Employee Level Assessment

Often times, a survey is used to assess the health needs and interests of an employee population.  These surveys may focus on a single health issue (e.g., daily physical activity levels) or encompass a wide variety of issues and beliefs such as: nutrition, physical activity, tobacco use/alcohol misuse, vaccinations, physical examinations, as well as interest and opinions regarding a workplace wellness initiative.

An employee health survey can be a low-cost way to assess the health attitudes, beliefs, and behaviors of a given employee population and serves as an informative tool when planning new programs and policies.

Suggestions for the design and delivery of employee health surveys

The sections that follow describe some of the things to consider when developing, implementing, and analyzing employee health self-assessment surveys. Some additional limitations or caveats include:

When designing and delivering a survey

• Design a survey that works for the organization. Careful consideration should be given to the employees who will participate and the ultimate outcomes of the survey and should guide decisions on the questions asked, the length of the survey, and the format of the survey (e.g., paper and pencil, web-based, focus group, etc.). Be sure to obtain the participants written consent to participate when distributing the survey
• Consider the representativeness of the sample. Ask the following questions: ◦Do the employees who responded to the questionnaire adequately represent all employees?
  • Was there any bias in the way the surveys were distributed or collected?  For instance, were surveys provided to all units, or only personally distributed to employees in the day shift?
  • Is there any way to increase participation in the surveys?
• Make sure that employees see the surveys as anonymous or confidential. This will help increase employee’s willingness to participate in the survey as well as participate in the workplace health program. Insurance of anonymity/confidentiality will also most likely encourage honesty in responses
• Employers need to be aware of the implications for workplace health programs of the Genetic Information Nondiscrimination Act (GINA) of 2008. GINA prohibits discrimination in health coverage and employment based on genetic information. It generally prohibits health insurers or health plan administrators from requesting or requiring an individual or individual’s family member’s genetic information, or using the information for decisions regarding coverage such as determining premium rates, or eligibility. The law also prohibits most employers from using genetic information for employment decisions such as hiring or firing. Questions regarding genetic information such as family medical history are sometimes used as part of Health Risk Assessments (HRAs). GINA specifically addresses the restrictions on HRAs. Under GINA, HRAs administered by group health insurance plans or insurers are prohibited from including questions on family medical history or other genetic information if 1) a financial incentive is provided for completion of the HRA; 2) the HRA is administered in connection with enrollment in a health plan (or any time prior to the effective date of coverage); or 3) the HRA is administered as a criteria for participation in wellness and disease management programs
• The Department of the Treasury, Department of Labor, and the Department of Health and Human Services has posted Interim Final Rules Prohibiting Discrimination Based on Genetic Information in Health Insurance Coverage and Group Health Plans [PDF – 240K] that describes the regulations for the prohibition of collecting genetic information in wellness and disease management programs that use of Health Risk Assessments. The rules are illustrated by several examples
• Build trust with employees by sharing the results and taking action. Company climate and relationships may also impact success of the survey. If the company has good relationships with their employees then the team is more likely to get higher participation. A way to increase trust and response is through ongoing communication of the purpose and use of the information and sharing aggregate results with employees following analysis. In addition to sharing the results of the survey, employers should follow up and take action on issues of importance raised in the survey. A common complaint regarding employee surveys is that employers fail to make any changes despite the results. Responding to the needs of the workforce will help improve employee morale and is likely to increase participation in future surveys
• Consider that employees may exhibit more reluctance to complete some items than others. For example, some employees will not indicate their weight, though they will respond to other health questions

When analyzing the survey results

• Use caution when only a few (e.g., less than 30 or so) employees from particular sub-groups respond to the surveys. In cases where there is a small worksite, the team may want to report data on everyone as a group, being careful that no one individual can be identified when data are presented. Make sure that individual employees can not be identified through any of the tables or comparisons. If the data are not weighted to reflect the total population of the workforce, this would lead to assumptions that non-respondents are similar to respondents – a theory that could not be tested with the data available. Low participation also greatly reduces the ability to examine statistical significance and the confidence in the conclusions  
• Recognize that there is inherent bias in self-reporting. Respondents tend to under report their weight or over report their height. If asking about food intake, people have trouble recalling the foods they have eaten even after a couple of days. Nonetheless, self report surveys still offer valuable and useful information in a cost-efficient format
• Carefully choose comparison data sets with local, state, or national population samples and take the demographic description of those data sets into consideration when drawing conclusions about the workplace sample. Many workforce populations may tend to be younger and healthier and may also differ in terms of racial or gender demographics than the surrounding community. The analyses should statistically adjust the local/state/national data; at a minimum the demographic differences should be highlighted in the description of the survey results  
• Recognize that questionnaires and surveys used as national comparisons may not have all the questions desired for a workplace evaluation in the same year. For instance, the Centers for Disease Control Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) may have some questions you desire within their 2009 survey and others only within the 2008 survey  
• Recognize that depending on the frequency of the survey, the results generated are only point-in-time estimates. Things tend to change within a company – employees develop diseases, lose weight, start or stop smoking, etc. Surveys should be repeated periodically to analyze trends and changes in the employee environment    

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