A Review of the Knowledge Base on Healthy Worksite Culture

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DOI: 10.1097/JOM.0b013e31824be25f · Source: PubMed
To identify the need for worksite cultures of health, the organizational factors that support worksite cultures of health, the tools that have been used to measure worksite cultures of health, and the research needs related to healthy worksite culture. A cross-sectional survey involving a sample of 500 companies representing a broad spectrum of industries and business sectors. A literature review was conducted. Similar to a culture of safety that encourages safer behaviors and enables a safer workplace, a culture of health provides a supportive work leadership with a favorable work environment and health-related policies that promote employee health and result in substantial decrease in employee health risks and medical costs. Worksite policies and environments supporting a culture of health are important to helping employees adopt and maintain healthy behaviors.
A Review of the Knowledge Base on Healthy Worksite Culture
Steven G. Aldana, PhD, David R. Anderson, PhD, LP, Troy B. Adams, PhD, R. William Whitmer, MBA,
Ray M. Merrill, PhD, MPH, Victoria George, MA, MPH, and Jerry Noyce, BBA
Objective: To identify the need for worksite cultures of health, the organiza-
tional factors that support worksite cultures of health, the tools that have been
used to measure worksite cultures of health, and the research needs related
to healthy worksite culture. Methods: A cross-sectional survey involving
a sample of 500 companies representing a broad spectrum of industries
and business sectors. A literature review was conducted. Results: Similar
to a culture of safety that encourages safer behaviors and enables a safer
workplace, a culture of health provides a supportive work leadership with
a favorable work environment and health-related policies that promote em-
ployee health and result in substantial decrease in employee health risks and
medical costs. Conclusion: Worksite policies and environments supporting
a culture of health are important to helping employees adopt and maintain
healthy behaviors.
orksite health promotion programs (HPPs) in the United
States are intended to improve employee health, reduce grow-
ing employee health care costs, improve employee productivity,
and increase employee satisfaction. The primary method by which
HPPs positively impact these desired outcomes is through integrat-
ing health promotion initiatives into an organizational environment
conducive to improving employee health behaviors, thereby reduc-
ing health risks and lowering the incidence of chronic diseases
that are the primary drivers of health care costs and lost worker
The success of the HPP is dependent on the orga-
nizational environment, which can either facilitate or diminish the
effectiveness of the program. The body of organizational factors that
promote healthy lifestyle choices has been collectively referred to
as a “worksite culture of health.”
That is, the worksite promotes
patterns of healthy behaviors among its employees. Having organi-
zational and environmental policies and supports that encourage the
adoption and maintenance of healthy behaviors is the essence of a
worksite culture of health. These environmental policies and sup-
ports should reflect prevailing values and expectations of employees
in order to effectively influence the way they think, feel, and behave
toward personal and group health.
An example of how organizational factors can promote
healthy behaviors is found in worksite safety initiatives.
To keep
employees safe, many companies have worked to create a culture
of safety. A culture of safety is one in which employee behavior is
guided by safety procedures, norms, and supports that encourage a
safe working environment. In these companies, safety behaviors are
incorporated into the vision and goals of leadership. Formal safety
From the Lifestyle Research Group (Drs Aldana and Adams), Mapleton, Utah;
Health Enhancement Research Organization (HERO) Research Committee
(Dr Anderson), St Paul, Minnesota; Health Enhancement Research Organi-
zation (HERO) (Mr Whitmer and Mr Noyce), Edina, Minnesota; Department
of Health Science (Dr Merrill), College of Life Sciences, Brigham Young
University, Provo, Utah; and Total Health & Productivity Program Evaluation
(Ms George), Kaiser Permanente Oakland, California.
This project was sponsored by Kaiser Permanente HealthWorks.
The authors declare no conflicts of interest.
Address correspondence to: Ray M. Merrill, PhD, MPH, Department of Health
Science, College of Life Sciences, Brigham Young University, 29-A Richards
Building, Provo, UT 84602 (Ray_Merrill@byu.edu).
2012 by American College of Occupational and Environmental
DOI: 10.1097/JOM.0b013e31824be25f
policies with corresponding incentives, recognition, or penalties are
well communicated and understood. Rules reinforce the safety cul-
ture, and modifications are often made to the physical environment
to facilitate safety. These organizational factors are critical to the
sustainability of safety initiatives and help employees replace unsafe
behaviors and conditions with safer options.
In essence, a culture of safety enables an employer to en-
courage safe behaviors and surround employees with everything
they need to work safely. Well-designed safety initiatives have
proven effective. A culture of safety has been associated with fewer
more accurate reporting of accidents,
safer driving,
and other safety-related conditions and behaviors.
Perhaps, the
most critical component of successful safety initiatives is universal
buy-in. No safety initiative could change the corporate culture if only
a small proportion of employees complied. An effective employee
culture of safety must reach all employees.
In a similar manner, there is a need to create and sustain a
worksite culture of health. It may be that having a worksite culture of
health is essential for HPPs to effectively help employees adopt and
maintain healthy behaviors. Nevertheless, there is little published
evidence to support the impact of a healthy worksite culture or that
identifies specific, effective strategies to change worksite culture.
Furthermore, there are few tools available to systematically measure
the degree to which a culture is healthy or whether a worksite culture
is changing. The purpose of this review is fourfold: (1) to identify
evidence that supports the need to create worksite cultures of health,
(2) to identify “healthy culture” organizational factors that must be
present for a worksite culture of health to exist, (3) to identify tools
that have been used to measure worksite health culture, and (4) to
identify gaps in the knowledge base and propose research needs
related to healthy worksite culture.
High-performing companies are characterized by employ-
ees who demonstrate healthy behaviors, have few health risks,
show low prevalence of chronic diseases, and have low employee-
related expenses. These companies also demonstrate high levels of
Worksite health promotion efforts that help employ-
ees adopt and maintain healthy behaviors must involve experiences
that enhance awareness, increase motivation,andbuild skills and,
most important, that create supportive policies and environments
that make positive health practices the easiest choice.”
The need
to create supportive policies and environments is a fundamental as-
pect of health promotion efforts, which is consistent with its earlier
identification as fundamental in behavior change theory.
17, 18
nizational and environmental policies and supports that encourage
the adoption and maintenance of healthy behaviors are components
of behavior change referred to as “opportunity.”
Opportunity is
having access to the environment that makes choosing a healthy
behavior the normative choice.
Although creating a worksite culture of health may appear
key to helping employers realize the benefits of having healthy
employees, the question remains how common is it for work-
sites to have a culture of health? Working in collaboration with
the employee benefits consulting company Mercer, the Health En-
hancement Research Organization (HERO) sought to answer this
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
414 JOEM
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Volume 54, Number 4, April 2012 Healthy Worksite Culture
question and others when it created the HERO Employee Health
Management Best Practice Scorecard in Collaboration with Mercer
(HERO Scorecard).
This online assessment was developed to col-
lect employer-specific data describing employee health management
programs to identify best practices associated with the most suc-
cessful employee health management programs. The HERO Score-
card has been promoted through professional organizations, industry
leaders, and word of mouth. Since 2006, more than 500 companies
representing a broad spectrum of industries and business sectors
have voluntarily completed the scorecard.
The respondent employers were representative of a diverse
range of industries, with 28% being in equipment/chemicals/food
manufacturing. The number of work locations in the respondent
employers ranged from 1 to 3000, with an average of 392. The age
of employees included in the sample ranged from 18 to 74 years, with
the average being 42.6 years. The percentage of female employees
was 45.5%. Each of these employers had an existing HPP.
In response to the question, “Taken altogether, how supportive
of HPP is senior leadership and the corporate culture in your orga-
nization?” 26% said very supportive, 45% supportive, 27.5% mini-
mally supportive, and 1.5% not supportive. The physical work envi-
ronments were also reported to be favorable (59% indicated having
fitness centers, walking or biking trails, etc, 74% indicated a smoke-
free working environment, 61% indicated healthy food choices in the
cafeterias, vending machines, or at catered events; 87% indicated a
safe work environment, including ergonomics; and 79% indicated
well-lit and accessible stairwells). The organizations also tended to
have the following policies in place: 58% flextime or work at home,
73% support for early return to work following disability (eg, modi-
fied work schedules or modified duty, or both), 45% recognition and
rewards for health behaviors, and 63% allow participation in health
management activities during work time. Thus, a supportive leader-
ship with a favorable work environment and health-related policies
is fundamental to a culture of health. Although the respondents
of this survey from a nonrandom convenience sample and are not
necessarily representatives of worksites in the United States, these
results provide evidence that a large proportion of organizations are
supportive of a worksite culture of health. These results should be
viewed with the understanding that worksites that completed the
HERO Scorecard are most likely organizations looking to evaluate
or benchmark their program and may represent some of the best
HPPs in the country. If this is the case, it could be expected that they
would report high levels of support.
For more than 15 years, the C. Everett Koop National Health
Award has been given to a select group of the nation’s most effective
worksite wellness programs.
Worksites that receive the award are
generally considered to be among the best worksite HPPs in the
country. Discussion with Koop Award selection committee members
reveals that most of the award-winning programs documented the
presence of a strong worksite culture of health (oral communications
with Koop committee members, July 8, 2010). Many, but not all,
of the Koop Award recipients have published evidence about the
importance of organizational and leadership support of their program
in peer-reviewed research.
22 26
A corporate culture of health appears to be important; yet,
in a review of 350 published reports describing HPP interventions,
only 17 included efforts to create a supportive environment and only
1 of these 17 studies met the highest standard for research design.
According to these results, it is possible that these HPP interventions
were based on behavior change strategies that did not include en-
vironmental and policy change efforts. Alternatively, environmental
and policy changes may have occurred but were not reported. On the
basis of a recent report about corporate global wellness programs, it
is likely that the former is the case.
In this report involving a sam-
ple of 1248 organizations representing nearly 13 million employees,
just one of three respondents felt that their company had a culture
of health but four of five respondents reported that they intended to
begin improving their health culture. The authors concluded, “This
significant gap between today’s reality and the intent for tomorrow
indicates that a culture of health is perceived to be an ideal, and
likely will be aggressively pursued by many employers.”
some of the organizations with existing worksite HPPs indicated
having a worksite culture of health, few of the companies mentioned
environmental and policy change efforts. Nevertheless, companies
seem to recognize the importance of having a worksite culture of
health. It is apparent that many worksites believe that a worksite cul-
ture of health must be defined, promoted, and sustained to increase
the effectiveness of HPPs. What is not clear is whether and to what
extent having a worksite culture of health can improve employee
engagement, health, and productivity and reduce employee-related
In order for the investment of time, support, and money related
to creating healthy worksite culture to be warranted, doing so should
result in improved healthy behaviors and productivity and lower
employer-related expenses. To evaluate the association between a
culture of health and improved employee outcomes, we conducted
a review of the literature, interviewed professionals in the field, and
spoke with officers of professional organizations. There is some
evidence that best practice worksite HPPs incorporate more cultural
elements in their strategies and result in a reduction of employee
health risks by as much as 5% per year, a level 2.5 times as much as
standard practice programs.
This is notable because we know that
reducing employee risk by as little as 0.1% to 0.2% per year can result
in breakeven for the wellness program investment.
Outside of
these studies, there is little published evidence that directly supports
the association between a worksite culture of health and improved
health risks.
32, 33
There is even less direct evidence that a culture of health re-
sults in improved employee cost outcomes. In 2001, a comprehensive
review of the financial impact of HPPs was published.
Part of this
review included a subsection of studies that measured the impact of
wellness programs on health care costs—specifically addressing the
rate of return on the invested cost of the programs. Since that article,
a recent meta-analysis of the literature about costs and savings asso-
ciated with worksite HPPs, medical costs were shown to fall about
$3.27 for every dollar spent on the programs and that absenteeism
costs fell by about $2.73 for every dollar spent on the programs.
updated list of studies can be divided into three categories: (1) those
that primarily employed strategies to raise awareness (low-impact
36 42
; (2) those that raised awareness and employed be-
havior change strategies (medium-impact references) (L. Chapman,
Chapman, MPH, et al, 2002, unpublished data)
; and (3) those
that raised awareness, changed behavior, and documented efforts to
create a worksite culture of health (high-impact references).
the seven studies that primarily raised awareness, the average med-
ical and/or absenteeism cost return on investment (ROI) was about
$3.75 for every dollar invested. The average medical and/or absen-
teeism cost ROI for the second group of studies was about $6.00,
whereas the average for the third group of studies was about $7.75.
Admittedly, these three groups are composed of a very small number
of studies and any conclusions should be treated as preliminary. Nev-
ertheless, they do support the idea that a worksite culture of health
may have an impact on the effectiveness of the wellness efforts and
subsequent reductions in health care expenditures.
Using the newly available survey data from the HERO Score-
card, the relationship between supportive leadership and both em-
ployee risk and employee health care cost trends was evaluated
specifically to be included in this review. The primary variable of
interest was supportive leadership, which was categorized into three
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2012 American College of Occupational and Environmental Medicine 415
Aldana et al JOEM
Volume 54, Number 4, April 2012
levels: “very supportive,” “supportive,” and “minimally support-
ive.” The dependent measures were self-reported improvement in
employee health risk and medical plan cost.
The data were analyzed using cross-tabulation procedures.
Percentages and χ
statistics are reported for employee health risk
(Table 1) and medical plan cost (Table 2). The results indicate that
organizations with very supportive leadership were almost 4 times
more likely to report substantial improvement in employee health
risk and 2.5 times more likely to report substantial improvement in
medical cost trend. The inverse was also true. Organizations with
minimally supportive leadership were about 4 times more likely
to report minimal improvement in both employee health risk and
medical cost trends.
All of the data from the HERO Scorecard were self-reported
and could therefore contain biases. Respondents who indicated that
their program had strong leadership and cultural support may have
been more prone to report larger improvements in outcomes. In addi-
tion, these findings do not in and of themselves support the direction
of the relationship or causality. It might have been the case that lead-
ership support was gained only because the program produced these
outcomes rather than the support having contributed to them. Yet, the
HERO Scorecard data and the detailed review of the published ROI
provide some evidence that there is a positive relationship between
effective HPPs and HPPs supported by a worksite culture of health.
Almost 25 years ago, researchers published some of the first
information and rationale for the need to create a worksite culture of
They adopted an existing generic worksite culture change
framework to address the need to create a worksite culture of health
(Fig. 1).
This framework posits that the behavioral choices employees
make are influenced by five organizational dimensions.
are the social boundaries that define the expected and accepted
ways of behaving with respect to health issues. Shared values reflect
the collective beliefs about health-related issues that are important.
TABLE 1. Improvement in Employee Health Risk According
to Level of Senior Leadership Support*
Degree of Senior
Very 10.7 36.6 44.7
Somewhat 42.6 47.6 44.7
Marginal 42.7 15.9 10.5
= 20.27 (P = 0.0025, df = 5).
TABLE 2. Improvement in Medical Cost Trend According
to Level of Senior Leadership Support*
Degree of Senior
Very 18.5 36.6 46.3
Somewhat 51.9 48.8 46.3
Marginal 29.6 14.6 7.3
= 13.40 (P = 0.0037, df = 5).
FIGURE 1. A culture change framework.
Touch points are the systemwide provision of informal and formal
structures, services, policies, and procedures that influence the or-
ganizational culture in matters of health. Work climate includes a
set of temporary employee attitudes, feelings, and perceptions that
are influenced by workplace social and structural characteristics and
serves as a catalyst to individual health behavior change. The last
component in the framework is peer support.
The Lifegain Health Culture Audit uses this framework to
measure a worksite’s level of engagement within each dimension.
Validity and reliability of this instrument have been demonstrated.
The Lifegain Health Culture Audit is not the only attempt to cre-
ate a survey that could be used to measure worksite health culture.
Similar scales have been developed that have not relied on the cul-
ture change framework but are focused more on the policy and
environmental components of some behavior change models.
61 63
Basen-Engquist and colleagues
created a scale to measure work-
site health and safety organizational climate. Climate in this study
was simply another way of describing worksite organizational health
culture. Climate is more sensitive to workgroup norms and highly
variable across an organization, whereas culture is more enduring
and stable across the entire organization. This scale was shown to be
valid and reliable and was subsequently used to document changes
in organizational climate across 40 worksites. Results showed that
the scale was associated with smoking programs and policies but
was not associated with employee health behaviors. Climate scores
increased at worksites that were implementing HPPs.
Ribisl and
also developed a scale to measure worksite health envi-
ronment. It is unclear whether this scale is reliable and valid, but its
values are related to health behaviors. No other uses of this survey
have been found.
In 2009, General Mills used the Total You Health Values
Survey in an effort to quantify employee interest in worksite heath
promotion and perceived cultural support for healthy living.
survey queried several opinions including some information about
worksite culture. The validity and reliability of the survey are
Each of these attempts to quantify worksite health culture
involved qualitatively assessing employee perceptions of shared val-
ues, norms, and peer support. With the exception of the references
listed here, there is no other peer-reviewed literature documenting
the development or use of these surveys. Two of these tools appear to
have been deployed in a worksite setting only once.
61, 63
The Lifegain
Health Culture Audit appears to have been more widely used on the
basis of anecdotal reports, but there is not a body of peer-reviewed
literature to support the premise or outcomes of this tool. Currently,
there is no standard tool to measure worksite health culture.
A second way of attempting to quantify worksite health culture
employs a business methodology. Rather than using the traditional
culture change framework to guide the creation of the survey instru-
ments, this approach has focused on identifying effective worksite
HPPs and then describing the various organizational and program
elements contained therein. The idea is to identify several programs
that could be considered to have best practices and a healthy work-
site culture and to declare these as “best in class” or the standard by
which other programs could be compared. The process of comparing
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2012 American College of Occupational and Environmental Medicine
Volume 54, Number 4, April 2012 Healthy Worksite Culture
practices against a standard or standards thus derived is called bench-
marking. This process was used by Goetzel and colleagues
to iden-
tify HPP best practices. Working under the direction of the Centers
for Disease Control and Prevention, Goetzel and colleagues used
site visits, surveys, literature reviews, and discussions with content
experts to identify best practice worksites and to establish a list of
seven HPP best practices that were common among the best worksite
programs. Three of these seven best practices could be considered
important in creating a worksite culture of health. These include
integrating health and productivity management programs into the
organization’s operations, while addressing individual, environmen-
tal, policy, and cultural factors affecting health and productivity, and
communicating successful outcomes to key stakeholders.
These three best practices provide one perspective of what
could constitute a worksite culture of health. Best practices for
healthy worksite culture have also been suggested by other orga-
nizations. These include the Wellness Councils of America Well
Workplace Checklist,
Five Fundamental Pillars,
and Six Essential
Each of these publications identifies lists of organizational
factors that are common in companies that have been determined to
have good HPPs and a strong worksite culture of health, but none
of these lists were focused specifically on worksite health culture.
These lists of best practices are a compilation of organizational fac-
tors believed to be found in worksites thought to have strong HPPs.
Although not all of these factors are focused specifically on worksite
culture, these attempts to benchmark HPPs provide a valuable way
for other worksites to determine whether their programs have good
worksite HPPs and a supportive worksite culture of health. In each
of these best practice attempts, worksite culture is just one of many
factors suggested to influence HPP success.
Some organizations have created surveys based on best prac-
tices that employers can use to benchmark their programs. These
include online survey tools such as the HERO Scorecard and the
Well Workplace Checklist.
20, 65
Both of these tools use a series of
questions to provide a progress report in each of several sections
and tailored electronic feedback regarding HPP best practices. The
state of Wisconsin has produced a paper-pencil checklist called the
Worksite Wellness Resource Kit that contains an entire section about
worksite culture.
Using many of the same best practice findings,
WellSteps created an online, tailored worksite culture change tool
called the “Checklist to Change.” Unlike the other best practice
surveys mentioned here, the Checklist to Change focuses on just
worksite policies and environmental elements that support healthy
All of these online or paper-pencil assessment tools
are basically checklists of best practices and include many of the
worksite culture strategy items shown in Table 3.
Table 3 includes a sampling of the strategies that may con-
tribute to a worksite culture of health and provides an example of
what is generally included in the worksite culture sections of best
practice assessment tools. These assessment tools are designed to
provide worksites with a checklist of strategies that can be imple-
mented to create a healthy worksite culture and ultimately help em-
ployees adopt and maintain healthy behaviors. These simple best
practice–based checklists appear to have much broader use and ac-
ceptance than some of the published health culture scales. For work-
sites wanting to improve the effectiveness of their current health
promotion programming, a best practice checklist may help them
identify weaknesses in existing health-related policies and environ-
ments, but they may be less useful tools in assessing or measuring
improvements in worksite health culture across time. Conversely,
the three culture-specific scales discussed earlier may not provide
specific strategies for improving worksite culture, but they could po-
tentially have some utility as stand-alone culture measurement tools.
Nevertheless, all three culture-specific scales need to be subjected
to more critical peer review and overcome the lack of demonstrated
reliability and validity.
TABLE 3. Culture Change Strategies
Physical activity strategies
Display point-of-decision prompts for stair use
Creation of or enhanced access to places for physical activity
Support participation in community walking events
Develop inside and outside walking paths
Distribute maps of various walking and running routes
Encourage stair-climbing with artwork from children of workers
Encourage “walking meetings”
Offer incentives for those who park further away or who active
Build physical activity breaks into meetings
Support physical activity clubs for walking, running, etc
Sponsor youth-athletic teams with volunteer employee coaches
Negotiate fitness center discounts
Install bicycle racks in a secure area
Nutrition strategies
Add healthy food choices to vending machines and cafeteria
Deliver and make available fruit and vegetables in the workplace
Post nutrition information on vending machines and cafeteria
Use price differentials to motivate purchasing of healthy foods
Host healthy potluck lunches
Host a healthy food tasting with a recipe exchange
Communicate locations of farmers markets
Host a drop site for community-supported agriculture
Facilitate serving of healthy food at company meetings and functions
Provide refrigerators and microwaves so that healthy food can be
Tobacco control strategies
Implement smoke-free policies, bans, or restrictions
Offer lower premiums for not smoking or participating in a cessation
Subsidize cessation products, especially for pregnant women
Other strategies
Inclusion of spouses and significant others
Allow flextime and/or telecommuting so that employees have time to be
Encourage employees to take meal breaks and to use vacation days
Employee a consistent communication strategy to raise employee
Implement an employee recognition program to share success stories
Sponsor periodic “Lunch and Learn” meetings
Behavior change theory, expert opinion, and best practice
standards indicate that worksite policies and environments support-
ing a culture of health are an important aspect of helping individuals
adopt and maintain healthy behaviors. Lincoln Industries, a small
steel manufacturing plant in Lincoln, Nebraska, provides a real-
world example of why a healthy worksite culture is so important.
Health promotion program outcomes at Lincoln Industries demon-
strate how having a worksite culture of health has improved em-
ployee health outcomes across time and how the employees have
fewer health risks and better health than comparable employees at
other worksites in the same geographic area.
23, 24
Lincoln Industries
President Hank Orme sums up the importance of worksite culture:
In today’s competitive business world we are looking for ev-
ery edge to improve performance, and we have found that
investing in our culture of healthy lifestyles has created a
Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2012 American College of Occupational and Environmental Medicine 417
Aldana et al JOEM
Volume 54, Number 4, April 2012
workplace that yields high returns in all metrics including
operating profit, customer satisfaction, supplier satisfaction,
individual opinion surveys, and trust surveys.
A worksite culture of health will help improve the effective-
ness of worksite HPPs, which, in turn, will help worksites to be more
productive and profitable. The development and implementation of
worksite safety programs provide an excellent example of how work-
site organizational change, leadership support, and effective policies
can alter employee behavior. Long before scientific investigations
of the outcomes of safety programs were available, worksites were
implementing safety initiatives. Even without rigorous studies of the
impact of safety programs, having an effective safety culture had
become an important business strategy. Likewise, support for the
need to have a workplace culture of health is likely to follow a sim-
ilar course—belief-based implementation first, outcome evaluation
second. Like safety, this may be a case of the scientific evidence to
support the value of a healthy worksite culture struggling to capture
and quantify what has already been recognized and accepted as an
important worksite practice.
The prevalence of worksites with cultures of health is un-
known. Large organizations with established HPPs most likely have
some level of cultural support. Nevertheless, in mid-size and small
companies, the presence of worksite wellness efforts is less com-
mon and information regarding the existence of supportive cultures
is nonexistent. There is also a void of evidence on the connections
between worksite cultures of health and improvements in employee
behavior, health risk, and business outcomes. If having a worksite
culture of health truly is an important aspect of effective HPPs, future
research may be able to capture this effect. Well-designed investiga-
tions may even be able to determine what proportion of employee
health improvement is due to cultural support.
Health promotion program benchmarking efforts have pro-
vided the best practical information for employers attempting to
make their programs more effective, but these checklists do not pro-
vide employers with a valid measure to document culture changes
across time. Some best practice tools provide numeric scores for
each best practice factor. Future research could use the best practice
healthy worksite culture subsection to create a stand-alone tool that
could be used to provide quantitative scoring about worksite health
culture. Future research could also measure the level of maturity of
a culture of health within an organization, which would link it to the
leadership support and the environmental/policy support in a way
that might help in applying consistency.
If shown to be valid, such a tool could be used by organizations
to document improvements in health culture. This information could
be valuable to worksites wondering whether implemented policy
and environmental changes were sufficient to influence worksite
culture in a meaningful way. Such a tool could also help worksites
evaluate the impact of worksite culture on employee health and
This project was sponsored by Kaiser Permanente Health-
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2012 American College of Occupational and Environmental Medicine 419
    • "Organizational-level strategies are seen as particularly important for program implementation [33], to change the culture of an organization [30,34], and for programs to be institutionalized into the organization and sustained [30]. Key organizational-level strategies include having management support for programs [33,34] and implementing the program from within the organization via dedicated onsite staff or workplace 'champions' [35]. Despite these frameworks, workplace interventions targeting MVPA have typically targeted the individual and not the organizational-or environmental-level influences [36,37]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The office workplace is a key setting in which to address excessive sitting time and inadequate physical activity. One major influence on workplace sitting is the organizational environment. However, the impact of organizational-level strategies on individual level activity change is unknown. Further, the emergence of sophisticated, consumer-targeted wearable activity trackers that facilitate real-time self-monitoring of activity, may be a useful adjunct to support organizational-level strategies, but to date have received little evaluation in this workplace setting. Objective: The aim of this study is to evaluate the feasibility, acceptability, and effectiveness of organizational-level strategies with or without an activity tracker on sitting, standing, and stepping in office workers in the short (3 months, primary aim) and long-term (12 months, secondary aim). Methods: This study is a pilot, cluster-randomized trial (with work teams as the unit of clustering) of two interventions in office workers: organizational-level support strategies (eg, visible management support, emails) or organizational-level strategies plus the use of a waist-worn activity tracker (the LUMOback) that enables self-monitoring of sitting, standing, and stepping time and enables users to set sitting and posture alerts. The key intervention message is to 'Stand Up, Sit Less, and Move More.' Intervention elements will be implemented from within the organization by the Head of Workplace Wellbeing. Participants will be recruited via email and enrolled face-to-face. Assessments will occur at baseline, 3, and 12 months. Time spent sitting, sitting in prolonged (≥30 minute) bouts, standing, and stepping during work hours and across the day will be measured with activPAL3 activity monitors (7 days, 24 hours/day protocol), with total sitting time and sitting time during work hours the primary outcomes. Web-based questionnaires, LUMOback recorded data, telephone interviews, and focus groups will measure the feasibility and acceptability of both interventions and potential predictors of behavior change. Results: Baseline and follow-up data collection has finished. Results are expected in 2016. Conclusions: This pilot, cluster-randomized trial will evaluate the feasibility, acceptability, and effectiveness of two interventions targeting reductions in sitting and increases in standing and stepping in office workers. Few studies have evaluated these intervention strategies and this study has the potential to contribute both short and long-term findings.
    Full-text · Article · May 2016
    • "be getting employees to participate. Short of requiring people to participate the literature suggests that incentives, matching program components to employees' interests, top leadership support, and a culture for health are key factors (Aldana, et al., 2012). "
    [Show abstract] [Hide abstract] ABSTRACT: Employee health and wellness are important for employees, their families, and their organizations. We review the literature on both stress management interventions in organizations and workplace health promotion and wellness programs, from the lens of primary, secondary, and tertiary interventions as well as the framework provided by the job demands-resources model (Bakker & Demerouti 2007). Stress management interventions tend to be ameliorative, often focusing on restoring resources that have been depleted by the work environment, whereas workplace health promotion and wellness programs tend to be more preventive, enhancing job and personal resources for all employees. There appears to be a trend toward incorporating stress management as a component of workplace wellness programs, with these programs taking more of a primary or secondary intervention approach than a tertiary approach. In addition, although organization-level interventions are still relatively rare, there is growing evidence that organizational interventions, especially when combined with individual-level interventions, can be quite effective in promoting a positive, healthy work environment. We conclude the review by offering suggestions for future research and some considerations for the design and evaluation of future interventions.
    Article · Apr 2015
    • "In Europe, WHP studies often assume a broader scope incorporating the work organization and the work environment, and thus reflecting the content of the Luxemburg Declaration of Workplace Health Promotion in the European Union (European Network for Workplace Health Promotion, 2007). Recent reviews of this general pattern in the US literature on WHP has led to emphasis on the need for broader approaches to WHP and development of a healthy workplace culture (Aldana et al., 2012; Goetzel et al., 2014). Regarding these differences in research focus, the research presented in this thesis primarily concerns the research for WHP and aligns with the broader view of WHP applied in most European studies. "
    [Show abstract] [Hide abstract] ABSTRACT: The workplace is a suitable setting for health promotion, not least due to the amount of time employees spend at work. Previous research indicates large variations in employers' handling of workplace health promotion (WHP) efforts. However, more empirical knowledge of how WHP is handled in public sector organizations is needed. The overall aim of the thesis was to explore how WHP is managed and implemented in municipal organizations. The thesis draws on health promotion as the point of departure, further accompanied with concepts related to organizational change and implementation research. The thesis is based on three studies using different empirical materials. Both quantitative and qualitative research designs were used. In the first study, questionnaires were sent to both top managers and employees in a nationwide random sample of 60 of the 290 municipal social care organizations in Sweden. Data were analysed at the organizational level, linking WHP measures provided by the employer to employee health. In the second study, interviews concerning the management of WHP were carried out with senior managers representing various departments in two municipalities. The third study analysed the implementation of a health-promoting leadership programme, and the interviews made, concerned the experiences of line and middle managers participating in the programme. The results show that the provision of individual- and organizational-directed WHP measures was associated to employee health at the organizational level. Furthermore, the senior managers described WHP management as components contributing to the organization's capacity for WHP. However, they mainly described WHP as providing healthy lifestyle activities, and mapping working conditions and employee health. In the study analysing the implementation of the leadership programme, line and middle managers described employee involvement as an enabling factor, whereas high workload and lack of senior management support were barriers described. Recurrent organizational Changes and other politically-initiated projects and routines were also pointed out as competing events in the implementation process. From this thesis, it can be concluded that WHP management is dominated by measures directed towards the individual employee and needs to include more of psychosocial and organizational measures. Finally, the varied organizational conditions for municipal managers as well as the support from senior management and human resources staff needs to be considered and ensured as part of an active and continuous WHP practice.
    Full-text · Thesis · Feb 2015
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