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Worksite: Assessment of Health Risks with Feedback to Change Employees' Health – AHRF Used Alone

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What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 32 studies (search period through June 2005). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to worksite health promotion.

Context

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Summary of Results

Detailed results from the systematic review are available in the Task Force Finding and Rationale Statement pdf icon [PDF - 130 kB].

Thirty-two studies qualified for the review.

  • Results were considered inconsistent, with some in favor and some not in favor of the intervention.
  • The magnitude of effect for the eleven outcomes considered in this review was small.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Research Gaps

The following outlines evidence gaps for assessment of health risks with feedback when used alone, and when combined with health education programs, with or without additional interventions.

This review of the use of assessments of health risks with feedback in worksite settings addressed important questions that earlier reviews were unable to address, such as:

  • Does AHRF, when used alone, lead to behavior change or change in health outcomes among employees?
  • Does this type of assessment, when used with other worksite-based intervention components result in change?
  • And finally, what types of behaviors or health outcomes are affected by these interventions?

The structure of this review, however, leaves two additional questions about worksite health promotion programs unanswered:

  • Are worksite health promotion programs with a health education component effective in the absence of AHRF and
  • Does AHRF add value to worksite health promotion programs with regards to behavior change and improvement in health outcomes?

The field will also likely be interested in addressing questions related to implementation of the intervention: what components are necessary and for whom are they most effective? How many times must AHRF occur and for how long must employees be exposed to additional intervention components? What qualifications of staff or health educators are needed? How long do the effects last? With regards to the assessment: Are there key assessment questions or aspects of the assessment (like biometric screening) that provide information resulting in a more effective intervention? Does the format of the questionnaire or the feedback make a difference? Is employee participation in creation of the program important and what role does organizational support play in participation rates and overall effectiveness?

Finally, questions regarding economic efficiency will be of interest to most in the field and should be addressed more systematically. A first step would be to clearly delineate the aspects of program costs and benefits that should be assessed in program evaluation. How many employees need to be reached for a positive ROI? What should the GRP (gross rating product) be for the ROI? Is there a “break even point” or a certain amount of time for which costs will outweigh benefits before there are actual savings from program implementation? Although the questions above stem from this review of assessments of health risk with feedback, many of them pertain to the broader field of worksite health promotion and can be used to inform future evaluation of these programs.

Study Characteristics

  • Of the 32 studies included in the AHRF review:
    • Eight studies included an untreated or lesser treated comparison group.
    • One study was a time series study.
    • Twenty-three studies were included as before-after study designs.
  • Evaluated programs were conducted in small (2 studies), medium (6 studies), and large (24 studies) companies.

Publications