Best practices in evaluating worksite health promotion programs.

Program evaluation is generally recognized as a "best practice" activity for worksite health promotion programs. The importance of "best practice" worksite health promotion programming is increasing with the stakes anticipated by health care reform. Volvo's health promotion activities are used as an example of "best practice" programming with a particular focus on creating a dashboard of evaluation metrics that can meet the accountability needs of senior management. The role of a comprehensive evaluation framework using nine components is explored along with reasonable expectations for program outcomes. Finally, stakeholder utility from the evaluation approach is explored.

Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes.

OBJECTIVE: To explore how changing incentive designs influence wellness participation and health outcomes. METHODS: Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes. RESULTS: Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL) (P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk. CONCLUSION: Incentive design and organizational characteristics impact population-level participation and health outcomes.

Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support.

PURPOSE: This study tested relationships between health and well-being best practices and 3 types of outcomes. DESIGN: A cross-sectional design used data from the HERO Scorecard Benchmark Database. SETTING: Data were voluntarily provided by employers who submitted web-based survey responses. SAMPLE: Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017. MEASURES: Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support. ANALYSIS: Three structural equation models were developed to investigate the relationships among study variables. RESULTS: Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index > 0.96). Organizational and leadership support was the strongest predictor (P < .05) of participation (n = 276 organizations), impact (n = 160 organizations), and perceived organizational support (n = 143 organizations). Incentives predicted participation in health assessment and biometric screening (P < .05). Program comprehensiveness and program integration were not significant predictors (P > .05) in any of the models. CONCLUSION: Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data.

Development and Validity of a Workplace Health Promotion Best Practices Assessment.

OBJECTIVE: To explore the factor structure of the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer (HERO Scorecard) to develop a reduced version and examine the reliability and validity of that version. METHODS: A reduced version of the HERO Scorecard was developed through formal statistical analyses on data collected from 845 organizations that completed the original HERO Scorecard. RESULTS: The final factors in the reduced Scorecard represented content pertaining to organizational and leadership support, program comprehensiveness, program integration, and incentives. All four implemented practices were found to have a strong, statistically significant effect on perceived effectiveness. Organizational and leadership support had the strongest effect (ß = 0.56), followed by incentives (ß = 0.23). CONCLUSION: The condensed version of the HERO Scorecard has the potential to be a promising tool for future research on the extent to which employers are adopting best practices in their health and well-being (HWB) initiatives.

The role of incentive design, incentive value, communications strategy, and worksite culture on health risk assessment participation.

PURPOSE: To examine the impact of financial incentives, communications strategy, and worksite culture on health risk assessment (HRA) participation rates. DESIGN: A cross-sectional study design was used to examine factors that influence employee participation, including incentive value, incentive design, communications strategy, and worksite culture. SETTING: Large private-sector and public-sector employers. PARTICIPANTS: Thirty-six employers (n = 559,988 employees) that provided financial incentives to promote employee HRA participation. INTERVENTION: Organizations implemented the HRA as part of a more comprehensive worksite health promotion strategy that included follow-up interventions and a variety of other components. The primary outcome of interest was employee HRA participation. MEASURES: Information on program design and structure, as well as on HRA eligibility and participation, was collected for each organization via standard client report and semistructured interviews with account managers. General linear regression models were used to examine the extent to which factors influence HRA participation independently and when controlled for other factors. RESULTS: Incentive value (r2 = .433; p < .000), benefits-integrated incentive design (r2 = .184; p = .009), culture (r2 = .113; p = .045), and communications strategy (r = .300; p = .001) had positive bivariate associations with HRA participation rates. When all factors were included in the model, incentive value (p = .001) and communications strategy (p = .023) were significantly associated with HRA participation. Variance accounted for by all factors combined was R12 = .584. CONCLUSION: This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.

Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements.

OBJECTIVE: To identify and evaluate the evidence base for culture of health elements. DATA SOURCE: Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements. STUDY INCLUSION AND EXCLUSION CRITERIA: Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors. DATA EXTRACTION: Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted. DATA SYNTHESIS: Data synthesis focused on research approach and design as well as culture of health elements evaluated. RESULTS: The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome. CONCLUSIONS: A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.

Linking Workplace Health Promotion Best Practices and Organizational Financial Performance: Tracking Market Performance of Companies With Highest Scores on the HERO Scorecard.

OBJECTIVE: The aim of the study was to evaluate the stock performance of publicly traded companies that received high scores on the HERO Employee Health Management Best Practices Scorecard in Collaboration with Mercer© based on their implementation of evidence-based workplace health promotion practices. METHODS: A portfolio of companies that received high scores in a corporate health and wellness self-assessment was simulated based on past market performance and compared with past performance of companies represented on the Standard and Poor's (S&P) 500 Index. RESULTS: Stock values for a portfolio of companies that received high scores in a corporate health and wellness self-assessment appreciated by 235% compared with the S&P 500 Index appreciation of 159% over a 6-year simulation period. CONCLUSIONS: Robust investment in workforce health and well-being appears to be one of multiple practices pursued by high-performing, well-managed companies.

Sanitarians' work with indoor-tanning businesses: findings from interviews in two major metropolitan areas.

In spite of health risks, indoor tanning is a popular practice and a growing industry. Although published studies indicate that tanning businesses' compliance with regulations is poor, no studies describe enforcement activity and the related knowledge and perceptions of environmental health professionals. As part of a larger study of indoor tanning in Minnesota and Massachusetts, both states with statutes that regulate tanning, the investigation reported in this paper involved interviews of 27 sanitarians in the Twin Cities and 30 sanitarians in the Boston metropolitan area about their awareness, experiences, and practices. Overall, Massachusetts performed better than Minnesota with respect to familiarity with regulations (93 percent versus 67 percent), routine business inspections (90 percent of agencies versus 27 percent), and priority given by agencies to indoor-tanning work-differences likely attributable to a stronger state statute. Participants in both states, however, recalled few aspects of the regulations and were able to identify few of the health risks associated with indoor tanning, and most reported receiving inadequate training. Various steps must be taken to improve environmental health work with tanning businesses, including educating the public, strengthening regulations, addressing resource issues, and training sanitarians.

Is It Time for a Broader Approach? Recasting the Value of "Employee Health" With a Focus on Workforce Capability.

A discussion about a value proposition for investment in employee health initiatives that necessitates a more comprehensive and multifaceted approach to optimizing the human capital within an organization.

Key Requirement for the Future: Broadening Our Perspective.

Reviews of three new books that introduce approaches to enhance workforce health and well-being through culture and organizational change.

Exploring the Value Proposition for Workforce Health: Business Leader Attitudes About the Role of Health as a Driver of Productivity and Performance.

A survey of more than 500 leaders showing how business leaders think about the concepts of productivity and performance, and also their beliefs about the connection between health, productivity, and performance.

Health risk change as a predictor of productivity change.

OBJECTIVE: To assess how health risk change influences concurrent and subsequent change in absenteeism and presenteeism. METHODS: A retrospective, longitudinal study design analyzed repeated health assessment survey data using maximum likelihood structural equation modeling. RESULTS: A statistically significant relationship was detected between self-reported health risks at one point in time and lower productivity (absenteeism and presenteeism) at the same point in time as well as a longitudinal effect of increasing risks at one point in time associated with decreased productivity at subsequent measurement periods. CONCLUSIONS: Health is a predictor of productivity, and the benefits of improved health on improved productivity are cumulative over time.