15 November 2014

Review of Health and Wellness Promotion Programs

Review of Health and Wellness Promotion Programs

Implementation of Substance Abuse Prevention; Evaluation of Changes in Health Risks and Productivity; Offering Financial Incentives to Participants; Structured Versus Non-Structured Exercise Programs

The purpose of this review is to evaluate the effectiveness of certain aspects of health and wellness programs, specifically; substance abuse prevention, changes in health risks and productivity, offering financial incentives, and structured versus non-structured exercise programs.  Two studies will be review that examine how substance abuse prevention programs have been implemented into pre-existing health and wellness programs.  One study will be reviewed showing the positive effects of health and wellness programs on health risks and worker productivity.  Two studies will be reviewed showing the effectiveness of financial incentives in a health and wellness promotion program.  One study will be review showing the comparison between structured and non structured exercise programs with the health and wellness program.

Substance Abuse Prevention
This review evaluated two studies that examined the effectiveness of adding a substance abuse prevention program to an already existing workplace-based health and wellness promotion program.  This review will highlight the main points and determine if adding substance abuse prevention programs can be successful in terms of improving employee health.  The two studies examined if the addition of the program made a difference in substance abuse among employee health.  One study was designed to explore employee characteristics associated with the utilization of employee assistance program services and health care after the implementation of the substance abuse prevention program (Deitz, Cook, & Hersche, 2005).  The Deitz (2005) study used the information that most heavy drinkers and users of illicit drugs are working adults and health promotion programs can be excellent vehicles for integrating substance abuse prevention materials and messages as a basis for their study. 

The objective of the other study was to determine whether certain enhancements to existing employee assistance programs, and employee wellness programs made a difference in substance abuse and overall health (Lapham, Chang, & Gregory, 2000).   The Lapham study was more focused on the prevention and early intervention program.  The theory was that the program should prevent non-risky drinkers from becoming risky drinkers and reduce the level of risky drinking among persons identified as being at risk (Lapham et al., 2000).

In the Deitz (2005) study the employee assistance program distributed print and video materials addressing alcohol abuse to the employees.  A considerable number of them participated in classes that emphasized health alternatives to using alcohol and/or drugs for stress relief purposes.  These program participants, through involvement with the employee assistance program, were encouraged to use humor, call upon friends, make time for themselves, and develop alternative strategies to alcohol or drug use when subjected to stressful situations (Deitz et al., 2005).  The date from the survey indicated that employees who received the substance abuse prevention intervention reported a decrease in heavy drinking while individuals in the control work site reported a significant increase during this same time period (Deitz et al., 2005).  This finding is important to the field of work site health promotion because it validates that the employee assistance program serves as an important link in the chain of resources available to employees requiring counseling or referral to the health care system (Deitz et al., 2005).

In the Lapham (2000) study the additions included substance abuse awareness training, mailings of substance abuse prevention materials to persons completing the health risk assessment, and brief motivational counseling.  The mailings were not negatively perceived, may facilitate family dialog, and may enable other household members to personally benefit from prevention messages (Lapham et al., 2000).  Through the implementation of these interventions the existing wellness program was able to improve the health of the employees.  This implementation experience shows that substance abuse identification, treatment, follow-up can be integrated into workplace settings when placed in the context of overall health (Lapham et al., 2000).  The employees appeared more attracted to programs that promised improved nutrition, fitness, and stress management and less likely to take advantage of programs marketed toward personal substance abuse only (Lapham et al., 2000).

Changes in Health Risks and Productivity
This review evaluated a study that examined the association between changes in health risks and changes in productivity over time.  More specifically the study addressed if health risks change is there also a change in absenteeism and presenteeism?  Is so, are reductions in some health risks more likely to be associated with improvements in absenteeism and presenteeism than other health risks?  As the number of health risks changes, do the magnitudes of absenteeism and presenteeism change in parallel? (Pelletier, Boles, & Lynch, 2004).  The data for this study consisted of survey responses from 500 employees of a large national employer located in the Northeast.  Participants responded voluntarily to all items on surveys before and after a wellness program.  All respondents were members of corporate-sponsored fitness centers (Pelletier et al., 2004).  The study used an on line Health Risk Assessment that asked about chronic conditions, health status, demographics, biometric measures, and lifestyle (Pelletier et al., 2004).  Participants in the study had access to a variety of wellness programs and services offered through the company's employee benefits department.  Through the benefits department the employees had access to on line wellness programs, off line behavior change programs such as workshops and nutritional counseling, ongoing communications on relevant health issues to promote employee health and wellness benefits, and a variety of fitness center services (Pelletier et al., 2004).  The employees that, according to the health risk assessment, lowered their health-risk status experienced a measurable improvement in work productivity (Pelletier et al., 2004).  Therefore this study determined that positive changes in health risks are associated with positive changes in productivity (Pelletier et al., 2004).

Financial Incentives
This review evaluated two studies that examined the effectiveness of offering financial incentives to the participants of its health and wellness programs.  One corporation offered financial incentives to employees who completed an initial health risk assessment (Goetzel, Ozminkiwski, Bruno, Rutter, Isaac, & Wang, 2002).  The health and wellness program concentrated on reducing individual behavioral and psychosocial risk factors before these were transformed into disease and disability by having employees participate in the program (Goetzel, et al., 2002).  The corporation offered its employees a $500 medical benefit plan credit to participate in the program.  Borderline-risk individuals received risk-specific mailings (Goetzel et al., 2002).  The health and wellness programs, prevention activities, and self-care (Goetzel et al., 2002).  This study shows that there is evidence that work site health promotion programs that offer incentives can achieve long-term health improvements in an employee population because of the improvements in lifestyle (Goetzel et al., 2002).

The other study examined the impact of a work site health promotion program, which featured a reimbursement model as incentive for participation, on short-term disability (Serxner, Gold, Anderson, & Williams, 2001).  The company implemented a flexible wellness program that was available to both employees and family members.  The program included both on-site and remotely delivered components  On-site components are p provided by a local third-party vendor and include occupational health services, physical therapy, fitness center, special programs addressing the top five risk areas, biofeedback, ergonomics, nutrition counseling, massage therapy, weight management, and smoking cessation programs (Serxner et al., 2001).  Remotely delivered components included a health risk assessment, telephonic risk-reduction intervention programs, telephonic counseling support, and a self-care book with access to a nurse advice line, and a fitness and wellness reimbursement program (Serxner et al., 2001).  Once an employee completes the health risk assessment, he or she can receive reimbursement of up to $450 per year for fitness and wellness activities (Serxner et al., 2001).  Results showed that employees receiving short term disability who were participants in the health promotion program used an average of 6 fewer net disability days than similar employees receiving short term disability who were not participants in the program.  The analyses also showed that average net short term disability days for non-participants significantly increased during the study period.  These findings are consistent with the findings of others that determined that low-risk populations left unattended will become high-cost populations, and that doing nothing to support high-risk populations will likewise result in their increased risk (Serxner et al., 2001).  This study also supports the notion that health promotion programs contribute to the health and productivity of employees and may be useful to target frequently occurrin gcauses of STD use that are also k nown to generate significant medical costs, such as stress, mental health, and tobacco use (Serxner et al., 2001).

Structured versus Non-Structured Exercise
This review evaluated a study that compared the physiological outcomes of participants who completed structured exercise in a corporate wellness program with participants who completed non structured exercise.  Persons in the structured exercise group attended planned exercise classes whereas those in the non structued group had access to exercise facilities and were encouraged to exercise but were not enrolled in exercise classes nor were they provided a specific exercise plan (Elberson, Daniels, & Miller, 2001).  Individuals in both groups had the benefit of corporate wellness educational sessions and materials as well as social support and annual assessments of various physiological parameters.  The education al sessions incorporated various topics including nutrition, exercise, lifestyle modification, and disease prevention (Elberson et al., 2001).  This study found that the corporation's wellness program, which offers screening and education sessions and materials on critical health -risk factors, had a statistically significant impact on the participants in both groups in terms of improving their HDL cholesterol and HDL ratio levels.  HDL cholesterol was raised an average of 3.79 points in the structured group and raised an average of 3.9 points in the non structured group (Elberson et al., 2001).  HDL ratio levels were lowered an average of 0.36 points in the structured group and lowered an average of 0.28 points in the non structured group (Elberson et al., 2001).  Overall results from this study suggest that the corporation's wellness program was beneficial for all participants.  Results support the argument that work site-wellness programs can be beneficial in assisting employees to improved their health behaviors and their health outcomes regardless of the type of exercise program chosen (Elberson et al., 2001).

Discussion
Results of this review show that health and wellness programs are effective and beneficial in improving the health of employees.  The best way to implement a substance abuse prevention program is to integrate it into a health and wellness program that also offers improvements in nutrition, fitness, and stress management.  The studies showed a decrease in heavy drinking and an improvement in the general health of the employees.  By mailing home packets of information an employee is more likely to open a dialog with the family regarding the dangers of substance abuse.  Thus it is shown to be a positive element in the substance abuse prevention program.

Health and wellness programs contribute to positive changes in health risks and productivity by lowering individuals' risk on health risk assessments.  These positive changes in health translated to positive changes in productivity by decreasing absenteeism among employees and improving the time spend working.  Health and wellness programs also improved productivity by decreasing the number of disability days employees used.

The studies showed that health and wellness programs that offer financial incentives to its participants have long term health benefits in the employees that participate.  By offering an incentive to employees to complete a health risk assessment the program coordinates are able to determine which employees are at high risk.  This allows the program to lower th risk factor for the employee population.  Programs that also maintain the low-risk factor of employees are also successful because it is shown that low risk employees can and will become high risk employees.  Health and wellness programs improve the lifestyles of employees by reducing tobacco use, improving seat belt use, and decreasing drinking and driving.

Studies also showed that it is important to offer employees both structured and non structured exercise programs.  By giving employees access to wellness education sessions, materials, social support, and annual assessments of physiological parameters employees can benefit by improved HDL cholesterol levels and HDL ratio levels.  This study showed that work site wellness programs that implement physical exercise into the program can be beneficial in assisting employees to improve their health.

References
Deitz, D., Cook, R., & Hersch, R. (2005).  Workplace health promotion and utilization of health services: Follow-up data findings.  Journal of Behavioral Health Services & Research, 32(3), 306-319.

Elberson, K. L., Daniels, K. K., & Miller, P. M. (2001) Structured and non structured exercise in a corporate wellness program.  A comparison of physiological outcomes.  Outcomes Management for Nursing Practice, 5(2), 82-86.

Goetzel, R. Z., Ozminkowski, R. J., Bruno, J. A., Rutter, K. R., Isaac, F., & Wang, S. (2002).  The long term impact of Johnson & Johnson's health and wellness program on employee health risks. Journal of Occupational & Environmental Medicine, 44(5), 417-424.

Lapham, S. C., Chang, I., & Gregory, C. (2000).  Substance abuse intervention for health care workers: A preliminary report. Journal of Behavioral Health Services & Research, 27(2), 131-143.

Pelletier, B., Boles, M., & Lynch, W. (2004).  Change in health risks and work productivity over time.  Journal of Occupational & Environmental Medicine, 46(7), 746-754.

Serxner, S., Gold, D., Anderson, D., & Williams, D. (2001).  The impact of a work site health promotion program on short-term disability usage.  Journal of Occupational & Environmental Medicine, 43(1), 25-29

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