A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1995-1998 update (IV)

The effectiveness of dietary workplace interventions: a systematic review of systematic reviews

Objective

To summarise findings of systematic reviews that distinctively report dietary intervention components and their effects on diet-, health- and economic-related outcomes in the workplace setting.

Design

MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library and Google Scholar were searched in December 2014 and the search was updated in August 2017.

Results

The search identified 1137 titles, of which nineteen systematic reviews from the initial search and two systematic reviews from the updated search met the inclusion criteria (twenty-one systematic reviews, published in twenty-two papers). Most systematic reviews were of moderate quality and focused on dietary behaviour change outcomes and some health-related biomarkers. Evidence was strongest for interventions to increase fruit and vegetable intake, reduce fat intake, aid weight loss and reduce cholesterol. Few reported workplace-related and evaluation outcomes.

Conclusions

These findings suggest that workplace dietary interventions can positively influence diet and health outcomes. Suggestions for effective interventions components have been made.

The Impact of a Policy-Based Multicomponent Nutrition Pilot Intervention on Young Adult Employee's Diet and Health Outcomes

PURPOSE

Evaluate the effect of a policy-based, multicomponent workplace diet intervention on young adult employees' diet and health.

DESIGN

A 6-month, single-armed pilot study with before and after assessments.

SETTING

Insurance company in Belfast, Northern Ireland.

PARTICIPANTS

Employees who worked at the company throughout the intervention period were included. Employees were excluded if pregnant, breast-feeding, or following a strict diet.

INTERVENTION

Multicomponent diet intervention: ban of unhealthy foods brought into the premises, free fruit, education, individual advice, and further support.

MEASURES

Mixed-methods approach: Diet-, health-, and work-related measures were assessed quantitatively. The campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semistructured interviews).

ANALYSIS

Changes in measures were analyzed using paired samples t tests. Interviews were analyzed using thematic analysis.

RESULTS

Sixty (75.9%) staff completed all assessments. Males reduced their sugar intake on working days (-8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (-3.3 SD: 9.9; P value <.05 and -8.0 SD: 7.7; P value <.001, respectively); 85.2% of staff strongly agreed/agreed that they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial.

CONCLUSION

Influencing workplace policies and offering additional dietary support could lead to meaningful changes in employees' diet and health and may change workplace culture.

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.

The Association between Health Risks and Medical Expenditures in a Japanese Corporation

Purpose.

To examine the relationship between health risks and medical care expenditures in an employer setting in Japan.

Design.

A cross-sectional, correlational study.

Setting.

A large Japanese corporation.

Subjects.

A total of 6543 employees of a large Japanese electronics company, for whom medical expenditures, lifestyle risks and biometric data were available, were included in the analysis. Seventy-six percent were male, and subjects were primarily white-collar workers.

Measures.

Medical expenditure data were available for fiscal year 2000, including inpatient, outpatient, and total expenditures, measured in Japanese yen. Binary expenditure indicators for those having no claims and those having high claims (90th percentile) were also created. Risk measures included biometric assessment of high blood pressure and high body mass index (BMI, body weight and height) and self-reported stress, lack of exercise, excess alcohol consumption, poor nutrition, current smoking, and recent quitting. High cholesterol and high blood glucose measures were also available for some subjects from company physicals.

Results.

Average total expenditures were ¥48,017 (US$445). The 90th percentile of the expenditure distribution was approximately ¥111,750 (US$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35%), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1%), and high blood glucose (9.4%). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76% higher for recent quitters and 22.6% higher for employees with high blood pressure. Males and younger employees had consistently lower expenditures. Current smoking, poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors.

Conclusions.

This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees. The investigation uncovered some significant levels of risk for lack of exercise, smoking, and stress. Although results indicate some significant associations between health risks and medical expenditures, several unexpected associations were noted that require further study. Such information provides a solid foundation for health promotion efforts in Japan and direction for subsequent investigations of health risks and medical expenditures. Future studies should address important issues of health risk measurement, data collection, and research design.

International Collaboration in Health Promotion and Disease Management: Implications of U.S. Health Promotion Efforts on Japan's Health Care System

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.

The Relationship between Modifiable Health Risks and Future Medical Care Expenditures: The Korea Medical Insurance Corporation (KMIC) Study

Context.

The relationship between lifestyle risk factors, morbidity, and mortality is well established, but the relationship between lifestyle risk factors and medical care costs is not as well defined.

Objectives.

To determine the ability of modifiable biometric and lifestyle risk factors to predict future medical care costs.

Design.

Prospective cohort study.

Setting and Participants.

Data on modifiable risk factors collected in 1992 and medical care costs collected in 1998 by the Korea Medical Insurance Corporation in South Korea. Data were examined for a final cohort 78 of 728 men and 50,414 women enrolled in the health insurance plan from 1990 through 1998.

Main Outcome Measures.

Outcome measures included likelihood of any inpatient, outpatient, and total medical care costs and outlier costs; amount of inpatient, outpatient, and total medical care costs; and portion of total medical costs attributable to each risk factor through unadjusted and adjusted multivariate analyses.

Results.

Baseline modifiable risk factors measured in 1992 (including lifestyle factors such as smoking high body mass index, exercise, and biometric measures such as cholesterol, blood sugar, blood pressure, and urinary sugar) were important predictors of the amount of medical care costs incurred 6 years later in 1998, even after controlling for age, perceived health status, and each of the other modifiable variables. These risk factors were generally better predictors than nonmodifiable demographic risk factors, including income level and type of job. For men, lifestyle risk factors were associated with total costs that were 2.4% (for high blood pressure) to 16.1 % (for former smokers) higher than among men without those risk factors. Biometric risk factors were associated with costs ranging from 9.2% (for cholesterol) to 38.2% (for positive urinary glucose) higher. For women, lifestyle risk factors were associated with total costs that were 2.5% (for exercise) to 6.4% (for current smokers) higher than among those without the risk factors. Biometric risk factors were associated with costs ranging from 10.2% (for cholesterol) to 60.4% (for positive urinary glucose) higher. For men, a cluster of six heart disease risk factors were associated with total costs 54.7% higher, and a cluster of three stroke risk factors were associated with total costs 22.2% higher than in men who had none of these risk factors. Modifiable risk factors accounted for 23.1% of medical costs for men and 8.7% for women.

Conclusions.

These results suggest that modifiable biometric and lifestyle risk factors can predict a moderate portion of future medical care costs. If these risk factors can be reduced, future medical care costs may be reduced.

The relationship between return on investment and quality of study methodology in workplace health promotion programs

OBJECTIVE

To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs.

DATA SOURCE

Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded.

DATA EXTRACTION

Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI.

DATA SYNTHESIS

ROI was calculated as ROI = (benefits - costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored.

RESULTS

Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84-.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38-1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n = 18) had a smaller mean ROI, 0.26 ± 1.74 (.23-.30), compared to moderate (n = 16) 0.90 ± 1.25 (.90-.91) and low-quality (n = 27) 2.32 ± 2.14 (2.30-2.33) studies. Randomized control trials (RCTs) (n = 12) exhibited negative ROI, -0.22 ± 2.41(-.27 to -.16). Financial returns become increasingly positive across quasi-experimental, nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11-1.14), 1.61 ± 0.91 (1.56-1.65), and 2.05 ± 0.88 (2.04-2.06), respectively.

CONCLUSION

Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.

Work Site Health Promotion Research: To what Extent can we Generalize the Results and what is Needed to Translate Research to Practice?

Information on external validity of work site health promotion research is essential to translate research findings to practice. The authors provide a literature review of work site health behavior interventions. Using the RE-AIM framework, they summarize characteristics and results of these studies to document reporting of intervention reach, adoption, implementation, and maintenance. The authors reviewed a total of 24 publications from 11 leading health behavior journals. They found that participation rates among eligible employees were reported in 87.5% of studies; only 25% of studies reported on intervention adoption. Data on characteristics of participants versus nonparticipants were reported in fewer than 10% of studies. Implementation data were reported in 12.5% of the studies. Only 8% of studies reported any type of maintenance data. Stronger emphasis is needed on representativeness of employees, work site settings studied, and longer term results. Examples of how this can be done are provided.

Economic impact of corporate wellness programs in Europe: A literature review

OBJECTIVES

The purpose of this review is to summarize the current evidence on the economic impact of corporate wellness programs (CWPs) in Europe from the results of randomized controlled trials (RCTs) published up to 2013.

METHODS

A review was undertaken by searching for RCTs with key words in the following databases: PubMed, SPORT-Discus, and Business Source Premier. Only RCTs that evaluated the economic impact of CWPs, and included analyses performed in Europe with results converted into monetary values, were eligible for inclusion. An approach to economic analyses from both an employer's perspective and a societal perspective was also undertaken.

RESULTS

Eleven RCTs were identified, and review of these studies determined that the economic impact of the majority of CWPs analyzed was mostly negative. We discuss a possible explanation for these discrepancies with regard to prior reviews in this area. Despite the fact that the RCT is the "gold standard" for investigating without bias, several limitations to the methodology may have influenced the results of the studies in this review and suggested the use of caution in the interpretation of the results.

CONCLUSIONS

The findings of this review could be a "wake up call" for companies regarding the high probability of bias from non-RCT studies, the majority of which report a positive economic impact of these programs, and the risk of taking inappropriate decisions based on the results of such studies.

Heart healthy online: an innovative approach to risk reduction in the workplace

OBJECTIVES

To examine whether a Web-based cardiovascular health promotion program was associated with changes in self-reported behaviors, attitudes, and biometric indicators in a population of working adults.

METHODS

Employees (n = 210) were recruited and randomized into either an Internet-based or control condition. Participants completed pre- and postintervention self-report assessments on diet, exercise, smoking, and mental health. Pre- and postintervention biometric screenings were also obtained on blood pressure, heart rate, weight, and hip/waist circumference.

RESULTS

The intervention was associated with significant improvements in dietary attitudes (P = 0.003; F = 8.83), dietary intentions (P = 0.031; F = 4.72), dietary self-efficacy (P = 0.015; F = 5.97), exercise self-efficacy (P = 0.002; F = 9.51), exercise habits (P = 0.016; F = 5.94), and coping with stress (P = 0.003; F = 8.85) and depression (P = 0.036; F = 4.46).

CONCLUSIONS

The program showed promise for promoting cardiovascular risk reduction behaviors. These results are consistent with similar Web-based interventions.

Healthy workplaces? A survey of Massachusetts employers

PURPOSE

This study examines worksite health promotion (WHP) and occupational health and safety (OHS) activities by Massachusetts employers, and the extent to which workplaces with programming in one domain were more likely to have the other as well.

DESIGN

In 2008, the Massachusetts Department of Public Health surveyed a stratified sample of Massachusetts worksites.

SETTING

A mailed questionnaire to be completed by workplace representatives.

SUBJECTS

Massachusetts worksites returning the questionnaire.

MEASURES

Questionnaire items about worksite characteristics, WHP, and some OHS practices.

ANALYSIS

We scored levels of WHP and OHS activity; examined the relationship between activities in the two domains by employer characteristics; and assessed self-reported coordination between them.

RESULTS

The 890 responding worksites had higher scores for OHS (mean = 48% of practices, SD = 24%) than WHP (mean = 20%, SD = 12%). The difference between these scores varied by a factor of two across industry sectors and was smallest for workforces of 100+ employees (p = .001). Employers with no unionized workers reported fewer activities in both domains (p < .0001). Only 28% of respondents reported always/often coordinating OHS and WHP efforts; these organizations had more activities overall in both domains.

CONCLUSION

Larger and unionized workplaces in Massachusetts were more likely to offer both WHP and OHS programming. Self-reported coordination was somewhat associated with more activity in both domains, although levels of WHP activity varied widely.

Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.

Compression of morbidity 1980-2011: a focused review of paradigms and progress

The Compression of Morbidity hypothesis—positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability—was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based “healthy aging” interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity.

Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review

BACKGROUND

The worksite is a promising setting for health promotion. This review summarizes the evidence of effect of intervention studies in European countries promoting a healthy diet solely and in combination with increasing physical activity at the workplace.

METHODS

A systematic review of published literature was carried out. Inclusion criteria were: studies conducted in European countries; papers published from 1 January 1990 to 1 October 2010; worksite-based interventions promoting a healthy diet solely or in combination with physical activity; primary prevention; measurement of anthropometrical or behavioural change and adults (≥18 years old). Levels of evidence for intervention effectiveness on behavioural determinants, nutrition and physical activity behaviours and body composition and the quality of the included interventions were assessed.

RESULTS

Seventeen studies solely focusing on promotion of a healthy diet were identified. Eight were educational, one used worksite environmental change strategies, and eight used a combination of both (multi-component). None of the interventions were rated as 'strong'; seven met the criteria for 'moderate' quality. The reviewed studies show moderately evidence for effects on diet. Thirteen studies focusing both on nutrition and physical activity (nine educational and four multi-component studies) were identified. Ten were rated as having 'weak' and three as having 'moderate' methodological quality, providing inconclusive evidence for effects.

CONCLUSION

Limited to moderate evidence was found for positive effects of nutrition interventions implemented at the workplace. Effects of workplace health promotion interventions may be improved if stronger adherence to established quality criteria for such interventions is realized.

Worksite health promotion: the value of the Tune Up Your Heart program

Successful wellness initiatives at DaimlerChrysler Canada Incorporated (DCCI) led to a unique partnership between key stakeholders that allowed implementation of Tune Up Your Heart, a program aimed at improving workforce cardiovascular disease (CVD) risk. Volunteers were screened and stratified according to their CVD risk. Interventions were tailored to risk level and included goal setting, monitoring progress, and company-wide education programs. Outcome data (CVD risk and components of risk) were collected at study entry and after 18 months. The economic impact of the program was determined using a model based on subject movement across risk categories and historical claims data for life insurance, short- and long-term disability, prescription drugs, and casual absenteeism. Intervention participants (N = 343) demonstrated a significant (P = .0113) relative CVD risk reduction of 12.7%; 36% of participants lost weight, and average body mass index decreased from 28.4 to 28.2 (P = .0419). Average systolic and diastolic blood pressure significantly decreased (P < .0001 and P = .0221, respectively). Subjects reported increased adherence to recommended exercise and diet regimens, and the number of smokers decreased by 14%. The majority of subjects reported satisfaction with the program. Annual savings were estimated at Can$793 for the intervention group and Can$18,461 when projected to the entire workforce (N = 13,629). Savings were sensitive to cost weighting when subjects moved to a lower risk class but more robust to other parameters. The Tune Up Your Heart program significantly improved employee CVD risk profile, and was associated with savings for DCCI.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008

OBJECTIVE

To conduct the seventh periodic review and analysis of the clinical and cost-effectiveness research conducted in worksite/corporate environments between 2004 and 2008.

METHODS

A literature search of US-based research was conducted using a multistage process including MEDLINE, ADI, EDGAR, CARL, Inform, Lexis-Nexis, as well as direct inquiries to key researchers in this area of expertise.

RESULTS

From 2004 to 2008, there were 16 new studies that met the Inclusion/Exclusion criteria. These studies are critiqued and entered into a data table consisting of 13 variables and citations of the 16 new studies.

CONCLUSIONS

Clinical and cost-effectiveness research in the worksite/corporate environment continues to evolve although there was only one randomized clinical trial conducted during the most recent interval. There are innovations in pilot studies, quasi-experimental methodologies, and econometric modeling as indicative of future trends.

A conceptual framework for integrating workplace health promotion and occupational ergonomics programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health--especially ergonomics--with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Workplace Stress, Organizational Factors and EAP Utilization

This study examined relationships between workplace stress, organizational factors and use of EAP counseling services delivered by network providers in a large, privately-insured population. Claims data were linked to measures of workplace stress, focus on wellness/prevention, EAP promotion, and EAP activities for health care plan enrollees from 26 employers. The association of external environment and work organization variables with use of EAP counseling services was examined. Higher levels of EAP promotion and worksite activities were associated with greater likelihood of service use. Greater focus on wellness/prevention and unusual and significant stress were associated with lower likelihood of service use. Results provide stakeholders with insights on approaches to increasing utilization of EAP services.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

Manager beliefs regarding worksite health promotion: findings from the Working Healthy Project 2

PURPOSE

To explore differences in manager beliefs about worksite health promotion programs (HPPs).

DESIGN

Cross-sectional written survey.

SETTING

Twenty-four manufacturing worksites, with 11,811 employees and 1719 eligible managers.

SUBJECTS

Sixty-six percent (1133/1719) of managers completed the survey; 1047 managers were categorized by level (169 senior, 567 middle, and 311 line supervisors).

ANALYSIS

Results are reported on overall manager beliefs (and by manager level) about importance, efficacy, barriers, and benefits of HPPs. Multilevel analysis modeled the influence of manager level, age, and experience with HPPs on beliefs about HPPs, while accounting for worksite-level effects.

RESULTS

Seventy-five percent of managers believed that offering HPPs is highly important. Eighty percent believed that HPPs improved employee health, 68% believed that they reduced health care costs, and 67% believed that they improved employee morale. Few significant differences by manager level were observed on the perceived importance of health promotion, employer responsibilities for health promotion and protection, and efficacy of health promotion strategies or perceived benefits. Senior managers (vs. line supervisors) were significantly less likely to believe that space or cost was a barrier to offering HPPs and were less likely than middle managers or line supervisors to believe that production conflicts were barriers to offering HPPs.

CONCLUSION

Targeted interventions to address manager beliefs, including differences by age, experience, and manager level, are worth consideration when planning worksite HPPs.

The association between health risk change and presenteeism change

OBJECTIVE

This prospective study investigates whether changes in health risks are associated with changes in presenteeism (on-the-job productivity loss).

METHOD

A total of 7026 employees of a national financial services company responded to a health risk appraisal (HRA), which included a modified version of the Work Limitation Questionnaire (WLQ) in both 2002 and 2004. The association between changes in health risks and changes in self-reported presenteeism was examined.

RESULTS

Changes in perceptual/psychologic health risks had a strong association with changes in presenteeism. Individuals who reduced their risks generally saw an improvement in productivity, whereas those who gained risks or remained high-risk status saw deterioration in productivity. Each risk factor increased or reduced was associated with a commensurate change in 1.9% productivity loss over time and estimated to be 950 dollars per year per risk changed.

CONCLUSIONS

Positive and negative changes in health risks are associated with same-direction changes in presenteeism.

Using sequential e-mail messages to promote health behaviors: evidence of feasibility and reach in a worksite sample

Background

US adults report suboptimal physical activity and fruit and vegetable intake. Innovative strategies to promote healthy behaviors are needed. Employee health promotion programs have been associated with reductions in health risks but are labor-intensive and costly to implement. Email and Web-based worksite programs have the potential to reach a broad adult population and to provide a cost-effective approach to employee wellness programming.

Objective

To assess the feasibility of using sequential email messages to promote physical activity and increase fruit and vegetable intake among employed adults.

Methods

Employees at one worksite of a large insurance company in New York State were invited to participate. Interested workers provided written consent. After completing a baseline survey, participants received daily emails, Monday through Friday, for 26 weeks. The emails provided (a) succinct strategies to encourage physical activity or increase fruit and vegetable intake and (b) links to detailed Web-based information and tools. Program reach was assessed by the number of emails opened, measures of sustained participation over 6 months, and the number of health-related Web-links clicked.

Results

Of 960 employees, 388 (40%) consented to participate; of these, 345 (89%) completed the baseline health survey. After 6 months, 70% of the 345 participants had opened 50% or more of the daily emails. In addition, 75% of participants continued to open at least one email a week through week 26 of the study. Email opening rates did not vary by gender, age, income, education, ethnicity, or baseline health behavior.

Conclusions

The rate of enrollment and sustained participation document the feasibility, broad reach, employee acceptance, and potential value of using electronic communications for health promotion in the workplace.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VI 2000-2004

This critical review focuses on the 12 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2000 and 2004. Although these new studies indicate further evidence of positive clinical and cost outcomes, the quantity and quality of such research continue to decline. When corporations and health plans are demanding more evidence-based outcomes, this decline in rigorous research marks a serious challenge to the field of health promotion and disease management.

Participation rates in worksite-based intervention studies: health promotion context as a crucial quality criterion

Recently, a set of specific quality evaluation criteria for health promotion research has been proposed in this journal. One of the quality criteria identified is the 'health promotion context'. With this paper we would like to contribute to the dialogue by specifying the importance of this criterion on the basis of our on experience with worksite-based obesity prevention interventions. We advocate the reporting of participation rates among approached worksites in publications on worksite intervention effects. Such information will help to draw conclusions on the practical relevance of the shown effectiveness of the intervention. Health promotion practice is advised to adopt and disseminate evidence-based interventions, accompanied by a diffusion study with a minimal research burden for participants.

Wellness at work: enhancing the quality of our working lives

This paper was prepared for the International Review of Psychiatry as part of an effort to improve understanding of the connection between employee health and performance and to begin to identify new strategies through which treating wellness as an investment in human capital can lead to greater organizational success. Computer database searches of peer-reviewed literature published between 1993 and 2005 and manual reviews of 20 journals were used to identify research on the link between employee health and performance. Data was extracted to summarize the overall findings on the magnitude of health problems addressed by health promotion and disease prevention programmes, and the impact of interventions on improving health risk, reducing health care cost, and improving worker performance. From this summary, major conclusions on early detection of disease, the impact of behaviour change programmes were drawn. This systematic review is supplemented with a case study description of a preliminary evaluation of a corporate wellness programme in a major international organization. The influence of developments in work/family issues, complementary and alternative medicine, and quality of care and health outcomes research are briefly discussed. Finally, a conceptual framework for studying the impact of health and productivity is described.

Evaluation of empowerment processes in a workplace health promotion intervention based on learning in Sweden

The aim of this study was to evaluate a theory-based method for workplace health promotion (WHP) with regard to possible facilitation of empowerment processes. The intervention tool was the pedagogic method known as problem-based learning (PBL). The aim of the intervention was to promote empowerment and health among the employees. The intervention was implemented in three organizations within the public sector in Sweden, in a bottom-up approach. All employees, including management, in each organization, were offered the opportunity to participate (n = 113) and 87% (n = 97) participated. The intervention was implemented in 13 groups of six to eight participants who met once a week over a period of 4 months. The predetermined overall goal of the intervention was to promote employee health within the organizational setting. A facilitator in each group and a group-specific mutual agreement guided the intervention, as did the problem solving process. The participants set goals and developed strategies to reach their goals between the meetings. Thirty informants were interviewed in seven focus groups after the intervention about the intervention method and the process, following a semi-structured theme guide. The phenomenographic analysis resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and actions. The results correspond to established theories of components of empowerment processes. The method initiated processes of change at organizational, workplace and individual levels as the participants examined their work situation, determined problems and initiated solutions. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realization. The findings indicate that systematic improvements of social support and group coherence among employees ought to be facilitated by the organization as a health-promoting arena. PBL appears to be a profitable and powerful instrument with the potential to enable empowerment.

Workplace health promotion and utilization of health services

This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.

Integrating services for optimal proactive care

While case management, disease management and health advocacy each approach the patient relationship from a different angle, there are opportunities to integrate the three to achieve better results and move past finding only the sickest 1-3% in order to produce cost stabilization for employers. This article looks at how and why we should add survey-based predictive tools and coaching to the current case management and disease management mix to achieve substantial cost reduction and successful intervention.

Comparing excess costs across multiple corporate populations

The purpose of this study was to examine the relationship of health risk level to charged medical costs and determine the excess cost of higher risk individuals compared to low risk. Two years of medical claims from six corporations were used to determine costs of health risk assessment (HRA) participants and nonparticipants. A total of 165,770 employees, 21,124 of which took an HRA, were used for the study. Costs increased as risk level increased. There were no significant differences within a risk level between companies for the cost ratio. Percent of medical costs due to excess risk ranged from 15.0-30.8% for HRA participants and 23.8-38.3% for the study population. Cost patterns were consistent across companies. Excess cost as the result of increased risk level accounted for a substantial portion of the cost at each company. These results can be used to justify the need for a health-promotion program and to estimate potential savings as the result of excess risk. Even without the use of an HRA, health practitioners should feel confident stating that excess risk accounts for at least 25% to 30% of medical costs per year across a wide variety of companies, regardless of industry or demographics. The numbers can be used as a realistic estimate for any health promotion program financial proposal.

Examination of risk status transitions among active employees in a comprehensive worksite health promotion program

Most worksite health promotion programs are designed to effect risk reduction. Net changes in the prevalence of health behaviors are a combination of individuals who reduce to low-risk and those who become high-risk. It is the purpose of this study to examine overall risk status transitions, between low-risk (0-2 risks); medium-risk (3-4 risks); and high-risk (5 or more risks), within a comprehensive worksite health promotion program over the first year of the program (short-term) and after 5 years (long-term). Significant increases were demonstrated in the numbers of individuals who transitioned to lower risk status. Nearly half (0 percentage points) of the net reduction to low-risk status (+10.4 percentage points) occurred during the first year of the program. The design of health promotion programs may need to be adjusted from risk reduction in the short-term to programs that maximize retention of individuals within low-risk categories over the long-term. This program design would maximize the opportunity to obtain initial risk reduction during the first years of the program and then maximize the opportunity to maintain low-risk status in the long-term.

Quantifiable impact of the contract for health and wellness: health behaviors, health care costs, disability, and workers' compensation

Current literature about the long-term impacts of corporate health and wellness programs has brought to light new evidence about the cost savings associated with health-promotion interventions. A critical element in these initiatives is attracting the participation of employees at risk for high benefits use. This study presents evidence that suggests accomplishing this task has economic savings implications to large employers. A health and wellness intervention program offered at GlaxoSmithKline, entitled the Contract for Health and Wellness, is examined. Focusing on a group of 6049 employees, the study examines the impact on health behaviors and on integrated health benefits use of this continuously employed population from 1996 to 2000. Total benefits costs are examined for participants and nonparticipants, and the annual savings associated with the isolated impact of the program are, on average, $613 per participant. Reductions in disability costs accounted for the majority of these savings.

Cost-effectiveness of a cardiovascular disease risk reduction program aimed at financially vulnerable women: the Massachusetts WISEWOMAN project

OBJECTIVE

The Massachusetts WISEWOMAN Project is a cardiovascular disease (CVD) risk reduction program targeting older uninsured and underinsured women. The cost-effectiveness of providing CVD screening and enhanced lifestyle interventions (EI), compared with providing CVD screening and a minimum intervention (MI), was assessed at five El and six MI healthcare sites.

METHODS

Cost calculations were based on data collected during screenings and intervention activities conducted with 1586 women in 1996. Risk factor data, including cholesterol and blood pressure measures, were used to create a summary effectiveness outcome, the 10-year probability of developing coronary heart disease (CHD). The cost-effectiveness ratio of the EI, compared with the MI, was calculated by dividing the incremental cost of the EI by the incremental effectiveness of the EI.

RESULTS

The incremental cost of the EI was $191. During the 1-year study period, the 10-year probability of CHD decreased from 9.4% to 9.2% in the MI group and from 10.3% to 9.8%in the El group. Based on these results, it would cost $637 to achieve a 1 percentage point larger decrease in the 10-year probability of CHD for women enrolled in the El. However, because differences between groups were not statistically significant, we cannot reject the hypothesis that the El results in no greater reductions in CHD risk.

CONCLUSIONS

Although women enrolled in both the MI and El showed decreases in CHD risk during the study period, future research is needed to assess the impact of lifestyle interventions targeting financially disadvantaged women.