Process evaluation results from an environmentally focused worksite weight management study

The workplace health group: A case study of 20 years of multidisciplinary research

The Workplace Health Group (WHG) was established in 1998 to conduct research on worker health and safety and organizational effectiveness. This multidisciplinary team includes researchers with backgrounds in psychology, health promotion and behavior, and intervention design, implementation, and evaluation. The article begins with a brief history of the team, its guiding principles, and stages of team formation and development. This section provides examples of the roles, team composition, structure, processes, cognition, leadership, and climate played in the various stages of team development, as well as how they influenced team effectiveness. The WHG formed with functional diversity-variety in knowledge, skills, and abilities-in mind, and the impact of this diversity is discussed throughout the article. Illustrations of how the functional diversity of the WHG has led to real-world impact are provided. The article concludes with some lessons learned and recommendations for creating and sustaining multidisciplinary teams based on the WHG's 20 years of experience and the team science literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Applying Theory of Change to a Structural Change Initiative: Evaluation of Model Communities in a Diverse County

Structural change approaches, also called policy, systems, and environmental change approaches, have been increasingly promoted and adopted by public ealth agencies in the past decade. These interventions require attention to multilevel, complex and contextual influences on individual and community health outcomes, requiring a sound theoretical framework that links the many processes and outcomes over time. The Model Communities program of Cook County, Illinois Communities Putting Prevention to Work program employed a theory of change (ToC) framework to inform the evaluations' design and execution. The main objective of this study was to apply findings from the longitudinal multiple case study evaluation to develop an adapted ToC. We conducted 97 key informant interviews across three waves, with a focus on Model Communities program participants', Communities Putting Prevention to Work staff, and technical assistance providers' experiences over time. Four analysts organized and coded the data using qualitative software; exploratory functions and data matrices were employed throughout three waves of analysis. Adaptations to the ToC included the addition of a construct, "change readiness," as well as refinements to constructs: organizational capacity (human capital, technical assistance, informal and formal leadership), local partnerships, and the importance of sustainability. The findings offer a data-informed theoretical framework that may be considered for use in evaluations of structural change interventions in complex and diverse counties.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity

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.

Truckies and health promotion: using the ANGELO framework to understand the workplace’s role

Purpose

Workplaces are challenging environments which place workers at the risk of obesity. This is particularly true for Australian road transport industry workplaces. The Analysis Grid for Environments Linked to Obesity (ANGELO) framework is a public health tool which can be used to conceptualise obesogenic environments. It suggests that workplaces have a variety of roles (in the physical, economic, political and sociocultural domains) in responding to obesity in transport industry workplaces. The purpose of this paper is to present the findings which explore this idea.

Design/methodology/approach

The project used a mixed-methods approach located within a participatory action research framework, to engage workplace managers and truck drivers in the implementation and evaluation of workplace health promotion strategies. The project involved six transport industry workplaces in Queensland, Australia.

Findings

This study found that transport industry workplaces perceive themselves to have an important role in addressing the physical, economic, political and sociocultural aspects of obesity, as per the ANGELO framework. However, transport industry employees – specifically, truck drivers – do not perceive workplaces to have a major role in health; rather, they consider health to be an area of personal responsibility.

Practical implications

Balancing the competing perceptions of truck drivers and workplace managers about the workplace’s role in health promotion is an important consideration for future health promotion activities in this hard-to-reach, at-risk population.

Originality/value

The use of the ANGELO framework allows the conceptualisation of obesity in a novel workplace context.

Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress

Structural change approaches—also known as policy and environmental changes—are becoming increasingly common in health promotion, yet our understanding of how to evaluate them is still limited. An exploratory scoping review of the literature was conducted to understand approaches and methods used to evaluate structural change interventions in health promotion and public health literature. Two analysts—along with health sciences librarian consultation—searched PubMed, Web of Science, and EMBASE for peer-reviewed U.S.-based, English language studies published between 2005 and 2016. Data were extracted on the use of evaluation frameworks, study designs, duration of evaluations, measurement levels, and measurement types. Forty-five articles were included for the review. Notably, the majority (73%) of studies did not report application of a specific evaluation framework. Studies used a wide range of designs, including process evaluations, quasi- or nonexperimental designs, and purely descriptive approaches. In addition, 15.6% of studies only measured outcomes at the individual level. Last, 60% of studies combined more than one measurement type (e.g., site observation + focus groups) to evaluate interventions. Future directions for evaluating structural change approaches to health promotion include more widespread use and reporting of evaluation frameworks, developing validated tools that measure structural change, and shifting the focus to health-directed approaches, including an expanded consideration for evaluation designs that address health inequities.

The Role of Leadership Support for Health Promotion in Employee Wellness Program Participation, Perceived Job Stress, and Health Behaviors

Purpose:

The purpose of the study was to explore the relationship between leadership support for health promotion and job stress, wellness program participation, and health behaviors.

Design:

A cross-sectional survey design was used.

Setting:

Four worksites with a range of wellness programs were selected for this study.

Participants:

Participants in this study were employees (n = 618) at 4 organizations (bank, private university, wholesale supplier, and public university) in the southeastern United States, each offering an employee wellness program. Response rates in each organization ranged from 3% to 34%.

Measures:

Leadership support for health promotion was measured with the Leading by Example instrument. Employee participation in wellness activities, job stress, and health behaviors were measured with multi-item scales.

Analysis:

Correlation/regression analysis and descriptive statistics were used to analyze the relationships among the scaled variables.

Results:

Employees reporting higher levels of leadership support for health promotion also reported higher levels of wellness activity participation, lower job stress, and greater levels of health behavior ( P = .001). To ascertain the amount of variance in health behaviors accounted for by the other variables in the study, a hierarchical regression analysis revealed a statistically significant model (model F7,523 = 27.28; P = .001), with leadership support for health promotion (β = .19, t = 4.39, P = .001), wellness activity participation (β = .28, t = 6.95, P < .001), and job stress (β = −.27, t = −6.75, P ≤ .001) found to be significant predictors of health behaviors in the model. Exploratory regression analyses by organization revealed the focal variables as significant model predictors for only the 2 larger organizations with well-established wellness programs.

Conclusion:

Results from the study suggest that employees’ perceptions of organizational leadership support for health promotion are related to their participation in wellness activities, perceived job stress levels, and health behaviors.

Effectiveness of offering healthy labelled meals in improving the nutritional quality of lunch meals eaten in a worksite canteen

Healthier meal selections at restaurants and canteens are often limited and not actively promoted. In this Danish study the effectiveness of a healthy labelling certification program in improving dietary intake and influencing edible plate waste was evaluated in a quasi-experimental study design. Employees from an intervention worksite canteen and a matched control canteen were included in the study at baseline (February 2012), after completing the certification process (end-point) and six month from end-point (follow-up) (total n=270). In order to estimate nutrient composition of the consumed lunch meals and plate waste a validated digital photographic method was used combining estimation of food intake with food nutrient composition data. Food satisfaction was rated by participants using a questionnaire. Several significant positive nutritional effects were observed at the intervention canteen including a mean decrease in energy density in the consumed meals from 561kJ/100g at baseline to 368 and 407kJ/100g at end-point and follow-up, respectively (P<0.001). No significant changes were seen with regard to food satisfaction and plate waste. In the control canteen no positive nutritional effects were observed. The results of the study highlight the potential of using healthy labelling certification programs as a possible driver for increasing both the availability and awareness of healthy meal choices, thereby improving dietary intake when eating out.

Combining environmental and individual weight management interventions in a work setting: results from the Dow chemical study

OBJECTIVE

To evaluate the comparative effectiveness of environmental weight loss interventions alone versus in combination with an individual intervention.

METHODS

A quasi-experimental design compared outcomes for two levels of environmental interventions and for participants who did or did not simultaneously self-select into an individually focused weight loss intervention (YW8). Analysis of covariance and logistic regression techniques were used to examine risk outcomes.

RESULTS

Employees who participated in YW8 were no more successful at losing weight than those exposed to only the environmental interventions. Approximately, 13.5% of each group lost at least 5% of their body weight; overall changes in mean body weight and body mass index were negligible in both groups.

CONCLUSIONS

Simple worksite environmental modifications may help with weight maintenance, but are not likely to result in substantial weight reductions even when combined with low-intensity individual interventions.