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Issue #22

Getting employees on board: Factors influencing participation in worksite health promotion programs

By Mari Ryan, MBA, MHP, CWWPC, Founder/CEO of AdvancingWellness, a Massachusetts-based worksite health promotion consulting firm

Issue #22

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When planning program interventions, worksite health promotion professionals should be concerned about whether the program will attract people, from all job and demographic groups of employees. Participation is the whole point of a worksite health promotion program. Without participation, the likelihood of achieving positive outcomes is jeopardized. Higher participation rates lead to better program outcomes and make your efforts worthwhile. 

So if you build it, will they come? Utilizing these best practices from the field of worksite health promotion will increase the probability of high participation rates. 

Management Support. Management support has long been considered a best practice in the field of health promotion by organizations such as the Health Enhancement Research Organization (HERO) and the Wellness Councils of America (WELCOA). Management establishes the mandate, provides access to resources, and creates cultural support by defining the norms of the organization. A survey of best practices scorecard data found that in organizations with strong management support, employees were more likely to complete a health risk assessment (59 percent versus 41 percent) and to participate in biometric screening (53 percent versus 38 percent) than organizations with little or no leadership support.i Management support may take various forms, including the executive sponsor promoting the program in company communications, executives being visible program participants themselves, and support from middle managers through flexible work schedules.

Know Your Audience. Another best practice in worksite health promotion is to collect data on the employee population and use that information in program planning. Data collection can be through health risk assessments, needs and interest surveys, or medical, dental and disability claims reports. A key goal is to understand what the employee population is interested in doing. Questions that identify those areas of behavior where employees are most ready to make changes will most likely draw more participants. Health risk assessments typically include 'readiness to change' questions, based on the Transtheoretical Model of behavior change.ii When designing programs we have to balance addressing those factors that are driving medical costs while meeting the needs and interests of the employees we hope to attract to participate. 

Incentives. As most of us have experienced personally, changing behavior and adopting new habits is difficult to do. Without a reason or motivation to change, many people will not make a change. Incentives can serve as motivation to encourage change. Incentives have become a standard part of worksite health promotion programs, with nearly 50% of employers using incentives to encourage employee participation in programs.iii Some experts in the field believe that, “The relative effectiveness, or overall participation levels,… is directly related to the dollar value of the rewards.” iv Incentives need to be designed with attention to both the short-term participation goals and the long-term behavior change goals. Incentives may be tangible rewards such as prizes, money, time off; or intangibles such as recognition from others, or opportunity to achieve a personal accomplishment or meet a desired challenge. 

Marketing and Communications

If you build it, will they come? They might, but only if they know about it. Well-planned and executed marketing and communications activities are key drivers of program participation. Using principles of social and commercial marketing to develop the communication plan can help ensure the information is delivered in the right time frame, using media that will capture the attention of the target population with the appropriate information and a call to action. When these elements are successfully coordinated, the marketing will drive the participation that your program deserves. For communication to be effective, it needs to be frequent and to take various forms. For example, don't assume that everyone in an organization has access to email. Posters, break room tent cards, and other visual cues can supplement other forms of communication.

Policy and Environmental Changes

Sometimes those who might benefit most from health improvements might be the least likely to choose to participate in a formal program. Changes to workplace policies and the environment provide impact for individuals who many not directly enroll in a specific activity. Creating a supportive environment where the default choice is the healthy choice provides an opportunity to practice healthy behaviors. Policies such as tobacco-free workplaces or healthy food options at meetings are good examples. Environmental changes, such as making staircases friendlier with bright paint and lighting, or mapping walking paths or routes in the workplace neighborhood, provide additional opportunity and encouragement.

Closing Thoughts

Successful implementation of a worksite health promotion program requires incorporating many different elements. Each has to be designed and implemented in a way that will deliver effective programming that meets the needs of your target population. When this is done, they will come.

Mari Ryan, MBA, MHP, CWWPC is Founder/CEO of AdvancingWellness, a Massachusetts-based worksite health promotion consulting firm. Mari is also a founder of the Worksite Wellness Council of Massachusetts. 


iEmployee participation in health and wellness programs soars with senior management commitment. Health Enhancement Research Organization. Retrieved March 15, 2011, from:

iiProchaska J., Norcross J., DiClemente C. (1994) Changing for good; A revolutionary six-stage program for overcoming bad habits and moving your life positively forward. New York, NY: Quill. 

iiiSeaverson E.L.D., et al. The role of incentive design, incentive value, communication strategy, and worksite culture on health risk assessment participation. American Journal of Health Promotion 2009 May-Jun;23(5):343-52.

ivChapman L. Employee participation in workplace health promotion and wellness programs: How important are incentives, and which work best. NC Medical Journal 2006 Nov-Dec; 67(6): 431-432.

CPH-NEW, a Center for Excellence to Promote a Healthier Workforce of the National Institute for Occupational Safety and Health, is a joint initiative of the University of Massachusetts Lowell and the University of Connecticut. CPH-News & Views is a semi-monthly column written by Center researchers on emerging topics related to healthy workplaces. These comments reflect thoughts of the individual researchers and do not represent conclusive research summaries, nor do they necessarily reflect a consensus among all Center personnel. We welcome your responses and discussion. Please send all questions and comments to

CPH News and Views Issue 22

© Copyright 2013 The Center for the Promotion of Health in the New England Workplace (CPH-NEW)

July 2011