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Nutrition

Once a company has conducted assessment and planning of nutrition programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. The evaluation plan should be in place before any program implementation has begun. 

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs.  It is not necessary to use all these metrics for evaluating programs.  Some information may be difficult or costly to collect, or may not fit the operational structure of a company.  These lists are only suggested approaches that may be useful in designing an evaluation plan.  

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

2 women looking at book

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.

Good nutrition can lower the risk of many chronic diseases, including heart disease, stroke, type 2 diabetes , high blood pressure , osteoporosis, and some cancers.  It has a direct effect on obesity and high cholesterol.

Changes in diet are difficult to relate to direct changes in work productivity, health care costs, or health outcomes.  However, the evaluation can include employee’s reported changes in behaviors, knowledge, and skills regarding healthy eating.  Evaluation of nutrition interventions should be conducted in the context of a comprehensive workplace program that includes physical activity, nutrition, and overweight/obesity interventions.

Intervention evidence suggests that even when evaluating direct disease outcomes (e.g., obesity) it will be difficult to separate the effects of nutrition interventions in a comprehensive health program that includes clinical counseling, nutrition education, and physical activity.1-2

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Worker productivity measures for nutrition3-4

Healthier employees are less likely to call in sick.  Companies can sometimes assess sick day use as the most direct measure to determine whether health programs are increasing worker productivity.

Baseline
  • Determine the average number of sick leave days per employee over the previous 12 months for health conditions affected by dietary behavior such as type 2 diabetes
    • This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
  • Determine the costs for worker absenteeism including costs of replacement workers, costs in training replacement workers, and loss and delay in productivity
  • Determine time employees spend during working hours participating in nutrition related worksite programs
Process
  • Re-assess the average number of sick days per employee at the first follow-up evaluation
  • Periodic repeats of other baseline measures
Outcome
  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in time employees spend during working hours participating in nutrition related worksite programs
  • Assess changes in costs from baseline

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Health care cost measures for nutrition3-6

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline
  • Determine current health care use and costs, including pharmaceuticals, counseling, and inpatient and outpatient care, for the diseases and conditions affected by dietary behavior. Examples include: type 2 diabetes, high blood pressure, obesity and high cholesterol
  • Determine the current health care use and costs for clinical nutrition services (if covered), including counseling, prescribed supplements and other medication, outpatient and inpatient care for employees
  • Determine the health care use and costs of program participants before education and other programs are initiated and after operation of these programs
Process
  • Periodic repeats of baseline health measures
Outcome
  • Assess changes in health care use and costs from baseline
  • Assess changes in the type, use, and costs of employee health benefits related to clinical nutrition services (if covered)
  • Compare health care use and costs of program participants before education and other programs are initiated and after operation of these programs

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Health outcomes measures for nutrition3-7

The effectiveness of nutrition programs depends on the intensity of program effort and the use of multiple interventions.  A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in employee nutrition levels such as:
    • Changes in the percentage of employees reaching dietary guidelines
    • Changes in the percentage of employee eating the recommended number of cups of fruit and vegetables daily (visit the National Fruit & Vegetable Program to determine recommended intake based on age, sex, and physical activity level)
  • Changes in health conditions such as cholesterol levels, Body Mass Index (BMI), or blood pressure can assess the effects of improved nutrition
    • Compare changes between program participants before education and other programs are initiated and after operation of these programs
  • Assess changes in employee knowledge, attitudes, and beliefs about good nutrition
  • Assess changes in employee awareness of existing workplace nutrition programs, policies, and benefits
  • Assess changes in the number of employees receiving clinical nutrition services (if covered)

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Organizational change measures for nutrition3-6

Woman talking on phone in front of computer

Healthy eating, along with other health habits, require ongoing support from employers.  New programs can be added over time and evaluated periodically for their effectiveness in establishing, maintaining, and increasing employee healthy eating.  For best results, recognition of the benefits of healthy eating should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., changes of food options in the cafeteria).  These efforts need to be integrated for greatest effectiveness and will require time for full implementation.  Regular measures of employee attitudes and program success are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline
  • Determine barriers to employee healthy eating at the workplace
  • Assess current workplace nutrition programs
    • List current nutrition options for employees through worksite and identify number of employees (i.e., participation in classes or tracking of food items bought in vending machines) using each option. Examples:
      • Number of nutrition classes (e.g., menu planning, food label interpretation, vitamin and mineral supplements, nutrition for older adults, and food safety) and participation in these programs
      • Availability of educational materials on nutrition
      • Number of nutrition-related policies
      • Number of environmental strategies such as healthy foods in the vending machines, cafeterias, snack shops, or garden markets
      • Number of partnerships with community resources for nutrition such as YMCAs, local hospital or health department
    • Determine costs of current company nutrition programs such as:
      • Capital investment in building or facilities such as cafeterias or vending machines
      • Staffing, equipment, and space
      • Cafeteria and vending machine contracts
      • Incentives tied to nutrition programs
    • Conduct survey of employee satisfaction with current workplace supported nutrition programs
Process
  • Reassess barriers to employee healthy eating
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed)
      • Employee participation (e.g., number of desired participants in nutrition classes)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, cafeteria and vending machine contracts, printed and online educational material, etc
    • Identify opportunities for new partnerships with community groups who provide nutrition programs (e.g., YMCA, local health department, local hospital, etc.)
  • Reassess employee satisfaction regarding workplace supported nutrition programs
Outcome
  • Measure reductions in the number and type of employee barriers to healthy eating in the workplace
  • Assess changes in workplace nutrition programs
    • Measure changes in the number of nutrition program options for employees through the worksite and changes in employee participation using each option before and after the nutrition program or campaign. Examples:
      • Number of new programs developed and offered to employees and participation in these programs
      • Number of new educational materials developed and made available to employees
      • Number of nutrition-related polices developed and implemented compared to baseline
      • Number and type of new environmental support changes made (e.g., healthy foods in garden markets, vending machines, cafeterias, etc.)
      • Number of new partnerships with community groups created to enhance access and opportunity for employees to eat healthy 
    • Assess changes in program costs from baseline
      • New capital investments made (e.g., cafeteria)
      • Increases in staffing or materials needs due to new program offerings
      • New incentives or changes in existing incentives based on employee participation
      • Changes in costs for vending or cafeteria contracts
    • Assess changes in survey responses for employee satisfaction following implementation of a workplace supported nutrition program and compare with baseline

Depending on goal success, review the need to adjust workplace programs.


Tools and Resources

Nutrition Baseline Measures

The assessment tools described in the assessment module include specific questions related to nutrition.

  Health-related Programs

  • Q11; Q12; Q13; Q20b,i; Q21d,e,f; Q24a,b,d,e,l; Q26; Q27; Optional Questions A, B, C, I, J, M, OO

  Health-related Policies

  • Q28b

  Health Benefits

  • Q31; Q32; Q36; Q37; Optional Question T, W

  Environmental Support

  • Q24g; Q39; Q40; Q41; Q45; Q46; Q47; Optional Question CC, DD, EE, FF, JJ, MM

Additional Tools

  • CDC Health Scorecard [PDF – 3.5MB] developed by the Centers for Disease Control and Prevention (CDC), the Health Scorecard is a tool designed to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership

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