educator conducted the programme in high regard. The suggestions that were received can be used to further improve the acceptability and feasibility of the programme.

The ACTIVATE Study: Results from a Group-Randomized Controlled Trial Comparing a Traditional Worksite Health Promotion Program with an Activated Consumer Program

PURPOSE. This study compares a traditional worksite-based health promotion program with an activated consumer program and a control program DESIGN. Group randomized controlled trial with 18-month intervention. SETTING. Two large Midwestern companies. SUBJECTS. Three hundred and twenty employees (51% response). INTERVENTION. The traditional health promotion intervention offered population-level campaigns on physical activity, nutrition, and stress management. The activated consumer intervention included population-level campaigns for evaluating health information, choosing a health benefits plan, and understanding the risks of not taking medications as prescribed. The personal development intervention (control group) offered information on hobbies. The interventions also offered individual-level coaching for high risk individuals in both active intervention groups. MEASURES. Health risk status, general health status, consumer activation, productivity, and the ability to evaluate health information. ANALYSIS. Multivariate analyses controlled for baseline differences among the study groups. RESULTS. At the population level, compared with baseline performance, the traditional health promotion intervention improved health risk status, consumer activation, and the ability to recognize reliable health websites. Compared with baseline performance, the activated consumer intervention improved consumer activation, productivity, and the ability to recognize reliable health websites. At the population level, however, only the activated consumer intervention improved any outcome more than the control group did; that outcome was consumer activation. At the individual level for high risk individuals, both traditional health coaching and activated consumer coaching positively affected health risk status and consumer activation. In addition, both coaching interventions improved participant ability to recognize a reliable health website. Consumer activation coaching also significantly improved self-reported productivity. CONCLUSION. An effective intervention can change employee health risk status and activation both at the population level and at the individual high risk level. However, program engagement at the population level was low, indicating that additional promotional strategies, such as greater use of incentives, need to be examined. Less intensive coaching can be as effective as more intensive, albeit both interventions produced modest behavior change and retention in the consumer activation arm was most difficult. Further research is needed concerning recruitment and retention methods that will enable populations to realize the full potential of activated consumerism.