A participatory approach to worksite health promotion

A review of literature suggests that individual, social, and organizational factors are important to consider in the development of worksite health promotion programs. This article describes a conceptual framework that integrates these factors. The implications of this framework for the development, implementation, and evaluation of worksite health promotion programs and the results of an intervention based on this approach are presented. The results from this study highlight the importance of active employee involvement in all stages of worksite health promotion programs. The findings also indicate that programs need to address the causes, not just the symptoms, of stressful working conditions.     

Issues related to participation in worksite health promotion: a preliminary study

PURPOSE. The purpose of this study was to identify characteristics associated with participation in worksite-based health promotion activities. DESIGN. Follow-up interviews were used to identify demographic, attitudinal, and behavioral differences among three employee groups. Reasons employees chose not to participate in health promotion activities were also explored. SETTING. All respondents were employed at a large midwestern university and were eligible to participate in free onsite health fairs and health promotion programs. SUBJECTS. A stratified random sample of 89 nonparticipants, health fair participants, and behavior change program participants was interviewed. MEASURES. The interview was comprised of questions related to demographic information, personal health habits, physical activity, perceived health status, perceived self-efficacy, worksite norms, health promoting lifestyle factors, and knowledge about health promotion activities. RESULTS. ANOVA and chi-squared comparisons revealed few group differences. Graduate students and employees with advanced degrees were most likely to take part in health fairs. Behavior change program participants were older, clerical-technical staff members, and women. Faculty members were least likely to participate. A lack of time was the most often cited reason for nonparticipation. CONCLUSIONS. The study was retrospective and the analyses limited due to low statistical power. The results suggest that different groups of employees are attracted to different types of health promotion activities.     

Changing health practices: the experience from a worksite health promotion project

This paper uses data from an employee health promotion project for government employees to examine initial health practices and their relationship to social and demographic variables. It then uses data collected one year later to examine changes in health behaviors and to try to explain what types of people are most likely to undertake health behavior changes in a year, within the context of a worksite health promotion project. Most people in this sample of employees do make positive changes in health habits in at least one of the following areas: smoking, seatbelt usage, diet, exercise, alcohol usage. While a variety of different social and demographic variables are important in explaining initial differences in health practices, these same variables along with measures of personal efficacy and job stress are poor predictors of whether people change their health behavior over a year. Future research might usefully focus on more detailed collection of qualitative data to help understand what factors motivate people to change health behavior. Future survey approaches may then incorporate broader and more diverse categories of explanatory variables into regression models.     

Evaluating research in worksite health promotion

Critical review of studies published in the area of worksite health promotion is an important skill for health promotion professionals. Most studies have some weaknesses which make it difficult to draw meaningful conclusions. Therefore, it is important to consider the research design of these studies. By accurately evaluating the conclusions of health promotion investigations, health promotion professionals will be able to make better recommendations for effective program development.     

Metabolic syndrome and worksite health promotion

Metabolic Syndrome represents a relatively new clinical condition whose individual risk parameters have been associated with a variety of additional or excess costs for working populations. This article reviews much of the current clinical findings on this condition and provides suggestions for employers. The worksite represents one of the most promising settings for early detection and follow-up interventions. The most technically promising response from those responsible for employee health management is not clear at the present time.     

Employee perceived barriers to participation in worksite health promotion

Aim

Many employers offer worksite health promotion (WHP), but a high percentage of the workforce does not participate. As the employees’ perspective regarding potential barriers to participation has received little attention in research so far, improvements in program design are delayed. The aims of the present paper therefore are to investigate perceived barriers to WHP participation from the employees’ point of view, and to construct a barrier typology.

Subject and methods

A quantitative questionnaire was developed on the basis of existing studies and distributed in four Austrian organisations offering comprehensive WHP programs. 237 respondents rated the appreciability of 22 potential barriers to WHP participation. Barrier categories and typologies were defined using principal component analysis (PCA), multiple correspondence analysis (MCA), and regression analysis.

Results

The PCA identified six barrier types: (1) integration into the daily routine; lack of (2) information; an (3) imbalance of benefits and costs; the requirement of too much (4) involvement; (5) interpersonal barriers; and (6) incredibility of the company’s honest commitment. According to the MCA, one group perceives barriers intensively, another hardly, and a third mainly program design related barriers. The regression analysis shows that especially being too busy at work and feeling physically not up to participating in WHP activities are major barriers.

Conclusion

The results provide a comprehensive overview and categorization of barriers to WHP participation perceived by employees in companies offering holistic programs. Moreover, they can be used as guidelines for analysing existing and/or preventing barriers of occurring when designing and implementing WHP programs.     

Applying the health promotion model to development of a worksite intervention.

INTRODUCTION: Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. PURPOSE: The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. SUBJECTS/SETTING: Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. DESIGN: Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. MEASURES: All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). RESULTS: Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. CONCLUSION: Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.     

A psychosocial-approached health promotion program at a Japanese worksite

This study examined trends of sickness absence before and after a psychosocial-approached health promotion program (HPP) at a Japanese worksite. The subjects were 1029 male employees working at a manufacturing company from April 1991 to March 1999. The HPP was performed from April 1995 to decrease sickness absence through helping to improve all employees' lifestyles according to a psychosocial approach incorporating six characteristics: 1) concept based on the population strategy, 2) use of a health risk appraisal (HRA), 3) setting easy lifestyle targets, 4) praising the employees' personal lifestyle initiatives, 5) supported (sponsored) by the management, 6) award of subsidiary payments. Sickness absence was considered to be consecutive days calculated by medical certification and company records. Absences due to musculoskeletal diseases and total diseases decreased, when comparing four-year periods before and after the program's introduction. In this report we show that trends of sickness absence changed after the introduction of the psychosocial-approached health promotion program.     

Frequency of worksite health promotion activities.

The first National Survey of Worksite Health Promotion Activities surveyed a random sample of all private sector worksites with 50 or more employees, stratified by number of employers, geographic location, and type of industry. The 1,358 completed interviews constituted a response rate of 83.1 per cent. Of responding worksites 65.5 per cent had one or more areas of health promotion activity with slightly more than 50 per cent of activities initiated within the previous five years. Overall prevalence by type of activity included health risk assessment (29.5 per cent), smoking cessation (35.6 per cent), blood pressure control and treatment (16.5 per cent), exercise/fitness (22.1 per cent), weight control (14.7 per cent), nutrition education (16.8 per cent), stress management (26.6 per cent), back problem prevention and care (28.5 per cent), and off-the-job accident prevention (19.8 per cent). Mean number of activities across all worksites was 2.1 and for worksites with activities, 3.2. Activity frequency increased with worksite size, was highest in the western region (2.34) and lowest in the northeast (1.96), and varied considerably by industry type. The majority of worksites paid the entire cost of these activities.     

Assessment of worksite health promotion environments]

Organizational intervention rather than the individual approach is gaining greater attention in worksite health promotion, but little research has been done on the health promotion environment. The purpose of this study was to investigate the actual conditions in health promotion environments at worksites, and determine which environmental items in each health promotion area at worksites need. A survey was conducted by mailing a questionnaire to occupational physicians at 450 worksites in Japan. The questionnaire contained 182 items including 6 areas in a health promotion environment; tobacco control, healthy diet, physical activity and exercise, stress management, health screening, and health administration. 142 physicians (32.7%) responded to our survey, the number of employees was more than three hundred and 71.1% of respondents were working at manufacturing worksites. The mean rate of positive answers in 6 areas was highest in the 'health screening' (72.5%), followed by 'stress management'. The lowest rate was seen in 'tobacco control'. Popular facilities for health promotion were a stress counseling room, cafeteria, rest room and outdoor exercise field, but the rate of positive answers to promote utilization of these facilities was relatively low. Among the health education programs, the practice rate for exercise promotion was the highest (63.6%), but those for healthy food and body weight control were relatively low. The number of employees positively correlated with the rate of positive answers to all items and in the stress managing area. Manufacturing worksites had more items for enhancing physical activity than other types of industrial worksites. The results of this survey had determined the environmental intervention items in each health promotion area at worksites.     

Stakeholder analysis in worksite health promotion programming

Stakeholder analysis is a formal management tool that is used primarily for planning purposes and policy development. A number of key planning questions are used to help identify major issues with internal and external stakeholders that can affect, or often are affected by, a worksite health promotion program. Organizational size is correlated with the various likely stakeholders. Desired contributions and strategies for efficient management of stakeholder relationships are also offered.     

Implementation and outcomes of a comprehensive worksite health promotion program

BACKGROUND: This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. METHODS: The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). RESULTS: Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p = 0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful. CONCLUSIONS: This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.     

Determinants of participation in worksite health promotion programmes: a systematic review

Background  

The workplace has been identified as a promising setting for health promotion, and many worksite health promotion programmes have been implemented in the past years. Research has mainly focused on the effectiveness of these interventions. For implementation of interventions at a large scale however, information about (determinants of) participation in these programmes is essential. This systematic review investigates initial participation in worksite health promotion programmes, the underlying determinants of participation, and programme characteristics influencing participation levels.