By: Paul Terry, PhD, HERO Senior Fellow

In what direction has health promotion research been evolving over the past twenty years? What proportion of occupational health researchers have been focusing on how health impacts work compared to researchers who ask how work affects health? To answer questions about the “must read” studies in the community, school, and worksite wellness discipline, I sought out some of the most accomplished and fecund researchers in the public health and worksite health and well-being fields to offer their views on those studies that every health promotion professional should be familiar with. You will see that I reached out to all of HERO’s Mark Dundon Research Award winners along with several other of this nation’s public health research luminaries.

Here are:

  1. The Most Important Studies in Health Promotion. (Community, School, Patient Education)
  2. The Most Important Studies in Workplace Health Promotion.

To be sure, assembling such a ‘best of’ list is as subjective as it is audacious. Please note that I asked each of these expert contributors to include at least one of their own research studies alongside one or two others that they view as prominent and pioneering. So when you see our researchers citing themselves, be reminded that I asked them to set aside their humility and pick a favorite from among their many ‘children’. I know, cruel but edifying nevertheless.

The criteria I suggested contributors consider for their “best of” recommendations includes whether the body of research or specific study addressed a topic of vital importance in health promotion, the research questions were clearly stated and the methodologies used were well executed; whether the research is often cited and downloaded and if the study findings offer a unique contribution to the literature. In addition, I challenged contributors to bring us those enduring research projects that were groundbreaking for our discipline in ways that informed and improved best practices. These are the studies that prove that well-executed health promotion (i.e. education, policy, environmental support) is effective at producing significant and lasting health improvements for individuals and for organizations.

Your Opinions Welcomed!

I encourage HERO blog readers to join in with your opinions about those seminal studies we missed. Bring your umbrage as well as your advocacy and if I’m subject to enough finger-wagging about important research we missed I’ll gladly publish an updated list. Join in this “best of research” conversation:

I urge you to “reply all” below with your comments and additions so others can reinforce or challenge your opinions and pile on with additional ideas about the best research that has shaped the worksite health and well-being discipline.

Below is a teaser of five of the twenty-five ‘Must Read’ Workplace Health Promotion Research Studies. I invite you to read about all of the “top twenty-five” in the editorial linked above before you weigh in with your opinions about what we missed.

 

From Wayne Burton, M.D., Healthcare Strategic Advisor and Former Global Corporate Medical Director at American Express.

Reducing health risk factors is good for business!

Health promotion professionals and worksite wellness programs focused on improving the health of employees. Research from the University of Michigan demonstrated that changes in health risk factors was associated with changes in their medical claims costs. This study provided strong evidence that improving individual and population health status was associated with financial benefits to an employer.

  • Edington DW, Yen LT, Witting P. The Financial Impact of Changes in Personal Health Practices. 1997. Journal of Occupational and Environmental Medicine.[1]

From Kerry E. Evers PhD, Co-President and CEO of ProChange Behavior Solutions

Measuring Participation in Employer-Sponsored Health and Well-Being Programs.  While the research established that employees with a higher level of participation in workplace health and well-being experienced health risk improvement, perhaps one of the most intriguing aspects of the research was the development of more fine-tuned definitions of engagement and participation that is based on the types of programs and number of interactions.

  • Seaverson ELD, Gingerich SB, Mangen DJ, Anderson DR. “Measuring Participation in Employer-Sponsored Health and Well-Being Programs: A Participation Index and Its Association with Health Risk Change.” 2019. American Journal of Health Promotion.

From Ron Goetzel, Ph.D., Senior Scientist and Director of the Institute for Health and Productivity Studies, Johns Hopkins University Bloomberg School of Public Health.

A systematic literature review of workplace health promotion programs found that they can improve workers’ health behaviors, biometric measures, and business outcomes, but only if the programs are more than just screenings.  This 2010 systematic review conducted by the Community Preventive Service Task Force (Community Guide) housed at the CDC remains the gold standard for evidence of effectiveness related to workplace health promotion.

  • Robin E. Soler, PhD, Kimberly D. Leeks, PhD, MPH, Sima Razi, MPH, et. al., The Task Force on Community Preventive Services. “A Systematic Review of Selected Interventions for Worksite Health Promotion The Assessment of Health Risks with Feedback.” 2010. American Journal of Preventive Medicine.[2]

From Rachel Mosher Henke PhD, Senior Director at IBM and co-editor of Knowing Well Being Well, American Journal of Health Promotion.

Why employers should care about employee mental health and well-being.  An article by Goetzel and colleagues provides a compelling argument for why employers should be invested in employee mental health.  Despite federal and state mental health parity legislation and accumulating research on the costs of untreated depression, employers still have a way to go to reduce the stigma of mental health disorders and improve prevention, diagnosis, and treatment of behavioral health conditions.  The article by Lerner and Henke documents the research on the impact of depression on unemployment, absences, and at-work performance deficits, three important outcomes for employers.

  • Goetzel RZ, Ozminkowski RJ, Sederer LI, Mark TL. “The business case for quality mental health services: why employers should care about the mental health and well-being of their employees.” 2002. Journal of occupational and environmental medicine.[3]

From Laura A. Linnan, ScD, Senior Associate Dean for Academic and Student Affairs; Professor, Health Behavior, University of North Carolina, Chapel Hill, Gillings School of Global Public Health

Why taking a Comprehensive Approach to Worksite Wellness Matters. In 1988, 1992, and 1997 there were a series of national surveys of employers to monitor the extent to which they offered worksite health promotion programs.  Results from these surveys repeatedly found that more than 80% of employers reported they offered any type of worksite health promotion programs.  The paper by Linnan and colleagues was the first to distinguish between offering “any” wellness programs, however minimal, from employers that offered a “comprehensive” health promotion program that would be more likely to produce an impact on employee health.

  • Linnan L., Bowling M., Bachtel J., et.al. (2008). Results of the 2004 national worksite health promotion survey.” 2008. American Journal of Public Health.[4]

 

A Thought Experiment Challenge

For those of you who review the full “Twenty Five Best” article, I challenge you to the following thought experiment. Tally the twenty-five studies summarized in this editorial into two columns. In one column include studies about how health affects work. In the second column include studies about how work affects health. Note the dates of the studies and ask whether researchers are shifting toward one of these orientations or the other? If you want to reflect further into research trends in workplace wellness, create a two-by-two crosstabs table and organize these two columns according to research that focuses on organizational level variables versus studies aimed at individual lifestyle-related factors. See if you agree with my conclusion at the end of the editorial concerning where workplace wellness research is heading.

 

References

[1] Edington DW, Yen LT, Witting P. The Financial Impact of Changes in Personal Health Practices. Journal of Occupational and Environmental Medicine.  1997; 39(11): 1037-1046.

[2] Robin E. Soler, PhD, Kimberly D. Leeks, PhD, MPH, Sima Razi, MPH, David P. Hopkins, MD, MPH, Matt Griffith, MPH, Adam Aten, MPH, Sajal K. Chattopadhyay, PhD, Susan C. Smith, MPA, MLIS, Nancy Habarta, MPH, Ron Z. Goetzel, PhD, Nicolaas P. Pronk, PhD, Dennis E. Richling, MD, Deborah R. Bauer, MPH, RN, CHES, Leigh Ramsey Buchanan, PhD, MPH, Curtis S. Florence, PhD, Lisa Koonin, MN, MPH, Debbie MacLean, BS, ATC/L, Abby Rosenthal, MPH, Dyann Matson Koffman, DrPH, MPH, James V. Grizzell, MBA, MA, CHES, Andrew M. Walker, MPH, CHES, the Task Force on Community Preventive Services. “A Systematic Review of Selected Interventions for Worksite Health Promotion The Assessment of Health Risks with Feedback.” (Am J Prev Med 2010;38(2S):S237–S262)

[3] Goetzel RZ, Ozminkowski RJ, Sederer LI, Mark TL. “The business case for quality mental health services: why employers should care about the mental health and well-being of their employees.” Journal of occupational and environmental medicine. 2002 Apr 1:320-30.

[4] Linnan L., Bowling M., Bachtel J., Lindsay G., Blakey C., Pronk S., Royalle P. (2008). Results of the 2004 national worksite health promotion survey.  Am J Public Health. 98(8):1503-1509.

 

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