Chapter 7: Applications of PRECEDE-PROCEED in Occupational Settings

1. Chapter 7: Applications of PRECEDE-PROCEED in Occupational Settings

2. The Ecological Context of Workplace Health Programs • Historical Context of Health in the Workplace • Demographic Context • Political-Regulatory Context: Occupational Health & Safety Legislation • Economic Context • The Worksite Wellness and Health Promotion Context • The Blending of the Occupational Health Ecologies and Cultures

3. History: Substance Abuse Context Referral Community Mental and Social Services Mental health Counseling Employee Assistance Programs Marriage or Family Counseling Treatment Mandatory drug testing Emerging Workplace Health Programs Dismissal

4. Sources of payment for private health insurance coverage, 1987-2000. Individual Policy Premiums6% Individual Policy Premiums9% Employee Contribution to Private Health Insurance19% Employee Contribution to Private Health Insurance22% Employer Contribution to Private Health Insurance72% Employer Contribution to Private Health Insurance72% 1987 2000 Source: U.S. Department of Health and Human Services, Center for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, 2002. Chartbook, Chapter 4, online at http://cms.hhs.gov/charts/default.asp, accessed Dec 7, 2003. .

5. Figure 7-5. Changes (annual percentage increases) in employer health insurance premiums, overall inflation, and workers’ earnings, 1989-2001. Employer health insurance premiums are rising rapidly again.

6. Target and baseline:

7. Target: 85 percent for nutrition or weight management; 75 percent for physical activity and fitness programs. Target setting method: 55 percent improvement. Data source: National Worksite Health Promotion Survey, Association for Worksite Health Promotion (AWHP). Offer Physical Activity and Fitness Programs

8. Cautions on Workplace Health Program Planning • Ethical Concerns • Conflicting loyalties of health professionals • “Victim-blaming” vs paternalism • Labeling and coercion of individual workers • Privacy, confidentiality, loss of medical care benefits, discrimination in hiring or promotions, based on health consideration • Exaggerated Benefits? • Claiming too much in order to get support for program is a set-up for disappointment • Overselling the economic benefits

9. Application of the Precede-Proceed Phases • Phase 1: Social Assessment and Participatory Planning • Phase 2: Epidemiological Diagnosis: Health, Behavioral, and Environmental Assessments • Descriptive Epidemiology: Extent and Distribution of the Health Problems • Etiological Epidemiology: The Behavioral and Environmental Determinants • Phase 3: Educational and Ecological Assessment • Phase 4: Administrative and Policy Assessment • Phase 5: Implementation and Evaluation • A Case Study: Air Quality Control in a State Agency

10. Intake 1 Is employee motivated? No 2 Is employee faced with barriers? Counseling on the benefits of full participation No Yes Education and suggestions to overcome barriers 3 Are expectations realistic? Counseling to adjust expectations or to provide alternative rewards No Yes Predisposing, enabling, or reinforcing factors identified Problems 4 Assess progress Start program or continue program Fig 7-11 No Problems Yes