Assessment of Health Risks with Feedback to Change Employees’ Health

This intervention includes:

• An assessment of personal health habits and risk factors (that may be used in combination with biomedical measurements of physiologic health)
• A quantitative estimation or qualitative assessment of future risk of death and other adverse health outcomes
• Provision of feedback in the form of educational messages and counseling that describes how changing one or more behavioral risk factors might change the risk of disease or death

Worksite interventions may use an assessment of health risks with feedback (AHRF) alone or as part of a broader worksite health promotion program that includes health education and other health promotion components offered as follow-up to the assessment.

Summary of Task Force Recommendations & Findings

Assessment of Health Risks with Feedback

The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of assessments of health risks with feedback when implemented alone in achieving improvements in one or more health behaviors and conditions among participating workers. Evidence is considered insufficient because of inconsistent effects and concerns about the lack of controlled studies.

Task Force Finding & Rationale Statement

Assessment of Health Risks with Feedback Plus Health Education With or Without Other Interventions

The Task Force recommends the use of assessments of health risks with feedback when combined with health education programs, with or without additional interventions, on the basis of strong evidence of effectiveness in improving one or more health behaviors or conditions in populations of workers. Additionally, the Task Force recommends the use of assessments of health risks with feedback when combined with health education programs to improve the following outcomes among participants:

• Tobacco use (strong evidence of effectiveness)
• Excessive alcohol use (sufficient evidence of effectiveness)
• Seat belt use (sufficient evidence of effectiveness)
• Dietary fat intake (strong evidence of effectiveness)
• Blood pressure (strong evidence of effectiveness)
• Cholesterol (strong evidence of effectiveness)
• Number of days lost from work due to illness or disability (strong evidence of effectiveness)
• Healthcare services use (sufficient evidence of effectiveness)
• Summary health risk estimates (sufficient evidence of effectiveness)

The Task Force finds insufficient evidence for

• Body composition
• Consumption of fruit and vegetables
• Fitness

Task Force Finding & Rationale Statement

 

Results from the Systematic Reviews: Assessment of Health Risks With Feedback

Thirty studies qualified for the review.

• Six studies included an untreated or lesser treated comparison group.
• One study was a time series study.
• Twenty-four studies were included as before-after study designs.
• Results were considered inconsistent, with some in favor and some not in favor of the intervention.
• The magnitude of effect for the eleven outcomes considered in this review was small.

Results from the Systematic Reviews: Assessment of Health Risks with Feedback Plus Health Education With or Without Other Interventions

Fifty-one studies qualified for the review.

• Nineteen studies included an untreated or lesser treated comparison group.
• Eight studies were either retrospective cohort or time series designs.
• Twenty-three studies were included as before-and-after study designs.
• This review considered a range of outcome measures for each outcome category. Conclusions for each of these outcomes are based on a review of both quantified and qualitatively described results.

Health Behavior Outcomes

• Excessive Alcohol Use
  • Nine studies qualified for the review.  
    • The majority of study results were in favor of the intervention.
    • There were moderate decreases in prevalence rates of risky drinking behaviors and amount of alcohol consumed.
• Dietary Behavior
  • Fourteen studies qualified for the review.
    • With the exception of one study that showed no change in intake of fruits and vegetables, changes in dietary behaviors were in favor of the intervention.
    • Intake of fruits and vegetables: median increase of 0.09 servings per day (6 studies)
    • Percent of employees with high risk fat intake: median relative decrease of 5.4% (interquartile interval: -21.9% to -1.8%; 13 studies)
• Physical Activity
  • Eighteen studies qualified for the review.
    • The majority of results were in favor of the intervention.
    • Percent of employees who were physically active: median relative increase of 15.3% (interquartile interval: 8.3% to 37.2%; 16 study arms)
• Seatbelt Use (percent of directly observed use, percent of self-report use)
  • Ten studies qualified for the review.
    • All but one finding were in favor of the intervention.
    • Percent of employees not using seatbelts all of the time: median relative decrease of 27.6% (interquartile interval: –56.4% to –7.4%; 10 studies)
• Tobacco Use
  • Twenty-nine studies qualified for the review.
    • All results were in favor of the intervention.
    • Prevalence rates (percent of employees who smoke): median relative decrease of 13.3% (interquartile interval: –24.0% to –3.3%; 27 study arms)
    • Cessation rates (percent of employees who quit):17.8% (interquartile interval: 12.0% to 22.6%; 21 study arms)

Physiologic Indicators

• Blood Pressure
  • Thirty-one studies qualified for the review.
    • Results were in favor of the intervention.
    • Diastolic blood pressure: median decrease of 1.8 mm Hg (interquartile interval: –4.4 to –0.3 mm Hg; 22 study arms)
    • Systolic blood pressure: median decrease of 2.6 mm Hg (interquartile interval: –4.8 to –0.3 mm Hg; 24 study arms)
    • Change in prevalence rate of employees with high risk blood pressure reading: median decrease of 4.5 percentage points (interquartile interval: –8.7 to –0.4 percentage points; 16 study arms)

• Body Composition (weight, body mass index [BMI] or percent body fat)
  • Twenty-seven studies qualified for the review.
    • Some of the results were in favor of the intervention and some were not.
    • Change in body weight: median decrease of 0.56 pounds (interquartile interval: –5.1 to +1.5 pounds; 17 study arms)
    • Change in BMI: median decrease of 0.50 points (interquartile interval: –1.1 to –0.3 points BMI)

• Cholesterol
  • Twenty-seven studies qualified for the review
    • Results were in favor of the intervention.
    • Total cholesterol: median decrease of 4.8 mg/dL (interquartile interval: –10.4 to 0.0 mg/dL; 23 study arms)
    • HDL cholesterol: median increase of 0.94 mg/dL (interquartile interval: –0.9 to 2.3 mg/dL; 10 study arms)
    • Percent of employees with high risk readings: decrease of 6.6 percentage points (interquartile interval: –14.8 to –2.4 percentage points; 12 study arms)

• Fitness (aerobic capacity, heart rate after a stepping exercise or Astrand Rhyming test for sub-maximal fitness)
  • Six studies qualified for the review.
    • Results were in favor of the intervention.
    • Effect estimates were small and difficult to interpret.

Other Variables

• Risk Status (health risk score, appraised age, healthy lifestyle or % employees in a high-risk category)
  • Sixteen studies qualified for the review.
    • Results were in favor of the intervention.
    • The size of the effect estimate was moderate.

• Healthcare Service Use
  • Six studies qualified for the review.
    • The direction of the results was mixed as reported outcomes varied across studies.
    • While indicators varied by study, the majority of results were in favor of the intervention and effect estimates were generally of moderate size.

• Absenteeism
  • Ten studies qualified for the review.
    • Results were in favor of the intervention.
    • The size of the effect estimate was moderate.

Additional Useful Information about the AHRF Reviews

• The majority of these studies were conducted in the United States, but a few were conducted in Europe, Australia, Finland, Canada, Japan, the Netherlands, Sweden, and Switzerland.
• The interventions evaluated in this review were implemented in:
  • Manufacturing plants, healthcare facilities, health insurance companies, government offices, banks, and schools
  • Companies or worksites with more than 500 employees
  • Urban and suburban settings
• The participating employees:
  • Averaged 40 years of age
  • Had a range of educational levels and job positions
  • Were predominately White, though African Americans were well represented

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to worksite health promotion.

Supporting Materials

• Analytic framework [PDF - 324KB] – see Figure 1 on page S241
• Research gaps
• Summary evidence tables
  • AHRF used alone [PDF - 504KB]
  • AHRF with feedback plus health education with or without other interventions [PDF - 103MB]
• Included studies
  • AHRF used alone
  • AHRF with feedback plus health education with or without other interventions
• Search strategy
  • Assessment of Health Risks with Feedback to Change Employees’ Health

Publications

Soler RE, Leeks KD, Sima Razi, Hopkins DP, Griffith M, Aten A, Chattopadhyay SK, Smith SC, Habarta N, Goetzel RZ, Pronk NP, Richling DE, Bauer DR, Ramsey Buchanan LR, Florence CS, Koonin L, MacLean D, Rosenthal A, Koffman DM, Grizzell JV, Walker AM, Task Force on Community Preventive Services. A systematic review of selected interventions for worksite health promotion: the assessment of health risks with feedback. [PDF - 324KB] Am J Prev Med 2010;38(2S):237-62

Task Force on Community Preventive Services. Recommendations for worksite-based interventions to improve workers' health. [PDF - 67KB] Am J Prev Med 2010;38(2S):232-6.

More Community Guide publications about Worksite Health Promotion

Related Publications

Fielding JE, Hopkins DP. An introduction to evidence on worksite health promotion. In Pronk NP, editor. ACSM's Worksite Health Handbook: A Guide to Building Healthy and Productive Companies (2nd edition). Champaign (IL): Human Kinetics; 2009:75-81.

Soler RE, griffith m, Hopkins DP, Leeks KD. The assessment of health risks with feedback: results of a systematic review. In Pronk, NP, editor. ACSM's Worksite Health Handbook: A Guide to Building Healthy and Productive Companies (2nd edition). Champaign (IL): Human Kinetics; 2009:82-91.

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Assessment of health risks with feedback to change employees’ health. www.thecommunityguide.org/worksite/ahrf.html. Last updated: MM/DD/YYYY.

Reviews completed: June 2006, February 2007