Help Preferences Among Employees Who Wish to Change Health Behaviors

Abstract

Objective. To examine the help preferences of employees in the Danish police who had acknowledged that they wished to change health behaviors. In addition, we explored whether preferences varied with age, gender, chronic health concerns, positive expectations of good health, and past experiences of in-house health promotion services (i.e., wellness service). Methods. Respondents to an electronic questionnaire who acknowledged wishing to change health behaviors in relation to smoking (n = 845), alcohol (n = 684), eating (n = 4,431), and physical activity (n = 5,179) were asked to choose up to three help alternatives on a predefined list. Results. In descending order, smokers preferred help from nicotine gum, no help, and help and support from family and friends. Alcohol consumers preferred no help or help and support from family and friends or “other” forms. Employees who wanted to change eating habits preferred a free fruit bowl, free nutritional guidance, and healthy food at work. Employees who wanted to change physical activity patterns preferred exercise at work, offers of free exercise, and exercise in a social/collegial context. Conclusion. Wishing to change health behaviors is not always accompanied by perceiving a need for assistance. The no-help option was selected fairly frequently and mostly in relation to alcohol and smoking. A fruit bowl was the most preferred option for help, followed by exercise at work and free exercise. Help from traditional health services was ranked low, possibly reflecting that they are primarily viewed as a solution for stopping disease rather than promoting health.

Keywords

barriers health promotion motivation police work

High participation in health promotion activities is essential for their effectiveness. Participation in health promotion programs is, however, often low, and health promotion activities may not always reach the individuals in greatest need of health improvement (Goetzel & Ozmlnkowski, 2008; Linnan, Sorensen, Colditz, Klar, & Emmons, 2001). While several studies have focused on the effectiveness of health activities among self-selected groups of employees, relatively few studies have addressed the issue of understanding participation (Crump, Earp, Kozma, & Hertz-Picciotto, 1996; Grosch, Alterman, Petersen, & Murphy, 1998; Kruger, Yore, Bauer, & Kohl, 2007; Nöhammer, Schusterschitz, & Stummer, 2010). Collectively, the studies on participation seem to indicate that tailored actions on both the individual and the organizational level might improve participation in various health activities at the work site. However, the often thin descriptions of the health activities as regards their delivery, context, content, and periodization obscure the understanding of results. Given that difference in legislations, designs of health care systems, and culture also complicates translation of results between settings and countries, it becomes evident that there is a need for better contextualized studies and observations from different settings and countries.

Since participation in health promotion programs is typically voluntary, it seems reasonable to assume that the potential user’s motivations and preferences toward various help options will be an important determinant of participation. Indeed, Nöhammer et al. (2010) underlined that the design of the offer, including ease of access and the matching of individual and social needs, was an important factor for participation. Even if motivational constructs (e.g., self-efficacy or personal efficacy, trait anxiety, and satisfaction with one’s own health) are a common ingredient in health behavior models (Redding, Rossi, Rossi, Velicer, & Prochaska, 2000) and have received some attention in relation to participation (Davis, Jackson, Kronenfeld, & Blair, 1987), preferences for help have attracted lesser interest. In fact, the closest attempt we have found is Middlestadt and colleagues (Middlestadt, Sheats, Geshnizjani, Sullivan, & Arvin, 2011), who described the distribution of salient beliefs underlying people’s intentions to participate in a hypothetical work-site wellness program. From a theoretical perspective, however, preferences are believed to represent general and stable evaluative judgments as regards the relative disposition to a given stimulus, and they are primarily thought to affect approach and avoidance behaviors (Scherer, 2005). When compared with the theoretical stance adopted in health models such as the health belief model, the theory of reasoned action, social cognitive theory, and the transtheoretical model (Redding et al, 2000), it becomes clear that a focus on people’s preferences represents a simpler approach that assumes no obvious rationality or reasoning to explain behavior. Indeed, people may acquire preferences without necessarily knowing why or being able to specify how these preferences was acquired in the first place. Even so, it is obvious that liking or disliking things, or circumstances, may affect a person’s choice and that mapping preferences may, therefore, give a clue to the path of least resistance. Hence, knowledge about people’s preferences may serve to inform various service providers who, in turn, may try to optimize the selection of detailed actions, general policies, or the planning of work-site health promotion programs.

With this background in mind, we undertook—in the context of a process evaluation of a multipurpose in-house wellness service in the Danish police—an exploration and mapping of employees’ preferences for help from the consultants and from other available help options within and outside the organization. Taking our lead from the focus areas of the wellness service and addressing the four major lifestyle factors, we examined preferences for help in relation to physical activity, nutrition, alcohol, and smoking. The intent was not to explore how preferences were directly associated with the uptake or use of a specific health activity. The reason for this was twofold. First, because we had no a priori knowledge about the statistical distribution of people’s preferences, a stipulation of statistical relationships was deemed premature. Second, a test of statistical relationships between preferences and participation would also have required that we collect participation data in relation to each preference. The objective of our study design was, rather, to map the preferences for help among all employees who had expressed a wish to change behavior. In addition, it was also of interest to examine whether the preferences for help varied as a function of the participant’s age, gender, perceptions of current and future health, and in relation to whether they had past experiences with the wellness service. Although it is conceivable that a number of different circumstances may affect the shaping of a person’s preferences, these contrasts were selected in view of their high theoretical validity as modifying factors influencing approach and avoidance behaviors in relation to health and health promotion.

Materials and Method

This research is part of a study that has explored demographical and psychosocial determinants for the uptake of a multipurpose wellness service in the Danish police and why employees with suboptimal health do not make use of it (Persson et al., 2013; Persson, Cleal, Jakobsen, Villadsen, & Andersen, 2014).

The Wellness Service

The wellness service consisted of six full-time consultants (five women) whose role was to provide wellness services for all employees in the Danish National Police and the 12 police districts. The consultants travelled frequently, with the goal of visiting the main stations in the various districts at least once every 4 to 6 weeks. The wellness service was available and free of charge to all employees and could be used during working hours as long as the appointments did not conflict with daily work tasks. The work of the wellness service focused on improving physical well-being related to the four major lifestyle factors. The main task was to provide counseling in relation to exercise, eating, drinking, and smoking habits. The scope and level of the individual-targeted initiatives varied in accordance with the care seeker’s needs and aspirations. At times, the consultation only served to increase the employee’s awareness; on other occasions, the consultation served to support more radical lifestyle changes. Furthermore, the counseling contained elements of primary, secondary, and tertiary prevention. While most activities were directed toward individual employees, other activities, such as group activities, health campaigns, and education, were also occasionally endorsed. At the time of the investigation, the service had been fully operational for approximately 2 years.

Participants

The research was conducted in accordance with Danish Law and institutional guidelines on ethics in research and is, therefore, compliant with the Declaration of Helsinki (Williams, 2008). All potential users of the wellness service—that is, all administrative workers (e.g., lawyers, clerks, and a minority of employees with special skills such as mechanics) and police officers—were invited to respond to an electronic questionnaire (n = 15,284). There were in total 6,373 respondents (41.8%). Only those that were employed in the Danish National Police, or in the 12 police districts, and had responded to at least two thirds of the items in the questionnaire were included (N = 6,062). For the purposes of the present study, only participants who had responded that they perceived a need for lifestyle changes were included: (a) “Do you wish to quit smoking or cut back on your smoking?” (N = 845), (b) “Do you wish to cut back on your alcohol consumption?” (N = 684), (c) “Do you wish to eat healthier food?” (N = 4,431), and (d) “Do you wish to be more physically active?” (N = 5,179). The proportion of participants that primarily worked daytime, two shifts, three shifts, or another form of work schedule and wanting to change smoking habits were 72%, 5%, 18%, and 4%, respectively. The corresponding figures for participants wanting to change alcohol habits were 72%, 9%, 15%, and 4%, respectively; participants wanting to change eating habits were 66%, 8%, 22%, and 4%, respectively; and participants wanting to change physical activity level were 67%, 8%, 21%, and 4%, respectively. Demographics and lifestyle characteristics concerning age, gender, and health behaviors are presented in Table 1.

Table 1.

Demographic and Lifestyle Characteristics for Each of the Four Subgroupings.

Smokers
Age in years, mean (SD)	45 (11)
Gender (% women)	33
Proportion with basic training as police officer (% of the study sample)	67
Proportion wanting to change behavior (% of the study sample)	14
Number of cigarettes per day, median (25th to 75th percentile)	12 (7-35)
Number of cigars per day, median (25th to 75th percentile)	0 (0-0)
Number of pipe chambers per day, median (25th to 75th percentile)	1 (0-4)
Alcohol consumers
Age in years, mean (SD)	47 (10)
Gender (% women)	20
Proportion with basic training as police officer (% of the study sample)	78
Proportion wanting to change behavior (% of the study sample)	11
Number of consumed units per week, median (25th to 75th percentile)	5 (3-7)
Proportion consuming alcohol up to 3 to 4 times per week (%)	76
Proportion consuming alcohol up to 5-7 times per week (%)	24
Healthier diet
Age in years, mean (SD)	43 (11)
Gender (% women)	29
Proportion with basic training as police officer (% of the study sample)	70
Proportion wanting to change behavior (% of the study sample)	73
Proportion consuming at least one serving of fruit per day (%)	43
Proportion consuming at least one serving of vegetables per day (%)	34
Proportion consuming fast food at least one time per week (%)	16
Physical activity
Age in years, mean (SD)	44 (11)
Gender (% women)	29
Proportion with basic training as police officer (% of the study sample)	72
Proportion wanting to change behavior (% of the study sample)	85
Proportion physically active for at least 30 minutes 7 days a week (%)	7
Proportion physically active for at least 30 minutes 0 to 3 days a week (%)	57

Note. Physical activity is defined as any activity that increases the respiration rate (e.g., heavy garden work, walking at a fast pace, competitive sports, etc.) for at least 30 minutes per day.

Measures

Data were collected via an electronic questionnaire. The items on preferences and help options were in part derived and constructed from information that had been collected in 21 preceding group interviews (n = 84; mean age = 46 years, and SD = 11 years). The groups were identified in collaboration with employer, union, and wellness representatives and derived from a strategic sampling that aimed to maximize the contrast between potential interest groups defined by geographic regions (i.e., the capital Copenhagen and the northern most part of the Jutland peninsula), occupational groups (i.e., lawyers, administrators, police officers on continuous shift work; police officers with only occasional shift work; and police officers with line management responsibility), and users and nonusers of the wellness service. From these interviews, we learned about various extant help offers and could include these in the questionnaire. Some options referred to the help in the workplace, whereas other options referred to help outside work.

Preferences for Help

Four items assessed the preferences for help in relation to smoking, alcohol, eating, and physical activity. The response was registered on a list that provided rationales that were both generic and lifestyle factor specific. There were seven generic rationales: I do not want help, help and support from family and friends, opportunity to do it in a social/collegial context, help from my doctor, help from wellness consultants, help from other health care workers, and other. The number of lifestyle specific rationales varied between four and six (presented in the tables). Multiple answers were allowed up to a maximum of three.

Chronic health concerns were assessed with one item that read, “To what extent have you, during the past 12 months, had serious worries about your own health?” The item had five response categories: 1 = not at all, 2 = a little, 3 = moderately, 4 = quite a lot, and 5 = extremely. The answers were trichotomized so as to represent 1 = not at all, 2 and 3 = some, and 4 and 5 = to a very high degree.

Anticipated future health was assessed with one item that read, “If you consider your health, do you believe that you will be able to perform your current work in 2 years from now?” The item had five response categories: 1 = yes, absolutely certain, 2 = certain, 3 = maybe, 4 = no probably not, and 5 = no definitely not. The answers were trichotomized so as to represent 1 = very certain, 2 = certain, and 3 to 5 = doubtful. The 2-year period was selected somewhat arbitrarily, albeit with a view to what we believed could be a reasonable time frame.

Previous experience with the wellness service was assessed by identifying users and nonusers who were defined according to their responses on an item that assessed the number of times the participants had been in contact with the wellness service (0 = never, 1 = one time, 2 = two times, up to 6 = six times or more). The answers were trichotomized so as to represent 0 times, one to two times, and three times or more.

Information was also collected on age and gender. Age was categorized into three age-groups: 18 to 39, 40 to 49, and 50 to 65 years.

Data Analyses

The statistical computations were made with IBM SPSS 19.0 (IBM, 2010). P values less than .05 were considered statistically significant. The trichotomization of the contrast variables was conducted in consideration of the underlying response scale. The intent was to capture robust differences in people’s response statements. Between-group comparisons were first made with Pearson’s chi-square test. If this test was statistically significant, we performed Bonferroni-adjusted ordinary z tests to evaluate post hoc differences in proportions of persons expressing certain responses. Only the results from the post hoc test are presented in Tables 2 to 5.

Table 2.

Rank Order of Prevalence of Personal Preferences Among Those Participants That Explicitly Had Expressed That They Wanted to Quit Smoking (N = 845). Participants Were Allowed to Select a Maximum of Three Options.

	All		Gender (%)		Age-Group in Years (%)			Chronic Health Concerns (%)			Anticipated Good Health (%)			Experience With Wellness Service (%)
What kind of help do you prioritize if you are about to stop or cut down on smoking?	n	%	Men	Women	18-39	40-49	50-65	Not at All	Some	To a High Degree	Very Certain	Certain	Doubtful	No	1 to 2 Times	3 or More Times
Nicotine gum or other nicotine substances	247	29	32	23*	25	37*	29	28	30	25	30	29	27	28	31	28
I do not want help	243	29	29	28	30	27	29	40	28*	22*	29	24	39*	28	29	31
Help and support from family and friends	236	28	28	28	29	27	27	31	27	28	28	28	23	29	28	21
Smoking cessation course	208	25	25	23	25	24	25	13	26*	33*	25	29	12*	27	23	22
Help from alternative practitioner (e.g., acupuncture, hypnosis, etc.)	187	22	18	30*	24	23	20	18	22	29	22	26	15	19	27	19
Opportunity to do it with others	136	16	15	19	18	12	18	19	16	12	18	14	8	16	15	20
Help from my doctor	96	11	13	8*	9	12	12	7	11	17*	9	16*	17*	10	13	12
Help from wellness consultants	92	11	12	8*	10	13	10	6	12	13	10	13	9	10	13	8
Other forms of help	53	6	5	9*	7	6	6	4	7	6	6	7	9	6	5	12*
Help and support from my work	50	6	6	5	7	6	5	3	5	13*	5	5	12	6	5	7
Help from other health care workers	11	1	2	1	1	0	2	1	2	0	1	3	0	1	1	2

Note. Gender, men n = 565, women n = 280; age in years, 18-39 n = 255, 40-49 n = 243, 50-65 n = 346; chronic health concerns, not at all n = 134, some n = 599, to a high degree n = 112; anticipated good health, very certain n = 589, certain n = 190, doubtful n = 66; experience with wellness service, no n = 412, 1 to 2 times n = 324, 3 or more times n = 108.

Post hoc z-test p < .05 compared with the left most column. ^†Post hoc z-test p < .05 compared with the second left most columns.

Table 3.

Rank Order of Prevalence of Personal Preferences Among Those Participants That Explicitly Had Expressed That They Wanted to Cut Down on Drinking (N = 684). Participants Were Allowed to Select a Maximum of Three Options.

	All		Gender (%)		Age-Group in Years (%)			Chronic Health Concerns (%)			Anticipated Good Health (%)			Experience With Wellness Service (%)
What kind of help do you prioritize, if you are about to cut down on alcohol?	n	%	Men	Women	18-39	40-49	50-65	Not at All	Some	To a High Degree	Very Certain	Certain	Doubtful	No	1 to 2 Times	3 or More Times
I do not want help	520	76	76	76	73	78	76	86	77	62*	77	74	76	79	75	71
Help and support from family and friends	112	16	18	11	18	18	14	15	15	22	17	16	15	17	18	13
Other	48	7	7	9	9	6	7	0	7	12	7	7	9	7	5	13^†
Help from my doctor	37	5	5	5	1	4	8*	5	6	4	4	8	5	4	5	9
Help from wellness consultants	29	4	5	3	8	2*	4	4	4	5	4	5	4	4	5	4
Opportunity to do it with others	29	4	5	2	3	6	3	9	4	4	4	4	4	3	6	3
Help and support from my work	15	2	2	2	4	2	2	1	2	2	3	2	2	1	3	3
Prohibition of alcohol at work	9	1	2	0	1	1	2	0	1	3	1	1	4	2	1	1
Contact with an alcohol help center	8	1	1	1	2	0	1	1	1	3	1	2	0	1	1	1
(Antabuse) treatment	8	1	1	1	1	1	1	3	1	1	1	2	0	0	1	3^†
Help from other health care workers	6	1	1	1	1	1	1	1	1	2	0	2	0	0	1	2

Note. Gender, men n = 548, women n = 136; age in years, 18-39 n = 135, 40-49 n = 217, 50-65 n = 332; chronic health concerns, not at all n = 80, some n = 504, to a high degree n = 100; anticipated good health, very certain n = 437, certain n = 192, doubtful n = 55; experience with wellness service, no n = 268, 1 to 2 times n = 297, 3 or more times n = 119.

Post hoc z-test p < .05 compared with the left most column. ^†Post hoc z-test p < .05 compared with the second left most columns.

Table 4.

Rank Order of Prevalence of Personal Preferences Among Those Participants That Explicitly Had Expressed That They Wanted to Eat Healthier (N = 4,431). Participants Were Allowed to Select a Maximum of Three Options.

	All		Gender (%)		Age-Group in Years (%)			Chronic Health Concerns (%)			Anticipated Good Health (%)			Experience With Wellness Service (%)
What kind of help do you prioritize, if you are about eat healthier?	n	%	Men	Women	18-39	40-49	50-65	Not at All	Some	To a High Degree	Very Certain	Certain	Doubtful	No	1 to 2 Times	3 or More Times
Free fruit bowl	2,450	55	59	46*	60	55*	50^†	60	56	49*	56	55	51	56	57	50*
Free nutritional guidance	1,816	41	39	46*	45	43	35*	40	41	42	42	39	40	40	42	40
Healthy food at work	1,679	38	37	40	42	39	32*	39	37	39	38	38	31	39	37	37
Free exercise offer	1,547	35	35	36	40	37	28*	31	35	37	35	34	34	32	36	39*
Help from wellness consultants	932	21	22	19*	20	22	22	18	21*	23*	21	21	20	18	21	27*
Help and support from family and friends	776	18	18	15*	16	18	19	16	17	20	18	17	15	17	18	18
Free weight loss course	509	11	8	20*	10	12	13*	6	11*	18^†	11	13	13	10	12	14*
I do not want help	483	11	12	8*	7	10*	17^†	14	11*	8*	10	11	15*	13	10*	8*
Opportunity to do it with others	436	10	8	15*	9	9	11	6	10*	12*	10	11	9	9	10	11
Other	131	3	3	3	3	3	3	2	3	4	3	3	4	3	3	4
Help from my doctor	47	1	1	2*	1	1	1	1	1	2	1	1	2	1	1	1
Help from a psychologist	44	1	0	2*	1	1	1	0	1	2	1	1	3	1	1	2
Help from other health care workers	30	1	1	1	0	1	1	0	1	1	1	1	2	0	1*	1*

Note. Gender, men n = 3,136, women n = 1,295; age in years, 18-39 n = 1,668, 40-49 n = 1,294, 50-65 n = 1,464; chronic health concerns, not at all n = 688, some n = 3,156, to a high degree n = 583; anticipated good health, very certain n = 3,134, certain n = 1,010, doubtful n = 285; experience with wellness service, no n = 1,834, 1 to 2 times n = 1,822, 3 or more times n = 733.

Post hoc z-test p < .05 compared with the left most column. ^†Post hoc z-test p < .05 compared with the second left most columns.

Table 5.

Rank Order of Prevalence of Personal Preferences Among Those Participants That Explicitly Had Expressed That They Wanted to Be More Physically Active (N = 5,179). Participants Were Allowed to Select a Maximum of Three Options.

	All		Gender (%)		Age-Group in Years (%)			Chronic Health Concerns (%)			Anticipated Good Health (%)			Experience With Wellness Service (%)
	n	%	Men	Women	18-39	40-49	50-65	Not at All	Some	To a High Degree	Very Certain	Certain	Doubtful	No	1 to 2 Times	3 or More Times
Possibility to exercise at work	2,377	46	49	39*	49	50	40*	41	47*	46*	47	46	40	41	49*	51*
Free exercise offer	2,253	44	44	41*	50	44*	37^†	42	43	47	44	44	40	43	43	46
Opportunity to do it with others	1,603	31	29	36*	34	30	29*	27	32*	31	32	30	23*	28	32*	33*
Help from wellness consultants	1,110	21	22	20	19	22*	23*	15	22*	27^†	21	24	23	18	21*	31*^†
I do not want help	893	17	18	15*	12	16*	24^†	26	16*	12^†	18	15*	20	20	16*	13*
Help and support from family and friends	565	11	10	13*	12	12	9*	8	11*	13*	11	10	9	11	12	10
Shorter distance to sports facilities	561	11	10	12*	16	10*	6^†	10	11	12	11	9	11	12	10*	10
The training should be located in the home	481	9	7	15*	9	10	9	7	9	12*	9	10	9	9	9	9
Other	452	9	9	9	11	9	7*	7	9	11*	8	10	12	9	9	9
Help from other health care workers	52	1	1	1	1	1	2*	0	1	2*	1	1	3*	1	1	1
Help from my doctor	29	1	1	1	0	0	1	0	0	2*	0	1*	2*	1	1	0

Note. Gender, men n = 3,685, women n = 1,494; age in years, 18-39 n = 1,854, 40-49 n = 1,507, 50-65 n = 1,814; chronic health concerns, not at all n = 886, some n = 3,614, to a high degree n = 674; anticipated good health, very certain n = 3,679, certain n = 1,156, doubtful n = 314; experience with wellness service, no n = 2,137, 1 to 2 times n = 2,131, 3 or more times n = 910.

Post hoc z-test p < .05 compared with the left most column. ^†Post hoc z-test p < .05 compared with the second left most columns.

Results

Smoking

The 845 smokers that expressed a wish to stop, or reduce, their smoking habit marked, on average, 1.8 options from the list of alternatives. The results are presented in Table 2. Generally speaking, smokers who wished to change behavior primarily preferred help by nicotine gum (29%), no help (29%), and help and support from family and friends (28%).

Focusing on the greatest differences across our contrast groups, we observed that men preferred nicotine gum (32%) and that women preferred help from alternative practitioners (30%).

Participants in the age-group of 40 to 49 years expressed a higher preference for nicotine gum (37%) than younger and older participants.

Participants with a high degree of chronic health concerns preferred, to a greater extent, smoking cessation courses (33%), help from a doctor (17%), and help and support from work (13%). In addition, they were also less likely to report that they did not want help (22%).

Participants who expressed doubt in relation to their future health status stated that they did not want any help (39%), or if they did, they wanted it from their own doctor (17%). They were, moreover, also less likely to select smoking cessation courses (12%).

Participants that had used the wellness service three times or more were more likely to express a positive interest in other forms of help (12%).

Alcohol

The 684 alcohol consumers that wished to cut down on drinking marked, on average, 1.3 options from the list of alternatives. The results are presented in Table 3. Primarily, they preferred not being helped (76%) to receive help and support from family and friends (16%), or by other unspecified alternatives (7%).

Focusing on the greatest differences across our contrast groups, we observed that people with a high degree of chronic health concerns were less inclined to select the option that they did not want any help (62%), while participants who had used the wellness service three times or more were more inclined to report that they preferred other forms of help (13%).

Eating

The 4,431 participants that wished to adopt a healthier diet marked, on average, 2.5 options from the list of alternatives. The results are presented in Table 4. Their principal preferences were a free fruit bowl (55%), free nutritional guidance (41%), and healthy food at work (38%).

Focusing on the greatest differences across our contrast groups, we observed that men preferred a free fruit bowl (59%), whereas women expressed a preference for free nutritional guidance (46%) and free weight loss courses (20%) and opportunities to engage with others (15%).

Participants in the age-group of 50 to 65 years were more likely to report that they did not want any help (17%) and less likely to report that they wanted a free fruit bowl (50%), free nutritional guidance (35%), healthy food at work (32%), or a free exercise offer (28%).

Participants with a high degree of chronic health concerns preferred, to a greater extent, a free weight loss course (18%) and the possibility to engage with others (12%). In contrast, the fruit bowl, while still immensely popular, was a less common preference among those with the highest chronic health concerns (49%), both when compared with those without chronic health concerns and those with only some chronic health concerns. In addition, the group of people with the highest chronic health concerns were also less inclined to report that they did not want help (8%).

Participants with a pessimistic outlook regarding their future health status were, relatively speaking, more likely to express the view that they did not want any help (15%).

Participants that had used the wellness service three times or more were more inclined to report that they preferred help from the wellness consultants (27%), free exercise offers (39%), and help from family and friends (14%).

Physical Activity

The 5,179 participants who wanted to be more physically active marked, on average, 2.0 options from the list of alternatives. The results are presented in Table 5. Overall, they preferred the possibility to exercise at work (46%), free exercise offers (44%), and the opportunity to exercise in a social/collegial context (31%).

Focusing on the greatest differences across our contrast groups, we observed that men preferred physical exercise at work (49%), whereas women wanted the training to be located in the home (15%).

Participants in the oldest age-group (50-65 years) were more inclined to report that they did not want any help (24%), but they were less inclined to report exercise at work (40%), free exercise offers (37%), and a shorter distance to sports facilities (6%).

Participants with a high degree of chronic health concerns preferred help from the wellness consultants (27%) and were less inclined to report that they did not want any help (12%).

Participants that were pessimistic with respect to their future health status were less inclined to receive help by engaging with others (23%).

Participants that had used the wellness service frequently (defined as three visits or more) were more likely to report a preference for help from the wellness consultants (31%) and the possibility to be physically active at work (51%).

Discussion

In the course of a process evaluation of a multipurpose in-house wellness service in the Danish police force, we examined the preferred help options of employees who had reported that they wished to change their health behaviors in relation to smoking, alcohol, nutrition, and physical activity. Participants were allowed to select among several help options, both within and outside the organization.

The fact that the wellness service received their highest approval ratings in relation to behavior change in eating and physical activity habits probably reflects the overall thrust of their activities. The relatively small proportion of participants that reported that they preferred help from the wellness consultants with regard to smoking (11%) and drinking (4%) could reflect that people consider smoking and drinking to be private concerns and possibly somewhat awkward to admit to in the work context. Given that 42% of the participants had no practical experience of the wellness service, the relatively high preference for help from the wellness consultants suggests that the wellness service is well and positively positioned in the participants’ minds. It is, however, obvious that the wellness service is not in any sense viewed as being the only source to draw from when wanting to change health behaviors. This is, perhaps, particularly obvious when it comes to selecting help for cessation or reduction of smoking, where the wellness service reached its lowest ranking (i.e., rank 8 of 11). In contrast, in relation to alcohol, eating, and physical activity, we observed that help from the consultants was ranked 5 of 11, 5 of 13, and 4 of 11, respectively.

The most homogeneous response patterns were found in relation to alcohol consumption. Notably, 76% of the participants stated that they did not want any help. This is markedly more than the proportion of participants that reported that they did not want any help in relation to smoking (29%,), eating (11%), and physical activity (17%). Whether this just reflects normal consumption patterns or is, rather, indicative of something else, such as the fact that social desirability may play a part in the reporting of alcohol (Choi & Pak, 2005), is not known.

In contrast to alcohol consumption, the other lifestyle factors show a more mixed assortment of preferences. Help preferences in relation to smoking were, perhaps, the most evenly scattered, and there was no single preference that stood out. A popular choice was to select the no-help option, which was ranked 2 of 11 and was only outranked by the preference to receive help from nicotine gum, or other nicotine substances.

By far, the most popular form for help, however, was the offer of a free fruit bowl, an option presented as a conceivable solution for those who wished to adopt a healthier diet and which was endorsed in 55% of cases. The interest in fruit bowls is noteworthy, not least since there is, as far as we are aware, very little evidence to suggest that provision of a fruit bowl at work has any positive health effects. In other words, the fruit bowl seems, from a health perspective, to have an unwarranted appeal. Nonetheless, a fruit bowl can be viewed as a symbol that signals health and possibly commitment from the employer’s side. It is also, it must be said, a relatively nonintrusive and easy option in relation to health promotion. Likewise, the fact that the fruit bowl was, in many cases like the wellness service itself, an option that had already been implemented, may also provide another reason for its high approval.

The second and third most commonly rated help preferences were found among those who wanted to be more physically active. The possibility to exercise at work, or to be offered free exercise, was endorsed by 46% and 44%, respectively. That these options were so commonly endorsed is probably because of the fact that the question of free exercise during work hours is an issue that has been on the agenda for many years, both within this particular organization and in Denmark more generally. In reality, and just as was the case with the fruit bowl and access to wellness consultants, some of the participants had the option of exercising during work hours provided that their local leadership allowed for it.

While help and support from family and friends was a relatively popular choice of preference for help in relation to smoking and alcohol, it was less so in relation to eating and physical activity.

The opportunity to engage with others was ranked more favorably in relation to physical activity when compared with its ranking in relation to the other three lifestyle factors. This suggests that health promotion through physical activity may best be served by the provision of group activities to those individuals that feel a need to be more physically active.

Interestingly, help from traditional health services, such as a family doctor or health services outside work, were a less commonly preferred option. Even if help from doctors was ranked as number 4 of 11 in relation to alcohol, this option was only endorsed in 5% of the total cases. The low selection rate possibly reflects the fact that traditional health services deal with diseases and less so with lifestyle factors and well-being, even if these questions have been of increasing concern for traditional health services in recent years.

Variations Across Subgroups

Turning to our observations as to whether the preferences for help varied as a function of the participant’s age, gender, chronic health concerns, anticipated future health, or experiences with the wellness service, we observed that it was predominantly age and gender that were associated with variations in preferences. When comparing chronic health concerns with anticipated future health, it seems as if chronic health concerns in general is more closely associated with variations in help preferences. This is, perhaps, because of the fact that chronic health concerns reflect negative outcome expectations that are more proximate to certain ideas about preferences than future health anticipations about good health. That preferences vary with age, gender, and chronic health concerns suggests that variations in these factors should also be taken into consideration when designing health promotion offers. Based on the present result and in relation to eating and physical activity, it seems clear that offering women the possibility to participate in group activities could be the optimal means to encourage participation in such health-promoting endeavors.

Methodological Considerations

Since behavior change in relation to different lifestyle factors requires different solutions, we did not standardize the response alternatives. They were, rather, tailored to make sense for each individual lifestyle factor. However, this obviously leads to a different framing of the response alternatives and one should, therefore, be careful when comparing the rank order of preferences across the lifestyle factors. The external validity of our findings is strengthened by the fact that the electronic survey had a nationwide reach and that it was sent to all occupational positions and groups in the Danish police force. Since all information was derived from self-reports, a number of potential sources of common-method bias also need to be considered (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). The most critical source seems to be that all scores have been delivered by the same person (i.e., common rater effects). The trustworthiness of the results is increased, however, by the fact that there was some variation in the mean number of selected preferences for each lifestyle factor. Participants had, moreover, to select the preference options from four quite extensive lists of alternatives, suggesting that they made active choices. Obviously, the overall response rate of 41% is a weakness, and it inevitably raises questions about how well the participants represent all employees. Even so, an analysis of e-mails from participants who actively declined to participate in our survey indicated that the reasons for not participating were multifold, including both positive and negative attributes. A further issue in relation to the generalizability of our findings is the fact that the police undertake a quite specialized type of work. At the same time, many organizations operate under different conditions and with different aims, requiring unique organizational solutions.

Conclusion

The results of our explorative mapping of preferences for help among people who wished to change health behavior underline that wishing to change health behaviors is not always accompanied by perceiving a need for assistance. In fact, the no-help option was selected quite frequently and notably so in relation to alcohol and smoking. The second most preferred option for help was a free fruit bowl, followed by exercise at work and subsidized free exercise using publicly available facilities. Help from traditional health care services was generally ranked low, probably reflecting the fact that they were primarily viewed as a solution for stopping disease rather than as a solution for promoting health. Help preferences varied with gender, age, and chronic health concerns, indicating that tailored actions may be warranted to improve participation.

Footnotes

Acknowledgements

We are grateful for the cooperation of the participants, the wellness service, the employer representatives from the Danish National Police and the Danish police, the representatives from The Police Union, and the “HK-politiet” who partook and contributed to the project in various ways.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study received financial support from the Danish National Police.

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