Worksite health and wellness programs in India

Effectiveness of technology-assisted and self-directed interventions to sit less and move more among Indian desk-based office workers: A three-arm cluster randomised controlled trial (SMART-STEP trial)

This cluster-randomized controlled trial evaluated the effectiveness of technology-assisted programs in replacing sedentary time (ST) with physical activity (PA) among Indian office workers. A total of 136 sedentary workers were randomized into two intervention groups: technology-assisted (SMART) and self-directed (TRADE), along with a control group. The SMART group used a smartphone app featuring hourly exercise video prompts and a pedometer, while the TRADE group received a wellness manual with strategies for reducing ST and increasing PA. ST and PA levels were assessed using accelerometers at baseline, 3 months, and 6 months. The SMART group showed a marginal reduction in ST (∼6 min/day) at 3 months (β = -0.340, p = 0.015) and 6 months (β = 0.114, p = 0.030). But the improvements were not sustained at 6 months in TRADE group (β = 0.105, p = 0.064). A significant decline in compliance (n = 57, 63 %) in both intervention groups. Future trials should incorporate organizational-level strategies to enhance compliance.

Association Between the Improvement of Knowledge, Attitude and Practice of Hypertension Prevention and Blood Pressure Control-A Cluster Randomized Controlled Study

BACKGROUND

Hypertension-related knowledge, attitude and practice (KAP) of hypertensive patients can affect the awareness, treatment and control of hypertension. However, little attention has been paid to the association between the change of hypertension preventive KAP and blood pressure (BP) control in occupational population using longitudinal data. We assess the effectiveness of a workplace-based multicomponent hypertension intervention program on improving the level of KAP of hypertension prevention, and the association between improvement in KAP and BP control during intervention.

METHODS

From January 2013 to December 2014, workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20) using a cluster randomized control method. All employees in each workplace were asked to complete a cross-sectional survey to screen for hypertension patients. Hypertension patients in the intervention group were given a 2-year workplace-based multicomponent hypertension intervention for BP control. The level of hypertension prevention KAP and BP were assessed before and after intervention in the two groups.

RESULTS

Overall, 3331 participants (2658 in the intervention group and 673 in the control group) were included (mean [standard deviation] age, 46.2 [7.7] years; 2723 men [81.7%]). After 2-year intervention, the KAP qualified rate was 63.2% in the intervention groups and 50.1% in the control groups (odds ratio = 1.65, 95% CI, 1.36∼2.00, P < .001). Compared with the control group decreased in the qualified rate of each item of hypertension preventive KAP questionnaire, all the items in the intervention group increased to different degrees. The increase of KAP score was associated with the decrease of BP level after intervention. For 1 point increase in KAP score, systolic blood pressure (SBP) decreased by .28 mmHg and diastolic blood pressure (DBP) decreased by .14 mmHg [SBP: β = -.28, 95%CI: -.48∼-.09, P = .004; DBP: β = -.14, 95%CI: -.26∼-.02, P = .024]. SBP and DBP was significantly in manual labor workers (SBP: β = -.34, 95%CI: -.59∼-.09, P = .008; DBP: β = -.23, 95%CI: -.38∼-.08, P = .003), workers from private enterprise, state-owned enterprise (SOE) (SBP: β = -.40, 95%CI: -.64∼-.16, P = .001; DBP: β = -.21, 95%CI: -.36∼-.06, P = .005) and a workplace with an affiliated hospital (SBP: β = -.31, 95%CI: -.52∼-.11, P = .003; DBP: β = -.16, 95%CI: -.28∼-.03, P = .016). The improvement of knowledge (SBP: β = -.29, 95%CI: -.56∼-.02, P = .038; DBP: β = -.12, 95%CI: -.29∼.05, P = .160), as well as attitude (SBP: β = -.71, 95%CI: -1.25∼-.18, P = .009; DBP: β = .18, 95%CI: -.23∼.59, P = .385) and behavior (SBP: β = -.73, 95%CI: -1.22∼-.23, P = .004; DBP: β = -.65, 95%CI: -.97∼-.33, P < .001) was gradually strengthened in relation to BP control.

CONCLUSION

This study found that workplace-based multicomponent hypertension intervention can effectively improve the level of hypertension preventive KAP among employees, and the improvement of KAP levels were significantly associated with BP control.

TRIAL REGISTRATION

Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial

BACKGROUND

Structured lifestyle change education reduces the burden of cardiometabolic diseases such as diabetes. Delivery of these programs at worksites could overcome barriers to program adoption and improve program sustainability and reach; however, tailoring to the worksite setting is essential.

METHODS

The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at 11 large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, and peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system.

RESULTS

Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add a wider variety of exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees.

CONCLUSION

This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02813668. Registered June 27, 2016.

Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial

Background

Delivery of proven structured lifestyle change education for reducing the burden of cardiometabolic diseases such as diabetes at worksites could overcome barriers to program adoption and improve sustainability and reach of these programs; however, tailoring to the worksite setting is essential.

Methods

The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at eleven large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system.

Results

Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees.

Conclusion

This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings.

Trial Registration

Clinicaltrial.gov NCT02813668, registered June 27, 2016.

A Toolkit for Strengthening Health Care Policies and Infrastructure of Industries in Developing Countries

Background:

The health risks faced by textile workers calls for a workplace health system that is comprehensive and accessible. To enhance the capacity of workplaces to strengthen their health system, a toolkit was developed by the Business for Social Responsibility (BSR), a non-profit global business network and sustainability consultancy.

Methods:

The Health System Strengthening (HSS) toolkit was designed to provide a set of tools, resources, and concrete steps for the factory management and health staff to work toward continuous improvement of their on-site health systems. It was then implemented with academic collaboration simultaneously In three factories/ in three manufacturing units/ in three workplaces in South India over 6 months to find out its usefulness as a self-reference tool for HSS. Monitoring and evaluation tools and indicators were developed based on the logic framework.

Results:

The main outcomes of the HSS pilot program include the formation of a health committee which was able to utilize the modules, perform a self-assessment of the health system, and come out with short- and long-term action plans for HSS under expert supervision and guidance.

Conclusions:

Overall, the toolkit was found to be an effective solution for HSS in industries which require expert guidance for implementation.

Identifying opportunities and barriers for introducing a workplace nutrition and health program for employees: Findings from formative research

BACKGROUND: The work style of employees engaged in the Information Technology (IT) and Business Process Outsourcing (BPO) sector in India is dominantly sedentary exposing them to detrimental obesogenic environments with unhealthy diets, increasing the risk of non-communicable diseases (NCDs). Workplace health interventions have been reported to have the potential of reducing NCDs and related risk factors among the employees and thus reduce cost of absenteeism and improve productivity. OBJECTIVE: This formative research study aims to explore the opportunities and barriers of the development and implementation of a Workplace Health Programme (WHP). METHODS: In this study, a mixed method including qualitative and quantitative approaches were used. Focus group discussions (FGDs) were conducted with employees and senior managers in employers of IT/BPO companies of different sizes in Hyderabad, India. The food and physical activity environment in the workplaces were explored using a checklist and ground truthing approach. A Knowledge, Attitudes and Practices (KAP) questionnaire was developed to assess health, nutrition and physical activity of the employees. RESULTS: Through this formative research, the required areas for nutrition, physical activity and health education were identified. The scopes of utilising existing facilities for physical activity and modifying the food environment was explored. We noted optimistic bias among the junior employees who did not consider themselves at risk of developing NCDs. CONCLUSIONS: The identified opportunities and barriers will help in developing strategic WHPs suitable to individual workplaces. The qualitative methods, ground truthing approach, checklist and KAP tools used here can assess the company environment and employee health and nutrition status.

Fostering cardiovascular health at work - case study from Senegal

BACKGROUND

Of the 15 million annual premature deaths from non-communicable diseases (NCDs), 85% occur in low- and middle-income countries (LMICs). Affecting individuals in the prime of their lives, NCDs impose severe economic damage to economies and businesses, owing to the high mortality and morbidity within the workforce. The Novartis Foundation urban health initiative, Better Hearts Better Cities, was designed to improve cardiovascular health in Dakar, Senegal through a combination of interventions including a workplace health program. In this study, we describe the labor policy environment in Senegal and the outcomes of a Novartis Foundation-supported multisector workplace health coalition bringing together volunteering private companies.

METHODS

A mixed method design was applied between April 2018 and February 2020 to evaluate the workplace health program as a case study. Qualitative methods included a desk review of documents relevant to the Senegalese employment context and work environment and in-depth interviews with eight key informants including human resource representatives and physicians working in the participating companies. Quantitative methods involved an analysis of workplace health program indicators, including data on diagnosis, treatment and control of hypertension in employees, provided by the coalition companies, and a cost estimate of NCD-related ill-health as compared to the investment needed for hypertension screening and awareness raising events.

RESULTS

Senegal has a legal and regulatory system that ensures employee protection, supports social security benefits, and promotes health and hygiene in companies. The Dakar Workplace Health Coalition comprised 18 companies, with a range of staff between 300 and 4'220, covering 36'268 employees in total. Interviews suggested that the main enablers for workplace program success were strong leadership support within the company and a central coordination mechanism for the program. The main barrier to monitor progress and outcomes was the reluctance of companies to share data. Four companies provided aggregated anonymized cohort data, documenting a total of 21'392 hypertension screenings and an increasing trend in blood pressure control (from 34% in Q4 2018 to 39% in Q2 2019) in employees who received antihypertensive treatment.

CONCLUSION

Evidence on workplace health and wellness programs in Africa is scarce. This study highlights how private sector companies can play a significant role in improving cardiovascular population health in LMICs.

Barriers to and facilitators for implementing an office ergonomics programme in a South African research organisation

The focus of this study was on the possibility of implementing an office ergonomics programme as part of a broader workplace health initiative at a South African research organisation. We explored the perspectives of actors in the workplace regarding organisational barriers and facilitators to implementing ergonomic interventions. This qualitative study presents the perspectives of three workplace actor groups: operational managers (n = 4); health and safety representatives (n = 9); and office employees (n = 4) who were involved in a previous ergonomic assessments that proposed several corrective and preventive actions. Eight factors emerged as either barriers or as simultaneous barriers and facilitators to the implementation of proposed ergonomic interventions. These are: organisational culture; information and specialist support; funding; support from operational managers; attitude towards changes; general organisational awareness; individual knowledge of ergonomics; and support from colleagues. This study is one of the first in South Africa to investigate the perspectives of workplace actors in an office setting with regard to factors that influence implementation of ergonomics initiatives to reduce work-related musculoskeletal disorders.

Workplace health promotion of large and medium-sized businesses

Purpose

– The purpose of this paper is to investigate the relationship between different areas of workplace health promotion (WHP) activities and predictors of the number of areas in which WHP activities are offered.

Design/methodology/approach

– A questionnaire with ten questions on WHP was mailed to the 478 largest businesses in Berlin and Brandenburg, Germany. The cross-sectional data from this survey are presented and explored using correlation and linear regression analyses.

Findings

– In total, 30 businesses, of which 90 percent offered WHP activities, participated in the survey. Businesses with WHP were, on average, active in 5.59 (SD=2.24) areas of health promotion. Offering an activity was positively correlated with offering an activity in at least one other area for all WHP areas except ergonomic workplace design (p < 0.05). Among businesses offering WHP, reporting that WHP would be strengthened with more support (−2.02, 95 percent CI: −4.04 to −0.01) and being a medium-sized business with an information need (−3.63, 95 percent CI: −5.70 to −1.57) or an opinion that health insurance companies should offer WHP (−1.96, 95 percent CI: −3.86 to −0.05) were all associated with offering activities in fewer WHP areas. In a multiple regression analysis, the information need of mid-size businesses was the only significant predictor (−5.25, 95 percent CI: −9.41 to −1.08).

Practical implications

– Addressing the information needs of medium-sized businesses concerning WHP could be an effective strategy for increasing the spectrum of WHP activities offered.

Originality/value

– This study complements existing studies by assessing associations between WHP activities and predictors of WHP activity emphasizing business size.

Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs.

A worksite intervention to reduce the cardiovascular risk: proposal of a study design easy to integrate within Italian organization of occupational health surveillance

BACKGROUND

Despite the substantial amount of knowledge on effectiveness of worksite health promotion (WHP) in reducing cardiovascular disease (CVD) risk, WHP programs are not systematically applied in Italy. The aim was to design an intervention easy to integrate within the Italian organization of workplace health surveillance.

METHODS

We used the "pretest-posttest design". Workers were employed in multiple occupations and resident in Veneto region, Italy. Occupational physicians (OPs) performed all examinations, including laboratory evaluation (capillary blood sampling and measure of glycaemia and cholesterolemia with portable devices), during the normal health surveillance at worksite. CVD risk was computed based on sex, age, smoking habit, diabetes, systolic pressure and cholesterol level. After excluding those with <40 years of age, missing consent, CVD diagnosis or current therapy for CVD, missing information, CVD risk <5%, out of 5,536 workers 451 underwent the intervention and 323 male workers were re-examined at 1 year. CVD risk was the most compelling argument for changing lifestyle. The counseling was based on the individual risk factors. Individuals examined at posttest were a small fraction of the whole (6% = 323/5,536). In these workers we computed the ratio pretest/posttest of proportions (such as percent of subjects with cardiovascular risk >5%) as well as the exact McNemar significance probability or the exact test of table symmetry.

RESULTS

CVD risk decreased by 24% (McNemar p = 0.0000) after the intervention; in a sensitivity analysis assuming that all subjects lost to follow-up kept their pretest cardiovascular risk value, the effect (-18%) was still significant (symmetry p < 0.0000). Each prevented CVD case was expected to cost about 5,700 euro.

CONCLUSIONS

The present worksite intervention promoted favorable changes of CVD risk that were reasonably priced and consistent across multiple occupations.