Workplace health promotion programmes (WHPPs): a review of effectiveness in achieving optimal health among employees effectiveness in achieving optimal health among employees

This segment is also linked with the first research question (section 1.4). It offers documented effects of WHPPs in combating diseases and attaining optimal health among the employed population.

Goetzel and Ozminkowski (2008) defined workplace health promotion programmes (WHPPs) as activities planned and implemented by the employer to prevent and address disease among the workforce or to prevent disease progression from the initial level to a severe one. This is with a view to improving employees’ health and wellbeing. In order to preserve the life and health of employees (human resources), it is important to put in place a well-planned, systematic, preventive and health-promoting programme in the workplace (Zungu et al. 2007).

Mokdad and Marks (2004) noted that individual health behaviour or lifestyle contributes to development or control of chronic health challenges (in or outside the work environment). For example, in the United States in 2000, 365,000 recorded deaths (15.2% of total recorded deaths) were attributable to a combination of poor diet and physical inactivity. Hence, Zungu et.al. (2007) acknowledged the importance of implementing WHPPs to address unhealthy lifestyles among employees.

Workplace health promotion is identified as being offered at three levels – primary (directed at a healthy workforce, such as educating employees on healthy eating and physical fitness), secondary (directed at those at risk, e.g., employees who are obese or who have high cholesterol) and tertiary (directed at workers with existing ailments such as diabetes, asthma and hypertension) – with the aim of reducing the disease impact. Additionally, tertiary-level programmes include supporting affected workers to comply with medication instructions and follow up relevant appointments (Goetzel et al. 2007).

72

Also, it has been noted that any WHPP must be implemented for a minimum of one year in order to be meaningfully assessed and for results to be credited to such an intervention (Moore et al. 2000). These authors noted that any outcome attributed to a WHPP implemented for less than one year may be misrepresentative. Aldana (2001) suggested an average of 3.5years to determine the effectiveness of a WHPP. Additional benefits documented for WHPPs by this author include early risk or disease detection (particularly at the pre-symptomatic phase), improved health awareness (through useful corresponding health information) and prompt referral to health care professionals (for employees with high levels of health risk). Aldana admitted that individualised counselling for ‘high health risk’ employees was the most effective and significant WHPP. Meanwhile, Deaton et al. (2011) concluded that both individual and group approaches are useful in promoting heart health and preventing or controlling CVDs.

Specifically, successful intervention strategies must take into consideration the particular needs of an organisation in order to effectively prevent and combat disease in the workplace (Lowe 2004). Generally, in the past, WHPPs used to target a single ailment or risk factor of disease. They overlooked the effects of organisation and environment and social health determinants (Chu et al. 2000).

Hence, Lowe (2004) argued that a WHPP focusing on one issue was inadequate to achieve a healthy workplace. Lowe noted that adjustment to a job, work design, organisational systems, management practices, workplace culture and environment are more important and effective in achieving HWs than interventions targeted at individuals only. As a result, there is a need to increase and improve employees’ knowledge and skills to manage health within and outside the workplace.

Successful factors for WHPPs are divided into four categories (Chu et al. 2000):

(a) participation–all workers must be part of the process from top to bottom and across the hierarchy, (b) project management, including needs assessment, planning, implementation and evaluation, (c) integration – it must be integrated into the organisational management plan, and (d) comprehensiveness in relation to the individual, organisation and environmental needs.

Furthermore, Queensland (1996) summarised 12 principles of a

health-73

promoting workplace in a report termed ‘Better Health for Working People’.

These are as highlighted below:

1. Cost-effective. Generally and to date, employers appreciate good value for the money spent on the business and employees.

2. Supports the workplace health and safety plan. A workplace health promotion programme must be part of a big picture or system in a workplace. It should not stand alone and must fit into the organisational plan of health, wellbeing and safety.

3. Managed by the workplace. In all ramifications and for sustainability, a WHPP is better coordinated by the workplace. Having a designated occupational health department/division affords such an opportunity.

4. Considers needs assessments. It is vital for a WHPP to reflect the peculiar requirements of a workplace (contextualising the WHPP) for effectiveness and impact purposes.

5. Voluntary participation. Individual employees should be encouraged and not coerced into participating in any WHPP. They need to be given the freedom to decide if they wish to be involved. The importance of such a programme should be established and employees must have the opportunity of informed consent before taking part in such activities.

6. Training on health promotion principles. Professionally trained individuals (e.g., occupational health practitioners) who have been taught the principles of health promotion must conduct the WHPPs.

7. Suitable. Consideration of the suitability of a WHPP is strategic to employees’

health, wellbeing, safety, performance and productivity. There must be reasons to implement each of the WHPPs and they must be relevant to the organisation’s goals.

8. Involves social justice. Open access must be given to all in planning and implementing WHPPs. They must address the needs of the diverse workforce, for example gender needs.

74

9. Evaluation process. On implementation, all WHPPs must have an evaluation procedure or plan to determine their effectiveness. For instance, this study essentially assisted in evaluating the WHPPs at the organisations studied. This had not happened at the two workplaces prior to this research being conducted.

10. Involves a mixed-strategy approach. A variety of approaches to the implementation of WHPPs provides opportunities for a wider scope or effectiveness among individual employees. Approaches to learning differ across individuals; for instance, utilising a particular strategy may not meet the learning needs of all. Some WHPPs could be more impactful with hands-on practical demonstrations.

11. Considers family involvement where necessary. The role of family support in health and wellbeing cannot be overemphasised. Thus, the family must be co-opted where required to achieve the desired outcome of health and wellbeing among the workforce.

12. Considers the structures, cultures, laws and policies of the workplace. A good WHPP needs to consider and contextualise its activity by adapting the local provision in a workplace. It needs to be flexible and fit into an organisation’s big picture without compromising the achievement of improved health and wellbeing among the workforce.

Despite the accrued benefits of WHPPs, authors have noted the potential negative consequences of such activities, including workers’ unwillingness and refusal to participate due to fear of detecting a health risk or breach of confidentiality. Also, regarding the recorded successes of WHPPs in community settings (including organisations), Ebrahim et al. (2006) opined that there is no consistency in the success of these activities. They noted that there was little or no effect on CVD and mortality, in a Cochrane systematic review of the effect of multiple risk factors for primary prevention of CVD and associated mortality.

However, most of the available evidence highlighted the positive influence of WHPPs when and if ‘rightly’ implemented (relevant, needs-based and with adequate resources).

75

Finally, achieving sustainable development, particularly on social and economic platforms, becomes practically impossible if workers’ health and the work environment are not given the required attention. Such efforts demand organised, proactive monitoring and need to offer interventions to potential health problems at work. Proactive monitoring and prompt intervention are possible through curtailment of sickness absence, productivity losses and deaths among the workforce. The effectiveness of such proactive programmes depend largely on the organisation of relevant WHPPs, including early detection and intervention of illnesses among the workforce (WHO 2012).

2.2.1.3.6 The business case for workplace health promotion programmes This segment is linked with both research questions (section 1.4) as it discusses the impact of WHPPs in combating diseases and ensuring gender equality in health on organisations’ business activity.

Over the last two decades, experimental and quasi-experimental studies have concluded that WHPPs do yield good financial output (Aldana 2001; Pelletier 2001; United States Department of Health and Human Services 2003; Chapman 2005). This is particularly useful for programmes that make use of specific and personalised programme to guide counselling of individuals with high levels of health risk. Also, WHPP is cost effective for employees (Goetzel and Ozminkowski 2008).

Chapman (2005) utilised and summarised findings from 56 studies that examined the economic consequences of WHPPs for employees. These studies revealed lower health care and sickness absenteeism costs in 25–30% of participants compared with non-participant groups. Similarly, only four (non-randomised design) of 32 reviewed studies (the other 28 used randomised design) had a negative conclusion and reported WHPPs to be non-useful economically (Aldana 2001). Moreover, Aldana (2001) highlighted that 14 studies focusing on the impact of WHPPs on sickness absenteeism showed significant reductions, irrespective of the research design. Three of these studies documented values for ROI ratio ranging from USD2.50 to USD10.10 for every dollar spent. Similarly, the report pointed to ‘acceptable’ signals demonstrating the usefulness of multi-component WHPPs in realising long-term positive behavioural adjustment among

76

employees. Also, the indirect or non-financial benefits of promoting health at work have been highlighted (WHO 1999) to include decreased absenteeism, increased productivity, reduced musculoskeletal complaints, reduced employee turnover, reduced claims, and improved organisational effectiveness and efficiency, leading to improved performance and productivity. Also, the WHO (2005b) reiterated the cost-effectiveness of implementing broad WHPPs and instituting the necessary workplace health policies (e.g., non-smoking policies or restricted smoking areas in the workplace) to employers. Up to 50% of associated disability and even death from heart disease could be eliminated through cost-effective preventive strategies directed at individual employees in the workplace.

Moreover, Wang et al (2007) demonstrated the cost-effectiveness of incorporating physical activities for sedentary obese workers. Furthermore, Goetzel and Ozminkowski (2008) asserted in a review that a well-designed WHPP can improve performance, productivity and employees’ health outcomes.

2.3 Summary

This chapter discussed findings from the first literature review. It presented analysis, synthesis and interpretation from relevant literature directed at exploring existing knowledge on the research aim (section 1.3) and the first research question (section 1.4). The chapter outlined the interaction between health and work. Specifically, the chapter examined the relevant literature, and documented the positive and important contribution of employment to an individual’s health and wellbeing. Also, it presented relevant literature on the prevention and eradication of disease at work. The review in this chapter is linked with MDG 6, which requires member states to combat HIV/AIDs, malaria and ‘other diseases’. However, due to a significant reduction in new HIV/AIDs infections globally, and comprising Nigeria, where the study was carried out, HIV/AIDS was not kept in focus in this review and study. Malaria is still a major concern in Nigerian communities (such as in the private and public sectors), so, it was a main focus in this study. Moreover, the literature reviewed demonstrated the magnitude of malaria disease in developing nations, with Nigeria ranking top in terms of the incidence and prevalence of the global malaria disease burden, hence, remained a focus.

77

Additionally, based on the researcher’s experience and previous research reports, it was clear that chronic health problems (NCDs) associated with a sedentary lifestyle are issues for concern (in terms of morbidity and mortality) in the country of study. This is why NCDs are kept in focus (captured under ‘other diseases’) in this study. Also, chronic NCDs are of significant impact in the world, with CVD diseases presenting the highest global morbidity and mortality among humans. Diabetes is among the worrying health challenges, ranking fourth in the global chronic NCD burden.

Furthermore, findings from review studies demonstrated the negative impact of poor hygiene and unhealthy lifestyles on incidence of disease. Prevention, control and management strategies were highlighted in line with available global best practice from the literature reviewed. Also, the literature emphasised the workplace as a vital and strategic setting to prevent and curb the spread of diseases through planning and implementation of relevant WHPPs.

There is a dearth of literature on the contributions of non-health organisations to the achievement of the MDGs (including the realisation of goal 6 – preventing and combating malaria and ‘other diseases’). The literature review indicated the need for employers to provide the necessary facilities (structural and organisational policies, among others), including establishing a division/department coordinating health, wellbeing and safety affairs at work (e.g., OH division). This will facilitate the organisation of WHPPs that will reduce prevent or combat (eradicate) of diseases, and promote employees’ health and wellbeing.

Overall, the researcher concentrated on and thus reviewed literature that focused mainly on HWs with strategies targeted at improving the health and wellbeing of the workforce. These strategies include reducing sickness absence, combating diseases and improving performance among employees.

Consequently, this chapter outlined the impact of preventing and combating disease at work. This is directly linked to MDG6, and SDG3 of the ‘Global Goals’

with a target year of 2030 (appendix 7).

78 2.4 Conclusion

The first literature review segment was presented in this chapter using a systematic approach to literature review (Booth and Papaioannou 2012), and involving the use of PRISMA to illustrate the included articles for the quality assessment. Two checklists for quality criteria were adapted for this review. The first is the qualitative Critical Appraisal Skills Programme (CASP 2014) (in line with quality assessment criteria outlined by Guba and Lincoln 1985, and Dixon-Woods et al. 2007). The second is Clearinghouse for Labour Evaluation and Research (CLEAR 2014) for quantitative studies. Literature relevant to the research topic which examined the existing strategies on prevention/eradication of malaria and ‘other diseases’ were reviewed. The literature was sourced from databases and grey literature. Key findings from the literature revealed various ways to prevent malaria and ‘other diseases’.

The next chapter presents the second and third literature review segments.

79