The effects of a workplace health promotion program in small and middle-sized companies: a pre–post analysis

Preventive health measures in small and medium-sized enterprises: A scoping review on implementation strategies

OBJECTIVE

To describe implementation strategies for preventive health measures in SMEs and the effectiveness of the strategies on implementation outcomes.

METHODS

A literature search was performed in multiple electronic databases. Studies published between 2000 and 2021 that evaluated the implementation of preventive health measures in SMEs were included. Classification of implementation strategies was based on two complementary classification systems.

RESULTS

Nineteen studies, of which 5 RCTs were included. Eighteen distinct implementation strategies were reported. All studies applied a combination of implementation strategies, and nearly all reported a positive effect on one or more implementation outcomes: sustainability, acceptability, feasibility, penetration, fidelity, adoption, and appropriateness.

CONCLUSIONS

Overall, a positive effect of combined implementation strategies on the implementation outcome(s) was found. The 'distribution of educational materials' and 'provide ongoing consultation' combined show positive effects on sustainability.

Physical activity of physiotherapists in Germany: a cross-sectional study

Aim

We aimed to quantify the work-related physical activity of physiotherapists in Germany.

Subjects and methods

We included working physiotherapists aged between 18 and 65 years in Germany. We excluded physiotherapists working less than 20 h a week. We measured our primary outcome, work-related physical activity, by the average number of steps taken daily during work, standardized on an 8-h working day. We controlled the main outcome for potential confounders, such as working hours per week, age, weekday, and clinical setting (outpatient vs. inpatient), by multivariate linear regression analysis. We used R statistics for all statistical analyses.

Results

We included 35 participants (7 outpatient and 28 inpatient), with a median age category of 20–29 years. Our participants had a mean work-related physical activity of 6614 steps (95% confidence interval, CI [6118; 7111]) per workday. Higher age, outpatient clinical setting, and working full time were associated with lower step count, but these associations were not statistically significant.

Conclusions

The work-related physical activity of physiotherapists in Germany is comparable with results from other countries and can be regarded as ‘low’. Our result, however, might be affected by volunteer bias and gender effects. Further research should identify high-risk groups in the profession for cost-effective prevention.

Exploring the active ingredients of workplace physical and psychological wellbeing programs: a systematic review

Previous reviews have established that workplace wellbeing initiatives are effective at promoting wellbeing, but less is known about which intervention characteristics or "active ingredients" underpin this effectiveness (i.e., behavior change techniques [BCTs]). This review aims to illuminate the connections between the types of BCTs and the level of intervention intensity with intervention effectiveness. A systematic search for peer-reviewed studies evaluating a workplace wellbeing initiative was undertaken across five databases: Medline, Scopus, PsycInfo, and CINAHL (Ovid Emcare). Eligible studies included those that evaluated the effect of a workplace wellbeing initiative on participants' physical wellbeing (e.g., physical activity and quality of life) and psychological wellbeing (e.g., mental health and stress), were published between 2009 and September 2019, and utilized a comparator (e.g., control group or prepost change). Studies were screened in independent duplicate to minimize bias. Effect sizes were calculated. Following removal of duplicates, 1,541 studies were identified and screened for eligibility. Of these, 23 studies reporting 28 comparisons were deemed to meet eligibility criteria. Just over 50% of these studies reported evidence of either a strong or moderate effect across a physical and a psychological outcome, providing a positive indication that workplace wellbeing programs can promote physical and psychological wellbeing in workers. Interventions tended to employ multiple BCTs (mean range 8.1-9.4), however, no discernible patterns between the types or numbers of BCTs employed and intervention effectiveness was found. Further experimental work is required that compares and contrasts workplace wellbeing initiatives to enable a better understanding of how to develop and implement highly effective programs.

Physical activity and health promotion for nursing staff in elderly care: a study protocol for a randomised controlled trial

INTRODUCTION

Nursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness.

METHODS AND ANALYSIS

A randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20-30 min) and subsequently, back-fitness training (12 weeks, once a week for 45-60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up).

ETHICS AND DISSEMINATION

The study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241).

Predictors of uptake of general and tailored services to improve employee health and wellbeing

ISSUE ADDRESSED

Healthy workplace programs can improve employee health and wellbeing. However, there is little research on how they are adopted by organisations. The study aimed to investigate uptake and predictors of service use amongst organisations utilising a comprehensive government-funded healthy workplace program.

METHODS

Employees taking part in the Healthier Workplaces WA program can access general services (ie, basic information on workplace health and wellbeing) and tailored services (ie, personalised support on implementing changes). A sample of 358 eligible program participants from 204 organisations completed a service experience survey 6 months after engaging with any service. Predictors of service use were analysed using a Kruskal-Wallis H test.

RESULTS

On average, respondents accessed 3.4 (out of 7) services. General services were accessed more frequently than tailored services. The Kruskal-Wallis H test showed that respondents working in Human Resources or Health and Safety and those from large organisations were more likely to access a greater range of services compared to employees in other roles and those working in small to medium organisations. Additionally, greater perceived support from management or co-workers was associated with greater service use.

CONCLUSIONS

Respondents reported accessing general services more than tailored services. Service use was greater amongst those who perceived greater support from their managers and/or co-workers, those who worked in large organisations and those who worked in HR/OHS. SO WHAT?: These findings are informative for practitioners assisting organisations to improve health and wellbeing initiatives and service providers interested in increasing service uptake. A mix of general and tailored services is likely to be useful in building employees' capacity to increase health and wellbeing in their workplace. Support from management and co-workers is an important facilitator, and small organisations may require more focussed targeting due to the lower tendency to engage with these programs and increased benefits.

Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers

BACKGROUND

The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers.

OBJECTIVES

To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses.

MAIN RESULTS

We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence).

AUTHORS' CONCLUSIONS

Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.

Program implementation and effectiveness of a national workplace physical activity intervention: UPnGO with ParticipACTION

INTERVENTION

UPnGO with ParticipACTION (UPnGO) is a 6-week workplace physical activity (PA) initiative aiming to increase habitual PA (steps) during the workday. Core intervention components included (1) self-monitoring of steps and action planning behaviours using a Web/mobile app with incentives and (2) organizational support, which included senior management's role modeling and endorsement of the program.

RESEARCH QUESTION

What is the effectiveness and levels of implementation of the UPnGO intervention? What is the relationship between effectiveness and levels of implementation?

METHODS

A single-arm, pre-/post-test study design was used. Participants were 660 employees from nine organizations who had valid step data and complete socio-demographic information at baseline. The primary outcome (mean daily steps) was assessed by Garmin VivoFit. Using the usage data from the UPnGO web-based system, a composite score for levels of implementation was calculated based on participant's compliance with the self-monitoring component and senior management's role modeling. Associations of interest were analyzed using linear mixed-effects models.

RESULTS

Levels of implementation were highly variable across organizations (mean = 68.22% ± 18.75, range = 19.8 to 100%). A significant Time × Implementation (IM) status interaction effect was observed. When stratified by IM status, a significant increase in mean daily steps at week 6 was found among participants in the high (β = 540.01 ± 202.69, p = 0.011) but not low (β = - 81.54 ± 291.96, p = 0.78) implementation group.

CONCLUSION

Findings suggest significant intervention effects in increasing average daily steps among participants who were exposed to optimal levels of implementation (~ 70%). UPnGO may be a scalable workplace PA intervention at a national level, although this needs further verification with more rigorous study designs.

The BASE-Program-A Multidimensional Approach for Health Promotion in Companies

Multidimensional assessments for conducting interventions are needed to achieve positive health effects within companies. BASE is an acronym, consisting of B = "Bedarfsbestimmung" (requirements); A = "Arbeitsplatzorganisation" (organisation of work); S = "Schulung des belastungsverträglichen Alltagshandelns" (coaching preventive behaviour at work); E = "Eigenverantwortung und Selbstwirksamkeit" (self-responsibility and self-efficacy). It is a prevention program designed to avoid and reduce work-related musculoskeletal diseases. It was developed to support prevention strategies within companies. It comprises aspects of health protection, ergonomics, exercise and self-efficacy. A comprehensive assessment will identify strain e.g., musculoskeletal discomforts due to body positions or psychological stress. Moreover, the general health status, preferences and barriers for participating in health promotion programs are evaluated. This analysis leads to practical and goal-oriented recommendations and interventions which suit the needs of companies and employees. These are executed onsite in real workplace situations and involve the introduction of first-hand experience in behavioural change. Therefore, this practical approach enhances the employees' acceptance and self-efficacy for health promotion. This can result in long-term health promoting behaviour. This article presents the outcome and sustainability effects of BASE in three different application fields (logistic, industrial and office workers).