Abstract
Purpose
Although workplaces are prime settings for health promotion, little is known about the implementation of policy, systems, and environmental (PSE) changes focused on chronic disease. PSEs have broader reach and are more sustainable than individual level strategies.
Design
non-experimental, one group design with no control.
Subjects
Convenience sample of 27 workplaces, representing 6 industry types.
Intervention
$1000 in micro funding awarded to workplaces to participate in Centers for Disease Control and Prevention (CDC) Work@Health®/ScoreCard, and implement PSEs.
Measures
ScoreCard baseline results; post project survey results
Analysis
Descriptive analysis of ScoreCard; survey responses coded into PSE and I (individual level strategies) categories; frequencies were calculated.
Results
63% of the workplaces were very small (1-100 employees). Chronic disease-related organizational practices (ScoreCard) were minimal: nutrition (5/24), physical activity (7/22), diabetes (5/15), cholesterol (4/13), and high blood pressure (6/16). Workplaces reported a total of 95 PSEs: P-8, S-55, and E−32.
Conclusion
Policy change was the least frequently attempted and reported PSE strategy. More research with a stronger study design is needed to determine if (1) baseline organizational practices (Scorecard scores) improve, (2) PSEs (especially P) can be implemented without micro funding/TA, (3) workplace-type is related to use of the funds/TA, and (4) enacting PSE changes leads to healthier employees.
Purpose
Chronic diseases, the leading causes of death in the US, are linked to decreased workplace productivity.1,2 Workplaces typically implement individual level strategies and have less experience with policy, systems, and environmental (PSE) strategies. 3 PSEs have broad reach and are more sustainable than individual level strategies. 4
CDC’s Work@Health® training and ScoreCard help workplaces assess and implement evidenced-based strategies. 5 Little is known about efforts that pair these approaches with micro funding and technical assistance (TA) to promote PSEs in workplaces; this study combined these approaches. Key questions include: (1) What is the extent of workplaces’ organizational practices related chronic disease prevention/management? (2) How many and types of PSEs were implemented? and (3) What challenges were encountered?
Methods
Design
Non-experimental, one-group design with no control.
Sample
A convenience sample of 27 workplaces in 1 state received micro funding for 1 year (10 in 2019; 17 in 2020). Data are reported at the workplace level. Workplace size ranged from 21-2,500 employees: 63% very small, 19% small, 11% medium, and 7% large and included education (10 public schools and 4 institutions of higher education), health care (2 hospitals, 2 local health departments, 2 Federally Qualified Health Centers). There were 4 community development/capacity building organizations; others included a conservancy, a sanitary board, and a real estate business.
Intervention Methods
Funding and TA are effective mechanisms for disseminating evidence-based practices. 6 A request for Proposals (RFP) solicited applications from workplaces. The RFP and supporting materials specifically stated that the purpose of the funding was to promote PSE changes and contained examples of PSEs; applicants could select the examples or create their own. An “other” section also allowed for description of any non-PSE strategies. Applications were reviewed using a standardized rubric. Funded workplaces ($1000 maximum) designated one employee to complete the Work@Health® training and ScoreCard.
TA was provided throughout the Work@Health training and implementation period by one full time staff member of the funding organization. The intent of TA was to nudge worksites toward use of PSE strategies. Worksites did not have to use their funding to pay for TA. Toward the end of the funding period, TA focused on evaluation and sustainability.
Measurement Methods
Workplace size was calculated using established definitions of the number of employees: very small (1-99), small (100-249), medium (250-749), and large (750+). 5 Workplaces were categorized into organizational types, using the Internal Revenue Service’s typology. 7
The ScoreCard, an organizational assessment with established validity and reliability, 8 provides guidance about evidence-based strategies. Questions assess strategy implementation using a yes/no format. Lower scores indicate fewer evidenced-based organizational practices. Although the entire ScoreCard includes 18 topics and 154 questions, this study only used those aligned with the funding foci: nutrition, physical activity, diabetes, cholesterol, hypertension, and tobacco.
PSE implementation was assessed via an on-line survey during the last month of the grant funding. Respondents reported on all P, S, E or “other” strategies they implemented.
Descriptive Analysis
ScoreCard scores were grouped and averaged by topic and workplace type. PSEs were deductively coded using existing definitions: (1) policy: a written plan/course of action; (2) systems: changes to organizational practices/procedures; and (3) environmental: changes to the physical, social, or economic environment. 4 Non-PSE strategies, such as one-off events, eg, health fairs, were coded as I (individual strategies). Two reviewers independently coded strategies; discrepancies were resolved by consensus. Frequencies were calculated and grouped by workplace type. Budget items were also grouped and tallied by PSE or I strategies. Implementation challenges were identified from discussions among project team members.
Results
ScoreCard Average Baseline Scores by Workplace (n = 27) Type and Chronic Disease Topic Area (total possible points).
aTob=Tobacco; High Blood Press=High Blood Pressure; Choles=Cholesterol; Weight Mgt=Weight Management; Nut=Nutrition; Diab-Diabetes.
PSE Strategies by Workplace Type.
Challenges included a preference for implementing individual level activities and the complexity of implementing PSEs which typically involve multiple levels of an organization. Several workplaces reporting receiving pushback from upper-level management about policy development.
Discussion
Summary
Workplace organizational practices were weak in comparison to those reported in a study of healthcare and social assistance workplaces. 9 Education and health care workplaces scored higher on tobacco than the other topics-this could be attributed to existing national policies for these workplaces. Policy was the least frequently attempted and reported PSE strategy. Other research also found policy development to be challenging for workplaces. 10 The generalizability of the funding provided to the workplaces is unknown.
Limitations
Limitations include no control group, self-reported data, and the possibility that these results may have relied on the funding worksites received. A strength was the variety of workplaces.
Significance
Although workplaces implemented various PSEs, facilitating the transition from individual level strategies to PSEs was challenging. This project addresses the gap of understanding the challenges of promoting PSEs in workplaces.
So What?
What is already known on this topic?
Workplace health promotion programs can mitigate chronic disease risks, but several barriers hinder adoption and implementation, including senior level support, lack of qualified vendors and personnel, and cost. 5 CDC’s Work@Health® training and Scorecard enable workplaces to address barriers and prioritize evidenced-based strategies to implement. 5
What does this article add?
This study identified weak organizational practices related to chronic disease prevention/management and specific challenges to the implementation of PSE changes in workplaces, including a preference for implementing individual level strategies. Further, as found in other research, 10 policy strategies were less likely to be adopted.
What are the implications for health promotion practice or research?
Although these results are promising, more research with a stronger study design is needed to determine if 1) baseline organizational practices (Scorecard scores) improve, 2) PSEs (especially P) can be implemented without microfunding/TA, 3) workplace-type is related to use of the funds/TA, and 4) enacting PSE changes leads to healthier employees.
Footnotes
Acknowledgments
We would like to thank Dasheema Jarrett, MA, Public Health Advisor and Field Assignee to West Virginia Bureau for Public Health, for her technical assistance and mentorship to Active Southern West Virginia in launching our Workplace Health Promotion Pilot Program in 2017. We also acknowledge Michael Fisher of Active Southern West Virginia for his editing contributions.
Author Contributions
Conceptualization-M.S, V.C., N.O.T, and J.V.; methodology, N.O.T and M.S., analysis, N.O.T. and V.C; writing—original draft preparation, N.O.T., M.S and V.C.; writing—review and editing, N.O.T., M.S, V.C. and J.V. project administration, M.S. and V.C. All authors have read and agreed to the submitted version of the manuscript.
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 work was supported by the West Virginia Department of Health and Human Resources [grant number G220438].
