Benchmarking for Best Practices for Multiple Behavior Changes in Employee and Other Populations

Transcription

1 Benchmarking for Best Practices for Multiple Behavior Changes in Employee and Other Populations Janet L. Johnson, Ph.D. Senior VP of Innovation and Implementation Pro-Change Behavior Systems, Inc.

2 How Do We Know if Wellness Programs Work? Many ways to evaluate worksite wellness programs: Organizational support Financial outcomes (i.e. claims savings) Participation Satisfaction Health impact Productivity and performance Value on investment (VOI)

3 How Do We Know if Wellness Programs Work? Engagement Participation Satisfaction Organizational support Health Health impact Behavior change Impact Productivity Financial outcomes VOI/ROI

4 Worksite Wellness Programs Review of 59 studies reporting wellness programs containing Health Risk Assessment with feedback, plus other wellness components. TOBACCO CESSATION FRUIT & VEGETABLES 0.0% 17.8% Strong or sufficient evidence for meaningful effects for Exercise, Healthy Eating (fat reduction), and Tobacco Cessation Median participation rates 57.3% (IQI=44.2% %) HEALTHY EATING 5.4% EXERCISE 15.3% 0% 5% 10% 15% 20% 25% 30% Soler et al. (2010) A Systematic Review of Selected Interventions for Worksite Health Promotion: The Assessment of Health Risks with Feedback, American Journal of Preventive Medicine, 38, S237-S262.

5 TTM: A Population Approach to Wellness Identifies change processes that work best for each stage of change Stage-matched interventions shown to outperform one size fits all Uses methods for proactively reaching out to facilitate change Shown large impact on a population basis

6 TTM Randomized Control Trials Review of 14 studies using TTM computerized tailored interventions Studies provided 26 behavior outcome comparisons across 6 behaviors

7 Common Metrics Smoking Cessation 24 hr. point prevalence Regular Exercise 150 minutes per week Healthy Eating reduced fat and calories Fruit & Vegetable Intake 4½ cups a day Stress Management effectively managing stress Depression Prevention effectively practicing depression prevention

8 Stress Management 70% 60% 50% 40% 30% 20% 10% 0% BASELINE 6 MONTH 12 MONTH 18 MONTH TREATMENT CONTROL Evers, K.E., Prochaska, J.O., Johnson, J.L., Mauriello, L.M., Padula, J.A., & Prochaska, J.M. (2006). A randomized clinical trial of a population- and Transtheoretical model-based stress-management intervention. Health Psychology, 25,

9 Healthy Eating 40% 35% 30% 25% 20% 15% 10% 5% 0% BASELINE 12 MONTH 24 MONTH TREATMENT CONTROL Prochaska, JO, Velicer, WF, Redding, CA, Rossi, JS, Goldstein, M, DePue, J, Greene, GW, Rossi, SR & Sun, X. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer and receive regular mammograms. Preventive Medicine, 41,

10 Regular Exercise 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% BASELINE 6 MONTH 12 MONTH 18 MONTH TREATMENT CONTROL Johnson, SS, Driskell, MM, Johnson, JL, Dyment, SJ, Prochaska, JO, Prochaska, JM, & Bourne, L. (2006). Transtheoretical model intervention for adherence to lipidlowering drugs. Disease Management, 9,

11 Healthy Eating Outcomes 32.3% Range: 20.2% to 47.5% Average: 32.3% JOHNSON 2008 JOHNSON % 20.2% PROCHASKA 2005 VELICER 2004 PROCHASKA % 30.7% 34.0% JONES 2003 PROCHASKA 2004 VELICER 2004 PROCHASKA 2005 JOHNSON 2006 JOHNSON 2008 JONES % 5.4% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Healthy Eating Criteria: fat and calorie intake

12 Exercise Outcomes 47.5% Range: 43.3% to 57.3% PROCHASKA 2012 (COACH) 57.3% Average: 47.5% PROCHASKA 2012 (CTI) 46.6% JOHNSON 2006 PROCHASKA % JOHNSON 2008 PROCHASKA 2008 PROCHASKA 2012 (CTI) JOHNSON % PROCHASKA 2012 (COACH) JOHNSON % 15.3% 0% 10% 20% 30% 40% 50% 60% 70% Exercise Criteria: 150 minutes per week

13 Smoking Cessation Outcomes 23.7% PROCHASKA % Range: 21.1% to 25.6% PROCHASKA % Average: 23.7% VELICER % PROCHASKA 1993 PROCHASKA 2001a PROCHASKA % PROCHASKA 2001b JONES 2003 JONES % PROCHASKA 2004 VELICER 2004 PROCHASKA 2001b 23.2% PROCHASKA 2005 PROCHASKA 2008 PROCHASKA 2001a 25.6% PROCHASKA % 17.8% 0% 5% 10% 15% 20% 25% 30% Smoking Cessation: 24 hour point prevalence

14 Fruit & Vegetable Outcomes Range: 21.0% to 48.5% Average: 34.8% 34.8% GREENE 2008 JOHNSON % 48.5% JOHNSON 2008 GREENE % 0% 10% 20% 30% 40% 50% 60% Fruit & Vegetable Criteria: 4½ cups per day

15 Stress Management Outcomes Range: 60.0% to 74.9% 68.4% Average: 68.4% PROCHASKA 2012 (COACH) 74.9% PROCHASKA 2012 (CTI) PROCHASKA % 73.9% EVERS 2006 PROCHASKA 2008 PROCHASKA 2012 (CTI) PROCHASKA 2012 (COACH) EVERS % 0% 10% 20% 30% 40% 50% 60% 70% 80% Stress Management Criteria: effectively managing stress

16 Depression Outcomes Levesque 2011: 66.7% LEVESQUE % LEVESQUE % 10% 20% 30% 40% 50% 60% 70% 80% Depression Prevention: effectively practicing depression prevention

17 Worksite Case Study 6,544 employees and covered spouses from Oct 2005 through Dec 2010 Participants completed at least 2 Health Risk Interventions To be included in this analyses, there had to be a minimum of 2 years between first and last HRI; the average was 4 years Incentivized for participation Over 90% of the eligible sample participated Female 48% Male 52%

18 Case Study Intervention Female 48% Male 52%

19 Worksite Case Study Program participation was voluntary Incentivized by ability to enroll in preferred benefit plan if actively participated in the wellness program Participation defined as: Female Annual Health Risk Intervention Annual Male 48% biometric screening 52% Enrollment and active participation in LifeStyle Management and/or condition management programs

20 Case Study Intervention 20 operating companies located in 8 states Mixed salaried and hourly jobs Average age 44 Average BMI 28.1 (sd=6.3) African- American 10% Hispanic 4% Other 2% Female 48% Male 52% White 84%

21 Healthy Eating Outcomes CASE STUDY 44.0% Range: 20.2% to 47.5% 32.3% Average: 32.3% JOHNSON % Case Study: 44.0% JOHNSON % JONES 2003 PROCHASKA 2004 PROCHASKA % VELICER 2004 PROCHASKA 2005 JOHNSON 2006 VELICER % JOHNSON 2008 PROCHASKA % CASE STUDY JONES % 5.4% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Healthy Eating Criteria: fat and calorie intake

22 Exercise Outcomes CASE STUDY 55.3% Range: 43.3% to 57.3% 47.5% Average: 47.5% PROCHASKA 2012 (COACH) 57.3% Case Study: 55.3% PROCHASKA 2012 (CTI) 46.6% JOHNSON 2006 JOHNSON 2008 PROCHASKA 2008 PROCHASKA % PROCHASKA 2012 (CTI) PROCHASKA 2012 (COACH) JOHNSON % CASE STUDY JOHNSON % 15.3% 0% 10% 20% 30% 40% 50% 60% 70% Exercise Criteria: 150 minutes per week

23 Smoking Cessation Outcomes CASE STUDY 33.7% 23.7% Range: 21.1% to 25.6% PROCHASKA % Average: 23.7% PROCHASKA % PROCHASKA 1993 Case Study: 33.7% VELICER 2004 PROCHASKA % 22.0% PROCHASKA 2001a PROCHASKA 2001b JONES 2003 PROCHASKA 2004 JONES % VELICER 2004 PROCHASKA 2005 PROCHASKA 2008 PROCHASKA 2001b 23.2% CASE STUDY PROCHASKA 2001a 25.6% PROCHASKA % 17.8% 0% 5% 10% 15% 20% 25% 30% 35% 40% Smoking Cessation: 24 hour point prevalence

24 Fruit & Vegetable Outcomes Range: 21.0% to 48.5% Average: 34.8% Case Study: 50.4% CASE STUDY GREENE % 34.8% 21.0% JOHNSON 2008 GREENE 2008 CASE STUDY JOHNSON % 0.0% 0% 10% 20% 30% 40% 50% 60% Fruit & Vegetable Criteria: 4½ cups per day

25 Stress Management Outcomes Range: 60.0% to 74.9% Average: 68.4% CASE STUDY 67.8% 68.4% Case Study: 67.8% PROCHASKA 2012 (COACH) 74.9% EVERS 2006 PROCHASKA 2008 PROCHASKA 2012 (CTI) PROCHASKA 2012 (CTI) 64.7% PROCHASKA 2012 (COACH) CASE STUDY PROCHASKA % EVERS % 0% 10% 20% 30% 40% 50% 60% 70% 80% Stress Management Criteria: effectively managing stress

26 Depression Outcomes Levesque 2011: 66.7% Case Study: 68.0% CASE STUDY 68.0% LEVESQUE 2011 CASE STUDY LEVESQUE % 0% 10% 20% 30% 40% 50% 60% 70% 80% Depression Prevention: effectively practicing depression prevention

27 Summary of Case Study Outcomes 5 of 6 behaviors within the range of RCT outcomes Smoking exceeded the range 4 behaviors were higher than the RCT average Smoking, Exercise, Healthy Eating, Fruit & Vegetable 2 approximately equal to the RCT average Stress Management, Depression Prevention

28 Why Successful? High participation Consistent program delivery, communications, and leadership commitment Participants allowed choice of behavior Ongoing treatment Co-action

29 Benchmarking Wellness Randomized clinical trials may be the gold standard, but not always possible Review of existing programs and previous RCTs can provide basis for expected effects These expected effects can be utilized over time to ensure implemented programs are performing

30 Moving Beyond the Benchmark As new program components are added, can compare to the benchmarks and previous results to ensure programs still having an impact Texting added to existing Smoking Cessation program Cessation rates found to be 40.3% RCT average 23.7% Case study 33.7%

31 Wellness Programs: a word of caution Comparisons of programs without RCT need to be done cautiously Important to develop and implement programs that have built in assessment and evaluation Not all wellness programs work as well as others