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Inspiring Healthy Change in the Worksite Environment: Using the Evidence

Inspiring Healthy Change in the Worksite Environment: Using the Evidence. Network for a Healthy California Annual Conference March 4, 2009 Katie Tharp, PhD, MPH, RD California Department of Public Health. Agenda. Elements of worksite wellness programs Barriers to success

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Inspiring Healthy Change in the Worksite Environment: Using the Evidence

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  1. Inspiring Healthy Change in the Worksite Environment: Using the Evidence Network for a Healthy California Annual Conference March 4, 2009 Katie Tharp, PhD, MPH, RD California Department of Public Health

  2. Agenda • Elements of worksite wellness programs • Barriers to success • Examples of evidence-based worksite interventions • Evaluation of program effectiveness • Practical issues to consider when implementing a worksite wellness program

  3. California Workers • In 2006… • 18,064,496 workers were in the labor force (16+ years old) • 64.5% of the population (16+ years) was in the labor force • Mean travel time to work was 26.8 minutes • Median household income: $56,645 • Median family income: $64,563 • 9.7% of families were below poverty level 2006 American Community Survey. US Census Bureau www.census.gov

  4. Elements of a Comprehensive Worksite Health Promotion Program • Health education • Supportive social and physical environments • Integration of the worksite program into the organization’s structure • Linkage to related programs • Worksite screening programs • Follow-up interventions • An evaluation and improvement process Adapted from Healthy People 2010 and Partnerships for a Healthy Workforce

  5. Common Program Delivery Methods • Printed materials • Internet • In-person • Telephone • Only 49.5% of sites used data to guide program direction • Only 30.2% had a 3- or 5- year strategic plan for worksite health promotion Linnan, et al. Am J Public Health 2008 Aug;98(8):1503-9. Epub 2007 Nov 29

  6. Barriers to Program Success • Lack of employee interest • Staff resources • Funding • Low participation among high-risk employees • Management support Linnan, et al. Am J Public Health 2008 Aug;98(8):1503-9. Epub 2007 Nov 29

  7. Common Program Activities • Employee assistance programs • Back injury prevention • Stress management • Nutrition • Health care consumerism • Weight management • In general, the larger the worksite, the more programs that are offered

  8. Screenings Blood pressure Alcohol or drug abuse Cholesterol Diabetes Cancer Disease management programs Cardiovascular disease Diabetes Obesity Chronic Obstructive Pulmonary Disease Common Screenings and Disease Management Programs

  9. A cafeteria available to employees Labeling healthy food choices Promotions for healthy food choices Catering policies promoting healthy food options Healthy options available in vending machines Classes, workshops, and peer learning on healthy food choices Worksite Changes:Promotion of Healthy Eating

  10. On-site shower facilities On-site fitness facility or enhanced access to an offsite facility Fitness or walking trails Signage to encourage stair use Stairwell enhancements Fitness breaks Fiscal incentives for using mass transit Nearby parking restrictions Worksite Changes:Promotion of Physical Activity

  11. What is the importance of program evaluation?

  12. One study reported 44.1% of employers expected a return on investment! Linnan, et al. Am J Public Health 2008 Aug;98(8):1503-9. Epub 2007 Nov 29

  13. Employee feedback Employee participation Workers’ compensation costs Health care claims costs Time lost or absenteeism Health risk appraisals Common Methods of Program Evaluation

  14. Issue: Health programs need to demonstrate effectiveness Potential Solutions: • Document participation and resulting improvements in the target population • Select interventions based on the evidence base • What have other worksites found to be effective? • What are the needs specific to each worksite? Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007

  15. Potential Solutions: Use available assessment tools Document cost savings and the return on investment (ROI) Model services on award-winning programs C. Everett Koop Health Project Innovation in Prevention Partnership for Prevention Wellness Councils of America (WELCOA) California Fit Business Awards Issue: Employers are concerned about cost-effectiveness Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007

  16. Potential Solutions: Demonstrate the demand for interventions and measurements of the various productivity factors Conduct ongoing data collection on disparities Do interventions address differences in: Culture? Gender? Age? Disabilities? Health Literacy? Socioeconomic status? Issue: Employers want to increase employee productivity

  17. Potential Solutions: Explore new approaches to communication and dissemination that can improve health literacy and informed decision-making Why is a change in behavior important? How does an individual go about changing their behavior? Issue: There is a movement towards consumerism Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007

  18. Potential Solutions Gain buy-in from both management and staff of each worksite Place weight on interventions that affect the entire organization Evaluate for disparities in implementation effectiveness Provide supportive work environments Encourage corporate culture change Issue: How do we balance individual and group health? Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007

  19. Worksite Changes: Examples from New York • The average worksite reported 5.64 supports • Nutrition (1.82) • Stress management (1.93) • Physical activity (0.96) • Preventive health screening (0.93) • Blood pressure • General health risk appraisals Brissette, et al. Prev Chronic Dis 2008;5. www.cdc.gov/pcd/issues/2008/apr/07_0196.htm

  20. What made the most difference? • Worksite size was related to the number of supports • Worksites with a wellness committee or coordinator reported a greater number of supports. • Worksite with both a coordinator and committee reported the most supports.

  21. What didn’t work? • Low HRA response rate (17.6%): • No financial incentive • Survey length • Lack of leadership/manager engagement • Leaders or managers felt the program was a NYC “service” rather than a home-grown initiative they inspired and owned Goetzel, et al. J Occup Environ Med 2008;50:190-201

  22. Most common barriers No time during work (42.5%) Lack of time before or after work (39.4%) Younger workers were more likely than older workers to say they are too tired to use worksite health promotion services Regularly active adults say they are already involved in other programs What barriers do employees have to using worksite wellness services? Kruger, et al. Am J Health Promotion 2007;21:439-447

  23. What are the greatest incentives for using worksite services? • Convenient time (73.2%) • Convenient location (72.8%) • Paid time off (69.6%) • Women were more likely men to report convenient time, location, or co-worker participation as incentives • Regularly active adults were also more likely to report convenient time and location as incentives Kruger, et al. Am J Health Promotion 2007;21:439-447

  24. Physical activity services Fitness centers (80.6%) More women than men On-site exercise classes (55.2%) More women than men Sports leagues (36.3%) Nutrition services Weight loss programs (67.1%) Personalized diet and exercise counseling (49.8%) Healthy eating and cooking classes (48.2%) Weight loss support groups (32.4%) Online tracking tools (25.6%) What do employees want? Kruger, et al. Am J Health Promotion 2007;21:439-447

  25. How can employers encourage staff participation in worksite wellness? • Stage-match and individualize interventions to employee’s readiness to change • Allow all staff to participate in the change process, even if they are not prepared to take action • Resistance is most often caused by poorly planned implementation of change initiatives • Leaders are often at a higher readiness for change than their employees • Leaders tend to be more action oriented and have more time to consider the pros and cons Prochaska, et al. A Transtheoretical Approach to Changing Organizations. Admin Policy in Mental Health. 2001;28:247-261.

  26. For More Information • Network for a Healthy California Worksite Program • http://www.cdph.ca.gov/programs/CPNS/Pages/WorksiteProgram.aspx • The Community Guide • http://www.thecommunityguide.org • Click on “worksite” • Wellness Council of America • www.welcoa.org • Click on “free materials” • The Health Project • http://healthproject.stanford.edu/

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