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.