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Gawlik A, Haberstock S, Beckert J, Zepp C. What moves truck drivers? A person-centered perspective on workplace physical activity promotion. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:425-435. [PMID: 38326221 DOI: 10.1080/10803548.2024.2315898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Objectives. In developing physical activity (PA) promotion measures in the workplace, individual needs of the target groups must be considered. For this reason, this study aimed to qualitatively identify the individual needs for an increase of PA in truck drivers, representing a neglected working group in terms of PA promotion. Methods. Semi-structured interviews were conducted (N = 19; mean age 50.5 years, SD 11.4 years; 10.5% female). The interview guide was based on the COM-B model to identify needs related to PA behavior in terms of capabilities, opportunities and motivation. The interviews were transcribed and coded by two independent investigators. Results. Altogether, the codes encompassed 395 statements, and the code system contained 14 codes. Three additional codes described further individual needs related to other health behaviors (nutrition, recreation) or external incentives for health interventions. Conclusion. The results reveal a variety of needs that are fundamental to the development of PA-promoting interventions for truck drivers. These needs appear to be closely linked, so a combination of capabilities, opportunities and/or motivation should be considered when developing holistic interventions. An example would be linking automatic motivation and psychological capabilities that encompass motivational techniques combined with information for psychoeducation of truck drivers.
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Affiliation(s)
- Angeli Gawlik
- Institute of Psychology, German Sport University Cologne, Germany
| | | | - Johanna Beckert
- Institute of Psychology, German Sport University Cologne, Germany
| | - Christian Zepp
- Institute of Psychology, German Sport University Cologne, Germany
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Crizzle AM, Wawzonek PA, Bigelow PL. Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey. J Occup Environ Med 2024; 66:20-27. [PMID: 37800354 DOI: 10.1097/jom.0000000000002988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population. METHODS This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population. RESULTS Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population. CONCLUSIONS Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.
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Affiliation(s)
- Alexander M Crizzle
- Form the School of Public Health, University of Saskatchewan, Saskatoon, Canada (A.M.C.); and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada (A.M.C., P.A.W., P.L.B.)
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Batson A, Berecki-Gisolf J, Newnam S, Stathakis V. Pre-injury health status of truck drivers with a workers' compensation claim. BMC Public Health 2022; 22:1683. [PMID: 36064341 PMCID: PMC9446842 DOI: 10.1186/s12889-022-13885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Truck drivers are a vulnerable population due to the high number of workplace injuries and fatalities predominant in their occupation. In Australia, the road freight transportation industry has been identified as a national priority area in terms of creating preventative measures to improve the health and safety of its workers. With an environment conducive to poor nutritional food choices and unhealthy lifestyle behaviours, many barriers exist to creating a safe and healthy workforce. Thus, the current study aimed to describe the pre-injury hospital-recorded health conditions and health service use of truck drivers with a worker’s injury compensation claim/s when compared to workers in other industries. Data was obtained from a compensation claims database and linked with hospital admissions data recorded five years prior to the injury claim. Health and lifestyle behaviour data for the occupational code of truck drivers was compared to other occupational drivers, as well as to all other occupations. Analysis was conducted via logistic regression. The results found that when compared to other occupational drivers, truck drivers were significantly more likely to have a hospital-recorded diagnosis of diabetes and/or hypertension, as well as being significantly more likely to have a hospital record of tobacco use and/or alcohol misuse/abuse. The findings show that there is a need to review and revise existing health strategies to promote the health and wellbeing of truck drivers, especially given their challenging work environment.
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Affiliation(s)
- Angela Batson
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, VIC, 3800, Australia.
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, VIC, 3800, Australia
| | - Sharon Newnam
- Queensland University of Technology, School of Psychology and Counselling, VIC, Australia
| | - Voula Stathakis
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, VIC, 3800, Australia
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Savira F, Wang BH, Kompa AR, Ademi Z, Owen AJ, Liew D, Zomer E. The impact of coronary heart disease prevention on work productivity: a 10-year analysis. Eur J Prev Cardiol 2020; 28:418-425. [PMID: 33624015 DOI: 10.1093/eurjpc/zwaa037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022]
Abstract
AIMS To determine the impact of preventing new (incident) cases of coronary heart disease (CHD) on years of life and productivity, using the novel measure 'productivity-adjusted life year' (PALY), over the next 10 years. METHODS AND RESULTS A dynamic life table model was constructed for the total Australian working-age population (15-69 years) over 10 years (2020-2029), separated by CHD status. Productivity estimates were sourced from the literature. The PALY was ascribed a financial value in terms of gross domestic product (GDP) per equivalent full-time worker. The total number of years lived, PALYs, and economic burden (in terms of GDP per PALY) were estimated. The model simulation was repeated assuming incidence was reduced, and the differences represented the impact of CHD prevention. All outcomes were discounted by 5% per annum. Over 10 years, the total projected years lived and PALYs in the Australian working-age population (with and without CHD) were 133 million and 83 million, respectively, amounting to A$17.2 trillion in GDP. We predicted more than 290 000 new (incident) CHD cases over the next 10 years. If all new cases of CHD could be prevented during this period, a total of 4 000 deaths could be averted, resulting in more than 8 000 years of life saved and 104 000 PALYs gained, equivalent to a gain of nearly A$21.8 billion (US$14.8 billion) in GDP. CONCLUSION Prevention of CHD will prolong years of life lived and productive life years, resulting in substantial economic benefit. Policy makers and employers are encouraged to engage in preventive measures addressing CHD.
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Affiliation(s)
- Feby Savira
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Bing H Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Andrew R Kompa
- Department of Medicine, University of Melbourne, St Vincent's Hospital, 37 Regent St, Fitzroy, VIC 3065, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
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A Structured Health Intervention for Truckers (SHIFT): A Process Evaluation of a Pilot Health Intervention in a Transport Company. J Occup Environ Med 2019; 60:377-385. [PMID: 29271840 DOI: 10.1097/jom.0000000000001258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To undertake a process-evaluation of a structured health intervention for truckers (SHIFT) implemented in a sample of UK lorry drivers. METHODS A combination of "debrief interviews," focus groups and one-to-one interviews, in addition to observations and reflections of the two lead researchers were used to collect data on the acceptability of SHIFT from a group of 16 lorry drivers and four transport managers. RESULTS The SHIFT program was considered relevant and acceptable to lorry drivers. It provided them with health information tailored to their specific health needs, long-lasting tools and techniques, which helped to raise their awareness of key health issues and helped to stimulate lifestyle changes during their daily routine. CONCLUSION This process-evaluation suggests that the SHIFT program should now be evaluated on a larger scale and tested through fully randomized controlled trials.
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Gordois AL, Toth PP, Quek RG, Proudfoot EM, Paoli CJ, Gandra SR. Productivity losses associated with cardiovascular disease: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:759-769. [PMID: 27831848 DOI: 10.1080/14737167.2016.1259571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION People with cardiovascular disease (CVD) often require time off work to recover from illness or surgery; for example, following a myocardial infarction (MI) or stroke. These individuals incur income losses, work-related productivity is reduced for employers, and output is reduced for the wider economy. Productivity impacts to the economy also arise due to CVD-related mortality. Areas covered: A systematic literature review was conducted to identify and collate studies that report the magnitude of work-related productivity losses associated with CVD generally or specific cardiovascular (CV) events or conditions (coronary heart disease, MI, stroke, transient ischemic attack, angina, heart failure, peripheral artery disease, coronary revascularization). The search was conducted using Medline, Embase, the Cochrane Library, and Google to find studies published from January 2004 to January 2015. In total, 60 studies were identified, including 20 studies conducted in the USA, 25 studies conducted in Europe, and 18 studies conducted in other countries (three studies were conducted in multiple regions). The studies differed by the scope of losses assessed (absenteeism, presenteeism, early retirement, premature mortality) and CVD conditions/events included. Studies reported either average patient or population losses, and generally used a human capital rather than friction cost method. Outcomes were standardized and adjusted to 2015 US dollars where possible. Expert commentary: The review demonstrates that CVD imposes substantial morbidity- and mortality-related productivity costs. The studies identified in the review may be used to inform and populate societal economic evaluations in CVD, with the most appropriate source study being that most closely matching the context of the evaluation.
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Affiliation(s)
- Adam L Gordois
- a Covance Market Access Services Inc. , Sydney , Australia
| | - Peter P Toth
- b University of Illinois College of Medicine , Peoria , IL , USA.,c Ciccarone Center for the Prevention of Cardiovascular Disease , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Baxter S, Sanderson K, Venn AJ, Blizzard CL, Palmer AJ. The relationship between return on investment and quality of study methodology in workplace health promotion programs. Am J Health Promot 2016; 28:347-63. [PMID: 24977496 DOI: 10.4278/ajhp.130731-lit-395] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs. DATA SOURCE Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus. STUDY INCLUSION AND EXCLUSION CRITERIA Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded. DATA EXTRACTION Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI. DATA SYNTHESIS ROI was calculated as ROI = (benefits - costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored. RESULTS Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84-.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38-1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n = 18) had a smaller mean ROI, 0.26 ± 1.74 (.23-.30), compared to moderate (n = 16) 0.90 ± 1.25 (.90-.91) and low-quality (n = 27) 2.32 ± 2.14 (2.30-2.33) studies. Randomized control trials (RCTs) (n = 12) exhibited negative ROI, -0.22 ± 2.41(-.27 to -.16). Financial returns become increasingly positive across quasi-experimental, nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11-1.14), 1.61 ± 0.91 (1.56-1.65), and 2.05 ± 0.88 (2.04-2.06), respectively. CONCLUSION Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.
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Does Targeting Higher Health Risk Employees or Increasing Intervention Intensity Yield Savings in a Workplace Wellness Program? J Occup Environ Med 2015; 57:1257-61. [DOI: 10.1097/jom.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McDonough B, Howard M, Angeles R, Dolovich L, Marzanek-Lefebvre F, Riva JJ, Laryea S. Lone workers attitudes towards their health: views of Ontario truck drivers and their managers. BMC Res Notes 2014; 7:297. [PMID: 24886231 PMCID: PMC4023166 DOI: 10.1186/1756-0500-7-297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Truck driving is the second most common occupation among Canadian men. Transportation of goods via roads is of crucial importance for the Canadian economy. The industry is responsible annually for $17 billion in GDP and is projected to increase by 28% over the next 10 years. Recruitment is an issue with 20% of drivers projected to retire or leave the profession in the next 10 years. Despite the reliance on transport truck drivers for the delivery of goods which affects Canada's economy and daily living of residents, little is known about the health care needs of this large cohort of primarily male lone workers from a drivers' perspective. Transport truck drivers are independent workers whose non traditional workplace is their tractor, the truck stops and the journey on the road.The objective of this study was to obtain a contextually informed description of lifestyle issues, health and disease risk factors experienced by drivers and perceived by their managers in the truck driving occupation. METHODS Using a grounded theory approach, 4 focus groups were conducted with drivers (n = 16) and managers (n = 10) from two trucking companies in Southwestern Ontario to identify the lived experience of the drivers as it relates to preventable risks to health and wellness. A semi structured guided interview was used to explore the lifestyle context of transport truck driving and organizational aspects of the occupation (workplace culture, working conditions and health and wellness promotion). RESULTS The predominant themes described stress, workplace, communication, lifestyle, driving culture, family, and fatigue concerns. In terms of the transportation work environment, drivers and managers were aware of the profession's potential to foster lifestyle related chronic diseases but described challenges in making the profession more amenable to a healthy lifestyle. CONCLUSIONS Workplace environmental determinants are significant in shaping health behaviours. Chronic disease health risks were the main health concerns identified. Health risks were exacerbated by working conditions (job demands, work hours, financial pressure and the sedentary nature of the job). Workplace health strategies will need to take into account the unique challenges of the occupation.
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Affiliation(s)
- Beatrice McDonough
- Department of Family Medicine, McMaster University, McMaster Innovation Park, Suite 201A, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada
- Healthy Living Division, City of Hamilton Public Health Services, 1447 Upper Ottawa, Unit 10, Hamilton, ON L8W 3J6, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, McMaster Innovation Park, Suite 201A, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, McMaster Innovation Park, Suite 201A, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, McMaster Innovation Park, Suite 201A, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada
- Centre for Evaluation of Medicine, 105 Main Street East, Level P1, Hamilton, ON L8N 1G6, Canada
| | - Francine Marzanek-Lefebvre
- Department of Family Medicine, McMaster University, McMaster Innovation Park, Suite 201A, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada
| | - John J Riva
- Department of Family Medicine, McMaster University, McMaster Innovation Park, Suite 201A, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada
| | - Stephanie Laryea
- Pan-American Health Organization/World Health Organization, Paramaribo, Suriname
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Abu Dabrh AM, Firwana B, Cowl CT, Steinkraus LW, Prokop LJ, Murad MH. Health assessment of commercial drivers: a meta-narrative systematic review. BMJ Open 2014; 4:e003434. [PMID: 24604478 PMCID: PMC3948638 DOI: 10.1136/bmjopen-2013-003434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motor vehicle accidents associated with commercial driving are an important cause of occupational death and impact public safety. OBJECTIVES We summarise the evidence regarding the type, prevalence and impact of medical conditions discovered during health assessment of commercial drivers. EVIDENCE REVIEW We conducted a systematic review of multiple electronic databases and made a manual search for relevant studies that enrolled commercial drivers in any country and reported the outcomes of health assessment carried out in the context of commercial driving through November 2012. Data were extracted by a pair of independent reviewers and synthesised using a metanarrative approach. RESULTS We identified 32 studies of moderate methodological quality enrolling 151 644 commercial drivers (98% men). The prevalence of multiple health conditions was high (sleep disorders 19%, diabetes 33%, hypertension 23% and obesity 45%). Some conditions, such as sleep disorders and obesity, were linked to increased risk of crashes. Evidence on several other highly relevant medical conditions was lacking. Cost-effectiveness data were sparse. CONCLUSIONS Several medical conditions are highly prevalent in commercial drivers and can be associated with increased risk of crashes, thus providing a rationale for health assessment of commercial drivers.
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Affiliation(s)
- Abd Moain Abu Dabrh
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Belal Firwana
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - Clayton T Cowl
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence W Steinkraus
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad Hassan Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
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Cancelliere C, Cassidy JD, Ammendolia C, Côté P. Are workplace health promotion programs effective at improving presenteeism in workers? A systematic review and best evidence synthesis of the literature. BMC Public Health 2011; 11:395. [PMID: 21615940 PMCID: PMC3123596 DOI: 10.1186/1471-2458-11-395] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/26/2011] [Indexed: 01/22/2023] Open
Abstract
Background Presenteeism is highly prevalent and costly to employers. It is defined as being present at work, but limited in some aspect of job performance by a health problem. Workplace health promotion (WHP) is a common strategy used to enhance on-the-job productivity. The primary objective is to determine if WHP programs are effective in improving presenteeism. The secondary objectives are to identify characteristics of successful programs and potential risk factors for presenteeism. Methods The Cochrane Library, Medline, and other electronic databases were searched from 1990 to 2010. Reference lists were examined, key journals were hand-searched and experts were contacted. Included studies were original research that contained data on at least 20 participants (≥ 18 years of age), and examined the impacts of WHP programs implemented at the workplace. The Effective Public Health Practice Project Tool for Quantitative Studies was used to rate studies. 'Strong' and 'moderate' studies were abstracted into evidence tables, and a best evidence synthesis was performed. Interventions were deemed successful if they improved the outcome of interest. Their program components were identified, as were possible risk factors contributing to presenteeism. Results After 2,032 titles and abstracts were screened, 47 articles were reviewed, and 14 were accepted (4 strong and 10 moderate studies). These studies contained preliminary evidence for a positive effect of some WHP programs. Successful programs offered organizational leadership, health risk screening, individually tailored programs, and a supportive workplace culture. Potential risk factors contributing to presenteeism included being overweight, a poor diet, a lack of exercise, high stress, and poor relations with co-workers and management. Limitations: This review is limited to English publications. A large number of reviewed studies (70%) were inadmissible due to issues of bias, thus limiting the amount of primary evidence. The uncertainties surrounding presenteeism measurement is of significant concern as a source of bias. Conclusions The presenteeism literature is young and heterogeneous. There is preliminary evidence that some WHP programs can positively affect presenteeism and that certain risk factors are of importance. Future research would benefit from standard presenteeism metrics and studies conducted across a broad range of workplace settings.
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Affiliation(s)
- Carol Cancelliere
- Master of Public Health Program, Faculty of Graduate Studies, Lakehead University, Thunder Bay, Ontario, Canada.
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