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This is to certify that the
dissertation entitled

Factors Influencing EAP Utilization:
A Control Theory Perspective

presented by

Suzanne Marie Crampton

has been accepted towards fulﬁllment
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FACTORS INFLUENCING EAP UTILIZATION:
A CONTROL THEORY PERSPECTIVE
By

Suzanne Marie Crampton

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Management

1 992

 

 

iIi

IIII

 

 

ABSTRACT

FACTORS INFLUENCING EAP UTILIZATION:
A CONTROL THEORY PERSPECTIVE

By

Suzanne Marie Crampton

The purpose of the present research was to examine factors which may inﬂuence
an individual’s decision to utilize services at an Employee Assistance Program (EAP).
Past research that explored EAP usage typically examined demographic characteristics
of EAP users and the types of problems presented at the EAP in order to create a
profile of EAP users. The major problem with this research is that organizations gained
little practical knowledge because it did not help us understand why individuals decide
to use/not use an EAP. In addition, there was little theoretical basis for including
research variables.

The present research incorporated into this decision process individual
personality variables (Health Locus of Control, or HLOC), beliefs held by individuals
regarding health-related issues (health goals, social group health norms, past and present
health status) and perceptions regarding an EAP (expectations regarding its ability to
improve one’s health and perceived support, pressure, and barriers to using an BAP).
A Control Theory Model of EAP Utilization was developed based on control theory
which assumes that behavior is goal directed, and this model was used to provide a
structure to studying factors hypothesized to influence the EAP decision process.

A questionnaire was mailed to a sample consisting of both EAP users and non—
users who were employed by a large organization and who had equal access to the on—

site BAP. Seven hypotheses were examined using multiple regression analyses. Three

 

 

 

 

 

 

factors were predicted to inﬂuence an individual’s desired health goal level, but only one
hypothesis was partially supported when Chance HLOC was found to have a negative
relationship to one’s desired goal level. Of the variables hypothesized to inﬂuence the
EAP utilization decision, Internal HLOC and Chance HLOC were found to moderate

the relationship between a perceived discrepancy in one’s current and desired health and

the decision to utilize EAP services. In addition, perceptions of both personal and

work-related sources of support, pressure, and barriers to using an EAP were found to
signiﬁcantly impact an individual’s decision to seek EAP assistance. Implications of

these results, limitations, and recommendations for future research are discussed.

 

To my best friend and husband, Dave,
without whose years of love, support and encouragement
this would not have been possible
and to my parents, Eugene and Mary Churchill,
with thanks for their love, prayers, and support
throughout all my educational experiences.
This is dedicated to each of them as a

way to express all they have done for me.

 

 

ACKNOWLEDGMENTS

The easiest task of this research is to thank those individuals most responsible for
assisting me in the completion of this project.

I would like to thank my dissertation chair, Dr. Daniel Ilgen, for the many hours
he spent providing guidance and support. His efforts have been invaluable and
contributed significantly to not only the research methodology but to the overall quality
of this dissertation. His valuable ideas and refinements to the document helped me
deveIOp professionally. I wish to also express my appreciation to my other committee
members, Dr. Alison E. Barber and Dr. Richard Block, for their timely comments and
assistance which contributed to the completion of the final product.

I also appreciate the assistance received from the director of MSU’s Employee
Assistance Program, Thomas Helma, who helped me obtain the necessary approval and
access to the research site and sample. The completion of my doctoral program was
facilitated by my colleagues and the faculty and staff in the Department of Management.
They were instrumental in my professional development and their efforts are also
reﬂected in this research.

I would also like to express my appreciation for the financial assistance provided
toward this project by The International Foundation of Employee Benefit Plans for their
research grant which assisted in the completion of the study. I am also very appreciative
for being awarded the Harvey Wilson/SHRM Foundation Doctoral Dissertation Research

Grant to aid in completing this project.

 

 

Finally, I wish to express my gratitude to my husband, my parents, my three
stepchildren and the rest of my family who had to put up with the very limited amounts
of time available while I completed the doctoral program. Their unrelenting love and

support made my accomplishments possible and worthwhile.

vi

 

Will

TABLE OF CONTENTS

LIST OF TABLES ................................................. x
LIST OF FIGURES ............................................... x1
CHAPTER 1
STATEMENT OF THE PROBLEM .................................... 1
Introduction ...................................................... 1
Employee Assistance Programs ........................................ 5
The Pervasiveness of the Need for EAPs ........................... 11
The Costs Of Troubled Employees ................................ 14
The Beneﬁts of EAPS .......................................... 17
Diversity of EAPs ............................................ :2
Assumptions of the Research ........................................
Organization of the Research ........................................ 26
CHAPTER 2
REVIEW OF EAP AND HEALTH-RELATED LITERATURE ............. 28
Historical Background .............................................. 3:
Historical Background to 1940--Welfare Movement ................... 33
Occupational Alcoholism Programs (OAPs) ........................
The 1970’s to the Present-—The Legal Inﬂuences on EAPs .............. 38
The 1970’s to the Present--Additional Inﬂuences on EAPs ............. :3
The Wellness Concept ......................................... 43
Summary of Models/Attitudes Regarding Employee Health ................. 48
The Structure and Diversity of EAPs .................................. 57
EAP Research .................................................... 59
Research on EAP Utilization/Participation ......................... 61
MaritalStatus ()2
Gender ................................................ 62
Race 63
Age ................................................... 63
Tenure/Seniority ....................................... ()4
OccupationalLevel.....................................:. 65
Income ............................................... 66
Education ....................... . . .. .................. ()6
Problem Type and EAP Utilization/PartICIpatIon ................
vii

CHAPTER 2 (cont’d)

Referral Source and EAP Utilization/Participation ............... 67

Summary ........................................................ 72
CHAPTER 3

CONTROL THEORY AND A MODEL OF EAP UTILIZATION ........... 76

Control Theory ................................................... 76

A Control Theory Perspective on Health-Related Activities ................. 91

A Systems Perspective on EAPs ...................................... 94

A Control Theory Model of EAP Utilization ............................ 96

Overview of the Model ........................................ 96

The Goal/Standard ........................................... 102

Health History ......................................... 107

Hypothesis #1 .................................... 108

Health Locus Of Control .................................. 108

Hypothesis #2 .................................... 112

Social Group Health Values/Norms ......................... 113

Hypothesis #3 .................................... 115

Summary Of the Health Goal Component ..................... 116

The Sensor/Feedback Function ................................. 116

The Comparator Mechanism ................................... 117

The Behavior/Effector Component ............................... 119

Health Locus of Control .................................. 120

Hypothesis #4a .................................... 122

Hypothesis #4b ................................... 126

Hypothesis #4c .................................... 126

Expectancy ............................................ 126

Hypothesis #5 .................................... 129

Support/Pressure/Barriers ................................. 129

Personal Sources of SupportJPressure and Barriers ......... 133

Hypothesis #6 ................................ 136

Work-Related Sources of Support/Pressure and Barriers ..... 136

Hypothesis #7 ................................ 143

Summary ....................................................... 143
CHAPTER 4

METHODOLOGY ............................................... 146

Power Analysis .................................................. 146

Research Site ................................................... 147

Sample ........................................................ 149

Human Rights ................................................... 159

Study Design/Procedures ........................................... 159

Pilot Tests ...................................................... 160

Measures ....................................................... 162

Health History .............................................. 162

viii

 

CHAPTER 4 (cont’d)

Health Locus of Control ...................................... 164
Social Group Health Values/Norms .............................. 166
Desired Health Goal Level ..................................... 167
Current Health Status ........................................ 168
Health Goal-Health Status Discrepancy ........................... 169
Expectancy Of Goal Attainment ................................. 170
Support/Pressure/Barriers to Using the EAP ....................... 171
EAP Utilization ............................................. 174
Other Variables ............................................. 174
Analytic Methods ................................................ 174
CHAPTER 5
RESULTS ...................................................... 177
Hypothesis #1 .................................................. 181
Hypothesis #2 .................................................. 182
Hypothesis #3 .................................................. 182
Hypothesis #4a, #4b, and #4c ..................................... 184
Hypothesis #5 .................................................. 189.
Hypothesis #6 .................................................. 189
Hypothesis #7 .................................................. 192
Post-Hoe Analyses ................................................ 192
CHAPTER 6
DISCUSSION ................................................... I97
Hypothesis #1: Effect of Health History on Desired Health Goal ............ 197

Hypothesis #2: Effect of Health Locus Of Control on Desired Health Goal . . . . 201
Hypothesis #3: Effect Of Social Group Health Values/Norms on

Desired Health Goal ......................................... 202
Summary of Relationships With Desired Health Goal ..................... 205
Hi’Pothesis #4a, #4b and #4c: The Moderator Inﬂuence Of Health

Locus of Control ............................................ 208
HYpothesis #5: The Moderator Inﬂuence of Expectancy ...... . ............ 213
Hypothesis #6 and # 7: Effect of Personal Support/Pressure/Barriers

. . and Work Support/Pressure/Barriers on EAP Utilization .............. 217
leltations and Future Research .................................... 221
Summary ....................................................... 226
LIST OF REFERENCES .......................................... 228
APPENDICES
Appendix A - Definition of Terms ................................... 32;
Appendix B - Survey Instrument .....................................

ix

LIST OF TABLES

Table 1: EAP Cost—Impact Studies .................................. 20
Table 2: Descriptive Statistics of Sample ............................ 152
Table 3: Descriptive Statistics of Sample (Means of Demographics) ........ 154

Table 4: Frequencies of Demographic Variables by EAP Usage/Non-Usage . . 157

Table 5: Descriptive Statistics of Major Variables in the Model ........... 163
Table 6: Means and Standard Deviations of Major Variables in the Model . . 178
Table 7: Intercorrelations Among Major Variables in the Model .......... 179

Table 8: Regression Results for the Health Locus Of Control (HLOC)
Subscales on Desired Health Goal Level ...................... 183

Table 9: Results of Regressing EAP Utilization on Health Locus of .
Control Subscales, Perceived Discrepancy, and the Interaction ..... 185

Table 10: Results of Regressing EAP Utilization on Expectancy,
Perceived Discrepancy, and the Interaction ................... 190

Table 11: Results of Regressing EAP Utilization on Demographic Variables,
Support/Pressure/Barriers Variables, and Personal Beliefs/Value
Variables .............................................. 194

Table 12: Crosstabulation Analysis of Availability of Other Resources
and EAP Utilization ..................................... 196

Figure 1:
Figure 2:
Figure 3:
Figure 4:
Figure 5:
Figure 6:
Figure 7:
Figure 8:
Figure 9:
Figure 10:
Figure 11:
Figure 12a:

Figure 12b:

Figure 12c:
Figure 13:

Figure 14:

Figure 15:

LIST OF FIGURES

Approaches To Health At Work .............................
Hierarchy of Man and Science ..............................
Flow Diagram of Key EAP Activities .........................
The TOTE Unit .........................................
The Negative Feedback Loop ...............................
Cybernetic Model of Self-Attention Processes ..................
Control Systems Model of Motivation .........................
An Integrated Control Theory Model of Work Motivation .........
Control Theory Model of EAP Utilization ....................
Factors Affecting Desired Health Goal Level ..................
Relationship Between Perceived Discrepancy and EAP Utilization

Hypothesized Relationship of Internal Health Locus of Control . . . .

Hypothesized Relationship of Powerful Others Health Locus of
Control ................................................

Hypothesized Relationship of Chance Health Locus of Control . . . .
Hypothesized Relationship of Expectancy .....................

Results of Regressing EAP Utilization on Perceived
Discrepancy by Internal Health Locus of Control (IHLC) ........

Results of Regressing EAP Utilization on Perceived
Discrepancy by Powerful Others Health Locus of Control (PHLC)

xi

 

44
47

49

8O

86

90

100

103

104

123

124

125

130

186

187

 

 

LIST OF FIGURES (cont’d)

Figure 16: Results of Regressing EAP UtilizatiOn on Perceived

Discrepancy by Chance Health Locus of Control (Cl-ILC) ........ 188

Figure 17: Results of Regressing EAP Utilization on Perceived

Discrepancy by Expectancy ................................ 191

xii

 

 

 

CHAPTER 1

STATEMENT OF THE PROBLEM

Introduction
The traditional barrier that has existed between an employee’s personal problems
and an employer’s involvement in the personal lives of employees has been breaking
down during the past two decades as more and more employers have extended help to
employees through the establishment of employee assistance programs, or EAPs.
Employees often experience personal problems, such as alcoholism, drug abuse, social
and psychological problems that negatively impact their work performance.
Organizations have found these problems can manifest themselves in the form of
excessive absenteeism, tardiness, industrial accidents, insurance claims, and grievances
along with decreases in efficiency, employee health and morale-which, in turn, affect
organizations’ overall profit, quality and efficiency. Thus, maintaining a healthy
workforce will result in economic benefits for the employee, the firm, and for society.
Health is currently defined as ”a state of complete physical,-rnental, and social well-
being" (Stone, 1979). Health behavior is concerned with factors inﬂuencing one’s choice
among alternative methods of dealing with bodily threats (Stone, 1979). Health is viewed
not only as the absence of disease but as both an ideal "state" to be achieved as well as
a "motive" where one strives to develop and adapt behaviors to respond more
appropriately to the environment (Dubos, 1965; Stone, 1979). Experts distinguish
between health and illness behaviors where health behavior refers to activity undertaken
by a healthy individual to prevent disease while illness behavior is activity undertaken

by someone who feels ill in order to Obtain relief (Kasl & Cobb, 1966).

 

 

 

 

 

2

In 1980, a-national study found that the annual economic cost Of alcohol, drug, and
mental disorders was $190.6 billionuwith over $75 billion of the costs related to reduced
productivity at work (DHHS, 1982). In 1987, health costs were $400-500 billion, or 10%
of the nation’s GNP (Bureau of the Census, 1986; Terborg, 1986). It has been estimated
that these expenditures will exceed $1 trillion before the year 2000 (Wriston, 1982).
Employers typically pay 27-30% Of these costs (Terborg, 1986). Good employee health
is an industrial policy that helps to serve the selfointerests of industry. Melvin Glasser
of the United Auto Workers stated in 1969 that the workplace should be used as a focal
point for providing health service for job-related diseases as well as preventive health
services, health education, and all health problems.

Business and labor organizations have endorsed interventions to enhance employee
health and contain health costs—-one of which is the employee assistance program (EAP).
Employee Assistance Programs are defined as:

Policies, procedures and services which respond to employees whosepeisonal,

emotional or behavioral problems interfere directly or indirectly with work

performance by providing confidential counseling and/or professional
information, care or referral to appropriate sources for help (Schmitz, 1982,

p.3).
The term EAP is a generic term for all occupational programs that enable troubled
employees (i.e., those whose work history is characterized by productivity problems,
absenteeism, accidents and other job-related problems) to receive help for a variety of
problems-~ranging from alcohol and drug abuse, gambling addiction and eating disorders
to child-care and pre- and post-retirement counseling—by either identifying or
responding to employees whose problems interfere with their work performance (Bureau

of National Affairs, 1987; Leavitt, 1983; McCroskey, 1982; Thomas, 1982). Diverse

 

 

 

 

3

educational, physical fitness and recreational programs may also be included in such
programs (Thomas, 1982).

A more extensive review of the relevant literature will be presented in the second
chapter. Based on the review in that chapter, the following conclusions will be drawn.
First, despite the diversity and scope of EAPs today, and the fact that a signiﬁcant
number of employees may be in need of assistance, there are many employees reluctant
to utilize the services when needed. Second, to date most research has been atheoretical
in nature. There appears to be an absence of theory surrounding the relationships
inﬂuencing health and help-seeking behaviors. Third, several variables have been
neglected surrounding EAP research. For example, McKinlay (1975) argued that
"organizational phenomena may be as highly related to utilization behavior as the
personal characteristics of users" (p. 257).

It is concluded that there is a limited theoretical basis guiding the study of
organizational assistance programs. While there have been conceptual models of the
EAP referral process developed by a number of researchers (e.g., Savoca, 1986; Wrich,
1980b), 3 specific model outlining factors which inﬂuence an individual’s decision to
seek assistance from an EAP has not been developed. A number of variables have been
examined to gain knowledge on what a typical profile of an EAP user resembles.
However, most of the data gathered to date have focused on factors that can be obtained
directly from EAP records-gender, race, age, job status, income, problem type, etc.
These factors offer little understanding of why some employees utilize EAP services
while others do not. Furthermore, many of the conclusions reached on EAP

participation factors have often been inconclusive or contradictory.

 

 

 

4

The purposes of the present research are (1) to examine factors which might
inﬂuence an employee’s decision to seek EAP assistance and (2) to develop a conceptual
model to help guide future research on employee usage of EAP services. A model of
the utilization process will be developed based on a control theory perspective. Control
theory has been applied to behavioral issues in many areas of study, including the areas
of cognitive, clinical, and health psychology (Carver & Scheier, 1981, 1982; Wiener,
1948).

Control theory is based on the key concept of a standard or reference value and
a process whereby sensed information, or feedback, is compared to this standard or goal
(Carver & Scheier, 1981; Miller et al., 1960; Powers, 1973; Von Bertalanffy, 1968;
Wiener, 1948). If a discrepancy between these variables exists, a force is created to
motivate an individual to reduce the standard-feedback discrepancy via affective,
behavioral, and/or cognitive responses (Taylor, Fisher & Ilgen, 1984).

Because "good health" is considered a standard and since many factors inﬂuencing
the development, amelioration, or prevention of disease and illness are considered under
the control of an individual, control theory is seen as an acceptable model to use as a
guideline in examining health-related behaviors (Carver & Scheier, 1982; Karoly, 1985).
Speciﬁc health activities where control theory has provided a useful framework are
behaviors related to monitoring one’s current health state (e.g., examining one’s pulse,
blood pressure, or temperature) to determine if one’s health is less than ideal and, if not,
motivating the individual to action (Carver & Scheier, 1982; Leventhal, Meyer & Nerenz,
1980; Schwartz, 1978, 1979).

The present study attempts to examine relationships among variables of interest in

health and help-seeking behaviors--specifically, variables inﬂuencing an employee’s

 

 

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5

seeking assistance at an EAP. Ilgen (1990) suggests that the timing, frequency and
nature of access to health care services by those in need have important consequences
to employees (e.g., health, quality of life) and organizations (e.g., financial, productivity);
however, these health care system access behaviors are not well understood. The aim
of the present study is a scientific one by contributing to our knowledge of help—seeking
behaviors in an EAP setting and to the development of a theoretical basis for examining
the relationships involved. The aim is also a practical one by enabling organizations,
human resource managers, and EAP staff members to better understand the utilization

process. In the following section, an overview of EAPs will be presented.

Employee Assistance Programs

Employee Assistance Programs exist within a variety of organizational
environments-business, sports, government, hospitals, public utilities, entertainment,
educational, and labor unions (Castro, 1986). Employers generally agree that personal
problems are still a private domain, except when such problems have a negative impact
on work behavior. More and more these problems are being addressed at work through
EAPs, with the expectation that the beneﬁts will be greater than the costs incurred in
establishing such programs;e.g., decreases in absenteeism and in the costs of hiring and
training replacements, and increases in morale and productivity (Lyons, 1987, p. 38).

Many forces began to evolve that changed both the attitude of the employee as well
as the employer since the 1960’s. For example, American workers have been in a state
of transition during the last couple of decades. The transitions have occurred for many
reasons, which include: the median educational level for employees has increased from

8.7 years in 1940 to 12.7 years by 1984; 44% of the workforce is made up of women; only

 

 

 

ill

III

 

 

6

one-third of the households in the US. have only one spouse employed; 52% of female
employees have children less than six years of age; and increased automation and
technology have resulted in increased specialization of workers and training costs
(Hayghe, 1984; McClellan, 1985). These transitions have, in turn, brought about changes
in employee attitudes and expectations whereby workers expect more from work than
just a job and a paycheck. Employees demand a healthy work environment, and good
jobs are assessed based on a variety of social and psychological needs. ”Workers are no
longer content to be just economic tools in the production of goods and services. They
want to be treated as human beings who have hopes, aspirations, anxiety, and fears that
need to be recognized" (Ozawa, 1980, p. 466).

Societal changes have also taken place during the last several years. The number
of alcoholics, drug abusers, divorced couples, single parents, step-parents, and those
caring for elderly relatives has increased (Masi, 1984; Myers, 1984). These changes,
along with the higher educational levels of employees, increasing numbers of women and
minorities in the labor force, high requirements of technical competence, changing
management practices, and foreign competition all impact on the workplace. As society
and workforce attitudes changed over the years, a humanization of the workplace began
to emerge (Cascio, 1986).

As we begin the 1990’s, business realizes the importance of human resources to
successful operations, and nearly all believe that the most productive workers are
healthy-mot only physically but also mentally. The effects of increasing threats of
foreign competition have further compelled the business world to modify its practices

and programs to meet the challenges faced.

 

 

 

 

ill

 

 

7

While the above changes in society and the workforce were occurring, organizations
began recognizing the need to take a more holistic approach when dealing with their
employees. In a 1974 survey of management personnel by the American Management
Association, 90% thought corporations should be concerned with the total person and
not just with daily output (Work, 1974). Based on his research for the National Institute
of Business and Industrial Chaplains, Brown (1983) identified the following as major
industrial concerns: marriage and family, alcohol abuse, pastoral care, crisis situations,
other personal concerns (e.g., anxiety, depression), job-related problems, financial
problems, mental illness, drug abuse, and court/legal issues (pp. 14-15). Employers have
also been forced to pay more attention to the interpersonal and personal concerns of
employees due to the legal constraints and requirements placed on organizations.
Examples of such federal and state legislation include Title IX and Title VII of the Civil
Rights Act of 1964, as amended, Title VI (apprenticeships), and Executive Order 11246,
as amended (sex discrimination) (Bloom, 1986). These acts mandate that organizations
avoid discrimination based on non-work related factors and take affirmative action to
increase job opportunities of members of protected classes.

As a result of these forces, firms developed human resource programs to address
the needs and welfare of employees and assist workers in dealing with both personal and
work-related problems; i.e., programs such as participative management, expanded
benefits, improved organizational structure, and employee counseling services (Carr &
Hellan, 1980; Shamir & Bargall, 1982). While these all improved organizational life, they
did not address the needs of the employee as well as the EAP has (Carr & Hellan, 1980).

Management and unions both recognized that EAPs were effective for meeting both

competitive challenges and employee needs. The work site was also viewed as an

 

 

 

 

8

effective location for the delivery Of health programs since the workplace is where
employees spend one-third or more Of their time (Alderman, 1984; Fielding, 1984a).
Terborg (1988) cited three additional reasons why the work site is an excellent place to
conduct health promotion activities: (1) a large number of people are employed on a
regular basis, (2) there is a potential for manipulating the social and physical
environments, and (3) there is the possibility of reducing health-care costs and increasing
productivity. Other forces that make the work site an effective EAP environment and
move troubled employees to seek EAP assistance include the fact that serious personal
problems often impair work performance in some manner, organizations expect
employees to maintain certain standards of performance, there is a strong desire on the
part of an employee to keep his/her job, the employee Often is under pressure from
external sources (e.g., coworkers, spouse, friends) to get some help, and the fact that help
is often available and easily accessible in the form of an EAP (Masi, 1984; Myers, 1984).

One question that might still be asked is whether the employer’s involvement in an
EAP is an unwarranted encroachment into the personal lives of employees. The answer
is ”no" for several reasons. Most employees, for instance, keep their personal problems
from affecting their job performance because income is important to them, so employers
only become involved when the problem is beyond what the individual can handle and
deteriorating job performance is observed. Also, many employees do not know where
to receive help for problems or can not afford help from external resources, so EAPs at
the workplace are useful for assisting employees. For example, Pardue (1987) found that
if the company had not established an EAP, of the 200 clients interviewed, only 25%

stated they would have sought assistance for their problem at an external resource.

 

 

 

 

9

Finally, employers do not become directly involved in the specific personal problems Of
an employee since confidentiality is a requirement for any EAP to succeed and survive.

Initial efforts on the part Of employers to assist employees were in the area of
alcohol-related problems. Threatt (1976) noted that researchers have accumulated a
substantial amount of evidence to support the assumption that the use of alcohol causes
alterations in human physical and cognitive functioning. Consequently, the first
occupational programs were typically low-keyed and designed along the lines Of
Alcoholics Anonymous (Roman, 1983a).

The EAPs of today evolved out of these original alcoholism programs. Major
federal initiatives undertaken in 1972 resulted in more formal Occupational Alcoholism
Programs (OAPs) (Masi, 1984). The early OAPs functioned mostly on a trial and error
basis because of the lack of experience with such programs. Since society during the
1940’s and 1950’s viewed an employee with an alcohol problem as weak or immoral,
program effectiveness was hampered as companies took a more punitive approach to
dealing with employees by threatening or dismissing them. However, by the 1960’s
OAPs were reported to save money and production time (Trice & Schonbrunn, 1981).
It was this success that led to the realization that help might be successfully provided for
other employee problems, which further lead to the development of EAPs (Trice &
Schonbrunn, 1981).

Since the 1960’s, EAPs have changed in form, grown in numbers, and gained in
popularity. By 1980, Wrich estimated that EAPs had been adopted by approximately
60% of the Fortune 500 companies and thousands of others (Wrich, 1980b). There are
now over 10,000 EAPs operating in the US. covering millions Of workers (BNA, 1987;

Champion, 1988). Five significant factors have inﬂuenced this growth. First, the

 

 

10

enactment of the Hughes Act, or the Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment and Rehabilitation Act, in 1970 provided federal funding for state
programs and created’the National Institute of Alcoholism and Alcohol Abuse in 1971
(Forrest, 1983; Masi & Teems, 1983). Second, the Secretary of Health and Human
Services was authorized to promote the development of “screening, consultation, referral
and education programs at employment sites to detect and prevent early mental health
problems" (Mental Health Systems Act Of 1980, Section 208). This made the EAP
concept a public policy issue and corporations became interested as a matter of "social
responsibility" (Scanlon, 1986). Third, the passage of the Rehabilitation Act of 1973
prohibited discrimination against any handicapped employee and required employers
to provide services for troubled employees before terminating them. In addition,
"handicapped" was interpreted to include those suffering from alcohol, drug, mental or
emotional problems (Masi & T eems, 1983; Roman, 1981). Fourth, the US. labor force
experienced its first drop in the productivity level for hourly employees and employers
became concerned that the drop may be due partly to employees experiencing personal
or work-related problems (Shuster, 1978). A final factor was that organizations were
faced with increased foreign competition and needed to develop new ways to improve
profit (Forrest, 1983; Googins, 1975).

Employee assistance programs today cover a broad array of personal problems and,
thus, are able to reach a larger population than the more narrowly-focused alcohol
programs. They have also demonstrated their positive impact on health costs,

productivity, and job performance (Masi, 1984; Myers, 1984; Wrich, 1980b).

 

 

 

11

The Pervasiveness of the Need for EAPs

While some employees can successfully separate their work from their personal life
and continue to function well on the job, others bring their problems to work, resulting
in a variety of dysfunctional behaviors (e.g., tardiness, poor performance, poor inter-
relationships with supervisors and coworkers, increased accidents and grievances, etc.).
Experts differ in their perception of the pervasiveness of ”troubled" employees. Storm
(1977) has pointed out that in any given employee population, at least ten percent‘will
be seriously troubled by personal problems, which include medical, alcohol and drug
related, emotional, marital, family, financial, or other problems. However, others suggest
this ﬁgure is much higher (Baxter, 1981; Cahill, 1983; Egdahl & Walsh, 1980; Weiner et
al., 1973; Wrich, 1980).

There are over 110 million drinkers in America with an estimated 10.2 million
adult problem drinkers, an additional 3 million problem drinkers ranging from age 14
to 17, and 100,000 to 200,000 new cases of alcoholism annually (New York Executive
Chamber, 1982; NIAAA, 1978). In a 1985 Gallup poll, one-third of all families reported
substance abuse in a family member (BN A, 1987). Baxter (1981) estimated that alcohol
problems affect between 5-15% of the workforce and Applebaum (1982) cited estimates
that alcoholics cut across all organizational levels-25% whiteicollar, 30% manual
workers, and 45% professional and managerial. Others have estimated that another 3
to 5% of the workforce is involved in drug abuse (Baxter, 1981) and that as many as 20
to 30% of the US. working population has a serious personal problem (Cahill, 1983;
Egdahl & Walsh, 1980; Weiner et al., 1973; Wrich, 1980b).

In a survey of top executives, however, Roman (1978) found that most failed to

perceive the problems as severe as those researchers cited in the preceding paragraph,

 

 

 

 

12
although they agreed that no organization is exempt from these problems. Trice and
Roman (1972) estimated that alcohol and drug abuse problems in the workplace affect
between 3 and 4% of the workforce, and the frequency of other employee problems is
another 3 or 4%. While experts may disagree as to the size of the problem, no one can
question whether a problem exists. For instance, according to Trice and Roman (1972):

When the potential impact of any one deviant drinker is considered, . . . the

relevance of the problem for organizational functioning mounts rapidly. In other

words, the disruptive consequences of deviant drinking may far exceed the cost

entailed if 4% of the work force were absent or simply sat at their jobs and did

practically nothing. The very essence of a work organization is the inter-

dependence of job performances. Deviance by one employee may ”reverberate”
beyond his work station or desk, sometimes disrupting an entire organization.

Thus the prevalence ﬁgures alone do not tell the full story. (p. 2)

Thus, it seems a snowball effect is produced as a result of any one employee’s
dysfunctional work behavior in the form of direct costs of the worker (absenteeism, poor
productivity) and indirect costs as work group activities and morale are disrupted and
supervisors must spend time and attention dealing with deviant behaviors.

While employees are affected by non—work related problems, the unique
characteristics of the work setting have also been recognized as inﬂuencing the emotional
health of employees. For example, much has been written about stress and burnout at
work. Industrial stress has been estimated to account for $32 billion annually in work-
related accidents, and contributes to heart disease-which is responsible for losses of over
135 million work days annually (McClellan, 1985, pp. 29-30). Vicary and Resnik (1982)

reported that job-related stress is one of the most frequent reasons for drug abuse and
other health problems.
Examples of job stress include: physical environment factors (e.g., temperature,

illumination, noise, office design) (Quick & Quick, 1984), organizational stressors (e.g.,

deadline pressures, failure to obtain promotions, fear of failure, job insecurity,

 

 

 

 

 

l3

competition, task demands, long working hours, hazardous conditions, organizational
tolerance for deviant behavior) (Brodsky, 1977; Landy & Trumbo, 1976; Martin &
Schermerhorn, 1983) and individual level workplace stressors (e.g., personality clashes,
social density, group pressure, labeling, social support) (House, 1981; Levinson, 1976).
Yankelovich (1978) adds there is stress resulting from the tension. between the old
cultural values where employees become subsumed in their job, which still prevail in the
workplace, and the new values of workers today who expect personalized, self—fulfilling
work.

Trice and Roman (1972) discuss four work environment factors which increase the
probability of substance—related deviance: (1) lack of visibility, such as job positions with
ﬂexible hours and those which keep the employee isolated from supervisors and
coworkers; (2) absence of structure; (3) absence of social controls, such as when drinking
is part of the work role; and (4) miscellaneous factors, such as roles which place
individuals under severe strain, competitive work climates, and employees who are
illegal drug users. House (1974) suggested the following aspects should be investigated
regarding work stress: objective work conditions conducive to stress, individual
perceptions of stressful work situations, individual responses and outcomes to perceived
stress, and individual or social situational characteristics that condition the relationship
between the ﬁrst four factors. Specific employee groups have been found to be under
a great deal of stress, such as employees who work on rotating shifts who suffer stress
due to irregular sleep patterns, poor nutrition, and other pressures as a result of irregular
work patterns (e.g., ﬂight attendants, nurses, police officers, factory workers) (Fever,
1983). Women also are often under great stress from the multiple role expectations and

conﬂicting demands placed on them (Roth, 1981).

 

 

14

Role conﬂict (when an employee receives ambiguous and/or conﬂicting demands
from others at work) and role ambiguity (responses to behavior are unpredictable or role
requirements are unclear) are the most heavily researched aspects of job stress (Knapp,
1985). Role ambiguity and conﬂict have been positively associated with somatic
complaints, depression, irritation, anxiety and tension (Caplan et al., 1975; French,
Caplan & Van Harrison, 1982; Margolis, Kroes & Quinn (1974).

No longer are employees today satisfied with just receiving a wage, and when other
needs are unmet, many employees feel frustration and stress. One reason found by
researchers for alcohol abuse is that alcohol may be used as a coping strategy against
stress (Lazarus, 1974; Pearlin & Radabaugh, 1976; Williams, Calhoun & Ackoff, 1982).
However, the effect of stress on health appears to depend on the context of the stressful
agent, how individuals perceive it, and the social supports and resources available to the
individual (Breznitz & Goldberger, 1982; Cohen & Syme, 1985). Occupational stress
management programs typically focus on treatment and helping employees cope with
stress through such methods as assertiveness training, biofeedback, and coping skills
training, rather than on prevention or removing the sources of stress (Everly, 1984;

Ganster, Mayes, Sime & Tharp, 1982; Pelletier & Lutz, 1988).

The Costs of Troubled Employees

In presenting the costs involved in employing and assisting troubled employees, one
type of cost to employers is represented in the many costs associated with the
deteriorating work performance Of troubled employees. It has been estimated that 70
million American workers function at only half their daily capacity (United States

Congress, 1982). As mentioned in the previous section, for example, a major health

 

 

 

 

 

15

problem in the US. is alcohol abuse where over half of the adult problem drinkers are
employed across all organizational levels (Applebaum, 1982). These employees cost
American business over $42 billion annually (White House Office of Drug Abuse Policy,
1978)--costs which are manifested in a variety of work behaviors of alcoholic employees:
excessive absences, on-the-job accidents, and health benefits (Kuzmits & Hammonds,
1979). In addition, Wrich (1980b) estimates a 25% loss of efficiency per alcoholic
employee-or $5,000 a year for an employee earning $20,000. Furthermore, alcoholism
has been cited as a possible cause in 70% of all filed grievances (Wrich, 1980b).
Employees with substance abuse problems average between two and three times
more absences, three times more sick leave and accident benefits, and five times more
compensation claims than employees without such problems (Pattison & Kaufman, 1983;
Wrich, 1980b). Hall (1983) added that 10% of the employed population that abuses
alcohol or other drugs produce at 25% below capacity and the average ﬁrm has a loss
of 2.5% in payroll costs.
In addition to the costs of substance-abuse problems described above, it has been
estimated that employees’ emotional problems and stresses cost industry billions of
dollars in absenteeism and turnover costs, excessive tardiness, negative work attitudes,
increased employee alienation from the workplace, decreased American productivity,
annual increases in health insurance claims and other costs (Baxter, 1981; Berry &
Boland, 1977; Busch, 1981; Carr & Hellan, 1980; Follman, 1978; Masi, 1984; Murray,
1983; Shain & Groeneveld, 1980; Trice & Roman, 1972). For example, it has been
reported that business loses from $1,622 to over $3,000 per employee annually due to

emotional problems (Myers, 1934)-

 

 

 

 

IOU

 

 

16

Experts have found that workers experiencing stress from jobvrelated factors are
less efﬁcient, experience reduced concentration, greater absenteeism, decreased morale,
have greater problems handlingjob pressures, increased turnover, and increased negative
health outcomes (Cooper, 1981; Fly, 1980; House, 1974; Matteson & Ivancevich, 1982).
It has also been estimated that 80-90% of all industrial accidents may be traced to
personal problems, while emotional problems are implicated in 65-80% of all employee
terminations (Brown, 1973; Egdahl & Walsh, 1980; Pati & Adkins, 1983). Smoking is
another major health issue that has been reported to reduce mental efficiency by 23%
and result in 77 million work days lost per year (Myers, 1984).

It has been reported that a person’s psychological makeup is often associated with
ulcers, obesity, migraine headaches, arthritis, colitis, and some forms of cancer--costs
which organizations experience in increased health costs (Compcare, 1981). In a recent
article, it was reported that it was costing companies an average of $1,985 per worker
each year in health-care beneﬁts (Employee Health Care, 1988). Others have estimated
that costs of lost productivity in American industry range from 829 billion dollars a
year, and when drug abuse and other problems are included, the figures increase from
30-70 billion dollars each year (Applebaum, 1982; Berry & Boland, 1977; Egdahl &
Walsh, 1980; Follman, 1978; United States Congress, 1982).

While the costs of troubled employees have been great to organizations, there are
also high personal costs involved for troubled employees and their families. For
example, researchers have stated that suicide rates are 58% higher for alcoholics
compared to the national average, alcohol is cited as a cause in 55% of all auto
accidents, in 64% of all fatal auto accidents, in 40% of all cases brought before family

courts, in 11% of all annual deaths, in 50% of home accidents, that from 25 to 50

 

 

17

percent of patients in the hospital are suffering from an alcohol-related illness, and that
20% of all referrals to child—guidance clinics are children of alcoholics (BNA, 1987;
Kinney & Leaton, 1983; Matsunaga, 1983; McClellan, 1982; United States Congress,
1978). Nonealcoholic family members (in families with an alcoholic) are also a financial
burden to business since these individuals have been found to have sick leave costs ten
times more than a control group (Compcare, 1981; Wrich, 1986). Substance abuse has
also been cited as a contributing factor in 50 to 60 percent of drownings and 80 percent
of all suicide cases (Wrich, 1986).

There are other costs incurred by the organization which involve the
implementation and administration of an EAP. Some of these costs include: (1) the
compensation of the EAP staff; (b) office expenses for renting/leasing office space, paying
for utilities, furniture, equipment, and supplies; (c) training expenses for renting/buying
materials and time spent in training (training of supervisors, employees, and EAP staff);
((1) provision of EAP services; and (e) liability and health benefits insurance (Myers,
1984, p. 109). Various estimates have been cited for these costs. James Wrich’s cost
estimate is $67,220 for the first year of operation for a company with 1,000 employees
with long—term costs over 25 years estimated at $426,740 (Masi, 1984, p. 198). Westrate
(1983) estimated that the average cost per employee at one EAP was $1.50 a month, or
$18.00 annually. Others have estimated the cost to be approximately $5.00 per employee

annually (Masi, 1984; Schlenger & Hayward, 1975).

The Benefits Of EAPs

Despite the various costs involved in establishing and maintaining EAPs, many

researchers have indicated the benefits outweigh the costs. Several early evaluation

 

 

Iii

SUI]

 

 

18

studies conducted on OAP effectiveness (Asma, Eggert & Hilker, 1971; Googins &
Kurtz, 1981; Hoffman & Roman, 1984; Kurtz, Googins & Howard, 1984) generally
reported positive results. For example, a 1980 cost-benefit study at the Illinois Bell
alcohol-related EAP tracked 752 problem drinkers referred to the EAP. The study
found that after referral to the EAP, 66% of the employees had "good" job performance
ratings compared with 90% having ”fair to poor” ratings prior to referral, and that
disability claims decreased 52%, off—duty accidents decreased 42.4%, and on-duty
accidents decreased 61.4% after referral (BNA, 1987).

Similarly, evaluative studies of broad—brush EAPs have generally reported positive
outcomes (County of Alameda, 1978; DuPont, 1979; Foote et al., 1978; Washington
Business Group on Health, 1978). Unfortunately, there appears to be little or no
consensus on how to measure EAP effectiveness. Most evaluation measures relate to the
goals of the particular program. Jerrell and Rightmyer (1982) reviewed 38 empirical
EAP studies published from 1958 to 1980 which focused on four types of measures
employed in EAP evaluation. The first set covers accidents, sick leave, and medical~
surgical costs. The second group focuses on outcome measures that include absenteeism,
tardiness, and leaving work early. The third set looks at rehabilitation rates. The last
group examines employee morale and satisfaction variables, job performance ratings,
grievances, disciplinary actions.

A few examples of EAP evaluation studies that have been conducted are
summarized below:

(1) Foote, Erfurt, Straugh, and Guzzardo (1978) conducted a detailed analysis of
costs and benefits of eight programs. Significant reductions were found on the

organizational outcome variables examined (e.g., absenteeism, grievances, on-the-job

 

 

19

accidents, health benefits), but they concluded that much work and more data were
needed to develop an accurate and reliable cost-benefit analysis.

(2) The Washington Business Group on Health (1978) concluded that most
companies report benefits in improved productivity, absenteeism rates, morale, and

health insurance cOsts.

(3) Featherston & Bednarek (1981) reported reduced replacement, training, and
unemployment insurance costs.

(4) General Mills American Family Forum (1980) provided evidence Of improved
productivity, morale, self-esteem, and more satisfying personal relationships and
reductions in hospitalizations, medical utilization, and absenteeism.

(5) DeFuentes (1986) reported improvements in absences, disciplinary actions,
performance reviews, and medical leaves. Those self-referred showed more promotions,
higher resolution of the problem, and higher performance ratings while those referred
by others showed reduced disciplinary actions, increased absences, and reduced medical
leaves.

Table 1 provides a chart identifying the major EAP cost—benefit studies which were
gathered by the Minnesota-based Hazelden Foundation (taken from BNA, 1987, pp. 27-

29). It seems that most evaluative studies track improvements in employment—related
criteria that are easily quantifiable, such as decreased absenteeism rates, medical costs,
on-the~job accidents, disability claims, grievances, and quantifiable measures of work

performance. There is little information on cost savings achieved through broad-brush

 

EAPs for employees in areas such as eating disorders, gambling compulsions, legal or
financial problems, and personal relationships because these benefits are more indirect

and more difficult to measure (BNA, 1987).

 

 

 

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In general, EAPs have been shown to make improvements in monetary areas since
many ﬁrms have been able to decrease absenteeism by 300%, medical costs by 200%,
and terminations for those using the EAP by ten times compared to those not using the
EAP (Busch, 1981; Sager, 1979). Additionally, EAPs have been shown to improve non—
monetary areas, such as staff morale, quality of performance, and improved relationships
with coworkers (Roth, 1981). When EAP success has been defined as an improvement
in job performance or in an individual’s overall functioning relationship, several
companies have reported success rates ranging in improvements from 60% to 80%--E.I.
DuPont de Nemours & Co. with a 66% success rate with 950 alcoholics receiving
treatment; Bethlehem Steel Corporation with a 60% success rate; and Minnesota Mining
and Manufacturing Company with a reported 80% success rate (Storm, 1977). Annual
savings have been noted as follows at other EAPs: $2 million by the US. Postal Service,
$1.5 million by the New York Telephone Company, and $5 million by DuPont
(Scanlon, 1983). Otto Jones, the president of a Salt Lake City EAP, cites a return of
$3.10 for every EAP dollar spent (Lovenheim, 1979). Others cite average returns of
$5.78 per EAP dollar spent (Scanlon, 1983), $8.00 (United States Congress, 1982), $14.00
(at Burlington Northern Railroad), and $16.35 (at a ”major airline”) (BNA, 1987, p. 25).
Wrich (1980b) found that ”companies that have developed cost effectiveness data report
that the benefit to cost ratio in employee assistance programs is frequently over 1,000
percent" (p. 113). Wrich (1980b) also determined that helping all troubled employees
in an organization costs about one-tenth what only one alcoholic employee will cost the
Organization.

While research has reported on the cost-effectiveness of most EAPs, several

problems have been noted with this research. Albert, Smythe, and Brook (1985) and

 

 

 

24

Steidinger (1985) reviewed EAP evaluation research and practices and concluded that
conceptual and methodological problems are inherent in this research and that -most
studies were poorly designed and used nonostandardized performance measures. The
thoroughness and validity of many studies has also been criticized. Most of the
published literature concerning the success of EAPs is anecdotal and, of the empirical
work, much is primarily descriptive data (J errell & Rightmyer, 1982; Kurtz, Googins, &
Howard,'1984). In addition, there is a basic difficulty facing EAP evaluators which is
a resistance. by EAPs and affiliated companies to conduct evaluations (Kilburg, 1980;
Masi & Teems, 1983). For example, Ford and McLaughlin (1981) found that only 13
of 110 companies with an EAP calculated any dollar or productivity benefits; rather they
focused primarily on changes in absenteeism rates. In a survey of EAPs by Straussner
(1986), only 52% of the EAPs conducted an evaluation of their programs and the
purpose was not to examine their services, but to validate the value of the program to
management. Similarly, Coleman (1984) found that only 40.6% of the EAPs examined
in higher educational institutions had a formal mechanism used in evaluating their
programs and that only 37.5% do so annually. Finally, 34 San Francisco area EAPs
were surveyed by Steidinger (1985) but only 59% reported conducting program
evaluations and the majority of these were external/off—site EAPs.

As previously mentioned, often employees are able to confront and resolve their
problems before the problems negatively impact their work performance. However,
there are times when these problems cannot be resolved and employees experience
decreased job effectiveness, increased absenteeism and tardiness, and other negative
effects. Methodological problems notwithstanding, EAPs can help combat these

problems.

 

 

lni

 

 

25

Div r i of EAP

There is no typical EAP. There are variations in the EAP model utilized, structure,
size, administrative policies and procedures, services provided, service delivery, funding,
management support, staffing, etc. What they have in common is the basic premise that
healthy employees are more productive/better employees and are valued assets and the
basic goal to reduce or eliminate the basis of an employee’s impairment (Roman, 1983a).
Thus, an EAP exists because the organization recognizes the value of employees and the
need to maintain employees’ health (Lovenheim, 1979; Scanlon, 1983; Wrich, 1980b).

EAPs are diverse in their ideological basis (Trice, 1980), although many typically
are grounded in both a "humanitarian” concern for the overall well-being of employees
(Trice & Roman, 1978) and a need to utilize controls to attain high productivity from
employees (Trice, 1980). Diversity is also evident in the type of EAP model utilized.
There are two basic EAP models. One model deals primarily with substance abuse
difﬁculties, primarily those that continue their original focus on alcohol-related
problems. The second model is referred to as "broad brush.“ The latter model provides
services that deal with more than alcohol—related problems which may negatively affect
job performance (Starr & Byram, 1985). Examples of ”broad-brush” services include
crisis intervention, short-term counseling and/or referrals for employees experiencing
difficulties related to marital problems, domestic violence, child abuse, emotional
stressors, psychological disorders along with providing information on financial, legal,
and vocational issues.

There are also generally three basic structural models or approaches of EAPs:
internal/on-site, external/off-site, or combination models. These will be discussed in

more detail in chapter two. Each approach accepts a variety of referral types: self-

 

 

 

 

26

referrals, supervisor-referrals, union-referrals, significant—other referrals, or any other
method by which employees come to seek assistance. It is assumed that many who are

identiﬁed and referred to an EAP will again become ”good" employees.

Assumptions of the Research

The following assumptions are important to this study:

1. An employee’s personal and work life are interdependent; thus, some employees
have problems which will affect their work performance.

2. An employer has an obligation to its employees and also to its constituencies,
students, and general public, and an employer cannot adequately meet the public’s needs
unless it also attends to the human needs of its employees.

3. Behavior is goal—directed.

4. Understanding an individual’s motivation to perform health-related behaviors
requires identifying the expectations of future performance regarding health behaviors,
the individual’s value placed on health, and the perceived benefits of health behaviors
(Pender, 1982; Rotter, 1954; Wallston, Maides, & Wallston, 1976).

5. The occurrence of a behavior is determined by the nature or importance of
goals or reinforcements and by a person’s expectancy that these goals will occur.

6. Employees who either participate or do not participate in EAPs have the

necessary resources and equal access to participate in the EAP if they choose to do so.

Organization of the Research
Chapters of this dissertation are organized as follows. Chapter two provides a

comprehensive review of the related EAP literature while chapter three presents a

 

 

 

 

 

27

discussion of both control theory in general and the Control Theory Model of EAP
Utilization developed in the present research. Chapter four outlines the research design
and method. Chapter five presents the results and analyses of the study. Chapter six
includes a summary of major conclusions, implications, and recommendations drawn
from the results. In Appendix A, common terms referred to in this research are defined.

Appendix B illustrates the survey instruments completed by the participants in this

study.

 

 

 

 

CHAPTER 2 '

REVIEW OF EAP AND HEALTHvRELATED LITERATURE

Interest in work site assistance programs crosses several disciplinary fields. In 1986,
Molloy indicated that "organizational and management theories have not addressed the
employee assistance field per se” (p. 47). Assistance programs should fall under the
human resource management (HRM) and organizational behavior (OB) ﬁelds because
they focus on organizational activities that are concerned with affecting the behavior of
the human resources (Ivancevich & Matteson, 1980). Since the HRM and OB fields
integrate research and perspectives from several other disciplines, such as sociology,
economics, psychology, and medical science, EAPs which focus on treating the physical
and mental health problems of employees encompass concerns and concepts from these
fields as well. Employee health, the rising costs associated with employee health, and
the social and cultural variables which impact one’s health behaviors makes employee
health a social, organizational, medical, economical, and psychological concern (BNA,

1983).

Historical Background
Historical Background to 1940--Welfare Movement
Little concern for the workers and their needs seemed to exist during the early
phases of the Industrial Revolution. The Industrial Revolution has been characterized
by three specific developments: ”the deve10pment of machinery, the linking of human
power to the machines, and the establishment of factories in which a large number of

people were employed" (Cascio, 1986). Labor was considered a commodity to be

28

 

 

 

 

 

bought and
conditions,
and produo
specializati
noted the n
less raw 1112
and tools),
Smith and j
only a few 5
only an op;
(Cascio, 19:

One 0
0fthe 19th
and Was one

hitder [0 d6

lead [0 p00]

Chlld empk

3di'0cated b

Pioneer 0f F

BY the
QHEd the ”i1
ititatigmu ‘

 

 

29

bought and sold at will and the environment was characterized with dangerous working
conditions, children forced to work long hours under hazardous conditions, low wages,
and productivity as the primary goal. This was also a time when a great deal of job
specialization developed. While Adam Smith (1776), Charles Babbage (1835) and others
noted the many advantages produced by a division of labor (e.g., reduced training time,
less raw materials wastage, better worker placement, greater worker expertise on tasks
and tools), there were also disadvantages which we are still dealing with today. Adam
Smith and Karl Marx stressed the psychological consequences of workers who perform
only a few simple operations: they argued that a person becomes ignorant, is viewed as
only an appendage to a machine, and exists without the need for intellectual processes
(Cascio, 1986).

One of the first moves toward a concern for employees came around the beginning
of the 19th century. In 1799, Robert Owen became a partner in a cotton-weaving mill
and was one of the first managers who believed employers and communities should work
harder to develop human talents and eliminate practices that stiﬂe individual ability and
lead to poor health (Cascio, 1986). By 1810, Owen was busy attacking the practices of
child employment, long working hours, and unsafe working conditions. He also
advocated better housing for his apprentices and instituted one of the ﬁrst performance
appraisal systems (Cascio, 1986). Because of his efforts, he has been recognized as ”the
pioneer of personnel management“ (Urwick, 1956).

By the early 1900’s, several US. corporations became engaged in what has been
called the "industrial welfare" movement (Shain, Suurvali & Boutilier, 1986), or ”welfare
capitalism" (Brandes, 1976). Welfare capitalism was defined by Brandes (1976) as "any

service provided for the comfort or improvement of employees which was neither a

 

 

 

 

density of the industry

hyanumber of factors: 2
it Campbell, 1972), e
industrialization (Brant
unionism (Popple, 1981)
and a need to help imn
tdjust(Popple, 1981).
During this movem
employed to help empk
more women and immi
them a unique set of pr
beginnings of industrial
sexism... [and] as bus
enployees, they found tl
problems; one answer w
These welfare assis
generally, had four basit
housing of workers), (
moronic welfare (e.g.,
(4) personal welfare (e.
1981). Other speciﬁc
Providing medical bene

ill immigrants, lunch

counselors (Popple, l9

 

 

 

 

30

necessity of the industry nor required by law" (p. 6). Welfare capitalism was motivated
by a number of factors: a humanitarian and paternalistic concern for employees (Nelson
& Campbell, 1972), an attempt to deal with social problems resulting from
industrialization (Brandes, 1976), a desire to keep employees loyal and to avoid
unionism (Popple, 1981), a need to reduce production costs (Nelson & Campbell, 1972),
and a need to help immigrants, young workers, and females enter the workforce and
adjust (Popple, 1981).

During this movement, full-time welfare assistants or welfare/social secretaries were
employed to help employees with personal and work—related problems, particularly as
more women and immigrant groups began entering the workforce and bringing with
them a unique set of problems for business. Brandes (1976) has suggested that ”the
beginnings of industrial social work are rooted in what might be considered a form of
sexism . . . [and] as businesses grew and employers faced growing numbers of female
employees, they found themselves at a loss about treating their workers’ peculiar ’female’
problems; one answer was the hiring of ’specialists’."

These welfare assistants/secretaries were often educated as teachers or nurses and,
generally, had four basic roles: (1) physical welfare (e.g., health, safety, sanitation and
housing of workers), (2) cultural welfare (e.g., recreation, libraries, education), (3)
economic welfare (e.g., loans, pensions, hiring, firing, wage setting of employees), and
(4) personal welfare (e.g., social work services for workers and their families) (POpple,
1981). Other Specific services offered during this movement included programs
providing medical beneﬁts with sick pay, clinics, doctors, nurses, schools and training
for immigrants, lunch rooms, company stores, housing, recreational programs and

counselors (Popple, 1981). The ﬁrst recorded social secretary was Mrs. Aggie Dunn

 

 

 

the 1,200 females in the
20;Popple, 1981, p. 16(
iii large US. compan
external agency for soci

Paternalistic attitur
designed to increase pr
developed at Amoskeag
community of houses, cl
lor the unmarried fem;
forbidding smoking and
Motor Company provit
problems (Bellows, 19¢
Rubber Company whicl
and was only the second
provided for paid vacal
houriugwhich could be 1
1986).

Some of the ﬁrst
intplemented in 1917 b
bore in New York Ci
boployed a psychiatrist

iDawson, 1948). In r

llbblems had an impac

 

 

 

 

31

hired by the H. J. Heinz Company in 1875 to interview, hire, counsel, and watch over
the 1,200 females in their work setting (Miller & Coghill, as cited in Googins, 1987, p.
20; Popple, 1981, p. 160). By 1919, the Bureau of Labor Statistics reported that of the
431 large US. companies surveyed, 295 employed a welfare secretary or utilized an
external agency for social work services (US. Bureau of Labor Statistics, 1919).
Paternalistic attitudes are evident in an early industrial welfare program speciﬁcally
designed to increase proﬁts and decrease labor problems (and prevent unionization)
developed at Amoskeag Textile Mills in Massachusetts. Amoskeag developed its own
community of houses, churches, clubs, and parks and took it upon itself to act as parents
for the unmarried female employees by setting curfews and establishing regulations
forbidding smoking and drinking (Shain, Suurvali & Boutilier, 1986). In 1914, the Ford
Motor Company provided counselors who advised employees on personal and legal
problems (Bellows, 1961). Paternalistic programs were implemented by Goodyear
Rubber Company which was committed to hiring and maintaining healthy employees
and was only the second U.S. organization to establish a factory hospital. Goodyear also
provided for paid vacations, eight—hour workdays, pensions plans, and quality family

housing which could be purchased through the organization (Shain, Suurvali & Boutilier

3

1986).

Some of the first programs designed specifically to help troubled employees were
implemented in 1917 by Northern States Power In Minnesota and Macy’s Department
Store in New York City and in 1919 by Metropolitan Life Insurance Company which
employed a psychiatrist to deal with the mental health problems of employees (Bowler
& Dawson, 1948). In research conducted by Macy’s staff, it was found that personal

problems had an impact on the quality and quantity of workers’ job performance. As

 

 

 

 

hired by the H. J. Heinz

the 1,200 females in their
id;l’opple, 1981, p. 160).
431 large US. companie
enema] agency for social

Paternalistic attitude
designed to increase pro:
developed at Amoskeag '
community of houses, Chl
lor the unmarried femal
forbidding smoking and d
Motor Company provide
problems (Bellows, 1961
Rubber Company which
and was only the second I
provided for paid vacatit
housing which could be p
in),

Some of the ﬁrst pr
implemented in 1917 by
Store in New York City
eItlployed a psychiatrist t

iDawson,1948). In r

lr0b|ems had an impact:

 

 

31

hired by the H. J. Heinz Company in 1875 to interview, hire, counsel, and watch over
the 1,200 females in their work setting (Miller & Coghill, as cited in Googins, 1987, p.
20; Popple, 1981, p. 160). By 1919, the Bureau of Labor Statistics reported that of the
431 large U.S. companies surveyed, 295 employed a welfare secretary or utilized an
external agency for social work services (U.S. Bureau of Labor Statistics, 1919).

Paternalistic attitudes are evident in an early industrial welfare program specifically
designed to increase profits and decrease labor problems (and prevent unionization)
developed at Amoskeag Textile Mills in Massachusetts. Amoskeag developed its own
community of houses, churches, clubs, and parks and took it upon itself to act as parents
for the unmarried female employees by setting curfews and establishing regulations
forbidding smoking and drinking (Shain, Suurvali & Boutilier, 1986). In 1914, the Ford
Motor Company provided counselors who advised employees on personal and legal
problems (Bellows, 1961). Paternalistic programs were implemented by Goodyear
Rubber Company which was committed to hiring and maintaining healthy employees
and was only the second U.S. organization to establish a factory hospital. Goodyear also
provided for paid vacations, eight-hour workdays, pensions plans, and quality family
housing which could be purchased through the organization (Shain, Suurvali & Boutilier,
1986).

Some of the first programs designed speciﬁcally to help troubled employees were
implemented in 1917 by Northern States Power In Minnesota and Macy’s Department
Store in New York City and in 1919 by Metropolitan Life Insurance Company which
employed a psychiatrist to deal with the mental health problems of employees (Bowler
& Dawson, 1948). In research conducted by Macy’s staff, it was found that personal

problems had an impact on the quality and quantity of workers’ job performance. As

 

 

 

cresult, the company

Dawson, 1948). These p
changing needs (BNA, 1‘
By the late 1920’s ti
Prini f S i ni
productivity. The scient
emphasis on efﬁciency, ﬁr
and a lack of interest i
Revolution had led to tr
organize themselves agai
adversarial relationship c
nonunion sentiment by 1
programs should be distr
toward the welfare prog
program was abandonec
management and began
(Bellows, 1961). Two ad
here the deaths of the p
tithin these organizatio
blossoms had been impl
While the number
of their functions moved

Personnel management

lid occupational menta

 

 

32

a result, the company felt a need to view employees as whole persons (Bowler &
Dawson, 1948). These programs have since been expanded to meet their employees’
changing needs (BNA, 1987; LeRoux, 1982).

.By the late 1920’s the growth of welfare programs began to decrease. In his book
Principles of Scientiﬁc Management, Taylor (1911) outlined ways to increase
productivity. The scientific management movement then began to catch on, with its
emphasis on efficiency, financial motivations, an intolerance for non-productive workers,
and a lack of interest in humanistic programs. At the same time, the Industrial
Revolution had led to much worker discontent and fostered the need for workers to
organize themselves against the abuses in the workplace. As a consequence, a strong
adversarial relationship existed between labor and management during this time. The
anti—union sentiment by management along with unions’ belief that the monies for these
programs should be distributed to employees in the form of wages affected the attitude
toward the welfare programs. In the case of the Ford Motor Co., their counseling
program was abandoned after employees developed a mistrusting attitude toward
management and began to resist the paternalistic interference into their private lives
(Bellows, 1961). Two additional reasons for the decline in these early welfare programs
were the deaths of the primary people who were involved in their initial establishment
within these organizations and a decline of the textile industry where many of these
programs had been implemented.

While the number of welfare secretaries decreased after the first World War, many
of their functions moved into two directions-one which lead to the development of the
personnel management field and the other which lead to the field of industrial health

and occupational mental health (Graham, 1984; Nelson & Campbell, 1972; Popple,

 

 

 

1981). The merging o

occupational programs v

QootpahomaLAimm
‘ Alcohol abuse wasr
unnibuted to this abu
eighteenth and nineteen
employers (Meyers, 1981
breaks, similar to our cc
Also, alcohol became a p
saloons as a substitute f0
Addictive drinking 1
are most productive and
efforts to eliminate alcol
more disciplined and (1
Movement along with the
alcohol from the workpl
A major impetus t
founding of Alcoholics
Prohibition. This was als
other than a "moral or
dcoholism" was originall

that alcoholism follows a

Menage similar to conta

 

 

 

 

33

1981). The merging of elements from these two fields is the foundation of the

occupational programs which are now referred to as EAPs.

Occupational Alcoholism Progxams (OAPs)

0

Alcohol abuse was reported as a problem as early as 5000 BC. and employers often
contributed to this abuse because consumption of alcohol on the job during the
eighteenth and nineteenth centuries was not only condoned but expected by U.S.
employers (Meyers, 1985). Employers offered employees wine, whiskey, and brandy
breaks, similar to our coffee breaks today (Trice & Schonbrunn, 1981, pp. 172-173).
Also, alcohol became a problem as immigrants and other transient workers frequented
saloons as a substitute for the homes and families left behind (Brandes, 1976).

Addictive drinking usually takes hold between the ages of 35 to 50 when employees
are most productive and valuable to their employer. From the 1880’s to the 1920’s,
efforts to eliminate alcohol from the workplace were undertaken in order to build a
more disciplined and dependable workforce. During this time, the Temperance
Movement along with the emergence of workmen’s compensation laws helped to remove
alcohol from the workplace (Trice & Schonbrunn, 1981, pp. 173-174).

A major impetus to the revival of corporate counseling programs came after the
founding of Alcoholics Anonymous (AA) in 1935, two years after the repeal of
prohibition. This was also a time when alcoholism ﬁrst began to be viewed as a sickness
rather than a "moral or spiritual deficiency" (BNA, 1987). This “disease concept of
alcoholism” was originally introduced by Dr. E. M. J ellinek in 1939 whose theory stated
that alcoholism follows a pattern of progressive psychological and physiological bodily

damage similar to contagious diseases (Jellinek, 1960). Defining alcoholism as a disease

 

 

—

idped pave the way for
Itporteti as the most wit
cuts across all profession
Roman, 1978).

With the help of A}
jobs and improve their v
of occupational alcoholi
employees and providing
(Masi, 1984). These 1
employees. The threat
limiting to a problem a

During this time, t
wheeling services. In 1‘.
providing services relate
recreational work, housir

Some of the first
eloployees with alcohol—
Co, BasnnaneKodak
Consolidated Edison of
Co.(BNA, 1987; Roman,
brooch humanitarian an
“i an increase. Simil

ccGnostic advantages, w

“i a desire to save jobs

   

 

 

 

34

helped pave the way for medical intervention in its treatment. Today alcohol has been
reported as the most widely used mood-altering drug in the U.S. and is a problem that
cuts across all professions and occupations equally (Pattison & Kaufman, 1983; Trice &
Roman, 1978).

With the help of AA, alcoholic employees were able to maintain sobriety and their
jobs and improve their work productivity. The success of AA led to the establishment
of occupational alcoholism programs (OAPs) which focused on recognizing alcoholic
employees and providing help before their reduced performance resulted in termination
(Masi, 1984). These programs were initially supervised by recovered alcoholic
employees. The threat of job loss had a major impact on an alcoholic employee
admitting to a problem and seeking help.

During this time, the Federal Government also began implementing employee
counseling services. In 1938, the Social Security Board established a counseling program
providing services related to guidance, psychiatric and social work, personnel and
recreational work, housing and transportation problems (Bowler & Dawson, 1948).

Some of the first OAPs that were established in the mid-1940’s to rehabilitate
employees with alcohol—related difficulties were offered by El. DuPont de Nemours &
Co., Eastman-Kodak Co., Kemper Insurance, Allis-Chalmers Manufacturing Co.,
Consolidated Edison of New York, Standard Oil of New Jersey, and Caterpillar Tractor
Co.(BNA, 1987 ; Roman, 1980a). Implementation of the DuPont program was prompted
by both humanitarian and economic motives since the termination rate of employees was

on an increase. Similarly, management’s interest at Allis-Chalmers focused on the
economic advantages, while the union’s interest was based on a humanitarian concern

and a desire to save jobs (Baxter, 1978). Impressive results were often reported with

 

 

—

these early programs. 1
employees treated for al
World War II was
him conditions at the t
skilled workers was Iimi
which resulted in the hi
work with them (BNA, 1
problems, organizations
employees. Long work 1
horror demands, and int
problems which interfere
Consequently, mental he
help integrate workers is
Occupational Alcr
employees and encourag
during the post World W
who wanted to share th
Programs claimed an av
hogan to slow down (M
their mental health prog
Programs remained sma

Several reasons ace

 

responsibility to identi

Participation in the org

   

 

 

35

these early programs. For example, Eastman Kodak reported that 75% of the 3000
employees treated for alcoholism were rehabilitated (Norris, 1948).

World War II was another strong force in the establishment of OAPs due to the
labor conditions at the time. Industries were forced to mass produce, but selection of
skilled workers was limited so companies were forced to lower employment standards,
which resulted in the hiring of more workers who brought their diverse problems to
work with them (BNA, 1987). Additionally, as soldiers returned with alcohol and other
problems, organizations realized they needed to take an active part in helping
employees. Long work hours and shift work, pressure to improve productivity to meet
the war demands, and inexperienced supervisors unable to deal with employees’ personal
problems which interfered with their job performance further exacerbated the problems.
Consequently, mental health and social service programs in industry were established to
help integrate workers into the workplace (BNA, 1987; Lewis, 1981).

Occupational Alcoholism Programs were established to identify alcoholic
employees and encourage them to seek treatment. The early programs in existence
during the post World War II era often depended on the fervor of recovered alcoholics
who wanted to share their sobriety with other employees (Baxter, 1978). While these
programs claimed an average recovery rate of 60-70 percent, growth of such programs
began to slow down (Masi, 1982). After the war, the majority of companies shut down
their mental health programs, and throughout the 1950’s the number of businesses with
Programs remained small" (Sonnenstuhl & Trice, 1986 cited in BNA, 1987).

Several reasons account for this slow growth. First, it was typically the supervisors’
responsibility to identify employees with drinking problems and encourage their

participation in the organization’s program. This method worked well in identifying

 

—

rank-and-ﬁle personnel
of the working populati
because alcoholism was
attempted to hide their (
ass witch-hunt of non-i
prevailed (Masi, 1984).
confronted, they typical
Fourth, often there is a 5
about making accusation
sometimes feared that b'
they have an alcoholism
wasalack of available re
(Masi, 1984). Thus, l
occupational counselin
rehabilitation programs
During the 1960’s,
factors inﬂuenced this gr
alcohol symptoms to im
alcoholism as a disease.
extruding and a concer
developed in order to se
influencing this search f

hellth agencies over—tax

awareness of the inﬂue

   

 

 

 

36

rank-and—ﬁle personnel but not managerial-level employees. Therefore, a large segment
of the working population was not only ignored, but management avoided treatment
because alcoholism was seen as afﬂicting only the lower echelons. Second, employees
attempted to hide their drinking problem since they viewed a supervisor’s confrontation
as a witch-hunt of non-managerial personnel, and thus an us—versus-them atmosphere
prevailed (Masi, 1984). Third, alcoholics not only deny they have problems but when
confronted, they typically blame their problem on anyone or anything but themselves.
Fourth, often there is a social stigma attached to alcoholism so supervisors were hesitant
about making accusations until the problem was in advanced stages. Fifth, organizations
sometimes feared that by offering a visible program they would be acknowledging that
they have an alcoholism problem in the organization (Holden, 1973). Sixth, often there
was a lack of available resources and of trained professionals to administer the programs
(Masi, 1984). Thus, by 1959, only 50 American companies had implemented
occupational counseling programs--35 which focused exclusively on alcohol
rehabilitation programs (Carr & Hellan, 1980; Masi, 1984).

During the 1960’s, however, the number of OAPs began to grow. Three major
factors inﬂuenced this growth-growth in community health services, a shift in focus from
alcohol symptoms to impaired job performance and work behaviors, and acceptance of
alcoholism as a disease. First, during the 1960’s community mental services were greatly
expanding and a concern about developing other effective, briefer methods of therapy
developed in order to serve more people. Gelso and Johnson (1983) cite several factors
influencing this search for other methods: increased demands for service had left mental
health agencies over-taxed; long waiting lists resulted in service delays; heightened public

awareness of the inﬂuence psychological factors have on human functioning caused

 

 

—

many types of people t
populations other than
pay for mental health tr
treatments.

The second impetu
refocus on a "job perfor
performance of employ
occupational programs.
alcoholism symptoms. ”l
the uncomfortable role
performance was manife
employer could legitima
Supervisors were now tr:
alcoholic behaviors. Joh
toasupervisor’s subjecti
not directly accusing thi
watchful in getting th
problem-drinking empl
The confrontational app
to motivate workers to
“rice, 1976).

Finally, the “diseas

Medical Association in

(Follman,1978). Viewi

   

 

37

many types of people to seek treatment; mental health services became available to
populations other than the middle class; and demands on health insurance policies to
pay for mental health treatment lead to insurance companies examining the efficacy of
treatments.

The second impetus for OAP growth was that, during this time, organizations began
to focus on a "job performance model" where dysfunctional work behaviors and the job
performance of employees were used to help identify those who might be helped by
occupational programs. These behaviors were believed to be less stigmatic than
alcoholism symptoms. The focus on work behaviors also removed the supervisor from
the uncomfortable role of diagnostician (Wrich, 1980b). Since deterioration in job
performance was manifested in the early stages of some problems (e.g., alcoholism), the
employer could legitimately intervene to bring about change (Roman & Trice, 1976).
Supervisors were now trained to observe declining job performance rather than to spot
alcoholic behaviors. Job behaviors are more difficult for employees to deny compared
to a supervisor’s subjective evaluation. By focusing on declining job performance and
not directly accusing the employee of being an alcoholic, supervisors may be more
successful in getting the employee to admit to having a drinking problem. Since
problem—drinking employees must support their habit, they don’t want to lose their job.
The confrontational approach toward employees’ job performance was viewed as a way
to motivate workers to help themselves and modify their destructive behavior (Roman
& Trice, 1976).

Finally, the "disease model" of alcoholism was officially accepted by the American
Medical Association in 1956 (Masi, 1984), and in 1959 the AFL-CIO followed suit

(Follman, 1978). Viewing alcoholism as a treatable disease moved organizations away

 

—

from taking a punitive
The new approach was
previously mentioned th
OAPs were the basis 0
emotional, psychologicr

impacting work perform

1 0’ Fr r
In a 1979 survey,
broader-focused EAPs. t
to family members of e
occurred to further inﬂt
For example, the er
into the late 1960’s ant
initially, industry‘s respr
that of alcoholism; i.e.
Mutated of abusing dr
in addition to the
enhanced due to the leg
prohibiting discriminati
Rehabilitation Act of 19
the deﬁnition of "ha

humane approach to dru

(it, Department of Def

   

 

 

 

 

38

from taking a punitive approach to one that was more positive toward the employee.
The new approach was coined "tough love,” which used the confrontational strategy
previously mentioned that focused on breaking down an alcoholic’s denial system. Thus,
OAPs were the basis of the development of “broad-brush" EAPs which address the
emotional, psychological, and social needs of employees and problems negatively

impacting work performance.

The 1970’s to the Present--The Legal Inﬂuences on EAPs

In a 1979 survey, Roman (19803) found that most OAPs were housed in the
broader-focused EAPs. Occupational programs were also expanded to include assistance
to family members of employees. During the late 1960’s and 1970’s, several forces
occurred to further inﬂuence the growth and development of EAPs.

For example, the evolution from alcoholism to other personal problems continued
into the late 1960’s and 1970’s as drug abuse became more of a societal problem.
Initially, industry’s response to the increased occurrence of drug abuse was similar to
that of alcoholism; i.e., initial denial or punitive actions toward those employees
suspected of abusing drugs (Johnston, 1971; Rush & Brown, 1971; Stevens, 1970).

In addition to the types of problems addressed by EAPs, the growth of EAPs was
enhanced due to the legal climate during the 1970’s. Federal legislation in the 1970’s

prohibiting discrimination against handicapped individuals, such as the Vocational
Rehabilitation Act of 1973, which was extended to include alcoholics and drug abusers
in the definition of "handicapped”, was a major force in the development of a more
humane approach to drug abuse (Vicary & Resnik, 1982, p. 16). The federal government

(e.g., Department of Defense) also established programs during this time which focused

 

 

 

 

on education, rehabilitz
The Hughes Act, 0:
Treatment and Rehabil
resurgence of occupatio.
(National Institute on 1
Education, and Welfare
private and public sect
alcoholism programs in
abuse was included (M
funding to pay for servic
programs (Masi, 1984).
Several factors inﬂ
1980’s. First, there wa:
where employers were I
problems as a result of co
ﬁnancially responsible in
iul9ll afﬁrmative actior
drug addicts and alcol
ldtuuations expanded
psychotherapy. Fourth
iilliterate benefits and p!
1987iTersine & Hazeldil
ill Health Act, equal

torsion legislation alst

 

 

 

 

39

on education, rehabilitation, and treatment (Korcok & Seidler, 1978).

The Hughes Act, or the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act, is also considered to be a major impetus to the
resurgence of occupational programs during the 1970’s. This law established the NIAAA
(National Institute on Alcohol Abuse and Alcoholism) in the Department of Health,
Education, and Welfare to coordinate efforts in combatting alcohol problems in both the
private and public sectors. The Hughes Act also mandated the implementation of
alcoholism programs in all federal agencies and military installations. In 1972, drug
abuse was included (Masi, 1984). Through the NIAAA, states could obtain federal
funding to pay for services of trained consultants who could help establish rehabilitation
programs (Masi, 1984).

Several factors influenced the tremendous growth of EAPs during the 1970’s and
1980’s. First, there was a broadening of worker’s compensation/handicap coverage
where employers were held more liable for employees’ alcohol, drug, and emotional
problems as a result of court rulings and arbitration decisions. Employers were also held
ﬁnancially responsible for on-the-job accidents regardless of fault (BNA, 1987). Second,
in 1977 affirmative action programs were implemented requiring the hiring of qualiﬁed
drug addicts and alcoholics by federal contractors and subcontractors. Third,
organizations expanded the beneﬁts offered to employees to include counseling and
psychotherapy. Fourth, unions began demanding alcoholism and mental health
insurance benefits and programs as part of their collective bargaining agreements (BNA,
1987; Tersine & Hazeldine, 1982, pp. 69-70). Fifth, passage of the Occupational Safety
and Health Act, equal employment opportunity legislation, and environmental

protection legislation also spurred a change in corporate attitudes and culture toward a

 

 

 

 

greater concern about
employees.
Additional forces I

the 1970’s are discussed

The 1910’s to the PIQQI

During this period
job performance. Cons
personal problems such 1
problems, retirement, as
Thain & Groeneveld, 19

We have also move
workers-workers who t
conditions compared to

The shift in the stn

produce more thar

enough. Work also
The focus of EAPs was a
the realization that techn
American industry spent
he human element-whr
fiduciary-industry bl
hippie who operate tht

hundred because thei

toilets experience inert

 

 

 

 

40
greater concern about employers’ social responsibility for their communities and

employees.

Additional forces cited as inﬂuencing the growth and development of EAPs since

the 1970’s are discussed in the following section.

The 1920’s to the Present-~Additional Inﬂuences on EAPs

During this period other problems were recognized as having a negative impact on
job performance. Consequently, EAPs focused on alcoholism, drug abuse, and other
personal problems such as depression, phobias, divorce, domestic violence, child-rearing
problems, retirement, anxiety, relocation issues, etc. (BNA, 1987; Carr & Hellan, 1980;
Shain & Groeneveld, 1980; Trice & Roman, 1972).

We have also moved towards a technological society that requires highly skilled
workers--workers who tend to hold different values regarding their job and working
conditions compared to the factory worker of the past. In 1974, Drucker stated:

The shift in the structure and character of work has created a demand that work

produce more than purely economic benefits. To make a living is no longer

enough. Work also has to make a life (p. 179).

The focus of EAPs was also broadened as a result of increased foreign competition and
the realization that technology is not enough to maintain high productivity levels. While
American industry spent a great deal of time automating factories and trying to eliminate
the human element-~which was believed to be a major cause of error and decreased
productivity-industry began realizing that machines are not enough; rather, it is the
people who operate the machines who are valuable resources that must also be
maintained because they are so costly to train and replace (Lewis, 1981). Also, as

workers experience increased alienation from the workplace and as limited dollars are

 

 

 

 

available for salary incr
concerned with the ove
In 1979, there wer
sector (DHHS, 1982).
additional 1,000 outside
by 1987 over 10,000 E)
which included 80% of
of most programs today
the program and to rel
rather than performanc
increasing the professior
to improve their ability
(llirkland, 1983; Forrest
EAPs have typical!
and other substance-abs
increase in the number a
approach taken by organ
refunds. Thus, the EA!
hnsidcntify troubled c

three, and it is aimed at

Groeneveld, 1980).

 

 

 

 

41

available for salary increases, both employers and employees have had to become more
concerned with the overall quality of life within the workplace.

In 1979, there were over 5,000 EAPs in the private sector and 677 in the public
sector (DHHS, 1982). By 1983 the total ﬁgure had increased to 8,000 EAPs with an
additional 1,000 outside consultants providing a variety of services (Roman, 1983b), and
by 1987 over 10,000 EAPs were operating in the U.S. (BNA, 1987; Champion, 1988),
which included 80% of the Fortune 500 companies (BNA, 1987). The broader concern
of most programs today is considered to result in less stigma attached to those utilizing
the program and to relieve the supervisor of having a primary role as diagnostician
rather than performance evaluator (Wrich, 1980b). Organizations have also been
increasing the professionalism of the counseling staff within the EAP and their training
to improve their ability to handle and/or refer employees with all types of problems
(Birkland, 1983; Forrest, 1983).

EAPs have typically relied on supervisory referrals to get employees with alcohol
and other substance-abuse problems to seek treatment. However, as a result of the
increase in the number of problems handled by EAPs today and the more humanistic
approach taken by organizations, a greater emphasis has been placed on employee self-
referrals. Thus, the EAP of today has a dual focusnit is used in the workplace to help
firms identify troubled employees and control problems such as alcoholism and drug
abuse, and it is aimed at helping employees with a broad range of problems (Shain &

Groeneveld, 1980).

 

 

 

 

The Wellness Concept

The broad-brush:
many programs include
programs-in addition tr
typical substance abuse
under the more tradit
programs may be offerr
nutrition, ﬁtness, stress
variety of formats (e.g.,
amount of evidence tha
Belloc & Breslow, 1972;
Therefore, in addition I
problems, organizations
and maintain a healthy 1
lounger, 1987; Perham

The relationship be
wellness programs have a
The success of corporate
the down, maintain he
touhled employees typit
1932; Levine, 1983). TI
iflied "mega-brush" prol

her 50,000 organization!

l”Blinds, 1983).

 

 

 

42
W

The broad-brush approach to EAPs has most recently expanded to the point where
many programs include a third component—employee wellness or prevention—oriented
programs-~in addition to the rehabilitative and disciplinary components. Along with the
typical substance abuse, ﬁnancial, child-rearing, stress, and other problems handled
under the more traditional broad-brush EAPs discussed above, a variety of other
programs may be offered under the wellness umbrella. Such programs may include
nutrition, fitness, stress management, and weight control which may be offered in a
variety of formats (e.g., classes, lectures, workshops, and brochures). There is a great
amount of evidence that lifestyle factors influence one’s health status (Belloc, 1973;
Belloc & Breslow, 1972; Fielding, 1984b; Palmore, 1971; Public Health Service, 1979).
Therefore, in addition to their continued interest in helping employees with existing
problems, organizations are now emphasizing the need to deter problems and promote
and maintain a healthy lifestyle among employees (Brink, 1983; Goodstadt, Simpson &
Loranger, 1987; Perham, 1984).

The relationship between one’s health behavior and health status is evident, and
wellness programs have attempted to influence a variety of employee health behaviors.
The success of corporate wellness programs has come in their ability to keep company
costs down, maintain healthy employees, and to reach many more workers than the
troubled employees typically assisted under the broad-brush concept (J euchter & Utne,
1982; Levine, 1983). These expanded programs are developing into what have been
called "mega—brush" programs (Delaney, 1983). Some have estimated that there are now
over 50,000 organizations involved in some type of work site health promotion (Howe,

1983; Jacobs, 1983).

 

—

Slum f o l

The above section
EAPs in the workplace
have evolved over the
helpful to summarize ti
and their health.

llgen and colleagu
Swisher, 1989) describe
health at work. These h
of employee health. Fi
each. A brief discussion
for the current focus on

in the early 1900’
primarily concerned witl
was given to employee ht
llgen (1990), the ﬁrst m
result of public concern 1
he'hafety" model since
conditions of employees
only the formation of g(
conditions (e.g., the Nat:
hmpensation plans whic

his], health was viewe«

hunter on the worker.

   

 

 

43

Summary of Models/Attitudes Regarding Employee Health

The above sections have provided an historical overview of the development of
EAPs in the workplace and outlined how employers’ attitudes toward employee health
have evolved over the years. Before continuing the discussion of EAPs, it might be
helpful to summarize the evolutionary process that has occurred regarding employees
and their health.

Ilgen and colleagues (Hollenbeck, Ilgen & Crampton, 1990; llgen, 1990; llgen &
Swisher, 1989) described five general models or approaches that have been applied to
health at work. These have progressed from a focus on safety to a broader systems view
of employee health. Figure 1 outlines the basic models and the primary concerns of
each. A brief discussion of the models will follow to provide an understanding and basis
for the current focus on a systems perspective to health.

in the early 1900’s when scientific management was popular, employers were
primarily concerned with the productivity and efficiency of employees and little concern
was given to employee health and problems. According to Ilgen and Swisher (1989) and
Ilgen (1990), the first model of health at work emerged in the 1930’s and 1940’s as a
result of public concern over dangerous working conditions. This first model was called
the ”safety" model since its primary focus was on the job environment and working
conditions of employees (Ilgen, 1990; Ilgen & Swisher, 1989). This model was spurred
on by the formation of government agencies formed speciﬁcally to address safe working
conditions (e.g., the National Safety Council) along with the development of workers’
compensation plans which aided employees injured on the job (llgen, 1990). Under this

model, health was viewed as unidirectional--factors from the job environment have an

impact on the worker.

 

—

Summary of ModelszAtt

The above sections
EAPs in the workplace a
have evolved over the y
helpful to summarize the
and their health.

llgen and colleague
Swisher, 1989) described
health at work. These ha
of employee health. Fig
each. Abrief discussion c
for the current focus on 2

in the early 1900’s
primarily concerned with
wasgiven to employee bez
lien (1990), the ﬁrst moi
result of public concern 0
he"snfety" model since
conditions of employees
My the formation of go
Conditions (e.g., the Nati
cOlttpensation plans whic

Model, health was viewed

littlest on the worker.

   

 

 

43

Summary of Models/Attitudes Regarding Employee Health
The above sections have provided an historical overview of the development of
EAPs in the workplace and outlined how employers’ attitudes toward employee health
have evolved over the years. Before continuing the discussion of EAPs, it might be
helpful to summarize the evolutionary process that has occurred regarding employees
and their health.
llgen and colleagues (Hollenbeck, llgen & Crampton, 1990; llgen, 1990; llgen &
Swisher, 1989) described five general models or approaches that have been applied to
health at work. These have progressed from a focus on safety to a broader systems view
of employee health. Figure 1 outlines the basic models and the primary concerns of
each. A brief discussion of the models will follow to provide an understanding and basis
for the current focus on a systems perspective to health.
in the early 1900’s when scientific management was popular, employers were
primarily concerned with the productivity and efficiency of employees and little concern
was given to employee health and problems. According to Ilgen and Swisher (1989) and
llgen (1990), the ﬁrst model of health at work emerged in the 1930’s and 1940’s as a
result of public concern over dangerous working conditions. This first model was called
the "safety" model since its primary focus was on the job environment and working
conditions of employees (Ilgen, 1990; Ilgen & Swisher, 1989). This model was spurred
on by the formation of government agencies formed specifically to address safe working
conditions (e.g., the National Safety Council) along with the development of workers’
compensation plans which aided employees injured on the job (Ilgen, 1990). Under this

model, health was viewed as unidirectional--factors from the job environment have an

impact on the worker.

—

rode 1

term
"Jerking Candida

EARLY ERGONOHICS
Working Condition

MESS
Life Style<-,\ All

MEMO“.
Iﬂma/Injuryéd

Work Environment:
Social. Systems (S
Indtvdual. System:

no nnnnnnnnnnnnnnn 09¢

Source: Hollenbeck

figure 1: Approach

A

 

 

 

44
Hodel. target of: Concern
SAFETY
'Qoricing Condition“ Workers Job Environment

(Safe Worktng Conditions)

EARLY ERCONOHICS .
tJoric:l.ng Conditions (o) Workers Job Envaronment

(Safe Working Conditions and
Safe working Behaviors)

'JELL‘JESS
Life Styla<o> All. Employees Employee Behaviors
(Diet. Smoking, Substance
Abuse)
HEDICAL
Illness/Injury“) All. Employees Physical. Syntons
HEALTH
Work Environments (WE) -- -- WE All Components in
Social Systems (33) {S‘5 SS Interaction
Indivﬁual. Systems (IS) .-- -- IS

oooooooooooooooooooo coo-o-scoooooooooooooooooooo.90---.ooooooooooooooooooo-

Source: Hollenbeck, Ilgen & Crampton, 1990

Figure 1: Approaches To Health At Work

 

 

 

 

 

The impetus for It
model-came about with
with employees, improvt
on the environment bu
incentives provided to en
olindividuals. This new
conditions played a majc
regulations as a result of '
ergonomics model coincit
1950’s for the alcohol-rel
the development of CAP

A5 Previously discu

employees is important

society. Consequently

 

 

 

45

The impetus for the development of the second model--the ”early ergonomics"
model--came about with the realization that since work environments interact so closely
with employees, improvement in safe working conditions must include not only a focus
on the environment but also on the safe working behaviors of the workforce, the
incentives provided to encourage safe behaviors, and the safe selection and/or placement
of individuals. This new bi-directional relationship between workers and their working
conditions played a major role in training workers in safe behaviors and in developing
regulations as a result of the Occupational Health and Safety Act (OSHA) of 1970. The
ergonomics model coincides with the greater occupational concern during the 1940’s and
1950’s for the alcohol-related problems of employees-—which, as outlined above, lead to
the development of OAPs (Occupational Alcoholism Programs).

As previously discussed, eventually employers realized that the overall health of
employees is important to the performance of the employee, the organization, and
society. Consequently, EAPs, wellness programs, and other occupational health
promotion programs developed in the 1970’s and 1980’s as a dual concern evolved to
include not only the prevention of injuries but the encouragement of healthy physical
and psychological life-styles (Brink, 1983; Delaney, 1983; Goodstadt, Simpson &
Loranger, 1987; llgen, 1990; Perham, 1984). This third approach toward employee
health is referred to as the "wellness" approach because it focuses on the inter-
relationships between employee behaviors (e.g., diet, exercise, smoking, substance abuse)
and their life-style, rather than simply focusing on job conditions as the causes of health
problems (Ilgen, 1990; llgen & Swisher, 1989).

The fourth model, according to llgen and Swisher (1989), actually predated the

above three and is still in use today. This is known as the "medical" model and focuses

 

 

—

on the physical symptor
injury or are ill. The w
from one or a few defin
health problems today at
psychological, social, el
dealing with employee 1
The last model or r
by emphasizing the inter.
individual systems (Holl
systems consist of indivi
beliefs and communicatic
tothehiopsychosocial n
consideration the biologit
impact on the health of \
Humans are inﬂueni
scholar, organ, organ s
liﬂyder,1989). These re
of complexity, deﬁned as
liSwisher, 1989). To un
heeded one has on oth
tonne the lower levels

00Illtllurrity, culture, etc.)

he focus of the past and

“lifted, biolpsycho/soci

   

 

 

 

46

on the physical symptoms of workers who are referred to physicians when they have an
injury or are ill. The weakness of this approach is that illnesses are assumed to result
from one or a few definable causes, which can be isolated and treated. However, many
health problems today are caused by a complex set of interdependent systems (biological,
psychological, social, etc.) and thus a broader systems perspective is required when
dealing with employee health.

The last model or approach to health at work takes on the "systems" perspective
by emphasizing the inter-relationships among the work environments, social systems, and
individual systems (Hollenbeck et al., 1990; llgen, 1990; llgen & Swisher, 1989). Social
systems consist of individuals interacting with others according to a shared system of
beliefs and communication means (Wiseman, 1966). The ”systems“ perspective is similar
to the biopsychosocial model of medicine espoused by Engel (1977) which takes into
consideration the biological, psychological, and social environments and their combined
impact on the health of workers.

Humans are influenced by and made up of many organizational levels--molecular,
cellular, organ, organ system, psychological, behavioral, environmental, social, etc.
(Snyder, 1989). These levels are arranged hierarchically in Figure 2 in ascending order
of complexity, defined as the number of interactions possible at a specific level (llgen
& Swisher, 1989). To understand the major inﬂuences impacting on an employee and
the effect one has on other levels, we must take on a broader systems perspective and
examine the lower levels (systems, organs, tissues, etc.) and the upper levels (family,
community, culture, etc.) which man frequently interacts with. Figure 2 also identiﬁes

the focus of the past and current perspectives (i.e., bio-medical approach, psycho/social

approach, bio/psycho/social approach) in examining health and work behaviors.

 

 

 

 

Psycho/Social
Approach

F?

l
Rio Medical
Approach

Source: Ilge

Figure 2: Hi

 

 

47

RIERARCHY OF m AND SCIENCE

BIOSPHERE

HOHOSAP {ENS

 

SOCI {TY/NATION

CULTURE
Psycho/Social
Approach
l SUBCULTURE

CWUN IT?

 

FAMILY‘ . Bi «Psycho/Social
Behavior

 

P5150»
(Levels. of Conduct and Expert ente)

SYSTEHS

 

 

Bio Hedi cat
Approach: ORGANS

TISSUES
CELLS r
OﬁWELLS

 

HOLECULES

 

 

AIOHS
. suaArontc PARTICLES
ounaxs

Source: Ilgen & Swisher, 1989

Figure 2: Hierarchy of Man and Science

 

 

—

This evolution in
evolution of EAPs. Tc
toward employee heal
environmental, psycholt
the employee’s health it
environments.

This systems perSpt
Utilization for the press
remainder of this chap

current status and struct

Themgmrg and Dryer
As mentioned in 1
depending on the organiz
There are no guidelines
individual programs. E
policies established, de
delivery, depending to a
Regardless of the
minagernent support an
Management and labor (
ii key to obtaining em p

lttypical assessment

hemmed by Wrich (

   

—7

48

This evolution in the approaches toward health at work coincides with the
evolution of EAPs. Today, industry has taken on this broader "systems" perspective
toward employee health by recognizing that many factors (e.g., biological, social,
environmental, psychological, etc.) influence an employee’s overall health and, in turn,
the employee’s health influences all areas of his/her life-both the work and non-work
environments.

This systems perspective has been applied in the development of the Model of EAP
Utilization for the present research, which will be presented in the next chapter. The
remainder of this chapter will continue the discussion of EAPs by focusing on the

current status and structure of EAPS and specific areas of research.

 

 

The Structure and Diversity of EAPs

As mentioned in chapter one, EAPs today are very diverse in composition,
depending on the organizational setting, needs, and the labor-management relationship.
There are no guidelines or mandates on the structure, functioning, or breadth of
individual programs. Employee Assistance Programs vary in the model implemented,
policies established, degree of management support, services provided, and service
delivery, depending to a great extent on the size of the organization and employee needs.

Regardless of the model implemented, the most successful EAPs have t0p
management support and are jointly designed, implemented, and maintained by both
management and labor (Beyer & Trice, 1978; Minter, 1983). In addition, confidentiality
is a key to obtaining employee trust and utilization. A flow-chart of activities involved
in a typical assessment and referral process, regardless of the model utilized, is

diagrammed by Wrich (1980b) in Figure 3. While standardized procedures do exist, the

 

 

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3:333. .3: a: 539:9 >5...—

 

 

—

process an employee m3
problem (Wrich, 1980b
and possess the necess:
employee and recommt
The two most popr
the "broad-brush" EA]
Regarding speciﬁc servi
services that can be c
Administration includes
and evaluating the prog
appropriate treatment n
provide management co
As stated earlier,
administration of EAPs
employee who has a prol
conﬁdentiality) and
Management’s attitude
structure, as well as the
both geographically and
nEAP’s success. Mas'

hderlhe personnel fun

Nearly the concern of

   

 

 

SO

process an employee may take within an EAP is individualized according to the worker’s
problem (Wrich, 1980b). The EAP counselor must understand the resources available
and possess the necessary assessment, diagnostic, and clinical skills for evaluating an
employee and recommending treatment.

The two most popular models of service for employee counseling are the CAP and
the "broad-brush” EAP model, both discussed above (Forrest, 1983; Wrich, 1980b).
Regarding specific services offered, Winkelpleck (1984) states that most EAPs provide
services that can be classified into two functions: administration and counseling.
Administration includes activities such as implementing, marketing, stafﬁng, maintaining
and evaluating the program. Counseling includes problem assessment and referral to
appropriate treatment resources. In addition to these functions, some EAPs may also
provide management consultation, education, and organizational development.

As stated earlier, confidentiality is a critical issue inﬂuencing the successful
administration of EAPs (Masi, 1984; Myers, 1984; Wrich, 1974, 1980a). Since it is the
employee who has a problem, it is his or her perceptions of the EAP policies (including
conﬁdentiality) and management’s attitude toward the EAP that are critical.
Management’s attitude can be inﬂuenced by how the EAP fits into the organizational
structure, as well as the physical location of the EAP; therefore, the location of the EAP
both geographically and within the organization’s structure is often a key issue impacting
an EAP’s success. Masi (1984, p. 34) argues that "it is vital that the EAP be located
under the personnel functions . . . (since) EAPs are connected to job performance which
is clearly the concern of personnel."

The location of EAP services within an organization’s hierarchy has also changed

over the years. Early programs focusing primarily on alcohol-related problems were

 

 

 

 

 

typically started and d

most programs fall und

professionals such as 5

location of an EAP \l

Sponsorship of the EA

alternatives (i.e., spor
organization assumes a
performs some function
for-service basis which
0rionization pays an on
lorsupervisor training a
sen-ices rendered which
0ltanization pays a ﬂat
insurance carrier for 3pc
ft is also critical to

EAP should be access

conﬁdentiality (Masi 1
lllustratedb e exister

E
Al’s. We really do not

b
lHung (1988) on exi

 

 

 

51

typically started and directed by a company’s medical department. Today, however,
most programs fall under the personnel/industrial relations division and are staffed by
professionals such as social workers and psychologists (Erfurt & Foote, 1977). The
location of an EAP within an organization’s hierarchy is often influenced by the
sponsorship of the EAP. According to Masi (1984), there are basically four funding
alternatives (i.e., sponsorship approaches) available to an organization: (1) the
organization assumes all expenses and maintains its own staff; (2) the organization
performs some functions but contracts out for referral and counseling services on a fee-
for-service basis which is covered by the organization’s insurance carrier; (3) the
organization pays an outside contractor a ﬂat administrative fee per employee (typically
for supervisor training and administrative management by the contractor) plus a fee for
services rendered which are covered by the organization’s insurance carrier; or (4) the
organization pays a flat fee to an outside contractor, who is not reimbursed by an
insurance carrier for specific services rendered.

[t is also critical to the success of an EAP to consider its physical location. The
EAP should be accessible by all employees and should be located to maximize
confidentiality (Masi, 1984). Geographical diversity in the structure of EAPs is
illustrated by the existence of both on-site, or internal, EAPs and off-site, or external,
EAPs. We really do not know which approach is more critical. ln research conducted
by Hung (1988) on existing EAPs, approximately an equal distribution was found
between internal/on-site and external/off—site programs. The physical location of an EAP
is often influenced by the sponsorship or funding of the EAP. In addition to the internal
and external programs, other methods of providing EAP services include a hybrid of

both the internal and external models, a union model, peer model, the 800-number, and

 

 

 

 

 

the consortium model-
The internal mod
full- or part-time coun
coordinate employees’ 1
typically provide servic
subsequent referrals to
short-term counseling
recommended (BNA,
programs: EAP counse
working environment, (

isavital factor in the sur

easier for employees wh

concerns about conﬁder
the Regional Manager 0

concerns may not be eli

External pf0glams
lorservices which are Dr

trample, COPE (Center

DC. provides EAP sen
3
(MW). External

a .
metrme remove the E

to . '
inmunrcatton that is 11E
aI
fin order to justify a

mini
Um number of 2,(

 

 

 

52

the consortium model. Each of these will be discussed in more detail below.

The internal model is used mostly in larger organizations which employ either a
full— or part-time counseling staff that functions within an organization’s structure to
coordinate employees’ needs with treatment resources (Myers, 1984). Internal programs
typically provide services in-house, which usually include employee assessment with
subsequent referrals to external community services. The programs may also undertake
short-term counseling with referral to outside providers if longer-term treatment is
recommended (BNA, 1987). Researchers cite the following advantages of on-site
programs: EAP counselors are often more attuned to a company’s needs and to the
working environment, on-site programs tend to have more managerial support—-which
is a vital factor in the success of an EAP (Fabricatore & Rogal, 1984), and access is often
easier for employees when the EAP is in close proximity to their workplace. However,
concerns about confidentiality and trust may be greater with on-site programs, though
the Regional Manager of Counseling Services for AT&T, Dan Caliendo, indicates these
concerns may not be eliminated even with off—site programs (BNA, 1987).

External programs are those in which typically smaller organizations contract out
for services which are provided primarily off-site by a large, multi-service provider. For
example, COPE (Center for Occupational Programs for Employees, Inc.) in Washington,
DC. provides EAP services for 45 companies with approximately 35,000 employees
(BNA, 1987). External programs insure a great amount of confidentiality, but at the
same time remove the EAP from the daily operations of the company and the ongoing
communication that is needed with employees (Lewis, 1981). McClellan (1985) suggests
that in order to justify an on-site full-time EAP worker, the work site must employ a

minimum number of 2,000 workers. However, 80% of all non-government workers

 

 

 

 

today are in work sil
contracting-011i We“
program costs (BNA, 1'
such as the legal advanl
up time for companies
marketing methods of .1
Combination inter
organizations spread or
providea certain level (
in close enough proxim
small in size to justify a f
EAP providers (BNA, 1
While the above a]
markets and work popu
EAPs supported jointly
President of the AFL~C
the Well being of their Ir.

referral program, such .

 

 

 

53

today are in work sites with less than 100 employees; therefore, the external, or
contracting—out system, has become the fastest growing EAP model because of the lower
program costs (BN A, 1987). Straussner (1985) cites other benefits of external programs,
such as the legal advantages of a program that exists outside the organization, faster start-
up time for companies using contractors who have established programs, and aggressive
marketing methods of EAP contractors.

Combination internal/external approaches to providing services are often used by
organizations spread out in several geographic locations. These programs are able to
provide a certain level of treatment internally by a professional staff to those employees
in close enough proximity of the services while in other locations, which usually are too
small in size to justify a full—time staff, contractual relationships are established with local
EAP providers (BNA, 1987).

While the above approaches are common, other approaches exist to serve specific
markets and work populations. In 1979, the AFL-CIO adopted a resolution in favor of
EAPs supported jointly by labor and management. According to Lane Kirkland,
president of the AF L-CIO, "American trade unions have a fundamental concern with
the well being of their members and their families” (Myers, 1984, p. 54). A union/peer
referral program, such as the one in use by the Association of Flight Attendants, is
supported by the union and comprised of union and employee/peer members who are
responsible for educating and referring troubled employees to available EAP services

(BNA, 1987; Myers, 1984). Flight attendants are trained to detect and intervene in
behavioral/medical problems of troubled ﬂight attendants in order to help the employee
obtain professional help. There are also programs offered directly by unions. By

confronting troubled employees whose job performance has deteriorated, shop stewards

 

 

 

 

 

function similarly to th
The too-Numbelf
several locations withir
on). This program P1
to other treatment res
senice, and increased (
the eye (BNA, i987)-
and referral services (h
in which several organ
employees in the partic
It should be noted
not only to employees l
affectan employee’s job
(1986) found that 83%
ffrilly members whose |
Another manner it
elllllioyee referral stratey
model where an employ
lirEAP is held in stri

signiﬁcant others (6 8

 

—ﬁ—

54

function similarly to the supervisor in a company-sponsored program (Myers, 1984).

The 800-Number is a telephone-based counseling service where employees from
several locations within an organization can call in for assistance (BNA, 1987; Myers,
1984). This program provides for short-term counseling via listening along with referral
to other treatment resources if needed. It has the advantages of low cost, 24-hour
service, and increased comfort of clients who do not have to wait or look counselors in
the eye (BNA, 1987). However, typically hot—lines offer minimal problem assessment
and referral services (Myers, 1984). A final approach to be discussed is a consortium
in which several organizations pool their resources and develop a program to serve
employees in the participating organizations (Myers, 1984).

It should be noted that in all the above approaches, EAP services may be available
not only to employees but to their dependents as well whose personal problems could
affect an employee’s job performance or personal well-being. However, while Straussner
(1986) found that 83% of the EAPs were available to families, 39% counseled only
family members whose problems were specifically related to an employee’s problem.

Another manner in which EAPs exhibit diversity and ﬂexibility is in the different
employee referral strategies EAPs handle. These include: (1) a voluntary, self—referral
model where an employee voluntarily seeks assistance, and his or her participation in
the EAP is held in strict confidence; (2) a peer or significant others model where
Signiﬁcant others (e.g., family, coworkers) encourage the impaired employee to seek
assistance (Wolf, 1982) and where participation in the EAP is held in strict conﬁdence;
and (3) a supervisory-referral, confrontation model where a third party within an
organization (e.g., supervisor, union, medical department) actually refers an employee

Whose performance is suffering to an EAP (Featherston & Bednarik, 1981; Fisher, 1983;

 

 

 

 

 

Wrich,1980b). In this
showed up and partiCi
problem or treatment.

Experts suggest th
EAP users should be vr
about the EAP is a ke
Regardless of the educa
refuse to acknowledge

Supervisors can play a

performance ratings ant
get along with coworke
Thus, supervisory-refer:
Roman refer to the pr0(
declining work perform
tithe few legitimate ave
life and motivate a that
important, maintaining
Performance is also criti

a .
rescuse for rnadequatr

We also vary in l

 

 

55

Wrich, 1980b). In this case, supervisors are notified regarding whether the employee
showed up and participated, but they are not advised of the nature of the employee’s
problem or treatment. -

Experts suggest that in order for programs to be considered successful, 40% of all
EAP users should be voluntary, self-referrals (Hobson, 1982; Wrich, 1980b). Education
about the EAP is a key component to obtaining support and usage from employees.
Regardless of the education a company may provide, however, many employees will still
refuse to acknowledge the existence of a problem and will fail to seek assistance.
Supervisors can play a key role in breaking employees’ denial pattern by using job
performance ratings and other documentation (e.g., absenteeism, irritability, inability to
get along with coworkers) to identify troubled employees and refer them to an EAP.
Thus, supervisory-referrals are considered important to EAP effectiveness. Trice and
Roman refer to the process whereby a supervisor confronts an employee with his or her
declining work performance in order to refer the worker to professional help as ”one
of the few legitimate avenues, save police power," to effectively intervene in a worker’s
life and motivate a change in behavior (1972, p. 171). Although confidentiality is
important, maintaining the impaired employee’s accountability for his or her own job
performance is also critical to successful intervention. Being treated cannot be used as
an excuse for inadequate performance.

EAPs also vary in the training and educational backgrounds of the staff. Staffing
is often considered the most critical issue in an EAP (Masi, 1984). During the 1940’s
when programs emphasized alcohol-related interventions, programs were typically staffed
by recovering alcoholics. These programs relied a great deal on referrals from

supervisors who were trained to detect and confront alcoholics. Today, EAP counselors

 

 

 

 

 

are also responsible for
dysfunctional work bei
performance is impair
employees about the |
staffed by individuals we
workers, psychiatrists,
counselors, and person
Finally, while EA
appear to be consensus
(1) Management
(2) Union suppo
(3) Assurance of
(4) Written polic
reSpousibilities of the or
disc’p’inafy consequent
"dining Programs;
(5)

ill health

An employee i
th
. recognize s

(6) A

Ccess of serv

7 A suIiervisory

iii

ployee (e‘g's tardin.
siveness, C) does

audit,

 

56

are also responsible for training supervisors to detect ”troubled employees," to document
dysfunctional work behaviors, and to recommend and/or refer employees to EAPs if job
performance is impaired; i.e., supervisors are not expected to counsel or confront
employees about the problem. Employee Assistance Program counselors today are
staffed by individuals with diverse mental health backgrounds, which may include social
workers, psychiatrists, psychologists, Alcoholics Anonymous members, nurses, trained
counselors, and personnel employees (Masi, 1984).

Finally, while EAPs vary in structure, models, and services provided, there does

appear to be consensus on the basic components that encompass an effective EAP:

(1) Management support;

(2) Union support;

(3) Assurance of confidentiality;

(4) Written policies and procedures delineating the
responsibilities of the company and employees regarding unacceptable work behaviors,
disciplinary consequences, and methods of problem identification, such as supervisory
training programs;

(5) An employee education program to teach employees to take responsibility for
their health, recognize symptoms, and refer themselves;

(6) Access of services by dependents;

(7) A supervisory training program which centers around identifying a troubled
employee (e.g., tardiness, absenteeism, inability to get along with coworkers,
defensiveness, etc.), documenting deteriorating performance, confrontational methods,

and the referral process;

(8) Breadth of counseling and clinical services which provide easy and convenient

 

 

 

 

 

access and include dia
(9) Labor and n
(10) Health insur
(11) Adequate cc
of the EAP to empl
presentations, etc); am
(12) Professional
iGroeneveld, 1980).
While the above
assessment and referral
EAP and that the sta

alilirrrpriately.

There has been a IT

lithe faStgTOWth of the:

P
brains have not been

lilan .
agcmem, unions) sir

 

57

access and include diagnosis, treatment, referral, follow—up and evaluation;
(9) Labor and management orientation and labor-steward training;
(10) Health insurance coverage;
(11) Adequate communication of the existence, objectives, functions and services
of the EAP to employees (via newsletters, brochures, payroll stuffers, posters,

presentations, etc.); and

(12) Professional leadership (Dickman & Emener, 1982; Greenwood, 1983; Shain
& Groeneveld, 1980).

While the above are all desirable components, Wrich (1982) indicates that
assessment and referral are the critical links between the troubled employee and the

EAP and that the staff specialist/counselor must be trained to assess and refer

 

appropriately.

 

EAP Research
There has been a minimal amount of empirical research related to EAPs compared
to the fast growth of these programs (Jones, 1983; Roman, 1984). Employee Assistance
Programs have not been required to report their activities, except to their sponsors (e.g.,
management, unions) since they are not subject to any voluntary or governmental agency
regulations or accountability requirements, as are mental health and drug and alcohol

abuse programs (Jones, 1983). Roman,(1984) characterized the current state of EAP

 

research as "a hodgepodge of materials which have been prepared by persons whose
credentials range from experienced social scientists to cynical self-promoters, all of
which comprise a shapeless bag of ’ﬁndings’ and ’data’." In addition, much research

that does exist focuses primarily or is intertwined with research on OAPs (Fielding,

 

 

 

 

1984a). While these

narrower.

In a review of alcv
“most studies indicate
here isa 10:1 payback
and improved product
measures used in OAF
changes in drinking bel

absenteeism, illness, a

absenteeism, job efﬁcir

Program reaches a targr
of the cases examined.

concerns of validity EDP

brief follow-up times 5

treatment staff).

Most of the literat

or
uses on characteristi

seo °
pa and administratii

 

 

 

58

1984a). While these programs were the forerunners of vE-APs, their focus was much
narrower.

In a review of alcoholism programs, Tersine and Hazeldine (1982, p. 72) stated that
"most studies indicate a success rate of 50 to 85%." They further cite an estimate that
there is a 10:1 payback from alcoholism programs due to less turnover and absenteeism
and improved productivity. In a review of OAPs by Kurtz et a1. (1984), a variety of
measures used in OAP evaluations were found, which were grouped into four classes:
changes in drinking behavior (abstinence, rehabilitation), work performance level (e.g.,
absenteeism, illness, accidents, turnover, efficiency), cost reduction (savings from
absenteeism, job efficiency), and penetration rates of risk groups (i.e., the extent a
program reaches a target population). Favorable outcomes were reported in over 60%
of the cases examined, although also noted was the lack of rigorous standards and
concerns of validity applied to the evaluation processes (e.g., lack of control groups, too-
brief follow-up times, subject selection problems, poor employer documentation and
treatment staff).

Most of the literature directly examining EAPs dates from the early 1970’s and
focuses on characteristics of the EAPs themselves, company practices related to the
scope and administration of such programs, and provides primarily descriptions of
individual programs and anecdotal reports (Akabas et al., 1979; Bierman, 1981; Bloom,
1986; BNA, 1974; Googins, 1984; Gould & McKenzie, 1984; Masi, 1979; Miller, 1977;
Rivera, 1984; Skidmore etal., 1974; Smirnow, 1980; Straussner, 1986; Weissman, 1976),
surveys related to EAPs (Erfurt & F oote, 1977; Ford & McLaughlin, 1981; Grimes, 1980;
Opinion Research Corporation, 1972, 1974, 1976, 1979), and current reviews of the ﬁeld

(Leavitt, 1983; Roman, 1981).

 

 

 

 

 

A major area of
effectiveness of the prv
and "outcome." Rese;
section on EAP benef
understanding of the fr
the following section i

factors found to inﬂue

Research on EAP Util

Terms which his
”participation "
utilization/participatior
refers to the actual usag
of troubled employees '

I . .
can rn-person vrsit to

referral. When the tern

ll -
art' '
t rcrpatron" or "usa

h
ave personal or work-r

lieEAP "utilization ra

 

 

 

59

A major area of EAP research which companies are interested in focuses on the
effectiveness of the programs. Effectiveness also refers to program "success," "impact,"
and "outcome." Research on EAP effectiveness was reported in the ﬁrst chapter in the
section on EAP benefits. Since the purpose of the present research is to gain a better
understanding of the factors inﬂuencing one’s decision to seek assistance from an EAP,
the following section will present EAP research on utilization/participation rates and

factors found to inﬂuence EAP utilization/participation.

Research on EAP Utilization/Participation

Terms which have been used synonymously with EAP "utilization” include
"participation" and ”penetration”, particularly when referring to
utilization/participation/penetration rates. "Employee Assistance Program utilization"
refers to the actual usage of an EAP by an employee, or the total number or percentage
of troubled employees who participate in EAP services. The term "EAP usage" refers
to an in-person visit to the EAP office or a call for an appointment, information, or a
referral. When the term "utilization" is used in this paper, it will also refer to the term
"participation" or "usage” in an EAP. Utilization does not refer to employees who may
have personal or work-related problems but have chosen not to participate in an EAP.
The EAP ”utilization rate” typically refers to the ratio of EAP clients to the employee
population (Myers, 1984), which is similar to the "penetration rate"--or the rate at which
employees have penetrated the EAP.

If the reported EAP success rates of 60-90% (Baxter, 1981; Holden, 1973; Judd,
1980; Shetty, 1982; United States Congress, 1982) are to have meaning, we have to

assume that a signiﬁcant percentage of troubled employees are participating in the

 

 

 

 

 

prom, Therefore,

in its evaluation pr0<
discussing utilization r
is the fact that a ”gree
keep systematic data I

For example, in

records on utilization 1
average rate of 13%.

utilization rates cited-
Champion, 1988; Dunl
Groeneveld, 1980; Stra
clout-year period (Uri
cited by specific EAPs
Steelcase, Ina-20%, U

etal.,1977). Since the

rtwould be extremely us

In hrs research on

 

 

60

program. Therefore, in order for any program to be judged successful, one component
in its evaluation process should include employee utilization. Unfortunately, when
discussing utilization rates, one major problem found in an EAP study by Weiss (1980)
is the fact that a "great many" of the responding companies who had an EAP did not
keep systematic data regarding usage of their program.

For example, in an examination of 14 EAPs by Uyeno (1988), nine maintained
records on utilization rates--which ranged from a low of 1.1% to a high of 36%, with an
average rate of 13%. In other research, there have been a variety of estimates on
utilization rates cited-—ranging from lows of 1% to 5% (Busch, 1981; Cahill, 1983;
Champion, 1988; Dunkin, 1981; Featherston & Bednarek, 1981; Marino, 1985; Shain &
Groeneveld, 1980; Straussner, 1986), to a 7% utilization rate at General Motors during
a four-year period (United States Congress, 1982), to reports ranging from 9% to 30%
cited by specific EAPs; e.g., Boston College--9%, Michigan State University-~3-14%,
Steelcase, Inc.—-20%, University of Missouri--30% (Grimes 1980; Masi, 1978; Thoresen
et al., 1977). Since the range of reported utilization rates is extremely broad, it seems
it would be extremely useful to better understand factors which might influence this rate.

In his research on EAPs, Donald Jones (1983) developed benchmarks or standards
on which to compare programs. One of these standards was the percentage of
employees who should utilize a company’s EAP-~which was estimated to be between 5-
10% after the first year of operation. Some question this ﬁgure since this utilization rate
was based on an externally-contracted EAP that served many organizations. Also, while
Kurtz, Googins and Howard (1984) examined penetration or utilization rates of risk
gr OUps when evaluating occupational programs, Herring (1987) suggests that what

constitutes a "successful" penetration rate is not known and that not all populations are

 

 

 

 

 

equally penetrable.
Regardless of ii
programs and their re
they are designed to as
never receive treatmei
of Health, Education,
the programs fall far sh
are seeing only about 4
1987, p. 140). If it is
personal problems, thi:
rot obtaining the assist
Avariety of varia

research. One approa

have used EAP service

client statistics regardin
raceoccupational level
stress, ﬁnancial probler
Significant other-refers

inconsistent. Research f

Problem type, and refer

W

any researchers ha

m .
arrred (Cromidas 19E

 

 

 

61

equally penetrable.

Regardless of the standard and despite the need for occupational assistance
programs and their reported effectiveness, EAPs often remain underutilized by those
they are designed to assist. For example, it has been estimated that 85% of all alcoholics
never receive treatment (Matsunaga, 1983). Joseph Califano, J r., the former Secretary
of Health, Education, and Welfare, argues that deSpite the successes reported by EAPs,
the programs fall far short of their potential. He adds that “even the ’effective’ programs
are seeing only about 4 percent of the problem drinkers among their employees." (BNA,
1987, p. 140). If it is true that up to 30% of the U.S. workforce may have serious
personal problems, this would suggest EAPs are underutilized and many employees are
not obtaining the assistance that could improve their work and personal lives.

A variety of variables and approaches have been represented in EAP utilization
research. One approach consists of researchers examining profiles of employees who
have used EAP services. This research, however, has focused primarily on examining
client statistics regarding participation by demographics (e.g., age, gender, marital status,
race, occupational level, education, income, tenure), problem type (e.g., substance abuse,
stress, financial problems), and referral source (i.e., self-referral, supervisory-referral,
significant other-referral). In addition, much of the research on utilization is often
inconsistent. Research findings regarding EAP utilization/participation by demographics,

problem type, and referral source are reported below.

Marianna:
Many researchers have found that the majority of individuals utilizing the EAP are

married (Cromidas, 1987; Marino, 1985; Uyeno, 1988) with the second most common

 

 

user being divorced (
in spouses encouragi
employees may not fe
other problem areas .

substance abuse, fmar

Gender

Research findinj
researchers have conc

more than males (Cha

1988), others have four.

1986), while still other

females (Grimes, 1980.

 

Research has also

again the results are i

 

females use services Int

1984) while others to

“fluently and female

iStraussner, 1986).

 

 

 

 

62

user being divorced (Uyeno, 1988). In general, it is assumed that being married results
in spouses encouraging one another to seek assistance (Serxner, 1988). While single
employees may not feel the need to use an EAP for marital or child—rearing problems,
other problem areas are still endemic to this group which the EAP could assist (e.g.,

substance abuse, financial problems).

Gender.

Research findings on utilization rates and gender are mixed. While many
researchers have concluded that females utilize EAP and occupational health services
more than males (Champion, 1988; Hung, 1988; Jorrisch, 1986; Serxner, 1988; Uyeno,
1988), others have found that males tend to use the services more frequently (DeFuentes,
1986), while still other researchers conclude utilization rates are equal among males and
females (Grimes, 1980; Straussner, 1986; Sudduth, 1984).

Research has also been conducted on EAP usage by gender and program type, but
again the results are inconclusive. For example, some researchers have found that
females use services more if the program is on—site/internal (Champion, 1988; Sudduth,
1984) while others concluded that males tend to use on-site/internal EAPs more
frequently and females tend to make more use of off-site/external contractors

(Straussner, 1986).

Race

M

)

Race is another demographic characteristic examined with regard to utilization, and
as with gender, conclusions are often mixed. Regarding general health behavior, Blacks

have been found to have fewer physician visits and telephone consultations than Whites

 

 

 

 

 

p-

but twice the rate 1
However, others have
Hung, 1988; Jorrisch,
of health services in
group seems to depenr
(1988) and Hung ( I98:
Champion (1988) fou
Mexican-Americans h
to the presence of inft
as cited in Serxner, 19
Usage by race anr
internal/on-site and er
tend to use external, or

internal, in-house prof
bgg

The age of most
research conducted. Ir
ages of 20~29 with the s
(1988)

reported an ave

users ranged from 18 it

 

———

63

but twice the rate of hospital outpatient utilization than Whites (Serxner, 1988).
However, others have found that Whites are the primary EAP users (Champion, 1988;
Hung, 1988; Jorrisch, 1986; Uyeno, 1988; Straussner, 1986) as well as the primary users
of health services in general (Rosenstock & Kirscht, 1979). The second major user
group seems to depend on the particular research conducted. For example, while Uyeno
(1988) and Hung ( 1988) found Hispanics were the second major user group after Whites,
Champion (1988) found that Blacks were second with Hispanics third. In general,
Mexican-Americans have been found to underuse mental health services, due probably
to the presence of informal family support discouraging such use (Keefe & Casas, 1980

as cited in Serxner, 1988).

Usage by race and EAP type has also been examined. Straussner (1986) compared

 

internal/on-site and external/off—site usage rates and concluded that White employees

tend to use external, contracted—out programs more often while minority employees use

internal, in-house programs more frequently.

has

The age of most EAP users also appears to vary depending on the particular
research conducted. In research by Uyeno (1988), most EAP users were between the

ages of 20-29 with the second most common age group between 40-49. However, Hung

 

(1988) reported an average age of 38.6, while DeFuentes (1986) found that the age of

users ranged from 18 to over 60 with the majority in the 26-44 age group.

Why

Leavitt (1983) found that employees with more organizational seniority utilize the

EAP services more frequently, as was shown in a 1975 study at Oldsmobile where the

 

 

 

 

 

average seniority was
study of four ﬁrms w
Hung(1988) also fou;
EAP.

When seniority
employees with greats
off-site programs.

management support

MW

DeFuentes (198i
salaried employees use
that lower occupatior
employees, are the higl
1986; Suddeth, 1984;
erIrployees utilized EA
and executive (3.5%) er
of executives and man:
pork related problems

at toplevel manager:

 

—7—

64

average seniority was ten years. A similar result was found three years later in a 1978
study of four firms where tenure of users averaged from 8 to 18 years (Leavitt, 1983).
Hung (1988) also found the greater one’s seniority, the greater the willingness to use an
EAP.

When seniority was examined by program type, Sudduth (1984) found that
employees with greater seniority utilized internal, on-site programs more than external,
off-site programs. Sudduth suggested that external programs may receive less

management support so they are utilized less.

Occupational Level

DeFuentes (1986) and Roman (1984) suggested professionals, supervisors and

 

 

salaried employees use EAPs more often. However, there appears to be greater support
that lower occupational levels, such as the office/technical group and hourly-paid
employees, are the highest EAP users (Hung, 1988; Ford & McLaughlin, 1981; Jorrisch,
1986; Suddeth, 1984; Uyeno, 1988). For example, Uyeno (1988) found blue collar
employees utilized EAPs more frequently (50.2%) compared with white collar (46.1%)
and executive (3.5%) employees. Other studies have identiﬁed the under-representation
of executives and managers who tend to be reluctant to seek help for work and non-
work related problems (NIAAA, 1982; Trice & Beyer, 1980). Leavitt (1983) suggested
that top-level managers tend to use EAP services less frequently because they are less
subject to coercion from the employer to seek assistance. Other reasons cited for
managerial under-utilization include the lack of supervision which makes performance

problems less visible (Myers & Myers, 1985) and the fear of jeopardizing future career

 

Opportunities (Hung, 1988). It often takes a serious event such as an automobile

 

accident, heart attack
denial even then is ‘
(Johnson, 1973).

The type of EA
relationship between t
examined occupation:
site, contracted-out p
under-represented by
reﬂected the status of

Baxter (1976) ex.
EAP usage by family
Period, the majority r

members (22%), facul

 

 

hm

in a review of dar

band that lower incon
was the middle income

I .
sweat and highest inco

Kirscht (1979) also for

t
efluently, while those

more frequently
0a the other hanr

us
its. Hung reported 1

 

 

 

 

65

accident, heart attack, or emotional breakdown for a problem to be acknowledged, and
denial even then is very strong without additional inﬂuence from significant others
(Johnson, 1973).

The type of EAP model or program (internal or external) may moderate the
relationship between occupational level and EAP usage. For example, Straussner (1986)
examined occupational level and program type. In that research, it was found that off—
site, contracted-out programs were over—represented by higher—level employees and
under-represented by lower-level workers while internal, on-sitc programs better
reﬂected the status of the workforce (Straussner, 1986).

Baxter (1976) examined the organizational level of employees and the degree of
EAP usage by family members at Rutgers University and found that in a two-year
period, the majority of the users were at the general staff level (49%), then family

members (22%), faculty (18%), and administrative and professional workers (10%).

became

In a review of data prior to 1965 on income and utilization rates, Serxner (1988)
found that lower income employees used health services the least; however, by 1968 it
was the middle income group which underutilized physicians and health care while the
lowest and highest income groups used health services most frequently. Rosenstock and
Kirscht (1979) also found that those below poverty level used medical services less
frequently, while those in the higher socioeconomic groups tend to use health services
more frequently.

On the other hand, Hung (1988) reached the opposite conclusion regarding EAP

usage. Hung reported that in his examination of EAPs, the highest-income employees

 

 

 

 

 

were the lowest EAP
was the second lowesr
and 32030000) utili:
income group are als
to agree with researc

services the least.

Emaﬂ

There was not or
0988) examined this
the future if needed a

10 use an EAP in the

—7

66

were the lowest EAP users ($50-69,000) and the lowest-income group (less than $30,000)
was the second lowest user group. The two middle income employee groups ($30-39,000
and $20-30,000) utilized the services most frequently. If we assume those in the highest
income group are also in the higher occupational levels, then Hung’s research appears

to agree with research on occupational levels where executives were found to use the

services the least.

Education

There was not much available literature found on education and EAP usage. Hung

(1988) examined this variable as it related to employees’ willingness to use an EAP in

the future if needed and found that those who were more educated were more willing

to use an EAP in the future.

Problem Type and EAP Utilization/Participation

The preceding sections focused on demographic factors inﬂuencing EAP utilization.
This section will examine research on utilization and the types of problems
employees/clients seek assistance on at the EAP. These ﬁndings also tend to be mixed.

Champion (1988) and Wells (1988) found marital, family, child, and psychological
problems were the main ones handled at EAPs. However, Savoca (1986) and Baxter
(1976) found EAP clients sought help mainly for job—related, emotional, and drinking
problems. Others agreed in part with each of the above researchers. For example,

Cromidas (1987), Jorrisch (1986), and Straussner (1986) found the primary problems

 

presented at an EAP were for emotional, chemical dependence, and marital problems.

DeFuentes (1986) found the primary problems encountered were for alcohol, legal, and

 

 

 

 

 

 

emotional problems.
along with poor i0
encountered at the l

DeFuentes (191
presented at the EA]
to addition, males, \
substance abuse prol
emotional problems (

Bloom (1986) ex
employees to an EAP
ref

errals: tardiness/at

personal problems, en

Referral Source nd E

 

 

67

emotional problems. Substance abuse, financial, legal, emotional, and marital problems
along with poor job performance and absenteeism were the primary problems
encountered at the 14 EAPs examined by Uyeno (1988).

DeFuentes (1986) examined gender and ethnicity and the type of problem
presented at the EAP. Both males and females equally experienced family problems.
In addition, males, Whites, and Hispanics most frequently experienced alcohol and
substance abuse problems while females and Blacks sought assistance primarily on
emotional problems (DeFuentes, 1986).

Bloom (1986) examined the primary types of problems which supervisors referred
employees to an EAP for and found the following were frequently cited as reasons for
referrals: tardiness/absenteeism, deteriorating work performance, preoccupation with

personal problems, emotional problems, and suspected alcoholism and drug abuse.

Referral Source and EAP Utilization/Participation
The last area of research on EAP utilization to be discussed focuses on EAP
utilization and referral source. There are three basic referral approaches to EAP
utilization: self-referral, supervisory referral, and referral by significant others. Self-
referral or "voluntarism" has been shown to be a key factor inﬂuencing the success of
an EAP (Wrich, 1974). Supervisory referrals are another major source since
deterioration of an employee’s job performance is one of the basic reasons referrals are
made to an EAP. Supervisors are able to get employees whose work performance has
deteriorated to seek assistance because supervisors can threaten them with disciplinary
action (Wrich, 1974). Significant others, defined as "those persons who exercise major

influence over the attitudes and behavior of individuals" (Woelfel & Haller, 1971, p. 75),

 

 

 

 

 

is the last major referral
in general, self-refe:
seek assistance at an EA
last main source (81001
Straussner,1986; UyenO,
Uyeno (1988) found all p
referrals and the second
next. Similarly, Bloom (I
examined were self~referr
examination of 32 EAPs i;
Stpervisory and peer (sigr
ERR clients interviewed s
65% were referred by suj:

it. Finally, while Straussnr

77'

68

is the last major referral method and includes referral by peers, coworkers, family, etc.

In general, self—referrals are the most common source by which employees/clients
seek assistance at an EAP, with supervisory referrals second and signiﬁcant others the
last main source (Bloom, 1986; Coleman, 1984; DeFuentes, 1986; Pardue, 1987;
Straussner, 1986; Uyeno, 1988). For example, in a study of 14 companies with EAPs,
Uyeno (1988) found all programs examined reported the majority of referrals were self-
referrals and the second major source came from supervisors, with signiﬁcant others
next. Similarly, Bloom (1986) found that approximately 80% of the clients in the EAPs
examined were self-referred and 20% were supervisory referred. In Coleman’s (1984)
examination of 32 EAPs in higher education, most users were self-referred, followed by

supervisory and peer (significant others) referred. Pardue (1987) found 79% of the 200

 

 

EAP clients interviewed stated they realized the need for assistance on their own while
6.5% were referred by supervisors and 6.5% came because a fellow employee suggested
it. Finally, while Straussner (1986) found self-referrals (54%) and supervisory—referrals
(25%) were the main referral sources, medical (13%) and other referrals by union,
family members, etc. (8%) were secondary sources.

In a look at gender and referral type, DeFuentes (1986) found that both male and
female users were primarily self-referred (52.4%), followed by males and females who
were referred by the medical department (16.9%), the supervisor (14.7%) and the union
(8%).

Several explanations have been provided to help us understand why employees seek
assistance at an EAP. In describing the referral process, most research has focused
either on the self-referral (voluntary) process or the supervisory-referral process. The

major referral sources (self, supervisory, significant others), however, are not completely

 

 

 

 

independent of one an0
may also equally inﬂuenr
simultaneously recommr
Trice (1978), Myers (19'
process as being influenr
(1) a family membe
and inﬂuences an emplo
referrals by significant or
(2) ﬁnancial conside

from seeking help;
(3) the degree to w
insistence on the employ:
(4) the amount of p
and its services and about
provided to help employg
(5) the existence of a
”“1113ng voluntary pa.

(6) to

AP tenure sin

b
rcause employees’ belief

 

 

69

independent of one another since many of the factors inﬂuencing one type of referral
may also equally inﬂuence another type. In addition, more than one referral source may
simultaneously recommend/pressure an employee to seek EAP assistance. Beyer and
Trice (1978), Myers (1984), Scanlon (1986), and Wrich (1974) describe the referral

process as being inﬂuenced by the following factors:

(1) a family member, a friend, or a coworker seeks information regarding the EAP

and inﬂuences an employee to seek help~-this factor may affect both self-referrals and

referrals by signiﬁcant others;

(2) ﬁnancial considerations regarding the cost of services may discourage employees

from seeking help;

(3) the degree to which the employee feels free of hassle from the EAP staff’s

 

insistence on the employee modifying his or her behavior;

(4) the amount of publicity and education received by employees about the EAP
and its services and about particular problems (i.e., the amount of self—analysis literature
provided to help employees recognize behavioral patterns of a troubled employee);

(5) the existence of a supportive climate on the part of the company and union in
encouraging voluntary participation; and

(6) EAP tenure since new EAPs must overcome initial employee skepticism
because employees’ belief in program effectiveness is necessary to gain credibility.

A number of additional reasons affecting EAP utilization by employees have been

SUggested in the literature. Some of these include:

(7) fear of a breach of confidentiality (Myers, 1984; Myers & Myers, 1985; Wrich,

1974);

(8) the perception of a possible adverse affect on tenure or promotional

 

 

 

 

opportunities (Myers, 1‘
(9) fear of a social
an alcoholic, a drug addi
dRoman, 1978);
(10) the degree of cr
(1]) lack of a with

(12) type 0f progr
Scanlon, 1986);

(13) EAP model tyy

(14) the occupation:

1981; Hung, 1988; JorriSr

Peter, 1980; Uyeno, 19m

(15) fear of giving t1

(Hung, 1988).

In related research 1

torrrfluence an individuai

sPtrrptoms. hese factors

identiﬁed include:

(1)

6 the perceived u
on
(18)

(19
ran).

availability of a.
the costs of the

i the general valor

From the above list,

 

70
opportunities (Myers, 1984; Myers & Myers, 1985; Wrich, 1974);

(9) fear of a social stigma attached to EAP utilization (e.g., label person as being
an alcoholic, a drug addict, in a troubled marriage, etc.) (Brewer & McAvoy, 1986; Trice
& Roman, 1978);

(10) the degree of convenience and accessibility of the EAP services (Wrich, 1980a);

(11) lack of a written policy statement defining responsibilities (Wrich, 1980a);

(12) type of program sponsorship (union, management, joint) (Roman, 1984;
Scanlon, 1986);

(13) EAP model type (internal/on-site vs. external/off—site) (Straussner, 1986);

(14) the occupational level of the employee (DeFuentes, 1986; Ford & McLaughlin,

1981; Hung, 1988; Jorrisch, 1986; Leavitt, 1983; Roman, 1984; Suddeth, 1984; Trice &

 

Beyer, 1980; Uyeno, 1988); and

(15) fear of giving the impression of being unable to manage one’s own problems
(Hung, 1988).

In related research by Rosenstock and Kirscht (1979), several factors were found
to inﬂuence an individual’s decision to seek professional help in the presence of illness
symptoms. These factors may also have an effect on seeking EAP assistance. Factors
identified include:

(16) the perceived urgency and severity of the condition;

 

(17) availability of alternative paths of action open to individuals;

(18) the costs of the different courses of action; and

(19) the general value an individual places on medical care (Rosenstock & Kirscht,
1979).

From the above list, it may be concluded that the employee’s perception of the

 

 

 

 

utility of utilizing EAP se
the employee has a pro
affected by the perceptio

As previously mer
important means of enco
areina good position of i

mightbeneﬁt from EAP I

however, often resist bet

which have been found It
(1) there usually ha
Supervisor will confront a
(2) often ambivale.
”Wilfrid employee so bot

(3) nrany supervisor:

a - .
retequrred in order to c?

(4)

organizations diff

behaviors (Molloy, 1986)

I
3

(5) the type of EAP

(residuum, 1984, cont

intern
alprogranrscomparr

iilajo '
"‘Slie EAP
S are 11]

management) .

WW ( 1980b) adds

pro
cess for the following i

 

 

 

 

 

71

utility of utilizing EAP services is a key factor inﬂuencing his/her behavior. Even though
the employee has a problem, the individual’s decision to participate in an EAP is
affected by the perception of the positive consequences of such a decision.

As previously mentioned, supervisory referrals have been recognized as an
important means of encouraging employees to utilize EAP services because supervisors
are in a good position of identifying “unsatisfactory job performance" of employees who
might benefit from EAP participation (Gam, Sauser, Evans, & Lair, 1983). Supervisors,
however, often resist becoming involved in a formal referral process. Some factors
which have been found to influence supervisory referrals include the following:

(1) there usually has to be sufficient deterioration in job performance before a
supervisor will confront and refer an employee (Wrich, 1980a);

(2) often ambivalence permeates the relationship between a supervisor and a
troubled employee so both parties frequently utilize cover—up strategies (Myers, 1984);

(3) many supervisors have failed to develop "good” human relations skills which
are required in order to deal with troubled employees (Googins & Kurtz, 1980);

(4) organizations differ in the extent supervisors are required to monitor workers’
behaviors (Molloy, 1986);

(5) the type of EAP model (on-site vs. off-site) influences referrals by supervisors
(e.g., Sudduth, 1984, concluded that there were more supervisory referrals to on-site,
internal programs compared with external programs, presumably because supervisors feel
that on—site EAPs are more integrated into the organization and accepted by top
management).

Roman (1980b) adds that supervisors fail to become involved in an EAP referral

process for the following reasons:

 

 

 

 

 

(b) supervisors expt
(7) supervisors fail '
(8) supervisors do r
(9) supervisors are a
and
(10) supervisors don’t

stigma that may be attack

Stump

This chapter prOVidf
in the United States. BUS
troubled employees over
Taylor in the early 1900
tcgatively inﬂuenced the I
tried to ignore the person:
SPaciﬁc duties in exchang
We 10 problems outside I
shaPe up or ship out (BN.

3P the 1940’s and 19

 

 

 

 

 

72

(6) supervisors expect the dysfunctional behaviors will disappear;
(7) supervisors fail to see an EAP as a legitimate organizational strategy;
(8) supervisors do not want to be involved with employees;
(9) supervisors are afraid they will lose power over employees after they refer them;
and
(10) supervisors don’t want to label or mis-label an employee or be involved in any

stigma that may be attached to the employee once referred.

Summary

This chapter provided an historical overview of organizational assistance programs
in the United States. Businesses have changed their perspective and treatment toward
troubled employees over the years. Initially, the scientific management attitudes of
Taylor in the early 1900’s, with the emphasis solely on efﬁciency and productivity,
negatively inﬂuenced the treatment and attitude toward problem employees. Employers
tried to ignore the personal problems of employees and expected employees to perform
speciﬁc duties in exchange for wages. If an employee’s performance at work suffered
due to problems outside the control of managers, then the employee was expected to
shape up or ship out (BNA, 1987; Wrich, 1980b).

By the 1940’s and 1950’s, however, a concern about the alcohol-related behaviors
of employees evolved and precursors of Employee Assistance Programs (EAPs)
developed in the form of Occupational Alcoholism Programs (OAPs). Occupational
Alcoholism Programs were considered an innovation in resolving job performance
problems and mental—health issues by attempting to help alcoholics in the workplace.

The success of these programs was typically based on the employee’s return to an

 

 

 

 

 

 

acceptable level 0f l0b l
expansion of occupation
legal, medical and other
brush EAPs.
Organizations now
long-run than if their p
personal, social, emotion
illnesses, absenteeism, ac
1984b). Human resour
affecting troubled empl
(Scanlon,l983). As EAI
it the workplace has alsv
fliers employees whose

tissrstance Programs toe

Promote voluntary/self-re

EAPs vary in both

pro
gram format, services

to '
ntrnued to evolve over

acti ' '
vrty make it necessary

retaini ‘
og their human re

prov' ‘
rde assrstance to em]

aforties.

While EAPs have be

if add '
ressrng both work

 

 

73

acceptable level of job performance. By the 1970’s, early OAP successes led to the
expansion of occupational programs to focus on a broader range of personal, social,
legal, medical and other problems that hinder job performance--known today as broad—
brush EAPs.

Organizations now recognize that untreated troubled employees cost more in the
long-run than if their problems were diagnosed and treated early. Employees with
personal, social, emotional, and other problems are less productive, have higher rates of
illnesses, absenteeism, accidents, and disability than those who are ”healthy" (Fielding,
1984b). Human resource managers have realized that by attacking the problems
affecting troubled employees, the corporation can experience measurable savings
(Scanlon, 1983). As EAPs have replaced alcohol-based programs, the supervisor’s role
in the workplace has also changed. The supervisor is now perceived as an agent who
refers employees whose performance has deteriorated to specialists. Employee
Assistance Programs today advocate not only supervisory referrals but attempt to
promote voluntary/self—referrals as well.

EAPs vary in both management philosophy and structural dimensions (e.g.,
program format, services provided, evaluation methods) (Myers, 1984). They have
continued to evolve over time as employee needs, foreign competition, and legislative
activity make it necessary for employers to take a pro-active stance in maintaining and
retaining their human resources. Employee Assistance Programs have the ability to

provide assistance to employees/clients who have not traditionally used social service
agencies.
While EAPs have become an integral part of American business and are capable

of addressing both work and nonwork-related problems of employees through a

 

 

 

 

comprehensive system 0'
they are most designer
identiﬁcation increases I
(Busch, 1981; Father,
Progression of substance-
intervention and treatmE
beneﬁt-through refill“
performance, and impr C
Wrich, 1980b).

While descriptive re
has been conducted along
more research is requirer
use EAP services. Reset
utilization. However, mu
users and lacks a theor
underlying factors influer
0"What the employee 1
Understanding why the be

The variables of inte
rtsearch have been conce
selected as a guiding ham

or " ' ‘
rndrvrdual’s decrsron~

or '
ervrew of control the

aPProaches found in the

 

 

74

comprehensive system of services, EAPs often remain underutilized by those employees
they are most designed to reach. Most professionals agree that early problem
identification increases treatment success and is necessary to obtain maximum results
(Busch, 1981; Farber, 1982; Ford & McLaughlin, 1981; Witte & Cannon, 1979).
Progression of substance-abuse and other personal problems may then be avoided. Early
intervention and treatment are important because both the employee and the employer
beneﬁt—-through reduced absenteeism, sick time and accidents, improved job
performance, and improved work and spousal relationships (Googins & Kurtz, 1980;
Wrich, 1980b).

While descriptive research on EAP models, services provided, and clients of EAPs
has been conducted along with empirical research on the effectiveness of these programs,
more research is required to examine factors inﬂuencing why individuals use or do not
use EAP services. Researchers have presented a multitude of factors that affect EAP
utilization. However, much of the present research emphasizes demographic profiles of
users and lacks a theoretical base. Therefore, there is a need to understand the
underlying factors inﬂuencing the EAP utilization process. Researchers have focused
on what the employee has done (i.e., used or not used EAP services) but not on
understanding why the behavior occurred.

The variables of interest in examining factors inﬂuencing EAP usage in the present
research have been conceptualized in a control theory framework. Control theory was
selected as a guiding framework because its underlying premise attempts to understand
an individual’s decision-making behavior. The following chapter will provide an
overview of control theory and its relation to organizational health models and

approaches found in the literature. The model developed in the present research to

 

 

examine factors inﬂuenc

 

will then be presented a

 

 

 

75

examinefactors inﬂuencing the process involved in the decision to utilize EAP services

will then be presented along with the hypotheses of interest.

 

 

 

 

 

 

CONTROL 1

Meant

As previously state
individual’s decision-m
general systems theory I

that utilizes the basic

disconnection of feedb

framework is based on t

one must understand the

systems perspective.
While control thee
acceptance in such diver

and medicine until Wien
1982). The theory has al
individuals due to the we

Carver and Scheier (1982

heselfregulation of bus

and social psychology, 9
1982

fora review) and 0

j .
939, Hollenbeck & Brie

”West 1987;Tayroi, Fis

In general, control t

 

 

 

CHAPTER 3

CONTROL THEORY AND A MODEL OF EAP UTILIZATION

Control Theory

As previously stated, control theory has been used to explain factors inﬂuencing an
individual’s decision-making behavior. Control theory is based on a cybernetic or
general systems theory perspective. General systems theory is a meta-theory or strategy
that utilizes the basic concepts of feedback, self-regulation, and disregulation--i.e.,
disconnection of feedback loops among the system’s parts (Schwartz, 1979). The
framework is based on the view that to understand the behavior of a system as a whole,
one must understand the interaction of its parts. Control theory is based on this general
systems perspective.

While control theory has been around for a long time, it did not gain wide
acceptance in such diverse disciplines as engineering, applied mathematics, economics,
and medicine until Wiener (1948) published his book on cybernetics (Carver & Scheier,
1982). The theory has also been applied in the fields of psychology and the behavior of
individuals due to the work of Miller, Galanter, and Pribram (1960), Powers (1973), and
Carver and Scheier (1982). For example, many theorists have applied control theory to
the self~regulation of human behavior in the ﬁelds of cognitive psychology, personality
and social psychology, clinical psychology, health psychology (see Carver & Scheier,
1982 for a review) and organizational behavior (Campion & Lord, 1982; Hollenbeck,
1989; Hollenbeck & Brief, 1987; Hollenbeck & Williams, 1987; Klein, 1989; Lord &
Hanges, 1987; Taylor, Fisher & llgen, 1984).

In general, control theory deals with the manner in which systems (e.g., humans)

76

 

 

 

 

 

collect and process in:
(Campion & Lord, 1981
emphasizes goals (also
behavior by focusing on
is a difference between i
an individual is drinking
adiscrepancy exists bet
discrepancy which is if
individual to respond in

Control theory of f
(TOTE) cybernetics pri
called the feedback loo
detects discrepancies be
monitoring process of g
(also called the goal, st
iscrepartcy is perceives

activity to reduce the d

 

 

77

collect and process information in order to achieve and maintain a desired state
(Campion & Lord, 1981; Carver & Scheier, 1981; Lord & Hanges, 1987). Control theory
emphasizes goals (also called standards or referent values) and feedback to regulate
behavior by focusing on goal-feedback discrepancies. A discrepancy exists when there
is a difference between what is desired and what one currently has. For example, when
an individual is drinking more than desired or is experiencing more stress than desired,
a discrepancy exists between the desired and current state. It is the detection of a
discrepancy which is the basis for action because a discrepancy may motivate an
individual to respond in some way in order to reduce the discrepancy.

Control theory of human motivation is an elaboration of the test-operate—test—exit
(TOTE) cybernetics principle proposed by Miller et al., (1960). Miller et a1. (1960)
called the feedback loop the TOTE sequence. The TOTE sequence (see Figure 4)
detects discrepancies between the current and desired states by engaging in a self-
monitoring process of Legging input data on the current state against the desired state
(also called the goal, standard, or referent value). According to the theory, when a
discrepancy is perceived, the system (e.g., the individual) initiates (operates) some
activity to reduce the discrepancy. The test-operate sequence is repeated until the
discrepancy is perceived to be eliminated or reduced to an acceptable level-—at which
time the sequence is terminated via an ex_it process. An example illustrating this process
is when an individual monitors his/her current body temperature (for example, using a
thermometer) and compares it to the desired temperature or goal (usually 98.6 degrees).
If a discrepancy is found between the desired and current states, then the individual
attempts to reduce the discrepancy through some response (e.g., taking aspirin, going to

a doctor). The monitoring process continues until the temperature returns to the

 

 

 

(137001

 

 

Source: Ad0pt

Figure 4 z The

 

 

78

 

 

 

>' Te 8 t ' ,9-
(Congrats?

 

 

 

(ﬁzcongrzzit‘y)

 

 

 

a,
0;) era z‘e

 

 

 

 

 

 

Source: Adopted from Miller, Galanter & Pribram, 1960

Figure 4: The TOTE Unit

 

 

 

 

individual’s desired ten

Other models has
discrepancy-reducing p
models include additior
understand the decision
below are Carver and Sr

Carver and Scheie

Their illustration of the

elements: (1) a refers

input/sensor/perception

fraction. A ﬁfth eleme.

impacts on the four m
feedback 100p is an 0Pe
Three of the elements or
comparator, and the out;
the loop along with the it.
further divided into cogt

in the Carver and .

st
andards or objectives '

 

 

 

79

individual’s desired temperature (goal).

Other models have been developed by control theorists which are based on a
discrepancy-reducing process similar to that proposed by Miller et al. (1960). These
models include additional elements and are typically more detailed to help us better
understand the decision-making process. Two useful models of control theory discussed
below are Carver and Scheier’s (1982) and Campion and Lord’s (1982) models.

Carver and Scheier’s (1982) model applied control theory to human behavior.
Their illustration of the negative feedback loop in Figure 5 consists of four main
elements: (1) a referent value which is also called a standard or goal, (2) an
input/sensor/perception function, (3) a comparator, and (4) an output or effector
function. A fifth element known as "disturbance” is the external environment which
impacts on the four main system elements. Disturbance is included because the
feedback loop is an open system and is inﬂuenced by external environmental forces.
Three of the elements originate within the loop: the input or perception function, the
comparator, and the output function. The standard or reference value originates outside
the 100p along with the "disturbance" (Carver & Scheier, 1982). These elements can be
further divided into cognitive and affective components as described below.

In the Carver and Scheier (1982) model, goals may be either explicit or implicit
standards or objectives. The input function senses the present state or condition, which
is then compared. against the goal/standard through the comparator mechanism. The
goals and the process of matching inputs to standards encompass the cognitive
component of the model. According to the model, if a discrepancy is detected, negative
affect may occur (the affective component) which may be in the form of dissatisfaction,

frustration, or anger (Carver & Scheier, 1981). Based on the model, it is this negative

 

(PE

 

 

SOUrCe

Figure

 

 

80

 

REFERENCE VALUE

if

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

t COMPARATOR
INPUT ' ourpur
Funcrrou . surrender
(assessment 1- (BEHAVTOR)
runner on i [
suvrnormsarr

 

 

 

t—Forsruaaaucs

Source: Carver & Scheier, 1982

 

Figure 5: The Negative Feedback Loop

 

 

 

 

 

affect which motivates :
behavioral output fun
discrepancy directly,
environment. This imp
which leads to a differe
isthe perception of the
discrepancy, rather tha
and responding contin
provides a dynamic per
A feedback loop
where a system (e.g., i
current and desired stat
discrePoncy between the
sensing Ola disCrepanc

regulate human motivati

information on the cur
u . .
ndesrrable Ill mechanic

is
often not necessarily

Scheier (1981)

those

 

81

affect which motivates an individual to initiate a discrepancy-reducing response, or some
behavioral output function. The behavioral output is not expected to reduce the
discrepancy directly, but rather it does so through its impact on the system’s
environment. This impact is then hypothesized to create a change in the present state,
which leads to a different perception, which is then again compared to the standard. It
is the perception of the current compared to the desired state that results in a perceived
discrepancy, rather than an objective state. The entire process of sensing, comparing,
and responding continues until the discrepancy disappears. Thus, control theory
provides a dynamic perspective to understanding human behavior.
A feedback loop may be either positive or negative. A "negative" loop is one
where a system (e.g., individual) attempts to decrease the discrepancy between the
current and desired state and a ”positive” feedback loop would attempt to increase the
discrepancy between the current and desired state. According to control theory, it is the
sensing of a discrepancy and the subsequent response to eliminate or reduce it that
regulate human motivation and performance (Powers, 1973). Feedback provides crucial
information on the current state. While sensing any type of discrepancy is equally
undesirable in mechanical systems, regardless of the direction (positive or negative), this
is often not necessarily true in human systems (Carver & Scheier, 1981). Carver and
Scheier (1981) suggest that positive and negative feedback results in different
consequences, and that often in human systems dissatisfaction from an "over—shot"
standard may not occur as it typically would when a standard is "under-shot".
In the present study, the focus is on the perceived health of individuals and their
help-seeking behaviors when they ”under-shoot" or are below their "health" standard.

It is assumed that if an individual is healthier than one’s health standard, the

 

 

 

 

"overshooting" discret
behaviors to reduce th
when the health standar

To understand he
introduce the idea of a I
be strings of TOTE uni
(1982) and Powers (19
connected hierarchicall
superordinate system se
lower-level standards In

When applied to h'
of control systems when

than simple cybernetic

complex. For examp

capabilities (Carver & Sr

contend that an individu
nor do all individuals h

l
n Carver and Scheier'

Scheier, 1979b; Carver 8

 

 

82

"overshooting“ discrepancy is not likely to produce the same negative affect and
behaviors to reduce the discrepancy and achieve the health ”standard" compared to
when the health standard is "undershot" (i.e., the individual is not as healthy as desired).

To understand how feedback loops regulate behavior, it is also necessary to
introduce the idea of a hierarchical system. Miller et a1. (1960) suggested that there may
be strings of TOTE units functioning within each operation’s phase. Carver & Scheier
(1982) and Powers (1973) also discussed the possibility that control systems may be
connected hierarchically through a system of superordinate and subordinate goals. The
superordinate system sets standards or referent values for the subordinate systems, and
lower-level standards must be attained prior to the attainment of higher-level standards.

When applied to human systems, Powers (1973) proposed a hierarchy of nine levels
of control systems where each level in the hierarchy controls different behaviors. Thus,
when simple cybernetic systems are applied to human systems, the system becomes more
complex. For example, individuals are limited in their information processing
capabilities (Carver & Scheier, 1981; March & Simon, 1958). Carver and Scheier (1981)
contend that an individual does not have the ability to monitor all possible control loops,
nor do all individuals have similar abilities in carrying out the self-regulation process.
In Carver and Scheier’s model of self-regulation (Carver, 1979; Carver, Blaney &
Scheier, 1979b; Carver & Scheier, 1981), it is proposed that the loop engaged in depends
on one’s focus of attention. Carver and Scheier (1981) suggest that there are two
directions in which an individual’s attention can be focused, and that the direction
inﬂuences attitudes and behaviors. Attention can be directed inward, or toward the self,
in which case the individual engages in self-focus or self-attention. Attention can also

be directed outward, or toward the environment.

 

 

 

 

 

 

Self-focus has imf
that the negative feedb
blotivation to alleviate
negative reaction regar
salientamongself-focus
self-focused individuals
initiate the comparator.
to facilitate this com par
1975; Carver & Scheier
discrepancy is discove:
behaviors to counter th

At this point, one
discrePolicy-reducing pr

to reduce the discrepant

Scheier (1982) suggest tl

current and desired stat
occur automatically. 1

indivi ’
dual s expectancy

 

 

 

83

Self~focus has implications for control theory because Carver and Scheier suggest
that the negative feedback loop operates when specific attentional requirements exist.
Motivation to alleviate a discrepancy requires an awareness of the standard and a
negative reaction regarding the discrepancy-—both of which are suggested to be more
salient among self-focused individuals (Carver & Scheier, 1982; Hollenbeck, 1989). High
self-focused individuals have been found to have more salient internal standards, to
initiate the comparator, or matching-tostandard, process, and to seek out information
to facilitate this comparison more often than low self-focused individuals (Carver, 1974,
1975; Carver & Scheier, 1982; Gibbons, 1978; Scheier, Fenigstein & Buss, 1974). If a
discrepancy is discovered, self-focused individuals are also more likely to initiate
behaviors to counter the discrepancy and attain the standard.

At this point, one additional dimension must be included in the goal-feedback-
discrepancy-reducing process. This is an individual’s expectancy regarding his/her ability
to reduce the discrepancy and future discrepancies through some behavior. Carver and
Scheier (1982) suggest that an individual will attempt to reduce a discrepancy when the
current and desired states are dissimilar, and that a discrepancy-reducing response will
occur automatically. However, this process may be interrupted as a result of an
individual’s expectancy regarding one’s ability to reduce the discrepancy. According to
Carver and Scheier (1981), a self-focused individual’s expectancy of being able to match
the standard impacts whether the individual will actually attempt to reduce the
discrepancy or will withdraw from any such attempt (either physically/behaviorally or
mentally/cognitively). Thus, in control theory, there are two distinct functions which
occur: an expectancy-assessment process and a discrepancy-reduction process. The

expectancy-assessment process involves synthesizing information from several sources

 

 

(e.g.,physicalconstrain
Once this process is cor
it the expectancy to In
expectancy is negative
Figure 6 (Carver,
process and the behavr'
theory. Research has
between standards an
combined, researchers
expectancies lead to i:
expectancies lead to ear
Carver, 1974; Carver, 1
&Fine, 1972; Scheier, F
Will may inﬂuence 0

control, social inﬂuence

the standard (Carver &

The valence one h
i .
nﬂnencrng one’s discrel

has a positive valence
)

desired.

 

84

(e.g., physical constraints, social constraints, resources available, importance of standard).
Once this process is completed, the theory suggests that either a positive affect will occur
if the expectancy to meet the standard is positive or a negative affect will occur if the
expectancy is negative (Carver & Scheier, 1982).

Figure 6 (Carver, 1979) presents a flow of activities in the expectancy-assessment
process and the behavioral responses that are expected to occur according to control
theory. Research has provided evidence that self-focus increases the congruence
between standards and behavior and that, when self-focus and expectancies are
combined, researchers have found that for those high in self-focus, favorable
expectancies lead to increased effort to reduce the discrepancy while unfavorable
expectancies lead to early withdrawal (Archer, Hormuth & Berg, 1979; Brockner, 1979;
Carver, 1974; Carver, 1975; Carver, Blaney & Scheier, 1979a, 1979b; Duval, Wicklund
& Fine, 1972; Scheier, Fenigstein & Buss, 1974; Steenbarger & Aderman, 1979). Factors
which may influence one’s expectancies include: prior success and failure, locus of
control, social influence, and causal attributions made regarding one’s failure to match
the standard (Carver & Scheier, 1981).

The valence one has regarding the standard has also been recognized as a factor
influencing one’s discrepancy-red ucing behavior (Carver & Scheier, 1981). If a standard
has a positive valence, then the standard is assumed to be a goal or objective that is
desired. According to control theory, if a discrepancy exists between the current state

and the standard, then a behavioral output will likely be triggered to reduce the
discrepancy. If a standard has a negative valence, then the standard is assumed to not
be desired (thus, a discrepancy from the standard is acceptable).

Another model of control theory (see Figure 7) presented by Campion and Lord

 

 

 

 

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n glékh<gpz r: A{/\\‘Jl
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azrunu ro eostrrv: staartvr ViTﬂOlAHAL
mnmmdm -
“MUM
n r:
‘K
can EFFICACY ntcu crrrcacv Lou errrcacr are» EFFICACY
maniacs: mcmrous: “REITIGS: PEIQPTIOIS;
nun una una Mun
mufta' momma momma usocmto
with llfﬂ urru arrn
aunnmw nu tn! mumnnw

 

 

 

 

 

 

 

 

 

Source: Adopted from Carver, 1979

Figure 6: Cybernetic Model of Self—Attention Process

 

 

 

E

rtioron
ngnal

Sensor
“Qﬂﬂl

SOUrCe:

F18Ure ]

 

 

 

 

 

 

86
‘ referent .1.
(goal) \

l ' - cognitive
referent change»
signal e

error i

 

 

 

 

 

h.) 1” decision .
a comparator "'"""' a mechanism

 

 

 

 

 

 

 

 

sensor .
w . that":
i SYSTEM . .
‘ sensor I ‘ effector 1
-o- ----------- ~50--
as
output
feedback . ENVIRONMENT (0-93.
' acuon)

 

 

 

“ QﬂV‘fOHMCN' e—J'

Source: Campion & Lord, 1982

Figure 7: Control Systems Model of Motivation

 

 

(1982) focused on goal
components-four of v
standard or goal, the :
current state, the co
information from the .
mechanism invoked aft
to Campion and Lord,

Of course, in Carver at

made explicit.

Campion and Lori

because it differentiates

(1) a cognitive change

change where the perso

modify a strategy or the

sensrng device. It is
behavioral responses to.

etttcctancies (Campion

Kernan and Lord (1987

i r -

trtrally encountered di:
co "

gnltrve responses, but
i .

"crease or order to red

The three models

1982; Miller et al., 1%

Under -
Standmg the self~r

 

 

87

(1982) focused on. goal~setting behavior. The «Campion and Lord model consists of five
components-evfour of which are similar to those in Carver and Scheier’s model: the
standard or goal, the sensor which inputs feedback from the environment about the
current state, the comparator mechanism which compares the standard to the
information from the environment, and the effector. The ﬁfth element is a decision
mechanism invoked after the standard-to—current~state comparison is made. According
to Campion and Lord, if a discrepancy or error is detected, a decision must be made.
Of course, in Carver and Scheier’s model, this decision process also exists but it is not
made explicit.

Campion and Lord’s model is more detailed than the other models presented here
because it differentiates between two possible outcomes used to reduce the discrepancy:
(1) a cognitive change where an individual modifies the standard or (2) a behavioral
change where the person attempts to modify the environment, through the effector (e.g.,
modify a strategy or the amount of effort utilized), which then provides feedback to the
sensing device. It is important to note that Lord and colleagues suggested that
behavioral responses follow high expectancies while cognitive responses result from low
expectancies (Campion & Lord, 1982; Lord & Hanges, 1987). Campion and Lord (1982),
Kernan and Lord ( 1987), and Sibley and McFarland (1974) have also suggested that for
initially encountered discrepancies, behavioral responses are more likely to result than
cognitive responses, but as discrepancies persist over time, cognitive responses tend to
increase in order to reduce discrepancies.

The three models presented above (Campion & Lord, 1982; Carver & Scheier,
1982; Miller et al., 1960) are important in that they provide a basic foundation to

understanding the self-regulation process, although they differ somewhat in their focus,

 

 

 

 

 

types of responses, a
comparison of models
on the following basi
goal/standard that is co
adecision mechanism
detected, and an effect
which allows the system
on control theory, whet
types of strategies or
increasing one’s effor
distorting the feedback
affective responses (Taj
In his book m
number of key concept:
behavior is goal—direcre
again“ the current start
regarding one’s behavic
affect/emotion may be a
h

union behavioral cont

control systems do not r

hesystem'

,(8)standardt
9) control systems 2
ctween people and the

Finally, Klein (198

 

 

88

types .of responses, and procedures by which these responses are invoked (for a
comparisOn of models see Klein, 1989). In summary, control theory generally focuses
on the following basic components: a mechanism that senses the environment, a
goal/standard that is compared to this sensed environment via a comparator mechanism,
a decision mechanism which determines what action to take when a discrepancy is
detected, and an effector or discrepancy-reducing response if a discrepancy is detected
which allows the system to interact with its environment (Lord & Hanges, 1987). Based
on control theory, when a sufficiently large goal-feedback discrepancy is detected, three
types of strategies or responses may be enacted: (1) behavioral responses, such as
increasing one’s effort to improve performance, (2) cognitive responses, such as
distorting the feedback, modifying the standard, or altering expectancy beliefs, and (3)
affective responses (Taylor et al., 1984).

In his book WW1, Karoly summarized a
number of key concepts and assumptions of control theory: (1) control theory assumes
behavior is goal—directed; (2) goals are explicit or implicit standards used to compare
against the current status; (3) self-regulation of goals requires an openness to feedback
regarding one’s behavior; (4) goals are arranged hierarchically within an individual; (5)
affect/emotion may be an input, output or a mediating factor in the control process; (6)
human behavioral control systems can operate at various levels of automaticity; (7)
control systems do not operate in a vacuum; i.e., social and nonsocial factors inﬂuence
the system; (8) standards/goals change due to internally or externally mediated processes;
and (9) control systems are subject to various disruptions; e.g., disconnections may occur
between people and the environment (1985, p. 26).

Finally, Klein (1989) used control theory as a basis for developing a meta—theory

 

 

 

for understanding wor
Klein identiﬁed several
issues, which include tl
other theories-cg, g0:
satisfaction, turnover,
information processing
theory to motivated b
attention on the cognit
on the self-regulation a
in chapter two, a r
health of employees war
of concern by ernploye
the scientific manageme
workplace and the subs.
the overall health of em
and wellness programs,

the research on empk

utilization. A general

 

89

for understanding work motivation (see Figure 8). From his review of control theory,
Klein identified several advantages to applying a control theory perspective to behavioral
issues, which include the following: (1) it provides a dynamic framework for integrating
other theories—-e.g., goal setting, feedback, expectancy, equity, cognitive dissonance, job
satisfaction, turnover, decision making, attribution, social learning, need, and
information processing theories; (2) it synthesizes the work of authors applying control
theory to motivated behavior; (3) it is a simple heuristic framework; (4) it focuses
attention on the cognitive processes underlying motivation; and (5) it focuses attention
on the self-regulation and internal influences of behavior.

In chapter two, a discussion of the evolution of organizational attitudes toward the
health of employees was presented. This discussion focused on the evolution from a lack
of concern by employers toward the personal lives and problems of employees during
the scientific management-Taylor era to a concern about alcohol—related problems in the
workplace and the subsequent development of OAPs, to finally a broader concern about
the overall health of employees——which lead to the development of occupational EAPs
and wellness programs. It was noted that there has been a lack of a theoretical base to
the research on employee health--particularly with reference to EAP research on
utilization. A general overview of control theory has been presented in the present
chapter to provide a basis for understanding control theory and the Control Theory
Model of EAP Utilization developed for the present research. However, prior to
presenting this model, examples of health—related activities based on a control theory,

or systems, perspective will be discussed.

 

 

 

Source: Kle

Figul'e 8 g

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9O
13
Behavnor \
Chane g]
.. ll 1° 12 tr— 2 '
hdmdmﬂ &mwaheﬁnnaa1 Gaﬂcnmbe (3‘1 i &mamu
and Stmauonat ~--r- Utility of Goat and Wu” (Standard) * (reactors "'
Characteristic Attainment Chance
4t ..
g 8 U 3 b
. . nanuamu
inmhmpmﬂ Eimpma Pmbnmnme
Response
a
‘ﬁS w
s 5 ‘
Eur? CbmmaNMR iSmu§f
NO

 

 

 

 

 

 

Source: Klein, 1989

Figure 8: An Integrated Control Theory Model of Work Motivation

 

 

 

AControl Theory Per

hwmmmﬁ
oriented perspective u
systems theory (Von
Ludwig Von Bertalant
mutual interaction . ..
be closed (it is isolates
within and outside its
concept of the "brair
framework known as '

Karoly, 1985; Kimball,

The biopsychOSO‘

the biomedical and m

disease and medical tre

perspective (Fabrega,

disruption in or deviat

factor,“ and treatment i

1989, p. 3). The seconr

0i helping which focus
aPhysical problem be)

responsible for their [3

r r'
ponders are responsil

The biomedical a

Perspective.

The forum

 

 

91

A Control Theory Perspective on Health-Related Activities

The emerging field of health psychology today has found a control or systems—
oriented perspective useful. This system perspective to health has evolved from general
systems theory (Von Bertalanffy, 1968) and from cybernetic theory (Wiener, 1948).
Ludwig Von Bertalanffy (1966) has defined a system as a ”complex of components, in
mutual interaction . . . any whole consisting of interacting parts" (p. 709). A system may
be closed (it is isolated from its environment) or open (interacts with the environment
within and outside its own boundaries). The health psychology field has examined the
concept of the ”brain as a health care system" (Schwartz, 1979) and developed a
framework known as the ”biopsychosocial” model of health and illness (Engel, 1977;
Karoly, 1985; Kimball, 1981; Snyder, 1989; Stone et al., 1979).

The biopsychosocial perspective used in the health ﬁeld has its historical roots in
the biomedical and medical paradigms of healthuwhich were the prevailing views of
disease and medical treatment in Western society until the popularization of the systems
perspective (Fabrega, 1974). Under the biomedical paradigm, disease is defined as "a
disruption in or deviation from biological norms caused by some physical or chemical
factor,” and treatment is via some corrective physical or chemical manipulation (Snyder,
1989, p. 3). The second perspective traditionally in use has been the medical paradigm
of helping which focuses on individuals who seek the aid of an expert when they notice
a physical problem beyond their own ability to cure. Patients are viewed as not being
responsible for their problem but only for the seeking of treatment, while the health
providers are responsible for diagnosing and providing treatment (Snyder, 1989).

The biomedical and medical paradigms are different from the biopsychosocial

perspective. The former two focus on people as passive, uninformed organs requiring

 

 

 

 

Physical or chemical
biopsychosocial p6”
preventative interveﬂl
systems view was dew
and medical paradigm
that chronic diseases
biochemical, and phys
assumed by the indiv
evaluation of his or he
to treatment and place
1989).

In contrast to the
recognizes the comple
responsibility for their
(Snyder, 1989). The 5
health and illness as tl
and environmental (e.g
individual must contin
'0 it as well as to chan
€01tSidcred healthy wl
(Fabrega, 1974).

Carver and Schei.

are
used a erbernetic r

their health. Health PT
i

 

 

92

physical or chemical treatment due to factors beyond their control. The latter
biopsychosocial perspective includes psychosocial and behavioral factors and
preventative interventions taken on the part of the individual. The biopsychosocial or
systems view was developed for two basic reasons: (1) the inability of the biomedical
and medical paradigms to address a number of health problems and (2) the recognition
that chronic diseases have behavioral and sociocultural causes as well as biological,
biochemical, and physical causes. Furthermore, the passivity and lack of responsibility
assumed by the individual under the medical paradigm disregards a person’s self-
evaluation of his or her health, the timely use of the health care system, or adherence
to treatment and places immense responsibility and power on health providers (Snyder,
1989).

In contrast to the biomedical and medical perspectives, the systems perspective
recognizes the complexity of humans and the need for individuals to not only accept
responsibility for their behavior but to be responsible for modifying it if necessary
(Snyder, 1989). The systems framework takes on a heuristic perspective by viewing
health and illness as the interdependence of physical/biological, social, psychological,
and environmental (e.g., physical, social, etc.) dimensions. In a systems perspective, the
individual must continually obtain feedback from the external environment and adapt
to it as well as to changes present in his or her internal environment. Individuals are
considered healthy when they successfully adapt to these environmental changes
(Fabrega, 1974).

Carver and Scheier (1982) identified areas in health psychology where theorists
have used a cybernetic or control system framework to understand how people maintain

their health. Health protection and promotion are often considered to be self-mediated

 

 

 

 

behaviors. A commo
symptomologies and a
believed to be largely
emphasis on the self-r
useful set of guideline
Examples of heal
include checking one’:
”current state" are on
order to determine if (
feSpond (Carver & Sc

1979). These examp

framework for unders
sensing function, a co
Individuals often mon
induces a certain beha'

Other factors pre
relevant to health beh
health-relevantbehavic

d I
etennrne the degree tr

 

 

 

93

behaviors. A common assertion in health psychology is that many illnesses and their
symptomologies and antecedents are the result of personal life-style behaviors, which are
believed to be largely under the individual’s control (Karoly, 1985). Therefore, with its
emphasis on the self—management process, control theory has been found to provide a
useful set of guidelines for examining self-management and health-related behaviors.

Examples of health activities where control theory has provided a useful framework
include checking one’s pulse, blood pressure, or temperature because the results of this
"current state" are only meaningful when compared to a standard or normal state in
order to determine if one’s health is less than ideal and thus motivate the individual to
respond (Carver & Scheier, 1982; Leventhal, Meyer & Nerenz, 1980; Schwartz, 1978,
1979). These examples illustrate how the elements of control theory provide a
framework for understanding health-related behaviors: there is a standard, an input
sensing function, a comparator mechanism, and an outcome or behavioral function.
Individuals often monitor their current health and compare it to a standard, which
induces a certain behavioral or cognitive response.

Other factors previously discussed within a control theory framework are also
relevant to health behaviors. For example, self-focus has been shown to influence
health—relevant behaviors. Mullen and Suls (1982) provide evidence that self-focus helps
determine the degree to which people attempt to remove stress. In addition, the section
above on control theory outlined the idea that a hierarchy of goals and feedback loops
exists within the context of an individual’s behavior. Hierarchically-ordered levels of
self—regulation also are relevant in one’s health behavior (Carver & Scheier, 1982). For
example, monitoring one’s blood pressure to compare it to a "normal" range is a

subordinate goal to the higher-level goal of staying healthy and maintaining a normal

 

 

 

 

 

 

 

condition.

The basic princiy
behaviors, but little at
the decision-making p
recognized the need '
previously stated, cont
section will present sp
model of EAP utilizat

the present research it

ASystems Perspective

The general syst
philosophy underlying
its open systems, hum
and external environml
eta single cause, but

en r ‘
\rronment, rnteractir

Assistance Programs a

healthy, all aspects of (

ﬁn .
3

 

 

 

94

condition.

The basic principles of control theory have been applied to various health-related
behaviors, but little attention has been given to applying it to understanding EAPs and
the decision-making process influencing EAP usage. However, some researchers have
recognized the need to take a general systems view regarding the EAP process. As
previously stated, control theory is based on general systems theory. Therefore, the next
section will present specific EAP research that has utilized a systems perspective. The
model of EAP utilization based on a control theory perspective that was developed for

the present research will then be outlined.

A Systems Perspective on EAPs

The general systems perspective and control theory tie in very well with the
philosophy underlying EAPs. Control theory, EAPs, and humans are all open systems.
As open systems, humans are subject to dynamic interchanges with both their internal
and external environments. Learning theorists recognize that ”behavior is not the result
of a single cause, but of multiple causes. It is the result of heredity interacting with
environment, interacting with time" (Sprinthall & Sprinthall, 1981, p. 56). Employee
Assistance Programs are based on the view that for an employee to be considered
healthy, all aspects of one’s life need to be healthy—-emotional, psychological, physical,
financial, legal, social, etc. In other words, all systems inﬂuencing an individual must
be maintained in a healthy state. Since individuals are Open systems, models based on
a general systems model, a control theory model, and the biopsychosocial model of
health provide a useful foundation for examining EAPS.

As described above, EAPs are ”systems" for identifying and treating individuals for

 

 

 

 

 

avariety of problems
system interacting wit
maintain contact with
an EAP: internal org
personnel and medir
outpatient and inpatie
excellentframework ff

loop.

Savoca (1986) de‘
components: (I) inpu
services) and the clien
and medical departmer
relationship between tl
which consists of the se

it)

outcome function, \

results; and (5) feedbac

 

 

 

95

a variety of problems (Wrich, 1980b). To do this, an EAP must function as an open
system interacting with the human, organizational, and community environments it must
maintain contact with. Savoca (1986) has identified several environmental influences on
an EAP: internal organizational influences (e.g., supervisor, management, employee,
personnel and medical departments, union), the family, external social services,
outpatient and inpatient services, and self-help groups. A systems model provides an
excellent framework for understanding the EAP process because it can utilize a feedback
loop.

Savoca (1986) developed a systems model of EAPs which consisted of the following
components: (1) input function, which encompasses EAP resources (e.g., staff, funds,
services) and the clients involved in EAP usage (e.g., employees, supervisors, personnel
and medical departments); (2) through- put or transformation process, which involves the
relationship between the EAP staff and clients and client assessment; (3) output function,
which consists of the services provided to the client; e.g., counseling, referral, follow-up;
(4) outcome function, which refers to the impact the services have on the clients; i.e., the
results; and (5) feedback which flows from the results back to the input-sensing function
which feeds into the process so it can cycle through the loop again. ”Feedback enables
the system to correct its own functioning or seek changes in the environment" (Savoca,
19.86, p. 49).

In order for EAPs to be considered successful, the major ingredient is for
employees to utilize the services. As discussed in chapter two, employees may be
referred to an EAP by a third party (e.g., supervisor, union steward, etc.) or a person
may self-refer--i.e., utilize the services voluntarily. The purpose of the present study is

to examine factors which may influence an individual’s decision to seek assistance from

 

 

 

 

an EAP. Since cor
concerned with the s
usefulness as an anal
noted above, Wrich (‘
the entire EAP proces
problem resolution).

speciﬁc procedures in
amodel based on a

decision-making proc
Control Theory Mode
The model conceptuz
system variables, and E

making process inﬂue:

A
Overview of the Mode
The model preser

tuhelp us better under

 

 

96

an EAP. Since control theory is based on a general systems perspective and is
concerned with the self-regulation of behavior, the present research will examine its
usefulness as an analytic tool that can be applied to the EAP utilization process. As
noted above, Wrich ( 1980b) and Savoca (1986) have applied a systems view to illustrate
the entire EAP process (from the initial EAP appointment to referral, to treatment, and
problem resolution). However, a detailed systems model has not been applied to more
speciﬁc procedures involved within the entire EAP process. For the current research,
a model based on a control theory perspective was developed to help examine the
decision-making process influencing an employee’s utilization of EAP services. The
Control Theory Model of EAP Utilization will be presented in the following section.
The model conceptualizes the interrelationships among control theory components,
system variables, and EAP usage to help contribute to our knowledge about the decision-

making process inﬂuencing an employee’s seeking of health assistance.

A Control Theory Model of EAP Utilization

Overview of the Model

 

The model presented in this section retains the basic components of control theory
to help us better understand a specific health behavior--the utilization of EAP services.
However, the Model of EAP Utilization expands on the basic control theory model
presented in the preceding section by including variables which may influence some of
the basic control theory components.

Prior to presenting the Model of EAP Utilization, it would be helpful to understand
the rationale for basing the model on a control theory perspective. Past research on

EAP usage has typically been conducted by measuring specific variables that might be

 

 

 

related to usage and
were typically demo:
often there was little .
inastudy. The anal:
with EAP usage or b)
or problem type (e.g-
education levels, etc.)
there are two problen
staffs want to know w
isimpossible for man:
usage. Existing workf
force of employees
characteristics are a 1
between speciﬁc dem
understanding why suc
d0110f know how to i
EAP utilization resear
rescarch is limited.

As discussed in t

 

 

97

related to usage and that were of interest to the particular researcher. These variables
were typically demographic factors and the types of problems clients presented, and
often there was little or no theoretical or conceptual basis for the inclusion of variables
in a study. The analysis was conducted by either correlating the demographic factors
with EAP usage or by simply examining the percentage of EAP users by demographics
or problem type (e.g., percentage of usage by males and females, by various ages and
education levels, etc.). While this research familiarized us with types of EAP clients,
there are two problems with this past research. First, although organizations and EAP
staffs want to know who is utilizing their services (i.e., demographic characteristics), it
is impossible for management or EAP counselors to apply this information to inﬂuence
usage. Existing workforce characteristics cannot be modified in order to create a labor
force of employees who tend to avail themselves of EAP services since these
characteristics are a constant. Second, even though relationships have been found
between specific demographic variables and EAP usage, we are still no closer to
understanding why such relationships exist. Therefore, organizations and EAP staffs still
do not know how to inﬂuence or improve utilization rates. Consequently, while past
EAP utilization research has been interesting, the practical knowledge gained from this
research is limited.

As discussed in the preceding chapters, EAPs have been found to improve the
effectiveness of both employees and organizations. Current EAP utilization research is
based on the belief that EAPs are successful in eliminating or improving employees’
problems. However, as previously mentioned, experts recommend that 40% of all EAP
users should be self-referred in order for programs to be considered successful (Hobson

’

1982; Wrich, 1980b). Therefore, interest should be focused on how to get employees to

 

 

 

 

voluntarily make U5
utilization, however,
to choose to seek or
for us to understand
make better choices.
In research on i
that in order for ind
exercise more, take n
(e.g., visit a physician
there is something wr
and their current hea
tube true in research
drinking from others
serious to hide or igr
drunk driving, excessir

to save his/her job, m

h
ere that a necessary

individual that a healt

in the present str

 

 

 

98

voluntarily make use of EAP services. Before organizations can inﬂuence EAP
utilization, however, they must first understand what factors affect employees’ decisions
to choose to seek or not seek assistance. The current literature fails to provide a way
for us to understand this decision-making/choice process or how to get employees to
make better choices.

In research on factors inﬂuencing health decisions, it has typically been assumed
that in order for individuals to be motivated to modify their present behaviors (e.g.,
exercise more, take medication, stop drinking, etc.) or to seek some type of assistance
(e.g., visit a physician or health clinic), it is necessary for individuals to perceive that
there is something wrong-that is, that there is a discrepancy between their desired goal
and their current health behaviors or health status. For example, this has been found
to be true in research on alcoholics who tend to deny there is a problem and hide their
drinking from others. This conduct continues until problems develop that are too
serious to hide or ignore (e.g., deteriorating job performance, excessive absenteeism,
drunk driving, excessive accidents) and the alcoholic is forced to seek treatment in order
to save his/her job, marriage, etc. (Scanlon, 1986; Trice & Roman, 1972). It is argued
here that a necessary condition for seeking EAP assistance is the awareness by the
individual that a health discrepancy exists.

In the present study, control theory was selected as a framework to gain a better
understanding of the decision-making process for seeking EAP assistance and to suggest
ways to help increase the likelihood of voluntary EAP usage among employees. There
are three basic reasons for utilizing this framework: (1) control theory explicitly
recognizes that behavior is goal-directed; (2) according to control theory, behavioral

and/or cognitive changes of an individual are motivated by an individual’s perception

 

 

 

 

ofa problem or disc
individual currently
is an employee’s PC“
seek EAP assistance;
variables which migl
theory may provide a
behavior (e.g., using
between a desired Sta
Figure 9 presen‘
present research and
seek EAP assistance.
demographic variable
component-where dc
However, there is a u
used EAP services at
inﬂuence the utilizatic
three control theory c
the decision-making g
variables which migh
Proposed that control

var Suggest ways to

assistance

The variables of

w'
ill be presented in de

 

 

99

of a problem or discrepancy existing between what is desired (the goal) and what the
individual currently has (the current state). In the present research, it is argued that it
is an employee’s perception that a health problem exists that motivates the employee to
seek EAP assistance; and (3) control theory provides a framework for examining key
variables which might inﬂuence the decision to seek EAP assistance. Thus, control
theory may provide a guiding framework for the present research because it focuses on
behavior (e.g., using an EAP) which is motivated by the sensing of a discrepancy
between a desired state (the goal) and current health state (e.g., a health problem).

Figure 9 presents a Control Theory Model of EAP Utilization developed for the
present research and identifies factors hypothesized to affect an individual’s decision to
seek EAP assistance. In the model in Figure 9, past research that has examined
demographic variables focused only on the last component in the model—-the behavioral
component-~where demographic factors would typically be correlated with EAP usage.
However, there is a wide gap between knowing the characteristics of clients who have
used EAP services and understanding the complex interrelationships of factors that
inﬂuence the utilization decision. In the model in Figure 9, it is proposed that the other
three control theory components (goal, sensor, and comparator mechanism) also affect
the decision-making process of EAP utilization. The present study examines specific
variables which might affect some of the control theory model components. It is
proposed that control theory will help us to better understand this decision process and
will suggest ways to increase the likelihood of use by those individuals who need
assistance.

The variables of interest in the present study and the hypotheses of the research

will be presented in detail throughout the rest of this chapter. While Figure 9 presents

 

 

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the complete model .
There are two types
Figure 9. The firstt
side of the model are
side. The diagram :
behavioral sciences,
where variable A pre
bya third variable C.
the flow of activitie
statement about the
diagram to another.
In the model in
using typical statistica

comparator/discrepar

comparator process.

there are two causal r
occurs. Two variables
sensor data perceived
as a result of the co
discrepancy exists bets

it actually a ﬂow

model t

proc:

o the causal ri

Since the flow model 4

aslied of Figure 9 W

 

 

 

101

the complete model developed for the present study, the model will be tested in sections.
There are two types of models that are typically diagrammed like the model shown in
Figure 9. The first type consists of causal models where the variables on the left—hand
side of the model are hypothesized to inﬂuence the variables identified on the right—hand
side. The diagram from left to right represents a causal pattern. In the social and
behavioral sciences, we are capable of dealing with these types of causal relationships
where variable A predicts variable B, or where A and B may be moderated or mediated
by a third variable C. The second type of model is similar to a flowchart which diagrams
the ﬂow of activities and variables within some process but attempts to make no
statement about the nature of the relationships as we progress from one side of the
diagram to another.

In the model in Figure 9, it is not possible to test the complete model all at once
using typical statistical techniques (such as path analysis or causal modeling) because the
comparator/discrepancy variable is not ”caused" by the two variables which enter the
comparator process. Figure 9 actually represents a combination of both model types-—
there are two causal models connected by a flow model where the comparison process
occurs. Two variables are input into this comparison process-the goal/standard and the
sensor data perceived by the individual on the current state. A new variable is created
as a result of the comparison process--the individual’s perception as to whether a
discrepancy exists between the input variables. The comparator mechanism in the model
is actually a ﬂow process that represents a connection of the causal left-hand side of the
model to the causal right—hand side. Flow and causal models have different purposes.
Since the flow model or connection is descriptive, no hypotheses are developed on this

aspect of Figure 9. While hypotheses are developed for the causal parts of the model,

 

 

 

 

they will have t0 bf
completely causally
relationships among
double lines indicate
the model may not
research question. (
the model might fit I
The model will I
the health goal and
relationship between
will betested along wi
EAP usage (see Figr
individual’s perceive
variable that will be c
arelationship betweer
based on the motivat
difference between or
relationship between
discrepancy as a methl

in“ as eXpected

it has been sug

eh '
WIS, are influem

 

102

they will have to be tested separately because the ﬂow throughout the model is not
completely causally connected. The solid lines in Figure 9 represent predicted
relationships among variables in the present research that were examined while the
double lines indicate aspects of the flow model which were not directly examined. While
the model may not be fully tested, it still might prove to be useful in examining the
research question. Once the model is tested in parts, implications of how the parts of
the model might fit together will be discussed.

The model will be tested in sections as follows: (I) the causal relationships between
the health goal and its predictors will be tested (see Figure 10); (2) the causal
relationship between the com parator/perceived discrepancy variable and EAP utilization
will be tested along with the moderator and predictor variables hypothesized to inﬂuence
EAP usage (see Figure 11); and (3) the correlation will be calculated between an
individual’s perceived discrepancy as measured in #2 above and the discrepancy
variable that will be calculated using the goal and sensor inputs to test whether there is
a relationship between the actual and perceived discrepancy. Because control theory is
based on the motivating influence of the discrepancy variable as calculated using the
difference between one’s desired goal and current state, it is important to examine the
relationship between this calculated discrepancy and an individual’s perceived
discrepancy as a method check to determine whether the model and relationships might

exist as expected.

The Goal/Standard
It has been suggested by various researchers that health behaviors, like other

behaviors, are inﬂuenced by a person’s desired goals regarding health along with a few

 

 

 

F\

iHealth r

 

Figure

 

 

 

Health History

 

 

 

 

Health Locus
of Control

103

 

 

 

 

 

 

Social Group
Health Values/
Norms

 

 

l

Desired Health
Goal Level

 

Figure 10: Factors Affecting Desired
Health Goal Level

 

 

 

 

 

Perce
Discre

Persr
Pres
to

 

FlQUI

 

10,4

 

Health Locus
of Control

 

 

 

 

 

 

Perceived v

 

 

Expectancy

 

 

 

 

w EAP

 

Discrepancy

 

 

 

Personal Support/
Pressure/Barriers
to Using EAP

 

 

 

Utilization

 

 

 

 

 

Work Support/
Pressure/Barriers
to Using EAP

 

 

 

Figure 11: Relationship Between Perceived
Discrepancy and EAP Utilization

other key variables
Richards, 1988) F‘
and attitude regard
engaged in are infill
people with whom t
Nader, and Rogers .
influenced by three
knowledge of behavl
{3) the individual’s t
Locus of Control). 5
and perceived cont
perceived health stat
Research suppo

For an individual to
assumed that the ind
behavior is goal~direr
desired end, or a wait

research focuses on t

the level of health do
decide to utilize an

motivated to do some

t

r
l-e.,adiscrepancy be
Health has been

h ' .
11,15er1, mental, and

 

 

105

other key variables (Christiansen, 1981; DiMarco, 1985; Parcel, Nader, & Rogers, 1980;
Richards, 1988). For example, DiMarco (1985) suggested that an individual’s concept
and attitude regarding health and illness and the nature of health-related activities
engaged in are inﬂuenced by the life the person leads, his/her values and goals, and the
people with whom the individual associates. According to Richards (1988) and Parcel,
Nader, and Rogers (1980), whether an individual’s behavior is conducive to health is
inﬂuenced by three factors: (1) the individual’s desire to maintain good health; (2)
knowledge of behaviors conducive to health and which can minimize health risks; and
(3) the individual’s belief that his/her behavior can inﬂuence his/her well—being (Health
Locus of Control). Similarly, Christiansen (1981) found that the importance of health
and perceived control were significant predictors of health behaviors and added
perceived health status as a third important predictor.

Research supports the conclusion that individuals’ goals and values affect behavior.
For an individual to be motivated to perform or modify his/her behavior, it is generally
assumed that the individual holds some goal or standard regarding that behavior; i.e.,
behavior is goal-directed (Karoly, 1985; Pender, 1982). A goal is defined as "an aim, a
desired end, or a valued outcome" (Pender, 1982). The goal of interest in the present
research focuses on the overall health standard an individual desires to maintain—-i.e.,
the level of health desired. It is argued in the present research that for an individual to
decide to utilize an EAP, the individual must desire good health in order to be
motivated to do something about his/her health when he/she recognizes a health problem
(i.e., a discrepancy between desired health goal and current health state).

Health has been defined by the World Health Organization as a "state of complete

physical, mental, and social well-being and is not merely the absence of disease or

 

 

 

 

infirmity" (Stone, 1‘.
of over 400 univer
employees included
that most individua
individuals have bee
in their life (DiMarc
for individuals, such
physical pain, not be
in control of one’s lil
than physical health

one’s health may be i
an EAP (e.g., financ

etc.).

Since human b
individuals will neces
example, one individt

once the individual hi

to take more proactiv

activities such as mai
smoking and drinking
action of internal cc
from the environment

Research suppor

related to health beha'

 

 

106

inﬁrmity" (Stone, 1979, p. 7). In an examination of perceived health and wellness needs
of over 400 university employees, Barker (1987) found the primary concerns of
employees included their physical and mental/emotional well-being. It seems reasonable
that most individuals will maintain a general goal or desire to be healthy--in fact,
individuals have been found to invariably rank health as one of the most valued things
in their life (DiMarco, 1985). However, being healthy may take on different meanings
for individuals, such as not being under high levels of stress or pressure, being free of
physical pain, not being on an emotional roller-coaster, not being overweight, or feeling
in control of one’s life. In EAP research, an individual’s health goal encompasses more
than physical health and includes emotional and psychological or mental health since
one’s health may be inﬂuenced by a variety of problems which are typically handled by
an EAP (e.g., financial, marital, legal, child-rearing, care of elderly, substance abuse,
etc.).

Since human beings prioritize goals and behaviors available to them, not all
individuals will necessarily hold the same desired health goal level (Pender, 1982). For
example, one individual may be interested in doing something about his/her health only
once the individual becomes ill (e.g., visit a doctor) while another individual will desire
to take more proactive measures to maintain a healthy state (undertake healthy lifestyle
activities such as maintaining a proper diet and sleep habits, exercising regularly, not
smoking and drinking, etc.). According to Pender (1982), specific goals desired are a
function of internal cognitive processes which determine "what information is received
from the environment and how it will be interpreted and structured" (p. 13-14).

Research supports the use of desired health goal level as a significant predictor

related to health behavior (Richards, 1988). In research by Kegeles (1969) and Seeman

 

 

 

 

and Seeman (1983i
important motivato
has also been foun
behaviors (Kaplan .
participate in free i
desired (Attitudes T
&Sagan, 1959). H.
behavior appears to
of locus of control a

that health goals did

healthy state did not

exam) in research cc

In the present 5
is goal-directed, it is
the more likely an in
being met. The leVr

research to be influer

and the health value.

below.

W

The first variable
tudividual’s health his

see '
ms logical that the I

i

107

and Seeman (1983), the saliency of health (i.e., the desired level) was found to be an
important motivator in preventive/protective health behavior. Desiring a healthy state
has also been found to be an important predictor in decreasing levels of smoking
behaviors (Kaplan & Cowles, 1978). Other research has found that individuals who
participate in free medical examinations are those who consider health to be highly
desired (Attitudes Toward Co-operation in a Health Examination Survey, 1961; Borsky
& Sagan, 1959). However, the relationship between desired health goals and health
behavior appears to be inconsistent. In a study by Baughman (1978) on the relationship
of locus of control and health goals with health status and behavior, it was concluded
that health goals did not predict one’s health status or behavior. Similarly, desiring a

healthy state did not correlate with the practice of a specific health behavior (breast self-

 

 

exam) in research conducted by Gramse (1982).

In the present study, based on a control theory view and the belief that behavior
is goal-directed, it is suggested that the higher an individual’s desired health goal level,
the more likely an individual will be to seek EAP assistance when the health goal is not
being met. The level of an individual’s health goal is hypothesized in the present
research to be inﬂuenced by three variables: health history, Health Locus of Control,
and the health value/norms of one’s social group. These variables will be discussed

below.

 

 

H thitr

The ﬁrst variable hypothesized to inﬂuence one’s desired health goal level is the
individual’s health history, or past health status. This variable was selected because it

seems logical that the more an individual has previously experienced problems regarding

his/her health, the r
of good health. Wl
be physically, emoti
disruptions which ir
these disruptions, it
hidher health. Prev
goals was not found.
reported that some i
gods following succe
research to the prese
Previously experient

healthy state. ThUS,

Hungary

desired such the

 

have a higher h

health problems

He

. alth Locus of Con:

A second variab

an individual’s Healtl

as the degree to whi

behavior; i.e., the degr

of externally (Wallst

herons, 1978)

 

 

 

108

his/her health, the more likely the individual will be concerned about preserving a state
of good health. When an individual does not feel he/she is in good health, whether it
be physically, emotionally, mentally, etc., the individual frequently experiences negative
disruptions which impede his/her normal lifestyle. The more frequent one experiences
these disruptions, it is assumed that the individual would be more concerned about
his/her health. Previous research on the relationship between health history and health
goals was not found. However, studies examining the general goal-setting process have
reported that some individuals raised their goals after failure while others lowered their
goals following success (Campion & Lord, 1982; Kernan & Lord, 1985). If we apply this
research to the present study, it might be that the more health problems individuals have
previously experienced (failures), the more the individuals would desire to obtain a
healthy state. Thus, the hypothesis of interest in the present research is:
Hypothesis i 1: An individual’s health history will affect the health goal level
desired such that individuals who have had more health problems in the past will
have a higher health goal level desired than individuals who have had fewer past

health problems.

Health Locus of Control

 

A second variable that has been found to have an impact on health goal levels is
an individual’s Health Locus of Control. Health Locus of Control (HLOC) is defined
as the degree to which individuals believe their health is determined by their own
behavior; i.e., the degree to which individuals believe their health is controlled internally
or externally (Wallston, Wallston, Kaplan & Maides, 1976; Wallston, Wallston &

DeVellis, 1978).

 

 

The general c-
Theory where an i
beliefs concerning ‘
theory 0f per 50m“
stimulus-response/f'
(Rotter, 1975). In
forces nor controlle
dealt with motivatir
control" to refer to ‘
internal or external

According to
reinforcement) is de
hon or is contingent
actions. The locus 0'
or reinforcements as
almost exclusively se
events beyond the cr
two extremes describ-
Control, outcomes fol
“‘Ck, Chance, fate, tl

Complexity of forces 2

||'
Internal" locus of co

own ability, skills, of

more initiative in the

 

 

109

The general concept of locus of control was included in Rotter’s Social Learning
Theory where an internal-external locus of control scale was developed to measure
beliefs concerning the control of personal destiny. Social Learning Theory is a molar
theory of personality that attempts to integrate two diverse trends in psychology--the
stimulus-response/reinforcement theories and the cognitive theories of motivation
(Rotter, 1975). In the social learning approach, a person is neither driven by inner
forces nor controlled entirely by his/her environment (Bandura, 1971). Rotter (1966)
dealt with motivation as it related to locus of control and used the term ”locus of
control" to refer to the expectancy that rewards were contingent upon or controlled by
internal or external resources.

According to Rotter (1966), an individual’s reaction to an event (reward or
reinforcement) is determined by the degree the individual perceives the reward follows
from or is contingent upon his/her own behavior or occurs independently of his/her own
actions. The locus of control theory postulates that individuals perceive their outcomes
or reinforcements as being controlled by forces that fall along a continuum going from
almost exclusively self-control (internal) at one end to being controlled primarily by
events beyond the control of the individual (external) at the other end. Typically the
two extremes describe individuals as follows. If an individual has an ”external" locus of
control, outcomes following personal actions are believed to be attributed by him/her to
luck, chance, fate, the inﬂuence of powerful others, or as unpredictable due to the
complexity of forces around him/her, rather than resulting from his/her own action. An
"internal" locus of control individual perceives outcomes as being determined by his/her
own ability, skills, or effort (Rotter, 1966). Research has revealed that internals exhibit

more initiative in their efforts to attain goals and control their environment (DiMarco,

 

 

1985). Evidence alt
awareofenvironme
(b) try to improve I
and value their owt
(Rotter, 1966). Ind
characteristics at th
The locus of Cr
behaviors (Balch 6
reduction, birth cc
immunization and p
research on locus of
that the majority t
precautionary health
if control seek mort
for their health bel
compared locus of c

hospital p0pulation r

 

 

 

110

1985). Evidence also exists that those labeled "internals" are more likely to (a) be more
aware of environmental cues that provide useful information influencing future behavior,
(b) try to improve their conditions, (c) emphasize skill or achievement reinforcements
and value their own ability, and (d) show more resistance to others’ inﬂuence attempts
(Rotter, 1966). Individuals are viewed as being predisposed to behave in line with the
characteristics at the end of the continuum with which they are associated.

The locus of control construct has been found to be related to a variety of health
behaviors (Balch & Ross, 1975; Sonstroem & Walker, 1973), including smoking
reduction, birth control utilization, weight loss, adherence to medical regimens,
immunization and preventive dental care (Malen, 1982; Pender, 1982). In a review of
research on locus of control and health-related behaviors, Strickland (1978) concluded
that the majority of research on the relationship between locus of control and
precautionary health practices provides evidence that individuals with an internal locus
of control seek more information on health maintenance and take more responsibility
for their health behavior than externals. For example, Seeman and Evans (1962)
compared locus of control and the learning of behaviorally relevant information in a
hospital population and found that a person’s sense of personal control was a factor in
determining the level of interest and the degree of knowledge possessed concerning
his/her illness. Internally-controlled individuals possessed more knowledge about their
illness than externally-controlled individuals.

Others have concluded, however, that the early studies did not produce consistent
results (Wallston & Wallston, 1978). For example, in studies on smoking behavior, locus
of control was found to be a relevant factor where non-smokers tended to be internals

(James, Woodruff & Werner, 1965) and individuals who valued health and who were

 

 

 

 

internally-oriented
(Kaplan & Cowle:
utilization (F isch, I
Wallston, l978) are

The locus-of-r
accept personal res
reinforcement expe
internal or external
1985). Therefore, it
is that the initial sc
measure of reinfor
Therefore, to better
and Maides (1976)

to measure the deg

behavior (i.e., is inte

because it was felt t

HLC scale was modi

to he a unidimensic

responsible for their
care professionals)
Multidimensional Hr
the Internal Health 1
Of Control (PHLC
l

W .
allston, Wallston,

 

 

 

111

internally-oriented on health were more successful in changing their smoking behaviors
(Kaplan & Cowles, 1978). However, conclusions from research on birth control
utilization (Fisch, 1974; Harvey, 1976) and weight loss (Balch & Ross, 1975; Wallston &
Wallston, 1978) are more ambiguous.

The locus-of~control construct distributes individuals based on the degree they
accept personal responsibility for what happens to them, which is influenced by past
reinforcement experiences. The idea that an individual develops a belief about an
internal or external locus of control is now thought to be situation—specific (DiMarco,
1985). Therefore, it was suggested that one reason for the inconsistent research findings
is that the initial scale was not designed as a specific health measure but as a global
measure of reinforcement expectancy across a wide range of potential situations.
Therefore, to better apply this concept to the field of health, Wallston, Wallston, Kaplan,
and Maides (1976) developed a unidimensional Health Locus of Control (HLC) scale
to measure the degree to which people believe their health is determined by their
behavior (i.e., is internal or external). Another revision of the LE scale was undertaken
because it was felt that the definition of externality was too broad. Thus, in 1978, the
HLC scale was modified when it was found that Health Locus of Control did not appear
to be a unidimensional construct——some health-externals believed fate or chance was
responsible for their health while other health-externals saw powerful others (e.g., health
care professionals) responsible for their health. The new scale is known as the
Multidimensional Health Locus of Control (MHLC) Scale and includes three sub—scales:
the Internal Health Locus of Control (IHLC) Scale, the Powerful Others Health Locus
Of Control (PHLC) Scale, and the Chance Health Locus of Control (CHLC) Scale

(Wallston, Wallston, & DeVellis, 1978). Individuals are still classiﬁed as being either

 

 

 

”internals" (”Sing
since these are b0
developers of this
factor used to EXPIE
more of a multitudr
play a signiﬁcant rt
168).

The new scale
(1981) found that r
patients who were
externals. Seemanz
concern placed on
practicing more pos

In the present
they factor in inflt
individuals with an
803's; however, it \
difﬁcult soars (Hollr

level desired st
Of Control sub:
Who score lowe

COntrol subscal

 

 

 

112

"internals" (using the IHLC scale) or "externals'l (using the PHLC and CHLC scales
since these are both, dimensions of externality). It should be noted that while the
developers of this scale found it useful, they cautioned that it should not be the only
factor used to explain health behavior—-that ”only in interaction with one, or preferably
more of a multitude of contributing factors, will beliefs in the locus of control of health
play a significant role in the explanation of health behavior” (Wallston et al., 1978, p.
168).

The new scales have been administered in health research. For example, Schultz
(1981) found that using the Health Locus of Control Scale, adolescent cystic fibrosis
patients who were internals were more likely to arrange and keep clinic visits than
externals. Seeman and Seeman (1983) found that one’s health motivation (i.e., value or
concern placed on health) and an internal locus of control resulted in individuals
practicing more positive health behaviors than those with an external locus of control.

In the present study, the perception of control over one’s health is suggested to be
a key factor in influencing one’s desired health goal level. It has been suggested that
individuals with an ”internal" locus of control are less likely to reject setting difficult
goals; however, it would be unrealistic for ”externally oriented” individuals to set
difficult goals (Hollenbeck & Brief, 1987). The hypothesis to be examined is:

Hypothesis ﬁ 2: An individual’s Health Locus of Control will affect the health goal

level desired such that individuals who score higher on the Internal Health Locus

of Control subscale will have a higher desired health goal level than individuals
who score lower on the internal scale or higher on either of the External Locus of

Control subscales (Powerful Others or Chance).

 

 

 

 

Social GFOU Heal

The third set
goal level are the l
Present. ltWaS MP
of one’s social 8T0“
goals. A norm is de
beliefs, attitudes, el
and psychological .
exposure to peers, z
isa function of OI
inﬂuences (Ajzen &
person or group ind
and feelings) of ar
socialization proces
hrnction in society tl
norms, attitudes, pr
ETOUp (Clausen, 196
Social agents 0

ethnic group, and o

1 u °
968a). Socralizatir

 

 

 

113
W

The third set of variables hypothesized to inﬂuence an individual’s desired health
goal level are the health values and norms of members of one’s social group-~past and
present. It was hypothesized that the health attitudes and norms possessed by members
of one’s social group would inﬂuence the degree individuals desired to maintain healthy
goals. A norm is defined as a " generally agreed upon pattern of appropriate behaviours,
beliefs, attitudes, etc.” (Winefield & Peay, 1980, p. 234). Meanings are given to physical
and psychological experiences as a result of ”cultural conditioning in the family, by
exposure to peers, and through the mass media" (Mechanic, 1982). A person’s attitude
is a function of one’s personal nature and attitudes as well as one’s social group
inﬂuences (Ajzen & Fishbein, 1980; Fishbein, 1966). Social influence occurs when "one
person or group induces a change in the behaviour (overt behaviour or internal thoughts
and feelings) of another” (Winefield & Peay, 1980, p. 225). It is an individual’s
socialization process which determines how the individual learns to participate and
function in society through exposure to other individuals and the transmission of values,
norms, attitudes, preferred behavioral patterns and expectations, and sanctions of a
group (Clausen, 1968a; Goslin, 1969; Hammitt, 1984; Loy & Ingham, 1973).

Social agents or social group members include an individual’s family, social class,
ethnic group, and others who contribute to the development of social roles (Clausen,
1968a). "Socialization" is a continual interactive process between an individual and the
values and expectations held by the larger social group (Brim, 1968; Clausen, 1968a).
This lifelong process varies by the situations and socializing agents an individual interacts
with (Inkeles, 1968). For example, socializing agents vary as one ages, with the family

and school groups acting as primary socializing agents for children, and peers, work and

 

 

 

 

 

 

 

other groups bec
McPherson & Ken
The medical
etiology and health
with its interest in 6
1988). An individt
sheeting attitudes a
norms (Pender, 19l
inﬂuence the emer,
examined the antec-
lo-year period and
childhood. Childre
as though their ow
importance socializa
Mothers appear to 1
since a high correlat
the behavior of moth
Placed on health an
inlllortant influence
behavior" (p. 248). 1

Concept, health g0a1<

114
other groups becoming more inﬂuential as one matures (Clausen, 1968b; Loy,
McPherson & Kenyon, 1978).

The medical field has recognized the importance of social factors on disease
etiology and health behaviors, as evidenced by the emerging field of cultural medicine
with its interest in examining the inﬂuence of social factors on health behaviors (Mayer,
1988). An individual’s social group can inﬂuence an individual’s health behavior by
affecting attitudes and beliefs or by forcing an individual to conform to group behavioral
norms (Pender, 1982). According to Pender (1982), ”family patterns of health care
inﬂuence the emerging values and lifestyles of offsprings" (p. 73). Mechanic (1978)
examined the antecedents of various health and illness responses and behaviors over a
16—year period and concluded that sick-role behavior is, in part, learned during one’s
childhood. Children learn through the health behaviors they observe in others as well
as through their own health experiences (Pender, 1982). Rosenstock (1975) cited the
importance socialization into one’s family had on an individual’s lifelong health patterns.
Mothers appear to be important role models for the health behavior of their children
since a high correlation was also found by Tyroler, Johnson and Fulton (1965) between
the behavior of mothers and their children. Bruhn and Cordova (1977) stated the ”value
placed on health and the level of knowledge about health by parents represents an
important inﬂuence on how a child will be reared with respect to health attitudes and
behavior" (p. 248). It is this "parental modeling" which helps a child develop a health
concept, health goals, and perceive a responsibility and control over one’s own health
(Bruhn, Cordova, Williams & Fuentes, 1977).

Concepts of health and illness are influenced by "parents’ attitudes and actions

before children understand the significance of these attitudes and actions on their own

 

 

health behavior " (
also inﬂuence an

children grow old
information, varylf
family relationship
patterns of exercis
interpersonal relati
(Pender, 1982). He
groups and within 2
and behaviors. D
differently.

Of particular i
of others inﬂuence
individual typically
degree of uniformitj
l“ the present reset

members of his/her

individual’s health E

Hypothesis £2
his/her social g
individual who
members of his
an individual v

norms and valu

 

 

115

health behavior" (DiMarco, 1985). However, other members of one’s social group can
also inﬂuence an individual’s attitude toward health and health behaviors. "When
children grow older . . . their attitudes and habits . . . are inﬂuenced by new health
information, varying social contacts, and demands made upon them by school, jobs, and
family relationships" (DiMarco, 1985). ”Conversations with others regarding their
patterns of exercise, nutrition habits, rest and relaxation, management of stress, and
interpersonal relationships” have been found to act as cues for one’s health behaviors
(Pender, 1982). Health norms may exist both within an individual’s nonwork and work
groups and within an entire organization, which all act as regulators of health attitudes
and behaviors. Different groups may desire to maintain health-related behaviors
differently.

Of particular interest in the present study is whether the health values and norms
of others inﬂuence the level of health goals desired by an individual. Because an
individual typically chooses members of his/her social group, it is likely that a certain
degree of uniformity of goals, attitudes, and norms will prevail among group members.
In the present research, an individual’s perception of the health norms and values of
members of his/her social group will be examined to assess their impact on the
individual’s health goal level desired. The hypothesis of interest is as follows:

Hypothesis #3: An individual’s perception of the health values and norms of

his/her social group members will affect the health goal level desired such that an
individual who perceives high general health goals and positive health norms of
members of his/her social group will have a higher health goal level desired than
an individual who perceives members of his/her social group hold lower health

norms and values.

 

 

 

 

 

W
The specific
individual’s desire
problems as well a
vary in the extent
hypothesized to im
of Control, and the
ﬂoup. The next set

Model of EAP Util

The second pr
asensor function it
environmental stimt
receives feedback frt
Slmptoms. Research
Sistem depends on tl

ltCervone, 1983; Err

 

 

116

Summary of the Health Goal Component

The specific overall goal or standard of interest in the present research is the
individual’s desired health goal level-~which includes the desire to avoid illness or
problems as well as rec0ver from illness or problems. It is suggested that individuals
vary in the extent they desire to maintain good health. Three specific variables were
hypothesized to impact on the level of one’s health goal: health history, Health Locus
of Control, and the health attitudes, values, and norms held by members of one’s social
group. The next section will discuss the second major component of the Control Theory

Model of EAP Utilization—-the Sensor Function.

The Sensor/Feedback Function
The second primary element in the Control Theory Model of EAP Utilization is
a sensor function which activates the process through which an individual perceives
environmental stimuli and responds to them. In the present model, the sensor function
receives feedback from the environment regarding one’s present health status and health
symptoms. Research has indicated that for the effective regulation of behavior, a control
system depends on the interaction of goals and feedback to affect performance (Bandura
& Cervone, 1983; Erez, 1977; Locke, Shaw, Saari & Latham, 1981). Feedback, therefore,
is necessary along with the goal or standard in order to initiate a discrepancy-reducing
response if a discrepancy exists. It is the discrepancy between the goal and the present
state that leads to behavior (Winefield & Peay, 1980). According to the model, the
sensing process is a dynamic one where an individual is continually monitoring his/her
health status.

In the Control Theory Model of EAP Utilization presented in Figure 9, initially an

 

 

 

 

 

individual’s curret
health status is th
comparator mecha
is perceived betw.
discrepancy is pen
the behavioral ou
status/symptoms at
repeated.

While this sen
0f EAP Utilization
individual’s perceii

Problems scale devt

 

r1—

117

individual’s current health status is perceived by the sensor function. The individual’s
health status is then compared to the standard or desired health goal level via the
comparator mechanism. This sensing-comparison process is repeated until a discrepancy
is perceived between the desired health goal and perceived health state. Once a
discrepancy is perceived and a behavioral response occurs (e.g., seek treatment), then
the behavioral outcome (i.e., from the treatment) along with the current health
status/symptoms are fed back into the sensor function and the sensing process is
repeated.
While this sensor component is an important element in the Control Theory Model
of EAP Utilization, no hypothesis will be examined on this aspect of the model. An

individual’s perceived current health state will be measured using the Current Health

 

Problems scale developed for this research (see Part VII, Appendix B).

The Comparator Mechanism

 

The comparator mechanism is the third primary component in control theory. Two
variables are input into the comparator mechanism to create a third variable-the
perceived discrepancy between the desired and current state. Once the sensor function
is activated whereby an individual perceives his/her current health status, the comparator
mechanism compares the individual’s desired health goal with his/her current health
status as perceived by the sensor function. The outcome of this comparison process is
a perception or decision regarding whether a discrepancy exists between the desired goal
and current state. According to control theory, if an individual perceives no

discrepancy, then a discrepancy—reducing response need not necessarily be undertaken.

 

Instead, the individual continues to monitor and compare his/her current health

 

 

 

 

 

symptoms against
individual’s desire
decision-making I
respond to the di!
(modify the desirt
process). It should
as an individual I
symptoms by com

As previously
using a causal mod
variables which are
sensor/perceived he
the comparator/disr
in Figure 9 is one oi
connecting point t
connection or com

process. In the casr

are the health stand.
the variable coming

In control the
subtracting the sens
hey are similar~~i.e.

hudei, an examinatir

between the disctell

 

 

 

118

symptoms against the standard. However, once a discrepancy is detected between an
individual’s desired health state or goal and current health status, it is predicted that a
decision—making process is activated which inﬂuences whether the individual will
respond to the discrepancy either behaviorally (seek EAP assistance) or cognitively
(modify the desired goal or the interpretation of symptoms through the comparator
process). It should be noted that the comparator mechanism is continually re-activated
as an individual monitors his/her current health status and interprets the current
symptoms by comparing them to his/her desired health goal.

As previously discussed, it is not possible to test this aspect of the model directly
using a causal model because the comparator process is a ﬂow—type model and the two
variables which are input into the comparator/discrepancy process (the goal and the
sensor/perceived health status) are not predictor or causal variables of the outcome of
the comparator/discrepancy process (i.e., the discrepancy variable). Rather, the model
in Figure 9 is one of a ﬂow-chart type of model connecting two causal models and at the
connecting point the model is discontinuous. Two variables are input into the
connection or comparator process (an operator) and a third variable ﬂows out of that
process. 'In the case of the model in Figure 9, the variables going into the ﬂow model
are the health standard and the sensor (health status) data (shown via double lines) and
the variable coming out is a perceived discrepancy variable.

In control theory, the perceived discrepancy variable is typically created by
subtracting the sensing function’s output from the desired goal to determine whether
they are similar-~i.e., whether a discrepancy exists. Therefore, to study this aspect of the
model, an examination was conducted on whether there was a correlational relationship

between the discrepancy variable computed using measures of the desired goal and

 

 

 

 

 

current health st:
individual’s percey
as a method check
be working as expr
aframework for u
if there was not as
been suggested her:
because it may not
health state whicl
relationship to be t
usefulness of this fr

the Control Theory

The behavior/t
when an individual
current state. In tl‘.
variable, focuses on

compared hlS/hel‘ df

This asuect of

Presented in Figure

tel ‘ .

C
ontrol, Which c on

a.

 

 

 

119

current health state and a variable of perceived discrepancy as measured by an
individual’s perception of whether a discrepancy exists. This relationship was examined
as a method check on the validity of the discrepancy variable to see if the model might
be working as expected. If a strong relationship existed, then use of control theory as
a framework for understanding the EAP decision process might be considered useful.
If there was not a strong relationship, then control theory may not be as helpful as has
been suggested here in understanding an individual’s motivation to seek EAP treatment
because it may not be the actual discrepancy between an individual’s desired goal and
health state which motivates a response. There is no hypothesis covering the
relationship to be examined here, but a method check will be conducted to verify the
usefulness of this framework. The next section will present the last main component of

the Control Theory Model of EAP Utilization—-the behavior/effector component.

The Behavior/Effector Component

The behavior/effector component is the discrepancy-reducing response undertaken
when an individual perceives there is a discrepancy or error between the desired and
current state. In the present study, the behavior of interest, which is the dependent
variable, focuses on whether an employee utilizes EAP services after an individual has
compared his/her desired state with his/her current health state.

This aspect of the Control Theory Model of EAP Utilization to be tested is
presented in Figure 11 where it is hypothesized that two variables will moderate the
relationship between perceived discrepancy and EAP utilization: (1) Health Locus of
Control, which consists of three subscales or variables, and (2) expectancy of goal

attainment. Two additional variables, personal support/pressure/barriers and work

 

 

 

 

support/pressure/bart
regardless of whether
below.

In general, it is
depends on whether
Control and a high 0
Based on the model i
of Control (HLOC) Sl
likely to behaviorally
an individual is low (
HLOC subscales (Por
then the individual
perceived. A cogniti
health goal or altering
Present study is on '
assistance. The varia

discussed below.

He

alth Locus of Cont

Health Locus of

affecting the level of a

e - O
xamrne this variable

bet
ween a perceived (

assistance at an EAP

 

 

120

support/pressu're/barriers, are hypothesized to have a direct effect on EAP utilization,
regardless of whether a discrepancy is perceived. These relationships will be discussed
below.

In general, it is suggested that whether an individual responds to a discrepancy
depends on whether an individual possesses an internal or external Health Locus of
Control and a high or low expectancy that the EAP will help lead to goal attainment.
Based on the model in Figure 9, if an individual is high on the Internal Health Locus
of Control (HLOC) subscale or perceives a high expectancy, then the individual is more
likely to behaviorally respond to a discrepancy and utilize EAP services. However, if
an individual is low on the Internal HLOC subscale or high on either of the External
HLOC subscales (Powerful Others or Chance) or perceives a low level of expectancy,
then the individual is more likely to cognitively respond when a discrepancy is
perceived. A cognitive response might be in the form of modifying the individual’s
health goal or altering the interpretation of health symptoms/status. The interest in the
present study is on whether the individual responds behaviorally by seeking EAP
assistance. The variables hypothesized to inﬂuence the behavioral response will be

discussed below.

Health Locus of Control

 

Health Locus of Control has previously been discussed as a variable potentially
affecting the level of an individual’s desired health goal. The present research will also
examine this variable as to whether it has a moderating inﬂuence on the relationship
between a perceived discrepancy in a person’s health and the decision to seek health

assistance at an EAP. As previously mentioned, individuals tend to hold primarily an

 

internal or external
individuals believe th
Kaplan & Maides, 19
external locus of co
determined by luck, «
due to the complexitj
onone’s own action.
as being determined l
is more assertive in sl
Health Locus of

the health behavior de

 

personal behavior car
health. Lau (1982) ut
its three subscales-hi
control over health w
unless an individual be
and future health, Ii
rtSponsibility for his/l.

Ongoing researc]
associated with h
motivation, reduv
utilization of hea

use of alcoht
Health Locus of t

f
Wild that nonsmoker

ani ‘
nternal orientation

 

 

121

internal or external view of power. Health Locus of Control is the degree to which
individuals believe their health is determined by their own behavior (Wallston, Wallston,
Kaplan & Maides, 1976; Wallston, Wallston & DeVellis, 1978). If an individual has an
external locus of control, outcomes following one’s actions are perceived as being
determined by luck, chance, fate, the inﬂuence of powerful others, or as unpredictable
due to the complexity of forces around him/her, rather than being entirely contingent
on one’s own action. An individual with an internal locus of control perceives outcomes
as being determined by his/her own ability, skills, or effort (Rotter, 1966) and generally
is more assertive in shaping his/her environment (Pender, 1982).

Health Locus of Control was chosen as potentially having a moderating impact on
the health behavior decision process because it involves an individual ’s belief that his/her
personal behavior can make a critical difference in the individual’s present and future
health. Lau ( 1982) utilized the Multidimensional Health Locus of Control scale (with
its three subscales--Internal, Powerful Others, and Chance) and concluded that self-
control over health was a good predictor of self-care behavior (p. 328). It seems that
unless an individual believes his/her behavior can have a direct impact on his/her current
and future health, little motivation will exist to seek health assistance and take
responsibility for his/her health. According to Rosenstock (1975):

Ongoing research suggests that external control, alienation or powerlessness are
associated with higher rates of morbidity, lower rates of compliance, lower health

motivation, reduced tendency to seek behaviorally relevant information, reduced
utilization of health care services, and reduced ability to control weight, smoking

and use of alcohol and other drugs (p. 135).
Health Locus of Control was examined in studies on smoking behavior, and it was
found that nonsmokers and those who quit smoking tended to be more likely to have

an internal orientation (Best, 1975; Coan, 1973; James, Woodruff, & Werner, 1972; Platt,

 

 

 

 

1969; William
been examine
For example,
externally con
success in a r
oriented. Ht
correlation be
in other
reported more
l972), ln add
in tescarch 0n
lime COmparet
‘0 PaillClpants
Price (1982) wt
ml" I10npartic;
There is e

The lOIlOWing s
examined in tin
relatitmshi
are high Or
belWeen th

are l0w on

 

122

1969; Williams, 1972 as cited in Pender, 1982, p. 63). Health Locus of Control has also
been examined in relation to weight and weight loss; however, the results are equivocal.
For example, O’Bryan (1972) found that overweight individuals tend to be more
externally controlled than those of normal weight, and Balch and Ross (1975) concluded
success in a weight loss program was found to occur more among those internally
oriented. However, Bellack, Rozensky and Schwartz (1974) found no signiﬁcant
correlation between weight loss and locus of control.

In other health-related research, individuals who are internally controlled have
reported more frequent use of seat belts than those externally controlled (Williams,
1972). In addition, the importance of an individual’s HLOC has also been supported
in research on the use of birth control where internals tended to practice birth control
more compared with externals (McDonald, 1970). Finally, the MHLC was administered
to participants and nonparticipants in a work site fitness program by O’Connell and
Price (1982) who found that participants in the program were more internally oriented
than nonparticipants.

There is evidence that locus of control is relevant to predicting health behaviors.
The following set of hypotheses, which are outlined in Figures 12a to 12¢, are to be
examined in the present research:

Hypothesis #4a: Internal Health Locus of Control (HLOC) will moderate the
relationship between perceived discrepancy and EAP utilization. Individuals who
are high on the Internal HLOC subscale will respond to a perceived discrepancy
between their desired and current health by utilizing an EAP more than those who

are low on the Internal HLOC subscale.

EAP
Utilizat

 

Fighe 12a:

 

 

Hypothesis #4a

Yes High IHLC

EAP
Utilization

N0 Low IHLC

 

 

 

 

 

 

L H

Perceived Discrepancy

 

 

Figure 123: Hypothesized Relationship of Internal Health Locus of Control
(IHLC)

Utilizar

l‘lElll‘e 12b:

 

124

Hypothesis #4b

Yes Low PHLC

EAP
Utilization

No High IHLC

 

 

L H

Perceived Discrepancy

___¥

Figure 12b: Hypothesized Relationship of Powerful Others Health Locus of
Control (PHLC)

 

 

 

 

 

EAP
Utilizatiol

Figure 120: H:

 

125

Hypothesis #40

Yes Low CHLC

EAP
Utilization

No High CHLC

 

 

L H

Perceived Discrepancy

.g

Figure 12c: Hypothesized Relationship of Chance Health Locus of Control
(CHLC)

 

 

 

 

 

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are 10‘” 0

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Expectancies ar e

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Expectancy
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Individual will act

(expectancy). Cot

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126

ﬂypgjhesﬁiﬁib: Powerful Others Health Locus of Control (HLOC) will moderate
the relationship between perceived discrepancy and EAP utilization. Individuals
who are low on the Powerful Others HLOC subscale will respond to a perceived
discrepancy between their desired and current health by utilizing an EAP more
than those who are high on the Powerful Others HLOC subscale.

Hypothesis #4c: Chance Health Locus of Control (HLOC) will moderate the

relationship between perceived discrepancy and EAP utilization. individuals who

are low on the Chance HLOC subscale will respond to a perceived discrepancy

between their desired and current health by utilizing an EAP more than those who

are high on the Chance HLOC subscale.

Expectancy

 

 

 

The second variable hypothesized to moderate the relationship between a perceived

 

health discrepancy and the discrepancy—reducing response is the individual’s expectancy,
which refers to the individual’s perception that a given action will achieve the desired
goal; i.e., the belief that a specific health action will prevent or ameliorate illness.
Expectancies are considered to be important in determining whether behavior will be

initiated, the amount of effort exerted, and whether effort will be sustained over time

(Bandura, 1977b; 1982).

 

Expectancy ties into Rotter’s (1954) social learning theory, which postulates that
behavior is influenced by the expected probability of an outcome occurring. An
individual will act if he/she believes the behavior will lead to the goal/reinforcements
(expectancy). Control theory models have also emphasized the importance of outcome

€Xpectancies in determining whether (a) behavioral or cognitive changes occur (e.g.,

 

 

——7

127

Taylor et al., 1984) and (b) whether the individual withdraws or persists (e.g., Carver &
Scheier, 1981).

As previously discussed, self—regulation is also a key concept in control theory. The
concept of expectancy is relevant to the self-regulation of health process since an
individual’s expectancy regarding a particular health behavior has been found to have
an important inﬂuence on behavior and on the direction of actions. For example, one’s
expectancy of being able to eliminate a discrepancy (e.g., high blood pressure) in order
to meet the goal (e.g., normal blood pressure range) can have an influence on the type
of outcome that occurs (i.e., whether an individual takes medication, modifies diet, etc.
depends on whether the person feels the behavior will reduce his/her blood pressure).

In the present research, expectancy refers to the employee’s perception of the

 

 

likelihood that utilizing an EAP will help lead to the achievement of the individual’s
health goal and the reduction or elimination of the perceived discrepancy between the
desired and current state. According to the model developed in the present research,
if an individual’s expectancy regarding the attainment of his/her goal is high, meaning

that he/she believes the seeking of assistance at an EAP will improve one’s current and

 

future health state and reduce the perceived discrepancy, then it is more likely the
individual will seek EAP assistance. However, if an individual’s expectancy regarding
the EAP’s ability to achieve the health goal is low or poor, then the individual will
decide to not make use of EAP services.

Expectancy that an EAP will help red uce/resolve health problems can be inﬂuenced
by an individual’s expectations regarding the benefits to seeking EAP assistance. Thus,
the more benefits perceived by an individual to using EAP services, the higher one’s

perceived expectancy might be regarding the EAP’s ability to help. Prior research

 

 

 

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mhe

hpr
phi
emp]

Wat

[he 5|
Piiso‘
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inﬂue]
reiatio

E
regirth
expirie

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i

128

examining health behaviors has identified a number of benefits or motivators that have
been found to inﬂuence not only an individual’s belief that seeking assistance will help
but also inﬂuence the actual seeking of assistance. Some of these benefits or motivators
for health and help-seeking behaviors include:
(1) a desire for social approval (Gochman, 1971; Haefner & Kirscht, 1970; Pender,
1982);
(2) a desire to avoid disease, improve health, or receive approval from significant
others (Antonovsky & Kats, 1970);
(3) the ability of the program to provide strategies to reduce stress, reduce
depression, improve one’s self—concept, improve overall health, improve one’s work

performance/career (Straussner, 1986), help employees recover from alcoholism, save

 

employees’ jobs, improve morale, save money (Straussner, 1986), promote psychological

 

well~being, and decrease anxiety (Sidney & Shephard, 1976).

In addition to the above motivators or benefits that might influence one’s belief in
the success of an EAP (i.e., expectancy), another factor hypothesized to inﬂuence a
person’s expectancy is an employee’s prior experience with an EAP and whether that
experience was positive or negative. Prior experience has been found to be a factor
inﬂuencing one’s future behavior (Bandura, 1982; Carver & Scheier, 1981). For
example, Ajzen and Fishbein (1980) suggested the strength of the attitude—behavior
relationship may be moderated by the direct experience one has with the object.

Expectancies have been found to increase after success and fall after failure

 

regarding the specific behavior (Feather, 1966, 1967; Feather & Saville, 1967). Prior
experience regarding usage of an EAP has also been found to influence an individual’s

future expectancy on the EAP’s ability to assistemployees. Pardue (1987) found that

 

 

 

V6

hig

bel

ex]:

i

129

of 200 clients surveyed, 98% stated they would recommend the EAP to others, 71% were
very satisfied with the service provided, and 85% reported they experienced
improvement in their problem situation. Ford and McLaughlin (1981) found that the
highest group willing to use EAP services was the group of former EAP users.

In the present research, expectancy is hypothesized to moderate the health-seeking
behaviors of an individual. Therefore, the hypothesis to be examined regarding the
expectancy variable, which is presented in Figure 13, is:

Hypothesis # 5: Expectancy regarding the ability of the EAP to resolve or improve

 

an individual’s perceived health problems will moderate the relationship between
perceived discrepancy and EAP utilization. Once a discrepancy is perceived
between an individual’s desired and current health, an individual with a high

expectancy regarding the EAP will seek assistance from the EAP more than an

  
 
  
    
  
   
  
  

individual with a low or poor expectancy.

The next variables hypothesized to inﬂuence whether an individual seeks assistance
t an EAP are the perceived social support or social pressure along with perceived
arriers from both work and non-work sources that encourage/discourage the individual
i make use of EAP services. House (1981) has defined social support as a "ﬂow of
strumental aid, information, and/or appraisal (information relevant to self-evaluation)
‘ tween people” (p.26). Social support involves interpersonal transactions that include
‘I e or more of the following elements: affect, affirmation, and aid (Kahn & Antonucci,
, 30). Others have identified different types of social support in terms of the functions

ved by each type: emotional, informational, instrumental, and belongingness (Cohen

 

 

130

Hypothesis #5

Yes High Exp'y

EAP
Utilization

No Low Exp'y

 

 

 

 

L H

Perceived Discrepancy

Figure 13: Hypothesized Relationship of Expectancy (Exp'y)

 

 

131

Hoberman, 1983; Spacapan, 1988).

People within an individual’s social environment (e.g., family, social group, peer
Jup, school, coworkers, supervisors, etc.) may provide strong support in goal
:ainment and problem-solving in a variety of social situations (Loy, McPherson &
anyon, 1978; Wynne, 1986). Haskell and Blair (1980) emphasize that the attitudes and
actions of those with whom a person interacts determine whether an individual will
rticipate and adhere to some activity. Similarly, Fishbein (1966) predicts a person will
gage in a specific behavior if the behavior is evaluated positively and if the individual
rceives that others within his/her social group think it should be performed. This
bjective norm may exert pressure to perform or not perform a behavior that may be
lependent of a person’s attitude toward the behavior (Hammitt, 1984). Therefore,
e’s personal perception of the social pressure to perform or not to perform a behavior
1 key inﬂuence on behavior (Ajzen & Fishbein, 1980). For example, Anderson and
ﬁrm ( 1973) examined the health behaviors of students enrolled in a university health
0 and found that the more positive students perceived the attitude of others was
ard the student health center, the more positive was the students’ own view toward
health services, which in turn inﬂuenced their utilization of services. Of interest in
)resent research is the encouragement/discouragement received by other individuals
rding the seeking of assistance and the utilization of EAP services.

Also of interest are the perceived barriers to using an EAP. While individuals may
re an EAP can help reduce/resolve their problem(s), they still may not seek
ince because of perceived barriers or costs. These barriers might also be classified
ro categories-~those perceived to exist that are not related to the work environment

ose that are related.

 

 

 

 

———f

132

In the present research, it is hypothesized that social support/pressure from both
individual’s personal life as well as work life along with perceived barriers related to
e’s personal and work environments will directly inﬂuence the decision to seek help.
5 suggested that these variables will directly inﬂuence an individual’s behavior rather
in moderate the relationship between a perceived discrepancy and EAP usage because
individual may seek EAP assistance due to pressures from sources in one’s work or
n-work environment even when the individual does not perceive there is something
mg with his/her health (a discrepancy). However, when combined with barriers,
ial support/pressure may have a different inﬂuence on EAP utilization. These
nbined variables will be examined in the present research.

In this research, support/pressure from the work environment was separated from
port/pressure received from other individuals in one’s personal life because it has
0 suggested that these may be separate constructs. Mayer (1988) noted that there has
1 sparse evaluation of management support as a significant variable in health
arch and that there appears to be no empirical evidence that management support
1 significant effect on health promotion efforts at the work site. Mayer notes that
:social system variables, such as norms and social support, have been examined as
air inﬂuence on health behavior and suggests that management support is often
porated into the global construct of "social support,” which generally refers to all
as and forms of support behavior provided to an individual, rather than being
Jed as a separate concept. Mayer and others suggest that social support from

friends, and significant others one socializes with is not the same construct as
:ment-based support within an organization (Broadhead et al., 1983; Bruhn &

1987; Mayer, 1988). Therefore, the present research will examine social

 

 

———’f

133

support/pressure regarding the seeking of assistance at an EAP that is received from
individuals both outside and within the workplace. In addition, as previously
mentioned, barriers to using an EAP can also be classified into those related to one’s
personal or work environments. Sources of support/pressure that might be received
from individuals within one’s personal life along with personal barriers will be discussed

first and then possible sources of support/pressure and barriers from the work

environment will be presented.

Personal Sgurces of Support/Pressure and Barriers

There are several sources of social support within an individual’s personal life
which might inﬂuence the person’s behavior. These include support from parents and
relatives, friends, and others with whom an individual socializes with outside the
workplace. Social support has been examined in health research and found to inﬂuence

articipation in health activities (Hammitt, 1984; Merriman, 1984; Snyder & Spreitzer,
973), adherence, and changes in health behaviors (Terborg, 1988 as cited in Mayer,
988). However, while social support has been examined in health research, such as its
ect on participation and adherence to treatment, (Broadhead et al., 1983; Leavy,
83), Terborg (1988, as cited in Meyer, 1988) suggests the results from this research are
uivocal.

Blackwell (1979) believes that the family plays an important role in reinforcing
pr0priate health behaviors and eliminating inappropriate health behaviors. Caplan
76) found that individuals reporting high levels of social support tend to perceive
ir hypertension treatment as more beneﬁcial than costly. Individuals who discussed

tal problems with their family and friends have also been found to be more likely to

 

 

 

134

Leek preventive dental visits compared with those reporting no such discussions
Antonovsky & Kats (1970). Haskell and Blair (1980) found that pressure from one’s
ocial group inﬂuenced the success of motivating individuals to maintain a more active
festyle.

Warren (1982) indicates that health-seeking behaviors often require informed
:ferral agents to encourage the seeking of assistance. He estimates that 90% of those
ho self-refer for help do so after talking with a natural helper. In EAP research,
tampion (1988) demonstrated that external sources of support inﬂuence whether
ents follow through on EAP referrals. In another study by Pardue (1987) on 200 users
an internal EAP, clients stated their awareness of the EAP’s existence came through
npany publications (30%), company training (24%), fellow employees (17%), and a
Jervisor (11%). While most clients in the Pardue (1987) study stated they were self—
arred (79%)--primaril y because they saw their own job performance deteriorating-~the
raining used the EAP as a result of suggestions by the supervisor, fellow employees,
’amily members.

In addition to support, encouragement, and pressure from sources in one’s personal
hat might inﬂuence an individual’s decision to seek assistance at an EAP, there may
be a number of barriers or obstacles that exist that can inﬂuence an individual’s
ion to not seek EAP assistance. A number of EAP experts have identified several
ers that might deter EAP usage. The present research has classified some of these
ers as being from “personal” sources, which means they are barriers perceived by
dividual to exist outside of his/her workplace. Some of these barriers include:

1) inconvenience, unavailability, or difficulty in attending the EAP (Ultsch, 1983);

2) competing responsibilities (Langlie, 1977);

 

 

 

 

135

(3) a stigma associated with many problems which an EAP addresses (e.g.,
lcoholism, drug dependency, and mental and behavioral problems) where an individual
afraid friends/family will perceive the person as being weak or deviant (Roth, 1981;
rich, 1980). Such stereotyping has been associated with mental health issues
unnally, 1961), where an employee may be perceived as pathological, uncooperative,
curable, untreatable, or has having some inherent character defect because of such
oblems (Mierkiewicz-Alleva, 1986);

(4) ﬁnancial problems, such as poor insurance benefits or limited coverage for some
.atments (Dickman & Emener, 1982; Straussner, 1986);

(5) perceived barriers regarding the EAP itself: limited EAP staff availability, lack
24-hour coverage, lack of attention on prevention (Straussner, 1986), failure to
wide services to meet all the person’s needs, lack of follow-up (Dickman & Emener,
l2; Straussner, 1986), lack of confidence in. the EAP staff (Hung, 1988), and luck of
appropriate relationship with community mental health, drug, and alcoholism

cies (Thoresen, 1978);

(6) lack of knowledge on how to contact the EAP;

(7) availability of other resources (Marino, 1985).

It is hypothesized that the combination of both support/pressure and barriers from
sonal" sources will have a direct inﬂuence on an individual’s decision to utilize EAP
ces. This new "combined" variable called "personal support/pressure/barriers" will

amined in the present study. In the Control Theory Model of EAP Utilization

Oped in the present research, it is predicted that this variable may inﬂuence an
idual’s seeking of EAP assistance regardless of whether the individual has actually

ived a discrepancy in his/her health between the desired and current health state.

 

 

 

 

 

136

or example, while an individual may not think he/she has a health problem, such as
hen an alcoholic denies such a problem, the person may still go to an EAP because
tis/her spouse encourages/pressures him/her to go. However, if the person also perceives
)0 many barriers to seeking assistance, then despite this spousal pressure, the person

aay still not seek assistance.

The hypothesis to be examined is:

 

Hypothesis ﬁ 6: An individual’s perception of the combination of support/pressure

and barriers from "personal" sources to seeking EAP assistance will have an effect
on the individual’s utilization of EAP services. Individuals who perceive high
levels of support or pressure to seek EAP assistance and few barriers will tend to

have contacted the EAP for assistance more than individuals who report low levels

of support or pressure and many barriers to seeking assistance.

irk-related Sources of Support/Pressure and Barriers

The second form of support and barriers which might influence an individual’s

ision to seek EAP assistance occurs at the workplace. Glasgow and Terborg (1988)
Syme (1986) indicate that organizational factors are likely to inﬂuence occupational
th interventions and outcomes. Individuals at the work place are a captive audience

workers, managers/supervisors, members of the labor union, and the organization

    
 

Four different types of support at the work site will be discussed: from coworkers,

diate manager/supervisor, unions, and the organization itself. Following this

ssion, work—related barriers to EAP utilization will be discussed. While work group

s (Coburn & POpe, 1974; Green, 1970; Kirscht, 1983) and management support

 

 

 

 

137

have frequently been cited as two key organizational factors inﬂuencing behavior (Beer,
1980; Everly & Feldman, 1984; Felix et al., 1985; French & Bell, 1984; Mayer, 1988),
empirical evidence regarding their inﬂuence on EAPs is minimal (Mayer, 1988).

The first potential source of work site support/pressure is an individual’s coworkers
>r work group. Gottlieb ( 1982) views coworkers as natural helpers at the workplace who
:an help an individual change a situation by providing assistance and information about
vailable services. Coworkers can also serve as inﬂuential mediators between the
'oubled employee and professional assistance and can either block or facilitate the path
> assistance. Work groups can provide rewards or sanctions in order to inﬂuence the
ealth behaviors of members.

Social group attitudes and norms are informal regulators of behavior that have been
und to be an important factor in understanding organizational behavior (Albrecht &
oldman, 1985; Blau & Scott, 1962; Burawoy, 1979; Goldman, 1983; Gouldner, 1954;
itz & Kahn, 1966). As discussed above, the health norms and values of members of

individual’s social group were hypothesized to inﬂuence the individual’s desired
lth goal. In this section, it is suggested that other individuals’ norms may also
uence health behaviors of employees. For example, work group norms have been
nd to inﬂuence both health benefit use and health-related absences from work
yer, 1988). Mayer (1988) found that employees’ perceptions of pro-health work
p norms were related to fewer absences for illness and injury and lower health

s/costs compared to work groups with adverse health norms. The ﬁndings,
ever, were inconclusive regarding the overall impact since Mayer (1988) concluded
work norms had no inﬂuence on health risk behaviors (smoking, etc.). Allen and

n (1986) examined negative health norms and found such norms can have a negative

 

 

 

138
impact on health behaviors and the reduction of health risks.

In the present study, work group attitudes toward seeking assistance will be
examined as one form of support or pressure generated to inﬂuence another’s health—
related behavior. Employees who are in a work group that does not support seeking
assistance and encourage good health behaviors and the use of the EAP may be
discouraged from using EAP services for fear of job loss, alienation or ridicule from
others.

A second potential source of work site inﬂuence on an individual’s behavior is the
immediate manager or supervisor. Management support has been recognized as an
important factor inﬂuencing work behaviors related to work site health promotion
programs (e.g., Everly & Feldman, 1984; Felix et al., 1985; Orlandi, 1986). It seems
logical that managers would also play a key role in inﬂuencing employees in seeking
EAP assistance. Past EAP research has identified management support as a critical
factor impacting on EAP effectiveness (Dickman & Emener, 1982; Greenwood, 1983;
hain & Groeneveld, 1980) and also on the number of supervisory referrals made to
EAPs (Myers & Myers, 1985; Roman, 1984).

A third potential source of work site support or pressure may come from the labor
mica/labor stewards. While supervisors and coworkers may have an impact on one’s
lecision to seek EAP assistance, for the utilization of EAP services to occur, the full
articipation and support of any organized labor group/union within the organization
required (Gordon, 1973; Trice & Roman, 1972). According to Trice and Roman:

An established fact of industrial relations is that management programs involving
employee welfare must have the full consent and cooperation of the labor union
pggther employee organizations if they are to be effective and durable (1972, p.

)p stewards as well as coworkers and supervisors are often able to identify fellow

 

 

———i

139

employees in trouble and to maintain a closer working relationship-thus, an employee
may be more open to advice from the union or peers compared to a supervisor.
Therefore, labor is in a good position to encourage an employee’s seeking of treatment,
and labor’s opposition would result in a reluctance on the part of employees to self—
'efer.

A last source of support or pressure at the workplace to be discussed comes from
he organization itself. This form of support encompasses the extent to which an
mployee perceives that the organization encourages or discourages the employee to
taintain his/her health and seek EAP treatment when needed. As previously
tentioned, human beings learn to participate in society through a process called
icialization, defined as "an interactional process whereby a person acquires a social
entity, learns appropriate role behavior, and in general conforms to expectations held
' members of the social systems to which he belongs or aspires to belong" (Loy &
gham, 1973, p. 258). Organizational socialization occurs at the work site to regulate
lployees’ behavior through a process whereby employees learn the organization’s
eptable norms (rules) of behavior. Mitchell and Hurley (1981) indicated that "an
ortant area for future research is how various social settings inﬂuence the
elopment of helping networks and supportive transactions” (p. 295). Some settings
promote or deter guidance and support.

An organization can develop social norms just as an employee’s work group does,
these also play a big part in human behavior in organizational settings.
nizational health norms differ from the work group health norms in that the
nizational health norms are a much broader concept and consist of an employee’s

ption regarding the organization’s general attitude toward health and toward the

 

 

i

140

EAP in particular. Work group norms are focused on a narrower field of perception in
that only the group of coworkers the employee regularly interacts and works with are
considered part of his/her work group.

Glasgow and Terborg (1988) and Syme (1986) state that it is very likely that
organizational factors affect work site health programs and their outcomes. Research has
suggested that organizational support is needed for the success of EAPs to occur
(Dickman & Emener, 1982; Greenwood, 1983; Shain & Groeneveld, 1980).
Organizational sponsorship and support of a program helps legitimize a project, provides
rewards, and helps to control worker behaviors, just as the withdrawal of this support
or sponsorship from a project causes the new work behaviors to decline (Crockett, 1977;

Frank & Hackman, 1975; Mayer, 1988; Miller, 1975). More employees are likely to use

 

EAP services when managers are given the support and authority they need to act in
their referral role, and when the program is given high visibility throughout the
organization with adequate training provided on implementation, use, and location
(Googins & Kurtz, 1981). Wrich (1978) claims that regardless of the work setting (e.g.,
'ndustrial, government, university), EAPs are established to help people with problems
nd the key ingredient is whether an environment is created that will encourage
oluntary referrals. Such an environment stresses trusting relationships, a nonpunitive
rogram policy, confidentiality, absence of labels to users, provides a choice of action
r those seeking assistance (Wrich, 1978), a climate of acceptance of trust, Open
mmunication, and a control system that optimizes individual freedom (Crookston,
75).
Mayer (1988) examined health promotion activities at the work site and proposed

at some organizations are more likely to develop strong norms to support health

 

 

 

141

ctivities while others may develop equally strong norms to discourage them. However,
e found that supportive organizational health norms had no relationship with
mployees’ health behaviors. The only empirical research found in the literature review
hich specifically examined EAP usage and organizational support was conducted by
ung (1988) who measured employees’ perceptions of their organization’s climate in
neral. Organizational climate may be defined as ”a set of measurable properties of the

ork environment, perceived directly or indirectly by the people who live and work in
is environment and assumed to influence their motivation and behavior" (Litwin &
ringer, 1968, p. 2). Hung did not examine employee perceptions regarding a specific
ganizational "health " climate or norm; rather, a "general" climate measure was utilized
(1 climate was then dichotomized as being either "warm" or "cool”. What is
:eresting about this research is that Hung (1988) found that EAP use was not
niﬁcantly related to employees’ climate perceptions, although many employees
nmented on the lack of their company’s concern for its employees as a barrier to
.P usage.

The research by Mayer (1988) and Hung (1988) contradicts the traditional assertion
organizational support is essential in inﬂuencing employee behaviors. However,
e Hung (1988) concluded the perception of a warm or cool organizational climate
no inﬂuence on actual EAP usage, Hung did conclude that organizational climate

eptions had an inﬂuence on responses by both EAP users and non-users regarding

 

future willingness to use an EAP--with those perceiving a warmer climate being
willing to use the EAP in the future if needed. Organizational climate also
need perceptions of whether using the EAP would hurt one’s career where

oyees perceiving a warmer organizational climate strongly disagreed that using the

 

 

 

 

142
AP would hurt their careers (Hung, 1988).

While support and pressure from work-related sources might inﬂuence an
dividual’s decision to seek assistance at an EAP, there may also be a number of
lfl'leS or obstacles that can be classiﬁed as ”work—related” that can deter an individual
)m seeking EAP assistance. Some of these barriers have been identified by EAP
perts and include:

(1) a stigma associated with seeking assistance where an employee may be labeled
weak or deviant by his/her peers if they find out the employee sought help or the
,ployee fears that using the EAP would be held against them-—e.g., future promotions,
. (Nunnally, 1961; Roth, 1981; Wrich, 1980);

(2) perceived lack of confidentiality--which remains a primary concern of both
ployees and EAP providers (Dickman & Emener, 1982; Lovenheim, 1979; Marino,
5; Pardue, 1987);

(3) lack of support by all organizational levels—veg, supervisors, unions, t0p
agement (Beyer & Trice, 1978);

(4) inaccessibility to entire workforce or to dependents (Straussner, 1986);

(5) failure to provide services to meet all the needs of employees (Dickman &
ner, 1982; Straussner, 1986);

(6) lack of union support or labor—steward training (Dickman & Emener, 1982);
(7) inadequate communication to all employees regarding the EAP--the existence,
tives, functions, and services (Greenwood, 1983; Shain & Groeneveld, 1980);

8) belief that problems should be resolved outside the workplace by the employees
elves (Marino, 1985).

f particular interest in the present research is the inﬂuence that work-related

 

 

 

————i

143

sources might have on an employee’s utilization of an EAP. It is postulated that

 

employees’ perceptions regarding the concern for their health from managers,
coworkers, labor unions, and the organization and the support/pressure received to seek
assistance is important in inﬂuencing employee behavior. In addition, the perceived
barriers within the workplace are also predicted to inﬂuence an employee’s decision to
seek assistance. It is hypothesized that the combination of both support/pressure and
barriers from ”work” sources will have a direct inﬂuence on an individual’s decision to
utilize EAP services. This new ”combined” variable called “work
support/pressure/barriers” will be examined in the present study. It is hypothesized that

this variable may inﬂuence an individual’s seeking of EAP assistance regardless of

 

whether the individual has actually perceived a discrepancy in his/her health between

the desired and current health state.

 

The hypothesis to be examined is:

Hypothesis #7: An individual’s perception of the combination of
support/pressure and barriers from "work" sources to seeking EAP assistance will
have an effect on the individual’s utilization of EAP services. Individuals who
perceive high levels of support or pressure at work to seek EAP assistance and few
barriers will tend to have contacted the EAP for assistance more compared with
individuals who report low levels of support or pressure and many barriers to

seeking assistance.

   
  

Human behavior is very complex and control theory is one theoretical framework

at has been applied to help us better understand behavior. Control theory has been

 

 

 

144

used in research in a variety of disciplines, such as engineering, applied mathematics,
economics, organizational behavior, clinical and health psychology, etc. This chapter
began with an overview of control theory which emphasizes goals, feedback (current
state), and goal-feedback discrepancies as key inﬂuences on an individual’s behavior.
Various models based on a control theory perspective were presented along with a
escription of the basic control theory components (Campion & Lord, 1982; Carver &
Scheier, 1982; Klein, 1989; Miller, Galanter & Pribram, 1960).

The present research is focused on a specific health behavior (EAP usage) and
:xamples of how control theory has been applied to the field of health were discussed.
‘he physical and social environments in which an individual lives have profound effects
n the individual’s concepts and attitudes toward health and illness. Health behavior
: inﬂuenced by several interrelated variables including cultural, social, psychological
1d organizational determinants. Identifying and understanding the underlying causes
’ health behavior should help us develop and implement more effective health
ograms.

A Control Theory Model of EAP Utilization deveIOped for the present research

3 then discussed (see Figure 9) along with the hypotheses to be tested. The basic
ponents of the model were presented as they relate to the present research on EAP
ization: the goal/standard, sensor function, comparator mechanism, and the
avior/effector. The overall goal or standard of interest in the present study is an
ividual’s health goal and it was hypothesized that three variables would inﬂuence an
ividual’s desired health goal level: health history, Health Locus of Control, and social
p health values/norms. Two variables were also hypothesized to have a moderator

ence on EAP utilization: Health Locus of Control (with three subscales) and

 

 

 

 

 

 

145

expectancy of goal attainment. Finally, personal and work sources of support/pressure
and barriers were hypothesized to directly inﬂuence seeking EAP assistance. The next

chapter will outline the method to be used to test the hypotheses presented in this

chapter.

 

 

IIIIIIll.-------—————____ﬁ

CHAPTER 4

METHODOLOGY

This chapter describes the data and methods used to examine factors inﬂuencing
employees’ decision to utilize or not utilize EAP services. The variables to be studied

have been conceptualized based on a control theory framework (refer to Figure 9).

Power Analysis

A power analysis was conducted to determine the sample size required in order to
acquire an adequate level of power to detect significant effects. The hypotheses
presented in the preceding chapter were tested primarily with regression analysis. The

statistic of interest is the standardized regression coefficient.

 

Assuming that the standardized regression coefficient for the moderator explains

 

at least a small effect (R2=.10, Cohen & Cohen, 1983), it was determined that 137
individuals would provide a power of .80 at an alpha level of .05 based on seven

independent variables (determined using the section of the model to be tested that

 

includes the greatest number of independent variables). Barker (1987) notes that the

 

usual rate of return by university employees for mail surveys is approximately 30
percent. Therefore, to account for a 30% return rate, questionnaires had to be mailed
to at least 457 employees.

In the present study, participants were categorized into two groupsr-those who had
used an EAP and those who had not. In addition, analyses of employees in the group
that had not used an EAP were to be conducted only on those who might be classiﬁed

as ”needing" some form of EAP service (if individuals have no health problems, there

‘1 46

 

77

147

would be no reason for them to seek any assistance and, therefore, they should not be
included in the analyses comparing individuals who use/do not use an EAP despite
having similar problems). It has been estimated that up to 30% of an employer’s
workforce has serious personal problems (Cahill, 1983; Egdahl & Walsh, 19890; Weiner
et al., 1973; Wrich, 1980b). To ensure this 30% was included in the analyses, it was
determined that the non-user group would be divided in half based on the level of
current problems being experienced. Utilizing 50% of the group in the analyses (those
with more problems) was viewed as a conservative approach (i.e., if only 30% potentially
require EAP services and significant results are obtained by including an additional 20%
that may not require assistance, then more confidence might be placed in the findings).

To ensure an adequate number of surveys would be returned by employees who had

 

used and not used an EAP, the following number of questionnaires were mailed to

 

employees: 300 to EAP users and 600 to non-EAP users (to account for the fact that

only half of those returned from non-EAP users would be utilized in the analyses).

Research Site

 

 

Michigan State University (MSU) was the data collection site selected. This
research site was chosen for several reasons. First, the characteristics of the university’s
labor force made it ideal to examine participation/non-participation in an EAP, since
there was a large proportion of full-time employees, a large number of males and
females, and a variety of occupational levels that included clerical, maintenance, and
supervisory employees. Second, a positive response for conducting the research was
received from university personnel, particularly from the EAP staff, who indicated the

present area of research had not been studied extensively in the past. Third, the

 

 

——'—

148

accessibility of the EAP to the majority of employees minimized the constraints of time,
distance, and cost. Fourth, the use of a single research site provided a means of
controlling for the potentially confounding effects of organizational and logistical
differences extraneous to the research.

Finally, there has been a great deal of concern about the plight of the troubled
employee in the post-secondary educational setting. The primary resources in higher
education are human resources. Researchers have suggested there is an urgent need for
colleges and universities to implement the EAP concept and provide services for the
recognition, treatment, and rehabilitation of employees whose behavior affects their work
performance (Trice, 1980; Trice & Roman, 1972; Von Wiegand, 1974). Post-secondary

educational institutions rely on the quality and well—being of the staff, who are subject

 

to the same personal and work problems that employees working in other business and

 

industrial settings face. While industrial organizations have been dealingwith the mental
and emotional health of employees for almost a century, the programs are relatively new

in higher education. Due to the labor intensity within a university setting and the need

 

to maintain healthy human resources, programs have been implemented in institutions

 

of higher education and today there are approximately 300 university-based EAPs.
Wrich (1978) suggests that the impact of programs established by universities is much
greater on the community at large than all the money the federal government could
Spend promoting such programs on its own. University programs not only help the
employees directly involved in their usage but the community as a whole due to the
inter-relatedness and interdependence of us all.

Michigan State University established an internal (on-site) employee assistance

program as a beneﬁt available at no cost to employees and their immediate family

 

 

 

 

149

members to assist them with personal problems or difficulties that could negatively affect
job performance in order to help "employees resolve their difficulties and return to a
more satisfactory work and personal life“ (Employee Assistance Program Services, 1990).
Like most EAPs, the MSU program had its beginnings in a substance abuse program
developed in the 1970’s which included such services as confidential professional
consultation, referral, and follow-up care. By the late 1970’s, the program was expanded
to encompass a broad range of personal problems, such as personal, medical,
psychological, work-related, substance-abuse, and financial and legal problems (though
individuals may be referred to other resources depending on the type and severity of the
problem). In 1985 the EAP became a division of the Department of Human Relations
and the program was expanded to include prevention and educational services along
with its existing assessment, consultation, and referral services. The university’s internal
EAP is a broad-brush model located in a building on the university’s campus which is
easily accessible to employees. Initial consultations/interviews were scheduled with an
EAP counselor at a convenient time for the employee and information revealed by an
employee through consultation with the EAP staff does not become a part of the

individual’s employment record.

Sample

The final sample consisted of full-time employees of Michigan State University who
had the availability of the EAP as part of their benefits package and who had equal
accessibility to EAP services (i.e., employees were located on campus). In order to
obtain an adequate sample of employees who had utilized the EAP and to be able to

Compare these employees with similar employees who had not utilized the EAP, EAP

 

 

———f

150

utilization was examined by union groups at the university and employees who were
members of the unions with the highest EAP utilization rates were selected. It is argued
that if union/employee groups were selected whose utilization was extremely low, then
there would not be enough variance in the dependent variable (EAP usage) to
adequately examine differences between EAP users and non—users. Following are the
union/employee groups selected along with their respective EAP utilization rate for the
fiscal year from July 1, 1989 to June 30, 1990: the Administrative Professional
Association (APA) and Administrative—Professional Supervisors’ Association (APSA)
unions with a combined utilization rate of 10.3%; the Clerical—Technical (CT) union with
a 12% utilization rate; the American Federation of State, County, and Municipal

Employees (AFSCME) Local 1585 with a 4.6% utilization rate; and the AFSCME Local

 

999 with a 14.5% utilization rate.

 

A list of university employees who were classified as being members of the selected
union/employee groups was obtained from the university. The employees were then
classiﬁed as being EAP users or non—EAP users based on data provided by staff from the
university’s EAP. A total of 900 employees were then randomly selected from within
these two groups as follows: 100 EAP users and 200 non-EAP users from the
APA/APSA group, 100 EAP users and 200 non-users from the CT group, and 100 EAP
users and 200 non-users from a combination of both AF SCME (999 and 1585) locals.

Questionnaires were returned from 426 employees for an overall return rate of
47%, or 59% for EAP users and 42% for non-EAP users. Of these 426 questionnaires,
reSponses from 406employees were examined (12 surveys were returned late and 8 were
incomplete). Of the 406 surveys examined, there were 168 EAP users and 238 non-EAP

users. The non-user group was then divided approximately in half based on the median

 

 

 

 

151

level of current problems (where 131 were classified as employees with the lowest level
of current health problems and 107 were classiﬁed as having the highest level of current
health problems). The ﬁnal sample included in the analyses consisted of 168 EAP users
and the 107 non-EAP users with the highest level of current health problems, for a total
of 275 employees.

General characteristics of the final sample are provided in Tables 2 and 3.
Frequencies were run on all demographic variables, and Table 4 displays the total
number and percentage of individuals possessing each characteristic by EAP usage/non-
usage. Crosstabulation analyses were also conducted to examine the respondents’
characteristics in more detail. This procedure provides information about the
relationships between variables-i.e., about their independence. A Pearson chi-square
statistic is obtained to test the hypothesis that the variables are independent. 1f the
statistic is small enough (e.g., < .10) then the hypothesis that the two variables are
independent is rejected. In the final sample, there was a significant disparity between
the job position held and gender where females tended to hold primarily clerical
positions while males were more distributed among four of the other positions--
maintenance, skilled, professional, and managerial (p < .01). No significant differences
were found in the sample when examining race and gender, marital status and gender,
job position and race, job position and marital status, and marital status and race.
Crosstabulation analyses were also calculated to compare EAP usage/non-usage on the
various demographic factors. In this sample, there was no significant difference between
EAP users and non-users on race, education, job position, age, and tenure with the

organization.

 

 

 

152

Table 2: Descriptive Statistics of Sample

 

Variable Code N* Percent Mean Median ,§Q_
Gender 1.74 2.00 .44
Male 1 71 25.8
Female 2 204 74.2
Race 1.18 1.00 .68
White 1 250 90.9
Black 2 9 3.3
Hispanic 3 4 1.5
American Indian 4 5 1.8
Asian -5 4 1.5
Other 6 2 .7
Missing Value 1 .4

 

Education 4.04 4.00 1.27
Some High School 1 3 1.1
High School 2 45 16.4
Trade School 3 26 9.5
Some College 4 101 36.7
Undergraduate 5 63 22.9
Graduate 6 36 13.1
Missing Value 1 .4
l
l
Job Position 3.51 3.00 1.51 i
Maintenance 1 31 11.3
Skilled 2 23 8.4
Clerical 3 114 41.5
Technical 4 19 6.9
Professional 5 47 17.1
Manager 6 37 13.5
Other 7 3 1.1
Missing Value 1 .4
Marital Status 3-74 3-00 1.24
Single w/o children 1 72 26.2
Single w/children 2 40 14.5
Married w/o chldren 3 52 18.9
Married w/children 4 111 40.4

 

* Total N=275

 

 

 

153
Table 2 (cont'd)

Descriptive Statistics of Sample

 

 

Variable Code N* Percent Mean Median §Q_
Family Income 4.51 4.00 1.65
Less than 310.000 1 1 .4
~310,000 — 319.999 2 22 8.0
‘520,000 — $29,999 3 74 26.9
330,000 - $39,999 4 55 20.0
$40,000 - $49,999 5 36 13.1
350.000 - $59,999 6 32 11.6
$60,000 Or More 7 53 19.3
Missing Value 2 .7
Age 4.49 5.00 1.96
Under 25 1 9 3.3
26 — 30 2 45 16.4
31 - 35 3 42 15.3
36 _ 4O 4 41 l .9
41 - 45 5 52 18.9
46 — 50 6 43 15.6
51 - 55 7 22 8.0
56 ~ 60 8 15 5.5
Over 60 9 6 2.2
Tenure At Organization 4.13 5 00 1 11 f
Less than 1 year 1 4 1.5 l
1 to < 3 years 2 30 10.9
3 to < 5 years 3 38 13.8
5 to < 3 years 4 55 20.0
8 Or More Years 5 148 53.8

* Total N=275

 

 

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Table 4: Frequencies of Demographic Variables by EAP Usage/Non-usage

 

Total Non—EAP Usage EAP Usage

Variable N N x N %
Gender
Male 71 37 .52 34 .48
Female 204 70 .34 134 .66
Race
White 250 96 .38 154 .62
Black 9 6 .67 3 .33
Hispanic 4 O O 4 1.00
American Indian 5 2 .40 3 .60
Asian - 4 2 .50 2 .50
Other 3 1 .33 2 .67
Education
Some High School 3 3 1.00 O 0
High School 45 15 .33 3O .67
Trade School 26 13 .50 13 .50
Some College 101 37 .37 64 .63
Undergraduate 63 25 .40 38 .60
Graduate 36 13 .36 ' 23 .64
Missing Value 1 1 1.00
Job Position
Maintenance 31 18 .58 13 .42
Skilled 23 11 .48 12 .52
Clerical 114 38 .33 76 .67
Technical 19 8 .42 11 .58
Professional 47 20 .43 27 .57
Manager 37 11 .30 26 .70
Missing Value 4 1 25 3 75
Marital Status
Single w/o children 72 28 .39 44 .61
Single w/children 4O 8 .20 32 -80
Married w/o children 52 23 .44 29 .56

Married w/children 111 48 .43 63 .57

 

158

Table 4 (cont'd)

Frequencies of Demographic Variables by EAP Usage/Non—usage

 

Total Non~EAP Usage EAP Usage
Variable N N s N %

Family Income

 

 

 

Less than $10,000 1 1 1.00 O 0
$10,000 - $19,999 22 6 .27 16 .73
$20,000 - $29,999 74 27 .36 47 .64
$30,000 - $39,999 55 18 .33 37 .67
$40,000 ~ $49,999 36 19 .53 17 .47
$50,000 - $59,999 ~ 32 20 .63 12 .37
$60,000 Or More 53 16 .30 37 .70
Missing 2 2 1.00
Age
Under 25 9 4 .44 5 .56
26 — 30 45 14 .31 31 .69
31 - 35 42 18 .43 24 .57
36 - 4O 41 15 .37 26 .63
41 ~ 45 52 2O .38 32 .62
46 ~ 50 43 15 .35 28 .65
51 - 55 22 9 .41 13 .59
56 — 6O 15 7 .47 8 .53
Over 60 6 5 .83 1 .17
Tenure At Organization
Less than 1 year 4 2 .50 2 .50
1 to < 3 years 30 13 .43 17 .57
3 to < 5 years 38 12 .32 26 .68
5 to < 8 years 55 20 .36 35 .64

8 Or More Years 148 60 .41 88 .59

 

 

 

 

159

Human Rights

To insure protection of employees’ rights, approval for this study was obtained from
the Human Subjects Committee of MSU. A letter identifying the purpose of the study
was included with the questionnaire to employees for their approval. Employees were
informed they would derive no beneﬁts nor incur any risks from the study and complete

confidentiality was guaranteed.

Study Design/Procedures

The research explored a self-motivated health behavior-EAP utilization--and was
conducted in a natural setting using a cross-sectional, nonexperimental research design
since no variable is manipulated and the individuals could not be randomly assigned to
the EAP usage or non—usage group. Regarding the value of nonexperimental research
designs, Abdellah and Levine (1979) stated:

An important value of nonexperimental research is the broader scope that such

studies can have, since it is less costly to use large samples of study subjects than

in experiments. Therefore, more independent variables can be studied, with
perhaps a greater depth of analysis possible than in an experimental approach to
the same problem. Moreover, the artificiality of the experimental situation is
eliminated, thereby providing findings that can have more relevant application to

the real world (pp. 237-238).

The research involved the collection of data by means of a survey mailed to the
employee sample described earlier. It was mailed during the Spring 1992 academic term.
The questionnaire packets contained: (1) a cover letter explaining the project and use
of the data; (2) an informed consent form; (3) an explanation of the voluntary nature of

participation and a statement informing participants that they could decline to answer

any or all questions; (4) the questionnaire; (5) a letter (A or B) on the cover of the

survey used to identify the respondent as a member of the EAP user group (A) or the

 

 

*7

160

non—user group (B); (6) assurance of confidentiality and an explanation that results
would not be included in any personnel record or provided to the university for any
reason; (7) an offer to pay respondents $5.00 upon return of the questionnaire; and (8)
a stamped, addressed return envelope for direct mailing of responses to the researcher

via U.S. Mail.

Pilot Tests

Three pilot tests were conducted. The first pilot study was conducted to determine
the potential for obtaining enough employees who would volunteer to participate in a
research project examining their health and health—related behaviors. Seventy employees

were randomly selected from the university’s staff phone book and mailed a letter in

 

 

August 1990 describing the proposed research and asking whether they would be
willing/unwilling to participate in such research if they were randomly selected.
Responses were obtained from 40% (n==28) of the original letters mailed. Of those
returned, 75% (n =21) of the employees stated they would be willing to participate, 18%
(n =5) stated they would be unwilling to participate, and 7% (n =2) were returned with
responses that the employee was no longer employed at the university.

A second pilot study was conducted to determine whether employees who had
actually utilized the EAP would be willing to participate in the research to see how
willing they would be to admit to EAP usage and to respond to questions about their
health. A letter describing the proposed research and requesting their response to
whether they would be willing to participate was given to all employees who came to the
EAP ofﬁces for assistance during a one-week period in September 1990. Because this

week happened to be the first week of the Fall academic term at the university, which

 

 

———i

161

traditionally is a low EAP—usage week, and because there was only one EAP counselor
working during that week due to recent turnover, only six letters were distributed to
clients and returned to the researcher. However, all six employees responded positively,
thus 100% stated they were willing to participate in the research if randomly selected in
the future. Based on these ﬁrst two pilot tests, approval was given by the dissertation
committee to continue the research project.

A third pilot study was conducted to test the format, factor structure, and reliability
of the survey instrument prior to administering it to the ﬁnal sample. There were 145
college students from management courses who volunteered for this pilot study in
exchange for research credit provided by their instructor toward their course grade. The
questionnaire tested in this pilot study included items for all measures except for those

included in the support/pressure/barriers scales (discussed below). Participants attended

 

two sessions approximately two weeks apart during which they completed the same

 

survey in order to examine the stability (Cronbach alpha or test-retest reliability) of the

 

measures. Most of the items and scales included in the final questionnaire were those
found to have a reliability of .70 or higher from this pilot test. These items and scales
will be discussed below in the "Measures” Section.

A fourth pilot test was conducted to examine the items developed for the perceived
support/barriers/pressures scales (personal and work-related items). It was felt that
actual employees would be the appropriate sample to test these items on. MSU
employees were randomly selected from among the three employee groupings utilized
in this study. Three-hundred questionnaires were mailed along with a cover letter to the
following employees: 100 to employees who were members of the APA and APSA

unions (50 employees in each union), 100 to employees who were members of the CT

 

 

 

—7—

162

union, and 100 to employees who were members of the 999 and 1585 AFSCME unions
(50 employees in each). The overall return rate was 39% (n=118 with 115 fully
completed surveys returned). Items included in the final survey are reported in the

following section regarding the Support/Pressure/Barriers scales.

Measures

This section describes the measures used to operationalize the variables in the
study. The independent variables are: health history, Health Locus of Control (3
subscales), social group health values/norms, general health goal, self-focus, current
health status, perceived discrepancy between the individual’s health goal and health
status, expectancy of goal attainment, and personal and work-related
support/pressure/barriers to using the EAP. The dependent variable is a measure of

whether the employee has used or not used EAP services. All measures are included

 

in Appendix B. Each variable will be discussed based on results from the pilot studies

 

conducted above and from the analyses conducted on the surveys returned from the ﬁnal

 

 

sample (i.e., 168 EAP users and 107 non-EAP users). Descriptive statistics of the
variables discussed below are provided in Table 5.

Health History. A series of questions regarding an individual’s past health were
develOped for purposes of the present research. The following areas of health were
focused on: general physical health, head, cardiovascular/respiratory,
eyes/ears/nose/throat/mouth, and miscellaneous. Of the 72 questions included in the
pilot study, the most reliable items (test-retest reliabilities ranging from .70 to .94) most
representative of the above health areas were included in the final survey (see Part III

of the survey in Appendix B). Test-retest reliability was calculated and used to

 

 

163

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determine the items to include because it was not expected that the items included in
health history measure were similar enough to utilize Cronbach alpha reliability-—i.e., just
because an employee may have high blood pressure does not necessarily indicate the
employee also has cancer, diabetes, liver disease, allergies, etc. However, in the ﬁnal
study, Cronbach alpha reliability was calculated based on the responses from actual
employees (this was low at .62).

Employees responded either yes/no to 14 health problems presented in the survey
and also responded to an open-ended question where they were asked to identify the
number of additional health problems they had experienced that were not included in
the survey. An overall health history score was obtained for each individual by adding

up the number of "yes” responses along with the number of additional problems

 

 

identiﬁed in question 15. Scores ranged from 0 to 15.

Health Locus of Control. Rotter (1966) devised one of the first instruments to
measure locus of control. This I—E scale consisted of 29 forced-choice items which has
received extensive validation (Herring, 1987; Rotter, 1975). To better apply this concept
to the ﬁeld of health, Wallston, Wallston, Kaplan, and Maides (1976) developed a
unidimensional Health Locus of Control (HLC) scale to measure the degree to which
people believe their health is determined by their behavior and is under their control
(i.e., is internal or external). The [-1 LC scale was composed of 11 items. Individuals with
high HLC scores were "health-externals" who perceived factors such as luck, fate,
chance, or powerful others determined their health. Low scorers were labeled "health—
internals” for those who believed one became healthy or sick as a result of one’s own
behavior. The HLC was based on Rotter’s (1966) I-E Locus of Control Scale but used

a Likert-type scale response format (rather than a forced-choice format) and was found

 

 

—’7

165

to correlate .33 with the I-E Scale (Wallston et al., 1976).

Wallston, Wallston and DeVellis (1978) employed the HLC scale on other samples
and found that the original alpha reliability of .72 decreased to somewhere in the range
of .40 to .54. The dimensionality of the scale was then re-examined and, based on the
work of Levenson (1974), the scale was modified when it was found that some health-
externals believed fate or chance was responsible for their health while other health-
externals saw powerful others (e.g., health care professionals) were responsible for their
health (Levenson, 1974). Therefore, three new scales were constructed: internal,
powerful others, and chance. Wallston, Wallston, and DeVellis (1978) further developed
and tested this more specific tool, which they referred to as the Multidimensional Health
Locus of Control (MHLC), with the idea that: ”by assessing more than one dimension
of Health Locus of Control, the probability of increasing understanding and prediction

of health behaviors could be increased“ (p. 167). The three sub-scales were referred to

 

 

as the Internal Health Locus of Control (IHLC) Scale, the Powerful Others Health Locus

 

of Control (PHLC) Scale, and the Chance Health Locus of Control (CHLC) Scale, where l
the last two are dimensions of externality. All three subscales were used in this study.
Internal Health Loeus of Control (IHLC) is the perception that the reinforcement for
participation in the EAP is contingent upon the individual’s own behavior. Mu;
Others Health Loeus of Control (PHLC) is the perception that reinforcement for
participation in the EAP is under the control of powerful others. gimme
of Cpntrol (CHLC) is the perception that reinforcement for participation in the EAP is
a result of chance.
Form A of the MH LC scale was selected for this study which contained a total of

18 statements (six from each of the three dimensions). Internal consistency values, or

 

 

 

166

alphas, which were reported by Wallston, Wallston, and DeVellis (1978) for the IHLC,
PHLC, and CHLC scales were .77, .67, and .75 respectively. Wallston and Wallston
(1981) reported test-retest reliabilities (over a four- to six-month period) for the three
scales as .66, .71, and .73 respectively. Results of the third pilot test indicated reliability
was lower than Wallston and Wallston (1981) reported on two of the scales: IHLC .78,
PHLC .67, CHLC .66. The MHLC scales are intended for use with adults with at least
an eighth grade reading level and no functional impairment (Malen, 1982). Each scale
consists of six items which utilize a six- point Likert-type scale that ranges from "strongly
agree“ (1) to "strongly disagree” (6), with no neutral midpoint so respondents were
forced to make a decision: This was done to eliminate the inability of a person to make
a decision as a variable in scale development. The scores on each scale can range from
6 to 36. The higher the score for each dimension (36 being the highest obtainable for
any dimension), the more indicative of that particular locus of control inﬂuence. Total
IHLC, CHLC, PHLC scores were calculated for all individuals by adding up scores from
the six items in each scale.

The MHLC scales can be found in Part I of Appendix B (Form A). Questions
included in the IHLC subscale are 1, 6, 8, 12, 13, 17; questions included in the PHLC
subscale are 3, 5, 7, 10, 14, 18; questions included in the CHLC subscale are 2, 4, 9, 11,
15, 16. Reliability for the three subscales based on the final sample (IHLC .64, PHLC
.58, CHLC .67) was found to be lower than that calculated from the pilot test results.
Other descriptive statistics on the three scales are provided in Table 4.

Social Group Health Values/Norms. This scale measures employees’ perceptions
of the health values and norms (past and present) of members of their social group

(parents, friends, spouse, coworkers, etc.). This scale examines the following areas:

 

 

 

 

167

general health norms, physical health, mental health, nutrition and. fitness,
lifestyle/habits, and current inﬂuence. Of the 34 items pilot-tested, 17 were included in
the ﬁnal measure (see Part V, Appendix B) based on test-retest reliabilities calculated
on items in the third pilot study (reliabilities of the 17 items ranged from .70 to .75).
Cronbach alpha reliability calculated on the ﬁnal survey responses was .79. Responses
to each question were scored so that the more positive the response, the higher the score
assigned to that response. For example, if a question had five responses to choose from
and the ﬁrst one, or "a", was the most positive regarding health inﬂuence, then this
response was assigned a score of ”5" while the least positive response, or ”e", was
assigned a score of "1". Item responses were then summed to obtain a ﬁnal score. The
higher the score, the more positive the individual perceived the health value/norms of
his/her social group. Scores ranged from 24 to 57, with a mean of 41.68.

Desired Health Goal Level. An individual’s desired health goal level refers to the
desired level of health aspired to. As stated in the previous chapter, it seems reasonable
that most individuals will maintain a general goal or desire to be healthy. Thus, in order
to measure the degree individuals vary in their desired health goal, it was felt that it
would take more than just asking employees ”Do you desire good health?“ because of
the demand characteristics present. Therefore, employees were asked about their desires
and aspirations regarding specific aspects of their health (e.g., weight, nutrition, smoking,
sleep, stress level, etc.). Of the 17 items included in the pilot test, 12 were included in
the final measure (see Part VI, Appendix B) based on test-retest reliabilities (which
ranged from .65 to .81). Test-retest reliability was used to examine items in this scale
because it was not expected that the items would be internally consistent-~i.e., just

because an individual desires to not smoke or drink alcoholic beverages does not mean

 

 

 

 

 

 

 

 

 

168

the individual also desires to regularly exercise or refrain from eating unhealthy snack
foods. (Cronbach alpha reliability was calculated on the final survey responses, and it
was .38). Individuals’ scores ranged from 25-55 (see Table 4). Responses to each
question were scored so that the more positive the response, the higher the score
assigned to that response. Item scores were then summed to obtain an overall Desired
Health Goal Level score where the higher the person’s score, the greater the health goal
level desired.

Current Health Status. Health. status refers to the physical and mental well—being
of employees (Levey & Loomba, 1984). Health status was operationalized with a series
of questions focusing on the following areas of health: physical, mental/emotional,
nutrition and fitness, lifestyle/habits, and general. Employees were asked to measure
their current health on several items using a Likert—type scale ranging from ”Very Poor"
(1) to ”Excellent" (5). Of the 71 items pilot-tested, 37 were included in the ﬁnal
questionnaire (see Part VII, Appendix B). Cronbach alpha reliability calculated on the
final responses was .97. Employees’ responses to the items were summed to obtain an
overall Current Health Status score. The lower the number, the more health problems
perceived by the individuals. Scores ranged. from 76-185 (for EAP users and non—users
in the ﬁnal sample). Other descriptive data are shown in Table 4.

This variable was used to determine initially which of the non—EAP using
employees were to be included in the analyses. The group of non-users who responded
(total n =238) were divided based on their overall Current Health Status score (refer to
the ”Power Analysis" section above for an explanation). While the intent was to divide
the group based on the median score (median = 153), upon examination of the data a

more natural dividing point in the sample was indicated at a score of 162. Therefore,

 

 

 

 

 

 

 

 

 

 

169

all employees whose score was less than 162 were included in the ﬁnal non-EAP usage
group (n==107) while the remaining employees whose health was perceived as better
were not included in any additional analyses (n =131).

Health Goal—Health Status Discrepancy. In a control theory model, it is predicted
that an individual is motivated to act based on the existence of a discrepancy between
his/her goal and his/her current status regarding that goal. In the present research, the
discrepancy of interest was the perceived discrepancy between a person’s desired health
goal level and current health status. Unfortunately, the variables in the current EAP
control theory model are not quantifiable as they often are in other control theory
studies so calculating a discrepancy cannot be calculated in an objective manner. (For
example, in a quantifiable measure, if one’s production goal is 20 pieces per hour and
the current rate is 15, then there is a discrepancy of 5.) Two measures were developed
to examine the existence of a discrepancy for use in the present research.

The first measure developed was used for the ”perceived discrepancy" variable
identified in Figure 11 in order to test this aspect of the model. For each of the items
included in the Current HealthStatus measure, employees were asked to identify the
change in their health which they desired on each of the items using a ﬁve-point scale
ranging from ”No Change Desired” (1) to a “Very Large Change Desired” (5) (see Part
VII, Appendix B). An employee’s discrepancy score was calculated by summing the item
responses. The higher the score, the more an employee perceived a discrepancy between
his/her current and desired health. Scores ranged from 27 to 188 with a mean of 74.59
(see Table 4). Cronbach alpha reliability of the final survey responses was .97.

The second discrepancy measure was calculated by standardizing the scores on the

Desired Health Goal Level measure and the Current Health Status measure to examine

 

 

 

 

 

 

 

170

whether each participant’s score on each variable fell within the same percentile (e.g.,
upper 25th, 51-75th, 26-50th, or lower 25th on both measures). If both scores for an
individual did not fall within the same percentile, a discrepancy existed. For example,
if a person’s Desired Health Goal score was within the upper 25th percentile (high
health goal level), a discrepancy between the desired and current health existed if the
person’s Current Health Status score did not also lie in the upper 25th percentile.
Quartile cut-off scores for the Desired Health Goal Level measure were under 41, 43,
46, and over 46 and cut-off scores for the Current Health Status scale were under 138,
152, 160, and over 160. Based on the quartile scores, individuals were classiﬁed as either
having a discrepancy or not. This discrepancy measure was used as a method check to
examine whether the model and the relationships hypothesized existed by correlating it
with the ”perceived discrepancy" measure calculated above using the responses on the
”Desired Change" scale in order to examine whether the control theory framework
might be useful in guiding this type of research.

Expeetaney of Goa] Attainment. Perceptions have been the basis of most research
on health-protective behaviors, with particular emphasis on beliefs (Ultsch, 1983).
Expectancy in the present research refers to the perception or belief an individual has
that utilizing the EAP will help attain his/her desired health goaI--i.e., eliminate the
perceived discrepancy between desired and current health.

In the present research, expectancy was measured by asking participants whether
they perceived going to an EAP would help resolve the speciﬁc health problems they
were experiencing, as identified in their Current Health Status survey. Individuals
responded to each item based on a scale ranging from "Very Poor/EAP Would Be of No

Help” (1) to “Excellent/EAP Would Help a Lot" (5). An individual’s scores on all items

 

 

 

 

 

 

 

171

were summed to obtain an overall Expectancy score. Scores ranged from 1 to 172 with
a mean of approximately 94 (see Table 4). Cronbach reliability based on responses from
the ﬁnal survey was .98.

WW. Two scales were created to measure
perceived support/pressure/barriers to using the EAP--a scale representing items from
sources or barriers perceived in one’s personal life (parents, friends, other relatives, self)
and from sources or barriers perceived in one’s work life (supervisor, coworkers, union,
the organization). The questions in these scales addressed participants’ perceptions
regarding others’ encouragement of, discouragement of, and involvement in EAP
participation along with various pressures or barriers which may inﬂuence the use of
EAP services. A high score on either scale indicates that a high level of support and few
barriers were perceived from the particular source (personal or work).

The Personal Support/Pressure/Barriers scale was developed based on the fourth
pilot test discussed above that was conducted using 115 MSU employees (note that pilot-
study participants were not included in the ﬁnal sample). This pilot test was conducted
in order to develOp weights in analyzing the ﬁnal survey data for each source of support
or pressure or barrier category. Actual employees were used in the pilot study because
it was felt that their responses to perceived support and barriers would have greater
external validity for determining the items best to include in the final survey to be
mailed to other ”similar" employees. A number of support and barrier items were
included in the pilot test. In order to determine which items may be perceived as more
important in inﬂuencing EAP behavior, weights were calculated based on responses from
the pilot which were then used to calculate scores for the personal support/pressure and

barriers scales for employees in the final study.

 

 

 

 

 

 

—”f

172

To calculate these weights, pilot study participants were asked to respond to 24
statements regarding perceived support, encouragement, discouragement and barriers
from sources in their personal lives (i.e., friends, spouse/significant other, family, and
others) using a six-point scale ranging from "Strongly Disagree" (1) to “Strongly Agree"
(6). Ten statements were related to "personal“ sources of perceived
support/pressure/encouragement. For each statement all individuals’ scores were
summed (e.g. Item 1 scores for individuals 1 to 115 were summed together for a total
item 1 score). Items were then grouped together based on the particular source (i.e.,
three questions referred to support from friends, two related to spouse, two to family and
two to other sources). Item scores were then added together for each source and an

average score was calculated per source. Next, the 14 items relating to "personal“

 

barriers were divided into eight categories and item scores were added together for each

 

 

 

category and averages were calculated. Finally, an overall percentage was calculated for
each personal source/category in order to obtain weights to assign to each for use in
analyzing results from the final survey responses (i.e., a percentage was calculated by
summing all averages to use as the total score and calculating the percentage of this total

accounted for by each personal category).

 

Refer to Part IV in Appendix B for the final items included in the personal and
work support/pressure/barriers measures. The measure of personal sources of
support/pressure calculated for the final sample consisted of six items with weights based
on the above pilot results (see Part IV, Appendix B, for items 1, 4, 5, 9, 11, 12, weighted
.027, .022, .034, .022, .038, .028 respectively). Individuals’ weighted scores were summed
on these six items to create the Personal Support/Pressures scale where the higher the

score the more support perceived. The final measure of personal barriers consisted of

 

#1

173

seven items (2, 3, 6, 7, 8, 10, 13) weighted according to the pilot results (.036, .029, .038,
.030, .033, .038, .031, respectively). Cronbach alpha reliability for the Personal
Support/Pressures scale was .81. Individuals’ weighted scores were summed on these
seven items to create the Personal Barriers scale where the higher the score the more
barriers perceived. Finally, one score was developed to include all the "personal"
related perceptions regarding support/pressure and barriers to using EAPs in order to
examine the overall inﬂuence of people and things (barriers) from personal sources.
This overall Personal Support/Pressure/Barriers variable was calculated by subtracting
the total personal barriers score for each individual from his/her total personal
support/pressure score. This score was then interpreted as the higher the score the more
support and fewer barriers perceived from personal sources, and this score was used to

examine the impact of personal inﬂuences on EAP utilization.

 

A similar procedure was used to develop weights for the Work

 

 

Support/Pressure/ Barriers measure. Participants in the fourth pilot study were asked to

 

respond to 28 statements on perceived support, encouragement, discouragement and i

barriers from work sources using a six—point scale. The items were then categorized by

 

source (6 items related to supervisor, 3 to union, 8 to coworkers, 3 to the
university/organization) and by barrier type (8 items). Total participants’ scores were
summed by item and weights were calculated for each category based on the percentage
of the total each accounted for (same as the procedure described above). These weights
were used in analyzing data from final sample participants. The Work Support/Pressure
measure was calculated using the following items and weights (Part IV, Appendix B,
items 14 to 19, 21, 24, 25, 27 weighted .026, .026, .028, .021, .030, .028, .039, .032, .084,

.043 respectively). Cronbach alpha reliability for this measure based on the final survey

 

 

174

responses was .71. The Work Barriers measure was calculated using the following items
and weights (items 20, 22, 23, 26, 28, 29 weighted as .037, .029, .030, .055, .029, .057
respectively). Cronbach alpha reliability for the Work Barriers scale was .79. Finally,
in order to examine the overall inﬂuence of work-related factors on EAP utilization, an
overall Work Support/Pressure/Barriers variable was calculated by subtracting the total
work barriers score for each participant from his/her total personal support/pressure
score. This score was then interpreted as the higher the score the more support and
fewer barriers perceived from work sources.

EAP Utilization. This dependent variable was a dichotomous variable representing
the employee’s utilization or non-utilization of the EAP. This measure was obtained
from three sources: (1) EAP records, (2) a question on the survey regarding EAP usage
(see Part VIII, Appendix B, question #3), and (3) a series of questions relating to EAP
usage to be completed only if employees had used EAP services (Part VIII, Appendix
B, questions 4-12). If all three sources indicated the individual had utilized an EAP, the
individual was classified as an EAP-user. If all sources did not agree, the individual was
classiﬁed as a non-user.

Other Variables. Demographic information was collected on the participants for

additional analyses and information. Employees were asked to provide information

regarding their age, gender, education, marital status, income, occupational status, race,

and organizational tenure.

Analytic Metheds

This section describes the statistical procedures used to analyze the hypotheses.

Frequency distributions for all items were obtained for the entire sample and by group

 

 

 

 

—7’

175

(EAP users and non-users). Matrices of Pearson Correlation Coefficients were
developed to examine the intercorrelations for the variables in each scale and to assist
in examining the discrimination and validity of the scales.

Regression and hierarchical multiple regression was utilized to analyze the
hypotheses. The multiple correlation coefficient (R) represents the degree to which a
dependent variable can be predicted from simultaneous consideration of independent
variables. The model and hypotheses will be tested in stages (refer to Figures 10 and
11).

Hypotheses 1 to 3 suggest similar predictions regarding the relationship of health
history, Health Locus of Control, and social group health values/norms with an
individual’s desired health goal. Each hypothesis was stated as a main effect for the

speciﬁc variable on health goal level and was tested by regressing health goal level on

 

 

each variable. Support for each hypothesis was indicated by the specific variable

 

explaining a signiﬁcant amount of variance in desired health goal level.
Hypotheses 4a, 4b, 4c and 5 each predicted speciﬁc variables (the three Health
Locus of Control variables and expectancy of goal attainment) would moderate the

relationship between the perceived goal-sensor discrepancy and EAP utilization. Each

 

hypothesis was tested via hierarchical multiple regression where the perceived goal—
sensor discrepancy variable was entered in the ﬁrst step, the particular moderator
variable in the second step, and the discrepancy by moderator interaction in the third
step. Support for each hypothesis was indicated by a statistically significant beta
coefficient corresponding to the interaction variable.

Hypotheses 6 and 7 suggest similar predictions regarding the relationship of

personal support/pressure/barriers and work support/pressure/barriers with an

 

 

7—7

176

individual’s use of an EAP. Each hypothesis was stated as a main effect for the specific
variable on EAP utilization and was tested by regressing EAP utilization on each
variable. Support for each hypothesis was indicated by the specific variable explaining
a signiﬁcant amount of variance in EAP utilization.

Post-hoe analyses were conducted to further examine relationships among the

variables and to compare demographic characteristics of EAP users and non—EAP users.

 

 

 

 

 

 

if

CHAPTER 5

RESULTS

Descriptive statistics (Ns, means, and standard deviations) of variables in the
model are presented in Table 6. Sample sizes vary across scales because of missing
values. lntercorrelations among key variables were also calculated and are shown in
Table 7. Few variables are highly correlated with one another. Those that signiﬁcantly
correlate over .40 (at p < .01) worth noting are personal support/pressure to using an
EAP with personal barriers (r = .61) and with work barriers (r = .45) (note that these
are the individual variables that are used to create the personal and work
support/pressure/barriers variables), indicating that those perceiving more personal
sources of support/pressure to use an EAP also perceive more barriers. In addition, the

personal barriers to using an EAP measure is significantly correlated with work barriers

 

(r = .67) and with using an EAP (r = -.46) so those perceiving more barriers tend to

 

not use an EAP. Work—related support/pressure to use an EAP is negatively related with
work—related barriers (r = -.44), indicating those individuals perceiving more support
to use an EAP from sources at work (e.g., coworkers, supervisor, union) perceive fewer
barriers in the workplace to using an EAP. In general, when the perceived barriers
measure is subtracted from the perceived support/pressure measure (both personal and
work sources), those perceiving more support/pressure and fewer barriers from personal
sources also tend to perceive more support/pressure and fewer barriers from work
sources (r = .51). It is also important to note that the correlation (r = -.77) between
personal support/pressure/barriers (PSPB in Table 7) and personal barriers (PBAR) is

artiﬁcially high because of the differential score used to develop the personal

 

177

 

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180

support/pressure/barriers measure-i.e., the personal barriers measure is used as one
variable to calculate the personal support/pressure/barriers measure. Similarly,
correlations are artificially high between work support/pressure/barriers (WSPB) and the
two sources used to develop this variable (work support/pressure or WSUPP with r =
.77, and work barriers or WBAR with r = -.91).

The correlation between current problems and desired change (i.e., perceived
discrepancy) is also significant (r = —.63) where those who have more health problems
(a low score on the current problems scale) tend to perceive more of a discrepancy
between their desired and current health (a high score on the desired change scale).

Finally, as previously mentioned, a health goal-health status discrepancy measure
was calculated to use as a method check to determine whether the model and
relationships exist as predicted within the control theory framework. This health goal-
health status discrepancy variable was calculated by standardizing each employee’s scores
on both the desired health goal and current health problems measures. These scores for
each employee were then compared to determine whether the scores fell within the same
percentile-i.e., if an employee’s standardized score on desired health goal was in the
Upper 25th percentile and the person’s standardized score on current health problems
was also in the upper 25th percentile of scores then no discrepancy exists. If both scores
for an individual did not fall within the same percentile, a health goal-health status
discrepancy existed. Once all participants’ scores were calculated, a t—test was conducted
using the “perceived discrepancy” measure as the dependent variable to examine
whether a signiﬁcant difference was found between individuals without a discrepancy
and those with one (with individuals categorized with/without a discrepancy based on

standardized scores). The t-test indicated a significant difference between the two groups

 

 

 

 

 

181

(p = .02). As a method check on the control theory model, this calculated health goal—
health status discrepancy measure (called the ”actual" discrepancy) was also correlated
with the "perceived” discrepancy measure created by the desired change variable (r =
.13, p < .05). To determine whether the relationships within the model might exist as
predicted, these two variables should be significantly correlated. The correlation
between the variables was found to be significant but weak. Thus, additional research
may be required to assess how useful control theory may be as a framework for

understanding the EAP decision process.

Hypothesis # 1

The first set of hypotheses (#1, #2 and #3) suggested similar predictions
regarding the relationship ofa speciﬁc independent variable with an individual’s desired
health goal. Each hypothesis was tested by regressing desired health goal level on the
particular variable.

Hypothesis #1 suggests that an individual’s past health (health history) will
inﬂuence his/her desired health goal level. A main effect was predicted for health
history such that individuals with more prior health problems would demonstrate a
higher desired health goal level than individuals with fewer prior health problems. This
hypothesis was tested by regressing desired health goal on health history. A significant
amount of variance in the desired health goal level was not explained by health history
(R2=.001, n.s., n=274); thus, support for the hypothesis is not indicated. The
correlation between health history and health goal level was also not significant (r = .02,

11.8.).

 

 

 

 

 

182
11112941393315.1912.

Hypothesis #2 predicted that an individual’s Health Locus of Control (HLOC)
will have an effect on the person’s desired health goal level such that individuals who
are internals will have a higher desired health goal level than those who are externals
(i.e., score higher on either the powerful others or chance subscale). To test this, a
separate regression was conducted on each of the three HLOC subscales. Table 8
displays the results of these regressions.

Internal HLOC was not a significant predictor of desired health goal. The
correlation was also not signiﬁcant (1' = .07, n.s.). Similarly, the Powerful Others HLOC
subscale was not a significant predictor. However, the Chance HLOC subscale was a
significant predictor of desired health goal level. In addition, Chance HLOC correlated
negatively with an individual’s desired health goal level, and the correlation between

these variables was significant (r = -.235. P < ~01)-

Hypothesis # 3

Hypothesis #3 suggested that an individual’s perception of the health values and
norms of members of his/her social group would affect the individual’s desired health
goal such that individuals who perceived more positive health norms among family and
friends, past and present, would hold higher health goals than those who perceived lower
health norms among their family and friends. This hypothesis was tested by regressing
desired health goal on the social health values/norms measure. The regression results

indicate that support for this hypothesis was not found (R2=.004, n.s., n =274).

 

 

 

 

 

 

 

183

Table 8: Regression Results for the Health Locus of Control (HLOC)
Subscales on Desired Health Goal Level

 

Regression Results for the Internal Health Locus of Control
(HLOC) Subscale on Desired Health Goal Level

 

Variable B R R2 p of R2

Internal HLOC .084 .071 .005 n.s.

 

Regression Results for the Powerful Others Health Locus of Control (HLOC)
Subscale on Desired Health Goal Level

 

Powerful Others
HLOC -.052 .051 .005 n.s.

 

 

 

Regression Results for the Chance Health Locus of Control (HLOC) Subscale
on Desired Health Goal Level

 

Chance HLOC -.217 .235 .055 .0001**

 

* p < .05
** p < .01

E4mE
. _

 

 

 

 

184

Hypotheses #4aﬁa#4b}and #4c

The fourth set of hypotheses stated that the Health Locus of Control variables
would moderate the relationship between perceived discrepancy and EAP utilization.
Hypothesis # 4a predicted that individuals who are high on the Internal HLOC subscale
would respond to a perceived discrepancy between their desired and current health
status by utilizing an EAP more than those who are low on the Internal HLOC subscale.
Hypothesis #4b predicted that individuals who are low on the Powerful Others HLOC
subscale would respond to a perceived discrepancy between their desired and current
health status by utilizing EAP services more compared to those who are high on this
scale. Similarly, hypothesis #4c predicted that individuals who are low on the Chance
HLOC subscale would respond to a perceived discrepancy between their desired and
current health status by utilizing an EAP more than those who are high on this scale.
Thus, it was predicted that those individuals who were internals (i.e., high on Internal
HLOC) would respond to their perceived discrepancy by utilizing an EAP more than
individuals who were externals (i.e., high on Powerful Others or Chance HLOC).

These hypotheses were tested by running separate moderated regression analyses
for each of the Health Locus of Control subscales. EAP usage was regressed on
perceived discrepancy, each of the Health Locus of Control subscales, and the perceived
discrepancy by Health Locus of Control subscale interaction term. These results are
displayed in Table 9 and plotted in Figures 14 to 16. The interaction term for Internal
HLOC by perceived discrepancy was marginally significant (at the p < .10 level). The
interaction term for Chance HLOC by perceived discrepancy was also significant (p <

.05). However, the interaction of Powerful Others HLOC by perceived discrepancy was

 

 

 

 

 

 

 

 

185

Table 9: Results of Regressing EAP Utilization on Health Locus of
Control Subscales, Perceived Discrepancy, and the Interaction

 

Hypothesis #4a: Results of Regressing EAP Utilization on Internal Health
Locus of Control (HLOC), Perceived Discrepancy, and the Interaction

 

Hierarchical 2 2
Step Variable Beta R Adj R Change R
1 Perceived Discrepancy .682 .022 —.003 .001
2 Internal HLOC .417 .105 .004 .011*
3 Perceived Discrepancy
x Internal HLOC ~.732 .144 .001 .001*

 

Hypothesis #4b: Results of Regressing EAP Utilization on Powerful Others
Health Locus of Control (HLOC), Perceived Discrepancy, and the Interaction

 

Hierarchical 2
Step Variable Beta R Adj R Change R2
1 Perceived Discrepancy *.263 .022 —.003 .001
2 Powerful Others HLOC ~.352 .130 .010* .017**
3 Perceived Discrepancy
x Powerful Others HLOC .386 .154 .013* .007

 

HYpothesis #4c: Results of Regressing EAP Utilization on Chance Health
Locus of Control (HLOC), Perceived Discrepancy, and the Interaction

—-¥

Hierarchical 2
Step Variable Beta R Adj R Change R2
1 Perceived Discrepancy -.399 .022 —.003 .001
2 Chance HLOC -.410 .033 -.006 .001
3 Perceived Discrepancy
X Chance HLOC .556 .136 .008 .018**

* p < .10 ** p < .05

 

 

 

186

Hypothesis #4a

Yes High IHLC

EAP
Utilization

No Low IHLC

 

 

50 63 75 88 100

Perceived Discrepancy

 

Figure 14: Results of Regressing EAP Utilization on Perceived Discrepancy
by Internal Health Locus of Control (IHLC)

 

 

 

187

Hypothesis #4b

Yes Low PHLC
High PHLC

BAP
Utilization

N0

 

 

50 63 75 88 100
Perceived Discrepancy

 

Figure 15: Results of Regressing EAP Utilization on Perceived Discrepancy
by Powerful Others Health Locus of Control (PHLC)

 

 

188

Hypothesis #40

Yes Low CHLC

EAP
Utilization
High CHLC

No

 

 

50 63 75 88 100
Perceived Discrepancy

 

Figure 16: Results of Regressing BAP Utilization on Perceived Discrepancy
by Chance Health Locus of Control (CHLC)

 

 

 

 

 

 

 

189

not significant. Moderator effects for Internal and Chance HLOC were found, thus

hypotheses #4a and #4c were supported.

Hypothesis # 5

Hypothesis # 5 predicted that an individual’s expectancy regarding the ability of
the EAP to resolve or improve his/her current health problems would moderate the
relationship between perceived discrepancy and EAP utilization. It was predicted that
individuals who are high on the expectancy measure will respond to a perceived
discrepancy between current and desired health by utilizing an EAP more compared to
individuals who are low on the expectancy scale. Employees’ EAP usage was regressed
on perceived discrepancy, expectancy, and the perceived discrepancy by expectancy
interaction term. Table 10 and Figure 17 display the regression results which indicate
that expectancy is not significant as a moderator between perceived discrepancy and

EAP utilization.

Hypothesis #6

This hypothesis predicted a main effect for personal support/pressure/barriers to
seeking EAP assistance such that individuals who perceive higher levels of
support/pressure and fewer barriers from personal sources will tend to have used an
EAP for services more compared to individuals who report low levels of
support/pressure and perceive more personal barriers to seeking EAP assistance. This
hypothesis was tested by regressing the personal support/pressure/barriers measure on
EAP utilization. A significant amount of variance in EAP utilization was explained by

this variable, thus the hypothesis is supported (R2 = .158, P < -01, D = 274).

 

 

 

 

 

 

 

190

Table 10: Results of Regressing EAP Utilization on Expectancy, Perceived
Discrepancy, and the Interaction

 

Hierarchical

 

Step Variable Beta R Adj R2 Change R2
1 Perceived Discrepancy «.118 .026 -.003 .001
2~ Expectancy —.635 .031“ —.006 .000
3 Perceived Discrepancy

x Expectancy .567 .047 —.009 .001
* p < .10

** p < .05

 

 

 

 

 

 

 

191

Hypothesis 5

Yes High Exp'y

EAP Low Exp'y
Utilization

No

 

 

50 63 75 88 100
Perceived Discrepancy

 

 

 

 

Figure 17: Results of Regressing'EAP Utilization on Perceived Discrepancy
by Expectancy

 

 

 

 

 

 

 

192

Hypothesis # 7

Hypothesis # 7 suggested a main effect for work-related support/pressure/barriers
to seeking EAP assistance such that individuals who perceive higher levels of
support/pressure and fewer barriers from sources within the organization will tend to
have used an EAP for services more compared to individuals who report low levels of
support/pressure and perceive more work-related barriers to seeking EAP assistance.
This hypothesis was tested by regressing the work support/pressure/barriers measure on
BAP utilization. A significant amount of variance in EAP utilization was explained by
this variable, thus the hypothesis is supported (R2 = .058, p < .01, n = 274).

The work support/pressure/barriers variable was calculated by subtracting an
individual’s perception of work—related barriers to using an EAP from his/her perception
of work support/pressure to use an EAP. The correlation between this new variable
created called work support/pressure/barriers and EAP utilization was significant (r =
.24, p < .01). The work—related barriers variable alone was also significantly correlated
with EAP utilization (r = -.294, p < .01). The correlation between work

support/pressure and EAP utilization was not significant (r = .074, n.s.).

Post-Hoc Analyses

Most past EAP research has examined demographic variables and EAP utilization
to understand the profile of EAP users. The purpose of the present research was to
examine additional factors which potentially may influence EAP utilization. These
additional variables might be classified into two categories: those that are related to
perceived support, pressures, and barriers to using EAP services and those that are

related to personal attitudes, characteristics, and beliefs. A post-hoc analysis was

 

 

 

 

 

 

 

 

 

 

193

conducted to examine whether the two additional categories of variables significantly
added to our understanding of EAP utilization beyond demographic characteristics. To
do this, a hierarchical regression was conducted where demographic variables were
entered in the first step, the support/pressure/barriers variables were entered in the
second step, and the attitudes and belief variables were entered in the third step. Results
of this regression are displayed in Table 11. The regression indicates that demographics
had no significant inﬂuence on EAP utilization (R2 change = .039, n.s., n = 262) while
the addition of the personal and work support/pressure/barriers variables had a
significant impact on EAP usage (R2 change = .175, p < .01, n = 262). Also, adding
the attitudes and beliefs variables (Health Locus of Control and Expectancy) significantly
added to explaining EAP utilization beyond the demographic and
support/pressure/barriers variables (R2 change == .008, n.s., n == 262). This regression
indicates that Health Locus of Control and the expectancy that an EAP will help resolve
problems may be key variables influencing EAP utilization along with perceptions of
personal and work-related sources of support/pressure and barriers to utilizing EAPs.

A few additional variables measured on all participants were examined next and
individuals were again compared by EAP-usage and non-usage. Employees were asked
whether they had the opportunity to utilize affordable assistance services other than the
organization’s EAP. This question was asked separately to examine the relationship
between having other resources available and EAP utilization. The potential availability
of other resources was not included in the personal support/pressure or barriers
measures described above because these resources were not viewed as a potential source
0f support nor as a potential barrier to EAP usage. While it might be argued by some

that the availability of other resources might decrease EAP usage, the present research

 

 

 

194

Table 11: Results of Regressing EAP Utilization on Demographic Variables,
Support/Pressure/Barriers Variables, and Personal Bel iefs/Value

 

 

 

Variables

Hierarchical ,
Step Variable Beta R Adj R2 Change R2
1 Demographics .197 .008 .039

" Tenure .042

Job Position .106

Race —.021

Marital Status —.057

Gender .122

Age —.082

Education - -.004

Family Income ~.007
2 Support/Pressure/Barriers .462 .182** .175**

Personal .409

Work .029

3 Health Locus of Control

and Expectancy .471 .178** .008**

Internal HLOC .056

Powerful Others HLOC -.029

Chance HLOC .027

Expectancy —.067

 

**p< .01

 

 

 

 

 

 

 

 

195

did not view EAP utilization in this manner. EAP services include the referral of clients
to external resources, thus EAPs typically operate in an environment where a variety of
other assistance services are available and EAPs are often viewed by clients as the first
source of assistance.

A t—test was conducted examining the differences in the means between EAP
users and non-users on this variable. This test was significant (p < .05) and indicated
that EAP users also perceived more access to other resources. A crosstabulation analysis
was performed between EAP usage and perceived opportunity to use other services, and
results are presented in Table 12. Those who perceive an opportunity to utilize other
assistance services (e.g., spouse’s EAP, church counselors, psychiatrist) still tend to take
greater advantage of the organization’s EAP services. Also, those who do not use the
organization’s EAP also do not perceive there are other services available.

Individuals were also asked about their willingness to use the organization’s EAP
if the services were needed. A t-test was conducted comparing the means of the EAP
users and non-users on this variable and the t—test was significant (p < .01). While it
may n0t be surprising to find that EAP users tend to be more willing to use an EAP in
the future compared with non-users, it is encouraging to find that the experience of using

an EAP did not turn EAP users against future utilization.

 

 

 

 

 

 

. .
a

 

 

 

 

196

Table 12: Crosstabulation Analysis of Availability of Other Resources and
EAP Utilization

 

Total Non-EAP Usage EAP Usage Chi-Square

 

 

 

Variable N N % N % Significance
Other Resources .024**
Yes 150 49 .33 101 .67
% of N by Usage .46 .60
No 124 57 .46 67 .54
% of N by Usage .53 .40
* p < .05

** p < .01

 

 

 

 

 

 

 

 

 

CHAPTER 6

DISCUSSION

The purpose of the present research was to examine factors which may inﬂuence
an employee’s decision to seek EAP assistance and to develop a conceptual model to
guide research in this area. A Control Theory Model of EAP Utilization was developed
and parts of the model were tested in order to gain a better understanding of the EAP
utilization process. The setting was an organization which provided a number of EAP
services to all employees as part of its employee benefits package. All employees in the
sample had equal access to the EAP.

Seven main hypotheses were studied. Three hypotheses examined factors
inﬂuencing the goal/standard variable, i.e., the desired health goal, within the control
theory model. None of these hypotheses was fully supported. In addition, two
hypotheses predicted a moderator effect on the relationship between perceived
discrepancy and EAP utilization for Health Locus of Control and expectancy that an
EAP will help improve one’s health problems. Health Locus of Control was found to
moderate this relationship, though the hypothesis was not completely supported. The
last two hypotheses tested for a direct relationship with EAP utilization for the following
two variables: personal support/pressure/barriers and work support/pressure/barriers.
Both variables were found to be significantly related to usage. The following sections

will provide a discussion of these findings.

H. ypothesis ﬁ 1; Effect of Health History on Desired Health Goal

Hypothesis #1 predicted that an individual’s health history would significantly

affect his/her desired health goal level such that the more health problems an individual

197

 

 

 

 

 

 

 

 

198

has experienced, the more likely he/she would hold higher health goals. The regression
analysis found no significant relationship between health history and desired health goal,
thus this hypothesis was not supported.

There are a number of potential reasons for the failure to observe a significant
relationship between a person’s past health experiences and his/her desired health goal.
First, there may be problems with the measurement of the health goal construct. For
example, it may be difficult to obtain variability among individuals when measuring what
they desire their health to be because how many individuals would desire or admit to
desiring poor health? A second possible explanation for the lack of an observed
relationship is that the expectations for the effect may have been overly Optimistic. Since
there was no previous research found that suggested a relationship might exist between
these two variables, the hypothesis was based on an inferred relationship. This
relationship assumed that poor health would lead to a heightened desire for good health,
and thus to higher health goals.

An alternative explanation might be that the lack of a relationship suggests that
some individuals with poor health may actually want to try to improve their health and
desire higher health goals while others with poor health may become more realistic
about their health status and actually feel they will have to learn to live with their
problems. Thus, due to their past health experiences, individuals may actually lower
their health goals to what may be more realistic health expectations. It could be that no
relationship between past health and desired health goal was observed due to the two
potential responses among individuals that may have cancelled each other out.

Research on goal—setting may further help to explain the lack of an observed

relationship. Campion and Lord (1982) have stated that the literature indicates that past

 

 

 

 

 

199

performance and ability are primary determinants of initial goal levels, which then serve
as referents for future behavior. Subsequent discrepancies between feedback and this
referent goal creates a motivation to reduce the discrepancy. However, depending on
individual or situational characteristics, a person may reduce the discrepancy by
modifying either his/her behavior or goals (Campion & Lord, 1982). Campion and Lord
found that past success and high ability tend to lead to higher goal levels. Hollenbeck
and Williams (1987) also concluded that those individuals setting the highest goal levels
held perceptions of high past performance levels. However, others examining the goal-
setting process have reported that some individuals raised their goals after failure while
others lowered their goals following success (Kernan & Lord, 1985).

Two additional variables that have been found to inﬂuence the goal-setting
process may explain the ambiguity. These are goal importance and self-focus.
According to Carver and Scheier (1981), a person’s attention can be directed in one of
two directions: inward toward the self or outward toward the environment. When
attention is inward, the individual is engaging in self-focus or self-attention. Hollenbeck
and Williams (1987) found that individuals high in self-focus are more aware of the
discrepancy between goals and feedback, and thus are more likely to undertake
discrepancy-reducing behavior compared to individuals who are low in self-focus. They
also found that the setting of a goal is an interactive function of perceptions of one’s past
performance, self—focus, and perceived goal importance where the more successful the
performance and the higher the level of self-focus and goal importance, the more the
individual sets higher goal levels. Future research should examine the inﬂuence of self-

focus and goal importance on desired health goal level.

 

 

 

 

 

 

 

 

200

Another variable that may be important in understanding the goalesetting process
is self—efficacy. Self—efficacy refers to the judgments people make about their ability to
execute courses of action, where those who are high in self—efﬁcacy feel they can master
some task. It differs from Internal Health Locus of Control because those high in
Internal HLOC believe their actions are responsible for outcomes received but having
an Internal HLOC does not necessarily mean the person believes he/she has the ability
to actually execute the actions to obtain desired outcomes (Bandura, 1982). Individuals
high in self-efficacy tend to perceive they have the ability to execute the actions. Self-
efficacy is not the same as believing one has control, although. there may be a
relationship between Health Locus of Control and self-efficacy (it seems logical that
individuals who have an internal health locus might also be high in self-efficacy,
although the relationship between self-efficacy and external locus of control is
uncertain). Self-efficacy has been found to be related to a person’s past
accomplishments where past successes increase feelings of self-efficacy if attributable to
unchanging factors, like personal ability, while past failures tend to reduce these feelings
(Bandura, 1982). If individuals have been relatively healthy in the past (health success),
their self-efficacy may increase, depending on what they attribute the cause of their
success to. These individuals may increase or hold a high desired health goal level
because they believe they have the ability to carry out their tasks/goals. On the other
hand, if individuals have had poor health in the past, their self—efficacy may be lower,
and thus they may tend to hold lower health goals because they fail to perceive they
have the ability to achieve these goals anyway. Thus, self-efficacy may be an additional

individual characteristic that might interact with past history to determine future goal

 

 

 

 

 

 

 

 

 

 

 

 

 

201

levels. Future research might examine the relationship among self-efficacy, prior health

status, and health goals.

Hypothesis #2: Effect of Health Locus of Control on Desired Health Goal

In the second hypothesis, individuals with an Internal HLOC were predicted to
hold a higher desired health goal level compared to individuals with an External HLOC
(either Powerful Others or Chance). There was no statistically signiﬁcant relationship
found between desired health goal level and Internal HLOC or between desired health
goal level and Powerful Others HLOC (an external subscale). However, the regression
analysis found a statistically significant relationship between desired health goal level and
individuals’ beliefs about the extent their health is a function of luck or fate-—i.e., Chance
HLOC (External). Thus, while the hypothesis is not fully supported, it is interesting to
note that those individuals who believed their health was determined by chance also held
lower desired health goals. After all, belief in chance suggests the individual has no
control over his/her health.

It is interesting to note that the present research provides more explanation on
why individuals lower their health goals but few guidelines as to why individuals may be
more health conscious. While chance may be associated with a reduction in desired
health goals, no explanation was provided in the research as to factors that enhance an
individual’s health goals. Also, a potential problem in observing an effect, as previously
discussed, is that it may be difficult to obtain adequate variation in the desired health
goal level. Being healthy is such a desired state that little variation may exist in the

population regarding this factor.

 

 

 

 

 

 

202

Past research on Health Locus of Control has examined its relationship with
actual healthy and health-seeking behaviors. The relationship between Health Locus of
Control and what one desires, i.e., desired health goals, has not been previously
examined. Also, no research was found on health decisions and the difference between
what an individual desires and what the person actually does. Thus, further research
needs to be conducted to understand personality factors which may be involved.
Certainly it’s not unique for there to be a discrepancy between what people say and what

they do.

Hypothesis #3: Effect of Social Group Health Values/Norms on Desired Health Goal

 

Hypothesis #3 predicted a relationship between an individual’s desired health
goal level and the health values and norms held by members of the individual’s social
group. It was hypothesized that the more positive the perceived health values/norms are
of one’s social group members, the higher the individual’s desired health goal level.
Similar to Mayer’s (1988) conclusion that health norms within an organizational setting
had no relationship with an employee’s health attitudes and behaviors and Hung’s (1988)
finding that EAP use was not signiﬁcantly related to perceptions of the organization’s
"climate" (warm or cool toward employees), the regression analysis in the present study
found no signiﬁcant relationship between health norms/values of social group members
and the individual’s health goals. However, this finding is contrary to past research that
has concluded that sick-role/healthy attitudes and behaviors are, at least partly, learned
from others (Bruhn & Cordova, 1977; Mechanic, 1978; Pender, 1982; Rosenstock, 1975).

This is an area that may require additional clarification.

 

 

 

 

 

 

i

203

One explanation for the lack of a relationship may be that there are perhaps two
effects going on simultaneously which would tend to cancel each other out. For
example, a person’s social ties may result in one of two responses. Social relationships

have been found to help reduce stress levels among individuals with close relationships

 

(Cassel, 1976; Hirsch, 1980; Kaplan & Cassel, 1977). In addition, Lin, Simeone, Ensel
and Kuo (1979) found that social support contributed signiﬁcantly and negatively to
illness symptoms such that individuals with more social support experienced fewer
symptoms. Therefore, if social ties are close, individuals may actually experience fewer
health problems/symptoms (Eaton, 1978; Hirsch, 1980; Lin, Simeone, Ensel & Kuo,
1979). In addition, close social ties have been found to encourage individuals to be more
positive and proactive in their health attitudes and behaviors when they feel they have
problems (Haskell & Blair, 1980; House, 1981). It thus seems that an important factor

inﬂuencing attitudes and behaviors is that individuals must perceive a need or problem.

 

On the other hand, if social ties are weak or disrupted, the inﬂuence of the

 

 

members of one’s social group on an individual may actually increase the person’s

susceptibility and perception of illness (Pilisuk & Minkler, 1985). Thus, the perception

 

of the norms and values of social group members may result in different responses
depending on the closeness of the individual members. The actual relationship might
be as follows: Social Group Health Values/Norms > Health History ----- > Desired-
Health Goal Level. If the two responses discussed were occurring simultaneously, then
no effect would have been found between social group health values/norms and desired
health goal level or between health status and desired health goal level (hypothesis # 1).

Another potential problem is that in the present research, social health

norms/values were examined regarding past social group members (parents, family,

 

 

 

 

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friends growing up) as well as present members (spouse, children, etc.) and these
perceptions were formed into one measure. Current levels of ”closeness" to past/present
social group members were not measured in the present research, nor was the present
"quality" of the relationships measured; thus, positive norms of social group members
may exist or have existed, but depending on whether these members are still an
important aspect of an individual’s life could determine the degree of inﬂuence the
norms/values currently have on individuals.

In further examining the relationship between social group health values/norms
and desired health goal, the correlation between these two variables was also found to
not be significant. However, it is interesting to note the variables with which the social
group health values/norms measure was found to be signiﬁcantly correlated. For
example, the social group health values/norms measure was significantly correlated with
the number of current health problems reported by an individual (r = .23, p < .01) as
well as the expectancy than an EAP will help resolve these problems (r = .13, p < .05).
This might suggest that, while peer pressure/norms may not affect an individual’s health
goals, these social inﬂuences could be related to the person’s perception of his/her
current health such that individuals who perceive more positive health norms of social
group members (i.e., the more health conscious the social group is perceived) also tend
to perceive more health problems in themselves and to believe the EAP will help resolve
these problems. Thus, a person’s social group may be inﬂuencing his/her perceptions
when the person compares his/her own health to the health and health-consciousness of
his/her social group. Therefore, although the regression analysis suggests there is no

significant relationship between social group health values/norms and desired health goal

 

 

 

 

205

level, correlationally an individual’s perceptions of the health values/norms of social
group members appear to be related to other issues.

The issue of how one’s social group inﬂuences an individual’s desired health
standard/goal is an important concern within organizations. With the amount of effort
and money being spent by ﬁrms to encourage employees to be more health conscious,
a greater understanding of the role of peer pressure and social group norms is required.
We don’t know enough about these inﬂuences, and, in fact, there were contradictory
ﬁndings in the manner others may inﬂuence individuals’ health behavior. For example,
in the present research Powerful Others Health Locus of Control had no inﬂuence on
what an individual wanted regarding his/her health (desired health goal). However,
when an individual perceived his/her social group to be health conscious, then the
individual tended to report more health problems. This suggests that on the one hand
there may be a relationship between perceptions of the health consciousness of one’s
social group and the health problems reported by that same individual. However, when
individuals specifically perceive others are in control of them (i.e., their health) then
these others may have less of an impact on the person. The interplay between what a
person sees others doing (being health conscious) and its effect on the person and the

effect others have on individuals when they are perceived to be in control of the person

needs further study.

Summ r of Rel tionshi s with Desir H al h Goal

It could be concluded that an individual’s perception of his/her health history,
perceiving being in control of his/her health (Internal HLOC) and the health values and

norms of one’s social group did not inﬂuence the individual’s desired health goal level

 

 

 

 

 

 

 

206

in this study. However, while prior health problems and feeling in control over one’s
health may not have affected the person’s health goal, believing chance controls the
person’s health may be an important factor because the person who believes that chance
is the controlling factor tends to hold lower health goals. Also, if individuals that the
person associates with are health conscious, these individuals may inﬂuence the person
to perceive that he/she is not as healthy (and thus report more health problems, or
possibly inﬂuence the person to do something to improve his/her health, such as seeking
EAP assistance).

On the one hand, it may be helpful to understand how the belief in
chance/fate/luck controlling one’s health might operate'to inﬂuence a person’s health
goal. The suggestion in the present research that the belief in chance controlling one’s
health might inﬂuence a person to lower his/her health goals is intriguing. For instance,
could the relationship between Chance Health Locus of Control and desired health goal
level be inﬂuenced by a person justifying or rationalizing his/her health beliefs and
behaviors? Might a person believe that chance controls his/her health because it’s a
good excuse to not have to work toward good health? For example, how often does a
person who smokes say “I know smoking causes cancer but it won’t happen to me" or
say ”it doesn’t matter what I do, if I’m supposed to get sick I will”? Thus, a person can
justify smoking or other unhealthy behaviors and thus not have to make any changes in
his/her life since ”it won’t do any good anyway” because the person believes his/her
health is based on luck (or chance).

On the other hand, future research examining inﬂuences on the desired health
goal level may not produce a greater understanding of EAP utilization behavior. Given

the fact that the variables hypothesized to influence desired health goals were not

 

 

 

 

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207

significantly related to the desired health goal level, along with the ﬁnding that an
individual’s desired health goal level was not correlated with EAP utilization, it may be
. that health goals do not signiﬁcantly impact EAP utilization. However, as previously
suggested, the lack of an observed relationship with desired health goal level may have
been due to the operationalization of the desired health goal construct in the present
study. One criticism of the measure is that it failed to discriminate among individuals
holding high or low desired health goals. The range of scores that was possible for the
desired health goal level measure was 11 to 58. In the present research, scores ranged
from 24 to 56, with a mean and median of 44 and a standard deviation of 4.68. Over 84
percent of the respondents scored over 40 and less than one percent scored under 30.
When comparing the scores from the top and bottom third of the respondents, the lower

third scored 42 or less while the upper third scored 46 or more. It may be that

 

 

individuals will not vary greatly in the extent they desire to be healthy, or not be
consciously aware of a lower desired health goal level.
Another potential problem with the measure used is that the questions were

worded in an absolute sense so that it was difficult to tell if a person’s desire to be in

 

good health was the same whether expressed by a healthy or less healthy individual. For
example, individuals were asked what their desired health level was compared to others
their age. Over 82 percent reported they desired above average or way above average
health level and less than two percent desired to be less than average. In another
example, individuals were asked how many pounds within their ideal weight they would
like to fall. Over 43 percent desired to be within two to ﬁve pounds of their ideal weight
and a total of 77 percent responded they desired to be within ten pounds of their ideal

weight. Only 8 percent reported they desired to be 25 pounds or over 25 pounds from

 

 

 

 

 

 

 

208

their ideal weight. The wording of the questions did not make it possible to differentiate
among the different degrees of desired health. An individual who weighed 350 pounds
and desired to be within 30 pounds of his/her ideal weight would be classified as desiring
to be less healthy than the person who weighs 140 pounds but desires to be within ten
pounds of his/her ideal weight. It may be necessary to develop a measure of desired
health that is corrected for the absolute level on the variable to adequately distinguish
among different desired health goal levels. A final issue regarding the health goal
measure may involve whether individuals consciously hold specific health goals, or at
least goals that go beyond simply a "general desire to be healthy."

How behavior and goals are inﬂuenced is a complicated matter. For example,
one factor predicted to be central to EAP utilization behavior is the perceived
discrepancy variable (in the present study this is the perceived discrepancy between
desired and current health). The remaining hypotheses focus on factors which were

predicted to inﬂuence actual help—seeking behavior regarding EAP usage.

Hypgtheses #4a, #4b and ﬁ4c: The Moderator Inﬂuence of Health Locus of Control

The fourth set of hypotheses predicted that Health Locus of Control would
moderate the relationship between perceived discrepancy and EAP utilization. In other
words, it was predicted that the strength of the relationship between the difference
between desired and current health and EAP utilization will be stronger for those
individuals who are high on Internal HLOC than it will be for those with who have a low
Internal HLOC. It was also predicted that the strength of the relationship between the
difference between desired and current health and EAP utilization will be weaker for

those individuals who are high on either of the External HLOC subscales (Powerful

 

 

 

 

 

 

 

209

Others or Chance) than it will be for those with who are lower on either of these
subscales. The regression analysis indicated that Internal HLOC and Chance HLOC
were both significant moderators between perceived discrepancy and EAP utilization.
Hypotheses # 4a and # 4c were supported in that those with an Internal HLOC did tend
to use the EAP while those believing luck controlled their health tended to not use the
EAP. However, Powerful Others HLOC had no significant moderator effect, just as it
had no signiﬁcant direct effect on desired health goal (see hypothesis #2). In other
words, the belief that powerful others control an individual’s health had no significant
relationship with the individual’s health goals or health behavior (EAP usage).

It is interesting to find that Internal HLOC was significantly related to a person’s
EAP use but was not related to the person’s desired health goal (see hypothesis #2).
Prior research on HLOC compared internals and externals on a speciﬁc behavior—-
smoking/stop smoking, weight loss, use of seat belts or birth control, etc.--and has
typically found internals to be more proactive. In the second hypothesis, however,
HLOC was examined in its relationship to something desired (goal) not an actual
behavior undertaken. It is possible that there might be a difference between a health
goal, which is what one desires, and using an EAP (hypothesis #4), which is what one
actually does. On the other hand, it is also possible that the lack of a relationship with
desired health goal level was due to the operationalization of the construct, as previously
discussed.

Another explanation as to why individuals who believe chance controls their
health do not tend to use an EAP might be that those who believe chance controls their
health simply see no need to undertake such a behavior (going to an EAP) in order to

influence their health. This explanation is consistent with the relationships reported in

 

 

 

 

 

 

 

 

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the present research. For example, Chance HLOC was found to be negatively related
to the belief that an EAP will help (r = -.18, p < .01) and positively related to the
number of barriers perceived to using an EAP from both personal and work-related
sources (r = .14, p < .05 for both personal barriers and work barriers). In addition,
Chance HLOC was also negatively correlated with perceived current health problems
(r = -.21, p < .01), thus believing that chance controls one’s health is related to an
individual perceiving fewer health problems.

The regression analysis suggested that Powerful Others HLOC had no impact on
EAP utilization. Previous research has typically found that individuals with an External
HLOC (including Powerful Others HLOC) tend to take less control over their health
behaviors--e.g., External HLOC individuals don’t tend to quit smoking or lose weight,
"external" cystic fibrosis patients don’t tend to keep doctor appointments-because
presumably they believe their behaviors will not impact their health ((Best, 1975; Coan,
1973; James, Woodruff, & Werner, 1972; O’Bryan, 1972; Platt,. 1969; Schultz, 1981).
However, regarding some health behaviors the ﬁndings have been equivocal. For
example, Bellack, Rozensky and Schwartz (1974) found no significant relation between
weight loss and locus of control. The present analysis indicated that usage and non-
usage of an EAP occurred by both employees who scored high and employees who
scored low on the Powerful Others HLOC subscale. In the present research the
correlation between Powerful Otheis HLOC and the belief or expectancy that an EAP
will improve one’s health was also not signiﬁcant.

The lack of a relationship between Powerful Others HLOC and EAP utilization
might be due to the low reliability of the Powerful Others HLOC subscale in the present

study. While Wallston and Wallston (1978) previously found reliability for this subscale

 

 

 

 

 

 

 

211

to be .71 (Cronbach Alpha), results from the third pilot test conducted for the present
research indicated a reliability of .67 while results from the actual study data indicated
a reliability of only .58. Also, in examining the data, almost 67% of the employees were
classiﬁed as "low" on this measure and only .4% (one person) were classified as "high"
(refer to the "Measures” section in Chapter 4 on Health Locus of Control). Thus, there
may also be a restriction of range problem on this measure.

Another explanation is that individuals who tend to hold a Powerful Others
HLOC have been found to be more susceptible to external or social pressures
(Saltzer,1978). For some, social pressures may be viewed as a form of support. House
( 1981) has suggested three ways in which support may reduce the impact of stress on an
individual: it may reduce the importance of the perception that a situation is stressful,
it may tranquilize the individual’s system (neuroendocrine system) so people are less
reactive to perceived stress, and it may facilitate health behaviors. Consequently, for
some individuals, believing that others control one’s health may be viewed as a form of
support so that when a "powerful" person in the individual’s life encourages/supports
the individual in seeking help, the individual tends to seek assistance. For others,
control by Powerful Others may be viewed as a form of social support that may tend to
actually reduce the number of perceived health problems.

For instance, as previously mentioned, Lin, Simeone, Ensel and Kuo (1979)
found that social support contributed significantly and negatively to illness symptoms
such that individuals with more social support experienced fewer symptoms. Eaton
(1978) studied life events, social support and psychiatric symptoms and concluded that
social support among household members helps prevent mental disorders. Hirsch (1980)

compared individuals who had recently been divorced and found that support enhances

 

 

 

 

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one’s adaptation to stress. Cassel (1976) and Kaplan and Cassel (1977) concluded that
social support may actually ameliorate the effects of stress for individuals and, thus,
reduce the need for treatment. It is possible that feeling others are controlling or
concerned about one’s health may act as a buffer and protect individuals from feeling
under as much stress and in need of some form of assistance. Thus, Powerful Others
HLOC may have failed to have a significant impact on EAP usage because two responses
might be possible for individuals who believe others control their health. These
individuals may see the situation as less in need of their seeking assistance because
others are taking care of them or because others reduce the impact of their problem, or
individuals may perceive more support and encouragement to do something about their
health problem as being positive and thus may tend to follow the advice of these
powerful others in their lives.

To further explore why Powerful Others HLOC did not seem to significantly
affect what a person desires (health goals) or what the person does (seek EAP assistance)
when a problem is perceived, an examination of the intercorrelations between Powerful
Others HLOC and other key variables was undertaken. Powerful Others HLOC was
found to be significantly correlated with: the number of reported past health
problems/health history (r = .23, p < .01) ), reported current health problems (r = -.16,
p < .01), and EAP utilization (r = -.l3, p < .05). It is interesting to note the direction
of the relationships. Believing that powerful others have control over a person’s health
is related to an increase in the number of health problems the individual reports he/she
experienced in the past but to a decrease in the number of health problems the

individual reports he/she currently has.

 

 

 

 

 

 

 

 

 

 

213

While the negative relationship between Powerful Others HLOC and current
health problems does not allow us to make a causal conclusion, the relationship might
suggest that believing powerful others control one’s health may actually be viewed as a
form of support that might inﬂuence (reduce) the current number of perceived health
problems. The negative relationship might also suggest some form of denial process.
It could be argued that believing others control an individual’s health may inﬂuence the
problems reported but may have less inﬂuence on whether the person will do something

about it--i.e., go to an EAP (since the individual reports fewer current problems). We

 

need to better understand the nature of Health Locus of Control and how perceptions
of who or what controls health (Internal, Powerful Others, or Chance) impact health
attitudes and behaviors. A focus of future research could be to explore this relationship
between powerful others and chance. Since the data indicate that both are related
(correlationally) to an individual’s reporting fewer health problems, the inﬂuence of
external factors on an individual’s decision making process regarding health-related
matters is obviously a complicated phenomenon that deserves more study. Perhaps
efforts designed to encourage more health-related behaviors need to consider the
importance of ﬁrst making the individual think he/she is in control of his/her health

before others can inﬂuence (tell) the individual what to do.

H the is # ' Th Moderator Influence of Ex ectanc

It was hypothesized that an individual’s belief that an EAP will help
reduce/resolve current health problems identified by the individual (referred to as the
"expectancy" that an EAP will help) would moderate the relationship between perceived

discrepancy and EAP utilization. lf individuals perceive a discrepancy between their

 

 

 

 

 

 

 

 

214

current and desired health and believe that the EAP will help reduce this discrepancy,
it was predicted that the individuals would be more likely to go to an EAP. However,
if individuals perceive a discrepancy but do not believe the EAP will help, then they will
tend to not use the EAP. In the moderated regression analysis, an individual’s
expectancy that an EAP will improve one’s health was not found to be a signiﬁcant
moderator between an individual’s perception of a health discrepancy and EAP
utilization. The zero-order correlation between expectancy and EAP utilization was also
not significant (r = -.02, n.s.).

Expectancies have been found to be important in determining whether behavior
will be initiated, and the amount of effort exerted and sustained over time (Bandura,
1977b, 1982). However, it has also been recognized that human beings do not go
through rational patterns when making decisions about their behavior (Swanson, 1972).
Irrational emotions and motivations are also driving forces in health behavior (DiMarco,
1985). Knowledge about one’s health and belief in treatment effectiveness to improve
it do not ensure one will act wisely, due to emotions and motives (DiMarco, 1985;
Moriyano, Kreuger & Stamler, 1971). According to Rotter (1954), the occurrence of a
behavior is a function of the individual’s expectancy that the given behavior will secure
a reinforcement and the value of that reinforcement. An individual seeks to maximize
positive rewards or reinforcements (Rotter, Chance & Phares, 1972). Thus, while an
individual may believe an EAP can help improve his/her health, the person may not feel
compelled or motivated enough to actually seek treatment. Bandura and Walters (1963)
suggest that for behavior to occur in a given situation, it must be available to the person
and must have been reinforced during previous learning experiences. Thus, individuals

who have a positive or high expectancy that an EAP will help and believe a high

 

 

 

 

 

 

 

 

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incentive or reinforcement exists may tend to seek treatment while others who have a
high expectancy may not necessarily perceive enough incentive or reinforcement to act.

To better understand why expectancy was not a significant variable in the present
study, a post hoc analysis was conducted to examine the relationship between expectancy
and other major variables within the model. The correlation between expectancy and
Chance HLOC was significant and negative (r = -.18, p < .01). Thus, it could be that
the more an individual believed his/her health was due to chance (and less to internal
factors) the less the person believed the EAP would help reduce/resolve any problems
the individual may have had.

The correlations between expectancy and perceived barriers to using an EAP
from both personal sources (r = -.15, p < .05) and work sources (r = -.l3, p < .05)
were also significant. Based on these relationships, it appears that there is a relationship
between barriers and expectancy and that as an individual perceives more barriers to
using an EAP, the individual also tends to place less faith in the EAP’s ability to help
resolve problems.

When combining the two variables of perceived personal support/pressure and
perceived personal barriers to using an EAP into a new variable identiﬁed as Personal
Support/Pressure/Barriers and the two variables of perceived work support/pressure and
work barriers into a new variable called Work Support/Pressure/Barriers, the
correlations of these new variables with expectancy were positive and significant (both
at r = .14, p < .05). Thus, this suggests that the more perceived support to using an
EAP and the fewer barriers perceived, the more likely an individual was to also believe
the EAP would help. Roadblocks or barriers seem to be key factors inﬂuencing

exPectancy perceptions because if an individual obtains support from both work and

 

 

 

 

 

 

 

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personal sources, the individual may be more likely to believe the EAP will help as long
as the person perceives few hassles/barriers involved in using it. In fact, the effect of
perceived hassles on EAP usage again may be inﬂuenced by irrationality. The decision
making process associated with the health-related behavior (EAP usage) seems to be
compromised by emotions. Going to a doctor (or counselor) often includes a little fear
for many individuals. I can understand how perceptions of hassles (along with a belief
in chance controlling one’s health) could encourage employees to not perceive EAP
services to be of benefit and thus to not use EAP services. After all, for some
individuals, no news is good news.

In examining other significant correlations with expectancy, two additional
variables were found to be signiﬁcantly and positively related. An individual’s
perception of the health values and norms of members within his/her social group was
signiﬁcantly related to the expectancy that an EAP will help (r = .13, p < .05). The
more positive the health norms of those within one’s social group, the more the
individual tended to believe the EAP would help. It could be that discussing problems
and solutions with others inﬂuenced one’s belief that help was available. In addition,
expectancy and perceived discrepancy were significantly related (r = .13, p < .05) which
might suggest that when individuals perceived a discrepancy between their current and
desired health they may also have tended to believe the EAP could resolve this.

The only significant correlation between expectancy that the EAP will help and
the Health Locus of Control subscales, was the correlation with the Chance HLOC
subscale (r = ~.18, p < .01). Based on the relationship between expectancy and Chance
H LOC and between expectancy and the work and personal barriers variables, it appears

that if a person believes his/her health is a function of chance and also perceives barriers

 

 

 

 

217

to using an EAP, the person is less likely to believe the EAP will help. In addition, as
discussed above, the more positive the perceptions of the health norms and behaviors
of a person’s social group, along with the more encouragement received to go to an EAP
from both a person’s social and work group, the more likely the person was to believe
the EAP would help. So, why wasn’t a relationship found between expectancy and EAP
utilization? Perhaps the lack of a relationship may be due to the low test—retest
reliability of some of the items, as determined by the third pilot test (reliability of the

items in the expectancy measure ranged from .51 to .75).

Hypotheses #6 and #7: Effect of Personal Support/Pressure/Barriers and Work
Support/Pressure/Barriers on EAP Utilization

The final two hypotheses predicted a significant relationship between EAP
utilization and the two support/pressure/barriers variables. The first variable was
calculated by combining the personal support/pressure and personal barriers variables
into Personal Support/Pressure/ Barriers to examine the overall inﬂuence of support and
barrier factors in one’s personal life on EAP usage. The second variable was created by
combining the work support/pressure and work barriers variables into Work
Support/Pressure/ Barriers to examine the overall inﬂuence of support and barrier factors
perceived in one’s work situation. Results of the two regression analyses found both
variables to be signiﬁcantly related to EAP utilization. This coincides with other
researchers who have concluded that social pressure and attitudes are a key factor
inﬂuencing behavior (Ajzen & Fishbein, 1980; Anderson & Bartkus, 1973; Gottlieb &

Green, 1984; Hockbaum, 1958; Shephard, I985).

 

 

 

 

 

218

For example, Hockbaum (1958) found that social support was a decisive factor
leading to participation in a preventive tuberculosis screening. Hockbaum found that
individuals who voluntarily participated knew others who had also participated, while
those not participating knew fewer people who intended to participate or recalled
unfavorable discussions about the screening. Similarly, Shephard (1985) studied
employees participating and not participating in the General Foods Corporation fitness
program and found that participants had more social support from spouses and friends
than nonparticipants. Gottlieb and Green (1984) found that social support was positively
related to five positive health practices: smoking, exercise, alcohol use, weight
maintenance, and sleep. 1

The present research indicates that perceptions of support and/or pressure appear
to have a great impact on the utilization of EAP services. Given the fact that there was
little relationship between desired health goal level and EAP utilization (r = —.01, n.s.)
or between perceived discrepancy in health and EAP utilization (r = —.02, n.s.),
individuals in the sample who sought assistance at an EAP may have done so, not for
health enhancement purposes, but due to some overarching non-health reason.

In addition to the regression analyses, further examination was undertaken on the
relationships between the Personal and Work Support/Pressure/Barriers variables and
the other major variables in the model. For example, the Personal
Support/Pressure/Barriers variable was #signiﬁcantly and positively correlated to the
following four variables: Internal HLOC (r = .12, p < .05), perceived current health
problems (r = .14, p < .05), expectancy that an EAP will help (r = .14, p < .05), and
going to an EAP (r = .40, p < .01). In other words, a person tended to perceive more

SUpport and fewer barriers to using an EAP when the person also had an Internal

 

 

 

 

 

219

HLOC, perceived more current health problems, and believed the EAP would help. In
addition, the more a person perceived support and few barriers to using an EAP, the
more likely the person was to use an EAP.

Significant correlations were also found between Work Support/Pressure/Barriers
and other key variables of interest. These are: Internal HLOC (r = .15, p < .05),
Powerful Others HLOC (r = -.12, p < .05), Chance HLOC (r = -.13, p < .05), current
problems (r = .26, p < .01), social group health values/norms (r = .21, p < .01),
perceived discrepancy between current and desired health (r = -.16, p < .01),
expectancy that an EAP will help (r = .15, p < .05), and EAP utilization (r = .24, p <
.01).

With regard to the Health Locus of Control variables (Internal, Powerful Others,
and Chance), their relationships with Work Support/Pressure/Barriers might indicate that
an Internal HLOC is related to an individual perceiving a higher level of Work
Support/Pressure/Barriers (i.e., higher support and fewer barriers) while having an
External HLOC (Powerful Others or Chance) is related to an individual perceiving a
lower level of Work Support/Pressure/Barriers (i.e., less support and more barriers). The
Significant relationships outlined above indicate that individuals who perceive a higher
level of Work Support/Pressure/Barriers also tend to perceive more current health
problems, more positive health values/norms of members within their social group, a
more positive belief that an EAP will help, and have a greater likelihood of going to an
EAP.

The positive relationship between Work Support/Pressure/Barriers and perceived
level of current problems might suggest that a positive work environment could

potentially make it easier for individuals to recognize or identify health problems. The

 

 

 

220

fact that this relationship was higher between current problems and Work
Support/Pressure/Barriers (r = .26, p < .01) than with Personal
Support/Pressure/Barriers (r = .14, p < .05) might suggest that an individual is under
different types of pressures when sharing problems in a work environment versus a
personal environment. A supportive, barrier-free (regarding EAP usage) environment
might be one of the key elements toward improving EAP utilization. As discussed
earlier, it seems to be the employee’s perception of the absence of barriers (hassles) from
both personal and work environments that could signiﬁcantly inﬂuence EAP utilization.
It has also been suggested that support/pressure from work sources and personal
sources are separate constructs even though most research has incorporated them into
one global support construct (Broadhead et al., 1983; Bruhn & Philips, 1987; Mayer,
1988). Social support from personal sources has been found to inﬂuence participation
in health activities (Hammitt, 1984; Merriman, 1984; Snyder & Spreitzer, 1973). While
many have suggested that organizational factors such as management support are likely
to affect occupational health outcomes (Dickman & Emener, 1982; Glasgow & Terborg,
1988; Greenwood, 1983; Syme, 1986), Mayer (1988) has noted there has been little
examination of management support in health research and ”no empirical evidence that
management support has a significant effect on health promotion efforts at the work
site." However, there is available research on the importance of supervisors in the
effectiveness of alcohol—related programs (e.g., Trice & Roman, 1972) so that, although
individual decision making is often compromised by emotional factors, the role of the
organization and of management cannot be overlooked and additional research is

needed to examine their inﬂuence.

 

 

 

 

 

221

In examining just the personal support/pressure and work support/pressure
variables (without barriers) and their relationship with EAP utilization in the present
research, personal support/pressure was significantly correlated with utilization (r = -.23,
p < .05) while work support/pressure was not (r = .07, n.s.). As Mayer has suggested,
these may in fact be Separate constructs. Contrary to prior research (Antonovsky &
Kats, 1970; Blackwell, 1979; Champion, 1988), however, personal sources of
support/pressure did not have a positive inﬂuence on health behavior (EAP usage) but
rather these sources were negatively related to utilization. As discussed above, the
personal sources of support/ pressure measure was negatively related to EAP utilization
(1’ = -.23, p < .01) as was the personal barriers measure (r = -.46, p < .01).

Finally, the negative correlation between Chance HLOC and Work
Support/Pressure/Barriers is consistent with previous discussions anti seems to suggest
that since Chance HLOC is less inﬂuenced by the organization, a greater challenge to
organizations exists in attempting to understand other factors they may be able to

inﬂuence that encourage EAP utilization behavior.

Limitations and Future Research

 

Previous EAP research has examined primarily demographic variables of EAP
users to gain an understanding of what a typical profile of an EAP user resembles. Most
of the data gathered to date have focused on factors that can be obtained directly from
EAP records—gender, race, age, job status, income, etc. These factors offer little
understanding of why some employees utilize EAP services while others do not.
Furthermore, many of the conclusions reached on EAP participation factors have often

been inconclusive or contradictory.

 

 

 

 

 

 

 

222

The present research has contributed to prior research on EAP utilization in the
following ways. The research is based on the premise that EAP usage is a function of
a decision that is made by an individual to utilize EAP services. Simply studying the
means and variances of various demographic variables of EAP users, as conducted by
past researchers, does not aid in understanding this decision process. It is necessary to
better understand this decision process by examining factors which might inﬂuence the
decision. To aid in this understanding, the present research incorporated the following.
First, individual personality variables predicted to inﬂuence health attitudes and
behaviors were examined. Second, beliefs held by individuals which were hypothesized
to be critical in making a decision regarding EAP utilization were analyzed-in
particular, beliefs examining expectations regarding the EAP’s ability to improve one’s
health, beliefs about the health consciousness of one’s social group, and beliefs about
one’s health-related goals were explored. Third, a control theory framework was
developed to provide a structure to studying the EAP decision process. The potential
inﬂuences were incorporated into a control theory model which was based on the
concept of a standard or goal being used as a reference value in a process where sensed
information about one’s current state is compared to this standard or goal. If a
discrepancy between the goal and current state existed, it was predicted that a force is
created that motivates an individual to reduce the discrepancy (e.g., to seek EAP
assistance).

The present research also went beyond past EAP utilization research by not only
including EAP users in the sample (as past research has done) but also individuals who
had not used EAP services despite the fact that these non-EAP users may have had

problems that EAP’s could provide assistance on. Thus, the dependent variable was

 

 

 

 

223

expanded to include EAP usage and non-usage so a better understanding of factors
inﬂuencing this decision might be obtained. In addition, a positive factor in measuring
the dependent variable, EAP usage, is that this behavior was measured in two ways--via
a self-report measure as well as via EAP records--so verification of usage/non-usage was
able to be undertaken.

While the above presents some contributions to EAP utilization research, there
are some limitations to the present research which should be considered when examining
the results of this study. First, the research was conducted with employees who were all
members of one of five unions included in the sample. Thus, the generalizability of the
results to other employees who are non-union may be questionable. However, while the
sample selected may have been limited to the unions included in the research, on the
positive side is the fact that the unions represented positions that included clerical,
maintenance, technical, and supervisory occupations. In addition, the overall return rate
was excellent at 47%, which was well represented by both EAP users (with a 59% return
rate) and non‘EAP users (with a 42% return rate).

A second limitation to the research may be the setting under which the present
study was undertaken. All employees included in the sample had equal access to an on-
site (internal) EAP which had ofﬁces lo'cated on the premises of the organization. The
extent the results are generalizable to external or contracted-out EAPs is uncertain.

A third potential limitation is that the model in Figure 9 cannot be fully tested
(from left to right) using causal modeling techniques. Because the model developed is
a flow model rather than a causal model, it was not possible to directly examine
relationships among all the control theory components (i.e., health goals, feedback on

health status, discrepancy) and EAP utilization. While some of the components within

 

 

 

 

 

 

 

 

 

224

the model might be useful conceptually in guiding future research on EAP utilization,
at the present time the relative usefulness of utilizing a control theory framework to
examine EAP usage behavior is questionable. Because human behavior tends to be goal
directed, the present study predicted that a perceived discrepancy between an
individual’s desired health and current health state would motivate the person to reduce
this discrepancy. The goal that was examined as the basis for motivating an individual
to improve his/her health was a person’s desired health goal level. However, the present
study found no relationship (at least correlationally) between desired health goal level
and EAP utilization so the idea that an individual’s health goal directs his/her behavior
may not be the apprOpriate goal to examine. Also, as previously discussed, the present
research also indicated that it may be difficult to obtain variance on the desired health
goal measure. Thus, it is unlikely that a control theory model of EAP utilization that
is guided by a discrepancy between a person’s desired and current health state will
contribute much to understanding this decision process. Since control theory is based
on the concept of behavior being goal-directed, the use of this theory may still be
relevant in examining health-seeking behaviors if we can determine the proper goal that
is driving this behavior. Future research might focus on trying to understand the specific
factors or goals involved; that is, exactly what goal the individual is attempting to attain
when seeking EAP assistance--the one to be healthy or the one to avoid a negative
consequence?

The present research suggests some interesting findings regarding the variables
examined. For example, much of the past research has indicated that inﬂuences from
others regarding their attitudes, beliefs, norms, etc. have a signiﬁcant effect on an

individual’s own beliefs, attitudes and behaviors (e.g., Haskell & Blair, 1980; Loy,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

225

McPherson & Kenyon, 1978; wynne, 1986). However, the present research suggests that
social inﬂuences alone may have little inﬂuence on health goals and on a speciﬁc health
behavior-EAP utilization. This may be because individual characteristics/personality
traits may have more of an inﬂuence on usage than has previously been examined. For
example, the control issue seems to be important as it relates to EAP utilization. An
individual’s decision to seek help seems to be inﬂuenced by his/her perception of who
primarily controls one’s health (internal forces or external forces of chance/luck) as well
as personal and work-related factors. The issue of control arises not only with regard
to control over one’s health (i.e., Health Locus of Control) but also control over the
situation. For example, while the belief that luck or chance controls one’s health can
inﬂuence non-EAP utilization behavior, is there a point where the support/pressure from
one’s boss or spouse encourages (forces) the employee to seek EAP services despite this
belief in “chance” (e.g., the threat of losing one’s job or the threat of divorce)? Also,
in addition to the Health Locus of Control subscales, there may be other individual
characteristics that significantly affect EAP usage which might be examined in the future
(e.g., coping style, degree of self-focus).

The issue of inﬂuence from others requires future study in several other areas.
In the present research, the social group health values and norms measure was not
Significantly related to health goals. However, this does not necessarily imply these
factors don’t inﬂuence other health—related beliefs or behaviors. The social group health
values/norms measure was found to be signiﬁcantly correlated with (1) believing others
control one’s health (i.e., Powerful Others HLOC), (2) the individual’s perception of
his/her current health status, and (3) the belief that an EAP will be helpful. Therefore,

social inﬂuences may still be important in inﬂuencing other attitudes and behaviors.

 

 

 

 

 

 

 

 

 

226

Since one of the organization’s goals is to encourage EAP usage among "troubled"
employees, further research examining how employees are potentially inﬂuenced by

others in the health area should be examined.

Summary

Organizations have recognized that troubled employees cost the organizations
more in the long—run than if the employees’ problems were diagnosed and treated early.
Employees who have personal, social, emotional, and other problems are less productive
and have higher illness, absenteeism, accident, and disability rates. Therefore, it is in
the organizations’ own best interest to understand factors that encourage troubled
employees to seek or not seek assistance. The assistance examined in the present
research focused on Employee Assistance Programs.

The purpose of the present research was twofold: to develop a control theory
framework that might be useful in guiding future EAP utilization research and to test
this conceptual framework. The model incorporated variables that have previously not
been examined in EAP utilization research. Health history and social group health
values and norms were found to have no signiﬁcant inﬂuence on health goals. While not
all hypotheses were fully supported, in general the perception of who (self or others) or
what (chance or luck) controls one’s health seems to be an important variable
inﬂuencing both health goals and EAP utilization. In addition, the combined effects of
Support/pressure and barriers had a significant impact on EAP usage. However, the
expectancy or belief that an EAP can help reduce/resolve health problems was found to
have no significant impact on seeking EAP assistance. Explanations as to why these

results may have occurred were offered.

 

 

 

 

 

 

 

 

 

227

An individual’s perception of control, support, pressure and barriers, like
anyone’s perception, appears to be a complicated phenomenon. No single variable is
robust enough to predict EAP participation alone. Cultural, social, psychological and
other variables all interact to inﬂuence health behavior. EAP utilization is a
complicated decision-making process and organizations face a challenge when attempting
to determine how they might inﬂuence this behavior. By examining a combination of
variables, we may significantly increase the ability to explain participation factors.
Future research is necessary to examine the separate and combined effects of Health
Locus of Control and social inﬂuences from both personal and work environments on

EAP utilization.

 

 

 

 

 

 

 

 

LIST OF REFERENCES

 

 

 

 

 

 

 

LIST OF REFERENCES

Abdellah, F ., & Levine, E. (1979). Better patient care through nursing research (2nd
ed.). New York: Macmillan Publishing Company.

Adams, S. L. (1959). Health misconceptions among students enrolled in freshmen health
classes at the University of Oregon. (Master’s thesis, University of Oregon.)

Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social

behavior. New Jersey: Prentice-Hall.

Akabas, S. H., Kurzman, P., & Kolben, N. (1979). Labor and industrial settings: Sites
for social work practice. New York: Industrial Social Welfare Center, CUSSW.

Albert, W. C., Smythe, P. C., & Brook, R. C. (1985). Promises to keep: An evaluator’s

perspective on employee assistance programs. Evaluation and Pro am Plannin , _8_,
175-182.

Albrecht, S. L., & Goldman, P. (1985). Men, women, and informal organization in
manufacturing. Sogiological Focus 18 279-288.

)—9

Alderman, M. (1984). Worksite treatment of hypertension. In J. D. Matarazzo, S. M.
Weiss, J. A. Herd, N. E. Miller, & S. M. Weiss (Eds), Behavioral health: A

handbook of health enhancement and disease prevention (pp. 862-869). New York:
Wiley.

Alheim, W. R. (1973). An analysis of the effectiveness of traditional teaching, team
teaching, and contract teaching methods of basic health education to junior college
students. (Doctoral dissertation, The Florida State University.)

Allen, J. S., & Allen, R. F. (1986). Achieving health promotion objectives through
cultural change systems. American Journal of Health Promotion, 1, 42-29.

Anderson, J. G., & Bartkus, D. E. (1973). Choice of medical care: A behavioral model
of health and illness behavior. Journal of Health & Social Behavior 14 348-362.

’—)

Antonovsky, A., & Kats, R. (1970). The model dental patient--An empirical study of
preventive health behavior. Social Science and Medicine, 4, 367-380.

228

 

 

 

 

 

 

 

 

 

 

229

Applebaum, S. (1982). A human resource counseling model: The alcoholic employee.
Personnel Administrator, 21(8), 35-44.

Archer, R. L., Hormuth, S. E., & Berg, J. H. (1979). Self-disclosure under conditions
of self-awareness. Paper presented at the annual meeting of the American
Psychological Association, New York.

Asma, F., Eggert, R., & Hilker, R. (1971). Long-term experience with rehabilitation of
alcoholic employees. Journal of Occupational Medicine, 12, 581—585.

Attitudes toward co-Operation in a health examination survey. Public Health Service

Series D, No.6, US Department of Health, Education, and Welfare: Health Statistics.

Babbage, C. (1835). On the economyof machinery and manufacturers (4th ed.).
London: Charles Knight.

Balch, P., & Ross, A. W. (1975). Predicting success in weight reduction as a function of
locus of control: A unidimensional and multidimensional approach. Journal of

Consulting and Clinical Psychology, 43, 119.

Bandura, A. (1971). Social learnipg theory. New York: General Learning Press.

Bandura, A. (1977a). Self-efficacy: Toward a unifying theory of behavioral change.
Psychological Review, 84, 191-215.

Bandura, A. (1977b). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.

 

Bandura, A. (1982). Self-efficacy mechanism in human agency. American limholtngist,
3_7_, 122-147.

Bandura, A., & Cervone, D. (1983). Self-evaluation and self-efficacy mechanisms
governing the motivational effects of goal systems. Journal of Personalit and Social
Psychology 45 1027-1028.

,—7

Bandura, A., & Walters, R. (1963). Social learning and personality development. New
York: Holt, Reinhart, and Winston.

Barker, J. W. (1987). Perceived wellness needs of university employees and variations
in relation to personal and employment characteristics (Doctoral Dissertation, North

Carolina State University). Diss rt tion Abstracts Intern tional, ﬂ(02),SECA, 204.

Baughman, M. K. (1978). The relationship of locus of control and value beliefs to health
status and behavior among clerical workers. (Doctoral dissertation, University of

Cincinnati, 1978). Dissertation Abstracts International, 3, 5217A-5218A.

Baxter, A. K. (1976, Oct—Nov). University employees as people: A counseling service

for faculty and staff. College and University Personnel Assoeiation Journal, 2i, 44-

49.

 

 

 

 

 

 

230

Baxter, J. (1978). Employee assistance programs in historical perspective: The melding
of economics and- humanlconcerns. Conference Proceedings, August 7-9, 1977,

Employee Assistance Programs in Higher Education. Columbia: University of
Missouri and NIAAA.

Baxter, J. (1981, March/April). The dollars and sense of EAPs. Alcoholism Magazine,
pp. 29-30.

Beer, M. (1980). Organization change and development. Glenview, IL: Scott, Foresman.

Bellack, H. S., Rozensky, R., & Schwartz, J. (1974). A comparison of two forms of self-

monitoring--a behavioral weight reduction program. Behavior Therapy, 5(4), 523-
530.

Belloc, N. B. (1973). Relationship of health practices and mortality. Preventive
Medicine, 2, 67-81.

Belloc, N. B., & Breslow, L. (1972). Relationship of physical health status and health
practices. Preventive Medicine, 1, 409-421.

Bellows, R. (1961). Psychology ofﬁpersonnel in business and industry (3rd ed).
Englewood Cliffs, NJ: Prentice—Hall, Inc.

Berry, R. E., & Boland, J. P. (1977). The work-related costs of alcohol abuse. In C. J.
Schramm (Ed.), Alcoholism and its treatment in industry (pp. 37-48). Baltimore:
Johns Hopkins University Press.

Besch, C., Boyle, G., Gott, S., Hutchinson, K., et al. (1977). A consumer look at EAP’s:
University of Missouri—Columbia personnel, faculty, union, state OPC. Conference

Proceedings, August 1-3, 1976, Employee Assistance Programs in Higher Education.
Columbia: University of Missouri and NIAAA.

Best, J. A. (1975). Tailoring smoking withdrawal procedures to personality and
motivational differences. Journal of Consultin and Clinical Ps cholo ,4;(1), 1-8.

Beyer, J., & Trice, H. (1978). Implementing change: Alcoholism policies in work
organizations. New York: MacMillan.

Bierman, M. E. (1981). Characteristics of selected Wisconsin EAP’s. In EAP Digest
Annual 1981-1982, Troy, MI: Performance Resource Press.

Birkland, S. P. (1983). Staffing employee assistance programs. EAP Di est, 3(4), 24-27.

Blackwell, B. (1979). Treatment adherence: A contemporary overview. W,
20, 27-35.

Blau, P. M., & Scott, R. W. (1962). Formal or anization: A com )arative a roach. San
Francisco: Chandler.

 

 

 

 

 

 

 

 

231

Bloom, S. (1986). Employee assistance programs: The structure of counseling
applications withinorganizational settings. (Doctoral dissertation, Southern Illinois
University at Carbondale).

Borsky, P. N., & Sagan, O. K. (1959). Motivations toward health examinations.
American Journal of Public Health, _4_9_, 514-527.

Bowler, E. M. & Dawson, F. T. (1948). Counseliagyemﬁployees. New York: Prentice—
Hall, Inc.

Brandes, S. D. (1976). American welfare capitalism 1880-1940. Chicago: The University
of Chicago Press.

Brewer, L. 8., & McAvoy, K. (1986). St. Mary’s bridges the EAP stigma gap. E P
Digest, _6_, 80.

Breznitz, S., & Goldberger, L. (1982). Stress research at a crossroads. In L. Goldberger
& S. Breznitz (Eds), Handbook of stress (pp. 1-6). New York: Free Press.

Brim, O. G., Jr. (1968). Adult socialization. In J. A. Clausen (Ed.), Socialization and
society. Boston: Little, Brown, and Co.

Brink, S. D. (1983). Deﬂating health care costs. Business Insurance, 11(52), 17-18.

Broadhead, W. E., Kaplan, B. H., James, S. A., Wagner, E. H., Schoenbach, V. J.,
Grimson, R., Heyden, S., Tibblin, G., & Gehlbach, S. H. (1983). The epidemiologic
evidence for a relationship between social support and health. WW

Epidemiology, 1g, $21-$37.

Brockner, J. (1979). The effects of self-esteem, success-failure, and self—consciousness
on task performance. Journal of Personality and Social Psychology, 32, 1732-1741.

Brodsky, C. M. (1977). Long term work stress in teachers and prison guards. Journal
of Oceupational Medicine, 19, 133.

 

Brown, B. S. (1973). Forward. In Hyman J. Weiner, Sheila Akabas, & John J. Sommer
(Eds), Mental health care in the world of work. New York: Association Press.

Brown, R. C. (1983). Industrial Chaplaincy in America--a profile. Research paper for
the National Institute of Business and Industrial Chaplains, Ridgecrest, NC, 1981.
Winston-Salem, NC: R. J. Reynolds Industries.

Bruhn, J. G., & Cordova, F. D. (1977). A developmental approach to learning wellness
behavior part I: Infancy to early adolescence. Health Values: Achieving High-Level
Wellness, 1(16), 246-254.

Bruhn, J. G., Cordova, F. D., Williams, J. A., & Fuentes, R. G. (1977). The wellness
process. Journal of Community Health, 2, 209—221.

 

 

 

 

 

 

 

232

Bruhn, J. G., & Philips, B. U. (1987). A developmental basis for social support. Journal
of Behavioral Medicine,_1_Q, 213-229.

 

Burawoy, M. (1979). Manufacturing consent: Changes in the labor process under
capitalism. Chicago: University of Chicago Press.

Bureau of National Affairs (BNA). (1974). Personnel policies, (No.. 333), Washington,
D. C.: U.S. Government Printing Ofﬁce, _2__4_5_: 151-1452154.

Bureau of National Affairs (BNA). (1983). Controlling health care costs: Crisis in
employee beneﬁts. Washington, DC: Author.

Bureau of National Affairs (BNA). (1987). Employee assistance programs: benefits,
problems, and prospects (BSP 59). Washington, DC: The Bureau of National Affairs,

Inc.

Bureau of the Census. (1986). Statistical abstract of the United States: 1986.
Washington, DC: U. S. Government Printing Office.

Busch, E. J. (1981). Developing an employee assistance program. Personnel Journal,
60, 708-71 1.

Cahill, M. H. (1983). Tailoring EAP services to organizational needs. EAP Di est, 3(4),
32-35.

Campion, M. A., & Lord, R. G. (1982). A control systems conceptualization of the goal-

setting and changing process. Organizational Behavior and Human Performance, 30,
265-287.

Caplan, R. (1976). Adhering to medical regimens: Pilot experiments inypatient
education and social support. Ann Arbor: The University of Michigan, Institute for
Social Research.

Caplan, R D., Cobb, 8., French, J. R. P., Harrison, R. V., & Pinneau, S. R. (1975). Job

u—

demands and worker health. U.S. Department of Health, Education and Welfare,
HEW Publication No. (NIOSH) 75-160.

Caplan, R. D., Robison, S. A. R., French, J. R. P., Caldwell, J. R., & Shinn, M. (1976).
Adhering to medical regimen. Ann Arbor: University of Michigan.

Carr, J. L., & Hellan, R. T. (1980). Improving corporate performance through employee
assistance programs. Business Horizons, 2_3(2), 57-60.

Carver, C. S. (1974). Facilitation of physical aggression through objective self-awareness.

Journal of Experimental Social Psychology, m, 365-370.

 

 

 

 

 

 

 

 

 

 

233

Carver, C. S. (1975). Physical aggression as a function of objective self-awareness and

. . attitudes towardpunishment- Journalof Experimental Social Psychology, _1_1,, 510-
519.

Carver, C. S. (1979). A cybernetic model of self-attention. Journal of Personality and
Social Psychology, 31, 1251-1281.

Carver, C. S., Blaney, P. H., & Scheier, M. F. (1979a). Focus of attention, chronic
expectancy, and responses to a feared stimulus. Journal of Personality and Social
Psychology, 31, 1186-1195.

Carver, C. S., Blaney, P. H., & Scheier, M. F. (197%). Reassertion and giving up: The
interactive role of self-directed attention and outcome expectancy. Journal of

Personality and Social Psychology, 3_7_, 1859-1870.

Carver, C. S., & Scheier, M. F. (1981). Attention and self-regulation: A control theory
approach to human behavior. New York: Springer-Verlag.

Carver, C. S., & Scheier, M. F. (1982). Control theory: A useful conceptual framework

for personality-social, clinical, and health psychology. Psychological Bulletin, ﬂ,
111—135.

Cascio, W. F. (1986). Managing human resources: Productivi_ty.10ruality of work life,
m. New York: McGraw-Hill Book Co.

Cassel, J. (1976). The contribution of social environment to host resistance. American
Journal of Epidemiology, 113(2), 107-23.

Castro, J. (1986, March 17). Battling the enemy within: Companies ﬁght to drive illegal
drugs out of the workplace. Time, pp. 52-61.

Champion, P. S. (1988). A comparison of telephone and face-to-face intervention within
an employee assistance program (Doctoral dissertation, California School of
Professional Psychology, Berkeley).

Christiansen, K. E. (1981). The determinants of health promoting behavior (Doctoral
dissertation, College of Nursing, Rush University).

Clausen, J. A. (1968a). Socialization as a concept and as a field of study. In J. A.
Clausen (Ed), Socialization and society. Boston: Little, Brown, and Co.

Clausen, J. A. (1968b). Perspectives on childhood socialization. In J. A. Clausen (Ed.),
Socialization and society. Boston: Little, Brown, and Co.

Coan, R. W. (1973). Personality variables associated with cigarette smoking. Journal of
Personali and Social Ps holo , _2_(_)(1), 86-204.

 

 

 

 

 

 

 

 

 

 

 

234

Coburn, D., & Pope, C. (1974). Socioeconomic status and preventive health behavior.
Journal of Health and Social Behavior, 1_5__, 67-78.

Cohen, J., & Cohen, P. (1983). Analysis for the behavioral sciences. Hillsdale, NJ:
Lawrence Erlbaum Associates.

Cohen, S., & Hoberman, H. (1983). Positive events and social supports as buffers of life

change stress. Journal of Applied Social Psychology, _13, 99-125.

Cohen, 8., & Syme, S. L. (Eds). (1985). Social support and health. New York:
Academic.

Coleman, T. L., Jr. (1984). A study of the nature, content, and process of employee
assistance programs at selected higher education institutions (Doctoral Dissertation,
North Texas State University). Dissertation Abstracts International, 43(03), SECA,
759.

Compcare. (1981). Employee assistance program: A dollar sense issue. Newport Beach,

CA: Comprehensive Care Corporation.

C00per, C. L. (1981). The stress check: Cogingwith the stresses of life and work.
Englewood Cliffs, NJ: Prentice-Hall.

County of Alameda, California, Division of Occupational Health Services Personnel

Department. (1978, May 30). Evaluative study of the Alameda County EAP and
occupational health services, Inc.. Alameda, CA: Author.

Crockett, W. (1977). Introducing change to a government agency. In P. Mirvis & D.
Berg (Eds), Failures in organizational development: Cases and essays for learning
(pp. 201-219). New York: Wiley—Interscience.

Cromidas, C. A. (1987). Some aspects of compliance in an employee assistance program
(Master’s Thesis, University of Texas at Arlington). Masters Abstracts International,
26(04), 386.

Crookston, B. B. (1975). Human development: Actualizing people in actualizing

organizations. ,loarnal of College Student Personnel, 16(5), 368—375.

DeFuentes, N. (1986). A study of implementation and evaluation of an aerospace
employee assistance program (Doctoral dissertation, California School of Professional
Psychology, Los Angeles). Dissertation Abstracts International, _4_7(05), SECA, 2209.

Delaney, T. (1983, October). Executive director’s comment. The ALMACAN,_13(10),
2.

DHHS (Department of Health and Human Services). (1982, March). Re ort to the U.S.

Con ress on fed ral activities on alcohol abuse and alcoholism FY 1980. Rockville,
MD: NIAAA.

 

 

 

 

 

 

 

 

 

 

 

 

235

Dickman, F., & Emener, W. G. (1982). Employee assistance programs: Basic concepts,
. attributes, and an evaluation. Personnel Administrator, 2_2, 55-62.

DiMarco, C. A. (1985). An examination of the existing relationships among specific
health behaviors, health locus of control, stress manifestations, extra-curricular
activities and selected demographics within a university population (Doctoral
dissertation, Pennsylvania State University).

Drucker, P. E. (1974). Management tasks, responsibilities and practices. New York:
Harper and Row.

Dubos, R. J. (1965). Man adapting. New Haven, CT: Yale University Press.

Dunkin, W. (1981, March/April). The EAP movement, past and present. Alcoholism
Magazine, pp. 27-28.

Dunn, D. A. (1980). The relationship of health locus of control and health value to
medical self-care knowledge and attitudes of undergraduate and graduate health
education majors in Oregon (Doctoral dissertation, University of Oregon).

DuPont, R. (1979, January 17-19). The control of alcoholism and drugabuse in
industry. Background paper written for the National Conference on Health
Promotional Programs in Occupational Settings. Washington, DC: Department of
Health, Education and Welfare.

Duval, S. 1., Wicklund, R. A., & Fine, R. L. (1972). Avoidance of objective self-
awareness under conditions of high and low intra-self discrepancy. In S. Duval &
R. A. Wicklund (Eds), A theorypf opjective self-awareness. New York: Academic
Press.

Eaton, W. W. (1978). Life events, social support, and psychiatric symptoms: A re-
analysis of the New Haven data. Journal of Health and Social Behavior, 19(2), 230-4.

Egdahl, R. H., & Walsh, D. C. (1980). Mental wellness programs for employees. New
York: Springer-Verlag, Inc.

E. mployee assistance program services for faculty and staff employees of Michigan State
University (1990). Annual Report July 1, 1989 - June 30, 1990. East Lansing, MI:

Employee Assistance Program.

Employee health-care costs rose 7.9% in 1987. (1988, Feb. 10). Lo An eles Times, sec.
4, 17.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine.
Seience, 126, 129-136.

Erez, M. (1977). Feedback: A necessary condition for the goal-setting-performance
relationship. ournal of A )Ii d Ps holo , 6_2_, 624-627.

 

 

 

 

 

 

 

236

Erfurt, J. C., & Foote, A. (1977). Occupational employee assistance programs for
substance abuse andmental health problems. Ann Arbor, MI: The University of

Michigan--Wayne State University.

Everly, G. S. (1984). The develOpment of occupational stress management programs.

In G. S. Everly & R. H. G. Feldman (Eds), Occupational health promotion (pp. 49-
73). New York: Wiley.

Everly, G. S., & Feldman, R. H. G. (Eds). (1984). Occupational health promotion.
New York: Wiley.

Fabrega, H. (1974). Disease and social behavior: An interdisciplinaryperspective.
Boston: MIT Press.

F abricatore, J. M., & Rogal, R. A. (1984). Employee assistance programs: Psychological,
organizational and professional considerations. Report of the task force on EAPs.
Los Angeles, CA: California State Psychological Assn.

Farber, L. R. (1982). Giving employees in crisis what they need. Supervisory
Management, 11(1), 34-39.

Feather, N. T. (1966). Effects of prior success and failure on expectations of success and
subsequent performance. Journal of Personality and Social Psychology, 3, 287-298.

Feather, N. T. (1967). Level of aspiration and performance variability. Journal of
Personality and Social Pchhology, p, 37-46.

Feather, N. T., & Saville, M. R. (1967). Effects of amount of prior success and failure
on expectations of success and subsequent task performance. Journal of Personality

and Social Psychology, _5_, 226-232.

Featherston, H. J., & Bednarek, R. J. (1981). A positive demonstration of concern for
employees. Personnel Administrator, 23(9), 43—47.

Felix, M. R., Stunkard, M. D., Cohen, R. Y., & Cooley, N. (1985). Health promotion at
the worksite. Preventive Medicine 14 99-108.

7—,

Fenigstein, A., Scheier, M. E., & Buss, A. H. (1975). Public and private self-
consciousness: Assessment and theory. Journal of Consultin and Clini al
Psychology, 43, 522-527.

Fever, B. (1983). A peer referral model that works. EAP Di est, 3(4), 36-37.

Fielding, J. E. (1984a). Corporate health management. Reading, MA: Addison-Wesley.

Fielding, J. (1984b). Health promotion and disease prevention at the worksite. Anpug]
Review P Ii He lth, 3, 237-65.

 

 

 

 

 

 

 

 

237

Fisch, M. (1974). Internal versus external ego orientation and family planning
effectiveness among poorblackwomen. . Dissertation Abstracts International, 33(2-
B), 1045-1046.

F ishbein, M. (1966). The relationships between beliefs, attitudes and behavior. In S.

Feldman, (Ed.), Cognitive consistency: Motivational antecedents and behavioral
consequents (pp. 199-223). New York: Academic Press.

Fisher, G. L. (1983). Employee counseling programs and related services in the public

sector. In J. S. Manuso (Ed.) Oceupational clinical psychology. New York: Praeger
Publishers.

Fly, R. D. (1980). Why rotating shifts sharply reduce productivity. Supervisoﬁry
Management, 23(1), 16—21.

Follman, J. F. (1978). Helping the troubled employee. New York: Amacon.

Foote, A., Erfurt, J., Straugh, P., and Guzzardo, T. (1978). Cost effectiveness of
occupational EAPs. Ann Arbor, MI: University of Michigan, Institute of Labor and
Industrial Relations.

Ford, R. C., & McLaughlin, F. S. (1981). Employee assistance programs: A descriptive
survey of ASPA members. Personnel Administrator, 2_6,(9), 29-35.

Forrest, D. V. (1983). Employee assistance programs in the 1980’s: Expanding career
options for counselors. Personnel and Guidance Journal, 32(2), 105-107.

Frank, L. L., & Hackman, J. R. (1975). A failure of job enrichment: The case of the
change that wasn’t. Journal of Applied Behavioral Science, 1_1, 413-436.

French, J. R. P., Caplan, R. D., & Van Harrison, R. (1982). The mechanisms of job
stress and strain. New York: Wiley.

 

French, W. L., & Bell, C. H. (1984). Organization development. Englewood Cliffs, NJ:
Prentice-Hall.

Gam, J., Sauser, W. 1., Evans, K. L., & Lair, C. V. (1983). Implementing an employee
assistance program. Journal of Employment Counseling, 20(2), 61—69.

Ganster, D. C., Mayes, B. T., Sime, W. E., & Tharp, G. D. (1982). Managing

organizational stress: A field experiment. Journal of A lied Ps cholo , 6_7, 533-
542.

Gelso, C. J., and Johnson, H. D. (1983). Explorations in time-limited counseling and
psychotherapy. New York: Teachers College, Columbia University.

General Mills American Family Forum. (1980, May 13). Private sector initiatives to
romote ment l h lth. Washington, DC: Author.

 

 

 

 

 

 

 

 

 

238

Gibbons, F. X. (1978). Sexual standards and reactions to pornography: Enhancing
behavioral consistency through self-focused attention. Journal of Personality and
Social Psychology 36 976-987.

’—-—,

Glasgow, R., & Terborg, J. R. (1988). Occupational health promotion programs to
reduce cardiovascular risk. Journal of Consulting and Clinical Psychology, 53, 365-
373.

Glasser, M. A. (1969, November). Prepaid psychiatric care experience with UAW
members. American Journal of Psychiatry.

Goldman, P. (1983). The labor process and the sociology of organization. Perspectives
in organizational sociology; Theory and researeh, 2, 49-81.

Goodstadt, M. 8., Simpson, R. I., & Loranger, P. D. (1987). Health promotion: A
conceptual integration. American Journal of Health Promotion 1 58-63.

2—7

Googins, B. (1975). Employee assistance programs. Social Work, 23(6), 464-467.

Googins, B. (1984). EAP: An ecological perspective. In H. Grimes (Ed.), EAP
Research. Troy, MI: Performance Resource Press, Inc.

Googins, B. (1987). Occupational social work. Englewood Cliffs, NJ: Prentice-Hall.

Googins, B., & Kurtz, N. (1980). Factors inhibiting supervisory referrals to occupational
alcoholism intervention programs. Journal_of Studies on Alcohol, 4_Q, 1196—1208.

Googins, B. & Kurtz, N. (1981). Discriminating participating and nonparticipating
supervisors in occupational alcoholism programs. Journal of Dru 'Issues,2, 199-216.

Gordon, G. A. (1973). Occupational programming. Michi an Challen *e, HQ), 27-28.

Goslin, D. A. (Ed.) (1969). Handbook of socialization theory and research (pp. 1-19).
Chicago: Rand McNaIIy.

Gottlieb, B. (1982). Social support in the workplace. In D. Biegel and A. Naperstek
(Eds), Community support systems and mental health. New York: Springer.

Gottlieb, N. H., & Green, L. W. (1984). Life events, social network, life-style, and
health: An analysis of the 1979 national survey of personal health practices and

consequences. Health Education Quarterly, ﬂ“), 91-105.

Gould, G., & McKenzie, C. (1984). The expanding scope of industrial social work. In
E. McBroom (Ed.), Social Work Papers, Vol. 18. Los Angeles, CA: School of Social
Work, University of Southern California.

Gouldner, A. W. (1954). Patterns of industrial bureaucracy. New York: Free Press.

 

 

 

 

 

 

239

Graham, R. S. (1984). The corporate medical department: History of the development
-of, occupational healthprogramsandan overviewof. the future. .InrJ. Manusco (Ed.),
Occupational Clinical Psychology. New York: Praeger Publishers.

Gramse, C. A. (1982). The relationship of internal-external health expectencies, value
of health, health beliefs and health behavior regarding breast self-exam in women
(Doctoral dissertation, New York University, 1982). Dissertation Almtracts
International 43 385-8.

,—-,

Green, L. (1970). Status identity and preventive health behavior. Pacific Health
Education Reports, 1, 1-18.

Greenwood, M. (1983). Communicating EAPs. EAP Digest, 3(4), 30-31.

Grimes, C. H. (1980). A needs assessment for a faculty/employee assistance program in
the Florida State University system (Doctoral dissertation, Graduate School of the
University of Florida). Dissertation Abstracts International, 4_2_(02), SECA, 568.

Hall, D. (1983, June 20). Helping employees treat problems of drugs and alcohol. New
England Business, 3(11), 52-53.

Hammitt, S. A. (1984). The inﬂuence of social group, past experience, and attitude on
participation and nonparticipation in sports and physical activities (Doctoral
dissertation, University of Tennessee). Dissertation Abstracts International, 4_5(02),
SECA, 452.

Harvey, A. (1976). Risky and safe contraceptors: Some personality factors. Journal of
Psychology, _92, 109-112.

Haskell, W. L., & Blair, S. N. (1980). The physical activity component of health
promotion in occupational settings. WW, 9_5, 109-118.

Hayghe, H. (1984). Research summaries. Monthly Labor Review, 31-33.
Herring, R. A. (1987). Change in work related attitudes among alcoholics in an
employee assistance program: An empirical investigation (Doctoral dissertation, The

Florida State University).

Hirsch, B. J. (1980). Natural support systems and coping with major life changes.
American Journal of Community Psychology, 8(2), 159-72.

Hobson, G. W. (1982). Utilizing the systems approach to develop, implement, and
evaluate an employee assistance program (Doctoral dissertation, Union for

Experimenting Colleges and Universities). Dissertation Abstracts International, ﬂ,
2029.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

240

Hochbaum, G. M. (1958). Public participation in medical screening programs: A
sociological study. -. Public HealthService, PHS Pub. #572, U.S. Government
Printing Office.

Hoffman, E. & Roman, P. (1984). Effects of supervisory style and experientially based
frames of reference on organizational alcoholism programs. Journal of Studies on
Alcohol, 4_5_(3), 260-267.

Holden, C. (1973, January). Alcoholism: On the job referrals mean early detection,
treatment. Science, 179, 363-365.

Hollenbeck, J. R. (1989). Control theory and the perception of work environments: The
effects of focus of attention on affective and behavioral reactions to work.

Organizational Behavior and Human Decision Processes, 43, 406-430.

Hollenbeck, J. R., & Brief A. P. (1987). Self-regulation in the workplace: Towards a
uniﬁed approach to understanding worker attitudes and behaviors. In R. Schuler

(Ed.), Readings in Personnel and Human Resource Management. St. Paul, MN:
West Publishing.

Hollenbeck, J. R., & Brief A. P. (1987). The effects of individual differences and goal

origin on goal setting and performance. Organizational Behavior and Human
Decisien Processes 40 392-414.

7—-—)

Hollenbeck, J. R., Ilgen, D. R., Crampton, S. M. (1990). Lower back disability in

occupational settings: A focus on the management of prevention, treatment, and
recovery. Unpublished manuscript, Michigan State University, Department of

Management, East Lansing, MI.

Hollenbeck, J. R., & Williams, C. R. (1987). Goal importance, self-focus, and the goal-
setting process. Journal of Applied Psychology, 22, 204-211.

House, J. S. (1974). Occupational stress and physical health. In J. O. O’Toole (Ed.),
Work and th ualit of lif : Resource a ers for work in Americ (pp. 147-170).

Cambridge, MA: MIT Press.
House, J. S. (1981). Work stress and social support. Reading, MA: Addison-Wesley.

Howe, C. (1983). Establishing employee recreation programs. Journal of Physical
Education Recreation and Dance, _5_4, 34-52.

 

Hoye, J. C. (1965). Pre-test and post-test of health information possessed by students
enrolled in the course health information for teachers (Master’s Thesis, University
of Wisconsin).

Hung, K. K. (1988). Factors in employee assistance program usage (Master’s Thesis,
California State University). Mas r A str t In rn ti n l,21(03), 416.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

241

Ilgen, D. R. (1990). Health issues at work: Opportunities for industrial/organizational
psychology. American Psychologist, 43, 273—283.

Ilgen, D. R., Nebecker, D. M., & Pritchard, R. R. (1981). Expectancy theory measures:
An empirical comparison in an experimental simulation. Organizational Behavior
and Human Performance, 28, 189—223.

Ilgen, D. R., & Swisher, S. N. (1989). An integrated approach to health in the

workplace. In E. M. Welch (Ed.), Strategies for lower costs and reducing workers’
spffering (pp. 117—134). Fort Washington, PA: LRP Publications.

Inkeles, A. (1968). Society structure and child socialization. In J. A. Clausen (Ed.),
Socialization and society. Boston: Little, Brown, and Co.

Ivancevich, J. M., & Matteson, M. T. (1980). Optimizing human resources: A case for
preventive health and stress management. Organizational Dynamics, 2, 5-25.

Jacobs, B. A. (1983). Sound minds, bodies . . . and savings. Industry Week, 218, 67-68.

James, W., Woodruff, A., & Werner, W. (1965). Effect of internal and external control
upon changes in smoking behavior. Journal of Consultingfsychology, 2_9, 184-186.

Jellinek, E. M. (1960). The disease coneept of alcoholism. New Haven, CT: College
University Press; in association with New Brunswick, NJ: Hill Tour Press.

Jerrell, J. M., & Rightmyer, J. F. (1982). Evaluating employee assistance programs: A
review of methods, outcomes, and future directions. Evaluation and Program
Planning, 3, 255-267.

Jeuchter, W. M., & Utne, T. (1982). Wellness: Addressing the "whole" person. Training
and Development Journal, 3_6_(5), 112—116.

Johnson, V. (1973). I’ll quit tomorrow. New York: Harper & Row.

Johnston, R. G. (1971). A study of drug abuse among employees in Akron, Ohio.
Akron, OH: Bureau of Business and Economic Research, University of Akron.

Jones, D. (1983). Performance benchmarks for the comprehensive employee assistance
programs. Center City, MN: Hazelden Foundation.

Jorrisch, M. R. (1986). Variables affecting compliance to treatment in an employee
assistance program (Doctoral dissertation, University of Louisville). Dissertation

Abstracts International, 41(10), SECA, 3664.

Judd, P. M. (1980). Treatment success in occupational alcoholism programs (Doctoral
dissertation, Brandeis University). Dissertation Abstr ct International, 41, 2294.

 

 

 

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241

Ilgen, D. R. (1990). Health issues at work: Opportunities for industrial/organizational
psychology. American Psychologist, 4_5, 273-283.

Ilgen, D. R., Nebecker, D. M., & Pritchard, R. R. (1981). Expectancy theory measures:
An empirical comparison in an experimental simulation. Organizational Behavior
and Human Performance, 28, 189-223.

 

Ilgen, D. R., & Swisher, S. N. (1989). An integrated approach to health in the

workplace. In E. M. Welch (Ed.), Strategies for lower costs and reducing workers’
suffering (pp. 117-134). Fort Washington, PA: LRP Publications.

Inkeles, A. (1968). Society structure and child socialization. In J. A. Clausen (Ed.),
Socialization and society. Boston: Little, Brown, and Co.

Ivancevich, J. M., & Matteson, M. T. (1980). Optimizing human resources: A case for
preventive health and stress management. Organizational Dynamics, 2, 5-25.

Jacobs, B. A. (1983). Sound minds, bodies . . . and savings. lndustpLWeek, 213, 67-68.

James, W., Woodruff, A., & Werner, W. (1965). Effect of internal and external control
upon changes in smoking behavior. Journal of Consultin Ps holo ,2_9_, 184-186.

Jellinek, E. M. (1960). The disease coneept of alcoholism. New Haven, CT: College
University Press; in association with New Brunswick, NJ: Hill Tour Press.

Jerrell, J. M., & Rightmyer, J. F. (1982). Evaluating employee assistance programs: A
review of methods, outcomes, and future directions. Evaluation and Program.
Mg, 3, 255-267.

Jeuchter,W. M., & Utne, T. (1982). Wellness: Addressing the "whole" person. Training
and Development Journal, 33(5), 112—116.

Johnson, V. (1973). I’ll quit tomorrow. New York: Harper & Row.

Johnston, R. G. (1971). A stu of dru abuse amon m 10 ees in Akron Ohio.

Akron, OH: Bureau of Business and Economic Research, University of Akron.

Jones, D. (1983). Performance benehmarks for the comprehensive employee assistance
W. Center City, MN: Hazelden Foundation.

Jorrisch, M. R. (1986). Variables affecting compliance to treatment in an employee
assistance program (Doctoral dissertation, University of Louisville). Dissertation

WW. 511(10), SECA, 3664.

Judd, P. M. (1980). Treatment success in occupational alcoholism programs (Doctoral
dissertation, Brandeis University). Dissertation Abstra ts In ernational, 41, 2294.

 

 

 

 

 

 

 

 

 

 

242

Kahn, R. L., & Antonucci, R. (1980). Convoys over the life course: Attachments, roles

...and social support. In P. B. Baltes & O. Brim (Eds), Life-span development and
pehayior (Vol. 3). Boston: Lexington Press.

Kaplan, B. H., & Cassel, J. C. (1977). Social support and health. Health Education
Monographs, 3(2), 129-137.

Kaplan, C., & Cowles, A. (1978). Health locus of control and health value in the
prediction of smoking reduction. Health Education Monographs, 3(2), 129-137.

Karoly, P. (1985). The logic and character of assessment in health psychology:

Perspectives and possibilities. In P. Karoly, Measurement Strategies in Health
Psychology (pp. 3-45). New York: John Wiley & Sons, Inc.

Kasl, S. V., & Cobb, S. (1966). Health behavior, illness behavior and sick role behavior.
I. Health and illness behavior. Archives of Environmental Health 12 246-266.

7—)

Katz, D., & Kahn, R. (1966). The sociology of organizations. New York: Wiley.

Kegeles, S. (1969). A field experimental attempt to change beliefs and behavior of
women in an urban ghetto. Health and Social Behavior. 10, 115-124.

Kernan, M. C., & Lord, R. G. (1985). Multiple versus single goals: Effects of valence

and feegbaek speeificity. Unpublished manuscript.

Kernan, M. C., & Lord, R. G. (1987). The effects of participative versus assigned goals

and feedback on goal commitment and performance in a multi-trial laboratory task.
Motivation and Emotion, ﬂ.

Kilburg, R. (1980). Metaphysics and professional resistance to program evaluation.
Evaluation and Program Planning, 3, 185-190.

Kimball, C. P., MD. (1981). The biopsy/phosocial approach to the patient. Baltimore,
MD: Williams & Wilkins.

Kinney, J., & Leaton, G. (1983). Loosening the grip: A handbook 3f alcohol
W. St. Louis: C. V. Mosby.

Kirscht, J. P. (1983). Preventive health behavior: A review of research and issues.

H I h Ps holo , 2, 277-302.

Klein, H. J. (1989). An integrated control theory model of work motivation. Academy
MW, 14., 150-177.

Klipstein, K. H. (1960). Your health nd industr . New York: National Health Council.

 

 

 

 

 

 

 

 

 

 

 

243

Knapp, S. L. (1985). The effect of occupational stress and social support on alcohol use
and abuse (Doctoral Dissertation, Southern Illinois University at Carbondale).

Dissertation Abstracts International, 33(10), SECB, 3583.

Korcok, M., and Seidler, G. (Eds). (197 8, February-March). Focus on alcohol and drug
issues, 1(1), 4-5.

Kurtz, N. R., Googins, B., & Howard, W. C. (1984). Measuring the success of
occupational alcoholism programs. Journal of Studies on Alcohol, 4_5(1), 33-45.

Kuzmits, F., & Hammonds, H. (1979, April). Rehabilitating the troubled employee.
Personnel Journal, 238-250.

Landy, F. J., Trumbo, D. A. (1976). Psychology of work behavior. Homewood, IL:
Dorsey Press.

Lazarus, R. S. (1974). Psychological stress and coping in adaptation to illness.
International Journal of Psychiatry in Medicine, 3, 321-333.

Leavitt, R. L. (1983). Employee assistance and counseling programs. New York:
Community Council of Greater New York.

Leaw, R. L. (1983). Social support and psychological disorder: A review. Journal of
Community Psychology, 11, 3-21.

LeRoux, M. (1982). Employee assistance programs: Well worth their cost, employers
say. Wren—Ce, £65), 3-20.

Levenson, H. (1974). Activism and powerful others: Distinctions within the concept of
internal-external control. Jo m l of Person lit Assessment, 38, 377-383.

Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense representation of
illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2). New York:
Pergamon.

Levine, H. Z. (1983). Corporate wellness programs. P3r_s_o_p_r1el_, 30(4), 50—53.
Levinson, H. (1976). The abrasive personality. Harvard Business Review, 33, 86-94.

Lewis, K. A. (1981). Employee assistance programs: The current state of the art of
mental health services in government and industry (Doctoral dissertation,
Northwestern University). WW, 3058. (University
Microfilms No. 8124944)

Lin, N,, Simeone, R, S,, Ensel, W. M., & Kuo, W. (1979). Stressful life events, and

illness: A model and empirical test. rn l fH lth n i IB h vi 132.912),
108-19.

 

 

 

 

 

244

Litwin, G. H., & Stringer, R. A., Jr. (1968). Motivation and organizational climate.
Boston: Division of Research, Graduate School of Business Administration, Harvard
University.

Locke, E. A., Shaw, K. N., Saari, L. M., & Latham, G. P. (1981). Goal setting and task
performance: 1969-1980. Psychological Bulletin, %, 125-152.

Lord, R. G., & Hanges, P. J. (1987). A control systems model of organizational

motivation: Theoretical development and applied implications. Behavioral Scienee,
3_2, 161-178.

Lovenheim, B. (1979, April 1). More care given employee’s psyches. New York Times,
1,3.

Loy, J ., & Ingham, A. (1973). Play, games, and sport in the psychosocial development

of children and youth. In G. Rarick (Ed.), Physical activity: Human growth and
development (pp. 257—302). New York: Academic Press.

Loy, J., McPherson, B., & Kenyon, G. (1978). Sport and social sgtems: A guide to the
analysis, problems and literature. Reading, MA: Addison-Wesley.

Lyons, P. (1987). EAPs the only real cure. Management Review, 13(3), 38-41.

Malen, A. L. (1982). Factors inﬂuencing participation in a health promotion program
of exercise (Doctoral dissertation, University of Oklahoma).

March, J. G., & Simon, H. A. (1958). Organizations. New York: Wiley.

Margolis, B. L., Kroes, W., & Quinn, R. P. (1974). Job stress: An unlisted occupational
hazard. Journal of Occupational Medicine, 13(10), 659-661.

Marino, J. A. (1985). Identifying factors relating to employee assistance program
utilization (Doctoral dissertation, George Peabody College for Teachers of Vanderbilt
University).

Martin, T. N ., & Schermerhorn, J. R. (1983). Work and nonwork inﬂuences on health:
A research agenda using inability to leave as a critical variable. Academy of

W, 8(4), 650-659.

Masi, D. A. (1978). Implementation strategies in EAP’s in higher education.
nf r n Pr e in 3 Au ust -9 1977 Em lo eAssistance Pro rams in Hi h r
Educadm. Columbia: University of Missouri and NIAAA.

Masi, D. A. (1979). Combating alcoholism in the workplace. He 1 h nd Soci I Work,
4(4), 41-59.

Masi, D. A. (1982). W. Lexington, MA: D. C. Heath and
Company.

 

 

 

 

 

 

245

Masi, D. A. (1984). Designing employee assistance programs. New York: American

Management Associations.

Masi, D. & Teems, L. (1983). Employee counseling services evaluation system: Design,

issues and conclusions. Evaluation and Program Planning, 3, 1-6.

Matsunaga, S. (1983). The federal role in research, treatment and prevention of
alcoholism. American Psychologist, 3_8, 1111-1115.

Matteson, M. T., & Ivancevich, J. M. (1982). The how, what and why of stress
management training. Personnel Journal, 31, 768-774.

Mayer, S. J. (1988). An exploratory study of the correlates associated with a worksite
health promotion intervention (Doctoral dissertation, University of Oregon).

Dissertation Abstracts International, 33(02), SECA, 483.

McClellan, K. (1982). An overview of occupational alcoholism issues for the 80’s.

Jeurnal of Drug Education, 12(1), 1-27.

McClellan, K. (1985). The changing nature of EAP practice. Personnel Administrator,
3_0(8), 29-37.

 

McCroskey, J. (1982). Employers subsidize day care. Wm, 3(2).

McKinlay, J. B. (1975). The help-seeking behavior of the poor. In J. Kosa and I. K.
Zola (Eds), Poverty and health (pp. 224-273). Cambridge, MA: Harvard University

Press.

Mechanic, D. (1982). The epidemiology of illness behavior and its relationship to
physical and psychological distress. In David Mechanic (Ed.), mm
behavior, and help-seeking (pp. 1-24). New York, NY: Prodist.

Merriman, W. J. (1984). The relationship of socialization, attitude and placement to the
degree of participation in physical activity of emotionally disturbed high school
students (Doctoral Dissertation, New York University). LEW

W, 36(02), SECA, 374.
Meyers, D. W. (1985). Employee problem preyention and counseling: A guide for

We. Westport, CT: Quorum Books.

Miller, E. J . (1975). Socio-technical systems in weaving, 1953-1970: A follow-up study.
W, 28, 349-386.

Miller, G. A., Galanter, E., & Pribram, K. H. (1960). Plans and the structurle
kinking. New York: Holt, Rinehart and Winston.

Miller, L. (1977). A counseling program in industry: Polaroid. Social Thought, 3(1), 37—
45.

 

 

 

 

246
Minter, J. (1983). A contracted or in—house EAP? EAP Digest, 3(4), 21-22.

Mitchell, R., & Hurley, D. (1981). Collaborating with natural helping networks. In B.
Gottlieb (Ed.), Social networks and social support. California: Sage Publications.

Molloy, D. J. (1986). Planning and implementing a worker based and participatory
model for employee assistance programs (Doctoral dissertation, City University of
New York).

Moriyana, I., Kreuger, D., & Stamler, J. (1971). Cardiovascular Diseases in the United
States. Cambridge, MA: Harvard University Press.

Mullen, B., & Suls, J. (1982). "Know thyself": Stressful life changes and the ameliorative

effect of private self-consciousness. Journal of Experimental Social Psychology, 18,
43-55.

Murray, E. (1983). Human resource services needs in business and industry:
Implications for the preparation of guidance personnel by universities (Doctoral
dissertation, The Ohio State University). Dissertation Abstracts International, 1416.
(University Microfilms No. 8318410)

Myers, D. W. (1984). Establishing and building employee assistance programs.
Westport, CT: Quorum Books.

Myers, P. S., & Myers, D. W. (1985). Are employers conforming to standards? EAP
Digest, 3, 55-63.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). 1978. Third special
report to the US. Congress on alcohol and health. Washington, DC: U.S.

Government Printing Office.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1982). Occupational

aleoholism: A review of research issues. Research Monograph No. 8. Washington,
DC: NIAAA.

Nelson, D., & Campbell, S. (1972, Spring). Taylorism vs. welfare work in American
industry. Business History Review, 1-16.

New York Executive Chamber. (I982). The 1982 report on drug abuse and alcoholism.
Prepared for Governor Hugh L. Carey by Joseph A. Califano, Jr. New York:
Executive Chamber.

Norris, J. (1948). Cost and remedy of the alcoholic hangover in industry. Industrial
Medicine and Surgery, ﬂ, 129—132.

 

 

 

247

O’Bryan, G. G. (1972). The relationship between an individual’s I-E orientation and
information-seeking learning and use of weight control relevant information.
(Doctoral dissertation, University of Nevada). Dissertation Abstracts International,
1972, 33B,447B. (University Microfilms No. 72-19,541).

O’Connell, J. K., & Price, J. H. (1982). Health locus of control of physical fitness in
program participants. Perceptaal and Motor Skills, 5(3), 925-926.

Opinion Research Corporation (1972, 1974, 1976, 1979). Executives’ knowledge,

attitudes, and behavior regarding alcoholism and alcohol abuse: A report of executive
caravan ﬁndings. Princeton, NJ: Opinion Research Corp.

Orlandi, M. A. (1986). The diffusion and adoption of worksite health promotion
innovations: An analysis of barriers. Preventive Medicine, ﬂ, 522-536.

Ozawa, M. N. (1980). Development of social services in industry: Why and how? Social
Work, 23, 464-470.

 

Palmore, E. (1971). Longevity predictors: Implications for practice. Postgraduate
Medical Journal, 33, 160-164.

Parcel, G. S., Nader, P. R., & Rogers, P. J. (1980). Health locus of control and health

values: Implications for school health education. Health Values: Achieving High
Level Wellness, 4, 32-37.

Pardue, M. A. (1987). A secondary analysis of a client satisfaction survey for an internal
employee assistance program (Doctoral dissertation, University of Texas at
Arlington).

Pati, G. C., & Adkins, J. I. (1983). The employers role in alcoholism assistance.
W, 62. 568-572.

Pattison, E. M., & Kaufman, E. (Eds) (1983). Encyclopedic handbook of alcoholis_m.
New York: Gardner Press.

Pearlin, L. I., & Radabaugh, C. W. (1976). Economic strains and the coping functions
of alcohol. American Joprnal of Sociology 82 652-663.

,—,

Pelletier, K. R., & Lutz, R. (1988). Healthy people--healthy business: A critical review

of stress management in the workplace. American Journal of Health Promotion, 2,
5-12.

Pender, N. J. (1982). Health promotion in nursing practice. New York: Appleton-
Century-Crofts.

Perham,J. (1984). Companies gain in health cost fight. Dun’ Bu in M n h, 123(3),
68-74.

 

 

 

 

 

 

 

 

248

Pilisuk, M., & Minkler, M. (1985). Supportive ties: A political economy perspective.
Health Education Quarterly, 12(1), 93—106.

Platt, E. S. (1969). Internal-external control and changes in expected utility as
predictions of the change in cigarette smoking following role-playing. Paper
presented at the Eastern Psychological Association, Philadelphia, 1969.

Popple, P. R. (1981, June). Social work practice in business and industry, 1875-1930.
Social Service Review, p. 259.

Powers, W. T. (1973). Behavior: The control of perception. Chicago: Aldine.

Public Health Service. (1979). Healthy people: The surgeon general’s report on health

promotion and disease prevention. Washington, DC: U.S. Government Printing
Ofﬁce.

Quick & Quick (1984). Organizational stress and preventive management. McGraw-
Hill.

Richards, C. M. B. (1988). The comparison of health motivation, health knowledge,
health locus-of—control, and health protective behavior of freshmen and senior
college nursing majors (Doctoral dissertation, Boston University). Dissertation
Abstracts International, 3(06), SECA, 2111.

Rivera, M. V.. (1984). Alcoholism and employee assistance programs in the public
sector: Past, present, and future prospects (Doctoral dissertation, State University of
New York at Albany).

Roman, P. M. (1978). Adapting employee alcoholism and assistance programs for

college and university faculty. Conference Proceedin 5 Au ust7-9 1977 Em 10 ee

Assistance Pregrams in Higher Education. Columbia: University of Missouri and
NIAAA.

Roman, P. M. (1980a, August). Employee alcoholism and assistance programs. Journal

of Higher Education, 31, 135-149.

 

Roman, P. M. (1980b). Medicalization and social control in the workplace: Prospects
for the 1980s The Journal of Applied Behavioral Science, 13(3), 3.

Roman, P. M. (1981). From employee alcoholism to employee assistance. W
St di n Alcohol, 42(3), 244-272.

Roman, P. M. (1983a). Employee assistance programs in Australia and the United
States: Comparison of origin, structure, and the role of behavioral science research.

19mg] 3f Applied Behayioral Seienee, 19(3), 280-286.

 

 

 

R01

R01

 

 

 

249

Roman, P. M. (1983b). Pitfalls of ’program’ concepts in the development and

maintenance of employee assistance programs. Urban and Social Change Review,
2(1), 9-12.

Roman, P. M. (1984). The environment for EAP research: Comments on structure of
organizational support. In C. H. Grimes (Ed.), EAP research. An annual of
research and research issues (pp. 1-10). Troy, MI: Performance Resource Press.

Roman, P. M., & Trice, H. (1976). Alcohol abuse and work organizations. In B. Kissen

& H. Beglieler (Eds), Biology of alcoholism (Vol. 4, pp. 445-517). New York:
Plenam Press.

Rosenstock, I. M. (1975). Individual responsibility for health maintenance. In S. M.

Weiss (Ed.), Proceedings of the national heart and lung institute working conference
on health behavior (DHEW Pub. No. NIH 76-868). Bethesda, MD: Public Health
Service.

Rosenstock, I. M., & Kirscht, J. P. (1979). Why people seek health care. In G. C. Stone,

F. Cohen, & N. E. Adler Health psychology--a handbooszheories, applications, and

challenges of a psychological approach to the health care system (pp. 161-188). San
Francisco, CA: Jossey-Bass Publishers.

Roth, R. (1981, March/April). The EAP works: A profitable new tool for the private
sector. Alc_o_holism Magazine, pp. 23-27.

Rotter, J. B. (1954). Social learning and elinical psychology. New York: Prentice-Hall.

Rotter, J. B. (1966). Generalized expectancies for internal versus external control of
reinforcements. Psychological Monographs: General and Applied, 83, 1-28.

Rotter, J. B. (1975). Some problems and misconceptions related to the construct of
internal vs. external control of reinforcement. Journal of Consulting and Clinical

Psychology, ﬂ, 55-67.

Rotter, J., Chance, J., & Phares, E. (1972). Applications of a Social Learning Theory of
My. New York: Holt, Reinhard, and Winston.

Rush, H., & Brown, J. (1971, March). The drug problem in business: A survey of
business opinions and experience. The Conference Board Record, 1(3), 7-15.

Sager, L. B. (1979). The corporation and the alcoholic. W3, 13(6), 79-82.
Savoca, L. A. (1986). The structure and service delivery characteristics of selected
employee assistance programs in the tri-state area of New York, New Jersey and

Connecticut. (Doctoral dissertation, Adelphi).

Scahill, J. L. (1963). Effects of secondary school health instruction on the health
knowledge of college freshmen (Doctoral dissertation, State University of Iowa).

 

 

 

 

 

 

 

 

250

Scanlon, W. (1983). Trends in EAPs: Then & now. EAP Digest, 3(4), 38-41.

Scanlon, W. F. (1986). Alcoholism and drug abuse in the workplace. New York:
Praeger Publishers.

Scheier, M. F., Fenigstein, A., & Buss, A. H. (1974). Self-awareness and physical
aggression. Journal of Experimental Social Psychology, m, 264-273.

Schlenger, W. E., & Hayward, B. M. (1975). Assessing the impact of occupational
programs. Raleigh, NC: Human and Ecology Institute.

Schmitz, H. (1982). The handbook of employee counseling programs. New York: The
New York Business Group on Health.

Schultz, S. K. (1981). An exploratory study of the relationship of some psychosocial
factors and health beliefs to compliance with the therapeutic regimen among

adolescents with cystic fibrosis. Dissertation Abstracts International, 42, 2867A-
2868A.

Schwartz, G. E. (1978). Psychobiological foundations of psychotherapy and behavior

change. In S. L. Garfield & A. E. Bergin (Eds.)., Handbook of Psychotherapy and
behavior change (2nd Ed.). New York: Wiley.

Schwartz, G. E. (1979). The brain as a health care system. In G. C. Stone, F. Cohen,
& N. E. Adler (Eds), Health psychology--A handbook. San Francisco: Jossey-Bass.

Seeman, M., & Evans, J. W. (1962). Alienation and learning in a hospital setting.
American Sociological Review, 21(6), 772-783.

Seeman, M., & Seeman, T. (1983). Health behavior and personal autonomy: A
longitudinal study of the sense of control in illness. Journal of Health and Social
mm. 2.4, 144-160.

Seltzer, E. (1978). Locus of control and the intention to lose weight. Health Education
Menographs, 3, 118-127.

 

Serxner, S. A. (1988). Organizational environment and employee participation in
worksite health promotion programs (Doctoral dissertation, University of California).
D. issertatien Abstraets Internatienal, 49105), SECA, 1647.

Shain, M., & Groeneveld, J. (1980). Employee assistance programs; Philosophy, theory
W. Lexington, MA: Lexington Books.

Shain, M., Suurvali, H., & Boutilier, M. (1986). H lthi r orker : Health romo ion
9W. Lexington, MA: D. C. Heath.

Shamir, B, & Bargal, D, (1982). Occupational welfare and organizational effectiveness:

Some theoretical notes. WM, 3(4), 43-52.

 

 

 

 

 

 

 

 

 

 

251

Shephard, R. J. (1985). Motivation: The key to fitness compliance. The Physician and
iports Medicine, Q0), 88-101.

Shetty, Y. K. (1982). Key elements of productivity improvement programs. Business
Horizons, 23(2), 15-22.

Shuster, P. (1978). Human resources management: Key to the future. The Personnel

Administrator, _9_, 33-36.

Sibley, R., & McFarland, D. (1974). A state-space approach to motivation. In D.
McFarland (Ed.), Motivational control systems analysis (pp. 213-250). New York:
Academic Press.

Skidmore, R. A., Balsam, D., & Jones, 0. F. (1974). Social work practice in industry.
Social Mrk, 12(3).

Smirnow, B. (1980). Case studies in mental wellness programming. In R. Egdahl and
D. Walsh (Eds), Mental wellness program for employees. New York: Springer.

Smith, A. (1776). An inquiry into the nature and causes of the wealth of nations. R. H.
Campbell, A. S. Skinner, & W. B. Todd (Eds). London: Oxford University Press
1976.

)

Snyder, E., & Spreitzer, E. (1973). Family inﬂuence and involvement in sports.

Research Quarterly, 44, 249—255.

Snyder,J. J. (1989). Health psychology and behavioral medicine. Englewood Cliffs, NJ:
Prentice Hall.

Sonstroem, R. J., & Walker, M. I. (1973). Relationship of attitudes and locus of control
to exercise and physical fitness. Perceppml and Motor Skills, 33, 1031-1034.

Spacapan, S. (1988). Psychosocial mediators of health status: An introduction. In S.

Spacapan and S. Oskamp (Eds), The so i l s holo of health (pp. 17-29).
Newbury Park, CA: Sage Publications, Inc.

Sprinthall, R. C., & Sprinthall, N. A. (1981). Educational psychology; A developmental
W (3rd ed.). Reading, MA: Addison-Wesley.

Sta", A. & Byram, G. (1985). Cost/benefit analysis for employee assistance programs.
WW, 3, 8, 55-62.

Steenbarger, B. N., & Aderman, D. (1979). Objective self-awareness as a nonaversive

state: Effect of anticipating discrepancy reduction. rnal of P r onalit , 41, 330-
339.

Steidinger, J. (1986). Assessment of the current state of evaluation practices in employee

assistance programs. Dis r i A ct Intern i n 1,46, 2637.

 

 

 

 

 

 

 

252

Stevens, J. R. (1970, June). It’s high time to have a drug policy. Modern Office
Procedpres, 28-36.

 

Stone, G. C. (1979). Health and the health system: A historical overview and conceptual
framework. In G. C. Stone, F. Cohen, & N. E. Adler, Health psychology--a

handbook: Theeries, applications, and challenges of a psychological approach to the
health care system (pp. l—17). San Francisco, CA: Jossey-Bass Publishers.

Stone, G. C., Cohen, F., & Adler, N. E. (1979). Health psychology-~a handbook:

Theories, applications, and challenges of a psychological approach to the health care
system. San Francisco, CA: Jossey-Bass Publishers.

Storm, L. D. (1977). Solving job performance problems. Tallahassee: Human
Conservation Associates.

Straussner, L. A. (1985). The nature and growth of contractual EAPs. ALMACAN,
13(9), 20-23.

Straussner, S. L. A. (1986). Helping troubled employees: An analysis of selected
employee assistance programs under management auspices. (Doctoral Dissertation).

Strickland, B. R. (1978). Internal—external expectancies and health-related behaviors.

Journal of Consulting and Clinical Psyehology, 43, 1192-1211.

Suddeth, A. B. (1984). Assessing employee use of internal and external employee
assistance programs for alcohol and control group. In C. H. Grimes (Ed.), EAP

researeh, Ap annual of research and researeh issues, (Vol. 1, pp. 24-36). Troy, MI:
Performance Resources Press.

Swanson, J. (1972). Second thoughts on knowledge and attitude effects upon behavior.

ournal of School Health, 3, 363-365.

Syme, S. L. (1986). Strategies for health promotion. Preventive Medicine, 13, 492-507.

Taylor, F. (1911). Principles of Scientifie Management. New Norton.

Taylor, M. S., Fisher, C. D., & Ilgen, D. R. (1984). Individuals’ reactions to performance
feedback in organizations: A control theory perspective. In K. Rowland and J. Ferris

(Eds), Research in Perseanel ana Human Resoarees Management (Vol. 2, 81-124).
Greenwich, CT: J Al Press.

Terborg, J. R. (1986). Health promotion at the worksite: A research challenge for
personnel and human resources management. In K. M. Rowland & G. R. Ferris

(Eds), Research in Persennel and Hpman Reseurces Management (Vol. 4, pp. 225-
267). Greenwich, CT: JAI Press.

 

 

 

 

253

Terborg, J. R. (1988). The organization as a context for health promotion. In S.

Spacapan and S. Oskamp (Eds), The social psychology of health (pp. 129-174).
Newbury Park, CA: Sage Publications, Inc.

Tersine, R. J ., & Hazeldine, J. (1982, August). Alcoholism: A productivity hangover.
Business Horizons, 68-72.

Thomas, D. (1982). Who’s using the new fringes? The ALMACAN, Q00).

Thomas, J. M. S. (1984). Relationship of general health motivation and dietary sodium
intake (Doctoral dissertation, Texas Woman’s University). Dissertation Abstracts
International, 43(12), SECB, 3775.

Thoresen, R. W., Knocke, F., Roberts, L., & Pascoe, E. (1977). The University of
Missouri EAP: Orientation training, referral services, evaluation. Conferenee

Proceegings, August 1-3, 1976, Employee Assistance Programs in Higher Education.
Columbia: University of Missouri and NIAAA.

Trice, H. M. (1980, Spring). Applied research studies: Job-based alcoholism and
employee assistance programs. Alcohol, Health & Research World, 4, 4-16.

Trice, H. M., & Beyer, J. M. (1980). Job based alcoholism programs: Motivating
problem drinkers to rehabilitation. In E. M. Pattison and E. Kaufman (Eds), _T_he
American Handbook of Alcoholism. New York: Gardner Press.

Trice, H. M., & Roman, P. M. (1972, 1978). Spirits and demons at work: Alcohol and
ether drugs on the job. Ithaca, NY: Cornell University Press.

Trice, H. M., & Schonbrunn, M. (1981). A history of job based alcoholism programs:
‘1900-1955. Journal of Drug Issues, 2, 171-198.

Tyroler, H. A., Johnson, A. L., & Fulton, J. T. (1965). Patterns of preventive health
behavior in populations. Journal of Health and Human Behavior, 3, 128-140.

Ultsch, S. L. (1983). Motivation for voluntary regular exercise and the health beneﬁt:
An analysis of attributions and other factors (Doctoral dissertation, University of
Alabama, Birmingham).

United States Congress. (1978). Senate committee on human resources. Subcommittee
on alcoholism and drug abuse (Aug. 17, 1978). Oceupatienal aleoholism programs
under federal contracts. GPA Item No.: 1043; Washington, D.C.: U.S. Government
Printing Office.

United States Congress. (1982). Committee on Labor and Human Resources.
Subcommittee on Alcoholism and Drug Abuse and Subcommittee on Employment
and Productivity (July 14, 19.82) W
(GPO Item No.: 1043- A, 1043- B; microﬁche). Washington, D..:C US Government
Printing Office.

 

 

 

 

 

 

 

 

 

 

254

U.S. Bureau of Labor Statistics. (1919). Welfare work for employees.
Urwick, L. (1956). The golden book of management. London: Newman Neame.

Uyeno, C. M. (1988). Characteristics of primary care provided by employee assistance
programs. (Doctoral dissertation)

Vicary, J. R., & Resnik, H. (1982). Preventing drug abuse in the workplace (Drug Abuse
Prevention Monograph Series). Rockville, MD: National Institute on Drug Abuse.

Von Bertalanffy, L. (1966). General systems theory and psychiatry. In S. Arieti, (Ed.),
American Handbook of Psychiatry, (Vol. 3). Basic Books.

Von Bertalanffy, L. (1968). General systems theory. New York: Braziller.

Von Wiegand, R. A. (1974, January). Advance in secondary prevention of alcoholism
through the cooperative efforts of labor and management in employer organizations.

Preventive Medicine, 3, 80-83.

Wallston, K. A., Maides, S. A., & Wallston, B. S. (1976). Health-related information
seeking as a function of health-related locus of control and health value. Journal of
Research in Personality, 18, 215-222.

Wallston, B. S., & Wallston, K. A. (1978, Spring). Locus of control and health: A review
of the literature. Health Education Monographs, 3, 107-115.

Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the
multidimensional health locus of control (MHLC) scales. Health Education

Monographs, 3, 160-170.

 

Wallston, B. S., Wallston, K. A., Kaplan, G. D., & Maides, S. A. (1976). Development
and validation of the health locus of control (HLC) scale. ournal fConsul in nd

Clinieal Psychology, ﬂ, 580-585.

Warren, D. (1982). Using helping networks: A key social bond of urbanites. In D.

Biegel & A. Naparstek (Eds.),Communi su orts stems and ment lh alth. New
York: Springer.

Washington Business Group on Health (1978). A survey of industry sponsored healt_h

premetien, prevention, and edueation programs. Unpublished interim report

prepared for the Department of Health, Education and Welfare, National Conference
on Health Promotion in Occupational Settings. Washington, D.C.: Author.

Weiner, H. J., Akabas, S. H., & Sammer, J. J. (1973). Mental health care in the worlp
91m. New York: Association Press.

Weiss, R. M. (1980). D lin wi h l h li m in the work I . New York: The

Conference Board.

 

 

Will

Wim

Winl

Wise]
P;

 

255

Weissman, A. (1976). Industrial social services: Linkage technology. Social Casework,
51(1).

Wells, S. E. (1988). Employee assistance programs: Profile of EAP workers at 15 major
employing Orange County companies. (Master’s Thesis, California State University,

Long Beach).

Westrate, R. M. (1983, January). White collar Stress. Central New Jersey Monthly, pp.
66-67.

White House Office of Drug Abuse Policy. (1978). Drug use patterns, eonsequences and
the federal response: A policy review. Washington, D.C.: Author.

Wiener, N. (1948). Cybernetics: Control and communication in the animal and the
machine. Cambridge, MA: MIT Press.

Williams, A. F. (1972). Factors associated with seat belt use in families. Journal of
Safety Research, 4, 133-138.

Williams, T. A., Calhoun, G., & Ackoff, R. L. (1982). Stress, alcoholism, and
personality. Human Relations, 33(6), 491-510.

Wineﬁeld, H. R., & Peay, M. Y. (1980). Behavioural science in " ' London:
George Allen & Unwin.

Winkelpleck, J. M. (1984). Direction EAPs move. EAP Digest, 4(5), 18-21.

Wiseman, H. (1966). Political systems: Some sociological approaches. New York: F. A.
Praeger.

Witte, R., & Cannon, M. (1979). Employee assistance programs: Getting top
management’s support. Personnel Administrator, ﬂ(6), 23-26;44.

Woelfel, J., & Haller, A. (1971). Significant others, the self—reﬂexive act and the attitude
formation process. American Soeiological Review, 3_6, 74—87.

Wolf, K. (1982). Casefinding models to identify and refer the impaired professional.
EAP Digest, 2(6), 38—39.

Work. (1974, December 1). Boston Globe, pp. 1—4.
WIICh, J. (1974). The employee assistance program. Center City, MN: Hazelden.
W’iCh. J. (1978). Employee assistance programs: Models and alternatives. m

Proeeedings, Augus; Z—9, 1272, Employee Assistance Programs in Higher Education.
Columbia: University of Missouri and NIAAA.

 

 

 

 

 

 

 

256

Wrich, J. T. (1980a). Guidelines for developing an employee assistance pregram.
Center City, MN: The Hazelden Foundation.

Wrich, J. T. (1980b). The employee assistance program; Updated for the 1980’s.
Minneapolis, MN: Hazelden Foundation.

Wrich, J. T. (1986). The impact of substance abuse at the workplace. In H. Axel (Ed.),

Corperate strategies for controlling substance abuse, (Report No. 883, pp. 11-18).
New York, NY: The Conference Board, Inc.

Wriston, W. B. (1982). Introduction: Worksite health promotion. Health Education

Quart—$11, 9.. 7-8-

Wynne, K. L. (1986). The relationship of social support contracting to worksite weight
control (Doctoral dissertation, University of South Carolina). W
International, 41(11), SECA, 3991.

Yankelovich, D. (1978, May). The new psychological contracts at work. Psycpplpgy
M!) 46750-

 

 

 

 

 

 

APPENDIX A

DEFINITION OF TERMS

 

 

 

 

 

 

 

 

 

 

APPENDIX A

DEFINITION OF TERMS

Broad-Brash EAP refers to an EAP designed to address a wide variety of employee
concerns and problems, including alcoholism, drug abuse, divorce, marital
discord, child rearing, stress, financial management, behavioral and psychological
concerns, and legal problems. Its purpose is to reach as many workers and their
dependents as possible.

Comparator Mechanism is a component within the control theory model of EAP
utilization which compares an individual’s goal (i.e., to remain healthy) with the
individual’s current health status to determine whether a discrepancy exists.

Curren; Health Status refers to the current health-related symptoms and current health
condition of the employee.

EAP Effeetiyepess refers to the cost-benefit evaluation used to assess the success of an
EAP and help justify the disbursement of funds allocated to the implementation
and administration of an EAP. Unfortunately, there is no consensus on how to
measure EAP effectiveness.

wage refers to an in-person visit to the EAP office or a call for an appointment,
information, or a referral. (Also see Utilization/Referral Rate.)

E ' n I D's r 3 refers to intrapersonal tension which may inﬂuence

ineffective physical and/or emotional functioning.

257

 

 

e
E

G

H

 

258

Employee Assistance Program refers to an intervention strategy designed to assist
employees in resolving work and non-work related problems that impair job
performance. These problems may include substance abuse, eating disorders,
compulsive gambling, mental and emotional problems, financial, legal, and
marital concerns. Help is provided through a variety of assessment, counseling,
and referral methods—though EAP’s stress self—referrals in addition to
supervisory referrals which the narrower alcohol-related programs relied on.

Expectancy is a component within the Control Theory Model of EAP Utilization which
refers to an individual’s perception regarding his/her ability to attain his/her goal

(i.e., remain healthy).

 

External EAP refers to an intervention strategy involving counseling off the actual job
site, typically provided by agencies or firms who contract with an organization.
These include multi-service agencies which provide easy access to a variety of
resources.

mm is a component within the Control Theory Model of EAP Utilization
which refers to the end result an individual strives for; i.e., in the present
research the goal of interest is to be healthy. This is also called the referent
value.

Health Locus of Control is a measure of peOple’s beliefs regarding whether their health
is or is not determined by their behavior (Wallston, Wallston & DeVellis, 1978,
p. 160).

w refers to a company-hired counseling staff housed at the work site.

MI “agement Social Support refers to "the social support provided by immediate

supervisors and managers to employees who are interested in adopting and

 

deg
extl
De
He

(Pl

 

 

 

 

259

maintaining health-related behaviors or in participating in health-related
activities" (Mayer, 1988).

WWW (MHLC) is defined as the degree to which
individuals believe their health is determined by their own behavior; i.e., the
degree to which individuals believe their health is controlled internally or
externally (Wallston, Wallston, Kaplan & Maides, 1976; Wallston, Wallston &
DeVellis, 1978). The MHLC expands the original HLC scale to reﬂect three
Health Locus of Control dimensions: “internality (IHLC), powerful others
(PHLC), and chance (CHLC) externality" (Wallston, Wallston & DeVilIis, 1978,
p. 162).

Occupational Alcoholism Programs provide services for alcoholic employees in industry,
and include diagnostic, treatment, and rehabilitation programs.

Problem/Troubled Employee is one whose work history is characterized by productivity
problems, tardiness and absenteeism, accidents, and other on-the—job problems.

Referral Seurce/Model is the strategy utilized in obtaining employee utilization of EAP
services. The major models include: (I) a self-referral model where an employee
voluntarily seeks assistance, and his or her participation in the EAP is held in
strict conﬁdence; (2) a supervisory-referral, confrontation model where a third
party within an organization (e.g., supervisor, union, medical department)
actually refers an employee whose performance is suffering to an EAP; and (3)
a peer or significant others model where signiﬁcant others (e.g., family,
coworkers) encourage the impaired employee to seek assistance (Wolf, 1982), and

where participation in the EAP is held in strict confidence (Featherston &

Bednarik, 1981; Fisher, 1983).

 

Sensor/Feed]

 

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status
envirc
receii
or ad
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Wyni
Mm
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(Wis
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260

Sensor/Feedback is a component within the Control Theory Model of EAP Utilization
which receives feedback from the environment regarding one’s present health
status and symptoms, perceptions regarding past usage of an EAP, and other
environmental stimuli.

Social Support is "input provided by another person (or group) which moves the
receiving person towards goals which the receiver desires” (Caplan et al., 1976)
or activities provided by an individual’s social environment which reinforce and
encourage an individual to undertake some behavior (Levy, 1980 as cited by
Wynne, 1986). Input may be physical, verbal/information, or social/emotional.

Social Systems are sets of "individuals who are . . . interacting with others on the basis
of a minimal degree of complimentary expectations by means of, and according
to . . . a shared system of beliefs, standards and means of communication”
(Wiseman, 1966, p. 5).

m is ”an interactional process whereby a person acquires a social identity,
learns appropriate role behavior, and in general conforms to expectations held
by members of the social systems to which he belongs or aspires to belong” (Loy
& Ingham, 1973, p.258).

Troubled/Problem Employee is one whose behavioral/medical problems adversely affect
on-the-job performance or which would motivate the employee to seek help.

Urilization/Referral Rates refers to the percentage of actual EAP service utilization;i.e.,
the ratio of EAP clients to the employee population (Myers, 1984). This rate has
also been referred to as the "participation“ rate or the ”penetration“ rate, which

is the rate at which employees have penetrated the EAP.

 

261

Wellness refers to pro-active, preventative strategies designed to prevent the
development of employee problems within or outside the workplace. Examples
of such programs might include seminars on nutrition, weight control, physical
fitness, stress recognition and management, pre—retirement counseling, and
improvement of social skills.

Work-group Health Norms refers to the informal health rules and "social pressures
generated by an employee’s referent work group in inﬂuencing health-related

behavior" (Mayer, 1988).

 

 

 

 

APPENDIX B

SURVEY INSTRUMENT

 

 

 

 

 

 

 

 

 

 

 

 

262

 

 

Dear M.S.U. Employee:

I am a PhD. student at M.S.U. interested in Employee Assistance Programs
(EAPS). My dissertation is on factors affecting the use or non-use of one particular
EAP—the one at M.S.U. To complete this research I need your participation.

At Michigan State University. the Employee Assistance Program is offered as part
of employees’ beneﬁts package and is designed to deal with employees' problems and
needs in both work and nonwork-related areas. You. as an employee. are eligible to use
its services if the need arises. My research is being conducted with the approval of
M.S.U.’s Employee Assrstance Program.

The purpose of this letter is to ask you (0 complete the attached survey. I really
need your assistance in completing this survey because I have only sent this to a
randomly selected sample of M.SLU. employees. To encourage you to volunteer to
participate in the study. I will pay you $5.00 upon your completion and return of the
survey in the enclosed envelope wuhin twp weeks. It should only take you about a half
hour to complete.

It is critical that I receive responses from two groups of individuals-those who
have previously used the EAP and those who have not. Therefore, it is very important
to me that you respond. Please be assured your responses will be kept completely
conﬁdential. I will need your name and CAMPUS address on the next page so I know
where to send your payment. However, as soon as I receive your survey. this page will
be separated from your survey and you will be paid. I will have no way of matching
survey responses to speciﬁc individuals. (If you do not wrsh to provide your name and
do not wish (0 be paid. then you can return your survey Without this data.) The only
other identiﬁcation on the survey IS the letter "A” or ”B" which identifies those who
have or have not used the EAP services at the university.

I thank you in advance for your time in completing the survey.‘ If I don‘t receive
a response from you in [W0 weeks. I will send a follow-up letter. Obvrously, 1f the costs
of the follow-up can be avoided. I would appreciate II.

Please return the survey to me in the enclosed envelope via U.S. MAIL as soon
as possible. I feel the research subject is an important one and I need your responses to
continue my work on this topic.

Sincerely,
Thomas Helma

3:21;“? Stampmn M.S.U. EAP Coordinator
. . In em

 

 

' Iunde
behaviors. I
only to be us
Assistance P‘

In ext
enclosed en!
conﬁdential.
survey, I out
With speciﬁc

NAME (Ple

CAMPUS ;
to send pay

SOCIAL s

263

INFORMED CONSENT FORM

" I understand the purpose of this research is to study faCtors inﬂuencing health attitudes and
behaviors. I am participating voluntarily. I understand that the Group Identiﬁcation (A or B) is
only to be used to match my responses to either the group that has used or not used an Employee

Assistance Program in the past.

In exchange for my participation. I will be paid $5.00 when I return the survey in the
enclosed envelope within two weeks. I understand that my responses will be kept completely
conﬁdential. My name must be provided only so payment can be sent to me. Once I return the
survey, I understand my name will be detached so there will be no way to match survey responses

with speciﬁc individuals.

NAME (Please Print):

 

 

 

CAMPUS ADDRESS .______——————-—-—-——
to send payment to:

 

 

SOCIAL SECURITY NUMBER:

(Required in order to pay you from a research fund)

INSTRU

 

264

SURVEY GROUP

SURVEY ON HEALTH BELIEFS & BEHAVIORS
INFLUENCING USAGE OF EMPLOYEE ASSISTANCE PROGRAMS

INSTRUCTIONS:

This survey asks about your beliefs regarding your health and your experiences pertaining
to speciﬁc health behaviors. It is important that you think about each statement and answer

it honestly.

There are no right or wrong answers.

Please try to answer each item independently when you are making your choice—do nor be
inﬂuenced by your previous choices. Answer all queStions using only the response choices

given.

Your answers will be kept completely confidential. Once each survey is completed and
returned, your name will be removed from the survey so it will not be possible to match

responses to any speciﬁc individual.

PLEASE TURN THE PAGE TO BEGIN THE SURVEY!

 

 

 

 

PART

 

 

265

PART I

This section is designed to determine the way in which different people view certain
important health-related issues. Each item is a belief Statement with which you may agree
or disagree. Refer to the scale below and for each item circle the number that represents the
uncut to which you disagree or agree with the statement. (For example. if you ”slightly
disagree" with a statement. circle the number 3 on your answer sheet.)

Please circle only one number per item. Remember that this is a measure of your personal
beliefs—obviously there are no right or wrong answers.

Try to respond to each item independently—do not be influenced by your previous choices.

It is important that you respond according to your actual beliefs and mm according to how
you feel you should believe. or how you think someone wants you to believe.

 

(SD) (MD) . (SD) (SL) (MA) (SA)
Strongly Moderately Slightly Slightly Moderately Strongly
Disagree Disagree Disagree Agree Agree Agree
1 3 3 4 5 6
. so MD so SLMASA

1. If I get sick, it is my own behavior which determines how

soon I will get well again ...................................... I 2 3 4 S 6
2. No matter what I do. if I am going to get sick, I will get sick ............ I 2 3 4 5 6
3. Having regular contact with my physician is the best way

for me to avoid illness ........................................ I 2 3 4 5 6
4. Most things that affect my health happen to me by accident ............ 1 2 3 4 S 6
5. Whenever I don’t feel well. I should consult a medically

trained professional .......................................... I 2 3 4 5 6
6. [am in control of my health .................................... I 2 3 4 5 6
7. My family has a lot to do with my becoming sick or staying healthy ...... I 2 3 4 S 6
8 When I get sick, I am to blame .................................. I 2 3 4 5 6
9. Luck plays a big pan in determining how soon I will recover

from an illness .............................................. l 2 3 4 5 6
10. Health professionals control my health ............................ 1 2 3 4 5 6
II. My good health is largely a matter of good fortune ................... l 2 3 4 5 6
12. The main thing which affects my health is what I myself do ............ I 2 3 4 5 6
13. If I take care of myself. I can avoid illness ......................... 1 2 3 4 5 6
14. When I recover from an illness. it’s usually because other people (e.g..

doctors, nurses. family, friends) have been taking good care of me ....... I 2 3 4 5 6
15. No matter what I do. I'm likely to get sick ......................... I 2 3 4 5 6
16. If it’s meant to be. I will Stay healthy ............................. l 2 3 4 5 6
17. [fl take the right actions. I can stay healthy ........................ I 2 3 4 S 6
18. Regarding my health. I can only do what my doctor 1 2 3 4 - 6

tells me to do ..... ' ..........................................

 

PART
Plo
you

949*:—
:1:
a:
<

266

PART II
Please rate how strongly you agree or disagree with the following statements with respect to
your life in general. Circle the appropriate number usmg the scale below.

(SD) (D) (U) (A) (SA)
Strongly Strongly
Disagree Disagree Uncertain Agree Agree

1 2 4 '

 

:—T

so 0 SA
I. I’m always trying to figure myself out ............................. 1 2 3 4 3
2. I’m concerned about my style of domg things ....................... I 2 3 4 5
3. Generally. I’m n0t very aware of myself ........................... 1 2 3 4 5
4. I reflect about myself a lot ..................................... I 2 3 4 5
5. I’m concerned about the way I present myself ...................... I 2 3 4 5
6. I’m often the subject of my own fantasies .......................... I 2 3 4 5
7. I never scrutinize myself ....................................... I 2 3 4 5
8. I’m self-conscious about the way I look ........................... I 2 3 4 5
9. I’m generally attentive to my inner feelings ........................ 1 2 3 4 S
10. I usually worry about making a good impression ..................... I 2 3 4 5
11. I’m constantly examining my own motives ......................... I 2 3 4 5
12. One of the last things that I do before I leave the house is look in the mirror I 2 3 4 5
13. I sometimes have the feeling that I’m off somewhere watching myself ..... I 2 3 4 5
14. I'm concerned about what other people think of me .................. I 2 3 4 5
IS. I’m alert to changes in my mood ................................ I 2 3 4 5
16. I’m usually aware of my appearance .............................. I 2 3 4 5
17. I’m aware of the way my mind works when I work through a problem . . . . I 2 3 4 5
PART III

This section examines how healthy you have been throughout your life. These questions cover
your health while growing up and as an adult. For each statement below. please respond by
circling either 0 for NO or I for YES.

& ﬂ

1. Have you ever been considered a sickly person? .......................... O I
2. Have you ever had a weight problem (overweight or underweight)? .......... O I
3. Have you frequently experienced injuries (sprains. burns. poisoning.

dislocations. serious back problems. etc.) ............................... O I
4. Have you ever had a tumor. cancer. cyst. or growth? ...................... 0 I
5. Have you ever had major surgery? .................................... O 1
6. Have you ever had repeated painful headaches (e.g., migraine) or any types of

fits (seizures. epilepsy. convulsions)? .................................. 0 I
7. Have you ever had any serious trouble with your hearing or vision? ........... 0 I
8. Have you ever suffered from high blood pressure or hypertension? ............ 0 I
9. Have you ever had diabetes or a gallbladder or liver disease? ................ 0 I

 

PART II.

IO. Have
ll. Have

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I2. Have

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13. Have
I4. Have
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PART IV
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267
PART III (Continued)
929. YES

10. Have you ever been diagnosed as having high cholesterol levels? ............. 0 I
I1. Have you ever had any kind of trouble with your blood (blood dysfunction. bleed

longer from cuts than most peOple. anemia. excessive bleeding with periods. etc.)? 0 I
l2. Have you ever had any serious respiratory problems (lungs. bronchitis.

pneumonia. frequent heavy chest colds. etc)? ............................ 0 I
13. Have you had frequent infecrions (kidney, urinary, throat. skin. etc)? .......... 0 I

0 I

14. Have you had problems with allergies? .................................
15. @W MANY serious health problems have you had not listed above? Write number:

PART IV

The questions in this section refer to an Employee Assistange Prgggam (EAP). M.S.U. provides
an EAP as a beneﬁt to all its employees to help them resolve any type of problem they may be

experiencing (e.g., personal. emotional. physical. nutritional. legal. subStance abuse. ﬁnancial.
marital, child-care. etc.). M.S.U.’s EAP is located in a building on campus and provides a
variety of services which include diagnosis of the problem. short-term and long-term counseling
services. seminars on a variety of topics. and referral to community resources if needed.

Please circle the one best response for each item using the following scale:

 

(SD) (MD) (SD) (SL) (MA) (SA)
Strongly Moderately Slightly Slightly Moderately Strongly
Disagree Disagree Disagree Agree Agree Agree

1 2 3 4 3 6

 

I. My friends outside the workplace have supported. encouraged. or so MDSDSLMA SA

pressured me to use the EAP services OR they would need to support

my going to the EAP for me to seek assistance at the EAP ............. l 2 3 4 5 6
2. I think the EAP is too inaccessible or inconvenient for me to use ........ I 2 3 4 S 6
3. I would never use the EAP because I’m too shy or would be

embarrassed to discuss any problem I might have with a counselor ....... 1 2 3 4 J 6
4- My friends outside the workplace would need to have utilized an EAP

before I would go to an EAP to help resolve any problem I may have I 2 3 4 5 6
5- My family would need to support my using the EAP before I would go

to the EAP to help resolve any problem I may have .................. I 2 3 4 5 6
6. Going to the EAP would interfere with my Other activities/

take too much time .......................................... I 2 3 4 5 6
7. I think pe0ple should handle their problems on their own without

seeking any type of counseling .................................. 1 2 3 4 5 6
8. I would never use the EAP because it doesn’t provide the types of -

services or staff I need to help me with any problems I might have ....... 1 2 3 4 a 6
9- Members of my family would need to have used an EAP before I

would use any of the EAP services available ........................ I 2 3 4 5 6
10. I would nor use the EAP because either I don‘t know how to contact 7 3 4 5 6

the EAP or I just don’t know anything about the EAP ................ I

 

 

 

PART IV (

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29

 

 

 

 

268
PART IV (Continued)
(SD) (MD) (SD) (SL) (MA) (SA)
Strongly Moderately Slightly Slightly Moderately Strongly
Disagree Disagree Disagree Agree Agree Agree
1 2 3 4 5 6
I

11. My spouse/signiﬁcant other would have to pressure me into seeking souo so SLMASA

assistance at the EAP before I would use any of the EAP’s services ...... I 2 3 4 5 6
12. My close acquaintances would need to encourage me and undersrand

why I felt I needed to seek assistance at the EAP before I would

utilize any of‘the EAP’s services ................................. I Z 3 4 5 6
13. I would not use M.S.U.’s EAP because I am afraid the EAP Staff would

NOT keep my problem conﬁdential .............................. I 2 3 4 5 6
I4. My supervisor at work would' need to encourage. pressure. or require

me to use M.S.U.’s EAP before I would seek assistance at the EAP office . . I 2 3 4 5 6
15. The union I belong to at work would have to encourage employees

to use the EAP before I would ever use any of its services ............. I 2 3 4 S 6
16. The only way I would use M.S.U.’s EAP is if I knew one or more of ‘

my coworkers had already used the EAP services at some time .......... l 2 3 4 5 6
17. My supervisor would need to have used the EAP for me to use it for

resolving any problem I may have ............................... I 2 3 4 5 6
18. It is important to me to do what my coworkers think is best so they

would need to encourage/support my using the EAP before I would

use any of its services ......................................... 1 2 3 4 5 6
19. My supervisor doesn't care about my health or my problems so I

wouldn’t go to M.S.U.’s EAP even ifl had a problem ................ I 2 3 4 5 6
20. I would be too embarrassed to have anyone at work ﬁnd out I went

to the EAP ................................................ I 2 3 4 5 6
21. M.S.U. would have to promote and encourage employees to go to the

EAP before I would use any of its services ......................... 1 2 3 4 5 6
22. I would be afraid my coworkers at work would think I was weak if I

wenttOtheEAP ........................................... 12345 6
23. I would not use the EAP because I am afraid someone at work would

find out and it would hurt my career/job at M.S.U. ................. I 2 3 4 5 6
24. M.S.U. doesn’t care about my health or my problems so I wouldn‘t go

to M.S.U.’s EAP even ifI had a problem .......................... I 2 3 4 5 6
25- My coworkers don’t care about my health or my problems so I would

not listen to their advice about going to the EAP ................... I 2 3 4 5 6
26. My coworkers think peOpIe should handle their own problems so I .

would never go to the EAP ................................... I 2 3 4 3 6
27. I would not go to the EAP because M.S.U. doesn’t keep employees -

informed about the services available ............................ I 2 3 4 a 6
28. I would contact M.S.U.’s EAP if I had a problem because I feel the EAP _

is a good beneﬁt provided to employees .................... . ...... 1 2 3 4 3 6
29. I would prefer using counselors/resources outside of the workplace if I 7 3 4 5 6

I ever had a problem which required counseling ...................

 

 

._.

Ix)
o

269

PART V

....

[Q

.L»

w.

U:

0*

an

Please circle the one best response (letter) to each question.

. Looking back to when vou were growing up, how would you describe your family‘s practice

of healthy behaviors (exercismg, sleeping, eating, seeking medical aid when necessary, etc.)?
a. It was a very important part of our daily lives

b. It was moderately important to us

c It was somewhat important. but only carried out haphazardly

d: It was not seen as having priority

Looking back to W, how w0uld you describe your mew; practice
of healthy behaviors (exercismg, healthy diet and sleeping habits)?

. It was a very important part of their lives

It was moderately important

It was somewhat important

. It was not at all important .

ape—re

How w0uld you currently describe your family‘s practice of healthy behaviors (exercising,
sleeping, eating, seeking medical aid when necessary. etc.)?

a. It is a very important part of their lives

b. It is moderately important

It is somewhat important

. It does not seem to be important

. How would you cgagntly describe your friends’ practice of healthy behaviors (exercising,

healthy diet and sleeping habits)?

a. It is a very important part of their lives
b. It is moderately important

c. It is somewhat important

d. It does not seem to be important

. How frequently would you say you visited a health professional (medical doctor. dentist. health

clinic. hospital, etc.) while you were growing up?
Never

. Seldom

. Often

. Very often

CCU?

. Which of the following would best describe the seeking of health assistance by members of your

family was (Parents, spouse. etc.)?

a. They go to a doctor for regular check-ups as well as any time they feel ill
b- They only go to the docror when they feel they have something wrong

c. They seldom go to the doctor even when they are in pain

d. They never go to the doctor or seek any medical assistance

e. I don‘t know

 

270

PART V (Continued)

7.

Do you feel your parents/family were good at handling stress and emotional problems in their
lives when vou were growing LL12?

a. Most of the time
b. Some of the time
c. Rarely
d. Never
e. Not sure

. Which of the following would best describe the seeking of health assistance by your friends

today?

a. They go to a doctor for regular check-ups as well as whenever they feel ill
b. They only go to the doctor when they feel they have something wrong

c. They seldom go to the doctor even when they are in pain

d. They never go to the doctor or seek any medical assistance

e. I don’t know

Did any of your family members or friends ever seek professional assistance/counseling. to help
cope with their emotional problems (such as marital or child-rearing problems. depressmn. jOb
stress. handling grief, etc.) while vou were growing ug?

a. Yes

"b. No

c. Not sure

. How often did members of your family take part in regular exercise/sports while ygu wgrg

gzgwing up?

:1. Never
b. Not often
c. Often
d. Very often

. How often do members of your current family (spouse. children, parents. brOthers, Sisters. etc.)

mm take part in regular exercise/sports?

a. Never
b. N0t often
c. Often
d. Very often

. . . . 7
. How often do your current friends take part in gguju; exerCise/sports.

21. Never
b. Not often
c. Often
d. Very often

' ' ' ll ﬁt?
- DOCS your immediate supervisor exerCise or appear to value being physxca y

a. Yes
b. No
c. Don’t know

 

PAI

Oa‘plc H-

16. Ii

271

PART V (Continued)

14.

U.

How often did your friends encourage you I0 maintain healthy behaviors (proper sleep patterns,
no smoking, limited alcohol. no non-prescription drugs, etc.) while you were growing uu?

21. Never

b. Not often

c. Often

(1. Very often

. Do you feel your family members or friends ever abused prescription or non-prescription drugs

whil ou were owin u ".7

a. Yes
b. No
c. Not sure

. In general. how strong are your current social ties with your family and friends?

a. Very strong

b. Mostly strong

c. Somewhat strong
d. Not very strong

. How often do your current family members and/or friends encourage you to participate in

 

exercise/sports?
a. Never

b. Not often
c. Often
d. Very often

PART VI

,_4

.N

. Compared to other persons your age. what do you DESIRE

. . . . . .. . .7 . . k ou
This section examines different health deSires of indiwduals. The followmg questions as y
about your DESIRED health goals and behaviors IF YOU COULD CHOOSE THESE
TODAY. There are no right or wrong answers. Please respond honestly to what you really
DESIRE regarding your health, not what you think might be a correct response. by Circling the
one appropriate response.

your general health to be?

:1. Far ahead of the average
b. Somewhat above average
c. Average or same as others
d. Somewhat below average
e. Way below average

If you could select your level of exercise. what would you DESIRE yolur‘cucrtiéeg level of aerobic
exercise to be per week (e.g., biking. jogging, SWImmmgv aerobics ‘- 35“ ' '

Less than once

Once

. Twice

. Three or four times

. Five or more times

0’!”

00.0

10

PAR

IlﬁcftndLLCd

at)“

(Lambnmiﬂmnmtiu
1%.

 

 

 

 

 

 

 

 

 

 

 

272

PART VI (Continued)

3.

a?

999?

How many times per week would you LIKE to make a conscientious effort to manage your
stress by utilizing progressive relaxation. exercise. religion. music, or Other stress reducrion
techniques?

' 0-1 time per week

2-3 times per week

4-5 times per week

6-7 times per-week

9‘?“

Considering your height and body build, how many pounds within your ideal weight would you
LIKE to fall?

. Within 2-5‘ pounds (either over or under)

Within 10 pounds (either over or under)

Within 15 pounds (either over or under)

Within 20 pounds (either over or under)

Within 25 pounds (either over or under)

It’s OK to be more than 25 pounds from my ideal weight (either over or under)

0.9g»

e9

Which statement most closely describes your DESIRED daily eating pattem?

a. Eating snack foods whenever I feel hungry (potato chips. soda pop. cookies. candy, pastry,
etc.)

Eating one balanced meal per day and eating snack foods at other times during the day
Eating two balanced meals per day and eating snack foods at Other times during the day
Eating three balanced meals per day and eating snack foods at other times during the day
Eating three balanced meals per day and not snacking

What stress level do you DESIRE to achieve in your personal/home life?
a. I would like to be completely free of stress

b. A minimal amount of stress is OK

c. A moderate amount of stress is OK

d. A high level of stress is OK

Which statement best describes how you would LIKE to feel about anxiety?

:1. It never bothers me to frequently feel anxious/uptight

b. Feeling anxious/uptight occasionally does not bother me

c. I dislike feeling anxious/uptight even occasionally

(1. I hate ever feeling anxious/uptight and wish I would never have these feelings

Which statement best describes your DESIRED level of cigarette smoking behavior?
I would like to have no desire to smoke at all

I would like to smoke I/2 pack or less per day

I would like to smoke between 1/2 and 1 pack per day

I would like to smoke from I to 1/2 packs per day

I would like to smoke over l-I/Z packs but less than 2 packs per day

I would like to smoke 2 packs or more per day

change

11

 

 

 

 

PART VI

9. Which

273

PART VI (Continued)

0

"Gs-noun 0-D

. Which choice best describes the consumption of alcoholic beverages which you DESIRE?
. 0 drinks per day (I would like to never drink)

. I drink or less per day

. 2 drinks per day

. 3 drinks per day

. 4 drinks per day

2 drinks or less per weekday. and more than I drink per day on weekends

. None of the above

10. How many cups of caffeinated beverages (coffee. tea, cola, etc.) do you DESIRE to drink per
day? -

F”?

....
..:

P

a.

b
c.
d

Less than 1 cup
1-3 cups

c. 4—6 cups
d.

7 or more cups

. Which best describes your DESIRED drug use pattern (over the counter. prescription. and non-

rescription drugs)?

Use drugs I want whenever I want

. Use drugs I feel I need while following common sense
Use only medically required drugs exactly as directed
. Rarely use drugs of any kind

12. How often do you DESIRE to have a medical checkup?

00.00””

. Never or only when something is wrong

. Only for Pap tests or other regular checks

. Every 3-5 years

. At least every 2 years

. At least every year

12

 

 

'0‘)

 

274

PART VII

[0

 

This section presents a liSt of problems or concerns which you may currently be experiencing or may
have experienced during the past year. There are three types of responses you should make
regarding each problem or area of concern. Some of the quesuons refer to an Employee Assistance
Program (EAP), which was defined in the previous section. The three scales to be used in this
section of the survey are:

CURRENT PROBLEMS SCALE

In the FIRST column following each statement. please rate your current status regarding each of the

health concerns or problem areas listed. Use the following scale and circle your best response under

the ”CURRENT PROBLEMS" column. The items refer to ygu_r health unless otherwise n0ted.

EXAMPLE I: If you feel your GENERAL PHYSICAL HEALTH is "Poor“ then you should circle
the number "2" for question Ia.

EXAMPLE 2: If you feel you have no BLOOD OR ANEMIA PROBLEMS then you should circle
the number "5" for "Excellent/No Problem" for question 13a.

(V?) (P) ~ (A) (G) (15)
Very Poor/ Poor Average Good Excellent/
Have a Problem No Problem
I 2 3 4 S

 

DESIRED CHANGE SCALE

In the 5% column following each item, please indicate the extent you would LIKE to change

your health or improve your health in each of the problem areas by using the following scale and

marking your responses under the "DESIRED CHANGE“ column.

EXAMPLE: If you desire a "Very Large Change" in your current "GENERAL PHYSICAL
HEALTH" then you should circle the number "5" for question lb.

 

(N0) (SL) (M0) (L0) (VL)
No Change Slight Moderate Large Very Large
Desired Change Desired Change Desired Change Desired Change Desired
I 2 3 4 5

 

EXPECTANCY SCALE

In the m column following each item, please respond whether you believe going to an
Employee Assistance Program (EAP) would help you either eliminate or decrease the problem liSted.
regardless of whether you currently are experiencing that problem or not. Use the scale below.
EXAMPLE: If you believe the EAP would be "Excellent/Help a great deal" in handling your
"GENERAL PHYSICAL HEALTH“ problems. then circle "5" for question 1c.

(V?) (P) (A) (G) (E)
Very Poor Poor Average Good Excellent
1 2 3 4 5
(EAP would be no help) (EAP would help a l0t)

 

13

 

 

 

 

PART V

CURREh

(VP)
Very P001
Have Prol

.W >1 9‘ .w 5— 5.... .~.—-
0-D
5"
(D
"I

 

 

 

 

 

 

 

 

 

 

275

PART VII (Continued)
EXPECTANCY THAT EAP WOULD HELP SCALE:

 

(VP) (P) (A) (G) (E)
Very Poor Poor Average Good Excellent
1 2 3 4 5
(EAP would be no help) (EAP would help a lOt)

 

DESIRED CHANGE SCALE:

 

(NO) (SL) (MD) (LG) (VL)
No Slight Moderate Large Very Large
Change Change Change Change Change
DeSired Desired Desired Desired Desired

l 2 3 4 5

 

 

CURRENT PROBLEMS SCALE:

 

(VP) (P) (A) (G) (E)
Very Poor/ Poor Average Good Excellentj

 

 

 

 

 

Have Problem No Problem
I 2 3 4 5
CURRENT DESIRED EXPECT ANCY THAT
PROBLEMS CHANGE AN EAP WOUID HELP
W W W
I. General physical health (a) l 2 3 4 5 (b) 1 2 3 4 5 (c) l 2 3 4 5
2. Cancer/cysts/growths (a) 1 2 3 4 5 (b) l 2 3 4 5 (c) l 2 3 4 5
3. Serious backaches (a) I 2 3 4 5 (b) l 2 3 4 5 (c) I 2 3 4 5
4. Other serious aches (a) 1 2 3 4 5 (b) l 2 3 4 5 (c) l 2 3 4 5
5. Weight problem (a) I 2 3 4 S (b) I 2 3 4 5 (c) I 2 3 4 5
6. Blood pressure/hypertension (a) I 2 3 4 5 (b) l 2 3 4 5 (c) l 2 3 4 5
7. Cholesterol level (a) l 2 3 4 5 (b) l 2 3 4 3 (c) l 2 3 4 5
8.Diabetes (a)12345 (b)l2345 (c)12345
9. Cardiovascular/heart problem (a) l 2 3 4 5 (b) l 2 3 4 S (c) l 2 3 4 5
10. Respiratory problem(s) (a) l 2 3 4 5 (b) l 2 3 4 3 (c) I 2 3 4 5
11. Vision or hearing (a) I 2 3 4 5 (b) 1 2 3 4 5 (c) l 2 3 4 3
12.Ulcer(s) (a) 12345 (b)12345 (c)12345
l3. InfeCtion(s) (a) l 2 3 4 S (b) l 2 3 4 5 (c) I 2 3 4 3
14. Blood problems/anemia (a) l 2 3 4 5 (b) I 2 3 4 S (c) l 2 3 4 5
15. Handling stress (a) l 2 3 4 5 (b) l 2 3 4 5 (c) l 2 3 4 3
16. Legal problems (a) I 2 3 4 5 (b) l 2 3 4 5 (c) l 2 3 4 5
l7. Marital/signiﬁcant (a) I 2 3 4 5 (b) l 2 3 4 3 (c) I 2 3 4 5
Other problems (a) l 2 3 4 5 (b) I 2 3 4 3 (c) l 2 3 4 5
18. Financial problem(s) (a) l 2 3 4 5 (b) 1 3 3 4 5 (C) 1 3 3 4 5
l4

 

PART VII

RRENT
CU

(VP)
Very ‘Poor/
Hill/C Pl’ObIl

I
\

19 Caring ;
20- Child c;
31- Family/l
22- DIVOrc¢
1 ' Dealing
2' Bumoui
1' Depress
6» Suicidal

- Anxietyi
28' TrOuble
29' Feel alit
- Feel insi
3]. Proper;
32' Eating d
(aﬂOrexi
33‘ Regular
34' AlCOhol
35» Use of d

 

 

 

276

PART VII (Continued)
EXPECTANCY THAT EAP WOULD HELP SCALE:

 

(V?) (P) (A) (G) (E)
Very Poor Poor Average Good Excellent
I 2 3 4 5
(EAP would be no help) (EAP would help a lot)

 

DESIRED CHANGE SCALE:

(N0) (SL) l MD) (LG) (VL)
No Slight Moderate Large Very Large
Change Change Change Change Change
Desired Desired Desired Desired Desired

I 2 3 4 5

 

 

 

CURRENT PROBLEMS SCALE:

 

(VP) (P) (A) (G) (E)
Very'Poor/ Poor Average Good Excellent/

 

 

 

 

 

Have Problem No Problem
1 2 3 4 5

CURRENT DESIRED EXPECTANCY THAT

PROBLEMS CHANGE AN EAP WOULD HELP .

w W ELLA—(LE
I9. Caring for aged (parents. etc.) (a) l 2 3 4 5 (b) 1 2 3 4 5 (c) l 2 3 4 5
20. Child care problems (a) l 2 3 4 5 (b) 1 2 3 4 5 (c) I 2 3 4 5
21. Family/parenting problems (a) l 2 3 4 5 (b) I 2 3 4 5 (c) 1 2 3 4 5
22. Divorce/separation (a) l 2 3 4 5 (b) I 2 3 4 5 (c) I 2 3 4 5
23. Dealing with death/loss (a) l 2 3 4 5 (b) l 2 3 4 5 (c) 1 2 3 4 S
24. Burnout/mental fatigue (a) I 2 3 4 5 (b) I 2 3 4 5 (C) l 2 3 4 5
25. Depressed/unhappy feeling (a) l 2 3 4 5 '(b) l 3 3 4 5 (C) 1 2 3 4 5
26. Suicidal feelings (a) 1 2 3 4 S (b) l 2 3 4 5 (c) 1 2 3 4 5
27. Anxiety/phobias (a) l 2 3 4 5 (b) l 2 3 4 5 (c) 1 2 3 4 5
28. Trouble with relatives (a) 1 2 3 4 5 (b) 1 2 3 4 5 (C) 1 3 3 4 5
29. Feel alienated/withdrawn (a) l 2 3 4 5 (b) l 2 3 4 5 (c) l 2 3 4 5
30. Feel insecure (a) I 2 3 4 S (b) l 2 3 4 5 (c) I 2 3 4 S
3]. Proper nutrition (3) l 2 3 4 S (b) I 2 3 4 5 (c) I 2 3 4 5
32. Eating disorders "

(anorexia. bulimia) (a) I 2 3 4 5 (b) 1 2 3 4 5 (c) 1 2 3 4 5
33. Regular exercise (a) I 2 3 4 5 (b) l 2 3 4 5 (C) I 2 3 4 5
34. Alcohol useJabuse (a) 1 2 3 4 5 (b) l 2 3 4 5 (c) 1 2 3 4 S
35. Use of drugs/medications (a) I 2 3 4 5 (b) l 2 3 4 5 (C) I 2 3 4 5
15

 

PART

CURR

(Vi
Very}!
Havel

36~ Sit
37. At

Please 1
[hm YOI

List:

I‘ll

PLEAs

 

 

277

PART VII (Continued)
EXPECTANCY THAT EAP WOULD HELP SCALE:

 

(VP) (P) (A) (G) (E)
Very Poor Poor Average Good Excellent
I 2 3 4 S
(EAP would be no help) (EAP would help a lot")

 

DESIRED CHANGE SCALE:

(NO) (SL) (MD) (LG) (VL)

No Slight Moderate Large Very Large
Change Change Change Change Change
Desired ' Desired Desired Desired Desired

l 2 3 4 3

 

 

CURRENT PROBLEMS SCALE:

(VP) (P) (A) (G) (E)
Very'Poor/ Poor Average Good Excellent/

 

 

 

 

I-Iave Problem No Problem
I 2 3 4 5
CURRENT DESIRED EXPECT ANCY THAT
PROBLEMS CHANGE AN EAP WOULD HELP
we W W
36. Smoking habits (a) l 2 3 4 5 (b) I 2 3 4 3 (c) I 2 3 4 3
37. Absences from work (a) l 2 3 4 5 (b) 1 3 3 4 3 (C) 1 - 3 4 3

utritional. emotional. etc.) nOt mentioned above

Please 1' lth roblems ( h sical. n
m below any other hea p p y blems. please continue with PART VIII on the

that you may be experiencing. If you have no Other pro
following page.

 

 

List:

‘ ' 2345
38. a12343 (b)l234a (c)I.. _
39. (312345 (6)1234) ((312343
40. (a)12345 (b)12345 (@1234:

 

PLEASE CONTINUE WITH PART VIII
16

PAR'

[Epab

I
l

Elbnmde.

3m

HCnminm‘Mithsiu gin

I,“

I I
.l .J

 

 

278

PART VIII

!~)

This section focuses on any previous experience you have had with an EAP and your attitude
toward utilizing an EAP. Please circle the appropriate letter for each queStion.

. Do you have an opportunity to utilize other assistance services Other than those at M.S.U.’S

EAP that are either free or affordable (e.g., spouse's EAP, church counselors. psychiatrist.
psychologist. etc.)?
a. Yes

b. No

How willing would you be to use M.S.U.‘s EAP if you needed the services?
Very willing

Willing

Neither willing nor unwilling

Unwilling

Very unwilling

9999'?

Have you used any of the following resources for help with a problem that has bOthered you?
Circle ALL THAT APPLY.

EAP counselor-either at M.S.U.'S EAP or an EAP where you may previously have worked
Mental health center (other than EAP counselor)

Private counselor/psychologist

Psychiatrist

Clergy .

Family member (circle which: spouse. child. parent, brOther, Sister. Other ____)
Fdend .

Self-help group (Alcoholics Anonymous. Parents Anonymous. weight-control group, etc.)
Work supervisor

Other. specify:

. 9' f"

*r‘r'sqs ran 0.9

 

If you HAVE used ANY EAP in the past. please respond to the following questions in this

seCtion (continue with quesﬁon 4 below). . .
If you HAVE NOT ever used an EAP. please continue Wlth PART IX on page 19.

Circle the one response which best describes the improvement you experienced in
your problem situation as a result of contacung the EAP:

a. My problem was resolved

b. I can see great improvement

c. I can see some improvement

d. I cannot see any improvement

e. My situation has become worse

f. I didn’t contact the EAP referral

Was the problem you sought assistance on affecting your )Ob performance?
a. Yes

b. No

c. Don’t know

17

279

PART VIII (Continued)

6.

10.

To what extent do you think your job performance improved as a result of contacting the EAP?
a. To a great extent

b. To some extent

c. No change

d. Deteriorated somewhat

e. Deteriorated a IOt

How satisﬁed were you with the EAP?
Very satisfied

Satisfied

Neither satisﬁed nor dissatisfied
Dissatisﬁed

Very dissatisfied

0’?

{no.0

Would you recommend the EAP to others?
I. Yes
2. No - If no, why not?

If there had been no EAP where you work. would you have sought some other assistance on

, your own at that time?

a. Yes, I would have

b. I probably would have
c. Uncertain

(I. Probably not

e. No

How do you feel about using the EAP’S services again?
. Very willing

Willing

Neither willing nor unwilling

Unwilling

Very unwilling

9999's

. Who initially referred you to the EAP?

Self~referral
Supervisory-referral . . ‘
Significant Other in personal life referral (family member. close friend. spouse)
Coworker referral ‘

Union (ofﬁcial union representative)

f. Other. please specify:

L

SPF-PS"

 

. How long would you estimate the problem(s) which brought you to the EAP had

been affecting you or your job before you contacted the EAP?

a. Less than 6 months

b. 6 months to I year

c. Over 1 but less than 3 years
d. 3 years or more

18

.)..

THAI

PLEA
PAYh

280

PART [X

Please answer the following questions about yourself for background and analyses purposes.
Remember. your responses will be confidential and anonymous once you return the survey and

your name is detached.

1. What is your gender?

a. Male
b. Female
2. What is your race or ethnic background?
White
Black
Hispanic -

American Indian/Alaskan
Asiaanacific Islander
Other

”can?!”

3. What is your educational level?
a. Some or no high school
b. High school graduate
c. Tradelvocational school
. (1. Some college
e. Undergraduate college degree
f. Graduate college degree

4. What type of job position do you hold
at M.S.U.?
a. Service or maintenance worker
b. Skilled labor/trade
c. Clerical
d. Technical
e. Professional
t. Administrator/manager
g. Other

What is your current marital Status?
a. Single (or divorced. widowed)
with no dependents/children
b. Single (or divorced. widowed)
with dependents/children
c. Married with no dependents/children
(I. Married with dependents/children

.Ui

THANK YOU FOR Y

PLEASE RETURN IT VIA W IN THE ENCLOSE

PAYMENT!

6. What is your family income?
Less than 39.999
510.000 to $19,999
320.000 to 829.999
330.000 to 339.999
340.000 to $49,999
$50,000 to $59,999
$60,000 or more

9‘?

eraser»

7. In what age group are you?
Under 25

26-30

31-35

36—40

41-45

46-50

51-55

56—60

61 or over

cassette???

8. How long have you been

employed at M.S.U.?

a. Less than 1 year

b. At leaSt l but less
than 3 years

c. At least 3 but less
than 5 years

d. At least 5 but less
than 8 years

c. 8 years or more

OUR PARTICIPATION! YOU HAVE COMPLETED THIS SURVEY!
D ENVELOPE TO RECEIVE YOUR

19

281

If there are any comments you wish to make about the questionnaire or

any aspect of the questionnaire administration process. please feel free
to do so below. Thank you.

20

   

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