The effect of a workplace wellness program on disability, function and pain in healthcare providers workers with low back pain-outcomes of 3040 academic health center employees.

PURPOSE: (1) Identification of musculoskeletal risk factors for healthcare providers suffering low back pain (LBP) and the creation of risk profiles for those individuals and (2) analyze the impact of a workplace wellness program on healthcare providers who suffer from low back pain. METHODS: A total of 3040 employees at an academic healthcare center underwent a computer-adaptive survey of health-related quality of life (HRQOL), biometric tests, and a disability and functional movement assessment as part of the workplace wellness program (WWP). Clinical interventions with a rehabilitation specialist were offered to employees identified as at risk for low back pain. Data collected were analyzed using descriptive methods and multivariable regressions to address the study objectives. RESULTS: Of the 3040 healthcare providers enrolled in this study, 77% identified with non-specific LBP with greater weakness, numbness, reduced flexibility, and physical activity. The major predictive risk factors for LBP were Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference score, PROMIS fatigue, previous work injury, flexibility, numbness, PROMIS social function, level of education, and BMI. Healthcare providers with LBP who completed the WWP improved in most dimensions of HRQOL and disability and functional outcomes. CONCLUSIONS: A high proportion of healthcare providers suffer from LBP as a result of the nature of their work. Disability and functional outcomes measurements and PROMIS results quantitatively assess healthcare providers with LBP. Organizations can develop injury mitigation programs to target employees at high risk of LBP using the risk factors we identify. Completion of the WWP was associated with improvements in disability, HRQOL and functional measures.

Factors of Overweight and Obesity Among Employees of Petrochemical Manufacturing Companies.

The high prevalence of overweight and obesity is a major contributor to the global burden of disease, and create an economic burden for nations, including both direct and indirect costs. Although the Kingdom of Saudi Arabia is rapidly industrializing and the economy is now less dependent on oil, oil industry is still the main contributor to the Saudi labor force (41%). However, the productivity growth lags behind many developing countries. No studies have been conducted to explore the factors that can be associated with the lower productivity in this population of Saudi Arabia. This study aimed to estimate the prevalence of overweight/obesity and examine the association between overweight/obesity and lifestyle habits among employees of petrochemical manufacturing companies in the Kingdom of Saudi Arabia. A total of 1000 employees were surveyed. Chi-square test and logistic regression were used to predict odds ratios for obesity. About 47% of the sample was normal weight, while 28.5% was overweight and 21.2% was obese. Four factors were found to be predictive of obesity: feelings about weight, age, marital status, and childhood region. More than 52% of employees reported being happy with their weight. Those unhappy with their weight had more than six times greater odds of obesity as compared to those happy with their weight. Married employees were about twice as likely as unmarried to be obese. The findings of high prevalence of overweight and obesity among employees of petrochemical manufacturing suggest that more efforts are needed to promote healthy behaviors among employees. Workplace wellness programs and educational campaigns are recommended to encourage healthy lifestyle habits at both the workplace and in the community.

Impact of Sit-to-Stand and Treadmill Desks on Patterns of Daily Waking Physical Behaviors Among Overweight and Obese Seated Office Workers: Cluster Randomized Controlled Trial.

BACKGROUND: Sit-to-stand and treadmill desks may help sedentary office workers meet the physical activity guideline to "move more and sit less," but little is known about their long-term impact on altering the accumulation patterns of physical behaviors. OBJECTIVE: This study explores the impact of sit-to-stand and treadmill desks on physical behavior accumulation patterns during a 12-month multicomponent intervention with an intent-to-treat design in overweight and obese seated office workers. METHODS: In total, 66 office workers were cluster randomized into a seated desk control (n=21, 32%; 8 clusters), sit-to-stand desk (n=23, 35%; 9 clusters), or treadmill desk (n=22, 33%; 7 clusters) group. Participants wore an activPAL (PAL Technologies Ltd) accelerometer for 7 days at baseline, 3-month follow-up (M3), 6-month follow-up (M6), and 12-month follow-up (M12) and received periodic feedback on their physical behaviors. Analyses of physical behavior patterns included total day and workday number of sedentary, standing, and stepping bouts categorized into durations ranging from 1 to 60 and >60 minutes and usual sedentary, standing, and stepping bout durations. Intervention trends were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects. RESULTS: The treadmill desk group favored prolonged sedentary bouts (>60 min), whereas the sit-to-stand desk group accrued more short-duration sedentary bouts (<20 min). Therefore, compared with controls, sit-to-stand desk users had shorter usual sedentary bout durations short-term (total day ΔM3: -10.1 min/bout, 95% CI -17.9 to -2.2; P=.01; workday ΔM3: -20.3 min/bout, 95% CI -37.7 to -2.9; P=.02), whereas treadmill desk users had longer usual sedentary bout durations long-term (total day ΔM12: 9.0 min/bout, 95% CI 1.6-16.4; P=.02). The treadmill desk group favored prolonged standing bouts (30-60 min and >60 min), whereas the sit-to-stand desk group accrued more short-duration standing bouts (<20 min). As such, relative to controls, treadmill desk users had longer usual standing bout durations short-term (total day ΔM3: 6.9 min/bout, 95% CI 2.5-11.4; P=.002; workday ΔM3: 8.9 min/bout, 95% CI 2.1-15.7; P=.01) and sustained this long-term (total day ΔM12: 4.5 min/bout, 95% CI 0.7-8.4; P=.02; workday ΔM12: 5.8 min/bout, 95% CI 0.9-10.6; P=.02), whereas sit-to-stand desk users showed this trend only in the long-term (total day ΔM12: 4.2 min/bout, 95% CI 0.1-8.3; P=.046). The treadmill desk group accumulated more stepping bouts across various bins of duration (5-50 min), primarily at M3. Thus, treadmill desk users had longer usual stepping bout durations in the short-term compared with controls (workday ΔM3: 4.8 min/bout, 95% CI 1.3-8.3; P=.007) and in the short- and long-term compared with sit-to-stand desk users (workday ΔM3: 4.7 min/bout, 95% CI 1.6-7.8; P=.003; workday ΔM12: 3.0 min/bout, 95% CI 0.1-5.9; P=.04). CONCLUSIONS: Sit-to-stand desks exerted potentially more favorable physical behavior accumulation patterns than treadmill desks. Future active workstation trials should consider strategies to promote more frequent long-term movement bouts and dissuade prolonged static postural fixity. TRIAL REGISTRATION: ClinicalTrials.gov NCT02376504; https://clinicaltrials.gov/ct2/show/NCT02376504.

A deductive thematic analysis of nurses with job-related problems who completed suicide during the early COVID-19 pandemic: A preliminary report.

BACKGROUND: Prior to the novel coronavirus (COVID-19) pandemic, nurses died by suicide more frequently than the general population. Antecedents prior to death include known job problems, such as disciplinary action; diversion of medications; inability to work due to chronic pain; and physical and mental illness. AIM: The aim of this study was to explore the suicide experience of nurses who died with known job-related problems during the early phase of the COVID-19 pandemic compared to what has been previously described. METHOD: Deductive reflexive thematic analysis was used to analyze narratives of nurses with known job problems who died by suicide from the Centers for Disease Control and Prevention's National Violent Death Reporting System. RESULTS: Forty-three nurses with known job-related problems completed suicide between March and December 2020. Factors associated with death were similar to previous findings with notable exceptions, increased prevalence of suicidal ideation and post-traumatic stress prior to the event. Pandemic-specific issues were noted including reduction in hours, fear of disease transmission, civil unrest, and grief-related trauma. LINKING EVIDENCE TO ACTION: Suicide prevention programs need to address both institutional and individual factors associated with nurse suicide. As previously recommended, transitions into retirement and job loss are vulnerable times warranting psychological support. Further, strategies to reduce the impact of stressors and increase support for nurses are needed at the organizational level. A systems level approach to hardwire coping strategies is indicated pre-licensure and throughout nurses' careers. A new focus on how to process personal and professional grief is warranted. Resources are needed for nurses traumatized by life (rape, childhood trauma) or work-related experiences.

A systematic review of randomized controlled trials examining workplace wellness interventions.

BACKGROUND: One of the influencing factors associated with weight gain is overeating as a maladaptive coping strategy to process or avoid the emotional impact of psychological stress. Psychological stress is chronically and pervasively associated with stress stemming from the workplace environment. Workplace wellness interventions have a unique opportunity to change environmental factors impacting psychological stress, which can improve individual food choice and weight management efforts. AIM: To synthesize evidence from randomized controlled trials on workplace wellness interventions that impact employee psychological stress and food choice or weight management. METHODS: A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selected studies were limited to English-language articles exploring randomized interventions at workplaces among adult employees and included measurements of psychometric stress and food choice (qualitative or quantitative) or biometric weight management. From the search, 10 studies were included in the final review. RESULTS: Results were inconsistent across studies. There was no observable association between psychological stress reduction and food choice or weight management. Mid-length interventions (ranging from 6 to 9 months) had more consistent associations between intervention program implementation, reduced psychological stress, and improved food choice or weight management. CONCLUSIONS: The studies examining employee food choices and weight management efforts remained very heterogeneous, indicating that more research is needed in this specific area of employee wellness program planning and measurement. Consistent research methodology and assessment tools are needed to measure dietary intake.

Steering Teens Safe: translation to a workplace wellness program in the USA.

Parent-based teen driving interventions have been shown to increase safe teen driving but few have been translated beyond the research setting. As employers focus more on total worker health, the workplace offers a unique opportunity to implement a safe teen driving program into a workplace wellness program. The aim of this study was to adapt the evidence-based, parent-focused teen safe driving program Steering Teens Safe (STS) into workplace wellness programs, and to evaluate the implementation process and effect on parent-teen communication. The Replicating Effective Programs framework was used to modify STS to fit the workplace setting. The implementation process of the STS workplace wellness program was measured using direct observation and recordings of parent communication trainings while the effectiveness was measured by parent questionnaires. Forty-five parent employees across three businesses participated in the study. STS trainers were skilled in training parents in effective communication, including using open-ended questions and reflections. Parents reported increased success in conversations with their teens regarding safe driving through increased affection, receptivity, trust and equality in conversations. Workplaces may play a key role in assisting parents with teaching their children about safe driving.

Exploring biopsychosocial correlates of pain, pain management strategies, and risk for opioid misuse among home care workers in Washington State.

Home care workers (HCWs) are at high risk for musculoskeletal pain and injury, and they are an important population for pain management research and intervention. The purpose of this study was to gather novel data on HCWs' work characteristics, pain experiences, pain management strategies, and risk for opioid misuse. A survey invitation was e-mailed to a random sub-sample of HCWs in Washington State, and 421 responded. Over half (54.2%) reported chronic or currently elevated pain. Pharmacological pain management strategies were used by 67.3% of all respondents with 4.8% reporting prescription opioid use. Biopsychosocial factors like injuries, interpersonal conflict, financial strain, and anxiety were associated with increased opioid misuse risk. Multimodal primary and secondary interventions are recommended to improve HCWs' pain management.

Efficacy and costs of a workplace wellness programme.

BACKGROUND: Research investigating the efficacy of workplace wellness programmes to promote exercise, and by extension, reduce obesity and increase productivity has proliferated in recent years. Although preliminary work is encouraging, more work is needed. AIMS: To evaluate the effects and overall cost of a workplace exercise programme on multiple physical outcomes, including body mass index, aerobic fitness and muscular fitness. METHODS: Data from the Bruin Health Improvement Programme .5 (BHIP) between August 2013 and July 2018 were analysed. BHIP is a 12-week workplace wellness programme that assesses multiple areas of physical and mental health. For this study, changes in weight, waist-to-hip ratio, aerobic fitness and muscular endurance were analysed using paired samples t-tests and chi-squared tests. Using results from a prior analysis of Medical Expenditure Panel Survey, the estimated medical expenditure savings associated with weight loss were also analysed. RESULTS: A total of 518 participants (84% female) took part in the BHIP programme (mean age = 41 years, SD = 1.17). There were significant decreases in all anthropometric indices and significant increases in all fitness outcomes (P < 0.01) from baseline to follow-up. Estimated programme cost per participant, per session was $473 US Dollars (USD), and weight loss is estimated to reduce annual medical care costs by ~$2200 USD. CONCLUSIONS: Results showed significant improvements in all physical outcomes of interest. Additionally, there appears to be an inverse relationship between improvements in employee health and employer healthcare costs. Strengths, limitations and future directions are discussed.

Assessing virus infection probability in an office setting using stochastic simulation.

Viral infections are an occupational health concern for office workers and employers. The objectives of this study were to estimate rotavirus, rhinovirus, and influenza A virus infection risks in an office setting and quantify infection risk reductions for two hygiene interventions. In the first intervention, research staff used an ethanol-based spray disinfectant to clean high-touch non-porous surfaces in a shared office space. The second intervention included surface disinfection and also provided workers with alcohol-based hand sanitizer gel and hand sanitizing wipes to promote hand hygiene. Expected changes in surface concentrations due to these interventions were calculated. Human exposure and dose were simulated using a validated, steady-state model incorporated into a Monte Carlo framework. Stochastic inputs representing human behavior, pathogen transfer efficiency, and pathogen fate were utilized, in addition to a mixed distribution that accounted for surface concentrations above and below a limit of detection. Dose-response curves were then used to estimate infection risk. Estimates of percent risk reduction using mean values from baseline and surface disinfection simulations for rotavirus, rhinovirus, and influenza A infection risk were 14.5%, 16.1%, and 32.9%, respectively. For interventions with both surface disinfection and the promotion of personal hand hygiene, reductions based on mean values of infection risk were 58.9%, 60.8%, and 87.8%, respectively. This study demonstrated that surface disinfection and the use of personal hand hygiene products can help decrease virus infection risk in communal offices. Additionally, a variance-based sensitivity analysis revealed a greater relative importance of surface concentrations, assumptions of relevant exposure routes, and inputs representing human behavior in estimating risk reductions.

A Longitudinal Analysis of Nurse Suicide in the United States (2005-2016) With Recommendations for Action.

BACKGROUND: Previous studies have demonstrated nurses are at risk of suicide. This is the first national longitudinal study of U.S. nurse suicide. AIMS: To identify the longitudinal incidence, method, and risks of nurse suicide in the United States. METHODS: 2005 to 2016 Centers for Disease Control and Prevention National Violent Death Reporting System retrospective analysis of suicide incident rate ratios (IRR). RESULTS: A total of 1,824 nurse and 152,495 non-nurse suicides were evaluated. Nurses were at greater risk of suicide than the general population (female IRR 1.395, 95% confidence intervals [CI] 1.323, 1.470, p < .001; male IRR 1.205, 95% CI 1.083, 1.338, p < .001). Female nurses who completed suicide did so most frequently by pharmacologic poisoning (n = 399, 27.2% vs. n = 8,843, 26.9%), whereby male nurses and the general public used firearms (n = 148, 41.7% vs. n = 57,887, 48.4%). Job problems were more likely in nurses (female odds ratio [OR] 1.989, 95% CI 1.695, 2.325, p < .001; male OR 1.814, 95% CI 1.380, 2.359, p < .001), as well as mental health history (female OR 1.126, 95% CI 1.013, 1.253, p < .027; male OR 1.302, 95% CI 1.048, 1.614, p = .016) and leaving a suicide note (female OR 1.221, 95% CI 1.096, 1.360, p < .001; male OR 1.756 [1.412, 2.181], p < .001). LINKING EVIDENCE TO ACTION: The increased risk of suicide in nurses is congruent with previous reports. The consistency in results increases confidence that findings are generalizable and warrant action. The use of pharmacologic poisoning as a method of suicide, most often by opioids and benzodiazepines, indicates a need for improved identification and treatment of nurses with substance use. Workplace wellness programs need to focus on reducing workplace stressors. Further research is indicated to determine best prevention methods. Policy indications include the need to accurately track gender in nursing, enhance substance use disorder programs, and mandate suicide prevention activities.

Sustainability and Outcomes of a Suicide Prevention Program for Nurses.

BACKGROUND: We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse-centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at-risk nurses. AIM: The purpose of this paper is to report the 3-year sustainability and outcomes of this nurse suicide prevention program. METHODS: Descriptive statistics are provided of program outcomes over the course of 3 years. RESULTS: Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy-six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment. LINKING EVIDENCE TO ACTION: The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well-received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.

Four-year review of presenteeism data among employees of a large United States health care system: a retrospective prevalence study.

BACKGROUND: Historically, in an effort to evaluate and manage the rising cost of healthcare employers assess the direct cost burden via medical health claims and measures that yield clear data. Health related indirect costs are harder to measure and are often left out of the comprehensive overview of health expenses to an employer. Presenteeism, which is commonly referred to as an employee at work who has impaired productivity due to health considerations, has been identified as an indirect but relevant factor influencing productivity and human capitol. The current study evaluated presenteeism among employees of a large United States health care system that operates in six locations over a four-year period and estimated loss productivity due to poor health and its potential economic burden. METHODS: The Health-Related Productivity Loss Instrument (HPLI) was included as part of an online Health Risk Appraisal (HRA) administered to employees of a large United States health care system across six locations. A total of 58 299 HRAs from 22 893 employees were completed and analyzed; 7959 employees completed the HRA each year for 4 years. The prevalence of 22 specific health conditions and their effects on productivity areas (quantity of work, quality of work, work not done, and concentration) were measured. The estimated daily productivity loss per person, annual cost per person, and annual company costs were calculated for each condition by fitting marginal models using generalized estimating equations. Intra-participant agreement in reported productivity loss across time was evaluated using κ statistics for each condition. RESULTS: The health conditions rated highest in prevalence were allergies and hypertension (high blood pressure). The conditions with the highest estimated daily productivity loss and annual cost per person were chronic back pain, mental illness, general anxiety, migraines or severe headaches, neck pain, and depression. Allergies and migraines or severe headaches had the highest estimated annual company cost. Most health conditions had at least fair intra-participant agreement (κ ≥ 0.40) on reported daily productivity loss. CONCLUSIONS: Results from the current study suggested a variety of health conditions contributed to daily productivity loss and resulted in additional annual estimated costs for the health care system. To improve the productivity and well-being of their workforce, employers should consider presenteeism data when planning comprehensive wellness initiatives to curb productivity loss and increase employee health and well-being during working hours.

A qualitative study of facilitators and barriers to implementing worksite policies that support physical activity.

BACKGROUND: Physical inactivity is associated with several chronic diseases that are costly to society, employers, and individuals. Workplaces are a common location for physical activity (PA) initiatives because of the amount of time individuals who are employed full time spend at work. This research examined a statewide worksite wellness program, the Healthiest Maryland Businesses (HMB) program, to fill an important gap regarding the facilitators for and barriers to implementing workplace policies that support PA. METHODS: Individual telephone interviews were conducted in December 2015 with six HMB Coordinators and their supervisor, and from August through October 2016 with a purposeful sample of 15 businesses of various sizes from across Maryland, to learn about the role of leadership, and successes and challenges of implementing PA programs and policies. The sample of businesses was intentionally selected to capture perspectives from a range of businesses. Interviews were recorded and professionally transcribed. Descriptive coding was used to identify dominant themes that addressed the study aims and research questions. RESULTS: PA was not described as a priority for several large and small businesses. To garner more support for PA, interviewees emphasized associating PA initiatives with measures the businesses care about, such as health care costs from claims data. Small businesses also described having a need for PA programming yet reported having significant resource constraints. There was a strong interest in developing guidance for implementing PA break policies, which was mentioned as a critical support for workplace PA promotion. More commitment and investment of resources from leadership, and an engaged wellness committee with company representation at all levels and roles, were identified as vital for impactful programs. CONCLUSIONS: Most businesses are implementing PA programs with limited policy supports, which was mentioned as a barrier. Successful implementation of workplace wellness programs broadly, and PA initiatives specifically, are achievable through leadership buy-in, employee input, and policy supports, along with highlighting the economic benefits for businesses.

Workplace wellness: industry associations are well placed and some are ready to take a more active role in workplace health.

BACKGROUND: Investments in settings-based health interventions can include workplaces, however, engaging with businesses and convincing them to take a role can be difficult. Our research investigated the potential for trade or industry associations (IAs) to have a role in promoting workplace health initiatives to their members. METHODS: Seventeen semi-structured interviews were undertaken with senior executives from IAs representing industries in the mining, transport, agriculture, manufacturing, farming, hospitality, and construction sectors. Analysis of interviews identified themes around attitudes to workplace health promotion programs and the perceived, actual and potential role/s of IAs in promoting workplace wellness. RESULTS: IA representatives believed workplaces had potential to be promoting the health and wellbeing of workers through their member organisations; however for some the extent of their role was unclear and for others there was confusion between government-mandated safety initiatives and non-mandated health and wellbeing initiatives. All reported that their IA could have a role in promoting worker health and wellbeing initiatives to member organisations. IAs with larger companies as members were more likely to recognise the importance of workplaces promoting workers' health; however, the degree of involvement considered appropriate varied. Most IAs had not discussed the topic with their member organisations although they identified resources and support that could assist them in encouraging members to undertake workplace health programs. Resources included industry-relevant business cases outlining the benefits of workplace health, and industry-appropriate worker health information. CONCLUSIONS: Our research suggests that across many industry sectors, larger IAs in particular are ready to take a more active role in workplace health initiatives and are well placed to promote these to member organisations.

Perception, Interpretation, and Impact of Health Risk Appraisal Feedback: Pilot Studies of an Assessment Tool.

One mandate of the Affordable Care Act is continued support of workplace wellness programs. A tool used to encourage behavior change is a health risk appraisal (HRA). However, research indicates there is limited benefit to HRAs unless supported by additional health interventions. The purpose of these two pilot studies was to examine effects of the individual HRA personalized feedback, including the perceived value of the feedback and its influence on behavior change. Six months after completing and receiving HRA personalized feedback, participants in two separate Indiana organizations answered survey questions about the HRA value, motivational influence, and ability to prompt behavior change. Descriptive statistics, chi-square tests, analyses of variance, and factor analysis were used to analyze the influence of various factors and test the relationship between HRA generated feedback and these characteristics. The majority of respondents indicated the HRA was helpful with 69% (Study 1, n = 51) and 63% (Study 2, n = 116) of the respondents reporting an attempted behavior change. Preliminary results indicate that completion of an HRA with feedback alone may be beneficial in prompting behavior change.

Effects of an employee exercise programme on mental health.

BACKGROUND: Prior research indicates that workplace wellness programmes (WWPs) are generally associated with lowered healthcare costs and improved employee health. Despite the importance of mental well-being in workplace productivity and attendance, few WWP studies have focused on improvements in psychological well-being. AIMS: To examine the effects of the Bruin Health Improvement Program (BHIP), a 3-month exercise and nutrition WWP, on seven domains of health: physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life. METHODS: Using data from BHIP completers, we conducted multiple one-way multivariate analyses of variance and follow-up univariate t-tests to examine changes in physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life. Effect sizes were also calculated post hoc to determine the magnitude of each effect. RESULTS: Results for the 281 participants reveal significant improvements across all seven domains (P < 0.001). Effect sizes ranged from 0.19 to 0.67. CONCLUSIONS: This study is unique in revealing the effects of a WWP on multiple domains of psychological well-being. Given rising healthcare costs associated with mental health, targeting mental health through WWP may be an effective strategy for reducing indirect healthcare costs associated with absenteeism and presenteeism.

The economic impact of workplace wellness programmes in Canada.

BACKGROUND: The economic benefits of workplace wellness programmes (WWPs) are commonly cited as a reason for employers to implement such programmes; however, there is limited evidence outside of the US context exploring their economic impact. US evidence is less relevant in countries such as Canada with universal publicly funded health systems because of the lower potential employer savings from WWPs. AIMS: To conduct a systematic review of the Canadian literature investigating the economic impact of WWPs from an employer perspective. The quality of that evidence was also assessed. METHODS: We reviewed literature which included analyses of four economic outcomes: return on investment calculations; cost-effectiveness or cost-benefit analyses; valuations of productivity, turnover, absenteeism and/or presenteeism costs; and valuations of health care utilization costs. We applied the British Medical Journal (BMJ) Economic Evaluation Working Party Checklist to evaluate the quality of this evidence. RESULTS: Eight studies met the inclusion criteria. Although the studies showed that WWPs generated economic benefits from an employer perspective (largely from productivity changes), none of the reviewed studies were in the high-quality category (i.e. fulfilled at least 75% of the checklist criteria) and most had severe methodological issues. CONCLUSIONS: Though the Canadian literature pertaining to the economic impact of WWPs spans over three decades, robust evidence on this topic remains sparse. Future research should include a comparable control group, a time horizon of over a year, both direct and indirect costs, and researchers should apply analytical techniques that account for potential selection bias.

Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism.

BACKGROUND: Presenteeism is a growing problem in developed countries mostly due to an aging workforce. The economic costs related to presenteeism exceed those of absenteeism and employer health costs. Employers are implementing workplace health promotion and wellness programs to improve health among workers and reduce presenteeism. How best to design, integrate and deliver these programs are unknown. The main purpose of this study was to use an intervention mapping approach to develop a workplace health promotion and wellness program aimed at reducing presenteeism. METHODS: We partnered with a large international financial services company and used a qualitative synthesis based on an intervention mapping methodology. Evidence from systematic reviews and key articles on reducing presenteeism and implementing health promotion programs was combined with theoretical models for changing behavior and stakeholder experience. This was then systematically operationalized into a program using discussion groups and consensus among experts and stakeholders. RESULTS: The top health problem impacting our workplace partner was mental health. Depression and stress were the first and second highest cause of productivity loss respectively. A multi-pronged program with detailed action steps was developed and directed at key stakeholders and health conditions. For mental health, regular sharing focus groups, social networking, monthly personal stories from leadership using webinars and multi-media communications, expert-led workshops, lunch and learn sessions and manager and employee training were part of a comprehensive program. Comprehensive, specific and multi-pronged strategies were developed and aimed at encouraging healthy behaviours that impact presenteeism such as regular exercise, proper nutrition, adequate sleep, smoking cessation, socialization and work-life balance. Limitations of the intervention mapping process included high resource and time requirements, the lack of external input and viewpoints skewed towards middle and upper management, and using secondary workplace data of unknown validity and reliability. CONCLUSIONS: In general, intervention mapping was a useful method to develop a workplace health promotion and wellness program aimed at reducing presenteeism. The methodology provided a step-by-step process to unravel a complex problem. The process compelled participants to think critically, collaboratively and in nontraditional ways.

Participatory workplace wellness programs: reward, penalty, and regulatory conflict.

UNLABELLED: POLICY POINTS: Workplace wellness programs that provide incentives for completing a health risk assessment are a form of participatory programs. There are legal and ethical concerns when employers assess penalties for not completing a health risk assessment, raising questions about the voluntariness of such a program. The Departments of Treasury, Labor, and Health and Human Services' 2013 regulations for participatory programs and employers' current practices conflict with the Equal Employment Opportunity Commission's prevailing interpretation of the Americans with Disabilities Act of 1990. CONTEXT: In keeping with the Patient Protection and Affordable Care Act, Congress revised the law related to workplace wellness programs. In June 2013, the Departments of Treasury, Labor, and Health and Human Services passed the final regulations, updating their 2006 regulatory framework. Participatory programs that reward the completion of a health risk assessment are now the most common type of wellness program in the United States. However, legal and ethical concerns emerge when employers utilize incentives that raise questions about the voluntariness of such programs. At issue is that under the Americans with Disabilities Act (ADA) of 1990, employers cannot require health-related inquiries and exams. METHODS: To analyze the current interpretation of the ADA, I conducted research on both LexisNexis and federal agency websites. The resulting article evaluates the differences in the language of Congress's enabling legislation and the federal departments' regulations and how they may conflict with the ADA. It also reviews the federal government's authority to address both the legal conflict and ethical concerns related to nonvoluntary participatory programs. FINDINGS: Employers' practices and the federal departments' regulations conflict with the current interpretation of the ADA by permitting employers to penalize employees who do not complete a health risk assessment. The departments' regulations may be interpreted as conflicting with Congress's legislation, which mentions penalties only for health-contingent wellness programs. Furthermore, the regulatory protections for employees applicable to health-contingent wellness programs do not apply to participatory programs. CONCLUSIONS: Either Congress or the federal agencies should address the conflict among employers' practices, the wellness regulations, and the ADA and also consider additional protections for employees. Employers can avoid ethical and legal complications by offering voluntary programs with positive incentives.