Tara Keaton, CSEA/SEIU Local 2001, Hartford, CT; Alicia Dugan, PhD, Department of Medicine, UConn Health, Farmington, CT; Matthew Brennan, MPH, Department of Medicine, UConn Health, Farmington, CT; Sara Namazi, PhD, Department of Health Sciences, Springfield College, Springfield MA; Timothy Cocozza, BS, Department of Medicine, UConn Health, Farmington, CT; Martin Cherniack, MPH, MD, Department of Medicine, UConn Health, Farmington, CT
Purpose/Objectives
The purpose of this workforce-based participatory intervention study was to assess the efficacy of a training delivered by a design team (DT) of unionized corrections supervisors (CSs). There were three hypotheses. H1: following training, participants will demonstrate greater knowledge of healthy eating practices, report healthier eating and exercise behaviors generally, and report healthy eating behavior at work. H2: following training, participants will have better health outcomes. H3: participants who rated the training higher as having more appeal regarding innovation characteristics will report higher dissemination and implementation (D&I) outcomes.
Background
Many employees in corrections work second and third shifts and overtime. 1 Altered sleep patterns and incidents associated with a violent culture carry increased risk for obesity. Adverse health behaviors, including lack of exercise and a poor diet are contributory. Limited research pertains to obesity interventions among correctional workforces. Few studies have assessed intervention characteristics most strongly associated with uptake and reach.2,3
CSEA/SEIU Local 2001 collaborated with researchers at the University of Connecticut since 2014. Its DT utilized the Center for the Promotion of Health in the New England Workplace’s Healthy Workplace Participatory Program to develop and implement trainings to address health and well-being in their workforce. The first two interventions focused on Sleep and Mental Health. This third intervention addressed obesity by implementing a training aimed at improving their eating habits and promoting physical exercise.
The focus on eating was based on findings from a large workforce survey customized by the DT to assess the health concerns of CSs. 4 89% of CSs were overweight or obese, 43% never or rarely met expert dietary recommendations, and 37% reported never or rarely meeting expert recommendations for physical activity. A majority reported wanting to improve healthy eating (66%), and physical exercise (62%).
Intervention Design: The training format included lecture, discussion and interactive activities. Originally designed as an in-person training, COVID-19 restrictions required virtual delivery via zoom. CSEA/SEIU Local 2001 has successfully included union-led health interventions in its contract.
Methods
Participants and Procedure. A total of 173 supervisors attended the training which took place over 11 sessions between October and December 2020. Participants were recruited through facility-based email. Participants completed an online survey at the start of the training. A post-intervention survey was emailed one month after completing the training. A $15 Amazon gift card was offered to individuals who completed both surveys.
Measure. Surveys questions consisted of demographics, general work information, health status and a brief assessment of their knowledge about healthy eating. Participants were asked about their healthy eating and physical activity behaviors as well as their motivation and self-efficacy for healthy eating. The post-intervention also evaluated the training.
Analysis Strategy. Hypotheses 1 and 2 were analyzed using paired-samples t-tests. Of pre-/post -training data. Hypothesis 3 was analyzed using an independent-sample t-test (created via median spilt) to compare ratings of participants who evaluated the training has having low-appeal vs. high-appeal on key D&I outcomes
Findings
There was a statistically significant increase in healthy eating knowledge from the pre-training (M=80.65, SD = 14.24) [H1] to the post-training time point (M=88.23, SD = 11.24), t (61) = -5.23, p = .000. There was a marginal increase in choosing healthy take-out meals at work from pre-training (M=2.27, SD = 1.10) to the post-training time point (M=2.52, SD = 1.20), t (61) = -1.79, p = .079. We did not find support for [H2] (improvement in health outcomes). There was a statistically significant difference in adoption satisfaction among trainees who rated the training as having low-appeal (M=3.38, SD = 1.04) versus high appeal (M=4.20, SD = 0.71), t (71) = -4.01, p = .000 and a statistically significant difference in intent to sustain use of healthy eating strategies among trainees who rated the training as having low-appeal (M=3.42, SD = 0.94) vs. high appeal (M=4.18, SD = 0.64), t (71) = -3.92, p = .000; and a statistically significant difference in diffusion behavior among trainees who rated the training as having low-appeal (M=3.18, SD = 1.16) vs. high appeal (M=3.83, SD = 0.81), t (71) = -2.69, p = .009 [H3].
Discussion
Training improved knowledge and had a marginal effect in changing healthy eating behaviors. There were no differences in health outcomes. Program satisfaction was associated with adopting healthy eating knowledge, intention to sustain use, and diffusion of behavior.
There were barriers introduced by the virtual format, in particular participants intermittently turned off their videos, and censored discussion. The DT successfully planned and implemented this training with less professional support, and adopted a virtual format. With a bottom up approach and union contract inclusion, attendance and investment of staff increased over prior employer training efforts.
Conclusions
The HWPP is an effective method for implementing initiatives to improve the Total Worker Health of CSs.