The efficacy of a workplace wellness program to promote healthy lifestyles in hemodialysis center staff

Increasing habitual physical activity and reducing dietary sodium intake are two lifestyle habits that are targeted in both hemodialysis patients and the general population. Hemodialysis patients have greatly reduced physical activity levels compared to the general population, and are at a greater risk of muscle wasting. They also have excessive dietary sodium intake, which increases thirst and contributes to chronic volume overload, hypertension, and cardiovascular mortality. Similar to hemodialysis patients, the general population would also benefit from increasing physical activity levels and reducing dietary sodium intake. Directly targeting the hemodialysis patients with health promotion strategies often results in poor adherence and outcomes. Targeting the patient-provider interaction may provide a better platform for behavior translation to the hemodialysis patients. Therefore, the purpose of this dissertation was to improve the understanding of the impacts of a standardized workplace wellness program on the staff of an outpatient hemodialysis clinic and the patients that they serve. Previous work suggests that workplace wellness programs have a positive impact on increasing physical activity behavior and improving dietary patterns. However, these findings were not in the unique setting of an outpatient hemodialysis center and did not factor in the impact of a standardized program on the patients served by those who participate. In study 1, we demonstrated that those who participated in the Working on Wellness (WOW) program achieved significant improvements in body weight, body composition, systolic and diastolic blood pressure, and reduced their perceived barriers to engaging in physical activity and in making healthy dietary choices. In study 2, we confirmed that hemodialysis patients want and need information about exercise and dietary habits from the staff of hemodialysis center and that WOW was a meaningful vehicle for clinic staff to increase their knowledge and to build skills in health promotion as it relates to physical activity and dietary sodium reduction. In study 3, we were able to validate and demonstrate the fidelity of the WOW program as a standardized program delivered by students who were; recruited, trained, and supported in the delivery of the program. In study 4, we conducted interviews with the WOW wellness coaches to evaluate the public health impact and sustainability of the program using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Overall, the studies performed as part of this dissertation show that a standardized workplace wellness program, specifically the WOW program; is effective and reproducible with a high level of fidelity. Moreover, it seems that the WOW program has the potential to be transformative to hemodialysis center staff, patients and the trained interventionists