Posts tagged with "research study"

Reducing Stress With Online Mindfulness Program

Reducing Stress with Online Mindfulness Programs – At a Fraction of the Cost of Traditional Programs

Thomas J. Morledge, MD, Didier Allexandre, PhD, Emily Fox, MBA, MSSA, LSW, et al. “Feasibility of an Online Mindfulness Program for Stress Management – A Randomized, Controlled Trial.” JOEM. Volume 58: Number 3, March 2016.

ABSTRACT:

  • Purpose: This study aims to determine feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial.
  • Methods: Participants were randomly allocated to ISM, ISM plus online message board (ISM+), or control groups. Perceived stress, mindfulness, self-transcendence, psychological well-being, vitality, and quality of life were measured at baseline, week 8, and week 12 using standard validated questionnaires.
  • Results: ISM and ISM+ groups demonstrated statistically significant improvements compared with control on all measures except vitality and physical health.
  • Conclusions: The ISM program effectively and sustainably reduced measures of stress. The magnitude of improvement is comparable to traditional mindfulness programs, although fewer participants were engaged. This feasibility study provides strong support for online stress management programs, which increase access at a fraction of the cost of traditional programs.

Chronic stress affects many Americans – approximately 35% of North Americans are affected by severe psychological stress.1 Stress is a major public health issue, and calls have been made for better access to stress management programs to prevent and manage chronic diseases. Stress can be reduced by “cultivating mindfulness, a state of consciousness that focuses on individual’s attention and awareness on the present moment and developing a nonjudgmental, conscious awareness of the moment-to-moment experience of one’s environment, thoughts, feelings, and actions.”2, 3, 4

However, stress management programs may be expensive or have limited access. The purpose of this study was to determine the feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial.

The 12-week, randomized, parallel, controlled trial was administered entirely online at the program Website. Participants provided their name and e-mail address and were automatically randomized (using a computer-generated list with a block size of three) into one of three groups: ISM, ISM plus online message board (ISM+), or control. All participants were asked to complete online questionnaires at 0 (baseline), 8, and 12 weeks and to fill out weekly activity logs for weeks 1-8. ISM+ group was asked to participate in an online message board hosted by iVillage.com.

Since high dropout rates are expected for online studies 5, 6, 7, the study enrolled approximately 700 people to obtain the target sample size.

  • 1,204 people received the study description, and 684 (57%) people enrolled in the study between September 2010 and August 2011.
  • The study ended in November 2011. Of those enrolled, 133 (19%) were lost prior to providing baseline data.
  • Of the remaining (81%) who enrolled and completed the baseline questionnaire (n=551), more than half (57%) also completed one or both follow-up questionnaires (n=312).
  • The 8- and 12-week completion rates differed across treatment groups: 41 and 33% for ISM, 44 and 38% for ISM+, and 67 and 65% for the control group at weeks 8 and 12, respectively.

This study demonstrates that Internet-based stress management program (ISM) participants experienced significant reductions in stress. The study found that a person who practices meditation techniques an average of 5 times/week will experience a 6.12 decrease (1.53 times 4) in Perceived Stress Scale (PSS) score versus practicing once per week.

Feedback about the ISM program and message board was provided by 78 ISM and 68 ISM+ participants who practiced the relaxation exercise at least once. Of those respondents, 45% found the overall program to be very or extremely helpful, 35% somewhat helpful and 19% little or not at all helpful.

Approximately one third (35%) of all ISM and ISM+ enrollees showed online program activity for 6–8 weeks, and 42% completed the questionnaires at 8 weeks. Program and study retention may be lower than most small-sample size studies of Web-based programs for psychological disorders, which range from 17 to 98% with an average of about 70%6 ; the rates are comparable to larger effectiveness studies5,7 and may be more reflective of real-world settings.

When asked about how helpful and beneficial specific components were, 53% found the meditation techniques, 43% the weekly audio lesson and 48% the articles to be very or extremely helpful.

This study demonstrated an 8-week ISM program could feasibly and effectively reduce stress. Benefits were sustained through week 12 for a well-educated, mostly female and computer savvy self-selected population. Although the participant completion rate was low, the magnitude of improvement was significant for those who completed the online program. This study provides support for online stress management programs that are publicly accessible and not cost prohibitive.

About USPM and Cleveland Clinic

U.S. Preventive Medicine (USPM) partnered with the Cleveland Clinic Wellness Institute in an innovative strategic partnership to integrate their next generation information technology platform and population health management services with their best-of-class wellness programs and e-Coaching services. Cleveland Clinic Wellness focuses on changing behavior in the “Big 4” causes of chronic diseases (food choices, tobacco, physical inactivity, and stress) through programs such as Healthy Performance with Stress Free Now, Cleveland Clinic Wellness e-Coaching, and interactive online programs Stress Free Now, Go! Foods, and Go! to Sleep. Cleveland Clinic’s Healthy Performance with Stress Free Now and CC e-Coaching have driven remarkable results across a wide variety of industries. Cleveland Clinic has led numerous successful community and institutional campaigns committed to improving the lives of children and adults. Also, in 2005 they were the first hospital to become a smoke-free workplace.


References

  1. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case–control study. Lancet. 2004;364(9438):937-952. doi:10.1016/S01406736(04)17018-9.
  2. Baer RA.Mindfulness training as a clinical intervention: A conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125-143.
  3. Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T. Cultivating mindfulness: Effects on well-being. J Clin Psychol. 2008;64(7):840-862.
  4. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. J Altern Complement Med. 2009;15(5):593-600.
  5. Meyer B, Berger T, Caspar F, Beevers CG, Andersson G,Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial. J Med Internet Res. 2009;11(2):e15.
  6. Melville KM, Casey LM, Kavanagh DJ. Dropout from Internet based treatment for psychological disorders. Br J Clin Psychol. 2010;49(Pt 4):455-471.
  7. Verheijden MW, Jans MP, Hildebrandt VH, Hopman-Rock M. Rates and determinants of repeated participation in a Web-based behavior change program for healthy body weight and healthy lifestyle. J Med Internet Res. 2007;9(1):e1.
Healthy Workplace Healhty Performance

Can a Healthier and Safer Workforce Promote a Healthier Bottom Line for Employers?

Fabius, R; Loeppke, R; Hohn, T: et.al. “Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate Health Achievement Award Applicants”. JOEM. Volume 58: Number 1. Jan, 2016.

ABSTRACT:

  • Objective: To test the hypothesis that comprehensive health and safety efforts, judged separately on their merits by the CHAA, contribute to better performance in the marketplace.
  • Methods: Stock market performance of CHAA winners tracked under 6 different scenarios using simulation and past market performance.
  • Results: The results demonstrate that a portfolio of companies recognized for excellence in workforce health or safety, or both, outperform in the marketplace. When we deconstructed the CHAA process and established portfolios among the applicants and award winners that achieved threshold scores in either health or safety as well as threshold scores in both, all significantly outperformed the S&P 500 standard index companies.
  • Conclusions: This study adds to the growing evidence that a healthy and safe workforce correlates with a company’s performance and its ability to provide “healthy” returns to shareholders.

A growing body of evidence supports the notion that focusing on the health and safety of a workforce is good business. Engaging in a comprehensive effort to reduce the health risks of a workforce and mitigate the complications of chronic illness within these populations, can produce remarkable impacts on health care costs, productivity and performance.

To more objectively test this hypothesis, the stock market performance of the prior American College of Occupational and Environmental Medicine (ACOEM) Corporate Health Achievement Award (CHAA) winners were tracked under 4 different scenarios. Using simulation and past market performance, a theoretical initial $10,000 investment in publicly traded award winners was tracked from 1999 to 2012.  This portfolio of publicly traded award winning companies clearly outperformed the market. Though correlation is not the same as causation, the results consistently and significantly suggest that companies focusing on the health and safety of their workforce are yielding greater value for their investors as well. More research needs to be done to better understand the value of building these “cultures of health” in the workplace. Perhaps such efforts as this simply identify “smart” companies that outperform. But the evidence appears to be building that healthy workforces provide a competitive advantage in ways that benefit their investors.

The literature is replete with examples demonstrating that the health of employees impacts their performance and productivity. Additionally, for the majority of employers who pay for the cost of health care provided to their employees there is a direct impact on the bottom line.

Consider these statistics:

  • Over 22% of working age adults surveyed reported health-related work impairment from chronic illness in the previous 30 days. Those with impairment average 6.7 lost days. This is equivalent to $2.5 billion impaired days per year.(1)
  • In a 2003 study, it was found that illness and disability reduces total work hours by approximately 8.6%, with nearly 8.7 million Americans unable to work. The loss to the U.S. economy represented about $468 billion.(2) In 2006, over $2 trillion was spent on health care with three-fourths of that amount focused on treating chronic conditions.(3)
  • In a multi-employer study by ACOEM, IBI and Dr. Kessler of Harvard Medical School, Loeppke, et.al., reported that for every dollar of medical and pharmaceutical costs spent an employer lost an additional $2.30 of health-related productivity costs. Health-related presenteeism was shown to have a larger impact on lost productivity than absenteeism, with executives and managers suffering higher losses. Co-morbidities demonstrated the largest effects on productivity loss.(4) 

These facts led to a hypothesis: Companies that envelope their employees and dependents in an environment that reinforces conscious and unconscious lifestyle choices as well as more effective accessing of healthcare, i.e. surround them with a “culture of health,” should be more productive and that productivity should be reflected in the price of their stock.

To test the hypothesis, we turned to the American College of Occupational & Environmental Medicine’s corporate health awards (http://www.chaa.org/). The Corporate Health Achievement Award (CHAA), established in 1997, recognizes organizations with exemplary health, safety and environmental programs. Participating organizations submit a comprehensive application about their program and undergo a rigorous review by an expert panel to assess four key categories:

  1. Leadership & Management
  2. Healthy Workers
  3. Healthy Environment
  4. Healthy Organization

Awards have been given to organizations in manufacturing and service sectors, including city health departments, federal agencies and healthcare systems. Most years since inception of the award there has been at least one recipient. Most recipients have been publicly traded companies.

Since these award-winning companies are recognized for their exemplary efforts in creating a healthy workforce and since a healthy workforce generates less health care costs and improved productivity, we tested the thesis that a portfolio of these companies would outperform the marketplace.

Our results strongly support the notion that focusing on the health and safety of a workforce is good business. Engaging in a comprehensive effort to reduce the health risks of a workforce and mitigate the complications of chronic illness within these populations, can produce remarkable impacts on health care costs, productivity and performance.

Dee Edington, Ph.D., has demonstrated that companies who do not pay any attention to elevating the health status of their workforce will see their employees developing increasing health risks and health care costs.(12) His results found that non-managed workforces acquire increased health risks and conditions resulting in increased costs over time. In fact, his research found that within non-managed populations the low risk cohort diminishes by roughly 5% while the moderate and high risk segments increase by roughly 8% and 11% respectively over a three-year period. He also demonstrated that it is possible to markedly reduce this trend through the execution of risk reduction programs at the workplace.(13)

Preventive services can stem the progression of health risks, chronic conditions and medical costs. RAND Corporation estimates one fifth of all healthcare expenditures will be devoted to treating consequences of obesity by 2020. Lowering obesity rates to 1998 levels could lead to annual productivity gains of $254 billion as well as the avoidance of $60 billion in annual treatment expenditures.

Seven chronic conditions (cancer, heart disease, hypertension, mental disorders, diabetes, pulmonary conditions and stroke) are currently costing the U.S. economy alone more than $1 trillion per year. Assuming the current trend continues to 2023, it would lead to a 42% increase in cases of the seven chronic diseases for a total of 230.7 million cases of these diseases with $4.2 trillion in treatment costs and lost economic output.

Plausible estimates of potential gains in 2023 associated with reasonable improvements in prevention, detection and treatment of just those seven conditions include:

  • Preventing 40 million fewer cases of illness
  • Cutting annual treatment costs in the U.S. by $217 billion
  • Reducing annual health-related productivity losses by $905 billion
  • Yielding more than $1 trillion in labor supply and efficiency(14)

Employers can realize similar results by implementing the best efforts in prevention, early detection and evidence based treatment for their workforce and covered lives.

A critical Meta-Analysis of 22 research studies in the scientific literature published in Health Affairs in February 2010 showed that medical and pharmacy costs fall by about $3.27 and absenteeism costs fall by about $2.73 for every $1 invested in wellness.(15)  This results in a return on investment of six to one.

Recognizing the merits of a healthy workforce even before this paper, ACOEM provided significant guidance. The College has stated that the marketplace has markedly underestimated the full impact of poor health in the workplace and on the economy. Employers would benefit by having a better understanding of the diseases and conditions that impact their employees and covered lives so that they could implement programs to mitigate their consequences. There is a connection between the health and safety and the productivity of workforces. Health care costs should be viewed as an investment in their employees rather than an expense. Health improvement strategies have proven to produce excellent returns. Comprehensive programs focus on primary, secondary as well as tertiary prevention.(16)

The workplace offers unique advantages for the implementation of health improvement initiatives. Roughly one quarter of our population is employed. When including retirees and family members this reach includes the majority of Americans. The workplace environment and the corporate culture can reinforce healthy behaviors. Powerful communication and educational assets can be leveraged. Incentives, penalties and mandates can be built into compensation and health benefits. Tenured employee relationships can promote sustainability. And finally employers possess the capability to measure the impact of health improvements on performance, productivity and business results.

The logic behind investing in workplace health is straight forward.

  • A large proportion of illness is preventable by reducing health risks. (17)
  • Health risks can be improved through workplace health programs. (18)
  • Reductions of health risks can lead to reductions in health costs. (19)
  • Worksite health programs can produce a positive ROI and VOI. (20,21,22,23,24)

Moreover, research supports a corporate-wide impact. Towers Watson has demonstrated that employers with highly effective health and productivity programs:

  • Generate 20% more revenue per employee
  • Realize a 16.1% higher market value and
  • Deliver 57% higher shareholder returns(25)

A recently published paper by Loeppke et al(26) emphasized the importance of integrating health promotion and health protection. This paper suggests that the CHAA assessment process should be realigned to follow the format of the DJSI. The CHAA’s current categories of measurement would be converted to mirror the DJSI’s categories, which include economic, environmental, and social metrics. This would result in an Integrated Health and Safety Index (IH&S Index).

Imagine a future scenario in which employers of sufficient size would be required or encouraged to publicly report on the degree to which they have achieved a culture of integrated health and safety. Those that report high Integrated Health and Safety Index scores could potentially be rewarded in the marketplace with greater investment as well as premium cost-reductions for group health and/or workers’ compensation insurance.

This would provide a major incentive for more companies to focus on the health and safety of their workforces and markedly aid in addressing many of the factors that are driving the American health care crisis—including the rise of chronic disease. If enough companies were able to improve and sustain the health status of their workforces, it could impact millions of Americans, providing a national tipping point in our effort to improve health outcomes and lower costs. The data in this paper suggest that such an effort might also contribute to investment-oriented opportunities and company differentiation in the marketplace.

Integrating health promotion (wellness) and health protection (safety) strategies creates synergy among these efforts, enhancing the overall health and well-being of the workforce, empowering employees to perform at the height of their potential and improving the organization’s bottom line.


References:

  1. Kessler et al. the Effects of Chronic Medical Conditions on Work Loss and Work Cutback. JOEM. 2001; 43(3):218-225.
  2. Berger, M, et al. Investing in Healthy Human Capital. JOEM. 2003; 45(12):1213-1225)
  3. Goetzel R. Do Prevention or Treatment Services Save Money? The Wrong Debate. Health Affairs. 2009; 28(1):37-41.
  4. Loeppke, R., et al., “Health and Productivity as a Business Strategy: A Multi-Employer Study”, JOEM, 51:4, April, 2009. pp 411-428.
  5. Peterson K W, Yarborough CM III, Ferguson EB, Matthew SJ. ACOEM Award: The American College of Occupational and Environmental Medicine’s Corporate Health Achievement Award.J Occup & Environ Med. 1996;38(10):969-972.
  6. Baldrige Award Winning Quality, 17th edition, by Mark Graham Brown, CDC Press, 2008.
  7. Malcolm Baldrige National Quality Award. [website]
  8. C. Everett Koop Award [website]
  9. Yarborough, CM. Administrative Track: What Constitutes Excellence for the Corporate Health Achievement Award. J Occup & Environ Med. 1998;40(4):381.
  10. Scope of Occupational and Environmental Health Programs and Practice. J Occup Environ Med. 1992;34:
  11. NCQA. Health Evaluation Data Information Set (HEDIS) 3.0. Washington, DC. National Commission on Quality Assurance. 1996.
  12. Edington, AJHP, May-June 2001, Vol 15, No. 5, pp-341-349. Research Overview of Natural Flow
  13. ZERO TRENDS by Dee Edington, 2009, published by the Health Management Research Center – University of Michigan
  14. Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction” Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264.
  15. Devol, R et.al, 2007, An Unhealthy America: The Economic Burden of Chronic Disease. Charting a New Course to Save Lives and Increase Productivity and Economic Growth, Milken Institute
  16. Baicker, K., et.al., Workplace Wellness Programs Can Generate Savings., Health Affairs, Feb. 2010, Vol 29, No. 2. pp: 1-8
  17. ACOEM Guidance Statement, Healthy Workforce/Healthy Economy: The Role of Health, Productivity and Disability Management in Addressing the Nations’ Health Care Crisis, JOEM, 51:1, pp 114-119, January, 2009.
  18. Healthy People 2000, 2010; Amler & Dull, 1987; Breslow, 1993; McGinnis & Foege, 1993; Mokdad et al., 2004.
  19. Loeppke, et al., 2008; Wilson et al., 1996; Heaney & Goetzel, 1997; Pelletier, 1999.
  20. Edington et al., 2001; Goetzel et al., 1999
  21. Aldana SG. Financial impact of health promotion programs: A comprehensive review of the literature. Am J Health Promotion 2001;15:296-320.
  22. Loeppke R. “The Value of Health and the Power of Prevention”. Int J Workplace Health Manage. 2008; 1(2):95-108.
  23. Serxner, S., et.al., Do Employee Health Management (EHM) Programs Work? Am J Publ Health2009; 23(4):
  24.  Goetzel, R; Loeppke, R, et al. “Do Workplace Health Promotion (Wellness) Programs Work.” J Occup Environ Med. 2014; 56 (9):927-934, September, 2014.
  25. National Business Group on Health/Watson Wyatt “Staying at Work Report” 2007/2008 from Survey of 355 Large Employers
  26. Loeppke, R; Hohn, T; et.al. “Integrating Health and Safety in the Workplace: How Closely Aligning Health and Safety Strategies can Yield Measureable Benefits.” Journal of Occupational & Environmental  Medicine 2015: 57 (5): 585-597. May, 2015.

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