Getting the message across
For any health promotion programme to have an impact it must be creative and innovative or it will simply be ignored. Agood knowledge of your workforce will help a tailor-made approach to reach the target and bring real results. By Liz Hall
Running an effective health promotion is about much more than pinning up the odd smoking cessation poster in the hope that staff might notice it on their way to the canteen.
For a health promotion programme to have an impact, it should be underpinned by needs assessment, clear goal setting, cost-benefit analysis and outcome measurement.
But it should also be creative and innovative to capture and keep capturing the interest of complacent or reluctant employees.
"The most important thing is to stimulate debate, to be light-hearted and informal to get people interested," says occupational health nurse John Walker, who was involved in running a successful scheme at Motorola's factory near Glasgow before it closed.
Staff need to be motivated
Staff reluctance was certainly something that faced BAE Systems Marine's occupational health manager Karen Bryce.
The shipbuilding firm's workforce - some 4,500 staff in Glasgow and 5,000 in Barrow - is about 90 per cent male.
"The male staff here are very resistant to change and reluctant to look after their health," says Bryce.
Before embarking on health promotion interventions, it is important to draw up a profile of the workforce, assessing specific needs. Apart from areas common to all workforces such as heart disease, each industry will have different needs, with slips, trips and falls common in construction, and musculoskeletal disorders typically common in the high- tech sector, for example.
In BAE Systems Marine's case, around 42 per cent of its male employees were in the high-risk group for cardiovascular disease. Musculoskeletal problems and manual handling injuries were common because of staff working with heavy machinery in tightly confined spaces. Eye injuries were also rife, with many men refusing to wear protective eyewear. A year ago, it was not unusual for 10 staff in one day to be rushed off to the local eye infirmary, some of them with horrific injuries.
Despite employee reticence, Bryce set up health promotion strategies to tackle some of these problems. She carried out a cost-benefit analysis demonstrating to top management the financial implications of eye injury - the cost of taxis to and from the infirmary and lost productivity, for example.
Selling the message to management
Bryce says, "It is important to be able to cost-benefit things to sell it to management, spelling out how much is spent dealing with problems and highlighting how things could be cheaper."
She enlisted support from managers, set up team briefings and ran a poster design competition.
Since the eye protection campaign, the cost of dealing with eye injuries has more than halved and Bryce cannot remember the last time an employee was sent to the infirmary.
Last November Bryce launched a manual handling campaign, tying in with National Back Care Week. It featured eye-catching posters from the Arthritis Society, prizes, a physiotherapy questionnaire, a roadshow in the canteen and taster sessions of activities such as yoga and Pilates, which have proved highly popular - even with the men.
Sickness absence - much of which was due to musculoskeletal problems - has dropped from 14 per cent to 3.6 per cent in the last year and a 30 per cent reduction in musculoskeletal problems has been achieved since November.
"This is very good for this industry. People are now reporting problems more quickly and getting sorted out earlier," says Bryce.
Apart from being creative, effective health promotion programmes should make good use of local resources and attract the support of managers at all organisational levels.
"You need support from top level management and managerial support from all departments. Once employees see this effort, you see rewards," says Walker, who now works for Corporate Health, a contractor providing occupational health services to Scottish Equitable.
Motorola's scheme Workplace Health at Motorola was based around the effective use of existing resources. The Wham team worked closely with human resources, the on-site fitness centre, the canteen and the employee assistance provider.
Having assessed which needs should be addressed, it is important to set out clear goals before embarking on health promotion interventions. Typical goals might include reducing the number of smokers in the workplace, tackling obesity, promoting healthy eating, and reducing staff turnover or absenteeism.
Wham's overall goals were to increase staff retention and tackle staff turnover but it also set itself numerous other goals along the way such as increasing attendance at the workplace fitness centre. This it achieved, with fitness centre membership having increased noticeably two years after Wham's launch. Employee turnover, graphed by the OH department, was significantly dropping, as was absenteeism. A three-day working week of 12-hour shifts was common for much of the 4,500 strong workforce overseen by Wham.
Many organisations take their lead from government bodies when setting goals. Tying in with the Health and Safety Executive's occupational health strategy, Securing Health Together, Scottish Equitable has stepped up its efforts to tackle absenteeism. Its goals are to cut the number of days lost to ill health by 30 per cent over a 10-year period as well as to improve opportunities for rehabilitation back to work.
The financial institution's absenteeism rate is comparatively low at 4.2 days a year per employee, equating to an average of 1.69 per cent overall. The figures have been monitored since 1996 and each year the absence figure has been falling at a rate of 0.3 per cent.
"We are keen to maintain this low percentage through various occupational health efforts, but as you can see we are reaching a point where maintenance of the figures at a low level will become a major priority, as people do become ill at times," says Walker.
Evaluation
One of the keys to effective health promotion is incorporating evaluation into any new intervention programme. It is no good collecting figures after the intervention - they need to be collected beforehand to allow for constructive comparisons.
The Health Development Agency recommends using quantitative and qualitative procedures as well as statistical techniques and randomised controlled trials where possible.
But evaluation is seen by many as difficult and time-consuming. "We do things like keep accident statistics but we haven't got an evaluation system set up yet as it's very time-consuming and difficult because of having to do individual risk assessments. You end up relying on people's honesty," says Bryce.
Walker agrees, "Evaluating health promotion is not easy as it tends to be about evaluating interest. Some people get help then don't feed it back to you and how do you evaluate wellbeing? But you can look at things like rises in attendance or productivity or focus on specific areas," says Walker.
The Wham team drew up monthly graphs on a range of things including interest from staff in fitness training or blood pressure management and information sent out.
Interventions
Health promotion interventions offering staff something concrete or targeting individuals tend to be popular. A Health Education Authority study of 15 workplace health promotion programmes concluded that, "individualised delivery of information appeared effective in a range of interventions".
On-site cholesterol tests and massages proved popular at City bank UBS Warburg's health fair, which has been held annually for the last five years, attracting around 800 visitors a day. The event aims to promote health education to all employees with the goal of preventing long-term disease.
"We promote key issues relating to healthier lifestyles, preventing long-term disease and helping staff relax," says Elaine Fletcher, occupational health practice nurse.
The global bank employs some 7,000 staff in the UK, many typically working 12 to 14 hour days. Stress is a major issue, causing insomnia for some staff.
The fair consists of stalls offering information on areas such as exercise, healthy eating, smoking cessation, relaxation techniques and travel vaccinations. On-site blood pressure and cholesterol level testing is available and nutritionists and complementary therapy practitioners such as reflexologists are invited to exhibit. The British Heart Foundation exhibited for the first time at this year's event, held in July.
Although Fletcher says there are too many employees to do individual follow-ups after the fair, the event has definitely become more well known.
"We have about 1,000 new people a year and existing staff have now come to expect the fair. We have never had any negative response."
But as Bryce warns, however, successful an intervention is, it is important not to rest on your laurels. "People forget and you need to be innovative to keep their attention. As soon as you stop paying attention to it, the problems start cropping up again."
NHS Health Promotion England: www.hpe.org.uk
Health Development Agency: www.hda-online.org.uk
Health Education Board Scotland: www.hebs.org.uk
How to run an effective programme
