Review and special article
Workplace Health Promotion: A Meta-Analysis of Effectiveness

https://doi.org/10.1016/j.amepre.2012.12.007Get rights and content

Context

An unhealthy lifestyle may contribute to ill health, absence due to sickness, productivity loss at work, and reduced ability to work. Workplace health promotion programs (WHPPs) aim to improve lifestyle and consequently improve health, work ability, and work productivity. However, systematic reviews on intervention studies have reported small effects, and the overall evaluation of effectiveness of WHPPs is hampered by a large heterogeneity in interventions and study populations. This systematic review aims to investigate the influence of population, study and intervention characteristics, and study quality on the effectiveness of workplace health promotion programs.

Evidence acquisition

A systematic literature search was conducted identifying RCTs, published before June 2012, evaluating the effect of a WHPP aimed at smoking cessation, physical activity, healthy nutrition, and/or obesity on self-perceived health, work absence due to sickness, work productivity, or work ability. Studies were included in the meta-analyses if quantitative information was present to calculate an effect size (ES). A meta-analysis, stratified meta-analyses, and meta-regression analyses were performed in Spring 2012 using Comprehensive Meta-analysis software 2.0 and PAWS 17.0.2.

Evidence synthesis

In 18 studies describing 21 interventions, the overall effect of a WHPP was small (ES=0.24, 95% CI=0.14, 0.34). The effectiveness of a WHPP was larger in younger populations, in interventions with weekly contacts, and in studies in which the control group received no health promotion. A 2.6-fold lower effectiveness was observed for studies performing an intention-to-treat analysis and a 1.7-fold lower effectiveness for studies controlling for confounders. Studies of poor methodologic quality reported a 2.9-fold higher effect size of the WHPP.

Conclusions

The effectiveness of a WHPP is partly determined by intervention characteristics and statistical analysis. High-quality RCTs reported lower effect sizes. It is important to determine the effectiveness of WHPPs in RCTs of high quality.

Section snippets

Context

An unhealthy lifestyle is one of the major risk factors for chronic diseases in developed countries.1 Additionally, for employees, unhealthy lifestyle behaviors and obesity might lead to negative effects related to work.2 Research has shown that unhealthy employees and those with an unhealthy lifestyle are less productive at work, have decreased work ability, and take more sick days.3, 4, 5, 6, 7

The workplace is considered to be a fruitful setting for public health promotion because of the

Identification of the Studies

Relevant articles were identified by means of a computerized search in the bibliographic databases PubMed, Embase, and Web of Science up until November 2011 with an update for up to June 2012. The search terms were related to (1) workplace; (2) health promotion program; (3) lifestyle: physical activity, nutrition, and smoking; (4) outcome: work ability, productivity, sickness absence, self-perceived health; and (5) RCT. In June 2012, an additional search was performed including the search terms

Evidence Synthesis

Eighteen studies evaluated the effect of a workplace health promotion program (WHPP) either on self-perceived health (n=8)26, 27, 28, 29, 30, 31, 32, 33; sickness absence (n=12)28, 29, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42; work productivity (n=4)30, 31, 41, 43; or work ability (n=2).32, 33 The study populations ranged in size from 40 to 860, and reflected a wide range of workplace settings (Table 1). The majority of the studies were from northern European countries (n=11/18). The content of

Discussion

The overall effectiveness of WHPPs was small across all work-related outcome measures: self-perceived health, sickness absence, productivity at work, and work ability. This study is the first to show meta-analytically that effectiveness of a workplace health promotion programs depends on the study population, the intervention content, and the methodologic quality of the study. This study also demonstrates the relative importance of these factors for the effectiveness. Studies performed among

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