Best practice

Success Stories | Success Factors | Programmes & Incentives | Implementation & Evaluation

Most successful interventions emerging from the research

In studies on the effectiveness of varying physical activity and exercise programmes the best results were obtained when counselling was offered to inactive employees, combined with peer support and opportunities to exercise with others at work. One-to-one counselling alone was second. Education/motivational campaigns that include scheduled opportunities for fun and moderate group activity can be quite effective in increasing physical activity on a population-wide basis. A doctor's advice plus referral to a health/fitness educator for more information has also been found to be effective in improving patients' physical activity.

Regarding different strategies for offering fitness programmes, a lead researcher concludes that the most effective and cost-effective option is to provide a moderately-well-equipped facility, an active outreach to non-participants, one-to-one counselling, and a corporate environment that encourages a healthy lifestyle.

Providing opportunities for individual risk reduction.

Results from well-conducted randomised trials suggest that providing opportunities for individual risk reduction and counselling for high-risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion programme. Researchers concluded that there was a significant positive effect of one-to-one counselling and encouragement of employees' long-term behaviour change.

Fitness and health promotion services have been found to show a return between US$1.49 and US$6.15 for every dollar spent. Disease management programmes have been found to show a return between US$7.33 and US$10.31 for every dollar spent.

Research clearly shows that a health management programme that focuses on high-risk populations can result in financial savings to employers.

Effective co-ordination and management of health and productivity management programmes is crucial to success.

Target employees' readiness to change

The Australian National Workplace Health Project - The Good Form Programme found that strategies which target employees' readiness to change (eg, get smokers to think about quitting) can increase their participation in subsequent programme activities. The study found that readiness to change was significantly associated with employee attendance at workplace health-risk assessments and interventions.

Co-worker support is a vital ingredient in moving employees from a 'precontemplation' or 'contemplation' phase to a 'preparation' stage of programme uptake.

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Success Factors

Meg and Jiri Davidson-Rada have written a book on wellness programmes in New Zealand workplaces (Beyond Band.aid, Wellington, 1992). In their book they list the eight critical success factors of a workplace wellness programme:

• Support from the top - approval, dollars, ie, commitment that is firm, visible and ongoing.
• Employee involvement - input, consultation, ie, ownership that is extensive, co-operative and on-going.
• Trust and credibility - this means doing a few small, non-threatening activities first to build credibility, assure confidentiality, and making sure the programmes are accessible to all.
• Good planning & leadership - This needs key people such as managers, health practitioners and staff representatives who jointly hold planning, budgeting, and scheduling skills. It needs dynamic, enthusiastic people who are really interested in health.
• Clear and appropriate goals - derived after in-depth assessment of company and employee needs, probable company resources available, and likely industry and community resources.
• Adequate resources - try creative resourcing; make maximal use of 'cheap and easy' ideas.
• A well-planned, well-promoted programme - put posters up around the worksite, send out newsletters and use other media; promotions should be well-timed and well-targeted, and use 'pushes' already occurring in the community or company.
• A programme kept going and kept energised - recognise the difficulty of maintaining programme energy, and use tools such as company policy and ongoing educational programmes to help. Use known motivational techniques such as feedback, rewards, variety, and reimbursement. Evaluate as a process and refine the programme.

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Programmes & Incentives

Ron Goetzel is a leading researcher of worksite health programmes. He is the author of many of the articles listed in the bibliography. In his article 'Essential Building Blocks for Successful Worksite Health Promotion Programs' Ron lists the main ingredients of successful programmes:

• Organisational Commitment
• Secure senior management commitment - with buy-in by middle managers.
• Establish and articulate a 'healthy company' norm and culture.
• Find and empower a visible leader or champion.
• Involve an employee-driven advisory board.
• Define specific programme goals and objectives - set realistic expectations.
• Align organisational, human resources, and health promotion policies and practices.
• Hope for organisational stability and resiliency.

Incentives

Offer the right incentives to participate in the programme (eg, benefits, cash, or visibility) - incentives are necessary to recruit individuals least likely to get involved. Support effective marketing and communication campaigns to engage those hard to reach. Provide easy access to programmes and facilities.

Screen and Triage

Cast a wide net (in the form of a comprehensive health risk assessment) to identify the highest risk individuals - remember to protect participants' confidentiality. Recruit, cajole, prod, reach out, and engage those at highest risk. Triage individuals into programmes that produce the greatest impact and payoff. Co-ordinate efforts with the provider community.

Take Advantage of State-of-the-art Intervention Programmes

Insist that worksite health promotion programmes be science-based (not fad based). Customise and individualise interventions - for example, make sure that interventions are directed at participants' appropriate level of 'readiness to change'. Balance high touch with high tech - remember to maintain human connections. Build in psychosocial considerations in design of the programme by recognising that individuals make decisions concerning health and self-care based on their feelings and attitudes as well as their actual state of health. Emphasise the long-term effort in maintaining change - make sure that the programme's supporters are in it for the long term. Know and use what works - know and discard what doesn't.

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Implementation & Evaluation

Implement Effectively

Offer a variety of topics and engagement modalities to catch and sustain interest. Engage and involve participants - don't let go. Hire the right staff - individuals who are talented, enthusiastic and organised. Integrate the staff into the fabric of the organisation. Spend the right amount of money to achieve a desired return on investment.

Evaluate Success

Understand the sequence of critical success factors:

• Awareness
• Participation
• Increased knowledge
• Improved attitudes
• Behaviour change
• Risk reduction
• Reduced utilisation
• Reduced benefit costs.
• Budget dollars for evaluation efforts (range from 3-5 % of the cost of the intervention)
• Perform both tracking and rigorous evaluation studies
• Publish results (internally and externally)
• Learn from the successes and failures of others.

The Canadian Council for Health and Active Living at Work have described the seven criteria that contribute to programme success. These are:

• The programme meets needs of employees both in terms of their physical health and overall sense of wellbeing.
• The process is well-planned, officially introduced and includes a health education component.
• The programme positioning incorporates the idea that employee health and wellbeing is primarily the responsibility of the employee, with thoughtful and sustained support from the organisation and, where appropriate, the union.
• The organisation needs to be seen to be providing access to active living at work as a tool to help employees maintain and improve their health.
• The programme is flexible and allows employees to choose how best to incorporate active living into their daily lives.
• Individual health management is visibly supported by senior management.
• Communications activities link wellness programmes to overall business goals such as adaptability, resilience, competitiveness, productivity, individual responsibility etc.

A panel of experts was assembled to identify and rank the highest quality studies that have been published on the relationship between health risk, health promotion programmes and financial outcomes. This study is documented in Golaszewski, T (see abstracts).
It should be noted that many of these studies can not be directly related to the New Zealand context as they take into account the high cost of medical care and insurance incurred by employers in the USA.

• The Health Enhancement Research Organisation 1 (HERO-1) Study
• The HealthPartners Study
• The HERO-2 Study
• The Steelcase Study
• The Co-operative Health Education Project (CHEP)
• The Johnson & Johnson Study
• The Dupont Study
• The City of Birmingham Study
• The Citibank Study
• The California Public Employees' Retirement System (PERS) Study
• The Health Worker project (HWP)
• The Travellers' Study

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Updated | 22 Oct 2006.

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