Abstract
Purpose:
To explore, by income level, employee perceptions of an employer offered wellness incentive program.
Design:
Qualitative and quantitative study that includes a survey with close-ended and open-ended questions.
Setting:
The study setting was a hospital in Wisconsin.
Participants:
Participants (n = 105).
Measures and Analysis:
Quantitative responses were analyzed using descriptive statistics in Qualtrics and logistic regression in Statistical Analysis System.
Results:
Sixty-three percent participated in the wellness incentivized program because their employer offers them a reward; 52% said they would participate without a reward; 48% feel like they must participate in this year’s program; and 34% feel like they would have to disclose information about their health at or below the current reward level.
Conclusion:
Income does not have a significant effect on whether employees feel they must participate or disclose health information. However, income has a significant effect on employee’s beliefs about whether or not employers should play an active role in improving the health of their employees.
Keywords
Purpose
Employers offer wellness incentive programs to employees to improve employee and organizational outcomes. 1 Wellness incentive programs include health promotion and prevention activities such as health screenings, smoking cessation programs, healthy food options and cooking classes, and paid gym memberships and/or paid time to exercise. 2 -6 Employer promotion of health produces benefits such as reduced absenteeism and health insurance costs as well as increased employee satisfaction, retention, and productivity. 7,8 Moreover, health prevention services provided by employers can be cost effective and reduce morbidity and mortality. 9
Many factors influence employee engagement in employer offered wellness incentive programs. These factors include employee perceptions of the value of employee wellness programs, the employer’s role in employee wellness and the employee’s responsibility for their own wellness, the commitment of the CEO, senior leaders and company leaders to employee wellness, the contribution of the work environment to employee wellness, employer offered resources for maintaining wellness, support for achieving wellness goals, and incentives for participation.
Employers use a number of strategies to increase employee engagement in wellness programs including offering discounts on health insurance premiums in exchange for employee participation. 10 Koruda analyzed workplace wellness incentive programs to determine whether incentives discriminate against low-income individuals, racial minorities, and individuals with disabilities. 11 Koruda found that workplace wellness incentive programs make low-income individuals, racial minorities, and individuals vulnerable to health-care cost-shifting. 11 We tested to see whether low-income workers are more likely than middle- and high-income workers to feel like they have to participate and disclose health information in an employer offered wellness incentive program. In addition, we examined the role employee perceptions play in employee engagement in the program and tested the relationship between income and employee perceptions related to and engagement in the program.
Method
Design
We conducted a cross-sectional study using data from a survey of employee perceptions of their employer offered wellness incentive program. This study was granted approval by the Institutional Review Board at the University of Wisconsin Milwaukee.
Sample
Participants (n = 105) were employees of a community hospital in Wisconsin. Participants’ ages were relatively evenly dispersed across age groups and the majority of participants identified female (96%). The majority of participants indicated they were of middle-income (72%) and working as clinical employees (51%; see Table 1).
Employee Characteristics.
Measures
The hospital administrative staff shared the survey with their 1000 employees, 482 of whom participate in the employer offered wellness incentive program, in the hospital’s newsletter. Participants were surveyed about their perceptions of the value of the program, the employer’s role in employee wellness and the employee’s responsibility for their own wellness, the commitment of the CEO, senior leaders and company leaders to employee wellness, the contribution of the work environment to employee wellness, employer offered resources for maintaining wellness, support for achieving wellness goals, and rewards for participation. Responses were collected using Qualtrics, a data collection and analysis software (Qualtrics, Seattle, Washington).
Analysis
To examine the themes of the open-ended questions, we used In Vivo Coding in Atlas.ti version 8.3.1 (Scientific Software Development GmbH, Berlin, Germany). Each quotation was qualitatively analyzed to determine employee perceptions of the employer offered wellness incentive program, including how they perceive the program, how they perceive the employers role, the CEO’s role and the company’s leaders’ roles in employee wellness, how they perceive their work environment in relation to their wellness and how they perceive the reward for participating in the program. Then, we used code frequency matrices to determine how many quotations for each question were linked to each code. Lastly, we narrowed these lists to the most popular themes for each question.
Descriptive statistics are used to present how participants responded to each survey question and statement with respect to income. Participants’ text responses were entered into Atlas.ti and coded for themes. The top 5 most prevalent themes for each open-ended question were identified. Logistic regression was used in Statistical Analysis System (SAS Institute, Raleigh, North Carolina) to test for statistically significant relationships between participants’ perceptions of wellness incentive program and their income level. Employees were offered a US$10 gift card for participating in the study.
Results
Participants (n = 105) were employees of a community hospital in Wisconsin. Participants’ ages were relatively evenly dispersed across age groups and the majority of participants identified female (96%). The majority of participants indicated they were of middle-income (72%) and working as clinical employees (51%; see Table 1).
Out of 98 employees, 17 (17.35%) think it’s important for employers to play an active role in employee wellness, and income has a significant effect on this response (F 3,100 = 5.42; P = .002). More specifically, there is a statistically significant difference in the mean scores of the high-income group and the middle-income group (P = .01). However, there is not a statistically significance difference in the mean scores of the low-income group and the middle-income group (P = .48). About 22% of the variation in the responses is associated with income in this sample. Our estimate of the proportion of variance accounted for by income in the population is 94.23%. Therefore, middle-income employees are more likely than high- but not low-income employees to agree that it’s important for employers to play an active role in employee wellness. In addition, we can conclude that low-income employees are more likely than high- but not middle-income employees to agree (see Table 2).
Employee Perceptions.
Abbreviation: LSN, Least Significant Number.
Out of 97 employees, 47 (48%) feel like they have to participate in this year’s program at or below the current reward level of US$200, and income does not have a statistically significant relationship with this response (χ2 = 3.84, df = 3, P = .2789; see Table 2). Out of 95 employees, 32 (34%) feel like they would have to disclose information about their health at or below the current reward level of US$200, and income does not have a statistically significant relationship with this response (χ2 = 4.2830, df = 3, P = .2325; see Table 2). According to the retrospective power analysis, the effect of income on whether or not employees feel like they have to participate is not significant (Least Significant Number (LSN) = 199, α = .05, σ = 3.37, δ = 0.6746) and the effect of income on whether or not employees feel like they have to disclose health information is not significant (LSN = 197, α = .05, σ = 4.11, δ = 0.8275). Therefore, the data suggests income is not important for whether or not employees feel like they have to participate or disclose their health information in the employer offered wellness incentive program.
Discussion
Summary
Our findings show that income is not important for employee perceptions of the value of the employer offered wellness incentive program, the employee’s responsibility for their own wellness, the commitment of the CEO, senior leaders, and company leaders to employee wellness, the contribution of the work environment to employee wellness, employer offered resources for maintaining wellness, support for achieving wellness goals, or incentives for participation. Furthermore, income is not important for whether or not employees feel like they have to participate or disclose their health information in the program.
However, income is important for employee perceptions of the employer’s role in employee wellness. We found middle- and low-income employees were more likely than high-income employees to agree that employers should play an active role in employee wellness.
Limitations
The sample was taken from a single location, which limits the generalizability of the findings. Moreover, the sample was composed of health-care workers who we would expect to be more health minded than the general population. Therefore, participants’ perceptions and willingness to engage in the wellness incentive program may be biased and not generalizable to other settings. In addition, the majority of participants identified as female (96%), therefore we could not test for gender differences and this limits generalizability to the population. Finally, the sample is 18% low-income, 72% middle-income, and 10% high-income. Naturally, there would be an unequal distribution of individuals across income groups similar to what is represented here. However, the small sample size limits our ability to make between group comparisons with respect to income.
Significance
Our findings do not give support to critics who suggest that wellness incentive programs are coercive to otherwise disinterested employees. 12 In addition, incentive level is not important for whether or not employees feel like they have to participate in the program considering 52% (n = 46) said they would participate without a reward. Moreover, our findings do not give support to studies that have found that wellness incentive programs have a disproportionate negative impact on low-income employees. 11
So What?
What is already known on this topic?
Koruda found that low-income individuals are vulnerable to discriminatory health-care cost-shifting as a result of wellness incentive programs 11
What does this article add?
Our findings show that income is not important for whether or not employees feel like they have to participate and disclose health information in the employer offered wellness incentive program.
What are the implications for health promotion practice or research?
There is a need for further investigation of employee perceptions of employer offered wellness incentive programs with respect to income level.
Footnotes
Authors’ Note
All authors of this manuscript contributed to the following: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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) received no financial support for the research, authorship, and/or publication of this article.
