Transcript Transforming the Norm Obesity Prevention in California

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
 Examples of evidence-based worksite
interventions
 Evaluation of program effectiveness
 Practical issues to consider when
implementing a worksite wellness program
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California Workers
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In 2006…
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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
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
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Adapted from Healthy People 2010 and Partnerships for a
Healthy Workforce
Common Program Delivery Methods
Printed materials
 Internet
 In-person
 Telephone
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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
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Linnan, et al. Am J Public Health 2008 Aug;98(8):1503-9. Epub 2007 Nov 29
Barriers to Program Success
Lack of employee interest
 Staff resources
 Funding
 Low participation among high-risk
employees
 Management support
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Linnan, et al. Am J Public Health 2008 Aug;98(8):1503-9. Epub 2007 Nov 29
Common Program Activities
Employee assistance programs
 Back injury prevention
 Stress management
 Nutrition
 Health care consumerism
 Weight management
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In general, the larger the worksite, the
more programs that are offered
Common Screenings and Disease
Management Programs
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Screenings
 Blood pressure
 Alcohol or drug abuse
 Cholesterol
 Diabetes
 Cancer
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Disease management programs
 Cardiovascular disease
 Diabetes
 Obesity
 Chronic Obstructive Pulmonary
Disease
Worksite Changes:
Promotion of Healthy Eating
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A cafeteria available to employees
Labeling healthy food choices
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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 Physical Activity
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On-site shower facilities
On-site fitness facility or enhanced access
to an offsite facility
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Fitness or walking trails
Signage to encourage stair use
Stairwell enhancements
Fitness breaks
Fiscal incentives for using mass
transit
Nearby parking restrictions
What is the importance of
program evaluation?
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
Common Methods of Program
Evaluation
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Employee feedback
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Employee participation
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Workers’ compensation costs
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Health care claims costs
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Time lost or absenteeism
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Health risk appraisals
Issue: Health programs need to
demonstrate effectiveness
Potential Solutions:
 Document participation and resulting
improvements in the target population
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Select interventions based on the evidence base
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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
Issue: Employers are concerned about
cost-effectiveness
Potential Solutions:
 Use available assessment tools
 Document cost savings and the return on
investment (ROI)
 Model services on award-winning programs
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C. Everett Koop Health Project
Innovation in Prevention
Partnership for Prevention
Wellness Councils of America (WELCOA)
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California Fit Business Awards
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Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007
Issue: Employers want to increase
employee productivity
Potential Solutions:
 Demonstrate the demand for interventions and
measurements of the various productivity factors
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Conduct ongoing data collection on disparities
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Do interventions address differences in:
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Culture?
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Gender?
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Age?
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Disabilities?
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Health Literacy?
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Socioeconomic status?
Issue: There is a movement towards
consumerism
Potential Solutions:
 Explore new approaches to communication and
dissemination that can improve health literacy
and informed decision-making
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Why is a change in behavior important?
How does an individual go about changing their
behavior?
Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007
Issue: How do we balance individual and
group health?
Potential Solutions
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Gain buy-in from both management and staff of
each worksite
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Place weight on interventions that affect the
entire organization
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Evaluate for disparities in implementation
effectiveness
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Provide supportive work environments
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Encourage corporate culture change
Adapted from: Goetzel, et al. The Art of Health Promotion. Sept/Oct 2007
Worksite Changes:
Examples from New York
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The average worksite reported 5.64
supports
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Nutrition (1.82)
Stress management (1.93)
Physical activity (0.96)
Preventive health screening (0.93)
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Blood pressure
General health risk appraisals
Brissette, et al. Prev Chronic Dis 2008;5.
www.cdc.gov/pcd/issues/2008/apr/07_0196.htm
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.
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What didn’t work?
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Low HRA response rate (17.6%):
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No financial incentive
Survey length
Lack of leadership/manager engagement
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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
What barriers do employees have to
using worksite wellness services?
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Most common barriers
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Younger workers were
more likely than older
workers to say they
are too tired to use
worksite health
promotion services
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Regularly active adults
say they are already
involved in other
programs
No time during work
(42.5%)
Lack of time before or
after work (39.4%)
Kruger, et al. Am J Health Promotion 2007;21:439-447
What are the greatest incentives for
using worksite services?
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Convenient time (73.2%)
Convenient location (72.8%)
Paid time off (69.6%)
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Women were more likely men to report
convenient time, location, or co-worker
participation as incentives
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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
What do employees want?
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Physical activity services
 Fitness centers (80.6%)
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On-site exercise classes
(55.2%)
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More women than men
More women than men
Sports leagues (36.3%)
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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%)
Kruger, et al. Am J Health Promotion 2007;21:439-447
How can employers encourage staff
participation in worksite wellness?
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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
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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.
For More Information
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Network for a Healthy California Worksite
Program
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The Community Guide
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http://www.thecommunityguide.org
Click on “worksite”
Wellness Council of America
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http://www.cdph.ca.gov/programs/CPNS/Pages/Worksit
eProgram.aspx
www.welcoa.org
Click on “free materials”
The Health Project
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http://healthproject.stanford.edu/