The relationship between structural and policy level changes at the workplace and employee health indicators as part of a worksite health promotion program: Findings from the Western New York Wellness Works study
Foley, Gabrielle S.
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The Western New York Wellness Works (WNYWW) initiative was a community-based, pre-post study which measured changes in employee health among organizations which implemented worksite health promotion initiatives. Ten worksites conducted self-directed and self-implemented two-year wellness intervention programs at their respective worksites. The employee population of each worksite was offered the opportunity to complete an individual Health Risk Appraisal (HRA) at baseline (2005) and follow-up (2007). HRAs were completed by 1,468 employees at baseline, and 1,720 at follow-up, with 783 participants completed measures at both time points. Structural and policy level changes at the workplace due to the implementation of multi-component worksite wellness interventions were measured using newly developed measures. These included the Heart Check Policy (HCP) and Heart Check Structure (HCS) question sets, which allowed for the quantification and comparison of policy and environmental strategies used in worksite wellness interventions. The HCP score was measured through the summation of favorable responses to 41 questions referring to written workplace health policies, the organizational mission statement, and communications from upper level management. The HCS score was comprised of favorable responses to 21 questions relating to changes to the workplace environment that promote physical activity, healthy eating and general wellness. Employee health indicators included Body Mass Index (BMI), blood pressure knowledge, blood pressure, cholesterol knowledge, total cholesterol, physical activity, diet and smoking. This study aimed to describe the relationship between changes in the physical structures/environment and workplace health policies, and changes in employee health status after a two-year wellness intervention. The individual effects of structural and policy level changes on employee health, in addition to the possible interaction effect between the two, was explored; with the goal of identifying the most effective practices associated with known improvements in employee health status. Changes in HCP and HCS scores as predictors of change in employee health, based on data from 783 participants, was analyzed using linear and logistic regression. In adjusted models, change in HCP was a significant predictor of decreased diastolic blood pressure when looking at both percent change in HCP (adjusted β; = -0.16, p = 0.012) and HCP score at follow-up controlling for baseline score (adjusted β; = -0.98, p = 0.009). HCP scores were negatively associated with employees gaining knowledge of their cholesterol, when looking at both percent change in HCP scores (aOR = 0.97, 95% CI (0.93, 1.00), p = 0.048) and HCP score at follow-up, controlling for baseline (aOR = 0.77, 95% CI (0.61, 0.97), p = 0.024). There was also a negative association between percent change in HCP and improved diet (aOR = 0.98, 95% CI (0.97, 0.99), p = 0.028). Change in HCS scores was not found to be a statistically significant predictor of changes in employee health. There were no statistically significant interaction effects between percent change in HCP and HCS, and follow-up HCP and HCS, for changes in any of the dependent variables analyzed. However, the interaction effect between follow-up HCP and HCS approached significance in predicting change in diastolic blood pressure (adjusted β = -0.01, p = 0.052). With the exception of a statistically significant finding for change in HCP and decreased diastolic blood pressure, changes in workplace policies and structures (as measured by the HCP and HCS) did not predict healthful population- level behavior changes among employees in this study. The results of this study of worksite health interventions among organizations in Western New York suggest that further research is needed to determine what interventions best produce health behavior changes among employees. Measurement tools such as the HCP and HCS are necessary to quantitatively capture changes in workplace policies and structures due to interventions. A better understanding of the utility of the HCP and HCS questionnaires in measuring worksite changes and predicting changes in employee health is also needed. As more businesses choose to implement worksite wellness programs, it is essential that evidence-based evaluation tools demonstrate the effectiveness of such interventions.
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