Health promotion programs in small worksites: results of a national survey

Stages of organizational development and employee assistance programs in Taiwan

Employee assistance programs (EAPs) provide work, living, and health services to help employees overcome personal and organizational obstacles that affect their productivity. Most businesses in Taiwan are small or medium-sized, and their scale, stage of development, and resources affect their implementation of EAPs. This study explored EAPs and related measures that organizations can implement in each stage of their development. The results may serve as a reference for human resources personnel in planning EAPs, specifically in identifying appropriate measures to implement for each developmental stage of their organizations. The modified Delphi method and fuzzy analytic hierarchy process were used to organize and analyze key EAP measures and their weights during the creation, guidance, authorization, coordination, and collaboration stages of organizational development. Data analysis revealed that in all five stages of organizational development, work-related EAP measures are the most crucial. As an organization transitions from the creation to collaboration stages, the work dimension is neglected in favor of the health dimension. In the authorization stage, the organization begins to provide a wider range of services in the living dimension. The results and other information regarding EAP service models indicate that in each developmental stage, an organization should adopt a different EAP service model that suits its resources, organizational structure, implementation of EAP measures, and other factors.

Strategic Choice and Implementation of Workplace Wellness Programs in the United States

Despite widespread discussion and public policy support for workplace wellness programs in the United States, their diffusion has been slow. Using data from the 2017 Workplace Health Administration Survey, this paper explored the importance of establishment characteristics, unionization, and strategic choice in the adoption of workplace health initiatives and employee participation in these programs. An ordinary least squares analysis revealed that unionization (β = 1.59, 95% CI = 1.20−1.97, p < 0.001) and management support (β = 1.67, 95% CI = 1.25−2.10, p < 0.001) were the strongest predictors of the number of programs adopted by an establishment. In logistic regression analyses of nine workplace wellness programs, it was also found that unionization and management were the strongest predictors of the adoption of these programs. Management support was also correlated with employee participation of in nutrition (OR = 2.66, 95% CI = 1.23−5.71, p < 0.05) and obesity programs (OR = 3.66, 95% CI = 1.03−12.97, p < 0.05).

Health promotion program for office workers with SEM based on the WHO’s healthy workplace framework

This study attempts to develop and verify the effectiveness of a health promotion program for office workers based on the social ecological model and the World Health Organization’s Healthy Workplace Framework. This study involved 272 office workers of a small and medium-sized enterprise in Korea. Data were analyzed through descriptive statistics, repeated measures analysis of variance (ANOVA) and Bonferroni correction using SPSS/WIN 23.0. Workplace environmental support was provided to all workers, while a 6-month intensive core program based on social support was implemented for the intensive management group. Based on the participation rate, individuals were divided into the core and dropout groups. In all office workers, there were negative changes in high-density lipoprotein cholesterol and job stress during the period. Meanwhile, the intensive group showed significant changes in body mass index and diastolic blood pressure. The study suggests that the organization’s support for a healthy environment and an individual’s continued participation based on social support are essential for the effectiveness of a health promotion program for office workers.

The Impact of Worksite Wellness Programs by Size of Business: A 3-Year Longitudinal Study of Participation, Health Benefits, Absenteeism, and Presenteeism

Objective

Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP.

Methods

We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism.

Results

Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed.

Conclusions

Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.

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.

Perceptions of work environment priorities: Are there any differences by company size? An ecological study

BACKGROUND

Earlier studies suggest that the quality of handling occupational health and safety (OHS) activities differs between companies of different sizes. Company size is a proxy variable for other variables affecting OHS performance.

OBJECTIVE

The objective of this study was to investigate if there is an association between company size and perceptions of work environment prioritizations.

METHODS

Data from 106 small- and medium-sized Swedish manufacturing companies was collected. One manager and one safety delegate at each company rated different aspects of their companies' work environment prioritizations with a 43-item questionnaire. Ratings were aggregated to a summary statistic for each company before analysis.

RESULTS

No significant differences in perceptions of priority were found to be associated with company sizes. This is in contrast to earlier studies of objective differences. The respondents in small companies, however, showed significantly greater consensus in their ratings.

CONCLUSIONS

Company size does not appear to be associated with perceptions of work environment prioritizations. Company size is an important proxy variable to study in order to understand what factors enable and obstruct safe and healthy workplaces. The work presented here should be viewed as an initial exploration to serve as direction for future academic work.

Competing discourses of workplace health

This article presents an analysis of workplace health programme discourses within an international information technology company. Discourse refers to a system of statements that share a common force and coherence and which are socially constitutive. The representation of entities such as workplace health can be subject to competition between discourses. A critical discourse analysis was undertaken on semi-structured interviews, participant observation and workplace health programme documents. Two competing discourses were identified: health as safety and health as lifestyle. Each discourse is described and shown to both implicitly and explicitly define health within this particular workplace. Lifestyle discourse encouraged moves towards linking of the employees' working and private lives while safety discourse defined health in the relationship between workers and their physical environment. Competition between discourses both constricts and opens spaces for alternative understandings of health in the workplace. The implications of this competition for workplace health policy and practice are discussed.

Health promotion in small business: a systematic review of factors influencing adoption and effectiveness of worksite wellness programs

OBJECTIVE

To assess the evidence regarding the adoption and efficacy of worksite health promotion programs (WHPPs) in small businesses.

METHODS

Peer-reviewed research articles were identified from a database search. Included articles were published before July 2013, described a study that used an experimental or quasiexperimental design and either assessed adoption of WHPPs or conducted interventions in businesses with fewer than 500 employees. A review team scored the study's rigor using the WHO-adapted GRADEprofiler "quality of evidence" criteria.

RESULTS

Of the 84 retrieved articles, 19 met study inclusion criteria. Of these, only two met criteria for high rigor.

CONCLUSIONS

Fewer small businesses adopt WHPPs compared with large businesses. Two high-rigor studies found that employees were healthier postintervention. Higher quality research is needed to better understand why small businesses rarely adopt wellness programs and to demonstrate the value of such programs.

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.

Safety practices in Jordanian manufacturing enterprises within industrial estates

This paper investigates occupational health and safety practices in manufacturing enterprises within Jordanian industrial estates. Response rates were 21.9%, 58.6% and 70.8% for small, medium and large sized enterprises, respectively. Survey results show that most companies comply with state regulations, provide necessary facilities to enhance safety and provide several measures to limit and control hazards. On the negative side, little attention is given to safety training that might be due to the lack of related regulations and follow-up, financial limitations or lack of awareness on the importance of safety training. In addition, results show that ergonomic hazards, noise and hazardous chemicals are largely present. Accident statistics show that medium enterprises have the highest accident cases per enterprise, and chemical industries reported highest total number of accidents per enterprise. The outcomes of this study establish a base for appropriate safety recommendations to enhance the awareness and commitment of companies to appropriate safety rules.

Organizational factors and the attitude toward health promotion in German ICT-companies

This study takes a first step toward examining the relationship between organizational characteristics and the perceived attitude toward health promotion in companies from the perspective of chief executive officers (CEOs). Data for the cross-sectional study were collected through telephone interviews with one CEO from randomly selected companies within the German information and communication technology (ICT) sector. Multivariate logistic regression analysis (LRA) was performed, and further LRA was conducted after stratifying on company size. LRA of data from a total of n = 522 interviews found significant associations between the attitude toward health promotion and the company's market position, its number of hierarchical levels, the percentage of permanent positions and the percentage of employees with an academic education. After stratification on company size, the association between the attitude toward health promotion and both market position and the percentage of employees with an academic education was still present in small companies. There were no significant relationships between the attitude toward health promotion and the structural characteristics of medium-sized and large companies. The preliminary results of the study indicate that a perceived attitude toward health promotion in companies can be explained, to a certain degree, by the intraorganizational characteristics analyzed. Our key findings highlight that efforts toward establishing a positive attitude toward health promotion should focus on small companies with a lower market position and a greater number of employees with a lower education level.

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.

A pilot study of an online workplace nutrition program: the value of participant input in program development

OBJECTIVE

Tailored nutrition Web programs constitute an emerging trend in obesity prevention. Initial investment in innovative technology necessitates that the target population be well understood. This pilot study's purpose was to determine the feasibility of a workplace nutrition Web program.

DESIGN

Formative research was conducted with gaming industry employees and benefits managers to develop a consensus on workplace-specific nutrition needs. A demonstration Web program was piloted with stakeholders to determine feasibility.

SETTING

Indiana, Mississippi, Nevada, and New Jersey gaming establishments.

PARTICIPANTS

86 employees, 18 benefits managers.

INTERVENTION

Prototype Web program.

MAIN OUTCOME MEASURES

Concept mapping; 16-item nutrition knowledge test; satisfaction.

ANALYSIS

Concept mapping was used to aggregate importance ratings on programmatic content, which informed Web program curriculum. Chi-square tests were performed postintervention to determine knowledge improvement.

RESULTS

(1) Employees and benefits managers exhibited moderate agreement about content priorities for the program (r = 0.48). (2) There was a significant increase in employees' nutrition knowledge scores postintervention (t = 7.16, df = 36, P < .001); those with less knowledge exhibited the greatest gains in knowledge scores (r = -0.647, P < .001).

CONCLUSIONS AND IMPLICATIONS

Employees and benefit managers do not necessarily agree on the priority of nutrition-related content, suggesting a need for programs to appeal to various stakeholders. Computer-based approaches can address various stakeholder health concerns via tailored, customized programming.

Reporting of skin cancer risks in the house-building industry: alternative approaches to the analysis of categorical data

BACKGROUND

Increasing incidence of skin cancer is of concern to public health. Working predominantly outside, construction workers are at increased risk of sunburn and certain forms of skin cancer. The objective of this paper was to explore these concerns via use of alternative approaches to categorical data analysis by considering the relationship between the size of house-building companies, use of risk assessments and the system for reporting sunburn.

METHODS

The survey population was speculative house-building companies. A self-administered questionnaire was sent to health and safety advisors in house-building companies. Questions related to the number of house units built, inclusion of adverse weather in the risk assessment, and the presence or absence of a system for reporting sunburn were analysed. Alternative approaches to conventional chi(2) tests were used in order to investigate a multiway data structure. A loglinear model was employed using Statistical Package for Social Sciences to explain data in three-way tables.

RESULTS

The questionnaire achieved a response rate of 31% (n=94). A significant association identified in a two-way study of the mechanisms of reporting sunburn also appeared at the sublevels introduced by the inclusion of a third method of categorization. Finally, correspondence analysis was used to present a graphical insight into the study.

CONCLUSIONS

In the two-way analysis, the size of house-building company had a significant impact on the presence of a system for reporting sunburn, although this was not translated into the three-way analysis. The establishment of systems within risk assessments to incorporate exposure of construction workers to ultraviolet radiation, and reporting of incidents of sunburn, is essential if this public health issue is to be addressed.

Results of the 2004 National Worksite Health Promotion Survey

OBJECTIVES

We examined worksite health promotion programs, policies, and services to monitor the achievement of the Healthy People 2010 worksite-related goal of 75% of worksites offering a comprehensive worksite health promotion program.

METHODS

We conducted a nationally representative, cross-sectional telephone survey of worksite health promotion programs stratified by worksite size and industry type. Techniques appropriate for analyzing complex surveys were used to compute point estimates, confidence intervals, and multivariate statistics.

RESULTS

Worksites with more than 750 employees consistently offered more programs, policies, and services than did smaller worksites. Only 6.9% of responding worksites offered a comprehensive worksite health promotion program. Sites with a staff person dedicated to and responsible for health promotion were significantly more likely to offer a comprehensive program, and sites in the agriculture and mining or financial services sector were significantly less likely than those in other industry sectors to offer such a program.

CONCLUSIONS

Increasing the number, quality, and types of health promotion programs at worksites, especially smaller worksites, remains an important public health goal.

Organizational characteristics of small metal-fabricating businesses in Minnesota

Small U.S. businesses are underserved in terms of occupational health and safety (OHS) services. Little is known about organizational factors influencing OHS in these establishments. Machine guarding was quantitatively evaluated in 40 small businesses. Checklists were used to develop safety scores. Organizational information such as number of employees, unionization, and number of machines was obtained. Experience modification rates, annual sales, and credit ratings were also obtained. Safety scores were divided into terciles. Businesses with safety scores in the top third were unionized, had effective safety committees, and had been operational for more than 30 years. Interventions and policies targeted toward development and implementation of safety committees are needed to improve OHS in this cohort. Financial capability had no bearing on ability of a small business to mount an OHS programs. Non-unionized small businesses may be more vulnerable to occupational injuries.

Process evaluation results from the Healthy Directions-Small Business study

The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conducted using quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.