Historique
Article de Périodique
Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity (Review) (2018)
Auteur(s) :
L. WOLFENDEN ;
S. GOLDMAN ;
F. G. STACEY ;
A. GRADY ;
M. KINGSLAND ;
C. M. WILLIAMS ;
J. WIGGERS ;
A. MILAT ;
C. RISSEL ;
A. BAUMAN ;
M. M. FARRELL ;
F. LEGARE ;
A. BEN CHARIF ;
H. T. V. ZOMAHOUN ;
R. K. HODDER ;
J. JONES ;
D. BOOTH ;
B. PARMENTER ;
T. REGAN ;
S. L. YOONG
Article en page(s) :
CD012439 ; 129 p.
Sous-type de document :
Revue de la littérature / Literature review
Domaine :
Alcool / Alcohol ; Tabac / Tobacco / e-cigarette
Langue(s) :
Anglais
Thésaurus mots-clés
MILIEU PROFESSIONNEL
;
TABAC
;
ALCOOL
;
NUTRITION
;
ACTIVITE PHYSIQUE
;
OBESITE
;
INTERVENTION
;
FACTEUR DE RISQUE
;
EDUCATION POUR LA SANTE
;
PREVENTION
;
EFFICACITE
Résumé :
The review question: Implementation strategies are meant to improve the adoption and integration of evidence-based health interventions into routine policies and practices within specific settings. This review examined whether using these strategies improved the implementation of policies and practices in the workplace promoting healthy eating, physical activity, weight control, tobacco cessation and prevention of risky alcohol consumption. We also wanted to know if these strategies changed employees' health behaviours, caused any unintended effects, and were good value for money.
Background: Workplaces are a good setting for programmes that aim to improve health-related behaviours like diet, physical activity and tobacco use, as adults spend a long time at work each day. However, these kinds of workplace-based interventions are often poorly implemented, limiting their potential impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to increase their impact on chronic disease prevention.
Study characteristics: We looked for studies that compared strategies to support the implementation of health-promoting policies and practices in workplaces versus either no implementation strategy or different implementation strategies. Implementation strategies could include quality improvement initiatives, education, and training, among others. They could target policies or practices directly instituted in the workplace (e.g. workplace healthy catering policy), as well as workplace-led efforts to encourage the use of external health promotion services (e.g. employee gym membership subsidies).
We found six eligible studies that investigated these strategies. Most took place in the USA, and workplaces were in the manufacturing, industrial and services-based sectors. The number of workplaces examined in the studies ranged from 12 to 114. Implementation strategies in the six studies targeted different workplace policies and practices: healthy catering; point-of-purchase nutrition labelling; environmental prompts and supports for healthy eating and physical activity; tobacco control policies; sponsorship of employee weight management programmes; and adherence to national guidelines for staff health promotion. All studies used multiple strategies to improve the implementation of these policies and practices, including: educational meetings, interventions tailored to the specific needs of the workplace, and workplace consensus processes to implement a policy or practice. Four studies compared implementation strategies versus no intervention, one study compared different implementation strategies, and one study compared two implementation strategies with each other and a control. Researchers used surveys, audits and observations in workplaces to evaluate the effect of the strategies on the implementation of workplace policies and practices.
Search date: The evidence is current to 31 August 2017.
Key results: When we combined findings from three studies, we did not find any difference in the level of implementation of health-promoting policies or practices between workplaces that received implementation strategy support versus those that did not, indicating that these strategies may make little to no difference. In the two trials comparing different implementation strategies, both reported improvements in implementation, favouring the more intensive implementation support group. Findings for effects on employee health behaviours were inconsistent and based on very low to low certainty evidence, so it is unclear whether the implementation strategies improved these outcomes. One of the included studies reported on cost, and none on the unintended adverse consequences of implementation strategies.
Certainty of evidence: There were few included studies, and they used inconsistent terminology to describe implementation strategies, limiting the strength of the evidence. We rated the certainty of the evidence as low for the effect of implementation strategies on policy and practice implementation, based on four randomised studies (where groups are randomly assigned to different study groups), and very low based on two non-randomised studies. We also graded evidence on employee health behaviours and cost outcomes as low and very low. The findings of the review do not provide clear evidence regarding the impact of implementation strategies on workplace health-promoting policy and practice implementation or on employee health behaviours. Further research is needed.
Background: Workplaces are a good setting for programmes that aim to improve health-related behaviours like diet, physical activity and tobacco use, as adults spend a long time at work each day. However, these kinds of workplace-based interventions are often poorly implemented, limiting their potential impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to increase their impact on chronic disease prevention.
Study characteristics: We looked for studies that compared strategies to support the implementation of health-promoting policies and practices in workplaces versus either no implementation strategy or different implementation strategies. Implementation strategies could include quality improvement initiatives, education, and training, among others. They could target policies or practices directly instituted in the workplace (e.g. workplace healthy catering policy), as well as workplace-led efforts to encourage the use of external health promotion services (e.g. employee gym membership subsidies).
We found six eligible studies that investigated these strategies. Most took place in the USA, and workplaces were in the manufacturing, industrial and services-based sectors. The number of workplaces examined in the studies ranged from 12 to 114. Implementation strategies in the six studies targeted different workplace policies and practices: healthy catering; point-of-purchase nutrition labelling; environmental prompts and supports for healthy eating and physical activity; tobacco control policies; sponsorship of employee weight management programmes; and adherence to national guidelines for staff health promotion. All studies used multiple strategies to improve the implementation of these policies and practices, including: educational meetings, interventions tailored to the specific needs of the workplace, and workplace consensus processes to implement a policy or practice. Four studies compared implementation strategies versus no intervention, one study compared different implementation strategies, and one study compared two implementation strategies with each other and a control. Researchers used surveys, audits and observations in workplaces to evaluate the effect of the strategies on the implementation of workplace policies and practices.
Search date: The evidence is current to 31 August 2017.
Key results: When we combined findings from three studies, we did not find any difference in the level of implementation of health-promoting policies or practices between workplaces that received implementation strategy support versus those that did not, indicating that these strategies may make little to no difference. In the two trials comparing different implementation strategies, both reported improvements in implementation, favouring the more intensive implementation support group. Findings for effects on employee health behaviours were inconsistent and based on very low to low certainty evidence, so it is unclear whether the implementation strategies improved these outcomes. One of the included studies reported on cost, and none on the unintended adverse consequences of implementation strategies.
Certainty of evidence: There were few included studies, and they used inconsistent terminology to describe implementation strategies, limiting the strength of the evidence. We rated the certainty of the evidence as low for the effect of implementation strategies on policy and practice implementation, based on four randomised studies (where groups are randomly assigned to different study groups), and very low based on two non-randomised studies. We also graded evidence on employee health behaviours and cost outcomes as low and very low. The findings of the review do not provide clear evidence regarding the impact of implementation strategies on workplace health-promoting policy and practice implementation or on employee health behaviours. Further research is needed.
Affiliation :
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia