By Cesar Morocho

The Biomedical Engineering and Biotechnology program invites you to attend a doctoral dissertation defense by Cesar Morocho on “Assessing engagement, fidelity, and cost of implementing a participatory Total Worker Health program.”

Candidate Name: Cesar Franco Morocho Albarracin
Defense Date: Tuesday, Jan. 31, 2023
Time: 9 - 11 a.m.
Location: Perry Hall 415, North Campus


  • Advisor Laura Punnett, Department of Biomedical Engineering, University of Massachusetts Lowell
  • Angela Wangari Walter, Department of Public Health, University of Massachusetts Lowell
  • Saira Latif, Department of Finance, University of Massachusetts Lowell


Background: In participatory intervention research, the systematic participation of frontline workers throughout the implementation of workplace changes is essential and requires careful monitoring to respond proactively to obstacles in real time. The measurement of participant engagement and implementation fidelity is inconsistent in the public health literature, and there are only a few economic evaluations of participatory workplace interventions. The commitment of personnel time and length of the participatory process are often concerns of employers, and cost estimates can help them make informed decisions about whether or not to support a participatory change process. The overall purpose of this dissertation was therefore to evaluate these features of the implementation of a participatory Total Worker Health (TWH) program called the Healthy Workplace Participatory Program (HWPP) in five public medical facilities in the New England region of the United States.

Method: This dissertation describes a practical method to operationalize the longitudinal evaluation of worker engagement, implementation fidelity, and costs. Engagement was measured as the magnitude and diversity of participant effort in program implementation, with measures of effort specific to each participant role. Implementation fidelity, or the extent to which the program protocol was followed, was measured as proportion of program content implemented, dose (person-time of program exposure), and reach (representativeness of participants). Cost of personnel time entailed meeting time, time with a research coach for training on the program and meeting facilitation, and between-meeting time in program-related activities. (No other costs were incurred during the available follow-up time for this study.)

Results: The five facilities achieved different stages of program completion because the COVID-19 pandemic interrupted all planned activities in March, 2020. Overall, worker Design Team (DT) members were highly engaged throughout the available follow-up time. Most DT members contributed to meeting discussions, interacted positively and respectfully, and considered equally the suggestions from supervisory and frontline workers. Four of the five facilities closely followed the program protocol during implementation and therefore had good implementation fidelity. These facilities implemented a high proportion of the program content, received more than the minimum suggested dose in the protocol guidelines, and sustained DT membership with representation of most departments and bargaining units in each facility. Those facilities following the recommended times for each step in the protocol had lower costs. In each facility, the salary costs of initiating the program represented a very small investment relative to the person-hours of program participants at work during the implementation period and to the facility’s annual payroll expenses.

Conclusions: Facilities established a committee structure representing multiple levels in the organization and frontline workers were highly engaged in the HWPP implementation. This dissertation illustrates the benefit of practical measures to monitor and evaluate program implementation. Consistent measurement of engagement, implementation fidelity, and costs will help compare the implementation process among studies and aggregate evidence on the impact of the implementation process on desired workforce health outcomes. Implementing participatory TWH programs ideally represents a long-term workplace investment; effectiveness evaluation of HWPP is still needed to assess its impact.

All interested students and faculty members are invited to attend the defense.