Why behaviour change should be driving force in employee wellbeing programs.
Have you ever made a New Year’s resolution? If you have then there is a very good chance that it was something around your health. Get fitter, eat better, be more active, join a gym etc. A report by the NBC found that getting healthy was by far the most popular resolution, nearly double number 2 on the list. These resolutions are made with the best of intentions yet how often do we manage to keep them for any length of time? In fact, no matter when we decide to make a change, or how motivated we are, the formation of any healthy habit, or the breaking of a bad one, is incredibly difficult.
Most people know what they should be doing for their health, they know they need to exercise, eat healthy, maintain a good body fat percentage, limit alcohol, get enough sleep and don’t smoke. Most people are also aware that by looking after themselves they are reducing their risk of disease, will feel better, function more effectively and will have higher levels of self confidence. These changes do not only impact us today but also in our later years. Studies have found that people who do not look after their modifiable lifestyle factors today are much more likely to be admitted into a nursing home in later years.
So most of us have this knowledge, we know what we should do, we know it is good for us, we know the long term benefits of making these healthy changes yet so often we chose the unhealthy option. Many programs focus simply on the premise that rational people will make the healthy choice if they understand the benefits, yet, people are rarely rational, they will make the irrational choice even if it’s counterproductive to their wellbeing. People will not necessarily focus on their long term health when a short term reward is on offer, for example, the pizza, chocolate and bingeing on TV is more appealing in the short term.
I previously published this post focusing on why businesses should embrace corporate wellness programs, whilst this remains an absolute must have from a business perspective, it is also vital that one of the key aims of any wellness program is to improve the long term health of their employees. This must be the overarching goal of any program, anything less may be viewed as tokenistic and employees may become more disengaged from the program. One of the key ways to ensure that your wellness program is seeking to improve long term health is to focus on changing behaviours of your employees for the better.
So what does behaviour change mean? What is it? Simply put, it refers to any change or modification to a person’s behaviour, although this definition is typically used in reference to individuals it can also be used in reference to organisations and communities. It is underpinned by a number of theories which seek to understand why behaviours change and it can be applied to a number of areas including health, education and criminology. There are a number of these theories although here I will only be looking at the Transtheoretical or Stages of Change model, this is the one most commonly applied to health settings. If you’re after some further reading on the topic, here is a good place to start. More on this shortly.
The first piece to building a program that supports behaviour change across an organisation is to build a culture that supports and nurtures employees on their health journey. Organisational culture is key to running a high performance business, ignoring this and ignoring the role this plays in the success or failure of a wellness program will almost certainly see the program fail no matter how good the intention.
A healthy company culture is built intentionally. It is about creating a way of life in the workplace that integrates into every aspect of business, from company policies to everyday work activities. A culture that’s supportive of career, emotional, financial, physical and social well-being. Examples include offering flexible work schedules, giving workers a say in decision-making, setting reasonable health goals, providing support, enforcing health-promoting policies and establishing a healthy physical environment including food options, stairs and an environment that supports employees to be healthy. In addition to this, support of the leadership is vital, a successful wellness program starts with a commitment from company leaders, and its continued success depends on ongoing support at all levels of the organisation. Leaders at companies with successful programs establish a healthy work environment by integrating health into the organisation’s overall vision and purpose.
Change can be achieved in two ways, either by choice and design or organically and evolutionary. By choice is often forced and disruptive. It is fast and sometimes necessary but can be destructive. These are the conversations that are had a meetings and conferences and are pushed across the business. Evolutionary change is slower and more gentle but can take a long time. These are the conversations that take place over coffee, in the hallways and in passing between colleagues. The conversations that make up the very fabric of organisational change. This is not to say either is a better or more effective method for creating change. In fact a hybrid of both is likely the best way to achieve change.
The next piece is to understand the Stages of Change that people will go through on their behaviour change journey. Change does not happen in an instant, it’s not an event, it is a process.
Precontemplative — In this stage, people are not interested in change, can’t see the need to change and have no intention of doing anything differently. People in this stage tend to avoid reading, talking, or thinking about the unhealthy behaviour, but their awareness and interest may be sparked by outside influences. To move past precontemplation, you need to sense that the unhealthy behavior is blocking your access to important personal goals, such as being healthy enough to travel or enjoy children or grandchildren.
Contemplative — In this stage, people start to think about the issue and the possible need to make some changes. They recognise that there is a problem and that they can and should do something to make their lives better. Contemplators are essentially weighing up the pros and cons of making a change. Giving up an enjoyed behaviour causes them to feel a sense of loss despite the perceived gain. At this stage, people are very open to information and scour sources for options and strategies.
Preparation — A change is about to happen. The person concerned has realised how serious their situation is, has made a decision or a commitment to change and is currently completing any ‘pre-change’ steps with a view to making the required change. This where plans are being made and it is important to anticipate obstacles and situations that might cause challenges and plan for ways to overcome these.
Action — This stage applies to those people who have made real and overt changes or modifications to their lives. While the chances of relapse and temptation are very strong, there is also openness to receiving help and support. People may also need to implement their support strategies identified in the preparation stage.
Maintenance — By this stage, people are working to consolidate any changes in their behaviour, to maintain the ‘new’ status quo and to prevent relapse or temptation. The former behaviour is now seen as no longer desirable and a number of coping strategies have been put in place and are working.
Some updated versions of the model have added in a sixth stage which sought to build on the previous model.
Termination/Advocacy/Transcendance stage — This stage is the continuing part of any behaviour change and includes the understanding that going back to old habits or behaviours would ‘feel weird’ and that former problem behaviours are no longer perceived as desirable. This stage can also have an element of advocacy about it with some people committed to spreading the word to their neighbours, family members or the public at large. This sort of advocacy plays an important part in helping move other people along the behaviour change path and needs to be encouraged and supported. During this stage, relapse can occur, but it is not seen as a failure but rather as a learning opportunity to help strengthen coping strategies and support mechanisms.
So what does this mean for developing a corporate wellness program in the workplace? It means employees need to be supported at each stage of change, they need a range of offerings, ones that are the right offering at the right time to support their needs. For example, a person or organisation in the Maintenance phase may find little value in information seminars however this may be perfect for people contemplating change.
Simply offering health checks without additional tools and resources will also not promote behaviour change. Feedback reports that remind employees that smoking, not exercising, or being overweight is unhealthy does not motivate change unless workers are given the tools and resources to actually change and track their behaviors. Likewise for “Biggest Loser” challenges or pedometer challenges, these one off events may seen as random acts of wellness and fail to engage employees.
Similarly to this, simply offering a corporate health plan does not constitute a wellness program, these programs do not improve population health alone unless they are part of a broader comprehensive health promotion program that offers many ways to become engaged. Whilst this is an important part of a company offering to employees, in isolation will do little to encourage better health.
Employees need to have a say in their program, engagement in wellness can only be achieved when workers own the program, understand how they and the company benefit, and are given a meaningful voice in its ongoing operation. People will only undertake change if they see it as being easy, accessible and of value, if they do not feel supported or have a sense of ownership over it they are less likely to engage.
Finally, evaluation of the program is critical to maintaining accountability of a wellness program. To do this well, develop an evaluation plan at the start of a program so that useful baseline data collection can occur and be monitored over time. This should involve measuring both return on investment (ROI) and Value of investment (VOI). ROI is limited to examining the tangible benefits of a program, such as absenteeism. VOI calculations, on the other hand, allow employers to examine the broader impact of programs and their impact on core priorities which may include improved employee morale, employee attraction and retention, enhanced company loyalty and heightened customer loyalty.
When it comes to constructing a wellness programs there are many options out there and a lot of confusion and, as a result, many leaders pick and choose options blindly, doing their employees and their company a disservice. Leaders need to understand why their program is important, what works and then combine health promotion programs with change interventions that build on and support a healthy company culture. This can be a challenge but one that be incredibly rewarding.