Why won’t they participate? Barriers to participation in worksite health promotion programmes

Perceived Factors Influencing Blue-Collar Workers' Participation in Worksite Health Promotion Programs in Freight Transport: A Qualitative Investigation Using the TDF and COM-B

Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs.

Factors associated with blue-collar workers' participation in Worksite Health Promotion Programs: a scoping literature review

A growing number of employers implement worksite health promotion programs (WHPPs). In particular, blue-collar workers may benefit from these WHPPs. However, they are less likely than other workers to participate and little is known about which factors affect their participation. The aim of this scoping literature review is to produce an overview of studies on factors associated with blue-collar workers' participation in WHPPs. Five databases were searched: BSU, PsycINFO, Medline, Web of Science and CINAHL. The review included peer-reviewed empirical studies on determinants associated with blue-collar workers' participation in WHPPs. Factors were extracted and categorized. Similar determinants were clustered and the direction of the associations was further examined. Nineteen papers describing 11 qualitative and 4 quantitative studies met the eligibility criteria. Seventy-seven determinants were analyzed (in quantitative studies) or reported (in qualitative studies). In most studies, only participant characteristics were investigated. Participation may be enhanced by addressing needs, tailoring from a broad range of activities, offering group activities, requiring little effort and commitment at the start, using incentives, leading by example and combining WHPPs with occupational safety interventions. WHPPs seem to be able to reach blue-collar workers, but it remains particularly challenging to reach shift workers and those who do not yet experience health complaints.

Arbeitsgestaltung bei hoher Arbeitsintensität und Zeit- und Leistungsdruck

Zusammenfassung. Eine hohe Arbeitsintensität (AI) wird von Beschäftigten als Zeit- und Leistungsdruck (ZLD) erlebt. Sie gilt als Schlüsselfaktor psychischer Belastung, dem geeignete Arbeitsschutzmaßnahmen entgegengesetzt werden müssen. In mehreren Projekten erforscht die Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA) die betriebliche Umsetzung dieser Arbeitsschutz- und Gestaltungsaufgabe, um zu beantworten, 1) warum es nicht gelingt, hohe AI/ZLD in der betrieblichen Praxis ausreichend zu vermeiden (Barrieren) und 2) welche Gestaltungsansätze in der Praxis dennoch entwickelt werden. Inhaltsanalytisch thematische Auswertungen von 79 leitfadengestützen Interviews aus zwei Studien (Studie 1: Akteursperspektive, Studie 2: Beschäftigtenperspektive) zeigen, dass zwei Faktoren die Entwicklung von Schutzmaßnahmen durch betriebliche Akteur_innen beeinträchtigen: die Komplexität der Entstehungsbedingungen und als gering wahrgenommene Gestaltungsspielräume. Beide Faktoren werden mit Bezug zu hoher AI/ZLD weiter ausdifferenziert. Weiterhin werden in der Zusammenschau der Perspektiven vielfältige Ansätze herausgearbeitet und diskutiert, mit denen hoher AI/ZLD auf den verschiedenen Ebenen des Unternehmens begegnet wird.

A German Model Project for Workplace Health Promotion-Flow of Communication, Information, and Reasons for Non-Participation in the Offered Measures

BACKGROUND

Workplace health promotion (WHP) as a part of workplace health management (WHM) was strengthened in German legislature with the Prevention Act of 2015. However, smaller enterprises often do not offer WHM or WHP. Accordingly, a model-project for improving the uptake and implementation, particularly in micro-, small, and medium-sized enterprises (MSMEs) was carried out. The aim of the study was to determine reasons for non-participation in WHP offers and analyze communication issues, both from the employee's and employer's perspective.

METHODS

In total, 21 managers or persons responsible for WHP participated in the first online survey between March and April 2020, and 156 employees responded to the second online survey between June and October 2021. The importance of barriers and communication issues was investigated. Based on a principal component analysis on non-participation, differences regarding sociodemographic variables were analyzed.

RESULTS

Most employees knew about the offered measures and that the measures were cost free. There was no significant association between having communicated the offers to the employees and considering them suitable for their needs. Most of the managers or persons responsible for WHP rated the measures as sufficiently varied and allowed staff to take part during working-time. Reasons for non-participation from the managers' point of view were travel time to the location of the offers, lack of time, and a missing fit between offers and employees' needs. From the employees' point of view, workload (including working time) was the main barrier to participation.

CONCLUSIONS

For the practical implementation of model projects in MSMEs, special attention should be paid to ensuring opportunity to participate, which may be easier with in-house offers.

STAR-VITAL, a Four Year Comprehensive Workplace Health Promotion Program: Study Design

Background: Premature death, chronic disease, and productivity loss can be reduced with the help of programs that promote a healthy lifestyle. Workplace health promotion programs have been shown to be an efficient way of improving employee health. These can also benefit employers by improving retention, reducing worker turnover, and lowering healthcare costs. In Slovenia, a workplace health promotion program called “STAR-VITAL—Joint Measures for the Vitality of Older Workers” targeting small- and medium-sized enterprises has been ongoing since September 2017. We hypothesize that this workplace health promotion program will yield long-term health changes for the included employees and employers. Methods/Design: The manuscript presents a workplace health promotion program design that introduces some novel approaches and solutions to workplace health promotion program implementation. It also introduces a measurement of their effects that address the problem of low participation rates and the effectiveness of workplace health promotion programs, as follows: (1) the multifaceted and individualised approach to implementation, (2) customer relationship management (CRM) -based interaction management with program participants, and (3) impact evaluation based on employee health and labour market data observing both intermediate outcomes and the final outcomes based on national micro administrative data. Discussion: Although the novel approaches introduced with the STAR-VITAL program proved to be effective during the COVID-19 pandemic, they deserve the attention of scholars and practitioners. Further research is called for to further explore the potential of CRM in health promotion contexts, the effectiveness of multifaceted and individualised workplace health promotion program interventions, and micro administrative data-based impact evaluations. Conclusions: The STAR-VITAL program introduces several new approaches addressing the problem of low participation rates and the effectiveness of WHPPs. Further research is called for to discover and explore the potential of those novel approaches.

Predicting Employee Participation in, and Satisfaction With, Wellness Programs: The Role of Employee, Supervisor, and Organizational Support

OBJECTIVE

To examine the role of employee, supervisor, and organizational support in the prediction of employee participation in wellness programs.

METHODS

Data were collected at two-time points (T1 and T2) from 194 Australian employees.

RESULTS

Hierarchical binary logistic regressions revealed that higher levels of employee and supervisor support for wellness at T1 each predicted T2 participation, and high supervisor support was more effective when organizational support was high and did not compensate for when organizational support was low. Employees with higher perceptions of T1 poor general health had a lower likelihood of T2 participation, and higher levels of T1 supervisor support was a further deterrent to participation.

CONCLUSIONS

Different sources of support for wellness predict employee attendance at wellness programs and it is important to ensure that supervisor and organizational support are aligned.

Interventions as the centrepiece of psychosocial risk assessment – why so difficult?

Purpose

Due to the “European Union Framework Directive on Safety and Health at work” (Directive 89/391/EEC, 1989), every employer is obliged to avoid psychosocial hazards when designing work. Little is known empirically about the barriers that workplace actors experience while developing and implementing OSH measures that prevent psychosocial hazards. The purpose of this paper is to explore barriers, causes and attempts to overcome them and discusses them with reference to relevant theoretical concepts and models that help to explain how these barriers hinder the development and implementation of OSH measures.

Design/methodology/approach

Semi-structured interviews with workplace actors in charge of psychosocial risk assessment (PRA) were conducted in 41 business cases, and transcripts were analysed using a thematic analysis approach. Barriers, causes and attempts to overcome them were extracted inductively and discussed with reference to relevant theories and explanatory models.

Findings

The complex nature of psychosocial risks, hindering general beliefs, lack of a perceived scope for risk avoidance, lack of assumptions of responsibility among players on all hierarchical levels, discrepancies between formal responsibility and decision authority, and low reflexivity on processes of development and implementation of interventions were described as barriers. Causes and attempts to overcome these barriers were reflected upon by workplace actors.

Practical implications

Recommendations on the organisation of PRA will be given with respect to the reported results and relevant research in this field.

Originality/value

This qualitative study explores the barriers to developing and implementing OSH measures to eliminate psychosocial hazards, from the perspective of actors in charge of PRA, and why they might fail.

The impact of worksite interventions promoting healthier food and/or physical activity habits among employees working 'around the clock' hours: a systematic review

We conducted a systematic review of randomised studies on the impact of worksite interventions to promote healthier food and/or physical activity among people who work irregular hours ‘around the clock’, that is, outside of ordinary daytime working hours. The population–intervention–comparator–outcomes–study (PICOS) design format was used. Data sources were PubMed and CINAHL. An updated search was conducted on October 2017 using Google Scholar and the related articles function in PubMed on initially included studies to identify additional studies. Risk of bias was used to assess study quality. A total of seven studies (reports published in 14 papers) were included in the systematic review: Two interventions with a broader lifestyle approach, three focusing on physical exercise and two on providing healthier food or meal options. The studies had sample sizes from 30 to 1,000 and targeted a mixture of occupations, including both male- and female-dominated occupational groups. The interventions lasted from 2 to 12 months. Only one had an extended follow-up. In general, the studies showed small-to-moderate effect sizes on several measures, including dietary and/or physical activity measures, suggesting acceptable effectiveness for interventions involving community-level behaviour change. Our findings highlight a need to further develop and implement well-designed health promotion interventions with comparable outcome measures and effect size reports. A mixture of health promotion strategies is recommended for future practice in this target population, including individually tailored programmes, improving the food and physical activity environment and using broader lifestyle approaches including the use of participatory and empowerment strategies. While more research is needed in this field, the existing knowledge base on effective approaches awaits translation into practice.

Factors Associated With Participation in a University Worksite Wellness Program

INTRODUCTION

Healthcare reform legislation encourages employers to implement worksite wellness activities as a way to reduce rising employer healthcare costs. Strategies for increasing program participation is of interest to employers, though few studies characterizing participation exist in the literature. The University of Michigan conducted a 5-year evaluation of its worksite wellness program, MHealthy, in 2014. MHealthy elements include Health Risk Assessment, biometric screening, a physical activity tracking program (ActiveU), wellness activities, and participation incentives.

METHODS

Individual-level data were obtained for a cohort of 20,237 employees who were continuously employed by the university all 5 years. Multivariate logistic regression was used to assess the independent predictive power of characteristics associated with participation in the Health Risk Assessment, ActiveU, and incentive receipt, including employee and job characteristics, as well as baseline (2008) healthcare spending and health diagnoses obtained from claims data. Data were collected from 2008 to 2013; analyses were conducted in 2014.

RESULTS

Approximately half of eligible employees were MHealthy participants. A consistent profile emerged for Health Risk Assessment and ActiveU participation and incentive receipt with female, white, non-union staff and employees who seek preventive care among the most likely to participate in MHealthy.

CONCLUSIONS

This study helps characterize employees who choose to engage in worksite wellness programs. Such information could be used to better target outreach and program content and reduce structural barriers to participation. Future studies could consider additional job characteristics, such as job type and employee attitudinal variables regarding health status and wellness program effectiveness.

Workplace health promotion of large and medium-sized businesses

Purpose

– The purpose of this paper is to investigate the relationship between different areas of workplace health promotion (WHP) activities and predictors of the number of areas in which WHP activities are offered.

Design/methodology/approach

– A questionnaire with ten questions on WHP was mailed to the 478 largest businesses in Berlin and Brandenburg, Germany. The cross-sectional data from this survey are presented and explored using correlation and linear regression analyses.

Findings

– In total, 30 businesses, of which 90 percent offered WHP activities, participated in the survey. Businesses with WHP were, on average, active in 5.59 (SD=2.24) areas of health promotion. Offering an activity was positively correlated with offering an activity in at least one other area for all WHP areas except ergonomic workplace design (p < 0.05). Among businesses offering WHP, reporting that WHP would be strengthened with more support (−2.02, 95 percent CI: −4.04 to −0.01) and being a medium-sized business with an information need (−3.63, 95 percent CI: −5.70 to −1.57) or an opinion that health insurance companies should offer WHP (−1.96, 95 percent CI: −3.86 to −0.05) were all associated with offering activities in fewer WHP areas. In a multiple regression analysis, the information need of mid-size businesses was the only significant predictor (−5.25, 95 percent CI: −9.41 to −1.08).

Practical implications

– Addressing the information needs of medium-sized businesses concerning WHP could be an effective strategy for increasing the spectrum of WHP activities offered.

Originality/value

– This study complements existing studies by assessing associations between WHP activities and predictors of WHP activity emphasizing business size.