We’ve all heard the adage: If at first you don’t succeed, try and try again. Jacquie LaFay, a consultant with Public Sector Consultants (PSC), believes the saying applies equally to changing human behavior and launching new health and wellness programs.
“Last year, our firm worked with the Small Business Association of Michigan (SBAM) to turn what had been a fun, friendly competition between our organizations into a statewide effort,” says LaFay. “It was a tough but good learning experience for all of us — the people trying to improve their health by participating in the program and those of us trying to launch the program, see how it worked and find ways to make it better.”
The Small Business Worksite Wellness Challenge, as the program is now called, was created because SBAM wanted to assist its members with reducing health care claims and insurance premiums by improving the health of their employees. PSC, in turn, wanted to help SBAM accomplish its goals and give their own employees a way to become healthier. By working together, SBAM and PSC successfully turned their once-pleasant rivalry into a full-scale behavior-change program embraced by 18 small businesses across the state.
“What was particularly great about the challenge is that PSC was involved in every aspect right from the beginning.”
How the Small Business Worksite Wellness Challenge works
The challenge was designed to help employees develop good health habits — one week at a time. Over the course of 12 weeks, participants began a new healthy behavior every other week while maintaining the behaviors adopted in previous weeks. Each behavior was based on recommendations from national health organizations, such as the Centers for Disease Control and the Mayo Clinic.
The behaviors included:
- Engaging in 150 minutes of moderate aerobic activity per week
- Limiting consumption of sugar-sweetened beverages to 12 ounces per day
- Eating five or more servings of fruits and vegetables per day
- Sleeping at least seven hours per night
- Limiting consumption of sugar-sweetened foods to one serving per day (e.g., one three-inch cookie, one slice of cake or a half cup of ice cream)
- Conducting strength-training exercises two times per week
The challenge was intentionally designed to reflect what many health experts have known for years — behavior change is a process, not a one-time event.
“People don’t just stop smoking, run a marathon or lose weight overnight,” says LaFay.
And, as research shows, there’s a good chance that if too many changes are made too fast, people will relapse into unhealthy patterns. For that reason, PSC wanted to develop a program that included manageable but effective health behaviors and encouraged gradual but steady change.
The challenge also asked participants to track their progress using the online HealthyLife® Wellness Portal and mobile app developed by the American Institute for Preventive Medicine. For example, each day, each person would enter how long he or she engaged in cardio activity, if at all. Then, the system assigned that person points based on his or her entry. Over the course of the program, participants could earn up to 6,420 points.
“We incorporated online tracking into the challenge because we know that collecting and recording information and data helps people stick to their health goals,” says LaFay. “Also, seeing the points pile up is great motivation.”
The challenge also employed other best practices, including asking participants to see their physician before starting the new program and helping employees draw a direct connection between each behavior and its associated health benefits.
LaFay notes that, from the participant surveys, PSC learned that many employees were simply unaware of how certain behaviors could improve their health. The regular e-mails and updates distributed by PSC over the course of the program provided participants with valuable health information they might not otherwise have had access to.
How PSC helped develop, implement and evaluate the challenge
PSC took a number of steps to create and launch the initiative, drawing on both its health care knowledge and its program development, implementation and evaluation expertise.
“It was the perfect project for PSC in the sense that it drew on many of our skill sets,” says Melissa Gibson, PSC senior consultant. “To start, our relationships with people in the health care industry allowed us to make important connections and bring more players to the table.”
For example, PSC enlisted current and former clients — Consumers Mutual Insurance of Michigan, the Michigan Health & Hospital Association and the Michigan Association of Health Plans — to underwrite the program’s administrative costs. It also used its relationships with health care leaders to engage hospitals in providing free health screenings to participants in their area.
Next, PSC’s content and program design experts developed protocols and procedures, created necessary training materials and conducted informational webinars. They even completed and filed an application with Western Michigan University’s Human Subjects Institutional Review Board to ensure the challenge complied with all federal regulations and protected the rights and welfare of participants.
After that, the evaluation experts stepped in.
“What was particularly great about the challenge is that PSC was involved in every aspect right from the beginning,” says Gibson. “That means we were able to identify the data we needed, create avenues to collect it and have all the necessary information at the end to effectively assess program outcomes.”
PSC’s evaluation effort had three overarching objectives:
- Identify the extent to which participants improved their health behaviors and biometric measures (e.g., BMI, blood glucose levels, blood pressure and cholesterol levels)
- Identify any correlation between the adoption of specific behaviors and decreases in health risks
- Begin to identify possible benefits for small businesses (healthier employees, lower health care claims costs, etc.) when their employees take part in the challenge
PSC also surveyed participating businesses and individuals to collect pre- and postchallenge information and data.
What PSC learned from its analysis
With regard to the healthy behaviors, the easiest one to adopt and stick to was getting at least seven hours of sleep for five or more nights per week. That was followed, in order, by conducting strength-training exercises at least two times a week, limiting consumption of sugar-sweetened foods and engaging in 150 minutes of physical activity per week. Not surprisingly, participants had the hardest time limiting their intake of sweetened beverages and eating at least five servings of produce per day.
As one participant said in the postchallenge survey, “I learned that I definitely don’t eat enough fruit and vegetables!”
Unfortunately, participation waned during the challenge — which is not at all unusual in behavior-change programs — and many of those who stuck with the program struggled with tracking their activity. By week 12, about 100 fewer participants were entering information into the system than in week one.
These hurdles prevented PSC from drawing statistically significant conclusions about such things as improvements in biometric measures, the relative influence of various challenge behaviors on health outcomes, potential decreases in health risks and cost savings for businesses. PSC was able, however, to pinpoint program strengths and identify numerous ways to increase and sustain participation in the future.
“Maybe that’s what made Jacquie think of the adage,” says Gibson. “Although we weren’t able to accomplish everything we hoped for this time around, we’d certainly like to try again.”
“This is such a fun and effective way to change behavior,” she says. “Now we have a lot more information and ideas about how to make the challenge even better so that PSC and SBAM can continue improving Michiganders’ health one small business at a time.”