Results of Employee Involvement in Planning and Implementing the Treatwell 5-a-Day Work-Site Study

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DOI: 10.1177/109019810002700208 2000 27: 223Health Educ Behav

Mary K. Hunt, Ruth Lederman, Steven Potter, Anne Stoddard and Glorian SorensenResults of Employee Involvement in Planning and Implementing the Treatwell 5-a-Day Work-Site Study

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Health Education & Behavior (April 2000)Hunt et al. / Employee Involvement

Results of Employee Involvement inPlanning and Implementing the

Treatwell 5-a-Day Work-Site Study

Mary K. Hunt, MPH, RD, FADARuth Lederman, MPH

Steven Potter, MSAnne Stoddard, ScD

Glorian Sorensen, PhD, MPH

When work-site health promotion programs incorporate theories of community organization, it is likely thatemployee ownership and participation are enhanced. This article reports quantitative indicators of involvementof Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relation-ships between EAB member time spent on project activities and work-site size, with indicators of the extent ofimplementation and variables associated with behavior change and work-site support. The results reported hereindicate that a greater number of EAB member hours spent on program activities was associated with a greaternumber of events implemented. Smaller work-site size was associated with greater employee awareness of theprogram and greater participation in project activities as reported on the employee survey. These results suggestthat the number of hours employee representatives devote to project activities might be an important con-sideration in planning employee involvement in work-site health promotion programming.

Community-organizing principles are an important component of state-of-the-artwork-site health promotion programs.1-5 Involving employees in the planning processincreases the likelihood of greater employee participation in intervention activities

Mary K. Hunt is associate director, Dana-Farber Cancer Institute, Center for Community-Based Research,Boston, Massachusetts. Ruth Lederman is assistant director of evaluation, Center for Community-BasedResearch, Dana-Farber Cancer Institute, Boston, Massachusetts. Steven Potter is a data manager, Center forCommunity-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts. Anne Stoddard is an asso-ciate professor, University of Massachusetts School of Public Health and Health Sciences, University of Massa-chusetts, Amherst, Massachusetts. Glorian Sorensen is a professor, Center for Community-Based Research,Dana-Farber Cancer Institute, Division of Cancer Epidemiology and Control, Boston, Massachusetts;Department of Health and Social Behavior, Harvard School of Public Health, Harvard University, Boston,Massachusetts.

Address reprint requests to Mary K. Hunt, MPH, RD, FADA, Center for Community-Based Research,Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115; phone: (617) 632-2184; fax: (617) 632-1999; e-mail: [email protected].

This study was supported by Grant 5 R01 CA59728 from the National Cancer Institute. The authors ac-knowledge the support of additional grants from the Liberty Mutual Group, the Boston Edison Company, andNew England Electric. The authors are indebted to the 22 community health centers that participated in thisstudy and to the Project Director, Evelyn Stein, MPH, LLD; and intervention staff Flora Baker, MS, EdM, RD,Candace Combe, MS, RD, and Valerie Brinkman-Kaplan, MS, RD, who implemented interventions and main-tained the process tracking data documented here.Health Education & Behavior, Vol. 27 (2): 223-231 (April 2000) 2000 by SOPHE

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by Alina Maria on October 2, 2014heb.sagepub.comDownloaded from

because employee representatives have a voice in shaping interventions to suit the com-pany culture. High levels of employee participation in activities enhance the possibility ofgreater positive health behavior change.1,3,6,7 Several models of community organizingand community building have evolved during the past several decades.6 Many communityand work-site-based studies have used community-organizing strategies based on thelocality development and social planning typologies suggested by Rothman.8,9 Localitydevelopment includes a process of consensus and cooperation in building group identity,whereas the social planning model often uses outside experts and is more task oriented,stressing rational-empirical approaches to problem solving. In the Treatwell 5-a-Daywork-site study, these theories were operationalized by designating primary work-sitecontacts (work-site coordinators) and forming employee advisory boards (EABs).Work-site coordinators served on the EABs. Members represented a variety of depart-ments and occupational categories. Dana-Farber Cancer Institute (DFCI) staff served asoutside experts and EABs used a combination of consensus building and task orientationto plan and implement interventions.

The purposes of this article are (1) to report quantitative measures of the amount ofEAB member involvement in program planning and implementation and (2) to examinethe correlations of an indicator of EAB involvement, amount of EAB member timedevoted to project activities, and work-site size with number of events implemented;employee awareness, participation, and behavior change; and work-site support.

METHOD

Study Design and Setting

Treatwell 5-a-Day was one of the nine community studies supported by the NationalCancer Institutes Five-a-Day for Better Health campaign, which examined the effi-cacy of interventions in increasing the consumption of fruits and vegetables to five ormore servings a day.10 Treatwell 5-a-Day was a randomized, controlled work-site inter-vention study that investigated the role of household support in increasing employeesfruit and vegetable consumption.4,11,12 This work-site study was conducted in 22 commu-nity health centers (CHCs) in Massachusetts. The CHCs ranged in size from 27 to 640employees; 9 of the 22 sites had fewer than 100 employees. The CHCs were randomlyassigned to one of two intervention conditions or a third condition, minimal interventioncontrol. One intervention condition focused on the work site only (WO). The secondintervention condition focused on both work sites and employees families (WPF).Employees in the WO intervention reported a 7% increase (approximately 0.2 servings)in daily servings of fruits and vegetables, while those in the WPF condition reported a19% increase (approximately 0.5 servings). There was no change observed in the mini-mal intervention control condition. The overall difference among the intervention groupswas statistically significant (p = .05).12

Employee Involvement in InterventionPlanning and Implementation

The Treatwell 5-a-Day intervention model incorporated three key constructs: (1)employee involvement based on principles of community organization; (2) use of asocioecological model that addressed individual, family, coworker, and organizational

224 Health Education & Behavior (April 2000)


influences on employee eating behavior; and (3) the incorporation into interventionactivities of tested behavioral and educational strategies. While the overall process track-ing system was designed to document all three key constructs, this article focuses on theemployee involvement component. Details of the complete intervention model,4 finalresults,12 and measurement of the extent of intervention implementation and reach13 aredescribed elsewhere. In this article we refer to two levels of employee participation; one isthe participation of employees in program activities and the other is employee involve-ment in program planning and implementation through EABs.

EABs met monthly with project staff to plan interventions. Typical responsibilities ofboard members included planning for the implementation of core intervention activities,designing EAB-initiated activities, promoting program activities and events, staffing pro-gram activities and events, delivering intervention messages to coworkers, and maintain-ing required documentation.

Data Collection

Data used in this article were collected from three sources: the EAB questionnaire, theprocess tracking system, and the employee survey.

Employee Advisory Board QuestionnaireDFCI staff administered the 34-item EAB questionnaire in seven WO and seven WPF

health centers during Month 12 of the 19.5-month intervention. It was administered at oneof the monthly meetings with follow-up by the work-site coordinator of current membersnot attending the meeting and former EAB members.

Process Tracking System

EAB involvement data were collected with the process tracking system. The termevent is used to describe either multiple-activity interventions or single-activity events.The term activity refers to components of multiactivity events.

Employee Survey

Self-administered baseline and follow-up surveys were given to a census of eligibleemployees in 20 sites with 120 or fewer employees, and to a random sample of 100employees in the two larger sites employing 350 and 600 workers. Those eligible for thesurvey were permanent employees working at least 15 hours per week. The baseline sur-vey was distributed to 1,588 employees and completed by 1,359 (response rate 87%;range across work sites: 75%-100%), and the follow-up survey was distributed to 1,824eligible employees and completed by 1,306 (response rate 76%; range across work sites:56%-100%).

Measures

Employee Advisory Board QuestionnaireThe EAB questionnaire included demographic items and 22 questions that were

used to form three scales measuring EAB membersperception of work-site autonomy/

Hunt et al. / Employee Involvement 225


independence, management involvement and support, and institutionalization/commit-ment. These scales were developed and tested in the Working Well Trial and were foundto have excellent to adequate internal consistency.14 The autonomy/independence scaleconsisted of six questions designed to measure the level of work-site autonomy related toactivities such as deciding on the meeting agenda, chairing meetings, deciding whatactivities occur, when activities occur, who prepares promotional materials, and who runsthe activities. The management involvement/support scale consisted of six items includ-ing the levels of enthusiasm, participation, and support of executive directors andmidlevel managers. The institutionalization/commitment scale consisted of four ques-tions, that is, provision of logistic support, financial contributions, and the provision offood and incentives such as prizes and gifts.

Process Tracking System

Measures of employee involvement and measures of the extent of implementation andreach were documented with the process tracking system.

For employee involvement, staff recorded the demographic characteristics of EABmembers and the number of hours EAB members spent on each project activity. Measuresof the extent of intervention implementation and reach included the number and type ofintervention activities and events and the number of employees attending interventionactivities and events.

Employee Survey

Items from the follow-up employee survey used for this article included measures ofawareness of the project, participation in nutrition-related activities, and fruit and vegeta-ble consumption. Awareness and participation were included because they serve as mile-stones on a continuum that may lead to behavior change.15 That is, employees must firstbe aware of a program so they can participate and learn how to change their behavior.Fruit and vegetable consumption was calculated by using a fruit and vegetable screeneradministered at both the baseline and follow-up surveys.

Program awareness. The program awareness question asked, During the past 2 years,have any of the following health promotion programs or activities been offered at yourworkplace? Respondents chose from five possible program names. Yes responses tothe Treatwell 5-a-Day choice indicated program awareness.

Program participation. To measure participation, we asked, During the past 2 years,have you participated in any of the following nutrition-related activities in your work-place? Five possible responses included nutrition classes or programs; centerwide eventssuch as holiday parties, picnics, or potlucks that included nutrition-related activities; fruitand vegetable taste tests; nutrition-related contests or games; and a learn-at-home nutritionprogram. Yes responses on one or more items were counted as participation.

Fruit and vegetable consumption was measured using the screener that was developedfor use in the National Cancer Institutes nine 5-a-Day for Better Health research projects,based on the national 5-a-Day survey and other fruit and vegetable screeners.16,17 The fol-lowing items were used to assess fruit and vegetable consumption: the frequency of daily



servings of orange or grapefruit juice; other fruit juices; green salad; baked, boiled, ormashed potatoes; vegetables not counting salad or potatoes; and fruit not counting juices.

Data Analysis

Results from each assessment (EAB survey, process tracking, and employee survey)were aggregated to the work-site level and the work site was used as the unit of analysis.For the process tracking data, the number of members and number of hours and eventswere summed across each work site and a total was recorded. To obtain rates peremployee, the totals were divided by the number of employees in a specific work site. Forthe EAB survey, the involvement scales were computed for each EAB member and thenaveraged across the work site. Similarly for fruit and vegetable consumption, the servingsper day were calculated for each respondent to the baseline and follow-up surveys. Thesewere averaged across the work site at each time point, and the work-site specific meanchange was computed by subtraction. For program awareness and participation, the per-centage of employees for each work site was computed.

Analyses were conducted using Statistical Analysis System (SAS) Version 6.10 wherethe CHC was the unit of analysis. General descriptive statistics of mean and standarddeviation, minimums, and maximums were calculated on all variables. Pearson product-moment correlations were calculated to evaluate the bivariate relationships betweenhours of EAB time devoted to project activities and work-site size with the number ofevents, variables on the behavior change continuum, and indicators of work-site support.

RESULTS

The number of hours spent by EAB members on project activities, the number ofevents implemented per site, the number of events offered per employee, and increase inconsumption of fruits and vegetables were greater in the WPF condition. The number ofEAB members per site and percentage participation per event were greater in the WOcondition (see Table 1). The conditions were similar in the number of EAB hours peremployee; the number of EAB members per employee; and percentage awareness of, andparticipation in, programs. Measures of work-site-level involvementthat is, autonomy,management involvement, and institutionalizationwere similar in both conditions.

To examine the relationships between the variables of interest, we combined the con-ditions. EAB involvement was a key construct in both intervention conditions and anexploration of items associated with this involvement was not condition dependent.

As delineated in Table 2, greater numbers of EAB hours spent on program activitieswere correlated with greater numbers of events. Smaller work-site size was associatedwith higher levels of employee awareness of the project and employee participation inproject activities. There were no statistically significant correlations between indicatorsof work-site support and the variables of interest.

The scales measuring work-site support were examined for internal consistency usingthe Cronbachs alpha statistic. These were then compared with the alphas found in theWorking Well Trial in which the scales were developed. Comparing the Working Well Trialwith Treatwell 5-a-Day, the alphas for the autonomy/independence scale were .89 versus.83, for management support .90 versus .85, and for institutionalization .65 versus .70.



DISCUSSION

These results provide quantitative measures of the level of EAB involvement achievedin Treatwell 5-a-Day as well as correlations of an indicator of EAB involvement, numberof EAB hours spent on project activities, with the number of events implemented. Smallwork-site size was associated with higher levels of employee awareness of the project andparticipation in project activities. The main findings from these analyses support empiri-cal evidence for what is commonly understood among health promotion program plan-ners, that is, that the amount of employee involvement is likely to have an impact on theextent of interventions implemented and that it may be advisable to calibrate theamount of EAB member time to the size of the work site. In Treatwell 5-a-Day, it appearsthat the amount of time spent by EAB members on project activities may have been themost important employee involvement factor. While there were fewer EAB members persite in the WPF condition, where the sites achieved a significant change in fruit and vege-table consumption, the number of hours per member spent on project activities was con-siderably larger.

These results provide quantitative support for the findings of other investigators aboutthe potential impact of using community or work-site members in program planning andimplementation.6,18 From a qualitative perspective, Treatwell 5-a-Day EAB membersworked with DFCI to plan and deliver educational and behavior change strategies in a


Table 1. Means and Standard Deviations for Variables by Condition

Work Site Work SiteOnly Plus Family

M SD M SD

Variables documented with process tracking systemNumber hours/EAB member/site 17.3 8.0 27.4 10.4Number EAB members/site 11.0 3.3 7.6 3.1Number EAB hours/employee/site 2.1 1.6 2.2 1.5Number EAB members/employee 0.10 0.04 0.09 0.07Number events/site 32.7 5.0 46.4 5.4Number events/employee 0.33 0.18 0.57 0.35Percentage participation/event 0.35 0.11 0.29 0.12

Variables measured with the employee surveyPercentage aware of the program 90 5.3 89 15.2Percentage participation in events 81 9.9 79 16.3Change in servings of fruits and vegetablesper day 0.4 0.29 0.6 0.69

Measures of indicators of work-site supportfrom survey of EAB members

Autonomy/independencea 3.4 0.63 3.2 0.20Management involvementa 3.2 0.61 3.3 1.0Institutionalizationb 2.8 0.63 2.6 0.52Work-site coordinatorsa 4.8 0.10 4.9 0.05

Average number of employees per site 134 109 186 267

NOTE: EAB = employee advisory board.a. High numerical score indicates higher level of the variable.b. Low numerical score indicates a higher level of institutionalization.


way that appealed to employees with different ethnic backgrounds, ages, and householdcomposition unique to their work sites. For example, all work sites implemented conteststhat included taste tests with recipes and prize drawings. In some sites, these activitieswere combined to form family poetry contests, while in others the activities were deliv-ered as family recipe contests. EAB members also identified and recruited other employ-ees to help with implementation of events and recruited coworkers to participate in pro-gram events.

Process evaluation systems typically use both quantitative and qualitative datasources.

19,20 Much of the literature on process evaluation has been in the form of case stud-ies and descriptive analysis.20 Evaluators have identified a need for quantitative measuresthat provide empirical evidence of the extent of intervention implementation and its rela-tionship to outcome.21 Two other studies have reported quantitative results for employeeinvolvement as part of work-site health promotion. Sorensen et al. identified a relation-ship between program awareness and employee involvement1 and Linnan et al.14 devel-oped quantitative scales that measured EAB members perceptions of work-site supportof health promotion programming.

The correlation of the number of EAB hours spent per employee on project activitieswas strongly and significantly (p =

There are limitations to the interpretation of the findings reported here. Generalizabil-ity is limited because these data were collected in small CHCs. These data were generallyself-reported and so cannot be applied with the same level of confidence as those that arevalidated with objective measures. The product-moment correlation coefficient providesa measure of the general level of association. The test of hypothesis is very sensitive todepartures from the assumption of bivariate normality and to the sample size, thus the pvalues need to be interpreted with caution. Correlation does not indicate causation; how-ever, correlation coefficients of .40 or greater indicate that the two measures vary togetheror that there may be factors influencing them in common.

In conclusion, this study provides quantitative indicators of the level of employeeinvolvement that was achieved in a work-site health promotion program, which incorpo-rated principles of community organization theory and practice. As noted by others, suchinvolvement increases the likelihood for success in the change process and fosters work-site ownership of programs.6,18 Future studies will benefit from the use of process trackingsystems that provide further quantification of employee involvement in program plan-ning and implementation and in examining the relationships between employee involve-ment, process indicators of the extent of intervention implementation, and studyoutcomes.

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Results of Employee Involvement in Planning and Implementing the Treatwell 5-a-Day Work-Site Study