Evaluating worksite health programs

Worksite health enhancement programs utilize screening and early disease detection or risk reduction as health promotion activities. Objectives for these include improving the health and productivity of employees and reducing health care costs. However, critical questions about the effectiveness of programs should be answered before managers initiate these activities. Issues include accuracy of measurement and subject classification, adequate use of comparisons and follow-up in evaluation studies, and evidence of cost effectiveness.     

Mediating factors in dietary change: understanding the impact of a worksite nutrition intervention.

This report, based on 1,795 participants in the Next Step Trial, examines how a dietary intervention program affected mediating factors for dietary change. The model tested whether intervention increased predisposing (skills, knowledge, and beliefs) and enabling (social support and norms) factors for change and advanced participants into action and maintenance stages of change. The intervention significantly increased both predisposing factors for dietary change and the likelihood of moving into or remaining in action and maintenance stages of change. Changes in predisposing and enabling factors and stage of change at follow-up (regardless of stage at baseline) were associated with significant dietary change. Changes in mediating variables explained between 34% and 55% of the effects of the dietary intervention. These results support the value of measuring mediating factors as part of dietary intervention evaluations and suggest that interventions that target norms and eating environments in addition to skills and knowledge may further increase intervention effectiveness.     

The cardiovascular health impact of an incentive worksite health promotion program

PURPOSE: We examined the cardiovascular health profiles of benefit-eligible hospital employees who participated in an incentive screen program for 4 years. We also determined if cardiovascular health changes differed between participants (CHAP) who enrolled in structured follow-up risk reduction programs (CHAPplus) compared with those who chose less formal options (CHAPonly). METHODS: CHAP consisted of cardiovascular screens, results counseling, and encouragement to participate in education and behavioral support programs. After adjusting for gender, medication use, and baseline levels of adiposity and physical activity, cardiovascular health changes were tested with repeated-measures analysis of covariance (ANCOVA) among CHAP participants and by CHAP type. RESULTS: CHAP 4-year members (n = 278) were generally healthy and mostly women (87%) with an average age of 40.6 +/- .5 years at baseline. Despite increases in overall (p = .034) and central adiposity (p = .001), cardiovascular health improvements were found for the total cholesterol/high-density lipoprotein ratio (TCHOL/HDL; p = .007), low-density lipoprotein (p = .009), and blood glucose (p = .018) among 4-year CHAP members. CHAPonly employees showed greater improvements in most cardiovascular health indicators than CHAPplus participants, although these differences did not achieve statistical significance. DISCUSSION: Cardiovascular health improvements were associated with long-term participation in a hospital worksite incentive screen program. The cardiovascular health benefits tended to be greatest for CHAP employees who chose informal follow-up risk reduction options (CHAPonly) than those who enrolled in structured programs (CHAPplus).     

Comparison of participation in federal worksite and community health promotion programs

The extent to which employees rely on the worksite exclusively for health promotion programs was examined in a cross-sectional study of 10 federal worksites. Responses were received from 3,403 of the 5,757 employees surveyed (59%). Fewer than 10% of employees exclusively used agency programs for physical fitness, nutrition, substance abuse, smoking cessation, and support group meetings. A higher percentage participated in health risk assessment (27%), health and disease risk education activities (17%), medical care services (23%), personal safety and first aid training 26%, and stress management programs (17%) only at the worksite. Men were more likely than women to participate exclusively in workplace programs.     

The impact of an incentive-based worksite health promotion program on modifiable health risk factors

A health promotion program consisting of an annual health screening and financial rebates for good health practices was offered to all 2540 employees of Salt Lake County in Utah. Changes in health risks were measured for the 304 full time employees who participated in assessments for four years. Significant improvements were seen in body fat, cholesterol, systolic and diastolic blood pressure, seat belt use, and overall physical health among the high risk group and the low risk group. There was a net increase in the number of people in the high risk group over the four year period.     

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

PURPOSE: The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multicomponent worksite health promotion programs. SEARCH METHOD: A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed. IMPORTANT FINDINGS: The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities to learn and practice new skills were also offered. A smaller number of programs incorporated modifications in organizational policy or the physical work environment. Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program. Just offering low intensity, short duration programs aimed at increasing awareness of health issues for the entire employee population may not be sufficient to achieve desired outcomes. MAJOR CONCLUSIONS: The results of the studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and some general guidance as to the critical components and characteristics of successful programs. Overall, the evidence suggests that a rating of indicative/acceptable may best characterize this literature.     

The impact of a worksite health promotion program on short-term disability usage

This study examined the impact of a worksite health promotion program on short-term disability (STD) days in a large telecommunications company. The evaluation used a quasi-experimental, multiple time-series design with between-group comparison of workdays lost due to STD to determine impact. The study period was 3 years and included 1628 employees on STD leave. Self-selected program participants were compared with non-participants on net days lost at three assessment points: the year before the launch of the program, and each of 2 years post-launch. A comprehensive health promotion program was developed to reduce health care costs, improve employee satisfaction, and enhance the employer's image. Key features of the program included reimbursement for employees participating in the Health Risk Assessment and in wellness or fitness activities. Other features included occupational health services, targeted interventions for high-risk employees, self-care materials, and a nurse advice line. Results revealed no significant differences at baseline between participants and non-participants for net days lost while on STD leave. At the post-program launch, non-participants' net days lost significantly increased from 33.2 to 38.1 when controlled for age, gender, job type, tenure, and STD category, whereas the participant group average net days lost decreased from 29.2 to 27.8. After adjusting for baseline differences, we found a 6-day difference between groups, which represented a 20% program impact. This study found that participation in a health promotion reimbursement program had a significant impact on average net days lost for employee STD absence. These findings represented potential savings in excess of $1,371,600 over a 2-year period. Future program evaluation efforts will address the impact on medical care costs related to program participation.     

Getting closer to the truth: overcoming research challenges when estimating the financial impact of worksite health promotion programs

The authors describe the most important methodological challenges often encountered in conducting research and evaluation on the financial impact of health promotion. These include selection bias, skewed data, small sample size, metrics. They discuss when these problems can and cannot be overcome and suggest how some of these problems can be overcome through a creating an appropriate framework for the study, and using state of the art statistical methods.     

Nutrition and health education intervention for whole grain foods in the Georgia older Americans nutrition programs

This study examined the effects of a nutrition education intervention on improving the intake and behaviors related to whole grain foods in congregate meal recipients in senior centers in north Georgia. Participants were a convenience sample and completed a pretest, an educational intervention, and a post-test (N = 84, mean age = 77 years, 88% female, 76% Caucasian, and 24% African American). At the pre-test, most participants agreed that eating more whole grain foods would help reduce their risk of cancer (69%), heart disease (76%), type 2 diabetes (65%), and bowel disorders (82%), but consumption of 11 whole grain foods was low (10.5 times/week). Following the intervention, participants were more likely to suggest one or more correct ways to identify whole grain foods (45 vs. 62%, P< or = 0.05), and to report an increased intake of whole grain bread, cereal, and crackers (5.8 vs. 6.9 times/week, P < or = 0.05). While awareness of the health benefits of whole grain foods was high, the intakes were low. As a first step, this intervention improved several aspects of the consumption of whole grain foods; however, additional interventions that target the individual and the congregate meal program are needed to increase intakes to the recommended three servings daily.     

Planning worksite health promotion programs: models, methods, and design implications

As the field of Worksite Health Promotion and Wellness matures, greater pressure is being place on programs that produce mitigation of health risks, improved employee productivity and increased levels of economic return. To achieve these expected results and to successfully contend with the challenges of today's workplace and work force it will likely become even more critical to carefully plan both new and existing programs each year. A model for the planning and development of worksite programs is presented and discussed along with a variety of design implications for different population segments.