Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

Application of theoretical domains framework to explore the enablers and barriers to physical activity among university staff and students: a qualitative study

BACKGROUND

Physical inactivity is one of the major risk factors for developing several chronic illnesses. However, despite strong evidence indicating the health benefits of physical activity, many university staff and students tend to be physically inactive. University settings provide a stable environment where behaviour change interventions can be implemented across multiple levels of change. The aim of this study is to examine the perceived barriers and enablers to physical activity among staff and students in a university setting, using the Theoretical Domains Framework (TDF), a precursor of COM-B behaviour model.

METHODS

This was a qualitative study carried out at a Midlands University in the United Kingdom. Eight group interviews were conducted with the sample (n = 40) consisting of 6 male and 15 female university staff (mean age = 40.5 ± 10.6 years) with different job roles (e.g., academic, administrative, cleaning and catering staff), and 12 male and 7 female students (mean age = 28.6 ± 4.7 years) at different stages of study (e.g., undergraduate, postgraduate, and international students). Interviews were audio recorded, transcribed verbatim and imported into NVivo12 software, responses were mapped using the TDF where theory-driven deductive content analysis was used for data analysis.

RESULTS

Six prominent domains were identified from the group interviews as enablers and/or barriers to physical activity among university staff and students: Environmental context and resources; intentions; social influences; knowledge; beliefs about capabilities; and social/professional role and identity. The themes emerging from the group interviews fit into all 14 domains of the TDF; however, 71% of the themes fit into the six most prominent domains.

CONCLUSIONS

These findings suggest that several enablers and barriers influence university staff and students' capability, opportunity, and motivation to engage in physical activity. This study, therefore, provides a theoretical foundation to inform the development of bespoke interventions to increase physical activity among inactive university staff and students.

Barrier profiles in workplace health promotion in Germany

Workplace health promotion (WHP) is often faced with low-participation rates despite high relevance. This limits the potential for creating positive effects for the organization and its staff. Therefore, we investigated the barriers perceived by employees themselves using a representative sample (regarding age, gender and education) in Germany. Data were collected using a quantitative online questionnaire and then analyzed regarding underlying patterns. We found that there are different barrier types, and their importance differs depending on demographic criteria of the participants and the organizations they work for. These results can help organizations to reduce participation barriers to WHP for their staff.

Opt-in HIV testing in construction workplaces: an exploration of its suitability, using the socioecological framework

Background

Late diagnosis of HIV remains a challenge, despite improved testing and treatment. Testing is often targeted at high-risk groups; workplace events might normalise testing and allow access to a wider population. The construction workforce has a number of risk factors for HIV. In the Test@Work study, HIV tests were delivered within general health checks to construction employees, with high uptake and acceptability. This paper reports on the experiences of construction managers and health professionals involved in Test@Work and explores the suitability of construction worksites as a venue for opt-in HIV testing.

Methods

Qualitative interviews (n = 24) were conducted with construction managers who had facilitated health check/HIV testing (n = 13), and delivery partners (n = 11) including i) healthcare volunteers who had delivered general health checks (n = 7) and, ii) HIV professionals who had conducted HIV testing (n = 4) at 21 Test@Work events held on construction sites. Interviews explored their experiences of these events and views towards HIV testing in the workplace. Exit questionnaires (n = 107) were completed by delivery partners after every event, providing qualitative data identifying facilitators and barriers to effective delivery. Thematic analysis identified themes that were mapped against a socioecological framework.

Results

Delivery partners reported high engagement of construction workers with workplace HIV testing, peer-to-peer encouragement for uptake, and value for accessibility of onsite testing. HIV professionals valued the opportunity to reach an untested population, many of whom had a poor understanding of their exposure to HIV risk. Managers valued the opportunity to offer workplace health checks to employees but some identified challenges with event planning, or provision of private facilities.

Conclusions

The construction sector is complex with a largely male workforce. Providing worksite HIV testing and education to an untested population who have poor knowledge about HIV risk helped to normalise testing, encourage uptake and reduce HIV-related stigma. However, there are practical barriers to testing in the construction environment. Rapid testing may not be the most suitable approach given the challenges of maintaining confidentiality on construction worksites and alternatives should be explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13787-5.

Activating Worksites to Implement Policy, Systems, and Environmental Changes: Outcomes and Overcoming Challenges

PURPOSE

Although workplaces are prime settings for health promotion, little is known about the implementation of policy, systems, and environmental (PSE) changes focused on chronic disease. PSEs have broader reach and are more sustainable than individual level strategies.

DESIGN

non-experimental, one group design with no control.Setting: West Virginia, a state with significant chronic disease-related health disparities.

SUBJECTS

Convenience sample of 27 workplaces, representing 6 industry types.

INTERVENTION

$1000 in micro funding awarded to workplaces to participate in Centers for Disease Control and Prevention (CDC) Work@Health®/ScoreCard, and implement PSEs.

MEASURES

ScoreCard baseline results; post project survey results.

ANALYSIS

Descriptive analysis of ScoreCard; survey responses coded into PSE and I (individual level strategies) categories; frequencies were calculated.

RESULTS

63% of the workplaces were very small (1-100 employees). Chronic disease-related organizational practices (ScoreCard) were minimal: nutrition (5/24), physical activity (7/22), diabetes (5/15), cholesterol (4/13), and high blood pressure (6/16). Workplaces reported a total of 95 PSEs: P-8, S-55, and E-32.

CONCLUSION

Policy change was the least frequently attempted and reported PSE strategy. More research with a stronger study design is needed to determine if (1) baseline organizational practices (Scorecard scores) improve, (2) PSEs (especially P) can be implemented without micro funding/TA, (3) workplace-type is related to use of the funds/TA, and (4) enacting PSE changes leads to healthier employees.

Determinants of nutrition practice and food choice in UK construction workers

The workplace is considered an effective setting for health and wellbeing interventions, including programmes focusing on nutrition, and provides opportunities to tailor programmes to meet the specific needs of industry and employees. This study explored nutrition practices amongst construction workers and managers to inform the design of a nutrition intervention. Five focus groups were conducted on three construction sites: two with managers (n = 11) and three with workers (n = 27). Construction workers and managers identified several unhealthy nutrition-related behaviours, including high consumption of convenient and fast foods, excessive coffee, alcohol, energy drinks and low fruit and vegetable intake. These behaviours were often attributed to high workloads, long working hours and physically demanding jobs. Snacking and skipping meals were repeatedly reported, attributed to short breaks and poor accessibility to food outlets. The nutritional quality of meals differed between individuals (homemade vs fast food), depending on the type of sites (temporary vs permanent) and site location. Nutrition knowledge, establishing routines, meal planning and preparation were recognized as important in sustaining healthy nutrition habits. However, meal preparation depended on the facilities available, which differed between managers and workers, highlighting the complex relationship between the workplace context and eating behaviours. Construction workers were interested in learning about nutrition and improving their eating habits through nutrition intervention. However, they highlighted that better cooking and storage facilities on site, together with fewer job demands and longer break times, would enhance the sustainability of the intervention and their ability to make healthier food choices.

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.

Work site access to fluoridated tap water and retail beverages: An assessment of the University of California, San Francisco campuses

BACKGROUND

Employees with fluoridated drinking water access at work can reap oral health benefits. The purpose of this study was to assess the availability, appeal, and promotion of fluoridated tap water in publicly accessible spaces compared with retail beverages at the University of California, San Francisco.

METHODS

The authors collected information on beverages available in publicly accessible spaces at University of California, San Francisco hospitals and campuses in San Francisco, California, from December 2019 through February 2020 using a web-based survey tool. Data collected included fluoridated water and retail beverage locations; type of water or retail beverage source; number of water sources per station; cleanliness, flow, and any obstruction of water sources; proximity of water stations to retail beverage locations; signage near the beverage locations about water and beverage consumption; and type of retail beverages available.

RESULTS

Fluoridated water stations were identified in 230 locations and had 377 water sources (for example, traditional drinking fountain and motion-sensor bottle-filling station). One water station was available for every 80 students and employees; however, 25% were obstructed, dirty, or had unsatisfactory flow. Approximately 1 in 5 watercoolers lacked disposable cups. Of 41 retail beverage locations identified, 29% had a water station within sight. Only 11% of beverage locations had signage encouraging healthier beverage choices.

CONCLUSIONS

A systematic assessment of work site access to fluoridated water can provide actionable evidence to improve availability, appeal, and promotion.

PRACTICAL IMPLICATIONS

This study provides a model to assess work site availability of fluoridated drinking water that can be used for future evaluations.

Stakeholder dialogue on dilemmas at work as a workplace health promotion intervention including employees with a low SEP: a Responsive Evaluation

Background

The aim of this study was to evaluate the perceived changes of an innovative workplace health promotion intervention and evaluation. In this study, a bottom-up approach was taken to define the central themes and relevant outcomes of an intervention. These central themes and relevant outcomes of the intervention were defined together with stakeholders, including employees with a low socioeconomic position.

Methods

The intervention consisted of a series of structured stakeholder dialogues in which dilemmas around the – by employees defined —health themes were discussed. The intervention was implemented in a harbor service provider with approximately 400 employees. Over a two-year period, 57 participants engaged in eight dialogues of one hour. 15 interviews and six participant observations took place for the evaluation of the intervention.

Results

Together with the stakeholders, high workload and mental health were defined as central themes for the dialogue intervention in the male-dominated workplace. The dialogue intervention contributed to changes, on different levels: individual, team, and organization. Overall, the stakeholder dialogues advanced the understanding of factors contributing to high workload and mental health. In reply to this, several actions were taken on a organizational level.

Conclusions

Taking a bottom-up approach in WHP allows to understand the health issues that are important in the daily reality of employees with a low socioeconomic position. Through this understanding, workplace health promotion can become more suitable and relevant for employees with a low socioeconomic position.

Trial registration

Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, Retrospectively registered https://www.trialregister.nl

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12802-z.

Semmelweis Caring University Model Program Based on the Development of a Center of Preventive Services: Health for All Employees at a University Occupational Setting

The leadership of the Semmelweis University as a leading institution of higher education in Hungary and the Central Eastern European region within the area of medicine and health sciences has decided to reflect on the unfavorable public health situation in the country as well as the deteriorating health behavior and health status indicators in the Hungarian population by the development of an occupational setting-based personalized public health model program targeting its about 8500 employees. Based on its infrastructure and human resources the core element of the program is the establishment of the Center of Preventive Services (CPS) with units providing health risk assessment for each employee, and whenever necessary consultation with medical specialist in preventive medicine and public health, as well as counseling with dietician, physiotherapist and/or health psychologist. The service providers are the staff members of the relevant faculties in collaboration with partner primary and occupational care physicians. The units of the CPS can also serve as practical training sites for students at various levels of medical and health sciences training, and strongly contribute to the development and improvement of their skills to be able for working as a team in service provision. The employees are not only beneficiaries of health risk assessment and screening repeated on a regular basis and adequate interventions at the right time, but they also serve as a sample for a longitudinal cohort study and further ad hoc surveys for defining and implementing interventions to support health protection, disease prevention and healthy aging among them.

Workplace cardiovascular risk reduction by healthcare professionals-a systematic review

BACKGROUND

Cardiovascular disease has a significant impact on public health and is largely preventable by addressing modifiable risk factors. As most adults spend on average half of their waking hours at work, this provides a significant opportunity to address modifiable risk factors through health promotion interventions. Healthcare professionals have the knowledge and skills to provide workplace interventions aimed at cardiovascular risk reduction.

AIMS

This study was aimed to assess the literature regarding the effect of workplace interventions led by healthcare professionals on cardiovascular risk factors.

METHODS

Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, MEDLINE, PsycINFO and SPORTDiscus were systematically searched from inception to March 2021. Included studies evaluated impact of workplace interventions by healthcare professionals on cardiovascular health. Data on study design, baseline characteristics, interventions, outcomes and conclusions were extracted and qualitatively analysed.

RESULTS

Forty-five studies representing 77 633 participants were included in the analysis. Healthcare professionals involved included: nurses, nurse practitioners, physicians, dietitians, pharmacists, physician assistants, medical technicians/emergency medical technicians and physiotherapists. Workplace interventions by healthcare professionals generally improved surrogate markers of cardiovascular health. Success varied based on provider and nature of the intervention. Addressing motivation and including follow-up were key factors for successful intervention to reduce cardiovascular risk factors.

CONCLUSIONS

Workplace health promotion initiatives delivered by healthcare professionals may improve cardiovascular risk markers if they are evidence based and customized for target populations. More research is needed to determine clinical relevance of interventions and ideal interventions for specific employee groups.

Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis

Background

The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors.

Methods

We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library, Web of Science, and Education Resources Information Center, from Jan 1, 1990, to June 30, 2020, for studies with controlled evaluation designs that assessed multicomponent workplace wellness programmes. Investigators independently appraised the evidence and extracted the data. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. Pooled effects were calculated by inverse-variance random-effects meta-analysis. Potential sources of heterogeneity and study biases were evaluated.

Findings

From 10 169 abstracts reviewed, 121 studies (82 [68%] randomised controlled trials and 39 [32%] quasi-experimental interventions) met the eligibility criteria. Most studies were done in North America (57 [47%]), and Europe, Australia, or New Zealand (36 [30%]). The median number of participants was 413·0 (IQR 124·0–904·0), and median duration of intervention was 9·0 months (4·5–18·0). Workplace wellness programmes improved fruit and vegetable consumption (0·27 servings per day [95% CI 0·16 to 0·37]), fruit consumption (0·20 servings per day [0·11 to 0·28]), body-mass index (−0·22 kg/m² [−0·28 to −0·17]), waist circumference (−1·47 cm [−1·96 to −0·98]), systolic blood pressure (−2·03 mm Hg [−3·16 to −0·89]), and LDL cholesterol (−5·18 mg/dL [−7·83 to −2·53]), and to a lesser extent improved total fat intake (−1·18% of daily energy intake [−1·78 to −0·58]), saturated fat intake (−0·70% of daily energy [−1·22 to −0·18]), bodyweight (−0·92 kg [−1·11 to −0·72]), diastolic blood pressure (−1·11 mm Hg [−1·78 to −0·44]), fasting blood glucose (−1·81 mg/dL [−3·33 to −0·28]), HDL cholesterol (1·11 mg/dL [0·48 to 1·74]), and triglycerides (−5·38 mg/dL [−9·18 to −1·59]). No significant benefits were observed for intake of vegetables (0·03 servings per day [95% CI −0·04 to 0·10]), fibre (0·26 g per day [−0·15 to 0·67]), polyunsaturated fat (−0·23% of daily energy [−0·59 to 0·13]), or for body fat (−0·80% [−1·80 to 0·21]), waist-to-hip ratio (−0·00 ratio [−0·01 to 0·00]), or lean mass (1·01 kg [−0·82 to 2·83]). Heterogeneity values ranged from 46·9% to 91·5%. Between-study differences in outcomes were not significantly explained by study design, location, population, or similar factors in heterogeneity analyses.

Interpretation

Workplace wellness programmes are associated with improvements in specific dietary, anthropometric, and cardiometabolic risk indicators. The heterogeneity identified in study designs and results should be considered when using these programmes as strategies to improve cardiometabolic health.

Employer perspectives concerning the self-management support needs of workers with long-term health conditions

Purpose

Long-term health conditions are a significant occupational and global burden and can undermine people's ability to work. Workplace support for self-management of long-term conditions has the potential to minimise adverse work effects, by enhancing health and work outcomes. No data exist about employers' views concerning supporting workers with long-term conditions to self-manage.

Design/methodology/approach

The exploration of employers' views involved recruiting 15 participants with responsibilities for workplace health, well-being and safety responsibilities, who participated in a semi-structured interview about self-management and support. Data were analysed using a qualitative six-stage thematic analysis technique.

Findings

Self-management support is not purposely provided to workers with long-term conditions. Support in any form rests on workers disclosing a condition and on their relationship with their line-manager. While employers have considerable control over people's ability to self-manage, they consider that workers are responsible for self-management at work. Stigma, work demands and line-manager behaviours are potential obstacles to workers' self-management and support.

Practical implications

Workplace discussions about self-managing long-term conditions at work should be encouraged and opened up, to improve health and work outcomes and aligned with return-to-work and rehabilitation approaches. A wider biopsychosocial culture could help ensure workplaces are regarded as settings in which long-term conditions can be self-managed.

Originality/value

This study highlights that employer self-management support is not provided to workers with long-term conditions in a purposeful way. Workplace support depends on an employer knowing what needs to be supported which, in turn, depends on aspects of disclosure, stigma, work demands and line management.

Using nudges to promote physical activity and to reduce sedentary behaviour in the workplace: a scoping review protocol

INTRODUCTION

Physical inactivity and sedentary behaviour are associated with numerous health problems and increasing risks of premature morbidity and mortality. Workplace health promotion with a focus on increasing physical activity (PA) and reducing sedentary behaviour is of growing interest. The concept of choice architecture with the use of nudges is a promising approach to influence decision making regarding health behaviours. It can help to understand why people often fail to act in their best interest, to follow well-informed preferences or to achieve their set goals. Nudges, the way the choice is presented, can help to overcome these challenges by using the same habits, biases or boundaries to alter our decision-making in favour of the more preferred behaviour. Aims of the scoping review will be to analyse (a) to what extent the concept of choice architecture is used in workplace health promotion to promote PA and/or to reduce sedentary behaviour and (b) which instruments (nudges) are used to archive that.

METHODS AND ANALYSES

Medline, PsychInfo, Web of Science and CINHAL will be searched from 2009 until June 2020. Applying a two-level screening process, title and abstracts will be screened according to a set of predetermined inclusion and exclusion criteria. Included articles will be screened a second time to determine the extent to which choice architecture has been used. Analyses for publication year, location, setting and target group will be provided. Interventions will be analysed presenting the instruments used, number of studies per instrument, combinations of instruments and alteration of the environment. Outcome measures and results will be reported as they occur.

ETHICS AND DISSEMINATION

Due to the nature of the scoping review, ethical concerns are minimal. No patient data will be included. Results are published in peer-review journals.

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

BACKGROUND

The aim of this study was to assess the evidence regarding economic evaluations of worksite health promotion programs in Europe.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search, study selection, data extraction and quality appraisal were performed independently by two researchers. Full economic evaluations of worksite health promotion programs carried out in a European workplace were included.

RESULTS

From 1728 search results, 39 articles describing 37 studies were included. Regarding methodological quality, 9 studies were rated as strong, 15 as moderate and 15 as weak. Six of the studies fulfilled the minimum standard for health economic evaluations. Worksite health promotion was applied in many different forms for a wide range of settings. Cost-effectiveness, cost-benefit and cost-utility analyses were performed from different perspectives. Effects on health outcomes tended to be small and uncertain. Only 9 out of 21 cost-benefit analyses reported a financial benefit and 10 out of 23 cost-effectiveness analyses concluded that the intervention was cost-effective. Two out of eight cost-utility analyses were found to be cost-effective. Productivity loss accounted for more than 85% of the total costs and thus, was the main cost driver in the analyses.

CONCLUSIONS

Due to considerable heterogeneity, no specific type of intervention could be identified to be particularly effective and the economic value of worksite health promotion remains uncertain. Further studies, investigating comprehensive worksite health promotion programs are needed to provide evidence on their efficiency. Guidelines to perform economic evaluations in the field of worksite health promotion, especially for valuation of productivity loss, are required.

Pilot test of an interactive obesity treatment approach among employed adults in a university medical billing office

Background

There is a need for workplace programs promoting healthy eating and activity that reach low-wage employees and are scalable beyond the study site. Interventions designed with dissemination in mind aim to utilize minimal resources and to fit within existing systems. Technology-based interventions have the potential to promote healthy behaviors and to be sustainable as well as scalable. We developed an interactive obesity treatment approach (iOTA), to be delivered by SMS text messaging, and therefore accessible to a broad population. The aim of this pilot study was to evaluate participant engagement with, and acceptability of, this iOTA to promote healthy eating and activity behaviors among low-wage workers with obesity.

Methods

Twenty participants (self-reporting body mass index ≥ 30 kg/m²) of a single workgroup employed by a university medical practice billing office had access to the full intervention and study measures and provided feedback on the experience. Height and weight were measured by trained research staff at baseline. Each participant was offered a quarterly session with a health coach. Measured weight and a self-administered survey, including dietary and activity behaviors, were also collected at baseline, 3, 6, 12, 18, and 24 months. Participant engagement was assessed through responsiveness to iOTA SMS text messages throughout the 24-month pilot. A survey measure was used to assess satisfaction with iOTA at 3 months. Due to the small sample size and pilot nature of the current study, we conducted descriptive analyses. Engagement, weight change, and duration remaining in coaching are presented individually for each study participant.

Results

The pilot was originally intended to last 3 months, but nearly all participants requested to continue; we thus continued for 24 months. Most (14/20) participants remained in coaching for 24 months. At the 3-month follow-up, eight (47%) of the remaining 17 participants had lost weight; by 24 months, five (36%) of the remaining 14 participants had lost weight (one had bariatric surgery). Participants reported very high satisfaction.

Conclusions

This pilot provides important preliminary results on acceptability and participant engagement with iOTA, which has significant potential for dissemination and sustainability.

Effects of a Workplace-Based Virtual-Run Intervention Among University Employees

Virtual runs (real running or walking activities using online recording platforms) have been popular in the digital age and could have the potential to promote physical activity (PA) in workplaces. We investigated the effects of a virtual-run intervention (VRI) on PA and body compositions among university employees. A three-phase intervention was conducted over 6 months: 0 (pre-intervention), 1 (during intervention), and 2 (post-intervention). Exercise stages of change were assessed in phases 0 and 2. Body compositions (body weight, body mass index, fat mass, percentage of fat mass, fat-free mass, and percentage of fat-free mass) were assessed in phases 0, 1, and 2. Running and walking times were recorded through a mobile application. Forty-seven participants completed the VRI. The number of participants at the maintenance stage increased from 34.04% in phase 0 (n = 16) to 63.83% in phase 2 (n = 30). None of the changes in body compositions were significant (p > 0.05). The median running and walking time among participants at the maintenance stage was 151.85 (interquartile range, 109.15) min/week. Future research should focus on approaches to improve the efficacy of VRIs and their effects on health outcomes.

Responsive evaluation of stakeholder dialogue as a worksite health promotion intervention to contribute to the reduction of SEP related health inequalities: a study protocol

BACKGROUND

Large health inequalities exist in the Netherlands among individuals with a high compared to a low socioeconomic position. Worksite health promotion interventions are considered promising to reduce these inequalities, however, current interventions seem not to have the desired effects. This study proposes 'moral case deliberation', a form of stakeholder dialogue on moral dilemmas, as an integrated and inclusive intervention for worksite health promotion. This intervention takes into account three factors that are considered possible underlying causes of low effectiveness of current interventions, namely the lack of deliberate attention to: 1) the diverging values and interests of stakeholders in worksite health promotion, 2) the ethical issues of worksite health promotion, and 3) the connection with the lived experience (lifeworld) of lower SEP employees. Moral case deliberation will help to gain insight in the conflicting values in worksite health promotion, which contributes to the development of a vision for worksite health promotion that is supported by all parties.

METHODS

The intervention will be evaluated through Responsive Evaluation, a form of participatory research. Key to Responsive Evaluation is that stakeholders are consulted to determine relevant changes as a result of the intervention. The intervention will be evaluated yearly at both fixed moments (baseline and annual evaluation(s)) and continuously. Mixed methods will be used, including interviews, participatory observations, analyses of HRM-data and short questionnaires. In addition, the intervention will be evaluated economically, on both monetary and non-monetary outcomes.

DISCUSSION

This protocol proposes an innovative intervention and a novel participatory evaluation in the context of worksite health promotion. The study aims to gain understanding in how dialogue on moral dilemmas on health and health promotion can contribute to heightened personal and mutual understanding among stakeholders and practice improvements in the work context. By evaluating the intervention in more than one setting, findings of this study will provide knowledge about how MCD can be adapted to specific work settings and what changes it may lead to in these settings.

TRIAL REGISTRATION

Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, retrospectively registered. https://www.trialregister.nl/.

Health promotion program for office workers with SEM based on the WHO’s healthy workplace framework

This study attempts to develop and verify the effectiveness of a health promotion program for office workers based on the social ecological model and the World Health Organization’s Healthy Workplace Framework. This study involved 272 office workers of a small and medium-sized enterprise in Korea. Data were analyzed through descriptive statistics, repeated measures analysis of variance (ANOVA) and Bonferroni correction using SPSS/WIN 23.0. Workplace environmental support was provided to all workers, while a 6-month intensive core program based on social support was implemented for the intensive management group. Based on the participation rate, individuals were divided into the core and dropout groups. In all office workers, there were negative changes in high-density lipoprotein cholesterol and job stress during the period. Meanwhile, the intensive group showed significant changes in body mass index and diastolic blood pressure. The study suggests that the organization’s support for a healthy environment and an individual’s continued participation based on social support are essential for the effectiveness of a health promotion program for office workers.

A systematic review protocol examining workplace interventions that aim to improve employee health and wellbeing in male-dominated industries

BACKGROUND

The workplace environment potentially provides access to a large population who are employed, and it is an employer's responsibility to provide appropriate conditions for its employees. Whilst the aetiology of cardiovascular disease is multifactorial, it is generally acknowledged that working conditions, gender and age are involved in its development. Male-dominated industries (comprising > 70% male workers, e.g., agriculture, construction, manufacturing, mining, transport and technology) have a higher prevalence of health risk behaviours than other population subgroups. Working in a gender-dominated industry can impact an employee's health and wellbeing, particularly for the opposite sex. This systematic review examines workplace interventions that address the health and wellbeing of employees in male-dominated industries.

METHODS

We will include randomised controlled trials and studies with non-randomised intervention groups. The interventions must aim to improve employee physical and/or mental health and wellbeing implemented in the workplace in male-dominated industries. There will be no limits on date. The following electronic databases will be searched for published studies: Web of Science, Embed, MedLine, PsycInfo and the Cochrane Database. The search strategy will include free-text terms and MeSH vocabulary, including 'male-dominated industries', 'workplace interventions', 'occupational stress', 'mental health', 'cardiovascular disease', 'blood pressure', 'body mass index' and 'exercise'. Two authors will independently select, review and extract data from studies that meet the inclusion criteria. The Cochrane's Risk of Bias tool will be used to assess risk of bias. We will perform structured summaries of the included studies and, if possible, conduct meta-analyses or construct an Albatross plot.

DISCUSSION

There are an increasing number of interventions designed to improve employee health and wellbeing in the workplace, but no prior review that systematically evaluates their effectiveness. A systematic review is required to prioritise the future implementation of those interventions found to be most effective.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019161283.

Qualitative Exploration of the Feasibility and Acceptability of Workplace-Based Microgrants to Improve Physical Activity: The 10,000 Steps Pedometer Microgrant Scheme

OBJECTIVE

Despite the benefits associated with workplace health programs, many organizations are unable to offer them due to financial constraints. To address this barrier, the existing 10,000 Steps program trialed the 10,000 Steps Pedometer Microgrant Scheme. This study assessed the feasibility and acceptability of the Microgrant Scheme.

METHODS

Semi-structured interviews with employee representatives (n = 19) were used to explore perceptions of the Microgrant Scheme. Thematic inductive analysis was conducted.

RESULTS

Three main themes emerged: 1) the need for workplace initiatives to address health promotion issues (The Need); 2) the factors associated with the application and implementation process (The Process); and 3) employee and employer benefits associated with the Microgrant Scheme (The Outcomes).

CONCLUSION

These findings highlight the potential utility of a Microgrant Scheme to extend the reach and long-term sustainability of workplace health promotion activities.

The cross-sectional association of cognitive stimulation factors and cognitive function among Latino adults in Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

INTRODUCTION

Higher cognitive stimulation (CS) is associated with improved cognition. Sources of CS among Hispanics/Latinos are understudied.

METHODS

In the Hispanic Community Health Study/Study of Latinos 2008 to 2011 (n = 9438), we used finite mixture models to generate latent CS profiles, and multivariate linear regressions to examine associations with cognition in Hispanic/Latino adults (45-74 years). CS included education, occupation, social network, and acculturation. Cognitive measures included the Six-Item Screener, Brief-Spanish English Verbal Learning Test Sum and Recall, Controlled Oral Word Association Test, Digit Symbol Substitution, and Global Cognition.

RESULTS

Two CS profiles emerged, and were labeled "typical" and "enhanced." The enhanced CS profile (22%) had more family connections, bicultural engagements, skilled/professional occupations, education, and higher cognitive scores.

DISCUSSION

An enhanced CS profile emerged from contextual and culturally relevant factors, and was associated with higher cognitive scores across all measures. This provides initial evidence on how factors coalesce to shape cognitive protection in Hispanics/Latinos.

Impact of Diabetes and Disease Duration on Work Status Among U.S. Older Adults

Objectives: To examine the effects of diabetes and disease duration on work status over a 9-year period. Method: Multinomial logistic regression models examined the probability of retirement and disability impeding work, using data from the Health and Retirement Study (n = 5,576). Results: Among participants who had retired in 2012, almost 14% had incident diabetes (4.91 mean years with diabetes, 95% confidence interval [CI] = [4.67, 5.15]). Approximately 22% of participants who reported a disability impeded labor force participation had prevalent diabetes (17.1 mean years with diabetes, 95%CI = [16.41, 17.71]). Only prevalent diabetes that indicated longer disease duration was associated with disability (relative risk ratio [RRR] = 1.83, 95% CI = [1.30, 2.57]). There was evidence of effect modification among Hispanics only (p = .02). Discussion: Diabetes increased risk of exiting the workforce due to disability, and mean disease duration was associated with changes. Disease management and workplace interventions may enable older adults to continue being productive should they choose to remain in the workforce.

Development of a scalable weight loss intervention for low-income workers through adaptation of interactive obesity treatment approach (iOTA)

BACKGROUND

Describing how and why an evidence-based intervention is adapted for a new population and setting using a formal evaluation and an adaptation framework can inform others seeking to modify evidence-based weight management interventions for different populations or settings. The Working for You intervention was adapted, to fit a workplace environment, from Be Fit Be Well, an evidence-based intervention that targets weight-control and hypertension in patients at an outpatient clinic. Workplace-based efforts that promote diet and activity behavior change among low-income employees have potential to address the obesity epidemic. This paper aims to explicitly describe how Be Fit Be Well was adapted for this new setting and population.

METHODS

To describe and understand the worksite culture, environment, and policies that support or constrain healthy eating and activity in the target population, we used qualitative and quantitative methods including key informant interviews, focus groups, and a worker survey; these data informed intervention adaptation. We organized the adaptations made to Be Fit Be Well using an adaptation framework from implementation science.

RESULTS

The adapted intervention, Working for You, maintains the theoretical premise and evidence-base underpinning Be Fit Be Well. However, it was modified in terms of the means of delivery (i.e., rather than using interactive voice response, Working for You employs automated SMS text messaging), defined as a modification to context by the adaptation framework. The adaptation framework also includes modifications to content; in this case the behavioral goals were modified for the target population based on updated science related to weight loss and to target a workplace population (e.g., a goal to avoiding free food at work).

CONCLUSIONS

If effective, this scalable and relatively inexpensive intervention can be translated to other work settings to reduce obesity and diabetes risk among low-SES workers, a group with a higher prevalence of these conditions. Using a formal evaluation and framework to guide and organize how and why an evidence-based intervention is adapted for a new population and setting can push the field of intervention research forward.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02934113 ; Received: October 12, 2016; Updated: November 7, 2017.

Evaluation of a Lifestyle Change Worksite Weight Management Program Across Multiple Employers and Sites

OBJECTIVE

The aim of the study was to assess weight loss outcomes among participants (N = 1090) of a weight management program across multiple worksites (N = 10) in a retrospective analysis.

METHODS

Weekly classes focused on diet, exercise, and behavior change. One employer provided incentives for weight loss and two incentivized weight loss and class attendance.

RESULTS

Mean weight loss (N = 1090; 79.3% female) was -2.9% (SD = 3.0%). Average number of classes attended was 6.87/10 (SD = 2.9) and was significantly correlated with percent weight change (r = -0.46; P < 0.001). Participants incentivized for attendance attended significantly more classes (M = 7.5, SD = 2.8) than did those not so incentivized (M = 6.4, SD = 2.9, P < 0.001), but did not lose more weight (P = 0.24). Participants incentivized for weight loss did not lose significantly more weight than those not so incentivized (P = 0.26).

CONCLUSIONS

These data support the effectiveness of this worksite program. Utilizing incentives to promote class attendance may be beneficial for increasing engagement in similar programs.

Obstacles and Future Prospects: Considerations on Health Promotion Activities for Older Workers in Europe

The ageing of workers is one of the most important issues for occupational health and safety in Europe. The ageing of the active population means that health promotion is a necessity rather than a mere option. This review considers barriers and perspectives for workplace health promotion for older workers. Lack of awareness on the part of management and inflexibility in the occupational health and safety system appear to be major barriers. To overcome these, it will be necessary to disseminate knowledge regarding the effectiveness of health promotion actions for older workers, encourage greater involvement on the part of social partners, recover resources by replacing medical consumerism and bureaucratic practices, adopt an integrated approach combining the prevention of occupational risks and the promotion of healthy lifestyles, and recognize subsidiarity and the ability of working communities to regulate themselves.

Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial

Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72]) relative to CDSMP (‘Usual Care’ [n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23–72) and self-reported 3.25 chronic conditions (range: 1–16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient–provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings.

Effectiveness of a Type 2 Diabetes Screening Intervention in the Canadian Workplace

OBJECTIVES

There is a lack of Canadian data concerning the effectiveness of diabetes interventions in the workplace. The objective of this study was to evaluate the effectiveness of Motivaction, a diabetes screening and education pilot program, in the workplace.

METHODS

The Motivaction program involves a voluntary web-based diabetes health-risk assessment, the Canadian Diabetes Risk Questionnaire (CANRISK), combined with an opportunity for those eligible (i.e. having diabetes or having a CANRISK score ≥21) to attend 2 on-site biometric screening meetings with a registered nurse and 4 educational sessions by telephone with a certified diabetes educator. Biometric data, as well as information about self-efficacy, lifestyle changes, productivity, well-being, mental health and program satisfaction, were collected at baseline and at 6 months.

RESULTS

Attendance at the initial and 6-month clinical visits included 293 people. At baseline, 21% were identified as having prediabetes (13%) or having diabetes (8%). Statistically significant reductions in glycated hemoglobin levels from baseline to the study's end were observed in those with prediabetes or diabetes. No statistically significant changes in glycated hemoglobin levels were observed in individuals with normal levels or in those at risk for diabetes at baseline. No statistical differences were observed in terms of productivity or mental health for the full population or across diabetes-risk categories. More than 90% of employees would recommend the Motivaction program to other employers.

CONCLUSIONS

This study provides a framework for future diabetes interventions in the workplace and demonstrates that workplace interventions may reduce employees' diabetes risk levels and are valued by employees.