Health Wellness ProgramHealth and Wellness Programs and Wellness Program Consulting

In today’s fast paced world our busy lives leave little time, energy, or motivation for people  to focus on their own needs.

Those that do seek to improve their wellness traditionally turn to friends, family, professionals and published materials for support and information. All too often those support structures fail to make a lasting difference.

This happens for a number of reasons. Friends and family might not be capable of helping. Working with professionals is time consuming and expensive and very few of us are effective at taking published, generic information and applying it to our own lives.

Gold’s Fitness Center Winston-Salem has created a new internet based wellness program that expands the range of support available to those wishing to make healthy lifestyle changes.

The wellness program, Gold’s Gym Health Coach, focuses on the everyday challenges of making positive lifestyle changes and has the advantages of being more personalized and efficient than generic, published information and less intense and costly than professional face-to-face counseling.

Utilizing a collaborative problem-solving model the goal isn’t to give advice, but rather to help person think through the issues and come to their own conclusions.

The coach offers ideas for consideration, assists the individual generate ideas of their own, assists the individual consider the various ideas, select a direction, and then supports them in the implementation of their decision.

Difficult the conventional wisdom that relationship formation requires in-person interaction; Gold’s Fitness Club has found that members and coaches can easily build significant relationships via internet based communication.

Utilizing industry leading technology a Gold’s Health Club Wellness Coach can offer members a secure, user-friendly personal website where they can access their coach in a real-time or via email with responses delivered in less than 24 hours.

The site authorizes coaches to hand pick relevant articles that are written on a consumer level and that are targeted to the issue at hand and add them to a member’s online personal library.

The site also contains various wellness programs and tools which are designed to assist the coach and member to set, implement and track specific goals.

The collaborative relationship formed between member and coach enhances the quality ice and efficiency of service.  The familiarity that a coach develops with a member’s circumstances and meaningful relationships allows them over time to more rapidly offer useful ideas and assistance.

With traditional call-in assistance lines, the time intensive exercise of getting background and contextual information is repeated each time. IN that scenario efficiency is lost.

Moreover, Gold’s Fitness Club Health Coach has created a protocol based on key principals from the field of psychotherapy and behavior modification.

The protocol is embedded within a proprietary problem-solving that is based on the concept that people  often act without a good understanding of a problem. Their responses then complicate matters and often make matters worse.

Gold’s Gym Health Coach offers the opportunity to step back, take a second look at what’s going on, and rapidly asses the factors influencing the situation. But, having an idea of “what” to do is very different than actually “doing” something about it.

People  need help with the follow-through. Also, after figuring out “what” to do, Gold’s Fitness Center Wellness Coach focuses on implementation.

Here Gold’s Health Club Wellness Coach builds on sound research and experience from the field of behavior modification that has to do with goal-setting and with implementation support.

The result is a highly personalized, effective, user-friendly way of improving the wellness of an individual.  The efficient nature of the web-based relationship permits Gold’s Fitness Club Wellness Coach to keep the price point within reach of virtually whoever.

Information to evaluate your wellness program comes from routinely collected screening and follow-up data of your wellness program that look at process and outcomes of your program.

The Employee Health Program has available a computerized case-management system which includes queries that allow easy assessment of process and outcome results at any point in time.

Process Examination

Process examination looks at the health promotion program’s impact as seen at various points in time.

Information that is collected from the various forms that wellness workers fill out ought to supply you with the following –

• How many personnel were screened?

• How many workforce who were referred to a physician went?

• Precisely how many staff who expressed interest in health promotion programs went?

• Just how many workforce who were referred to wellness programs went?

• Just how many workers who went to wellness programs completed them?

• How many workforce are in follow-up caseload?

You can use this kind of process investigation to evaluate and learn about the health of your health promotion program.

Health Promotion Program Outcome Investigation

A central objective of the health promotion program is to improve the health of employees. Information on how to judge how well your health promotion program is meeting this objective is called “outcome investigation” because you are evaluating  the end results or outcome of your health promotion program.

In health promotion programs, objectives are measured by specific (outcomes) behavior changes and reductions in health risk levels. Have staff decreased their blood pressure? Have they lost weight? Are they exercising more? is alcohol consumption at a safe level?

For example these are the kinds of questions you are able to ask to determine when you are reaching your goals –  

• For workforce with high blood pressure (140 / 90 or higher or on medication) at screening, what percentage have it under control (below 140 / 90) a year later?

• What is the change in typical blood pressure (BP) levels among all personnel with high blood pressure (BP) 1 year after screening? Two years later?

• For workers with high blood cholesterol levels (above 240) at screening, what percentage has decreased their cholesterol to borderline-high levels (200-239)?

• For personnel with borderline-high blood cholesterol levels, what percentages have reduced their cholesterol to the desirable range (below 200)?

• What’s the change in typical cholesterol levels among all workers with high and borderline-high blood cholesterol levels 1 year after screening? Two years later?

• For employees who were overweight at screening, what percentage have lost 20 pounds or more a year later? Ten pounds or more? What’s the average losing weight?

• For workers who were smokers at screening, what percentages have quit smoking? for at least a year?

• For personnel whose level of alcohol consumption put them at-risk at screening, what percentage have quit drinking alcohol? Are eating alcohol at levels considered safe by CDC guidelines? Have reduced their drinking, but are still at-risk?

• For workers, what percentages are exercising at least three times a week for at least 20 minutes?

• When levels of fitness were measured, what percentages have improved fitness?

Make sure to set a regular time like every 6 months to look at which workers your wellness program is reaching and how effective it’s at helping them reduce their health risks. Use this information to make new decisions about how to direct your wellness program efforts. Then make the change you need to improve your wellness program.

Some may feel that analysis is a frill; it is not. Analysis is a necessary part of a health promotion program. You will need to know what’s working and what’s not.

Decision-makers who fund the wellness program need to be updated on the performance of the wellness program. Examination will provide you with necessary data to maintain and expand the wellness program and convince upper management to continue to support the wellness program.

The keys to a successful wellness program are persistent one-on-one outreach and follow-up counseling to encourage health improvement, adherence to treatment programs, changes in lifestyle behaviors, and to prevent relapse.

Periodic outreach and follow-up procedures provide employees with a safety net which keeps them involved in the wellness program and prevents treatment dropout and relapse.

Counselors ought to follow up on employees at least every 6 months throughout the career of the worker at the worksite.  The objectives of follow-up are to –  

• Involve employees that have health risks in treatment and risk reduction programs.

• Involve all personnel in health promotion programs and worksite-wide wellness activities.

• Support personnel in carrying out the risk reduction or health betterment activities they have chosen.

• Make sure to help employees follow their treatment programs.

• Avoid relapse.

• Avoid staff members from dropping out.

• Make sure to help workers maintain behavior changes.

Follow-up can be conducted in person, by phone, mail, and via computer when the technology is available. Most preferable is an in-person contact.

Computer programs which could do case load management are available to help counselors track information and perform follow-up.

Priorities for Follow-Up

Individuals  with multiple health risks ought to be at the top of the list. Individuals  in key positions like union leaders or department heads with health risks should also be contacted early so that they learn what the health promotion program is about and can share the information with others.

People  who need a medical evaluation for high blood pressure (BP) or cholesterol should also be targeted early. Many employees will have seen their physicians then of the screening, but some will need more encouragement to do so. Those with no health risks can be followed up yearly.

A follow-up counseling session can take 20 to 45 minutes.  At minimum, follow-up must include those who were told to seek medical investigation for high blood pressure (BP) readings, high cholesterol readings, or borderline high blood cholesterol readings with 2 or more other risk factors.

It could include those who were identified as at-risk for one or more of the other major risk factors –  at-risk levels of alcohol consumption, being overweight, and having low HDL.

Follow-Up With Physicians

A letter (see forms) ought to be sent to the doctor or clinic of each worker who has high blood pressure, high cholesterol, or is under a doctor’s care.

The letter should explain the health promotion program and should include the employee’s relevant, current health measurements.

Along with the letter, send a self-addressed return envelope. Follow-up with the doctor ought to be repeated every 6 months until it is determined that the staff member is under satisfactory control.

Contacting the physician is important for three reasons –

• The physicians receive employees’ health measurements taken at the workplace.

• You receive the blood pressure (BP) and cholesterol readings the physician takes and information on the treatment the physician prescribes.

A lot of times the worker does not have this information or does not remember it.  The information may be used when counseling the worker.

• Follow-up encourages doctors to pay closer attention to heart illness risk factors among their patients.

The menu approach offers staff a range of choices to support lifestyle changes. It permits people  to pick the type of help that suits their schedules and preferences.

The four basic kinds of health promotion programs include –

• Classes

• Minigroups

• Guided self help

• Individual counseling

Classes

Classes (8 or more) could be an effective means of providing education and social support for behavior change.  The length of a class can vary depending on topic requirements. It is not sufficient to offer only classes at a workplace.

A lot of staff are under time constraints with after work commitments and although they might be interested they simply can’t participate because of their schedules.

Employees might  be very eager to begin a wellness program but because of lack of participants to meet class quotas, the wellness program is canceled.

Many national companies such as the American Heart Association, American Cancer Society, Weight Watchers, etc. offer classes; you should have little trouble in identifying a provider for class kind wellness programs.

You could want to contact your local hospital, health department, or YMCA for possible choices. for choosing  a vendor to provide a health promotion program you could want to review the section on health promotion program structure.

Minigroups

When there isn’t enough interest to develop a class, those who are interested in a given health topic may be formed into a minigroup (2 to 7).

The minigroup can cover the same content as a class but do so in a less formal manner. Presentation of information and discussion is the major format of the minigroup.

Guided Self-Help

Most personnel don’t want formal help in making health changes; they prefer to do it on their own. In guided self-help, the wellness counselors provide support, materials, and encouragement.

Meeting times can be arranged and contact can be made either in individuals, by phone, or computer. Materials can be made available at the worksite, or mailed to the individual. Some worksites now make information available via intranets or the Internet.

Individual Counseling

One of the most successful ways to help individuals change and improve their health status is counseling (or coaching) on a one-on-one basis.

In published studies, health promotion programs which incorporated individual counseling as part of the health promotion program process achieved significantly higher participation rates and achieved greater risk reduction/risk elimination than standard group programs. Studies have demonstrated that individual counseling is both cost effective and cost beneficial.

A wellness counselor should be trained in screening techniques, for in certain situations, they could be required to both screen person and counsel them. They ought to know how to do the following –  

• Review employee health risks

• Contact staff members that have health risks.

• Counsel staff members on a one-on-one basis, assisting them set goals, solve problems, and get specialist help when they need it.

• Make certain to help employees follow their treatment recommendations and make lifestyle and health behavior changes.

• Recruit workers into health promotion programs, such as losing weight and tobacco use cessation.

• Make sure to work with personnel on a one-on-one basis using guided self-help.

• Conduct classes and minigroups if necessary.

• Be certain to work with wellness committee members to plan and conduct workplace-wide wellness activities.

Health Promotion counselors are health generalists; they must have basic understanding of a broad range of health topics and health risks.

Counselors should be able to speak with staff about their medical problems and the treatments prescribed by their doctors.

They should’ve a good overview of nutrition, exercise physiology, pathophysiology of disease, pharmacology, psychology, and behavior modification skills.

The educational program ought to include approaches to stress awareness/reduction at the environmental level and at the individual level.

Social, physical, and organizational stressors must be explained and methods to ease or elevate stressors must be presented.

At the individual level how changes in attitudes and behaviors help one to cope with stressors; learning techniques to minimize stress response, like meditation, relaxation response, and exercise.

Content of the program ought to provide the following –

• Identifying sources of stress

• Relationship of stress to health

• Just how the individual experiences stress, personal, family, work

• Solutions for coping and managing stress

• Techniques for lowering stress

• Value of stress, both negative and positive

• Practical steps of incorporating stress reduction into lifestyle

Personnel conducting stress management programs should have training in psychology, behavioral sciences, or related disciplines like mental health experts, counselors, health educators, psychologists, and psychiatrists.

Training in a reputable program on how to teach the stress management course including group process skills is a must.

A nutrition education program should include a nutritional needs assessment, education counseling, and referral as necessary.

Educational sessions and materials should include the following information –

• The relationship of nutrition and chronic conditions

• Improving eating patterns

• Relationship of nutrition and proper weight maintenance

• Exercise

• Stress

• Blood pressure (BP)

• Cholesterol

• Diabetes and other chronic diseases.

• Nutritionally exact information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into consuming habits. Guidelines for bettering consuming habits must be based on or consisitent with national recommendations such as the Food Guide Pyramid.

Instructor should be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition.

When an allied health expert instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It’s recommended that use of tobacco cessation programs subscribe to the Code of Practice for Smoking Cessation Programs.

Smoking cessation programs must be multi-component with a focus on skills to build positive voluntary behavior change practices.

Useful techniques include establishing reasons for quitting, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term goal establishing, weight control, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or frighten tactics.

In wellness programs that use aids like the “patch” or medications like “Zyban” appropriate consultation must be available on the usage of these aids.

The instructor should have formal training in tobacco use cessation from a nationally recognized organization like American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program like Smoke Enders.

Evaluation of success is sometimes very dubious in use of tobacco cessation programs. Measurement of success ought to include participation rate, including the number starting the program, the number completing the program, and the average number per session.

Furthermore included, number and% who stopped smoking at the end of the program, and the number and% who had not resumed smoking by the end of one year.

Participatory fitness programs ought to include education on benefits of regular exercise and risks of a sedentary lifestyle, its impact on cardiovascular health and diseases, its relationship with weight control and stress management, and aerobic activity choices.

Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components.  The wellness program follows guidelines by the American College of Sports Medicine.

Safety precautions ought to include the following –

• Informed consent prior to starting exercise with clear and complete written and verbal instructions of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.

• A screening/evaluation of participants to determine when medical evaluation is necessary for exercise like the Exercise Readiness Questionnaire (PAR-Q, see forms).

• Measurements of blood pressure and resting heart rate are useful screening information to determine exercise readiness.

• Participants who fail screening are medically referred and should obtain a written clearance from their physician to exercise.    

• The basic content of an aerobics program should include –     

Warm up   5 – 10 minutes

Aerobic exercise   20 – 40 minutes

Cool down   5 – 10 minutes

Exercise instructors should’ve education and training in exercise physiology, physical education, physical therapy or comparable discipline, or possess a current certification by a nationally recognized sports medicine or exercise association, and be CPR certified.   

Wellness Program offered is consisitent with scientific and medical recommendations for weight loss, reflects a multi-disciplinary approach which offers four components –  behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance for Treatment of Adult Obesity. It includes –    

• Screening to verify that the participant lacks medical or psychological conditions which would make weight loss inappropriate, and to identify the participant’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and overall heath risk.

• Referral for participants who are morbidly obese who would require medical guidance for losing weight.

• Informed consent, explanation of potential physical and psychological risk from losing weight and regain, likely long-term success of wellness program, full cost of the wellness program, credentials of the staff.

• Identification of factors to participant’s weight status, serving as the basis for an individualized weight loss plan which includes the weight goal and plans for nutrition, exercise, and behavioral components.

• Weight goal of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial weight reduction goal does not exceed loss of 10% of body weight, 1-2 pounds per week.

• Explanation of unsafe weight reduction methods.

• Daily calorie level is adjusted to meet each participant’s recommended rate of weight reduction.

• Daily caloric intake isn’t less than 1,000 calories; when less, doctor monitoring is required.

• Food plan designed so participants can select foods which meet 100% of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, nevertheless should not greatly exceed RDAs.    

• Nutrition education encouraging permanent healthy consuming habits based on the Food Guide Pyramid.    

• Participant involved in meal planning and food selection.    

The protein, fat, carbohydrate, and fluid content of the food plan meet safety recommendations –     

Protein   Between 0.8 and 1.5 grams of protein per kilogram of goal body weight, but no more than 100 grams of protein a day.

Fat   10 – 30% calories as fat.

Carbohydrate   At least 100 grams per day.

Fluid   At least one liter of water daily.

• Exercise component ought to be a meaningful portion of the wellness program and be both didactic and experiential.

• Participant is appropriately screened for exercise using a screening questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.

• Participants work towards 30-60 minutes of exercise 5-7 days per week.

• No appetite suppressant drugs.

• Maintenance plan offered for continued support.

• Weight control programs should be conducted by a registered dietitian or by degreed health experts with training in nutrition with consultation by a registered dietitian.

• Trained lay leaders may assist when supervised by nutrition expert.

Note – There is an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

Program is required to provide appropriate interpretation of cholesterol screening results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national guidelines –

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 – 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows –    

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, when history of coronary heart disease or when two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.

200 - 239 mg/dl    If history of CHD or when two or more other risk factors are detected, refer to medical care or risk reduction service within two months; when no announced history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.

> 240mg/dl    Refer to medical care within two months.

HDL   

> 35 mg/dl   When fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Give the following –    

• The relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include –  high blood pressure 140/90 or higher or on hypertension medication; current cigarette use of tobacco; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.

   o Negative risk factor –  high HDL 60 mg/dl or greater (subtract one risk factor).

   o Risk factors like family history, smoking, high fat or other unhealthful diet, andphysical inactivity lead to the development of cardiovascular disease (CVD).

• Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.    

• Wide range of treatment choices, including diet (e.g., importance of controlling fat intake less than 30 percent of sum calories from fat, less 10 percent saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.    

• Importance of following prescribed treatment and expert advice.