Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research.

BACKGROUND: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. OBJECTIVE: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. METHODS: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. RESULTS: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). CONCLUSIONS: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons.

Content comparison of campus medical amnesty policies.

Objective: To describe common components of medical amnesty (MA) policies and examine how MA policies differ across institutions. Participants: 50 U.S. colleges and universities with current MA policies. Methods: A checklist was developed to compare and assess the campus MA policies of 50 institutions. Descriptive statistics, chi-square, and regression analyses were used to examine common policy components and differences across types of institutions. Results: 40% of policies did not include a purpose statement. 42% of policies had no mention about how to use the policy. 48% did not mention restrictions on amnesty. 32% did not mention follow-up actions. 24% of policies mentioned extending amnesty for additional person(s) present. There were no significant differences in policy components across school characteristics. Conclusions: Many policies lacked detail, highlighting the need for guidelines and best practices to develop MA policies. Future research could examine the effects of these policy components on help seeking intentions.

Evaluation of a Pilot Program to Prevent the Misuse of Prescribed Opioids Among Health Care Workers: Repeated Measures Survey Study.

BACKGROUND: Overprescription of opioids has led to increased misuse of opioids, resulting in higher rates of overdose. The workplace can play a vital role in an individual's intentions to misuse prescription opioids with injured workers being prescribed opioids, at a rate 3 times the national average. For example, health care workers are at risk for injuries, opioid dispensing, and diversion. Intervening within a context that may contribute to risks for opioid misuse while targeting individual psychosocial factors may be a useful complement to interventions at policy and prescribing levels. OBJECTIVE: This pilot study assessed the effects of a mobile-friendly opioid misuse intervention prototype tailored for health care workers using the preparation phase of a multiphase optimization strategy design. METHODS: A total of 33 health care practitioners participated in the pilot intervention, which included 10 brief web-based lessons aimed at impacting psychosocial measures that underlie opioid misuse. The lesson topics included: addiction beliefs, addiction control, Centers for Disease Control and Prevention guidelines and recommendations, beliefs about patient-provider relationships and communication, control in communicating with providers, beliefs about self-monitoring pain and side effects, control in self-monitoring pain and side effects, diversion and disposal beliefs, diversion and disposal control, and a conclusion lesson. Using a treatment-only design, pretest and posttest surveys were collected. A general linear repeated measures ANOVA was used to assess mean differences from pretest to posttest. Descriptive statistics were used to assess participant feedback about the intervention. RESULTS: After completing the intervention, participants showed significant mean changes with increases in knowledge of opioids (+0.459; P<.001), less favorable attitudes toward opioids (-1.081; P=.001), more positive beliefs about communication with providers (+0.205; P=.01), more positive beliefs about pain management control (+0.969; P<.001), and increased intentions to avoid opioid use (+0.212; P=.03). Of the 33 practitioners who completed the program, most felt positive about the information presented, and almost 70% (23/33) agreed or strongly agreed that other workers in the industry should complete a program like this. CONCLUSIONS: While attempts to address the opioid crisis have been made through public health policies and prescribing initiatives, opioid misuse continues to rise. Certain industries place workers at greater risk for injury and opioid dispensing, making interventions that target workers in these industries of particular importance. Results from this pilot study show positive impacts on knowledge, attitudes, and beliefs about communicating with providers and pain management control, as well as intentions to avoid opioid misuse. However, the dropout rate and small sample size are severe limitations, and the results lack generalizability. Results will be used to inform program revisions and future optimization trials, with the intention of providing insight for future intervention development and evaluation of mobile-friendly eHealth interventions for employees.

Effects of Workplace Variables on Workers Intentions to Misuse Prescription Opioids.

OBJECTIVE: Workers in industries with high rates of opioid dispensing as well as those with high rates of non-fatal work-related injuries are at greater risk for opioid misuse, which can lead to addiction, overdose, or death. METHODS: Using secondary cross-sectional data collected from 856 healthcare workers, this pilot study examines a conceptual model for workers' intentions to seek out prescription opioids and intentions to use opioids at higher doses over longer periods. RESULTS: Results showed significant protective effects of beliefs, injunctive and subjective norms, and behavioral control on intentions to seek out opioids. On intentions to use higher doses over a longer time, knowledge, beliefs, behavioral control, patient-provider communication, workplace safety, and workplace autonomy had significant protective effects. CONCLUSIONS: Findings from this study could be used to inform future multilevel interventions to prevent opioid misuse among employee populations.

Quantifying Value of Worksite Well-Being Programs With a Health Equity Lens: It's Time to Raise the Bar.

Calls to address workforce health inequities have been met with expanded well-being programming, without an assessment of programming relevance or evaluation of equity-related outcomes. The goal of this commentary is to summarize current practices and gaps in evaluation of well-being programs, provide evidence supporting the need for broader participation in well-being offerings, and make recommendations to incorporate health equity measures into planning and evaluation efforts conducted by both employers and vendors. Data sharing, expanded measurement, more rigorous evaluation methods, and alignment of goals are some of the recommendations to better address health inequities and differential participation among employees.

Student awareness of campus medical amnesty policies.

ObjectiveExamine students' awareness of medical amnesty policies and the influence of policy awareness on the expected consequences of bystander help seeking in alcohol-related emergencies among student-athletes and non-athletes. Participants: 1,012 college students. Methods: Spearman's correlation and chi-square tests were used to examine accuracy in awareness of amnesty policies. Nominal logistic regression was used to test the relationship between amnesty policy awareness and expected consequences of bystander help seeking. Results: About 25% of students were unsure if their school had an amnesty policy; of these students, 67% attended schools with such a policy. Students who were unsure about the presence of amnesty policies were more likely to expect serious negative consequences of calling for help for both non-athlete peers (B = 1.152 p < 0.001) and student-athlete peers (B = 0.887 p = 0.001). Conclusions: Greater attention is needed to how amnesty policies are implemented on college campuses, including how they are communicated to and interpreted by student-athletes.

A Scoping Review of Economic Evaluations of Workplace Wellness Programs.

OBJECTIVE: Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI. METHODS: We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome. RESULTS: We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates. CONCLUSION: This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.

Return on Investment of Workplace Wellness: Evidence From a Long-Term Care Company.

BACKGROUND: Workplace wellness programs (WWPs) are increasingly promoted by businesses and governments as an important strategy to improve workers' overall health and well-being and to reduce health care and other organizational costs. Few studies have evaluated WWPs in small businesses to provide evidence on the potential return-on-investment (ROI) that WWPs might yield. This study aimed to fill this gap by presenting a quasi-experimental, ROI analysis of a WWP in a small company. METHODS: This observational quasi-experimental study evaluated economic outcomes of a multicomponent WWP implemented by a small long-term care company. The company provided approximately 2 years of de-identified, individualized data on its employees for 2013-2015. There were 116 WWP participants and 323 nonparticipants. Difference-in-differences models were used to evaluate the program using organizational costs and ROI estimates. FINDINGS: The estimated program cost was $132.692 (95% confidence interval [CI]: [$112.957, $156.101]) per participant and the estimated organizational costs savings were $210.342 (95% CI: [-4354.095, 2002.890]). The WWP achieved an ROI of $0.585 (95% CI: [-$35.095, $14.103]) per participant. Although not statistically significant, the results suggest that the WWP saved $1.585 for every $1 invested. CONCLUSIONS/APPLICATION TO PRACTICE: These results suggest that the evaluated WWP yielded a positive, although nonsignificant, ROI estimate. While ROI is still one of the most common evaluation metrics used in workplace wellness, few studies present ROI estimates of WWPs in small companies. Given policy efforts to promote WWPs in small businesses, there is a need to conduct high-quality ROI analyses for WWPs in smaller companies.

Tracking Changes in US Organizations' Workplace Health Promotion Initiatives: A Longitudinal Analysis of Performance Against Quality Benchmarks.

PURPOSE: To examine changes in organizations' workplace health promotion (WHP) initiatives over time associated with repeated self-assessment using the Well Workplace Checklist (WWC). DESIGN: Well Workplace Checklist data include a convenience sample of US organizations that selected to assess their performance against quality WHP benchmarks. SETTING: Workplaces. SUBJECTS: In total, 577 US organizations completed the WWC in 2 or more years from 2008 to 2015. MEASURES: The WWC is a 100-item organizational assessment that measures performance against the original set of quality benchmarks that were established by the Wellness Council of America (WELCOA). ANALYSIS: This study examined changes in overall WWC scores as well as 7 separate benchmark scores. Multilevel modeling was used to examine changes in scores associated with repeated assessments, controlling for the year of assessment and organizational characteristics. RESULTS: There were significant increases in overall WWC scores (ß = 2.93, P < .001) associated with the repeated WWC assessments, after controlling for organizational characteristics. All 7 benchmark scores had significant increases associated with reassessment. Compared to other benchmarks, operating plan (ß = 6.18, P < .001) and evaluation (ß = 4.91, P < .001) scores increased more with each reassessment. CONCLUSION: Continued reassessment may represent more commitment to and investment in WHP initiatives which could lead to improved quality. Other factors that may positively influence changes in performance against benchmarks include company size, access to outside resources for WHP, and a history with implementing WHP.

Association Between the Characteristics of Organizations and Their Profile of Performance Against Quality Benchmarks for Workplace Health Promotion.

OBJECTIVE: This study explored subgroups of performance profiles measured by organizations' Well Workplace Checklist (WWC) benchmark scores and examined company characteristics associated with performance subgroups. METHODS: The sample included 3728 US organizations that completed the WWC in 2008 to 2015. Latent profile analysis (LPA) was used to extract distinct subgroups of organizations based on benchmark performance. Multinomial logistic regression analysis was used to examine associations between the characteristics of organizations and their performance subgroup. RESULTS: Three distinct subgroups of performance resulted from the LPA. Significant associations were found between subgroup assignment and characteristics such as size, industry, how WHP initiatives were paid for, and reasons for implementing WHP initiatives. CONCLUSION: The characteristics associated with subgroups of performance suggest utility for developing specific interventions tailored to different types of organizations to improve their overall quality of WHP initiatives.

Performance Against WELCOA's Worksite Health Promotion Benchmarks Across Years Among Selected US Organizations.

PURPOSE: The purpose of this study was to quantify the performance of organizations' worksite health promotion (WHP) activities against the benchmarking criteria included in the Well Workplace Checklist (WWC). DESIGN: The Wellness Council of America (WELCOA) developed a tool to assess WHP with its 100-item WWC, which represents WELCOA's 7 performance benchmarks. SETTING: Workplaces. PARTICIPANTS: This study includes a convenience sample of organizations who completed the checklist from 2008 to 2015. The sample size was 4643 entries from US organizations. MEASURES: The WWC includes demographic questions, general questions about WHP programs, and scales to measure the performance against the WELCOA 7 benchmarks. ANALYSIS: Descriptive analyses of WWC items were completed separately for each year of the study period. RESULTS: The majority of the organizations represented each year were multisite, multishift, medium- to large-sized companies mostly in the services industry. Despite yearly changes in participating organizations, results across the WELCOA 7 benchmark scores were consistent year to year. Across all years, benchmarks that organizations performed the lowest were senior-level support, data collection, and programming; wellness teams and supportive environments were the highest scoring benchmarks. CONCLUSION: In an era marked with economic swings and health-care reform, it appears that organizations are staying consistent in their performance across these benchmarks. The WWC could be useful for organizations, practitioners, and researchers in assessing the quality of WHP programs.