Development of the Environmental Assessment Tool (EAT) to measure organizational physical and social support for worksite obesity prevention programs

A Multicomponent Workplace Environmental Intervention to Promote Physical Activity among the Staff of Universiti Malaysia Sarawak

BACKGROUND

Physical inactivity is a significant public health issue affecting working adults because it can increase the risk of noncommunicable diseases.

OBJECTIVES

The objective is to determine the outcomes of a multi-component workplace environmental intervention that incorporated physical activity self-regulation (PASR) to promote physical activity (PA) among employees.

MATERIALS AND METHODS

This was a 6-month intervention with a two-group, parallel, quasi-experimental study. A total of 11 workplaces were randomly assigned to intervention group (IG) or control group (CG) using a 1:1 allocation ratio. In each group, 84 eligible participants were recruited. The IG was exposed to the organizational support and the PA support components throughout the study. The PASR Scale, International PA Questionnaire, and pedometer were used to measure the outcome at the baseline, 3rd-month, and 6th-month follow-ups, respectively. The repeated measures-analysis of variance analysis was used to determine the changes in the PASR skills, MET-min/week, and step/week over time.

RESULTS

The IG had 75 participants (51 females and 24 males) and the CG had 73 participants (52 females and 21 males) at the 6th-month follow-up. Despite there was no statistically significant difference in the outcomes between groups over time, the IG showed significant improvements in total PASR (ηp2 = 0.021), goal setting (ηp2 = 0.024), total MET-min/week (ηp2 = 0.031), housework-related PA (ηp2 = 0.101), and step/week (ηp2 = 0.827) throughout this intervention.

CONCLUSION

This intervention was found to be effective in improving the PASR skills, MET-min/week, and step/week of IG participants. Meanwhile, because some effect sizes were small, these findings should be interpreted with caution.

Assessment of Questionnaire of Physical Activity at Workplace Based on the Social Cognitive Theory (PAWPQ-SCT): A Psychometric Study in Iranian Gas Refinery Workers

Background

This study aimed to develop and assess the psychometric features of the Physical Activity at Workplace Questionnaire (PAWPQ) based on the Social Cognitive Theory (SCT) to evaluate employees' physical activity (PA) behaviors at the workplace.

Methods

This psychometric cross-sectional study was conducted on 455 employees working in one of the gas refineries in Iran. The participants were selected using the proportional stratified sampling method in 2019. The data collection tools were a demographic information questionnaire, the short form of the International Physical Activity Questionnaire (IPAQ), and a questionnaire developed based on the SCT, whose psychometric features were confirmed in terms of validity and reliability. Data were analyzed using SPSS22 and AMOS20 software.

Results

The first version of PAWPQ-SCT had 74 items. After evaluating content and face validity, nine items were removed. The results of the content validity index (0.98), content validity ratio (0.86), and impact score (3.62) were acceptable for the whole instrument. In exploratory factor analysis, after removing seven items-58-item final version of the scale-six factors could explain 73.54% of the total variance. The results of structural equation modeling showed the acceptable fit of the model into the data (RMSEA = 0.052, CFI = 0.917, NFI = 0.878, TLI = 0.905, IFI = 0.917, CMIN/DF = 2.818). Cronbach's alpha coefficient and Intraclass Correlation were 0.90 and 0.86, respectively.

Conclusion

This study confirmed that the psychometric features of the 58-item final version of PAWPQ-SCT constructs were acceptable in a sample of Iranian employees. This questionnaire can be used as a valid and reliable tool to evaluate Iranian employees' PA behaviors and develop effective educational interventions for workers and managers.

Development and piloting of a Checklist for healthy eating And Physical Activity in the Workplace (CEPAW)

To develop and pilot a tool that assesses the infrastructure and policy workplace environment characteristics that may influence employee healthy eating and physical activity behaviours. A checklist was developed with reference to prior tools and piloted at eight worksites. Piloting of the tool demonstrated that it was generally feasible to use, took 1-2 hours to complete and appeared sensitive to differences between workplace environment characteristics. Refinement of the tool occurred after piloting. The final 21-item checklist contains sub-scores capturing policy, infrastructure, healthy eating and physical activity characteristics. This new checklist overcomes some limitations of pre-existing tools as it explicitly considers policy and is short, inexpensive and can be used by workplaces for self-assessment and by health promotion professionals in evaluation studies or as an intervention tool.

A scoping review of workplace wellness audit tools assessing physical activity and sedentary behaviour

BACKGROUND

Regular physical inactivity and excessive sedentary behaviour are public and population health concerns. The workplace is an ideal health promotion intervention setting to support employees, particularly office workers. Workplace assessments are a critical component of workplace health promotion programming. The aim of this project was to conduct a scoping review to systematically identify and describe workplace audit tools that assess physical activity and sedentary behaviour influences, as two independent behaviours, through a social ecological lens.

METHODS

Fourteen electronic databases were searched for academic literature and 69 web-based resources were searched for grey literature in May 2017. English language workplace audit tools with items on physical activity or sedentary behaviour established in western countries were included. Key characteristics (ie, aim, type, health behaviour, validity, reliability and theory/model/framework) of the audit tools, checklists or questionnaires for office-based workplaces were identified, described and summarised.

RESULTS

The scoping review identified 21 relevant tools. Most tools focused on physical activity alone and did not address sedentary behaviour as a distinct behaviour. Few tools included items assessing physical activity and sedentary behaviour influences across multiple levels of the social ecological model. The most common social ecological focuses in the tools were policy and environmental influences.

CONCLUSIONS

Numerous workplace physical activity and/or sedentary behaviour audit tools were available. However, a gap was identified as tools and resources that assess and support organisational changes to influence physical activity and sedentary behaviour as two independent health behaviours across multiple social ecological levels within the workplace had not been developed.

The workplace health group: A case study of 20 years of multidisciplinary research

The Workplace Health Group (WHG) was established in 1998 to conduct research on worker health and safety and organizational effectiveness. This multidisciplinary team includes researchers with backgrounds in psychology, health promotion and behavior, and intervention design, implementation, and evaluation. The article begins with a brief history of the team, its guiding principles, and stages of team formation and development. This section provides examples of the roles, team composition, structure, processes, cognition, leadership, and climate played in the various stages of team development, as well as how they influenced team effectiveness. The WHG formed with functional diversity-variety in knowledge, skills, and abilities-in mind, and the impact of this diversity is discussed throughout the article. Illustrations of how the functional diversity of the WHG has led to real-world impact are provided. The article concludes with some lessons learned and recommendations for creating and sustaining multidisciplinary teams based on the WHG's 20 years of experience and the team science literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Improving Environmental Capacities for Health Promotion in Support Settings for People with Intellectual Disabilities: Inclusive Design of the DIHASID Tool

People with intellectual disabilities (ID) have unhealthier lifestyles than the general population. To sustainably improve their lifestyle and health status, a whole-system approach to creating healthy environments is crucial. To gain insight into how support for physical activity and healthy nutrition can be embedded in a setting, asset mapping can be helpful. Asset mapping involves creating a bottom-up overview of promoting and protective factors for health. However, there is no asset mapping tool available for ID support settings. This study aims to develop an asset mapping tool in collaboration with people with ID to gain insight into assets for healthy nutrition and physical activity in such settings. The tool is based on previous research and development continued in an iterative and inclusive process in order to create a clear, comprehensive, and usable tool. Expert interviews (n = 7), interviews with end-users (n = 7), and pilot testing (n = 16) were conducted to refine the tool. Pilot participants perceived the tool as helpful in pinpointing perceived assets and in prompting ideas on how to create inclusive environments with support for physical activity and healthy nutrition. This overview of assets can be helpful for mobilizing assets and building the health-promoting capacities of ID support settings.

Data Collection Instruments for Obesogenic Environments in Adults: A Scoping Review

The rise in obesity prevalence has increased research interest in the obesogenic environment and its influence on excess weight. The aim of the present study was to review and map data collection instruments for obesogenic environments in adults in order to provide an overview of the existing evidence and enable comparisons. Through the scoping review method, different databases and webpages were searched between January 1997 and May 2018. Instruments were included if they targeted adults. The documents were categorised as food environment or built environment. In terms of results, 92 instruments were found: 46 instruments measuring the food environment, 42 measuring the built environment, and 4 that characterised both environments. Numerous diverse instruments have been developed to characterise the obesogenic environment, and some of them have been developed based on existing ones; however, most of them have not been validated and there is very little similarity between them, hindering comparison of the results obtained. In addition, most of them were developed and used in the United States and were written in English. In conclusion, there is a need for a robust instrument, improving or combining existing ones, for use within and across countries, and more sophisticated study designs where the environment is contemplated in an interdisciplinary approach.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

BACKGROUND

Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes.

OBJECTIVES

To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff.

SEARCH METHODS

We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research.

SELECTION CRITERIA

Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies).

DATA COLLECTION AND ANALYSIS

Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome.

MAIN RESULTS

We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search.

AUTHORS' CONCLUSIONS

Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

UMIN Clinical Trials Registry (ID=UMIN000024069).

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.

Associations among workplace environment, self-regulation, and domain-specific physical activities among white-collar workers: a multilevel longitudinal study

BACKGROUND

Psychological and environmental determinants have been discussed for promoting physical activity among workers. However, few studies have investigated effects of both workplace environment and psychological determinants on physical activity. It is also unknown which domains of physical activities are promoted by these determinants. This study aimed to investigate main and interaction effects of workplace environment and individual self-regulation for physical activity on domain-specific physical activities among white-collar workers.

METHODS

A multi-site longitudinal study was conducted at baseline and about 5-month follow-up. A total of 49 worksites and employees within the worksites were recruited. Inclusion criteria for the worksites (a) were located in the Kanto area, Japan and (b) employed two or more employees. Employee inclusion criteria were (a) employed by the worksites, (b) aged 18 years or older, and (c) white-collar workers. For outcomes, three domain-specific physical activities (occupational, transport-related, and leisure-time) at baseline and follow-up were measured. For independent variables, self-regulation for physical activity, workplace environments (parking/bike, signs/bulletin boards/advertisements, stairs/elevators, physical activity/fitness facilities, work rules, written policies, and health promotion programs), and covariates at baseline were measured. Hierarchical Linear Modeling was conducted to investigate multilevel associations.

RESULTS

Of the recruited worksites, 23 worksites and 562 employees, and 22 worksites and 459 employees completed the baseline and the follow-up surveys. As results of Hierarchical Linear Modeling, stairs/elevator (γ=3.80 [SE=1.80], p<0.05), physical activity/fitness facilities (γ=4.98 [SE=1.09], p<0.01), and written policies (γ=2.10 [SE=1.02], p<0.05) were significantly and positively associated with occupational physical activity. Self-regulation for physical activity was associated significantly with leisure-time physical activity (γ=0.09 [SE=0.04], p<0.05) but insignificantly with occupational and transport-related physical activity (γ=0.11 [SE=0.16] and γ=-0.00 [SE=0.06]). Significant interaction effects of workplace environments (physical activity/fitness facilities, work rules, and written policies) and self-regulation were observed on transport-related and leisure-time physical activity.

CONCLUSIONS

Workplace environments such as physical activity/fitness facilities, written policies, work rules, and signs for stair use at stairs and elevators; self-regulation for physical activity; and their interactions may be effective to promote three domain-specific physical activities. This study has practical implications for designing multi-component interventions that include both environmental and psychological approaches to increase effect sizes to promote overall physical activity.

Availability and Use of Workplace Supports for Health Promotion Among Employees of Small and Large Businesses

PURPOSE

To explore the availability and utilization of workplace health supports by employees of small and large-sized employers.

DESIGN

Cross-sectional, telephone-based interviews collected on 16 workplace health supports for physical activity and diet.

SETTING

Participants selected by random-digit-dialing from 4 metropolitan areas of Missouri employees from 2012 to 2013.

PARTICIPANTS

Two thousand fifteen working adults.

METHODS

We explored the availability and use of supports by employer size (<100 employees vs ≥100 employees), accounting for industry and personal factors.

ANALYSIS

We examined distributions and Poisson regression models of availability for supports by employer size and by industry and use of supports by employer size and personal factors.

RESULTS

One-fifth of the 1796 employees were employed by small-sized employers. Large employers offered more supports than small (mean: 6 vs 3), but a higher proportion of employees of small-sized employers used supports when available (59% vs 47%). The differences in offered supports between industries were not due to size alone. In regard to the determinants of participation, the personal factors of gender, age, weight, and income were associated with participation in 10 of the supports. Employer size was also associated with participation in 10 supports. No associations were found between personal factors or workplace size and participation for 3 supports.

CONCLUSION

A higher proportion of employees working for smaller businesses use available supports than employees of larger businesses. Supports offered by employers should target the needs and interests of the workforce, particularly for the higher risk low-income employees.

Does Availability of Worksite Supports for Physical Activity Differ by Industry and Occupation?

PURPOSE

To explore combinations of worksite supports (WSS) for physical activity (PA) that may assist employees in meeting PA recommendations and to investigate how availability of WSS differs across industries and occupations.

DESIGN

Cross-sectional.

SETTING

Several Missouri metropolitan areas.

PARTICIPANTS

Adults employed >20 h/wk outside the home.

MEASURES

Survey utilized existing self-reported measures (eg, presence of WSS for PA) and the International Physical Activity Questionnaire.

ANALYSIS

Logistic regression was conducted for 2 outcome variables: leisure and transportation PA. Independent variables included 16 WSS. Of particular interest were interaction effects between WSS variables. Analyses were stratified by 5 occupation and 7 industry types.

RESULTS

Overall, 2013 people completed the survey (46% response rate). Often, availability of 1 WSS did not increase the likelihood of meeting PA recommendations, but several pairs of WSS did. For example, in business occupations, the odds of meeting PA recommendations through transportation PA increased when employees had access to showers and incentives to bike/walk (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.16-2.22); showers and maps (OR = 1.25; 1.02-1.55); maps and incentives to bike/walk (OR = 1.48; 1.04-2.12).

CONCLUSION

Various combinations of WSS may increase the likelihood that employees will meet PA recommendations. Many are of low or no cost, including flexible time for exercise and maps of worksite-adjacent walk/bike routes. Findings may be instructive for employers seeking to improve employee health through worksite PA.

Effects of a multicomponent workplace intervention programme with environmental changes on physical activity among Japanese white collar employees: a protocol for a cluster randomised controlled trial

INTRODUCTION

Physical activity is one of the most important health behaviours as a determinant of physical and mental health. Although intervention strategies for promoting physical activity among workers are needed, evidence for the effectiveness of multilevel workplace interventions with environmental changes on the promotion of physical activity are still limited due to lack of cluster randomised controlled trials (RCTs). The aim of this study is to investigate effects of a 3-month workplace intervention programme with environmental changes on the improvement in physical activity among Japanese white collar employees.

METHODS AND ANALYSIS

This study will be a two-arm and parallel-group cluster (worksite) RCT. Japanese worksites and employees who are employed by the worksites will be recruited through health insurance associations and chambers of commerce. Worksites that meet the inclusion criteria will be randomly allocated to intervention or control groups. The intervention worksites will be offered the original intervention programme that consists of 13 contents with environmental changes. The control worksites will be able to get three times feedback of the assessment of the amount of physical activity and basic occupational health service in each worksite. The primary outcome will be the total amount of physical activity measured by the Global Physical Activity Questionnaire at baseline, 3 months and 6 months. Multilevel latent growth modelling will be conducted to examine the effectiveness of the intervention programme.

ETHICS AND DISSEMINATION

This study was ethically approved by the research ethics committee of the Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Japan (No. 11230). Results will be submitted and published in a scientific peer-reviewed journal.

TRIAL REGISTRATION NUMBER

UMIN000024069; Pre-results.

Sociocultural Factors Influencing Eating Practices Among Office Workers in Urban South Korea

OBJECTIVE

To understand the sociocultural factors affecting the eating behaviors of South Korean employees.

DESIGN

In-depth individual interviews.

SETTING

Two metropolitan areas of South Korea.

PARTICIPANTS

Thirteen male and 9 female office workers.

PHENOMENON OF INTEREST

The effects of sociocultural factors on office workers' eating behaviors.

ANALYSIS

The researchers transcribed and analyzed audio-recorded interviews using thematic analysis.

RESULTS

Among social and economic factors, participants with a family described a connection between female employment and lower frequency of home-cooked family meals. Working parents felt guilty about their need to depend on eating outside the home and eating processed foods because of their schedules. In addition, competitive and stressful working environments negatively affected workers' nutritional choices. Regarding cultural factors, given the powerful influences of collectivism and Confucianism on daily life, hierarchy and group harmony clearly had an important role in workers' everyday food choices. These included choosing menus that were most suitable for group meals and having to miss dinnertime while waiting until higher-position workers to leave work in the evening.

CONCLUSIONS AND IMPLICATIONS

In this sociocultural setting, targeting office workers and changing social norms for healthy eating may be more effective than providing individualized interventions. These findings may be transferable to other, similar Asian countries.

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.

The Moderating Effect of Health-Improving Workplace Environment on Promoting Physical Activity in White-Collar Employees: A Multi-Site Longitudinal Study Using Multi-Level Structural Equation Modeling

OBJECTIVE

This longitudinal study aimed to investigate the moderating effect of health-improving workplace environment on relationships between physical activity, self-efficacy, and psychological distress.

METHODS

Data were collected from 16 worksites and 129 employees at two time-points. Health-improving workplace environment was measured using the Japanese version of the Environmental Assessment Tool. Physical activity, self-efficacy, and psychological distress were also measured. Multi-level structural equation modeling was used to investigate the moderating effect of health-improving workplace environment on relationships between psychological distress, self-efficacy, and physical activity.

RESULTS

Psychological distress was negatively associated with physical activity via low self-efficacy. Physical activity was negatively related to psychological distress. Physical activity/fitness facilities in the work environment exaggerated the positive relationship between self-efficacy and physical activity.

CONCLUSIONS

Physical activity/fitness facilities in the workplace may promote employees' physical activity.

The Impact of Worksite Supports for Healthy Eating on Dietary Behaviors

OBJECTIVE

The purpose of this study was to assess the availability of worksite supports (WSS) for healthy eating and examine associations between existing supports and dietary behaviors.

METHODS

A cross-sectional, telephone-based study was conducted with 2013 participants in four metropolitan areas in 2012. Logistic regression was used to examine associations between dietary behaviors and the availability or use of WSS.

RESULTS

Those reporting the availability of a cafeteria/snack bar/food services at the worksite were more likely to consume fruits and vegetables more than twice/day, and less likely to consume fast food more than twice/week.

CONCLUSIONS

Study results highlight the utility of specific WSS to improve employee dietary behaviors while raising questions about why the presence of healthy foods at the worksite may not translate into employee consumption of such foods.

Worksite nutrition supports and sugar-sweetened beverage consumption

Objective

This study examined the link between worksite environmental supports for nutrition behaviours and sugar‐sweetened beverage (SSB) consumption and offers insight into potential intervention points for reducing SSB consumption and combatting overweight and obesity.

Methods

Perceived worksite supports for healthy nutrition and self‐reported SSB consumption were analysed for 2,015 working adults in the state of Missouri using a subset of questions from the Supports at Home and Work for Maintaining Energy Balance (SHOW‐ME) study.

Results

Employees' use of vending facilities and the availability of water coolers/water bottles was significantly associated with increased SSB consumption, while use of cafeterias was significantly associated with decreased SSB consumption. Symbols or signs to identify healthy alternatives were significantly associated with sports drink consumption.

Conclusions

This study supports previous work indicating the worksite as a necessary environment for nutrition interventions. When choices (vending and cafeteria) are provided, employees report making healthier decisions. For worksites without cafeterias, alternatives should be explored including mobile food trucks and farmer's markets.

Assessing and understanding sedentary behaviour in office-based working adults: a mixed-method approach

Background

Sedentary behaviours (SB) can be characterized by low energy expenditure in a reclining position (e.g., sitting) often associated with work and transport. Prolonged SB is associated with increased risk for chronic conditions, and due to technological advances, the working population is in office settings with high occupational exposure to SB. This study aims to assess SB among office workers, as well as barriers and strategies towards reducing SB in the work setting.

Methods

Using a mixed-methods approach guided by the socio-ecological framework, non-academic office workers from a professional school in a large public university were recruited. Of 180 eligible office workers, 40 enrolled and completed all assessments. Self-reported and objectively measured SB and activity levels were captured. Focus group discussion (FGD) were conducted to further understand perceptions, barriers, and strategies to reducing workplace SB. Environmental factors were systematically evaluated by trained research staff using an adapted version of the Checklist for Health Promotion Environments at Worksites (CHEW). Thematic analysis of FGD was conducted and descriptive analysis of quantitative data was performed.

Results

The sample was mostly Chinese (n = 33, 80 %) with a total of 24 (60 %) female participants. Most participants worked five days a week for about 9.5(0.5) hrs/day. Accelerometer data show that participants spend the majority of their days in sedentary activities both on workdays (76.9 %) and non-workdays (69.5 %). Self-report data confirm these findings with median sitting time of 420(180) minutes at work. From qualitative analyses, major barriers to reducing SB emerged, including the following themes: workplace social and cultural norms, personal factors, job scope, and physical building/office infrastructure. CHEW results confirm a lack of support from the physical infrastructure and information environment to reducing SB.

Conclusions

There is high SB among office workers in this sample. We identified multiple levels of influence for prolonged occupational SB, with a particular emphasis on workplace norms and infrastructure as important barriers to reducing SB and increasing PA. A larger, representative sample of the Singaporean population is needed to confirm our findings but it seems that any intervention aimed at reducing SB in the workplace should target individual, environmental, and organizational levels.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3023-z) contains supplementary material, which is available to authorized users.

Evaluation of worksite policies and practices promoting nutrition and physical activity among hospital workers

Purpose

– As posited by the ecological model of health, improvements in the nutrition and physical activity environments of worksites may facilitate healthier dietary intakes and physical activity patterns of employees. This cross-sectional study describes current policies and practices targeting these environments in five large Texas-based hospitals employing approximately 40,000 adults. The paper aims to discuss these issues.

Design/methodology/approach

– The environmental assessment tool survey, an observation tool, was used to assess these policies and practices in August and September 2012.

Findings

– Results demonstrated major policy and practice deficiencies, including a lack of policies supporting on and offsite employee physical fitness, no healthy catering or healthy meeting policies, minimal subsidizing of healthy food and beverage options, few health-promoting vending services, and no performance objectives related to worksite health improvement. Hospitals having an active employee wellness staff consistently performed better on implementation of policies and practices supporting healthy eating and physical activity.

Practical implications

– This study supports practice recommendations including engaging executive leadership to prioritize worksite wellness and using policies to create an infrastructure that promotes healthy eating and encourages physical activity among employees.

Originality/value

– This study is the first to compare and contrast the nutrition and the physical activity environments of large hospitals, allowing for the identification of common environmental barriers and supports across multiple hospital and foodservice systems.

The relationship between workplace environment and employee health behaviors in a South African workforce

OBJECTIVE

To determine the relationship between the availability of wellness facilities at worksites and self-reported employee health behaviors (physical activity [PA] and nutrition [NUT]).

METHODS

Employers (n = 71) and employees (n = 11472) participated in the South African Healthy Company Index survey. The survey included self-reported clinical measures and lifestyle behaviors. A facility score was calculated, ranging from 0 to 100. Hierarchical linear models were used to calculate the relationship between facility scores and whether employees met PA and NUT guidelines.

RESULTS

The mean total facility score was 58.5 ± 25.5. The number of facilities at each worksite accounted for 5.4% of the variance in PA among employees (r = 0.054; P = 0.036). Higher facility scores were associated with better NUT habits among employees.

CONCLUSIONS

Employers providing wellness facilities are likely to have employees with better PA and NUT habits.

Review of measures of worksite environmental and policy supports for physical activity and healthy eating

Introduction

Obesity prevention strategies are needed that target multiple settings, including the worksite. The objective of this study was to assess the state of science concerning available measures of worksite environmental and policy supports for physical activity (PA) and healthy eating (HE).

Methods

We searched multiple databases for instruments used to assess worksite environments and policies. Two commonly cited instruments developed by state public health departments were also included. Studies that were published from 1991 through 2013 in peer-reviewed publications and gray literature that discussed the development or use of these instruments were analyzed. Instrument administration mode and measurement properties were documented. Items were classified by general health topic, 5 domains of general worksite strategy, and 19 subdomains of worksite strategy specific to PA or HE. Characteristics of worksite measures were described including measurement properties, length, and administration mode, as well as frequencies of items by domain and subdomain.

Results

Seventeen instruments met inclusion criteria (9 employee surveys, 5 manager surveys, 1 observational assessment, and 2 studies that used multiple administration modes). Fourteen instruments included reliability testing. More items were related to PA than HE. Most instruments (n = 10) lacked items in the internal social environment domain. The most common PA subdomains were exercise facilities and lockers/showers; the most common HE subdomain was healthy options/vending.

Conclusion

This review highlights gaps in measurement of the worksite social environment. The findings provide a useful resource for researchers and practitioners and should inform future instrument development.

Applying RE-AIM to the Evaluation of FUEL Your Life

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce.

Validation of Performance Indicators for Evaluation of Workplace Health Promotion

PURPOSE

To validate performance indicators for evaluating workplace health promotion (WHP) programs based on a logic model and to analyze the structural relationships between constructs.

DESIGN

The study design is cross-sectional.

SETTING

Design setting was small manufacturing companies implementing WHP programs provided by the Korea Industrial Health Association.

SUBJECTS

Seventeen occupational health experts completed a questionnaire to determine the content validity of indicators. In addition, 58 health care managers completed a questionnaire to determine reliability and construct validation. The response rate was 84.1%.

MEASURES

Based on a logic model, 13 constructs of WHP programs were identified: WHP program input, four activities for workplace environment management, two activities for employee health care management, two outputs, and two short-term outcomes.

ANALYSIS

Interrater agreement index was used for testing the content validity of indicators. Confirmatory factor analysis was used to test for the reliabilities, and the convergent and discriminant validities. Structuring equation modeling was also used to analyze the relationships among constructs.

RESULTS

A total of 35 performance indicators from 11 constructs showed good reliability and validity. All relationships among WHP input, activities, outputs, and short-term outcomes were significant, except for the relationship between environment outputs and short-term outcome.

CONCLUSION

These findings illustrate that the logic model and structuring equation modeling can be used to develop and validate performance indicators for planning and evaluation of the WHP program.

Development and reliability testing of the Worksite and Energy Balance Survey

CONTEXT

Worksites represent important venues for health promotion. Development of psychometrically sound measures of worksite environments and policy supports for physical activity and healthy eating are needed for use in public health research and practice.

OBJECTIVE

Assess the test-retest reliability of the Worksite and Energy Balance Survey (WEBS), a self-report instrument for assessing perceptions of worksite supports for physical activity and healthy eating.

DESIGN

The WEBS included items adapted from existing surveys or new items on the basis of a review of the literature and expert review. Cognitive interviews among 12 individuals were used to test the clarity of items and further refine the instrument. A targeted random-digit-dial telephone survey was administered on 2 occasions to assess test-retest reliability (mean days between time periods = 8; minimum = 5; maximum = 14).

SETTING

Five Missouri census tracts that varied by racial-ethnic composition and walkability.

PARTICIPANTS

Respondents included 104 employed adults (67% white, 64% women, mean age = 48.6 years). Sixty-three percent were employed at worksites with less than 100 employees, approximately one-third supervised other people, and the majority worked a regular daytime shift (75%).

MAIN OUTCOME MEASURES

Test-retest reliability was assessed using Spearman correlations for continuous variables, Cohen's κ statistics for nonordinal categorical variables, and 1-way random intraclass correlation coefficients for ordinal categorical variables.

RESULTS

Test-retest coefficients ranged from 0.41 to 0.97, with 80% of items having reliability coefficients of more than 0.6. Items that assessed participation in or use of worksite programs/facilities tended to have lower reliability. Reliability of some items varied by gender, obesity status, and worksite size. Test-retest reliability and internal consistency for the 5 scales ranged from 0.84 to 0.94 and 0.63 to 0.84, respectively.

CONCLUSIONS

The WEBS items and scales exhibited sound test-retest reliability and may be useful for research and surveillance. Further evaluation is needed to document the validity of the WEBS and associations with energy balance outcomes.

Factors in adoption of a fire department wellness program: champ-and-chief model

OBJECTIVE

To identify and evaluate determinants of fire departments' wellness program adoption.

METHODS

The Promoting Healthy Lifestyles: Alternative Models' Effects fire service wellness program was offered for free to all medium-sized fire departments in Oregon and Washington. An invitation to participate was mailed to key fire department decision makers (chief, union president, and wellness officer). These key decision makers from 12 sites that adopted the program and 24 matched nonadopting sites were interviewed and results were analyzed to define adoption determinants.

RESULTS

Three adoption requirements were identified: (1) mailer connection, (2) local firefighter wellness champion, and (3) willing fire chief, whereas a fourth set of organizational factors had little or no impact on adoption including previous and ongoing wellness activities, financial pressures, and resistance to change.

CONCLUSIONS

Findings identified determinants of medium-sized fire service wellness program adoption.

PACES: a Physical Activity Campus Environmental Supports Audit on university campuses

PURPOSE

This study evaluated the policy and built and recreation environmental supports for physical activity on 13 university campuses.

DESIGN

Environmental audit survey.

SETTING

Thirteen U.S. universities, 2009. Subjects. University policies, recreation programs and facilities, and at least five additional buildings per campus.

MEASURES

The Physical Activity Campus Environmental Supports Audit was developed for this study.

ANALYSIS

Analysis of variance with post hoc Tukey's B and χ(2) assessed differences by institution and building type.

RESULTS

The mean obesogenic policy score was significantly lower than the desired score, ≥7 (p = .002), with only one campus scoring 10. The mean built environment audit score (5.4 ± 1.7) was low, with significant differences between institutions (p < .001) and only three campuses scoring above the desired score, ≥7. Although generally stairwells were clean and well lighted, there was a lack of signage to encourage stair use (p < .001). Overall, recreation programs (7.1 ± .7) and facilities (7.1 ± 1.2) scored well, but amenities scores were lower for satellite (2.8 ± 1.6) versus main (4.1 ± 1.8) recreation facilities (p = .04).

CONCLUSION

On these 13 university campuses, recreation programs and facilities were supportive of healthful lifestyles for obesity prevention, but policies and the built environment were not. This physical activity environmental audit survey requires testing in a wider sample of postsecondary institutions to corroborate its utility and provide evidence to support initiatives to improve campus environments for physical activity.

Workplace health promotion implementation, readiness, and capacity among midsize employers in low-wage industries: a national survey

OBJECTIVE

To describe workplace health promotion (WHP) implementation, readiness, and capacity among midsize employers in low-wage industries in the United States.

METHODS

A cross-sectional survey of a national sample of midsize employers (100 to 4999 employees) representing five low-wage industries.

RESULTS

Employers' WHP implementation for both employees and employees' spouses and partners was low. Readiness scales showed that employers believe WHP would benefit their employees and their companies, but they were less likely to believe that WHP was feasible for their companies. Employers' capacity to implement WHP was very low; nearly half the sample reported no capacity.

CONCLUSION

Midsize employers in low-wage industries implement few WHP programs; their responses to readiness and capacity measures indicate that low capacity may be one of the principal barriers to WHP implementation.

Worksite translation of the Diabetes Prevention Program: formative research and pilot study results from FUEL Your Life

This article summarizes formative research and pilot study findings from a workplace translation of the Diabetes Prevention Program (DPP). The overarching goal was to devise a relatively straightforward weight management intervention suitable for use in a wide array of work settings. This project was conducted in conjunction with Union Pacific Railroad at one of their locomotive maintenance facilities. Participating employees were predominately male and middle-aged. Formative data were collected through stakeholder interviews, focus groups, and direct observation of the work environment. These results were used to adapt the DPP into a largely self-directed intervention augmented by peer health coaches and the on-site nurse. A small pilot test of the adapted program (n = 67) produced modest but statistically significant weight reductions at both 6 (core intervention period) and 12 months (maintenance period). These results are discussed in terms of the original DPP and other DPP translation studies.

Process evaluation results from an environmentally focused worksite weight management study

There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively simple, low-cost environmental modifications designed to facilitate healthy eating and physical activity; the intense treatment added elements intended to actively involve and engage management in program efforts. Fidelity varied across the 11 interventions comprising the two treatment conditions but did not vary systematically by treatment condition (moderate vs. intense). Environmental assessments showed improvements in workplace supports for weight management and significant differences by treatment level. Positive shifts in health climate perceptions also occurred, but sites receiving the intense treatment were not perceived as more supportive by employees. Challenges and limitations associated with environmental interventions are discussed with specific reference to activating management support.

Exploring occupational and behavioral risk factors for obesity in firefighters: a theoretical framework and study design

Firefighters and police officers have the third highest prevalence of obesity among 41 male occupational groups in the United States (US). However, few studies have examined the relationship of firefighter working conditions and health behaviors with obesity. This paper presents a theoretical framework describing the relationship between working conditions, health behaviors, and obesity in firefighters. In addition, the paper describes a detailed study plan for exploring the role of occupational and behavioral risk factors in the development of obesity in firefighters enrolled in the Orange County Fire Authority Wellness Fitness Program. The study plan will be described with emphasis on its methodological merits: adopting a participatory action research approach, developing a firefighter-specific work and health questionnaire, conducting both a cross-sectional epidemiological study using the questionnaire and a sub-study to assess the validity of the questionnaire with dietary intake and physical activity measures, and evaluating the strengths and weaknesses of the body mass index as an obesity measure in comparison to skinfold-based percent body fat. The study plan based on a theoretical framework can be an essential first step for establishing effective intervention programs for obesity among professional and voluntary firefighters.

Combining environmental and individual weight management interventions in a work setting: results from the Dow chemical study

OBJECTIVE

To evaluate the comparative effectiveness of environmental weight loss interventions alone versus in combination with an individual intervention.

METHODS

A quasi-experimental design compared outcomes for two levels of environmental interventions and for participants who did or did not simultaneously self-select into an individually focused weight loss intervention (YW8). Analysis of covariance and logistic regression techniques were used to examine risk outcomes.

RESULTS

Employees who participated in YW8 were no more successful at losing weight than those exposed to only the environmental interventions. Approximately, 13.5% of each group lost at least 5% of their body weight; overall changes in mean body weight and body mass index were negligible in both groups.

CONCLUSIONS

Simple worksite environmental modifications may help with weight maintenance, but are not likely to result in substantial weight reductions even when combined with low-intensity individual interventions.

Assessment of a Worksite Health Promotion Readiness Checklist

OBJECTIVE

To assess the utility of a Worksite Health Promotion Readiness Checklist (WRCL) designed to evaluate the worksite's readiness for implementing health promotion and health protection programs.

METHODS

The WRCL was pilot tested in worksites with (WHPy) and without (WHPn) health promotion programs. The two parts of WRCL scores (observational and administrative) for WHPy and WHPn sites were compared within and between the worksites to establish WRCL utility and sensitivity.

RESULTS

Observational WRCL (completed by two observers per site) demonstrated high interrater reliability (P < 0.05) for most items. Administrative WRCL (completed by three administrators per site) showed some discrepant responses between administrators. Overall, both sections of WRCL produced higher scores for WHPy sites.

CONCLUSIONS

WRCL could be a valid and reliable instrument to measure readiness of a worksite toward health promotion and health protection programs.

Health promotion site selection blues: barriers to participation and implementation

OBJECTIVE

To shed light on research-to-practice challenges in workplace health promotion research.

METHODS

More than 1200 companies serviced by a national insurer were assessed by measures, including management surveys, and insurance premium costs and risk profile. A 21-item Workplace Readiness Checklist was the core assessment tool. Quantitative and qualitative measures were used to identify 12 to 14 companies deemed most "ready for change."

RESULTS

The four priority candidate companies decided against participation. A post hoc survey to evaluate reasons for non-participation identified factors such as time allocations, the deteriorating economic environment, and the participatory nature of the interventions proposed for half of the study sites. Differing priorities within management also seemed to interfere with participation.

CONCLUSIONS

A highly structured process for determining corporate readiness for participatory health promotion produced contradictory results.

Second-year results of an obesity prevention program at the Dow Chemical Company

OBJECTIVE

Evaluate innovative, evidence-based approaches to organizational/supportive environmental interventions aimed at reducing the prevalence of obesity among Dow employees after 2 years of implementation.

METHODS

A quasi-experimental study design compared outcomes for two levels of intervention intensity with a control group. Propensity scores were used to weight baseline differences between intervention and control subjects. Difference-in-differences methods and multilevel modeling were used to control for individual and site-level confounders.

RESULTS

Intervention participants maintained their weight and body mass index, whereas control participants gained 1.3 pounds and increased their body mass index values by 0.2 over 2 years. Significant differences in blood pressure and cholesterol values were observed when comparing intervention employees with controls. At higher intensity sites, improvements were more pronounced.

CONCLUSIONS

Environmental interventions at the workplace can support weight management and risk reduction after 2 years.

Environmental assessment at worksites after a multilevel intervention to promote activity and changes in eating: the PACE project

OBJECTIVE

To evaluate changes in the worksite environment in response to a multilevel intervention over a 2-year period.

METHODS

Worksites were recruited in the greater Seattle area, and 34 were randomized to intervention or comparison condition. The intervention was based on the ecological model, with a framework of defined phases of intervention that included worksite-wide events implemented in partnership with employee-based advisory boards. The assessment of the worksite environment used a modification of the Checklist of Health Promotion Environments at Worksites. Subscales were developed using baseline data only. The intervention effect on different aspects of the worksite environment was estimated using logistic regression with robust estimating procedures.

RESULTS

Only changes in the physical activity and nutrition information environments were significantly associated with the intervention.

CONCLUSIONS

This article provides one of the first attempts at using environmental assessment in the evaluation of worksite interventions.

Worksite environmental interventions for obesity control: an overview

In 2004, the National Heart, Lung, and Blood Institute funded seven independent research projects to test the effectiveness of multicomponent weight control interventions at worksites that include environmental changes alone or in combination with individually targeted strategies (Pratt et al, Obesity. 2007;15:2171-2180). The studies were conducted in a variety of worksites across the United States. This supplement to the Journal of Occupation and Environmental Medicine includes a series of manuscripts that evaluate various aspects of the funded studies, including environmental and cost-related findings, process evaluation, and the impact of acute and chronic psychosocial work stressors on body mass index.

First-year results of an obesity prevention program at The Dow Chemical Company

OBJECTIVE

To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company.

METHODS

A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests.

RESULTS

After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased.

CONCLUSIONS

Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.