Business of Well-being

Quality of Life in Worksite Wellness: What Matters?

Quality of life is on the rise in worksite wellness, and perhaps with good timing. Historically, wellness programs have focused on targeted health areas such as smoking cessation, weight management, and physical activity. Although the scientific literature shows clinical and financial effectiveness for these interventions, participation is typically low, effect sizes (i.e., magnitude of improvement) are typically small to modest, and improvements aren't happening fast enough to stave off the impending healthcare crisis.

Most notably, the percentage of overweight Americans (i.e., BMI ? 25) has been steadily increasing for the past decade to near 75 percent and the number of Americans that meet nutrition guidelines is less than 15 percent for most food categories. All of these facts suggest that we need to keep improving our efforts.

In reaction, the next phase of programs is evolving to include a more comprehensive approach to worksite wellness. There is a need to connect health to things people care about, like enjoying their work. These topics go by all manner of names such as well-being or happiness, but all fall nicely under the umbrella of Quality of Life (QOL).

The definition of QOL covers both objective and subjective factors that provide people with a sense of life satisfaction. It reflects a perception of their life's conditions compared to their needs and desires. The key point here is that QOL relies heavily on people's opinions of their situation, not just whether they have a chronic condition.

For many programs this is a new approach to worksite wellness and the challenge will be to learn which factors improve employee QOL and how to implement programs based on this content. The current scientific, societal, and economic conditions have created an opportunity to embrace QOL as a primary outcome.

Scientifically, fields such as subjective well-being led by Ed Diener, PhD., positive psychology led by Martin Seligman, PhD and Chris Peterson, PhD, and the global advancement of QOL assisted by Michael Frisch, PhD, have developed a robust evidence base so that business and society can rely on the research outcomes.

The Centers for Disease Control and Prevention, World Health Organization, and National Institutes of Health are also on board. For example, the CDC identified QOL as a critical goal of public health (CDC, 2010). Employees are also ready, and they are saying so.

Data from our nationally representative Landmark employee survey (N=3000) clearly shows that having a fuller and longer good QOL ranks highest when compared to a variety of options. It only makes sense to engage employees with what they care about most. And economically, the Harvard Business Review's Summer 2012 edition on Happiness highlights that employers are taking note of more than just medical costs and absenteeism.

They also support the claim that happier employees are better for the bottom line. Altogether, a stage is well set for QOL to emerge more clearly in worksite wellness. Although QOL has a long history, recent and focused research addresses QOL that is more relevant for employers. In fact, businesses are considering QOL in determining where to establish sites and employees are taking it into consideration when looking for work.

From an individual perspective, one's own perception of QOL is a very powerful piece of data. For example, self-rated QOL is a powerful predictor of productivity, above medical factors in some cases and QOL can predict the likelihood of returning to work after a heart attack. It has also been ranked as more important than physical outcomes in people with health problems.

And more broadly, self-rated QOL is a stronger predictor of 7-year mortality than physical measures of health. If in fact QOL continues to increase in importance as a worksite wellness priority and proves useful as a self-rating data point, there are a number of implications. First, employers will need to learn how to intervene in ways that improve QOL.

There is a broad base of research to draw from and there are other lines of study that are quite specific (e.g., "quality of worklife"). This shift highlights a few other issues. First, factors that improve QOL are different than those considered in typical worksite wellness programs. Instead of focusing on the physical health domains exclusively, psychological domains will have to become more prominent.

Data from studies on QOL show that mental factors account for over a third of someone's QOL rating. The second major implication is that subjective self-report data may become the gold-standard. The health field has been somewhat skeptical of self-report data for a long time, sometimes for good reason. It may be appropriate when asking for certain biometric and health risk behaviors. However, under these circumstances self-report data is the most critical. The best way to know if someone is satisfied with their life is to ask.

In summary, QOL appears to be emerging in worksite wellness, which comes with some optimism, challenges, and implications. The optimistic view is that connecting people with interventions that improve their QOL will make health improvement that much more effective.

The main challenge will be to adapt programs to include psychological factors and learning which ones have the most impact on their employees. Self-report and psychological data may take on a new level of importance.

Shawn T. Mason, PhD, Associate Director of Research and Data Analytics at Wellness & Prevention Inc. and Director of Research and Data Analytics at the Human Performance Institute.; Johnson & Johnson Companies.

Dr. Mason manages data analytics and outcomes, as well as research study planning and design across multiple organizational and customer platforms. He is a licensed Clinical Psychologist and Assistant Professor, adjunct at the Johns Hopkins University School of Medicine. Previously, he was lead for risk, resilience, and recovery outcomes at the US Army Southern Regional Medical Command Warrior Resiliency Program.

Dr. Mason completed his doctoral degree in Clinical Psychology at Eastern Michigan University, internship at the Henry Ford Hospital in Detroit, Michigan and fellowship at the Johns Hopkins School of Medicine where he spent the majority of his effort in the Johns Hopkins Burn Center in collaboration with the National Institute on Disability and Rehabilitation Research Burn Model Systems Grants. Dr. Mason is active in presenting and publishing both nationally and internationally.

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