Implementation challenges in worksite health promotion programs.

challenges that occur during planning, development, implementation, and evaluation efforts. In this commentary, we focus on implementation challenges faced by employers— issues that must be addressed after an organization has made a commitment to offering a worksite health promotion program. Of course, initial support from top management must be secured. But evidence suggests that management support alone does not guarantee program success. A nationally representative sample of employers responded to the 2004 National Worksite Health Promotion Survey and reported that the most common barriers or challenges to health promotion program success were: lack of interest among employees (63.5%); lack of staff resources (50.1%); lack of funding (48.2%); lack of participation among high-risk employees (48.0%); and lack of management support (37.0%). No significant differences in barriers were reported based on industry type or worksite size except that worksites with 750+ employees were significantly more likely to report lack of participation by high risk employees as a barrier. We review each of these potential implementation challenges and argue that engaging employees and managers in identifying and addressing them early in the planning process allows an organization to develop the necessary strategies to overcome them. First, some employers clearly believe that employees are not interested in worksite health promotion programs. This tends to occur when employee participation in programs is low. It is important to both understand and clarify some of the potential underlying “causes” of low levels of employee interest and participation. For example, insufficient or ineffective communication about health promotion programs could result in low levels of participation simply because employees were not aware of programs being offered. Another potential “cause” of low perceived employee interest is that employees might not participate at all (or in lower numbers) if they have to pay to join a program, or if the program is offered at inconvenient times or locations, or when child care and other issues may limit participation. Employees exposed to stressful and/or otherwise hazardous work conditions might not participate because they are skeptical of worksite health promotion programs and/or angry if these programs are being prioritized ahead of addressing work conditions. Additionally, if employees believe that employers are intruding on their privacy or trying to “control” their health, they may not participate. Thus, low employee participation may be caused by several of these factors and may lead to a perception among employers that employees are not “interested” in health promotion programs. Implementation Challenges in Worksite Health Promotion Programs