Promising Practices in Employer Health and Productivity Management Efforts: Findings From a Benchmarking Study

Building the Worksite Wellness Foundation Infrastructure: A Critical Component of the WorkWell KS Strategic Framework

OBJECTIVE

Workplace health programs can be ineffective, and changes are likely to be temporary without first establishing a wellness infrastructure. This study sought to determine whether attending a WorkWell KS Building the Worksite Wellness Foundation (Foundation) workshop enabled worksites to develop this infrastructure.

METHODS

Survey data were collected from worksites before attending a workshop and approximately 1 year later. Survey items were designed to assess whether the worksite was implementing best practices.

RESULTS

In total, 212 worksites participated in a workshop and completed both a baseline and follow-up assessments. At follow-up, more worksites reported having a wellness committee (89.6% vs 59.7%, P < 0.001) and having wellness committee duties included in position descriptions (26.2% vs 6.4%, P < 0.001).

CONCLUSIONS

This study suggests that Foundation workshops can support worksites' implementation of best practices to establish worksite wellness infrastructure.

The Validity and Reliability of the Workplace Culture of Health Scale-Short Form

OBJECTIVE

A positive workplace culture of health can have significant benefits for both employees and organizations. The objective of this study was to test the validity and reliability of the Workplace Culture of Health (COH) Scale-Short Form.

METHODS

We conducted a confirmatory factor analysis on data collected from a sample of 12,907 employees across 14 organizations. We examined the construct validity of the 14-item short-form version of the Workplace COH scale and assessed its reliability using internal consistency measures.

RESULTS

Our confirmatory factor analysis demonstrated that the Workplace COH Scale-Short Form had strong model fit, indicating good construct validity. In addition, we found that all constructs had strong internal consistency reliability.

CONCLUSIONS

Findings suggest that the Workplace COH Scale-Short Form is a valid and reliable way to practically assess workplace culture of health from the employee perspective.

Association of Organizational Factors With the Proportion of Healthy Behaviours and Control of Blood Pressure at a Company Level

OBJECTIVES

The study examined a relationship between organizational factors and the health outcomes (health behaviors and blood pressure control) at a company level.

METHODS

This cross-sectional study using data from listed corporations on a stock exchange with 1000 to 30,000 employees that completed the health and productivity management survey of Japan in 2019.

RESULTS

We analyzed 886 companies. The presence of occupational health staff was associated with good health behaviors (no smoking and healthy body mass index) and good control of blood pressure. Implementation of education for manager was associated with low smoking rates.

CONCLUSION

The implementation of organizational factors by corporations may improve the lifestyle behaviors and disease management of their employees.

Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study

BACKGROUND

An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps.

OBJECTIVE

The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications.

METHODS

The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS-SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant.

RESULTS

The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%).

CONCLUSIONS

mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users' symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender.

Service provider perspectives on implementing the NSW Get Healthy at Work program

Purpose: One approach increasingly used by governments to deliver on public initiatives is to partner with private enterprise through public–private partnerships. This study is a qualitative process evaluation of an Australian state-wide workplace health programme “Get Healthy at Work” from the currently under-researched perspective of the private service providers. Methods: Semi-structured interviews were conducted with nine service providers. Interviews were transcribed and analysed inductively. Results: Service providers reported an alignment of motives and skills between the programme and their organizations as a benefit of the partnership. However, they also described misalignments: between the potential and realized value of the programme to businesses and service providers; the programme cycle and business operational processes; and the capacity building approach and businesses’ expectations of the service.Conclusions: Although several hallmarks of a well-functioning private–public partnership were evident, misalignments of process and expectations challenged sustained partnership involvement by providers. Careful consideration must be given to the ongoing management functioning of cross-sector engagement and partnering in health promotion practice in order to ensure public health goals are being met, but also that the model is mutually sustainable.

Actions Speak Louder Than Words: Workplace Social Relations and Worksite Health Promotion Use

OBJECTIVE

To study whether workplace social relations explain use of worksite health promotion (WHP), by examining colleagues' and team managers' WHP encouragement of a healthy lifestyle, and colleague WHP uptake.

METHODS

Multilevel data came from the second wave of the European Sustainable Workforce Survey (4345 employees of 402 team in 9 countries). Linear probability models were used to test use of two types of WHP: healthy menus and sport facilities.

RESULTS

Employees are more likely to use healthy menus and sport facilities when more colleagues do so too and when colleagues encourage a healthy lifestyle. Surprisingly, encouragement by one's manager plays no role.

CONCLUSIONS

Social contact among colleagues can facilitate WHP use, and WHP initiatives should pay attention to the influential role of colleagues.

The effectiveness of two levels of active office interventions to reduce sedentary behavior in office workers: a mixed-method approach

Sedentary behavior (SB) rates are rising globally, especially during working hours. This research focused on the effectiveness of two levels of active office interventions to reduce SB in office workers. Participants were 78 nonacademic university employees divided into a control (CON) group and an intervention (INT) group. At the organizational level, it was found that the organizational health culture, the physical and social environment, and the organizational health behavior were dramatically changed. At the individual level, compared with the CON group, the INT group was significantly higher in the METs rate; light-intensity physical activity (LPA); and moderate-to-vigorous-intensity physical activity, and was lower in SB (CON, 397.30 ± 39.33 minutes vs. INT, 389.09 ± 37.59 minutes), all p < .05. The intervention was effective in changing health behavior related to SB of office workers in both organization and individual levels.

An investigation of the health-promoting practices of Australian universities

Workplace health promotion programmes (WHPPs) are more likely to succeed where design and implementation account for the influence of health's complex, systemic nature. Thus, a greater understanding of how frameworks developed to progress WHPPs are operationalized across different countries and industries is needed. This study investigates health concerns targeted in an underexplored setting-Australian universities, describing how diverse programmes are implemented to target different health issues and health risk factors. Content analysis is used to outline how Australian universities implement WHPPs to target diverse health concerns. Content from 497 website documents is collected and analysed using NVivo software. A framework for examining diverse WHPPs currently used in practice is developed. Based on this framework, it was evident that Australian universities emphasized initiatives targeting health issues focusing on 'mental health' and 'diabetes'. Regarding health risk factors, 'alcohol and other addictions', 'discrimination and harassment', and 'physical activity' were emphasized. Links between different health concerns targeted and corresponding WHPPs implemented, provide workplaces with a benchmark for designing and implementing programmes. University WHPPs targeted a diverse range of health concerns when enough legal and political motivations to do so existed. These findings about the motivations for improving employee health indicate a potential gap between health promotion benefits reported in literature and the appreciation for these benefits in practice.

Creating a Workplace Culture of Preventive Health: Process and Outcomes of the Colon Cancer-Free Zone at Virginia Cooperative Extension

Colorectal cancer is the third leading cause of cancer death in the USA, yet is highly preventable and detectable at an early stage through screening. Virginia Cooperative Extension (VCE) implemented a worksite colon cancer awareness program to increase colorectal cancer screening rates and preventive lifestyle behaviors among its employees. The Colon Cancer-Free Zone program is designed using best practice principles of worksite health programs and includes information sessions covering the topics of colorectal cancer, screening guidelines, insurance coverage, and preventive lifestyle behaviors. It is conducted in a campaign format that includes a strategic communication strategy targeting relevant screening barriers and facilitators, peer champions, and incentives. The program was implemented with VCE employees statewide utilizing a web-based system for the information sessions, and resulted in broad participation, a significant increase in screening self-efficacy (4.15 ± 0.64 vs 3.81 ± 0.76, ρ = 0.006), changes in diet and physical activity (50% and 40% of participants, respectively), and a 20.6% increase in the employee colorectal cancer screening rate. A Colon Cancer-Free Zone toolkit was developed for use by Extension Agents to implement the program at worksites in their service communities.

Anatomy of an effective workplace health intervention: a comprehensive new model

Purpose

This study proposes a new model, called the Integrated Human Health Model (IHHM), to improve the design and effectiveness of Workplace Health Promotion (WHP) interventions.

Design/methodology/approach

Eighteen participants were purposefully selected from 44 participants in a 2.5-day WHP intervention targeting multiple health behaviours (MHB). The intervention has shown to improve quality of life and health-related behaviours in rigorous studies. Qualitative data collection methods were observations, repeat semi-structured interviews and weekly e-journals collected over three months. Template analysis was used to develop the IHHM describing participants' experiences.

Findings

The IHHM describes the health behaviour change process using eight themes: facilitation, assessment, desired life, barriers, knowledge and skills, insights, action planning, and monitor and support.

Practical implications

With the paucity of evidence informing WHP intervention effectiveness, this study provides a preliminary model serving practitioners to design more effective interventions and scholars to improve evidence.

Originality/value

This study proposes a practical comprehensive model for practitioners and leaders to more effectively design and evaluate successful MHB WHP interventions compared to existing models.

Worksite health promotion and social inequalities in health

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

Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support

Purpose:

This study tested relationships between health and well-being best practices and 3 types of outcomes.

Design:

A cross-sectional design used data from the HERO Scorecard Benchmark Database.

Setting:

Data were voluntarily provided by employers who submitted web-based survey responses.

Sample:

Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017.

Measures:

Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support.

Analysis:

Three structural equation models were developed to investigate the relationships among study variables.

Results:

Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index > 0.96). Organizational and leadership support was the strongest predictor ( P < .05) of participation (n = 276 organizations), impact (n = 160 organizations), and perceived organizational support (n = 143 organizations). Incentives predicted participation in health assessment and biometric screening ( P < .05). Program comprehensiveness and program integration were not significant predictors ( P > .05) in any of the models.

Conclusion:

Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data.

Measuring Participation in Employer-Sponsored Health and Well-Being Programs: A Participation Index and Its Association With Health Risk Change

PURPOSE

To develop an index of participation in workplace health and well-being programs and assess its relationship with health risk status.

DESIGN

Study design comprised a retrospective longitudinal analysis of employee health risk assessment (HRA) and program participation data.

SETTING

Data from 6 companies that implemented health and well-being programs from 2014 to 2016.

PARTICIPANTS

Employee participants (n = 95 318) from 6 companies who completed an HRA in 2014 to 2016. After matching those who completed the HRA in all 3 years, the longitudinal file included 38 789 respondents.

MEASURES

Participation indicators were created for 9 different program components. The sum of these 9 components established the total participation index.

ANALYSIS

Descriptive and correlation analyses were conducted on all participation measures. Repeated-measures analysis of variance was used to assess the impact of participation level on health risk over time.

RESULTS

Higher levels of participation were associated with a greater reduction in risks, with each participation dose yielding a reduction of 0.038 risks (P < .001).

CONCLUSION

Results suggest that employees who participate more in workplace health and well-being programs experience more health risk improvement. The study also supports a more granular definition of participation based on the number of interactions and type of program.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Barriers to and facilitators for implementing an office ergonomics programme in a South African research organisation

The focus of this study was on the possibility of implementing an office ergonomics programme as part of a broader workplace health initiative at a South African research organisation. We explored the perspectives of actors in the workplace regarding organisational barriers and facilitators to implementing ergonomic interventions. This qualitative study presents the perspectives of three workplace actor groups: operational managers (n = 4); health and safety representatives (n = 9); and office employees (n = 4) who were involved in a previous ergonomic assessments that proposed several corrective and preventive actions. Eight factors emerged as either barriers or as simultaneous barriers and facilitators to the implementation of proposed ergonomic interventions. These are: organisational culture; information and specialist support; funding; support from operational managers; attitude towards changes; general organisational awareness; individual knowledge of ergonomics; and support from colleagues. This study is one of the first in South Africa to investigate the perspectives of workplace actors in an office setting with regard to factors that influence implementation of ergonomics initiatives to reduce work-related musculoskeletal disorders.

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

PURPOSE

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

INTERVENTION

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

MEASURES

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

ANALYSIS

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

RESULTS

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

CONCLUSIONS

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

Organizational Culture and Implications for Workplace Interventions to Reduce Sitting Time Among Office-Based Workers: A Systematic Review

Background: Time spent in sedentary behaviors is an independent risk factor for several chronic diseases (e.g., cardiometabolic diseases, obesity, type 2 diabetes, and hypertension). Recently, interventions to reduce sitting time at work (a prominent sedentary behavior) have been developed and tested. Organizational culture plays a critical role in the success of workplace interventions. However, there are a limited number of studies that have examined the role of organizational culture in reducing sitting time in the workplace.

Objectives: Therefore, in this systematic review, we summarized the empirical literature investigating organizational culture and sedentary behavior in the workplace and identify gaps in the knowledge base.

Methods: We described the procedures of our systematic review and included two study flow diagrams that detailed the step by step process. Combinations of several search terms were used; the databases searched were PubMed, Medline, Academic Search Complete, and Google Scholar. We started with thousands of citations. After applying the inclusion and exclusion criteria, eight relevant articles were identified.

Results: For each identified article, the data extracted included citation, sample, objective, intervention, assessment of organizational culture and workplace sitting, findings, and implications. Each article was rated for risk of bias by population, intervention, comparator, outcomes, and study design (PICOS) analysis. The classification for each study was either: high-, moderate-, or low-quality evidence. Given the paucity of data, no definitive conclusions were presented; however, positive trends were highlighted.

Conclusions: Work place interventions to reduce sitting time at work may benefit from considering elements of organizational culture; however, the evidence to date is sparse and more high-quality studies in this area are needed. To advance the field of workplace health promotion, organizational culture, and interventions to reduce sitting at work, we present 11 recommendations.

Elements of a Workplace Culture of Health, Perceived Organizational Support for Health, and Lifestyle Risk

PURPOSE

We investigated the impact of elements of a workplace culture of health (COH) on employees' perceptions of employer support for health and lifestyle risk.

DESIGN

We used 2013 and 2015 survey data from the National Healthy Worksite Program, a Centers for Disease Control and Prevention (CDC)-led initiative to help workplaces implement health-promoting interventions.

SETTING

Forty-one employers completed the CDC Worksite Health Scorecard to document organizational changes.

PARTICIPANTS

Eight hundred twenty-five employees provided data to evaluate changes in their health and attitudes.

MEASURES

We defined elements of a COH as environmental, policy, and programmatic supports; leadership and coworker support; employee engagement (motivational interventions); and strategic communication. Outcomes included scores of employees' perceptions of employer support for health and lifestyle risk derived from self-reported physical activity, nutrition, and tobacco use.

ANALYSIS

We estimated effects using multilevel regression models.

RESULTS

At the employee level and across time, regression coefficients show positive associations between leadership support, coworker support, employee engagement, and perceived support for health ( P < .05). Coefficients suggest a marginally significant negative association between lifestyle risk and the presence of environmental and policy supports ( P < .10) and significant associations with leadership support in 2015 only ( P < .05).

CONCLUSION

Relational elements of COH (leadership and coworker support) tend to be associated with perceived support for health, while workplace elements (environmental and policy supports) are more associated with lifestyle risk. Employers need to confront relational and workplace elements together to build a COH.

Employee Perceptions of Workplace Health Promotion Programs: Comparison of a Tailored, Semi-Tailored, and Standardized Approach

In the design of workplace health promotion programs (WHPPs), employee perceptions represent an integral variable which is predicted to translate into rate of user engagement (i.e., participation) and program loyalty. This study evaluated employee perceptions of three workplace health programs promoting nutritional consumption and physical activity. Programs included: (1) an individually tailored consultation with an exercise physiologist and dietitian; (2) a semi-tailored 12-week SMS health message program; and (3) a standardized group workshop delivered by an expert. Participating employees from a transport company completed program evaluation surveys rating the overall program, affect, and utility of: consultations (n = 19); SMS program (n = 234); and workshops (n = 86). Overall, participants’ affect and utility evaluations were positive for all programs, with the greatest satisfaction being reported in the tailored individual consultation and standardized group workshop conditions. Furthermore, mode of delivery and the physical presence of an expert health practitioner was more influential than the degree to which the information was tailored to the individual. Thus, the synergy in ratings between individually tailored consultations and standardized group workshops indicates that low-cost delivery health programs may be as appealing to employees as tailored, and comparatively high-cost, program options.

An Investigation of Self-reported Health-related Productivity Loss in Office Workers and Associations With Individual and Work-related Factors Using an Employer's Perspective

OBJECTIVE

Office workers have a high prevalence of musculoskeletal conditions. This can be a significant economic burden due to health-related productivity loss. Individual and work-related factors related to office worker health-related productivity were investigated.

METHODS

A survey including the Health and Work Performance Questionnaire, which estimated productivity loss, also recorded individual and work-related factors with potential associations with health-related productivity. Muscle function and workstation ergonomics were examined through physical assessments. Linear models investigated the relationships between these factors and health-related productivity.

RESULTS

Significant factors identified were occupational category (0.001 < P < 0.050), job satisfaction (P < 0.001), psychological wellbeing (P = 0.031), and musculoskeletal pain (P = 0.023). Health-related productivity loss was greater in office workers working as managers, with lower job satisfaction and psychological wellbeing, and those with musculoskeletal pain.

CONCLUSION

Office worker health-related productivity loss is represented by a combination of both individual and work-related factors.

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program

OBJECTIVE

To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP).

METHODS

NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later.

RESULTS

The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight.

CONCLUSIONS

Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.

Tracking The Changing Landscape Of Corporate Wellness Companies

The corporate wellness industry is diversifying and now includes legacy wellness companies, divisions of health plans or delivery systems, and new technology-focused solution enterprises. We conducted in-depth interviews with leaders in the industry to understand the changes in its supply side, the drivers of these changes, future trends, and their implications for employers and policy makers. Three key trends emerged from the interviews: The industry is expanding and becoming increasingly diverse and competitive; wellness companies are redefining their business models to promote a culture of health; and the value proposition of employee wellness programs is shifting from a return on investment to a new idea: value on investment. Our findings clarify wellness companies' innovations, their contributions to population health improvement efforts, and the need for additional evidence to demonstrate the value of the new generation of wellness products and services.

Is More Always Better in Designing Workplace Wellness Programs?: A Comparison of Wellness Program Components Versus Outcomes

OBJECTIVE

Assess whether adding more components to a workplace wellness program is associated with better outcomes by measuring the relationship of program components to one another and to employee participation and perceptions of program effectiveness.

METHODS

Data came from a 2014 survey of 24,393 employees of 81 employers about services offered, leadership, incentives, and promotion. Logistic regressions were used to model the relationship between program characteristics and outcomes.

RESULTS

Components individually are related to better outcomes, but this relationship is weaker in the presence of other components and non-significant for incentives. Within components, a moderate level of services and work time participation opportunities are associated with higher participation and effectiveness.

CONCLUSIONS

The "more of everything" approach does not appear to be advisable for all programs. Programs should focus on providing ample opportunities for employees to participate and initiatives like results-based incentives.

Integration of eHealth Tools in the Process of Workplace Health Promotion: Proposal for Design and Implementation

BACKGROUND

Electronic health (eHealth) and mobile health (mHealth) tools can support and improve the whole process of workplace health promotion (WHP) projects. However, several challenges and opportunities have to be considered while integrating these tools in WHP projects. Currently, a large number of eHealth tools are developed for changing health behavior, but these tools can support the whole WHP process, including group administration, information flow, assessment, intervention development process, or evaluation.

OBJECTIVE

To support a successful implementation of eHealth tools in the whole WHP processes, we introduce a concept of WHP (life cycle model of WHP) with 7 steps and present critical and success factors for the implementation of eHealth tools in each step.

METHODS

We developed a life cycle model of WHP based on the World Health Organization (WHO) model of healthy workplace continual improvement process. We suggest adaptations to the WHO model to demonstrate the large number of possibilities to implement eHealth tools in WHP as well as possible critical points in the implementation process.

RESULTS

eHealth tools can enhance the efficiency of WHP in each of the 7 steps of the presented life cycle model of WHP. Specifically, eHealth tools can support by offering easier administration, providing an information and communication platform, supporting assessments, presenting and discussing assessment results in a dashboard, and offering interventions to change individual health behavior. Important success factors include the possibility to give automatic feedback about health parameters, create incentive systems, or bring together a large number of health experts in one place. Critical factors such as data security, anonymity, or lack of management involvement have to be addressed carefully to prevent nonparticipation and dropouts.

CONCLUSIONS

Using eHealth tools can support WHP, but clear regulations for the usage and implementation of these tools at the workplace are needed to secure quality and reach sustainable results.

Antecedents and associations of sickness presenteeism and sickness absenteeism in nurses: A systematic review

AIMS

This study comprehensively analysed and systemized the elements associated with nursing sickness presenteeism (SP) and sickness absenteeism (SA).

BACKGROUND

Both behaviours represent a real challenge to nursing departments because they can increase costs, cause health care adverse events, and impact the quality of health care.

DESIGN

The systematic review of cohort studies was designed to be consistent with the PRISMA guidelines.

DATA SOURCES

PubMed, ProQuest, and Emerald were systematically searched for peer-reviewed articles published from the 1950s to December 2016.

REVIEW METHODS

Cohort studies were included (12 SA and 1 SP) in the review if they examined the association between one or more exposures and SP and/or SA in nurses. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Twenty-three antecedents were associated with SA and grouped as work and organizational, mental and physical health, and demographic; 3 antecedents were associated with SP (job demands, burnout, and exhaustion). Exhaustion (fatigue) and job demands were associated with SA and SP. Depersonalization was an outcome of SP over time.

CONCLUSION

The ability to predict presenteeism and absenteeism in nursing is useful to constrain costs and ensure that quality care is delivered.

An analysis of healthy workplace accreditation and health promotion efforts based on employees' perspectives

This study was conducted to analyze the effects of health promotion efforts in relation to a workplace accreditation program and differing workplace sizes. The research population for the study consisted of 966 employees working at a total of 84 different worksites located in Taipei, Taiwan. The survey instructions used were developed by the European Network for Workplace Health Promotion (WHP). The results indicate that accredited workplaces have better WHP quality than nonaccredited workplaces (p < .001) and commonly implement health promotion measures related to specific health issues. It is recommended that the government provide more health-related resources in workplaces, especially those of small and medium companies.

Employer and Promoter Perspectives on the Quality of Health Promotion Within the Healthy Workplace Accreditation

OBJECTIVES

To explore the employers' and promoters' perspective of health promotion quality according to the healthy workplace accreditation.

METHODS

We assessed the perspectives of 85 employers and 81 health promoters regarding the quality of health promotion at their workplaces. The method of measurement referenced the European Network for Workplace Health Promotion (ENWHP) quality criteria.

RESULTS

In the large workplaces, the accredited corporation employers had a higher impression (P < 0.001) of all criteria. The small-medium accredited workplace employers had a slightly higher perspective than non-accredited ones. Nevertheless, there were no differences between the perspectives of health promoters from different sized workplaces with or without accreditation (P > 0.05).

CONCLUSIONS

It seems that employers' perspectives of healthy workplace accreditation surpassed employers from non-accredited workplaces. Specifically, large accredited corporations could share their successful experiences to encourage a more involved workplace in small-medium workplaces.

Results of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection Policies

PURPOSE

To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial.

DESIGN

A randomized pretest-posttest controlled design with 2-year follow-up was conducted in 2010 to 2013.

SETTING

Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation.

PARTICIPANTS

Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts).

INTERVENTION

Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group.

MEASURES

Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition.

ANALYSIS

Policy scores were analyzed with logistic and Poisson regression models using imputation.

RESULTS

At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ² = 31.29, P < .01; intent to treat: χ² =73.79, P < .01) and stronger (χ² = 24.50, P < .01; intent to treat: χ² = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased ( P < .05).

CONCLUSION

The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.

Managing workplace health promotion in municipal organizations: The perspective of senior managers

BACKGROUND

Previous research indicates that companies manage workplace health in various ways, but more in-depth empirical knowledge of how workplace health promotion (WHP) is managed in public sector organizations is needed.

OBJECTIVE

The aim of this study was to explore how WHP is managed and incorporated into the general management system in two large Swedish municipal organizations.

METHODS

A qualitative descriptive approach was used. Fourteen senior managers were purposefully selected and interviewed using semi-structured interviews. Documents were used as supplementary data. All data were analysed using qualitative content analysis.

RESULTS

The management of WHP was described as a set of components that together contribute to the organization's capacity for WHP. The informants described WHP as dominated by fitness programmes and as following a problem-solving cycle, in which the annual employee survey emerged as an important managerial tool. Achieving feasible WHP measures and appropriate follow-ups were described as challenges. The provision of leadership competence for WHP and use of supportive resources were described as additional components.

CONCLUSIONS

The WHP management approach needs to be broadened to include work environment and organizational factors. Further integration with occupational health and safety and the general management system in the organizations is also needed.

Results From the Bipartisan Policy Center's CEO Council Physical Activity Challenge to American Business

OBJECTIVE

The aim of this study was to describe findings from a survey of employees at 10 businesses participating in the "Building Better Health: Physical Activity Challenge," an effort led by the Bipartisan Policy Center's CEO Council on Health and Innovation.

METHODS

Employers provided employees with pedometers as part of an 8-week Physical Activity Challenge (Challenge). Employees were then asked to complete a survey about their awareness of, participation in, and satisfaction with the Challenge.

RESULTS

One hundred three thousand three hundred eighty-three employees participated in the Challenge, averaging 6886 steps per day per participant. Of the 3820 respondents to an employee survey sent to all workers, 62% reported enrolling in the program, and of those, the majority reported positive impacts on health (76%), fitness (73%), and lifestyle (70%).

CONCLUSION

A brief, workplace-based physical activity challenge can achieve positive self-reported health impacts when supported by senior management of the company.

Performance Against WELCOA’s Worksite Health Promotion Benchmarks Across Years Among Selected US Organizations

Purpose:

The purpose of this study was to quantify the performance of organizations’ worksite health promotion (WHP) activities against the benchmarking criteria included in the Well Workplace Checklist (WWC).

Design:

The Wellness Council of America (WELCOA) developed a tool to assess WHP with its 100-item WWC, which represents WELCOA’s 7 performance benchmarks.

Setting:

Workplaces.

Participants:

This study includes a convenience sample of organizations who completed the checklist from 2008 to 2015. The sample size was 4643 entries from US organizations.

Measures:

The WWC includes demographic questions, general questions about WHP programs, and scales to measure the performance against the WELCOA 7 benchmarks.

Analysis:

Descriptive analyses of WWC items were completed separately for each year of the study period.

Results:

The majority of the organizations represented each year were multisite, multishift, medium- to large-sized companies mostly in the services industry. Despite yearly changes in participating organizations, results across the WELCOA 7 benchmark scores were consistent year to year. Across all years, benchmarks that organizations performed the lowest were senior-level support, data collection, and programming; wellness teams and supportive environments were the highest scoring benchmarks.

Conclusion:

In an era marked with economic swings and health-care reform, it appears that organizations are staying consistent in their performance across these benchmarks. The WWC could be useful for organizations, practitioners, and researchers in assessing the quality of WHP programs.

Promoting Healthy Workplaces by Building Cultures of Health and Applying Strategic Communications

OBJECTIVE

The aim of the study was to identify key success elements of employer-sponsored health promotion (wellness) programs.

METHODS

We conducted an updated literature review, held discussions with subject matter experts, and visited nine companies with exemplary programs to examine current best and promising practices in workplace health promotion programs.

RESULTS

Best practices include establishing a culture of health and using strategic communications. Key elements that contribute to a culture of health are leadership commitment, social and physical environmental support, and employee involvement. Strategic communications are designed to educate, motivate, market offerings, and build trust. They are tailored and targeted, multichanneled, bidirectional, with optimum timing, frequency, and placement.

CONCLUSIONS

Increased efforts are needed to disseminate lessons learned from employers who have built cultures of health and excellent communications strategies and apply these insights more broadly in workplace settings.

Incentives, Program Configuration, and Employee Uptake of Workplace Wellness Programs

OBJECTIVES

The aim of this study was to determine the effect of wellness program configurations and financial incentives on employee participation rate.

METHODS

We analyze a nationally representative survey on workplace wellness programs from 407 employers using cluster analysis and multivariable regression analysis.

RESULTS

Employers who offer incentives and provide a comprehensive set of program offerings have higher participation rates. The effect of incentives differs by program configuration, with the strongest effect found for comprehensive and prevention-focused programs. Among intervention-focused programs, incentives are not associated with higher participation.

CONCLUSIONS

Wellness programs can be grouped into distinct configurations, which have different workplace health focuses. Although monetary incentives can be effective in improving employee participation, the magnitude and significance of the effect is greater for some program configurations than others.

The Stock Performance of C. Everett Koop Award Winners Compared With the Standard & Poor's 500 Index

OBJECTIVE

To explore the link between companies investing in the health and well-being programs of their employees and stock market performance.

METHODS

Stock performance of C. Everett Koop National Health Award winners (n = 26) was measured over time and compared with the average performance of companies comprising the Standard and Poor's (S&P) 500 Index.

RESULTS

The Koop Award portfolio outperformed the S&P 500 Index. In the 14-year period tracked (2000-2014), Koop Award winners' stock values appreciated by 325% compared with the market average appreciation of 105%.

CONCLUSIONS

This study supports prior and ongoing research demonstrating a higher market valuation--an affirmation of business success by Wall Street investors--of socially responsible companies that invest in the health and well-being of their workers when compared with other publicly traded firms.

Cross-cultural adaptation of the CDC Worksite Health ScoreCard questionnaire into Portuguese

OBJECTIVE

Despite the progress in the implementation of health promotion programs in the workplace, there are no questionnaires in Brazil to assess the scope of health promotion interventions adopted and their scientific basis. This study aimed to translate into Brazilian Portuguese and culturally adapt the CDC Worksite Health ScoreCard (HSC) questionnaire.

METHOD

The HSC has 100 questions grouped into twelve domains. The steps are as follows: translation, reconciliation, back-translation, review by expert panel, pretesting, and final revision. The convenience sample included 27 individuals from health insurance providers and companies of various sizes, types and industries in São Paulo. Data were analyzed using descriptive statistics.

RESULTS

The average age of the sample was 38 years, most of the subjects were female (21 of 27), and were responsible for programs to promote health in these workplaces. Most questions were above the minimum value of understanding set at 90%. The participants found the questionnaire very useful to determine the extent of existing health promotion programs and to pinpoint areas that could be developed.

CONCLUSION

The Brazilian Portuguese version of the HSC questionnaire may be a valid measure and useful to assess the degree of implementation of health promotion interventions based on evidence in local health organizations.

National workplace health promotion surveys: the Affordable Care Act and future surveys

This commentary reviews findings from the four previous national surveys of workplace health promotion activities (1985, 1992, 1999, and 2004, respectively) and offers recommendations for future surveys mandated under the Affordable Care Act of 2010. Future surveys should place greater emphasis on assessing program quality, reach, and effectiveness. Both employer and employee input should be sought. In addition, sampling plans should differentiate worksites from employers, and results should include public as well as private sector organizations. Ideas are offered for addressing these limitations and for creating a sustainable survey process and multifunctional database of results.

Early Success Is Vital in Minimal Worksite Wellness Interventions at Small Worksites

INTERVENTION

In an effort to increase physical activity, 15 workplaces participated in a minimal-contact 10,000-steps-a-day program sponsored by the Sedgwick County Health Department in 2007 and 2008. Pedometers were provided to measure participants' weekly steps for the 10-week intervention.

METHOD

Participants were defined as those who completed the preregistration survey and logged at least 1 week of results. Registrants were defined as those who completed a registration survey but did not log any weekly results. The primary dependent variable was whether or not participants achieved weekly success, as measured by achieving at least 70,000 steps in a week. A secondary dependent variable was participants' number of steps each week during the weeks they logged results. Repeated measures logistic regression analysis was conducted to identify factors associated with weekly success.

RESULTS

Of the 2,515 registrants, 1,292 (51%) were participants. The average number of weeks of participation for this 10-week intervention was 5.6 weeks (SD = 3.4). Those from small employers (n < 750) were more likely (OR = 2.0) than those from large organizations (n > 750) to become participants. Participants who achieved at least 70,000 steps in the first week of the intervention were 7.3 times more likely than participants who walked less than 70,000 steps in the first week to achieve 70,000 steps each week for all 10 weeks.

CONCLUSIONS

Results from implementing a minimal-contact 10,000-step intervention can be maximized by targeting small worksites and supporting employees to achieve 70,000 steps in their first week.

Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial

Objective

To investigate the effectiveness of a worksite social and physical environment intervention on need for recovery (i.e., early symptoms of work-related mental and physical fatigue), physical activity and relaxation. Also, the effectiveness of the separate interventions was investigated.

Methods

In this 2×2 factorial design study, 412 office employees from a financial service provider participated. Participants were allocated to the combined social and physical intervention, to the social intervention only, to the physical intervention only or to the control group. The primary outcome measure was need for recovery. Secondary outcomes were work-related stress (i.e., exhaustion, detachment and relaxation), small breaks, physical activity (i.e., stair climbing, active commuting, sport activities, light/moderate/vigorous physical activity) and sedentary behavior. Outcomes were measured by questionnaires at baseline, 6 and 12 months follow-up. Multilevel analyses were performed to investigate the effects of the three interventions.

Results

In all intervention groups, a non-significant reduction was found in need for recovery. In the combined intervention (n = 92), exhaustion and vigorous physical activities decreased significantly, and small breaks at work and active commuting increased significantly compared to the control group. The social intervention (n = 118) showed a significant reduction in exhaustion, sedentary behavior at work and a significant increase in small breaks at work and leisure activities. In the physical intervention (n = 96), stair climbing at work and active commuting significantly increased, and sedentary behavior at work decreased significantly compared to the control group.

Conclusion

None of the interventions was effective in improving the need for recovery. It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery. Furthermore, the intervention itself could be improved by increasing the intensity of the intervention (for example weekly GMI-sessions), providing physical activity opportunities and exercise schemes, and by more drastic environment interventions (restructuring entire department floor).

Trial Registration

Nederlands Trial Register NTR2553

Health and performance: science or advocacy?

Purpose

– The purpose of this paper is to examine the literature assessing the return-on-investment (ROI) of healthy workplace programs.

Design/methodology/approach

– Used a narrative review to summarize and evaluate findings.

Findings

– Although substantial ROI data now exist, methodological and logical weaknesses limit the conclusions that can be drawn.

Practical implications

– A strategy for monetizing the benefits of healthy workplaces that draws on both human resource accounting and strategic human resource management is described.

Social implications

– The promotion of healthy workplaces is an important goal in its own right. To the extent that ROI estimates are important in advancing this goal, these estimates should be based on clear logic and strong methodology.

Originality/value

– The paper suggests the need for stronger research designs but also note the difficulties in monetizing outcomes of the healthy workplace.