Worksite health promotion programs in the U.S.: factors associated with availability and participation

Is It Time to Re-Shift the Research Agenda? A Scoping Review of Participation Rates in Workplace Health Promotion Programs

Workplace health promotion programmes (WHPPs) are among the most important measures to improve the health and motivation of the ageing workforce. However, they are accompanied with certain challenges, such as low participation rates and higher participation levels of the more health-conscious workers, often failing to engage those who need such interventions the most. Following the PRISMA guidelines, this scoping review examined participation rates reported in articles on WHPPs to identify potential knowledge gaps. The results are worrying: participation rates are not only infrequently reported, but also low. Of the 58 articles, 37 report participation rates, with the majority (20) reporting an average participation rate of less than 50%. Reported participation rates refer either to different target groups, the type of intervention, or to single points in time, which makes it difficult to establish consistent criteria for comparison. We argue that despite the importance of WHPP efficacy, research focus should shift to the determinants of participation, as well as the issue of standardising the reporting of participation rates, alongside the potential problem of reporting bias.

Barrier profiles in workplace health promotion in Germany

Workplace health promotion (WHP) is often faced with low-participation rates despite high relevance. This limits the potential for creating positive effects for the organization and its staff. Therefore, we investigated the barriers perceived by employees themselves using a representative sample (regarding age, gender and education) in Germany. Data were collected using a quantitative online questionnaire and then analyzed regarding underlying patterns. We found that there are different barrier types, and their importance differs depending on demographic criteria of the participants and the organizations they work for. These results can help organizations to reduce participation barriers to WHP for their staff.

Association Between the Characteristics of Organizations and Their Profile of Performance Against Quality Benchmarks for Workplace Health Promotion

OBJECTIVE

This study explored subgroups of performance profiles measured by organizations' Well Workplace Checklist (WWC) benchmark scores and examined company characteristics associated with performance subgroups.

METHODS

The sample included 3728 US organizations that completed the WWC in 2008 to 2015. Latent profile analysis (LPA) was used to extract distinct subgroups of organizations based on benchmark performance. Multinomial logistic regression analysis was used to examine associations between the characteristics of organizations and their performance subgroup.

RESULTS

Three distinct subgroups of performance resulted from the LPA. Significant associations were found between subgroup assignment and characteristics such as size, industry, how WHP initiatives were paid for, and reasons for implementing WHP initiatives.

CONCLUSION

The characteristics associated with subgroups of performance suggest utility for developing specific interventions tailored to different types of organizations to improve their overall quality of WHP initiatives.

Tracking Changes in US Organizations' Workplace Health Promotion Initiatives: A Longitudinal Analysis of Performance Against Quality Benchmarks

PURPOSE

To examine changes in organizations' workplace health promotion (WHP) initiatives over time associated with repeated self-assessment using the Well Workplace Checklist (WWC).

DESIGN

Well Workplace Checklist data include a convenience sample of US organizations that selected to assess their performance against quality WHP benchmarks.

SETTING

Workplaces.

SUBJECTS

In total, 577 US organizations completed the WWC in 2 or more years from 2008 to 2015.

MEASURES

The WWC is a 100-item organizational assessment that measures performance against the original set of quality benchmarks that were established by the Wellness Council of America (WELCOA).

ANALYSIS

This study examined changes in overall WWC scores as well as 7 separate benchmark scores. Multilevel modeling was used to examine changes in scores associated with repeated assessments, controlling for the year of assessment and organizational characteristics.

RESULTS

There were significant increases in overall WWC scores (β = 2.93, P < .001) associated with the repeated WWC assessments, after controlling for organizational characteristics. All 7 benchmark scores had significant increases associated with reassessment. Compared to other benchmarks, operating plan (β = 6.18, P < .001) and evaluation (β = 4.91, P < .001) scores increased more with each reassessment.

CONCLUSION

Continued reassessment may represent more commitment to and investment in WHP initiatives which could lead to improved quality. Other factors that may positively influence changes in performance against benchmarks include company size, access to outside resources for WHP, and a history with implementing WHP.

Putting the National Diabetes Prevention Program to Work: Predictors of Achieving Weight-Loss Goals in an Employee Population

Introduction

Differences in eligibility criteria and intervention characteristics have limited the generalizability of findings from studies of worksite translations of the National Diabetes Prevention Program (DPP). The objective of our study was to identify factors associated with achievement of the DPP’s 5% weight-loss goal in the Vanderbilt University Medical Center (VUMC) Faculty and Staff Health and Wellness DPP from 2014 to 2017.

Methods

We analyzed data from a DPP worksite translation that adhered to national standards for program quality and intervention fidelity. We compared baseline characteristics and program metrics for participants who did and did not achieve the program’s 5% weight-loss goal, and we developed a multivariable logistic regression model to identify independent predictors of achieving this goal.

Results

Of the 165 employees enrolled in the DPP from 2014 to 2017, 43.6% (n = 72) met the 5% weight-loss goal. Mean (standard deviation) percentage weight loss for the program was 5.2% (6.0%), or 4.8 (6.0) kg. The median (interquartile range) body mass index at baseline was lower among participants who achieved the 5% weight-loss goal than among those who did not (31.6 [29.4–37.4] vs 34.7 [31.5–39.2], P = .009), and participants who achieved the goal reported more physical activity minutes per week (166.0 [135.2–223.0] min vs 128.5 [83.2–169.8] min, P < .001). Session attendance was greater for participants achieving the 5% weight-loss goal (23 [21–25]) sessions vs 18 [12–21] sessions, P < .001). In the adjusted analysis, physical activity and session attendance remained significant predictors of achieving the 5% weight-loss goal.

Conclusion

Session attendance and physical activity independently predicted achievement of the 5% weight-loss goal in this worksite translation of the DPP. Strategies designed to improve these metrics may increase DPP success rates.

Assessing Workplace Health and Safety Strategies, Trends, and Barriers through a Statewide Worksite Survey

Chronic diseases have added to the economic burden of the U.S. healthcare system. Most Americans spend most of their waking time at work, thereby, presenting employers with an opportunity to protect and promote health. The purpose of this study was to assess the implementation of workplace health governance and safety strategies among worksites in the State of Nebraska, over time and by industry sector using a randomized survey. Weighted percentages were compared by year, industry sector, and worksite size. Over the three study periods, 4784 responses were collected from worksite representatives. Adoption of workplace health governance and planning strategies increased over time and significantly varied across industry sector groups. Organizational safety policies varied by industry sector and were more commonly reported than workplace health governance and planning strategies. Time constraints were the most common barrier among worksites of all sizes, and stress was reported as the leading employee health issue that negatively impacts business. Results suggest that opportunities exist to integrate workplace health and safety initiatives, especially in blue-collar industry sectors and small businesses.

Availability of and Participation in Workplace Health Promotion Programs by Sociodemographic, Occupation, and Work Organization Characteristics in US Workers

PURPOSE

To examine how the availability of and participation in workplace health promotion programs (WHPPs) vary as a function of sociodemographic, occupation, and work organization characteristics.

DESIGN

Cross-sectional study.

SETTING

2015 National Health Interview Survey and Occupational Health Supplement.

PARTICIPANTS

The study sample included 17 469 employed adults who completed the WHPP questions.

MEASURES

The 2 dependent outcome measures were availability of WHPPs and participation in these programs when available. Independent variables included occupation and 8 work organization and employment characteristics: company size, hours worked, supervisory responsibility, hourly pay, paid sick leave, health insurance offered by employer, work schedule, and work arrangement.

ANALYSIS

Poisson regression analyses were conducted with SUDAAN 11.0.1.

RESULTS

Overall, 57.8% of 46.6% employees who have WHPPs available reported participating in these programs. This study found that adults who worked ≤20 h/wk, worked regular night shifts, were paid by the hour, or worked for temporary agencies were less likely to participate in WHPPs. Workers who supervised others were 13% more likely to participate than nonsupervisors. Borderline associations were seen for having access to employer-sponsored health insurance and working at a site with <10 employees.

CONCLUSION

Despite the potential for improving physical and mental health, only 58% of US workers participated in WHPPs. Since barriers to WHPP participation (eg, time constraints, lack of awareness, and no perceived need) may vary across occupations and work organization characteristics, employers should tailor WHPPs based on their specific work organization characteristics to maximize participation.

The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment

BACKGROUND

The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outcomes and associated costs, especially within a causal framework. Health related fiscal impacts of transit investment should be a key consideration in major transit investment decisions.

METHODS

The Rails & Health study is a natural experiment evaluating changes in clinical measures, health care utilization and health care costs among Kaiser Permanente Northwest (KPNW) members following the opening of a new light rail transit (LRT) line in Portland, Oregon. The study is prospectively following 3036 adults exposed to the new LRT line and a similar cohort of 4386 adults who do not live close to the new line. Individual-level outcomes and covariates are extracted from the electronic medical record at KPNW, including member demographics and comorbidities, blood pressure, body mass index, lipids, glycosylated hemoglobin, and health care utilization and costs. In addition, participants are surveyed about additional demographics, travel patterns, physical activity (PA), and perceived neighborhood walkability. In a subsample of the study population, we are collecting direct measures of travel-related behavior-physical activity (accelerometry), global positioning system (GPS) tracking, and travel diaries-to document mechanisms responsible for observed changes in health outcomes and cost. Comprehensive measures of the built environment at baseline and after rail construction are also collected. Statistical analyses will (1) examine the effects of opening a new LRT line on chronic disease indicators, health care utilization, and health care costs and (2) evaluate the degree to which observed effects of the LRT line on health measures and costs are mediated by changes in total and transportation-associated PA.

DISCUSSION

The results of the Rails & Health study will provide urban planners, transportation engineers, health practitioners, developers, and decision makers with critical information needed to document how transit investments impact population health and related costs.

Supporting the Health of Low Socioeconomic Status Employees: Qualitative Perspectives From Employees and Large Companies

OBJECTIVE

The aim of this study was to identify alignments between wellness offerings low socioeconomic status (SES) employees need and those large companies can provide.

METHODS

Focus groups (employees); telephone interviews (large companies). Employees were low-SES, insured through their employers, and employed by large Washington State companies. Focus groups covered perceived barriers to healthy behaviors at work and potential support from companies. Interviews focused on priorities for employee health and challenges reaching low-SES employees.

RESULTS

Seventy-seven employees participated in eight focus groups; 12 companies completed interviews. Employees identified facilitators and barriers to healthier work environments; companies expressed care for employees, concerns about employee obesity, and reluctance to discuss SES.

CONCLUSION

Our findings combine low-SES employee and large company perspectives and indicate three ways workplaces could most effectively support low-SES employee health: create healthier workplace food environments; prioritize onsite physical activity facilities; use clearer health communications.

Is work keeping us from acting healthy? How workplace barriers and facilitators impact nutrition and exercise behaviors

The purpose of this study was to identify common barriers and facilitators to healthy nutrition and exercise behaviors in the workplace and examine their relationships to those actual daily health behaviors. We utilized a concurrent embedded mixed methods approach to collect data from 93 participants over the span of four days. Participants reported 2.80 nutrition and 3.28 exercise barriers on average over the 4 days, while reporting 2.93 nutrition and 1.98 exercise facilitators in the same timeframe. Results indicated that workload and temptations around the office prevented nutritious eating; exercise behaviors were frequently hindered by workload. The most commonly mentioned eating facilitator was proper planning, while having time to exercise facilitated physical activity. Furthermore, the number of barriers reported negatively related to their respective health behaviors (i.e., more nutrition barriers translated to poorer nutrition habits) and facilitators were positively related to them, both overall and more so on the specific day they were reported. The implications of these finding show the importance of barriers/facilitators in the workplace and aid in the creation of more targeted health promotion that could increase positive employee health behaviors by eliminating common barriers and enhancing facilitators.

Reasons for using workplace wellness services: Cross-sectional study among 6000 employees

AIMS

While workplace wellness services are proactively established to improve well-being and reduce sickness absence, knowledge of reasons for using these services remains sparse. This study investigates which factors determine use of an in-house wellness service at a large organization (the Danish Police) with several departments in different geographical locations.

METHODS

All potential users of the Wellness service ( n = 15,284) were invited to respond to a cross-sectional questionnaire. Of 6060 eligible respondents, 58% had used the service at least once (any use) and 17% had used the service at least three times (frequent users). Two items assessed the frequency of statements of justifications for using or not using the Wellness service. Associations between 32 demographic and psychosocial variables and use of the Wellness service were evaluated with unadjusted bivariate logistic regression analyses.

RESULTS

The two primary justifications for using the Wellness service were: to get a blood pressure assessment (37%) and to rehabilitate injury (26%). The two most common justifications for not using the Wellness service were: no perceived need (44%) and already physically active (34%). Of the 32 demographical and psychosocial variables included, 28 were associated with any use and 24 with frequent use.

CONCLUSIONS

Use of the Wellness service appears to be driven by a complex configuration of factors that resist easy translation into practical advice. Non-participation was accounted for in terms of both positive and negative barriers. Use of the service for purposes of primary prevention and health promotion was, relatively speaking, lagging behind.

Perceived workplace health support is associated with employee productivity

PURPOSE

To examine the relationship between perceived workplace health support and employee productivity.

DESIGN

A quantitative cross-sectional study.

SETTING

Washington State agencies.

SUBJECTS

A total of 3528 employees from six state agencies were included in this analysis.

MEASURES

Perceived workplace health support was assessed by two questions that queried respondents on how often they felt supported by the workplace for healthy living and physical activity. The Work Productivity and Activity Impairment Questionnaire was used to measure health-related absenteeism and presenteeism in the past 7 days.

ANALYSIS

Multivariate linear regression was used to estimate the mean differences in productivity by levels of perceived health support.

RESULTS

Most participants were between 45 and 64 years of age and were predominantly non-Hispanic white. Presenteeism varied significantly by the level of perceived workplace health support, with those who felt least supported having higher presenteeism than those who felt most supported. The difference in presenteeism by perceived workplace support remained significant in models adjusting for sociodemographic and health characteristics (mean difference: 7.1% for support for healthy living, 95% confidence interval: 3.7%, 10.4%; 4.3% for support for physical activity, 95% confidence interval: 1.7%, 6.8%). Absenteeism was not associated with perceived workplace health support.

CONCLUSION

Higher perceived workplace health support is independently associated with higher work productivity. Employers may see productivity benefit from wellness programs through improved perceptions of workplace health support.

The Lucent-Takes-Heart Cardiovascular Health Management Program

This prospective, pre- and postevaluation of a worksite cardiovascular health management program consisted of employee education, measurement of cardiovascular risk factors, and on-site individual counseling for all employees, along with follow up screening for high risk participants. Of 1,099 employees (16.4% of those eligible) who participated in the initial screening, 596 (54.2%) were classified as high risk. A total of 167 (28.0%) high risk participants completed the 6 month follow up screening. Most high risk participants in the 6 month follow up screening reported they had increased their exercise (64.7%), improved their diet (71.3%), and visited a physician (61.7%). A minority of the participants (16.8%) began new cardiovascular medications, and 2.4% were diagnosed with diabetes. In addition, there were statistically significant decreases in the percentages of participants with elevated systolic blood pressure, diastolic blood pressure, low density lipoprotein cholesterol, and total cholesterol to high density lipoprotein ratio. Almost all (99.7%) of the 909 participants (82.7% of all participants) who completed the satisfaction survey were satisfied or very satisfied with the overall program. Screening in the workplace can identify individuals at high risk for cardiovascular disease. In this study, more than half of the participants were classified as high risk. Most high risk individuals who attended the 6 month follow up screening had improved their cardiovascular health, but attrition remains a challenge for worksite programs.

Worksite Food and Physical Activity Environments and Wellness Supports Reported by Employed Adults in the United States, 2013

PURPOSE

To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size.

DESIGN

Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA.

SETTING

Worksites in the United States.

PARTICIPANTS

A total of 2101 adults employed outside the home.

MEASURES

Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments.

ANALYSIS

Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size.

RESULTS

Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers.

CONCLUSION

Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

Process Evaluation of an Integrated Health Promotion/Occupational Health Model in WellWorks-2

Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

Does employee participation in workplace health promotion depend on the working environment? A cross-sectional study of Danish workers

OBJECTIVES

To investigate if participation in workplace health promotion (WHP) depends on the work environment.

METHODS

Questionnaire data on participation in WHP activities (smoking cessation, healthy diet, exercise facilities, weekly exercise classes, contact with health professionals, health screenings) and the work environment (social support, fatiguing work, physical, quantitative and emotional demands, job control and WHP availability setting) were collected cross-sectionally in 2010 in a representative sample (n=10 605) of Danish workers. Binary regression analyses of the association between work environment characteristics and participation in WHP were conducted and adjusted for age, gender and industry.

RESULTS

WHP offered during leisure time was associated with lower participation in all measured activities compared with when offered during working hours. Low social support and fatiguing work were associated with low participation in WHP. No associations with participation in WHPs were observed for physical work or quantitative demands, work pace or job strain. However, high physical demands/low job control and high emotional demands/low job control were associated with low participation.

CONCLUSIONS

Lower participation in WHP was associated with programmes during leisure, low social support, very fatiguing work and high physical or emotional demands with low job control. This suggests that to obtain proper effect of health promotion in a workplace setting, a good work environment is essential.

Policy, environment, and worksite fitness program participation among financial enterprise employees in Taiwan

BACKGROUND/OBJECTIVE

This study explored the intertwined effects between the policies and regulations of the companies and personal background on participation in the physical fitness programs and leisure-time activities in financial enterprises.

METHODS

A total of 823 employees were selected as the sample with the multilevel stratification random-sampling technique. The response rate was 52.0%. Data were analyzed with descriptive statistics and hierarchical linear logistic regression.

RESULTS

Thirty-two percent and 39% of the employees participated in the physical fitness programs and leisure-time activities, respectively. The factors affecting participation were categorized into intrapersonal factors, interpersonal processes, and primary groups, as well as institutional factors. In the interpersonal processes and primary groups level, higher family social support, more equipment in health promotion was associated with more participation in the programs. With the influence from the institutional level, it was found that health promotion policy amplified the relationship between employees' age and participation, but attenuated the relationship between education level and participation. Health promotion equipment in the institutes attenuated the relationship between colleague social support, family social support, and education level with program participation. Physical activity equipment in the community attenuated the relationship between family social support and program participation.

CONCLUSION

The influential factors of social support and worksite environment could predict the employees' participation in the physical fitness programs and leisure-time physical activities. Health promotion policy and equipment attenuated the negative effects of nonparticipation as well as amplified the positive effects of participation.

Organizing workplace health literacy to reduce musculoskeletal pain and consequences

Background

Despite numerous initiatives to improve the working environment for nursing aides, musculoskeletal disorders (pain) is still a considerable problem because of the prevalence, and pervasive consequences on the individual, the workplace and the society. Discrepancies between effort and effect of workplace health initiatives might be due to the fact that pain and the consequences of pain are affected by various individual, interpersonal and organizational factors in a complex interaction. Recent health literacy models pursue an integrated approach to understanding health behavior and have been suggested as a suitable framework for addressing individual, organizational and interpersonal factors concomitantly. Therefore, the aim of the trial is to examine the effectiveness of an intervention to improve health literacy (building knowledge, competences and structures for communication and action) at both the organizational and individual level and reduce pain among nursing aides.

Methods/design

The intervention consists of 2 steps: 1) Courses at the workplace for employees and management in order to organize a joint fundament of knowledge and understanding, and a platform for communication and action about pain prevention in the organization. 2) Organizing a fixed 3-weekly structured dialogue between each employee and her/his supervisor, with particular focus on developing specific plans to prevent and reduce pain and its consequences. This enables the workplace to generate knowledge about employee resources and health challenges and to act and convey this knowledge into initiatives at the workplace.

Discussion

Previous studies to improve health literacy have primarily targeted patients or specific deprived groups in health care or community settings. Recently the idea of the workplace as an arena for improving health literacy has developed emphasizing the organizational responsibility in facilitating and supporting that employees obtain basic knowledge and information needed to understand and take action on individual and occupational health concerns. The literature about workplace health literacy is very limited but points at the importance of educating employees to be able to access, appraise and apply health information and of organizing the infrastructure and communication in the organization. This study suggests a concrete operationalization of health literacy in a workplace setting. Results are expected published in 2016.

Enhancing workplace wellness efforts to reduce obesity: a qualitative study of low-wage workers in St Louis, Missouri, 2013-2014

INTRODUCTION

The objective of this study was to examine workplace determinants of obesity and participation in employer-sponsored wellness programs among low-wage workers.

METHODS

We conducted key informant interviews and focus groups with 2 partner organizations: a health care employer and a union representing retail workers. Interviews and focus groups discussed worksite factors that support or constrain healthy eating and physical activity and barriers that reduce participation in workplace wellness programs. Focus group discussions were transcribed and coded to identify main themes related to healthy eating, physical activity, and workplace factors that affect health.

RESULTS

Although the union informants recognized the need for workplace wellness programs, very few programs were offered because informants did not know how to reach their widespread and diverse membership. Informants from the health care organization described various programs available to employees but noted several barriers to effective implementation. Workers discussed how their job characteristics contributed to their weight; irregular schedules, shift work, short breaks, physical job demands, and food options at work were among the most commonly discussed contributors to poor eating and exercise behaviors. Workers also described several general factors such as motivation, time, money, and conflicting responsibilities.

CONCLUSION

The workplace offers unique opportunities for obesity interventions that go beyond traditional approaches. Our results suggest that modifying the physical and social work environment by using participatory or integrated health and safety approaches may improve eating and physical activity behaviors. However, more research is needed about the methods best suited to the needs of low-wage workers.

Worksite influences on obesogenic behaviors in low-wage workers in St Louis, Missouri, 2013-2014

INTRODUCTION

More than one-third of US adults are obese. Workplace programs to reduce obesity and improve overall health are not available or accessible to all workers, particularly low-wage workers among whom obesity is more prevalent. The goal of the study was to identify modifiable workplace factors and behaviors associated with diet and exercise to inform future workplace interventions to improve health.

METHODS

We distributed paper and online surveys to 2 groups of low-wage workers, hospital workers and retail sales workers, at the worksites. The surveys assessed obesity, obesogenic behaviors, workplace factors, and worker participation in workplace health programs (WHPs). Descriptive and regression analyses were conducted to examine workplace factors associated with obesogenic behaviors.

RESULTS

A total of 529 surveys were completed (219 hospital workers and 310 retail workers). More than 40% of workers were obese and 27% were overweight. In general, workers had poor diets (frequent consumption of sugary and high-fat foods) and engaged in little physical activity (only 30.9% met recommended physical activity guidelines). Access to and participation in workplace health programs varied greatly between hospital and retail sales workers. We identified several modifiable workplace factors, such as food source and work schedule, that were associated with diet, exercise, or participation in workplace health programs.

CONCLUSION

This study illustrates the high prevalence of obesity and obesogenic behaviors workers in 2 low-wage groups. The differences between work groups indicated that each group had unique facilitators and barriers to healthy eating and exercise. An understanding of how socioeconomic, demographic, and work-related factors influence health will help to identify high-risk populations for intervention and to design interventions tailored and relevant to the target audiences.

Adoption of workplaces and reach of employees for a multi-faceted intervention targeting low back pain among nurses' aides

Background

Workplace adoption and reach of health promotion are important, but generally poorly reported. The aim of this study is therefore to evaluate the adoption of workplaces (organizational level) and reach of employees (individual level) of a multi-faceted workplace health promotion and work environment intervention targeting low back pain among nurses’ aides in elderly care.

Methods

Percentage of adopters was calculated among eligible workplaces and differences between adopters and non-adopters were evaluated through workplace registrations and manager questionnaires from all eligible workplaces. From the adopted workplaces reach was calculated among eligible employees as the percentage who responded on a questionnaire. Responders were compared with non-responders using data from company registrations. Among responders, comparisons based on questionnaire data were performed between those consenting to participate in the intervention (consenters) and those not consenting to participate in the intervention (non-consenters). Comparisons were done using Student's t-test for the continuous variables, Fisher's exact test for dichotomous variables and the Pearson’s chi² for categorical variables. Moreover odds ratios for non-responding and non-consenting were investigated with binary logistic regression analyses.

Results

The project was adopted by 44% of the offered workplaces. The main differences between adopters and non-adopters were that workplaces adopting the intervention had a more stable organization as well as a management with positive beliefs of the intervention’s potential benefits. Of eligible employees, 71% responded on the questionnaire and 57% consented to participate. Non-responders and non-consenters did not differ from the responders and consenters on demographic factors and health. However, more non-responders and non-consenters were low skilled, worked less than 30 hours pr. week, and worked evening and nightshift compared to responders and consenters, respectively. Consenters had more musculoskeletal pain and reduced self-rated health, as well as higher physical exertion during work compared to non-consenters.

Conclusions

Our recruitment effort yielded a population of consenters that was representative of the target population of nurses’ aides with respect to demographic factors, and health. Moreover more consenters had problems like pain and high physical exertion during work, which fitted the scope of the intervention.

Trial registration

The study is registered as ISRCTN78113519.

Job design and ethnic differences in working women's physical activity

OBJECTIVE

To document the role job control and schedule control play in shaping women's physical activity, and how it delineates educational and racial variability in associations of job and social control with physical activity.

METHODS

Prospective data were obtained from a community-based sample of working women (N = 302). Validated instruments measured job control and schedule control. Steps per day were assessed using New Lifestyles 800 activity monitors.

RESULTS

Greater job control predicted more steps per day, whereas greater schedule control predicted fewer steps. Small indirect associations between ethnicity and physical activity were observed among women with a trade school degree or less but not for women with a college degree.

CONCLUSIONS

Low job control created barriers to physical activity among working women with a trade school degree or less. Greater schedule control predicted less physical activity, suggesting women do not use time "created" by schedule flexibility for personal health enhancement.

Help Preferences Among Employees Who Wish to Change Health Behaviors

OBJECTIVE

To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e., wellness service).

METHODS

Respondents to an electronic questionnaire who acknowledged wishing to change health behaviors in relation to smoking (n = 845), alcohol (n = 684), eating (n = 4,431), and physical activity (n = 5,179) were asked to choose up to three help alternatives on a predefined list.

RESULTS

In descending order, smokers preferred help from nicotine gum, no help, and help and support from family and friends. Alcohol consumers preferred no help or help and support from family and friends or "other" forms. Employees who wanted to change eating habits preferred a free fruit bowl, free nutritional guidance, and healthy food at work. Employees who wanted to change physical activity patterns preferred exercise at work, offers of free exercise, and exercise in a social/collegial context.

CONCLUSION

Wishing to change health behaviors is not always accompanied by perceiving a need for assistance. The no-help option was selected fairly frequently and mostly in relation to alcohol and smoking. A fruit bowl was the most preferred option for help, followed by exercise at work and free exercise. Help from traditional health services was ranked low, possibly reflecting that they are primarily viewed as a solution for stopping disease rather than promoting health.

Prevention of low back pain and its consequences among nurses' aides in elderly care: a stepped-wedge multi-faceted cluster-randomized controlled trial

BACKGROUND

A high prevalence of low back pain has persisted over the years despite extensive primary prevention initiatives among nurses' aides. Many single-faceted interventions addressing just one aspect of low back pain have been carried out at workplaces, but with low success rate. This may be due to the multi-factorial origin of low back pain. Participatory ergonomics, cognitive behavioral training and physical training have previously shown promising effects on prevention and rehabilitation of low back pain. Therefore, the main aim of this study is to examine whether a multi-faceted workplace intervention consisting of participatory ergonomics, physical training and cognitive behavioral training can prevent low back pain and its consequences among nurses' aides. External resources for the participating workplace and a strong commitment from the management and the organization support the intervention.

METHODS/DESIGN

To overcome implementation barriers within usual randomized controlled trial designed workplace interventions, this study uses a stepped-wedge cluster-randomized controlled trial design with 4 groups. The intervention is delivered to the groups at random along four successive time periods three months apart. The intervention lasts three months and integrates participatory ergonomics, physical training and cognitive behavioral training tailored to the target group. Local physiotherapists and occupational therapists conduct the intervention after having received standardized training. Primary outcomes are low back pain and its consequences measured monthly by text messages up to three months after initiation of the intervention.

DISCUSSION

Intervention effectiveness trials for preventing low back pain and its consequences in workplaces with physically demanding work are few, primarily single-faceted, with strict adherence to a traditional randomized controlled trial design that may hamper implementation and compliance, and have mostly been unsuccessful. By using a stepped wedge design, and obtain high management commitment and support we intend to improve implementation and aim to establish the effectiveness of a multi-faceted intervention to prevent low back pain. This study will potentially provide knowledge of prevention of low back pain and its consequences among nurses' aides. Results are expected to be published in 2015-2016.

TRIAL REGISTRATION

The study is registered as ISRCTN78113519.

Does workplace health promotion in Denmark reach relevant target groups?

The aim of the current study was to investigate whether Workplace Health Promotion (WHP) is available for workers with poor health status (overweight, musculoskeletal disorders, sickness absence and poor self-rated health) or health behaviour (smoking, poor diet and sedentarism) and whether they participate in WHP. In total, 9835 workers responded to questions regarding availability to 6 different types of WHP through The Danish Work Environment Cohort Study in 2010. Logistic regression analyses adjusted for age, gender and industry were performed to calculate odds ratios for availability and participation of WHP among groups with different health behaviours and health status. In general, poor health behaviours were associated with reduced availability of and participation in WHP. In contrast, poor health status was generally associated with higher availability of WHP and increased participation. However, poor self-rated health was associated with lower availability of several types of WHP and reduced participation. In general, workers with health challenges that are visible to others had WHP available, whereas workers with less visible health challenges had WHP less frequently available. Health challenges visible to others were associated with higher participation in WHP, whereas poor health behaviour and reduced self-rated health were associated with reduced participation in WHP programmes.

The Influence of Worksite and Employee Variables on Employee Engagement in Telephonic Health Coaching Programs: A Retrospective Multivariate Analysis

Purpose.

This study assessed 11 determinants of health coaching program participation.

Design.

A cross-sectional study design used secondary data to assess the role of six employee-level and five worksite-level variables on telephone-based coaching enrollment, active participation, and completion.

Setting.

Data was provided by a national provider of worksite health promotion program services for employers.

Subjects.

A random sample of 34,291 employees from 52 companies was selected for inclusion in the study.

Measures.

Survey-based measures included age, gender, job type, health risk status, tobacco risk, social support, financial incentives, comprehensive communications, senior leadership support, cultural support, and comprehensive program design.

Analysis.

Gender-stratified multivariate logistic regression models were applied using backwards elimination procedures to yield parsimonious prediction models for each of the dependent variables.

Results.

Employees were more likely to enroll in coaching programs if they were older, female, and in poorer health, and if they were at worksites with fewer environmental supports for health, clear financial incentives for participation in coaching, more comprehensive communications, and more comprehensive programs. Once employees were enrolled, program completion was greater among those who were older, did not use tobacco, worked at a company with strong communications, and had fewer environmental supports for health.

Conclusion.

Both worksite-level and employee-level factors have significant influences on health coaching engagement, and there are gender differences in the strength of these predictors.

Promoting walking among office employees - evaluation of a randomized controlled intervention with pedometers and e-mail messages

BACKGROUND

The purpose of the study was to evaluate a 6-month intervention to promote office-employees' walking with pedometers and e-mail messages.

METHODS

Participants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N = 241) were randomized to a pedometer (STEP, N = 123) and a comparison group (COMP, N = 118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12 months), process evaluation and interviews (12 months).

RESULTS

The intervention reached 29% (N = 646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2 months in "walking for transportation" (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6 months in "walking for leisure" (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of "walking stairs" at 2 and 6 months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12 months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in "walking stairs" (OR 2.24, 95%CI 0.94 to 5.31) and in "walking for leisure" (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant.

CONCLUSIONS

The findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment. TRIAL REGISTERATION: ISRCTN79432107.

Effects on musculoskeletal pain, work ability and sickness absence in a 1-year randomised controlled trial among cleaners

Background

Only a few workplace initiatives among cleaners have been reported, even though they constitute a job group in great need of health promotion. The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain, work ability and sickness absence among cleaners.

Methods

A cluster-randomised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training (PCT), cognitive behavioural training (CBTr) or a reference group (REF). Questionnaires about musculoskeletal pain and work ability were completed at baseline and after one year's intervention. Sickness absence data were obtained from the managers' records. Analyses were performed according to the intention-to-treat-principle (ITT).

Results

No overall reduction in musculoskeletal pain, work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses. However, explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT. People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF (p = 0.05).

Conclusions

The PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners. It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence.

Trial registration

ISRCTN: ISRCTN96241850

Preventing chronic disease in the workplace: a workshop report and recommendations

Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work-family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace.

Healthcare workers' participation in a healthy-lifestyle-promotion project in western Sweden

BACKGROUND

Healthcare professionals play a central role in health promotion and lifestyle information towards patients as well as towards the general population, and it has been shown that own lifestyle habits can influence attitudes and counselling practice towards patients. The purpose of this study was to explore the participation of healthcare workers (HCWs) in a worksite health promotion (WHP) programme. We also aimed to find out whether HCWs with poorer lifestyle-related health engage in health-promotion activities to a larger extent than employees reporting healthier lifestyles.

METHOD

A biennial questionnaire survey was used in this study, and it was originally posted to employees in the public healthcare sector in western Sweden, one year before the onset of the WHP programme. The response rate was 61% (n = 3207). In the four-year follow-up, a question regarding participation in a three-year-long WHP programme was included, and those responding to this question were included in the final analysis (n = 1859). The WHP programme used a broad all-inclusive approach, relying on the individual's decision to participate in activities related to four different themes: physical activity, nutrition, sleep, and happiness/enjoyment.

RESULTS

The participation rate was around 21%, the most popular theme being physical activity. Indicators of lifestyle-related health/behaviour for each theme were used, and regression analysis showed that individuals who were sedentary prior to the programme were less likely to participate in the programme's physical activities than the more active individuals. Participation in the other three themes was not significantly predicted by the indicators of the lifestyle-related health, (body mass index, sleep disturbances, or depressive mood).

CONCLUSION

Our results indicate that HCWs are not more prone to participate in WHP programmes compared to what has been reported for other working populations, and despite a supposedly good knowledge of health-related issues, HCWs reporting relatively unfavourable lifestyles are not more motivated to participate. As HCWs are key actors in promoting healthy lifestyles to other groups (such as patients), it is of utmost importance to find strategies to engage this professional group in activities that promote their own health.

Does workplace social capital buffer the effects of job stress? A cross-sectional, multilevel analysis of cigarette smoking among U.S. manufacturing workers

OBJECTIVE

To investigate whether workplace social capital buffers the association between job stress and smoking status.

METHODS

As part of the Harvard Cancer Prevention Project's Healthy Directions--Small Business Study, interviewer-administered questionnaires were completed by 1740 workers and 288 managers in 26 manufacturing firms (84% and 85% response). Social capital was assessed by multiple items measured at the individual level among workers and contextual level among managers. Job stress was operationalized by the demand-control model. Multilevel logistic regression was used to estimate associations between job stressors and smoking and test for effect modification by social capital measures.

RESULTS

Workplace social capital (both summary measures) buffered associations between high job demands and smoking. One compositional item--worker trust in managers--buffered associations between job strain and smoking.

CONCLUSION

Workplace social capital may modify the effects of psychosocial working conditions on health behaviors.

The Worksite Health Promotion Capacity Instrument (WHPCI): development, validation and approaches for determining companies' levels of health promotion capacity

Background

The Worksite Health Promotion Capacity Instrument (WHPCI) was developed to assess two key factors for effective worksite health promotion: collective willingness and the systematic implementation of health promotion activities in companies. This study evaluates the diagnostic qualities of the WHPCI based on its subscales Health Promotion Willingness and Health Promotion Management, which can be used to place companies into four different categories based on their level of health promotion capacity.

Methods

Psychometric evaluation was conducted using exploratory factor and reliability analyses with data taken from a random sample of managers from n = 522 German information and communication technology (ICT) companies. Receiver operating characteristic (ROC) analyses were conducted to determine further diagnostic qualities of the instrument and to establish the cut-off scores used to determine each company's level of health promotion capacity.

Results

The instrument's subscales, Health Promotion Willingness and Health Promotion Management, are based on one-dimensional constructs, each with very good reliability (Cronbach's alpha = 0.83/0.91). ROC analyses demonstrated satisfactory diagnostic accuracy with an area under the curve (AUC) of 0.76 (SE = 0.021; 95% CI 0.72-0.80) for the Health Promotion Willingness scale and 0.81 (SE = 0.021; 95% CI 0.77-0.86) for the Health Promotion Management scale. A cut-off score with good sensitivity (71%/76%) and specificity (69%/75%) was determined for each scale. Both scales were found to have good predictive power and exhibited good efficiency.

Conclusions

Our findings indicate preliminary evidence for the validity and reliability of both subscales of the WHPCI. The goodness of each cut-off score suggests that the scales are appropriate for determining companies' levels of health promotion capacity. Support in implementing (systematic) worksite health promotion can then be tailored to each company's needs based on their current capacity level.

Tobacco use cessation and weight management among motor freight workers: results of the gear up for health study

OBJECTIVES

To present the results of a study of a worksite-based intervention to promote tobacco use cessation and improve weight management among motor freight workers.

METHODS

This study used a pre-test/post-test, non-randomized design to assess the effectiveness of a four-month intervention that addressed the social context of the work setting. We evaluated 7-day tobacco quit prevalence among baseline tobacco users, and successful weight management, defined as no weight gain in workers with BMI <25 at baseline and any weight loss among overweight and obese workers.

RESULTS

At baseline, 40% were current tobacco users, and 88% had a BMI of 25 or greater. Of 542 workers invited to participate, 227 agreed to participate and received at least the first telephone call (42%). Ten-month post-baseline, baseline tobacco users who participated in the intervention were more likely to have quit using tobacco than non-participants: 23.8% vs. 9.1% (p = 0.02). There was no significant improvement in weight management.

CONCLUSIONS

Incorporating work experiences and job conditions into messages of health behavior change resulted in significant tobacco use cessation among participating motor freight workers.

The Effect of a Holistic Program on Health-Promoting Behaviors in Hospital Registered Nurses

Purpose: The purpose of the study was to examine the effect of a holistic program, the Collaborative Care Model (CCM) Program, and the development of a self-care plan on health-promoting behaviors in hospital nurses. Design: A quasi-experimental, pretest, posttest, repeated measure, comparison-group design was used. Method: The study was conducted in a large, academic medical center in the northeast. The experimental group included registered nurses (RNs) from units in one institution introduced to the CCM and development of a self-care plan in an 8-hour program. The control group received no intervention. Data were collected using the Health Promoting Lifestyle Profile II instrument (HPLP II); a 52-question Likert-type scale with six subscales examining health-promoting behaviors. Findings: Using repeated measures analysis of variance there was a significant increase ( p = .02) in the overall HPLP II mean, spirituality ( p = .04), interpersonal relations ( p = .04), and nutrition scores ( p = .04) of the experimental group as compared over time with the control group. Conclusions: The CCM plus the development of a self-care plan significantly increased overall health promoting behaviors, and spirituality, interpersonal relations, and nutrition scores in these RNs.

Successful reach and adoption of a workplace health promotion RCT targeting a group of high-risk workers

Background

Cleaners are rarely introduced to workplace health promotion programs. The study's objective was to evaluate the reach and adoption of a workplace randomized controlled trial (RCT) among cleaners in Denmark.

Methods

Cleaning businesses with at least 30 employees, that could offer a weekly 1-hour intervention during working hours, were invited to participate. Employees working at least 20 hours/week were invited to answer a screening questionnaire and consent to participate. Analyses determined the differences in health variables between responders and non-responders, consenters and non-consenters, participants and non-participants and between participants of the RCT's three groups: physical coordination training, cognitive-behavioural theory-based training and reference group.

Results

From 16 eligible workplaces, a representative sample of 50% adopted the trial. Of 758 eligible employees, 78% responded to the screening questionnaire and 49% consented to participate. Consenters and participants differed from non-consenters and non-participants by having higher BMI, more chronic diseases and poorer musculoskeletal health.

Conclusions

This study indicates that workplace health promotion programs directed at health risk factors among cleaners enable significant adoption and reach to a high-risk subgroup of the Danish workforce.

Trial registration

Trial registration ISRCTN96241850

The role of tailored consultation following health-risk appraisals in employees' health behavior

OBJECTIVES

This study evaluates employees' health and lifestyle changes following health risk appraisal only and health risk appraisal with a consultation (HRAC) based on the constructs of Transtheoretical model (TTM).

METHODS

Sixty employees self-selected to an HRAC or health risk appraisal only, implemented in 6-month interval. Demographics, lifestyle behavior, and stage of change (SOC) assessments based on TTM along with weight, height, body mass index, blood pressure, blood glucose, and cholesterol were measured.

RESULTS

Second health risk appraisal showed improvements in nutrition, fitness, and overall health in both groups (P < 0.05). Significant improvements were found between HRAC group and their SOC for exercise, nutrition, and overall lifestyle. Also, group differences in SOC for exercise, amount of snack food, fruits and vegetables consumed, and physical activity (P < 0.05) were significant.

CONCLUSION

HRAC based on TTM constructs is effective in promoting behavior change in high-risk employees.

MassBuilt: effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers

Objective

Blue-collar workers are difficult to reach and less likely to successfully quit smoking. The objective of this study was to test a training site-based smoking cessation intervention.

Methods

This study is a randomized-controlled trial of a smoking cessation intervention that integrated occupational health concerns and was delivered in collaboration with unions to apprentices at 10 sites (n = 1,213). We evaluated smoking cessation at 1 and 6 months post-intervention.

Results

The baseline prevalence of smoking was 41%. We observed significantly higher quit rates in the intervention versus control group (26% vs. 16.8%; p = 0.014) 1 month after the intervention. However, the effects diminished over time so that the difference in quit rate was not significant at 6 month post-intervention (9% vs. 7.2%; p = 0.48). Intervention group members nevertheless reported a significant decrease in smoking intensity (OR = 3.13; 95% CI: 1.55–6.31) at 6 months post-intervention, compared to controls.

Conclusion

The study demonstrates the feasibility of delivering an intervention through union apprentice programs. Furthermore, the notably better 1-month quit rate results among intervention members and the greater decrease in smoking intensity among intervention members who continued to smoke underscore the need to develop strategies to help reduce relapse among blue-collar workers who quit smoking.

Physical work capacity in older adults: implications for the aging worker

BACKGROUND

In many developed countries, the workforce is rapidly aging. Occupational demands however, have not decreased despite the fact that workers see a decline in physical work capacity with age. The purpose of this review is to examine the physiological adaptations to aging, the impact of aging on performance and the benefits of physical fitness in improving functional work capacity in aging individuals.

METHODS

An extensive search of the scientific literature was performed, acquiring published articles which examined the physiological changes associated with age-related decrements in the physical work capacity of healthy aging adults. The databases accessed included AARP Ageline, AccessScience, Annual Reviews, CISTI, Cochrane Library, Clinical Evidence, Digital Dissertations (Proquest), Embase, HealthSTAR, Medline, PubMed, Scopus, and PASCAL and included relevant information sites obtained on the world wide web.

RESULTS

While a great deal of variation exists, an average decline of 20% in physical work capacity has been reported between the ages of 40 and 60 years, due to decreases in aerobic and musculoskeletal capacity. These declines can contribute to decreased work capacity, and consequential increases in work-related injuries and illness. However, differences in habitual physical activity will greatly influence the variability seen in individual physical work capacity and its components. Well-organized, management-supported, work-site health interventions encouraging physical activity during work hours could potentially decrease the incidence of age-related injury and illness.

CONCLUSIONS

Age-associated functional declines and the accompanying risk of work-related injury can be prevented or at least delayed by the practice of regular physical activity. Older workers could optimally pursue their careers until retirement if they continuously maintain their physical training.

The effects of workplace flexibility on health behaviors: a cross-sectional and longitudinal analysis

OBJECTIVE

To examine the cross-sectional and longitudinal associations between workplace flexibility and health behaviors, and estimate the potential importance of flexibility for effective worksite health promotion programs.

METHOD

Cross-sectional and longitudinal health risk appraisal data were obtained from US based employees of a multinational pharmaceutical company (n = 3193). Examined health behaviors were hours of sleep, physical activity frequency, health education seminar attendance, frequency of practicing personal resilience techniques, and self-appraised lifestyle. Self-reported flexibility in the workplace was the primary independent variable.

RESULTS

Each health behavior, except regular attendance in health education seminars, was positively related to perceived flexibility in cross-sectional analyses. Sleep and self-appraised lifestyle were significantly related to changes in perceived flexibility over time.

CONCLUSIONS

Workplace flexibility may contribute to positive lifestyle behaviors, and may play an important role in effective worksite health promotion programs.