Larry Chapman’s Blog

Results-Driven Worksite Wellness

Prevalence and Trends in Lifetime Obesity

Author: Larry Chapman

Introduction: Estimates of obesity prevalence based on current BMI are an important, but incomplete indicator of the total effects of obesity on a population. Methods: In this study, data on current BMI and maximum BMI were used to estimate prevalence and trends in lifetime obesity status, defined using the categories never (maximum BMI ≤30 kg/m), former (maximum BMI ≥30 kg/m ≥30 kg/m and current BMI ≤30 kg/m), and current obesity (current BMI). Prevalence was estimated for the period 2013–2014 and trends for the period 1988– 2014 using data from the National Health and Nutrition Examination Survey. Predictors of lifetime weight status and the association between lifetime weight categories and prevalent disease status were also investigated using multivariable regression.

Results: A total of 50.8% of American males and 51.6% of American females were ever obese in 2013–2014. The prevalence of lifetime obesity exceeded the prevalence of current obesity by amounts that were greater for males and for older persons. The gap between the two prevalence values has risen over time. By 2013–2014, a total of 22.0% of individuals who were not currently obese had formerly been obese. For each of eight diseases considered, prevalence was higher among the formerly obese than among the never obese.

Conclusions: A larger fraction of the population is affected by obesity and its health consequences than is suggested in prior studies based on current BMI alone. Weight history should be incorporated into routine health surveillance of the obesity epidemic for a full accounting of the effects of obesity on the U.S. population. The population burden of obesity is larger than indicated by data on current BMI alone. In total, half of the U.S. adult population has been affected by obesity in their lifetime compared to the 37% who are obese based on current weight status. The formerly obese population, which accounts for the gap between these two estimates, is an important and growing minority of the population with elevated disease risks. It should be distinguished from never obese individuals in routine health surveillance for a full accounting of the effects of obesity on the U.S. population.

The types of issues addressed in this article includes:

  • Prevalence and trends for obesity in the U.S. population.
  • Percentage of people who are obese now and where obese at some point in their lives.
  • Importance of obesity in employee health surveillance.
  • Age, race, gender and ethnicity differences in obesity.
  • Common disease conditions associated with obesity.

Wellness professionals can use this information to:

  • Compare their own populations to national data.
  • Educate management about the importance of weight management in working populations.
  • Evaluate the incremental effect of their obesity prevention efforts.
  • Make a stronger case for a more serious weight management initiative within their wellness program.
  • Relate data on obesity to the incidence and prevalence of 8 common diseases.

In summary, this is an authoritative look at the size, significance and occurrence of obesity for Americans.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Newly Released Health Insurance Chartbook for 2016

Author: Larry Chapman

Recently the federal government released one of the most comprehensive and authoritative chartbooks profiling health insurance coverage, costs and trends for working Americans.  This 168 page publication provides one of the most sweeping and most valid profiles of employer provided health insurance coverage and characteristics that has been published to date.  It also includes a large number of useful graphs and charts that can be extracted and used to educate senior management and employees on health cost and health insurance related issues.

The Medical Expenditure Panel Survey Insurance Component (MEPS-IC) is an annual survey of private employers and State and local governments. The MEPS-IC produces national and State level estimates of employer-sponsored insurance, including offered plans, costs, employee eligibility, and number of enrollees along with a number of other issues.

The types of issues addressed in the Chartbook includes:

  • Major trends affecting health insurance coverage.
  • Differences in health insurance coverage by firm size.
  • Trends and patterns for single, employee plus one and family coverage.
  • Health insurance offer and take up rates.
  • Premium costs and employee cost sharing trends.
  • Employee cost sharing patterns.
  • Employee eligibility and enrollment rates and trends.
  • Health plan characteristics by firm size and type.

Wellness professionals can use this information to:

  • Compare their organization or client organizations health plan coverage.
  • Design wellness health plan incentives.
  • Estimate potential for economic return for wellness programming.
  • Augment employee education on health care consumerism and medical self-care.
  • Estimate likely health plan premium growth rates.

In summary, this is an excellent comprehensive reference on health insurance coverage and costs in the U.S. up to and including 2016.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

New Guidelines for the Diagnosis and Treatment of Hypertension

Author: Larry Chapman

On November 13, 2017,  the American College of Cardiology (ACC) and the American Heart Association (AHA) released a new report that recommends changing the clinical parameters for the diagnosis of hypertension from 140sbp/90dbp to 130sbp/80dpb.  This is a big deal and will affect everyone who performs blood pressure measurement including worksite wellness programs and specifically their preventive screening interventions.  This change also means that tens of millions of more people will now be diagnosed with hypertension and will now need lifestyle and prescription drug intervention.
The full report which is 400+ pages is available at no cost on the American College of Cardiology website at http://www.acc.org/guidelines.

Below you will find a much more readable and practical document called the 2017 ACC/AHA/AAPA /ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: GUIDELINES MADE SIMPLE: A Selection of Tables and Figures.

It is interesting that the full report has no mention of the United States Clinical Preventive Services Task Force (USCPSTF) which will ultimately have to weigh in on this significant change in clinical standards.  The ACC and AHA apparently feel that they have sufficient research data to meet the burden of proof required for USCPSTF agreement.  The National Institutes of Health (NIH) will also have to weigh in on this change as it relates to the National High Blood Pressure Education Program.

The document you can download below will allow you to:

  • See the full new standard including new numbers for various stages
  • Assess the epidemiological relevance of the change
  • Adjust your preventive screening activity and employee education efforts
  • See the recommended advice on hypertension that physicians are expected to give patients
  • Use this change to energize your preventive screening activity

In summary, this is an excellent quick reference on the newly recommended standards surrounding the diagnosis and treatment of hypertension.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Short Primer on Evaluation of Worksite Wellness Programs

Author: Larry Chapman

This 30 page document provides a quick and efficient look at key issues in program evaluation of worksite wellness and health promotion programs.  It includes discussion of a number of key issues and is a helpful reference in establishing your own approach to program evaluation.  The table of contents includes:
PURPOSE, SCOPE AND FORMAT …………………………………………………………………  1
IMPORTANCE OF EVALUATION …………………………………………………………………..  1
TYPES OF EVALUATION ……………………………………………………………………………….  1
Structure Evaluation …………………………………………………………………………………………. 1
Process Evaluation ……………………………………………………………………………………………. 2
Outcome Evaluation  ……………………………………………………………………………………….. 2
Interrelationship of Variables …………………………………………………………………………….. 2
Qualitative versus Quantitative Evaluation ……………………………………………………….. 2
SETTING REALISTIC EXPECTATIONS ………………………………………………………………  3
Program Budgets ……………………………………………………………………………………………… 4
HRA participation …………………………………………………………………………………………….. 4
Tobacco Cessation Rates …………………………………………………………………………………. 4
Medical Care Cost and Absenteeism Reduction ……………………………………………… 4
Other program outcomes ………………………………………………………………………………… 4
METHODOLOGY FOR OUTCOMES EVALUATION ………………………………………….  6
Study Structure …………………………………………………………………………………………………. 6
Posttest Only ……………………………………………………………………………………………………………..  6
Pretest/Posttest ………………………………………………………………………………………………………….  6
Pretest/Posttest Structure with a Comparison Group  …………………………………………………  6
Experimental Design  …………………………………………………………………………………………………  7
Solomon Four Group ………………………………………………………………………………………………….  7
Time Series or Longitudinal Analysis ……………………………………………………………………………  7
Measures………………………………………………………………………………………………………….. 8
Validity ………………………………………………………………………………………………………………………  8
Reliability ………………………………………………………………………………………………………………….  10
Study Sample …………………………………………………………………………………………………. 12
Representative ………………………………………………………………………………………………………..  13
Size  …………………………………………………………………………………………………………………………  13
Analysis …………………………………………………………………………………………………………… 14
TYPICAL EVALUATION STRATEGIES …………………………………………………………….  15
No Evaluation Efforts……………………………………………………………………………………….. 15
Compare Health Risk Assessment (HRA) Over time …………………………………………. 15
In-depth, longitudinal analysis.  ………………………………………………………………………. 15
REFERENCES …………………………………………………………………………………………….  21

Excellent quick reference on program evaluation.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Summary of Evidence on Text Messaging and Health Behavior Change

Author: Larry Chapman

This edition of Connections contains a brief summary of the findings from 15+ research studies on the effectiveness of text messaging (‘SMS’) in assisting with health behavior change.  ‘Mobile’ is old news. With mobile devices going from a curiosity to a virtual appendage for most workers in the 10 years since the launch of the iPhone, it is no surprise that more wellness programs have an associated app. But apps aren’t a silver bullet. They have a learning curve and are hard to get employees to download and consistently use. In addition, about 60% of app users disable notifications-making apps unable to drive engagement proactively. Unfortunately, most wellness programs ignore the most powerful engagement tool of all: the humble text message (AKA ‘SMS’).

TEXT MESSAGING USAGE STATS:
* 90% of texts are read in less than 3 minutes
* Texts have 4x the open rate of emails
* 81% of employees use text messaging at least weekly
* 95% of employees are on an unlimited text  messaging plan
* Text messaging is now the preferred channel  for customer service

Given the level of engagement of text messaging, it is surprising how few wellness programs leverage on this communication medium. In the past year, of the many employers we have spoken with, only a couple reported that they use SMS in their programs. Fear, uncertainty, and doubt persist about text messaging. Even though many dentists text patients, many HR leaders still feel worried about using text messaging to reach employees. Some fear that employees will be charged for text messages, even though almost all employees are on unlimited texting plans. Most employees want to text for work: In a recent survey, 70% of employees preferred text to any other channel for communicating on work topics.

Text messaging may well enable wellness professionals to move into both personalized and proactive programming resulting in significant boosts in employee participation and engagement. Wellness professionals need to consider harnessing the power of text messaging for their own programming.  If you want to explore the use of one of these newly emerging SMS tools please contact us.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Do you AMSO? “O” is for opportunity to practice behaviors

amso-practice

When was the last time you had someone from IT help you solve a particularly annoying software problem? For me it was yesterday. Well, as you listened to the solution and if you didn’t write down the instructions or practice the fix several times, what is likely to happen the next time you run into that same problem? It won’t be pretty. I am sure you too have learned that the key to using new technology is taking the opportunity to practice.

Unfortunately much of life follows this pattern and wellness skills aren’t an exception. In the language of AMSO, the “O” represents “Opportunity to practice the new wellness behavior.” If our workplace wellness programs are not giving people clear opportunities to practice new healthy behaviors and refine skills then they are not likely to adopt these new behaviors and actually change their long term health behavior. And remember: no behavior change –> no health improvement –> no economic/measurable impact –> in no time you have no program!

Practicing skills gives allows us to do something enough so that it begins to feel familiar and natural. In the process of getting familiar we learn how to overcome little things that will otherwise grow into real resistance to performing the new healthy behavior. Unfamiliarity is often an enemy of behavior change because it can create uncertainty, fear or increase the perceived personal “cost” associated with overcoming that which is unfamiliar.

An opportunity to practice gives us an entry point to a new skill like healthy meal planning, adding a walk to our daily routine, or core strength exercises that prevent back pain. Opportunity can depend entirely on individual action or it can harness the social power of having others involved. It can also include feedback loops such as recording or tracking a behavior or using wearable tools like a Fitbit.

How many opportunities to practice are necessary? There isn’t hard science on this but the more the better! People will self-select into these opportunities but we want to provide enough options so that no one fails to change for lack of opportunities to practice. Also many wellness behaviors are carried out once every year or three, such as a preventive screening. In the case of episodic behaviors we probably want to make sure we have reminder systems in place.

The critical thing for us to remember about AMSO is that the opportunity to practice needs to be repeated often enough to lead to the formation of a habit. Habits are really the result of our consistent intention multiplied by the number of opportunities to practice. Habits are powerful and need to be cultivated and re-cultivated over time. We are actually trying to build a whole constellation of healthy habits in the individuals we seek to serve with our wellness programs.

Here ways that our wellness programs can provide the opportunities for practicing a new health behavior:

  • Tip #1 – Embed the practice experience into the program activity: Regardless of the type of wellness program activity always include a practice session (or sessions!) into the activity. If it’s an educational session like a lunch and learn have part of the time dedicated to actually doing or practicing the specific activity to the maximum extent possible. Demo everything always including websites, YouTube videos, wellness coaching calls, health advice lines, stretches, specific exercises, stress reduction strategies, and testing.
  • Tip #2 – Emphasize explicitly the formation of habits in all programs: Make explicit the discussion about tips for forming healthy habits. Talk about relapse prevention and behavior modification to help participants form consistent habits. The overriding concern of the wellness program should be habit formation not just the one time performance of a specific health behavior. Provide tools for participants that are intended to help them form those long term habits.
  • Tip #3 – Plan follow-up sessions that emphasize practice opportunities: For each formal wellness program activity provide a follow-up practice session where it makes sense. Using experiential learning to its maximum extent always plan a week later session or month later session and label them “follow-up practice session”. Give people an opportunity to reconnect with the skills.
  • Tip #4 – Actively link people who want to practice the same new behavior: Create or utilize social networking technology to help aggregate people who are working on the same health behavior change so that they can practice the new behavior together.   This method works well with walking, group exercise, fitness facility use, nutritional learning experiences like grocery store walk-throughs, healthy pot-lucks, watching LMS modules together with discussion afterward, healthy vacation options, stress reduction technique practice, humorous movies, chair massage, and many others.
  • Tip #5 – Orient wellness coaching to focus on practicing the new behavior: Have wellness coaches focus on helping the individual structure practice sessions for the behaviors they are working on. They should formulate personal wellness objectives that emphasize practice. Look for ways to suggest practice opportunities that can be piggy-backed into the person’s average day. If the wellness coach is asking consistently about practice experience of the individual it is likely to have a stronger behavior change impact on the individual.
  • Tip #6 –Use criteria in wellness incentive programs to emphasize practice: We believe that a long term wellness incentive program linked to $600 to $1,200 of reduced health plan contribution levels tied to a variety of wellness criteria is a necessary end game strategy for all Results-Driven Wellness programs. These incentive criteria can be crafted to encourage practice of healthy behaviors. The criteria can also be constructed to provide formal opportunities for practicing specific behaviors. The individual criteria can have alternative ways of being met and can include practice considerations.
  • Tip #7 – Use annual wellness incentive programs to draw people back to selected wellness practices: The core long term wellness incentive program can also be used to call individuals back into wellness behaviors and to practice sessions. This overall process is what we call an annual opportunity to “get on the Wellness bus.” This calls people back to practice opportunities.
  • Tip #8 – Start acknowledging people who have formed a new healthy habit: Just as many wellness programs do write-ups about people who have accomplished a significant wellness event, such as hiking through the Himalayas you can also do write-ups of people who have successfully developed a new wellness habit. If you set the definition of a “habit” as a full six months of a minimum level of behavior change then you can acknowledge those individuals and give an impetus for people developing a new habit.

This focus on structuring opportunities to practice the new skills and new behaviors needs to be intentionally built into every aspect of your program. At the same time you need to constantly work to bring new ways to help people change by helping them practice the new behavioral skills and develop those healthy habits.

Next time we’ll look at the new initiative of the Health Promotion Advocates to bring wellness and health promotion to every American.

Don’t forget, strategies for using AMSO are a key area of emphasis in each level of certification in the WellCert Program!

WellCert Grads: Check out our new WellCert Membership and be sure to sign up for your FREE TRIAL!

Do you AMSO? Part 3: “S” is for Skills

coach-skills-huddleTrue confessions: I grew up in Southern California with lots of opportunity to surf, but was a pretty lousy surfer. I could never get the fine balance skill between being too far forward “pearling” the board and being too far back and missing the wave. I lacked the key skill that would have helped me be in the right place on the board at the right time and place in the wave.

Unfortunately, I didn’t get the help I needed to develop the skill I was missing. That’s a real regret of mine. As a result I did become a pretty competitive body surfer and body boarder, but I still regret that I didn’t get the help I needed to be the surfer I wanted to be.

The “S” in AMSO is for skill acquisition–acquiring skills that support the new healthy behaviors participants want to take on. To bring the “S” in AMSO, your wellness program has to have various methods that help people acquire the new skills they need to become a regular exerciser, eat more healthily, reduce tobacco use, reduce heart disease risks, maintain a healthy body weight, handle stress more effectively and many more specific healthy behaviors.

The desired new healthy behaviors participants are motivated to adopt always require the acquisition of new skills for the individual making the change! The skills are complex and need to reflect individual differences and circumstances.

If your wellness program is not helping people get those new skills across the full range of prevention targets your program is addressing, then it is not likely to be effective at helping people change their short term, let alone long term health behavior.

No participation-> no skill acquisition; no skill acquisition -> no behavior change; no behavior change -> no health improvement; no health improvement -> no economic return. None of the above –> no program and no worksite wellness career!

But remember, acquiring a new skill is not rocket science, we learn new skills all the time, but we do need to thoughtfully build in to our wellness programs many ways and options for learning those new skills. Skills are fundamentally about how we do something.

Some of us need more help than others at picking up what the new skill is and how we actually should go about doing something. Some of us can simply be told how to do something and we will figure it out. But others of us need to see someone doing the new skill in order to grasp it and yet others need to have a coach giving them personal feedback on how we are doing with the new skill.

Here are the major ways that our wellness programs usually impart the skills associated with a new health behavior.

Method #1 – Provide written information on demand: In newsletters, informational brochures, websites and FAQs that address how to do what you need to do to change that unhealthy behavior into a healthy behavior. We are talking about things like: how to quit smoking, how to use a fitness facility, how to eat healthy on the road, how to lose weight, how to manage your personal stress, how to moderate your alcohol consumption, how to seek advice for common self-limiting medical symptoms, how to select a PCP, how to build your personal resilience and literally hundreds of other “how-to’s”. However, the information provided has to be intentionally skill oriented and organized in easy to follow step-by-step sequence.

Method #2 – Provide video and learning modules: Why is YouTube so popular? Among other things because It gives people clear visual examples of how to do something. Helpful YouTube videos can be made available that cover key health behavior skills and more formal Learning Management Systems (LMS) can be used in the same way to emphasis the acquisition of key skills for specific health behavior changes. Those under 40 years of age are beginning to see video as THE main way they want information.

Method #3 – Provide experiential learning opportunities: Experiential learning is powerful and effective if done correctly. Tasting a healthy salad after seeing how it is made can help someone acquire that new skill. Having them make the salad themselves is another great experimental skill-building technique. Going through a cafeteria line with a nutrition coach giving feedback about your choices would be another example of experiential learning. Taking someone through the set-up process for a Fitbit wearable would be another example. Using a fitness facility for the first time with a buddy that has used one for years and coaches you would be another example. Navigating a restaurant menu with a wellness coach would be an example of experiential learning at its most practical. Lots of ways experiential learning can be woven into the fabric of your employee wellness program!

Method #4 – Provide telephonic coaching help: Using telephonic coaching is a typical intervention that wellness programs use to help participants acquire the necessary skills to prepare for or begin a healthy behavior. Trained and/or certified wellness coaches can provide skill building expertise to employees. The coaching help can be one time or multiple times over a year period and it can be combined with supplemental learning techniques such as biblio-therapy, support groups, health advice line use, website use and other methods. If we know how our participants likes to learn we can augment the coaching process and make it even more powerful.

Method #5 – Provide face-to-face coaching help: In many situations it is possible to use wellness coaches in the work environment on a regular basis. This process can be made available to specific work groups or for specific health behaviors and can become a regular part of the work environment. The wellness coach can help participants individually scope out and prepare for a behavior change and problem solve to help reduce recidivism. The process of knowing that you will be facing your coach soon is also likely to help support your change process.

Method #6 – Provide wellness mentors: By intentionally linking those employees of the same gender that have already successfully made a specific health behavior change with those who are just starting out with a similar change you can set up an opportunity for key skills to be acquired. Mentors are not trained wellness coaches, but can be trained and alerted to focus on the how-to issues reinforcing what skills their mentee needs to acquire.

This focus on skill building and skill acquisition in all these methods need to be strongly and clearly aligned and we need at the same time to constantly work to bring improvements to our efforts to help people change by helping them acquire new behavioral skills.

Next week we’ll look at the “O” in AMSO- a powerful framework for making sure your wellness program is producing results!

Don’t forget, strategies for using AMSO are a key area of emphasis in each level of certification in the WellCert Program!

Do you AMSO? Part 2 – “M” is for Motivation

sale-incentives

Think about the last time you found yourself shopping for clothes. Looking over the multi-colored business shirts at Joseph A. Banks last week, though I needed a shirt, I wasn’t feeling that motivated to jump in and buy. Sensing my interest in the shirts, the saleswoman informed me about their current deal: three shirts for the price of two! So like magic I went from thinking I needed maybe one shirt to walking out with three!

Don’t you feel bombarded by deals, special incentives, and promotions? If the multi-trillion dollar retail marketplace uses these tricks to take latent intrinsic motivation all the way to a sale, why should we be surprised that we need incentives to trigger action in wellness?

The “M” in AMSO stands for Motivation. I was motivated by the deal to buy 3 shirts instead of 1. The tried and tested AMSO framework holds that effective wellness programs need to have multiple strategies for enhancing the intrinsic motivation for wellness that already exists in participants. In my experience about 20% of most populations are already intrinsically motivated to engage in wellness even before a wellness program is offered. The problem is that the other 80% usually aren’t motivated strongly enough to participate in a wellness program and often tend to ignore it, making the wellness program run the risk of looking (and being) unsuccessful.

Now some wellness advocates believe that if they can just talk to those in the 80% group they will eventually become intrinsically motivated to participate in wellness programs. However, I see absolutely no evidence in the scientific literature that anyone has ever sustained high short or long term wellness program participation by simply talking with people—more information doesn’t create motivation out of thin air. I believe that it takes an attractive “deal” to get more of those 80%’ers to engage.

The “deal” can be so many things–this is where you need to think out of the box.  It could be a sense of belonging, an opportunity to contribute, greater disposable income, a sense of achievement, fun, more time off, lower health plan costs, or dozens of other pay values. All of these types of “deals” represent extrinsic sources of motivation that are intended to augment the intrinsic motivation that innately exists in virtually all populations.

Once you have the 80%’ers participating you have an opportunity to work on converting the extrinsic sources of motivation to intrinsic motivation. Intrinsic motivation is absolutely what creates sustained change, but we need folks to get on the wellness bus in order to have a bite at that apple (more about that in another series of posts).

What kinds of strategies should you consider using to help reach the 80%’ers? Here’s what I recommend:

Step #1 – First, spend time learning about the 80%’ers. Find out what they think about wellness, what it means to them, and what do they know about why wellness makes sense for them. Typically this can be done through an interest surveys, focus groups, interviews, online chat rooms and open forums.

Step #2 – Next, ask about why they don’t find wellness very interesting or important. In your discussions with individuals and small groups ask about why they don’t see wellness as important. Use questions like: “What would it take for you to actively participate? What’s holding you back?”; “What do you see as the main barriers to taking better care of your health?”; “How important is your own well-being to you?”; “What kind of a “deal” would help you participate?”

Step #3 – Probe about what it would take for them to participate and authentically engage. When discussing wellness ask them questions like: “If you could feel better would you want to participate?” or “If you could pay less for your health plan would you be willing to participate?” Use ‘what if’ questions like: “What if you were part of a team? Would that appeal to you?” You want to get under how your 80%’ers feel about the following possible extrinsic reasons for participating in a wellness program:

  • Feeling and looking better
  • Receiving a sizable financial reward
  • Avoiding a significant financial penalty
  • Receiving more time-off from work
  • Getting a desirable material goods
  • Receiving a special privilege at work
  • Being recognized for an accomplishment
  • Being part of a team in a group competition
  • Being able to exercise some control and ownership over the program
  • Having access to wellness made easier
  • Having a personal role in feedback
  • Having something new to experience
  • Having an opportunity to gamble or win something
  • Having an opportunity to belong to a group
  • Having an opportunity to experience humor
  • Help in meeting a personal challenge
  • Enjoying fun and lightness
  • An opportunity to develop self-mastery
  • Experiencing a sense of acceptance or approval
  • Experiencing comfort
  • Having an ability to contribute to something bigger than yourself
  • Experiencing a creative outlet
  • Opportunity to be a good exemplar to others
  • Opportunity for high visibility or attention
  • Opportunity to avoid personal discomfort
  • Opportunity to meet and mix with managers

Step #4 – Combine 3 or 4 of the most popular extrinsic reasons into a long term incentive program. Select the extrinsic reasons of your 80%’ers that seem to be the most often mentioned into a reoccurring core incentive design. My experience is that a $100 a month lower health plan premium for several wellness achievements is one of the single most effective extrinsic reasons for participation in a worksite wellness program.

Step #5 – Look for ways to build as many of the other extrinsic reasons for participation into your program as possible. In addition to a formal incentive program I recommend that you look for creative ways to address several more of the most popular reasons cited by your 80%’ers associated with participation. Look to combine other popular “pay values” into other program interventions or short term incentives.

Step #6 – Communicate about all the extrinsic reasons with your entire population. Once you have selected your 3 or 4 core extrinsic reasons for participating and the other extrinsic reasons you select, keep communicating about them to your entire population. If employees and their spouses don’t know about the extrinsic reasons for participating in their wellness program then they are not likely to participate.

Step #7 – Create programs that convert extrinsic motivation to intrinsic motivation. This is a big topic In another series of posts I’ll be sharing about programming strategies for helping convert the extrinsic sources of motivation into intrinsic motivation.Step #8 – Rinse and repeat: cycle back around to fine tune your approach. Take the time each year to examine your “deals” or extrinsic reasons for participation and consider new or modified “deals” or pay values. Keep your novelty draw high with new challenges and new learnings.

Next time we’ll look at the “S” in AMSO a powerful framework for making sure your wellness program is producing results!

Don’t forget, strategies for using AMSO is a key area of emphasis in each level of certification in the WellCert Program!

Do you AMSO? Part 1 – “A” is for Awareness

When was the last time you decided to buy a car? Just as soon as you decide on a make and model you want, you start to see your heartthrob vehicle everywhere you look. Amazing huh! Not really! You just turned on your Reticular Activating System, among other things, that mediates what grabs your attention. Your brain is helping you find the object of your desire. Until we amped up our awareness of that car, our brains just dumped that stimulus out of our heads like so much random noise.

Our wellness programs exist to get participants’ brains to seek out healthy behaviors. My recent four-part series on the HRA reflected on how to use HRAs as awareness drivers. Awareness is our starting point and is critical in behavior change! We want the HRA, among other program interventions, to help each individual become aware of health and wellness issues that are relevant to their own present and future health and well-being.

Michael O’Donnell, one of the most prolific and influential leaders in the field of health promotion (AKA Wellness) developed an analytic framework that helps us determine whether a wellness program will actually work—whether it will change the long-term behavior and improve the health of a population. He came up with the acronym “AMSO” to help us remember all four of the key parts of programs that create lasting behavior change.

O’Donnell’s evidence-based finding is that for a wellness program to change behavior, it must do four things. The first requirement is, you guessed it, AWARENESS of health issues for each individual in your population. This Awareness isn’t just a general idea like “we should eat our vegetables.” While general messages are fine, the Awareness here is really about the specific health issues relevant each individual. HRAs are one of the most useful tools for raising awareness of individual own health and wellness issues thus our connection of AMSO to my recent series on HRAs.

To fully realize the awareness potential of the HRA we need to:

  • Have everyone complete an HRA each year.
  • Provide useful and changing information and feedback from the HRA each year.
  • Communicate clearly the consequences of current health choices.
  • Provide easy to understand relevant insights about how they can improve their health present and future.
  • Provide easy to access follow-up interventions in health behavior areas of interest.

We also need to include other ways of raising awareness of health issues for the individual besides the HRA. These other interventions may include: eHealth portals, access to wellness coaches, wellness newsletters, self-help groups, online learning modules and wellness mentor programs. The intentional linking of these potential interventions to maximize awareness in each individual is one of those areas of “art” for the health promotion and wellness practitioner.Next week we’ll look at the “M” in AMSO- a powerful framework for creating effective wellness programing.Don’t forget, strategies for using AMSO is a key area of emphasis in each level of our WellCert worksite wellness certification.

HRA as MVP Part 4 – Game plan for dealing with HRA vendors

vendors-trade-show

I hope you are starting to raise your expectations on what you can achieve with your HRA. Inevitably, making changes often means working with your vendor (or getting a new one).

Now let’s think about pens. If you’re like me, you have a drawer somewhere with a bunch of old pens—many of them I got for free at some long forgotten conference or event. There are also many from vendors. Now I don’t want to malign vendor tchotchkes, but let’s be honest, free pens from vendors aren’t usually going to be the best pens—the ones that you look forward to writing notes with in the important meeting. Free isn’t usually synonymous with “the best”.

There seems to be a growing trend of the “gift with purchase” HRA. You get the HRA with the purchase of other services, or by working with a specific health plan, etc. While “free” is always pretty tempting, there are many times when a free HRA is no bargain, especially if it’s poorly designed and can only realize poor utilization. Often, free HRAs don’t have many of the features I described in past posts that drive a WOW. Especially features that provide instant value to your employees. HRAs aren’t all created equal.

Give your HRA check-up from the neck-up

Before you go through the headache of changing vendors, you need to find out if your current HRA vendor can change an improve your HRA. The best vendors will be willing to work with you—from salespeople to account management and technical staff. They should want the same things you do: an HRA that drives results by engaging employees in healthy lifestyle choices.

To give your current HRA vendor a chance to get on board, here’s what I would do if I were you:

 

Step #1 – Collect some employee feedback on your current HRA. Ask employees right after they complete the HRA and have access to their personal report, the following 4 questions:

  • Q#1: How would you rate your experience with our current HRA on a 1 – 7 scale with “7” being “excellent” and “1” representing “poor.” (Average their scores)
  • Q#2: Does our current HRA provide you with new insights about your health and wellness each time you complete it? (Yes or No) or (Always, Often, Seldom, Never)
  • Q#3: Has the HRA helped you change a health behavior? (Yes or No) or (Always, Often, Seldom, Never)
  • Q#4: Would you recommend that your friends complete this HRA? (Yes or No)

Step #2 – Sit down with your HRA vendor and share your findings. Summarize the answers to the four questions with your vendor. Lay out your findings and describe how you got them. Ask if other clients have done anything like this and what did they find. Ask if this is what they expect employees to be experiencing when they complete their HRA. Do they want to produce a “wow” experience for users?

Step #3 – If the survey shows poor results, tell them this situation is not acceptable –you need to have an HRA that does better. If your numbers are as low as I think they will be then be candid with them and tell them that you are going to have to make a change unless they can improve the HRA experience for your employees in a significant way.

Step #4 – Set a date for your vendor to give you their plan for improving the HRA. Make sure you give them enough, but not too much time, to come up with a remedial plan for addressing the needed improvements. I have found that it is necessary for the vendor to actually believe that you will really dump them if they don’t fix the problem. Make sure you give yourself enough time to review the plan in depth.

Step #5 – Determine if their plan for improvements is acceptable. Consider how soon the vendor will be able to make the necessary improvements as well as if the proposed changes will fully address the current defects. Will you have to wait one, two or three HRA cycles before the improvements come on line? Will the improvements produce a “wow” HRA experience?

Step #6 – Keep your current vendor or get a new one! Based on steps #1 -#5 decide to either keep your current vendor and work with them or go get a new one. Make sure you are actually accomplishing the improvements that will make the HRA a “wow” experience for your employees and spouses.

Step #7 – Get the same kind of employee feedback on the new HRA. Use the same survey questions to evaluate the new HRA among a small pilot group. Compare the results with the previous 4 question survey results. Determine if the new HRA is performing at an acceptable level.

Don’t forget that the HRA should be one of your wellness program’s most valuable players and its full potential takes consistent effort to realize!Next week we’ll look at how HRAs connect to the “A” function of “AMSO”- a powerful framework for making sure your wellness program is producing results!

Don’t forget, strategies for effective use of HRAs are one of the key skills we teach in our Level 1 WellCert worksite wellness certification program and we have a new set of “Virtual” trainings coming!