Positive changes and worksite health education

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

OBJECTIVE

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

DATA SOURCE

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

STUDY INCLUSION AND EXCLUSION CRITERIA

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

DATA EXTRACTION

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

DATA SYNTHESIS

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

RESULTS

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

CONCLUSIONS

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

Implementing University-Based Wellness: A Participatory Planning Approach

Community and work-site wellness programs are increasing in prominence. However, planning and implementing such programs at large bureaucratic institutions are difficult. This project established a wellness program at a major university using a participatory planning approach that is applicable to other complex organizations. University students, faculty, staff, administrators, and retirees volunteered to participate in a 12-week planning project. The project consisted of weekly sessions designed to promote participation, ownership, and problem solving. Activities included information exchange, wellness lifestyle practice, reflection, discussion, and wellness program planning. Participants organized themselves into special task forces to identify campus health problems, barriers, and resources as well as to define goals and implementation strategies for a proposed ongoing university wellness program. A campus-wide university wellness program was implemented the following academic year. The project was effective in overcoming institutional barriers and mobilizing community resources. It is recommended that this approach be used in other settings.

Promising Practices for the Prevention and Control of Obesity in the Worksite

Purpose.

To identify worksite practices that show promise for promoting employee weight loss.

Data Source.

The following electronic databases were searched from January 1, 1966, through December 31, 2005: CARL Uncover (via Ingenta), CDP, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Library, CRISP, Dissertation Abstracts, EMBASE, ERIC, Health Canada, INFORM (part of ABI/INFORM Proquest), LocatorPlus, New York Academy of Medicine, Ovid MEDLINE, SPORTDiscus, PapersFirst, PsycINFO, PubMed, and TRIP.

Study Inclusion and Exclusion Criteria.

Included studies were published in English, conducted at a worksite, designed for adults (aged ≥18 years), and reported weight-related outcomes.

Data Extraction.

Data were extracted using an online abstraction form.

Data Synthesis.

Studies were evaluated on the basis of study design suitability quality of execution, sample size, and effect size. Changes in weight-related outcomes were used to assess effectiveness.

Results.

The following six promising practices were identified: enhanced access to opportunities for physical activity combined with health education, exercise prescriptions alone, multicomponent educational practices, weight loss competitions and incentives, behavioral practices with incentives, and behavioral practices without incentives.

Conclusions.

These practices will help employers and employees select programs that show promise for controlling and preventing obesity. (Am J Health Promot 2011;25[3]:e12–e26.)

A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback

BACKGROUND

Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees.

EVIDENCE ACQUISITION

The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity.

EVIDENCE SYNTHESIS

The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone.

CONCLUSIONS

The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement.

Meta-analysis of workplace physical activity interventions

CONTEXT

Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research.

EVIDENCE ACQUISITION

Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008.

EVIDENCE SYNTHESIS

Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose.

CONCLUSIONS

These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

Evaluating worksite-based interventions that promote safety belt use

OBJECTIVE

The objective of this study was to evaluate the effectiveness of worksite-based interventions in increasing the use of safety belts among employees.

SEARCH STRATEGIES

Using the Cochrane Collaboration search strategy, we searched in electronic databases, review articles, U.S. government documents, and reports of research agencies.

SELECTION CRITERIA

Studies had to be evaluations of worksite-based interventions with a clear description of the program. The outcomes evaluated were the percentage of drivers using their safety belts before and after the intervention and (when possible) after a follow-up period. Safety belt use had to be measured in an objective manner, and a comparison group was necessary.

RESULTS

Forty-eight interventions met the selection criteria. All interventions increased safety belt use among employees, and in 16 the increases were significant (p<0.05). In 15 of the 33 interventions in which follow-up observations were reported, safety belt use continued significantly higher than at baseline. Different strategies (and combinations of strategies) were used across interventions. Interventions incorporating incentives seemed to have stronger effects in increasing safety belt use.

CONCLUSIONS

All reviewed interventions had a positive impact on increasing driver use of safety belts. However, it is important to note the low baseline safety belt use existing at the time when the studies took place, the short-term duration of most interventions, and the short-term follow-up reported (if any). More rigorous research in contemporary worksites is needed.