Worksite Wellness ProgramsWorksite Wellness Programs

The menu approach offers workers a range of options to support lifestyle changes. It allows people to choose the kind of help that suits their schedules and preferences. The four basic types of programs include:

• Classes
• Minigroups
• Guided self help
• Individual counseling

Classes

Classes (8 or more) can be an effective means of offering 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 classes at a worksite. Many workers are under time constraints with after work commitments and even though they may be interested they simply can’t take part because of their schedules. workers may be very eager to start a program but because of lack of participants to meet class quotas, the program is canceled. Many national businesses such as the American Heart Association, American Cancer Society, Weight Watchers, etc. offer classes; you ought to have little trouble in identifying a provider for class sort programs. You may want to contact your local hospital, health department, or YMCA for possible options. For selecting a vendor to support a program you may want to review the section on program structure.

Minigroups

When there is not sufficient interest to establish a class, those who are interested in a given health topic can 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 support 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 worksite, or mailed to the individual. Some worksites now make information available via intranets or the Internet.

Individual Counseling

One of the most efficacious ways to help individuals change and improve their health status is counseling (or coaching) on a one-on-one basis. In published research studies, wellness programs which incorporated individual counseling as part of the program process achieved significantly higher participation rates and achieved greater risk reduction/risk elimination than standard group programs. Studies have shown that individual counseling is both cost effective and cost productive. A wellness counselor ought to be trained in evaluation techniques, for in certain situations, they may be needed to both screen individuals and counsel them. They ought to know how to do the following:

• Review employee health risks
• Contact workers who have health risks.
• Counsel workers on a one-on-one basis, helping them set goals and objectives, solve concerns, and get expert help when they need it.
• Help workers follow their treatment recommendations and make lifestyle and health behavior changes.
• Recruit workers into health improvement programs, such as weight loss and tobacco cessation.
• Work with workers on a one-on-one basis using guided self-help.
• Conduct classes and minigroups if necessary.
• Work with Worksite Wellness Program Committee members to plan and conduct worksite-wide wellness activities.

Wellness counselors are health generalists; they must have basic knowledge about a wide range of health subject matters and health risks. Counselors must be able to talk with workers about their medical care concerns and the treatments prescribed by their doctors. They ought to have a good overview of nutrition, exercise physiology, pathophysiology of disease, pharmacology, psychology, and behavior change skills.

The educational program ought to include approaches to stress awareness/reduction at the environmental level and at the individual level. Social, physical, and company stressors ought to be explained and methods to ease or elevate stressors ought to 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 support the following:

• Identifying sources of stress
• Relationship of stress to health
• How the individual experiences stress, personal, family, work
• Solutions for coping and managing stress
• Techniques for lowering stress
• Value of stress, both negative and positive
• Practical steps of incorporating stress reduction into lifestyle

Personnel conducting stress management programs ought to have training in psychology, behavioral sciences, or related disciplines such as mental health professionals, 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 significant. Educational sessions and materials ought to include the following information:

• The relationship of nutrition and chronic diseases
• Improving eating patterns
• Relationship of nutrition and proper weight maintenance
• Exercise
• Stress
• Blood Pressure
• Cholesterol
• Diabetes and other chronic diseases.
• Nutritionally accurate 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 consistent with national recommendations such as 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. If an allied health professional instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It is recommended that tobacco cessation programs subscribe to the Code Of Practice for Smoking Cessation Programs. Smoking cessation programs ought to be multi-component with a focus on skills to build positive voluntary behavior change practices. Useful techniques include establishing reasons for stopping, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the concerns of stopping, short-term objective setting, weight control, stress management, effect of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or scare tactics. In programs that use aids such as the “patch” or medications such as “Zyban” appropriate consultation ought to be available on the usage of these aids. The instructor ought to have formal training in tobacco cessation from a nationally recognized company such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders. Assessment of success is occasionally very dubious in tobacco cessation programs. Measurement of success ought to include participation rate, including the number beginning the program, the number completing the program, and the average number per session. Also included, number and percent who stopped smoking at the end of the program, and the number and percent who had not resumed smoking by the end of one year.

Participatory exercise programs ought to include education on benefits of regular exercise and risks of a sedentary lifestyle, its influence on cardiovascular health and diseases, 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 program follows standard procedures by the American College Of Sports Medicine. Safety precautions ought to include the following:

• Informed consent prior to beginning exercise with clear and complete written and verbal standard procedures 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 care evaluation is significant for exercise such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).
• Measurements of Blood Pressure and resting heart rate are useful evaluation information to determine exercise readiness.
• Members who fail screening are medically referred and ought to get a written clearance from their physician to exercise.
• The basic content of an aerobic physical activity program ought to include

Warm up 5 – 10 minutes Aerobic exercise 20 – 40 minutes Cool down 5 – 10 minutes Exercise instructors ought to 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 certified.

Program provided is consistent with scientific and medical care recommendations for weight loss, 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 colleague has no medical or psychological conditions which would make weight loss inappropriate, and to identify the colleague’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and central heath risk.
• Referral for participants who are morbidly obese who would require medical care guidance for weight loss.
• Informed consent, explanation of potential physical and psychological risk from weight loss and regain, likely long-term success of program, full cost of the program, credentials of the employee.
• Identification of contributing factors to colleague’s weight status, serving as the basis for an individualized weight loss plan which includes the weight objective and plans for nutrition, exercise, and behavioral components.
• Weight objective of colleague is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss objective does not exceed loss of 10% of body weight, 1-2 pounds per week.
• Explanation of unsafe weight loss methods.
• Daily calorie level is adjusted to meet each colleague’s recommended rate of weight loss.
• Daily caloric intake is not less than 1,000 calories; if less, physician monitoring is needed.
• Food plan designed so participants can select foods which meet 100% of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, however ought to not greatly exceed RDAs.
• Nutrition education encouraging permanent healthful eating 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 objective 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 ought to be a important portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a evaluation questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.
• Members work towards 30-60 minutes of exercise 5-7 days per week.
• No appetite suppressant prescriptions.
• Maintenance plan provided for continued support.
• Weight control programs ought to be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.
• Trained lay leaders may assist if supervised by nutrition professional.

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

A program is needed to support appropriate interpretation of cholesterol evaluation results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol. Follow national standard procedures: Total Cholesterol Desirable cholesterol < 200 mg/dl Borderline cholesterol 200 – 239 mg/dl Hypercholesterolemia > 240 mg/dl HDL Desirable HDL > 35 mg/dl Low HDL < 35 mg/dl Refer cholesterol evaluation participants to medical care as follows: Total Cholesterol < 200 mg/dl Recheck cholesterol in five years, if history of coronary heart disease or if two or more CHD risk factors are detected refers to risk reduction program or health professionals, 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 stated 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 If fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years. Offer the following:

• The relationship of blood lipids, elevated Blood Pressure, and other risk factors.
• Risk factors include: elevated Blood Pressure 140/90 or higher or on hypertension medication; current cigarette smoking; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.
• Negative risk factor: high HDL 60 mg/dl or greater (subtract one risk factor).
• Risk factors such as family history, smoking, high fat or other unhealthy diet, and lack of exercise lead to the development of cardiovascular disease (CVD).
• Definitions and causes of elevated blood lipids 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 options, including diet (e.g., effect 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 professional advice.

Appropriate medical care or allied health professional trained in measurement of Blood Pressure, referral protocols, and delivering educational messages to colleague conducting Blood Pressure programs. These programs are needed to follow national standard procedures.

• National standard procedures for Blood Pressure protocols
• Calibration of Blood Pressure calculating equipment

be done at least each year.

• Two or more measurements of colleague’s Blood Pressure ought to be taken.
• Referral of participants with elevated Blood Pressure readings to personal physician for further evaluation.
• 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 colleague that Blood Pressure 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 colleague have Blood Pressure rechecked within 1 year unless under treatment. Advise colleague that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of 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 physician for further evaluation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise colleague of readings and need to get Blood Pressure to a objective of 140/90 or less.
• Isolated Systolic Hypertension: 140-159 systolic and < 90 diastolic in a colleague 65 years of age or older.
• Action: Advise colleague to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
• Urgent: 180-209 systolic and/or 110-119 diastolic
• Action: Recommend obtaining medical care evaluation within 1 week.
• Emergency: >210 systolic and/or >120 diastolic
• Action: Obtain immediate medical care attention.
• Provides the following
• Written results, referral standard procedures, and an explanation of Blood Pressure levels given to each colleague with individualized counseling, including advice about the interval of time recommended when the colleague ought to be checked again.
• Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Assessment 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 elevated Blood Pressure and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
• Definition and causes of elevated Blood Pressure.
• Importance of following prescribed treatment.

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

• Blood Pressure measurements – at least two Blood Pressure measurements taken during the evaluation episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure treatment status – ascertain whether the colleague is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for hypertension.
• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer offering immediate feedback to the client, or sending blood to a laboratory offering 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 sort of treatment for elevated cholesterol.
• Obesity – utilize an accepted method for estimating obesity. For example evaluate participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
• Identify people 20% or more above their ideal weight.
• Smoking status – evaluate whether the colleague 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 cholesterol and glucose measurements.
• Cerebrovascular disease or occlusive PVD – ascertain 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 – ascertain if the client has had a heart attack or other sort of coronary heart disease.
• Stress – colleague’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 needed in which the colleague authorizes the program to draw blood for testing to send information to the colleague’s medical care provider if medical 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 gathered previously, the evaluation activity must evaluate levels of interest in programs such as: weight control, tobacco cessation, fitness or exercise, stress management, nutrition, 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, 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 standard procedures for such referral.

Demographic information ought to include location of the evaluation, worksite, client’s name, address, social security number, work and home phone number, sex, race, date of birth, relevant job information (e.g., hourly or salaried), department number, and work shift.

Program directors or providers ought to have a background in wellness programming and a professional health-related degree or certification. They ought to have expertise in content areas, planning, promotion, administration, evaluation, 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 performance of service personnel, to evaluate satisfaction of participants, and for personnel training and continuing education. An central policy statement ought to be available from directors and program vendors addressing the following concerns: assurance of confidentiality of health data, referral to medical care for at-risk participants, follow-up with referred participants and those at-risk, program evaluation on process and outcomes, company of the worksite for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services ought to be provided.