Barriers and Facilitative Factors in the Implementation of Workplace Health Promotion Activities in Small and Medium-Sized Enterprises: A Qualitative Study

Abstract

Background: It is reasonable to target small and medium-sized enterprises (SMEs) as a workplace to promote the implementation of evidence-based interventions (EBIs) for reducing health inequalities. 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 enterprise, 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 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 inequalities in worksite health promotion implementation by company size.

Implementation of an internet-based stress management program in micro- and small-sized enterprises: A study protocol for a pre-post feasibility study of the effectiveness-implementation hybrid type 2 trial

“…This study protocol will apply the specific implementation strategy wherein researchers meet with employers/managers online for 30-45 minutes to encourage them to invite employees to participate in the "WellBe-LINE" Program. This strategy is based on previous findings of leadership engagement being a considerable barrier in the health program implementation (7). Furthermore, PPI partners who engaged in all research stages will provide essential suggestions in implementation, leading to a positive impact on field-specific studies (65).…”

“…After obtaining agreement, researchers will provide 30-45 minutes of online semi-structured lectures (meetings) with employers and managers via zoom to determine the situation at the company and provide knowledge about behavioral changes and an effective way to invite employees for participation and attain high penetration. A previous qualitative study suggested that fundamental factors influencing the implementation of workplace health promotion in SMSEs entail the leadership engagement of employers (7). Table 1 presents and justifies the contents of the semi-structured lecture with implementation strategy specification guidelines introduced by Proctor et al (42) for each component.…”

“…Previous studies have identified barriers to the implementation of mental and health interventions in small companies (7)(8)(9)(10)(11)(12): low leadership engagement of employers (7), lack of knowledge about the impact on business (8), limited resources (9,12), limited time and money (11), regulations (no legal requirement) (12), lack of understanding on the necessity of the interventions and suboptimal approach (10). Additionally, job-related stressors between small and large companies varied (13).…”