Larry S. Chapman

Meta-Evaluation of Worksite Health Promotion Economic Return Studies: 2012 Update

Two earlier editions of The Art of Health Promotion reported formal meta-evaluations of economic return studies of worksite health promotion programs. These meta-evaluations were among the most popular articles in our publishing history because practitioners, scientists, and employers continue to seek evidence on the economic effectiveness of workplace health promotion. The 2003 report examined 42 peer-reviewed journal articles that met the inclusion criteria, and the 2005 report examined 56 peer-reviewed journal articles. This 2012 update examines 10 additional studies that met the same set of inclusion criteria; four of the weaker studies were dropped, resulting in a total of 62 studies in this report. The meta-evaluation method used here is the same as used in the earlier reports and has been adapted from use with other preventive health programs, providing an overall summary and individual look at the quality of the peer reviewed articles that comprise the current scientific evidence of economic return for worksite health promotion and wellness programs. The term ‘‘meta-evaluation’’ as used in this article is defined as the application of a systematic review process to a set of evaluation studies with a similar purpose in order to determine their respective quality and to summarize their primary findings. It applies the formal meta-evaluation review process and methodology developed and refined by Windsor and Orleans and further modified by Boyd and Windsor to studies of multi-component worksite health promotion programs as defined by Heaney. This report include excerpts from the book Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, seventh edition, revised and expanded in December of 2011, which applies the same methodology. This edition of The Art of Health Promotion addresses the following topics:

Spiritual health: a component missing from health promotion.

The vast majority of existing health promotion programs in community, workplace or special population settings do not deal with spiritual health issues. It is rare to find a program that openly labels a specific activity or intervention as oriented to enhancement of spiritual health. Yet any perspective that defines the human condition in a narrowly mechanistic or value free manner seems to be unnecessarily sterile and consequently incomplete. Our current collective approach to health promotion gingerly side steps this reality. We generally feel somewhat embarrassed to mention things like love, joy, peace, sense of purpose, connectedness, reverence for living or achieving one’s full potential in the context of most health promotion programs. Should we not strive to broaden our concept of health promotion to include these kinds of issues? After all, what is life worth if there is no love in it? Or joy? Or peace? Or an overriding sense of purpose? Or connectedness to others? Or the goal of being all that we can be? Are we only interested in prolonging life and unclogging arteries? I hope not.

Enhancing Intrinsic Motivation in Health Promotion and Wellness

Health promotion and wellness specialists have long held this belief: ‘‘If you build a wellness program to help people lead healthier lives, they will come.’’ And why wouldn’t they? Start with completing a health risk assessment (HRA) and possibly biometric screening; the process alone can potentially be lifesaving, alerting people with conditions such as high cholesterol, hypertension, and diabetes to the significant risk of these conditions. Similarly, the HRA can help identify predisposition to deadly diseases, such as cancer, that require immediate intervention. Who would not want to know the results of such an important assessment? Wellness interventions such as HRAs can build awareness, lead employees towards making better health decisions, and reduce companies’ ever-increasing health care costs. So why aren’t employees participating in large numbers in worksite wellness programs? From our general experience with wellness programs, we’ve seen that offering employees opportunities to improve health is simply not enough to cause them to use it. Despite the significant personal advantages from health promotion and wellness programs, many people still do not actively participate. To build intrinsic motivation for change, we believe that individuals need todiscover their own rewards forhealthybehavior.Employeesmust be supported within an organizational health culture to build their own goals, enhance their own knowledge, and follow through on their own concrete action steps. Through this health culture, employees can develop their own intrinsic values or incentives that help maintain their efforts towards achieving health goals. This article reviews scientific studiesofbehaviorchange thatprovideadeeperunderstandingofhuman motivation. The issues raised address how to design more effective health promotion and wellness programs, and illustrate ways to implement health change programs so that they enhance intrinsic motivation. To help us accomplish this we will be addressing the following topics:

The role of health and wellness coaching in worksite health promotion.

Health and wellness coaching has rapidly become a best practice element of worksite health promotion programs. Coaching as a process is a very old technology, but its use in the field of health promotion is relatively new. Coaching can be provided in different forms or modalities yet currently lacks a rigorous science base or a defined set of standards or common elements. In larger worksite settings several variants or forms of coaching are usually provided to employee populations. The need for more proactive and direct forms of intervention in health promotion is contributing to the rapid growth of coaching programs. There are currently an assortment of coaching strategies or techniques that are in common use in most coaching interventions. A main contention of current coaching practice is that coaching that uses facilitation strategies rather than prescriptive advice is more effective at producing long term behavior change. The congruence and size of wellness incentives with the coaching process are likely to be of significant importance. From a long term perspective, coaching is likely to become a staple of worksite health promotion practice.

Emerging trends in health and productivity management

Many large U.S. employers have generally embraced a Health and Productivity Management (HPM) perspective to guide their multiple employee health management efforts. In looking ahead there are a number of emerging trends that are helping to shape these efforts. As health promotion professionals assess the implications of these trends on their respective role and function within the worksite, it may provide a very useful process for refining strategies for programming and professional development. The identified trends also have a variety of implications for health promotion vendors and the growth of the health management marketplace.

Bringing Wellness to the Small Employer

Historically the predominant models of programming have evolved from mid to large size employer settings. Yet the majority of employees in any given community work for organizations that employ fewer than 500 employees. These small employers also constitute a disproportionate majority of all employers. Wellness practitioners need to develop programming models and strategies that are designed specifically for these small employer organizations. This article establishes a perspective for bringing wellness to the small employer based on recent research and considering the implications of the differences between small and large employers from a programming perspective. Finally, several anticipated aspects of future programming are described along with summary conclusions.

Strategies for strengthening the evidence base for employee health promotion programs.

Employee health promotion programs have been a visible facet of the American workplace for more than 30 years. During that time, a substantial amount of research on best practices has been conducted, but because of a lack of significant public investment in research funding there is still much to be done. Most researchers and practitioners familiar with the literature recognize the need to strengthen the evidence base for the field. In this edition of The Art of Health Promotion we examine the primary recommendations emerging from a recent federally sponsored effort to identify strategies for strengthening the evidence base for employee health promotion.

Health promotion in faith-based institutions and communities.

Approximately 83% of the U.S. population belongs to some form of faith-based institution or community. Approximately 40% of the entire population attends at least one service per week and at least 59% pray at least once each week. The majority of Americans (76%) identify themselves as Christians, mostly within Protestant and Catholic denominations, accounting for 51% and 25% of the entire population, respectively. The primary non-Christian religions (including Buddhism, Hinduism, Islam, Judaism, and ‘‘other’’) collectively make up about 3.9% to 5.5% of the adult population. Another 15% of the adult population identifies themselves as having no religious belief or no religious affiliation, whereas 5.2% said they did not know, or refused to reply. The 83% of the U.S. population that is part of faith-based institutions and communities is roughly equivalent to the proportion of the population that are in some way connected to employers, either as employees, family members of employees, or retirees of an employer (82%). Unquestionably this represents the vast majority of Americans and therefore represents a potentially important avenue for reaching individuals and families with health promotion and wellness. At the same time, the field of health promotion has not focused on faith-based communities or institutions with any consistency or depth. Thus, our reason for addressing this particular topic in this edition of The Art of Health Promotion; in doing so, we will examine the unique challenges of providing health promotion and wellness in faith-based institutions and communities, the primary disadvantages and advantages, and an example of an ‘‘ideal’’ program. Our plan is to address the following issues:

eHealth portals: who uses them and why?

The role of the Internet and specifically ehealth portals continue to expand at a significant pace. The various major functions of ehealth portals are identified, along with the results of an online survey conducted among employees of eight major U.S. employers. Demographic variables, job characteristics, reasons for use of the portal and selected behavioral outcomes are presented from a sample of more than 20,000 employees, with a response rate in relation to the entire employee population of 19%. Major implications from the survey findings are then identified, with an intention of enhancing the health improvement effectiveness of the ehealth portal.

Status report on disease management efforts for the health promotion community.

Status Report on Disease Management Efforts for the Health Promotion Community by Shirley Musich and Larry Chapman . . . . . . . . . . . . . . . . . . 1 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Selected Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Closing Thoughts, by Larry S. Chapman . . . . . . . . . . . . . . . . 15