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Steps to Wellness – A Physical Activity Program for Worksites

State: NE Type: Promising Practice Year: 2018

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Four Corners Health Department
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Steps to Wellness – A Physical Activity Program for Worksites
Four Corners Health Department serves a population of 45,500 (2010 U.S. Census) within the counties of Butler, Polk, Seward, and York, located in the southeast part of Nebraska. The District covers approximately 2,166 square miles, and is considered agriculturally based and rural. Public Health Issue: In the Four Corners District, over 20% of the population spends little or no leisure time on physical activity. Less than half of the population meets aerobic physical activity recommendations. Only 16% of the adult population in the Four Corners District meets aerobic and muscle strengthening recommendations. Most businesses in the district are small to medium, without easy to access to physical activity opportunities. Most worksites do not have a fitness opportunity onsite, nor an accessible walking area outside. Project Goal 1: Continue and expand current primary and secondary preventive services, incorporating evidence-based physical activity strategies into worksites. Objective 1.0 By September 15, 2016, FCHD will engage at least two additional businesses, increasing from 8 to 10, to participate in Four Corners' worksite wellness program, Take Heart Live Smart, in an evidence-based program Steps to Wellness”, with an enhanced focus on physical activity. Objective 2.0 By September 15, 2016, FCHD will implement an evidence-based worksite wellness program, engaging businesses in increased physical activity, using Center for Disease Control and Prevention's (CDC) Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace.”. Objective 3.0 By September 15, 2016, FCHD will complete and implement a plan for sustaining currently engaged and future businesses in the Steps To Wellness physical activity program. Project Goal 2: Improve District businesses and staff capacity or competency through participation in training and/or education, and memberships, in order to improve the effectiveness of future delivery of public health interventions, both primary and secondary prevention. Objective 1.0 By September 15, 2016, key FCHD staff and business wellness coordinators will attend training for worksite wellness development, and other pertinent trainings, such as policy/systems/environmental change, and community health. Implementation Businesses were invited into a worksite wellness partnership. A baseline was established: completion of the Health Score Card within the last 1 to 2 years, health risk assessment, culture audit, and individual measurements. Each wellness leader was given a toolkit, monthly resources, and weekly emails. Four Corners staff met with each participant at each worksite to explain the program, to get their individual measurements, and to guide them in setting small goals. Each month had an additional challenge of balance, strength, or flexibility exercises. Each month, participants were to track their minutes of moderate intensity physical activity and minutes spent on the challenge exercise. They earned incentives based on their level of participation. Those who turned in their tracking sheet were eligible for a reward and to be entered into a drawing for a pass to a local fitness place. Wellness leaders at each business were given a certificate template to use for employee recognition and to record number of points earned each month. At the end of the program, FC staff scheduled times with the businesses to come on site to do the post-assessments. Each person was requested to give written feedback on the program. Based on the number of points earned during the whole program, participants earned an additional physical activity support. Results The results exceeded expectations. Besides the individual data listed below, the integrity of the program captured the interest of other businesses and community stakeholders. Showcasing the program impact led to a worksite wellness partnership with a local hospital and clinic. Postassessment data was obtained from 94 employees from six different worksites. 89 of the employees improved in at least one area, with a success rate of 95%. Areas that were measured include: weight, Body Mass Index, waist circumference, blood pressure, and physical activity minutes. - 8 participants improved in all 5 areas - 24 participants improved in 4 areas - 24 participants improved in 3 areas - 16 participants improved in 2 areas - 17 participants improved in 1 area. Provided below is the percent of participating employees that improved in each of the five measurements: Weight: 67% Body Mass Index: 64% Waist Circumference: 55% Blood Pressure: 22% Physical Activity Minutes: 65% The program not only positively impacted the health of the employee, it also benefited the culture of the business. The program served to equip employees to bring these important health concepts into their family and community. Four Corners Health Department website: www.fourcorners.ne.gov
Problem: In the Four Corners District, as well as the state of Nebraska, over 20% of the population spends little or no leisure time on physical activity. Less than half of the population meets the aerobic physical activity recommendations. Only 16% of the adult population in the Four Corners District meets aerobic and muscle strengthening recommendations. The specific target for this project is males and females, ages 18 – 64, who are employed at worksites in the Four Corners District. Most businesses in the district are small to medium, without easy access to physical activity opportunities. Most worksites do not have a fitness opportunity onsite, nor an accessible walking area outside. The percentage of people living below the poverty level range from 7.2% to 9.2% in the four counties. The Four Corners' area is predominantly white with less than 4% minority. However, each of the counties is beginning to see an increase in diversity. In this project, Four Corners worked with six rural businesses, with a combined total of approximately 840 employees. Based on 2010 U.S census, total population of those within the target population of 18 – 64 is 26,145. Therefore, Four Corners reached a little over 3% of the population. History of addressing the problem In 2011, Four Corners received a Healthy Communities grant to reduce deaths from heart disease. The target audience chosen was worksites. The Take Heart Live Smart (THLS) worksite wellness program was created from this funding. We started with three pilot businesses. One of the pilot sites continues with us and eight other businesses have joined in, including the three additional ones that joined in 2016. The THLS program focuses on delivering a comprehensive worksite wellness program, based on evidence-based principles. Each business is encouraged to complete baseline assessments, create a wellness plan, establish a wellness policy, evaluate their programs, and then reassess after about a year has passed. In 2015, Four Corners received a Public Health and Health Services Block Grant to implement an evidence-based physical activity program in 2016 with the current worksites and to recruit at least two new worksites. Even though, in previous years, physical activity and nutrition were a prominent focus in the THLS program, there was a need for a more structured and intensive focus. FC staff felt that with incentives, peer support, environmental changes, and policy enhancements, employees could more easily lead an active lifestyle. The evaluation plan was set up in a way to show individuals and employers the impact of regular physical activity on a person's health. The outcome exceeded the expectations of the project coordinator. Steps to Wellness Made a Difference Four Corners implemented the CDC's Steps to Wellness tool as part of the Take Heart Live Smart (THLS) worksite wellness program. The purpose of Steps to Wellness was to help businesses become more physical activity friendly and employees increase the amount of physical activity in which they participate. This addresses Healthy People 2020 objective PA-2.4, which aims to increase the proportion of adults who meet the objectives for aerobic physical activity and for muscle-strengthening activity. Based on the ideas and suggestions in the Steps to Wellness guide, worksites were offered education and opportunities to enhance their physical activity, supporting employees no matter where they are on the stages of change continuum. Employee participation was recognized through a point system, with the incentive that the points can be redeemed for rewards at the end of the program. At the end of each month, participants who met the minimum requirements for points and turned in their sheet received an item to support their wellness efforts, such as book Aim for a Healthy Weight”. To measure the success of the program, a baseline of physical activity was measured at the beginning of the program and then measured again at the end of the program. Through Four Corners' partnership in delivering worksite wellness services, The Steps to Wellness program made a significant and measurable difference in the lives of those who participated. Going on site to meet with employees for the pre- and post-assessments gave them one-on-one attention to focus on their personal goals and barriers to reaching them. The worksites involved in this program don't have a designated person that can give one-on-one attention to employee wellness. Combined with the measurements, face-to-face visits between Four Corners and employees allowed them time to share concerns and struggles. The Four Corners staff offered guidance using health coaching and motivational interviewing techniques. Through seeing the results of the program, employers were affirmed in the value of worksite wellness and supporting their staff in physical activity at work and at home. The program gave the employers something more tangible and immediate for seeing the results of focused attention on worksite wellness. We see this project as a creative use of an existing tool. The evidence-based resource used for this program was the Centers for Disease Control and Prevention, Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace, Atlanta: U.S. Department of Health and Human Services; 2012.
Nutrition, Physical Activity, and Obesity
Goals and Objectives: Project Goal 1: Continue and expand current primary and secondary preventive services, incorporating evidence-based physical activity strategies into worksites. Objective 1.0 By September 15, 2016, Four Corners Health Department (FCHD) will engage at least two additional businesses, increasing from 8 to 10, to participate in Four Corners' worksite wellness program, Take Heart Live Smart (THLS), in an evidence-based program – Steps to Wellness”, with an enhanced focus on physical activity. Objective 2.0 By September 15, 2016, FCHD will implement an evidence-based worksite wellness program, engaging businesses in increased physical activity, using CDC's Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace.”. Objective 3.0 By September 15, 2016, FCHD will complete and implement a plan for sustaining currently engaged and future businesses in the Steps to Wellness physical activity program. Project Goal 2: Improve District businesses and staff capacity or competency through participation in training and/or education, and memberships, in order to improve the effectiveness of future delivery of public health interventions, both primary and secondary prevention. Objective 1.0 By September 15, 2016, key FCHD staff and business wellness coordinators will attend training for worksite wellness development, and other pertinent trainings, such as policy/systems/environmental change, and community health Steps Taken to Implement the Program Each business followed these similar steps: 1. A baseline was established: completion of the Health Score Card within the last 1 to 2 years, health risk assessment, culture audit, and individual measurements. 2. Each wellness leader was given an implementation guide, the Wellness Champion Toolkit. The project coordinator met individually with the wellness leaders at each worksite to explain the program and how to implement it on site. An agreement was reviewed to explain what Four Corners will provide and what the wellness leaders will need to do. 3. Four Corners staff met with each participant at each worksite to explain the program, to get their individual measurements, and to guide them in setting small goals. During this time, they were given a folder with resources that explained the program, moderate intensity physical activity, recommended guidelines for physical activity, and the tracking sheet they would need for their first month of participation. During this time, they also were instructed on what to include to increase their chances of success: social support, setting small goals, recording their activity. 4. Employees were asked to sign an agreement form at the start of program. The form let them know that a pre and post assessment would be done during this program. It also got their permission to take their picture that would be shared on the wellness board or with Four Corners. 5. Besides a focus on physical activity, each month had an additional challenge built in to encourage them to incorporate other beneficial types of activity. On a rotation, each month had either a focus on strength, flexibility, or balance. For the six months program, each additional focus was offered two different times. For the three months program, each was offered one time. To assist Four Corners in preparing these and to give college students experience, Concordia University students prepared materials focused on these additional challenges. They provided exercise guides, posters, and newsletters focused on these topics. 6. Participants were to track their moderate intensity physical activity (MIPA) each month, recording on a provided tracking sheet. They earned 10 points if they, at a minimum, were active 3 times per week, 10 minutes each time, for 3 weeks of the month. The concept behind the program would be welcoming to those who are at 0 MIPA and would see rewards for getting started. Once a person reached 150 minutes per week for at least 3 weeks of the month, they earned another 10 points. 7. Participants were to track also their time spent doing any balance, flexibility, or strength exercises. They earned 10 points for spending a minimum of 10 minutes two times week, for at least 3 weeks of the month. 8. Participants could earn at the most 30 points per month. They needed to have earned at least 10 points in order to turn in their tracking sheet. Those who turned in their tracking sheet were eligible for a reward and to be entered into a drawing for a pass to a local fitness place. 9. Wellness leaders at each business were given a certificate template to use for employee recognition and to record number of points earned each month. They were asked to track number of points also. Certificates were given to each participant who turned in their tracking sheet. They were encouraged to do this in a public way to give employees recognition for their achievement. 10. Each month, FC requested the number of participants who met the minimum requirements to earn points. Wellness leaders were given enough rewards to supply each of these participants. These rewards differed each month and included items such as Aim for Healthy Weight, Office of Aging Exercise Guide, Office of Aging travel size exercise guide, and pedometers. 11. Each month, wellness leaders were equipped with resources to support employees doing the monthly challenge activities. For example, during one of the strength focused months, each site was given 5 stretch bands with an exercise and safety guide to share with their employees. Employees could borrow one and try at home or the wellness leader could make them available in a designated space at the worksite. 12. At the end of the program, FC staff scheduled times with the businesses to come on site to do the post-assessments. Besides repeating the measurements that were completed during the pre-assessment, we asked each person to give some written feedback on the program. 13. Based on the number of points earned during the whole program, participants earned an additional physical activity support: Nalgene water bottle, stretch band set, or fitness in a box. 14. Some participants are being encouraged to share their story and these will be shared as success stories. 15. With a student volunteer's help, a physical activity guide was created that shared all the free opportunities for being active in each of the four counties in the district. This was very well received. 16. Almost weekly emails were shared with wellness leaders. These emails were intended to be shared with all employees at their worksite, not just those directly involved with the program. Each email had a focused message, such as goal setting, having a buddy for staying accountable, healthier eating, staying motivated, and tips for being active. Handouts for posting and emailing were often attached to these emails. 17. Wellness leaders were encouraged to create a wellness board at their workplace. This gave a central location for employees to find program and general wellness information. Leaders were encouraged to post pictures of employees making good choices or of their achievements, such as participating in a 5k. 18. The program was set up to allow new people to join during any month of the program. The hope was that employees who weren't ready when the program began, would be motivated to join in a later month. Also, employees had the flexibility to participate only during those months that worked for them. 19. Wellness leaders were encouraged to consider establishing new policies or enhancing existing policies. Sample policies were shared with them on the topics of general wellness, physical activity, food at meetings, and vending machines. 20. Businesses were encouraged to look at their environments to see where they could create a walking space for employees to use during their breaks. 21. A workshop was offered to enrolled businesses. The workshop helped them to know the physical activity guidelines and strategies for supporting physical activity at the workplace. Criteria The program was implemented with the worksites that had enrolled in the Take Heart Live Smart worksite wellness program that Four Corners offered in the four county district. Timeframe The program was implemented in 2016 as a three or six months program. The length of program was determined by when the worksite enrolled in the THLS program. Worksites that enrolled after the program started followed a three months program. Stakeholders Several stakeholders from the state and local level were engaged in the planning and the implementation of the program. - As the grant was being written, staff consulted with those at the state to have them review the plan and give feedback. - The project coordinator consulted with Brian Coyle, the state contact for physical activity, during the development of the program. Brian Coyle was enlisted to provide a local workshop to the participating businesses. He provided a well-received workshop on the new Walk It Guide created in Nebraska. - Wellness leaders at each worksite worked with the project coordinator to implement the program. They were instrumental in the implementation for giving feedback on what was working and what needed revision. - Physical activity vendors in the communities of the participating businesses were asked to participate through showcasing their programs. Each month, there was a drawing at each business from the tracking sheets that were submitted. The project coordinator provided each participating business a pass to share for the drawing. For those communities that didn't have as many fitness vendors, they were offered a physical activity CD or item to support activity. - The community Chamber of Commerce offices supported the program through publicizing the opportunity. Funding Four Corners applied for funding from Nebraska Department of Health and Human Services, Division of Public Health, Health Promotion Unit. The funding came from a Preventive Health and Health Services Block Grant. Line item Amount requested Personnel (include % FTE for each position) $10,536.37 Fringe benefits $4,284.75 Travel Mileage $726.30 Meals and lodging Other (specify) Project operating expenses Training cost/tuition/registration $1.095.00 Rental of facilities, equipment Printing $723.50 Postage $4.05 Materials and supplies $7,019.07 Communications $7,532.84 Evaluation cost Contractual Indirect costs $3,191.90 TOTAL $35,113.78
The evaluation focused on both outcome and impact evaluation. This helped us make sure the program had an impact on the participants, increasing the amount of physical activity they participated in each week. We also used this evaluation to make sure the program was meeting the needs of the businesses and employees participating. Project Goal 1: Continue and expand current primary and secondary preventive services, incorporating evidence-based physical activity strategies into worksites. Objective 1.0 By September 15, 2016, FCHD will engage at least two additional businesses, increasing from 8 to 10, to participate in Four Corners' worksite wellness program, Take Heart Live Smart, in an evidence-based program Steps to Wellness”, with an enhanced focus on physical activity. Activity: Develop and implement a marketing plan for engaging businesses. Performance Measure Achieved: Completed marketing plan. Three new businesses were engaged in the Take Heart Live Smart worksite wellness program and also the Steps to Wellness program. Activity: Engage at least 3 partnerships with fitness vendors, wellness centers, or higher education institutions. Performance Measure Achieved: Six new partnerships created. Activity: Determine fee for each participating workplace. Performance Measure Achieved: Completed and adopted fee schedule for participating workplaces. Objective 2.0 By September 15, 2016, FCHD will implement an evidence-based worksite wellness program, engaging businesses in increased physical activity, using CDC's Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace.”. Activity: Collect pre-program information for each business by completing the pre-assessments as outlined in the Steps to Wellness” guide. Performance Measure Achieved: Completed assessment for each participating business. Reviewed employee physical activity needs assessment for each participating business. Activity: Collect baseline physical activity information for participating employees at each business. Performance Measure Achieved: Collected baseline physical activity levels for participating employees at each enrolled business. Activity: Implement the wellness plans for each business. Performance Measure Achieved: completed wellness plans for each participating worksite, tailored to that worksite's specific baseline assessment information. Activity: Collect end of program physical activity information. Performance Measure Achieved: Collected physical activity data from participating employees at six of the enrolled business. Activity: Evaluate program results. Performance Measure Achieved: Completed an evaluation report for each of the six businesses. 100% of the six enrolled businesses saw an improvement in physical activity minutes. Across all six businesses, 65% of the participating employees increased their minutes of moderate intensity physical activity from the measured baseline. Objective 3.0 By September 15, 2016, FCHD will complete and implement a plan for sustaining currently engaged and future businesses in the Steps to Wellness physical activity program. How Met: A sustainability plan was created to continue the supports for physical activity. Through resources, policy changes, assessment reports, environmental changes, leadership education, and established wellness plans, businesses were better equipped to support and encourage physical activity for their employees. Activity: Within the first month, create a sustainability plan, including anticipated costs for Four Corners and participating worksites. Performance Measure Achieved: Created sustainability plan. Activity: Mid project, assess the feasibility of the sustainability plan and revise as needed. Performance Measure Achieved: Completed Plan Do Check Act Quality Improvement cycle on the sustainability plan. Activity: At the conclusion of the project, assess the results of the plan and revise as appropriate. Performance Measure Achieved: Documented lessons learned. Project Goal 2: Improve District businesses and staff capacity or competency through participation in training and/or education, and memberships, in order to improve the effectiveness of future delivery of public health interventions, both primary and secondary prevention. Objective 1.0 By September 15, 2016, key FCHD staff and business wellness coordinators will attend training for worksite wellness development, and other pertinent trainings, such as policy/systems/environmental change, and community health. How Met: Wellness leaders at the participating businesses were offered a workshop focused on the benefits of promoting physical activity at the workplace and strategies for being successful in doing this. Four of the worksites attended this workshop. For those that weren't able to attend, the project coordinator shared and reviewed the resources provided in the workshop. Activity: Partner with NE Department of Health and Human Services in providing and /or attending trainings to build capacity in district businesses. Performance Measure Achieved: A capacity building opportunity was offered to the partnering businesses. Activity: Renew partner worksite wellness memberships as appropriate. Performance Measure Achieved: Continued membership with the Wellness Council of America and WorkWell. Other specific evaluation questions were: 1. How many businesses are engaged to participate in the program? There were nine businesses that started the program and seven that completed the program. One dropped out because their business closed and another dropped out because of losing some key wellness leaders. Four Corners staff participated in the program, but their data was not included in the analysis. 2. How many partnerships are created throughout the program with fitness vendors, wellness centers, or higher education institutions? a. Concordia University, Nebraska, the Health Promotion class, worked on materials for six months of the program. For each of the six months, they created a newsletter, posters, and recipes. b. Local fitness vendors were invited to donate passes for the participants to use their facility. The intent of this step was to help participants experience local resources available to them for being active. The step also helped to support local businesses. 3. Is there an overall increase in the number of minutes of physical activity noted in participating employees? 65% of those we obtained valid pre and post data had an increase in physical activity minutes. Data Collection Primary Sources Data was collected from each of the participating worksites, as well as from participating employees. Data collected from the worksites included: CDC Worksite Health Scorecard Assessment Tool for physical activity Walkability audit to assess how friendly the area around the business is to walkers Each of these assessments was completed with the businesses' wellness coordinator upon enrollment. Data collected from individuals included: Health Risk Assessment for each worksite Individual health data Weight, BMI, blood pressure, waist circumference, and the average number of physical activity minutes completed each week. Individual health data was collected both at the beginning and the end of the program, and then compared as a way to measure improvement from beginning to end. The goal is that we would see at least 1% increase in physical activity of employees at 75% of the enrolled businesses. This goal was met. The results of the individual health data collection are as follows: From the participating businesses, the results are as follows. Post assessment data was obtained from 94 employees. 89 of them improved in at least one area - 8 participants improved in all 5 areas - 24 participants improved in 4 areas - 24 participants improved in 3 areas - 16 participants improved in 2 areas - 17 participants improved in 1 area. In the program, this is the percent that improved in each of the five measurements: Weight: 67% Body Mass Index: 64% Waist Circumference: 55% Blood Pressure: 22% Physical Activity Minutes: 65% Data Collection Secondary Sources 1. Nebraska Behavioral Risk Factor Surveillance System (BRFSS), Office of Health Statistics, Division of Public Health, Nebraska Department of Health and Human Services 2. United States Census Data 3. Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Modifications to the Practice Each of the participating businesses evaluated the results of the program and considered what they could continue throughout the year. One of the businesses continued a tracking competition throughout the year to encourage physical activity and other healthy habits. Another worksite had set up an indoor walking path with information about how many steps/distance it provided.
Collaboration of local public health system partners was key to sustaining the Steps to Wellness program. As we continue to build relationships, we promote the program and link worksites to the program. Through resource development, we connect the population served to resources available in the District. Steps to Wellness informs, educates, and empowers participants about health issues, this in turn positively impacts population health. When a member of the family is in a wellness program such as this, the whole family is affected. This serves as one reason for worksites to participate or to continue with the program…the impact reaches beyond the one employee. The project coordinator and other staff learned many lessons throughout the implementation of this program. Here are some of them: 1. Offering both a three months and six months program provides a way to tailor a program to a worksite's capacity, interest, and needs. Initially, the program was set up to offer a six month program. However, due to some businesses starting after the initial implementation, a three month option needed to be offered. We learned though that not all businesses are suited to implementing a six months long program, due to such things as staffing capacity and their work demands. Suggestion for next implementation: At the start of the program, ask participating businesses to complete a capacity/interest type inventory to better match the health incentive program to their business. 2. Engaging employees more effectively can help in obtaining the post-assessment data. It was challenging for the project coordinator to set up a time with the businesses to come on site for the post-assessment visit. Also, less employees participated in the post assessment than the pre-assessment. Suggestion for next time: When initiating the program, establish the pre and post assessment visit dates with each business. During the pre-assessment visits, provide the date for the post-assessment. 3. Better preparing the wellness leaders in a comprehensive and efficient way can benefit the worksites and the project coordinator. Wellness leaders at individual small to medium size businesses are busy people. Performing these duties most often are in addition to their work responsibilities that take 40 hours to achieve. Suggestion: Besides providing a toolkit, offer an implementation meeting in each county where the businesses in each community can join together for a meeting. They can build comradery and enthusiasm. Also, questions and instructions will be addressed more efficiently for both the worksite and Four Corners. 4. More training could be provided for those who gather the pre- and post-assessment data. With different staff members involved in gathering this data, setting guidelines for how to ask questions and measure numbers will promote consistency in the data measurement, for example measuring blood pressure and helping participants recall their number of moderate intensity physical activity minutes. 5. Be proactive with wellness leaders in improving employee retention. All businesses had some employees stop participating. Suggestion: During the implementation, share with wellness leaders the average percent that can be expected to drop out. Also, share a written guide for keeping employees engaged or re-engaging them once they drop out. The program can be sustained through ongoing worksite membership fees and new businesses enrolling. Four Corners is preparing their new marketing plan to re-enroll current businesses and to engage new businesses. The membership fee helps to support the work of implementing a worksite wellness program from a Local Health Department. To cover any additional costs, infrastructure and grant funds are used. As the program grows, the project coordinator and Executive Director believe that less infrastructure funds will be needed. Sustainability at the business level is achieved several different ways: 1. Each business was equipped with health messages to share through emails, handouts, posters, and laminated signs. These can be used ongoing after the actual program. Some companies began employee walks during business hours. Some measured a space for walking inside and put up signs to let them know the distance. Many participated in the Walk at Lunch Day in April. 2. Wellness leaders were given suggestions throughout the program on how to better give recognition to employees for making healthy choices. This enhanced knowledge can be applied to other programs they choose to do. 3. Employees were provided opportunities for skill building, knowledge about themselves, and resources to support them in healthier habits. a. They had one-on-one visits with a nurse at the start and at the end of the program. They were instructed on the American Heart Association recommendations for physical activity and other tools. The weekly emails, handouts, posters, and signs all served to build their knowledge. b. During the pre- and post-assessments, participating employees learned their numbers and what these numbers mean. By learning their blood pressure, waist circumference, Body Mass Index, physical activity minutes, they were better equipped to make an informed decision on their choices. c. At the end of each month of participation, employees were given a resource to enhance their knowledge in physical activity or nutrition. Also, they were given exercises for balance, strength, or flexibility. At the end of the program, they were given an item to further support healthy choices. Cost/Benefit Analysis Four Corners is a non-profit organization. At the end of an enrollment year for a business, Four Corners often will do a cost/benefit analysis for a worksite to show the value of their enrollment fee and the other ways they invest in worksite wellness. For one of the larger businesses, the project coordinator completed a cost/benefit analysis at the time of their re-enrollment. The analysis included the related expenses for the Steps to Wellness program. The results showed that Four Corners invested an additional $4.00 for every $1.00 this business invested. Four Corners is able to accomplish this level of investment through leveraging other programs and obtaining materials at no or low cost to the department. For example, Four Corners was able to obtain many free high-quality materials from the Nebraska Department of Health and Human Services, and from national government organizations. In Summary Through the various forms of evaluation, employers were able to see the value of the overall worksite wellness program – Take Heart Live Smart, as well as the health incentive campaign – Steps to Wellness. The cost/benefit analysis and individual results show the great value of the program to employers. They realize their enrollment fee is a good investment. Results such as these are what sells worksite wellness programming to employers, especially programming that follows evidence-based practices. The program results generated great enthusiasm for a continued partnership with Four Corners and a strengthened commitment to worksite wellness. All of this contributes to Four Corners' ongoing outreach to local businesses and to our ability to sustain the evidence-based worksite wellness programming in the four counties we serve.
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