Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study

BACKGROUND

Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation.

OBJECTIVE

This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand.

METHODS

The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the "Discover" (understanding of current gaps) and "Define" (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the "Develop" phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final "Deliver" phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool.

RESULTS

A new digital tool, Healthy Kai (Food) Checker-a searchable database of packaged food and drink products that classifies items according to the Policy's nutritional criteria-was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions.

CONCLUSIONS

Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool's acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool's utility.

Workplace mental health promotion in a large state organization: Perceived needs, expected effects, neglected side effects

Background

Work ability and mental health in the workplace is increasingly promoted in terms of workplace health management. In order to select suitable interventions at work in a concrete context, employees and managers of a large state organization (science and development sector) were asked about perceived needs, desired effects and possible side effects of health promotion interventions.

Methods

13 semi-structured interviews with managers and three focus group interviews with employees ( N = 20) were conducted in autumn 2020 by a behavior therapist in training. The evaluation was carried out by a qualitative content analysis of the interview transcripts according to a deductive procedure and was checked by two independent raters.

Results

Most frequently, need was expressed for individual case counselling by a health expert due to the diversity of work-related problems. Managers would like to see more health-related leadership training, and a review of the various communication channels of their organization. Expected positive effects are increased self-efficacy, higher person-job-fits and reduced absenteeism. Side effects were mentioned, such as confusion of health management activities with therapy, or sensitization effects when speaking too much about mental health in mentally healthy teams. Lack of competence with the topic of mental health was mentioned as a reason for non-participation in mental health promotion activities.

Conclusions

The role of managers in relation to mental health needs to be more defined. Side effects related to mental health activities should be considered in evaluations. Selection of health interventions should depend on the concrete needs of the organization.

Conducting formative research during a pandemic threat to inform the development of an obesity prevention social and behaviour change communication strategy in Tonga

ISSUE ADDRESSED

The global epidemic of obesity is overtaking many parts of the world with the Pacific Islands at particular risk. Tonga population surveys identify significant increases in overweight and obesity with Social and Behaviour Change Communication (SBCC) offering opportunities for curbing the rise in non-communicable diseases. Formative research was conducted during the Covid-19 pandemic to assess stakeholder and program beneficiary needs and wants toward an obesity prevention SBCC strategy in Tonga.

METHODS

Semi-structured interviews with 17 key informants and 18 focus group discussions (N = 168) were conducted in Tongatapu. Data analysis was conducted on Nvivo 2020 qualitative software with desk research of secondary data supporting in-field findings.

RESULTS

Potential barriers to behavioural compliance included social/cultural norms, poor attitudes; low motivation and capability; and vulnerabilities of gender and other social determinants. Opportunities included the Tongan collective mindset and the desire for greater social interaction and fun. Strong political will to affect change was apparent with the need to consider targeting to youth, social mobilisation of communities through empowering messaging, and an integrated range of activities.

CONCLUSIONS

Co-design in the formative research process was able to be fostered via online communication processes to overcome the challenges of Covid-19 travel restrictions. The innovative approach provided a number of learnings including identification of national and regional priorities and improved efficiencies in SBCC planning, implementation and evaluation. SO WHAT?: Formative research adopting co-design approaches with stakeholders and program beneficiaries can provide optimal engagement and ownership in the SBCC strategy including insights into messaging approaches.

Challenges and barriers to healthy eating behaviors in the workplace: A pragmatic approach to promoting healthy aging

BACKGROUND

The role of health-related behaviors, particularly eating behavior, in the health of middle-aged individuals in the workplace is crucial. This qualitative study aimed to gain a deeper understanding of the challenges and barriers to healthy eating behaviors in the industrial workplace from the perspectives of middle-aged workers and employers.

METHODS

Semi-structured interviews were conducted with 15 participants, including 5 workers aged 35 to 59 years, 3 nutrition experts, 2 health, safety and environment (HSE) experts, and 5 employers from industrial workplaces in Tehran, Iran. Purposeful sampling was used to select participants who could provide meaningful insights into the research question. The data were analyzed using Graneheim and Lundman approach with MAXQDA software.

RESULTS

The study revealed three main themes that hindered healthy eating behaviors in the workplace: (i) the absence of organizational structures for well-being and health, including sub-themes such as the lack of health-oriented organizational policies, inaccessibility to healthy nutritional resources, and restrictive rules, (ii) the pressure of organizational social norms, including sub-themes such as the impact of friendship networks and colleagues, and the effect of workplace culture, and (iii) the lack of a supportive learning environment for healthy behavior, including sub-themes such as the impact of poor interactions and the absence of supportive training.

CONCLUSION

The findings highlight the need for workplace health programs that address the identified challenges and promote healthy eating behaviors among middle-aged workers. Implementing health-focused policies and fostering a workplace environment that encourages nutritious food choices can enhance the overall health and well-being of workers and potentially lead to healthy aging in the future.

Exploring factors that influence the cardiovascular health of bus drivers for the improvement of transit safety

The causes of traffic accidents include sudden cardiovascular disease events of drivers that go undetected in routine physical examinations of their health. While increased attention has been paid to proactive driver management by the frequent monitoring of drivers' mental and physical condition to avoid such events, very few studies have examined the deeper risk factors that influence the cardiovascular health of bus drivers represented by workload and scheduling. To fill this knowledge gap, this study adopts a data mining approach to exploring the factors influencing the cardiovascular health of intercity bus drivers using their daily cardiovascular measurement data along with their schedules and routine physical examination results. Ten influencing factors were identified, including medical history, late-night habits and afternoon and evening driving schedules. The present findings will be useful for preventing accidents where cardiovascular disease is involved, which in turn will help improve transit safety.

Work-life balance and work engagement across the European workforce: a comparative analysis of welfare states

BACKGROUND

Few large-scale, comparative studies have examined both the positive mental well-being outcomes of work-life balance and the broader socio-economic context by which it is shaped. Therefore, the aim of this study was to investigate the association between work-life balance and work engagement across a wide range of European welfare states, as well as to examine whether work-life balance varies across European countries and whether this variance can be explained by welfare regime, controlling for individual-level factors.

METHODS

This study utilized data from the 2015 European Working Conditions Survey. In total, 35 401 workers from 30 European countries could be classified into the adopted welfare regime typology. Work engagement was measured using an ultra-short version of the Utrecht Work Engagement Scale, and work-life balance with a question on the fit between working hours and family or social commitments. Due to the hierarchical structure of the data, multilevel regression models were applied.

RESULTS

A statistically significant positive association between work-life balance and work engagement across the European workforce was found. Between-country variance in work-life balance was demonstrated and this can in part be explained by welfare regime.

CONCLUSIONS

While it has long been recognized that occupational stress and work-related mental health problems are shaped by the socio-economic context and thus regarded as public health concerns in Europe, our results suggest that this applies to well-being at work and related support factors as well.

Factors associated with blue-collar workers' participation in Worksite Health Promotion Programs: a scoping literature review

A growing number of employers implement worksite health promotion programs (WHPPs). In particular, blue-collar workers may benefit from these WHPPs. However, they are less likely than other workers to participate and little is known about which factors affect their participation. The aim of this scoping literature review is to produce an overview of studies on factors associated with blue-collar workers' participation in WHPPs. Five databases were searched: BSU, PsycINFO, Medline, Web of Science and CINAHL. The review included peer-reviewed empirical studies on determinants associated with blue-collar workers' participation in WHPPs. Factors were extracted and categorized. Similar determinants were clustered and the direction of the associations was further examined. Nineteen papers describing 11 qualitative and 4 quantitative studies met the eligibility criteria. Seventy-seven determinants were analyzed (in quantitative studies) or reported (in qualitative studies). In most studies, only participant characteristics were investigated. Participation may be enhanced by addressing needs, tailoring from a broad range of activities, offering group activities, requiring little effort and commitment at the start, using incentives, leading by example and combining WHPPs with occupational safety interventions. WHPPs seem to be able to reach blue-collar workers, but it remains particularly challenging to reach shift workers and those who do not yet experience health complaints.

Who cares for wellbeing? Corporate wellness, social reproduction and the essential worker

This paper seeks to contribute to the rethinking of wellbeing in organisation studies. First, it contributes to critiques of corporate wellness by drawing on social reproduction theory to show how the wellbeing of every individual worker is dependent on the efforts of many, often unacknowledged, others. Corporate wellness initiatives epitomise the dominant, neoliberal narrative of wellbeing in which individuals are posited as responsible for the maintenance of their own wellbeing. Against this, social reproduction theory highlights the relational, socially distributed and materially grounded character of wellbeing. Second, the COVID-19 pandemic opened an opportunity to radically rethink wellbeing. A social reproduction reading of the category of the essential worker allows us to analyse some of the tensions and contradictions involved in the work of producing wellbeing today. It shows the unequal distribution of both the work involved and of its rewards. In sum, this paper helps extend debates over wellbeing in organisation studies beyond, on the one hand, individualised accounts of wellbeing and, on the other, accounts that ultimately confine understandings of wellbeing to the traditional workplace. It argues for the need for organisational studies of wellbeing to take the wider social reproduction of wellbeing as its starting point.

Factors influencing implementation of health-promoting interventions at workplaces: Protocol for a scoping review

INTRODUCTION

Health-promoting interventions at workplaces can be effective in modifying lifestyle-related behavioral risk factors for non-communicable diseases (NCDs). However, the interventions are not always successful in the real-world setting, and the evidence for effective strategies to implement the interventions has been limited. We propose a scoping review to identify the topics in need of study and areas for future research on barriers to and facilitators of the implementation of workplace health-promoting interventions.

MATERIALS AND METHODS

This scoping review will explore these issues from the perspective of supply-side stakeholders, who have a direct role in the implementation of these interventions. An electronic systematic search of MEDLINE (using PubMed), Web of Science, and Scopus databases from 1986 to 2022, in accordance with the PRISMA-ScR guidelines, will be performed. Supplementary hand searching will be undertaken with reference lists from included articles and consulting with relevant stakeholders. Two authors will be responsible for individually screening the corresponding articles by first reading the titles and abstracts and then the full texts to assess whether they meet the inclusion criteria. Data extraction will be conducted using standardized data collection forms, and data analysis will be aligned to the consolidated framework for implementation research (CFIR), a determinant framework of factors affecting implementation, using a directed content analysis approach.

DISCUSSION

We will present the findings from this review at national and international conferences and submit them to a peer-reviewed journal for publication. Future workplace interventions will significantly benefit from this comprehensive scoping review to identify factors that enable improvement of the implementation, and the barriers to improvement, of evidence-based health-promoting interventions at workplaces.

Establishment and management of a workplace health promotion network in rural areas: a case study

Health is an increasingly important issue in the workplace, but the dissemination of health-promoting interventions in companies, especially in small and medium-sized enterprises (SMEs), remains limited. Inter-organizational networks seem to be a promising approach to promote and implement workplace health management (WHM) in SMEs. This study analyses the establishment and coordination of the network 'ERZgesund-Healthy Companies in the Ore Mountains' for WHM in SMEs in a rural area of Germany. The case study, which builds on a mixed method approach (expert interviews, participant observations and document analysis), finds that ERZgesund evolved from a top-down approach (politically initiated, regionally anchored and financed from promotional funds). The network's hierarchy is disproportionately vertical, and the project group has limited decision-taking power and limited opportunities to act, which has reduced their overall engagement in the network. We conclude that although long and stable relationships are important for successful networks, change-especially at the leadership level-can lead to increased engagement of network participants if the hierarchy within the network is horizontally aligned. The findings of this explorative case study contribute to the planning process, the development and implementation of network structures, and successful WHM interventions.

The effect of the fatalistic perception on the perceptions of occupational health and safety practices: The case of a hospital

BACKGROUND: Many factors threaten occupational health and safety, such as technology and production systems used by businesses as well as employee qualifications. This research addresses the issue of how these factors have become a threat to occupational health and safety. OBJECTIVE: This study aims to determine whether healthcare professionals’ fatalistic perceptions affect their perceptions of occupational health and safety practices. METHOD: The population of the study consists of 538 nurses and other auxiliary healthcare professionals working in a private hospital in Istanbul. The study initially intended to reach the whole population without establishing a sample, but 221 (41.1%) employees were reached due to reasons such as the shift system, employees’ unwillingness to participate, and personnel on leave. The study employed a survey form consisting of three parts as data collection tool. The first part of the survey includes demographic information, the second part is a Fatalism Scale and the last part is the Occupational Health and Safety (OHS) Practices Scale. Descriptive statistical analyses and SEM analysis were used for data analysis. The analyses were performed within the 95% confidence interval. RESULTS: A negative relationship was found between fatalism and occupational health and safety practices. In addition, employees’ fatalistic perceptions negatively affect their occupational health and safety practices. CONCLUSION: Fatalistic perception plays an important role in occupational health and safety practices. For this reason, employees can be shown through trainings that occupational accidents are not fate and can be prevented by certain measures they can take.

A Scoping Review of Economic Evaluations of Workplace Wellness Programs

OBJECTIVE

Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI.

METHODS

We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome.

RESULTS

We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates.

CONCLUSION

This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.

The BELE program: The development of a holistic interdisciplinary health-promoting program enhancing work-life balance among female employees working in human service organizations in Sweden

BACKGROUND

Despite an increase in work-life balance literature, the development of successful support to help employees manage their work -life balance is slow. Moreover, there are few interventions with a comprehensive approach to workplace health promotion focusing on work-life balance.

OBJECTIVE

This paper aims to present the development and building blocks of a holistic interdisciplinary health-promoting program, the BELE program, to enhance female employees working in human service organizations health and well-being with a focus on work-life balance.

METHODS

The planning and development of the program was done through an intervention mapping and research circles methodology.

RESULTS

The planning- and development process of the program resulted in a theoretical framework, and a program structure with a program content. The intervention program was named "The Balance in Everyday Life Empowerment program" (BELE program).

CONCLUSIONS

The BELE program adds to the existing body of work-life balance knowledge, so far often based on a conflict approach. Interventions focusing on a comprehensive approach to health and work-life balance with a salutogenic approach are rare. Furthermore, the integration with occupational therapy and health promotion in a workplace health promotion framework is innovative. In a previous study, the BELE program has shown that it enhances women's well-being and balance in their everyday life.

What We Eat and Where We Work Is What We Become: Worksite Food Environment Exposure and Cardio-Metabolic Health among Employed Adults of Urban Delhi, India

The incidence of metabolic syndrome (MS) which is a predictor of increasing CVD is on the rise among adults in urban India. The present study was designed to measure the prevalence of cardio metabolic risk (CMR) as per MS among employed adults in Delhi, India. Study design was cross-sectional. Anthropometric and biochemical measurements were carried out using standard techniques on apparently healthy males and females (n=455) working in various government and private organisations in Delhi, India after obtaining ethical permissions. It was found that more than one-third of the study population had MS (43.8%). A significant difference in the prevalence of MS was seen among males (34.7%) and females (57.5%, p<0.05). The prevalence of MS components was: abdominal obesity (54.3%), hypertriglyceridemia (61.9%), hypertension (56.6%), hypertriglyceridemia (27.4%), low HDL-c levels (63.7%). CMR (assessed from 0-5, where 0 means no MS). It was found that CMR increased with age (β: 0.01; 95% CI: 0.009,0.01; p=0.000) especially among females (β: 0.29; 95% CI: 0.19,0.38; p=0.000) who were consuming frequent non-vegetarian foods (β: 0.04; 95% CI: 0.01,0.09; p=0.07), had family history of diseases (β: 0.08; 95% CI: 0.01,0.18; p=0.09) and were sedentary workers (β: 0.05; 95% CI: 0.00,0.10; p=0.06). Unhealthy worksite food environment characterised by high fast food outlet density (β: 0.003; 95% CI: 0.00,0.007; p=0.04) in close proximity (β: 0.17; 95% CI: 0.36,0.00; p=0.05) to worksite were also associated with MS. There is a high prevalence of individual components of MS and overall prevalence of MS. Food environment and physical inactivity were two paramount factors resulting in increased CMR among the study population.

Workplace health promotion interventions for Australian workers with intellectual disability

Workplace health promotion (WHP) and the general wellbeing of workers in the Australian workforce should be a priority for all management. Our study argues that management support for workers with an intellectual disability (WWID) can make a difference to their health promotion and ultimately their participation in the workforce. We adopt a qualitative approach, through semi-structured interviews with 22 managers, across various organizations, to examine their perspectives around the WHP of WWID. We integrate the key values of WHP; rights for health, empowerment for health and participation for health (Spencer, Corbin and Miedema, Sustainable development goals for health promotion: a critical frame analysis, Health Promot Int 2019;34:847-58) into the four phases of WHP interventions; needs assessment, planning, implementation and evaluation (Bortz and Döring, Research Methods and Evaluation for Human and Social Scientists, Heidelberg: Springer, 2006) and examine management perspectives (setting-based approach) on WHP of WWID. Where this integration had taken place, we found some evidence of managers adopting more flexible, innovative and creative approaches to supporting the health promotion of WWID. This integration seemed to drive continuous improvement for WWID health promotion at the workplace. We also found evidence that some organizations, such an exemplar film company, even over deliver in terms of supporting WWID needs by encouraging their capabilities in film making interventions, whilst others are more direct in their support by matching skills to routine jobs. Our approach demonstrates that incorporating key WHP values into the four-phase WHP framework is critical for the effective health promotion of WWID.

The Challenges of Partnering to Promote Health through Sport

Interagency partnerships and collaborations underpin a settings-based approach to health promotion in all settings, including sport. This study used an online concept mapping approach to explore the challenges that Regional Sports Assemblies (RSAs) in Victoria, Australia experienced when working in partnerships to develop and deliver physical activity programs in a community sport context. Participants from nine RSAs brainstormed 46 unique partnership-related challenges that they then sorted into groups based on similarity of meaning and rated for importance and capacity to manage (6-point scale; 0 = least, 5 = most). A six cluster map (number of statements in cluster, mean cluster importance and capacity ratings)—Co-design for regional areas (4, 4.22, 2.51); Financial resources (3, 4.00, 2.32); Localised delivery challenges (4, 3.72, 2.33); Challenges implementing existing State Sporting Association (SSA) products (9, 3.58, 2.23); Working with clubs (8, 3.43, 2.99); and Partnership engagement (18, 3.23, 2.95)—was considered the most appropriate interpretation of the sorted data. The most important challenge was Lack of volunteer time (4.56). Partnerships to implement health promotion initiatives in sports settings involve multiple challenges, particularly for regional sport organisations working in partnership with community sport clubs with limited human and financial resources, to implement programs developed by national or state-based organisations.

Truckies and the Australian transport industry: Managers' perspectives about enablers and inhibitors to workplace health promotion

BACKGROUND

There is little published research about managers' views about implementing and embedding workplace health promotion interventions.

OBJECTIVE

To shed light on research-to-practice challenges in implementing workplace health promotion interventions in the Australian road transport industry.

METHODS

In this Participatory Action Research project, managers from small-to-midsized companies in the Australian road transport industry were asked their views about enablers and barriers to implementing nutrition and physical activity interventions in their workplace.

RESULTS

Managers identified practical assistance with resources, ideas, and staffing as being key enablers to implementation. Barriers included time restraints, worker age and lack of interest, and workplace issues relating to costs and resources.

CONCLUSION

Manager perspectives add new insights about successful implementation of workplace health promotion. A Participatory Action Research approach allows managers to develop their own ideas for adapting interventions to suit their workplace. These findings add to a small body of knowledge about managers' views regarding implementing workplace health promotion in small-to-midsized road transport companies - a relatively unexplored group. Managers highlight the importance of time constraints and worker availability when designing interventions for the road transport industry. Managers require a good understanding of the workplaces' socio-cultural context for successful health promotion and health behaviour change.

Family as a health promotion setting: A scoping review of conceptual models of the health-promoting family

BACKGROUND

The family is a key setting for health promotion. Contemporary health promoting family models can establish scaffolds for shaping health behaviors and can be useful tools for education and health promotion.

OBJECTIVES

The objective of this scoping review is to provide details as to how conceptual and theoretical models of the health promoting potential of the family are being used in health promotion contexts.

DESIGN

Guided by PRISMA ScR guidelines, we used a three-step search strategy to find relevant papers. This included key-word searching electronic databases (Medline, PSycINFO, Embase, and CINAHL), searching the reference lists of included studies, and intentionally searching for grey literature (in textbooks, dissertations, thesis manuscripts and reports.).

RESULTS

After applying inclusion and exclusion criteria, the overall search generated 113 included manuscripts/chapters with 118 unique models. Through our analysis of these models, three main themes were apparent: 1) ecological factors are central components to most models or conceptual frameworks; 2) models were attentive to cultural and other diversities, allowing room for a wide range of differences across family types, and for different and ever-expanding social norms and roles; and 3) the role of the child as a passive recipient of their health journey rather than as an active agent in promoting their own family health was highlighted as an important gap in many of the identified models.

CONCLUSIONS

This review contributes a synthesis of contemporary literature in this area and supports the priority of ecological frameworks and diversity of family contexts. It encourages researchers, practitioners and family stakeholders to recognize the value of the child as an active agent in shaping the health promoting potential of their family context.

Professional courage to create a pathway within midwives' fields of work: a grounded theory study

BACKGROUND

The theory of salutogenesis focuses on resources for health and health-promoting processes. In the context of midwives' work, this is not well described despite the importance for occupational health and the intention to remain in the profession. In order to promote a healthy workplace, it is necessary to consider the facilitating conditions that contribute to a sustainable working life. Therefore, the aim of this study was to explore health-promoting facilitative conditions in the work situation on labour wards according to midwives.

METHODS

A constant comparative analysis was applied to face-to-face interviews with midwives that constituted the empirical material in this classical grounded theory study.

RESULTS

The substantive theory of Professional courage to create a pathway within midwives' fields of work emerged as an explanation of the health-promoting facilitative conditions in midwives' work situation. The theory consists of a four-stage process with prerequisite contextual conditions: visualising midwifery, organisational resources and a reflective and learning environment, that were needed to fulfil the midwives' main concern a Feasibility of working as a midwife. This meant being able to work according to best-known midwifery theory and practice in each situation. Positive consequences of a fulfilled main concern were a professional identity and grounded knowledge that enabled the development of the resistant resource professional courage. The courage made it feasible for midwives to move freely on their pathway within the different fields of work extending between normal and medicalised birth and being autonomous and regulated.

CONCLUSIONS

A professional courage was required to create a pathway within midwives' fields of work, to move freely depending on what actions were needed in a particular work situation. Professional courage could be seen as a resistance resource, enabling midwives to become resilient when dealing with the unpredictable work situation. However, there are vital organisational preconditions that needed to be fulfilled for workplaces to become facilitative, organisational resources, visualising midwifery and a reflective environment. The theory can be used to foster health-promoting and sustainable work situations for midwives, which is possible if the organisational preconditions are met. This could be a key factor in retaining midwives in the profession.

Description of an integrated e-health monitoring system in a Portuguese higher education institution: the e.cuidHaMUstm program

BACKGROUND

The World Health Organization and the International Labour Organization recognize that workplace health is not only affected by occupational hazards, but is mainly affected by social determinants and individual factors. An accelerated rise in noncommunicable diseases has fostered the importance of creating supportive environments and encouraging healthy behaviours. Therefore, an operational approach to making workplaces healthy and sustainable is needed. This paper describes the development of an e-Health monitoring program entitled 'Integrated eHealth Monitoring System for Health Management in Universities' (e.cuidHaMUs^TM) as a possible solution to that operational approach.

METHODS

We developed the program e.cuidHaMUs^TM that proposes to detect risk behaviours related to noncommunicable diseases and to implement problem-solving measures by establishing a health-promoting workspace in a Portuguese higher education institution. Based on the 'I-Change' conceptual model, our program provides personalized feedback; improves health-related knowledge, attitude and good practices; and encourages actions to promote healthy lifestyles through individual health capacitation. Focusing on evaluation as an activity that generates knowledge, the e.cuidHaMUs^TM program aggregates all the relevant health information, shares the results with decision-makers and evaluates health-related policy changes in the workplace.

DISCUSSION

This paper presents the design of the e.cuidHaMUs^TM program, the development of an eHealth web platform to share information between the different stakeholders, and a questionnaire to evaluate the health status of higher education institution workers (e.cuidHaMUs.QueST®). Also, the procedures for data collection and analysis are outlined. The e.cuidHaMUs^TM program can enhance health surveillance through cross-sectional and longitudinal studies and provide scientific evidence to support the envisioned interventions and promotions of healthy lifestyles. This program is an effort to incorporate a holistic culture of health-promoting workspace in higher education institution policies.

Organizational and Individual Outcomes of Health Promotion Strategies-A Review of Empirical Research

The main purpose of the paper is to identify the outcomes for employers and employees indicated in research related to workplace health promotion interventions (WHPIs). We investigated what methods are used and what types of organization this type of research is most often carried out in. In addition, the authors attempted to assess to what extent the methods used in the previous research prove the effectiveness of the implemented WHPIs. A systematic review of English-language papers (2000–2020) focused on types of health-promoting interventions in the workplace, and outcomes for employers and employees were conducted using the SCOPUS database (n = 260). As a result, 29 texts qualified for a final qualitative synthesis of the results. The analyses were most frequently conducted in small and medium-sized enterprises (SMEs) based on both quantitative and qualitative methods. In order to draw conclusions, analyses were made by classifying the research presented in the texts according to the type of intervention implemented, classifying the outcomes identified, and indicating the type of evaluation made by the researcher. The analysis showed that most of the outcomes presented refer to changes in the strategy and organizational culture, as well as the behavior of employees. In 18 studies, the indication of outcomes resulted directly from the evaluation outcomes. In other cases, the outcomes were identified by an evaluation of the process or structure of WHPI. The conducted analysis showed significant diversity in terms of the outcomes measured and the research methods used. The quasi-experimental methods, randomly controlled cluster trials, or cross-sectorial studies used in the study to confirm the effectiveness of WHPI were used only in every third study. In these studies, measurements were usually performed twice: at baseline and after intervention. The majority of studies confirmed that WHPIs led to a positive change in the healthy behavior of employees and effected an organizational change, and more rarely led to savings or a reduction in costs resulting from sickness absenteeism, presentism, turnover, etc., and return on investment (ROI). The article shows the need to conduct further research towards the development of guidelines for the evaluation of the effectiveness of implemented programs.

Implementing Organizational WHP Into Practice: Obstructing Paradoxes in the Alignment and Distribution of Empowerment

Background: According to policy and theory, there is need for organizational workplace health promotion (WHP) to strengthen working conditions for all employees. However, earlier studies show it is hard to implement in practice. The aim was to critically analyze and identify interacting mechanisms and obstacles behind failures of organizational WHP projects from system perspectives. Methods: A holistic case study was performed, to critically analyze data from an organizational WHP project approach at a public health care organization. The qualitative data was collected over 5 years and included interviews with key actors (n = 80), focus groups (n = 59 managers), structured observations (n = 250 hours), continuous field observations and documents (n = 180). Questionnaires to employees (n = 2,974) and managers (n = 140) was complementing the qualitative-driven mixed method approach. Results: The analysis shows obstructing paradoxes of alignment and distribution of empowerment during the process of implementation into practice. The obstacles were interacting over system levels and were identified as: Governance by logics of distancing and detaching, No binding regulation of WHP, Separated responsibility of results, Narrow focus on delegated responsibilities, Store-fronting a strategic model, Keeping poor organizational preconditions and support for developments and Isolate WHP from other organizational developments. Conclusions: The following premises can be formulated regarding successful organizational WHP programs. Consider (1) the uncertainty a distributed empowerment to all system levels may create; (2) the distributed impact to define the target and allow broader areas to be included in WHP; and (3) the integration into other development processes and not reducing the organizational WHP to the form of a project.

Exploring HIV-Related Stigma and Discrimination at the Workplace in Southwestern Uganda: Challenges and Solutions

Globally, the HIV/AIDS pandemic continues to have an enormous impact on affected societies. Despite several health promotion interventions being carried out, HIV/AIDS remains a major cause of deaths in low and middle income countries. At the workplace, the pandemic has brought about reduction in productivity, increased staff turnover, increased production costs, high levels of stigma, etc. HIV stigma is one of the main reasons why the pandemic has continued to devastate a number of societies around the world. HIV stigma presents barriers to HIV prevention in different settings including the workplace. Unlike large enterprises, small-scale enterprises have received less attention in the fight against HIV/AIDS. This study’s purpose was to explore how employers and employees can overcome challenges of HIV-related stigma at the workplace. This study employed a qualitative case study design. Data were collected from eighteen participants in three small-scale enterprises in Kabale. Findings indicate that small-scale enterprises are faced with the fear of HIV testing, status disclosure, staff turnover, suicidal thoughts, gossip, etc. Implementing operative national HIV workplace policies may enable small-scale enterprises to overcome challenges of HIV-related stigma at the workplace.

Learning Processes as Key for Success in Workplace Health Promotion Interventions in Health Care

There is limited previous research on how learning processes contribute to the outcomes of workplace health promotion (WHP) leadership interventions. The aim of this study was to identify the outcomes of a system-based WPH education program for managers and investigated what impact the intervention program had on health-oriented leadership, improvement work, and employee well-being, as well as what factors (i.e., how manager's active work following the intervention and organizational learning climate) contributed to these outcomes. A mixed-methods approach was applied, including qualitative interviews with 23 managers and process leaders, as well as questionnaires to employees and managers representing 17 public health care units in Sweden. The results showed that health-oriented leadership, improvement work, work satisfaction, and vitality increased at workplaces that worked actively to implement WHP following the program. Working actively with WHP and health-oriented leadership was of central importance for success and was a covariate with improved social learning climate, improved developmental leadership, and increased degree of improvement work. All included factors of learning during the intervention were associated with improved job satisfaction, while the increase in vitality seemed unrelated to program implementation. In conclusion, successful outcomes of WHP interventions interact with dimensions of organizational learning climate in the workplace.

Scoping review of health in office design approaches

Purpose

This paper aims to explore the literature on office design approaches (ODAs) in relation to employee health. The overall goal is to facilitate the practical use and theoretical development of design approaches to healthy offices.

Design/methodology/approach

A scoping review of 7,432 papers collected from 4 electronic databases and 5 scientific journals resulted in the selection of 18 papers for content analysis.

Findings

Various ODAs relating to building design features and health were identified. The findings highlight challenges for this emergent field, including a paucity of literature on ODAs, a lack of definitions of health and healthy offices, ambiguous design strategies and a lack of a holistic ODA.

Originality/value

ODAs are potentially valuable resources but an under-considered topic for healthy office development. To the best of the authors’ knowledge, this study is the first scoping review to map and compare different design approaches in the context of office design and its main contribution is in encouraging researchers and practitioners to bring a salutogenic and holistic perspective to their design approaches.

Antioxidant Components of Brassica Vegetables Including Turnip and the Influence of Processing and Storage on their Anti-oxidative Properties

Brassica vegetables, particularly turnip, contain many natural antioxidants. This review focuses on antioxidant components and the influence of different processing and storage conditions on antioxidant activities of some Brassica vegetables including turnip. Long storage times had an adverse effect on antioxidant value of turnip. Also, the activity of antioxidants in cruciferous vegetables could be influenced by antioxidant breakdown and leaching during cooking. Heat treatment has a major impact on the antioxidant activity of Brassica vegetables and it has been perceived minor antioxidant ability in processed vegetables compared with uncooked samples. Food processing operations in terms of blanching, canning, sterilizing and freezing, in addition to cooking methods perhaps can have a major influence on the yield, chemical structure and bioavailability of antioxidants in Brassica family. Cooking methods such as steaming and microwaving are proper methods for a short time. Consumption of raw or slightly blanched turnip is an appropriate way to maximize its health benefits.

Exploring the Association Between Health Literacy and Psychological Well-Being Among Industry Managers in Germany

OBJECTIVE

Industry managers are typically exposed to high work demands but have received limited attention by research, particularly concerning the issue of health literacy and how this relates to their psychological well-being. The aim of this study was to explore the association between health literacy and psychological well-being among managers in Germany.

METHODS

An online survey of a sample of 126 commercial industry managers was conducted. Effects of health literacy on psychological well-being (WHO-5 index) were investigated using path analysis.

RESULTS

The findings show a quarter of managers were classified as having poor well-being. Health literacy, namely the facets self-regulation (β = 0.40, P < 0.001), self-perception (β = 0.26, P < 0.001), self-control (β = 0.25, P < 0.01), and proactive approach to health (β = 0.09, P < 0.05), were positively associated with psychological well-being.

CONCLUSION

The study indicates that higher health literacy is associated with decreased risk of poor well-being.

Managers’ learning process during a health-promoting leadership intervention

Purpose

The increasingly demanding psychosocial working conditions in Swedish public sector workplaces call for implementation of workplace health promotion (WHP) interventions. There is a need to increase first-line public sector managers’ capacities for health-promoting leadership. The purpose of this paper is to investigate first-line managers’ experiences of participating in an intervention aimed at strengthening health-promoting leadership. More precisely, the aim is to study what obstacles and prerequisites the intervention have for their learning processes to become health-promoting managers.

Design/methodology/approach

A qualitative study in Northern Sweden at workplaces in the county council and municipalities was conducted. The data were gathered through individual interviews with 18 participating first-line managers. Inductive-content analysis was used to analyse the data.

Findings

The results identify time for reflection and collegial discussions about leadership as prerequisites for learning about health-promoting leadership. Managers experienced the intervention as a confirmation of the leadership behaviours already gained. However, the health-promoting leadership intervention was seen as a contradiction, since organisational prerequisites to implement WHP measures were perceived to be lacking. The managers were not involved in the planning of the intervention and questioned why the organisation did not involve them more when the educational activities were created.

Originality/value

When the organisation understands how and when its managers learn, what they need and want to learn about WHP, and what they already know, tailored participatory interventions can be facilitated that consider the unique prerequisites for the particular organisation.

Feel well and do well at work

Purpose

This paper aims to investigate employee well-being in relation to office landscapes in a post-relocation context. The aims are to identify spatial attributes of the office landscape that influence employee well-being and underlying contextual factors that explain employee well-being post-relocation.

Design/methodology/approach

A mixed-method approach was adopted. The data collection involved 16 semi-structured interviews with employees, an interview with the leading architect of the office renovation, study of a dossier on the renovation project and observations.

Findings

Most of the informants experienced the new office landscape positively despite few shortcomings. Spatial attributes were identified that influenced the informants’ well-being positively in terms of affects, satisfaction, social relations and environmental mastery. Conversely, negative influences on well-being were also reported regarding affects, satisfaction and environmental mastery. Conflicting views on some of the spatial attributes and contextual factors related to the planning process and the former office landscape were identified.

Originality/value

The value of this paper lies in investigating the office landscape at the spatial attributes level, despite office type, and their influence on hedonic and eudaimonic components of employee well-being. The research approach adopted proved its usefulness for in-depth studies of the interrelations between office landscapes and employee well-being.

Lifestyle characteristics as moderators of the effectiveness of weight control interventions among semiconductor workers

BACKGROUND

Workers in high technology industry are experiencing stressful environment and have been ranked as a high risk group for adverse health effects. The effectiveness of worksite health promotion is important for occupational health. This study is to investigate the effect of health interventions on body measurement changes while examining the role of their lifestyle factors.

METHODS

A total of 904 participants aged over 30 years were recruited from 14 semiconductor worksites in Taiwan from 2011 to 2015. A multi-settings, quasi-experimental study was conducted that assigned participants into two intervention programs, including exercise program and diet-plus-exercise program. The outcomes include the changes of body weight, waist circumference, body mass index (BMI), and biophysiological indicators. Lifestyle variables include alcohol consumption, cigarette smoking, and regular exercise. Multiple linear regression analyses were performed to test the association.

RESULTS

The findings have demonstrated that one kilogram body weight reduction is associated with a decrease of 0.58 mmHg SBP (p < 0.001), 0.29 mmHg DBP (p < 0.001), 3.33 mg/dL triglyceride (p < 0.001), 0.96 mg/dL total cholesterol (p < 0.001), and 0.68 mg/dL LDL (p < 0.001). The diet-plus-exercise group had more significant effect on both weight changes and biophysiological changes than exercise-only group (p < 0.001). Lifestyle factors, including cigarette smoking, alcohol consumption, and regular exercise, were significant moderators of the effectiveness of health interventions.

CONCLUSIONS

Both exercise and diet interventions are important to the effectiveness of health promotion in occupational sectors. Lifestyle modifications are vital for weight control programs in improving body shape changes and biophysiological indicators.

Healthy Universities. The development and implementation of a holistic health promotion intervention programme especially adapted for staff working in the higher educational sector: the ARK study

Underpinned by the Healthy Universities settings concept, this paper presents a holistic intervention approach, called ARK, to improve the health and well-being of academic staff. ARK (a Norwegian acronym for work environment and climate study) has been conducted in 18 universities and university colleges in Norway. The survey has collected information on employees' perceptions of the psychosocial work environment, well-being, and health from over 15,000 respondents. Further, it has provided valuable information and experiences on organizational development processes on how to successfully implement a health-promoting intervention programme. The aim of this paper is to present the ARK project and provide suggestions on how to conduct a health-promoting intervention programme in a university setting based on the experience and knowledge acquired from ARK. This understanding can inform and inspire the planning of future Health Promoting University initiatives to meet the distinctive needs of its employees.

Facilitating and limiting factors of workplace health promotion at Rhodes University, South Africa

BACKGROUND

Workplace health promotion programs, when well designed and implemented are beneficial to both employees and their employers.

OBJECTIVE

To investigate the factors that affect workplace health promotion initiatives intended for support staff at Rhodes University. To explore ways in which future initiatives that aim to reduce the prevalence of non-communicable diseases in the workplace may be improved.

METHODS

A qualitative study, using semi-structured interviews and focus group discussions with key stakeholders and support staff. All interviews and focus group discussions were voice recorded and then transcribed verbatim. Transcripts were uploaded into NVivo® 10 for coding and thematic analysis.

RESULTS

Key stakeholders reported that health promotion initiatives have been attempted and were advertised, however the turnout was poor. The support staff in turn, stated that past initiatives were not tailored to their health needs and they lacked context-specificity and cultural sensitivity. They also suggested improvements for future initiatives such as convenient venues and using films and short plays as a means of delivering health information.

CONCLUSIONS

Based on inputs from key stakeholders and support staff, there are several factors that affect the success of health promotion initiatives in the workplace. Employees, who are the recipients of the planned initiatives, need to be involved in all stages of the planning and implementation.

Barriers and facilitators to implementation of menu labelling interventions to support healthy food choices: a mixed methods systematic review protocol

BACKGROUND

Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices.

METHODS

This review will use the 'best fit' framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed.

DISCUSSION

Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017083306.

How far are we from full implementation of health promoting workplace concepts? A review of implementation tools and frameworks in workplace interventions

Introduction

Health promoting workplace frameworks provide a holistic view on determinants of workplace health and the link between individuals, work and environment, however, the operationalization of these frameworks has not been very clear. This study provides a typology of the different understandings, frameworks/tools used in the workplace health promotion practice or research worldwide. It discusses the degree of their conformity with Ottawa Charter's spirit and the key actions expected to be implemented in health promoting settings such as workplaces.

Method

A comprehensive online search was conducted utilizing relevant key words. The search also included official websites of related international, regional, and national organizations. After exclusion, 27 texts were analysed utilizing conventional content analyses.

Results

The results of the analysis were categorized as dimensions (level or main structure) of a healthy or health promoting workplaces and subcategorized characteristics/criteria of healthy/health promoting workplace.

Discussion and conclusion

Our analysis shows diversity and ambiguity in the workplace health literature regarding domains and characteristics of a healthy/health promoting workplace. This may have roots in lack of a common understanding of the concepts or different social and work environment context. Development of global or national health promoting workplace standards in a participatory process might be considered as a potential solution.

Obstacles and Future Prospects: Considerations on Health Promotion Activities for Older Workers in Europe

The ageing of workers is one of the most important issues for occupational health and safety in Europe. The ageing of the active population means that health promotion is a necessity rather than a mere option. This review considers barriers and perspectives for workplace health promotion for older workers. Lack of awareness on the part of management and inflexibility in the occupational health and safety system appear to be major barriers. To overcome these, it will be necessary to disseminate knowledge regarding the effectiveness of health promotion actions for older workers, encourage greater involvement on the part of social partners, recover resources by replacing medical consumerism and bureaucratic practices, adopt an integrated approach combining the prevention of occupational risks and the promotion of healthy lifestyles, and recognize subsidiarity and the ability of working communities to regulate themselves.

Study design and baseline characteristics of a combined educational and environmental intervention trial to lower sodium intake in Swiss employees

BACKGROUND

Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics.

METHODS

Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples.

DISCUSSION

Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.

Exploring strategies to improve the health promotion orientation of Flemish sports clubs

Sports clubs are increasingly recognized as an innovative setting for health promotion, as exemplified by the health promoting sports club concept. This study aims to assess the health promotion orientation of both youth sports clubs (YSC) and adult sports clubs (ASC) in Flanders and to identify the motives and barriers as reported by their representatives as a basis for proposing intervention strategies to improve the health promotion orientation in sports clubs. A total of 253 Flemish sports clubs, consisting of 156 YSC and of 97 ASC, completed the online questionnaire, covering club characteristics (e.g. finances, human resources), perceived motives and barriers for health promotion and the health promoting sports club index. Even though YSC were more health promoting than ASC, the results indicated that all sports clubs could improve their health promotion orientation. The most consistent predictors of health promotion orientation are perceived motives index for YSC and perceived lack of resources for ASC. Based on these results, interventions to enhance the health promoting orientation need to tackle the lack of resources such as lack of expertise regarding health promotion. Interventions aimed specifically at YSC should emphasize the direct benefits, for example by demonstrating how health promotion helps clubs to improve the provision of high quality sports participation and by awarding a health promotion quality label.

Social cognitive aspects of the participation in workplace health promotion as revealed by the theory of planned behavior

Health-promoting efforts strongly depend on individual cognitions such as attitudes as well as social cognitive aspects of the work environment such as leadership and support. Using the theory of planned behavior (TPB) as a theoretical frame, participation behavior of employees in courses offered by the workplace health promotion (WHP) program of the German Armed Forces was investigated. Social cognitive aspects of the work environment, such as leadership behaviors by setting an example or optimizing organization of work, were included in the TPB components of subjective norm and perceived behavioral control, which allowed for an investigation of the specific effects of leadership on WHP participation. A survey study with N=1385 members of the German Armed Forces was conducted in 2015 in Germany. Results showed that perceived behavioral control and attitudes towards WHP were the strongest predictors for WHP participation. While subjective norm was positively related to attitudes, it had a slightly negative effect on intention to participate in WHP activities. These findings suggest that the most effective way for leadership to increase WHP participation is to enhance perceived behavioral control. Quite contrary, creating a positive subjective norm regarding WHP participation may even result in psychological reactance.

Designing equitable workplace dietary interventions: perceptions of intervention deliverers

BACKGROUND

Workplaces are a good setting for interventions that aim to support workers in achieving a healthier diet and body weight. However, little is known about the factors that impact on the feasibility and implementation of these interventions, and how these might vary by type of workplace and type of worker. The aim of this study was to explore the views of those involved in commissioning and delivering the Better Health at Work Award, an established and evidence-based workplace health improvement programme.

METHODS

One-to-one semi-structured interviews were conducted with 11 individuals in North East England who had some level of responsibility for delivering workplace dietary interventions. Interviews were transcribed verbatim and analysed using thematic framework analysis.

RESULTS

A number of factors were felt to promote the feasibility and implementation of interventions. These included interventions that were cost-neutral (to employee and employer), unstructured, involved colleagues for support, took place at lunchtimes, and were well-advertised and communicated via a variety of media. Offering incentives, not necessarily monetary, was perceived to increase recruitment rates. Factors that militate against feasibility and implementation of interventions included worksites that were large in size and remote, working patterns including shifts and working outside of normal working hours that were not conducive to workers being able to access intervention sessions, workplaces without appropriate provision for healthy food on site, and a lack of support from management.

CONCLUSIONS

Intervention deliverers perceived that workplace dietary interventions should be equally and easily accessible (in terms of cost and timing of sessions) for all staff, regardless of their job role. Additional effort should be taken to ensure those staff working outside normal working hours, and those working off-site, can easily engage with any intervention, to avoid the risk of intervention-generated inequalities (IGIs).

Salt intake, blood pressure, and socioeconomic disparities among government employees in Sri Lanka: a cross-sectional study

Our study estimated salt intake, examined the association between blood pressure (BP) and salt intake, and explored the socioeconomic variations in salt intake among administrators (government employees). This is a cross-sectional study. We studied 168 randomly selected administrators aged 30-60 years attached to government offices in Colombo, Sri Lanka. Self-administered questionnaire gathered information on socio-demographic, work-related information, lifestyle practices, and medical history. BP, 24-hour urine collection, and anthropometric indices were measured. Mean salt intake levels measured by 24-hour Sodium (Na) excretion in hypertensives and non-hypertensives were 202.56 (SD ± 85.45) mmol/day and 176.79 (SD ± 82.02) mmol/day, respectively. A 100-mmol increase in sodium was associated with an average increase of 3.1 (95 per cent CI 2-4.2) mmHg in systolic BP and 1.8 (95 per cent CI 0.89-2.6) mmHg in diastolic BP. Higher salt intake was found in managerial assistants (12.38 ± 5.0 g) compared with senior officers (10.84 ± 4.9 g). Salt intake among these administrators was alarmingly high. High salt intake was positively associated with hypertension and more prevalent in lower socioeconomic strata.

Managing workplace health promotion in municipal organizations: The perspective of senior managers

BACKGROUND

Previous research indicates that companies manage workplace health in various ways, but more in-depth empirical knowledge of how workplace health promotion (WHP) is managed in public sector organizations is needed.

OBJECTIVE

The aim of this study was to explore how WHP is managed and incorporated into the general management system in two large Swedish municipal organizations.

METHODS

A qualitative descriptive approach was used. Fourteen senior managers were purposefully selected and interviewed using semi-structured interviews. Documents were used as supplementary data. All data were analysed using qualitative content analysis.

RESULTS

The management of WHP was described as a set of components that together contribute to the organization's capacity for WHP. The informants described WHP as dominated by fitness programmes and as following a problem-solving cycle, in which the annual employee survey emerged as an important managerial tool. Achieving feasible WHP measures and appropriate follow-ups were described as challenges. The provision of leadership competence for WHP and use of supportive resources were described as additional components.

CONCLUSIONS

The WHP management approach needs to be broadened to include work environment and organizational factors. Further integration with occupational health and safety and the general management system in the organizations is also needed.

A cost-analysis of complex workplace nutrition education and environmental dietary modification interventions

BACKGROUND

The workplace has been identified as a priority setting to positively influence individuals' dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer's perspective.

METHODS

Cost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace.

RESULTS

The combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist's time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs).

CONCLUSIONS

Within multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN35108237 . Date of registration: The trial was retrospectively registered on 02/07/2013.

An evaluation of the health and wellbeing needs of employees: An organizational case study

Introduction:

Workplace health and wellbeing is a major public health issue for employers. Wellbeing health initiatives are known to be cost-effective, especially when the programs are targeted and matched to the health problems of the specific population. The aim of this paper is to gather information about the health and wellbeing needs and resources of employees at one British organization.

Subjects and Methods:

A cross-sectional survey was carried out to explore the health and wellbeing needs and resources of employees at one British organization. All employees were invited to participate in the survey, and, therefore, sampling was not necessary.

Results:

838 questionnaires were viable and included in the analysis. Employees reported "feeling happier at work" was the most important factor promoting their health and wellbeing. Physical tasks, such as "moving and handling" were reported to affect employee health and wellbeing the most. The "provision of physiotherapy" was the most useful resource at work. In all, 75% felt that maintaining a healthy lifestyle in the workplace is achievable.

Conclusions:

More needs to be done by organizations and occupational health to improve the working conditions and organizational culture so that employees feel that they can function at their optimal and not perceive the workplace as a contributor to ill-health.

Addressing social determinants of health inequities through settings: a rapid review

Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity. This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in 12 settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programmes to be evaluated for differential equity impacts and published to provide a more solid evidence base.