Category — Health Promotion

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 programs are required to follow national guidelines.

National guidelines for blood pressure (BP) protocols -     

• Calibration of blood pressure (BP) measuring equipment should be done at least yearly .    

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

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

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 ought to 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 doctor for further evaluation 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 (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 if 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.

Quality health screening programs offer 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 recommended when the participant should be checked again.

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

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

• Relationship of high blood pressure and other risk factors, such as family history, smoking, high fat and unhealthy 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 screening programs should be carried out on a one-on-one basis by trained health care specialists. Health risk measures should include the following -

• Blood pressure 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 type 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 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 client is under a doctor’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 example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index (BMI) .

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

• Use of tobacco status - assess whether the participant currently smokes cigarettes, whether the client 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 client 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 if the client has had a stroke or other kind of blood vessel 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 disease - ascertain if the client has had a heart attack or other type of coronary heart disease .    

• Stress - participant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions reviewing 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 program to draw blood for testing to send information to the participant’s medical care provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.

• Participant interest survey - if an assessment of interest hasn’t 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, total cholesterol, and any other physiological measures taken.

• Referral of participants for treatment - participants with elevated risks must 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, workplace , 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.

Corporate Wellness Program directors should’ve a background in Corporate Wellness Programming and a specialist health-related degree or certification. They should’ve expertise in content areas, planning, promotion, administration, evaluation , and ability to grow a program and tailor the program to the worksite .   

Corporate Wellness Program providers should have 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 should be available from Employee Health Promotion Program provider s 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 analysis 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.   

Corporate Health Promotion Program Incentives can be used to increase participation rates, help with completion or attendance at events, and to help individuals change or adhere to healthy behaviors. The purpose of the incentive is to encourage employees 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.   

Refrain from being the “best” or doing the “most.” Encouraging people  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 goals that are attainable by most individuals . Recognition, acknowledgment by top management, or special privileges are examples of excellent intangible incentives.   

Employee Health Promotion Program Incentive ideas -    

• Free or Low-Cost Employee Health Promotion Program Incentives     

   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 Employee Wellness Program Incentives    

   o Entertainment tickets
   o Sweatshirts
   o Waist packs
   o Subscriptions to health magazines
   o Health and fitness books
   o Videos

• High Cost Employee Health Promotion Program Incentives     

   o Week-end getaways
   o Dinner for two
   o Clocks
   o Watches

• Other Employee Health Promotion Program Incentives    

   o Cash
   o Gift certificates

A major concern in Employee Wellness Programming is attracting workers to participate and maximizing participation. When introducing a program, a letter briefly explaining the program signed by the president or Chief Executive Officer (CEO) (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 could want to provide an incentive for any staff member who recruits another staff member to any of the program offerings.

When selecting  a program from a vendor you should ask the following questions -

• How many worksite s have done the program?

• What types 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 workers ?

• What follow-up do you provide?

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

• How do you know the program works?

• How do you measure participant satisfaction?

When staffing your Employee Health Promotion Program you need to consider whether to hire a wellness staff or contract with wellness specialists from outside your organization.

Small and medium size workplace s don’t usually have a wellness specialist on staff. When your workplace is in this category, you will need to contract with providers outside your company .

Large companies have several choices . They can hire a staff solely for the Employee Wellness Program, they can contract with outside wellness providers, or they are able to use a combination of internal staff and outside providers.

When selecting  a provider some key questions in the areas of staff, program structure, process, and effectiveness need to be addressed. Each of these key questions is discussed in the following sections.

Employee Health Promotion Program Staff

Health specialists become wellness specialists when they are trained in the full range of wellness activities. Wellness specialists are generalists who come from a broad variety of backgrounds and schooling. They might be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But in addition to their main training, they know something about all wellness topics, including smoking, stress, exercise, and nutrition. They also know how to engage and support people  in making and sustaining health improvements and have good people  skills.

Usually , wellness specialists at worksite s fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the program, take health measurements, collect health-related information, provide initial counseling, and help workers define for themselves what they need and want in a Corporate Wellness Program.

• Health counselors work with staff members after the screening to help them create and carry out a plan to reduce their risks and improve their health.

• Health instructors teach classes and minigroups on different health topics.

A Employee Wellness Program in a small company can be staffed by a single staff individuals who fills all three roles. Bigger workplace s will use different individuals  to fill these roles.

When selecting  staff or selecting  among vendor s, ask the following questions -

• Do prospective employees have a range of health backgrounds that will provide appropriate expertise in the topics to be addressed?

• Have prospective employees functioned well as wellness screeners, wellness counselors, and/or wellness instructors?

• Will this staff include people  from the racial and ethnic backgrounds found in your staff member population?

• Is each staff member comfortable with the range of backgrounds found in your staff member population, and able to communicate effectively with the various social and educational levels of your staff members ?

• Do employees have a warm, but specialist, counseling style when interacting with employees ?

An annual plan for the major Employee Health Promotion Programs and activities is a useful management tool. This is an excellent wellness committee task. Often an activity and wellness theme per month is offered to workers .

Some organizations pick to follow a National Health Observances calendar which offers advantages. The materials developed by these various national health organizations are very credible. The materials are usually high quality and available free or at a nominal cost.

The company benefits from additional publicity that occurs in various media throughout the community related to the national observance. For planning suggestions you could want to utilize the HOPE Publications Wellness Resource Planning Guide available for free at this Web site.

A HRA is sometimes used in conjunction with a health screening. An HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle. An HRA seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual.

An Health Risk Assessment (HRA) instrument is derived from an understanding of the course of a illness . Based on this understanding, useful prediction instruments can be constructed to assess the health risks of an individual. Person with a higher number of health risks tend to have more serious medical problems over time.

Drawing attention to their health risks can help clients reduce risk factors which lead to the onset of unnecessary disease and subsequent premature death. The questionnaire covers lifestyle habits (such as smoking, seat belt use, and exercise) and physical measures (such as cholesterol, blood pressure (BP) levels, height, and weight).

For accuracy, it is critical to obtain direct measures of blood pressure, cholesterol and HDL-cholesterol. The HRA also provides recommendations and indicates what risks are modifiable. Kinds of measures to assess health risks are discussed under Screening Programs.

The impact of a Health Risk Assessment (HRA) is much greater when it’s given in-person, with immediate feedback to the client. This also provides an opportunity to invite the client’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age can be computed based on the individual answers to the questionnaire and physiologic factors. The health age may indicate the individual to be younger or older than their chronological age.

Health Risk Assessment (HRA) programs are one the most prolific types of wellness activities utilized by organizations. Continuing research on Health Risk Assessment (HRA) s is examining the efficacy of this tool. One of the large benefits of this tool is that it can provide an aggregate group report of a corporation and can be utilized as an investigation tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on Health Risk Assessment (HRA) s.

The most common health screening performed in Corporate Health Promotion Programs is heart health assessment.

The health screening can include a written heart health test, blood pressure (BP) measurement, cholesterol/HDL-cholesterol test, glucose (blood sugar), weight, educational materials specific to diet, nutrition, exercise, cholesterol, smoking, and weight.

The health specialist conducting the health screening then provides a consultation and helps set goals with the participant.