Research Layer - Getting Started & Sustaining Active Living at Work Programs

Preparing to Start

1. Understanding Workplace Wellness
   Influences on Wellness in the Workplace. Technical Report. Health and Welfare Canada.
   Shehadeh, V and Shain, M (1990)
2. How to Start a Physical Activity Program in the Workplace
   Government of Canada, Fitness and Amateur Sport

Participation

1. Lechner & de Vries (1995) studied the determinants of adherence level in an employee fitness program. Pre-test and post-test design was used to survey 236 employees (police) who intended to start participating in a program. An initial questionnaire was given at this time, followed by a second questionnaire to the same employees 10 months later.

   The determinants measured included attitude toward an employee fitness program, self-efficacy expectation, and social support.

   The indirectly measured self-efficacy at the post-test was the best predictor for average exercise frequency, followed by attitude. Therefore, the authors suggest that promotion to improve adherence should focus on how to overcome the barriers.
   Lechner, L., de Vries, H., Adriaansen, S., Drabbels, L. (1997) Effects of an employee fitness program on reduced absenteeism. JOEM 39(9):827-831.

2. Crump et al (1996) studied 3388 employees from 10 federal agencies by way of an employee survey to investigate whether organizational variables and the process of implementation of Health Promotion and Disease Prevention (HPDP) programs affected participation. The study indicated that on average, employees participated in fewer than two agency-supported health-related activities per year.

   Results showed that employees participated more when their co-workers and managers endorsed the programs. Greater participation in fitness activities was achieved in organizations that were able to reduce more barriers to participation or market their program better. Some of the barriers that were removed included making the times and locations of programs more convenient and using evaluation data to improve the programs. Minority employees and those in lower level positions participated in fitness activities when the organizations had a more comprehensive program structure, engaged in more marketing strategies, gave time off for employees to participate or had on-site facilities. Employees who were male, white and higher level positions participated more when there was more management support for the program.
   Crump, C.E., Earp, J.L., Kozma, C.M., Hertz-Picciotto, I. (1996) Effect of organization-level variables on differential employee participation in 10 federal worksite health promotion programs. Health Educ Q 23(2):204-223

3. Wilson (1990)provides some suggestions for increasing participation in workplace health promotion programs, in a review article. He cites studies that indicate that marketing techniques are showing some success in health-related settings. He suggests the use of a marketing plan specifically for increasing health program participation.
   Wilson, M.G. Factors associated with, issues related to, and suggestions for increasing participation in workplace health promotion programs, Health Values, vol. 14, no 4, 1990, p. 29-36.

4. Peterson & Aldana (1999) evaluated the effect of a stages of change-based exercise intervention in a randomized trial of adults working in a corporate setting. Evaluations were measured by changes in activity and stage of change.

   Authors conclude that stage-based, tailored messages on physical fitness tend to be more effective at increasing short-term activity than either generic messages or no information at all.
   Peterson, T.R., Aldana, S.G. (1999) Improving exercise behavior: An application of the stages of change model in a worksite setting. Am J Health Promot 13(4)229-232.

5. Jaffee et al (1999) studied the incentives and barriers that working women experience in attempting to incorporate physical activity into their lives, and the role of the workplace in encouraging this activity. A questionnaire using Prochaska's stages of change model was developed for this purpose. From 1406 female employees, a random sample of 750 was selected to send the questionnaire to. 393 (52.4%) responded. Once physical activity level was established using well established stages-of-change categories, differences in barriers and incentives were studied between the groups. There were significant differences in expectations for physical activity between all variables.

   Barriers included lack of time for physical activity among all groups, and self-consciousness about exercising in front of others. Women in the contemplation and preparation stages reported barriers related to low self-confidence or self-consciousness more than any other groups.

   Authors suggest that women in the pre-contemplative stage would benefit most from education on the benefits of physical activity and programs geared toward women who have never exercised. While contemplators are aware of the benefits, they have the highest number of perceived barriers, so programming for this group needs to be flexible to schedules and offer a wide variety of programs. This study indicates that the stages of change model may offer direction for health promotion practitioners in efforts to increase participation by working women in physical activity.

   Jaffee, L., Mahle Lutter, J., Re, J., Hawkes, C., Bucaccio, P. (1999) Incentives and barriers to physical activity for working women. Am J Health Promot 13(4):215-218.

Integration

1. Dishman, et al (1998) suggest that many workplace programs have been ineffective because they did not utilize the workplace environment and organization as optimally as they could. They compare North American workplace wellness strategies and research with that of European worksites. NA workplaces (note: USA especially) tend to take an approach which focuses on individual responsibility for health, whereas in Europe the environmental and organizational strategies have been more fully developed and in the authors' view have great potential for increasing physical activity.
   Dishman, R.K., Oldenburg, B., O'Neal, H., Shephard, R.J. (1998) Am J Prev Med 15(4):344-361.

2. Shephard, R.J. (1999) comments that few research reports have considered external factors influencing program success, such as organizational policies, involvement of managers and supervisors, or company goals and objectives.
   Shephard, F.J. (1999) Do work-site exercise and health programs work? The Physician and Sportsmedicine 27(2):48-72..

3. DeJoy & Southern (1993) argue that health promotion efforts should be integrated into the corporate health strategy of the organization, and that there needs to be an equal concern for individual lifestyle modification and safe/healthy working conditions.
   
   The authors divide concerns with health and the workplace into four quadrants (high employer/employee control; high employer/low employee control; low employer/high employee control; and low employer/employee control.) Typically, Occupational Health & Safety has dealt with issues that are high in the employer control and low in the employee control, such as the work environment, design of machinery, etc. Workplace Health Programs have typically dealt with issues that are high in employee control and low in employer control such as lifestyle programs and personal health habits. Comprehensive approaches will require efforts in all 4 quadrants.
   
   Their paper proposes an integrative model of worker health featuring three interactive systems: 1) job demands and worker characteristics, 2) work environment, and 3) extra-organizational influences. This requires a broader view of worker health and a movement away from the "program approach" to a more "comprehensive approach" to workplace health.
   
   They indicate that in many cases, policy and organizational changes need to precede integrative program strategies to increase effectiveness. They conclude that from a business perspective, an integrative model should assist in 1) limiting redundancy of workplace health programs and services, 2) more effectively link existing programs and services, and 3) establish a more open and comprehensive process for identifying problems and establishing health promotion and health protection priorities.
   Dejoy, D.M., Southern, D.J. (1993) An integrative perspective on work-site health promotion. JOM 35(12): 1221-1230.

Making it Work

Making it Work with Active Living in the Workplace

Canadian Centre for Active Living in the Workplace, Nansi Cunningham ISBN 1-895670-08-X