The role of business size in assessing the uptake of health promoting workplace initiatives in Australia

Abstract

BackgroundWorksite health promotion (WHP) initiatives are increasingly seen as having potential for large-scale health gains. While health insurance premiums are directly linked to workplaces in the USA, other countries with universal health coverage, have less incentive to implement WHP programs. Size of the business is an important consideration with small worksites less likely to implement WHP programs. The aim of this study was to identify key intervention points and to provide policy makers with evidence for targeted interventions.MethodsThe worksites (n = 218) of randomly selected, working participants, aged between 30 and 65 years, in two South Australian cohort studies were surveyed to assess the practices, beliefs, and attitudes regarding WHP. A survey was sent electronically or by mail to management within each business.ResultsSmaller businesses (<20 employees) had less current health promotion activies (mean 1.0) compared to medium size businesses (20–200 employees – mean 2.4) and large businesses (200+ employees – mean 2.9). Management in small businesses were less likely (31.0 %) to believe that health promotion belonged in the workplace (compared to 55.7 % of medium businesses and 73.9 % of large businesses) although half of small businesses did not know or were undecided (compared to 36.4 and 21.6 % of medium and large businesses). In total, 85.0 % of smaller businesses believed the health promotion activities currently employed in the worksite were effective (compared to 89.2 % of medium businesses and 83.1 % of large businesses). Time and funding were the most cited responses to the challenges to implementing health promoting strategies regardless of business size. Small businesses ranked morale and work/life balance the highest among a range of health promotion activities that were important for their workplace while work-related injury was the highest ranked consideration for large businesses.ConclusionThis study found that smaller workplaces had many barriers, beliefs and challenges regarding WHP. Often small businesses find health promotion activities a luxury and not a serious focus of their activities although this study found that once a health promoting strategy was employed, the perceived effectiveness of the activities were high for all business regardless of size. Tailored low-cost programs, tax incentives, re-orientation of work practices and management support are required so that the proportion of small businesses that have WHP initiatives is increased.

Enabling healthy food choices in the workplace: the canteen operators’ perspective

“…The workplace has been recognised as an important platform for health promotion, and as many employers are investing in initiatives that foster employee wellbeing as part of development of their human resources (Heinen and Darling 2009), the workplace could be instrumental in reducing employee's risk of developing chronic disease (Quintiliani et al 2010). Companies frequently adopt communication strategies and interventions that encourage individuals to make healthier choices when eating at work (Taylor et al 2016), however, canteen food is often criticized for being nutrient-poor, energy-dense and expensive (Sharma et al 2016;Jaworowska et al 2013;Pridgeon and Whitehead 2013).…”

Reasons for Engagement

“…In a further study, it was reported that low participation on the part of 'high risk' SME employees is an additional barrier to engagement in workplace health and wellbeing programs [27]. Taylor et al [28] have also demonstrated that one in five SME owner/managers do not believe health promotion activities belong in the workplace, with a further 50% reporting being unsure or undecided. Subsequently, calls have been made [12] to develop greater understanding regarding the motivations of SME owner/managers to engage with workplace health promotion interventions.…”

“…Previous research has reported that up to one fifth of SME owner/managers do not believe that health promotion activities belong in the workplace and are therefore unlikely to promote or engage in these activities [28]. As such, it is clear that more education regarding the benefits of workplace health promotion is needed within this sector, as changing these notions is a first step to increasing uptake of these types of programs [15].…”

Organizational level factors and their association with smoking-related initiatives and outcomes at small and very small workplaces

“…In one study focused on workplaces with 50 employees or fewer, there were no significant differences in the adoption of a written smoking policy between workplaces employing 5-9, 10-19, 20-29, and greater than 30 employees (Uslan et al, 2007). In a more recent study conducted in Australia, smoking cessation policies were less common among very small workplaces (fewer than 20 employees), compared to medium (20-200 employees) and large (over 200 employees) worksites (Taylor et al, 2016).…”

“…Workplaces employing at least 750 employees have almost seven times the odds of providing a comprehensive health promotion program, compared to workplaces with 50-99 employees (80.5% vs. 29.6%, respectively) (Linnan et al, 2008). Small and very workplaces are also less likely to have smoke and tobaccofree policies in place (Ablah, Dong, & Konda, 2017;Taylor, Pilkington, Montgomerie, & Feist, 2016).…”