Strategies for strengthening the evidence base for employee health promotion programs

Qualitative comparative analysis of the implementation fidelity of a workplace sedentary reduction intervention

BACKGROUND

Stand and Move at Work was a 12-month, multicomponent, peer-led (intervention delivery personnel) worksite intervention to reduce sedentary time. Although successful, the magnitude of reduced sedentary time varied by intervention worksite. The purpose of this study was to use a qualitative comparative analysis approach to examine potential explanatory factors that could distinguish higher from lower performing worksites based on reduced sedentary time.

METHODS

We assessed 12-month changes in employee sedentary time objectively using accelerometers at 12 worksites. We ranked worksites based on the magnitude of change in sedentary time and categorized sites as higher vs. lower performing. Guided by the integrated-Promoting Action on Research Implementation in Health Services framework, we created an indicator of intervention fidelity related to adherence to the protocol and competence of intervention delivery personnel (i.e., implementer). We then gathered information from employee interviews and surveys as well as delivery personnel surveys. These data were aggregated, entered into a truth table (i.e., a table containing implementation construct presence or absence), and used to examine differences between higher and lower performing worksites.

RESULTS

There were substantive differences in the magnitude of change in sedentary time between higher (-75.2 min/8 h workday, CI₉₅: -93.7, -56.7) and lower (-30.3 min/8 h workday, CI₉₅: -38.3, -22.7) performing worksites. Conditions that were present in all higher performing sites included implementation of indoor/outdoor walking route accessibility, completion of delivery personnel surveys, and worksite culture supporting breaks (i.e., adherence to protocol). A similar pattern was found for implementer willingness to continue role and employees using face-to-face interaction/stair strategies (i.e., delivery personnel competence). However, each of these factors were also present in some of the lower performing sites suggesting we were unable to identify sufficient conditions to predict program success.

CONCLUSIONS

Higher intervention adherence and implementer competence is necessary for greater program success. These findings illustrate the need for future research to identify what factors may influence intervention fidelity, and in turn, effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

Work productivity loss from depression: evidence from an employer survey

BACKGROUND

National working groups identify the need for return on investment research conducted from the purchaser perspective; however, the field has not developed standardized methods for measuring the basic components of return on investment, including costing out the value of work productivity loss due to illness. Recent literature is divided on whether the most commonly used method underestimates or overestimates this loss. The goal of this manuscript is to characterize between and within variation in the cost of work productivity loss from illness estimated by the most commonly used method and its two refinements.

METHODS

One senior health benefit specialist from each of 325 companies employing 100+ workers completed a cross-sectional survey describing their company size, industry and policies/practices regarding work loss which allowed the research team to derive the variables needed to estimate work productivity loss from illness using three methods. Compensation estimates were derived by multiplying lost work hours from presenteeism and absenteeism by wage/fringe. Disruption correction adjusted this estimate to account for co-worker disruption, while friction correction accounted for labor substitution. The analysis compared bootstrapped means and medians between and within these three methods.

RESULTS

The average company realized an annual $617 (SD = $75) per capita loss from depression by compensation methods and a $649 (SD = $78) loss by disruption correction, compared to a $316 (SD = $58) loss by friction correction (p < .0001). Agreement across estimates was 0.92 (95% CI 0.90, 0.93).

CONCLUSION

Although the methods identify similar companies with high costs from lost productivity, friction correction reduces the size of compensation estimates of productivity loss by one half. In analyzing the potential consequences of method selection for the dissemination of interventions to employers, intervention developers are encouraged to include friction methods in their estimate of the economic value of interventions designed to improve absenteeism and presenteeism. Business leaders in industries where labor substitution is common are encouraged to seek friction corrected estimates of return on investment. Health policy analysts are encouraged to target the dissemination of productivity enhancing interventions to employers with high losses rather than all employers.

TRIAL REGISTRATION

CLINICAL TRIALS REGISTRATION NUMBER

NCT01013220.

Moving the Worksite Health Promotion Profession Forward

Standards in any profession are adopted to assure that the individuals hired are adequately trained and the programs that they oversee are of the highest quality. Worksite health promotion should be no different from any other field. A review of the research conducted by experts in worksite health promotion is examined, along with an assessment of skills needed to ensure that wellness programs are effective and employees, their families, and even their communities are educated on the ways to best prevent chronic diseases and occupational incidences through healthy and safe behaviors. This article is consistent with Health Promotion Practice’s mission and focuses on the exploration of the processes used to plan effective worksite health promotion programs, and it suggests initial discussions on whether these processes should become standards for professionals in the worksite health promotion field.

Do work relationships matter? Characteristics of workplace interactions that enhance or detract from employee perceptions of well-being and health behaviors

This qualitative case study adopted the position that health and health behaviors are complex social constructs influenced by multiple factors. Framed by the social ecological model, the study explored how work interactions enhanced or detracted from the perceptions of well-being and health behaviors. Despite the fact that previous studies indicated that the social workplace environment contributed to employee health, there was little information regarding the characteristics. Specifically, little was known about how employees perceived the connections between workplace interactions and health, or how social interactions enhanced or detracted from well-being and health behaviors. The participants included 19 volunteers recruited from four companies, who shared their experiences of workplace interactions through interviews and journaling assignments. The findings indicated that feelings of well-being were enhanced by work interactions, which were trusting, collaborative, and positive, as well as when participants felt valued and respected. The study also found that interactions detracted from well-being and health behaviors when interactions lacked the aforementioned characteristics, and also included lack of justice and empathy. The enhancing and detracting relationships generated physical symptoms, and influenced sleeping and eating patterns, socializing, exercise, personal relations, careers, and energy. Surprisingly, the study found that regardless of how broadly participants defined health, when they were asked to rate their health, participants uniformly rated theirs on physical attributes alone. The exclusive consideration of physical attributes suggests that participants may have unconsciously adopted the typical western medical view of health - an individually determined and physiologic characteristic. Despite research suggesting health is more than biology, and despite defining health broadly, participants uniformly adopted this traditional view. The study also offers human resource development professionals with evidence supporting interventions aimed at minimizing workplace incivility. Interventions designed to improve employee engagement could minimize financial and human costs of negative interactions. The bottom line is that workplaces should be physically, emotionally, and psychologically safe for well-being and healthy behaviors to flourish.

Improving work participation for adults with musculoskeletal conditions

The impact of musculoskeletal disorders on work is demanding more attention from clinicians. For many rheumatologists, inflammatory arthritis is the most frequently encountered condition that interferes with work. However, the cumulative burden of non-inflammatory arthropathies and disorders such as back pain, osteoarthritis and limb pain as a whole results in a much greater economic and human cost to society than inflammatory disease. New conceptual approaches and research results support the view that work loss does not need to be a frequent consequence of a musculoskeletal disorder or disability. This is often accomplished through a biopsychosocial and interdisciplinary approach, involving interaction between those with a musculoskeletal condition, their clinicians and employers. This review outlines the challenges and draws on the results of empirical studies to highlight potential opportunities to promote sustained ability for patients to successfully remain on the job. It also outlines future research opportunities.