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Comprehensive Workplace Health Promotion: Recommended and Promising Practices for Situational Assessment Tools

As a member of the Ontario Health Promotion Resource System (http://www.ohprs.ca),
The Health Communication Unit (THCU), at the Centre for Health
Promotion, University of Toronto, works to build the capacity of health
promoters in Ontario. THCU has been supporting professionals working in
the field of comprehensive workplace health promotion (CWHP) since
1999, as one of the preventive programs within the Ontario Stroke
Strategy. 

If you have a resource or point of view to add to this article, let us
know by writing to [email protected]. More information on our Letters to
the Editor column can be found in the our submission guidelines at http://www.ohpe.ca.

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I Introduction

Workplace health--or wellness as it often referred to in this
setting--continues to grow in importance in Ontario as both a channel
through which to reach many Ontarians and as a setting in which to
support health.  It is an area that many health promotion
practitioners find themselves working in without a lot of formal
training provided to them.

In a typical planning model for Comprehensive Workplace Health
Promotion (CWHP), an early step involves an assessment of the
environment, which in turn informs the plans and actions.  As
outlined in THCU's Introduction to Health Promotion Planning workbook
(2001),

"A situational assessment influences planning in significant ways--by
examining the legal and political environment, the stakeholders, the
health needs of the population, the literature and previous
evaluations, and the overall vision for the project. The phrase
"situational assessment" is intentional - this terminology is used as a
way to avoid the common pitfall of only looking at problems and
difficulties and a way to consider the strengths and assets of
individuals and communities. In a health promotion context, this also
means looking at socioenvironmental conditions and broader determinants
of health. This critical and often time-consuming part of getting
started on the plan for your health promotion project involves various
forms of data gathering. In this part of the planning process, we use
data to provide answers to a number of questions we are concerned
about. And in doing so, we need to determine the best ways to find out
the answers."

A number of sources, including the Workplace Project's Advisory
Committee, identified the need to collect recommended practices for
undertaking these situational assessments in a workplace. 

Increasingly, health promotion practitioners are challenged to select
approaches that have evidence of relevant impact and a high likelihood
of success. To identify these approaches many planners will undertake a
review of the literature, both published (often peer-reviewed) and
unpublished. This process is not only time consuming, it is also often
duplicated across communities. Catalogues of best practice and
systematic reviews have become popular resources to find this
information.  There are many types of these assessments and many
versions of tools, which are often confusing for the practitioner to
sort through. 

Consequently, THCU undertook a thorough review of available situational
assessment tools, the result of which is Comprehensive Workplace Health
Promotion: Recommended and Promising Practices for Situational
Assessment Tools, a catalogue of  29 tools.  Of these, 21 are
"recommended," in that they satisfied the highest level of evidence
required in the assessment, and 8 are "promising," meaning they were at
the "silver medal" level of evidence.

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II The Assessment Process

The assessment process used in the review was built directly from the
best practices assessment process developed by the Centre for
Behavioral Research and Program Evaluation at the University of
Waterloo and applied in the Heart Health Resource Centre's
International Scans of Heart Health Best Practices, PTCC's Better
Practices Toolkit in Tobacco Control, and the Nutrition Resource
Centre's What Works in Nutrition Promotion.  THCU preserved the
essence of these reviews by utilizing the three primary review
categories of

  • Effectiveness (the intervention had a positive outcome or impact evaluation using a good quality research design)
  • Plausibility (the extent to which the intervention is likely to
    be effective based on formative/process evaluations and content and
    process attributes)
  • Practicality (the extent to which the intervention is likely to
    be effective in the context of the adopting community) Practicality
    addressed issues such as ease of implementation in the workplace,
    availability of materials related to the tool, cultural and linguistic
    accessibility.  It should be noted that cost was not considered as
    a review criteria because some tools have a cost associated with them
    and this does not preclude them from being appropriate for use in
    Ontario.

THCU adapted this process and undertook the following steps (see the full resource for more detail):

  • An 18 member review panel was recruited from workplace practitioners, providers and researchers in Ontario.
  • An extensive international search identified 125 tools for
    potential assessment. Inclusion criteria were applied to the tools to
    determine those to be assessed.  The most common reason why
    potential tools were discarded was the lack of information available
    upon which to base a review. Thirty-five tools were eventually
    reviewed. 
  • The criteria used in other best practice assessments were adapted
    for application to this type of resource.  The basic categories of
    Effectiveness, Plausibility, and Practicality were maintained.
  • Each tool to be assessed was described using an extensive
    annotation template, the fields of which were tested in advance by the
    reviewers and the intended users of the resource to ensure
    applicability.
  • The 18 member review panel was trained and provided with a
    web-based application to examine, in pairs, 35 situational assessment
    tools (3 to 5 tools each).
  • Meetings were held with the Review Panel throughout the process to
    • Confirm the process to be consistently applied to all reviews
    • Collectively review all the findings to ensure overall confidence in recommendations
    • Generate principles associated with conducting situational assessments that transcend the use of any one tool

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III Results

A Types of tools

The resource describes recommended or promising practices categorized
by six kinds of situational assessment tools.  Some of these are
geared to assessing all employees in a workplace while others are used
singularly as a review of the overall workplace.  The six
categories, described in more detail in the resource, are

  • Current practice survey
  • Health risk assessment
  • Interest survey
  • Needs assessment
  • Organizational culture survey
  • Workplace audit

A decision tree was used to track the logic that resulted in the
particular label for a given tool.  Of the 18 possible
combinations of Effectiveness, Plausibility and Practicality, there
were three possible routes to becoming "recommended":

  • "Yes" for effectiveness, "good" for plausibility, and "good" for practicality
  • "Yes" for effectiveness, "fair" for plausibility, and "good" for practicality
  • "No" for effectiveness, "good" for plausibility, and "good" for practicality

B Recommended

Twenty-one tools were "recommended" for use in Ontario workplaces.
These were seen as plausible and practical for implementation and may
or may not have been evaluated (i.e., reliability and validity testing
may or may not have taken place) in Ontario workplaces.

C Promising

Nine tools were identified as "promising" practices for use in Ontario
workplaces.  Some had highly promising aspects of plausibility and
practicality and may or may not have been evaluated (i.e., reliability
and validity testing may or may not have taken place).  Only eight
have been included in the annotated list and database as one source did
not want to be identified as only "promising" following the review.

D Not recommended

Five tools were not recommended for use in Ontario workplaces (not
identified due to confidentiality agreements). Although they each had
particular strengths, they were not recommended for one or more of the
following reasons:

  • The tool had limited reference or relevance to CWHP.
  • The tool had a limited focus.
  • The tool was not easily accessible to Ontario workplaces.
  • The survey structure was poor.
  • The quality of the questions was poor.
  • The analysis/reporting was poor.
  • Ease of implementation was poor.

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IV  Principles for Using Situational Assessment Tools in a Workplace

A Designing Phase

  • Complement the situational assessment using other sources of
    data, such as records of on-the-job accidents or injuries. When other
    sources of data exist, researchers can decide whether those sources
    should be used instead of a situational assessment or whether there is
    value in collecting both sources in order to validate the report.5
  • Prior to selecting the tool, provide training to the committee on CWHP as needed.
  • Even if the tool addresses only one of the three aspects of CWHP, acknowledge all three at the outset.
  • Ensure survey questions and instructions are clear and the question format is consistent.
  • State the literacy level of the tools.
  • In large workplaces, ensure the analysis process for the results allow for sophisticated cross tabulations.

B Planning Phase

  • Secure the commitment of senior management within the workplace as early as possible.
  • The implementation process of a situational assessment should be
    driven by a workplace committee. This committee should have
    representation from all employee groups (e.g., in a complex
    organization like a hospital, there should be
    nursing/physician/housekeeping/other representation) and union buy-in,
    in relevant workplaces.
  • Ensure appropriate policies and procedures are in place to deal with sensitive issues.
  • When using surveys for the purposes of establishing a wellness
    program, consult with legal counsel well versed in labour, privacy and
    employment law.
  • Once the tool has been identified, decide on the report format
    and audience (e.g., one report for all employees, an individual report
    for each employee, one report for the committee, one report for
    management).
  • To improve the response rate, tell employees about the survey at least twice before it is distributed.
  • Ensure effective communication throughout the process. A commitment to action based on the results should be made up front.
  • Clearly outline the full process and purpose of the assessment
    process, including what will happen before and after the survey.
    Follow-up after the survey is critical - respondents need to know what
    happened to the data and what will happen next.

C Implementation Phase

  • Voluntary participation is essential for ethical use of health risk appraisals and for accuracy in self-reported data.10
  • Tools should be easy to implement and still meet the intended objectives.
  • Cost and the necessary time for completion are aspects to
    consider when selecting a tool. Employers should provide the required
    time.

D Evaluation Phase

  • The assessment should be part of a systematic approach to health promotion that is followed by implementation and evaluation.

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V  Conclusion

Workplace health continues to grow as a viable and necessary health
promotion strategy both as a channel through which to reach many
Ontarians and as a setting for direct change that affects health. 
Many Ontario public health agencies, often with the support of their
local Ontario Heart Health Program (OHHP: Taking Action on Healthy
Living), allocate resources to supporting workplace health. 
Comprehensive Workplace Health Promotion: Recommended and Promising
Practices for Situational Assessment Tools is intended to contribute to
this evolving field and, resources permitting, the catalogue of
recommended practices will grow over time as more tools are assessed.

Although workplace health promotion intermediaries in Ontario are the
primary intended users of this resource, other workplace health
promotion stakeholders may also find it helpful in assisting them with
either selecting and implementing a situational assessment tool in an
Ontario workplace or replicating and adapting the best practice process
and methodology in developing their own tools.

These stakeholders may include

  • workplace health practitioners
  • occupational health nurses
  • workplace wellness committees
  • workplace wellness coordinators
  • human resource managers
  • union representatives

The full resource, including the conceptual background, methodology
used, lessons learned, principles and tips to follow as well as all of
the detailed results of the review in the form of an annotated
searchable database of 29 situational assessment tools can be found and
downloaded at http://www.thcu.ca/Workplace/sat/index.cfm (PDF  273 pp, 2.9mb).

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VI  References

The Health Communication Unit. (April 2001). Introduction to Health Promotion Program Planning. Version 3.0. Toronto: ON.

The Health Communication Unit (November 2005). Comprehensive Workplace
Health Promotion: Recommended and Promising Practices for Situational
Assessment Tools. Version 1.0. Toronto: ON.