An Intervention to Promote Appropriate Management of Allergies in a Heavy Manufacturing Workforce: Evaluating Health and Productivity Outcomes

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

Background

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

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

Methods

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

Results

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

Conclusions

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

Structuring successful interventions in employee health programs

This literature review explored common characteristics of successful health promotion interventions that have produced positive outcomes for the diverse populations studied. Health education interventions delivered in structured environments with quarterly monitoring produced the most positive outcomes. Interventions delivered to employees in a "team" format were as successful as interventions delivered one on one. Single disease- or health behavior-focused interventions were more successful than multifocused interventions. Review findings indicate that academic or consultant researchers may lend expertise to research methods and informed consent as employers create health promotion programs they wish to evaluate. Employers may find benefits in conducting health-related studies developed through partnerships or collaborations with academic researchers.

Do long workhours impact health, safety, and productivity at a heavy manufacturer?

OBJECTIVES

To test the health, safety, and productivity effects of long workhours.

METHODS

Secondary analyses of a longitudinal employee panel (n = 2746). Average hours worked during spring 2001 were assessed relative to health, safety, and productivity outcomes spanning summer 2001 through spring 2002.

RESULTS

Employees working overtime were no more likely to incur adverse physical or mental health, presenteeism, or disability outcomes. Those working 60+ hours were more likely to report new injuries and diagnoses, but these effects were overwhelmed by prior health, demographics, and compensation type.

CONCLUSIONS

Much previous work has suggested that long workhours generate a wide range of adverse outcomes across the employee continuum. This study found no evidence for pervasive workhour effects. Rather, long workhours--especially weekly schedules at the 60 hour or above mark--can lead to problems in certain areas of health and safety. More research is needed that tests group differences across segmented characteristics (eg, poor versus good health) but keeps workhour impact in perspective.

The Burden of Pain on Employee Health and Productivity at a Major Provider of Business Services

OBJECTIVE

The objective of this study was to examine the burden of pain on employee health and productivity at a Fortune 100 company headquartered in the northeastern United States to prioritize target areas for reducing this burden.

METHODS

An electronic survey was conducted in late 2004, which produced a reasonably representative national sample of 1039 active employee respondents.

RESULTS

A total of 28.6% of respondents met the study definition for pain. Pain was linked to: 1) drops of more than 45% and 23%, respectively, in Overall Physical and Mental Health; 2) a fivefold increase in health-induced limitations in work performance; and 3) nearly three and two thirds workdays lost to presenteeism and absenteeism over a 4-week period. Afflicted workers displayed considerable room for improvement in their capacity for pain control and management.

CONCLUSIONS

The prevalence of pain and its impact on those with the condition combine to make it an area of much opportunity for improving workforce health and productivity. Musculoskeletal diseases offer a promising initial target for corporate intervention.

Validating self-reported measures of productivity at work: a case for their credibility in a heavy manufacturing setting

The extent to which employee responses to productivity surveys assess what they are intended to assess has become a pivotal issue for employers and providers. Much work is now being devoted to the validity and reliability of these self-reports. Such issues will likely be resolved only over the long term. In the interim, the skepticism of business decision-makers who are unfamiliar with survey techniques needs to be addressed. This article taps the widespread acceptance that administrative adverse events have gained as indicators of productivity loss to address this issue. Joint analyses of adverse event measures and productivity self-reports on employees at International Truck and Engine Corporation are conducted to test 2 types of criterion validity: 1) concurrent validity; do prior/concurrent adverse events associate with self-reports as logic and common sense dictate? and 2) predictive validity; do self-reports distinguish the risk of subsequent adverse events? Self-reports are found to perform well in both sets of tests. The results are explored in light of: 1) concerns that users have with respect to how self-reports are now being applied, and 2) ways in which self-reports serve as a cornerstone for 3 articles that follow in this issue.

Using self-report and adverse event measures to track health's impact on productivity in known groups

The use of survey data to measure and monitor health and productivity differences between groups is an issue of increasing importance. This article examines the capacity of productivity self-reports (derived from surveys) and adverse event measures (derived from administrative sources) to differentiate groups with a priori known characteristics. A replication strategy is used to test the contributions that productivity self-reports make, alone as well as above and beyond measures of adverse events, to the discrimination of 5 pairs of groups classified by clinical, job type, and demographic criteria. These tests are conducted on representative samples of the active, largely blue-collar employee population at International Truck and Engine Corporation. The results show that both productivity self-reports and adverse event measures differentiate and track known groups. Even in the presence of highly significant effects from adverse event measures, self-reports improve the assessment of productivity. We conclude that: 1) although the joint use of self-reports and adverse event measures is the better approach, practitioners can use self-reports with the expectation that this method will track group differences in health and productivity when adverse event measures are not available; and 2) survey self-reports make unique and independent contributions when adverse events measures are used.