Obesity is presently one of the leading preventable causes of mortality and is an increasing issue that affects the workplace. This pilot study investigates the effects of a multidisciplinary obesity management program on employees within a community hospital setting. The purpose of this study is to assess the outcome factors of the intervention and to detect an association between the participants’ biological factors, psychological status, eating behaviors, and lifestyle components to that of their current body weight status. Methods. An evaluation of a tailored obesity management program was conducted in a corporate setting with employees of a large community hospital. The evaluation sought to determine if this program could be efficiently and effectively implemented in this corporate setting. This program also allowed an exploration of those sociological, biological, and behavioral factors that were associated with weight loss. An employee health outcomes assessment visit was used to identify, recruit and enroll overweight employees into a quasi-experimental study designed to evaluate potential impacts of a tailored weight management program. The 6-month intervention included medical assessments, nutritional coaching, activity counseling, and behavioral therapy. The following specific aims were proposed for this dissertation research: Specific Aim 1 sought to evaluate the effectiveness of the multidisciplinary weight loss program to change a series of modifiable health risk factors, body composition, clinical indicators, and biological markers from baseline to 6 months for overweight participants. Specific Aim 2 evaluated factors associated with achieving weight loss and patterns of attrition from the program. Weight and lifestyle factors included onset of obesity, family history, weight loss history, weight loss goals, self-perceptions, physical activity factors, and eating habits/patterns. Within Specific Aim 3, we determined if body composition measurements [body mass index (BMI), weight, basal metabolic rate, fat mass, percent fat, fat free mass, and total body water] correlated with standing or supine measurements of waist, hip, or thigh circumferences. We also investigated if there was a significant difference between recording measurements made in both positions. This aim sought to determine if both sets of position measurements needed to be included for subsequent weight management studies. Results. Forty-six (46) employees, with a mean age of 48.6 +/- 10.9 years and predominately female (91.3%), consented to participate in the pilot intervention, with 26 participants completing the 6 months (response = 50.9%). Statistically significant changes from baseline were seen at 6 months in the 44 participants that continued in the study after enrollment. In the intent to treat analysis, the participants, regardless of completion status, had a clinically significant (p<.0001) mean percent weight loss of 4.1% and a total weight loss of 9.3 pounds, with a corresponding 5.6% mean weight loss in those participants that completed the program. When analyzing predictors of attrition from the program, models indicated significant associations between overall program attrition and an increase in baseline systolic blood pressure (p=0.02), along with decreased compliance with eating three meals per day (p=0.04). Primary attrition (dropout < 3 months) was statistically associated with an increase in baseline systolic blood pressure (p=0.02) and decreased compliance with eating three meals per day (p=0.01). Secondary attrition (dropout between 3-6 months) was associated with decreased compliance with eating three meals per day (p=0.05) and an increase in weight loss expectations during the intervention (p=0.05). The mean absolute difference between the two techniques (standing vs. supine) was 4.14 inches for waist, hip, and thigh measurements combined. An increase in body mass index was associated with a greater magnitude of discrepancy in the measurement between the two techniques for waist circumference (p=0.02). Conclusions. The changes seen following this multidisciplinary intervention were clinically significant and advantageous for the participants. These substantial results suggest that the use of multidisciplinary weight management programs merits further investigation in larger, randomized, controlled trials.

Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire; 2) Review the current literature on the availability and effectiveness of mobile phone interventions targeting sugar-sweetened beverage (SSB) consumption; and 3) Use the updated BEVQ-15 to conduct the Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The Healthy Beverage Habits study was an online randomized controlled pilot trial with an 8-week intervention and a 4-week maintenance period delivered through Instagram. The materials were adapted from the in-person SIPsmartER SSB reduction intervention. Data analysis included RM-ANOVAs to test for differences in beverage intake between the Instagram intervention group and the E-mail control group. Results: For the Healthy Beverage Habits trial, no significant between group over time differences were found. However, the Instagram group demonstrated a significant reduction in total beverage kcal (mean difference±SE=-156±48; p=0.049), and increase in total HBI scores (mean difference±SE= 11.9±2.3; p=0.025) from baseline to the end of the maintenance period. No within group differences were demonstrated for the E-mail control group over the intervention or maintenance period. The study retention rate was 38%, with 39 participants initially enrolled and 15 participants completing all study visits through maintenance. Results for the validity and reproducibility of the updated BEVQ-15 and a review of the availability and effectiveness of mobile phone interventions targeting SSB consumption are presented. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions. / Doctor of Philosophy / Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire which estimates habitual average daily intake of 15 beverage categories as well as total sugar-sweetened beverages (SSB) and total beverages. 2) Review the current literature of the availability and effectiveness of mobile phone interventions targeting SSB consumption. 3) Use the updated BEVQ-15 to conduct The Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The updated BEVQ-15 was assessed for agreement between the BEVQ-15 and dietary recalls. Researchers compared beverage intake between two BEVQ-15 administrations. The Healthy Beverage Habits pilot study was an 8-week intervention with a 4-week maintenance period. Data analysis included testing for differences in beverage intake between the Instagram group and the E-mail group. Results: The updated BEVQ-15 demonstrated moderate agreement between the BEVQ-15 and dietary recalls for total SSB intake and total beverage intake. All beverage variables were significantly correlated. For the systematic review, 11 of the 17 studies (65%) were successful in reducing SSB consumption through mobile phone delivery. The successful studies used multiple types of technology. There were no significant differences for any beverage variable between the Instagram and E-mail groups over time. However, for within group changes, Instagram significantly reduced total beverage kcals and improved total HBI score, while the E-mail group did not demonstrate any significant changes. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits pilot trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions.

Syfte Syftet med denna studie har varit att studera och inventera en arbetsgrupp med lokalvårdares uppfattning om arbetsvillkor, ergonomi och i vilken utsträckning hälsofrämjande aktiviteter utövades under eller efter arbetstid. Bakgrund: Ett intresse finns bland arbetsgivarna att förbättra arbetstagarnas hälsotillstånd och muskuloskeletala hälsa då det är möjligt att minska sjukfrånvaron och påverka produktiviteten. Olika diskurser förespråkar att yrkesrelaterade hälsoproblem kan lösas med olika typer av träning. Känsligheten för att drabbas av belastningsskador varierar mellan individer. Brister i den organisatoriska och psykosociala miljön kan påverka hälsan negativt. Klass och kön har stor inverkan på hur vi kan påverka och forma våra liv både privat och i arbetslivet. Enligt jämställdhetsbarometern råder det fortfarandestora stora klass- och könsskillnader i arbetslivet, och personer i arbetsyrken har i allmänhet en sämre arbetsmiljö Metod: Metodansatsen för denna studie har varit en kombination av flera metoder som följer; Enkäter QPS Nordic 34+ avseende psykosocial och organisatorisk arbetsmiljö. Kompletterande frågor (KFS) om kondition, ergonomi och träningsvanor. Fältarbete i form av observationer och intervjuer. Deltagarna bestod av 56 lokalvårdare/städare. Resultat: Resultaten visade att en övervägande andel enligt QPS ansåg att arbetsgivarens intresse för personalens hälsa var lågt och hälften ansåg att det fanns betydande brister i organisationskultur och organisationsklimat som inte var tillräckligt stödjande, liksom i interaktion på arbetsplatsen samt i arbetskrav. På den positiva sidan såg de allra flesta sig själva som yrkesskickliga. Resultaten från intervjuerna visade att en förbättrad introduktion, vi-känsla, socialt stöd och grupptillhörighet, bättre arbetsorganisering. hjälpmedel, transporter samt trivselskapande aktiviteter skulle förbättra arbetsmiljön. Enligt KFS-frågorna visade en övervägande andel svalt intresse att delta i en grupp för att prova motions- och friskvårdsaktiviteter. En övervägande andel ansåg dock att deras hälsotillstånd kunde förbättras måttligt eller avsevärt. Stresshantering och avspänning var något som önskades, liksom intresse för konditionsförbättrande aktiviteter, friskvård under arbetstid och egenvalda aktiviteter. Många ansåg sig redan ha kunskap om ergonomi. Studien gör inte anspråk på att vara generaliserbar men avser att bidra till ökat lärande om interventioner och deras förutsättningar. Slutsats: Genomgående i alla metoder framkom brister i arbetskrav, organisationskultur och ledarskap, arbetsklimat och interaktion, belöning och stöd i den psykosociala och organisatoriska arbetsmiljön vilka sammanföll med kategorierna i QPSNordic34 + och vad som framkom från KFS. De flesta (80%) önskade förbättra sin hälsa och lika många (80%) ansåg att arbetsgivarens intresse för de anställdas hälsa var lågt. Stress och tidspress var vanligt hos 70% och 65% upplevde bristande ledarskap. Belöning och trivselfaktorer var andra områden som 66% var missnöjda med. De flesta städare ansåg det viktigt med ergonomiaspekten för den totala arbetsbelastningen samt att arbetsorganisationen var viktig för god ergonomi. Studien har visat att det fanns en brist på hälsofrämjande strategi för att motivera medarbetarna till en aktörsroll Den forskning som presenterades av Marmot (2006) överensstämmer med vad som framkom i studien, att obalans i livssituationen, ojämlik arbetsmarknad och att arbetsförhållandena är faktorer viktiga för den sociala gradienten. Ju högre upp i hierarkin och status en individ befinner sig desto bättre hälsa. Därför är fler studier om lokalvårdarnas psykosociala och organisatoriska arbetsmiljö eftersträvansvärda.

This research presents a way for digitalising worksite benefits programs. The related work analysis and results of user interviews showed the important role of benefits programs in the wellbeing of employees, and as a result in company performance and employer branding. However shortcomings were discovered in the current format of worksite programs and suggested that digital transformation might help to address these shortcomings. The research used semi-structured interviews and analysis, user journey mapping, prototyping, and heuristic evaluation methods to deliver the concept of an employee insurance wallet. Furthermore, the research stepped beyond product design and presented a comprehensive framework for developing, monitoring, and operating such digital worksite benefit product. The framework incorporates stakeholder needs to ensure business success and user-centred design methodology to embrace usability and engagement principles. According to the research results, the real-life version of the product was developed. / Denna forskning presenterar ett sätt för digitalisering av arbetsplatsfördelningsprogram. Den relaterade arbetsanalysen och resultaten från användarintervjuer visade den viktiga rollen som förmånsprogram har för anställdas välbefinnande, och som ett resultat i företagets prestanda och varumärke från arbetsgivare. Emellertid upptäcktes brister i det aktuella formatet av arbetsplatsprogram och föreslog att digital transformation kan hjälpa till att lösa dessa brister. Forskningen använde semistrukturerade intervjuer och analyser, kartläggning av användarresor, prototyper och heuristiska utvärderingsmetoder för att leverera konceptet för en anställdsförsäkringsplånbok. Vidare gick forskningen bortom produktdesign och presenterade ett omfattande ramverk för att utveckla, övervaka och använda sådana digitala arbetsplatsfördelar. Ramverket innehåller intressentbehov för att säkerställa affärsframgång och användarcentrerad designmetodik för att omfatta användbarhets- och engagementsprinciper. Enligt forskningsresultaten utvecklades den verkliga versionen av produkten.

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Background: Worksite screening programs are increasingly being provided by employers as a means to reduce cardiovascular risk in employees. A screening program that consists of fasting serum analysis of glucose plus a lipid panel is offered yearly to employees at the VA medical center in Tampa. A retrospective study was conducted to determine if a wellness clinic exposure resulted in significant changes in employees' markers of cardiovascular risk. Methods: Computerized records were used to follow serial outcomes for glucose, triglycerides, HDL cholesterol, and LDL cholesterol in employees whose screening results showed abnormal levels of one or more of these markers. An intervention group with 66 subjects received a wellness clinic visit including a health risk assessment and education for lifestyle change, and a reference group with 109 subjects received only serum analysis. Outcomes at repeat screening were compared for the two groups. Results: Both groups showed improvement in cardiovascular risk. In the intervention group there was significant intra-subject improvement from baseline for all markers except glucose. For triglycerides and LDL cholesterol there was a significantly greater proportion of subjects who improved in the intervention group. In addition, the improvement for triglycerides was significantly better in the intervention group. Conclusions: This investigation confirms the value of a worksite wellness program in reducing cardiovascular risk in the population studied. A differential impact of age and gender was seen for glucose and triglycerides and indicates that such modifiers should be considered through covariate analysis in assessing wellness program effectiveness. Increasing levels of employee wellness participation to targets identified in this study and adding a health risk assessment for everyone screened will help to identify the specific benefits of the face to face wellness counseling intervention.

Cardiovascular disease (CVD) is responsible for approximately 600,000 deaths in the United States each year, with African Americans (AAs) disproportionately affected. Individual-level approaches to reducing CVD remain ineffective, mobilizing a movement that advocates for population-based solutions. Workplace wellness programs (WWPs) have gained considerable traction as a viable strategy for ameliorating CVD burden among workers in general. However, no studies have looked at the efficacy of WWPs in ameliorating CVD specifically among AA employees--a knowledge gap that this investigation aimed to close. Based on the health belief model and the social cognitive theory, this retrospective cohort study used de-identified secondary data to evaluate the racial differences in the mean change in CVD biomarkers between 163 AAs and 228 Caucasians civilian workers participating in a U.S. Marine Corp self-directed WWP. The 4 CVD biomarkers evaluated were systolic blood pressure (SBP), diastolic blood pressure (DBP), and waist-to-hip ratio. Repeated measures MANCOVA analysis was used to establish the contribution of the independent variable (race) to SBP, DBP, LDL cholesterol, and waist-to-hip ratio. Results showed an overall significant main effect of time for changes in SBP and DBP even after controlling for race, sex, age, and days from baseline. However, there was no overall main effect of time for changes in LDL cholesterol or waist-to-hip ratio. Further research using randomization, a comprehensive health risk appraisal, and a larger sample size may yield additional benefits to AAs. Implications for positive social change include reduction of the extraordinarily high CVD disease burden and disparity among AAs.

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A crescente epidemia de obesidade tem incentivado profissionais da saúde a procurar por intervenções que possam atingir um grande número de indivíduos de maneira custo-efetiva. Os Programas de Qualidade de Vida no Trabalho vêm sendo apontados como ferramentas importantes para a promoção da saúde e qualidade de vida. Neste contexto, o Coaching em Saúde e Bem Estar vem despontando como um componente promissor nas intervenções desenvolvidas nestes programas, de modo a atingir resultados positivos e permanentes para mudança de comportamento para um estilo de vida saudável. Desta forma, o propósito desta revisão é verificar o efeito do Coaching em Saúde e Bem Estar sobre o peso corporal, nível de atividade física e consumo de frutas, legumes e vegetais de trabalhadores. Para tanto, foi conduzida uma busca nas bases de dados PubMed, CINAHL, EMBASE, LILACS e Cochrane Library. Onze ensaios clínicos randomizados atenderam aos critérios de elegibilidade, aos quais foi aplicado o instrumento de avaliação de risco de viés da Colaboração Cochrane e extraídas as informações relevantes de cada estudo. Encontrou-se associação de efeito na direção esperada para peso corporal, atividade física e consumo de frutas, legumes e vegetais. No entanto, 72,7% dos estudos (n=8) apresentaram alto risco de viés. Assim, conclui-se que as evidências para responder à pergunta desta revisão são limitadas e, portanto, sugere-se que mais estudos sejam realizados, considerando-se a transparência no relato das evidências e o rigor metodológico recomendado para sua execução. / The expanding outbreak of obesity has stimulated health professionals to search for interventions capable to encompass a large number of individuals in a cost-effective manner. Worksite Wellness Programs have been pointed out as important tools for the promotion of workers\' health and quality of life. In this context, Health and Wellness Coaching is emerging as a promising component of the interventions developed in such programs, leveraging achievement of positive and permanent results on behavior change for a healthy lifestyle. Under such perspective the purpose of this review is to verify the effect of Health and Wellness Coaching on workers\' body weight, physical activity and consumption of fruits and vegetables. Therefore, a survey was conducted in PubMed, CINAHL, EMBASE, LILACS and Cochrane Library databases. Eleven studies met the selection criteria of this research. The risk of bias analysis tool developed by Cochrane collaboration was applied, and the relevant data were extracted from each study The analysis of results of such studies demonstrated association of positive effect for the increase of workers\' physical activity, body weight and fruits and vegetables intake. Nevertheless, 72,8% of the studies (n=8) showed a high risk of bias. So the conclusion is that the evidences found are not enough to answer the proposed question. Further studies are necessary in order to gather consistent data raised with the required methodological rigor.