Individuals who are being considered for the team should be well respected by their peers. Other considerations include: Do they have time to come to meetings? Will managers allow them to attend meetings during the workday? Will community members be given some sort of compensation for their time?

• When will group meetings be scheduled, and how will they be conducted? The schedule and agenda for the group meetings should be sent out in advance by the group leader in order to allow group members to plan for the time away from their work, prepare for the discussion, and suggest additional issues for the agenda.The schedule and agenda for the group meetings should be sent out in advance by the group leader in order to allow group members to plan for the time away from their work, prepare for the discussion, and suggest additional issues for the agenda.

A variety of problems can arise during group meetings. These generally relate to individual member attendance and participation. Individuals may agree to participate, and then allow other responsibilities to take precedence over attendance at the meetings. Factors that would promote attendance would include getting the support of members’ supervisors and providing incentives to volunteer members.

As each individual may be representing a particular population at the worksite, attendance and participation are very important. During meetings, all in attendance should be given some control of decisions made, so that the interests of each are represented in the ultimate wellness plan. To summarize, the basic ground rules are:

• Members of the team must attend scheduled meetings.
• Members will be given an opportunity to share their ideas and/or participate in a group vote.
• Members must be willing to carry out assignments in order to meet objectives of the program.

At large facilities, there may be multiple groups working on wellness initiatives. For example, at a large teaching hospital, the physical therapy department may be working on promoting physical activity, the nutrition department on promoting nutrition education, and the administrators on decreasing employee healthcare costs. These groups can collaborate on program ideas and pool resources and influence, while making sure not to duplicate each other’s efforts.

Communication campaign

The most effective routes of communication available at the worksite must be identified. Email, newsletters, fliers, bulletin boards, and messages on paychecks, as well as announcements at meetings, are all common methods of disseminating important information at a worksite.

The delivery of motivational messages and information via email can be done quickly, and the actual mailing does not incur costs to the sender. Researchers testing the effectiveness of email messages to promote intake of fruits and vegetables found that email was an effective tool for getting their messages to employees (37, 38). Franklin and colleagues conducted their study at a site where 388 of the 960 employees consented to participate (38). Program reach was evaluated by the number of emails opened. After six months, 70% of subjects had opened 50% or more of the study emails which indicated that email was an effective way of getting the intended messages to the participants. These emails provided strategies for increasing fruit and vegetable intake, as well as links to additional information and tools on the web. Another emailed worksite nutrition intervention program, which included assessment and tailoring over 12 weeks, suggested a significant improvement in the stage of change and increase in fruit and vegetable consumption (38). Email messages sent to program participants should be consistent while supporting the wellness goals.

Implementing the program

After the initial planning has been completed, the workers will be invited to participate in the program. Though their awareness of the program will have been raised by the communications campaign, they may not be aware of their personal health risk. Implementation will include the health risk appraisal (HRA), interventions, data collection, program evaluation, data analysis, and reporting.

Identifying health risk

The HRA is a type of screening tool commonly used for worksite wellness programs. These surveys can often be completed online and require that the user reply to various questions related to health, such as physical activity level, personal history of disease, family history of disease, eating habits, and stress levels. After answers are provided, the individual’s “health risk” can be tabulated and feedback provided. Collecting information without having individuals provide identifying information may result in responses that are more candid (39).

Incentives

When the wellness initiative is promoted, the ultimate incentive of better health could be emphasized. Incentives for individuals could also include reductions in the cost of health insurance, fitness center memberships, and healthful food items in the cafeteria. In addition, free or discounted fitness and nutrition classes and health publications can be provided. Prizes, such as food samples of whole-grain cereal, unsalted nuts, fresh fruit, and vegetables, or small pieces of fitness equipment, such as a pedometer, could be offered for completion of wellness targets and competitions. Incentives should not detract from goals of the wellness program; indeed, they should promote healthful behaviors.

Interventions

Educational interventions include:

• Lectures on stress reduction, healthful cooking methods, increasing physical activity.
• Personal nutrition and/or wellness counseling.
• Weight management support groups.
• Free fitness classes—walking programs, yoga, dance, meditation.

An environmental nutrition intervention has been defined as “one that affects availability, access, incentives, or information about foods at the point of purchase” (40). Examples of environmental interventions in different settings include:

• Cafeteria—modify recipes, provide healthful snacks, post nutrient labels.
• Vending machines—provide healthful snacks, post messages (see below), decrease prices of healthful options for additional incentive.
• Stairways—make stairwells safe, clean, freshly painted, well lit, and easily accessible; enhance with music.
• Elevators/escalators—slow the speed to deter use; post messages to motivate stairway use
• Competitions—organize individuals or groups/departments to have competitions to lower health risks.

Motivational messages should promote behavioral changes that are easy to implement, and that, if followed, could contribute to a healthful lifestyle. Messages should be posted in strategic locations such as in stairwells, by elevators, and in the cafeteria. Posted messages should be attractive and brief, so that they are attention catching and can be read quickly.

Box 24-3 features an example of a specific set of worksite interventions developed to promote BMI awareness, improved nutrition, and increased physical activity at New York-Presbyterian Hospital and Columbia University Medical Center.

Box 24-3 Case Study: “Be Fit to Be’ne’Fit”

Site: New York-Presbyterian Hospital and Columbia University Medical Center

Planning

The initiator of the campaign met with department heads and administrators from the Medical School, School of Public Health, and Institute of Human Nutrition, as well as hospital and nutrition department administrators, to discuss plans for an anti-overweight campaign at the medical center. Priority health issues were confirmed and support was elicited. Next, a team created a research study that would address goals, outline wellness program initiatives, and evaluate the effect of the campaign “Know your BMI” for one year. Funding was obtained through companies that promote weight management. The NYPH administrators provided funding for scales, T-shirts, and screens for privacy. The program logo is shown below:

Be Fit to Be’ne’Fit Study Design and Methods

The study protocol was reviewed and approved by the Institutional Review Board. The program was publicized via recruitment fliers, articles in the medical center’s newsletters, emails, and website postings. Eight hundred and nine employees of Columbia University Medical Center and New York-Presbyterian Hospital (NYPH) enrolled in the study, and 100 completed a follow-up visit within 12 months. BMI awareness initiatives were instituted during the 12-month study period. Publications and postings conveyed messages that increasing BMI is associated with heightened chronic disease risk, as well as strategies for achieving a better BMI. Nutrition and physical activity promotion supported the BMI awareness campaign.

“Be Fit to Be’ne’Fit” Objectives

• Help decrease calorie and fat intake.
• Help increase physical activity.
• Help decrease body weight by at least 5–10% in people who need to manage weight within the first year of the campaign.

Body Composition and Screening

In an effort to reach the maximum number of potential study participants, the study coordinator visited a variety of sites on campus. This was possible because a mobile unit, consisting of a wheeled cart, privacy screens, scales, and computer interface, was used for participant screening and follow-up visits. At baseline visits, informed consent and Stage of Readiness questionnaires were collected from participants, BMI and body composition were measured, and education materials were provided. Participants agreed to return for follow-up at 6 and 12 months, at which time data collection and measures were repeated.

BMI Awareness Promotions

• BMI charts sent to physicians encouraged their use as a tool for overweight and obesity awareness and management.
• Pediatric obesity seminar—provided educational information to concerned employees.
• Health fairs—provided nutrition counseling and education materials at a variety of health fairs on campus.
• Posted motivational messages, educational materials, and articles in various sites on campus, on the website, and in newsletters.
• National Nutrition Month—promoted via messages and “Be Fit” red bag lunches.
• A picture of a bumblebee on a treadmill was created as the campaign logo.
• Magnets with the campaign slogan and the picture of the bumblebee mascot were distributed.

Nutrition Promotion

• Recipe revisions—met with chef to revise recipes for foods served in cafeterias. Emphasized replacing butter with unsaturated oils and decreasing fat amount, as well as increasing whole grains and vegetables.
• Portion size training—”Be Fit” coordinator met with cafeteria workers to emphasize the importance of serving appropriate portion sizes.
• “Be Fit” lunch special—healthful food combinations were offered at attractive prices.
• Nutrition labels—cafeteria recipes were analyzed and nutrient labels were created and posted alongside foods and in binders.
• Vending machine—healthful snacks were added to the vending machine food selections and marked with the “Be Fit” Bee.

Physical Activity Promotion

• Stairwells—two were designated “Be Fit” stairwells; they were repainted and better lighting was installed. Promotional and motivational messages were posted at each landing.
• Elevators—promotional and motivational messages that provided directions to stairwells were hung at the entrances to elevators.
• Indoor path—”Be Fit Walking Loop” was identified and promoted within the facility halls.
• Fitness classes—free yoga, salsa dancing, Pilates, aerobics and weight-training classes were offered and taught by trained/certified employee volunteers.
• Fun walks—monthly one-mile walks were offered at three different times of the day. An additional walk was offered one afternoon per week. Pedometers, educational materials, water bottles, and encouragement were provided.
• Fitness team—walkers teamed up to participate in the JP Morgan Chase Corporate Challenge “Race for the Cure,” a 3.1-mile race.

Collaboration

• Facilities department worked to improve and maintain stairwells.
• Nutrition department worked to improve offerings in vending machines and to maintain nutrient labels in cafeterias.
• Executive chef worked to revise menus to “Be Fit” specifications.
• “Be Fit” jingle was written by a security officer.
• Fitness classes were led by employee volunteers.
• Website was created by an employee volunteer.
• Educational materials and articles were created/written by dietetic interns of Teachers’ College, Columbia University.

Evaluation

• Participant feedback was elicited during the study through email and in small group sessions conducted by the coordinator.
• Baseline and follow-up analyses of Stage of Change questionnaires and weight/BMI changes were done.

Conclusions

• Degree of overweight in study population was reflective of that of the general US population, but higher than that of the New York City population.
• “Be Fit to Be’ne’Fit” continues to be the best-known wellness program on the campus. The program was adopted in the medical center’s community hospital for a “Be Fit Friends” weight loss competition, as well as in community BMI awareness programs.