Category — Health Promotion

In today’s fast paced world our busy lives leave little time, energy, or motivation for individuals  to focus on their own needs.

Those that do seek to improve their wellness traditionally turn to friends, family, specialists and published materials for support and information. All too often those support structures fail to make a lasting difference. This happens for a number of reasons. Friends and family may not be capable of helping. Working with specialists is time consuming and expensive and very few of us are effective at taking published, generic information and applying it to our own lives.

Gold’s Gym Winston-Salem has created a new internet based program that expands the range of support available to those wishing to make healthy lifestyle changes. The program, Gold’s Gym Health Coach, focuses on the daily challenges of making positive lifestyle changes and has the benefits of being more personalized and efficient than generic, published information and less intense and expensive than specialist face-to-face counseling.

Utilizing a collaborative problem-solving model the goal is not to give advice, but rather to help individuals think through the issues and come to their own conclusions. The coach offers ideas for consideration, helps the individual generate ideas of their own, helps the individual consider the various ideas, choose a direction, and then supports them in the implementation of their decision.

Difficult the conventional wisdom that relationship formation requires in-person interaction; Gold’s Gym has found that members and coaches are able to build meaningful relationships via internet based communication. Utilizing industry leading technology a Gold’s Gym Wellness Coach is able to offer members a secure, user-friendly personal website where they can access their coach in a real-time or via email with responses delivered in less than 24 hours.

The site permits coaches to hand select relevant articles that are written on a consumer level and that are targeted to the issue at hand and add them to a member’s internet based personal library. The site also contains various programs and tools which are created to assist the coach and member to set, implement and track specific objectives .

The collaborative relationship formed between member and coach enhances the quality ice and efficiency of service. The familiarity that a coach develops with a member’s circumstances and meaningful relationships permits them over time to more rapidly offer useful ideas and assistance. With regular call-in assistance lines, the time intensive exercise of getting background and contextual information is repeated each time. IN that scenario efficiency is lost.

Moreover , Gold’s Gym Wellness Coach has developed a protocol based on key principals from the field of psychotherapy and behavior modification. The protocol is embedded within a proprietary problem-solving that is based on the theory that individuals  often act without a good understanding of a problem. Their responses then complicate matters and often make matters worse.

Gold’s Gym Health Coach offers the opportunity to step back, take a second look at what has going on, and rapidly asses the factors influencing the situation. But, having an idea of “what” to do is very different than actually “doing” something about it.

Individuals  need help with the follow-through. So, after figuring out “what” to do, Gold’s Gym Wellness Coach focuses on implementation. Here Gold’s Gym Wellness Coach builds on sound research and experience from the field of behavior modification that has to do with goal-setting and with implementation support.

The end result is a highly personalized, effective, user-friendly way of improving the wellness of an individual. The efficient nature of the online relationship allows Gold’s Gym Wellness Coach to keep the price point within reach of virtually whoever .

For more information contact Gold’s Gym Winston Salem (http://goldsgymreynolda.com/)

Information to evaluate your program comes from routinely accumulated screening and follow-up data of your program that look at process and outcomes of your program.

The Worker Medical Program has available a computerized case-management system which includes queries that allow easy assessment of process and outcome results at any point in time.

Employee Wellness Program Process Evaluation

Process investigation looks at the program’s impact as seen at various points in time.

Information that is gathered from the various forms that wellness employees fill out should supply you with the following -

• How many workers were screened?

• How many workers who were referred to a doctor went?

• How many staff members who expressed interest in health betterment programs went?

• How many employees who were referred to health betterment programs went?

• How many workers who went to health improvement programs completed them?

• How many workers are in follow-up caseload?

You can use this kind of process evaluation to evaluate and learn about the health of your program.

Employee Wellness Program Outcome Investigation

A central objective of the program is to improve the health of employees . Information on how to judge how well your program is meeting this objective is called “outcome evaluation ” because you’re reviewing the end results or outcome of your program.

In Corporate Health Promotion Programs, objectives are measured by specific (outcomes) behavior changes and reductions in health risk levels. Have workers reduced their blood pressure? Have they lost weight? Are they exercising more? Is alcohol consumption at a safe level? For example these are the types of questions you are able to ask to find out if you are reaching your objectives -  

• For employees with high blood pressure (140 / 90 or higher or on medication) at screening, what percentage have it under control (below 140 / 90) a year later?

• What’s the change in average blood pressure levels among all workers with high blood pressure 1 year after screening? Two years later?

• For staff members with high blood cholesterol levels (above 240) at screening, what percentage has reduced their cholesterol to borderline-high levels (200-239)?

• For staff members with borderline-high blood cholesterol levels, what percentages have reduced their cholesterol to the desirable range (below 200)?

• What is the change in typical cholesterol levels among all staff members with high and borderline-high blood cholesterol levels 1 year after screening? Two years later?

• For employees who were overweight at screening, what percentage have lost 20 pounds or more a year later? Ten pounds or more? What’s the average weight loss?

• For staff members who were smokers at screening, what percentages have quit smoking? For at least a year?

• For workers whose level of alcohol consumption put them at-risk at screening, what percentage have quit drinking alcohol? Are consuming alcohol at levels considered safe by CDC guidelines? Have reduced their drinking, but are still at-risk?

• For staff members , what percentages are exercising at least three times a week for at least 20 minutes?

• If levels of fitness were measured, what percentages have improved fitness?

Be certain to set a regular time such as every 6 months to look at which staff members your program is reaching and how effective it’s at assisting them reduce their health risks. Be certain to use this information to make new decisions about how to direct your program efforts. Then make the change you need to improve your program.

Some might feel that evaluation is a frill; it’s not. Examination is a necessary part of a Corporate Wellness Program. You’ll need to know what’s working and what’s not. Decision-makers who fund the program need to be updated on the performance of the program. Examination will provide you with necessary data to maintain and expand the program and convince management to continue to support the program.

The keys to a successful Corporate Health Promotion Program are persistent one-on-one outreach and follow-up counseling to encourage health improvement, adherence to treatment regimens , changes in lifestyle behaviors, and to prevent relapse. Periodic outreach and follow-up procedures provide workers with a safety net which keeps them involved in the program and prevents treatment dropout and relapse.

Counselors ought to follow up on staff members at least every 6 months throughout the career of the employee at the worksite . The goals of follow-up are to -  

• Involve employees who have health risks in treatment and risk reduction programs.

• Involve all staff members in health betterment programs and worksite -wide wellness activities.

• Support employees in carrying out the risk reduction or health betterment activities they have chosen.

• Make certain to help employees comply with their treatment programs .

• Prevent relapse.

• Prevent workers from dropping out.

• Make sure to help workers maintain behavior changes.

Follow-up can be conducted in individuals , by phone, mail, and via computer if the technology is available. Most preferable is an in-person contact. Computer programs which can do case load management are available to help counselors track information and perform follow-up.

Employee Wellness Program Priorities for Follow-Up

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

People  who need a medical investigation for high blood pressure or cholesterol should also be targeted early. A lot of staff members will have seen their doctors as a result of the screening, but some will need more encouragement to do so. Those with no health risks can 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 examination for high blood pressure (BP) readings, high cholesterol readings, or borderline high blood cholesterol readings with 2 or more other risk factors.

It may 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.

Corporate Health Promotion Program Follow-Up With Physician s

A letter (see forms) should be sent to the doctor or clinic of each staff member who’s high blood pressure, high cholesterol, or is under a doctor ’s care.

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

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

Contacting the physician is important for three reasons -

• the doctors receive Worker ’s health measurements taken at the worksite .

• You receive the blood pressure (BP) and cholesterol readings the doctor takes and information on the treatment the doctor prescribes. A lot of times the staff member doesn’t have this information or doesn’t remember it. The information can be used when counseling the staff member .

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

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

The four basic types of programs include -

• Classes

• Minigroups

• Guided self help

• Individual counseling

Corporate Health Promotion Program Classes

Courses (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 isn’t sufficient to offer only classes at a worksite .

A lot of employees are under time constraints with after work commitments and although they may be interested they simply cannot participate because of their schedules.

Employees may be very eager to start a program but because of lack of participants to meet class quotas, the program is canceled. Many national organizations 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 programs.

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

Employee Wellness Program Minigroups

When there isn’t enough interest to create a class, those who are interested in a given health topic can 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.

Corporate Health Promotion Program - Guided Self-Help

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

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

Employee Wellness Program - Individual Counseling

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

In published studies, Corporate Wellness Programs which incorporated individual counseling as part of the 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 should be trained in screening techniques, for in certain situations, they might be required to both screen individuals and counsel them. They ought to know how to do the following -  

• Review staff member health risks

• Contact workers who have health risks.

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

• Make certain to help workers follow their treatment recommendations and make lifestyle and health behavior changes.

• Recruit workers into health betterment programs, such as weight loss and smoking cessation.

• Work with employees on a one-on-one basis using guided self-help.

• Conduct classes and minigroups if necessary.

• Work with wellness committee members to plan and conduct worksite -wide wellness activities.

Wellness counselors are health generalists; they have to have basic knowledge about a wide range of health topics and health risks.

Counselors must be able to consult with employees about their medical problems and the treatments prescribed by their doctors. They should’ve a good overview of nutrition, exercise physiology, pathophysiology of disease , pharmacology, psychology, and behavior change skills.

Employee Wellness Programs should include stress management programs at the environmental level and at the individual level.

Social, physical, and organizational stressors should be explained and methods to ease or elevate stressors should 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 stress management program ought to provide the following -

• Identifying sources of stress

• Relationship of stress to health

• 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 specialists, 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.

Corporate Wellness Programs that make available  a nutrition education program ought to 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 diseases .

• Nutritionally exact 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 such as the Food Guide Pyramid.

Instructor should be a dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition. When an allied health specialist instructs the program, a consultation and review of the program design by a dietitian is advised .

Employee Wellness Programs that offer  smoking Cessation should subscribe to a Code Of Practice for Smoking Cessation Programs.

Use of tobacco cessation programs should be multi-component with a focus on skills to build positive voluntary behavior change practices. Useful techniques include establishing reasons for quitting, understanding the smoking 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. Make sure to use no aversive or scare tactics.

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

The instructor should have formal training in smoking cessation from a nationally recognized organization such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders.

Investigation of success is sometimes very dubious in smoking 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. Additionally included, number and% who stopped smoking at the end of the program, and the number and% who had not resumed smoking by the end of one year.

Employee Health Promotion Programs that provide participatory exercise programs should 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 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 ought to include the following -

• Informed consent prior to beginning 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 evaluation is necessary for exercise such as the Physical Activity 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 aerobics 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 certified.   

Corporate Health Promotion Programs that provide  weight control programs 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 has no 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 on the basis of associated medical conditions and overall heath risk.

• Referral for participants who are morbidly obese who would 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 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 recommended rate of weight loss.    

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

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

• Nutrition education encouraging permanent healthy 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 percent calories as fat.

Carbohydrate   At least 100 grams per day.

Fluid   At least one liter of water daily.

• Exercise component should be a significant 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 should be conducted by a dietitian or by degreed health specialists with training in nutrition with consultation by a 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.

Corporate Wellness Programs that offer health screening should always 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 specialists, as appropriate.

200 - 239 mg/dl    If history of CHD or if two or more other risk factors are detected, refer to medical care or risk reduction service within two months; if no announced 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 total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Quality health screening programs offer 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 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, smoking, high fat or other unhealthy diet, andlack of exercise lead to the development of cardiovascular disease (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% 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.