One Size Does Not Fit All

An ever-changing demographic landscape creates both challenges and opportunities for employers that want to establish a healthy workplace culture that contributes to worker productivity, while keeping healthcare cost increases at bay.

Wednesday, August 28, 2013
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The average American workplace is becomingly increasingly diverse. According to data from the United States Department of Labor, the next 10 to 15 years will bring significant change to the demographic makeup of our workforce. For starters, the age and gender of the American workforce will continue to evolve. No longer will the 25 to 54 year olds represent the biggest slice of the pie. Instead, it's anticipated that nearly half of all new workers will be 55 or older, and one in five new workers will be between the ages of 16 and 24. As for the male-dominated workplace of years ago? That, too, is expected to change as the number of women in the workforce increases another 6.2 percent by 2020, topping 77 million, according to the Center for American Progress.

This changing demographic landscape creates both challenges and opportunities for employers who want to establish a healthy workplace culture that contributes to worker productivity, while keeping health care cost increases at bay. A new research study from StayWell Health Management, which was published in the April issue of the Journal of Occupational and Environmental Medicine, demonstrates how factors like the age, gender, and the existing health status of your workforce affect wellness program outcomes. The study focused on employer use of widely accepted best practices for comprehensive workplace health management and examined the degree to which differences in age, gender and health status influenced the relationship between best practices and program outcomes.

Over the years, the employee health management industry has successfully identified a number of best practices that are associated with optimal program outcomes, along with the program elements that are most common among high-performing workplace programs. For example, numerous studies have demonstrated that benefits-integrated incentive designs and comprehensive communication strategies are associated with higher health assessment participation rates. However, there has been little evidence to support that such best practices will predict program success and whether factors like age and gender influence the impact that those best practices have on program outcomes.

The study was designed to more precisely measure the impact of best practices on workplace health management outcomes and to account for employee attributes of age, gender and health status. Data from 205,672 participants from 55 different companies were examined, pulling from three StayWell sources: individual demographic and health assessment data, employer use of selected best practices, and individual health coaching participation data. The study examined enrollment in a coaching program, active participation in the program, and behavior change for those enrolled in the program.

We all know that men and women are different, but this study shows how these differences influence the way people respond to the health management best practices that are designed to encourage participation in wellness programs. Results demonstrate that best practices do influence engagement and outcomes, but that all best practices did not have the same degree of influence on all participants, nor did they influence outcomes in the same way. For example, the study showed that:


*         In general, females and older individuals were more likely to enroll, but this was not true for all companies;

*         Non-cash incentives, such as a T-shirt or duffel bag for participation in coaching programs actually decreased enrollment in coaching programs;

*         When biometric screenings were offered, older employees were more likely to enroll in coaching programs;

*         While companies that used a non-cash incentive saw lower overall enrollment, offering a cash incentive did not necessarily lead to greater levels of active  participation in coaching programs once individuals were enrolled; and

*         The use of onsite wellness champion networks improved behavior change for older adults.

"One of the most interesting findings from this study is support for something called 'The Herd Effect,' which means people tend to behave like their peers around them. For example, if a worksite is predominantly male, then male employees will tend to participate or change behaviors in a similar manner to their male co-workers. Women, on the other hand, may be less likely to adopt these same behaviors. However, if a male-dominated company follows best practices, the women may be more likely to buck the majority trend to overcome this herd effect," said Paul Terry, Ph.D., chief science officer for StayWell and lead author of this study.

One example of the "herd effect" can be applied to participation in coaching programs. Men are typically less likely to participate in health management programs, especially when men are the minority group in a female-dominant workplace. When men see other men like them participating in a program, it increases the likelihood that they will also participate. This study found that in female-dominant settings, men were more likely to participate in health coaching programs when onsite biometric screenings were implemented. According to Terry, in this instance, the herd effect may have occurred when men saw other men participating in screenings, which then influenced their participation in other wellness program offerings.

While many employers already may have some idea about how program participation and outcomes vary across locations in their workplace, this research provides more concrete evidence of how important differences in workforce demographics are and how they can influence wellness program activities. It also underscores the importance of customizing health management strategies and best practices to the demographics and established cultural norms of a workplace. Specific workplace "lessons" that can be gleaned from this research include:

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*         Best practices do not have the same influence in every work environment. In short, one size does not fit all when it comes to health management programming. Some best practices will influence outcomes more strongly in one organization but not to the same degree in another. Selection and application of specific best practices continues to be more art than science;

*         Be cautious about how incentives are used because they may influence intrinsic motivation and behavior change in different ways for men and women;

*         In female-dominated or gender-balanced workplaces, special strategies may be needed to engage men in coaching programs;

*         Although men are more hesitant to enroll in programs, once they do enroll, they are just as likely to actively engage and they see slightly better outcomes; and

*         The use of biometric screenings and a strong wellness champion network may help older employees get into coaching programs and improve their health risks.

In addition, the findings shed light on how employers can leverage different best practices to achieve different program goals, based on the demographic makeup of their population. For example, studies have shown companies that use wellness champion networks to increase employee participation and engagement in health management programs, realize increased levels of behavior change among men. These findings align with well-established social sciences research that shows we tend to imitate those whom we admire and, in particular, those whom we admire and who we see as similar to ourselves. Business researchers have also picked up on this tenet and the latest issue of the Harvard Business Review features articles that come back to it often. These articles demonstrate that when we like others, owe favors to others (reciprocity principle), have agreed to do something with others (commitments) and have a sense of "social proof" (others are doing this thing), then the probability that social influence will affect our behavior increases. 

Why all the fuss about best practices? Quite simply, because employers who take the time to invest valuable budget dollars into employee health management programs should do everything they can to ensure the success of their program and generate an optimal return on their investment. The first step to achieving such positive outcomes is to understand your workplace culture and characteristics of your employee population, and to customize these best practices accordingly.

Jessica Grossmeier, Ph.D., is vice president of research at StayWell Health Management, where she provides research consultation and oversees the design and implementation of studies to examine population health processes and the medical and financial impact of wellness programs.

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