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Saito J, Odawara M, Takahashi H, Fujimori M, Yaguchi-Saito A, Inoue M, Uchitomi Y, Shimazu T. Barriers and facilitative factors in the implementation of workplace health promotion activities in small and medium-sized enterprises: a qualitative study. Implement Sci Commun 2022; 3:23. [PMID: 35236511 PMCID: PMC8889638 DOI: 10.1186/s43058-022-00268-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/01/2022] [Indexed: 03/27/2024] Open
Abstract
Background There is an immense difference between large companies and small and medium-sized enterprises (SMEs) in implementation of evidence-based interventions (EBIs). Previous literature reveals various barriers that SMEs face during implementation, such as a lack of time, accessibility, and resources. However, few studies have comprehensively examined those influential factors at multi-levels. This study aims to identify the factors influencing the implementation of non-communicable disease prevention activities (tobacco, alcohol, diet, physical activity, and health check-up) in SMEs using Consolidated Framework for Implementation Research (CFIR). Methods We conducted 15 semi-structured interviews with health managers and/or employers in 15 enterprises with less than 300 employees, and four focus groups among public health nurses/nutritionists of health insurers who support SMEs in four prefectures across Japan. A qualitative content analysis by a deductive directed approach was performed. After coding the interview transcript text into the CFIR framework constructs by two independent researchers, the coding results were compared and revised in each enterprise until an agreement was reached. Results Of the 39 CFIR constructs, 25 were facilitative and 7 were inhibitory for workplace health promotion implementation in SMEs, which were across individual, internal, and external levels. In particular, the leadership engagement of employers in implementing the workplace health promotion activities was identified as a fundamental factor which may influence other facilitators, including “access to knowledge and information,” “relative priority,” “learning climate,” at organizational level, and “self-efficacy” at the health manager level. The main barrier was the beliefs held by the employer/manager that “health management is one’s own responsibility.” Conclusions Multi-level factors influencing the implementation of non-communicable diseases prevention activities in SMEs were identified. In resource-poor settings, strong endorsement and support, and positive feedback from employers would be important for health managers and employees to be highly motivated and promote or participate in health promotion. Future studies are needed to develop context-specific strategies based on identified barriers and facilitative factors, and empirically evaluate them, which would contribute to narrowing the differences in worksite health promotion implementation by company size. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00268-4.
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Affiliation(s)
- Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hirokazu Takahashi
- Division of Screening Assessment and Management, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Maiko Fujimori
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yosuke Uchitomi
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Hente L, Schlesinger T. Factors influencing the implementation of workplace health promotion in companies in rural areas. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2021. [DOI: 10.1108/ijwhm-04-2020-0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeWorkplace health promotion (WHP) is becoming increasingly important due to the ageing workforce and a shortage of skilled workers. Nevertheless, too few companies have reacted to the demographic change and introduced health-promoting measures. This paper aims to identify which factors influence the implementation of WHP, especially in small and medium-sized enterprises (SMEs) in rural areas.Design/methodology/approach253 companies in a rural area in the federal state of Saxony (Germany) were surveyed using a standardised questionnaire via a computer-assisted telephone interview. Bivariate analyses and logistic regression models were carried out. The focus was on the relationship between the status of WHP and the size of the company, pressure of demographic change, health-related attitude and organisational capacity factors.FindingsIt was shown that, in addition to the control variables company size and pressure of the shortage of skilled workers, a company's attitude regarding health promotion, financial capacity and planning and development capacity has a relevant influence on the status of WHP.Practical implicationsBased on the results, targeted measures can be developed and converted to implement WHP, particularly in SMEs in rural regions. The focus should be on sensitisation, knowledge transfer and capacity development.Originality/valueThe present paper reveals the relationship between company size, pressure of demographic change, health-related attitude and organisational capacities regarding the status of health-promoting measures in SMEs in a rural region.
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Wolfenden L, Goldman S, Stacey FG, Grady A, Kingsland M, Williams CM, Wiggers J, Milat A, Rissel C, Bauman A, Farrell MM, Légaré F, Ben Charif A, Zomahoun HTV, Hodder RK, Jones J, Booth D, Parmenter B, Regan T, Yoong SL. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane Database Syst Rev 2018; 11:CD012439. [PMID: 30480770 PMCID: PMC6362433 DOI: 10.1002/14651858.cd012439.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes. OBJECTIVES To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff. SEARCH METHODS We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research. SELECTION CRITERIA Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies). DATA COLLECTION AND ANALYSIS Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome. MAIN RESULTS We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search. AUTHORS' CONCLUSIONS Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.
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Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Sharni Goldman
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanNSWAustralia2287
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Andrew Milat
- NSW Ministry of HealthCentre for Epidemiology and EvidenceNorth SydneyNSWAustralia2060
- The University of SydneySchool of Public HealthSydneyAustralia
| | - Chris Rissel
- Sydney South West Local Health DistrictOffice of Preventive HealthLiverpoolNSWAustralia2170
| | - Adrian Bauman
- The University of SydneySchool of Public HealthSydneyAustralia
- Sax InstituteThe Australian Prevention Partnership CentreSydneyAustralia
| | - Margaret M Farrell
- US National Cancer InstituteDivision of Cancer Control and Population Sciences/Implementation Sciences Team9609 Medical Center DriveBethesdaMarylandUSA20892
| | - France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)Université Laval2525, Chemin de la CanardièreQuebecQuebecCanadaG1J 0A4
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne ‐ Université LavalHealth and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR‐SUPPORT Unit of Québec2525, Chemin de la CanardièreQuebecQCCanadaG1J 0A4
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Benjamin Parmenter
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Tim Regan
- University of NewcastleThe School of PsychologyCallaghanAustralia
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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Passey DG, Brown MC, Hammerback K, Harris JR, Hannon PA. Managers’ Support for Employee Wellness Programs: An Integrative Review. Am J Health Promot 2018; 32:1789-1799. [DOI: 10.1177/0890117118764856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: The aim of this integrative literature review is to synthesize the existing evidence regarding managers’ support for employee wellness programs. Data Source: The search utilized multiple electronic databases and libraries. Study Inclusion and Exclusion Criteria: Inclusion criteria comprised peer-reviewed research published in English, between 1990 and 2016, and examining managers’ support in the context of a worksite intervention. The final sample included 21 articles for analysis. Data Extraction: Two researchers extracted and described results from each of the included articles using a content analysis. Data Synthesis: Two researchers independently rated the quality of the included articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating. Results: Factors that may influence managers’ support include their organization’s management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers’ support may influence the organizational culture, employees’ perception of support, and employees’ behaviors. Conclusions: When designing interventions, health promotion practitioners and researchers should consider strategies that target senior, middle, and line managers’ support. Interventions need to include explicit measures of managers’ support as part of the evaluation plan.
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Affiliation(s)
- Deborah G. Passey
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Meagan C. Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kristen Hammerback
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Jeffrey R. Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Peggy A. Hannon
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
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Assessing parents’ receptiveness to a vegetable-focussed in-school nutrition intervention. Appetite 2017; 117:359-364. [DOI: 10.1016/j.appet.2017.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/22/2022]
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Williams SL, Mummery WK. We can do that! Collaborative assessment of school environments to promote healthy adolescent nutrition and physical activity behaviors. HEALTH EDUCATION RESEARCH 2015; 30:272-284. [PMID: 25697581 DOI: 10.1093/her/cyv007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Evidence for effectiveness of school-based studies for prevention of adolescent obesity is equivocal. Tailoring interventions to specific settings is considered necessary for effectiveness and sustainability. The PRECEDE framework provides a formative research approach for comprehensive understanding of school environments and identification of key issues/areas to focus resources and energies. No reported studies have tested applicability of the PRECEDE framework in schools in relation to obesity. Adolescents (n = 362), parents (n = 349) and teachers (n = 146) from six secondary schools participated in two quantitative studies and two qualitative studies. Data collected from these studies permitted confirmation of adolescent overweight/obesity a health issue for schools; the need for secondary schools to focus health promotion efforts on healthy nutrition, with inclusion of parents/homes and appreciation for gender differences in developing interventions. Community buy-in and commitment to school-based obesity prevention programs may be dependent on initially addressing what may be perceived as minor issues, and developing policies to guide practices within schools in relation to supply and access to healthy foods, use of sporting equipment and participation in physical activities. The PRECEDE framework allows systematic assessment of school environments and provided opportunity to identify realistic and relevant interventions for promoting healthy adolescent physical activity and nutrition behaviors.
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Affiliation(s)
- Susan L Williams
- School of Medical and Applied Sciences, CQ University, North Rockhampton, QLD 4702, Australia and Faculty of Physical Education and Recreation, University of Alberta, W1-34 van Vliet Centre, Edmonton, AB T6G 2H9, Canada
| | - W Kerry Mummery
- School of Medical and Applied Sciences, CQ University, North Rockhampton, QLD 4702, Australia and Faculty of Physical Education and Recreation, University of Alberta, W1-34 van Vliet Centre, Edmonton, AB T6G 2H9, Canada
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Rongen A, Robroek SJW, van Ginkel W, Lindeboom D, Pet M, Burdorf A. How needs and preferences of employees influence participation in health promotion programs: a six-month follow-up study. BMC Public Health 2014; 14:1277. [PMID: 25512055 PMCID: PMC4301819 DOI: 10.1186/1471-2458-14-1277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/11/2014] [Indexed: 01/07/2023] Open
Abstract
Background Low participation in health promotion programs (HPPs) might hamper their effectiveness. A potential reason for low participation is disagreement between needs and preferences of potential participants and the actual HPPs offered. This study aimed to investigate employees’ need and preferences for HPPs, whether these are matched by what their employers provide, and whether a higher agreement enhanced participation. Methods Employees of two organizations participated in a six-month follow-up study (n = 738). At baseline, information was collected on employees’ needs and preferences for the topic of the HPP (i.e. physical activity, healthy nutrition, smoking cessation, stress management, general health), whether they favored a HPP via their employer or at their own discretion, and their preferred HPP regarding three components with each two alternatives: mode of delivery (individual vs. group), intensity (single vs. multiple meetings), and content (assignments vs. information). Participation in HPPs was assessed at six-month follow-up. In consultation with occupational health managers (n = 2), information was gathered on the HPPs the employers provided. The level of agreement between preferred and provided HPPs was calculated (range: 0–1) and its influence on participation was studied using logistic regression analyses. Results Most employees reported needing a HPP addressing physical activity (55%) and most employees preferred HPPs organized via their employer. The mean level of agreement between the preferred and offered HPPs ranged from 0.71 for mode of delivery to 0.84 for intensity, and was 0.47 for all three HPP components within a topic combined. Employees with a higher agreement on mode of delivery (OR: 1.72, 95% CI: 0.87-3.39) and all HPP components combined (OR: 2.36, 95% CI: 0.68-8.17) seemed to be more likely to participate in HPPs, but due to low participation these associations were not statistically significant. Conclusion HPPs aimed at physical activity were most needed by employees. The majority of employees favor HPPs organized via the employer above those at their own discretion, supporting the provision of HPPs at the workplace. This study provides some indications that a higher agreement between employees’ needs and preferences and HPPs made available by their employers will enhance participation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1277) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Suzan J W Robroek
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Anderson Steeves E, Martins PA, Gittelsohn J. Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions. Curr Obes Rep 2014; 3:451-8. [PMID: 25574452 PMCID: PMC4283210 DOI: 10.1007/s13679-014-0120-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment prior to implementation. In addition, we outline the need for strategies for addressing these issues including conducting additional pilot interventions, developing additional methodologies, and embracing the use of simulation models.
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Affiliation(s)
- Elizabeth Anderson Steeves
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Global Center
on Childhood Obesity and Center for Human Nutrition, 615 North Wolfe Street, Baltimore
MD 21044, Phone: 937-901-7137, Fax: 410-955-0196
| | - Paula Andrea Martins
- Universidade Federal de São Paulo, Departamento de Ciências
do Movimento Humano., Av. Ana Costa, 95, Vila Matias, 11060001 - Santos, SP –
Brasil, Phone: (13) 38773700, Fax: (13) 38773700
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Global Center
on Childhood Obesity and Center for Human Nutrition, 615 North Wolfe Street, Baltimore
MD 21044, Phone: 410-955-3927, Fax: 410-955-0196
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Wong JY, Gilson ND, Peeters G(G, Ostini R, Bush RA, Brown WJ. The characteristics of inactive men working in a regional area of Queensland, Australia. J Sci Med Sport 2014; 17:56-60. [DOI: 10.1016/j.jsams.2013.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/09/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
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Wierenga D, Engbers LH, Van Empelen P, Duijts S, Hildebrandt VH, Van Mechelen W. What is actually measured in process evaluations for worksite health promotion programs: a systematic review. BMC Public Health 2013; 13:1190. [PMID: 24341605 PMCID: PMC3890539 DOI: 10.1186/1471-2458-13-1190] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/03/2013] [Indexed: 12/02/2022] Open
Abstract
Background Numerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). Research primarily focused on the effectiveness of these WHPPs. Whereas process evaluations provide essential information necessary to improve large scale implementation across other settings. Therefore, this review aims to: (1) further our understanding of the quality of process evaluations alongside effect evaluations for WHPPs, (2) identify barriers/facilitators affecting implementation, and (3) explore the relationship between effectiveness and the implementation process. Methods Pubmed, EMBASE, PsycINFO, and Cochrane (controlled trials) were searched from 2000 to July 2012 for peer-reviewed (randomized) controlled trials published in English reporting on both the effectiveness and the implementation process of a WHPP focusing on physical activity, smoking cessation, alcohol use, healthy diet and/or relaxation at work, targeting employees aged 18-65 years. Results Of the 307 effect evaluations identified, twenty-two (7.2%) published an additional process evaluation and were included in this review. The results showed that eight of those studies based their process evaluation on a theoretical framework. The methodological quality of nine process evaluations was good. The most frequently reported process components were dose delivered and dose received. Over 50 different implementation barriers/facilitators were identified. The most frequently reported facilitator was strong management support. Lack of resources was the most frequently reported barrier. Seven studies examined the link between implementation and effectiveness. In general a positive association was found between fidelity, dose and the primary outcome of the program. Conclusions Process evaluations are not systematically performed alongside effectiveness studies for WHPPs. The quality of the process evaluations is mostly poor to average, resulting in a lack of systematically measured barriers/facilitators. The narrow focus on implementation makes it difficult to explore the relationship between effectiveness and implementation. Furthermore, the operationalisation of process components varied between studies, indicating a need for consensus about defining and operationalising process components.
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Affiliation(s)
- Debbie Wierenga
- Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, Netherlands.
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Kime N, McKenna J, Webster L. Young people's participation in the development of a self-care intervention--a multi-site formative research study. HEALTH EDUCATION RESEARCH 2013; 28:552-562. [PMID: 23221590 DOI: 10.1093/her/cys107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The poor outcomes of young people with chronic health conditions indicate that current services and self-care programmes are not meeting the needs of young people. How young people self-manage their condition impacts on long-term health outcomes, but there is little published evidence that details the development of self-care programmes and their most effective components. This article reports on an innovative formative research study, the purpose of which was to develop a self-care intervention prototype. Participants were 87 young people, aged 12-17, and seven young adult facilitators, aged 18-25, with type 1 diabetes or asthma. Each contributed to talking groups exploring themes that young people wanted to be addressed within a self-care programme. Instead of being focused on 'illness', young people's main concerns were directed toward 'life as an adolescent', while at the same time building sustainable daily routines of self-care. Overall, this article illustrates the process of initiating and implementing a developmental approach focused on young people, while also demonstrating the tailored self-care intervention that the process developed. This approach can be used to involve young people in the design and development of other conditions that rely on self-care interventions.
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Affiliation(s)
- Nicola Kime
- 'Getting Sorted', Carnegie Faculty, Leeds Metropolitan University, Leeds LS6 3QQ, UK.
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Nagler EM, Pednekar MS, Viswanath K, Sinha DN, Aghi MB, Pischke CR, Ebbeling CB, Lando HA, Gupta PC, Sorensen GC. Designing in the social context: using the social contextual model of health behavior change to develop a tobacco control intervention for teachers in India. HEALTH EDUCATION RESEARCH 2013; 28:113-29. [PMID: 22669010 PMCID: PMC3549584 DOI: 10.1093/her/cys060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 04/03/2012] [Indexed: 05/24/2023]
Abstract
This article provides a theory-based, step-by-step approach to intervention development and illustrates its application in India to design an intervention to promote tobacco-use cessation among school personnel in Bihar. We employed a five-step approach to develop the intervention using the Social Contextual Model of Health Behavior Change (SCM) in Bihar, which involved conducting formative research, classifying factors in the social environment as mediating mechanisms and modifying conditions, developing a creative brief, designing an intervention and refining the intervention based on pilot test results. The intervention engages users and non-users of tobacco, involves teachers in implementing and monitoring school tobacco control policies and maximizes teachers' role as change agents in schools and communities. Intervention components include health educator visits, discussions led by lead teachers, cessation assistance, posters and other educational materials and is implemented over the entire academic year. The intervention is being tested in Bihar government schools as part of a randomized-controlled trial. SCM was a useful framework for developing a tobacco control intervention that responded to teachers' lives in Bihar.
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Affiliation(s)
- Eve M Nagler
- Center for Community Based-Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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ZINN C, SCHOFIELD G. Using formative work to enhance a workplace weight loss maintenance intervention: Balancing what employees want and what they need. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2012.01607.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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DeJoy DM, Wilson MG, Padilla HM, Goetzel RZ, Parker KB, Della LJ, Roemer EC. Process evaluation results from an environmentally focused worksite weight management study. HEALTH EDUCATION & BEHAVIOR 2012; 39:405-18. [PMID: 22002249 PMCID: PMC11034935 DOI: 10.1177/1090198111418109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
Abstract
There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively simple, low-cost environmental modifications designed to facilitate healthy eating and physical activity; the intense treatment added elements intended to actively involve and engage management in program efforts. Fidelity varied across the 11 interventions comprising the two treatment conditions but did not vary systematically by treatment condition (moderate vs. intense). Environmental assessments showed improvements in workplace supports for weight management and significant differences by treatment level. Positive shifts in health climate perceptions also occurred, but sites receiving the intense treatment were not perceived as more supportive by employees. Challenges and limitations associated with environmental interventions are discussed with specific reference to activating management support.
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Devine CM, Maley M, Farrell TJ, Warren B, Sadigov S, Carroll J. Process evaluation of an environmental walking and healthy eating pilot in small rural worksites. EVALUATION AND PROGRAM PLANNING 2012; 35:88-96. [PMID: 22054528 DOI: 10.1016/j.evalprogplan.2011.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 08/08/2011] [Accepted: 08/10/2011] [Indexed: 05/31/2023]
Abstract
Small Steps are Easier Together (SS) was a pilot environmental intervention in small rural worksites in Upstate New York in collaboration with Extension educators. Worksite leaders teamed with co-workers to select and implement environmental changes to increase walking steps over individual baseline and to choose healthy eating options over 10 weeks. Participants were 226 primarily white, women employees in 5 sites. A mixed methods process evaluation, conducted to identify determinants of intervention effectiveness and to explain differences in outcomes across worksites, included surveys, self-reports of walking and eating, interviews, focus groups, and an intervention log. The evaluation assessed reach, characteristics of recruited participants, dose delivered, dose received, and context and compared sites on walking and eating outcomes. Emergent elements of participant-reported dose received included: active leadership, visible environmental changes, critical mass of participants, public display of accomplishments, accountability to co-workers, and group decision making. Participants at sites with high reach and dose were significantly more likely than sites with low reach and dose to achieve intervention goals. Although this small pilot needs replication, these findings describe how these evaluation methods can be applied and analyzed in an environmental intervention and provide information on trends in the data.
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Affiliation(s)
- Carol M Devine
- Division of Nutritional Sciences, MVR Hall, Cornell University, Ithaca, NY 14853-4401, USA.
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Combining environmental and individual weight management interventions in a work setting: results from the Dow chemical study. J Occup Environ Med 2011; 53:245-52. [PMID: 21346636 DOI: 10.1097/jom.0b013e31820c9023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness of environmental weight loss interventions alone versus in combination with an individual intervention. METHODS A quasi-experimental design compared outcomes for two levels of environmental interventions and for participants who did or did not simultaneously self-select into an individually focused weight loss intervention (YW8). Analysis of covariance and logistic regression techniques were used to examine risk outcomes. RESULTS Employees who participated in YW8 were no more successful at losing weight than those exposed to only the environmental interventions. Approximately, 13.5% of each group lost at least 5% of their body weight; overall changes in mean body weight and body mass index were negligible in both groups. CONCLUSIONS Simple worksite environmental modifications may help with weight maintenance, but are not likely to result in substantial weight reductions even when combined with low-intensity individual interventions.
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Della LJ, DeJoy DM, Mitchell SG, Goetzel RZ, Roemer EC, Wilson MG. Management support of workplace health promotion: field test of the leading by example tool. Am J Health Promot 2010; 25:138-46. [PMID: 21039296 PMCID: PMC11034929 DOI: 10.4278/ajhp.080930-quan-225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study tested a repeated-measures application of the Leading by Example (LBE) questionnaire, a self-report instrument measuring organizational leadership support for health promotion. DESIGN The efficacy of the LBE was tested in a quasi-experimental health promotion intervention trial. Twelve worksites were assigned to three intervention conditions (i.e., control, moderate, high intensity). SETTING The worksites were selected from a large U.S.-based chemical company. SUBJECTS Baseline data were collected from employees in various job roles in 2005 (N = 125). Follow-up data were collected in 2006 (N = 114) and 2007 (N = 106). Response rates ranged from 54% to nearly three-fourths of potential respondents. INTERVENTION Worksites assigned to both treatment conditions received changes in the built environment via supports for weight management. Worksites assigned to the intense condition received additional elements designed to impact leadership's support for a positive health promotion climate. MEASURES Four LBE factors measuring management support for health were assessed over time. ANALYSIS The Kruskal-Wallis H-test and analyses of variance/covariance were used to compare LBE scores. RESULTS Significant changes from baseline to 2006 were identified for the four factors (p = .000) of the LBE. No significant changes were found from 2006 to 2007. CONCLUSIONS The LBE effectively captured perceptions of management support for health. Researchers and practitioners alike should consider using the LBE to track and evaluate perceptions of management support for health promotion.
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Affiliation(s)
- Lindsay J Della
- Department of Communication, University of Louisville, 310 Strickler Hall, Louisville, KY 40292, USA.
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Abstract
OBJECTIVE Evaluate innovative, evidence-based approaches to organizational/supportive environmental interventions aimed at reducing the prevalence of obesity among Dow employees after 2 years of implementation. METHODS A quasi-experimental study design compared outcomes for two levels of intervention intensity with a control group. Propensity scores were used to weight baseline differences between intervention and control subjects. Difference-in-differences methods and multilevel modeling were used to control for individual and site-level confounders. RESULTS Intervention participants maintained their weight and body mass index, whereas control participants gained 1.3 pounds and increased their body mass index values by 0.2 over 2 years. Significant differences in blood pressure and cholesterol values were observed when comparing intervention employees with controls. At higher intensity sites, improvements were more pronounced. CONCLUSIONS Environmental interventions at the workplace can support weight management and risk reduction after 2 years.
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Environmental assessment at worksites after a multilevel intervention to promote activity and changes in eating: the PACE project. J Occup Environ Med 2010; 52 Suppl 1:S22-8. [PMID: 20061883 DOI: 10.1097/jom.0b013e3181c7512c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate changes in the worksite environment in response to a multilevel intervention over a 2-year period. METHODS Worksites were recruited in the greater Seattle area, and 34 were randomized to intervention or comparison condition. The intervention was based on the ecological model, with a framework of defined phases of intervention that included worksite-wide events implemented in partnership with employee-based advisory boards. The assessment of the worksite environment used a modification of the Checklist of Health Promotion Environments at Worksites. Subscales were developed using baseline data only. The intervention effect on different aspects of the worksite environment was estimated using logistic regression with robust estimating procedures. RESULTS Only changes in the physical activity and nutrition information environments were significantly associated with the intervention. CONCLUSIONS This article provides one of the first attempts at using environmental assessment in the evaluation of worksite interventions.
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Freedman MR, Rubinstein RJ. Obesity and Food Choices Among Faculty and Staff at a Large Urban University. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2010; 59:205-210. [PMID: 21186451 DOI: 10.1080/07448481.2010.502203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE in order to address increasing health care costs associated with obesity, this study sought to determine prevalence of overweight and obesity and examine eating behaviors, food choices, health beliefs, and attitudes of university employees. PARTICIPANTS AND METHODS an online survey was distributed to > 3,800 faculty and staff at a large public metropolitan university in Winter 2008. RESULTS almost half (48%) of 806 respondents were classified as overweight or obese. Compared to those with normal weights, overweight and obese respondents consumed fewer fruits and vegetables (p < .05), were less confident in making healthful food choices (p < .001), and were more influenced by food choices available in on-campus dining facilities (p < .05). CONCLUSIONS obesity among university employees warrants attention. Because these employees have less self-efficacy and consume less healthful diets than their normal weight colleagues, universities need to improve on-campus access to healthful foods.
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Affiliation(s)
- Marjorie R Freedman
- Department of Nutrition, Food Science and Packaging, San Jose State University, San Jose, California 95192-0058, USA.
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Application of the Environmental Assessment Tool (EAT) as a Process Measure for a Worksite Weight Management Intervention. J Occup Environ Med 2010; 52 Suppl 1:S42-51. [DOI: 10.1097/jom.0b013e3181ca3b37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med 2009; 51:786-96. [PMID: 19528832 DOI: 10.1097/jom.0b013e3181a86671] [Citation(s) in RCA: 253] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the accuracy of self-reported health care utilization and absence reported on health risk assessments against administrative claims and human resource records. METHODS Self-reported values of health care utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson's correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. RESULTS Self-report and administrative data showed greater concordance for monthly compared with yearly health care utilization metrics. Percent agreement ranged from 30% to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their health care utilization and absenteeism. CONCLUSIONS Self-reported health care utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods.
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Gong F, Baron S, Ayala L. Formative research in occupational health and safety intervention for diverse, underserved worker populations: a homecare worker intervention project. Public Health Rep 2009; 124 Suppl 1:84-9. [PMID: 19618810 DOI: 10.1177/00333549091244s110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The increasing numbers of minority, low-income, and contingent workers in the U.S. labor force present new challenges to occupational safety and health interventions. Formative research can be used to help researchers better understand target populations and identify unanticipated barriers to safety changes. The National Institute for Occupational Safety and Health initiated an intervention project to improve health and safety among homecare workers in Alameda County, California. Investigators conducted systematic formative research to gather information to guide intervention development. METHODS Various qualitative methods were used including 11 focus groups (conducted in English, Spanish, and Chinese) and 10 key informant interviews. This article focuses on two picture-based focus group activities that explored workers' views on their relationships with consumers and their perceived barriers to interventions. RESULTS Findings indicated cultural differences regarding workers' perceptions of their relationships with consumers. Chinese homecare workers mostly focused on respecting elders rather than initiating changes. Some English- and Spanish-speaking workers described efforts to negotiate with consumers. Results also identified workers' perceived barriers to interventions, such as consumers' resistance to changes and lack of resources. These findings played important roles in shaping the intervention materials. For example, given the lack of resources among consumers, the project tried to tap into community-level resources by collaborating with local stakeholders and developing community resource guides. CONCLUSION Formative research can be a valuable step to inform the development of occupational health and safety interventions for diverse, underserved worker populations.
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Affiliation(s)
- Fang Gong
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 4676 Columbia Pkwy., MS R-17, Cincinnati, OH 45226, USA
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Abstract
CONTEXT Employers have pursued many strategies over the years to control health care costs and improve care. Disappointed by efforts to manage costs through the use of insurance-related techniques (e.g., prior authorization, restricted provider networks), employers have also begun to try to manage health by addressing their employees' key lifestyle risks. Reducing obesity (along with tobacco use and inactivity) is a priority for employers seeking to lower the incidence and severity of chronic illness and the associated demand for health services. METHODS This article describes the employer's perspective on the cost impact of obesity, discusses current practices in employer-sponsored wellness and weight management programs, provides examples from U.S. companies illustrating key points of employers' leverage and opportunities, and suggests policy directions to support the expansion of employers' initiatives, especially for smaller employers. FINDINGS Researchers and policymakers often overlook the extensive efforts and considerable impact of employer-sponsored wellness and health improvement programs. Greater focus on opportunities in the workplace is merited, however, for the evidence base supporting the economic and health impacts of employer-sponsored health promotion and wellness is growing, although not as quickly as the experience base of large employers. CONCLUSIONS Public and private employers can serve their own economic interests by addressing obesity. Health care organizations, particularly hospitals, as well as public employers can be important role models. Policy development is needed to accelerate change, especially for smaller employers (those with fewer than 500 employees), which represent the majority of U.S. employers and are far less likely to offer health promotion programs.
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Affiliation(s)
- LuAnn Heinen
- National Business Group on Health, 50 F Street NW, Washington, DC 20001, USA.
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Goetzel RZ, Baker KM, Short ME, Pei X, Ozminkowski RJ, Wang S, Bowen JD, Roemer EC, Craun BA, Tully KJ, Baase CM, DeJoy DM, Wilson MG. First-year results of an obesity prevention program at The Dow Chemical Company. J Occup Environ Med 2009; 51:125-38. [PMID: 19209033 PMCID: PMC2877035 DOI: 10.1097/jom.0b013e3181954b03] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. METHODS A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests. RESULTS After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. CONCLUSIONS Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.
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Affiliation(s)
- Ron Z Goetzel
- Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Dejoy DM, Wilson MG, Goetzel RZ, Ozminkowski RJ, Wang S, Baker KM, Bowen HM, Tully KJ. Development of the Environmental Assessment Tool (EAT) to measure organizational physical and social support for worksite obesity prevention programs. J Occup Environ Med 2008; 50:126-37. [PMID: 18301169 PMCID: PMC2917629 DOI: 10.1097/jom.0b013e318161b42a] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the development, reliability, and validity of the Environmental Assessment Tool (EAT) for assessing worksite physical and social environmental support for obesity prevention. METHODS The EAT was developed using a multistep process. Inter-rater reliability was estimated via Kappa and other measures. Concurrent and predictive validity were estimated using site-level correlations and person-level multiple regression analyses comparing EAT scores and employee absenteeism and health care expenditures. RESULTS Results show high inter-rater reliability and concurrent validity for many measures and predictive validity for absenteeism expenditures. CONCLUSIONS The primary use of the EAT is as a physical and social environment assessment tool for worksite obesity prevention efforts. It can be used as a reliable and valid means to estimate relationships between environmental interventions and absenteeism and medical expenditures, provided those expenditures are for the same year that the EAT is administered.
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Affiliation(s)
- David M Dejoy
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA 30602-6522, USA.
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Affiliation(s)
- Charlotte A Pratt
- Division of Prevention and Population Science, NHLBI, 6701 Rockledge Drive, MSC 7936, Room 10118, Bethesda, MD 20892-7936, USA.
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