Workplace health promotion and employee health in Swedish municipal social care organizations

Aim

The aim of this explorative study was to investigate the employers’ management characteristics, their provision of workplace health promotion (WHP) measures, and employee satisfaction with WHP in relation to employee health in Swedish municipal social care organizations.

Subjects and methods

A cross-sectional design was used, and questionnaires were sent to top managers (representing the employer) and employees in a nationwide random sample of 60 of the 290 municipal organizations for the social care of elderly and disabled people in Sweden. The questionnaire data from the 60 managers were linked to aggregated employee data concerning self-rated health and satisfaction with WHP from a representative sample of 8,082 employees in the same organizations. All analyses were performed at the organizational level using independent t-test, Spearman’s rank correlation and multiple linear regression analysis.

Results

In the multivariate analysis, the organizational WHP index (i.e. local WHP projects and WHP coordinators), individual WHP index (i.e. health profile assessment, fitness activities and medical check-up), and the level of employees’ satisfied with WHP were associated with employee health (F?=?9.64, p?<?0.001, adjusted R ²?=?0.48). General organizational and management characteristics were, however, not statistically related to employee health.

Conclusion

The results suggest that the provision of individual-directed and organizational-directed health-specific measures were related to employee health in Swedish municipal social care organizations and, therefore, can be part of a comprehensive approach to address WHP.     

A cultural economy approach to workplace health promotion in Australian small and medium sized workplaces: a critical qualitative study

Workplace health promotion (WHP) is advocated to progress the health and well-being of employees. However, research findings on its uptake and impacts are equivocal, particularly in smaller workplaces. This paper describes managers’ and workers’ responses to a WHP programme in the Australian Capital Territory. Informed by a cultural economy framework, in-depth interviews were conducted with 44 workers and managers from 10 small to medium sized enterprises (SMEs). Examining their availability and acceptability to workers and managers, we found a limited array of health promotion activities were adopted; a caring environment, provision of healthy foods, occasional health checks and health advice. Physical activity programmes during work hours were unlikely to be accepted by managers due to time costs, and workers were reluctant to spend their non-paid time on them. Casual workers were often excluded from WHP activities because their work times did not synchronize with other employees’ hours. This study illuminates how WHP is shaped by a complex of employment regulations that stress individual performance, associated limits on employer and worker time and resources, and organizational, cultural norms and practices regarding healthy work environments. We conclude that SMEs are implementing a limited array of behaviour change initiatives reflecting a particular view of health promotion. While organizational change may expand adoption of health practices during the workday, there are impediments to workers adopting wholesale changes in their health practices given a national culture of long hours, and intense job demands embedded in Australia’s neoliberal employment system.     

Zielgruppenorientierung und betriebliche Gesundheitsförderung

Background

In research regarding workplace health promotion (WHP), the employees’ perspective has so far been a neglected issue. Thus, employees’ potential opposition towards WHP due to perceived program-related barriers regarding information as well as program design has also received little attention. The latter is the focus of this study.

Methods

Preliminary hypotheses regarding WHP program-related barriers as well as proposals for their reduction were created on the basis of problem-centered interviews. These interviews were conducted with 19 employees in three organizations, four persons in charge of WHP within these organizations, and nine health experts.

Results

From the employees’ perspective, individual criteria such as the perceived utility of the WHP program, social aspects such as the internal acceptance of WHP, and organizational prerequisites such as access conditions potentially create barriers to the implementation and use of WHP programs.

Conclusion

On the individual level, barriers related to program design can be reduced by, for example, stressing certain topics. On the interpersonal level, offering activities with a strong group orientation is a possibility. On the organizational level, creating attractive organizational conditions represents a favorable intervention.     

Leadership in workplace health promotion projects: 1- and 2-year effects on long-term work attendance

BACKGROUND: Despite the acknowledged role of leadership in the psychosocial work environment, few studies focus on how leadership qualities and strategies may act as key processes of importance to positive effects of workplace health promotion (WHP). The aim of this study was to increase knowledge about how leadership qualities and strategies in WHP projects influence employees' long-term work attendance. METHOD: The 1- and 2-year effect of leadership on the prevalence of long-term work attendance among municipal human service workers (n = 3 275) was analysed using 3-year register-based data on sick leave, questionnaires and a qualitative categorization of each unit. RESULT: Increased leadership qualities, especially where leaders used rewards, recognition and respect, were associated with higher prevalence of work attendance at follow-up [PR 1.42 (1.20-1.69)]. Leaders' strategies and views on work-related health had a significant impact on increased work attendance in projects that had goals clearly focusing on changeable factors [1.36 (1.11-1.67)], in multi-focused projects [1.60 (1.24-2.04)] and in projects aimed to increase employees' awareness of their health. Workplace health promotion strategies with a single focus on strengthening individual, professional or organizational resources were negatively associated with work attendance. A higher proportion of employee work attendance was also seen in units whose leaders viewed the organization or the society (rather than individual workers) as responsible for the high rate of sick leave. CONCLUSION: Leadership, WHP strategies and leaders' attitudes towards employee work-related health have importance for implementation processes, as well as affecting employee work attendance. In this study, multi-focused WHP interventions had the largest effect on work attendance.     

Workplace health promotion and stakeholder positions: a Finnish case study

Modern workplace health promotion (WHP) requires collaboration, partnerships, and alliances with both internal and external stakeholders. However, the identification of the key stakeholders as well as the systematic mapping of their views has barely been covered in the existing research literature. This article describes the stakeholders and stakeholder positions in WHP in Finland. In this study, the stakeholders were classified as internal, interface, and external stakeholders. Furthermore, based on the authors' research, stakeholders and their positions were represented on a stakeholder map as well as by the power-interest matrix of the stakeholders. The governmental authorities play a key role in driving the strategic change toward WHP by preparing the required legislation and regulatory measures. However, both active employers and active employees can through their own work accelerate the development of new WHP services. Close collaboration between employers and employees is required at the individual workplaces. Some stakeholders, such as pension funds and occupational health services (OHS) providers, can act as important driving forces and support the strategic implementation of WHP in the workplaces. However, alone they have only limited opportunities to organize the WHP activities. Understanding the various stakeholders and the systematic mapping of their positions is essential for the successful planning and implementation of WHP activities.     

Organizational change--key to capacity building and effective health promotion

Contemporary health promotion is now a well-defined discipline with a strong (albeit diverse) theoretical base, proven technologies (based on program planning) for addressing complex social problems, processes to guide practice and a body of evidence of efficacy and increasingly, effectiveness. Health promotion has evolved principally within the health sector where it is frequently considered optional rather than core business. To maximize effectiveness, quality health promotion technologies and practices need to be adopted as core business by the health sector and by organizations in other sectors. It has proven difficult to develop the infrastructure, workforce and resource base needed to ensure the routine introduction of high-quality health promotion into organizations. Recognizing these problems, this paper explores the use of organizational theory and practice in building the capacity of organizations to design, deliver and evaluate health promotion effectively and efficiently. The paper argues that organizational change is an essential but under-recognized function for the sustainability of health promotion practice and a necessary component of capacity-building frameworks. The interdependence of quality health promotion with organizational change is discussed in this paper through three case studies. While each focused on different aspects of health promotion development, the centrality of organizational change in each of them was striking. This paper draws out elements of organizational change to demonstrate that health promotion specialists and practitioners, wherever they are located, should be building organizational change into both their practice and capacity-building frameworks because without it, effectiveness and sustainability are at risk.     

Communicating Health at Work: Organizational Wellness Programs as Identity Bridges

With the growth in workplace health promotion (WHP) initiatives, organizations are asking employees to enact their personal health identities at work. To understand this prominent yet poorly understood phenomenon, we surveyed 204 employees at a company with a WHP program and found that participation in the wellness program mediated personal health and organizational identities. Results fill a gap in communication literature by demonstrating the effect of individual identity enactment on organizational identification and contribute to recent research stressing the relationship between identity and health behaviors. In addition, findings illuminate the role of situated activity in identity negotiation, suggesting that certain activities in organizations, like wellness programs, serve as identity bridges between personal and work-related identity targets.     

Audience segmentation in worksite health promotion: a procedure using social marketing concepts

This study demonstrates how techniques of audience segmentationcan be combined with principles of social marketing to enhanceplanning for worksite health promotion (WHP). Using data froma mail survey of university employees, ‘future participation’was regressed on three blocks of (1) demographic, (2) behavioraland (3) psychosocial variables. Each block contributed significantlyto explaining variance in the dependent variables. All threeblocks together explained 40% of the variability in future participationand so all variables in the regression formed the basis forthe segmentation procedures. Six substantive clusters were identifiedthat differed along demographic, behavioral and psychosocialdimensions as well as work location. Analyses of variance demonstratedthat clusters were significantly related to differences on severalvariables important to planning and can be used to provide usefulinformation for program planning by associating group membershipwith specific preferences for different types of programs andchannels for delivery.     

Social context for workplace health promotion: feasibility considerations in Costa Rica,Finland, Germany,Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.     

Employees attitudes to workplace health promotion programs for cancer prevention

OBJETIVE: We describe a method for feasibility assessment of workplace health promotion (WHP) programs as a necessary prerequisite of any WHP program. METHODS: A total of 167 employees from five workplace communities participated in the study. A questionnaire on the basic components of feasibility (risk factors, attitudes to workplace health promotion interventions, and social-occupational context) was administered. RESULTS: Risk behaviours were common among the employees interviewed. Health promotion in the workplace was favorably viewed by 79% of subjects but reported participation would be lower. Interventions on diet and physical activity received the highest acceptance. Participation would be greatest among local administration employees. CONCLUSIONS: The method demonstrated its utility in obtaining useful data for designing workplace health promotion interventions.     

Phases of school health promotion implementation through the lens of complexity theory: lessons learnt from an Austrian case study

The implementation of health promotion concepts in (school) settings is a complex undertaking on which little scientific knowledge exists. The purpose of this study was to better understand organizational influences on the implementation of school health promotion. An extended case study design that incorporated important insights from complexity science was used. This design influenced the focus of analysis and led to the use of multiple methods of data collection and analysis. A primary school in Vienna served as a case for observing and analysing the first year of implementing the health-promoting school concept. The study provided detailed insights into the implementation process. Results showed four chronologically overlapping implementation phases (starting health promotion, deciding what to do, planning health promotion projects, doing health promotion) on different system levels. In each phase, the original health-promoting school concept was adapted to the necessities and characteristics of each level and, therefore, changed considerably. Implications for possible adaptations of the health-promoting school concept to better fit the situation in schools are discussed.     

Betriebliche Gesundheitsförderung in der Bundesrepublik Deutschland

The Luxembourg Declaration defines workplace health promotion (WHP) as the combined efforts of employers, employees and society to improve the health and well-being of people at work. WHP aims at encouraging personal development and healthy lifestyle, improving work organisation and the working environment by a wide range of measures, and at promoting active participation of employees in WHP processes. The procedure of WHP is oriented on the Cycle of Business Excellence. This article presents the development, methods, projects, evaluation and quality control of WHP.     

Why do managers allocate resources to workplace health promotion programmes in countries with national health coverage?

There is extensive evidence that worksite health promotion (WHP) programmes reduce healthcare costs and improve employee productivity. In many countries, a large proportion of healthcare costs are borne by the state. While the full benefits of WHP are still created, they are shared between employers and the state, even though the employer bears the full (after-tax) cost. Employers therefore have a lower incentive to implement WHP activity. We know little about the beliefs of managers with decision responsibility for the approval and implementation of WHP programmes in this context. This article reports the results of a study of the attitudes of Canadian senior general managers (GMs) and human resource managers (HRMs) in the auto parts industry in Ontario, Canada towards the consequences of increasing discretionary spending on WHP, using Structural Equation Modelling and the Theory of Planned Behaviour. We identified factors that explain managers' intentions to increase discretionary spending on wellness programmes. While both senior GMs and HRMs are motivated primarily by their beliefs that WHP reduces indirect costs of health failure, GMs were also motivated by their moral responsibility towards employees (but surprisingly HRMs were not). Importantly, HRMs, who usually have responsibility for WHP, felt constrained by a lack of power to commit resources. Most importantly, we found no social expectation that organizations should provide WHP programmes. This has important implications in an environment where the adoption of WHP is very limited and cost containment within the healthcare system is paramount.     

Encouraging Schools to Promote Health: Impact of the Western Australian School Health Project (1992 — 1995)

The Western Australian School Health (WASH) Project, a school health promotion intervention operating over a four-year period (1992-1995), provided a comprehensive, year-long intervention to help successive groups of schools develop health promotion programs. The WASH Project worked with self-selected school communities and used community development strategies to support participating schools in identifying and responding to health concerns relevant to their students. This paper reports the school impact results of the WASH Project. School impact data involved 24 variables categorized into two areas: school organizational factors supportive of health promotion, and school health promotion factors. Two methods of analysis were used: logistic regression indicating the direction of change, and linear regression indicating the magnitude of change. Results demonstrated that schools successfully made organizational changes, such as the allocation of additional time, personnel, and monetary resources, to support health promotion.     

A planning framework for community empowerment goals within health promotion

Health promotion often comprises a tension between 'bottom-up' and 'top-down' programming. The former, more associated with concepts of community empowerment, begins on issues of concern to particular groups or individuals, and regards some improvement in their overall power or capacity as the important health outcome. The latter, more associated with disease prevention efforts, begins by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies, and regards improvement in particular behaviours as the important health outcome. Community empowerment is viewed more instrumentally as a means to the end of health behaviour change. The tension between these two approaches is not unresolvable, but this requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article presents a framework intended to assist planners, implementers and evaluators to systematically consider community empowerment goals within top-down health promotion programming. The framework 'unpacks' the tensions in health promotion at each stage of the more conventional, top-down programme cycle, by presenting a parallel 'empowerment' track. The framework also presents a new technology for the assessment and strategic planning of nine identified 'domains' that represent the organizational influences on the process of community empowerment. Future papers analyze the design of this assessment and planning methodology, and discuss the findings of its field-testing in rural communities in Fiji.     

An examination of the stages of change construct for health promotion within organizations.

PURPOSE: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change. DESIGN/METHODOLOGY/APPROACH: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods. FINDINGS: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating. PRACTICAL IMPLICATIONS: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness. ORIGINALITY/VALUE: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.     

The Working Healthy Project: a worksite health-promotion trial targeting physical activity, diet, and smoking.

Worksites are a key channel for delivery of interventions designed to reduce chronic disease among adult populations. Although some evaluations of worksite physical-activity interventions have been conducted, to date very few randomized trials of worksite health promotion have included the goal of increasing physical-activity levels as part of a comprehensive multiple risk factor approach to worksite health promotion. This article presents the results regarding behavior change found among the cohort of 2055 individuals who completed three health-behavior assessments as part of their worksites' participation in The Working Healthy Project (WHP), a multiple risk factor intervention implemented in 26 manufacturing worksites. In this study, a randomized matched-pair design was used. Fifty-one percent (n = 2,761) of the employees who completed the baseline assessment also completed the interim survey. Eighty-three percent of those who completed the interim assessment also completed the final survey. The WHP intervention targeted smoking, nutrition, and physical activity. At baseline, 38% of the sample reported engaging in regular exercise, and subjects reported consuming an average of 2.7 servings of fruits and vegetables per day, 7.9 grams of fiber per 1000 kilocalories, and 35.4% calories from fat per day; 28% of the sample were smokers. By the time of both the interim (intervention midpoint) and final (end of intervention) assessments, participants in the intervention condition had significantly increased their exercise behavior, compared with the control condition. There was also increased consumption of fruits and vegetables and fiber in the intervention condition by the time of the final assessment, compared with the control condition. No differences by condition were found with regard to percentage of calories from fat consumed or smoking cessation. These results suggest that among a cohort of participants in a worksite health promotion study, there were significant health behavior changes across two risk factors over time. These data suggest that further investigation of multiple risk factor worksite health promotion is warranted, particularly with a focus on ways to increase participation in these programs and to diffuse intervention effects throughout the entire workforce.     

Perspectives for workplace health promotion in Latin America and the Caribbean

The Latin American and Caribbean region is witnessing the emergence of discussion on workplace health promotion (WHP). The authors propose WHP as an equitable collective action targeting primarily work hazards and their determinants. It has its economic-political "macro" level and a downstream "micro" level. On the macro level, neoliberalism, privatization, and deregulation threaten equitable health and labor issues. Effective labor and health legislation and a fair degree of social redistribution of resources support WHP. Micro-scale WHP is important for contextual reasons and social diffusion, and can literally save lives. Worker involvement, free association of workers, public health affiliation, the precautionary principle, sensitization and training, employer responsibility for healthy working conditions, coalitions between workers and health professionals, and preference for reduction of direct work hazards over modification of personal lifestyles are basic tenets of WHP.