1
|
Chong S, Huynh B, Wong S, Woldeyesus T, Faulks M, El-Amin K, Thibeaux J, Lewis J, Harlin R, Carter M, Shatara R, Zhou C, Oni-Orisan A. Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings. Health Equity 2023; 7:835-842. [PMID: 38145054 PMCID: PMC10739686 DOI: 10.1089/heq.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. Methods We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Results Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Discussion Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.
Collapse
Affiliation(s)
- Sarah Chong
- Department of Clinical Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Brittany Huynh
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Wong
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Temesgen Woldeyesus
- Department of Medicine, Stanford University, Palo Alto, California, USA
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | - Melvin Faulks
- Department of Clinical Programs, Roots Community Health Center, Oakland, California, USA
| | | | | | - Joseph Lewis
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Robert Harlin
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Mario Carter
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Ramy Shatara
- Chicago 2 Barbershop, San Francisco, California, USA
| | - Crystal Zhou
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Salinger M, Levy DE, McCurley JL, Gelsomin ED, Rimm EB, Thorndike AN. Employees' Baseline Food Choices and the Effect of a Workplace Intervention to Promote Healthy Eating: Secondary Analysis of the ChooseWell 365 Randomized Controlled Trial. J Acad Nutr Diet 2023; 123:1586-1595.e4. [PMID: 37257691 PMCID: PMC10592532 DOI: 10.1016/j.jand.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Little is known about whether the effectiveness of workplace wellness programs differs by employees' baseline health behaviors. OBJECTIVE This study examined the association of baseline cafeteria food choices with the effect of a workplace intervention on cafeteria food choices, dietary quality, and body mass index (BMI). DESIGN This was a secondary analysis of the ChooseWell 365 randomized controlled trial, testing a set of behavioral interventions to improve diet and prevent weight gain. PARTICIPANTS/SETTING Participants were 602 employees of a Boston, MA, hospital who had purchased food from cafeterias, which used traffic-light food labeling. Data were collected in 2016-2020. INTERVENTION The 12-month intervention (plus 12 months' follow-up) involved financial incentives and personalized feedback on cafeteria purchases. The control group received monthly letters with generic healthy eating and exercise tips. MAIN OUTCOME MEASURES Healthy purchasing scores (HPS) were calculated by weighting color categories (red = 0, yellow = 0.5, green = 1) and scaling from 0 to 100 (healthiest); employees were categorized into baseline (pre-intervention) HPS tertiles (T1 = least healthy, T3 = healthiest). Healthy eating index (HEI-2015) scores were calculated from two 24-hour dietary recalls. Intervention effects on 12- and 24-month changes in HPS (primary outcome), HEI-2015 score, and BMI were compared among tertiles. Subgroup analyses examined whether changes by tertile varied with financial rewards received. STATISTICAL ANALYSES Adjusting for baseline characteristics, multivariable linear regression assessed intervention effects across baseline HPS tertiles. RESULTS Compared with T3, T1 employees had lower education; higher obesity, hypertension, and pre-diabetes; and lower HEI-2015 scores. The intervention increased HPS, but no change was observed in HEI-2015 scores or BMI; the intervention effect did not differ among tertiles at 12 or 24 months. Financial incentives were associated with a larger effect on 12-month HPS changes for T1 than for T2/T3 (P-interaction < 0.001). CONCLUSION Compared with employees with healthier baseline food choices, employees with the least healthy food choices and highest cardiometabolic risk had similar improvements in the nutritional quality of cafeteria purchases as a result of the behavioral intervention, and they appeared to be more responsive to financial incentives.
Collapse
Affiliation(s)
- Maggie Salinger
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jessica L. McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emily D. Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, MA
| | - Eric B. Rimm
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Leino T, Turunen JKA, Pehkonen I, Juvonen-Posti P. Important collaborative conditions for successful economic outcomes of work disability management: A mixed methods multiple case study. Work 2022; 74:685-697. [PMID: 36278370 DOI: 10.3233/wor-210026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Work disability management (WDM) interventions have usually focused on a single factor and its impact on outcomes such as employee health or work disability costs. Research on company-level WDM activities and their economic impact is scarce. OBJECTIVE The aim of this study was to explain the change in company-level work disability costs and their relation to WDM practices, and to identify the mechanisms of impact through which the successful economic outcome emerged. METHODS The study design was a convergent mixed methods design with a multiple case study. The data from 14 business units concerned business context, personnel, investments in and processes of WDM, and the costs of work disability in 2010-2013. The data were constructed into case descriptions which were analysed using qualitative comparative analysis. The economic analysis was carried out from the employers' perspective. RESULTS Five business units gained net benefits of approximately 1.5-2.5% of the payroll sum from their investments in WDM. These benefits were characterised by a combination of four strategic processes: i) dismantling barriers to co-operation, ii) improving the visibility of the strategic goals of work ability management in everyday practice, iii) WDM actions targeting the company's main work disability risks, and iv) the facilitation of multi-actor co-operation through co-ordination and flow of information. CONCLUSION Strategic processes to support the effectiveness of WDM were found. When aiming for economic success in work disability management, in addition to measuring and managing disability costs, it is also essential to maintain collaborative operations in everyday practice.
Collapse
Affiliation(s)
- Timo Leino
- Finnish Institute of Occupational Health, Työterveyslaitos, Finland
| | | | - Irmeli Pehkonen
- Finnish Institute of Occupational Health, Työterveyslaitos, Finland
| | | |
Collapse
|
4
|
Odawara M, Saito J, Yaguchi-Saito A, Fujimori M, Uchitomi Y, Shimazu T. Using implementation mapping to develop strategies for preventing non-communicable diseases in Japanese small- and medium-sized enterprises. Front Public Health 2022; 10:873769. [PMID: 36276371 PMCID: PMC9582744 DOI: 10.3389/fpubh.2022.873769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Workplace programs to prevent non-communicable diseases (NCDs) in the workplace can help prevent the incidence of chronic diseases among employees, provide health benefits, and reduce the risk of financial loss. Nevertheless, these programs are not fully implemented, particularly in small- and medium-sized enterprises (SMEs). The purpose of this study was to develop implementation strategies for health promotion activities to prevent NCDs in Japanese SMEs using Implementation Mapping (IM) to present the process in a systematic, transparent, and replicable manner. Methods Qualitative methods using interviews and focus group discussions with 15 SMEs and 20 public health nurses were conducted in a previous study. This study applied the Consolidated Framework for Implementation Research and IM to analyze this dataset to develop implementation strategies suitable for SMEs in Japan. Results In task 2 of the IM, we identified performance objectives, determinants, and change objectives for each implementation stage: adoption, implementation, and maintenance; to identify the required actors and actions necessary to enhance implementation effectiveness. Twenty-two performance objectives were identified in each implementation stage. In task 3 of the IM, the planning group matched behavioral change methods (e.g., modeling and setting of graded tasks, framing, self-re-evaluation, and environmental re-evaluation) with determinants to address the performance objectives. We used a consolidated framework for implementation research to select the optimal behavioral change technique for performance objectives and determinants and designed a practical application. The planning team agreed on the inclusion of sixteen strategies from the final strategies list compiled and presented to it for consensus, for the overall implementation plan design. Discussion This paper provides the implementation strategies for NCDs prevention for SMEs in Japan following an IM protocol. Although the identified implementation strategies might not be generalizable to all SMEs planning implementation of health promotion activities, because they were tailored to contextual factors identified in a formative research. However, identified performance objectives and implementation strategies can help direct the next steps in launching preventive programs against NCDs in SMEs.
Collapse
Affiliation(s)
- Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Tokyo, Japan,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Tokyo, Japan,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Tokyo, Japan,*Correspondence: Taichi Shimazu
| |
Collapse
|
5
|
Rubery PT, Ramirez G, D'Agostino CR, Vasalos K, Thirukumaran C. A workplace wellness program at an academic health center influences employee health, satisfaction, productivity and the rate of workplace injury. Int Arch Occup Environ Health 2022; 95:1603-1632. [PMID: 35501508 DOI: 10.1007/s00420-022-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Workplace wellness (WP) programs are an employer strategy to improve employee health and satisfaction. Their impact on productivity and benefit expense remains unclear. This study examines the association of a voluntary WP at an academic health center with both employee metrics and employer costs. METHODS We retrospectively reviewed prospectively collected data from January 2016 to April 2018 for employees who voluntarily underwent screening for a WP at an academic medical center. We used their demographic, social, work, and clinical data to address the central research question. The primary outcomes included wellness measures from the Patient-Reported Outcomes Measurement Information System (PROMIS), secondary wellness outcomes such as body mass index, job-related outcomes such as job satisfaction, and workers' compensation metrics such as the claim amount. The key independent variables were whether an observation was from before or after the WP. For workers' compensation metrics, additional key independent variables were intervention/control group, and an interaction between the before/after and intervention/control variables. We conducted univariate and bivariate/unadjusted analyses, and estimated multivariable linear, logistic, and gamma regression models that also controlled for confounders. RESULTS The study included 370 employees. Participation in the program was associated with significant improvements in the PROMIS pain interference, fatigue and sleep quality domains. Hip circumference diminished, and functional movement outcomes were improved. Job satisfaction improved by 4.4 percentage points (95% Confidence Interval [CI]: 0.3-8.5, p = 0.04) and self-reported productivity by 14.5 percentage points (95% Confidence Interval [CI]: 9.5-19.5, p < 0.001). The likelihood of a new compensation claim during the 12-month follow-up period fell by 10.1% (95% Confidence Interval [CI]: - 15.5 to - 4.7, p < 0.001). However, the value of a new claim was unchanged. CONCLUSION Employees who completed a WP at an academic medical center demonstrated improvements in several recognized patient-reported outcome measures, in job satisfaction and self-reported productivity, a decrease in hip circumference, an improvement in functional motion and a decreased rate of compensable injury.
Collapse
Affiliation(s)
- Paul T Rubery
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA.
| | - Gabriel Ramirez
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| | - Charles R D'Agostino
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| | - Kostantinos Vasalos
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| |
Collapse
|
6
|
Kugathasan TA, Gilbert JA, Laberge S, Tremblay J, Mathieu ME. Activate Your Health: impact of a real-life programme promoting healthy lifestyle habits in Canadian workers. Health Promot Int 2022:6542533. [PMID: 35244699 DOI: 10.1093/heapro/daac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The workplace has been suggested as a good setting for the promotion of healthy lifestyles. This article examines the impact of Activate Your Health programme, provided over an average of 1.35 years, on employee health and lifestyle habits (actual and intention to improve). Companies selected one of the programme's four options (number of interventions in parentheses): Control (2), Light (8), Moderate (13) and High (14). Employees (n = 524) completed an online questionnaire at baseline and post-intervention. Mixed-effect models and generalized estimating equations models were used, where appropriate. There was an interaction effect of time by option for the number of employees intending to improve sleep habits (p = 0.030): +11.0% in Light (p = 0.013). No significant interaction effect of time by option was observed for body weight, body mass index, number of health problems or lifestyle habits (actual and intention to improve). When stratified by sex, there was an interaction effect of time by option for the number of women intending to improve sleep habits (p = 0.023): -26.1% in Moderate (p = 0.014). There was an interaction effect of time by option for body weight in men (p = 0.001): -0.58 kg in High (p = 0.031) and +2.58 kg in Control (p = 0.005). Other outcomes of interest were stable or improved post-intervention, regardless of option. The Activate Your Health programme allowed employees to maintain or improve outcomes related to health and lifestyle habits. A package like High may be beneficial for body weight regulation in men.
Collapse
Affiliation(s)
- Thiffya Arabi Kugathasan
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, #8223 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Jo-Anne Gilbert
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, #8223 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Suzanne Laberge
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, #8223 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Jonathan Tremblay
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, #8223 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada
| | - Marie-Eve Mathieu
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, #8223 Édouard-Montpetit, Montreal, QC H3T 1J4, Canada.,Université de Montréal, PO Box 6128, Downtown Station, Montreal, QC H3C 3J7, Canada.,Sainte-Justine University Health Centre, Montreal, QC, Canada
| |
Collapse
|
7
|
Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. MEDICAL EDUCATION 2022; 56:48-55. [PMID: 34559421 DOI: 10.1111/medu.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care. DISCUSSION In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges. CONCLUSION Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
Collapse
Affiliation(s)
- Daniel Mendelsohn
- Lions Gate Hospital, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Gea Cabrera A, Caballero P, Wanden-Berghe C, Sanz-Lorente M, López-Pintor E. Effectiveness of Workplace-Based Diet and Lifestyle Interventions on Risk Factors in Workers with Metabolic Syndrome: A Systematic Review, Meta-Analysis and Meta-Regression. Nutrients 2021; 13:nu13124560. [PMID: 34960112 PMCID: PMC8704618 DOI: 10.3390/nu13124560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/20/2022] Open
Abstract
Workplace health interventions are essential to improve the health and well-being of workers and promote healthy lifestyle behaviours. We carried out a systematic review, meta-analysis and meta-regression of articles measuring the association between workplace dietary interventions and MetS risk. We recovered potentially eligible studies by searching MEDLINE, the Cochrane Library, Embase, Scopus and Web of Science, using the terms “Metabolic syndrome” and “Occupational Health”. A total of 311 references were retrieved and 13 documents were selected after applying the inclusion and exclusion criteria. Dietary interventions were grouped into six main types: basic education/counselling; specific diet/changes in diet and food intake; behavioural change/coaching; physical exercise; stress management; and internet/social networks. Most programmes included several components. The interventions considered together are beneficial, but the clinical results reflect only a minimal impact on MetS risk. According to the metaregression, the interventions with the greatest impact were those that used coaching techniques and those that promoted physical activity, leading to increased HDL (effect size = 1.58, sig = 0.043; and 2.02, 0.015, respectively) and decreased BMI (effect size = −0.79, sig = −0.009; and −0.77, 0.034, respectively). In contrast, interventions offering information on healthy habits and lifestyle had the contrary effect, leading to increased BMI (effect size = 0.78, sig = 0.006), systolic blood pressure (effect size = 4.85, sig = 0.038) and diastolic blood pressure (effect size = 3.34, sig = 0.001). It is necessary to improve the efficiency of dietary interventions aimed at lowering MetS risk in workers.
Collapse
Affiliation(s)
- Alicia Gea Cabrera
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technology, Universidad Miguel Hernández, 03550 Alicante, Spain;
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science (Spain), University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain;
| | - Carmina Wanden-Berghe
- Grupo de Nutrición Clínica y HAD del Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - María Sanz-Lorente
- Department of Public Health and History of Science, Universidad Miguel Hernández, 03550 Alicante, Spain;
| | - Elsa López-Pintor
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technology, Universidad Miguel Hernández, 03550 Alicante, Spain;
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Correspondence:
| |
Collapse
|
9
|
Zhou YF, Chen S, Wang G, Chen S, Zhang YB, Chen JX, Tu ZZ, Liu G, Wu S, Pan A. Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis. Hypertension 2021; 79:230-240. [PMID: 34878893 DOI: 10.1161/hypertensionaha.121.18305] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Limited studies had investigated the potential benefits of workplace-based hypertension management programs on long-term blood pressure (BP) control and health outcomes. This study used the propensity score matching to examine the effectiveness of a workplace-based hypertension management program on BP control and risks of major adverse cardiovascular events and all-cause mortality. Within the Kailuan study, a workplace-based hypertension management program was initiated in 2009 among men with hypertension, which included regular BP measuring (twice a month), free antihypertensive medications, and individualized health consultation. Participants were followed until loss to follow-up, death, or December 31, 2019. Among 17 724 male hypertensives aged 18 to 60 years, 6400 participated in the program. The propensity score matching yielded 6120 participants in the management group and 6120 participants in the control group. Both systolic and diastolic BPs were significantly lower in the management group than in the control group over follow-up, and the mean between-group difference at the 10th year was -7.83 (95% CI, -9.06 to -6.62) mm Hg for systolic BP and -4.72 (95% CI, -5.46 to -3.97) mm Hg for diastolic BP. Participants in the program were more likely to achieve BP control (odds ratio, 1.70 [95% CI, 1.41-2.06]) and had significantly lower risks of major adverse cardiovascular events (hazard ratio, 0.83 [95% CI, 0.72-0.94]) and all-cause mortality (hazard ratio, 0.71 [95% CI, 0.58-0.86]), compared with those who were not in the program. A workplace-based hypertension management program was related to reduced BP levels and lower risks of major adverse cardiovascular events and mortality in Chinese men with hypertension.
Collapse
Affiliation(s)
- Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Lab of Environment and Health (Y.-F.Z., Y.-B.Z., J.-X.C., Z.-Z.T., A.P.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Germany (Simiao Chen).,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Simiao Chen).,Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China (G.W., Shuohua Chen, S.W.)
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China (G.W., Shuohua Chen, S.W.)
| | - Shuohua Chen
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Lab of Environment and Health (Y.-F.Z., Y.-B.Z., J.-X.C., Z.-Z.T., A.P.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Lab of Environment and Health (Y.-F.Z., Y.-B.Z., J.-X.C., Z.-Z.T., A.P.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Xiang Chen
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Lab of Environment and Health (Y.-F.Z., Y.-B.Z., J.-X.C., Z.-Z.T., A.P.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou-Zheng Tu
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Lab of Environment and Health (Y.-F.Z., Y.-B.Z., J.-X.C., Z.-Z.T., A.P.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, and Hubei Key Laboratory of Food Nutrition and Safety (G.L.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China (G.W., Shuohua Chen, S.W.)
| | - An Pan
- Department of Epidemiology and Biostatistics, and Ministry of Education Key Lab of Environment and Health (Y.-F.Z., Y.-B.Z., J.-X.C., Z.-Z.T., A.P.), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
10
|
Melián-Fleitas L, Franco-Pérez Á, Caballero P, Sanz-Lorente M, Wanden-Berghe C, Sanz-Valero J. Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression. Nutrients 2021; 13:3945. [PMID: 34836200 PMCID: PMC8622081 DOI: 10.3390/nu13113945] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health. METHOD This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021. RESULTS A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise. CONCLUSIONS Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).
Collapse
Affiliation(s)
- Liliana Melián-Fleitas
- Nutrition Department, University of Granada, 18012 Granada, Spain;
- Geriatric Service, Insular Hospital, Health Services Management of the Health Area of Lanzarote, 35500 Arrecife, Spain
| | - Álvaro Franco-Pérez
- Playa Blanca Health Center, Health Services Management of the Health Area of Lanzarote, 35580 Playa Blanca, Spain;
| | - Pablo Caballero
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain;
| | - María Sanz-Lorente
- Department of Public Health & History of Science, University Miguel Hernandez, 03550 Alicante, Spain;
- Center of Public Health, Consellería of Universal Health and Public Health, 46940 Manises, Spain
| | - Carmina Wanden-Berghe
- Health and Biomedical Research Institute of Alicante, University General Hospital, 03010 Alicante, Spain;
| | - Javier Sanz-Valero
- Department of Public Health & History of Science, University Miguel Hernandez, 03550 Alicante, Spain;
- National School of Occupational Medicine, Carlos III Health Institute, 28029 Madrid, Spain
| |
Collapse
|
11
|
Chan TKC, Tan LWL, van Dam RM, Seow WJ. Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study. Front Oncol 2021; 11:684917. [PMID: 34476210 PMCID: PMC8406849 DOI: 10.3389/fonc.2021.684917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population. Methods We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders. Results The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month. Conclusions Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.
Collapse
Affiliation(s)
| | - Linda Wei Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| |
Collapse
|
12
|
Mulaney B, Bromley-Dulfano R, McShane EK, Stepanek M, Singer SJ. Descriptive Study of Employee Engagement With Workplace Wellness Interventions in the UK. J Occup Environ Med 2021; 63:719-730. [PMID: 34491963 DOI: 10.1097/jom.0000000000002219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To explore sequential steps of employee engagement in wellness interventions and the impact of wellness interventions on employee health. METHODS Using previously collected survey data from 23,667 UK employees, we tabulated intervention availability, awareness, participation, and associated health improvement and compared engagement by participation and risk status. RESULTS Employees' awareness of wellness interventions at their workplaces was often low (mean 43.3%, range 11.6%-82.3%). Participation was highest in diet/nutrition initiatives (94.2%) and lowest in alcohol counseling and smoking cessation interventions (2.1%). Employees with health risks were less likely than lower-risk employees to report awareness, participation, and health improvements from wellness interventions addressing the relevant health concern. CONCLUSION Employers and policymakers should consider variation in intervention engagement as they plan and implement wellness interventions. Engaging employee populations with higher health risks requires a more targeted approach.
Collapse
Affiliation(s)
- Bianca Mulaney
- Stanford University School of Medicine, Stanford, California (Ms Mulaney, Ms Bromley-Dulfano, Ms Singer, Ms McShane, Dr Singer); Vitality Health, London, UK and Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic (Dr Stepanek); Stanford Graduate School of Business, Stanford, California (Dr Singer)
| | | | | | | | | |
Collapse
|
13
|
Song Z, Baicker K. Health And Economic Outcomes Up To Three Years After A Workplace Wellness Program: A Randomized Controlled Trial. Health Aff (Millwood) 2021; 40:951-960. [PMID: 34097526 PMCID: PMC8425177 DOI: 10.1377/hlthaff.2020.01808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Workplace wellness programs aim to improve employee health and lower health care spending. Recent randomized studies have found modest short-run effects on health behaviors, but longer-run effects remain poorly understood. We analyzed a clustered randomized trial of a workplace wellness program implemented at a large multisite US employer. Twenty-five randomly selected treatment worksites received the program, with five of the worksites added at the trial's midpoint, and 135 randomly selected control worksites did not. The program included modules on nutrition, physical activity, and stress reduction, implemented by registered dietitians. The effects of program availability and participation were assessed. At the end of three years, employees at the treatment worksites had better self-reported health behaviors, including a higher rate of actively managing their weight. No significant differences were found in self-reported health; clinical markers of health; health care spending or use; or absenteeism, tenure, or job performance. Improvements in health behaviors after three years were similar to those at eighteen months, but the longer follow-up did not yield detectable improvements in clinical, economic, or employment outcomes.
Collapse
Affiliation(s)
- Zirui Song
- Zirui Song is an assistant professor of health care policy and medicine at Harvard Medical School, a general internist at Massachusetts General Hospital, and faculty member in the Center for Primary Care at Harvard Medical School, in Boston, Massachusetts
| | - Katherine Baicker
- Katherine Baicker is dean of and the Emmett Dedmon Professor in the Harris School of Public Policy, University of Chicago, in Chicago, Illinois
| |
Collapse
|
14
|
Unsal N, Weaver G, Bray J, Bibeau D. A Scoping Review of Economic Evaluations of Workplace Wellness Programs. Public Health Rep 2021; 136:671-684. [PMID: 33541206 DOI: 10.1177/0033354920976557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI. METHODS We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome. RESULTS We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates. CONCLUSION This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.
Collapse
Affiliation(s)
- Nilay Unsal
- 37504 Department of Economics, Ankara University, Ankara, Turkey
| | - GracieLee Weaver
- 14616 Office of Research & Engagement, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jeremy Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Daniel Bibeau
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| |
Collapse
|
15
|
Fischer JE, Genser B, Nauroth P, Litaker D, Mauss D. Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings. J Occup Med Toxicol 2020; 15:33. [PMID: 33292316 PMCID: PMC7664018 DOI: 10.1186/s12995-020-00284-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Absence from work due to sickness impairs organizational productivity and performance. Even in organizations with perfect work conditions, some inevitable baseline sickness absence exists amongst working populations. The excess sickness absence observed above this baseline rate has become the focus of traditional health promotion efforts, addressing preventable physical illness, health behavior and mental health at the personal level. However, a health and safety approach following the TOP-rule would consider work-group psychosocial work characteristics as a potential risk factor amenable to organizational measures. To date, there is a scarcity of studies relating psychosocial work characteristics to possible reduction of excess sickness-absence rates. METHODS We aimed to estimate the potentially avoidable excess fraction of absence attributable to work-group psychosocial characteristics. We considered work-group averaged perception of psychosocial work characteristics as a proxy to the methodologically elusive objective assessment of organizational characteristics. Participants were recruited from multiple sites of a German automotive manufacturer with individuals nested within work groups. We predicted 12-month follow-up work-group sickness absence rates using data from a baseline comprehensive health examination assessing work characteristics, health behavior, and biomedical risk factors. We considered the quartile of work-groups yielding favorable psychosocial work characteristics as a realistic existing benchmark. Using the population attributable fraction method we estimated the potentially amenable sickness absence from improving work-group psychosocial characteristics. RESULTS Data from 3992 eligible participants from 29 work groups were analyzed (39% participation rate, average age 41.4 years (SD = 10.3 years), 89.9% males and 49% manual workers.). Work-group absence rates at follow up varied from 2.1 to 8.9% (mean 5.1%, 11.7 missed days). A prediction model of seven psychosocial work characteristics at the work group level explained 70% of the variance of future absence rates. The estimated reduction from improving psychosocial work characteristics to the benchmark level amounted to 32% of all sickness absence, compared to a 31% reduction from eliminating health behavioral and medical risk factors to the benchmark target. CONCLUSIONS Psychosocial characteristics at the work-group level account for a relevant proportion of all sickness absence. Health promotion interventions should therefore address psychosocial characteristics at the work group level.
Collapse
Affiliation(s)
- Joachim E Fischer
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Germany.
| | - Bernd Genser
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Germany
| | - Peter Nauroth
- HealthVision GmbH, Hans-Bunte-Str. 8-10, 69123, Heidelberg, Germany
| | - David Litaker
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Germany
| | - Daniel Mauss
- Mannheim Institute of Public Health, Mannheim Medical Faculty, University of Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Germany
| |
Collapse
|
16
|
Kernan G, Cifuentes M, Gore R, Kriebel D, Punnett L. A Corporate Wellness Program and Nursing Home Employees' Health. Front Public Health 2020; 8:531116. [PMID: 33194941 PMCID: PMC7664128 DOI: 10.3389/fpubh.2020.531116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Many employed Americans suffer from chronic conditions like obesity, diabetes, and cardiovascular diseases. Worksite wellness programs provide opportunities to introduce health promotion strategies. While there is evidence of the effectiveness of workplace health promotion, this is tempered by concern that benefits may be less available to low-wage workers with inflexible working conditions. Objective: The aim was to evaluate a workplace health promotion (WHP) in the long-term care sector (skilled nursing facilities). Methods: Nursing home employees from 18 facilities within a single company were surveyed by a standardized, self-administered questionnaire. A company-sponsored WHP program was offered to the facilities, which were free to take it up or not. We categorized the facilities by level of program adoption. Cross-sectional associations were estimated between program category and prevalence of individual-level worker health indicators, adjusting for center-level working conditions. Results: A total of 1,589 workers in 5 job categories completed the survey. Average levels of psychological demands and social support at work were relatively high. Supervisor support stood out as higher in centers with well-developed WHP programs, compared to centers with no programs. There were no differences among program levels for most health outcomes. Workers in centers with well-developed programs had slightly lower average body mass index and (unexpectedly) slightly lower prevalence of non-smoking and regular aerobic exercise. Conclusions: Only small health benefits were observed from well-developed programs and working conditions did not appear to confound the negative results. This low-intensity, low-resourced workplace health promotion program may have benefited a few individuals but seems to have had only modest influence on average levels of the measured health indicators. Many nursing home employees experience obstacles to health behaviors; approaches that provide more environmental and economic supports for healthy behaviors, such as Total Worker Health®, may yield larger health benefits.
Collapse
Affiliation(s)
- Gabriela Kernan
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Manuel Cifuentes
- Department of Public Health, Regis College, Weston, MA, United States
| | - Rebecca Gore
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| | - David Kriebel
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Laura Punnett
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| |
Collapse
|
17
|
Kailasam M, Vankayalapati P, Hsann YM, Yang KS. Inter-rater reliability of a composite health promotion scoring system developed in Singapore. Singapore Med J 2020; 63:93-96. [PMID: 32668836 DOI: 10.11622/smedj.2020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In view of the important role that environment plays in improving population health, the implementation of health promotion programmes are recommended in living and working environments. Assessing the prevalence of such community health-promoting practices is important for identifying gaps and making continuous and tangible improvements to health-promoting environments. We aimed to evaluate the inter-rater reliability of a composite scorecard used to assess the prevalence of community health-promoting practices in Singapore. METHODS Inter-rater reliability for the use of the composite health promotion scorecards was evaluated in eight residential zones in the western region of Singapore. Three raters were involved in the assessment and each zone was evaluated by two raters. Health-promoting practices in residential zones were assessed based on 44 measurable elements under five domains - community support and resources, healthy behaviours, chronic conditions, mental health and common medical emergencies - in the composite scorecard using weighted kappa. The strength of agreement was determined based on Landis and Koch's classification method. RESULTS A high degree of agreement (almost perfect-to-perfect) was seen between both raters for the measurable elements from most domains and subdomains. An exception was observed for the community support and resources domain, where there was a lower degree of agreement between the raters for a couple of elements. CONCLUSION The composite scorecard demonstrated a high degree of reliability and yielded similar scores for the same residential zone, even when used by different raters.
Collapse
Affiliation(s)
| | | | - Yin Maw Hsann
- Epidemiology, Ng Teng Fong General Hospital, Singapore
| | | |
Collapse
|
18
|
Nathan N, Murawski B, Hope K, Young S, Sutherland R, Hodder R, Booth D, Toomey E, Yoong SL, Reilly K, Tzelepis F, Taylor N, Wolfenden L. The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144998. [PMID: 32664554 PMCID: PMC7400238 DOI: 10.3390/ijerph17144998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
Abstract
There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed.
Collapse
Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- Correspondence:
| | - Beatrice Murawski
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kirsty Hope
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Sarah Young
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rebecca Hodder
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, University Road, Galway H91 TK33, Ireland;
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council New South Wales, 153 Dowling St, Woolloomooloo, NSW 2011, Australia;
- School of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Longworth Avenue, Wallsend, NSW 2287, Australia; (S.Y.); (R.S.); (R.H.); (S.L.Y.); (K.R.); (F.T.); (L.W.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (B.M.); (K.H.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| |
Collapse
|
19
|
Roemer EC. The Evolution of Organizational Health Scorecards and Future Directions. Am J Health Promot 2020; 34:326-332. [DOI: 10.1177/0890117119898026f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
20
|
Grossmeier J, Calitz C, Pham K, Lang JE, Mummert A, Roemer EC, Kent KB, Koffman DM, Goetzel RZ, Rosenbaum E, Imboden M, Noeldner S, Martin S, Picarella R, Pitts JS. The Art of Health Promotion: linking research to practice. Am J Health Promot 2020; 34:316-332. [PMID: 31997654 DOI: 10.1177/0890117119898026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Jones D, Molitor D, Reif J. What do Workplace Wellness Programs do? Evidence from the Illinois Workplace Wellness Study. THE QUARTERLY JOURNAL OF ECONOMICS 2019; 134:1747-1791. [PMID: 31564754 PMCID: PMC6756192 DOI: 10.1093/qje/qjz023] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Workplace wellness programs cover over 50 million U.S. workers and are intended to reduce medical spending, increase productivity, and improve well-being. Yet limited evidence exists to support these claims. We designed and implemented a comprehensive workplace wellness program for a large employer and randomly assigned program eligibility and financial incentives at the individual level for nearly 5,000 employees. We find strong patterns of selection: during the year prior to the intervention, program participants had lower medical expenditures and healthier behaviors than nonparticipants. The program persistently increased health screening rates, but we do not find significant causal effects of treatment on total medical expenditures, other health behaviors, employee productivity, or self-reported health status after more than two years. Our 95% confidence intervals rule out 84% of previous estimates on medical spending and absenteeism.
Collapse
|
22
|
Abstract
OBJECTIVE To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage. METHODS We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace. RESULTS A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and investigation. CONCLUSIONS Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight.
Collapse
|
23
|
Sedani A, Stover D, Coyle B, Wani RJ. Assessing Workplace Health and Safety Strategies, Trends, and Barriers through a Statewide Worksite Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2475. [PMID: 31336749 PMCID: PMC6678341 DOI: 10.3390/ijerph16142475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 11/16/2022]
Abstract
Chronic diseases have added to the economic burden of the U.S. healthcare system. Most Americans spend most of their waking time at work, thereby, presenting employers with an opportunity to protect and promote health. The purpose of this study was to assess the implementation of workplace health governance and safety strategies among worksites in the State of Nebraska, over time and by industry sector using a randomized survey. Weighted percentages were compared by year, industry sector, and worksite size. Over the three study periods, 4784 responses were collected from worksite representatives. Adoption of workplace health governance and planning strategies increased over time and significantly varied across industry sector groups. Organizational safety policies varied by industry sector and were more commonly reported than workplace health governance and planning strategies. Time constraints were the most common barrier among worksites of all sizes, and stress was reported as the leading employee health issue that negatively impacts business. Results suggest that opportunities exist to integrate workplace health and safety initiatives, especially in blue-collar industry sectors and small businesses.
Collapse
Affiliation(s)
- Ami Sedani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Derry Stover
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA.
| | - Brian Coyle
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA
| | - Rajvi J Wani
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA
| |
Collapse
|
24
|
Fiedler S, Pförtner TK, Nitzsche A, McKee L, Pfaff H. Health literacy of commercial industry managers: an exploratory qualitative study in Germany. Health Promot Int 2019; 34:5-15. [PMID: 28973222 DOI: 10.1093/heapro/dax052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Managers have been neglected in health literacy research. There still is little known about the health-literacy status and needs of commercial industry managers. This article reduces the existing knowledge gap by presenting findings of an exploratory qualitative study. We conducted 23 separate semi-structured interviews of managers from all management levels (low, middle and top) and experts in the field of health management and/or personnel management. The qualitative interviews were analysed according to Mayring's content analytic approach using MAXQDA. The findings indicate that managers do have considerable information levels about existing health topics and relevant problems but have difficulties of discernment as to which sources of information can be activated or accessed in a timely fashion due to work and information overload. Even those who devise strategies often fail in implementing health-literate behavior. Experts and managers had fairly consistent views on the importance of health literacy among managers. Most agreed that mental health was neglected and that company conditions were important in influencing the ability to act in a way that promoted health literacy. The findings also show that strengthening of managerial self-perception, self-regulation and self-control, raising awareness and ability to take personal responsibility for one's own health, developing skills in handling large amounts of information and fostering open and trusting communication are all essential.
Collapse
Affiliation(s)
- Silja Fiedler
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), The University of Cologne, Medical Faculty, Cologne, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), The University of Cologne, Medical Faculty, Cologne, Germany
| | - Anika Nitzsche
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), The University of Cologne, Medical Faculty, Cologne, Germany
| | - Lorna McKee
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), The University of Cologne, Medical Faculty, Cologne, Germany
| |
Collapse
|
25
|
Song Z, Baicker K. Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial. JAMA 2019; 321:1491-1501. [PMID: 30990549 PMCID: PMC6484807 DOI: 10.1001/jama.2019.3307] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/06/2019] [Indexed: 12/14/2022]
Abstract
Importance Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs. Objective To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. Design, Setting, and Participants This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016. Interventions There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites. Main Outcomes and Measures Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites. Results Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance). Conclusions and Relevance Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term. Trial Registration ClinicalTrials.gov Identifier: NCT03167658.
Collapse
Affiliation(s)
- Zirui Song
- Harvard Medical School, Massachusetts General Hospital, Boston
| | - Katherine Baicker
- University of Chicago Harris School of Public Policy, Chicago, Illinois
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
| |
Collapse
|
26
|
Wolfenden L, Goldman S, Stacey FG, Grady A, Kingsland M, Williams CM, Wiggers J, Milat A, Rissel C, Bauman A, Farrell MM, Légaré F, Ben Charif A, Zomahoun HTV, Hodder RK, Jones J, Booth D, Parmenter B, Regan T, Yoong SL. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane Database Syst Rev 2018; 11:CD012439. [PMID: 30480770 PMCID: PMC6362433 DOI: 10.1002/14651858.cd012439.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Sharni Goldman
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanNSWAustralia2287
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Andrew Milat
- NSW Ministry of HealthCentre for Epidemiology and EvidenceNorth SydneyNSWAustralia2060
- The University of SydneySchool of Public HealthSydneyAustralia
| | - Chris Rissel
- Sydney South West Local Health DistrictOffice of Preventive HealthLiverpoolNSWAustralia2170
| | - Adrian Bauman
- The University of SydneySchool of Public HealthSydneyAustralia
- Sax InstituteThe Australian Prevention Partnership CentreSydneyAustralia
| | - Margaret M Farrell
- US National Cancer InstituteDivision of Cancer Control and Population Sciences/Implementation Sciences Team9609 Medical Center DriveBethesdaMarylandUSA20892
| | - France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)Université Laval2525, Chemin de la CanardièreQuebecQuebecCanadaG1J 0A4
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne ‐ Université LavalHealth and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR‐SUPPORT Unit of Québec2525, Chemin de la CanardièreQuebecQCCanadaG1J 0A4
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Benjamin Parmenter
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Tim Regan
- University of NewcastleThe School of PsychologyCallaghanAustralia
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | | |
Collapse
|
27
|
The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program. J Occup Environ Med 2018; 59:631-641. [PMID: 28594703 DOI: 10.1097/jom.0000000000001045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). METHODS NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. RESULTS The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. CONCLUSIONS Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.
Collapse
|
28
|
Effectiveness of a Type 2 Diabetes Screening Intervention in the Canadian Workplace. Can J Diabetes 2018; 42:493-499.e1. [PMID: 29555342 DOI: 10.1016/j.jcjd.2017.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is a lack of Canadian data concerning the effectiveness of diabetes interventions in the workplace. The objective of this study was to evaluate the effectiveness of Motivaction, a diabetes screening and education pilot program, in the workplace. METHODS The Motivaction program involves a voluntary web-based diabetes health-risk assessment, the Canadian Diabetes Risk Questionnaire (CANRISK), combined with an opportunity for those eligible (i.e. having diabetes or having a CANRISK score ≥21) to attend 2 on-site biometric screening meetings with a registered nurse and 4 educational sessions by telephone with a certified diabetes educator. Biometric data, as well as information about self-efficacy, lifestyle changes, productivity, well-being, mental health and program satisfaction, were collected at baseline and at 6 months. RESULTS Attendance at the initial and 6-month clinical visits included 293 people. At baseline, 21% were identified as having prediabetes (13%) or having diabetes (8%). Statistically significant reductions in glycated hemoglobin levels from baseline to the study's end were observed in those with prediabetes or diabetes. No statistically significant changes in glycated hemoglobin levels were observed in individuals with normal levels or in those at risk for diabetes at baseline. No statistical differences were observed in terms of productivity or mental health for the full population or across diabetes-risk categories. More than 90% of employees would recommend the Motivaction program to other employers. CONCLUSIONS This study provides a framework for future diabetes interventions in the workplace and demonstrates that workplace interventions may reduce employees' diabetes risk levels and are valued by employees.
Collapse
|
29
|
Karasick AS, Peik S. The American College of Preventive Medicine Policy Recommendations on Public Health Funding. Am J Prev Med 2017; 53:928-930. [PMID: 29051019 DOI: 10.1016/j.amepre.2017.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 12/01/2022]
Abstract
The American College of Preventive Medicine Policy Committee makes policy guidelines and recommendations on Preventive Medicine and Public Health topics for Public Health decision makers. After a review of the current evidence available in 2016, the College is providing policy recommendations designed to inform public health investment. The American College of Preventive Medicine advocates for policies that recognize the health and economic value of public health funding and promote investment in these vital capabilities. Shortfalls in public health infrastructure, particularly workforce funding, must be corrected to ensure lasting benefits. Contingency funding for public health emergencies should be established and fully funded to adequately respond to emerging threats.
Collapse
Affiliation(s)
- Andrew S Karasick
- Department of Preventive Medicine, Johns Hopkins University, Baltimore, Maryland;.
| | | |
Collapse
|
30
|
Sotos-Prieto M, Cash SB, Christophi CA, Folta S, Moffatt S, Muegge C, Korre M, Mozaffarian D, Kales SN. Rationale and design of feeding America's bravest: Mediterranean diet-based intervention to change firefighters' eating habits and improve cardiovascular risk profiles. Contemp Clin Trials 2017; 61:101-107. [PMID: 28710052 DOI: 10.1016/j.cct.2017.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/08/2017] [Accepted: 07/07/2017] [Indexed: 11/19/2022]
Abstract
Among US firefighters, cardiovascular disease is the leading cause of on-duty death. Poor diet contributes to this burden, but effective strategies to encourage healthy eating in the fire service are not established. "Feeding America's Bravest" motivates firefighters and their families to modify their food culture and reduce cardiometabolic risk profiles by adopting Mediterranean diet principles. Feeding America's Bravest is a cluster-randomized, controlled trial within the 44 stations of the Indianapolis Fire Department, including about 1000 firefighters. It compares a Mediterranean Diet Nutritional Intervention (MDNI) (group 1) vs. usual care (group 2) for 12months; followed by 12months of self-sustained continuation phase in the group 1 and cross-over to Mediterranean Diet Nutritional Intervention in group 2. Group 2 will receive the MDNI for 6months to test the efficacy of a shorter intervention followed by 6months of self-sustained phase. The intervention includes behavioral and environmental components. The primary outcome is 12-month change in Mediterranean diet score comparing group 1 vs. group 2; we will also assess 12- and 24-month change in group 1, and 6- and 12-month change in group 2, from baseline. Secondary outcomes are changes in body weight, body composition and other cardiometabolic risk markers; and correlations between self-reported dietary habits and biomarkers of dietary adherence. This innovative trial tests a novel worksite approach to introduce Mediterranean diet among US firefighters, through multi-pronged MDNI combining evidence-based behavior change strategies with economic incentives, family and peer support and environmental changes, informing recommendations for the US fire service and potentially other similar workforces. TRIAL REGISTRATION NUMBER NCT02941757.
Collapse
Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Department of Food Science and Nutrition, School of Applied Heath Sciences and Wellness, Ohio University, Athens, OH 45701, United States.
| | - Sean B Cash
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Costas A Christophi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., 3036 Lemesos, Cyprus.
| | - Sara Folta
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Steven Moffatt
- National Institute for Public Safety Health, IN 324 E New York Street, Indianapolis, IN 46204, United States.
| | - Carolyn Muegge
- National Institute for Public Safety Health, IN 324 E New York Street, Indianapolis, IN 46204, United States.
| | - Maria Korre
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States.
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States.
| |
Collapse
|
31
|
Buden JC, Dugan AG, Faghri PD, Huedo-Medina TB, Namazi S, Cherniack MG. Associations Among Work and Family Health Climate, Health Behaviors, Work Schedule, and Body Weight. J Occup Environ Med 2017; 59:588-599. [PMID: 28471768 PMCID: PMC5477673 DOI: 10.1097/jom.0000000000001049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Correctional employees exhibit elevated obesity rates. This study examines interrelations among health behaviors, health climate, body mass index (BMI), and work schedule. METHODS Using survey results from correctional supervisors (n = 157), mediation and moderated-mediation analyses were performed to examine how health behaviors explain relationships between obesity, work health climate (WHC) and family health climate (FHC), and work schedule. RESULTS Over 85% of the sample was overweight/obese (mean BMI = 30.20). Higher WHC and FHC were associated with lower BMI, mediated by nutrition, and physical activity. The interaction effect between health behavior and work schedule revealed a protective effect on BMI. Overtime shift work may share a relationship with BMI. CONCLUSIONS Findings may have implications for reexamining organizational policies on maximum weekly overtime in corrections. They provide direction for targeted obesity interventions that encourage a supportive FHC and promote healthy behaviors among supervisors working overtime.
Collapse
Affiliation(s)
- Jennifer C. Buden
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | - Alicia G. Dugan
- Division of Occupational and Environmental Medicine, UConn Health Center, Farmington, CT
| | - Pouran D. Faghri
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT
| | | | - Sara Namazi
- Division of Occupational and Environmental Medicine, UConn Health Center, Farmington, CT
| | - Martin G. Cherniack
- Division of Occupational and Environmental Medicine, UConn Health Center, Farmington, CT
| |
Collapse
|
32
|
Zivin K, Sen A, Plegue MA, Maciejewski ML, Segar ML, AuYoung M, Miller EM, Janney CA, Zulman DM, Richardson CR. Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees. Am J Prev Med 2017; 52:347-352. [PMID: 27866825 DOI: 10.1016/j.amepre.2016.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/22/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. METHODS This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. RESULTS After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-$1,055.39 vs -$577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-$1,037.60 vs -$388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. CONCLUSIONS Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees.
Collapse
Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Ananda Sen
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michelle L Segar
- Sport, Health, Activity Research and Policy (SHARP) Center, University of Michigan, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Mona AuYoung
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Erin M Miller
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Carol A Janney
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Michigan State University College of Human Medicine, Midland, Michigan
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; Division of General Medical Disciplines, Stanford University, Stanford, California
| | - Caroline R Richardson
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| |
Collapse
|
33
|
Kilpatrick M, Blizzard L, Sanderson K, Teale B, Jose K, Venn A. Barriers and facilitators to participation in workplace health promotion (WHP) activities: results from a cross-sectional survey of public-sector employees in Tasmania, Australia. Health Promot J Austr 2017; 28:225-232. [DOI: 10.1071/he16052] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022] Open
|
34
|
Effect of Workplace Weight Management on Health Care Expenditures and Quality of Life. J Occup Environ Med 2016; 58:1073-1078. [DOI: 10.1097/jom.0000000000000864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
35
|
Klatt MD, Sieck C, Gascon G, Malarkey W, Huerta T. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention. Complement Ther Med 2016; 27:139-44. [DOI: 10.1016/j.ctim.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/12/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022] Open
|
36
|
Pasos Saludables: A Pilot Randomized Intervention Study to Reduce Obesity in an Immigrant Farmworker Population. J Occup Environ Med 2016; 57:1039-46. [PMID: 26461858 DOI: 10.1097/jom.0000000000000535] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate a workplace-based diet and physical activity intervention to reduce obesity in a Latino farmworker population. METHODS 254 Latino farmworkers were allocated in a 1:2 control:intervention ratio to parallel groups in this randomized controlled study, [Clinical Trial ID# NCT01855282]. Intervention participants attended 10 weekly educational sessions led by promotoras. All participants had anthropometry and lifestyle habits recorded before randomization and at follow-up after 12-14 weeks. RESULTS Seventy percent (n = 112 intervention and 66 control) completed the study. Intervention females (not controls) decreased the primary outcome measures of weight, BMI, and waist circumference (mean [95% CI]) of -0.7 [-1.3 to -0.1] kg, -0.3 [-0.4 to -0.2] and -0.9 [-1.7 to -0.1] cm, respectively. Intervention participants increased water consumption, fruit and vegetable servings, and moderate physical activity in a dose-dependent fashion. CONCLUSIONS The successful pilot workplace intervention offers a model to reach otherwise difficult-to-access Latino farmworkers.
Collapse
|
37
|
Beck AJ, Hirth RA, Jenkins KR, Sleeman KK, Zhang W. Factors Associated With Participation in a University Worksite Wellness Program. Am J Prev Med 2016; 51:e1-e11. [PMID: 26995315 DOI: 10.1016/j.amepre.2016.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 01/19/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Healthcare reform legislation encourages employers to implement worksite wellness activities as a way to reduce rising employer healthcare costs. Strategies for increasing program participation is of interest to employers, though few studies characterizing participation exist in the literature. The University of Michigan conducted a 5-year evaluation of its worksite wellness program, MHealthy, in 2014. MHealthy elements include Health Risk Assessment, biometric screening, a physical activity tracking program (ActiveU), wellness activities, and participation incentives. METHODS Individual-level data were obtained for a cohort of 20,237 employees who were continuously employed by the university all 5 years. Multivariate logistic regression was used to assess the independent predictive power of characteristics associated with participation in the Health Risk Assessment, ActiveU, and incentive receipt, including employee and job characteristics, as well as baseline (2008) healthcare spending and health diagnoses obtained from claims data. Data were collected from 2008 to 2013; analyses were conducted in 2014. RESULTS Approximately half of eligible employees were MHealthy participants. A consistent profile emerged for Health Risk Assessment and ActiveU participation and incentive receipt with female, white, non-union staff and employees who seek preventive care among the most likely to participate in MHealthy. CONCLUSIONS This study helps characterize employees who choose to engage in worksite wellness programs. Such information could be used to better target outreach and program content and reduce structural barriers to participation. Future studies could consider additional job characteristics, such as job type and employee attitudinal variables regarding health status and wellness program effectiveness.
Collapse
Affiliation(s)
- Angela J Beck
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Richard A Hirth
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Kathryn K Sleeman
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
38
|
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.
Collapse
|
39
|
Gray BJ, Bracken RM, Turner D, Long SJ, Thomas M, Williams SP, Davies CA, Morgan K, Williams M, Rice S, Stephens JW. A workplace-based risk assessment improves predicted lifetime cardiovascular disease risk in male steelworkers. Public Health 2016; 138:160-3. [PMID: 27132069 DOI: 10.1016/j.puhe.2016.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- B J Gray
- Policy, Research and International Development, Public Health Wales, Cardiff, UK.
| | - R M Bracken
- Diabetes Research Group, College of Medicine, Swansea University, Singleton Park, Swansea, UK; Applied Sports Technology Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Swansea University (Bay Campus), Swansea, UK
| | - D Turner
- RedBull North America, Santa Monica, CA, USA
| | - S J Long
- Policy, Research and International Development, Public Health Wales, Cardiff, UK
| | - M Thomas
- Public Health Wales, Carmarthen, Carmarthenshire, UK
| | - S P Williams
- TATA Steel Packaging Recycling, Trostre, Llanelli, Carmarthenshire, UK
| | - C A Davies
- TATA Steel Packaging Recycling, Trostre, Llanelli, Carmarthenshire, UK
| | - K Morgan
- Hywel Dda Health Board, Prince Philip Hospital, Llanelli, Carmarthenshire, UK
| | - M Williams
- Hywel Dda Health Board, Prince Philip Hospital, Llanelli, Carmarthenshire, UK
| | - S Rice
- Hywel Dda Health Board, Prince Philip Hospital, Llanelli, Carmarthenshire, UK
| | - J W Stephens
- Diabetes Research Group, College of Medicine, Swansea University, Singleton Park, Swansea, UK
| |
Collapse
|
40
|
Kilpatrick M, Blizzard L, Sanderson K, Teale B, Nelson M, Chappell K, Venn A. Investigating Employee-Reported Benefits of Participation in a Comprehensive Australian Workplace Health Promotion Program. J Occup Environ Med 2016; 58:505-13. [DOI: 10.1097/jom.0000000000000713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Jarman L, Martin A, Venn A, Otahal P, Sanderson K. Does workplace health promotion contribute to job stress reduction? Three-year findings from Partnering Healthy@Work. BMC Public Health 2015; 15:1293. [PMID: 26703459 PMCID: PMC4690240 DOI: 10.1186/s12889-015-2625-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/16/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Workplace health promotion (WHP) has been proposed as a preventive intervention for job stress, possibly operating by promoting positive organizational culture or via programs promoting healthy lifestyles. The aim of this study was to investigate whether job stress changed over time in association with the availability of, and/or participation in a comprehensive WHP program (Healthy@Work). METHOD This observational study was conducted in a diverse public sector organization (~28,000 employees). Using a repeated cross-sectional design with models corroborated using a cohort of repeat responders, self-report survey data were collected via a 40 % employee population random sample in 2010 (N = 3406) and 2013 (N = 3228). Outcomes assessed were effort and reward (self-esteem) components of the effort-reward imbalance (ERI) measure of job stress. Exposures were availability of, and participation in, comprehensive WHP. Linear mixed models and Poisson regression were used, with analyses stratified by sex and weighted for non-response. RESULTS Higher WHP availability was positively associated with higher perceived self-esteem among women. Women's mean reward scores increased over time but were not statistically different (p > 0.05) after 3 years. For men, higher WHP participation was associated with lower perceived effort. Men's mean ERI increased over time. Results were supported in the cohort group. CONCLUSIONS For women, comprehensive WHP availability contributed to a sense of organizational support, potentially impacting the esteem component of reward. Men with higher WHP participation also benefitted but gains were modest over time and may have been hindered by other work environment factors.
Collapse
Affiliation(s)
- Lisa Jarman
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, TAS, Australia
| | - Angela Martin
- Tasmanian School of Business and Economics, University of Tasmania, Hobart, 7000, TAS, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, TAS, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, TAS, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, TAS, Australia.
| |
Collapse
|
42
|
Jacobson RM, Isham GJ, Finney Rutten LJ. Population Health as a Means for Health Care Organizations to Deliver Value. Mayo Clin Proc 2015; 90:1465-70. [PMID: 26410573 DOI: 10.1016/j.mayocp.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | | | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| |
Collapse
|
43
|
Robbins R, Wansink B. Employee health codes of conduct: what would they look like and who wants to accept them? INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2015. [DOI: 10.1108/ijwhm-01-2014-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Most workplace health promotion efforts have failed to consistently and sustainably encourage employees to take responsibility for their health. The purpose of this paper is to explore a potentially high-impact solution – Health Codes of Conduct – for engaging and motivating employees to assume responsibility for their health.
Design/methodology/approach
– This mixed methods study draws on interview and survey methodology with a sample of 149 working adults to examine the feasibility of Health Codes of Conduct. Descriptive and inferential statistics are calculated to understand reactions, characteristics of the companies likely to support the idea, and components of a Health Code of Conduct.
Findings
– Nearly all employees offered moderate to high support for Health Codes of Conduct; this included overweight but not obese employees. Additionally, all demographic groups either moderately or strongly supported the policy when they included either monetary incentives (such as prescription discounts) or often overlooked non-monetary incentives (such as employee recognition). Some of the more popular features of Health Codes of Conduct included annual physical exams, exercise routines, and simply being encouraged to stay home when ill.
Research limitations/implications
– Health Codes of Conduct offer a surprisingly well-supported potential solution. Favorable reactions were observed across all examined segments of workers, even overweight (but not obese) employees. Using the specific features of Health Codes identified here, visionary companies can tailor their company’s Health Code of Conduct with the appropriate monetary and non-monetary incentives and disincentives.
Social implications
– What if the workplace could be a positive source of health and empowerment for valued employees? The authors show employee Health Codes of Conduct could be this empowering, engaging solution that has been missing.
Originality/value
– This paper is the first to propose the concept Health Codes of Conduct and solicit feedback from employees on this novel idea. Furthermore, the authors identify both the monetary and non-monetary incentives and disincentives that employees believe would be most compelling.
Collapse
|
44
|
Health Care Expenditures for University and Academic Medical Center Employees Enrolled in a Pilot Workplace Health Partner Intervention. J Occup Environ Med 2015; 57:897-903. [PMID: 26247644 DOI: 10.1097/jom.0000000000000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of a pilot workplace health partner intervention delivered by a predictive health institute to university and academic medical center employees on per-member, per-month health care expenditures. METHODS We analyzed the health care claims of participants versus nonparticipants, with a 12-month baseline and 24-month intervention period. Total per-member, per-month expenditures were analyzed using two-part regression models that controlled for sex, age, health benefit plan type, medical member months, and active employment months. RESULTS Our regression results found no statistical differences in total expenditures at baseline and intervention. Further sensitivity analyses controlling for high cost outliers, comorbidities, and propensity to be in the intervention group confirmed these findings. CONCLUSIONS We find no difference in health care expenditures attributable to the health partner intervention. The intervention does not seem to have raised expenditures in the short term.
Collapse
|
45
|
Rodriguez-Fernandez R, Rahajeng E, Viliani F, Kushadiwijaya H, Amiya RM, Bangs MJ. Non-communicable disease risk factor patterns among mining industry workers in Papua, Indonesia: longitudinal findings from the Cardiovascular Outcomes in a Papuan Population and Estimation of Risk (COPPER) Study. Occup Environ Med 2015; 72:728-35. [PMID: 26231573 PMCID: PMC4602234 DOI: 10.1136/oemed-2014-102664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 07/13/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Non-communicable diseases (NCDs) constitute an increasing slice of the global burden of disease, with the South-East Asia region projected to see the highest increase in NCD-related deaths over the next decade. Mining industry employees may be exposed to various factors potentially elevating their NCD risk. This study aimed to assess the distribution and 5-year longitudinal trends of key metabolic NCD risk factors in a cohort of copper-gold mining company workers in Papua, Indonesia. METHODS Metabolic indicators of NCD risk were assessed among employees (15 580 at baseline, 6496 prospectively) of a large copper-gold mining operation in Papua, Indonesia, using routinely collected 5-year medical surveillance data. The study cohort comprised individuals aged 18-68 years employed for ≥1 year during 2008-2013. Assessed risk factors were based on repeat measures of cholesterol, blood glucose, blood pressure and body weight, using WHO criteria. RESULTS Metabolic risk indicator rates were markedly high and increased significantly from baseline through 5-year follow-up (p<0.001). Adjusting for gender and age, longer duration of employment (≥10 years) predicted raised cholesterol (adjusted OR (AOR)=1.13, p=0.003), raised blood pressure (AOR=1.16, p=0.009) and overweight/obesity (AOR=1.14, p=0.001) at baseline; and persistent raised cholesterol (AOR=1.26, p=0.003), and both incident (AOR=1.33, p=0.014) and persistent raised blood glucose (AOR=1.62, p=0.044) at 3-year follow-up. CONCLUSIONS Individuals employed for longer periods in a mining operations setting in Papua, Indonesia, may face elevated NCD risk through various routes. Workplace health promotion interventions and policies targeting modifiable lifestyle patterns and environmental exposures present an important opportunity to reduce such susceptibilities and mitigate associated health risks.
Collapse
Affiliation(s)
- Rodrigo Rodriguez-Fernandez
- Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia NCD Asia Pacific Alliance, Tokyo, Japan
| | - Ekowati Rahajeng
- Non-Communicable Disease Control, Ministry of Health, Jakarta, Indonesia
| | - Francesca Viliani
- Public Health Consulting Services and Community Health, International SOS, Copenhagen, Denmark
| | - Haripurnomo Kushadiwijaya
- Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia Faculty of Medicine, Department of Public Health, Gadjah Mada University, Yogyakarta, Indonesia
| | - Rachel M Amiya
- NCD Asia Pacific Alliance, Tokyo, Japan Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michael J Bangs
- Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia
| |
Collapse
|
46
|
Chae D, Kim S, Park Y, Hwang Y. The Effects of an Academic--Workplace Partnership Intervention to Promote Physical Activity in Sedentary Office Workers. Workplace Health Saf 2015; 63:259-66. [PMID: 26012515 DOI: 10.1177/2165079915579576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the effect of an academic-workplace partnership intervention, "3,000 more steps," on improving physical activity (PA) and body composition of workers, and compare the characteristics of those workers who completed and did not complete the program. Participants were 70 sedentary office workers from an airline company. Pedometers determined their daily steps, and body composition was compared before and after the 8-week intervention; 39 of 70 (55.7%) participants completed the program. Daily steps increased from 5,811 to 9,240, and fat mass, waist-hip ratio, and body mass index (BMI) decreased for the completers. Non-completers had lower average PA and higher average fat mass at baseline than did completers. Overall, a workplace PA program could be successfully undertaken by occupational health nurses and a research team in partnership. However, to implement a cost-effective intervention program for inactive workers, further research is needed to ascertain why some workers do not complete the program.
Collapse
|
47
|
Cahalin LP, Kaminsky L, Lavie CJ, Briggs P, Cahalin BL, Myers J, Forman DE, Patel MJ, Pinkstaff SO, Arena R. Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease. Prog Cardiovasc Dis 2015; 58:94-101. [PMID: 25936908 DOI: 10.1016/j.pcad.2015.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs.
Collapse
Affiliation(s)
- Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
| | - Leonard Kaminsky
- Human Performance Laboratory, Clinical Exercise Physiology Program, Ball State University, Muncie, IN
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA
| | | | | | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Healthcare System, Palo Alto, CA
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mahesh J Patel
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC
| | - Sherry O Pinkstaff
- Department of Physical Therapy, University of North Florida, Jacksonville, FL
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL
| |
Collapse
|
48
|
|
49
|
Plotnikoff R, Collins CE, Williams R, Germov J, Callister R. Effectiveness of Interventions Targeting Health Behaviors in University and College Staff: A Systematic Review. Am J Health Promot 2015; 29:e169-87. [PMID: 24720391 DOI: 10.4278/ajhp.130619-lit-313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. Evaluate the literature on interventions targeting tertiary education staff within colleges and universities for improvements in health behaviors such as physical activity, dietary intake, and weight loss. Data Source. One online database, Medline, was searched for literature published between January 1970 and February 2013. Study Inclusion and Exclusion Criteria. All quantitative study designs, including but not limited to randomized controlled trials, quasi-experimental studies, nonrandomized experimental trials, cohort studies, and case-control studies, were eligible. Data Extraction. Data extraction was performed by one reviewer using a standardized form developed by the researchers. Extraction was checked for accuracy and consistency by a second reviewer. Data Synthesis. Data in relation to the above objective were extracted and described in a narrative synthesis. Results. Seventeen studies were identified that focused on staff within the tertiary education setting. The review yielded overall positive results with 13 reporting significant health-related improvements. Weight loss, physical activity and fitness, and/or nutrition were the focus in more than half (n = 9) of the studies. Conclusion. This appears to be the first review to examine health interventions for tertiary education staff. There is scope to enhance cross-disciplinary collaboration in the development and implementation of a “Healthy University” settings–based approach to health promotion in tertiary education workplaces. Universities or colleges could serve as a research platform to evaluate such intervention strategies.
Collapse
|
50
|
Caloyeras JP, Liu H, Exum E, Broderick M, Mattke S. Managing manifest diseases, but not health risks, saved PepsiCo money over seven years. Health Aff (Millwood) 2015; 33:124-31. [PMID: 24395944 DOI: 10.1377/hlthaff.2013.0625] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo's wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.
Collapse
|