Succeeding at workplace health promotion: key influencing factors from a systematic review

Background: With the growing emphasis being placed on workplace health promotion in maintaining health and well-being of employees and increasing (their) productivity, numerous workplace health promotion interventions (WHPIs), both research and practise-based, have been conducted. However, not all of these projects are (cost) effective. Knowledge on factors responsible for the undesired results is important for development and delivery of future interventions. Evaluations of the processes that accompany the implementation of individual WHPIs would provide information on factors for their success or failure. However, such process evaluations are not only rare, but also of poor quality, creating a dearth of knowledge on factors that may affect the implementation of WHPIs. Moreover, the current literature provides inadequate comprehensive and systematic information (reviews) on this topic. Therefore, our aim is to systematically analyse hindering and facilitating factors identified in already evaluated WHPI research projects. In addition, following a recent review on influencing factors found in practise-based WHPIs, we will also contrast its results with ours, thus contributing to a comprehensive understanding of influencing factors.

Methods: For comparison purposes, the methods used were in line with those used in a recent overview on practice-based WHPIs. Research evidence was identified by searching electronic databases and by visually scanning reference lists of included articles. Two reviewers independently reviewed abstracts and full texts, followed by thematic-analysis-guided independent identification, extraction and coding of facilitators of and barriers to the conduction of the projects.

Results: Of the 798 articles screened, 53 articles met our criteria. The factors were summarized under the following themes: contextual and project management aspects; characteristics of the organization, the intervention, the target group, the implementers; and aspects of the evaluation and data analyses. The majority of the factors were associated with the particular characteristics of the intervention and participants. While the facilitators were mostly attributed to the intervention aspects, the barriers were mostly related to the characteristics of the target group. Factors that were described as both facilitating and impeding were defined as central factors, in line with the practise-based review. These included context factors (weather, economic situation); organizational and external project management structure; company resources; suitability and user-friendliness of the intervention; personality and resources of implementers; attitude, lifestyle and resources of participants; quality of the evaluation design as well as data collection and analysis.

Discussion: Central factors identified in both research-based and practise-based projects were defined as' key-success factors'. For eleven central factors found in research-based projects, an analogous factor in practise-based projects was found, for example factors relating to the (infra)structure of the organization, or the format of the intervention. Major differences lied in the reporting of factors referring to the implementers' characteristics, which were found only in research-based projects. Moreover, the importance of stakeholder participation in 'health circles' was found to be an influencing factor only in practise-based projects.

Identifying 'key success factors' will be important for conducting future WHPIs. Such an outcome could be regarded as a first step towards developing evidence-based guidelines for evaluating WHPIs.