Survey-based Evaluation of a Fish Consumption Information Dissemination Campaign Within an Integrated Health System: Learnings From ChooseYourFish.

INTRODUCTION/OBJECTIVES: Safe fish consumption is important for people who are or could become pregnant. A health system in Minnesota partnered with the Minnesota Department of Health to develop and disseminate messages to promote safe fish consumption for this population via the ChooseYourFish initiative. The ChooseYourFish message was delivered through 5 channels: the Healthy Pregnancy Program (HPP) with phone-based coaching, a clinic brochure, in the clinic after visit summary (AVS), direct mailing of the brochure with a letter, and in images on clinic waiting room monitors. METHODS: We designed a pragmatic evaluation to understand the likelihood that each channel would result in awareness of the message and increase a recipient's intent to act on the information. We surveyed 1050 women aged 18 to 40 in March-May 2020. Results are reported with descriptive statistics. RESULTS: The survey was completed by 524 respondents (51%). Respondents receiving the ChooseYourFish message through any channel except clinic monitors reported a higher awareness of recommendations about eating fish (42%-56%) than respondents in the no-message comparison group (21%). The after visit summary and Healthy Pregnancy Program channels had more confidence in following recommendations (50%-54%) and showed more intention to eat fish (61%-62%) compared to lower-intensity channels (24%-31% and 19%-32%, respectively). CONCLUSIONS: Messages delivered by an often-trusted source (eg, healthcare provider) were more likely to increase confidence and intent. Despite the trend toward online health information, physical brochures still have large reach. Repetition of exposure may be important. Because all communication channels have advantages and drawbacks, using multiple delivery channels is appropriate in communication campaigns.

Behaviors, Beliefs, and Recommendations to Optimize Promotion of Safe Fish Consumption Before and During Pregnancy: A Physician Survey.

INTRODUCTION: Eating fish before and during pregnancy is important but care must be taken to choose fish which maximize developmental outcomes. Physicians, a trusted health information source, could provide this nuanced communication. This cross-sectional survey of a representative sample of 400 family medicine and obstetrics and gynecology (OB-GYN) physicians in Minnesota was designed to understand physician behaviors and beliefs about safe fish consumption, describe barriers to physician-patient conversations about safe fish consumption generally and as part of prenatal care and to identify resources to help facilitate conversations on this topic. METHODS: Data was collected January to April 2020. Two hundred nineteen surveys were completed (55% response rate) with 194 reporting seeing patients at least 1 day a week. Descriptive survey results from all were summarized and analyzed overall and by physician specialty. Responses to 3 open-ended questions were thematically coded to enrich the quantitative results. RESULTS: While 62% of these reported discussing nutrition topics, only about one-third reported discussing with patients the benefits and about one-quarter the risks of eating fish. Despite the relative infrequency of fish discussions, almost all (>90%) respondents agreed that it is important to discuss fish consumption with people who are or may become pregnant. The largest reported barrier to these conversations was time (82%), and the most endorsed resource to overcome identified barriers was talking points (72%). CONCLUSIONS: Because physicians report limited time, resources that facilitate fish consumption should be succinct while serving to both nudge the message and direct clinicians and their patients to robust information.

Promoting Fish Consumption Messages: Perspectives of Hmong Women of Childbearing Age.

Objectives: Through focus groups, we aimed to understand ways to promote safe and healthy fish consumption among Hmong women in Minnesota. Methods: English-speaking Hmong women aged 18-40 were eligible to participate in 90-minute focus groups. Through our questions, we sought to gain understanding of the women's health-seeking behaviors and to obtain feedback on current messaging. We recorded the focus groups and transcribed and double-coded the data using sequential directed content analysis. Results: Thirteen Hmong women participated across 3 focus groups. The final coding tree included 6 primary themes related to health messaging, with adequate inter-coder reliability for each. Women identified the Internet as the primary source of health information with website preferences driven in-part by preferences of elders. Discrepancies between health beliefs of elder and younger generations were noted, with some evidence that personal fish consumption preferences outweighed cultural norms. Messages clearly targeting the Hmong population were preferred, with discrepancy in risk-versus benefit-framed messages. Conclusions: Findings highlight the need for culturally informed messages that are clear and carefully tailored. Our findings will inform future development of safe and healthy fish consumption messaging to better support the Hmong community in Minnesota.

Perceived Workplace Health and Safety Climates: Associations With Worker Outcomes and Productivity.

INTRODUCTION: This study investigates the associations between perceived workplace health and safety climates and a variety of worker and employer outcomes. METHODS: Self-reported data were collected from an employee health assessment offered at 3 companies (n=959) in 2014. Independent variables included 2 climate variables: perceived safety climate and perceived health and well-being climate. Logistic regression models, performed in 2016-2017, explored the associations between the 2 climate variables and 3 sets of outcomes: worker outcomes, worker health behaviors, and employer outcomes. RESULTS: Perceived workplace safety climate was positively associated with physical activity and optimal sleep. Stronger perceived workplace health and well-being and safety climates were related to less depression, higher job and life satisfaction, less back pain, and higher general health. Stronger perceived climates of workplace safety and health and well-being were associated with less productivity loss. CONCLUSIONS: Conditions of work, such as perceived climate, are associated with improved worker behaviors (physical activity and sleep), worker outcomes (depression, job and life satisfaction, back pain, and general health), and employer (productivity) outcomes.

Responses to a Social Media Campaign Promoting Safe Fish Consumption Among Women.

We used a framework to systematically evaluate which Facebook advertisements promoting safe fish consumption increased traffic to our website. Keeping images and headlines constant, we tested 11 message types in 5 categories between 2 audiences over a 24-hour weekday period. We identified clear preferences in 9 of 10 comparisons and evidence to suggest that more women prefer presentation of question format compared with narratives, marketing compared with patient education copy, and uncertain compared with certain copy. Our test of messages on a social media platform is a quick and inexpensive way to select the most engaging public health messages for broad dissemination.

Concordance Between Life Satisfaction and Six Elements of Well-Being Among Respondents to a Health Assessment Survey, HealthPartners Employees, Minnesota, 2011.

INTRODUCTION: We assessed and tracked perceptions of well-being among employees of member companies of HealthPartners, a nonprofit health care provider and health insurance company in Bloomington, Minnesota. The objective of our study was to determine the concordance between self-reported life satisfaction and a construct of subjective well-being that comprised 6 elements of well-being: emotional and mental health, social and interpersonal status, financial status, career status, physical health, and community support. METHODS: We analyzed responses of 23,268 employees (of 37,982 invitees) from 6 HealthPartners companies who completed a health assessment in 2011. We compared respondents' answers to the question, "How satisfied are you with your life?" with their indicators of well-being where "high life satisfaction" was defined as a rating of 9 or 10 on a scale of 0 (lowest) to 10 (highest) and "high level of well-being" was defined as a rating of 9 or 10 for 5 or 6 of the 6 indicators of well-being. RESULT: We found a correlation between self-reported life satisfaction and the number of well-being elements scored as high (9 or 10) (r = 0.62, P < .001); 73.6% of the respondents were concordant (high on both or high on neither). Although 82.9% of respondents with high overall well-being indicated high life satisfaction, only 34.7% of those indicating high life satisfaction reported high overall well-being. CONCLUSION: The correlation between self-reported life satisfaction and our well-being measure was strong, and members who met our criterion of high overall well-being were likely to report high life satisfaction. However, many respondents who reported high life satisfaction did not meet our criterion for high overall well-being, which suggests that either they adapted to negative life circumstances or that our well-being measure did not identify their sources of life satisfaction.

Congruence of Organizational Self-Score and Audit-Based Organizational Assessments of Workplace Health Capabilities: An Analysis of the HealthLead Workplace Accreditation.

OBJECTIVE: The aim of this study was to provide descriptive characteristics of companies accredited as part of the HealthLead Workplace Accreditation and to assess congruence between data reported via online organizational self-assessment and third-party onsite audit. METHODS: Synthesized organizational level data collected through the HealthLead accreditation process (N = 22). Online self-assessment and onsite third-party audit data were compared using paired t-tests. RESULTS: Statistical tests revealed significantly higher onsite audit scores than organizational self-assessment scores. Descriptive analyses demonstrated that Outcomes Reporting was the lowest scoring area among all companies. Companies also varied widely in levels of Leadership Support for wellness. CONCLUSIONS: Gaps observed between organizational self-assessment and onsite audit scores were relatively stable across the sample, indicating that observed differences may be process related. Organizations awarded accreditation show a wide variation in Leadership Support, and Outcomes Reporting appears to be low across the sample.

The association between optimal lifestyle-related health behaviors and employee productivity.

OBJECTIVE: To investigate the association between lifestyle-related health behaviors including sleep and the cluster of physical activity, no tobacco use, fruits and vegetables intake, and alcohol consumption termed the "Optimal Lifestyle Metric" (OLM), and employee productivity. METHODS: Data were obtained from employee health assessments (N = 18,079). Regression techniques were used to study the association between OLM and employee productivity, sleep and employee productivity, and the interaction of both OLM and sleep on employee productivity. RESULTS: Employees who slept less or more than 7 or 8 hours per night experienced significantly more productivity loss. Employees who adhered to all four OLM behaviors simultaneously experienced less productivity loss compared with those who did not. CONCLUSIONS: Adequate sleep and adherence to the OLM cluster of behaviors are associated with significantly less productivity loss.

The effect of price reduction on salad bar purchases at a corporate cafeteria.

The objective of this study was to determine the effect of a price reduction on salad bar purchases in a corporate cafeteria. We reduced the price of salad bar purchases by 50% during March 2012 and analyzed sales data by month for February through June 2012. We also conducted an anonymous survey. Salad bar sales by weight more than tripled during the price reduction and returned to baseline afterward. Survey respondents reported that the high price of salad relative to other choices is a barrier to purchases. Policies that make the price of salads equal to other choices in cafeterias may significantly increase healthful food consumption.

Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011.

BACKGROUND: Prolonged sitting time is a health risk. We describe a practice-based study designed to reduce prolonged sitting time and improve selected health factors among workers with sedentary jobs. COMMUNITY CONTEXT: We conducted our study during March-May 2011 in Minneapolis, Minnesota, among employees with sedentary jobs. METHODS: Project implementation occurred over 7 weeks with a baseline period of 1 week (period 1), an intervention period of 4 weeks (period 2), and a postintervention period of 2 weeks (period 3). The intervention group (n = 24) received a sit-stand device during period 2 designed to fit their workstation, and the comparison group (n = 10) did not. We used experience-sampling methods to monitor sitting behavior at work during the 7 weeks of the project. We estimated change scores in sitting time, health risk factors, mood states, and several office behaviors on the basis of survey responses. OUTCOME: The Take-a-Stand Project reduced time spent sitting by 224% (66 minutes per day), reduced upper back and neck pain by 54%, and improved mood states. Furthermore, the removal of the device largely negated all observed improvements within 2 weeks. INTERPRETATION: Our findings suggest that using a sit-stand device at work can reduce sitting time and generate other health benefits for workers.

Adherence to optimal lifestyle behaviors is related to emotional health indicators among employees.

Simultaneous adherence to abstinence from smoking, adequate physical activity, eating 5 servings of fruits and vegetables each day, and consuming limited or no amount of alcohol has been associated with a variety of health outcomes, but not emotional health. The purpose of this investigation was to study the association between optimal lifestyle behaviors and self-reported emotional health indicators among employed adults. Emotional health indicators studied were feeling depressed, stress risk, and the impact of emotional health on daily life among employees (N = 34,603). Binary logistic regression models were used to predict likelihood of feeling depressed and risk of stress based on degree of adherence to optimal lifestyle. Multinomial logistic regression models were used to assess the association between adherence to optimal lifestyle and likelihood of emotional quality of life among employees. Analyses were adjusted for age, sex, socioeconomic status (using the area deprivation index), sleep, self-perceived health status, self-efficacy, and chronic conditions including depression. All data were self-reported except for the area deprivation index. Adherence to any 3 or 4 components of the optimal lifestyle was associated with all 3 emotional health issues studied: Lower odds of feeling depressed, reporting stress risk, and emotional health affecting daily life. Adherence to any 2 components of the optimal lifestyle metric was associated with lower odds of feeling depressed and emotional health affecting daily life. All 4 individual lifestyle behaviors had significant associations with at least 2 of the 3 emotional health outcomes studied. Adherence to optimal lifestyle is associated with significantly more positive emotional health states as measured by feeling depressed, risk for high stress, and impact of emotional health on daily life. While causality cannot be inferred, the strength of the associations warrants trials to determine the extent to which adopting positive lifestyles can result in improved mental health.