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MSU In An Affirmative ActionlEqnl Opponunlty III-titular!
WM‘

 

AN ANALYSIS OF
HEALTH PROMOTION MEDIA USE
IN ORGANIZATIONS WITHIN THE UNITED STATES
By

Gary L. Flegal

. A DISSERTATION

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

DOCTOR OF PHILOSOPHY
Department of Physical Education and Exercise Science

1996

 

ABSTRACT

AN ANALYSIS OF
HEALTH PROMOTION MEDIA USE
IN ORGANIZATIONS WITHIN THE UNITED STATES
By

Gary L. Flegal

Downie, Fyfe, and Tannahill’s (1990) model of health promotion was utilized in
this study to assess the use of media in companies providing worksite health promotion
programs. Subjects were 212 (response rate = 35.33%) health promotion professionals
and members of the Association for Worksite Health Promotion. Nine research questions
were used to explore (a) the types of programs offered by organizations, (b) the value
placed upon various criteria for rating program effectiveness, (c) the types of media used
to promote various programs, ((1) the media and non-media reasons health promotion
practitioners identify for program effectiveness and non-effectiveness, (e) the importance
0f specific media characteristics in promoting health promotion programs, and (f)
demographic information about the respondents and their organizations. Major findings
of the study indicated that professionals’ promotional efforts were primarily in the
W(49-7%),W015%L andP_r¢x§_n_t_ix.e.
m (13.6%) domains. Professionals reported that W, Am,

n T r H h— t Im r v m n , and Mmagement Favors It are the primary
criteria by which their organizations judge their programs and that ILrgengy, Detail,
9131, um, and Interactive are the most important qualities in their choice of media.

Media choice (e. g., face-to—face, word-of—mouth, newsletter) in effective programs

 

differed from ineffective programs primarily in the frequency of use. Personal gontagt
and mm were identified as the major media and non-media reasons for
program effectiveness, respectively. Lack Qf Promotion for an event and Readiness
were identified as the major media and non-media reasons for program ineffectiveness,

respectively.

Copyright © by
GARY L. FLEGAL
1996

This dissertation is dedicated to Leona Washbum
and the inspiration that she provided in my life.
May your dance never end . . .

ACKNOWLEDGMENTS

There are many peOple to whom a word of thanks is due for the suffering that

they have personally endured to help me through my doctoral school process.

First I would like to thank Vernon Miller, without whose patient guidance this
dissertation would never have happened.

A M thank you to Ed and Lillian Kivela who provided my "home away
from home.” Thank you for making me part of your family.

For all his many patient hours helping me locate resources, thank you, Bill
Nelton, my favorite librarian in all the world.

A word of appreciation to Willa Manchester, who has given me the
opportunity to work in my chosen field, and will be particularly pleased to see
me finished with this degree.

A thank you to my parents, Joe and Donna Flegal, who gave me life and an
attitude to win.

To my children, Samuel Judson Flegal and Diana Rose Flegal, I love you guys
and want to thank you for gypsying all over the country with your wayward

dad. Thanks for being the special peOple you are.

vi

The most important and biggest thank YOU goes to my wife, Daphna.

You stayed with me the whole way - that says a lot. I love you, more than

you’ll ever know.

vii

TABLE OF CONTENTS

LIST OF TABLES ...................................... xii
LIST OF FIGURES ...................................... xiv
CHAPTER 1

AN ANALYSIS OF HEALTH PROMOTION MEDIA USE IN ORGANIZATIONS

WITHIN THE UNITED STATES ............................ l

Introduction .......................................... l

Research Questions ..................................... 1

Literature Review ...................................... 2

Health Promotion Programs .............................. 5

The Public Health Model .............................. 5

The Medical Authority Model ........................... 6

The Employee Assistance Model ......................... 6

The Health Era Model ............................... 7

Definitions ....................................... 8

Beyond One Dimensional Models ........................ 11

Domains of Health Promotion .......................... 13

Positive Health Education ........................... 15

Preventive Services .............................. 16

viii

Positive Health Protection .......................... 17

Preventive Health Education ......................... 18
Preventive Health Protection ......................... 20
Health Education Aimed at Positive Health Protection ......... 21
Health Education for Preventive Health Protection ............ 23
Research Questions 1 & 2 ............................ 25
Effectiveness Of Health Promotion Programs .................. 26
Potential Benefits .................................. 26
Relationship Of Benefits To Health Promotion Domains .......... 30
Cost-Benefit Analyses ............................... 30
Challenges When Measuring Effectiveness .................. 31
Research Question 3 ................................ 33
Research Question 4 ................................ 34
Promoting Health Promotion Programs ...................... 34
Health Promotion and Communication Goals ................. 34
Channels for Health Communication in Organizations ............ 38
Health Program Promotion Mediums ...................... 43
Message Mediums ................................. 43
Research Questions 5 & 6 ............................ 48
Media Applications for Domains of Health Promotion ........... 48
Research Question 7 ................................ 54
Media Choice and Effectiveness ......................... 54
Research Questions 8 & 9 ............................ 57

ix

CHAPTER 2

METHODOLOGY AND RESEARCH DESIGN .................... 59
Research Questions .................................... 59
Subjects ........................................... 60
Procedures ......................................... 71
Instrument Used in the Survey ............................. 73

Health Promotion Program Offerings ....................... 74
Health Promotion Typology ............................. 77
Type of Industry ................................... 77
Program Effectiveness ................................ 78
Important dimensions of media ........................... 79
Factors associated with program success or failure ............... 80
Background Information ............................... 80
Statistics ........................................... 81

CHAPTER 3

RESULTS ............................................ 82

CHAPTER 4

DISCUSSION ......................................... l 13
Theme 1: What Health Promotion Professionals Do And The Criteria For

Determining Their Success ........................ 114
Theme 2: Important Media And Their Characteristics .............. 118
Theme 3: The Contribution Of Media And Non-Media Factors To Successful

And Unsuccessful Programs ....................... 120
Limitations ......................................... 122

Future Research Questions ................................ 124

Epilogue . . .

APPENDICES

APPENDIX A -

APPENDIX B -

APPENDIX C -

APPENDIX D -

APPENDIX E -

APPENDIX F -

APPENDIX G -

APPENDIX H -

APPENDIX I -

APPENDIX J -

REFERENCES .

........................................ 126

SURVEY INSTRUMENT ...................... 128

SELECTED DIMENSIONS FOR DETERMINING THE
EFFECTIVENESS OF HEALTH PROMOTION PROGRAMS 138

MEDIA CHARACTERISTICS (DIMENSIONS) ......... 139
TYPES OF MEDIA .......................... 140

HEALTH PROMOTION PROGRAM DOMAINS - A CODE
BOOK .................................. 141

MEDIA REASONS FOR MOST EFFECTIVE PROGRAM . . 152

NON-MEDIA REASONS FOR MOST EFFECTIVE
PROGRAM ............................... 160

MEDIA REASONS FOR LEAST EFFECTIVE PROGRAM . 170

NON-MEDIA REASONS FOR LEAST EFFECTIVE
PROGRAM ............................... 177

TYPOLOGY OF HEALTH PROMOTION PROGRAMS IN
NORTH AMERICAN CORPORATIONS AND GOVERNMENT
AGENCIES ............................... 187

........................................ 188

xi

Table 1 -

Table 2 -

Table 3 -

Table 4 -

Table 5 -

Table 6 -

Table 7 -

Table 8 -

Table 9 -

Table 10 -

Table 1 l -

Table 12 -

Table 13 -

Table 14 -

Table 15 -

Table 16 -

LIST OF TABLES

Potential Benefits from Worksite Health Promotion Programs ..... 27
The Relationship Between Media Characteristics and Media

Richness ..................................... 44
Media Use .................................... 49
Distribution of Subjects by Education Levels ............... 62
Distribution of Subjects by Departments .................. 63
Distribution of Subjects by Department Size ............... 64
Distribution of Subjects by Industry Type ................. 65
Distribution of Subjects by Size of Organization ............. 66
Distribution of Subjects by Length of Tenure with Organization . . . 67
Distribution of Subjects by Time In Current Position .......... 68
Distribution of Subjects by Status/Rank within Organization ...... 69
Distribution of Subjects by Number of Years Health Promotion Program
Has Existed Within Organization ...................... 7O
Factor Loadings for Items and Reliabilities for Program Effectiveness
Scale ....................................... 75
Factor Loadings for Items and Reliabilities for Important Dimensions of
Media Scale ................................... 76
Major Health Promotion Domain Use Reported In Study ........ 83
Percentages of Program Usage By Domains ................ 85

xii

Table 17 -

Table 18 -

Table 19 -

Table 20 -

Table 21 -

Table 22 -

Table 23 -

Table 24 -

Table 25 -

Table 26 -

Table 27 -

Table 28 -

Table 29 -

Table 30 -

Table 31 -

Table 32 -

Table 33 -

Distribution Of The Usage Of Health Promotion Program Domains

Across Types Of Industry .......................... 87
Means, Standard Deviations and Correlations of Criteria for Reported

Values of Organizations In Determining Program Effectiveness . . . . 89
T-Tests Between Program Effectiveness Criteria ............. 90

Means and Standard Deviations for Comparison between Media
Characteristics in the Various Industry Types ............... 91

Means and Standard Deviations for Comparison between Media
Characteristics in the Three Most Represented Health Promotion
Domains ..................................... 93

Means, Standard Deviations and Correlations of Important Media
Characteristics ................................. 94

T-Tests Between Important Media Characteristics Criteria ....... 95

Correlations Between Program Effectiveness Criteria And Important
Media Characteristics ............................. 96

Summary of Top 10 Media Used For Health Promotion Programs . . 99

Totals of Media Reasons for Most Effective Programs ......... 101
Totals of Non-Media Reasons for Most Effective Programs ...... 102
Totals of Media Reasons for Least Effective Programs ......... 104
Totals of Non—Media Reasons for Least Effective Programs ...... 106

Percentages of Media Use for Most and Least Effective Health
Promotion Programs by Promotion Domains ............... 108

Percentages of Media Reasons for Most Effective Programs by
Domains ..................................... 109

Percentages of Non-Media Reasons for Most Effective Programs by
Domains ..................................... 110

Percentages of Media Reasons for Least Effective Programs by
Domains ..................................... 111

xiii

Table 34 - Percentages of Non-Media Reasons for Least Effective Programs by
Domains ..................................... 112

Table 35 - Comparison of Results with Rawson (1987) and Heirich, et a1. (1989) 123

xiv

LIST OF FIGURES

Figure l - Relationship between Well-being and Ill-health .............. 12
Figure 2 — A Model of Health Promotion ........................ 14
Figure 3 - 12 Key Questions To Guide In The Assessment Of Communication

Environment And Development Of Communication Guidelines . . . . 40
Figure 4 - Eight Steps to Effective Worksite Communication of Health

Information ................................... 4 l

XV

CHAPTER 1
AN ANALYSIS OF
HEALTH PROMOTION MEDIA USE
IN ORGANIZATIONS WITHIN THE UNITED STATES

Introduction

In this study the health promotion practices of organizations within the United
States are examined. In an effort to more adequately describe downward dissemination
of health promotion efforts in corporations, this study identifies: (a) the characteristics
of the corporate health program domains, (b) the downward-directed message
dissemination strategies typifying these health program domains, and (c) the role of
communication in program effectiveness.
Rgoarch Questions

Nine research questions are asked in order to determine the characteristics of
corporate health promotion programs and the role of communication in program
effectiveness. The nine research questions are listed below.
RQl: What types of health promotion programs are used by organizations?
RQ2: How do health promotion programs differ across various types of industry?
RQ3: What criteria (dimensions) do health promotion professionals perceive that

their organizations value as being most useful in determining program

effectiveness?
RQ4: How do criteria used to evaluate the effectiveness of health promotion

programs vary across the types of industry?

RQS: What do health promotion professionals consider to be the most important

media characteristics (i.e., "media dimensions") in promoting programs?

2

RQ6: How do these rated media characteristics vary by industry?
RQ7: What uses of media characterize effective and ineffective health promotion
programs?
RQ8: What do health promotion professionals regard as the key media and non-
media factors in the success or failure of promotions?
RQ9: What is the relationship between health promotion program success or failure
and media use in their respective health promotion domains?
Background information for each question is developed in the literature review.
i v’ w
Throughout North America and Europe, organizations are endorsing health
promotion programs in an effort to improve employees’ fitness, health, and wellness
(Chen, 1988; Fielding, 1984; Terborg, 1986). Nearly two-thirds of all companies in the
United States have at least some type of health promotion program (Mayer, 1991) serving
their employees and the employees’ dependents (Vass, Gatlin, & Walsh-Allis, 1988).
Worksite health promotion has potential to reduce corporate expenses through improved
employee performance (Anderson, 1986; Bhagat, 1983; Donoghue, 1977; Howard &
Mikalachki, 1979; Shephard, Cox, & Corey, 1981), attitudes (Holzbach, Piserchia,
McFadden, Hartwell, Herrmann, & Fielding, 1990; Waller, Crow, Sands, & Becker,
1988; Yoder, Jones, & Jones, 1985), job attendance (Bell & Blanke, 1986; Bertera,
1990; Boyce, Jones, & Hiatt, 1991; Hendricks & Czujko, 1986; Jones, Bly, &
Richardson, 1990; Tucker, Aldana, & Friedman, 1990), lifestyles linked with lower
disease risks (Reed, 1991; Shephard, Corey, Renzland, & Cox, 1983), and cost

containment of employee benefit/health plans (Bly & Jones, 1986; Chenoweth, 1990;

3
Elias, 1986; Erfurt, Foote, & Heirich, 1991a; Pelletier, 1991; Philips, 1988; Schwartz

& Rollins, 1985; Super, 1987). With the establishment of worksite health promotion
programs, employers want assurance that health promotion expenditures will, in fact,
curtail costs in the aforementioned areas and involve significant numbers of employees
(DeFriese & Barry, 1982; Emont & Cummings, 1990; Fielding, 1982; Harris, 1991;
Lovato & Green, 1990; Terry, 1990; Wilson, 1990).

Recent research suggests that measurable improvements in employee health result
from corporate programs dealing with hypertension control, physical fitness, nutrition
education, weight management, cholesterol control, stress management, substance
management, and smoking control (Chen, 1988; Erfurt & Foote, 1990; Erfurt et al.,
1991a, 1991b; Fielding, 1982; Walker & Evans, 1987). Among health promotion
practitioners, there is general agreement that the dissemination of information about
programs and activities is a key factor in health promotion effectiveness (Heirich,
Cameron, Erfurt, Foote, & Gregg, 1989; Rawson, 1987; Solomon & Maccoby, 1984;
Yeater, Fink, & West-Barker, 1985). Their conclusions are based on the premise that
employees’ awareness of and participation in corporate health programs can be traced to
receiving timely and relevant messages about these programs. In light of the importance
of communication processes relative to program success, health promotion professionals
should be knowledgeable of the various nuances inherent in marketing, advocating, and
orchestrating their programs (Heirich et a1. , 1989; Rawson, 1987; Solomon & Maccoby,
1984).

While organizations advertise health promotion programs through in-house

publications, union publications, word of mouth, memos attached to paychecks, in-house

4

closed-circuit television, posters, the organizational hierarchy, and union stewards
(Barnes & Given, 1991), there is no guarantee that these messages are effective in
informing or motivating employees. On the contrary, corporate efforts at downward
dissemination of information are often ineffective in producing desired results (Redding,
1972; Stohl & Redding, 1987). Superiors may not relay messages to subordinates
because (a) messages are interpreted as irrelevant, (b) messages are not understood, (c)
messages fail to motivate the superior, or (d) superiors simply do not send messages.
Given the reliance of health promotion professionals on message dissemination for the
success of their programs, it is alarming that to date no systematic effort has been made
to examine the effectiveness of how health promotion programs are promoted. Authors
describing the dissemination of health promotion information have restricted their work
to "how-to" lists lacking in theoretical or empirical basis (e.g., Anderson, 1986; Heirich
et al., 1989; Rawson, 1987). Without theoretically based empirical assessments, it is
impossible to determine the extent of employee response to corporate wellness efforts and
the effective use of budgeted dollars.

In an effort to more adequately describe downward dissemination of health
promotion efforts in corporations, the following factors are identified: (a) the
characteristics of the corporate health programs, (b) the downward-directed message
dissemination strategies typifying these health programs, and (c) the role of
communication in program effectiveness. In the first section of this review the terms
”health promotion program " and its elements as reflected in current industry practice will
be defined. In the second section effective and ineffective health promotion programs

will be distinguished. In the third section, entitled "Promoting Health Promotion

5

Programs," the role that corporate communication takes with regard to disseminating
information about health promotion programs will be examined.
Health Promotion Programs

Current models of health promotion are the result of reactions to previous health-
related models. These include (a) The Public Health Model, (b) The Medical Authority
Model, (c) The Employee Assistance Model, and (d) The Health Era Model. A brief
overview of these four models follows in order to give the reader an historical
perspective on the roots of modern health promotion.
Tho Public Halth Model

The great strides in health protection during the early years of the twentieth
century were largely due to legislation and subsequent regulation in such areas as
improved ventilation in public buildings, public sewer and water systems, improved
waste storage guidelines, and mandated immunizations (McClary, Zahrt, Montgomery,
Walker, & Petry, 1985; Means, 1962). Public health programs receive credit for
controlling and eradicating many of the contagious diseases that prevailed during the 19th
century and into the early 1900’s (McClary et al., 1985). The primary focus of public
health programs is changing physical, social, and/or legal environments by controlling
options within these environments (Klarreich, 1987). For example, a city has choices
about how it purifies its water, but these choices are affected by regulations of other
government agencies (e.g. , state inspectors examine city water purification systems). In
this way, public health targets communities, not individuals. Individuals are only of

interest "...for statistical purposes - as a smoker, drinker, drug abuser, or an entry in

6
the Centers for Disease Control Weekly Mortality and Morbidity Report" (Ainsworth,

1984, p.5).
The Medieal Aothority Model

This model, sometimes called the Acute Care Model, assumes that health depends
upon control of diseases (Academy for Educational Development, 1985). McClary et a1.
(1985) also refer to this model as emanating from "The Medical Era," a period between
1920 and 1960 which was characterized by extreme specialization within the medical
community and patients’ acceptance of physicians’ expert power. Perhaps the greatest
indicator of this kind of power is the patient who, when asked how he or she is doing,
turns to their physician and asks, "Well, how am I doing, Doctor?" The development
of "miracle" cures for the major illnesses of our day (e. g., open heart surgery; chemo-
therapy for cancer) exemplify the thrust of medical specialization, but this model does
little to prevent these diseases or induce the personal responsibility necessary to reduce
the risk of disease. Historically, physicians have told patients to stop smoking, lose
weight, or exercise in order to prevent disease, but have not taught patients how to do
these things. According to Ainsworth (1984),

Physicians are not involved in health care. They confine their

professional activities to illness, that is, care of the sick. They are taught

to diagnose and treat disease. The healthy person has not been their

concern. In fact, physicians define health as the absence of disease,
something beyond their interest, training, and competence (p.5).

The Emplon Am nce Model
Employee assistance programs (EAPS) surfaced during the early to mid 1940s in
order to assist employees in overcoming alcohol-related problems (Brody, 1988). In

general, sober workers reduced direct costs to employers through fewer accidents, better

7

attendance and higher productivity. The inauguration of workmen’s compensation laws
also motivated employers to eliminate on-the-job alcohol-related problems. These laws
held employers financially responsible for most work-related injuries regardless of who
was at fault.

The framing of alcoholism as a disease in 1956 by the American Medical
Association fundamentally changed the approach to employee alcohol problems. Based
on the Yale Center of Alcohol Studies, program titles in the 1960s and 19705 contained
descriptors such as "personal counseling" to remove the stigma attached to alcoholism
(Brody, 1988). Metaphors like "counseling" led to new EAP services for a broad range
of problems, including mental health, marital and family difficulties, money management,
as well as substance abuse (Carr & Hellan, 1980). These new EAPS contained
educational, preventive, and safety-oriented components.

The Health Em Model

This model emphasizes understanding health from a "wellness" perspective, a
view that sees an individual’s health as a complex function of the environment
interrelated with behaviors and choices made by the individual. Also referred to as the
"Post-Medical Era" (McClary et al., 1985), the Health Era Model views health as a
participatory process where individuals take responsibility for their own level of health
in conjunction with physicians and other health care professionals. This is in contrast
to the mechanistic view of health provided by the Medical Authority Model which treats
individuals’ bodies as machines to be worked upon by highly skilled mechanics. The
Health Era Model stresses that both public health and the medical professions are

necessary for maintaining and supporting wellness (McNight, 1982). Indeed, they are

8

responsible for bringing us to the place in history where we are able to pursue wellness.
At its most elemental level, wellness is a state resulting from individuals’ conscious
choices to improve or sustain physical, social, spiritual, and psychological health to
pursue a higher level of health and well-being, not simply the absence of disease. For
example, the main causes of premature death in our society are "lifestyle diseases (Edlin
& Golanty, 1985, p.206—210)," meaning that we participate in the causes of these
maladies.

Our participating in the development of an illness means that we make

certain choices to expose ourselves to stressful situations, and

furthermore, to react to these stresses in certain ways. These choices are

made unconsciously more often than consciously, and will depend on our

personality, on various external constraints and on social and cultural

conditioning (Capra, 1982, pp 162-163).
It is important to understand that individuals, in part, create their illness through
behaviors and choices (e. g., smoking, avoiding exercise). Taking partial responsibility
for any illness allows for one of two responses: individuals can either feel guilty, or they
can work at improving their health.
Definitioos

Prior to defining health promotion, three historical uses of the term "health" are
first compared. These concepts include (a) traditional medical understandings of health,
(b) the relationship of health education to health, and (c) the "wellness" or health
promotion understanding of health. Medical and health sciences have traditionally
focused upon how to avoid (primary prevention), cure (secondary prevention), or control

further complications from illness and disease (tertiary prevention) (Tannahill, 1985a).

These three levels of prevention constitute the range of physicians’ and public health

9

workers’ necessary functions. As such, "health" is the outcome of the medical process
and can be defined as the absence or control of signs and symptoms of disease
(Stachtchenko & Jenicek, 1990). While this medical orientation currently dominates the
health field, these efforts focus on the negative concept of ill-health. "In speaking about
ill-health, one might be referring to disease, injury, illness, disability or handicap, singly
or in various combinations and experienced over a long or a short period of time"
(Downie, Fyfe, & Tannahill, 1990, p.10). Strictly speaking, this approach "has
attempted to repair damage after it has been done without eliminating its causes"
(Anspaugh, Hamrick, & Rosato, 1991, p.3). In turn, a primary focus on remediating
ill-health does little to remediate the leading causes of premature death (i.e., heart
disease, cancer, etc.) which are related to behaviors and lifestyle choices (e.g. , smOking,
exercise, eating habits) (Anspaugh et al., 1991).

In contrast, health education is better equipped to address needed behavior
changes. Health education professionals provide background information and help clients
"develop skills and a healthy level of self-esteem, so that they come to feel significant
control resides within themselves, rather than feeling buffeted about by external forces
outside their sphere of influence" (Downie, et al., 1990, pp.59-60). Yet, health
educators lack the ability to handle the medical problems associated with behaviors and
lifestyles (e.g., surgery for cancer, prescription of drugs to control blood pressure).

Health promotion provides a basis for unifying the efforts of the traditional
medical community and health education professionals. "Health promotion" considers
health to be a resource which individuals bring to life situations, much the same as other

basic resources like income, shelter, and food (Nutbeam, 1986). Health promoters (a)

10

emphasize approaches and activities that sustain and enhance existing levels of health and
(b) view health as a positive and multidimensional concept (Stachtchenko & Jenicek,
1990). Central to health promotion is helping individuals discover (a) how to exercise
power that they may already possess, but are afraid to use, and (b) new skills enabling
them to manage parts of their lives that have been out of control. Learning how to say
"No" to a boss or acquaintance without feeling guilty exemplifies the former; learning
how to monitor blood pressure and keep it in a healthful range illustrates the latter.
Health promotion enables coordinated health care by (a) emphasizing the gains
of joint efforts on a potential or current medical problem, (b) identifying areas of
common interest, and (c) specifying the roles of medical and health education
professionals. Consider the following two examples. First, a smoking cessation class
based on behavior modification techniques also uses the medical prescription of epidermal
nicotine patches. Such a two-pronged attack only becomes possible when health
education and medical professionals work in concert. Instructors teach participants how
to deal with the stresses which reinforce the need to smoke and the patch temporarily
eliminates or reduces the urge to smoke. Second, surgery that corrects an existing
problem (secondary prevention) can be re-conceptualized as sustaining health. In this
case, individuals are brought back to the point where they can begin to deal with the
positive aspects of health. After bypass surgery, patients can begin supervised exercise
which may reduce the risk of future heart ailments and improve their overall health.
In summary, health promotion offers the widest possible array of strategies to deal
with the health issues of employers and employees, including cost containment. Just

replacing employees who have experienced heart attacks was estimated to cost employers

11

$700 million in 1989, with the total annual cost of cardiovascular disease estimated at
$88.2 billion (American Heart Association, 1989). Health promotion recognizes the need
for medical interventions as well as behavior modification education to control or prevent
some of the causes (e. g., smoking, lack of exercise) of potential health problems. Thus,
instead of maintaining the division between prevention and health education (Nutbeam,
1986), health promotion enables medical professionals and health educators to address
the complete range of health and wellness as a team (Anspaugh et al., 1991; Catford,
1983). Health protection (i.e., safety) programs are now recognized as compatible with
health education and behavioral/lifestyle change programs (Cohen & Murphy, 1989).
This suggests that safety engineers who work to reduce occupational exposures to toxic
and other harmful agents also can contribute to health promotion.
Be on n Dime ion 1 M dels

Downie et a1. (1990) suggest that the popular one dimensional health model
(Anspaugh et a1. , 1991; Catford, 1983) placing ill-health at one end and well-being at the
other end of the continuum is inadequate. Flaws in the one dimensional model are
obvious. Individuals can feel very positive about life in the presence of a life-threatening
disease, or they can be free from illness and not have feelings of well-being. Downie
and colleagues advocate a two dimensional model featuring both health and well-being
continuums. As depicted in Figure 1, individuals in quadrant 1 experience a high level
of well-being and are free from ill-health. Individuals in the second quadrant have no
evidence of ill-health, but exhibit a low level of well-being due to depression or simply

being unable to enjoy physical health. Individuals in quadrant 3 have a low level of

12

Figure 1
Relationship between Well-being and Ill-health
adapted from Downie et al. (1990)

WELL-BEING

high A

E:
E-
&
y—t

low

 

A

IHPD’H’J—l‘l‘“

 

low

V

13
well-being and a high level of ill-health. These persons may be depressed and have a

terminal illness or be experiencing chronic pain. Persons in quadrant 4 experience a high
level of well-being despite a high level of ill-health. These individuals may have a
serious illness, but accept what is happening and are at peace with themselves. In short,
it is important to recognize that (a) well-being and health both constitute our daily
definitions of a person’s state, and (b) that the relationship between well-being and health
is dynamic and always in flux.
Domoios of HQILD Promotion

Downie et al. (1990), based upon work by Tannahill (1985b), propose that health
promotion consists of seven "domains": Positive Health Education; Preventive Services;
Posio've HQLth Protgtion; Preventive Health Edoeation; Preventive Health Proteetion;
Hglth Egoeafioo aimgt at Positive Heolth Proteetion; and Health Edugtion for
Preventive Heath Protection. As illustrated in Figure 2, these seven domains of health
promotion are the result of the dynamic interaction of three main domains, health
education, prevention, and health protection. This model: (a) depicts activities frequently
considered to be health promotion, (b) shows how health education, prevention, and
health protection overlap, (c) includes both the positive and negative aspects of health,
and (d) identifies the political dimension of health care where legislation aimed at
protecting public health is introduced and lobbied. The following discussion describes
the health activity of each domain as proposed by Downie et al. (1990). This manuscript
then extends the description of each domain’s health activities and specifies the means

(i.e. media, channels) by which the activities are communicated.

14

Figure 2
A Model of Health Promotion
adapted from Downie et al. (1990)

    
      
 

Health Education

   

Prevention Health Protection

Legend:

1.

2.

3.

Positive Health Education

General instructional health activities.

Preventive Services

Screenings, immunizations, and surgical interventions for clients or populations.
Positive Health Protection

Creation of health legislation or regulatory policy.

. Preventive Health Education

Interventions for specific, identified health problems, (i.e., Weight loss, smoking cessation,
counseling, & EAPS).

. Preventive Health Protection

Enforcement of legislation/regulations to prevent health problems caused by workplace
hazards, toxins, or radiation.

. Health Education aimed at Positive Health Protection

Safety education to teach proper safety techniques, raising awareness and support for
legislation among employers and employees to combat potential health risks.

. Health Education for Preventive Health Protection

Educating legislators and policy makers of the need for laws/policies to prevent health and
safety problems.

15

According to Downie et al. (1990), the model demonstrates the wide range of
possibilities for health promotion. The domains "... are not seen as occupying rigidly
separate compartments (p. 59)." However, upon careful inspection of the model, it is
clear that each of the domains is intended to perform certain functions or is intended for
a specific audience. Since one of the purposes of this study is to understand more about
the kinds of health promotion activities used in business and industry, an effort is made
to categorize health promotion activities into specific domains. Intentionality of a
program or service ("What is the intention or purpose of a program?" or ”For whom is
it intended?") is a major ingredient in classifying activities into specific domains.
Without intentionality some programs could fit in several categories.

Positive Health Education. Positive Health Education is intended to provide
general health information, instruction, or a general activity to a nonspecific/general
population (e. g., everybody who works here). As noted earlier, positive health focuses
on helping individuals acquire lifeskills, a sense of autonomy, and personal power or
self-esteem. Positive Health Education is an instructional process which seeks (a) to help
individuals clarify their values in relation to themselves, health, and health-influencing
behaviors as well as (b) to teach up—to-date knowledge about health. Common offerings
may include classes related to fitness, nutrition, recreational skills, stress management,
self-esteem, and death education. Information is often conveyed through lectures in
small group seminars or traditional class settings. At other times, information is
provided to employees through newsletters or pamphlets.

In general, the promotion of Positive Health Education emphasizes teaching and

encouraging people to take greater responsibility for their health through the recognition

16
that their behaviors and choices impact upon their health (Tannahill, 1985b). Media

appropriate for promoting Positive Hglth Edoeetion offerings include posters, television
advertisements, radio, video, newspaper advertisements and articles, flyers, pamphlets,
college course catalogues, face-to-face meetings, and memos. In the workplace, it is
observed that flyers and internal memos tend to be the most dominant media choices used
to make employees aware of Positive He_alth Education events. This is probably due to
their case of use and the ability to target specific individuals if desired.

Preventive Services. Preventive Services are intended to prevent disease or
illness from developing or continuing to spread. In this domain, a health professional
generally performs a physical procedure upon a client. These procedures consist of
screenings and immunizations for risk factors which may lead to disease or the early
stages of an existing disease, as well as more advanced procedures such as surgery to
deal with secondary and tertiary prevention. Typical activities include screening for
cervical cancer, hypertension, cholesterol, vision, and handicapping congenital disorders
like scoliosis (Downie et al., 1990; Fielding, 1984, 1991). Examples of diseases for
which immunizations are available include mumps, measles, diphtheria, polio, rubella,
and tetanus (Green & Anderson, 1986). Two of the most common Preventive Services
offered to employees are cholesterol and hypertension screenings (Parkinson and
associates, 1982).

Common means for promoting Preventive ServiceS are posters, paycheck inserts,
in-house publications, newspaper advertisements and articles, flyers, billboards, the
yellow pages, postcards, face-to-face contacts, pamphlets, radio and TV commercials,

and memos. It is observed that the most used media in promoting Prexenfixejem’m

17

in the workplace tend to be flyers and memos, due to the ease of their use and the ability
to target specific individuals.

Preventive service messages contain two of three elements. All preventive service
messages emphasize the Q to the employee. As a fear—arousing appeal, the nature of
the risk varies from morbidity (i.e., illness, heart disease) to mortality (i.e., death).
Preventive service messages also include either a "screening" or an "inoculation"
message. While both messages focus on means to alleviate the risk, screening messages
advocate that the danger can be reduced only if the person becomes aware of the risk.
For instance, most individuals experience no signs or symptoms of hypertension. Only
by participating in a screening can they learn that they have high blood pressure.
Inoculation messages argue that the risk can be reduced only if precautions (i.e.,
vaccinations) are administered. Health care workers who handle blood and other body
fluids are encouraged to participate in a hepatitis-B vaccination program to protect against
this life-threatening disease.

Positive Health Protgtion. Mfive Health Protection includes legal or
legislative activities that create laws or policies whose purpose is to protect the health of
those under the jurisdiction of the laws or policies. Top management also seeks to
improve employee health by implementing policies that will have immediate as well as
long-term physical benefits. These policies may stem from legislation mandating change
or the organization’s attempt to mirror conventional wisdom espoused by the medical
community. Examples include workplace smoking policies which encourage cleaner
office air and fetal protection programs for expectant workers. These policies may also

encourage the use of management or union funds to construct leisure facilities which

18

promote the improvement of workers’ health (Downie et al., 1990). Thus, enactment
of legislation or regulatory policy designed to influence employee health is the
distinguishing characteristic of health activity in this domain.

WM messages mirror the power of legislation or regulatory
policy. The power of a policy resides in part with the govemment’s ability to enforce
it. While a number of states have mandatory seatbelt laws, few states have the
manpower to enforce those laws. The power of a policy also resides in the govemment’s
desire to enforce it. For instance, many public buildings have "no smoking" signs
posted, but enforcement ranges from casual disregard in restaurants to strict compliance
in some manufacturing environments and health care facilities. Consequently,
compliance-gaining messages vary with the issue, and range from recommendations to
demands. Group meetings provide the general forum for the creation of legislation or
policy, with the meeting of the safety committee being the most dominant arena for this
activity in the workplace.

Preventive Health Edoeation. Preventive Health Education is intended to
prevent identified, specific health problems from getting worse in specific populations
or clients. Activities are classified as Preventive Health Educatio_n if they provide
information or skills to assist employees in preventing ill-health. Preventive Health
Education activities are interventional in nature, including both counseling and education
that range from one-on-one to group interactions. Organizations promote counseling for
hypertension and hyperlipidemia, often following a screening, because individuals can
modify lifestyle behaviors and thereby lower the risk of heart disease. Counseling

usually involves a professional health care provider meeting with an employee (as client)

19

in order to educate the employee about the condition and its treatment. Organizations
also sponsor classes designed to address specific prevention topics (e.g., Stress
Management, How to Help a Friend Quit Smoking, and "Heart Healthy" cooking and
nutrition). Examples of intervention activities include weight loss programs, smoking
cessation, and employee assistance programs (EAPS) which feature alcohol and drug
withdrawal programs, as well as family and personal counseling (Brody, 1988; Downie
etal., 1990; Mayhew, 1991; Smith, 1990).

Preventive Health Education illustrates the inter-relatedness of health promotion
programs. For instance, an employee’s need for preventive education may be identified
by (a) a screening event, (b) the study of epidemiological data (Mayhew, 1991), (c) the
employee, ((1) the employer (i.e., "You will get counseling for your drug/alcohol
problem!"), or (e) legislative mandate (Occupational Safety and Health Administration
[OSHA]). Moreover, counseling which continues after the start of a Preventive Health
flueatLoo activity for hypertension control, weight loss, and smoking cessation improves
the results of the initial intervention (Erfurt et al., 1991b).

Preventive Healm Edogtion messages also emphasize the health risks faced by
employees. These messages differ from Positive Health Education messages in that they
(a) target identified risk populations, (b) disseminate background information about a
health risk (e.g., one out of nine women will get breast cancer), and (c) concomitantly
emphasize the means to reduce the risk (e.g., use a preventive service, get a
mammogram). Some message functions inherent in these activities are supporting ("You
are strong enough to do this"), encouraging ("Doing this really is for your benefit, as

well as your family’s"), advising ("It is recommended that you have this procedure done

20

annually"), instructing ("Those who have this procedure done increase their chances of
early detection significantly"), and confronting ("If you won’t do it for yourself, do it for
your family").

The immediacy of a health risk may determine how Preventive Health Edueation
messages are disseminated. Thus, organizations rely on word-of-mouth transmission,
company newsletters, and bulletin board posters to promote fitness and stress
management classes. In contrast, when health risks are identified through screenings or
self-reports from the client, organizations use a more personal, focused mode of
communication. Appointments are scheduled and reminders are made face-to-face
(sometimes at the point-of-contact following a screening), over the phone, and through
personal letters. Posters, pamphlets, and bulletin board displays are appropriate channels
to advertise counselling services and intervention classes to all employees. It is observed
that word-of-mouth (person-to-person), posters, and flyers seem to predominate as media
choices for helping employees learn about Preventive Health flugtion programs and
services.

WWW. Breyentive Health Proteetion activities are
intended to enforce health-related laws and regulations for the purpose of preventing the
development of health problems from exposure to workplace or environmental hazards.
Prevena'ye Hgith Protection messages follow the recommendations or mandates of
regulations and/or legislation. The intent of these messages is to enforce the legislation
and/or policies created in the Positive Health Protgtion domain. These messages vary
in content and range from recommendations to directives. For instance, while

communities are not required to fluoridate public water supplies, manufacturers and

21

importers of chemicals are required by law to (a) evaluate hazards inherent in their
chemicals and (b) notify employees, shippers, and customers of the hazards by container
labeling and Material Safety Data Sheets (MSDS) (OSHA’s Hazard Communication
Standard — OSHA regulation 29 CFR 1910.1200). These companies are also required
to institute a hazard communication program for employees which includes information
about labels, MSDS, and training for employees who may be exposed to chemicals
and/or chemical containers in the workplace. Other obvious examples of Preventive
Health Proteotion in the workplace include enforcing the use of various protective devices
(e. g., safety glasses, hard hats, hearing protection, steel-toe shoes, etc.) and compliance
with required actions (e.g. , for restaurant workers, washing hands following the handling
of money or use of the bathroom before any further food preparation). In addition, many
regulations require personal inspections or monitoring by those empowered to enforce
laws or regulations. These could include face-to-face engagements as well as personal
and non-personal letters or memos, posters, and telephone communications. Memos,
posters, and inspections seem to be the dominant methods used to mediate Preventive
Halth Protgtion messages because 1) memos can target specific detailed information
to those required to enforce legislation; 2) posters are a point-of-use reminder for
employees to follow legislation; and 3) inspections are specifically targeted to employees
and employers to force compliance with safety and health regulations (e. g., cleanliness
standards for food preparation, or storage standards for hazardous materials).

Hgfih flogtion Aimeo at Positive Health Protection. H th 'on
m'meg at Positive Hath Protection is intended to target those who would or could be

impacted by some area of health legislation or regulation. This domain emphasizes

22
safety education and parallels the efforts of professionals in the Health Mucation for

Preventive Health Protection domain. The key for inclusion in this domain is that
activities raise awareness and secure support for Positive Health Proteetion measures
among those affected by a potential health risk. Health Education aimed at Positive
Health Protection encourages both employers and employees to support (a) the
monitoring of exposure to risks in the workplace (toxins, noise and other unavoidable
risks) and (b) education programs that inform employers and employees regarding their
rights and responsibilities in protecting their health. Examples include educational safety
programs (a) encouraging workers to wear ear protection and instructing them regarding
correct use while working near loud equipment, or (b) educating employees in the use
of correct lifting techniques. This information can be delivered during meetings, by
reminders from co—workers, or by posters and labels located in the workplace.

Hath Education aimed at Positive Health Protection messages also can be
disseminated by individual instruction, classes, workgroup meetings, and posters directed
at employers and employee groups (i.e., unions, etc.). These messages potentially
promote an awareness of activities and procedures that can prevent exposure to danger
(e. g., working without a hard hat or safety glasses, improper handling of chemicals or
blood products) and thereby may protect employees from accidents or disease. Such
messages are also directed at the public through posters, bumper stickers, and television
advertisements. A classic example of a message in this category is the crash—dummy
advertisement campaign that suggests, "Only a dummy would drive without a seatbelt. "
The dominant media for presenting these messages in the workplace seems to be

mandatory health and safety meetings and memos. Mandatory health and safety meetings

23

can assure employers of worker exposure to specified information, as well as allowing
employees the opportunity to ask for clarification regarding new policies and/or
procedures. Memos serve as an excellent reinforcement tool following such meetings,
and also can be used to introduce new information with less difficulty than the scheduling
of another meeting.

Health Moeation for mventive Heath Protgttion. Heaith flooation for
Preventive Hath Eroteetion is intended to target those who make health-related laws and
policies for the purpose of educating or influencing them, as well as making them aware
of the need to protect the public by creating new legislation. Health professionals in this
domain encourage change in work and social environments through education.
Educational efforts directed at legislators have resulted in Preventive Health Protection
laws, such as seat-belt legislation (Bernstein, Radius, & McDonald, 1990; Downie et al.,
1990) and non-smoking areas in public buildings (Fielding, 1986; Naidoff, 1992;
Parkinson & Eriksen, 1987, p.359-360). The purpose of such efforts is to eliminate
health risk before exposure takes place, thus preventing disease and protecting health.
Health professionals in this domain are typically removed from direct contact with
employees, but still affect employees. They educate and influence legislators and other
public policy makers who consider legislation, policies and regulations which impact
employees’ health risks. These efforts enable legislators to become familiar with issues
and advise them regarding preferred courses of action. The key for inclusion in this
domain is the intention to influence/educate legislators and/or policy makers regarding

the creation of health and safety legislation or regulations.

24

The channels for familiarizing and educating legislators vary from face-to—face
meetings to television advertisements (i.e., encouraging individuals to influence
legislators/policy makers by informing them, by letter or telephone call, of concern
regarding an issue). The education of legislators who draft laws concerning improper
or excessive exposure to workplace toxins can assist in the effort to protect workers’
health. In this case, lobbying requires face-to-face interaction, writing personalized
letters, and arranging meetings with large groups of affected workers and targeted
legislators. Within local organizations, where professional health lobbyists do not exist,
Heaitii Egoeation for Preventive Haith Proteetion messages are delivered on a more
personal level. Preventive Heaith Protgtion messages are directed at influencing those
who make local health policy decisions, usually the health and safety committee. The
media most often used at the local organizational level for this domain takes the form of
related journal or newspaper articles sent to committee members, or face-to-face
conversation.

In summary, health education is a central focus of this model of health promotion.
This recognition does not elevate health education above any other component in the
model, but reflects an emphasis within a new, behavioral approach to health care. It also
takes advantage of the historical opportunities for the prevention of the lifestyle diseases,
avoidance of worksite accidents, and facilitation of medical rehabilitation.

The model of health promotion proposed by Downie et al. (1990) implies that
health promotion is not an assortment of programs, but rather is a unifying concept that
serves to coordinate existing services and programs for the benefit of potential clients.

Therefore it is important to make a distinction between the term "health promotion" and

25

"health promotion programs." The former is a unifying concept that includes health
educators, medical professionals, legislators, and others who have the potential to impact
the health of workers and consumers in this nation; the latter is a procedure that has been
designed to help deliver a certain set of health programs and/or services to those who
need them. Health promotion is literally about promoting, upgrading, or elevating the
health of employees and their families through medical, educational, motivational, and
legislative means. This definition also recognizes that there is semantic confusion with
terminology in the field Of health promotion, including the word "promotion" itself.

For the purposes of this investigation, health promotion programs are defined as
activities, services, classes, materials, and screenings offered by organizations for the
purpose of helping individuals enhance their level of health and/or wellness. However,
given confusion over the term, "health promotion," and the variety of programs for
employees, the first set of questions in this investigation asks:
RQl: What types of health promotion programs are used by organizations?
RQ2: How do health promotion programs differ across various types of industry?

Research question 1 is answered by analyzing the respondents’ identification of
the health promotion programs that are used in their organizations. A list of health
promotion programs offered in North American corporations and government agencies
(compiled and adapted from Parkinson, et al., 1982) is included from which to make
selections. Space is also provided for open-ended responses (survey Section I) (see
Appendix A).

Research question 2 is answered by analyzing respondents’ identification of their

industry type. Respondents are offered a list of industry types as identified by The

26
Standard Industrial Classification Manual (1987) and modified by Miller (1988).

Subjects are asked to identify their organizations’ industry types (survey Section VI, Part
e.). The responses from research question 1 are analyzed by industry type data gathered
in research question 2.
Effectiveness Of Health Promotion Programs

The potential benefits from participating in health promotion programs, how these
benefits relate to health promotion domains, the attractiveness of these programs to
corporate decision makers, and the issues with which decision makers must contend when
measuring the effectiveness of health promotion programs are examined in this section.
Pmential Benefita

Health promotion programs positively impact employees’ health in many ways.
A summary of 26 benefits of health promotion programs identified by Anderson (1986)
and Terborg (1986) arranged under Downie et al.’s (1990) categories is presented in
Table 1. In general, these benefits represent three outcomes: health benefits;
employer/cost benefits; and employee/attitude benefits. Health benefits directly impact
employees’ physical health through decreases in fatigue, overall improved quality of life,
and reduced on-the-job accidents. Employer cost benefits manifest themselves directly
through extended employee work years, as well as reduced health insurance costs, health
service and medical costs, utilization of medical facilities, and workers’ compensation
costs. Indirect cost benefits for employers are realized through reduced absenteeism and
tardiness, reduced voluntary turnover, increased employee productivity, and improved
labor relations, recruiting, and workgroup cohesiveness. Employee attitudinal benefits

include increased employee morale, improved self-image, and greater employee

27

Table 1
Potential Benefits from Worksite Health Promotion Programs'

 

 

 

 

 

Domains Positive Preventive Podtive Preventive Preventive Health Health
Health Services Health Health Health Education Education
Education Protection Education Protection aimed at for
Positive Preventive
Health Health
Potential Protection Protection
Benefits 1 2 3 4 5 6 7
Health
Benefits
less employee x x x
fatigue
improved x x x x x x x
employee health
overall improved x x x x x x x

quality of life

 

reduced on- and x x x x x
off-the-job
accidents”

 

reduced x x x x x x x
disability“

 

reduced time lost x x x x x x
from work due to
illness and
injury”

 

reduced early x x x x x x x
mortality“

 

 

 

 

 

 

 

 

 

 

Table l (cont’d). 28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Domains Positive Prevaitive Positive Preventive Preventive Health Health
Health Services Health Health Health Education Education
Education Protection Education Protection aimed at for
Positive Preventive
Health Health
Potential Protection Protection
Benefits 1 2 3 4 5 6 7
Employer/Cost
Benefits
reduced health it x x x x x x
insurance costs
reduced health x x x x x x
service and
medical costs
extended x x x x x x 3 x
employee work
years
reduced utilization x x x x x x
of medical
facilities
reduced workers‘ x x x x x
compensation
costs
reduced x x
absenteeism
reduced tardiness x x
increased x x x
employee
productivity
improved labor x x x x x x
relations
improved x x x
recmiting
reduced voluntary x x
turnover
improved x x x
Workgroup
Cohesivencss‘”

 

 

 

 

 

 

 

 

 

 

 

 

Table 1 (cont’d). 29
Domains Positive Preventive Positive Preventive Preventive Health Health
Health Services Health Health Health Education Education
Education Protection Education Protection aimed at for
Positive Preventive
Health Health
Potential Protection Protection
Benefits 1 2 3 4 5 6 7
lll'l l' l
Benefits
increased x x x x

employee morale

 

increased
employee loyalty

 

positive attitude
toward
employment

 

greater employee
creativity

 

increased health
awareness

 

improved
employee self-
image

 

improved
corporate image

 

 

 

 

 

 

 

 

 

 

**
*Ilfll‘

Compiled from Anderson (1986) and Terborg (1986) & arranged under
Health Promotion Domains from Downie et a1. (1990)
Could also be categorized as Employer/Cost Benefit
Could also be categorized as Attitudinal Benefit

 

3O

creativity. However, some attitudinal benefits such as increased employee creativity
might benefit the company only if that creativity is applied to work-related tasks.
Relationship Of Benefits To Health Promotion Domains

By arranging benefits under Downie ct al.’s (1990) categories, a number of
patterns become apparent. First, several benefits (e.g., reduced disability) could easily
fit under more than one health promotion category. Second, all seven domains of health
promotion (with minor exceptions) contribute to the overall health of employees. Third,
all seven health promotion domains reduce employers’ direct costs by reducing medical
expenses. In contrast, Positive Health Education and Preventive Health Protection
programs contribute primarily to reducing indirect costs of employers. Fourth, attitudinal
benefits generally result from Positive Health Education, Preventive Services, and

Preventive Health Education efforts.

Cost-Benefit Analyses

The attractiveness of health promotion programs for corporate decision makers
emanates from the promise of decreased costs and increased productivity (Terborg,
1986). Corporations measure the impact of most programs in projected dollars saved or
by cost-benefit analysis. Yet, as Banta and Luce (1983) contend, "health often does not
lend itself to quantification" (p. 147), and some outcomes (6. g. , corporate image) do not
directly impact profitability. Since employers are looking for ways to reduce health care
expenses, programs that show a positive cost-benefit analysis (i.e., direct cost benefits)
provide their own arguments that they are "worth it" (Barry & DeFriese, 1990, p. 448).

Consider the following examples of health promotion programs directly impacting

profitability. TRW, Inc. in Cleveland estimates that a blood pressure control program

31

costs the company $150 per participating hypertensive employee as compared to $10,000
when an employee has a heart attack (Brennan, 1983). Participants in Johnson &
Johnson’s Live for Life health promotion program save the company approximately $33
per employee per year in hospital costs (Jones et al., 1990). Employees participating in
a corporate fitness program at the Mesa Petroleum Company in Amarillo, Texas, incur
$173 per employee in medical costs as compared to $390 for sedentary employees
(Gettman, 1986).

The most complete documentation of cost benefits currently comes from studies
of fitness and exercise programs (Cumming, 1986; Eddy, Eynon, Nagy, & Paradossi,
1990; Falkenberg, 1987; Lynch, Golaszewski, Clearie, Snow, & Vickery, 1990;
Shephard et al., 1981; Shephard et al., 1983). Reasons for extensive documentation
include: (a) the popularity of fitness programs and, consequently, more opportunities to
measure their impact, (b) the longevity and continuity of these programs which facilitate
longitudinal comparisons, (c) the ability to measure physiological changes in contrast to
psychological changes, and (d) the need to justify expenditures for facilities (e. g.,
gymnasiums) and equipment (e. g., weight machines, basketballs). The combination of
visibility and direct cost benefits derived from fitness and exercise programs provides a
powerful argument for inclusion in health promotion.

Challenges When Measuring Effectiveness

While measurements of the cost benefits from health promotion programs focus
on actual costs or benefits when possible, many benefits are indirect. In other words,
they are difficult to substantiate in dollar-related terms (e.g. , employee self-image, labor-

relations) and employers must rely on projected or estimated costs or benefits. The

32

measurement of benefits from programs producing ”indirect" benefits is complicated by
three factors. First, any one realized benefit may be the result of several health
promotion programs, making it difficult to establish causality and singular effects.
Second, there is a lack of measurement of "direct" and "indirect" benefits. In the
relatively recent period of time since the inception of the health promotion field,
quantitative evaluation of programs has not been the norm. According to Downie et al.
(1990), corporations must improve their ability to measure the impact of health
promotion programs in order to: (a) confirm that activities are having the desired effect;
(b) minimize waste of resources; (c) improve program materials and methods for
delivering services; ((1) overcome the skepticism about the effectiveness of health
promotion; and (e) assess whether activities are ethically justifiable. Third, the complex
and unique needs of every organization make the establishment of criteria for evaluation
difficult. For one organization, the perception that employees are fairly happy with the
program may be sufficient to justify the existence of the program. In another
organization, a proportionately high participation rate in the program may be necessary
to insure the future of the program. Other companies may demand to see monetary
savings or participation by different groups of employees. In cases where the company
CEO has experienced a heart attack, the CEO may embark on a personal mission to
convert employees to a low cholesterol diet and jogging. Thus, what is deemed effective
may vary from a strict management of health care costs to universal participation in a
program without regard to quantifiable results.

Despite the problems associated with measuring the success of health promotion

programs (especially those producing indirect benefits), health promotion programming

33

will continue to grow given the alternatives of the traditional medical authority model and
the desire to control rising health care costs. The largest medical expenditures in a
health care budget result from lifestyle related diseases such as heart disease (Terborg,
1986). If a company only targeted smoking cessation, major reductions in heart disease
incidents (direct benefit) would transpire (Stachnik & Stoffelmayr, 1983). At the same
time, quitting smoking may lead to a better self-image and increased loyalty to the
company (indirect benefits).

In sum, the best composite of health promotion programs within a given
organization will be contingent upon the needs of that particular organization. Central
to the effectiveness of any health promotion program are the methods by which programs
are promoted. Organizations should pay attention to how health promotion programs are
communicated because (a) employees could be recruited, or urged, to comply with
programs that have a proven record for improving participants’ health, (b) measuring the
monetary investment of an organization in a communication strategy for a program may
be the only indicator of the interest of the organization in health promotion, and (c) the
degree of participation in a program may be the only available outcome measurement
(however poor) of the success of a program.

Given the need for measuring the success of health promotion programs, a second
set of research questions asks:

RQ3: What criteria (dimensions) do health promotion professionals perceive that
their organizations value as being most useful in determining program

effectiveness?

34

RQ4: How do criteria used to evaluate the effectiveness of health promotion
programs vary across the types of industry?

Answers to research question 3 are based on survey responses to the criteria
within the six hypothetical health promotion program effectiveness dimensions identified
in appendix B (survey Section 11).

Research question 4 is answered by analyzing responses to a list of industry types
as defined by The Standard Industrial Classification Manual (1987) and modified by
Miller (1988) (see survey Section VI, Part e.). The responses from research question
3 are analyzed by industry type data.

Promoting Health Promotion Programs
Considerable confusion surrounds the term "promotion" when referring to " health

promotion. On one hand, promotion means advancing or moving forward, whether
referring to improving a person’s level of health by a company-sponsored intervention
or to a series of advertising messages eliciting attendance at an event. On the other
hand, health promotion programs will not achieve the ends for which they were designed
without specific messages persuading an audience to participate or adhere. It is this latter
use of the term which is emphasized in the remainder of this manuscript.
Health Promotion and Communication Goals

In general, the advocation of health promotion programs employs three theoretical
frameworks: communication-behavior change (Bandura, 1977), community organization
(Rothman, 1979), and social marketing theories (Kotler, 1975). The communication-

behavior change model postulates that individuals must receive messages that initially

alter knowledge, then attitudes, and finally, behaviors (Bandura, Adams, & Beyer,

35

1977). Community organization theorists use legislation and policy changes to solve
organizational problems from within existing power structures (Rothman, 1979), as
illustrated by recent laws regarding smoking in public buildings and on airlines. Social
marketing uses a consumer-based approach and applies marketing principles to social
campaigns (Solomon & Maccoby, 1984). The basic concepts of social marketing,
revolving around "product, price, place, and promotion" (p.212), are difficult to use in
health promotion because the content of health promotion programs (e.g., quitting
behaviors that you like, such as eating high cholesterol foods; beginning behaviors which
appear tedious, like exercising and eating "health" food) is often not attractive to
employees. Nonetheless, it is assumed that the basic elements that make messages
palatable are (a) exposure, (b) credibility, (c) attention getting, (d) memorable, and (e)
motivational (Flay, DiTecco, & Schlegel, 1980; Rawson, 1987; Solomon & Maccoby,
1984, p. 218).

As noted earlier, health promotion professionals at times focus on programs,
services, and campaigns as the "products" of health promotion in lieu of changes in
participants’ health. In this sense, health promotion products vary along a continuum
from one-shot programs to on—going campaigns. One-shot programs target very focused
audiences (e.g., Breast Health Month with free mammograms for women age 35 and
older who have not had a previous exam). One-shot programs employ unique, attention-
getting messages and mediums to highlight the uniqueness of the event. In contrast, on-
going health campaigns share the following five characteristics: (a) integrated series of
communication activities, (b) use of multiple operations and channels, (c) aimed at

saturating a large target audience or population, (d) long duration, and (e) clear purpose

36
(Flay & Burton, 1990). One-shot programs and campaigns also differ in the goals of the

promotion messages. The promotion messages of one-shot programs solicit employee
attendance through enticing titles and two sentence descriptions (or "blurbs"). The goals
of messages for on-going campaigns in health promotion are multifaceted and include:
soliciting attendance, eliciting a long term commitment to health outcomes, educating
employees, and reinforcing program content.

While one-shot programs and on-going campaigns differ in many respects, the
nature of the promotion messages is similar in four ways. First, messages contain a
certain level of informativeness, or amount of information. The volume and type of
information to be transmitted influences media selection (Sitkin, Sutcliffe, & Barrios-
Choplin, 1992; Stohl & Redding, 1987). Some media are superior to others at carrying
large amounts of text, pictures, or sound data. At times, as in one-shot publicity, the
message may not provide details regarding scientific findings or steps to elicit a change
in behavior or attitude. Other messages will contain greater amounts of information in
an attempt to stimulate the audience’s awareness and evaluation. People process
information cues in terms of existing generalities or stereotypes in order to reduce the
amount of individual pieces of information that they must handle (Meyer, 1990).
However, a risk of using health promotion messages that fit within existing social
constructs is that they may be perceived as boring or trite.

Second, the credibility associated with the message and its sender greatly
influences to what degree a message is attended. Credibility refers to the accuracy,
trustworthiness, and intent of the message (Cooper, 1932; Cronkhite, 1969). The

confidence that someone attaches to a message greatly affects its impact (Redding, 1972).

37

Rogers (1983) suggests that clients require messages to be associated with "competence,
trustworthiness, and empathy" (p.316) before accepting the innovation. Likewise, an
institution whose image is respected by employees may have greater compliance with its
campaign messages than those institutions lacking credibility.

Third, the attention-getting ability of a message is dependent upon the receiver’s
perceived need, or the relevance that the message has to the receiver. Meyer (1990)
suggests six characteristics of messages that make them engaging, or of interest to
message receivers: (a) health messages get more attention if they have an element of
timeliness, as employees place a level of importance to issues that are new; (b) message
relevance is greatly enhanced if the consequence of the health-related finding is included
so that it shows how this information will change or impact employees’ lives; (c) a
message that contains an element of human interest helps draw attention to the message
by eliciting an emotional response to the message; ((1) conflict is inherently attention-
getting and portrayed as individuals struggle to "win" against illness; (e) prominence can
make a message more attention-getting, such as referring to a celebrity’s health condition
or disease; and (f) anything that adds to the unusualness of a message will catch people’s
attention. In an investigation of message characteristics and their effectiveness in
producing belief change, Morley and Walker (1987) found that novelty, importance, and
plausibility must go together, and that omitting even one of these significantly reduced
the power of a message. In other words, the message must present new information
which is important to the audience and which indicates plausible or reasonable actions

by which the audience will improve their health condition. Without hope of being able

 

38
to apply the information to their situation, a message that initially gets employees’
attention will soon be tuned out.

Fourth, health messages from both one-shot programs and on-going campaigns
must be socially acceptable before they will be received. Individuals in a workplace
culture that allows smoking at meetings may show resistance to a campaign for a smoke-
free workplace (Flay & Burton, 1990). The culture that develops within an organization
produces a system of shared symbols and meanings. These basic "themes" within the
culture of an organization meaningfully influence the values and relationships that exist
for the membership of the organization (Smircich, 1983). Cultural themes within
individual organizations may need to be assessed and understood before successful health
campaigns can be designed. In sum, the success of health promotion messages relies on
their informativeness, credibility, attention-getting qualities, and social acceptability.
However, constructing an appropriate message represents only half of the challenge to
health promoters. The message must be communicated to have any impact.

Channels for Health Communication in Organizations

The success of health promotion programs ultimately depends upon the ability of
messages to flow throughout the organization. Frequently considered message channels
are vertical, horizontal, formal, and informal. McPhee (1988) notes,

Vertical channels allow the transmission of goals, orders, and performance

evaluations downward, and of problems, feedback about programs, and

other relevant information upward. Such flows are essential for the

coordination of action by individuals and groups in the organization and

for control over efficiency and deviance. Thus, although vertical

communication chains may not contain all or even most communication

or contain only orders, etc., they are especially important conduits
(pp.475-476).

39

Horizontal channels allow communication to flow between departments and individuals.
Informal communication structures supplement formal hierarchical communication
structures (Likert, 1967; McPhee, 1988; Simon, 1976). Informal channels provide
horizontal and vertical links which are vital in filling the gaps that are often not covered
by the formal vertical channels. According to Burns (1954), only an oversimplified view
of organizations would deny the existence of complementary horizontal communication
channels within groups and organizations. Yet, corporations commonly rely only on
formal vertical channels to disseminate messages to their employees (Baker, Ballentine,
& True, 1949; Heirich, Cameron, Erfurt, Foote, & Gregg, 1989; Jablin, 1984; Peterson
& Jenkins, 1948; Stohl, & Redding, 1987). In contrast, writers on the downward
dissemination of information advocate identifying and using existing, informal networks
(Rogers, 1983) and using both oral and written mediums (Daft, & Lengel, 1984; Dahle,
1953; Tompkins, 1984) to reinforce the promotion message and to reduce the waste of
resources. Thus, it seems prudent for health promotion professionals not to automatically
assume that employees will read bulletin boards, pay inserts, or even flyers in the
cafeteria.

A number of untested guidelines for designing effective health promotion
programs exist. For instance, Rawson (1987) suggests "the first step in any health
promotion program is to establish the specific role or roles that communications will
play" (p. 71). Other advice includes check lists (see Figures 3 and 4) to guide the
effective design of health promotion programs. However, these guidelines lack a
theoretical background, appear to be a collection of various experiences, and lack

empirical validation.

40

Figure 3
12 Key Questions To Guide In The Assessment Of Communication Environment
And Development Of Communication Guidelines."

1.

10.

ll.

12.

What is the objective of the planned wellness program? To increase awareness?
To influence attitudes? To modify behavior? What response is desired from the
audience?

What information will be communicated to employees during the program? Are
scripts or speeches involved? Will material be obtained from existing literature?
Obtain all details.

How will the information be communicated? When and where? Is it a seminar,
a workshop, a lecture? Will it be held during office hours? On site or off site?
Who is the targeted audience? All employees or management? At which
locations?

What do we know about this group? Is the target audience homogeneous? What
are its demographic and psychographic traits?

What attitudes or concerns may this group have about the subject matter? Will
it be receptive to the message? What are its preconceived ideas? Beliefs?
What are the values, norms, and sensitivities of the workplace in which the
program will be promoted? Would you describe the organization’s culture as one
that recognizes people? Profits? Innovation? Technology? How would you
describe the company if it were a person?

What lessons have been learned from previous wellness communication
programs? Have employee surveys been taken? Did certain communication
vehicles work better than others?

What other employee communication programs currently exist within the
company? What is the competitive environment in which communications will
be received?

What vehicles are currently being used to communicate internally? Is there a
company newsletter? Are there bulletin boards?

Are there executional considerations to be aware of? Brochures to be distributed?
A health department logo to be used? Areas of the company where
communications are prohibited?

How much money can we afford to promote the program? Is there an established
budget or an acceptable promotional expenditure per employee?

" From Rawson, 1987, p. 73-74

41

Figure 4
Eight Steps to Effective Worksite Communication of Health Information.b

1.

Use existing formal communication channels

— Place short articles and announcements in newspapers and magazines

- Make presentations to groups

- Present announcements and requests for assistance in company "chain of
command" meetings

. Create a new, official health communication channel

- Create a Wellness Committee with strategic membership, including persons in
health-relevant work roles, some key decision makers in both union and
management, and some rank-and-file employees

- Set up regular meetings and an agenda which includes their support for wellness
activities and their help in solving logistical problems

Create direct-link, one-to-one outreach with plant employees

- Offer plant-wide voluntary health screening and immediate counseling sessions
with individual employees

- Send post card invitations to employees to come in for follow-up wellness
counseling (send these to different sets of employees weekly)

- Make follow-up phone calls to employees who need reminding

- Visit "no show" employees at their work locations

Create informal health communication flow by targeting strategically-placed

employees for early one-to-one outreach

- Include Wellness Committee members

- Include "Bees" whose jobs have them moving throughout the worksite and able
to talk with others

- Include people at the hub of communication interaction (e.g., secretaries in key
offices)

Enlarge and reinforce short-link communication chains
- Invite people who want to make health changes to create their own buddy systems
and support groups

Create new health communication networks

- Invite people with a common health status to have lunch together and plan ways
to help others (e. g., ex-smokers, successful weight losers, successful cardiac
rehabilitation patients)

Figure 4 (cont’d). 42

7. Organize special health events involving
- Friendly competition
- Humor
- Gimmicks that encourage participation
- Opportunities for social support while making changes
- Small rewards for successful health changes (e.g., smokeouts, smoke reduction
campaigns, walking contests, weight loss contests)

8. Create attention for focused health messages
- Use poster posting techniques
- Use moving targets
- Use sight and sound surprises

" From Heirich, Cameron, Erfurt, Foote, & Gregg, 1989, p.116

43
Health Program Promotion Mediums
As noted by Solomon and Maccoby (1984), the relationship between the

objectives of a media program and the medium used is often overlooked. ...decisions
have often been made on the basis of personal preferences for film, videotape, or print,
without further consideration" (p.216). Media are also selected at times on the basis of
costs, prior experience, available resources, expertise, or organizational history.
Noticeably missing when making decisions relative to advertising health promotion
programs (e. g., Heirich et al. , 1989; McGuire, 1981; Rawson, 1987) is a theoretical base
from which to proceed.

Message Mediums. Although much has been written about the means by which
information is disseminated within organizations, Redding (1972) states that "the
communication manager or corporate editor will be disappointed if he expects to find
established principles which reliably predict, in each individual circumstance, the most
appropriate medium, modality, or channe " (p.462). Nonetheless, Redding (1972) and
others (Daft & Lengel, 1984; Sitkin et. al, 1992) argue that practitioners can apply
communication theory to specific situations when seeking the most appropriate medium
to disseminate information, recruit participants, and educate employees.

Mediums are specific modes of transmitting information. Common modes are
face-to-face, small group, large group, videoconferencing, telephone, electronic
messaging, written-personal, written-formal, numeric-personal, or numeric-formal (Sitkin
et al., 1992). Channels refer to general categories for transmitting data, such as audio

or visual. Taken together, the descriptors, medium and channel, enable fairly precise

classification of intra-organizational communication means as illustrated by Table 2.

44

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For example, telephone conversations currently offer only an audio channel. The visual
channel creates additional layers of information (e.g. , facial expressions, shrugs, hunched
shoulders) absent in telephone conversations but present in face-to-face exchanges.

Face-to-face interactions offer both audio and visual channels for transmitting data
and are comparatively "richer" in information than either solely audio or visual channels.
Information richness (Daft & Lengel, 1984) refers to the potential information-carrying
capacity of data. Rich media "convey multiple cues and enable rapid feedback. Less
rich media oversimplify complex topics and may not enable the exchange of sufficient
information" (Daft & Lengel, 1984, p. 200). For instance, facial expressions (e.g., a
wink or a frown) bring a level of understanding, or richness, to an information exchange
unavailable on the telephone or in a letter. Mediums containing multiple channels (audio
and visual) contain higher levels of information richness. Face-to-face feedback provides
the richest information because of the use of multiple channels and its immediacy which
allows the understanding of messages to be verified and their interpretations to be
revised.

Each media form has its own special set of strengths and weaknesses, suggesting
that there may be no one form of message transmission that is best for all purposes. The
most effective media for a particular message depends on the target audience’s
preferences, the interest value and comprehensibility of the message, and the
characteristics (e.g. , credibility) of the message source. Written information conveyed
by memos or reports can be very clear and precise, but may (a) lack relational affect
conveyed by intonation and delivery speed or (b) leave the other party in a confused state

since the information sender is not present to clarify the message.

46

Complex messages are better understood when they are in print than when they
are in audio or audio-visual form. In contrast, easily comprehended messages are more
positively attended to when they are presented in video format (Petty & Cacioppo, 1981).
In one national study, more than 80 percent of the respondents identified television as the
most influential medium (Atkin, 1979). However, there are advantages and
disadvantages with both broadcast and print media. For instance, the video/television
medium combines music, professional announcers, and professional models to add layers
of meaning to the formal message. The disadvantages of video messages include limited
exposure to the video telecast and inaccessibility to the technology needed to view and
hear a tape. In contrast, print media uses only the visual channel, which ranges from
simple black on white printing to slick, full color layouts. A major advantage of print
is that, once it is produced and distributed, it is always ready to view.

There are times when the medium can be a symbol that is as important as the
message itself. A handwritten letter may symbolize greater personal attention than a
computerized form letter, even if it contains the same information. Employees in
different organizations appear to vary in their view of the same medium (e. g. , electronic
mail) given their experience with the chosen style of communicating (Sitkin et al. , 1992).
For instance, within the same high-tech company the use of e-mail can be considered as
a measure of competence and power by management. In contrast, assembly line workers
may be bothered or even intimidated by others’ use of e-mail. In addition, media vary
in their ease of conveying symbols. A handwritten note is often more appropriate than
a typed note for a personal message. A medium can also become the standard or

" normal" way for particular kinds of information to be conveyed within an organization.

47

For instance, mandatory inservice meetings showing video-taped messages on closed-
circuit television may be the norm for disseminating top management’s viewpoints.
Thus, the choice of which medium to use in sending a message may determine the
audience’s level of attention to the message, or even if the message is received,
underscoring the dual-capacity of the media to carry both (a) data, or information, and
(b) symbolic meanings or values.

When choosing media, health promoters also should consider (a) the importance
or urgency of the information, (b) the clarity of the message, (c) the nwd for fwdback,
(d) the novelty of the information or program, (e) the novelty of the message medium
to the audience, and (t) the availability of funding for promotion (which is sometimes the
most critical consideration). For example, messages perceived as important or urgent
garner more resources (time, energy, money). Easily understood messages may be
effectively delivered through media low in information richness, whereas richer media
(e. g., face-to-face) may be more appropriate for delivering complex information which
requires clarification. In addition, health messages which are innovative may require
long periods of time before audiences will accept the messages. Individuals accept novel
information at different rates of speed. "It matters little, so far as human behavior is
concerned, whether or not an idea is ’objectively’ new as measured by the lapse of time
since its first use or discovery. The perceived newness of the idea for the individual
determines his or her reaction to it" (Rogers, 1983, p.11).

In summary, for effective message dissemination, health promotion practitioners
must choose media based on (a) the media’s richness, (b) the goals of the individual

message, (c) the resources available to help in delivering that message, and (d) the

48

organization’s norms for message sending and receiving. This advice follows Sitkin et
al’s (1992) suggestion that models of media selection and usage must "take account of
both task contingencies and normative contingencies as key determinants" (p. 573). To
date, it is unclear how health promotion practitioners conceptualize the richness or the
effectiveness of the media which they use on a daily basis. Further, it is unclear whether
they make distinctions in their media use given the different types of health promotion
activities (Downie et al., 1990) embodied in organizational health promotion programs.
Consequently, the third set of research questions inquires:

RQS: What do health promotion professionals consider to be the most important

media characteristics (i.e., "media dimensions") in promoting programs?

RQ6: How do these rated media characteristics vary by industry?

Research question 5 is answered by examining respondents’ ratings of the
importance of the five media characteristics (dimensions) identified in appendix C (survey
Section V).

Research question 6 is answered by analyzing responses to the list of industry
types as identified by The Standard Industrial Classification Manual (1987) and modified
by Miller (1988) (see survey Section VI, Part e.). The responses from research question
5 are analyzed by industry type data.

Media Applications for Domains of Health Promotion

There are two media application possibilities in the different health promotion

domains (see Table 3): (a) media promotes the event and creates awareness (i.e.,

advertising), or (b) media imparts information or subject content. This section reviews

49

 

 

 

 

 

 

 

 

Table 3
Media Use
Domaim of A. Promotional Media, A1. Dominant B. lrnparting Information
Health for Creating Awareness Promotional Media on a Subject
Promotion of Event, Advertising Choice for the
Workplace
1. Positive Health radio, video, television, flyers or internal radio. video & filmed
Education film, newspaper ads & memo public service
articles, posters/flyers, announcements (PSA),
pamphlets, college course newspaper articles,
catalogues, face-to-face classes, posters, handouts,
meeting, memos pamphlets, books
2. Preventive newspaper ads & articles, flyers or internal newspaper articles,
Services posters/flyers, paycheck memo physician referral services,
inserts, billboards, the billboards, posters, direct
yellow pages, postcards, mail. one—on-one contact,
face-to-face contact. radio & TV programs
pamphlets, radio & TV
commercials, memos
3. Positive Health face-to-face, both one-on- safety committee face-to-face committee or
Protection one and group format meeting legislative meeting,
reports, laws
4. Preventive person-to-person referral, word-of-mouth, face-to-face counseling,
Health posters/flyers, newspaper posters/flyers newspaper & magazine
Education articles or ads, telephone, articles, TV & radio
TV programs & programs, classes, posters,
commercials, pamphlets pamphlets, books
5. Preventive letters, memos, telephone inspections (face-to- face-to-face formal
Health discussion, face-to-face face), memos, evaluation/investigation/ins
Protection meetings, posters, signs posters, signs pection, meetings, letters,
memos, telephone,
conversations
6. Health face-to-face meetings, safety committee face-to-face meetings &
Education print & TV ads, posters, meeting, memos classes (one-on-one &
aimed at memos group), print, TV, & radio
Positive Health campaigns, posters,
Protection pamphlets, billboards,
direct mail
7. Health face-to-face meetings, send photocopy of face-to-face meetings,
Education for print & TV campaigns, articles and print, TV, & radio
Preventive posters, direct mail newspaper clippings campaigns, posters, direct
Health to safety committee mail
Protection members and/or
management

 

 

 

 

 

 

50

the focus for each of the previously described domains of health promotion and identifies
appropriate media possibilities for each.

Pesitive Health Education consists of general instructional health activities which
help individuals learn more about themselves, health, health-influencing behaviors, and
up-to-date information about health. This domain covers a wide range of topics and
encourages individuals to make informed, responsible choices regarding their health-
related behaviors. For health promoters it is important to make people aware of the
existence of the programs and activities that are available. The key for inclusion in the
creating awareness category (Table 3, column A) is whether or not the media can
effectively carry a message that can raise the awareness of individuals in the target
market regarding an upcoming event. Appropriate media for advertising, or raising
awareness of Positive Health Education activities include radio, video, television, film,
newspaper advertisements and articles, posters/flyers, pamphlets, college course
catalogues, face-to-face meeting, and memos. Individuals commonly receive messages
through these media regarding a variety of public events, including Positive Health
Edueation events.

In interviews conducted with professional health promoters regarding media
choices for promoting events in the workplace, it is clear that there are dominant media
choices in each of the health domains that seem to reflect both custom and usage, and
pragmatic necessity. These dominant promotional media choices for the workplace are
included in Table 3 (column A1). Media used for imparting topic information (Table 3,
column B) include radio, video and filmed public service announcements (PSA),

newspaper articles, classes, educational posters, handouts, pamphlets, and books. The

51

key for inclusion in this category is whether or not the media can be used for instruction.
If the media can carry the desired message to the intended audience, it can be used for
imparting topical information.

The traditional medical profession and the field of public health are reflected in
activities within the Preventive Serviees domain. Promotion activities in this domain
include various levels of prevention, ranging from screenings to surgery, and are
generally performed by health care professionals. Messages from this domain accentuate
a client’s risk, determined by a procedure (e.g., blood pressure measurement) which
provides data useful in advising the client. Advertising for Preventive Services uses
newspaper advertisements and articles, posters and billboards, the yellow pages,
postcards, one-on-one persuasive contact, pamphlets, and radio and television
commercials. Individuals traditionally search these sources when they are seeking health
information. Additional information regarding these services can be obtained through
newspaper articles, physician referral services, billboards, posters, direct mail, one-on-
one contact, and radio and television programs.

Enacting legislation or regulatory policies that influence health is characteristic
of the Pesitive Heglth Pretgg‘en domain. Primarily the realm of legislators, this domain
consists mainly of legislative meetings to create health policies and laws. Committee and
large group meetings constitute the primary activities in this domain and written reports
and documents are the products of such meetings.

Preventive Hglth Edeeetien activities are interventional in nature, assisting
employees in achieving high levels of wellness (Anspaugh et al., 1991, p. 8). Activities

in this domain combine education, medical, and behavior modification interventions to

52

address specific identified health problems of individuals and to develop measures of
control over health problems. Health promoters raise client awareness of programs and
services by person-to-person referral, posters, newspaper articles or ads, television
programs and commercials, and pamphlets because, as stated earlier, individuals are
conditioned to obtain expert information from these sources. Once contacted, it is
important to use media that have the ability to pass on facts and details in sufficient
quantity to those needing more knowledge. Appropriate media for imparting this
information include face-to—face counseling, newspaper and magazine articles, television
commercials and programs, classes, posters, pamphlets, and books.

Preventive Health Protection is the law enforcement branch of health promotion,
responsible for protecting employees’ health by preventing health problems through the
implementation of health and safety legislation and policies. Individuals working in this
domain inspect and monitor workplaces to insure compliance with the law. Appropriate
media to create awareness of an upcoming inspection event include letters, memoranda,
telephone discussions, and face-to-face meetings. These media commonly inform
individuals of upcoming public forums. Media used to impart subject information
include face-to-face formal evaluation/investigation/inspection, meetings, letters,
memoranda, and telephone conversations.

It is important to note that some media serve to raise awareness and teach subject
matter, underscoring the versatility of certain media. For example, a memorandum could
inform someone about an upcoming inspection or contain detailed information about how

to prepare for an inspection. Thus, there are multiple uses for the same media.

53

The domain of Health Education aimed gt Positive Health Protection specializes
in education activities whose purpose is to protect the health and safety of employees in
the workplace. In addition to programs designed to teach workers safe behaviors (e. g.,
use of hearing protection devices, use of proper lifting techniques to protect employees’
backs), this domain encourages employees to become supportive of workplace safety
legislation and the creation of a safer, more healthful work environment. Safety
education plans for contingencies and trains employees (or the public) to make safe
choices. "Educational programs that emphasize awareness are an essential facet of
controlling workplace hazards" ("Health and Safety in Small Industry: A Practical Guide
For Managers," 1989, p. 7) and other such programs are believed to be effective
(Mayhew, 1991, p 885; Vojtecky, 1987, p. 13). Appropriate media for advertising
events in this domain include face-to—face meetings, print and television ads, posters, and
direct mail because these media have the ability to carry sufficient information to a group
of targeted individuals. An often used medium within this domain is face-to-face
meetings (one-on-one or group), typified in the workplace by mandatory health and safety
meetings. Other educational media appropriate for this domain include print and
television campaigns, posters, pamphlets, billboards, and direct mail.

Health flegtjen for Preventive Health Pregtien is the central domain (Domain
#7) of the health promotion model (see Figure 2, p. 14). These activities focus on the
education of legislators and policy makers by health educators and others with interests
in health and safety issues in order to influence the development of health and safety-
related legislation. Educators working in this very political domain often represent

special interest groups (e.g. , National Rifle Association, Mothers Against Drunk Drivers)

54

and at times are called lobbyists. Special interest groups often sponsor campaigns to
keep the attention of legislators focused on key issues. In this domain the distinctions
between creating awareness and imparting information blur as special interest groups use
media to draw attention to their causes, often twisting the interpretation of facts and
events to support their crusades. Special interest groups use media to sensationalize
events which simultaneously serve to draw attention and "teach." Appropriate media for
this purpose are face-to-face meetings, telephone, print and television campaigns, posters,
and direct mail because these are all ways to either directly (by lobbyists) or indirectly
(by constituents) influence legislators regarding special interest groups. To date, no
research exists determining the most frequently used media within each health promotion
program. Such information might be helpful in training health promotion professionals
and in understanding the reasons for their media selection. Consequently, this study also
investigates the following research question:

RQ7: What uses of media characterize effective and ineffective health promotion

programs?

Research question 7 is tested by using a list of media types (Appendix D)
expanded from Sitkin et al. (1992). Subjects identify which media are used to promote
the programs that subjects reported as their most effective health promotion programs
(survey Section III) and their least effective health promotion programs (survey Section
IV). A comparison is made between the reported effective and ineffective conditions to
examine differences in media use for the two conditions.

Media Choice and Effectiveness. Much of the health promotion information

within organizations is downward directed (Heirich et al., 1989). Redding’s (1972)

55

summary of downward-directed information questions this method because downward-
directed messages are (a) often ignored, (b) often not passed along to others, (c) often
not understood, and (d) the impact of efforts at sending downward-directed messages is
unclear. Nonetheless, health promotion professionals may use the richest downward—
directed mediums (e. g. , official announcements at required meetings) for events soliciting
a large attendance. Health promotion professionals may use rich mediums if attendance
justifies the existence of the program. In some cases, program effectiveness may be
determined by asking, " Did you get a crowd?" This is in contrast to a behavior-change
focus that asks the question, "Did you impact health behaviors?" The definition of
program effectiveness may vary depending upon who is evaluating the program and its
design (e.g., health educator, risk management specialist, public relations manager).
However, reasonable criteria for judging program effectiveness include: (a) changed
behaviors, (b) saved dollars, (c) the extent to which participants or management liked the
program, and (d) reduced health risk.

When selecting a particular medium, the users’ (a) budget and (b) familiarity with
types of media may preempt issues of effectiveness or appropriateness. Unless a health
promoter has ample funds budgeted for the promotion of a specific program, the money
will always be an influencing factor in the selection of media. No matter what media is
desired, unaffordable mediums will not be used. Even if creative funding (donations) is
available, external funding often comes with strings attached that favor certain media.
In turn, familiarity with various media may be due to limited experience, previous
success, and the technology that the organization has available. If newspaper advertising

was the only promotional media previously used for an event and the event was

56

successful, the success may unduly influence future media selection. Also, sending
everyone a reminder about an event on e-mail will not be possible if the organization
does not provide access to a computer terminal for each employee.

The criteria of message effectiveness ultimately determines message success in
relation to the goal of the message. Part of the measure of message effectiveness will
include (a) expenditure of energy on the part of the message sender(s) and (b)
expenditure of money. Yet, it is difficult to pinpoint objectively why a promotion
succeeds (e. g., many personnel attend, the event makes/saves money). Intuitively,
individuals assign causes when promotions are deemed "effective" or "ineffective" (e. g. ,
nobody/very few attend(s), the event loses money) because they wish to identify signs
leading to wise choices in the future. A focus on media and related factors that are
perceived to lead to positive or negative outcomes (i.e., what was not effective) in
corporate health promotion programs would provide insight into professionals’ beliefs
about media use and aid in the predicting of future media use. Furthermore,
comparisons between media used in professionals’ successes and failures may provide
more precise guidelines for future media use specific to their industry and health
promotion domain. These comparisons may allow for media selection that effectively
promotes the programs and services to the members of their organizations.

While the use of media certainly impacts the effectiveness or success of health
promotion programs, it is important to note that there may be a number of non—media
influences that also impact program success. These might include such things as, "It is
just a great program!"; "Just plain dumb luck. "; "It was the right time for this

program"; "Employees are required to attend at least 3 programs, and this program was

57

the most convenient." While this list is not exhaustive, it suggests that there may be any

number of non-media factors that may influence health promotion program success.

Thus, the last research questions of this study ask:

RQ8: What do health promotion professionals regard as the key media and non-
media factors in the success or failure of promotions?

RQ9: What is the relationship between health promotion program success or failure
and media use in their respective health promotion domains?

Research question 8 is answered through examination of responses to two open-
ended questions. Subjects are asked to identify what they consider to be three primary
media and non-media reasons for program effectiveness and ineffectiveness (survey
Sections 111 and IV).

Research question 9 is answered by asking subjects to identify the type of
program and intended audience in order to help place the program in the proper health
domain (Downie, et al., 1990). Coders (see Appendix E for code book) follow
information about the type of program and intended audience to help in categorizing the
identified programs into one of the seven health promotion domains. Intentionality
("What is the intention or purpose of a program?" or "For whom is it intended?") of a
program or service is a major ingredient for classification into one area of health
promotion as opposed to another. As Figure 2 illustrates, the categories overlap, making
it imperative that intentionality is understood. Without intentionality, some programs
could fit in several categories. For the purposes of this study, intentionality is used to
classify health promotion activities into unique domains. For example, knowing that a

program is about exercise allows a program to be in one of several domains. But

 

58

knowing that an exercise program is for the general public allows it to be categorized
into domain 1 (Pesitive Health Egttgtien). An exercise program for people who need
to lose weight is categorized into domain 4 (Preventive Health Education) because it is
an intervention for an identified population. It is, therefore, necessary to have
knowledge of both the kind of program and its intended audience in order to properly
categorize a health promotion program. A comparison is then made between the health

promotion domain and the media used (survey Sections III and IV).

CHAPTER 2

METHODOLOGY AND RESEARCH DESIGN

Research Questions

This study examined the health promotion practices of organizations belonging to

the Association for Worksite Health Promotion (AWHP). Nine research questions were

asked in order to determine the characteristics of corporate health promotion programs

and the role of communication in program effectiveness:

RQl:

RQ2:

RQ3:

RQ4:

RQS:

RQ6:

RQ7:

RQ8:

RQ9:

What types of health promotion programs are used by organizations?

How do health promotion programs differ across various types of industry?
What criteria (dimensions) do health promotion professionals perceive that
their organizations value as being most useful in determining program
effectiveness?

How do criteria used to evaluate the effectiveness of health promotion
programs vary across the types of industry?

What do health promotion professionals consider to be the most important
media characteristics (i.e., "media dimensions") in promoting programs?
How do these rated media characteristics vary by industry?

What uses of media characterize effective and ineffective health promotion
programs?

What do health promotion professionals regard as the key media and non-
media factors in the success or failure of promotions?

What is the relationship between health promotion program success or failure

and media use in their respective health promotion domains?

59

Subjects

Since the basic purpose of this research was to learn more about the condition of
the field of health promotion, subjects in the primary study were health promotion
professionals who actively work in the field of health promotion. A sample of 600
subjects was randomly selected from the members of the Association for Worksite Health
Promotion (AWHP). The AWHP, one of the oldest professional organizations in the
field of worksite health promotion, was established in 1974 and represented: (a)
professionals who are currently working in the field of health promotion, (b) a wide
variety of industries, and (c) all states in the United States.

As this study sought subjects who actively worked in the field of worksite health
promotion, survey recipients completed three screening questions before answering the
survey questions. The three screening questions, to be answered by "yes" or "no"
responses, were (a) " Your health promotion and/or safety program directs services to
your organization’s employees," (b) "You help make decisions about the types of media
(print, broadcast, face-to-face, etc.) to be used in conducting or promoting health
programs," and (c) "At least 50% of your work time is devoted to or spent on health
promotion and/or safety programs." A "Yes" response to each of these questions
indicated that subjects were in decision making, professional positions in the field of
health promotion. If recipients answered "No" to any question, the person was thanked
and asked to please pass the survey on to someone who would be able to answer
affirmatively to all three questions.

Two hundred and twelve surveys out of 600 were returned representing a

response rate of 35.33%. Research participants can be characterized as follows: the

61

mean age for subjects was 36.62 years of age (median = 36.00 years); nearly three
fourths (71.7%, n = 152) were female, while about one forth (28.3%, n = 60) were
male; and education levels ranged from high school graduate to doctoral level, with
approximately 30% earning only a bachelor’s degree and 60% earning a master’s degree
(see Table 4). Subjects represented a variety of departments within organizations:
finance, production, research and development, marketing, personnel/human resources,
support, and health services with nearly half being in Personnel/Human Resources and
a third being in Health Services (see Table 5). Subjects’ departments varied in size (see
Table 6), and subjects worked in a variety of industries (process technology,
manufacturing and construction, service, and trade, see Table 7).

In addition, nearly one third of the subjects were employed in organizations with
between 1001 and 5000 employees, another third in organizations with over 10,000
employees, and nearly another third in organizations containing all other numbers of
employees (see Table 8). At the time of completing the survey instrument, just over
80% of the subjects had been with their organizations for ten years or less (mean = 6.39
years, median = 5.00 years) (see Table 9). Nearly 80% of respondents had been in their
current positions within the organization 5 years or less (mean = 2.91, median = 3.00)
(see Table 10). Subjects reported their status within their organizations by ranking
themselves from lowest to highest with over 80% rating themselves plus or minus 1 from
the middle of a 1 to 7 scale (see Table 11). Additionally, subjects reported that their
organizations had established health promotion programs an average of 9.52 years (range
= 1 to 126 years, median = 7.00) (see Table 12), with approximately 46% having

programs 6 years or less.

62
Table 4

° ri ion f ’ b Ed tinLevels

 

 

Education Level n %
High School 4 1.9
Associate’s 6 2.9
Bachelor’s 63 30.3
Master’s 126 60.6

Doctorate 9 4.3

 

63

 

 

Table 5
' ri ion f ' men

Department n %
Finance 3 1.4
Production 1 .5
Research and Development 2 1.0
Marketing 4 1.9
Personnel/Human Resources 99 47.8
Support 19 9.2
Health Services 69 33.3
Other 10 4.8

 

Table 6

Dg' ribution of Subjects by Depertment Size

 

 

Number of Employees in Department n %
1 to 5 80 44.9

6 to 10 46 25.9

11 to 15 8 4.5

16 to 25 15 8.4

26 to 99 22 12.4

100 + 7 3.9

 

65

 

 

Table 7

D’ ri ion of ' In st T

Industry n %
Process Technology 13 6.6
Manufacturing 71 36.0
Service 101 51.3

Trade 12 6. 1

 

 

 

66
Table 8

D' ribui nof u 'ectsb Size fOr an' ion

 

 

Organization Size n %
1 to 99 members 5 2.5
100 to 500 members 16 7.8
501 to 1000 members 22 10.8
1001 to 5000 62 30.4
5001 to 10,000 31 15.2

over 10,001 members 68 33.3

 

 

67

 

 

Table 9

D'ri in fu' nh anrewih anization

Years with Organization n %
1 year 20 9.5
2 to 5 years 97 46.0
6 to 10 years 59 27.9
11 to 15 24 11.4
16 + 11

5.2

 

68
Table 10

Dg' rihtttien of Subjects by Time In Current Position

 

 

Time in Current Position 11 %
6 months or less 13 6.2
7 months to less than 2 years 52 24.9
2 to 5 years 97 46.4
6 to 10 years 38 18.2
11 to 15 years 5 2.4

16 + years 4 1.9

 

 

69
Table 11

D'tstrittgtion ef Sgtziects by Smtus/Rank within Qt‘ganization

 

 

Status/Rank n %
Lowest l 3 1.5
2 14 6.9
3 51 25. 1
4 62 30.5
5 54 26.6
6 9 4.4
Highest 7 10 4.9

 

70
Table 12

Dyst' ribution ef Subjects by Number of Years Health Promotion

Pr ram H Ex' d Within anization

 

 

Health Promotion Program Years 11 %
l to 3 45 21.8

4 to 6 49 23.8

7 to 9 40 19.4

10 to 12 36 17.5

13 to 15 20 9.7

16 to 20 6 2.9

More than 20 10 4.9

 

 

71

Procedures

A cover letter to survey recipients explained possible benefits to participants,
including (a) a chance to contribute to current understandings of health promotion, (b)
a better understanding of what makes programs effective, (c) an industry-specific look
at program effectiveness, ((1) an opportunity to determine whether or not the choice of
communication media can influence the effectiveness or success of health promotion
programs, (e) an opportunity to learn if the way media are used is characteristic of
various health promotion programs, and (0 an opportunity to learn what health promotion
professionals perceive to be the key media and non-media factors in the successful
promotion of health promotion programs. Respondents were provided with an addressed,
stamped envelope in which to return the survey. Two follow-up postcards were mailed
at one week intervals as reminders to subjects, asking them to complete and return the
survey.

A pilot survey instrument based upon the criteria from academic and popular
publications was developed in order to answer the nine research questions, gathering
information from working health promotion professionals (see "Instrument Used in the
Survey"). Twenty—five working health promotion professionals from a large Southeastern
city completed the survey and provided commentary in an attempt to improve the survey
instrument. These twenty-five professionals, who were excluded from the final survey,
fit the same criteria used in the survey, namely: (a) involvement with delivery of health
promotion services to employees, (b) involvement in making decisions about the types
of media used in conducting and promoting health programs, and (c) at least 50% of their

work time is devoted to or spent on health promotion programs. Results of the pilot

72

study suggested (a) the rewriting of several examples offered in the survey in order to
improve clarity and (b) the addition of a list of brief descriptions of the seven health
promotion categories (Downie, et al., 1990) by which survey respondents could identify
their primary type of health promotion activity.

Subjects received the revised survey which solicited information about (a) the type
of industry in which they work, (b) the kinds of health promotion programs they offer
employees, (c) the criteria used to assess program effectiveness within their workplace,
(d) dimensions of media used within their organization, in general, and (e) media used
in health promotion programs in their organization. This information provided the data
for answering research questions 1 - 7.

The final survey also solicited information regarding media use in both
"successful" and "unsuccessful" conditions (survey Sections 111 and IV). Respondents
were asked to list (open-ended responses) the program name, or title, for their most
successful health promotion program during the previous twelve months. Information
was solicited regarding the target audience of the program and the intention or purpose
of the program in order to categorize the program according to Downie et al.’s (1990)
classifications. Respondents were asked to list reasons that they attribute as leading to
the successful promotion of the program they reported. For the most unsuccessful
program, the same open-ended format was also used to ask respondents to list the
program name for the health promotion program that they consider to be their least
successful during the previous twelve months. Information was again requested
regarding the target audience, the program’s purpose, and factors leading to program

success or failure. These responses constitute the data for research questions 8 and 9.

 

73

Additional information gathered about each subject’s background and program use
provided the ability to define the subject population and interpret the data.

The returned surveys were compiled and assigned subject numbers for coding.
Two adult volunteers were trained to categorize independently the open-ended responses
(survey Sections 111 and IV) into the seven domains from Downie et al. (1990). The
coders also categorized the media and non-media reasons for program effectiveness based
upon categories and code books (see Appendices F, G, H, and I for the codebooks) that
were developed by the researcher after scanning responses for key and unique ideas. The
reliabilities (Scott’s 1r) of the coders were as follows: for effective programs, .98 for
domain types, .89 for media reasons, .85 for non-media reasons; for ineffective
programs, .98 for domain types, .96 for media reasons, .89 for non-media reasons
(Scott, 1955).
Instrument Used in the Survey

The final survey solicited information from health promotion practitioners about
(a) the types of programs offered by their organizations, (b) the value placed upon
various criteria for rating program effectiveness, (c) the types of media used to promote
various programs, ((1) the media and non-media reasons health promotion practitioners
identify for program effectiveness and ineffectiveness, (e) the importance of specific
media characteristics in promoting health promotion programs, and (0 various
demographic information about the respondents and their organizations. Additionally,
respondents were asked to identify which of the seven health promotion categories from

Downie et al. (1990) was the primary type of health promotion activity in which their

74

organization engages. The following descriptions provide information regarding the
origin and use of instruments used in developing the survey instrument for this study.

Following procedures specified by Hunter (1980; Hunter & Gerbing, 1982)
confirmatory factor analysis tests of face validity, item loading, internal consistency, and
external consistency were applied to each of the Likert—type scales (Program
Effectiveness, Important Dimensions of Media). Primary factor loadings for all items
and the reliability coefficients for each scale are reported in Tables 13 and 14. Except
for the deviations discussed below, all items met the criteria for internal consistency: (a)
face validity; (b) a primary factor loading of .4 or greater; (c) less than 5% of the
discrepancies between predicted and observed correlations were outside the bounds of the
confidence interval (at a p < .05); and (d) a nonsignificant sum of squared errors showing
no departure from the hypothesized unidimensional model. For tests of parallelism, less
than 5% of discrepancies between predicted and observed correlations fell outside the
confidence interval.

Health Promotion Program Offerings. Parkinson et al. (1982) provided an
extensive listing of health promotion program offerings by organizations (see Appendix
J). This list reflected current practices among a number of large corporations and
government agencies within the United States. Subjects were asked to identify the health
promotion programs that their organization sponsors for employees. Subjects were also
given space to reply in open-ended format. These responses were used to identify what

health promotion programs currently exist in business and industry (survey Section 1,

R01).

75
Table 13

Factor Loadings for Items and Reliabilities for Program Effectiveness Scale

 

PROGRAM EFFECTIVENESS

"A health promotion program in my organization is viewed as being effective when . . .

Cost-financial
it makes money ....................................
it doesn’t lose money .................................
it pays for itself ....................................
it is a profit center for the organization ......... *

Long Term Health/Cost Improvement
it reduces the company’s overall health care expenditures ...........
it is linked to corporate savings ...........................
it brings down cost in other areas (e.g., insurance) ...............
it saves the company money overall ........................

Program Attendance
many people participate ...............................
my expectation of the number of participants is met ..............
employees show support for the program by participating ...........
there are enough participants to justify the program’s existence

Public Relations
it results in media coverage (radio, tv, newspaper) ...............
it generates good publicity ..............................
it makes the company look good ..........................
there is a good feeling about the program throughout the organization

Management Favors It
management personnel participate .........................
management wants it .................................
management views the program favorably
management discusses it while recruiting new employees

Behavior Change
participants learn new health-related skills ....................
participants incorporate new healthy behaviors into their daily routine
participants demonstrate behavioral changes ...................
behavioral changes are clearly visible and measurable

.59
.88
.65

.82
.86
.81
.87

.68
.68
.71

.61
.79
.68

.51
.51

.82
.88
.84

 

* items without factor loading score were dropped

76
Table 14

Factor Loadings for Items and Reliabilities for Important Dimensions of Media Scale

 

INIPORTANT DIMENSIONS OF MEDIA

"Please rate the importance of each of the following media characteristics as you decide how
to publicize health promotion programs in your organization."

Cost
The expense of preparing materials (flyers, posters, advertisement) ..... .77
The cost of delivering the materials/information to potential clients ..... .77

How much money had been spent on promoting other health promotion programs *

Interactive
The ability of the medium to tailor the message to each individual ..... .55
The medium provides employees with the opportunity to ask questions . . . .55

The ability to get quick feedback from potential participants

Urgency
The ability to get information to potential participants quickly ........ .72
The medium’s ability to reach many people in the shortest amount of time .81

The speed with which the medium can deliver a message to the target audience .87

Detail
Particular medium’s ability to deliver detailed information .......... .59
The medium has sufficient capacity to give employees all the information they
need ........................................... .59
The ability to convey detailed information

Novelty
The use of a promotional medium that had not been used recently ...... .69
The medium presents the message in a novel manner ............. .69

The ability of the medium to grab employees’ attention

 

* items without factor loading score were dropped

77
Health Emmetion Tynelugy. In keeping with Downie, et al. (1990), this survey

sought information on the purpose and intended audience of health promotion program
offerings to determine the type of health promotion program. Subjects identified the
purpose (general instructional health activities, services intended to prevent disease or
illness, legal or legislative activity, interventional activities, health-related laws and
regulations, health education targeting those impacted by health legislation or regulation,
and health education targeting legislators and policy makers) and intended audience (e.g.,
women over 40 years of age, workers exposed to radiation, the general public) of
specific program offerings which were categorized according to Downie, et al.’s (1990)
classifications. Subjects identified their use of existing programs by: (a) marking a box
adjacent to each of the listed programs and (b) through open-ended responses (survey
Sections 111 and IV, RQ3, RQ7, RQ8, and RQ9). The survey also asked respondents to
mark the one description from Downie et. al’s categories which best represented the
primary type of health promotion activity within their organizations.

Type bf Industt'y. The survey solicited information concerning the nature of the
industry in which subjects work. The Standard Industrial Classification Manual (1987)
identifies ten types of industry, including (a) agriculture, forestry, and fishing, (b)
mining, (c) construction, ((1) manufacturing, (e) transportation and public utilities, (f)
wholesale trade, (g) retail trade, (h) finance, insurance, and real estate, (i) services, and
(j) public administration. Since the data followed prior reporting patterns, these industry
types were collapsed into four industry types (Miller, 1988) in order to facilitate a more
manageable sample size: (a) manufacturing and construction; (b) service (hospital, public

administration, public utilities, finance, insurance); (c) process technology (oil refinery,

78

nuclear power plant, mining, agriculture, forestry); and (d) trade (wholesale and retail)
(survey Section VI, RQ2, RQ4, and RQ6).

Prugpm Effeetiveness. Twenty-four survey items from Appendix B were used
to evaluate program effectiveness (RQ3) as perceived by health promotion professionals.
These items represent criteria suggested by the literature review and were used to assess
subjects’ organization’s emphasis on: (a) cost/finaneial outcomes (Anderson, 1986;
Barry & DeFriese, 1990; Brennan, 1983; Gettman, 1986; Jones et al., 1990; Terborg,
1986), (b)l n rmh — stim r vem n (Anderson, 1986;Barry &DeFriese, 1990;
Brennan, 1983; Gettman, 1986; Jones et al., 1990; Terborg, 1986), (c) mgtam
attendance (Anderson, 1986; Terborg, 1986), ((1) public relations (Anderson, 1986;
Terborg, 1986), (e) management favors it (Anderson, 1986; Terborg, 1986), and (t)
ehange in behavior§ (Anderson, 1986; Bandura, Adams, & Beyer, 1977; Cumming,
1986; Eddy, Eynon, Nagy, & Paradossi, 1990; Falkenberg, 1987; Lynch, Golaszewski,
Clearie, Snow, & Vickery, 1990; Shephard et al., 1981; Shephard et al., 1983; Terborg,
1986). Respondents were urged to rate criteria as they are valued in determining
program effectiveness within their organization, recognizing that not all items are equally
important to their organization. Finally, respondents were asked to rate each criterion
on its own merit based upon their workplace experience, not necessarily according to
their personal preference (survey Section II, RQ3). Subjects rated the degree of
importance each criterion receives within their organization with 1 being the lowest value
in determining program effectiveness to 11 being the highest value of effectiveness.

In keeping with the above theoretical dimensions, the results of the confirmatory

factor analysis of the 24 item scale indicated the presence of six factors (see Table 13).

79

After removing items which exceeded their confidence intervals, subsequent tests of
internal consistency revealed that less than 5 % of discrepancies between the observed and
predicted correlations exceeded the bounds of the confidence interval (at a p < .05). The
sum of squared errors in the test of internal consistency was nonsignificant for each
factor (eesttfinaaeial euteomes, X2 = .18, 3 df, p> .05; long term health-cost
imprbvements, x2 = .25, 6 df, p>.05; W, x2 = .02, 3 df, p>.05;
public relations, X2 = .02, 3 df, p> .05; management favors it, X2 = .08, 1 df, p> .05;
and ehaage in behaviors, X2 = .04, 3 df, p>.05). The scales were judged to be
heterogenous as less than 5 % of items excwded the bounds of the confidence interval and
a test of the sum of squared errors showed no significant departure from the hypothesized
model (sum of squared errors = .64, X2 = 125.11, 134 df, p>.05).

Important dimensions of media. Organizations vary in what forms of media are
acceptable for health promotion and are necessary to engage employees’ attention. A 15
item scale assessing 5 categories was used to evaluate the importance of dimensions of
media (RQS) as perceived by health promotion professionals within various organizations
(see Appendix C). The categories, suggested by the literature review, include: eps_t
(Sitkin et al., 1992), interactive (Daft & Lengel, 1984; Sitkin et al., 1992), utgeaey
(Steinfield & Fulk, 1986; Sitkin et al., 1992), _d_e_tai_l (Daft & Lengel, 1984; Sitkin et al.,
1992), and aoyelty (Heirich et al. , 1989; Rogers, 1983). Respondents were asked to rate
items on an 11 point scale from 1 = "no importance" to 11 = "highest level of
importance" in planning a recent health promotion program (survey Section V, RQS).

The results of the confirmatory factor analysis of the 15 item scale (see Table 14)

revealed the presence of five factors: fist, intetactive, urgeney, detail, and novelty.

80

Items which exceeded their confidence intervals were dropped. Subsequent tests of
internal consistency revealed that less than 5 % of discrepancies between the observed and
predicted correlations exceeded the bounds of the confidence interval (at a p < .05). The
sum of squared errors in the test of internal consistency was nonsignificant for each
factor (east, X2 = .08, 1 df, p>.05; intetactive, X2 = .08, 1 df, p>.05; my,
X2 = .04, 3 df, p>.05; M, X2 = .08, 1 df, p>.05; and may, X2 = .08, 1 (If,
p > .05). The scales were judged to be heterogenous as less than 5% of items exceeded
the bounds of the confidence interval and a test of the sum of squared errors showed no
significant departure from the hypothesized model (sum of squared errors = .22, X2 =
42.67, 48 df, p> .05).

Faetors flociated with prugram suecess or failure. As previously described,
a 24 item section of the survey instrument was used to assess subjects’ evaluations of
program effectiveness. Because health promotion professionals may recognize other
measures of effectiveness, subjects were asked to identify in open-ended format (a) the
three most important or key media factors and (b) the three most important non-media
factors that contributed to one of their most effective programs in the previous twelve
months (RQ8 and RQ9). Additionally, they were asked for the name of the program and
the intended audience. The same procedure was observed for the least ineffective
program to discover the range over which success can occur (survey Section III and IV,
RQ8 and RQ9).

Backgrpung Infurmatien. Additional demographic information was requested
from respondents. This information was used to assist in the interpretation of data.

These items include (a) gender, (b) highest education level completed, (0) age, ((1) tenure

81

in organization, (e) job title, (0 status in organization (hierarchical position), (g) health
promotion budget, (h) staff, and (i) number of years health promotion program has
existed within the organization (survey Section VI).

SM. Multivariate comparisons complement Research Questions 1,3,5, and
7 which assess multiple dependent variables and which seek descriptive information,
respectively, regarding the type of health promotion programs offered by organizations,
how they measure program effectiveness, dimensions of media that are important to the
respondent, and media actually used by organizations. Tests of Research Questions 4,
6, and 7 employed a 4 x 4 MANOVA design with 4 levels of program types and 4 levels
of industry types. These analyses measured the impact of the program type and industry
on health promotion program effectiveness criteria, dimensions of media, and actual
media use, respectively. Two separate multivariate analyses were undertaken because
the dependent variables are theoretically distinct and each dependent variable has
multidimensional constructs.

In testing Research Question 2, a Chi Square Test of independence examined
differences in the types of programs offered across 4 types of industry. A Chi Square
Test of Independence also measured differences in media use by program for two levels
of success (most effective or least effective health promotion program outcomes) in
testing research question 9. Finally, in testing research question 8, a Chi Square test of
Independence was used to assess differences in media and non-media factors leading to

effectiveness or ineffectiveness of health promotion program outcomes.

CHAPTER 3
RESULTS

Research Question One asked, "What types of health promotion programs are
used by organizations ?" While Downie, et al. (1990) identify seven domains of health
promotion, health professionals in this sample reported that their organizations focused
on some domains to the exclusion of others and, at times, promoted sets of programs
constituting two new unique domains.

As listed in Table 15, subjects reported using (in descending order of frequency):
Pesitive Health Education (Domain 1 - programs offering general health information on
one or more health topics); Preventive Health Education (Domain 4 - intervention
programs offering specific information or counseling on specific, identified health risks);
&eventjve Serviees (Domain 2 - screenings, immunizations, and surgical interventions
for clients or populations); Spe_c_ifie Educatibn (composed of combinations of Domains
1, 2, and 4 - these programs are limited to education and screening activities to the
exclusion of legislation/policy creating related domains); Doing It All (composed of
Downie, et al.’s Domains 1 - 7); Health Edueation Aimed At Positive Hglth Pretgu'bn
(Domain 6, education and training specific to employees); and mag/gm
Pretection (Domain 5 — enforcement of health-related laws and/or regulations for industry
or the public).

Results of a Chi-Square Test of Goodness of Fit indicated that the variation in the
distribution of domain use was significantly greater than by chance (X2 = 351.79, 8 df,
n=l99, p< .001). An analysis of the distribution indicates that almost half of health

professionals report using Positive Health Education. The use of Preventive Healtb

82

83
Table 15

Major Health Promotion Domain [Jae Remrtfl In Study

 

 

Type of Health Promotion Frequency Percent
1 Positive Health Education 102 49.7
2 Preventive Services 28 13.6
3. *Positive Health Protection - -
4. Preventive Health Education 44 21.5
5. Preventive Health Protection 2 1.0
6. Health Education Aimed at Positive Health Protection 3 1.5
7. *Health Education for Preventive Health Protection - -
8. “Specific Education 14 6.8
9. l’Doing It All 12 5.9

Total 205 100.0

 

* The use of categories 3 and 7 were reported in combinations with other health domains and did
not appear uniquely from other domains.

" Specific Education was composed of combinations of Domains 1, 2, and 4 and are limited to
education and screening activities to the exclusion of legislation/policy creating related domains.

" Doing It All resulted from subjects reporting the use of all of Downie, et al.’s Domains l - 7.

84
Euueattou and Preventive Serviees accounted for approximately one third of health

professionals’ efforts. SW and Doing It All were the focus of a small
percentage of health professionals’ efforts (6.8% and 5.9%, respectively). Health
professionals focused on Preventive Health Protection and Health Education Aimed At
Pbsitive Health Proteation relatively infrequently. In this particular sample, PM
Health Protection and Health Education For Preventive Health Protection were never
identified as being used separate from other domains (see Table 15).

Constituting each health promotion domain were the specific programs which
professionals offer to the organizations’ employees. The distribution of 66 programs
across the three most often represented domains is reported in Table l6. The overall
pattern indicated considerable overlap in the programs offered by organizations across
domains. Only two significant differences in the offering of specific programs were
present (see Table 16). Thirteen programs were offered by more than 75% of
organizations in the three most often represented domains, Positive Health Educau'on,
Preventive Services. and Preventive Health Education.

Research Question Two inquired, "How do health promotion programs dzfier
across various types of industry ?" The distribution of the usage of health promotion
program domains across types of industry is reported in Table 17. A Chi-Square Test
of Independence revealed that the distribution of health promotion domains did not differ
significantly across the industry types (X2 = 20.10, 18 df, p = .33). The lack of

significant differences appears to be principally due to the relatively small sample size.

85

 

 

Table 16
e n f Pr m s B Dom i

Positive Preventive Preventive
Program Titles Overall Health Ed. Services Health Ed.
‘Nutrition Counseling 81.8 76.5 89.3 81.8
'Weight Control Program 92.5 94.1 96.4 88.6
"Employee Assistance Program (EAP) 87.3 84.3 85.7 90.9
Family Counseling 51.9 46.1 57.1 61.4
Personal Counseling 63.2 54.9 71.4 75.0
Planned Safety Meetings 72.6 68.6 71.4 77.3
'Smoking Cessation Program 80.2 75.5 89.3 84.1
Hypertension Modification Program 57.1 47.1 71.4 61.4
Serum Lipid Modification Program 60.8 46.1 75.0 75.0
Counseling & Referral for Substance Abuse 70.8 62.7 85.7 77.3
‘Health Risk Appraisal 80.2 82.4 82.1 79.5
"Stress Management (learning relaxation, etc.) 83.0 78.4 89.3 88.6
At work Fitness Center (company owned) 73.6 78.4 64.3 77.3
Off site Fitness Center (owned or contracted) 24.1 17.6 25.0 27.3
Aerobic Dance (for everyone) 75.5 81.4 67.9 70.5
Aerobic Dance (specifically for weight loss) 10.4 5.9 10.7 13.6
Other aerobic exercise programs (tm, bike, etc.) 74.1 82.4 60.7 72.7
Circuit training (weight machines) 67.0 74.5 50.0 65.9
Swimming Instruction 10.4 10.8 10.7 9.1
*Cardiac Rehab 19.3 10.8 10.7 36.4
Recreational Skills 42.9 46.1 53.6 31.8
Self-help Groups (AA, etc.) 17.9 17.6 21.4 18.2
Safety Training 69.8 69.6 75.0 63.6
‘Back Safety 79.2 79.4 82.1 81.8
Proper Lifting Techniques 72.6 70.6 75.0 72.7
How To Start An Exercise Program 71.2 72.5 75.0 68.2
HIV/AIDS Information 52.8 52.0 50.0 47.7
Women’s Health Issues 66.0 66.7 64.3 54.5
How To Prevent Heart Disease 68.4 63.7 67.9 72.7
Second Hand Smoke and Your Health 25.0 21.6 32.1 13.6
"Basic Nutrition 86.3 87.3 82.1 86.4
Nutritional Label Reading 76.9 77.5 82.1 72.7
Planning For Retirement 52.4 53.9 57.1 50.0

 

 

 

Table 16 (cont’d). 86
Positive Preventive Preventive
Program Titles Overall Health Ed. Services Health Ed.
Heart Healthy Cooking Class 54.2 56.9 53.6 43.2
Cancer Education (general) 59.4 56.9 60.7 61.4
Breast Cancer Education 64.6 61.8 60.7 65.9
Breast Self-Examination 56.6 51.0 53.6 61.4
Testicular Self-Examination 36.3 33.3 32.1 40.9
Colo-rectal Cancer Education 33.0 26.5 46.4 36.4
Cardio-Pulmonary Resuscitation (CPR) 79.7 85.3 67.9 79.5
‘Stress Management (information class) 83.5 76.5 85.7 90.9
Exercise Education (general info - not activity) 67.5 69.6 64.3 68.2
Self-Esteem 33.5 36.3 28.6 22.7
Death Education 6.6 3.9 3.6 9.1
*Life Saving (swimming) 4.7 3.9 10.7 100.0
First Aid 59.9 63.7 57.1 59.1
‘Health-related Brochures 81.6 79.4 85.7 86.4
Health-related Newsletter 73.6 76.5 60.7 77.3
Wellness Library for Employees 67 .0 69.6 64.3 59.1
Skin Cancer Screening 37.7 39.2 50.0 31.8
Mammography 57.1 50.0 78.6 56. 8
Colo-rectal Screening 33.5 30.4 39.3 34.1
Lung Cancer Screening (chest X-ray) 10.4 5.9 17.9 13.6
Prostate Cancer Screening 33.5 27.5 46.4 34.1
Cervical Cancer Screening 13.7 11.8 10.7 22.7
Immunization 48. 1 46. 1 57. 1 43.2
Aerobic Capacity Test (Max tm test with EKG) 18.4 15.7 21.4 15.9
Aerobic Capacity Test (Sub-Max bike, no EKG) 56.6 61.8 39.3 54.5
‘Body Composition (body fat) Testing 88.7 91.2 85.7 90.9
Flexibility Testing 72.2 77.5 64.3 70.5
Muscular Strength & Endurance Testing 65.6 72.5 53.6 65.9
Vision Screening 45.3 41.2 57.1 52.3
Glaucoma Screening 32.2 26.5 46.4 40.9
Low Back Clinic/Screening 28.8 31.4 28.6 27.3
Scoliosis Screening 7.1 6.9 14.3 4.5
‘Hypertension Screening 94.3 93.1 100.0 97.7
‘Cholesterol Screening 90.1 88.2 100.0 93.2
n=212 n=102 n=28 n=44

 

* denotes significance between Domains at p< .05

‘ program offered by more than 75% of organizations in the three most represented domains

f

m Domains Across T
Health Promotion Type

87
1th Promotion Pr

ri ution fThe sa eOfH

Indu

 

 

Organizational Type

Table 17
D'

_.< .158

558...:— 5.8.5
58825....
5.8: 25.8.. a
.85.... 5585.: 5.8:

5288.5
5.8: 2588....

858%:

5.8: 2588.:

8933 03.5.5...—

=e..8=..: 5.8: 25.8..

14
26

10

ll

6
38
51

 

Process Technology
Manufacturing

Service
Trade

88

The third research question asked, "What criteria (dimensions) do health
promotion professionals perceive that their organizations value as being most usefitl in
determining program eflectiveness?" According to health promotion professionals (see
Table 18), their organizations value the criterion, behaviom ehange, as the most
important in determining program effectiveness, followed by attendance, long term
halth-Qst improvement, management favors it, public relations, and cost/financial.
While behavioral ehange was weakly correlated with other criteria, attendauee,
mauagement favors it, public relations. and cost/financial were moderately correlated
with each other. Results of t-tests between the mean scores of the criteria (see Table 19)
indicated that all criteria significantly differed from each other in importance except for
attendance and mgement favors it when either were compared to long term hglth-eest
immovement.

The fourth research question sought to identify variations in the criteria to
evaluate the efiectiveness of health promotion programs due to the industry of the health
professional. While a multivariate analysis of variance revealed no significant differences
in criteria due to industry type (see Table 20), analyses indicated a significant univariate
effect in the importance of attendance (F=2.92, df=3,204, p< .04, eta2=.05).
Subsequent post hoc Tukey HSD tests indicated that attendance was a more important
criterion for health promotion success for organizations in trade (it = 8.88) and
manufacturing (x = 8.55) than in process technology industries ()1 = 7.28).

Additional exploratory analyses, however, revealed a significant multivariate
effect (Mult. F=l.58, df=6,181, p< .02, R2=.27) in the importance of the criteria for

judging program effectiveness due to professional’s primary health promotion program

89
Table 18

Mgm, Standard Deviations and Qprrelations pf Criteria for Remifled Values of
r ani ion In trminin Pro r m Effectiveness

 

 

 

Criteria x s.d.

Behavioral Change 9.20 1.61 -

Attendance 8.41 1 .56 . l9 -

Long Term Health-Cost Improvement 8.17 2.43 .14 -.03 -

Management Favors 1t 7.90 1.80 .22 .48 .43 -

Public Relations 5.85 2.20 -.02 .46 .08 .55 -
Cost/Financial 4.94 2.62 -.18 .22 .46 .50 .40 -
N=195

Rating scale was 0 to 10, but was adjusted by adding one to each response to create a scale of
l to 11 for statistical purposes.

Table 19

T-T Between Pro ram Eff tiveness riteria

 

 

Variables t-values (if p
Cost/Financial vs. Long Term

Health-Cost Improvement -16.76 1,204 .000
Cost/Financial vs. Attendance -18.00 1,205 .000
Cost/Financial vs. Public Relations — 4.49 1,201 .000
Cost/Financial vs. Management

Favors It -15.38 1,203 .000
Cost/Financial vs. Behavioral

Change -18.69 1,205 .000
Long Term Health-Cost

Improvement vs. Attendance - 1.27 1,205 .205
Long Term Health-Cost Improvement

vs. Public Relations 10.58 1,201 .000
Long Term Health-Cost Improvement

vs. Management Favors It 1.56 1,203 .119
Long Term Health-Cost Improvement

vs. Behavioral Change - 5.43 1,205 .000
Attendance vs. Public Relations 16.60 1,204 .000
Attendance vs. Management

Favors lt 3.71 1,207 .000
Attendance vs. Behavior Change - 5.61 1,209 .000
Public Relations vs. Management

Favors It -12.47 1,202 .000
Public Relations vs. Behavior

Change - 17.32 1,204 .000
Management Favors It

vs. Behavior Change - 8.47 1,207 .000

 

91

 

 

 

 

 

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92

domain (see Table 21). Results of an analysis of variance indicated that only the
criterion of attendance varied significantly among health promotion programs (F=5.93,
df=6,181, p< .0001, eta2=.21). Subsequent post hoc Tukey HSD tests revealed that

attendance is a more important criterion in Specific Education ()1 = 9.02), Positive

 

Hath Edaeatien ()1 =8.92) and Preventive Servigs (x = 8.73) than in Preventive Hglm
Edugtien (x = 7.50) and Preventive Health Pretggtien (it = 7.33) programs.

Research Question 5 was, " What do health promotion professionals consider to
be the most important media characteristics (i.e. , "media dimensions ") in promoting
programs?" As reported in Table 22, health promotion professionals in this study
identified u_rget§y as the most important media dimension, followed by m, east,
n_ov_e1_ty, and interactive. Professionals’ rating of am as an important characteristic was
also moderately correlated with the ratings of tagLney and interactive while ratings of
way were moderately correlated with interactive. Results of t—tests (Table 23)
indicated that all media characteristics significantly differed from each other in
importance except for east compared to intemetive and Mm, as well as integctive
compared to aeyelty.

Additional exploratory analyses examined the relationship between professionals’
rating of criteria for health promotion success and the importance of media
characteristics. As indicated in Table 24, moderate but significant correlations were
present for behavior ehange compared to (Leg and integctive, as well as attendance
compared to gag.

The sixth research question asked, "How do these rated media characteristics vary

by industry?" Multivariate analyses indicated a significant multivariate main effect for

93

 

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Table 22

M S ndar Deviations and orr 1 ions of Im n Media Characteristics
Criteria )2 s.d.

Urgency 8.85 1.58 -

Detail 8.46 1 .49 .53 -

Cost 7.28 2.22 .04 .11 —

Novelty 7.22 1.76 .30 .29 .08 -
Interactive 7.15 1.91 .31 .52 .01 .60 -
N = 195

Rating scale was 0 to 10, but was adjusted by adding one to each response to create a scale of
l to 11 for statistical purposes.

95

Table 23

T-Tfl Qtween Impoflnt Media Chamcteristies Criteria

 

 

Variables t-values (If p

Cost vs. Interactive 0.37 1,204 .711
Cost vs. Urgency - 8.62 1,205 .000
Cost vs. Detail - 6.63 1,203 .000
Cost vs. Novelty - 0.21 1,200 .833
Interactive vs. Urgency -10.71 1,206 .000
Interactive vs. Detail - 8.04 1,204 .000
Interactive vs. Novelty — 0.50 1,201 .617
Urgency vs. Detail 3.21 1,204 .002
Urgency vs. Novelty 10.37 1,202 .000
Detail vs. Novelty 8.26 1,199 .000

 

96

Table 24

 

 

Urgency Detail Cost Novelty Interactive

Behavioral Change .11 .28** .13 .17 .28**
Attendance .09 .25** .03 .09 - .00
Long Term

Health-Cost Improvement - .06 .08 .15 .06 - .02
Management Favors It .13 .16 .12 .18 .10
Public Relations .03 .17 .08 .08 - .02
Cost/Financial .04 .04 . 18 .04 .06

 

N: 187 2-tailed Signif: ** - .001

97
industry type (Mult. F = 1.83, df= 15,522, p=.03, R2=.13). A significant main effect

for professionals’ rating of W (F =3.889, df=3,193, p=.01, eta2=.06) was also
present. Subsequent Tukey HSD post hoc analyses revealed that my was perceived
to be more important in manufacturing (7: = 8.96) and service industries (x = 8.93) than
in the sales industry (it = 7.41).

Additional exploratory analyses examined the impact of participants’ primary
health promotion domain type on their ratings of media characteristics. While a
multivariate main effect was not present, univariate analyses indicated a significant main
effect for tam (F=2.35, df=6,181, p=.03, eta2=.07) and intetaetive (F=2.19,
df=6,181, p=.05, eta2=.07). However, post hoc tests were unable to identify
significant differences in media characteristics due to subjects’ health promotion program
domain.

Research Question 7 asked, "What uses of media characterize efi’ective and
ineflective health promotion programs ?" Health professionals were asked to identify, by
open-ended response, their "most" and "least" effective health promotion programs.
They were also asked to identify the various media (out of a list of 42) used in their
programs. Health promotion professionals (n = 208) named 51 different education or

screening programs as their "most effective" programs. Professionals most often
identified Health Fairs (8.7%), Health Serfining (8.2%), Weight Loss/Mgagement

(7.2%), Cholesterol Screening (5.3%), and Regreatienal Programming (golf, tennis,

rafting trip, ete,) (3.8%) as their most effective programs. Health promotion
professionals (n = 184) also named 59 education or screening programs as their "least

effective" programs. Programs most often identified as least effective were Smeking

98
Cessatien glass/Preggm (15.8 %), Exereise/ Fitness Edagtion (6.0%), General N utritien

Edaga'on and Stress Management (5.4%), Self-Care Edacation (3.8%), and General

 

Health flacatiea and L n h m Br wn B on an i (3.3%).

As professionals report the use of more than one medium, those media used in
50% or more for "most effective" programs by all respondents are identified in Table
25. Ten types of media were identified by this process. With one exception, these 10
most frequently used media matched the 10 most frequently used media for "least
effective" programs. Actually, the top 11 media forms match completely if
memorandums are included. Since less than 50% of professionals identified using
memorandums in their "most effective" programs, memorandums were excluded from
comparisons. The following 10 types of media were used more than half of the time in
their "most effective" programs in the last 12 months: one-on-one (face-to—face), word
of mouth, newsletter, bulletin board, flyers, one-on—group (in person), posters,
announcement at a meeting, in-house publication, and e-mail. In contrast, health
professionals reported most frequently using the following media (in descending order)
in their "least effective" programs: flyers, newsletters, bulletin board, word-of-mouth,
in-house publication, one-on-one (face to face), e-mail, announcement at meeting,
posters, and one-on-group (in person).

Subsequent pairwise Chi Square Tests of Independence revealed significant
differences in the use of these media in the "most" and "least" effective programs, except
for the use of newsletters and flyers. Overall, the results indicated that the 10 most
frequently used media were used more often in effective programs than in least effective

programs.

99
Table 25

Swan ef Tap 10 Media Used For Health Promotien Programs "

 

Most Effective Programs Least Effective Programs

 

% used % used
* One-on-one (face to face) 73 40
* Word-of-mouth 71 45
Newsletter 65 50
* Bulletin board 63 45
Flyers 62 57
* One-on-group (in person) 60 25
* Posters 57 32
* Announcement at meeting 56 35
* In-house publication 56 42
* E-mail 51 37
n = 208 n = 183

 

‘ Health professionals could identify as many as 42 media used in their most effective
and least effective programs. The top 11 media match completely if memos are
included. However, since less than 50% of professionals identified using memos in
their most effective programs, comparisons between memos in the most versus least
effective programs were not computed.

* indicates a significant difference in media use between most and least effective
conditions at p< .05.

100

In addition to identifying the types of media used in their most and least effective
health promotion programs, professionals also provided in an open-ended format the
media-based and non-media based reasons for program success or failure. Consequently,
Research Question 8 asked, " What do health promotion professionals regard as the key
media and non-media factors in the success or failure of promotions ?" With regard to
media reasons for program effectiveness, professionals’ reasons (see Table 26) for the
media’s role in program success fell into eight categories: Personal Contag (one person
spreading information to another person or group), Use Of Speeifie Media (identified by
references that simply list a particular kind or type of media), Placement QfZPQint Qf
Contact With Media (i.e., where media were placed), Content/Message Of Media (i.e.,
what was said or how it was said), Qaality Of The Promotion (i.e., references to the
quality of the message’s presentation), Top Management Media Contact (i.e., messages
coming directly from administrators, managers, and/or supervisors), Multiple Media
(i.e., use of more than one medium), and Timing Qf Media (i.e., focus on when the
media messages were presented to employees).

A Chi-Square Goodness of Fit Test indicated that the frequency of reasons for
success significantly differed from chance (x2 = 141.54, 7 df, p<.001). Overall,
professionals indicated that program success was primarily due to Persenal Centaet, the
Use Of Smifie Media, and the Plaeement onPeint ef Cenget with the Media.

With regard to non-media reasons for programs being effective, professionals’
responses were placed into one of thirteen categories (see Table 27): Madagement
m (i.e., the support or endorsement from management), Ingntives (i.e.,

enticements to participate such as prizes), Economie Issues (i.e., the cost of the

10 1
Table 26

Tetats ef Media Refiom fer Mast Effective Pregram

 

 

Media Reasons For Most Effective Programs Total
Personal Contact .................................. 112
Use Of Specific Media ................................ 95
Placement Of/Point Of Contact With Media ................... 74
Content/Message Of Media ............................. 50
Quality Of The Promotion ............................. 43
Top Management Media Contact .......................... 36
Multiple Media .................................... 23
Timing of Media ................................... 22

Total number of reasons .............................. 455

 

102
Table 27

Tetals of Non-Media Reasons for Most Effective Programs

 

 

Non-Media Reasons For Most Effective Programs Total
Management Support ................................. 91
Incentives ........................................ 62
Economic Issues ................................... 58
Ease/Convenience ................................... 47
Credibility ....................................... 38
Individualized Programming ............................ 37
Fun/Social ....................................... 34
Timing Of Program ................................. 30
Instructor Attributes ................................. 26
Novelty ......................................... 16
Success Measured By Participation ........................ 13
Required Attendance ................................. 13
Ease Of Administration ................................ 2

Total number of reasons .............................. 467

 

103
program), Ease/Cenvenience (i.e., the ease of participation), uccess M sur B

Pa_rticipation (i.e., attendance by "regular" and first time employees and/or their
families), My (i.e., uniqueness of the program or location), Timing Of Program
(i.e., "timely" in meeting curiosity or needs), Instgietor Attributes (i.e., characteristics
of the program leader), Ease Cf Administration (i.e., easy to organize the program),
Fun/Social (i.e., participants’ enjoyment of the program), Individualized
Programming(i.e. , tailored programs), Credibility (i.e. , the integrity of the program), and
W (i.e., participation mandated by law or management).

A Chi-Square Goodness of Fit Test revealed that the frequency of non-media
reasons significantly differed from chance (X2 = 196.17, 12 df, p< .001). As indicated
by Table 27, professionals named Management Supmgt, Incentives, flenemie Issues,
and Cam/Convenience most frequently as contributing to program success.

Research Question 8 also inquired into media and non-media reasons contributing
to professionals’ least effective program. As reported in Table 28, professionals’ eight
media reasons for their least effective programs were: Qck Cf Premetion (i.e. , the lack
of promotion of the event), Timing Of Media (i.e., focus on when media messages were
presented to employees), Placement Of/Point Of Contact With Media (i.e., where media
are placed), ContendMessage Cf Media (i.e., what was said or how it was said),
Pergnfl Contaet (i.e. , one person spreading the information to another person or group),
Non-Media Factors (i.e. , respondents indicated that the media were not an issue), Qaalfiy
Of The Premotion (i.e. , references to the quality of the message’s presentation), and lap

Management Media Contact (i.e., messages coming directly from administrators,

104
Table 28

Totals df Media Reasons for M Effective Progmm

 

 

Media Reasons For Least Effective Programs Total
lack Of Promotion .................................. 61
Timing of Media ................................... 34
Placement Of/Point Of Contact With Media ................... 34
Content/Message Of Media ............................. 29
Personal Contact ................................... 24
Non-Media Factors .................................. 17
Quality Of Promotion ................................ 14
Top Management Media Contact .......................... 10

Total number of reasons .............................. 223

 

105

managers, and/or supervisors). A Chi-Square Goodness of Fit test revealed that the
frequency media reasons for least effective programs significantly differed from chance
(X2 = 64.22, 7 df, p< .001). Specifically, professionals cited the Lack Of Promotien
most frequently as the media reason for program failure.

With regard to non-media reasons for program lack of effectiveness (see Table
29), professionals identified fifteen reasons (in descending order): Rgdiness (i.e.,
potential participants not understanding program benefits), Timing Qf Progaam (i.e. , not
"timely" in meeting curiosity or needs), Proggam Administrative (i.e., disorganization
of the program), Conflicts (i.e., too many things scheduled), Management Supmtt (i.e. ,
lack of support or endorsement from management), flenomie Issues (i.e. , the cost of the
program), My (i.e., the uniqueness of the program or location), F_ear_ (i.e., anxiety
about participation), Ease/Convenience (i.e., the ease of participation), Worklead (i.e.,
too busy due to work), Success Measured By Participation (i.e., poor attendance),
lngntives (i.e., lack of enticements to participate), Instguctor Attribates (i.e.,

characteristics of the program leader), Weather (i.e., inclement weather), and Facilities

 

(i.e., inadequate facility or location). A Chi-Square Goodness of Fit Test revealed that
the frequency of non-media reasons for least effective programs significantly differed
from chance (X2 = 272.41, 14 df, p< .001,). The lack of Rgdiness ef Empleygs and
the poor Timing of Programs were the most frequently named reasons for program
failure.

The ninth research question asked, "What is the relationship between health
promotion success or failure and media use in their respective health domains ?" In

answering this question, reports of media use of successful health promotion programs

106
Table 29

lotaismf Non-Media Reasons for Least Effective Pregr_ams

 

 

Non-Media Reasons For Least Effective Programs Total
Readiness ........................................ 84
Timing Of Program ................................. 48
Program Administration ............................... 34
Conflicts ........................................ 33
Management Support ................................. 24
Economic Issues ................................... 19
Novelty ......................................... 17
Fear ........................................... 16
Ease/Convenience ................................... 14
Workload ........................................ 12
Success Measured By Participation ........................ ll
Incentives ......................................... 9
Instructor Attributes ................................ '. . 7
Weather .......................................... 5
Facilities ......................................... 5

Total number of reasons .............................. 338

 

107

were compared across professionals’ respective domains. Due to the limited number of
professionals in other categories (15 %), only media use in the domains of Positive Haith
Education, Preventive Services, and Preventive Health Education are reported by health
professionals below. As indicated in Table 30, media use within the three domains
varied widely. While the overall patterns of media use in effective and ineffective
programs continued, the use of only ene-en-ene (face to face) and one—on-groap (in
person) were significantly different in the reported most and least effective programs
across the three domains.

In keeping with prior analyses, this investigation also examined differences in
media and non-media reasons for professionals’ most and least effective programs within
Positive Health Education, Preventive Serviees, and Preventive Hegth flugtion
domains. Media and non-media reasons for program success and failure across these
domains are reported in Tables 31 - 34. In general, results indicated few significant
differences among domains. The overall listings of media and non-media reasons
contributing to the most and least effective programs are relatively consistent across these

three health promotion domains.

108

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Table 31
Pgflmgg of Mfiig Rmom for Most Effective Programs by Domains

Positive Preventive Preventive
Media Reasons For Most Effective Programs Health Ed. Services Health Ed.
Personal Contact 24.4 19.3 28.2
Use Of Specific Media 23.5 13.1 23.2
Placement Of/Point Of Contact With Media 13.0 20.2 16.7
Content/Message Of Media 7.8 15.8 9.3
Quality Of The Promotion 11.3 7.9 9.7
Top Management Media Contact 6.1 9.6 7.4
Multiple Media 8.7 4.4 3.2
*Timing of Media 5.2 9.7 2.3
Number of responses per category 115 114 216

 

* indicates significant difference in given media reason across domains at p< .05

1 10
Table 32

ngntagg of Non-Mflia Rflom for Mg§t Effgtive Programs by Domains

 

 

Positive Preventive Preventive
Non-Media Reasons For Most Effective Programs Health Ed. Services Health Ed.
Management Support 19.7 22.9 17.6
Incentives 18.0 10.7 12.6
*Economic Issues 6.8 16.4 12.6
Ease/Convenience 7.7 13. 1 9.0
Credibility 9.4 8.2 7.7
Individualized Programming 4.3 5.7 10.8
*Fun/Social 12.0 3.3 7.2
Timing Of Program 8.5 4.1 6.3
Instructor Attributes 3.4 3.3 7.7
Novelty 6.0 4.9 1.3
Success Measured By Participation 3.4 4.9 2.7
Required Attendance .8 2.5 3.6
Ease Of Administration 0.0 0.0 .9
Number of responses per category 117 122 222

 

* indicates significant difference in given non-media reason across domains at p< .05

1 l 1
Table 33

P n esofM i Reas nsfr Eff iv Pr ram b Domains

 

Positive

Preventive Preventive

 

Media Reasons For Least Effective Programs Health Ed. Services Health Ed.
Lack Of Promotion 25.3 37.5 27.2
Timing of Media 14.1 18.8 14.6
*Placement Of/Point Of Contact With Media 12.1 31.3 16.5
Content/Message Of Media 17.2 6.2 9.7
*Personal Contact 15.2 0.0 8.7
*Non-Media Factors 9.1 0.0 7.8
Quality Of Promotion 3.0 6.2 9.7
Top Management Media Contact 4.0 0.0 5.8
Number of responses per category 99 16 103

 

* indicates significant difference in given media reason across domains at p < .05

112

Table 34

 

 

Positive Preventive Preventive
Non-Media Reasons For Least Effective Programs Health Ed. Services Health Ed.

 

Readiness 24. 1 25 .0 24.8
*Timing Of Program 17.2 5.6 12.7
*Program Administration 11.0 25.0 7.0
*Conflicts 5.5 2.8 15.3
Management Support 6.9 5.6 7.6
Economic Issues 6.9 2.8 5.1
*Novelty 4.8 0.0 6.4
*Fear 4.8 11.1 3.2
Ease/Convenience 4.8 8.3 2.6
Workload 2.8 2.8 4.4
Success Measured By Participation 3.5 0.0 3.8
Incentives 2.1 2.8 3.2
Instructor Attributes 2.1 0.0 2.6
Weather 2.1 0.0 1.3
*Facilities 1 .4 8.3 0.0
Number of responses per category 145 36 157

 

* indicates significant difference in given non-media reason across domains at p < .05

CHAPTER 4
DISCUSSION

Health promotion professionals rely on communication media to advertise
programs and services. However, few empirical investigations examine how
professionals promote their programs or the reasons for program success or failure. In
general, the health promotion communication literature consists of stories or lists based
on anecdotal experiences (e. g., "If you do what I did, you will have a successful
program"). Even more elaborate communication guidelines by Rawson (1987) and
Heirich, et a1. (1989) lack empirical support. Consequently, a major contribution of this
study is the empirical investigation of health promotion professionals’ activities and the
role of communication in their promotion efforts. This investigation represents a first
step to examine the services and programs offered by health promotion practitioners and
to learn from their practices.

This study also increases understanding of how organizations evaluate the success
of programs or services. Health professionals in this study identified criteria used to
evaluate their programs and the importance of each criteria in their organizations. In the
age of managed health care and capitated spending, professionals can no longer afford
the luxury of continuing ineffective promotion practices and may tailor programs to
insure success or be more selective in program offerings. Another contribution is the
examination of differences in health promotion practitioners’ criteria for success and
media use by the emphasis of their programs. As such, this study reports a test of

Downie, et al.’s (1990) program distinctions and the use of communication in health

113

114

promotion within these domains. In addition, this study reports differences in program
criteria and media use by practitioners’ industry affiliation.

This study also contributes to the health promotion and communication fields by
examining both media and non-media factors in program success. In other words, this
study acknowledges that both media factors (e. g. , where the publicity is placed) and non-
media factors (e.g. , the novelty of the program; weather) contribute to program successes
and debacles. By acknowledging the role of communication and non-communication
factors, professionals may avoid short-circuiting their efforts by excelling in the
promotion of their programs only to see the program fair poorly in their superiors’ eyes
due to non-communication factors or vice versa.

In discussing the results of this investigation, three major themes are addressed
to help organize those results into a more meaningful format: (a) the programs offered
by health promotion professionals and the criteria for judging program success; (b)
important characteristics of media and their use by health promotion professionals; and
(c) the role of media and non-media factors in effective and ineffective programs.
Theme 1: What Health Promotion Professionals Do And The Criteria For

Determining Their Success

A variety of health promotion programs occur across workplace settings.
Respondents classify themselves as primarily focusing on Positive Health Edgeetien
(49.7%), Preventive Services (13.6%), and Preventive Health Education (21.5%) health
promotion domains. While educational and screening programs are the primary focus
of three-fourths of the professionals in this study, these proportions are representative of

the sample and do not suggest that Downie and colleagues (1990) err regarding the

115

existence of other domains. There is a great likelihood that only a small proportion of
health professionals situated in organizations work on health-related legislation or lobby
legislators. Rather, Downie et al. ’8 model demonstrates the inter-relatedness of observed
health promotion activities, a supposition borne out in the discussion below.

The majority of promotion professionals in this study offer programs and services
to address risk factors for the lifestyle diseases (i.e., heart disease, cancer, stroke, some
of whose risk factors include hypertension, obesity, high cholesterol, stress, smoking,
and physical inactivity). They also offer screening programs to educate employees about
the origin of disease processes within their bodies (mammography, hypertension,
cholesterol) and various safety programs to teach employees healthy on-the-job practices
(back safety, proper lifting techniques). Focussing only on whether any of 62 programs
are offered, results reveal numerous non-significant differences in program use across
the three most represented domains. The lack of differences suggest that professionals
across these domains offer similar health promotion programs and that professionals in
this study cover an array of needs despite their primary specialties.

In judging program effectiveness, organizations employ four primary criteria: (a)
Health Behavior Change; (b) Attendance; (c) Qng Term Health-Cost Improvement; and
(d) Menggement Fevers It. It is not surprising that health promotion professionals
believe Health Behevier Change is primary to evaluating program effectiveness. The top
three causes of premature death in our society are classified as lifestyle diseases (Edlin
& Golanty, 1985), implying that employees must change their health-related behaviors
related to smoking, control of cholesterol and blood pressure, and physical inactivity to

improve their health. Without attendance at programs, health promotion programming

116
has little opportunity to create behevier ehange. While "getting a crowd" seems

superficial, it is necessary to influence health behaviors and ultimately improve
cost/benefit ratios. Lifestyle behevier ehange is difficult to achieve. Consequently,
attendance provides (a) managers with a substitute measure for evaluating the effective
expenditure of money and (b) health promotion professionals with a measure of political
(albeit popular) support among the rank-and-file of their organizations.

Atteedaeee is a more important criterion for health promotion program success
for trade and manufacturing organizations than in process technology industries. Reasons
for these differences include a greater number of programs required by law and a more
visible link between full attendance and productivity in trade and manufacturing than in
process technology industries. Additionally, atten_dagee is a more important criterion in
Besig've Halth Edugtion and Peeventive Servigs than in Preventive Heelth Edggtjen
domains. Preventive Hglth Educatien are interventional programs (e. g., weight loss,
smoking cessation, cardiac rehab) and target specific individuals for specific, identified
health problems. These targeted programs use appointments and are not as dependant
on large numbers of employees for their success as Positive Health Edugg'en (e. g.,
aerobic dance for everyone, a general informational program on nutrition) and Preventive

Services (e. g., a blood pressure or cholesterol screening for everyone) programs.

 

Long Term Hglth-Cost Improvement is "the" renowned cost/benefit ratio,

depicting benefits to the company in reduced expenditures in insurance and lost hours of
work. No matter how wonderful the purported benefits of any program, eventually there
will be a reckoning with the bottom line. Correspondingly, M m n v r I

provides the administrative "buy-in" for health promotion programs which insures

117

program and budget survival. Managers understand cost/benefit results. However, it
is not uncommon for management to support programming that does not produce change
or improved bottom lines because an executive or his/ her family member has experienced
a particular health problem (e. g., heart attack) and simply wants the program.

These criteria for judging the work of health promotion professionals suggest a
number of practical guidelines for program development. First, since Health Behavier
nge is the most important criterion for judging program effectiveness, health
promotion professionals may want to routinely document initially observed behaviors of
clients in order to show changes in employee health behavior. Professionals may also
document the plan of action (i.e. , what will be done and how it will be done) facilitating
clients’ behavioral changes to substantiate the success or failure of the process. Second,
professionals may maintain Mam records for programs and regularly report
attendance to administrators and supervisors in order to demonstrate the number of
employees being impacted by the programs. Thus, it is not surprising for health
promotion articles to promote friendly competition in attendance between sections or
teams (Heirich, et al., 1989). Third, it is important for professionals to stay up-to-date
with methods of measuring 14mg Term Heath-Cost Imprevement. Changes in
cost/benefit computations may have a considerable impact on the health-cost outcomes
predicted by professionals. Fourth, top management should! be updated on the progress
of health promotion programs and involved in planning and idea sessions. As the
Mmgement Favors It criterion suggests, health promotion programs can operate in a

supportive atmosphere. By regularly informing key individuals of the progress of their

118

favored programs, health professionals may be able to broaden the basis of their political
support within the organization.
Theme 2: Important Media And Their Characteristics

A major finding of this study indicates that the 10 most frequently used media in
professionals’ "most" and "least" effective programs differ in the quantity or frequency

of use. For instance, professionals report using ene-en-one (face to face), werd-ef-

 

mouth, one-on- rou (in person), and announcement at meeting to a greater extent in
their successful than in their unsuccessful programs. The use of these media, which
involve personal contact, suggest that program success is largely dependent (a) on
personal relationships and the capacity of interpersonal information exchanges to
communicate promotion messages effectively or (b) on the use of media capable of
handling the highest levels of information richness (Sitkin et al., 1992).

Other media used over half the time in promoting programs named by
professionals are newsletters, bulletin boards, M, m, in-house publigtions, and
ein_ai_l. For purposes of this discussion, these could be labeled Print Media and face-to-
face interactions could be labeled Personal Contact Media. The use of these media
require respondents to read printed messages which convey less information richness.
In general, Print Media are less effective in gaining receivers’ attention compared to
Personal Contact Media (Daft & Lengel, 1984).

According to health professionals, mm is the most important media
characteristic followed by d_e_t_e.i_l, m, g9_v_e1_ty, and intemetive. According to Steinfield
and Fulk (1986), media must be able to convey messages to many people in a short

amount of time. This urgeney can enable organizations to deliver messages quickly and

119

respond to employees’ needs, thus motivating employees to attend. In addition, it is
important to professionals that a particular medium deliver sufficient mil (who, what,
where, when, why, how) about the event in a comprehensible manner. Media must also
be affordable (i.e., met), or it will be used sparingly. Of comparatively less importance
to health professionals is the HM! of the media. While promoting messages through
non-routine means increases message recall (Morley & Walker, 1987), the myelty of the
promotion media may be less of a priority due to the cost of the media, the
inconvenience that a different media may represent, or the belief in the efficacy of the
previously used media. Finally, the intetacgve nature of the media is reported to be the
least important media characteristic. Paradoxically, Personal Contact Media offer
interaction between message senders and receivers. Some interactive media, such as
face-to-face interaction, require considerable time and effort of professionals. Other
interactive attempts, such as a message on a poster saying, "For more information call
..." are easily presented but probably ineffective.

In addition, titgm is a more important media characteristic in manufacturing
and service than in trade (sales) industries. The importance of my in manufacturing
industries may be due to a desire by management to get messages to employees quickly
and appear responsive to employee needs. In turn, professionals in service industries
may seek to alert a large number of employees quickly and maximize their attention to
the message lest they be distracted by other concerns and forget the message. In
contrast, professionals in trade industries may have less need to alert a maximum number

of employees at one time as their employees may not be geographically concentrated.

120

There are a number of ways that health professionals can apply the findings of
this study regarding frequently used media in successful programs and preferred media
characteristics in general. First, it seems imperative for professionals to maximize
Personal Contact Media. With their greater ability to carry "multiple cues and enable
rapid feedback" (Daft & Lengel, 1984, p. 200), they are powerful conduits for
communicating with employees. The use of Personal Contact Media seems particularly
well suited for conveying messages in a quick (i.e. , Lrgertcy) and d_etail oriented fashion.
Thus, 21W may be especially relevant if professionals work in manufacturing
or service industries. Second, it is important to recognize that while Personal Contact
Media were used more than 50% of the time for "most" effective programs, so were
Print Media. The key difference in media use between "most" and "least" effective
programs is the greater frequency of use of a_l_l media in the most effective programs.
Theme 3: The Contribution Of Media And Non-Media Factors To Successful

And Unsuccessful Programs

Health promotion professionals’ reports of media and non-media factors
contributions to the success or failure of their programs provide unique insights into the
promotion process. In response to questions about media reasons for program
effectiveness in the prior 12 months, professionals report that Personal Centact and Lg
Qf Smeifie Media are the primary media reasons for program success. As previously
discussed, a greater frequency in the use of The Persenel Conmt Media (ene-en-ene,
word-of-mouth, one-on-group, and announcement at meeting) are significantly related to
effective programs. It is important to note that respondents’ identification of specific

media included voice mail messages, "Dog and Pony Shows," telephone confirmation

121

system, fliers, and announcement on PA system. Professionals did not detail why a
particular medium contributed to success. However, it is reasonable to theorize that
these examples matched the media environment of their organization.

Management Supmrt is identified as the most important non-media reason for
program effectiveness and reinforces the importance of Management Favors It as a
criterion for judging a program’s success. Others (Heirich, et al., 1989) suggest that
administrative support is a key element in health promotion program success. Practically
speaking, if management does not see the value of a program, the program is unlikely
to be prevalent within that company unless it is mandated by law.

In turn, professionals list Lack Of Premotien as the single most important media
reason for program ineffectiveness (as reported from open-ended responses). In
hindsight, professionals are always likely to see what they could have done to promote
a program. Yet, it would be of interest for future research to explore their reasons for
not creating a greater quantity of promotion for a particular program.

Regarding non-media reasons for program failure, the lack of participant
Readiness dominates professionals’ answers. Similar to the concept of "readiness" in
self-directed learning and adult education (Guglielmino, Guglielmino, & Long, 1987),
individuals best learn when they are prepared to receive what is being taught.
DiClemente and Prochaska (1982) identify several reasons for individual’s lack of
readiness to change, including (a) never considered change and need information, (b)
considered change but not yet committed, (c) desire change but need motivation, and (d)
attempting change but need structure, support, and skills. Assessing the readiness levels

in individuals may be essential for creating effective programs. For instance, smoking

122

cessation is the most often mentioned "least effective" program (15.8%). Interventional
programs (e. g. , smoking cessation, heart risk management) will never be as effective as
desired if participants aren’t interested.

In sum, health professionals provide clear distinctions in the use of media (both
frequency and specific types) and non-media factors for effective and ineffective
programs. While the results of this study generally support anecdotal claims of Rawson
(1987) and Heirich, et al. (1989), there are notable differences. First, while Rawson
recognizes the importance of employee readiness (see Table 35), Rawson emphasizes the
use of print media (as opposed to The Per on Con Medi to promote programs.
Heirich, et al.’s steps for effective worksite communication of health information note
the role of both interpersonal influence (e. g. , ene-on-one, group presentation) and print
media. They also acknowledge the importance of mmegement supmg and the use of
novel media. However, Heirich, et al. (1989) omit more important criteria for judging
program success and other helpful media characteristics such as etge_ney and SIM.
Consequently, the results of this study clarify potentially erroneous recommendations and
provide guidelines for the use of media in promoting health promotion programs.
Limitations

There are a number of limitations to this study. The sample size for this study
(n = 212) was sufficient to measure large statistical effects (p= .01). However, the size
of the sample limited the ability of statistical analyses to detect small effects. Although

the literature suggests potential differences in program use across domains and industries,

Table 35

123

Qemparison of Results with Rawson (1987) and Heig'ch. et al. (1289)

 

Rawson

Heirich, et al.

Results of this Study

 

Criteria for judging
program effectiveness

Relation of media use
to program outcomes

Important media
characteristics

Important media &
non-media reasons
for program
success/failure

none

use print media,
newsletters, bulletin
boards indiscriminately

O
C
(A
0-0

11181182611161“ SUQQIT

emphasizes print
media, developing one-
on-one “outreach“, and
making presentations
to groups

emphasizes povelty

emphasizes firsonal
contact and

management supmrt

health behavior
change, attendance

long term health-cost

im rovement
management favors it

 

media emphasizing
personal contact used
frequently in successful
programs, print media
used most often in
unsuccessful programs

urgency, detail, cost,
novelty, and interactive
of media

program SUCCCSSZ

personal contact,
spgific media, and
W.
program failure: leek

of promotion and l_a_c_k_
mm

 

124

few were found. Thus, this study would be improved by a larger sample of the members
of the AWHP, the professional organization providing the sample. Relatedly, there was
considerable imbalance in the sample toward Positive Health Education, Preventive
m, and Preventive Health Educatien. It is unclear if this imbalance represents the
distribution of professionals across the health promotion profession. Thus, the ability to
adequately test for differences across domains could have been limited by the distribution
within the AWHP.

The survey also restricted the number of potential criteria considered in
determining program effectiveness and media characteristics. Although these criteria and
media characteristics derived from popular writings and academic literature, it is possible
that other criteria may exist. Further, the use of the various media were measured by
a "yes" or "no" response format. While this format was helpful in determining the
variety of health promotion offerings, this format was not sensitive to the frequency of
specific media use or the sequence of media use in promoting programs. In addition, the
survey did not directly ask participants why a particular program was effective or
ineffective. Such information might have provided valuable insight beyond the media
and non-media reasons for effectiveness and ineffectiveness.

Future Research Questions

This study suggests a number of directions for future research. First, researchers
should endeavor to measure the frequency with which professionals’ offer specific health
programs and the frequency of specific media use. Such information would be helpful

in (a) determining which factors are important to the effectiveness of programs and

125

media, (b) evaluating the efficiency of media use by professionals, and (c) advising those
with less successful programs.

Second, this study identified the lack of promotion as the most important media
reason for program ineffectiveness. Since this is not an uncommon occurrence in the
field of health promotion, researchers should seek to answer several questions, including
(a) "Why was there a lack of promotion?" and (b) "How much promotion is enough?"
Knowing when, "enough is enough" would allow health promotion professionals to be
more focussed in their application of media, as well as more financially responsible in
reducing waste and redundancy in using media, both Personal Contact and Print. It is
also possible that "threshold" levels exist. Once professionals have exerted a certain
level of effort in their promotional efforts (e. g., number of flyers; number of one-to-
group presentations), professionals may perceive little to be gained by additional
promotions. Consequently, information on professionals’ prior promotional efforts would
be helpful in conserving the expenditures for health promotion projects. Researchers
may need to consider professionals’ fatigue on a project, the potential depletion of their
budget, and the perception of potential return from additional promotional effort.

Third, the concept of rminess needs refinement to be more applicable to the field
of health promotion. Naturally, each employee comes with his or her own unique
readiness level for learning the various ideas and skills that health promotion
professionals hope to teach. Future research should seek to clarify what professionals
meant by "readiness" as well as to link communication promotion strategies to specific
readiness problems. For example, are there certain types of media that are more

effective when used with employees of a higher readiness level than for those at a lower

126

level? Is it possible to apply existing tools for measuring readiness such as the Self-
Directed Learning Readiness Scale (SDLRS) (Guglielmino, 1977) in the field of health
promotion? Additionally, some of the self-directed learning readiness factors reported
by Brockett (1985), including creativity, self-concept, involvement in learning projects,
health-promoting behavior, and motivational orientation, should be tested to learn if they
have direct application to health promotion.

Fourth, it is interesting to note that not as many respondents were willing to
disclose information on their least effective programs as were willing to share their most
effective programs. Some respondents even emphasized in writing that they had no
"least effective" programs. It is unclear whether subjects interpreted the request to name
an unsuccessful program as a request to publicly admit a failure or if their programs
were equally effective. Future research should explore professionals’ understanding of
"effective" and "ineffective" programs to understand health professionals’ evaluations of
programs.

Epilogue

In conclusion, Downie et al. (1990) present a model of health promotion that
unifies distinct activities by identifying the inter-relatedness of health activities. It is of
interest to note that the three most represented areas of the model in this investigation,
Pesitive Health Education, Preventive Services. and Preventive Heeith Educatien, are
highly interconnected. This interconnection suggests that many specialties have reason
to work together in a coordinated fashion in offering a wide range of programs and
services to meet the needs of patients. While many individuals seek health care only

when they are ill, the health promotion model strives to educate patients to take greater

127

responsibility for their health and well-being. Health promotion facilitates coordinated
health care by (a) emphasizing the gains of joint efforts on potential or current medical
problems, (b) identifying areas of common interest, and (c) specifying the roles of
medical and health education professionals. It is hoped that the delivery of the programs
and services will be enhanced by the improved application of media and non-media

resources in health promotion.

 

APPENDICES

APPENDIX A

SURVEY INSTRUNIENT

128

Appendix A page 1

Survey Instrument

Health Promotion: Program Effectiveness & Media Use

This is a survey that examines your involvement and activities in promoting health within
the business or industrial setting. While much has been written on how to do health promotion,
not much has been done to actually study what is being done by individuals such as yourself.
This study seeks to fill an important gap in our scientific understanding of what health promotion
professionals like you do. It will also look at the effectiveness of health promotion programs
as perceived by health promotion professionals. Additionally, the study examines the role that
various media play in helping to achieve program effectiveness.

This survey is part of a doctoral research study from the department of Physical Education
and Exercise Science at Michigan State University, and cooperation in collection and
dissemination of research information is supported by the Association for Worksite Health
Promotion (AWHP).

Please Respond To The Followmg Checklist BEFORE Starting The Survey

D. B Your health promotion and/or Safety program directs servrces to your
‘ . organization’s employees.‘

D _ ' 1.7 You help make decisions about the types of media (print, broadcast, face-to-

: . 5. face, etc.) to be used in conducting and promoting health programs

D i A; D "; At least 50% of your work time is devoted to or spent 011 health promotion
‘ , and/or safety programs . . v »

.07 i: If YOU answered "NO" to any of these descriptions thank you for your
.time, but please pass this Survey to Someone else' In your company
*Who can answer all of the questions "YES". ' ' .. . . . . . .

i If you answered all Of these descriptions " YES" please continue and
. :cOmplete the entire surVey. THANK YOU. ~ , . V

The survey should take approximately 20 minutes to complete. You indicate your voluntary
agreement to participate by completing and returning this questionnaire. A self-addressed
stamped envelope is enclosed for your convenience. Thank You.

If you would like a summary report of this study when it is complete, please mark the
appropriate box at the end of the survey.

Gary L. Flegal
Michigan State University

129

96902

HEALTH PROMOTION SURVEY

Thank you for participating in this investigation. As indicated in the cover letter, this survey examines factors
related to health promotion and communication within organizations. Please answer the questions in the survey
as frankly as possible. Your employer will not have access to how you answered any particular question.

Section I of this survey asks you to identify the various health promotion programs that are present within your
organization.

 

The following are examples of health promotion programs

as defined in this survey. (see also page 3)

 

Examples:

1 5. health promotion programs. Teaching and enforcing safety promotes health by
helping to reduce accrdents therefor resulting in fewer 1nj uries and a higher level of health. If the program
in your place of business 15 called a ”safety program," it is considered health promotion for the purposes

of this survey.

 

 

______ . ‘__g . '3 A service that either identifies or monitors an
employee s health status (e g blood pressure cholesterol mammography, posture in a workstation) and
allows for corrective achon (the promotion of health) to take place if necessary.

   

 

3 Employee 7“""stauce Pro"j_"f1’_ (BAP) ARE tit motion programs Counseling services or programs
may be provided either" in- house" or from an Outside agency.

 

 

5 Smoking cessation programs ARE health pri’ffifigrarns They must include a structured plan whereby
participants meet with a counselor or health educator, in either a one-on-one or group setting, to receive
instruction on changing behaviors or correct usage of the nicotine patch. A poster or pamphlet on quitting
smoking, offered by itself, with no other related programming in place is my a health promorion program

for the purposes of this study.

   

~ .. . _ . w , when they support or
are in: addition to emtmg servrces or programs for the purposes of: this survey A poster or pamphlet on
a health- related issue, oflered by itself, with no Other related programming in place is not a health
promotion program for purposes of this study.

 

Please refer to these examples when completing the rest of this survey.

130

110903

Section | Based on the examples from the previous page, please check U the health promotion
programs that your company sponsors for employees:

Activities

D nutrition counseling

D weight control program

D Employee Assistance Program (EAP)
D family counseling

D personal counseling

D planned safety meetings

D smoking cessation program

D hypertension modification program

D serum lipid (cholesterol) modification
program

D counseling & referral for substance
abuse

Cl health risk appraisal (questionnaire)

D stress management (learning relaxation
& other practical techniques)

Dar work fitness center (company
owned)

D off site fitness center (owned or
contracted)

D aerobic dance (for everyone)

D aerobic dance (specifically for weight
loss)

D other aerobic exercise programs
(treadmill, bike, stairclimber,
NordicTrack“, walking, etc.)

D circuit training (weight machines)
D swimming instruction

D cardiac rehabilitation

D recreational skills

Dself-help groups (Alcoholics
Anonymous, etc.)

D Other activities

 

 

 

ClasSes (non-exercise activities) .
D safety training
El back safety
- proper lifting techniques
how to start an exercise program
D HIV/AIDS mromntion .
D women s health issues
D how to prevent heart disease
D second hand smoke and your health
D basic nutrition
El nutntionni rabbi readmg
D plannmg for retirement
D heart healthy cooking class
D cancer education (general)
D breast cancer education:
D breast Self-examination 7 ,
D testicular self-examinauon
D colo-rectal cancer education I
I audio—pulmonary resuscitation (CPR)
- stress management '

0 exercise education (general information
‘ or theory, not: activity class/program)

D self-esteem _
Ddeath education
D life-saying (swimming)
Cl first aid ‘ 5 .
E1011... 1.....- “

Printed Offerings
Cl health-related brochures
D health-related newsletter

D wellness library for ew1oyees (books,
‘ brochures, films/videos)

‘- of.

Screenings
[3 skin cancer screening
D mammography

D colo-rectal screening (hemoccult or
ColoCARE)

D lung cancer screening (chest X-ray)

D prostate cancer scrwmn' g

D cervical cancer screenm' g

D immunization

D aerobic capacity testm' g (maxrm' um
stress headmill test with electro-
cardiogram)

D aerobic capacity testm' g(sub-manm' um

stationary bicycle ergometer test
without electrocardiogram)

D body composition (96 body fat) testing
Cl flexibility testing
D muscular strength & endurance testing
D vision screening
D glaucoma screening
D low back clinic/screening
D scoliosis screening
D hypertension (high blood pressure)
screening
Cl cholesterol screening
0 o 0
Others
D Please list all other health promotion

programs that you sponsor for your
employees:

 

 

 

 

 

 

131

page 4

Section II This section asks you to rate the following criteria as they are valued in determining
program effectiveness in your organization. Please use the following scale to rate the degree
of importance each criterion has for your organization:

moderate value in

lowest value in
__ c determining program
1__ Us determining program

effectiveness
highest value in
__ S determining program

effectiveness
effectiveness

Please rate the value of each criterion on a scale of O to 10 as it relates to your workplace
experience, not necessarily according to your personal preference.

 

"A health promotion program in my organization is viewed as being effective when . . Fill-in the
Blank
0 - 10
1. it reduces the company’s overall health care expenditures ......................
2. many people participate ..........................................
3'. it results in media coverage (radio, tv, newspaper) ..........................
4. management views the program favorably ...............................
5. participants learn new health-related skills . .. .......................... , .1 . -
6. my expectation of the number of participants is met .........................
7. it generates good publicity ............ I .............................
8. management personnel participate ....................................
9. participants incorporate new healthy behaviors into their daily routine ..............
10. it makes money ...............................................
11. there is a good feeling about the program throughout the organization ..............
12. management discusses it while recruiting new employees ......................
13. participants demonstrate behavioral changes .............................. ’ .
14. it doesn’t lose money . .‘V. ...................................... V. .
15. V it is linked to corporate savings .....................................
16. management wants it ..... .......................................
17. behavioral changes are clearly visible and measurable ........................
18. it is a profit center for the organization ................................. __
19. it brings down cost in other areas (e. g, insurance) ..........................
20. there are enough participants to justify the program’s existence .................. _
21. it pays for 1tself ..... V. . .V ......... ’ ...... ' ........................ __
22. it saves the company money overall . . ._ ................................ __
23‘. employees show support for the program by participating ...................... __

24. it makes the company look good . g ................... . ........... . .

r...

ft

NTW

F

_ _

h.

h .

s _

:1. :

:1.~

:

.. ..L . L ‘1:

..

132

”905

Section III Questions about your "Most Effective Health Promotion Program." Thinkback over the
last twelve months of health promotion programming. Select what you consider to have been

your most efibctive health promotion program during those 12 months. Efective refers to getting

1H
(I) the desired result. Write the title of the health promotion program you selected as your most
0 effective program for the previous 12 months in blank below. Our most effective program

during the last 12 months was:

 

E

 

Next, as precisely as possible, identify the target audience for this program.

Example:
for male employees."

The intended target audience for the most effective program was:

Be as specific as possible.

"PSA tests for male employees 50 years of age and older" is much more specific than "PSA tests

 

 

Means of Promotion

The following is a list of media. Check a those that you and/or your staff used to promote the program

which you identified above.

Cl Direct mail
D Memos

D One-on-one (face-to-face)
Queen—group (in person)

Announcement at a class

D Pay-check inserts

E] Newsletter
D In-house publication
Union publication

D Announcement at a meeting D Post cards College course catalog
D Videoconferencing Posters D Pamphlet
Telephone D Bumper stickers Magazine
D Yellow pages D Flyers Newspaper ads
Voice mail D Slides D Newspaper articles
D Electronic bulletin board D Audio tape recording a Union steward
E-mail D T-shirt Supervisor
Cl Television/Video CI Billboard Cl "Grapevine"
D Film D Bulletin board Cl Word-of-mouth
El Radio CI Books D Organizational hierarchy
D Personal letters D Booklets D Chart (graphic or numeric)

Reasons For Program Effectiveness

0n the lines below, please list what you consider to be the
three main m reasons that the program (which you
identified above) was effective or successful in meeting
predetermined goals. Feel free to supply any additional
informationm that will help explain your reasoning.

 

lots of media coverage. The colorful flyers were eye-
catching.

l.

 

 

0n the lines below, please list what you consider to be the
three main non-media reasons that made the program (which
you identified above) effective or successful in meeting
predetermined goals Feel free to supply any additional
information that will help explain your reasoning.

I. t Examples" The program was effective because
it was offered on company time Attendance was required.

 

 

 

 

 

 

 

 

 

 

133

96906

Section IV Questions about your “Least Effective Health Promotion Program." Once again, think
back over the last twelve months of health promotion programming. This time, select what you

Least

consider to have been your least eflective health promotion program during those 12 months.
Remember that effective refers to getting the desired result.
promotion program you selected as your least effective program for the previous 12 months in
the blank below. Our least effective program during the last 12 months was:

Write the title of the health

 

Next, as precisely as possible, identify the target audience for this program. Be as specific as possible.

Example:

“Screening mammography for women 40 or more years of age who are employees at ABC

Company" is more specific than "Mammograms for women employees."

The intended target audience for the least effective program was:

 

 

Means of Promotion

The following is a list of media. Check 2 those that you and/or your staff used to promote the program

which you identified above.
D One-on-one (face-to-face) D Direct mail
One—on-group (in person) Memos

D Announcement at a class

D Pay-check inserts

E] Newsletter
D In-house publication
D Union publication

D Announcement at a meeting D Post cards College course catalog
D Videoconferencing Posters Pamphlet
D Telephone a Bumper stickers Magazine
Yellow pages a Flyers Newspaper ads
D Voice mail D Slides D Newspaper articles
Electronic bulletin board [I Audio tape recording Union steward
E-mail D T-shirt Cl Supervisor
D Television/video Cl Billboard Cl "Grapevine"
Film Cl Bulletin board Cl Word-of-mouth
Cl Radio Books Cl Organizational hierarchy
D Personal letters D Booklets D Chart (graphic or numeric)

Reasons For Program Non-Effectiveness

0n the lines below, please list what you consider to be the
three main media reasons that the program (which you
identified above) was not effective or successful in meeting
predetermined goals. Feel free to supply any additional
information that will help explain your reasoning.

 

 

it received little media coverage. The flyers were ugly.

l.

 

 

 

 

 

 

0n the lines below, please list what you consider to be the
three main non-Mia reasons that made the program (which
you identified above) not effective or not successful in
meeting predetermined goals. Feel free to supply any
additional information that will help explain your reasoning.
flonefiledaa Examples: The program was not effective
because it conflicted with school programs. Attendance atthe
program was required.

1.

 

 

 

 

 

 

134

98907

Section V This section asks you to evaluate the importance of specific media characteristics in
promoting Health Promotion Programs over the last 12 months. Please use the following

scale to rate the degree of importance in your organization:

"5
~: 3 ‘5
U > —
23 33 38

‘ a
EE 5? ht
:5. =73 £8
E GE .20;
2'. E_ :e-

r__c
~—r—-
_N
We.»
“"8
___Ut
—-a«
—\1

_co
—-\0
——3

Please rate the importance of each of the following media characteristics as you decide how to
publicize health promotion programs in your organization.

10.
11.
12.

13.
I4;
15.

Fill-in the

. The expense of preparing materials (flyers, posters, advertisement) ......... ..i .......
. The ability to get quick feedback from potential participants ......................
. The ability to convey detailed information ................................ ».

. The use of a promotional medium that had not been used recently ..................
. The ability to get information to potential participants quickly .....................
. The ability of the medium to tailor the message to each individual ..................

. The ability of the medium to grab employees’ attention .............. y ......... ‘ ...
. The cost of delivering the materials/information to potential clients . . . . . . . ._ ..........

. Particular medium’s ability todeliver detailed information .......................

The medium’s ability to reach many people in the shortest amount of time .............
The speed with which the medium can deliver a message to the target audience ..........

The medium presents the message in a novel manner ..........................

How much money had been spent on promoting other‘health promotion programs ....... g. .
The medium has suffiCient capacity to giveemployees all the information they need . t ......

The medium provides employees with the opportunity to ask questions ................

Blank
0- 10

135

90908

Please fill in the blanks, check a box a or circle numbers to indicate your answer to each question. Please answer all
questions. Even if you are unsure of the exact answer, please give your best answer.

 

Section VI
Background information.

0

P-

f!

M

5'

r‘r'

D Yes, I would like a summary of the results of this study. Mail it to: Name

Address

. Number of years company has had Health Promotion Program

Age: — (years) b. Sex: B Female El Male

. Job Title:

 

Highest Education Level Completed: D High-School D Associate’s D Bachelor‘s D Master’s Cl Doctorate

. Primary type of organization (check one):

Cl agriculture D construction D wholesale trade D real estate
Cl forestry D manufacturing D retail trade El service
D fishing D transportation D finance D public administration
D mining C] public utilities D insurance D other
. Approximate number of employees within your entire g. Approximate Annual Health Promotion Budget:
organization (check one): D less than $1000 00
Cl 10° “less Cl $1000.00 to $5000.00
D 101 ‘° 500 El $5001.00 to $10,000.00
t .

50’ ° 100° Cl $10,001 to $25,000.00

C! 1001 to 5000

El $25,001 to $50,000.00

5001“ 10’0“) Cl $50,001 to $100,000.00

D over 10’000 D over $100,000.00

. Number of years you have been employed by this organization: (please round to nearest whole year)
Type of department (check one):
D finance D sales D marketing D support
D production D research &development D personnel D other

Approximate number of employees within your department (including you):

 

Rank your status in your organization by circling the number I. How long have you been in your current position?

corresponding to you‘ rank: Cl 6 months or less

7 highest
6 Cl 7 months to less than 2 years
5 Cl 2 - 5 years
' g D .6 to 10 years
2 D ‘11 to 15 years
1 lowest . D 16 + years

.Please Prinr

 

 

City State___ Zip

136
Types of Health Promotion Activity

Instructions: First, please carefully read all of each of the descriptions below. Then, check the boxes next

El

CI

to the ones that accurately describe how you spend most of your professional health promotion-
related time.

Pom' 've Health Education is intended to provide general health information, instruction, or a general activity to a non-
speafic/general population (e.g., everybody who works here). This could include basic health information classes,
general aerobic dance, and other activity based classes for general populations.

 

Preventive Services intended to prevent disease or illness from developing or continuing to spread (e.g., screenings,
immunizations, surgery). A cholesterol or blood pressure screening can help prevent heart disease by identifying or
recognizing early symptoms, or a surgery can help prevent a condition from getting worse than it already is.

 

Eesmge Ml; Protection is a legal or legislative activity that creates laws or policies whose purpose is to protect the
health of those under the jurisdiction of the law or policy.

 

Preventive Health Education is interventional activities intended to prevent identified, specific health problems from
getting worse in specific populations or clients. A general health education program may lead people to realize the nwd
for a more specific program. Or a client may be directed to participate in a specific program for a specific problem as
a result of a preventive service (e.g., cardiac rehab following heart surgery). The key is directing an educational service
at a specific problem (e.g., weight loss, smoking cessation, alcohol abuse, cardiac rehab, control of blood pressure or
cholesterol) to help people related to the problem (both the affected individual and family/friends), and not simply those
who want general information. Most of these programs tend to be interventional activities. An aerobic dance class could
fit here, if it is part of a specific intervention for an individual.

Preventive Health Protection activities intended to enforce health-related laws and/or regulations for industry or the
public for the purpose of preventing the development of health problems from exposure to workplace or environmental
hazards. This could include inspections, review of records, interviews, measuring levels of compliance against standards
for exposure to environmental or workplace toxins or radiation, leading to certification of compliance or a citation for
not maintaining approved standards. To require the wearing of protective clothing or monitoring of levels of exposure
to toxins or radiation, or to enforce the availability of a worker's right to know information all fit in this category.

 

Health Education Aimed A4 PM ‘ve Hglth Protgion is education intended to target those who would or could
be impacted by some area of health legislation or regulation, either pending or existing. The purpose of this education
is to raise awareness of how the intended legal changes will impact people’s lives and to gain support for the legal
changes. A call to action in a general sense might be to contact your representative, to tell a friend or coworker, to sign
a petition, or to vote for or against a change that will impact those in the targeted group. A call to action in a specific
setting might be to inform and/or remind employees about certain actions that they must perform to protect themselves
in the work environment (e.g., correct lifting technique, always following safety procedures specific to their workplace).

 

 

 

 

Health Education F_or Preventive Health Proteg’on is intended to target those who make health-related laws and
policies. The purpose of this domain is to educate or influence legislators, making them aware of the need to protect
the public by either creating new laws, or revising old laws. A specific area under the creation of new laws is legislation
that promotes a more satisfactory social structure for encouraging people to make healthful choices, sometimes even in
spite of themselves (e. g., passive seatbelt restraints, no smoking policies in public buildings). Part of the intention is to
influence legislators and policy makers to assume responsibility for the health of those they represent. Lobbying in all
its forms is a prime activity in this domain.

Please read all seven of the descriptions before completing this page. Thank you.

137
Dear Health Promotion Professional (Letter was personalized with name),

My name is Gary Flegal. I am a doctoral student at Michigan State University
working to complete my degree while being employed by a hospital in Tennessee. Please
take a few minutes to look through these materials.

Enclosed is a survey that examines your involvement in the field of health
promotion. Many books have been written on how to do health promotion, but not much
has been done to scientifically study what health promotion professionals such as yourself
actually do. This study seeks to fill an important gap in our scientific understanding of
what health promotion professionals like you do. It will also look at the effectiveness
of health promotion programs as perceived by health promotion professionals, as well
as the role of media in health promotion program effectiveness.

This survey is part of a doctoral research study from the department of Physical
Education and Exercise Science at Michigan State University, and cooperation in
collection and dissemination of research information is supported by the Association for
Worksite Health Promotion (AWHP). Filling out the survey should take approximately
20 minutes. Participation is completely voluntary. Your individual responses will be
strictly confidential. No one will be able to identify your responses. You indicate your
voluntary agreement to participate by completing and returning this questionnaire.

If you have any questions about the survey or the study, please call any of those
listed below.

Thank you.

Gary L. Flegal

Michigan State University
Vernon D. Miller, Ph.D. Kevin Hacke
Michigan State University Executive Director
College of Communication Arts and Association for Worksite Health

Sciences Promotion
Department of Communication 60 Revere Drive, Suite 500
East Lansing, MI 48824-1212 Northbrook, IL 60062
PH: (517) 355-3280 PH: (708) 480-9574
Gary Flegal

Baptist Center For Health & Wellness
2000 Church Street

Nashville, TN 37236

PH: (615) 329-5433

APPENDIX B

SELECTED DIMENSIONS FOR DETERMINING THE EFFECTIVENESS OF
HEALTH PROMOTION PROGRAMS

138

Appendix B
Selected Dimensions For Determining Effectiveness Of Health Promotion Programs

In this organization, a health promotion program is effective:

Cost/Financial

When it makes money.

When it is a profit center for the organization.
When it doesn’t lose money.

When it pays for itself.

Long Term Health-Cost Improvement

When it reduces the company’s overall health care expenditures.
When programs are linked to corporate savings.

When it brings down cost in other areas (e. g., insurance).
When it saves the company money overall.

Program Attendance

When the expectation of the number of participants is met.

When there are enough participants to justify the program’s existence.
When many people participate.

When employees show support for the program by participating.

Public Relations

When it results in media coverage (radio, tv, newspaper).

When there is a good feeling about the program throughout the organization.
When it is well thought of.

When it makes the company look good.

Management Favors It

When management discusses it while recruiting new employees.
When management personnel participate.

When management wants it.

When management views program favorably.

Behavior Change

When participants learn new health-related skills.

When participants demonstrate behavioral changes.

When participants incorporate new healthy behaviors into their daily routine.
When behavioral changes are clearly visible and measurable.

APPENDIX C

MEDIA CHARACTERISTICS (DMENSIONS)

 

139

Appendix C
Media Characteristics (Dimensions) '

Cost

The expense of preparing materials (flyers, posters, advertisement).

The cost of delivering the materials/information to potential clients (e.g., mail,
newspaper ad, air time).

How much money had been spent on promoting the previous health promotion program.

Interactive

Getting quick feedback from potential participants.
Tailoring each message to individuals.

Providing employees with the opportunity to ask questions.

Urgency

To impress upon potential participants how important the program is for their health.

To inform potential attenders that they must reserve their space right away.

To inform potential participants that their health may be at risk for disease, and that they
will not know it unless they attend.

Detail

Can convey a lot of detailed information.

Sufficient capacity to give employees all the information they need.
Emphasizes providing information over catching their attention.

Novelty

Use a promotional medium (e. g. , flyers, telephone calls) that had not been used recently.
Present the message in a novel manner.

Promote so as to attract employees’ attention.

Adapted from Daft and Lengel (1984); Heirich et al., (1989); Rogers (1983); and
Sitkin et al. (1992).

APPENDIX D

TYPES OF MEDIA

 

Appendix D
Types of Media ‘

Types of Media

a.

‘.<?‘€FFF’Y’5-P'PPPBi‘FT'r'F‘WTPPP‘PP‘

Face-to—face

l. one-on-one
2. one-on-group
Videoconferencing
Telephone
Voice mail
E-mail
Television/Video
Film

Radio

Personal letters
Memos

Posters

Flyers

. Slides

Audio tape recording
T-shirt

Billboard

Bulletin board
Books

Booklets

Newsletter

Pamphlet

Magazine

. Newspaper

"Grapevine"
Chart (graphic or numeric)

‘ expanded from Sitkin et a1. ( 1992)

140

APPENDIX E

HEALTH PROMOTION PROGRAM DOMAINS
A CODE BOOK

141

Appendix E
Health Promotion Program Domains ’
A Code Book

The purpose of the following coding definitions and rules is (1) to help the coder
understand the distinction between each of the seven Health Promotion Domains ’, (2)
to explain to the coder the operational definitions between the Domains, (3) to provide
the coder with examples to illustrate correct coding, and (4) to test the coders to make
certain that he/ she understands how to categorize into the proper Domains. Following
is a diagram of the seven Health Promotion Domains.

    

Health Educatlon

   
 
   

Health Protection

 

Prevention

 

Legend:
1. Positive Health Education
General instructional health activities.
2. Preventive Services
Screenings, immunizations, and surgical interventions for clients or populations.
3. Positive Health Protection
Creation of health legislation or regulatory policy.
4. Preventive Health Education
Interventions for specific, identified health problems, (i.e., Weight loss, smoking cessation,
counseling, & lEAPs).
5. Preventive Health Protection
Enforcement of legislation/regulations to prevent health problems caused by workplace
hazards, toxins, or radiation.
6. Health Education aimed at Positive Health Protection
Safety education to teach proper safety techniques, raising awareness and support for
legislation among employers and employees to combat potential health risks.
7. Health Education for Preventive Health Protection
Educating legislators and policy makers of the need for laws/policies to prevent health and
safety problems.

' adapted from Downie et al. (1990)

Appendix E continued . . . 142

Intentionality ("What is the intention or purpose of a program?" or "For whom is it
intended?") of a program or service is a major ingredient in classifying activities in one area of
health promotion as opposed to another. As the diagram illustrates (previous page), the
categories overlap, making it imperative that intentionality is understood. Without intentionality,
some programs could fit in several categories. For the purposes of this study, intentionality and

type of program will be used to classify health promotion activities into only one domain.

Domain 1. Positive Health Education. General instructional health activities.
Key Thought
Positive Hath flecetion is intended to provide general health information, instruction, or a

general activity to a non-specific/general population (e.g., everybody who works here). This
could include basic health classes, general aerobic dance, and other activity based classes for

general populations.

Intentionality

0 This program is for the general public . . .

0 This program is for everybody . . .

0 To give everyone a basic understanding of . . .
0 It is for whoever shows up . . .

0 Information that every woman should know . . .

Example
An aerobic dance class

offered to all employees.

An exercise program to help
you drop those pounds.

A program on the health
risks related to smoking.

A smoking cessation
program.

A program on sinus
problems that is open to the
public.

A finger—stick cholesterol
screening for the general
public.

Ma
The key is "offered to all employees." This is Domain 1
because no attempt is made to be more specific as to audience.

The key is "to help you drop those pounds." This is Domain
4 because it is specified as a weight loss intervention.

No specific audience is identified. This is Domain 1.

Smoking cessation (stopping the behavior) is for those who
smoke, thus, smokers are the specific audience and this belongs
in Domain 4.

The key is "open to the public." The audience is not specific
and this is, therefore, Domain 1.

The key is the word "screening." Screenings are part of

Preventive Services for the purpose of identifying those at risk
for specific health problems. This is Domain 2.

 

Appendix E continued . . . 143

Domain 2. Preventive Services. Screenings, immunizations, and surgical interventions for
clients or populations.

Key Thought
Preventive Servicee are intended to prevent disease or illness from developing or continuing
to spread. A cholesterol or blood pressure screening can help prevent heart disease by
identifying or recognizing early symptoms, or a surgery can help prevent a condition from
getting worse than it already is.

Intentionality

0 This is a screening event for everyone (whoever shows up) . . .
0 To identify people who are at risk for . . .

0 To perform a test for . . .

0 Free immunizations for . . .

0 A health risk appraisal to identify risk for . . .

Example Gem
A maximum stress treadmill The key word is ”test." Treadmill testing is used to identify

test for a man 40 years of risk for heart disease. This is Domain 2.
age.

A blood pressure screening The key word is "screening.” Screenings are part of Preventive
offered to all employees. Services for the purpose of identifying those at risk for specific
health problems. This is Domain 2.

One—on—one counseling with The key word is "counseling." Counseling is an educational
an employee who has high intervention for someone with an identified problem or
blood pressure. condition. This is Domain 4.

Every employee is required The key word is "test.” A TB test is used to screen for
to have an annual TB test. tuberculosis. This is Domain 2.

All management personnel The key here is "physical exam." It is a series of tests or
are required to have an screening procedures performed by medical professionals. This
annual physical exam. is Domain 2.

Appendix E continued . . .

Domain 3.

Key Thought

144

Positive Health Protection. Creation of health legislation or regulatory policy.

Positive Health Pretection is a legal or legislative activity that creates laws or policies whose
purpose is to protect the health of those under the jurisdiction of the law or policy.

Intentionality

' Any activity that produces laws, policies, or regulations whose purpose is to protect the health
and well-being of those under the jurisdiction of the legislative body . . .
0 To improve/promote health in the general public by reducing risk of injury or death by legally

requiring seatbelt use . . .

0 To reduce risk of injury by legally requiring the use of safety equipment (e. g., hard hat, safety
glasses, hearing protection) . . .

0 To require that municipalities test drinking water for certain levels of toxins, and that they must
cooperate with public health officials who are required to analyze water resources (Requiring
the test is not the same as conducting the test. Conducting the test falls in Domain 5) . . .

Example
Legislators create a law

requiring employers to
disclose information to
employees about toxins in
the workplace.

A company’s administrative
committee makes a policy
that the company will be
smoke-free as of January 1.

The Fire Marshall inspects a
worksite for adherence to
the fire code.

The health and safety officer
for ABC company conducts
an inservice on how to use
Material Safety Data Sheets.

Coding
The key words are "create a law." This law makes it

mandatory for employers to make certain information available
to employees that could impact the health of employees. This
is Domain 3.

The key words are "makes a policy." This policy will mandate
the health benefits of escaping environmental tobacco smoke
(ETS), or second hand smoke, for all employees while they are
in the workplace. It is Domain 3.

Two key words are "inspects" and "adherence." They tell you
the code is being enforced, not created. Enforcement or
monitoring are activities of laws that are already in existence
and are in Domain 5.

This is an educational activity to fulfill the directive of a
guideline that is already in existence. Educational activities that
are the result of legislation or regulation are Domain 6.

Appendix E continued . . .

Domain 4.

145

Preventive Health Education. Weight loss, smoking cessation, counseling, &

EAP’s as educational interventions for clients.

Key Thought

Preventive Health flpeetien is comprised of interventional activities intended to prevent
identified, specific health problems from getting worse in specific populations or clients. A
general health education program may lead people to realize the need for a more specific
program. Or a client may be directed to participate in a specific program for a specific
problem as a result of a preventive service (e.g., cardiac rehab following heart surgery). The
key is directing an educational service at a specific problem (e.g., weight loss, smoking
cessation, alcohol abuse, cardiac rehab) to help people related to the problem (both the affected
individual and family/friends), and not simply those who want general information. Most of
these programs tend to be interventional activities. An aerobic dance class could fit here, if
it is part of a specific intervention for an individual.

Intentionality

0 A program for people with a known problem (smoking, over-weight, substance abuse, marriage
difficulties, etc.), designed to assist participants with behavior management, counseling,
medication, and other strategies that are appropriate for each individual and the problem(s)

under treatment . . .

0 If it is unknown that a person has a condition, a screening might be conducted to make that
determination. The screening is in Domain 2. If a screening identifies a person’s problem,
any educational intervention for the specific problem is in Domain 4.

0 The key for inclusion in Domain 4 is some kind of educational/counseling activity designed to
help someone with an identified problem. Identification of a problem might come from a
screening (Domain 2) or an individual might identify him/herself based upon a general health
education event (Domain 1) . . .

Example
An aerobic dance class as

part of a weight loss
program.

One-on-one counseling (for
some identified problem).

Teaching a group of
employees strategies for
lowering blood pressure.

wing
The key is "part of a weight loss program." A weight loss
program is for an identified population - people who need/want
to lose weight - this becomes part of an intervention and is in
Domain 4.

"Counseling" is the key word. Counseling is always
interventional, and is designed to help individuals with some
identified problem (e.g., depression, marital, financial,
substance abuse, etc.).

The key words are "a group of employees." This is general and

therefore domain 1. Unless it is known that this is a group of
employees with high blood pressure, it cannot be Domain 4.

Domain 4 continued . . .

 

Appendix E continued . . .

Example
Having a blood pressure

station in the company
eating area to offer free
blood pressure readings.

Having a blood pressure
screening for employees
known to have high blood
pressure.

146

cm
This is general - for everybody who wants to stop by. It is also
a screening. This is Domain 2.

This activity is intended for a specific group of employees
"known to have high blood pressure." This is Domain 4.

Appendix E continued . . . 147

Domain 5. Preventive Health Protection. Enforcement of legislation/regulations to
prevent health problems caused by workplace hazards, toxins, or
radiation.

Key Thought

Preventive Heelth Prptgtien activities are intended to enforce health-related laws and
regulations for industry or the public for the purpose of preventing the development of
health problems from exposure to workplace or environmental hazards. This could
include inspections, review of records, interviews, measuring levels of compliance
against standards for exposure to environmental or workplace toxins or radiation,
leading to certification of compliance or a citation for not maintaining approved
standards. To require the wearing of protective clothing or monitoring of levels of
exposure to toxins or radiation, or to enforce the availability of a worker’s right to
know information all fit in this category.

Intentionality

0 To enforce legislation, regulations, or policies created in Domain 3. A city
government might be required by law to analyze drinking water at regular intervals and
to comply with state officials during inspections. Creation of a law requiring such an
analysis and compliance with officials is in Domain 3. The inspection and analysis of
the public water supply under such a law is in Domain 5.

Enforcement of any health or safety related law or policy (e.g., driving under the
influence, seatbelt use, the wearing of hard hats in construction zones, the use of eye
or hearing protection in the workplace, exposure monitoring for workplace toxins or
other environmental hazards). The key activity is enforcing health- related legislation.
Measuring a toxin level is a screening event that is in Domain 2. Inspecting the
workplace to make certain that required screenings take place is in Domain 5. Key
words are enforce, inspect, investigate.

_a_p_eExml Mg

A company complies with
a federally mandated
safety inspection.

Imposing a fine upon an
employee for repeated
negligence in the use of
safety equipment.

Performing required
maintenance upon public
elevators as required by
law.

The keys are "inspection" and "mandated." This is
Domain 5.

Enforcing a safety requirement is Domain 5.

Following mandated guidelines as set forth by law and
public safety codes is Domain 5.

Appendix E continued . . .

Domain 5 continued . . .

Creating a new safety
code, following the death
of an employee, to
prevent further accidents.

148

Creating laws, policies, or codes to establish safer or
healthier conditions is Domain 3. Domain 5 is the
enforcement of laws or regulations, not the creation of
laws or regulations.

Appendix E continued . . . 149

Domain 6. Health Education aimed at Positive Health Protection. Raising
awareness and/or support for legislation among employers and employees
to combat potential health risks.

Key Thought

Hglth Education aimgg at Positive Health Promg'gn is education intended to target
those who would or could be impacted by some area of health legislation or regulation,
either pending or existing. The purpose of this education is to raise awareness of how
the intended legal changes will impact people’s lives and to gain support for the legal
changes. A call to action in a general sense might be to contact your representative,
to tell a friend or coworker, to sign a petition, or to vote for or against a change that
will impact those in the targeted group. A call to action in a specific setting might be
to inform and/or remind employees about certain actions that they must perform to
protect themselves in the work environment (e. g., correct lifting technique, always
following safety procedures specific to their workplace).

Intentionality

0 To educate employees about new legislation or policy that will affect some aspect of
work-related health or safety.

0 To educate employees about new legislation that requires disclosure of harmful material
in the work environment and how to handle it safely (Material Safety Data Sheets
(MSDS)).

0 To teach employees proper safety techniques to comply with safety regulations.

0 The key for inclusion in Domain 6 is to educate or teach employees regarding some
aspect of compliance with a health or safety-related law or policy.

Example Codi g
An annual required class The key is "required class" or "inservice." This is

(inservice) to teach and/or Domain 6.
remind employees about

blood-borne pathogens

and correct handling of

materials.

A meeting with Updating employees about new safety legislation is an
employees to discuss the educational process about mandated safety requirements.
changes that will take This is Domain 6.

place when a new piece

of safety legislation goes

into effect.

Meeting with alaw-maker Meeting with a legislator for purposes of educating or
to convince him or her of influencing him or her is lobbying. This is Domain 7.
the need for certain safety Domain 6 targets those who will live under the law.
legislation.

Appendix E continued . . . 150

Domain 7. Health Education for Preventive Health Protection. Educating
legislators and policy makers of the need for laws to prevent health
problems.

Key Thought

Health Education for Preveno've Health Protootion is intended to target those who make
health—related laws and policies. The purpose of this domain is to educate or influence
legislators, making them aware of the need to protect the public by either creating new
laws, or revising old laws. A specific area under the creation of new laws is
legislation that promotes a more satisfactory social structure for encouraging people to
make healthful choices, sometimes even in spite of themselves (e. g., passive seatbelt
restraints, no smoking policies in public buildings). Part of the intention is to influence
legislators and policy makers to assume responsibility for the health of those they
represent. Lobbying in all its forms is a prime activity in this domain.

Intentionality

0 To educate or influence law and policy makers toward a more favorable (to the public
or health promoters) outcome in the creation of health and safety legislation. Lobbying
fits here. Activities in Domain 7 are directed at law and policy makers, not at those
who will be impacted by legislation. Educating the public or employees in the
workplace about an upcoming legal change in a health policy or law is in Domain 6.
If someone is informing or teaching a group of employees how a potential law or
policy might affect the employees the activity is in Domain 6. However the Domain
6 activity might lead to a Domain 7 activity if employees are encouraged to write or
call their legislators to offer their positive or negative support for the impending

legislation.

Example
A legislative committee

holds public debates to
gather information
regarding nuclear waste
disposal.

Citizens of a small town
organize a telephone and
letter writing campaign to
their members of
congress to voice their
concerns about the new
health care reform bill.

Coding
Public debates often include moments of lobbying by those
who speak. They are intended as information gathering,
or educational sessions about programs that influence the
public. This is Domain 7.

Communicating with legislators is a form of lobbying that
is available to everyone. It is an opportunity to let those
who create laws and policies learn what some of their
constituents desire. This is Domain 7.

Appendix E continued . . .

Example
Your manager holds a

meeting to review the
implications of a new
worksite safety law.

151

Coding
This is education about an existing safety law. This is
Domain 6 because it targets those who must live under the

law.

APPENDIX F

MEDIA REASONS FOR MOST EFFECTIVE PROGRAM
SURVEY SECTION III
A CODE BOOK

152

Appendix F
MEDIA Reasons For MOST EFFECTIVE Program/Survey Section III
A Code Book

The purpose of the following coding definitions and rules is:

(l) to help the coder understand the distinction between various media reasons offered
in the open-ended responses of survey section III;

(2) provide the coder with general rules to use when coding surveys; and

(3) to provide the coder with specific rules for specific situations that may present
coding difficulties.

Basically, Media can be thought of as the methods, or technologies, used to transmit
messages. Examples of Media reasons include:

0 People talking to other people in person or through video, film, telephone, or radio
technologies, either one-on-one, one-on-group, word-of-mouth, public address (p.a.)
system announcements, "grapevine," etc.

0 Printed materials, such as the Yellow pages, personal letters, memos, posters, fliers,
pamphlets, books or booklets, magazine or newspaper articles, messages on t-shirts
(not the t-shirt itself), newsletters, post cards, billboards or bulletin boards, pay-
check inserts, bumper stickers, etc.

0 Electronic messages such as voice mail, E-mail, electronic or computer bulletin
boards, videoconferencing, audio or video tape recordings, etc.

Non-media reasons include items and issues other than those associated with how the
message is presented. These will be dealt with in another codebook.

The following are categories for media reasons for most effective programs:
Media Reasons For Most Effective Programs

Personal Contact

Top Management Media Contact

Timing Of Media

Placement Of/Point Of Contact With Media
Content/Message Of Media

Quality Of The Promotion

Multiple Media

Use Of Specific Media
Unknown/Respondent didn’t know

. Other

SPWNP‘V'PPP?‘

153

1. Personal Contact reasons are identified by references to one person spreading the
information to another person or group. Examples include:

> people liked program and told coworkers
> special invitation

pencouraged volunteers to spread the word
. presentation made at meeting

- This category represents the personal effort to get information from one person to
one or more others in a direct and individual manner.

2. Top Management Media Contact reasons are identified by references to
information coming directly from managers, supervisors, and/or administrators.
Examples include:

> letter from CEO

> media support by top management

0 (the emphasis here is the media support from management, not simply support.
Without the word "media" this would simply be a non-media example of
management support)

pnotified of event by supervisor

, verbal endorsement of senior managers

0 (again, not simply the feeling of support from management, but the obvious use
of media - verbal - to supply that support)

3. Timing Of Media reasons are identified by references to when the media were
presented to employees. Examples include:

>fliers desk dropped to all employees immediately prior to event

0 (note emphasis on timing - immediately prior)

> e-mail everyday

0 (note the reference to everyday - without the time reference this would be an
example of use of a certain type of media)

preminder postcards sent

0 (a reminder is the use of some form of media and implies the prompting of an
individual’s knowledge regarding a known event, prior to that event taking place -
it is a timing issue)

pcalled back to confirm appointments

0 (confirmation is the use of media to remind or prompt an individual’s knowledge
regarding a known event, prior to that event taking place - it is a timing issue)

154

4. Placement Of/Point Of Contact With Media reasons are identified by references
to where media are placed. Examples include:

>bulletin boards are in prominent locations

0 (the emphasis is on location - without this emphasis, this would be an example
of use of a certain type of media)

pflier sent to home address

0 (emphasis on where employees came in contact with media - without this
emphasis it would be an example of use of a certain type of media)

>flier given with paycheck

O (emphasis on where employees came in contact with flier - almost everybody
looks at paycheck and flier is right there - without this emphasis it would be
another example of use of a certain type of media)

badvertised in restroom

0 (doesn’t even tell how, emphasis is on location of media)

5. Content/Message Of Media reasons are identified by references to what was said
or how it was said. Examples include:

>fliers used humor

0 (not only was a certain type of media used, the message was fun to read - refers
to content)

> media followed central theme

0 (theme refers to focus, subject, or content)

, motivating memos

O (the format of "memo" is rarely motivating — the subject matter or content could
be)

> specific/practical material

0 (the reference of specific or practical is a content issue)

155

. Quality Of The Promotion reasons are identified by references to some attribute
that adds value or quality to the media. Examples are:

pprofessional look of resource

0 (not only was there a resource, it looked professional)

, glossy color flier

0 (not only was there a certain type of medium used - flier - but it was produced
in color AND on glossy paper - ooh!)

pposters were eye-catching

0 (not only were posters used, they were good enough to demand attention, to get
people to look at them)

battractive brochure

0 (not just a brochure, one that looked great!)

The emphasis here seems to be one of overall impression of the media upon potential
participants.

. Multiple Media reasons are identified by references to the use or utilization of more
than one use of a medium. Examples include:

, multiple avenues for communication

> used multiple media channels

, more than one flier

>fully laid out promotional campaign, posters, orientation

The obvious concern here is that more than one effort has been made to promote the
event.

. Use Of Specific Media reasons are identified by references that simply list a
particular kind or type of media. Examples include:

pfliers

0 (no qualifiers, simply a kind of media)

announcement on PA system

pvoice mail messages

> "Dog and Pony Shows"

> telephone confirmation system

0 (emphasis here seems to be not just a confirmation system, but that it be made by
telephone)

156

9. Unknown/Respondent Didn’t Know reasons are identified by comments made by

the respondent to indicate that they don’t know why the media were successful.
Examples include:

> don’t know

,7 - (respondent wrote a question mark in the blank)
> not sure

10. Other reasons are items that simply don’t fit in any other category.

157

Summary Of MEDIA Reasons For MOST EFFECTIVE Program

1.

10.

Personal Contact reasons are identified by references to one person spreading the
information to another person or group.

Top Management Media Contact reasons are identified by references to
information coming directly from managers, supervisors, and/or administrators.

Timing Of Media reasons are identified by references to when the media were
presented to employees.

Placement Of/Point Of Contact With Media reasons are identified by references
to where media are placed.

Content/Message Of Media reasons are identified by references to what was said
or how it was said.

Quality Of The Promotion reasons are identified by references to some attribute
that adds value or quality to the media.

Multiple Media reasons are identified by references to the use or utilization of more
than one use of a medium.

. Use Of Specific Media reasons are identified by references that simply list a

particular kind or type of media.

. Unknown/Respondent Didn’t Know reasons are identified by comments made by

the respondent to indicate that they don’t know why the media were successful.

Other reasons are items that simply don’t fit in any other category.

158

Coders will test themselves on the following examples:
Advertisement appeared on Sports page of paper
Used in-house TV

Receptionist told everyone who came by

159

Answers for previous page examples:

Advertisement appeared on Sports page of paper
- this is a Placement Of/Point Of Contact With Media example and
should be coded 4.

Used in-house TV
- this is a Use Of Specific Media example and should be coded 8.

Receptionist told everyone who came by
- this is a Personal Contact example and should be coded l.

APPENDIX G

NON—MEDIA REASONS FOR MOST EFFECTIVE PROGRAM
SURVEY SECTION III
A CODE BOOK

160

Appendix G
NON-MEDIA Reasons For MOST EFFECTIVE Program/Survey Section III
A Code Book

(1)

(2)
(3)

The purpose of the following coding definitions and rules is:

to help the coder understand the distinction between various non-media reasons
offered in the open-ended responses of survey section III;

provide the coder with general rules to use when coding surveys; and

to provide the coder with specific rules for specific situations that may present
coding difficulties.

Basically, Media can be thought of as the methods, or technologies, used to

transmit messages. This will be addressed in another codebook.

Non-media reasons include items and issues other than those associated with how

the message is presented. Examples of Non-media reasons include:

Cost associated with the program (economic issues), whether it is free or has a
fee

Participation/attendance

Conflict with other events and programs — people can only attend one thing at a
time

Fear - someone may not want to attend a program on skin cancer; it might mean
having to admit the possibility of getting skin cancer

Locating an event right next to the cafeteria might make it convenient for people
to participate

161

The following are categories for non-media reasons for most effective programs:

Non-Media Reasons For Most Effective Programs

1. Economic Issues

2. Ease/Convenience

3. Incentives

4. Success Measured By Participation
5. Perception Of New/Novel

6. Management Support

7. Timing Of Program

8. Instructor/Leader Attributes

9. Ease Of Administration

10. Fun/Social

ll. Individualized/Personalized Programming
12. Credibility

13. Required Attendance

l4. Unknown/Respondent didn’t know
15. Other

H

. Economic Issues are identified by references to money, cost, etc., such phrases as:

> free

>10w cost

, self-paid basis
poo-pay waived

> fee charged

r cost containment
>health benefits plan
> discounted price

> reduced price/cost
vinsurance premiums

162

2. Ease/Convenience reasons are identified by references to making the process or
service easy or convenient for employees to use. Examples include:

. user friendly regarding participant time
, simplified process

v "elementary" format

> flexible scheduling

>convenience

>accommodated everyone

veasy

3. Incentives reasons are identified by references to enticements to get people to
participate, such as prizes, give-aways, etc. Examples include:

>offer of time off

> cash award

> t-Shil't

, food, refreshments
pprogram tied to flex credits
> prizes

D raffle

4. Success Measured By Participation reasons are identified by references to increased
participation, as well as participation by those who usually don’t participate. May
also include inclusion of those outside the employee population, such as spouse,
children, or retirees. Examples include:

pemployees who usually don’t participate used this service
> high participation
> spouse involved

5. Perception Of New/Novel reasons are identified by references to newness of the

program or service, uniqueness, or variety of program or program location.
Examples include:

> 1st time offered

>perception of "special" event

> unique to company

poff-site meeting

0 (when listed as a reason for program effectiveness, the novelty of being away
from the worksite is the emphasis rather than inconvenience that might be
suggested if listed as a reason for non-effectiveness)

163

6. Management Support reasons are identified by references to positive support,
backing, or endorsement from management. Examples include:

>top management support

, simply the word "support"

phigh value by senior management

pletter from CEO

0 (emphasis is on who letter is from, not on form of media)
>on company time

0 (this is also convenient, but doesn’t happen without management support)
, good corporate culture

0 (results from management support)

, management participated

0 (demonstrated support)

7. Timing Of Program reasons are identified by references to reaching people at a
time that is appropriate, relevant, or "timely" for those people. Examples include:

> good timing

>hot topic

poffered on-site - great hours

0 (this could also be convenience, but the emphasis is on the " great hours" - timing
of the event)

> season of the year

0 (implies that some programs or services may be more successful during certain
seasons of year than at other seasons)

8. Instructor/Leader Attributes reasons are identified by references to some
characteristic or quality of the program planner/leader or instructor that lead to the
success of the program or event. Examples are:

pinstructor charisma

pprofessional instructor

> well planned

>wellness representatives are committed/dedicated
v excellent vendor

9. Ease Of Administration reasons are identified by references to circumstances or
events that made the program easy for the program leaders to organize and present.
Examples include:

>easy to administer
, very little promotion needed

164

10. Fun/Social reasons are identified by references to participants having a good time

11.

or socializing during the event or program. Examples include:

>it’s fun

ha competitive challenge

, score board

>peer support

bused humor in memos

O (memos would be a media reason, but emphasis here is on content of message,
not how the message was delivered)

plist of weekly progress

0 (suggestion of information to be topic of socializations in workplace)

>participants encouraged each other

> not intimidating

> group building

Individualized/Personalized Programming reasons are identified by references to
programs or events that are not general in nature, but have taken into account the
nwds and desires of those who will use the program or service. Something has been
done to individualize the activity or offering. Examples include:

ppersonal touch

pa translator was available

>lots of choices

psessions were personalized

breadiness of participants was measured

>employees ready for it

, multidisciplinary approach

, pre-registration was required

0 (implies ability to know who is coming and individualize program)
prequested service

>employees got to give their ideas

ppromotion theme targeted our population

>people don’t want to sweat - program not physical-activity oriented

12.

13.

14.

15.

165

Credibility reasons are identified by references to details or items that add value or
integrity to the program or service. Examples include:

> high interest of participants

pprior success of program

>3rd year offered

>demonstrated improved health results
> identified one case of breast cancer
, confidentiality

>it’s "the right thing to do"
>perceived value of program

> therapists are good sources of information
>very measurable outcomes
ppopularity of service

Required Attendance reasons are identified by references to mandatory or required
participation. While this might also reflect management support, it does not
necessarily imply that such support is voluntary. Some programming, such as
certain safety or blood-borne pathogen programs, is required by law and therefore
the reason for getting participation relies on compliance with law, not support by
management. Examples include:

> mandatory attendance on company time

0 (main emphasis is on mandatory, most mandatory programs are offered on
company time)

pparticipation required

Unknown/Respondent Didn’t Know reasons are identified by some overt comment
by the respondent that they simply don’t know, or were unable to identify any
specific reason(s) for the effectiveness of the program or service. Examples include:

b don ’t know
, unsure

Other reasons are items that simply don’t fit in any other category. Examples
include:

, weather cooperated
> beautiful corporate grounds

166

Summary Of NON-MEDIA Reasons For MOST EFFECTIVE Program

1.

2.

10.

11.

12.

Economic Issues are identified by references to money, cost, etc.

Ease/Convenience reasons are identified by references to making the process or
service easy or convenient for employees to use.

. Incentives reasons are identified by references to enticements to get people to

participate, such as prizes, give-aways, etc.

. Success Measured By Participation reasons are identified by references to increased

participation, as well as participation by those who usually don’t participate. May
also include inclusion of those outside the employee population, such as spouse,
children, or retirees.

. Perception Of New/Novel reasons are identified by references to newness of the

program or service, uniqueness, or variety of program or program location.

Management Support reasons are identified by references to positive support,
backing, or endorsement from management.

Timing Of Program reasons are identified by references to reaching people at a
time that is appropriate, relevant, or ”timely" for those people.

Instructor/Leader Attributes reasons are identified by references to some
characteristic or quality of the program planner/leader or instructor that lead to the
success of the program or event.

Ease Of Administration reasons are identified by references to circumstances or
events that made the program easy for the program leaders to organize and present.

Fun/Social reasons are identified by references to participants having a good time
or socializing during the event or program.

Individualized/Personalized Programming reasons are identified by references to
programs or events that are not general in nature, but have taken into account the
needs and desires of those who will use the program or service. Something has been
done to individualize the activity or offering.

Credibility reasons are identified by references to details or items that add value or
integrity to the program or service.

167

13. Required Attendance reasons are identified by references to mandatory or required
participation. While this might also reflect management support, it does not
necessarily imply that such support is voluntary. Some programming, such as
certain safety or blood-borne pathogen programs, is required by law and therefore
the reason for getting participation relies on compliance with law, not support by
management.

14. Unknown/Respondent Didn’t Know reasons are identified by some overt comment
by the respondent that they simply don’t know, or were unable to identify any
specific reason(s) for the effectiveness of the program or service.

15. Other reasons are items that simply don’t fit in any other category.

168

Coders will test themselves on the following examples:
Program offered on company time
We had the most people we’ve ever had

Excellent program

169

Answers for previous page examples:

Program offered on company time

- this is a Management Support example because no matter how
convenient it may be, programs do not happen on company time without
the support of administrators - this should be coded as a 6

We had the most people we’ve ever had
- this is a Success Measured By Participation example - this should be
coded as a 4

Excellent program
- this is a Credibility example as perceived excellence adds value to the
program. This should be coded as a 12.

APPENDIX H

MEDIA REASONS FOR LEAST EFFECTIVE PROGRAM
SURVEY SECTION IV
A CODE BOOK

170

Appendix H
MEDIA Reasons For LEAST EFFECTIVE Program/Survey Section IV
A Code Book

m

m
®

The purpose of the following coding definitions and rules is:

to help the coder understand the distinction between various media reasons
offered in the open-ended responses of survey section IV;

provide the coder with general rules to use when coding surveys; and

to provide the coder with specific rules for specific situations that may present
coding difficulties.

Basically, Media can be thought of as the methods, or technologies, used to

transmit messages. Examples of Media reasons include:

People talking to other people in person or through video, film, telephone, or
radio technologies, either one-on-one, one-on-group, word-of-mouth, public
address (p.a.) system announcements, "grapevine," etc.

Printed materials, such as the Yellow pages, personal letters, memos, posters,
fliers, pamphlets, books or booklets, magazine or newspaper articles, messages
on t-shirts (not the t-shirt itself), newsletters, post cards, billboards or bulletin
boards, pay—check inserts, bumper stickers, etc.

Electronic messages such as voice mail, E—mail, electronic or computer bulletin
boards, videoconferencing, audio or video tape recordings, etc.

Non-media reasons include items and issues other than those associated with how

the message is presented. These will be dealt with in another codebook.

The following are categories for media reasons for least effective programs:

Media Reasons For Least Effective Programs

Spwsewewwr

Personal Contact

Top Management Media Contact

Timing Of Media

Placement Of/Point Of Contact With Media
Content/Message Of Media

Quality Of Promotional Material
Non-Media Factors

Lack Of Promotion

Unknown/Respondent didn’t know

Other

171

. Personal Contact reasons are identified by references to one person spreading the
information to another person or group. Examples include:

plow "word-of-mouth"
>personal letters sent only once
0 (implication is that there was personal contact, but not enough)

This category represents the personal effort, or lack thereof, to get information from
one person to one or more others in a direct and individual manner.

. Top Management Media Contact reasons are identified by references to
information coming directly from managers, supervisors, and/or administrators. An
example might include:

pno direct memo from management
0 (there may or may not have been management support, but lack of overt
demonstration of support may be interpreted as low or no support)

. Timing Of Media reasons are identified by references to when the media were
presented to employees. Examples include:

b fliers sent out late

0 (fliers were sent out, but they were ineffective because of the timing)

> short notice

0 (whatever media were used were ineffective because of timing)

>not advertised soon enough

0 (there was advertising, but it wasn’t used soon enough to accommodate potential
participants)

. Placement Of/Point Of Contact With Media reasons are identified by references
to where media are placed. Examples include:

, fliers not posted - participants had to pick them up

0 (there were fliers, but the point of contact - the method which allowed potential
participants to come in contact with the fliers - was less than desirable)

pposters for elevator areas not hung

O (for whatever reason, media designated for a high traffic area didn’t get placed
and potential participants could not come in contact with the media)

172

5. Content/Message Of Media reasons are identified by references to what was said
or how it was said. Examples include:

, fliers too verbose

O (verbose refers to content)

> negative flier

O (emphasis on tone of content, not necessarily on type of media)
>not enough detail on flier

O (emphasis on content, not on type of media)

>brochure too lengthy

0 (what makes a media piece lengthy? - content!)

6. Quality Of Promotion reasons are identified by references to some attribute that
adds value or quality to the media. Examples are:

particle not flashy enough

0 (there was an article in some publication, but it apparently was not of high
enough quality to get attention)

>posters not exciting

0 (there were posters, but they were lacking in some detail of quality)

, reports are not very aesthetic to look at

0 (the word aesthetic directly addresses the concept of quality)

>printed material could have been more colorful

0 (not so much concerned with content as with the look, a degree of quality)

- The emphasis here seems to be one of overall impression, or lack thereof, of the
media upon the potential participants.

7. Non-Media Factors reasons are identified by comments made by the respondent to
indicate that they believe the media they created/used was not the issue. Examples
include:

, media was not the problem

>not a media issue - other factors involved
> media/promotion ok

>don’t feel like media was ”unsuccessful"

173

8. Lack Of Promotion reasons are identified by references to some lack or deficiency
in the methods used to promote the event/service/program. Examples include:

>inadequate - inept PR

>too little promo - not wide enough publicity
>did not use e—mail

0 (example of lack)

>poor communication

ppromotion too limited

pdidn’t make it a big enough deal

> not promoted well

- Phrases here are "not enough," "did not use," "needed more," too little,"
"inadequate," and phrases with like intention.

9. Unknown/Respondent Didn’t Know reasons are identified by comments made by

the respondent to indicate that they don’t know why the media were successful.
Examples include:

> don’t know

>? - (respondent wrote a question mark in the blank)
>not sure

10. Other reasons are items that simply don’t fit in any other category.

174

Summary Of MEDIA Reasons For LEAST EFFECTIVE Program

1.

10.

Personal Contact reasons are identified by references to one person spreading the
information to another person or group.

. Top Management Media Contact reasons are identified by references to

information coming directly from managers, supervisors, and/or administrators.

. Timing Of Media reasons are identified by references to when the media were

presented to employees.

. Placement Of/Point Of Contact With Media reasons are identified by references

to where media are placed.

. Content/Message Of Media reasons are identified by references to what was said

or how it was said.

Quality Of Promotion reasons are identified by references to some attribute that
adds value or quality to the media.

. Non-Media Factors reasons are identified by comments made by the respondent to

indicate that they believe the media they created/used was not the issue.

. Lack Of Promotion reasons are identified by references to some lack or deficiency

in the methods used to promote the event/service/program.

. Unknown/Respondent Didn’t Know reasons are identified by comments made by

the respondent to indicate that they don’t know why the media were successful.

Other reasons are items that simply don’t fit in any other category.

175

Coders will test themselves on the following examples:
Extremely poor posters
Hard to understand fliers

Article came out day of event

176

Answers for previous page examples:
Extremely poor posters
- this is a Quality Of Promotion example and should be coded 6.

Hard to understand fliers
- this is a Content/Message Of Media example and should be coded 5.

Article came out day of event
- this is a Timing Of Media example and should be coded 3.

APPENDIX I

NON-MEDIA REASONS FOR LEAST EFFECTIVE PROGRAM
SURVEY SECTION IV
A CODE BOOK

177

Appendix I
NON-MEDIA Reasons For LEAST EFFECTIVE Program/Survey Section IV
A Code Book

(1)

(2)
(3)

The purpose of the following coding definitions and rules is:

to help the coder understand the distinction between various non-media reasons
offered in the open-ended responses of survey section IV;

provide the coder with general rules to use when coding surveys; and

to provide the coder with specific rules for specific situations that may present
coding difficulties.

Basically, Media can be thought of as the methods, or technologies, used to

transmit messages. This will be dealt with in another codebook.

Non-media reasons include items and issues other than those associated with how

the message is presented. Examples of Non-media reasons include:

Cost associated with the program (economic issues), whether it is free or has a
fee

Participation/attendance

Conflict with other events and programs - people can only attend one thing at a
time

Fear - someone may not want to attend a program on skin cancer; it might mean
having to admit the possibility of getting skin cancer

Locating an event right next to the cafeteria might make it convenient for people
to participate

178

The following are categories for non-media reasons for least effective programs:

Non-Media Reasons For Least Effective Programs

1. Economic Issues

2. Ease/Convenience

3. Incentives

4. Success Measured By Participation
5. Novelty

6. Management Support

7. Timing Of Program

8. Instructor Attributes

9. Program Administration

10. Fear

ll. Conflicts

12. Readiness

l3. Workload

14. Weather
15. Facilities
16. Unknown/Respondent didn’t know
17. Other

~

. Economic Issues are identified by references to money, cost, etc., such phrases as:

pmost programs free - this had a fee

boost of offering - may have been prohibitive

pincluded a co-pay

>company paid entire cost of program

vinstructor increased price

0 (might also be an instructor issue, but emphasis seems to be on money)

2. Ease/Convenience reasons are identified by references to making the process or
service less than easy or convenient for employees to use. Examples include:

plocation not convenient

, held off-site

>activity too challenging
pconfusing

pasked participants to do too much

179

. Incentives reasons are identified by references to enticements, or the lack thereof,
to get people to participate, such as prizes, give-aways, etc. Examples include:

>no intrinsic or extrinsic rewards
b no food
pprizes not valued enough

. Success Measured By Participation reasons are identified by references to reduced
participation or poor attendance. Examples include:

> low participation
pno one signed up
pleast attended

. Novelty reasons are identified by references to lack of newness of the program or
service, uniqueness, or variety of program or program location. Examples include:

>have heard it all before
> same program for 4th year
remployees are sick of health fairs

. Management Support reasons are identified by references to the lack of positive
support, backing, or endorsement from management. Examples include:

plack of support

>not on company time

0 (if this is a reason for lack of program effectiveness, it implies that lack of
management support is the issue, not timing of the event, or timing would be
listed specifically)

> lack of management understanding

, management did not buy into idea

7.

10.

180

Timing Of Program reasons are identified by references to reaching people at a
times that are inappropriate or not "timely" for those people. Examples include:

pconflicted with lunch time

pheld on Saturday

plunch time too short for effective programming

> multiple sessions - too much time commitment

>work schedules

>contest too long

pafter work

0 (might also be convenience, but specifically addresses the timing of the program)
>no set schedule

Instructor Attributes reasons are identified by references to some characteristic or
quality of the program leader or instructor that lead to the lack of effectiveness of
the program or event. Examples are:

> speaker disrespectful of women/minorities
plousy instructor

pspeaker tried to sell his own product at event
bpeople couldn’t relate to the instructor

Program Administration are identified by references to some deficit in planning or
organization of the program or service. Examples include:

, late planning

pno way to measure outcomes
rprogram didn’t fit group
padministrative nightmare
pprogram mis-managed

>not organized well

bunable to target correct individuals

Fear reasons are identified by references to topics or items that cause anxiety,
worry, or fear in potential participants. Examples include:

pemployees want to tan, not think about skin cancer
>too sensitive of a subject

are afraid will be disappointed with results

> stigma

precent HIV related death

181

11. Conflicts reasons are identified by references to items that might cause friction or
difficulty with participation in a program or event. They include:

ppeople out of town

>program conflicted with company’s problems
> other priorities

>other activities going on

playoffs, job terminations

12. Readiness reasons are identified by references to items that identify the
understanding of the concepts and benefits of a program, as well as simply being
personally ready to deal with those understandings. Examples include:

pno perception of risk

plack of understanding

>don’t like to sweat

>program not viewed as important
>tough group to motivate

> little interest

> smokers not ready to quit

pdull topic

> male dominated company

0 (implies lack of interest in female health issues)
rseemingly boring topic

>too general of a topic

13. Workload reasons are identified by references to stress and workload. Examples
include:

pstaff overworked

>not enough time

>no time is a good time

0 (could be a timing issue, but emphasis is on "no time is a good time" - this
suggests stress)

>target audience "too busy"

>program seen as another task or responsibility, not a benefit

, information saturation of employees

14. Weather reasons are identified by references to the weather. Examples include:

>nice weather
blousy weather

182

15. Facilities reasons are identified by references to having or not having an adequate
or appropriate location to hold the event. Examples include:

>hard to get room

plack of proper facilities
plimited number of showers
O (for athletic programming)

16. Unknown/Respondent Didn’t Know reasons are identified by some overt comment
by the respondent that they simply don’t know, or were unable to identify any

specific reason(s) for the lack of effectiveness of the program or service. Examples
include:

> don’t know
, unsure

17. Other reasons are items that simply don’t fit in any other category.

183

Summary Of NON-MEDIA Reasons For LEAST EFFECTIVE Program

1.

2.

10.

ll.

l2.

l3.

14.

15.

Economic Issues are identified by references to money, cost, etc.

Ease/Convenience reasons are identified by references to making the process or
service less than easy or convenient for employees to use.

. Incentives reasons are identified by references to enticements, or the lack thereof,

to get people to participate, such as prizes, give-aways, etc.

Success Measured By Participation reasons are identified by references to reduced
participation or poor attendance.

. Novelty reasons are identified by references to lack of newness of the program or

service, uniqueness, or variety of program or program location.

. Management Support reasons are identified by references to the lack of positive

support, backing, or endorsement from management.

. Timing Of Program reasons are identified by references to reaching people at times

that are inappropriate or not "timely" for those people.

. Instructor Attributes reasons are identified by references to some characteristic or

quality of the program leader or instructor that lead to the lack of effectiveness of
the program or event.

Program Administration are identified by references to some deficit in planning or
organization of the program or service.

Fear reasons are identified by references to topics or items that cause anxiety,
worry, or fear in potential participants.

Conflicts reasons are identified by references to items that might cause friction or
difficulty with participation in a program or event.

Readiness reasons are identified by references to items that identify the
understanding of the concepts and benefits of a program, as well as simply being
personally ready to deal with those understandings.

Workload reasons are identified by references to stress and workload.

Weather reasons are identified by references to the weather.

Facilities reasons are identified by references to having or not having an adequate
or appropriate location to hold the event.

184

16. Unknown/Respondent Didn’t Know reasons are identified by some overt comment
by the respondent that they simply don’t know, or were unable to identify any
specific reason(s) for the lack of effectiveness of the program or service.

17. Other reasons are items that simply don’t fit in any other category.

185

Coders will test themselves on the following examples:
Employees are tired of health programs
The prizes were really poor

Don’t have a fitness center

186

Answers for previous page examples:

Employees are tired of health programs
— this is a Novelty example - you can only get tired of something you have
had before - this should be coded as a 5

The prizes were really poor
- this is an Incentives example - this should be coded as a 3

Don’t have a fitness center
- this is a Facilities example - not having a center would limit the success
of certain kinds of programs - this should be coded as a 15

APPENDIX J

TYPOLOGY OF HEALTH PROMOTION PROGRAMS IN
NORTH AMERICAN CORPORATIONS AND GOVERNMENT AGENCIES

Appendix J
Typology of Health Promotion Programs in North American Corporations and
Government Agencies ’

General

9

0

0......990...09

0909 00.00

.

general health program or class, any
health topic (heart disease, women’s
issues, fitness, how to select a
physician, HIV/AIDS, how
secondhand smoke can affect your
health, nutrition, etc.)

safety training/awareness, specific
topic (back safety, proper lifting
techniques, etc.)

produce health-related brochures or
newsletter

nutrition counseling

nutrition education

weight control

heart healthy cooking class

cancer education (general)

breast cancer education

breast self-examination

testicular self-examination
colo-rectal cancer education

healthy heart program

Employee Assistance Program (EAP)
safety meeting

cardio-pulmonary resuscitation (CPR)
smoking cessation

counseling & referral for substance
abuse

health risk appraisal (questionnaire)
stress management

serum lipid modification

fitness center

exercise education (general
informational class/program)
swimming instruction

life-saving (swimming)

first aid

emphasis on self-help groups
(Alcoholics Anonymous, etc.)
wellness film/video available to
employees

187

Exercise (activity) programs

9
0

0
.

aerobic dance

aerobic exercise (treadmill, bike,
stairclimber, Nordic track, walking,
etc.)

circuit training (weight machines)
cardiac rehab

Health evaluations

9

999...... 0

9

aerobic capacity (maximum stress
treadmill with electrocardiogram)
aerobic capacity (estimated maximum
oxygen uptake)

flexibility

body composition

muscular strength & endurance testing
vision screening

glaucoma screening

low-back clinic/screening

cancer screening

breast cancer screening

colo-rectal cancer screening
(hemoccult)

hypertension (high blood pressure)
screening

cholesterol screening

‘ Modified from Parkinson, et al.
(1982)

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188

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