Category — Employee Wellness Newsletter

Health risk assessment programs ought to be carried out on a one-on-one basis by trained healthcare professionals. Health risk measures ought to include the following:

• Blood Pressure (BP) measurements – at least two Blood Pressure (BP) measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure (BP) treatment status – ascertain whether the colleague is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for hypertension.
• Blood cholesterol measurement – total 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 client is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for elevated cholesterol.
• Obesity – utilize an accepted method for estimating obesity. By way of example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
   o Identify people 20 percent or more above their ideal weight.
• Smoking status – evaluate whether the participant currently smokes cigarettes, whether the client has quit or never smoked, and the number of cigarettes smoked/day.
• Exercise habits – evaluation questions may 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 client has diabetes, and whether or not it is currently under control. A blood glucose may be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include blood lipid and glucose measurements.
• Cerebrovascular disease or occlusive PVD – evaluate if the client has had a stroke or other kind of blood vessel disease.
• 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 disease – evaluate if the client has had a heart attack or other sort of coronary heart disease.
• Stress – attendant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions assessing levels of stress are available from the Worker Health Program.
• Participant release form (see forms) – A release form is necessitated in which the colleague authorizes the program to draw blood for testing to send information to the colleague’s health care provider if health care risks are identified, and to get information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been collected previously, the evaluation exercise must evaluate levels of interest in programs such as: weight management, tobacco cessation, fitness or exercise, stress management, diet, self-care, cholesterol control.
• Health education messages – the screener must review with the colleague his/her identified health risks and what they mean to the colleague’s central health, and give the colleague a written record of the Blood Pressure (BP), total 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 must include location of the evaluation, worksite, client’s name, address, social security number, work and home phone numbers, sex, race, birthdate, relevant job information (e.g., hourly or salaried), department number, and work shift.

Program directors or providers should have a background in wellness programming and a professional health-related degree or certification. They should have expertise in content areas, planning, promotion, administration, assessment, and ability to grow a program and tailor the program to the workplace.

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

An overriding policy statement must be available from directors and program vendors addressing the following issues: assurance of confidentiality of health data, referral to health care for at-risk participants, follow-up with referred participants and those at-risk, program evaluation on process and outcomes, business of the workplace for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services must be provided.

Stay away from being the “best” or doing the “most.” Encouraging staff members 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 objectives that are attainable by most individuals. Recognition, acknowledgment by top management, or special privileges are examples of excellent intangible incentives and rewards.

Incentive ideas:

• Free or Low-Cost:
   o Certificates
   o Movie passes
   o Recognition in employee newsletter
   o Mugs
   o Water bottles
   o Commendation from management
   o T-shirts
   o Hats

• Moderate Cost:
   o Entertainment tickets
   o Sweatshirts
   o Waist packs
   o Subscriptions to health magazines
   o Health and fitness books
   o Videos

• High Cost:
   o Week-end getaways
   o Dinner for two
   o Clocks
   o Watches

• Others:
   o Cash
   o Gift certificates

Utilizing posters, newsletter articles, and flyers are good means of promoting the program. Other promotional methods to consider are e-mail and announcements at employee gatherings. Ask Company Health Promotion Program Committee members to recruit participants.

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

When selecting a program from a vendor you should ask the following questions:

• How many worksites have done the program?
• What types of employee population was the program offered?
• What educational materials are used?
• Will the program meet the needs of workers?
• What are the techniques used to help alter behaviors?
• Does the program help workers move through stages of readiness to make health behavior changes?
• How do you market the program to workers?
• What follow-up do you support?
• How do you make referrals for healthcare or other supportive services workers may need?
• How do you know the program works?
• How do you measure attendant satisfaction?

When staffing your wellness program you need to consider whether to hire a wellness employee or contract with wellness professionals from outside your employer.

Small and medium size worksites do not usually have a wellness professional on employee. If your workplace is in this category, you will need to contract with providers outside your business.

Large employers have several options. They can hire a employee solely for the wellness program, they can contract with outside wellness providers, or they can use a combination of internal employee and outside providers.

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

Staff

Health professionals become wellness professionals when they are trained in the full range of wellness activities. Wellness professionals are generalists who come from a wide variety of backgrounds and schooling. They may be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But in addition to their primary training, they know something about all wellness issues, including smoking, stress, exercise, and diet. They also know how to engage and support people in making and sustaining health improvements and have great people skills.

Generally, wellness professionals at worksites fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the program, take health measurements, collect health-related information, provide initial counseling, and help workers define for themselves what they need and want in a wellness program.
• Wellness counselors work with employees after the evaluation to help them set up and carry out a plan to lower their risks and improve their health.
• Wellness instructors instruct classes and minigroups on different health subject matters.

A wellness program in a small organization can be staffed by a single employee person who fills all three roles. Larger worksites will use different staff members to fill these roles.

When choosing employee or choosing among vendors, ask the following questions:

• Do prospective staff members have a range of health backgrounds that will provide appropriate expertise in the issues to be addressed?
• Have prospective workers functioned well as wellness screeners, wellness counselors, and/or wellness instructors?
• Will this employee include workers from the racial and ethnic backgrounds found in your employee population?
• Is each employee member comfortable with the range of backgrounds found in your employee population, and able to communicate effectively with the various social and educational levels of your workers?
• Do employees have a warm, but professional, counseling style when interacting with employees?

An yearly plan for the major wellness programs and activities is a useful management tool. This is an excellent Worksite Wellness Program Committee task. Often an exercise and wellness theme per month is provided to staff members.

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

The employer benefits from additional publicity that occurs in various media throughout the community related to the national observance. For planning suggestions you may want to utilize the HOPE Publications Wellness Resource Creating Guide available for no cost at this Web site.

A Health Risk Appraisal (HRA) is at times used in conjunction with a health assessment. An HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle. An HRA seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual.

An HRA instrument is derived from an understanding of the course of a disease. Based on this understanding, useful prediction instruments can be constructed to assess the health risks of an individual. Individuals with a higher number of health risks tend to have more genuine health issues over time.

Drawing attention to their health risks can help clients decrease risk factors which lead to the onset of unnecessary disease and subsequent premature death. The questionnaire covers lifestyle habits (such as smoking, Safety Belt use, and exercise) and physical measures (such as blood lipids, Blood Pressure (BP) levels, height, and weight).

For accuracy, it is crucial to get direct measures of Blood Pressure, cholesterol and HDL-cholesterol. The HRA also supports recommendations and indicates what risks are potentially modifiable. Types of measures to evaluate health risks are discussed under Screening Programs.

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

A health age can 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.

HRA programs are one the most prolific types of wellness activities utilized by businesses. Continuing research on HRAs is examining the efficacy of this tool. One of the big benefits of this tool is that it can offer an aggregate group report of a corporation and can be utilized as an evaluation tool.

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

The most common evaluation performed in Worksite Wellness Programs is heart health assessment.

The assessment can include a written heart health test, Blood Pressure (BP) measurement, cholesterol/HDL-cholesterol test, glucose (blood glucose), weight, educational materials specific to diet, nutrition, exercise, cholesterol, smoking, and weight.

The health professional conducting the evaluation then provides a consultation and helps set goals with the colleague.

The backbone of wellness programming at the workplace is health screening. It is the first primary activity a company ought to do when first starting a wellness program. Health screening is often used in conjunction with the administration of a Health Risk Appraisal (HRA).

The most effective way to screen is to utilize a health professional trained in wellness evaluation techniques and counseling to privately and individually assess participants. This wellness professional takes a brief health history and measures Blood Pressure (BP) and cholesterol. With computerized cholesterol desktop analyzers, results are obtained in about four minutes.

Immediate feedback, consultation, and educational materials are provided. For those identified at-risk, follow-up appointments can be scheduled at this time. The whole process takes about twenty minutes per individual. The screening also provides an immediate opportunity to register participants in various health improvement programs based on their interests and identified health risks.

Health evaluation can be done on an yearly basis and used as a means of monitoring health risks within the workplace.

A health screening program needs to offer multiple opportunities for participation. The service should be provided for all the various shifts of a employer. The screening program should be conducted in highly visible areas so the process can be observed.

Reluctant staff members frequently like to be able to see what the program is about before they participate. When wellness screeners are not busy, they ought to perform outreach going to areas where staff members gather and attempt to recruit staff members.

When well-planned and promoted, health evaluation can attract participation rates of 60% to 100%. These high participation rates have a beneficial impact on management producing support for further programming.