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Discover the three major lessons of successful program implementation

This is an excerpt from Implementing Physical Activity Strategies by Russell Pate & David Buchner.

Program leaders identified three major lessons that will assist with future implementation of similar programming: (1) use technology to automate administrative components of the program; (2) cultivate community partnerships and leverage existing partnerships to enhance program success; and (3) introduce gradually and progress mindfully.

The first year of ChooseWell LiveWell was entirely "paper-based." The wellness program manager and SPPS wellness champions administered program registration, materials, and communications manually. The administrative burden placed on these individuals detracted from their ability to focus on motivating and coaching employees and limited the scope of the program's reach. The development and launch of the district wellness website enabled program staff and volunteers to focus their roles on health promotion. The website helped broaden the reach of the program by facilitating 24/7 access to program information, registration, and materials.

Another key lesson was to form partnerships whenever possible. By design, ChooseWell LiveWell was created as a partnership between a local health services organization and a community school district. Annual meetings among leaders from both institutions have helped to facilitate communication and ensure that programming is informed by the latest evidence and industry knowledge and meets the needs of the population. The success of the program also can be attributed to partnerships within the school district. In the first three years of the program, ChooseWell LiveWell staff partnered with staff who worked on student-focused wellness efforts. The program leveraged the existing network of wellness champions from the Steps grant, as well as Minnesota's Statewide Health Improvement Program, to partner and promote program options available to employees throughout the district.

ChooseWell LiveWell was developed at a gradual pace, and monitoring and evaluation were used to inform program changes from year to year. Program expansion was mindful and deliberate, taking into account the needs of the employee population and the latest evidence-based interventions.

Program Evaluation

An advisory group consisting of program staff and leaders from both the school district and HealthPartners convenes annually to evaluate and assess the effectiveness of the program. The group's meetings include a program overview and discussions about the number of sites involved, available program options, and population-level health indicators from the health assessment. The discussions have informed annual program planning and staffing and provide an opportunity for leaders within the school district and HealthPartners to share ideas and discuss planning for the coming year and strategy going forward.

Central to evaluation of the ChooseWell LiveWell program is the employee health assessment offered each fall. Developed by HealthPartners, the health assessment contains a cross section of scientifically validated questions and medically approved algorithms that can accurately predict a person's likelihood of developing diabetes or heart disease in the next two to three years. It includes a series of questions in several areas: personal demographics and health history, self-care, women's health, nutrition, physical activity, alcohol and tobacco, safety, and readiness to change. The health assessment is predictive of health care costs and worker productivity indicators and has been a key instrument for the documentation of the program's impact on health and costs over time.

Annual reports are generated based on health assessment information, including summary health scores. The summary health scores allow for tracking of population health over time and are used to estimate the impact of the program on cost-related outcomes, such as estimated health care cost savings over time. In general, these indicators have shown a progressive improvement in overall population health, resulting in cost savings. In year 5 of the program, HealthPartners estimated cumulative four-year (2005-2006 through 2008-2009) health care cost savings of $632 per participant (or $158 per participant per year), based on the improvements in summary health scores. Additionally, a group of 1,942 unique individuals who participated in the program for all 5 program years, from 2005 to 2010, experienced statistically significant improvements in physical activity.

Tables 25.3 and 25.4 display the descriptive characteristics, key physical activity indicators, and aggregate improvement over time among a unique cohort of 1,942 participants who participated in the first five years of the ChooseWell LiveWell program.

Populations Best Served by the Program

The ChooseWell LiveWell program could be replicated in a variety of employer settings. The wellness website enabled easy communication and access to employees across the many sites in the school district. This program feature would serve employer populations in all sectors well, including small and medium-sized employers, and especially those with offices in many different locations.

Tips for Working Across Sectors

The core ChooseWell LiveWell program components - annual employee health assessment with personalized feedback, a variety of program options, incentives for participation and effective communications - have been demonstrated to be effective in other industries. Key to the success of this program was the leadership support from both major program partners as well as the focus on building and optimizing a culture of health within the organization. Future programs should consider the specifics of organizational culture and potential impacts on program implementation. The role of the wellness website, for example, may be less impactful in sectors in which computer access is limited.

Additional Reading and Resources

Bandura, A. Health promotion from the perspective of social cognitive theory. Psychol. Health 13:623-49.

Burke, L.E., J. Wang, and M.S. Sevick. 2010. Self-monitoring in weight loss: A systematic review of the literature. J. Am. Diet. Assoc. 111:92-102.

Helsel, D.L., J.M. Jakicic, and A.D. Otto. 2007. Comparison of techniques for self monitoring, eating and exercise behaviors on weight loss in a correspondence-based intervention. J. Am. Diet. Assoc. 107:1807-10.

Hogan, B.E., W. Linden, and B. Najarian. 2002. Social support interventions: Do they work? Clin. Psychol. Rev. 22(3):381.

Lindberg, R. 2000. Active living: On the road with the 10,000 steps program. J. Am. Diet. Assoc. 100(8):878-9.

Prochaska, J.O., and W.G. Velicer. 1997. The transtheoretical model of health behavior change. Am. J. Health Promot. 12(1):38-48.

N.P. Pronk. 2008. Designing a multisector approach to health and wellness. In: America's Health Insurance Plans (AHIP). AHIP innovations in prevention, wellness and risk reduction (pp. 18-21).

Pronk, N.P., Ed. 2009. ACSM's Worksite Health Handbook, Second Edition. A Guide to Building Healthy and Productive Companies. Champaign, IL: Human Kinetics.

Pronk, N.P. 2009. Physical activity promotion in business and industry: Evidence, context, and recommendations for a national plan. Journal of Physical Activity and Health 6(Suppl. 2):S220-35.

Pronk, N.P., M. Lowry, M. Maciosek, and J. Gallagher. 2011. The association between health assessment-derived summary health scores and health care costs. J. Occup. Environ. Med. 53(8):872-8.

Thygeson, M.N., J.M. Gallagher, K.K. Cross, and N.P. Pronk. 2009. Employee health at BAE Systems: An employer-health plan partnership approach. In: ACSM's Worksite Health Handbook: A Guide to Building Healthy and Productive Companies (pp. 318-326). N.P. Pronk, Ed. Champaign, IL: Human Kinetics.

Wantland, D.J., C.J. Portillo, W. Holzemer, R. Slaughter, and E.M. McGhee. 2004. The effectiveness of web-based vs. non-web-based interventions: A meta-analysis of behavioral change outcomes. J. Med. Internet Res. 6(4).

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