Best Practice Design Principles of Worksite Health and Wellness Programs

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Recently, a series of opinion papers, Web blogs, newspaper, and formal research articles have scrutinized the approach to and effectiveness of workplace wellness programs (4,8,9,11,14). Whereas some objections to these arguments have been broadly disseminated (e.g., Goetzel (6)), one of the major underlying issues barely has been addressed. This issue refers to the underlying principles of program design that are needed to ensure a successful outcome. It is the purpose of this column to outline a broad set of best practices for worksite health promotion programs that have been shared in the literature, to distill these down into a manageable set of broad categories or dimensions, and thus to identify a short list of key design principles associated with successful worksite health and wellness program outcomes. This short set of best practice design principles can be used to (a) assess the likelihood that programs will drive successful outcomes and (b) make informed judgments about the true impact that worksite health promotion programs can deliver.WHY BOTHER WITH BEST PRACTICES?In recent years, worksite health promotion increasingly has been referred to as a means to better manage costs for employers through cost savings caused by medical care, lower absenteeism, and improved on-the-job performance. In addition, the introduction of the Patient Protection and Accountability Care Act (13) emphasizes the potential role of worksite health promotion in the context of broader community health efforts (12). As a result, increased attention and focus are placed on worksite health promotion efforts to ensure that the associated resource investments are sound. I take this to be a good thing — it will make the field stronger and more accountable. However, the process used to derive conclusions and form decisions should be transparent, be based on a clear delineation of what is being considered, and appreciate what the important contextual issues are. For example, a recent Kaiser Foundation employer health benefit survey noted that most firms surveyed (77%; including almost all large employers) continued to offer wellness programs to help manage costs (3). However, firms were counted as having a wellness program as long as they offered at least one program option out of a defined set of activities (i.e., weight loss, gym membership, smoking cessation, health coaching, nutrition class, biometric screening, Web-based resources, a wellness newsletter, flu shots, or an employee assistance program). It is hardly reasonable to expect workplace wellness programs that consist of, for example, a newsletter activity, to have as much impact on cost and productivity outcomes as a comprehensive multicomponent program.These distinctions matter. In fact, the National Worksite Health Promotion Survey estimates that only 6.9% of all worksites in the United States offer a comprehensive worksite health promotion program, despite the fact that nearly all worksites (93.4%) indicated that they had a drug policy in effect (10). Comprehensive programs in that survey were defined as having five key components: health education, supportive physical and social environments, integration of the worksite program into the organization’s structure, linkage to related programs, and worksite screening programs. This kind of definition provides an important context in which to consider opinions about effectiveness and decision-making concerns related to worksite health promotion programs. It places importance on what we know about best practices and noncompromise design principles for highly effective programs.IDENTIFICATION OF BEST PRACTICESBest practices and benchmarks may be identified through literature reviews of the scientific literature and the so-called gray literature (less rigorous, non-peer-reviewed articles), as well industry reports and consensus statements.

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