Paul Avis questions what effects online health risk assessments have had on employee health, and discusses the next stage of evolution for this service.

Traditional approaches

As with all areas of health management, services exist to support employers already. For example, Occupational Health (OH) practices will offer pre-employment screening, health surveillance and health promotion. This could include non-smoking campaigns, alcohol reduction and increasing fitness levels but as it is usually not based on empirical data it is often the first thing to be cut when the budget is scrutinised.

Some employers have a physical health screening process and this covers various biometrics such as body mass index, lung function, audiometer, cholesterol, and so on. The cost of such screens can range from £40 for a voucher-driven approach at the local pharmacist, up to £600 for a full ‘executive’ medical at a private hospital.

In all cases, this gives the employee a summary of what they need to focus on and improve and, in some cases, corporate summaries on health, which are confidential at a personal level. While all of these are ‘nice to have’ benefits and are of value to the employee, the question is, what next? The objective of such services should be to put employees on a ‘road to health’ but without a robust mechanism to do so and the inability of employers to force employees to be ‘healthy’, the business benefit can be limited.

Online health risk assessment

There is nothing revolutionary about the online approach to health risk assessment but this approach was the next stage in health screening. The depth and delivery mechanisms allow them to become much more affordable and, with an increasingly sophisticated incentive programme approach, a greater degree of employee take-up can be expected where this is used.

The objective is to provide employees with metrics to allow them to take responsibility for their ‘total’ health and to provide employers with a summary of the health of the workforce. Employees complete a questionnaire (paper or web-based) and from their responses are provided with an initial report which highlights where they are today and where they could be with changes to lifestyle.

As the IT system is backed by clear clinical algorithms, and a sound academic base, employees are engaged to act on these recommendations. Questionnaire take-up from some suppliers can be 60 to 80% and the employer can either opt for an electronic or paper questionnaire distribution or for a licence, e.g. on an intranet. The questionnaires can take from 20 minutes to an hour to complete and can cover in excess of ten areas of scrutiny, e.g. sleep, nutrition, fitness/physical activity, alcohol, stress, body weight, smoking, mood, pain, risk behaviour, etc.

For the employer, a massive range of reports become available and the impact on business performance can be assessed, e.g. presenteeism, work-life issues, etc. The objective of the corporate purchaser can be quite complex. However, to achieve a reduction in sickness absence and staff turnover, an increase in employee morale, increased productivity, a competitive advantage and a reduction in insurance costs are all valid goals.

At an individual level, employees are reputed to be characterised by a whole range of changes which can include an increase in daytime energy, improved effectiveness, and performance, chances of advancement and resilience, all of which can provide business benefits. Return on investment (ROI) claims are estimated to be five times initial investment and this seems a reasonable benchmark.

Embedding positive health and behaviour change

When employees go through a health screen or online assessment they will know their particular health profile, but what happens next? Sometimes the employer will support changes such as healthy eating initiatives, gym membership subsidy/provision, walking clubs, etc. but these are always voluntary and may appeal more to the worried healthy ones, rather than those who would benefit most. And therein lies the conundrum; does behaviour influence lifestyle or lifestyle influence behaviour?

Until employers can get employees to appreciate that they can change, but inevitably will face barriers to change, then the circle of perpetual behaviour is complete and needs breaking.

Health coaching

One really innovative approach is in the form of health coaching on specific topics such as weight, tobacco cessation, stress, cardiovascular health and even family/work life relationships. Such programmes have been around for almost 20 years in the US and have been proven to embed positive employee behaviour into the workforce. Specifically, 30% tobacco cessation, 50% stress reduction and 90% weight loss or stabilisation have been reported with growing ROI over time, with employees reporting more productivity and energy as embedded behaviours create a virtuous circle.

The access process is simple. Employees can go through physical or online health assessments, are sign posted by the EAP or occupational health or simply self-refer to the programme. Access is online, in hard copy or via the telephone and the programme can be linked to fixed sessions of say four, seven or 11 sessions of health coaching by telephone or online.

The role of health coach is to help an individual understand how lifestyle affects behaviour and vice versa and the effect that this has on their health. Health coaching follows a motivational interview, interactive, supportive, client-centred approach where the coach and employee work as partners to address and improve the employee’s health and lifestyle.

The emphasis is on behaviour and not on personality or character assassination, with the health coach minimising barriers to change, opening the path to self-discovery and aiming to increasing self-efficacy. The aim is to build personal confidence, raise self-awareness and to move the individual to a ready, willing and able mindset.

Summary

Health screening and health risk assessment are still important as a means of identifying the health challenges that an organisation faces and providing employees with an awareness of where they stand at any given point. However, to gain real behaviour change, knowledge of what challenges you have may not elicit a clear response, so health coaching and positive employee engagement in specific programmes can be far more effective. Most of us know whether we smoke, drink too much, are overweight or are stressed, so the real question is what will make us address these issues in a cohesive way? Health coaching is the next evolution in embedding positive health in employee behaviour.

Paul Avis is corporate development manager at Ceridian UK.