National guidelines for blood pressure protocols -  

• Calibration of blood pressure measuring equipment must be done at least annually.

• Two or more measurements of participant’s blood pressure (BP) must be taken.

• Referral of participants with high blood pressure readings to personal doctor for further investigation.   

Systolic / Diastolic Follow-Up -     

• Normal -    <130 / <85   

   Action -  Recheck in 2 years

• High Normal -    130-139 / 85-90   

   Action -  Recheck in 1 year

Hypertension -     

• Stage 1 (Mild) -    140-159 / 90-99    

   Action -  Confirm within 2 Months.

• Stage 2 (Moderate) -    160-179 / 100-109    

   Action -  Refer to source of care within 1 month.

• Stage 3 (Severe) -    180-209 / 110-119    

   Action -  Refer to source of care within 1 week.

• Stage 4 (Very Severe) -    >210 / >120    

   Action -  Refer to source of care immediately.

Appropriate educational messages -     

• Normal -    <130 systolic and <85 diastolic   

   Action -  No referral. If on treatment, then inform participant that blood pressure (BP) is under good control today and ought to continue seeing and following treatment program.

• High Normal -    130-139 systolic and/or 85-89 diastolic   

   Action -  Recommend that participant have blood pressure rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that among the most effective means to lower blood pressure is to bring weight into normal range and to exercise.

• High -    >140 systolic and/or >90 diastolic   

   Action -  Refer to doctor for further analysis within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get blood pressure to a goal of 140/90 or less.

• Isolated Systolic Hypertension -    140-159 systolic and < 90 diastolic in a participant 65 years of age or older.   

   Action -  Advise participant to inform doctor of readings at next visit and consider advice regarding weight loss and exercise when appropriate.

• Urgent -    180-209 systolic and/or 110-119 diastolic   

   Action -  Recommend obtaining medical evaluation within 1 week.

• Emergency -    >210 systolic and/or >120 diastolic   

   Action -  Obtain immediate medical attention.

Provides the following -     

• Written results, referral instructions, and an explanation of blood pressure (BP) levels given to each participant with individualized counseling, including advice about the interval of time recommended when the participant ought to be checked again.    

• Utilizes the recommendations in the Fifth Report of the Joint National Committee on Detection, Investigation and Treatment of High Blood Pressure, March 1994.    

• Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically accurate information.    

• Relationship of high blood pressure (BP) and other risk factors, such as family history, use of tobacco, high fat and unhealthful diet, lack of exercise, in the development of cardiovascular illness, including stroke, kidney illness, heart attack, and other illnesses.

• Definition and causes of high blood pressure.

• Importance of following prescribed treatment.

• Blood pressure measurements - at least two blood pressure (BP) measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.    

• Blood pressure treatment status - ascertain whether the participant is under a physician’s care, on any medication, on a prescribed diet, or any other kind of treatment for hypertension.    

• Blood cholesterol measurement - sum cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the client, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.    

• Cholesterol treatment status - ascertain whether the patron is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for high cholesterol.    

• Obesity - utilize an accepted method for estimating obesity. for example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index (BMI).    

   o Identify individuals  20% or more above their ideal weight.

• Use of tobacco status - assess whether the participant currently smokes cigarettes, whether the patron has quit or never smoked, and the number of cigarettes smoked/day.    

• Exercise habits - screening questions might  be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.    

• Diabetes - whether the customer has diabetes, and whether or not it is currently under control. A blood glucose could  be also done via finger stick and desk top analyzer. A few manufactures make available cassettes which include cholesterol and glucose measurements.

• Cerebrovascular illness or occlusive PVD - ascertain when the customer has had a stroke or other kind of capillary illness.

• Family history of cardiovascular disease - ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart disease before age 55.

• Coronary heart illness - ascertain when the customer has had a heart attack or other kind of coronary heart illness.

• Stress - participant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions analyzing  levels of stress are available from the Worker Health Program.

• Participant release form (see forms) - A release form is required in which the participant permits the health promotion program to draw blood for testing to send information to the participant’s medical care provider when medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.

• Participant interest survey - if an assessment of interest hasn’t been gathered previously, the screening activity must assess levels of interest in health promotion programs like -  weight control, smoking cessation, fitness or exercise, stress management, nutrition, self-care, cholesterol control.

• Health education messages - the screener must review with the participant his/her identified health risks and what they mean to the participant’s overall health, and give the participant a written record of the blood pressure, sum cholesterol, and any other physiological measures taken.

• Referral of participants for treatment - participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized guidelines for such referral.

Demographic information should include location of the screening, workplace, customer’s name, address, social security number, home and work phone numbers, sex, race, birthdate, relevant job information (e.g., hourly or salaried), department number, and work shift.

They should’ve professionalise in content areas, planning, promotion, administration, investigation, and ability to grow a wellness program and tailor the wellness program to the workplace.   

Wellness Program providers should have a quality assurance program for assessing  the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.   

An overall policy statement should be available from directors and wellness program providers addressing the following issues -  

• Assurance of confidentiality of health data,
• referral to health and medical care for at-risk participants,
• follow-up with referred participants and those at-risk,
• wellness program examination on process and outcomes,
• organization of the worksite for promotion of wellness and changes in corporate culture.

A clear contract or letter of agreement for services ought to be provided.

The purpose of the incentive is to encourage employees to adopt positive behaviors or maintain an existing positive behavior.

Everybody who achieves a goal or maintains a behavior ought to receive something. Many organizations also provide incentives merely for participating in events.

Stay away from being the “best” or doing the “most.” Encouraging individuals  to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism.    

The best designed incentive programs are ones which are based on achieving goals that are attainable by most person. Recognition, acknowledgment by top management, or special privileges are examples of great intangible incentives.   

Wellness Program Incentive Ideas -    

• Free or Low-Cost Incentives-     

   o Certificates

   o Movie passes

   o Recognition in worker newsletter

   o Mugs

   o Water bottles

   o Commendation from upper-level management

   o T-shirts

   o Hats

• Moderate Cost Incentives -     

   o Entertainment tickets

   o Sweatshirts

   o Waist packs

   o Subscriptions to health magazines

   o Health and fitness books

   o Videos

• High Cost Incentives -     

   o Week-end getaways

   o Dinner for two

   o Clocks

   o Watches

• Other Incentives -     

   o Cash

   o Gift certificates

Utilizing posters, newsletter articles, and flyers are excellent means of promoting the health promotion program. Other promotional methods to consider are e-mail and announcements at staff meetings. Ask wellness committee members to recruit participants.

Once the wellness program is kicked off you may want to provide an incentive for any staff member who recruits another staff member to any of the wellness program offerings.

• Precisely how many workplaces have done the wellness program?

• What types of worker population was the health promotion program offered?

• What educational materials are used?

• Will the health promotion program meet the needs of employees?

• What are the techniques used to help change behaviors?

• Does the wellness program help individuals  move through stages of readiness to make health behavior changes?

• Precisely how do you market the wellness program to employees?

• What follow-up do you provide?

• Just how do you make referrals for medical care or other supportive services staff members may need?

• Precisely how do you know the health promotion program works?

• How do you measure participant satisfaction?

Small and medium size worksites don’t normally have a wellness expert on staff. If your worksite is in this category, you will need to contract with providers outside your company.

Large companies have a few options. They can hire a staff solely for the health promotion program, they can contract with outside wellness providers, or they are able to use a combination of internal staff and outside providers.

When selecting  a provider some key questions in the areas of staff, wellness program structure, process, and effectiveness need to be addressed. Each of these key questions is discussed in the following sections.

Health Promotion Business Staff

Health specialists become wellness specialists when they are trained in the full range of wellness activities. Health Promotion specialists are generalists who come from a broad variety of backgrounds and schooling.

They might be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But besides to their main training, they know something about all wellness topics, including smoking, stress, exercise, and nutrition.

They also know how to engage and support people  in making and sustaining health improvements and have good people  skills.

Typically, wellness experts at workplaces fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the health promotion program, take health measurements, collect health-related information, provide initial counseling, and help workers define for themselves what they need and want in a health promotion program.

• Health Promotion counselors work with workforce after the screening to help them develop and carry out a plan to reduce their risks and improve their health.

• Health Promotion instructors teach classes and minigroups on different health topics.

A wellness program in a small business could be staffed by a single staff individuals who fills all three roles. Bigger workplaces will use different people  to fill these roles.

When selecting  staff or selecting  among wellness businesses, ask the following questions -

• Do prospective staff have a range of health backgrounds that’ll provide appropriate specialistise in the topics to be addressed?

• Have prospective workforce functioned well as wellness screeners, wellness counselors, and/or wellness instructors?

• Will this staff include people  from the racial and ethnic backgrounds found in your employee population?

• Is each worker comfortable with the range of backgrounds found in your worker population, and able to communicate effectively with the various social and educational levels of your employees?

• Do staff have a warm, but expert, counseling style when interacting with employees?

Some businesses choose to follow a National Health Observances calendar which offers advantages.  The materials created by these various national health businesses are very credible.  The materials are normally high quality and available free or at a nominal cost.

The company benefits from additional publicity that occurs in various media throughout the community related to the national observance. for planning suggestions you might want to utilize the HOPE Publications Wellness Resource Creating Guide available for free at this Web site.

An HRA seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual.

An Health Risk Assessment (HRA) instrument is derived from an understanding of the in a disease. Based on this understanding, useful prediction instruments could be constructed to assess the health risks of an individual. Person with a higher number of health risks tend to have more serious medical problems over time.

Drawing attention to their health risks can help patrons reduce risk factors which lead to the onset of unnecessary illness and subsequent premature death.

The questionnaire covers lifestyle habits (like smoking, seat belt use, and exercise) and physical measures (like cholesterol, blood pressure levels, height, and weight).

For accuracy, it is critical to obtain direct measures of blood pressure, cholesterol and HDL-cholesterol.  The Health Risk Assessment (HRA) also provides recommendations and indicates what risks are modifiable. Types of measures to assess health risks are discussed under Screening Programs.

The impact of a health risk appraisal is much greater when it is given in-person, with immediate feedback to the patron. This also provides an opportunity to invite the patron’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age could be computed based on the individual answers to the questionnaire and physiologic factors.  The health age may indicate the individual to be younger or older than their chronological age.

Health Risk Assessment (HRA) programs are one the most prolific types of wellness activities utilized by organizations. Continuing research on HRAs is examining the efficacy of this tool.

Among the large advantages of this tool is that it can provide an aggregate group report of a company and could be utilized as an examination tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

The screening can include a written heart health test, blood pressure measurement, cholesterol/HDL-cholesterol test, glucose (blood sugar), weight, educational materials specific to diet, nutrition, exercise, cholesterol, use of tobacco, and weight.

The health specialist conducting the screening then provides a consultation and assists set objectives with the participant.