How to transform the workplace environment to prevent and control risk factors associated with non-communicable chronic diseases

Schouw, Darcelle (2019-04)

Thesis (PhD)--Stellenbosch University, 2019.


ENGLISH SUMMARY : The underlying causes of premature morbidity and mortality in South Africa (SA) are related to unhealthy lifestyle behaviours, which are modifiable. Chronic non-communicable diseases (cardiovascular disease, respiratory disease, diabetes and cancer) are partly attributed to behavioural risk factors such as tobacco smoking, harmful alcohol use, physical inactivity and unhealthy eating, which if not controlled, results in an increase in metabolic risk factors. The workplace is highlighted as an important setting for the prevention of non-communicable diseases (NCDs). The work environment directly shapes employee health, and health behaviours, and acts as an accelerator or preventer of chronic disease. Very little research in the African context has focused on how to transform the workplace environment to prevent and control the risk factors associated with NCDs. The aim of the research was to design, implement and evaluate a workplace health promotion program (WHPP) to prevent or reduce the risk factors for NCDs amongst the workforce at a commercial power plant in South Africa. The objectives were to monitor changes in NCD risk factors in the workforce, as well as monitor sick leave absenteeism and evaluate the costs and consequences of the workplace health promotion program. The abstracts for the four articles presented for the doctoral degree are provided here. Article 1 Title: Risk factors for non-communicable diseases in the workforce at a commercial power plant in South Africa. Background: Non-communicable diseases (NCDs) account for more than half of annual deaths globally and nearly 40% of deaths in South Africa. The workplace can be an important setting for the prevention of NCDs. Objectives: The objectives of this study were to describe the prevalence’s of reported NCDs and previously identified risk factors for NCDs, as well as to assess risky behaviour for NCDs, and the 10-year risk for cardiovascular disease, amongst the workforce at a commercial power plant in the Western Cape province of South Africa. Methods: A total of 156 employees was randomly selected from the workforce of 1 743. Questionnaires were administrated to elicit self-reported information about NCDs, tobacco smoking, alcohol use, diet, physical activity and psychosocial stress. Biometric health screening included measurements and calculations of blood pressure, total cholesterol, random glucose, body mass index (BMI), waist circumference and waist-to-hip ratio (WHR). The 10-year risk for cardiovascular disease was calculated using a chart-based validated non-laboratory algorithm. Results: The study participants had a mean age of 42.8 (25-64) years; 65.2% were male. A quarter (26.0%) smoked tobacco, 29.4% reported harmful or dependent alcohol use, 73.0% had inadequate fruit and vegetable intake, and 64.1% were physically inactive. Systolic and diastolic blood pressure was raised in 32.7% and 34.6% of the study participants, respectively, 62.2% had raised cholesterol, 76.9% were overweight or obese, and 27.1% had abdominal obesity. Overall, 17.4% were diagnosed with hypercholesterolaemia, 17.7% with hypertension, and 16.2% with depression. Around one third (34.1%) had a moderate-to-high 10-year cardiovascular disease risk. Conclusion: The prevalence’s of both behavioural and physical risk factors for NCDs amongst the power station study participants were high. There is a need for effective workplace interventions to reduce risk for NCDs. The workplace is ideally suited for targeted interventions. Article 2 Title: Transforming the workplace environment to prevent non-communicable chronic diseases: Participatory action research in a South African power plant. Background: The workplace is an important setting for the prevention of non-communicable diseases (NCDs). Policies for transformation of the workplace environment have focused more on what to do and less on how to do it. The aim of this study was to learn how to transform the workplace environment in order to prevent and control the risk factors for NCDs amongst the workforce at a commercial power plant in Cape Town, South Africa. Methods: The study design utilized participatory action research (PAR) in the format of a cooperative inquiry group (CIG). The researcher and participants engaged in a cyclical process of planning, action, observation and reflection over a 2-year period. The group used outcome mapping to define the vision, mission, boundary partners, outcomes and strategies required. At the end of the inquiry the CIG reached a consensus on their key learning. Results: Substantial change was observed in the boundary partners: catering services (78% of progress markers achieved), sport and physical activities (75%), health and wellness services (66%), and managerial support (65%). Highlights from a 10-point consensus on key learning included the need for: authentic leadership; diverse composition and functioning of the CIG; value of outcome mapping; importance of managerial engagement in personal and organizational change; and making healthy lifestyle an easy choice. Conclusion: Transformation included a multifaceted approach and an engagement with the organization as a living system. Future studies will evaluate changes in the risk profile of the workforce as well as the costs and consequences for the organization. Article 3 Title: Changes in risk factors for non-communicable diseases associated with a Healthy Choices at Work program at a commercial power plant. Background: Globally, 71% of deaths are attributed to non-communicable diseases (NCD). The workplace is ideal for interventions aiming to prevent NCDs, however much of the current evidence is from high income countries. Objective: The aim of this study was to evaluate changes in NCD risk factors associated with a Healthy Choices at Work program (HCW) at a commercial power plant in South Africa. Methods: This was a before-and-after study in a randomly selected sample of 156 employees at baseline and 2-years. The HCW focused on catering, physical activity, health and wellness services and managerial support. Participants completed questionnaires on their participation in the HCW, tobacco smoking, harmful alcohol use, fruit and vegetable intake, physical activity, psychosocial stress and history of NCDs. Clinical measures included blood pressure, total cholesterol, random blood glucose, body mass index (BMI), waist circumference and waist-to-hip ratio. The 10-year cardiovascular risk was calculated using a validated algorithm. Data was analysed with the Statistical Package for the Social Sciences. Results: Paired data was obtained for 136 employees. Their mean age was 42.7 years (SD 9.7); 64% were male. The prevalence of sufficient fruit and vegetables increased from 27% to 64% (p<0.001), those meeting physical activity guidelines increased from 44% to 65% (p<0.001). Harmful alcohol use decreased from 21% to 5% (p=0.001). There were significant improvements in systolic and diastolic blood pressure (mean difference -10.2mmHg (95%CI: -7.3 to -13.2); and -3.9mmHg (95%CI: -1.8 to -5.8); p<0.001) and total cholesterol (mean difference -0.45mmol/l (-0.3 to -0.6)). There were no significant improvements in BMI. Psychosocial stress from relationships with colleagues, personal finances, and personal health significantly improved. There was a non-significant decrease of 4.5% in people with a high 10-year cardiovascular risk. Conclusion: The HCW was associated with significant reductions in behavioural, metabolic and psychosocial risk factors for NCDs. Article 4 Title: Cost and consequence analysis of Healthy Choices at Work (HCW) program to prevent non-communicable diseases in a commercial power plant. Abstract: The workplace is identified as an ideal setting for the implementation of a Healthy Choices at Work program (HCW) to prevent and control NCDs. However, given the limited resources assigned to workplace health promotion programs in LMIC, this study aimed to conduct a cost and consequence analysis using participatory action learning to improve the NCD risk profiles at low cost. Methods: Incremental costs were obtained from the activities of the Healthy Choices at Work program at the commercial power plant over a two-year period. A total of 156 employees participated in the intervention but the affect was experienced by all employees. An annual health risk assessment at baseline and follow up was included in the consequence of the study. Results: The total incremental costs over the two-year period accumulated to $3745 for 1743 employees. The cost per employee on an annual basis was $1 resulting in -10.2mmHg in systolic blood pressure, -3.87mmHg in diastolic blood pressure, -0.45mmol/l in total cholesterol, significant improvements (p=0.001) for harmful alcohol use, fruit and vegetable intake and physical inactivity. There was no improvement in correlation between sickness absenteeism and risk factors for non-communicable diseases. Conclusion: The cost to implement the multicomponent HCW programs was considerably low as was the significant consequences in transforming the workplace environment. Findings of this study will be useful for small, medium and large (SML) organisations, the national department of health, and similar settings in LMIC. Conclusion: The high prevalence of behavioral and metabolic risk factors for NCDs amongst participants at the power station resulted in the design of an effective WHPP to reduce risks. A Healthy Choice at Work program (HCW) included a multifaceted approach and was associated with significant reductions in risk factors for NCDs. The cost to implement the HCW program was low with significant consequences in transforming the workplace environment, which are useful findings for small, medium and large organizations.

AFRIKAANSE OPSOMMING : Die onderliggende oorsake van voortydige morbiditeit en mortaliteit in Suid-Afrika (SA) is verwant aan ongesonde lewenstyl gedrag, wat bewerkbaar is. Chroniese nie-oordraagbare siektes (kardiovaskulêre siekte, respiratoriese siekte, diabetes en kanker) is deels toegeskryf aan gedrags risiko faktore soos tabak rook, skadelike alkohol gebruik, fisiese onaktiwiteit en ongesonde eetgewoontes, wat indien nie beheer word, lei tot 'n toename in metaboliese risiko faktore. Die werkplek is uitgelig as 'n belangrike instelling vir die voorkoming van nie-oordraagbare siektes. Die werksomgewing vorm die werknemer se gesondheid en gesondheid gedrag, en dien as 'n versneller of verhoeding in die bepalings van chroniese siekte. Baie min navorsing in die Afrika konteks het gefokus op hoe om die werksomgewing te transformeer om die risiko faktore wat verband hou met nie-oordraagbare siektes te voorkom en beheer. Die doel van die navorsing was om 'n werksplek gesondheidbevordering program te ontwerp, implementeer en te evalueer, en om die risiko faktore van nie-oordraagbaar siektes onder die werksmag by 'n kommersiële aanleg in Suid-Afrika, te voorkom of te verminder. Die doelstellings was om veranderinge in risikofaktore in nie-oordraagbaar siektes in die werksmag, sowel as siekteverlof te monitor, afwesigheid te monitor, en die koste en gevolge van die werksplek gesondheidbevordering program te evalueer. Artikel 1 Titel. Risiko faktore vir kroniese siektes in werkers by n kommersiele kragsentrale in Suid Afrika. Agtergrond: Wereldwyd word meer as die helfte van jaarlikse sterftes toegeskryf aan chroniese siektes en in Suid Afrika is chroniese siektes die oorsaak van tot 40% van sterftes. Doel: Die doel van die studie was om die insidensie van chroniese siektes, die geassosieerde risiko faktore en gewoontes, asook die 10 jaar risiko profiel vir kardiovaskulere siektes van werkers, in n kommersiele kragsentrale, in die Wes Kaap provinsie, Suid Afrika te beskryf. Metodes: Honderd ses en vyftig werkers is willekeurig selekteer vanuit die totale werksmag van 1743 werkers. Hierdie werkers het vraelyste voltooi oor chroniese siektes, alkohol gebruik, tabak rook, dieet, fisiese aktiwiteit asook psigo-sosiale stress. Vir 'n biometriese gesondheidsondersoek is die werkers se bloeddruk, totale cholesterol, ewekansige bloedglukose, liggaamsmassa-indeks, middellyfomvang en middel-tot-heupverhouding Om hulle 10 jaar kardiovaskulere risiko profiel te bepaal, is n grafiek gebaseerde gevalideerde nie-laboratorium algoritme gebruik. Resultate: Die gemiddelde ouderdom van die deelnemers was 42.8(25-64) jaar, en 65.2% was manlik. n Kwart (26%) was rokers, 29.4% het oormatige alkohol gebruik gerapporteer, 73% het ongesonde dieet met onvoldoende vrugte en groente inname gerapporteer en 64.1% was fisies onaktief. Die deelnemers se sistoliese en diastoliese bloeddruk was onderskeidelik verhoog in 32.7% en 34.6%, 62.2% se totale cholesterol was verhoog, 76.9% was oorgewig of vetsugtig, en 27.1% het abdominale vetsugtigheid gehad. As n geheel was 17.4% gediagnoseer met hipercholesterolemie, 17.7% met hipertensie en 16.2% met depresie. Naastenby 34.1% het n matige tot erge verhoogte kardiovaskulere risiko gehad. Gevolgtrekke: Die insidensie van gedraggebaseerde en fisiese risiko faktore vir chroniese siektes was duidelik verhoog in die studie populasie. Daar is n behoefte vir effektiewe werksplek gebaseerde intervensies om die risiko vir chroniese siektes te verlaag. Die werksplek is uiters geskik vir doelgerigte intervensies. Artikel 2 Titel: Transformasie van n werksplek omgewing om kroniese siektes te voorkom: deelnemende aksienavorsing in n Suid Afrikaanse kommersiële kragsentrale. Agtergrond: Die werksplek is 'n belangrike plek om kroniese siektes te voorkom. Beleid vir die transformasie van die werkplekomgewing vir beroepsgesondheid en veiligheid in Suid-Afrika fokus meer op wat om te doen, en minder oor hoe om dit te doen. Tans is daar geen riglyne beskikbaar nie, en min bewyse oor hoe om werkplekgebaseerde intervensies vir chroniese siektes te implementeer nie. Doel: Die doel van hierdie studie was om te leer hoe om die werkplek omgewing te transformeer om kardio-metaboliese risikofaktore vir kroniese siektes onder die werksmag te voorkom en te beheer in n kommersiële kragstasie in Kaapstad, Suid-Afrika. Metodes: Die studie metode is deelnemende aksie navorsing in die formaat van 'n koöperatiewe ondersoek groep. Die navorser en deelnemers het in 'n sikliese proses van beplanning, aksie, waarneming en refleksie oor 'n tydperk van twee jaar gewerk. Die groep het uitkoms-kartering gebruik om die visie, missie, grensvennote, uitkomste en strategieë te definieer. Aan die einde van die ondersoek het die groep 'n konsensus bereik oor hul sleutelleer. Resultate: Aansienlike veranderinge is waargeneem in die grensvennote: spysenieringsdienste (78% van vooruitgangspunte behaal), sport- en fisieke aktiwiteite (75%), gesondheids- en welsynsdienste (66%) en bestuursondersteuning (65%). Hoogtepunte uit 'n 10-punts konsensus oor sleutelleer het die behoefte aan: outentieke leierskap ingesluit; diverse samestelling en funksionering van die kooperatiewe ondersoek groep; waarde van uitkoms kartering; belangrikheid van bestuursbetrokkenheid in persoonlike en organisatoriese verandering; en om n gesonde leefstyl 'n maklike keuse te maak. Gevolgtrekking: Suksesvolle transformasie vereis 'n veelvoudige benadering en 'n betrokkenheid by die organisasie as 'n lewende sisteem. Toekomstige studies sal die veranderinge in die risikoprofiel van die werksmag, sowel as die koste en gevolge vir die organisasie navors. Artikel 3 Titel: Veranderinge in risikofaktore vir nie-oordraagbare siektes wat geassosieer word met 'n Gesonde Keuse by die Werk program by 'n kommersiële kragstasie. Agtergrond: Wereldwyd word 71% van sterftes toegeskryf aan nie-oordraagbare siektes. Die werkplek is n ideale plek vir intervensies gemik daarop om nie -oordraagbare siektes te voorkom. Meeste van die huidige relevante navorsing is egter gedoen in hoë inkomstelande. Doel: Die doel van hierdie studie was om die veranderinge in die risikofaktore vir kroniese siektes wat verband hou met 'n Gesonde Keuses by die Werkprogram by 'n kommersiële kragstasie in Suid-Afrika, te evalueer. Metodes: Dit was 'n voor-en-na-studie in 'n lukraak gekose steekproef van 156 werknemers by basislyn en opvolg na 2 jaar. Die program het gefokus op spyseniering, fisiese aktiwiteit, gesondheids- en welsynsdienste en bestuursondersteuning. Deelnemers het vraelyste voltooi oor hul deelname in die program, tabakrook, skadelike alkoholgebruik, vrugte en groente-inname, fisieke aktiwiteit, psigo-sosiale stres en geskiedenis van kroniese siektes. Kliniese observasies het ingesluit bloeddruk, totale cholesterol, ewekansige bloedglukose, liggaamsmassa-indeks, middellyfomvang en middel-tot-heupverhouding. Die 10-jarige kardiovaskulêre risiko van deelnemers is bereken deur gebruik te maak van 'n gevalideerde algoritme. Data is geanaliseer met die Statistiese Pakket vir die Sosiale Wetenskappe. Resultate: Gepaarde data is verkry vir 136 werknemers. Hul gemiddelde ouderdom was 42.7 jaar (SD 9.7); en 64% was manlik. Die inname van voldoende vrugte en groente het toegeneem van 27% tot 64% (p <0.001). Die werkers se fisiese aktiwiteit volgens die riglyne, het gestyg van 44% tot 65% (p <0.001). Skadelike alkoholgebruik het van 21% tot 5% afgeneem (p = 0.001). Daar was beduidende verbeteringe in sistoliese en diastoliese bloeddruk (gemiddelde verskil -10.2mmHg (95% CI: -7.3 tot -13.2) en -3.9mmHg (95% CI: -1.8 tot -5.8), p <0.001) en totale cholesterol (gemiddelde verskil -0.45mmol / l (-0.3 tot -0.6)). Daar was geen beduidende verbeteringe in BWI nie. Psigososiale stres van verhoudings met kollegas, persoonlike finansies en persoonlike gesondheid is aansienlik verbeter. Daar was 'n nie-beduidende afname van 4,5% in mense met 'n hoë 10-jaar kardiovaskulêre risiko Gevolgtrekking: Die program was geassosieer met n beduidende afname in gedrags-, metaboliese en psigo-sosiale risikofaktore vir nie-oordraagbare siektes. Artikel 4 Titel: Koste- en gevolganalise van die “Gesonde Keuses by die Werk” program om nie-oordraagbare siektes in 'n kommersiële kragstasie te voorkom in Suid-Afrika. Agtergrond: Die werkplek word geïdentifiseer as 'n ideale instelling vir die implementering van 'n Gesonde Keuses by die Werk program om nie-oordraagbare siektes te voorkom en te beheer. In die lig van die beperkte hulpbronne wat beskikbaar is vir gesondheidsbevorderingsprogramme in die werkplek in lae en middelklas inkomste lande, het hierdie studie 'n koste- en gevolganalise uitgeoefen deur middel van deelnemende aksie om die nie oordraagbare siekte -risikoprofiel van werkers te verbeter teen n lae koste. Metodes: Inkrementele koste is oor 'n tydperk van twee jaar verkry uit die aktiwiteite van die “Gesonde Keuses by die Werk”-program by n kommersiële kragsentrale. Altesame 156 werknemers het deelgeneem aan die intervensie, maar die effek is deur alle werknemers ervaar. n Gesondheidsrisiko-evaluasie by basislyn en jaarlikse opvolg is ingesluit in die resultate van die studie. Resultate: Die totale inkrementele koste oor die twee jaar tydperk vir 1745 werknemers het $ 3745 beloop. Die koste per werknemer op 'n jaarlikse basis was $ 1, wat gelei het tot -10.2mmHg in sistoliese bloeddruk, -3.87mmHg in diastoliese bloeddruk, -0.45mmol / l in totale cholesterol, beduidende verbeteringe (p = 0.001) in skadelike alkoholgebruik, vrugte en groente-inname en fisiese onaktiwiteit. Daar was egter geen verbetering in die korrelasie tussen siekte afwesigheid en risikofaktore vir nie-oordraagbare siektes nie. Gevolgtrekking: Die koste vir die implementering van die multi-komponent program, asook die beduidende gevolge van die omskakeling van die werkplekomgewing was laag. Die bevindinge van hierdie studie sal nuttig wees vir klein, medium en groot organisasies, die nasionale departement van gesondheid en soortgelyke instellings in lae en middle inkomste lande. Gevolgtrekking: Die hoë voorkoms van gedrags en metaboliese risiko faktore vir NCDs onder deelnemers by die kragstasie het gelei tot die ontwerp van 'n doeltreffende WHPP om risiko's te verminder. 'N gesonde keuse by werk program (HCW) ingesluit 'n veelvlakkige benadering en is geassosieer met 'n aansienlike vermindering in die risiko faktore vir NCDs. Die koste om die HCW program te implementeer was laag met beduidende gevolge in die transformasie van die werkplek omgewing, wat nuttige bevindinge vir klein, medium en groot organisasies hou.

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