Promoting health among vulnerable workers: Disentangling context and implementation

Thesis (Ph.D.)--University of Washington, 2019Despite a wealth of knowledge of what works in workplace health promotion, successful implementation of evidence-based interventions is often challenging and unsuccessful. The complexity of many health promotion programs necessitates an improved understanding of implementation processes and contextual factors that can influence success. Workplace Health Promotion Programs (WHPP) can be one effective health promotion approach to addressing chronic disease. However, most studies of WHPP focus on large worksites (750 employees) and WHPP effectiveness varies across worksites of all sizes. Small businesses are more likely to report that at least half of their employees are low-wage workers. This dissertation utilized longitudinal, multi-level, and qualitative data to provide a robust examination of the role contexts and implementation processes play in individual, organizational, and local health department-level WHPP outcomes for small businesses in low-wage industries. Aim 1 developed an index of implementation of workplace wellness committees (WCs) and tested this index’s association with the implementation of evidence-based practices (EBP) among small worksites in low-wage industries over a two-year period. Aim 2 tested whether employee race/ethnicity moderates the relationship between WHPPs and employees’ perceived employer support for health. Aim 3 examined local health department (LHD) contexts, capacity for, and interest in partnering with employers on workplace health promotion programs (WHPPs) for chronic disease prevention. The generalizable knowledge produced by this research can contribute to the identification of WHPP implementation strategies that are adaptable to differing contexts, or conversely, contexts that are amenable to WHPP intervention approaches