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Expert Interview

David M. DeJoyDavid M. DeJoy, Ph.D. is a Professor in the Department of Health Promotion and Behavior, College of Public Health, at The University of Georgia. He received his Ph.D. from The Pennsylvania State University. Dr. DeJoy directs the Workplace Health Group at the University of Georgia, and this inter-disciplinary research group has been involved in a number of workplace studies examining the impacts of both health promotion and occupational safety and health interventions. His areas of research include: intervention effectiveness, organizational climate/culture, work organization, risk communication, and theory-based intervention design. He serves on a variety of editorial boards, review committees, and advisory panels at the national and international levels. 

Q: Why are environmental health promotion interventions in the workplace important?
Dr. DeJoy: All behavior, including health behavior, takes place within some type of environmental context.  In simplest terms, health behaviors involve person-environment transactions.  The environmental context can serve to shape people's expectations, it can prompt certain behaviors, and it can make various behaviors easier or more difficult to accomplish.  In planning health promotion activities, the environment should be taken into consideration.   In many workplaces, there may be multiple environments, and the environmental context for one worker or group of workers may be quite different than for others.   

Q: How can the physical and social environment of the worksite support obesity prevention?
Dr. Dejoy: The physical and social aspects of the workplace environment can be exploited to encourage, facilitate, and reward physical activity and healthy dietary choices (to alter the energy intake/output balance).  Onsite showers and changing facilities as features of the built environment make it easier for employees to exercise.  Site planning can be used to encourage walking and outside activities.  Policies as a tool to change environments can encourage certain behaviors and discourage others.  Enacted policies and related measures serve to shape employee expectations, more specifically, their behavior-outcome expectations.   When we talk about culture or climate change in the workplace, we are really talking about changing employees' behavior-outcome expectations; their perceptions and beliefs about how we do things here; what things/behaviors are rewarded.  Examples here might include that is ok to use the fitness center during the lunch hour, or that there is sufficient work schedule flexibility to make time to exercise.   

Q: How can the physical and social environment of the worksite be assessed?
Dr. DeJoy: A number of validated assessment tools exist, included the CHEW (Checklist of Health Promotion Environments at Worksites), Heart-check, and the EAT (Environmental Assessment Tool).  These instruments tend to focus on physical and organizational characteristics, but they also tap into aspects of social environments.   Other instruments exists that can be used to examine various aspects of the social/organizational environment, such as – the LBE (Leading by Example Questionnaire), the Worksite Health Climate Scale, The Worksite Health and Safety Climate Scale, or event the HERO (Health Enhancement Research Organization) Scorecard.   In doing environmental assessments, it is useful to keep in mind that the objective and subjective environments are both important.  Instruments such as the CHEW focus mostly on the objective environment, whereas, climate surveys tend to focus on people's perceptions of environments, such as, perceptions about the extent of management support for health promotion.

Q: What does a healthy organization look like?  What are the benchmark characteristics of healthy employee populations? How should employers set goals and measure their organizations' progress?
Dr. DeJoy: In perhaps the truest sense, a healthy organization is one in which the core work processes are organized so that they best utilize and support the human capital (the workforce) of the organization.  Most of the tangible aspects of the healthy organization show up in three broad work domains: job design, organizational climate, and job future.   For me, benchmarks of a healthy organization focus more on measures of psychological work adjustment (job satisfaction, organizational commitment, etc.) rather than biometric or epidemiological measures.  Developing a successful health promotion program in an unhealthy organization is a difficult and uphill battle.      

Q: How can health promotion remain a priority when organizations are facing financial constraints?  What inexpensive environmental interventions can employers implement to support a healthy organizational culture?
Dr. DeJoy: Of course, it is quite difficult to maintain a comprehensive health promotion program in a negative business environment.   Part of being able to do so is to have accumulated effectiveness data for your program, both in terms of health and financial outcomes.  But the fact remains that even effective programs can be at risk, especially to the extent they are perceived as being outside the core business mission.  In this respect, integrating the health promotion program into the core structure and function of the organization should be a primary goal of any worksite health promotion program.  Another strategy in tough economic conditions is to focus more on the psychological climate of the organization; helping employees to maintain healthy mindsets and activities in the face of mounting job pressures and uncertainties.  This involves working closely with management and offering a constant and consistent message that good health is important, valued, and crucial for organizational success.  Some of the least expensive interventions are those that serve to shape the information environment and those than take advantage of existing social networks within the workplace.  Interesting, these same interventions can also be particularly helpful in organizations facing financial or competitive stresses.   

Q: How can employers assess the impact of environmental interventions in terms of health and financial outcomes?
Dr. DeJoy: Environmental interventions can be complicated to evaluate because it involves more than simply tracking program participates across time.   Assessment or evaluation should begin before the changes are implemented. Before deciding to implement a specific environmental intervention, program planners should be able to identify the target group or groups of employees, the desired outcome(s) and how the intervention is supposed to work.   The planning process should examine how well the intervention fits the context in which it is to be implemented.  For example, worker safety concerns may conflict with certain types of physical activity interventions in certain organizational settings.  Also, particular care should be taken to collect baseline or pre-intervention data.  For a vending intervention, it would be very helpful to have sales data prior to the intervention as well as after implementation.  If the intervention is designed to encourage stair use, an effort should be made to assess the base rate of usage.   Generally speaking, environmental interventions should be evaluated in terms of both proximal and distal indicators.   Three sets of indicators might include: employee response (awareness, participation, satisfaction, etc.), impact (sales, usage, behavior change, etc.), and outcome (biometric, risk transitions, productivity, financial, etc.).   In many cases, phasing in an intervention gradually within an organization can save money as well as allow for more sophisticated (i.e., experimental) assessment of intervention effectiveness. 

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The opinions expressed in these interviews are those of the interviewee and do not necessarily represent the official views of the Center for Disease Control and Prevention (CDC), the Department of Health and Human Services (DHHS), or the U.S. Government.  The placement of these interviews on the Center for Disease Control and Prevention's website does not imply the endorsement of one particular organization, author, product, or service over another. 

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