Corporate Wellness Program

Information to evaluate your wellness program comes from routinely gathered screening and follow-up data of your wellness program that look at process and outcomes of your program.

The Worker Medical Program has available a computerized case-management system which includes queries that allow easy assessment of process and outcome results at any point in time.

Process Investigation

Process evaluation looks at the health promotion program’s impact as seen at various points in time.

Information that is gathered from the various forms that wellness employees fill out should supply you with the following -

• Precisely how many employees were screened?

• Exactly how many employees who were referred to a physician went?

• Exactly how many workers who expressed interest in health promotion programs went?

• How many workers who were referred to wellness programs went?

• Precisely how many personnel who went to health promotion programs completed them?

• Precisely how many staff members are in follow-up caseload?

You can use this kind of process evaluation to evaluate and learn about the health of your health promotion program.

Wellness Program Outcome Examination

A central objective of the wellness program is to improve the health of staff. Information on how to judge how well your wellness program is meeting this objective is called “outcome analysis” because you’re analyzing  the results or outcome of your wellness program.

In health promotion programs, objectives are measured by specific (outcomes) behavior changes and reductions in health risk levels. Have personnel reduced their blood pressure? Have they lost weight? Are they exercising more? is alcohol consumption at a safe level?

For  instance these are the kinds of questions you can ask to determine when you are reaching your goals -  

• For employees with high blood pressure (BP) (140 / 90 or higher or on medication) at screening, what percentage have it under control (below 140 / 90) a year later?

• What is the change in typical blood pressure (BP) levels among all staff members with high blood pressure (BP) 1 year after screening? Two years later?

• For staff with high blood cholesterol levels (above 240) at screening, what percentage has reduced their cholesterol to borderline-high levels (200-239)?

• For personnel with borderline-high blood cholesterol levels, what percentages have reduced their cholesterol to the desirable range (below 200)?

• What’s the change in average cholesterol levels among all staff members with high and borderline-high blood cholesterol levels 1 year after screening? Two years later?

• For employees who were overweight at screening, what percentage have lost 20 pounds or more a year later? Ten pounds or more? What’s the average weight reduction?

• For staff members who were smokers at screening, what percentages have quit use of tobacco? for at least a year?

• For personnel whose level of alcohol consumption put them at-risk at screening, what percentage have quit drinking alcohol? Are eating alcohol at levels considered safe by CDC guidelines? Have reduced their drinking, but are still at-risk?

• For workers, what percentages are exercising at least three times a week for at least 20 minutes?

• If levels of fitness were measured, what percentages have improved fitness?

Be sure to set a regular time such as every 6 months to look at which staff your health promotion program is reaching and how effective it’s at assisting them reduce their health risks. Use this information to make new decisions about how to direct your health promotion program efforts. Then make the change you need to improve your health promotion program.

Some may feel that evaluation is a frill; it is not. Evaluation is a necessary part of a wellness program. You will need to know what’s working and what’s not.

Decision-makers who fund the health promotion program need to be updated on the performance of the health promotion program. Examination will provide you with necessary data to maintain and expand the health promotion program and convince upper management to continue to support the health promotion program.

The keys to a successful wellness program are persistent one-on-one outreach and follow-up counseling to encourage health improvement, adherence to treatment programs, changes in lifestyle behaviors, and to prevent relapse.

Periodic outreach and follow-up procedures provide staff members with a safety net which keeps them involved in the wellness program and avoids treatment dropout and relapse.

Counselors should follow up on employees at least every 6 months throughout the career of the staff member at the workplace.  The goals of follow-up are to -  

• Involve workforce that have health risks in treatment and risk reduction programs.

• Involve all staff members in wellness programs and workplace-wide wellness activities.

• Support staff in carrying out the risk reduction or health betterment activities they have chosen.

• Make sure to help workers follow their treatment regimens.

• Prevent relapse.

• Avoid workers from dropping out.

• Make sure to help employees maintain behavior changes.

Follow-up can be conducted in person, by phone, mail, and via computer when the technology is available. Most preferable is an in-person contact.

Computer programs which can do case load management are available to help counselors track information and perform follow-up.

Priorities for Follow-Up

Individuals  with multiple health risks must be at the top of the list. Individuals  in key positions like union leaders or department heads with health risks should also be contacted early so that they learn what the health promotion program is about and can share the information with others.

Individuals  who need a medical evaluation for high blood pressure or cholesterol should also be targeted early. Many workforce will have seen their physicians thus of the screening, but some will need more encouragement to do so. Those with no health risks can be followed up annually.

A follow-up counseling session can take 20 to 45 minutes.  At minimum, follow-up must include those who were told to seek medical analysis for high blood pressure readings, high cholesterol readings, or borderline high blood cholesterol readings with 2 or more other risk factors.

It may include those who were identified as at-risk for one or more of the other major risk factors -  at-risk levels of alcohol consumption, being overweight, and having low HDL.

Follow-Up With Doctors

A letter (see forms) should be sent to the doctor or clinic of each staff member who has high blood pressure, high cholesterol, or is under a doctor’s care.

The letter ought to explain the wellness program and ought to include the staff member’s relevant, current health measurements.

Along with the letter, send a self-addressed return envelope. Follow-up with the doctor must be repeated every 6 months until it’s determined that the employee is under satisfactory control.

Contacting the doctor is important for three reasons -

• The doctors receive employees’ health measurements taken at the worksite.

• You receive the blood pressure (BP) and cholesterol readings the doctor takes and information on the treatment the doctor prescribes.

Many times the worker does not have this information or does not remember it.  The information could be used when counseling the worker.

• Follow-up encourages doctors to pay closer attention to heart illness risk factors among their patients.

The menu approach offers workforce a range of choices to support lifestyle changes. It allows people  to select the kind of help that suits their schedules and preferences.

The four basic types of health promotion programs include -

• Courses

• Minigroups

• Guided self help

• Individual counseling

Classes

Courses (8 or more) can be an effective means of providing education and social support for behavior change.  The length of a class can vary depending on topic requirements. It is not sufficient to offer only courses at a workplace.

Many staff members are under time constraints with after work commitments and although they might be interested they simply cannot participate because of their schedules.

Workers may  be very eager to start a health promotion program but because of lack of participants to meet class quotas, the health promotion program is canceled.

A lot of national organizations like the American Heart Association, American Cancer Society, Weight Watchers, etc. offer classes; you should’ve little trouble in identifying a provider for class kind wellness programs.

You might want to contact your local hospital, health department, or YMCA for possible options. for picking  a provider to provide a wellness program you might want to review the section on wellness program structure.

Minigroups

When there isn’t enough interest to develop a class, those who are interested in a given health topic could be formed into a minigroup (2 to 7).

The minigroup can cover the same content as a class but do so in a less formal manner. Presentation of information and discussion is the major format of the minigroup.

Guided Self-Help

Most workers do not want formal help in making health changes; they prefer to do it on their own. In guided self-help, the wellness counselors provide support, materials, and encouragement.

Meeting times can be arranged and contact can be made either in person, by phone, or computer. Materials can be made available at the workplace, or mailed to the individual. Some workplaces now make information available via intranets or the Internet.

Individual Counseling

One of the most successful ways to help person change and improve their health status is counseling (or coaching) on a one-on-one basis.

In published studies, health promotion programs which incorporated individual counseling as part of the health promotion program process achieved significantly higher participation rates and achieved greater risk reduction/risk elimination than standard group programs. Studies have demonstrated that individual counseling is both cost effective and cost beneficial.

A wellness counselor ought to be trained in screening techniques, for in certain situations, they might be required to both screen individuals and counsel them. They ought to know how to do the following -  

• Review employee health risks

• Contact personnel that have health risks.

• Counsel personnel on a one-on-one basis, helping them set goals, solve problems, and get professional help when they need it.

• Make sure to help staff follow their treatment recommendations and make lifestyle and health behavior changes.

• Recruit staff members into health promotion programs, such as losing weight and smoking cessation.

• Be certain to work with workforce on a one-on-one basis using guided self-help.

• Conduct classes and minigroups if necessary.

• Be certain to work with wellness committee members to plan and conduct workplace-wide wellness activities.

Health Promotion counselors are health generalists; they must have basic understanding of a broad range of health topics and health risks.

Counselors ought to be able to consult with workers about their health problems and the treatments prescribed by their physicians.

They should have a good overview of nutrition, exercise physiology, pathophysiology of disease, pharmacology, psychology, and behavior modification skills.

The educational program should include approaches to stress awareness/reduction at the environmental level and at the individual level.

Social, physical, and organizational stressors should be explained and methods to ease or elevate stressors should be presented.

At the individual level how changes in attitudes and behaviors help one to cope with stressors; learning techniques to minimize stress response, such as meditation, relaxation response, and exercise.

Content of the program ought to provide the following -

• Identifying sources of stress

• Relationship of stress to health

• Precisely how the individual experiences stress, personal, family, work

• Solutions for coping and managing stress

• Techniques for decling stress

• Value of stress, both negative and positive

• Practical steps of incorporating stress reduction into lifestyle

Personnel conducting stress management programs should have training in psychology, behavioral sciences, or related disciplines such as psychological health experts, counselors, health educators, psychologists, and psychiatrists.

Training in a reputable program on how to teach the stress management course including group process skills is a must.

A nutrition education program ought to include a nutritional needs assessment, education counseling, and referral as necessary.

Educational sessions and materials should include the following information -

• The relationship of nutrition and chronic diseases

• Improving consuming patterns

• Relationship of nutrition and proper weight maintenance

• Exercise

• Stress

• Blood pressure (BP)

• Cholesterol

• Diabetes and other chronic diseases.

• Nutritionally exact information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into eating habits. Guidelines for bettering eating habits ought to be based on or consisitent with national recommendations like the Food Guide Pyramid.

Instructor ought to be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition.

When an allied health expert instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It’s advised that tobacco use cessation programs subscribe to the Code of Practice for Smoking Cessation Programs.

Use of tobacco cessation programs must be multi-component with a focus on skills to build positive voluntary behavior change practices.

Useful techniques include establishing reasons for quitting, understanding the use of tobacco habit, various techniques for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term goal setting, weight control, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or frighten tactics.

In wellness programs that use aids like the “patch” or medications like “Zyban” appropriate consultation should be available on the usage of these aids.

The instructor should’ve formal training in tobacco use cessation from a nationally recognized organization such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders.

Evaluation of success is sometimes very dubious in use of tobacco cessation programs. Measurement of success should include participation rate, including the number beginning the program, the number completing the program, and the typical number per session.

Moreover included, number and percent who stopped tobacco use after the program, and the number and percent who hadn’t resumed tobacco use by the end of one year.

Participatory exercise plans ought to include education on benefits of regular physical activity and risks of a sedentary lifestyle, its impact on cardiovascular health and illnesses, its relationship with weight control and stress management, and aerobic exercise options.

Discussion and practice of safe principles of exercise - warm up, cool down, frequency, intensity, duration, flexibility and strength components.  The health promotion program follows guidelines by the American College of Sports Medicine.

Safety precautions ought to include the following -

• Informed consent before starting exercise with clear and complete written and verbal instructions of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.

• A screening/evaluation of participants to determine if medical analysis is necessary for exercise like the Physical Activity Readiness Questionnaire (PAR-Q, see forms).

• Measurements of blood pressure and resting heart rate are useful screening information to determine exercise readiness.

• Participants who fail screening are medically referred and should obtain a written clearance from their doctor to exercise.    

• The basic content of an group exercise program ought to include -     

Warm up   5 - 10 minutes

Aerobic exercise   20 - 40 minutes

Cool down   5 - 10 minutes

Exercise instructors should have education and training in exercise physiology, physical education, physical therapy or comparable discipline, or possess a current certification by a nationally recognized sports medicine or exercise association, and be CPR qualified.   

Wellness Program offered is consisitent with scientific and medical recommendations for weight reduction, reflects a multi-disciplinary approach which offers four components -  behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance for Treatment of Adult Obesity. It includes -    

• Screening to verify that the participant has no medical or psychological conditions which would make weight loss inappropriate, and to identify the participant’s level of health risk, classifying participants not only on excess body weight, but also based on associated medical conditions and overall heath risk.

• Referral for participants who are morbidly obese who’d require medical guidance for losing weight.

• Informed consent, explanation of potential physical and psychological risk from losing weight and regain, likely long-term success of health promotion program, full cost of the health promotion program, credentials of the staff.

• Identification of contributing factors to participant’s weight status, serving as the basis for an individualized weight loss plan which includes the weight goal and plans for nutrition, exercise, and behavioral components.

• Weight goal of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial weight reduction goal doesn’t exceed loss of 10% of body weight, 1-2 pounds per week.

• Explanation of unsafe losing weight methods.

• Daily calorie level is adjusted to meet each participant’s recommended rate of losing weight.

• Daily caloric intake is not less than 1,000 calories; if less, physician monitoring is required.

• Food plan designed so participants can choose foods which meet 100 percent of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation could be used to achieve RDAs, nonetheless shouldn’t greatly exceed RDAs.    

• Nutrition education encouraging permanent healthy consuming habits based on the Food Guide Pyramid.    

• Participant involved in meal planning and food selection.    

The protein, fat, carbohydrate, and fluid content of the food plan meet safety recommendations -     

Protein   Between 0.8 and 1.5 grams of protein per kilogram of goal body weight, but no more than 100 grams of protein a day.

Fat   10 - 30% calories as fat.

Carbohydrate   At least 100 grams per day.

Fluid   At least one liter of water daily.

• Exercise component must be a significant portion of the wellness program and be both didactic and experiential.

• Participant is appropriately screened for exercise using a screening questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.

• Participants work towards 30-60 minutes of exercise 5-7 days per week.

• No appetite suppressant drugs.

• Maintenance plan offered for continued support.

• Weight control programs ought to be conducted by a registered dietitian or by degreed health specialists with training in nutrition with consultation by a registered dietitian.

• Trained lay leaders may assist if supervised by nutrition specialist.

Note - There is an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

Program is required to provide appropriate interpretation of cholesterol screening results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national guidelines -

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 - 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows -    

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, when history of coronary heart illness or when two or more CHD risk factors are detected refers to risk reduction program or health experts, as appropriate.

200 - 239 mg/dl    If history of CHD or if two or more other risk factors are detected, refer to medical care or risk reduction service within two months; if no reported history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.

> 240mg/dl    Refer to medical care within two months.

HDL   

> 35 mg/dl   When fewer than 2 risk factors and borderline sum cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following -    

• The relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include -  high blood pressure (BP) 140/90 or higher or on hypertension medication; current cigarette tobacco use; family history of premature CHD; diabetes mellitus; age - male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.

   o Negative risk factor -  high HDL 60 mg/dl or greater (subtract one risk factor).

   o Risk factors like family history, use of tobacco, high fat or other unhealthful diet, andphysical inactivity lead to the development of cardiovascular illness (CVD).

• Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.    

• Wide range of treatment choices, including diet (e.g., importance of controlling fat intake less than 30% of total calories from fat, less 10% saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.    

• Importance of following prescribed treatment and specialist advice.    

Appropriate medical or allied health professional trained in measurement of blood pressure, referral protocols, and delivering educational messages to participant conducting blood pressure (BP) programs. These health promotion programs are required to follow national guidelines.

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.