TABLE 2.

A MODIFIED SOCIAL ECOLOGICAL MODEL TO EVALUATE FACILITATORS AND BARRIERS FOR A PARTICIPATORY OCCUPATIONAL HEALTH/HEALTH PROMOTION PROGRAM

Factors/Facilitators and Barriers	Direct Quotes/Evidence Supporting Findings
Intrapersonal
Facilitators
Employee awareness and engagement	“The involvement is the biggest piece.” [middle management interviews]
Interpersonal
Barriers
Lack of communication	“…face-to-face, one-on-one, spreading the word out, being up on the floor…instead of… half dozen people around a table deciding what the rest of the building wants.” [middle management interviews]
Peer pressure	“But the biggest, the hardest piece of it… is the peer pressure people feel in leaving their unit to go do something like this.” [employee focus groups]
Institutional
Facilitators
Role of the wellness champion	The wellness champions led the H&W Teams and bridged mutual communications between the team, managers, and employees.
Function of the H&W Team	“We’re a very small team in this building. But we really try and include everybody in what we do.” [H&W Team focus groups]
Organizational structure and participatory culture	Most managers discussed H&W as part of their organizational structure. The participatory culture emerged in the program as an important motivator.
Leadership/management support	Management support was indicated in a number of ways, including enabling staff to take time off for meetings and activities, providing space for meetings and activities, as well as providing encouragement.
In-house resources	Using existing in-house resources was a motivator for the program.
Barriers
Lack of front-line employee participation	“It’s awfully hard…. We cannot get the aides off the floor because they’re either understaffed or, so it makes it really hard.” [H&W Team focus groups]
Top-down decision-making structure	“It took a long time to implement programs due to the ‘chain of command’” and “[decisions] start from the top to the bottom.” [H&W Team focus groups]
Lack of in-house financial support	Management verbal support was not necessarily backed up by financial resources.
Corporate
Barriers
Difficulty with time release	“I think it’s time. With patient care, it’s difficult. They don’t have always the same time for breaks. They don’t have the same time for lunch.” [middle management interviews]
Lack of corporate funding	No funds were allocated in the budgets for employee H&W in three centers.

Note. H&W = health and wellness.