Organizational Characteristics Influence Implementation of Worksite Health Protection and Promotion Programs: Evidence From Smaller Businesses

Putting implementation into context: Exploring the influence of physical, social, and task contexts on the implementation of health promotion programs

The aim of this paper is to empirically examine the influence of organizational context on the implementation effectiveness of human resource management (HRM) practices with the aim of maintaining the health and well-being of employees, known as health promotion programs (HPPs). HPPs are a strategic function in HRM and play a crucial role in creating and maintaining human capital. Effective implementation is typically viewed as a critical prerequisite for the success of HPPs. By exploring the influence of organizational context on the implementation of HPPs, this paper offers a fresh approach to understanding HRM implementation in a relatively neglected area of research. To uncover contextual influences a multiple-case study in four German organizations operating in the chemical industry was conducted. Data was collected using a multi-method design consisting of an analysis of documents and 28 semi-structured interviews. The study is among the first to apply the categorical model of context by Johns to the investigation of the implementation of health promotion programs. The results contribute to a more nuanced view of HRM implementation by highlighting the interrelationships between contextual factors stemming from the physical, social, and task context and implementation fidelity. By providing initial empirical evidence of the mechanisms underlying this relationship, this study sheds light on the complexity and breadth of contextual influences during the implementation of HPPs and offers several theoretical and practical implications.

Highly Educated Immigrant Workers' Perspectives of Occupational Health and Safety and Work Conditions That Challenge Work Safety

This study explored the perspectives of new immigrant workers regarding occupational health and safety and workplace conditions that increase workers' vulnerability to sustaining injury or illness. Using an interpretive research approach and semi-structured qualitative interviews, 42 new immigrant workers from a range of industries operating in two cities in a province in Canada were interviewed. Seventy-nine percent of the workers were highly qualified. A constant comparative approach was used to identify key themes across the workers' experiences. The findings revealed that new immigrant workers have an incomplete understanding of occupational health and safety. In many workplaces, poor job training, little worker support, lack of power in the workplace, and a poor workplace safety culture make it difficult for workers to acquire occupational health and safety information and to implement safe work practices. This study proposes workplace policies and practices that will improve worker occupational health and safety awareness and make workplaces safer for new immigrant workers.

Implementation Determinants of Zimbabwe National Occupational Safety and Health Policy in Willowvale Industrial Area, Zimbabwe

Zimbabwe introduced the National Occupational Safety and Health Policy (ZNOSHP) in August 2014 with the vision and mission to eliminate occupational accidents, injuries, diseases, and fatalities and to promote Occupational Safety and Health (OSH). This study was therefore aimed at exploring the individual- and organizational-level determinants of ZNOSHP’s implementation. Data were collected from 309 workers in the Willowvale industrial area in Harare, Zimbabwe. Negative binomial regression models were used to explore the determinants of ZNOSHP’s implementation. After adjustment, participant’s knowledge of ZNOSHP (Incidence Rate Ratio, IRR = 1.32; 95% Confidence Interval, CI: 1.19–1.46; p ≤ 0.001), production department (IRR = 1.13; 95% CI: 1.03–1.26; p ≤ 0.05), company years of operation (IRR = 1.33; 95% CI: 1.21–1.46; p ≤ 0.001), participants who identified several implementation barriers (IRR = 1.12; 95% CI: 1.01–1.25; p ≤ 0.001), and agricultural industry were associated with higher rates of ZNOSHP’s implementation. In conclusion, individual- and organizational-level determinants of implementation of OSH standards were explored, and positive associations were found. Policy implementation, enforcement, and follow up strategies need to be developed in order to ensure adherence to safety measures. This study should be extended to other parts of Zimbabwe in order to develop evidence-based policy.

Cardiovascular Health Research in the Workplace: A Workshop Report

Heart disease and stroke are the first and fifth leading causes of death in the United States, respectively. Employers have a unique opportunity to promote cardiovascular health, because >60% of US adults are employed, and most spend half of their waking hours at work. Despite the scope of the opportunity, <1 in 5 businesses implement evidence-based, comprehensive workplace health programs, policies, and practices. Integrated, systems-based workplace health approaches that harness data science and technology may have the potential to reach more employees and be cost-effective for employers. To evaluate the role of the workplace in promoting cardiovascular health across the lifespan, the National Heart, Lung, and Blood Institute, the National Institute for Occupational Safety and Health, and the American Heart Association convened a workshop on March 7, 2019, to share best practices, and to discuss current evidence and knowledge gaps, practical application, and dissemination of the evidence, and the need for innovation in workplace health research and practice. This report presents the broad themes discussed at the workshop and considerations for promoting worker cardiovascular health, including opportunities for future research.

Using Total Worker Health® Implementation Guidelines to Design an Organizational Intervention for Low-Wage Food Service Workers: The Workplace Organizational Health Study

Total Worker Health® (TWH) interventions that utilize integrated approaches to advance worker safety, health, and well-being can be challenging to design and implement in practice. This may be especially true for the food service industry, characterized by high levels of injury and turnover. This paper illustrates how we used TWH Implementation Guidelines to develop and implement an organizational intervention to improve pain, injury, and well-being among low-wage food service workers. We used the Guidelines to develop the intervention in two main ways: first, we used the six key characteristics of an integrated approach (leadership commitment; participation; positive working conditions; collaborative strategies; adherence; data-driven change) to create the foundation of the intervention; second, we used the four stages to guide integrated intervention planning. For each stage (engaging collaborators; planning; implementing; evaluating for improvement), the Guidelines provided a flexible and iterative process to plan the intervention to improve safety and ergonomics, work intensity, and job enrichment. This paper provides a real-world example of how the Guidelines can be used to develop a complex TWH intervention for food service workers that is responsive to organizational context and addresses targeted working conditions. Application of the Guidelines is likely transferable to other industries.

Applying the Social Vulnerability Index as a Leading Indicator to Protect Fire-Based Emergency Medical Service Responders' Health

During emergencies, areas with higher social vulnerability experience an increased risk for negative health outcomes. However, research has not extrapolated this concept to understand how the workers who respond to these areas may be affected. Researchers from the National Institute for Occupational Safety and Health (NIOSH) merged approximately 160,000 emergency response calls received from three fire departments during the COVID-19 pandemic with the CDC's publicly available Social Vulnerability Index (SVI) to examine the utility of SVI as a leading indicator of occupational health and safety risks. Multiple regressions, binomial logit models, and relative weights analyses were used to answer the research questions. Researchers found that higher social vulnerability on household composition, minority/language, and housing/transportation increase the risk of first responders' exposure to SARS-CoV-2. Higher socioeconomic, household, and minority vulnerability were significantly associated with response calls that required emergency treatment and transport in comparison to fire-related or other calls that are also managed by fire departments. These results have implications for more strategic emergency response planning during the COVID-19 pandemic, as well as improving Total Worker Health® and future of work initiatives at the worker and workplace levels within the fire service industry.

Building Capacity for Integrated Occupational Safety, Health, and Well-Being Initiatives Using Guidelines for Total Worker Health® Approaches

OBJECTIVES

To describe the process used to build capacity for wider dissemination of a Total Worker Health® (TWH) model using the infrastructure of a health and well-being vendor organization.

METHODS

A multiple-case study mixed-methods design was used to learn from a year-long investigation of the experiences by participating organizations.

RESULTS

Increased capacity for TWH solutions was observed as evidenced by the participation, plans of action, and experience ratings of the participating organizations. The planning process was feasible and acceptable, although the challenges of dealing with the COVID-19 pandemic only afforded two of the three worksites to deliver a comprehensive written action plan.

CONCLUSIONS

A suite of services including guidelines, trainings, and technical assistance is feasible to support planning, acceptable to the companies that participated, and supports employers in applying the TWH knowledge base into practice.

Organizational Perspectives on How to Successfully Integrate Health Promotion Activities into Occupational Health and Safety

OBJECTIVE

There is increasing recognition of the value of integrating efforts to promote worker health with existing occupational health and safety activities. This paper aimed to identify facilitators, barriers and recommendations for implementing integrated worker health approaches.

METHODS

Thirteen stakeholders from different job sectors participated in a workshop that targeted key issues underlying integrated worker health approaches in their own and other organizations. Included were participants from human resources, occupational health and safety, government, and unions. Thematic analysis and an online ranking exercise identified recommendation priorities and contributed to a conceptual framework.

RESULTS

Participants highlighted the importance of planning phases in addition to implementation and evaluation. Themes highlighted organizational priorities, leadership buy-in, external pressures, training, program promotion and evaluation metrics.

CONCLUSIONS

Findings provide practical directions for integrating worker health promotion and safety and implementation steps.

Health Links™ Assessment of Total Worker Health® Practices as Indicators of Organizational Behavior in Small Business

OBJECTIVE

The aim of this study was to conduct a cross-sectional assessment of the adoption of Total Worker Health (TWH) policies and practices by business size and evaluate extent and alignment of their safety and health.

METHODS

We conducted an analysis of 382 businesses that completed the Health Links Assessment. We measured organizational adoption of TWH across six benchmarks: organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation.

RESULTS

Benchmark scores were significantly associated with business size. Larger businesses were more likely to score higher across each benchmark.

CONCLUSION

Small businesses are implementing TWH in a variety of ways and the level of implementation differs by business size. Practical interventions as well as dissemination and implementation research should take business size into account to ensure that TWH is both effective and sustainable in meeting the needs of employees.

Fire Service Organizational-Level Characteristics Are Associated With Adherence to Contamination Control Practices in Florida Fire Departments: Evidence From the Firefighter Cancer Initiative

OBJECTIVES

To characterize the types of contamination control practices followed by Florida fire departments and examine the association between fire department organizational-level characteristics and adherence to contamination control practices.

METHODS

Using a cross-sectional study design, a survey was administered to 142 Florida firefighters. Validated survey measures assessed organizational level characteristics and 32 recommended national contamination control practices.

RESULTS

An average of 18.9 contamination control practices (standard deviation = 5.54; min = 3; max = 30) were reported by fire departments of which, wearing personal protective equipment (PPE) according to manufacturer instructions (98.9%) and access to special machine for cleaning (91%) were most cited. Fire departments with one or more health and safety officers had significantly higher implementation of contamination control practices (P = 0.032).

CONCLUSION

Health and safety officers may have a positive impact on the number of contamination control practices followed in Florida fire departments.

Management commitment and its impact on occupational health and safety improvement: a case of iron, steel and metal manufacturing industries

Purpose

Management commitments (MCs) have a prominent effect to create a safe work environment in the industries. Though there have been various studies on the prevalence and associated factors of OHS in Ethiopian manufacturing industries, the role of MCs in improving workplace safety, however, has not been studied so far. The purpose of this paper is, therefore, to investigate the role of MCs on improving OHS in iron, steel and metal manufacturing industries (ISMMI) in Addis Ababa.

Design/methodology/approach

This paper used a close-ended questionnaire to collect primary data from 89 ISMMI and fitted the data in structural equation modelling (SEM) techniques using SPSS and AMOS.

Findings

The major findings of the study showed that directly or indirectly there are good MCs in Ethiopian ISMMI. To some extent, MCs have also resulted in reducing risk and diseases causing factors, which subsequently reduced occupational risks and disease. However, the study showed that MCs are not strategically supported.

Research limitations/implications

Due to the limited scope of data collection, the research results may not be equally implemented outside Addis Ababa and other sectors.

Practical implications

The findings of the research may help policymakers and managers to strictly control MCs and follow up implementation of OHS policies.

Originality/value

This paper is the first of its kind in developing the conceptual framework model and attempting to assess MCs using structural equation model towards improving OHS in ISMMI.

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.

Exploring and Developing the Workplace Health Culture Scale in Taiwan

Background: The aim of this study was to develop and validate the workplace health culture scale.

Methods: This paper collected and re-organized current definitions about health culture from literature and created the domains and items to develop a new tool. Six enterprises and 2,431 participants were recruited from northern Taiwan for validity test.

Results: We found the workplace health culture scale had appropriate reliability and validity, including a good model fit for the 25-item scale.

Conclusions: Workplace health culture might be an important domain to the work of WHP. More validity and reliability studies about WHCS in wider industries and the correlation between WHCS and other WHP indicators are needed.

Assessing Workplace Health and Safety Strategies, Trends, and Barriers through a Statewide Worksite Survey

Chronic diseases have added to the economic burden of the U.S. healthcare system. Most Americans spend most of their waking time at work, thereby, presenting employers with an opportunity to protect and promote health. The purpose of this study was to assess the implementation of workplace health governance and safety strategies among worksites in the State of Nebraska, over time and by industry sector using a randomized survey. Weighted percentages were compared by year, industry sector, and worksite size. Over the three study periods, 4784 responses were collected from worksite representatives. Adoption of workplace health governance and planning strategies increased over time and significantly varied across industry sector groups. Organizational safety policies varied by industry sector and were more commonly reported than workplace health governance and planning strategies. Time constraints were the most common barrier among worksites of all sizes, and stress was reported as the leading employee health issue that negatively impacts business. Results suggest that opportunities exist to integrate workplace health and safety initiatives, especially in blue-collar industry sectors and small businesses.

'Nutrition is out of our control': soldiers' perceptions of their local food environment

Objective:

To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General’s worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace.

Design:

Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers’ nutrition behaviours.

Setting:

Three US Army installations located in the continental USA.

Participants:

Active duty soldiers (n 366) participating in one of the fifty-eight focus groups.

Results:

Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices.

Conclusions:

Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers’ nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers’ daily food allowances on local produce and increased availability of grab-and-go options.

Larger Workplaces, People-Oriented Culture, and Specific Industry Sectors Are Associated with Co-Occurring Health Protection and Wellness Activities

Employers are increasingly interested in offering workplace wellness programs in addition to occupational health and safety (OHS) activities to promote worker health, wellbeing, and productivity. Yet, there is a dearth of research on workplace factors that enable the implementation of OHS and wellness to inform the future integration of these activities in Canadian workplaces. This study explored workplace demographic factors associated with the co-implementation of OHS and wellness activities in a heterogenous sample of Canadian workplaces. Using a cross-sectional survey of 1285 workplaces from 2011 to 2014, latent profiles of co-occurrent OHS and wellness activities were identified, and multinomial logistic regression was used to assess associations between workplace demographic factors and the profiles. Most workplaces (84%) demonstrated little co-occurrence of OHS and wellness activities. Highest co-occurrence was associated with large workplaces (odds ratio (OR) = 3.22, 95% confidence interval (CI) = 1.15⁻5.89), in the electrical and utilities sector (OR = 5.57, 95% CI = 2.24⁻8.35), and a high people-oriented culture (OR = 4.70, 95% CI = 1.59⁻5.26). Promoting integrated OHS and wellness approaches in medium to large workplaces, in select industries, and emphasizing a people-oriented culture were found to be important factors for implementing OHS and wellness in Canadian organizations. Informed by these findings, future studies should understand the mechanisms to facilitate the integration of OHS and wellness in workplaces.

Total Worker Health: A Small Business Leader Perspective

Total Worker Health® (TWH) frameworks call for attention to organizational leadership in the implementation and effectiveness of TWH approaches. It is especially important to study this within in the small business environment where employees face significant health, safety, and well-being concerns and employers face barriers to addressing these concerns. The purpose of this study was to gain a better understanding of how small business leaders perceive employee health, safety, and well-being in the context of their own actions. We conducted semi-structured interviews with 18 small business senior leaders and used a qualitative coding approach to analyze the transcripts to determine the frequency with which leaders discussed each code. When we asked leaders about their leadership practices for health, safety, and well-being, leaders reflected upon their business (65%), themselves (28%), and their employees (7%). Leaders rarely discussed the ways in which they integrate health, safety, and well-being. The interviews demonstrate that small business leaders care about the health of their employees, but because of the perceived value to their business, not to employees or themselves. Thus, they may lack the knowledge and skills to be successful TWH leaders. The present study supports a need for continued small business TWH leadership research.

Validation and Dimensionality of the Integration of Health Protection and Health Promotion Score: Evidence From the PULSE Small Business and VA Medical Center Surveys

OBJECTIVE

To conduct validation and dimensionality analyses for an existing measure of the integration of worksite health protection and health promotion approaches.

METHODS

A survey of small to medium size employers located in the United States was conducted between October 2013 and March 2014 (N = 115). A survey of Department of Veterans Affairs (VA) administrative parents was also conducted from June to July 2014 (N = 140). Exploratory factor analysis (EFA) was used to determine the dimensionality of the Integration Score in each sample.

RESULTS

Using EFA, both samples indicated the presence of one unified factor. The VA survey indicated that customization improves the relevance of the Integration Score for different types of organizations.

CONCLUSIONS

The Integration Score is a valid index for assessing the integration of worksite health protection and health promotion approaches and is customizable based on industry.

CLINICAL SIGNIFICANCE

The Integration Score may be used as a single metric for assessing the integration of worksite health protection and health promotion approaches in differing work contexts.

The Health and Working Conditions of Women Employed in Child Care

Over one million women are employed in child care and are among the lowest wage workers in the US. The health and working conditions of 674 child care workers (118 administrators and 556 staff) from 74 centers is described using baseline data from a larger intervention trial. Participants were 39.9 (±13.0) years old; 55.4% African American, 37.1% Caucasian, and 5.3% of Hispanic ethnicity. Seventy-six percent reported having an Associate’s degree or less; 42% were classified as at or below poverty (<$20,000); and exhibited many health risks such as excess weight, insufficient activity, poor diet, and inadequate sleep. We investigated potential differences by income and job category. Lower income participants were significantly more likely to be current smokers (19.9% vs. 11.7%), drink more sweetened beverages (1.9 vs. 1.5), and report higher depressive symptoms (15.5 vs. 12.6). Administrators worked more hours weekly compared to staff (46.4 vs. 40.6), are less active (100 vs. 126 min/week), more sedentary (501 vs. 477 min/day), and reported higher job demands (13.3 vs. 12.5). Given the numerous health issues and challenging work conditions, we hope our results serve as a call to action for addressing low wages and the work environment as a means of influencing the health and well-being of child care workers.

Key Organizational Characteristics for Integrated Approaches to Protect and Promote Worker Health in Smaller Enterprises

OBJECTIVE

The aim of this study was to investigate relationships between worksite organizational characteristics (size, industrial sector, leadership commitment, and organizational supports) and integrated approaches to protecting and promoting worker health implemented in smaller enterprises.

METHODS

We analyzed web-based survey data of Human Resource Managers at 114 smaller enterprises (<750 employees) to identify organizational factors associated with levels of integrated approaches among their worksites.

RESULTS

The companies' mean integration score was 13.6 (SD = 9.6) of a possible 44. In multivariate analyses, having a safety committee (P = 0.035) and top leadership support for health promotion (HP) (P = 0.004) were positively associated with higher integration scores.

CONCLUSIONS

Smaller enterprises in one U.S. region have relatively low levels of implementing integrated safety and promotion approaches. Having a safety committee and leadership support for HP may be important contributors to implementing integrated approaches in smaller enterprises.

Integrating worksite health protection and health promotion: A conceptual model for intervention and research

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009-2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.

Congruence of Organizational Self-Score and Audit-Based Organizational Assessments of Workplace Health Capabilities: An Analysis of the HealthLead Workplace Accreditation

OBJECTIVE

The aim of this study was to provide descriptive characteristics of companies accredited as part of the HealthLead Workplace Accreditation and to assess congruence between data reported via online organizational self-assessment and third-party onsite audit.

METHODS

Synthesized organizational level data collected through the HealthLead accreditation process (N = 22). Online self-assessment and onsite third-party audit data were compared using paired t-tests.

RESULTS

Statistical tests revealed significantly higher onsite audit scores than organizational self-assessment scores. Descriptive analyses demonstrated that Outcomes Reporting was the lowest scoring area among all companies. Companies also varied widely in levels of Leadership Support for wellness.

CONCLUSIONS

Gaps observed between organizational self-assessment and onsite audit scores were relatively stable across the sample, indicating that observed differences may be process related. Organizations awarded accreditation show a wide variation in Leadership Support, and Outcomes Reporting appears to be low across the sample.

Validation of a New Metric for Assessing the Integration of Health Protection and Health Promotion in a Sample of Small- and Medium-Sized Employer Groups

OBJECTIVE

To conduct validation analyses for a new measure of the integration of worksite health protection and health promotion approaches developed in earlier research.

METHODS

A survey of small- to medium-sized employers located in the United States was conducted between October 2013 and March 2014 (n = 111). Cronbach α coefficient was used to assess reliability, and Pearson correlation coefficients were used to assess convergent validity.

RESULTS

The integration score was positively associated with the measures of occupational safety and health and health promotion activities/policies-supporting its convergent validity (Pearson correlation coefficients of 0.32 to 0.47). Cronbach α coefficient was 0.94, indicating excellent reliability.

CONCLUSIONS

The integration score seems to be a promising tool for assessing integration of health promotion and health protection. Further work is needed to test its dimensionality and validate its use in other samples.