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Understanding the impact of a workplace
health promotion program:
How do we know who got what, and how much is enough?
Dr Fiona Cocker
Evaluating Interventions
Randomised Controlled Trial (RCT)
• Aims to evaluate program/trial efficacy
• Considered the “gold standard”
• Pros: double blind, placebo controlled, strong internal validity
• Cons: Limited external/“real world” validity, limited “generalisability”
Evaluating Interventions
Pragmatic RCTs
• Aims to evaluate program/trial effectiveness, whilst reflecting the heterogeneity of individuals encountered in the “real world”
• Minimise exclusion criteria
• Functional outcomes emphasised, and measured over a sufficient time period
• Pros: rigour of randomisation, applicable to group of interest
Evaluating Interventions
“Real World” Evaluation
Evaluation aim: Implementation
Pros: more practical in a large, diverse, populations such as a multi-site workforce
Cons: no control group, may have no control over intervention
Example: Well@Work: Promoting Active and Healthy Workplaces by researchers at Loughborough University, UK
Evaluating H@W
• Healthy@Work H&WB activities and initiatives– varied widely between agencies– implemented at different times during H@W
• How do we know who got what?
• How do we determine how much is enough? – Comprehensiveness
• Potential to influence health outcomes?– How do we control for this?
What is a comprehensive WHP programme?
• Linnan et al. Results of the 2004 National Worksite Health Promotion Survey. Am J Public Health. 2008;98(8):1503-9.– Surveyed individuals “responsible for health promotion or wellness” to
identify which worksites offered “comprehensive” worksite health promotion program
• Pilkington et al. Survey of use of occupational health support. Edinburgh: Institute of Occup Med; 2002.– Surveyed 4950 randomly selected companies of varying size, sector
and region, to determine who uses occupational health support
• Used to inform exposure variable development because:– national in scope– covered multiple worksites of different sizes and industries
Components of a comprehensive work program
– Health education (skill development, awareness building)
– Supportive social & physical environment (accessible stairs or shower facilities, time to allow participation)
– Integration into organisation’s structure (management support, dedicated H&WB position/s)*
– Linkage to related programs (EAP, OH&S)
– Worksite screening (blood pressure, health checks)
Linnan et al. Am J Public Health. 2008;98:1503-09.*Pilkington et al. Institute of Occupational Medicine; 2002.
Measuring “comprehensive” or H&WB exposure: Methodology
Dose• How many H&WB activities and initiatives
did each agency implement?
• Cumulative exposure– Add activities across life of H@W to get a total score
Example of Raw Data - 2010
Total Score per Year
AGENCY 2008/09 2010 2011 2012 TotalA 15 10 20 29 74B 19 18 26 31 94C 11 8 19 35 73D 11 7 19 24 61E 19 14 24 35 92F 20 16 26 39 101G 26 21 30 47 124H 18 16 26 40 100I 15 11 36 49 111J 11 8 28 39 86K 12 9 37 46 104L 23 16 24 40 103M 10 6 34 46 96Z 13 7 21 31 72
Total Score/Year = 56
Total Score per Year
Total Score/Year = 56
AGENCY 2008/09 2010 2011 2012 TotalA 15 10 20 29 74B 19 18 26 31 94C 11 8 19 35 73D 11 7 19 24 61E 19 14 24 35 92F 20 16 26 39 101G 26 21 30 47 124H 18 16 26 40 100I 15 11 36 49 111J 11 8 28 39 86K 12 9 37 46 104L 23 16 24 40 103M 10 6 34 46 96Z 13 7 21 31 72
Agency Example
2008/09 2010 2011 20120
5
10
15
20
25
30
35
40
45
50
26
21
30
47
Agency G
Year
Nu
mb
er
of
H&
WB
A
ctiv
itie
s
Sensitivity of Measurement
Can we see differences between agencies?
2008/09 2010 2011 20120
5
10
15
20
25
30
35
40
45
50
26
21
30
47
15
10
20
29
10
6
34
46
Agency GAgency AAgency M
Year
Nu
mb
er
of
H&
WB
Act
ivit
ies
What’s next?
• Currently focused on an overall indicator– Total dose
• Employee reports of what was available & what they used– measure of individual exposure
• When did agencies implement activities?– Duration i.e. from 2008 or not until 2012
• Were activities in every domain?– Quality and comprehensiveness
• Does this impact on health outcomes?– Only 2012 important, close to measurement point?