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Intervention Summary

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Wellness Outreach at Work

Wellness Outreach at Work provides comprehensive risk reduction services to workplace employees, offering cardiovascular and cancer risk screening and personalized follow-up health coaching that addresses alcohol and tobacco use. Wellness Outreach at Work begins with outreach to all employees through voluntary, worksite-wide health risk screening, including biometric measures of health status, delivered as near to workstations as is practical. The screening directs employees' attention to health issues and to their own health risks and provides baseline information about the health risks of the total workforce. The screening takes approximately 20 minutes per employee and includes immediate feedback on health risks and first steps that might improve them. After the screening, employees are triaged for follow-up based on the number and severity of the health risks identified. Within the context of personalized, one-on-one coaching for cardiovascular health improvement and cancer risk, wellness coaches provide employees with education and counseling on alcohol use, tobacco use, weight control, and health management. Employees attend one to four 20-minute individual sessions per year thereafter. Computerized records allow employees to track their own health status and to access tools and information that can help them sustain their progress. Individual employees' health information is confidential, but profiles of changing risk factors for the workforce as a whole are made available periodically to employees and to management. The program includes long-term support for employees, both directly and through the corporate environment (e.g., alcohol-free public functions, peer encouragement of health promotion).

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: June 2008
1: Alcohol consumption
2: Smoking cessation
3: Overall health risks
Outcome Categories Alcohol
Tobacco
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities Black or African American
White
Race/ethnicity unspecified
Settings Workplace
Geographic Locations Urban
Suburban
Implementation History Wellness Outreach at Work, first implemented in the early 1970s, has been used with 6,500 individuals in 36 worksites. Approximately 5,000 individuals have participated in two major evaluation studies.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: June 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Erfurt, J. C., Foote, A., & Heirich, M. A. (1991). Worksite wellness programs: Incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization. American Journal of Health Promotion, 5(6), 438-448.  Pub Med icon

Study 2

Heirich, M., & Sieck, C. J. (2000). Worksite cardiovascular wellness programs as a route to substance abuse prevention. Journal of Occupational and Environmental Medicine, 42(1), 47-56.  Pub Med icon

Study 3

Heirich, M., Sieck, C. J., Klykulo, K., & Bonnington-Kouri, K. (2002). Moderation counseling as a route to substance abuse prevention: M-CARE's DrinkWise and Health Risk Appraisal Programs at the University of Michigan. Final Report for grant number 6 U 1 K SPO8146-03-02, awarded by SAMHSA/CSAP to the Greater Detroit Area Health Council and the University of Michigan.

Outcomes

Outcome 1: Alcohol consumption
Description of Measures During face-to-face interviews at the initial screening and the rescreening at the end of the 3-year intervention period, participants answered the following questions:

  1. Do you ever drink alcoholic beverages such as beer, wine, or liquor? (yes/no)
  2. On how many days in an average week do you drink something alcoholic? (0-7)
  3. On the days that you drink, how many drinks do you have? (open ended)
  4. How many drinks do you have in an average week? (open ended)
Key Findings One study examined drinkers who were at the highest risk level of alcohol consumption (those drinking three or more drinks three or more times per week) at initial screening. At rescreening, 38% of those who received counseling lowered their drinking to levels that did not put them at risk, compared with 22% of those who did not receive counseling. Because the drinkers at highest risk represented a small percentage of the study population, this finding was not statistically significant.

In another study, among drinkers who were at risk for alcohol-related problems (men who drank more than 3 drinks per day or 12 drinks per week and women who drank more than 2 drinks per day or 9 drinks per week) at initial screening, 68% of those who received ongoing follow-up counseling had reached a "safe" level of alcohol consumption at rescreening. By comparison, 46% of those who only received one brief, end-of-screening counseling session had reached a safe level at rescreening (p < .05).
Studies Measuring Outcome Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 3.1 (0.0-4.0 scale)
Outcome 2: Smoking cessation
Description of Measures During face-to-face interviews at the initial screening and the rescreening at the end of the 3-year intervention period, participants provided a history of their cigarette smoking (e.g., ever smoked, how often).
Key Findings In one study, worksites that provided follow-up monitoring and counseling along with a menu of four other service options (guided self-help, one-on-one formal consultation, mini-group interventions, and full-group classes) had higher rates of participation in worksite smoking cessation services than worksites with the regular offering of wellness-related activities (p < .001). Further, among employees identified as having smoking as a cardiovascular disease (CVD) risk factor, those who received follow-up and a menu of service options had higher rates of smoking cessation (p < .01) and lower rates of smoking recidivism (p < .01) at rescreening than those who received the regular offering of programs.

In another study, among those identified at initial screening as smokers or former smokers, 65% of those who received counseling were not smoking at rescreening, compared with 53% of those who did not receive counseling (p < .001).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 3: Overall health risks
Description of Measures Measures of overall health risks, obtained at the initial screening and the rescreening at the end of the 3-year intervention period, included systolic and diastolic blood pressure, weight, total cholesterol, and HDL cholesterol.
Key Findings In one study, worksites that provided follow-up monitoring and counseling along with a menu of four other service options (guided self-help, one-on-one formal consultation, mini-group interventions, and full-group classes) had higher rates of participation in worksite blood pressure treatment (p < .05) and weight loss (p < .001) services than worksites with the regular offering of wellness-related activities. Further, among employees identified as having high blood pressure or overweight as CVD risk factors, those who received follow-up and a menu of service options had better blood pressure control (p < .05) and greater weight loss (p < .01), respectively, at rescreening than those who received the regular offering of programs.

In another study, overall health risks improved among all study groups--those who received counseling and those who did not--from initial screening to rescreening: (1) of participants with hypertension, the percentage with blood pressure under control increased from 29% to 53% (p < .001); (2) of participants with hypercholesterolemia, the percentage with cholesterol under control increased from 2% to 27% (p < .001); and (3) of participants 20% or more overweight, 31% lost 3 or more pounds (p < .001), and 19% lost 10 or more pounds (p < .001).

In a third study, employees who received ongoing follow-up counseling had significant outcomes related to CVD risks, with a higher proportion of participants becoming risk free (p < .01) and a lower proportion of participants developing new CVD risks (p < .05) compared with employees who only received one brief, end-of-screening counseling session.
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
89.5% Male
10.5% Female
70.7% White
29.3% Race/ethnicity unspecified
Study 2 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Data not reported/available 63% Race/ethnicity unspecified
37% Black or African American
Study 3 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
64.5% Female
35.5% Male
81% White
10.8% Race/ethnicity unspecified
8.2% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Alcohol consumption 2.6 3.0 3.0 4.0 2.9 3.3 3.1
2: Smoking cessation 2.5 2.6 2.8 3.1 2.8 3.4 2.8
3: Overall health risks 3.6 3.6 2.8 3.5 3.1 3.5 3.3

Study Strengths

The studies were well designed and improved over time with the introduction of randomization at the subject level, use of health care utilization records, and use of more reliable and valid measures. The concordance between level of cardiovascular risk and indicators of drinking severity is an indication of the validity of both measures. In one study, a very high certainty of consistent service delivery could not be documented given the dispersal and sheer scope of the work conducted at the four experimental sites; however, counselors underwent a 2-day training, and new counselors were shadowed for the first few visits. Rescreening rates were above 80% of targeted respondents, which is high for large-scale studies like these. Missing data were rare, and in two of the three studies, missing values were imputed using the conservative LOCF (last observation carried forward) method. The authors considered and addressed many potential confounds. Logistic and other more sophisticated regression techniques were sometimes used and showed fairly clean relationships between the variables tested.

Study Weaknesses

The nonbiometric measures used are not well developed and have questionable reliability and validity. Some of the services provided (e.g., alcohol counseling) were complex and highly vulnerable both to inexpert usage and drift. Some important sources of potential bias were uncontrolled. For example, counselors, who could not have been blind to subjects' group assignment, may have been biased about the superiority of individual versus group follow-up counseling. In one study, workers randomized to the group condition wanted to cross over to the individual condition, and workers who were not included in the study wanted to participate in the individual follow-up. This necessitated modifications to the analytic scheme. The analytic techniques used were sometimes too simplistic. For example, partial or semipartial statistics could have been used to remove the influence of preintervention status from change scores.

Readiness for Dissemination
Review Date: June 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

NREPP submission overview

Program Web site (University of Michigan's Worker Health Program Web site), http://www.ilir.umich.edu/wellness/

Sieck, C. J., Heirich, M., & Major, C. (2004). Alcohol counseling as part of general wellness counseling. Public Health Nursing, 21(2), 137-143.  Pub Med icon

Wellness Outreach at Work program history and summary

Wellness Outreach at Work replications manual

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.0 3.0 1.0 2.3

Dissemination Strengths

A number of implementation materials and supports are available on the program Web site. Individual implementation protocols are detailed and easy to locate online. Training and implementation support and a client performance monitoring tool are available to implementing organizations for a fee. Outcome monitoring is encouraged.

Dissemination Weaknesses

Implementation of the intended program depends greatly upon appropriate assessment of organizational needs, and little guidance is provided for accomplishing this task. Some implementation resource links on the program Web site led to error pages. Training and support services are provided by a private company, and the content of these services is unclear. No training performance or implementation fidelity instruments are available to support quality assurance.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Protocols and intervention materials Free Yes
Licensing for use of program database, with computer support $25,000 plus $2 per employee per month entered into database No
2-day, on-site or off-site training $12,000 for up to 20 participants No

Additional Information

Employers interested in implementing the intervention must retain wellness coaches, health care professionals with certification in a health specialty and additional training as a "generalist." They should be qualified to provide counseling on a wide range of health issues and to refer clients to specialists when needed. Holtyn & Associates can be contracted to perform the full program implementation at a cost of $400 per employee.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Erfurt, J. C., Foote, A., & Heirich, M. A. (1991). Worksite wellness programs: Incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization. American Journal of Health Promotion, 5(6), 438-448.  Pub Med icon

* Heirich, M., & Sieck, C. J. (2000). Worksite cardiovascular wellness programs as a route to substance abuse prevention. Journal of Occupational and Environmental Medicine, 42(1), 47-56.  Pub Med icon

* Heirich, M., Sieck, C. J., Klykulo, K., & Bonnington-Kouri, K. (2002). Moderation counseling as a route to substance abuse prevention: M-CARE's DrinkWise and Health Risk Appraisal Programs at the University of Michigan. Final Report for grant number 6 U 1 K SPO8146-03-02, awarded by SAMHSA/CSAP to the Greater Detroit Area Health Council and the University of Michigan.

Contact Information

To learn more about implementation, contact:
Ken Holtyn
(269) 382-5897
ken@holtynhpc.com

To learn more about research, contact:
Max Heirich, Ph.D.
(734) 668-1008
mheirich@umich.edu

Cynthia J. Sieck, Ph.D.
(937) 286-4918
cynthiasieck@gmail.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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