A review of health-related outcomes of multi-component worksite health promotion programs

Physical activity interventions in workplace health promotion: objectives, related outcomes, and consideration of the setting-a scoping review of reviews

Background

The workplace is a recognized setting for promoting health among adults, and physical activity (PA) interventions are an integral part of workplace health promotion (WHP).

Objectives

The present review of reviews aims to provide an overview of the main objectives and related outcomes addressed in WHP-related PA interventions, as well as the setting-specific aspects considered in the research field.

Methods

A scoping review of reviews was conducted. Reviews were included if they were peer-reviewed, written in English, and focused on PA interventions conducted in the context of WHP. A literature search was conducted in PubMed, SPORTDiscus, and Web of Science. Reviews were included if they had been published after the year 2000. Information on the following dimensions was extracted: author, region, number of primary studies included, target group(s), PA interventions included, main objective(s), related outcomes, and setting-specific aspects.

Results

A total of 17 reviews were included. Six reviews aimed at solely identifying the effectiveness of promoting daily PA and reducing sedentary behavior. Eleven reviews showed a combined approach considering physical activity behavior and/or health and job-related outcomes. Outcomes in the primary studies were heterogeneous. None of the reviews had an explicit definition of WHP and setting-specific information was very general and sparse. The reported setting-specific information was referred to the general importance of the workplace setting, the specific importance as an access route to target groups, and implementation aspects. Regarding the additional characteristics of the reviews, the selection of primary studies was restricted to a specific region in 2 of the 17 reviews in advance. Three reviews restricted the target group (sedentary workers, women, desk-based workers), while eleven reviews included working adults in general and, three reviews gave no information about the target group. Eleven intervention approaches of the reviews were behaviorally oriented, two focused solely on environmental interventions, and four reviews can be attributed to a combined approach considering behavioral and environmental interventions.

Conclusion

For sustainable future developments, the present results indicate a strong need for conceptual consolidation of WHP in the research field of PA interventions. Therefore, both WHP and health-related PA interventions need to take a comprehensive approach comprising behavioral and environmental interventions.

Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study

Background

Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population.

Methods

We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders.

Results

The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month.

Conclusions

Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.

Financial Incentives and Employer-Sponsored Health Activities

OBJECTIVE

To understand how employer-sponsored incentives and participant-level characteristics drive health activity engagement.

METHODS

Multivariable hierarchical logistic regression models evaluated 283,365 individuals eligible for incentives through health savings accounts, health reimbursement accounts, health incentive accounts, gift cards, and other means, and estimated log odds of (1) completing a health survey; (2) participating in a biometric screening; (3) attaining a biometric target; (4) participating in a weight loss program; undergoing (5) breast, (6) colorectal, or (7) cervical cancer screening.

RESULTS

Larger incentives were associated with higher odds of participating in biometric screenings only (2% higher for every $25). Obesity, tobacco use, and lack of primary care were associated with lower odds.

CONCLUSION

Employers may wish to tailor incentive plans to the unique characteristics and needs of their populations to better drive participation in sponsored health activities.

Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support

Purpose:

This study tested relationships between health and well-being best practices and 3 types of outcomes.

Design:

A cross-sectional design used data from the HERO Scorecard Benchmark Database.

Setting:

Data were voluntarily provided by employers who submitted web-based survey responses.

Sample:

Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017.

Measures:

Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support.

Analysis:

Three structural equation models were developed to investigate the relationships among study variables.

Results:

Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index > 0.96). Organizational and leadership support was the strongest predictor ( P < .05) of participation (n = 276 organizations), impact (n = 160 organizations), and perceived organizational support (n = 143 organizations). Incentives predicted participation in health assessment and biometric screening ( P < .05). Program comprehensiveness and program integration were not significant predictors ( P > .05) in any of the models.

Conclusion:

Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data.

Messaging, monetary incentives, and participation in wellness programs

Purpose

Many companies in the USA have corporate wellness programs but are having trouble encouraging employees to take part in these programs. Even with monetary incentives, many employees do not join. The purpose of this paper is to consider whether timely reminders combined with monetary incentives improve participation in health benefit programs.

Design/methodology/approach

Employees of a large manufacturing company across multiple facilities were encouraged to enroll in a messaging service. Once a week, members received an SMS or e-mail reminder to complete a Health Risk Assessment (HRA) and Health Action Plan (HAP). The authors segmented employees based on prior year health insurance plan choice and HRA participation to analyze current HRA and HAP completion, with and without intervention.

Findings

The intervention increased completion rates 6 percent for subgroups that completed the HRA in the prior year and 34–37 percent for those that did not.

Practical implications

Corporate wellness programs should develop good communication channels with employees. The effectiveness of such programs will depend also on employee engagement.

Originality/value

With better communication, companies could raise participation in corporate wellness programmes and potentially reduce some of the monetary incentives that they currently offer.

Nepal Pioneer Worksite Intervention Study to lower cardio-metabolic risk factors: design and protocol

BACKGROUND

To increase cardiovascular disease prevention efforts, worksite interventions can promote healthy food choices, facilitate health education, increase physical activity and provide social support. This pioneer study will measure the effectiveness of a cafeteria and a behavioral intervention on cardio-metabolic risk in a worksite in Nepal.

METHODS

The Nepal Pioneer Worksite Intervention Study is a two-step intervention study conducted in Dhulikhel Hospital in eastern Nepal. In the first step, we will assess the effectiveness of a 6-month cafeteria intervention on cardio-metabolic risk using a pre-post design. In the second step, we will conduct a 6-month, open-masked, two-arm randomized trial by allocating half of the participants to an individual behavioral intervention based on the 'diabetes prevention program' for the prevention of cardio-metabolic risk. We will recruit 366 full time employees with elevated blood pressure, fasting blood sugar, or glycosylated haemoglobin (HbA1c). At baseline, we will measure their demographic variables, lifestyle factors, anthropometry, fasting blood sugar, HbA1c,and lipid profiles. We will measure cardio-metabolic outcomes at 6 months, 12 months, and 18 months. At 12 months, we will compare the proportion of participants who have attained two or more cardio-metabolic risk factor reduction goals (HbA1c decrease ≥0.5%; systolic blood pressure decrease ≥5 mmHg; or triglycerides decrease ≥10 mg/dL) during the cafeteria intervention period and the control period using generalized estimating equations. At 18 months, we will compare the proportion from the 'cafeteria only arm' to the 'cafeteria and behavior arm' for the same outcome using a chi-square test.

DISCUSSION

This pioneer study will estimate the effect of environmental-level changes on lowering cardio-metabolic risks; and added benefit of an individual-level dietary intervention. If the study demonstrates a significant effect, a scaled up approach could produce an important reduction in cardiovascular disease burden through environmental and individual level prevention programs in Nepal and similar worksites worldwide.

TRIAL REGISTRATION

The trial was retrospectively registered on clincaltrials.gov (Identification Member: NCT03447340 ; Date of Registration: February 27, 2018).

Does Availability of Worksite Supports for Physical Activity Differ by Industry and Occupation?

PURPOSE

To explore combinations of worksite supports (WSS) for physical activity (PA) that may assist employees in meeting PA recommendations and to investigate how availability of WSS differs across industries and occupations.

DESIGN

Cross-sectional.

SETTING

Several Missouri metropolitan areas.

PARTICIPANTS

Adults employed >20 h/wk outside the home.

MEASURES

Survey utilized existing self-reported measures (eg, presence of WSS for PA) and the International Physical Activity Questionnaire.

ANALYSIS

Logistic regression was conducted for 2 outcome variables: leisure and transportation PA. Independent variables included 16 WSS. Of particular interest were interaction effects between WSS variables. Analyses were stratified by 5 occupation and 7 industry types.

RESULTS

Overall, 2013 people completed the survey (46% response rate). Often, availability of 1 WSS did not increase the likelihood of meeting PA recommendations, but several pairs of WSS did. For example, in business occupations, the odds of meeting PA recommendations through transportation PA increased when employees had access to showers and incentives to bike/walk (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.16-2.22); showers and maps (OR = 1.25; 1.02-1.55); maps and incentives to bike/walk (OR = 1.48; 1.04-2.12).

CONCLUSION

Various combinations of WSS may increase the likelihood that employees will meet PA recommendations. Many are of low or no cost, including flexible time for exercise and maps of worksite-adjacent walk/bike routes. Findings may be instructive for employers seeking to improve employee health through worksite PA.

Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity

Background

This study examined whether specific worksite supports for physical activity (PA) were associated with total and domain-specific PA.

Methods

A cross-sectional, telephone-based study was conducted in four Missouri, USA, metropolitan areas in 2012 and 2013. Outcome variables included total PA and sub-domains (leisure, work, travel) measured using the International Physical Activity Questionnaire. Logistic regression determined odds of meeting PA recommendations, given access to and use of 18 unique PA worksite supports. A subsample of 119 participants also wore hip accelerometry for seven consecutive days and maintained a wear-time diary. Access to worksite supports were associated with odds of meeting objective moderate and vigorous (MV) PA above 150 min per week.

Results

Among 2013 survey participants, meeting PA recommendations while performing work-related tasks was significantly associated with several supports (e.g., walking maps, stair prompts), as was meeting recommendations during travel (e.g., flextime for PA, incentives for public transportation, walking/bicycling to work). Access to 11 worksite supports increased odds of meeting PA recommendations through leisure-time PA; five supports were associated with total PA. There were significant differences between access to and use of supports. Using objective MVPA, access to worksite challenges and bike storage were significantly associated with five and three times greater odds of meeting 150 min of MVPA per week, respectively.

Conclusions

Worksite wellness plans are increasing across the US and employers are eager for evidence-based supports for increasing PA. This study provides insights into the utility of multiple worksite supports for PA to increase odds that employees meet PA recommendations.

The Efficacy of Stage-Matched and Standard Public Health Materials for Promoting Physical Activity in the Workplace: The Physical Activity Workplace Study (PAWS)

Purpose.

To compare the effects of stage-matched and standard print materials for physical activity (PA) change.

Design.

Participants were randomized into (1) a stage-matched intervention group (n = 165), (2) a standard intervention group (n = 176), or (3) a no-contact control group (n = 166). The stage-matched and standard intervention groups both received materials at baseline, 3 months, and 6 months. Assessments of all three groups were conducted at baseline, 6, and 12 months.

Setting.

Canadian worksites.

Subjects.

Employees (N = 507).

Interventions.

Five motivationally targeted booklets were developed for the stage-matched group. The standard group received Canada's Physical Activity Guide and handbook.

Measures.

The main dependent variable was PA, expressed as metabolic equivalent (MET) minutes and measured using the Godin Leisure-Time Exercise Questionnaire. Demographic characteristics and stages of change for PA were also assessed.

Results.

At 12 months mean weekly MET minutes for combined moderate and vigorous activity increased from baseline by 223, 67, and 78 for the stage-matched, standard, and control groups, respectively; however, differences were not significant (p > .05). Women in the stage-matched group over the 12-month period significantly increased their activity by 327 weekly MET minutes whereas the standard and control groups declined their activity (F = 3.01, p < .05).

Conclusion.

PA stage-matched materials delivered in the workplace are efficacious for women but not men. Future interventions should explore the use of these intervention materials in conjunction with multilevel strategies, and particular attention should be paid to possible gender differences.

International Collaboration in Health Promotion and Disease Management: Implications of U.S. Health Promotion Efforts on Japan's Health Care System

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.

Competing discourses of workplace health

This article presents an analysis of workplace health programme discourses within an international information technology company. Discourse refers to a system of statements that share a common force and coherence and which are socially constitutive. The representation of entities such as workplace health can be subject to competition between discourses. A critical discourse analysis was undertaken on semi-structured interviews, participant observation and workplace health programme documents. Two competing discourses were identified: health as safety and health as lifestyle. Each discourse is described and shown to both implicitly and explicitly define health within this particular workplace. Lifestyle discourse encouraged moves towards linking of the employees' working and private lives while safety discourse defined health in the relationship between workers and their physical environment. Competition between discourses both constricts and opens spaces for alternative understandings of health in the workplace. The implications of this competition for workplace health policy and practice are discussed.

Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review

Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.

Cross-cultural adaptation of the CDC Worksite Health ScoreCard questionnaire into Portuguese

OBJECTIVE

Despite the progress in the implementation of health promotion programs in the workplace, there are no questionnaires in Brazil to assess the scope of health promotion interventions adopted and their scientific basis. This study aimed to translate into Brazilian Portuguese and culturally adapt the CDC Worksite Health ScoreCard (HSC) questionnaire.

METHOD

The HSC has 100 questions grouped into twelve domains. The steps are as follows: translation, reconciliation, back-translation, review by expert panel, pretesting, and final revision. The convenience sample included 27 individuals from health insurance providers and companies of various sizes, types and industries in São Paulo. Data were analyzed using descriptive statistics.

RESULTS

The average age of the sample was 38 years, most of the subjects were female (21 of 27), and were responsible for programs to promote health in these workplaces. Most questions were above the minimum value of understanding set at 90%. The participants found the questionnaire very useful to determine the extent of existing health promotion programs and to pinpoint areas that could be developed.

CONCLUSION

The Brazilian Portuguese version of the HSC questionnaire may be a valid measure and useful to assess the degree of implementation of health promotion interventions based on evidence in local health organizations.

Participatory action research in corrections: The HITEC 2 program

BACKGROUND

HITEC 2 (Health Improvement through Employee Control 2) is the follow-up to HITEC, a participatory action research (PAR) program that integrates health and work conditions interventions designed by the workforce. HITEC 2 compares intervention programs between two correctional sites, one using a pure workforce level design team and the other using a more structured and time delineated labor-management kaizen effectiveness team.

METHODS

HITEC 2 utilizes a seven step participatory Intervention Design and Analysis Scorecard (IDEAS) for planning interventions. Consistent with PAR, process and intervention efficacy measures are developed and administered through workforce representation.

RESULTS

Participation levels, robustness of participatory structures and sophistication of interventions have increased at each measured interval. Health comparisons between 2008 and 2013 showed increased hypertension, static weight maintenance, and increased 'readiness to change'.

CONCLUSIONS

The PAR approaches are robust and sustained. Their long-term effectiveness in this population is not yet clear.

Critical connections: health and academics

BACKGROUND

While it is a national priority to support the health and education of students, these sectors must better align, integrate, and collaborate to achieve this priority. This article summarizes the literature on the connection between health and academic achievement using the Whole School, Whole Community, and Whole Child (WSCC) framework as a way to address health-related barriers to learning.

METHODS

A literature review was conducted on the association between student health and academic achievement.

RESULTS

Most of the evidence examined the association between student health behaviors and academic achievement, with physical activity having the most published studies and consistent findings. The evidence supports the need for school health services by demonstrating the association between chronic conditions and decreased achievement. Safe and positive school environments were associated with improved health behaviors and achievement. Engaging families and community members in schools also had a positive effect on students' health and achievement.

CONCLUSIONS

Schools can improve the health and learning of students by supporting opportunities to learn about and practice healthy behaviors, providing school health services, creating safe and positive school environments, and engaging families and community. This evidence supports WSCC as a potential framework for achieving national educational and health goals.

Integrated health programs, health outcomes, and return on investment: measuring workplace health promotion and integrated program effectiveness

OBJECTIVE

To explore return on investment (ROI) in workplace health promotion studies.

METHODS

Studies with high ROI attribution for workplace health promotion were reanalyzed using standardized measures. Key variables included intervention duration, sector and population size, annualized cost, and health outcomes.

RESULTS

ROI was often overestimated. Programs with the highest reported ROI were concentrated in large corporations, where cognitive programs incurred low per person costs. Ten of the 12 studies involved individualized health promotion only, and did not engage work organizational modification or integration with occupational health. Some effective health interventions were discounted because they were not easily monetized.

CONCLUSIONS

ROI, an investment metric, amplifies short-term labor-related effects and discounts longer-term chronic disease prevention.

The steps to health employee weight management randomized control trial: rationale, design and baseline characteristics

BACKGROUND

The workplace can be an important setting for addressing obesity. An increasing number of employers offer weight management programs.

PURPOSE

Present the design, rationale and baseline characteristics of the Steps to Health study (STH), a randomized trial to evaluate the effectiveness of two preexisting employee weight management programs offered at Duke University and Medical Center.

METHODS

550 obese (BMI ≥30) employee volunteers were randomized 1:1 to two programs. Baseline data, collected between January 2011 and July 2012, included height/weight, accelerometry, workplace injuries, health care utilization, and questionnaires querying socio-cognitive factors, perceptions of health climate, physical activity, and dietary intake. In secondary analyses participants in the two programs will also be compared to a non-randomized observational control group of obese employees.

RESULTS

At baseline, the mean age was 45 years, 83% were female, 41% white, and 53% black. Mean BMI was 37.2. Participants consumed a mean of 2.37 servings of fruits and vegetables per day (in the past week), participated in 11.5 min of moderate-to-vigorous physical activity, and spent 620 min being sedentary.

CONCLUSION

STH addresses the need for evaluation of worksite interventions to promote healthy weight. In addition to having direct positive effects on workers' health, worksite programs have the potential to increase productivity and reduce health care costs.

Making Healthy Behaviors the Easy Choice for Employees

As employers look for ways to reduce rising health care costs, worksite health promotion interventions are increasingly being used to improve employee health behaviors. An alternative approach to traditional worksite health promotion programs is the implementation of environmental and/or policy changes to encourage employees to adopt healthier behaviors. This review examines the evidence for the effectiveness of worksite health promotion programs using environmental and/or policy changes either alone or in combination with individually focused health behavior change strategies. A review of the relevant literature, published between 1995 and 2010, identified 27 studies that met all inclusion criteria. Limited evidence was found for the effectiveness of environmental and/or policy changes alone ( n = 11) to change employee behavior, but more promising results were identified with multicomponent interventions ( n = 16). There is a strong need for improvement in the design and evaluation of future health promotion programs focusing solely on environmental and/or policy changes at the worksite.

The impact of alternative incentive schemes on completion of health risk assessments

PURPOSE

The biggest challenge for corporate wellness initiatives is low rates of employee participation. We test whether a behavioral economic approach to incentive design (i.e., a lottery) is more effective than a direct economic payment of equivalent monetary value (i.e., a grocery gift certificate) in encouraging employees to complete health risk assessments (HRAs).

DESIGN

Employees were assigned to one of three arms. Assignment to a treatment arm versus the nontreatment arm was determined by management. Assignment to an arm among those eligible for treatment was randomized by office.

SETTING

A large health care management and information technology consulting company.

PATIENTS

A total of 1299 employees across 14 offices participated.

INTERVENTION

All employees were eligible to receive $25 for completing the HRA. Those in the lottery condition were assigned to teams of four to eight people and, conditional on HRA completion, were entered into a lottery with a prize of $100 (expected value, $25) and a bonus value of an additional $25 if 80% of team members participated. Those in the grocery gift certificate condition who completed an HRA received a $25 grocery gift certificate. Those in the comparison condition received no additional incentive.

MEASURES

HRA completion rates.

ANALYSIS

Logistic regression analysis.

RESULTS

HRA completion rates were significantly higher among participations in the lottery incentive condition (64%) than in both the grocery gift certificate condition (44%) and the comparison condition (40%). Effects were larger for lower-income employees, as indicated by a significant interaction between income and the lottery incentive.

CONCLUSION

Lottery incentives that incorporate regret aversion and social pressure can provide higher impact for the same amount of money as simple economic incentives.

The ACTIVATE Study: Results from a Group-Randomized Controlled Trial Comparing a Traditional Worksite Health Promotion Program with an Activated Consumer Program

Purpose.

This study compares a traditional worksite-based health promotion program with an activated consumer program and a control program

Design.

Group randomized controlled trial with 18-month intervention.

Setting.

Two large Midwestern companies.

Subjects.

Three hundred and twenty employees (51% response).

Intervention.

The traditional health promotion intervention offered population-level campaigns on physical activity, nutrition, and stress management. The activated consumer intervention included population-level campaigns for evaluating health information, choosing a health benefits plan, and understanding the risks of not taking medications as prescribed. The personal development intervention (control group) offered information on hobbies. The interventions also offered individual-level coaching for high risk individuals in both active intervention groups.

Measures.

Health risk status, general health status, consumer activation, productivity, and the ability to evaluate health information.

Analysis.

Multivariate analyses controlled for baseline differences among the study groups.

Results.

At the population level, compared with baseline performance, the traditional health promotion intervention improved health risk status, consumer activation, and the ability to recognize reliable health websites. Compared with baseline performance, the activated consumer intervention improved consumer activation, productivity, and the ability to recognize reliable health websites. At the population level, however, only the activated consumer intervention improved any outcome more than the control group did; that outcome was consumer activation. At the individual level for high risk individuals, both traditional health coaching and activated consumer coaching positively affected health risk status and consumer activation. In addition, both coaching interventions improved participant ability to recognize a reliable health website. Consumer activation coaching also significantly improved self-reported productivity.

Conclusion.

An effective intervention can change employee health risk status and activation both at the population level and at the individual high risk level. However, program engagement at the population level was low, indicating that additional promotional strategies, such as greater use of incentives, need to be examined. Less intensive coaching can be as effective as more intensive, albeit both interventions produced modest behavior change and retention in the consumer activation arm was most difficult. Further research is needed concerning recruitment and retention methods that will enable populations to realize the full potential of activated consumerism.

Factors associated with participation in work-site wellness programs: implications for increasing willingness among rural service employees

The purpose of this study was to identify factors underlying decisions to participate in work-site wellness programs. A sample of 279 full-time workers from a service division of a rural Midwestern university completed a survey assessing demographic and job characteristics, health status and health behaviors, and Reasoned Action Approach (RAA) variables for participating in work-site wellness activities. Regression analyses identified factors associated with intention; multivariate analyses of variance compared low to high intenders on salient beliefs. In sequential regression analyses, constructs of RAA predicted intention over and above the three significant background variables of age, exercise in past month, and fruit and vegetable consumption (R (2) = .469, R (2) change = .409, p < .001). Attitude had the highest relative weight (β = .445, p < .001); perceived norm had a significant weight (β = .273, p < .001). Significant differences in beliefs were found. To increase participation, planners should design programs that provide benefits employees perceive as advantageous and ensure coworker and supervisor support.

Effects on cardiovascular disease risk of a web-based health risk assessment with tailored health advice: a follow-up study

Introduction:

A large proportion of the cardiovascular disease (CVD) burden can potentially be prevented by primary prevention programs addressing major causal risk factors. A Web-based health risk assessment (HRA) with tailored feedback for individual health promotion is a promising strategy. We evaluated the effect on CVD risk of such a program among employees of a Dutch worksite.

Methods:

We conducted a prospective follow-up study among 368 employees who voluntarily participated in a Web-based HRA program at a single Dutch worksite in 2008. The program included a multicomponent HRA through a Web-based electronic questionnaire, biometrics, and laboratory evaluation. The results were combined with health behavior change theory to generate tailored motivational and educational health advice. On request, a health counseling session with the program physician was available. Follow-up data on CVD risk were collected 1 year after initial participation. The primary outcome was a change in Framingham CVD risk at 6 months relative to baseline. We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program 6 months later.

Results:

A total of 176 employees completed follow-up measurements after a mean of 7 months. There was a graded relation between CVD risk changes and baseline risk, with a relative reduction of 17.9% (P = 0.001) in the high-risk category (baseline CVD risk ≥20%). Changes were not explained by additional health counseling, medication, or an increase in health consciousness within the company.

Conclusions:

Voluntary participation in a Web-based HRA with tailored feedback at the worksite reduced CVD risk by nearly 18% among participants at high CVD risk and by nearly 5% among all participants. Web-based HRA could improve CVD risk in similar populations. Future research should focus on the persistence of the effects underlying the CVD risk reduction.

Comparing alternative methods of targeting potential high-cost individuals for chronic condition management

OBJECTIVE

To compare the performance of predictive models based on health care claims, health risk assessment (HRA), or both in prospectively identifying high-cost individuals with chronic conditions.

METHODS

Participants included 8056 employees who completed an HRA and were enrolled in a health plan for at least 6 months during the 36-month study period. Two-stage multivariate regression identified predictors of claims cost in four age-by-gender groups.

RESULTS

All models predicted costs effectively, but the combined model performed better (R2 = 0.198 to 0.309) than either the claims-based (R2 = 0.168 to 0.263) or HRA-based model (R2 = 0.125 to 0.205).

CONCLUSION

An HRA-based predictive model appears to be a reasonable alternative to claims-based predictive models for identifying individuals for chronic condition management outreach. Where practical, a combined model offers advantages of both approaches and meaningfully increases accuracy.

The Worksite Supportive Environments for Active Living Survey: Development and Psychometric Properties

Purpose.

The purpose of this study was to develop a self-report instrument to measure perceived physical and social environmental factors in the worksite setting that are shown to influence physical activity.

Design.

Initial items were generated from a review of the literature and were sent out for peer and expert panel review. A revised questionnaire was sent to 1250 participants to determine and test the emerging factor structure.

Setting.

The instrument was tested at two worksites in the mid-South.

Participants.

Participants consisted of a random sample of regular full-time employees at the two worksites.

Measures.

Principal axis factoring with a varimax rotation was used to explore the data in the first group of participants. Confirmatory factor analysis was used to test the fit of the final model in the second group of participants. Measures used included the comparative fit index, parsimony goodness of fit index, root mean square error of approximation, and the root mean square residual.

Results.

The final analysis showed an adequate fit of the data to the hypothesized factor structure (n = 683). The instrument showed good internal consistency, temporal stability, construct reliability, and discriminant validity.

Conclusion.

The Worksite Supportive Environments for Active Living Survey is a reliable and valid tool for investigating perception of the worksite environment related to physical activity.

Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time

BACKGROUND

Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries.

METHODS

A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?"

RESULTS

The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects".

CONCLUSION

It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.

Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector

INTRODUCTION

Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards.

METHODS

A systematic review of the literature used a best evidence synthesis approach to address the general question "Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?" This was followed by an evaluation of the effectiveness of specific interventions.

RESULTS

The initial search identified 8,465 articles, for the period 1980-2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006-2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health.

CONCLUSIONS

The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.

The association between medical costs and participation in the vitality health promotion program among 948,974 members of a South African health insurance company

PURPOSE

Examine the association between the levels of participation in an incentive-based health promotion program (Vitality) and inpatient medical claims among members of a major health insurer.

DESIGN

A 1-year, cross-sectional, correlational analyses of engagement with a health promotion program and hospital claims experience (admissions costs, days in hospital, and admission rate) of members of a national private health insurer.

SETTING

Adult members of South Africa's largest national private health insurer, Discovery Health. Insured members were also eligible for voluntary membership in an insurance-linked incentivized health promotion program, Vitality.

SUBJECTS

The study sample included 948,974 adult members of the Discovery Health plan for the year 2006. Of these, 591,134 (62.3%) were also members of the Vitality health promotion program.

MEASURES

The study sample was grouped based on registration and the level of engagement with the Vitality health promotion program into the following: not registered (37.5%), registered but not engaged with any health promotion activity (21.9%), low engagement (30.9%), and high engagement (9.5%). High engagement was defined a priori by the accumulation of an arbitrary number of points on the Vitality program, allocated against specific activities (knowledge, fitness-related activities, assessment and screening, and healthy choices). Hospital admission costs, the number of days in hospital, and hospital admission rates were compared among highly engaged members and those members who were not enrolled in the program, nonengaged, and lowly engaged. Data were normalized for age, gender, plan type, and chronic disease status.

RESULTS

Highly engaged members had lower costs per patient, shorter stays in hospital, and fewer admissions compared with other groups (p < .001). Low or no engagement was not associated with lower hospital costs. Admission rates were also 7.4% lower for cardiovascular disease, 13.2% lower for cancers, and 20.7% lower for endocrine and metabolic diseases in the highly engaged group compared with any of the other groups (p < .01).

CONCLUSIONS

Engagement in an incentive-based wellness program, offered by a health insurer, was associated with lower health care costs.

Impact of an occupational health promotion program on subsequent illness and mortality experience

BACKGROUND

Integrating general health initiatives into established occupational health programs may be an effective way of contributing more broadly to employee health. Objective assessment of the success of such initiatives is needed, but is often difficult to carry out because of their voluntary nature.

METHODS

A cohort of 24,586 wage employees, 35+ years of age and with 15+ years of prior employment, was established to assess morbidity and mortality outcomes relative to participation in an ongoing health initiative instituted in 1983. Outcomes were evaluated for employees who attended the seminar program (attendees), those who had clearance examinations, but did not take part in the program (withdrawals), and non-participants.

RESULTS

At entry to follow-up, the prevalence of chronic illnesses including diabetes, obesity, and diseases of the circulatory system was lowest among non-participants and highest among withdrawals. During the follow-up period, the incidence of new disease conditions was similar between attendees and non-participants; however, overall mortality was significantly reduced among attendees after adjustment for explanatory factors including age, job grade, smoking history, alcohol intake, and body-mass-index (relative risk = 0.83; 95% confidence interval: 0.69-0.99) and was still marginally decreased when withdrawals were combined with attendees.

CONCLUSIONS

Although self-selection cannot be ruled out as a contributing factor to the reduction in mortality risk among attendees, our findings indicate that offering health promotion activities in the context of an existing occupational health program may benefit overall employee health.

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System

OBJECTIVE

To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives.

METHODS

Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input-output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%.

RESULTS

From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23-24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17-19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment.

LIMITATIONS

The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism; and no sensitivity analyses performed.

CONCLUSION

This analysis indicates that providing benefits for the LAGB procedure to eligible members of the Texas ERS and their dependents is worthy of support from payer, employer, and societal perspectives.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008

OBJECTIVE

To conduct the seventh periodic review and analysis of the clinical and cost-effectiveness research conducted in worksite/corporate environments between 2004 and 2008.

METHODS

A literature search of US-based research was conducted using a multistage process including MEDLINE, ADI, EDGAR, CARL, Inform, Lexis-Nexis, as well as direct inquiries to key researchers in this area of expertise.

RESULTS

From 2004 to 2008, there were 16 new studies that met the Inclusion/Exclusion criteria. These studies are critiqued and entered into a data table consisting of 13 variables and citations of the 16 new studies.

CONCLUSIONS

Clinical and cost-effectiveness research in the worksite/corporate environment continues to evolve although there was only one randomized clinical trial conducted during the most recent interval. There are innovations in pilot studies, quasi-experimental methodologies, and econometric modeling as indicative of future trends.

The effect of worksite physical activity intervention on physical capacity, health, and productivity: a 1-year randomized controlled trial

OBJECTIVE

To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention (REF) on various health outcomes.

METHODS

A 1-year randomized controlled trial was conducted with specific resistance training (SRT), all-round physical exercise (APE), and REF.

RESULTS

SRT and APE compared with REF showed significant reductions in systolic blood pressure (approximately 6 mm Hg), body fat percentage (approximately 2.2 body fat%), as well as shoulder and back pain (approximately 30% reduction in duration). Muscle strength (APE and SRT) and maximal oxygen uptake (APE) increased approximately 10%.

CONCLUSIONS

Worksite intervention with both SRT as well as APE is recommended, since these activities compared with REF resulted in clinically relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms, in combination with minor increases in physical capacity.

The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review

This report presents the results of a systematic review of the effectiveness of worksite nutrition and physical activity programs to promote healthy weight among employees. These results form the basis for the recommendation by the Task Force on Community Preventive Services on the use of these interventions. Weight-related outcomes, including weight in pounds or kilograms, BMI, and percentage body fat were used to assess effectiveness of these programs. This review found that worksite nutrition and physical activity programs achieve modest improvements in employee weight status at the 6-12-month follow-up. A pooled effect estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based on six RCTs. The findings appear to be applicable to both male and female employees, across a range of worksite settings. Most of the studies combined informational and behavioral strategies to influence diet and physical activity; fewer studies modified the work environment (e.g., cafeteria, exercise facilities) to promote healthy choices. Information about other effects, barriers to implementation, cost and cost effectiveness of interventions, and research gaps are also presented in this article. The findings of this systematic review can help inform decisions of employers, planners, researchers, and other public health decision makers.