Worksite Health Promotion Research Articles

The motivating power of gamification

Purpose An increasing number of firms have implemented workplace health promotion programmes (WHPPs). However, such programmes can only be effective and economically viable if employees actually engage. In an effort to uncover ways to promote employee engagement and, hence, WHPP effectiveness, the purpose of this paper is to assess the impact of the inclusion of a gamification element in a worksite health promotion programme on health outcomes. Design/methodology/approach Real-life data from a WHPP provider firm were analysed. Linear and logistic regression analyses were performed to assess the impact of participating in a step challenge on average daily step count and the likelihood of reaching the widely communicated goal of taking at least 10,000 steps per day. Findings It was found that the inclusion of gamification elements was significantly positively related to physical activity outcomes: employees who participated in the step challenge took considerably more steps than employees who did not participate (β=1,139.36, p<0.005). Participation increased the likelihood of fulfilling the recommended goal of 10,000 steps per day significantly vs non-participants (β=1.81, p=0.005). Finally, the results indicate that challenge participation was associated with a considerably greater increase in steps for men than for women. Originality/value This research advances the scientific understanding of the modern types of WHPPs that build on digital solutions and gamification. As an increasing number of firms face the challenge of designing a programme that actually works, the finding that the inclusion of gamification considerably increases programme effectiveness in terms of health outcomes is highly valuable.

Drivers and barriers in the practice of health-specific leadership: A qualitative study in healthcare

Managers have a significant impact on the health and well-being of employees, particularly when the managers lead in a health-specific way and intentionally foster their employees' health. However, the data on contextual and individual factors influencing the practice of health-specific leadership is at present limited. To survey the experiences of healthcare managers with health-specific leadership skills and identify the drivers and barriers in the practice of health-specific leadership. Semi-structured interviews were conducted with 51 managers from 18 geriatric-care facilities in Germany, between November 2014 and February 2015. The interviews were analysed through qualitative content analysis. In their reports, managers mentioned several drivers and barriers in the practice of health-specific leadership. These drivers and barriers were found at the leader level, the employee level, and the organizational level. The factors identified relate to the theoretical aspects of health-specific leadership: health value, health awareness, health behaviour, and role modelling. For successful practice of health-specific leadership, the findings suggest a more holistic approach for worksite health promotion. Managers should promote personal initiative that benefit employee health, encourage their employees to exhibit healthy behaviour themselves, address organizational resources and restrictions, and gain competencies in change management.

Validity and Reliability of the Updated CDC Worksite Health ScoreCard.

The aim of this study was to evaluate the reliability and validity of the updated 2019 CDC Worksite Health ScoreCard (CDC ScoreCard), which includes four new modules. We pilot tested the updated instrument at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity, and refined the instrument for public distribution. The mean question concurrence rate was 73.4%. Respondents reported the tool to be useful for assessing current workplace programs and planning future initiatives. On average, 43% of possible interventions included in the CDC ScoreCard were in place at the pilot sites. The updated CDC ScoreCard is a valid and reliable tool for assessing worksite health promotion policies, educational and lifestyle counseling programs, environmental supports, and health benefits.

The 2018 Physical Activity Guidelines for Americans II

The 2018 Physical Activity Guidelines for Americans II

Effort-Reward Imbalance, Over-Commitment and Depressive Episodes at Work: Evidence from the ELSA-Brasil Cohort Study.

A growing burden of mental illness, and in particular depression, among workers is a concern of occupational public health. Scientific evidence has revealed consistent associations of work-related stress, as measured by theoretical models, with depression, but mostly so in developed countries. This contribution explores these associations in a developing Latin American country, Brazil, by applying an internationally established work stress model, the effort-reward imbalance (ERI). This model focuses on the work contract where unjust exchange between high efforts spent and low rewards received in turn contributes to stress-related disorders. The model’s extrinsic (‘effort’, ‘reward’) and intrinsic components (‘over-commitment’), as well as their combination, are hypothesized to be related to a higher risk of depressive episodes (DE). Using cross-sectional data from the ELSA-Brasil study, including 10,034 workers from the public sector, we observed increased prevalence ratio (PR) of DE according to ERI scales. The quartiles of highest ‘effort’ (PR = 1.85; 1.44–2.37), highest ‘over-commitment’ (PR = 3.62; 2.80–4.70) and lowest ‘reward’ (PR = 3.44; 2.55–4.64) were associated with DE, on adjusted models, as well was the E–R ratio (PR = 2.47; 1.92–3.17). An additive interaction was identified between the E–R ratio and ‘over-commitment’. The results support the use of ERI as a screening tool for work stress in the Brazilian context and will offer guidance for worksite health promotion programs.

Cardiovascular and Psychophysical Response to Repetitive Lifting Tasks in Women.

BackgroundUnderstanding the cardiovascular and psychophysical demands of repetitive lifting tasks is important in job design strategies. This study determined the cardiovascular (oxygen consumption (VO2) and heart rate (HR) and psychophysical response to repetitive lifting tasks in women.MethodsTen female (age 27 ± 5 yrs) participants transferred 11.4, 15.9, and 20.5 kg weights back and forth from a rung 40.6 cm high to a rung 156.2 cm high. Rungs were 195.6 cm apart horizontally. Three, 10 minute bouts (1 = 11.4 kg; 2 = 15.9 kg; 3 = 20.5 kg) were performed at 6 lifts per minute. Cardiovascular and psychophysical (rating of perceived exertion, RPE) parameters were monitored throughout the bouts. VO2max and HRmax were determined via a maximal treadmill test.ResultsVO2, HR, and RPE were significantly different between each work bout (p < 0.01), with each outcome variable increasing as load increased. VO2max and HRmax equaled 46.5 ± 7.5 mL·kg−1·min−1 and 191 ± 11 bpm, respectively. Work at 11.4 kg was performed at 38% VO2max and 63% HRmax; at 15.9 kg at 41% VO2max and 72% HRmax; and at 20.5 kg at 49% VO2max and 81% HRmax. RPE at 11.4, 15.9, and 20.5 kgs were: 8.4 ± 1.6, 11.4 ± 1.9, and 15.0 ± 2.2.ConclusionDuring these repetitive lifting tasks, metabolic cost and perceived exertion increased with weight lifted; average work intensity ranged from 63 to 81% of HRmax and 38 to 49% of VO2max. Results have important implications in relation to job pacing and design, and worksite health promotion strategies aimed at reducing work place injury.

Workplace Health Promotion Is Growing Up but Confusion Remains About What Constitutes a Comprehensive Approach.

Professionals interested in advancing best practices in worksite wellness have been calling for more organizational and environmental approaches that will advance a culture of health. We seem to be getting the message across because a recent national survey shows that "supportive social and physical environment" is one of the 5 elements used to define a comprehensive program that has increased the most from 29.2% naming this as part of their approach in 2004 to 56% of companies in 2017. Yet 2 worksite health promotion studies that garnered media attention this past year offer telling examples of what occurs when researchers conflate or confuse the effectiveness of a health education program with a socioecological approach. I would suggest we replace the term "comprehensive programs" with "socioecological approach" or a "culture of health approach" or, at least, "a comprehensive approach," anything but continued use of the oxymoronic term "comprehensive program."

Effects of a multi-behavioral health promotion program at worksite on smoking patterns and quit behavior.

Tobacco use is associated with various severe health risks. Therefore, the need to decrease smoking rates is a great public health concern. The workplace has capability as a setting through which large groups of smokers can be reached to encourage smoking cessation. The aim of the present study was to evaluate effects of a multi behavioral worksite health promotion intervention. The primary outcome was the change of smoking rate. Secondary outcomes were changes in smoking attitudes and readiness to stop smoking among employees over an intervention period of 12 months. 112 and 110 employees were enrolled in the intervention and control arm respectively. The intervention group received a 12-month multicomponent health promotion intervention. One of the main elements of the multicomponent intervention was a smoking cessation and counseling program. During the pilot year, participants completed a self-evaluation questionnaire at baseline and again after 12 months to related outcomes and changes. Results showed that participants' quit behavior and smoking behavior changed over time in the intervention group (IG). Readiness to quit smoking also increased in the IG compared to the comparison group (CG). Some positive intervention effects were observed for cognitive factors (e.g., changes attitudes towards smoking). Baseline willingness to change smoking behavior was significantly improved over time. This study showed initial results of a long-term multicomponent worksite health promotion program with regard to changes in smoking behavior, attitudes towards smoking and readiness to quit smoking. The evaluation suggests that a worksite health promotion program may lead to improvements in smoking behavior for a number of workers.

Health and prolonging working lives: an advisory report of the Health Council of The Netherlands.

Objective This opinion paper summarizes the main findings and recommendations of an advisory report on health and prolonging working life, which was requested by the Dutch Minister of Social Affairs and Employment. Methods The advisory report was compiled by a multidisciplinary committee of ten scientists appointed by the Health Council of The Netherlands. The committee`s aims were to (i) describe the health of the ageing population, (ii) describe how prolonging working life influences health, (iii) describe determinants, besides health, for prolonging working lives, and (iv) review the literature on interventions aimed at retaining or improving employability of older workers. Results The report was presented to the Minister on 26 June 2018. As the likelihood of health problems increases with age, prolonging working life may be difficult. In general, life expectancy increases and gains in life years and health seem mainly attributable to people aged >75 years. Work is good for mental health. However, it may be beneficial for mental health to stop working around the retirement age. Besides health, financial factors, lifestyle, motivation to work, and working conditions play a role in prolonging working life. A systematic review of the evidence indicated that interventions such as worksite health promotion or career development workshops can support older workers in this matter. Conclusions The Health Council advised the Dutch Government to focus on worksite health promotion and career development interventions as well as the improvement of their implementation. This requires a tailored approach as there is a large diversity in health among older workers and particularly between low- and high-educated people. With this in mind, it was further recommended to explore whether flexible pension schemes might better suit this diversity.

Longitudinal trajectories of physical activity among employees participating in a worksite health promotion intervention: A latent class growth approach

ObjectivesThis study investigated different patterns of physical activity (PA; frequency, intensity, and duration) among employees during and after participating in a worksite health-promotion intervention over a period of one year. The study aimed to assess whether different patterns of PA were associated with perceived competence and motivational regulations for PA. DesignA cluster randomized controlled trial with a delayed-intervention control group. The design of the group-based intervention was based on the tenets of Self-determination theory (SDT). MethodThe study consisted of employees (N = 202, M age = 42.5) working with manual labor in an (Anonymized) transport and logistics company. A person-centered approach was applied in order to explore if there were different latent trajectories within the sample related to PA. The data was analyzed with latent class growth analysis (LCGA) and the modified BCH method. ResultsThe LCGA identified three PA trajectories: (1) employees high at baseline who declined significantly (n = 16), (2) employees who remained stable at a moderate level (n = 55), and (3) the majority of employees who reported low levels at baseline and increased significantly (n = 128). High levels of PA were associated with higher levels of perceived competence and autonomous forms of motivation for, which is in line with the tenets of SDT. Contrary to study hypothesis, controlled forms of motivation increased in all three trajectories after the intervention. ConclusionsDifferent trajectories of PA were found, and the intervention was able to attract employees with low levels of PA.

Expenditures of The German Statutory Health Insurance for Health Promotion and Disease Prevention 2012-2017: Positive Effects Due To The Disease Prevention Law?

The German Prevention Act aims to strengthen health promotion and disease prevention. The law makes changes to the so-called "§20 measures". Target values were newly given for the expenditures of the health insurance funds in this area. The objective here was to examine how the prevention expenditures of the statutory health insurance developed in the period from 2012 to 2017, and whether the requirements of the Prevention Act were met. The accounting results of the statutory health insurance funds were evaluated for the period 2012-2017. The expenditures per insured person were calculated and the changes in expenditures were analysed. The effect of the prevention law was highlighted by differentiation of the time periods 2012-2014 and 2014-2017. In 2017, about 2.5% of the total expenditure of the German statutory health insurance, around 5 billion euros, was accounted for in the reported prevention areas. Nearly 60% of these prevention expenditures were on early detection and vaccinations. Expenditure on "§20 measures" amounted to € 7.17 per insured person and thus reached the statutory guideline but accounted for less than 10% of all prevention expenditure. Although prevention expenditure per insured person increased over the period, the proportion of money spent on prevention measures as a whole had decreased since 2015. Expenditure on prevention measures that were directly aimed at the insured (individual approach, bonus programmes) and the setting approach (non-occupational settings, worksite health promotion) had hardly increased overall since the Prevention Act came into force. This effect is due to the equally strong decrease in bonuses for health-conscious behaviour among insured persons, despite the sharp increase in expenditure on company and noncompany settings. The proportion of money spent on disease prevention in total expenditure is still decreasing. The targets set by the Prevention Act, however, have been reached. Thus, target values have apparently proved to be an effective instrument for regulating prevention expenditure and have led to an increase in expenditure in the setting approach. Overall, there has been no expenditure effect in the area of disease prevention since the Prevention Act was enacted, as compensation was made at the expense of the non-setting measures without target values.

A Move-A-Thon Event: A Workplace Demonstration of a Proposed Alternative Strategy to Incentivize Workers to Engage in Physical Activity.

Motivating employees to increase their physical activity is a health promotion challenge. A Move-A-Thon (MAT) event approach was implemented as an alternative incentive to help workers to optimize their physical activity levels. We implemented a demonstration project in which workers were incentivized for their participation through monetized donations to charity. Their steps were monitored over the 2-week demonstration period. The MAT goal was for participants to achieve a minimum of 3,000 daily steps for 2 weeks, for which they could earn a total donation of up to US$20. Participants walking at least once with up to five different "exercise buddies" could earn up to US$2 more per buddy for donation. Of 10 workers invited, nine enrolled and eight completed participation by logging their monitored steps across an average of 13.75 full MAT participation days. Participants averaged 9,330.8 steps per day-more than triple the lower threshold required for a maximum US$20 charitable donation. The eight participants walked with a total of 21 "exercise buddies." They were receptive to future MAT events of longer duration. In total, the monetized donation to charity made by those eight participants was US$202. The MAT event participants were successful at promoting physical activity among a small group of workers for 2 weeks. Future worksite health promotion projects with this type of incentive strategy are indicated.

Socioeconomic inequalities in reach, compliance and effectiveness of lifestyle interventions among workers: protocol for an individual participant data meta-analysis and equity-specific reanalysis

IntroductionObesity and unhealthy behaviour are more prevalent among workers with a low compared with a high socioeconomic position (SEP), and thus contribute to socioeconomic health inequalities. The occupational setting is...

Assessing Physical Activity, Sedentary Behavior, and Cardiorespiratory Fitness in Worksite Health Promotion.

Assessing Physical Activity, Sedentary Behavior, and Cardiorespiratory Fitness in Worksite Health Promotion.

Worksite physical activity intervention and somatic symptoms burden: The role of coworker support for basic psychological needs and autonomous motivation.

Suffering from somatic symptoms can seriously hamper one's quality of life and ability to function, causing lost work productivity, sickness absence, and extensive medical utilization. Physical activity (PA) has demonstrated promising results related to mild to moderate cases of somatic symptoms. The present study explored whether a worksite health promotion intervention was able to increase PA and cardiorespiratory fitness, and to reduce somatic symptoms and sickness absence. The intervention was designed based on the tenets of Self-determination theory. A pre-post cluster randomized controlled trial was conducted with 202 industrial workers in a Norwegian logistics company. Results from repeated measures, multivariate analysis of variance, revealed an overall intervention effect and significant change between groups related to somatic symptoms in favor of the intervention group, albeit no significant change in sickness absence. We applied structural equations modeling to test a model of health behavioral change, which posited that increased support for PA from coworkers and autonomous motivation for PA predicted changes in PA, cardiorespiratory fitness, and somatic symptoms. The results underline the effectiveness of including coworker social support in health promotion programs aimed to increase PA and reduce somatic symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Association of Single and Multiple Medical Conditions with Work Status among Adults in the United States.

BackgroundThe purpose of this study was to comprehensively examine the association of a multitude of individual medical conditions, as well as multimorbidity, on work status among a national sample of U.S. adults.MethodsThe present study included 7 cycles (1999–2012) from the National Health and Nutrition Examination Survey (N = 28,119).ResultsIn total, 26 medical conditions increased the odds of not working. Multimorbidity as well as having prevalent medical condition(s) within each of the Cumulative Index Rating Scale Morbidity Classes were associated with increased odds of not working. Few medical conditions were associated with higher odds of working part-time (vs. full-time) or unemployment (vs. working).ConclusionThese findings underscore the importance of instating comprehensive worksite wellness health promotion policies, as well as providing individuals with resources to preserve and enhance personal health.

\u201cWorking on Wellness:\u201d protocol for a worksite health promotion capacity-building program for employers

BackgroundIn the United States, worksite wellness programs are more often offered by larger employers. The Massachusetts Working on Wellness (WoW) program is an innovative, statewide capacity-building model designed to increase the number of smaller employers (200 or fewer workers) adopting health promotion initiatives. This article describes the WoW program design and approaches to recruitment, implementation, and evaluation.Methods/designWoW provides employer training, technical assistance and seed funding, utilizing a Wellness Program Development framework based on recognized good practices. For-profit employers with 200 employees or fewer are eligible for and encouraged to apply for a Massachusetts Small Business Wellness Tax Credit. During the phase described in this paper, employer organizations applied to the program and committed to designating a champion responsible for program implementation. Interventions were to include policy and environmental supports, as well as those targeting individual behavior change through raising awareness and education. Supports provided to employers included seed grants for qualifying activities (up to $10,000 with matching required), community linkages, data collection and organization-specific feedback tools, an on-line curriculum supplemented with technical assistance, and an expert webinar series. Data collection at multiple time points, from the initial application through program completion, provides information for evaluation of recruitment, planned and completed activities.DiscussionThis model is grounded in literature on good practices as well as in local knowledge about Massachusetts employers. It does not directly address the influence of working conditions, which can affect both worker participation and health behaviors. Implementation may be less successful with some organizations, such as those with many workers who are part-time or geographically distributed rather than in a centralized physical location. Program evaluation will assess the extent to which WoW achieves its goals. The data are expected to increase understanding of the needs of smaller employers and industries not traditionally implementing employee wellness programs.

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.

Staff Self-Efficacy and Staff Outcome Expectations for Function-Focused Care: Rasch Testing.

The purpose of this study was to test the reliability and validity for two new scales. We used baseline data from a worksite health promotion project with 98 long-term care staff and Pearson correlations and Rasch analysis testing. For Staff Self-Efficacy for Function Focused Care and Staff Outcome Expectations for Function Focused Care item, reliability was .80 and .83, respectively. All items except one had acceptable INFIT and OUTFIT mean square statistics. Both new scales were significantly correlated (r = .342, p = .007), but neither of the scales were correlated with participants' baseline exercise levels (r = .014, p = .918; r = .092, p = .454, respectively). There was some evidence of validity and internal consistency for both scales. Suggestions are provided to improve the measures for future use.

Lifestyle characteristics as moderators of the effectiveness of weight control interventions among semiconductor workers

BackgroundWorkers in high technology industry are experiencing stressful environment and have been ranked as a high risk group for adverse health effects. The effectiveness of worksite health promotion is important for occupational health. This study is to investigate the effect of health interventions on body measurement changes while examining the role of their lifestyle factors. MethodsA total of 904 participants aged over 30 years were recruited from 14 semiconductor worksites in Taiwan from 2011 to 2015. A multi-settings, quasi-experimental study was conducted that assigned participants into two intervention programs, including exercise program and diet-plus-exercise program. The outcomes include the changes of body weight, waist circumference, body mass index (BMI), and biophysiological indicators. Lifestyle variables include alcohol consumption, cigarette smoking, and regular exercise. Multiple linear regression analyses were performed to test the association. ResultsThe findings have demonstrated that one kilogram body weight reduction is associated with a decrease of 0.58 mmHg SBP (p < 0.001), 0.29 mmHg DBP (p < 0.001), 3.33 mg/dL triglyceride (p < 0.001), 0.96 mg/dL total cholesterol (p < 0.001), and 0.68 mg/dL LDL (p < 0.001). The diet-plus-exercise group had more significant effect on both weight changes and biophysiological changes than exercise-only group (p < 0.001). Lifestyle factors, including cigarette smoking, alcohol consumption, and regular exercise, were significant moderators of the effectiveness of health interventions. ConclusionsBoth exercise and diet interventions are important to the effectiveness of health promotion in occupational sectors. Lifestyle modifications are vital for weight control programs in improving body shape changes and biophysiological indicators.