HMB coordinators
HMB coordinators each supported an average of 50 businesses across Maryland. All coordinators completed the Certified Worksite Wellness Specialist Program through the National Wellness Institute, and some coordinators mentioned completing the CDC Work@Health training. Coordinators described how the CDC HSC data helped them to assess priority areas for businesses and connect them with resources based on their specific needs. Among the key themes that emerged from the coordinators and their supervisor were that small businesses have the greatest need and resource constraints, and are therefore more challenging to assist.
PA was not a priority for many businesses they supported. To address this barrier, there was an expressed need to better communicate about how PA impacts measures the businesses care about, such as absenteeism rates, and costs from claims data with the understanding that it may take a few years to see return-on-investment (ROI). To promote PA to the businesses, the coordinators relied on existing resources available on the Internet from organizations such as the CDC and the American Heart Association.
Another challenge cited was that grant funds for the HMB program had aims that sometimes differed from businesses’ needs and priorities. For example, HMB grant funds aimed to increase PA and walking, but some businesses prioritized improving nutrition and tobacco cessation. Merging those different priorities and providing information for PA/walking as a priority was a challenge the coordinators tried to address.
A few coordinators noted that some businesses wanted to be held up as an example of leadership for wellness. Being a leader in employee wellness is something the businesses could use for their own marketing and perhaps distinguish them from their competitors. Coordinators also noted that local health departments could serve as a model for what other businesses can and should do regarding policies for PA breaks during the work day. For example, if health departments are encouraging businesses to allow PA breaks during work time, but the health department itself does not have that policy for their own employees, businesses may be less likely to implement it.
HMB case studies
Table
1 describes the 15 businesses that participated in a case study interview. In addition to size and type, the businesses were also categorized by county/region because we aimed to have a representative sample from rural/suburban/urban areas. Of the 15 businesses, 6 were small businesses (of which 1 was for profit, 2 were non-profit/government, 3 were non-profit/other); 4 were medium-sized businesses (of which 1 was for profit, 2 were non-profit/government, 1 was non-profit/other); and 5 were large businesses (of which 2 were for profit, 0 were non-profit/government, 3 were non-profit/other). As reflected in Table
1, most businesses were small- and large-sized, non-profit/other businesses from the health care and social service sector serving rural areas.
Table 1
Description of businesses included in the qualitative analysis (n = 15)
Small (< 200) |
6 | Health Care and Social Service | Non-Profit/Other | Rural |
10 | Construction | For Profit | Suburban |
45 | Health Care and Social Service | Non-Profit/Other | Rural |
69 | Health Care and Social Service | Non-Profit/Government | Rural |
94 | Health Care and Social Service | Non-Profit/Government | Rural |
173 | Professional, Scientific and Technical Services | Non-Profit/Other | Suburban |
Medium (200–550) |
242 | Transportation and Warehousing | For Profit | Rural |
288 | Health Care and Social Service | Non-Profit/Government | Rural |
331 | Health Care and Social Service | Non-Profit/Government | Urban |
535 | Utilities | Non-Profit/Other | Rural |
Large (551+) |
1000 | Accommodation and Food Services | For Profit | Suburban |
1267 | Health Care and Social Assistance | Non-Profit/Other | Rural |
3000 | Manufacturing | For Profit | Urban |
6917 | Health Care and Social Assistance | Non-Profit/Other | Suburban |
8000 | Educational Services | Non-Profit/Other | Urban |
Key findings from the interviews are summarized in Table
2. Respondents consistently identified role modeling on the part of leadership as a facilitator for PA policies and programs. Having commitment and investment from leadership was identified as essential to the success of any PA policies and programs. For example, one interviewee shared a perspective that we heard from others we spoke with:
“The programs that are most successful are the ones that senior representation, senior management really embraces and talks up. That helps raise the awareness. We’ll send out emails, talk in meetings about upcoming wellness initiatives, be it a program, a contest, but when senior management reinforces it and follows up with their own email or they talk about it, that always helps generate more interest and excitement in doing it. I mean, really their influence is very important.”
Table 2
Key themes from the interviews with case study participants (n = 15)
Barriers to PA Initiatives | - Limited resources, particularly for small businesses - Many workplaces find it difficult to make PA a priority - Burdensome to implement PA break policies - HMB grant aims do not always coincide with the priorities and needs of participating businesses - Lack of support from HMB business leadership - Extreme weather poses a challenge for outdoor PA - Physical limitations for gym equipment, space to conduct workout classes, access to stairs and shower facilities - Workplace culture is not viewed as a place to promote PA (e.g., viewed PA as a personal issue rather than a company one) - Low rates of participation in PA programming among workers - Logistics of certain businesses prevent programming and activities—liability associated with PA, government organizations cannot offer certain participation incentives |
Facilitators of PA Initiatives | - Leadership support for PA programs is vital to success - Offering programs at a convenient time for employees helps to improve participation - Having a budget specifically for wellness activities - Need a wellness committee comprised of employees separate from HR responsible for planning and giving feedback on PA activities - Have tools in the office that could prompt PA among workers such as hula hoops and jump ropes - Offer a wide range of activities to attract a wider range of employees - Encourage employees to share PA success stories - Putting policies in writing improves uptake and participation - Some employees are more motivated to participate in PA programs when incentives are offered - Employees are motivated by different things, therefore communication advertising PA activities should address these motivators |
This point was emphasized by another interviewee who stated:
“Our CEO participates when we have different challenges, and he runs the 5Ks and 10Ks with the employees. He definitely is a big part of the getting that support from the top down. It is very important, and we do have that so I think it is a key part of why we’re so successful. It’s been reiterated that the supervisors need to provide support because (the program takes place) during work time. So we have had to have management reminded that they are to be supportive of the wellness program.”
Interviewees also shared their perspectives on what has worked and what some challenges have been. An engaged wellness committee with company representation at all levels and roles was also identified as vital, particularly for enacting PA break policies and impactful programs. A few participants mentioned that incentives and competitions are useful especially when trying to get employees to try new things and to engage new people. However, employees may stay engaged longer if they also contribute something to participate, for example, a small fee to participate in a fitness class. Respondents from larger companies that were able to subsidize employee costs to participate in fitness programs and or gym memberships did not think the issue was cost, but supporting the right programs. One respondent captured this well and said: “I think it’s a matter of finding the right programs to increase the participation.”
Businesses like to know what other similar type businesses are doing that works, and a newsletter was suggested as one way of disseminating that information. Highlighting businesses, through recognition and awards, for being leaders in employee health can motivate similar type businesses to be competitive and initiate their own PA initiatives.
Key themes identified as challenges involved certain types of businesses that have unique challenges to implementing PA policies and programs because of unusual work hours, shifts, working off-site, and limitations to what can be worn in the work environment (i.e., no Fitbits, smartphones, or pedometers). For a small subset of businesses that operated in around the clock shifts, finding the right time to hold fitness classes was a challenge. There were challenges engaging part-time and hourly employees who work in the field. Some businesses, such as those in hospitality, don’t have all employees under one roof and experience high turnover as well.
Small businesses generally have unique challenges related to a lack of funding, access to resources, and a limited number of employees. Small businesses also described challenges with having the physical space to support activity. For example, the small businesses in our sample did not have stairs to promote stair use. Other businesses with stairs noted the lack of showers for people to use after doing things like stair walking, which when done at a good pace could make someone sweat.
Most PA policies were informal and indicated that PA initiatives take place on employees’ time including during their lunchtime. This becomes a convenience issue for many employees. Additionally, staff employees who are responsible for PA initiatives in the workplace have limited time, multiple responsibilities, and few resources. Even for businesses that have a formal PA policy in place that allows time during work hours to engage in PA, there are challenges. For example, these policies typically require that an employee’s work not fall behind, and he/she first obtain permission from the supervisor, some of whom may be more supportive of the policy than others. Some employees may be perceived as not having enough work to do if they are able to take a 30-min PA break during the workday. One non-profit government business reported that only about 20 out of 285 employees utilized the policy because of these barriers. The policy should be consistently implemented across departments, divisions, and supervisors with enforcement from management/leadership in order to address some of these barriers. One other policy challenge, noted by small workplaces, is how a policy that encourages walk breaks can become a burden for a small business if there are only a few employees doing the work. These small businesses are looking for guidance as to how to reduce this burden and still promote PA.
The importance of evaluation was also discussed by the interviewees. Tracking the number of employees who partake in PA initiatives and satisfaction surveys were the most frequent types of evaluation used in this subset of businesses. Some workplaces surveyed employees about what types of activities they would participate in. There was expressed interest in learning more about how to evaluate policies and programs and any tools to guide this process, especially because of lack of capacity or understanding regarding the best ways to evaluate workplace health promotion initiatives. Businesses requested access to template surveys and an outline of how to evaluate their efforts (formative, process, and program evaluation); these were perceived to be valuable tools. There were also requests for trainings through webinars showing businesses how to conduct evaluations of policies and programs and to identify evidence-based PA programs.