| Assessment of intervention efficacy and characteristics associated with efficacy |
Assess the efficacy of interventions coordinating and integrating efforts to promote individual behavior change, improve the work environment, and address work-family-community interface. See Figure 1. Identify opportunities for improved coordination across formal/informal worksite policies, programs and practices aimed at promoting and protecting worker health. Identify factors that contribute to the adoption of integrated interventions leading to both work environment changes and individual changes, and to the participation of organizations and employees (or their representatives) regarding integrated interventions that change behaviors/policies and sustain behavioral/policy changes. Assess factors associated with differential effectiveness of interventions for worksites of varying sizes, industries, and groups within worksites (management, unions, individuals, workers’ families). Investigate the effectiveness of minimal intensity or “default” intervention strategies that require little up-front investment, and deliver small doses to the majority of workers with little initiative required by the individual worker, particularly in addressing health equity, e.g., for physical activity, policy changes that mandate exercise breaks or restrict nearby parking.58 Address a range of obstacles to participation in coordinated interventions among worksites (e.g., competing priorities, organizational commitment, corporate culture, costs, lack of staff expertise) and for individual workers (e.g., scheduling, long work hours, language, privacy concerns or job control.)
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| Attending to population, job, and worksite characteristics |
Increase the generalizability of intervention research by systematically including a broad range of workers, by age, occupation, income, education, language and literacy level, gender, race, ethnicity, co-morbidities, family roles/responsibility, immigration status, urban or rural status and socio-economic position. Assess intervention efficacy by job characteristics; job title; occupational status; full time, part-time or contingent status; schedule flexibility; site-based vs. off-site (e.g., construction and transportation) Assess worksite intervention efficacy across a range of worksite characteristics, including by industry, size, turnover rates, unionization status, rural versus urban location, public/private sector, and other key factors. Assess the interplay of organizational policies (formal/informal) and practices related to health promotion and health protection, roles of management structure and collective bargaining, leadership style (e.g., transactional, transformational), and management practices in supporting or inhibiting health program effectiveness, sustainability and worker engagement. Assess factors associated with employers’ decisions in purchasing programs, including economic outcomes that may elucidate the business case for worksite health programs.
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| Use of appropriate study designs and methods |
Select methodologically rigorous and theory-based research designs appropriate to the research question and setting, including cluster randomized controlled trials, observational studies, panel/cohort studies, time series analyses, monitoring/surveillance studies, natural experiments and qualitative studies. Assess multi-level interventions, e.g., individual, interpersonal, family, workplace policies and state and national policies (e.g., legislative, regulatory) using appropriate statistical techniques accounting for intra-class correlation and clustered data. Develop a registry of worksite health promotion/health protection efforts that would provide a means of tracking existing worksite health efforts over time. Use participatory research approaches that seek involvement of individuals and groups likely to be affected by worksite interventions, both work site-based (e.g., employees, senior/middle management, employee health services, human resources, benefit plan, employee assistance, absence/disability management, medical, organization development, and labor unions) and community- based (e.g., families, worker advocacy groups, committees on occupational safety and health and occupational medicine clinics). Stimulate the use of mixed methods (quantitative and qualitative methods combined) and comparative case studies to gain access to in-depth descriptions of processes in the context of real-world environments that can aid in the identification of best practices and provide examples of practice-based evidence of successful programs.
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| Application of appropriate and expanded measures and metrics |
Measure multiple exposures, processes and outcomes, including morbidity, mortality, risk factors, health behaviors, incidence, presenteeism, absenteeism, work ability index, biological markers, quality adjusted life years (QALYs), organizational culture, economic measures (including return of investment, productivity and related indicators), sustainability, process measures, work-family spillover and cross over effects. Develop parsimonious measures, such as health risk appraisal tools that incorporate health behaviors, occupational hazards, and work-family balance. Assess the wide range of hazardous occupational exposures, including toxic substances; long work hours, shiftwork, harassment and other work stressors; organizational restructuring or downsizing; lean production; temporary or contract work; and telecommuting and home work.129 Examine potential mediators and moderators of intervention effectiveness, change, cost variables (cost effectiveness, cost benefit and return on investment). Assess factors that document the mechanisms of change, e.g., intervention reach, levels of employee participation, dose delivered, dose received, fidelity to intervention objectives, implementation, and intervention exportability.72 RE-AIM (reach, efficacy, adoption, implementation and maintenance)161 and the 4 S’s of program design (size, scope, scalability and sustainability)148
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| Studying sustainability and knowledge transfer |
Study the process of adaptation of evidence-based interventions for use with employees and special subgroups of workers at disproportionate risk of chronic disease (e.g. adapt for low wage workers, literacy and ESL concerns, shift workers, etc.) Assess program adoption and implementation of packaged evidence-based worksite health promotion/health protection interventions. Conduct research on the process of knowledge transfer to identify factors that promote or inhibit program adoption, implementation and maintenance within a range of worksite settings, including employee and management involvement.
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| Addressing global concerns |
Assess the impact of competition in the global economy and policies related to globalization (e.g., deregulation, privatization) on working conditions, work-life balance and health. Identify ways to promote better work environments and employee health for employees of multinational corporations outside the U.S. Measure and redress health disparities in the U.S. and in a global context.
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