Abstract
BACKGROUND:
Occupational therapy presently has a limited presence within the workplace wellness industry and the profession’s contribution within this area of practice is not fully understood. Occupational therapy’s holistic, occupation-based, and client-centered approach has the potential to provide a valuable contribution to the field of workplace wellness.
OBJECTIVE:
To explore the experience of organizational employees participating in a workplace wellness program centered in the occupational therapy domain and process.
METHODS:
Six occupational therapy workplace wellness program participants completed in-depth semi-structured interviews one month after program completion followed by deductive thematic analysis of transcripts.
RESULTS:
Three themes emerged (sustainable change across context, process matters, and therapeutic relationship supporting wellness), along with subthemes, describing the participant experience.
CONCLUSIONS:
The structured and individualized process of occupational therapy delivered within a workplace wellness program was appreciated by participants as a means of addressing workplace wellness and providing sustainable wellness results.
Workplace wellness programs are employer sponsored programs and services that provide comprehensive health promotion and prevention offerings addressing a wide range of physical and psychosocial conditions [1, 2]. The workplace wellness industry has grown significantly since its inception in the 1970 s [3] and is currently an eight billion dollar industry with 90% of organizations offering employees some form of wellness services [4]. These workplace wellness services are delivered at the individual, group, and organizational levels [5]. The goal of workplace wellness programs is to address the health and wellness needs of employees as well as generate a return on investment (ROI) for employers through lowered healthcare expenditures and improved productivity [5, 6].
The need for wellness in the workplace has grown alongside the workplace wellness industry. It is estimated that $36.4 billion dollars are lost annually due to common chronic conditions within the workforce such as diabetes, high blood pressure, and obesity [7]. Mental health issues are also a growing concern in the workplace. Depression and anxiety impact the quality of life and wellbeing of employees and are estimated to cost the global economy one trillion dollars annually in lost productivity [8]. Work related musculoskeletal disorders (MSDs), traditionally the focus of workplace health, safety, and ergonomic programs, have also increased significantly over the last decade with MSDs contributing to over half of organizational healthcare costs [9]. It is within this context that workplace wellness programs address the health and wellness needs of the workforce.
Despite the dramatic growth of the workplace wellness industry and pressing need for a healthy workforce, workplace wellness programs have yielded mixed results. Research on health outcomes and ROI associated with workplace wellness programs have shown positive outcomes such as decreased employee stress levels, reduced burnout, improved job satisfaction, reduced body weight, improved sleep quality, reduced worker compensation claims, and lowered employer healthcare costs [10–12]. However, insignificant or inconclusive outcomes have also been found regarding overall employee health benefits, healthcare utilization, and organizational cost savings [13–15] leading to skepticism about the overall ROI of these programs. However, several high profile studies on the ineffectiveness of workplace wellness programs have subsequently been scrutinized due to questions around the efficacy and number of wellness offerings provided within the studies [16, 17]. To date, there is significant heterogeneity and limited consensus on the optimal delivery of workplace wellness services.
As an emerging area of practice, occupational therapy has made some inroads into the workplace wellness industry though remains significantly underrepresented within this setting [18]. Occupational therapy has been active within the practice setting of industrial rehabilitation and ergonomics and has demonstrated positive results in the areas of injury prevention, workplace injury rehabilitation, and return to work [19–21]. Additionally, occupational therapy has been shown to positively impact psychosocial aspects within the workforce such as building mindful self-compassion among healthcare workers [22] and enhanced life balance among female social service workers [23]. To date, however, limited evidence exists to support the efficacy of occupational therapy within comprehensive workplace wellness programs. This represents a missed opportunity as it is estimated that 157 million workers in the United States could be reached by programs addressing health and wellness within the context of the workplace [7]. Occupational therapy’s focus on the domain of population level health management leading to outcomes of prevention, health and wellness, and wellbeing [24] positions the profession to make significant contributions to the health and wellness of the nation’s workforce. Additionally, occupational therapy’s comprehensive, holistic approach as outlined in the profession’s domain and process [24] has the opportunity to provide an effective, evidence-based perspective to this field. The domain of occupational therapy, which outlines the scope of the profession, provides the occupational therapy practitioner the training and tools to address a wide range of employee wellbeing concerns spanning the areas of physical, psychological, social, and spiritual wellness. Further, the domain’s focus on developing health-promoting occupations through building sustainable habits and routines within the client’s natural context allows the client to achieve sustainable change. This is accomplished through the process of occupational therapy which includes a thorough evaluation, goal-directed interventions, and a summative outcomes session to measure client progress and address sustainment post-intervention. More research is needed to better understand the unique contribution of occupational therapy to the practice area of workplace wellness. To this end, this qualitative study sought to answer the following question: what is the experience of participating in a workplace wellness program centered on the occupational therapy process?
Method
Study design
This qualitative study used a deductive thematic analysis approach to explore the experience of participating in a workplace wellness program intentionally designed to reflect the occupational therapy process [25]. Specifically, the program addressed participant wellness using the occupational therapy process through the gathering of an occupational profile, a thorough and individualized occupational therapy evaluation, occupation-based goal setting, evidence-based interventions targeting these goals, re-assessment of outcome measures, and planning for sustainment of progress made. Client self-selected wellness areas spanned physical and psychosocial domains and included increasing physical activity, healthy eating at work, time management, mindfulness, and stress management. The workplace wellness program consisted of three individual 60 minute telehealth (Zoom) wellness sessions (detailed below) incorporating the breadth of the occupational therapy process as well as one in-person session focused on office ergonomics. The telehealth sessions were scheduled every other week to allow for integration of wellness goal behavior into the client’s routine prior to the following session. The in-person ergonomic session was scheduled between sessions one and two based on the client’s availability. The program was designed by the primary investigator within the context of an occupational therapy doctorate (OTD) level I fieldwork program and all sessions were conducted by OTD students with faculty supervision.
Occupational therapy workplace wellness program design
Session 1 (Assessment): The focus of the initial session included an occupational profile, evaluation of workplace wellness and occupations, a standardized assessment of the client’s chosen wellness area, analysis of occupational performance, and goal setting. The occupational profile focused on each participant’s work history, values, and current patterns of performance including those that added to and detracted from their overall wellness. The information from this profile, along with the information from the assessment, was used to collaboratively design the wellness goal that the participant would focus on during the wellness program. The goal, which aligned to the client’s chosen wellness area, followed the SMART goal format. SMART goals are goals which are specific, measurable, achievable, relevant, and time-based [26].
Session 2 (Intervention): The focus of the second session included the integration of evidence-based strategies into goal-directed wellness participation, collaborative problem solving, and updating the client’s goal to reflect the just-right challenge. The intervention plan carried out within this session was developed from the information gathered in the prior assessment session and aligned to the client’s goal. The session facilitators shared the evidence-based recommendations they had researched since the prior session with the participant and collaboratively explored how these might be integrated into existing routines to help the participant meet their goals. Examples include integration of evidence-based mindfulness practices into the workday or designing work tasks to facilitate more movement throughout the day. Barriers to goal progress were addressed and problem solved within the session. This included redesigning goals to better meet the just-right challenge or reconsidering how the desired wellness behavior was embedded into the client’s existing routine.
Session 3 (Outcomes): The focus of the final session included sustainment of wellness performance and progress after the discontinuation of the OT wellness program and post-test assessments to measure progress. All participants completed a standardized assessment aligned with their wellness goal during the assessment process and these were reassessed at this time. Examples of assessments used in both the assessment and outcome sessions included the International Physical Activity Questionnaire (IPAQ) [27] to measure change in physical activity, the Perceived Stress Scale [28] to assess degree of stress across life situations, and the Occupational Balance Questionnaire (OBQ11) [29] to assess improved life balance. Further, habit and routine-building strategies were discussed and integrated into the participant’s wellness routine to promote sustainment of their new wellness behaviors post-program. Sustainment was an important aspect of the outcomes session as it was the final session in the occupational therapy work wellness program. Sustainment strategies included the co-creation of environmental and behavioral cues for continued habit formation and the removal of friction from the completion of desired wellness behaviors to facilitate continued performance [30, 31].
Researcher description & positionality
The primary investigator is an occupational therapist and academic with 20 years of experience. To reduce bias, a reflexive journal was kept and utilized throughout the data collection and analysis stages of the research study. Also, though the thematic analysis used a deductive approach to adequately answer the research question, bracketing was used during the semi-structured interview design and data collection phases in order to allow the participant experience to emerge without interference [32].
Participants
The participants within this study were all participants of the occupational therapy workplace wellness program that had been completed six weeks prior to the interviews with all interviews completed by June 2022. The six participants of the workplace wellness program were contacted by the primary investigator via email inviting them to participate in 1 : 1 interviews over Zoom to discuss their experiences within the program. All six participants elected to participate in the interview. The participants were all full-time staff members within the same Midwest public research university as the occupational therapy department that ran the workplace wellness program, though were from departments outside of and unrelated to the occupational therapy department. The participants worked in different staff positions within two separate academic programs within the university and a majority of their work was at their computer work stations. The specific departments were invited to participate in the occupational therapy workplace wellness program based on recommendations from previous program participants. The workplace wellness program had run one time prior to this offering six months earlier. The author’s university institutional review board determined that this activity is not subject to the requirements of the United States Department of Health and Human Services or Food and Drug Administration regulated research involving human subjects, however all participants were informed of the voluntary nature of the interviews and all data collected was de-identified to maintain participant privacy.
Procedure
Individual interviews were completed with each of the work wellness program participants over Zoom. Each interview was conducted by the primary investigator and lasted approximately 45–60 minutes. Interviews were then transcribed by the primary investigator verbatim in preparation for thematic analysis. Interviews were initially transcribed and then reviewed a second time for accuracy of transcription. The primary question guiding the interview was “Describe your experience participating in the work wellness program” followed by open-ended probes to elicit further information about their experience. The questions and prompts used in the interview purposefully avoided language found within the Occupational Therapy Practice Framework to avoid leading questions or confirmation bias.
Data analysis
Data analysis followed the six-phase approach to thematic analysis as described by Braun and Clarke [25]. The text transcriptions and recordings were reviewed to ensure accuracy and increase familiarization with the interview data. Initial coding was completed across all six interview transcripts. Deductive thematic analysis was utilized to generate initial themes to answer the research question of understanding the experience of participating in a workplace wellness program intentionally designed to reflect the occupational therapy process. To this end, theme and sub-theme generation was from the conceptual basis of the occupational therapy practice framework. Constant comparative analysis was completed during the generation of themes.
The study followed guidelines for qualitative research trustworthiness as described by Nowell et al. [33]. The primary investigator of the study collaborated with an experienced qualitative researcher during question construction for the semi-structured interviews and during theme identification and analysis. The primary investigator kept a reflexive journal throughout the study design, data collection, and analysis aspects of the study. Finally, member checking for both transcript accuracy as well as theme coherency was completed to improve fidelity of theme analysis to the participant experience.
Results
The following three themes and supporting subthemes emerged: (1) sustainable change across context (subthemes: performance patterns, radiating wellness, sustained results), (2) process matters (subthemes: the OT process, client centeredness), and (3) therapeutic relationship supporting wellness (subthemes: therapeutic use of self, relational accountability) (Table 1).
Themes and sub-themes
Themes and sub-themes
All six participants experienced a positive change in their overall wellness through the development of new habits and routines which proved to be both sustained and, in some cases, generalized to areas beyond the workplace.
Theme: Process matters
Participants found that the occupational therapy process through which the workplace wellness program was delivered was integral to their overall experience and wellness gains. This included both the structure of the OT process described in the study design as well as its inherent focus on client centeredness.
Theme: Therapeutic relationship supports wellness
Participants expressed how the relationship they developed with the OTD students facilitating the workplace wellness program not only enhanced the experience but supported their wellness outcomes as well.
Discussion
While occupational therapy has been active within the practice context of industrial rehabilitation and ergonomics, the profession has not made significant inroads into the growing workplace wellness market. The results of this study suggest that occupational therapy can provide valued services within this practice area. One clear theme from this qualitative study was the appreciation for the individualized, client-centered nature of a workplace wellness program designed around the ethos and process of occupational therapy. This is an important point as the construct of ‘workplace wellness’ is not monolithic. Studies have shown that the concept of workplace wellness is constructed differently across professions and there is no singular concept of what it means to be ‘well’ in the workplace [34, 35]. For example, findings suggested that while institutional support and work-life balance were key for workplace wellness in intensive care unit nurses [35], community service workers valued opportunities to provide support to others as essential to their wellness at work [36]. Occupational therapy’s approach of client-centeredness and individualization can allow the client to construct their own unique concept of workplace wellness and then design client centered goals towards this end. This fits with existing evidence supporting workplace wellness participants’ desire for individually developed goals instead of a one size fits all approach to wellness [37]. This aligns with the experience of the occupational therapy workplace wellness program as the participants chose to address a wide variety of wellness areas including physical activity, healthy eating in the workplace, stress management, mindfulness, and time management. Occupational therapists working within the domain and process of occupational therapy can provide a significant level of individualization to deliver the just right challenge that allows clients to meet their goals. Whether this level of individualization can be delivered at the scale of an entire organization remains to be seen. Workplace wellness programming can be offered at both the individual and group level [5] and research within the field of psychology suggests that group level intervention can be as effective as individual level intervention [38]. Exploration of this within the context of workplace wellness would further address this question.
Another important consideration taken from the results of the study is how occupational therapy services delivered in the context of the workplace can have broad ranging effects. Goals and interventions designed to promote wellness in the workplace can extend into different elements of the participant’s life. In part, this could be due to clients being able to apply the wellness promoting routines learned in the program towards their routines outside of the context of work. This has the ability to have a multiplicative effect as wellness promoting behaviors implemented at work can be implemented at home as well. Prior research findings have also noted that workplace wellness programs can impact wellness beyond the workplace context into the participants’ home lives [39] adding support to this concept. This speaks to the positive impact of delivering occupational therapy services within a workplace context. The results of this study add to the body of literature suggesting that the workplace is an effective context in which occupational therapy services can and should be delivered.
A unique aspect of the occupational therapy profession is the training and experience of practitioners to focus on both physical and psychosocial aspects of the workplace. Participants in this study valued both the ergonomic assessment of their physical environment as well as the individualized wellness interventions that focused on behavior change and psychosocial wellbeing. It has been demonstrated that there is a relationship between musculoskeletal disorders (MSDs) addressed by ergonomic interventions and the psychosocial sequelae if MSDs are to occur [40, 41]. The relationship between physical environment and psychosocial wellbeing, however, may be more nuanced than the psychosocial benefits secondary to injury prevention. Kropman et al. [42] found that the physical environment of the workplace has a direct effect on worker psychosocial factors, such as feelings of stress, wellbeing, and burnout, independent of the development of MSDs. Further, a proactive stance towards optimal environmental design in the workplace such as the creation of active health spaces to facilitate spatial playfulness has the ability to address the physical and psychosocial wellbeing of workers simultaneously at the level of prevention [43]. The results of the current study along with the emerging research on the complex interaction between physical workplace design and worker wellbeing suggest the need for the occupational therapy profession to further develop its conceptualization of a holistic approach towards the physical context of work.
Limitations of this study include the fact that all participants were from the same organization. It has already been discussed that professions conceptualize workplace wellness in different ways [34, 35], though it is unclear whether or not the experience of participating in a workplace wellness program would change across different organizations. Further research could explore this question across multiple organizational contexts. Another limitation of the study is that it did not utilize objective measures of effectiveness of the program such as client gains specific to their wellness areas. This qualitative design provides a starting point for exploring the benefits of occupational therapy within this context, however a follow-up quantitative or mixed methods approach could further address efficacy of an occupational therapy focused workplace wellness program.
Implications for occupational therapy practice
The results of this study suggest the following implications towards the practice of
occupational therapy: The process of occupational therapy is well suited for the practice area of
workplace wellness. Occupational
therapy’s individualized, client-centered approach is appreciated by work wellness
participants and is supported by literature on the individualized conceptualization
of wellness at work. The workplace is
an effective setting to address the unmet occupational needs of individuals with the
impact potentially spreading beyond the workplace to other aspects of the
participants’ lives.
Conclusion
The practice area of workplace wellness is currently underserved by occupational therapy. The results of this study suggest that the delivery of workplace wellness intervention through the process of occupational therapy can provide an effective means of addressing the occupational needs of the workforce. Specifically, occupational therapy’s focus on client centeredness through individualized goal setting, evidence-based intervention, and integration of performance patterns for sustained wellness can make significant contributions to the wellness of the workforce. Further, individualized occupational therapy intervention not only impacts wellness within the work setting but may positively impact other areas of participants’ lives.
Acknowledgments and declarations
Ethical approval
The University of Minnesota Institutional Review Board reviewed the study and determined that this activity is not subject to the requirements of the United States Department of Health and Human Services or Food and Drug Administration regulated research involving human subjects.
Informed consent
All participants were informed of the voluntary nature of the interviews and all data collected was de-identified to maintain participant privacy.
Conflict of interest
There are no conflicts of interest related to this study.
Footnotes
Acknowledgments
N/A.
Funding
N/A.
MeSH Database Keywords: wellness program, workplace, wellness, health promotion, occupational therapy, occupational health, work, qualitative research.