Evidence-Based Health PromotionSeparating the Wheat from the Chaff

Dr. Joel Bennettlearn@organizationalwellness.comOctober, 2012

• Tremendous growth in workplace wellness programs

• Little in the way of evidence-based guidelines for understanding – what works, the why, and the how

• This presentation provides the latest research information on – best practice guidelines and – essential elements of effective programs

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Objectives

• Distinguish between programs that may be sold well and those that work

• Identify the common and core elements of effective wellness programs

• Be able to evaluate whether your current or prospective programs are meeting the standard

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Outline

PART 1: Evidence & Insights (lots)

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PART 1: Evidence & Insight

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Ease of Use

Cost Quality ROI

Does it work?

(some) factors leading to decision

Caveat• This presentation is about “Does it work?”• NOT the other stuff

5 Insights (preview)

1. Your ownership (of any program) is the key to success

2. You can “set the bar” on how much evidence you need to help select your wellness program

3. You can move from program “selection” to program “crafting”

4. System-level stress management is essential5. Your ownership is the key to success

(commitment)

Success does not lie in the programs themselves but in the INTERACTION between the internal

programmers, the work environment, and the programs. You have to “OWN” the program!

INSIGHT # 1

GROW FROM WITHIN AND STAY THERE

GROW FROM WITHIN AND STAY THERE

Will it work? (two standards)

Will it work for me?

What evidence do I need to know if it will work for me?

Hearsay

Marketing

Proof

Objectivity

Experience

Results

Strategy*

*HR Magazine: (March, 2011; Susan J. Wells)http://www.shrm.org/publications/hrmagazine/editorialcontent/2011/0311/pages/0311wells.aspx

Map a Wellness Strategy Assess your needs

Ask your employees

Start inside

Consider a comprehensive/integrated approach

Narrow field with accreditation/certification

Keep up to date on what works

Involve others, collaborate

Ask for assurances, guarantees

Evidence-based

Is there research behind the product/service??Was it independent research??What is the quality of the research??

• What does this term mean? • Danger of it being over-used and ill-defined• So, three key questions to ask:

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Is there research behind the product/service?? Testimonials: One Testimonials: Many (independent) Customer Satisfaction Expert Panels Case studies Follow-up change in self-report Follow-up change in behavior Pre-post change Experimental Design (single study) Experimental Design (many studies) Reviews and Meta-analysis

Settingthe bar

One internal evaluator, paid for by the company

Internal evaluators, paid for by outside sources

External evaluators, paid for by the company

External evaluators, paid for by outside sources

Non-affiliated research scientists with multiple target sites

Was it independent research??

One case study Multiple case studies Observational study (longitudinal) Correlation analysis Pre-post (self-report) Pre-post (behavior) Pre-post with control group Randomized clinical trial

What is the quality of the research?

Where you set “the bar” for determining “sufficient evidence” is determined by many factors. The key is that you can at least

know that there is a bar/standard to set; bring into the purchase conversation. You have to show intelligence!

INSIGHT # 2

COMMUNICATE YOUR STANDARD

COMMUNICATE YOUR STANDARD

My goal today is synthesis!

• Review of evidence-based approaches• Synthesize into core ideas (memory aids)• Five areas to get started or to refresh

1. Walk the talk (Leadership)2. Love your “sparkplugs” (Advocates)3. The power of small groups (Teams)4. Think strategically about wellness (Climate)5. Keep giving back (Community)

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Preview Memory Aids

Broad Recommendations

Specific Benchmarks

Evidence-Based Criteria

OperationalGuidance

Broad

Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing (NIOSH, 2008; DHHS No. 2010-140)List derived by panel of experts

Promising Practices in Employer Health and Productivity Management Efforts: Findings From a Benchmarking Study (Goetzel, Schecter, Ozminkowski et al. 2007)Literature review of 5 best-practice studies, site visits to 9 promising practice employers, interviews with SMEs

Promising Practices for the Prevention and Control of Obesity in the Worksite (Archer, Batan, Buchanan, Soler et al., 2011)Synthesis of empirical results from 136 studies, each weighted on the basis of study design, quality, and effect size.

Organizational Culture/Leadership⦁ Develop a “Human

Centered Culture”⦁ Demonstrate

leadership⦁ Engage mid-level

management

Program Design⦁ Establish clear principles⦁ Integrate relevant systems⦁ Eliminate occupational

hazards⦁ Promote employee

participation⦁ Tailor programs to specific

workplace⦁ Find and use the right tools⦁ Adjust the program as

needed

Program Implementation⦁ Be willing to start small

and scale up⦁ Communicate

strategically⦁ Build accountability

into program implementation

Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing (NIOSH, 2008; DHHS No. 2010-140)

List derived by panel of expertsNote. Incomplete, list below is example of 20 recommendations.

Broad recommendations

Promising Practices in Employer Health and Productivity Management Efforts: Findings From a Benchmarking Study (Goetzel, Schecter, Ozminkowski et al. 2007)Literature review of 5 best-practice studies, site visits to 9 promising practice employers, interviews with SMEsNote. Incomplete, following are from Table 1 (parentheses is # of the 5 best-practice studies that showed evidence for the characteristic)

Benchmarks

•Organizational commitment (all 5)•Identification of wellness champions (3)•Data collection, measurement, reporting, and evaluation (including ROI) (3)•Ongoing program evaluation (3)•Program linked to business objectives (2)•Effective communication (2)•Effective operation plan (2)•Program goals include productivity & morale (2)•Interdisciplinary team focus (2)•Incentives to participate (2)•Effective screening and triage (2)•State-of-the-art interventions (2)

Classic Benchmarking Study (2000)*

1. Align with business strategy2. Create diverse teams (HR, benefits, safety, legal)3. Cultivate champion(s) with a sense of purpose4. Put senior managers/business ops on the team5. Assure health promotion staff are heavily engaged

*Goetzel, R., Guindon, A., Turshen, I., & Ozminkowski, R. (2001). Health and productivity management. Journal of Environmental & Occupational Medicine, 43(1), 10-17.

6. Emphasize quality-of-life improvement, not just cost cutting 7. Increase importance of evaluation over time 8. Communicate constantly and throughout the organization9. Show a constant need to improve BY learning from others10. Have fun

Another Benchmark Example

Best Practice Score-Card (2010)*

Strategic planning (formal plan with objectives) Leadership engagement (senior, champions, policies) Program level management

Programs (risk appraisal, evidence-based lifestyle management) Engagement methods (engaging communication, incentives) Measurement and evaluation

Employee Health Management Best Practice Scorecard*http://www.the-hero.org

Program diversity (safety, diet, exercise, occ. health, EAP)

Vendor alignment and coordination

Very good access to program for all workers

Benefits design promotes utilization

Another Benchmark Example

Promising Practices for the Prevention and Control of Obesity in the Worksite (Archer, Batan, Buchanan, Soler et al., 2011)Synthesis of empirical results from 136 studies, each weighted on the basis of study design, quality, and effect size.

Evidence-Based Criteria

Note. List below shows all studies found and those that were deemed of "Greatest Suitability" due to high quality and positive outcomes.

•Enhanced access to opportunities for physical activity combinedwith health education (5 studies, 3 suitable)•Exercise prescriptions alone (14 studies, 10 suitable)•Multi-component educational practices (25 studies, 13 suitable)•Weight loss competitions and incentives (16 studies, 6 suitable)•Behavioral practices with incentives (17 studies, 8 suitable)•Behavioral practices without incentives (47 studies, 26 suitable)

Computer-Delivered Interventions for Health Promotion and Behavioral Risk Reduction: A Meta-Analysis of 75 Randomized Controlled Trials, 1988 – 2007*

CDIs were successful at improving nutrition, reducing tobacco use, reducing substance use, increasing safer sexual behavior, reducing binge/purging behaviors, and promoting general health maintenance

No improvements were observed for physical activity, weight loss, diabetes control, or weight gain/maintenance.

KEY FACTORS: PLACEBO? Providing individuals with any active

intervention content is likely to lead to change. MOTIVATION MAY WEAKEN: Interventions that

had users look at the costs/benefits of quitting an unhealthy behavior or adopting a healthy one were less effective.

Another Evidence-Based Criteria

*http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572996/

Another Evidence-Based Criteria

Healthy Workplace

Team Awareness

Wellness Outreach at Work

Coping with Work &Family Stress

There is so much information about “what works” that we can now re-frame the decision-making from “What should I

select?” to “How can I best craft/shape programs based on my needs/costs?”

Use evidence-based principles!

INSIGHT # 3

OWN YOUR OWN CREATIVITY

OWN YOUR OWN CREATIVITY

Another Evidence-Based Criteria

Stress ManagementEffective Elements(2008 reviews)

Parks, K. M., & Steelman, L. A. (2008). Organizational wellness programs: A meta-analysis. Journal of Occupational Health Psychology, 13, 58–68.Richardson, K. M., & Rothstein, H. R. (2008). Effects of occupational stress management intervention programs: A meta-analysis. Journal of Occupational Health Psychology,13, 69–93.

LaMontagne et al:30 different interventions

Parks & Steelman:15 different studies

Richardson & Rothstein:36 experimental studies, representing 55 interventions

Lamontagne, A. D., Keegel, T., Louie, A. M., Ostry, A., & Lansbergis, P. A. (2007). A Systematic review of the job-stress intervention evaluation literature, 1990–2005. International Journal of Occupational and Environmental Health, 13, 268–820.

It makes no sense to only focus on individual stress management; like teaching someone to fish instead of always

feeding them it pays to help the system to help itself

Use multi-level approaches!

INSIGHT # 4

TREAT THE SYSTEM…PLEASE!

TREAT THE SYSTEM…PLEASE!

Other NoteworthyResources

(to help re-frame)

• Assists employers in identifying gaps in their health promotion programs• Helps them prioritize high-impact strategies for the following health topics:

• organizational supports,• tobacco control• nutrition• physical activity• weight management• stress management• depression• high blood pressure• high cholesterol• diabetes• signs and symptoms of heart attack and stroke• emergency response to heart attack and stroke.

You can have the greatest technology based on solid evidence-based principles but if you don’t have ownership

of the program you may be wasting your time, money, or both.

Own programs from the inside out!

INSIGHT # 5

Burden Compliant Obligation

Reasoned Obligation

MotivatedResponsibility

Visioning Calling/Cause

EmbodiedPassion

resistance “have to” “need to” “want to” “We can achieve”

“We can change”

“We are transforming”

Your Health

Your Values

Levels of Ownership

Greater chancesof success

Reduced chances of success

We start moving from obligation to ownership when our role is driven by our own values and when we see that our own health and well-being is part of our role.

© Organizational Wellness & Learning Systems, 2012.

AccountabilityInterest

HRM39

PART 2: Synthesis

Illness

Wellness

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OWLS Best Practice Thumbnail

OWLS Best Practice Thumbnail

oMotivationoMood & EnergyoSense of BelongingoSense of EngagementoPresenteeism

We

Its

I

It

oGood Diet & ExerciseoRole ModelingoParticipationoPerformanceoCommunicate

oTeam SpiritoCulture of Healtho Wellness CommitteeoLocal “Peer” ClimateoConnectedness

o Biometrics/ProgramsoRisk appraisal dataoCulture/climate dataoFiles/Benefits, IncentivesoCommunications

Belonging Participation

Culture/climate

Communications

Tip # 1: Walk the talk

Up to 50% of all executives will die of stress-related diseases

Employee’s relationships with their boss predicts their future health

Tip # 2: Love your sparkplugs

Early adopters Wellness advocates Champions Change agents

Tip # 2: Love your sparkplugs

Hunt them down

Engage them

Support them

Reward them

www.prevtools.com

Give them room

Tip # 3: Empower groups/committees

Formal Committee

1.Part of job description2.Diverse3.Promoted well4.Frequent communication5.A strong leader6.Meets regularly7.Continuing education

WELCOA (2007)

Informal/Training

TeamAwareness

Tip # 4: Think strategically about wellness

Why give workers healthy lifestyle skills and ignore a “toxic” work environment?

Is it possible that the underlying risks for cardiovascular disease/obesity lie in

psychological and environmental factors?

You maximize ROI when you attend to climate and depression engagement stress

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Presence

Teamwork Policy

Support

Work-LifeBalance

Coping

Wellness

RISK

RESILIENT

The climate of work units vary in health

Some are healthier than others

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PolicyTeamwork

SupportWork-LifeBalance

Wellness Presence Coping

RISK

RESILIENT

Upper Limit Problem

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What factors ‘upper limit’ wellness?

Tip # 4: Think strategically about wellness

Assess the work climate (level & dimension)

Include behavioral health (depression)

Identify your upper limiting factors early on

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2

3

REVIEW

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Tip # 5: Keep giving back (community)

You’re helping families of workers (community)

Small businesses can band together

The business itself becomes the role model

1

2

3

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Tip # 5: Keep giving back/Community

www.sbwi.orgLeadership Sparkplugs Groups Climate

Review

Groups/TeamsLeadership

Sparkplugs

Climate

Helping… …families,other businesses,community

Contact Information

Dr. Joel BennettOrganizational Wellness & Learning Systems

3321 Collinsworth St. (suite 220)Fort Worth, Texas, 76107

www.organizationalwellness.com(817) 921-4260

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