Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons

Back Onside protocol: A physical activity intervention to improve health outcomes in people who are unemployed or at risk of unemployment

Given the effects of physical activity on people's mental and physical health, a better understanding is needed of how physical activity interventions may impact the health of people who are unemployed or at risk of unemployment. This has added urgency in the context of rising rates of poverty-related unemployment in the UK in 2022. The current paper details the protocol used in the evaluation of the Back Onside Programme; a community-based programme delivered by the Bradford Bulls Foundation in the Bradford District. The Programme supports people from low socio-economic backgrounds who are unemployed or at risk of unemployment to maintain regular physical activity through a ten-week physical activity intervention. This pilot study evaluates how a physical activity intervention may impact the mental and physical health of people who are unemployed or at risk of unemployment in an uncontrolled pragmatic pilot study. Four cohorts run back-to-back between May 2021 and May 2022, with separate groups for men (N = 100) and women (N = 60). Physical and wellbeing assessment at baseline and post-intervention is conducted. If the intervention works in this context for these individuals, it will be a promising low-cost community-based intervention for people who are unemployed or at risk of unemployment.

The development of a health-promoting employment intervention with physical activity for young people Not in Education, Employment or Training (NEET): NEXT STEP-on the path to education and job

Background

In the EU, approx. 16.5% of the 20–34-year-olds are Not in Education, Employment or Training (NEET). Research shows that good health is an important progression factor towards employment, and daily physical activity as well as participation in sports has a positive effect on physical and mental health as well as in the development of life skill. However, there is an absence of studies investigating what role physical activity can play in the employment efforts. The aim of this study is to investigate experiences with physical activity in employment interventions and to describe the development of a health-promoting employment intervention with physical activity for young people aged 18–30 years who are NEET.

Methods

The study combined an evidence-based approach with practice-based experiences. It included a Mapping of Danish employment interventions with physical activity for young people NEET, an overview of national reports and international literature, a workshop with leaders and employees from Danish municipalities, and fieldwork in four municipalities. Key findings were grouped thematically and were transformed into intervention content in a close dialog with relevant researchers and practitioners.

Results

In general, physical activity was assessed as a meaningful method when working with young people NEET. A range of positive experiences was highlighted, including successful experiences, surplus of mental resources, new ways of meeting, and new social relations. Based on these findings, a 16-week health-promoting employment intervention, NEXT STEP, was developed with the following intervention components: (1) fixed boundaries, (2) body and physical activity, (3) social relations and network, and (4) life skills and future. NEXT STEP is designed to be implemented in Danish job centers.

Conclusion

The study found the great potential of including physical activity in employment interventions for young people NEET. The planning and development of the intervention have reinforced a comprehensive evaluation; however, the first intervention in its entirety is ready for testing in a randomized feasibility trial.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01174-1.

Adherence to physical exercise recommendations among type 2 diabetes patients during the COVID-19 pandemic

Background

In the era of the COVID-19 pandemic, nonadherence to the recommended physical exercise for diabetic patients is a difficult issue. Regular physical exercise is critical for reducing further complications of diabetes mellitus and the COVID-19 pandemic. The purpose of this study was to determine the predictors of type 2 adult diabetes patients’ exercise recommendations during the COVID-19 pandemic.

Methods

An institution-based cross-sectional study was conducted among 576 diabetes mellitus patients from August 1, 2020, to September 28, 2020. A systematic random sampling technique was used to select the study participants. An interviewer-administered questionnaire was used to collect the data. Frequency tables and percentages were used to explain the study variables. A binary logistic regression was used to investigate the relationship between the dependent and independent variables.

Result

A total of 576 diabetes mellitus patients participated in the study, with a response rate of 99.3%. The overall prevalence of exercise adherence was 26.4%, whereas 73.6% were non-adherents to exercise recommendations. Rural residency (AOR = 1.95, 95% CI: 1.16–3.27) and COVID-19 related knowledge (AOR = 9.95, 95% CI: 41.14–5.24) were both strongly associated with exercise recommendations.

Conclusion

In this study, only one-fourth of patients had exercised adherence during the era of the COVID-19 pandemic. Knowledge about COVID-19 was one of the factors that was strongly associated with adherence to exercise recommendations for diabetes patients. During the COVID-19 pandemic, encouraging home-based exercises can improve adherence to exercise recommendations.

Health-improving interventions for obtaining employment in unemployed job seekers

BACKGROUND

Unemployment is associated with decreased health which may be a reason or a consequence of becoming unemployed. Decreased health can inhibit re-employment.

OBJECTIVES

To assess the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers.

SEARCH METHODS

We searched (3 May 2018, updated 13 August 2019) the Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, PsycINFO, CINAHL, SocINDEX, OSH Update, ClinicalTrials.gov, the WHO trials portal, and also reference lists of included studies and selected reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. The primary outcome was re-employment reported as the number or percentage of participants who obtained employment. Our secondary outcomes were health and work ability.

DATA COLLECTION AND ANALYSIS

Two authors independently screened studies, extracted outcome data, and assessed risk of bias. We pooled study results with random-effect models and reported risk ratios (RRs) with 95% confidence intervals (CIs) and assessed the overall quality of the evidence for each comparison using the GRADE approach.

MAIN RESULTS

We included 15 randomised controlled trials (16 interventions) with a total of 6397 unemployed participants. Eight studies evaluated therapeutic interventions such as cognitive behavioural therapy, physical exercise, and health-related advice and counselling and, in seven studies, interventions were combined using therapeutic methods and job-search training. Therapeutic interventions Therapeutic interventions compared to no intervention may increase employment at an average of 11 months follow-up but the evidence is very uncertain (RR = 1.41, 95% CI 1.07 to 1.87, n = 1142, 8 studies with 9 interventions, I² = 52%, very low-quality evidence). There is probably no difference in the effects of therapeutic interventions compared to no intervention on mental health (SMD 0.12, 95% CI -0.06 to 0.29, n = 530, 2 studies, low-quality evidence) and on general health (SMD 0.19, 95% CI -0.04 to 0.41, n = 318, 1 study, moderate-quality evidence). Combined interventions Combined interventions probably increase employment slightly compared to no intervention at an average of 10 months follow-up (RR 1.12, 95% CI 1.06 to 1.20, n = 4101, 6 studies, I² = 7%). There were no studies that measured work-ability, adverse events, or cost-effectiveness.

AUTHORS' CONCLUSIONS

Interventions combining therapeutic methods and job-search training probably have a small beneficial effect in increasing employment. Therapeutic interventions may have an effect on re-employment, but we are very uncertain. Therapeutic interventions may not improve health in unemployed job seekers. Large high-quality RCTs targeting short-term or long-term unemployed people are needed to increase the quality of the evidence. A cost-effectiveness assessment is needed of the small beneficial effects.

Dual Benefits of a Student-Assisted Interprofessional Men's Healthy Lifestyle Pilot Program

Men are less willing to seek health professional advice than women and die more often than women from preventable causes. Therefore, it is important to increase male engagement with health initiatives. This study reports the outcomes of a student-assisted, interprofessional, 12-week health program for overweight adult males. The program included weekly health education and structured, supervised group exercise sessions. Thirteen males (participants) and 18 university students (session facilitators) completed the program. Participants were assessed for a range of health and physical activity measures and health and health profession knowledge. Participants demonstrated significant improvement in activity, knowledge, and perceptions of physical and mental function, and appreciated the guided, group sessions. Students completed an interprofessional readiness questionnaire and reported significant improvement in the understanding of the benefits of interprofessional education and of their role in health care. This program provides evidence of the dual benefit that occurs from the delivery of a student-assisted, interprofessional men's health program to at-risk community members.

Effects of a Health Promotion Program Based on a Train-the-Trainer Approach on Quality of Life and Mental Health of Long-Term Unemployed Persons

Background. Long-term unemployment is associated with poorer mental health. The aim of this study was to evaluate the effectiveness of a health promotion program using the train-the-trainer approach on health-related quality of life (HRQoL) and mental health of long-term unemployed persons. Methods. A prospective parallel-group study was conducted among 365 long-term unemployed persons. 287 participants (179 members of the intervention group IG and 108 members of the control group) were reassessed after three months. The intervention comprised both individual sessions based on Motivational Interviewing and participatory group sessions; no health promotion program was administered in the control group. The endpoints were HRQoL (SF-12), depression, and anxiety. The effect size of the change across time in the IG and CG was measured by Cohen's d. To assess the significance of group differences in the change across time, a random effects model was used. Results. Within three months HRQoL improved and anxiety and depression decreased significantly in the IG. A significant intervention effect was observed for anxiety (p = 0.012). Effect sizes in the IG were small to moderate in terms of Cohen's d (anxiety: d = -0.33; SF-12 mental: d = 0.31; depression: d = -0.25; SF-12 physical: d = 0.19). Conclusions. The health promotion program, based on a train-the-trainer approach, showed positive effects on HRQoL and mental health, especially anxiety, of long-term unemployed persons, a highly burdened target group where an improvement in mental health is a crucial prerequisite to social participation and successful reintegration into the job market.

Does provision of targeted health care for the unemployed enhance re-employment?

Background

There is increasing pressure to develop services to enhance the health of the workforce on the periphery of the labour market. Health promotion among unemployed people may improve their health but also to increase their employability. We tested whether re-employment can be enhanced with a health care intervention targeted at the unemployed.

Methods

A 3-year follow-up, controlled design was used. The data were collected among unemployed people (n = 539) participating in active labour market policy measures. The baseline survey included established habitually used health questionnaires. The intervention consisted of three health check-ups and on-demand health services. Logistic regression analyses were used to obtain the odds ratios of the intervention group versus control group for being re-employed at follow-up. Health-related differences in the re-employment effects of the intervention were assessed through the significance of the interaction in the regression analyses.

Results

The intervention did not serve to improve re-employment: at follow-up 50% of both the intervention group and the control group were at work. In further analyses, the odds ratios showed that the intervention tended to improve re-employment among participants in good health, whereas an opposite tendency was seen among those with poor health. The differences, however, were statistically non-significant.

Conclusion

The experimental health service did not show any beneficial effects on re-employment. Nevertheless, rather than considering any particular health care as unnecessary and ineffective, we would like to stress the complexity of providing health services to match the diversity of the unemployed.

Effects of a structured physical-activity counseling and referral scheme in long-term unemployed individuals: a pilot accelerometer study

Unemployment is associated with health risks. Physical activity produces health benefits. This study examined the effects of a physical activity counseling and exercise referral scheme on physical-activity behavior in long-term unemployed individuals. In this study, 51 long-term unemployed persons received physical-activity counseling and exercise referral. Further, 21 unemployed and 17 employed persons with no intervention were included. Physical activity was measured over 7 consecutive days prior to and 12 weeks after counseling by accelerometer. Participants who started exercising increased their amount of moderate physical activity from 26 ± 14 to 35 ± 25 minutes/day and total physical activity from 207 ± 86 to 288 ± 126 counts/minute. Generally, unemployed persons were less active and less healthy compared to employed persons. Persons who are willing and motivated benefit from structured physical activity counseling and exercise referral and increase physical activity to a health promoting level. Physical activity inequalities could be reduced.

The impact of an employee wellness programme in clothing/textile manufacturing companies: a randomised controlled trial

Background

The prevalence of health risk behaviours is growing amongst South African employees. Health risk behaviours have been identified as a major contributor to reduced health related quality of life (HRQoL) and the increased prevalence of non-communicable diseases. Worksite wellness programmes promise to promote behaviour changes amongst employees and to improve their HRQoL. The aim of this study was to evaluate the short-term effects of an employee wellness programme on HRQoL, health behaviour change, body mass index (BMI) and absenteeism amongst clothing and textile manufacturing employees.

Methods

The study used a randomised control trial design. The sample consisted of 80 subjects from three clothing manufacturing companies in Cape Town, South Africa. The experimental group was subjected to a wellness programme based on the principles of cognitive behaviour therapy (CBT) as well as weekly supervised exercise classes over six weeks. The control group received a once-off health promotion talk and various educational pamphlets, with no further intervention. Measurements were recorded at baseline and at six weeks post-intervention. Outcome measures included the EQ-5D, Stanford Exercise Behaviours Scale, body mass index and absenteeism.

Data was analysed with the Statistica-8 software program. Non-parametric tests were used to evaluate the differences in the medians between the two groups and to determine the level of significance. The Sign test was used to determine the within group changes. The Mann–Whitney U test was used to determine the difference between the two groups.

Results

At six weeks post intervention the experimental group (39 subjects) demonstrated improvement in almost every parameter. In contrast, apart from an overall decrease in time off work and a reduction in BMI for all study participants, there was no significant change noted in the behaviour of the control group (41 subjects). Seventy percent of the experimental group had improved HRQoL EQ-5D VAS scores post intervention, indicating improved perceived HRQoL. In comparison, only 58% of the control group had improved HRQoL EQ-5D VAS scores post intervention. There was no significant difference between the two groups at baseline or at six weeks post intervention.

Conclusion

An employee wellness programme based on the principles of CBT combined with weekly aerobic exercise class was beneficial in improving the perceived HRQoL and changing health-related behaviours of clothing manufacturing employees. However, it cannot be concluded that the EWP was more effective than the once off health promotion talk as no significant changes were noted between the two groups at 6-weeks post intervention.This trial has been registered with ClinicalTrials.gov (trial registration number NCT01625039).

The correlates of psychological health among the Turkish unemployed: psychological burden of financial help during unemployment

The purpose of this study is to examine the major determinants of psychological health during unemployment. With this in mind, 438 (17% female and 83% male) unemployed individuals were contacted through Turkey's State Employment Office. It was expected that the relationship between duration of unemployment and psychological wellbeing would be nonlinear. Additionally it was hypothesized that perceived social support would moderate the relationship between length of unemployment and psychological health. Further, we suggested that self-esteem would be related to psychological health and moderate the relationship between length of unemployment and psychological health. The results supported the curvilinearity hypothesis of the relationship between unemployment duration and psychological health as measured by General Health Questionnaire. However, social support was not found to moderate the relationship between unemployment duration and psychological health. The hypothesis that self-esteem would moderate the relationship between length of unemployment and psychological distress was not supported, although self-esteem was a strong negative determinant of psychological distress during unemployment. Regression analysis showed that the best predictors of psychological health were self-esteem, perceived social support and perceived adequacy of financial aid received from relatives. Interestingly, perceived adequacy of the financial aid was negatively related to psychological health. This result was contradictory with the previous literature pointing out that financial aid reduces the effects of poverty due to unemployment. The findings of this study are important since the relationship between unemployment duration and psychological health was nonlinear, indicating that relevant services should be especially careful to intervene to increase social support and self-esteem during these critical times. The other results and limitations are discussed.

[Health promotion for long-term unemployed. Effects on motivation for a healthy lifestyle]

Among the long-term unemployed ill health is often a hindrance to successful reintegration in the job market. In a quasi-experimental controlled study we examined the effects of a health promotion intervention program tailored to the specific needs of the long-term unemployed combining individual sessions based on motivational interviewing and participatory group sessions including physical activity. Over a period of 3 months the participants of the intervention group (n = 179) showed more improvement compared to the control group (n = 108) in terms of motivation for lifestyle changes towards more physical activity and healthier nutrition. Participants of the intervention group developed an intention to act significantly more often (active lifestyle: odds ratio 4.44; 95% CI: 2.00-9.83; healthy nutrition: odds ratio 3.94; 95% CI: 1.55-10.00) and actually implemented a behavior change significantly more often (active lifestyle: odds ratio 2.77; 95% CI: 1.35-5.71; healthy nutrition: odds ratio 4.34; 95% CI: 1.92-9.78). In terms of smoking and alcohol consumption no significant intervention effects were detected. The results of the study show the effectiveness of the described health promotion program regarding a lifestyle change towards more healthy nutrition and more physical activity.

Factors associated with differences in perceived health among German long-term unemployed

BACKGROUND

Unemployment is associated with reduced physical and psychological well-being. Perceived health is an important factor influencing health outcomes as well as successful returns to work. This study aims to determine the extent to which perceived health correlates with mental health, various health risk characteristics and socio-demographic characteristics in a setting-selected sample of long-term unemployed persons.

METHODS

Using SF-12, 365 long-term unemployed persons were assessed for self-perceived health and various socio-demographic and health characteristics. Perceived health data of the sample was compared to the German SF-12 reference population. Bivariate analyses and multiple linear regression models were applied to identify those variables significantly associated with perceived health.

RESULTS

The study population reported poorer perceived health compared with the general population. Analyses showed that perceived mental health was significantly worse in women, among persons with heightened depression and anxiety scores, and in participants reporting reduced levels of physical activity. Perceived physical health was significantly lower among older persons, participants with a higher BMI, and participants with heightened depression and anxiety scores. Both mental and physical health were worse among the unemployed assigned to an employment center as compared to those engaged in the secondary labor market. In total, 36% of the variance in the SF-12 mental score and 20% of the variance in the SF-12 physical score were explained by the factors included in the final multiple linear regression models.

CONCLUSIONS

Perceived health among a select group of long-term unemployed is reduced to a clinically relevant extent compared to the general population. The preliminary findings underline an association between mental health and perceived health. Negative self-perceptions of health were also associated with the labor market setting and some of the socio-demographic and health behavior variables. Further research is needed to determine risk factors leading to reduced perceived health in the unemployed. The strong association between mental health and perceived health suggests interventions targeting mental health are urgently needed to positively influence perceived health, a key determinant of individuals' chances to successfully return to work.