Workplace Wellness Program

The keys to a successful wellness program are persistent one-on-one outreach and follow-up counseling to encourage health improvement, adherence to treatment programs, changes in lifestyle behaviors, and to prevent relapse.

Periodic outreach and follow-up procedures provide staff with a safety net which keeps them involved in the health promotion program and avoids treatment dropout and relapse.

Counselors should follow up on workers at least every 6 months throughout the career of the employee at the worksite.  The objectives of follow-up are to -  

• Involve workforce who’ve health risks in treatment and risk reduction programs.

• Involve all staff members in health promotion programs and workplace-wide wellness activities.

• Support staff members in carrying out the risk reduction or health improvement activities they have chosen.

• Make sure to help staff members obey their treatment programs.

• Prevent relapse.

• Avoid staff from dropping out.

• Be certain to help employees maintain behavior changes.

Follow-up may be conducted in person, by phone, mail, and via computer if the technology is available. Most preferable is an in-person contact.

Computer programs which could do case load management are available to help counselors track information and perform follow-up.

Priorities for Follow-Up

Individuals  with multiple health risks should be at the top of the list. Individuals  in key positions like union leaders or department heads with health risks should also be contacted early so that they learn what the health promotion program is about and can share the information with others.

Individuals  who need a medical examination for high blood pressure (BP) or cholesterol should also be targeted early. Many workers will have seen their doctors so of the screening, but some will need more encouragement to do so. Those with no health risks may be followed up annually.

A follow-up counseling session can take 20 to 45 minutes.  At minimum, follow-up must include those who were told to seek medical evaluation for high blood pressure readings, high cholesterol readings, or borderline high blood cholesterol readings with 2 or more other risk factors.

It might include those who were identified as at-risk for one or more of the other major risk factors -  at-risk levels of alcohol consumption, being overweight, and having low HDL.

Follow-Up With Physicians

A letter (see forms) ought to be sent to the physician or clinic of each employee who’s high blood pressure, high cholesterol, or is under a physician’s care.

The letter ought to explain the wellness program and ought to include the employee’s relevant, current health measurements.

Along with the letter, send a self-addressed return envelope. Follow-up with the physician ought to be repeated every 6 months until it is determined that the employee is under satisfactory control.

Contacting the doctor is important for three reasons -

• The physicians receive employees’ health measurements taken at the workplace.

• You receive the blood pressure (BP) and cholesterol readings the physician takes and information on the treatment the physician prescribes.

Many times the worker doesn’t have this information or doesn’t remember it.  The information could be used when counseling the worker.

• Follow-up encourages doctors to pay closer attention to heart disease risk factors among their patients.

The menu approach offers workers a range of choices to support lifestyle changes. It permits people  to choose the kind of help that suits their schedules and preferences.

The four basic kinds of wellness programs include -

• Courses

• Minigroups

• Guided self help

• Individual counseling

Classes

Classes (8 or more) can be an effective means of providing education and social support for behavior change.  The length of a class can vary depending on topic requirements. It is not sufficient to offer only courses at a worksite.

Many workers are under time constraints with after work commitments and although they could be interested they simply can’t participate because of their schedules.

Employees might  be very eager to begin a wellness program but because of lack of participants to meet class quotas, the wellness program is canceled.

Many national businesses such as the American Heart Association, American Cancer Society, Weight Watchers, etc. offer classes; you should have little trouble in identifying a provider for class kind wellness programs.

You could want to contact your local hospital, health department, or YMCA for possible choices. for selecting  a provider to provide a wellness program you could want to review the section on wellness program structure.

Minigroups

When there isn’t enough interest to develop a class, those who are interested in a given health topic may be formed into a minigroup (2 to 7).

The minigroup can cover the same content as a class but do so in a less formal manner. Presentation of information and discussion is the major format of the minigroup.

Guided Self-Help

Most workers don’t want formal help in making health changes; they prefer to do it on their own. In guided self-help, the wellness counselors provide support, materials, and encouragement.

Meeting times could be arranged and contact could be made either in individuals, by phone, or computer. Materials could be made available at the workplace, or mailed to the individual. Some workplaces now make information available via intranets or the Internet.

Individual Counseling

One of the most successful ways to help individuals change and improve their health status is counseling (or coaching) on a one-on-one basis.

In published studies, health promotion programs which incorporated individual counseling as part of the health promotion program process achieved significantly higher participation rates and achieved greater risk reduction/risk elimination than standard group programs. Studies have demonstrated that individual counseling is both cost effective and cost beneficial.

A wellness counselor must be trained in screening techniques, for in certain situations, they may be required to both screen individuals and counsel them. They should know how to do the following -  

• Review staff member health risks

• Contact employees who have health risks.

• Counsel staff on a one-on-one basis, assisting them set goals, solve problems, and get specialist help when they need it.

• Be certain to help staff members follow their treatment recommendations and make lifestyle and health behavior changes.

• Recruit workforce into health promotion programs, such as weight loss and use of tobacco cessation.

• Be sure to work with workforce on a one-on-one basis using guided self-help.

• Conduct classes and minigroups if necessary.

• Make certain to work with wellness committee members to plan and conduct workplace-wide wellness activities.

Health Promotion counselors are health generalists; they must have basic information about a wide range of health topics and health risks.

Counselors ought to be able to speak with workers about their medical problems and the treatments prescribed by their doctors.

They should have a good overview of nutrition, exercise physiology, pathophysiology of disease, pharmacology, psychology, and behavior modification skills.

The educational program should include approaches to stress awareness/reduction at the environmental level and at the individual level.

Social, physical, and organizational stressors ought to be explained and methods to ease or elevate stressors ought to be presented.

At the individual level how changes in attitudes and behaviors help one to cope with stressors; learning techniques to minimize stress response, such as meditation, relaxation response, and exercise.

Content of the program should provide the following -

• Identifying sources of stress

• Relationship of stress to health

• Exactly how the individual experiences stress, personal, family, work

• Solutions for coping and managing stress

• Techniques for decreasing stress

• Value of stress, both negative and positive

• Practical steps of incorporating stress reduction into lifestyle

Personnel conducting stress management programs should have training in psychology, behavioral sciences, or related disciplines such as mental health professionals, counselors, health educators, psychologists, and psychiatrists.

Training in a reputable program on how to teach the stress management course including group process skills is a must.

A nutrition education program should include a nutritional needs assessment, education counseling, and referral as necessary.

Educational sessions and materials should include the following information -

• The relationship of nutrition and chronic diseases

• Improving consuming patterns

• Relationship of nutrition and proper weight maintenance

• Exercise

• Stress

• Blood pressure

• Cholesterol

• Diabetes and other chronic illnesss.

• Nutritionally precise information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into consuming habits. Guidelines for improving consuming habits should be based on or consisitent with national recommendations like the Food Guide Pyramid.

Instructor ought to be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition.

If an allied health expert instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

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

Use of tobacco cessation programs must be multi-component with a focus on skills to build positive voluntary behavior modification practices.

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

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

The instructor should have 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 should include participation rate, including the number beginning the program, the number completing the program, and the typical number per session.

Furthermore included, number and% who stopped use of tobacco after the program, and the number and% who had not resumed use of tobacco by the end of one year.

Participatory exercise plans ought to include education on advantages of regular physical activity and risks of a sedentary lifestyle, its impact on cardiovascular health and illnesses, its relationship with weight control and stress management, and aerobic activity options.

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

Safety precautions should include the following -

• Informed consent prior to 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 when medical examination 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 ought to obtain a written clearance from their doctor to exercise.    

• The basic content of an group fitness program ought to 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.   

Health Promotion Program offered is in line with scientific and medical recommendations for losing weight, 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 has no medical or psychological conditions which would make losing weight 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 reduction.

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

• Identification of contributing 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 does not exceed loss of 10 percent of body weight, 1-2 pounds per week.

• Explanation of unsafe weight loss methods.

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

• Daily caloric intake is not less than 1,000 calories; when less, physician monitoring is required.

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

• Nutrition education stimulating permanent healthy consuming 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 should be a meaningful portion of the wellness 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 experts with training in nutrition with consultation by a registered dietitian.

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

Note - There is 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 experts, as appropriate.

200 - 239 mg/dl    If 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   When fewer than 2 risk factors and borderline sum cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following -    

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

   o Risk factors include -  high blood pressure 140/90 or higher or on hypertension medication; current cigarette use of tobacco; 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 like family history, smoking, high fat or other unhealthful diet, andlack of exercise 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 prior to diagnosis.    

• Wide range of treatment choices, including diet (e.g., importance of controlling fat intake less than 30 percent of sum calories from fat, less 10 percent 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 specialist trained in measurement of blood pressure, referral protocols, and delivering educational messages to participant conducting blood pressure programs. These health promotion programs are required to follow national guidelines.

National guidelines for blood pressure protocols -  

• Calibration of blood pressure measuring equipment must be done at least yearly.

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

• Referral of participants with high blood pressure (BP) readings to personal physician for further investigation.   

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 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 among 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 doctor for further investigation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. When already on treatment, advise participant of readings and need to get blood pressure 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 doctor of readings at next visit and consider advice regarding losing weight and exercise when appropriate.

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

   Action -  Recommend obtaining medical examination 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 (BP) levels given to each participant with individualized counseling, including advice about the interval of time advised when the participant ought to be checked again.    

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

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

• Relationship of high blood pressure (BP) and other risk factors, such as family history, tobacco use, high fat and unhealthful diet, lack of exercise, in the development of cardiovascular illness, including stroke, kidney illness, heart attack, and other diseases.

• Definition and causes of high blood pressure.

• Importance of following prescribed treatment.

Health risk screening programs ought to be carried out on a one-on-one basis by trained health care specialists. 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 treatment status - ascertain whether the participant is under a physician’s care, on any medication, on a prescribed diet, or any other kind of treatment for hypertension.    

• Blood cholesterol measurement - sum cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the client, 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 BMI.    

   o Identify individuals  20% or more above their ideal weight.

• Smoking status - assess whether the participant currently smokes cigarettes, whether the patron has quit or never smoked, and the number of cigarettes smoked/day.    

• Exercise habits - screening questions could  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 could  be also done via finger stick and desk top analyzer. A few manufactures make available cassettes which include cholesterol and glucose measurements.

• Cerebrovascular illness or occlusive PVD - ascertain if the client has had a stroke or other kind of blood vessel illness.

• Family history of cardiovascular disease - ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death because of heart disease before age 55.

• Coronary heart illness - ascertain when the patron has had a heart attack or other type of coronary heart illness.

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

• Participant release form (see forms) - A release form is required in which the participant authorizes the health promotion 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 collected previously, the screening activity must assess levels of interest in wellness programs such as -  weight control, use of tobacco 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, total cholesterol, and any other physiological measures taken.

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

Demographic information should 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.