1. Understanding the impact of a workplace health promotion program: How do we know who got what, and how much is enough? Dr Fiona Cocker

2. Evaluating Interventions Randomised Controlled Trial (RCT) Aims to evaluate program/trial efficacy Considered the “gold standard” Pros: double blind, placebo controlled, strong internal validity Cons: Limited external/“real world” validity, limited “generalisability”

3. Evaluating Interventions Pragmatic RCTs Aims to evaluate program/trial effectiveness, whilst reflecting the heterogeneity of individuals encountered in the “real world” Minimise exclusion criteria Functional outcomes emphasised, and measured over a sufficient time period Pros: rigour of randomisation, applicable to group of interest

4. Evaluating Interventions “Real World” Evaluation Evaluation aim: Implementation Pros: more practical in a large, diverse, populations such as a multi-site workforce Cons: no control group, may have no control over intervention Example: Well@Work: Promoting Active and Healthy Workplaces by researchers at Loughborough University, UK

5. Evaluating H@W Healthy@Work H&WB activities and initiatives –varied widely between agencies –implemented at different times during H@W How do we know who got what? How do we determine how much is enough? –Comprehensiveness Potential to influence health outcomes? –How do we control for this?

6. What is a comprehensive WHP programme? Linnan et al. Results of the 2004 National Worksite Health Promotion Survey. Am J Public Health. 2008;98(8):1503-9. –Surveyed individuals “responsible for health promotion or wellness” to identify which worksites offered “comprehensive” worksite health promotion program Pilkington et al. Survey of use of occupational health support. Edinburgh: Institute of Occup Med; 2002. –Surveyed 4950 randomly selected companies of varying size, sector and region, to determine who uses occupational health support Used to inform exposure variable development because: –national in scope –covered multiple worksites of different sizes and industries

7. Components of a comprehensive work program –Health education (skill development, awareness building) –Supportive social & physical environment (accessible stairs or shower facilities, time to allow participation) –Integration into organisation’s structure (management support, dedicated H&WB position/s)* –Linkage to related programs (EAP, OH&S) –Worksite screening (blood pressure, health checks) Linnan et al. Am J Public Health. 2008;98:1503-09. *Pilkington et al. Institute of Occupational Medicine; 2002.

8. Measuring “comprehensive” or H&WB exposure: Methodology Dose How many H&WB activities and initiatives did each agency implement? Cumulative exposure –Add activities across life of H@W to get a total score

9. Example of Raw Data - 2010

10. Total Score per Year AGENCY2008/09201020112012Total A1510202974 B1918263194 C118193573 D117192461 E1914243592 F20162639101 G26213047124 H18162640100 I15113649111 J118283986 K1293746104 L23162440103 M106344696 Z137213172 Total Score/Year = 56

11. Total Score per Year Total Score/Year = 56 AGENCY2008/09201020112012Total A1510202974 B1918263194 C118193573 D117192461 E1914243592 F20162639101 G26213047124 H18162640100 I15113649111 J118283986 K1293746104 L23162440103 M106344696 Z137213172

12. Agency Example Year Number of H&WB Activities

13. Sensitivity of Measurement Can we see differences between agencies? Year Number of H&WB Activities

14. What’s next? Currently focused on an overall indicator –Total dose Employee reports of what was available & what they used –measure of individual exposure When did agencies implement activities? –Duration i.e. from 2008 or not until 2012 Were activities in every domain? –Quality and comprehensiveness Does this impact on health outcomes? –Only 2012 important, close to measurement point?