The Wellness Councils of America

Choosing Appropriate Interventions

Here's What You'll Learn:

What data to base your intervention choices on
Why you need multiple interventions to change behavior
Where to research the effectiveness of various interventions
An example of a comprehensive program for stress management
Why you should offer a variety of awareness offerings

Ideally, by the time you're choosing interventions, you've got your wellness team together, and you've collected data on the wellness needs and interests of your population. You have taken the time to envision your goal and identify objectives. You've got a budget and plans for evaluating and promoting your program. Your interventions should flow naturally from your data, goals and objectives. You take an objective, like reducing the number of smokers, and research the options in smoking cessation programs, and choose one you can afford.

But it isn't always that clear. The choices in subject and delivery methods can be dizzying. Should you touch on many topics, or focus on one or two? Go high-tech or high-touch? How do you choose?

Base your choices on…

1. What risk factors are prevalent in your population?
Health promotion plans are increasingly tailored to reduce the health risk factors that cost the most in medical claims and productivity. If you do HRA's, your aggregate report should identify prevalent risk factors, and claims analysis from your health care provider can add to your information. Look at group data you collect from screenings, too. And look at your demographics--an employee group including many young women may benefit from prenatal care education, while an aging workforce may need heart health interventions.

2. What does senior management want the wellness program to achieve?
Look at the results of surveys and meetings with management. If their goal is short-term cost savings, you may need to focus on programs like self-care to decrease utilization, and disease management to help expensive high-risk individuals cope more effectively with health conditions.

If they are more concerned about employee retention, corporate culture and image, improving morale, and the long-term health of the employees, you may consider a broader range of programming, including stress management on an individual and cultural level, child care initiatives, fitness activities, wellness team competitions, and much more.

3. What do your employees want?
You'll want to provide some programming that matches employee interests as indicated in surveys or focus groups you've conducted. And you'll want to promote them aggressively. Visible programs that appeal to many employees establish goodwill and a caring image for your program and organization.

4. How much money and time do you have?
Your resources will determine what interventions you consider. If you have little money, work on bringing community, nonprofit and government resources in to your worksite, and educate workers about what's available "out there"-from the local YMCA to health information and support groups in cyberspace.

5. What does the latest research indicate?
Keeping up with health promotion research can save you years of ineffective, trial and error programming. Read the American Journal of Health Promotion. Look at the results of the HERO research online at www.the-hero.org. Find out what's working.

Choosing Interventions to Reduce Stress

You've figured out that stress is a major risk factor in your workplace, and picked stress reduction as a major topic for intervention.

First, do your homework.
Find out what's being done in workplaces to reduce stress. Read the AJHP review article on stress management interventions in work settings. Talk to other wellness professionals about what's worked best for them. Look at products available from the government, nonprofit organizations and vendors that may be useful.

Next, use that information to target stress as comprehensively as possible.
Use multiple delivery methods- some are listed below, add any others you can think of! Remember, offering your message in a variety of ways works best to change behavior.

Printed health information
Paycheck stuffers and brochures can raise awareness of stress symptoms and solutions.
Senior management message
A message from the top that the company is serious about reducing stress legitimizes the program. It's especially helpful if it sets up a vehicle for two-way communication.
Group education
Stress-management classes teaching muscle relaxation and cognitive-behavioral skills are effective.
Self-study programs
Stock your wellness library with relaxation books, tapes and workbooks and advertise them to employees.
Your EAP
Remind employees that your EAP is available and ready to help with stress issues anytime.
Computer-based programs
Screen your favorite health websites for stress information, diagnostic quizzes, and other aids. Provide links on the company Intranet, or hand out the web addresses.
Personal coaching
Meet weekly with employees who want help. Give non-threatening stress reduction homework and check in frequently, perhaps by email, providing support and accountability for their efforts to change.
Support groups
Employees can share their experiences with stress and the problem solving they've done. You can also refer them to online and community support groups.
Your health care provider
Employees whose stress symptoms may qualify as anxiety disorders can and should be referred for mental health evaluation.
Point-of-decision prompts
Reminders at workstations, lounges, coffee machines, to breathe deeply, take a muscle relaxation break, or to think realistically ("Rome wasn't built in a day") can help employees to develop healthier habits. Computers can be set up to flash reminders to workers to stretch every hour.
Corporate policies
Policies providing for flex time and assistance with childcare can make a big difference. Setting up a walking path indoors or out encourages taking healthy breaks.
Worker involvement in the design and evaluation of ongoing stress management programs is preferable to use of outside vendors or consultants.
Recognition for success
Corporate recognition for employees and managers who participate in programs sends the right message.
Competition
Although this seems antithetical to stress management, you may get the people who need it most if you set up an individual or team competition that involves earning points for stress-reduction activities.
Incentives for participation
Incentives can be awarded for participation in individual events or for cumulative participation in a series of offerings.

Use a similar format to plan any major campaign. Do your research, then plan interventions using every delivery mode available. Be a broken record--but broadcast in different languages so that everyone can understand in their own way.

Offer a variety of awareness programs

Awareness programs rarely change behavior-but then, most people aren't ready to turn in their burgers for tofu anyway. With behavior change programs, you have to commit considerable resources and programs comprehensively to get results. But you can offer a variety of awareness programs without breaking the bank, and enjoy the following benefits:

They can set the stage for behavior change, helping people to recognize health issues and giving them "permission" to consider taking action.
They can increase the visibility of your program, keeping it alive in the public eye.
They can bring people together who normally don't mix. Activities that cut across the usual hierarchy and departmental divisions are healthy for everyone.
They're a great response to employee interest data. You can offer classes on topics that employees requested.
You can offer something for everyone. Personal finance, all kinds of recreation, parenting, cooking, weight control, fitness, time management, medical self-care, elder care, nutrition, smoking cessation, home safety, consumer education, assertiveness training, alternative medicine, living wills, prenatal care, mental illness, heart health, stress management-the topics are limited only by your imagination and resources.
And the last reason to offer a variety of awareness programs? They're fun!

Behavior Modification and the Matter of Time

In health promotion, we often invest too little and expect too much. To change stubborn behavior patterns, we need to pick a target health behavior and provide a comprehensive, long-term series of interventions.

If you've ever been in sales, you probably know that people rarely buy on the first approach. They have to hear about the product through a variety of media - an introductory letter, a phone call, an advertisement, then a sales call- before they'll buy.

It's the same in health promotion. You need to give people time to get acquainted with the idea of making changes, and offer a variety of opportunities to jump in and try. The more exposure they have, the more normal it will seem.

EXAMPLE: In the 1950's the idea of NOT letting people smoke in our homes would have seemed the height of rudeness. Today, it's he/she who lights up in your home or office who's out of line. That cultural change took many years to accomplish. Awareness programs, the Surgeon General ordered warnings on cigarette packages, stop smoking programs and workplace smoking policy changes followed. Lawsuits against manufacturers and smoking cessation aids - and through dogged and continuous effort, smoking rates that span the ages have plummeted drastically. So - if you decide to seriously target a health behavior, go for it with all the arrows in your quiver - determine the most effective intervention, and plan for a LONG campaign.

Tips for Choosing Appropriate Interventions

Talk to other wellness professionals about their experiences with different types of interventions, good and bad. Ask for advice on how to choose, structure, time, and promote activities.
Ask senior managers to participate in activities, be members of wellness teams, and lend their support to your interventions.
Build on successful activities by making them annual events, preferably at the same time of year. Improve them, and make them a part of the corporate culture and calendar.
Get someone to take photographs whenever appropriate for use in newsletters, bulletin boards, and future promotions. Consider videotaping fun events-you can even collect video testimonials for use at company meetings.
Plan how you'll evaluate interventions from the start. Make sure you have a way to measure participation, satisfaction, and related health benefits.
There's a lot to consider when choosing interventions for your wellness program. Don't overdo, especially if your program is new and your resources are scarce. Give yourself time for adequate research, planning, and promotion. Next year you'll know so much more, and be able to refine the activities that worked, drop the duds, and add exciting new programs.

References

Chapman, L. What Newer Forms of Health Management Technology Can Be Used in Programming? The Art of Health Promotion, September/October 1997, Vol. 1, No 4.

O'Donnell, M. Design of Workplace Health Promotion Programs, 1995. Call (800) 783-9913 to order.

Health Promotion: Sourcebook for Small Businesses published by the Wellness Councils of America. Call (402) 827-3590 or visit www.welcoa.org to order.