Socioeconomic inequalities in effectiveness of and compliance to workplace health promotion programs: an individual participant data (IPD) meta-analysis

Abstract

Background This individual patient data (IPD) meta-analysis aimed to investigate socioeconomic inequalities in effectiveness on healthy behavior of, and compliance to, workplace health promotion programs. Methods Dutch (randomized) controlled trials were identified and original IPD were retrieved and harmonized. A two-stage meta-analysis was conducted where linear mixed models were performed per study (stage 1), after which individual study effects were pooled (stage 2). All models were adjusted for baseline values of the outcomes, age and gender. Intervention effects were assessed on physical activity, diet, alcohol use, and smoking. Also, we assessed whether effects differed between participants with low and high program compliance and. All analyses were stratified by socioeconomic position. Results Data from 15 studies ( n = 8709) were harmonized. Except for fruit intake (beta: 0·12 [95% CI 0·08 0·15]), no effects were found on health behaviors, nor did these effects differ across socioeconomic groups. Only participants with high compliance showed significant improvements in vigorous and moderate-to-vigorous physical activity, and in more fruit and less snack intake. There were no differences in compliance across socioeconomic groups. Conclusions Workplace health promotion programs were in general not effective. Neither effectiveness nor compliance differed across socioeconomic groups (operationalized by educational level). Even though stronger effects on health behavior were found for participations with high compliance, effects remained small. The results of the current study emphasize the need for new directions in health promotion programs to improve healthy behavior among workers, in particular for those in lower socioeconomic position.

Parental Compliance towards Oral Health Education among Preschoolers with Special Healthcare Needs

“…In the present study, there were no differences in compliance across participants with various socioeconomic backgrounds. This was consistent with a meta-analysis conducted by Coenen and colleagues [ 26 ]. In the bivariate analysis, participant adherence to follow-ups was related to parents’ perception of children’s oral hygiene status, parents’ attitudes towards the education topics, and parents’ OHL scores, whereas parental compliance with investigators’ advice was only related to parents’ perception of the usefulness of the OHE material.…”

“…Apart from the parent-report compliance with the investigators’ advice, we also analyzed participants’ adherence to follow-up studies. Coenen and colleagues also determined compliance by assessing the participant adherence to health promotion programs [ 26 ]. By assessing participant adherence to follow-ups and parental compliance with investigators’ advice, an analysis of parental compliance towards the OHE program was provided in this study.…”

Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy

“…By applying an equity lens to the analysis of data from PA intervention studies, our strategy offers an approach to filling the gap in knowledge about the impact of these interventions on health inequalities. In contrast to other approaches of equity-specific re-analysis, our strategy proposes the consideration of several SEP indicators instead of focusing on education only [ 40 , 41 ] or using several SEP indicators interchangeably [ 38 , 39 ]. Moreover, besides equity-specific intervention effects, the novel strategy includes investigating equity-specific intervention reach, adherence, and dropout, allowing for a comprehensive assessment of equity-specific intervention benefits.…”

“…47 (33) 206 (63) 121 (37) 167 (65) 89 (35) 102 ( 67 282 (40) 154 (59) 107 (41) 268 (60) 175 (40) 177 (54) 153 (46) 148 ( 68)…”

“…A criticism of this approach is that few studies are designed with adequate sample sizes to run such interaction or subgroup analyses, so that many of the current findings are based on potentially underpowered post-hoc analyses with limited credibility [33,34]. However, given the importance of better understanding whether, how, and why interventions affect health inequalities, and the plausibility of differential intervention effects, equityspecific re-analyses of data of existing intervention studies are arguably a valuable approach [35][36][37][38][39][40][41]. One particular reason is that the consistent conduct and reporting of such analyses allows for pooling effect estimates across studies, which increases statistical power and improves the credibility of the findings [42].…”