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Wha Can You Achie e in Eigh Yea s? : A Case S udy on Pa icipa ion, E ec i eness, and
O e all Impac o a Comp ehensi e Wo kplace Heal h P omo ion P og am
2019 The Au ho (s)
Published e sion
Äikäs, An i He manni; Abse z, Pil ikki; Hi ensalo, Mi ja Hannele; P onk, Nicolaas
P.
Äikäs, A. H., Abse z, P., Hi ensalo, M. H., & P onk, N. P. (2019). Wha Can You Achie e in Eigh
Yea s? : A Case S udy on Pa icipa ion, E ec i eness, and O e all Impac o a Comp ehensi e
Wo kplace Heal h P omo ion P og am. Jou nal o Occupa ional and En i onmen al Medicine,
61(12), 964-977. h ps://doi.o g/10.1097/JOM.0000000000001699
2019
Wha Can You Achie e in 8 Yea s? A Case S udy on Pa icipa ion,
E ec i eness, and O e all Impac o a Comp ehensi e Wo kplace
Heal h P omo ion P og am
An i He manni A
¨ika
¨s, MSc, Pil ikki Abse z, PhD, Mi ja Hannele Hi ensalo, PhD,
and Nicolaas P. P onk, PhD
Objec i e: The aim o his s udy was o in es iga e pa icipa ion and
e ec i eness o a mul iyea comp ehensi e wo kplace heal h p omo ion
(WHP) p og am. Me hods: Pa icipa ion and e ec i eness da a came om
employe and endo sys ems. Heal h da a came om heal h isk assess-
men s (HRA) and biome ic sc eenings. Pa icipa ion and e ec i eness we e
analyzed using desc ip i e analyses, es s, and Mann–Whi ney U es s
whe e app op ia e. O e all impac was assessed using he PIPE Impac
Me ic. Resul s: Eigh y-six pe cen o employees comple ed he HRA and
80% he biome ical sc eenings. Annual pa icipa ion a e was 24%, and o al
each was 58%. The po ion o success ul pa icipan s was 23% in 2010 o
2013 and 18% in 2014 o 2017. PIPE Impac sco es we e 18% o 2010 o
2013 and 14% o he 2014 o 2017 s udy pe iods. Conclusion: Despi e
modes annual pa icipa ion a es, o e all 8-yea each was conside ed
easonable. Conse a i ely, we conside he o e all p og am impac o be
mode a e.
Keywo ds: e ec i eness, implemen a ion, pa icipa ion, p og am design,
p og am e alua ion, wo kplace heal h p omo ion
Abes p ac ice wo ksi e heal h p omo ion (WHP) p og am is a
syn hesis o an e idence-based design p ocess, a cos -e icien
implemen a ion wi h ongoing e alua ion, an engagemen o an
o ganiza ion and i s managemen and employees, and a success ul
p ocess o suppo owa d beha io al change, which in all leads o
be e heal h and p oduc i i y ou comes a an indi idual and com-
pany le el.
1–6
Pa icipa ion is a c ucial elemen o a success ul
p og am o gain eligible heal h e ec s.
6–8
The e o e, WHP p o-
g ams should seek high pa icipa ion le els. Desc ip i ely, in a
No h Ame ican su ey almos all US (89%) and Canadian (87%)
employe s (n¼335) s a e employee heal h and p oduc i i y as co e
componen s o hei o ganiza ional heal h s a egy, ye pa icipa ion
a es can be low in disease managemen o smoking cessa ion
p og ams, o en alling below 20%.
9
The pa icipa ion a es epo ed in sys ema ic e iews a y a
g ea deal. In a e iew o 24 s udies, Bull e al ound a wide ange o
pa icipa ion a es be ween 8% and 97%, wi h a median o 61%.
10
Mo e ecen ly, Rob oek e al documen ed pa icipa ion a es
be ween 10% and 64% and a lowe median o 33% in p og ams
aimed a physical ac i i y and/o nu i ion.
8
E en i single long- e m
p og ams ha e documen ed pa icipa ion a es o o e 70%,
11,12
pa icipa ion le els in WHP in e en ions end o emain below
50%.
8–10
The la ge a ia ion among single s udies may be explained
by di e en employe sizes, mixed se ice con en s, and a ied
du a ion and incen i e usage, bu also by he de ini ion o pa ici-
pa ion.
8,13
Some s udies de ine he employees’ in en ion o a end a
p og am as pa icipa ion, whe eas o he s in e p e an en y in o a
p og am as pa icipa ion, and ye o he s de ine i only as long- e m
adhe ence.
8,13
I has been sugges ed ha pa icipa ion a es o comple ing a
heal h isk assessmen (HRA) should be in es iga ed sepa a ely
om a endance in o he p og am’s se ices.
8
A mean pa icipa ion
a e o 57% (44.2% o 75%) o baseline HRA was calcula ed in a
e iew o 37 s udies.
14
In No h Ame ica, a e age pa icipa ion in
biome ic sc eenings was epo ed o be 45% wi h incen i es and
25% wi hou incen i es.
9
One o he highes HRA a es ha e been
achie ed in he Johnson & Johnson mul iyea p og am, whe e 76%
o he eligible employees comple ed a heal h assessmen bo h a
baseline in 2002 and a ollow-up in 2007.
12
This high pa icipa ion
a e and well-engaged popula ion was la gely a esul o a signi i-
can inancial incen i e.
12
Resea ch shows ha incen i es can push
HRA pa icipa ion om a 20% o 40% le el o a le el o 70% o
90%.
15,16
The au ho s o he No h Ame ican su ey sugges ed ha
incen i es a e clea ly e ec i e in boos ing a ela i ely simple ac ion
o ask, such as comple ing an HRA, bu inancial incen i es migh
no be enough o d i e people o pa icipa e in p og ams ha aim o
long-las ing heal h beha io change.
9
Ini ial pa icipa ion a es lose hei alue, i d opou a es a e
high.
17
Success in WHP e o s demands adhe ence ha gene a es a
su icien numbe o pa icipan s wi h imp o ed heal h.
6,18,19
In an
HRA e iew, Sole e al no ed ha he median e en ion a e o
HRAs was 79%, meaning ha e e y i h employee d opped ou
be o e he ollow-up assessmen .
15
In a e iew o 32 s udies by
Ma shall e al, mos o he physical ac i i y in e en ions achie ed
e en ion a es om 51% o 63%.
17
Long- e m pa icipa ion anal-
yses a e e y a e, bu one incen i e-based WHP p og am e ealed
ha pa icipa ion a es lowe ed om 43% o 37% du ing 7 yea s,
and 30% o he employees en olled in he p og am con inuously.
20
F om he Facul y o Spo and Heal h Sciences, Uni e si y o Jy a
¨skyla
¨, Mikkeli,
Finland (M A
¨ika
¨s); Uni e si y o Eas e n Finland, Ins i u e o Public Heal h
and Clinical Nu i ion, Head o Resea ch and De elopmen , P o en ion L d.,
Finland (D Abse z); Facul y o Spo and Heal h Sciences, Uni e si y o
Jy a
¨skyla
¨, Mikkeli, Finland (D Hi ensalo); Heal hPa ne s Ins i u e and
Chie Science O ice , Heal hPa ne s, Minneapolis, Minneso a (D P onk).
Funding: Me sa
¨mies en sa
¨a
¨ io
¨, Finland, suppo ed inancially he manusc ip
w i ing p ocess. U heiluopis osa
¨a
¨ io
¨, Finland, suppo ed inancially he da a
collec ion and analysis.
Con lic s o in e es : AA
¨is an employee o 4e en L d, which designed and
implemen ed he s udy’s wo ksi e heal h p omo ion p og am. PA has kep wo
single eam wo kshops o 4e en L d du ing 2013 o 2015; he pa icipan s
(10 o 20 pe sons) we e employee o S o a Enso Me sa
¨. O he au ho s: None
decla ed. Consul an Jouni Lah i, PhD, Adjunc P o esso in he Uni e si y o
Helsinki: None decla ed.
Supplemen al digi al con en s a e a ailable o his a icle. Di ec URL ci a ion
appea s in he p in ed ex and is p o ided in he HTML and PDF e sions o
his a icle on he jou nal’s Web si e (www.joem.o g).
Clinical signi icance: High pa icipa ion a es (80%) can be achie ed in heal h
isk assessmen s also wi hou incen i es. Eigh -yea wo ksi e heal h p omo-
ion p og am (WHP) achie ed easonable o al each and mode a e heal h
impac , despi e modes annual pa icipa ion. S udy’s indings ag ee wi h
ea lie li e a u e, sugges ing ha comp ehensi e WHP p og ams can p omo e
li es yle changes and heal h imp o emen s.
Add ess co espondence o: An i He manni A
¨ika
¨s, MSc, Facul y o Spo and
Heal h Sciences, Uni e si y o Jy a
¨skyla
¨, Hauskanka u 1b, 50100 Mikkeli,
Finland ([email p o ec ed]).
Copy igh ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on
behal o he Ame ican College o Occupa ional and En i onmen al
Medicine. This is an open access a icle dis ibu ed unde he C ea i e
Commons A ibu ion License 4.0 (CCBY), which pe mi s un es ic ed
use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal
wo k is p ope ly ci ed.
DOI: 10.1097/JOM.0000000000001699
964 JOEM Volume 61, Numbe 12, Decembe 2019
ORIGINAL ARTICLE
Ano he 7 yea ’s in es iga ion epo ed a o al each o 48%, bu no
d opou a es.
21
A ew simple easons o he 20% o 40% d opou a e may be
di ec ly ela ed o he wo kplace con ex . Fi s , s a is no s a iona y,
employees change jobs, business uni s and wo kplaces o hey
e i e.
6,9
Ac oss all employee g oups, u no e a es can ange om
2% o 46%.
22
Acco ding o a ecen s udy, he annual a e age
u no e a e was 22% in he Uni ed S a es and 20% in Canada.
23
The mo e he wo k o ce swi ches, he mo e likely he dec ease is in
long- e m adhe ence.
4
Second, heal h sc eenings a e usually o e ed
o all employees, bu ‘‘ he need’’ o ac ual heal h p omo ion
se ices e lec s a smalle p opo ion o he s a .
18,24
In a heal h
isk educ ion s udy, 13% o he pa icipan s we e in a high isk
g oup, 31% in a mode a e isk g oup, and 56% in a low isk g oup.
18
Conside ing his con ex , expec ing o each a high pa icipa ion a e
only om he employees who a e a a mode a e o high isk g oup
may be o e ly op imis ic.
P e iously, some employee cha ac e is ics ha e been iden i-
ied as being associa ed wi h pa icipa ion, such as being amilia
wi h heal h beha io and i s bene i s, conce n o one’s heal h,
ha ing a posi i e a i ude owa d he p og am, being eady o make
changes, and gi ing high p io i y o he expec ed ou comes.
24,25
Fu he mo e, women end o pa icipa e mo e o en han men,
nonsmoke s mo e o en han smoke s, whi e-colla wo ke s mo e
o en han blue-colla wo ke s, employees wi h day jobs mo e o en
han shi wo ke s, and employees wi h secu e jobs mo e o en han
pa - ime o empo a y wo ke s.
8,11,25
I is no unexpec ed ha
employees wi h weake in en ions pa icipa e less.
8
Un o una ely,
employees wi h mo e se e e heal h isks, such as an abno mal body
mass index (BMI), a e he leas likely ones o pa icipa e.
12,14,26,27
P og ams ha consis o se e al componen s ha e a mode a e le el
o se ices, and p og ams whe e pa icipa ion is possible du ing
wo king hou s a e expec ed o ha e highe pa icipa ion a es han
hose which ha e a minimal numbe o se ices, and whe e he
e en s ake place ou side wo k.
8,28
To summa ize he li e a u e indings on pa icipa ion, he
pa icipa ion a es can exceed 50% o HRAs, bu end o dec ease
o s ay below 50% du ing in e en ion and long- e m moni o -
ing.
8,14,20,21
Posi i e in en ions and belie s, as well as suppo
ecei ed om pee s, managemen s, and he en i onmen , unc ion
as acili a o s, whe eas he ac o s ela ed o ime, heal h, and he job
end o unc ion as ba ie s.
8,24,25,27–29
Al hough impo an , pa icipa ion alone is no su icien o
p oduce popula ion impac , bu needs o be complemen ed wi h
e ec i e p og am s a egies.
29
Changes in beha io and imp o e-
men in heal h on an indi idual le el a e necessa y d i e s o a
p og am o be o e all success ul and e ec i e.
5,30
Se e al e iews
ha e e alua ed e ec i eness o WHP p og ams om di e en ypes
o pe spec i es. Sole (2010) e alua ed p og ams including HRA,
eedback, and a sho - e m (<1 yea ) in e en ion componen (eg,
heal h educa ion, enhanced access o physical ac i i y) and showed
meaning ul posi i e e ec on a wide ange o ou comes including
dec ease in obacco use, alcohol use, sea bel nonuse, die a y a
in ake, blood p essu e, choles e ol, heal h isk es ima es, wo ke
absen eeism, and heal h ca e se ice use, bu no on ui and
ege ables in ake, body composi ion, and ca dio espi a o y i -
ness.
14
Two sys ema ic e iews e alua ing physical ac i i y in e -
en ions a wo kplace e ealed modes e ec s a bes on physical
ac i i y beha io ,
31,32
as well as on i ness, lipids, wo k a endance,
and job s ess.
32
In a sys ema ic e iew, comp ehensi e WHP p og ams wi h
du a ion anging om ew mon hs up o 7 yea s, Osilla e al
obse ed mixed esul s ega ding he p og ams’ impac on
heal h- ela ed beha io , subs ance use, physiological ma ke s,
and cos s.
33
They also ound ha he e idence on absen eeism,
incen i e usage, and men al heal h was insu icien .
33
In a
sys ema ic e iew o RCTs, whe e maximum du a ion was 2 yea s,
he o e all e ec o he p og ams was pe cei ed o be small bu
posi i e ac oss wo k- ela ed ou come measu es such as pe cei ed
heal h, absence due o sickness, p oduc i i y a wo k, and wo k-
abili y.
34
No ably, e ec s we e la ge among younge popula ions
and in in e en ions wi h weekly con ac s, and smalle in s udies
which me he c i e ia o high-quali y RCTs.
34
To summa ize ea lie li e a u e, WHP p og ams can gene a e
imp o emen in heal h beha io and in heal h pa ame e s, educe
absen eeism, and he eby p oduce posi i e inancial e u n o he
employe ,
14,32,34,35
bu clea ly no all WHP e o s ha e been
success ul.
30,31,33
Fu he mo e, e y li le is known abou he
long- e m e ec i eness o WHP p og ams, al hough a 7-yea s udy
epo ed sa ings om diminished heal h ca e cos s and absen ee-
ism,
20
a olun a y incen i e-based p og am no ed imp o emen s in
isk ac o s du ing 7 yea s o ollow-up
21
and a 6-yea p og am
yielded posi i e changes in heal h isks and ROI.
12
Mul iyea pa icipa ion and e ec i eness analyses a e a ely
epo ed in he li e a u e.
12,20,21
The e o e, he pu pose o his s udy
was o analyze pa icipa ion le els o a comp ehensi e WHP
p og am ha las ed o 8 yea s (he ea e e e ed o as ENSO).
The annual pa icipan s o he ENSO p og am we e epo ed om
he whole s udy popula ion pe iod and sepa a e analyses we e
comple ed o h ee di e en heal h s a us g oups (poo , mode a e,
good). In addi ion, cumula i e 8-yea pa icipa ion analyses we e
done o ep esen he o al each o ENSO.
Ea lie , ENSO was analyzed om a design and implemen a-
ion pe spec i e using he 4-S and Bes P ac ice Dimensions de el-
oped by P onk,
2,36
and he con en and implemen a ion o he
p og am’s i s 4 yea s we e desc ibed in mo e de ail.
37
In his
s udy, we p esen a de ailed desc ip ion o he la e hal o he
ENSO p og am. The cu en s udy also pi o s he e alua ion
pe spec i e o obse e ‘‘ he gene a ed e u ns o he p og am.’’
To epo ENSO’s e ec i eness, an analysis o success ul pa ic-
ipan s and a compa ison o cha ac e is ics o success ul and unsuc-
cess ul pa icipan s we e comple ed be ween he yea s 2010 o
2017, and sepa a ely o 2010 o 2013 and 2014 o 2017. In addi ion,
he o e all p og am impac was quan i ied using he PIPE Impac
Me ic Model based on a ge popula ion pene a ion, implemen a-
ion, pa icipa ion, and e ec i eness da a.
36,37
METHODS
S udy Design
This case s udy ocuses on a mul iyea implemen a ion o a
WHP in a single company, wi h a e ospec i e quasi-expe imen al
s udy design wi hou a con ol g oup a h ee di e en measu emen
poin s in 2010 o 2011, 2013 o 2014, and 2016 o 2017. In he a ea
o heal h p omo ion, expe imen al and quasi-expe imen al designs
a e sui able o ques ions on he e ec i eness ou come.
38
The
pa icipa ion and e ec i eness analyses acco ding o he PIPE
Impac Me ic Model by P onk we e ca ied ou o e lec he
gene a ed heal h e u ns o he mul iyea WHP execu ed in a
eal-wo ld se ing.
36
This model has been desc ibed in a ious
le els o de ail in p e ious discussions ela ed o esea ch ansla-
ion,
36,39
a sys ems app oach and i s dissemina ion and implemen-
a ion in a eal-wo ld se ing,
36,39–41
and i has been used in
e alua ing diabe es p e en ion in e en ions
42–44
and physical
ac i i y p og ams.
36,45
In e en ion
S o a Enso Me sa
¨, he employe , implemen ed a heal h
p omo ion p og am (ENSO) in Finland as pa o hei global
eThink ans o ma ion p ocess s a ing in 2010 and las ing un il
2017. The ENSO p og am can be classi ied as a comp ehensi e
p og am, including all i e elemen s ha a e based on he Heal hy
JOEM Volume 61, Numbe 12, Decembe 2019 Eigh -yea Ou comes o Wo ksi e Heal h P omo ion
ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine. 965
People 2010 de ini ion: heal h educa ion, suppo i e en i onmen ,
in eg a ion in o o ganiza ion’s s uc u e, linkage o ela ed p o-
g ams, and wo ksi e sc eening.
46
The employe is a wood supply
company, and i s main business is o buy, ha es , and anspo
wood o S o a Enso mills h oughou Finland. A he ime, he
employe had al oge he o e 100 company business uni s na ion-
wide. Employees o S o a Enso Me sa
¨we e he pa icipan s o he
p og am; subcon ac o s and amily membe s we e excluded. The
ENSO p og am was a ailo ed e sion o a comp ehensi e WHP
concep p oduced by he p o ide o he p og am, 4e en L d.
As a heo e ical ounda ion, ENSO deployed he ans heo -
e ical model (TTM) and a mix u e o di e en beha io al change
echniques, such as sel -moni o ing and mo i a ional in e iew-
ing.
37,47,48
ENSO was execu ed in p ac ice by he se ice p o ide ’s
head coach and app oxima ely 30 wellness coaches and p o essio-
nals. The wellness p o essionals had a leas a Mas e ’s deg ee and
he coaches a minimum an unde g adua e educa ional deg ee in
ei he nu i ion, physical educa ion, heal h sciences, o coaching.
The p og am managemen was sha ed mos ly be ween human
esou ces execu i es and he p o ide . A mu ual pension company
and occupa ional heal h ca e uni s we e in o med abou he p o-
g am, bu hey we e no in ol ed in he design o implemen a ion
p ocesses un il he e y las yea .
The main goal o he p og am was o imp o e he heal h and
well-being o e e y employee. Al oge he 27 di e en se ices ook
place om 2010 un il 2013. The main aim o hese se ices was o
suppo low-e o , pleasan li es yle changes and o c ea e a posi i e
heal h concep ion a he han a nega i e one. I is no ewo hy ha
he emphasis o he se ices shi ed in 2014. Mo e se ices and ools
we e es ablished o main ain and imp o e he wo kplace clima e and
s ess managemen , as well as o s eng hen men al esou ces om
2014 un il 2017, whe eas less a ge ed se ices ela ed o nu i ion,
physical ac i i y, and li es yle we e o e ed han du ing he i s hal .
Du ing hese las 4 yea s, 49 di e en se ices we e implemen ed.
Du ing i s en i e 8-yea -long pe iod, ENSO consis ed o al oge he
76 di e en se ices, h ee assessmen s o heal h isks, and se en
annual WHP e en s, and i con ained se e al communica ions
ma e ials such as he Vi ali y Book (2011) and six Se ice Books
(2012 o 2017). A lowcha o he p og am du ing he yea s 2014 o
2017 is p esen ed in Figu e 1, and a mo e de ailed in o ma ion abou
he yea s 2009 o 2013 has been published ea lie .
37
ENSO had six main componen s du ing i s 8-yea pe iod.
Fi s , assessmen s o heal h isk wi h eedback we e made a ailable
o all employees a h ee di e en ime poin s, 2010 o 2011, 2013
o 2014, and 2016 o 2017. The assessmen consis ed o biome ical
measu emen s and a HRA ques ionnai e. Biome ical sc eening was
execu ed using a mobile Pola Body Age clinic, which was ans-
e ed in o di e en loca ions o mee he employees.
49,50
As a second main componen , based on he esul s o he
HRA and biome ical sc eening, pa icipan s we e o e ed a ge ed
se ices o he 4e en WHP concep . Suppo o li es yle change
was ca ego ized in o h ee di e en subg oups o heal h and i ness
s a us: poo ,mode a e, and good. The pa icipan s we e classi ied
in o he g oups acco ding o hei Body Age measu emen esul s.
The esul o he measu emen is exp essed as plus o minus yea s o
be added o o educed om he pe son’s ac ual age. The esul o he
poo heal h s a us g oup was þ6 yea s o highe , he mode a e heal h
s a us g oup be ween þ1 and þ5 yea s, and he good heal h s a us
0 yea o less han pe son’s own age. Fu he mo e, i an HRA
pa icipan was iden i ied wi h a isk beha io o heal h isk (such as
poo heal h s a us, physical inac i i y, o e weigh , s ess, unc ional
insomnia, o a igue), a coach in i ed he esponden o pa icipa e
in sui able a ge ed se ice. No ably, he s onges li e change
suppo was o e ed o he popula ion o poo heal h s a us wi h
limi ed coaching places. Employees wi h mode a e heal h s a us
we e encou aged o pa icipa e in g oup sessions wi h mode a e
suppo , and employees wi h a good heal h s a us we e o e ed g oup
se ices wi h minimal li es yle change suppo . The in i a ion
ou each p o ocol included phone calls, ex messages, g oup o
indi idual emails depending on he size o he g oup, and each-
abili y and da a p o ec ion necessi ies o a se ice. Robus incen i es
we e no used o p omo e pa icipa ion in o HRAs o o he se ices.
Howe e , employees we e ee o a end some o he se ices du ing
paid wo king hou s.
The hi d main componen o ENSO was ha i had se ices
ha we e o e ed o all employees. These included annual WHP
e en s, open webina s, and hiking ips in Eu ope. In addi ion, he
p o ide s a ed local g oup coaching sessions in 16 loca ions in 2017.
As a ou h componen , o ensu e local awa eness o he
p og am wi hin a widely dispe sed o ganiza ion, a playmake
ne wo k was es ablished in 2011. Playmake s we e nonmanagemen
employees olun ee ing o be ained by he p o ide o assis in he
implemen a ion and communica ions p ocesses o ENSO. A play-
make was asked o p omo e well-being in hei own local a ea.
E e y yea hey had hei own lis o asks such as o enhance
pa icipa ion, p omo e wo kplace clima e, o o ganize local low-
e o spo e en s. A single playmake was esponsible o 15 o 30
employees, so o co e he en i e s a , he e we e annually 23 o 28
playmake s in o al.
Wi h he help o he employe , he p o ide in oduced se e al
communica ion solu ions, including home mailings, pos e s, a web-
si e, an in ane , se ice lye s, a ge ed phone calls, emails, Skype
mee ings, and elec onic egis a ion p ocesses. This can be seen as
he i h main componen o ENSO. I ep esen ed a communica ion
s a egy based on mul ichannel in o ma ion o make he p og am as
a ailable and isible as possible o he employee audience.
Ongoing p og am managemen was ENSO’s six h compo-
nen . This was a sha ed esponsibili y be ween he HR execu i es
and ep esen a i es o he p o ide . Based on use expe ience,
eedback, assessmen s o heal h isks, and he p ocess e alua ion
epo s, he p o ide planned he p og am’s annual solu ions and i s
con inuum, and he HR execu i es made he inal decisions. A e
eaching an ag eemen , he p o ide implemen ed he p og am. As
s a ed in he design e alua ion o ENSO, he p ocess was lacking a
plan o long- e m sus ainabili y,
37
and bo h pa ies we e willing o
op imize e iciency ela ed o adminis a i e wo k. As a esul , o
suppo he p og am managemen , he p o ide nomina ed a ‘‘head
coach’’ o main ain he p ocess, and deployed a cus ome ela ion-
ship managemen sys em (CRM) o help wi h he managemen . In
2017, he se ice p o ide , he occupa ional heal h ca e p o ide , he
mu ual pension company, and he HR es ablished a collabo a i e
s ee ing g oup which showed posi i e impac owa d s onge co-
ope a ion a he end o he p og am.
Pa icipan s
The ENSO p og am and he assessmen s o heal h isk we e
made a ailable o he whole s a o S o a Enso Me sa
¨. Subcon-
ac o s we e no in ol ed. In he o e 100 o ices, mos o he
employees we e execu i es, local o es o ice s, o ganiza ion o i-
cials, and lumbe jacks, whe eas he s a in he wo king s a ions
connec ed in o S o a Enso’s eigh pape mills consis ed o e minal
wo ke s. S a u o y labo nego ia ions ook place wice du ing he
in e en ion. Fi s , a new o ganiza ion was es ablished in 2013 o 2014
and as a esul he o alnumbe o employees declined. A e 2014, he
local o es o ice s in Wes e n Finland and he lumbe jacks we e no
longe pa o heo ganiza ion. The second nego ia ion in 2017 did no
ha e a majo in luence on he s udy popula ion. Hence, he o al
numbe o employees dec eased om 2010 o 2017 as ollows: 651,
634, 630, 625, 530, 526, 523, and 523. Employees, who did no ake
pa in HRAs o biome ical sc eenings (10% a baseline, 20% a he
i s ollow-up, and 13% a he second ollow-up), s ill e ained access
o he se ices du ing he whole p og am pe iod o 2010 o 2017.
A
¨ika¨s e al JOEM Volume 61, Numbe 12, Decembe 2019
966 ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine.
FIGURE 1. A low cha o he p og am du ing 2014 o 2017. T ¼Ta ge ed se ice o speci ic popula ion based on loca ion o
con en o he se ice; A ¼Se ice was a ailable o all employees (see e e ence 37 o low cha o he yea s 2009 o 2013).
JOEM Volume 61, Numbe 12, Decembe 2019 Eigh -yea Ou comes o Wo ksi e Heal h P omo ion
ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine. 967

Da a Collec ion
The e a e a a ie y o ways o de ine pa icipa ion, such as
es ima ing in en ions o use se ices o applica ions, en olling in o
HRAs and in o single se ices, comple ing coaching p og ams, and
pa icipa ing in sel -ca e ac i i ies.
6,24
In his s udy, pa icipa ion was de ined as ac ual a endance a
he ac i i ies ha we e implemen ed. The in en ion o pa icipa e o
cases whe e an employee egis e ed o a se ice bu ne e ook pa
we e excluded. In o ma ion on pa icipa ion wascollec ed ei he om
e- egis a ion lis s o om scanned lis s o he pa icipan s’ names.
The da a abou con ac s ( ace- o- ace s e-con ac s; g oup s
indi idual; o al) we e ga he ed by combining he da a o ac ual
a endance and he o de ed numbe o con ac s based on he
p o ide ’s annual se ice books and o ien a ion ma e ials o he
coaches. Each a endance o a se ice accumula ed he con ac da a,
which was used also in he e ec i eness analysis.
D opou a es om single se ices could no be used in his
s udy, due o he ac ha he majo i y o he se ices we e execu ed
ace- o- ace ( 2 ), and a sepa a e lis o hose pa icipan s who le
he se ice ea lie han expec ed was no es ablished by he
employe o he se ice p o ide . In addi ion, egis a ion o webi-
na s and Skype mee ings, as well as o he playmake s’ local e en s,
was mo e di icul o de ine, and his in o ma ion was los du ing he
da a collec ion. The e o e, he inal pa icipa ion da a in ou analysis
we e conduc ed along a p io i de ined pa ame e s.
The inal elemen o he PIPE Impac Me ic Model is e ec-
i eness. Acco ding o P onk (2003), e ec i eness e e s o he a e o
success ul pa icipan s.
36
E ec i eness should be conside ed in he
con ex o a p og am conduc ed in a eal-wo ld se ing, and he c i e ia
o success should be de ined as pa o he design phase: wha is
planned o be achie ed?
36
Fu he mo e, c i e ia o success should be
closely ela ed o he design phase and o he p og am’s abili y o
gene a e expec ed ou comes. Aziz e al, o example, associa ed he
e ec i eness o diabe es p e en ion p og ams wi h h ee main c i e ia:
weigh loss, diabe es isk educ ion absolu e, and ela i e.
42
Acco ding
o ea lie indings o he ENSO p og am,
37,51
he p ima y a ge s o he
p og am we e o suppo li es yle changes, imp o e heal h me ics, and
o e ime imp o e he heal h s a us o he people in poo o mode a e
heal h s a us g oups. Based on hese ac o s, pa icipan s we e consid-
e ed o be success ul i hey me wo clea c i e ia. Fi s being ha he
pe son answe ed YES o he ques ion ‘‘Ha e you made a li es yle
change du ing he p og am?’’, and chose a leas one om a lis o nine
li es yle change op ions. The op ions we e (1) I’m ea ing be e quali y
a y acids. (2) I ea mo e ege ables, salads, be ies and ui s. (3)
Nowadays, I enjoy a decen b eak as and lunch. (4) I ha e dec eased
he amoun o high-calo ic d inks and delicacies. (5) I ha e inc eased
endu ance aining such as skiing, swimming, No dic walking, cycling.
(6) I ha e inc eased muscula i ness aining such as gym, wa e
ae obics, ci cui aining. (7) I ha e inc eased my e e yday exe cise. (8)
I ha e dec eased he use o alcohol. (9) I ha e cu down on smoking.
Second, he pe son’s biome ic heal h pa ame e s had o be imp o ed
based on he Body Age biome ic sc eening.
The answe s o he ques ion abou li e change we e collec ed
wi h an HRA ques ionnai e
52
a he same ime wi h he Body Age
biome ical sc eenings. In 2016 o 2017, employees who we e no
able o a end biome ical sc eenings illed he HRA ques ionnai e
ia a web-based su ey ool. The ques ionnai e was a combina ion
o ques ions om an annual na ional su ey Heal h Beha iou and
Heal h among he Finnish Adul Popula ion (physical ac i i y,
habi s),
53
Pola Body Age es p o ocol ( es ing sa e y), he s ages
o change ans heo e ical model,
47
he employe ’s own ques ions
(backg ound in o ma ion), and he p o ide ’s own ques ions ( i al-
i y, weigh managemen , musculoskele al diso de s).
52
The ques-
ionnai e also assessed absences due o musculoskele al diso de s,
bu no in o ma ion conce ning o heal h ca e cos s o occupa ional
heal h ca e usage.
52
The da a on heal h imp o emen was based on he Body Age
measu emen . The Body Age me hod is a echnology-aided es ing
sys em, p ima ily a ge ed o use in i ness and heal h- ela ed
en i onmen s o mo i a e indi iduals o be physically ac i e and o
imp o e hei o e all well-being
49,50
and i was chosen by he
p o ide o enew employe ’s physical heal h es ing pa e n.
51
I
con ained i e physiological ac o s and ou pe o mance ac-
o s.
49,50
The i e physiological ac o s we e body mass index, body
a pe cen age, sys olic blood p essu e, dias olic blood p essu e, and
VO
2
max. The ou pe o mance ac o s we e numbe o c unches in
60 seconds, a leg endu ance es , a bicep cu l, and a si -and- each es .
As a summa ion o each o hese pe o mance es s, he BodyAge
sys em calcula ed he Body Age alue, whe e poo heal h pa ame e s
inc eased he body age and good o excellen alues dec eased i . An
example o wo di e en Body Age alues o same-aged males, is
gi en in Figu e 2. The me hod had been es ed in a RTC s udy and
mo e de ailed desc ip ions o he measu emen p o ocol and he Body
Age calcula ion had been published ea lie .
49,54
The Body Age alue was calcula ed i a pa icipan had a
leas ou ou o i e physiological ac o s measu ed.
49
In his s udy,
he heal h imp o emen was ca ego ized as posi i e, i an employee
succeeded o imp o e he o e all e alua ion o hei Body Age. Fo
example, i a pa icipan had a esul o þ5 yea s in he baseline
measu emen and 2 yea s in he ollow-up, he heal h imp o e-
men was coun ed as posi i e. I he Body Age s ayed he same o
go highe , i was conside ed as nega i e.
Mos o he pa icipa ion and e ec i eness da a we e ga he ed as
pa o he se ice p o ision by he p o ide . To educe po en ial bias in
he da a collec ion, he da a esou ces, he pa icipa ion lis s, and he
pa icipa ion da a collec ion we e double-checked by an ex e nal WHP
p o essional (PhD, Adjunc P o esso a he Uni e si y o Helsinki).
Da a Analysis
Da a on pa icipa ion and e ec i eness we e analyzed om
he whole p og am con inuum 2010 o 2017. Desc ip i e s a is ics
including equencies, means, s anda d de ia ions, and pe cen ages
we e used in epo ing he cha ac e is ics o he s udy popula ion
and ends in pa icipa ion. Pa icipa ion pe cen ages we e calcu-
la ed by di iding he numbe o ac ual a endan s by he annual
amoun o employees. Addi ional pa icipa ion analyses we e con-
duc ed o ep esen he low and accumula ion o pa icipa ion in he
h ee di e en heal h s a us g oups du ing he whole p og am. In
hese analyses, only hose employees who ook pa in bo h he
annual WHP e en and he a ge ed se ices du ing he same yea
(he ea e e e ed o as BOTH g oup) we e included.
E ec i eness analysis included hose employees who com-
ple ed wo HRAs andbiome ical sc eenings ei he be ween 2010 and
2017, 2010 and 2013 o be ween 2014 and 2017. To analyze he
e ec i eness a e among employees, a compa ison o cha ac e is ics
o success ul and unsuccess ul pa icipan s was conduc ed. The
dicho omous a iables we e p esen ed in pe cen ages: li e change
(yes/no), heal h s a us (poo , mode a e, good), gende , and pe sonnel
g oup, whe eas con inuous a iables we e p esen ed in means and
s anda d de ia ions. S a is ical compa isons be ween age, Body Age
change, and pa icipa ion in o ma ion we e ca ied ou by using he
es and he Mann–Whi ney U es , as app op ia e. A di e ence
be ween he a iables was conside ed s a is ically signi ican a a
s anda d P0.05. All analyses we e ca ied ou using he IBM SPSS
S a is ics e sion 24.0 o Windows.
Finally, o comple e he impac analysis, he o al calcula ion o
he PIPE Impac Me ic sco e was calcula ed sepa a ely o he yea s
2010 o 2013 and 2014 o 2017 as ollows: pene a ion implemen-
a ion pa icipa ion e ec i eness.
36
To es ima e he pene a ion
a e, bo h he p o ide and he employe ga e hei own independen
e alua ions abou he amoun o employees eached wi h in i a ions
and communica ion ma e ials, and he inal pene a ion a e was an
A
¨ika¨s e al JOEM Volume 61, Numbe 12, Decembe 2019
968 ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine.
a e age o hese wo e alua ions. The implemen a ion coe icien
ep esen s he a e o implemen ed ac ions compa ed wi h he a e o
planned ac ions.
36
The da a o his ac o we e calcula ed simila ly o
A
¨ika
¨s e al by compa ing he p o ide ’s annual budge s wi h he
execu ed ac ions ma ked in he p o ide ’s CRM da abase.
37
A
coe icien o he pa icipa ion was calcula ed by di iding he
numbe o pa icipan s wi h he p opo ion o he a ge popula ion
ha was eached wi h in i a ions (pene a ion).
36
In his s udy, he
pa icipa ion alue o he PIPEImpac Me ic’s analysis was a sum o
BOTH pa icipan s. Mo e speci ically, he alue o he yea s 2010 o
2013 ep esen s he accumula i e sum o pa icipan s who had
pa icipa ed in a leas once in o WHP e en and a ge ed se ice
ei he in 2011, 2012, o 2013. The pa icipa ion a e o heyea s 2010
o 2017 and 2014 o 2017 was calcula ed he same way. In calcula ing
he e ec i eness coe icien , he numbe o indi iduals who me he
wo success c i e ia o he p og amwe eused as henume a o and he
pa icipa ion alue was he denomina o .
36
E hical Issues
The employe and all he employees p o ided an in o med
consen o he p og am e alua ion s udy. The p o ocol o he s udy
wi h an in o med consen o m was included in he HRA emapping
ques ionnai e bo h in 2013 o 2014 and in 2016 o 2017 and gi en o
each employee. Pa icipa ion in he s udy, as well as gi ing au ho i-
za ion o use ea lie HRA and biome ical sc eening esul s and
pa icipa ion his o y, was olun a y. The da a and he ma e ial ela ed
o he pa icipa ion and e ec i eness componen s o ENSO we e
e ained ca e ully by he esea che . The s udy was conduc ed acco d-
ing o he e hical p inciples o he Uni e si y o Jy a
¨skyla
¨and he
esea ch guidelines p o ided by he Na ional Ad iso y Boa d on
Resea ch E hics in Finland.
55
RESULTS
Pa icipa ion in Assessmen s o Heal h Risk and
Popula ion Cha ac e is ics
The desc ip i e s a is ics o he ep esen a i e sample o
hose who pa icipa ed in he HRA and biome ical sc eenings
du ing he p og am a e shown in Table 1. Pa icipa ion in
he baseline HRA ques ionnai e was 90%, 80% o he i s
ollow-up, and 87% o he second ollow-up (a e age 86%).
The co esponding alues o biome ical sc eenings we e 90%,
80%, and 69% (a e age 80%). Bo h a e age pa icipa ion a es
we e high. Mos o he biome ical sc eening a endan s we e
ca ego ized in o good heal h s a us g oup, 40% a he baseline,
47% a he i s ollow-up, and 51% a he second. The a es o
mode a e heal h s a us g oup a hese assessmen imes we e 29%,
29%, and 25%, espec i ely, and 31%, 24%, and 24% o poo
heal h s a us, espec i ely. F om a human esou ce pe spec i e, all
pe sonnel g oups we e ep esen ed in he HRAs, al hough he
numbe o lumbe jacks dec eased in 2013 and none o hem was
a pa o he company a e 2014 due o s uc u al changes in he
o ganiza ion. Mos o he HRA pa icipan s we e male and local
o es o ice s.
Pa icipa ion
O he o al amoun annual employees, 51% o 70% ook pa
in annual WHP e en s in 2010 o 2017 and 16% o 70% in a ge ed
se ices in 2011 o 2017 (see Table 2). The a e age pe cen age o
a ending he annual WHP e en s du ing he in e en ion was 63%
and o a ge ed se ices 36%. The lowes a endance in a ge ed
se ices was epo ed in 2011 (16%) and he highes in 2017 (70%).
Mos o he pa icipan s we e male, 82% in he WHP e en s and
77% in he a ge ed se ices.
In his esea ch, he bo h pa icipa ion (BOTH) a e e lec s
he combined analysis o he WHP e en and he a ge ed se ices.
The annual amoun o employees in he BOTH g oup a ied
be ween 14% and 42%, esul ing as an a e age o 24%. Sex
di e ences o he BOTH g oup ollowed he same pa e n as in
he ea lie sepa a ed analysis, e en hough emale employees end o
pa icipa e mo e o en, i esul s (74% males and 26% emales)
a e compa ed wi h he baseline sex dis ibu ion a he baseline (83%,
17%; see Table 1).
When s udying he BOTH pa icipa ion o he h ee di e en
heal h s a us g oups, he main inding indica ed ha e e y heal h
s a us g oup was in ol ed in he p og am each yea . In he poo
FIGURE 2. An example o wo di e en Body Age alues o he same age g oup and sex.
JOEM Volume 61, Numbe 12, Decembe 2019 Eigh -yea Ou comes o Wo ksi e Heal h P omo ion
ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine. 969
heal h s a us g oup, 21 o 79 employees (28% o 56% o he o al
BOTH g oup) ook pa annually. Values o he mode a e heal h
s a us popula ion we e 12 o 74 employees (14% o 33%) and o he
good heal h s a us g oup 25 o 81 employees (28% o 47%). An
a e age pa icipa ion a e o he 7 yea s was 32% o he poo , 26%
o he mode a e, and 38% o he good heal h s a us g oup. The
numbe o pa icipan s in he poo heal h s a us g oup dec eased o
20 o 35 people a e he i s 2 yea s, and ose up again in 2017.
BOTH a es we e lowe a e he HRA in 2011, in 2013 o
2014, and also in 2016. The highes pa icipa ion a es occu ed in
2012 and 2017, when he p og am eached a leas 38% o
he employees.
In he pe sonnel g oup analysis, mos o he BOTH g oup’s
a endan s (55%) wo ked as local o es o ice s all o e he
coun y. Pa icipa ion a es o execu i es (13%) and o ganiza ion
o icials (22%) we e p opo ional o o al s a . Te minal wo ke s
(6%) and lumbe jacks (3%), on he con a y, we e no
eached success ully.
The cumula i e pa icipa ion a e o he BOTH g oup wi hin
he whole s udy pe iod is p esen ed in Figu e 3. O e all, he
pa icipa ion low s eadily inc eased ac oss all heal h s a us g oups.
Howe e , he numbe o people in he poo and mode a e heal h
s a us g oups inc eased sligh ly less han in he good heal h s a us
g oup, and a e 2013 hose wi h he bes heal h condi ion we e he
la ges pa icipan g oup. Taken oge he , 491 employees we e
anked in o he BOTH pa icipa ion g oup a leas once be ween
he yea s 2010 and 2017. This esul indica es ha he ENSO
p og am eached 58.1% (491/845) o hose employees, who wo ked
a leas o 1 yea in he o ganiza ion. A he same ime, he annual
employee u no e a e a ied be ween 3.6% and 17.0% wi h a
mean o 7.8% pe yea (da a a ailable upon eques ). The highes
acc e ions occu ed du ing he same yea s as he highes pa icipa-
ion jumps occu ed: 2012, 2015, and 2017. A mino i y o he BOTH
pa icipan s (n¼24) did no comple e a HRA.
To summa ize he pa icipa ion esul s, he ENSO p og am
achie ed mode a e gains in a endance e e y yea a e he launch o
he p og am. App oxima ely one in ou (24%) employees ook pa
in he p og am annually, and wi h he help o long- e m implemen-
a ion, he p og am managed o each 58% o he o al wo k o ce a
leas once du ing he 8 yea s. Mos o he pa icipan s we e males
which ep esen ed he s udy popula ion. The e we e no majo
a endance di e ences among he h ee di e en heal h s a us
g oups. The only pe sonnel g oups which we e no deeply in ol ed
in he p og am we e e minal wo ke s and lumbe jacks.
TABLE 1. Pa icipan s in Assessmen s o Heal h Risks, Popula ion Cha ac e is ics, and Desc ip i e Resul s a Th ee Di e en
Time Poin s
2010–2011 2013–2014 2016–2017
Yea N(%) N(%) N(%)
HRA pa icipan s 586 (90%) 422 (80%) 457

(87%)
HRA declined 65 (10%) 108 (20%) 66 (13%)
Sex
Male 489 (83) 348 (82) 363 (79)
Female 97 (17) 74 (18) 94 (21)
Pe sonnel g oup
Execu i es 85 (14) 98 (23) 118 (26)
Local o es o ice s 275 (47) 207 (49) 224 (49)
O ganiza ion o icials 110 (19) 59 (14) 62 (13)
Te minal wo ke s 71 (12) 42 (10) 53 (12)
Lumbe jacks 34 (6) 16 (4) 0
NA 11 (2) 0 0
N¼586 N¼422 N¼363

Pa icipan s in Biome ical Sc eenings Mean (SD) Mean (SD) Mean (SD)
Age 43.8 (11.0) 45.0 (10.7) 44.8 (11.1)
BMI 26.9 (4.0) 26.6 (4.0) 26.8 (4.1)
Sys olic BP, mm Hg 137 (16.6) 135 (15.5) 134 (16.3)
Dias olic BP, mm Hg 79 (10.1) 80 (9.7) 78 (9.6)
Body a pe cen age 26.3 (6.7) 26.3 (6.5) 26.8 (6.4)
Bicep cu l, kg 40.6 (10.3) 41.0 (10.5) 41.2 (10.8)
Si and each es , cm 32.2 (9.6) 36.4 (10.9) 36.6 (11.7)
C unches in 60 s 36.8 (13.1) 32.0 (14.6) 33.0 (16.0)
Leg endu ance, s 107 (53.1) 129 (60.7) 132 (64.2)
VO
2
max, mL/kg/min 37.9 (8.3) 38.1 (8.2) 38.4 (8.3)
Fi ness class 1–7 4.2 (1.3) 4.3 (1.3) 4.4 (1.3)
Heal h S a us in HRA
y
N(%) N(%) N(%)
Good 235 (40) 201 (47) 184 (51)
Mode a e 168 (29) 121 (29) 91 (25)
Poo 183 (31) 100 (24) 88 (24)

457 employees answe ed he HRA ques ionnai e and 363 o hem comple ed also he biome ical sc eenings.
y
Heal h s a us based on he Body Age (BA) calcula ions. I he BAwas a mos 0 yea s, a pa icipan was ca ego ized in o he good heal h s a us g oup. The BA alue be ween þ1
and þ5 yea s esul ed mode a e heal h s a us and he BA alue a leas þ6 yea s was coun ed as poo heal h s a us.
A
¨ika¨s e al JOEM Volume 61, Numbe 12, Decembe 2019
970 ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine.
E ec i eness
Table 3 p o ides a compa ison o success ul and unsuccess ul
pa icipan s om 2010 o 2017, 2010 o 2013, and 2014 o 2017. To
be included in he e ec i eness analysis, a pa icipan had o ha e
wo HRAs and biome ical sc eenings comple ed om he 2010 o
2017, 2010 o 2013, o 2014 o 2017 ime pe iods. The inclusion
ga he ed 253 people in o he whole con inuum, 359 people in o he
i s ime pe iod, and 255 in o he las . No ably, 215 pa icipan s
comple ed all h ee HRAs and biome ical sc eenings, meaning ha
a la ge pa o he pa icipan s we e included in all pe iods’ analysis
(mo e de ailed da a is p esen ed in Appendix 1, h p://links.
lww.com/JOM/A599). O included pa icipan s, 134 pe sons in
2010 o 2017, 143 pe sons in 2010 o 2013, and 96 pe sons in
2014 o 2017 me he c i e ia o success (li es yle change and
imp o emen in heal h) du ing he in e en ion. The success ul a es
o pa icipan s we e 52% (134/253) and 40% (143/359) and 38% (96/
255) o he same h ee pe iods, espec i ely. Al oge he 67% o he
HRA pa icipan s (281/422) epo ed ha hey had made a li es yle
change du ing he i s hal o he in e en ion. Du ing he second hal ,
he p opo ion was 55% (198/363) and 87% (220/253) o hose who
comple ed bo h he baseline HRA and he las ollow-up HRA.
The e we e no demog aphic (age, sex) di e ences be ween
he success ul and he unsuccess ul g oups. When compa ing heal h
s a us (good, mode a e, poo ) in he success ul g oup, he di e -
ences o success ul pa icipan s we e qui e simila du ing all
pe iods, 34%, 36%, and 25% o he success ul pa icipan s came
om he poo heal h s a us g oup. Co esponding esul s o he
mode a e heal h s a us g oup we e 24%, 29%, and 37.5%. Fo he
good heal h g oup, he a es we e 42%, 35%, and 37.5%,
espec i ely. No iceably, mos o he unsuccess ul pa icipan s came
om he good heal h s a us g oup: 51% in 2010 o 2017 and 2010 o
2013 and 59% in 2014 o 2017.
In he pe sonnel g oup analysis, local o es o ice s com-
posed he majo i y g oup behind success ulness, ollowed by o ga-
niza ion o icials and execu i es. Te minal wo ke s and lumbe jacks
showed he lowes success a es in all in es iga ions pe iods.
The e we e no able di e ences in pa icipa ion and con ac s
be ween he g oups o success ul and unsuccess ul pa icipan s.
Pa icipa ion in annual WHP e en s did con ibu e o e ec i eness
only du ing he whole p og am pe iod (P¼0.040), bu no du ing
he hal es o he p og am in ou analysis (P¼0.108, P¼0.147). A
he ea ly yea s o he in e en ion, pa icipa ion in a ge ed se ices
ended o be highe in he success ul g oup (P¼0.030), bu he
di e ence was no signi ican du ing 2010 o 2017 o 2014 o 2017.
The BOTH pa icipa ion was sligh ly highe in he success ul g oup
be ween 2010 o 2017 and 2014 o 2017 han in he unsuccess ul
g oup (P¼0.020, P¼0.034). When compa ing he con ac s
be ween he g oups, p ima y indings we e ha he success ul g oup
ecei ed mo e ace- o- ace mee ings and g oup con ac s in all h ee
s udy pe iods (P<0.010). Co espondingly, he o al amoun o
con ac s was somewha highe in he success ul g oup han in he
unsuccess ul g oup (P¼0.034, P¼0.014, P¼0.044). In e es ingly,
he g oups did no di e in e-con ac s o indi idual con ac s.
Pipe Impac Me ic Sco e
PIPE Impac Me ic sco e was calcula ed as a p oduc o bo h
design and execu ion elemen s o he WHP p og am. The calcula-
ion o mula along wi h he coe icien s o each o he ou elemen s
and he esul ing PIPE Impac Me ic sco e o he Enso p og am o
TABLE 2. Pa icipa ion Ra es in WHP E en s, Ta ge ed Se ices, and Sepa a ed BOTH Pa icipa ion Analysis Du ing 2010 o
2017
Yea 2010 2011 2012 2013 2014 2015 2016 2017 Mean%
To al pe sonnel N 651 634 630 625 530 526 523 523
N(%) N(%) N(%) N(%) N(%) N(%) N(%) N(%) 63%
Pa ic. in WHP e en 431 (66%) 423 (67%) 428 (68%) 437 (70%) 289 (55%) 367 (70%) 269 (51%) 312 (60%)
Sex
Male 361 (84) 351 (83) 360 (84) 363 (83) 225 (78) 307 (84) 223 (83) 243 (78) 82
Female 70 (16) 72 (17) 68 (16) 74 (17) 64 (22) 60 (16) 46 (17) 69 (22) 18
Pa ic. in a ge ed se ices 104 (16) 268 (43) 130 (21) 132 (25) 223 (42) 189 (36) 365 (70) 36%
Sex
Male 79 (76) 216 (81) 96 (74) 91 (69) 173 (78) 150 (79) 294 (80) 77
Female 25 (24) 52 (19) 34 (26) 41 (31) 50 (22) 39 (21) 71 (20) 23
BOTH pa icipa ion (WHP e en and TS) 88 (14%) 240 (38%) 95 (15%) 90 (17%) 148 (28%) 76 (15%) 222 (42%) 24%
Sex
Male 68 (77) 195 (81) 67 (71) 58 (64) 114 (77) 54 (71) 175 (79) 74
Female 20 (23) 45 (19) 28 (29) 32 (36) 34 (23) 22 (29) 47 (21) 26
Heal h s a us

Good 25 (28) 81 (34) 39 (41) 42 (47) 64 (43) 28 (37) 86 (39) 38
Mode a e 12 (14) 74 (31) 21 (22) 20 (22) 44 (30) 25 (33) 64 (29) 26
Poo 49 (56) 79 (33) 27 (28) 26 (29) 35 (24) 21 (28) 65 (29) 32
NA 2 (2) 6 (3) 8 (9) 2 (2) 5 (3) 2 (2) 7 (3) 4
Pe sonnel g oup
Execu i es 9 (10) 33 (14) 9 (10) 19 (21) 24 (16) 5 (7) 28 (13) 13
Local o es o ice s 57 (65) 122 (51) 47 (49) 52 (58) 61 (41) 48 (63) 126 (57) 55
O ganiza ion o icials 19 (22) 48 (20) 20 (21) 19 (21) 26 (18) 22 (29) 49 (22) 22
Te minal wo ke s 1 (1) 20 (8) 1 (1) 0 (0) 37 (25) 1 (1) 16 (7) 6
Lumbe jacks 2 (2) 13 (5) 15 (16) NA NA NA NA 3
NA 0 (0) 4 (2) 3 (3) 0 (0) 0 (0) 0 (0) 3 (1) 1

The heal h ca ego iza ion was based on he pa icipan ’s i s HRA. Fo example, i an employee pa icipa ed in he se ices in 2011, bu had he /his i s HRA in 2013 and he
second in 2017, his analysis used he heal h s a us om 2013 assessmen .
JOEM Volume 61, Numbe 12, Decembe 2019 Eigh -yea Ou comes o Wo ksi e Heal h P omo ion
ß2019 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal o he Ame ican College o Occupa ional and En i onmen al Medicine. 971