Social and physical barriers and facilitators of successful health interventions in companies

Background The modest participation in WHPP and their moderate effects raises questions about the influence of the social and physical environment on health behaviour and on participation in health programmes offered. Objective This study will evaluate the social and environmental barriers and facilitators for participation in the WHPP offered in companies, both at individual level as well as organisational level. Methods The project will consists of: (1) a baseline cross-sectional study, (2) annually repeated surveys at company level during the follow-up period of 24 months, and (3) embedded case-control surveys among workers during the follow-up period of 24 months. The study population comprises companies with a health management programma in place, but who will substantially increase their efforts in health promotion through their participation in “Kroon-plaza”, an internet-based health portal with several tools for advice on increasing physical activity, improving diet, quiting smoking, and reducing work-related stress. The website provides information for companies to design health management programmes based on effective interventions, to contact experts for guidance and support, and to participate in joined activities aimed at supporting the implementation of WHPP. The website also provides information to individual workers to evaluate their own health and work ability, to receive computer-tailored advice to increase awareness of their lifestyle, to contact a personal advisor-online, to monitor their own progress in changing health behaviour, and to sign up for WHPP activities offered within their company. The cross-sectional survey at baseline will focus on the organisations as well as the workers within these organisations. The following instruments will be used at the level of the organisation: benchmark Health Management (health, sickness absence, reïntegration), physical environment questionnaire (CHEW observational checklist for workplace environmental features such as facilities, canteen, etc), social environment questionnaire (social suport, leadership, organisational culture), and RE-AIM framework for implementation. The following questionnaire elements will be used at the level of individual workers: individual characteristics, physical activity, smoking, alcohol use, nutrition (frequency and duration, motivation, social support, self--reported barriers, self-efficacy, perceived needs and preferences), General Health, work ability and productivity. Lifestyle factors will include questions on planned behaviour. Additional questions are asked on ethical considerations with respect to employer interference with personal life. The repeated surveys at company level during the 24 months will consist of annual follow-up surveys on the array of health interventions offered to workers (which interventions, why this selection), overall participation levels in these interventions, changes in social and physical environmental factors influencing the participation in interventions, and changes in the organisation that may affect participation in WHPP. Embedded case-control surveys among workers will be conducted for distinctive health interventions by comparing participants in a particular intervention and non-participants for planned behaviour, ethical considerations, health, and work ability. Interventions offered to workers in each company will be classified according to the scheme used in a recent systematic review and meta-analysis, distinguishing three main groups of interventions: (1) programmes with a fitness centre or exercise programme as main component, (2) with education or counselling as main component, (3) and multi-component programmes (Robroek 2009). Within each group of interventions a case-control study will be conducted with 200 cases and 200 controls, whereby cases are defined as workers who have enrolled in the intervention and controls as workers who have declined participation. Cases will be approached about 3 months after enrolment and controls will be machted on company. Since start of participatioin in interventions is possible during the complete follow-up, the enrolment will cover a period of approximately 18 months with cases and controls identified over time. Among all subjects in these 3 case-control studies information will be collected on individual characteristics, physical activities, smoking, alcohol use, health behaviour, ethical considerations, general health, and productivity and work ability. This study will advance our knowledge (i) which health promotion activities within companies are attractive for workers to be engaged, (ii) how the social and physical environment in companies and their direct vicinity influences participation in WHPP, (iii) how lifestyle behaviour and ethical considerations influence participation in WHPP, and (iv) and what the contribution is of company policies to an optimal uptake of WHPP.