The benefits of positive health behaviors, such as consistent physical activity or a balanced diet, are well documented. General knowledge dictates that one should exercise and eat plenty of leafy greens; the problem, however, seems to be getting people from “should” to “will”. Public health initiatives aside, this continues to be a particular area of concern for U.S. employers. Countless occupational health studies have shown that only a small percentage of working-age Americans incorporate these behaviors into their lifestyle. In a particularly revealing observation, one researcher described workers as “influenced by feelings of personal wellbeing rather than by health outcomes,” and that “health was viewed as a predetermined destiny that was outside the individual’s personal control [1].”
While this attitude may seem irrational, it is nevertheless quite prevalent in today’s workforce. Since poor compliance and other common occupational health issues are often direct results of such attitudes, organizational psychology can help us understand how to change them. The link between action and belief is best explained by the Theory of Planned Behavior (TPB), which presents reasons for why people engage in certain behaviors as well as strategies to predict and influence human behavior [6]. Predictably, these ideas are most often utilized in advertising and public relations campaigns, but are also incredibly applicable to occupational health promotion and intervention.
Using the TPB framework, nearly 600 blue-collar workers were surveyed in 2001 to determine which factors had the most influence on their exercise behavior [1]. Perceived behavioral control—the degree to which someone believes they can accomplish a certain task—was found to have a significantly higher degree of influence on employees than social pressure or individual attitude. This supports previous evidence that a perceived lack of control negatively influences employees’ health behaviors. In other words, people are more likely to perform a behavior if they are confident in their ability to do it, and less likely if they believe themselves to be incapable.
From theory to practice
These insights carry great potential for helping employees adopt and maintain positive health behaviors. In practice, employers can leverage the Theory of Planned Behavior by reinforcing two key factors: 1) perceived control and 2) perceived positive outcome.
Perceived control. The first part of this is empowering employees to take control of their health by holding them accountable to realistic health goals. Weight loss, for example, may seem a daunting goal for many. But when broken up into a series of short-term goals forming an action plan, these health goals can be shifted into the realm of reasonable expectations. Per the TPB, each goal must be as specific as possible in terms of time, context, and the action itself. An occupational health professional might encourage an employee to begin with a goal of 5,000 steps on a fitness tracker during the first week, progress to 7,000 daily steps during the second, and by the fifth week incorporate brief intervals of aerobic activity. By focusing on one small goal at a time, employees can be given greater perceived control over their health behavior.
Perceived positive outcome. The second part is to make the goals relevant to employees by bringing awareness of personal benefits. An employee with a weight loss goal might be more likely to engage in an exercise program if made aware of the benefits he stands to gain, such as greater physical mobility, improved sleep quality, and decreased risk of heart disease. Well-being indicators are another meaningful aspect of personal benefits that should be communicated to employees. The ability to enjoy moderate leisure activities, travel, or spend time with family—without being inhibited by functional limitations—are all ways in which changing one’s behavior can bring about a higher quality of life.
It must also be noted that the concept of establishing benefit goes much deeper than simply promising material rewards for participation. Employees should feel they are engaging in these positive behaviors for their own well-being, not to advance some distant corporate objective or to appease upper management.
Together, these factors form the foundation of participative health management [5], in which:
- Employees are given a collaborative role in decision making and problem solving
- Safety and health professionals bridge the gap between management and workforce
- Employers share responsibility and accountability
- Employees are empowered to take control of their own well-being
Shifting accountability
Although organizational expectations for health and safety outcomes are often made clear, many companies do not see consistent fulfillment of these goals. The role of participative health management is to go a step further and help employees understand the aspects of their performance needed to achieve these outcomes.
Part of what makes this approach so valuable is that it gradually helps employees become self-sufficient. Participative health brings about an accountability shift: using external accountability (support from an occupational health professional) to develop internal accountability (self-monitoring health behaviors). Not only does this help facilitate collaboration between employees and management, it creates opportunities for early intervention and support. By giving them the tools to maintain positive health behaviors, employees will be able to make better decisions for themselves far beyond the context of the workplace.
Evidence-based strategies
The strength of participative health management has been demonstrated most notably through the chronic disease self-management programs (CDSMP) developed by Stanford University, which used a participatory approach to improve health behaviors [3]. Upon reviewing 13 major CDSMP studies, the Centers for Disease Control and Prevention found strong, measurable improvements in patients’ health behavior and quality of life; outcomes included more frequent exercise, reduced fatigue, and greater self-efficacy [4]. Not only did these outcomes remain consistent over time, they successfully decreased healthcare utilization along with associated costs. From the summary of benefits: “CDSMP also saves enough through reductions in healthcare expenditures to pay for itself within the first year.”
With consideration to existing wellness programs or initiatives, below is an evidence-based model for integrating a participative health approach within an organization:
- Set clearly defined, attainable goals with specific metrics. Goals will vary greatly based on type of industry and population health needs; for example, injury reduction may be the top priority for warehouse employees, while eliminating sedentary behavior is the top concern for office workers.
- Provide the resources to achieve these goals. This includes training and educating employees on relevant topics (such as ergonomics, nutrition, or exercise), as well as access to proper equipment and medical support.
- Consistently monitor progress toward goals and provide feedback. Occupational health professionals should seek open communication with employees regarding their health behavior and remain available for individual support throughout the process.
- Recognize accomplishment of goals. Accountability is more effectively supported by positive reinforcement and should ideally not be associated with negative consequences. This means employers must focus on performance rather than simply reacting to unfavorable results—or conversely, handing out gimmicky rewards that fail to motivate employees in the long term.
The compelling benefits of a participative approach
Shifting health behavior accountability from external to internal is a proven way to connect organizational expectations to desired outcomes. By pursuing an accountability shift, occupational health and safety leaders can bring valuable improvements to both employees and the company as a whole. From a financial standpoint, a more vigilant workforce strengthens overall cost-efficiency with fewer on-site injuries, fewer missed work days, and fewer health claims for preventable illness and injury.
The long-term value of participative health management is also apparent within the context of workplace culture and behavior. A gradual shift from external to internal accountability results in employees who are motivated to maintain positive health behaviors, which are then reflected by improved performance and better compliance. Furthermore, making a visible effort to help employees manage their health is a powerful way to build trust and job satisfaction, both of which are factors that boost employee retention.
Sources
- Blue, C., Wilbur, J., & Marston-Scott, M. (2001). Exercise among blue-collar workers: Application of the theory of planned behavior. Research In Nursing & Health, 24(6), 481-493. http://dx.doi.org/10.1002/nur.10008
- Blue, C. & Black, D. (2005). Synthesis of Intervention Research to Modify Physical Activity and Dietary Behaviors. Research And Theory For Nursing Practice, 19(1), 25-61. http://dx.doi.org/10.1891/rtnp.19.1.25.66333
- Lorig, K. & Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals Of Behavioral Medicine, 26(1), 1-7. http://dx.doi.org/10.1207/s15324796abm2601_01
- Gordon, C., and Galloway, T. (2008). Review of findings on chronic disease self-management program (CDSMP) outcomes: Physical, emotional & health-related quality of life, healthcare utilization and costs. Centers for Disease Control and Prevention and National Council on Aging
- Muller, M. (1995). Participative management in health care services. Curationis, 18(1), 15-21. http://dx.doi.org/10.4102/curationis.v18i1.1347
- Ajzen, I. (1985). From Intentions to Actions: A Theory of Planned Behavior. In J. Kuhl & J. Beckmann, Action Control: From Cognition to Behavior (1st ed., pp. 11-39). München: Springer Berlin Heidelberg.
