Health Promotion Literature Review
Wellness and health promotion programs have been prevalent in the industry’s health care service offerings for many years. According to The Care Continuum Alliance, a wellness program should be designed to:
- help individuals maintain and improve their level of health and well-being by identifying health risks and educating them about ways to mitigate these risks;
- increase awareness of factors that can affect health and longevity;
- enable individuals to take greater responsibility for their health behaviors;
- prevent or delay the onset of disease; and
- promote healthy lifestyles and general well-being.
Peer reviewed published literature varies in reporting the outcomes of programs in part due to the complexity of wellness program evaluation as well as the variation that exists from one program to the next.
Wellness and health promotion programs can include a variety of components. These components include both wellness specific risk reduction components as well as prevention components such as immunizations. Some possible program components include:
- Health risk appraisal
- Biometric screening (e.g., blood pressure, cholesterol)
- Smoking cessation
- Weight loss
- Diet and nutrition
- Stress reduction
- Exercise and fitness programs
- Ergonomic programs
- Safety (both at the workplace and home)
- Sleep hygiene
- Health advocacy
- Disease screening
In addition, programs can vary by outcomes desired, population served, and mode of delivery. As a result each set of goals and objectives are often unique to a program which makes comparisons and standard evaluations difficult. Pelletier did find, however, that a critical component of any worksite intervention program should be a focus on providing individual risk reduction interventions for all people including those that are high risk.
Nonetheless there are examples in the peer review literature of programs that have achieved desired outcomes on a variety of different populations as well as those that have missed the mark. The evidence included in this section is not exhaustive of all the literature but simply a sample of recent (5 years or less) evidence published in peer-reviewed literature that is thorough and insightful. This evidence from the literature can be separated into three categories.
- Wellness and health promotion programs that were designed to address specific risk factors including prevention
- Wellness and health promotion programs that focus on specific interventions such as weight reduction
- Wellness and health promotion programs that are comprehensive and offer a full menu of interventions for all people in a population
Specific Risk Factor Programs
Common specific risk factor programs focus on a specific disease such as diabetes or a risk factor for disease such as cardiovascular risk factors. In addition, single risk prevention programs such as those that focus on flu vaccines are also included. Overall, the focus on a single disease or single risk factor/preventative measure, can be successful for a variety of outcomes measures including cholesterol, BMI, and physical activity. Although the interventions vary by program goal, typical categories of interventions for these types of programs include onsite services such as screenings and exercise facilities as well as the use of incentives for engagement and participation.
For more information, see references (1)-(6).
Wellness and health promotion programs can also be interventions-specific. Employers who have analyzed their population and have discovered a high prevalence of a certain risk factor may choose to focus their program on a proven effective intervention. In addition, employers may also choose these intervention specific models to address risk factors that have been shown to lead to higher health care costs and reductions in worker productivity. The interventions selected often focus on high prevalent risk factors such as BMI so weight loss or obesity focused interventions are common. The evidence presented below offers a variety of programs including those that focused on a unique population such as lone workers or those that assessed the impact of multiple HRA deliveries. Those that show improved outcomes see to focus on the unique needs of the population and the goal of the program.
For more information, see references (7)-(18).
Comprehensive Wellness and Health Promotion
Comprehensive programs have been shown to have a greater impact on overall outcomes than intervention or risk specific programs. These programs tend to show higher engagement and participations rates, which often leads to better outcomes. While there is published research that suggests the components of a true comprehensive program (see Getting Started section), the sample of the evidence below offers a broad range of programs including those that offer onsite services as well as those that offered health coaching and 24 hour help line access.
For more information, see references (19)-(25).