Moving to a Model of Wellness: Workplace Cancer Prevention and Health Promotion Programs

Coordinator: Welcome and thank you for standing
by. At this time, all lines are in a listen-only mode. During our question-and-answer session,
you can use the chat feature or press Star 1 and record your name when prompted. This
conference is being recorded. If you have any objections, you may disconnect. And I’d
like to turn today’s conference over to Ms. Margaret Farrell. Thank you and you may begin. Margaret Farrell: Good afternoon everyone.
I’m Margaret Farrell and on behalf of the National Cancer Institute, I’d like to welcome
everyone to our April Research to Reality Cyber Seminar. NCI launched the Research to
Reality community practice five years ago with the aim of bringing together researchers
and practitioners in an ongoing discussion around the promise and the perils of moving
evidence-based cancer control programs and policies into practice. Today’s presentation focuses on interventions
that reach us where we spend much of our waking hours, at the workplace. Worksite wellness
programs are drawing increasing attention for their promise in reducing the burden of
cancer as well as improving the quality of life of cancer survivors. Today’s cyber seminar will examine two worksite
wellness initiatives that have implemented effective and innovative policy systems and
environmental changes. Dr. Peggy Hannon of the University of Washington School of Public
Health will start us off by framing the issue a bit and sharing more in HealthLinks, a workplace
wellness program, and it’s current randomized control trial. She’ll also touch on early
work with the American Cancer Society targeting large employers and efforts to tailor an approach
to meet the needs of smaller employers including some formative work with employers and employees. Dr. Joanne Pike of the Preventive Health Partnership
will speak about the role federal and state advocacy work plays to ensure a modern prevention
delivery system as part of the national healthcare reform debate. In addition to discussing the
role of advocacy, Dr. Pike will highlight PHP’s co-branded, clinically oriented programs
and materials designed to raise awareness and utilization of preventive services. Following their presentations, we’ll host
a robust interactive discussion with you about your experiences building the capacity of
others to move evidence-based programs and policies into practice. Full bios for Dr.
Hannon and Dr. Pike are available on where you’ll also be able to engage in a discussion
forum around today’s topic as well as other topics of interest and see our robust archives
of previous cyber seminars. The final part of this call as I know that
we’ll be devoted to your questions and comments. So at any time during the presentation please
press Star 1 to be placed in queue to ask your question live during the question and
answer portion. Or if you prefer, you can also type your question using the Q&A feature
at the top of your screen. You just type in your question and hit ask. We specifically and warmly welcome those of
you who are joining us for the first time and we invite you to engage in the discussion
today both on the call and online with the R to R community of practice. And we’re very
appreciative of all of you who were able to join us today. So Peggy now all our housekeeping
is done. So I’m delighted to turn this over to you and Joanne. So thank you. Peggy Hannon: Thank you. Thank you very much
for the opportunity to present as part of Research to Reality and thanks to everybody
attending for your interest in our week. I’m very pleased to be here with Joanne and to
share our work and our collaboration with you. What I will do during the first part
of our time is I’ll briefly discuss why we look at workplace health promotion as a key
venue for cancer prevention and control. I’ll talk about why a lot of our work focuses
on small employers. I’ll spend a lot of time giving you an overview of the HealthLinks
intervention and talking about our current randomized control trial that has health link.
And I’ll start talking a little bit about future directions and Joanne’s going to discuss
that in some detail. So, you know, Margaret’s already sort of giving
you the key reason. I think why we’re interested in workplace health promotion that is we are
interested in adults ages 18 to 65. This is where the majority of them are spending a
lot of their time. So their employers and their worksites are a great path to reaching
them. Also, even folks who are well enough to have jobs and who have all of the advantages
that jobs bring have significant health risks. And what I’m showing on this slide everything
is framed as negative as what we would not want to see. So on top you can see people who are lacking
up to a cancer screening and then current smoking and current rates of obesity and physical
inactivity. And in this analysis of employee develops ages 18 to 65 we can see that on
some behaviors everybody has a lot of room for improvement like we see in typical inactivity.
But we can also see that there are significant disparities by income as well. So those with
annual household incomes of less than $35,000 in the greenish teal bars have significantly
higher rates of missed cancer screenings and of smoking. The other thing is that employers actually
have a lot of promise as implementers of evidence-based approaches to cancer prevention and control.
And in this table I�m showing you the four behaviors that we try to address in HealthLinks:
cancer screening, tobacco use, healthy eating and physical activity. And then evidence-based
approaches for each of those behaviors that are taken from the guide to community preventive
services. These are not necessarily a comprehensive list of the community guides approaches for
each of these behaviors but rather the approaches that seemed feasible for employers to implement
in worksites. So why focus a lot of effort on small employers.
Our initial work with the American Cancer Society focused on large employers and we
still have ongoing efforts that address large employers. And it’s great to work with a single
organization and reach thousands and thousands of people. But we didn’t want to stop there
simply because small employers are just a huge population within the United States. So if you think of small employers of having
less than 500 employees, as the Small Business Administration does, more than 99% of U.S.
work places fall into that category and these small employers employ more than 55 million
people or approximately half of private sector employees are working for a small employer. The other piece is that we know from national
survey work that’s been done both by our group and by other groups as well that small employers
are less likely to offer health promotion and wellness programs to their employees.
And it’s – they face a lot of challenges when they try to offer those programs. There are
wellness and health promotion vendors that serve small employers but a lot of vendors
really don’t have services for small employers. We also know that small employers are more
likely to report that they employ low wage employees and we know that low wage employees
record higher rates of chronic diseases. And as we saw a couple of slides ago higher
rates of some risk behaviors as well. So after we’d work together with the American Cancer
Society for a few years on our efforts to address large employers, we saw this need
– the American Cancer Society saw this need to address small employers as well. And we
started working together on an intervention that they had started developing called HealthLinks. So what are we trying to get employers to
do with HealthLinks? This is really an intervention approach that is targeting the employer and
the worksite and trying to institute changes at that organizational level. And the changes
we’re trying to make sort of map back to that table from the community guide. So first of
all we try to help the employer do policy and environmental changes that will make healthy
choices easier. And this includes things like strengthening
or implementing a tobacco policy, changing what kind of food is offered at the worksite
and that really is tailored to what the small employer is doing. Some sell food and some
don’t but even if they don’t sell food there’s opportunity to improve norms around what kind
of foods are offered at meetings and company events. Also we try to address physical activity.
This picture shows a worksite that installed bike racks to support active commuting to
work. But we also work with employers to subsidize gym members or to map out walking trails around
the worksites or to institute policies supporting physical activity breaks. We also want employers
to communicate more about health and wellness with their employees, to offer evidence-based
programs such as the American Cancer Society’s Active for Life program which is a ten week
physical activity challenge that’s been shown to improve employee’s physical activity levels.
And also where appropriate to offer tools that help employees monitor, track, and improve
their health behavior. Finally in HealthLinks we encourage employers
to connect employees with free resources. And the two we focus on are the state tobacco
quit lines. Many employers and employees aren’t aware that these quit lines exist and that
they offer smokers free physician support. And we also encourage employers that have
a lot of uninsured employees to promote the state cancer screening programs. All of the states have breast and cervical
early detection programs funded by the Centers for Disease Control and Prevention and about
half of the states including Washington State where we are – have colorectal cancer control
funding as well. So we try to help employers let employees know that if they need insurance
and income requirements they may be eligible for free screening. It’s a lot to ask employers to do, so how
do you build an approach that tries to help an organization deal with all of these things.
So I’m showing you a dissemination framework that my center, the Health Promotion Research
Center developed a few years ago where the focus is on evidence-based practices and having
researchers and disseminating organizations partner with each other to develop and test
dissemination approaches that get these evidence-based practices to user organizations. So this has
guided a lot of our thinking about how we develop and test HealthLinks. And I�m going
to return to this framework a little bit later. The HealthLinks approach really occurs in
three phases. And generally speaking a staff person at the American Cancer Society serves
as the interventionist who goes to employers to deliver HealthLinks and this is a free
program. In the first phase, the assessment phase, the interventionist is really trying
to achieve a couple of aims. He’s trying to begin a dialogue with wellness about the main
contact, a lead person at the employer. And also just do an assessment of where they’re
at on all of those practices that we’re promoting that I just walked through. Once the assessment phase is over, we enter
the recommendation phase and at this point the interventionist takes the completed assessment
and creates a tailored recommendations report that’s going to be unique to each employer.
It basically shows a gap analysis for the employer. It shows what they are currently
doing and points out what they could be doing and offers them evidence-based recommendations
for improvement. Most of the time within HealthLinks, it’s been in the implementation phase. At this point the interventionist gives the
employer toolkits to support the recommendations. We have a toolkit for each of the best practices
that I walked through. And these have just very practical resources such as policy templates,
policy development guidelines, communications materials to support changes that are ready
to go to be handed to employees as well as information about the programs and free state
resources that I only did two. In some cases, the interventionist encourages the employer
to form a wellness committee to try to increase their capacity to make these changes. The
interventionist also offers some assistance with onsite wellness programs and education
for employees and works with the employer to adopt new policies to support healthy behavior. We’ve already completed a couple of fairly
large scale pilot projects to do some initial testing of HealthLinks and whether it’s feasible
and effective. So our first pilot was done in Mason County, Washington which you can
see on this map. It’s a fairly rural and fairly economically depressed county. We had 23 worksites
participate in this initial pilot test and we score the employer on best practice implementation
from 0% if they’re implementing anything we recommend all the way up to 100% if they’re
fully implementing each and every best practice. Most employers fall somewhere in between.
And what we saw baseline was that on average employers were implementing less than 40%
of the best practices. And at follow up six months later, that had improved to nearly
60%. So we saw more than a 20% absolute increase in best practice implementation over a fairly
short time period. Our second completed project was done in partnership
with our local public health department, Public Health Seattle in King County as part of their
communities putting prevention towards a grant. So this project was located in out Seattle
in south King County, a very different environment from where we started, much more urban. We
had 47 worksites enrolled and completing this study. And here we saw an interesting picture in
that at baseline they had a lot less going on. So they were implementing just over 20%
of our best practices. So they really were doing very little. And at follow up six months
later, they were implementing over 40% of our best practices. So a similar increase
in best practice implementation of our first project. And you can see that we’re not getting
to the total pot of gold at the end of the rainbow here. They’re not at a 100% and they
have a long way to go. And yet they were able to double their implementation in a fairly
short amount of time and a single interventionist did HealthLinks with all 47 of these worksites. Our current projects include a five year RO1
that’s funded by the National Cancer Institute under the dissemination and implementation
research and health mechanism. This includes a randomized control trial to test HealthLinks
and we also did a big project in the initial year of this grant to develop a readiness
instrument that was theory based and appropriate for small employers. And we did that because in our pilot projects
that I just described, we were seeing a lot of difference among employers in how ready
they were to try to take on an effort like this. But we didn’t feel like we had a tool
that would allow us to systematically capture that. And we felt like we really needed a
tool to do that. We’re also doing a HealthLinks project with
the Washington State Department of Health where we deliver HealthLinks to employers
in counties in rural Washington. And we’re also testing some new ways of delivering HealthLinks
and Joanne’s going to talk a little bit more about that in her piece. I’m going to spend
most of the rest of this talk describing the randomized control trials to test HealthLinks. So we’re trying to do more than just test
HealthLinks against a control group in this trial. We really had a question we wanted
to answer about building internal capacity within the worksites for wellness. And when
I talk about capacity for wellness, I’m really talking about three things that a worksite
could have: a budget dedicated to wellness and health promotion, dedicated staff time,
a person whose full or part time job duties address wellness and health promotion, and
a wellness committee staffed by a variety of employees throughout the worksite. We know
from our formative work both qualitative and survey work we’ve done with smaller businesses
that most commonly they lack all three of these things and that makes it very challenging
for them to try to implement wellness programs. And when we thought about what was feasible
for us to ask employers to do, we thought well we can’t demand that they have a budget
for wellness and we can’t demand, especially in our current economic climate, that they
go hire a person but we can certainly request that they form a volunteer wellness committee.
So one of our key questions in this trial is if you specifically have wellness committees
as a component of or in addition to HealthLinks do we get a benefit in implementation over
and above just a standard HealthLinks approach that doesn’t include wellness committees? So this is a three armed randomized controlled
trial. We collected our baseline data during the recruitment phase and we did employer
assessment surveys as I described in terms of the HealthLinks process. But we also had
all of our employers allowed us to do employee survey data that we could look at the employee’s
health behaviors and also their perspective on what kind of wellness is in place at their
worksite. We then randomized worksites to one of three arms. So we have a standard HealthLinks
arm, HealthLinks plus wellness committees and then delayed program worksites. So right now we’re in the intervention phase
where companies in the two intervention arms are receiving HealthLinks. And then we’re
going to do follow up 12 months after randomization. We’ll do surveys again with both employers
and employees. And we also had a maintenance question we wanted to ask with this study
which is are they able to keep this going after the intervention is over. So we’ll do
a second follow up about a year later and our delayed program worksites will have the
opportunity to receive HealthLinks after we get the two year follow-up data. So returning to our framework, I’ve now filled
this in. So you can see that we have the Health Promotion Research Center partnering with
the American Cancer Society and Preventive Health Partnership. I’ve alluded a little
bit to a lot of some of the formative work we’ve done trying to learn how best we can
work with small worksites, our dissemination approach with HealthLinks that we deliver
to small worksites. We developed a tool to assess readiness and
we will continue to assess readiness as part of our employer assessments. And we’re looking
at their adoption, implementation, and maintenance of HealthLinks best practices. And we’re looking
at those practices both at the organizational and we’ll look at individual employee’s perceptions
of those practices and their health behaviors. So the current status on our trial is that
we have 78 worksites enrolled. They’ve all provided their baseline data. Fifty four of
those worksites were randomized to one of the two intervention arms and are receiving
HealthLinks and our one year follow-up data collection is going to start in May next month.
The characteristics of the worksites that are enrolled are shown here. So we enrolled worksites that had between
20 and 200 employers and about 40% of them are – have less than 50 and about 60% are
in the 50 to 200 size. And this is interesting because those of you who focus on small employers
know that these are not that small, that many, many employers have fewer than 20 employees.
And we have found that those employers there really are capacity struggles with doing HealthLinks
when they have fewer than 20 people. We had six industries that were eligible to
participate in this trial. And these are some of the largest industries that have medium
salaries, the low $40,000 to $45,000 a year. Nearly half of our companies are in healthcare
and social assistance and then fairly evenly divided among the other five industries that
were eligible. And similar to our other HealthLinks studies, the mean best practices score baseline
across our companies is 25%. And we really weren’t seeing significant differences by
arm on this. So it looks like our randomization went well. So once we’re past this trial, something that
we’re already thinking with our partners about is how to expand HealthLinks’ reach. As it
is, the American Cancer Society staff delivering HealthLinks is one model. It’s certainly better
than my research center doing it in terms of having some national reach and capacity. But when you think about how numerous small
employers are, there’s more than five million small employers that have actual employees
around the country. There’s still concerns about how broad reach can be with one group
being responsible. So we’re trying to think together about other delivery models that
are going to be sustainable for the Cancer Society and the Preventive Health partnership
and for the Health Promotion Research Center as well. So thank you very much for your attention
for this first part of the talk. I’d like to acknowledge the National Cancer Institute
and the Centers for Disease Control and Prevention for providing funding support for this as
well as the Washington State Department of Health for funding some of the work that Joanne
will touch on. I’d also like to acknowledge collaborators who are not presenting on this
part of the webinar and they are listed here. If you have questions that you’re not able
to ask during the webinar, please feel free to contact me. And now I’m going to turn it
over to Joanne Pike to continue the conversation. Thank you. Joanne Pike: Thank you Peggy and also thank
you to everybody for joining us today for this conversation. Where I’m going to pick
up is at the point of where we are taking the University of Washington’s research and
making it applicable and available for dissemination through our organization in the partnership,
the Cancer Society, the American Diabetes Association, and the American Heart Association. Peggy briefly touched on the sustainability
model that we are looking at and that they have done some initial research on and that
our partnership is thoroughly interested in making available. And that’s through the work
that we are doing with the prevent – the PRC, Prevention Research Center that’s funded through
the CDC and also that they have previously been funded through the Washington State Department
of Health. And that’s where we look at a sustainability
model of taking HealthLinks to local health jurisdiction staff or county Department of
Health staff, train them and provide them the tools and resources to do small worksite
wellness and then support them on the back end. So when I am talking about HealthLinks,
I am referencing this model of using public health agencies as part of the dissemination
practice. So though to get started, I wanted to just
provide a two minute history on the Preventive Health Partnership because I think we’re often
asked or not many people have heard of our work together and the impacts that we’ve had.
So in 2004, the CEOs of our – at the time of our three organizations came together with
the understanding that focusing on four things could aid in the prevention of our respective
disease states, that being physical activity, eating healthy, not using tobacco products
and receiving preventive healthcare. We’ve got that time that they made the commitment
to begin the partnership. In the beginning, the partnership worked really
focused on a comprehensive consumer directed ad campaign with Ad Council. The first campaign
was entitled Protect Yourself from Yourself in 2004 while the second campaign was focused
on African American women entitled Sisterhood is Healthy. That launched in 2006. And over
the course of the first three years and spanning those two campaigns the partnership had over
$150 million in donated media to support those efforts. Simultaneously to the campaigns and continuing
after those ad campaigns closed, we also jointly published scientific papers on the importance
of primary and secondary prevention. In addition, the partnership really focused on significant
joint advocacy efforts at the state, federal and international levels working on important
issues such as the annual prevention visit, physical education at school guidelines and
also contributing to the global non-communicable disease discussion. And then starting in 2007, implementing our
joint prevention and screening guidelines within healthcare systems also became a major
focus of our work. Our partnership created material for healthcare systems, staff, and
physicians to utilize to enable the in person patient communication exchange regarding recommended
screenings. We’re often – we often refer to them as health card kits. It’s a paper based
tool that enables that communication exchange. And also building off the Heart Association’s
great success with Get With the Guidelines inpatient work. The partnership focused on
building outpatient quality improvement and population health management tools with the
Guideline Advantage. We don’t have enough time to go through all the successes or lessons
learned in those first ten years of work together, but you can also find additional information
and some of the publications that we have put out at which is our
partnership’s Web site. In 2014 at our ten year anniversary, it was
really not just a time marker in the partnership but it also afforded us the opportunity to
review what we had accomplished and what it was that we wanted to do together over the
next five to ten years. It was really important to the CEOs also at that time that we looked
at the continual evolution of the partnership and how we could have regular impact together. I think it was also a great opportunity to
really look at what had changed in the public health environment from 2004 to 2014. There
were certainly lots of things that happened if you think about that decade that have influenced
the work that we’re doing today. How had we as organizations changed? Where could we capitalize
on our strengths and similar strategies? But also where could we focus work that we would
not do alone or that we could be stronger together? So after a strategic review process across
the – our organizations, we all agreed that the biggest opportunity was to look at ways
to utilize our collective voice surrounding social determinants of health and the public
health interventions that could help influence creating healthy communities. And I just want
to highlight that I mentioned the public health interventions and not the social determinant
interventions. But instead the public health interventions and I’ll briefly mention the
first focus area but the second area is where I’m going to focus the rest of my slides because
it really ties into why we’re partnering with University of Washington on some of this work. So we believe that we have a role, responsibility,
and imperative to utilize our collective scientific teams to join the public health community
in focusing attention on the upstream causes of health. So in the future we’ll – we’re
going to be publishing and promoting social determinants of health and how they impact
our respective disease states. However, that second area is where we’re going to be looking
at the work with the University of Washington. And with that in mind, looking at broadening
the impact of HealthLinks with local health jurisdictions that had originally be piloted
with ACS. So how did HealthLinks rise to the top of
the intervention list? I just want to repeat some of the things that Peggy mentioned in
her presentation. I think she did an excellent job of highlighting some of those disparities
seen within small to mid-sized worksites and with low wage earnings. But just to reiterate,
small businesses are typically under resourced and do not provide worksite health promotion. Small businesses make up over half of America’s
private sector workforce. The small businesses historically pay low wages and low wage earners
are at increased risk of chronic disease and are more likely to report having low education
and low literacy levels and higher rates of tobacco use and lower physical activity. From an operational standpoint, worksite wellness
offers a partnership and opportunity to capitalize on each of their strengths in the field while
applying it outside of the typical fortune 1000 or high density urban cities and markets.
So we can utilize each of their scientific credibility and work to apply that to rural
and small business markets where we typically do not have the organizational resources to
be alone. So a quick note. I’m not going to go into a great amount of detail on each organization’s
worksite wellness strategy or programs or products that they offer. We did include links
to that information with the registration for today’s seminar and I’m more than happy
to provide that again. And a quick note, the Heart Association actually even just refreshed
some of their worksite wellness materials just last week and that link was included
with the registration. So for us, the future of HealthLinks grows
and models empowering the state department of health and local health jurisdiction or
county department of health staff to reach otherwise unreached and underserved in a workplace
wellness market. What we’re looking to do is speed the process of research to reality
by creating a nationwide execution strategy to first train state and county DOH staff
to assess and reach low wage, low education level, small worksites. Second, maintaining a targeted approach to
states and counties with low high school graduation rates. So looking at being very targeted to
within that data set and high – that also have a high percentage of rural to midsize
markets. Third, maintaining an intervention and scientific wellness guidelines from all
three of our organizations together. Peggy mentioned that this work originally
had been done with the American Cancer Society. Right now we’re going back through all of
the materials and making it applicable also to the scientific guidelines of the Heart
Association and the Diabetes Association. We’re looking at adapting those current materials
to be delivered in a virtual environment with access to support and ongoing learnings through
that virtual platform. And last but certainly not least, we’re maintaining a commitment
to the continuous evaluation and growth of the model and to the ongoing dissemination
and the results with stakeholders. So while we’re in the early stages of implementation
through the prevention research center funding to the University of Washington, our partnership
is fully committed to a thoughtful growth and implementation cycle for more stakeholders
nationwide than just the counties that will be impacted in Washington. I think it’s also
worth noting that in a time with constrained budgets and reduced resources within the state
and county department of health, we’re attempting to build a resource for health department
staff that will help them meet chronic disease prevention objectives while also providing
a consistent and evidence-based platform nationwide. So in a nutshell, workplace wellness no longer
is limited to the largest corporations or the well resourced corporations. It also has
the opportunity to be a community driven model where our science based grassroots organizations
work with public health agencies to disseminate and evidence-based intervention with a long
term commitment to the evaluation and research, the impact it has on small businesses in rural
to midsized counties nationwide. And I’ll just finish really quickly with a
quote from Dr. Howard Koh while he was the Assistant Secretary at HHS. When he – this
quote was taken he was discussing the leading health indicators and social determinants
of health for health people 20/20 and I think it really exemplifies not only the need for
science around social determinants but also the public health interventions that we need
to implement as a community to make a healthier America. And it goes – it starts with “I’d like to
say that health is much more than what happens to you in a doctor’s office. It’s where people
live, labor, learn, play, and pray. If you want to keep people healthier, you need, in
addition to good direct care, healthy homes, healthy workplaces, healthy schools, and good
recreational areas.” So with that, Margaret I’ll turn it back over to you. Margaret Farrell: Great. Thank you so much
and what a great note to end it on as well Joanne. You know, I mean that’s certainly
the message that, you know, so many of us are kind of grappling with. Right, how do
we make these programs effective in the places where people are and where they’ll be most
open to them? So thank you to both of you, to Peggy and Joanne. And this is a wonderful
time to open up the phone lines and to give everyone an opportunity to join the discussion. We have some questions that have already come
in over Live Meeting. So I’ll just, you know, as a reminder you can press Star 1 to be placed
in the queue to ask your question live over the phone or you could type your question,
submit it on – using the Q&A feature at the top of your screen on Live Meeting. So you
just type in your question and then hit the ask button. So a couple of questions have
– that have come in already, one from (Sarah Burke) Peggy for you. And she asked what – is
there a Web site to HealthLinks or a place where there is more information available
online? Peggy Hannon: That’s a really good question.
We don’t have a detailed Web site about HealthLinks. We have a very simple Web site that was primarily
created for recruitment purposes where we were trying to reach out to small businesses.
On our Health Promotion Research Center Web site, we do have a tab for our workplace projects
and that includes information about HealthLinks. And I�m also happy to, you know, connect
with people via email to follow up if they have specific questions or want to see a given
resource. Margaret Farrell: No and thanks for that Peggy
and we also just for everyone who’s on the call. We also on
have links to some of your publications to share with as well and that might be a helpful
resource to people as well. (Katrina Diaz) says – is asking about PowerPoint presentations
but before she does she just wants to say what a great presentation. So much information
is available that she’s looking forward to putting into work. So thank you for that.
I was on another call that – another question that just came in from (Sarah Vernal) who
asks what are some of the most frequent responses of organizations not interested in implementing
programs? Would either of you have a feel for that? Maybe Joanne through your research? Joanne Pike: I’m sorry. I have to admit to
reading (Katiana’s) question that she submitted. Can you repeat that one more time? Margaret Farrell: Oh sure. She was asking
for slides but did want to say thank you. We have another question from (Sarah) who
says what are some of the most frequent responses of organizations who aren’t interested in
implementing programs? What are some barriers that you find most often? Joanne Pike: I think actually Peggy was probably
best suited for that, especially as it relates to the HealthLinks research that she’s done. Peggy Hannon: Yes. I’m happy to take that.
I think that really one of the biggest things that we hear from employers who don’t take
up the opportunity to participate in one of our projects is just again the capacity issue
is very challenging. You know, most of these smaller employers really don’t have a person
who has wellness as any part of their roles and a lot of them are still struggling with
the economic climate even though it’s slowly improving. So we hear a lot of we’ve had to lay people
off. Nobody has time for this. And that’s been one of the biggest struggles. You know,
we make it – the whole point of HealthLinks is to make it as easy as it can possibly be
made for them but there’s no getting around that it’s still going to take somebody’s time.
And that time can be really, really hard. I think that’s the biggest barrier. Sometimes we find in our qualitative work
with small employers that they’re a little bit reluctant to go into these issues. They
think that health and wellness is incredibly important, but if you think about being in
a small organization and addressing issues like tobacco and weight when you’re on a first
name basis with everybody and when some of these behaviors are obvious. They really get
concerned about getting into other people’s business. We’ve heard a lot about gosh it’s
a delicate balance between supporting health and being actively intrusive. So that’s one
of the other barriers that we hear sometimes. Margaret Farrell: That’s true and that brings
up a good point doesn’t it? You know and I think that’s something that we hear also in
some of the face based wellness programs as well, you know, that at what point are you,
you know, kind of crossing a line almost with a social versus preventive health message.
You know? Thank you. Joanne anything to add to with that with some of the programs that
you’ve seen? What’s been helpful in overcoming those barriers? Joanne Pike: I think, you know, one of the
best things that we’ve seen, especially as it relates to the work that University of
Washington does, is – and just to highlight one of the things that Peggy mentioned about
the process is that where they’re providing and what the staff on the ground are providing
is really that gap analysis. So even if they don’t have the resources to move today, they
at least have the background and the resources to know what they do need to do for the future. Margaret Farrell: Great. Thanks. That’s a
good point. We have a question from (Abby Mulder) who asks is there any additional information
about the Guideline Advantage and results from that pilot? And is going to be available
more widely? And if so, who would your target be? Joanne Pike: (Abby) thank you for the question… Margaret Farrell: I’ll try to pull up that
slide while you’re talking. Joanne Pike: There actually – I don’t have
a slide in there on the Guideline Advantage. It was just a brief speaking point. The Guideline
Advantage is actually widely available now. It’s the kind of population health management
tool that’s available through the partnership and includes all of the scientific guidelines
related to primary care and wellness that you would want to receive from ACS, diabetes
and heart and in addition, a few other measures outside of our three organizations. You can easily link the Guideline Advantage
and more detailed information about it from from our partnership Web
site. On the rotating banner, you will see the Guideline Advantage and you can go straight
over to their site to look at more detail. But it’s absolutely not in pilot alone right
now and it’s available to primary care offices nationwide. (Unintelligible). And just to answer that
last question, who would your target be I the – I think the best targets related to
this, especially from a disparity standpoint, are the federally qualified health centers
and what could be provided from that quality improvement side there. Margaret Farrell: Great. Thanks Joanne. That’s
a good point and having as a thorough answer. And we’ll make sure the link – more information
about the Guideline Advantage on R to R. The – we – I know that we do have some federally
qualified health centers on the call. So, you know, please feel free to call in with
your questions and reflections as well. Our next question is from – I�m going to chop
up your name and I apologize (Heather), (Heather Kristniss) who asks can the HealthLinks program
be used in small doctor’s offices where doctors can be instructed on promoting preventive
screening or is this completely out of HealthLinks’ scope? For example, some patients don�t
know that their Medicaid might, for example, cover smoking cessation. Peggy Hannon: I think that’s a really good
question. We have had healthcare facilities participate in HealthLinks in the past. So
in terms of, you know, could those types of groups participate in HealthLinks I think
definitely. I do not know whether we as interventionists
have, you know, given them any extra support on addressing their patient population specifically,
although they might choose to do so and I think that’s something that’s been very interesting
that we run into when we have healthcare facilities of all kinds and schools. We’ve had both of
those participate and a lot of times I think they’re interested in this because health
and well being is such a key part of their mission for the people they’re serving. And a lot of them do have this interest around
if we can help our employees with this message, hopefully they’re going to pass that message
on to patients, to students or, you know, to their relevant constituents. But the intervention
as it currently stands doesn’t have any standard materials to achieve that aim. Joanne Pike: The one thing I would add and
this is Joanne is I mentioned the physician outreach program that the partnership has
done called the health card kits. And that does include all of the primary and secondary
related screening recommendations from ACS, ADA and AHA together in a simple card format
for physicians or healthcare staff to utilize with a patient to enable that screening related
conversation. And that is available for order for healthcare systems from our site at Margaret Farrell: Great. Thank you both. We
have a question from (Nicole Braun) who asks is there an effort to balance the focus on
promoting health behaviors with broader changes to the workplace? So, for example, promoting
living wage, flexible scheduling, family focused workplace policies. Peggy Hannon: This is Peggy and we are starting
to do some formative work around really addressing stress more thoroughly and stress is a very
broad topic. And certainly that can include things like policies around flexible scheduling
and encouraging work/life balance. We’ve seen that employers know this is a very
salient issue to their employees and they seem very, very hungry for tools to help their
employees manage stress. And in our formative work with employees in these organizations,
we hear a lot about stress from them as well. You know, everybody understands the behaviors
that we’re addressing are important, but I think when people think about happiness and
quality of life today stress is a really big issue. So we are working to try to be more
inclusive and to do more with that topic. So we’ve been developing some new materials.
They’re not part of the randomized controlled trial but we are starting to integrate them
in some of our other projects. Joanne Pike: I think it’s an extremely important
topic and I appreciate (Nicole) bringing it up especially as it relates to living wage
and how much of a hot topic it is especially around social determinants of health and poverty.
And I think it’s – there are lots of directions we could be going with the small worksites
especially because historically they are low wage earners. And I think it – there’s opportunity
there. We just need to find it and certainly we need to with the partnership of our research
groups look at ways that that’s meaningful to include. Margaret Farrell: Great. Thank you. And (Nicole)
if you have a follow-up, you know, please let us know because I do think it sets up
a very interesting, you know, push pull dynamic too, you know, like a – how much of these
policies in the workplace help drive – help improve health, you know, and also these other
benefits, how much they would improve the ability to have a bit more work/life balance
as well. So it’s an interesting policy and personal discussion, you know, on both ends
of it. So thank you. I think we might be coming to
the end of our questions. So I just wanted to ask – just put you on the spot Peggy or
Joanne if there was anything else that you wanted to add. I’ll give you the opportunity
to have the final moment and maybe give us some – a sense of maybe even like next steps
or something that you’re looking forward to coming up that we should be on the lookout
for. Peggy Hannon: Well thank you for that opportunity.
You know, I think for us, our next steps, you know, first of all we need to get to our
outcome data on this trial. Certainly our pilot data are very, very promising but we
really wanted to do this project that has a very robust future to design and see where
we are. But again we also know that we don’t want to wait until the very end to start thinking
about broader dissemination and sustainability issues that Joanne and I had touched on. So we’ve already done a pilot in one county
with training somebody within a local health jurisdiction to do the intervention and having
us really be in a somewhat different role where we’re providing materials and technical
support. We’re about to expand that effort within Washington state and Joanne and I and
our groups continue to think about how to put together a broad based effort to really
try to make that opportunity broader than it currently is. So I think that’s what we’re
hoping is the next big thing for us. Joanne do you want to add to that? Joanne Pike: Yes. I would just echo that.
I think that the work that we have ahead of us with the PRC project from the CDC really
is the small starting point and we’re looking forward to finding ways to expand that beyond
Washington. Margaret Farrell: Great. Well thank you both
and we’ll look forward to hearing more about that and keeping, you know, this group that’s
gathered on the call today and most of the R to R community, you know, apprised and hope
to have you back to keep talking about this discussion and ways that this important work,
you know, as you move forward especially around sustainability. And, you know, just want to
thank both of our speakers again and thank all of you for joining us today. Your feedback is very important to us and
we encourage you to complete our online evaluation. A link to survey will be sent to you shortly
in an email. And as we mentioned, we’d like to continue this discussion from the cyber
seminar online at where you can continue to ask questions of
Peggy and Joanne and engage with each other and we hope share some of your success stories
around worksite wellness programs. And we look forward to seeing you back next month
on May 19 at a special time, at three o’clock where we’ll – our next cyber seminar. We’ll
talk about face based physical activity and other initiatives in Latino communities. So look for that registration coming out shortly.
So with one more thank you to Peggy and Joanne, I’d like to thank all of you for joining us
today, and enjoy the rest of your day. Thank you so much. Coordinator: Leader and speakers, please stand
by for your post conference. That concludes today’s conference. All participants may disconnect.

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