Barriers and facilitative factors in the implementation of workplace health promotion activities in small and medium-sized enterprises: a qualitative study

Abstract

Background There is an immense difference between large companies and small and medium-sized enterprises (SMEs) in implementation of evidence-based interventions (EBIs). Previous literature reveals various barriers that SMEs face during implementation, such as a lack of time, accessibility, and resources. However, few studies have comprehensively examined those influential factors at multi-levels. This study aims to identify the factors influencing the implementation of non-communicable disease prevention activities (tobacco, alcohol, diet, physical activity, and health check-up) in SMEs using Consolidated Framework for Implementation Research (CFIR). Methods We conducted 15 semi-structured interviews with health managers and/or employers in 15 enterprises with less than 300 employees, and four focus groups among public health nurses/nutritionists of health insurers who support SMEs in four prefectures across Japan. A qualitative content analysis by a deductive directed approach was performed. After coding the interview transcript text into the CFIR framework constructs by two independent researchers, the coding results were compared and revised in each enterprise until an agreement was reached. Results Of the 39 CFIR constructs, 25 were facilitative and 7 were inhibitory for workplace health promotion implementation in SMEs, which were across individual, internal, and external levels. In particular, the leadership engagement of employers in implementing the workplace health promotion activities was identified as a fundamental factor which may influence other facilitators, including “access to knowledge and information,” “relative priority,” “learning climate,” at organizational level, and “self-efficacy” at the health manager level. The main barrier was the beliefs held by the employer/manager that “health management is one’s own responsibility.” Conclusions Multi-level factors influencing the implementation of non-communicable diseases prevention activities in SMEs were identified. In resource-poor settings, strong endorsement and support, and positive feedback from employers would be important for health managers and employees to be highly motivated and promote or participate in health promotion. Future studies are needed to develop context-specific strategies based on identified barriers and facilitative factors, and empirically evaluate them, which would contribute to narrowing the differences in worksite health promotion implementation by company size.

Effect of employers' concerns about cancer countermeasures on the implementation of cancer screening and support for balancing cancer treatment and work in small and medium-sized Japanese enterprises

“… 33 A recent report noted that continuous support for SMEs' employers improved leadership and promoted workplace health implementation. 34 The Corporate Action to Promote Cancer Control, an MHLW‐commissioned project, involves numerous SMEs and provides cancer education in the workplace, including some seminars and E‐learnings (in the Japanese and English versions). 35 These outside organizations could support improving the cancer awareness of SMEs' employers.…”

Using implementation mapping to develop strategies for preventing non-communicable diseases in Japanese small- and medium-sized enterprises

“…CFIR, a meta-framework, includes five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and the process ( 28 ). We used CFIR because it is important to have a comprehensive understanding of the barriers and facilitators affecting the implementation process at different levels in SMEs, which can then be used to identify context-specific implementation strategies ( 17 ). In this study, we used CFIR primarily to identify performance objectives and determinants for task 2.…”

“…Task 1 was conducted prior to this study and has been published as an original publication ( 17 ). In this previous study, we identified several barriers and facilitative factors of SMEs using CFIR through the semi-structured interviews with employers and health managers ( 17 ).…”

“…Task 1 was conducted prior to this study and has been published as an original publication ( 17 ). In this previous study, we identified several barriers and facilitative factors of SMEs using CFIR through the semi-structured interviews with employers and health managers ( 17 ). Semi-structured interviews were conducted with health managers and/or employers in 15 enterprises with <300 employees and four focus group discussions with 20 public health nurses/nutritionists at the Japan Health Insurance Association (JHIA) branch offices that support SMEs in four prefectures across Japan.…”

“…The challenges smaller workplaces face in offering workplace health promotion programs include having few vendors to serve them, low commitment to and internal capacity for program delivery ( 15 ), and limited direct or administrative costs of running programs ( 16 ). The identified barrier in Japanese SMEs also includes the beliefs held by the employer/manager that health management is one's own responsibility ( 17 ). Furthermore, as smaller workplaces often have high employee turnover rates, investing in workplace health promotion programs designed to prevent chronic diseases made little sense to employers ( 18 ).…”