When someone mentions the workplace and health, our first thoughts might be about safety and avoiding accidents, but workplaces also provide an opportunity for interventions to improve the general health of employees. Luke Wolfenden of the University of Newcastle in Callaghan, Australia and colleagues have looked into this and we asked him to tell us what they found for their new Cochrane Review, published in November 2018.
Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. When someone mentions the workplace and health, our first thoughts might be about safety and avoiding accidents, but workplaces also provide an opportunity for interventions to improve the general health of employees. Luke Wolfenden of the University of Newcastle in Callaghan, Australia and colleagues have looked into this and we asked him to tell us what they found for their new Cochrane Review, published in November 2018.
Luke: Several workplace-based interventions are available to improve the diet, physical activity and weight status of employees or to reduce their use of alcohol or tobacco. The implementation of such interventions can reduce the risk of future chronic disease, but their implementation is not routine and we wanted to find what could be done to improve this. We hoped to identify strategies that might help, in particular with interventions that target employee diet, activity, obesity, tobacco or alcohol use, but were disappointed to find shortcomings with the current evidence.
We searched for studies that had assessed the impact of an implementation strategy, for example, training, audit and feedback or incentives, on the fidelity of implementation of a health-promoting intervention, and were willing to include both randomised and non-randomised studies. Eligible strategies could have targeted policies and practices implemented in the workplace environment, such as changes to what is available in the cafeteria; or workplace‐initiated efforts to encourage the use of external services to promote health behaviour change, such as giving the employees subsidies for gym membership.
After much searching, we were able to include six studies: four from the USA and one each from Brazil and the UK. Four of the studies were randomised trials and all tested multi-strategic implementation strategies. The most common of these were educational meetings, tailored interventions and local consensus processes; and the workplaces included those in the manufacturing, industrial and services‐based sectors. Unfortunately, though, the general quality of this existing evidence was so low that we are not able to draw strong conclusions.
Combining the results of three of the randomised trials in a meta-analysis provided low certainty evidence that there was no benefit of implementation support in improving policy or practice implementation, compared to control. Three trials of the impact of implementation strategies on employee health behaviours provided either very low or low certainty evidence and reported mixed effects for diet and weight status, and no effect for physical activity or tobacco use.
In conclusion, the findings of our review don’t provide the clear evidence needed to know the impact of strategies intended to improve the implementation of workplace-based health-promoting policy and practice interventions. Improving this evidence base will require new studies and these are needed if policies, practices and programs designed to improve employee health are to be applied effectively and efficiently and to yield their intended benefits.
Monaz: If you would like to delve deeper into the current evidence base and watch for future updates of this review should the new studies get done, you can find the full review at Cochrane Library dot com, with a search for 'implementation of workplace-based interventions'.