Ten questions (TenQ) on workplace HEPA promotion results from a survey to HEPA. Finnish Olympic Committee, Radiokatu 20, Helsinki, Finland

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1 HEPA Europe working group Workplace HEPA promotion Ten questions (TenQ) on workplace HEPA promotion results from a survey to HEPA Europe members Aittasalo M 1, Livson M 2 1 The UKK Institute for Health Promotion Research, PO Box 30, Tampere, Finland 2 Finnish Olympic Committee, Radiokatu 20, Helsinki, Finland Contact information: Minna Aittasalo, minna.aittasalo@uta.fi Matleena Livson, matleena.livson@olympiakomitea.fi

2 Working group Workplace HEPA promotion in HEPA Europe HEPA Europe (European network for the promotion of health-enhancing physical activity) works for better health through physical activity among all people in the WHO European Region, by strengthening and supporting efforts to increase participation and improve the conditions for healthy lifestyles. Workplace HEPA promotion is one of the working groups of HEPA Europe. The aim of the working group is to provide a platform for exchanging and disseminating practices and experiences of workplace HEPA promotion in the European Region. Over the past few years the working group has mainly focused on practices, which reduce sedentary behaviour (SB) at worksite settings. For this purpose the leaders of the working group have annually collected information from the members of the working group about country activities reducing SB. The information has been collected via Word-format survey completed by the members. The responses in 2015 were reported in Spring Survey about workplace HEPA promotion in HEPA Europe countries In 2016 the leaders of the working group Workplace HEPA promotion changed and its scope was broadened to workplace HEPA promotion in general including SB. It was considered that reducing SB was one part of overall HEPA promotion and not always applicable for example in non-office workplaces. As a result, information about the practices related to the larger spectrum of workplace HEPA promotion in European countries was needed. In order to get this kind of information an electronic survey (TenQ) was conducted by to all the members of HEPA Europe. The intention was to repeat the survey prior to annual HEPA Europe Conferences to track possible changes in the policies and implementation of workplace HEPA promotion in the European Region.

3 Survey procedure and contents The TenQ-survey was group- ed in June 2016 to all 146 members of HEPA Europe by Sonja Kahlmeier, the executive member of the HEPA Europe Steering Committee. The survey s incomplete list of HEPA Europe member countries was updated in September and the ing was repeated. The survey was closed in the end of November after one reminder to the working group members in the HEPA Europe s annual conference in Belfast and a second reminder by in October. The survey included ten questions (Q1-Q10) concerning HEPA promotion policies and strategies in worksite setting (Appendix 1). Responses were given anonymously and the data were stored in the Finnish National Sports Confederation Valo. Voluntariness to complete the survey was clearly informed in the cover letter and the respondents gave their informed consent by responding to the survey. In the last question the respondents were free to give their address if they wanted to be contacted for the presentations in the next working group meeting in Belfast in Survey results The results are presented in numbers and/or proportions concerning each specific question. The country-specific results are not reported systematically because in most questions there were only one or two respondents per country. However, in some questions the responses are also outlined briefly at country level because they give interesting additional information.

4 Respondents (Q1 and Q2) During the period from June to November 2016 altogether 127 persons (87%) viewed the survey. Of them 40 persons (32%) responded to the survey. They represented 20 European countries (Table 1). Table 1. Respondents to the TenQ survey by country Country Number of respondents 1 Belgium 4 2 Croatia 2 3 Czech Republic 1 4 Denmark 3 5 Finland 2 6 France 2 7 Germany 6 8 Greece 1 9 Iceland 1 10 Ireland 3 11 Italy 1 12 Malta 1 13 Netherlands 3 14 Poland 1 15 Romania 1 16 Slovenia 1 17 Spain 2 18 Sweden 1 19 Ukraine 1 20 United Kingdom (UK) 3 Total 40 The respondents were asked to indicate in which role they were primarily involved in workplace HEPA promotion. The alternatives were health practitioner / health professional, exercise specialist, public health promoter, project coordinator, researcher and other, what? Based on the responses 45% were researchers and 25% public health promoters. Also health practitioners, exercise specialists and project coordinators were represented (7.5%, 7.5% and 2.5%, respectively). The category other (12.5%) included two consultants, an observer in HEPA Europe, a public policy advisor, and a public HEPA promoter.

5 Workplace HEPA promotion in the national policy (Q3) The respondents were asked whether workplace HEPA promotion was included in the national policy on HEPA promotion in their country. All forty persons responded to the question. Approximately one half (53%) of them representing 12 countries (Belgium, Denmark, Finland, France, Germany, Ireland, Italy, Netherlands, Poland, Slovenia, Ukraine and United Kingdom) said that workplace HEPA promotion was included in their national policy on HEPA promotion. About one third (30%) of the respondents said that workplace HEPA promotion was not included in the national policy on HEPA promotion. Fifteen percent of the respondents could not say, and one respondent (2%) said that their country did not have national policy on HEPA promotion. The opinions of the respondents from the same country were contradictory in seven countries. Monitoring and reporting workplace HEPA promotion (Q4) The question was about whether the implementation of workplace HEPA promotion was systematically monitored and reported. Again, 40 persons responded. Fifteen percent of them from five countries answered "yes". Majority (65%) answered "no" and the rest (20%) could not say. Those who gave a positive answer were asked to specify the name of the document. Based on the answers and document links (5 different documents), it seemed that a national data collection and reporting system for workplace HEPA promotion existed in one country only (Finland).

6 Systems for financial incentives or refunds (Q5) The respondents were asked whether there was a system in their country that offers employers financial incentives or refunds for workplace HEPA promotion. Of the 40 respondents, 37.5% said that there were such incentives, 45% reported no such incentives and 17.5% could not say. The respondents that answered "yes" were from Belgium, Czech Republic, Finland, Germany, Ireland, Netherlands, Sweden, United Kingdom. The most commonly mentioned systems were i) tax refunds or benefits in general or concerning active travel to work and leisure time physical activity (10 respondents, 6 countries) and ii) funding for workplace HEPA related activities (3 respondents, 3 countries). Additional systems mentioned by single respondents were health insurance, a contribution scheme on preventive services including HEPA, a national competition involving activities for workplace health promotion, exercise vouchers and refunding of entrance fees. Information sources or platforms for implementation (Q6) The respondents were asked whether there was a joint information source or platform (e.g. website) in their country, where the employers can find support for implementing workplace HEPA promotion (e.g. guidelines, tools, material, examples, evaluation methods etc.). Thirtyeight persons responded to the question. One half (50%) of them representing nine different countries said that there was an information source or platform available to support workplace HEPA promotion. Internet addresses related to the information sources were received from ten respondents. Thirty-seven percent of the respondents said there was no such platform available, and 13 percent could not say.

7 Most common means for implementation (Q7) The respondents were instructed to choose means, which they viewed the three most common ones that the employers in their country used to implement HEPA promotion (Appendix 1). Twenty-one ready-made means were listed followed by an alternative Other, what? where the respondents were able to indicate means not mentioned in the list. All 40 persons responded to the question. Almost one third (28%) of the respondents from eight countries stated that workplace HEPA promotion had not reached priority in their country. Most popular mean among the three most common ones was arranging exercise events or campaigns (40%, 12 countries) followed by using financial incentives (33%, 12 countries), providing facilities (23%, 6 countries), organizing sports competitions (20%, 7 countries) and sports clubs (20%, 7 countries) and having exercise space (20%, 7 countries). Slightly less frequently mentioned means were lectures to employees (15%, 6 countries), exercise to employees with impaired work ability (13%, 3 countries), flexi time (10%, 4 countries) and organizational mobility plans (10%, 4 countries). Bike-sharing system (8%, 3 countries), fitness tests (8%, 3 countries), collaboration with occupational health care (8%, 2 countries), active work stations (5%, 2 countries), individual counseling (3%, 1 country) and group counseling (3%, 2 countries) were the least frequently mentioned means and none of the respondents chose exercise equipment, personalized travel plans or active meetings to the series of top three means. Respondents had also an opportunity to indicate means not mentioned in the ready-made list (10%, 4 countries). As a result, bike storage facility, placing printers at walking distance

8 to encourage steps and financial incentives to the employees cycling or using public transportation to work were added. The respondents also brought up that the variety of means used by the employers is great and it is quite difficult to indicate what is being used and by whom. It was also stated that the means varied substantially according to the particular workplace and local circumstances. Barriers for implementation (Q8) Similarly to the previous question the respondents were asked to choose the three most common barriers for the employers to implement workplace HEPA promotion in their country. The list included 10 barriers and ended to an alternative Other, what? where the respondents were able to indicate barriers not mentioned in the list. Thirty-nine persons responded to this question. The most frequently mentioned barrier among the top three was lack of interest (47%, 13 countries) followed by financial issues (41%, 14 countries), uncertainty about the effectiveness or cost-benefits (39%, 8 countries) and not recognizing HEPA as part of workplace health promotion (33%, 11 countries). Also not knowing how to implement HEPA promotion (31%, 9 countries) and poor participation of physically inactive employees (31%, 7 countries) were often seen amongst the top three barriers. Resistance of the employees (8%, 3 countries) and lack of collaborators (5%, 2 countries) were the least mentioned barriers. Barriers indicated in the open space (8%, 3 countries) were lack of systematic support at company and national policy level (e.g. occupational health and safety institutes) and not having enough human resources to organize practical arrangements. One respondent felt

9 that it was difficult to answer the question. Another respondent pointed out that not all employees are interested in physical activity and therefore, workplace HEPA promotion such as flexi time or financial incentives, could be an extra benefit for a selected group of employees. Future of workplace HEPA promotion (Q9) The respondents were asked how they saw the future of workplace HEPA promotion in their country at policy and workplace level within the next year. The response alternatives were no change, change for the better, change for the worse and cannot say. In addition, open space was provided for justification after the first three alternatives. Thirty-eight persons responded to both parts of the question (policy level and workplace level). In the first part the respondents were from 20, and in second part from 19 countries. At policy level: Sixteen percent of the respondents from 6 countries were unable to take stand. More than one half (58%, 14 counties) viewed that workplace HEPA promotion will change for the better within the next year in their country. The most frequent reasons for the positive view were improved recognition, documentation, legislation and financial support as well as implementation of more activities both at national and local level. One fourth (26%, 9 countries) of the respondents saw that workplace HEPA promotion stays the same in their country within the next year. The most common reasons for predicting no change were related to the fact that political priorities and agenda focused on other things such as workplace health promotion in general, labor market and economical issues. It was

10 also seen that the change in policy is a long and tedious process. None of the respondents predicted change for the worse. At workplace level: Almost one third (29%, 10 countries) of the respondents were not able to predict the future of workplace HEPA promotion at workplace level. More that one half (53%, 11 countries) thought that a change for the better happens in their country within the next year. The most common reasons for the positive view were related to the increased interest and awareness among the employers. Better understanding about the financial impacts and aging of the population were also mentioned as well as new legislations, increased adoption of national policy and better availability of the results from national projects. Almost one fifth (18%, 5 countries) of the respondents felt that there is going to be no change in their country s workplace HEPA promotion at workplace level within the next year. The reasons listed were lack of investment or financial support and HEPA promotion at workplaces not being critical on the political agenda. One respondent described that positive signs are only seen in multi-national companies but there too, the initiatives are weakly implemented and seldom evaluated. None of the respondents saw change for the worse in the future. Involvement in HEPA Europe working group Workplace HEPA promotion (Q10) The last question asked whether the respondent would like to be involved in the HEPA Europe s working group Workplace HEPA promotion in the next meeting in Belfast in The first part of the question was about presenting policies, programs, material etc. and the second part about hearing about other participants policies, programs, materials etc. The response alternatives to both parts were simply Yes or No. After a positive response a

11 specification was asked as well as the contact information. Thirty-three persons representing 18 countries responded to the first and 37 respondents from all 20 countries to the second part of the question. As a result, majority (85%) of the respondents did not want to give a presentation in the working group meeting. Those who did would have liked to introduce a current project or material developed for workplace HEPA promotion. Majority (73%) of the respondents wanted to hear about the policies, programs or materials of other countries. The specifications included knowledge exchange concerning policy measures, advocacy strategies and material, good practices, successful interventions and implementation strategies. Also systems related to incentives, certificates and quality assessment were mentioned as well as plans, which are used in managing HEPA promotion processes at workplaces. Summary of the findings Based on the findings of TenQ survey the policies and implementation concerning workplace HEPA promotion seem to vary greatly between European countries. Moreover, although not reported here in every question, the responses from persons representing the same country seemed to vary giving an impression that there is a need in many countries for more systematic data collection and dissemination of policies. Nevertheless, it was delightful that in 12 of the countries represented by the respondents, workplace HEPA promotion seem to have been recognized in a national policy although in most cases it was part of general HEPA promotion policy. However, as expected, very few

12 respondents indicated that workplace HEPA promotion was systematically monitored or reported in their country. This is in line with the findings, which showed a discrepancy in the within-country responses concerning the policies and implementation of workplace HEPA promotion. The use of financial incentives was reported in eight countries. According to specifications, taxation seemed to be the most common way of supporting workplaces financially. However, financial issues were the second in the list of top three barriers for the employers to implement HEPA promotion. It seems therefore that efforts to improve financial issues are needed in many countries. One half of the respondents representing nine countries reported having a joint information source or platform for supporting the implementation of workplace HEPA promotion in their country. However, based on the specifications it seems that many countries have no single joint platform but numerous platforms located in various websites. This may make it more difficult for the employers to seek and get the information they need effectively. The lack of joint information source may also be one reason for the respondents to commonly report not knowing how to implement HEPA promotion in practice to the series of top three barriers for the employers. Based on the views of the respondents exercise events and campaigns were by far the most commonly used mean to promote workplace HEPA among the employers. This may result from employers limited resources or know-how to carry out more targeted means of promotion. It may also reflect employers traditional way of thinking about health promotion, which in this case, may need widening of the perspective in many countries.

13 Considerations for interpreting the results The response rate to the survey was 27%, which can be considered reasonable. However, the respondents represented 20 (39%) of the 51 European countries most being from western economies. This limits the generalization of the findings more widely in Europe. Moreover, in 13 (65%) countries only one or two persons responded to the survey, which hinders the generalization of the results also at country level. Thus, the responses merely reflect the views of the individual respondents rather than country-specific situations. A survey delivered to various stakeholders in each country would lead to more generalizable information. This could be achieved, for instance, by utilizing the physical activity part of the Company Health Check (CHC), which has been developed in the EU s 7 th initiative Move Europe ( and translated in 22 languages. It is thus directly deliverable to the stakeholders of the countries using these languages. The delivery could be organized via members of HEPA Europe. At the time of TenQ survey the leaders of the working group Workplace HEPA Promotion were not aware of CHC but now consider utilization of CHC one option to conduct next TenQ survey. Conclusions Respondents views about the policies and implementation of workplace HEPA promotion varied within and between countries. Overall, it seems that HEPA promotion specifically in worksite setting has not yet been systematically integrated into national policies. Also, in most countries the supportive information to the employers about how to implement workplace HEPA promotion is scattered and probably not easy to find. The findings likewise indicate that there is still plenty of work to do in practically all countries in developing a

14 monitoring system, which can help to assess the needs of HEPA promotion at workplace level and to follow the impacts of implementation at national, regional and local level. To get more generalizable picture about country-specific situations a survey to the major stakeholders in each country should be carried out. One way of doing it would be by utilizing Company Health Check (CHC, which has already been translated in many languages. The HEPA Europe s working group Workplace HEPA promotion is considering this as an alternative for repeating TenQ in fall 2017.

15 Ten Q on workplace HEPA promotion Ten Q on workplace HEPA promotion Dear colleague, HEPA Europe s working group Workplace HEPA Promotion is interested in how HEPA is promoted in workplaces across European countries. We ask you to complete this electronic survey with ten multiple-choice questions, which will take only little of your time. The survey has been delivered to persons actively involved in HEPA Europe and to those, who have given their contact information for the working group. Our intention is to repeat the survey prior to annual HEPA conferences to track the possible changes in workplace HEPA promotion and to see what issues are considered important in the upcoming working group meetings. In order to utilize the responses for this year s meeting in Belfast, we kindly ask you to complete the survey by Friday, the 9th of September. Thank you. Best Regards, Leaders of the HEPA Europe working group "Workplace HEPA promotion" Matleena Livson, Valo, Finnish Sports Confederation, matleena.livson@valo.fi Minna Aittasalo, The UKK Institute for Health Promotion Research, Finland, minna.aittasalo@uta.fi 1. Which country do you represent? Choose option In which role are you primarily involved in workplace 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 1 / 7

16 Ten Q on workplace HEPA promotion In which role are you primarily involved in workplace HEPA promotion? Health practitioner / health care professional Exercise specialist Public health promoter Project coordinator Researcher Other, what? 3. Is workplace HEPA promotion included in the national policy on HEPA promotion in your country? Yes No Can not say My country does not have national policy on HEPA promotion. 4. Is the implementation of workplace HEPA promotion systematically monitored and reported in your country? Yes, please specify the name of the document No Can not say 5. Is there a system in your country, which offers 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 2 / 7

17 Ten Q on workplace HEPA promotion Is there a system in your country, which offers employers financial incentives or refunds for workplace HEPA promotion? (funding, tax refunds etc.) Yes, please specify what kind No Can not say 6. Is there a joint information source or platform (e.g. website) in your country, where the employers can find support for implementing workplace HEPA promotion (e.g. guidelines, tools, material, examples, evaluation methods etc.)? Yes, please specify the source(s) or platform(s) (website etc.) No Can not say 7. Based on your view, what are the three most common means that the employers use for implementing workplace HEPA promotion in your country? Workplace HEPA promotion has not generally reached priority in my country. Organisation s own sports / exercise clubs Financial incentives (exercise vouchers, free access to sports clubs, subsidies etc.) Exercise / physical activity events / campaigns Company sports competitions 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 3 / 7

18 Ten Q on workplace HEPA promotion Lectures to employee on physical activity and other well-being issues Exercise groups or courses for employees with impaired work ability Fitness tests (with or without feedback) Exercise equipment (dumbbells, stationary bikes, table tennis etc.) Exercise space / gym Flexi time (flexible working hours to enable e.g. active commuting to work) Facilities (showers, lockers, drying cabinet etc.) Bike-sharing system at the workplace Organisational Mobility plans Personalized Travel Plans (individual employee) Active workstations (Sit-Stand, Walk & Work, stability ball etc.) Active meetings (walking, standing etc.) Self-monitoring devices (record sheets, pedometers, Smart Phone Apps etc.) Individual physical activity counselling Group-based counselling on physical activity Collaboration with occupational health care Other, what? 8. Based on your view, what are the three most common 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 4 / 7

19 Ten Q on workplace HEPA promotion Based on your view, what are the three most common barriers for the employers to implement workplace HEPA promotion in your country? HEPA promotion has not generally reached priority in my country Financial issues Not knowing the overall benefits of HEPA Not recognizing HEPA as part of workplace health promotion Not knowing how to implement HEPA promotion in practice Lack of interest / Not considered employer s business Uncertainty about the effectiveness / cost-benefits Poor participation of physically inactive employees Employees resistance Lack of collaborators Other, what? 9. How do you see the future of workplace HEPA promotion in your country within the next year? a) At policy level 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 5 / 7

20 Ten Q on workplace HEPA promotion a) At policy level No changes, please specify why Change for the better, please specify why Change for the worse, please specify why Can not say b) At workplace level No changes, please specify why Change for the better, please specify why Change for the worse, please specify why Can not say 10. Would you like to be involved in the HEPA Europe s working group Workplace HEPA Promotion in the next meeting in Belfast... a) to present policies, programs, material etc. of your 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 6 / 7

21 Ten Q on workplace HEPA promotion a) to present policies, programs, material etc. of your country? Yes, please specify what and and give your contact information No b) to hear about other participants policies, programs or material etc.? Yes, please specify what and give your contact information No Submit 0% Powered by Surveypal 2M-pMY2IJt4Td6ytIAHRpE&_hid=Ten-Q-on-workplace-HEPA-promotion Sivu 7 / 7