Date: Sat, 16 Feb 2008 10:16:34 -0500

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#253

Date: Sat, 16 Feb 2008 15:20:22 -0500

From: Jim at CPP <jvgrizzell@CSUPOMONA.EDU>

Subject: Re: knowledge and behavior

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I'm finally responding to Debra's questions about whether or not knowledge alone can influence or change behavior. I'd say from a business and economic point of view such as return on investment, cost effectiveness knowledge does not affect behavior. Here's text from an email I sent to others.

---------------------------

The Worksite Committee of CDC's Guide to Community Preventive Services has just completed a "systematic review" of literature (over 300 peer reviewed journal articles) for effectiveness of worksite interventions. We spent 2 hours on conference calls each month for a year and found strong evidence and sufficient evidence to say that "assessments of health risks with over

1 hour of health education or repeated multiple times over a year plus other interventions" do reduce health care and lost productivity costs.

An assessment of health risks is a health risk appraisal (HRA) often with biometric screenings. Health education was considered to that lasting at least an hour or repeated in multiple sessions over a year. The other intervention components include those like enhanced access to physical activity, smoke-free policies, reduction of out-of-pocket costs for healthcare services.

Assessments of health risk with just feedback (written or verbal) DID NOT show evidence of effectiveness at reducing health care or lost productivity costs.

Here's a bullet point summary of the Worksite Committee's findings:

1. Program costs ranged in studies from $40 up to $647 per participant or employee, and the median for studies in this review was $104.

2. Economic benefits from the intervention ranged from $66 up to $972 per participant or per employee, and the median for studies in this review was $328.

3. The range of Return on Investment (ROI) ratios was 1.4:1 to 5.7:1, with a median of 3.4:1.

Concluding paragraph from an article being written:

The results of this review in combination with the results of the review described above (the assessment of health risks with feedback when used alone), both of which are specific to worksite settings, indicate that the assessment of health risk with feedback (typically conducted with a biometric screening) has utility as a gateway intervention to a broader worksite health promotion program that includes health education lasting at least an hour or being repeated multiple times during a year, and that may include an array of health promotion activities. The specific magnitude of effect an employer might expect from implementing different types of health promotion programs will vary and may be influenced by type and duration of intervention component offered, participation rates, participant characteristics (evidence suggests that higher risk participants will experience greater health gains) and other contextual factors.

To get significant health and productivity improvements for the company nearly all employees should complete the assessment of health risks and at least 80% should participate in at least one health promotion program in a year. With this a 3:1 ROI is possible within a year if =/>80% participate.

To get high participation in HRAs companies give incentives like no deductions on pay checks for 6-months to a year if the employee completes an HRA and brief health screenings of glucose; total, HDL and LDL cholesterol; triglycerides; blood pressure; physical activity; smoking and stress. Some companies offer free (even unlimited phone health

advising/coaching) for a health risk for 3 months after the screenings.

Another incentive one company did was to charge the employee $500 more per year for insurance if the HRA was not completed bi-annually.

The CDC Worksite Committee guidelines will be at this webpage in a few months.

Note that health care costs only account for about 40% of a company's losses. Lost productivity costs are from absenteeism, presenteeism, worker's comp, short-term and long-term disability account for the other 60% of losses.

-----------------------

Jim

> From: Debra Lafler <deblafler@CHARTER.NET>

> To: <HEDIR-L@listserv.siu.edu>

> Date: 2/4/2008 8:43:30 AM

> Subject: knowledge and behavior

>

> I am curious to get your take/feedback on the the whole 'knowledge

> does

not

> change behavior.'

>

> When I have brought this up in the past, even to other health

> educators, some disagree and say that knowledge is what people need to

> change...for example with taking an Health Risk Assessment

> (HRA)...that it is necessary for people to take an HRA to know their

> health status and risk so they can make change. (One benefit to the

> popular HRAs these days is that the profile participants receive is

> usually full of recommendations for

change,

> IF people are ready, interested and open to hear them!)

>

> So, what I am looking for is - how would you respond or speak to those

that

> don't understand that knowledge ALONE doesn't change behavior? What

> resources, references, web links, etc. would you use to support your

> discussion?

Jim Grizzell, MBA, MA, CHES, HFI, FACHA

CHES CEU NCHEC Provider # SSP2786

C - 909-856-3350

E - jvgrizzell@csupomona.edu

E - jim@healthedpartners.org

F - 202-379-9786

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