The occupational therapy process in workplace wellness: A qualitative study of client experience

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.

Keywords

Occupational therapy work wellness health promotion occupational health prevention

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?

1 Method

1.1 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.

1.1.1 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].

1.2 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].

1.3 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.

1.4 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.

1.5 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.

2 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).

Table 1
Themes and sub-themes

Themes Sub-themes

Sustainable change across context Performance patterns

Radiating wellness

Sustained results

Process matters OT process

Client centeredness

Therapeutic relationship supporting wellness Therapeutic use of self

Relational accountability

Themes	Sub-themes
Sustainable change across context	Performance patterns
	Radiating wellness
	Sustained results
Process matters	OT process
	Client centeredness
Therapeutic relationship supporting wellness	Therapeutic use of self
	Relational accountability

2.1 Theme: Sustainable change across context

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.

Subtheme: Performance patterns. All six participants expressed the gains they made towards their wellness goals in language reflecting positive changes in performance patterns. In particular, the performance patterns of habit and routine formation emerged. For some participants it was about moving from prior, maladaptive routines such as addressing issues of poor time management within staff meetings: “I think it’s been more about that habit of just what I assumed; let’s meet and have it be an hour and let’s talk until it’s over versus what is the actual intentionality here and how do we get to our end goal sooner and then be okay with being done and moving on to something else” (P3). Additionally, as routines matured they grew more pragmatic: “so that’s probably one of the main things I have learned. I just let go of ‘the ideal routine’ and it’s, just like ‘the reality routine.’ Do what you can when you can and that’s it” (P4) and “I feel like not every day is perfect. Some days it’s just busier than others, but I do notice habits that I’ve picked up with the stretches and looking out into the distance and finding little ways to move” (P5).

Subtheme: Radiating wellness. The workplace wellness program focused on wellness goals within the context of the participants’ employment, however participants noticed that the positive wellness routines being established at work radiated out into other aspects of their lives. One participant found that time management strategies at work became integrated at home: “We started to look at our schedules as a family and so I laminated a calendar for each of my kids and then my spouse \dots just to have them have more insight and feel like they have a little bit more control over their calendars too” (P3). Additionally, a participant voiced how information learned from an in-office ergonomic assessment generalized to her home set-up as well: “I have incorporated some of those things into both my setup at home and at work and how I’m standing or sitting and things like that” (P2).

Subtheme: Sustained results. Participants experienced progress towards their wellness goals while participating within the program and shared how they were able to sustain it during the six weeks between the end of the program and the follow up interviews. “What’s it been, a couple of months now? I’m still working that plan, you know, of what’s the priority” (P1). An additional participant whose goal focused on enhanced physical activity also expressed how her gains sustained beyond the program: “I feel like I could continue to meet with people and go through wellness practice programs, but I also know I was equipped with tools to keep momentum on my own with a specific kind of wellness goal of getting in activity during your day” (P5).

2.2 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.

Subtheme: OT process in workplace wellness. In describing their experience, the participants expressed an appreciation for the OT process in positively impacting their progress towards their wellness goals. Specific elements of the OT process were mentioned by participants independent of any cuing or foreknowledge of the OT process. This included the occupational profile: “They were following my story, right. They were following what I was telling them. So they were not just asking random questions with random answers. They were trying to understand the big picture of my life and then how that affects physical activity” (P4). Likewise, the assessment and outcomes aspects of the OT process were addressed: “The assessments I found to be really interesting and just having a chance to look at the pattern across my responses and then compare the before and after. I love that there was a pre and post assessment. I love that there was, you know, goal setting activity” (P2).

Subtheme: Client centeredness. An important aspect of the occupational therapy process is client centeredness. Participants appreciated how they were able to guide what wellness area they wanted to focus on and design their own goals: “I think having that choice \dots there are really so many ways in which you can look at your wellness, what’s important to me right now, and for me that was getting that physical wellness while being in an office” (P5). Beyond the initial focus of the program, client centeredness extended throughout the experience: “I found that really helpful throughout and just moving at my pace within there. I felt that was a really nice benefit in that it was very directed at what’s going to be helpful for me versus having a really rigid structure” (P6).

2.3 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.

Subtheme: Therapeutic use of self. A core aspect of occupational therapy is engaging therapeutic use of self to build a trusting relationship with clients to support progress towards a client’s goals. The student’s use of therapeutic use of self was expressed as an important element of the program: “I think it was that they were able to build rapport soon. I think, without that rapport, this is just an exercise” (P1). Additionally, the therapeutic use of self that was demonstrated by the program facilitators supported participants through the challenges of meeting their wellness goals: “I also really appreciated the very open, nonjudgmental approach to it because creating new routines and sticking to those can be hard” (P6).

Subtheme: Relational accountability. An aspect of the OT workplace wellness program was an accountability check-in between sessions in which the OTD student asked how the goal was progressing. Participants found that this was effective in part due to the positive therapeutic relationship developed with the OTD students facilitating the program: “I’m like, okay they’re going to ask me about this, so I got to make sure that I can have an example of following through. So I really had appreciated having their voice in the back of my head and building that relationship with them” (P3). Another participant expressed “I think there’s also this sense of accountability, you don’t want to let them down” (P1).

3 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.

3.1 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.

3.2 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.

References

Daniels

, Tregaskis

, Nayani

, Watson

. Achieving sustainable workplace wellbeing. Springer; 2022.https://doi.org/10.1007/978-3-031-00665-4.

Mattke

, Liu

, Caloyeras

, Huang

, Van Busum

, Khodyakov

, Shier

. Workplace wellness programs study: Final report. Rand Health Quarterly. 2013;3(2):7.

Chernoff

. Wellness interventions in the workplace. In W. IsHak (Ed.), The Handbook of Wellness Medicine (pp.248-57). Cambridge: Cambridge University Press; 2020.doi: 10.1017/9781108650182.020.

Lieberman

. What wellness programs don’t do for workers. Harvard Business Review 2019; 14. Retrieved from:https://hbr.org/2019/08/what-wellness-programsdont-do-for-workers.

Baicker

, Cutler

, Song

. Workplace wellness programs can generate savings. Health Affairs. 2010;29(2):304–11.https://doi.org/10.1377/hlthaff.2009.0626.

Lowensteyn

, Berberian

, Belisle

, DaCosta

, Joseph

, Grover

. The measurable benefits of a workplace wellness program in Canada: Results after one year. Journal of Occupational and Environmental Medicine. 2018;60(3):211–6https://doi.org/10.1097/JOM.0000000000001240.

Centers for Disease Control and Prevention. Workplace health promotion. 2022. Retrieved from:https://www.cdc.gov/chronicdisease/resources/publications/factsheets/workplace-health.htm#::text=Chronic%20health%20conditions%20and%20unhealthy,employees%20missing%20days%20of%20work.

World Health Organization. Guidelines on mental health at work. 2022. Retrieved fromhttps://www.who.int/publications/i/item/9789240053052.

International Foundation of Employee Benefit Plans.Workplace wellness trends 2019 survey report. International Foundation of Employee Benefit Plans. 2019.

10.

Ledikwe

, Kleinman

, Mpho

, Mothibedi

, Mawandia

, Semo

, O’Malley

. Associations between healthcare worker participation in workplace wellness activities and job satisfaction, occupational stress and burnout: A cross-sectional study in Botswana. BMJ Open. 2018;8(3):E018492.

11.

Rezai

, SantaBarbara

, Almirol

, Shedd

, Terry

, Park

, et al Efficacy and costs of a workplace wellness programme. Occupational Medicine. 2020;70649–55.https://doi.org/10.1093/occmed/kqaa189.

12.

Rubery

, Ramirez

, D’Agostino

, Vasalos

, Thirukumaran

. A workplace wellness program at an academic health center influences employee health, satisfaction, productivity and the rate of workplace injury. International Archives of Occupational and Environmental Health. 2022;95(7):1603–32https://doi.org/10.1007/s00420-022-01865-5.

13.

Drishti Baid , Edward Hayles , Eric

. Finkelstein . Return on investment of workplace wellness programs for chronic disease prevention: A systematic review. American Journal of Preventive Medicine. 2021;61256–66.https://doi.org/10.1016/j.amepre.2021.02.002.

14.

Jones

, Molitor

, Reif

. What do workplace wellness programs do? Evidence from the Illinois Workplace Wellness Study. The Quarterly Journal of Economics. 2019;134(4):1747–91.

15.

Song

, Baicker

. Effect of a workplace wellness program on employee health and economic outcomes: A randomized clinical trial. JAMA. 2019;321(15):1491–501.doi: 10.1001/jama.2019.3307.

16.

Goetzel

. Commentary on the study: “What Do Workplace Wellness Programs Do? Evidence from the Illinois Workplace Wellness Study“. American Journal of Health Promotion. 2020;34(4):440–4.https://doi.org/10.1177/0890117120906664.

17.

Terry

. External validity and worksite wellness: Lessons from China and Illinois. American Journal of Health Promotion.. 2021;35(1):9–12>. DOI: 10.1177/0890117120970333.

18.

American Occupational Therapy Association. 2019 workforce & salary survey. 2020.

19.

De Dios Perez

, McQueen

, Craven

, Radford

, Blake

, Smith

, Thomson

, Holmes

. The effectiveness of occupational therapy supporting return to work for people who sustain serious injuries or develop long-term (physical or mental) health conditions: A systematic review. British Journal of Occupational Therapy. 2023;86(7):467–81.

20.

Fisher

. Radiologic and sonography professionals’ ergonomics: An occupational therapy intervention for preventing work injuries. Journal of Diagnostic Medical Sonography. 2015;31(3):137–47.

21.

Naber

, Molitor

, Willhite

. Impact of OT intervention on sedentary behaviors among office workers. The American Journal of Occupational Therapy. 2020;74(S1):7411520465–7411520465p1.https://doi.org/10.5014/ajot.2020.74S1-PO1900.

22.

Knier

, Watson

, Duffy

. The effects of mindful self-compassion (MSC) training on increasing self-compassion in healthcare professionals. The American Journal of Occupational Therapy. 2020;74(S1):7411515371–7411515371p1.

23.

Agosti

, Andersson

, Bringsén

, Janlöv

. “The importance of awareness, support and inner strength to balance everyday life” - A qualitative study about women’s experiences of a workplace health promotion program in human service organizations in Sweden. BMC Women’s Health. 2019;19(1):7–7https://doi.org/10.1186/s12905-018-0704-z.

24.

American Occupational Therapy Association.

Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy. 2020;74(Suppl.2):7412410010.https://doi.org/10.5014/ajot.2020.74S2001.

25.

Braun

, Clarke

. Thematic analysis. In H. Cooper, P.M. Camic, D.L. Long, A.T. Panter, D. Rindskopf, & K.J. Sher (Eds.), APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 57-71). American Psychological Association. 2012.https://doiorg.ezp1.lib.umn.edu/10.1037/13620-004.

26.

Bailey

. Goal setting and action planning for health behavior change. American Journal of Lifestyle Medicine. 2019;13(6):615–8https://doi.org/10.1177/1559827617729634.

27.

Booth

. Assessment of physical activity: An international perspective. Research Quarterly for Exercise and Sport. 2000;71(2):114–20.https://doi.org/10.1080/02701367.2000.11082794.

28.

Cohen

, Kamarck

, Mermelstein

. A global measure of perceived stress. Journal of Health and Social Behavior. 1983;24(4):385–96.https://doi.org/10.2307/2136404.

29.

Håkansson

, Wagman

, Hagell

. Construct validity of a revised version of the Occupational Balance Questionnaire. Scandinavian Journal of Occupational Therapy.. https://. 2020;27(6):441–9.https://doi.org/10.1080/11038128.2019.1660801.

30.

Gardner

, Sheals

, Wardle

, McGowan

. Putting habit into practice, and practice into habit: A process evaluation and exploration of the acceptability of a habit-based dietary behaviour change intervention. International Journal of Behavioral Nutrition and Physical Activity. 2014;11135.doi: 10.1186/s12966-014-0135-7.

31.

Wood

, Neal

. Healthy through habit: Interventions for initiating & maintaining health behavior change. Behavioral Science & Policy. 2016;2(1):71–83.

32.

Tufford

, Newman

. Bracketing in qualitative research. Qualitative Social Work: QSW: Research and Practice. 2012;11(1):80–96.

33.

Nowell

, Norris

, White

, Moules

. Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods. 2017;16(1):1–13.

34.

Anderson

, Pio

, Jones

, Selak

, Tan

, Beck

, Hamilton

, Rogan

, Yates

, Sagarin

, McLeay

, MacLean

, Fayerberg

, Hayward

, Chiang

, Cadzow

, Moran

, Nicholls

. Facilitators, barriers and opportunities in workplace wellbeing: A national survey of emergency department staff. International Emergency Nursing. 2021;57101046.doi: 10.1016/j.ienj.2021.101046. Epub 2021 Jul 6. PMID: 34243105

35.

Jarden

, Sandham

, Siegert

, Koziol-McLain

. Intensive care nurse conceptions of well-being: A prototype analysis. Nursing in Critical Care. 2018;23(6):324–31.

36.

Hamling

, Jarden

, Schofield

. Recipes for occupational wellbeing: an investigation of the associations with wellbeing in New Zealand workers. New Zealand Journal of Human Resource Management. 2015;12(2):151–73.

37.

Dejonghe

, Biallas

, McKee

, Rudolf

, Froböse

, Schaller

. Expectations regarding workplace health coaching: A qualitative study with stakeholders. Workplace Health & Safety. 2019;67(7):317–25.

38.

Rosendahl

, Alldredge

, Burlingame

, Strauss

. Recent developments in group psychotherapy research. American Journal of Psychotherapy. 2021;74(2):52–9.https://doi.org/10.1176/appi.psychotherapy.20200031.

39.

Townsley

, Waldron

, Alborn-Yilek

, Schares

, Huckstadt

, McNamara

, Gute

. School administrators’ experiences in a 6-month health and wellness community of practice. The Journal of School Health. 2021;91(10):857–66.https://doi.org/10.1111/josh.13073.

40.

de Almeida

, Vieira

, Zaia

, de Oliveira Santos

, Lourençco

ARV

, Quemelo

PRV

. Musculoskeletal disorders and stress among footwear industry workers. Work. 2017;56(1):67–73https://doi.org/10.3233/WOR-162463.

41.

Hassan

MHA

, Ahmad (a) Manap

, Baharom

, Johari

, Jamaludin

, Jalil

, Mat Sahat

, Omar

. A systematic review of risk factor associate with musculoskeletal disorder: biomechanical and psychosocial factor. In Human-Centered Technology for a Better Tomorrow (pp. 661-80). Springer Singapore Pte. Limited. 2021.https://doi.org/10.1007/978-981-16-4115-254.

42.

Kropman

, Appel-Meulenbroek

, Bergefurt

, LeBlanc

. The business case for a healthy office; a holistic overview of relations between office workspace design and mental health. Ergonomics. 2023;66(5):658–75.https://doi.org/10.1080/00140139.2022.2108905.

43.

Jiao

, Tang

, Guo

. Proactive health interventions in the workplace: The role of spatial playfulness in promoting mental health. Work. 2023;76(3):1203–17.https://doi.org/10.3233/WOR-220486.