Abstract
BACKGROUND:
Universities could positively impact the health and well-being of employees through workplace wellness programs (WWP).
OBJECTIVE:
To assess the prevalence of WWP among Asia-Pacific universities, identify gaps and challenges, and solutions to challenges.
METHODS:
An online survey was sent to members of the Association of Pacific Rim Universities to assess programs on physical fitness, nutrition/weight, mental health/stress, family support, chronic disease prevention, and safety.
RESULTS:
Employees at 28 universities in 13 economies completed the survey on behalf of their university. Most common WWP were paid maternity/paternity leave (89.3% /85.7%), disaster preparedness training (85.7%), fitness challenges (78.6%), written policies regarding discrimination/hate speech (75.0%), and quiet rest areas (71.4%). However, few addressed childcare, breastfeeding support, workplace sexual harassment, tobacco use, or mental health. Programs rarely aligned with the reported goal of increasing employee morale, but instead resulted from government mandates. Many universities offered sporadic, one-off programs but lacked comprehensive, coordinated programming and adequate evaluation procedures. Key challenges were low employee participation, limited budget, and lack of leadership support. This study highlights the need for improved program administration, information dissemination, data collection to evaluate impact, and leadership support.
CONCLUSION:
WWP could benefit universities and employees but should be implemented and evaluated as part of a comprehensive campus wellness culture.
Keywords
Introduction
Employers have an increasing awareness that their employees’ physical, mental, and social well-being impacts productivity and performance [1]. Studies have shown that improving employee health can reduce health care costs, disability, and absenteeism, while increasing productivity and overall well-being [2]. Given that the typical working adult spends at least 40 hours per week at work, workplace wellness programs (WWP) can be an appropriate avenue for health promotion [3]. This is likely why over 85% of US companies with 1,000 or more employees offer WWP [4]. Studies have found that most WWP focus on stress, physical activity, nutrition, work-life balance, weight management, depression and anxiety [5].
Even when WWP are in place, many have surprisingly low participation given the large workforce, with mostly women participating [6]. Studies have shown that the top barriers are lack of personal motivation, time, skepticism, and a lack of awareness [5]. One study found that only 60% of employees were aware their company offered such programs [7]. Other studies found that participation rates are over 40% for health screenings, but drop to around 20% or less for programs relating to fitness, smoking cessation, weight management, or disease management [4, 7]. Studies have found that fewer than half of employees feel their work environment supports a healthy lifestyle [8].
These trends have primarily been studied in the US or other Western contexts; few studies have been conducted in the Asia-Pacific region. This study aims to address a gap in the literature regarding the implementation of WWP among different Asia-Pacific economies, focusing on universities. Universities are often one of the largest employers in the cities in these regions. Therefore, it is critical to examine how universities can better promote employee health. In this paper, we report on several trends in Asia-Pacific universities’ workplace wellness policies and programs, as well as provide recommendations to address observed gaps and challenges.
Methods
The Association of Pacific Rim Universities (APRU) is an international, non-profit consortium of universities in the region, representing 18 economies 1 , 250,000 faculty members and more than two million students. The APRU Global Health Program (GHP), launched in 2007, is managed by the University of Southern California in the US. The main purpose of the GHP is to foster education and research about global health among more than 3,000 faculty, researcher, and student members.
In 2018, the APRU GHP sponsored an online survey for all APRU member institutions (50 at that time). The four study aims were to: 1) identify the main priorities and motivations of universities to offer WWP, 2) investigate the management of WWP, 3) assess the range and scope WWP at Asia-Pacific universities, and 4) identify barriers and challenges of WWP.
The link to an online survey in English was sent by email to a university employee at the Senior Leadership or Global Affairs Offices at each university, as well as to the Office of Human Resources and/or Employee Health/Workplace Wellness Office, if one existed. Participants were asked to ensure that the person completing the survey was the key person responsible for workplace wellness at their university. One employee answered the survey on behalf of the university. The survey was open between January-June 2018 and consisted of some close-ended and some write-in response questions. As seen in Table 1, the survey assessed a range of employee benefits, WWP management and information, and program offerings in six categories: physical fitness, nutrition and weight, mental health and stress, family support, chronic disease prevention, and safety. The survey questions were developed collaboratively by the research team after a review of the literature and were pilot tested by representatives of employee health and wellness offices at two APRU member universities in the US and Australia. Participants were asked to focus on programs specifically for employee health and wellness, not student health programs or occupational safety programs. Participants gave consent online prior to initiating the survey.
Survey components
Survey components
Participants
University characteristics
Of the 50 APRU member institutions, 28 universities in 13 economies completed the survey, a response rate of 56% (see Table 2). Most universities were very large public institutions. More than half (57.1%) employed between 2,500-9,999 faculty and staff, while 3.6% employed less than 2,500, 25.6% employed 10,000-19,999, and 10.7% employed 20,000 or more. Student populations ranged from 20,000-40,000 in 39.3% of the universities participating and more than 40,000 in 39.3%, while 21.5% had less than 10,000 students.
Economies of participating institutions
Economies of participating institutions
Participants were asked to rank university priorities and motivations to conduct WWP according to three key areas. The prevention and management of disease was ranked as the most important focus, promotion of a healthy lifestyle ranked second, and well-being/happiness/satisfaction was ranked last. Participants were also asked to rank the importance of six health topics; chronic diseases was ranked the highest, followed by physical fitness, mental health/stress, nutrition/weight, smoking cessation and safety. Participants also ranked five possible motivations of the university to offer WWP. Improved employee morale ranked highest, followed by improved workplace safety, reduced absenteeism, improved employee productivity, and reduced health care costs. Many elaborated in the text that the bulk of the WWP offered were mandated by law, including sexual harassment policies, smoke-free campuses, and family leave policies.
Management of WWP
As seen in Table 2, the vast majority (78.6%) of universities had at least one dedicated, paid employee responsible for WWP. Only two universities reported that they did not have an allocated budget for these programs. A very high proportion of participants reported that they felt university leaders were aware of WPP at their universities (75.0%) and were involved in decision-making about WWP (60.7%). Only 42.9% reported that upper leadership actively participated in the programs or was involved in program evaluation. Only about one-third (32.1%) reported offering protected time for employees to participate in regular health-related activities during the work week.
In terms of information dissemination, about two-thirds (64.3%) had a dedicated website for workplace wellness. The two main ways that participants thought that employees accessed the information were the website and through emails. However, the use of various other avenues to disseminate information about WWP was quite low, with only 25.0% using mobile applications, 28.6% using text messaging, 32.1% using social media sites, and 21.4% using printed materials and billboards on campus (see Table 3).
Workplace wellness program design, management, and information
Workplace wellness program design, management, and information
*Do not add up to 100 due to missing data.
Little data were being collected to evaluate WWP. In terms of collecting data on number of users, 71.4% reported collecting some data on users. However, when asked to report on the actual annual number of users for each of the six program categories, no universities said this information was being collected or was available. Many universities also reported not collecting any data at all to measure program efficacy. Other sources for program evaluation included data on employee absenteeism (57.1%), disability claims (50.0%) and user satisfaction surveys (53.6%).
Benefits and basic employee health and wellness policies
In terms of annual vacation days/holidays for full-time employees, all universities offered at least 11 days. In fact, 39.3% of universities offered 11-20 days, 35.7% offered 21-30 days, and 24.9% offered more than 30 days. In addition, 39.1% offered 1-9 paid sick days, 21.7% offered 10-15 days, and 39.1% offered more than 15. All universities offered health insurance to full-time employees, although about 60% had universal coverage in their economy. More than three-quarters (77.8%) covered psychological services, while 74.1% covered dental care, 74.1% covered vision care, and 61.5% covered drug and alcohol abuse services, including in-patient and out-patient care.
Physical fitness
Information regarding the specific programs commonly offered in each of the six categories is outlined in Table 4. The most frequently offered programs related to physical fitness. Common physical fitness programs included gym access (85.7%), on-campus fitness classes (78.6%), fitness challenges or competitions (most commonly charity walks, special one-day fitness events, intramural sports teams) (50.0%), and promoting biking (53.6%).
Specific workplace wellness programs offered by category
Specific workplace wellness programs offered by category
*Do not add up to 100 due to missing data.
In terms of nutrition and weight, most had specific nutritional policies on foods served at campus eateries (64.3%). Some also had weight reduction/management meetings or counseling (35.7%) and educational resources on healthy weight or weight loss (32.1%). One university sponsored weight loss competitions among employees (3.6%).
Mental health and stress
For the mental health and stress category, many had quiet areas for rest (71.4%) and offered yoga or meditation classes for employees (67.9%) as well as recreational activities for employees (64.3%). Few had mandatory depression or mental health screenings for employees (21.4% required it for all employees, 25.0% required it for certain employees).
In terms of family support, the vast majority had paid maternity leave (89.3%), paid paternity leave (85.7%), and more than one-half reported breastfeeding support for women who are working (57.1%). Some also had on-site childcare for employees for a fee (46.4%) or free (7.1%).
Chronic diseases
For the chronic diseases category, most served alcohol on campus (60.7%) but did not allow smoking on campus (60.7%).
Safety
Finally, in terms of safety, the most popular program was on-campus disaster preparedness training (85.7%) followed by written policies regarding discrimination or hate speech against employees (75.0%). Less than one-half had mandatory sexual harassment training (42.8%), with 21.4% offering it online and 21.4% offering it in-person. However, most reported that it lasted one hour or less and required this training only upon hiring. Programs relating to domestic violence prevention training or support for employees experiencing domestic violence were less common (35.7%).
Barriers and challenges
When asked to describe the main challenges in terms of WWP, by far the three most commonly reported challenges, reported by almost every participant, were low employee participation, limited budget, and lack of leadership support. Other challenges mentioned included limited staff, information dissemination, and limited program offerings. Participants also provided suggestions for future programming. By far, the most common suggestion was additional mental health and psychological programs and resources, including stress management. Other suggestions included infectious disease control, the use of mobile applications, mobile fitness classes, nutritional education and training, chronic disease prevention, and women’s health issues.
Discussion
This study demonstrates that a wide range of WWP are being offered by Asia-Pacific universities. However, there were also several important gaps in terms of the health problems that were addressed through such programs.
Mental health services
Our research also underscores the gaps in WWP around mental health and stress. Only about one-half of universities reported any screening of employees for depression or other mental health issues. In 2010, mental health disorders accounted for 5.45% of global disease burden [19], and is also the top contributor to the global burden of disease in terms of years lived with disability (YLDs) [20]. The global cost of mental health issues is expected to grow to US$6 trillion by 2030 [21]. To address mental health, programs should make prevention, rather than just detection and treatment, a central focus. It is also important to identify actionable, practical recommendations at both the individual and university level, which has been called for in other studies [22–24]. Furthermore, due to associated stigma and discrimination, creative measures should be used rather than the traditional “fixing-what-is-wrong” approach, including those capitalizing on individuals’ strengths or positive traits to buffer the negative effects of stressors, regardless of cause [25–27]. Systemic, institutional-level issues that may create mental health challenges should be addressed early to prevent such problems. Organizational justice can be improved through enhancing communication style and task allocation, provision of platforms for skill enhancement, and support for childcare [28]. Universities can also create “no work hours” to reduce the stress that may come from the constant communication made possible by technology [29]. Given that many chronic diseases can be managed or reduced through physical fitness, healthy diets, and reduced stress, universities should prioritize stress management among their employees [16].
Tobacco control
Our results underscore the need for tobacco control among many Asia-Pacific universities, especially among men [30]. Tobacco smoking is one of the largest contributors to the burden of disease globally, dramatically increasing the risk for cancer, heart disease, stroke, lung diseases, type 2 diabetes, and other chronic health conditions. In a 2012 WHO study, the Western Pacific region had the highest smoking prevalence (48.5%) among men, compared to the global average of 36.1% [30]. All participants, except for Indonesia, Russia, and the US, belong to this region. About one-third of universities in our survey did not have a smoke-free campus policy and less than one-half had smoking cessation programs for employees. Given the very high prevalence of smoking in this region and the multitude of negative health impacts of smoking, we recommend converting all campuses to smoke-free environments, increasing enforcement of smoke-free policies, and implementing the WHO’s tobacco-free initiative MPOWER measures [31], which have been widely shown to effectively decrease smoking prevalence [32, 33]. Universities are encouraged to ban on-campus smoking advertisements, the sale of tobacco product, and events sponsored by tobacco companies. Employers should provide smoking-cessation programs to benefit smokers and those affected by secondhand smoke. There are discussions about outcomes-based incentive programs or not hiring smokers to reduce smoking on campuses and encourage cessation, but these proposals remain controversial [34, 35].
Gender, discrimination, and violence
This study demonstrated that another major gap that should be addressed in WWP is discrimination. Programs and policies must be in place to effectively prevent and address sexual harassment and discrimination of all types, including discrimination relating to gender, sexual identity, race/ethnicity, age, or other categories. It is also important to recognize that harassment and bullying can be experienced by men, and that women can also be perpetrators of harassment and bullying. About one in four participating universities (25.0%) reported no specific written policies regarding discrimination or hate speech against employees. Gender discrimination is associated with poor mental and physical health, higher burnout rates, and lower career satisfaction [36, 37]. About one in three (32.10%) universities lacked a designated employee to handle investigation of claims for sexual harassment or discrimination. Employees reporting sexual harassment or discrimination may already face barriers such as lack of awareness of policies, taboo, fear, and lack of power in relation to the perpetrator [38]. Therefore, providing support to encourage disclosure is warranted.
Most participating universities (64.3%) did not have any programs relating to domestic violence. Furthermore, less than half (42.8%) had mandatory sexual harassment trainings and of those that did, most were one-time training programs upon hiring and/or lasted an hour or less. Given that about one in three women worldwide will experience physical and/or sexual violence in their lifetime and that those who have been physically or sexually abused report higher rates of health problems [39], it is critical that there be increased efforts to implement programs and policies to prevent and address these issues.
Workplace intolerance for harassment and bullying must start with the leadership. More research is needed to study how cultural values may influence these issues. For example, since the amendment of the Equal Employment Opportunity Law in Japan in 1997, women in Japan are now protected by law from sexual harassment and have greater awareness and understanding of their rights [40].
The variation in the violence prevalence observed within and between communities, countries, and regions highlights that violence is in fact not inevitable and can even be prevented, such as through addressing economic and socioeconomic factors [39]. Other ways to combat gender violence include challenging social norms that support male authority and control over women or violence towards women, reducing levels of childhood exposure to violence, reforming discriminatory family law, improving women’s economic and legal rights, and eliminating gender inequalities with wages and secondary education. Providing services, including mental as well as sexual and reproductive health care, can be critical to supporting the health of those who have experienced violence [39].
This study also pinpoints several gaps and challenges that universities face in implementing effective programs. Here, we make several recommendations on how to support effective programming to promote employee health and wellness.
Need for leadership support and protected time
The main challenges reported by participants included low employee participation, limited budget, and lack of leadership support. Low program participation was the most important perceived challenge. Only 32.1% of our participants offered protected time for participation in wellness activities. To increase WWP participation, dedicated time to participate is recommended. Program times should also align well with most employees’ schedules [9–11]. In our study, the majority of participants felt leadership was generally aware of, and involved in, decision-making around WWP. Even when managers support programs in theory, factors such as workload, scheduling inflexibility, low support from their own managers, or lack of familiarity with the program itself may discourage employees to participate [12]. The literature demonstrates that managerial and senior level staff buy-in is crucial to the success of WWP. If leadership’s priorities are not established early on, the sustainability of such programs may be jeopardized [13]. Setting formal expectations within the organization and training to increase program familiarity and encourage support at all leadership levels must occur is also recommended to promote a campus wellness culture [12, 14]. Given the interconnectedness of factors such as campus culture, leadership support, collaboration with industry providers, financial resources, and physical environment, a goal of creating lasting institutional support may be key to effectively implementing WWP [15]. In order for WWP to be relevant, culturally-sound, and actually used by employees, there must be a culture of health that fits into daily practices and also accounts for cultural norms and local traditions [16].
Improving stewardship and participation through data
To ensure the maximum positive impact, institutions must regularly collect data to ensure a high level of participation, satisfaction, and impact, as well as to identify and address any problems or gaps quickly so as not to waste resources and decrease program credibility [7, 16]. Many universities offered sporadic or one-off programs with no comprehensive, coordinated wellness programming. Overall, many programs related to compliance with laws and risk management, such as mandated sexual harassment training and smoke-free campuses, as opposed to increasing employee morale/engagement, which was reported as a top priority. It was unclear whether the programs enumerated in our study were having a positive impact because very little data were collected to evaluate them. It is possible that in economies with universal health coverage, employers may feel less motivation as they do not pay for employee’s health insurance plans, compared to the US where it is the employer’s responsibility [17]. Collecting both quantitative and qualitative data is crucial to effectively track participation, measure user satisfaction, and quantify program efficacy [13]. Disaggregated data on age, gender, income, sexual orientation, etc. should be collected to examine needs and gaps specific to certain groups of employees [13, 18].
The Asia-Pacific Economic Cooperation’s Healthy Women, Healthy Economies created a Policy Toolkit which is a helpful resource for interventions to address gender gaps faced by women worldwide [41]. The recommendations are grouped into five main areas: workplace health and safety, health awareness and access, sexual and reproductive health, gender-based violence, and work-life balance. A consistent theme throughout is the need for sex-disaggregated data so that appropriate gender-based research and analyses can be conducted to inform gender-specific interventions and close gender gaps. A Monitoring and Evaluation Framework supplements the Toolkit to provide guidelines on how to evaluate progress, including suggested indicators.
Effective information dissemination
In university settings, where many employees are highly educated and technologically savvy, capitalizing on electronic modes of delivery to increase employee awareness and participation is warranted [6]. In this study, only 25.0% of universities had mobile applications for employees relating to health topics, 28.6% utilized text messaging, and 32.1% disseminated information via social media sites. These avenues for information dissemination and research can be better leveraged. For example, the use of apps for health promotion has numerous benefits including being relatively inexpensive, easily accessible and updateable, and allowing for instant feedback and support. Important factors to consider in using technology-based modalities include data security and anonymity, as well as appropriate human resources required to analyze the data [42].
Family support
Policies should explicitly state how women will be supported in the workplace. For example, if work-life balance and family life is to be prioritized, then paid leave, flexible working hours, and supportive childcare policies and social norms about women’s roles need to be incorporated into university policies [20, 41]. Many universities in our study were already excelling in this area, as 89.3% offered paid maternity leave and 85.7% offered paid paternity leave. However, only 57.1% offered breastfeeding support and 53.5% offered onsite childcare, which could facilitate more women’s return to the workforce after childbirth. In many of the economies we surveyed, women are the primary caregivers; therefore this study focused on women. However, our overall hope is to support all families and caregivers regardless of gender identity.
Government’s role
Many universities had implemented health screenings and sexual harassment trainings due to government mandates or to prevent lawsuit-related losses. Our study suggests that governments can play a significant role in ensuring that relevant policies are implemented at the university level. With legislation, however, enforcement is required. For example, in Japan, sexual harassment policies lack enforcement or sanctions, and no compliance regulations exist to prevent sexual harassment [40]. The same lack of regulations and compliance has been seen in instances of occupational health policy, such as equal opportunity and work-life balance [43, 44]. However, even when organizations want to implement WWP, the lack of financial resources may be a formidable barrier [45]. As such, the government can play a key role in prioritizing and incentivizing workplace health promotion, as in the case of Taiwan’s Health Promotion Administration, which provides workplace health promotion accreditation services, and Australia’s government-funded Get Healthy at Work program, which works with workplaces to identify needs and priorities in order to develop action plans to improve work environment and culture, as well as individual health outcomes [45–47]. As shown by these examples, having a unifying group or set of guidelines can greatly assist in implementing a wellness program. In our study, many universities were publicly funded so increasing their budgets for workplace wellness programs specifically could spark more efforts in this area.
Future directions
While this survey examines the current state of WWP in many Asia-Pacific countries, there needs to be further analysis of possible mediating factors affecting the ways in which WWP are designed and implemented. As already stated, the presence of government regulations and policies can greatly influence the extent to which WWP are administered. However, other factors not studied in this article but that are of great importance include country income-level and cultural values relating to health and wellness. There are no low-income countries in APRU and additional research regarding university WWP in low-income countries is needed. In the corporate setting, there has been limited research in low- and middle-income countries, which has shown that there is a need for innovative toolkits for WWP, assistance with building local partnerships, and a need for tools and training relating to WWP data collection and analysis [48]. These needs likely extend in university settings in these countries. Much of the literature about health and wellness is also closely tied to Western perceptions of medicine and it would be worthwhile to further explore Eastern perceptions of health and wellness and how these views influence the design, implementation, and efficacy of WWP. As described earlier, there is some literature about the Eastern values and gender inequality but the literature specifically discussing WWP is extremely limited. Possibly, the inefficacy of some WWP in the Asia-Pacific may be due to lack of consideration or accordance with local cultures. More research on workplace bullying perceptions and behaviors is also warranted to elucidate additional possible avenues for intervention. Lastly, there must be sufficient teaching and education about the benefits of WWP for employees as well as return of investment and financial gain from improved employee health. Improved understanding of these benefits and adaptation of these values would potentially decrease the need for mandated government programming. In 2019, the APRU produced the Sydney Statement on Workplace Wellness, an important beginning step in the conversation about employee health, as it urged universities to “value and promote a culture of health within their institutions, dedicate resources towards comprehensive programs that promote overall well-being among employees as well as students, share expertise and best practices in employee health and well-being with other universities and employers in surrounding communities, and work towards 100% tobacco free campuses among Members.” Statements of this nature are critical to establishing a foundation for advancing employee health, but it is critical that actionable steps are taken to promote progress.
Limitations
This study had several limitations. Although this study included universities from many economies, some economies only were represented by a single responding university and thus may not represent other universities of the same economy. Also, no universities in low-income economies were represented. Limited collection of evaluation data also made it difficult to analyze program efficacy. While the team that helped to develop the survey had members from several Asian-Pacific economies, the survey was only piloted at two Western universities (in the US and Australia). Therefore, it may reflect more of a Western viewpoint. Finally, the survey was distributed in English. While most high-level staff at universities speak English, this could have been a barrier for some.
Conclusion
Our study assessed university wellness programs among Asia-Pacific economies and identified several important gaps. Our results suggest the need for improved program administration in the areas of dissemination of information, funding, evaluation of program efficacy, leadership support, and protected time to increase participation. Many programs were implemented as a result of government legislation and thus the government may play a key role in encouraging workplace wellness initiatives. Universities should develop a comprehensive wellness culture so that employee health is approached with a unified, strategic approach that aligns with university objectives for such programs while also considering the needs and priorities of the employees that will be engaging in them.
Footnotes
Acknowledgments
The authors would like to express their appreciation to the student research assistants, including Christine Bach and Elisa Bicera. They also wish to acknowledge the support of the APRU Secretariat, and the Provost’s Office of the University of Southern California. Finally, they would like to thank the university representatives for taking the time to participate in this study.
Ethics approval
The institutional review board of University of Southern California deemed the study exempt from ethical approval.
Informed consent
Not applicable.
Conflict of interest
The authors have no conflicts of interest to disclose.
Author contributions
VH: Investigation, validation, writing original draft, writing review and editing; NS: Conceptualization, data curation, investigation, writing review and editing; MW: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, and writing original draft.
Funding
None to report.
APRU’s policy is to use the word “economies” instead of “countries” in order to include Chinese Taipei and Hong Kong SAR.