Towards Effective Design and Evaluation of Workplace Wellness Programs

In an effort to reduce chronic disease burden on the workforce, both public and private initiatives have promoted the rapid expansion of workplace wellness programs to encourage healthy behavior. Despite enthusiasm about these programs, evidence for their effectiveness remains mixed. The major reasons postulated for these mixed results include low participation rates, heterogeneity in program design and non-existent or poorly designed evaluations. In this dissertation, I attempted to address the gaps in the research on program components, their interactions and provide a method for evidencebased evaluation. The first chapter focuses on incentives, which are often prescribed by guidance literature to increase participation. I examined the relationship of high-value and penalty-type incentives to participation rates in a nationwide sample of employers. Results suggested that increasing the value of an incentive may not yield much in terms of participation. Penalty-type incentives were associated with higher participation, but would require significant employee buy-in to implement. The second chapter examines the relationship between program design and employee engagement. Much of the guidance literature recommends adding more components to achieve higher outcomes. However, based on analysis of data from employers and employees, it appears that there are interactions between program components and employee engagement. A program with an average number of services available may be better served by increasing the number of opportunities for employees to participate rather than increasing the number of services. The final chapter synthesizes evidence from the other chapters, guidance from the literature and interviews with wellness program stakeholders in order to provide an evidence base for an interactive evaluation tool. This tool allows small-size employers or employers at the early stages of program implementation to include evidence-based evaluation as part of their program. This dissertation addresses a need in the guidance for a rapidly-expanding wellness market. Researchers can use these findings to adapt guidance to the changing landscape and employers can use the evaluation tool to connect to the evolving guidance.