ron plotnikoff, phd professor university of alberta acknowledgment: tricia prodaniuk, ma, bpe
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Physical Activity in the Workplace. Ron Plotnikoff, PhD Professor University of Alberta Acknowledgment: Tricia Prodaniuk, MA, BPE Research Coordinator Slides can only be copied with permission. Director, Physical Activity and Population Health Lab (PAPH) - PowerPoint PPT PresentationTRANSCRIPT
Ron Plotnikoff, PhDProfessor
University of Alberta
Acknowledgment:Tricia Prodaniuk, MA, BPE
Research Coordinator
Slides can only be copied with permission.
Physical Activity in the Workplace
Director, Physical Activity and Population Health Lab (PAPH)Centre for Health Promotion Studies
Faculty of Physical EducationAlberta Centre for Active Living
Dept. of Public Health Science (Adjunct) University of Alberta
Health Scholar: Alberta Heritage Medical Foundation
New Investigator: Canadian Institutes for Health Research
PAPH Research Team is focused on the:
development of efficacious/effective PA programs, for
the primary and secondary prevention and treatment
of cardio vascular disease and diabetes, and the
promotion of general health.
PAPH: Physical Activity and Population Health Research Lab
Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion
Overview
Leading Causes of Death in Alberta
3.73
2.97
3.843.64
3.32
2.21
2.95
2.53.042.37
3.63
2.55
0
1
2
3
4
5
Tabacco Nutrition Physical Activity
RHA involvement in Schools, Workplaces, Health care, and community for 2002
Smoking Bans in workplaces; PA =/>more important (Population Health Perspective)
Time is one of the greatest barriers of PA – workplace is an ideal context for PA to, at & from work
Aging workforce
Workplace stress is increasing
40% of workers want rec/ex. facilities/programs
Workplace Issues
Approximately two-thirds of Canadian adults are risking their health and quality of life because of inactive lifestyles.
(CFLRI, 2001)(CFLRI, 2001)
Prevalence
Physical Activity/CVD: Population Attributable Risk
↑ Obesity
↑ Diabetes Type II
= ↑ Mortality/Morbidity & Economic Costs
Of Great Significance
CONTRIBUTING CONTRIBUTING FACTORSFACTORS
CONTRIBUTING CONTRIBUTING FACTORSFACTORS
What can we do and where?What can we do and where?
Downstream –
Midstream –
Upstream –
individually orientedtreatments
interventions aimed atinterventions aimed atworksite organizationsworksite organizations,,health care settings andentire communities
macro-level programsand healthy publicpolicies
Population Model of Prevention
McKinlay’s (1995)
The majority of Canadian adults are in the workforce.
The majority of adults are (have been) employed in workplace settings.
Importance of the Workplace
Most Can. adults (15M) spend 1/2 their waking hours in the workplace
Workplaces offer unique opportunities for health promotion
Potential to be more successful than community settings - exposure to mass reach approaches
Corporate Image and recruitment
self-esteem, self-efficacy and self-determined employees organizational support for good health practices positive effect on work culture
Productivity
increased arousal, work satisfaction, leadership development, develops communication and interpersonal skills
Employer Benefits of Workplace PA Programs
Decreased absenteeism
Toronto Life Assurance- lower absenteeism was linked to to current participation rather membership versus non-membership
Decreased Turnover
studies indicate a reduction in turnover among active employees versus inactive
helped to retain female who were employed as clerks, service workers, semi-skilled operatives and general labourers
Lower medical costs
drug purchases doctors’ visits hospital days disability days
Improved health and well-being
Social benefits (Reducing barriers between co-workers)
Increase employee commitment
Employee Benefits of PA
Cancer
Type II Diabetes
Anxiety
Cardiac Risk
Health Hazard Appraisal Scores
Blood Pressure
Body Mass Index
Bone density
Health Benefits of Workplace PA Programs
Intervention Type: Behaviour Modification (.34) Exercise Prescription (.14) Health Ed/Risk Appraisal (.06)
Worksite: University (.24) Public (.14) Corporate (.05)
Setting Onsite (.15) Offsite (.13) Dishman et al. Am J of Prev Med 15:344-361
Workplace PA Meta-analysis: Moderators of intervention effects (r)
Activity Supervision Supervised (.15) Not supervised (.12)
Incentive Reinforcement Incentives (.18) No Incentives (.10)
PA Measure Self-report (.14) Cardiorespiratory fitness (.09)
Workplace PA Meta-analysis con’t:
Participation program rate is 20-30% with only half of these participating on a regular basis.
Of the best published intervention studies – at best “small effects” on program impact ie. fitness/behaviour
….We need programs… and better ones where ones exist.
How Successful are our programs?
Demographics: gender, socioeconomic status,
occupation, visible minority groups (culture, language)
Organizational Capacity (will, infrastructure, leadership)
Working conditions
Physical environments
Factors Associated with Participation Rates
Individual level focus (P & R)
Programs not theoretically grounded (P & R)
Poor measurement (i.e., validity / reliability) (P & R)
Poor definitions of the intervention (P)
Employer cost (i.e., time and money) (P)
Lack of randomized controlled trials (R)
Practice (P) and Research (R) Limitations
Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion
Overview
Behaviour Change Theories
Protection Motivation Theory
Theory of Planned Behavior
Transtheoretical Model
Social Cognitive Theory
Theories at the Individual Level:
1. the desire to avoid illness or to get well (value) and,
2. The belief that a specific health action available to a person would prevent or remedy the illness - (expectancy).
Value Expectancy Theories
Protection Motivation TheoryProtection Motivation TheoryProtection Motivation TheoryProtection Motivation Theory
PROTECTION
MOTIVATION
Vulnerability
Fear
Severity
Self Efficacy(perceived ability)
Response Efficacy
(perceived consequences)
THREAT APPRAISAL
COPING APPRAISAL
Protection Motivation TheoryProtection Motivation TheoryProtection Motivation TheoryProtection Motivation Theory
Vulnerability
Fear
Severity
Self Efficacy(perceived ability)
Response Efficacy
(perceived consequences)
THREAT APPRAISAL
COPING APPRAISAL
Intentions BEHAVIOR
Theory of Planned BehaviorTheory of Planned BehaviorTheory of Planned BehaviorTheory of Planned Behavior
Attitude Toward Behavior
Subjective Norms
Perceived Behavioral
Control
BehaviorIntention
One of the most popular models in Health Promotion & Health Education in the past decade.
Prochaska & DiClemente (1983); originally based on smoking behaviour
Marcus – PA domain; worksite
Transtheoretical ModelTranstheoretical Model
Maintenance
Action
Preparation
Contemplation
Pre-Contemplation
Stage of Behaviour Change Model
TTM - Constructs TTM - Constructs
Self-efficacy Decisional Balance
+ Pros
- Cons 10 Processes of
Change
Health practitioners seem to like it….Why?
…staging concept; easy to use widgets
Transtheoretical ModelTranstheoretical Model
Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion
Overview
An Example…An Example…
Large Randomized Controlled Trial in Alberta (n=900)
Funded by the Canadian Institutes for Health Research and Alberta Heritage Foundation for Medical Research
Workplace Physical Activity Study Plotnikoff et al (under review, Am J Health Prom)
Step Series
Canada’s PA Guide
• Pre- and post-test exp/control group design
• Interventions were delivered at baseline and 6 months
• PA behaviour was assessed at baseline, 6 & 12 months
Methods - Results
Time
321
Ph
ysic
al A
ctiv
ity M
ea
ns
1200
1100
1000
900
800
Group
control
standard
stage
Women
StandardStage
Control
Workplace Physical Activity and Healthy Eating - Electronic
Messaging Study Plotnikoff, McCargar, Wilson & Loucaides
(2005) American Journal of Health Promotion
Funded by Health Canada
• To assess the efficacy of a 12-week electronic messaging intervention for the promotion of PA and nutrition behaviour in the workplace
Purpose
• 2598 employees - 5 large Canadian workplaces were randomized and completed baseline measures
• Exp grp received 1 weekly PA and nutrition email message (with links) for 12 wks.
Methods
TIME
321
Est
ima
ted
Ma
rgin
al M
ea
ns
960
940
920
900
880
860
840
820
800
GROUP
experimental group
control group
Men
Control
Exp.
• Tailored print-based info on PA readiness worked well for women (Study 1)
• General e-messaging worked for both genders (Study 2)
• In follow-up interviews with 10% of Study 1, women > importance of tailoring messaging/information re: gender specificity
• Consistent with much of women’s health information e.g., decisional aids
Discussion
• Study recruitment: more women participants
• Men have higher baseline activity scores than women (both studies) -- ceiling effects for men
Discussion Con’t
500
600
700
800
900
1000
Time1
Time2
Time3
ME
t.m
inu
tes
Male
Female
- self-efficacy
- intention
- cons
Men reported Men reported higher meanshigher means
Women reported Women reported higher meanshigher means
Gender Differences
At their best, theories explain:
~40-50% of intention to do a behaviour
~20-30% of actual behaviour
This declines over time….
To recap a few important points…
Definition One’s confidence in one’s ability to take action
Application Provide training, guidance, in performing action Use progressive goal setting Give verbal reinforcement Demonstrate desired behaviours Reduce anxiety
Theory: Self-efficacy Important
Demographical Factors: Age Sex Occupation Socio Economic Status Language/culture
Stage of Readiness
Tailoring Considerations
Our knowledge base is limited Most successful programs are grounded in
theory (mainly at the individual level)
Individual level strategies are partially successful – however, long-term data are needed
Organization capacity appears to be important
Current/Future Directions
Where is the field going? …
Ecological Models
The interaction between the individual (e.g., knowledge & attitudes & behaviours) with the environment (e.g., social,
organizational, community, policy/legislation).
Richard et al., Green et al., - health promotion Sallis and Owen – PA domain
Ecological Models
Individual Social Organizational Community Government Policy & Legislation Physical Environment
Levels of Intervention
INDIVIDUAL
POLICY
SOCIAL
COMMUNITY
ORGANIZATION
PHYSICAL
ENV
INDIVIDUAL
POLICY
SOCIAL
COMMUNITY
ORGANIZATION
PHYSICAL
ENV
An Example…An Example…
Ron Plotnikoff
Tricia Prodaniuk
Allan Fein
Leah Milton
Health Promotion Practice, 2005
Funded by Alberta Community Development
Program Standard and Audit Tool for Workplace Physical
Activity
Needs Assessment
51 in-depth interviews:
key stakeholders, managers and practitioners
government and private institutions in Alberta
Plotnikoff, R.C., Poon, P.P.L., McGannon, K.R., & Prodaniuk, T. (2004) Can workplace active living work? Perspectives from the workplace. Avante, 10(2), 57-70.
Phase I: 2000-2001 Objective: development of the Program StandardProcess: literature review, expert and stakeholder review
Phase II: 2001-2002 Objective: development of the Audit ToolProcess: literature review, expert and stakeholder
review, pilot testing
Phase III: 2002-2003 Objective: trialing the Program Standard & Audit Tool.Process: trial across diverse workplaces, qualitative
interviews, revisions based on feedback
Three-phased Project
Program Standard
Standard of best practices for workplace PA programs.
Based on an ecological framework
Modeled after the OHS Partnerships Program
Developed through:
Literature review
Expert and stakeholder review
Workplace consultations / trials
Audit Tool
Measures a workplace PA program against the Program Standard.
45 yes / no questions that require validation procedures
Validation procedures:
1. Observation: observing the factor in the workplace
2. Documentation: having a document in place
3. Interview: talking to employees
PREPARATION PROGRAM COMPONENTS
PROCEDURES
Management & Employee
Commitment
Environment & Needs
Assessment
Program Administration
Safety & Emergency
Management
IND
IVID
UA
L
CO
MM
UN
ITY
SOCIAL
OR
GA
NIZ
ATI
ON
POLICY
Management and Employee Commitment
Environmental and Needs Assessment
Preparation
Knowledge – Re: the benefits of being and how to be physically active
Attitudes/cognitions – Re: How the individual feels/thinks about PA
Behaviours / Skills – Performing specific physical activities; also includes skills such as time management
Individual level
Program Components
Individual counseling Behaviour modification Incentives Telephone prompting Monitoring Goal setting Health education Print materials/staged matched Information technology Publicly displayed attendance charts
Potential Strategies at the Individual level
The Pedometer Craze
Relationships between individuals that influence PA Includes relationships within and outside of the
workplace
Social climate needs to be examined for its capacity to influence PA
Positive and enhancing relationships are necessary to foster PA
Social level
Program Components
Refers to how the capacity (infrastructure/will) of the organization influences PA adoption, participation and adherence
Includes “top down” leadership and “bottom up” champions
Organization level
Program Components
• Capability of an organization to promote health, formed by its will to act and infrastructure and leadership to drive organizational change.
Example: Capacity
• Will to Act• Infrastructure• Leadership
(The Singapore Declaration, 1998)
Capacity
Anderson, D., Plotnikoff, R., Raine, K., Cook, K., Smith, C., & Barrett, L. (2004). Towards the development of scales to measure “will” to promote heart health within health organizations. Health Promotion International, 19, 471-481. Barrett, L.L., Plotnikoff, R.C., Raine, K., & Anderson, D. Development of measure of organizational leadership for health promotion. (2005) Health Education & Behavior. Plotnikoff, R., Anderson, D., Raine, K., Cook, K., Barrett, L., & Prodaniuk, T. Scale development of individual and organization infrastructure for heart health promotion in Regional Health Authorities. 2005 Health Education.
AHHP Publications:
Addresses partnerships between groups within the workplace and relationships with other organizations outside of the workplace that foster PA
Opportunities to partner with community organizations, other corporations or the government re: specific services, funding or exercise space should be sought
Community level
Program Components
Can include micro policy initiatives within the workplace that foster PA or macro, government policies that address:
Time for PA Formal recognition of participation Commuting policies Incentives for participation Implementation of programs Equity of access
Policy level
Program Components
Physical Environment Level….Design: Longitudinal Study assessed 4 interventions for increasing stair use:
1. new carpet and painting the walls
2. framed art on stair landings
3. motivational signs throughout the building
4. playing music in the stairwell
N=664 employees CDC Rhodes Building in Atlanta Georgia
Proximity sensors installed in stairwell monitored stair usage
Results: Signage increased stair usage in the first three months; Music increased stair usage in the second three months.
Conclusion: Motivational signage, and music can increase PA
Kerr, N.A., Yore, M.M., Ham, S.A. & Dietz, W.H. (2004). Increasing stair use in a worksite through environmental changes. American Journal of Health Promotion, 18, 312-215.
Program Administration e.g. evaluation
Risk Management
Procedures
The “Framework”
http://www.centre4activeliving.ca/research/reresources.html
Download the “Program Standard”, and the “Audit Tool” free of charge from the
Alberta Centre for Active Living website.
Plotnikoff, R., Prodaniuk, P, Fein, A., & Milton. Development of an ecological assessment tool for a workplace physical activity program standard, Health Promotion Practice (2005).
Workplace Physical Activity FrameworkWorkplace Physical Activity Framework – High recommended/ranked in a – High recommended/ranked in a critique of workplace health assessment critique of workplace health assessment toolstools
See: www.thcu.ca/workplace/satSee: www.thcu.ca/workplace/sat
Comprehensive Workplace Health Promotion Catalogue of Situational Assessment Tools (2006, U of T)
Internet resource which provides info on:
Research
What works & how to get started
Template for practitioners in developing a Business Case for PA in their organization
Health Canada’s Business Case for Active Living at Work
http://www.hc-sc.gc.ca/hppb/fitness/work/
Plotnikoff, R., & Moodie, J. (2003) Canadian Coalition for Active Living Policy Platform – Workplace Action Plan
Other PA/Workplace Initiatives
Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion
Overview
1. Emphasize the broad spectrum of PA2. Take an ecological approach3. Base programs on major theories of
behaviour change, org. change (and communication/marketing sciences)
4. Learn from other worksite behaviour change programs eg tobacco control
5. Partner/Collaborate intersectorally & interdisciplinary with govt, industry, university
Recommendations
6. Use linkages with other program settings eg community, home/family
7. Evaluate where possible; use valid/reliable measures; attitude & behaviour
8. Ensure “buy in” from the top
9. Ensure programs meet the needs of all employees
Recommendations
Why Physical Activity? Behaviour Change Theories Examples in the Workplace Recommendations Scenario / discussion
Overview
You have been asked to develop a physical activity program for a mid-size company which has had no such program in the company’s history. You have been provided with a “generous budget” to develop the program and the management wants to ensure that the majority of the employees will adhere to the program.
Scenario
What specific “ecological components” should the program target? In what order? And why?
Individual
Social
Organizational
Community
Policy
Physical Environment
Discussion
Thank you!
Questions?
Please contact [email protected], [email protected], or 492-4372 for further information.
*Slides can only be copied with permission.