You Say You Want a Revolution? Drawing on Social Movement Theory to Motivate Transformative Change

Abstract

Personal well-being of service employees and others is declining, yet well-being is likely to influence on-the-job productivity. Workplace wellness programming (WWP) is prevalent among service organizations, but is controversial with critics questioning the appropriateness and efficacy of employer involvement in personal health. To understand how employers engage employees in personal wellness, we conducted a qualitative field study of WWP in 10 diverse organizations. We found lower employee engagement and higher resentment in firms that relied primarily on wellness training, incentives, and impersonal communications. Employee engagement was higher in firms that collaborated with wellness-minded employees to (1) tap into long-standing, deeply held belief systems to forge an inspirational wellness ideology, (2) leverage social capital to recruit participants and resources, and (3) modify the physical environment to signal the importance of healthful behaviors and to reduce obstacles to healthful choices. The three strategies are pillars of social movement (SM) organization. Drawing on the rich SM literature and our fieldwork, we developed and tested an SM-inspired model for cultural and behavioral change. The findings have implications for internal marketing and social marketing theory and for managers seeking to create a culture of health and improve employee productivity and effectiveness in serving customers.

Keywords

internal marketing social movement social marketing personal well-being workplace wellness

Introduction

Aristotle characterized the pursuit of well-being, or eudaimonia, as the ultimate quest (Fowers, Mollica, and Procacci 2010). Well-being—or its equivalent, wellness—is a holistic construct encompassing physical, spiritual, emotional, and mental health. Enhanced well-being is associated with higher productivity, greater engagement, and other social goals, yet a recent Gallup survey in the United States found that only 7% of respondents reported high levels in all dimensions (Rath and Harter 2010). Each facet of well-being is challenged. Chronic disease—including cardiovascular disease, cancer, chronic respiratory disease, and type 2 diabetes brought on in part by unhealthful diets and inadequate physical activity—has now replaced infectious disease as the leading cause of death in the world (Yach et al. 2004). In the United States, mental illness is rising with an anticipated 54% increase in the prevalence of mental disorders from 2003 to 2023 (Bodenheimer, Chen, and Bennett 2009). Despite an increase in real personal income over the past four decades, subjective well-being is declining (Schnittker 2008; Stevenson and Wolfers 2009).

Service workers’ well-being is important personally as well as important to the quality of service work. Much service work is onstage in full view of the customer. The interaction between the customer and the provider is often crucial to the service performance. But how can we expect service providers to be at their best with customers if they do not feel their best? Customers may be served by a flight attendant suffering from depression, a retail salesperson with chronic lower back pain, a medical doctor who is emotionally burned out, or a call center representative addicted to pain medication. Service workers are expected to display positive emotions, but the emotional dissonance created when required to act differently than they feel further erodes their well-being (Pugh, Groth, and Hennig-Thurau 2011).

The erosion of personal well-being also takes a toll on organizational financial health. Escalating health care costs threaten the economic performance of U.S. firms that pay for the direct medical care of insured employees and dependents through insurance premiums or employee claims (Sood, Ghosh, and Escarce 2009). Absenteeism and presenteeism, the extent to which employees underperform while at work due to physical and emotional health issues, drain organizational productivity. The productivity losses have twice the financial impact of medical and pharmacy costs (Hemp 2004; Loeppke et al. 2009).

Unfortunately, the habits associated with personal well-being are difficult to maintain. The goal may be fuzzy because wellness is not simply the absence of pathology; it is a positive state that the individual may not have previously experienced. Healthful behaviors often involve sacrifice (skipping a donut) or resource expenditure (finding time to exercise) for uncertain future gains. Education, while an important element of behavioral change, is unlikely to permanently eradicate old, familiar habits (Elfhag and Rössner 2005).

And so we were intrigued by recent evidence of sustained wellness gains among employees of U.S.-based firms sponsoring workplace-based health promotion programs. Several systematic reviews of the peer-reviewed workplace health promotion literature point to improved worker productivity, reduced turnover, and lower health benefit outlays (Aldana 2001; Baicker, Cutler, and Song 2010; Chapman 2005; Mattke et al. 2013; Pelletier 2005). The initiatives are quite popular; over 90% of firms with 200 or more employees offer some kind of program (Mattke et al. 2013; The Kaiser Family Foundation and Health Research and Educational Trust 2013). The U.S. public health strategy has endorsed these programs as a way to reduce the incidence and costs of chronic diseases, and provisions in the Patient Protection and Affordable Care Act encourage their expansion (Horwitz, Kelly, and DiNardo 2013).

Despite the growing interest in the programs, research on how firms promote employee engagement in wellness activities is sparse. Most research focuses on program structure and outcomes rather than the drivers of employee involvement. Yet, soft engagement levels challenge nearly half of the sponsoring firms (National Business Group on Health and Towers Watson 2010). Employers cannot mandate healthy behaviors. At most, they can influence behaviors, sometimes in ways that may appear intrusive (cf. Horwitz, Kelly, and DiNardo 2013; Schmidt 2012; Wilkie 2009). Nor can employers restrict employment to healthy individuals. Doing so would not only narrow the pool of potential employees but also violates the Americans with Disabilities Act protection for individuals with chronic illnesses (Hemp 2004). And while many programs use financial and other tangible incentives to build participation, the importance of intrinsic motivation to sustained wellness gains suggests external incentives may be insufficient to promote deep-seated change (Elfhag and Rössner 2005).

In this article, we explore ways in which firms foster employee engagement in a personal, difficult-to-change domain. We conducted extensive field research within 10 organizations known for their employee wellness programs following recognized methods for qualitative research (Denzin and Lincoln 2003; Strauss and Corbin 2008). From this fieldwork and reviewing literature, we uncovered an intricate interplay between managers and employees engaged in creating a culture of health.

Our research revealed that all firms in our sample engaged in internal marketing (IM) efforts including educating employees on health and wellness behaviors and offering tangible participation incentives. We found that firms that relied primarily on these tactics encountered employee mistrust and resentment and achieved only limited employee engagement. In contrast, firms with successful programs collaborated with wellness-minded employees to pursue three additional strategies: (1) tapping into long-standing, deeply held belief systems to forge an inspirational ideology, (2) deploying social capital to recruit participants and resources, and (3) modifying work environments to signal the importance of healthful behaviors and to reduce obstacles to healthful choices.

We came to realize that these strategies are used by social movement (SM) organizers. SMs arise when individuals band together for a common goal. While some SMs aim to shift external power relationships (e.g., minority nationalism, workers movements, and Arab Spring), many exist to promote personal transformation (e.g., do-it-yourself and some religious movements) or to change cultural values (e.g., environmentalism and animal rights) (Turner and Killian 1957). The wellness movement—together with related movements such as the organic foods and natural health movements, among others—falls under the umbrella of the health movement (Goldstein 1992). SM theory examines who becomes involved in actions, why, and how. The SM lens helped us understand why some workplaces achieved a widespread employee engagement in wellness while others did not.

Our research contributes to IM theory, a theory born in the services literature. The extant IM literature has shown how selectively recruiting new employees, instilling a corporate vision, training, and incenting desired employee behaviors contribute to higher employee engagement and performance (Berry and Parasuraman 1992; Gronroos 1990; Lings and Greenley 2005; Varey and Lewis 1999; Wieseke et al. 2009). We learned of the limitations of conventional IM initiatives such as training and incentives in altering personal, difficult-to-change behaviors. The other forces we uncovered in our research—namely, framing messages that draw on the external health movement ideology, strategic use of social capital, and construction of a supportive physical and organizational environment—were central to successfully engaging employees in healthful behaviors.

A second contribution lies in our theoretical extension of the social marketing literature. Social marketing uses the tools of commercial marketing to improve societal welfare (Andreasen 2012). The practitioners of social marketing are often nonprofit service organizations. We believe SM theory relating to the role of social networks in participant recruitment can help social marketers more effectively engage target markets, particularly in highly charged, difficult-to-change arenas.

Third, we contribute to the SM literature an investigation of the ways senior management and wellness-minded employees may collaborate to change the organization’s culture. While SMs are extra-institutional, their influence is often felt within organizations as, for example, women seeking equal opportunity within the Catholic church and the military and gay rights activists promoting workplace diversity (Clemens and Minkoff 2004). Employees bring social beliefs into the workplace. The agendas implied by those beliefs may create cleavages between groups and individuals supporting and resisting the changes. The firm provides unique resources and constraints not experienced by conventional SM organizations. Our exploration of these issues contributes to this strand of the SM literature (Clemens and Minkoff 2004; Scully and Segal 2002; Zald and Berger 1978).

Finally, our study offers new insights into transformative change in the arena of personal well-being. The potential connection between a service employee’s state of well-being and his or her performance has been given little thought in the services literature and is too important to ignore any longer. How can we expect service workers to do well when they feel unwell? Although the extant services literature deals with specific aspects of well-being such as cancer or financial well-being (cf. Berry and Bendapudi 2007; Guo et al. 2013; McColl-Kennedy et al. 2012), our study examines holistic wellness and identifies the roles of social and environmental factors in promoting sustained wellness gains. This contribution may be valuable for service organizations in their roles as employers and also for the many service organizations directly engaged in providing health care services.

Method

To discover how employers are promoting healthier behaviors, we studied firms engaged in workplace wellness programming (WWP). Workplace wellness is an organized employer-sponsored program designed to engage and support employees—and sometimes their families—in adopting and sustaining behaviors that reduce health risks, improve quality of life, enhance personal effectiveness, and benefit the organization’s bottom line (Berry, Mirabito, and Baun 2010).

We used a grounded theory approach that is particularly appropriate for generating depth and breadth of understanding when little is known (cf. Glaser and Strauss 1967; Wünderlich, Wangenheim, and Bitner 2013). We began by immersing ourselves in the worksite health promotion literature, developing a fluency in the epidemiological analysis of worksite programs designed to promote smoking cessation, physical activity, safety, chronic disease management, and to reduce other health risks. We conducted field visits to 10 organizations known for their extensive experience with workplace wellness initiatives. The sample was selected to provide diversity in business type, size, ownership structure (publicly traded, privately held, not-for-profit), organizational structure (decentralized/centralized), employee demographics, and geography.¹ We continued interviewing organizations until additional interviews failed to yield new insights, indicating theoretical model saturation (Strauss and Corbin 2008). Most organizations in our study were pure service firms, and others were not-for-profit service organizations or hybrid manufacturing/service firms. Several of our respondents were pioneers in workplace wellness. Pharmaceutical manufacturer Johnson & Johnson and health information publisher Healthwise adopted WWP in the 1970s, and Fortune magazine spotlighted SAS’s WWP in stories describing SAS as the best place to work in the United States (Murray 2011). Three companies were relatively new to wellness, having adopted WWPs within the past 10 years. The other four had 10 to 30 years’ experience.

Typically, we visited together each organization for two and one-half days, studying wellness initiatives in their natural setting, and seeking to interpret workplace wellness through the interviewees’ meanings and terms (Denzin and Lincoln 2003). We interviewed approximately 300 employees between October 2009 and January 2010, including approximately 100 individual interviews lasting 30 to 60 minutes with senior executives (usually the CEO and chief financial officer [CFO]), wellness department staff, middle managers, and frontline supervisors. We used a semistructured interview guide offering respondents ample opportunity to expand upon their answers. Key questions included the primary reasons for sponsoring the wellness program now and at the inception, the business case for workplace wellness, the most/least successful initiatives and why, program challenges, evaluation metrics, perceived integration of the program into the corporate culture, lessons learned, future vision, and respondents’ own participation in the programs.

We conducted group interviews with wellness program participants and with nonparticipants. The interviews were with groups of 4 to 10 employees and lasted 60 to 90 minutes. Our internal contacts in each organization recruited the participants and the nonparticipants typically by posting signs or e-mail messaging. Our internal contacts assured employees of confidentiality. We asked employees about their personal participation in the organization’s wellness program, reasons for participating/not participating, beliefs about why the organization offered the programs, the program elements and the appropriateness of those elements, program strengths and weaknesses, and personal goals and plans for meeting those goals, if any.

We toured wellness facilities and attended formal wellness activities that occurred during our visits including exercise classes in company gyms, stress management workshops, a spiritual exploration session, and a grief recovery program. We met with consultants including employee assistance program counselors, health care providers, communications vendors, and program designers.

We took several steps to encourage candor including: assuring respondents that comments were confidential, conducting interviews in closed private spaces, adopting neutral tones in discussing the programs, and emphasizing our interest in hearing multiple perspectives. We transcribed interviews from audio recordings and from detailed notes. The organizations also provided relevant internal documents including internal program reports and communications materials.

We analyzed the data using a constant comparative method (Glaser and Strauss 1967) in which field findings were coded to identify common themes, then compared with earlier findings. Similar concepts were integrated and then generalized to maximize the model’s parsimony and scope while remaining true to the data. We continually looked for negative cases and alternative understandings (Strauss and Corbin 2008). We then conducted member checks with key informants in each of the firms to confirm the interpretation and authenticity of our findings and with external domain experts to assess the transferability of our interpretations (Strauss and Corbin 2008).

Conceptual Framework and Findings

Our study began as an exploration of the way firms used IM to engage employees in WWP. Only after immersing ourselves in the research did we come to understand WWP as a distinctive phenomenon: a transformational SM. Enthusiast employees repeatedly portrayed themselves as part of a larger, extra-organizational movement aimed at enhancing well-being. By analyzing transcripts and other source documents and studying negative cases, we found that organizations with robust employee engagement in personal well-being collaborated with wellness-minded employees to deploy three SM strategies: (1) tapping into long-standing, deeply held belief systems to forge an inspirational ideology, (2) leveraging social capital to recruit participants and resources, and (3) modifying work environments to signal the importance of healthful behaviors and to reduce obstacles to healthful choices.

Employee Perceptions of Workplace Wellness

All of the firms in our sample offered services designed to help employees become more physically active, eat better, manage stress, and manage personal financial affairs. Some firms created elaborate gyms staffed with personal trainers. Others equipped a spare room with yoga mats, weights, and exercise equipment. Vending machines and cafeterias, if present, featured more healthful choices. Several firms offered nondenominational discussion groups and mentoring for spiritual development. Incentives for participation or progress in the form of cash bonuses and promotional items (e.g., pedometers, water bottles, and workout gear) were common. Incentives were often gamified with rewards earned for training, engaging in activities, and intramural competitions.

We asked employees to explain what wellness means in their organization. These comments are from a focus group of wellness program participants in a firm with widespread engagement in the WWP:

The core fundamental component here is taking care of the employee. It’s maintaining a culture that started 30 years ago. And it has not been lost in the company’s growth.

Our wellness program caters to everyone in the organization whereas a lot of wellness programs are only on the physical side. It’s great to have a fitness room. But overall wellness creates balance in an individual’s life.

Our wellness program speaks to me that the leadership is sincerely interested in my health at work. It is not to bump a metric like “the employees at [our company] are healthier than other companies.” It’s their genuine intention.

Movements create a sense of purpose and inclusiveness as evidenced in these respondents’ emphasis on management’s intent and on organizational outcomes. Indeed, employees in firms with widespread participation in wellness often spoke of the firm’s culture of health.

Wellness participants in firms with lower levels of engagement typically offered a different perspective on WWP, as evidenced in these comments from focus group members:

It’s a corporate health and wellness program with some cool incentive pieces in it as well.

I use the exercise log. The website also reminds me to do yearly exams and screenings. I use the food journal to help keep me on track with eating.

I don’t necessarily use it daily, but when I go online to log my exercise and food, I read about things I should be doing. It’s a great reminder.

The pattern was repeated throughout our sample. Employees in firms with lower levels of engagement often described their firm’s wellness initiative by pointing to posters, programs, facilities, and tangible incentives. In contrast, employees in firms with robust engagement emphasized outcomes, including health gains, relationships, and collective identity.

Crafting an Ideology to Inspire Engagement

An ideology is the belief system of an SM. Effective ideologies inspire collective action by bringing meaning to situations, identifying solutions, justifying action, and motivating participation (Noakes and Johnston 2005). There are four components of the ideological narrative: a salient grievance, a culpable adversary, a motivating goal, and a viable solution (Benford and Snow 2000; Noakes and Johnston 2005). For example, while exploring the ideology of the anti-consumption movement, Kozinets and Handelman (2004) show how activists, railing against materialism (grievance), blame both corporate elites and overspending consumers (adversaries) as they seek to change consumer culture (goal). Movements are not ideologically homogenous. Different ideological messages may appeal to different streams within the broader movement. Some pro-life movement participants, for example, see abortion as murder; for others, abortion represents social engineering (Munson 2008). We discovered ideological commonalities and differences between WWP participants, nonparticipants, and management.

The motivating grievance and the culpable adversary

Motivating ideologies often frame the grievance as an injustice (Benford and Snow 2000). The civil rights movement framed racism as an injustice and, in so doing, attracted the support of a broad coalition of Americans who hold justice as a sacred value (Benford 1997). In our study, employees grieved the diminished quality of life associated with poor health, while management was concerned with escalating health care benefit costs.

Our respondents often blamed the chronic disease epidemic on the cultural environment, especially on the fast-food culture and the time demands of contemporary life. A CEO blamed the human species’ failure to evolve:

When an event happens, the chemistry in your body changes, and when it passes there’s a flow of endorphins, followed by hunger. That worked when the crisis was a lion; we needed the food. Today we’re hungry after solving desk crises, and we eat the food we can find. That’s usually junk food.

This perspective reflects a common theme in popular health movements that illness and disease are not inevitable in the natural order of life but are injustices arising from contemporary life circumstances (Goldstein 1992). Even when individual choices might be implicated in poor health, many informants identified mitigating circumstances. A human resources executive mused:

Why is it that so many employees in the service industry are in poor health? Is it because we pay our people to care for others, rather than for themselves? So [our employees] think, “I’m giving, I’m giving … I deserve this cupcake.” The majority of our employees are working moms. They are very busy. These folks are putting their children’s needs on top of their agenda. You can argue that to be the best mom you have to take care of yourself first. But most moms don’t have the luxury to think this way.

While blaming the environment for wellness losses, both participants and nonparticipants often held individuals responsible for solving the problem:

It’s a lifestyle. We all have 24 hours in a day. We all make choices. If I can’t find time to work out, I have to ask myself: Is there something in my schedule I enjoy but I could give up two or three times a week? Each person has to figure out how to take action. (Participant, midlevel manager)

I know I need to lose weight. For me, food is all about emotions. I have to stop eating when I’m emotional; I know I’m the only one who can do it. (Nonparticipant, frontline supervisor)

I know I should take advantage of the program. I’ve seen great outcomes from people who’ve quit smoking or lost 20 pounds. I wish I were better at managing my time so I could take advantage of it. (Nonparticipant, frontline supervisor)

While it may seem paradoxical to hold individuals responsible for health problems created by the external culture, the dual beliefs are culturally grounded. The workplace culture holds individuals responsible for work performance, even though some aspects of the job may be beyond personal control. In addition, Judeo-Christian teachings have for centuries held individuals responsible for diet, hygiene, and physical activity, sometimes linking illness with sin (Dorff 1986). Eastern wellness philosophies and the 20th-century feminist movement’s emphasis on women’s control of their bodies also promote individual responsibility (Goldstein 1992).

The goals: high-level wellness and improved productivity

Many health promotion movements aim not simply to eliminate health disorders but to reach a state of peak mental, physical, and spiritual well-being. The Roman physician Galen described good health as “taking part in government, bathing, eating, and doing the other things we want” (Goldstein 1992, p. 18). Similarly, the intertwining of mind, body, and spirit was embedded in religious traditions that offered supernatural explanations for sickness and healing. Enthusiasts emphasized multiple facets of well-being when explaining their participation in the WWP:

It’s about fulfillment and creating balance. (Midlevel manager)

I just plain feel better. When I work out every day, when I eat right, when I’m centered, wow, my mind is so much clearer. (Cashier)

Wellness is spiritual. Sure, people around here run for fitness, but mainly people run to clear the head. Nobody around here talks about wellness in medical terms, like lowering cholesterol. (Frontline supervisor)

In contrast to participants’ desire for optimal, holistic well-being, nonparticipants and lapsed participants often described WWP as a way to address illnesses or infirmities. Explaining why their peers participate in WWP, informants in a nonparticipant focus group of frontline workers told us:

Physical wellness. More than anything else: weight management, healthy eating.

Blood pressure. One of my current employees has benefited tremendously.

To learn to get exercise.

Similarly, a lapsed participant saw WWP as a way to eliminate the need for maintenance medications:

I got a wakeup call. My doctor told me I had high cholesterol, the highest he had seen in 20 years in medicine. I asked, “What prize do I get?” He said, “A stroke.” So I did the healthy weight program, I lost some weight, and I was able to get off cholesterol medication. But then I relapsed and went back on cholesterol medication, because there wasn’t support for the rest of my family. (Frontline worker)

While WWP was viewed as a quest for peak performance (employee participants) or improved physical condition (employee nonparticipants), management informants frequently described their investment in WWP as a way to manage health care benefit costs while supporting employees and boosting productivity.

We looked at wellness because of our health care costs. We are self-insured for most of our health coverage with a high stop loss. As we saw our healthcare costs increase, we wanted to control them. But if healthcare cost cuts were our only priority, we could have simply restructured benefits [shifting benefit costs to employees]. That would be easier. We implemented wellness because it’s good for employees. If your only reason is to cut healthcare costs, you won’t get employee buy in and support. If you’re only focused on costs, there’s nothing motivating, nothing to get behind, for anyone other than senior management. (CFO)

It’s not complicated. It should save us [healthcare benefit] cost over time. And it’s the right thing to do for our people. Most business people want to do the right thing. And it makes good business sense. Healthy people should be happier and do a better job. So it makes sense from the bottom line. (Executive Vice President)

We found that participants in firms with successful programs acknowledged management’s interest in the enhanced productivity of healthier employees, as these employees noted during a focus group interview:

Here, I feel like someone is always thinking about me and knowing that the healthier I am in my body and my mind, the better the work I do for the company. But it’s more than that. I believe the leadership wants me to be a healthy person, per se. The benefit for the company is that I’ll do my work better; I’ll be energized when I’m here. (Program manager)

[Our CEO] understands what is needed to spark creativity. Happy, healthy employees are the key. (Analyst)

We’re just more productive. In my old job, we’d hold a meeting and swirl and churn. Here, we go for a run in the afternoon or a walk in the garden. Then when we meet, people just seem clearer, more able to get down to business. We don’t waste time making decisions, then having to do it all over again. (Frontline manager)

While many participant employees perceived a productivity-based business case for the firm’s workplace wellness benefit, many nonparticipants offered a cost-based business case:

Look at the trends in health care costs. It’s unreasonable. For an employer, it’s a problem. [With the wellness program,] they are trying to control healthcare costs. (Frontline worker)

They just do it to reduce health care costs. Besides, a lot of employees think this whole wellness program is invasive. It’s not any of the company’s business. It’s like this. Companies use phone records to see who employees are calling. They use time card information to make sure we’re at our desks. Now, could they use my wellness blood screen to see if I’m taking drugs? Yeah, it’s a slippery slope. (Call center worker)

Thus, we found that respondents who attributed their employer’s investment in WWP to a health care benefit cost reduction strategy were less likely to participate. Those respondents also raised concerns about privacy infringement.

Summary

Robust ideologies are frequently rooted in long-standing cultural values. Employee engagement appeared to be deeper in organizations in our sample that offered an ideology based on the promise of peak mental, physical, and spiritual well-being. The key ideological planks include attributing poor health to the environment but holding individuals responsible for taking corrective action, crafting a solution built on mind-body-spirit development, understanding that responsibility and rewards are shared by the individual and the employer, and sharing an identity with other wellness-minded individuals. More than a few nonparticipants saw WWP as an affront to personal dignity, with employers reaping financial rewards.

Leveraging Social Capital to Recruit and Sustain Participants

To achieve their goals, SMs require volunteers and resources. And while bumper stickers and speeches create awareness, people join movements through personal contacts (Granovetter 1973). Personal contacts assure prospects that the leaders are trustworthy and the goals achievable. Those contacts also help to socialize new recruits by setting expectations and enforcing norms (Edwards and McCarthy 2004; Passy and Giugni 2001). A wellness participant told us:

You can’t just inform people. You need to motivate them to get on board. Motivation comes from looking people in the eye, telling stories, personalizing things. (Frontline worker)

Recruiting participants

Social capital represents a store of goodwill—sympathy and trust—that can be tapped to promote action (Adler and Kwon 2002). Residing in the personal relationships among individuals and in their capacities within organizations, social capital holds the potential for conveying information, exercising influence, and enforcing social norms (Coleman 1988). Individuals have strong ties with close friends and colleagues, weak ties with acquaintances, and no ties with strangers (Granovetter 1973). Strong ties marked by material, emotional, and symbolic saliency have greater information- and influence-wielding power (Adler and Kwon 2002). Committing to a more healthful lifestyle can be risky. Novice participants may worry about keeping pace in the gym or adhering to a nutritional regimen. Friends (strong ties) are more likely to have the credibility and influence required to persuade others to join a movement, particularly when the risks are high (Passy and Giugni 2001). We observed many instances of strong-tie personal recruitment, with informants describing their lunch time workout buddies and their immediate workgroup’s fitness competitions.

Our respondents told us that workplace hierarchical relationships were not necessarily useful in motivating wellness participation. Employees may feel personal wellness is too private to discuss with a boss. Yet respondents also noted the motivational power of certain managers. A retailer described two colleagues who were particularly effective in engaging employees in wellness efforts:

One of our VPs is amazing. He touches one person at a time. He’ll say, “Come, run a 10 K with me.” And people do it. Another regional manager, [naming the manager], she’s seen too many people with diabetes. She has a ton of passion around this topic. She talks about it all the time. She personally intervenes and gets in your face. Her people see there’s something in it for them, that she cares about them. This inspires and endears commitment to her and to the company. Plus they feel better and can be more productive.

The informant’s observations suggest that, in this high-risk context, hierarchical relationships may be effective to the extent that they foster trust (Adler and Kwon 2002).

Professional wellness staff members also recruited employees with presentations at staff meetings, hallways conversations, and office visits. Participants acknowledged the persuasive power of the wellness staff:

At the fitness center, if I’ve been away, [the gym receptionist] says, “Hey, what’ve you been doing, slacking off?” It’s like Cheers, everyone knows your name. You have a friend that helps you through this process. (Systems analyst)

I had major surgery three months ago and I was on short-term disability. The gym made me an eight-week rehabilitation program. The wellness staff are knowledgeable and I can see that they care. (Administrative assistant)

While the wellness staff typically had only weak-tie relationships with prospective recruits, their persuasiveness was boosted by the interpersonal qualities described by the first respondent and the subject matter expertise described by the second respondent. Most wellness staffs are too lean to reach all employees directly. Instead, in most of the organizations we studied, the professional wellness managers deputized volunteer wellness “champions” throughout the organization. Selected for their capacity to inspire coworkers to adopt healthier lifestyles, the volunteers were charged with ensuring that programs met their individual work teams’ needs, informing colleagues of upcoming events, and encouraging participation. The wellness champions we interviewed explained the ways they engaged their work group:

I lost 46 pounds. I mean, wow, I’m excited. I tell people in my store that they can do it, too. So then one of my coworkers lost 80 pounds by joining Weight Watchers. (Frontline worker)

One of my coworkers has a daughter with asthma. I don’t think he realized how serious asthma is. It’s dangerous and it puts limits on his daughter. So I talked to him. We talked about how he and his wife could learn more about asthma and treatment programs. Now, with management of the condition, the child has begun playing sports. (Warehouse employee)

The volunteers served as network boundary spanners, connecting the wellness staff with the volunteers’ strong-tie personal networks. Formal recognition of the wellness champions enhanced their recruiting potential.

Enforcing social norms

Social norms are more likely to be enforced in densely connected communities (Coleman 1988). It can be personally costly for a lone individual to enforce norms, but when groups are tightly connected, individuals reward each other for upholding standards (Piskorski and Gorbatai 2013). We found that tightly connected coworkers enforced the WWP’s social norms around food consumption, physical activity, and stress. A first-level manager described the way colleagues helped each other moderate snacking. Speaking of the weekly company-sponsored social gathering, she noted:

Yesterday, we had an ice cream social because someone was leaving who loves ice cream. It was a special occasion so there was a reason for the snack to be unhealthy, and it was acknowledged and stated as such. But typically, we have healthy snacks like fruit, yogurt, frozen yogurt, cheese sticks, almonds, all with reasonable portions. You take a scoop of almonds, not a bowlful. I have a friend who really loves almonds so she sometimes takes my almonds. Then the next week, she’ll give me her frozen yogurt. You just don’t feel right taking a gargantuan portion.

Similarly, personal connections can serve as positive role models (Passy and Giugni 2001). A novice described how seasoned wellness enthusiasts encouraged her:

I never rode my bike to work before. I live ten miles away. I started to ride my bike to work once a week. When you show up at work, pitted out, and you’ve got the helmet on, you get a lot of reinforcement. [The accomplished cyclists] say, “Good job, how far did you come?”

While social norms can limit negative behaviors or encourage positive ones, the effects are not always sanguine. An analyst told us:

I feel guilty working out at lunch when I know my boss is eating lunch at his desk.

Summary

Our respondents emphasized that impersonal communications such as e-mail, posters, videos, and websites were insufficient to counter the considerable mental resistance to personal change required in adopting wellness behaviors. SM mobilization relies on strong-tie connections, particularly when the costs and risks of engagement are high. Enthusiasts in our sample emphasized the role of friends recruiting friends to the WWP. Trustworthy managers were effective recruiters. Because friends tend to know the same people, movements that rely exclusively on strong-tie recruitment are eventually unable to gather new recruits and other resources (Edwards and McCarthy 2004). Weak-tie connections are needed to reach other social clusters. We found that volunteer wellness champions bridged coworkers with the professional wellness staff. Personal contacts also help to socialize new recruits by setting expectations and enforcing norms.

Constructing a Physical and Organizational Environment to Support Participation

Geographic place, scale, and spatial arrangements affect the ways SMs evolve (Martin and Miller 2003; Nicholls 2009). Space and geography are more than a backdrop; they influence the way threats are perceived, opportunities are imagined, and solutions can be found. While institutional settings may inhibit mobilization by reinforcing power relationships, those settings can also foster new interactions. Our respondents told us that walking trails and company gyms created opportunities for employees to interact with managers they might not otherwise see.

The arrangement of the physical environment can also shape cognitive and cultural lenses that influence wellness behaviors. Onsite exercise facilities and distinctive architectural features such as an arresting, centrally located staircase or an inspiring sculpture reminded participants to take well-being enhancing actions. A senior executive told us:

Facilities promote wellness. Our location close to the foothills creates the opportunity to bike, hike and run. If you need to take a run during the day, you can do it. You’re accountable for your work. You decide when to do it.

Facilities can also serve to connect participants and strengthen bonds. A wellness manager described the enabling role of the built environment.

We can talk all day about behaviors, but unless I set up an environment where people can make choices, nothing’s going to happen. People focus on cafeterias and fitness centers but the other pieces are just as important. We now have 250 employees who ride their bikes to get to work, rain or shine. I need to make sure the bike racks work, and that they are covered, and that bikers can get to them safely.

Seventy percent of our employees are women. I realized that for new mothers wellness is lactation rooms. People would laugh, but we put the rooms in. Now we have 225 women each week using the 8 lactation rooms. We knew that many of the new moms were depressed, sad to leave their child at home. In the lactation rooms, women write to each other on the whiteboards. We see moms come back to work faster, and they feel better. Even if they never have children, those rooms tell employees how the institution feels about women and the health of new mothers.

Some employees attributed their lack of participation to limited wellness facilities, as this frontline worker noted:

I want an exercise program but I do not want to research local gyms. I would like to see classes offered here that I can participate in with friends at 5:30.

The types of wellness facilities and organizational practices influenced participation rates and attitudes. The facilities in organizations with effective WWPs were not always elaborate, but they were attractive and visible. Nonparticipants frequently noted gaps between management’s stated intentions and their behaviors, as these focus group respondents emphasized:

If you don’t respect me enough to take care of me when I’m sick, then I don’t think you really care about wellness and I’m not going to help your wellness program.

I can barely get enough accrued time to get a week of vacation because most of the time I have to use that time when I’m sick or my kids are sick. Before I know it, I don’t have time to get female tests or my teeth cleaned. Give us a few days to get those done. If you work 9-6, when are you supposed to do that?

We are in a stressful environment. Wellness is a people-service. We’re all stressed to the max, trying to do our job. Management could work with us more.

Transformational Outcomes of WWPs

Company records documented employee well-being gains on multiple dimensions including reduced health risks and improved health outcomes such as weight loss, smoking cessation, and lower blood pressure. Those gains are consistent with the findings in the health promotion literature (Baicker, Cutler, and Song 2010; Goetzel et al. 2014; Mattke et al. 2013). We also observed the influence of WWPs on personal and collective social identity.

Transformations in personal identity

As might be expected from investigations of organizations with robust wellness initiatives, our interview transcripts contain numerous self-reports of personal transformation:

Before I came here, I wasn’t as healthy, I didn’t exercise as much, I wasn’t as involved in the community. It took a number of months for me to engage in healthier behavior. I made one change and then another. It’s changed my perception of wellness and the benefits of it and strengthened my sense of camaraderie with coworkers because I have something in common with them. It’s easier to change behavior when you can see other people changing behavior and benefiting. (Manager)

I now realize that wellness is not so much about an ideal body type as it is making lasting changes in your life. (Secretary)

Several informants emphasized the personal nature of transformations. One executive commented,

Health education can be so preachy, so “should.” People are more successful if they identify their own priorities. You might not choose the highest payoff area. But if you choose it, your chances of success are phenomenal. Little successes create big ones. Smoking is the most important behavioral change, but it’s so tough. So instead, think about what else you are interested in, and start there. People will build on those successes and be successful for a lifetime.

Another manager offered a similar perspective, citing her personal experience with wellness.

Who would have thought that it would take me to come here to change? I started by cutting my hair every six weeks. Then I thought, okay, if I can do that, then I can get my nails done. Then I started exercising. Then I started shopping smarter. It started with: I have a new identity, a new responsibility, and a new obligation.

While wellness participants often reported positive personal transformations, some nonparticipants expressed privacy and self-efficacy concerns, as these excerpts from separate interviews with nonparticipants indicate:

For me, it’s balance between work and personal life. More and more, work encroaches on my personal life. I have to take calls at home. I answer emails at home. Last night I finished a report at home. They [the employer] ought to stay out of my life. (Junior analyst)

When you’re on the floor, making your numbers, trying to keep the job you’ve got, at that point, you don’t have time to look and see what the resources are [for the wellness program]. (Call center worker)

Transformations in collective identity

Collective identity refers to “that part of the self-concept of the individual that derives from his knowledge about his membership in a social group(s), and from the value and the emotional meaning that accompany this membership” (Tajfel 1981, p. 255). While our cross-sectional design does not permit an analysis of changes to the organizational culture, our informants offered insights into the collective identity in organizations with well-established wellness cultures. In particular, participants emphasized a collective identity marked by pride in participants’ personal and professional selves. A manager for an organization located in a rural area described a recent visit by a prospective client:

Clients do business with us because of our culture, and wellness is our culture. They think we’re in Podunk. But they visit, they see the architecture, the cool culture, the smart people, and it helps with our success. People see we’re leaders in culture, and that makes them think we’re leaders in our products, too.

By activating the informants’ workplace-based collective identity, the shared characteristics become more salient, sharpening the distinction between collective actors and outsiders (Brewer and Gardner 1996). Informants revealed evidence of distinct collective identities.

The culture is void of finger pointing, of misplaced scrutiny. I just don’t have those burdens on my shoulders. That brings profound mental wellness. (Analyst)

There is more mutual respect than I’ve found in any company. You don’t go into meetings and hear, “Debbie didn’t do this.” I think if someone would backstab (and I’ve never heard it), you’d hear someone else say, “Wait a minute, she tried really hard.” (Manager)

The comments are consistent with research indicating that cooperation, positive evaluations of other members, and a greater concern for the collective organization become prominent in organizations with strong collective identities (Brewer and Gardner 1996; David and Bar-Tal 2009).

Discussion

Our research investigated the efforts of organizations to engage their employees in a transformative, but difficult-to-achieve, change: improved personal well-being. Unhealthful behavioral choices and stress threaten not only the welfare of employees and their families but also organizational competitiveness and social safety nets.

Respondents in our study acknowledged internal training, communications, and incentives, in line with IM theory. However, we learned that firms that relied principally on these tactics encountered employee mistrust and resentment and lower levels of participation. In contrast, informants in firms with more successful programs emphasized their organization’s “wellness movement” and the way both management and employees personally recruited other employees to create a “culture of health.” This led us to investigate the explanatory powers of SM theory, a domain seemingly underexplored in services and in marketing (for important exceptions, see Kozinets and Handelman 2004; Varman and Belk 2009).

Tapping Into Social Movement Theory

SM theory dealing with the strategic framing of ideologies, the deployment of social capital, and the influence of the external environment proved particularly useful to our understanding of employee engagement in wellness programming.

The social construction stream of SM theory connects individuals’ decision to engage in a movement with meanings they ascribe to the movement. While the meanings may arise organically, SM organizers in mature movements may frame the movement’s agenda in a way that promotes action. Four facets of an SM frame form the movement’s belief system and its blueprint for action: a problem or grievance, the party responsible or adversary, the goal, and the solution. But as we illustrate in Table 1, firms’ and employees’ native ideologies do not completely overlap. Management, blaming the external environment (the adversary) for employees’ health challenges and the related health care costs (grievance), believed the combination of the WWP and employees’ new more healthful behaviors (the solution) would improve productivity and lower health care costs. Employees blamed the external culture (the adversary) for their diminished quality of life (the grievance). But while employee participants believed the WWP would facilitate making more healthful choices (the solution) and ultimately optimal, holistic well-being, nonparticipant employees looked to themselves (the solution) to address illnesses (the goal). Thus, the ideological differences between management and participants lie in the threat assessment and in the goal. Differences between engaged and nonengaged employees lie in the goal and the solution.

Table 1.

Workplace Wellness Ideology.

Primary Concern of
	Management	Employee Participants	Employee Nonparticipants
Grievance	Escalating health care costs	Diminished quality of life
Adversary	External forces including intense job demands, lack of time for exercise and healthful food preparation, and the prevalence of poor nutritional options
Solution	Workplace wellness program Individual responsibility		Individual responsibility
Goal	Improved productivity Lower health care benefit costs	Peak mental, physical, and spiritual well-being	Addressing illnesses and infirmities

We also found that managers and wellness-oriented employees used social capital, a linchpin of SM recruitment, to encourage quiescent employees to become engaged. Wellness behaviors require a substantial investment of time and effort and are unlikely to be undertaken lightly. Our respondents showed us that social networks facilitated wellness engagement. The trust embedded in strong-tie social connections facilitated friend-to-friend invitations. But most people have relatively few strong-tie connections. Weak ties provide a crucial bridge for less sensitive information (events, philosophy, and symbols) to flow between otherwise unconnected clusters of friends and to raise overall awareness of the movement (Granovetter 1973). In our study, our informants emphasized the role of weak-tie wellness “champions” in recruiting new employees. We also found that the tightly connected social networks tended to enforce social norms moderating food consumption and stress and encouraging exercise.

Our informants emphasized the importance of onsite wellness facilities and services, such as healthful food options and exercise equipment. Employees’ physical surroundings can facilitate the achievement of organizational goals (Bitner 1992). The perceived servicescape can influence behavior directly and indirectly by influencing employees’ beliefs and emotions about a place and the people in the place. Just as cues from the physical environment can help customers judge capabilities and quality, so too can they promote or hinder employee engagement in internal initiatives. Many wellness nonparticipants in our study were at locations with limited or inconvenient facilities which they often interpreted as evidence of the firm’s disingenuous engagement in wellness.

Contributions to Internal Marketing Theory

IM deploys the philosophy and tools of marketing to help employees execute the organization’s strategies and meet its goals (Berry, Hensel, and Burke 1976; Gronroos 1990). Based on the principle that satisfied, better prepared employees are more likely to satisfy external customers, IM encourages creative, rigorous recruiting processes to attract employees with the skills and attitudes to perform effectively; communicating a compelling corporate vision that brings meaning to jobs and engages employees in the work effort; offering attractive compensation and incentive packages; preparing and empowering employees to perform their work well; and measuring results (Berry and Parasuraman 1992; Gronroos 1990; Lings and Greenley 2005; Varey and Lewis 1999; Wieseke et al. 2009).

The theory has been developed in contexts that are linked to the organization’s mission such as adopting a customer orientation, improving service delivery, and improving service productivity. Our personal wellness context represented a different challenge. The targeted behaviors are deeply personal, debatably outside the employer’s ethical purview (Horwitz, Kelly, and DiNardo 2013). We found that effective message framing emphasized employers’ and employees’ common adversary (the toxic external culture) and solution (WWP), while acknowledging each party’s unique grievances and goals. Wellness participants bridged the ideological differences and perceived the programs as a win-win: Management was funding a program that would help individuals meet their personal goals while satisfying management’s financial and productivity concerns. Nonparticipants were more prevalent in firms that did not candidly address commonalities and differences. In those firms, nonparticipants perceived the programs as a win-lose with management reaping the rewards of healthier employees and employees losing control of a private matter.

Our research also extends IM theory by showing how social capital can be strategically deployed to recruit participants and resources. While clear communications are a hallmark of IM, personal connections can support engagement, as a wellness enthusiast respondent emphasized:

When you read a flyer, or watch a video about wellness, there’s no warmth there. High touch is important to have with health. High touch means nurturing. It means being present. It means listening, really listening. High touch helps people reach inside themselves, and make the changes they want.

IM researchers have pointed to the power of charismatic leaders (Wieseke et al. 2009). Our research shows the power of influential employees throughout the organization. In a demonstration of the way social capital can enforce social norms, informants emphasized peers’ influence in helping them to maintain their fitness regimens, maintain portion control, and manage personal stress. MD Anderson Cancer Center reported a 2 to 3 times gain in participation in departments with volunteer wellness champions, compared to those without.

IM theory identifies the importance of equipping employees with the right tools for the task; in our context that means improved access to healthful food, exercise facilities, and programming. We uncovered an additional symbolic effect of these investments. Both participants and nonparticipants pointed to the tools as evidence of the firm’s intentions. Management “walked the talk.” However, employees in locations with limited access to these tools tended to doubt the firm’s motivations.

Contributions to Social Marketing Theory

While IM focuses on engaging internal audiences, social marketing aims to reach an external audience. Social marketing parallels SMs in many aspects (Douglas 2008). Both social marketing (Andreasen 2012) and SMs concern changing behaviors of a large number of people to benefit them and at least a segment of society. Both engage multiple audiences: the target audience, donors, volunteers, political allies, and bystanders. Both undertake marketing activities, including identifying value propositions for key audiences, crafting persuasive messages, and delivering those messages. Both frequently are faced with persuading an unengaged audience to adopt seemingly unappealing behaviors. Finally, the gains from both SMs and social marketing often accrue to an entire class of people, and so both paradigms share the challenge of free riders, for example, litterers who enjoy the benefits of a municipality’s successful “stop littering” campaign.

But SMs and social marketing differ in the nature of their goals and in the locus of the change agent, and those differences may influence the choice of tools used to effect change. SM goals may be radical, even subversive; social marketing goals are often more measured. Social marketing is often conducted by subject matter experts such as government agencies or nonprofit organizations for the benefit of another party. SMs arise organically, with the ideological development work and the mobilization efforts often spearheaded by members of the class of people who will benefit from the effort. The social marketer can conduct market research, write a marketing plan, secure funding, and execute the plan, bringing to bear the strengths of the sponsoring institution. The SM decision making and implementation, however, are more ambiguous because organizers often lack institutional authority and resources. Decisions about ideology, strategy, and execution are subject to ongoing negotiation among shifting participants over time. As a result, SM ideologies that withstand the ongoing negotiations are likely to be culturally grounded, deeply nuanced, and elaborate, and thus may resonate more deeply with constituents.

The two paradigms also place different emphases on mobilization strategies. Social marketing often relies on advertising and promotion to motivate behavior change. In contrast, SMs attract participants and resources primarily through personal communications and meetings. Mass communication through bumper stickers, news stories, and public relations events are only secondary tools. In other words, SMs emphasize personal connections for recruiting participants and enforcing social norms. While, for example, the press dubbed the Arab Spring uprisings “Twitter Revolutions,” deeper analysis suggests Twitter and the Internet—weak-tie connections—created awareness of planned events, bringing together groups of dissenters (Gladwell 2010). Ideological conversion to the Arab Spring cause, however, had been built through strong-tie personal relationships. An implication is that social marketing designed to promote relatively low-barrier changes (e.g., encouraging flu shots) can successfully rely on impersonal communications. Higher barrier changes (e.g., smoking cessation, adopting an active lifestyle, and postponing sexual activity) may respond better to strong-tie persuasion strategies. This is consistent with recent social contagion empirical work that shows the crucial importance of source credibility in promoting high-risk adoptions within a social network (Godes and Mayzlin 2009; Iyengar, Van den Bulte, and Valente 2011).

Finally, early social marketing efforts were based on individual-level models for behavior change. More recently, social marketers have recognized the need to influence both the individual and the broader environment including societal norms, cultural symbolism, and social and economic conditions (Andreasen 2006), but much of the theory and practice continue to emphasize individual change (Hastings, MacFadyen, and Anderson 2000; Lefebvre 2013). In contrast, the SM literature emphasizes cultural and political change as well as personal transformation.

Limitations and Opportunities for Future Research

WWPs are sometimes portrayed as a neoliberal solution to health care spending pressures. In 2009, Safeway CEO Steven Burd (2009) proposed that national health care spending could be slashed by 40% if people were incentivized to eliminate preventable illnesses. In contrast, our respondents emphasized the importance of culture change as well as incentives. There is an opportunity to better understand the contexts in which incentives alone can promote health gains.

Our qualitative methodology enabled us to understand the rich nuances of SM dynamics. The methodology does not, however, permit path modeling or other quantitative analyses, an avenue for future research. We hope future research investigates the role of selective incentives in promoting individual engagement in the collective context. Also, a deeper exploration of the way servicescapes and infrastructure can foster the use of social capital to spread movement ideologies and to sustain engagement would be fruitful. We found, for example, heightened engagement in organizations that used architecture, nature, and exercise facilities to create a wellness atmosphere.

SMs are no longer exclusively the province of extra-organizational individuals, as more organizations are beginning to experiment with SM concepts. Dove (2012), the personal products brand, is catalyzing an SM to improve the self-esteem of women and young girls by broadening conceptions of beauty and to make an individual’s unique appearance “a source of confidence, not anxiety.” The brand’s global “Campaign for Real Beauty” features striking visual images of older, larger women rather than traditional models. A fruitful research avenue may be the exploration of the ways service businesses, with social ties among employees and between employees and customers, may be particularly well positioned to launch SMs. For example, Trader Joe’s, Panera Bread, The Container Store, Whole Foods, and other progressive businesses have banded together to foment a “conscious capitalism” movement that extends business meaning and purpose beyond profits (Mackey, Sisodia, and George 2013).

The concept of personal responsibility remains controversial within the workplace wellness movement. Responsibility can imply causality, liability, or both. Our respondents emphasized the causal role, with many respondents offering personal testimonies about the preventive and healing roles of diet, exercise, and work/life balance. The liability facet of responsibility is more controversial. While some organizations have penalized employees for failing to adhere to health behavioral standards (cf. Burd 2009), several of our respondents in both frontline and management ranks rejected that idea. Moreover, the concept of personal responsibility for health is not universally held (cf. Katz 2001) and, as noted earlier, movement beliefs that are not consistent with cultural narrations are less easily accepted. An executive in our study commented,

Some cultures are fatalistic. Many of our employees say, “I’m going to get a touch of sugar [diabetes]; my whole family gets a touch of sugar.” The belief is that, “I will get diabetes; it’s not a question of if, but of when.” It’s difficult for [people] who have that belief to take back control for their own health.

A deeper exploration of the interpretations of personal responsibility may help promote more effective efforts to transform personal well-being.

Finally, our qualitative research suggests that service employees’ own well-being is likely to influence their on-the-job productivity and effectiveness. There is an opportunity to test the hypothesis quantitatively, with an emphasis on understanding the link between employee well-being and service quality.

Conclusion

Many service organizations either operate in the wellness space (e.g., hospitals and weight loss clinics) or market offerings that directly influence wellness (e.g., recreation companies and restaurants). Moreover, all service organizations have employees and, as our research shows, bringing the wellness movement into the firm can benefit both employees and the firm. The 10 organizations in our study are all making inroads in solving one of the most difficult problems of our time: encouraging and enabling individuals to lead healthier, more fulfilled lives. Transformative service work often requires reversals in deeply held attitudes and behaviors. SMs—facing equally daunting challenges—have eliminated oppressive foreign rule and changed attitudes toward slavery and sexism. Our theory-driven model harnesses the fundamental processes propelling SMs to deliver transformative changes in the well-being of service workers and in the performance of service organizations.

Footnotes

Acknowledgment

The authors thank the special issue editors and JSR reviewers for their thoughtful and constructive suggestions.

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.

Note

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