Effectiveness of an integrated workplace health promotion program

An unhealthy lifestyle is one of the major risk factors for health problems and
chronic diseases, such as diabetes, cardiovascular disease and cancer. With the
rising number and the substantial public health and economic impact of chronic
diseases, the promotion of a healthy lifestyle is of crucial importance.

The workplace offers an ideal setting for health promotion, since a large
amount of persons aged 18 to 67 years is reached including many persons whose
health and lifestyle needs improvement. Health promoting interventions in
general have shown positive effects for lifestyle behaviors, weight-related
outcomes, other metabolic risk factors, psychological wellbeing and other
mental health outcomes, including depression and burnout.

Studies showed that programs with an additional environmental component are
more effective for workers than single component approaches. Within an
integrated approach, implementation of interventions is possible on various
domains: knowledge and education, identification and support, adjustments in
the social and physical environment, and policy. An integrated approach,
including both individual- and work environment interventions, is proven to be
effective in improving the lifestyle of employees. Workplaces offer an
appropriate setting to implement integrated approaches for health promotion,
since the workplace offers opportunities to promote health by means of physical
and social environmental changes, such as altering the availability of foods
served in the canteen and, providing sit/stand desks, fitness facilities or
nudges to promote taking the stairs.

The Lombardy WHP Network, recognized as a European good practice in the
occupational setting in the European Joint Action CHRODIS, is an example of an
integrated WHP initiative. The Lombardy WHP Network is unique, widespread and
offers potential as it involves an integrated approach targeting multiple
lifestyle factors, at both the individual and environmental level. Based on a
pilot project in 2011 in Bergamo with 94 companies involved and 21,000 workers,
a reduction was found in important risk factors for chronic diseases after 12
months of follow-up, particularly for fruit and vegetable intake and smoking
cessation. Especially, the implementation of this program was highly
successful. Because of its success, the WHP network is currently also being
implemented in Andalusia in Spain. The Lombardy WHP Network was translated and
tailored to the Dutch context using a bottom up approach, resulting in the
Dutch WHP Program. Due to the involvement of the employers and employees during
the development of this program, it is based on their needs and preferences.

The integrated Dutch WHP program is expected to improve lifestyle and health of
employees, which benefits both the employee and the employer. Potential
benefits of the Dutch WHP program at the employer and societal level include
lower sickness absence and reduced health care costs. Scientific evidence about
the effectiveness of integrated workplace health promotion is scarce. In this
clustered randomized trial, we will examine whether this program is effective
on the lifestyle of employees. Furthermore, the effect on general health,
wellbeing, the separate lifestyle themes targeted and work-related outcomes
(need for recovery and work engagement) will be estimated. Alongside the effect
evaluation a process evaluation will be conducted, to gain insight in the
implementation process of the Dutch WHP program. This study will add to the
body of evidence of the effectiveness of integrated workplace health promotion.

The effectiveness of the Dutch WHP program will be evaluated in a two-armed
cluster randomized controlled trial (RCT) with a follow up of 12 months. A
cluster randomized controlled trial assures that there is no contamination
between the control condition and intervention condition. Organizations in the
intervention condition will receive a catalogue with core elements of
interventions and an implementation plan, following this, these organizations
are required to implement interventions on at least two different lifestyle
themes and on the various domains (knowledge and education, identification and
support, adjustments in the social and physical environment and policy) which
is a prerequisite to fulfill the criterion of an integrated approach.
Organizations in the control condition will receive the catalogue and
implementation plan of the Dutch WHP program after the trial finished. To
evaluate the effect of the Dutch WHP program, i.e. to analyze differences in
outcomes between the intervention condition and the control condition,
employees will be asked to complete an online questionnaire at baseline, 6 and
12 months follow-up and to wear a triaxial accelerometer at baseline and a
subgroup (participants within both the intervention and control condition) at
12 months follow-up. Furthermore, the employers and a subgroup of approximately
10 employees in the intervention condition will be asked to participate in
interviews at 12 months, if necessary more interviews will be conducted until
data saturation is reached. Both employees that did participate in the
implemented interventions as well as employees that did not participate will be
asked to participate in these interviews.

Organizations in the Dutch WHP program condition will receive a catalogue in
which core elements of health promoting interventions for multiple lifestyle
themes and various domains are included, enabling an integrated approach.
Additionally, they get access to an implementation plan which will assist the
organizations in implementing the health promoting interventions. Employers
will select interventions that are most relevant and feasible for their
organization and employees. During the study, employers are required to
implement multiple interventions on the various domains of the integrated
approach (knowledge and education, identification and support, adjustments in
the social and physical environment and policy) which is a prerequisite to
fulfill the criterion of an integrated approach. Employees can voluntarily
participate in these health promoting interventions. The control condition will
not get initial access to the Dutch WHP catalogue and implementation plan
during the 12 month follow-up and receive the catalogue afterwards.

Employees will be asked to complete online questionnaires at baseline and 6 and
12 months follow up. Employees will wear a triaxial accelerometer at baseline
and a subgroup (participants within both the intervention and control
condition) also at 12 months follow-up. A subgroup of approximately 10
participants will be asked to participate in interviews after 12 months, if
necessary, more interviews will be conducted until data saturation is reached.
Participants in the WHP group can benefit from the WHP program, as their
lifestyle and health are expected to improve. No risks are associated with the
intervention.