Worksite health presents a unique area of opportunity for targeted population health campaigns.
Author: Zack Papalia
Worksite health presents a unique area of opportunity for targeted population health campaigns. The relationship between employment, health behavior, and healthcare coverage creates a unique situation within which to develop health promotion programming. With unemployment rates as of July 2019 nearing the lowest they have been in over a decade, and over half of American adults receiving healthcare coverage through their employer, the worksite is a logical target for health promotion efforts (Bureau of Labor Statistics, 2019a; Fischer, Lang, Goetzel, Linnan, & Thorpe, 2018). Leveraging this scenario to improve employee health can also generate significant benefits for employers. However, in order to capitalize on this opportunity, worksite health programs must implement evidence-based strategies in an efficient and effective manner. In order to do this, it is important to evaluate and ensure that existing norms in the worksite health space are producing the desired results in an efficient manner.Worksite health programs have seen a steady increase in prevalence over the last decade. According to the RAND Employer Survey, as of 2012, 51% of employers with 50 or more employees offered some form of a wellness program, with larger businesses (greater than 100 employees) reporting significantly higher prevalence of programs (62% vs. 39%) (RAND Health, 2013). As of 2017, the percentage had risen to 81%, with employers investing an average $800 per employee annually for wellness programming (Emerman, 2017; Fischer et al., 2018). Among the leading health-related concerns for employers are absenteeism, presenteeism, and low-back pain among employees. The combined direct and indirect costs of such conditions take a significant financial and operational toll on industry. Worksite health professionals interested in generating both a humanistic and financial impact should be designing evidence-based programs aimed at improving these outcomes. However, some of the most popular components of worksite health promotion, such as on-site biometric screening, may not be generating the desired impact. Furthermore, as a greater percentage of occupations become sedentary, the impact of sedentary behavior and physical inactivity may be exacerbating these issues. Examining the relationship between these components and targeted areas of employer concern is essential in refining and enhancing future worksite health programming. Aim 1 of the present study examined the relationship between traditional worksite health assessment outcomes and employee performance. The relationships were examined among 48 participants (64.6% female). Participation was on a volunteer-basis, with participants receiving no incentives for enrolling in the study. Health assessments were conducted during a one-hour health assessment. Assessments included protocols commonly found in employee health assessments (e.g. biometric screening). Employee performance (e.g. presenteeism, absenteeism, low-back pain) was assessed via self-report questionnaire. Occupational sedentary behavior was assessed via direct accelerometry. Regarding outcomes of interest, presenteeism was found to be correlated with Pain Score (r = 0.-0.342, p = 0.031). Absenteeism showed significant correlation with Triglycerides (r = 0.378, p = 0.011), and Sedentary Time (r = 0.362, p = 0.020). In addition, there was a significant relationship between age and HDL levels (r = 0.303, p = 0.039), and age and fasted glucose (r = 0.451, p = 0.001). Significant differences were also found between sedentary and non-sedentary groups in regard to the relationship between HDL and absenteeism, as well as the relationship between low back pain and both total cholesterol and LDL. Changes in HDL explained 13.9% of the change in absenteeism F(1, 37) = 6.626, p = 0.014. Differences in TC explained 11.7% of pain variance, F(1, 37) = 5.724, p = 0.022. Differences in LDL explained 16.1% of the variance in pain F(1, 37) = 8.531, p = 0.006. Sedentary minutes at work was found to explain 13.1% of the variance in absenteeism F(1, 39) = 5.871, p = 0.020.Aim 2 of the present study examined the relationship between physical fitness and mobility assessment outcomes and employee performance, among the same sample. Participants were taken through a series of physical fitness-related assessments (e.g. handgrip dynamometry, functional movement screen, etc.), with employee performance (e.g. absenteeism, presenteeism, low-back pain) being assessed via self-report, and occupational sedentary behavior assessed via direct accelerometry. Participant age and sex was evaluated for potential impact on employee performance outcomes and occupational sedentary behavior. No significant relationships were identified relative to age and sex and employee performance outcomes, or occupational sedentary behavior. Age was found to solely correlate muscular strength (r = 0.443, p = 0.002) and overhead squat performance (r = -0.319, p = 0.029). Sex differences were identified only among three variables: aerobic capacity (2 (1) = 7.855, p = 0.005), body fat percentage (2 = 6.831, p = 0.009), and muscular strength (2 = 10.581, p = 0.001). The overhead squat mobility assessment identified significant differences between groups relative to Presenteeism (F(2, 42)=4.359, p=0.02, 2 = 0.187), and pain (F2, 42)=3.392, p=0.026, 2 = 0.064). A post-hoc Tukey analysis showed presenteeism was significantly lower (p = 0.038) among individuals scoring a 2 on the overhead squat compared to those scoring 3. Inversely, pain was significantly higher in those scoring 2, and lowest among participants scoring 3 on the overhead squat (p = 0.027).Aim 3 looked to provide a commentary on existing evidence and gaps care relative to employee health assessments and identify potential areas for improvement in addressing employee performance (e.g. absenteeism, presenteeism, and low-back pain). Existing literature on absenteeism, presenteeism, and low-back pain was examined alongside the results of Aim 1 and 2 to determine potential disconnects between worksite health program components and intended outcomes. Best practice suggestions were developed based upon these results. Overall, the present study generated several conclusions of use to worksite health professionals. Worksite health practitioners interested in maximizing impact on employee performance should be designing programs with evidence-based best-practices in mind. However, some of the most popular components of worksite health promotion, such as on-site biometric screening, may not be generating the desired impact. Given the existing literature, changes to worksite health promotion best practices could be implemented to better address the impact of absenteeism, presenteeism, and low-back pain on employee health and performance. Implementing programs designed to improve workplace culture and promote healthy lifestyle behavior, while encouraging employees to regularly engage with medical providers, may be the best use of employer resources to significantly impact and improve these outcomes.