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Assessing Personal Strengths for Wellness: Improving Upon the HRA With Judd Allen
A strengths-based approach to personal health assessment is proposed as an alternative to traditional health risk appraisals (HRAs). Strengths-based assessments would measure positive health behaviors and an individual's lifestyle strengths rather than focusing solely on risks. This approach may increase the appeal of assessments for employees and provide a better starting point for health promotion programs. Future research is needed to determine if strengths-based assessments can effectively predict health outcomes and evaluate wellness programs, as well as influence workplace health culture.
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Assessing Personal Strengths for Wellness: Improving Upon the HRA With Judd Allen
- 1. A New Directionin Personal Assessment
- 2. Overview • Provide backgroundon HRA • Discuss challenges faced by HRA • Discuss a strengths-based approach to personal assessment • Share future research goals
- 3. Health Risk Appraisal A health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Commonly a HRA incorporates three key elements – an extended questionnaire, a risk calculation or score, and some form of feedback i.e. face-to-face with a health advisor or an automatic online report. The Centers for Disease Control and Prevention define a HRA as: “a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.” http://en.wikipedia.org/wiki/Health_risk_assessment
- 4. HRA Measures There are a range of different HRAs available, however most capture information relating to: • Demographic characteristics – age, sex • Lifestyle – exercise, smoking, alcohol intake, diet • Personal and family medical history (in the US, due to the current interpretation of the Genetic Information Non- discrimination Act, questions regarding family medical history are not permitted if there is any incentive attached to taking a HRA) • Physiological data – weight, height, blood pressure, cholesterol • Attitudes and willingness to change behavior in order to improve health http://en.wikipedia.org/wiki/Health_risk_assessment
- 5. HRA Goals Themain objectives of a HRA are to: • Assess health status • Estimate the level of health risk • Inform and provide feedback to participants to motivate behavior change to reduce health risks http://en.wikipedia.org/wiki/Health_risk_assessment
- 6. HRA History The originalconcept of the HRA can be traced back to a project, led by Dr. Lewis C. Robbins of the Public Health Service in Framingham Massachusetts. The study was based on in-depth longitudinal studies of 5,000 families. Original guidance for personal assessment was available in 1970. It wasn't until 1980, when the Centers for Disease Control and Prevention released a publicly available version, that the HRA became widely used, particularly in workplace settings. http://en.wikipedia.org/wiki/Health_risk_assessment
- 7. Lifestyle Change Happensin Clusters For better and for worse health behaviors spread from person to person. The behaviors investigated so far are: Healthy Smoking Eating Physical Alcohol Activity Abuse Happiness Source: Framingham Heart Health Study 1971 – 2007 of 4,439 friends, family and neighbors sited in Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives by Nicholas A. Christakis and James H. Fowler, New York: Little, Brown and Company, 2009.
- 8. HRA Efficacy Extensive researchhas shown that HRAs can be used effectively to: • Identify health risk factors • Predict health-related costs • Measure absenteeism and presenteeism • Evaluate the efficacy and return on investment of health promotion strategies It is generally accepted that HRAs are most effective at promoting behavior change when they form part of an integrated, multi-component health promotion program. The HRA is used primarily as a tool to identify health risks within a population and then target health interventions and behavior change programs to address these areas. http://en.wikipedia.org/wiki/Health_risk_assessment
- 9. White Paper onHRAs A Framework for Patient-Centered Health Risk Assessments Providing Health Promotion and Disease Prevention Ser vices to Medicare Beneficiaries Ron Z. Goetzel, PhD; Paula Staley, MPA, RN1; Lydia Ogden, PhD, MPP; Paul Stange, MPH1; Jared Fox, PhD, MPP; Jason Spangler, MD, MPH; Maryam Tabrizi, MS; Meghan Beckowski, MPH; Niranjana Kowlessar, http://www.cdc.gov/policy/opth/hra/FrameworkForHRA.pdf
- 10. HRA Challenges • Medicalimplications seem most appropriate in primary care conversation • Privacy, trust and economic concerns make the employer and health plan less appropriate for HRA administration (HIPA, ADA, Incentives in Health Care Reform) • Low completion rates make HRA less suitable for program planning/evaluation
- 11. A Cultural Perspectiveon HRAs • Medical, illness and death framework versus wellness quality-of-life framework • Risk language (negative framework) versus lifestyle strengths (positive framework) • Individual focus may undercut attention to supportive environments
- 12. StrengthsBuilder Measures • Lifestyleimprovement goals • Past lifestyle change successes • Personal lifestyle strengths (e.g., not smoking, physical activity, etc.) • Support system strengths
- 13. Employees Are Attemptingto to Achieve Healthier Lifestyles Last Year’s Goals Attempted at Least One Goal Lifestyle Change Yes Lose weight 69.9% No 14% Eat healthier 80.6% Increase physical activity 81.4% Manage stress 77.6% Improve social relationships 67.0% Stop smoking 21.9% Address alcohol or other drug abuse problems 15.2% Yes Increase Health Screenings 70.1% 86% Other lifestyle goal 4.7%
- 14. Some Employees are Successful Moderately Successful 53% Very Successful 30% Not Successful 17%
- 15. Employees Are Planningfor Lifestyle Improvement Next Year’s Goals Planning to Pursue at Least One Lifestyle Change Goal Future Lifestyle change Yes Lose weight 63.2% Eat healthier 60.9% Increase physical activity 70.7% No 21% Manage stress 57.1% Improve social relationships 33.8% Stop smoking 6.0% Address alcohol or other drug abuse problems 1.5% Increase health screenings 33.8% Yes Other lifestyle goal 0.8% 79%
- 16. Cultivating Healthy Behavior Norms Shared Touch Values Points Behavior Choices Peer Climate Support
- 17. Assessing Our Personal Wellness Zones Among At Work Friends In the At Home Community
- 18. Research Agenda • Canwe use measures of lifestyle strengths to predict health and economic outcomes (adapting HRA research findings)? • Will a strengths-based approach to individual assessment be more appealing to employees? • Is the new approach a better starting place for follow-up (coaching, targeted health information, peer mentoring, and program recruitment)? • Is the new approach suitable for program planning and evaluation? • What impact does the new approach have on the wellness culture (shared values, norms, climate etc.)?
- 19. Likely Finding Success =Initiative + Support
Editor's Notes
- #3 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #4 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #5 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #6 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #7 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #9 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #10 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #11 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #12 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #13 This picture shows the entrance to a company that purchased bikes for commuting employees. Each month they bring in a bike mechanic who provides free repairs.
- #14 Show your data from the Lifegain Wellness Culture Survey about recent lifestyle change attempts.This is great wellness news. The vast majority of employees are so convinced that wellness is important that they have recently tried to improve their health habits. We want managers to realize that employees are now engaged in a major struggle to achieve personal wellness. Time permitting, discuss which goals seem to be most popular.
- #15 Most employees are not fully successful in achieving their lifestyle goals. Follow-up interviews usually determine that moderate success is reported when people only achieve temporary or intermittent lifestyle change. Losing 10 pounds out of a goal of losing 20 pounds is one example of moderate success. The more likely scenario is that 10 pounds were lost, but came back.One of the reasons we are so interested in a wellness culture is to help employees avoid developing new unhealthy behaviors. It is very hard to change unhealthy practices. We want to stop the flow towards unhealthy practices such as overeating and becoming unfit. It is a good idea to create a culture where few employees will find themselves in need of addressing new unhealthy behaviors. Helping 50% of employees be "Very Successful" is an ambitious and necessary goal. Such a high success rate will greatly enhance peoples’ enthusiasm for wellness. It will also mean a dramatic improvement in other performance measures such as the program’s return on investment.We must work to create conditions for success. This means greatly reducing real and perceived barriers to maintaining healthy lifestyles.
- #16 Show your data from the Lifegain Wellness Culture Survey about lifestyle change intentions. Once again, the coach should acknowledge the high level of interest in healthy lifestyles. He or she may also want to call attention to those lifestyle goals that are most popular. Efforts should be made to assist these employees in achieving their goals. This could come in the form of wellness coaching, support groups, peer coaching and educational programs. Ideally, changes to the environment would be made that would make it easier to achieve and maintain desired lifestyle practices. Lead a discussion of the primary lifestyle change goals and what can be done to support employees’ lifestyle improvement efforts.
- #18 The methods we are using were first developed to assist Coca-Cola when they bought Minute Maid Orange Juice and became the largest employer of migrant workers in the United States. Coke realized that it needed a healthy culture to improve the conditions of migrant workers. A first issue of the American Journal of Health Promotion came out in 1986. It included an article about the project with Minute Maid. A book, called the Quiet Revolution also talked about this early wellness program. As can be seen in the slide, great strides were made in creating a healthier culture at Minute Maid. The project resulted in great business, health and human relations outcomes. It was a quiet revolution in that the workers and company collaborated peacefully to create a much healthier and more productive work environment. The culture-based approach was subsequently applied at Johnson & Johnson and Hoffmann La Roche. These companies were among the first to offer wellness at the worksite. Since that time more than 1,000 companies, government agencies and educational institutions have used the culture-based approach to advance their wellness programs. More information, including a client list, is available at www.healthyculture.com.