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If Wellness Programs Work so Well, Why Isn’t Everybody Convinced?

Given my success as a marketer, getting one to buy something they might not (know they) need or that they might consider a luxury is second nature. When it comes to wellness programs, much has already been written about companies advertising the positive return on wellness – different numbers are consistently tossed around: from a ROI estimate of about $3 for every dollar spent to humbler claims of $1.65 saved for every dollar invested (Naydeck et al., 2008). Until recently, these research findings were generously and unquestionably provided to clients to make them feel confident about their investment in workplace wellness (by using quantifiable data that substantiated the managers’ decisions to invest in the program).

Researcher and participant bias

An undeniable concern of wellness program assessments is that they are often performed by the consultants who advocate them. Therefore, if a particular program is evaluated as ineffective, this could lead to the loss of a client or a job (Lewis & Khanna, 2013).

Another bias has to do with the selection of research participants: employees who opt-in to workplace wellness willingly are generally a group of volunteers who are already motivated to engage. The control group, on the other hand, is usually comprised of disproportionate amount of people who decided not to take part in the program, so in comparison, this group could be considered less motivated to improve their health (Lewis & Khanna, 2013). Since motivation is the key factor when it comes to changing health-related behaviors, having a group of motivated people compared to a group of (potentially) non-motivated people becomes highly questionable in terms of research validity, and certainly a methodological limitation.

Those who shout the loudest are not necessarily in the biggest trouble

A recent critique of workplace wellness programs has been that they provide for employees who do not really need them and who would likely lead a healthy lifestyle with or without these initiatives. People who might be at higher risk (smokers, the obese) are less likely to be drawn in – instead merely serving as a control group that positions the program as viable.

However, non-participants are more than just a methodological glitch. They also embody the industry’s challenge to engage people who could arguably benefit most from health promotion – if only we could sway them to participate in the programs wholeheartedly and continuously.

Why doesn’t more of the workforce participate?

Critics of workplace wellness such as Lewis and Khanna (2013) argue if wellness programs do so much in terms of health improvement and save both employers and employees’ money, how come not everybody is jumping onboard?

Barb Hendrickson (2013) explored some of the reasons employees choose not to participate in sponsored wellness programs. The explanations ranged from not being interested in improving health (ex. smokers usually know that smoking is bad for them) to not trusting the company’s intentions regarding the handling of their health data.

More often than not, workers opt-out due to their established believes (about health, the company, the management’s motivations, etc.) and/or because deeply rooted behaviors take more than a health questionnaire and a health club membership to alter.

The twofold question

How do we make the non-participants participate?

Workplace wellness providers often focus their efforts on those who are willing to participate. This is likely because strategies to engage those who lack motivation are more difficult to execute. Arguably, engaged participants are prone to change their risky behavior with or without the extra support and are internally motivated to do so anyway. It is the not so eager ones who are often exposed to higher health risks and could benefit most from good health initiatives.  

How do we build a stronger evidence-base for wellness programs?

When conducting studies, it is possible to employ a somewhat less biased participant selection, as demonstrated by Naydeck and colleagues (2008). In their study, participants and non-participants were carefully matched on a variety of factors that are known to contribute to health cost such as gender, age, total medical expenditure for one year, evidence of heart disease and diabetes, and scores on the Charlson Comorbidity Index (which predicts mortality, stroke, the presence of some health conditions, and the length of hospital stay).

Through research and civil discourse, these two questions can get answered. As we continue to get a better understanding of participants’ motivation – one of the key factors for success in improving health – we in the field need to ensure we consult other disciplines such as behavioral psychology, social psychology, environmental engineering, nutrition, and also employ novel/less conventional methods of assessments that can capture this complex phenomenon.  Furthermore, the concept of cultivating a culture of wellness within organizations needs to be further explored. Otherwise, wellness programs will remain primarily activity-based and participation rates in the long-term will remain flat.

Comments

Heather

It’s funny to read this… I’m working on my education to become a health coach, so will be getting out of the corporate grind soon enough (or not soon enough depending on how you look at it).

My current employer decided to punish anyone not participating in the “Wellness Program” this year. While there is no one you can work with if your blood pressure is too high or if you need help losing weight, you do get charged an extra $1000/ year on your health insurance if you don’t go complete the biometric testing.

There is not incentive to do anything for the employees, really. With that extra money, they could hire a coach to work directly with the employees who are struggling with health issues, but they don’t.

Michael Rucker

Hi Heather. First, thank you for taking the time to read my article. Truly grateful. Second, I see from your IP address you’re posting from Honeywell. Given your company’s history (EEOC’s Wellness Lawsuits Target Incentives, Spark Criticism your comment doesn’t surprise me. Figuring out how to use incentives effectively will most likely play out in short order. The recent proposed regulations from the EEOC (Time for a wellness program check-up: New regulations on the horizon) suggests that policy makers understand the need to better manage the way incentives are getting used.

Lauren Burnhill

Mike,

I enjoyed this piece all the way up to “how do we make non-participants participate”. We cannot “make” anyone do anything in a sustainable way. Figuring out internal & external motivators – and a broad enough set to serve people with different needs – that’s the challenge. My sense is that corporates would like “the solution” delivered seamlessly, yet right now we still need to test & tweak different approaches. I’m intrigued by your comment on corporate wellness program evaluations. Good governance suggests there is a business opportunity there!