The Role of Managers in Employee Wellness Programs: A Mixed-Methods Study

Abstract

Purpose:

The purpose of this study is to evaluate managers’ barriers and facilitators to supporting employee participation in the Washington State Wellness program.

Design:

Exploratory sequential mixed methods.

Setting:

Four Washington State agencies located in Olympia and Tumwater, Washington.

Participants:

State employees in management positions (executive, middle, and line), whose job includes supervision of subordinates and responsibility for the performance and conduct of a subunit or group.

Methods:

We interviewed 23 managers and then used the results to create a survey that was fielded to all managers at the 4 agencies. The survey response rate was 65% (n = 607/935).

Analysis:

We used qualitative coding techniques to analyze interview transcripts and descriptive statistics to summarize survey data. We used the Total Worker Health framework to organize our findings and conclusions.

Results:

Managers support the wellness program, but they also face challenges with accommodating employees’ participation due to workload, scheduling inflexibility, and self-efficacy to discuss wellness with direct reports. About half the managers receive support from the manager above them, and most have not received training on the wellness program.

Conclusion:

Our findings point to several strategies that can strengthen managers’ role in supporting the wellness program: the provision of training, targeted messages, formal expectations, and encouragement (from the manager above) to support employees’ participation.

Keywords

managers supervisors worksite health promotion wellness programs mixed methods research state employees

Purpose

Research has shown that employee participation in wellness programs can improve health risk factors, decrease burnout, and increase productivity.^1,2 Wellness programs are workplace initiatives directed at supporting healthy behaviors and chronic disease prevention for employees.² The workplace influences employees’ health behaviors through 4 main avenues: the provision of health insurance, organizational policies, wellness programs, and communications about health.^1,3 Managers and supervisors (hereafter managers) influence employees’ use of health-promoting avenues in the workplace, and this makes them an important upstream determinant of employee participation in wellness programs.⁴ For example, managers mediate the relationship between wellness programs and employee health by allocating resources to support wellness programs or not.⁵ Managers may cultivate an organizational culture that encourages wellness by visibly supporting employees’ health and endorsing wellness programs.³ The organizational culture is the product of the individual and group norms, attitudes, and beliefs that determine the organization’s commitment to employee wellness.⁶ Employers with successful wellness programs include wellness as part of the organizational culture and provide encouragement and support for employee participation.⁷

Research on gaining managers’ support tends to focus on the “business case” for supporting wellness programs, which is often targeted toward executive leaders⁸ who have responsibility for the overall conduct and performance of the organization. Executive leaders develop the strategies, objectives, and long-term plans of an organization.⁹ Middle managers are responsible for implementing executive leaders’ strategies and supervising the work of line managers. Line managers supervise the work of frontline employees (who do not hold management positions) and have the most direct contact with them.⁹ Unlike executives, middle and line managers are more concerned with the short-term completion of daily job tasks and not the long-term objectives of the organization.⁹ Executive leadership commitment to employee health is a defining element of the Total Worker Health (TWH) approach put forth by the National Institute of Occupational Safety and Health. The TWH model recommends that executive, middle, and line managers actively support efforts to improve employee health.¹⁰ However, the incentives to take an active role in supporting wellness programs may not be the same for middle and line managers as for executives. Research suggests that successful wellness programs have support from all levels of management (executive, middle, and line).^7,11

The role of managers is widely acknowledged as a critical factor for implementing wellness programs and policies, but there is limited evidence on how managers at all levels (executive, middle, and line) support employee participation in wellness programs.¹¹ Research on managers’ beliefs about wellness programs has yielded contradicting results. While some managers believe that wellness programs improve employee health and are important to provide, many feel it is not the employer’s responsibility to support a healthy lifestyle for employees through workplace wellness programs.^11,12 To understand managers’ role in supporting wellness programs, we conducted a mixed-methods study to explore managers’ barriers and facilitators to supporting their employees’ participation in wellness programs. The results will help us design intervention approaches to increase managers’ support for their employees’ participation in the wellness program. This study includes all levels of managers (line, middle, and executive) at the participating agencies. Our approach enabled us to explore whether managers at each level experienced different roles, barriers, or facilitators related to wellness. When relevant, we made distinctions among the results gathered from managers at these 3 levels. For example, when we found no intralevel differences in responses, we present the results for the managers as a whole with no reference to managerial level. When we found intralevel differences, we present the results with distinctions made among line, mid-level, and executive-level managers.

Methods

We used mixed methods to understand managers’ role in supporting wellness programs. Mixed-methods research involves both qualitative and quantitative data collection and analysis.¹³ Mixed methods provide strong evidence for conclusions through the convergence and corroboration of qualitative and quantitative data.¹³

Design

This study uses a sequential exploratory design, in which data collection is in 2 sequential phases: qualitative building to quantitative. The sequential exploratory design is a mixed-methods approach to study a phenomenon with a small sample with the potential to generalize qualitative findings to a larger population.¹³ For the first phase, we conducted in-depth interviews to explore managers’ barriers and facilitators to supporting employee participation in wellness programs. Qualitative research is emergent and cannot be tightly prescribed, which makes it a suitable approach for studying a relatively unknown phenomenon.¹⁴ To have credible findings, qualitative research requires adherence to rigorous methodology for the collection, coding, and interpretation of qualitative data. For this study, we followed the methodology described by Creswell and Clark.^13,14 For the second phase, we created a survey instrument to collect quantitative data on managers’ barriers and facilitators to supporting their employees’ participation in the wellness program. The survey results assist in the interpretation of qualitative data and provide quantitative evidence to generalize findings from the study sample to the broader population.¹⁴ This study was determined exempt from review by the University of Washington Institutional Review Board.

Setting

The State of Washington employs several thousand employees representing a variety of job titles, income levels, and backgrounds. This study focuses on 4 Washington State agencies located in Tumwater and Olympia, Washington. The agencies cover several job descriptions and titles and range in size from 200 to 1800 employees. Before initiating the mixed-methods study, we interviewed each agency’s wellness coordinator, an individual whose job is to coordinate wellness programs and activities (n = 4 interviews total). The wellness coordinator interviews provided background information and context for our manager interview guide (first phase) and survey (second phase). We discovered that the agencies have comprehensive wellness programs with on-site and online elements including an active wellness committee (see Table 1 for an overview of the agencies’ wellness programs).

Table 1.

Elements of the Employee Wellness Program at 4 Agencies.

Staff and resources	Wellness coordinator in charge of promotion and activities 50% FTE (1 agency with volunteer coordinator)
	Volunteer wellness committee meets regularly to plan activities Committee includes managers and employees Allowed time during work to meet
	Allocated budget to support wellness programs and activities
Policy	Healthy-eating guidelines for events and meetings
	Tobacco use Employees can use tobacco on premises but not inside the building Tobacco-free campus (1 agency only)
	Scheduling Allowed time for onsite preventive services (eg, flu shots, Mammo-van) Allowed time for walking breaks and meetings
	Telework policies (2 agencies only)
Communication and promotion	E-mail messages about wellness programs and activities Monthly electronic newsletter Upcoming activities
	Signage to promote Healthy eating Tobacco cessation Walking and/or taking the stairs
On-site activities	Physical activity Monthly physical activity challenges (eg, “Couch to 5k”) Provide walking maps to employees Dedicated space for physical activity (2 agencies only) Bicycle rack/cages (3 agencies only)
	Healthy eating Healthy options are labeled in onsite cafeteria and/or vending machines Educational seminars (eg, brown bag meetings) Drop site for community sponsored agriculture (CSA)
	Employee stress management Promote employee assistance (EAP) mental health benefits
	Link onsite activities to online component
Online activities	Online platform for employees to: Complete well-being assessment Track wellness activities for points Earn an incentive ($125) through wellness points

Abbreviations: FTE, Full-Time Equivalent.

Sample

Eligible individuals were employed in a management-level position, whose job includes supervision of subordinates and/or responsibility for the performance and conduct of a subunit or group. We gathered qualitative and quantitative data from these managers from May to December 2016.

For the interviews, we worked with the agency’s wellness coordinator to identify a small group of eligible managers that represented all levels of management (executive, middle, and line). Approximately 5 to 6 managers at each agency were sent an e-mail describing the study and interviews. We interviewed managers if they responded to the e-mail.

For the survey, we worked with the agency’s wellness coordinator to identify all eligible managers currently employed at the agency. An executive leader at each agency sent managers an e-mail message that described the purpose of the survey and provided the survey link. Three reminders to complete the survey followed the initial e-mail. We included survey responses from all managers responding to the survey.

Measures

Interview guide

We created a manager interview guide by conducting an integrative literature review (manuscript under review) and drawing on the wellness coordinator interviews for background. The manager interview guide included questions about managers’ attitudes and beliefs toward wellness programs, organizational culture, and perceived role expectations regarding supporting the wellness program. Two trained researchers conducted 30-minute semistructured interviews with managers over the telephone. Interviews were recorded with permission from each manager and sent to an experienced transcriptionist (Proof Positive Transcriptions, Garland, Texas).

Survey Questionnaire

We developed questions for the manager survey instrument using words, concepts, and categories from the qualitative analysis as well as by drawing on the wellness coordinator interviews to provide context. The survey questions cover managers’ roles and expectations regarding the wellness program, and the last question provided an optional comment box to write any thoughts managers had regarding the wellness program. The survey instrument was administered electronically using the online platform, Research Electronic Data Capture, hosted by the Institute of Translational Health Sciences at the University of Washington.

Analysis

Interviews

We used thematic analysis to analyze the interview transcripts.¹⁵ Thematic analysis is a qualitative research methodology that uses inductive coding to analyze interview data. Inductive coding is the process of breaking down of qualitative data by assigning codes to actual statements or phrases from respondents.¹⁶ This approach generates codes and themes that are inductively derived from the data.¹⁶ We collated codes into groups of codes or themes that have clear definitions. Through this process, we discovered 2 larger themes: facilitators and barriers. We compiled the groups of codes under these 2 larger themes. We reviewed and refined the themes to generate a “thematic narrative” of managers’ facilitators and barriers to supporting their employees’ participation. We used the constant comparative method of data analysis to judge topic saturation and theoretical complexity.¹⁴ This method compares emerging codes and themes from early transcripts and contrasts them from later transcripts. Qualitative validation strategies included triangulation of multiple data sources and “peer debriefing” sessions to check the credibility of the findings and interpretations.¹⁴ To ensure the dependability of results, 2 researchers independently coded transcripts and then came to consensus on the codes and themes. Qualitative findings are presented as facilitators or barriers, with associated themes and representative quotes.

Survey

The quantitative analysis used descriptive methods to summarize the survey findings. Our goal was to generate descriptive quantitative data on the phenomenon of interest and not to make statistical inferences about group comparisons.¹⁷ The descriptive statistics include response frequencies (number and percentage), means, standard deviations, and basic demographic information on survey respondents (age, gender, job title, and number of direct reports). We analyzed the 148 text comments provided by managers using a content analysis, which is a technique for evaluating text provided by participants.¹⁶ The survey results presented are by survey topic area with additional information from text comments. The survey analysis was conducted using Stata 14 (College Station, Texas).

Results

First Phase: Qualitative Interviews

We present the interview findings from managers responding to the e-mail invitation (23/23; 100%). The demographic characteristics of the managers interviewed are shown in Table 2.

Table 2.

Demographics of Managers Working in 4 Washington State Agencies and Participating in Qualitative Interviews Regarding Workplace Wellness Programs, 2016.^a

Gender
Female	10 (43)
Male	13 (57)
Manager role
Line	10 (43)
Middle	8 (35)
Executive	5 (22)
Number of direct reports
1-5	6 (26)
6-10	11 (48)
11-20	6 (26)

^aN = 23, frequency (%).

Facilitators

Managers described several facilitators to supporting their employees’ participation in wellness programs. They include: (1) awareness of wellness activities and resources, (2) regular communications from the wellness program, (3) supportive culture, (4) perceived benefits of providing wellness programs, (5) employees’ view of the wellness program, (6) role expectations, (7) role-modeling, (8) comfort in talking about wellness, (9) awareness of the agency’s policies (regarding participation), and (10) scheduling flexibility. We provide a summary of each facilitator, with associated quotes, and identify the speaker as an executive, middle, or line manager.

Awareness of wellness activities and resources

All the managers are aware of the wellness activities and resources available within their agency. Some managers reported that they participated in activities in the past or still participate. “We have a library of materials that are available to folks through the wellness program, and we do sponsor things like flu shot programs and other kinds of wellness activities onsite.”—Middle

Regular communications

All the managers receive regular communications from their agency’s wellness coordinator or related staff via e-mail and postings on the intranet website. For the most part, managers rely on wellness coordinators or related staff to send out reminders and promotional materials to their employees.

Supportive culture

Most managers feel their agency supports a culture of wellness among its employees. Managers describe several ways their agency creates a culture of wellness among employees; these include the allocation of money, staff time, and active promotion through e-mails, employee intranet, posters/signage, and announcements in staff meetings and all-staff broadcasts.

Perceived benefits of the wellness program

All the managers believe that wellness programs are beneficial to employees. Managers describe several benefits of offering wellness programs to employees; these include lower stress and burnout, increased productivity, lower health-care costs, and less absenteeism.

Employees’ view of the wellness program

Most of the managers believe employees appreciate that the wellness program exists and view it as a positive resource. “Overall, I think that the employees of the agency are engaged and like the activities.” —Executive

Role expectations

Several managers said they feel expected to encourage, support, and be flexible with employees’ participation in wellness activities. “I think the manager’s role is to make sure that they know about the opportunities and the value, and to make sure that they know they have the time to do it if they want to participate.”—Middle

Role modeling

In general, managers see themselves as a role model for their employees. “it’s just the power of being a role model and saying that you care about wellness and that you’re participating in the activities.”—Line

Comfortable talking about wellness

Most managers feel comfortable talking and sharing information with employees about wellness. A few managers discuss wellness with employees using formal channels, such as office meetings, or as part of the new employee orientation process.

Awareness of agency policies

Several managers are aware of a written policy regarding employee participation in the wellness program. “They’re written in the agency policies. I would say in general that they encourage staff to participate, and they encourage managers to enable the participation of staff.”—Line

Scheduling flexibility

Several managers perceive having flexibility with their employees’ schedules. They describe balancing workload to accommodate participation. “I mean at the most practical level it’s about making space and time for people to do these things.”—Line

Barriers

Managers described several barriers to supporting their employees’ participation in wellness programs. They include (1) challenges with wellness activities and resources, (2) generic messaging, (3) the culture surrounding wellness is not integral to all agencies, (4) perceived lack of employee buy-in, (5) lack of formal expectations, (6) lack of self-efficacy to engage employees, (7) lack of supportive messages from manager above, (8) lack of awareness of agency policies (regarding participation), (9) scheduling inflexibility, and (10) workload. We provide a summary of the barriers with associated quotes.

Challenges with wellness activities and resources

Many managers describe challenges with navigating online components of the wellness program and feel the incentive to track wellness activities is not worth the time and effort. “I want it to be user-friendly…I don’t want to go hunting, picking, searching—it’s kind of a labyrinth without a map. Well, then I’m done.”—Middle

Generic messaging

Managers receive the same wellness communications as employees, but for some managers, this is not enough. “There are those messages that we get, but I don’t feel like it’s a targeted message.”—Middle

Culture surrounding wellness is not integral to all agencies

A small number of managers perceive areas within their organization as having a supportive culture but feel it may not be widespread. “It’s like these gung ho messages from the director and all this stuff, but then the opportunities are not provided as part of just daily life to participate in things”—Middle

Perceived lack of employee buy-in

Some managers perceive a lack of employee support or buy-in for the wellness program. Several managers describe employees’ view of the wellness program as mixed. “It depends on the staff. I definitely have staff that are heavily involved and other staff that aren’t involved”—Middle

Lack of formal role expectations

Managers, for the most part, did not feel they had a formal obligation to take an active role in the wellness program. “There has never been an expectation or direction that I can recall where I’ve been told that it’s part of my expectations that I talk about the wellness program.” —Executive

Lack of self-efficacy to engage employees

Some managers feel their role in the wellness program is not an important factor in employees’ participation. “I think that the employee—the want from the employee themselves—I think it is more than anything I would be able to do as a supervisor.”—Line

Lack of supportive messages from manager above

Many of the managers describe not receiving messages of support from their own manager. “I don’t know that I receive many messages from her at all really, you know?”—Line

Unaware of agency policies

Several managers are not aware of a written policy regarding employees’ participation. Managers most often describe the policy as voluntary participation. “It’s not a required thing and to my knowledge, there is no policy around it.”—Line

Scheduling inflexibility

Overall, managers feel they can support employee participation, but only as far as scheduling permits. “…it gets a little bit harder for folks who have production-related work, and so in our agency that’s like…the folks that work in the call centers.”—Line

Workload

Managers describe workload as a barrier to supporting their employees’ participation as well as their own participation. “Even though we’re officially allotted time to participate…I think that’s wonderful, but for the people like me that tend to be in meetings all day it’s challenging…I think it’s known that we’re understaffed in certain areas, or that we have more work than we can do…”—Middle

At the end of the interview, we asked each manager to describe any additional resources that would help them support their employees’ participation. Responses included having snippets of scientific data to help facilitate conversations with employees, guest speakers to talk about wellness topics with employees, and wellness trainings for all employees to attend.

Second Phase: Quantitative Survey

We included survey responses from all managers responding to the survey (607/935; 65% response rate). Of the 607 responding to the survey, 598 (98%) responded to demographic questions and 547 (90%) provided information on their age, gender, job title, and number of direct reports. The demographic characteristics of the managers surveyed are in Table 3. In addition, 148 (24%) managers provided additional thoughts in the optional comment box.

Table 3.

Demographics of Managers Working in 4 Washington State Agencies and Participating in a Survey Regarding Workplace Wellness Programs, 2016.^a

Age
18-34	23 (5)
35-44	115 (19)
45-54	213 (36)
55-65	199 (33)
65+	19 (3)
Prefer not to answer	29 (5)
Gender
Male	233 (39)
Female	334 (56)
Prefer not to answer	29 (5)
Manager roles
Line	302 (51)
Middle	189 (32)
Executive	56 (9)
Prefer not to answer	51 (8)
Number of direct reports
1-5	245 (41)
6-10	184 (31)
11-20	72 (12)
21-50	36 (7)
51+	28 (5)
Prefer not to answer	27 (4)

^an = 598, frequency (%).

The quantitative survey results are provided by topic area with the percentage of managers responding positively (“agree” or “strongly agree”) to the question. The main topic areas were identified from the interview findings and include (1) agency culture, (2) scheduling and workload, (3) communication, (4) encouragement, (5) policies, and (6) training. We provide a narrative summary of the survey results and describe the text comments provided by managers, as applicable. The summary of survey responses overall and by job title is in Table 4.

Table 4.

Summary of Survey Responses, Overall and by Job Title, Response Frequencies, Means, and Standard Deviations.^a

		Percent Responding, “Strongly Agree” or “Agree”
	Mean (SD)	Overall, N = 607	Executive,^b n = 56	Middle,^b n = 189	Line,^b n = 302
1. I read the monthly communications from my agency about wellness programs and activities.	3.7 (1.1)	67	79	69	68
2. I share information about the agency’s wellness efforts with my employees.	3.5 (1.2)	54	59	54	56
3. I encourage my employees’ personal wellness efforts.	4.1 (0.8)	82	96	84	80
4. I receive training on employee wellness as part of my job.	2.6 (1.3)	17	20	17	18
5. My employees’ workload allows them to participate in wellness activities.	3.4 (1.2)	55	66	58	55
6. I am flexible with my employees’ work schedules to encourage participation in wellness activities.	4.2 (0.9)	85	91	89	85
7. My agency’s policies support employee participation in wellness activities.	4.0 (0.9)	77	86	82	75
8. My agency’s culture supports employee wellness.	3.9 (1.0)	75	85	77	77
9. My agency expects me to support my employees’ participation in wellness activities.	3.8 (1.0	69	84	72	68
10. I am a positive wellness role model for my employees.	3.6 (1.0)	54	69	58	51
11. My supervisor encourages my personal wellness efforts.	3.5 (1.1)	51	74	35	47

Abbreviation: SD, standard deviation.

^aCoded 1 = strongly disagree to 5 = strongly agree.

^bOf the 547 managers who provided job title.

Agency culture

Most managers (75%) believe their agency’s culture supports employee wellness, and most (69%) report they have an expectation to support employee participation. Half the managers (54%) believe they are personally a positive role model for wellness. More executives (84%) felt an expectation to support employee participation than did middle (72%) or line (68%) managers.

Scheduling and workload

Managers, for the most part, believe they are flexible with employees’ work schedules to encourage participation in the wellness program (85%). About half the managers (55%) believe their employees’ workload allows them time to participate. In the text comments, managers cited workload and schedule as the biggest barriers to their employees’ participation, as well as their own participation.

Communication

Two-thirds (67%) of the managers read the monthly communications from the wellness program, and about half (54%) share information about their agency’s wellness efforts with their employees.

Encouragement

Overall, managers (82%) believe they encourage their employees’ personal wellness efforts, and half (51%) report their own supervisors encourage their wellness efforts. Fewer middle (35%) and line (47%) managers than executives (75%) report their own supervisor encourages their wellness efforts.

Policies

Overall, managers (77%) believe their agency’s policies support employees’ participation in the wellness program. Managers’ comments suggest making policies consistent and visible across the agency, such as policies that detail how much time employees are provided to participate.

Training

Only a small percentage of managers (17%) indicate they receive training on employee wellness as part of their job. The lack of training was reported by survey respondents at every level of management (executive, middle, and line).

Discussion

The most notable of our findings was the lack of training on wellness. We found in the interviews that some managers were unaware of the wellness program policies and fewer of them felt a formal expectation to support the wellness program. The survey findings corroborated the interviews, as very few managers across all levels reported they had received training on the wellness program. In our interviews, we found that managers are supportive of their agency’s wellness program and perceive many benefits to offering wellness activities and resources to employees. Similarly, managers reported via the surveys that their agency’s policies support participation in wellness activities, and they feel expected to support their employees’ wellness efforts. In the interviews, managers described employee buy-in as key to employee participation but also emphasize the importance of serving as a role model for their employees. We found from interviews that managers did not view their own manager as a wellness role model for them, and on the surveys only about half report that they receive encouragement from their direct supervisor. The interviews and surveys suggest that managers value the regular communications they receive regarding the wellness program but would welcome more targeted messages. The interviews and surveys found that managers experience a supportive culture at their agency, but they also report difficulties accommodating participation due to inflexibility of schedules and heavy workload.

Our findings build on previous research using mixed methods to understand managers’ perspectives about their barriers and facilitators and their role in supporting employee participation in wellness programs. One qualitative study with human resource managers found that while most managers believed worksite health promotion was important, many pointed to barriers such as cost, time, logistical challenges, and unsupportive culture.¹² Although we found a few differences among executive, middle, and line managers, our findings suggest that workload and scheduling are very common barriers. Previous research from health-care systems suggests several factors specifically influence middle managers’ support for intervention implementation: policies, resources, role overload, executive management support, and organizational culture.¹⁷ Similarly, we found that role expectations, awareness of policies, and a supportive culture are facilitators for managers’ support for wellness programs. Previous research suggests executive leaders’ support has a direct effect on middle managers’ commitment.¹⁸ To promote and support wellness programs, the TWH approach suggests that line and middle managers should be engaged throughout program design and implementation.¹⁰

We found differences in the level of support reported by executives, middle, and line managers. For example, three-quarters of executives, but only one-third of middle managers, reported that their supervisor encourages their own wellness efforts. This finding is an example of what the TWH framework recognizes as an opportunity to provide executive leaders with corrective actions to help them better support middle and line managers.¹⁰ We found that not all the managers felt expected to support wellness programs, which suggests that there may be inconsistent messaging or understanding around managers’ expectations. According to the TWH approach, executive leaders are important for building support among lower levels of managers.¹⁰

One issue that surfaced in some of the interviews, and has been raised again as we work with these agencies to develop a wellness program training for their managers, is that talking with employees about their health and health behaviors can be intimidating. Some of the managers we interviewed expressed doubts about how to support employees’ health without being intrusive. This, combined with a lack of training on the wellness program, lack of clear expectations for the managers’ role in the wellness program, and for some managers, a lack of a clear role model in their own manager, could make it difficult for managers to venture into the wellness arena with their direct reports. The TWH approach recommends that executive, middle, and line managers receive training on relevant workplace topics in order to improve implementation and support for wellness programs.¹⁰ Training for managers should not only address the components of the wellness program and expectations for managers but also address the delicate balance between promoting wellness and demanding healthy behavior. Training can help managers gain confidence in their ability to have constructive interactions with employees about the wellness program.

Limitations and Strengths

Mixed-methods research has the same limitations as qualitative and quantitative research. The telephone interviews and online surveys rely on self-reported data from participants. Another limitation is the generalizability of the survey instrument to populations outside the Washington State agencies; however, it may be applicable to the wider network of state agencies. Washington is a large employer with over 63 000 employees (excluding higher education) and hundreds of office locations around the state. In addition, the manager survey instrument used in this study has not been validated. We used the qualitative findings to inform the survey questions. Future research will need to validate our survey instrument. To our knowledge, previously published workplace health promotion survey instruments do not assess managers’ support at the level of detail as our survey instrument. The strengths of using mixed-methods research include the ability to provide stronger evidence through the corroboration of findings.¹⁹ Another strength of this study is that the findings are grounded in the managers’ experiences. Mixed methods provide more in-depth knowledge of the views managers have regarding wellness programs. The findings are more robust, with quantitative data supporting the qualitative findings. For example, we corroborated interview findings with survey results to draw conclusions about the lack of targeted messaging and training.

Implications for Practice

Wellness programs are not implemented in a vacuum; managers need guidance on their role in implementing and supporting wellness programs. Following the recommendations of the TWH approach may assist practitioners and researchers in implementing successful wellness programs. These approaches, outlined below, include training, support, commitment, and clear expectations for managers at all levels. All managers need training on how to support the wellness program and activities as well as training on the content and evidence behind the wellness program. Training can increase managers’ awareness of wellness policies, as well as expectations for their role, and the provision of training is an indication of senior management’s commitment to the wellness program. Executive leaders should receive additional training to facilitate middle and line managers’ support for the wellness program. Our findings suggest that implementing wellness programs should take a top-down and bottom-up approach. Middle and line managers reported receiving less support from the manager above them than did executives. Executive leadership should provide verbal encouragement to middle and line managers to support their employees’ participation in wellness programs. The values, attitudes, and behaviors that are committed to wellness efforts define the culture surrounding wellness. Managers need their workload and schedules to align with their expected role in supporting the wellness program. For example, we found that workload and scheduling was a barrier to managers’ participation in the wellness program. Managers (of all levels) need targeted messages from the wellness program, such as information and best practices for managers to use when discussing wellness-related topics with employees.

Conclusions

Our findings suggest managers are supportive of wellness programs but may fail to accommodate employees’ participation due to lack of training about the programs, workload, scheduling inflexibility, lack of self-efficacy, and lack of formal expectations. The strategies we provide may help engage managers at all levels to take a more active role in supporting employees’ participation in wellness programs. Future research will need to test and evaluate strategies that engage managers to support wellness programs.

SO WHAT?

What is already known on this topic?

The role of managers is widely acknowledged in the Total Worker Health framework, as a critical factor for implementing and evaluating wellness programs and policies, but there is limited evidence on how to increase managers’ support.

What does this article add?

We interviewed and surveyed executive, middle, and line managers in 4 state agencies about the barriers and facilitators to supporting their employees’ participation. We found that managers are supportive of the wellness program but face challenges with accommodating employees’ participation due to lack of training about the program, workload, scheduling inflexibility, lack of self-efficacy to discuss wellness with direct reports, and lack of formal expectations.

What are the implications for health promotion practice or research?

Several strategies may assist managers to support their employees’ participation in wellness programs: the provision of training, targeted messages, formal expectations, and encouragement (from the manager above) to support employees’ participation.

Footnotes

Acknowledgments

Deborah Passey gratefully acknowledges funding received from the National Institute for Occupational Safety and Health (T42OH008433) while working on this study. Also acknowledges Marlana J. Kohn for her assistance with programming the survey and data collection in REDCap.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a contract from the State of Washington Health Care Authority. Additional research support was by the University of Washington Health Promotion Research Center (HPRC), one of the Centers for Disease Control and Prevention’s Prevention Research Centers Program (HPRC cooperative agreement U48DP005013). Deborah Passey received funding from the National Institute for Occupational Safety and Health (T42OH008433) while working on this study.

ORCID iD

Deborah G. Passey, MS

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