Research ArticleFactors Associated With Participation in a University Worksite Wellness Program
Introduction
The health status of the U.S. workforce is a growing concern.1, 2 The workforce is aging owing to retirement delay3, 4 and the increase of “lifestyle diseases” characterized by poor nutrition and inactivity have contributed to the rising prevalence of chronic diseases among workers of all ages,2, 5 both of which result in mounting healthcare costs for employers.5, 6 U.S. healthcare spending has risen substantially faster than the general rate of inflation for several decades7, 8, 9 and around 60% of Americans obtain health insurance through an employer.10 As a result, many employers are struggling to contain the rise in health insurance premiums.11, 12
Healthcare reform legislation has encouraged the implementation of employee wellness programs as a tool to reduce healthcare costs.5, 11 Worksite wellness programs consist of employment-based activities or employer-sponsored benefits focused on health promotion and disease management.2, 5 In addition to targeting rising costs of healthcare coverage, these programs are posited to reduce economic burden of disease such as health-related loss of productivity (absenteeism and presenteeism).5 Emerging research has also suggested that worksite wellness programs may have other beneficial effects.13, 14 They may, for example, contribute to the profitability of an organization by increasing morale and performance8, 15 and facilitating employee recruitment and retention,16, 17 and healthy employees not only command lower health insurance premiums but are also more productive and satisfied with their jobs.18, 19
A RAND study estimates that about half of employees complete Health Risk Assessments (HRAs) or participate in clinical screenings as part of worksite wellness programs.5 Participation rates vary significantly for individual employers.20 Concerns related to selection bias in program participation have surfaced,21 as questions remain as to whether healthier employees participate and those with the most health risk do not.22 Other descriptive studies among wellness programs generally show higher rates of participation among women,22 younger23 and more-educated23 employees; those who perceive benefits to the program24; and those exhibiting high levels of self efficacy.23 Barriers to participation often include factors related to time, interest, convenience, and health beliefs.25 Descriptive studies that focus on specific aspects of wellness programs, such as exercise programs,26 health coaching,27, 28 and HRA completion,29, 30, 31 show some different and additional participation patterns. Varying participation patterns also exist based on the use of incentives within the wellness program and its components.32, 33 Better reporting of factors associated with worksite wellness program participation has been emphasized as key to understanding generalizability of program outcomes and can inform effective implementation and management of interventions.21
The University of Michigan (UM) established an employee wellness program, MHealthy, in 2009 and conducted a 5-year analytic evaluation of the program in 2014. MHealthy has an integrated organizational structure, including wellness and risk reduction services, employee assistance programs, and occupational health services, and has worked to create a model community of health for UM’s approximately 40,000 employees. Since its inception in 2009, MHealthy has implemented a wide variety of programs and services intended to serve everyone on a continuum of health, as well as leadership engagement strategies, communications, incentives/rewards, and workplace culture and environment improvements. MHealthy uses an annual HRA and periodic biometric screenings to collect employee data, supports a physical activity tracking program (ActiveU), and offers wellness activities and participation incentives.34, 35 This paper analyzes factors associated with MHealthy participation by using multivariate analyses to assess the independent predictive power of employee characteristics associated with various participation metrics.
Section snippets
Methods
De-identified individual-level employee data were obtained from MHealthy’s data warehouse vendor and cleaned by the study team. The final study population was limited to a cohort of 20,237 employees who were employed by the university for the entire 5-year period (2009−2013) and therefore eligible to participate in MHealthy each year (“continuously enrolled”). Data were collected from 2009 to 2013 for all measures except healthcare spending and health factors, which were 2008 data. Analyses
Results
Descriptive statistics showed that the majority of the 20,237 employees in the continuously enrolled sample were female (65%), white (77%), non-union (89%), staff members (86%) located at UM-Ann Arbor (~55%). The percentage of employees aged <30 years decreased from 9% to 3%, and the percentage aged ≥60 years increased from 8% to 18% over the 5-year period. Wages shifted higher over time, with a 7% decrease in in the lowest wage category and 12% increase in the highest wage category, likely
Discussion
This study has several notable features that help address literature gaps on employee wellness program participation. First, having 5 years of data allows the authors to assess participation trends and predictors of participation frequency. Most predictors of participation were quite stable across years, but the effects of income and race on HRA participation evolved somewhat over time. Second, the program’s participation rate of close to 50% implies near maximal variation in participation,
Conclusions
MHealthy has attracted participation from roughly half of the employee population. A consistent demographic and job characteristic profile emerged among program participants, which better characterizes employees who choose to engage in employee wellness activities. The results of this study can guide efforts to identify the causes of participation trends, both in terms of employee attitudes and workplace barriers. Such information could be used to better target outreach and program content and
Acknowledgments
This study was supported by the University of Michigan. No financial disclosures were reported by the authors of this paper.
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