Opportunities to Improve Health Equity for Employees in Low-Wage Industries in the United States

This review describes employees working in low-wage industries in the United States, their health risks, and their access to health promotion and other health-related resources through their employers. We use publicly available datasets to illustrate how low-wage jobs affect employees' social determinants of health, health risk behaviors, and chronic conditions. We also discuss how the COVID-19 pandemic has shifted these employees' and employers' health-related priorities and work settings. We describe employees' access to health supports through federal programs and their employers and the potential ways in which low-wage employers could support employee health and well-being. We close with a brief research and practice agenda to improve health equity for employees in low-wage industries. The goal of this review is to help practitioners and researchers in workplace health promotion, occupational health, and public health reach employees and employers in low-wage industries with interventions that address employees' health risks and employees' and employers' health priorities.

A Qualitative Analysis of Workers Perceptions on the Role of Management in Promoting Health Behavior, Informed by the COM-B Model

BACKGROUND

The primary objective of this study was to explore the viewpoints held by employees at a pharmaceutical manufacturing workplace in a middle-income country regarding management's role in promoting health behaviors in the workplace.

METHODS

This study used transcripts of focus group discussion from an original study that investigated employee perceptions of factors associated with healthy behaviors among South African pharmaceutical manufacturing factory workers.

RESULTS

Participants felt that workplace managers could improve capability through health promotion strategies, supportive leadership, and promoting a culture of health. They could provide opportunity through employee engagement programs and resources, and physical activity opportunities were specifically identified.

CONCLUSIONS

This study demonstrates that managers in a middle-income country have the potential to contribute to workplace health in a range of ways that include addressing capability, opportunity, and motivation of their workers.

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation

BACKGROUND

There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH.

METHODS

This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation.

RESULTS

Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation.

CONCLUSIONS

As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.

The Role of Wellness Climate in Small Business Health Promotion and Employee Wellbeing

Wellness involves physical, emotional, behavioral, social, and spiritual dimensions. A climate for wellness exists at both the psychological and organizational levels, consisting of individual and shared perceptions of policies, structures, and managerial behavior that support or promote employee wellbeing. This study explored the associations between psychological and organizational wellness climate and the effectiveness of a team health promotion training on employees' perceived physical and mental wellbeing and substance use. Employees from 45 small businesses completed self-report measures of wellness climate, wellbeing, positive unwinding behavior, work-family conflict, job stress, drug use, and alcohol use, assessed before, and one and six months after, attending either of two types of onsite health promotion training. Team Awareness training targeted improvements in the social climate at work. Healthy Choices training targeted individual health behavior. A control group did not receive training until after the study. Businesses were randomly assigned to conditions and data were analyzed using multi-level modeling. Models that included wellness climate as a mediator fit the data significantly better than models without climate as a mediator. Team Awareness participants showed greater improvements in wellness climate and wellbeing compared to the control group. Healthy Choices participants showed no changes in climate and no mediation effects of climate. Health promotion efforts may be enhanced by including wellness climate as a target in program design at multiple levels.

From sense of competence to work–life and life–work enhancements of medical doctors: Sen’s capability approach

Purpose

Drawing upon the capability approach, this study aims to investigate the impact of sense of competence on work–life and life–work enhancements. It also examines the mediating roles of mindfulness and flow at work in the above relationships.

Design/methodology/approach

A sample of 254 medical doctors in various hospitals in Vietnam was surveyed to validate the measures via confirmatory factor analysis and to test the model and hypotheses using structural equation modeling.

Findings

The results demonstrate that mindfulness and flow at work fully mediate the effects of sense of competence on both work–life and life–work enhancements, but sense of competence does not have any direct effect on both.

Originality/value

To the best of the authors’ knowledge, this study is among the first to examine the roles of sense of competence, mindfulness and flow at work in work–life and life–work enhancements, adding further insight into the literature on work–life balance. It also offers evidence for the capacity approach in explaining work–life and life–work enhancements in an emerging market, Vietnam.

The impact of benevolent human resource management attributions on employees’ general work stress, with the mediating influence of gratitude

Workplace stress can cause serious physical and mental illness and result in billions of dollars in lost productivity every year. Researchers have called for the development of frameworks through which Human Resource Management (HRM) practices can reduce employee stress. Building on HRM attribution theory, this study builds a framework based on benevolent HRM attributions. Benevolent HRM attributions are employee beliefs that their management has enacted HRM practices to support their performance ( performance HRM attributions) and improve their well-being ( well-being HRM attributions). This study examined if both benevolent HRM attributions engender employee gratitude, which in turn may reduce their general job stress levels. Respondents of the study were chosen from the telecom sector of Pakistan as they operate in a high stress inducing environment. The theoretically based causal associations were examined by employing the structural equation modeling (SEM) method. The results confirmed the hypotheses and also showed that both benevolent HRM attributions reduce employees’ job stress with the mediating influence of gratitude. The theoretical and practical implications of these findings are discussed as well.

The Relationship between Work, Health and Job Performance for a Sustainable Working Life: A Case Study on Older Manual Employees in an Italian Steel Factory

BACKGROUND

Supporting and retaining older workers has become a strategic management goal for companies, considering the ageing of the workforce and the prolongation of working lives. The relationship between health and work is especially crucial for older workers with manual tasks, considering the impact of long-standing health impairments in older age. Although different studies investigated the relationship between work ability and job performance, few studies have analysed the impact of workers' capability to balance between health and work demands, including managerial and organisational support (work-health balance). Considering health as a dynamic balance between work and health demands influenced by both individual and environmental factors, we assess the mediator role of work-health balance in the relation between work ability and job performance, both self-reported and assessed by the supervisor.

METHODS

The study utilises data from a case study of 156 manual workers, who were 50 years old or older and employed in a steel company in Italy. Data were collected inside the company as an organiational initiative to support age diversity.

RESULTS

The findings show that work-health balance partially mediates the relationship between work ability and self-rated job performance, while it does not mediate the relationship with job performance as rated by the supervisor. Supervisor-rated job performance is positively associated with work ability, while it decreases with the increasing perceived incompatibility between work and health.

CONCLUSION

A perceived balance between health and work is a strategic factor in increasing manual older workers' job performance. For older workers, not only the perceived capability to work is important but also the organisational health climate and supervisor's support. More studies are needed to verify if managers overlook the importance of health climate and support, as strategic elements that can foster performance for older employees.

Factors affecting the physical activity of healthcare workers of Iran University of Medical Sciences: a qualitative study

Background

Low physical activity in adulthood is a major public health challenge. The majority of adults spend many hours each week at work, and workplace thus becomes a suitable location in which to promote health and implement physical activity programs. This qualitative study was conducted to identify the barriers and facilitators of worksite physical activity from the perspective of the employees of Iran University of Medical Sciences.

Methods

In this qualitative thematic analysis, five focus group discussions were held with the participation of 68 staff members of Iran University of Medical Sciences who had been selected by purposive sampling with maximum diversity.

Results

The analysis of the data led to the identification of three general themes, including challenges and barriers, strategies, and incentives (facilitators). The four main categories of challenges and barriers included policy-making and legislation, organizational factors, structural factors, and personal factors. Most barriers identified by the participants were placed in the personal factors and organizational factors categories. The strategies for increasing physical activity were identified in the following three categories: Policy-making and legislation, organizational factors, and environmental factors. The majority of the strategies proposed were placed in the organizational factors and policy-making and legislation categories.

Conclusions

Increasing physical activity in the workplace as a strategy for the general promotion of physical activity in people requires interventions in different areas, especially with regard to organizational factors and policy-making and legislation.

Partnerships to expand worksite wellness programs - A qualitative analysis of state and local health department perspectives

Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the U. S. Because the central mission of state and local health departments (HDs) is to protect, promote, and improve population health, these agencies are well-positioned to address risk behaviors for chronic disease. HD-employer partnerships could enhance worksite wellness programming, but few studies have explored this topic. Building upon previously published findings, the purpose of this qualitative study was to describe the context and environment for HDs' delivery of worksite wellness programs, including interest, barriers, facilitators, and decision-making processes. We conducted 12 interviews with directors of state chronic disease programs, 21 interviews with local directors, and three focus groups with local staff. We performed a thematic analysis of the data. Key themes include the following: (1) worksite wellness programs delivered by HDs were diverse in topic and scope and delivered both internally (at the HD for their agency) and externally (for other employers); (2) decisions made about chronic disease prevention were largely driven by funding priorities, with federal, state, and local entities playing roles in the decision-making process; and (3) HDs expressed potential interest in worksite wellness program delivery, dependent upon staff capacity, available funding, and employer buy-in. Our results suggest that funding should be increased for and reallocated towards chronic disease prevention, including worksite wellness. To overcome HD barriers to program delivery, key funders and stakeholders should prioritize and communicate the importance of worksite wellness.

How Managers Perceive and (Do Not) Participate in Health Promotion Measures-Results from a Cross-Sectional Mixed-Methods Survey in a Large ICT Company

Managers often face stress and high work demands. Yet they have received limited attention as targets of workplace health promotion measures (HPMs). This study’s primary objective (1) is to examine managers’ self-reported participation in HPMs and factors associated with HPM participation. The secondary objective (2) is to examine managers’ perceptions of their working conditions. A cross-sectional mixed-methods online survey was conducted with a nonrandom sample of 179 managers in a large German ICT company. Stepwise logistic regression and qualitative content analysis were used for data analysis. Quantitative findings revealed that 57.9% of managers had not participated in HPMs yet. “Workload relief through digital tools” resulted as a significant predictor of managers’ previous HPM participation (OR: 2.84, 95% CI: 1.42–5.66). In qualitative findings, workload, time, lack of knowledge, and lack of demand were reported as participation barriers (1). Managers reported that work facility traits, workload, social support, and corporate culture should be improved to make their working conditions more health-promoting (2). These findings suggest that providing adequate organizational working conditions may help improve managers’ HPM participation rates and their perception of health-promoting work.

Development and Pilot Test of an Online Training to Engage Managers to Support Workplace Wellness

OBJECTIVE

To contribute to a broader understanding of effective implementation strategies to help managers engage employees in workplace wellness.

METHODS

We beta-tested an online training at four Washington state agencies (two test, two control). We administered a post-training evaluation, re-administered an online manager survey and conducted additional interviews with wellness leads.

RESULTS

Training participation rate was high. The two test agencies experienced a significant increase in the percentage of managers who: agreed that they received training on employee wellness; agreed their agency's culture supports employee wellness; and encouraged their employees to participate in wellness activities. Approximately 80% of managers who received the training agreed they could apply information learned to support employee wellness.

CONCLUSIONS

If proven effective, the training could be administered at a low cost and disseminated to improve employee health.

Implementing practices focused on workplace health and psychological wellbeing: A systematic review

RATIONALE

Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs.

OBJECTIVE

We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Doing so provides a platform for future theoretical development.

METHODS

We reviewed 74 separate studies that assessed the implementation of WHWPs and their effects on psychological health or psychological wellbeing. Most studies were from advanced industrial Western democracies (71). Intervention types included primary (e.g., work redesign, 37 studies; and health behavior change, 8 studies), secondary (e.g., mindfulness training, 11 studies), tertiary (e.g., focused on rehabilitation, 9 studies), and multifocal (e.g., including components of primary and secondary, 9 studies).

RESULTS

Tangible changes preceded improvements in health and wellbeing, indicating intervention success cannot be attributed to non-specific factors. Some interventions had beneficial effects through mechanisms not planned as part of the intervention. Three factors were associated with successful WHWP implementation: continuation, learning, and effective governance.

CONCLUSIONS

The review indicates future research could focus on how organizations manage conflict between WHWP implementation and existing organizational processes, and the dynamic nature of organizational contexts that affect and are affected by WHWP implementation. This systematic review is registered [PROSPERO: the International Prospective Register of Systematic Reviews ID: CRD42019119656].

The Workplace Support for Health Scale: Reliability and Validity of a Brief Scale to Measure Employee Perceptions of Wellness

PURPOSE

To examine the reliability and validity of a brief measure (the Workplace Support for Health [WSH] scale) to assess employees' perceived support for a healthy lifestyle.

DESIGN

Repeated cross-sectional surveys.

SETTING

We collected employer- and employee-level survey data from small, low-wage workplaces in King County, WA enrolled in a randomized controlled trial.

SAMPLE

We analyzed data from 68 workplaces that had 2,820 and 2,640 employees complete surveys at baseline and 15 months, respectively.

MEASURES

The WSH scale consisted of five items. To assess validity, we examined associations between the WSH scale and employer implementation of evidence-based interventions for health promotion, employee self-rated health, and job satisfaction.

ANALYSIS

We performed an exploratory factor analysis to assess the unidimensionality of the WSH scale items, and produced Cronbach's alpha coefficients to examine scale reliability. We ran regression models using generalized estimating equations to examine validity.

RESULTS

The factor analysis indicated one factor, which accounted for 59% of the total variance in the workplace support for health items. The scale had good reliability at baseline (α = 0.82) and 15 months (α = 0.83). Employer evidence-based intervention implementation was positively associated with WSH. WSH was also associated with higher self-rated health and job satisfaction. These associations indicate good concurrent validity.

CONCLUSION

The WSH scale is a reliable and valid measure of perceived workplace support for health. Employers can use the scale to identify gaps in support and create a plan for improvement.

Towards a HR Framework for Developing a Health-Promoting Performance Culture at Work: A Norwegian Health Care Management Case Study

The Norwegian Institute of Public Health (NIPH) states that Norway faces several major health challenges. Sick leave is at 6% and costs employers approximately EUR 1.75 billion annually. The NIPH proposes, with the support of the Public Health Act and the national strategy HealthCare21, that preventive measures should be developed to address negative lifestyle factors in order to decrease the number of new cases in the related disease groups (e.g., stroke, high blood pressure, type 2 diabetes, osteoporosis, obesity). The purpose of this article is to answer why and how organisations should develop a health-promoting performance culture and to provide a conceptual model displaying the importance of this type of culture for organisational performance. To boost the national health standard as a consequence of employee physical activity at work, I suggest additional occupational safety and health (OSH) directives. Based on cross-disciplinary theorizing, I propose a definition of a health-promoting performance culture. This kind of culture consists of dimensions such as health objectives, shared health values, supportive health environment, goal-oriented and value-based behaviour of leaders and employees, and a winning mindset. In addition, the article underscores the importance of related individual HR drivers like fun at work, engagement, physical and mental health for increasing organisational performance. The company cases used in this paper, Schibsted, Gjensidige, Findus and Wilhelmsen, and findings from five in-depth interviews, indicate that health-promoting activities are the result of either an HR strategy or individuals’ initiative and voluntariness among the companies’ sports enthusiasts. The case of Findus exemplifies an ongoing development toward a health-promoting performance culture and the importance of leaders’ participation. The findings support several elements of the conceptual model showing the relations between a health-promoting performance culture, individual HR drivers and organisational performance. A framework for developing a health-promoting performance culture in practice is presented.

Size Matters: A Latent Class Analysis of Workplace Health Promotion Knowledge, Attitudes, Practices and Likelihood of Action in Small Workplaces

Workplace health programs (WHPs) have been shown to improve employee health behaviours and outcomes, increase productivity, and decrease work-related costs over time. Nonetheless, organizational characteristics, including size, prevent certain workplaces from implementing these programs. Past research has examined the differences between small and large organizations. However, these studies have typically used a cut-off better suited to large countries such as the USA. Generalizing such studies to countries that differ based on population size, scale of economies, and health systems is problematic. We investigated differences in WHP knowledge, attitudes, and practices between organizations with under 20 employees, 20–99 employees, and more than 100 employees. In 2017–2018, a random sample of employers from 528 workplaces in Alberta, Canada, were contacted for participation in a cross-sectional survey. Latent Class Analysis (LCA) was used to identify underlying response pattern and to group clusters of similar responses to categorical variables focused on WHP knowledge, attitudes, practices and likelihood of action. Compared to large organizations, organizations with fewer than 20 employees were more likely to be members of the Medium–Low Knowledge of WHP latent class (p = 0.01), the Low Practices for WHP latent class (p < 0.001), and more likely to be members of Low Likelihood of Action in place latent class (p = 0.033). While the majority of workplaces, regardless of size, recognized the importance and benefits of workplace health, capacity challenges limited small employers’ ability to plan and implement WHP programs. The differences in capacity to implement WHP in small organizations are masked in the absence of a meaningful cut-off that reflects the legal and demographic reality of the region of study.