Many worksite wellness programs today are not making a difference. And you do want your program to be making a difference for your employees, right?
If your worksite wellness program is not having the impact you desire, there are essentially three possible reasons why this might be the case:
1. Faults in Problem Theory: The wellness program is built upon a faulty understanding of the underlying economic, social and other processes that are creating the employee health problem. In other words, there is a disconnect between understanding what the true nature of the problem is and the program designed to address it. An example here is the belief that chronic diseases arise solely from lifestyle and behavior and are not the result of any of the other determinants of health.
2. Faults in Program Theory: The wellness program design is built upon a faulty understanding of how to translate the problem theory into specific program strategies or interventions. Here the disconnect is between understanding the theory and the strategies and interventions needed to best address it. A good example here would be using a biggest loser type intervention to address issues related to employee weight.
3. Faults in Program Implementation: Here the fault lies in how the proposed programming or interventions are implemented. The problems could be in the specific strategies, programming and interventions chosen, the level of resources committed by the organization and/or how the programming and/or interventions are delivered to employees. Here an understanding of the problem theory would be correct, the overall program design may be fine, but the programming and/or interventions are poorly implemented or not inadequately supported by the committed resources. An example would be expecting the wellness program to operate on now or lost cost resources.
Problem Theory Failure
In terms of employee health and wellness, one of the more persistent failures in problem theory is due to our under-estimating the complexity related to the determinants of health. An individual’s health is generated by very complex causal processes involving interactions of a very complex nature between the environment, social and individual level processes. The worksite wellness community tends to focus solely on employee behavior and lifestyle processes, while the World Health Organization and the U.S. Centers for Disease Control and Prevention take a much broader view.
The WHO states that the determinants of health include:
• The social and economic environment,
• The physical environment, and
• The person’s individual characteristics and behaviors.
The WHO recognizes that the context of people’s lives determine their health and individuals are unlikely to be able to directly control many of the determinants of health.
The U.S. Centers for Disease Control and Prevention states that the factors that contribute to a person’s current state of health may be biological, socioeconomic, psychosocial, behavioral, or social in nature. According to the CDC, scientists generally recognize five determinants of health:
• Biology and genetics
• Individual behavior
• Social environment
• Physical environment
• Access to health services
A consequence of our under-estimating the complexity of the health problem is often to over-estimate our abilities to affect change and impact the individual employee’s health status. This means that we are generally overly optimistic about how much of an effect we can expect to achieve.
Program Theory Failure
Program theory failures arise when a proper understanding of a problem gets translated into inappropriate programming and interventions to address the problem. A great example here is the use of dieting type programming and interventions while the research supports the use of nutrition and exercise strategies for weight management. Very few worksite wellness programs use the available evidence based programming and interventions. Too often programming and interventions are also based on the idea of the month or the shiny object syndrome and not what is needed as identified through a comprehensive needs assessment.
Program Implementation Failure
Although in principle it is possible to distinguish program theory failures from program implementation failures, in practice it is difficult to do so. Program implementation failure occurs when a correct program is incorrectly delivered. Typically, program implementation failures are the most common causes of ineffective programs. Here are some examples of ways in which program implementation failures can occur:
• Programming and interventions used are not the most effective available
• The programming and interventions are correct but the dose is insufficient. In many areas of worksite wellness programming and interventions, little is known about what constitutes adequate dosing.
• The method used to deliver the programming or intervention is inappropriate for the setting or intended audience
• Level and type of resources provided are inadequate to achieve desired goals
• Inadequate or inappropriate reward system – Since incentives play such a large role in worksite wellness programs, it is important to understand how the use of extrinsic incentives and intrinsic motivators differ and how each should be best utilized for supporting successful change.
The reality of worksite wellness programs is that if you build it, they may not necessarily utilize it. Few worksite wellness programs have been found to be even minimally effective. Even fewer programs have been found to be spectacularly effective. It is important to remember that worksite wellness programs should be based on a solid underpinning of the known science and theories, the programming and interventions undertaken should be proven to address the problem and should be carefully and appropriately implemented.