Worksite health promotion programs with environmental changes: a systematic review

Effects of a cafeteria-based sustainable diet intervention on the adherence to the EAT-Lancet planetary health diet and greenhouse gas emissions of consumers: a quasi-experimental study at a large German hospital

BACKGROUND

Sustainable diets contribute to improving human health and reducing food-related greenhouse gas emissions (GHGE). Here, we established the effects of a facility-based sustainable diet intervention on the adherence to the EAT-Lancet Planetary Health Diet and GHGE of consumers.

METHODS

In this quasi-experiment, vegan menus and educational material on sustainable diets were provided in the largest cafeteria of a German hospital for 3 months. Regular customers (> 1/week) in this cafeteria (intervention group) and in all other hospital cafeterias (control group) completed a questionnaire about their sociodemographic and dietary characteristics before and after the intervention period. We calculated difference-in-differences (DID), their 95% confidence intervals (CIs), and p-values for the adherence to the EAT-Lancet Planetary Health Diet Index (PHDI; 0-42 score points) and food-related GHGE. The protocol was registered at the German Clinical Trial Register (reference: DRKS00032620).

FINDINGS

In this study population (N = 190; age range: 18-79 years; women: 67%; highest level of formal education: 63%), the mean baseline PHDI (25·1 ± 4·8 vs. 24·7 ± 5·8 points) and the mean baseline GHGE (3·3 ± 0·8 vs. 3·3 ± 0·7 kg CO2-eq./d) were similar between the intervention (n = 92) and the control group (n = 98). The PHDI increase was 0·6 points (95% CI: -0·4, + 1·6) higher in the intervention group than in the control group. This trend was stronger among frequent consumers of the vegan menu than among rare and never consumers. No between-group difference was seen for GHGE changes (DID: 0·0; 95% CI: -0·2, + 0·1 kg CO2-eq./d).

INTERPRETATION

Pending verification in a longer-term project and a larger sample, this quasi-experiment in a big hospital in Germany suggests that offering vegan menus and information material in the cafeteria enhances the adherence to healthy and environmentally friendly diets among regular customers. These findings argue for making sustainable food choices the default option and for improving nutrition literacy.

FUNDING

Federal Ministry of Economic Affairs and Climate Action (BMWK), Else-Kröner-Fresenius Foundation (EKFS), Robert-Bosch Foundation (RBS).

Exploring Successful Implementation of Organizational Supports at the Worksite Environment: A Mixed Methods Approach

While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses (n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.

A Systematic Review of Workplace Physical Activity Coaching

Aim Studies show that about 60 min of moderate physical activity (PA) per day compensate for sitting all day at work. However, the workplace offers an ideal setting for health-promoting interventions such as PA coaching as a person-centered intervention aimed at achieving lasting health behavior changes. Given a good evidence base of health coaching studies in general, this systematic review aims to provide an overview of workplace PA coaching interventions. Methods This review was conducted according to PRISMA guidelines. Studies published up to July 2021 were considered based on the following inclusion criteria: (1) longitudinal intervention studies, (2) analysis of PA at work, (3) sedentary employees, (4) PA coaching in the workplace as intervention, (5) increasing workplace PA. Results Of 4323 studies found, 14 studies with 17 interventions met inclusion criteria. All 17 interventions indicated an increase in at least one PA outcome. Twelve interventions indicated significant improvements in at least one workplace or total PA outcome. There is a high variation within the different coaching parameters, such as behavior change techniques and communication channels. The study quality showed a moderate to high risk of bias. Conclusions The majority of interventions provided evidence for the effectiveness of workplace PA coaching. Nevertheless, the results are inconclusive with regard to the variety of coaching parameters and thus no general statement can be made about the effectiveness of individual parameters. However, this variety of parameters also leads to a high degree of individualization of workplace PA coaching interventions to increase PA for different groups of employees and different types of workplaces.

Effectiveness of a Lifestyle Intervention for People With a Severe Mental Illness in Dutch Outpatient Mental Health Care: A Randomized Clinical Trial

Importance

People with a severe mental illness (SMI) have a life expectancy reduced by 10 to 20 years compared with the general population, primarily attributable to cardiometabolic disorders. Lifestyle interventions for people with SMI can improve health and reduce cardiometabolic risk.

Objective

To evaluate the effectiveness of a group-based lifestyle intervention among people with SMI in outpatient treatment settings compared with treatment as usual (TAU).

Design, Setting, and Participants

The Severe Mental Illness Lifestyle Evaluation (SMILE) study is a pragmatic cluster randomized clinical trial performed in 8 mental health care centers with 21 flexible assertive community treatment teams in the Netherlands. Inclusion criteria were SMI, age of 18 years or older, and body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or greater. Data were collected from January 2018 to February 2020, and data were analyzed from September 2020 to February 2023.

Interventions

Weekly 2-hour group sessions for 6 months followed by monthly 2-hour group sessions for another 6 months, delivered by trained mental health care workers. The intervention targeted overall lifestyle changes, emphasizing establishing a healthy diet and promoting physical activity. TAU (control) did not include structured interventions or advice on lifestyle.

Main Outcomes and Measures

Crude and adjusted linear mixed models and multivariable logistic regression analyses were performed. The main outcome was body weight change. Secondary outcomes included changes in body mass index, blood pressure, lipid profiles, fasting glucose level, quality of life, self-management ability, and lifestyle behaviors (physical activity and health, mental health, nutrition, and sleep).

Results

The study population included 11 lifestyle intervention teams (126 participants) and 10 TAU teams (98 participants). Of 224 included patients, 137 (61.2%) were female, and the mean (SD) age was 47.6 (11.1) years. From baseline to 12 months, participants in the lifestyle intervention group lost 3.3 kg (95% CI, -6.2 to -0.4) more than those in the control group. In the lifestyle intervention group, people with high attendance rates lost more weight than participants with medium and low rates (mean [SD] weight loss: high, -4.9 [8.1] kg; medium, -0.2 [7.8] kg; low, 0.8 [8.3] kg). Only small or no changes were found for secondary outcomes.

Conclusions and Relevance

In this trial, the lifestyle intervention significantly reduced weight from baseline to 12 months in overweight and obese adults with SMI. Tailoring lifestyle interventions and increasing attendance rates might be beneficial for people with SMI.

Trial Registration

Netherlands Trial Register Identifier: NTR6837.

Promoting physical activity-related health competence to increase leisure-time physical activity and health-related quality of life in German private sector office workers

BACKGROUND

Office workers (OWs) are at risk of low levels of health-enhancing physical activity (HEPA) and impaired health-related quality of life (HRQOL). Interventions based on physical activity-related health competence (PAHCO) aim to facilitate long-term changes in HEPA and HRQOL. However, these assumptions rely on the changeability and temporal stability of PAHCO and have not been tested empirically. This study therefore aims to test the changeability and temporal stability of PAHCO in OWs within an interventional design and to examine the effect of PAHCO on leisure-time PA and HRQOL.

METHODS

Three hundred twenty-eight OWs (34% female, 50.4 ± 6.4 years) completed an in-person, three-week workplace health promotion program (WHPP) focusing on PAHCO and HEPA. The primary outcome of PAHCO as well as the secondary outcomes of leisure-time PA and HRQOL were examined at four measurement points over the course of 18 months in a pre-post design by employing linear mixed model regressions.

RESULTS

PAHCO displayed a substantial increase from the baseline to the time point after completion of the WHPP (β = 0.44, p < 0.001). Furthermore, there was no decrease in PAHCO at the first (p = 0.14) and the second follow-up measurement (p = 0.56) compared with the level at the end of the WHPP. In addition, the PAHCO subscale of PA-specific self-regulation (PASR) had a small to moderate, positive effect on leisure-time PA (β = 0.18, p < 0.001) and HRQOL (β = 0.26, p < 0.001). The subscale of control competence for physical training (CCPT) also had a positive small to moderate effect on HRQOL (β = 0.22, p < 0.001).

CONCLUSION

The results substantiate PAHCO's theoretical characteristics of changeability and temporal stability, and underline the theoretically postulated effects on leisure-time PA and HRQOL. These findings highlight the potential of PAHCO for intervention development, which can be assumed to foster long-term improvements in HEPA and HRQOL in OWs.

TRIAL REGISTRATION

The study was retrospectively registered in the German Clinical Trials Register, which is an approved Primary Register in the WHO network, at the 14/10/2022 (DRKS00030514).

A study protocol of the adaptation and evaluation by means of a cluster-RCT of an integrated workplace health promotion program based on a European good practice

Background

An integrated workplace health promotion program (WHPP) which targets multiple lifestyle factors at different levels (individual and organizational) is potentially more effective than a single component WHPP. The aim of this study is to describe the protocol of a study to tailor a European good practice of such an integral approach to the Dutch context and to evaluate its effectiveness and implementation.

Methods

This study consists of two components. First, the five steps of the Map of Adaptation Process (MAP) will be followed to tailor the Lombardy WHP to the Dutch context. Both the employers and employees will be actively involved in this process. Second, the effectiveness of the integrated Dutch WHPP will be evaluated in a clustered randomized controlled trial (C-RCT) with measurements at baseline, 6 months and 12 months. Clusters will be composed based on working locations or units - dependent on the organization’s structure and randomization within each organization takes place after baseline measurements. Primary outcome will be a combined lifestyle score. Secondary outcomes will be the separate lifestyle behaviors targeted, stress, work-life balance, need for recovery, general health, and well-being. Simultaneously, a process evaluation will be conducted. The study population will consist of employees from multiple organizations in different industry sectors. Organizations in the intervention condition will receive the integrated Dutch WHPP during 12 months, consisting of an implementation plan and a catalogue with activities for multiple lifestyle themes on various domains: 1) screening and support; 2) information and education; 3) adjustments in the social, digital or physical environment; and 4) policy.

Discussion

The MAP approach provides an appropriate framework to systematically adapt an existing WHPP to the Dutch context, involving both employers and employees and retaining the core elements, i.e. the catalogue with evidence-based activities on multiple lifestyle themes and domains enabling an integrated approach. The following process and effect evaluation will contribute to further insight in the actual implementation and effectiveness of the integrated WHP approach.

Trial registration

NTR (trialregister.nl), NL9526. Registered on 3 June 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13352-0.

Partnerships to expand worksite wellness programs - A qualitative analysis of state and local health department perspectives

Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the U. S. Because the central mission of state and local health departments (HDs) is to protect, promote, and improve population health, these agencies are well-positioned to address risk behaviors for chronic disease. HD-employer partnerships could enhance worksite wellness programming, but few studies have explored this topic. Building upon previously published findings, the purpose of this qualitative study was to describe the context and environment for HDs' delivery of worksite wellness programs, including interest, barriers, facilitators, and decision-making processes. We conducted 12 interviews with directors of state chronic disease programs, 21 interviews with local directors, and three focus groups with local staff. We performed a thematic analysis of the data. Key themes include the following: (1) worksite wellness programs delivered by HDs were diverse in topic and scope and delivered both internally (at the HD for their agency) and externally (for other employers); (2) decisions made about chronic disease prevention were largely driven by funding priorities, with federal, state, and local entities playing roles in the decision-making process; and (3) HDs expressed potential interest in worksite wellness program delivery, dependent upon staff capacity, available funding, and employer buy-in. Our results suggest that funding should be increased for and reallocated towards chronic disease prevention, including worksite wellness. To overcome HD barriers to program delivery, key funders and stakeholders should prioritize and communicate the importance of worksite wellness.

Improving the Dietary Intake of Healthcare Workers Through Workplace Dietary Interventions: A Systematic Review and Meta-Analysis

The workplace has been identified as a potential location for dietary intervention delivery due to the amount of time spent and the meals eaten in this setting. It is recommended that interventions are tailored to specific occupational groups, and to date, there is limited synthesis of the evidence relating to healthcare workers. This review characterises and evaluates the effectiveness of dietary interventions in healthcare workers to aid the design and implementation of interventions. The MEDLINE database was searched to September 2020. The reference list of an umbrella review was hand searched for additional titles against inclusion criteria. The search included i) population, ii) intervention and iii) work environment. Studies were assessed for risk of bias. Harvest plots and Forest plots were created to display study quality, direction and size of effect of selected primary (energy, fruit and vegetable and fat intake) and secondary outcomes (weight, body mass index, blood pressure and serum cholesterol levels). Thirty-nine articles assessing thirty-four interventions were eligible for inclusion. Intervention types most commonly used were environmental, educational, educational plus behavioural, and behavioural. Due to the heterogeneity in study design and intervention type, results were largely inconclusive. For dietary outcomes, interventions produced small-moderate favorable changes in fruit, vegetable and fat intake. Decreased fat intake was mainly observed in environmental interventions and increases in fruit and vegetable intake were observed when an educational or/and behavioral component was present. Interventions producing weight loss were mostly non-randomised trials involving education and physical activity. Total and low-density lipoprotein cholesterol decreased in interventions involving physical activity. Meta-analyses revealed significant decreases in energy intake, weight, blood pressure, total cholesterol, and LDL cholesterol in non-randomised trials where data were available. Much more research is needed into strategies to promote diet quality improvement in healthcare workers. Statement of significance: It is recommended that workplace dietary interventions are tailored to specific occupational groups. To our knowledge, this is the first review to examine the effects of dietary workplace interventions in healthcare professionals. Small-moderate favourable changes in fruit and vegetable intake can be achieved when an educational or/and behavioural component is included in the intervention. For weight loss, interventions involving nutrition education and physical activity in addition to a dietary component show benefit. In the studies reviewed, a high level of heterogeneity was evident and insufficient information reported to ascertain potential bias.

Effects of a workplace exercise intervention on cardiometabolic health: study protocol for a randomised controlled trial

INTRODUCTION

The worldwide rising levels of physical inactivity especially in the United Arab Emirates (UAE) and the Eastern Mediterranean region are alarming. The UAE reports one of the highest rates of non-communicable disease mortality and insufficient physical activity (PA) is a major underlying cause. Therefore, action is required to reduce physical inactivity using evidence-based strategies. This study aimed to evaluate the efficacy of a worksite exercise intervention on cardiometabolic health in the UAE.

METHODS AND ANALYSIS

This is a protocol for a pragmatic parallel randomised controlled trial with a 1:1 allocation ratio to the intervention group and delayed intervention group. A total of 150 participants will be recruited from a semigovernment telecommunications company in Dubai (UAE) after meeting the eligibility criteria. The intervention group will receive 2 hours of exercise per week during working hours for 12 weeks (maximum 1 hour/day). The intervention group will be assigned to attend personal trainer sessions in the workplace gym throughout the intervention period. After the intervention is completed, the delayed intervention group will also receive 2 hours of exercise time per week from working hours for 4 weeks. The main outcome measure is the change in the cardiometabolic risk components, that is, systolic or diastolic blood pressure, waist circumference, glycated haemoglobin, fasting plasma glucose, low-density lipoprotein cholesterol from baseline to the end of the intervention. The secondary outcome is to examine whether the workplace exercise intervention improves PA levels 4 weeks postintervention.

ETHICS AND DISSEMINATION

The study has been approved by the Dubai Scientific Research Ethics Committee (DSREC-SR-08/2019_02). The results will be disseminated as follows: at various national and international scientific conferences; as part of a PhD thesis in Public Health at the College of Medicine and Health Sciences, UAE University; and in a manuscript submitted to a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT04403789.

Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature

OBJECTIVE

To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies.

DESIGN

A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up.

RESULTS

From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to evaluate whether individual recruitment strategies met sample size goals, with 77 % successfully achieving recruitment targets. Reporting for retention was slightly better with 69 % of studies providing sufficient information to determine whether individual retention strategies achieved adequate retention rates. Of these, 65 % had adequate retention.

CONCLUSIONS

This review highlights poor reporting of recruitment and retention information across trials. Findings may not be applicable outside a university setting. Guidance on how to improve reporting practices to optimise recruitment and retention strategies within young adults could assist researchers in improving outcomes.

Workplace cafeteria and other multicomponent interventions to promote healthy eating among adults: A systematic review

The objective of this review is to evaluate evidence for the effectiveness of workplace cafeteria and other supporting multicomponent interventions to promote healthy eating and reductions in health risks among adults. We conducted an electronic search in EMBASE, CINAHL, EconLit, Ovid, Cochrane, Web of Science and PubMed for English-language articles published from 1985 to July 2019. Studies were original articles reporting the results of workplace cafeteria interventions to promote healthy eating and reduction in health risks. Outcomes were classified as changes in fruit and vegetable intake, health risk indicators, dietary intake, and food sales. Interventions were categorized as interventions targeting food quality or quantity, targeting price, targeting food choice at point of purchase, targeting improved supply, targeting client's information, education or motivation and targeting organization policies. Behavioral change conditions used in interventions were identified using the COM-B system of behavioral change. Results were presented in a narrative summary. A total of 55 studies out of 6285 articles were identified for this review. Several studies used multicomponent interventions and the most featured interventions included interventions targeting food quality or quantity, targeting client's information, education or motivation and targeting food choice at point of purchase. There is evidence that workplace cafeteria and other supporting multicomponent interventions resulted in higher intake of fruit and vegetables, improved dietary intake, improved health outcomes and healthy food sales. The findings of this review have the potential to inform future cafeteria-based and other supporting multicomponent workplace health interventions. The review protocol was not registered in a repository.

Organizational and Individual Outcomes of Health Promotion Strategies-A Review of Empirical Research

The main purpose of the paper is to identify the outcomes for employers and employees indicated in research related to workplace health promotion interventions (WHPIs). We investigated what methods are used and what types of organization this type of research is most often carried out in. In addition, the authors attempted to assess to what extent the methods used in the previous research prove the effectiveness of the implemented WHPIs. A systematic review of English-language papers (2000–2020) focused on types of health-promoting interventions in the workplace, and outcomes for employers and employees were conducted using the SCOPUS database (n = 260). As a result, 29 texts qualified for a final qualitative synthesis of the results. The analyses were most frequently conducted in small and medium-sized enterprises (SMEs) based on both quantitative and qualitative methods. In order to draw conclusions, analyses were made by classifying the research presented in the texts according to the type of intervention implemented, classifying the outcomes identified, and indicating the type of evaluation made by the researcher. The analysis showed that most of the outcomes presented refer to changes in the strategy and organizational culture, as well as the behavior of employees. In 18 studies, the indication of outcomes resulted directly from the evaluation outcomes. In other cases, the outcomes were identified by an evaluation of the process or structure of WHPI. The conducted analysis showed significant diversity in terms of the outcomes measured and the research methods used. The quasi-experimental methods, randomly controlled cluster trials, or cross-sectorial studies used in the study to confirm the effectiveness of WHPI were used only in every third study. In these studies, measurements were usually performed twice: at baseline and after intervention. The majority of studies confirmed that WHPIs led to a positive change in the healthy behavior of employees and effected an organizational change, and more rarely led to savings or a reduction in costs resulting from sickness absenteeism, presentism, turnover, etc., and return on investment (ROI). The article shows the need to conduct further research towards the development of guidelines for the evaluation of the effectiveness of implemented programs.

Eastern North Carolina Head Start Teachers' personal and professional experiences with healthy eating and physical activity: a qualitative exploration

OBJECTIVE

Explore the interrelationship between teachers' personal and professional socio-ecological structures while examining Head Start (HS) teachers' experiences with (1) trying to eat healthy and engage in physical activity (PA) and (2) promote healthy eating and PA in their classrooms.

DESIGN

In-depth semi-structured interviews were collected from March through June 2017. Researchers designed the data collection and analysis methods using a phenomenological approach. All interviews were recorded using digital audio and transcribed verbatim.

SETTING

Seven HS centres in two rural eastern North Carolina counties.

PARTICIPANTS

Teachers (n 15) who had recently participated in a healthy eating and physical activity intervention. Participants were 100 % female, an average age of 43 years (sd 9·6) and primarily Black/African American (93·3 %).

RESULTS

Eighteen primary themes were identified providing unique insight into individual, social and environmental determinants that may influence teachers' personal health behaviours and professional health promotion practices. Findings indicated that teachers want to improve health behaviours personally (individual/family health) and professionally (children/families served); however, barriers exist at all levels impacting their ability to improve their own health and facilitate positive behaviours among the children/families they serve. Many teachers observed connections between their personal and professional experiences, but not beyond the individual level.

CONCLUSIONS

Study findings highlight the importance of considering and emphasising the potential relationship between personal and professional determinants of health when working with early childhood teachers. Findings from this study may be useful for informing the development, implementation and evaluation of future health promotion interventions using teachers as implementers.

A Corporate Wellness Program and Nursing Home Employees' Health

Background: Many employed Americans suffer from chronic conditions like obesity, diabetes, and cardiovascular diseases. Worksite wellness programs provide opportunities to introduce health promotion strategies. While there is evidence of the effectiveness of workplace health promotion, this is tempered by concern that benefits may be less available to low-wage workers with inflexible working conditions. Objective: The aim was to evaluate a workplace health promotion (WHP) in the long-term care sector (skilled nursing facilities). Methods: Nursing home employees from 18 facilities within a single company were surveyed by a standardized, self-administered questionnaire. A company-sponsored WHP program was offered to the facilities, which were free to take it up or not. We categorized the facilities by level of program adoption. Cross-sectional associations were estimated between program category and prevalence of individual-level worker health indicators, adjusting for center-level working conditions. Results: A total of 1,589 workers in 5 job categories completed the survey. Average levels of psychological demands and social support at work were relatively high. Supervisor support stood out as higher in centers with well-developed WHP programs, compared to centers with no programs. There were no differences among program levels for most health outcomes. Workers in centers with well-developed programs had slightly lower average body mass index and (unexpectedly) slightly lower prevalence of non-smoking and regular aerobic exercise. Conclusions: Only small health benefits were observed from well-developed programs and working conditions did not appear to confound the negative results. This low-intensity, low-resourced workplace health promotion program may have benefited a few individuals but seems to have had only modest influence on average levels of the measured health indicators. Many nursing home employees experience obstacles to health behaviors; approaches that provide more environmental and economic supports for healthy behaviors, such as Total Worker Health®, may yield larger health benefits.

Design and baseline data of a randomized trial comparing two methods for scaling-up an occupational sun protection intervention

Background

Successful methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults who work outdoors in the sun.

Methods

A randomized trial is being conducted comparing two methods of scaling-up the Sun Safe Workplaces (SSW) intervention. Departments of transportation (DOTs) from 21 U.S. states are participating and their 138 regional districts were randomized following baseline assessment. In districts assigned to the in-person method (n = 46), project staff meets personally with managers, conducts trainings for employees, and provides printed materials. In districts assigned to the digital method (n = 92), project staff conduct these same activities virtually, using conferencing technology, online training, and electronic materials. Delivery of SSW in both groups was tailored to managers' readiness to adopt occupational sun safety. Posttesting will assess manager's support for and use of SSW and employees' sun safety. An economic evaluation will explore whether the method that uses digital technology results in lower implementation of SSW but is more cost-effective relative to the in-person method.

Results

The state DOTs range in size from 997 to 18,415 employees. At baseline, 1113 managers (49.0%) completed the pretest (91.5% male, 91.1% white, 19.77 years on the job, 66.5% worked outdoors; and 24.4% had high-risk skin types). They were generally supportive of occupational sun safety. A minority reported that the employer had a written policy, half reported training, and two-thirds, messaging on sun protection.

Conclusions

Digital methods are available that may make scale-up of SSW cost-effective in a national distribution to nearly half of the state DOTs.

Trial registration: The ClinicalTrials.gov registration number is NCT03278340.

Nudging healthy eating in Dutch sports canteens: a multi-method case study

OBJECTIVE

To provide a micro-investigation into the long-term effects and process of implementation of a nudge intervention on food choice in sports canteens.

DESIGN

Multi-method case study.

SETTING

Eight products were added to the range of foods and drinks in two football canteens in the Netherlands for 3 and 15 weeks, serving as a baseline period. In the intervention period, these products were promoted with the use of salience, scarcity, availability and default nudges, for 26 and 16 weeks, respectively. Aside from the collection of sales and revenue data, reach, acceptability, adherence and applicability were measured using observations, questionnaires and interviews.

PARTICIPANTS

Questionnaires were filled in by seventy and fifty-nine visitors of the canteens. Four interviews were held with board members and canteen personnel.

RESULTS

Mixed results were obtained regarding the suitability of nudges to be used to promote healthy eating in sports clubs. Sales and revenue data did show positive trends, the intervention was seen as acceptable by all stakeholders and the intervention had a large reach. However, adherence to the intervention in both canteens and the effects of the nudges on the total consumption pattern were low. Factors were identified that promoted or hindered the intervention at an individual, interventional and organisational level.

CONCLUSIONS

Nudges seem to be a valuable addition to other efforts to combat unhealthy eating. However, the extent of their impact as a single intervention tool is limited in the current food-abundant environment.

Socioeconomic inequalities in effectiveness of and compliance to workplace health promotion programs: an individual participant data (IPD) meta-analysis

BACKGROUND

This individual patient data (IPD) meta-analysis aimed to investigate socioeconomic inequalities in effectiveness on healthy behavior of, and compliance to, workplace health promotion programs.

METHODS

Dutch (randomized) controlled trials were identified and original IPD were retrieved and harmonized. A two-stage meta-analysis was conducted where linear mixed models were performed per study (stage 1), after which individual study effects were pooled (stage 2). All models were adjusted for baseline values of the outcomes, age and gender. Intervention effects were assessed on physical activity, diet, alcohol use, and smoking. Also, we assessed whether effects differed between participants with low and high program compliance and. All analyses were stratified by socioeconomic position.

RESULTS

Data from 15 studies (n = 8709) were harmonized. Except for fruit intake (beta: 0·12 [95% CI 0·08 0·15]), no effects were found on health behaviors, nor did these effects differ across socioeconomic groups. Only participants with high compliance showed significant improvements in vigorous and moderate-to-vigorous physical activity, and in more fruit and less snack intake. There were no differences in compliance across socioeconomic groups.

CONCLUSIONS

Workplace health promotion programs were in general not effective. Neither effectiveness nor compliance differed across socioeconomic groups (operationalized by educational level). Even though stronger effects on health behavior were found for participations with high compliance, effects remained small. The results of the current study emphasize the need for new directions in health promotion programs to improve healthy behavior among workers, in particular for those in lower socioeconomic position.

Do working characteristics influence the participation at health measures? Findings from a trial phase of workplace health promotion

Background

Health behavior is presumed to be influenced by organizational factors. This study analyzes how workplace characteristics influence health behavior in terms of participation at health measures.

Methods

Employees of the German Federal Ministry of Defense were surveyed at the beginning (January / February 2015) and at the end (June 2015) of the trial phase of workplace health promotion (WHP). Differences in participation of characteristic groups were calculated using Pearson's Chi²-Test and T-Test, chances of participation were estimated using multilevel logistic regression.

Results

Employees who reported higher satisfaction with work demand participated more often in health measures (aOR: 1.02, 95%-CI = 1.01, 1.04, p < 0.001). Large amount of variance in participation can be attributed to department level.

Conclusion

Participation at WHP varies significantly between settings after controlling for individuals' characteristics. Thus, working characteristics should be considered as a decisive factor for WHP effectiveness. There is consensus that behavioral prevention is most effective when conditional prevention is granted as behavior is presumed to be influenced by individuals´ environmental conditions. Though objective working conditions may seem similar further context characteristics which remain unconsidered may lead to different behavior patterns. This article shows that more attention must be payed to setting specific characteristics with regard to effective Occupational Health Promotion.This project is registered by the Federal Ministry of Defense (research number: E/U2AD/ED003/EF555).

The impact of a complex workplace dietary intervention on Irish employees' off-duty dietary intakes

A paucity of evidence exists regarding the impact of workplace dietary interventions on employees' off-duty dietary intakes. This study assessed the impact of workplace dietary interventions that included nutrition education and environmental dietary modification both alone and in combination on employees' dietary intakes inside (on-duty) and outside (off-duty) of work. A pre-post study on employees' on and off-duty dietary intakes was undertaken. Data were obtained from a complex workplace dietary intervention study (Food Choice at Work Trial). Four manufacturing workplaces were allocated to: Control (n = 111), nutrition education (n = 226), environmental dietary modification (n = 113) and nutrition education and environmental dietary modification combined (n = 400) (2013-14). Seven- to nine-month follow-up data were obtained for 517 employees (61% response) [Control (n = 67), Education (n = 107), Environment (n = 71) and Combined (n = 272)]. Dietary intakes were measured using 24-h dietary recalls. Differences between on and off-duty mean dietary intakes were compared and regression analyses adjusted for potential confounders. Significant reductions in on-duty intakes of total fat (-14.2 g/day, p = 0.000), saturated fat (-7 g/day, p = 0.000), salt (-1.4 g/day, p = 0.000) and total sugars (-8.9 g/day, p = 0.003) were observed in the Combined and in the Environment [total fat (-11.4 g/d, p = 0.017) and saturated fat (-8.8 g/day, p = 0.000)]. In the Combined, significant changes were also observed in off-duty intakes of total fat (-10.0 g/day, p = 0.001), saturated fat (-4.2 g/day, p = 0.001), salt (-0.7 g/day, p = 0.020) and total sugars (-8.1 g/day, p = 0.020). Food service can have a positive impact in our everyday environments, including inside and outside of work. Dietary interventions combining nutrition education and environmental dietary modification can improve employees' on and off-duty dietary intakes.

Associations Between the Breakroom Built Environment, Worker Health Habits, and Worker Health Outcomes: A Pilot Study Among Public Transit Rail Operators

OBJECTIVE

To investigate the association between the breakroom built environment and worker health outcomes.

METHODS

We conducted this study in a mass transit organization (rail). We collected a user-reported breakroom quality score (worker survey), a worksite health promotion score (validated audit tool), and self-reported worker health outcomes (survey).

RESULTS

Among the 12 breakrooms audited and 127 rail operators surveyed, the average worksite health promotion score was 9.1 (out of 15) and the average user-reported breakroom quality was 3.1 (out of 7). After multivariable regression, breakrooms with higher worksite health promotion scores and user-reported breakroom quality were associated with lower odds of depression and fewer medical disability days.

CONCLUSIONS

This cross-sectional study demonstrates an association between the quality of the breakroom built environment and worker health, specifically depression and medical disability days.

Implications of multimorbidity on healthcare utilisation and work productivity by socioeconomic groups: Cross-sectional analyses of Australia and Japan

BACKGROUND

Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups.

METHODS

Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models.

RESULTS

Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only.

CONCLUSION

Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment.

Worksite health promotion and social inequalities in health

It is well-documented that higher educated employees have better health than the lower educated. The workplace has been put forward as a contributor to this inequality. We extend previous work on workplace characteristics that could influence employee health by asking to what extent workplace health promotion (WHP) can account for the relation between education and health. Two ways in which WHP may relate to health inequalities are addressed: higher educated employees may be more likely to use WHP than lower educated employees and the effect of WHP on health may be stronger for higher educated than for lower educated employees. Using data from the European Sustainable Workforce Survey which contains information on over 11000 employees in 259 organisations, we test whether three types of WHP mediate or moderate the relation between education and health: healthy menus, sports facilities and health checks. We find that higher educated employees are in better health and that use of WHP positively relates to health. Use of healthy menus and sports facilities in the workplace can contribute to increasing health inequalities, as lower educated employees are less likely to make use of these. Health checks could contribute to diminishing health inequalities, as lower educated employees are more likely to use them compared to higher educated employees. The effect of WHP is not contingent on education. We advise stimulating lower educated employees to make more use of WHP, which can contribute to decreasing health inequalities.

Contemplation by Design: Leveraging the "Power of the Pause" on a Large University Campus Through Built and Social Environments

College and university campuses have long been designed as embodied places of societal values and aspirations, reflecting both academic traditions and heritages alongside social and scientific change and innovation. More pragmatically, these spaces share some commonalities with other living and working environments, and must adapt to changing technological and social norms. Since the 1970's, workplace adaptations included employer-sponsored health promotion programs and facilities. While campus environments such as fitness centers and dining halls have been incorporated into health promotion initiatives, other aspects of human well-being have been neglected. In this paper, we describe an initiative, Contemplation By Design, to incorporate contemplation and mindfulness into the daily lives of all members of the Stanford University community, including students, faculty, staff, and their families, as well as alumni and retirees who live close by. This case study highlights ways that physical planning and programmatic initiatives for contemplative practices have been integrated to deliver generalizable, community-based well-being resources that can be emulated in diverse settings throughout the Stanford University campuses, including the main campus and local satellite campuses. Based on experience drawn from Contemplation By Design, practical recommendations for designing contemplative practice spaces and programs are offered.

Drivers of healthy eating in a workplace in Nepal: a qualitative study

OBJECTIVE

To explore the perceptions, enablers and barriers to employees' healthy eating in a hospital site.

DESIGN

A qualitative study including focus group discussion and in-depth interview, data were analysed using thematic analysis method.

SETTING

The study was carried out among employees of Dhulikhel Hospital-Kathmandu University Hospital, located about 30 km east of Nepal's capital Kathmandu.

PARTICIPANTS

Focus group discussions were conducted among the 33 participants, who were divided into four groups: (a) support staff (drivers, cook, laundry, gardeners and ward boys), (b) hospital administrators and managers, (c) health personnel (doctors, nurses and assistants) who work 8-12 hours shifts and (d) health personnel who work during office hours. Nine in-depth interviews were conducted among six canteen operators and three managers.

RESULTS

The major factors for promoting healthy eating were identified as the availability of affordable healthy food options in the cafeterias, a commitment to such promotion by the cafeteria manager, operators, staff and hospital administration and the level of education of the employees. The most commonly reported barriers for healthy eating were the unavailability of healthy options, including the lack of food supply from local market, the higher cost of healthy foods, individual food preferences and limited human resources in the cafeteria.

CONCLUSION

The availability of affordable healthy foods, supply of healthy foods from the market, commitment from cafeteria managers, hospital administrators and health awareness among cafeteria operators may promote healthy eating among employees in a Nepali hospital setting.

Office cake culture

Purpose

The purpose of this paper is to explore the characteristics of office cake (OC) consumption and the associated attitudes and behaviours among UK office workers to gain insight into the implications for workplace health.

Design/methodology/approach

A cross-sectional online questionnaire was completed by 940 respondents. Data were analysed using descriptive statistics and cross-tabulation withχ2tests for between-group difference.

Findings

Respondents reported both positive social and negative health-related consequences of OC. OC influenced eating behaviour through increased salience and availability, and the effects of social influencing. Almost all (94.8 per cent) reported ideal OC frequency to be once/week or less. Gender and age significantly affected attitudes and behaviour.

Research limitations/implications

The questionnaire was not validated so data accuracy could have been diminished or biased. Portion size was not examined and consumption data were self-reported which could have resulted in under-reporting. Only office workers were investigated therefore results may not be applicable to other workplaces.

Practical implications

OC appears to influence both the workplace eating environment and employee eating behaviour. It could therefore affect employee health and workplace health promotion programme efficacy. However the findings suggest that nudge-based initiatives could reduce OC consumption to make workplaces healthier while retaining social benefits.

Originality/value

The present study provides the first data on OC culture and insights on how to address it sensitively. It also highlights that sweet treats used for celebration and employee recognition should be considered a relevant part of workplace food provision alongside canteens and vending.

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.

The effectiveness of workplace nutrition and physical activity interventions in improving productivity, work performance and workability: a systematic review

BACKGROUND

Healthy lifestyles play an important role in the prevention of premature death, chronic diseases, productivity loss and other social and economic concerns. However, workplace interventions to address issues of fitness and nutrition which include work-related outcomes are complex and thus challenging to implement and appropriately measure the effectiveness of. This systematic review investigated the impact of workplace nutrition and physical activity interventions, which include components aimed at workplace's physical environment and organizational structure, on employees' productivity, work performance and workability.

METHODS

A systematic review that included randomized controlled trials and or non-randomized controlled studies was conducted. Medline, EMBASE.com, Cochrane Library and Scopus were searched until September 2016. Productivity, absenteeism, presenteeism, work performance and workability were the primary outcomes of our interest, while sedentary behavior and changes in other health-related behaviors were considered as secondary outcomes. Two reviewers independently screened abstracts and full-texts for study eligibility, extracted the data and performed a quality assessment using the Cochrane Collaboration Risk-of-Bias Tool for randomized trials and the Risk-of-Bias in non-randomized studies of interventions. Findings were narratively synthesized.

RESULTS

Thirty-nine randomized control trials and non-randomized controlled studies were included. Nearly 28% of the included studies were of high quality, while 56% were of medium quality. The studies covered a broad range of multi-level and environmental-level interventions. Fourteen workplace nutrition and physical activity intervention studies yielded statistically significant changes on absenteeism (n = 7), work performance (n = 2), workability (n = 3), productivity (n = 1) and on both workability and productivity (n = 1). Two studies showed effects on absenteeism only between subgroups.

CONCLUSIONS

The scientific evidence shows that it is possible to influence work-related outcomes, especially absenteeism, positively through health promotion efforts that include components aimed at the workplace's physical work environment and organizational structure. In order to draw further conclusions regarding work-related outcomes in controlled high-quality studies, long-term follow-up using objective outcomes and/or quality assured questionnaires are required.

TRIAL REGISTRATION

Registration number: PROSPERO CRD42017081837.

Sun Safe Workplaces: Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

OBJECTIVE

Occupational skin cancer prevention is a priority because outdoor workers are exposed to high levels of ultraviolet radiation, the primary risk factor for skin cancer.

METHODS

A 2-year follow-up assessment of the impact of Sun Safe Workplaces (SSW), a workplace sun safety program that promoted policy adoption and education, on employee sun safety behavior was conducted. Sixty-three of 98 local government organizations from the original study participated.

RESULTS

Outdoor workers (n = 1724) completed surveys on personal sun protection practices. Employees' sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW's effect was mediated by the number of workplace actions to implement elements of the policy, including sun protection messages and equipment and employee reports of sun safety training.

CONCLUSION

Policy promotion is a feasible approach to occupational skin cancer prevention.

Do Adults Draw Differently-Sized Meals on Larger or Smaller Plates? Examining Plate Size in a Community Sample

Background

Prior research has reported that plate size may influence an individual's perceptions and recall of food and meal size. Therefore, manipulating plate size could influence projected meal quantities and portion size among community dwelling adults.

Methods

The present study interviewed 281 adult parents in their own homes in a medium-sized city in the United States. Participants were asked to accurately draw and label the foods they expected to eat for dinner that night, drawing on either a 23 cm or 28 cm paper plate. The respondents were then asked to label each food drawn in order to ensure proper recording of meals.

Results

Results showed clear differences in drawn food sizes between plate sizes as well as between sexes. Larger plates had about 24% more food drawn on them than small plates. Men drew their meals on 28 cm plates to be 37% larger than men who received 23 cm plates, while women with 28 cm plates drew their meals to be about 17% larger than women given 23 cm plates. Most (60%) of the overall differences in food size between plates came from the biggest food that was drawn. Women and men both drew bigger meat portions on 28 cm plates when compared to the meat portions on 23 cm plates.

Conclusions

Overall, these findings support the concept that adult participants' estimates of dinner meal size may be shaped by plate size. The effect of differing plate sizes appears to be more powerful for men than women, and may encourage greater food consumption among men, primarily as meat products.

Do socio-demographic and anthropometric characteristics predict food choice motives in an Irish working population?

Dietary behaviour is influenced by a complex web of biological, psychological, physiological, social, economic and cultural factors. Understanding socio-demographic and anthropometric characteristics that influence food choice may be important in guiding dietary interventions. The present study aimed to identify whether socio-demographic and anthropometric characteristics influence food choice in an Irish working population. A cross-sectional survey was conducted in 2014 as part of the Food Choice at Work Study, a large clustered non-randomised, controlled trial based in county Cork, Ireland. Information regarding food motives was collected at the 3-4 months follow-up. The 'Food Choice Questionnaire' was used to measure food motives. Multiple linear regression was conducted to test the association between socio-demographic and anthropometric characteristics (age, sex, BMI, education, type of accommodation, living situation, marital status, parental status) and worksite and food motives. A total of 678 employees were included in the analysis. Overall, only a small percentage of food choice was influenced by the characteristics included in this analysis (1·6 to 8·8 %). Sensory appeal and satisfaction were scored most important by all sub-populations. Sex was most often associated with differences in food motives (i.e. all food motives except for familiarity and ethical concern were significantly more important to females compared with males; P = 0·001/P < 0·001). Worksite, age, BMI and marital status also seemed to play a small role in influencing food choice. The results show that food choice is complex and not easily explained by differences in socio-demographic or anthropometric population characteristics.

Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review

BACKGROUND

Children and adolescents do not meet the current recommendations on physical activity (PA), and as such, the health-related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA.

OBJECTIVE

The aim of this review was to systematically evaluate the effects of mobile health (mHealth) and wearable activity trackers on PA-related outcomes in this target group.

METHODS

Electronic databases such as the Cochrane Central Register of Controlled Trials, PubMed, Scopus, SPORTDiscus, and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to June 2018. Those included were articles that contained descriptions of interventions designed to increase PA among children (aged 6 to 12 years) only, or adolescents (aged 13 to 18 years) only, or articles that include both populations, and also, articles that measured at least 1 PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets, or mobile apps) or wearable activity trackers. Randomized controlled trials (RCTs) and non-RCTs, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with a PA comparison between groups were assessed for methodological quality.

RESULTS

In total, 857 articles were identified. Finally, 7 studies (5 with tools of mHealth and 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used an RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone apps were used as a tool. Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as an intervention and evaluation tool. No evidence was found for the effect of mHealth tools, respectively wearable activity trackers, on PA-related outcomes.

CONCLUSIONS

Given the small number of studies, poor compliance with accelerometers as a measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence.

Design of a randomized trial testing a multi-level weight-control intervention to reduce obesity and related health conditions in low-income workers

Weight-control is a major public health focus for preventing multiple obesity-related health conditions. While clinic-based intensive lifestyle interventions are successful, low-socioeconomic-status (SES) populations, which have a higher burden of obesity, are difficult to reach; thus, the workplace offers a useful setting to target low-SES workers. The current paper presents the design of a study testing a workplace intervention aimed at low-SES employees. Partnering with a large healthcare system and affiliated university, this project will test an innovative multi-level intervention ("Working for You") adapted from existing group- and individual-level intervention models to promote healthy weight among low-wage workers. The individual-level component is an interactive obesity treatment approach (iOTA) program that involves assessment of behavior risks, collaborative goal-setting with a health coach, and interactive SMS text-messages for ongoing support and self-monitoring. This mHealth intervention is embedded in the group-level component, a workplace participatory program that involves worker teams engaged in the design and implementation of interventions to change their workplace environments. These nested interventions are being tested in a group-randomized trial among 22 work groups (~1000 total workers, ~300 workers with obesity). The primary outcome will be program effects on weight at 2-year follow-up, compared to control, and the secondary outcomes will be effects on diet and physical activity; iOTA adherence, process measures, and work environment/support will also be examined. This pragmatic clinical trial will test scalable interventions that can be translated to other work settings to reduce obesity and related health risks among low-SES workers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02934113.

Organizational-level determinants of participation in workplace health promotion programs: a cross-company study

BACKGROUND

Attracted by the expected benefits such as reduced absenteeism and increased productivity, more and more firms decide to implement workplace health promotion programs (WHPPs). However, those programs can only be effective if employees actually participate. This study aims to (1) gain insight into the degree of enrolment rates in such programs across companies and (2) identify organizational level factors that are associated with employee participation. Building on existing theory on organizational drivers of participation in corporate wellness programs, the study's main goal is to investigate which organizational factors determine whether employees enroll in a corporate fitness program or not.

METHODS

A business-to-business fitness platform company provided organizational level data on 61 client firms that have recently implemented a corporate wellness program. The data contained information on the enrolment rate per company and different organizational level variables. The following potential determinants of participation were analyzed: firm size, organizational program support and employee co-payment. A random effects model was used to examine associations between potential determinants and the program enrolment rate.

RESULTS

The average participation is limited (15.37%) but varies highly across companies (range 0.07-100.00%, monthly basis). Looking at the determinants of program enrolment, we find that organizational program support - the degree to which firm leadership encourages participation - positively influences the enrolment rate (β = 0.051 p < 0.001) while employee co-payment - the financial contribution employees have to make to participate - has a negative impact (β = - 0.002, p < 0.001). Furthermore, firm size has a negative relationship with firm enrolment.

CONCLUSIONS

Enrolment rates in WHPPs are limited, as many companies have difficulties to promote participation in WHPPs among employees. Strong organizational program support and low employee co-payment were identified as drivers of employee participation in corporate health programs. Hence, intensifying both social and financial support of employee participation may help to drive enrolment rates. Firm size was found to negatively affect the enrolment rate in WHPPs, implying that larger firms have to account for their size and corresponding complexity when implementing such a program.

Nepal Pioneer Worksite Intervention Study to lower cardio-metabolic risk factors: design and protocol

BACKGROUND

To increase cardiovascular disease prevention efforts, worksite interventions can promote healthy food choices, facilitate health education, increase physical activity and provide social support. This pioneer study will measure the effectiveness of a cafeteria and a behavioral intervention on cardio-metabolic risk in a worksite in Nepal.

METHODS

The Nepal Pioneer Worksite Intervention Study is a two-step intervention study conducted in Dhulikhel Hospital in eastern Nepal. In the first step, we will assess the effectiveness of a 6-month cafeteria intervention on cardio-metabolic risk using a pre-post design. In the second step, we will conduct a 6-month, open-masked, two-arm randomized trial by allocating half of the participants to an individual behavioral intervention based on the 'diabetes prevention program' for the prevention of cardio-metabolic risk. We will recruit 366 full time employees with elevated blood pressure, fasting blood sugar, or glycosylated haemoglobin (HbA1c). At baseline, we will measure their demographic variables, lifestyle factors, anthropometry, fasting blood sugar, HbA1c,and lipid profiles. We will measure cardio-metabolic outcomes at 6 months, 12 months, and 18 months. At 12 months, we will compare the proportion of participants who have attained two or more cardio-metabolic risk factor reduction goals (HbA1c decrease ≥0.5%; systolic blood pressure decrease ≥5 mmHg; or triglycerides decrease ≥10 mg/dL) during the cafeteria intervention period and the control period using generalized estimating equations. At 18 months, we will compare the proportion from the 'cafeteria only arm' to the 'cafeteria and behavior arm' for the same outcome using a chi-square test.

DISCUSSION

This pioneer study will estimate the effect of environmental-level changes on lowering cardio-metabolic risks; and added benefit of an individual-level dietary intervention. If the study demonstrates a significant effect, a scaled up approach could produce an important reduction in cardiovascular disease burden through environmental and individual level prevention programs in Nepal and similar worksites worldwide.

TRIAL REGISTRATION

The trial was retrospectively registered on clincaltrials.gov (Identification Member: NCT03447340 ; Date of Registration: February 27, 2018).

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

INTRODUCTION

Obesity 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 considered an important setting to address unhealthy behaviours due to the possibility to efficiently reach a large group of adults through worksite health promotion. This paper describes the rationale and design for an individual participant data (IPD) meta-analysis and a socioeconomic equity-specific reanalysis aiming to: (1) investigate socioeconomic differences in the effectiveness of interventions aimed at promoting healthy behaviour and preventing obesity, (2) examine socioeconomic differences in reach and compliance and (3) to investigate underlying factors affecting possible socioeconomic differences.

METHODS AND ANALYSIS

A systematic search was conducted in electronic databases including Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar as well as in grey literature and trial registries. Two researchers have independently selected a total of 34 relevant studies (from 88 articles). Responsible researchers of these eligible studies were asked to provide their study data and an assessment of the methodological criteria was done. The data of the intervention studies will be pooled for the IPD meta-analysis, whereas the socioeconomic equity-specific reanalysis will focus on each study separately, stratified for SEP. Both methods will be conducted to investigate socioeconomic differences in effectiveness, reach and compliance (research aims 1 and 2). For research aim 3, different factors, such as population characteristics, organisational work environment and intervention characteristics, will be investigated as possible moderators in the associations between SEP and effectiveness, reach and compliance.

ETHICS AND DISSEMINATION

The Medical Ethical Committee of Erasmus MC declared that the Medical Research Involving Human Subjects Act does not apply to the meta-analyses. The findings will be disseminated through peer-reviewed publications and (inter)national conference presentations.

TRIAL REGISTRATION NUMBER

CRD42018099878.

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

BACKGROUND

Workers 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.

METHODS

A 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.

RESULTS

The 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.

CONCLUSIONS

Both 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.

The effectiveness of dietary workplace interventions: a systematic review of systematic reviews

Objective

To summarise findings of systematic reviews that distinctively report dietary intervention components and their effects on diet-, health- and economic-related outcomes in the workplace setting.

Design

MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library and Google Scholar were searched in December 2014 and the search was updated in August 2017.

Results

The search identified 1137 titles, of which nineteen systematic reviews from the initial search and two systematic reviews from the updated search met the inclusion criteria (twenty-one systematic reviews, published in twenty-two papers). Most systematic reviews were of moderate quality and focused on dietary behaviour change outcomes and some health-related biomarkers. Evidence was strongest for interventions to increase fruit and vegetable intake, reduce fat intake, aid weight loss and reduce cholesterol. Few reported workplace-related and evaluation outcomes.

Conclusions

These findings suggest that workplace dietary interventions can positively influence diet and health outcomes. Suggestions for effective interventions components have been made.

Environmental interventions to promote healthier eating and physical activity behaviours in institutions: a systematic review

OBJECTIVE

The present review evaluated the effectiveness of environmental-based interventions aimed at improving the dietary and physical activity behaviours and body composition indices of adults in institutions.

DESIGN

A systematic review was conducted. Electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, The Cochrane Library, Web of Science, ProQuest Dissertation and Theses, Scopus and Athena) were searched for relevant articles published between database inception and October 2017. Searching, selecting and reporting were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

SETTING

Military establishments and maritime workplaces.ParticipantsAdults in institutions, aged 18-45 years.

RESULTS

A total of 27842 articles were screened for eligibility, nine studies (reported in eleven articles) were included in the review. Five studies used multilevel strategies and four used environmental strategies only. Duration of follow-up ranged from 3 weeks to 10 years. Eight of the studies reported significant positive effects on dietary behaviours, but effect sizes varied. The study that targeted physical activity had no effect on activity levels but did have a significant positive effect on physical fitness. No evidence was identified that the studies resulted in improvements in body composition indices.

CONCLUSIONS

The evidence base appears to be in favour of implementing environmental interventions in institutions to improve the dietary behaviours of adults. However, due to the small number of studies included in the review, and the variable methodological quality of the studies and intervention reporting, further well-designed evaluation studies are required.

Work, worksites, and wellbeing among North American Indian women: a qualitative study

The purpose of this study was to understand what factors influenced work-family balance and related health behaviors among a sample of rural North American Indian women. We interviewed 89 women through both in-depth interviews and focus groups across four tribal communities in the American Southwest and Upper Midwest between July 2010 and August 2011. Interviews were transcribed, coded, and analyzed for emerging themes related to work- family demands placed on women and resources available to cope with those demands. Three prominent themes emerged: structural characteristics (the context of rural reservation life), role stressors (women's multiple and conflicting roles) and the influence of social support (communal nature of care in the family and institutional support in the workplace). We found that women in participating rural reservation communities often acted as primary caregivers for both immediate and extended family, and often placed the needs of others before themselves. The context of rural reservations, with high rates of unemployment, poverty, and chronic illnesses associated with the collective trauma of colonization, placed high demands on female caregivers. Social support from within the workplace, family, and cultural traditions helped some female caregivers balance the demands of home and work. Tribal worksites could be a resource for promoting health and work-life balance by being responsive to the particular demands placed on women that often interfere with engaging in positive health behaviors in general and tribal wellness programs in particular.

Design of ChooseWell 365: Randomized controlled trial of an automated, personalized worksite intervention to promote healthy food choices and prevent weight gain

BACKGROUND/AIMS

Behavioral nudges in the food environment increase healthy choices, but it is unknown if they improve diet and health. The ChooseWell 365 study will determine if an automated, personalized worksite intervention to nudge healthier choices improves overall diet and cardiometabolic health.

DESIGN

Randomized controlled trial of 602 hospital employees who regularly use on-site cafeterias and pay with an employee ID.

INTERVENTION

The intervention combines an environmental strategy (traffic-light labeling) with objective feedback and personalized nudges (health/lifestyle tips, social norms, incentives) to promote healthy food choices. The ChooseWell 365 software platform automatically generates personalized emails and letters that integrate employees' weight goals with health, lifestyle, and cafeteria purchasing data. Over one year, the intervention group receives two weekly emails. One provides a log of daily purchases; the second provides personalized health/lifestyle tips. The intervention group receives monthly mailed letters with social norm comparisons and financial incentives for healthier purchases. The one-year intervention will be completed in February 2019; all follow-up will be completed March 2020.

OUTCOMES

Weight, cardiometabolic risk factors, and dietary intake at one and two-year follow-up. Other outcomes include worksite food purchases by study participants and other non-participant employees who are socially connected (inferred from purchasing data) to participants.

CONCLUSIONS

ChooseWell 365 tests a novel strategy to deliver a scalable worksite prevention program that is integrated into the workday. The intervention is personalized but automated and therefore does not require costlier individual counseling. In the future, this program could be applied broadly in other worksite settings.

'I've worked so hard, I deserve a snack in the worksite cafeteria': A focus group study

This study obtained insight in motivation regarding food choices of Dutch employees, especially when visiting the worksite cafeteria. We also aimed to know why employees visit the worksite cafeteria. These insights are useful for intervention development to encourage healthier purchases in worksite cafeterias. We conducted seven focus groups among 45 employees of seven Dutch companies. The topics were 1) drivers and motives for food selection; 2) motives for visiting the worksite cafeteria; 3) motives for food selection in the worksite cafeteria; 4) perceptions of healthiness of products in the worksite cafeteria and 5) solutions brought up by the employees to encourage healthier eating. Thematic analyses were conducted with MAXQDA software. Qualitative analyses revealed that this group of Dutch employees mentioned 'healthiness', 'price' and 'taste' as most important drivers food selection. These employees generally visit the worksite cafeteria to have a break from their work setting. Healthiness played a less important role in visiting or making food choices in the worksite cafeteria. Reasons for buying unhealthy food items were being tempted and the feeling to 'deserve' it. In order to choose healthier foods employees suggested a bigger offer of healthy food options, providing knowledge, changing prices and prominent placing of healthy foods. This focus group study shows that drivers for food selection can differ from motives for visiting the worksite cafeteria and when choosing food there. Health is important for food choice in general, but less important in the worksite cafeteria. The results of this study could be used in the development of strategies that aim to change people's food choice behavior.

Implementation of Occupational Sun Safety at a 2-Year Follow-Up in a Randomized Trial: Comparison of Sun Safe Workplaces Policy Intervention to Attention Control

PURPOSE

Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention.

DESIGN

Two-year follow-up assessment in a randomized pretest-posttest controlled design.

SETTING

Local government organizations with workers in public safety, public works, and parks and recreation.

PARTICIPANTS

Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers.

INTERVENTION

Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education.

MEASURES

Observations of SSW messages and sun safety items and surveys on organizations' communication and actions on sun safety.

ANALYSIS

Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed).

RESULTS

At intervention worksites, more SSW messages ( P < .001) and sun safety items ( P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen ( P = .005) and communicated about sun safety ( P < .001); and more workers recalled receiving sun safety messages ( P < .001) and sun safety training ( P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats ( P = .009), long work pants ( P = .017), and shade structures ( P = .036). Older workers received the most written messages ( P = .015).

CONCLUSIONS

Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

Development of the 'Canteen Scan': an online tool to monitor implementation of healthy canteen guidelines

Background

To improve the availability and accessibility of healthier food and drinks in schools, sports and worksites canteens, national Guidelines for Healthier Canteens were developed by the Netherlands Nutrition Centre. Until now, no tool was available to monitor implementation of these guidelines. This study developed and assessed the content validity and usability of an online tool (the ‘Canteen Scan’) that provides insight into and directions for improvement of healthier food products in canteens.

Methods

The Canteen Scan was developed using a three-step iterative process. First, preliminary measures and items to evaluate adherence to the guidelines were developed based on literature, and on discussions and pre-tests with end-users and experts from science, policy and practice. Second, content validity of a paper version of the Canteen Scan was assessed among five end-users. Third, the online Canteen Scan was pilot tested among end-users representing school canteens. Usability was measured by comprehensibility, user-friendliness, feasibility, time investment, and satisfaction.

Results

The content validity of the Canteen Scan was ensured by reaching agreement between stakeholders representing science, policy and practice. The scan consists of five elements: 1) basic conditions (e.g. encouragement to drink water and availability of policy regarding the guidelines), 2) product availability offered on displays (counter, shelf) and 3) in vending machines, 4) product accessibility (e.g. promotion and placement of products), and 5) an overall score based on the former elements and tailored feedback for creating a healthier canteen. The scan automatically classifies products into healthier or less healthy products. Pilot tests indicated good usability of the tool, with mean scores of 4.0–4.6 (5-point Likert scale) on the concepts comprehensibility, user-friendliness and feasibility.

Conclusion

The Canteen Scan provides insight into the extent to which canteens meet the Dutch Guidelines for Healthier Canteens. It also provides tailored feedback to support adjustments towards a healthier canteen and with the scan changes over time can be monitored. Pilot tests show this tool to be usable in practice.

Effects of a Multi-Component Workplace Intervention Program with Environmental Changes on Physical Activity among Japanese White-Collar Employees: a Cluster-Randomized Controlled Trial

PURPOSE

This study aimed to investigate effects of a flexible multi-component workplace intervention program for improving physical activity among Japanese white-collar employees in a cluster randomized controlled trial design.

METHODS

A total of 208 worksites and nested employees were approached. Any worksite interested in a 3-month physical activity promotion intervention and white-collar workers aged 18 years or older were eligible. The worksites were randomly assigned to an intervention or a control, stratified by worksite size. The intervention worksites were offered an intervention program that allows these worksites to select intervention components from a set of options, including environmental changes. The control worksites were offered feedback and basic occupational health services. Physical activity level was measured using a self-reported questionnaire at baseline and at 3 and 6 months of follow-up.

RESULTS

Three worksites (92 employees) were allocated to the intervention and five worksites (98 employees) to the control worksites. The overall physical activity level in the intervention worksites significantly increased compared with the control worksites (Coeff = 0.45, SE = 0.19, p = 0.018). For subgroup analyses, the intervention effect on the overall physical activity level was significant among medium- and large-sized worksites but not among small-sized worksites.

CONCLUSION

This trial showed a significant and positive effect of the intervention program on physical activity. The program is unique because of its flexibility and feasibility. However, small worksites might receive less benefit from the program, indicating a need for further support and/or new technologies.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (ID=UMIN000024069).

[Physical exercise health promotion in the workplace: participative experimentation in a private company]

CONTEXT

The objective of this study was to identify collaborative processes involved in a physical activity health promotion project in companies, conducted through a participatory approach in a cross-sectoral partnership, and to estimate the preliminary effects in terms of employee health.

METHODS

Action research was conducted in an industrial company comprising 240 employees over a 2-year period. This research was based on 4 criteria: description of the actors' network, the opportunities and constraints of the project, the implementation of physical activities, the participation of employees in the various activities, the impacts observed (after 3 months of activities) on physical parameters and quality of life.

RESULTS

Six work groups selected two activities : muscle-development exercise and Taïchi. We evaluated muscle strengthening activity. The participation rate in the activity was 16%. A higher age, female gender and being a manager or employee rather than a worker were significantly associated with participation. A tendency towards increased physical and mental scores of SF12 was observed. We identified two major barriers: logistic and communicational.

CONCLUSION

The participatory approach, based on a cross-sectoral partnership, is the determining element of the project's success in a context of local opportunities. Two factors were identified to perpetuate this dynamic and improve the system: rationalization of the structuring of the service and greater resources, particularly financial resources.