Increasing Implementation of Evidence-based Interventions at Low-wage Worksites

Cancer and other chronic diseases are leading killers and disablers in the United States, and
low-income Americans are at high risk for these diseases. Multiple evidence-based
interventions (EBIs) exist to improve chronic disease risk behaviors, such as cancer
screening, healthy eating, physical activity, and tobacco cessation, yet EBI reach to
community settings is poor. Among community settings for reaching low-income adults,
worksites stand out because most low-income adults are employed, but worksite implementation
of health-promoting EBIs is low. Half of American workers work in small or low-wage
worksites, where implementation of these EBIs and readiness to implement are especially low.
Even though decision-makers at these worksites are often motivated to promote worker health,
they usually have no dedicated wellness staff and face three major barriers in implementing
EBIs: 1) lack of awareness of the potential benefits of EBIs, 2) lack of knowledge to choose
EBIs, and 3) lack of financial and personnel resources to implement EBIs. Non-profit
organizations and others who would assist these worksites face their own barriers.
Organizational readiness to implement EBIs is not well understood, and few validated measures
are available, especially for worksites. Without reliable and valid measures of worksite
readiness, those who would assist them have difficulty: a) identifying worksites that are
ready, and b) helping decision-makers get ready to increase their odds of implementation
success. The proposed research will address both sets of barriers and contribute to
dissemination and implementation research by testing the efficacy of a worksite EBI
dissemination program, HealthLinks, developed in partnership with the American Cancer
Society, a non-profit organization operating nationwide. HealthLinks is based on Greenhalgh's
diffusion of innovations framework and Rogers' diffusion of innovations theory and addresses
small and low-wage worksites' barriers by providing free on-site information and
recommendations for EBIs and by providing free on-site programs and temporary staffing to
assist implementation. We will test HealthLinks via a 3-arm randomized controlled trial.
Worksites will receive either 1) HealthLinks, or 2) an enhanced version of HealthLinks that
addresses small worksites' lack of personnel by adding worker wellness committees, or will 3)
serve in a delayed control group that receives HealthLinks at study end. We will measure
worksites' EBI implementation at baseline, 12 months (at the end of the intervention period),
and 24 months (to assess maintenance one year after the intervention ends). This design will
test the effectiveness of both HealthLinks and of worker wellness committees. We will also
measure the effect of both on workers' health behaviors at baseline, 12 months, and 24
months. Finally, we will develop, pilot-test, and validate a measure of worksite readiness to
implement EBIs.

Inclusion Criteria (for worksites):

- 20-200 employees

- In one of the following industries: accommodation and food services; arts,
entertainment, and recreation; educational services, health care and social
assistance, other services excluding public administration, retail trade

- Located in King County, Washington State

Exclusion Criteria:

- Has a wellness committee

- Fewer than 20% of workers report to a physical worksite