|A systematic review of selected interventions for worksite health promotion: the assessment of health risks with feedback
|Soler RE, Leeks KD, Razi S, Hopkins DP, Griffith M, Aten A, Chattopadhyay SK, Smith SC, Habarta N, Goetzel RZ, Pronk NP, Richling DE, Bauer DR, Buchanan LR, Florence CS, Koonin L, MacLean D, Rosenthal A, Matson Koffman D, Grizzell JV, Walker AM and Task Force on Community Preventive Services
This review assessed the effectiveness of Assessment of Health Risks with Feedback (AHRF) in work places and concluded that it was useful when combined with other interventions as a gateway to further work-site health promotion programmes. Due to variability in the study characteristics and limited availability of high-quality evidence, the robustness of the conclusion is unclear.
To provide recommendations on the effectiveness of interventions that use Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader work-site health promotion programme to improve the health of employees.
MEDLINE, Employee Benefits, Sports Information Resource Centre, Cambridge Scientific Abstracts, Business Weeks, ABI Inform, Health Promotion and Education, CINAHL, Office of Smoking and Health, AIDSline, PsycINFO and Sociological Abstracts were searched for relevant articles published in English between January 1980 and June 2005. Search terms were reported.
Primary studies that evaluated the effects of AHRF when delivered to workers in work-site settings and that assessed behavioural, physiological or other aggravated health outcomes were included. Only articles from peer-reviewed journals, technical reports and government reports meeting specific quality criteria were eligible.
Most interventions were conducted in large companies. Most studies used one-to-one feedback. Questionnaire types included named and other health risk assessments (HRAs), named questionnaires and biometric data. Methods of feedback included computerised, verbal and written. (All where reported).
Most were from USA. Outcome measures related to behavioural outcomes (which included alcohol use, diet, physical activity, seat belt use and tobacco use), physiologic outcomes (which included blood pressure, body composition, cholesterol and fitness) and other outcomes (which included healthcare service use, absenteeism and health risk estimates).
Included studies assessed AHRF either alone or in combination with other interventions (AHRF plus). Where reported, additional interventions included health interventions that lasted at least one hour, health education in group or one-to-one settings, enhanced access to physical activity, better nutrition and medical care and some form of incentive for participation or achieving programme-related goals.
It was unclear how many reviewers conducted the study selection.
Assessment of study quality
Studies were assessed by at least two reviewers independently in terms of the suitability of study design and quality of study execution. Each study was assessed as having a study design of greatest, moderate or least suitability and of having good, fair, or limited quality of execution. Studies of limited quality of execution were excluded.
For each of the extracted outcomes, pre- and post-intervention values for both intervention and comparison groups were extracted (where available) in order to calculate absolute and relative change for continuous variables and relative risks (RRs) for dichotomous variables. Where multiple measurements over time were available, the measurement soonest before the start of the intervention was used as the pre measurement and the last measurement was used as the post measurement.
Methods of synthesis
A narrative synthesis was conducted. Where at least seven studies reported the same outcome, the interquartile intervals (IQIs) of effect sizes were calculated and reported along with the median effect size. Results were first grouped by whether the intervention was AHRF alone or AHRF plus (combined with other interventions) and further grouped by outcome category (behavioural, physiologic or other).
Results of the review
Eighty-three studies were included: 32 evaluated AHRF alone and 51 evaluated AHRF plus. AHRF alone studies comprised six randomised controlled trials, a prospective cohort study and a controlled study (classified as greatest design suitability), one time series study (moderate suitability) and 23 before-and-after studies (least suitability). AHRF Plus studies comprised 20 either prospective cohort, group or individual randomised trials or other study designs with concurrent comparison groups (greatest design suitability), nine time series or retrospective cohort designs (moderate suitability) and 22 before-and-after study design (least suitability).
AHRF alone: The review reported favourable results for AHRF for alcohol use, dietary behaviour, physical activities and total cholesterol. There were inconsistent results for seatbelt use, tobacco use, blood pressure, Framingham Index and absenteeism. The authors reported no effect of AHRF on body mass index. Positive effects were described as small or modest in size and were predominantly from before-and-after studies, which were susceptible to several important sources of bias.
AHRF plus: Based on the rules of evidence synthesis used by the authors, there was evidence of meaningful positive effects for AHRF plus for tobacco use, seatbelt non-use, dietary fat intake, blood pressure, cholesterol, summary health risk estimates, worker absenteeism and healthcare service use. There was insufficient evidence to determine the effectiveness of intake of fruit and vegetables, body composition and physical fitness.
AHRF was a useful as a gateway intervention to a broader work-site health promotion programme that included health education of at least one hour or repeated multiple times during a year, and may include an array of health promotion activities.
This review addressed a broad set of review questions with broad inclusion and exclusion criteria. The search was conducted with sufficient attempts to minimise bias. It was unclear whether appropriate attempts were made to reduce error and bias in study selection and data extraction. Study quality and the appropriateness of design of the primary studies were assessed and appropriate study details were reported. The rationale for the approach to quantitative synthesis was unclear and statistical heterogeneity and the considerable diversity of the included studies were not investigated. The robustness of the authors' conclusion was somewhat unclear due to the limited high-quality evidence available and heterogeneity between the included studies.
Implications of the review for practice and research
Practice: Use of assessments of health risks with feedback when combined with health education programmes with or without other interventions was recommended (see Publications of Related Interest).
Research: Further reviews should be conducted to answer a range of questions about work-site health promotion. This should include whether work-site health promotion programmes with a health education component were effective in the absence of AHRF and whether AHRF added value to work-site health promotion programmes in terms of behaviour change and health outcome improvement.
Soler RE, Leeks KD, Razi S, Hopkins DP, Griffith M, Aten A, Chattopadhyay SK, Smith SC, Habarta N, Goetzel RZ, Pronk NP, Richling DE, Bauer DR, Buchanan LR, Florence CS, Koonin L, MacLean D, Rosenthal A, Matson Koffman D, Grizzell JV, Walker AM and Task Force on Community Preventive Services. A systematic review of selected interventions for worksite health promotion: the assessment of health risks with feedback. American Journal of Preventive Medicine 2010; 38(2 Supplement): S237-S262
Other publications of related interest
Task Force on Community Preventive Services. Recommendations for worksite-based interventions to improve workers' health. Am J Prev Med 2010; 38(2S): 232-236.
Guide to Community Preventive Services. Assessment of healthrisks with feednack to change employees health. http://www.thecommunityguide.org/worksite/ahrf.html
Subject indexing assigned by NLM
Efficiency; Feedback; Health Behavior; Health Education /methods; Health Promotion /methods; Humans; Occupational Health; Occupational Health Services /organization & administration; Risk Assessment /methods; Workplace
Database entry date
This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.