Taylor A W, Pilkington R, Montgomerie A, Feist H
Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia.
School of Public Health, The University of Adelaide, Adelaide, South Australia.
BMC Public Health. 2016 Apr 21;16:353. doi: 10.1186/s12889-016-3011-3.
Worksite 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.
The 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.
Smaller 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.
This 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.
工作场所健康促进（WHP）举措越来越被视为具有带来大规模健康收益的潜力。在美国，医疗保险费与工作场所有直接关联，而在其他实行全民医保的国家，实施WHP项目的动力则较小。企业规模是一个重要考量因素，小型工作场所实施WHP项目的可能性较小。本研究的目的是确定关键干预点，并为政策制定者提供针对性干预的证据。
在南澳大利亚的两项队列研究中，对年龄在30至65岁之间的随机选取的在职参与者的工作场所（n = 218）进行了调查，以评估有关WHP的实践、信念和态度。通过电子邮件或邮寄方式向每个企业的管理层发送了一份调查问卷。
与中型企业（20至200名员工，平均为2.4项）和大型企业（200名及以上员工，平均为2.9项）相比，小型企业（员工少于20人）目前的健康促进活动较少（平均为1.0项）。小企业的管理层认为健康促进属于工作场所的可能性较小（31.0%）（中型企业为55.7%，大型企业为73.9%），尽管一半的小企业不知道或未做决定（中型企业和大型企业分别为36.4%和21.6%）。总体而言，85.0%的小型企业认为工作场所目前开展的健康促进活动是有效的（中型企业为89.2%，大型企业为83.1%）。无论企业规模如何，时间和资金是实施健康促进策略面临挑战时被提及最多的因素。在一系列对其工作场所很重要的健康促进活动中，小企业将士气和工作/生活平衡排在最高位，而工伤是大企业最重视的因素。
本研究发现，小型工作场所在WHP方面存在诸多障碍、信念和挑战。小企业通常认为健康促进活动是一种奢侈，而非其活动的重点，尽管本研究发现，一旦采用了健康促进策略，所有企业（无论规模大小）对这些活动的感知效果都很高。需要制定量身定制的低成本项目、税收激励措施、调整工作方式以及提供管理支持，以提高实施WHP举措的小企业比例。
