SHORT REPORT |
Offering physical activity counselling in occupational health care—does it reach the target group?
1 The UKK Institute for Health Promotion Research, PO Box 30, Tampere, 33501, Finland
2 Kiipula Rehabilitation Centre, Kiipulantie 507, FI-14200 Turenki, Finland
3 Tampere School of Public Health, University of Tampere, Tampere, Finland
Correspondence to: Minna Aittasalo, The UKK Institute for Health Promotion Research, PO Box 30, Tampere, 33501, Finland. Tel: +35832829267; fax: +35832829200; e-mail: minna.aittasalo{at}uta.fi
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Abstract |
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Background Employees participating in worksite physical activity (PA) interventions are mostly the physically active and healthy ones. PA counselling may therefore have an important role in reaching ‘at-risk’ employees.
Aims To examine (i) how PA counselling offered by occupational health care (OHC) providers reaches the target group of physically inactive employees who have intentions to increase PA and (ii) the relations of 12 selected variables to respondents' willingness to participate in PA counselling.
Methods Questionnaire survey of employees of client companies of OHC providers.
Results Eight of the 19 OHC providers contacted participated and recruited a total of nine client companies to the study. A questionnaire survey was delivered to all the employees of the companies (n = 1349). Fifty-eight percent of employees (n = 784) responded to the survey and half of them (n = 380) belonged to the target group of being physically inactive and intending to increase PA. Only half of the respondents (n = 201) in the target group were willing to participate in counselling. Respondents in small companies were more interested in counselling than employees in large companies as were white-collar workers compared to blue-collar workers. Earlier PA discussions in OHC and intention to increase leisure-time PA were also positively related to willingness.
Conclusions A counselling offer attached to a survey did not effectively reach the target group of physically inactive employees who were ready to increase their PA. More individually based approaches such as brief conversations during client contacts are needed in OHC to raise the interest in lifestyle issues.
Keywords Health counselling; occupational health care delivery; participation; physical activity; survey
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Introduction |
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The traditional task of occupational health care (OHC) has gradually widened from the prevention of work-related diseases and accidents to health promotion. The role of OHC in the latter task cannot be underestimated because it can reach the most vulnerable groups, target its efforts according to the employees' needs and offer services which are accessible free of charge to all employees.
Physical activity (PA) is an important part of health promotion in OHC today. Various approaches, such as exercise campaigns and providing exercise facilities, supervised exercise sessions and vouchers have been used in OHC to promote employees' PA. Unfortunately, such measures usually attract only 30% or even less of employees [1] and the majority of those participating seem to be already physically active and in good health [2,3].
PA counselling, which can be tailored according to individual needs and targeted at employees most in need of counselling has therefore an important role in OHC. Tailored interventions have also been shown to be more effective than generic health promotion strategies in the workplace setting [4]. The purpose of this study was to undertake a survey to assess (i) how PA counselling offered by OHC providers reached the target group of physically inactive employees who had intentions to increase their PA and (ii) the relations of 12 selected variables to respondents' willingness to participate in PA counselling.
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Methods |
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All OHC providers from the city of Tampere (population
200 000 inhabitants) with at least one full-time occupational nurse (ON) were selected into the group of potential collaborators (n = 19). As a result of recruitment, eight OHC providers (42%) participated. They were committed to recruit at least one of their client companies to the PA counselling intervention, which included one primary and three follow-up counselling sessions (2, 6 and 12 months) delivered individually by the ON of the company. The counselling was based on structured conversations and the allocated time for the primary session was 60 min and for each of the follow-up sessions 30 min. Nine companies volunteered for the study and the intervention started with a survey which was delivered to all the employees of the companies (n = 1349). ‘The response rate’ was evaluated in each company as a crude measure of employees' interest in the OHC providers' offer. Employees' ‘willingness’ to take part in PA counselling was elicited at the end of the survey, where a short description of the PA counselling intervention was introduced. ‘PA status’ was assessed by asking the frequency and intensity of leisure-time physical activity (LTPA) in a usual week during the past 3 months [5]. Employees who had been engaged in moderate- to hard-intensity LTPA less than twice a week were considered as physically inactive and the rest as active. ‘Perceived work ability’ was assessed with a continuous scale developed by The Finnish Institute of Occupational Health, where 0 indicated total work disability and 10 as work ability at its best. ‘Intention to increase PA’ in the near future was elicited regarding LTPA, outdoor aerobic exercise (OAE) and everyday commuting activity (ECA). In LTPA the intention-related alternatives were (i) no, (ii) maybe and (iii) yes. Answering maybe or yes indicated intentions to increase LTPA. In OAE and ECA the principles of stages of change were applied according to Miilunpalo et al. [6].
In explaining the willingness to participate in counselling, 12 variables shown in Table 2 were used. Their relation to willingness was first analysed variable by variable with the chi-square test. After that the same variables were simultaneously entered in the logistic regression analysis to examine their possible interrelations with willingness.
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Results |
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The response rate was 58% (n = 784) but it varied from 39–95 depending on the company (Table 1). The response rates were higher in small companies (less than 100 employees) compared to larger companies.
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Of the respondents 51% (n = 402) were physically less active than recommended during their leisure time but most of the respondents (n = 698) were ready to increase one of the PA modes. Half of the respondents (n = 380) belonged to the target group of being both physically inactive and intending to increase PA. Again, half of them (n = 201) were willing to participate in the counselling intervention representing 15% of the total group of 1349 employees.
According to the chi-square test, respondents in small companies were more willing to participate in counselling than employees in larger companies (Table 2). Women were also more interested in counselling than men as were white-collar workers compared to blue-collar workers. In addition, those with PA discussions or fitness testing at earlier OHC visits showed more interest in participating than those without discussions or testing. The inactives and actives were similarly willing to participate in counselling. Positive intention to increase LTPA added respondents' willingness to take part in counselling but intentions towards OAE or ECA did not have the same influence. In the logistic regression analysis the statistical significance of gender and earlier fitness testing disappeared (Table 2).
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Discussion |
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A counselling offer attached to a survey without other supporting activities was not an effective measure to reach the target group for PA counselling especially in large companies. The strengths of this survey were that the total number of employees was high, the companies represented different fields of expertise and the OHC providers worked on a similar basis in delivering their services to their companies. However, there are few points to be considered regarding the generalization of the findings. First, the recruitment of participating companies may have led to selection bias and participation of the most compliant companies. This is a general problem related to voluntary participation and could therefore only partly have been avoided by random sampling of the companies. Secondly, since no data about the non-respondents were collected, information about the respondents' representativeness is not available.
The total response rate for the questionnaire was in line with most studies recruiting employees for worksite health promotion programs [7]. Nevertheless, 42% of the employees did not respond to the survey. In addition, half of the respondents were already physically active. Thus, half of the respondents belonged to the target group of physically inactive employees who were ready to increase PA. This illustrates that only a small proportion of the target group could be reached for counselling by a survey—especially since according to earlier studies [8] there seems to be much target group potential among the group of non-respondents. Interestingly, both the response and willingness rates favoured small companies. Moreover, employees with higher socio-economic status were more eager to participate than low-status employees as also found in other studies [9].
From the OHC point of view, willingness exclusively seemed a poor indicator of the need for counselling because physically inactives and actives were equally willing to participate in counselling. This needs to be realized when planning PA interventions at the workplace. Instead, the positive relation of earlier PA discussions to willingness was encouraging. It reinforces earlier findings that brief counselling contacts can get people interested in lifestyle changes [10]. As an additional support to this, intention to increase LTPA was clearly related to the willingness of employees to participate in counselling.
As an implication for clinicians, our study suggests that an individual approach such as brief conversations during client contact in OHC are needed to raise interest in PA and lifestyle issues. A challenge for future research is, however, how to implement such approaches in OHC so that they are both feasible and effective.
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Conflicts of interest |
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None declared.
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References |
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