Getting the message across

For any health promotion programme to have an impact it must be creative and
innovative or it will simply be ignored. A 
good knowledge of your workforce will help a tailor-made approach to
reach the target and bring real results. 
By Liz Hall

Running an effective health promotion is about much more than pinning up the
odd smoking cessation poster in the hope that staff might notice it on their
way to the canteen.

For a health promotion programme to have an impact, it should be underpinned
by needs assessment, clear goal setting, cost-benefit analysis and outcome
measurement.

But it should also be creative and innovative to capture and keep capturing
the interest of complacent or reluctant employees.

"The most important thing is to stimulate debate, to be light-hearted
and informal to get people interested," says occupational health nurse
John Walker, who was involved in running a successful scheme at Motorola’s
factory near Glasgow before it closed.

Staff need to be motivated

Staff reluctance was certainly something that faced BAE Systems Marine’s
occupational health manager Karen Bryce.

The shipbuilding firm’s workforce – some 4,500 staff in Glasgow and 5,000 in
Barrow – is about 90 per cent male.

"The male staff here are very resistant to change and reluctant to look
after their health," says Bryce.

Before embarking on health promotion interventions, it is important to draw
up a profile of the workforce, assessing specific needs. Apart from areas
common to all workforces such as heart disease, each industry will have
different needs, with slips, trips and falls common in construction, and
musculoskeletal disorders typically common in the high- tech sector, for
example.

In BAE Systems Marine’s case, around 42 per cent of its male employees were
in the high-risk group for cardiovascular disease. Musculoskeletal problems and
manual handling injuries were common because of staff working with heavy
machinery in tightly confined spaces. Eye injuries were also rife, with many
men refusing to wear protective eyewear. A year ago, it was not unusual for 10
staff in one day to be rushed off to the local eye infirmary, some of them with
horrific injuries.

Despite employee reticence, Bryce set up health promotion strategies to
tackle some of these problems. She carried out a cost-benefit analysis
demonstrating to top management the financial implications of eye injury – the
cost of taxis to and from the infirmary and lost productivity, for example.

Selling the message to management

Bryce says, "It is important to be able to cost-benefit things to sell
it to management, spelling out how much is spent dealing with problems and
highlighting how things could be cheaper."

She enlisted support from managers, set up team briefings and ran a poster
design competition.

Since the eye protection campaign, the cost of dealing with eye injuries has
more than halved and Bryce cannot remember the last time an employee was sent
to the infirmary.

Last November Bryce launched a manual handling campaign, tying in with
National Back Care Week. It featured eye-catching posters from the Arthritis
Society, prizes, a physiotherapy questionnaire, a roadshow in the canteen and
taster sessions of activities such as yoga and Pilates, which have proved
highly popular – even with the men.

Sickness absence – much of which was due to musculoskeletal problems – has
dropped from 14 per cent to 3.6 per cent in the last year and a 30 per cent
reduction in musculoskeletal problems has been achieved since November.

"This is very good for this industry. People are now reporting problems
more quickly and getting sorted out earlier," says Bryce.

Apart from being creative, effective health promotion programmes should make
good use of local resources and attract the support of managers at all
organisational levels.

"You need support from top level management and managerial support from
all departments. Once employees see this effort, you see rewards," says
Walker, who now works for Corporate Health, a contractor providing occupational
health services to Scottish Equitable.

Motorola’s scheme Workplace Health at Motorola was based around the
effective use of existing resources. The Wham team worked closely with human
resources, the on-site fitness centre, the canteen and the employee assistance
provider.

Having assessed which needs should be addressed, it is important to set out
clear goals before embarking on health promotion interventions. Typical goals
might include reducing the number of smokers in the workplace, tackling
obesity, promoting healthy eating, and reducing staff turnover or absenteeism.

Wham’s overall goals were to increase staff retention and tackle staff
turnover but it also set itself numerous other goals along the way such as
increasing attendance at the workplace fitness centre. This it achieved, with
fitness centre membership having increased noticeably two years after Wham’s
launch. Employee turnover, graphed by the OH department, was significantly
dropping, as was absenteeism. A three-day working week of 12-hour shifts was
common for much of the 4,500 strong workforce overseen by Wham.

Many organisations take their lead from government bodies when setting
goals. Tying in with the Health and Safety Executive’s occupational health
strategy, Securing Health Together, Scottish Equitable has stepped up its
efforts to tackle absenteeism. Its goals are to cut the number of days lost to
ill health by 30 per cent over a 10-year period as well as to improve
opportunities for rehabilitation back to work.

The financial institution’s absenteeism rate is comparatively low at 4.2
days a year per employee, equating to an average of 1.69 per cent overall. The
figures have been monitored since 1996 and each year the absence figure has
been falling at a rate of 0.3 per cent.

"We are keen to maintain this low percentage through various
occupational health efforts, but as you can see we are reaching a point where
maintenance of the figures at a low level will become a major priority, as
people do become ill at times," says Walker.

Evaluation

One of the keys to effective health promotion is incorporating evaluation
into any new intervention programme. It is no good collecting figures after the
intervention – they need to be collected beforehand to allow for constructive
comparisons.

The Health Development Agency recommends using quantitative and qualitative
procedures as well as statistical techniques and randomised controlled trials
where possible.

But evaluation is seen by many as difficult and time-consuming. "We do
things like keep accident statistics but we haven’t got an evaluation system
set up yet as it’s very time-consuming and difficult because of having to do
individual risk assessments. You end up relying on people’s honesty," says
Bryce.

Walker agrees, "Evaluating health promotion is not easy as it tends to
be about evaluating interest. Some people get help then don’t feed it back to
you and how do you evaluate wellbeing? But you can look at things like rises in
attendance or productivity or focus on specific areas," says Walker.

The Wham team drew up monthly graphs on a range of things including interest
from staff in fitness training or blood pressure management and information
sent out.

Interventions

Health promotion interventions offering staff something concrete or
targeting individuals tend to be popular. A Health Education Authority study of
15 workplace health promotion programmes concluded that, "individualised
delivery of information appeared effective in a range of interventions".

On-site cholesterol tests and massages proved popular at City bank UBS
Warburg’s health fair, which has been held annually for the last five years,
attracting around 800 visitors a day. The event aims to promote health
education to all employees with the goal of preventing long-term disease.

"We promote key issues relating to healthier lifestyles, preventing
long-term disease and helping staff relax," says Elaine Fletcher,
occupational health practice nurse.

The global bank employs some 7,000 staff in the UK, many typically working
12 to 14 hour days. Stress is a major issue, causing insomnia for some staff.

The fair consists of stalls offering information on areas such as exercise,
healthy eating, smoking cessation, relaxation techniques and travel
vaccinations. On-site blood pressure and cholesterol level testing is available
and nutritionists and complementary therapy practitioners such as
reflexologists are invited to exhibit. The British Heart Foundation exhibited
for the first time at this year’s event, held in July.

Although Fletcher says there are too many employees to do individual
follow-ups after the fair, the event has definitely become more well known.

"We have about 1,000 new people a year and existing staff have now come
to expect the fair. We have never had any negative response."

But as Bryce warns, however, successful an intervention is, it is important
not to rest on your laurels. "People forget and you need to be innovative
to keep their attention. As soon as you stop paying attention to it, the
problems start cropping up again."

NHS Health Promotion England: www.hpe.org.uk

Health Development Agency: www.hda-online.org.uk

Health Education Board Scotland: www.hebs.org.uk

How to run an effective programme

– Ensure visible support and
involvement from top management

– Involve employees at all levels in planning, implementation
and activities of interventions

– Increase participation by focusing on definable and
modifiable risk factors that are a priority for specific workers

– Tailor-make interventions to characteristics and needs of
employees

– Use local resources to organise and implement interventions

– Include evaluation in all new intervention programmes with a
range of outcome and process measures

Source: Health Development Agency

How to evaluate interventions

– Make sure health promotion
interventions have fully integrated evaluation components focusing on delivery,
acceptability and effectiveness

– Use appropriate quantitative and qualitative procedures and
statistical techniques to analyse effectiveness

– Use randomised controlled trials or even quasi-experimental
approaches with adequate control groups to study effectiveness

– Include systematic information on cost-effectiveness when
evaluating interventions

Source: Health Development Agency

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