Employers' views on the promotion of workplace health and wellbeing: a qualitative study

Approaches for the Use of AI in Workplace Health Promotion and Prevention: Systematic Scoping Review

BACKGROUND

Artificial intelligence (AI) is an umbrella term for various algorithms and rapidly emerging technologies with huge potential for workplace health promotion and prevention (WHPP). WHPP interventions aim to improve people's health and well-being through behavioral and organizational measures or by minimizing the burden of workplace-related diseases and associated risk factors. While AI has been the focus of research in other health-related fields, such as public health or biomedicine, the transition of AI into WHPP research has yet to be systematically investigated.

OBJECTIVE

The systematic scoping review aims to comprehensively assess an overview of the current use of AI in WHPP. The results will be then used to point to future research directions. The following research questions were derived: (1) What are the study characteristics of studies on AI algorithms and technologies in the context of WHPP? (2) What specific WHPP fields (prevention, behavioral, and organizational approaches) were addressed by the AI algorithms and technologies? (3) What kind of interventions lead to which outcomes?

METHODS

A systematic scoping literature review (PRISMA-ScR [Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews]) was conducted in the 3 academic databases PubMed, Institute of Electrical and Electronics Engineers, and Association for Computing Machinery in July 2023, searching for papers published between January 2000 and December 2023. Studies needed to be (1) peer-reviewed, (2) written in English, and (3) focused on any AI-based algorithm or technology that (4) were conducted in the context of WHPP or (5) an associated field. Information on study design, AI algorithms and technologies, WHPP fields, and the patient or population, intervention, comparison, and outcomes framework were extracted blindly with Rayyan and summarized.

RESULTS

A total of 10 studies were included. Risk prevention and modeling were the most identified WHPP fields (n=6), followed by behavioral health promotion (n=4) and organizational health promotion (n=1). Further, 4 studies focused on mental health. Most AI algorithms were machine learning-based, and 3 studies used combined deep learning algorithms. AI algorithms and technologies were primarily implemented in smartphone apps (eg, in the form of a chatbot) or used the smartphone as a data source (eg, Global Positioning System). Behavioral approaches ranged from 8 to 12 weeks and were compared to control groups. Additionally, 3 studies evaluated the robustness and accuracy of an AI model or framework.

CONCLUSIONS

Although AI has caught increasing attention in health-related research, the review reveals that AI in WHPP is marginally investigated. Our results indicate that AI is promising for individualization and risk prediction in WHPP, but current research does not cover the scope of WHPP. Beyond that, future research will profit from an extended range of research in all fields of WHPP, longitudinal data, and reporting guidelines.

TRIAL REGISTRATION

OSF Registries osf.io/bfswp; https://osf.io/bfswp.

Exploring drivers of women's well-being in hospitals: mapping the landscape

BACKGROUND AND PURPOSE

The workplace plays a key role in impacting the health and well-being of employees at various levels, including physical, psychological, and social aspects of health. This study aims to identify the drivers of a healthy environment that promotes the well-being of women employed in hospitals.

MATERIALS & METHODS

This qualitative study used purposive sampling to recruit a total of 48 working women across a diverse range of participants with different job categories and socio-demographic statuses. These include clinical health (e.g., nurse, head nurse, practical nurse, supervisor, physicians); allied health (e.g., diagnostic services); public health (e.g., health promotion specialists); and administrative (e.g., hospital managers). Data was collected through semi-structured interviews and were analyzed using content analysis by creating codes, sub-themes, and themes.

RESULTS

Content analysis resulted in 31 key codes, that generated 12 sub-themes and 4 key themes. These include Advancing women's health through collaborative leadership; a Psychologically safe environment for women; Thriving for positive social connections; and Advancing holistic health for women.

DISCUSSION AND CONCLUSION

Hospital managers and leaders play a pivotal role in creating supportive workplaces for women. They can significantly assist in prioritizing their psychological and social health through personalized approaches tailored to women's needs, positioning them as co-designers of their health and well-being.

Workplace health promotion programs: The role of compliance with workers' expectations, the reputation and the productivity of the company

INTRODUCTION

Addressing the health and safety of workers is key to achieving Sustainable Development Goals 3 and 8. The European Union urges companies in its member countries to promote measures in this regard. However, this type of program is not a general approach in European companies. This study aims to identify whether the implementation of Workplace Health Promotion measures is influenced by the company's desire to meet its employees' expectations in this area; and if this relationship involves the company's reputation and productivity.

METHODS

A multi-step methodology is used (descriptive sample portrait, analysis of influences by linear regression, and double-intermediation model analysis) to find out if reputation and productivity mediate the relationship between the satisfaction of employee health expectations and the number of Workplace Health Promotion measures applied.

RESULTS

The more weight the company gives to this compliance, the more motivated it is to implement a more significant number of Workplace Health Promotion measures. The increase in productivity does not seem to weigh in this relationship, but the improvement of the company's reputation does.

CONCLUSIONS

The more the employees' expectations of working in a healthy company are desired to be met, the more measures the company will put in place.

PRACTICAL APPLICATIONS

The findings have theoretical implications, by increasing knowledge about the factors that influence a company's decision to activate Workplace Health Promotion policies. They can also serve as guidance for implementing policies that encourage health promotion in companies and contribute to the achievement of Sustainable Development Goals 3 and 8: for workers' representatives, by better understanding how these factors influence the fulfillment of their constituents' expectations; for company managers, by better knowing the variables involved in this relationship; and for researchers of this topic.

A Qualitative Study Exploring White-Collar Employee/Manager Experiences of Mental Health and Well-being Initiatives in Corporate Environments

OBJECTIVE

The aim of the study is to explore white-collar corporate employee/manager experiences of current employer-led mental health and well-being initiatives.

METHODS

Twenty-five participants took part in semistructured interviews yielding over 19 hours of data. Thematic analysis of the interview transcripts was undertaken. Participants worked for organizations including investment banks, insurers, asset managers, consultants, public relations, marketing, and legal firms.

RESULTS

Many participants were skeptical of the effectiveness of current company-led mental health and well-being initiatives against a backdrop of high job demands and unsupportive cultures. A commonly expressed view was that organizations were paying lip service to the issue. Participants communicated that more leadership role modeling on mental health and well-being, supportive job designs, and accessible skills-focused psychological support would be beneficial.

CONCLUSIONS

Corporate white-collar employees/managers welcome mental health and well-being initiatives but are skeptical about their current effectiveness.

Worksite Health Promotion and Work Performance: Both Awareness and Use Matter

OBJECTIVE

This work aimed to study whether being aware of the existence of worksite health promotion (WHP), using it, or both are related to employees' task and contextual performance.

METHODS

Multilevel cross-sectional data came from the European Sustainable Workforce Survey, with data from more than 11,000 employees in 259 organizations. Generalized structural equation modeling was used to examine two types of WHP: healthy menus and sports facilities.

RESULTS

Awareness of healthy menus and sports facilities was positively associated with task and contextual performance. Healthy menus use was related to both higher task and contextual performance, whereas sports facilities use was only associated with contextual performance. The relation of WHP use was stronger for contextual than for task performance.

CONCLUSIONS

Organizations should ensure that employees are aware of the availability of WHP as well as stimulate employees to make use of it.

Barriers and facilitators to the implementation of workplace health promotion programs: Employers' perceptions

Background

Workplace health promotion programs (WHPPs) can benefit the lifestyle and health of employees. However, not all WHPPs have been successful in their implementation, and thus their effectiveness. This study aimed to identify the barriers and facilitators to implementing an integrated WHPP, which targets multiple lifestyle factors at different levels (individual and organizational), from an employer's perspective.

Methods

Data were collected by two online focus groups among 18 representatives of eight different organizations. Data from the focus group discussions were transcribed verbatim and analyzed using thematic analysis. Data were coded both inductively and deductively, using the Consolidated Framework for Implementation Research (CFIR) consisting of the following five domains: (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of individuals, and (5) process. Ratings were performed to indicate the positive or negative influence and strength of a construct regarding the implementation of WHPPs.

Results

Barriers and facilitators in all domains of the CFIR were found. Regarding characteristics of the WHPP, complexity and costs hindered implementation, while high adaptability facilitated it. An organization that met the needs of employees (the outer setting) facilitated implementation. Available resources, access to knowledge, leadership involvement, and continuity of communication were facilitators within the inner setting. Barriers were different approaches to implementation within one organization and the perceived interference with employees' lives. For the implementation process, the involvement of key stakeholders, including employees, was identified as an important facilitator.

Conclusion

Various barriers and facilitators in different domains play a role in the implementation of integrated WHPPs, according to employers. Strategies that tackle the identified barriers and incorporate the facilitators will likely contribute to the successful implementation of integrated WHPPs.

The kindness COVID-19 toolkit: a mixed-methods evaluation of a programme designed by doctors in training for doctors in training

OBJECTIVES

The impact of a coronavirus disease (COVID-19)-specific professional development programme on the well-being of obstetrics and gynaecology (O&G) doctors in training (DiT) working during the pandemic.

DESIGN

A mixed-method evaluation of a single group pre-post test design study.

SETTING

Melbourne, Australia between September 2020 and April 2021.

PARTICIPANTS

55 O&G DiT working across four healthcare sites of a major tertiary hospital in Victoria, Australia, were included in the programme.

INTERVENTIONS

The delivery of a codesigned peer-to-peer programme, which identified and addressed the well-being goals of O&G DiT. Seven interactive workshops were run alongside the implementation of a number of participant-led wellness initiatives.

MAIN OUTCOME MEASURES

Repeated-measures analysis of WHO Well-being Index (WHO-5) and Copenhagen Burnout Innovatory (CBI) scores across three time points during the programme. Multilevel generalised linear mixed-effects models with random intercept were fit to the data, both in the entire population (intention-to-treat) and restricted to those who attended the workshop ('per-protocol' analysis). Participatory experiences and programme learning were captured using the Most Significant Change (MSC) technique, which included inductive thematic analysis.

RESULTS

We demonstrated an overall 31.9% improvement in well-being scores (p=0.006). The MSC evaluation captured a shift in workplace culture as a result of the programme, with improvement across the domains of connection, caring, communication, confidence and cooperation.

CONCLUSIONS

We have successfully used a mixed-method approach to contextualise a productive programme to improve the well-being of COVID-19 front-line healthcare workers.

Stakeholders' Perceptions Regarding Adaptation and Implementation of Existing Individual and Environmental Workplace Health Promotion Interventions in Blue-Collar Work Settings

Blue-collar workers often have disadvantageous health statuses and might therefore benefit from a combination of individual and environmental workplace health promotion interventions. Exploring stakeholders' perceived facilitators and barriers regarding the combined implementation of these interventions in blue-collar work settings is important for effective implementation. A qualitative study consisting of 20 stakeholder interviews within six types of organisations in The Netherlands was conducted. The potential implementation of the evidence-based individual intervention SMARTsize and the environmental intervention company cafeteria 2.0 was discussed. Data were analysed using thematic analysis with a deductive approach. Five main themes emerged: (1) the availability of resources, (2) professional obligation, (3) expected employee cooperation, (4) the compatibility of the proposed health interventions, and (5) the content of implementation tools and procedures. Generally, stakeholders expressed a sense of professional obligation toward workplace health promotion, mentioning that the current societal focus on health and lifestyle provided the perfect opportunity to implement interventions to promote healthy eating and physical activity. However, they often perceived the high doses of employees' occupational physical activity as a barrier. We recommend co-creating interventions, implementation tools, and processes by involving stakeholders with different professional backgrounds and by adapting communication strategies at diverse organisational levels.

Corporate social responsibility and workplace health promotion: A systematic review

The complex situation that global society is facing as a result of COVID-19 has highlighted the importance of companies committing to the principles of social responsibility. Among the internal initiatives, those related to the health of workers are, obviously, highly topical. The objective of our research is to provide concise knowledge of the relationship between workplace health promotion (WHP) and corporate social responsibility (CSR) so that the relevant specialized research was gathered in a single document that lays the foundations of its applicability. A systematic review, following the PRISMA method, has been carried out. Twenty-seven articles have been selected from the main scientific databases. Their qualitative analysis concludes that CSR and WHP are linked, have beneficial reciprocal effects, need committed leadership respectful of autonomy and voluntariness, and require the establishment of specific goals within the framework of the organizations' sustainability policies. Future studies should establish the impact of the pandemic on these aspects.

Estimate of Occupational Exposure to Carcinogens among Migrant Workers in the United Arab Emirates: A Cross-Sectional Study

Occupational illnesses, such as cancer, cause more deaths each year than occupational accidents. Occupational carcinogens include physical, chemical, biological and organizational hazards. In the United Arab Emirates (UAE), migrant workers account for 80% of labor. Being sometimes employed as unskilled workers and more willing to work in demanding jobs, their vulnerability and exposure may be increased. This study aimed to estimate the prevalence of occupational exposure to workplace carcinogens among migrant workers in the UAE. A sample of employees working in construction, cleaning, dry cleaning, mechanic workshops and hair salons were recruited and interviewed. Using OccIDEAS (an online assessment tool), participants were asked questions about their demographics, work history and regular tasks. Exposure to various carcinogens was estimated using the in-built algorithms of OccIDEAS. A sample of 1778 workers was included. The sample consisted of workers from Bangladesh (19.2%), India (31%), Nepal (4.7%), Pakistan (29.9%) and the Philippines (4.8%), with the rest from other nationalities. Overall, the prevalence of probable exposure was considerable, with the highest among drivers (96%) and the lowest among laundry workers (52%). Moderate to high exposure was found to 20 different carcinogens. Self-rated health among those who were exposed to carcinogens was significantly lower than among those not exposed (AOR = 0.783, 95% CI [0.638-0.961]). Exposure to several different carcinogens is relatively common in the UAE among migrant workers. Further strengthening policies and the implementation of tailored interventions are needed to prevent exposure to occupational carcinogens and, consequently, to combat occupational cancer in the UAE.

Managers' Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions-A Systematic Review of Qualitative Studies

Research indicates that managers' active support is essential for the successful implementation of mental health-related organizational interventions. However, there is currently little insight into what subjective beliefs and perceptions (=mental models) make leaders support such interventions. To our knowledge, this is the first qualitative systematic review of this specific topic, and it considers 17 qualitative studies of managers' perspective. Based on the theory of planned behavior, this review provides an overview of three action-guiding factors (attitudes, organizational norms and behavioral control) that can serve as starting points for engaging managers in the implementation of mental health-related measures and ensuring their success. Our results provide evidence that supportive organizational norms may particularly help to create a common sense of responsibility among managers and foster their perceived controllability with respect to changing working conditions. Our study thus contributes to a more differentiated understanding of managers' mental models of health-related organizational interventions.

The impact of smoking on periodontal status and dental caries

INTRODUCTION

Investigations to explore the relationship between smoking and its oral manifestations are important to clinicians. Among these oral manifestations, periodontal diseases and dental caries have still a controversial association. This study aims to analyze the effect of smoking on periodontal disease and caries and their relevance to each other.

METHODS

Data on demographic and clinical features were retrieved from 7028 patients. Smoking status was categorized as a smoker, non-smoker, former smoker and passive smoker. Each patient received a diagnosis according to the new classification system for periodontal disease, in which periodontal disease is divides into stages (PS). The carries status was diagnosed by evaluating the decayed, missing, and filled teeth (DMFT) index.

RESULTS

Of the patients, 66.6% were non-smoker women, whereas 53.7 % of passive smokers were women. Being a worker and having a Bachelor’s degree was associated with a higher likelihood of getting diagnosed with periodontal disease and caries in smokers. Smoking significantly influences periodontal disease severity and DMFT values (p<0.001). This becomes more evident in former smokers by showing the highest severe periodontal problems (PS3: 29.7% and PS4: 18.9%), and the highest DMFT mean (16.4 ± 7.4) Accordingly, persons having high DMFT had significantly the most severe periodontal disease, namely PS4 (p<0.05).

CONCLUSIONS

Smoking is associated with higher caries prevalence and more severe periodontal disease, and DMFT tend to increase with the severity of periodontitis in the same subjects.

Management of Chronic Musculoskeletal Disorders in the Workplace from the Perspective of Older Employees: A Mixed Methods Research Study

(1) Background: This mixed methods research (MMR) study explored older employees’ experiences of chronic musculoskeletal disorders (CMSDs) in relation to their employment, their perspectives on managing these conditions in the workplace and the strategies used to facilitate and maintain their roles and responsibilities. The services offered to them were also identified. (2) Methods: A mixed methods exploratory sequential design was implemented. In the first qualitative phase, 16 semi-structured interviews gathered in-depth information from older employees. The findings informed the development of an online questionnaire in the survey phase, which was administered to older employees (N = 107). Both sets of findings were then integrated using a narrative joint display. (3) Results: The phenomena of presenteeism and leaveism were important components of employees’ strategies for managing their condition. The integrated findings highlighted the roles of employers, managers and social support in encouraging disclosure and supporting the management of CMSDs. The results also emphasised how self-management and professional health services are crucial for sustaining employability. (4) Conclusions: Current challenges call for employers to identify effective ways to support the ageing workforce and invest in training opportunities for managers and collaborative opportunities with healthcare professionals and other stakeholders. A flexible, empathetic and resourceful work environment is optimal for supporting sustained employability for an ageing workforce.

“We are our own worst enemy”: a qualitative exploration of work-related stress in the construction industry

Purpose

Around 400,000 working days per year are lost in the construction industry due to stress, depression or anxiety, but a large proportion of the industry – those primarily not based “on-site” – is not included in these statistics. Little research has been conducted in this group about their experiences of occupational stress. The authors explored how stress was experienced and managed by construction professionals and its perceived impact on health.

Design/methodology/approach

The authors interviewed 32 construction professionals in a British construction company, with varying levels of seniority and years in the industry. Interviews were transcribed, coded and analysed thematically.

Findings

Stress was viewed an inevitable and increasing part of the construction industry, exacerbated by recent economic challenges. Participants talked about a culture of stress and overwork but often felt unable to challenge it due to job insecurity. Senior management acknowledged stress was a problem within the industry and something that potentially threatened company productivity. Company-wide initiatives had been implemented to address stress levels (e.g. Mental Health First Aiders), but were criticised for ignoring underlying issues. Informal means of managing stress were identified, such as careful consideration of team dynamics, which allowed employees to form close bonds and using “banter” and camaraderie to relieve stress. However, the persistence of a macho male image meant some participants were reluctant to talk about their feelings at work. Participants described individual coping strategies, such as exercise, but these were hard to prioritise in challenging times.

Originality/value

There is growing recognition that health and well-being must be given greater priority in the construction industry. Industry pressures and competitive practices undermine efforts to improve staff well-being. Action must be taken at senior levels to address this conflict, while building on existing informal mechanisms of support and stress relief.

Shall We Dance? Recreational Dance, Well-Being and Productivity Performance During COVID-19: A Three-Country Study

Mental health issues are increasingly prevalent worldwide, emphasizing the need to research antecedents and consequences of well-being. Prior research shows that within organizations, higher levels of subjective well-being (SWB) promote productivity performance. Building on this research, the authors hypothesize that recreational dance positively influences productivity through higher SWB. Survey data from Brazil, Italy, and the United Kingdom reveal that recreational dancers are more productive than nondancers due to their higher intrinsic motivation and SWB. Dancing has an additional direct effect on productivity, beyond the mediating role of SWB. The results indicate well-being and productivity improvements in all three countries, although they show a moderating effect such that the relationship between recreational dance and SWB is stronger when social norms are perceived to be looser. This study indicates potentially far-reaching benefits that could be achieved by including recreational dance in corporate well-being programs. International dance organizations could market dance classes as a pathway to increase productivity at work and explore synergies with public health marketing to promote the benefits of recreational dance in joint international campaigns.

Worksite tobacco control - a qualitative study on perspectives from employers and employees at small worksites

BACKGROUND

Evidence-based interventions (EBIs) for tobacco control can be implemented in worksite settings to reduce tobacco use. Small worksites are less likely to adopt tobacco control EBIs than large worksites. The purpose of this qualitative study was to 1) explore factors that impact small employers' decisions to offer tobacco control EBIs, and 2) understand employees' perceptions of tobacco control at small worksites.

METHODS

Working with staff from small worksites (20-250 employees), we analyzed data from 12 semi-structured interviews with employers (via key informants) and four focus groups with employees. We recruited employers and employees through a purchased business list and market research company, respectively. Interview and focus group topics included perceptions of worksite tobacco control; internal and external forces shaping worksite tobacco control implementation; and perceived worksite support for cessation. We conducted thematic data analysis.

RESULTS

Key themes from the employer interviews included: the local environment played an important role in implementation of tobacco control EBIs; tobacco control was perceived as important but not a priority; and tobacco control decisions were driven by worksite culture. Key themes from the employee focus groups included: perceived employer support for tobacco cessation was limited although there was interest from employees; employees who currently used tobacco were stigmatized for their behavior; and incentives and coaching were considered ideal tobacco control EBIs.

CONCLUSIONS

Tobacco control has not been prioritized at small worksites, despite employees welcoming additional cessation support. This study contributes important information on contextual factors and employee preferences that could be targeted to improve tobacco control EBI implementation. Worksites should implement comprehensive tobacco-free policies, minimize stigma when promoting cessation, establish equitable break policies, and involve employees in decision-making related to tobacco control.

How supportive are workplace environments for sitting less and moving more? A descriptive study of Australian workplaces participating in the BeUpstanding program

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Workplaces varied in the number of activity-supportive characteristics present.

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Spatial characteristics were more common than resource or policy characteristics.

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Characteristics absent in most workplaces were likely to be modifiable or low cost (“easy wins”).

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Almost all workplaces had some room for improvement in terms of activity-supportive factors.

Desk-based workers are highly sedentary; this has been identified as an emerging work health and safety issue. To reduce workplace sitting time and promote physical activity it is important to understand what factors are already present within workplaces to inform future interventions. This cross-sectional study examined the prevalence of supportive environmental factors, prior to workplaces taking part in a ‘sit less, move more’ initiative (BeUpstanding). Participants were 291 Australian-based workplace champions (representing 230 organisations) who unlocked the BeUpstanding program’s online toolkit between September 2017 and mid-November 2020, and who completed surveys relating to champion characteristics, organisation and workplace characteristics, and the availability of environmental factors to support sitting less and moving more. Factors were characterized using descriptive statistics and compared across key sectors and factor categories (spatial; resources/initiatives; policy/cultural) using mixed logistic regression models. Of the 42 factors measured, only 11 were present in > 50% of workplaces. Spatial design factors were more likely to be present than resources/initiatives or policy/cultural factors. Centralised printers were the most commonly reported attribute (94%), while prompts to encourage stair use were the least common (4%). Most workplace factors with < 50% prevalence were modifiable and/or were considered modifiable with low cost. Organisations that were public sector, not small/medium, not regional/remote, and not blue-collar had higher odds of having supportive factors than their counterparts; however, workplaces varied considerably in the number of factors present. These findings can assist with developing and targeting initiatives and promoting feasible strategies for desk-based workers to sit less and move more.

A Toolkit for Strengthening Health Care Policies and Infrastructure of Industries in Developing Countries

Background:

The health risks faced by textile workers calls for a workplace health system that is comprehensive and accessible. To enhance the capacity of workplaces to strengthen their health system, a toolkit was developed by the Business for Social Responsibility (BSR), a non-profit global business network and sustainability consultancy.

Methods:

The Health System Strengthening (HSS) toolkit was designed to provide a set of tools, resources, and concrete steps for the factory management and health staff to work toward continuous improvement of their on-site health systems. It was then implemented with academic collaboration simultaneously In three factories/ in three manufacturing units/ in three workplaces in South India over 6 months to find out its usefulness as a self-reference tool for HSS. Monitoring and evaluation tools and indicators were developed based on the logic framework.

Results:

The main outcomes of the HSS pilot program include the formation of a health committee which was able to utilize the modules, perform a self-assessment of the health system, and come out with short- and long-term action plans for HSS under expert supervision and guidance.

Conclusions:

Overall, the toolkit was found to be an effective solution for HSS in industries which require expert guidance for implementation.

Exploring the active ingredients of workplace physical and psychological wellbeing programs: a systematic review

Previous reviews have established that workplace wellbeing initiatives are effective at promoting wellbeing, but less is known about which intervention characteristics or "active ingredients" underpin this effectiveness (i.e., behavior change techniques [BCTs]). This review aims to illuminate the connections between the types of BCTs and the level of intervention intensity with intervention effectiveness. A systematic search for peer-reviewed studies evaluating a workplace wellbeing initiative was undertaken across five databases: Medline, Scopus, PsycInfo, and CINAHL (Ovid Emcare). Eligible studies included those that evaluated the effect of a workplace wellbeing initiative on participants' physical wellbeing (e.g., physical activity and quality of life) and psychological wellbeing (e.g., mental health and stress), were published between 2009 and September 2019, and utilized a comparator (e.g., control group or prepost change). Studies were screened in independent duplicate to minimize bias. Effect sizes were calculated. Following removal of duplicates, 1,541 studies were identified and screened for eligibility. Of these, 23 studies reporting 28 comparisons were deemed to meet eligibility criteria. Just over 50% of these studies reported evidence of either a strong or moderate effect across a physical and a psychological outcome, providing a positive indication that workplace wellbeing programs can promote physical and psychological wellbeing in workers. Interventions tended to employ multiple BCTs (mean range 8.1-9.4), however, no discernible patterns between the types or numbers of BCTs employed and intervention effectiveness was found. Further experimental work is required that compares and contrasts workplace wellbeing initiatives to enable a better understanding of how to develop and implement highly effective programs.

Ping pong for health: the meaning of space in a sport based health intervention at the workplace

Purpose: This is a study on a sport-based intervention, with a focus on physical activity, social relations, and learning, to promote health and well-being in the workplace lived space. Lived space is situated and associated with social and cultural conventions which affect the quality of the perceived space at work. The aim of the paper is to elucidate the participant’s experiences of the intervention and how health and well-being were affected.

Methods: The intervention was conducted with employees from the warehouse of a company within the retail sector. The design consisted of one initial workshop as a baseline, a sport-based intervention, three group interviews, and a final workshop. A hermeneutic phenomenological analysis focused on experiences of the intervention and the meaning of the workplace as the lived space.

Results: Three themes emerged in the analysis; Expressing positive individual effects, Expressing improved work environment and The meaning of the workplace as lived space. The themes are discussed in relation to three basic health foci: physical activity, social relations and learning.

Conclusion: The workplace as a lived space offers a valuable opportunity for sport-based interventions that improve health and well-being through physical activity, social relations, and learning.

Sustainable Tourism Product Development: An Application of Product Design Concepts

This study examines sustainable tourism products in tourism destinations. Based on concepts of sustainable product design, our study proposes a framework for sustainable tourism products by adapting an existing Design for Sustainability Framework to consider and analyze the characteristics and themes of sustainable (tourism) products as well as their impact and scope. Using a pragmatic qualitative approach, 15 semi-structured interviews with destination managers from the German-speaking Alpine region formed the empirical basis of the study. The results emphasize key themes and multiple characteristics associated with sustainable tourism products in tourist destinations, addressing all sustainability components and design innovation levels. This study is the first to apply existing sustainable product design concepts to destination contexts and discuss their applicability for sustainable tourism products. For practitioners, this study provides support for the development of sustainable tourism products and contributes to a better understanding of the effects and levels of these products as well as sustainability marketing.

Truckies and the Australian transport industry: Managers' perspectives about enablers and inhibitors to workplace health promotion

BACKGROUND

There is little published research about managers' views about implementing and embedding workplace health promotion interventions.

OBJECTIVE

To shed light on research-to-practice challenges in implementing workplace health promotion interventions in the Australian road transport industry.

METHODS

In this Participatory Action Research project, managers from small-to-midsized companies in the Australian road transport industry were asked their views about enablers and barriers to implementing nutrition and physical activity interventions in their workplace.

RESULTS

Managers identified practical assistance with resources, ideas, and staffing as being key enablers to implementation. Barriers included time restraints, worker age and lack of interest, and workplace issues relating to costs and resources.

CONCLUSION

Manager perspectives add new insights about successful implementation of workplace health promotion. A Participatory Action Research approach allows managers to develop their own ideas for adapting interventions to suit their workplace. These findings add to a small body of knowledge about managers' views regarding implementing workplace health promotion in small-to-midsized road transport companies - a relatively unexplored group. Managers highlight the importance of time constraints and worker availability when designing interventions for the road transport industry. Managers require a good understanding of the workplaces' socio-cultural context for successful health promotion and health behaviour change.

"The Ripple Effect": The influence of social support on participation in a small workplace health promotion program

ISSUE ADDRESSED

Workplaces are key settings for health promotion. There is limited evidence pertaining to workplace health promotion [WHP] in Australian small and medium enterprises [SMEs], particularly in regional areas. This qualitative study explored employee perceptions of a pilot workplace health promotion program, LifeMAP, conducted in a small health service enterprise in regional Victoria 2014-2017, including facilitators of participation and perceived benefits of participation.

METHOD

Ten LifeMAP participants were recruited using convenience sampling. Individual semi-structured interviews (n = 7) and one focus group (n = 3) were conducted between August and September 2017. Data were analysed inductively and thematically to elicit emergent themes.

RESULTS

Social support emerged as the overarching theme influencing participation in LifeMAP, and a perceived benefit of participation. Using FitBits® and setting exercise challenges enabled social support to be fostered through role modelling, staff collegiality and community. There may be gendered differences in the experiences of role modelling in WHP.

CONCLUSIONS

This SME, and others like it, often feature high levels of employee social connectedness, with a strong workplace and community networks. Social support is a critical influence in social connectedness which needs to be considered and incorporated into the design, implementation and evaluation of WHP programs as a means of overcoming WHP recruitment and participation challenges in regional SMEs. SO WHAT?: The identification of social support as a key factor for WHP participation and employee satisfaction is a valuable finding providing insight into how similar programs may be better designed and implemented to enhance WHP program recruitment and retention.

Interfaces of occupational health management and corporate social responsibility: a multi-centre qualitative study from Germany

BACKGROUND

The workplace has been identified as a priority setting for health promotion. There are potential advantages of systematically integrating Occupational Health Management (OHM) and Corporate Social Responsibility (CSR). However, OHM and CSR are usually overseen by different management branches with different sets of values, and there is a lack of empirical research regarding interfaces between OHM and CSR. Germany offers a particularly useful setting due to legislation requiring health to be promoted in the workplace. This study aims to examine key stakeholders' views and experiences regarding interfaces between OHM and CSR in German companies.

METHODS

Individual semi-structured qualitative interviews were conducted with a sample of 77 German stakeholders from three different groups: experts in occupational health and corporate social responsibility from various companies (n = 35), business partners (n = 19), and various non-business partners (n = 23). Transcripts were analysed using qualitative content analysis.

RESULTS

Participants identified several areas in which OHM and CSR are already interacting at strategic, structural and cultural levels, but also highlighted several barriers that undermine a more meaningful interaction. Participants reported difficulties in articulating the underlying ethical values relevant to both OHM and CSR at the strategic level. Several structural barriers were also highlighted, including a lack of resources (both financial and knowledge), and OHM and CSR departments not being fully developed or undertaken at entirely different operational levels. Finally, the missing practical implementation of corporate philosophy was identified as a critical cultural barrier to interfaces between OHM and CSR, with existing guidelines and companies' philosophies that already connect OHM and CSR not being embraced by employees and managers.

CONCLUSIONS

There is already significant overlap in the focus of OHM and CSR, at the structural, strategic and cultural levels in many German companies. The potential is there, both in theory and practice, for the systematic combination of OHM and CSR. The insights from this study will be useful to ensure that closer integration between both management branches is set up in a socially sustainable and ethical manner.

Economic evaluation of workplace health promotion interventions focused on Lifestyle: Systematic review and meta-analysis

AIM

To identify and evaluate randomized clinical trials focusing on economic evaluation of workplace health promotion (WHP) interventions based on healthy lifestyles, physical activity and nutrition.

DESIGN

A systematic review and meta-analysis was carried out between March and May 2019, following the PRISMA statement.

DATA SOURCES

The literature search was conducted on Cochrane Library, Scopus, WOS and Medline databases.

REVIEW METHODS

The quality appraisal included the overall risk of bias (Cochrane Collaboration tool), the quality of the evidence (GRADEpro) and the quality of the health economic analysis (QHES instrument).

RESULTS

Of the 15 studies selected, 3 were interventions based on nutrition, 11 were focused on lifestyle and only one on physical activity. Given the heterogeneity of included studies, it was decided to do a subgroup analysis. For the weight loss (n = 5 studies), a general increase of 0.56 Kg (95% CI = 0.76, 0.84) I²  = 99.41%, and for the Quality-adjusted Life Years achieved (n = 5 studies) a very small increase of 0.003 (95% CI = 0.002, 0.004) I²  = 99.25%, were observed.

CONCLUSIONS

The implementation of lifestyle interventions in the workplace has proven to be cost-effective for both employers and society.

IMPACT

What problem did the study address? There are few studies aimed at evaluating the efficiency of WHP interventions. However, those that identify and assessing interventions related to lifestyle are particularly scarce, despite the evidence showing that these researchers improve the quality of care of occupational health. What were the main findings? This systematic review demonstrates the effectiveness of the WHP interventions, and in some cases, the efficiency of these interventions for both employers and society. Additional research in this area is necessary as well as the assessment of the cost-effectiveness of such interventions. Where and on whom will the research have an impact? To know the cost-benefit of different WHP interventions allows more efficient management of resources, which helps to make political and business decisions, becoming healthier and safer workplaces.

Health-Promoting Leadership: Concept, Measurement, and Research Framework

Employee health is not only positively related to the employee well-being and family happiness, but also impacts organizations, and society as a whole. We searched the health-promoting leadership literature in the following databases: Web of Science, ProQuest, EBSCO, and a Chinese local database. Based on this research, we clarify the concept of health-promoting leadership, propose a definition of health-promoting leadership, and examine measurement scales for this type of leadership. We also suggest a research framework for health-promoting leadership, demonstrating its potential outcomes at both the individual level (e.g., health, well-being, job attitudes) and the organizational level (e.g., health management culture and practices); the mechanisms for its development based on conservation of resources theory, the job demands–resources model, social learning theory, and social exchange theory; and antecedents (e.g., health values, health awareness, organizational health culture, organizational health climate, and organizational health promotion behavior control). Finally, we identify six potential research areas: Research level, performance, the impacts of health-promoting leaders on themselves, moderators, research methods, and intervention effects on health-promoting leadership.

Promoting Occupational Health through Gamification and E-Coaching: A 5-Month User Engagement Study

Social gamification systems have shown potential for promoting healthy lifestyles, but applying them to occupational settings faces unique design challenges. While occupational settings offer natural communities for social interaction, fairness issues due to heterogeneous personal goals and privacy concerns increase the difficulty of designing engaging games. We explored a two-level game-design, where the first level related to achieving personal goals and the second level was a privacy-protected social competition to maximize goal compliance among colleagues. The solution was strengthened by employing occupational physicians who personalized users' goals and coached them remotely. The design was evaluated in a 5-month study with 53 employees from a Dutch university. Results suggested that the application helped half of the participants to improve their lifestyles, and most appreciated the role of the physician in goal-setting. However, long-term user engagement was undermined by the scalability-motivated design choice of one-way communication between employees and their physician. Implications for social gamification design in occupational health are discussed.

Description of an integrated e-health monitoring system in a Portuguese higher education institution: the e.cuidHaMUstm program

BACKGROUND

The World Health Organization and the International Labour Organization recognize that workplace health is not only affected by occupational hazards, but is mainly affected by social determinants and individual factors. An accelerated rise in noncommunicable diseases has fostered the importance of creating supportive environments and encouraging healthy behaviours. Therefore, an operational approach to making workplaces healthy and sustainable is needed. This paper describes the development of an e-Health monitoring program entitled 'Integrated eHealth Monitoring System for Health Management in Universities' (e.cuidHaMUs^TM) as a possible solution to that operational approach.

METHODS

We developed the program e.cuidHaMUs^TM that proposes to detect risk behaviours related to noncommunicable diseases and to implement problem-solving measures by establishing a health-promoting workspace in a Portuguese higher education institution. Based on the 'I-Change' conceptual model, our program provides personalized feedback; improves health-related knowledge, attitude and good practices; and encourages actions to promote healthy lifestyles through individual health capacitation. Focusing on evaluation as an activity that generates knowledge, the e.cuidHaMUs^TM program aggregates all the relevant health information, shares the results with decision-makers and evaluates health-related policy changes in the workplace.

DISCUSSION

This paper presents the design of the e.cuidHaMUs^TM program, the development of an eHealth web platform to share information between the different stakeholders, and a questionnaire to evaluate the health status of higher education institution workers (e.cuidHaMUs.QueST®). Also, the procedures for data collection and analysis are outlined. The e.cuidHaMUs^TM program can enhance health surveillance through cross-sectional and longitudinal studies and provide scientific evidence to support the envisioned interventions and promotions of healthy lifestyles. This program is an effort to incorporate a holistic culture of health-promoting workspace in higher education institution policies.

Responsibility for chemical exposures: perspectives from small beauty salons and auto shops in southern metropolitan Tucson

Background

Throughout the United States, low-wage, minority workers are disproportionately affected by occupational illnesses and injuries. Chronic exposure to hazardous chemicals at work can lead to serious illnesses, contributing to health inequities. In this article, we expand on theories of ‘responsibilization’ in an occupational health context to reveal how responsibilities for workplace chemical exposures are negotiated by workers and owners in Latinx-owned small businesses.

Methods

We conducted semi-structured interviews with a total of 22 workers and owners in auto repair shops and beauty salons – two high-risk industries – in Southern Metropolitan Tucson. Participants were asked about their insights into workplace chemical exposures and health. A qualitative analysis team with representation from all study partner organizations collectively coded and reviewed the interview data in QSR International’s NVivo 11 and identified overarching themes across the interviews.

Results

We identified three primary themes: 1) ambivalence toward risks in the workplace; 2) shifting responsibilities for exposure protection at work; and 3) reflections on the system behind chemical exposure risks. Participants discussed the complexities that small businesses face in reducing chemical exposures.

Conclusions

Through our analysis of the interviews, we examine how neoliberal occupational and environmental policies funnel responsibility for controlling chemical exposures down to individuals in small businesses with limited resources, obscuring the power structures that maintain environmental health injustices. We conclude with a call for upstream policy changes that more effectively regulate and hold accountable the manufacturers of chemical products used daily by small business workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10336-4.

Flexible Work Arrangements and Health in White-Collar Urban Professionals

Although some research has examined health implications of flexible work arrangements, little is known about job flexibility and health in the context of modern working life, characterized by intensification. Grounded on the Job Demand-Resource model, this article explores access to flexible work arrangements and organizational climate on the health and well-being of white-collar, urban professionals in downtown Toronto. A qualitative content analysis of eight semistructured interviews with white-collar, urban professionals between the ages of twenty-five and thirty-two revealed three domains-intensity of work life and demands, coworker and managerial relations, and the boundaries between work and home-where demands outweighed resources to limit workers' ability to practice flexibility. Thus, an emerging trend where workers need to be flexible within flexible work arrangements emerged. Findings point to the need for organizational commitment and activities to address unhealthy behaviors in the context of modern working life.

Do health programmes within the New Zealand food industry influence the work environment for employees?

Workplace wellness programmes have increased over the past years, but as yet has not been investigated in food and grocery organizations in New Zealand (NZ). The study aim was to explore the commitment of NZ Food and Grocery Council (FGC) companies in altering the workplace environment for employee health and the efficacy of the current wellness policies. Using a mixed-methods approach, FGC companies (n = 22) completed a workplace environment audit (WEA) survey. Three focus groups were held, consisting of employees (n = 20) from four of the FGC companies that completed the WEA survey. Two sets of data were then compared via methodological triangulation. The mean WEA score was 46% (p = 0.00), indicating an 'average' commitment by the FGC to health-promotion in their own workplaces. Significantly more initiatives related to improving nutrition were offered (p = 0.00) and larger food companies scored higher than smaller companies (p = 0.063). During the focus groups, employees revealed they felt workplace wellness programmes increased productivity, improved their physical health, allowed work-life balance, promoted social interaction and provided health-related education. Barriers to participating in wellness activities were identified as lack of time, working in a blue-collar position and working externally to the main office. The results of this study have large implications for companies and employers in NZ for future planning, implementation and monitoring of health initiatives in the workplace.

Predictors of uptake of general and tailored services to improve employee health and wellbeing

ISSUE ADDRESSED

Healthy workplace programs can improve employee health and wellbeing. However, there is little research on how they are adopted by organisations. The study aimed to investigate uptake and predictors of service use amongst organisations utilising a comprehensive government-funded healthy workplace program.

METHODS

Employees taking part in the Healthier Workplaces WA program can access general services (ie, basic information on workplace health and wellbeing) and tailored services (ie, personalised support on implementing changes). A sample of 358 eligible program participants from 204 organisations completed a service experience survey 6 months after engaging with any service. Predictors of service use were analysed using a Kruskal-Wallis H test.

RESULTS

On average, respondents accessed 3.4 (out of 7) services. General services were accessed more frequently than tailored services. The Kruskal-Wallis H test showed that respondents working in Human Resources or Health and Safety and those from large organisations were more likely to access a greater range of services compared to employees in other roles and those working in small to medium organisations. Additionally, greater perceived support from management or co-workers was associated with greater service use.

CONCLUSIONS

Respondents reported accessing general services more than tailored services. Service use was greater amongst those who perceived greater support from their managers and/or co-workers, those who worked in large organisations and those who worked in HR/OHS. SO WHAT?: These findings are informative for practitioners assisting organisations to improve health and wellbeing initiatives and service providers interested in increasing service uptake. A mix of general and tailored services is likely to be useful in building employees' capacity to increase health and wellbeing in their workplace. Support from management and co-workers is an important facilitator, and small organisations may require more focussed targeting due to the lower tendency to engage with these programs and increased benefits.

Managers' Perceptions of Factors Affecting Employees' Uptake of Workplace Health Promotion (WHP) Offers

Managers are often charged with the responsibility of overseeing Workplace health promotion (WHP) for which significant amounts of resources are laid aside yearly. While there is increasing interest by employers to include WHP policies, studies show that WHP implementation and uptake by employees still need to be improved upon. Given that managers are part of organizational decision-making and implementation of new policies, they serve as the bridge between workers and management. The aim of this study is to investigate managers' perceptions of employees' WHP uptake as well as challenges encountered by managers in the execution of their WHP-related tasks. Method: This study is based on a qualitative method using semi-structured interviews. Participants in the study were managers at medium and large-scale private companies in Northcentral Sweden. To ensure that participating companies are comparable in terms of structure and policy, only companies within the private sector were eligible to participate. Furthermore, only one manager per company was interviewed. A total of nineteen managers participated and the data generated were analyzed using content analysis. Results: A total of three themes and nine subthemes emerged. The first theme deals with factors at the individual level, subthemes include awareness of WHP, work-life balance, and attitudes. The second theme comprises of factors related to the WHP offer, subthemes were design of the WHP, supportive collaborators and financing of WHP. The third theme deals with organizational factors, subthemes were the nature of the organization's operations, management as role models and resources and support for managers. Results show that most of the challenges encountered by managers in executing WHP were mostly at the organizational level. Conclusion: Addressing modifiable factors at the individual and organizational levels and those related to the WHP may improve WHP uptake among employees.

Effects of Workplace-Based Physical Activity Interventions on Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis of Controlled Trials

BACKGROUND

Cardiorespiratory fitness is a strong predictor of all-cause mortality. Physical activity of at least moderate intensity can improve cardiorespiratory fitness. Workplaces may provide a relatively controlled setting in which to improve cardiorespiratory fitness through physical activity. Limited work has been conducted to quantify the impact of delivering physical activity in the workplace on cardiorespiratory fitness.

OBJECTIVE

The objective of this systematic review was to quantify the effects of workplace physical activity interventions on peak oxygen consumption (VO_2peak) and explore study and participant characteristics as putative moderators.

METHODS

Seven databases were searched up to September 2018. Search terms included "workplace", "physical activity" and "intervention". Inclusion criteria were controlled trials where physical activity of at least moderate intensity was delivered in the workplace and compared to controls or non-active comparators; and cardiorespiratory fitness measured by actual or predicted VO_2peak. Risk of bias was assessed using the PEDro scale. A random-effects meta-analysis was conducted with between-study variation quantified and then explored for putative predictors with a meta-regression. Pooled estimate uncertainty was expressed as 90% confidence intervals (CIs) and assessed against our threshold value for clinical relevance of 1 mL·kg^-1·min^-1.

RESULTS

The final dataset consisted of 25 estimates of VO_2peak from 12 trials. The pooled mean differences between intervention and control arms was a beneficial improvement of 2.7 mL·kg^-1·min^-1 (90% CI 1.6-3.8). The 95% prediction interval ranged from a reduction in VO_2peak of - 1.1 to an improvement of 6.5 mL·kg^-1·min^-1. Between-study heterogeneity (τau) was ± 1.6 mL·kg^-1·min^-1. The meta-regression showed longer interventions (3.2 mL·kg^-1·min^-1; 90% CI 1.6-3.8) to have an additive effect and studies with a low risk of bias (- 2.5 mL·kg^-1·min^-1; 90% CI - 4.0 to - 1.0), and participants of greater baseline VO_2peak (- 1.6 mL·kg^-1·min^-1; 90% CI - 3.6 to 0.4), and age (- 1.4 mL·kg^-1·min^-1; 90% CI - 3.2 to 0.3) having a lesser effect. Participant sex (percentage female) had an additive effect on VO_2peak (0.4 mL·kg^-1·min^-1; 90% CI - 1.6 to 2.4).

CONCLUSIONS

Workplace-based physical activity interventions consisting of at least moderate-intensity activity improve cardiorespiratory fitness. At the present time, we surmise that no single group of employees (e.g. older employees or less fit individuals) can be definitively identified as standing to benefit more from workplace physical activity interventions than others. This demonstrates the potential utility of workplace physical activity interventions for improving cardiorespiratory fitness in a broad range of healthy employees. Protocol registration: PROSPERO (registration number: 42017057498).

Size Matters: A Latent Class Analysis of Workplace Health Promotion Knowledge, Attitudes, Practices and Likelihood of Action in Small Workplaces

Workplace health programs (WHPs) have been shown to improve employee health behaviours and outcomes, increase productivity, and decrease work-related costs over time. Nonetheless, organizational characteristics, including size, prevent certain workplaces from implementing these programs. Past research has examined the differences between small and large organizations. However, these studies have typically used a cut-off better suited to large countries such as the USA. Generalizing such studies to countries that differ based on population size, scale of economies, and health systems is problematic. We investigated differences in WHP knowledge, attitudes, and practices between organizations with under 20 employees, 20–99 employees, and more than 100 employees. In 2017–2018, a random sample of employers from 528 workplaces in Alberta, Canada, were contacted for participation in a cross-sectional survey. Latent Class Analysis (LCA) was used to identify underlying response pattern and to group clusters of similar responses to categorical variables focused on WHP knowledge, attitudes, practices and likelihood of action. Compared to large organizations, organizations with fewer than 20 employees were more likely to be members of the Medium–Low Knowledge of WHP latent class (p = 0.01), the Low Practices for WHP latent class (p < 0.001), and more likely to be members of Low Likelihood of Action in place latent class (p = 0.033). While the majority of workplaces, regardless of size, recognized the importance and benefits of workplace health, capacity challenges limited small employers’ ability to plan and implement WHP programs. The differences in capacity to implement WHP in small organizations are masked in the absence of a meaningful cut-off that reflects the legal and demographic reality of the region of study.

Exploring health and well-being in Taiwan: what we can learn from individuals' narratives

BACKGROUND

Our aim was to explore the concepts of health and well-being from the point of view of the people experiencing them. Most of the efforts to understand these concepts have focused on disease prevention and treatment. Less is known about how individuals achieve health and well-being, and their roles in the pursuit of a good life. We hoped to identify important components of these concepts that may provide new targets and messages to strengthen existing public health programs. An improved understanding of health and well-being - or what it means to be well - can guide interventions that help people lead healthier, more fulfilling lives.

METHODS

Using a grounded qualitative approach drawing from narrative inquiry, we interviewed 24 Taiwanese adults. Thematic inductive coding was employed to explore the nature of health and well-being.

RESULTS

Eight constituent domains emerged regarding well-being and health. While the same domains were found for both constructs, important frequency differences were found when participants discussed health versus well-being. Physical health and lifestyle behaviors emerged as key domains for health. Disease-related comments were the most frequently mentioned sub-category within the physical health domain, along with health care use and aging-related changes. For well-being, family and finances emerged as key domains. Family appears to be a cornerstone element of well-being in this sample, with participants often describing their personal well-being as closely tied to - and often indistinguishable from - their family. Other domains included work-life, sense of self, resilience, and religion/spirituality.

CONCLUSIONS

Health and well-being are complex and multifaceted constructs, with participants discussing their constituent domains in a very interconnected manner. Programs and policies intended to promote health and well-being may benefit from considering these domains as culturally-appropriate leverage points to bring about change. Additionally, while the domains identified in this study are person-centered (i.e., reflecting the personal experiences of participants), the stories that participants offered provided insights into how well-being and health are influenced by structural, societal and cultural factors. Our findings also offer an opportunity for future refinement and rethinking of existing measurement tools surrounding these constructs.

Exploring and Developing the Workplace Health Culture Scale in Taiwan

Background: The aim of this study was to develop and validate the workplace health culture scale.

Methods: This paper collected and re-organized current definitions about health culture from literature and created the domains and items to develop a new tool. Six enterprises and 2,431 participants were recruited from northern Taiwan for validity test.

Results: We found the workplace health culture scale had appropriate reliability and validity, including a good model fit for the 25-item scale.

Conclusions: Workplace health culture might be an important domain to the work of WHP. More validity and reliability studies about WHCS in wider industries and the correlation between WHCS and other WHP indicators are needed.

Burned Out: Workplace Policies and Practices Can Tackle Occupational Burnout

Burnout has been included as an occupational phenomenon in the International Classification of Diseases. Health promotion through workplace physical activity policies, incentives, and supports has the potential to prevent burnout.

Work Disability in Australia: An Overview of Prevalence, Expenditure, Support Systems and Services

Purpose This study sought to describe Australian systems of income support for people with work disability. Specific aims were to summarise and compare the features of the income support systems, including the rehabilitation and employment services funded or provided by those systems, and factors affecting transition between systems. Further objectives were to estimate the prevalence of work disability in Australia and the national expenditure on work disability income support. Methods A mixed methods project involving collation and analysis of existing publicly available documentation and data, and interviews with 25 experts across ten major systems of income support. The prevalence of work disability and expenditure in each system, and in total, was estimated using publicly accessible data sources. System features and service models were synthesised from data sources, tabulated and compared qualitatively. Results In Australia during the 2015/2016 financial year an estimated 786,000 people with work disability received income support from a Commonwealth, state, territory or private source. An additional 6.5 million people accessed employer provided leave entitlements for short periods of work incapacity. A total of $37.2 billion Australian dollars was spent on income support for these people during the year. This support was provided through a complex array of government authorities, private sector insurers and employers. Service models vary substantially between systems, with case management the only service provided across all systems. Healthcare and return to work services were provided in some systems, although models differed markedly between systems. Income support ranged from 19 to 100% of earnings for a person earning the average weekly Australian wage pre-disability. There is a paucity of information relating to movement between systems of support, however it is likely that many thousands of people with long periods of work disability transition between systems annually. Conclusions This study demonstrates the substantial financial and human impact of work disability on Australian society. Findings indicate multiple opportunities for reducing the burden of work disability, including aligning case management and healthcare service models, and engaging employers in prevention and rehabilitation. The findings suggest a need for greater interrogation and evaluation of Australian work disability support systems.

RE-AIM evaluation of a one-year trial of a combined educational and environmental workplace intervention to lower salt intake in Switzerland

Reducing excessive dietary sodium may reduce cardiovascular disease risk. Environmental and behavioral interventions in workplaces may reduce salt consumption, but information on the effectiveness of workplace nutrition interventions is sparse. We used the RE-AIM framework to evaluate a one-year trial in 2015–2016 of an educational and environmental intervention to lower salt intake of employees in organizations with catering facilities in Switzerland. Five educational workshops for employees and assessments that included 24-hour urine collection were combined with five coaching sessions and food analyses in catering operations. We studied the adoption, reach, implementation, effectiveness, and maintenance of the intervention.

Eight of 389 candidate organizations participated in the trial in which 145 (50% men) out of 5794 potentially eligible employees consented to participate, and 138 completed the trial with 13 in the control group.

The overall mean change of daily salt intake was −0.6 g from 8.7 g to 8.1 g (6.9%). Though the mean daily salt intake of women was unaltered from 7 g, the mean intake of men declined by −1.2 g from 10.4 g to 9.2 g. Baseline salt intake, sex, and waist-to-height ratio were significant predictors of salt reduction. The analysis also highlighted pivotal determinants of low adoption and reach, and program implementation in catering operations. We conclude that a workplace program of nutrition intervention for employees and catering staff is feasible. The acceptance, effectiveness, and maintenance of nutrition interventions in the workplace require strong employer support. In a supportive food environment, interventions tailored to sex, age, and CVD risk inter alia could be successful.

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Leadership support is of vital importance to success of workplace nutrition trials.

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The observed overall salt intake reduction was not statistically significant.

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Baseline salt intake, sex, and waist-to-height ratio explained salt reduction.

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Habits and high-salt food environment were cited as barriers to reduced salt intake.

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Catering has not succeeded in strictly implementing a gradual salt reduction approach.

Developing and Pilot Testing an Integrated Technology-Moderated Institutional Health Promotion Model Using Operational Research Approach

The study aimed to develop and pilot test an Integrated Technology-Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology-Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology-moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology.

Participants' Experiences of a Workplace-Oriented Problem Gambling Prevention Program for Managers and HR Officers: A Qualitative Study

Workplace health promotion programs (WHPPs) refer to a set of health promotion and protection strategies implemented at a worksite and designed to meet the health and safety needs of employees. One important question for WHPPs is how middle management experience their participation in a WHPP. This study aims to explore this question further by applying a qualitative content analysis to interviews with thirteen managers and ten human resource officers participating in a WHPP focusing on problem gambling. The WHPP consisted of two components: policy implementation and skills-development training. The participants were interviewed about their experiences of these two components and the implementation process. The qualitative content analysis resulted in six themes: (1) Expectations of the skills-development training, (2) Experiences of and prior beliefs about problem gambling, (3) A good foundation, (4) The difficult conversation, (5) Appreciated aspects of the training sessions, and (6) Remaining obstacles. The results suggest that the presentation of cases, facts, and general knowledge was appreciated by most participants. However, participants also expressed that they would benefit from tailored interventions, more support in the policy implementation process, and following up on the results.

The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees' health and fitness. Previous research has focused on such program's effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one's health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees.

Total Worker Health: A Small Business Leader Perspective

Total Worker Health® (TWH) frameworks call for attention to organizational leadership in the implementation and effectiveness of TWH approaches. It is especially important to study this within in the small business environment where employees face significant health, safety, and well-being concerns and employers face barriers to addressing these concerns. The purpose of this study was to gain a better understanding of how small business leaders perceive employee health, safety, and well-being in the context of their own actions. We conducted semi-structured interviews with 18 small business senior leaders and used a qualitative coding approach to analyze the transcripts to determine the frequency with which leaders discussed each code. When we asked leaders about their leadership practices for health, safety, and well-being, leaders reflected upon their business (65%), themselves (28%), and their employees (7%). Leaders rarely discussed the ways in which they integrate health, safety, and well-being. The interviews demonstrate that small business leaders care about the health of their employees, but because of the perceived value to their business, not to employees or themselves. Thus, they may lack the knowledge and skills to be successful TWH leaders. The present study supports a need for continued small business TWH leadership research.

Culture, management and finances as key aspects for healthy workplace initiatives

The aim of this study was to qualitatively explore the barriers and enablers to implementing healthy workplace initiatives in a sample of workplaces based in Perth, Western Australia. In-depth interviews were conducted with representatives from 31 organizations representing small, medium and large businesses in the Perth metropolitan area which reported having healthy workplace initiatives. In total, 43 factors were mentioned as influencing the implementation of healthy workplace initiatives. Factors appearing to exert the most influence on the implementation of health promoting initiatives in this sample were culture; support from managers and staff; collaboration with industry providers; financial resources circumstances and the physical environment. These factors appeared to be mutually reinforcing and interconnected. Findings suggest there may be merit in applying an organizational development lens to the implementation of workplace health promotion initiatives as this could assist in leveraging enablers and minimizing barriers.

Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study

OBJECTIVE

To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers.

DESIGN

Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up.

SETTING

Four multinational manufacturing workplaces in Cork, Ireland.

PARTICIPANTS

517 randomly selected employees (18-65 years) from four workplaces.

INTERVENTIONS

Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control.

OUTCOMES

The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty.

RESULTS

The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost-benefit analysis, whereby the system-level intervention yields the highest net benefit (€56.56 per employee).

CONCLUSIONS

System-level dietary modification alone offers the most value per improving employee health-related quality of life and generating net benefit for employers by reducing absenteeism. While system-level dietary modification strategies are potentially sustainable obesity prevention interventions, future research should include long-term outcomes to determine if improvements in outcomes persist.

TRIAL REGISTRATION NUMBER

ISRCTN35108237; Post-results.

Employer and Promoter Perspectives on the Quality of Health Promotion Within the Healthy Workplace Accreditation

OBJECTIVES

To explore the employers' and promoters' perspective of health promotion quality according to the healthy workplace accreditation.

METHODS

We assessed the perspectives of 85 employers and 81 health promoters regarding the quality of health promotion at their workplaces. The method of measurement referenced the European Network for Workplace Health Promotion (ENWHP) quality criteria.

RESULTS

In the large workplaces, the accredited corporation employers had a higher impression (P < 0.001) of all criteria. The small-medium accredited workplace employers had a slightly higher perspective than non-accredited ones. Nevertheless, there were no differences between the perspectives of health promoters from different sized workplaces with or without accreditation (P > 0.05).

CONCLUSIONS

It seems that employers' perspectives of healthy workplace accreditation surpassed employers from non-accredited workplaces. Specifically, large accredited corporations could share their successful experiences to encourage a more involved workplace in small-medium workplaces.

Healthy lifestyle behavior of employees in small and medium-sized enterprises in Aydin, Turkey

OBJECTIVE

To determine healthy lifestyle behavior and affecting risk factors in workers at small and medium-sized enterprises from four different sectors in Aydin, Turkey.

METHODS

This cross-sectional study was conducted at four different small and medium-sized enterprises in Aydin, Turkey and 264 employees participated in the study. A questionnaire was used for data collection. It consisted of questions about socio-demographic features (age, gender, marital status, education, perceived income, occupation and having children), health status, and medical history, medication use, having occupational accidents and occupational health and safety. Healthy Lifestyle Behavior Scale, which was developed by Walker et al. in 1996, was used to evaluate healthy lifestyle behaviors of the workers.

RESULTS

The mean score for Healthy Lifestyle Behavior Scale was 135.46±22.49. Gender, marital status, perceived income, sector of workplace, title, presence of a chronic disease, finding oneself healthy in the previous year and having an occupational accident in the previous year did not significantly affect any subscales of Healthy Lifestyle Behavior Scale. The workers aged over 50 years had significantly higher scores for health responsibility than those aged 20-29 years (p<0.05). The workers living in a village got significantly higher scores for Healthy Lifestyle Behavior Scale and its subscales health responsibility, physical activity, nutrition and spiritual development than those living in a city (p<0.05).

CONCLUSION

Although workers have good spiritual development, they may not adopt physical activity as a healthy lifestyle and that workers benefiting from occupational health and safety services can display healthy lifestyle behavior.