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Ten Reasons Why Your Wellness Program Lacks Participation

Todd McGuire

Two employees not participating in a meeting, by holding pencils under their nose.

This is the first installment of a 4 part series on a model for designing and managing a wellness program that gets measurable results. Each part of the series will cover one of the four stages of the model shown below. This “4 R’s” model can be applied to a broad-based wellness program or a narrow effort targeting a specific wellness area. In all cases, the objective is the same: Build a wellness program that gets used by your population while generating measureable results for your organization. Achieving this requires sustained participation over a long enough period of time to lead to genuine behavior change. We’re trying to replace many years (or decades) of bad habits with new, healthier ways of living. This takes time.

We will begin by discussing 10 common pitfalls that can derail your efforts to reach as many of your employees as possible. Avoid these common mistakes and you should be able to optimize the participation level in your wellness program.

Pitfall 1: No Incentives

It’s tempting to take the position that “good health is its own reward, so everyone should sign up for this program.” Unfortunately, that doesn’t get most people to take action. I call that “Wellness 1.0 Thinking.” The “motivated minority” will respond to this approach, but they are the minority. You are trying to get to the non-participating majority that usually sits on the sidelines.

Modern wellness programs attract the most people when incentives are involved.  Done properly, incentives will create a buzz in your workplace. That’s “Wellness 2.0.”  Instead of expecting your employees to leap at the opportunity to improve their HDL cholesterol, try appealing to their inherent interest in rewards. This will get your employees to take notice of your program and hopefully attend an information session that should lead to them signing up. Juicy gossip spreads fast, so there’s nothing better than having your employees ask one another “Did you hear about that new program that actually pays you to lose weight?!” (Insert the goal of your wellness program here.) Plan on using incentives every year as an integral part of your program.

Pitfall 2: Misplaced Incentives

So now you know that incentives are a key ingredient of a successful wellness program. But that’s just the beginning. Early attempts at incentive-based wellness programs tried applying the incentives to the first step of the process: Reach (or participation). This is tempting because it seems like the natural way to get people to join your program. The problem is that it leads to short-term thinking, “I just need to sign up and then I’ll earn the incentive,” and short-term programs filled with participants who aren’t really committed to changing their behavior. True behavior change is essential to a meaningful program that will help your employees and your bottom line.

To achieve this holy grail of behavior change, try to align the incentives with real outcomes that can be measured. If your program is focused on reducing hypertension, then measure pre and post blood pressure levels and align your rewards based on improvement. If you are aiming for weight loss and decreasing obesity, then help your employees track their baseline weight and Body Mass Index (BMI) and reward them for progress every three months (or whatever interval fits your organization) as measured by their new and improved weight level. This shift from “pay for participation” to “pay for performance” is crucial to create a long-term culture of health.

Pitfall 3: Pull vs. Push

Wellness 1.0 was all about “Pull” models of coaching – books, passive web sites, posters. They can have great information, but they suffer from a critical flaw: They require the employee to be motivated to seek out the information. There is a “motivated minority” that will do just that, but you’re missing the majority who won’t make the effort.

Your employees are busy. They often have more projects on their plate than they can reasonably handle. Ask most people what they do with 5 minutes of downtime between projects and they will be much more likely to get a quick news fix at CNN.com or ESPN.com on their phones than they are to diligently look up some nutrition information or log what they ate for lunch today. Fortunately, Wellness 2.0 has the answers: email, SMS text messages, Facebook, Twitter.

Pitfall 4: Wrong Communication Channel

What could be better than getting a personalized phone call from a nurse or coach who is dedicated to helping you improve your health? For some folks, that is ideal. But for a lot of busy, stressed out employees who already spend all day on the phone for their job (see Pitfall 3 above), the threat of another phone call is enough to scare them away from a wellness program. Survey your employees.  Ask them what would make wellness easier for them. We did, and the results were clear: 91.5% of our respondents are on Facebook (N=1,893) and 77% use social media tools at least weekly. So we now interact with our participants through those channels. Contact me at tmcguire@incentaHEALTH.com for a free copy of our “2011 Mobile and Social Media in Wellness Survey” if you’d like to see more.

Pitfall 5: Short Term Thinking

Another Wellness 1.0 mistake is to think wellness is a 6-week contest or a 12 week boot camp. Those things can be part of the answer; but you really need to stress the expectation that you’re asking your employees to adopt a new lifestyle where they know how to choose proper sized portions of healthy food, where they build the habit of taking the stairs instead of the elevator, where they make their health a daily priority. Unfortunately some of the reality shows on TV condition us to think getting healthy is something that can be achieved once and then forgotten.

Speaking of reality, it’s more like brushing your teeth. The results don’t last, which is why it’s recommended daily! Undoing 15, 20, even 30 years of bad habits takes time. Usually more than 6 weeks.  Most people will stumble a few times before finding success. I have seen the best success when we’ve told employees that this is the start of a multi-year campaign. The first stage is one year in duration. You’re going to earn incentives every three months for achieving, and maintaining, improvements in your health.

Pitfall 6: Privacy is Just a Legal issue

HIPAA does a good job of making the protection of personal health information a priority. It may also make us obsess over the legal requirements and perhaps overlook the reality that good privacy can actually increase participation. With the use of private screening kiosks, anonymous Q&A with health coaches over email, and online tools that allow team competition without revealing individual stats, Wellness 2.0 can attract the ideal demographic to your wellness efforts. As an example, the typical profile of a participant in wellness programs we’ve run is as follows: 43 years old, 33 BMI. These are great stats in terms of getting the people who need the most help to join your program.

Many executives we’ve discussed this with are thrilled because this demographic is the exact opposite of what they see when they put in a corporate gym. Gyms are great resources, but they often attract folks who are already working out and in shape. The 43-year-old with the 33 BMI is often intimidated by all those healthy gym goers (which is why over 70% of the employees we’ve coached choose the home-based exercise option that is emailed daily at 3:00 AM to their computer or smart phone). We hear from a lot of participants that they are doing simple strength exercises at home for the first time because they feel comfortable following an email and grabbing a soup can or set of resistance bands to do the exercises. That’s real world behavior change taking place!

Pitfall 7: Wellness is a Serious Medial Issue

Health and wellness is as serious as a heart attack. Unfortunately that doesn’t translate into how you should market your wellness program to your employees.  The reality is that most people are not motivated by stern lectures from their physician. They usually just want to look and feel better.  We’ve asked thousands of employees to rank their motivation for improving their health, and the top answer is always the same: “To fit in my old jeans.” And there are some other really good options on the list like “My doctor told me to get healthy” or “To have more energy for my family.” Maybe in another article I’ll dive deeper into some of the neat stats we’ve collected over the years about what the most common barriers and motivators are for people trying to improve their health.

As wellness professionals, we know that the health of our employees is critical for them and for our organizations. But when we’re focused on getting people to take the first step and enroll in a wellness program, we need to move beyond just the medical reasons and highlight how joining the program will help each employee reach goals that matter to them. Now that we know our participating employees’ number one motivator is to fit in their old clothes, we highlight the fact that all participants using our kiosk for screenings get a private, full-length digital photo of every one of their screenings. As a result, many employees use the kiosk once a week. We only require that they return to the kiosk once every 3 months, but they tell us they really like seeing the pictures of their progress!  Motivation is a personal matter. Your job is to find out what that motivation is and harness it.

Pitfall 8: Wellness is not Always a Team Sport

One of the most popular features in corporate wellness programs is the team challenge. Many people love them and get very competitive, which is great!  But for everyone that loves team-based approaches, there is someone (and usually many “someone’s”) who is sensitive about their health and would rather make it a personal journey. Make sure you respect that difference, especially when it comes to incentive programs. I have seen programs run the most smoothly when there are individual incentives for everyone who reaches benchmarks, and then group incentives for those who opt to participate in the team challenges.

Pitfall 9: Overly Thorough Enrollment Process

Data is good. More data is often better. As wellness professionals, we usually thrive on data. But there’s a very real risk of trying to get too much data. I’m not talking about overstepping privacy borders. I’m talking about enrollment forms that are just too long. You’ll know you’re guilty of this pitfall when you have to resort to incentives just to get people to sign up. A well-designed—and short—enrollment form will get people started in 5 minutes or less and you won’t need to spend a dime on participation. Save those dollars for rewarding progress!

Pitfall 10: Offer the Wrong Program

Tell me if this sounds familiar. You conduct a comprehensive Health Risk Assessment (HRA). The HRA stratifies your workforce according to prevalence of health risks. You then find and implement wellness programs that address each of these areas. You communicate with your employees that have hypertension something like this: “Hello Employee 2314, we have a great program to help you lower your blood pressure.” This makes perfect sense on paper, but again there’s a fatal flaw. Except for that “motivated minority” we talked about, many of your employees will see the information about that hypertension program and file it away in their “Health Plan” folder as something to look at when they get the time. And if you entice them with an incentive to use your hypertension program, some will reluctantly do it for just long enough to get the incentive. That’s not real behavior change.

Instead, find out what’s motivating your employees and try a more foundational wellness approach to get things moving. Virtually every HRA finds the same thing: Your workforce is overweight, stressed out, sedentary, has high blood pressure and has (or is heading for) heart health issues. Guess what is recommended (to accompany the medications that are prescribed) for each of these issues? The answer: Healthy eating and active living. If your employees are like the ones I’ve worked with over the years, they are already thinking about how to look and feel better and fit into their old clothes. So give them a program that helps them do just that, while also addressing just about every risk found in your HRA. Once your employees take those first steps and start feeling better, they just might be more receptive to the specialized programs that you have waiting in the wings.

In the next stop in this series we will look at the always-challenging topic of retention as we work our way toward the goal of building measurable wellness programs that get results.

About The Author

Todd McGuire is the co-founder and CTO of incentaHEALTH.  In this role, Todd has helped design and implement winning wellness programs across dozens of worksites in the U.S., U.K., Singapore and Puerto Rico.  He can be reached at tmcguire@incentaHEALTH.com

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