Worksite wellness and worksite wellness programs

It’s advised that use of tobacco cessation programs subscribe to the Code of Practice for Smoking Cessation Programs.

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

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

In programs that use aids like the “patch” or medications like “Zyban” appropriate consultation ought to be available on the usage of these aids.

The instructor should’ve formal training in use of tobacco cessation from a nationally recognized organization like American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program like Smoke Enders.

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

Additionally included, number and percent who stopped smoking at the end of the program, and the number and percent who had not resumed smoking by the end of one year.

Participatory fitness programs ought to include education on benefits of regular physical activity and risks of a sedentary lifestyle, its impact on cardiovascular health and diseases, its relationship with weight control and stress management, and aerobic activity choices.

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

Safety precautions should include the following –

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

• A screening/evaluation of participants to determine if medical analysis is necessary for exercise like the Exercise Readiness Questionnaire (PAR-Q, see forms).

• Measurements of blood pressure (BP) and resting heart rate are useful screening information to determine exercise readiness.

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

• the basic content of an group fitness program should include –     

Warm up   5 – 10 minutes

Aerobic exercise   20 – 40 minutes

Cool down   5 – 10 minutes

Exercise instructors should’ve education and training in exercise physiology, physical education, physical therapy or comparable discipline, or possess a current certification by a nationally recognized sports medicine or exercise association, and be CPR licensed.   

Program offered is consisitent with scientific and medical recommendations for weight loss, reflects a multi-disciplinary approach which offers four components –  behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance for Treatment of Adult Obesity. It includes –    

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

• Referral for participants who are morbidly obese who’d require medical guidance for weight loss.

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

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

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

• Explanation of unsafe weight loss methods.

• Daily calorie level is adapted to meet each participant’s advised rate of weight loss.

• Daily caloric intake isn’t less than 1,000 calories; if less, doctor monitoring is required.

• Food plan designed so participants can pick foods which meet 100 percent of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation could be used to achieve RDAs, nevertheless shouldn’t greatly exceed RDAs.    

• Nutrition education encouraging permanent healthful eating habits based on the Food Guide Pyramid.    

• Participant involved in meal planning and food selection.    

The protein, fat, carbohydrate, and fluid content of the food plan meet safety recommendations –     

Protein   Between 0.8 and 1.5 grams of protein per kilogram of goal body weight, but no more than 100 grams of protein a day.

Fat   10 – 30% calories as fat.

Carbohydrate   At least 100 grams per day.

Fluid   At least one liter of water daily.

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

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

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

• No appetite suppressant drugs.

• Maintenance plan offered for continued support.

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

• Trained lay leaders may assist if supervised by nutrition specialist.

Note –  There’s an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

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

Follow national guidelines –

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 – 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows –    

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, if history of coronary heart illness or if two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.

200 - 239 mg/dl    When history of CHD or when two or more other risk factors are detected, refer to medical care or risk reduction service within two months; when no reported history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.

> 240mg/dl    Refer to medical care within two months.

HDL   

> 35 mg/dl   If fewer than 2 risk factors and borderline sum cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Give the following –    

• the relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include –  high blood pressure (BP) 140/90 or higher or on hypertension medication; current cigarette smoking; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.

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

   o Risk factors such as family history, tobacco use, high fat or other unhealthful diet, andphysical inactivity lead to the development of cardiovascular illness (CVD).

• Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements before diagnosis.    

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

• Importance of following prescribed treatment and specialist advice.    

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

National guidelines for blood pressure protocols –  

• Calibration of blood pressure (BP) measuring equipment must be done at least annually.

• Two or more measurements of participant’s blood pressure (BP) should be taken.

• Referral of participants with high blood pressure readings to personal physician for further examination.   

Systolic / Diastolic Follow-Up –     

• Normal –    <130 / <85   

   Action –  Recheck in 2 years

• High Normal –    130-139 / 85-90   

   Action –  Recheck in 1 year

Hypertension –     

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

   Action –  Confirm within 2 Months.

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

   Action –  Refer to source of care within 1 month.

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

   Action –  Refer to source of care within 1 week.

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

   Action –  Refer to source of care immediately.

Appropriate educational messages –     

• Normal –    <130 systolic and <85 diastolic   

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

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

   Action -  Recommend that participant have blood pressure (BP) rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to lower blood pressure (BP) is to bring weight into normal range and to exercise.

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

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

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

   Action -  Advise participant to inform physician of readings at next visit and consider advice regarding weight loss and exercise when appropriate.

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

   Action -  Recommend obtaining medical investigation within 1 week.

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

   Action –  Obtain immediate medical attention.

Provides the following –     

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

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

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

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

• Definition and causes of high blood pressure.

• Importance of following prescribed treatment.

Health risk screening programs must be carried out on a one-on-one basis by trained health care experts. Health risk measures ought to include the following –

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

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

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

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

• Obesity – utilize an accepted method for estimating obesity. for  instance assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index (BMI).    

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

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

• Exercise habits – screening questions may  be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.    

• Diabetes – whether the customer has diabetes, and whether or not it is currently under control. A blood glucose may  be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include cholesterol and glucose measurements.

• Cerebrovascular illness or occlusive PVD – ascertain when the patron has had a stroke or other kind of capillary illness.

• Family history of cardiovascular illness – ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart illness before age 55.

• Coronary heart illness – ascertain if the patron has had a heart attack or other kind of coronary heart illness.

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

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

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

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

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

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

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

They should have specialistise in content areas, planning, promotion, administration, investigation, and ability to grow a program and tailor the program to the workplace.   

Program providers should’ve a quality assurance program for reviewing  the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.   

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

• assurance of confidentiality of health data,
• referral to health and medical care for at-risk participants,
• follow-up with referred participants and those at-risk,
• program evaluation on process and outcomes,
• organization of the worksite for promotion of wellness and changes in corporate culture.

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

Incentives may be used to increase participation rates, help with completion or attendance at programs, and to help person change or adhere to healthful behaviors.

The purpose of the incentive is to encourage workers to adopt positive behaviors or maintain an existing positive behavior.

Everybody who achieves a goal or maintains a behavior ought to receive something. Many organizations also provide incentives merely for participating in events.

Stay away from being the “best” or doing the “most.” Encouraging individuals  to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism.    

The best designed incentive programs are ones which are based on achieving objectives that are attainable by most individuals. Recognition, acknowledgment by top management, or special privileges are examples of excellent intangible incentives.   

Incentive ideas –    

• Free or Low-Cost –     

   o Certificates

   o Movie passes

   o Recognition in staff member newsletter

   o Mugs

   o Water bottles

   o Commendation from management

   o T-shirts

   o Hats

• Moderate Cost –     

   o Entertainment tickets

   o Sweatshirts

   o Waist packs

   o Subscriptions to health magazines

   o Fitness and health books

   o Videos

• High Cost –     

   o Week-end getaways

   o Dinner for two

   o Clocks

   o Watches

• Others –     

   o Cash

   o Gift certificates

A major concern in wellness programming is attracting staff members to participate and maximizing participation. When introducing a program, a letter briefly explaining the program signed by the president or Chief Executive Officer (CEO) is a great endorsement.

Utilizing posters, newsletter articles, and flyers are good means of promoting the program. Other promotional methods to consider are e-mail and announcements at staff meetings. Ask wellness committee members to recruit participants.

Once the program is kicked off you may want to provide an incentive for any employee who recruits another employee to any of the program offerings.

When selecting  a program from a vendor you ought to ask the following questions –

• How many worksites have done the program?

• What kinds of worker population was the program offered?

• What educational materials are used?

• Will the program meet the needs of employees?

• What are the techniques used to help change behaviors?

• Does the program help people  move through stages of readiness to make health behavior changes?

• How do you market the program to employees?

• What follow-up do you provide?

• How do you make referrals for medical care or other supportive services staff members may need?

• How do you know the program works?

• How do you measure participant satisfaction?