The effect of disease prevention and health promotion on workplace productivity: a literature review

Deprivation as a fundamental cause of morbidity and reduced life expectancy: an observational study using German statutory health insurance data

Across all developed countries, there is a steep life expectancy gradient with respect to deprivation. This paper provides a theoretical underpinning for this gradient in line with the Grossman model, indicating that deprivation affects morbidity and, consequently, life expectancy in three ways: directly from deprivation to morbidity, and indirectly through lower income and a trade-off between investments in health and social status. Using rich German claims data covering 6.3 million insured people over four years, this paper illustrates that deprivation increases morbidity and reduces life expectancy. It was estimated that highly deprived individuals had approximately two more chronic diseases and a life expectancy reduced by 15 years compared to the least deprived individuals. This mechanism of deprivation is identified as fundamental, as deprived people remain trapped in their social status, and this status results in health investment decisions that affect long-term morbidity. However, in the German setting, the income and investment paths of the effects of deprivation were of minor relevance due to the broad national coverage of its SHI system. The most important aspects of deprivation were direct effects on morbidity, which accumulate over the lifespan. In this respect, personal aspects, such as social status, were found to be three times more important than spatial aspects, such as area deprivation.

Capillary blood stability and analytical accuracy of 12 analytes stored in Microtainers®

Objectives

The aim of this study was to determine feasibility of collecting capillary blood by traditional fingerstick and next day analysis after transport in Microtainers® at ambient temperature with no plasma separation. This study is pursuing an acceptable alternative to venipuncture for measuring 12 analytes important for health risk assessment.

Design

and Methods: Performance standards of a 12-assay chemistry panel were assessed using a set of paralleled serum and capillary microsamples. The panel included Hemoglobin A1c (HbA1c), Total Cholesterol, Triglycerides, HDL-C, Creatinine, Urea Nitrogen (BUN), Uric Acid, alkaline phosphatase (ALP), ALT (GPT), AST (GOT), gamma-glutamyltransferase (GGT), and total protein. Correlation studies were performed using 31 simultaneous venous and capillary blood collections. Analytical bias, correlation, and medical decision points were calculated to determine equivalency of sample type and the impact of transport conditions. Clinical sensitivity, specificity, and predictive values were evaluated at calculated medical decision points for their usability in health screening initiatives.

Results

Laboratory test results using capillary blood samples stored in Microtainers® under conditions of delayed centrifugation, and mail transport at ambient temperature, showed an acceptable agreement with results obtained using their paired serum samples analyzed using standard methods, except AST.

Conclusions

Capillary blood samples can be self-collected at remote locations using Microtainers® and transported at ambient temperature for 24 h for successful performance of several medical tests important in large-scale health screenings programs.

The co-production of a workplace health promotion program: expected benefits, contested boundaries

Workplace health promotion (WHP) are often depicted as an opportunity for pursuing a better and broader well-being condition under the assumption that working environments affect the physical, mental, and social well-being of individuals who spend large proportion of waking hours at work. While most empirical studies provided medical evidence to the effectiveness of WHP programs, scholars question the instrumental purposes of these programs founded on the belief that "healthy workers are better workers". Little is known, for instance, about the design of WHP programs and their acceptance by workers. Our study addresses this gap, analyzing the co-production of a WHP program in an Italian research institute promoted by the healthcare authority, the local government and the national center for prevention and security in the workplaces. To this aim, we adopt the notion of boundary object investigate how different stakeholders reclaim to take part and being involved in this process, re-shaping their goals and their boundaries and why a WHP program or parts of it may be rejected or re-negotiated by its recipients. Our analysis reveals how each stakeholder contributes to re-shape the WHP program which emerges as the modular product of the composition of each matter of concern. Most notably, the strong rooting in a clinical perspective and the original focus on only workers at risk is gradually flanked by initiatives to involve all employees. Moreover, workers draw a line as for the legitimacy of employers' intervention in the personal sphere of health promotion, embracing interventions addressing diet and physical activity while rejecting measures targeting smoking and alcohol consumption.

Improving the Safety-Performance Nexus: A Study on the Moderating and Mediating Influence of Work Motivation in the Causal Link between Occupational Health and Safety Management (OHSM) Practices and Work Performance in the Oil and Gas Sector

The preventive systems required to ensure workers are protected from occupational accidents and injuries dwell heavily on effective occupational health and safety management (OHSM) systems and practices. In this study, the concepts of the job demand-resource model (JD-R), self-determination theory (SDT), and perceived organizational support for safety (POSS) theory were adopted to develop a holistic conceptual model that seeks to unravel moderating and mediating effects of work motivation on the causal link between OHSM practices and work performance in the oil and gas sector. The study measured OHSM practices from six distinct safety dimensional perspectives and work performance using a two-dimensional distinct construct that assesses different aspects of positive work behaviours. A quantitative research approach through the structural equation modelling analysis technique was applied. A total of 1310 participants were selected across three major organizations that represent downstream, upstream, and middle stream of the Ghanaian oil and gas sector. Respondents were recruited through stratified, purposive, and convenient sampling techniques. The findings from the path estimate through the SEM analysis suggested that OHSM practices positively and significantly influenced both safety performance and task performance of employees. However, OHSM practices indicated a higher positive significant influence on task performance than safety performance. The significant influence of OHSM practices on both task and safety performance was significantly moderated and partially mediated by work motivation, while both task performance and safety performance were significantly determined by work motivation. In this study, the dimensions for assessing work performance extend the performance theories established in previous literature, whereas the integrated multifaceted OHSM practices employed diverge from the traditional individualistic approach by providing insights into more flexible managerial practices that are employee-centred and outcome-oriented. The findings from this study address the need for organizations to appreciate the importance of managing workers’ perception of OHSM practices as a motivational drive that induces work performance.

Wellness marketing in the corporate context

Purpose

This paper aims to provide a literature review of corporate wellness programs to develop recommendations for effective internal marketing of healthy behaviors in work environments.

Design/methodology/approach

A review of research literature published since 2000 addresses corporate wellness programs’ justifications and best program design practices.

Findings

Corporate and employee benefits documented in the literature are reviewed and best practices from published literature are identified to guide the design of wellness programs. These include framing clear messages, alignment of corporate culture and business strategy with wellness program goals, senior leader support, clear objectives and evaluation, incorporation of peer support and enjoyable activities, utilization of effective priming for healthy choices and consideration of legal and ethical incentives.

Research limitations/implications

Further research is needed, including how to frame messages for diverse work groups, how to carry out effective program assessments, what types of marketing appeals are effective, what wellness activities lead to healthy behavior change and how is increased employee productivity related to quality of life. Additional questions include how priming encourages healthy behaviors, what promotes healthy workplace cultures and what social marketing appeals promote healthy behaviors.

Practical implications

Senior managers can implement findings to create effective wellness programs benefiting employees and firms through improved employee health and productivity and reduced corporate health-care costs.

Social implications

Effective wellness programs reduce overall health-care costs for society and provide improved participants’ quality of work, personal and family life.

Originality/value

This research uniquely applies internal marketing, social marketing and marketing exchange concepts to best practices from the wellness literature and applies these to recommendations for effective corporate-based wellness programs.

The Ethics of Workplace Health Promotion

Companies increasingly offer their employees the opportunity to participate in voluntary Workplace Health Promotion programmes. Although such programmes have come into focus through national and regional regulation throughout much of the Western world, their ethical implications remain largely unexamined. This article maps the territory of the ethical issues that have arisen in relation to voluntary health promotion in the workplace against the background of asymmetric relationships between employers and employees. It addresses questions of autonomy and voluntariness, discrimination and distributive justice, as well as privacy and responsibility. Following this analysis, we highlight the inadequacy of currently established ethical frameworks to sufficiently cover all aspects of workplace health promotion. Thus, we recommend the consideration of principles from all such frameworks in combination, in a joint reflection of an Ethics of Workplace Health Promotion.

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.

An Investigation of Self-reported Health-related Productivity Loss in Office Workers and Associations With Individual and Work-related Factors Using an Employer's Perspective

OBJECTIVE

Office workers have a high prevalence of musculoskeletal conditions. This can be a significant economic burden due to health-related productivity loss. Individual and work-related factors related to office worker health-related productivity were investigated.

METHODS

A survey including the Health and Work Performance Questionnaire, which estimated productivity loss, also recorded individual and work-related factors with potential associations with health-related productivity. Muscle function and workstation ergonomics were examined through physical assessments. Linear models investigated the relationships between these factors and health-related productivity.

RESULTS

Significant factors identified were occupational category (0.001 < P < 0.050), job satisfaction (P < 0.001), psychological wellbeing (P = 0.031), and musculoskeletal pain (P = 0.023). Health-related productivity loss was greater in office workers working as managers, with lower job satisfaction and psychological wellbeing, and those with musculoskeletal pain.

CONCLUSION

Office worker health-related productivity loss is represented by a combination of both individual and work-related factors.

The Associations of Multimorbidity With Health-Related Productivity Loss in a Large and Diverse Public Sector Setting: A Cross-Sectional Survey

OBJECTIVE

To evaluate absenteeism, presenteeism, and total lost productive time (LPT) associated with multimorbidity.

METHODS

Cross-sectional data from 3228 state-government employees from Tasmania were collected in 2013. The validated measures of absenteeism, presenteeism, and LPT were obtained from employees' self-reported data over a 28-day period. Analyses were stratified by sex. Negative binomial models were used to estimate the associations between multimorbidity and LPT.

RESULTS

The average health-related total LPT was 1.2 (standard deviation [SD] = 2.4) and 1.7 (SD = 3.5) days for men and women with multimorbidity, respectively. Women (rate ratio [RR] = 2.9, 95% confidence interval [CI] 1.8 to 4.9) and men (RR = 4.4, 95%CI 3.0 to 6.2) with 4+ chronic conditions were significantly more likely to report LPT compared with those without any chronic conditions.

CONCLUSION

We found multimorbidity is of concern within the workforce, with a positive association of multimorbidity and LPT observed, and significant differences in LPT between men and women reporting multimorbidity.

Dietary interventions to prevent and manage diabetes in worksite settings: a meta-analysis

OBJECTIVES

The translation of lifestyle intervention to improve glucose tolerance into the workplace has been rare. The objective of this meta-analysis is to summarize the evidence for the effectiveness of dietary interventions in worksite settings on lowering blood sugar levels.

METHODS

We searched for studies in PubMed, Embase, Econlit, Ovid, Cochrane, Web of Science, and Cumulative Index to Nursing and Allied Health Literature. Search terms were as follows: (1) Exposure-based: nutrition/diet/dietary intervention/health promotion/primary prevention/health behavior/health education/food /program evaluation; (2) Outcome-based: diabetes/hyperglycemia/glucose/HbA1c/glycated hemoglobin; and (3) Setting-based: workplace/worksite/occupational/industry/job/employee. We manually searched review articles and reference lists of articles identified from 1969 to December 2016. We tested for between-studies heterogeneity and calculated the pooled effect sizes for changes in HbA1c (%) and fasting glucose (mg/dl) using random effect models for meta-analysis in 2016.

RESULTS

A total of 17 articles out of 1663 initially selected articles were included in the meta-analysis. With a random-effects model, worksite dietary interventions led to a pooled -0.18% (95% CI, -0.29 to -0.06; P<0.001) difference in HbA1c. With the random-effects model, the interventions resulted in 2.60 mg/dl lower fasting glucose with borderline significance (95% CI: -5.27 to 0.08, P=0.06). In the multivariate meta-regression model, the interventions with high percent of female participants and that used the intervention directly delivered to individuals, rather the environment changes, were associated with more effective interventions.

CONCLUSION

Workplace dietary interventions can improve HbA1c. The effects were larger for the interventions with greater number of female participants and with individual-level interventions.

The Productivity Dilemma in Workplace Health Promotion

BACKGROUND

Worksite-based programs to improve workforce health and well-being (Workplace Health Promotion (WHP)) have been advanced as conduits for improved worker productivity and decreased health care costs. There has been a countervailing health economics contention that return on investment (ROI) does not merit preventive health investment. METHODS/PROCEDURES: Pertinent studies were reviewed and results reconsidered. A simple economic model is presented based on conventional and alternate assumptions used in cost benefit analysis (CBA), such as discounting and negative value. The issues are presented in the format of 3 conceptual dilemmas.

PRINCIPAL FINDINGS

In some occupations such as nursing, the utility of patient survival and staff health is undervalued. WHP may miss important components of work related health risk. Altering assumptions on discounting and eliminating the drag of negative value radically change the CBA value.

SIGNIFICANCE

Simple monetization of a work life and calculation of return on workforce health investment as a simple alternate opportunity involve highly selective interpretations of productivity and utility.

The impact of two workplace-based health risk appraisal interventions on employee lifestyle parameters, mental health and work ability: results of a randomized controlled trial

Health risk appraisals (HRA) are a common type of workplace health promotion programme offered by American employers. In the United Kingdom, evidence of their effectiveness for promoting health behaviour change remains inconclusive. This randomized controlled trial examined the effects of two HRA interventions on lifestyle parameters, mental health and work ability in a UK context. A total of 180 employees were randomized into one of three groups: Group A (HRA augmented with health promotion and education activities), Group B (HRA only) and Group C (control, no intervention). After 12 months, changes in mean scoring in 10 lifestyle, mental health and work ability indices were compared, Groups A and B demonstrated non-significant improvements in 70% and 80%, respectively, compared with controls (40%). Odds ratios revealed that, compared with the control group, Group A was 29.2 (95% CI: 9.22-92.27) times more likely to report a perceived change in lifestyle behaviour; Group B 4.4 times (95% CI: 1.65-11.44). In conclusion, participation in the HRA was associated with a higher likelihood of perceived lifestyle behaviour change which was further increased in the augmented HRA group, thereby providing preliminary evidence that HRA and augmented HRA in particular may help UK employees make positive healthy lifestyle changes.

Screening for hazardous drinking in migrant workers in southeastern Spain

OBJECTIVES

Despite the great impact the migration has had in economic, social and health-related fields, and the repercussions of alcohol consumption on them, few data exist concerning the extent of alcohol consumption in migrant workers. The aims of this study were to identify workers with a hazardous drinking problem by means of a self-reported questionnaire (Alcohol Use Disorders Identification Test-AUDIT) and a biomarker (carbohydrate-deficient transferrin-CDT) and to ascertain associated risk factors.

METHODS

A cross-sectional survey was conducted using a random sample of 385 migrant workers, undergoing a routine health examination as part of occupational health services.

RESULTS

The results showed that 13.8% (n=53) of the workers were screened as positive with the AUDIT (≥8) and/or CDT (>2.6) and identified as hazardous drinkers and that 53.8% (n=207) were teetotallers. Being a man (OR: 2.0), working in the construction industry (OR: 2.8) or agriculture (OR: 2.2), being resident in Spain for more than 7 years (OR: 2.3) and sharing a house with friends were the factors most closely associated with hazardous drinking.

CONCLUSIONS

Prevention-orientated programs, adjusted to the characteristics of each country and the origin of the migrants themselves, should be instituted to modify the drinking habits of migrant workers considered at risk.

The association between modifiable well-being risks and productivity: a longitudinal study in pooled employer sample

OBJECTIVE

To examine the longitudinal relationship between modifiable well-being risks and productivity.

METHODS

A total of 19,121 employees from five employers participated in baseline and follow-up well-being assessment surveys. Multivariate regressions assessed whether changes in absenteeism, presenteeism, and job performance were associated with changes in 19 modifiable well-being risks.

RESULTS

Over time, a 5% reduction in total count of well-being risks was significantly associated with 0.74% decrease in absenteeism, 2.38% decrease in presenteeism, and 0.24% increase in performance. High blood pressure, recurring pain, unhealthy diet, inadequate exercise, poor emotional health, poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being had greater independent contributions in explaining productivity impairment.

CONCLUSIONS

The often-ignored well-being risks such as work-related and financial health risks provided incremental explanation of longitudinal productivity variations beyond traditional measures of health-related risks.

Days-out-of-role associated with insomnia and comorbid conditions in the America Insomnia Survey

BACKGROUND

Insomnia is highly prevalent and impairing but also highly comorbid with other chronic physical/mental disorders. Population-based research has yet to differentiate the role impairments uniquely associated with insomnia per se from those due to comorbidity.

METHODS

A representative sample of 6791 adult subscribers to a large national US commercial health plan was surveyed by telephone about sleep and health. Twenty-one conditions previously found to be comorbid with insomnia were assessed with medical/pharmacy claims data and validated self-report scales. The Brief Insomnia Questionnaire, a fully structured, clinically validated scale, generated insomnia diagnoses according to inclusion criteria of DSM-IV-TR, ICD-10, and Research Diagnostic Criteria/International Classification of Sleep Disorders: Diagnostic and Coding Manual, Second Edition. The World Health Organization Disability Assessment Schedule-II assessed number of days in the past 30 when health problems prevented respondents from conducting their usual daily activities. Regression analyses estimated associations of insomnia with days-out-of-role controlling comorbidity.

RESULTS

Insomnia was significantly associated with days-out-of-role (.90 days/month) in a gross model. The association was reduced when controls were introduced for comorbidity (.42 days/month). This net association did not vary with number or type of comorbid conditions but was confined to respondents 35+ years of age. Insomnia was one of the most important conditions studied not only at the individual level, where it was associated with among the largest mean days-out-of-role, but also at the aggregate level, where it was associated with 13.6% of all days-out-of-role.

CONCLUSIONS

Insomnia has a strong net association with days-out-of-role that does not vary as a function of comorbidity.

Preventing eye injuries among citrus harvesters: the community health worker model

OBJECTIVES

Although eye injuries are common among citrus harvesters, the proportion of workers using protective eyewear has been negligible. We focused on adoption of worker-tested safety glasses with and without the presence and activities of trained peer-worker role models on harvesting crews.

METHODS

Observation of 13 citrus harvesting crews established baseline use of safety eyewear. Nine crews subsequently were assigned a peer worker to model use of safety glasses, conduct eye safety education, and treat minor eye injuries. Safety eyewear use by crews was monitored up to 15 weeks into the intervention.

RESULTS

Intervention crews with peer workers had significantly higher rates of eyewear use than control crews. Intervention exposure time and level of worker use were strongly correlated. Among intervention crews, workers with 1 to 2 years of experience (odds ratio [OR] = 2.89; 95% confidence interval [CI] = 1.11, 7.55) and who received help from their peer worker (OR = 3.73; 95% CI = 1.21, 11.57) were significantly more likely to use glasses than were other intervention crew members.

CONCLUSIONS

Adaptation of the community health worker model for this setting improved injury prevention practices and may have relevance for similar agricultural settings.

Are workplace health promotion programs effective at improving presenteeism in workers? A systematic review and best evidence synthesis of the literature

Background

Presenteeism is highly prevalent and costly to employers. It is defined as being present at work, but limited in some aspect of job performance by a health problem.

Workplace health promotion (WHP) is a common strategy used to enhance on-the-job productivity. The primary objective is to determine if WHP programs are effective in improving presenteeism. The secondary objectives are to identify characteristics of successful programs and potential risk factors for presenteeism.

Methods

The Cochrane Library, Medline, and other electronic databases were searched from 1990 to 2010. Reference lists were examined, key journals were hand-searched and experts were contacted. Included studies were original research that contained data on at least 20 participants (≥ 18 years of age), and examined the impacts of WHP programs implemented at the workplace. The Effective Public Health Practice Project Tool for Quantitative Studies was used to rate studies. 'Strong' and 'moderate' studies were abstracted into evidence tables, and a best evidence synthesis was performed. Interventions were deemed successful if they improved the outcome of interest. Their program components were identified, as were possible risk factors contributing to presenteeism.

Results

After 2,032 titles and abstracts were screened, 47 articles were reviewed, and 14 were accepted (4 strong and 10 moderate studies). These studies contained preliminary evidence for a positive effect of some WHP programs. Successful programs offered organizational leadership, health risk screening, individually tailored programs, and a supportive workplace culture. Potential risk factors contributing to presenteeism included being overweight, a poor diet, a lack of exercise, high stress, and poor relations with co-workers and management. Limitations: This review is limited to English publications. A large number of reviewed studies (70%) were inadmissible due to issues of bias, thus limiting the amount of primary evidence. The uncertainties surrounding presenteeism measurement is of significant concern as a source of bias.

Conclusions

The presenteeism literature is young and heterogeneous. There is preliminary evidence that some WHP programs can positively affect presenteeism and that certain risk factors are of importance. Future research would benefit from standard presenteeism metrics and studies conducted across a broad range of workplace settings.

Barriers to implementation of workplace health interventions: an economic perspective

OBJECTIVE

To identify insurance related, structural, and workplace cultural barriers to the implementation of effective preventive and upstream clinical interventions in the working age adult population.

METHODS

Analysis of avoided costs from perspective of health economics theory and from empiric observations from large studies; presentation of data from our own cost-plus model on integrating health promotion and ergonomics.

RESULTS

We identify key avoided costs issues as a misalignment of interests between employers, insurers, service institutions, and government. Conceptual limitations of neoclassical economics are attributable to work culture and supply-driven nature of health care.

DISCUSSION

Effective valuation of avoided costs is a necessary condition for redirecting allocations and incentives. Key content for valuation models is discussed.

Medical utilization among wellness consumers

This study investigates conventional medicine utilization by wellness-motivated, complementary and alternative medicine (CAM) consumers. While CAM consumers are typically characterized as high health care utilizers, negative correlations have been found between CAM-based wellness programs and the consumption of conventional medical care. We use a nationally representative sample to analyze both illness- and wellness-motivated CAM users, with an interest in whether CAM therapies used for wellness replace conventional medicine, thus potentially offering cost offsets. Results indicate that motivation for CAM use is neither associated with a lower probability nor a lower rate of conventional medicine utilization. Increasingly, individuals, workplaces, and governments incorporate wellness programs involving CAM modalities into health care and policy; as the conventional and unconventional medical spheres begin to integrate and influence one another, understanding our pluralistic medical environment and its consumers will better enable policy makers to balance health and wellness initiatives with economic imperatives.

Use of a normal impairment factor in quantifying avoidable productivity loss because of poor health

OBJECTIVE

Growing evidence demonstrates a relationship between excess health risk and preventable productivity loss. There is a need to quantify how much lost productivity is avoidable through employer-sponsored health management interventions. This study introduced the Normal Impairment Factor (NIF) to recognize the amount of productivity loss that cannot be mitigated through health management interventions.

METHODS

A health assessment questionnaire was administered to 772,750 employees, representing 106 employers within five industry sectors. Researchers used multivariate regression procedures to examine the association between preventable health risks and self-reported productivity loss.

RESULTS

Back pain, mental well being, and stress risk were the strongest predictors of on-the-job productivity loss. A strong association was also detected between the number of health risks and productivity loss ranging from 3.4% for those at lowest risk (the NIF group) to 24.0% loss for those at risk for eight risks.

CONCLUSIONS

This study demonstrated the utility of the NIF in estimating the level of productivity loss that cannot be regained through health management interventions.

Managers' Perceptions of the Current and Future Role of Occupational Health Nurses in Australia

Occupational health nurses face competition from other professionals in the field of occupational health and safety. This study investigated managers' perceptions of Australian occupational health nurses' roles. Managers were asked to rate the importance of occupational health nurses' activities and the time they believe occupational health nurses do or should dedicate to each activity now and in the future. The questionnaire included 22 activity statements grouped into eight areas of practice that were thought to constitute the occupational health nurse role, based on the Australian College of Occupational Health Nurses standards. Data revealed that emergent roles focused on injury prevention, health promotion, management, and research were of increasing importance, with more time being needed for them in the future. Fulfilling these expectations may place occupational health nurses in competition with other occupational health and safety personnel for particular responsibilities and may require negotiation to gain support for taking on these role activities. Fulfilling these emergent role activities effectively will require appropriate professional development and advanced education.

Well-being in residency: effects on relationships with patients, interactions with colleagues, performance, and motivation

OBJECTIVE

Previous studies about resident well-being have focused on negative aspects of well-being. We conducted this study to explore residents' conceptions of well-being and how it affects their work.

METHODS

One investigator conducted semi-structured interviews with residents at two hospitals during February-June 2005. Through random sampling stratified by program and gender, we invited 49 residents from internal medicine, psychiatry, surgery, emergency medicine, anesthesia, obstetrics/gynecology, and pediatrics. Using an editing analysis style, three investigators independently coded transcripts.

RESULTS

26 residents participated in 45-min interviews. Residents acknowledged that well-being affected four elements of their work: relationships with patients, interactions with colleagues, performance, and motivation. Residents described higher quality discussions with patients when their well-being was high and inappropriate exchanges when well-being was low. Residents attributed conflict with colleagues to lower states of well-being. Residents felt they had improved decision-making when their well-being was higher. Residents' motivation in their daily work and career varied with fluctuating well-being. Five residents initially denied that their well-being affects their work, voicing concerns that this would be unprofessional.

CONCLUSIONS

Most residents felt that both high and low levels of well-being affected their work, particularly their work relationships.

PRACTICE IMPLICATIONS

The educational and patient care goals of residency training may be enhanced through interventions that promote resident well-being.

Implementation and outcomes of a comprehensive worksite health promotion program

BACKGROUND

This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal.

METHODS

The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9).

RESULTS

Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p = 0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful.

CONCLUSIONS

This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.

The Impact of Obesity on Illness Absence and Productivity in an Industrial Population of Petrochemical Workers

PURPOSE

Examine employee illness absence and the economic impact of overweight and obesity in a petrochemical industry workforce.

METHODS

A 10-year follow-up (1994-2003) of 4153 Shell Oil Company employees was conducted. Absence frequency rates and average number of workdays lost were calculated for normal weight, overweight, and obese employees with and without the presence of additional risk factors. The study also assessed the change in overweight and obesity prevalence in the study population and estimated the current and future economic impact of these conditions.

RESULTS

Overall, obese employees were 80% more likely to have absences (24.0 vs. 13.3 per 100 employees) and were absent 3.7 more days (7.7 vs. 4.0 days) per year compared with those employees with normal body weights. Among employees with no additional risk factors, overweight employees lost more than 1.5 times more days (4.2 vs. 2.6 days) per year, and obese employees more than 2.5 times more days (7.2 vs. 2.6 days) compared with their normal-weight colleagues. Similarly, absence frequency attributable to cardiovascular disease significantly increased among employees with one or two additional risk factors present, such as smoking, high blood pressure, or hypercholesterolemia. The direct cost of illness absence from overweight and obesity for this study population was $1,873,500. Furthermore, 31% of the total illness absence was attributable to overweight and obesity in 1994, and the percentage had risen to 36% by 2003.

CONCLUSIONS

The economic impact to employers is great and will continue to rise unless measures are taken, particularly to reduce the number of employees moving from overweight to obesity with time.

The impact of comorbidity of mental and physical conditions on role disability in the US adult household population

CONTEXT

There is limited information that accounts for comorbidity on the impact of role disability associated with a wide range of mental and physical disorders in population-based samples.

OBJECTIVE

To estimate the comparative effects of common mental and physical conditions on role disability in the general population using a novel method that accounts for comorbidity.

DESIGN

Direct interviews about physical and mental conditions during the past year.

SETTING

The National Comorbidity Survey Replication, a nationally representative series of face-to-face interviews.

PATIENTS

A nationally representative sample of adults living in households (N = 5962 respondents, 18 years and older).

MAIN OUTCOME MEASURE

Disability in major life roles was assessed with the World Health Organization Disability Assessment Schedule. Simulations that allow for complex interactions among conditions were used to estimate the conditions' effects on disability days, when respondents were completely unable to carry out their usual daily activities because of problems with mental or physical health, in the past 12 months.

RESULTS

An estimated 53.4% of US adults have 1 or more of the mental or physical conditions assessed in the survey. These respondents report an average 32.1 more role-disability days in the past year than demographically matched controls, equivalent to nearly 3.6 billion days of role disability in the population. Musculoskeletal disorders and major depression had the greatest effects on disability days. Mental conditions accounted for more than half as many disability days as all physical conditions at the population level. Associations of specific conditions with disability decreased substantially after controlling for comorbidity, suggesting that prior studies, which generally did not control for comorbidity, overestimated disease-specific effects.

CONCLUSION

The staggering amount of health-related disability associated with mental and physical conditions should be considered in establishing priorities for the allocation of health care and research resources.

Measuring the distribution of health behaviors in working populations--the needs assessment

In this study, 79% of employees had one or more unhealthy behaviors that could result in disease or injury. needs assessment can be used to identify individual employees who have unhealthy behaviors and may be ready for behavior change. Focused health behavior interventions for employees who are ready to make a behavior change are more effective than generalized health promotion.

Physical Activity, Cardiorespiratory Fitness, and Body Mass Index in Relationship to Work Productivity and Sickness Absence in Computer Workers With Preexisting Neck and Upper Limb Symptoms

OBJECTIVE

The purpose of this study was to investigate associations among three modifiable risk factors (ie, physical activity, cardiorespiratory fitness, and body mass index), work productivity, and sickness absence in computer workers.

METHODS

All participants were computer workers with neck and upper limb symptoms in the preceding 6 months, the last 2 weeks, or both. Productivity and sickness absence were assessed with the Health and Performance Questionnaire (HPQ).

RESULTS

Physical activity and cardiorespiratory fitness were not associated with work productivity or sickness absence. Obese male workers reported lower absolute productivity than lean workers. Lean and overweight workers reported similar productivity levels. Body mass index was not associated with sickness absence.

CONCLUSIONS

In a population of white-collar workers with neck and upper limb symptoms, obese male workers showed significantly lower productivity than did lean or overweight workers.

Drivers and challenges of personal health systems in workplace health promotion

Novel technologies such as wearable sensors, electronic health diaries and personalized web services are thought to have the potential to improve population health in a cost- efficient manner. The use of personal health systems in workplace health promotion is of particular interest, since the workplace often provides an excellent setting and infrastructure to support health- related interventions. Compared to the elderly or those already debilitated by disease, working people are also generally more capable of taking advantage of information technology. Extant research on the use of ICT in health promotion has recognized several functional and technological requirements, but relatively little is known about other factors that affect the commercialization and adoption of such systems. This paper attempts to identify some economic and structural drivers and challenges that may be relevant to the success of personal health systems in workplace health promotion.

Occupational health care for the 21st century: from health at work to workers' health

A survey of relevant national and international legislation and recommendations on occupational health (OH) organization revealed two fundamental approaches to OH: 1) the historically older labor approach, essentially seeing OH care as an obligation of the employer derived from the labor contract, and 2) an emerging health approach, including all workers and all aspects of health, A draft decree on OH in Flanders seeks to integrate the two approaches. It extends the scope of OH to all workers (not only employees), introduces holistic health surveillance, rejects the incapacity concept, provides for strong integration of health and workplace surveillance, and stresses ethics. Workers' satisfaction is seen as the first criterion in quality control. Systematic data collection and analysis, and when necessary, scientific research are recommended. Additional resources for OH services should be provided by stakeholders other than employers.

The association of two productivity measures with health risks and medical conditions in an Australian employee population

PURPOSE

To investigate the impact of health on job performance using two measures of productivity loss: (1) a self-reported measure of health-related presenteeism and (2) an objective measure of absenteeism.

DESIGN

A cross-sectional survey using a Health Risk Appraisal (HRA) to evaluate self-reported presenteeism and the prevalence of 12 health risks and eight medical conditions.

SETTING AND SUBJECTS

Employees (n=224) of a private insurance provider in Australia.

MEASURES

A Health Risk Appraisal (HRA) questionnaire was used to evaluate self-reported presenteeism on different aspects of job demands and to assess the prevalence of 12 health risks and eight medical conditions. Illness absent hours were obtained from company administrative records.

RESULTS

Increased presenteeism was significantly associated with high stress, life dissatisfaction, and back pain, while increased illness absenteeism was significantly associated with overweight, poor perception of health, and diabetes. Excess presenteeism associated with excess health risks (productivity loss among those with medium- or high-risk status compared to those with low-risk status) was independently calculated at 19.0% for presenteeism and 12.8% for illness absenteeism.

CONCLUSIONS

This study demonstrates an association between health metrics and self-reported work impairment (presenteeism) and measured absenteeism. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss.

Best practices for an integrated population health management (PHM) program

Large employers are beginning to create much more robust and potentially effective systems of integrated health management interventions. This organization-wide activity is referred to as a "Population Health Management" (PHM) approach. Best practices are also beginning to emerge in this area, and a number of technical developments are helping shape the patterns of response from innovative employers. This initiative is rapidly emerging as a critical part of overall business and health care strategy.

Putting Promotion Into Practice: The African Americans Building a Legacy of Health Organizational Wellness Program

A Los Angeles REACH demonstration project led by Community Health Councils, Inc. adapted and implemented an organizational wellness intervention originally developed by the local health department, providing training in incorporating physical activity and healthy food choices into the routine “conduct of business” in 35 predominantly public and private, nonprofit-sector agencies. A total of 700 staff, members, or clients completed the 12-week or subsequently retooled 6-week curriculum. Attendance and retention rates between baseline and postintervention assessments were improved substantially in the shortened offering. Feelings of sadness or depression decreased significantly (p = .00), fruit and vegetable intake increased significantly (+0.5 servings/day, p = .00), and body mass index decreased marginally (-0.5 kg/m2, p = .08) among 12-week participants. The numbers of days in which individuals participated in vigorous physical activity increased significantly among 6-week participants (+0.3, p = .00). This model holds promise for extending the reach of environmentally focused work-site wellness programming to organizations and at-risk populations not traditionally engaged by such efforts.

The Future of Health Promotion/Disease Prevention Programs: The Incentives and Barriers Faced by Stakeholders

According to Healthy People 2010, 95% of employers with more than 50 employees reported that they offered at least one health promotion activity by 1999. Employment-based health promotion/disease prevention (hp/dp) programs have significantly increased in frequency and scope since 1985. Yet, 20 years later, the reported results for employee health lag behind the literature documenting the impact of lifestyle-related health risks on morbidity, healthcare utilization, and costs. In this article, we consider the key stakeholders involved-employers, health plans, and employees-and explore their legitimate and feasible roles in employment-based hp/dp programs, including the incentives and barriers they face to program participation. We argue for the integration of hp/dp programs into the traditional health protection mission of occupational health and safety professionals.

Commitment to Health Scale

The Commitment to Health Scale (CHS) was developed to predict likelihood of clients being able to permanently adopt new health-promoting behaviors. Commitment is based on the association between starting new health behaviors and long-term performance of those behaviors. The CHS evolved from an examination of Prochaska and DiClemente’s Stages of Change Algorithm, Decisional Balance Scale, and Strong and Weak Principle (Velicer, Rossi, Prochaska, & DiClemente, 1996). Scale items were assessed by classical and Rasch measurement methods. The research was performed in three separate studies at various locations in the United States and included approximately 1,100 subjects. A new unidimensional variable was identified called Commitment to Health. Internal consistency reliability of the scale was .94 (Cronbach’s alpha). External validity and reliability were assessed based on expected and observed ordering and between known groups. Scale scores predicted self-reported health behaviors and body mass index.