Abstract
During the past 2 decades, the health promotion industry has broadened its programming focus from physical health and lifestyle behaviors to include mental health offerings. In the past 10 years, industry recognition and support of other well-being domains, including financial, social, and others, has resulted in a more holistic and comprehensive framework for health promotion efforts. More recently, however, increased awareness of the importance of social determinants of health, particularly in the workplace setting, is generating a growing call for attention to more foundational employee needs.
Importantly, part of this growing awareness includes recognition of the fact that patient engagement in well-being programs may well be impacted by social determinants, which may drive individual preferences for program selection. Traditional health promotion program-based engagement approaches have promoted individual choice from a fixed array of available offerings that may or may not have particular relevance to potential enrollees. This practice may well explain comparatively low participation rates, when more pressing personal priorities, especially those related to social determinants of health, are acknowledged. 1 Imagine a low-wage worker with appreciable financial stress who is offered enrollment in a weight management program. It is likely that many in this situation will dismiss the opportunity because it is simply irrelevant to their urgent needs.
The research study by Kneipp et al 2 in this issue of the American Journal of Health Promotion provides evidence that individual priorities matter and particularly so in the setting of financial stress. The authors surveyed 324 workers with at least one chronic condition about their preference for financial or chronic condition (health) self-management program offerings. In their analysis, the authors incorporated demographic variables, including chronic disease burden, physical symptom burden, body mass index, depression status and financial strain, in addition to individual and household income. The authors found that individuals with appreciable depressive symptoms were more likely to choose a health self-management program, while the presence of financial strain more than doubled the likelihood of choosing the financial self-management offering. The presence of financial strain also significantly mitigated the selection of a health self-management program among individuals with depressive symptoms.
These findings add to our understanding of the importance of confounding factors when individuals make decisions about health/well-being program participation. The results are consistent with the hypothesis that an individual’s “pain points” or sources of stress are likely to drive their interest in and selection of a focused support offering. Not surprisingly, in this study, obesity—as an often asymptomatic condition—was not a significant influencer of participant program selection.
Two key points emerge from this article. First, this study helps to refocus the priorities of health promotion program sponsors away from a “one-size-fits-all” programmatic approach toward greater acknowledgment of individualized priorities and preferences. Suboptimal participation rates in current health promotion programs may be in part a function of misalignment with employee priorities. There is a need to expand program focus areas to more effectively identify and address actual employee concerns. The expansion of health promotion programs to encompass broader well-being domains, including personal financial issues as presented in this article, is a meaningful step in the right direction.
Second, the findings of this study also highlight the emerging significance of social determinants of health as an important consideration for employers. 3 As this article illustrates, individuals with significant financial stress may feel that their physical health issues are a secondary concern and are less likely to engage in health management programs. Workplace policies and practices, including just-in-time work scheduling, lack of paid sick leave, and inequitable benefits costs may exacerbate financial pressures, particularly for low-wage earners. Employers have an opportunity to broaden their perspective on health promotion to include the workplace as an important—and underappreciated—social determinant of health.
From a methodologic standpoint, the authors have included a number of important demographic and socioeconomic attributes in their analysis. In future studies, it may also be helpful to include structured social determinant of health variables (ie, housing stability, for example) as moderators of preference, as well as their effects on health promotion program effectiveness, to understand better how these factors influence individual preferences and choices, as well as program outcomes.
This article serves to open the proverbial door to greater consideration of personal priorities/social determinants of health when planning health promotion programs. The findings should stimulate greater interest in the broader research areas of social determinants of health, personal priorities, and meaningful program selection and engagement. As a result, instead of focusing on the outcomes for only those that do engage in programs, we can increase our understanding and ability to engage a broader proportion of eligible individuals in programs that matter to them.