Development and Pilot Test of the Workplace Readiness Questionnaire, a Theory-Based Instrument to Measure Small Workplaces' Readiness to Implement Wellness Programs

PURPOSE

To develop a theory-based questionnaire to assess readiness for change in small workplaces adopting wellness programs.

DESIGN

In developing our scale, we first tested items via "think-aloud" interviews. We tested the revised items in a cross-sectional quantitative telephone survey.

SETTING

The study setting comprised small workplaces (20-250 employees) in low-wage industries.

SUBJECTS

Decision-makers representing small workplaces in King County, Washington (think-aloud interviews, n = 9), and the United States (telephone survey, n = 201) served as study subjects.

MEASURES

We generated items for each construct in Weiner's theory of organizational readiness for change. We also measured workplace characteristics and current implementation of workplace wellness programs.

ANALYSIS

We assessed reliability by coefficient alpha for each of the readiness questionnaire subscales. We tested the association of all subscales with employers' current implementation of wellness policies, programs, and communications, and conducted a path analysis to test the associations in the theory of organizational readiness to change.

RESULTS

Each of the readiness subscales exhibited acceptable internal reliability (coefficient alpha range, .75-.88) and was positively associated with wellness program implementation ( p < .05). The path analysis was consistent with the theory of organizational readiness to change, except change efficacy did not predict change-related effort.

CONCLUSION

We developed a new questionnaire to assess small workplaces' readiness to adopt and implement evidence-based wellness programs. Our findings also provide empirical validation of Weiner's theory of readiness for change.

Promoting Diet and Physical Activity in Nurses

OBJECTIVE

To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses.

DATA SOURCE

English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non-peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses.

DATA EXTRACTION

Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer.

DATA SYNTHESIS

Extracted data were synthesized in a tabular format and narrative summary.

RESULTS

Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA.

CONCLUSIONS

Outcomes of interventions to change nurses' PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.

Active8! Technology-Based Intervention to Promote Physical Activity in Hospital Employees

PURPOSE

Increase physical activity in health care employees using health messaging, and compare e-mail with mobile phone short-message service (SMS) as delivery channels.

DESIGN

Randomized controlled trial Setting. U.K. hospital workplace.

SUBJECTS

Two hundred ninety-six employees (19-67 years, 53% of study Web site visitors).

INTERVENTION

Twelve-week messaging intervention designed to increase physical activity and delivered via SMS (n =147) or e-mail (n =149); content tailored using theory of planned behavior (TPB) and limited to 160 characters.

MEASURES

Baseline and 6, 12, and 16 weeks. Online measures included TPB constructs, physical activity behavior on the Global Physical Activity Questionnaire, and health-related quality of life on the Short-Form 12.

ANALYSIS

General linear models for repeated measures.

RESULTS

Increase in duration (mean h/d) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks. Short-lived increase in frequency (d/wk) of vigorous recreational activity from baseline to 6 weeks. Increase in duration and frequency of active travel from baseline to 16 weeks. E-mails generated greater changes than SMS in active travel and moderate activity (work and recreational).

CONCLUSION

Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure, which is maintained up to 1 month after messaging ends. Both channels were useful platforms for health communication; e-mails were particularly beneficial with hospital employees.

Perceived workplace health support is associated with employee productivity

PURPOSE

To examine the relationship between perceived workplace health support and employee productivity.

DESIGN

A quantitative cross-sectional study.

SETTING

Washington State agencies.

SUBJECTS

A total of 3528 employees from six state agencies were included in this analysis.

MEASURES

Perceived workplace health support was assessed by two questions that queried respondents on how often they felt supported by the workplace for healthy living and physical activity. The Work Productivity and Activity Impairment Questionnaire was used to measure health-related absenteeism and presenteeism in the past 7 days.

ANALYSIS

Multivariate linear regression was used to estimate the mean differences in productivity by levels of perceived health support.

RESULTS

Most participants were between 45 and 64 years of age and were predominantly non-Hispanic white. Presenteeism varied significantly by the level of perceived workplace health support, with those who felt least supported having higher presenteeism than those who felt most supported. The difference in presenteeism by perceived workplace support remained significant in models adjusting for sociodemographic and health characteristics (mean difference: 7.1% for support for healthy living, 95% confidence interval: 3.7%, 10.4%; 4.3% for support for physical activity, 95% confidence interval: 1.7%, 6.8%). Absenteeism was not associated with perceived workplace health support.

CONCLUSION

Higher perceived workplace health support is independently associated with higher work productivity. Employers may see productivity benefit from wellness programs through improved perceptions of workplace health support.

Promoting Influenza Vaccination to Restaurant Employees

PURPOSE

To evaluate an evidence-based workplace approach to increasing adult influenza vaccination levels applied in the restaurant setting

DESIGN

We implemented an intervention and conducted a pre/post analysis to determine effect on vaccination.

SETTING

Eleven Seattle-area restaurants.

SUBJECTS

Restaurants with 25+ employees speaking English or Spanish and over 18 years.

INTERVENTION

Restaurants received influenza vaccination promotion materials, assistance arranging on-site vaccination events, and free influenza vaccinations for employees.

MEASURES

Pre/post employee surveys of vaccination status with direct observation and employer interviews to evaluate implementation.

ANALYSIS

We conducted descriptive analysis of employee survey data and performed qualitative analysis of implementation data. To assess intervention effect, we used a mixed-effects logistic regression model with a restaurant-specific random effect.

RESULTS

Vaccination levels increased from 26% to 46% (adjusted odds ratio 2.33, 95% confidence interval 1.69, 3.22), with 428 employees surveyed preintervention, 305 surveyed postintervention, and response rates of 73% and 55%, respectively. The intervention was effective across subgroups, but there were restaurant-level differences.

CONCLUSION

An access-based workplace intervention can increase influenza vaccination levels in restaurant employees, but restaurant-level factors may influence success.

Determining Barriers and Facilitators Associated With Willingness to Use a Personal Health Information Management System to Support Worksite Wellness Programs

PURPOSE

To determine the barriers and facilitators associated with willingness to use personal health information management (PHIM) systems to support an existing worksite wellness program (WWP).

DESIGN

The study design involved a Web-based survey.

SETTING

The study setting was a regional hospital.

SUBJECTS

Hospital employees comprised the study subjects.

MEASURES

Willingness, barriers, and facilitators associated with PHIM were measured.

ANALYSIS

Bivariate logit models were used to model two binary dependent variables. One model predicted the likelihood of believing PHIM systems would positively affect overall health and willingness to use. Another predicted the likelihood of worrying about online security and not believing PHIM systems would benefit health goals.

RESULTS

Based on 333 responses, believing PHIM systems would positively affect health was highly associated with willingness to use PHIM systems (p < .01). Those comfortable online were 7.22 times more willing to use PHIM systems. Participants in exercise-based components of WWPs were 3.03 times more likely to be willing to use PHIM systems. Those who worried about online security were 5.03 times more likely to believe PHIM systems would not help obtain health goals.

CONCLUSIONS

Comfort with personal health information online and exercise-based WWP experience was associated with willingness to use PHIM systems. However, nutrition-based WWPs did not have similar effects. Implementation barriers relate to technology anxiety and trust in security, as well as experience with specific WWP activities. Identifying differences between WWP components and addressing technology concerns before implementation of PHIM systems into WWPs may facilitate improved adoption and usage.

Does Skin in the Game Matter if You Aren't Playing? Examining Participation in Oregon's Public Employee Health Engagement Model

PURPOSE

Employers are increasingly exploring health benefits that incentivize lifestyle change for employees. We used early data from an ongoing study of one such model-the Health Engagement Model (HEM), which Oregon implemented for all public employees in 2012-to analyze variation in employee participation and engagement.

DESIGN

A survey was designed to assess program engagement, opinions of the program, and self-reported lifestyle changes.

SETTING

Data were collected in 2012, about 9 months after HEM launched.

SUBJECTS

A representative random sample of 4500 state employees served as the study subjects.

MEASURES

Primary measures included whether employees signed up for the program, completed its required activities, and reported making lifestyle changes.

ANALYSIS

Logistic regression was used to analyze survey results.

RESULTS

Most employees (86%) chose to participate, but there were important socioeconomic differences: some key target populations, including smokers and obese employees, were the least likely to sign up; less educated employees were also less likely to complete program activities. Despite mostly negative opinions of the program, almost half of participants reported making lifestyle changes.

CONCLUSION

Oregon's HEM launch was largely unpopular with employees, but many reported making the desired lifestyle changes. However, some of those the program is most interested in enrolling were the least likely to engage. People involved with implementing similar programs will need to think carefully about how to cultivate broad interest among employees.

Improvements in Health Behaviors, Eating Self-Efficacy, and Goal-Setting Skills Following Participation in Wellness Coaching

Purpose . This project examined potential changes in health behaviors following wellness coaching. Design . In a single cohort study design, wellness coaching participants were recruited in 2011, data were collected through July 2012, and were analyzed through December 2013. Items in the study questionnaire used requested information about 11 health behaviors, self-efficacy for eating, and goal-setting skills. Setting . Worksite wellness center. Participants . One-hundred employee wellness center members with an average age of 42 years; 90% were female and most were overweight or obese. Intervention . Twelve weeks of in-person, one-on-one wellness coaching. Method . Participants completed study questionnaires when they started wellness coaching (baseline), after 12 weeks of wellness coaching, and at a 3-month follow-up. Results . From baseline to week 12, these 100 wellness coaching participants improved their self-reported health behaviors (11 domains, 0- to 10-point scale) from an average of 6.4 to 7.7 (p < .001), eating self-efficacy from an average of 112 to 142 (on a 0- to 180-point scale; p < .001), and goal-setting skills from an average of 49 to 55 (on a 16- to 80-point scale; p < .001). Conclusion . These results suggest that participants improved their current health behaviors and learned skills for continued healthy living. Future studies that use randomized controlled trials are needed to establish causality for wellness coaching.

Perspectives on Workplace Health Promotion Among Employees in Low-Wage Industries

PURPOSE

Study goals were to (1) understand the attitudes of employees in low-wage industries toward workplace health promotion, including views on appropriateness of employer involvement in employee health and level of interest in workplace health promotion overall and in specific programs, and (2) determine the potential for extending workplace health promotion to spouses and partners of these employees.

APPROACH

The study used 42 interviews of 60 to 90 minutes.

SETTING

Interviews were conducted with couples (married or living together) in the Seattle/King County metropolitan area of Washington State.

PARTICIPANTS

Study participants were forty-two couples with one or more members working in one of five low-wage industries: accommodation/food services, education, health care/social assistance, manufacturing, and retail trade.

METHOD

The study employed qualitative analysis of interview transcripts using grounded theory to identify themes.

RESULTS

Employees consider workplace health promotion both appropriate and desirable and believe it benefits employers through increased productivity and morale. Most have little personal experience with it and doubt their employers would prioritize employee health. Employees are most interested in efforts focused on nutrition and physical activity. Both employees and their partners support extending workplace health promotion to include partners.

CONCLUSION

Employees and their partners are interested in workplace health promotion if it addresses behaviors they care about. Concern over employer involvement in their personal health decisions is minimal; instead, employees view employer interest in their health as a sign that they are valued.

Understanding small business engagement in workplace violence prevention programs

PURPOSE

Worksite wellness, safety, and violence prevention programs have low penetration among small, independent businesses. This study examined barriers and strategies influencing small business participation in workplace violence prevention programs (WVPPs).

APPROACH

A semistructured interview guide was used in 32 telephone interviews.

SETTING

The study took place at the University of North Carolina Injury Prevention Research Center.

PARTICIPANTS

Participating were a purposive sample of 32 representatives of small business-serving organizations (e.g., business membership organizations, regulatory agencies, and economic development organizations) selected for their experience with small businesses.

INTERVENTION

This study was designed to inform improved dissemination of Crime Free Business (CFB), a WVPP for small, independent retail businesses.

METHODS

Thematic qualitative data analysis was used to identify key barriers and strategies for promoting programs and services to small businesses.

RESULTS

Three key factors that influence small business engagement emerged from the analysis: (1) small businesses' limited time and resources, (2) low salience of workplace violence, (3) influence of informal networks and source credibility. Identified strategies include designing low-cost and convenient programs, crafting effective messages, partnering with influential organizations and individuals, and conducting outreach through informal networks.

CONCLUSION

Workplace violence prevention and public health practitioners may increase small business participation in programs by reducing time and resource demands, addressing small business concerns, enlisting support from influential individuals and groups, and emphasizing business benefits of participating in the program.

Validation of Performance Indicators for Evaluation of Workplace Health Promotion

PURPOSE

To validate performance indicators for evaluating workplace health promotion (WHP) programs based on a logic model and to analyze the structural relationships between constructs.

DESIGN

The study design is cross-sectional.

SETTING

Design setting was small manufacturing companies implementing WHP programs provided by the Korea Industrial Health Association.

SUBJECTS

Seventeen occupational health experts completed a questionnaire to determine the content validity of indicators. In addition, 58 health care managers completed a questionnaire to determine reliability and construct validation. The response rate was 84.1%.

MEASURES

Based on a logic model, 13 constructs of WHP programs were identified: WHP program input, four activities for workplace environment management, two activities for employee health care management, two outputs, and two short-term outcomes.

ANALYSIS

Interrater agreement index was used for testing the content validity of indicators. Confirmatory factor analysis was used to test for the reliabilities, and the convergent and discriminant validities. Structuring equation modeling was also used to analyze the relationships among constructs.

RESULTS

A total of 35 performance indicators from 11 constructs showed good reliability and validity. All relationships among WHP input, activities, outputs, and short-term outcomes were significant, except for the relationship between environment outputs and short-term outcome.

CONCLUSION

These findings illustrate that the logic model and structuring equation modeling can be used to develop and validate performance indicators for planning and evaluation of the WHP program.

Effectiveness of interventions targeting health behaviors in university and college staff: a systematic review

OBJECTIVE

Evaluate the literature on interventions targeting tertiary education staff within colleges and universities for improvements in health behaviors such as physical activity, dietary intake, and weight loss.

DATA SOURCE

One online database, Medline, was searched for literature published between January 1970 and February 2013.

STUDY INCLUSION AND EXCLUSION CRITERIA

All quantitative study designs, including but not limited to randomized controlled trials, quasi-experimental studies, nonrandomized experimental trials, cohort studies, and case-control studies, were eligible.

DATA EXTRACTION

Data extraction was performed by one reviewer using a standardized form developed by the researchers. Extraction was checked for accuracy and consistency by a second reviewer.

DATA SYNTHESIS

Data in relation to the above objective were extracted and described in a narrative synthesis.

RESULTS

Seventeen studies were identified that focused on staff within the tertiary education setting. The review yielded overall positive results with 13 reporting significant health-related improvements. Weight loss, physical activity and fitness, and/or nutrition were the focus in more than half (n = 9) of the studies.

CONCLUSION

This appears to be the first review to examine health interventions for tertiary education staff. There is scope to enhance cross-disciplinary collaboration in the development and implementation of a "Healthy University" settings-based approach to health promotion in tertiary education workplaces. Universities or colleges could serve as a research platform to evaluate such intervention strategies.

A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study

PURPOSE

To determine whether a plant-based nutrition program in a multicenter, corporate setting improves depression, anxiety, and productivity.

DESIGN

A quasi-experimental study examined the impact of diet on emotional well-being and productivity.

SETTING

The study was conducted in 10 corporate sites of a major U.S. insurance company.

SUBJECTS

There were 292 participants (79.8% women, 20.2% men), with body mass index ≥25 kg/m(2) and/or previous diagnosis of type 2 diabetes.

INTERVENTION

Either weekly instruction in following a vegan diet or no instruction was given for 18 weeks.

MEASURES

Depression and anxiety were measured using the Short Form-36 questionnaire. Work productivity was measured using the Work Productivity and Activity Impairment questionnaire.

ANALYSIS

Baseline characteristics were examined by t-test for continuous variables and χ(2) test for categorical variables. Analysis of covariance models were adjusted for baseline covariates. Paired t-tests were used to determine within-group changes and t-tests for between-group differences.

RESULTS

In an intention-to-treat analysis, improvements in impairment because of health (p < .001), overall work impairment because of health (p = .02), non-work-related activity impairment because of health (p < .001), depression (p = .02), anxiety (p = .04), fatigue (p < .001), emotional well-being (p = .01), daily functioning because of physical health (p = .01), and general health (p = 0.02) in the intervention group were significantly greater than in the control group. Results were similar for study completers.

CONCLUSION

A dietary intervention improves depression, anxiety, and productivity in a multicenter, corporate setting.

A multilevel model of organizational health culture and the effectiveness of health promotion

PURPOSE

Organizational health culture is a health-oriented core characteristic of the organization that is shared by all members. It is effective in regulating health-related behavior for employees and could therefore influence the effectiveness of health promotion efforts among organizations and employees. This study applied a multilevel analysis to verify the effects of organizational health culture on the organizational and individual effectiveness of health promotion.

DESIGN

At the organizational level, we investigated the effect of organizational health culture on the organizational effectiveness of health promotion. At the individual level, we adopted a cross-level analysis to determine if organizational health culture affects employee effectiveness through the mediating effect of employee health behavior.

SETTING

The study setting consisted of the workplaces of various enterprises.

SUBJECTS

We selected 54 enterprises in Taiwan and surveyed 20 full-time employees from each organization, for a total sample of 1011 employees.

MEASURES

We developed the Organizational Health Culture Scale to measure employee perceptions and aggregated the individual data to formulate organization-level data. Organizational effectiveness of health promotion included four dimensions: planning effectiveness, production, outcome, and quality, which were measured by scale or objective indicators. The Health Promotion Lifestyle Scale was adopted for the measurement of health behavior. Employee effectiveness was measured subjectively in three dimensions: self-evaluated performance, altruism, and happiness.

ANALYSIS

Following the calculation of descriptive statistics, hierarchical linear modeling (HLM) was used to test the multilevel hypotheses.

RESULTS

Organizational health culture had a significant effect on the planning effectiveness (β = .356, p < .05) and production (β = .359, p < .05) of health promotion. In addition, results of cross-level moderating effect analysis by HLM demonstrated that the effects of organizational health culture on three dimensions of employee effectiveness were completely mediated by health behavior.

CONCLUSION

The construct connections established in this multilevel model will help in the construction of health promotion theories. The findings remind business executives that organizational health culture and employee health behavior help improve employee effectiveness.

Eat for life: a work site feasibility study of a novel mindfulness-based intuitive eating intervention

PURPOSE

To examine the efficacy of a novel intervention for problematic eating behaviors and body dissatisfaction.

DESIGN

Participants enrolled in the intervention or waitlist comparison group were assessed at pre and post 10 weeks.

SETTING

Midwestern university.

SUBJECTS

One hundred twenty-four female employees or partners/spouses.

INTERVENTION

Eat for Life is a 10-week group intervention integrating mindfulness and intuitive eating skills.

MEASURES

Self-report questionnaires included the Intuitive Eating Scale, Body Appreciation Scale, Five-Facet Mindfulness Questionnaire, Questionnaire for Eating Disorder Diagnoses, and an author-constructed supplemental and demographic questionnaire.

ANALYSIS

Analyses of covariance and ordinal regression measured group differences. Structural equation modeling examined mediation effects. Results . Significant differences between groups were observed for body appreciation (F1,121 = 40.17, p = .000, partial eta squared = .25), intuitive eating (F1,121 = 67.44, p = .000, partial eta squared = .36), and mindfulness (F1,121 = 30.50, p = .000, partial eta squared = .20), with mean scores significantly higher in the intervention group than waitlist comparison group after 10 weeks. The intervention group was 3.65 times more likely to be asymptomatic for disordered eating than the comparison group. Mindfulness served as a partial mediator.

CONCLUSION

The study provides support for an intervention combining intuitive eating and mindfulness for treatment of problematic eating behaviors and body dissatisfaction, with limitations including self-selection and lack of active control group.