Worksite Health ProgramsAll About Worksite Health Programs

The menu approach offers staff a range of options to support lifestyle changes. It authorizes individuals  to select the kind of help that suits their schedules and preferences.

The four basic types of wellness programs include -

o  Classes

o  Minigroups

o  Guided self help

o  Individual counseling

Classes

Classes (8 or more) may be an effective means of providing education and social support for behavior change.  The length of a class can vary depending on topic requirements. It isn’t sufficient to offer only courses at a worksite.

Many staff members are under time constraints with after work commitments and although they might be interested they simply cannot participate because of their schedules.

Workers could  be very eager to begin a wellness program but because of lack of participants to meet class quotas, the wellness program is canceled.

A lot of national businesses like the American Heart Association, American Cancer Society, Weight Watchers, etc. offer classes; you should’ve little trouble in identifying a provider for class type wellness programs.

You may want to contact your local hospital, health department, or YMCA for possible choices. for choosing  a provider to provide a health promotion program you may want to review the section on health promotion program structure.

Minigroups

When there isn’t enough interest to create a class, those who are interested in a given health topic could 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 staff do not want formal help in making health changes; they prefer to do it on their own. In guided self-help, the wellness counselors provide support, materials, and encouragement.

Meeting times may be arranged and contact may be made either in individuals, by phone, or computer. Materials may be made available at the workplace, or mailed to the individual. Some workplaces now make information available via intranets or the Internet.

Individual Counseling

One of the most successful ways to help individuals change and improve their health status is counseling (or coaching) on a one-on-one basis.

In published studies, health promotion programs which incorporated individual counseling as part of the health promotion program process achieved significantly higher participation rates and achieved greater risk reduction/risk elimination than standard group programs. Studies have demonstrated that individual counseling is both cost effective and cost beneficial.

A wellness counselor should be trained in screening techniques, for in certain situations, they could be required to both screen person and counsel them. They should know how to do the following -

o  Review staff member health risks

o  Contact personnel who’ve health risks.

o  Counsel personnel on a one-on-one basis, assisting them set goals, solve problems, and get specialist help when they need it.

o  Make sure to help staff follow their treatment recommendations and make lifestyle and health behavior changes.

o  Recruit personnel into wellness programs, like weight reduction and smoking cessation.

o  Make sure to work with workforce on a one-on-one basis using guided self-help.

o  Conduct courses and minigroups when necessary.

o  Be sure to work with wellness committee members to plan and conduct workplace-wide wellness activities.

Wellness counselors are health generalists; they must have basic knowledge about a wide range of health topics and health risks.

Counselors ought to be able to talk with workforce about their health problems and the treatments prescribed by their doctors.

They should have a good overview of nutrition, exercise physiology, pathophysiology of illness, pharmacology, psychology, and behavior change skills.

The educational program should include approaches to stress awareness/reduction at the environmental level and at the individual level.

Social, physical, and organizational 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, like meditation, relaxation response, and exercise.

Content of the program should provide the following -

o  Identifying sources of stress

o  Relationship of stress to health

o  Precisely how the individual experiences stress, personal, family, work

o  Solutions for coping and managing stress

o  Techniques for decreasing stress

o  Value of stress, both negative and positive

o  Practical steps of incorporating stress reduction into lifestyle

Personnel conducting stress management programs should have training in psychology, behavioral sciences, or related disciplines like mental health specialists, 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 necessary.

Educational sessions and materials should include the following information -

o  The relationship of nutrition and chronic illnesss

o  Improving eating patterns

o  Relationship of nutrition and proper weight maintenance

o  Exercise

o  Stress

o  Blood pressure (BP)

o  Cholesterol

o  Diabetes and other chronic conditions.

o  Nutritionally precise 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 consuming habits. Guidelines for improving consuming habits must be based on or consisitent with national recommendations such as the Food Guide Pyramid.

Instructor must be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition.

If an allied health expert instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It’s recommended that smoking cessation programs subscribe to the Code of Practice for Use of tobacco Cessation Programs.

Smoking cessation programs should be multi-component with a focus on skills to build positive voluntary behavior modification practices.

Useful techniques include establishing reasons for quitting, understanding the use of tobacco habit, various techniques for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term goal establishing, weight control, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or scare tactics.

In health promotion 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 should have formal training in use of tobacco cessation from a nationally recognized organization like American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program like Smoke Enders.

Investigation of success is sometimes very dubious in tobacco use cessation programs. Measurement of success ought to include participation rate, including the number starting the program, the number completing the program, and the average number per session.

Also included, number and percent who stopped tobacco use after the program, and the number and percent who had not resumed tobacco use by the end of one year.

Participatory fitness plans should include education on advantages of regular exercise and risks of a sedentary lifestyle, its impact on cardiovascular health and illnesses, its relationship with weight control and stress management, and aerobic activity choices.

Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components.  The wellness program follows guidelines by the American College of Sports Medicine.

Safety precautions should include the following -

o  Informed consent before starting exercise with clear and complete written and verbal instructions of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.

o  A screening/evaluation of participants to determine when medical examination is necessary for exercise such as the Exercise Readiness Questionnaire (PAR-Q, see forms).

o  Measurements of blood pressure and resting heart rate are useful screening information to determine exercise readiness.

o  Participants who fail screening are medically referred and should obtain a written clearance from their physician to exercise.    

o  The basic content of an group exercise program should include –     

Warm up   5 – 10 minutes

Aerobic exercise   20 – 40 minutes

Cool down   5 – 10 minutes

Exercise instructors should 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.   

Wellness Program offered is in line with scientific and medical recommendations for weight reduction, 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 –    

o  Screening to verify that the participant lacks medical or psychological conditions which would make weight loss inappropriate, and to identify the participant’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and overall heath risk.

o  Referral for participants who are morbidly obese who would require medical guidance for weight reduction.

o  Informed consent, explanation of potential physical and psychological risk from weight reduction and regain, likely long-term success of health promotion program, full cost of the health promotion program, credentials of the staff.

o  Identification of factors to participant’s weight status, serving as the basis for an individualized weight reduction plan which includes the weight goal and plans for nutrition, exercise, and behavioral components.

o  Weight goal of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial losing weight goal does not exceed loss of 10 percent of body weight, 1-2 pounds per week.

o  Explanation of unsafe weight reduction methods.

o  Daily calorie level is adjusted to meet each participant’s recommended rate of weight loss.

o  Daily caloric intake is not less than 1,000 calories; when less, doctor monitoring is required.

o  Food plan designed so participants can choose foods which meet 100% of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation could be used to achieve RDAs, notwithstanding should not greatly exceed RDAs.    

o  Nutrition education encouraging permanent healthy eating habits based on the Food Guide Pyramid.    

o  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 goal 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.

o  Exercise component ought to be a meaningful portion of the wellness program and be both didactic and experiential.

o  Participant is appropriately screened for exercise using a screening questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.

o  Participants work towards 30-60 minutes of exercise 5-7 days per week.

o  No appetite suppressant drugs.

o  Maintenance plan offered for continued support.

o  Weight control programs should be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.

o  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.

Program is required to provide appropriate interpretation of cholesterol screening results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national guidelines -

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 – 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows –    

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, when history of coronary heart disease or when two or more CHD risk factors are detected refers to risk reduction program or health specialists, 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   When fewer than 2 risk factors and borderline sum cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following –    

o  The relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include –  high 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.

   o Negative risk factor –  high HDL 60 mg/dl or greater (subtract one risk factor).

   o Risk factors like family history, use of tobacco, high fat or other unhealthful diet, andlack of exercise lead to the development of cardiovascular disease (CVD).

o  Definitions and causes of high blood cholesterol 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.    

o  Wide range of treatment options, including diet (e.g., importance of controlling fat intake less than 30 percent of total calories from fat, less 10 percent saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.    

o  Importance of following prescribed treatment and expert advice.    

Appropriate medical or allied health professional trained in measurement of blood pressure, referral protocols, and delivering educational messages to participant conducting blood pressure programs. These health promotion programs are required to follow national guidelines.

National guidelines for blood pressure protocols -

o  Calibration of blood pressure (BP) measuring equipment ought to be done at least yearly.

o  Two or more measurements of participant’s blood pressure ought to be taken.

o  Referral of participants with high blood pressure (BP) readings to personal doctor for further analysis.   

Systolic / Diastolic Follow-Up –     

o  Normal –    <130 / <85   

   Action –  Recheck in 2 years

o  High Normal –    130-139 / 85-90   

   Action –  Recheck in 1 year

Hypertension –     

o  Stage 1 (Mild) –    140-159 / 90-99    

   Action –  Confirm within 2 Months.

o  Stage 2 (Moderate) –    160-179 / 100-109    

   Action –  Refer to source of care within 1 month.

o  Stage 3 (Severe) –    180-209 / 110-119    

   Action –  Refer to source of care within 1 week.

o  Stage 4 (Very Severe) –    >210 / >120    

   Action –  Refer to source of care immediately.

Appropriate educational messages –     

o  Normal –    <130 systolic and <85 diastolic   

   Action -  No referral. If on treatment, then inform participant that blood pressure (BP) is under good control today and should continue seeing and following treatment program.

o  High Normal -    130-139 systolic and/or 85-89 diastolic   

   Action -  Recommend that participant have blood pressure (BP) rechecked within 1 year unless under treatment. Advise participant 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 (BP) is to bring weight into normal range and to exercise.

o  High -    >140 systolic and/or >90 diastolic   

   Action –  Refer to doctor for further examination within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. When already on treatment, advise participant of readings and need to get blood pressure (BP) to a goal of 140/90 or less.

o  Isolated Systolic Hypertension –    140-159 systolic and < 90 diastolic in a participant 65 years of age or older.   

   Action -  Advise participant to inform doctor of readings at next visit and consider advice regarding losing weight and exercise if appropriate.

o  Urgent -    180-209 systolic and/or 110-119 diastolic   

   Action -  Recommend obtaining medical analysis within 1 week.

o  Emergency -    >210 systolic and/or >120 diastolic   

   Action –  Obtain immediate medical attention.

Provides the following –     

o  Written results, referral instructions, and an explanation of blood pressure levels given to each participant with individualized counseling, including advice about the interval of time recommended when the participant should be checked again.    

o  Utilizes the recommendations in the Fifth Report of the Joint National Committee on Detection, Investigation and Treatment of High Blood Pressure, March 1994.    

o  Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically accurate information.    

o  Relationship of high blood pressure (BP) and other risk factors, like family history, use of tobacco, high fat and unhealthful diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other illnesses.

o  Definition and causes of high blood pressure.

o  Importance of following prescribed treatment.

Health risk screening programs must be carried out on a one-on-one basis by trained health care specialists. Health risk measures should include the following -

o  Blood pressure (BP) measurements – at least two blood pressure (BP) measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.    

o  Blood pressure treatment status – ascertain whether the participant is under a physician’s care, on any medication, on a prescribed diet, or any other kind of treatment for hypertension.    

o  Blood cholesterol measurement – sum cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the customer, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.    

o  Cholesterol treatment status – ascertain whether the patron is under a physician’s care, on any medication, on a prescribed diet, or any other type of treatment for high cholesterol.    

o  Obesity – utilize an accepted method for estimating obesity. for example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use BMI.    

   o Identify people  20% or more above their ideal weight.

o  Smoking status – assess whether the participant currently smokes cigarettes, whether the customer has quit or never smoked, and the number of cigarettes smoked/day.    

o  Exercise habits – screening questions could  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.    

o  Diabetes – whether the patron has diabetes, and whether or not it’s currently under control. A blood glucose might  be also done via finger stick and desk top analyzer. A few manufactures make available cassettes which include cholesterol and glucose measurements.

o  Cerebrovascular disease or occlusive PVD – ascertain when the client has had a stroke or other type of blood vessel disease.

o  Family history of cardiovascular disease – ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death because of heart disease before age 55.

o  Coronary heart illness – ascertain when the client has had a heart attack or other type of coronary heart illness.

o  Stress – participant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions analyzing  levels of stress are available from the Worker Health Program.

o  Participant release form (see forms) – A release form is required in which the participant authorizes the wellness program to draw blood for testing to send information to the participant’s medical care provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.

o  Participant interest survey – if an assessment of interest has not been gathered previously, the screening activity must assess levels of interest in health promotion programs such as –  weight control, use of tobacco cessation, fitness or exercise, stress management, nutrition, self-care, cholesterol control.

o  Health education messages – the screener must review with the participant his/her identified health risks and what they mean to the participant’s overall health, and give the participant a written record of the blood pressure, total cholesterol, and any other physiological measures taken.

o  Referral of participants for treatment – participants with elevated risks should be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized guidelines for such referral.

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

Wellness Program directors or providers should have a background in wellness programming and a expert health-related degree or certification.    

They should have professionalise in content areas, planning, promotion, administration, examination, and ability to grow a wellness program and tailor the wellness program to the worksite.   

Health Promotion Program providers should have a quality assurance program for analyzing  the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.   

An overall policy statement ought to be available from directors and health promotion program providers addressing the following issues -

o  Assurance of confidentiality of health data,

o  referral to health and medical care for at-risk participants,

o  follow-up with referred participants and those at-risk,

o  health promotion program analysis on process and outcomes,

o  organization of the workplace for promotion of wellness and changes in corporate culture.

A clear contract or letter of agreement for services must be provided.