Posts from — August 2010

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

The four basic kinds of programs include –

• Classes

• Minigroups

• Guided self help

• Individual counseling

Classes

Courses (8 or more) may 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 worksite.

Many workers are under time constraints with after work commitments and although they might be interested they simply cannot participate because of their schedules.

Staff Members might  be very eager to start a program but because of lack of participants to meet class quotas, the program is canceled.

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

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

Minigroups

When there is not enough interest to create a class, those who are interested in a given health topic could 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 employees do not 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 person change and improve their health status is counseling (or coaching) on a one-on-one basis.

In published studies, wellness programs which incorporated individual counseling as part of the 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 ought to be trained in screening techniques, for in certain situations, they may be required to both screen individuals and counsel them. They ought to know how to do the following –  

• Review worker health risks

• Contact staff members who have health risks.

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

• Be sure to help workers follow their treatment recommendations and make lifestyle and health behavior changes.

• Recruit workers into health betterment programs, such as weight loss and use of tobacco cessation.

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

• Conduct courses and minigroups when necessary.

• Be sure to work with wellness committee members to plan and conduct worksite-wide wellness activities.

Wellness counselors are health generalists; they must’ve basic knowledge about a wide range of health topics and health risks.

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

They should’ve a good overview of nutrition, exercise physiology, pathophysiology of illness, pharmacology, psychology, and behavior change 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 should provide the following –

• Identifying sources of stress

• Relationship of stress to health

• How the individual experiences stress, personal, family, work

• Solutions for coping and managing stress

• Techniques for decreasing 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 professionals, 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 ought to include a nutritional needs assessment, education counseling, and referral as necessary.

Educational sessions and materials ought to 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 conditions.

• 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 improving consuming habits ought to be based on or consisitent with national recommendations like the Food Guide Pyramid.

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

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

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

Tobacco use 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 setting, weight control, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or scare tactics.

In programs that use aids such as the “patch” or medications such as “Zyban” appropriate consultation should be available on the usage of these aids.

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

Analysis of success is sometimes very dubious in smoking cessation programs. Measurement of success ought to include participation rate, including the number starting the program, the number completing the program, and the typical number per session.

Also included, number and percent who stopped smoking after the program, and the number and percent who hadn’t resumed smoking by the end of one year.

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

Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components. the 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 such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).

• Measurements of blood pressure (BP) 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 group fitness program should include –     

Warm up   5 – 10 minutes

Aerobic exercise   20 – 40 minutes

Cool down   5 – 10 minutes

Exercise instructors should have 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 licensed.   

Program offered is in line 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 has no 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 because of associated health conditions and overall heath risk.

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

• Informed consent, explanation of potential physical and psychological risk from weight loss and regain, likely long-term success of program, full cost of the 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 loss goal doesn’t exceed loss of 10 percent of body weight, 1-2 pounds per week.

• Explanation of unsafe weight loss methods.

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

• 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 percent of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation could be used to achieve RDAs, notwithstanding should not greatly exceed RDAs.    

• Nutrition education encouraging permanent healthful eating 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 significant portion of the 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 must 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 professional.

Note –  There’s 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, if history of coronary heart illness or if two or more CHD risk factors are detected refers to risk reduction program or health specialists, 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   If fewer than 2 risk factors and borderline sum cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following –    

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

   o Risk factors include –  high blood pressure (BP) 140/90 or higher or on hypertension medication; current cigarette smoking; 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 such as family history, smoking, high fat or other unhealthy diet, andlack of exercise lead to the development of cardiovascular illness (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 before diagnosis.    

• Wide range of treatment options, including diet (e.g., importance of controlling fat intake less than 30% of total calories from fat, less 10% 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 professional advice.    

Appropriate medical or allied health expert trained in measurement of blood pressure, referral protocols, and delivering educational messages to participant conducting blood pressure programs. These programs are required to follow national guidelines.

National guidelines for blood pressure protocols –  

• Calibration of blood pressure (BP) measuring equipment should be done at least yearly.

• Two or more measurements of participant’s blood pressure (BP) should be taken.

• Referral of participants with high blood pressure (BP) readings to personal physician for further examination.   

Systolic / Diastolic Follow-Up –     

• Normal –    <130 / <85   

   Action –  Recheck in 2 years

• High Normal –    130-139 / 85-90   

   Action –  Recheck in 1 year

Hypertension –     

• Stage 1 (Mild) –    140-159 / 90-99    

   Action –  Confirm within 2 Months.

• Stage 2 (Moderate) –    160-179 / 100-109    

   Action –  Refer to source of care within 1 month.

• Stage 3 (Severe) –    180-209 / 110-119    

   Action –  Refer to source of care within 1 week.

• Stage 4 (Very Severe) –    >210 / >120    

   Action –  Refer to source of care immediately.

Appropriate educational messages –     

• Normal –    <130 systolic and <85 diastolic   

   Action -  No referral. If on treatment, then inform participant that blood pressure (BP) is under good control today and should continue seeing and following treatment program.

• High Normal -    130-139 systolic and/or 85-89 diastolic   

   Action -  Recommend that participant have blood pressure rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to lower blood pressure is to bring weight into normal range and to exercise.

• High -    >140 systolic and/or >90 diastolic   

   Action –  Refer to doctor for further evaluation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. When already on treatment, advise participant of readings and need to get blood pressure (BP) to a goal of 140/90 or less.

• Isolated Systolic Hypertension –    140-159 systolic and < 90 diastolic in a participant 65 years of age or older.   

   Action -  Advise participant to inform doctor of readings at next visit and consider advice regarding weight loss and exercise if appropriate.

• Urgent -    180-209 systolic and/or 110-119 diastolic   

   Action -  Recommend obtaining medical investigation within 1 week.

• Emergency -    >210 systolic and/or >120 diastolic   

   Action –  Obtain immediate medical attention.

Provides the following –     

• Written results, referral instructions, and an explanation of blood pressure (BP) levels given to each participant with individualized counseling, including advice about the interval of time advised when the participant must be checked again.    

• Utilizes the recommendations in the Fifth Report of the Joint National Committee on Detection, Analysis and Treatment of High Blood Pressure, March 1994.    

• Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically valid information.    

• Relationship of high blood pressure (BP) and other risk factors, like family history, use of tobacco, high fat and unhealthful diet, lack of exercise, in the development of cardiovascular illness, including stroke, kidney illness, heart attack, and other illnesses.

• Definition and causes of high blood pressure.

• Importance of following prescribed treatment.

Health risk screening programs should be carried out on a one-on-one basis by trained health care experts. Health risk measures ought to include the following –

• Blood pressure (BP) measurements – at least two blood pressure (BP) measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.    

• Blood pressure treatment status – ascertain whether the participant is under a doctor’s care, on any medication, on a prescribed diet, or any other kind of treatment for hypertension.    

• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the patron, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.    

• Cholesterol treatment status – ascertain whether the patron is under a doctor’s care, on any medication, on a prescribed diet, or any other kind of treatment for high cholesterol.    

• Obesity – utilize an accepted method for estimating obesity. for example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index (BMI).    

   o Identify individuals  20 percent or more above their ideal weight.

• Tobacco use status – assess whether the participant currently smokes cigarettes, whether the client has quit or never smoked, and the number of cigarettes smoked/day.    

• Exercise habits – screening questions might  be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.    

• Diabetes – whether the client has diabetes, and whether or not it is currently under control. A blood glucose may  be also done via finger stick and desk top analyzer. A few manufactures make available cassettes which include cholesterol and glucose measurements.

• Cerebrovascular illness or occlusive PVD – ascertain when the customer has had a stroke or other kind of blood vessel illness.

• Family history of cardiovascular disease – ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart disease before age 55.

• Coronary heart illness – ascertain if the patron has had a heart attack or other kind of coronary heart illness.

• Stress – participant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions investigating  levels of stress are available from the Staff Member Health Program.

• Participant release form (see forms) – A release form is required in which the participant allows the program to draw blood for testing to send information to the participant’s medical care provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.

• Participant interest survey – if an assessment of interest hasn’t been accumulated previously, the screening activity must assess levels of interest in programs such as –  weight control, smoking cessation, fitness or exercise, stress management, nutrition, self-care, cholesterol control.

• Health education messages – the screener must review with the participant his/her identified health risks and what they mean to the participant’s overall health, and give the participant a written record of the blood pressure, sum cholesterol, and any other physiological measures taken.

• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized guidelines for such referral.

Demographic information ought to include location of the screening, worksite, customer’s name, address, social security number, home and work phone numbers, sex, race, birthdate, relevant job information (e.g., hourly or salaried), department number, and work shift.

Program directors or providers should have a background in wellness programming and a expert health-related degree or certification.    

They should have specialistise in content areas, planning, promotion, administration, investigation, and ability to grow a program and tailor the program to the workplace.   

Program providers should have a quality assurance program for analyzing  the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.   

An overall policy statement should be available from directors and program vendors addressing the following issues –  

• assurance of confidentiality of health data,
• referral to health and medical care for at-risk participants,
• follow-up with referred participants and those at-risk,
• program analysis on process and outcomes,
• organization of the worksite for promotion of wellness and changes in corporate culture.

A clear contract or letter of agreement for services ought to be provided.