Rachel Pisula

12/09/2016
HEA 648: Program Planning

WorkHealthy America Internship

Prevention Partners
Chapel Hill, NC
Problem Defined

In 2010, chronic diseases represented seven of the top ten causes of death in the United States. The main

chronic diseases that America faces today are: heart disease, cancer, stroke, type 2 diabetes, obesity and arthritis,

with heart disease and cancer together accounting for nearly 48% of all deaths (Centers for Disease Control and

Prevention [CDC], 2016). In addition to their high prevalence and huge impact on health status, chronic diseases are

also costly: eighty-six percent of all health care spending in 2010 was for people with one or more chronic medical

conditions (Centers for Disease Control and Prevention [CDC], 2016). Although chronic diseases take a significant

amount of time to develop and tend to endure for a long time (World Health Organization [WHO], 2016), they are

also largely preventable since they are often the result of repeated lifestyle choices and health behaviors.

Taking the Social Ecological Model into consideration, Prevention Partners recognizes that our lifestyle

choices and health behaviors are the result of much more than just our individual attitudes, knowledge, and beliefs.

In fact, there is a larger scope under which all of our choices are made, with policies, the environment, and systems

having a much bigger impact on our choices and behaviors. Prevention Partners believes that the current policies

and systems in our environments are contributing to the burden of preventable chronic diseases in the U.S. One

definition of the word environment states that it is the surroundings or conditions in which a person, animal, or

plant lives or operates, meaning that individuals can have multiple environments in their lives. Prevention Partners

focuses on improving health and prevention efforts for chronic diseases in the specific environments of schools,

workplaces, hospitals, and clinics.

Prevention Partners creates technological innovations for workplaces, schools, hospitals, and clinics to

help improve their communitys health by adjusting current policies and systems already in place. Prevention

Partners aims to improve prevention efforts in these arenas for a good reason: typically workplaces, schools,

hospitals, and clinics already have an existing community. These communities can be very helpful in modifying

behavior, because its easier to take the steps we know we should quit smoking, change our diet, take up

exercise when our peers and supervisors are encouraging us with supportive programs, benefits and policies

(Prevention Partners, 2016).

 Laura Putnam, a leading keynote speaker on workplace wellness programs, mentions in her book that

workplaces are to adults as schools are to children. As adults, we spend most of our waking hours at work, and as

children, we spend most of our waking hours at school (Workplace Wellness that Works, 2015). Prevention Partners

believes that focusing on these environments will have the biggest impact on population health. They advocate that

the places where we work, learn, and provide and receive healthcare are built environments with their own policies

and systems that impact our health in a multitude of ways (Prevention Partners, 2016). Prevention Partners attempts

to address policies and systems in these built environments by focusing on schools through their LearnHealthy

America, on workplaces through their WorkHealthy America, and on hospitals and clinics through their Patient-Quit

Tobacco System and LeadHealthy America programs.

Given the broad population reach of Prevention Partners products, the intern will focus their efforts solely

on the workplace with Prevention Partners WorkHealthy America program. The workplace is a unique environment

to implement wellness strategies, because employees improved health leads to improved productivity, less

absenteeism, and less presenteeism, making wellness beneficial to the entire company. Implementing prevention

efforts in workplaces can be a good investment as well: In North Carolina alone, the costs of tobacco use, physical

inactivity, poor nutrition and obesity add up to $5,711 per employee in lost work time and health care treatment

(Prevention Partners, 2016).

According to Leslie Smith of Prevention Partners, the leading causes of chronic diseases are tobacco use,

poor nutrition, physical inactivity, obesity, and stress. However, these risk factors also work together synergistically,

rather than in a vacuum: the risk factors affect one another. Tobacco use is the heaviest weighted risk factor for

chronic diseases. In the U.S, smoking is the single largest preventable cause of disease and death, with more than

16 million Americans living with a disease caused by smoking (Prevention Partners, 2016). Regarding poor

nutrition and physical inactivity, over a third of U.S adults are now considered obese, contributing to 28% of

preventable disease and death (Prevention Partners, 2016). Stress is linked to high blood pressure, but is much

harder to measure than tobacco use, physical inactivity, and poor nutrition (L. Smith, personal communication,

October 12,2016).

Prevention Partners is seeking to translate evidence-based practice to real world problems. Businesses and

organizations who are looking to make changes in their environment, with their policies and within their systems are
seeking guidance for how to do so. Prevention Partners seeks to solve this problem by giving better access to clients,

providing distance-based education, and holding live trainings for organizational leaders.

The mission of Prevention Partners is to build healthier communities through a suite of products that guide

workplaces to address the leading causes of preventable disease: tobacco use, poor nutrition, physical inactivity,

obesity, and stress (Prevention Partners, 2016). Their goal is to provide webinars covering each of their 5 main

health topics for their WorkHealthy America product, and the intern will focus specifically on creating a webinar

focused on increasing physical activity in the workplace. As part of the internship, this webinar will be shared with

registered participants likely improving participants understanding of changing or implementing new wellness

policies and programs in their workplace that will specifically help improve physical activity among their

employees.

SWOT Analysis

Prevention Partners philosophy is that healthy places change lives (Prevention Partners, 2016). This

philosophy leads into one of the strengths listed in the SWOT analysis - the value of culture. Culture can often be

hard to identify, but staff at Prevention Partners could take an objective look at each organizations culture. An

opportunity for Prevention Partners to expand their current services could include adding in organizational culture

reviews. These reviews could be used to focus on shifting the workplaces culture to one that supports health.

The internship duties at Prevention Partners will include building upon current strengths, by contributing to

the facilitys workplace wellness modeling and value of health. Since Prevention Partners offers paid exercise

breaks, healthy snacks around the office, and walking meetings, the intern will get a good sense of what a healthy

workplace looks like. In addition, there will be opportunities to bring their own creative ideas to the table - including

leading exercise classes during paid breaks.

Prevention Partners new broad reach to states outside of N.C makes distance-based education essential.

This proves to be an opportunity for the intern to help with: they can find creative ways to train organizational

leaders. One way that Prevention Partners already does this is by utilizing webinars. The intern can expand on the

effectiveness of webinar trainings by making them more engaging to the audience and finding ways to get the

audience involved.
Problem Analysis

Prevention Partners lists tobacco use, obesity, poor nutrition, physical inactivity and stress as the leading

causes of preventable or chronic diseases. They help leaders of schools, workplaces, hospitals and clinics to create

and implement appropriate policies and programs to improve prevention efforts in the five noted risk factors for

chronic diseases. In framing the leading causes of preventable disease, the social ecological model of health

promotion (McElroy, Bibeau, Steckler & Glanz, 1988) was used to determine the layers of influence that affect each

leading cause using multiple ways to affect change in the workplace, but noticing that policy has a

disproportionately larger impact on health behavior and lifestyle choices than the other layers of the SEM.

Since the majority of the interns work at Prevention Partners will revolve around WorkHealthy America

and helping to conduct and disseminate webinars and trainings for that specific product, the conceptual model

(Figure 1) of chronic diseases is demonstrated as it relates specifically to the workplace.

Figure 1
Conceptual Model of Chronic Diseases in the Workplace
 The construction of a conceptual model (Figure 1) was helpful in analyzing the connections between the

health problem of chronic diseases and the non-health problem of improving and expanding WorkHealthy America

products, trainings, and webinars. The top of the model shows the relation between WorkHealthy products and its

effect on an organizations culture. Leaders in organizations have a huge role in the structure of culture, so working

with leaders allows us to the affect the workplace at its core (Workplace Wellness that Works, 2015). Affecting the

organizations culture can put a larger emphasis on the important of health and wellness, therefore affecting the

implementation of policies and programs in the workplace that affect employee health and well-being. Workplace

Environment is also listed towards the top of the model, as we know that environment plays a big part in our health.

However, Prevention Partners is not actually making changes in the physical environment of the workplace.

Organizations may choose to alter their environment, but not as a direct result of WorkHealthy America. Some

factors that affect the environment are listed, including: maintenance of stairways, the presence of a fitness facility

(hours/location), and the presence of a dining area and the food options in the workplace.

Continuing down the model, different sample policies and programs for the workplace are listed. Not all of

the available options are listed, but some of the common ones are. According to one article, policy development is
needed to accelerate change, especially for smaller employers (those with fewer than 500 employees), which

represent the majority of U.S. employers and are far less likely to offer health promotion programs. While

programs are important, policies are essential in driving change.

Food options, work hours, paid exercise breaks, and smoking restrictions are just some of the workplace

policies listed that have effects on the risk factors for chronic diseases (Workplace Wellness that Works, 2015).

Walking meetings, exercise classes, cooking classes, tobacco cessation group, yoga, and weight management

programs are some of the workplace programs suggested to leaders who use Prevention Partners. These programs all

are linked to the risk factors for chronic diseases as well. However, its important to notice that there are factors

outside of workplace policies, programs, and the environment that affect our health behavior and lifestyle choices

(Workplace Wellness that Works, 2015). On the edge of the model, genetics and personal health beliefs are listed as

additional outstanding factors that exist outside of the workplace and are determinants of our choices. Altogether,

genetics, health beliefs, physical activity, bmi, nutrition, stress management, and tobacco are used to show factors

which can contribute to the development of chronic diseases in the workplace.

Tobacco use accounts for 37% of preventable disease and death (Prevention Partners, 2016). In a study on the

short-term impact of national smoke-free workplace legislation in Finnish, they found that legislation was more

efficient than voluntary workplace-specific smoking restrictions in reducing passive smoking and cigarette

consumption (Heloma, Jaakkola, Khknen & Reijula, 2001). In this case, policy, the most encompassing section

of the SEM, may have the ability to reduce tobacco use effectively. Another study found that employees who

worked in a smoke-free worksite were over 25% more likely to make a serious quit attempt between 1988 and 1993,

and over 25% more likely to achieve cessation than those who worked in a worksite that permitted smoking

(Glasgow, Cummings & Hyland, 1997). Smoking restrictions in the workplace as a policy, and tobacco cessation

groups as a program are a way to address tobacco use in the workplace.

Incorporating more physical activity into the workplace is often a goal that organizations try to meet,

whether through policy, programming, or both. In one study, three public sector studies provided evidence that

workplace walking interventions using pedometers can increase daily step counts. Also, there was strong evidence

that workplace counseling influenced physical activity behavior (Brettle, Dugdill, Hulme, Long & McCluskey,

2008). In the conceptual model, walking meetings, paid exercise breaks, exercise classes, and yoga are some of the

options that Prevention Partners suggests to clients to add more movement into their workplace. Physical activity
counseling may likely be included in a weight management program. A weight management program would also tie

in to alleviating the prevalence of obesity among employees, what is considered here to be the opposite of Healthy

BMI/Weight in the conceptual model.

Some of the suggestions for improved nutrition among employees are cooking classes (where participants are

taught how to cook a nutritious meal) and increased access to healthful foods. This increased access could be

reached by changing whats available in the vending machines and in the cafeterias at the workplace. In one article

focused on the health of physicians within a hospital, they found that: In addition to identifying practical barriers

such as lack of time to stop and eat, inconvenient access to food and poor food choices, the physicians described

how their sense of professionalism and work ethic also hinder their work nutrition practices (Dinsmore, Lemaire,

Roberts, Wallace, 2010). Leaders helping to implement workplace wellness programs would benefit by noticing all

of the barriers that could be in the way of an employees ability to engage in health and wellness.

Regarding stress in the workplace, up to a certain point an increase in pressure will improve performance

and the quality of life. However, if pressure becomes excessive it loses its beneficial effect and becomes harmful

(Kushwaha, 2014). Stress management is the phrase often used in workplace wellness. This phrase recognizes that

stress cant always be avoided, but that one can learn how to manage it.

The outcomes of the conceptual model in Figure 1 are the following:

tobacco cessation
improved nutrition
improved BMI/weight
reduced stress and better managed stress
increased physical activity

Any of these outcomes, in combination or by themselves, contribute to decreasing ones chance for

developing a chronic, preventable disease. At the completion of the internship, there will be a deepened

understanding of working with organizational leaders to develop policy and programs in the workplace that improve

physical activity among employees, thus decreasing their risk for developing chronic diseases.

Internship Outline

During the internship, the overall focus will be on improving the non-health problem Prevention Partners

has identified: that current policies and programs in our environments are contributing to the burden of chronic

diseases in the U.S. Specifically, the intern will focus their efforts on increasing physical activity in the workplace,

given that physical inactivity is one of the risk factors for developing chronic diseases and given that workplaces are
an environment that Prevention Partners targets. Improving policies and programs in the workplace around physical

activity will require the expansion of distance-based education for leaders of organizations who are looking to create

healthier workplaces. The main way that the intern will contribute to resolving the problem is by creating a new

webinar that will help leaders implement policies and programs that increase safe, physical activity among their

employees.

The intern will begin by utilizing and analyzing resources that are currently available to Prevention Partners

in determining what should go into the physical activity webinar, as well as forms of communication already in

existence with WorkHealthy America consumers. The next step will be planning out the activities that will lead to

the creation of the webinar and distribution of information about the webinar to current consumers and future

consumers. The logic model will then show the outputs of the webinar production and the results it will bring.

Logic Model of WorkHealthy Webinar

Review of Previous Webinars

 By reviewing previous webinars produced by Prevention Partners, the intern will get a sense for how to put

one together effectively, beginning with creating an eye-catching title for the product. The intern will also review

webinars posted on WELCOAS (Wellness Corporations of America) website. This site will be especially useful in

determining proposed policy and program changes directly related to physical activity in the workplace. Given that

the webinar is designed mindfully, participants will be more knowledgeable about physical activity policies and

programs that can be implemented in their workplace. Participants self-efficacy will also increase, having evidence-

based practices translated into real-world problems. These webinars also create online venues for real time

discussions (Sipin, Humphreys, 2013), enabling the audience to become involved in the learning process.

Distribute Information

In order to gain participants for the webinar, the intern will focus on distributing information about the

webinar via Prevention Partners Facebook page, LinkedIn page, and their monthly newsletter. By using different

avenues of product promotion, the intern should be able to increase the registration rate. Previous registration rates

for webinars have been around 20% for eligible WHA consumers.

Email Reminders

During the three weeks before the launch of the webinar, the intern will email the database of WHA

consumers each week with a reminder about the webinar and how to register online. Continued communication with

potential participants should help to increase the registration rate.

Communication with Participants

Prior to developing the webinar, the intern will reach out to WHA consumers to determine top concerns

among improving physical activity in the workplace through policies and programs. This strategy allows the

consumers to be actively engaged in the production of the webinar, hopefully increasing the rate of participation as

well.

At the conclusion of the webinar, the intern will specifically reach out to WHA webinar participants to

determine what worked best for them. The intern will address top interests among participants and how participants

plan to implement information from the webinar into their own workplace policies and programs. These two
activities are essential in determining qualities and standards for future webinar presentations. According to Sipin

and Humphreys, the best way to evaluate webinars is through post-event surveys (2013).

Effective Registration

By ensuring that registration links are active and effective, participants will successfully be able to register

for the presentation. This includes ensuring successful links posted on social media and the Prevention Partners

website.

GANNT Chart

The GANNT chart provided below shows the expected timeline of activities to be completed during the

internship.

References
Brettle, A., Dugdill, L., Hulme, C. (2008). Workplace physical activity interventions: a systematic review.
International Journal of Workplace Health Management, 1, (1), 20 40.
http://dx.doi.org/10.1108/17538350810865578

Centers for Disease Control and Prevention. (2016). Chronic Diseases Overview. Retrieved from
http://www.cdc.gov/chronicdisease/overview/

Cummings, K.M., Glasgow, R.E., Hyland, A. (1997). Relationship of worksite smoking policy to changes in
employee tobacco use: Findings from COMMIT. Community Intervention Trial for Smoking Cessation. Tobacco
Control, 6, (2). http://tobaccocontrol.bmj.com/content/6/suppl_2/S44.short
Darling, H., Heien, L. (2009). Addressing obesity in the workplace: The role of employers. Milbank Quarterly, 87:
101122. Doi:10.1111/j.1468-0009.2009.00549.x

Dinsmore, K., Lemaire, J.B., Roberts, D., & Wallace, J.E. (2011). Food for thought: an exploratory study of how
physicians experience poor workplace nutrition. Nutrition Journal, 10, (18). Doi: 10.1186/1475-2891-10-18

Heloma, A., Jaakkola, M.S., Khknen, E. (2001). The short-term impact of national smoke-free workplace
legislation on passive smoking and tobacco use. Am J of Public Health, 91, (9), 1416-1418.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.91.9.1416

Kushwaha, S. (2014). Stress management at workplace. Global Journal of Finance and Management, 6, (5), 469-
472. http://www.ripublication.com/gjfm-spl/gjfmv6n5_13.pdf

McLeroy, K.R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion
programs. Health Education & Behavior, 15 (4), 351-377. https://www.ncbi.nlm.nih.gov/pubmed/3068205

Prevention Partners. (2016). Fast Facts. Retrieved from http://forprevention.org/p2/about-us/fast-facts/

Putnam, Laura. (2015). Workplace wellness that works: 10 Steps to infuse well-being and vitality into any
organization. Hoboken, New Jersey: John Wiley & Sons, Inc.

Sipin, M. (2013, August). Creating Successful Webinars: Best Practices and Lessons Learned. In 2013 National
Conference on Health Communication, Marketing, and Media. CDC.

World Health Organization. (2016). Non-communicable diseases. Retrieved from

http://www.who.int/topics/noncommunicable_diseases/en/