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Municipal government employee survey : preferences for and perceptions of employee health and assistance.. Jones, Deb 1990

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MUNICIPAL GOVERNMENT EMPLOYEE SURVEY: PREFERENCES FOR AND PERCEPTIONS OF EMPLOYEE HEALTH AND ASSISTANCE PROGRAMS by DEB  JONES  B . S c . H o m e Economics (Nutrition)  A THESIS SUBMITTED IN PARTIAL F U L F I L M E N T O F THE REQUIREMENTS FOR T H E DEGREE OF MASTER OFPHYSICAL EDUCATION  in T H E F A C U L T Y O F G R A D U A T E STUDIES SCHOOL OFPHYSICAL EDUCATION  W e accept this thesis as conforming to the required standard  T H E UNIVERSITY O F BRITISH COLUMBIA August,  1990  (c) D e b o r a h K a y Jones,  1990  In presenting  this thesis  in partial fulfilment of  the  requirements  for  an  advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. copying  of this thesis for scholarly  department  or  by  his  or  her  I further agree that permission for  purposes  may be granted  representatives.  It  is  by the head of  understood  that  publication of this thesis for financial gain shall not be allowed without permission.  Department The University of British Columbia Vancouver, Canada  DE-6 (2/88)  extensive  copying  my or  my written  ABSTRACT Promoting participation in E H A P s (employee health and assistance programs) by those employees most in need of health improvements is important to increasing the effectiveness of these programs.  P r o g r a m s which are designed to reduce perceived  barriers to participation and to meet the specific needs and interests of these employees have resulted in higher participation. T h e purpose of this investigation was to determine the extent to which demographics and perceived health status were associated with employees preferences a n d perceptions of E H A P s .  T h i s was done through survey analysis  of four hundred and one employees of a municipal government.  It was found that there  were no significant differences in employees' anticipated use of these programs based on a n y of the demographic or perceived health variables studied with the exception of the variable "current frequency of exercise".  However, different interests i n p r o g r a m  components were apparent among the various sub-groups of employees.  T h e r e were also  reported differences a m o n g the sub-groups for preferred program times a n d facilities. T h e r e were significant differences among some of the sub-groups in reported barriers to the use of E A P s and in reported comfort in exercising with fellow workers.  It was also  found that current frequency of exercise was significantly related to perceived health status.  F r o m these observations, recommendations for promoting participation among  these sub-groups have been made.  T h i s research has added to the understanding of the  differences between the various sub-groups of employees in terms of their preferences for E H A P components and the barriers they perceive toward participating in these programs. A better understanding of these factors as they pertain to employees in other workplaces m a y aid in the development of programs which better meet the needs of these employees, and hence, m a y increase their participation in E H A P s .  ii  TABLE OF CONTENTS  PAGE Abstract  ii  L i s t of Tables  vi  L i s t of Figures  '..  viii  Acknowledgements  x  INTRODUCTION TO T H E PROBLEM  1  CHAPTER 1  A.  Statement of the Problem  2  B.  Hypotheses  3  C.  Definitions  4  D.  Generalizability, Assumptions a n d  E. 2  Limitations  11  Significance of the Study  11  LITERATURE REVIEW A.  History  13  B.  T h e Corporate Perspective  15  C.  Participation  18  1.  D.  3  13  T h e Importance of Participation in  Worksite H e a l t h P r o g r a m s 2. Interpreting Participation Rates 3. F a c t o r s Influencing Participation S u m m a r y of Literature Review a n d Implications  18 18 20  for Influencing Participation  42  METHODS  46  iii  A.  B.  The Survey  46  1.  T h e Needs A s s e s s m e n t Project  46  2.  Format  46  3.  Distribution a n d Retrieval  47  4.  Respondents  48  5.  D a t a A n a l y s i s for the N . A . P  50  A n a l y t i c a l Procedures for the C u r r e n t Investigation  4  50  1.  Division of the D a t a  51  2.  Data Analysis  54  RESULTS A.  55  Differences in Responses B a s e d on Demographics  B.  55  1.  Preferences  56  2.  Barriers  101  3.  Benefits  112  Differences in Responses B a s e d on Perceived H e a l t h  113  1.  Preferred P r o g r a m Content  2.  Anticipated Participation and Interest  5  118  DISCUSSION A.  113  125  Demographics  126  1.  Age  126  2.  Sex  128 iv  6  3.  Classification of W o r k e r  133  4.  Exercise H a b i t s  139  B.  Perceived H e a l t h Status  142  C.  General Discussion  145  SUMMARY A N D CONCLUSIONS  150  A.  Summary  150  B.  Conclusions  152  C.  Limitations  155  D.  Recommendations  155  REFERENCES  161  APPENDICES  166  v  LIST OF TABLES  TABLE 1.  PAGE C o m p a r i s o n of S u r v e y Respondents to the T o t a l E m p l o y e e Group  49  2.  Preference for E H A P Components - A l l Employees  57  3.  Differences in Preferences for E H A P Components B a s e d on  4.  5.  Age  60  Differences in Preferences for E H A P Components Based on Sex  61  Differences in Preferences for E H A P Components Based on Collar T y p e  63  Differences in Preferences for E H A P Components Based on Worker T y p e  65  Differences in Preferences for E H A P Components B a s e d on Present Frequency of Exercise  66  8.  Preference for Method of Instruction - A l l E m p l o y e e s  67  9.  Results of the C h i - S q u a r e A n a l y s i s : Significant Differences (p< =0.05) in E m p l o y e e s ' Preferences for E H A P Components Based on Demographics  69  6.  7.  10.  11. 12.  Anticipated Participation in H e a l t h Promotion Programs/Seminars  71  Anticipated Participation in Exercise P r o g r a m s  72  Preferred T i m e of D a y for H e a l t h Promotion P r o g r a m s / S e m i n a r s and Exercise P r o g r a m s  74  13.  Preference for T y p e of Fitness F a c i l i t y on the Worksite  80  14.  Preference for T y p e of E A P to be Implemented  84  15.  Preference for Location of E A P Contact Person  85  16.  Anticipated U s e of a n E A P  87  vi  17.  Preference for F a m i l y U s a g e of E H A P  88  18.  Preference as to Retired E m p l o y e e ' s U s e of P r o g r a m  90  19.  Preference as to Volunteer C a p a c i t y  94  20.  Preference for Implementation of an E H A P  100  21.  Results of the C h i - S q u a r e A n a l y s i s : Significant (p < = 0.05) Differences in Possible B a r r i e r s to E H A P Participation Based on Demographics  102  22.  Biggest Concern Regarding an E H A P  103  23.  Preference as to P a y m e n t for Exercise P r o g r a m s  104  24.  Preference as to P a y m e n t for H e a l t h Promotion P r o g r a m s and S e m i n a r s  105  25.  Reported Comfort in E x e r c i s i n g with Fellow Workers  105  26.  Perceived B a r r i e r s to U s i n g C o m m u n i t y Services  108  27.  Perceived B a r r i e r s to U s i n g a n E A P  110  28.  Perceived Benefit from a n E H A P  112  29.  Differences in Preferences for E H A P Components B a s e d on  30.  Perceived G e n e r a l H e a l t h Differences in Preferences for E H A P Components B a s e d on Perceived Fitness L e v e l  31.  32.  33.  114 115  Differences in Preferences for E H A P Components B a s e d on Perceived L e v e l of Stress  116  Differences in Preferences for E H A P Components Based on Self-Reported E a t i n g H a b i t s  117  Results of the C h i - S q u a r e A n a l y s i s : Significant (p < = 0.05) Differences in E m p l o y e e s ' Perceived Participation Based on Perceived H e a l t h Status  119  vii  LIST OF FIGURES FIGURE 1.  2.  3.  4.  5.  PAGE  Perceived Participation in a n Exercise P r o g r a m (Based on Perceived F r e q u e n c y of Exercise)  73  Preferred T i m e for H e a l t h Promotion P r o g r a m s / S e m i n a r s (Based on Sex)  75  Preferred T i m e for Exercise Programs (Based on Sex)  76  Preferred T i m e for H e a l t h Promotion P r o g r a m s / S e m i n a r s Based on Collar T y p e  78  Preferred T i m e for Exercise P r o g r a m s B a s e d on Collar Type  79  6.  Preferred T y p e of F a c i l i t y B a s e d on A g e  81  7.  Preferred T y p e of Facility B a s e d on Sex  82  8.  Preferred T y p e of Facility (Based on Collar Type)  83  9.  Preferred Location of E A P Referral Person (Based on  10.  11.  12.  Collar Type)  86  Preference as to Whether F a m i l y M e m b e r s Should be Able to U s e P r o g r a m s (Based on Collar Type)  89  Preference as to Whether Retired Employees Should be Able to U s e P r o g r a m s (Based on Sex)  91  Preference as to Whether Retired E m p l o y e e s Should be Able to U s e P r o g r a m s (Based on Collar Type)  92  13.  Preferred Volunteer Capacity Based on A g e  95  14.  Preference for Volunteer Capacity Based on Sex  15.  Preference for Volunteer Capacity Based on Collar Type  16.  ..97  98  Perceived Volunteer C a p a c i t y (Based on Present F r e q u e n c y of Exercise)  99  viii  17.  18.  19. 20. 21.  22.  Comfort in Exercising with Fellow W o r k e r s (Based on F r e q u e n c y of Exercise)  107  B a r r i e r s to U s i n g C o m m u n i t y Services (Based on Collar Type)  109  B a r r i e r s to U s i n g and E A P (Based on Sex)  Ill  Cross-Tabulation of Self-Reported Frequency of Exercise and Perceived H e a l t h Status  122  C r o s s - T a b u l a t i o n of Self-Reported F r e q u e n c y of Exercise and Perceived Fitness L e v e l  123  C r o s s - T a b u l a t i o n of Self-Reported F r e q u e n c y of Exercise and E n e r g y L e v e l A f t e r W o r k  124  ix  ACKNOWLEDGEMENTS  I wish to thank all of m y committee members, D r . Patricia V e r t i n s k y , D r . J o h n M i l s u m , D r . E r i c B r o o m , and D r . S u s a n C r a w f o r d for their assistance with this thesis. special thank y o u to S u s a n C r a w f o r d for her continual enthusiasm, encouragement, and suggestions, and for the hours and hours of time she spent with me over the past two years.  T h a n k s also to Carol Schneider for proof-reading, and to Colin, whose support is  a l w a y s appreciated.  x  A  CHAPTER ONE INTRODUCTION TO THE PROBLEM T h e r e is abundant evidence showing worksite health promotion programs (HPPs) and employee assistance programs ( E A P s ) to be cost-effective i n terms of reducing on-thejob accidents, absenteeism and job turnover, a n d i m p r o v i n g productivity a n d morale (Chen 1988; C o n r a d 1988a; Z a v e l a , 1988).  There is also a wealth of literature discussing the  individual benefits that employees c a n gain f r o m these programs, such as improved fitness and health, increased coping skills, reduction of risk factors, etc. (Blair et al, 1986; C h e n , 1988; C o n r a d , 1988a; H i l l et a l , 1988; Patton et a l , 1986). N o w that E A P s and H P P s (collectively called employee health and assistance programs or E H A P s ) have been i n operation long enough to show measurable results, they are being recognized as wise investments rather t h a n just " p a s s i n g f a d s " (Chen, 1986; Metcalfe, 1987).  T h e question is no longer "are these programs beneficial?", but rather,  "how can we improve their effectiveness?". One of the major issues in employee health p r o g r a m m i n g today deals with how to improve a n d m a i n t a i n participation i n these programs.  M o s t of the work in this area  (Conrad, 1987b; D a v i s et a l , 1987; D a v i s et a l , 1984; Patton et a l , 1986), has tended to look at the issue exclusively from a management or health-professional point of view, while some of the more recent research is addressing the employee's perspective (Blozis et a l , 1989; C o n r a d , 1988a; H a r r i s a n d F e n n e l l , 1988; Tetting, 1989; Z a v e l a , 1988).  This  perspective could be a m i s s i n g link i n the understanding of how to increase participation amongst those individuals who most need such a p r o g r a m .  T h e employee - the individual  affected b y our health policy decisions, the target for our health and fitness p r o g r a m campaigns, a n d the one whose lifestyle habits are being challenged - is also the one who  1  INTRODUCTION  will make or break the success of an E H A P .  W i t h o u t the participation of those employees  who could most benefit from a n E H A P , the p r o g r a m will not likely be successful in i m p r o v i n g health and/or retaining health care costs. In order to achieve that participation, managers and health professionals m u s t put themselves in the employees' shoes by looking at their preferences for p r o g r a m content, as well as preferences for times, locations, cost, etc.  Identifying the barriers and benefits employees perceive in regard to participation in  these p r o g r a m s is also fundamental. It has been noted that the needs and interests of different sub-populations of employees (ie: blue vs white collar workers, males vs females, etc.) m a y be very different (Pechter, 1986). In order to develop programs which m a y better meet the needs of these sub-populations, it is important to study the differences between t h e m , regarding needs, preferences, barriers and benefits. Therefore, the objective of this research was to explore the preferences and perceived benefits and barriers reported by a large employee group (of a municipal government) regarding employee health and assistance programs, and to discuss the implications of these perceptions on p r o g r a m development.  A. STATEMENT OF PROBLEM T h e first a i m of this research was to determine the extent to which demographics (age, sex, classification of worker, and exercise habits) were associated with employees' preferences for, and perceptions of E H A P s .  (These perceptions include the "barriers to"  and "benefits f r o m " participating in these programs.)  2  INTRODUCTION The second aim was to determine whether or not employees' perceived health status was associated with their anticipated use of, and interest in, employee assistance and health promotion programs.  B.  HYPOTHESES  Hypothesis 1: Associations exist between specific demographic characteristics and employee preferences and perceptions (barriers and benefits) of EHAPs in this population. Hypothesis 2: Associations exist between perceived health status and perceived use of, and interest in, EHAPs in this population.  3  INTRODUCTION  C . DEFINITIONS  H e a l t h Promotion - "the process of enabling people to increase control over, and to improve their h e a l t h " ( W . H . O . ,  1984)  H e a l t h Promoting Behavior - " . . . behavior which sustains or increases well being" (Walker et al,  1988)  H e a l t h Protecting Behavior - behavior which is carried out for the purposes of preventing illness  (Walker et al,  1988)  (Worksite) H e a l t h Promotion P r o g r a m (HPP) - " . . . a n ongoing series of activities funded or endorsed by the organization that are designed to promote the adoption of personal behavior and corporate practices that are conducive to employee fitness, health and wellness." J . Terber, 1986  (as reported b y R o m a n and B l u m ,  1988)  E m p l o y e e Assistance P r o g r a m ( E A P ) - "Job-based programs operating within a work organization for the purposes of identifying "troubled employees", motivating t h e m to resolve their troubles, and providing access to counselling or treatment for those employees who need these services." reported b y R o m a n and B l u m ,  Sonnenstuhl W and Trice H , 1986  (as  1988)  E m p l o y e e H e a l t h and Assistance P r o g r a m ( E H A P ) - an employee health p r o g r a m which includes both an H P P and a n E A P . (Note:  "Wellness P r o g r a m " is often used  interchangeably with H e a l t h Promotion P r o g r a m in the literature, but for the  4  INTRODUCTION  purposes of this investigation will be used to m e a n E H A P .  W h e n designing the  employee questionnaire, it was decided that the t e r m Wellness P r o g r a m would be more easily understood by the employees.)  HMOs  (Health Maintenance Organizations) - "..group practices that accept annual p r e p a y m e n t f r o m individuals for health services.  Employees of H M O s usually  accept a s a l a r y rather t h a n fees based on services, so the H M O can better predict its labor costs. A l s o , through preventive medicine H M O s can decrease the onset of catastrophic diseases in their clients, thereby avoiding h a v i n g to provide costly c a r e . " (Patton et al,  PPOs  1986)  (Preferred Provider Organizations) - agreements between the purchaser (corporation) and provider (individual practitioners or institutions), whereby the provider will reduce their fees in return for the corporation promoting the provider's services and encouraging (sometimes through economic incentives) employees to use the practitioner (Patton et al,  1986)  Lifestyle - " . . . a l l those behaviors over which a n individual has control, including actions that affect a person's health r i s k s . " (Ardell, 1979 as cited in W a l k e r et al,  1987)  M u n i c i p a l G o v e r n m e n t - the organization which is responsible for the administration of the affairs of a C i t y , and all the employees who work within that organization.  5  INTRODUCTION  Perceived H e a l t h Status - self-reported perception of health, based on the employee's perception of his/her general health, fitness level, level of stress, eating habits, and energy level after work  T y p e of E m p l o y e e Categories: Since this study involved a specific organization, the classification of employees used by this organization was used to describe "worker types".  Following are the  definitions of the various worker types who completed the survey: D i r e c t o r / M a n a g e r - M a n a g e r refers to a D e p a r t m e n t H e a d ;  In this organization,  there are also three Directors who supervise the D e p a r t m e n t H e a d s a n d are directly responsible to the C i t y Commissioner.  Office Worker/Office S u p e r v i s o r / P r o g r a m m e r - includes a n y office employee (excluding clerical workers, directors and managers); includes computer p r o g r a m analysts, accountants, draftpersons, office supervisors, recreation p r o g r a m supervisors, etc.  Facility W o r k e r - any employee whose job involves m a i n t a i n i n g or operating one of the C i t y ' s facilities, such as the arenas, s w i m m i n g pool, etc; includes facility caretakers, facility supervisors, facility operators,  etc.  Enforcement/Inspection - Includes building inspectors, by-law enforcement officers, mechanical inspectors, fire inspectors, etc.  6  INTRODUCTION  Firefighter - includes all firefighting personnel, (other than office workers, clerical staff, and managers); includes platoon chiefs, captains, lieutenants, officers, firefighters,  etc.  L a b o u r e r - a n individual who performs various labouring duties such as construction and operating small motorized equipment; definition includes public works labourers, water treatment plant labourers, waste and sewage labourers, roads labourers, parks labourers, etc.  E q u i p m e n t / B u s Operator - a n y operator of a vehicle or large equipment; includes roads equipment operators, water treatment plant operators, bus operators, parks equipment operators, etc.  Maintenance/Repair W o r k e r - includes h e a v y duty mechanics, welders, building maintenance persons, etc.  Classification of Employees b y Collar T y p e :  Employees have been classified according to collar type (blue, white or pink), only to analyze the extent to which preferences and perceptions differ between these groups. Following is a brief discussion which deals with the classification of employees to these collar types, and the definitions which were used for this investigation.  7  INTRODUCTION Historically, the differentiation between blue and white collar employees was simply "manual" vs "non-manual" workers, or "manual" vs "intellectual" workers. For many reasons there is no longer as clear a distinction between these two categories as there once was. These reasons include the changed nature of many occupations and the heterogeneity of occupations in our society today. Although society still assumes that there is a clear division between blue and white collar workers, the fact is that many occupations do not fall into one category or the other (Hyman and Price, 1983). It has been suggested that a continuum exists with strictly blue collar workers on one side, strictly white collar on the other, and the majority of employees falling somewhere in between. While recognizing the problems which exist in trying to define and classify these workers, for the purposes of this investigation it was necessary to establish a division between the two. In light of the literature which suggests differing needs, interests, and perceived barriers and benefits between blue and white collar workers with respect to employee health programs, it was of interest to determine if these differences existed in this population. Therefore, for the purposes of this study, the following definitions have been established to describe blue and white collar employees:  White Collar Employees - those employees in possession of, or in close proximity to authority; closer in the chain of command to the employer; functions tend to be predominantly non-manual and often less routinized than blue collar workers, and generally include one or more of the following: administration, design, analysis, planning, supervising, managing, or coordinating; education level is often more 8  INTRODUCTION  advanced than that of blue collar workers; tend to be on salary vs hourly wage. T h i s definition includes directors and m a n a g e r s , office workers (other than clerical workers; see discussion of clerical workers which follows), office supervisors, computer programmers, etc.  Blue Collar Employees - those employees who are further f r o m authority; functions are predominantly m a n u a l or production related (including processing, machining, assembling and repairing jobs), as opposed to administrative or supervisoryrelated.  T h i s definition includes labourers, firefighters, maintenance workers,  equipment and bus operators, caretakers, etc.  Clerical workers have typically been classified as "white collar", as they tend to work i n offices a n d therefore subjectively identify themselves with m a n a g e m e n t (and hence, m a y share some of the attitudes of m a n a g e m e n t in regard to exercise, health, etc.). H o w e v e r , clerical workers are almost always in a subordinate position and do not often exercise control over other workers (with exception to some executive secretaries, and clerical workers who also supervise the office).  A s with blue collar workers, their salaries  are usually hourly, education levels are usually less advanced than white collar workers, and their jobs are often very routine, yet they usually do not carry out " h e a v y physical work".  Clerical workers seem to make up an entirety different category of employees,  possessing some of the characteristics of both blue and white collar workers, yet being additionally unique in that this group is predominantly female.  9  INTRODUCTION In order to study blue and white collar employees as separate groups and to also determine whether or not the clerical workers were unique in their needs, interests, and perceived barriers and benefits with respect to worksite health programs, clerical workers were defined as a separate group and treated as such in the analysis. This group has occasionally been referred to as "pink collar employees", which will be the term used to describe them in this study.  Pink Collar Employees - those employees performing clerical duties such as secretaries, typists, clerks, receptionists, stenographers and cashiers; usually further down the chain of command from the employer than white collar workers; usually less-educated and lower paid than white collar workers; tend to be on an hourly wage; tasks are usually non-manual but are often routinized.  10  INTRODUCTION  D. GENERALIZABILITY, ASSUMPTIONS AND LIMITATIONS T h i s study was designed to explore the differences in needs, preferences, and perceived barriers and benefits between different sub-groups of this employee population. T h e types of conclusions that can be d r a w n f r o m these results, especially w i t h regard to generalization to other C a n a d i a n municipal government organizations are limited, due to the focus of this study on only one organization.  A s s u m p t i o n s being made include: (1)  that self-reported health status and demographics are honest and accurate.  (Possible limitation: due to the concern some employees had for the confidentiality of the survey, they m a y not have always given honest answers to perception questions, or alternatively, they m a y have tried to disguise themselves by filling in inappropriate age, sex or type of worker categories.) (2)  that employees understood the concepts to which they were being asked to  respond.  While the questionnaire used for the survey was examined for ambiguity and redundancy, a limitation is that under the constraints of the original survey, it was not feasible to f o r m a l l y test the questionnaire.  E. SIGNIFICANCE OF THE STUDY Worksite health programs are being developed and implemented faster t h a n the research about t h e m can take place (Roman and B l u m , 1988). A l t h o u g h they have been present on the worksite for two decades, it is only within the last five to six years that  11  INTRODUCTION  research in this area has begun to address participation i n these programs.  A n area  where current research on participation of employees is scant, is the examination of the differing perceptions towards these programs among the various sub-populations of employees (eg. between blue and white collar workers, males and females, etc). T h i s is important because as workforce demographics shift (ie:  the amount of  females and the average age of employees is increasing), it is imperative to understand the differing health needs and concerns of these sub-groups in order to provide appropriate programs. It was beyond the scope of this research to actually develop a n employee health p r o g r a m based on these results, yet the investigation is significant in adding to our limited knowledge of the differing preferences and perceptions (barriers a n d benefits) of various employee sub-populations in regard to E H A P s .  A l t h o u g h each work organization varies in  its focus, size, demographics, etc., the results of this investigation could be useful to organizations of similar size and demographic profile, who w i s h to increase the participation of similar sub-groups of their employees. It is only within the last two to three years that investigations which examine the employee's viewpoint of E H A P s have begun to appear in the literature.  M a n y of these,  while providing some useful information, were limited to a particular classification or age group of employees.  T h e present investigation is unique in that it provides a comparison  of the preferences and perceptions of different sub-groups of employees within the same population.  K n o w i n g more about the particular p r o g r a m preferences and the perceived  barriers to participation in these programs will aid in the planning, development, and marketing of programs which should increase participation a m o n g these sub-groups.  12  CHAPTER TWO LITERATURE REVIEW  A. HISTORY H e a l t h Promotion Programs (HPPs) and E m p l o y e e Assistance P r o g r a m s ( E A P s ) have developed on the worksite d u r i n g the past two decades.  Aside f r o m occupational  health and safety, a n d medical/dental benefits, few companies h a d adopted emploj'ee health programs before the 1970s. T o d a y , estimates are that one-quarter (Conrad, 1987a) to two-thirds (Chen, 1988) of all U . S . companies with 50 employees or more offer some component(s) of a H P P . E A P s are provided i n the majority of larger U . S . companies (Walsh, 1982), being estimated to exist i n 60-70% of U . S . companies with 3000 employees or more (Hellan, 1986).  In C a n a d a , results of a national employee fitness survey reported that of  companies with 100 employees or more, 13% offer some type of fitness activities, 25% offer health education a n d lifestyle programs, a n d 44% offer sport/recreation (Canadian C h a m b e r of Commerce, 1987).  programs  A s there is a vague definition of what actually  constitutes an E A P , it is difficult to find statistics on the number of C a n a d i a n companies that operate E A P s .  S m a l l Business M a g a z i n e (Klarreich, 1989), reported that up until 10  years ago only 5-10% of C a n a d i a n companies h a d E A P s , whereas today they are present in approximately 25% of companies across the country. E m e r g i n g significantly in the early 1970's, E A P s have a longer workplace history t h a n H P P s (Conrad, 1988a; H e l l a n , 1986; R o m a n & B l u m , 1988). M a n y of the first E A P s were largely alcoholism programs, later developing into more multi-faceted services  13  LITERATURE REVIEW  (Minter, 1986).  Increased awareness and adoption of these programs followed the creation  of the (U.S.) N I A A A (National Institute of Alcohol A b u s e and Alcoholism) in 1970, which provided grants to each state to help fund development a n d implementation of E A P s in workplaces (Conrad, 1988a; R o m a n & B l u m , 1988). One of the early initiatives which encouraged increased worksite H P P s in the U . S . , was the Surgeon General's Report f r o m 1979, setting for health promotion (Chen, 1988;  which identified the workplace as a suitable  Surgeon G e n e r a l , 1979). T h i s was followed that  same year, by the "1st N a t i o n a l Conference on H e a l t h Promotion P r o g r a m s in Occupational Settings", sponsored b y the U . S . F e d e r a l Government (Chen, 1988). In C a n a d a , H i l l et al (1988), have identified three major reasons for the increase i n H P P s on the worksite.  T h e first was the trend for C a n a d a ' s H e a l t h C a r e S y s t e m to move  toward health promotion and health education programs as an alternative to traditional health care. mortality.  T h e second was the wealth of literature linking lifestyle to morbidity and  T h e Lalonde report of 1974 was instrumental to this w a y of thinking.  A l t h o u g h the report has been criticized for "putting too m u c h blame on the v i c t i m " and not enough emphasis on the environment and other areas which affect the health of the individual, it outlines the importance that lifestyle changes can have on health.  T h e third  reason identified for the growth of worksite H P P s in C a n a d a was the public's trend toward self-help and a w a y f r o m the reliance on institutional (medical) help. H i l l et a l , state that the combination of the above three factors has provided a framework for the development of E m p l o y e e Fitness and Lifestyle in C a n a d a . E m p l o y e e H e a l t h Promotion P r o g r a m s have evolved out of three different arenas: that of the public, that of businesses, and that of the health care providers. A s health promotion has become more and more accepted in the public domain, there is a n increasing  14  LITERATURE REVIEW  demand for this type of p r o g r a m m i n g by employees (Orlandi, 1986; R o m a n & B l u m ,  1988;  W a r n e r , 1987). Businesses seem to have m a n y motives for the development of H P P s , ranging from reducing health care costs to i m p r o v i n g the health of the employees (Chen, 1988; C o n r a d , 1988a; W a l s h , 1988; W a r n e r , 1987).  (The reduction or containment of  health care costs is a bigger issue in the U . S . t h a n in C a n a d a , as corporations are u s u a l l y responsible for their employees' health care p r e m i u m s . In C a n a d a , the cost-benefit issue is usually linked more with reducing absenteeism, increasing productivity, etc.)  H e a l t h care  providers of course, are also interested in the welfare of the employees, and see the workplace as a suitable "target" setting for reaching large numbers of the population (Conrad, 1988a; R o m a n & B l u m , 1988). H e a l t h Promotion and E m p l o y e e Assistance P r o g r a m s have historically been developed and administered by entirely different groups:  health and fitness specialists in  the case of H P P s , and m a i n l y psychologists and alcoholic treatment specialists in the case of E A P s .  F o r this reason, although the combining of E A P s and H P P s into one p r o g r a m  has been proposed, it has been postulated that this amalgamation m a y be difficult (Shain et al, 1986). H o w e v e r , the integration of these programs into what has been termed " E m p l o y e e H e a l t h and Assistance P r o g r a m s " ( E H A P s ) is gaining support, due to the potential to reach more employees, to d r a w on each other's resources, and to achieve greater economic benefit (Shain et al, 1986).  B. THE CORPORATE PERSPECTIVE Although it might seem that the major reason for businesses to be interested in H P P s and E A P s would be to help curb the direct or indirect cost that unhealthy employees  15  LITERATURE REVIEW  place on the organization, m a n y corporations s a y otherwise. s u r v e y of Colorado businesses conducted in 1984.  W a r n e r (1987), cites a  T h e most common reason given b y  companies who already had programs, as to wh}' they initiated them, was for the welfare of the employees.  (Although it could be argued that this m a y lead to reduced health care  costs, m a n y companies state that the improvement i n employee morale, a n d showing the employees that the company cares about them, are more important reasons for initiating programs.)  A m o n g those companies surveyed who did not already have programs, b u t  were considering them, the number one reason given w a s still the welfare of the employees, although this answer was just slightly higher than "reducing health care costs". A l t h o u g h the benefits of these programs to the company have been well documented, in terms of reducing or retaining health care costs (Chen, 1988; C o n r a d , 1988a; R o m a n a n d B l u m , 1988; Z a v e l a , 1988), reducing job turnover (Warner,  1987;  Y e n n e y , 1 9 8 6 ; Z a v e l a , 1988), reducing on-the-job accidents (Smith, 1990; Y e n n e y , 1986; Zavela, 1988) a n d absenteeism (Yenney, 1986; Z a v e l a , 1988), i m p r o v i n g productivity (Roman and B l u m , 1988; W a r n e r , 1987), a n d reducing employee grievances (Yenney, 1986), their long term cost-savings or cost-containment for the company is still being questioned (Warner, 1987). W a r n e r stated that past assessments which have concluded that H P P s are financially profitable m a y have contained some problems, such as d r a w i n g conclusions from simplistic evaluations, and not considering the possible increases i n pension payouts due to decreased morbidity a n d mortality (Warner,  1987).  H e suggested that i n terms of effectiveness, there are four types of H P P s :  (1)  those that are effective in producing the desired health related behavior changes i n the  16  LITERATURE REVIEW  employees, a n d w h i c h genuinely save the company money, (2) those that produce effective behavior changes and are cost-retaining, (3) those that produce the desired behavior changes but are not cost effective, and (4) ineffective programs that are costly to the company and do not produce behavior changes.  (Although his view of worksite health  promotion programs appears to be limited to changing lifestyle behaviors, and does not include producing changes to the work environment which would be conducive to health, the term "effectiveness" could be taken to include any change which brings about improved health of the employee.) T h e r e are m a n y other strategies being used by employers to contain health care costs, such as H e a l t h Maintenance Organizations ( H M O s ) , Preferred Provider Organizations (PPOs), health service review programs, etc.  (Please see definitions of  H M O s and P P O s in Chapter One.) H o w e v e r , the advantage that H P P s have over these other strategies is that they have the potential to contain costs plus improve health, whereas the other programs do not attempt to improve the employees' health in their costcontainment efforts (Warner,  1987).  Whether H P P s and E A P s are being used as health efforts,  cost-containment  devices, or a combination of the two, there remains m u c h that can be learned through further research efforts to improve their effectiveness.  A c h i e v i n g high employee  participation rates (or at least assuring participation by those employees who are in need of such programs) is fundamental in r u n n i n g effective programs.  17  LITERATURE REVIEW  C. PARTICIPATION  1. The Importance of Participation in Worksite Health Programs In their review of the literature regarding participation in workplace health programs, Lovato and G r e e n (1990), s u m m a r i z e d the reasons that " m a i n t a i n i n g participation" in programs is important as follows: (1)  to justify the program's existence to management,  (2) (3)  for effective delivery of programs, and to realize the intended health and/or economic benefits.  2. Interpreting Participation Rates Reported participation rates in worksite programs v a r y throughout the literature, but in a review of the research done i n this area, C o n r a d (1987b) reported that participation averages from 20-40% of the employees for onsite programs, and 10-25% for offsite programs.  S h e p h a r d (1988) reported that the situation in C a n a d a is v e r y similar to  that in the U n i t e d States, with average recruitment to employee fitness programs being 20%. T h e r e are two inherent problems in interpreting these rates.  T h e first is the fact  that the definition of participation varies f r o m study to study m a k i n g it impossible to compare one to the next.  T h e second is that unless we know the health status of those  who m a k e up the percentage that are participating, the numbers are meaningless. The  problem with defining participation involves deciding how m a n y classes or  activities an employee m u s t participate i n , in order to be classified as a "participant" (Conrad, 1987b).  If the employee shows up once, is he or she classified as a participant, or  18  LITERATURE REVIEW  is attendance every week necessary? Is an employee who signs up but does not show up v e r y often a participant or not? Lovato and G r e e n (1990) defined " m a i n t a i n i n g participation" as continued use of the H e a l t h Promotion P r o g r a m or of the recommended behavior. In other words, if the employee no longer participates in the smoking cessation program, but has continued to abstain f r o m smoking, he or she is still considered to be " m a i n t a i n i n g participation".  This  definition will be used hereafter when discussing participation. A s noted, the second problem in interpreting employee participation rates is that it is not a l w a y s clear who is participating. A n employee health p r o g r a m with high participation rates, that does not reach those employees who are in need of the p r o g r a m , cannot be considered successful if the intended goals were improved health and/or economic benefits.  H o w e v e r , a participation rate of 15% m a y meet the company's objectives if those  15% are "at r i s k " . C o n r a d (1987b) stated that the question of who comes to worksite wellness programs is an important one because there is the risk of self-selection based on health (only those who are already healthy attend), and on demographics (eg. greater attendance by white collar workers, younger age groups, etc.). Both of these issues will be discussed in the following sections of this chapter ("The Effects of Demographics on Participation", and " T h e Effects of Perceived H e a l t h Status on Participation"). Aside f r o m the two problems discussed here with respect to interpreting participation rates, there is the issue of differing perspectives on what is a n "acceptable" or "successful" level of participation. F o r example, participation or maintenance rates of 20-40% in worksite health programs are often viewed as failure, whereas in the public  19  LITERATURE REVIEW  health or commercial world, to convert 20% of the public to change a habit or adopt a behavior would be considered very successful (Lovato a n d G r e e n , 1990). Some of the research on participation has dealt with the differences between participants vs nonparticipants of E H A P s , whereas other research has looked at "intenders" vs "nonintenders". It should be noted that "intent" does not necessarily lead to actual participation. However, as will be seen in the following section, m a n y established models of health behavior have shown a correlation between behavioral intention and actual behavior (Davis et a l , 1984; D i s h m a n , 1988; H a w t h o r n e , 1990; Sloan & G r u m a n , 1988). The  study of those who "intend to participate" deals with what influences people to  decide to participate (eg: demographics, perceived health, etc.) as opposed to w h a t causes them to actualty start and continue participating. B y studying the issue i n this w a y it is possible to determine what subgroups of employees are attracted to these programs a n d possibly provide a profile of those who are not (to w h o m we should be targeting our health promotion efforts).  3. Factors Affecting Participation  a) The Use of Health Behavior  Models in Explaining  Participation  M a n y attempts have been made to explain individual's health protecting and health promoting behaviors through theoretical models. Some of these models have been extended to try to explain participation in health promotion programs such as those on the worksite.  20  LITERATURE REVIEW  One of the first, and probably the most well known of the models of health behavior is the H e a l t h Belief Model ( H B M ) .  T h i s model was originally developed by a  group of researchers with the U . S . Public H e a l t h Service i n 1952, a n d w a s designed to measure factors affecting a person's decision to change a health behavior (Dishman, 1988; H a w t h o r n e , 1990). T h e H B M basically deals w i t h health protection as opposed to health promotion. It includes p r i m a r y factors thought to have a n immediate effect on a person's likelihood of taking recommended preventive health action (benefits minus barriers; perceived threat of disease), and modifying factors which affect the p r i m a r y factors (demographics, sociopsychological factors, perceived susceptibility to disease, cues to action, etc.). T h i s model has been extensively tested and has been found to be effective in predicting changes i n preventive health behavior.  In a review of the studies which have  tested its effectiveness, it was found that "perceived b a r r i e r s " was the factor most closely associated with individuals likelihood of taking preventive action.  "Perceived susceptibility  to disease" was also closely associated (Hawthorne, 1990). A s noted, the H e a l t h Belief M o d e l was based on prevention of illness, and not on health promotion a n d therefore has not been found to be a particularly good model for predicting behavior i n health promoting activities such as exercise ( D i s h m a n , 1988). (Please refer to definitions of health promotion a n d health promoting behavior in Chapter One.)  Ajzen a n d F i s h b e i n developed the "Reasoned A c t i o n M o d e l " ( R A M ) , i n 1967, which was based on the premise that behavioral intention predicts behavior (Hawthorne, 1990). T h i s model has been tested to some degree with adherence to health preventing and health  21  LITERATURE REVIEW  promoting programs.  In D i s h m a n ' s (1988) review of research used to test the R A M , he  cited a study b y Olsen and Z a n n a where regular attenders in a n exercise p r o g r a m were found to have stronger intentions to exercise r e g u l a r ^ , and stronger motivation to meet expectations of significant others than the occasional exercisers and drop outs of the program. D a v i s et al (1984) stated that "behavioral intention h a s been demonstrated to be one of the most consistently relevant predictors of continued participation in health improvement p r o g r a m s " .  H o w e v e r , others have suggested that although the R A M (based  on intentional behavior) m a y be good at predicting immediate and short t e r m adherence, it has not been used extensively to predict long-term adherence (Dishman, 1988). A l t h o u g h the Reasoned Action Model, as will be seen, has been used i n the development of further models of health behavior, it w a s also based on illness prevention, and therefore c a n h a r d l y be used to predict health promoting behavior. (Hawthorne, 1990).  D a v i s a n d colleagues (1984) developed a model based on components of both the H B M and the R A M , called the "Theoretical Model of Modifiers of Participation i n H P P s and L i n k a g e to H e a l t h Behaviors a n d H e a l t h Benefits" (hereafter called the Participation Model). T h i s model was intended to measure factors influencing participation i n worksite H P P s , as well as the perceived benefit accrued from this participation.  T h e model  assumes that the p r i m a r y motivators for satisfaction or dissatisfaction with health are risk factors (weight, alcohol use, exercise, etc.) and psychosocial factors (personal efficacy, job stress and anxiety).  According to the model, "level of satisfaction with h e a l t h " is used to  explain "intent to change", which i n turn leads to "level of participation".  22  Participation is  LITERATURE REVIEW  also thought to be affected by social-ecological factors (opportunity, social and environmental support, and life cycle position). T h e model also predicts participation adherence (positive health behaviors) and perceived benefit from participation. P a r t s of the Participation Model were tested b y D a v i s ' s group in 1984. testing did not examine actual participation, but looked at:  This  (1) the extent to which risk  factors affected satisfaction with a health state and intention to change that state, and (2) the extent of variance in "satisfaction" or "intent to change" which could be explained b y the psychosocial variables. Results showed that risk factors were associated with dissatisfaction with health and greater intent to participate in relevant H P P s in the areas of weight loss, exercise, stress and tension. F o r alcohol use, nutrition a n d smoking cessation, this was not the case.  O f the psychosocial variables, personal efficacy explained the most variance i n  "satisfaction with h e a l t h " and "intent to change", although job stress and anxiety were also significantly related (Davis et al, 1984). T h e model was evaluated again in 1987 with the same sample, to look at the effects of "degree of satisfaction" and "intent to change" on actual participation (Davis et al, 1987). Neither of these variables were found to be consistently associated with actual participation.  Factors associated with participation were high job stress and high anxiety.  In stress management and weight control programs, those people at higher risk were more likely to participate.  T h i s was not true however, for exercise and alcohol awareness  programs. S p i l m a n (1988) tested this model to predict sex differences in participation in a workplace p r o g r a m .  H e concluded that the model was better for predicting participation in  preventive programs t h a n in health promotion (wellness) programs.  23  F o r example, the  LITERATURE REVIEW  model worked well for programs where risk factors were likely to be the m a i n motivator for joining (ie: s m o k i n g cessation), b u t not well for programs where the motivators were likely reasons other than risk factors (ie: exercise programs).  T h e model predicted  participation better for women i n certain programs (smoking and low back pain), a n d for m e n i n the other programs offered.  Sloan and G r u m a n (1988) expanded on the D a v i s model of participation b y adding "organizational factors" (such as clarity of responsibilities, workload, etc.) to the model. T h e y acknowledged the relationship between risk of disease, health satisfaction, intention to m a k e changes to health behaviors a n d participation i n H P P s . H o w e v e r , since inconsistent results have been found between satisfaction, intention a n d actual participation, they suggested there m u s t be other factors (such as organizational factors) which affect participation. Therefore, their "Theoretical Model of Participation i n Workplace H e a l t h Promotion P r o g r a m s " includes organizational factors as indirectly affecting (through h a v i n g a n effect on perceived risk a n d health satisfaction), a n d directly affecting participation (through perceived management support) (Sloan and G r u m a n , 1988). T h e model was tested b y its developers, on 192 employees (Sloan a n d G r u m a n , 1988).  T h e results showed that there was a causal link between perceived risk of disease,  health satisfaction, intention to change and participation, but the study also showed that organizational factors (and other factors such as demographics) were significantly related to participation.  T h e researchers concluded that improvements i n the organizational  climate (supportiveness of supervisors, appropriate workload, etc.) would improve participation in worksite H P P s .  24  LITERATURE REVIEW  T h e r e were several limitations to this study, one of which w a s that "participation" in this case m e a n t coming to a "wellness orientation meeting" a n d therefore w a s not actual participation in a n ongoing program.  T h e r e could have been m a n y reasons w h y employees  did not show up for this session, w h i c h m a y not be related to w h y they m a y or m a y not participate i n further programs of interest.  H o w e v e r , this study does provide a first look  at the issue of environmental or organizational factors (as opposed to personal factors) affecting participation. T h e final model to be discussed deals strictly with health promoting behavior. Originally developed b y Pender i n 1982, the H e a l t h Promotion Model ( H P M ) is i n p a r t based on the H B M , b u t was intended to measure "behavior which sustains or increases well-being, self actualization and personal fulfillment" (Walker, 1988). It consists of three major elements:  (a) cognitive/perceptual or psychological elements (eg. the importance  placed on health, perceived health status, etc.), (b) modifying factors such as demographic characteristics, interpersonal influences, etc., a n d (c) the likelihood of action directed toward enhancing or maintaining well-being (Weitzel, 1989). A tool to measure the dimensions of this behavior was subsequently developed, called the " H e a l t h Promoting Lifestyle Profile" ( H P L P ) , which has been extensively tested with m a n y demographic groups (Tetting, 1989; W a l k e r et al, 1987; W a l k e r et a l , 1988; Weitzel, 1989). Weitzel tested the H P M on a group of blue collar workers a n d found that health status and self efficacy accounted for the most variation i n these employee's health promotion behaviors (Weitzel, 1989).  O f the demographic variables, age w a s found to  account for the greatest amount of variance.  A l t h o u g h components of the H P M have been  25  LITERATURE  REVIEW  tested with various demographic groups, ongoing research will determine it's overall effectiveness i n predicting health promoting behavior (Walker et al, 1988).  T h e health behavior models discussed have been attempts to combine various factors which m a y contribute to the prediction of health protecting and promoting behaviors, and participation in worksite health p r o g r a m s .  T h e following sections of this  chapter will deal with some of these factors more specifically, especially with regard to their effect on participation, and the implications of this.  b) The Effects of Demographics  on  Participation  i) A g e . F o u r t e e n studies were reviewed to examine the differences among age groups as to their participation i n health protecting and promoting behaviors.  Some studies have  indicated that desirable health practices seem to increase with age (Kronenfeld et a l , 1988; W a l k e r et a l , 1988). T h i s does not appear to be true for participation in exercise however (Walker et a l , 1988; Y o s h i d a et a l , 1988). Y o s h i d a a n d associates (1988) report that " i t is well established that exercise decreases with a g e " (Yoshida et a l , 1988). These health behaviors are paralleled in employee health programs.  F o r example,  in Sloan a n d G r u m a n ' s study (1988) of participation in workplace health promotion programs, it was found that with increasing age, individuals reported a greater perception of health risks, which led to a n increased interest in modifying their health-related behaviors, a n d hence led to increased participation i n H P P s .  26  H o w e v e r , m a n y programs  LITERATURE REVIEW  have reported a lower participation rate a m o n g older employees (Blozis et al, 1989; Kronenfeld et a l , 1988; Z a v e l a et a l , 1988), a n d others have reported no difference in age between participants a n d non-participants (Conrad, 1988a; W a l k e r et a l , 1988). A possible explanation for this discrepancy m a y be that m a n y programs are perceived b y the employees to be p r i m a r i l y "Fitness oriented", which m a y be of lesser interest to the older employee. A s well, worksite health promotion programs have been described as h a v i n g a " y o u n g image" which m a y be another inhibiting factor for participation b y older employees (McDaniel, 1988). A d d r e s s i n g the influence of age on participation is important to the issues of assuring equal access to E H A P s , a n d reaching the employees who are i n need of such programs. M o s t employee health programs to date have been focused on middle-aged, male executives ( M c D a n i e l , 1988), and v e r y little attention has been given to the needs of the older workers (Walker et al, 1988).  E m p l o y e r s m a y wish to focus these programs on  young and middle aged employees, as they m a y perceive that these employees have more working years left w i t h the company.  H o w e v e r , if population predictions hold true, the  1990's will see increasing numbers of older workers (aged 50 and over) who are not yet interested in retirement, staying with the c o m p a n y well into their sixties a n d seventies (Barker, 1987; H e i r i c h et al, 1989).  H a v i n g an older workforce m a y bring with it a  number of health problems that are specific to that age group (eg. arthritis).  It would  therefore seem to be in a company's best interest to promote healthy lifestyle practices and provide programs aimed at preventing a n d treating the health problems specific to this group (Heirich et a l , 1989).  27  LITERATURE REVIEW  A s mentioned elsewhere in this report, there is a theory that health promotion efforts on the worksite m a y not be as financially beneficial as is commonly thought, due to the possibility that they m a y increase longevity of the employees involved and therefore cost the company more in pensions later on (Warner, 1987). H o w e v e r , there is also the argument that if employees are working to a more advanced age, a n d the health promotion efforts are able to prevent some of the illness and disability which often occurs during these years, that employees will be more productive right up until retirement (McDaniel, 1988). T h e major hurdles to overcome in increasing participation among older workers appear to be: (1)  a s s u r i n g that a variety of programs other t h a n fitness programs are offered  (2)  a s s u r i n g through proper m a r k e t i n g techniques, that employees do not perceive a well-rounded p r o g r a m as "just a fitness p r o g r a m " .  V e r y little empirical data have been gathered w h i c h examine the differing needs and interests of employees, based on age. Heirich and associates (1989) studied an older group of blue collar employees (males a n d females) to examine ways of increasing their participation i n company sponsored fitness a n d wellness activities.  These authors found  that i n terms of encouraging older workers to participate, the three most important aspects were:  (1)  M a k i n g one-on-one contacts with the employees. (The wellness staff counselled them individually on how to improve their lifestyles a n d how the worksite p r o g r a m could be of benefit to them.)  (2)  P r o v i d i n g simple, enjoyable activities that they could do on their own time and at their own pace (ie: a w a l k i n g track).  (3)  P r o v i d i n g contests (where everyone could be a winner) to draw attention to the programs,  (eg. teams of three could enter the w a l k i n g contest; for the  28  LITERATURE REVIEW first team to walk a pre-determined distance, a prize was awarded; for each individual who walked 50 miles, a prize was awarded, etc.)  ii) Sex. There are conflicting reports of the differences between males and females in terms of their participation i n employee health programs.  While some studies have shown no  differences (Harris and F e n n e l , 1988), a few have reported higher participation among m e n (Blozis et a l , 1989; Tetting, 1989), and the majority have reported higher participation a m o n g women (Kronenfeld et a l , 1988; Sloan and G r u m a n , 1988; S p i l m a n , 1988; Z a v e l a et a l , 1988). H a r r i s a n d F e n n e l (1988) s u r v e y e d a group of (white collar) employees to study their perceptions and anticipated use of resources for alcohol abuse (including E A P s ) . A l t h o u g h previous studies have suggested differences between males a n d females in anticipated use of these programs, this study showed that males and females were equally willing to use a n E A P . A l t h o u g h the majority of programs reviewed found higher participation among w o m e n , Blozis et al (1989) and T e t t i n g (1989) studied participants of c o m p a n y sponsored * fitness centers, a n d found participants to more often be male.  T h e distinguishing feature  of the programs described b y these investigators is that although other wellness activities were offered, these programs seemed to be very "fitness-oriented", whereas those programs boasting higher female participation were described as more comprehensive programs. One study showed that not only did more w o m e n participate i n a n H P P , but they tended to participate in more programs, for longer periods of time, and drop out rates were  29  LITERATURE REVIEW  lower (Spilman et a l , 1988). T h i s greater participation did not appear to be related to increased health risk, as this was reported to be similar for both women a n d m e n . W o m e n did, however, report greater intention to change behaviors than m e n , which according to the D a v i s model of participation in H P P s (1987), is significantly related to participation. In Sloan a n d G r u m a n ' s (1988) research however, although women participated more i n the H P P , sex appeared to be unrelated to perceived health risk and intention to change behaviors. In research, using the D a v i s model, it w a s shown that the factors predicting participation were somewhat different for women than for m e n (Spilman et a l , 1988). F o r example, in the weight control p r o g r a m , women tended to participate whether or not they were classified as "overweight", whereas only overweight m e n participated.  These  researchers concluded that sex-based socialization experiences and roles have a definite effect on individual perceptions a n d reactions to health related issues. W o m e n ' s greater participation in health promotion programs m a y in part be explained b y the medical expansionist theory described by S p i l m a n et al (1988).  This  theory claims that doctors tend to encourage women to define more of their life problems as "medical problems", a n d therefore tend to be more concerned about these problems a n d seek help in treating or preventing them more readily than m e n would.  T h e data in  S p i l m a n a n d associates (1988) study supports this theory in that women's greater participation tended to be in programs which were treatment oriented, and women were more apt to s a y they participated i n other programs for these reasons. W a l k e r et al (1988) cited evidence which indicated that in general, women tend to participate i n more preventive health behavior t h a n m e n . In their study which used the H e a l t h Promotion Model, women tended to have higher scores i n overall health promoting  30  LITERATURE REVIEW  lifestyles, as well as i n the H P M dimensions of exercise, health responsibility, nutrition and interpersonal support.  H o w e v e r , it has often been shown that women are less likely  to participate in exercise a n d competitive sport than m e n due to more perceived or actual barriers (Yoshida et a l , 1988). Some of the major barriers to exercising reported b y women include lack of time due to work and f a m i l y responsibilities; health reasons; a n d lack of energy, motivation or need (Yoshida et a l , 1988).  S t u d y i n g these barriers, as well as the barriers that m e n  perceive toward participating i n various worksite health programs, a n d the preferences of each sex, are fundamental steps to developing programs which will better meet the needs of each group and encourage greater participation. F r e e d m a n a n d Bisesi (1988), in their examination of women and workplace stress pointed out that stress manifests itself differently for women a n d m e n , a n d therefore, workplace stress management programs m u s t address different issues for each sex. A s indicated earlier, man}' of the original workplace wellness programs were designed m a i n l y for male executives, and therefore m a y not fit the needs of women.  Workforce  demographic projections suggest that in the 1990's the number of women i n the workforce will continue to increase, and therefore the importance of developing health programs designed to meet their specific needs is critical (Barker,  1987).  T h e literature provides some possible solutions for increasing participation i n E H A P s b y women.  Some of these include providing quality d a y care arrangements on the  worksite and providing flexible working schedules to allow for fitness a n d health promotion p r o g r a m participation during the work day (Freedman a n d Bisesi, 1988). F o r males, participation is likely to improve with the provision of programs which specifically meet their needs (eg. stress management programs focusing on the stressors  31  LITERATURE REVIEW which are more common to men).  Participation b y white collar m e n does not seem to be a  major issue, but the lack of participation b y the blue collar workforce is well documented. Since this is a separate issue from the effects of sex on participation, it will be discussed in m u c h more detail in the next section of this chapter.  32  LITERATURE REVIEW  iii) Classification of W o r k e r . According to numerous surveys, the level of exercise a n d other health promoting behaviors is reported to be lower a m o n g blue collar workers t h a n white collar workers (Allison & C o b u r n , 1985; C a n a d a H e a l t h S u r v e y , 1981; C a n a d a Fitness S u r v e y , 1982). T h i s behavior seems to be mirrored in the participation of blue collar workers i n E H A P s on the worksite.  T h e higher participation of white collar workers i n E H A P s m a y be a  reflection of their health promoting behaviors a w a y f r o m the worksite. T h e health promotion message seems to have been accepted more readily b y white collar workers as seen i n the increased exercise and lower prevalence of smoking among this group (Warner, 1987). O v e r the past two decades, one of the principal reasons for lower participation b y blue collar workers i n employee health programs has been their lack of access to them (Blozis et a l , 1989; Metcalfe, 1987).  T h i s stems in p a r t from m a n y programs being  implemented i n a "top-down" manner, m e a n i n g that they are initially offered to the c o m p a n y executives, a n d then later made available to the blue collar workers (Roman & B l u m , 1988).  T o d a y there remain fewer worksite programs available to the blue collar  segment of the workforce than to the white collar segment (King et a l , 1988), although more a n d more programs are becoming available to all workers. E v e n when there is equal access to programs, blue collar participation has been reported to be lower, a n d drop out rates higher (King et a l , 1988).  There are m a n y  theories which have attempted to explain this, but very few empirical investigations which have actually examined the blue collar workers reported barriers to participation or their preferences for employee health p r o g r a m m i n g .  33  LITERATURE REVIEW  A few theoretical reviews of this issue have offered a number of possible barriers to blue collar employee's participation i n worksite health programs, which are s u m m a r i z e d below (Allison & C o b u r n , 1985; Metcalfe, 1987; Pechter, 1986):  lack of time to participate due to v a r y i n g shifts, clocking i n and out of work, short lunch breaks, six d a y work weeks, work and f a m i l y responsibilities fear that screening test results m a y be used against them feel a lack of commitment f r o m management (ie: they are offered smoking cessation programs, y e t nothing is done about the unhealthy conditions they have to work in) "carpeted-floor s y n d r o m e " - the facilities usually being located in head office, where the blue collar workers m a y feel intimidated about going programs are not designed with the blue collar workers needs and interests in mind, but are adaptations of programs designed for white collar workers lack of trust between blue a n d white collar workers disinterest in physical fitness programs due to the p h y s i c a l nature of their jobs and tiredness after work less awareness of the health benefits of exercise and other health promoting practices M u c h of the research on employees' participation i n , and preferences for worksite health programs h a s also been oriented toward white collar workers, although a few studies have dealt strictly with blue collar workers (Blozis et a l , 1989; Weitzel, 1989). Blozis et al (1989) surveyed participants versus nonparticipants of a c o m p a n y fitness center for industrial workers. T h e study was limited to observing the types of activities these workers participated i n and s u r v e y i n g them as to further activities in which they m a y be interested.  B a r r i e r s and benefits to participation were not addressed. T h i r t y - s i x  percent of the workforce were found to be participating i n this center, which is a comparatively high rate, but participation was only defined as "fitness center m e m b e r s h i p " , which could include those who use the facility every d a y to those who only use it once per m o n t h or less.  34  LITERATURE REVIEW  T h e most popular activities (listed in descending order) were:  stationary bike,  aerobics, weight training, rowing machine, walking and jogging. W h e n asked their preferences for health education, the programs chosen (in descending order) were:  weight  loss, cancer screening and education, cholesterol education, nutrition, back care and blood pressure education.  Other choices (chosen m u c h less often) were stress management, C P R  and free weights (Blozis et a l , 1989). K i n g et al studied a very s m a l l sample (n = 38) of blue collar workers to explore methods for increasing their leisure time exercise ( K i n g et a l , 1988). Results of a n evaluation questionnaire given to the workers showed that these employees preferred to have programs offered immediately after, a n d within walking distance from work.  They  also expressed a concern to be involved i n p r o g r a m development and to have genuine supervisory support for the p r o g r a m . W a r n e r (1987) states that one of the major challenges in increasing both the . amount of programs offered to blue collar workers a n d their participation i n these programs, is convincing the blue collar workforce that they can benefit f r o m them.  If their  fear of E H A P s cutting into their basic benefits (such as medical and dental benefits) can be overcome, and they start demanding more programs, he predicts that we will see more widespread p r o g r a m development for this sector (Warner, 1987). Aside f r o m the few studies mentioned, there are virtually no other empirical data investigating the perceived barriers of blue collar workers toward E H A P s , a n d their specific preferences for p r o g r a m m i n g . Some solutions which have been suggested for increasing blue collar participation are listed below:  35  LITERATURE  REVIEW  hire a well trained, energetic professional to r u n the p r o g r a m make the p r o g r a m fun if the blue collar workers in the organization are at the greatest health risk, start the program in a "bottom-up" fashion vs "top-down" (ie: invite the blue collar workers first and m a n a g e m e n t later) include improvements to worksite risks as part of the p r o g r a m , or they won't take other parts of the p r o g r a m seriously stress the confidentiality of a n y medical (or other) records involved (Pechter, 1986) for off-site programs, or programs employees m u s t p a y to use, try a fee structure based on attendance (ie: if the employee shows up three times/week or more, the company pays 75% of the attendance fee and the worker pays 25%; if the employee participates twice/week the fees are distributed 50%-50%; if he shows up once per week or less the company only pays 25%) (Metcalfe, 1987) provide childcare services for after work programs if possible provide family activities (Ontario G o v e r n m e n t , 1985)  F u r t h e r research in this area will lead to a n increased understanding of w h y blue employees participate less and w h a t can be done to remedy this.  36  LITERATURE REVIEW  iv) Exercise H a b i t s . It has been noted that those individuals who have been previously active are more apt to join an employee fitness p r o g r a m (Lovato & G r e e n , 1990).  Also, although very little  data are available in this area to date, it has been postulated that those individuals who are involved i n exercise m a y tend to be more willing to participate in other positive health behaviors (Blair et a l , 1985). Therefore, a person's current frequency of exercise m a y also be a predictor of his/her participation in E H A P s . Some research has compared participants of corporate wellness programs to nonparticipants a n d found that the participants are more likely to exercise frequently a n d for longer time s p a n t h a n nonparticipants (Conrad, 1988a).  H o w e v e r , it could be argued that  this is a result of the program, not that these individuals exercised more frequently before joining the p r o g r a m . O t h e r studies have looked at frequencj of exercise prior to joining a H P P and have 7  found that those who have exercised frequently i n the past are more likely to participate (Eakin et a l , as cited i n Lovato & G r e e n , 1990; Godin, 1988). It has been found that previous exercise experience m a y be a n important factor in establishing intentions to participate in exercise a n d health promotion programs (Godin et al, 1988).  These researchers suggest that when promoting exercise on the worksite to  previously inactive employees, it should be promoted as a "pleasurable experience" rather t h a n attempting to get long-term commitment from those employees who m a y be unsure of what they are getting into.  37  LITERATURE REVIEW  F u r t h e r research which adds support to these observations will be important in establishing that it is, in fact the current exercisers who more often participate in worksite HPPs.  If this is the case, methods of enhancing participation among the inactive  employees are needed.  c)  The Effects of Perceived Health Status on  Participation  M a n y of the initial worksite health programs have been criticized for "cleansing the clean", suggesting that they were only reaching the segment of the employee population who were already well, or already converted to m a k i n g health behavior changes. Therefore, a n u m b e r of investigations have begun to evaluate health status in relation to participation in these programs, in order to determine the extent to which a n employee's health (or perception of health) affects his or her decision to participate.  Obviously, if the  objectives of a p r o g r a m are to improve the health of employees and/or reduce costs associated with poor health, a p r o g r a m w h i c h is not reaching those employees who are in "poor" or " f a i r " health, who could benefit the most f r o m a n E H A P , will not be entirely effective in meeting these goals. Individuals' perceptions of their own health are not always congruent to their actual health status, although m a n y recent studies have reported that perceived health is a reasonably valid estimation of actual health (six studies cited by Kronenfeld et al,  1988;  studies cited in C a n a d a ' s H e a l t h Promotion S u r v e y , H e a l t h a n d Welfare C a n a d a , 1988). A l t h o u g h perceived and actual health m a y not be congruent, both are thought to have an effect on participation, and therefore the variable "perceived h e a l t h " was dealt with in this investigation.  38  LITERATURE REVIEW  F i v e recent investigations have specifically addressed the relationship between perceived health status a n d participation in worksite health programs.  Z a v e l a et al (1988)  studied a n u m b e r of factors including self-reported physical and emotional health status of employees i n relation to their intention to attend a worksite H P P . A higher percentage of "intenders" perceived their health as only fair or poor, whereas significantly more " n o n intenders" rated their health as excellent.  These results suggest that in this population,  those employees who m a y be i n need of health improvement are attracted to employee health programs. Sloan and G r u m a n (1988), in their test of the "Theoretical Model of Participation in Workplace H e a l t h Promotion P r o g r a m s " found increased perceived risk of illness to be related to p r o g r a m participation. T h e i r model supported the D a v i s model (1984), i n that increased perceived risk of illness led to decreased health satisfaction, which led to increased intention to change habits, leading to increased participation. In other studies (Conrad, 1987b; Weitzel, 1989), results conflicted with those discussed above.  C o n r a d found participants of a worksite wellness p r o g r a m to be  significantly more inclined to rate their overall health better than non-participants. H o w e v e r , he was studying "participants" (as opposed to those who "intend to participate"). It is possible that the participants rated their health better as a result of the p r o g r a m and did not perceive their health to be as good before joining the program.  N o significant  differences were found between the two groups in terms of perceived overall stress, although participants were significantly more likely to perceive some, to a great deal of job related stress. In Weitzel's test of the H P M on blue collar workers (1989), perceived health status w a s a very powerful predictor of engagement in health promoting behaviors.  39  LITERATURE REVIEW  (Those employees who perceived themselves to be i n better health participated in more health promoting behaviors than those w i t h poor perceived health.) M o r g a n et al (1984), found that enrollment i n a n employee fitness program was associated with higher perceived health for m e n , b u t not for w o m e n . T h e r e was increased participation among m e n with higher perceived health, whereas for women, enrollment was associated with a lower perception of health. F r o m the conflicting results of these recent studies, it c a n be seen that there is as of yet no consensus on how perceived health status affects participation i n worksite health programs.  T h e results f r o m M o r g a n ' s study (1984) indicate that these effects m a y v a r y  according to sex. It follows, that other demographics, such as age, m a y also be interrelated with the effects of perceived health on participation. T h e lack of consensus on perceived health and participation implies that further research is necessary to determine if E H A P s are reaching those employees with low perceived health a n d who are possibly i n need of such programs, or alternatively, if the E H A P s are just reaching those who perceive their health as good or excellent, and therefore in effect are just "cleansing the clean".  40  LITERATURE REVIEW  d) Other Factors Affecting  Participation  Research to date on participation has largely dealt with determining the effects of demographics on employees' decisions to participate.  Since demographics have not  explained a large amount of variance i n the reasons individuals do or do not participate, other factors are being addressed, such as organizational factors. A s indicated in the discussion of Sloan and G r u m a n ' s model of participation (1988), organizational factors m a y be important i n explaining employee's participation in workplace health programs.  These investigators found m a n y organizational factors to  have both direct and indirect effects on participation. Perceived supportiveness of supervisor was found to have a direct effect on increasing participation (King et a l , 1988; Sloan a n d G r u m a n , 1988). In one study, the employee group with a supervisor who joined into fitness programs with the other employees and who strongly encouraged them to participate, had greater participation than other employee groups (King et a l , 1988). Perceived lack of control over work, lack of clarity of responsibilities, role ambiguity and work overload tended to have indirect, negative effects on participation, through increasing stress, causing increases in perceived risk of disease a n d health satisfaction, which then led to decreased participation levels. Cost has often been implicated as a possible barrier to participation, but survey results have shown that enrollment fees are not usually perceived as barriers b y employees ( D i s h m a n , 1985).  41  LITERATURE REVIEW  D. SUMMARY OF LITERATURE REVIEW AND IMPLICATIONS FOR INFLUENCING PARTICIPATION A s s u r i n g participation b y those employees i n need of E H A P s is important for the realization of improved health of the employees and/or economic benefits for the corporation.  T h e actual numbers are not as important as securing participation of  employees other than those who are i n excellent health (or who are already "converted" to m a k i n g health behavior changes). H e i r i c h et al (1989) state that approximately 15% of any employee population are the "conspicuously h e a l t h y " group, with another 15% being the very " a t r i s k " segment.  T h e 70% of employees i n between these two segments usually  have a number of risk factors which predispose t h e m to becoming at risk, and therefore the challenge is to encourage participation b y this segment.  A participation rate of at least  20% suggests that perhaps not only the "conspicuously healthy" are attending, participation rates should be at least 20%. M a n y theoretical health behavior models have been designed to t r y to explain the influences on health behavior and participation in health promotion programs.  The Health  Belief Model -and the Reasoned Action Model have been effective in predicting changes in preventive health behavior, but not in health promoting behavior ( D i s h m a n , 1988; H a w t h o r n e , 1990). D a v i s ' s "Participation M o d e l " (1984) showed that risk factors were associated with dissatisfaction with health and greater intent to participate i n some H P P s , n a m e l y in weight loss, exercise, stress a n d tension programs.  W h e n this model w a s tested  with participants vs non-participants of a n employee health program, factors found to be associated with participation were high job stress a n d high anxiety (Davis et a l , 1987). S p i l m a n (1988) found this model to also be better at predicting participation i n preventive health, (as opposed to health promotion) programs.  42  Sloan and G r u m a n ' s model (1988)  LITERATURE REVIEW  showed that organizational factors also h a d an effect on participation. Pender (1987) developed the H e a l t h Promotion M o d e l , which has shown good initial results in predictions of health promoting behavior, yet research on this model is ongoing. A l t h o u g h in general, health protecting and promoting behaviors seem to increase with age, m a n y E H A P s report lower participation by older employees.  T h i s is possibly  due to the " y o u n g i m a g e " of these programs and their emphasis on "fitness".  T h i s implies  that the development and m a r k e t i n g of employee health programs should emphasize a well-rounded p r o g r a m designed for all age groups. In strictly "fitness-oriented" programs, male participation has been reportedly higher than that of females, whereas the participation is often reversed in more comprehensive programs.  T h i s suggests that to assure high participation b y females, a  more comprehensive approach to p r o g r a m m i n g is needed.  F o r males, it appears that  participation will be higher as long as sport and fitness programs are included in the package.  Fitness programs have often been shown to be a catalyst to participation in  other programs (Blozis et al, 1989;  C o n r a d , 1988a).  Blue collar worker participation in E H A P s has usually been reported to be lower t h a n white collar worker participation.  T h i s is due in p a r t to limited access to programs  for blue collar workers, but has also been reported to be prevalent w h e n programs are offered to all workers. were reviewed.  M a n y barriers which need to be overcome to improve this situation  Solutions include involving this segment of the workforce in program  development, starting the programs i n a "bottom-up" fashion, and emphasizing improvements to worksite risks as p a r t of the p r o g r a m . Previous exercise experience appears to be a n influencing factor in individual's decisions to partake in employee health programs.  43  Therefore, methods of enhancing  LITERATURE REVIEW  participation among inactive employees, such as promoting worksite fitness as a "pleasurable experience" (and assuring that it is one!) are important. It is clear that demographics do at least explain some of the variance in individuals decisions to participate i n worksite health programs.  In order to develop programs which  m a y increase the participation of those demographic groups who are not participating, it is essential to have a better understanding of these sub-groups.  T h e current investigation  will aid i n this understanding, b y providing information with respect to the needs, preferences, barriers and benefits reported b y each of these groups. T h e r e is no consensus on how perceived health status affects participation, i m p l y i n g that further research is needed in this area.  Initial studies on the effects of  organizational factors such as supervisor support, and work overload, indicate that these factors m a y have a considerable impact on participation. L o v a t o a n d G r e e n (1990) suggest that sustaining participation requires that both individual a n d environmental motivational approaches be used. Individual approaches include determining the needs and interests (including barriers) of each group in question and attempting to meet those needs, a n d providing regular follow-up f r o m programs (Wilbur, 1983). K i n g et al (1988) showed that b y tailoring a p r o g r a m to meet the needs and interests of blue collar workers they were able to significantly affect participation rates. E n v i r o n m e n t a l approaches include assuring p r o g r a m locations are convenient and accessible, establishing worksite policies aimed at improving health (eg. nonsmoking policies), and incorporating flex-time arrangements to further facilitate employees' access to programs (Godin et a l , 1988; Lovato and G r e e n , 1990).  44  LITERATURE REVIEW F u r t h e r research will undoubtedly reveal more factors which affect participation, and hence improve our ability to provide programs which surpass the critical 15-20% participation levels.  45  CHAPTER THREE METHODS  A. THE SURVEY  1. The Needs Assessment Project T h e data used in this analysis were extracted from a survey conducted for a municipal government to determine the needs and interests of its employees for a n E m p l o y e e H e a l t h and/or Assistance P r o g r a m .  T h e s u r v e y was conducted during M a y and  J u n e of 1989 by this investigator, under the direction of the Personnel Director for this municipal government. It was designed as part of another project (hereafter called the Needs A s s e s s m e n t Project or N A P ) to study the feasibility for implementation of a H e a l t h Promotion and/or E m p l o y e e Assistance P r o g r a m .  T h e N A P also included a health screening surve}',  interviews with the C i t y managers and directors, and gathering of information regarding resources a n d facilities available for the C i t y ' s use.  2. Format T h e s u r v e y was in the format of a 36 item, self-administered questionnaire designed by the investigator, following questionnaire design guidelines (Patton,  1986;  S i m o n F r a s e r U n i v e r s i t y C o m p u t i n g Services, 1988). T h e major function of the questionnaire was to determine the overall needs a n d interests of the employee sample for  46  METHODS  the City's use in deciding whether or not to implement an Employee Assistance and/or Health Promotion Program. The questionnaire was composed of four sections dealing with interests, health knowledge and beliefs, perceived health, and demographics. The questions were in a closed-ended, multiple choice format. The questionnaire was examined for ambiguity and redundancy by the investigator, as well as two individuals who were experienced in questionnaire development. (Please see Appendix I for a copy of the questionnaire.)  3. Distribution and Retrieval All permanent employees of the City (n = 560) were requested to complete the Needs/Interest Questionnaire by the investigator. An attempt was made to distribute all questionnaires to individual departments, and when possible, explain the project to each group before having employees complete the questionnaires. However, the manager of each department made the decision as to whether the investigator would personally distribute surveys to the employees or whether the manager would have them distributed. A covering letter was attached to each questionnaire (see Appendix I). So in the cases where the managers distributed them, there was at least a brief explanation of the project preceding the questionnaire, with the investigator's phone number to call if questions arose. In most cases, employees were given work time to compete the surveys. One week after the questionnaires were distributed, a memo was sent to each manager requesting that they remind employees who had not already returned their questionnaires to the investigator to do so. The City was not in favor of any further  47  METHODS  reminders being sent.  F o u r hundred and one surveys were collected, comprising a 72%  return rate.  4. Respondents T h e respondents to the Needs/Interest survey comprised the subjects for the present investigation. T h e demographic profile of the s u r v e y respondents has been compared with that of the total employee group (all p e r m a n e n t employees) in T a b l e 1.  As  can be seen, the respondents were v e r y representative of the total employee sample, which (along with the high return rate), reduced the likelihood of a non-response bias.  48  METHODS  Table 1. Comparison of Survey Respondents to the Total Employee Group DEMOGRAPHICS:  SEX:  Male Female  AGE:  16-35 36-50 O v e r 50  COLLAR:  Blue White  TYPE:  Office W o r k e r Labourer Clerical Worker F a c i l i t y Worker E q u i p . Operator Manager/Director Maintenance/Repair Firefighter Enforcement/ Inspection Other  PERMANENT EMPLOYEES: 73% 27%  RESPONDENTS:  71% 26% (3% N o Response)  43% 38% 19% (Mean: 39.7) *60.6% 39.4%  42% 40% 16% (3% N o Response) 32.7% 30.4% (12.5% Pink) (**24.4% U n k n o w n )  19% 13% 16% 12% 14% 3% 4% 13%  24% 13% 13% 11% 9% * ** „„ 7%  3% 5%  4% 6%  8% 4%  T h e percentages of blue and white collar workers in the permanent employee group were provided b y the C i t y , a n d were categorized differently than they were for this investigation. In the C i t y ' s division they have included all clerical workers i n with the white collar group, whereas for this investigation clerical workers are i n a division called " P i n k Collar W o r k e r s " . * * It w a s impossible to determine collar type from worker classification for 24.4% of employees. These workers were not used in the analysis based on collar type. T h e majority of these employees were estimated to be blue collar workers however, and therefore i f counted in the summation the actual  49  METHODS  percentage of blue collar employees who responded to the survey is likely over 50%. * * * A l t h o u g h there are only 19 M a n a g e r s a n d Directors who work for the C i t y , 27 individuals filled in this category. These are likely supervisors who were not clear that the D i r e c t o r / M a n a g e r category referred to D e p a r t m e n t H e a d s . T h i s category has not been eliminated from the analysis of collar type however, as those who mistakenly filled in that category are p r e s u m a b l y white collar employees.  5. Data Analysis for the Needs Assessment Project  The data were entered into the I B M Systat Statistics P r o g r a m ( U . B . C . Systat 1988), checked for outliers and cleaned. F o r the Needs Assessment, the data analysis consisted of reporting frequencies of responses to each question for all respondents. T h e Needs Assessment Project ended at this point, with the total response frequencies being provided to the C i t y for their use in p r o g r a m development.  B.  ANALYTICAL  PROCEDURES  FOR THE CURRENT  INVESTIGATION  In the current investigation, the data from the previously described Needs A s s e s s m e n t Project were further analyzed i n this investigation to determine if the responses were associated with demographics and perceived health status.  Chapter O n e  (Introduction to the Problem) provides a more thorough description of this study. T h e statistical program used to analyze the data was the I B M S y s t a t Statistical Package ( U . B . C . Systat 1988).  50  METHODS  1. Division of the Data  T h e r e were 3 sets of variables derived from the questionnaire: (a)  (b) (c)  E m p l o y e e s ' preferences and perceptions (regarding barriers and benefits) of H e a l t h Promotion and E m p l o y e e Assistance Programs, Demographics, and Perceived H e a l t h Status.  E a c h questionnaire item within these sets was treated as an independent variable, with the frequencies of responses to each question being the dependent variables.  51  METHODS  a) Preferences, Barriers  i) P r o g r a m Preferences.  and Benefits  Respondents were asked to indicate their preferences for E H A P  components in 14 survey questions. G e n e r a l l y , each question required one answer unless otherwise specified. T h e preferences that the employees were asked to respond to were as follows:  1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14)  Preference for method of instruction (5 choices; asked to rank order them) Preference for type of E H A P activities (19 choices: asked to pick 7 activities and r a n k order them) Anticipated participation in H e a l t h Promotion P r o g r a m s and S e m i n a r s (5 choices) Anticipated participation in an exercise p r o g r a m (4 choices) Preferred time of day for programs and seminars (6 choices) Preferred time of day for exercise programs (6 choices) Preference for type of fitness facilities (6 choices) Preference for type of E A P (3 choices) Preference for whether E A P contact person is onsite or offsite (2 choices) Anticipated use of an E A P (3 choices) Preferences regarding family members usage of programs (5 choices) Preferences regarding retired employees usage of programs ( 2 choices) Preference as to volunteer capacity (6 choices) Preference as to whether or not an E H A P program should be implemented ( 3 choices)  ii) Perceived B a r r i e r s to Participation.  Perceived barriers were derived f r o m six survey  questions in which respondents were asked to select one answer.  T h e barriers on which  employees were questioned were as follows: • 1) 2)  Greatest concern regarding an E H A P on the worksite (5 choices) Acceptable cost per week for a n exercise program (5 choices)  52  METHODS  iii)  3)  Acceptable cost per m o n t h for health promotion programs and seminars (5 choices)  4) 5) 6)  Comfort in exercising w i t h all your fellow workers (3 choices) Perceived barriers to u s i n g available community services (6 choices) Perceived barriers to u s i n g a n E A P (6 choices)  Perceived Benefit from Participation.  One survey question with six response  choices  asked employees for their perception of personal benefit f r o m participating in a n E H A P .  b)  Demographics T h e demographic data of the respondents were gathered from a n optional section of  the survey which requested the following information: i) ii) iii) iv)  T y p e of worker (10 categories, including clerical worker, labourer, manager, etc.) A g e (3 categories) Sex Exercise habits (current frequency of physical exercise; 5 point scale)  * Classification of worker as to blue, white or pink collar worker was determined from worker type. Please see Chapter One for definitions of each classification.  c) Perceived Health  Status  One section of the questionnaire asked respondents to rate their current level of health (on 4 or 5 point scales; eg: f r o m poor to excellent), for the following health variables: 1)  G e n e r a l health  53  METHODS  2)  Fitness level  3)  E n e r g y level after work  4)  L e v e l of stress  5)  E a t i n g habits  2. Data Analysis F o r two questions (preference for p r o g r a m content and preference for method of instruction), respondents were asked to rank their choices f r o m highest to lowest interest. T o determine the overall interest of the group, these choices were weighted according to where they were ranked, and the overall r a n k i n g for each sub-group of employees is reported.  (Please see A p p e n d i x II for a n explanation of how the choices were weighted.)  T h e Chi-square test of independence was performed to determine whether the distribution of responses to each s u r v e y question (preferences, barriers and benefits) was independent of each of the demographic variables (age, sex, classification of employee and exercise habits). T h i s test was also performed to determine whether the distribution of responses to questions dealing with anticipated use of, and interest in E H A P s were independent of the perceived health status variables (perceived general health, fitness, stress, energy and diet). In order to assure that all assumptions of this statistical test were met, in each test, if more t h a n one-fifth of the cells contained frequencies of less t h a n five, categories were collapsed or eliminated according to criteria of subjectively determined relevance.  54  CHAPTER FOUR RESULTS  A. DIFFERENCES IN RESPONSES BASED ON DEMOGRAPHICS A s indicated i n C h a p t e r T h r e e (Methods), the data on which this analysis was based were derived f r o m an E H A P Needs and Interest Questionnaire completed by 401 employees of a m u n i c i p a l government.  W h i l e the original purpose of the questionnaire was  to collect general information regarding the need for a n E H A P , the data offered more specific information regarding demographics and perceived health which are analyzed i n this investigation. T h e survey was divided into three categories covering preferences for E H A P components, perceived barriers toward participation in a n E H A P , and perceived benefits f r o m participation in an E H A P .  T h e results in this first section deal with one of  the major purposes of this investigation, which was to determine if associations exist between demographic characteristics a n d employee perceptions of E m p l o y e e H e a l t h and Assistance P r o g r a m s .  T h e responses to each survey question are reported, with the  response of the complete sample being listed first, followed b y a breakdown of responses for each demographic variable being studied (age, sex, classification of worker by collar type and employee type, and exercise habits).  55  RESULTS  1. Preferences  a)  Preference for Type of EHAP  Activities (Survey Question  #2)  Fourteen s u r v e y questions dealt with employees' preferences for E H A P components.  In one question, (survey question #2; please see A p p e n d i x I), respondents  were asked to pick seven services or activities (of the 19 listed), in which they were most interested and r a n k them accordingly, f r o m highest to lowest preference.  T o determine the  overall interest of the group, the choices were then weighted according to where the employees r a n k e d them.  (Please see A p p e n d i x II for a n explanation of the weighting.)  T h e following table shows the order i n which the employees chose the various activities and services, (listed from highest to lowest interest):  56  RESULTS  Table 2. Preference for EHAP Components - All Employees Rank Order: 1 2 3 4 5 6 7 8 9 10 11 12 13 *13 14 15 16 *16 17  P r o g r a m s a n d Activities Preferred: Stress M a n a g e m e n t P r o g r a m s H e a l t h Education S e m i n a r s Personal/Professional Education Financial Management/Budgeting H e a l t h Screening Assessments CPR/First Aid Sport/Recreation P r o g r a m s E m p l o y e e Assistance P r o g r a m Preventive B a c k C a r e P r o g r a m s Individual Exercise P r o g r a m s Nutrition A s m t s / C o u n s e l l i n g Fitness Assessments/Counselling Weight M a n a g e m e n t P r o g r a m s Stop S m o k i n g P r o g r a m s Cut-rates at Fitness Facility Walking/Running Programs G r o u p Exercise P r o g r a m s Weight Training Programs * * Other  * A t both 13th and 16th preference, two programs were ranked equally. Some of the other activities/services suggested included retreats, time m a n a g e m e n t seminars, cultural programs, " S e a r c h for Excellence" seminars, and more attention be given to hazards and conditions at work.  The following key provides a brief description of the various programs and services which are abbreviated where necessary i n Tables 2 through 7.  57  RESULTS  Key; Health Education Seminars (or Health Ed): eg. heart health, cancer prevention, aging, etc. Personal/Professional Education (or Per/Pro): eg. retirement planning, coping w i t h change, etc. Health Screening Assessments (or Health Screening, Screen): eg. blood pressure, blood cholesterol, etc Sport/Recreation Programs (or Sport): eg. volleyball, baseball, curling, etc. Individual Exercise Programs (or Individual Ex, IndivEx): eg. h a v i n g a personalized exercise p r o g r a m prescribed  Group Exercise Programs (or Group Exercise, eg. Aerobics GroupEx): Stress (or StressMgt):  Stress M a n a g e m e n t Programs  Back Care: CPR: Financial Mgt (or FinMgt): EAP: Smok: Wt Control (or WtMgt): Fitness Asmt (or FitAsmt): Wt Training (or WtTrain): Walk/Run (or W/Run): Cut Rates (or CutRate): Nutrition Assessment (or NutrAsmt):  Preventive B a c k C a r e Programs CPR/First Aid F i n a n c i a l M a n a g e m e n t and Budgeting E m p l o y e e Assistance P r o g r a m Stop S m o k i n g P r o g r a m s Weight M a n a g e m e n t Programs  Fitness A s s e s s m e n t s and Counselling Weight T r a i n i n g W a l k i n g / R u n n i n g Programs C u t rates at a local Fitness F a c i l i t y Nutrition Assessments and Counselling  58  RESULTS  Table 3 outlines the differences among the age categories as to their preferences for p r o g r a m components.  T h e r e was a tendency for health screening and weight control  to be ranked higher as age increased. choice by the 16-35 groups.  C P R / F i r s t A i d was ranked as the third highest  year age group, as compared with sixth and seventh by the other two  Stress M a n a g e m e n t appeared to be a more popular item a m o n g the younger age  groups (picked first a m o n g the 16-35 over 50 age group).  and 36-50 year age groups, versus fourth for the  T h e r e was no apparent difference among the age groups as to  preference for a n E m p l o y e e Assistance P r o g r a m .  It is interesting to note that although  "group exercise" was ranked v e r y low b y all groups, the over 50 group ranked all of the fitness activities v e r y low.  59  RESULTS  Table 3. Differences in Preferences for EHAP Components Based on Age  Rank Order:  16-35:  36-50:  (n=167)  (n=159)  O v e r 50: (n = 62)  1  Stress M g t  Stress M g t  Health E d  2 3 4 5 6 7 8  FinMgt CPR Health E d Per/Pro Sport Screen EAP Back Care C u t Rates NutrAsmt  Per/Pro Health E d Screen FinMgt IndivEx  Per/Pro Screen  9 10 11 12 13 14 15 16 17 18 19  Fitness A s m t IndivEx Stop S m o k i n g W t Training GroupEx W t Control Walk/Run Other  CPR Back C a r e EAP W t Control Fitness A s m t Sport Walk/Run NutrAsmt C u t Rates Stop S m o k i n g Wt Training GroupEx Other  60  Stress M g t FinMgt CPR W t Control Back C a r e EAP Stop S m o k i n g IndivEx NutrAsmt Sport GroupEx Walk/Run Fitness A s m t C u t Rates Wt Training Other  RESULTS  T h e differences between males and females in their preferences for E H A P components are described in Table 4.  Preventive back care programs were ranked m u c h  higher b y the males than by the females (8th vs 17th). F e m a l e s tended to rank nutrition assessments/counselling, weight control programs, and group exercise m u c h higher t h a n males (8th vs 14th, 10th vs 16th, and 11th vs 18th, respective!}').  Table 4. Differences in Preferences for EHAP Components Based on Sex Rank Order: 1 2 3 4  Males: (n = 283)  Females: (n=103)  Health Education  5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  Stress M a n a g e m e n t Per/Pro Financial M g t H e a l t h Education CPR/First Aid H e a l t h Screening EAP Nutrition A s m t Individual E x W t Control Group Exercise Sport C u t Rates Walk/Run Fitness A s m t Stop S m o k i n g  Per/Pro Stress M a n a g e m e n t H e a l t h Screening Financial M g t CPR/First Aid Sport Back C a r e EAP Individual E x Fitness A s m t Stop S m o k i n g C u t Rates Nutrition A s m t W t Training W t Control Walk/Run  B a c k Care W t Training Other  Group Exercise Other  Table 5 illustrates the differences in preferences for E H A P components based on collar type.  Blue collar workers tended to r a n k preventive back care programs m u c h  higher (4th), than white and pink collar workers did (17th and 16th respectively).  61  Sport  RESULTS  and recreation programs were also more popular with the blue collar workers, who ranked them 7th, (as compared to 10th and 11th, for pinks and whites).  W h i t e and pink collar  employees were similar in r a n k i n g stress m a n a g e m e n t first, as compared to blue collar employees who r a n k e d it third.  O f the fitness-related activities, white collar workers chose  individual exercise programs as their first choice (7th choice overall), which was much higher than its r a n k i n g for blue and pink collar workers.  F o r the pink collar workers,  walking/running programs were the first on their list for fitness-related activities.  62  RESULTS  Table 5. Differences in Preferences for EHAP Components Based on Collar Type Rank Order: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  Blue:  White: (n=122)  Pink:  (n=131) Health E d Per/Pro Stress M g t Back C a r e FinMgt Screen Sport CPR EAP C u t Rates Stop S m o k i n g FitAsmt Wt Training IndivEx NutrAsmt W t Control Group E x . Walk/Run Other  Stress M g t Per/Pro Health E d FinMgt Screen CPR IndivEx EAP NutrAsmt W t Control Sport FitAsmt Group E x Walk/Run Stop S m o k i n g C u t Rates Back C a r e Wt Training Other  Stress M g t FinMgt Per/Pro Health E d CPR Screen  63  (n=50)  EAP NutrAsmt Walk/Run Sport Group E x W t Control C u t Rates IndivEx Stop S m o k i n g Back Care FitAsmt Wt Training Other  RESULTS  A more specific breakdown of worker classification showed further differences in preferences for p r o g r a m components.  T h e following table (Table 6) represents the r a n k  order of preferred activities for those worker types which appeared to differ notably f r o m that of the whole sample. based on complete sample.)  (Please refer to the beginning of this chapter for preference T h e firefighters tended to differ the most f r o m the overall  employee sample, in that they chose sport/recreation programs as their first choice, and E A P , C P R / f i r s t aid, and weight management programs were ranked m u c h lower than the other types of employees ranked them;  L a b o u r e r s and firefighters ranked preventive back  care programs m u c h higher than the other types of workers.  Individual exercise programs  appeared to be more popular with managers, office workers and firefighters t h a n with labourers and clerical workers.  T h e most popular fitness activity a m o n g the clerical  workers was w a l k i n g / r u n n i n g programs (ranked 9th as opposed to 14th to 17th for the other worker types).  64  RESULTS  Table 6. Differences in Preferences for EHAP Components Based on Worker Type Rank Order: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  Manager (n =  271)  HealthEd Per/Pro Screen Stress FinMgt EAP IndivEx Smok WtMgt FitAsmt NutrAsmt BackCare CPR GroupEx Sport WtTrain W/Run CutRate Other  Fire (n=16)  Office (n = 95)  Labourer  Sport Screen  Stress Per/Pro FinMgt  HealthEd BackCare Stress CPR Per/Pro FinMgt Screen Sport Smok FitAsmt EAP  Stress BackCare HealthEd IndivEx FitAsmt WtTrain Per/Pro CutRate GroupEx FinMgt NutrAsmt Smok W/Run EAP CPR Other WtMgt  HealthEd CPR Screen IndivEx EAP NutrAsmt Sport WtMgt FitAsmt GroupEx W/Run CutRate BackCare Smok WtTrain Other  65  (n = 51)  Clerical (n = 50) Stress FinMgt Per/Pro HealthEd CPR Screen EAP  CutRate WtTrain  NutrAsmt W/Run Sport GroupEx WtMgt CutRate  WtMgt IndivEx . NutrAsmt W/Run GroupEx Other  IndivEx Smok BackCare FitAsmt WtTrain Other  RESULTS  Table 7 shows the variations in preferred E H A P components based on the employee's present frequency of exercise.  T h e r e was a tendency for sport/recreation  programs to increase in popularity f r o m those who do not exercise to those who exercise three or more times per week. T h e r e was no apparent difference in interest for a stress management p r o g r a m between those who exercise v e r y little and those who exercise a lot. Those who do not exercise ranked "stop smoking p r o g r a m " as 6th, versus 18th for those who exercise three or more times per week. Interest in weight m a n a g e m e n t also appeared to decrease a m o n g those who exercise regularly.  Table 7. Differences in Preferences for EHAP , Components Based on Present Frequency of Exercise Present F r e q u e n c y of Exercise: Rank Order  None (n = 60)  <Once/Wk (n = 28)  Once/Wk (n = 45)  Twice/Wk  1 2 3 4  Stress Per/Pro HealthEd FinMgt Screen Smok EAP  Stress Per/Pro FinMgt EAP HealthEd Screen CPR IndivEx WtMgt NutrAsmt W/Run Sport GroupEx CutRate BackCare Smok  HealthEd Per/Pro Stress FinMgt  HealthEd Per/Pro Stress FinMgt  CPR Screen Sport CutRate BackCare FitAsmt IndivEx EAP Smok W/Run NutrAsmt  CPR Screen Sport EAP IndivEx Smok  5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  WtMgt CPR BackCare IndivEx NutrAsmt Sport GroupEx W/Run FitAsmt CutRate WtTrain  -  FitAsmt WtTrain  WtMgt GroupEx WtTrain  --  Other  66  (n = 77)  WtMgt BackCare FitAsmt NutrAsmt WtTrain W/Run CutRate Group Other  3 or > (n=182) Stress HealthEd Per/Pro Screen FinMgt Sport CPR BackCare EAP CutRate NutrAsmt FitAsmt IndivEx WtTrain GroupEx W/Run WtMgt Smok Other  RESULTS  b) Preference for Method of Instruction  (Survey Question #i )  A second question which requested employees to r a n k items, asked them to identify the methods of learning they most prefer, by listing the five choices in order from highest to lowest preference.  T h e choices were again weighted according to rank, (see Appendix II  for weighting) and the preferences of the total group are listed in Table 8.  Table 8. Preference for Method of Instruction - All Employees Rank Order: 1 2 3 4 5  Method: H a n d s - O n Activities Films/Videos Seminars/Lectures Books/Pamphlets/Posters * Other  * Some of the other methods suggested included s m a l l group discussions, correspondence courses, tours and projects.  W h e n broken down based on the various demographic variables, the order in which these methods were chosen did not appear to differ m u c h f r o m the order listed above. In a few cases, hands-on activities were not chosen as first choice, but were replaced by films and videos (for the over 50 age group, the enforcement/inspection worker type, and for those who do not exercise, or exercise twice per week).  c)  Other Preferences F o r each of the other "preference" questions on the survey, chi square analysis  was performed to determine if any significant differences in responses occurred between  67  RESULTS  the levels of each demographic variable (cross-tabulation of each preference question b y each demographic variable). Table 9 summarizes the results of the chi square analysis where significant differences in responses occurred.  68  RESULTS  Table 9. Results of the Chi-Square Analysis: Significant Differences (p< = 0.05) in Employees' Preferences for EHAP Components Based on DEMOGRAPHICS: Age: Sex:  Collar:  Type:  Freq:  PREFERENCE QUESTIONS: Parthp  **  Partex Timehp  **  **  Timex  **  **  **  **  *  Facility EAPtype  *  Site EAPuse  *  Family Retired Volunteer  **  **  *  *  **  **  EHAP p < = KEY:  .05  p < =  Freq Parthp  .01  - Self-reported frequency of exercise - Anticipated frequency of participation in H e a l t h Promotion Programs/Seminars Partex - Anticipated frequency of participation in exercise programs Timehp - Preferred time of day for health promotion programs/seminars Timex - Preferred time of day for exercise programs Facility - Preference for type of fitness facilities EAPtype - Preference for type E A P Site - Preference for whether E A P contact person is onsite or offsite EAPuse - Anticipated use/non-use of a n E A P  69  RESULTS  Family  - Preference to whether or not family members should be able to use p r o g r a m  Retired  - Preference for whether or not retired employees should be able to use p r o g r a m - Preference as to volunteer capacity - Preference as to whether or not a n E H A P should be implemented.  Volunteer EHAP  Following are the frequency distributions for each preference question listed in Table 9.  F o r those cross-tabulations where significant differences in responses occurred  between different demographic groups, histograms illustrating the differences are presented.  In each histogram, the results are presented as percentages of each group  being represented.  In the discussion of each histogram these percentages have been  rounded off to the nearest whole n u m b e r .  i)  Anticipated Participation in H e a l t h Promotion P r o g r a m s  and  Seminars  (Survey  Question #5).  Anticipated frequency of participation in H e a l t h Promotion P r o g r a m s / S e m i n a r s (eg. heart health, retirement planning, health screening, stress management, etc.) for the whole sample is shown in Table 10.  70  RESULTS  Table 10. Anticipated Participation in Health Promotion Programs/Seminars  Percentage of employees:  Anticipated frequency of participation per m o n t h :  30% 22%  Once Twice T h r e e or more times L e s s than once N o t at all D i d not answer  20% 16% 10% 2%  A s indicated in Table 9, there were no significant differences in anticipated participation in health promotion programs and seminars based on age, sex, collar and type of worker, or frequency of exercise.  71  RESULTS  ii)  Anticipated Participation in a n Exercise P r o g r a m (Survey Question 5).  Anticipated frequency of participation in Exercise P r o g r a m s (individual or group programs) for the total sample is shown in T a b l e 11.  Table 11. Anticipated Participation in Exercise Programs Percentage of employees:  Anticipated frequencj' of participation per week:  31% 28% 24% 9% 6% 2%  Once T h r e e or more times Twice Did not answer None L e s s than once  T h e r e were no significant differences in anticipated participation in exercise programs based on age, sex, collar or type of worker. T h e significant relationship (p < 0.01) between self-reported frequency of exercise a n d anticipated participation in exercise programs is shown i n F i g u r e 1. T h e majority of employees who reported currently exercising less t h a n once per week were more apt to anticipate that they would participate in a worksite exercise program once per week (49%), twice per week (24%), or three or more times per week (21%). O n l y 6% stated they participate less t h a n once per week.  72  RESULTS  <ONCE/WK ONCE/WK TWICE/WK 3 OR >/WK PERCEIVED PARTICIPATION IN AN EXERCISE PROGRAM Pearson C h i - S q u a r e Statistic =  34.25 with 6 degrees of freedom, p <  Figure 1. PERCEIVED PARTICIPATION IN AN EXERCISE PROGRAM (BASED ON PRESENT FREQUENCY OF EXERCISE)  73  0.01.  RESULTS  iii) Preferred T i m e of D a y for H e a l t h Promotion P r o g r a m s / S e m i n a r s and Exercise P r o g r a m s (Survey Question #6).  Preferred time of day for H e a l t h Promotion P r o g r a m s / S e m i n a r s a n d Exercise P r o g r a m s for the total sample is shown in Table 12.  Table 12. Preferred Time of Day for Health Promotion Programs/Seminars and Exercise Programs  Percentage of employees: T i m e of d a y :  H e a l t h Promotion Programs 32% 16% 14% 12% 9% 13% 7%  L u n c h break A f t e r work Evenings/weekends Before work N o t at all D i d not answer Other  Exercise P r o g r a m s :  25% 20% 12% 15% 12% 11% 6%  T h e r e was no significant difference i n preferred time of day for either H e a l t h Promotion or Exercise P r o g r a m s based on age, type of worker or frequency of exercise. F i g u r e s 2 a n d 3 respectively, illustrate the significant relationships between sex a n d preferred time for H e a l t h Promotion P r o g r a m s (p < 0.01), and between sex a n d preferred time for Exercise P r o g r a m s (p <  0.01).  74  RESULTS  In figure 2 it is apparent that although the highest percentage of both males and females preferred to have H e a l t h Promotion P r o g r a m s and S e m i n a r s at lunch time, m a n y more females (56%), than males (29%) preferred this. M a l e s tended to choose "before w o r k " and "after w o r k " more often than females did.  60  T  BEFORE WORK  LUNCH  AFTER WORK  EVE/ NOT AT OTHER WEEKALL END PREFERRED TIME FOR HEALTH PROMOTION PROGRAMS/SEMINARS  Pearson C h i Square Statistic = 29.10 with 5 degrees of freedom, p <  Figure 2. PREFERRED TIME FOR HEALTH PROMOTION „ PROGRAMS/SEMINARS (BASED ON SEX) s  75  0.01  RESULTS  F i g u r e 3 shows the significant (p < P r o g r a m s between males and females.  0.01) differences in preferred time for Exercise  A g a i n , the highest percentage of both males and  females chose to exercise on their lunch break, although with males, the responses were fairly evenly distributed between "before w o r k " , " l u n c h b r e a k " and "after w o r k " .  Forty  three percent of the females chose " l u n c h break" as compared to only 22% of the males. higher percentage of females (30%)  A  also chose "after w o r k " than males (20%).  45 T 40 •• 35  RESPONSE FREQpt)  2  5  2  0  • MALES • FEMALES  BEFORE WORK  LUNCH BREAK  AFTER WCRK  EVENING OR NOT AT ALL WEBCEND  OTHER  PREFERRED T M E FOR EXERCJSE  Pearson C h i Square = 27.91 with 5 d.f., p <  0.01  Figure 3. PREFERRED TIME FOR EXERCISE PROGRAMS (BASED ON SEX)  76  RESULTS  F i g u r e s 4 and 5 respectively, show the significant relationships between collartype a n d preferred time for H e a l t h Promotion P r o g r a m s (p < 0.01), and between collartype a n d preferred time for Exercise P r o g r a m s (p <  0.01).  It can be seen i n F i g u r e 4, that although lunch time was the most popular choice for health promotion programs a n d seminars for all collar types, a greater percentage of pink collar workers (51%), chose lunch time as compared to blues (28%), a n d whites (42%). A l s o a m u c h greater percentage of pink collar workers (28%), preferred evenings and weekends for courses as compared with blues (12%), a n d whites (13%). It appears that more blue collar workers would come to programs "before w o r k " (20%), as compared with whites (12%), and v e r y few pinks (2%). T h e preferences for programs after work were 20% (whites), 18% (blues), and 6% (pinks).  77  RESULTS  BEFORE WORK  LUNCH  AFTER EVENING/ NOT AT WORK ALL WEEKEND  OTHER  PREFERRED TIME FOR PROGRAMS  Pearson C h i Square = 24.39 with 8 d.f., p <  0.01  Figure 4. PREFERRED TIME FOR HEALTH PROMOTION PROGRAMS/SEMINARS BASED ON COLLAR TYPE  78  RESULTS  F i g u r e 5 outlines the variations i n preferred time of day for exercise programs, based on collar-type.  A s can be seen, pink collar workers m u c h preferred lunch time  (48%), as compared to whites (29%), a n d blues (20%). White collar workers choices were fairly evenly distributed between " l u n c h " a n d "after w o r k " , with a lesser amount choosing the r e m a i n i n g categories. Blue collar workers tended to choose before work (21%), lunch (20%), after work (16%), a n d evenings/weekends (20%) i n fairly even proportions. T h e percentage of blues (20%), choosing evenings/weekends was higher t h a n pinks (8%), a n d blues (10%).  BEFORE  LUNCH  AFTER EVENING/ NONE WORK WEEKEND PREFERRED TIME FOR EXERCISE PROGRAMS  Pearson C h i Square = 29.41 with 10 d.f., P <  0.01  Figure 5. PREFERRED TIME FOR EXERCISE PROGRAMS BASED ON COLLAR TYPE  79  RESULTS  iv) Preference for T y p e of Fitness Facilities (Survey Question # 1 0 ) .  The preference for type of fitness facilities employees would like to see on or near the worksite are represented in Table 13:  Table 13. Preference for Type of Fitness Facilities on the Worksite Percentage of employees:  Preferred type of facility:  44% 19% 13% 9% 8% 5% 3%  * Individual exercise a r e a G r o u p exercise area W o u l d not use Jogging or running area * * Other Showers/change area D i d not answer  * eg. weight room, exercise bike, etc. * * Some of the other suggestions for fitness facilities included: racquet courts, athletic fields, and g y m n a s i u m .  s w i m m i n g pool,  T h e r e were significant differences i n preference for type of facilities based on age (p = 0.03), sex (p = 0.01), and collar of worker (p < 0.01), but not based on type of worker a n d frequency of exercise. F i g u r e 6 shows the differences a m o n g the three age groups i n their preferences for type of fitness facility on the worksite. A l t h o u g h the largest percentage of each age category chose "individual exercise a r e a " (ie: weights, exercise bike, etc.), there appeared to be a tendency for interest in this type of facility to increase as age decreased.  There  was also a tendency for more employees to state that they would not use fitness facilities on the worksite, as age increased.  A l t h o u g h preference for a group exercise area was  80  RESULTS  fairly low (<25%), the younger group of employees (16-35 yrs) tended to be more interested in this type of facility (24%) than the two older groups (15% and 19% respectively).  SHOWER/ GROUP INDIV. RUNNING OTHER CHANGE EXERCISE EXERCISE AREA AREA AREA AREA PREFERRED TYPE OF FACILITY  WOULD NOT USE  Pearson C h i Square = 20.04 with 10 d.f., p = 0.03  Figure 6. PREFERRED TYPE OF FACILITY BASED ON AGE  81  RESULTS  Figure 7 illustrates the significant (p = 0.01) differences in type of fitness facility preferred, based on sex. T h e highest percentage of both males and females chose "individual exercise area", but the number of males (49%) was higher t h a n that of females (36%). T h e percentage of females (32%) who preferred a group exercise area was m u c h higher t h a n for males (15%).  SHOWER GROUP INDIV. RUNNING OTHER WOULD / EXERCISE EXERCISE AREA NOT USE CHANGE AREA AREA AREA PREFERRED TYPE OF FACILITY  Pearson C h i Square = 14.63 with 5 d.f.), P =  0.01  Figure 7. PREFERRED TYPE OF FACILITY BASED ON SEX  82  RESULTS  F i g u r e 8 portrays the significant (p < 0.01) differences in preferred type of fitness facility, based on collar type.  T h e first preference for blue and white collar workers (51%  and 36% respectively), was a n individual exercise area (ie: exercise bike, weights, etc.). Pink collar workers chose a group exercise area as their first choice (36%). A l t h o u g h v e r y few employees indicated their preference for "showers/change a r e a " and "jogging/running a r e a " , a slightly higher percentage of white collar workers preferred these.  60  7  50 •  RESPONSE FREQ. (%)  40 •  •  30  M PINK  20 •  H  10• 0  SHOWERS GROUP INDIV. JOGGING/ OTHER WOULD AREA AREA NOT USE /CHANGE RUNNING AREA AREA TYPE OF FACILITY PREFERRED Pearson C h i Square = 26.82 with 10 d.f., p <  0.01  Figure 8. PREFERRED TYPE OF FACILITY (BASED ON COLLAR TYPE)  83  BLUE WHITE  RESULTS  v) Preference for T y p e of E A P (Survey Question  #12).  E m p l o y e e s ' preferences for type of E m p l o y e e Assistance P r o g r a m to be implemented are presented in Table 14.  Table 14. Preference for Type of EAP to be Implemented Percentage of employees:  T y p e of E A P preferred:  66%  H e a l t h Promotion Model ( E A P is offered to employees in combination with a health promotion program) Assessment/Referral Model ( E A P referral person does no counselling, but refers employees on to appropriate professional in the community) Short-term Counselling M o d e l ( E A P contact person provides a limited number of hours of counselling; if problem is not solved in this time, employee is referred on to another professional) D i d not answer  17%  11%  7%  T h e r e were no significant differences in preferred type of E A P based on age, sex, collar and type of worker or frequency of exercise.  84  RESULTS  vi) Preference for Location of E A P Contact Person (Survey Question #15).  E m p l o y e e s ' preferences for whether the E A P contact person should be onsite or off site are shown i n T a b l e 15:  Table 15. Preference for Location of EAP Contact Person Percentage of employees:  Preference:  62%  Offsite Onsite D i d not answer  33% 4%  T h e r e were no significant differences i n whether or not the E A P referral person should be onsite or offsite based on age, sex, type of worker or frequency of exercise. H o w e v e r , when based on collar type, the relationship was significant (p = 0.03), as described in F i g u r e 9. A l l collar types chose offsite more often than onsite, but the percentage choosing offsite was larger for pinks (73%), and whites (69%), than for blues (55%).  85  RESULTS  RESPONSE FREQUENCIES (%)  BLUE  PINK COLLAR OF WORKER  Pearson C h i Square =  WHITE  7.16 with 2 d.f., p =  0.03  Figure 9. PREFERENCE FOR LOCATION OF EAP REFERRAL PERSON (BASED ON COLLAR TYPE)  86  RESULTS  vii)  Anticipated U s e / N o n - U s e of a n E A P (Survey Question #18).  There were no significant differences in anticipated use of a n E A P based on a n y of the demographic variables studied. T h e distribution of responses of the whole group are represented in T a b l e 16:  Table 16. Anticipated Use of an EAP Percentage of employees:  Perception of E A P use if the employee needed help:  72% 21% 6%. 1%  Would use D o n ' t know W o u l d not use D i d not answer  87  RESULTS  viii) Preference as to Usage of an EHAP by Family Members.  Preferences as to whether or not family members should be able to use the EHAP are shown in Table 17.  Table 17. Preference for Family Usage of EHAP Percentage of employees:  39% 32% 12% 10% 4% 3%  Preference as to whether or not family members should be able to use program: Yes, in all programs Yes, if room after the employees have all signed up No Yes, in EAP only *Other Did not answer  *Of those who chose "other", some of the responses were: spouse only; depends on what type of program is set up; Yes - with the stipulation that if any costs are picked up by the City, that family members do not get this financial assistance. There were no significant differences in the responses to this question based on age, sex, type of worker and frequency of exercise. However, when based on collar-type, the relationship was significant (p = 0.02) as described in Figure 10. The largest percentage of the blue collar workers preferred to have family members utilize the program (53%), as compared to white and pink collar workers (37% and 26% respectively). The highest percentage of pink collar workers (47%), felt that family members should have access only after employees had signed up. White collar workers were fairly evenly distributed between both of the above two opinions.  88  RESULTS  60  T  RESPONSE FREQUENCIES (%)  YES  YES, IF YES, EAP NO ROOM ONLY PREFERENCE AS TO WHETHER FAMILY MEMBERS SHOULD BE ABLE TO USE PROGRAM Pearson C h i Square =  14.46 with 6 d.f., p =  0.02  Figure 10. PREFERENCE AS TO WHETHER FAMILY MEMBERS SHOULD BE ABLE TO USE PROGRAM (BASED ON COLLAR TYPE)  89  RESULTS  ix)  Preference as to Retired E m p l o y e e s ' U s e of P r o g r a m (Survey Question #  20).  Table 18 shows the responses of the whole group as to whether or not retired employees should be able to utilize the p r o g r a m :  Table 18. Preference as to Retired Employees' use of Program Percentage of employees  Preference as to whether or not retired employees should be able to use program:  75% 22% 3%  Yes No D i d not answer  90  RESULTS  F i g u r e 11 shows the significant (p < 0.01) difference between males and females in their responses to this question. T h e majority of both males and females were in favor of retired employees being able to continue to use the E H A P , yet the percentage of males in favor was higher than for females (82% vs  66%).  90 r  YES to PREFERENCE FOR WHETHER OR NOT RETIRED EMPLOYEES SHOULD BE ABLE TO USE PROGRAM Pearson C h i Square = 9.99 with 1 d.f., p <  0.01  Figure 11. PREFERENCE AS TO WHETHER OR NOT RETIRED EMPLOYEES SHOULD BE ABLE TO USE PROGRAM (BASED ON SEX)  91  RESULTS  F i g u r e 12 portrays the significant (p <  0.01)  difference between the collar types in  their preference as to whether retired employees should be able to utilize a n E H A P .  The  majority of all three groups agreed that retired employees should use the program, but the percentages in favor differed between groups.  86% of blue collar workers agreed, as  compared with 75% and 59% of white and pink collar workers, respectively.  BLUE  PINK COLLAR TYPE  Pearson C h i Square =  WHITE  15.60 with 2 d.f., P <  0.01  Figure 12. PREFERENCE AS TO WHETHER RETIRED EMPLOYEES SHOULD BE ABLE TO USE PROGRAM (BASED ON COLLAR TYPE)  There was a significant (p <  0.01)  question among the various worker types.  difference in response frequencies to this T h e highest percentage of all worker types  92  RESULTS  agreed that retired workers should be allowed to use the E H A P , although the frequencies varied considerably. One hundred percent of the firefighters were i n favor, as compared with 85-95% of the maintenance workers and equipment operators, 75-85% of the office workers, facility workers and enforcement/inspection workers, a n d 55-65% of the clerical workers a n d managers/directors.  Based on age and frequency of exercise, there were no significant differences i n preference as to retired employees' use of an E H A P .  93  RESULTS  x) Preference for Volunteer Capacity (Survey Question #21).  W h e n asked if they would volunteer to help with a n E H A P , and if so, in what capacity, the response of the total sample was as depicted in Table 19.  Table 19. Preference as to Volunteer Capacity  Percentage of employees:  Preference: W o r k with peer support program W o u l d not volunteer Coach/Organizer of sports/recreation  39% 31% 15%  programs Fitness Instructor D i d not answer Other Instructor of health promotion seminars  7% 4% 3% 1%  Figure 13 represents the significant (p < 0.01) differences a m o n g the age categories as to w h a t they would prefer to volunteer for if a n E H A P were developed. A l l three age groups preferred the peer support category, yet there w a s a tendency for interest in this p r o g r a m to increase with increasing age (16-35 y r s : 34%, 36-50 y r s : 44%, and over 50 y r s : 55%). A s age increased, there was a declining tendency for volunteering as a coach or organizer of sports/recreation programs, with 22%, 15% and 3% of the respective age groups (youngest to oldest) choosing this category.  94  A l t h o u g h volunteering  RESULTS  as a fitness instructor w a s only chosen b y a few employees from each group (< 10%), there was a tendency for interest in this category to also decrease as age increased.  60  T  PEER SUPPORT  FITNESS INSTR.  COACHOR ORGANIZE SPORTS  WOULD NOT  PREFERRED VOLUNTEER CAPACITY Pearson C h i Square = 20.27 with 6 d.f., p < 0.01  Figure 13. PREFERRED VOLUNTEER CAPACITY BASED ON AGE  95  RESULTS  F i g u r e 14 outlines the significant (p = 0.03) differences between males and females as to what they would prefer to volunteer for i f a n E H A P were developed. A l t h o u g h the w a y males and females answered this question was significant overall, within each category the percentages were really v e r y similar. Slightly more females (44%), t h a n males (40%), said they would volunteer to help with a peer support p r o g r a m , and slightly more females (9%), than males (6%), would volunteer to teach fitness classes. M o r e males (18%) would volunteer as a coach or organizer of sports or recreation programs t h a n females (11%). Slightly more males than females said they would not volunteer at all (34% v s 29%).  96  RESULTS  PEER SUPPORT.  FfTNESS COACH OR INSTR. ORGANIZER OF SPORTS  OTHER  WOULD NOT  PREFERENCE FOR VOLUNTEER CAPACITY  Pearson C h i Square =  10.93 with 4 d.f., p = 0.03  Figure 14. PREFERENCE FOR VOLUNTEER CAPACITY BASED ON SEX  97  RESULTS  F i g u r e 15 shows the significantly different (p = 0.05)  response frequencies among  the three collar-type categories when asked in what capacity they would volunteer if a n E H A P were developed. A higher percentage of white collar workers (51%) in helping with a peer support p r o g r a m as compared with pinks (39%) M o r e blue collar workers (21%)  were interested  and blues (33%).  were interested in coaching or organizing sports and  recreation programs t h a n pinks (12%)  or whites (10%).  PEER FITNESS COACHOR WOULD NOT SUPPORTER INSTRUCTOR ORGANIZER PREFERENCE FOR VOLUNTEER CAPACITY  Pearson C h i Square =  Figure  12.46 with 6 d.f., p =  0.05  15.  PREFERENCE FOR VOLUNTEER CAPACITY ON COLLAR TYPE  98  BASED  RESULTS  F i g u r e 16 shows the significant (p = 0.01) relationship i n perceived volunteer capacity based on exercise habits.  T h e highest proportion of those who would not  volunteer tended to be those who exercised less than once per week. M o s t groups chose to volunteer with the peer support p r o g r a m .  PEER SUPPORTER  FITNESS COACHOR INSTRUCTOR ORGANIZER VOLUNTEER CAPACITY  WOULD NOT  Pearson C h i Square = 23.11 with 9 d.f., p = 0.01  Figure 16. PERCEIVED VOLUNTEER CAPACITY (BASED ON PRESENT FREQUENCY OF EXERCISE)  99  RESULTS  T h e r e was no significant difference among the worker types as to their preference for volunteering.  xi)  Preference for Implementation of a n E H A P (Survey Question  #22).  W h e n the employees were asked if they thought a n E H A P was a good idea and should be implemented, there were no significant differences seen in responses based on a n y of the demographic variables.  T h e response to this question was v e r y positive, with  the frequencies of responses as shown in Table 20:  Table 20. Preference for Implementation of an EHAP Percentage of employees  72% 21% 5%  Preference as to whether or not a n E H A P should be implemented: Yes D o n ' t know No  100  RESULTS  2. Barriers Six s u r v e y questions dealt with issues which m a y present themselves as barriers to employee use of an E H A P .  E a c h of these questions was cross tabulated with each  demographic variable using C h i square analysis, to determine if a n y significant differences in responses occurred between the levels of the demographic variables.  Table 21  summarizes the results of the analysis, representing the significant differences with asterisks.  101  RESULTS  Table 21. Results of the Chi Square Analysis: Significant (p < = 0.05) Differences in Possible Barriers to EHAP Participation Based on DEMOGRAPHICS: Age: Sex:  Collar:  Type:  Freq:  BARRIERS: Concern Payex Payhp  *  Comfort  *  Barrier  **  EAPBar * p < = ** < = p  .05 .01  KEY: Freq Concern Payex Payhp  -  Comfort Barrier EAPBar  -  Self-reported frequency of exercise Biggest concern regarding a n E H A P on the worksite Preference of p a y m e n t per week for a n exercise p r o g r a m Preference of p a y m e n t per month for health promotion programs and seminars Comfort in exercising with fellow workers Perceived barriers to using available community services Perceived barriers to using a n E A P  102  RESULTS  Following are the frequency distributions for each barrier question listed i n table 21.  F o r those cross-tabulations where significant differences in responses occurred  between different demographic groups, histograms illustrating the differences are presented.  a)  In each histogram, the results are presented as  Biggest Concern Regarding  an EHAP  percentages.  on the Worksite (Survey Question  #3)  W h e n asked what their biggest concern regarding an E H A P on the worksite would be, the responses of the whole sample were as shown in Table 22:  Table 22. Biggest Concern Regarding an EHAP  Percentage of employees: 61% 18% 9% 5% 4% 4%  Biggest concern: L a c k of time to participate L a c k of confidentiality L a c k of privacy Other Too m u c h competition among m y fellow workers D i d not answer  A s indicated in T a b l e 21, there were no significant differences in responses to this question based on age, sex, collar and type of worker, or frequency of exercise.  103  RESULTS  b) Preference as to Payment for Exercise and Health Promotion  Programs  (Survey Question  7) There were no significant differences seen in response to how m u c h the employees would be willing to p a y for exercise and health promotion programs on the worksite. T h e response of the whole group to these questions was as shown in Tables 23 and 24:  Table 23. Preference as to Payment for Exercise Programs Percentage of employees:  Preference for p a y m e n t per week for an exercise p r o g r a m :  29% 23% 20% 12% 8%  $10 or less W o u l d not pay $10 - 20 D o n ' t know D i d not answer $20 - 30  104  #  RESULTS  Table 24. Preference as to Payment for Health Promotion Programs and Seminars  Percentage of employees:  Preference for p a y m e n t per month for health promotion programs and seminars:  30% 28% 21% 9% 8% 3%  c)  Comfort in Exercising  W o u l d not p a y $10 or less D o n ' t know $10 - 20 Did not answer $20 - 30  with Fellow Workers (Survey Question  #9)  W h e n asked if they would be comfortable in exercising with all their fellow workers, the frequency of responses was as shown in Table 25:  Table 25. Reported Comfort in Exercising with Fellow Workers Reported comfort in exercising with fellow workers:  Percent of employees:  50% 23% 25% 2%  Yes, I would feel comfortable N o , I would not feel comfortable Maybe D i d not answer  105  RESULTS  T h e r e were no significant differences in the response to this question based on age, sex, collar or type of worker. H o w e v e r , F i g u r e 17 outlines the significant ( p =  0.01)  relationship between present frequency of exercise and comfort in exercising with fellow workers.  F o r those who stated that they did not exercise, or exercised less t h a n once per  week, their answers were fairly evenly distributed between " y e s " , " n o " and " m a y b e " . However, for those who reported exercising once or more per week a higher proportion stated that they would feel comfortable in exercising with their fellow workers.  106  RESULTS  60  T  NONE  <ONCE/WK ONCE/WK  TWICE/WK  3 OR MORE/WK  PRESENT FREQUENCY OF EXERCISE  Pearson  Chi S q u a r e  =  19.67  with 8  d.f.,  p  =  0.01  Figure 17. COMFORT IN EXERCISING WITH FELLOW WORKERS (BASED ON FREQUENCY OF EXERCISE)  107  RESULTS  d)  Perceived Barriers  to Using Available  Community  Services (Survey Question  #16)  Perceived barriers to using available community services (if no E A P were available) were as outlined in Table 26.  Table 26. Perceived Barriers to Using Community Services Perceived barriers:  Percentage of employees: 31%  N o t h i n g would stop m e ; I would use them  30%  I would put off going U n a b l e to afford it Would not know where to go Fear Other D i d not answer  16% 12% 5% 4% 2%  F i g u r e 18 shows the significant ( p = barriers to using c o m m u n i t y services.  0.01) relationship between collar-types a n d  Pink collar workers appeared to see fewer barriers  to using these services as compared to blue and white collar workers (45% stated that nothing would stop them from, using the services, as compared with 35% for whites and 26% for blues). T h e r e was very little difference between collar types in the percentage who chose "cost" as a barrier.  T h e biggest barrier for blue collar workers appeared to be  procrastination, whereas the majority of pinks a n d whites stated that nothing would stop them from using these services.  T h e r e were no significant differences in response to this  question based on age, sex, type of worker or frequency of exercise.  108  RESULTS  COST  WOULD WOULD FEAR OTHER NOTHING NOT PUT OFF KNOW WHERE TOGO BARRIERS TO USING COMMUNITY SERVICES  Pearson C h i Square =  14.96 with 5 d.f., p =  0.01  Figure 18. BARRIERS TO USING COMMUNITY SERVICES (BASED ON COLLAR TYPE)  109  RESULTS  e) Perceived Barriers  to Using an  EAP:  Perceived barriers to using a n E A P reported b y the whole sample are shown in Table 27.  Table 27. Perceived Barriers to Using an EAP Percent of employees:  Perceived barriers to using an E A P :  32%  N o t h i n g would stop me; I would use it L a c k of time L a c k of confidentiality  22% 16% 11%  Fear that it might affect performance appraisal Fear/intimidation about using it Other D i d not answer  10% 6% 4%  T h e r e was a significant (p =  0.01)  my  difference between males and females in the  barriers they reported toward using a n E A P , shown in figure 19.  A l t h o u g h the majority of  both sexes indicated that nothing would stop them f r o m using a n E A P , the barrier reported most often for males was lack of time to use the services (26 % vs 14% for females).  The  barrier most often reported by females was confidentiality (25 % vs 14% for males).  There  were no significant differences in responses to this question based on age, collar and type of worker, or frequency of exercise.  110  RESULTS  PERFORM. CONFIDEN- TIME FEAR OTHER APPRAIS. TIALITY BARRIERS TO USING AN EAP Pearson C h i S q u a r e =  NOTHING  14.96 with 5 d.f., p =  0.01  F i g u r e 19.  BARRIERS TO USING AN EAP BASED ON SEX  111  RESULTS  3. Benefits W h e n asked i n what w a y the employees felt they might benefit most from a n E H A P on the worksite, the frequencies of responses were as shown in T a b l e 28:  Table 28. Perceived Benefit From an EHAP Percentage of employees: 24% 22%) 19%  11%  *8% 5% 5%  Perceived benefit f r o m a n E H A P : Prevention of stress-related or lifestylerelated diseases/conditions Improve m y ability to cope with e v e r y d a y situations Improve m y fitness level Educate me about healthy lifestyles Other I would not benefit D i d not answer  Some of the other w a y s employees felt they m a y benefit included: improvements in working conditions, and increased awareness of resources available to them.  T h e r e were no significant differences seem a m o n g any of the demographic variables in the w a y the employees responded to this question.  112  RESULTS  B. DIFFERENCES IN RESPONSES BASED ON PERCEIVED  HEALTH  T h e following results deal with the second major purpose of this research which was to determine if associations exist between perceived health status and employees' perceptions of E H A P s (particularly their perceived use of the program).  A more limited  selection of survey questions (the questions dealing with perceived use of and interest in E H A P s ) were analyzed in relation to perceived health. T h e first question (rank order of employees' preferences for p r o g r a m content) was analyzed separately with each of: perceived general health, perceived fitness level, perceived level of stress, and self-reported eating habits, and is presented first, in tables 29 through 31.  Please refer to the key at  the beginning of this chapter for a brief description of the abbreviations in these tables.  1. Preferred P r o g r a m Content  In this question, respondents were asked to pick seven services or activities (of the 19 listed), in which they were most interested and rank them accordingly, f r o m highest to lowest preference.  T h e following table (Table 29), shows the order in which the employees  chose the various activities and services, based on their perceived general health.  There  was a tendency for weight management and smoking cessation programs to increase in popularity with decreasing perception of health.  Stress m a n a g e m e n t programs were  ranked v e r y low b y those who perceive themselves as being in poor or fair health.  Please  refer to Table 2 for the order in which the employees as a whole ranked this question.  113  RESULTS  Table 29. Differences in Preferences for EHAP Components Based on Perceived General Health Rank Order:  •  Poor/Fair: (n = 30)  1 2  Per/Pro FinMgt  3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  W t Control Screen Health E d Back Care EAP Smok CPR Sport NutrAsmt FitAsmt IndivEx C u t Rates StressMgt GroupEx Walk/Run WtTrain Other  Average: (n = 83)  Good: (n = 200)  Health E d Per/Pro Stress M g t FinMgt Screen CPR EAP  Per/Pro FinMgt Health E d Stress M g t Screen CPR Sport EAP  Sport Srnok Back Care W t Control WtTrain Walk/Run IndivEx FitAsmt C u t Rates GroupEx NutrAsmt  Back C a r e IndivEx NutrAsmt C u t Rates Smok FitAsmt W t Control Walk/Run GroupEx WtTrain Other  ~  114  Excellent: (n = 84) FinMgt Health E d Per/Pro CPR Screen Stress Sport IndivEx EAP C u t Rates FitAsmt NutrAsmt GroupEx Back C a r e Walk/Run WtTrain W t Control Smok  --  RESULTS  Table 30 outlines the order in which p r o g r a m components were chosen depending on perceived fitness level. T h e r e was a tendency for interest in weight control programs to decrease as perceived fitness level increased (from 2nd for those who perceive themselves as being "not v e r y fit", to 16th for those who perceive themselves as in much better shape than others their age and sex). H e a l t h Screening was the first choice for the "not v e r y fit" group, whereas the other groups tended to choose stress m a n a g e m e n t programs or health education programs as their first choice.  T h e " v e r y fit" group chose smoking cessation  programs as their last choice.  Table 30. Differences in Preferences for EHAP Components Based on Perceived Fitness Level Rank Order  Not F i t  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17  Screen Wt Mgt Per/Pro IndivEx HealthEd FinMgt Stress EAP FitAsmt BackCare Smok  Stress HealthEd EAP FinMgt Per/Pro Screen CPR Wt Mgt Smok Sport GroupEx  Stress Per/Pro HealthEd FinMgt CPR Screen BackCare Sport EAP IndivEx Smok  Stress Per/Pro HealthEd FinMgt Screen Sport CPR EAP BackCare FitAsmt IndivEx  HealthEd Stress Screen Per/Pro CutRate Sport FinMgt CPR NutrAsmt FitAsmt BackCare  CutRate CPR WtTrain GroupEx NutrAsmt Sport W/Run Other  NutrAsmt FitAsmt WtTrain IndivEx BackCare W/Run  Wt Mgt W/Run NutrAsmt FitAsmt CutRate GroupEx WtTrain Other  Smok NutrAsmt CutRate W/Run GroupEx  EAP WtTrain IndivEx GroupEx Wt Mgt W/Run Smok Other  18 19  (n=15)  < Average (n = 32)  CutRate Other  Average (n=159)  Better (n=131)  WtTrain Wt Mgt Other  Very Fit (n = 60) .  * Respondents were asked to rate their current fitness level compared to others their age and sex. " B e t t e r " refers to " A bit better t h a n average".  115  RESULTS  The differences in preferred program content based on perceived level of stress are described in Table 31. As might be expected, those individuals who perceived themselves as being under a great deal or a moderate amount of stress chose stress management programs as their highest ranked program choice. Those who perceived themselves as being under very little or no stress chose stress management programs as their 4th and 5th choices. There was a tendency for interest in "individual" exercise programs to increase with increased perception of stress. Perceived stress level did not appear to have much affect on interest in the other fitness activities however, except that for those who perceive themselves as "under no stress", all of the fitness activities were chosen at the end of the list.  Table 31. Differences in Preferences for EHAP Components Based on Perceived Level of Stress Rank Order: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  Very Much (n=54) Stress Health Ed Per/Pro FinMgt Screen CPR EAP IndivEx Back Care Sport NutrAsmt W/Run WtMgt Smok FitAsmt Cut Rate WtTrain GroupEx Other  Moderate (n=243)  Very Little (n=74)  Stress Health Ed Per/Pro FinMgt Screen CPR Sport EAP IndivEx Back Care Cut Rate NutrAsmt Smok FitAsmt WtMgt W/Run GroupEx WtTrain Other  Per/Pro Health Ed FinMgt Screen Stress CPR Sport Back Care EAP Wt Train FitAsmt W/Run Cut Rate WtMgt GroupEx IndivEx Smok NutrAsmt Other  116  None (n=25) Screen Per/Pro Health Ed Stress CPR Back Care FinMgt EAP NutrAsmt WtMgt Sport FitAsmt Smok Cut Rate W/Run GroupEx IndivEx WtTrain --  RESULTS  Table 32 illustrates the differences in preferences for E H A P components based on self-reported eating habits. T h e respondents were asked to rate their current eating habits on a 5-point scale f r o m poor to excellent.  A s c a n be seen f r o m Table 32, eating habits did  not appear to have a n y effect on order i n which individuals chose "nutrition assessments", (ie:  " N u t r i t i o n assessments" were chosen as the 17th choice b y those with poor eating  habits, as compared with 18th choice b y those with excellent eating habits.)  Interest in  weight control programs decreased slightly among those with better self-reported eating habits.  Table 32. Differences in Preferences for EHAP Components Based on Self-Reported Eating Habits Rank Order 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19  Poor  Fair  Average  Good  (n=19)  (n = 56)  (n=134)  (n=159)  Stress FinMgt Screen HealthEd Per/Pro EAP  Stress FinMgt HealthEd CPR Per/Pro EAP Screen Smok Sport IndivEx  Stress Per/Pro HealthEd FinMgt Screen  FitAsmt Sport GroupEx  BackCare WtMgt NutrAsmt CutRate GroupEx WtTrain  NutrAsmt WtMgt Smok W/Run IndivEx  NutrAsmt WtTrain  FitAsmt W/Run  CPR Smok WtMgt BackCare IndivEx CutRate W/Run  -  ~  CPR Sport BackCare EAP FitAsmt  GroupEx WtTrain CutRate Other  117  Excellent (n = 27)  WtMgt W/Run  HealthEd Per/Pro Screen CPR Stress Sport CutRate EAP IndivEx FinMgt Smok BackCare WtMgt FitAsmt W/Run WtTrain  GroupEx  GroupEx  Smok Other  NutrAsmt Other  HealthEd Per/Pro Stress Screen FinMgt CPR Sport EAP IndivEx CutRate BackCare NutrAsmt FitAsmt WtTrain  RESULTS  2. Anticipated Participation and Interest F o r each of the other variables analyzed with perceived health status, C h i square analysis was performed to determine if each of these variables were independent of each perceived health variable. Table 33 summarizes the analysis and shows where the significant differences occurred.  F o r each significant difference, a histogram follows  depicting the various responses for each level of the perceived health variables.  118  RESULTS  Table 33. Results of the Chi-Square Analysis: Significant (p < = 0.05) Differences in Employees' Perceived Participation Based on Perceived Health Status PERCEIVED Health:  HEALTH: Fitness:  Energy:  Stress:  Diet:  ANTICIPATED PARTICIPATION:  *  Parthp Partex EAPuse EHAP  *  Benefit  p <=  *  *  Freqex .05  **  p <=  .01  KEY: Health Fitness Energy Stress Diet Parthp  -  Partex EAPuse EHAP Benefit Freqex  -  Perceived level of general health Perceived fitness level compared to others of same age and sex Perceived energy level after work Perceived current level of stress Perceived current eating habits Anticipated frequency of participation in H e a l t h Promotion Programs/Seminars Anticipated frequency of participation in exercise programs Anticipated use/non-use of a n E A P Preference as to whether or not a n E H A P should be implemented Perception of how a n E H A P would be of most benefit to you Self-reported frequency of exercise at the present time. (Although this variable does not address perceived participation in an E H A P , it was of interest to determine i f those who perceive themselves as being healthier already exercise more, regardless of whether there is an E H A P in existence.)  119  RESULTS  a) Anticipated  Participation  in Health Promotion  and Exercise  Programs  A s can be seen in table 33, there were no significant differences in anticipated frequency of participation in health promotion programs and seminars based on a n y of the perceived health variables, with the exception of diet. significant (p =  0.01)  participation in H P P s .  T h e r e was no apparent trend in the  relationship between self-reported eating habits and anticipated H o w e v e r , those individuals who rated their nutritional habits as  excellent tended to either anticipate that they would participate in H P P s "three or more times per week" or "not at a l l " . F o r anticipated participation in exercise programs there were no significant differences in responses based on perceived health.  b) Anticipated  Use of an EAP (Survey Question #  18)  T h e r e were no significant differences in response to anticipated use of and E m p l o y e e Assistance P r o g r a m based on perceived health status.  c) Preference to Whether an EHAP  Should be Implemented (Survey Question #  22)  T h e r e were no significant differences in response to whether or not a n E H A P should be implemented on the worksite based on perceived health status.  120  RESULTS  d)  Perception of Benefit From an EHAP  (Survey Question  #23)  There were no significant relationships between "perception of benefit from a n E H A P " and perceived health, fitness level, stress or diet. There was a significant (p = 0.02)  difference in the responses to this question when broken down b y the variable  "perceived energy level after w o r k " . T h e r e was no apparent trend in this association. H o w e v e r , those who rated their energy level after work as "excellent" appeared to perceive a greater personal benefit in the w a y of increased fitness t h a n the other groups did.  e) Exercise Habits (Survey Question  #8)  A l t h o u g h self-reported frequency of exercise is not an indication of participation in a n employee exercise p r o g r a m , it was of interest to determine if those individuals who perceived themselves as being healthier actually exercised more t h a n those who did not. Therefore, this variable (freqex), was included in the analysis. There were significant relationships seen between frequency of exercise and perceived general health (p = 0.01), fitness (p < 0.01), and energy level (p <  0.01), which  are outlined in figures 20-22. There were no significant differences in frequency of exercise based on the variables stress and diet. T h e differences in frequency of exercise per week based on perceived general health are depicted in figure 20.  A s can be seen, among those who stated they exercise three or  more times per week, a higher percentage perceived their health to be good or excellent t h a n among those who exercise less,  (ie:  A m o n g those who said they exercise three or  more times per week 21% rated their health as poor or fair, whereas 70% rated their  121  RESULTS  health as excellent.) B y the same token, among those who said they do not exercise, a higher percentage rated their health as poor or fair (48%), than average (31%), good (10%) or excellent (1%).  70  T  DO NOT <ONCE/ EXERCISE WEEK  ONCE/ WEEK  TWICE/ 3 OR WEEK MORE/ WEEK FREQUENCY OF EXERCISE  Pearson C h i Square = 82.13 with 12 d.f., p =  0.01  Figure 20. CROSS-TABULATION OF SELF-REPORTED FREQUENCY OF EXERCISE AND PERCEIVED HEALTH STATUS  122  RESULTS  Figure 21 illustrates the significant (p < exercise and perceived fitness level.  0.01) relationship between frequency of  A s frequency of exercise per week increased,  perception of fitness level tended to increase,  (ie:  A m o n g those who stated they exercised  three or more times per week, only 3% rated their fitness level as less than average, whereas 71% rated it as better than average.) A m o n g those who said they did not exercise, 32% rated their fitness level as less t h a n average and only 10% rated it as better than average.  DO NOT  <ONCE/ WEEK  ONCE/ WEEK  TWICE/ WEEK  3 OR MORE/ WEEK  FREQUENCY OF EXERCISE  Pearson C h i Square =  117.09 with 8 d.f., p <  0.01  Figure 21. CROSS-TABULATION OF SELF-REPORTED FREQUENCY OF EXERCISE AND PERCEIVED FITNESS LEVEL  123  RESULTS  T h e differences in frequency of exercise based on perceived energy level after work are represented in figure 22.  There was a trend for reported "energy level" after work to  increase as frequency of exercise increased.  70 T  DO NOT <ONCE/ ONCE/ TWICE/ 3 OR WEEK WEEK WEEK MORE/ WEEK FREQUENCY OF EXERCISE Pearson C h i Square = 49.21  with 8 d.f., p <  0.01  Figure 22. CROSS-TABULATION OF SELF-REPORTED FREQUENCY OF EXERCISE A N D ENERGY L E V E L AFTER WORK  124  CHAPTER  FIVE  DISCUSSION T h e question of whether or not employee health programs, if properly developed, can improve the health of employees is no longer a n issue.  N o r is the question of whether  these programs c a n be of benefit in increasing productivity a n d morale, a n d decreasing absenteeism, job turnover and on-the-job accidents.  According to Z a v e l a and associates  (1988), we should also quit asking if participation rates i n these programs are high, b u t instead, concentrate health promotion efforts on assuring that the programs are reaching those who need t h e m .  T h i s means m a k i n g sure that more t h a n just the 15-20% of  employees who are "conspicuously h e a l t h y " are using the p r o g r a m (Heirich et al, 1989; S h a i n et a l , 1986). H o w e v e r , health promotion efforts should not only concentrate on the 10-15% of employees on the other end of the scale who are " v e r y at r i s k " , but also those 70% i n the center who are developing risk factors such as hypertension, high blood cholesterol, etc., and could possibly prevent further problems through healthy lifestyle and environmental changes. A s indicated previously (Chapter Two), research describing how factors such as demographics a n d perceived health status affect participation is limited and often equivocal.  Some of these studies have revealed significant differences among various  demographic groups in factors affecting their participation i n worksite health programs, however, further research is needed to determine whether these differences are also prevalent in different work populations (Spilman, 1988). Participation in worksite health programs b y some sub-populations of employees, such as the blue collar workforce, has been reported to be lower t h a n that of other segments for m a n y y e a r s .  It is only recently that investigations have begun studying the  125  DISCUSSION  particular needs a n d interests of these sub-populations for E H A P p r o g r a m m i n g (including perceived barriers to participating in these programs).  In the case of blue collar workers,  reports of recent programs which have taken steps to meet the specific needs and interests and to reduce barriers perceived by this group, have reported high participation rates (Blair et al, 1986; K i n g et al, 1988).  T h i s indicates that the importance of listening to the  employees to solve problems of participation cannot be underestimated. T h e present investigation was based on a needs assessment which requested information on preferences, barriers and benefits f r o m different demographic groups. T h e two major purposes of this research were to determine to what extent associations existed in this population between:  (1) specific demographics and employees' preferences and  perceptions of E H A P s , and (2) perceived health status and employees' anticipated use of, and interest in E H A P s . T h e results indicated that associations existed in both of these cases. In the following sections, these results will be s u m m a r i z e d , and the implications of these results for p r o g r a m planning will be discussed.  A.  DEMOGRAPHICS  1. Age T h e results of this study were consistent with other current research, in that interest in fitness activities tended to decrease with age.  T h e oldest age category  consistently ranked all of the fitness activities very low, when compared w i t h other health promotion components.  There was also less interest a m o n g the older group in volunteering  126  DISCUSSION  to help with fitness activities, as well as less interest i n an individual exercise area (exercise bike, weights, etc.) on the worksite. T h e r e could be a number of explanations for this, including the " y o u n g i m a g e " m a n y worksite fitness programs have (McDaniel, 1988), the lack of comfort older workers m a y perceive to exercising with members of the opposite sex (Shephard, 1988), a n d the fear that fitness programs a n d testing m a y jeopardize the older employees' positions (if it is determined that they are not " f i t " enough to do the job) ( M c D a n i e l , 1988). T h e fear of job loss m a y be especially true in jobs where a high standard of fitness is expected, such as for firefighters. In the present study, a personal conversation with the F i r e Chief revealed that in fact, m a n y firefighting personnel were concerned about fitness on the worksite due to their fear that it would become m a n d a t o r y , a n d a higher level of fitness would be expected of t h e m . A l t h o u g h fitness m a y be a d r a w i n g card to enhance participation in E H A P s a m o n g younger employees, it m a y have the opposite effect with the older age groups. Therefore, as indicated previously, to increase participation among this group, a variety of other programs should be offered. In the present study, health screening and weight control were two programs w h i c h tended to be more popular as age increased, a n d therefore could be offered to attract older employees. Although fitness programs were not as popular with the older age group, there were no significant differences seen a m o n g the age groups as to their anticipated participation in exercise programs on the worksite. T h i s could indicate that although older workers are more interested in  other  programs (besides fitness), they m a y still participate  in fitness programs on the worksite, or it could imply that although younger workers have  127  DISCUSSION  more interest i n fitness, m a n y of them would rather participate in this outside of work and therefore did not indicate on the survey that they would participate in a worksite p r o g r a m . T h e recommendations for increasing participation among older employees made b y H e i r i c h and associates (1989) would likely be applicable with this group as well. included:  These  (1) m a k i n g one-to-one contact with each employee to review their health risks  and current lifestyle behaviors, and to indicate what worksite programs m a y be of benefit to them, (2) providing simple, f u n activities that can be done on the employee's own time (eg. a w a l k i n g course set up through the parks which could be done at lunch time), and (3) providing contests for teams (to take the pressure off each individual). These suggestions are not only applicable to older workers, but could be used to encourage participation of any sub-group of employees who are inhibited about participating.  S h e p h a r d (1988) suggested that with exercise programs, i f older employees  feel uncomfortable about participating with the younger employees or with members of the opposite sex, a few classes should be offered which are segregated (eg. " 5 0  +  " , or separate  classes for males and females, etc.). These classes could then be personalized to the needs of those particular groups.  H e also recommended personal exercise prescription with older  employees, to give them direction in the fitness activities which would best meet their needs.  2. Sex T h e data showed no significant differences between males and females i n their anticipated use of health promotion programs/seminars and exercise programs. to the studies w h i c h have found higher male participation in  128  fitness-oriented  Contrar}'  programs  DISCUSSION  (Blozis et a l , 1989; T e t t i n g , 1989), males did not rate most fitness activities higher on their list of preferred p r o g r a m s than females did. T h e only exception to this w a s a greater interest i n sport a n d recreation programs b y males which provided support for the research b y Y o s h i d a a n d colleagues (1988), which showed women to be less likely to join sport and recreation programs.  T h e r e was a greater interest i n group exercise b y females,  although the most popular fitness activity a m o n g females was a n individual exercise program. One of the barriers to women participating i n sport programs m a y be that they are often held i n the e v e n i n g or on weekends, when f a m i l y responsibilities m a y hinder their participation more t h a n it would for males.  W o m e n m a y perceive that fitness classes take  less time (than sport a n d recreation programs) a n d would more likely be held at lunch time or immediately after work, when it m a y be more convenient for them to attend.  In fact,  when asked w h a t times they would prefer to attend exercise programs, women, more often t h a n m e n , chose lunch time or after work. F o r health promotion programs and seminars women again, chose lunch time m u c h more frequently t h a n m e n . B o t h males a n d females chose "individual exercise a r e a " (eg. a space for exercise bikes, weights, etc.) as their most preferred type of exercise facility, although males chose this more often t h a n females. T h e type of facility females most preferred was split fairly evenly between "group exercise a r e a " and "individual exercise area", with the percentage of women choosing the group area being more than twice that of the m e n . These differences were reflected in the aspects of the E H A P in which males and females stated they would prefer to volunteer to assist with.  Slightly more females t h a n  males stated they would volunteer to instruct fitness classes, whereas slightly more males  129  DISCUSSION  t h a n females stated they would volunteer to coach or organize sport or recreation programs. Stress m a n a g e m e n t programs appeared to be important to both sexes.  Females  chose stress m a n a g e m e n t as their first p r o g r a m choice, whereas males chose it as third (following health education and personal/professional education seminars).  Other research  has also identified stress management to be a high interest and a high perceived need among employees (Long et al, 1986; Schenck et a l , 1987), although one study (of blue collar workers) found interest i n stress m a n a g e m e n t to be v e r y low (Blozis et a l , 1988). M c D a n i e l (1988) has pointed out a number of stressors that m a y affect working women to a greater extent t h a n working m e n , (and which could also be related to the slightly higher interest in stress m a n a g e m e n t programs among the females in this population). These include stresses due to lower p a y , lesser job security, less control over their work, more sexual harassment, a n d more conflict between home and work responsibilities. She states that these stressors m a y be greater for older working women (50-65) who have often been termed the " s a n d w i c h generation", as they are still faced with the needs of their children (who m a y still be living at home), the needs of husbands who are often older and more sickly, as well as the needs of their aging parents (and perhaps their husband's parents). F o r the reasons indicated, stress m a n a g e m e n t programs m a y need to have a n entirely different focus for women than for m e n . It cannot be assumed that women's greatest stressors come from the workplace. Preventive back care programs were m u c h more popular a m o n g males t h a n females.  T h i s is presumably due to the number of blue collar workers (predominantly  male) i n this group, (as blue collar workers were m u c h more likely to choose this p r o g r a m t h a n white collar workers or the predominantly female pink collar workers).  130  T h i s is likely  DISCUSSION  a reflection of the m a n u a l work they do, causing a greater likelihood of back injuries. A l t h o u g h back care programs have been offered b y this organization before, the high interest i n them by males (especially blue collar males) indicates that there is a need to continue w i t h these programs. W o m e n appeared to be m u c h more interested i n nutrition assessments a n d weight control programs than m e n were.  T h i s m a y be a reflection of the higher percentage of  women i n society in general who seek nutrition counselling and join weight control programs more often than m e n do (National D a i r y Council, 1986; Porcello, 1985). A l t h o u g h a majority of both males a n d females were i n favor of retired employees being able to use the p r o g r a m , the percentage of males in favor (82%) was significantly higher t h a n females (66%). While the results in no w a y indicate a reason for this difference, perhaps males perceive a greater utilization of such a p r o g r a m after retirement. A l t h o u g h there were no significant differences seen between the sexes in terms of barriers to participating in E H A P s , lack of time to use the p r o g r a m was the biggest barrier perceived b y all employees, with 61% of all of the employees choosing this.  Other research  has also indicated that lack of time is usually the most commonly cited reason for lack of participation (Shephard, 1988).  S h e p h a r d suggests that for this reason, individual  exercise areas are important, so that people c a n exercise as time permits.  It should be  noted that a n individual exercise facility was the most preferred fitness facility b y the employees i n the present investigation. T h i s suggestion could also be applied to other types of programs, i n that if possible, they should be offered more t h a n once, at different times throughout the d a y , a n d at various locations, so that employees c a n participate as their work shifts permit.  131  DISCUSSION  T h e most common response a m o n g both males and females, when asked about barriers to utilizing a n Employee Assistance P r o g r a m was " N o t h i n g would stop me, I would use i t . " . In terms of reported barriers, again, lack of time was important, w i t h more m e n citing this as a barrier than w o m e n . W o m e n tended to cite "confidentiality" as their biggest concern. To increase participation among both sexes, flextime, more flexible working schedules, and allowance for time a w a y f r o m work to participate m a y reduce the barrier of "lack of t i m e " .  P r o v i d i n g programs at convenient times and locations as specified b y the  employees (eg. women's programs at lunch time or immediately after work) m a y also allow for greater participation. L a s t l y , to improve usage of programs, sensitivity to the particular needs of each sex is important (eg. providing more back care programs for males and blue collar workers, and more appropriate stress m a n a g e m e n t programs for females).  132  DISCUSSION  3. Classification of Worker The  analysis of the data based on collar type revealed that when asked about their  p r o g r a m preferences, none of the groups r a n k e d fitness activities higher t h a n seventh. Pink collar workers chose walking a n d r u n n i n g programs as their most popular fitness choice, w h i c h was ranked m u c h higher a m o n g this group than for white or blue collar workers.  Sport a n d recreation programs were the highest rated fitness activity  among the blue collar workers and individual exercise was the highest among the white collar workers, w h i c h corresponds with some of the literature addressing blue and white collar worker interests (Ontario G o v e r n m e n t , 1985; Ontario G o v e r n m e n t , 1981). H o w e v e r , most other program preferences (eg. H e a l t h Education, Stress M a n a g e m e n t , etc.) were r e m a r k a b l y similar in r a n k i n g a m o n g the different collar types. Stress m a n a g e m e n t appeared to be an important issue to the blue collar workers as well as the white a n d pink collar groups.  Therefore, the assumption that stress is just a  white collar issue does not hold true i n this population. A n o t h e r recent study of blue collar workers needs a n d interests showed stress m a n a g e m e n t programs to be the most popular perceived p r o g r a m need with this group (Schenck et a l , 1987). A s mentioned previously, one p r o g r a m which was ranked m u c h higher b y blue collar workers t h a n white and pink collar workers was preventive back care.  O f the blue  collar workers, the two types of workers who rated these programs highest were the labourers a n d the firefighters (who ranked back care 2nd and 4th respectively).  T h i s is  again, p r e s u m a b l y due to the nature of their jobs. It also provides support for another study of blue collar workers interests, where back care was also very popular (Blozis et a l , 1989).  133  DISCUSSION  T h e type of fitness facility preferred most often b y both blue and white collar workers was an individual exercise a r e a (weights, exercise bike, etc.). Pink collar workers most often chose group exercise area, followed closely b y individual exercise area. T h e firefighters, a predominantly blue collar group, ranked sport/recreation programs as their n u m b e r one choice overall. T h i s m a y be related to the fact that firefighters are often a younger group of employees t h a n some of the other blue collar workers would be. T h e firefighters were a unique group from the rest of the sample in some of their other preferences too, although this m u s t be viewed with caution due to the small sample size of this segment of the employees (n = 16).  It is possible that this sample  represents only one shift of workers, a n d therefore could be biased in not representing the view of the other firefighters. In light of this, the other unique preferences of this group were their much lesser interest in E A P s , C P R / F i r s t A i d , and Weight M a n a g e m e n t P r o g r a m s than the other employees.  It is understandable that C P R / F i r s t A i d would be of  lesser interest a m o n g this group, as extensive training in C P R and F i r s t A i d is already provided as part of their basic job training. A s for E A P s , the firefighters have a n established p r o g r a m where they can get counselling to deal with the t r a u m a they m u s t face as part of their jobs. Therefore, perhaps they perceive *a lesser need for an E A P . W e i g h t M a n a g e m e n t was listed as their last choice overall. A reason for this m a y be that they are a more fit group than the majority of the other employees and therefore perceive no need for a weight control p r o g r a m .  A n o t h e r reason m a y be that this group were  recently offered a " H e a r t H e a l t h " p r o g r a m through which any individual with a weight problem would have h a d an opportunity to have individual counselling with a dietitian, and therefore perhaps the need for weight m a n a g e m e n t programs among this group has already been met.  134  DISCUSSION  A l t h o u g h the highest percentage of each collar type preferred to have exercise and health promotion programs at lunch time, the percentages choosing each time category differed between the groups.  A higher percentage of pink collar workers preferred lunch  time for both types of programs (as compared with blue and white collar workers).  This  reflects the higher preference for lunch time b y females versus males (as the pink collar workers are predominantly female).  F o r exercise p r o g r a m s , the second choice of the pink  collar workers was "after w o r k " , but for health promotion programs v e r y few pink collar workers chose to participate at this time.  T h i s inconsistency is difficult to d r a w  conclusions from. M o r e blue collar workers than white or pink collar workers implied that they would attend both exercise and health programs before work. T h i s m a y be due to their shorter lunch breaks (making it impossible for them to attend classes at noon), a n d the unlikelihood of being released d u r i n g work hours to attend a program.  In a study of blue  collar m e n and women, Heirich et al (1989) found that there was little interest in staying after a long shift to attend an exercise p r o g r a m .  T h e y therefore h a d to structure classes  to fit into short lunch breaks and provide activities that could be done individually before work or on breaks. W o r k location m a y be another inhibiting factor for blue collar workers i n this population to attend programs.  In this organization, work locations are widely spread  across the C i t y in fourteen major areas.  A p p r o x i m a t e numbers of p e r m a n e n t staff in each  location are as follows:  135  DISCUSSION  Location:  _#_:  City Hall  148  F i r e H a l l s (3 locations)  91  Garage/Public W o r k s (2 locations)  75  T r e a t m e n t Plants (2 locations)  52  Transit  47  Recreation/Culture Centre  46  P a r k s (2 locations)  46  Electric, L i g h t and Power  45  RCMP  22  Note:  T h e r e are also m a n y employees f r o m the above locations that are itinerant, or w o r k i n g outside most of the work day in various other locations throughout the C i t y .  T h i s m a y be a contributing factor to the lower preference for programs at lunch time among blue collar (as opposed to white and pink collar) workers. T h e r e were no significant differences amongst collar types in anticipated usage of health promotion programs, exercise programs and E A P s .  T h i s is encouraging in light of  the research w h i c h indicates lower blue collar participation in worksite programs (Ontario Government, 1981; R o m a n and B l u m , 1988). O f course, anticipated  usage does not imply  participation, but it does indicate that in this population there is at least interest among blue collar workers in these types of programs.  136  DISCUSSION  T h e r e was a significant (p = 0.01)  difference however, amongst the collar types in  perceived barriers to using community services for assistance. Pink collar workers perceived fewer barriers than the other groups, whereas blue collar workers perceived more barriers.  T h e most common barrier cited by blue collar workers w a s procrastination  about going for help.  T h e r e was no apparent difference between collar tj^pes in choosing  "cost" as a barrier to using these services.  Cost was listed as the third choice for all  groups a n d therefore was no more of a barrier to blue collar workers t h a n the others. M o s t employees preferred the E A P referral person to be offsite, although the percentages of employees in each collar type who preferred this were significantly different.  M o r e pink collar workers and white collar workers were in favor of the referral  person being offsite t h a n blue collar workers were.  In regard to pink collar workers  (predominantly female), this preference could reflect the greater concern women showed for confidentiality of the p r o g r a m .  Access to an offsite E A P referral person would likely be  perceived as being more confidential. T h e location of the referral person m a y not have been as important to blue collar workers due to their varied work locations.  A l s o , m a n y of these workers do not have a  particular work location, but are in different locations every day. A high percentage of all worker types were in favor of family members utilizing programs.  Therefore, where financially feasible, this m a y be an important influence to  increasing participation in programs.  H a v i n g the support and involvement of significant  others has been shown to increase participation in health promotion programs (Chang and Boyle, 1989; L o v a t o and G r e e n , 1990). F a m i l y involvement was shown to be more important a m o n g blue collar workers in the present study than among the other two groups.  A l s o more important to blue collar workers was allowing retired employees to  137  DISCUSSION  participate i n programs, although again, a high percentage of all employees were i n favor of this. In s u m m a r i z i n g p r o g r a m preferences based on collar type, those reported b y blue collar workers were not exceptionally different from those of the white a n d pink collar workers. A s mentioned previously, there was also no significant difference in anticipated usage of exercise a n d health promotion programs, a n d interest in these programs was high among all groups. Therefore, conceivably i f an E H A P were developed which provided programs at convenient times a n d locations for all workers participation rates could be high. A l t h o u g h there was no significant difference between collar types as to their comfort in exercising with their fellow workers, 23% of the employees i n general stated they would not be comfortable with this. Therefore, perhaps some employees f r o m each collar type thought they would be inhibited b y exercising with other workers, secretary m a y be uncomfortable about exercising w i t h her/his supervisor).  (eg. A  C h a n g and  Boyle (1989) suggested that providing a few separate programs for different worker types m a y promote more participation. These could also be provided in different locations to m a k e them more convenient a n d accessible to everyone.  F o r example, with this  organization, if it w a s decided to provide fitness programs, and enough instructors were available, programs could be r u n at consecutive times at C i t y H a l l , i n one of the treatment plants, and in the recreation centre.  O n alternate days they could be r u n i n three other  locations. A few common themes are apparent in the literature addressing how to increase blue collar worker participation. These include involving blue collar workers i n the development of the E H A P s (King et al, 1988; Metcalfe, 1987; Y e n n e y , 1986), giving  138  DISCUSSION  genuine supervisory support (King et a l , 1988; Y e n n e y , 1986), and providing environmental changes conducive to health (such as safer working conditions) as well as the lifestyle programs (Blair et a l , 1986; Metcalfe, 1987; Pechter, 1986). T h e assumption that blue collar workers are not concerned about health promotion has been found to be false (Blair et a l , 1986; Schenck et a l , 1987; Weitzel, 1989). Certainly the present investigation adds support to this, as blue collar workers chose H e a l t h E d u c a t i o n as their number one p r o g r a m preference and indicated a high level of anticipated participation in programs.  L a c k of participation b y blue collar workers which  has been cited i n earlier research m a y have been due to limited access for blue collar workers to these programs, and lack of convenience for this group in terms of locations and times (Metcalfe, 1987; Pechter, 1986) These barriers were implied in the present investigation. P r o g r a m s which have been developed with these themes in m i n d have shown that blue collar worker participation c a n be equal to that of white collar workers (Blair et a l , 1986; K i n g et a l , 1988).  4. Exercise Habits It w a s of interest to determine whether or not, i n this population, anticipated participation i n E H A P s would be greater among those individuals who exercise more frequently (as determined b y self-reported frequency of exercise). A s indicated in Chapter T w o (Literature Review), a study done b y L o v a t o a n d Green (1990) showed that individuals who h a d previously been active were more apt to join a n employee fitness program.  Also, it has been hypothesized that those individuals who are involved in  139  DISCUSSION  exercise m a y tend to be more willing to participate in other positive health behaviors (Blair et al, 1985). It appeared f r o m the data that the possibility of an exercise p r o g r a m on the worksite at least m a k e s those who exercise infrequently perceive that they would exercise more.  F o r example, only 6% of those who reported that they currently exercise less t h a n  once per week stated that they would participate in a worksite exercise program once per week, whereas 21% of them stated they would participate in a worksite p r o g r a m three or more times per week.  O f those who reported exercising once to three or more times per  week, anticipated use of a worksite exercise p r o g r a m most often paralleled their current exercise habits. These results indicated that in this population, worksite exercise programs might attract not only the employees who are "already converted" to exercising, but also those who exercise i n f r e q u e n t ^ . Perhaps those who exercise infrequently perceive that a worksite p r o g r a m would make exercising more convenient for them and therefore their frequency of exercise would increase.  A l t e r n a t i v e l y , they m a y be overestimating the  amount that they would use a worksite p r o g r a m . • T h e r e were no apparent differences in popularity of most fitness activities between the different groups (those who do not exercise to those who exercise three or more times per week), with the exception of sport and recreation programs.  T h e popularity of these  programs increased with increasing self-reported exercise, f r o m being ranked 13th a m o n g those who do not exercise, to 6th a m o n g those who exercise three or more times per week. W h e n asked if they would be comfortable in exercising with their fellow workers, there was a significant (p = 0.01) frequency of exercise.  difference in the answers to this question based on  People's comfort in exercising at the worksite appeared to be  140  DISCUSSION  related to previous exposure to exercise, as a m u c h higher percentage of those who reported exercising once or more per week stated that they would feel comfortable in worksite exercise programs (when compared with those who reported exercising less than once per week). T h e results of this study do not totally support the theory that individuals involved in exercise are more willing to participate in other health promoting behaviors, i n that there was no significant difference (based on frequency of exercise) i n anticipated participation in health promotion programs/seminars and E A P s .  H o w e v e r , there was a  tendency for interest in smoking cessation and weight m a n a g e m e n t programs to decrease among those who reported exercising more.  T h i s could indicate that there were fewer  smokers among the individuals who reported exercising more, and that weight management m a y have been less of a problem among this group. W h e n asked in what capacity they would volunteer to help with E H A P activities, there was also a significant (p = 0.01) exercise).  difference in responses (based on frequency of  T h e highest percentage of those who stated they would not volunteer were those  who reported exercising less t h a n once per week.  If volunteering to help with E H A P  activities can be considered "participating in health promoting behaviors", perhaps this adds some support to the theory that exercisers are more willing to participate i n health promoting behaviors than infrequent exercisers. T h e implications of these results to p r o g r a m planning indicate that a n exercise p r o g r a m on the worksite (be it a group p r o g r a m , individual exercise area, etc.) m a y encourage infrequent exercisers to participate in fitness activities.  It is encouraging to find  that i n this population, both infrequent a n d frequent exercisers are attracted to E H A P s . H o w e v e r , since infrequent exercisers more often cited discomfort in exercising with fellow  141  DISCUSSION  workers, perhaps at least one exercise p r o g r a m could be designed and offered to the " u n f i t " as a w a y of introducing (or reintroducing) them to exercise. A l s o , offering the programs which this group indicated greater interest for (such as smoking cessation and weight management) m a y encourage higher participation i n the E H A P b y this group.  B. PERCEIVED HEALTH One of the objectives of this research was to determine for this population the extent to which perception of health affected the employees' anticipated use of, a n d interest i n E H A P s .  Results of other studies have not been consistent i n demonstrating the  affects of perceived health status on participation. O f the studies reviewed, one showed increased participation b y individuals w i t h lower perceived health status (Sloan and G r u m a n , 1988), two showed increased participation b y individuals with higher perceived health status (Conrad, 1987b; Weitzel, 1989), a n d one demonstrated that the effects of perceived health status m a y be dependent on sex, with increased participation being associated with higher perceived health status for m e n , whereas for w o m e n increased participation w a s related to lower perceived health status (Morgan et a l , 1984). T h e above investigations were studying participants versus non-participants of actual programs however, whereas the present investigation studied participation.  anticipated  One of the few studies w h i c h has investigated "intent" to participate in  E H A P s found more "intenders" to perceive their health as fair or poor, indicating that for that population these programs appealed to more than just the "already w e l l " group of employees (Zavela et a l , 1988).  142  DISCUSSION  T h e distinction between studying actual participation versus intent to participate is a n important one to m a k e .  W i t h the former, if participants are found to perceive  themselves as being healthier, it is difficult to determine whether it was the p r o g r a m that improved their perceived health, or whether they h a d higher perceived health to begin with. F o r this investigation, it was of interest to determine if perceived health was related to what attracted employees to E H A P s .  T h e results showed no significant  differences in anticipated use of programs based on perceived health, and therefore do not support Zavela's (1988) results. T h e exceptions to these results, were a significant difference seen in anticipated participation in health promotion programs based on nutritional habits, and a n increased perceived benefit f r o m E H A P s in the w a y of fitness b y those employees with higher reported energy level after work. H o w e v e r , the differences seen in these variables were not supported b y a n y of the other results, and did not show any apparent trends.  It was  therefore difficult to draw any meaningful conclusions f r o m these data. T h e r e was evidence which suggested that those individuals who perceived their health to be at risk identified more interest in weight management and smoking cessation t h a n those who perceived themselves to be at less risk. These results were consistent with the finding that those who reported exercising more identified less interest in smoking cessation. Those employees with poor perceived fitness levels ranked all of the fitness activities very low, w i t h the exception of individual exercise, which they ranked fourth on their list of "preferred activities".  A l t h o u g h this result should be viewed with caution, as  the number of employees in this group was small (n= 15) and therefore m a y not have been  143  DISCUSSION  representative of the " u n f i t employee population", this could indicate that those individuals who are unfit m a y feel uncomfortable about exercising in groups. T h e y m a y tend to participate more if a n individual exercise area were made available to t h e m . T h e r e was a tendency for interest in sport and recreation programs to increase with increased (self-reported) fitness level.  T h i s was consistent with the finding that those  who reported exercising more were also more interested in sport/recreation programs. A n implication of this m a y be that unfit employees are inhibited about participating in sports, and again, m a y participate more in an individual exercise p r o g r a m (at least until they improve their fitness level). A s would be expected, a n increased interest in stress m a n a g e m e n t programs was seen a m o n g those employees with higher perceived stress levels. Those who perceived their level of stress as being moderate or v e r y high indicated stress m a n a g e m e n t as their first choice for a n E H A P component. T h e employees who perceived themselves as being under no, or v e r y little stress were also interested in stress management, but r a n k e d it as their fourth and fifth p r o g r a m choices (consecutively). T h e r e was a tendency for interest in individual exercise programs to increase with increased levels of perceived stress.  T h i s is consistent with the results of one study that  found high job stress to be associated with increased participation in exercise programs (Davis et al, 1987).  Perceived stress did not appear to have a n j ' affect on employees'  preferences for other fitness activities however. In regard to nutrition, interest in nutrition assessments and counselling did not appear to change with changing perception of personal eating habits. H o w e v e r , as mentioned previously, those with poorer perceived eating habits expressed a greater interest in a weight management p r o g r a m , as well as in health education programs.  144  DISCUSSION  T h e variable "frequency of exercise" was also examined in relation to the perceived health variables, to determine i f those who perceived themselves to be healthier actually exercised more t h a n those who perceived themselves to be less healthy.  It appeared that  in this population, perception of health w a s related to current frequency of exercise.  There  was a significant relationship between frequency of exercise and the perceived health variables: general health (p = 0.01), fitness level (p < 0.01), and energy level (p <  0.01),  with a n increase i n self-reported frequency of exercise being seen a m o n g those individuals who rated their general health as being better, those who rated their fitness levels as being higher, and those who reported a higher energy level after work. No significant differences were seen i n anticipated use of E H A P s based on perceived health however.  It would appear that i n this population, E H A P s appeal to all  employees, regardless of perceived health status, and therefore, efforts to m a r k e t these programs to the employees would not need to focus specifically on those employees with poor perceived health status.  However, p r o g r a m planning should take into account the  different interests (and possible barriers) based on perceived health, such as providing a n individual exercise area for those who m a y be " u n f i t " and uncomfortable about exercising in group exercise or sport programs.  C. GENERAL DISCUSSION It was observed that employees in general chose exercise activities low on their list of preferred p r o g r a m s .  Other investigations have also noted that employees seem to be  less enthused about fitness p r o g r a m m i n g on the worksite than they once were (Blozis et a l , 1988; W a l k e r et a l , 1988). Perhaps this indicates that directors of worksite E H A P s should  145  DISCUSSION  no longer focus on fitness activities, a n d instead provide more comprehensive programs, which m a n y are doing.  Without the added expense of building a fitness facility which m a y  not be used b y a large percentage of the employees, programs would certainly be less costly to a company.  T h e C a n a d a Fitness S u r v e y (1982) showed that the most popular  fitness activities a m o n g C a n a d i a n s were w a l k i n g a n d cycling. Rather than building a costly fitness facility on the worksite, the provision of shower facilities could encourage employees to walk or cycle to work, or enjoy these activities on their lunch break.  Periodic  fitness testing and counselling could also be added as an incentive to encouraging employees to initiate a n d m a i n t a i n healthy exercise habits. W h e n asked to indicate their preference for E H A P activities, the top four items chosen b y the total group (Stress M a n a g e m e n t P r o g r a m s , H e a l t h Education Seminars, Personal/Professional Education, and F i n a n c i a l Management/Budgeting) were also the first four listed on the questionnaire (although they were listed i n a different order than the employees chose them).  T h i s could indicate that the order the activities were listed in on  the questionnaire was related to the order in which the employees chose them.  However,  when the preferences were evaluated according to the various sub-groups of employees, the order these activities were chosen i n did v a r y somewhat more. T h e profile of the employees in this investigation suggest that the recommendations made b y others for increasing participation in E m p l o y e e H e a l t h and Assistance P r o g r a m s would also be applicable to the employees in this investigation. F i r s t l y , the various segments of employees within the organization should be involved in the planning and implementation of these programs, and the programs should be tailored to the needs of these groups (Feldman, 1989; K i n g et a l , 1988; L o v a t o and G r e e n , 1990; Schenck et a l , 1987).  P r o g r a m s should also be tailored to specific worksites (Schenck et al, 1987), a n d  146  DISCUSSION  should be accessible a n d convenient to all workers i f possible (Feldman, 1989; Lovato a n d G r e e n , 1990).  Changes to the work environment that are conducive to good health are as  important as providing health lifestyle programs (Feldman, 1989; L o v a t o a n d G r e e n , 1990; Schenck et a l , 1987; Y e n n e y , 1986).  A s well as environmental changes involving  work safety, other changes which are consistent with the programs that are being promoted (such as a no smoking policy to encourage smoking cessation a n d shower facilities to encourage fitness) are also important (Wilbur, 1983). A f t e r a n employee has completed a p r o g r a m (eg. smoking cessation, weight management, etc.), periodic follow up by phone or mail to reinforce health behavior changes has been shown to encourage maintenance of these behaviors (Wilbur, 1983).  T h e management principle of giving  employees feedback on their work performance (which has been shown to increase performance) has been likened to providing incentives to employees to encourage their participation in worksite health programs.  Rewards, in the form of verbal encouragement,  prizes, etc., are thought to be important incentives for encouraging employees to continue participating in programs.  T h i s principle is especially important at the beginning of  programs when the internal rewards of improved fitness, weight loss, smoking cessation, etc., have not y e t been reached, and the employee m a y perceive more barriers (eg. cost, fatigue, time, failure to see immediate results) t h a n benefits to participation (Shephard, 1988; W i l b u r , 1983). Some established programs have achieved participation rates well above the average 15-20%, such as the C a n a d a L i f e A s s u r a n c e C o m p a n y p r o g r a m , which reported that 46.5% of the employees were participating after 18 months (Shephard, 1988), a n d the Tennaco p r o g r a m w h i c h reported a 75% participation rate (Baun a n d B e r n a c k i , 1988). F e a t u r e s of these programs which the developers suggest m a y contribute to the high  147  DISCUSSION  participation include a n enthusiastic management, periodic follow up with participants, and establishing a healthy, fun image of the programs through marketing (Baun a n d B e r n a c k i , 1988; S h e p h a r d , 1988). Pfeiffer (1987) h a s suggested that contemporary principles used in m a n a g e m e n t of the organization as a whole could be effectively used in m a n a g i n g employee health programs.  H e h a s suggested a n integrated approach to worksite health promotion  including individual health, work-team health and organizational health.  M o s t employee  health programs presently consist of only the individual health component, which includes lifestyle programs, occupational a n d environmental safety, and treatment programs (eg. a n E A P ) . T h e work-team health component involves h a v i n g departments or " t e a m s " of employees who already work together on other (work related) tasks, focus on issues which affect their health a n d implementations which could improve the situation. T h e concept is that a n y factor w h i c h affects how the t e a m works together (such as a n absent employee, or one who has a n alcohol problem, etc.) is a n issue for the whole team, and not just for that individual employee. and peer support.  W o r k - t e a m health thrives on problem solving, decision m a k i n g  T h e organizational health component of this approach involves  interventions w h i c h contribute to the health of the whole organization. These, of course, would include the interventions from the individual and work-team components, b u t would also include programs and policies which affect the organization as a whole, such as benefits, retirement planning programs, providing bike racks outside all work locations to encourage personal fitness, etc. Pfeiffer sees this approach as h a v i n g a broader focus than the typical worksite health programs, a n d b y being integrated into the organization's m a n a g e m e n t principles, becoming more of a coordinated effort between the different departments.  148  DISCUSSION  T h e results of this investigation indicate that the understanding of employees' perceptions of E H A P s involves m a n y complex interactions between collar type, sex, age and other demographic variables.  In this investigation, looking at the combined effects of  two separate demographic variables (eg. blue collar m e n versus blue collar women) was not possible due to the numbers of employees in the sample, which would have caused cell sizes to be too sparse.  H o w e v e r , since it appears that there are relationships between  these demographic variables, future research designed to study these combined effects would no doubt add significantly to understanding the differences between these subgroups of employees in regard to their preferences and perceptions of E H A P s .  149  CHAPTER SIX SUMMARY AND CONCLUSIONS  A. SUMMARY Promoting a n d maintaining participation i n worksite health programs is essential to their effectiveness in improving employee health a n d reducing costs associated with ill health.  A s participation rates v a r y a m o n g different sub-groups of a n y employee  population, it is important to concentrate health promotion efforts on those groups with high need but who participate less.  P a s t research has indicated that participation is often  lower amongst blue collar workers a n d older employees.  Participation based on sex has  been reported to be dependent on the type of p r o g r a m being offered. Research has shown that individuals who have exercised i n the past are more likely to join employee health programs.  Perceived health m a y also have an effect on participation, although the results  of studies which have investigated this have not been consistent. In order to provide programs to meet the needs of those employee groups who participate less (and m a y be in greater need of a program), it is necessary to understand their specific needs a n d interests, including the actual or perceived barriers which m a y impede them f r o m using these p r o g r a m s . Therefore, the objective of this research was to explore the preferences and perceived benefits and barriers reported by a large employee group regarding E H A P s , and to discuss the implications of these to program development.  C o m p a r e d with other work  populations on which research regarding employee health programs has been conducted, this population was unique in being a non-profit organization, made up of a wide variation  150  S u m m a r y and Conclusions  of employee sub-groups (eg. blue, white and pink collar employees; various age groups, etc.), working in m a n y locations, and belonging to three different unions.  T h e hypotheses being tested were as follows: Hypothesis 1:  Associations exist between specific demographic  characteristics  (age, sex, classification of worker and exercise habits) and employee preferences and perceptions (barriers and benefits) of E H A P s in this population. Hypothesis 2:  Associations exist between perceived health status and perceived  use of, and interest i n , E H A P s i n this population.  T h e data used in this analysis were extracted f r o m a survey conducted as part of a needs assessment for a municipal government organization to determine the needs and interests of their employees for a n E H A P .  Seventy two percent of the permanent  employees of the C i t y completed the Needs/Interest Questionnaire. T h e r e were three sets of variables derived f r o m the questionnaire, w h i c h were anatyzed: (1) (2) (3)  E m p l o y e e s ' preferences and perceptions (barriers and benefits) of H e a l t h Promotion and E m p l o y e e Assistance P r o g r a m s , Demographics, and Perceived H e a l t h Status.  F o r two of these variables, the respondents were asked to rank their choices, and the overall r a n k i n g of preferences for each sub-group of employees is reported. T h e Chi-square test of independence was performed on the r e m a i n i n g variables to determine:  151  S u m m a r y and Conclusions (1)  whether the distribution of responses to each survey question (preference, barrier or benefit) was independent of the demographic variables (age, sex, classification of employee and exercise habits), and  (2)  whether the distribution of responses to questions dealing with anticipated use of, and interest in E H A P s were independent of the perceived health status variables (perceived general health, fitness, stress, energy and diet).  B. CONCLUSIONS T h i s investigation provided support for both of the hypotheses being tested.  In  regard to the first hypothesis, the major results are s u m m a r i z e d below:  1.  T h e r e were no significant differences seen in anticipated participation in health promotion, exercise or employee assistance programs based on a n y of the demographic variables, with the exception of current frequency of exercise.  Those  who reported exercising infrequently anticipated increasing their frequency of exercise if a worksite exercise program were available, whereas the anticipated use of a worksite exercise program by frequent exercisers paralleled their current reported frequency of exercise more closely. 2.  There were significant differences seen based on age, sex, and collar type, as to preference for type of fitness facility, with a n individual exercise area being most preferred b y younger workers, males, and both blue and white collar workers. Older workers more often stated that they would not use worksite fitness facilities. T h e r e was also a tendency for interest in fitness activities to decrease with age.  152  S u m m a r y and Conclusions  T h e r e were significant differences in preferred volunteer capacity based on age, sex, collar type, and frequency of exercise. Interest i n helping with fitness activities (exercise programs, sports, etc.) decreased with age and interest in helping with a peer support p r o g r a m increased with age.  Slightly more males, as  well as more blue collar workers, indicated they would participate i n , and volunteer to coach or organize sport/recreation programs.  Interest in these programs also  increased as frequency of self-reported exercise increased.  Interest in helping with  peer support p r o g r a m was highest for white collar workers and lowest for blue collar workers.  M a l e s , as well as blue collar workers were m u c h more interested in  preventive back care programs than females, white collar and pink collar workers. Weight management and nutrition assessments were more popular with females. T h e r e was a significant difference between males and females in preferred time for health promotion programs/seminars a n d exercise programs.  W o m e n , more often  t h a n m e n , would prefer to exercise at lunch time or after work, and a higher percentage of women t h a n m e n chose " l u n c h time" to attend health promotion programs and seminars.  T h e r e were significant differences based on collar type in  preferred times for health promotion and exercise programs, w i t h a higher percentage of pink collar workers preferring lunch time for both types of programs. M o r e blue collar workers than white or pink collar workers would attend health promotion and exercise programs before work. M a l e s a n d blue collar workers (especially firefighters), were m u c h more in favor of retired employees utilizing a n E H A P t h a n females, white and pink collar workers were.  153  S u m m a r y and Conclusions  6.  There was a significant relationship between sex and barriers to utilizing E A P s . A l t h o u g h most employees reported no barriers to utilizing a n E A P , there was a significant relationship between sex and these barriers, with more males reporting lack of time as a barrier, and more females reporting confidentiality as a barrier.  7.  T h e r e was a significant difference based on collar type as to whether or not the E A P referral person should be located onsite or offsite. T h e percentage of blue collar workers choosing both of these categories were fairly equal, whereas more pink and white collar workers were in favor of the referral person being offsite.  8.  There was a significant difference based on collar type as to f a m i l y involvement in E H A P s , w i t h blue collar workers being m u c h more i n favor of h a v i n g f a m i l y members take p a r t in these programs.  9.  There was a significant difference based on collar type as to perceived barriers to using c o m m u n i t y services for assistance.  Pink collar workers perceived the fewest  barriers of the three groups, whereas blue collar workers perceived the most barriers. 10.  T h e r e was a significant difference based on exercise habits in regard to comfort in " exercising w i t h fellow workers.  Those who reported exercising more frequently  were more apt to state they would feel comfortable in exercising w i t h fellow workers.  154  S u m m a r y and Conclusions  W i t h regard to the second hypothesis, the major results w h i c h were revealed are s u m m a r i z e d below:  1.  There were no significant differences in anticipated use of health promotion, exercise a n d employee assistance programs based on perceived health status.  2.  There were significant relationships found between self-reported frequency of exercise a n d the perceived health variables:  general health, fitness level, and  energy level. Those with a higher perception of health according to these variables reported a greater frequency of exercise.  C. LIMITATIONS While this study only assessed perceived needs a n d interest, and anticipated participation in E H A P s , there is evidence that these link to actual participation. It is recognized that generalization of these results to other m u n i c i p a l government organizations is limited, due to the variations between establishments, and the focus of this investigation on only one organization. Therefore, these recommendations pertain specifically to promoting participation in worksite health programs at this organization. However, they m a y also be useful to organizations of similar size and demographic profile.  155  S u m m a r y and Conclusions  D.  RECOMMENDATIONS W i t h i n the limitations of this investigations, the following recommendations for  promoting higher participation in worksite health programs appear justified:  1.  General: Building a n exercise facility would not be a logical first step for this organization in their implementation of a n E H A P as in general, the employees' preferences were higher for other program components than for the fitness-related activities.  H o w e v e r , if personal fitness is to be promoted,  providing shower facilities at various work locations m a y encourage more employees to walk or cycle to work and on their lunch breaks. If exercise programs are offered, segregated classes (according to fitness level, age, etc.) m a y be of benefit in increasing participation of employees who are uncomfortable about exercising with other workers (due to poor condition, etc.) Stress management programs were of highest interest to the total employee group, and therefore would be recommended. However, these programs should be focused on the particular needs of the groups to w h o m they are offered.  A s indicated, females m a y have very different stress management  requirements than males. A n E A P should be provided, as there was a high degree of support for this type of p r o g r a m by the employees in general.  A n E A P m a y be of greatest  benefit in steering blue collar workers toward appropriate sources of help in the community, as they perceived the greatest barriers to u s i n g community  156  S u m m a r y and Conclusions  services.  T o promote more female utilization of this type of p r o g r a m ,  precautions should be taken to assure confidentiality (eg. hiring a referral person who respects confidentiality), also, the referral person's office should be a site separate from any of the employee's work locations, as most employees were in favor of this. A n alternative to this would be to have the E A P referral agent located in the E H A P headquarters and therefore other employees would not necessarily know if a n employee was coming to see the E A P agent or merely dropping b y to pick up information on another p r o g r a m , etc.  T o increase male usage of a n E A P , allowing time  a w a y f r o m work to visit the E A P office would be important, as males stated "lack of time to use the p r o g r a m " as their highest perceived barrier. 2.  T o Promote Participation A m o n g Older E m p l o y e e s : If fitness facilities are to be provided, an individual exercise area (eg. weights, exercise bikes, or simply a walking course through the parks) which could be utilized on their own time and at their own pace would likely increase the participation of older workers, as this was their highest preference. Offer health screening and weight control programs.  3.  T o Promote Participation by M a l e s : Provide a n individual exercise area which could be utilized on their own time. Provide sport and recreation programs. Provide preventive back programs.  157  S u m m a r y and Conclusions  4.  T o Promote Participation b y F e m a l e s : If group or organized fitness programs are to be offered, they should be held at lunch time or immediately after work. T h e majority of women preferred these times, as well as a fair number of the other employees. Provide weight management programs and nutrition assessments.  5.  T o Promote Participation b y Blue Collar W o r k e r s : A g a i n , an individual exercise area was most preferred by this group.  If  weights and other exercise equipment are provided, they should be in various, convenient locations in order to be utilized by these workers.  A  weight room in C i t y H a l l would not likely be highly utilized by firefighters, treatment plant labourers, etc.  Therefore, until funds are available to  provide these facilities in the various locations, they should not be provided. If a facility were built in C i t y H a l l , the E H A P in general m a y get a "white collar i m a g e " which m a y hinder the blue collar worker participation in other programs. Provide preventive back care programs. A l l o w f a m i l y members to participate whenever possible. 6.  T o Promote Participation b y Infrequent Exercisers: T h e survey indicated that provision of some type of exercise p r o g r a m at the worksite m a y increase participation by infrequent exercisers.  T h i s could be  provided inexpensively b y organizing w a l k i n g or r u n n i n g clubs at lunch breaks, or again, providing some equipment which could be utilized by the employees at their own pace and on their own time.  158  S u m m a r y and Conclusions  7.  Recommendations for F u t u r e Research: Dependent on the application of these recommendations to the development a n d implementation of a worksite health program i n this organization, future research could evaluate the extent to which stated needs and interests predict participation. T h i s study could test whether or not the structuring of programs according to identified needs will result i n participation beyond the n o r m of 15-20%. T h i s employee group would provide a suitable population for further testing of the D a v i s model of participation i n worksite health programs (1984), or the expanded D a v i s model, which included organizational factors (Sloan a n d G r u m a n , 1988). T o expand on the present investigation, a further study could look at the interactions between the various demographic and perceived health variables as to their effects on employees' perceptions of E H A P s .  This  would require a larger employee group, to assure that when one variable (eg. blue collar workers) is further broken down (eg. to male blue collar workers versus females blue collar workers), the frequencies in each cell r e m a i n large enough to perform statistical analysis o n . F u r t h e r research investigating the barriers perceived b y blue collar workers toward participating i n E H A P s would be recommended.  Recent studies  have indicated that blue collar workers are interested i n health promotion, and have shown that participation b y blue collar workers c a n match that of their white collar counterparts if these programs are developed with the blue collar employees' needs i n m i n d .  159  H o w e v e r , since most programs still  S u m m a r y and Conclusions  report lower blue collar worker participation, it is important to better understand the barriers that are impeding their participation in these programs.  160  REFERENCES Allison, K . & C o b u r n , D . (1985). E x p l a i n i n g low levels of exercise amongst blue collar workers. C A H P E R J o u r n a l , 51(7), 34-37. B a r k e r , F . H . (1987). In pursuit of a healthier workforce. Strategy, 8(Fall), 17-21.  T h e J o u r n a l of Business  B a u n , W . B . & B e r n a c k i , E . J . , (1988). W h o are the corporate exercisers and w h a t motivates them? In R . K . D i s h m a n (Ed.), Exercise adherence. 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H e a l t h beliefs a n d exercise habits in a n employee fitness p r o g r a m m e . C a n . J . A p p l . S p t . S c i . , 9(2), 87-93. N a t i o n a l D a i r y Council. (1986). N u t r i t i o n a n d women's health concerns. Digest, 57(1).  D a i r y Council  Ontario Government. (1981). Blue collar workers a n d physical activity. Toronto, O N T : Fitness Ontario, Sports a n d Fitness B r a n c h , M i n i s t r y of Culture a n d Recreation, 77 Bloor St. West, 8th Floor.  163  REFERENCES Ontario G o v e r n m e n t . (1985). W o r k site labour fitness. A guide for employee programs. Ontario: A R A Consultants.  fitness  O r l a n d i , M . A . (1986). T h e diffusion and adoption of worksite health promotion innovations: A n analysis of the barriers. Preventive Medicine, 15(5), 522-536. Patton, R . W . , C o r r y , J . M . , G e t t m a n , L . R . & G r a f , J . S . (1986). Implementing health/fitness programs. C h a m p a i g n , I L : H u m a n Kinetics Publishers Inc. Pechter, K . (1986). Corporate fitness and blue collar fears.  Across the B o a r d , Oct, 15-21.  Pender, N . (1987). H e a l t h promotion i n n u r s i n g practice. (2nd E d . ) . N o r w a l k , C T : A p p l e ton a n d L a n g e . Pfeiffer, G . J . (1987). Corporate health can improve if firms take an organizational approach. O c c . H & S , Oct, 96-97,99. Porcello, L . A . (1985). Characteristics of professional weight control programs. In J . H i r s c h & T . B . V a n Haltie (Eds.), Recent advances i n obesity research: I V . L o n d o n : J o n Libbey and Co. L t d . R o m a n , P . M . & B l u m , T . C . (1988). F o r m a l intervention i n employee health: Comparisons of the nature a n d structure of employee assistance programs and health promotion programs. S o c . S c i . M e d . , 26(5), 503-514. Schenck," A . P . , T h o m a s , R . P . , H o c h b a u m , G . M . & Beliczky, L . S . (1987). A labor and industry focus on education using baseline survey data i n program design. H e a l t h E d u c . Research, 2(1), 33-44. S h a i n , M . , et a l , (1986). Healthier workers; H e a l t h promotion and employee assistance programs. Toronto: D . C . H e a l t h and C o . S h e p h a r d , R . J . (1988). Exercise adherence i n corporate settings: Personal traits a n d p r o g r a m barriers. In R . K . D i s h m a n (Ed.), Exercise adherence. Its impact on public health (pp305-319). C h a m p a i g n , ILliinois: H u m a n Kinetics Books. S i m o n F r a s e r U n i v e r s i t y C o m p u t i n g Services. (1988). Guide to design and analysis of questionnaires. B u r n a b y , B . C . Sloan, R . P . & G r u m a n , J . C . (1988). Participation in workplace health promotion programs: T h e contribution of health and organizational factors. H e a l t h E d . Q . , 15(3), 269-288. S m i t h , B . R . (1990). Workplace stretching programs reduce costly accidents, injuries. O c c . H e a l t h & Safety, M a r c h , 24-25. S p i l m a n , M . A . (1988). Gender differences in worksite health promotion activities. S o c . S c i . M e d . , 26(5), 525-535.  164  REFERENCES  Surgeon G e n e r a l . (1979). H e a l t h y people. T h e Surgeon General's report on health promotion and disease prevention. ( D H E W Publication N o . (PHS) 79-55071). W a s h i n g t o n , D . C . : U . S . G o v e r n m e n t Printing Office. Tetting, D . W . (1989). Perceived benefits among regular exercisers at a health and fitness center. Fitness i n Business, 3(5), 183-189. W a l k e r , S . N . , Sechrist, K . R . & Pender, N . J . (1987). T h e health-promoting lifestyle profile: Development and psychometric characteristics. N u r s . R e s . , 36(2), 76-81.. W a l k e r , S . N . , V o l k e n , K . , Sechrist, K . R . & Pender, N . J . (1988). Health-promoting lifestyles of older adults: Comparisons with y o u n g and middle-aged adults, correlates a n d patterns. A d v . N u r s . S c i . , 11(1), 76-90. W a l s h , D . C . (1982). Employee assistance programs. M i l b a n k M e m l . F u n d Q . / H e a l t h S o c , 60(3), 492-517. W a r n e r , K . E . (1987). Selling health promotion to corporate A m e r i c a : the economic argument. H e a l t h E d u c . Q . , 14(1), 39-55.  U s e s a n d abuses of  Weitzel, M . H . (1989). A test of the health promotion model with blue collar workers. N u r s i n g Research, 38(2), 99-104. W i l b u r , C . S . (1983). T h e Johnson & J o h n s o n program.  Preventive Medicine, 12, 672-681.  W o r l d H e a l t h Organization. (1984). H e a l t h promotion: a discussion document on the concept and principles. Copenhagen: W . H . O . Regional Office for E u r o p e . Y e n n e y , S. (1986). Safeway B a k e r y . C o m m e n t a r y , 2(2), 37-41.  Success story of one division. Corporate  Y o s h i d a , K . K . , A l l i s o n , K . R . & O s b o r n , R . W . (1988). Social factors influencing perceived barriers to physical exercise among women. C a n . J . P u b . H e a l t h , 79(2), 104-108. Z a v e l a , K . J . , D a v i s , L . G . , Cottrell, R . R . & S m i t h , W . E . (1988). D o only the healthy intend to participate i n worksite health promotion? H e a l t h E d u c . Q . , 15(3), 259-267.  165  APPENDIX I NEEDS/INTEREST SURVEY  166  NB:  Please return to Personnel c/o Deb Jones, on or before May 31, 1989  EMPLOYEE WELLNESS PROGRAM NEEDS AND INTEREST SURVEY Wellness programs are designed to assist employees i n prevention and/or treatment of health-related or personal problems, and to promote healthy l i f e s t y l e s . They are usually run bjr employees for employees, and can include anything from health promotion/preventive programi Csuch as health seminars or fitness programs) to treatment programs (such as an Employee Assistance Program or EAP). An EAP is a counselling and referral service through which employees can seek c o n f i d e n t i a l , professional help with problems such as f i n a n c i a l d i f f i c u l t i e s , drug dependence, etc. PART I  NEEDS/INTERESTS  NB:  For each of the following questions, please place the number or l e t t e r of your answer in the box provided.  1.  Please rank the following i n terms of ways you most enjoy learning: (By placing the numbers 1-5 in the boxes provided, with 1 being the highest) Seminars/Lectures  | j  Books/Pamphlets/Posters  r~J  Films/Videos  j j  A c t i v i t i e s (Hands-on Experiences)  j |  Other (Please Specify:  •  168  2.  An Employee Wellness Program may include some of the following s e r v i c e s / a c t i v i t i e s . Please pick the seven a c t i v i t i e s / s e r v i c e s which would most interest you, and rank them from 1-7 (by placing the l e t t e r corresponding to the s e r v i c e / a c t i v i t y you are most interested i n , in box #1, e t c . ) , in the boxes provided. a. b. c. d. e. f. g. h. i. j. k. 1. m. n. o. p. q. r. s.  Health Education Seminars/Programs (eg. Heart Health, Cancer Prevention, Aging, etc) Seminars/Programs on Financial Management/Budgeting Stress Management Programs Personal/Professional Education Seminars (eg. Coping with Change, Retirement Planning, etc) Weight Control Programs Stop Smoking Programs Preventive Back Care Programs Health Screening Assessments (ie. Blood pressure screening, blood cholesterol screening, etc) CPR/First Aid Nutrition Assessments/Counselling Fitness Assessments/Counselling Individual Exercise Programs (ie. having a personalized exercise program prescribed for you Group Exercise Programs (ie. aerobics) Walking/running programs Sport/Recreation Programs Weight Training Cut-rates at a local fitness f a c i l i t y Confidential c o u n s e l l i n g / r e f e r r a l re: personal problems (ie. marital, family, etc), f i n a n c i a l problems, alcohol/drug dependence, mental health problems, etc. Other (Please specify:  The seven s e r v i c e s / a c t i v i t i e s are:  l i s t e d above that I am most interested in  • • • • • • • 169  3.  Which of the following would concern you most about a Wellness Program in the Workplace? a. b. c. d. e.  Lack of time to participate Lack of c o n f i d e n t i a l i t y Lack of privacy Too much competition among fellow employees Other (Please explain:  |—1 I—I  ) Describe the percentage of your work day spent in the following locations: Percentage of Day Office Car/Vehicle Parks Garage Recreation F a c i l i t y (ie. Arena Swimming Pool) Fire Station Treatment  Plants  Outside Labouring Other (Please specify)  5.  If an Employee Wellness Program were made available to City employees (ie. before or after work, during lunch breaks, etc), how often could you see yourself participating - in health promotion programs/seminars? seminars in question 2) a. b. c. d. e.  Less than once/month Once/month Twice/month Three or more times/month Not at a l l .  (see  examples of programs and  •  - in an exercise program? a. b. c.  •  Once/week Twice/week Three or more times/week  Comments:  170  6.  Of the following, when would you prefer to participate i n : - programs/seminars?  j j  - exercise programs?  j j  a. b. c. d. e. f.  Before work Lunch break After work Evenings/weekends Not at a l l Other (Please specify:  )  If you were asked to voluntarily pay for the components of the Employee Wellness Program that you participated i n , how much (from the choices below) would you be w i l l i n g to pay per month for  8.  - exercise programs/activities?  j j  - health promotion programs/seminars?  j~~j  a. $10 or less b. $10 - $20 c. $20 - $30 . d. I would not be w i l l i n g to pay e. Don't know How frequently are you involved in regular physical a c t i v i t y at the present time? a. b. c. d. e.  9.  •  Would you feel comfortable participating in an exercise program with a l l your fellow workers? a. b. c.  10.  I do not exercise to speak of Less then once/week Once/week Twice/week Three or more times/week  •  Yes No Maybe  If onsite or nearby fitness f a c i l i t i e s were available for your use, what do you think you would use the most? a. b. c. d. e. f.  Showers/change area Group exercise area Individual exercise area (ie. Jogging or running area Other (Please specify) Would not use  171  weight room, exercise bike)  I I I—I  11.  12.  13.  Had you ever heard of an Employee Assistance Program (EAP) before reading this questionnaire? (Please refer to paragraph 1 on page 1 for an explanation of EAP's). a. b. EAP's would  Yes I I No I—I can be c l a s s i f i e d into three categories. Which of the following you consider to be most effective for this organization?  a.  Assessment/Referral Model - employee contacts EAP contact person, who assesses employee's problem and refers him to appropriate professional for help (EAP person does no counselling)  b.  Short-term Counselling Model - EAP contact person assesses employee's problem and provides a limited number of hours of counselling.' If problem is not solved, employee is referred on to another professional  c.  Health Promotion Model - EAP (either of above models) is offered to employees along with preventive wellness programs (ie. money management, stress management, and other programs such as those l i s t e d in question 1)  What type of service for? a. b. c. d. e. f. g.  14.  this  Financial Concerns Legal Concerns Mental Health Problems (ie. depression, stress) Personal Problems (ie. marital, family) Alcohol/Drug Dependence Other (Please specify) A l l of the above  What percentage services? a. b. c. d. e. f.  15.  problems do you think employees would use  of  employees  do you think would  1 - 5% 6 - 10% 11-15% 16 - 20% over 20% none  type  • of I I '—'  benefit  from these  •  The Employee Assistance Program contact person may be located within the organization or at some outside location. Would you be more w i l l i n g to contact this person i f he/she were: a. b.  Onsite? Offsite?  1 I I—I  172  16.  If you had personal problems and no EAP was available, what would stop you from getting help from other available sources in the City? (ie. psychologist, n u t r i t i o n i s t , f i n a n c i a l counsellor, etc) a. b. c. d. e. f.  17.  c. d. e.  should be able  Yes, in a l l programs Yes, in a l l programs i f there is s t i l l employees have signed up Yes, but only in the EAP No Other (Please specify:  to  participate  room after  in an  the  Yes No  If you were to act as a volunteer what capacity would this be? a.  22.  •  Yes No Don't know  P"1 I—I -  Should retired employees be able to use the program? a. b.  21.  Fear that i t might affect my performance appraisal Fear that my fellow workers might find out that I went Lack of time I would feel scared/intimidated about going Other (Please specify: Nothing would stop me; I would use the EAP  Do you feel that family members Employee Wellness Program? a. b.  20.  )  If you ever needed help, could you see yourself using an EAP, provided you were assured confidentiality? a. b. c.  19.  I I I—I  What would stop you from using the EAP? a. b. c. d. e. f.  18.  Unable to afford i t Would not know where to get help Would put i t off Would feel scared about going Other (Please specify: Nothing would stop me; I would use these sources  I I I—I for an Employee Wellness Program,  b. c. d.  Peer Supporter (employee specially trained in communication s k i l l s who supports fellow workers by l i s t e n i n g and perhaps referring them to the EAP) Fitness instructor Coach/Organizer of sports/recreation programs Instructor of health promotion seminars (If so, what type?)  e.  Other (Please specify:  f.  I would not volunteer  in I I I—I  Do you think an Employee Wellness Program is a good idea and should be implemented?  173  a. b. c.  Yes No Don't know  I I  I—I  How do you perceive an Employee Wellness Program being of most benefit to you? a. b. c. d. e.  Prevention of stress-related or lifestyle-related diseases/conditions Improve my a b i l i t y to cope with everyday situations Educate me about healthy l i f e s t y l e s Improve my fitness level Other (Please specify:  f.  I do not think I would benefit from a program.  Further  comments?  PART II Rate your current a. b. c. d. e.  WELLNESS SELF-ASSESSMENT  level of general health  Poor Fair Average Good Excellent  Rate your current fitness level compared to others your age and sex: a. b. c. d. e.  Not very f i t Less than average Average A bit better than average Much better than average  Rate your current a. b. c. d. e.  •  level of (physical) f l e x i b i l i t y ?  Poor Fair Average Good Excellent  174  • • •  What i s your energy level after work? a. b. c. d. e.  Poor (no energy) Fair (a bit tired) Average Good Excellent  I I I—I  How would you rate your current level of stress? a. b. c. d.  I I I I  am am am am  under under under under  a great deal of stress a moderate amount of stress very l i t t l e stress no stress  Please rate your current eating a. b. c. d. e.  Poor Fair Average Good Excellent PART III  1.  habits?  I—I I I  •  HEALTH KNOWLEDGE/BELIEFS  Although exercise is a good thing, i t cannot be of much help in reducing weight. a. b. c.  •  True False Don't know  Being overweight can be a contributing factor to such problems as heart disease, diabetes, and hypertension. a. b. c.  •  True False Don't know  Most people gain weight when they stop smoking, so i t i s better to go on smoking than to get fat. a. b. c.  •  True False Don't know  The best way to avoid low back pain is to: a. b. c. d. e. f.  Manage Stress Use proper body mechanics Avoid Obesity Exercise regularly A l l of the above None of the above  [ I I—I  Do you believe that smoking is harmful? a. b. c.  Yes No Don't know  175  •  6.  Your blood cholesterol level can be influenced by the type of fat in your diet. a. b. c.  •  True False Don't know  Employee Information 1.  Employee Type: (Please put the l e t t e r of the category which best describes you in the box provided) a. b. c. d. e. f. g. h. i. j.  Director/Manager Office Worker/Office Supervisor/Programmer F a c i l i t y Supervisor/Caretaker/Operator Enforcement/Inspection C l e r i c a l Worker/Receptionist/Steno Firefighter Labourer Equipment/Bus Operator Maintenance/Repair Worker Other (Explain i f you wish:  I I I—I  )  Age a. b. c.  16 -35 36 - 50 over 50  Name of Department: a. b. c. d. e. f. g. h. i. j. k. 1. m. n. o. p. 4.  I—I I—I (Managers/Directors may omit i f desired)  Building Inspections City Clerks E. L. & P. Economic Development Fire Personnel Engineering Public Works RCMP Transit Computers Land & Tax Treasury Services Parks Recreation/Culture Social Planning  I I >—'  Sex: a. b.  Male Female  I I '—'  Thank you for completing this questionnaire. If you have any questions, please contact Deb Jones at 342-8148 (Personnel Department).  176  APPENDIX II WEIGHTING OF SURVEY QUESTIONS  177  A.  PREFERENCE FOR PROGRAM CONTENT:  T h e r e were 19 E H A P activities listed in survey question #2,  of which the  employees were asked to pick the seven activities they were most interested in and r a n k them f r o m highest to lowest in the boxes provided. In order to determine overall employee preference for these activities, the choices were weighted as follows:  Box #:  Weighting:  1  7 points  2  6 points  3  5 points  4  4 points  5  3 points  6  2 points  7  1 point  178  B.  PREFERENCE FOR METHOD OF INSTRUCTION:  In survey question #2, employees were asked to place the numbers one to five i n the boxes provided (with one being the highest), to indicate their most preferred method of instruction. In a n a l y z i n g this question, the numbers were simply added to determine which method was most popular, (with the lowest n u m b e r indicating highest popularity).  179  

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