Impact of workplace sociocultural attributes on participation in health assessments

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

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

Analyses of Employer Medical Claims Data to Assess Receipt of High-Priority Preventive Health Services

INTRODUCTION

The Affordable Care Act mandated that health plans cover preventive health services without patient cost sharing. A process, based on the analyses of medical claims data, is presented that allows companies to assess whether their healthcare plans are providing employees and dependents with age- and sex-appropriate high-priority preventive healthcare services.

METHODS

High-priority preventive healthcare services are defined as, a physical examination; type 2 diabetes screening; blood lipid screening; cervical, breast, and colon cancer screening; and osteoporosis screening. Current Procedural Terminology codes reflecting billing for these screening services were identified. Receipt of these age- and sex-appropriate services in rolling 3-year windows from 2010 to 2016 was assessed in 86,895,424 person-years of medical claims data from the IBM Watson Health MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefit Database. Data were analyzed in 2018 and 2019.

RESULTS

In the 2014-2016 period, 29% of men and 36% of women received the complete set of age- and sex-appropriate preventive health services, whereas 33% of men and 13% of women received none of these services.

CONCLUSIONS

Only a minority of individuals received a complete set of the defined high-priority preventive healthcare services. The process presented here allows employers to routinely analyze their medical claims data to assess the performance of their health and wellness plans in delivering these preventive services. The strengths and weaknesses of this approach are also described.

Employee Perceptions of Safety, Health, and Well-Being: Focus Group Findings From One Veterans Affairs Medical Center

OBJECTIVE

Focus groups were conducted at one veterans affairs (VA) medical center to understand (1) how the work environment and conditions of work influence employee safety, health, and well-being; (2) what programs, policies, and practices promote and protect employee safety and health in VA; and (3) how employee safety, health, and well-being impact the organizational mission.

METHODS

Nine focus groups were conducted with leadership, supervisor, and frontline employees. Focus groups were audio recorded, transcribed, and content analysis was performed.

RESULTS

Fifty-five employees participated in the focus groups. Six common themes emerged-stressful working conditions, health hazards, organizational factors, current program knowledge, participation barriers, and program suggestions.

CONCLUSIONS

Employees identified organizational and structural elements of work that impact safety, health, and well-being. Application of the Total Worker Health™ hierarchy of controls provided a novel framework for discussion of focus group findings.

Integrated Employee Occupational Health and Organizational-Level Registered Nurse Outcomes

OBJECTIVE

The study examined organizational culture, structural supports, and employee health program integration influence on registered nurse (RN) outcomes.

METHODS

An organizational health survey, employee health clinical operations survey, employee attitudes survey, and administration data were collected. Multivariate regression models examined outcomes of sick leave, leave without pay, voluntary turnover, intention to leave, and organizational culture using 122 medical centers.

RESULTS

Lower staffing ratios were associated with greater sick leave, higher turnover, and intention to leave. Safety climate was favorably associated with each of the five outcomes. Both onsite employee occupational health services and a robust health promotion program were associated with more positive organizational culture perceptions.

CONCLUSIONS

Findings highlight the positive influence of integrating employee health and health promotion services on organizational health outcomes. Attention to promoting employee health may benefit organizations in multiple, synergistic ways.

The £ for lb. Challenge. Evaluation of a novel, workplace-based peer-led weight management programme, 2014-2016

OBJECTIVES

To evaluate the £ for lb. Challenge, a novel country-wide, workplace-based, peer-led weight management programme with participants from a range of private and public organisations in Northern Ireland.

STUDY DESIGN

Pre- and post-intervention studies.

METHODS

The intervention was workplace-based, led by volunteer co-worker champions and based on the NHS Choices 12-week weight loss guide which incorporates dietary advice, physical activity, behaviour change methods and weekly weight monitoring. It operated from January to April in three consecutive years (2014-16). Overweight and obese adult workers were eligible. Training of peer champions involved two half-day workshops delivered by dieticians and physical activity professionals. Employers and/or participants pledged £1 to charity for every pound of weight lost. Weight was reported at enrolment and at either 12 weeks (2014) or at 12 weekly intervals (2015-16). Changes in weight and % weight, and body mass index were determined for all the participants and for gender and deprivation subgroups.

RESULTS

There were 734, 1559 and 1513 eligible participants, and 21, 31 and 35 participating companies in 2014, 2015 and 2016, respectively. Engagement rates were 94% and 96% and completion rates were 70% and 71% in 2015 and 2016, respectively. Mean weight loss was 1.9 kg (2.2%; 2014), 2.5 kg (2.8%; 2015) and 2.4 kg (2.7%; 2016). The proportions losing ≥5% initial bodyweight were 21% (2014), 24% (2015) and 26% (2016). Male participants were more than twice as likely as women to complete the programme (odds ratio: 2.5 [2015]; 2.2 [2016]) and to lose ≥5% bodyweight (odds ratio: 2.5 [2015]; 3.7 [2016]).

CONCLUSIONS

The £ for lb. Challenge was an effective, low-cost health improvement intervention with meaningful weight loss for many participants, particularly male workers. With high levels of engagement and ownership, and successful collaboration between public health, voluntary bodies, private companies and public organisations, it is a novel workplace-based model with potential to expand.

Identifying determinants to predict intention to complete a health risk assessment

Purpose

– The purpose of this paper is to determine which constructs (factors) will significantly predict and influence the intention to complete a health risk assessment (HRA) in a hospital employee population.

Design/methodology/approach

– The authors used a cross-sectional design using the theory of planned behavior to design a questionnaire to determine the variables associated with intention to complete an HRA. From a sample of those who completed (n=17) and those who did not complete (n=16) the HRA, the authors used elicitation inquiry to determine the leading factors associated with the intention to complete an HRA. The authors used the responses from this inquiry to develop a questionnaire for a hospital population (n=1,550). A total of 503 hospital employees completed and returned this questionnaire. Using the returned questionnaire data, the authors used logistic regression analysis to determine the best fit model for predicting intention to complete an HRA.

Findings

– The predictive model was statistically significant at the p < 0.001 level. Discriminant analysis correctly verified the predictive model classified intenders and non-intenders the majority (84 percent) of the time. These study results indicated that perceived behavioral control factors such as having time to complete the HRA, confidence in completing the HRA and trust that the information divulged in the HRA would be kept confidential had the strongest influence (OR=5.39) in predicting participation in taking an HRA.

Research limitations/implications

– Potential limitations of this study include; response and selection bias, homogeneity for age and sex and generalizability. These results help to identify key behavioral-related factors predicting hospital employee participation to complete an HRA.

Practical implications

– Administrators of worksite health promotion programs can systematically explore means of addressing identified participation barriers for the purpose of increasing overall HRA participation success beyond financial incentives.

Originality/value

– The HRA has become a widely accepted assessment tool used to help mitigate the rise in chronic disease. However, HRA completion rates are reported to be low to moderate with very limited research focussed on factors predicting HRA participation.

An exploratory study of inclusive worksite wellness: Considering employees with disabilities

BACKGROUND

An increasing number of employers are offering worksite wellness programs, yet, little is known about the participation of workers with disabilities.

OBJECTIVE

The primary purpose of this study was to explore the factors, which facilitate and impede participation in worksite wellness offerings by individuals with disabilities.

METHODS

Participants completed the Access to Worksite Wellness Services to Employees with Disabilities (AWWSED).

RESULTS

The decision to participate in worksite wellness programs is influenced by several individual, social, and organizational factors including perceptions of the impact of one's disability on health, the health habits of coworkers, and an organizational commitment to employee well-being. Study participants also indicated the importance of affordability, convenient times, and interest in the wellness activities being offered, as influencing participation decisions.

CONCLUSIONS

These findings suggest that individual, social, and organizational factors all contribute to the decision to participate and suggest that social support from colleagues as well as easily obtained and understandable program information from the employer, may be especially useful in engaging employees with disabilities in wellness programs.

Do overweight workers profit by workplace health promotion, more than their normal-weight peers? Evaluation of a worksite intervention

Background

Worksite health promotion programs have been identified as strongly effective in decreasing body weight and increasing awareness and change in health behavior. Aim of this study is to determine the effects of a multi-component intervention in workplace health promotion.

Methods

In a controlled study trail, 1,573 workers of a logistics company had the chance to participate in a one year worksite health promotion program. Main elements of the multi-component intervention were physical activity training in combination with nutrition counseling. Employees completed a questionnaire at baseline and then again after twelve month. Main outcome variables were changes in body weight and health behaviors. Secondary outcomes were subjective health indicators.

Results

Our results showed preliminary improvements in physical activity and eating behavior among normal weight and overweight/obesity weight groups. No significant weight reduction could be found, only a minimal reduction of BMI. The reduction was larger in the overweight group. Workers considered overweight or obese showed significantly greater body weight loss and changes in eating behavior than workers with a normal weight status. Workers with obesity/overweight scored their general health status significantly lower than their colleagues with normal weight status. No significant improvements were found for overall perception of health status between baseline and follow-up in the BMI-groups.

Conclusion

This 12-month intervention-control study suggests that a well-implemented multi-component workplace health promotion program may support substantial change in health behavior (e.g. nutrition and physical activity). It is indicated that overweight employees may especially profit from such worksite health promotion. An investigation of long-term effects of this multi-component intervention is strongly recommended.

Healthcare Worker Preferences for Active Tuberculosis Case Finding Programs in South Africa: A Best-Worst Scaling Choice Experiment

Objective

Healthcare workers (HCWs) in South Africa are at a high risk of developing active tuberculosis (TB) due to their occupational exposures. This study aimed to systematically quantify and compare the preferred attributes of an active TB case finding program for HCWs in South Africa.

Methods

A Best–Worst Scaling choice experiment estimated HCW’s preferences using a random-effects conditional logit model. Latent class analysis (LCA) was used to explore heterogeneity in preferences.

Results

“No cost”, “the assurance of confidentiality”, “no wait” and testing at the occupational health unit at one’s hospital were the most preferred attributes. LCA identified a four class model with consistent differences in preference strength. Sex, occupation, and the time since a previous TB test were statistically significant predictors of class membership.

Conclusions

The findings support the strengthening of occupational health units in South Africa to offer free and confidential active TB case finding programs for HCWs with minimal wait times. There is considerable variation in active TB case finding preferences amongst HCWs of different gender, occupation, and testing history. Attention to heterogeneity in preferences should optimize screening utilization of target HCW populations.

Creating a Representative Sample of Small Manufacturing Businesses for an Integrated Workplace Safety and Smoking Cessation Intervention Study

OBJECTIVES

We aimed to recruit a representative sample of small manufacturing businesses (20 to 150 employees) for a group-randomized trial of an integrated workplace safety and smoking cessation program.

METHODS

An initial sample was drawn from commercial databases, screened for duplicates or ineligibility, and contacted. Participating and nonparticipating businesses were compared on size, location, and type. Employee demographics of participating businesses were compared to a US Census Bureau database of similar businesses.

RESULTS

From an initial sample of 2716 businesses, 328 were eligible and 47 (9%) agreed to participate. Participating companies tended to be larger. They were similar to employees in the Census Bureau dataset.

CONCLUSIONS

Considerable resources were required to identify eligible businesses; commercial databases are the best resource but may not be comprehensive or current. The sample seemed to be representative of small manufacturing businesses in the study region.

Obese Employee Participation Patterns in a Wellness Program

The purpose of this research was to retrospectively examine whether demographic differences exist between those who participated in an employee wellness program and those who did not, and to identify the selection of employees' choice in weight management activities. A nonequivalent, 2-group retrospective design was used. This study involved employees at a large, not-for-profit integrated health system. Of the total organization employee pool (29,194), 19,771 (68%) employees volunteered to be weighed (mean body mass index [BMI]=28.9) as part of an employee wellness program. Weight management activities available included: (1) Self-directed 5% total body weight loss; (2) Healthy Solutions at home; (3) Weight Watchers group meetings; (4) Weight Watchers online; and (5) Employee Assistance Program (EAP)-directed healthy weight coaching. Measures were participation rate and available weight management activity participation rate among obese employees across demographic variables, including sex, age, race, job type, and job location. The analysis included chi-square tests for all categorical variables; odds ratios were calculated to examine factors predictive of participation. Of the total 19,771 employees weighed, 6375 (32%) employees were obese (defined as BMI ≥30); of those, 3094 (49%) participated in available weight management activities. Participation was higher among females, whites, those ages >50 years, and non-nursing staff. In conclusion, participation rate varied significantly based on demographic variables. Self-directed 5% weight loss was the most popular weight management activity selected. (Population Health Management 2016;19:132-135).

Medical Cost Savings for Web-Based Wellness Program Participants from Employers Engaged in Health Promotion Activities

Purpose.

Assess whether an insurer-provided Web-based wellness program results in cost and utilization improvements.

Design.

Quasi-experimental, pre-post, treatment-comparison design. Variables of interest were participation rates; medical, professional, and pharmacy expenditures; inpatient admissions; emergency room visits; and preventive service utilization.

Setting.

Six hundred forty-three employer-based wellness programs in Pennsylvania.

Subjects.

Forty-seven employers engaged in the Web-based wellness program and 596 employers who were not engaged. The engaged employer group included 10,463 wellness participants; an equal number of matched nonparticipant employees were identified from employers who were not engaged.

Intervention.

Web-based wellness program features were added to an on-site program in 2004. The program was followed through 2007.

Measures.

Outcomes were calculated using health insurance enrollment and claims history.

Analysis.

Participating employees were compared to nonparticipants using generalized linear mixed models to study changes in costs and utilization.

Results.

During the 2003 baseline year, engaged employers had greater costs, greater chronic disease prevalence, and greater hospitalization. Costs of program participants showed a lower rate of increase in 2004, and then dropped below those of the nonparticipants for the duration of the study. Between 2003 and 2007, the increase in medical expenditures of the participant group was significantly less than that of the nonparticipant group (31% vs. 46%, p < .01). In addition, the participant group showed a lower increase in professional service expenditures (p = .02) and greater utilization of preventive services (p < .01).

Conclusions.

Web-based insurer-provided wellness programs may decrease health care costs and encourage preventive service utilization. (Am J Health Promot 2011;25[4]:272–280.)

Barriers to participation in a worksite wellness program

The purpose of this research was to determine barriers that prevent participation in an employee wellness program, Wellness Wednesdays: "Eat & Meet" About Healthy Living, conducted at East Carolina University (ECU) in Greenville, North Carolina. All ECU ARAMARK employees (n = 481) over the age of 18 were eligible to participate in the wellness program. Weekly 30 minute classes, taught by a Registered Dietitian, on various nutrition- and health-related topics were conducted for 10-weeks. Five question knowledge quizzes were administered to participants at the end of each class to determine the comprehension of material presented. Qualitative interviews (n = 19) were conducted with employees (participants and non-participants) and the program organizer after the completion of the 10-week program to identify barriers to program participation. A total of 50 (10.4% of the total number of potential participants) ECU ARAMARK employees, managers, and leadership team directors attended Wellness Wednesdays at least once during the 10-week program. Employees, on average, scored 71-100% on the weekly knowledge quizzes administered at the end of each class. The most common barriers to participation reported included (most often to least often reported): insufficient incentives, inconvenient locations, time limitations, not interested in topics presented, undefined reasons, schedule, marketing, health beliefs, and not interested in the program. Results showed that employee wellness programs can be effective in increasing knowledge of employees on nutrition- and health-related topics. However, program planning that addresses identified barriers including insufficient incentives, inconvenient locations, and time limitations may facilitate higher participation in future worksite wellness opportunities.