Reliability and validity testing of the CDC Worksite Health ScoreCard: an assessment tool to help employers prevent heart disease, stroke, and related health conditions

Using CDC’s Worksite Health ScoreCard to Evaluate Nutrition and Physical Activity Interventions in Priority Communities in New York State, 2015–2020

The aim of our study was to evaluate a statewide obesity prevention program, designed to improve two social determinants of health (access to healthy foods and opportunities for physical activity) by changing worksite policies, systems, and environments. We used data on social determinants of health to identify priority communities and funded 25 contractors to recruit and engage worksites in those communities. We employed a pre/post quasi-experimental design and used the Centers for Disease Control and Prevention’s Worksite Health ScoreCard to assess implementation of nutrition and physical activity strategies. Contractors collaborated with partners to conduct pre- and postassessments at 313 worksites. Worksites were successful at implementing all except one strategy; implementation doubled for eight strategies and tripled for three. We used weighted scores to incorporate strength of the evidence-base and level of impact into our analysis; increases in strategy implementation were statistically significant in worksites that provided places to purchase food and beverages and in those that did not. Our study revealed several important recommendations for practice. Use available data to prioritize communities experiencing health disparities and identify PSE change strategies to increase access to nutritious foods and physical activity opportunities. Engage with reputable community-based partners from different sectors when designing and implementing programs. Use standardized tools, such as the Worksite Health ScoreCard, to evaluate public health initiatives.

Development and validation of the Health-Friendly Activity Index: an assessment tool to comprehensively measure health-friendly activities of corporations or organisations

OBJECTIVES

We developed the Health-Friendly Activity Index (HFAI) to comprehensively measure the health-friendly activities of corporations or organisations. We validated the developed tool and reported on its use as an assessment tool to improve consumers' health-related outcomes.

DESIGN

This was a cross-sectional study.

SETTING

Development of the HFAI questionnaire followed a three-phase process: item generation, item construction and validation with field testing. Using relevance and feasibility criteria, we developed a 105-item questionnaire with six domains (Governance and Infrastructure, Needs Assessment, Planning, Implementation, Monitoring and Feedback, and Outcomes).

PARTICIPANTS

To assess the sensitivity and validity of the questionnaire, the HFAI and Contribution Assessment Tool for Consumer's Health (CATCH) were administered to 302 participants (151 employers and 151 employees) from 151 Korean companies.

PRIMARY OUTCOME MEASURES

The CATCH measured the contribution of each company to the physical, mental, social and spiritual health of its consumers. To estimate the reliability and validity of all six HFAI domains and their respective scales, Cronbach's α coefficients and correlation coefficients were used.

RESULTS

Each domain and scale of the HFAI exhibited a Cronbach's α coefficient between 0.80 and 0.98 for the employers and employees. The overall HFAI and its six domains correlated significantly and positively with all health outcomes such as physical, mental, social and spiritual status scores evaluated using the CATCH (Spearman's correlation range: 0.37-0.68).

CONCLUSION

The HFAI, a unique assessment tool with acceptable psychometric properties, can help corporate managers assess their health-friendly activities.

Using the CDC Worksite Health ScoreCard to Promote Organizational Change

PURPOSE

To measure the impact of tying adoption of evidence-based worksite health promotion (WHP) interventions to annual organizational strategic objectives, as measured by the Centers for Disease Control and Prevention (CDC) Worksite Health ScoreCard (ScoreCard).

DESIGN

A prospective cohort study following Johns Hopkins Medicine (JHM) affiliates against industry-specific and large employer benchmarks from 2016-2020.

SETTINGS

JHM, the largest private employer in Maryland with facilities in Florida and the District of Columbia.

SUBJECTS

Twelve JHM affiliates representing over 40,000 employees.

INTERVENTION

A strategic objective was established annually based on the ScoreCard and organizational priorities.

MEASURES

JHM affiliates measured their WHP efforts annually using the ScoreCard. CDC industry-specific and large employer benchmarks were collected for comparison.

ANALYSIS

ScoreCard data was assessed annually to measure deviations from CDC benchmarks, determine whether strategic objectives were met, and inform additional annual objectives.

RESULTS

JHM demonstrated improvement from 8.9 percentage points above industry-specific and 3.4 percentage points below large employer benchmarks in 2016, to 26.4 percentage points above industry-specific and 21.8 percentage points above large employer benchmarks in 2020.

CONCLUSION

Large employers face unique challenges in implementing WHP programs. Our study suggests embedding health promotion in annual strategic objectives may alleviate these challenges by prioritizing the goal and ensuring adequate resources to be successful. There are however, some limitations on using benchmarking data for comparison.

Degree of Integration Between Occupational Safety and Health Programs and Wellness Programs: First-year Results From an Insurer-Sponsored Wellness Grant for Smaller Employers

OBJECTIVE

The aim of this study was to describe levels of integration between occupational safety and health (OSH) and workplace wellness programs/practices/policies ("programs") among participants in an insurer-sponsored wellness grant program.

METHODS

We analyzed survey responses about year 1 of an insurer-sponsored grant to start a wellness program from 220 small- and medium-sized employers. Responses yielded 25 indicators of OSH-wellness integration, and 10 additional indicators to summarize multiple responses.

RESULTS

At least half of the employers (N = 220) reported some level of integration within five of seven categories of OSH-wellness integration. Employers sometimes considered ergonomics, safety, or substance exposure hazards while designing their wellness program (15%) or reduced such hazards to support their wellness program (24%). Few meaningful differences were observed by employer size.

CONCLUSIONS

Although high levels of integration were unusual, some degree of integration was common for most indicator categories.

Validity and Reliability of the Updated CDC Worksite Health ScoreCard

OBJECTIVE

The aim of this study was to evaluate the reliability and validity of the updated 2019 CDC Worksite Health ScoreCard (CDC ScoreCard), which includes four new modules.

METHODS

We pilot tested the updated instrument at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity, and refined the instrument for public distribution.

RESULTS

The mean question concurrence rate was 73.4%. Respondents reported the tool to be useful for assessing current workplace programs and planning future initiatives. On average, 43% of possible interventions included in the CDC ScoreCard were in place at the pilot sites.

CONCLUSION

The updated CDC ScoreCard is a valid and reliable tool for assessing worksite health promotion policies, educational and lifestyle counseling programs, environmental supports, and health benefits.

Health Promotion for Small Workplaces: A Community-Based Participatory Research Partnership

BACKGROUND

The majority of U.S. worksites are smaller worksites that often employ low-wage workers. Low-wage workers have limited access to, and participation in, workplace health promotion programs. Community-based participatory research (CBPR) has been identified as a key method to directly engage employers in identifying the health promotion needs of smaller workplaces. This article describes a four-phased process where CBPR was used to tailor a workplace health promotion program to meet the needs of a smaller workplace that employees low-wage workers. Outcomes of this program were measured and reported over time.

METHODS

The CBPR approach was based on the Social Ecological Model along with two additional health promotion models. Publicly available evidence-based tools were also used for this four-phased process which included the following: (a) initial program assessment, (b) program planning, (c) program implementation, and (d) program evaluation. Key strategies for developing a comprehensive workplace health promotion program guided the process.

FINDINGS

The workplace's capacity for promoting health among its employees was improved. There were sustainable improvements in the health interventions and organizational supports in place.

CONCLUSION/APPLICATION TO PRACTICE

A CBPR approach may be a way to build the capacity of smaller workplaces with low-wage employees to address the health promotion needs of their workforces. The use of publicly available strategies and tools which incorporate the social ecological determinants of health is of equal importance.

Inter-rater reliability of a composite health promotion scoring system developed in Singapore

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.

Tracking Changes in US Organizations' Workplace Health Promotion Initiatives: A Longitudinal Analysis of Performance Against Quality Benchmarks

PURPOSE

To examine changes in organizations' workplace health promotion (WHP) initiatives over time associated with repeated self-assessment using the Well Workplace Checklist (WWC).

DESIGN

Well Workplace Checklist data include a convenience sample of US organizations that selected to assess their performance against quality WHP benchmarks.

SETTING

Workplaces.

SUBJECTS

In total, 577 US organizations completed the WWC in 2 or more years from 2008 to 2015.

MEASURES

The WWC is a 100-item organizational assessment that measures performance against the original set of quality benchmarks that were established by the Wellness Council of America (WELCOA).

ANALYSIS

This study examined changes in overall WWC scores as well as 7 separate benchmark scores. Multilevel modeling was used to examine changes in scores associated with repeated assessments, controlling for the year of assessment and organizational characteristics.

RESULTS

There were significant increases in overall WWC scores (β = 2.93, P < .001) associated with the repeated WWC assessments, after controlling for organizational characteristics. All 7 benchmark scores had significant increases associated with reassessment. Compared to other benchmarks, operating plan (β = 6.18, P < .001) and evaluation (β = 4.91, P < .001) scores increased more with each reassessment.

CONCLUSION

Continued reassessment may represent more commitment to and investment in WHP initiatives which could lead to improved quality. Other factors that may positively influence changes in performance against benchmarks include company size, access to outside resources for WHP, and a history with implementing WHP.

Mental Health in the Workplace: A Call to Action Proceedings From the Mental Health in the Workplace-Public Health Summit

OBJECTIVE

The aim of the study was to declare a call to action to improve mental health in the workplace.

METHODS

We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers.

RESULTS

The Advisory Council narrowed the list of ideas to four priority projects.

CONCLUSIONS

The recommendations for action include developing a mental health in the workplace (1) "how to" guide, (2) scorecard, (3) recognition program, and (4) executive training.

The Stock Performance of American Companies Investing in a Culture of Health

Purpose:

We investigated the relationship between companies’ efforts to build internal (COH-INT) and external cultures of health (COH-EXT) and their stock performance.

Design:

We administered 2 surveys, which measure companies’ programs, policies, and supports for improving the health of their employees and communities. We then compared the companies’ stock performance to the Standard and Poor’s (S&P) 500 Index from January 2013 through August 2017.

Setting:

United States.

Participants:

Representatives from 17 publicly traded companies who completed the COH-INT survey, of whom 14 also completed the COH-EXT.

Measures:

Culture of health scores were dichotomized into high versus low for both surveys. Stock price data for all companies were gathered from public sources.

Analysis:

We constructed 5 stock portfolios: all 17 companies, high COH-INT, low COH-INT, high COH-EXT, and low COH-EXT companies. We examined total returns for each portfolio compared to the S&P 500.

Results:

High COH-INT companies’ stock price appreciated by 115% compared to the S&P benchmark (+69%), while low COH-INT companies appreciated only 43%. In contrast, high COH-EXT companies underperformed (+44%) when compared to the S&P 500 (+69%) and low COH-EXT companies (+89%).

Conclusion:

This study supports the view that employers’ efforts to build an internal culture of health is a sound business strategy. More research is needed, however, to establish whether a link exists between supporting healthy community initiatives and company stock performance.

Research Methodologies for Total Worker Health®: Proceedings From a Workshop

OBJECTIVE

There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs.

METHODS

Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise.

RESULTS

TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature.

CONCLUSIONS

This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.

Development and Validity Testing of the School Health Score Card

BACKGROUND

The objective of this study was to develop the School Health Score Card (SHSC) and validate its psychometric properties.

METHODS

The development of the SHSC questionnaire included 3 phases: item generation, construction of domains and items, and field testing with validation. To assess the instrument's reliability and validity, we recruited 15 middle schools and 15 high schools in the Republic of Korea.

RESULTS

We developed the SHSC questionnaire of 158 items categorized into 5 domains: (1) Governance and Infrastructure, (2) Need Assessment, (3) Planning, (4) Health Prevention and Promotion Program, and (5) Monitoring and Feedback. All SHSC domains and subdomains demonstrated acceptable reliability with good internal consistency. Each domain and subdomain except for "Planning" was associated significantly with students' health status. Most subdomains, including school health philosophy, school policy, communication, the evaluation system, and monitoring, were significantly and negatively associated with student absence.

CONCLUSIONS

The SHSC shows significant association with the overall student health and can be useful in assessing comprehensive school health programs.

Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements

OBJECTIVE

To identify and evaluate the evidence base for culture of health elements.

DATA SOURCE

Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements.

STUDY INCLUSION AND EXCLUSION CRITERIA

Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors.

DATA EXTRACTION

Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted.

DATA SYNTHESIS

Data synthesis focused on research approach and design as well as culture of health elements evaluated.

RESULTS

The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome.

CONCLUSIONS

A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.

Health Promotion at the Construction Work Site: The Lunch Truck Pilot Study

The transient nature of construction work makes it difficult to conduct longitudinal worksite-based health promotion activities. As part of a workplace health assessment pilot study, we worked with a commercial lunch truck company to disseminate four types of health education materials including cancer screening, workplace injury prevention, fruit and vegetable consumption, and smoking cessation to construction workers purchasing food items from the truck during their job breaks. Two weeks following the worksite assessment, we followed up with these workers to ascertain their use of the health promotion materials. Of the 54 workers surveyed, 83% reported reviewing and sharing the cancer screening materials with their families, whereas 44% discussed the cancer screening materials with coworkers. Similar proportions of workers reviewed, shared, and discussed the other health promotion materials with their family. Lunch trucks may be an effective strategy and delivery method for educating construction workers on healthy behaviors and injury prevention practices.

Employee Health Behaviors, Self-Reported Health Status, and Association With Absenteeism: Comparison With the General Population

OBJECTIVES

To perform a comparison between health behaviors and health status of employees with those of the general population, to evaluate the association between employee health behaviors, health status, and absenteeism.

METHODS

Cross-sectional study enrolled 2433 employees from 16 Korean companies in 2014, and recruited 1000 general population randomly in 2012. The distribution of employee health behaviors, health status, and association with absenteeism were assessed.

RESULTS

Employees had significantly worse health status and low rates of health behaviors maintenance compared with the general population. Multiple logistic regression model revealed that regular exercise, smoking cessation, work life balance, proactive living, religious practice, and good physical health status were associated with lower absenteeism.

CONCLUSIONS

Maintaining health behaviors and having good health status were associated with less absenteeism. This study suggests investment of multidimensional health approach in workplace health and wellness (WHW) programs.

Development and Validity Testing of the Worksite Health Index: An Assessment Tool to Help and Improve Korean Employees' Health-Related Outcome

OBJECTIVES

The objective of this study was to develop the Worksite Health Index (WHI) and validate its psychometric properties.

METHODS

The development of the WHI questionnaire included item generation, item construction, and field testing. To assess the instrument's reliability and validity, we recruited 30 different Korean worksites.

RESULTS

We developed the WHI questionnaire of 136 items categorized into five domains, namely Governance and Infrastructure, Need Assessment and Planning, Health Prevention and Promotion Program, Occupational Safety, and Monitoring and Feedback. All WHI domains demonstrated a high reliability with good internal consistency. The total WHI scores differentiated worksite groups effectively according to firm size. Each domain was associated significantly with employees' health status, absence, and financial outcome.

CONCLUSIONS

The WHI can assess comprehensive worksite health programs. This tool is publicly available for addressing the growing need for worksite health programs.

Training Employers to Implement Health Promotion Programs: Results From the CDC Work@Health® Program

PURPOSE

Centers for Disease Control and Prevention (CDC) initiated the Work@Health Program to teach employers how to improve worker health using evidence-based strategies. Program goals included (1) determining the best way(s) to deliver employer training, (2) increasing employers' knowledge of workplace health promotion (WHP), and (3) increasing the number of evidence-based WHP interventions at employers' worksites. This study is one of the few to examine the effectiveness of a program designed to train employers how to implement WHP programs.

DESIGN

Pre- and posttest design.

SETTING

Training via 1 of 3 formats hands-on, online, or blended.

PARTICIPANTS

Two hundred six individual participants from 173 employers of all sizes.

INTERVENTION

Eight-module training curriculum to guide participants through building an evidence-based WHP program, followed by 6 to 10 months of technical assistance.

MEASURES

The CDC Worksite Health ScoreCard and knowledge, attitudes, and behavior survey.

ANALYSIS

Descriptive statistics, paired t tests, and mixed linear models.

RESULTS

Participants' posttraining mean knowledge scores were significantly greater than the pretraining scores (61.1 vs 53.2, P < .001). A year after training, employers had significantly increased the number of evidence-based interventions in place (47.7 vs 35.5, P < .001). Employers' improvements did not significantly differ among the 3 training delivery formats.

CONCLUSION

The Work@Health Program provided employers with knowledge to implement WHP interventions. The training and technical assistance provided structure, practical guidance, and tools to assess needs and select, implement, and evaluate interventions.

Comparing 2 National Organization-Level Workplace Health Promotion and Improvement Tools, 2013-2015

Creating healthy workplaces is becoming more common. Half of employers that have more than 50 employees offer some type of workplace health promotion program. Few employers implement comprehensive evidence-based interventions that reach all employees and achieve desired health and cost outcomes. A few organization-level assessment and benchmarking tools have emerged to help employers evaluate the comprehensiveness and rigor of their health promotion offerings. Even fewer tools exist that combine assessment with technical assistance and guidance to implement evidence-based practices. Our descriptive analysis compares 2 such tools, the Centers for Disease Control and Prevention's Worksite Health ScoreCard and Prevention Partners' WorkHealthy America, and presents data from both to describe workplace health promotion practices across the United States. These tools are reaching employers of all types (N = 1,797), and many employers are using a comprehensive approach (85% of those using WorkHealthy America and 45% of those using the ScoreCard), increasing program effectiveness and impact.

Worksite Food and Physical Activity Environments and Wellness Supports Reported by Employed Adults in the United States, 2013

PURPOSE

To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size.

DESIGN

Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA.

SETTING

Worksites in the United States.

PARTICIPANTS

A total of 2101 adults employed outside the home.

MEASURES

Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments.

ANALYSIS

Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size.

RESULTS

Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers.

CONCLUSION

Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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