This last blog of the semester is about strategies for increasing consumer participation in the policy process. I originally felt like I was going to be repeating myself quite a bit from last week, because the general strategy of engagement and motivation to increase participation in policy processes is also in part what will sustain innovative environments for policy change. When considering employee participation in workplace wellness program components, and especially development of strategies that promote decreased sitting time, there has to be some general connection and understanding that 1) sedentary behavior in the workplace is important enough to demand policy attention, 2) employees can be empowered to participate in the solution 3) all possible solutions can be freely put out on the table for consideration 4) people can still be free to participate or not. An additional point I’d like to add also is the corollary to point #4 that if you do not participate when having an option or opportunity to do so, you really can’t complain when the solutions don’t include you. We all have known co-workers (or perhaps ourselves at times) that are uninvolved, but are the first to gripe and moan about why something in their workplace isn’t working well. So, I just never want to be “that guy”.
Much has been written about employee participation (or lack thereof) in voluntary workplace wellness programs—it was identified as one of the key reasons that many of the programs aren’t successful. While there are some great, innovative programs out there, in many small businesses, there has been a reticence to create expensive programs or those involving up front investment when company’s operating margins are already thin, and there is not much current evidence of program success. A review of worksite health promotion interventions conducted by Kahn-Marshall and Gallant found inconclusive evidence that implementation of environmental and policy changes alone were successful, but more promising results were found when the policy and environmental changes were instituted in combination with individually focused health behavior change strategies (Kahn-Marshall & Gallant, 2012).
What does this even mean? Well, first of all, it means that no matter what “policy” is implemented, people still will not change their health behavior unless they are personally motivated to do so, feel some engagement in the process, and believe that what they are embarking on addresses their own life circumstances, needs, and priorities. Also, the RIGHT problems need to be solved, and perhaps employees are in the best position to tell what those real problems are, and how to solve them. Motivation is the key to consumer participation at any level—as well as education about the problem, and social network (workplace and other) support.
One of the main reasons I am researching the science of sitting and sedentary behavior as opposed to physical activity promotion is that the preponderance of evidence is showing that despite the availability of 30,000 gyms and health clubs, fitness bands, and commercialization of fast “weight loss” plans, Garcinia Cambogia (you can lose weight just taking a pill, doing NOTHING!), reality weight loss depicted in “The Greatest Loser”, our society is still sitting too much, and getting fatter, and sicker by the decade. Also, unfortunately we have almost developed too many electronic and technological advances for our own good (health), which contributes to our general lack of activity as a society—convenience has become engrained in our culture as a general timesaver–but convenience is slowly killing us.
Physical activity and exercise takes actual intent, and actualized EFFORT–a certain degree of motivation, and unfortunately many people just don’t like to “exercise”, say they don’t have time, or there are other ‘barriers”, and will find many other excuses to not exercise. Health behaviors are impacted by one’s motivation, just like activating intent to engage in workplace wellness programs and policy processes. Leaders and employers can help increase employee engagement and personal motivation to change their health behavior as well as be involved in policy change processes by modeling good practices, and demonstrating to employees that their ideas and preferences are considered, and make a difference.
Despite the well-documented scientific knowledge that sitting too much is REALLY bad for you, almost all of the health promotion programs, federal and state included, have chosen specifically NOT to address sedentary behavior in their own suggestions or strategies presented to workplaces for worksite health interventions. For example, the National Healthy Worksite has lots of training materials for employers, with intervention strategies taken directly from the CDC Worksite Health Scorecard.
It is a very nice boilerplate for organizations and employee worksite wellness teams to use in building their own programs. It is comprehensive, with one key exception: There is NO MENTION of strategies to decrease sedentary behavior in the workplace. The strategies address the following topics:
- Organizational supports
- Tobacco
- Nutrition
- Physical Activity (education and promotion of exercise)
- Weight Management
- Stress Management
- Depression
- High blood pressure
- High Cholesterol
- Diabetes
- Heart attack and Stroke
- Lactation support
- Occupational Health and safety (no mention of desk ergonomics here)
- Community Resources
I think what is happening is that because the state and federal programs aren’t addressing sedentary behavior yet, and there are all of these program planning templates out there available for general use, and the workplaces are using these as a template, without asking employees if there is anything ELSE that is important to THEM, as well as providing some good evidence based education to people about what happens when people sit too much. Thus, workplaces themselves aren’t perhaps considering something like standing desks or other workplace interventions that are “outside the CDC box” for their employees, but could be fairly straightforward to implement with provide a tremendous benefit, although there is an upfront cost.
Once again, you might think I have seriously digressed from discussion of strategies to encourage consumer participation in the policy process–but there was a method to my madness–The bottom line word to employers–consumers aren’t going to participate in policy processes to improve workplace health until they own the problem—until it is personally theirs. In order to “own” the problem, they have to identify a GAP between what they want, and what currently IS (available), and feel like they can truly have a voice in implementing that change. This means that you, the employer have to ASK, and then LISTEN. Social support from work leadership, co-workers and others, empowering education, and motivational support are key intervention strategies to motivate behavior change, even related to getting people more involved in workplace health policy. Ironically these strategies are also key constructs in the Wellness Motivation Theory, which conceptualizes motivation as “empowering potential”, which uses individuals unique needs, priorities, and personal health goals in initiating and sustaining health behavior change (Fleury, 1991).
References:
Bankoski, Andrea, et al. Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes care 34.2 (2011): 497-503.
Centers for Disease Control and Prevention. The CDC Worksite Health ScoreCard: An Assessment Tool for Employers to Prevent Heart Disease, Stroke, and Related Health Conditions. Atlanta: U.S. Department of Health and Human Services; 2014.
Centers for Disease Control and Prevention & Viridian Health Management. Worksite Health 101: Making the Case for Worksite Health, Healthy Arizona Worksites training module, accessed on April 20, 2015.
Fleury, J. D. (1991). Empowering potential: A theory of wellness motivation. Nursing Research, 40(5), 286-291.
Kahn-Marshall, J. L., & Gallant, M. P. (2012). Making healthy behaviors the easy choice for employees: A review of the literature on environmental and policy changes in worksite health promotion. Health Education & Behavior, 39(6), 752-776.
Levine JA, Vander MW, Hill JO, Klesges RC.). Non-Exercise Activity Thermogenesis: The Crouching Tiger Hidden Dragon of Societal Weight Gain. Arteriosclerosis, Thrombosis, and Vascular Biology, American Heart Association, 729-736. 2006.
Levine JA. Non-exercise activity thermogenesis—liberating the life-force.Journal of Internal Medicine, 2007; 262(3), 273-287.
WellOptima: Optimal Wellness 