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									    MPH Project: Final
    Determining Barriers and Possible
Solutions to an Online Employee Wellness

              Elaine Goldstein
           University of Maryland
                Spring 2007
                  Origin of the Project
• Intern and part-time employee at LiveHealthier
   – LiveHealthier is a health and wellness company that engages individuals in
     actively managing their health by providing access to
       •   Comprehensive health management tools
       •   Personal health records
       •   Trusted health information
       •   Private consultations with health professionals.
   – With an emphasis on prevention, risk reduction, early detection and quality
     care, LiveHealthier leverages its proprietary platform to deliver highly-
     customized private health portals to employers seeking to
       •   Improve employee health and well-being
       •   Decrease healthcare costs
       •   Reduce absenteeism
       •   Improve productivity.

• Client with online employee wellness program
• Low site-usage
• Desire to expand globally if site-usage increases
            Interest in the Issue
• Interested in what motivates and prevents people to actively
  engage in caring about their health.
• Curious as to why employees are not taking advantage of a
  FREE employee wellness program with the goal of improving
  their health.
• I believe that this online employee wellness program can impact
  employee’s health in a positive manner by encouraging them to:
   – Quit smoking
   – Provide a customized meal and activity plan that fits their needs
     and goals
   – Provide them with a network of support as they pursue their
     individual health goals
   – Provide them with screening recommendations which could help in
     the early detection of cancer.
• Course in Health Informatics and Communication
   – Connection between background in communication and working
     knowledge of public health.
                Literature Review
• Growth and influence of the Internet
   – 2002: over 100 million people in the US searched
     online for information
   Forkner-Dunn, 2003

• The Internet is the most prominent force
  shaping health and health care
  Eysenbach & Jadad, 2001

   – The Internet is the primary source of health
     information and education
   eHealth Institute, 2006
                Literature Review
• Pew Internet & American Life Project:
    – 41% of people surveyed in the year 2000 claimed that the
      Internet affected their health decisions in one way or another
• Patient-physician relationship can be
  enhanced by health information on the
    – In one study, breast cancer patients who used online
      education and support groups had increased confidence in
      their doctor and reported increased competence to deal with
      health information
    – More comfortable seeking information during doctor’s
      appointments and overall, felt more comfortable participating
      in their own care.
    – More likely to ask specific and informed questions during
      doctor’s visits.

Forkner-Dunn, 2003
                    Literature Review
• Employee wellness programs have grown in popularity
  – Since the 1980s, the number of wellness activities within
    public and private companies has increased rapidly
      Haynes et al., 1999
  – Health-insurance premiums are rising 10% / yr
      Panepento, 2004

• Benefits
  –   Reduce health risks and costs
  –   Reduce employee absenteeism
  –   Cut down on recruiting and hiring costs
  –   Improve employee morale
      Franklin et al., 2006
          Literature Review
• Employee Wellness Programs Barriers
  – Perceived as labor-intensive and costly to
  – Scattered locales make disseminating wellness
    information a challenge
     • Organizations are not housed in a single building.
                Literature Review
• Online Employee Wellness Programs
  – Web-based employee wellness programs offer a unique
    solution by providing a cost-effective approach to
    employee wellness programming.
     Franklin et al., 2006
  – Internet can span geographic and time differences,
    available 24/7.
  – 74 % of US adults in 2005, reported having Internet
  – 66% of US adults in 2005 reported having home access.

  Franklin et al., 2006
            Literature Review
• Barriers to site-usage and possible solutions to
  increase site-usage should be considered in order
  to improve existing programs and increase the
  amount of employers who chose to implement
  these programs.
   – Participation rates are not always at optimal levels
   – Many employers avoid employee wellness programs
     because employees do not take full advantage of these
                    Literature Review
• Innovative strategies are needed
     – Package information in a consumable manner - less
           • Tailor content according to individual characteristics
           • Use electronic communication
                 – Broad reach
                 – Eliminates the need for users to seek out health information,
                   which will entice less-motivated adults to get involved in the
                   online employee wellness program
     – Personal online-accessible health record
           • Enhance communication with a medical professional
           • Consumer empowerment
           • Drive the self-care movement by allowing patients to manage
             their own health conveniently and proficiently

Franklin et al., 2006
       Description of Project
• Developed a Focus Group Moderators Guide

• Conducted a Focus Group.
  – Goal: To identify and assess barriers, which may reduce
    employee participation in a company’s online employee
    wellness program and explore possible solutions to
    increase online participation.

• Wrote a Final Recommendations Report
  – Purpose: To logically group the barriers and solutions
    and give practical recommendations that could be
    implemented or investigated further.
     Summary of Findings: Barriers
           to Site-Usage
1.       Difficulty navigating the site.
     •          Recommendation: A site map with a hyperlinked table of contents.
2.       Remembering the site URL.
     •          Recommendation: Include link to the site on company intranet.
3.       Difficulty logging on and remembering username and password
     •          Recommendations:
            •       Provide a single sign on (SSO) process as a corporate initiative
            •       Provide usability test
4.       New-employees are not aware of the site.
            Recommendations:
               Include a hyperlink with log on information on intranet.
                   Newsletter campaign
                   Find offline ways to encourage employees to log on
                        Promote site around the office
                        Free giveaways
5.       Information on the site needs to be more proactive.
     •          Recommendation: Tailored information based on location and stage of change.
Summary of Findings: New Feature Ideas
•   Health management tool.
     – Possible Barrier: Confidentiality concerns and diagnosis concerns.
•   Access to other health experts in addition to RD and CPT.
     – Possible Barrier: In-person interactions were considered valuable.
•   Segmented health information by age and gender.
     – Possible Barriers:
         • Appropriate age ranges are up for debate.
         • Some health topics are applicable at all ages
         • If you were to segment health topics by age and a user identifies with a health topic that
           is not in their age range, they may feel isolated.
•   Incentives / rewards program.
     – Possible Barriers:
         • Costly
         • No way to verify or monitor self-reported behaviors
         • Discrimination
•   Health news alerts (RSS feed)
     – Possible Barriers:
         • Credibility issues
         • Distract users away from the main site
         • Over-communication
           Project Outcome
• Multiple barriers to site-usage and multiple
• Developing a health management tool with
  dynamic content was agreeable but would not
  bring them to the site any more often.
• Overall recommendation: Survey a larger
  employee population to determine if these
  recommendations have a broader corporate appeal.
  Conclusions and Suggestions
       for Modifications
• Importance of focus groups
   – Ideas that come from the intended audience can serve to
     be more powerful than the developer’s ideas
• Benefits of Evaluation
   – High level of stakeholder ownership
   – User involvement at the early stages of design can help
     to identify problems and suggest valuable additions or
   – Further refinements will reflect the requests of the
     target audience more closely

   Pagliari et al., 2003
             Presentation References
eHealth Institute. (2006). Sixth Annual eHealth Developers’ Summit Summary Report: eHealth: the
   Momentum is Building. Retrieved May 1, 2007, from

Forkner-Dunn, J. (2003). Internet-based patient self-care: the next generation of health care delivery.
    Journal of Medical Internet Research, 5 (2), e8.

Franklin, P., Rosenbaum, P., Carey, M., & Roizen, M. (2006). Using sequential email messages to
    promote health behaviors: evidence of feasibility and reach in a worksite sample. Journal of
    Medical Internet Research, 8 (1), e3.

Haynes, G., Dunnagan, T. & Smith, V. (1999). Do employees participating in voluntary health
   promotion programs incur lower health care costs? Health Promotion International, 14 (1), 43-

Pagliari, C., Clark, D., Hunter, K., Boyle, D., Cunningham, S., Morris, A., & Sullivan, F. (2003).
    DARTS 2000 online diabetes management system: formative evaluation in clinical practice.
    Journal of Evaluation in Clinical Practice, 9 (4), 391-400.

Panepento, P. (2004). Employee-wellness programs pay off in productivity and morale. Chronicle of
   Philanthropy, 16 (18), 38-39.
   Thank You

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