Are workplace health promotion programmes effective for all socioeconomic groups? A systematic review

Precision prevention in worksite health-A scoping review on research trends and gaps

OBJECTIVES

To map the current state of precision prevention research in the workplace setting, specifically to study contexts and characteristics, and to analyze the precision prevention approach in the stages of risk assessment/data monitoring, data analytics, and the health promotion interventions implemented.

METHODS

Six international databases were searched for studies published between January 2010 and May 2023, using the term "precision prevention" or its synonyms in the context of worksite health promotion.

RESULTS

After screening 3,249 articles, 129 studies were reviewed. Around three-quarters of the studies addressed an intervention (95/129, 74%). Only 14% (18/129) of the articles primarily focused on risk assessment and data monitoring, and 12% of the articles (16/129) mainly included data analytics studies. Most of the studies focused on behavioral outcomes (61/160, 38%), followed by psychological (37/160, 23%) and physiological (31/160, 19%) outcomes of health (multiple answers were possible). In terms of study designs, randomized controlled trials were used in more than a third of all studies (39%), followed by cross-sectional studies (18%), while newer designs (e.g., just-in-time-adaptive-interventions) are currently rarely used. The main data analyses of all studies were regression analyses (44% with analyses of variance or linear mixed models), whereas machine learning methods (e.g., Algorithms, Markov Models) were conducted only in 8% of the articles.

DISCUSSION

Although there is a growing number of precision prevention studies in the workplace, there are still research gaps in applying new data analysis methods (e.g., machine learning) and implementing innovative study designs. In the future, it is desirable to take a holistic approach to precision prevention in the workplace that encompasses all the stages of precision prevention (risk assessment/data monitoring, data analytics and interventions) and links them together as a cycle.

A Semantic Approach to Describe Social and Economic Characteristics That Impact Health Outcomes (Social Determinants of Health): Ontology Development Study

BACKGROUND

Social determinants of health (SDoH) have been described by the World Health Organization as the conditions in which individuals are born, live, work, and age. These conditions can be grouped into 3 interrelated levels known as macrolevel (societal), mesolevel (community), and microlevel (individual) determinants. The scope of SDoH expands beyond the biomedical level, and there remains a need to connect other areas such as economics, public policy, and social factors.

OBJECTIVE

Providing a computable artifact that can link health data to concepts involving the different levels of determinants may improve our understanding of the impact SDoH have on human populations. Modeling SDoH may help to reduce existing gaps in the literature through explicit links between the determinants and biological factors. This in turn can allow researchers and clinicians to make better sense of data and discover new knowledge through the use of semantic links.

METHODS

An experimental ontology was developed to represent knowledge of the social and economic characteristics of SDoH. Information from 27 literature sources was analyzed to gather concepts and encoded using Web Ontology Language, version 2 (OWL2) and Protégé. Four evaluators independently reviewed the ontology axioms using natural language translation. The analyses from the evaluations and selected terminologies from the Basic Formal Ontology were used to create a revised ontology with a broad spectrum of knowledge concepts ranging from the macrolevel to the microlevel determinants.

RESULTS

The literature search identified several topics of discussion for each determinant level. Publications for the macrolevel determinants centered around health policy, income inequality, welfare, and the environment. Articles relating to the mesolevel determinants discussed work, work conditions, psychosocial factors, socioeconomic position, outcomes, food, poverty, housing, and crime. Finally, sources found for the microlevel determinants examined gender, ethnicity, race, and behavior. Concepts were gathered from the literature and used to produce an ontology consisting of 383 classes, 109 object properties, and 748 logical axioms. A reasoning test revealed no inconsistent axioms.

CONCLUSIONS

This ontology models heterogeneous social and economic concepts to represent aspects of SDoH. The scope of SDoH is expansive, and although the ontology is broad, it is still in its early stages. To our current understanding, this ontology represents the first attempt to concentrate on knowledge concepts that are currently not covered by existing ontologies. Future direction will include further expanding the ontology to link with other biomedical ontologies, including alignment for granular semantics.

Perceived Factors Influencing Blue-Collar Workers' Participation in Worksite Health Promotion Programs in Freight Transport: A Qualitative Investigation Using the TDF and COM-B

Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs.

Menopause knowledge and education in women under 40: Results from an online survey

BACKGROUND

All women experience the menopause, yet education around the topic is limited. Studies conducted in women aged over 40 show that women have limited knowledge about the menopause.

OBJECTIVES

This study aims to understand what women under 40 know about the menopause, how they have acquired this knowledge and where they think menopause education should be taught. This data will help to determine how to effectively deliver menopause education.

DESIGN

A survey was designed that asked women under 40 what they know of, and their attitudes to, the menopause, using Qualtrics XM software.

METHODS

The survey was advertised for 5 weeks on social media. Six questions related to menopause education were analysed. Responses between age groups under 20, 21-30 and over 30 were compared using a chi-square test. A thematic-style analysis was also conducted on a free-text question where answers referred to education.

RESULTS

A total of 738 women's responses were included in the analysis; over 80% had no knowledge or just some knowledge of the menopause. Women over 30 used official websites (p = 0.017) and scientific literature (p = 0.047) significantly more than other age groups to learn about the menopause, while women under 20 were more likely to learn from family members (p = 0.002). These women felt education should start in schools.

CONCLUSION

Many women under 40 have limited education of the menopause. Women under 20 are more passive in their approach to learning about the menopause compared with those over 30, who are more proactive. Menopause education strategies must start at school and extend beyond schools adopting a multifaceted approach; it is recommended that the workplace, social media and public health campaigns are used to deliver menopause education moving forward.

Changes in Fruit and Vegetable Consumption and Leisure Time Physical Exercise after a Citizen Science-Based Worksite Health Promotion Program for Blue-Collar Workers

Blue-collar workers have, on average, poorer health than white-collar workers. Existing worksite health promotion programs (WHPPs) are often not successful among blue-collar workers. This study evaluates the effect of the Citizen Science-based WHPP on the targeted lifestyle behaviors among construction workers. The data of 114 participants were retrieved from questionnaires before (T0) and after (T1) the WHPP. Outcome measures were mean and categorical changes in daily fruit and vegetable intake and weekly leisure time physical exercise. Changes were tested using Wilcoxon signed rank tests and McNemar tests. No statistically significant changes were found between T0 and T1. In total, 73.7% of the participants felt involved in the WHPP. Changes in the outcome measures were not significantly different between subgroups based on age, nor in subgroups based on feelings of involvedness. The low intensity of the developed program could be an explanation for this lack of significant change. Future studies using the Citizen Science approach in an occupational setting should aim at developing a more intensified program and should test its effectiveness by comparing changes in a (randomized) controlled trial.

Determinants of nutrition practice and food choice in UK construction workers

The workplace is considered an effective setting for health and wellbeing interventions, including programmes focusing on nutrition, and provides opportunities to tailor programmes to meet the specific needs of industry and employees. This study explored nutrition practices amongst construction workers and managers to inform the design of a nutrition intervention. Five focus groups were conducted on three construction sites: two with managers (n = 11) and three with workers (n = 27). Construction workers and managers identified several unhealthy nutrition-related behaviours, including high consumption of convenient and fast foods, excessive coffee, alcohol, energy drinks and low fruit and vegetable intake. These behaviours were often attributed to high workloads, long working hours and physically demanding jobs. Snacking and skipping meals were repeatedly reported, attributed to short breaks and poor accessibility to food outlets. The nutritional quality of meals differed between individuals (homemade vs fast food), depending on the type of sites (temporary vs permanent) and site location. Nutrition knowledge, establishing routines, meal planning and preparation were recognized as important in sustaining healthy nutrition habits. However, meal preparation depended on the facilities available, which differed between managers and workers, highlighting the complex relationship between the workplace context and eating behaviours. Construction workers were interested in learning about nutrition and improving their eating habits through nutrition intervention. However, they highlighted that better cooking and storage facilities on site, together with fewer job demands and longer break times, would enhance the sustainability of the intervention and their ability to make healthier food choices.

Perceptions of employees with a low and medium level of education towards workplace health promotion programmes: a mixed-methods study

BACKGROUND

Understanding the perceptions of lower socioeconomic groups towards workplace health promotion is important because they are underrepresented in workplace health promotion activities and generally engage in unhealthier lifestyle behaviour than high SEP groups. This study aims to explore interest in workplace health promotion programmes (WHPPs) among employees with a low and medium level of education regarding participation and desired programme characteristics (i.e. the employer's role, the source, the channel, the involvement of the social environment and conditions of participation).

METHODS

A mixed-methods design was used, consisting of a questionnaire study (n = 475) and a sequential focus group study (n = 27) to enrich the questionnaire's results. Multiple logistic regression analysis was performed to analyse the associations between subgroups (i.e. demographics, weight status) and interest in a WHPP. The focus group data were analysed deductively through thematic analysis, using MAXQDA 2018 for qualitative data analysis.

RESULTS

The questionnaire study showed that 36.8% of respondents were interested in an employer-provided WHPP, while 45.1% expressed no interest. Regarding subgroup differences, respondents with a low level of education were less likely to express interest in a WHPP than those with a medium level of education (OR = .54, 95%, CI = .35-.85). No significant differences were found concerning gender, age and weight status. The overall themes discussed in the focus groups were similar to the questionnaires (i.e. the employer's role, the source, the channel, the involvement of the social environment and conditions of participation). The qualitative data showed that participants' perceptions were often related to their jobs and working conditions.

CONCLUSIONS

Employees with a medium level of education were more inclined to be interested in a WHPP than those with a low level of education. Focus groups suggested preferences varied depending on job type and related tasks. Recommendations are to allow WHPP design to adapt to this variation and facilitate flexible participation. Future research investigating employers' perceptions of WHPPs is needed to enable a mutual understanding of an effective programme design, possibly contributing to sustainable WHPP implementation.

The process evaluation of a citizen science approach to design and implement workplace health promotion programs

BACKGROUND

Many workplace health promotion programs (WHPPs) do not reach blue-collar workers. To enhance the fit and reach, a Citizen Science (CS) approach was applied to co-create and implement WHPPs. This study aims to evaluate i) the process of this CS approach and ii) the resulting WHPPs.

METHODS

The study was performed in two companies: a construction company and a container terminal company. Data were collected by questionnaires, interviews and logbooks. Using the framework of Nielsen and Randall, process measures were categorized in the intervention, context and mental models. Interviews were transcribed and thematically coded using MaxQDA software.

RESULTS

The involvement in the CS approach and co-creating the WHPPs was positively experienced. Information provision, sustained engagement over time and alignment with the workplace's culture resulted in barriers in the CS process. As to the resulting WHPPs, involvement and interaction during the intervention sessions were particularly experienced in small groups. The reach was affected by the unfavorable planning off the WHPPs and external events of re-originations and the covid-19 pandemic.

DISCUSSION

Continuous information provision and engagement over time, better alignment with the workplace's culture and favorable planning are considered to be important factors for facilitating involvement, reach and satisfaction of the workers in a Citizen science approach to design and implement a WHPP. Further studies continuously monitoring the process of WHPPs using the CS approach could be helpful to anticipate on external factors and increase the adaptability.

CONCLUSIONS

Workers were satisfied with the involvement in WHPPs. Organizational and social cultural factors were barriers for the CS approach and its reach. Involvement and interaction in WHPPs were particularly experienced in small grouped sessions. Consequently, contextual and personal factors need be considered in the design and implementation of WHPPs with CS approach among blue-collar workers.

Shining the Light on You:

Objective

To design and assess the effectiveness of an evidence-based intervention to improve the health and wellbeing of family child care professionals.

Methods

The early care and education (ECE) workforce, and family child care (FCC) educators in particular, face challenges to their wellbeing, mental and physical health. In addition, the demographics of the FCC workforce – disproportionately composed of low-income women of color - are associated with higher risk for chronic diseases. The Shining the Light on You program is designed to address FCC professional wellbeing in a feasible, evidence-based manner. The program includes weekly virtual sessions co-facilitated by a Board-Certified Health and Wellness Coach (HWC) and a Technical Assistance Coach (Early Childhood Specialist) and three individual coaching sessions with the HWC. HWC is built upon a foundation of behavior change theories, motivational strategies and effective communication approaches from psychology, medicine, public health and related fields. Using a mixed methods approach to gather data, participants from three initial cohorts of the program (n=33) implemented in Delaware reported improvement in health and wellbeing indicators.

Results

Participants reported improvements in social support, physical activity and water consumption from pre- to post-program surveys. In interviews conducted with the participants following the program, participants consistently commented on the connections between all components of wellbeing and the importance of self-care.

Conclusions

This model demonstrates the potential of integrating best practices from HWC and the ECE system.

Betriebliche Absichten für gesundheitsförderliche Telearbeit nach dem COVID-19-Lockdown 2020

Hintergrund

Unternehmen mussten wegen der Pandemie im Frühjahr 2020 schnelle Lösungen für die Weiterarbeit – von zu Hause aus – finden. Die Arbeitsbedingungen zu Hause (Telearbeit) entsprechen nicht immer den Grundprinzipien und Qualitätskriterien der betrieblichen Gesundheitsförderung (BGF).

Fragestellung

Wie stark ist der Ansatz gesundheitsförderlicher Telearbeit (Arbeit im Homeoffice) in Betrieben verankert und was beeinflusst die strategische Etablierung und Nutzung unterstützender Materialien?

Material und Methoden

Theoretisch abgeleitete Hypothesen wurden operationalisiert und 1858 österreichische Betriebe zur Teilnahme an einer Online-Befragung eingeladen. Die Stichprobe (n = 192) repräsentiert einen breiten Mix aus Unternehmensgrößen, Sektoren und Regionen.

Ergebnisse

Betriebe variieren stark in der Absicht zukünftig gesundheitsförderliche Telearbeit umzusetzen. Ein Teil der Variation kann durch multivariate Pfadmodelle aufgeklärt werden, wobei die Verhaltenskontrolle und die sozialen Normen eine zentrale Rolle einnehmen. Erstere wird vom Grad der Vorbereitung auf Telearbeit und ihre Umsetzung im Unternehmen bestimmt. Insbesondere zeigt sich, dass die Telearbeitskultur und die ‑bereitschaft für die Stärke von sozialen Normen gegenüber der Umsetzung von Telearbeit verantwortlich sind.

Schlussfolgerung

Telearbeit wurde bisher zu wenig im Sinne einer ganzheitlichen BGF betrachtet. Eine derartige Umsetzung hängt stark von Unternehmensstrukturen und -prozessen, der Kultur und den Handlungsspielräumen der Entscheidungsträger ab. Betrieben wird empfohlen, Kompetenzen aufzubauen und sich am Konzept der Kapazitätsbildung zu orientieren.

Factors associated with the implementation of health-promoting telework from the perspective of company decision makers after the first COVID-19 lockdown

Aim

Owing to the COVID-19 pandemic, many companies shifted to telework, with few insights into its implementation, organisational conditions or the role of workplace health promotion and management. This study focused on a multifactorial investigation of conditions in companies which implemented and evaluated telework during the first lockdown in 2020 as well as on their future intentions to facilitate teleworking under health-promoting working conditions.

Subject and methods

The research hypotheses relate to an extended technology acceptance model. In a mixed-methods design, expert interviews were fed into the development of an online questionnaire. Out of 1858 contacted companies representing a broad range of Austrian businesses, 192 responses (general management, workplace health managers, etc.) were analysed using descriptive and multivariate statistics.

Results

The degree of implementation and claim to teleworking increased significantly during the first lockdown and did not return to pre-pandemic levels afterwards. Changes depended on preparation and experience: evaluation of teleworking and willingness to continue offering teleworking were conditional on preparation and the degree of implementation. Prerequisites for future intentions to implement health-promoting teleworking included readiness, general willingness and existing workplace health promotion/management structures.

Conclusion

This paper demonstrates the potential of health-promoting organisational cultures for development processes – particularly in times of crisis. Anchoring health-focused structures in companies helps to create health-promoting frameworks. Health-promoting teleworking can be developed from workplace health promotion/management using established approaches. It is essential to build on in-house capacities and competencies to develop awareness for a holistic culture for health-promoting (tele)work and to encourage deliberations about potential measures.

Stakeholder dialogue on dilemmas at work as a workplace health promotion intervention including employees with a low SEP: a Responsive Evaluation

Background

The aim of this study was to evaluate the perceived changes of an innovative workplace health promotion intervention and evaluation. In this study, a bottom-up approach was taken to define the central themes and relevant outcomes of an intervention. These central themes and relevant outcomes of the intervention were defined together with stakeholders, including employees with a low socioeconomic position.

Methods

The intervention consisted of a series of structured stakeholder dialogues in which dilemmas around the – by employees defined —health themes were discussed. The intervention was implemented in a harbor service provider with approximately 400 employees. Over a two-year period, 57 participants engaged in eight dialogues of one hour. 15 interviews and six participant observations took place for the evaluation of the intervention.

Results

Together with the stakeholders, high workload and mental health were defined as central themes for the dialogue intervention in the male-dominated workplace. The dialogue intervention contributed to changes, on different levels: individual, team, and organization. Overall, the stakeholder dialogues advanced the understanding of factors contributing to high workload and mental health. In reply to this, several actions were taken on a organizational level.

Conclusions

Taking a bottom-up approach in WHP allows to understand the health issues that are important in the daily reality of employees with a low socioeconomic position. Through this understanding, workplace health promotion can become more suitable and relevant for employees with a low socioeconomic position.

Trial registration

Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, Retrospectively registered https://www.trialregister.nl

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12802-z.

The Association Between Work Status and the Use of Healthcare Services Among Women in the Republic of Korea

Introduction

Previous studies on occupational health focussed predominately on the occurrence of occupational diseases. Relatively few studies have measured how employment is associated with the use of healthcare services. This study investigates the association between employment and the extent and range of healthcare use, such as medical expenditures, of women in South Korea.

Methods

We analyze data of the Korean Health Panel, an ongoing longitudinal national representative survey, from 2008 to 2017, to identify the status of economic activity of women by year and age group. We estimate the association between female employment status and medical expenditures by using random effect panel Tobit models. Furthermore, we investigate the association between employment status and the range of healthcare services in biomedicine and traditional Korean medicine (KM) by conducting conditional fixed-effects logistic regression analyses.

Results

For women aged between 25 and 65 in 2017, the majority of them were employed or self-employed. (The proportion of employment of self-employment equals 64.80%). In addition, working women spent 11.6% less on healthcare than nonworking women, and self-employment lowered the healthcare expenditure by 13.1%. Neither work nor the type of work is related to the types and range of healthcare service use. Being employed or self-employed is negatively associated with women’s expenditure on healthcare.

Conclusions

The findings show that employment is associated with less spending on healthcare. They imply that employment has a positive impact on women’s health.

Do Multicomponent Workplace Health and Wellbeing Programs Predict Changes in Health and Wellbeing?

Organizations typically deploy multiple health and wellbeing practices in an overall program. We explore whether practices in workplace health and wellbeing programs cohere around a small number of archetypal categories or whether differences between organizations are better explained by a continuum. We also examine whether adopting multiple practices predicts subsequent changes in health and wellbeing. Using survey data from 146 organizations, we found differences between organizations were best characterized by a continuum ranging from less to more extensive adoption of practices. Using two-wave multilevel survey data at both individual and organizational levels (N = 6968 individuals, N = 58 organizations), we found that, in organizations that adopt a wider range of health and wellbeing practices, workers with poor baseline psychological wellbeing were more likely to report subsequent improvements in wellbeing and workers who reported good physical health at baseline were less likely to report experiencing poor health at follow-up. We found no evidence that adopting multiple health and wellbeing practices buffered the impact of individuals’ workplace psychosocial hazards on physical health or psychological wellbeing.

Socio-economic inequalities in the effectiveness of workplace health promotion programmes on body mass index: An individual participant data meta-analysis

This individual participant data meta-analysis assessed the effectiveness of workplace health promotion programmes on body mass index (BMI) across socio-economic groups and whether study and intervention characteristics explained inequalities in effectiveness. Studies were eligible if they assessed the effect of a workplace health promotion programme on BMI in the Netherlands, included workers of at least two different socio-economic positions (SEPs) and had a study design with premeasurement and postmeasurement and control condition. Data of 13 studies presenting 16 interventions (5183 participants) were harmonized. In a two-stage meta-analysis, the interaction between intervention and SEP on BMI was tested with linear mixed models for each study. Subsequently, the interaction terms were pooled. The influence of study and intervention characteristics on the effectiveness of workplace health promotion programmes was evaluated using meta-regression analyses. Compared with control conditions, workplace health promotion programmes overall showed a statistically non-significant 0.12 kg/m2 (95% CI: -0.01, 0.25) decrease in BMI, which did not differ across SEP. Interventions evaluated within randomized controlled trials, agentic interventions, those that focused on high-risk groups, included a counselling component, consisted of more than five sessions, or were offered at the individual level did statistically significantly reduce BMI. No evidence was found for intervention-generated SEP inequalities.

Does Dialogue Improve the Sustainable Employability of Low-Educated Employees? A Study Protocol for an Effect and Process Evaluation of "Healthy HR"

Background: There is a need to develop sustainable employability (SE) interventions that are better aligned to the needs of low-educated employees. This group needs to get a voice in intervention development and implementation. In this study, a dialogue-based approach is proposed consisting of an online step-by-step support toolkit for employers, "Healthy Human Resources" (HHR). When intervening, this toolkit enables and stimulates employers to have a continuous dialogue with their low-educated employees. By improving the employees' job control, HHR is aimed at cost-beneficially improving SE. This paper describes the protocol of the evaluation study to evaluate the effectiveness and implementation process of HHR on the SE of low-educated employees. Methods: The protocol of the evaluation study consists of: (1) an effect evaluation with a pretest-posttest design with a 1-year follow-up in five work organizations in the Netherlands deploying low-educated employees and with SE as the primary outcome and job control as the secondary outcome. The effect evaluation is expanded with a budget impact analysis; (2) a mixed-method process evaluation at 6 and 12 months after the start of HHR to evaluate the whole implementation process of HHR. This includes the experiences with HHR of various stakeholders, such as employees, human resource managers, and line managers. Discussion: The effect evaluation will give insight into the effects of HHR on the SE of low-educated employees. The process evaluation will provide insight into the underlying mechanisms of the (in) effectiveness of HHR. By improving dialogue, we hypothesize that HHR, through enhancing job control, will strengthen the SE of low-educated employees. Also for helping with tackling the socioeconomic health gap, if proven effective, the implementation of HHR on a wider scale can be recommended.

Adapting Citizen Science to Improve Health in an Occupational Setting: Preliminary Results of a Qualitative Study

Health interventions often do not reach blue-collar workers. Citizen science engages target groups in the design and execution of health interventions, but has not yet been applied in an occupational setting. This preliminary study determines barriers and facilitators and feasible elements for citizen science to improve the health of blue-collar workers. The study was conducted in a terminal and construction company by performing semi-structured interviews and focus groups with employees, company management and experts. Interviews and focus groups were analyzed using thematic content analysis and the elements were pilot tested. Workers considered work pressure, work location and several personal factors as barriers for citizen science at the worksite, and (lack of) social support and (negative) social culture both as barriers and facilitators. Citizen science to improve health at the worksite may include three elements: (1) knowledge and skills, (2) social support and social culture, and (3) awareness about lifestyle behaviors. Strategies to implement these elements may be company specific. This study provides relevant indications on feasible elements and strategies for citizen science to improve health at the worksite. Further studies on the feasibility of citizen science in other settings, including a larger and more heterogeneous sample of blue-collar workers, are necessary.