Review of Workplace Health Program

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Workplace Health and Physical Activity Program Review

The Department of Sport and Recreation

FINAL REPORT with appendices

October 2005

Timothy Ackland PhD

Rebecca Braham PhD

Vanessa Bussau BSc Hons

Kerry Smith Teach. Cert.

J. Robert Grove PhD

Brian Dawson PhD

Fiona Bull PhD


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ACKNOWLEDGEMENTS This report is a project of the Western Australian Department of Sport and Recreation, with support from the Premier’s Physical Activity Task Force, the WA Department of Health, the Disability Services Commission, the Department of Consumer and Employment Protection, the WA Chamber of Commerce and Industry, the WA Department of Education and Training, Fitness WA, Unions WA, and Active Alliance WA. The Review was undertaken from July – October 2005 under contract to The University of Western Australia. Special thanks must go to the various individuals and organisations who participated in the interviews, case study sessions and the survey. Your input was particularly valuable, and your enthusiastic participation much appreciated. University of Western Australia Research Team – Associate Professor Timothy Ackland (Project Director), Dr Rebecca Braham, Ms Vanessa Bussau, Mrs Kerry Smith, Professor J. Robert Grove and Associate Professor Brian Dawson. Project Officer – Ms Vanessa Bussau Consultant – Dr Fiona Bull (Loughborough University, UK) Department of Sport and Recreation, Western Austral ian Government Project Manager – Ms Lauren Cowan (Senior Policy Officer) Funding Provided by Department of Sport and Recreation, Western Australian Government Suggested Citation Ackland, T., Braham, R., Bussau, V., Smith, K., Grove, R. and Dawson, B. (2005). Workplace Health and Physical Activity Program Review – Report. Perth, Western Australia: Department of Sport and Recreation, Western Australian Government.


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CONTENTS ACKNOWLEDGEMENTS 1

CONTENTS 2

LIST OF TABLES 4

LIST OF FIGURES 5

EXECUTIVE SUMMARY 6

1. INTRODUCTION 11

2. METHODOLOGY 11

3. LITERATURE REVIEW – KEY POINTS 12

3.1 Positive Outcomes from WHPA Programs 12

3.2 Successful Programs and Strategies 13

3.3 Potential Barriers 13

3.4 Improvements Required 13

4. WHPA SERVICE PROVIDERS 14

4.1 Sample 14

4.2 Service Provider Characteristics 14

4.3 Services Provided 15

4.4 Convincing Organisations to Implement a WHPA Program 15

4.5 Facilitators for WHPA Program Success 16

4.6 Barriers to Successful Delivery of WHPA Programs 16

4.7 Current Issues and Challenges for WHPA Service Providers 17

4.8 Suggestions for Improvements 18

5. COMPANIES AND ORGANISATIONS 20

5.1 Sample Demographics 20

5.2 Current WHPA Programs 21

5.3 Attitudes 27

5.4 Barriers 29

5.5 Incentives 31

5.6 Organisational Commitment 32


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6. CASE STUDY REPORTS 34 6.1 Case 1 – Large Government Authority with Current WHPA Program 34

6.2 Case 2 – Mid-sized Company with ‘no’ WHPA Program 35

6.3 Case 3 – Mid-sized Local Government Organisation with Current WHPA Program 35

6.4 Case 4 – Large Government Authority with a Long-term WHPA Program 36

6.4 Case 5 – Large Commercial Company with a Comprehensive WHPA

Program 37

6.6 Case 6 – Small Commercial Business with no Formal Program 38

7. SUMMARY 39

8. RECOMMENDATIONS 41

GLOSSARY 46

REFERENCES 47

APPENDIX A – Survey and Associated Documents

APPENDIX B – Expanded Literature Review


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LIST OF TABLES 1. Number of survey respondents by organisation type and size (n=130) 20

2. Organisation location by survey respondents’ type (n=130) 20

3. WHPA programs by survey respondents’ worksite type and size (n=130) 21

4. Survey respondents’ view of the importance of WHPA programs 27

5. Who should be responsible for promoting health and physical activity? 27

6. Top 5 responses cited as barriers for contemplating, planning and/or establishing WHPA programs 29

7. Bottom 5 responses cited as barriers for contemplating, planning and/or establishing WHPA programs 29

8. Top 5 barriers for contemplating, planning and/or establishing a WHPA program by organisation size 30


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LIST OF FIGURES 1. A description of survey respondents by workplace activity 21

2. The variety of activities included in respondents’ WHPA programs 22

3. The means by which various WHPA program activities are implemented 23

4. On whose time are the various WHPA program activities run? 24

5. Sources of information for WHPA programs 25 6. Percentage of workforce participating in WHPA programs by organisation type

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7. Who should pay for the cost of WHPA programs? 28

8. Top 5 incentives to implement or expand a WHPA program 31

9. Respondents’ opinions and subjective company ratings on factors relating to successful implementation of WHPA programs 32


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EXECUTIVE SUMMARY Introduction Researchers from The School of Human Movement and Exercise Science at The University of Western Australia were engaged to review Workplace Health and Physical Activity (WHPA) programs and report the findings to the Department of Sport and Recreation. The aim of the Review was to provide baseline and background information to support the development of a range of strategies to promote and facilitate the take-up of WHPA programs in Western Australian workplaces (small to large organisations, both non-government/commercial and government). The Review focussed on the organisational commitment (including policy, strategic, structural and management factors) to establish a better understanding of the characteristics of successful WHPA programs. The findings of this Review will support the development and implementation of the Premier’s Physical Activity Taskforce proposed Workplace Healthy Lifestyles Initiative. Methodology Data were collected for this Review in three phases. Initially, a series of interviews with WHPA service providers (n=12) was conducted to draw upon their knowledge of the industry, and to gather feedback on elements of the survey. A comprehensive survey instrument was developed, in consultation with members of the Reference Group, and sent to various organisations in this state. Finally, representatives from several organisations (n=6) were selected for focus group interviews. Survey and Case Study Methods and Sample Owners, senior managers and human resources personnel from over 300 organisations were invited to participate in a survey shown in Appendix A. Completed surveys were received from 130 participants, with the majority (37%) from large organisations in the government and commercial sectors, but with good representation from small non-government businesses (21%). Follow-up case studies were also conducted with key personnel from representative organisations in order to provide more detailed responses to the questions posed in the survey. Literature Review A comprehensive review of the literature of WHPA programs was conducted, with the following key findings elicited:

• Positive Outcomes – WHPA programs may increase health awareness and strengthen motivation to change behaviour. Areas of positive improvements among employees include physical activity, nutrition, body composition, smoking cessation, and cardiovascular disease and type 2 diabetes risk. Highlighted economic benefits include reduced absenteeism, workers compensation and workplace costs, as well as a potential improvement in productivity.

• Successful Programs – Programs that adopt a comprehensive approach with strategies that alter the organisational structure and culture of the workplace are most successful in achieving positive outcomes. These programs are typically multidimensional, interdisciplinary, holistic and based on best practice in workplace health promotion.

• Potential Barriers – Several common barriers to successful WHPA programs were identified and these included economic pressures, lack of time and resources, other priorities, lack of employee participation, and problems of trust between employee and employer.

• Improvements Required – Numerous improvements were recommended for the better promotion and implementation of WHPA programs that involve all stakeholders, details of which are included later in this report.

Interviews with Service Providers


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There exists a wide range of WHPA service providers (from small locally based companies to larger national groups) who provide a variety of WHPA programs in Western Australian organisations. Through interviews with a number of service providers, the following issues emerged as challenges to be addressed:

• The need to increase awareness of the benefits of WHPA programs within industry;

• Educating organisations on the range of available options, and the cost-benefit of effective programs as opposed to the ‘token effort’ category;

• Organisations need to prioritise health and physical activity given that compliance is not enforced through standards or legislation;

• Government support is needed to help facilitate the implementation of programs across different organisation sizes, types, and locations;

• Insurance and liability issues need to be addressed; and

• Unprofessional service providers and poor practices need to be minimised either through legislation or agreed industry standards.

Existing WHPA Programs Half of the organisations surveyed currently had in place some form of WHPA program, with the majority being large employers (500+ employees). Small organisations, especially those with less than 50 employees, were less likely to offer a program. The most common activities offered with these programs include: employee support programs, health promotion seminars, social activities, injury prevention/rehabilitation, pre-employment and regular health screenings, individual counselling, and physical activity. Those responsible for managing WHPA programs in organisations (e.g. human resources or occupational health and safety managers or designated program managers) draw information from many sources, such as external consultants/service providers and internal staff with appropriate health and physical activity promotion training. Health promotion agencies, as well as government agencies and departments, also play an important role in providing support material for these programs. Participation rates in WHPA programs are skewed in favour of employees in the private/commercial sector, while less than 50% of government and local government employees elect to participate when programs are offered. The average budget for WHPA programs ranged from $500 to $500,000 per annum (reflective of the varying sizes of organisations reviewed). The Priority Given to WHPA Programs The majority of survey respondents (94.2%) placed a moderate to high importance on the priority of WHPA programs, but many (64%) thought their company or organisation gave this a lower priority. Most participants rated the employee as being primarily responsible for their own health and physical fitness (99%), but that the employer (97%), union groups (66%), and the government (93%) had at least some role to play. According to survey respondents, the most important benefits of a WHPA program were improved: mental alertness, energy and motivation, health, work quality, and morale. From the perspective of our respondents, the important benefits were primarily personal and social, rather than organisational.


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Most respondents favoured a model whereby the employee and employer shared the cost of WHPA programs. Less than 20% were in favour of the organisation bearing all the cost. Barriers to Program Implementation or Expansion The five most common barriers were cited as: time constraints, other priorities, financial cost, lack of employee interest, and lack of suitable on-site facilities (the latter being more important for smaller organisations). Incentives for Program Implementation or Expansion Whilst a range of factors impact on program implementation, the attitudes of key people within an organisation (employee demand and employer support), financial constraints, as well as a firm and widely communicated policy, are important within-company factors. The most widely stated external factor also related to budgetary constraints, with respondents highlighting financial subsidies from Government as a possible important motivator. Organisational Commitment A clear mismatch was evident between the participants’ opinions regarding the importance of organisational commitment and that which they perceive exists within their own company or department. The key points made in this regard were:

• Policy – Organisations should document and communicate a corporate policy that relates specifically to employee health and physical activity;

• Strategic – Organisations should integrate WHPA programs into existing structures and processes, and regularly assess the economic, health, and employee satisfaction benefits that accrue from the program;

• Structural – Programs that are regularly updated and refreshed should be made available to all staff, who are to be supported by their supervisors and encouraged by employers to find a healthy balance of family and working life. Organisations need to provide important facilities such as change rooms and lockers;

• Management – WHPA programs need to be managed by key people in an organisation, with the support of senior management. The elements and objectives of any program must be communicated to all staff, who need to be consulted in respect to program design and delivery; and

• Financial – Appropriate financial resources (budget commitment) need to be made available to conduct effective programs and activities.

Recommendations Education, Awareness and Advocacy:

1. That improved education, communication and advocacy be provided to Western Australian workplaces on the economic, social and health benefits of WHPA programs.

2. That a summit, forum, or conference be conducted involving key stakeholders to facilitate a

dialogue and networking opportunities among employer organisations, government policy makers, researchers, health promotion agencies and other key groups.

Promotion of Best Practice:

3. That the elements and characteristics of successful WHPA programs and best practice case studies be promoted widely throughout Western Australian workplaces.


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4. That consideration be given to creating an awards/recognition process to give due recognition

to progressive organisations that have implemented successful WHPA programs. A Co-ordinating Entity:

5. That an entity be established to enquire, coordinate, lobby, educate, and promote WHPA programs to employers and their workforce in Western Australia. Positioning of the WHPA initiative must be broader than just health, or just physical activity, and so this entity ought to bring together all key stakeholders with links to the Department of Sport and Recreation, the Health Department, the Occupational Health and Safety Commission, and the Premier’s Physical Activity Taskforce.

6. Establish partnerships to provide incentives for organisations to plan, implement and expand

WHPA programs (e.g. insurance, financial subsidies) Creating Incentives and Removing Barriers:

7. That the Western Australian Government explore opportunities to provide incentives and remove barriers for organisations to plan, implement or expand WHPA programs, including: − Establish a grants scheme of seed funding; − Review workers compensation insurance rules; − Introduce financial incentive schemes; and − Negotiate with the Federal Government on Fringe Benefits Tax barriers.

Regional, Rural and Remote Communities:

8. That current information, resources and consultancy support be provided to regional, rural and remote communities/organisations through a range of strategies, including: − Development of innovative, targeted education and training strategies; and − Dissemination of practical initiatives to facilitate WHPA program promotion in these areas,

via the engagement of local facilities and services. Small Business:

9. That practical initiatives be developed and disseminated to facilitate WHPA program promotion in small businesses via the creation of strategic partnerships, and engagement of local facilities and services.

Further Research: 10. That further research/investigation into the efficacy of various WHPA program models for

organisations of differing demography be conducted within the Western Australian context. 11. That further research/investigation be conducted in regard to employees as the recipients or

potential recipients of WHPA programs in order to complete this review process. WHPA Service Providers:

12. That the establishment of a WHPA service industry representative body (with functions to formulate minimum professional standards for training and education, code of ethics and best practice principles, accreditation and registration schemes for individuals and service provider organisations) be investigated with service providers.


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1. INTRODUCTION The School of Human Movement and Exercise Science at The University of Western Australia was engaged to review Workplace Health and Physical Activity (WHPA) programs and report the findings to the WA Department of Sport and Recreation.

The aim of the Review was to provide baseline and background information to support the development of a range of strategies to promote and facilitate the take-up of WHPA programs in Western Australian workplaces (small to large organisations, both non-government/commercial and government). The Review focussed on the organisational commitment (including policy, strategic, structural and management factors) to establish a better understanding of the characteristics of successful WHPA programs. The findings of this Review will support the development and implementation of the Premier’s Physical Activity Taskforce proposed Workplace Healthy Lifestyles Initiative. Specifically, the Review sought to establish the following:

• Summary of the benefits of WHPA programs from existing research literature;

• An understanding of the characteristics of existing WHPA programs in a variety of organisations;

• An understanding of the barriers to organisations establishing and managing WHPA programs, and evidence on how these barriers may be overcome or are currently being addressed;

• An understanding of the organisational commitment (including policy, strategic, structural, management and financial) that is required to support the establishment and ongoing management of WHPA programs across the continuum from small to large operations;

• Provision of evidence to support the promotion and development of a WHPA program (including resources, policy and program implementation); and

• Recommendations on strategies to progress promotion and increased take-up of WHPA programs in Western Australian organisations.

2. METHODOLOGY In order to achieve the above Review outcomes, the following methods were undertaken.

• Feedback was sought from the Industry Reference Group, convened by the Department of Sport and Recreation, to oversee the Review on the structure and focus of the review methodology including: priority areas for investigation, definitions, survey refinement and focus areas.

• A comprehensive review of the available literature was conducted, together with consideration of previous surveys on related topics – most notably the 1991 National Heart Foundation survey.

• The majority of Western Australian WHPA service providers were interviewed to understand the variety of WHPA programs offered and/or taken up by Western Australian organisations.

• Pilot interviews were conducted with human resources personnel and rehabilitation coordinators of several organisations to help with the formulation of the survey questions.

• Discussions with members of the reference group helped to refine the survey questions.

• Targeted individuals (executive and program managers) from more than 300 companies and organisations were asked to respond to this survey (with a mix of government, non-


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government and not-for-profit/large, medium and small/and metropolitan, regional and remote organisations targeted).

• Case studies for selected groups were conducted to provide further clarity on the key issues identified through the survey and to illustrate the characteristics of different types of WHPA programs in a range of organisations (including government, non-government, and not-for-profit sectors).

3. LITERATURE REVIEW – KEY POINTS An extensive review of the literature was conducted to establish some understanding of the efficacy of WHPA programs. Listed below are the key points.

3.1 Positive Outcomes

• Workplace health promotion programs have the potential to actively influence health behaviour by increasing awareness of health and increasing motivation to change behaviour 1-4.

• Evidence suggests positive improvements in the health of employees as a result of WHPA programs including: − an increase in physical activity3-8 − improved nutrition and decreased body fat levels3-6, 14 − smoking cessation 5,6 and alcohol moderation4,6,9,10 − substance abuse10-13 − improved cholesterol5,6 − decreased blood pressure14 − reduced stress levels5,6,15 and − reduced risk of lifestyle diseases such as type 2 diabetes and cardiovascular disease.15

• Economic benefits to organisations include: − reduced absenteeism1,2,6,15-21 − a decrease in workers compensation 18, 19 − a reduction in workplace costs6,15,18,21 and − a potential increase in productivity.1,2,6,18,22

Improvements in health as a result of WHPA programs will result in significant savings to the state in terms of reduced health care costs. 21

• Comprehensive and integrated WHPA programs improve the work environment with enhanced working conditions and safety6,20,21, decreased accidents and injuries 6,15,21 together with reduced job stress.6,21

• Implementing WHPA programs contributes to a positive corporate image6 and improves human resources outcomes that can strengthen overall workplace performance.6 These include increased job satisfaction2,6,23, enhanced motivation, greater commitment, loyalty and improved morale of employees.15,21,23 There is also evidence to suggest benefits such as improved recruitment and the retention of quality staff, and lower staff turnover. 6,23


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3.2 Successful Programs and Strategies

• Successful WHPA programs adopt a comprehensive approach to workplace health with strategies such as changing the organisational structure and culture of the workplace24,27, highlighting opportunities for healthy behaviour and providing a supportive environment.24,25,27-

29 Developing organisational policies that prioritise workplace health and improving the physical workplace environment can help to establish a positive culture of health in the workplace.24,25,27

• Successful programs adopt a multidimensional, interdisciplinary, holistic approach26,30-32, implement effective program strategies and utilise information on best practice in workplace health promotion.24,33

• Some examples of successful strategies in the planning phase include: − gaining senior and middle level management support24-26,30,31 − aligning programs with strategic business objectives25,26,30 − involving employees from all levels of the organisation in the planning process to

encourage a sense of program ownership25,26,30,31 − integration of program with organisation goals and policies25,26,30,31 and − using an interdisciplinary team of experienced, knowledgeable staff.26,27,30,31

• Effective ongoing communication24-27,30,31, successful recruitment and participation strategies24,25,27,30,31,34, together with a consistent follow-up process25,27,30,31, are essential for encouraging behaviour change and program success. Organisations should conduct regular and comprehensive evaluation25,27,30,31 and provide feedback25,27,30,31 and evidence of success to all levels of staff 27,30,31 to enhance the success of the program.

3.3 Potential Barriers

• Major disadvantages of the worksite setting that need to be acknowledged and overcome when planning and implementing workplace health programs include: − economic pressures21,30,35 − lack of resources21,30 − other priorities21,30 − difficulties with evaluation30 − size of the workplace30 − a lack of participation21 − lack of time21,30 and − problems of trust between employees and employers.30

• Organisations should strive to overcome these barriers with innovative and proactive strategies.30,36

3.4 Improvements Required

• The World Health Organization’s global healthy work approach calls for the development of a comprehensive approach towards the promotion of health in workplaces.37 There is a need to involve key stakeholders such as health promotion practitioners, organisations, researchers and government policy makers in a more integrated approach.21,24,38-43


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• The formation of networks and partnerships should be encouraged together with the development of health promotion infrastructure. 21,43,44 Links between the workplace and external settings such as the community should be created.21,42

• The development and implementation of supportive government policies and legislation (e.g. changes to fringe benefits tax, insurance) to encourage the uptake of workplace health promotion programs by organisations.21,44,45

• Development of ‘best practice’ guidelines incorporating information from key stakeholders and expertise from practitioners in the workplace to understand which health promotion strategies, programs and processes work best in particular organisations.24,38-41,43,44

• More scientifically rigorous research in the field of workplace health promotion is required as current research is limited. This is due partly to methodological problems and practical difficulties of conducting research in this setting.21,36,46,47

• The workplace provides a unique point of access to most adults15,30, including those subgroups with an increased risk of morbidity and mortality, such as those with less education, those in sedentary jobs and middle-aged males48-50. As the rate of obesity and inactivity increases in Western Australia42, together with national rates of lifestyle disease51, encouraging health promotion in the workplace setting is a promising approach to improve the health of Western Australians.

4. WHPA SERVICE PROVIDERS

4.1 Sample Companies that currently deliver health promotion services in workplaces across Western Australia were invited to participate in interviews and a focus group session to discuss key issues pertaining to WHPA program delivery. These companies (n = 12) provided us with an understanding of the programs currently offered to organisations, together with valuable insight into various issues relevant to WHPA promotion. The key findings from these sessions are summarised below.

4.2 Service Provider Characteristics The following characteristics describe WHPA service providers within the Western Australian market:

• Service providers range in size from small, Western Australian based companies to larger national companies;

• Health professionals involved in the delivery of WHPA programs include exercise physiologists, physiotherapists, dieticians, occupational therapists, psychologists, counsellors, naturopaths, doctors, nurses, diabetes educators and life coaches, as well as masseuses and other alternative therapists;

• Qualifications of service providers and their staff differ between companies;

• Service providers are employed on a range of terms from full time to casual, or in a consultancy or contract roles with organisations; and


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• Service providers contract to a range of clients from both the government and private sectors with employee numbers ranging in size. However, WHPA programs are more common in larger organisations.

4.3 Services Provided WHPA programs vary from ‘one-off’ health and/or physical activity promotions to comprehensive, ongoing intervention programs that are continually evaluated and improved. In the current market it is quite popular to provide only health screening services, although it is generally recognised that intervention programs with ongoing follow-up are more successful. Some companies offer intervention programs to all employees while others choose to target high-risk individuals with particular health issues (e.g. weight-loss programs). Most WHPA programs include a selection of activities such as individual counselling, group education seminars, physical activity sessions and screening of various health and environmental risk factors (e.g. cholesterol, blood glucose levels or questionnaires on topics such as diet, stress). Injury prevention and rehabilitation are often an important component of WHPA programs, as are social events, team building, leadership activities and employee assistance. Contracted allied health professionals provide education seminars on various health topics, or provide individual consultations. The use of reference tools such as the internet is increasing as technology improves. However, opinions on their efficacy is mixed, with few sites offering specific program suggestions or interventions, and most simply providing generic information. Organisations often provide infrastructure and facilities to encourage health promotion together with initiatives that encourage active transport to and from work (i.e. walking and cycling). Furthermore, many organisations offer subsidies and rebates to staff (e.g. subsidised Pilates classes, shoes, gym membership, smoking patches) in an attempt to promote a more active lifestyle.

4.4 Convincing Organisations to Implement a WHPA Pr ogram The service providers indicated that there were a range of motivating factors regarding WHPA promotion and advocacy which impacted on an organisation’s decision to implement and/or maintain a program, from:

• Internal – within company interest (this generally has the most successful outcomes); to

• External – service providers having to explain the benefits of WHPA programs to new potential customers.

Many organisations decided to prioritise a WHPA program after an increase in injury rates, a particular incident, or reports of serious health problems amongst their employees. Other factors that helped to facilitate the uptake of WHPA programs included interest from individuals within the workplace, senior and middle management support, together with company policies and goals that prioritise employee health and well-being.


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The service providers interviewed indicated the following were key ‘selling points’ of WHPA programs: maximising performance, reducing injuries and absenteeism, and improving quality of work. Although the numerous benefits (health, social and physical) of WHPA programs are well documented, it was suggested that a combination of academic research and carefully chosen local statistics demonstrating success of similar programs was found to be the most successful way of convincing potential client organisations. Service providers indicated that many organisations also placed importance on being viewed as a caring employer of choice, thereby enhancing corporate image and improving staff morale. Finally, offering a quality service at a competitive price where clients can see a return on their investment was considered essential. While service providers indicated that a wide variety of marketing strategies were utilised to attract new client organisations, many mentioned that they found it difficult to determine who best to approach within a company when negotiating a WHPA program concept. As WHPA programs are not generally authorised and coordinated by a single entity, service providers noted that a successful bid may need to be pitched at various levels including those in human resources and senior management, as well as the occupational health and safety personnel. Many service providers were approached by organisations to establish a WHPA program after referrals or testimonials from other worksites that have experienced successful programs. It was also common for key individuals within organisations that have an interest in health and physical activity to play an important role in instigating a WHPA program after moving to a new organisation without a program.

4.5 Facilitators for WHPA Program Success The service providers indicated that most WHPA program success was achieved through the following facilitators (not in any particular order):

• Comprehensive, innovative, creative, and well-organised programs;

• Programs that are aligned with strategic business objectives and integrated into organisational goals and policies;

• Middle and senior management support and involvement;

• A sense of ownership and involvement in program development from employees at all levels;

• Motivated, knowledgeable, organised program staff with good communication skills;

• The use of an interdisciplinary team to create a multidimensional, holistic approach;

• Good relationships developed within the organisation and among key staff (e.g. health and safety team).

• Having in place structured key performance indicators and agreed methods for measuring success; and

• Constant evaluation and improvement, with ongoing feedback to participant individuals and management.


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4.6 Barriers to Successful Delivery of WHPA Progr ams The service providers indicated that the following barriers were commonly experienced in the delivery of WHPA programs:

• The cost of the program – Organisational budget restrictions or nil budget allocated for the conduct of WHPA programs. WHPA programs were not prioritised and were seen as an ‘optional extra’ or a ‘luxury item’ that could be eliminated when there was a shortage of funds.

• Limited management and organisational support – Lack of understanding by middle and senior management personnel about WHPA programs and their potential impacts/benefits, hence a lack of priority afforded to WHPA programs.

• Lack of time – Linked with priority, lack of time was often cited as a barrier to WHPA implementation. This was especially evident in high risk companies that were focussed on high productivity, tight margins, and who tended to minimise the opportunity for staff breaks.

• Logistics or lack of basic facilities – Access to appropriate facilities and infrastructure was a problem for smaller worksites and regional centres where the size and location of the workplace made it difficult to deliver a comprehensive program.

• Difficulty in quantifying the impact – Establishing monitoring and evaluation systems for the accurate quantification of success was difficult when organisations were unwilling to provide accurate data (e.g. use of participation statistics, injury rates, workers compensation claims, absenteeism records). Concern was also expressed that injury statistics were often misleading and not representative of the true rates.

• Going through the motions – Organisational implementation of a program simply to improve corporate image and industrial relations, where the quality of the WHPA program was not seen as a priority. Service providers indicated that some organisations appeared only interested in ‘ticking the boxes’, and that creating meaningful change was not seen as important. Another major problem is that some companies do not want to know about individual or endemic problems because they may be obligated to address these problems as part of their duty of care.

• Problems with liability and insurance – Organisational belief that participation in WHPA programs carried the added risk of injury for their workforce.

4.7 Current Issues and Challenges for WHPA Service Providers To assist in the establishment of a way forward for WHPA program promotion, service providers identified the following key issues and challenges to be addressed:

• There is a need to increase organisational and executive management awareness and recognition of WHPA program benefits;

• Improved promotion and education is required for organisations regarding WHPA implementation, with various options made available to alleviate the problem of organisations not knowing what they want and/or not understanding the levels of service that could be provided;

• Lack of understanding by organisations of what makes a successful WHPA program (e.g. service providers indicated that effective WHPA programs involved more than just screening – with intervention, ongoing follow-up, and individual consultations being cited as important, despite the increased expense);


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• Service providers have difficulty retaining quality staff due to limited career opportunities;

• Improved use of technology tools to support program delivery (i.e. internet and intranet modalities, etc); however, service providers stressed the importance of individual consultations and one-on-one discussion and feedback sessions;

• The priority afforded to WHPA programs by organisations – many of which will not prioritise health and physical activity unless compliance is enforced through standards or legislation;

• The role of Government in supporting/facilitating the implementation of WHPA programs;

• Insurance and liability issues; and

• The existence of unprofessional service providers, which could give the industry a bad reputation. The use of poorly qualified staff and unprofessional practices needs to be minimised through either legislation or agreed industry standards.

4.8 Suggestions for Improvements Having experienced the difficult growth of this fledgling industry, the service providers were keen to offer the following suggestions for improvements within their industry.

• The establishment of a government taskforce involving key representative groups to address workplace health and physical activity issues.

• Government support through a range of initiatives such as:

− support and endorsement;

− rebates and subsidies;

− changes to policy and legislation that support workplace health promotion;

− reduced workers compensation premiums if organisations implement WHPA programs;

− changes to fringe benefits tax laws that affect WHPA programs; and

− creating a strong link between worksite health promotion and occupational health and safety.

• Formation of a representative WHPA service industry body that can address issues such as:

− creation of guidelines and a code of ethics;

− accreditation of service providers;

− problems with insurance and liability (lack of insurance companies offering policies relevant to WHPA, often specific restrictions, cover for ‘high risk’ individuals, disparity in charges and premium prices);

− links and affiliation to other peak industry bodies within the allied health fields; and

− staff qualifications and suggested salary scales.

It should be noted, however, that some service providers expressed concern over the structure and potential power of such a body. Further discussion would be required on the level of regulation and enforcement of industry standards required.

• Increased promotion and awareness of appropriate/acceptable qualifications of staff delivering

WHPA programs. People outside the health/physical activity industry often do not understand differences in allied health qualifications.


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• Increased provision of education and training opportunities, short courses and professional

development, and accreditation regimes are required to address the lack of well-qualified staff available to fill WHPA positions.

• Introduction and promotion of an awards scheme to recognise progressive organisations that

implement successful WHPA programs. Media coverage would enhance corporate image and would promote best practice in WHPA programs state-wide. An awards scheme may also be seen as an incentive for organisations to prioritise health and physical activity initiatives in their workplace.

• Recognition and promotion of best practice WHPA programs providing innovative solutions and multidisciplinary approaches to health and physical activity promotion.

• Development of an evidence base to support the promotion of WHPA programs, including:

− Documentation of the work performance benefits attributed to the implementation of successful WHPA programs. This has been found to create more interest than limiting the focus to health and the reduction of disease risk;

− Further investigation of the links to the burden of disease, and the return on investment to both the organisation and society from WHPA programs;

− More comprehensive research in worksite health promotion.

• The creation and promotion of practical initiatives that will facilitate worksite health and physical activity promotion in smaller organisations and regional areas (e.g. the use of community facilities by numerous organisations and utilisation of contractors and self-employed individuals).

5. 5. COMPANIES AND ORGANISATIONS Over 300 organisations were invited to participate in this Review by completing the survey in Appendix A. The survey was sent to the manager or principal of smaller organisations, as well as to both a member of the executive/senior management and the appropriate officer in Human Resources or Occupational Safety and Health of medium to large size organisations. A total of 130 completed surveys were returned. There was an even distribution regarding the role of the respondents within their company. Fifty percent of respondents were OSH or HR managers while almost 42% of respondents were Senior Management/Owner/Director. The remaining respondents were ‘other’ (e.g. Project Officer, Teacher or Staff Development Officer). The majority (59.3%) were not in a position to implement a program without seeking permission and funding from a higher authority.

5.1 Sample Demographics Table 1 displays the demographic data of survey respondents by organisation type and size. The majority of responses (35%) came from large organisations in the government and non-government (commercial) sectors, with good representation from small non-government businesses (20%).


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Table 1. Number of survey respondents by organisat ion type and size (n=130)

Organisation Type Organisation Size Government Local

Government Non-

Government Not for profit

Small < 100 8 (6.1) 2 (1.5) 27 (20.7) 4 (3.1) Medium 100 – 500 9 (6.9) 12 (9.2) 14 (10.8) 6 (4.6)

Large 500 + 17 (13.1) 3 (2.3) 25 (19.2) 3 (2.3)

Responses as a percentage of the total returns (in parenthesis) Most responses were received from organisations whose primary operations are in the metropolitan area (78.5%), with some (13.1%) representing regional employers, and only a minority (7.7%) of commercial operations involving a remotely located workforce (Table 2).

Table 2. Organisation location by survey responden ts’ type (n=130)

Organisation Type Worksite

Location Government Local Government

Non-Government Not for profit

Metropolitan 30 (23.1) 10 (7.7) 50 (38.5) 12 (9.2)

Regional 2 (1.5) 7 (5.4) 7 (5.4) 1 (0.8)

Remote 1 (0.8) 0 (0.0) 10 (7.7) 0 (0.0)

Responses as a percentage of the total returns (in parenthesis) Survey respondents were mainly from the Service industry (38.7 %), though this figure could be higher with the inclusion of the common response - Government as part of the Other category. Good representation was also received from the Mining (15.1 %) and Information/Education (10.7 %) sectors (Figure 1).


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5.2 Current WHPA Programs Survey respondents (n = 130) revealed half (50%) currently run some form of WHPA promotion program for their workforce, with 7% stating that they once had a program, but now do not. The majority of companies who currently run a WHPA program are large employers (>500 employees) (see Table 3) from the mining or service industries with business units located in the metropolitan area. Not surprisingly, smaller companies (especially those with less than 50 employees) were less likely to offer a program.

Table 3. WHPA programs by survey respondents’ orga nisation type and size (n=130)

Organisation Type Government

(+ local government) Non-Government Not for profit

Organisation Size

Yes No Yes No Yes No

Small < 100 1 9 5 22 2 2

Medium 100 – 500 11 10 7 7 3 3

Large 500 + 16 4 19 6 1 2

0

5

10

15

20

25

30

35

40

45

Health

Constr

uction

Manufac

turing

Mining

Retail

Whole

sale

Trans

port

Servic

e

Infor

mation

/Edu

catio

n

Gover

nmen

t

Other

Workplace activity

Per

cent

of r

espo

nse

Figure 1. A description of survey respondents by w orkplace activity


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Among the companies that currently run a WHPA program, the most frequent activities (see Figure 2) included:

• Employee support programs;

• Health promotion seminars;

• Social activities;

• Injury prevention/rehabilitation;

• Pre-employment and regular health screenings; and

• Individual counselling.

Since each of these activities represented less than 12% of the total activities cited by survey respondents, it cannot be concluded that there exists a single activity or group of activities that are commonly implemented in WHPA programs.

0

10

20

30

40

50

60

Pre-E

mploym

ent S

cree

ning

Regula

r Hea

lth S

creen

ing

Regula

r Fitn

ess S

creen

ing

Exerci

se/P

hysic

al Acti

vity

Health

Pro

motion

Semina

rs

Other H

ealth

Pro

motion A

ctivit

ies

Injury

Pre

venti

on/Reh

abilit

ation

Social A

ctivit

ies

Perso

nal D

evelop

ment/L

ife S

kills

Indivi

dual

Conse

lling

Emplo

yee S

uppo

rt

Vaccin

ation

s

Blood D

onatio

nsOthe

r

Type of activity included in the WHPA program

Num

ber o

f res

pons

es

Figure 2. The variety of activities included in re spondents’ WHPA programs


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Figure 3 illustrates the means by which various WHPA activities were implemented by those organisations that currently run a WHPA program. Passive health promotion strategies were commonplace, with the use of printed material and posters used widely for many health promotion activities. An assessment and screening strategy, as well as the use of guest speakers and, to a lesser extent, workshops, is generally employed in regard to areas that focus on exercise and physical activity, nutrition and weight management, specific disease prevention, and injury prevention and management. This strategy is then generally followed up with individual counselling sessions. Individual counselling is also used widely in regard to stress management and goal setting/life skills activities. The workshop and/or group activity approach is favoured for team building and social activities, and topics such as stress management, as well as injury prevention and exercise/physical activity.

10 20 30 40 50

Exercise/physical activity

Typ

e of

act

ivity

Number of responses

s

Other

Guest speakers

Workshops, groups activitie

Individual counselling

Assessment, screening, testing Printed materials & posters

Massage/ alternate therapy

Goal setting/ Life skills

Stress management

Injury prevention/ management

Team building/ social activities

Smoking/alcohol/ drugs

Specific disease prevention

Fatigue management

Nutrition/weight management

0

Figure 3. The means by which various WHPA program activities are implemented


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Time commitment was acknowledged as an important factor in the success of a WHPA program. Figure 4 displays information regarding the general times in which participants engage in various activities for organisations that do currently run a WHPA program. The activities conducted primarily on company time were injury prevention and management, and stress management and mental health initiatives. The activities conducted on shared time between employee and employer were team building and social activities, exercise and physical activity. Massage and alternative therapies were usually undertaken on the participants’ own time.

Those responsible for conducting WHPA programs in organisations (i.e. program, HR or OSH manager) currently draw information from a variety of sources as shown in Figure 5. The most common sources for this information are external consultants (service providers) and staff that are internal to the organisation. Health promotion agencies such as the National Heart Foundation and Diabetes Australia, as well as government agencies and departments such as the Health Department of WA (and others), play an important role in providing support material for these programs.

0 10 20 30 40 50

Act

ivity

Number of responses

Solely on employee time

Partly on company time

Mainly on company time

Massage / alternative

Goal setting / life skills

Stress management /

Injury prevention /

Team building / social

Smoking / alcohol /

Specific disease

Fatigue management

Nutrition / weight

Exercise / physical

Figure 4. On whose time are the various WHPA program activities run?

0 10 20 30 40 50

Act

ivity

Number of responses

Solely on employee time



Massage / alternative

Goal setting / life skills

Stress management /

Injury prevention /

Team building / social

Smoking / alcohol /

Specific disease

Fatigue management

Nutrition / weight

Exercise / physical

Figure 4. On whose time are the various WHPA progr am activities run?


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A comparison of employee participation rates of current WHPA programs in government, local government and private sectors is provided in Figure 6. Participation rates in the non-government/commercial sector were generally higher than those reported in the government sector. For the majority of government and local government organisations surveyed, less than 30% of employees elected to participate when WHPA programs were offered, whereas 14 out of the 30 responses for commercial organisations reported an uptake of 50% or greater. Participation rates were also a function of organisation size, though organisation type appears more influential. When a WHPA program has been offered, less than half of the employees take up that program in 71% of medium-size, and 70% of large-size organisations. Among the few small organisations (n=8) who have a WHPA program in place, more than half of the employees participated in the majority (62%) of these cases. With respect to program success, the majority of companies considered a participation rate of something above 50% (average response = 53.5%) to be indicative of a successful program. If this target was used as the criterion for success, the results in Figure 6 suggest that most WHPA programs (especially those in the government and local government areas) would not be judged successful.

Figure 5. Sources of Information for WHPA programs

0

10

20

30

40

50

60

Inter

nal S

taff

Loca

l Cou

ncil

Privat

e Con

sulta

nts

Gover

nmen

t age

ncies

/dep

artm

ents

Health

Pro

mot

ion A

genc

ies

Health

Insu

ranc

e Fun

ds

Commun

ity H

ealth

Cen

tres

Resea

rch O

rgan

isatio

ns

Emplo

yer G

roup

s

Trade

Unio

ns

Other

Inter

net S

ourc

esOth

er

Sources of Information

Fre

quen

cy


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The budget allocated to conduct WHPA programs was extremely varied between respondent organisations. The average annual budget was approximately $90,000 with a range of responses from $500 to $500,000. As would be expected, WHPA program budgets are related to the size of the organisation. Survey respondents provided the following data in this regard:

• Small organisations – median expenditure = $10,000 (range = $5,000 to $20,000);

• Medium organisations – median expenditure = $30,000 (range = $500 to $400,000);

• Large organisations – median expenditure = $60,000 (range = $3,500 to $500,000). The most common strategy for targeting non-participation in WHPA programs was advertising. For example, program coordinators value the use of newsletters and group emails (37.5%) to encourage participation. Providing positive feedback was the second most common mechanism to target non-participation, with 22% of respondents using this method. Other reported measures included: using well-qualified staff for presentations, offering a wide variety of activities, and utilising work time for some of these activities.

0

1

2

3

4

5

6

7

8

9

10

Less than10%

10-30% 30-50% 50-70% 70-90% greaterthan 90%

Percent of participation

Num

ber

of r

espo

nses

State/Federal Government

Local Government

Non-Government

Figure 6. Percentage of workforce participating in WHPA programs by organisation type


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5.3 Attitudes a) Priority The survey sought to ascertain the priority attributed to WHPA programs by program managers in comparison to the organisation. The mean responses, shown in Table 4, demonstrated a mismatch between program managers’ personal beliefs and a perception of the organisations’ priorities. Most respondents had definite views on the matter, with few returning an ‘unsure’ response. In general, respondents (64%) felt that the organisation should place a higher priority on WHPA programs. The majority (63%) of respondents who reported that their workplace should place a ‘very high’ priority on promoting health did not hold the required position in the management structure to implement a WHPA program.

Table 4. Survey respondents’ view of the importanc e of WHPA programs

Unsure Low Moderate Very High

What priority do you think your organisation currently places on promoting the general health and wellbeing of employees?

2.5 % 25.0 % 50.8 % 21.7 %

What priority should the organisation place on promoting the general health and wellbeing of employees? (your opinion)

5.0 % 0.8 % 39.2 % 55.0 %

b) Responsibility When asked to identify the level of responsibility for the promotion of health and physical activity by several stakeholders, most participants (73.3%) rated the ‘employee’ or ‘self’ as being primarily responsible (Table 5). However, they also believed that the employer, the government and the unions had ‘some responsibility’ in this regard.

Table 5. Who should be responsible for promoting health and physical activity?

Group N None at all Some responsibility

A great deal of responsibility

Employer 130 3.3 % 51.6 % 45.1 %

Employee 130 0.8 % 25.8 % 73.3 %

Unions 130 33.6 % 51.8 % 14.5 %

Government 130 6.9 % 67.2 % 25.9 %

Other 5 0.0 % 40.0 % 60.0 %


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c) WHPA Benefits The survey then asked respondents to rate the potential benefits that might accrue from participation in a WHPA program. The most important benefits of a WHPA program were cited as:

• Improved mental alertness, energy and motivation (mean = 2.84)

• Improved employee health (mean = 2.82)

• Increased quality of work as a benefit of WHPA (mean = 2.77)

• Improved morale (mean = 2.77) The least important benefits of WHPA program were cited as:

• Decreased compensation costs (mean = 2.63)

• Decreased staff turnover and increased attraction for new staff (mean = 2.61)

• Improved corporate image (mean = 2.50)

• Improved industrial relations (mean = 2.36) The important benefits were primarily personal and social rather than organisational. Therefore, the potential for achieving these personal and social outcomes should probably be emphasised in the early stages of WHPA program development and implementation. Doing so may improve acceptance/uptake of programs that are offered. d) Resourcing In regard to bearing the cost of any WHPA program, most respondents (55.7%) favoured a model whereby the employer paid for some aspects and the employee others (Figure 7). Less than 20% of respondents were in favour of the organisation bearing all the cost.

Almost two-thirds (58.8%) of respondents currently offer, or would consider offering, subsidies for participation in WHPA activities. Willingness to ‘split costs’ in this way would be advantageous for

0

10

20

30

40

50

60

Em ployerSolely

ParticipantSolely

Shared byEm ployer and

Participant

Em ployerSom e,

ParticipantSom e

Mos tProgram s

have no cos t

Other

Payment of cost of program

Per

cent

age

of re

spon

ses

Figure 7. Who should pay for the cost of WHPA prog rams?


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both employers and employees, leading to improved commitment by participants and management, and increased potential for breadth of program delivery.

5.4 Barriers

Tables 6 and 7 list the top five and bottom five responses cited as barriers for the planning and/or implementation of WHPA programs by organisations. Not surprisingly, one of the major barriers was time constraints on employees, as ‘lack of time’ is usually the most common reason reported in population surveys as to why people do not engage in regular physical activity. Another major barrier reported was a lack of employee interest in WHPA programs, and this may be a result of the other top five responses, namely time constraints, other priorities, financial cost of programs and lack of suitable on-site facilities. These factors may underscore a lack of employee interest and must be addressed in order to create greater interest among employees for WHPA programs. Developing and implementing strategies to modify these top five barriers will be an important challenge for company management to consider.

Table 6. Top 5 responses cited as barriers for con templating, planning and/or establishing WHPA programs

Response rank and description Mean Score (max = 5.0)

1. Time constraints on employees 3.61

2. Other priorities are more important 3.59

3. Financial cost of programs 3.42

4. Lack of employee interest 3.18

5. Lack of suitable on-site facilities 3.04

The bottom five barriers, while rating as less important than the previously discussed factors, also represent some challenges for company management. The issues of suspicion of employers’ motives, high employee turnover and doubts about the value of workplace activities suggest that further work is required in respect to ‘selling’ WHPA programs to the employees in order to improve program effectiveness and employee compliance.


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Table 7. Bottom 5 responses cited as barriers for contemplating, planning and/or establishing WHPA programs

Response rank and description Mean Score

16. High employee turnover 2.33

17. Have doubts about the value of workplace activities 2.33

18. Lack of suitable service provider 2.27

19. Suspicion of employer’s motives 2.10

20. Lack of child care 1.85

Due to the bias in the sample, with the majority of survey responses received from those in medium and large-sized organisations, the data have been stratified by organisation size (Table 8). Only minor differences are noted in the top five perceived barriers among organisations of varying demography in Table 8.

Table 8. Top 5 barriers for contemplating, plannin g and/or establishing a WHPA program by organisation size

Organisation Size

Small Medium Large

• Time constraints on employees • Other priorities more important • Other priorities more important

• Other priorities are more important • Time constraints on employees • Time constraints on employees

• Lack of employee interest • Financial cost of the program • Financial costs of the program

• Financial cost of the program • Lack of suitable on-site facilities • Lack of employee interest

• Lack of suitable on-site facilities • Lack of human resources • Lack of employee commitment

Time constraints, other priorities, lack of employee interest, and financial costs remain the most important issues regardless of company size. Small companies, however, cited a lack of suitable facilities on site as a major barrier. Of further interest in regard to these barriers, suspicion of employers’ motives was only ranked at the low end by participants from small and medium-sized organisations. Those from large organisations rated this barrier somewhat higher, so to better understand this aspect it would be essential to consider employee perceptions.


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5.4 Incentives Survey respondents were asked to identify those factors that would encourage the implementation of a WHPA program, or expansion of an existing program. The top five responses are shown in Figure 8. There exists a range of factors that impact on program implementation, and these are not centred on a single, predominant agency. However, the attitude of key people within the company or organisation, financial constraints, as well as a firm and widely communicated policy are important within-company factors, as a high percentage of respondents cited the following motivators:

• Employee demand (14.4 %);

• Senior management support (11.1 %);

• Budget surplus (9.1 %); and

• A company policy on health (8.6 %). The most widely stated external factor also related to budgetary constraints, with respondents highlighting financial subsidies from Government as an important incentive.

The least important incentives for implementing or expanding a WHPA program were:

• Advisory consultancy services (2.4 %);

• More government promotion/research (2.4 %);

• Resources/ ‘how to’ kits (4.7 %);

• Changes to fringe benefits tax rules (4.9 %);

• Legislation requirements (5.0 %).

0

2

4

6

8

10

12

14

16

Employee demand Financial subsidesf rom government

Senior managementsupport

Budget surplus A company policyon health promotion

Reasons for implementing programs

Per

cent

of r

espo

nses

(%)

Figure 8. Top 5 incentives to implement or expand a WHPA program


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5.5 Organisational Commitment The data in Figure 9 provide a summary of participants’ opinions on the importance (at left) of various factors as they influence the success or otherwise of WHPA programs. Each bar (with a maximum score of 5.0) represents the average response for a sub-set of factors within the designated categories of policy, strategic, structural, management and financial. The bars at right demonstrate the respondents’ subjective rating of their organisation’s performance related to these factors. A clear mismatch exists between the participants’ opinions regarding the importance of organisational commitment and that which they perceive exists within their own company or department. In respect to the policy, strategic, structural, management and financial aspects regarding organisational commitment to WHPA programs, survey respondents indicated the following.

Policy

Strategic

Structural

Management

Financial

Company rating

1 2 4 5

Tot

ally

ac

hiev

ed.

3

Som

e pr

ogre

ss

mad

e

2 0 3

Uns

ure .

4 1

Not

at a

ll im

port

ant.

5

Ver

y im

port

ant.

Con

side

red,

but

no

t im

plem

ente

d

Your opinion

Figure 9. Respondents’ opinions and subjective com pany ratings on factors relating to successful implementation of WH PA programs


22

• Policy – Survey respondents believed strongly that organisations should document a corporate policy that relates specifically to employee health and physical activity, and that this policy be communicated to all staff (means = 3.94 and 4.40 respectively).

• Strategic – The most important aspects were:

− integration of WHPA programs into existing organisational structures and processes (mean = 4.00);

− assessment of the economic benefits accrued from the program (mean = 4.00);

− assessment of employee satisfaction accrued from the program (mean = 4.42); and

− assessment of other health indicators accrued from the program (mean = 4.08).

• Structural – The following aspects were deemed very important:

− programs should be made available to all staff (mean = 4.71);

− organisations need to provide important facilities such as staff rooms, change rooms and lockers (mean = 4.28);

− staff must be supported by their supervisors to take part in a WHPA program (mean = 4.48);

− the organisation must support and encourage a healthy balance of family and working life (mean = 4.59);

− WHPA programs must be regularly updated and refreshed (mean = 4.38).

• Management – The most important aspects were:

− the support of management is essential (mean = 4.71);

− WHPA programs need to be managed by key people (mean = 4.33);

− the elements and objectives of any program must be communicated to all staff (mean = 4.53);

− there needs to be consultation with employees in respect to the design of any WHPA program (mean = 4.20).

• Financial – Survey respondents agreed strongly that appropriate financial resources need to

be made available to run effective programs and activities (mean = 4.67).


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6. CASE STUDY REPORTS

6.1 Case 1 – Large Government Authority with Curren t WHPA Program This large government authority currently has a WHPA program, run by a qualified Exercise Physiologist (EP) who has the full-time contract position of ‘Health Promotion and Wellness Coordinator’, working exclusively for the organisation. The Authority has employees based all over Western Australia, although the majority of employees are located in the Perth office. The majority of the workforce are aged over 50 years, with many workers having been employed over a long term. There are two components to the wellness program at this company – wellness activities, and specific health programs. Recently (in 2003), four male employees (blue and white collar workers) suffered heart attacks at work, which led to the initiation of the Health Risk Profiling Program to screen employees for coronary risk indicators. The company has an Occupational Physician and an Occupational Health and Safety Manager who developed the idea of a screening process and employed an EP who was responsible for screening all employees. This voluntary process took place over a period of about 17 months and was offered to 2500 people, although only 50% of employees opted to participate. This program required the EP to spend a lot of time giving individual, personalised feedback to participants about risk factors for coronary disease. The program was launched through emails, newsletters, and presentations by the EP at various meetings. The unions objected to this program for two, seemingly contradictory reasons (according to the interviewees): • that the information was not going to be treated confidentially, and • that the information was to be treated confidentially. For example, they were concerned that if a staff member was at risk of a heart attack, this information was going to be given to their manager, but at the same time were concerned that the manager might not be informed. This demonstrated a lack of knowledge of the program. In hindsight, the unions should have been consulted prior to the program launch so that participation amongst union members could be encouraged rather than discouraged. A report was compiled at the end of the screening program and the top three issues were identified as being: overweight and obesity, elevated blood lipids, and physical inactivity. Most program participants (82%) had one or more of these risk factors. A new program is now being developed based on the findings and recommendations from this screening process, which aims to improve the cardiovascular health of employees, and to make employee health part of the culture of the company. This program will be launched in December 2005 and is more of a lifestyle change program. A ‘champion’ will be nominated in each region, who will be responsible for disseminating information to the employees from the occupational health and safety team. People can also access information via an intranet site. The organisation also has in place such activities as ergonomic assessments, employee assistance programs, yoga, Pilates, massage, and has an on-site gym as well as facilities for active transport (cycle to work). These activities and facilities are all well utilised by employees. Whilst the specific health programs are quite new, the company has a calendar of events for employees and does also offer incidental activities which can be suggested by members of general staff as well as members of the occupational health and safety team (for example walk around Lake Monger and participation in sporting events against other companies in the same industry). The Occupational Health and Safety manager consults directly with the organisation’s directors about new health initiatives, though more as a courtesy rather than for approval. The Executive Group has a real interest in the health and wellbeing of their staff. Activities are run mostly on company time.


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6.2 Case 2 – Mid-sized Company with ‘no’ WHPA Progr am This medium sized commercial company is located in the CBD of Perth. It has an even representation of males and females, aged mostly in their late 20’s to early 30’s, and with the majority of staff (90%) employed on a permanent basis. The Human Resources representative reported that the company did not have a formal WHPA program. However, at the end of the discussion realized that they offered a variety of activities which would constitute a ‘wellness program’, but it was just not branded in that manner. Presently, the activities are under the direction of a human resource representative who is now in the process of branding the program which will be advertised on the company’s intranet as a wellness program. Currently on the company intranet, employees can access a Training and Development/Learning and Development section which has a wellness component where a wide variety of activities are advertised including: ergonomic training/assessment, first aid training, stress management training, flu vaccinations, massages, employee support program, yoga classes, and free gym memberships (for all permanent staff). In addition, a wide range of social events as well as sporting competitions against other companies in the industry are available, with free morning tea on a regular basis for all staff, and entry into community events such as the City to Surf fun run. New staff members are made aware of the program at recruitment and again during their induction into the company. As well as being able to access the intranet to see coming events, each staff member is reminded via email. Activities are open to all staff, with some being held in their own time, while others are on company time – but all paid for or subsidised by the company. Staff members who join the gym must first have an appraisal and be given a program. The company also has a specific program for senior staff called Coaching for High Performance, whereby senior officers learn about staff coaching and development. Activities are run mostly on company time. Essentially, much of what is offered has been contracted out to service providers, although overseen and organised by a member of the HR department. The company is open to suggestions from employees for new health/wellness activities; however, all new health initiatives require consultation with the HR manager, and then a senior partner has to sign off before they are introduced. There is a budget set aside for occupational health and safety but this is monitored each year and is adaptable depending on what is needed.

6.3 Case 3 – Mid-sized Local Government Organisat ion with Current WHPA Program

This local government organisation has been offering a physical activity program for the business and residential community for the past 12 months. The program was initiated from a successful grant awarded by the Physical Activity Task Force and money matched by the council. The program was implemented to facilitate and promote physical activity amongst community members and promote local health services. There was only a small budget to develop and implement this program and two EPs worked mostly in their own time to coordinate the program. A survey was administered to determine what days and times would suit most people. The program runs three afternoons a week, with two 45-minute exercise sessions on each day, and is open for residents and employees of the area to attend as frequently as they like. The target group was primarily business owners and workers in the area and secondarily, residents of the area.


25

Unfortunately, local council workers, who were responsible for initiating the program, were not targeted for insurance reasons. The program was promoted in the local newsletter as well as by personal pamphlet drops into all local businesses. Essentially, this was a physical activity program based on introductory sessions to different types of activities (e.g. tai chi, bootscooting, yoga and group fitness circuits). Each activity was conducted over a six-week period. The program is unique in that it caters from ages 15 through to 80 years and is more of an initiation into different types of physical activities, whilst promoting exercising at the appropriate level and intensity. Exercise leaders were drawn from service providers in the local area, so that if people enjoyed the particular activities, they could continue with that instructor away from the program. The program has received an excellent response, particularly from the residents of the area – some of whom have already registered to take classes with instructors who were part of the program. Since both the EPs and the council promoted the program as an introduction to physical activities, the notion was well received by the local area health and exercise providers, who did not see them as competition, but rather as an aid to their own business marketing. Funding for the program concludes at the end of October, and even though participants were asked to give a gold coin donation to participate, this may not be enough to sustain the program without government funding. There has been a real interest in continuing the program from the participants, so the council is still looking at cost-effective ways to offer it. Because this was essentially a pilot program, no minimum number of participants was set for each session to be viable; however, this aspect may need to be reviewed.

6.4 Case 4 – Large Government Authority with a Long -term WHPA Program

This organisation has had a WHPA program for about 15 years. They have both city and country sites which are all included in the program. The program began by specifically targeting fire fighters due to the physical nature of their work and a 10-year ‘Fire Fitness’ plan was developed to increase their fitness levels. The initial program engaged the unions as well as the organisation’s corporate body, and a working party was developed prior to implementation. To date, Fire Fitness has not been compulsory for all fire fighters, though it forms part of the corporate health and fitness program in which two permanent full-time staff members develop, implement and evaluate the program. Wellness testing (e.g. blood pressure, cholesterol, flexibility) is offered to all members of the organisation. Health awareness sessions and manual handling training are also part of the program which is taken to off-site staff members at least once a year. Many of the country locations have gyms set up for the staff to use; however, there is not a staff member employed specifically to oversee the gym and it is not monitored for use. Part of the Fire Fitness program involves a free medical check so the off-site employees are screened by their physician prior to using the gym. In the head office in Perth, there is a gymnasium which is well equipped and very well utilised. Many other initiatives are offered, including running groups, and programs such as ‘Warm-up for work’ are also offered as an injury prevention measure. Motivation of staff plays an important role in how the different initiatives are received. Occupational health and safety leaders are located at all sites but are limited in their powers to encourage participation. Quality of work, as well as morale, has increased as a direct result of these programs, which are offered mainly on work time, but the attendance of family members is also encouraged for activities outside of working hours.


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As well as the on-site gymnasiums, running and exercise groups, and ‘Warm-up for work’, a wide range of health activities are offered. A corporate team is entered into the City to Surf fun run every year, there is a mole scan initiative, promotion of National Health initiatives such as Climb to the Top, and bone density testing for osteoporosis. Activities such as Pilates, yoga, reflexology, massage, ergonomic assessment, employee assistance programs/staff counselling, injury management, manual handling training, health presentations (e.g. HIV, alcohol and drugs, health issues), and active transport/incidental exercise are also offered. There is a ‘15 for 15’ agreement within the fitness policy, whereby 15 minutes of employee time is matched with 15 minutes of employer time. The organisation is also considering subsidising gym memberships, but fringe benefits tax is an issue here. A calendar of events is about to be implemented where there will be regular activities each year like skin cancer checks during summer. A broadcast email notifies all employees of coming events. Those who are not able to access email are given hard copies of the Events calendar. Employees can request presentations on particular topics and these are always accommodated. There is an Occupational Heath and Safety team leader at each remote location that links in with the head office to engage off-site employees in wellness events and activities. Once a year these leaders are brought to the main office to be updated on changes in legislation, and are informed via seminars and given the opportunity to discuss any issues. Health and fitness programs have been developed to be self-perpetuating in remote regions. Employees have responded very well, and these programs are now embedded in the workplace culture.

6.5 Case 5 – Large Commercial Company with a Compre hensive WHPA program

This large company has sites throughout Western Australia, but still offers a comprehensive WHPA program as well as an employee assistance program. A variety of service providers are responsible for conducting programs at individual sites and these organisations provide a qualified EP (healthy lifestyle coordinator) to oversee the program. In past years, these service providers had no guidelines for their program and therefore there was no evaluation of the program’s effectiveness. However, in the past 12 months, providers’ contracts were amended to include key performance indicators. This served to provide a better structure to the program, with formal reporting requirements and better accountability. This also meant that the occupational health and safety manager had someone on site who was specifically accountable for the program. One of the two distinct shift models being used at present is the fly-in fly-out (FIFO) program leader who travels to and from site together with the shift workers. At some locations, there is a healthy lifestyle coordinator on site 24 hours a day, seven days a week. At others, the coordinator is not replaced on their days off. An alternate model services a residential workforce that is based in a town, and the healthy lifestyle program coordinator is also based in that town. The FIFO program model is more occupationally based with less of a focus on the community. Under these conditions, there is an emphasis on the traditional fitness assessment and gym program. The second model is more community focussed, whereby workers are typically interested in after-hours events, children's events, and activities that involve the community.


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The preference by Occupational Health and Safety personnel is to have someone on site all of the time to keep up the encouragement and momentum, and also for safety reasons. However, this decision (and budget item) rests with the mine manager. Given that the implementation of key performance measures is only new, the mine managers may currently use their discretion; however, once a database has been developed, having a healthy lifestyle coordinator on site all of the time may become part of the cultural norm, and financial restrictions will be less significant.

6.6 Case 6 – Small Commercial Business with no Form al Program This small, privately owned business has one office located in the Perth metropolitan area. Currently, this company does not run a formal WHPA program, although they offer some activities to facilitate socialisation. Each year, they enter a team in City to Surf and they have social gatherings on a bi-monthly basis, both of which the company pays for. The Managing Director noted that employees' response to activities that were currently offered was not strong, hence he did not feel that there was the demand from employees to offer more activities. However, management is open to suggestions for new activities or initiatives by staff. For example, this year they ran a football tipping competition where 80% of staff participated. Being a small business, lack of time is a major barrier to offering more activities, as it is not possible for employees to participate in physical activity sessions or for all to attend seminars at the same time during working hours. The management encourages healthy lifestyles by having a full kitchen available for staff to make or bring healthy lunches to work, and they promote a smoke-free environment at work. Although the management acknowledge the importance of health and healthy lifestyles, having a formalised program is not something that they currently offer as the management believe that the employees need to take some initiative in their health behaviours and there is not the demand to offer more than what is currently available. This company had heard of the initiative coordinated by the nearby local council which offered a program to local business and residents outside of work hours. They thought it was an excellent idea and something that they would most certainly embrace, promote and participate in, given the opportunity.


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7. SUMMARY

7.1 Current WHPA Programs GENERAL COMMENTS

• The majority of companies who currently run a WHPA program are large employers from the mining or

service industries with business units located in the metropolitan area.

• The most frequent activities included in a WHPA program are: employee support, health promotion, social activities, injury prevention/rehabilitation, pre-employment and regular health screening, and individual counselling.

• Time commitments are acknowledged as an important factor in the success or otherwise of a WHPA program.

• Most activities are run on company time, especially in regard to injury prevention and management, and stress management and mental health. The time is often shared between employee and employer for some activities like team building and social activities, exercise and physical activity, but massage and alternative therapies are usually undertaken on the participants’ own time.

• Information for these programs is most commonly drawn from external consultants (service providers) and internal staff with the appropriate background.

• Health promotion agencies and Government agencies also play an important role as a source of information.

• Survey respondents suggest that for programs to be viewed as successful, greater than 50% of employees are required to participate.

• The annual budget for those organisations that run a WHPA program ranges from $500 to $500,000.

• Common strategies for targeting non-participants include: advertising via email and newsletters, providing the workforce with positive feedback resulting from programs, using well-qualified presenters, offering a wide variety of activities and utilising work time for some of these activities.

ORGANISATION SPECIFIC COMMENTS

ORGANISATION TYPE SIZE GOVERNMENT

(including local government) NON-GOVERNMENT

(commercial)

SMALL

• Mainly local government organisations in

regional areas with fewer opportunities to engage quality service providers and local support agencies.

• Very few organisations run WHPA

programs.

• Some creative WHPA program models provide solutions that are specific to the needs of small business.

MEDIUM

& LARGE

• Generally lower participation rates for

organisations that do run a program.

• Generally higher participation rates for

companies that do run a program.


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7.2 Attitudes

GENERAL COMMENTS

• A mismatch exists between the priority that survey respondents believe ought to be given to WHPA

programs, and that which their organisations actually give.

• Most people (99.2%) believed the employee should take at least some responsibility for their own health and physical activity; however, the employer also had an important role to play (96.7%).

• The Government was also identified as having an important role to play, yet opinion was more divided on the role of union groups.

• The important perceived benefits of WHPA programs were primarily personal and social, rather than factors that affect the organisation as a whole. Benefits to the organisation were rated quite low.

• Most respondents favoured the sharing of WHPA program costs between employer and employee as the best funding model. This strategy may influence positively the uptake of these programs by staff.

• However, the data in this survey are biased in favour of the organisations’ views. Attitudes may well be different among employees as recipients, or potential recipients of these programs.

7.3 Barriers

GENERAL COMMENTS

• Across all organisation types and sizes, the most commonly perceived barriers for implementing WHPA

programs include: time constraints, other priorities, lack of interest, financial cost and lack of suitable on-site facilities.

• Though only given a low ranking, it is important to note that some respondents thought a lack of suitable service providers proved to be a barrier.

ORGANISATION SPECIFIC COMMENTS

ORGANISATION TYPE SIZE GOVERNMENT

(including local government) NON-GOVERNMENT

(commercial)

SMALL

• Lack of suitable facilities a major barrier

• Lack of suitable facilities a major barrier

• Pressures of time can be more pressing in smaller companies

MEDIUM

& LARGE

• Problems of trust and suspicion of

employer's motives a greater problem for large organisations

• Problems of trust and suspicion of

employer’s motives a greater problem for large organisations


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7.4 Organisational Commitment GENERAL COMMENTS

• The most important incentives for the promotion of WHPA programs included internal (to the

organisation) factors such as: employee demand, senior management support, a budget surplus, and having a company policy on health.

• Survey respondents cited financial subsidies from Government as the most important external incentive.


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8. RECOMMENDATIONS

8.1 Education, Awareness and Advocacy This Review has identified the following issues in regard to education, awareness and advocacy:

• What is a WHPA program? Many organisations do not recognise that they do in fact have elements of a program in place.

• Education is needed regarding the range of available program options, and the associated cost-benefit to both participants and the organisation.

• Awareness needs to be increased of the benefits of WHPA programs within industry. How do these programs benefit the organisation? How do they benefit the individual?

• The benefits of WHPA programs should not focus just on disease prevention, as benefits to the organisation are equally important.

• There exists a need to involve key stakeholders – health promotion practitioners, organisations, researchers and government policy makers, as well as allied groups such as urban planning and transport authorities, in a more integrated approach (i.e. a whole of industry coordination function).

• National and international level networks must be developed to bring best practice principles to the Western Australian scene.

Recommendation 1 – That improved education, communi cation and advocacy be provided

to Western Australian workplaces on the economic, s ocial and health benefits of WHPA programs.

Recommendation 2 – That a summit, forum, or confere nce be conducted involving key

stakeholders to facilitate a dialogue and networkin g opportunities among employer organisations, government policy makers, r esearchers, health promotion agencies and other key groups.

8.2 Promotion of Best Practice This Review has identified the following issues in regard to WHPA promotion and coordination:

• Development of best practice guidelines incorporating information from key stakeholders and expertise from practitioners in the workplace is needed to understand which health promotion strategies, programs and processes work best in particular organisations.

• Development of health promotion infrastructure, with links between workplace and external settings (e.g. local community facilities) is essential to the uptake of WHPA programs.

• A need was identified to develop and describe a rating system of WHPA programs whereby organisations can strive to attain a certain level of achievement in this area.

Furthermore, several barriers that prevent the implementation of WHPA programs have been identified in this review, yet there are numerous examples whereby organisations have put strategies in place to overcome these difficulties. These strategies (like the examples given below) must be collated and disseminated for use by other employers:


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• Time constraint barriers – options for sharing time commitment (e.g. the ‘15 for 15’ model), getting the right balance between work and private life and recognising the value of this balance to industry productivity.

• Financial impost barriers – options for cost sharing between employees, as well as collective employer groups.

• Lack of facilities barriers – options for sharing and coordinating the use of local community facilities and services.

• Lack of employee interest – alternative, creative programs (rather than just the standard WHPA activities) such as promotion of ‘active communication’ within the workplace, or ‘active transport’ from home to the workplace.

The ‘limited time’ excuse is not unique to this survey – it is the single, most frequently cited barrier for individual avoidance of physical activity. However, organisations have an opportunity to build a structure that allows people to engage in WHPA programs not as an ‘add on’, but rather to perceive this as part of their working day.

Such a structure has numerous benefits such as contributing to building a healthy populace, and employees taking responsibility for health and physical fitness as part of their time spent at work rather than being perceived as an extra task to be undertaken.

Recommendation 3 – That the elements and character istics of successful WHPA programs, and best practice case studies be promote d widely throughout Western Australian workplaces.

Recommendation 4 – That consideration be given to creating an awards/recognition

process to give due recognition to progressive orga nisations that have implemented successful WHPA programs.

8.3 A Co-ordinating Entity The workplace setting provides a unique opportunity to promote healthy lifestyles, prevention of disease, and physical activity. In general, the workforce includes persons from 16 to 65 years of age who spend approximately half of their waking life at work. As at August 2005, 1,043,800 Western Australian adults (aged between 15 years and over) were employed, full-time (45%) and part-time (18.8%).52 Approximately 10.4% (167,000) are employed in the Western Australian public sector.53 This presents a significant target audience and opportunity to implement programs and strategies for the betterment of the health and physical activity levels of our workforce. However, there currently exists no single body that promotes and provides information on workplace health and physical activity initiatives for companies, organisations, service providers, employees and other key stakeholders in Western Australia. This research has highlighted that a need exists for such an entity, with a wide representation from relevant disciplines that cover the breadth of services provided in best practice WHPA programs. Recommendation 5 – That an entity be established to enquire, coordinate, lobby, educate,

and promote WHPA programs to employers and their wo rkforce in Western Australia. Positioning of the WHPA initiati ve must be broader than just health, or just physical activity, and so this entity ought to bring


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together all key stakeholders with links to the Dep artment of Sport and Recreation, the Health Department, the Occupational Health and Safety Commission, and the Premier’s Physical Activity Tas kforce.

Recommendation 6 – Establish partnerships to provi de incentives for organisations to

plan, implement and expand WHPA programs (e.g. insu rance, financial subsidies).

8.4 Creating Incentives and Removing Barriers This Review has identified the following issues in regard to incentives and facilitators:

• Government support is needed to help facilitate the implementation of programs with policy support, rebates and subsidies, changes to workers compensation insurance premiums and fringe benefits tax laws.

• Formulation of supportive government policy and/or legislation to encourage uptake of WHPA programs is needed.

• Using the workplace as a key area to target health promotion strategies. Australian workers spend approximately half of their waking hours at work and this may provide a great opportunity for delivery of health promotion and disease prevention messages.

• Schemes like the ‘Training Guarantee’ might provide incentive for companies to prioritise WHPA programs.

Recommendation 7 – That the Western Australian Gove rnment explore opportunities to

provide incentives and remove barriers for organisa tions to plan, implement or expand WHPA programs, including:

− Establish a grants scheme of seed funding;

− Review workers compensation insurance rules;

− Introduce financial incentive schemes; and

− Negotiate with the Federal Government on Fringe Ben efits Tax barriers.

8.5 Regional, Rural and Remote Communities This Review has identified the following issues in regard to organisations in regional, rural and remote areas of Western Australia:

• These communities typically have poor access to qualified allied health professionals.

• These communities often lack suitable facilities and have problems of communication and timely access to information.

• A need to link rural education modules with College of General Practitioners and allied health profession governing bodies for the provision of continuing education points to ensure a better-informed local point of contact.


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• Several useful models can be adapted for use in these areas, including the ‘Pit stop’ model employed in the Gascoyne region of WA.

• The potential to expand upon the model used by the Subiaco Council in which local government provides a coordinating function to link local service providers and facilities with employees from companies and organisations in the local area.

• The socialisation aspects of such associations can aid in the development of community relationships for the betterment of community life.

• Issues pertaining to mental health and depression are particularly relevant in rural and regional Western Australia. There exists a unique opportunity to address some of these problems via WHPA programs.

Recommendation 8 – That current information, resour ces and consultancy support be provided to regional, rural and remote communities/ organisations through a range of strategies, including:

− Development of innovated, targeted education and tr aining strategies; and

− Dissemination of practical initiatives to facilitat e WHPA program promotion in these areas, via the engagement of loc al facilities and services.

8.6 Small Business The small business employer has the least opportunity (with respect to time and budget) to implement a WHPA program. Since this is a major employer group in Western Australian industry, a special emphasis needs to be given to resolve their unique problems in this regard.

Several creative program models, such as that developed by the Subiaco Council, could be adapted for use in all areas.

Recommendation 9 – That practical initiatives be de veloped and disseminated to facilitate WHPA program promotion in small businesses via the creation of strategic partnerships, and engagement of local facilities an d services.

8.7 Further Research This review has identified the following issues in regard to research:

• More scientifically rigorous research is required as valid data are limited and information mostly anecdotal, or based on research conducted overseas in a differing context.

• There is a strong need for data on program efficacy using local examples.

• The data from this survey is are biased toward the employer or organisation’s perspective, and certain findings (such as those listed below for example) must not be assumed to represent the belief of all stakeholders:

− That the best program model has a sharing of costs between employer and employee;


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− That the best program model has a sharing of time commitment between employer and employee; and

− That ‘suspicion of employers’ motives’ is not an important barrier to the uptake of WHPA programs.

• At present, we have little understanding about the reasons for the poor uptake of WHPA programs among employees in various organisations. Why is it, for example, that there is a higher percentage uptake of program activities among staff of private companies as opposed to government agencies and departments?

Recommendation 10 – That further research/investiga tion into the efficacy of various WHPA

program models for organisations of differing demog raphy be conducted in the Western Australian context.

Recommendation 11 – That further research/investiga tion be conducted in regard to

employees as the recipients or potential recipients of WHPA programs in order to complete this review process.

8.8 WHPA Service Providers Service providers indicated the need for improved standards and professionalism within the WHPA industry in Western Australia. This included improved and more focussed training for individuals responsible for WHPA programs and persons wanting to get involved in the industry, and the further investigation of relevant legislation or industry standards regarding the removal of unprofessional service providers.

Recommendation 12 - That the establishment of a WHP A service industry representative

body (with functions to formulate minimum professio nal standards for training and education, code of ethics and best pra ctice principles, accreditation and registration schemes for individu als and service provider organisations) be investigated with servic e providers.


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GLOSSARY Active communication

Any system of work that promotes physical activity to effect communication between people in the workplace.

Active transport Modes of travel that promote physical activity.

Alternate therapy These may include such activities as massage, aromatherapy, acupuncture,

Feldenkrais, Pilates etc. Employee assistance program

The Employee Assistance Program (EAP) is generally a confidential, short-term, professional counselling service offered at no cost to staff and members of their immediate family to address and resolve both work-related and personal problems that potentially could interfere with work performance. Issues such as financial, personal and relationship difficulties, crisis management, health issues (including stress, depression), and bullying are normally included.

Industry reference group

This group comprised representatives from Department of Sport and Recreation, Premier’s Physical Activity Taskforce, Department of Health, Disability Services Commission, Department of Consumer and Employment Protection, WA Chamber of Commerce and Industry, Department of Education and Training, Fitness WA, Unions WA, and Active Alliance WA.

Key stakeholders This group includes: employers, employees, WHPA service providers and

their respective professional bodies, government agencies and departments (especially those involved in the promotion of health and physical activity), unions, employer groups, health promotion agencies, research and training institutions, and local government.

Life skills The skills required to promote a happy and fulfilled life: communication skills,

oral and written; organisational skills; interpersonal skills. Organisation size Organisations were stratified based on the number of employees:

small < 100; medium = 100 – 500; large > 500. Organisation type Organisations were stratified based on the following types:

government; non-government/commercial; local government; not-for-profit. Organisation location Organisations were stratified according to the predominant location of their

workforce: metropolitan (Perth metropolitan area); regional (major regional centres in the state); rural and remote (all other locations).

Team building Activities designed to build a team of people with a shared belief system and

values, communicating freely, with each person embracing their role to achieve increased company productivity. Enhancing employee trust and motivation, identifying critical problem areas and creating a more cooperative and democratic social organisation will assist with the process.

WHPA programs Worksite health and physical activity programs include a variety of activities

intent on promoting healthy lifestyle, disease prevention and physical activity to the employee, while providing social, financial and productivity benefits for the employer.

WHPA service providers

Health professionals involved in the delivery of WHPA programs – including exercise physiologists, physiotherapists, dieticians, occupational therapists, psychologists, counsellors, naturopaths, doctors, nurses, diabetes educators, life coaches, together with masseuses and other alternative therapists.


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APPENDIX A - Survey and Associated Documents

1 August, 2005 Dear Sir/Madam,

Workplace Health and Physical Activity Review The University of Western Australia has been contracted to conduct a statewide survey of health and physical activity programs offered in the workplace, funded by the WA Department of Sport and Recreation, and under the guidance of an industry reference group. The aim of the survey is to provide information on workplace activities for maintaining or improving employee health and well-being. This investigation will provide the necessary background information to support the development and implementation of the Premier’s Physical Activity Taskforce initiative - Workplace Healthy Lifestyles Initiative commencing in 2005/06. Your workplace has been selected to provide information via this survey, based on its size and role in the State. Representative organisations from the government, non-government, and not-for-profit sectors have been approached. Even if your workplace does not offer any activities aimed at improving employee health, it is important that you respond so that the study will represent the views of a cross-section of employers in Western Australia. That is, your opinions are valuable to us even if you do not have, or don’t intend to have such a program. Please be assured, all information obtained from this survey will remain absolutely confidential. The research is being undertaken in the School of Human Movement and Exercise Science at the University of Western Australia, under the auspices of the Human Research Ethics Committee. Enclosed is a document which outlines the scope of this review, as well as the survey document. The latter should take approximately 15 minutes to complete, and we ask that you return it in the reply paid envelope within two weeks. Thank you in advance for helping us to collect this important information. In recognition of your input, DSR will be pleased to supply you with a copy of the final report summary. Timothy R Ackland PhD Associate Professor

School of Human Movement and Exercise Science

The University of Western Australia 35 Stirling Highway, Crawley WA 6009

Location: Parkway Entrance #3, Nedlands

Phone +61 8 6488 2361 Fax +61 8 6488 1039 Email [email protected]

In association with: The Premier’s Physical Activity Task Force Department of Sport and Recreation Department of Health Disability Services Commission Department of Consumer and Employment Protection WA Chamber of Commerce and Industry Department of Education and Training Fitness WA Unions WA Active Alliance WA

Workplace Health and Physical Activity Review

PROJECT INFORMATION You are invited to participate in a review of workplace health and physical activity in Western Australia. This research is being carried out by a team from The University of Western Australia in conjunction with the WA Department of Sport and Recreation. The responses you give will help to provide background information in this area, and assist in the development of a range of strategies to promote and facilitate take-up of workplace health and physical activity programs in small to large organisations (including government agencies, non-government/commercial companies, and not-for-profit organisations). The information you provide in this survey will remain confidential and strict measures will be taken to ensure your anonymity is preserved. Although information gathered from the survey may be published in reports or scientific journals, your name and that of your organisation will not be used. Submission of a completed survey will indicate your consent, so no other documentation is necessary. You may retain this document for future reference. Any questions or requests for clarification should be directed to Ms Vanessa Bussau on 6488 2361 or by email ([email protected]). Timothy R Ackland PhD Associate Professor The Human Research Ethics Committee at the University of Western Australia requires that all participants are informed that, if they have any complaint regarding the manner in which a research project is conducted, it may be given to the research team or, alternatively to the Secretary, Human Research Ethics Committee, Registrar’s Office, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 (telephone number 6488-3703). All study participants will be provided with a copy of the Information Sheet and Consent form for their personal records.

School of Human Movement and Exercise Science

The University of Western Australia 35 Stirling Highway, Crawley WA 6009

Location: Parkway Entrance #3, Nedlands

Phone +61 8 6488 2361 Fax +61 8 6488 1039 Email [email protected]

• Please complete this survey (approx 15 min) by circling the appropriate response(s) in blue or black

pen ; • Provide answers for the company, business unit or organisation for which you currently work; and • We are interested in your opinions, so please do not be concerned if you can’t provide exact answers.

PART A. DEMOGRAPHICS How would you describe your organisation? Q1. Type? Government (State/Federal) 1 Local government 2 Non-government (commercial) 3 Not-for-profit 4 Q2. Number of employees?

Less than 50 1 50 – 100 2 100 – 200 3 200 – 500 4 Greater than 500 5

Q3. Main location of the business unit for which you are responding ?

Metropolitan 1 Regional 2 Remote 3

Q4. Predominant activity? Health 1 Construction 2 Manufacturing 3

Mining 4 Retail 5 Wholesale 6 Transport 7 Service 8 Information/Education 9 Other (specify)_____________________ 10

How would you describe your role?

Q5. Senior management/owner/director 1 OSH/HR/office manager 2 Other (specify)_____________________ 3 Q6. Should you desire, are you in a position to authorise the

implementation of a health and/or physical activity program without seeking permission from a higher management/ organisational level?

Yes 1 No 2 Describe the proportion of employees under the following conditions:

Don’t <20% 20-50% 50-80% >80% know

Q7. Full time (e.g. 8-5pm) 1 2 3 4 5

Q8. Part time 1 2 3 4 5

Q9. Shift work 1 2 3 4 5

Q10. Casual 1 2 3 4 5

Q11. Work from home 1 2 3 4 5 To the best of your knowledge, what proportion of your employees:

Don’t <20% 20-50% 50-80% >80% know

Q12. walk to work 1 2 3 4 5

PART B. YOUR WORKPLACE HEALTH & PHYSICAL ACTIVITY (WHPA) PROGRAM Note: The definition of having a program is within the past 12 months. The placement of posters only should not be considered as having a WHPA program. Q17. Does your organisation have a WHPA program?

Yes 1 (Go on to Q18 ) Did have – but not currently 2 (Go to Part C ) No (never) 3 (Go to Part C)

Q18. Please indicate what activities have been, or are currently included in the WHPA program. (Select all relevant responses)

• Pre-employment screening 1

• Regular health screening 2

• Regular fitness screening 3

• Exercise/physical activity 4

• Health promotion seminars 5

• Other health promotion activities 6 • Injury prevention/rehabilitation 7

• Social activities 8

• Personal development/life skills 9

• Individual counselling 10

• Employee support 11

• Other (specify)______________________________ 12 (e.g. Vaccinations)

In this section we wish to identify activities at your worksite (in the last 12 months ), that are related to the promotion of physical activity and health. For each of the nominated categories, please select the relevant type of activities that your worksite has offered. (Select as many activity types as necessary).

Printed materials

& posters

1

Assessment, Screening,

Testing 2

Individual counselling

3

Workshops, Group

activities 4

Guest speakers

5

Other 6

N/A Q19. Exercise/physical activity 1 2 3 4 5 6 0 Q20. Nutrition/weight management 1 2 3 4 5 6 0 Q21. Fatigue management 1 2 3 4 5 6 0 Q22. Specific disease prevention or 1 2 3 4 5 6 0 management (e.g. Diabetes) Q23. Smoking, alcohol, drugs 1 2 3 4 5 6 0 Q24. Team building/social activities 1 2 3 4 5 6 0 Q25. Injury prevention/management 1 2 3 4 5 6 0

SURVEY

Workplace Health and Physical Activity Review

Q13. cycle to work 1 2 3 4 5

Q14. drive to work (solo) 1 2 3 4 5

Q15. car pool 1 2 3 4 5

Q16. take public or work- 1 2 3 4 5 provided transport

Q26. Stress management/mental health 1 2 3 4 5 6 0 Q27. Goal setting/life skills / 1 2 3 4 5 6 0 personal development Q28. Massage/alternative therapies 1 2 3 4 5 6 0 (e.g. meditation )

For each topic addressed below, please circle the section of the workforce that activity is aimed at and who are allowed to participate. (For example some health activities may be aimed at all staff , so for those you would circle the number 1).

All staff

1

Executives and/or

Managers 2

Clerical / Sales / Admin

3

Trades / Factory

floor 4

Contractors

and/or Consultant

s 5

Other

6

N/A Q29. Exercise/physical activity 1 2 3 4 5 6 0 Q30. Nutrition/weight management 1 2 3 4 5 6 0 Q31. Fatigue management 1 2 3 4 5 6 0 Q32. Disease prevention/management 1 2 3 4 5 6 0 Q33. Smoking, alcohol, drugs 1 2 3 4 5 6 0 Q34. Team building/social activities 1 2 3 4 5 6 0 Q35. Injury prevention/management 1 2 3 4 5 6 0 Q36. Stress management/mental health 1 2 3 4 5 6 0 Q37. Goal setting/life skills / 1 2 3 4 5 6 0 personal development Q38. Massage/alternative therapies 1 2 3 4 5 6 0 (e.g. meditation ) For each topic addressed, please indicate whether they are run mainly on company time, partly on company time, or on employee time. Please circle the appropriate number on each line.


1


2

Solely on employee

time 3

N/A

Q39. Exercise/physical activity 1 2 3 0 Q40. Nutrition/weight management 1 2 3 0 Q41. Fatigue management 1 2 3 0 Q42. Disease prevention/management 1 2 3 0 Q43. Smoking, alcohol, drugs 1 2 3 0 Q44. Team building/social activities 1 2 3 0 Q45. Injury prevention/management 1 2 3 0 Q46. Stress management/mental health 1 2 3 0 Q47. Goal setting/life skills / 1 2 3 0 personal development Q48. Massage/alternative therapies 1 2 3 0 (e.g. meditation ) Thinking overall about the WHPA program at your worksite, is there provision made for any of the following people to participate?

Q54. What are the sources of information for your WHPA program?

(Select all relevant responses)

• Internal staff 1

• Local council 2

• Private consultants 3 (e.g. health professionals)

• Government agencies/departments 4

• Health promotion agencies (e.g. Cancer Council) 5

• Health insurance funds 6

• Community health centres 7

• Research organisations 8

• Employer groups 9

• Trade unions 10

• Other internet sources 11

• Other (specify) _______________________ 12 Q55. In general, what percentage of your workforce participates in the

WHPA program?

• Less than 10 % 1

• 10 – 30 % 2

• 30 – 50 % 3

• 50 – 70 % 4

• 70 – 90 % 5

• Greater than 90 % 6 Q56. What % participation of your workforce would you consider

necessary for a program to be considered successful?

. % Q57. What strategies (if any) do you use to target the non-participants? ______________________________________________________

___ ______________________________________________________

___ ______________________________________________________

___ Q58. Please state (to the best of your knowledge) the total budget

allocated by your company, business unit or organisation for this program.

AUD$ PART C. ATTITUDES The questions below refer to the perceived value that you place on workplace health and physical activity promotion. Please answer each question by circling the most appropriate response. Q59. What priority do you think your organisation places on promoting

the general health and well-being of employees?

None Low Unsure Moderate Very high

1 2 3 4 5

Yes No N/A Q49. Families of staff 1 2 0

Q50. Part-time/casual workers 1 2 0

Q51. Aboriginal workers 1 2 0

Q52. Persons with a disability 1 2 0

Q53. Non-English speaking workers 1 2 0

Q60. In your opinion, what priority should the organisation you work for place on promoting the general health and well-being of employees?

None Low Unsure Moderate Very high

1 2 3 4 5

How much responsibility do you think each of the following should have for promoting the general health and well-being (not safety) of employees?

None at all Some responsibility

A great deal of

responsibility Q61. Employer 1 2 3 Q62. Employees 1 2 3 Q63. Unions 1 2 3 Q64. Government 1 2 3 Q65. Other ? _______________ 1 2 3 If a WHPA program could (or does- if you have one) offer the following benefits, how would you rate their importance ?

Not important

Somewhat important

Very important

Q66. Improved morale 1 2 3

Q67. Improved job satisfaction 1 2 3

Q68. Improved mental alertness, 1 2 3 energy & motivation

Q69. Improved employee health 1 2 3

Q70. Decreased absenteeism 1 2 3

Q71. Decreased staff turnover 1 2 3 and attraction for new staff

Q72. Increased productivity 1 2 3

Q73. Increased quality of work 1 2 3

Q74. Decreased worksite accidents 1 2 3

Q75. Decreased compensation costs 1 2 3

Q76. Improved industrial relations 1 2 3

Q77. Improved corporate image 1 2 3

Q78. Other? _____________________ 1 2 3

Q79. Other? _____________________ 1 2 3

Q80. Primarily, who ought to pay for the costs of workplace health and

physical activities? (Please circle only one response)

• The employer solely 1

• The participant solely 2

• All costs shared by employer and participant 3

• The employer should pay for some aspects 4 and participant for others

• Most programs don’t cost anything 5

• Other (specify) _______________________ 6 _______________________________________________

Q81. Do you currently, or would you consider offering a subsidy for

employees’ participation in external health promotion activities (e.g. gym membership) or an allied health consultation (e.g. remedial massage)?

Yes 1

No 2

PART D. BARRIERS Using the scale below, which of the following problems (if any), have you encountered when contemplating, planning and/or establishing a WHPA program?

Never 1

Rarely 2

Sometimes 3

Frequently 4

Always 5

Q82. Financial cost of programs 1 2 3 4 5 Q83. Risk of accidents/injuries 1 2 3 4 5 Q84. Shift work causes difficulties 1 2 3 4 5 Q85. Lack of child care 1 2 3 4 5 Q86. Other priorities are more important 1 2 3 4 5 Q87. Lack of employer commitment 1 2 3 4 5 Q88. Lack of employee interest 1 2 3 4 5 Q89. Lack of human resources 1 2 3 4 5 Q90. Lack of resource materials 1 2 3 4 5 Q91. Lack of suitable on-site facilities 1 2 3 4 5 Q92. Lack of expertise 1 2 3 4 5 Q93. Have doubts about the value of 1 2 3 4 5 workplace activities Q94. Difficulty agreeing on the program 1 2 3 4 5 Q95. Time constraints on employees 1 2 3 4 5 Q96. High employee turnover 1 2 3 4 5 Q97. Lack of low cost support from outside 1 2 3 4 5 Q98. Lack of a suitable service provider 1 2 3 4 5 Q99. Lack of government promotion/funding 1 2 3 4 5 Q100. Management doesn’t believe this is the 1 2 3 4 5 role of the company/organisation Q101. Suspicion of employer’s motive 1 2 3 4 5 Q102. Other? ________________________ 1 2 3 4 5 PART E. ORGANISATIONAL COMMITMENT Q103. Would you be more inclined to implement a program, or expand an

existing program, if there were: (Please select your top 5 responses only)

• A company policy on health promotion 1

• Senior management support 2

• Budget surplus 3

• Employee demand 4

• Dedicated health promotion staff 5

• Changes to fringe benefit tax rules 6

• Financial subsidies from government 7

• More government promotion/research 8

• Legislation requirements 9

• Insurance company incentives 10

• Resources/‘how to’ kits 11

• Advisory consultancy services 12

• Innovative promotion solutions 13

• Other? ___________________________ 14

In this last series of questions, please give your opinion of the importance of each item on the scale at left ,

then rate your company or organisation in terms of their provision of these measures at right .

YOUR OPINION How important do you feel the following measures are for the successful implementation of any WHPA program?

Not at all important

1

Not very important

2

Unsure

3

Moderately important

4

Very important

5 Policy Q104. A documented corporate philosophy that 1 2 3 4 5 relates specifically to employee health and physical activity Q105. Communication of this policy to all employees 1 2 3 4 5 Strategic Q106. Integration of WHPA programs into existing 1 2 3 4 5 organisational structures & processes Q107. Further training made available for staff to 1 2 3 4 5 take a leadership role in WHPA programs Q108. Assessment of the economic benefits 1 2 3 4 5 accrued from the program Q109. Assessment of employee satisfaction 1 2 3 4 5 accrued from the program Q110. Assessment of other health indicators 1 2 3 4 5 accrued from the program Structural Q111. Programs made available to all staff 1 2 3 4 5 Q112. Provision of important facilities such as 1 2 3 4 5 staff rooms, change rooms and lockers Q113. Staff supported by their supervisors to take 1 2 3 4 5 part in a program Q114. Support from the organisation to encourage 1 2 3 4 5 the healthy balance of family and working life Q115. Programs regularly updated and refreshed 1 2 3 4 5 Management Q116. Management support 1 2 3 4 5 Q117. WHPA program managed by key people 1 2 3 4 5 Q118. WHPA program elements and objectives 1 2 3 4 5 communicated to all staff Q119. Target groups set for all WHPA programs 1 2 3 4 5 Q120. Quantifiable outcomes set for all WHPA 1 2 3 4 5 programs

RATE YOUR COMPANY How does your company or organisation rate in terms of providing the following WHPA program measures?

No consideration

given 1

Considered but not

implemented 2

Some progress

made 3

Good progress

made 4

Totally achieved

5

Policy Q123. A documented corporate philosophy exists 1 2 3 4 5 that relates specifically to employee health and physical activity Q124. This policy is communicated to all employees 1 2 3 4 5 Strategic Q125. Integrating WHPA programs into existing 1 2 3 4 5 organisational structures & processes Q126. Further training is made available for staff to 1 2 3 4 5 take a leadership role in WHPA programs Q127. Assessment of the economic benefits 1 2 3 4 5 accrued from the program is made Q128. Assessment of employee satisfaction 1 2 3 4 5 accrued from the program is made Q129. Assessment of other health indicators 1 2 3 4 5 accrued from the program is made Structural Q130. Programs are made available to all staff 1 2 3 4 5 Q131. The organisation provides important facilities 1 2 3 4 5 in support of the WHPA program Q132. Staff are supported by their supervisors to take 1 2 3 4 5 part in a program Q133. The organisation supports the healthy balance 1 2 3 4 5 of family and working life Q134. Programs are regularly updated and refreshed 1 2 3 4 5 Management Q135. Management support 1 2 3 4 5 Q136. WHPA program is managed by key people 1 2 3 4 5 Q137. WHPA program elements and objectives are 1 2 3 4 5 communicated to all staff Q138. Target groups are set for all WHPA programs 1 2 3 4 5 Q139. Quantifiable outcomes are set for all WHPA 1 2 3 4 5

Q121. Staff consultation in WHPA program design 1 2 3 4 5 Financial Q122. Appropriate financial resources made 1 2 3 4 5 available to run programs and activities

programs Q140. Staff are consulted in WHPA program design 1 2 3 4 5 Financial Q141. Appropriate financial resources are made 1 2 3 4 5 available to run programs and activities

Thank you for completing this survey. Please return it in the reply paid envelope provided within 7 days.

Also insert a business card if you wish to go into the draw for a prize valued at $500.

APPENDIX B - Expanded Literature Review 1.0 Introduction

The promotion of health and physical activity in the workplace is a promising approach to improve the health of Western Australians. Unfortunately, the rate of obesity and inactivity is increasing in this state (1). This trend is reflected in national data (2), with this rise in modifiable risk factors contributing to elevated rates of lifestyle disease in Australia (3). The incidence of lifestyle disease in employees is likely to escalate further as the Australian workforce ages (4; 5). Likewise the reduction in productivity, increased risk of injury and elevated workplace costs (6) associated with the declining functional capacity of the aging Australian workforce will cause organisations major problems in the future if health promotion strategies are not implemented to counter these negative health trends. The workplace provides a unique point of access to most adults (7-10), including those subgroups with an increased risk of morbidity and mortality, such as those with less education, those in sedentary jobs and middle-aged males (11-13). Most adults spend a significant part of their life at work so this provides a ‘captive audience’ to target with health promotion campaigns (8; 10; 14; 15). Another benefit of the workplace setting is access to existing networks and facilities (16). Larger organisations often have the capability and resources to facilitate comprehensive workplace health programs (7), while smaller organisations may implement simple initiatives or collaborate with other businesses or community organisations to provide workplace health promotion programs (17). Peer and social support is potentially available in the worksite setting and this form of support is shown to enhance success of health promotion initiatives (7; 10; 14). Furthermore, well established communication channels and opportunities for promotion and recruitment in the workplace are other advantages of this setting (10; 14). Promoting health in the workplace will enhance productivity and success of organisations that implement these programs and improve the health and wellness of Western Australians. The reduction of risk factors for lifestyle disease will improve the health status of the nation and reduce the burden of disease (3). To help counter the rise in type 2 diabetes and insulin resistance in Australia, strategies that promote an increase in physical activity to the population are suggested (18). The workplace provides an ideal setting to deliver such health promotion programs. As outlined in the review of literature below, workplace health promotion programs have numerous benefits for both organisations and employees. The workplace provides a unique setting to deliver health promotion programs to enhance the health and productivity of Western Australians. 2.0 Positive Outcomes from Workplace Health & Physi cal Activity (WHPA)

Programs

2.1 Health Benefits

Workplace health promotion programs have the potential to actively influence health behaviour by increasing awareness of health and increasing motivation to change behaviour (19-22). There is evidence to suggest countless positive improvements in employee health as a result of WHPA programs, including:

• an increase in physical activity (10; 14; 16; 21-27), • improved nutrition (10; 21-23; 28), • decreased alcohol consumption (10; 22; 27; 29; 30), • reduction in substance abuse (30-33), • decrease in smoking rates and increased smoking cessation (10; 22; 23; 26; 34), • a reduction in body fat levels (10; 14; 22; 23; 26; 27; 35), • improved cholesterol (10; 23; 26; 34; 36), • decreased blood pressure (10; 26; 27; 34; 35), • reduced stress levels (9; 10; 14; 23; 26), • improved mental health (10; 14; 26), • reduced risk of lifestyle disease (e.g. cardiovascular disease, type 2 diabetes) (9;

36), • increase in healthy behaviours (10; 14; 37), • reduction in health risks (10; 26; 36; 38).

Furthermore, there are numerous studies showing the benefits of health promotion programs in various settings that are likely to be applicable to the workplace.

2.2 Economic Benefits to Organisations

Implementing workplace health and physical activity programs has a number of economic benefits to the organisation. These include:

• improved job performance (10; 14; 16), • reduced absenteeism (9; 10; 14; 16; 19; 20; 27; 36; 39-44), • reduction in sick leave (10; 14; 41), • decrease in worksite accidents (9; 10; 16; 41), • decrease in workplace injuries (9; 10; 16; 41), • reduced short-term disability rates and associated costs (10; 16; 41), • decrease in workers compensation (10; 41; 44-49), • reduction in workplace costs (9; 10; 14; 16; 41; 44; 46; 47), • improvements in cost to benefit ratio (16; 41; 44-46; 48), • potential increase in productivity (10; 14; 16; 19; 20; 41; 50).

Another economic benefit of WHPA programs is the reduction in ‘presenteeism’ (41; 51). This new concept attempts to quantify how existing health conditions of workers limit work performance and negatively influence productivity of the organisation.

2.3 Environmental Benefits to Organisations

Workplace health and physical activity programs improve the work environment in a number of ways. These include:

• enhanced working conditions and safety (9; 10; 14; 36; 43), • decreased accidents and injuries (9; 10; 16), • improved working atmosphere (14; 36), • increased social support (10; 14), • improved leadership style (10; 14), • reduced job stress (9; 10; 36; 52).

2.4 Social Benefits to Organisations

Implementing workplace health promotion programs contributes to improved human resources outcomes that can strengthen overall workplace performance. Other social benefits to the organisation are:

• increased job satisfaction (10; 16; 20; 52), • enhanced motivation, greater commitment, loyalty (10; 14), • improved morale of employees (9; 10; 14; 16; 26; 52; 53), • improved communication and teamwork (9; 10; 14), • enhanced corporate image (10; 53; 54), • improved recruitment (10; 14; 16), • lower staff turnover and the retention of quality staff (10; 14; 16; 52).

2.5 Summary of Benefits & Future Research Suggestio ns

As outlined above, there are countless benefits of health promotion programs conducted in a workplace setting. Furthermore, there are numerous studies showing the benefits of health promotion programs in various other settings that are likely to be applicable to the workplace. As the workplace health promotion field is relatively new, there is a need to further improve the quality of evidence demonstrating the benefits of WHPA programs (14). This evidence can in turn influence policy and support the uptake of workplace health promotion (55). It is suggested that more scientifically rigorous research in the field of workplace health promotion should be performed, as current research is limited (8; 56). This is due partly to methodological problems and practical difficulties of conducting research in this setting (9; 15; 55-58). In particular, research in Western Australian workplaces is required to document the benefits of WHPA programs under local conditions. Comprehensive studies assessing the health, economic, social and environmental benefits for both individuals and their organisation should be conducted. Unfortunately, international research can be limited in its applicability to the Australian workplace due to major differences in workplace health systems. In Australia, the greatest costs to employers are a result of musculoskeletal injury and stress (9), whereas in the USA, organisations need to meet the health costs of illness and accidents of their employees through insurance premiums (10). Improvements in health as a result of WHPA programs will result in significant savings to the state in terms of reduced health care costs (9). 3.0 Characteristics of Successful Programs

Successful workplace health promotion programs take a comprehensive and integrated approach to workplace health by implementing a number of strategies that aim to improve the organisational culture and provide a supportive environment. Successful programs seek to understand the target population, create a supportive environment for change, evaluate health promotion programs to encourage success and utilise information on best practice. Further information on ‘best practice’ strategies can be found in section 5.0.

3.1 Positive Workplace Culture & Supportive Environ ments

Creating a positive workplace culture and a supportive environment for change is essential to ensure WHPA program success (8; 59-65). It is important for organisations

to take a comprehensive approach to workplace health promotion and avoid focusing on a short-term fix to ensure that positive health behaviours become engrained in the culture of the workplace (15). Changes to organisational structure and supportive management strategies that reflect the commitment of the organisation to the health and wellness of their employees can help to establish a positive workplace culture (8; 59-65). Organisational policies that prioritise workplace health are important in ensuring successful implementation of WHPA programs (8; 59-65). Simple strategies such as creating a comprehensive WHPA policy that is clearly communicated throughout the organisation can be very effective in improving the workplace culture. This is further enhanced by organisational commitment to workplace health in terms of positive financial, management, strategic, structural and policy decisions (8; 59-65). Improving the workplace environment and providing a supportive environment to encourage behaviour change are strategies that help to institute a positive culture in an organisation (8; 36; 59-65). The workplace environment can be improved through policy changes and environmental strategies that enhance the physical workplace (24; 36; 66; 67). Other effective environmental strategies that can improve health behaviours in the workplace are providing access to facilities such as showers, lockers and gyms, increased access to healthier foods and the use of point-of-decision prompts like signs to encourage stair use (24). A checklist developed in Australia provides a method of evaluating workplace environmental characteristics that may influence health behaviours (67). This checklist may be used to assess the health promotion environment and to monitor changes as a result of workplace health initiatives.

3.2 Supportive Management Strategies

Organisations with successful WHPA programs have supportive management strategies. Senior and middle level management support is an essential characteristic of successful programs (8; 59-61). Multi-level program development is also important, together with the integration of program with organisation goals (8; 59-61). Effective communication and a sense of program ownership by employees are often considered important (8; 59-61). The ability of management to ‘institutionalise’ the program in the culture through the use of various strategies is also a characteristic of successful programs. This includes the alignment of organisational policies with the WHPA program (8; 60; 61).

3.3 Holistic Approach to Workplace Health Promotion

Successful programs adopt a multidimensional, interdisciplinary, holistic approach to workplace health promotion (7; 61; 68; 69). Progressive programs consider psycho-social aspects of health promotion and concepts such as work-life balance by promoting a culture which recognises the value of life beyond the workplace (8; 70). To maximise success in terms of behaviour change it is important to use the stages of change concept (8; 59). Successful programs also create supportive cultures and aim to enhance self efficacy (8; 59; 60). Tailoring messages and content, individual counselling, personal goal setting and offering incentives and rewards where appropriate are other important characteristics of successful WHPA programs (60).

3.4 Effective Communication

Successful workplace health promotion programs use effective communication strategies (7; 8; 59-62; 68). For successful ongoing communication it has been suggested that targeted personal communication, meeting announcements, printed flyers, health newsletters, intranet websites, payroll inserts and email are successful strategies (8; 59-61). A recent Australian study (71) has found that a proactive telephone-based intervention may have the potential to increase the number of health promotion initiatives undertaken in workplaces at relatively low cost (i.e. $225.85 per workplace). The use of technology, in particular email, has been shown to be a promising mode of delivery for health promotion in the workplace (72).

3.5 Ongoing Evaluation

Effective evaluation strategies are another important component of successful health promotion programs. It is important to evaluate health promotion programs regularly to encourage success and continual improvement (8; 59; 60; 62). A consistent follow-up process is essential for encouraging behaviour change (7; 60; 62; 68). Organisations should conduct regular and comprehensive evaluation of their WHPA programs (7; 60; 62; 68). To enhance the success of the program, feedback and evidence of success should be provided to all levels of the organisation, including both the individual participants and management (7; 60; 62; 68).

3.6 Successful Recruitment & Participation Strategi es

A critical factor in the success of a workplace health program is successful recruitment and participation strategies (7; 8; 59; 60; 62; 68; 73). Conducting regular needs assessments can help program coordinators to understand what the organisation wants from its WHPA program (62; 73). Creating and encouraging a positive culture of health within the organisation will also help to increase participation (59; 62). Marketing a WHPA program effectively is essential to success. Effective marketing approaches incorporate strategies such as creating a ‘brand identity’ to help to position the program powerfully in the organisation (62). Effective strategies for recruitment and participation include a multi-level invitation process, incentive recruitment, personal contact or word of mouth, targeted personal invitations, reminder calls, personal mailing, websites, intranet and email (3; 8; 59; 60; 62). Other strategies for increasing participation include targeting a greater number of employees, including those who are less likely to volunteer or join an ‘organised’ program (8). This can often be achieved through the promotion of incidental activity including active transport to and from work and active communication (8). It is important to successfully manage the health of employees at all levels, from those who helped to get health promotion started in the organisation to the ‘grass roots’ supporters and detractors (62). Another successful strategy is one-on-one counselling and contact (3; 59; 62; 74). Offering a selection of intervention options where possible so individuals can choose the most appropriate program is also a successful strategy (62). An important issue is setting appropriate participation goals for WHPA programs. Successful programs aim to reduce the overall level of health risk of employees through effective program design and management (62). Many effective programs utilise the concept of population health management which involves lowering the risk of higher-risk employees while maintaining the status of low-risk employees, leading to a higher return on health promotion investment (75). This is achieved by optimising success and program cost-effectiveness by directing individuals to interventions that best target their

current needs. Prochaska’s ‘stages of change’ model (76) provides an excellent framework for planning targeted, effective programs (59; 62). When using this strategy it is important to maximise participation in baseline and ongoing health risk assessments that provide information to select individuals for targeted programs (62). 4.0 Barriers to Implementing WHPA programs

4.1 Barriers of the Workplace Setting

There are disadvantages of the worksite setting that need to be acknowledged and overcome when planning and implementing workplace health promotion programs. Firstly, economic pressures often prevent adequate funding of WHPA programs with a lack of finance often named as the major barrier to organisations when considering worksite health promotion programs (7; 9; 17; 77). Organisations are often concerned about insurance and potential liability costs as a result of implementing workplace health programs (10). The demands of modern employment can be a barrier to worksite health programs, with a lack of time, resources, and other priorities often cited as reasons why programs are not implemented or less successful than planned (7; 9; 17). Practical considerations like the size of the workplace or lack of facilities can also be a barrier (7; 17). Not considering organisational strategies or the workplace environment are barriers to success (14; 57). Many workplace health programs have been ineffective due to a lack of integration with existing organisational structures and policies (14; 57). Other important factors that influence program success, such as organisational policies, involvement of managers and supervisors, company goals and objectives, or the culture of the organisation, can become barriers if not considered and managed effectively (14; 57; 78). Workplaces have a natural instability that makes continuity, follow-up and consistency challenging (7). Health promotion programs are traditionally difficult to evaluate thoroughly. A lack of participation and minimal involvement from ‘high risk’ individuals can also be a barrier to success (9).

4.2 Barriers to Individuals

There are many barriers that can limit the participation of employees in workplace health promotion programs. These include inconvenient timing of program activities, impractical locations, ineffective marketing strategies and lack of management support (79). A lack of peer support or a culture of ‘unhealthy’ behaviour can be a barrier to participation in workplace health programs. Potential distrust between employees and employers can also cause problems, as some employees are concerned about the confidentiality of their health results and the potential for substandard health measures to put their employment at risk (7; 10). Interestingly, a recent study found the main barriers to being more active for Western Australian adults were lack of time (49%), already being active (15%), lack of motivation (11%), poor health (10%) or childcare commitments (6%) (1). It is important to note that many of these barriers could be overcome by providing opportunities to be physically active in the workplace. Organisations should strive to overcome barriers to participation with innovative and proactive strategies (7; 15).

5.0 Current ‘Best Practice’ Strategies for WHPA Pro grams

The current ‘best practice’ strategies for the workplace health promotion are outlined below. It is important that ‘best practice’ guidelines are continually developed and draw on information from both researchers and practitioners in the workplace to determine which program strategies are the most effective (59; 80).

5.1 Best Practice in the ‘Planning Phase’

• Ensure strong senior management support (7; 8; 59-61; 68; 79) • Align program with strategic business objectives (7; 8; 59-61) • Integrate with organisation goals and policies (7; 8; 57; 60; 61; 68) • Involve employees from all levels of the organisation in the planning process to

encourage a sense of program ownership at all levels (7; 60; 61; 68) • Implement programs that address the needs of individuals in the organisation (7;

59) • Develop a clear set of goals and objectives (7; 60; 68) • Use an interdisciplinary team of experienced, knowledgeable staff (7; 8; 61; 62;

68) • Offer culturally sensitive and appropriate programs to engage economically

challenged, minority and underprivileged populations (81). Manage gender differences to improve workplace health and well-being outcomes (82).

5.2 Best Practice in the ‘Program Design Phase’

• Offer multi-faceted and holistic programs (8; 69; 79) • Ensure strategic and comprehensive approaches (8; 79) • Plan for active recruitment process (7; 8; 59; 60; 68) • Tailor WHPA programs to the particular workforce (16) • Utilise an annual survey or health appraisal to plan, target individuals and

evaluate progress (7; 83) • Use a number of different intervention modalities based on preferences of

individuals in the target population (7; 59; 68) • Select a broad scope of prevention targets from primary to tertiary levels of

prevention (7; 83) • Provide ‘virtual’ as well as site-based interventions through the improved use of

technology (7; 8; 59; 68; 84) • Target high risk individuals effectively (7; 8; 68) • Maximise accessibility to programs and eliminate barriers of access to programs

(7) • Integrate program activities within the organisation and integrate with external

activities and resources where appropriate (7; 8; 57; 68)

5.3 Best Practice in the ‘Program Implementation Ph ase’

• Maximise participation (7; 8; 59; 62; 73; 79) • Ensure consistent follow-up process (7; 60; 68) • Use incentives where appropriate however long-term change requires internal

motivation (7; 59; 60; 62; 73) • Encourage effective communication strategies (7; 8; 59; 60; 68)

• Create a supportive culture (7; 8; 59; 60; 62; 64) • Create a supportive environment so health promotion behaviour is easier to

initiate and maintain (7; 8; 59; 60; 62; 65) • Use ‘champions’ in the organisation to promote the program (61)

5.4 Best Practice in the ‘Program Evaluation Phase’

• Ensure a regular, comprehensive, systematic evaluation process (7; 8; 60; 79) • Provide formative feedback to continually improve the program (7; 79) • Evaluate participant satisfaction (7; 68; 73) • Carry out ongoing evaluation of program goals and objectives (7; 60; 68) • Determine changes in health behaviours and health status (7; 59; 68) • Evaluate improvements in the organisation as a result of the program (e.g.

improved productivity due to reduced absenteeism, lower workers compensation costs) (7; 68; 73)

6.0 Innovative Solutions & Suggestions for Future C onsideration

There are a number of strategies that can be implemented to increase the effectiveness of workplace health promotion in Western Australia. The World Health Organization’s (WHO) global healthy work initiative calls for the development of a comprehensive approach towards the promotion of health in workplaces (85; 86). This can be achieved through a number of suggestions outlined below.

6.1 Integrated Approach

There is a need to involve key stakeholders such as health promotion practitioners, organisations, researchers and government policy makers in a more integrated approach to workplace health promotion (1; 5; 8; 9; 57; 59; 86-90). These groups need to work together to implement strategies that encourage the adoption of workplace health promotion initiatives. Other key stakeholders that should be considered in an integrative approach are unions and employer/employee representative bodies (91). A Western Australian study also raised the hypothesis that trade unions could provide a potential means to encourage health promotion in the workplace (92). All key stakeholders need to work together to promote health and to raise the profile of health promotion in the worksite setting. The creation of networks, alliances, partnerships together with supportive government policy and legislation is also imperative. The importance of an integrated approach is demonstrated by the WHO’s global healthy work approach that links health promotion, occupational health and safety, human resource management and sustainable development (86). Other researchers have also mentioned the importance of the integration of health promotion with occupational health and safety (9). Other important factors in an integrated approach include considering organisational strategies and policies. The concept of creating supportive environments is also central to success (4; 5; 57; 85). Finally, general practitioners and other health professionals should promote the benefits of WHPA programs (16).

6.2 Creation of Networks, Alliances & Partnerships

The creation of networks, alliances and partnerships should be encouraged (5; 86; 93). This may involve complex arrangements to promote health and address broad health issues (5; 93) or more simple strategies that support workplace health promotion. There needs to be greater emphasis on advocacy to create supportive environments, public policy, supportive legislation, leadership and partnerships to encourage health promotion in the workplace (5). The European Network of Workplace Health Promotion (ENWHP) is an excellent model that demonstrates the importance of forming networks and sharing knowledge.

6.3 Supportive Government Policy & Legislation

The formation of supportive government policies and legislation should also be implemented to encourage the uptake of workplace health promotion programs by organisations (9; 78; 94). This could include supportive legislation, changes to fringe benefits tax and reduced insurance premiums (77).

The development of health promotion infrastructure is also important (9; 86; 94). The formation of links between the workplace and external settings such as the community should be encouraged (1; 8; 9). One suggestion is to establish state and/or regional

centre(s) for health promotion (94). Creating training programs will also help to improve the standard and success of workplace health promotion programs (94).

6.4 Strategies to Target Small Business

One particular group that could benefit from the creation of networks and partnerships is small business (17). This can be a challenging market for health promotion; however, the creation of partnerships with other businesses and links with the community is an innovative strategy to overcome potential barriers (17). Joint programs can be implemented that involve a number of smaller organisations (17). Likewise, collaborations between local government, chambers of commerce, other community agencies and small business may provide smaller organisations with access to WHPA programs (17). Other simple strategies that may be effective for health promotion in small business are implementing brief stretching and exercise breaks, forming a company sports team or walking program, healthy lunches and utilising free resources that are available from community health agencies (17)

6.5 Development of ‘Best Practice’ in Western Austr alia

The development of ‘best practice’ guidelines that are specific to Western Australia will be important for improving health promotion in the workplace in this state. These guidelines should incorporate information from key stakeholders and expertise from practitioners in the workplace to understand which health promotion strategies, programs and processes work best in particular organisations (59; 86-90; 94). More scientifically rigorous research in the field of workplace health promotion is required as current research is limited (8; 56). This is due partly to methodological problems and practical difficulties of conducting research in this setting (9; 15; 55-58). There is a need to improve the quality of evidence that in turn can influence policy (55). In particular, comprehensive research in Western Australian workplaces is required to identify ‘best practice’ under local conditions. 7.0 Conclusions

Health promotion in the workplace setting is a promising approach to potentially increase the productivity of organisations and to improve the health and wellbeing of employees. Implementation of WHPA programs results in numerous benefits to both the organisation and the individual. A comprehensive, integrated approach to health promotion in the workplace that enhances the workplace culture and environment is recommended. Supportive policy and legislative changes together with the creation of networks and infrastructure will increase the successful implementation of WHPA programs. More local research is needed in this developing field to increase the support of these programs and to develop ‘best practice’ guidelines. In conclusion, the workplace provides a unique opportunity to implement innovative health promotion programs to improve the health of Western Australians.

8.0 References

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