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Our society is facing a health crisis. Sedentary lifestyles, poor nutrition, and overcommitted schedules have led to obesity, chronic disease, elevated stress, and a host of other health problems for large segments of the population. The recent publication of the U.S. Health and Human Services Physical Activity Guidelines and launch of the National Physical Activity Plan have brought much-needed attention to these issues. These documents offer a road map for those working to promote healthier lifestyle choices, but it can be difficult to turn the guidelines into programs that appeal to the people most in need of help. Winning Health Promotion Strategies offers guidance to anyone looking to encourage the members of their communities, schools, and workplaces to make positive lifestyle changes.
In Winning Health Promotion Strategies, the author shares tips, techniques, and success stories based on her experiences implementing the governor’s award-winning Get Fit Rhode Island program, which was instrumental in Rhode Island’s being named the first Well State in the nation by the Wellness Councils of America. She has also gathered examples from model initiatives and evidence-based programs and advice from experts in the wellness industry that will help you better understand all of the factors involved in starting or improving your own initiatives. The book provides everything you need to succeed, whether your goal is to start a new program or to increase the visibility of existing programs:
• Information on the benefits of health and wellness programming in various settings that will help you show return on investment, making it easier to gain approval and support for your programs
• A step-by-step approach to program design and implementation that will make it easier for even those with little experience to develop successful initiatives
• Tips and techniques for maximizing participation by attracting new participants while keeping existing participants fully engaged
• Strategies for assessing and evaluating your initiatives and using that information to sustain or improve your programming
• 55 proven programs that can be used to jump-start your initiatives, whether you are scheduling stand-alone events or planning a longer-term intervention program
The ready-to-use programs in Winning Health Promotion Strategies cover a wide variety of wellness topics, including physical activity, motivation to exercise, nutrition, stress reduction, general well-being, and cancer prevention. Each program includes everything you need in order to educate and inspire your participants. You’ll find a brief introduction to the program, a discussion of its effectiveness, a list of goals, tips for carrying out the program, and suggestions for tailoring the program to meet the needs of your organization. A key categorizes the programs by setting (school, community, or worksite), type (awareness, education, or intervention), and cost, and an activity finder will help you quickly locate the programs that best fit your needs. Throughout the book you’ll also find sample program materials, such as handouts and log sheets.
Winning Health Promotion Strategies will help you step up to the challenge of inspiring healthier living in your community. Both new and veteran programmers will find the tips, tecchniques, strategies, and support they need in order to engage and entertain their participants while teaching them the skills for making the right choices about their health and wellness.
Part I: Understanding Wellness Initiatives
Chapter 1: Making Wellness Work in Various Settings
Chapter 2: Developing Successful Wellness Initiatives
Chapter 3: Creating Engaging Wellness Initiatives
Chapter 4: Improving and Expanding Existing Wellness Initiatives
Part II: Winning Wellness Programs
Chapter 5: Physical Activity Programs
Chapter 6: Nutrition Programs
Chapter 7: General Health and Prevention Programs
Anne Marie Ludovici-Connolly has over 30 years of experience in the health and wellness industry. From 2005 to 2008, Ludovici-Connolly served as director of the Governor’s Get Fit Rhode Island program, a statewide wellness initiative. She conducted a wide range of research projects and also developed and taught various health and wellness courses for the University of Rhode Island. She was owner and operator of Wakefield Health and Fitness for eight years. She is currently a national senior consultant and subject matter expert in health and productivity for Hewitt Associates, a global HR consulting and outsourcing company, and also serves as a scholar in residence at the University of Rhode Island’s Cancer Prevention Research Center, home of the transtheoretical model of behavior change.
Ludovici-Connolly earned her bachelor’s degree in business administration and marketing from the University of Rhode Island in 1982 and her master’s degree in the psychosocial aspects of exercise physiology from the University of Rhode Island in 2002. She is an ACSM-certified health fitness specialist and has served on the committees of numerous national and state organizations, including IDEA, IHRSA, the Medical Wellness Association, and the National Association for Health and Wellness. She was named IDEA’s Northeast Region Aerobic Instructor of the Year in 1989 and was given the Wellness Inspiration Award by Discover Wellness in 2007.
Ludovici-Connolly lives in Wakefield, Rhode Island. In her free time she enjoys music, traveling and skiing with her family, cooking, and exercising.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.
Wellness Where We Work, Live, and Learn
Learn how you can use these three settings, or channels, to implement wellness programs.
Priority 1: Wellness Where We Work
Health care has soared to the top of almost every CEO's agenda as health care costs continue to rise globally. Along with health care costs, the workweek continues to increase steadily, with the average now being more than 50 hours. These trends have resulted in support for worksite wellness. Organizations can glean numerous benefits from wellness programs. The return on investment (ROI) of wellness progress is threefold: for every dollar invested in wellness, three dollars are saved. Worksite wellness translates into the following:
- Reduction of documented perceived barriers (e.g., time, energy, resources)
- Stress reduction
- Improved social support of colleagues, improving exercise adherence
- Improved job satisfaction and morale (e.g., positive water cooler talk)
- Improved employer-employee relations (e.g., mayor walking with employees)
- Positive public opinion of elected officials
With the increase in dual-income families and the increase in the average workweek, many people have less discretionary time than ever before. Delivering wellness at work just makes sense and translates into lower health care costs, benefit savings, and improved quality of life for employees. Employers, large and small, have observed the numerous benefits that worksite wellness programs offer. Providing social support and time savings, wellness programs at the worksite appear to be a natural fit for successfully engaging adults in healthy lifestyle practices.
This perceived barrier of discretionary time has increased the demand for the convenience of worksite-based health promotion and wellness programs. As people spend more time at work, it makes sense to engage them where they are, making healthy lifestyles convenient and affordable at a place where they can receive social support and recognition or incentives for positive lifestyle changes. The following strategies and tips may assist you in developing effective worksite wellness programs:
- Self-directed programs. Self-directed programs have been proven to be effective because employees can have difficulty attending a class or event at a specific time. Such programs allow employees to be engaged at their own pace, on their own time, and at various levels of involvement.
- Short-duration programs. Educational workshops that are 15 to 30 minutes long attract more employees than longer ones do. If necessary, you can deliver more content over a series of workshops.
- Workday programs. Providing programs during work hours increases participation. If allowed to participate on company time, such as during breaks or lunch, even more employees attend.
- Programs with incentives. Incentives have been shown to increase participation in worksite wellness programs and initiatives, particularly when linked to health benefit credits such as a reduction of health insurance copayments. However, the affect of incentives on financial outcomes remains unclear. Incentives are discussed in chapter 3.
- Programs with top-down and bottom-up support. The support of senior leadership, middle management, and frontline employees, or ground troops, is a must. Even when senior leadership is on board, middle management may take additional recruitment efforts due to demanding workloads. Middle management, to whom the majority of employees directly report, needs to be supportive of employee participation in wellness events or meetings during normal business hours when possible. It is important that senior management and middle management openly discuss and address any supports and barriers to implementing a wellness initiative. It is also imperative that support come from the bottom up through peer and social networks (see chapter 3).
To reach the largest number of employees in a worksite setting, consider offering wellness programs at all locations, including remote or satellite locations, and during multiple work shifts. Worksite wellness programming must be sensitive to the time demands of employees as well as employers. Shorter programs may be an effective way to provide a taste of what a longer, more comprehensive initiative may entail. Programs offered at lunchtime are often better attended than those offered after work because many employees do not want to stay at their worksites after the workday has ended. Break time can be a good time to offer snapshots of health promotion opportunities. Wellness information and programs may be delivered to offices on mail carts to maximize participation, especially of the busiest executives.
Priority 2: Wellness Where We Live
On warm summer evenings on the streets of Nashville, Tennessee, you can get a great workout, along with dance lessons, engage in live music, and meet enthusiastic people at weekly summer dance block parties. Nashville's Metro Parks and Recreation Department hosts these dance parties for eight consecutive weeks. Each week a different band is featured, providing music for all ages. Dance lessons are provided for community members. This gives the community an opportunity to gather, socialize, and exercise.
In a Nashville senior center, Let's Dance, a one-hour dance class (featured in part II), attracted more participants than any physical activity program previously offered. The senior center had advertised many exercise classes in the past, only to draw minimal participation, until Let's Dance. This class had great appeal!
These examples demonstrate that girls and boys and men and women of all ages “just wanna have fun.” Dancing not only is a great physical activity program, but it also has a therapeutic social component, which fosters self-efficacy, or self-confidence in adopting healthy lifestyle behaviors. (Bandura's self-efficacy theory is discussed in chapter 3.) Communities, municipalities, and faith-based organizations are recognizing the need for members to practice healthy lifestyle behaviors. Of all the environments we move through, there may be no better place to achieve a healthy lifestyle than our own communities.
Communities have a unique opportunity to influence large populations; they have a captive audience and therefore can uniquely engage families, where they reside, in healthy lifestyle behaviors and programs. Communities may also have a variety of resources at their disposal to assist in wellness efforts, including departments such as buildings and grounds, recreation, and other municipal departments. These departments and their employees may have resources, services, budgets, and contacts, as well as unique perspectives and ideas, that can be leveraged to execute wellness programs.
How do wellness strategies in communities differ from other settings? How can you maximize results? Here are a few tips for success:
- Plan events that can easily accommodate large groups of people.
- Offer wellness opportunities for families.
- Take advantage of seasonal sports and activities. For example, offer snowshoeing or ice skating in the winter, and offer walking programs and dance lessons in the summer.
- Partner with other groups such as nonprofit organizations, other municipalities, and state departments.
- Advocate for effective policy and environmental changes to support healthy behaviors (see chapter 4).
- Arrange social opportunities to encourage commitment of participants in wellness activities.
Priority 3: Wellness Where We Learn
“Yuck! Look at all the germs, and I just washed my hands!,” the middle school girl declared to her friends. As students observed their hands in a dark box after applying Glo Germ, they were able to see the millions of germs remaining after hand washing prior to entering the lunchroom. At an annual Kick Colds and Flu campaign (featured in part II) to reduce the spread of flu and the common cold, faculty and staff may pick up information and giveaways and participate in hands-on demonstrations to increase children's knowledge and change their hand-washing habits to minimize the spread of germs.
Schools and universities recognize the opportunity and obligation to promote healthy minds and bodies through offering wellness programs to faculty, staff, and students where they spend most of their waking hours—at school. Featuring changes in policies, wellness programs, and conventional health and gym classes, schools are building a menu of wellness initiatives. Many schools are now developing wellness committees that include representatives from local government, nonprofit organizations, private businesses, parents, and teachers, among others.
First Lady Michelle Obama has assembled a new interagency task force that will develop a comprehensive plan of action to combat the growing obesity epidemic in children. Like the NGA Healthy America initiative, the National Physical Activity Plan (NPAP), and Get Fit, Rhode Island!, Obama's Let's Move campaign will take a comprehensive, interdisciplinary approach, and engage both the private and public sectors. The goal of the campaign is to, “help children become more active and eat healthier within a generation, so that children born today will reach adulthood at a healthy weight” (www.whitehouse.gov/blog/2010/02/09/making-moves-a-healthier-generation).
Let's Move provides solutions and challenges for healthy schools, such as the Healthier US Schools Challenge Program (www.letsmove.gov/schools/index.html). In addition to the abundance of resources provided to promote healthy schools, Let's Move also provides solutions to enhance access to improve nutrition and physical activity, along with many resources to promote healthy homes and communities (www.letsmove.gov/).
Call your local school district to see whether it has a wellness committee. If it does, join. If your district does not have a wellness committee, start one! How? Write to your superintendent and offer to organize such a committee. Identify key people involved in wellness in the community, and invite them to a meeting to discuss organizing a committee to improve the health and wellness of faculty, staff, and students.
Although academic success is strongly linked with health, increased academic pressures on school officials have prompted the request for more classroom time for academics, resulting in less time for physical education, physical activity, and recess. Competing demands for time pose barriers to wellness where we learn. Health-risk behaviors such as poor nutrition, physical inactivity, substance use, and violence are consistently linked to academic failure because they often affect students' school attendance, ability to pay attention in class, grades, and test scores. In turn, school funding is based, in part, on the overall academic performance of the school. Today, we are challenged with the need to embed health into the education environment for all students. One solution to improving health and academic performance is short-duration programs. These may be creative, educational, and trendy, and they can engage parents via take-home materials.
Integration into the academic curriculum may be another solution for promoting wellness where we learn. As adults spend a majority of their waking hours at the worksite, children spend the majority of their waking hours at school. Lesson plans in other subjects can include wellness education. For example, history class can include physical activity by going on historical walks, or math lessons can integrate nutrition concepts. Teachers can get creative with coupling wellness education with a variety of topics. ABC for Fitness and Nutrition Detectives, featured in part II, are just two model programs that effectively integrate wellness into the school curriculum.
How do wellness strategies at schools differ from other settings? How can you maximize results? Here are a few tips for success:
- Integrate wellness education throughout the curriculum.
- Institute effective wellness policies that are easy to implement.
- Offer wellness information and displays during lunchtime.
- Offer interactive demonstrations to capture interest and attention.
- Offer take-home brochures to engage and involve parents.
- Offer programs to both students and staff.
Measuring the Success of Wellness Initiatives
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful?
Step 2: Data—Collecting Data or Information
How do I measure the ROI of our wellness initiative? How can I tell if our wellness initiative is cost-effective? How do I know whether the wellness initiative is successful? These are a few of the most frequently asked measurement questions posed by senior leaders of organizations that have invested in or have contemplated the implementation of a wellness initiative. These are very reasonable questions and concerns. Senior leaders want to know how to determine whether their investment in wellness will provide financial returns. The answer lies in the data. To measure ROI, you must begin by collecting baseline data on the population, or the members of your organization, and monitor data measures periodically to assess progress. (This is discussed in more detail in Step 5: Success on page 40.)
To ensure that any investment is profitable, you must first collect baseline data for evaluation. Without collecting baseline data from a variety of related sources, or without taking the time to carefully evaluate that data initially and throughout the course of your wellness initiative, you will not be able to discover whether your initiative is making a positive impact. So, what type of data can you collect to measure the success of your wellness initiative? The following data collection strategies— health interest surveys, health risk surveys or health risk questionnaires, and biometric screenings—provide basic best-practice assessments for a comprehensive wellness initiative.
Health Interest Survey
The Wellness Council of America recommends the distribution of a health interest survey as an effective initial data collection strategy. A simple, short, nonintrusive survey listing potential programs to be offered as part of a comprehensive wellness initiative helps gauge the interest of potential participants. This information can provide very valuable data to use in the development of a targeted strategic plan also. It is important to know what individuals need to improve their health, but knowing what they want will allow you attain the highest level of engagement and participation in your programs.
A sample health and wellness survey is presented on pages 29-30. You may customize or tailor this survey to your organization by adding, deleting, or modifying questions. You may distribute the survey in paper form or post it online for completion at computer workstations. If you want help creating a survey from scratch, the Web site Survey Monkey offers “a revolutionary tool to create and publish custom surveys in minutes, and then view results graphically and in real time” (www.surveymonkey.com/).
A health interest survey is a powerful strategy for introducing a wellness initiative and engaging potential participants. Organizations have reported that people are somewhat suspicious when health risk surveys are used as the first data collection tool in the design of a comprehensive wellness initiative. They may question why the organization is requesting sensitive lifestyle information as well as what they are planning to do with this information. By distributing the health interest survey first, many organizations report that employees express fewer concerns, and that they are more likely to participate in a health risk survey later. By first asking people what they want via the health interest survey, you can then engage them in addressing what they needthrough the results of a health risk survey or questionnaire.
Health Risk Questionnaire (HRQ)
I Took Charge of My Health! This slogan was printed on custom-made stickers given to employees to put on their lapels once they completed their HRQ as part of the launching of a wellness initiative. The purpose of these stickers (which make the program visual, an example of the three Vs) is similar to the I voted stickers people wear after voting to promote others to do the same. The stickers create a buzz by encouraging others in the organization to attend the event, complete the HRQ, and start taking charge of their health!
Administering the HRQ is an essential step in determining the health risk behaviors of a population. A model HRQ asks questions that evaluate health risks as well as people's readiness to change their health behaviors. They are available from most health care providers, state and local public health departments, and private wellness vendors.
The HRQ is typically administered on an annual basis, providing valuable health information on a population over time (i.e., health related trends). It is a key tool for evaluating wellness program outcomes or progress. As such, the HRQ should be a scientifically reliable and validated instrument. Non-technically speaking, a reliable questionnaire is one that would give the same results if you used it repeatedly with the same population or group. For example, a reliable questionnaire will give the same results on Tuesday as it did the previous Monday. A validated questionnaire is one that has been shown to measure what it purports to measure. A reliable and validated HRQ can be used in pre- and post-evaluations of wellness initiatives, as well as in the evaluation of short- and long-term trends over time. A reliable and validated HRQ should be developed by, or in consultation with, someone with expertise in program evaluation or statistics to ensure that the results are meaningful.
The process of simply administering the HRQ may be considered a part of a health intervention because it is designed to raise individual health awareness via self-assessment. The HRQ also provides an organization with valuable information on the health of its population for effective wellness program planning. The administration of the HRQ should always be followed with a wellness program or implementing a health intervention based on the results.
ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 47) cautions: “Many health promotion practitioners have made the mistake of investing too much of their resources in a HRA (Health Risk Assessment) or HRQ. While an HRQ is a very important component, without the necessary resources for diligent follow-up, program success will not be achieved. A HRA alone will not create behavior change.”
Sample questions on an HRQ may be related to the following:
- Lifestyle behaviors such as diet, exercise, smoking, and seat belt use
- Preventive health care (e.g., annual physical exams, routine checkups)
- Stress and mental illness
- Readiness to change lifestyle behaviors
Biometric Screenings
A man once told a nurse who was providing blood pressure screenings at an on-site biometric screening worksite event, “If I knew my blood pressure was so high, I would have filled the prescription for my blood pressure medication that my physician gave me at my physical six months ago.” These were stunning words from a man whose blood pressure was through the roof! His blood pressure numbers were well over normal values. In fact, they were in such a dangerous range that the nurse requested that the man immediately call his physician, who saw the man in his office that very afternoon. The nurse later stated that if this man had not attended the screening event and seen his physician immediately, there would have been a high probability that he would have had a serious cardiac event. In other words, this screening event may, indeed, have saved his life.
Biometric screening events provide detailed assessments of basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL), and blood glucose. Such events are very valuable for creating awareness and providing educational opportunities for participants in worksite, community, and school settings. It is advantageous to offer biometric screenings in conjunction with the HRQ. Participants can then more accurately answer questions on the HRQ versus relying on estimates of their personal health data.
Evaluation a must before expanding wellness initiatives
A strong foundation is critical to sustaining many things, including wellness initiatives. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
Many people do not want to spend time fixing foundations. The work itself is not sexy or cutting edge. Foundations are hidden beneath the surface, cannot be showcased, and are not recognized for their worth. However, a strong foundation is critical to sustaining many things, including wellness initiatives. In the short term, it is often easier and faster to build on what you already have in place, no matter what the condition of the foundation. However, as the foolish man who built his house on sand learned, a successful, long-term outcome requires a solid foundation. Before building additions onto your existing wellness initiative or program, go back to the basics and ensure that your foundation is solid.
To evaluate whether your initiative has successfully met all of the basic criteria for success as outlined in chapters 2 and 3, ask yourself the following questions.
Infrastructure
- Do senior and midlevel leaders actively participate in five or more programs per year, each year?
- Do senior and midlevel leaders keep abreast of the progress of the wellness initiative or program? Are they well versed in the mission of the initiative and its goals to the extent that they are aware of other important organizational initiatives?
- Do senior and midlevel leaders recognize wellness champions on a regular basis?
- Does the wellness director possess the qualities outlined in chapter 2?
- Are wellness champions actively involved and engaged in the initiative? Do they contribute to the team? Do they meet monthly and average 80 percent attendance at meetings?
- Are wellness champions able to tell you what the goals of the initiative are?
- Do wellness champions possess the qualities outlined in chapter 2?
- Does the steering or oversight committee meet regularly to review short- and long-term goals and progress, and minimize barriers to progress?
Data
- Did you offer a health interest survey to your employees? Did you receive at least 50 percent participation?
- Did you offer a health risk survey or health risk questionnaire (HRQ)? Did you receive at least 50 percent participation?
- Did you offer biometric screenings? Did you receive at least 50 percent participation?
- Are your participation numbers increasing over time?
Evaluation
- Did your steering or oversight committee review all the data collected?
- Did you take time to review and discuss findings to set priorities and goals?
- Did you develop a written plan and time line based on the data collected?
- Do you stick to your plan and make adjustments when needed?
AEI Programming
- Are you offering targeted programs based on the results of collected data?
- Are your programs evidence-based or grounded in scientific research?
- Are your programs engaging? Are they fun?
- Are your participation numbers increasing over time?
- Are you offering a balanced blend of awareness, education, and intervention programs?
Success
- Are you addressing the health interests and needs of your audience?
- Are participants satisfied with the program?
- Are you conducting process and outcome evaluations?
- Are you using the results to refine or redefine your programs to maximize success in achieving your goals?
Engagement for Health Behavior Change
- Do you have a plan that addresses the four Ps of marketing?
- Do you have a brand and logo for your initiative?
- Are you reducing reported barriers to improving health behaviors?
- Are you promoting the pros of changing negative health behaviors?
- Are your programs incorporating evidence-based theories of behavior
change?
It is important that you answer these questions with brutal honesty and accurately assess your initiative as it stands. In his book Good to Great, Jim Collins (2001) notes (quoted material from pages 70-72), “You absolutely cannot make a series of good decisions without first confronting the brutal facts.” In his research, the good-to-great companies Collins studies, unlike the comparison companies, “redefined the path to greatness with the brutal facts of reality.” I challenge you to take Collins' advice and make an “honest and diligent effort to determine the truth of the situation” prior to strategizing on how to take your program to the next level. Once you evaluate your current wellness initiative with the brutal facts of reality, the right moves and decisions will not only reveal themselves, but they will have a greater effect. In turn, you will achieve a higher level of long-term success.
If you honestly answer “no” or “I don't know” to any of the preceding questions, it is important to go back to the basics to build on or improve your existing foundation before adding the next level. Revisit chapters 2 and 3 to review and strengthen the basic building blocks of your initiative prior to considering more advanced techniques for improvement. Additionally, remember my father's advice regarding the essential requirement for a solid foundation. A solid foundation will ensure maximum participation and positive results. If you answered “yes” to all of the questions, you are ready to take your wellness initiative to the next level!
Taking your wellness initiative to the next level
After ensuring that your existing wellness initiative has successfully met all of the basic criteria for success, you can use any of several strategies to take it to the next level. ACSM's Worksite Health Promotion Manual (Cox, 2003) has identified the following four areas meriting serious consideration for mature or seasoned initiatives or programs:
Increasing senior-level support
Clock building versus time telling
Developing key organizational health indicators
Broadening the understanding of the actual determinants of health
Increasing Senior-Level Support
According to ACSM's Worksite Health Promotion Manual (Cox, 2003, pg. 123), effective wellness initiatives, particularly mature initiatives, require “complete, unwavering support of senior corporate officers.” Senior-level support is defined as “more than just a casual interest or management by abdication.” With maturity, there is often an urgent need to increase senior-level support and to engage, or to increase the engagement of, midlevel leadership or management for ongoing success.
The ACSM (Cox, 2003) recommends the following key roles of leaders of mature wellness initiatives:
- Communicating the vision
- Providing a positive role model
- Allocating adequate resources and instituting supportive policies
- Recognizing and rewarding employee and champion success
Chapter 2 detailed strategies for increasing the interest and engagement of leadership over time. To take your wellness initiative or program to the next level, ensure comprehensive support from all of your organizational leaders, both senior and midlevel. Leadership's engagement in the wellness policies, programs, and environmental or cultural changes in any type of organization is one of the most important foundational elements for a successful wellness initiative.
David Anderson, PhD, senior vice president and chief health officer of StayWell Health Management and an expert in health promotion research, recommends strengthening the culture of wellness and senior leader support within an organization to foster continual growth of wellness initiatives or programs and to maximize positive health outcomes. The results of a study published by Dr. Anderson and colleagues suggest that a worksite culture supportive of wellness and a comprehensive communications strategy, along with other factors such as incentives, may all play a role in increasing HRQ participation (Seaverson, Grossmeier, Miller, and Anderson, 2009). In this study, a worksite culture score was derived from nine items including verifiable senior and midlevel management support, infrastructural support (i.e., physical environments and policies supportive of wellness), the wellness team, an integrated strategy that is woven into other aspects of health and wellness programs offered within the organization (e.g., disease management, behavioral health, other health benefit programs), and dedicated on-site staff with wellness responsibilities. Organizations that demonstrated a strong culture of wellness experienced greater engagement in their wellness initiatives than those that did not.
Clock Building Versus Time Telling
The ACSM's second recommendation involves the critical step of enlisting many people to join the wellness effort and avoiding the appointment of a single qualified leader. In the book Built to Last (1977), authors Collins and Porras described how some organizations have been able to survive and thrive in spite of overwhelming circumstances and a highly competitive business environment. They referenced the organizational concept of clock building versus time telling. Clock building is the long process of melding the various talents and skills of people in a group to build a cohesive, effective team that can thrive far beyond the capabilities of one single leader. To increase stature, influence, and effectiveness, and to survive over time, mature initiatives must be disseminated to a variety of key players throughout the organization. As discussed in chapter 2, it is important to recruit an interdisciplinary army of champions or ambassadors and to continue to develop that army so that wellness infiltrates throughout the organization. Once troops are recruited, leaders must sustain their engagement.
Developing Key Organizational Health Indicators
Mature programs improve and grow through ongoing data collection, evaluation, and appropriate action derived from valid and reliable sources such as health risk appraisals, biometric screenings, health care claims, and reports on absenteeism and workers' compensation. Using these data as “intelligence” to develop and continually refine or redefine a strategic plan will result in sound programming efforts, maximized engagement, and successful outcomes. Successful, mature programs continually seek improved participation in their health interest surveys, health risk surveys or HRQs, and biometric screenings, year after year.
Get Fit, Rhode Island! has taken their program to the next level by continuing to review and refine their strategy to target the top medical and pharmaceutical cost drivers specific to their population. Get Fit, Rhode Island! most recently implemented a “Rewards for Wellness” incentive strategy to enhance engagement and target key health behaviors. As a result, Get Fit, Rhode Island! has significantly increased program engagement and has begun to assess cost savings via medical claims data.
Aaron B. Schrader, MS, health promotion coordinator for the state of Delaware's comprehensive wellness program, DelaWELL, believes that “successful long-term wellness programming is a dynamic, rather than static process that advances based on employees' changing interests, thoughts and health concerns” (personal communication). Schrader has found that conducting regular needs assessments and evaluation techniques allows for the stratification of risks and the development of ongoing programs or events (i.e., health seminars, campaigns, or wellness challenges) that target employees' unhealthy lifestyle behaviors and ultimately promote positive change. This assessment process has involved online and paper-based Health Risk Assessments (HRA) with subsequent projection of annual avoidable health care costs based on aggregate demographic and health risk data collected, onsite biometric health screenings, and interest and feedback surveys. Schrader believes that “through the assessment of the wants, as well as the needs of the population(s) you are working with, potential participants in wellness programs become involved in the decision making process” (personal communication). By doing this, you have essentially just engaged them! Schrader has found that by asking employees what they want and examining other data sources to reveal what they need, employees remain engaged in the initiative, programs relevant to employee interests are maintained, and effective health improvement strategies are provided.
Collecting data allows you to gather intelligence on the major health risks of an organization's population so you can target your wellness strategies to generate significant health improvements. Without relevant data collection, and just as important, the evaluation of relevant data, you may fail to offer appropriate programs specific to the needs and wants of your population. Although the collection of relevant data is critical, a potential pitfall is the collection and analysis of too much data. The ACSM states that “we are living in the midst of an information explosion” (Cox, 2003, p. 125) and recommends the development of a targeted strategy based on four or five key pieces of data that provide meaningful information.
Broadening the Understanding of the Actual Determinants of Health
Most wellness initiatives focus on four health behaviors that contribute to 50 percent of annual deaths in the United States: poor nutrition, sedentary lifestyles, tobacco use, and excessive alcohol consumption (Cox, 2003). Although these four high-risk behaviors warrant a great deal of intervention, compelling evidence suggests that a variety of other socioeconomic factors significantly affect people's health, including occupation, work environment (including the quality and quantity of social interaction at work), on-the-job recognition (or lack thereof), income, and education. These factors account for many health disparities within organizations (see chapter 3) and may be root causes of unhealthy behaviors (Cox, 2003).
A better understanding of health determinants may help you take your wellness initiative to the next level by allowing you to tailor it more precisely to the population you serve. This may include incorporating strategies to strengthen social networks, improve work-life balance, create a less stressful work environment, and increase individuals' sense of purpose and value to the organization. Understanding determinants of healthy behaviors means uncovering the whys behind, or motivators for, unhealthy behaviors. An assessment of the environment of your organization may assist you with this.
Encourage positive lifestyle changes with these sample wellness programs
These programs cover wellness topics including physical activity, nutrition, and stress.
Fitness Bee
Fitness Bee is an educational program that is designed to increase knowledge of fitness and exercise facts. Fitness Bee may be offered in a variety of settings including worksites, communities, and schools. This one-hour program developed by the director of the Rhode Island State Office of Rehabilitation Services, Steven Brunero, and his wellness team may be offered as a Lunch and Learn wellness activity.
Goals
- Increase knowledge of fitness.
- Increase knowledge of exercise.
Description
Fitness Bee is based on the game show Truth or Dare and engages participants by asking them to provide answers to questions on fitness and exercise. Prizes are awarded for correct responses. Questions for Fitness Bee may be developed by the wellness director or the wellness champions. The questions may be developed as a team effort. The person, or team, that answers the most questions correctly wins the Fitness Bee. Following are some sample questions and answers:
Sample Questions and Answers
The following questions and answers are from the American Council on Exercise:
Question 1: If someone sweats during an aerobic workout, is he or she out of shape?
Answer: No. The reason for sweating is that body core temperature becomes elevated by the increase in metabolic heat production during exercise.
Question 2: Does regular participation in aerobic exercise lower an individual's risk of developing cancer?
Answer: Research suggests that exercise often modifies some of the risk factors associated with certain kinds of cancer. Obesity, for example, has been linked to cancer of the breast and the female reproductive system.
Question 3: What is HbA1c, and what does it measure?
Answer: The HbA1c (glycosylated hemoglobin) test measures the amount of glucose that attaches to red blood cells. The higher your blood glucose level, the more sugar your blood cells will accumulate over time. Because the typical life span of red blood cells is 90 to 120 days, the HbA1c test reflects your average blood glucose level over that time period. As a result, it measures how well your blood sugar has been controlled over a period of a few months.
Question 4: What are the benefits of varying your workout routine?
Answer: Varying your workout routine (1) prevents boredom associated with doing the same things workout after workout and (2) avoids or delays reaching a plateau in workout performance and, subsequently, training results. Research also suggests that adding variety to an exercise program may improve adherence.
Question 5: How important are the warm-up and cool-down portions of a workout?
Answer: Warm-up and cool-down activities should be an essential part of all exercise programs. Warm-up activities prepare the body for the conditioning phase of the exercise session. The cool-down phase assures that venous (blood) return to the heart is maintained in the face of significant amounts of blood going to the previously working muscles.
Enhancements
- Fitness Bee may be tailored to include a Nutrition Bee or a General Health Bee.
- Schedule Fitness Bee at lunchtime in the worksite, during class time in school, or in the evening at a community center.
- Advertise Fitness Bee and offer small prizes or incentives for teams or individuals who win.
- Fitness Bee can be offered in a variety of different ways. Offer Fitness Bee for a designated period of time such as six to eight consecutive weeks, or offer it as a one-time event.
- Include Fitness Bee as part of a health fair or other wellness event or program.
- If Fitness Bee is offered as part of a Lunch and Learn wellness program, a healthy lunch may be served.
For More Information
Visit www.cdc.gov/ for potential question content organized by health topics.
An Apple a Day
An Apple a Day is a nutrition intervention program. Participants who eat an apple each day at work, school, or a community-based organization such as a community center or health club for 21 consecutive days receive an incentive such as a raffle ticket.
Goals
- Increase apple (fruit) consumption.
- Educate participants on the benefits of eating apples (fruit).
Description
A bushel of shiny, delicious apples is prominently displayed on a table next to the front desk, and employees are encouraged to take one each day for the month of September. (Contact local orchards to obtain discounted rates on apples, or encourage participants to bring their own apple in each day.) Employees get Apple a Day cards punched each day they eat an apple. (See the bottom of this page for a punch card you can use.) At the end of the 21 days, anyone who hands in a completed punch card is entered into a raffle. Apple recipes are also provided each week to help employees continue eating apples by providing a variety of options for preparing or cooking with apples. This type of intervention is effective because it reinforces education (i.e., learning about the benefits of apple consumption) with the desired behavior change (i.e., increased apple consumption).
Enhancements
- Contact local registered dietitians or nutritionists in private practice or at your state or local health departments or universities, or contact your local culinary college or any college in your area that offers a culinary arts program, for handouts on the benefits of eating apples and other fruits and vegetables, recipes, or on-site cooking demonstrations.
- Recipe boards may be hung in various locations for participants to share apple recipes.
- This program may be just a one-day awareness event at which apples, recipes, and handouts on their health benefits are distributed.
For More Information
Visit www.fruitsandveggiesmatter.gov/ to read about the benefits of eating apples (fruit) and for creative recipes.
Stop, Stretch, and Breathe
Stop, Stretch, and Breathe is a 10-minute stress management and physical activity performed in a chair. This program may be offered at worksites, community-based organizations, or schools prior to meetings, classes, or workshops, or as a stand-alone program. Stop, Stretch, and Breathe may be offered as an eight-week series or as an ongoing program.
Goals
- Increase blood flow and improve range of motion through stretching.
- Reduce stress through muscle relaxation and deep breathing.
Description
You may immediately identify the smell of lavender when you enter the room for your Stop, Stretch, and Breathe class. The sound of water is coming from a small waterfall on a table in the front of the room. The lights are dim, and a screen saver of a fish tank is projected from a laptop computer on the front wall of the room. Ocean sounds emanate from a softly playing CD. All of these staging techniques help to enhance relaxation. The instructor, standing at the entrance to the room, encourages you to take a seat and begin to unwind for a few moments before the session begins.
Begin the session by walking participants through the following steps:
- Sit up straight and maintain this posture. Let your head balance between your shoulders so you feel no strain in your neck.
- Close your eyes if you feel comfortable enough to do so. (If not, ask participants to focus their attention on the fish tank screen saver or other relaxing visual projected on the front wall of the room.)
- Clear your mind, letting go of any stressful, negative, or judging thoughts.
- Notice your breathing. Your breathing should be slow and fairly regular, without any big gulps of air. Notice your chest rising and falling. Notice the feeling of air entering and exiting your throat.
- Notice any tightness, soreness, or stiffness in your muscles. Try to relax these muscles by tensing and relaxing them. Notice the difference between tension and relaxation.
Demonstrate and perform the following exercises (and be sure to have copies of this list to hand out):
- Do five repetitions of each of the following:
- Deep, relaxing breaths
- Forward neck rolls
- Front shoulder rolls
- Back shoulder rolls
- Upward shoulder shrugs while breathing in, and shoulder drops when breathing out
- Shoulder retractions by pulling the shoulders back so that the shoulder blades move toward each other
- Deeply inhale while raising both arms above your head. Hold for a moment then gradually lower your arms while slowly exhaling.
- Raise one arm, bend to the side, and lower the arm slowly. Repeat with the other arm.
- Raise your arms over your head again, and this time fold forward slowly, lowering your head between your legs until the top of your head faces toward the floor. Hold this position for several seconds while continuing to breathe. (This exercise is similar to inverted poses in yoga.)
- With your hands on your thighs just above your kneecaps, come up very slowly with your back in an arched (i.e., cat stretch) position.
- Return to a seated position and resume a straight posture.
- Notice whether any muscles in your body are still tense. If so, tense and relax those muscles until all strain is gone.
- End the session with five deep, relaxing breaths.
Enhancements
- Add more chair yoga exercises, such as the seated triangle pose, to extend the length of the program.
- Provide educational materials on stress management.
- Add a 10-minute educational component, or pair with an educational lecture provided by a health care professional or vendor (e.g., employee assistance program).
Screen Savers
Screen Savers is a health awareness program to increase healthy lifestyle behaviors throughout the work- or school day.
Goal
Improve lifestyle behaviors and health habits.
Description
The phrase Stop, Stretch, and Breathe moves across the computer screen. A screen saver (which supports the three Vs in chapter 2) reminds Sharon, a budget analyst working in a stressful state budget office, to take a few minutes every few hours to stop, stretch, and breathe to improve her breathing, reduce her mental and physical tension, and reduce her stress level. Putting a visual reminder on the computer screen at her desk prompts Sharon to perform a healthy behavior in the midst of a narrow focus on her primary task at hand—budget development and review. Sometimes at work or school, we may get so focused on our work, that we disregard any thoughts of incorporating healthy lifestyle behaviors into our daily schedules. Given that the average workweek has increased to 50 hours, it becomes even more important to integrate good health habits into our daily lives.
Here are some sample screen savers:
- Take a 10-minute walk.
- Look up a healthy recipe for dinner.
- Get at least eight hours of sleep tonight.
- Eat breakfast.
- Drink eight to ten 8-ounce (237 ml) glasses of water today.
- Check my blood pressure.
- Eat an apple.
Enhancements
- Distribute a list of screen savers. Ask participants to select one per month to display on their computers.
- As a school project, ask students to create their own screen savers to display on their computers each week or month.
- Create screen savers of photos of employees or students engaging in healthy lifestyle behaviors.
First steps in developing successful wellness initiatives
“If we were to offer a wellness initiative, where would we begin?”
Where to Begin
An organization was experiencing the worst financial climate in a decade. Employee morale was low, many jobs were being eliminated, and all department budgets were being cut. Leaders began investigating possible savings options within all divisions of the organization, including health care costs. To help accomplish this goal, they were contemplating the implementation of an employee wellness initiative. They were interested but not sure if they were fully committed to the idea. The director of human resources asked, “If we were to offer a wellness initiative, where would we begin?” Where would you begin? First, consider the following questions:
- What are your goals for wellness? If your goal is to introduce wellness to the organization, then you may want to begin by offering one or two wellness programs (see program examples in part II). If the goal is to make a significant impact on the culture and health of the organization, reduce health care costs and other costs such as workers' compensation or sick days, or achieve any other significant outcomes, begin planning for a comprehensive wellness initiative.
- What are your resources? If your resources and budget are slim, you may still offer a comprehensive wellness initiative, but you must be creative about using all of your current internal as well as external resources. Another option is to launch programs in phases over a period of time, or offer a few programs detailed in part II and wait until you can devote the funds and staff to make a bigger splash.
- How committed is the organization? If the organization and its leadership are fully committed to wellness, a comprehensive initiative may be successful. If the commitment is low, beginning with a few programs until you can garner full support may be the way to go.
- What is the climate of the organization at this time? Timing is everything. If it is a turbulent time within the organization, you may have a difficult time launching a comprehensive initiative. It really depends on many factors such as how the program is positioned and the commitment and goals of the organization.
There is no right or wrong direction in which to go based on how you answer these questions. You must use your best judgment and do what's best for your organization or group. The right answer for one organization may not be the right one for another. The wellness team or board of advisors should weigh all the internal and external variables when contemplating the timing of a program launch. Here are two strategies to choose from:
- Comprehensive wellness initiative: This chapter can assist those who would like to create a comprehensive wellness initiative. The evidence-based steps to building a successful initiative are easy to follow and highly effective.
- Traditional wellness programming: Another option for exploring wellness is to begin with a program or two. If you not quite ready or able to commit the time and resources to a full-scale initiative, begin with traditional programming to test the waters. Traditional programming may create some interest in wellness, reveal how open participants might be to a more comprehensive program, and provide time to get the support needed for a comprehensive initiative. Such programming also does not require intensive commitments such as employee health surveys. It is important to note that a return on investment (ROI) or organizational cost savings as a result of positive health behavior changes are less frequently observed with traditional programming.