Work towards Vitality!

Background of the study:
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.

Objective of the study:
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 improving 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.

Study design:
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 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 6 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.

Study population:
Organizations were recruited via the extensive network of the project team members. Participants will be employees recruited within the participating organizations. Due to the different characteristics and work sectors of the organizations, a diverse study population regarding age, sex, educational level, and type of work will be invited. Different communication channels will be used to create awareness for the study, and to recruit employees, including intranet, newsletters, posters, and flyers that will be distributed. Furthermore, all employees will receive an invitation by email for an information session at the workplace. In these sessions, which takes place prior to the randomization, researchers and representatives of the organization will provide information about the goal of the evaluation study. Those willing and eligible to participate will receive an informed consent, baseline questionnaire and the triaxial accelerometer.

Intervention:
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.

Lifestyle will improve as an effect of this integrated workplace health promotion program

Baseline, 6 months, 12 months

Workplace health promotion program (existing of a catalogue with WHP interventions and an implementation plan)