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Vitality and health: A lifestyle programme for employees
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European Journal of Integrative Medicine 3 (2011) e97–e101
Original article
Vitality and health: A lifestyle programme for employees Miranda van Duijn a , Ines von Rosenstiel b , Winnie Schats c,∗ , Carien Smallenbroek d , Rutger Dahmen a a
Department of Rehabilitation, Slotervaart Hospital Amsterdam, Netherlands b Department of Pediatrics, Slotervaart Hospital Amsterdam, Netherlands c Medical Library, Slotervaart Hospital Amsterdam, Netherlands d Human Resources, Slotervaart Hospital Amsterdam, Netherlands
Received 12 August 2010; received in revised form 18 April 2011; accepted 18 April 2011
Abstract Background: The implementation of Integrative Medicine in the Netherlands is still in its infancy, with the Amsterdam Slotervaart Hospital currently leading the way. Recently a project was started from the principles of the Healthy Hospitals, with specific attention for the health of the hospital personnel. Primary goal of the project is to offer a lifestyle programme (“Vitality and Health”) to the employees of the Slotervaart Hospital. Methods: To gain insight in the demands and needs about a lifestyle programme a survey was performed among employees of the Slotervaart Hospital. A questionnaire and an informative letter were sent to the home address of each hospital employee. The survey consisted of questions regarding four domains: health check, exercise, stress reduction and healthy nutrition. Results: The Slotervaart Hospital employees who responded to the questionnaire were positive towards an expansion of all four domains in the vitality and health programme: health check, exercise, stress reduction and nutrition. With the exception of a few activities percentages of 50% and often higher were scored. Conclusion: Employees are willing to invest in health (for instance by contributing financially) but they consider it important as well that the employer stimulates healthy behaviour. © 2011 Elsevier GmbH. All rights reserved. Keywords: Promotion of Health; Prevention; Hospital personnel; Integrative Medicine
Introduction The implementation of Integrative Medicine in the Netherlands is still in its infancy, with the Amsterdam Slotervaart Hospital currently leading the way. This hospital is the first and only health care institution that openly endorses and implements Integrative Medicine in its philosophy. A number of complementary and attractive medicine techniques have become part of the existing treatments for patients. Recently a project was started from the principles of the Healthy Hospitals, with specific atten-
∗
Corresponding author. E-mail address: [email protected] (W. Schats).
1876-3820/$ – see front matter © 2011 Elsevier GmbH. All rights reserved. doi:10.1016/j.eujim.2011.04.025
tion for the health of the hospital personnel. Primary goal of the project is to offer a lifestyle programme for the employees of the Slotervaart Hospital. The project was set up following media reports about the positive effects of healthy nutrition and exercise on employees. One of the demands at the start of the project was that it should supply integral advice on a healthy lifestyle, an exercise programme, a programme aimed at stress reduction and an improved supply of healthy foods. This project should clearly be non-committal and optional for the Slotervaart Hospital employees and the different parts of the program should be interconnected. Foundation for the expansion of the lifestyle programme was a questionnaire among all employees of the Slotervaart Hospital, to gain insight in the demands and needs of the staff regarding new programmes and the level of participation among personnel. This article reports on the findings from the survey.
e98
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101
Methods
Results
Literature search
Population
At the start of the project an inventory was made of the components that are supposed to be effective in developing a healthy lifestyle by employees. Emphasis in this inventory was the available scientific evidence regarding the effectiveness of various components. A substantial part of studies on lifestyle interventions in employees is aimed at stress reduction. A Cochrane Review of 14 RCTs concludes that both person-directed interventions and work-directed interventions can have a positive effect on stress and related health measures. Larger and better quality trials are needed to confirm the limited evidence [1,2]. Evidence was also collected about the effect of a sedentary lifestyle as a risk factor for absenteeism and health care costs [3–5]. Although results are not conclusive when absenteeism is the outcome assessment tool, exercise has a proven positive effect on other health measures [6]. Healthy nutrition has proven to be an important component for a healthy lifestyle as well. This has not only been shown in the general population but has also been studied among employees [7] and more specifically among hospital employees [8]. A multiple approach to a healthy lifestyle is advised, with attention for healthy nutrition, no smoking, adequate exercise and reducing stress, instead of an approach that is based on one single component.
A total of 1352 questionnaires were sent to the Slotervaart Hospital’s employees. A total of 412 questionnaires was returned that could be used for the analyses, a response rate of about one third. Bias in the results is possible because employees that did not respond might also not be positive towards new activities regarding a healthy lifestyle. However, there are no known data about the non-response group. Three quarters of the participating employees was female. The total population of the Slotervaart Hospital consists of 73% women. The average age was 43, this is also the average in the total staff population. Of the respondents the majority (88%) regarded themselves part of the Dutch population. Data on the profession of the respondents indicated that 28% belonged to nursing staff, 10% were medical specialists, 11% were paramedical staff, 14% were administrative staff, 9% were laboratory staff, 11% were auxiliary staff, and 17% of the responders were in the category ‘other jobs’. These response percentages are more or less in accordance with the different professional categories within the total population of employees in the Slotervaart Hospital. Only paramedical staff are over-represented in the questionnaire responses; about 50% of them responded. Since they are only a very small group within the hospital employee population this does not change the results of the study significantly.
The survey
Health check
The results of the literature search were used to determine which lifestyle interventions were possibly effective. The Slotervaart hospital employees were then asked how far they had a need for interventions in these domains and more specifically what these interventions should be. For this purpose a written questionnaire was developed, which consisted of questions regarding four domains: health check, exercise, stress reduction and healthy nutrition. An assessment was made through yes/no questions on how valuable the hospital employees considered an expansion of the current programmes and whether or not they would participate in any new activities. In a set of open questions employees could suggest new activities and the prerequisites for participation were mapped with a set of theses. The questionnaire and an informative letter were sent to the home address of each hospital employee. In the letter it was made clear that the questionnaire was anonymous, name and date of birth were not asked, only information was requested regarding age. The completed questionnaires could be posted in a big poll box in the hospital’s reception area. The box was regularly emptied by one of the research employees. A reminder was sent twice via intranet, each time emphasizing the respondent’s anonymity. Anyone who had not participated yet was asked to do so and those who had lost the questionnaire could request a new one or obtain one in the hospital’s restaurant.
Employees were asked for their opinion regarding a health check. It was explained that with such a health check assessments were made regarding individual health, for instance a fitness test and lipid measurements. Of all respondents 86% considered this a valuable addition, 79% would participate themselves. Several remarks were made regarding anonymity; employees want to have their health checked but want the resulting data to be available only to themselves. Physical activities An overview of possible new programmes regarding exercise is given in Table 1. In general these options are considered a positive addition to the existing program. With the exception of Nordic Walking all exercise activities are scored positive by more than half of the respondents. The discount on subscriptions to sports centres has the highest score (85%) in the “good addition” column. The highest percentages in the column on intention to participate can be found in activities with a high level of individual freedom, like an individual exercise programme (44%) and discount on sports centres subscriptions (74%). In the open questions regarding new exercise activities various suggestions are made, like salsa dancing, Tai Chi and an expansion of the current fitness programme.
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101 Table 1 Exercise activities, percentages regarding expansion of current programme and intention to participate (n = 412).
Lunch walks Nordic walking Individual exercise programme Open air fitness training Expansion to bicycle plan (extra financial compensation, repair and shower possibilities) Joint participation in external sports activities (business run, hockey competition) Expansion internal sports events Discount on sports subscription (e.g. fitness or swimming)
Good addition (%)
Count me in! (%)
52 35 67 62 75
25 12 44 37 50
55
27
68 85
44 74
Stress reduction This part of vitality has been described in the questionnaire as a good balance between physical strain and relaxation. Specifically information was asked about programmes aimed at stress reduction. Of all respondents 79% considered it desirable that there are activities aimed at stress reduction, Table 2 describes these. Percentages on the ‘value’ of the stress reduction activities are a little higher than those aimed at exercise. An easily accessible activity like chair massage in the workplace (63%) seems to score higher on participation level than, for instance, the yoga course (44%). In the open questions many different suggestions were made for activities aimed at a better balance, aimed at organisation and management and communal activities in the Slotervaart Hospital, like staff parties and a welfare day. Nutrition With regards to nutrition, questions were asked about the addition of specific products to the restaurant’s product range, which resulted in: light products (35%), vegetarian products (29%), biologic products (27%), lactose free (4%), gluten free (3%), and halal products (7%). To a question about whether healthy nutrition is emphasized enough in the Slotervaart Hospital, 61% responded negative Table 2 Stress reduction programmes, percentages regarding expansion and intention to participate (n = 412).
Yoga Stress management course (handling stress at work) Chair massages at the workplace Mindfulness coursea Coaching programme for balance work – home
Valuable addition (%)
Count me in! (%)
68 72
44 45
67 63 53
63 48 32
a Mindfulness teaches attention for the here and now. The exercises are a combination of Buddhist principles and knowledge from Western psychology.
e99
Table 3 Supply aimed at healthy nutrition, percentages regarding expansion and intention to participate (n = 412).
Discount on healthy foods Education by a dietician Expansion of coffee and tea provisions (cooled water, green tea, decaffeinated coffee) Cooking workshop Weight loss programme Alcohol use guidance Smoking cessation guidance
Good addition (%)
Count me in! (%)
84 60 79
77 35 73
41 67 47 65
32 31 3 9
whereas 29% of the respondents feels enough attention is given to healthy nutrition. Table 3 presents an overview of possible additions regarding the food assortment. Notable are the high percentages regarding discounts for healthy foods and expansion of coffee and tea provisions. The count-in percentage for guidance in smoking cessation was 9%. This low percentage is possibly linked to the smokefree status of the Slotervaart Hospital and an existing low-threshold program for employees to quit smoking. Participation prerequisites To the thesis regarding an appropriate time for the activities various replies were possible. Of all respondents 50% suggested they would participate after 16.30 h and 29% scored positive for participation during lunch time. To the thesis that it would be an extra stimulus to offer departmental activities (where people can participate with direct co-workers) 40% gave a positive response. One thesis was posted about financially contributing on an individual basis. 18.9% were completely in agreement about a personal financial contribution, 35.7% partly agreed, whereas 19.7% had a neutral position, they neither agree nor disagree. Less than 15% of participants in the survey were not willing to make a financial contribution, 14.6% partly disagreed and 2.7% completely disagreed with this possibility. Another thesis was posted regarding the fact that a reward like a fitness kit or a heart rate monitor would stimulate participation to activities. A positive score was given by less than half of the respondents (41%). A final thesis pertained to the thesis that the employer has a duty to promote a healthy lifestyle of its employees. This thesis was supported by respectively 33.7% (partly agreed) and 33% (completely agreed). Only 6.3% disagreed partly and 8.3% disagreed completely with this thesis, whereas 17% took a neutral standpoint (Figs. 1 and 2). Discussion The Slotervaart Hospital employees who responded to the questionnaire are positive towards an expansion of all four domains in the vitality and health programme: health check, exercise, stress reduction and nutrition. Except for a few activ-
e100
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101
Fig. 1. Thesis ‘Prepared to own financial contribution’.
ities percentages of 50% and often higher are scored. No distinction can be made between the different domains, expansion is desired for the entire range. The percentages on intention to participate are structurally lower – but still with high scores – than the desire for more activities. New activities with much individual freedom (e.g. discount on sports subscriptions) and low threshold activities (chair massages in the workplace, discounts on healthy foods) score higher on the intention to participate. Nonetheless the other percentages justify a well-advised decision on an actual expansion of such activities, especially considering the total amount of respondents that returned the questionnaire (n = 412). Regarding the prerequisites it can be concluded that employees are willing to invest in health (for instance with a financial contribution)
Fig. 2. Thesis ‘Duty of employer to promote healthy lifestyle’.
and that they consider it important that the employer stimulates healthy behaviour as well. The results are in line with the general advice that any vitality programme should begin with building good habits and awareness among employees, where a survey in the working area is a smart first step. Next to expanding the initiatives, education of the employees deserves attention. Seminars on stress management, nutrition, fitness and health monitoring could be established for patients and employees simultaneously in an Integrative Medicine program. Done well, companies sponsoring wellness programmes saw a 30% reduction in medical and absenteeism costs within 3.6 years, according to a 2005 survey by industry publication The Art of Health Promotion [9]. And the Wellness Councils of America (WELCOA) found up to a $13 return for every $1 that was spent on a comprehensive program [10]. The survey has a few limitations. Only questions were included regarding person-directed interventions, aimed to change personal characteristics without explicit reference to functioning at work. We did not study how far needs were related to the interaction between the person and his or her working environment. Also in this study no questions were included regarding the desire for organisational interventions [2]. A choice was made to start with lifestyle interventions that could relatively easily be implemented in a hospital setting. However, interventions aimed at the work environment or organisation can be effective [1] and will therefore be evaluated in a later stage. The survey was mailed to all personnel of the Slotervaart Hospital. The response rate was one third. A big drawback of this method is that we do not know whether people who did not respond to the survey are at all interested in the possible expansion of lifestyle interventions. Moreover there is the possibility of the healthy responder bias, which could have influence on the results. However, a response rate of one third to a questionnaire is acceptable. Furthermore, a lifestyle improvement among only part of hospital personnel is still a desirable outcome from an employer’s point of view. The evidence for the single components (nutrition, exercise, and stress reduction) is the basis of the survey and the lifestyle programme in the Slotervaart Hospital. A sidenote is that there is only limited evidence available yet, whereas the lifestyle programme is already in progress. The implementation of the programme is therefore accompanied by an evaluation of the effects of the participating employees. In this way the hospital wants to contribute to gathering new insight in lifestyle interventions for employees. The results of the questionnaire have been used as a guideline for the expansion of the vitality and health programme. For each activity it is summarised if it is a ‘winner’, based on the percentages of desirability and intention to participate, the costs and the chances. For each promising activity the necessary prerequisites are currently mapped. After consultation with the board of directors the new programme will be established. The aim is to have as many participants as possible, with specific attention for those that are initially not motivated to participate.
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101
Conflict of interest The authors declare there is no conflict of interest. Acknowledgements The staff of the rehabilitation department of the Slotervaart Hospital has greatly contributed in gathering and processing the necessary data. We would like to thank them for their contribution. References [1] Marine A, Ruotsalainen J, Serra C, Verbeek J. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev 2006;(4):CD002892. [2] Ruotsalainen J, Serra C, Marine A, Verbeek J. Systematic review of interventions for reducing occupational stress in health care workers. Scand J Work Environ Health 2008;34(3):169–78.
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[3] Atlantis E, Chow CM, Kirby A, Fiatarone Singh MA. Worksite intervention effects on physical health: a randomized controlled trial. Health Promot Int 2006;21(3):191–200. [4] Gundewall B, Liljeqvist M, Hansson T. Primary prevention of back symptoms and absence from work. A prospective randomized study among hospital employees. Spine (Phila Pa 1976) 1993;18(5):587–94. [5] Kellett KM, Kellett DA, Nordholm LA. Effects of an exercise program on sick leave due to back pain. Phys Ther 1991;71(4):283–91. [6] Brox JI, Froystein O. Health-related quality of life and sickness absence in community nursing home employees: randomized controlled trial of physical exercise. Occup Med (Lond) 2005;55(7):558–63. [7] Devine CM, Nelson JA, Chin N, Dozier A, Fernandez ID. “Pizza is cheaper than salad”: assessing workers’ views for an environmental food intervention. Obesity (Silver Spring) 2007;15(Suppl. 1):57S–68S. [8] Tountas Y, Manios Y, Dimitrakaki C, Tzavara C. Relationship between basic protective health behaviours and health related quality of life in Greek urban hospital employees. Int J Public Health 2007;52(6):341–7. [9] Chapman LS. Meta-evaluation of worksite health promotion economic return studies: 2005 updates. Art Health Promot 2005:1–15. [10] Goetzel R. ROI-PDQ: are employee wellness programs a solid investment? Absolute Advantage 2002;1(8):40–3.
European Journal of Integrative Medicine 3 (2011) e97–e101
Original article
Vitality and health: A lifestyle programme for employees Miranda van Duijn a , Ines von Rosenstiel b , Winnie Schats c,∗ , Carien Smallenbroek d , Rutger Dahmen a a
Department of Rehabilitation, Slotervaart Hospital Amsterdam, Netherlands b Department of Pediatrics, Slotervaart Hospital Amsterdam, Netherlands c Medical Library, Slotervaart Hospital Amsterdam, Netherlands d Human Resources, Slotervaart Hospital Amsterdam, Netherlands
Received 12 August 2010; received in revised form 18 April 2011; accepted 18 April 2011
Abstract Background: The implementation of Integrative Medicine in the Netherlands is still in its infancy, with the Amsterdam Slotervaart Hospital currently leading the way. Recently a project was started from the principles of the Healthy Hospitals, with specific attention for the health of the hospital personnel. Primary goal of the project is to offer a lifestyle programme (“Vitality and Health”) to the employees of the Slotervaart Hospital. Methods: To gain insight in the demands and needs about a lifestyle programme a survey was performed among employees of the Slotervaart Hospital. A questionnaire and an informative letter were sent to the home address of each hospital employee. The survey consisted of questions regarding four domains: health check, exercise, stress reduction and healthy nutrition. Results: The Slotervaart Hospital employees who responded to the questionnaire were positive towards an expansion of all four domains in the vitality and health programme: health check, exercise, stress reduction and nutrition. With the exception of a few activities percentages of 50% and often higher were scored. Conclusion: Employees are willing to invest in health (for instance by contributing financially) but they consider it important as well that the employer stimulates healthy behaviour. © 2011 Elsevier GmbH. All rights reserved. Keywords: Promotion of Health; Prevention; Hospital personnel; Integrative Medicine
Introduction The implementation of Integrative Medicine in the Netherlands is still in its infancy, with the Amsterdam Slotervaart Hospital currently leading the way. This hospital is the first and only health care institution that openly endorses and implements Integrative Medicine in its philosophy. A number of complementary and attractive medicine techniques have become part of the existing treatments for patients. Recently a project was started from the principles of the Healthy Hospitals, with specific atten-
∗
Corresponding author. E-mail address: [email protected] (W. Schats).
1876-3820/$ – see front matter © 2011 Elsevier GmbH. All rights reserved. doi:10.1016/j.eujim.2011.04.025
tion for the health of the hospital personnel. Primary goal of the project is to offer a lifestyle programme for the employees of the Slotervaart Hospital. The project was set up following media reports about the positive effects of healthy nutrition and exercise on employees. One of the demands at the start of the project was that it should supply integral advice on a healthy lifestyle, an exercise programme, a programme aimed at stress reduction and an improved supply of healthy foods. This project should clearly be non-committal and optional for the Slotervaart Hospital employees and the different parts of the program should be interconnected. Foundation for the expansion of the lifestyle programme was a questionnaire among all employees of the Slotervaart Hospital, to gain insight in the demands and needs of the staff regarding new programmes and the level of participation among personnel. This article reports on the findings from the survey.
e98
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101
Methods
Results
Literature search
Population
At the start of the project an inventory was made of the components that are supposed to be effective in developing a healthy lifestyle by employees. Emphasis in this inventory was the available scientific evidence regarding the effectiveness of various components. A substantial part of studies on lifestyle interventions in employees is aimed at stress reduction. A Cochrane Review of 14 RCTs concludes that both person-directed interventions and work-directed interventions can have a positive effect on stress and related health measures. Larger and better quality trials are needed to confirm the limited evidence [1,2]. Evidence was also collected about the effect of a sedentary lifestyle as a risk factor for absenteeism and health care costs [3–5]. Although results are not conclusive when absenteeism is the outcome assessment tool, exercise has a proven positive effect on other health measures [6]. Healthy nutrition has proven to be an important component for a healthy lifestyle as well. This has not only been shown in the general population but has also been studied among employees [7] and more specifically among hospital employees [8]. A multiple approach to a healthy lifestyle is advised, with attention for healthy nutrition, no smoking, adequate exercise and reducing stress, instead of an approach that is based on one single component.
A total of 1352 questionnaires were sent to the Slotervaart Hospital’s employees. A total of 412 questionnaires was returned that could be used for the analyses, a response rate of about one third. Bias in the results is possible because employees that did not respond might also not be positive towards new activities regarding a healthy lifestyle. However, there are no known data about the non-response group. Three quarters of the participating employees was female. The total population of the Slotervaart Hospital consists of 73% women. The average age was 43, this is also the average in the total staff population. Of the respondents the majority (88%) regarded themselves part of the Dutch population. Data on the profession of the respondents indicated that 28% belonged to nursing staff, 10% were medical specialists, 11% were paramedical staff, 14% were administrative staff, 9% were laboratory staff, 11% were auxiliary staff, and 17% of the responders were in the category ‘other jobs’. These response percentages are more or less in accordance with the different professional categories within the total population of employees in the Slotervaart Hospital. Only paramedical staff are over-represented in the questionnaire responses; about 50% of them responded. Since they are only a very small group within the hospital employee population this does not change the results of the study significantly.
The survey
Health check
The results of the literature search were used to determine which lifestyle interventions were possibly effective. The Slotervaart hospital employees were then asked how far they had a need for interventions in these domains and more specifically what these interventions should be. For this purpose a written questionnaire was developed, which consisted of questions regarding four domains: health check, exercise, stress reduction and healthy nutrition. An assessment was made through yes/no questions on how valuable the hospital employees considered an expansion of the current programmes and whether or not they would participate in any new activities. In a set of open questions employees could suggest new activities and the prerequisites for participation were mapped with a set of theses. The questionnaire and an informative letter were sent to the home address of each hospital employee. In the letter it was made clear that the questionnaire was anonymous, name and date of birth were not asked, only information was requested regarding age. The completed questionnaires could be posted in a big poll box in the hospital’s reception area. The box was regularly emptied by one of the research employees. A reminder was sent twice via intranet, each time emphasizing the respondent’s anonymity. Anyone who had not participated yet was asked to do so and those who had lost the questionnaire could request a new one or obtain one in the hospital’s restaurant.
Employees were asked for their opinion regarding a health check. It was explained that with such a health check assessments were made regarding individual health, for instance a fitness test and lipid measurements. Of all respondents 86% considered this a valuable addition, 79% would participate themselves. Several remarks were made regarding anonymity; employees want to have their health checked but want the resulting data to be available only to themselves. Physical activities An overview of possible new programmes regarding exercise is given in Table 1. In general these options are considered a positive addition to the existing program. With the exception of Nordic Walking all exercise activities are scored positive by more than half of the respondents. The discount on subscriptions to sports centres has the highest score (85%) in the “good addition” column. The highest percentages in the column on intention to participate can be found in activities with a high level of individual freedom, like an individual exercise programme (44%) and discount on sports centres subscriptions (74%). In the open questions regarding new exercise activities various suggestions are made, like salsa dancing, Tai Chi and an expansion of the current fitness programme.
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101 Table 1 Exercise activities, percentages regarding expansion of current programme and intention to participate (n = 412).
Lunch walks Nordic walking Individual exercise programme Open air fitness training Expansion to bicycle plan (extra financial compensation, repair and shower possibilities) Joint participation in external sports activities (business run, hockey competition) Expansion internal sports events Discount on sports subscription (e.g. fitness or swimming)
Good addition (%)
Count me in! (%)
52 35 67 62 75
25 12 44 37 50
55
27
68 85
44 74
Stress reduction This part of vitality has been described in the questionnaire as a good balance between physical strain and relaxation. Specifically information was asked about programmes aimed at stress reduction. Of all respondents 79% considered it desirable that there are activities aimed at stress reduction, Table 2 describes these. Percentages on the ‘value’ of the stress reduction activities are a little higher than those aimed at exercise. An easily accessible activity like chair massage in the workplace (63%) seems to score higher on participation level than, for instance, the yoga course (44%). In the open questions many different suggestions were made for activities aimed at a better balance, aimed at organisation and management and communal activities in the Slotervaart Hospital, like staff parties and a welfare day. Nutrition With regards to nutrition, questions were asked about the addition of specific products to the restaurant’s product range, which resulted in: light products (35%), vegetarian products (29%), biologic products (27%), lactose free (4%), gluten free (3%), and halal products (7%). To a question about whether healthy nutrition is emphasized enough in the Slotervaart Hospital, 61% responded negative Table 2 Stress reduction programmes, percentages regarding expansion and intention to participate (n = 412).
Yoga Stress management course (handling stress at work) Chair massages at the workplace Mindfulness coursea Coaching programme for balance work – home
Valuable addition (%)
Count me in! (%)
68 72
44 45
67 63 53
63 48 32
a Mindfulness teaches attention for the here and now. The exercises are a combination of Buddhist principles and knowledge from Western psychology.
e99
Table 3 Supply aimed at healthy nutrition, percentages regarding expansion and intention to participate (n = 412).
Discount on healthy foods Education by a dietician Expansion of coffee and tea provisions (cooled water, green tea, decaffeinated coffee) Cooking workshop Weight loss programme Alcohol use guidance Smoking cessation guidance
Good addition (%)
Count me in! (%)
84 60 79
77 35 73
41 67 47 65
32 31 3 9
whereas 29% of the respondents feels enough attention is given to healthy nutrition. Table 3 presents an overview of possible additions regarding the food assortment. Notable are the high percentages regarding discounts for healthy foods and expansion of coffee and tea provisions. The count-in percentage for guidance in smoking cessation was 9%. This low percentage is possibly linked to the smokefree status of the Slotervaart Hospital and an existing low-threshold program for employees to quit smoking. Participation prerequisites To the thesis regarding an appropriate time for the activities various replies were possible. Of all respondents 50% suggested they would participate after 16.30 h and 29% scored positive for participation during lunch time. To the thesis that it would be an extra stimulus to offer departmental activities (where people can participate with direct co-workers) 40% gave a positive response. One thesis was posted about financially contributing on an individual basis. 18.9% were completely in agreement about a personal financial contribution, 35.7% partly agreed, whereas 19.7% had a neutral position, they neither agree nor disagree. Less than 15% of participants in the survey were not willing to make a financial contribution, 14.6% partly disagreed and 2.7% completely disagreed with this possibility. Another thesis was posted regarding the fact that a reward like a fitness kit or a heart rate monitor would stimulate participation to activities. A positive score was given by less than half of the respondents (41%). A final thesis pertained to the thesis that the employer has a duty to promote a healthy lifestyle of its employees. This thesis was supported by respectively 33.7% (partly agreed) and 33% (completely agreed). Only 6.3% disagreed partly and 8.3% disagreed completely with this thesis, whereas 17% took a neutral standpoint (Figs. 1 and 2). Discussion The Slotervaart Hospital employees who responded to the questionnaire are positive towards an expansion of all four domains in the vitality and health programme: health check, exercise, stress reduction and nutrition. Except for a few activ-
e100
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101
Fig. 1. Thesis ‘Prepared to own financial contribution’.
ities percentages of 50% and often higher are scored. No distinction can be made between the different domains, expansion is desired for the entire range. The percentages on intention to participate are structurally lower – but still with high scores – than the desire for more activities. New activities with much individual freedom (e.g. discount on sports subscriptions) and low threshold activities (chair massages in the workplace, discounts on healthy foods) score higher on the intention to participate. Nonetheless the other percentages justify a well-advised decision on an actual expansion of such activities, especially considering the total amount of respondents that returned the questionnaire (n = 412). Regarding the prerequisites it can be concluded that employees are willing to invest in health (for instance with a financial contribution)
Fig. 2. Thesis ‘Duty of employer to promote healthy lifestyle’.
and that they consider it important that the employer stimulates healthy behaviour as well. The results are in line with the general advice that any vitality programme should begin with building good habits and awareness among employees, where a survey in the working area is a smart first step. Next to expanding the initiatives, education of the employees deserves attention. Seminars on stress management, nutrition, fitness and health monitoring could be established for patients and employees simultaneously in an Integrative Medicine program. Done well, companies sponsoring wellness programmes saw a 30% reduction in medical and absenteeism costs within 3.6 years, according to a 2005 survey by industry publication The Art of Health Promotion [9]. And the Wellness Councils of America (WELCOA) found up to a $13 return for every $1 that was spent on a comprehensive program [10]. The survey has a few limitations. Only questions were included regarding person-directed interventions, aimed to change personal characteristics without explicit reference to functioning at work. We did not study how far needs were related to the interaction between the person and his or her working environment. Also in this study no questions were included regarding the desire for organisational interventions [2]. A choice was made to start with lifestyle interventions that could relatively easily be implemented in a hospital setting. However, interventions aimed at the work environment or organisation can be effective [1] and will therefore be evaluated in a later stage. The survey was mailed to all personnel of the Slotervaart Hospital. The response rate was one third. A big drawback of this method is that we do not know whether people who did not respond to the survey are at all interested in the possible expansion of lifestyle interventions. Moreover there is the possibility of the healthy responder bias, which could have influence on the results. However, a response rate of one third to a questionnaire is acceptable. Furthermore, a lifestyle improvement among only part of hospital personnel is still a desirable outcome from an employer’s point of view. The evidence for the single components (nutrition, exercise, and stress reduction) is the basis of the survey and the lifestyle programme in the Slotervaart Hospital. A sidenote is that there is only limited evidence available yet, whereas the lifestyle programme is already in progress. The implementation of the programme is therefore accompanied by an evaluation of the effects of the participating employees. In this way the hospital wants to contribute to gathering new insight in lifestyle interventions for employees. The results of the questionnaire have been used as a guideline for the expansion of the vitality and health programme. For each activity it is summarised if it is a ‘winner’, based on the percentages of desirability and intention to participate, the costs and the chances. For each promising activity the necessary prerequisites are currently mapped. After consultation with the board of directors the new programme will be established. The aim is to have as many participants as possible, with specific attention for those that are initially not motivated to participate.
M. van Duijn et al. / European Journal of Integrative Medicine 3 (2011) e97–e101
Conflict of interest The authors declare there is no conflict of interest. Acknowledgements The staff of the rehabilitation department of the Slotervaart Hospital has greatly contributed in gathering and processing the necessary data. We would like to thank them for their contribution. References [1] Marine A, Ruotsalainen J, Serra C, Verbeek J. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev 2006;(4):CD002892. [2] Ruotsalainen J, Serra C, Marine A, Verbeek J. Systematic review of interventions for reducing occupational stress in health care workers. Scand J Work Environ Health 2008;34(3):169–78.
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