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Implementation of a wellness program, and the initiatives and strategies needed for employee engagement at a private international school

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Implementation of a wellness program, and the initiatives and strategies needed for employee engagement at a private international school

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Content Running head: IMPLEMENTATION OF A WELLNESS PROGRAM

Implementation of a Wellness Program, and the Initiatives and Strategies Needed for Employee
Engagement at a Private International School

by

Anne Patricia Wenstrom

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

August, 2018

Copyright 2018 Anne Patricia Wenstrom
IMPLEMENTATION OF A WELLNESS PROGRAM ii
Acknowledgements
My doctoral learning journey started in August 2015. I enjoyed the past three years and I
am grateful to so many people for their love and support. First, I am grateful to all my
exceptional USC professors that not only taught me how to be a leader in education, but how to
enjoy being a lifelong learner as well. I am especially thankful to Dr. Ruth Chung (my
dissertation chair) Dr. Larry Picus, and Dr. Monique Datta for being a part of my dissertation
committee. Thank you for your guidance and support. I could not have done this without you!
Secondly, I am grateful to the USC cohort of educators that I took on this learning
journey with the past three years. Dr. Amanda Wood, Dr. Betsy Hall, Dr. Cris Ewell, Dr. Dennis
Steigerwald, Dr. Jennifer Sparrow, Dr. Lauren Bokaer, Dr. Lauren Murphy, Dr. Lisa Wan, Dr.
Marianne Yong-MacDonald, Dr. Martha Began, Dr. Monica San Jose, Dr. Robin Pearson, Dr.
Sarah Farris, Dr. Scott Oskins, Dr. Susan Shaw, and Dr. Treena Casey...I learned more from you
than you’ll ever know. You are true EDU leaders! An extra thank you Scott, Lisa, Sarah, and
Betsy, for your friendship and encouragement. It got me through the lows on this rollercoaster
ride!
I am also grateful for the support of the international school where I work. Thank you
Dr. Chip Kimball, Dr. Jennifer Sparrow, and the whole OOL for making this EdD program
possible. I believe I have the best colleagues in the world and it is awesome to be a part of a
community that truly puts student learning first. Also, I am grateful to my students. You all are
the reason why I strive to try and make this world a better place. Our future is in good hands!
Thank you, Carmine Filice, for your collaboration in putting our thoughts into action with our
wellness program. Also, thanks to my PE/Health team for all your love and support!
IMPLEMENTATION OF A WELLNESS PROGRAM iii
Finally, thanks to my family and friends. I have learned so much from you all throughout
my life so far, and look forward to so many more shared experiences ahead. I knew that taking
on this doctorate program (on top of a full time job) would take a toll on my relationships.
Thanks for your support and patience. A huge thank you to my American and Singaporean
families for cheering me on these past three years. I appreciate your unconditional love. Mary
Wenstrom, you’ve been my BFF from day one. I am so glad we went into this same profession.
Thank you for being a role model for me. Love you, Twiny! Last but not least, a special thanks
to Selvie Sundari. Your patience, encouragement, and love have made this journey possible.
There are no words to express my gratitude to you. I will try and let you know how grateful I am
to you for the rest of our lives!

IMPLEMENTATION OF A WELLNESS PROGRAM iv
Table of Contents
List of Tables vii
List of Figures viii
Abstract ix
Chapter One: Overview of the Study 1
Causes of Noncommunicable Diseases 1
Prevention of Noncommunicable Diseases 2
Workplace Health Promotion Programs 3
Benefits of Workplace Health Programs 3
Context of Inquiry 6
Purpose of Study 8
Importance of the Study 8
Limitations and Delimitations 8
Chapter Two: Literature Review 10
Workplace Health Programs 10
Health and Wellness 10
Definition of Workplace Health Programs 11
Historical Context of Workplace Wellness Programs 11
Benefits of Workplace Wellness Health Promotion 13
Knowledge and Skills of Workplace Wellness Programs 14
Health Awareness in Workplace Health Programs 14
Workplace Health Program Health Awareness at MLA 15
Employee Knowledge and Skills 15
Workplace Health Program Knowledge and Skill Development at MLA 16
Workplace Health Program Knowledge and Goal-Setting 18
Goal-Setting at MLA 19
Health Screenings 19
Health Risk Assessments 20
Health Screenings and Assessments at MLA 20
Knowledge of Available Workplace Health Program Initiatives 21
Available Workplace Health Program Initiatives at MLA 21
Limitation of Knowledge 22
Motivation within Workplace Wellness Programs 23
Motivation 23
Importance of Motivation with Workplace Health Programs 24
Employee Engagement 24
Work Environments that Engage Employees 25
MLA Workplace Health Program Environment 27
Workplace Health Program Incentive Initiatives 29
Intrinsic Incentives 29
Extrinsic Incentives 30
Financial Incentives 31
Incentive Initiatives at MLA 32
Limitations of Workplace Health Program Motivation 32
Organization of Workplace Health Programs 34
Organizational Culture and Wellness Culture 34
IMPLEMENTATION OF A WELLNESS PROGRAM v
Healthy Organizational Culture at MLA 35
Designing an Effective Wellness Program 37
Workplace Health Program Assessments 38
Workplace Health Assessments at MLA 39
Planning the Program 39
Workplace Health Program Connection with Mission and Vision 40
Structure and Alignment with Goals 40
Structure of Workplace Health Programs 41
Planning Resources for Workplace Health Programs 43
Workplace Health Program Planning at MLA 43
Implementation of Workplace Health Programs 44
Types of Workplace Health Programs 45
Communication Strategies of a Workplace Health Program 46
Workplace Health Program Implementation at MLA 46
Evaluation of Workplace Health Programs 47
Evaluation of Workplace Health Programs at MLA 47
Limitation of the Organization of Workplace Health Programs 48
Summary 49
Purpose of Study 50
Chapter Three: Methodology 51
Rationale of Method of Study 51
Participants 52
Survey Participants 52
Access to Survey Participants 52
Focus Group Participants 53
Access to Focus Group Participants 54
Instruments 55
Survey 55
Focus Groups 55
Data Collection Procedures 56
Procedure Phase I – Surveys 56
Procedure Phase II – Focus Groups 57
Ethical Considerations 58
Data Analytic Strategy 59
Chapter Four: Findings 61
Research Question #1: Why do MLA Employees Participate in WHP? 61
Knowledge and Skills 61
Knowledge from Health Screenings 64
Benefits of Health 66
Intrinsic Motivation 68
Social Influences 69
Research Question #2: What Role, if Any, Do Constraints Play in
MLA Employees’ Decision to participate in WHP? 71
Time 71
Work-life Balance and Stress Management 73
Lack of Organizational Support and Resources 75
IMPLEMENTATION OF A WELLNESS PROGRAM vi
Accessibility to Course and Programs 75
Accessibility to Facilities and Resources 79
Conclusion 80
Chapter Five: Discussion 81
Summary of Findings 82
Implications 86
Reassess Allocated Time for Employee Wellness 86
Reassess Employee Access to Courses and Facilities 87
Assess the WHP and Continue Developing a Culture of Wellness 88
Continue to Foster and Support Knowledge and Skills of Health and Wellness 89
Recommendations for Future Research 89
Conclusion 90
References 92
Appendices 104
Appendix A: WHP Focus Group Discussion Guide 104
Appendix B: Request for Focus Group Participation Email 106
Appendix C: Request for Focus Group Participation Email 107
Appendix D: Qualtrics Employee Wellness Survey 108

IMPLEMENTATION OF A WELLNESS PROGRAM vii
List of Tables

Table 3.1 Survey Participants 53
Table 3.2 Focus Group Participants 54
Table 3.3 Key Themes and Color Codes 60

IMPLEMENTATION OF A WELLNESS PROGRAM viii
List of Figures
Figure 4.1 Would you say your general health is 62
Figure 4.2 Do you believe you have the knowledge needed to live a healthy lifestyle? 62
Figure 4.3 Do you believe you have the skills needed to live a healthy lifestyle? 63
Figure 4.4 When was the last time you had a comprehensive medical check-up
by a doctor? 64
Figure 4.5 What would motivate you to improve your wellness? 65
Figure 4.6 Which of the following reasons explain why you chose to participate
in the MLA W.O.W Program? 66
Figure 4.7 What are the top three health priorities for you to work on this year? 67
Figure 4.8 Which of the following reasons explain why you chose not to participate
in at least one or all of the MLA WHP Programs? 72
Figure 4.9 Please share whether you agree or disagree with the following statement-
my organization allows me to maintain good health 78

IMPLEMENTATION OF A WELLNESS PROGRAM ix
Abstract
The assumption that healthier employees are happier, more productive, safer, and
contribute to a positive work culture has helped to promote Workplace Health Program (WHPs)
initiatives and remains a focus of many WHPs today (O’Donnell, 2017; WHO, 2017e). There is
a large body of research that suggests that effective WHPs have become a widely accepted
strategy to improve employee productivity and presenteeism while reducing employee health
risks and healthcare costs (CDC, 2017a; WHO, 2017f). Even though there are well-documented
benefits of WHPs, there is limited research on the implementation of WHPs within international
schools. The purpose of this study was to understand the phenomenon of why employees choose
to (or not to) participate in the employee wellness program at a private international school in
Southeast Asia. It sought to understand promising practices utilized by comprehensive WHPs
and the barriers that hinder participation in WHPs.
A mixed methods research design was used to understand the phenomenon through
surveys and focus group discussions. The themes that emerged from the study for why
employees participate in a WHP were (1) prior knowledge of why healthy lifestyles are
important, (2) benefits of health, and (3) social influences. The themes that emerged for
constraints were (1) time, (2) work-life balance, and (3) lack of organizational support and
resources for employee wellness.

IMPLEMENTATION OF A WELLNESS PROGRAM 1
Chapter One: Overview of the Study
Over the last several decades, within the US and worldwide, an epidemic of “lifestyle
diseases” has emerged and have become a major burden as they lead to premature death and
disabilities, an increased cost of healthcare, and diminished quality of life (CDC, 2016;
USDHHS; 2013). What are these “lifestyle diseases”? They are noncommunicable diseases
(NCDs), also known as chronic diseases, that tend to be long-term if lifestyle behaviors are not
changed or if measures are taken by medical or health experts (CDC, 2016b). NCDs are the
result of an amalgamation of genetic, physiological, environmental and behavioral factors
(WHO, 2017a). The main types of NCDs, the leading causes of death worldwide, are
cardiovascular diseases, cancers, diabetes, and respiratory diseases (WHO, 2017a). Over 68% of
global deaths and over 80% of deaths in developing countries are caused by NCDs (CDC, 2017a;
WHO, 2017b). Furthermore, once thought to be the diseases of elders, there has been a shift
towards the onset of NCDs during the working age of adults, which adds an economic burden in
many countries. Unfortunately, NCDs are those illnesses that are related to loss of productivity
and reduced job performance at work (USDHHS; 2013). In order to fully understand NCDs, one
must first know what causes these diseases.
Causes of Noncommunicable Diseases
It is clear that people of all age groups, countries and regions of the world are affected by
NCDs (CDC, 2017a). The risk factors that align with and contribute to NCDs are unhealthy
diets, physical inactivity, unrelieved stress, environmental factors, lack of access to preventable
treatment, exposure to tobacco smoke or the damaging use of alcohol (CDC, 2017a; WHO,
2017c). NCDs are an emerging global health threat because worldwide, NCD deaths now
exceed all other deaths combined (WHO, 2017a). How is this happening?
IMPLEMENTATION OF A WELLNESS PROGRAM 2
One major reason is obesity, which has more than doubled worldwide since 1980 (CDC,
2017b; WHO, 2017d). In 2014, the number of overweight adults reached 1.9 billion (CDC,
2017a; WHO, 2017e). Common consequences of obesity are cardiovascular diseases,
musculoskeletal disorders, and some cancers (CDCa, 2017). In the United States, medical care
costs increased by 190.2 billion annually because of obesity (Cawley & Meyerhoefer, 2012).
Moreover, obesity is connected with $4.3 billion in job absenteeism costs annually (Cawley,
Rizzo, & Haas, 2007). The basic cause of overweight and obesity is an energy imbalance
between calories consumed and calories expanded (CDC, 2017d). Worldwide, there has been an
increased consumption of energy-dense foods that are high in fat, as well as in physical inactivity
due to increases in sedentary work and easier access to transportation (WHO, 2017c).
A significant risk factor for NCDs is lack of physical activity, which can be seen in
citizens of many countries (CDC, 2017c; UN, 2017; WHO, 2017e). Worldwide, 81% of school-
aged adolescents and 23% of adults are not sufficiently active (WHO, 2017e). Lack of physical
activity and unhealthy diets are truly leading to tremendous global health risks (WHO, 2017d).
Moreover, rapid urbanization, changing lifestyles and increased production of processed foods
have generated a change in dietary patterns. People are not eating enough vegetables, fruits and
dietary fibers, but instead are consuming foods higher in carbohydrates, fats, sugars and sodium
(WHO, 2015).
Prevention of Noncommunicable Diseases
Overall, implementing basic interventions that decrease NCD risk factors will reduce
premature deaths by 50-65%, and health systems that respond to the needs of people with NCDs
can diminish mortality by another third to half (WHO, 2017a). NCDs are preventable through
effective interventions that tackle common risk factors, namely tobacco use, unhealthy diet,
IMPLEMENTATION OF A WELLNESS PROGRAM 3
physical inactivity and harmful use of alcohol (CDC, 2017a; WHO, 2017a). In regard to cancer
alone, the World Health Organization website (2017a) states that “between 30% and 50% of
cancer deaths could be prevented by modifying or avoiding key risk factors, including avoiding
tobacco products, reducing alcohol consumption, maintaining a healthy body weight, regular
exercise, and addressing infection-related risk factors” (n.p.). Moreover, a healthy diet
throughout a lifetime helps to not only prevent malnutrition, but a range of NCDs as well (WHO,
2015). So, what are some effective preventative interventions?
Workplace Health Promotion Programs
In order to decrease the influence of NCDs on individuals and society, a comprehensive
approach is needed for bringing together multiple sectors in a collaboration (CDC, 2017a; WHO,
2017a). One major approach to NCDs prevention is done within the workforce through
Workplace Health Programs (WHPs). In fact, the value of WHPs continues to attract
considerable attention, and their popularity among employers has caused an increase in
organizations that implement WHPs to grow from 27% in 2006 to 75% in 2013. Also called
organizational wellness programs, WHPs show great promise for much needed health
interventions (CDC, 2017d). Adults spend a large portion of their waking hours at their place of
employment; hence, WHPs are seen as excellent preventative health interventions worldwide
(CDC; 2016c; WHO; 2016c). Since the number of working age adults with NCDs caused by
unhealthy lifestyle behaviors has increased significantly, an impact has been made on
productivity in the form of lower levels of productivity (presenteeism) and increased absence
from work (absenteeism) (CDC, 2016c; O’Donnell, 2017; Sorensen et al., 2011).
Benefits of Workplace Health Programs
The assumption that healthier employees are happier, more productive, safer, contribute
IMPLEMENTATION OF A WELLNESS PROGRAM 4
to a positive work culture, and stay longer has helped to promote WHP initiatives and remains a
focus of many WHPs today (Goetzel, Schoenman, Chapman, Ozminkowski, & Lindsay, 2011;
Sorensen et al., 2011). Supported by evidence-based research, effective WHPs have become a
widely accepted strategy to improve employee productivity and presenteeism and reduce both
employee health risks and health care costs (CDC, 2016c; Terry, Grossmeier, Mangen, &
Gingerich, 2013; WHO, 2016c). A study of European employers reported benefits of WHP
initiative also included employee feelings of well-being, reductions in work-related stress
factors, an increase in job and employer satisfaction, and improved abilities to effectively
function on the job (Goetzel et al., 2007; Seifert, Chapman, Hart, & Perez, 2012).
Another study of employers found a variety of benefits for offering WHPs, including an
impact on job satisfaction, decreased disability costs, improved employee commitment, and
improved organizational image enhancement for recruitment and staff morale (EU-OSHA, 2012;
O’Donnell, 2017). Also, as already mentioned, there is substantial evidence of the economic
benefits of effective WHPs in the form of decreased health care costs, reduced absenteeism rates,
and employee retention which are of great interest for employers (Baicker, Cutler, & Song, 2010;
O’Donnell, 2017). In a meta-analysis of WHP initiatives, Baicker et al. (2010) examined 32
peer-reviewed empirical studies to determine the standardized costs and benefits for each
program. It was found that, for every dollar spent on WHPs, health care costs were reduced by
$3.27 USD and absenteeism costs by $2.73 USD. Positive economic impacts such as these are
contributing to the popularity of WHPs in the workforce (Baicker et al., 2010; O’Donnell, 2017).
Moreover, Williams and Day (2011) conducted a longitudinal comparison study wherein the
change in medical costs for WHP participants was $332 per employee, which was lower than
costs for non-participant employees.
IMPLEMENTATION OF A WELLNESS PROGRAM 5
To address the multiple issues with poor health and wellness as previously described,
WHPs have been identified as a possible solution to health promotion reform (CDC, 2016c;
O’Donnell, 2017; WHO, 2016a). There has been a movement to utilize WHPs as a way to
prevent NCDs, increase the well-being of employees, reduce health care costs, decrease
absenteeism, and increase employee engagement (CDC, 2016d; O’Donnell, 2017). The World
Health Organization even views workplaces as a priority setting for health promotion in the 21
st

century (WHO, 2016c). When done effectively, WHPs can be of great benefit to employers and
employees; however, if the WHP is not assessed, planned, implemented and evaluated
effectively, it is unlikely that it will create positive results (Goetzel et al., 2014; O’Donnell,
2017).
Researchers who have studied WHPs for over 30 years have discovered various well-
designed, executed and assessed WHPs; however, far too often, they have found well-intentioned
programs that are poorly designed, implemented ineffectively, that were not evidence-based or
that did not utilize evidence-based best practices, are inadequately resourced, and are not
supported by the organizational culture (Goetzel et al., 2014). For example, the RAND
Corporation published national survey results of employers with 50 employees or more and
identified that 51% claim they offer wellness programs (Goetzel et al., 2014). Yet, even a
smaller percentage of these employers are implementing an effective evidence-based
comprehensive WHP (Goetzel et al., 2014; Taitel, Haufle, Heck, Loeppke, & Fetterolf, 2008).
Moreover, poor participation rates could prevent programs from ever realizing their full
potential. A recent study has indicated that 50%-75% of employees chose not to participate in a
WHP when offered the opportunity to do so. Studies suggest that there is a higher proportion of
female participants in WHP as well as significantly greater participation rate of individuals
IMPLEMENTATION OF A WELLNESS PROGRAM 6
between the ages of 30 to 59 (Merrill, Aldana, Garrett, & Ross, 2011). Organizations are even
using incentives to increase participation, yet some incentives could negatively impact behavior
change in the long term (Goetzel et al., 2014; O’Donnell, 2017). Historically, employers have
struggled to promote, sustain and increase participation in their WHPs, mainly because of a lack
of understanding of what drives employees to engage in those WHPs (Gingerich et al., 2012;
O’Donnell, 2017; Seaverson, Grossmeier, Miller, & Anderson, 2009). There are discrepancies in
WHP effectiveness in the workplace; however, there have been a multitude of researchers who
concluded that comprehensive WHPs that adopt best practices and create cultures of health do
produce positive outcomes for employers and employees (Goetzel et al., 2014).
Context of Inquiry
Modern Learning Academy (MLA)
1
is a private international school located in Southeast
Asia, which is one of the largest single campus international schools in the world. The school
was founded 61 years ago to provide an education for the children of American diplomats,
executives, and missionaries and is a non-profit school offering a preschool to grade 12
education to 4,000 students. The school has 642 employees and the average employee stays for
seven years. The employee demographics are 24 administrators, 377 faculty, and 241 support
staff. Approximately 75 percent of faculty members have obtained a master’s degree or higher.
The vision of MLA is to be an educational world leader, developing extraordinary
thinkers who are well-prepared for their futures. Three strategic anchors support the school’s
vision, one of which is to develop a culture of exceptional care and unwavering support for its
students. One way to help make this happen is for MLA to commit to helping employees feel
valued and cared for, which in turn, will create a ripple effect in students. The most important

1
Modern Learning Academy is a pseudonym used to protect the privacy of the actual academic institution that
was actually the focus of this study.
IMPLEMENTATION OF A WELLNESS PROGRAM 7
asset in an organization is its people and the ‘human’ resource should be nurtured and supported
(Bolman & Deal, 2013). When employees look after their wellness, productivity is increased, as
well as job satisfaction, while morale and organizational culture are improved (Fertman, 2015;
O’Donnell, 2017).
Furthermore, the Western Association of Schools and Colleges (WASC), the organization
that does the accreditation of MLA (WASC, 2014), cited healthy organizational culture as an
area of improvement for the school in their 2013-14 WASC Report (WASC, 2014). Since one of
the strategic anchors of MLA is extraordinary care, and healthy organizational culture was
identified as an area of growth, it is important for MLA to focus on improving organizational
culture and the well-being of employees. According to MLA Human Resource Director, John
Timsy, using the idea of “starting small, but dreaming big,” MLA created a WHP called
Working On Wellness (WOW) to address the issues around health care costs and improving
employee well-being in 2012 (J. Timsy, personal communication, May 22, 2017)
2
. This WHP is
organized under the umbrella of the Human Resource Department. There has been very little
evidence collected to evaluate the effectiveness of the WHP and yearly participation is not
known (F. Plymouth, personal communication, May 25, 2017). However, while employees
generally agree wellness is very important, there seems to be consistently low participation
overall in the WHP initiatives and events.
Moreover, MLA insurance broker and Asian IB Assistant Vice President, Catherine
Thomas, explained that between 2015 and 2016, insurance premiums increased by 33% for
overseas hires because MLA employees overspent on healthcare (C. Thomas, personal
communication, July 21, 2016). Improvements to the WHP need to also be considered in order

2
To protect their privacy, pseudonyms are used for all staff members interviewed for this study.
IMPLEMENTATION OF A WELLNESS PROGRAM 8
to hopefully stabilizing health care costs so insurance premiums can potentially be reduced at
MLA as well (C. Thomas, personal communication, July 21, 2016).
Purpose of the Study
The purpose of this study was to understand the phenomenon of why employees choose
to participate in the MLA WHP. It sought to understand promising practices utilized by
comprehensive WHPs and the barriers that hinder participation in WHPs. The following research
questions were addressed by this study:
1. Why do MLA employees participate in WHP?
2. What role, if any, do constraints play in MLA employees’ decision to participate
in the WHP?
Importance of the Study
There has been limited research into the creation and implementation of WHPs in
international schools. As international schools look at ways to retain healthy, effective,
employees in their organizations, findings from this study can be used to avoid potential
implementation barriers, as well as informing promising practices that can leverage employee
participation and program effectiveness. MLA has devoted resources and manpower to the
implementation of their WHP. Hence, it is important to understand the phenomenon of why
employees choose to (or not to) participate in the MLA WHP, and what factors could influence
participation and the well-being of MLA employees.
Limitations and Delimitations
The limitations of this study are with the sample of participants and the researcher. It is
acknowledged that the study was conducted within only one private international school in
Southeast Asia. Since the study was limited to one school, the research cannot be generalized for
IMPLEMENTATION OF A WELLNESS PROGRAM 9
other schools. The employee wellness program is unique to MLA. Furthermore, information
gathered from participants through surveys and focus groups discussions could have been biased,
as participants are all employees of MLA and could have felt hesitant in expressing their feelings
regarding any MLA programs. Finally, the researcher is a MLA employee and helps coordinate
the MLA WHP. The researcher acknowledges the possibility of being biased during this study
as well. However, Maxwell (2013) opined that since the “researcher is part of the world that he
or she studies—it is a powerful and inescapable influence” (p. 125).

IMPLEMENTATION OF A WELLNESS PROGRAM 10
Chapter Two: Literature Review
There is an increasing need for preventative measures to be taken to combat the rise of
non-communicable diseases worldwide (CDC, 2017a; WHO, 2017a; UN, 2018).
Since one-third of a person’s day is spent in their place of employment, it is vital that health
interventions be made within the workforce (CDC, 2016c). The workplace has a multitude of
opportunities to reduce NCDs because a large percentage of the working population can be
reached on multiple levels of influence on targeted behaviors (WHO, 2017f). The Center for
Disease Control website states that “a positive wellness culture in the workplace contributes to
the physical, mental, and emotional well-being of workers” (CDC, 2013b, n.p.).
This literature review provides the historical context, purpose, and promising practices of
WHPs, which emphasize the importance of employee wellness in the workplace. Additionally,
this chapter looks into what steps are necessary to assess, plan and design, implement, and
evaluate WHPs.
Workplace Health Programs
Health and wellness. One of the main constitutional principles of the World Health
Organization is that “health is a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity” (WHO, 2017g, n.p.). The potential and possibility of
having the highest attainable standard of health is a fundamental right of every human being
(WHO, 2017g). Good health enables people to realize their hopes and dreams, fulfil their needs,
and manage their environment in order to live a long, successful life (CDC, 2016e). Wellness is
the process of empowering people to increase control over their health and its determinants by
learning new life skills and becoming conscious of and making purposeful choices towards a
more balanced and healthy lifestyle (WHO, 2017d). This is all in regards to the dimensions of
IMPLEMENTATION OF A WELLNESS PROGRAM 11
wellness, which are: physical, emotional, social, intellectual, occupational, and spiritual (CDC,
2016e; O’Donnell, 2017). Some organizations even include environmental, cultural, and
financial wellness to this list (Auburn University, 2017; SAMHSA, 2017). Hence, it is important
to embed these areas of wellness into one’s daily life in order to strengthen and improve health
(SAMHSA, 2017). So, how does one do that?
Definition of workplace health programs. According to the Center for Disease
Control, “workplace health programs (WHP) are a coordinated and comprehensive set of health
promotion and protection strategies implemented at the worksite that includes programs,
policies, benefits, environmental supports, and links to the surrounding community designed to
encourage the health and safety of all employees” (CDC, 2017d, n.p.). WHPs have the capacity
to influence public policy at the organizational, local, regional, and national levels by its deep-
rooted socio-ecological model of health, which spans the individual, family, workplace,
community, and larger environment for health advocacy (Fertman, 2015). Furthermore, since
WHPs directly impact the physical, mental, economic and social well-being of employees, they,
in turn, also affect the health of employees’ families, community and society (WHO, 2017g).
Historical context for workplace wellness programs. There have been three distinct
phases in WHPs that have led to the promotion of healthy individuals and organizations
(Fertman, 2015; Kickbush & Payne, 2003). In the mid-19th century, the first phases of WHPs
were created to address unsafe working conditions, infectious diseases, and unsanitary conditions
(Fertman, 2015). During World War II, the transition from injury response to preventive
medicine became the focus for workplace health (Starr, 1982). Little was done to create safer
working conditions for the U.S. workforce until the Occupational Safety and Health Act of 1970
(Fertman, 2015), which was authorized by the US House of Representatives and Senate and that
IMPLEMENTATION OF A WELLNESS PROGRAM 12
attempted to provide for the general welfare of employees and establish safe and healthful
working conditions in order to preserve the ‘human resource’ in the workforce (OSHA, 1970).
However, work-related injuries and fatalities were still a significant threat to public health,
despite the federal measures (Fertman, 2015).
In 1970, the second phase within WHPs transpired when Marc Lalonde, Minister of
National Health and Welfare, released the ‘Lalonde Report’ titled, A New Perspective on the
Health of Canadians (Lalonde, 1974). The report is considered to be the first governmental
document in the modern Western world to recognize that our priority upon a biomedical health
care system is wrong, and that we must look beyond the traditional health care system if we hope
to improve the public health (Lalonde, 1974). This idea revolutionized health promotion because
it focused, not only on the need for people to take responsibility of changing their behaviors, but
also on the social, psychological, and economic determinants of health (Fertman, 2015; Navarro,
Voetsch, Liburd, Giles, & Collins, 2007). This phase in WHPs also pushed companies to think
about taking responsibility for more than just generating profits and jobs (Carroll, Lipartito, Post,
& Werhane, 2012). The rationale was that employee health was vital to an organization’s
performance and profits (Fertman, 2015). A cost analysis of WHPs demonstrated that the
promotion of employee wellness was not only cost-effective, but also a good return on
investment (ROI) (CDC, 2017b; WHO, 2016c). The other major apex of phase two came with
the launch of the American ‘Healthy People 2010’ program. Its goals were to increase the
number of workplaces that offered employee WHPs, as well as increased employee participation
in employer-sponsored health promotion (USDHHS, 2010a, 2015; Navarro et al., 2007). The
benefits of WHPs in the workforce were finally gaining significant attention (Fertman, 2015).
IMPLEMENTATION OF A WELLNESS PROGRAM 13
The third and current phase of WHPs focuses on a range of workplace health
determinants, such as personal, social, economic, and environmental factors and differences that
influence health status (CDC, 2017b; Fertman, 2015; ODPHP, 2017b). This is an ecological
approach to disease prevention and health promotion, centering on both levels of individuals and
the population within health and intervention. The health determinants fall into the categories of
policy making, social factors, health services, individual behaviors, and biology and genetics
(ODPHP, 2017a; WHO, 2017g). Organizational policy and procedures are notable in addressing
health determinants within wellness in the workplace (Fertman, 2015). For example, job
determinants addressed in WHPs are job strain, anxiety and physical illness (ODPHP, 2017b).
Examples of overall social determinants might be gender, quality schools, geographic location,
transportation options, ethnicity, social norms, sexual orientation, and exposure to mass media
and emerging technologies (ODPHP, 2017b). Presently, there are a growing number of tools and
resources for workplace health promotion to address health determinants in the workplace, all of
which fall under the dimensions of wellness.
Benefits of workplace health promotion. Over the years, numerous studies have been
done on the effectiveness and benefits of implementing WHPs (CDC, 2017d). Often, employers
hold WHPs to an extremely high standard of producing financial gains to justify their worth
(Goetzel et al., 2014). This viewpoint errs in its assumption that cost saving is the sole purpose
of WHPs and is the only result of interest (Goetzel et al., 2014; WHO, 2017f).
Based on evidence-based research, various health organizations and researchers have
cited the organizational benefits of WHP which, when implemented effectively, improved staff
morale, reduced staff turnover, reduced absenteeism, increased productivity, reduced health
care/insurance costs, reduced risk of fines and litigation, a well-managed health and safety
IMPLEMENTATION OF A WELLNESS PROGRAM 14
program, and a positive and caring company image for all stakeholders (CDC, 2016c; USDHHS,
2015; WHO, 2017f). Furthermore, effective WHPs have various employee benefits, such as
reduced stress, improved morale, increased job satisfaction, increased skills for health protection,
improved health, improved sense of well-being, enhanced self-esteem, and a safe and healthy
work environment (CDC, 2016d; USDHHS, 2015; WHO, 2017f). However, if the WHP is not
structured or designed effectively, it is unlikely that it will create positive results (Goetzel et al.,
2014). Besides the historical context of WHPs and why its benefits are so important, it is crucial
to further examine how WHPs affect employees and companies via an exploration of how
knowledge and skills play an important role in an effective WHP.
Knowledge and Skills of Workplace Wellness Programs
For improved participation in WHPs, it is important to discover whether people know
how (what and why) to achieve their goals (O’Donnell, 2017). WHPs play an important role in
providing employees with the knowledge and skills to lead happier and healthier lifestyles
(Fertman, 2015; Gantner; 2012).
Health awareness in workplace health programs. The origins of health promotion are
within health education as the focus is on the awareness of the unhealthy behavior risks such as
poor diets, excessive drinking or smoking, as well as the positive behavioral benefits like
physical activity, stress management, and regular health screenings (Fertman, 2015; O’Donnell,
2017). A positive outcome of effective WHP awareness campaigns is that they make people
conscious of health risks and health improvement options, as well the distribution of resources,
and where to find support for behavioral change (Fertman, 2015; O’Donnell, 2017). Moreover,
in order to bring awareness for the importance of living a healthy lifestyle, various health
campaigns aim to promote and educate the general population on topics such as healthy eating,
IMPLEMENTATION OF A WELLNESS PROGRAM 15
physical activity, adequate sleep, and stress reduction (CDC, 2016b; CDC, 2016c; WHO, 2017e).
Another reason for educational health campaigns is to mobilize through building support for a
plan or idea (O’Donnell, 2017). The big idea of designing a health awareness program is to
distribute information, reach those who are uninformed, and provide reminders for health
behaviors (O’Donnell, 2017).
Workplace health program health awareness at MLA. MLA has two programs that
are designed to educate employees and bring awareness to the school community. Its WHP Co-
Coordinator, Frank Plymouth, explained that each year the WHP helps support the cancer
awareness months for men (November) and women (October) by offering awareness campaigns
called Pinktober (women’s cancer awareness) and Movember (men’s cancer awareness) (F.
Plymouth, personal communication, May 25, 2017). During these months, WHP committee
members display cancer awareness posters around campus and include cancer prevention tips in
eNewsletters, as well as selling novelty items that employees and students can wear as reminders
about preventive health checks for cancer (F. Plymouth, personal communication, May 25,
1017).
Employee knowledge and skills. Health literacy is the level to which individuals have
the capacity to acquire, process, and understand basic health information and services need to
make appropriate health decisions (Seldon, Zorn, Ratzan, & Parker, 2000; WHO, 2017e). Health
literacy skills are an important factor in determining employees’ health outcomes (WHO, 2017e).
Increasingly, people search the Internet to determine a diagnosis or identify a medical condition
or problem (Fox & Duggan, 2013). People are looking for answers and solutions to personalize
and improve their health and wellness (Fertman, 2015), and knowledge and skill development is
a base for an effective WHP for employees (O’Donnell, 2017). It is vital to have the knowledge
IMPLEMENTATION OF A WELLNESS PROGRAM 16
and skills to commit to healthy behaviors as it increases perceived benefits to change behavior
and confidence to conquer barriers (Faghri & Buden, 2015). A peer-reviewed study of 47
multicomponent WHPs discovered that WHPs achieved long-term behavior change and
reduction of health risks among employees, and that the most effective programs offered general
health awareness initiatives for all employees, as well as targeted risk-reduction programs for
employees at high risk (Heaney & Goetzel, 1997; O’Donnell, 2017).
Workplace health program knowledge and skill development at MLA. There are
various WHP programs that provide MLA employees with the knowledge and skillsets to
develop healthy habits. One program, according to its WHP co-coordinator, Frank Plymouth, is
the 30-Day Wellness Challenge wherein participants choose from eight challenges that focus on
physical, social and emotional wellness, such as walking 10,000 steps a day, eliminating
processed sugars, or practicing mindful meditation for at least 20 minutes a day. During the
challenge, participants are provided a list of online resources and links to give them the
knowledge and skills to guide their success with the challenge (F. Plymouth, personal
communication, May 25, 2017). A second WHP initiative for developing employee knowledge
and skills around wellness are before- and after-school wellness courses offered on campus.
There are 18 course offerings each week that employees can join for free, or for a small fee.
These skill development courses are taught and led by MLA employees or local experts that are
qualified to instruct or coach their specific course such as yoga, water jogging, pilates, crossfit,
mindfulness, and zumba dance (F. Plymouth, personal communication, May 25, 2017).
Furthermore, according to HR Director, John Timsy, other WHP initiatives that are
implemented for developing employees’ knowledge and skillset around wellness are workshops
during the three in-service days each school year (J. Timsy, personal communication, May 22,
IMPLEMENTATION OF A WELLNESS PROGRAM 17
2017). WHP co-coordinators solicit employees to share their expertise in wellness areas or reach
out to before- and after-school wellness instructors to lead wellness workshops in the morning
and during the extended lunch break on the in-service day. Employees have a choice of 12-15
wellness workshops that they can sign up for, including areas of fitness, nutrition, relaxation, art
therapy, music therapy, and mindful walks in the rainforest (J. Timsy, personal communication,
May 22, 2017). Also, to support the numerous wellness courses offered on campus, MLA WHP
co-coordinators periodically arrange to have additional health and wellness experts present
informational sessions and workshops to interested employees on topics such as nutrition, cancer
prevention, mindfulness, and overall health prevention (F. Plymouth, personal communication,
May 25, 2017).
Moreover, the MLA WHP developed two large-scale wellness events that include the
greater MLA community. The MLA Family Fun Day is programmed and implemented by the
WHP co-coordinators and committee in order to provide employees and their families with an
enjoyable day on campus filled with wellness workshops, massage and foot reflexology options,
bouncy castles and carnival entertainment, as well as healthy snacks and a meal for all
participants (F. Plymouth, personal communication, May 25, 2017). This event not only
provides participants with health knowledge and skill development, but also nurtures social
health by providing a forum for employees and families to get to know each other in fun social
activities (O’Donnell, 2017). Also, in August 2014, WHP co-coordinators launched a MLA
Wellness Conference for employees and the greater Singapore community. The two-day
conference brought international experts and keynote speakers on happiness and mindfulness, as
well as local doctors and experts in the areas of exercise, nutrition, and social and emotional
IMPLEMENTATION OF A WELLNESS PROGRAM 18
well-being in order to share their knowledge and skill development in their specific areas of
wellness (F. Plymouth, personal communication, May 25, 2017).
Finally, a new WHP initiative called ‘Headspace’ was launched in September 2017 in
collaboration with its executive team. This personalized meditation app provides employees
with the information and skillset for mindfulness and stress reduction (F. Plymouth, personal
communication, May 25, 2017). Emerging evidence from studies has found that online
mindfulness-based interventions have the potential to reduce stress and improve mental health
outcomes (Spijkerman, Pots & Bohlmeijer, 2016).
Workplace health program knowledge and goal-setting. Setting specific goals leads
to higher performance, especially when a person attains the knowledge and skills to perform a
certain task (Marzano; 2007; O’Donnell, 2017). Goal-setting is important to the success of
health outcomes because it combines the knowledge of the desired outcome with the action steps
to get there (O’Donnell, 2017). George Doran (1981) created an effective and widely used
framework to define and manage goals and objectives called SMART goals. SMART goals help
move a person’s knowledge and skills into an actionable goal by utilizing the SMART acronym,
i.e., specific, measurable, achievable, realistic, and time-bound (CDC, 2015).
Once knowledge and skills are acquired, setting specific goals for performance increases
that performance by between 42% to 82% (Locke & Latham, 1990; O’Donnell, 2017).
Performance goals correlate with the attainment of specific knowledge and skills necessary to
reach a desired goal; however, there is greater engagement in learning and improved outcomes
when people explore their interests as well (O’Donnell, 2017). Nevertheless, before any specific
learning and performance goals are created, employees must have the knowledge of their overall
health (Fertman, 2015).
IMPLEMENTATION OF A WELLNESS PROGRAM 19
Goal-setting at MLA. According to MLA WHP co-coordinator, Frank Plymouth, there
are currently no initiatives that ask or require employees to create healthy SMART goals.
However, creating a SMART goal is a skill with which most MLA employees are familiar (F.
Plymouth, personal communication, May 25, 2017). During the online teacher appraisal process
called the Professional Growth Evaluation (PGE), supervisors require employees to create an
individual SMART goal as well as a Professional Learning Community (PLC) SMART goal
with other subject or grade-level team members (MLA TeachBoost, 2017). The knowledge
skillset to create a SMART goal for a personalized health action plan would be something that
could transfer from the PGE experience for employees (F. Plymouth, personal communication,
June 21, 2017).
Health screenings. Depending on insurance plans and coverage, many WHPs encourage
employees to get yearly health checks or health screenings with their medical doctor (CDC,
2016c), which is important because they provide an overall idea of their health (Fertman, 2015).
This involves the use of tests, physical examinations and other procedures in order to detect
disease early, even before a person shows or feels symptoms of an illness or disease. Early
detection and treatment result in better outcomes; and the screenings aim to detect health risks
such as obesity, hypertension, diabetes, high blood cholesterol, and certain cancers (MOH,
2015). Moreover, biometric testing can be done in the workplace by health professions for
screening purposes rather than diagnosis or treatment (Fertman, 2015). Some of the tests include
measurements of cholesterol, blood glucose, blood pressure, vision testing and BMI (Fertman,
2015; Gantner, 2012).
However, it is important to note that organizations that gather health information run the
potential risk of issues with various laws such as HIPAA, the ADA and the Genetic Information
IMPLEMENTATION OF A WELLNESS PROGRAM 20
Nondiscrimination Act (GINA) (Plump & Ketchen, 2013; O’Donnell, 2017). Employment or
termination of employment cannot be based on a person’s health records (Mello & Rosenthal,
2008). The proper filing of documents could be done easily by keeping medical and personal
information on employees separate, and in the case for MLA, Asian IB Insurance broker could
help separate this medical information from the school.
Health risk assessments. To facilitate employees’ understanding of the link between
their lifestyle behaviors and quality of life, WHPs normally offer Health Risk Assessments
(HRAs) to employees (Fertman, 2015; O’Donnell, 2017). These lifestyle questionnaires focus
on whether employees are meeting public health standards and recommendations from
government agencies (Fertman, 2015). HRAs are useful because they encourage health
awareness by reviewing employees’ individual lifestyle habits (physical, mental, social,
emotional well-being, etc.) and reveal health issues that could be impacted by personal choices
(O’Donnell, 2017). Nowadays, HRAs are largely computerized, with a variety of programs and
platforms for assessments (Fertman, 2015). Many HRAs are accompanied by online tracking
systems by commercial vendors (O’Donnell, 2017).
Health screenings and assessments at MLA. Through the school’s insurance
providers, all MLA employees are able to receive yearly health screenings or medical
examinations (J. Timsy, personal communication, May 22, 2017). Employees who are on a local
insurance plan are able to go to a specific medical provider and get their MLA customized and
comprehensive health screening. Employees who are on the overseas health insurance plan can
get their health screening done anywhere in Singapore and be reimbursed up to $450 USD. This
health benefit is communicated to employees through the HR department directly, as well as
promoted through the WHP program. Many employees take advantage of this benefit; however,
IMPLEMENTATION OF A WELLNESS PROGRAM 21
the MLA HR Department is not able to release the exact number. Furthermore, in March 2018,
the MLA WHP Co-Coordinators arranged to have health screenings offered on campus. The
free basic screening package offered full cholesterol (lipid) profile, blood glucose, blood
pressure, and body mass index. Employees could also choose to top-up their package to a more
comprehensive, premium package. It is estimated that over 25% of all MLA employees utilize
this opportunity onsite. It is important to note that the data collection for this research study was
done before MLA employees participated in the on-site health screenings. Finally, since
implementation of WHP at MLA, there have not been any research-based health risk assessments
presented to employees, only the promotion of health screenings.
Knowledge of available workplace health program initiatives. In general, it is crucial
for the organization’s WHP to have a planned communication strategy for employees to know
what interventions and events are being implemented (O’Donnell, 2017). Every employee
within the organization should know what the WHP is doing and why (NIOSH, 2008). There
needs to be a direct connection between the WHP decision makers and the employees in the
program (Gantner, 2012). If not, the WHP designers might have a great concept or program, but
because of lack of knowledge and information about the program given to employees, they might
have little interest in it (O’Donnell, 2017). Moreover, without proper awareness of what the
WHP can offer employees, many employees might miss out on certain opportunities (Fertman,
2015).
Available workplace health program initiatives at MLA. Several MLA WHP
initiatives were discussed in this chapter. The health awareness level initiatives include the
cancer awareness health promotion programs called Pinktober and Movember. The knowledge
and skill development level initiatives are comprised by the 30-Day wellness challenge, before
IMPLEMENTATION OF A WELLNESS PROGRAM 22
and after-school wellness courses, in-service day wellness workshops, various workshops and
courses led by doctors and health experts, as well as Headspace online mindfulness program.
Additionally, there are two large-scale programs that include employee families (MLA Family
Fun Day) and the greater Singapore community (MLA Wellness Conference). Moreover, as
mentioned earlier, the HR Department and WHP promote yearly health screenings by providing
funds towards these health checks and on-site health screenings.
Other current MLA WHP are the Telluride Mountainfilm Festival and various charity
race events around the country. The Telluride Mountainfilm Festival is coordinated by the MLA
Library Media Specialists for all students but involves the WHP because the employee film
screening is hosted by the MLA WHP (F. Plymouth, personal communication, May 25, 2017).
An event like this supports social health by creating an enjoyable way for employees to spend
time together (O’Donnell, 2017).
The final initiative currently implemented by the MLA WHP program is the promotion of
various charity races around the country. As an organization, WHPs support local organizations
by encouraging employees to participate in community events such as charity races (O’Donnell,
2017). MLA WHP covers the race entry fees for three annual charity race events. Employee
participation in public events also makes a statement about the organization’s encouragement
towards wellness (O’Donnell, 2017).
Limitations of knowledge. In the 1970s and 1980s, the belief was that if people had the
right information and education, they would make healthy choices (Fertman, 2015). Though
years of research, we have learned that education is not enough to change behavior for most
people, because if knowledge was enough, everyone would exercise and no one would smoke
(Fertman, 2015; Gantner, 2012). Programs designed to enhance health awareness increase
IMPLEMENTATION OF A WELLNESS PROGRAM 23
knowledge, but have very little impact on behavior (O’Donnell, 2017). A huge shortcoming of
awareness programs is that they advise people on what to do, but not how to do it (Fertman,
2015; O’Donnell, 2017). WHPs that build skills help employees to change specific health
behaviors, such as increasing physical activity or quitting smoking, and improve their personal
lifestyles (O’Donnell, 2017).
Skill-building programs within WHP demonstrate how to perform and integrate healthy
behaviors into their lives (O’Donnell, 2017); yet, those who complete these programs often
regress to old habits and unhealthy lifestyles (CDC, 2016e; O’Donnell, 2017). Long-term
changes are more likely to happen when employees are given the opportunity to make a healthy
choice the easiest choice and change their environment to incorporate the changed behavior
(Gantner, 2012; O’Donnell, 2017). This chapter will talk more about supportive healthy cultural
environments under the ‘organizational’ section.
In concluding this discussion of the knowledge and skills components of WHPs, one
must not forget the importance of determining whether people know how to achieve their goals
(Clark & Estes, 2008). It is crucial to first lay the foundation of knowledge and skills in order
for employees to achieve their goals. However, once knowledge and skills are acquired, how do
we motivate employees to work towards their goals and persist until they are achieved (Clark &
Estes, 2008)?
Motivation within Workplace Wellness Programs
Motivation. Motivation is the psychological process that gets us moving, keeps us
going, and assists us to get the job done (Bandura, 1997). One of the broadest gaps in WHP
organizational knowledge is the overall understanding of how to motivate employees within
those WHPs (O’Donnell, 2017). Depending on the organizational culture, strategies that
IMPLEMENTATION OF A WELLNESS PROGRAM 24
empower employees can have both positive and negative effects on motivation (Clark & Estes,
2008).
It is important to consider different motivational factors, such as self-mastery,
achievement, competition, hopes, social acceptance, etc. because people are different in regard to
what drives them (Gantner, 2012). In a WHP, it simply will not work to try and motivate an
employee with social acceptance if they are only interested in self-mastery so choosing the right
incentives and offering a variety of choices are crucial for behavioral change (Gantner, 2012).
Importance of motivation with workplace health programs. For most people,
changing behaviors means unlearning and relearning a skill, which can be uncomfortable or even
intimidating (Gantner, 2012). When experienced, intelligent people lack persistence, direction
and energy to work, they most often are this way because they are unmotivated (Clark & Estes,
2008). There is greater pursuit of behavioral changes when employees are invited to do so with
choice, guidance, and positive motivational messaging instead of communications of fear
(Gantner, 2012).
In a study done by Merrill et al. (2011) to assess the effectiveness of WHP, the reasons
for and benefits of creating organizational WHPs were clear; however, approaches to attaining
desired outcomes widely differ. Some programs strive to motivate healthy behavior through
education, others through monetary incentives, or wellness coaching, worksite facilities, free
health screenings, or through company wellness activities, etc. In actual fact, a combination of
these approaches are normally used and customized to fit the needs of the employees (Merrill et
al., 2011).
Employee engagement. Workplace well-being and engagement indicate the extent to
which employees are cognitively and emotionally devoted to and satisfied in their workplace role
IMPLEMENTATION OF A WELLNESS PROGRAM 25
(Parker & Martin, 2009; Saks, 2006). Within the workplace, engaged employees bring their
entire selves – cognitive, emotional and physical – to their work (Kahn, 1990). Employee
engagement in an organization is associated with positive outcomes and higher levels of job
performance (Bakker, 2011; Khan, 1990; O’Donnell, 2017). Undoubtedly, employees who
acknowledge greater value in WHP initiatives react with higher levels of engagement (James,
McKechnie, & Swanberg, 2011; Keysor, 2015). Yet, this correlation is contingent on the
perceived value of the WHP, which can vary depending on the individual, context, and
environment (Brough & O’Driscoll, 2010; Keysor, 2015). Furthermore, while there is a positive
relationship between wellness program participation and employee performance, the reasons
motivating employee decisions to participate in a WHP have been less often investigated and
rarely understood (Baicker, Cutler, & Song, 2010; Goetzel et al., 2011; Mattke et al., 2012).
Work environments that engage employees. In a survey of the American workforce,
half of all responding employees intending to look for a new job in the next year said it was
because they did not feel valued at work (APA, 2012). Moreover, in comparison with some
other professions, educators display high levels of exhaustion and cynicism, which are linked
with work burnout (Hakanen, Bakker & Schaufeli, 2006). In addition, studies suggest that
employee healthy behaviors and stress levels are influenced by workplace norms (Hoert, Herd, &
Hambrick, 2016). Lack of confidence or support to commit to healthy behaviors is something
reported by many highly stressed employees (Hoert et al., 2016). Coping strategy interventions
have been the subject of much research because those that are effective have been identified as a
fundamental intervention in helping build higher levels of well-being and engagement, while
defending teachers from the negative effects and high demands they face on a daily basis
(Cooper, Dewe, & O’Driscoll, 2001; Parker & Martin, 2009).
IMPLEMENTATION OF A WELLNESS PROGRAM 26
Furthermore, when WHPs help increase intrinsic motivation in employees, it can lead to
elevated feelings of autonomy, which makes work more meaningful (O’Donnell, 2017). Helping
employees develop self and team confidence in work skills, as well as creating a positive
emotional environment for individuals and teams, are ways to increase motivation (Clark &
Estes, 2008). Also, research has found that interventions that focus on a person’s self-perception
of their own ability to deal with daily setbacks and challenges, “resilience” and “buoyancy,” also
effectively enhance workplace well-being (Parker & Martin, 2009).
Additionally, there have been several research studies that suggested WHP employee
participation increases when health promotion is supported by organizational leaders (Fertman,
2015; O’Donnell, 2017). If there is lack of trust in leadership and management, often efforts to
change behaviors are met with resistance or even skepticism (Gantner, 2012). If employers
increase and strengthen existing WHP programs and invest in human capital within WHPs, while
implementing a safe and trusting environment, employees are far more likely to focus on their
health and change poor behaviors (Gantner, 2012). When organizations integrate and organize
occupational safety and health with a WHP, it is possible to increase employee participation and
program effectiveness, which can also benefit the vast context of work organization and
environment (CDC, 2017e).
Supportive WHP environments include a supportive culture, policies, programming, and
facilities. Access to opportunities to practice a healthy lifestyle is a crucial factor in helping an
employee advance from building new skills to forming healthy habits. A WHP program that has
a supportive environment, which includes leadership support, continual incentives to practice
healthy behaviors, and extensive wellness facilities, will have a greater chance of success than a
less intensive WHP program (O’Donnell, 2017).
IMPLEMENTATION OF A WELLNESS PROGRAM 27
Finally, a common environmental support for physical activity is onsite fitness facilities
and, if staffed with trained fitness professionals, effectiveness is increased in reaching inactive
employees (O’Donnell, 2017). WHPs must have comprehensive facilities and equipment plans
that ensure safety of participants, as well as a plan to maximize efficient use of the space
(Fertman, 2015; O’Donnell, 2017). Moreover, WHPs can encourage participation in community
wellness by connecting employees to local health-orientated businesses, as well as wellness
professionals (Fertman, 2015; O’Donnell, 2017).
MLA workplace health program environment. Frank Plymouth shared that in an
MLA employee culture and climate survey from the 2013-14 school year, the MLA leadership
team and employees focused on areas such as reducing the amount of yearly initiatives and
fostering a supportive healthy organizational culture. As a result, these areas have shown
improvement since that time and continue to be under the MLA school leadership’s purview.
The MLA WHP, however, is not connected to the MLA culture and climate committee and its
initiatives but does try to foster a sense of community that is focused on health and wellness
through its program initiatives. The MLA WHP has brought in speakers and presenters on
mindfulness for stress-reduction techniques, which employees can join if they wish (F.
Plymouth, personal communication, May 25, 2017).
The leadership team in MLA’s central administration has been supportive of WHP
initiatives, but they have not played a large role in initiatives and program decision as the MLA
WHP does not have a formalized committee with the involvement of MLA leadership (F.
Plymouth, personal communication, May 25, 2017). According to Superintendent John Knight,
the visibility of the MLA leadership team was another topic addressed in the 2013-14 culture and
IMPLEMENTATION OF A WELLNESS PROGRAM 28
climate employee survey, and MLA leadership has worked on this as well (J. Knight, personal
communication, September 8, 2015).
In regard to tracking employee engagement, the MLA WHP does not have a database of
employee engagement. Also, every WHP initiative has been voluntary. There are records of
who has signed up for different wellness initiatives and events, but attendance has never been
taken at those events (F. Plymouth, personal communication, May 25, 2017). In general, most
WHP initiatives have seen increased employee engagement over time, but participation
percentages have never been studied.
MLA is built on over 30 acres of land with state of the art facilities. It is one of the
largest single campus K-12 schools in the world (MLA, 2017b). As explained earlier in this
chapter, MLA employees have access to a variety of before- and after-school wellness courses
that take place on campus. Some of the facilities include 25-meter swimming pools, innovative
workout facilities, fitness and dance studios, as well as multiple gymnasiums, fields and an
outdoor running track (MLA, 2017b). Group rooms, music and art rooms are also used for
different courses such as art therapy, music jam sessions, mindfulness meditation, cooking
classes, and massage & foot reflexology options (F. Plymouth, personal communication, May
25, 2017). Even though MLA has various facilities available on campus, employees are not
allowed to use them for their personal wellness during the school day and are only to use the
facilities before or after-school, depending on their availability when students are not using them.
Also, the main start time for employee programs is 4:30 pm because that is when facilities are
usually available to employees; however, most employees at SAS finish their teaching day at
3:15pm or 3:30pm.
IMPLEMENTATION OF A WELLNESS PROGRAM 29
Workplace health program incentive initiatives. O’Donnell (2017) claimed that
rewards and punishments associated with different actions are incentives, which can be hidden or
explicit, that work in a variety of ways for different people. He argued that, in order to impact
behavior, an employee must see a distinct connection between their action and the result
(O’Donnell, 2017). It is challenging to convince employees to stay healthy by changing
unhealthy behaviors (Gantner, 2012). This is why over 70% of WHPs use some sort of incentive
system to promote participation and achieve greater success because of it (Anderson,
Grossmeier, Seaverson, & Snyder, 2008).
As further evidence of the importance of incentives within WHPs to increase
participation, the US National Institute of Occupational Safety and Health (NIOSH) suggested a
key element of an effective WHP is the consideration of incentives and rewards (CDC, 2017e;
NIOSH, 2008). In order to create effective incentives, they must be person-centered and timely,
provide choices and evolve over the continuation of the WHP (Gantner, 2012). When creating
incentives, Gantner (2012) suggested one approach is to begin with an extrinsic reward to inspire
participation, then over time, move to progress-based outcomes, full outcomes, social incentives,
and then finally to intrinsic incentives for long-term, sustainable behavior change. Resources
either intrinsically motivate engagement by fulfilling internal psychological needs, or
extrinsically motivate engagement by providing employees incentives and rewards to achieve
work related goals (Bakker, 2011; O’Donnell, 2017).
Intrinsic incentives. Intrinsic incentives are driven by interest or enjoyment and involve
internal feelings within an individual (O’Donnell, 2017; Seifert et al., 2012). This type of
incentive motivates behaviors because it feels good or brings happiness (O’Donnell, 2017).
WHP resources that promote healthy behavior due to interests, enjoyment, or even the reflective
IMPLEMENTATION OF A WELLNESS PROGRAM 30
process of external goals are what creates psychological well-being and intrinsically bolsters
engagement (Parker, Jimmieson, & Amiot, 2010). WHPs can increase employees’ motivation to
progress with creating healthy habits by helping them set goals that they are confident they can
achieve, and as they receive feedback on their progress, WHP also help to increase intrinsic
motivation of employees (O’Donnell, 2017).
To build intrinsic motivation for change, individuals need to discover their own rewards
for healthy behavior, be supported within a healthy organizational culture to construct their own
goals, strengthen their own health knowledge, and be accountable on their own action steps
(Seifert et al., 2012). Moreover, Gantner (2012) emphasized that “prosocial motivation” is the
desire to protect and promote the well-being of others. Research supports the idea that prosocial
motivation strengthens intrinsic motivation, which is predictive of productivity and persistence in
the workplace (Gantner, 2012). Prosocial motivation could play an important role within a
school setting as studies show that teachers can promote intrinsic motivation in education and
learning (Gantner, 2012; O’Donnell, 2017).
Extrinsic incentives. Extrinsic incentives are external rewards or punishments that
motivate people to performing a specific behavior (O’Donnell, 2017). In general, successful
WHP use rewards to drive participation rates up (Gantner, 2012; O’Donnell, 2010). Some
examples of such incentives are insurance premium reductions, raffles, cash, and gifts (Gantner,
2012). Some organizations transfer attention from participation to outcomes, rewarding people
for the small steps they attain on their quest to achieving a major health goal (Gantner, 2012;
O’Donnell, 2017).
This concept supports connecting incentives to outcomes to enhance WHP engagement
and sustained behavior change (Gantner, 2012). According to O’Donnell (2017), two studies
IMPLEMENTATION OF A WELLNESS PROGRAM 31
showed that WHPs with well-developed marketing efforts and strong leadership support had
participation rates in the 20% to 40% range, while those that also offered financial incentives to
participate had rates in the 70% to 90%. Many of those in the highest percentage range
integrated their incentives within their health plan design.
Financial incentives. A meta-review examined the impact of economic incentives for
motivating healthy behaviors, and the authors found that economic incentives seem to be
effective in the short term for basic preventative care (Kane, Johnson, Town, & Butler, 2004;
O’Donnell, 2017). The level of monetary incentives does not need to be excessive in order to
encourage participation in WHPs (Merrill et al., 2011). For example, a large empirical study of
559,988 employees explored how different levels of financial incentives impacted participation
in health risk assessments offered by employers (Anderson et al., 2008; O’Donnell, 2017). The
results showed that smaller incentives values (below $100) provided a greater positive trend in
participation than higher incentive values (Kane et al., 2004; O’Donnell, 2017).
According to O’Donnell (2017), it is important to understand why financial incentives
within WHPs are gaining popularity, especially among large, self-insured employers where the
full cost of the WHP is included in the organizational medical plan costs. Many of these self-
insured employers are integrating WHP financial incentives into medical plan premiums, so that
through these incentives, the amount of an employee’s health plan premium is in part connected
to their success in participating in programs or achieving health goals (O’Donnell, 2017). The
result is that employees who choose not to participate in the WHP pay the highest premiums, and
those who choose to participate in the WHP to achieve their health goals pay the lowest
premiums. Grounded in empirical literature related to program participation and equity, a major
driver for WHP financial incentives in the US is section 2705 of the Affordable Care Act
IMPLEMENTATION OF A WELLNESS PROGRAM 32
(O’Donnell, 2017). As a tenet of the Act, the Secretaries of Health and Human Services and
Treasury allow employers to provide up to a 50% discount on the total health plan cost for
employees who participate in WHPs or meet health standards (O’Donnell, 2017). O’Donnell
(2017) posited that this financial approach will gain momentum in future years and is likely to be
refined as employers gain more experience.
Incentive initiatives at MLA. The MLA WHP has a mix of incentives within the
program initiatives. Frank Plymouth shared that the majority of the WHP initiatives have
intrinsic motivation at the core where the purpose is to create enjoyment for employees and
allow them to feel good. However, many of the programs offer small incentives for participation
in events and activities. For example, the WHP might provide healthy snacks or a lucky draw at
the Telluride MountainFilm festival to lure more people to participate. Another way the WHP
has extrinsically motivated healthy outcomes for employees is by setting challenges and
rewarding outcomes of completion with the 30-Day Healthy Lifestyle challenge. The prizes for
completion are usually small mementos like water bottles, workout towels, and/or reusable lunch
bags for packing healthy lunches. These are to encourage further healthy active lifestyles (F.
Plymouth, personal communication, July 20, 2017). Furthermore, MLA Wellness Co-
Coordinators offer wellness goodie bags, which include discount offers and free items to families
that attend the annual Family Days for employees. It should be noted that, currently, MLA does
not have a wellness initiative that encourage employee healthy goal-setting in order to meet
certain health standards towards a reward in the reduction of insurance premiums or other
financial incentives.
Limitations of workplace health program motivation. In terms of employee
motivation to participate in WHPs, incentives and rewards for participants may encourage
IMPLEMENTATION OF A WELLNESS PROGRAM 33
engagement, yet poorly designed incentives may have unintended adverse consequences by
creating a sense of “winners” and “losers” (NIOSH, 2008). Incentives cannot discriminate and
need to be fair (O’Donnell, 2017). Also, studies have shown that some types of motivation
hinder long-term commitment, for example, when incentives are given for smoking cessation or
weight loss (O’Donnell, 2017). Furthermore, while a bit of competition can be a very motivating
experience, excessive rivalry can create a destructive level in which attention is focused away
from performance goals (Clark & Estes, 2008).
Moreover, NIOSH (2008) also emphasized the need to have incentives and rewards
aligned with program objectives, because without alignment, they are not as effective. Finally,
when change efforts are based on extrinsic motivational factors, they tend to fail in the long run,
yet intrinsic motivations and outcome-based incentives result in sustainable behavior change
(Gantner, 2012). Hopefully, as WHPs continue, developers will turn some of the external
financial incentives into incentives that employees inwardly value through social and intrinsic
motivators. Also, even with incentives, there is a potential barrier in relation to levels of
employee motivation to participate in WHPs. Employees who think or know they have critical
health risks may be least likely to participate in an WHP (Soler et al., 2010). This can make
health promotion challenging for any organization.
In conclusion, it is important to remember that motivation is the product of the synergy
between people and their work environment (Clark & Estes, 2008). Exceptional employee
performance within organizations is a mosaic of passion, belief, expectations, and expertise
(Clark & Estes, 2008). Research on motivation has distinctly established that in order to engage
employees in long-term behavior change, an amalgamation of extrinsic and intrinsic motivators
is needed to effectively engage individuals in long-term behavior change; especially intrinsic
IMPLEMENTATION OF A WELLNESS PROGRAM 34
motivation is essential for sustaining change (Benabou & Dirole, 2003; Seaverson et al., 2009).
A supportive culture, policies, programming, and facilities are essential when creating effective
WHP environments for employee engagement (O’Donnell, 2017). When considering all this
research on knowledge, skills, and motivation, the question is “how do WHPs plan and structure
a program to entice employee engagement?”
Organization of Workplace Health Programs
Organizational culture and wellness culture. Culture is the beliefs, goals, core values,
emotions, and processes learned as people progress long-term in families and work environments
(Clark & Estes, 2008; Schein, 2010). Work culture is who we are, what we value, and how we do
what we do as an organization, which is ever present in our unconscious and conscious
understanding (Clark & Estes, 2008; Schein, 2010). It would be difficult to find a workplace in
which employee health is not a value held by everyone, but it is one of many values that compete
for time and energy within an organization (Fertman, 2015).
A wellness culture is a social environment within the workplace that nurtures an
individual’s initiative to adopt healthier lifestyles, values and promotes healthy options for well-
being, and supports social influences that lead all people toward healthy behavior regardless of
their background (CDC, 2015; Fertman, 2015; Goetzel et al., 2014; O’Donnell, 2017). For
example, setting a positive wellness culture could be a worksite cafeteria that provides healthy
foods for employees, or a workplace norm where employees can use their break time for physical
activity, not just smoke breaks (Gantner, 2012).
Support for wellness culture within the workplace is growing. A 2016 survey of 1,248
organizations representing about 13 million employees found that 83% of these organizations
aspire to achieve a strong culture of wellbeing (Buck Consultants, 2016; O’Donnell, 2017). The
IMPLEMENTATION OF A WELLNESS PROGRAM 35
success of the WHP is dependent on the organizational environment, which can either support or
reduce the effectiveness of the overall program (Aldana et al., 2012). A WHP must involve
company leaders in fostering a culture of wellness in order for the program to be successful
(Fertman, 2015; Goetzel et al., 2014; O’Donnell, 2017). It has been found that talented people
leave their place of employment when they know their supervisors do not share their values,
demonstrate compassion towards others, or show any interest in their personal growth (Gantner,
2012; Sinek, 2009). In addition, Gantner (2012) posited that “the message for building great
WHPs is that organizational culture must change before individual and interpersonal behaviors
do” (p. 39).
Furthermore, healthy culture within a company is more than just checking off a list. A
team of researchers working with the Robert Wood Johnson Foundation (2014) visited
employers that embody a culture of health. In their visits, the researchers discovered that well-
being is woven into the organizational fabric (Goetzel et al., 2014). They found that
organizational executives create cultures of wellness, not just because it is the right thing to do,
but because they believe that when health and well-being are embedded in the organization’s
norms, values, and beliefs, then business metrics (revenue, profit, reputation, etc.) are enhanced
(Goetzel et al., 2014). If creating a culture of wellness and an effective WHP brings increased
participation in healthy behaviors and success to workplace, then what are the organizational
steps to setting it up? Organizational steps to establish a WHP in terms of best practices in
designing effective wellness programs are discussed further in this chapter.
Healthy organizational culture at MLA. According to the MLA Strategic Plan for
2020, the school will create a culture of extraordinary care that supports and advocates for all
students (MLA, 2016a). One way to help make this happen is to have every MLA leader and
IMPLEMENTATION OF A WELLNESS PROGRAM 36
employee help nurture a positive organizational culture that values people and that, in turn,
creates a ripple effect to all (Gantner, 2012). Bolman and Deal (2013) posited that “the most
important asset in an organization is its people and this human resource should be nurtured and
supported” (p. 22).
However, during the MLA accreditation review done by the Western Association of
Schools and Colleges (WASC), the main area of growth for MLA was to establish and maintain
a healthy organizational culture (MLA WASC Report, 2016). Over 75% of faculty and staff at
MLA have a masters or doctorate degree (MLA Annual Report, 2016). Through specialized
training and professional development, these individual have acquired their skills and education
to make significant investments in the human capital (Wheelan, 2010). Yet, employee surveys
on climate and culture display a dissatisfaction, and an area for growth with organizational
culture (J. Timsy, personal communication, May 22, 2016). Therefore, in 2014, a climate
committee was formed at MLA to address the climate and culture issues within the organization
(F. Plymouth, personal communication, September 7, 2014). Over the years, the MLA Climate
Committee and MLA WHP have functioned separately within the organization (F. Plymouth,
personal communication, May 25, 2017).
Another of the six institutional commitments for employees at MLA is to create healthy
organizational culture (MLA, 2017b), which entails participation in school events, work
committees, curriculum development, student activities, and/or projects beyond the scope of
duties. Employees are to sustain a collaborative culture and seek resolution to problems or
conflicts. The MLA six institutional commitments are a part of the faculty performance
appraisal system and faculty members share evidence of this area with their direct supervisor
each year (MLA, 2017b).
IMPLEMENTATION OF A WELLNESS PROGRAM 37
Again, a healthy organizational culture is a priority at MLA; however, MLA WHP
initiatives have not yet been specifically linked with healthy organizational goals set by
administrators. This is despite the fact that social unity plays an important role in enhancing
employees’ well-being, and people and organizations have more success when they get along,
feel they belong, and trust one another (O’Donnell, 2017).
Designing an effective wellness program. WHPs have been proven ineffective when
they simply orchestrate health risk assessment surveys or offer health improvement websites for
employees. Moreover, researchers have found that “cookie cutter” programs offered by health
vendors also fail if they are not integrated into the organizational culture or lack leadership
support (Goetzel et al., 2014). Many programs have been deemed unsuccessful or ineffective, so
the question arises as to “how do we go about designing an effective WHP that also attracts
participation of employees” (O’Donnell, 2010)? There are various WHP approaches to
addressing health concerns of employees, and these perspectives should adapt and change to
reflect individuals’ and organizations’ experiences, expectations, and dissatisfactions (Fertman,
2015).
Through extensive research, the US Centers for Disease Control and Prevention (2016c)
constructed a workplace health model that companies and organizations can use as a blueprint
when designing and developing a WHP. According to CDCs’ (2016c) Workplace Health Model,
the approach to WHP should integrate sound planning and organization, a comprehensive set of
programs, policies, benefits and environmental supports, in order to meet all employees’ health
and safety needs. The WHP model is important because supporting evidence shows WHPs
utilizing interventions that take integrated and coordinated approaches to diminishing health
risks to employees are more effective than traditional secluded programs (CDC, 2016c;
IMPLEMENTATION OF A WELLNESS PROGRAM 38
O’Donnell, 2017). The CDC (2016c) has formulated four steps to guide organizations towards
building an effective WHP: (a) conduct a workplace health assessment, (b) plan the program, (c)
implement the program, and (d) determine impact through evaluation. The CDC Workplace
Health model is utilized to describe the organizational structure of WHPs.
Workplace health program assessments. Information on both current health status and
ideal health status of employees is needed to understand how the health and wellness of these
employees might be improved (Fertman, 2015). This can be done through a needs assessment
using the four steps of (1) determine the scope of the assessment, (2) gather data, (3) analyze the
data, and (4) report the findings. Moreover, health insurance provider data can be a primary
source of information for WHPs, within legal restrictions (O’Donnell, 2017).
The WHO (2017f) Workplace Health Model states that the information gained from a
workplace health assessment allows the WHP developers to tailor their programs to suit the
workplace, meet employee needs, and address the organizational health goals. Furthermore, it
creates an opportunity to define employee health and safety risks and concerns, and to identify
barriers within the program (WHO, 2017f). The assessment can also be done informally through
conversations, or by using instruments such as employee health surveys (O’Donnell, 2017).
WHP founders need to conduct an overall workplace health assessment in order to learn about
best practices and implementation strategies for science-based health promotion (CDC, 2017f;
Goetzel et al., 2007; HERO, 2016; O’Donnell, 2017). There are various workplace capacities for
health assessments that can examine the operational support for WHPs, which then provide early
insight into culture and climate of a workplace (Fertman, 2015). One of the most frequently used
WHP assessments is the CDC Worksite Health Score Card (O’Donnell, 2017), which helps
employers to determine if they have implemented an evidence-based WHP in their workplace
IMPLEMENTATION OF A WELLNESS PROGRAM 39
(CDC, 2017f; Fertman, 2015). Another frequently used WHP assessment is the Health
Enhancement Research Organization (HERO) Health and Well-being Best Practices Scorecard,
which is designed to aid organizations to learn about best practices and determine what is
necessary for improvement and progress over time (Fertman, 2015; HERO, 2017).
A health assessment will also allow users to prioritize interventions and programs to meet
current health issues and employee interests. Involving employees from the beginning will
create buy-in, responsibility for and commitment to the WHP. In regard to employee
assessments to gather information directly from employees, the CDC (2016f) offers various
resources and tips for designing and delivering a quality survey to employees. Also, there is a
CDC assessment module that distributes tools, resources and guidelines for conducting a
workplace health assessment (CDC, 2015).
Workplace health assessments at MLA. According to HR Director, John Timsy, there
has been no formal health assessment of employees done at MLA. Moreover, there has been no
HERO Score Card or CDC Worksite Health Score Card conducted for overall WHP assessment.
According to MLA WHP Co-Coordinator, Frank Plymouth, throughout the tenure of the WHP at
MLA, there have been various informal assessments conducted by program coordinators in order
to gain employee perspectives and interests in events and initiatives (F. Plymouth, personal
communication, June 5, 2017). WHP founders within MLA have been open to employee
suggestions and different program initiatives, as well as wellness experts have been invited to
MLA because of employee recommendations.
Planning the program. Planning a WHP requires a series of decisions based on the
collection and analysis of a wide range of information (Fertman, 2016). A mindful planning
stage should come before any implementation WHP programs, policies or interventions (CDC,
IMPLEMENTATION OF A WELLNESS PROGRAM 40
2016c). This phase allows for the determination of WHP goals, prioritizing interventions, and
creating an organizational infrastructure (CDC, 2017d). To increase participation, it is important
to focus on developing the WHP, and not just the end results (O’Donnell, 2017). Fertman (2015)
posited that the focus should be on working with people, rather than for them, involving
employees and employers in the WHP design, ensuring all understand the implementation, and
use evaluation tools that are clear to all involved.
Workplace health program connection with mission and vision. A key component
for successful organizational change is to have a clear vision and a solid process for reaching that
goal (Clark & Estes, 2008; Reeves, 2016). A first and critical planning step to the successful
design of a WHP is to establish a clear connection between the WHP and the corporate mission
and vision statements (Fertman, 2015; Goetzel et al., 2014; Hoert, Herd, & Hambrick, 2016;
O’Donnell, 2017). This connection needs to be directed and supported by the top leaders within
an organization (Fertman, 2015). In fact, having strong top management support is one of the
characteristics of the best health promotion programs (O'Donnell, 2017). This is not about
leaders satisfying every stakeholder, but rather how to best serve their ultimate purpose through
mission and vision (Reeves, 2016).
Structure and alignment with goals. Successful WHPs are designed to achieve various
organizational goals, including reducing absenteeism, reducing health care expenditures,
improving the corporate image, and increasing work output and productivity (O’Donnell, 2017).
As mentioned before, it is important to align the culture of any organization with all the
important policies, procedures, and communication within that organization (Clark & Estes,
2008). To achieve various organizational goals for wellness, the right people need to be
involved (Fertman, 2015), with the governance structure of the WHP providing the leadership,
IMPLEMENTATION OF A WELLNESS PROGRAM 41
strategic direction, and organization necessary to utilize the features of the program. The
structuring of a WHP should involve departments such as human relations (HR), head
administration, communications, public relations, and safety & facilities management (Fertman,
2015; O’Donnell, 2017). The actual placement of the WHP within the organization will rely on
the focus of the program and the corresponding organizational goals; steps within the
organizational hierarchy; and image, personality, and workloads of various departments
(O’Donnell, 2017).
Structure of workplace health programs. To structure an effective WHP, those who
are involved must have the technical knowledge and skills on program design, curriculum
development, and health assessment in order to develop the program (Gantner, 2012; O’Donnell,
2017). Skilled staff are required to operate the overall functions of WHP; if the organization
does not have the human resources within its employee group, then a contract with an outside
vendor is necessary (Gantner, 2012).
Both Fertman (2015) and O’Donnell (2017) observed that it is important to understand
who should play a critical role in developing and defining criteria for a successful WHP within
an organization. One key member should be the company’s economic buyer (CEO or CFO) as
they are the visionary of the organization connecting company strategic objectives to WHP
objectives. Another is the WHP program administrator, who is responsible for running the
program and is knowledgeable about what the program can achieve. A medical or health science
professional is important to providing clinical supervision of the WHP, while the Human
Resource director is a key member who provides corporate-level management and funding for
the WHP. Other members could include fitness center directors, company consultants or general
managers. The WHP program director/administrator can be a part-time or full-time employee
IMPLEMENTATION OF A WELLNESS PROGRAM 42
(CDC, 2017e). Finally, those who handle safety and facilities need to be involved as well as
those who are knowledgeable about governmental laws and regulations so that the program
follows guidelines and does not discriminate against employees (O’Donnell, 2017).
Additionally, WHP program administrators should create a wellness committee for
employee input, design of the program, and for their unique perspective on organizational
climate and culture (Fertman, 2015; O’Donnell, 2017). The WHP committee can play an
integral part in supporting the cultural of wellness within the organization (Goetzel et al., 2014).
Moreover, it is suggested that this committee has a role in evaluating the program, identifying
the gaps and areas in need of improvement. In order to be effective, committees need to have
clear tasks and be well-managed (O’Donnell, 2017).
Also, the department and coordinator responsible for the WHP should have a positive
image within the organization, be well-respected, encouraging of the wellness concept, a good
role model, and have sufficient time to give support for the program (Fertman, 2015; O’Donnell,
2017). In a benchmarking study, the best WHP programs were found to have approximately one
full-time professional staff for every 800 employees, which is consistent with ratios by other
major management companies (O’Donnell, 2017). According to the CDC (2017), even smaller
organizations should have, at minimum, a part-time employee coordinating the WHP, but better
yet would be a full-time employee to manage the WHP for an organization (CDC, 2017d). This
WHP coordinator manages the overall design, procedures, and policies in the workplace
(O’Donnell, 2017).
Finally, in the successful planning of the WHP, it is not necessary to incorporate all best
practices and strategies at once. A truly remarkable program is one that selects elements that are
suited to the employee population and are implemented effectively (CDC, 2016c). It is
IMPLEMENTATION OF A WELLNESS PROGRAM 43
important to not focus on and create too many initiatives at once because it is imperative to build
successes early on rather than poorly implementing a multitude of interventions in the program’s
infancy (CDC, 2017d).
Planning resources for workplace health programs. In order to achieve performance
goals, organizations require resources such as funds, supplies, equipment and space (Clark &
Estes). In 2010, the average annual costs to implement a WHP program at an awareness level
was around $20-$70 USD per employee, a behavior-change level of program cost between $60-
$150 USD per employee, and a comprehensive supportive-environment program cost $150-350
USD per employee (O’Donnell, 2017). To ascertain the level of spending required for the WHP
to pay for itself, program developers can divide the expenditures in the areas expected to be
affected by the program by the cost of the program (O’Donnell, 2017).
As stated in a meta-analysis report by Harvard economists, for every dollar spent on
effective WHPs, medical costs decrease by $3.27 USD and absenteeism drops by $2.73 USD
(Baicker et al., 2010; Gantner, 2012; Goetzel et al., 2014). In fact, Citibank Health Management
Program estimated a savings of $4.50 USD for every dollar spent on their WHP (Baicker et al.,
2010; Gantner, 2012). In another meta-analysis that examined 42 studies, it was found that WHP
participants had approximately 25% lower medical and absenteeism expenditures than
nonparticipants in WHPs (Chapman, 2012; Goetzel et al., 2014). It is clear that when a WHP is
planned effectively, it can more than pay for itself (Fertman, 2015; Gantner, 2012; O’Donnell,
2017).
Workplace health program planning at MLA. In 2012, using the idea of ‘starting
small, but dreaming big’, MLA created a WHP called Working On Wellness (WOW) to address
the issues around health care costs and improving employee well-being (J. Timsy, personal
IMPLEMENTATION OF A WELLNESS PROGRAM 44
communication, July 14, 2016). The WHP is aligned under the MLA HR department with the
HR Director as the supervisor, and the program has two co-coordinators (F. Plymouth, personal
communication, May 25, 2017). One co-coordinator is employed full-time as a school
counselor, and the other co-coordinator is employed as a full-time health and physical education
teacher. The WHP co-coordinator positions are extra-curricular stipends, and the co-
coordinators plan the WHP in addition to their full-time positions at MLA (F. Plymouth,
personal communication, May 25, 2017). The program budget for the MLA WHP is $11,000
SGD to cover the program for 642 employees. This does not include health care insurance costs,
which are allocated in a separate budget within MLA HR Department. Furthermore, the two co-
coordinators are given a yearly stipend of $2,000 SGD for their work in planning and
implementing the WHP (J. Timsy, personal communication, May 22, 2017).
According to MLA WHP co-coordinator, Frank Plymouth, during the inception of the
program in the Spring of 2012, there was a committee comprised of interested members, but over
the years, committee involvement has fluctuated, dependent on different events and wellness
interventions. Since its inception, MLA has had four different HR directors. The initial structure
and planning of the MLA WHP was based on conversations within WHP committee members
and what they believed was important to MLA employees. Many of the programs and initiatives
from the program’s beginning have continued until today. The MLA WHP has not done a
formal evaluation to determine or prioritize program goals and a mission and vision statement
have not been determined (F. Plymouth, personal communication, May 25, 2017).
Implementation of workplace health programs. Once all the steps have been
determined in the planning process through the utilization of the CDC Workplace Health Model,
then the WHP needs to implement the strategies, interventions, and make it available to
IMPLEMENTATION OF A WELLNESS PROGRAM 45
employees (CDC, 2017e). However, careful thought needs to go into this process. For instance,
in a systematic review of WHP interventions, it was found that health assessment and feedback
alone was unlikely to have a positive effect on health outcomes; however, there was sufficient
evidence for meaningful effects of an assessment of health risks with feedback combined with
further interventions (O’Donnell, 2017; Soler et al., 2010).
Types of workplace health programs. According to the World Health Organization
(WHO, 2017f), there are three types of WHP interventions: informational approaches to change
knowledge and attitudes about the benefits of and opportunities for health and wellness within a
worksite; behavioral and social approaches to educate people on the behavioral management
skills needed for successful adaptation and continuation of behavior change as well as the social
environments that allow for behavior change; and environmental policy approaches that change
the structure of the organizational and physical environments to provide safe and enticing places
for healthy lifestyles (Kahn et al., 2002; WHO, 2017f).
Further, a person’s health is a by-product of both individual actions and the environment
within which those actions are taken (CDC, 2017e). Most employers think in terms of an
individual’s action level (i.e., weight loss, smoking cessation, etc.), but fail to understand that
changing the work environment simultaneously affects large groups of employees, creating a
much easier adoption of health behaviors when the workplace is supportive of healthy norms and
policies (CDC, 2016c). Therefore, it is crucial for WHPs to combine organizational and
individual strategies, as well as interventions to support wellness (CDC, 2016c).
As reported by the CDC (2016c), there are four major categories that WHP interventions
can be defined under for implementation, including health-related programs onsite or offsite to
support, change or maintain health behaviors; health-related policies, which are the informal and
IMPLEMENTATION OF A WELLNESS PROGRAM 46
formal written statements that are created to protect and promote employee health; health
benefits, i.e., the employee compensation packages which include health insurance coverage and
other free or discounted services regarding health; and environmental support, which refers to the
physical worksite factors that support and enhance employee health (CDC, 2016c).
Communication strategies of a workplace health program. Constant and candid
communication from leaders about plans and progress are necessary to engender trust (Clark &
Estes, 2008; Reeves, 2016). For employees to know what interventions and programs are being
implemented within the organization, there is a need for the WHP to develop a strategy for
communications (O’Donnell, 2017). The best strategies need to produce a high-quality standard
of communication, and an inclusive approach to reach the overall employee population
(O’Donnell, 2017); every organizational stakeholder should know what the WHP is doing and
why (NIOSH, 2008). Moreover, effective communication strategies are customized to the
individual characteristics of employees, including their individual priorities in life, and their
motivational readiness for behavioral changes (O’Donnell, 2017). The message should also
consistently reflect the values and direction of the WHP. It is critical that the WHP is transparent
within the organization and that data-driven evaluations and reports are utilized with
communication strategies (NIOSH, 2008).
Workplace health program implementation at MLA. The MLA WHP implements a
variety of programs and initiatives throughout the year, most of which fall under the category of
health-related programs on-site for employees. These programs include wellness and other
classes designed to meet the needs of employees. As mentioned in the knowledge section of this
literature review, programs align with essential wellness components and predominantly address
areas of physical, mental, social and emotional wellness.
IMPLEMENTATION OF A WELLNESS PROGRAM 47
In regard to communication strategies, WHP co-coordinators communicate directly with
MLA employees by sending emails to all employees. Collaboration plans were made for the
2017-18 school for the WHP co-coordinators to work with the MLA Communications office to
develop a WHP website and weekly course activities on the employee portal. Research-based
health and wellness resources are available to employees on the wellness website during the
2018-19 school year (F. Plymouth, personal communication, July 20, 2017).
Evaluation of workplace health programs. One of the most cost-effective activities in
performance improvement is the evaluation process because, when applied effectively, it can
ensure success (Clark & Estes, 2008). An evaluation of the WHP is essential to investigate the
quality, effectiveness, and importance of the program (CDC, 2017e), and should focus on
whether the program’s essential elements are being implemented and whether best practices are
being followed (Goetzel et al., 2014).
The CDC (2016c) Worksite Health Model stated that “the evaluation should focus on
questions that are relevant, salient, and useful to those who will use the findings and that the
evaluation process feeds into a continuous quality improvement loop to improve and strengthen
existing activities; identify potential gaps in current offerings; and describe the efficiency and
effectiveness of the resources invested” (n.p.). In addition, the evaluation process creates the
ability to check the impact of learning, motivation, and organizational changes after
implementation (Clark & Estes, 2008). The final evaluation step of the Worksite Health Model
is vital to the modification of WHP interventions and initiatives based on results the program has
measured and analyzed (NIOSH, 2008).
Evaluation of workplace health programs at MLA. There is no formal evaluation of
the WHP at MLA. However, informally, the evaluation of the WHP happens in two parts at
IMPLEMENTATION OF A WELLNESS PROGRAM 48
MLA. First, after the major programs are implemented at MLA, most of the time, WHP co-
coordinators send participants a Google Forms feedback on the event. The online survey
questions are developed by co-coordinators and focus on the employees’ viewpoint of strengths
and areas of growth of the program or event. The other types of WHP evaluations are reflective
conversations between co-coordinators as well as feedback from WHP committee members (F.
Plymouth, personal communication, July 20, 2017).
In conclusion, there are various WHP models that employers can use to set up an
effective program. The most effective WHPs follow some organizational variation of needs
assessment, planning, implementation, and evaluation (CDC, 2017d). Effective WHPs
understand employee and organizational needs; plan and structure the program to align with the
mission, vision and organizational goals that create a healthy organizational culture; implement
the program based on sound research and purposeful planning; and evaluate the program’s
effectiveness in order to make it better (CDC, 2017e).
Limitations of the organization of workplace health programs. The main limitation
of the organizational and implementation components within WHPs is that very few studies have
been done on employee participation within K-12 schools. Much of the research centers around
schoolwide health promotion and education with an emphasis on student wellness. The most
relevant research that can be found is on the implementation of wellness programs within
colleges and universities yet, again, most of the focus is on student rather than employee
wellness. Again, the researcher has found that there is very limited research on the
implementation and participation of employee wellness within schools, specifically, private
international schools.

IMPLEMENTATION OF A WELLNESS PROGRAM 49
Summary
The research and studies reviewed in this chapter support the concept that WHPs have the
ability to positively influence the physical, mental, economic and social well-being of employees
in the workplace (WHO, 2017e). Dynamic WHPs utilize a framework that focuses on needs
assessment for employees, plan of action, implementation and evaluation (CDC, 2016c). When
done right, the benefits of effective WHPs far outweigh the negatives and WHPs are one of our
greatest hopes for diminishing the worldwide epidemic of non-communicable diseases. A
healthy supportive organizational culture where employees thrive, are more productive, and
enjoy their relationships and work environment, is a culture all good organizational leaders
should want (O’Donnell, 2017). Schools, organizations and businesses around the world are
creating WHPs for their employees; some have highly effective programs, while others have less
desirable outcomes (CDC, 2017e; O’Donnell, 2017). An extensive amount of time, planning and
resources are needed in order to create effective WHPs for employee engagement and improved
health and wellness. Therefore, it is crucial that we understand the knowledge, skills, and
organization it takes to construct an effective WHP and why employees choose to participate
based on these areas.
Modern Learning Academy (MLA) is an international education organization that has
determined that its strategic anchor is the development of a culture of extraordinary care and
support for all students (MLA, 2017b). In order to meet this goal, employees must first feel
valued and cared for, and in turn, create a ripple effect to students. Bolman and Deal (2013)
posited that the most important asset in an organization is its people.
Based on advice from insurance brokers and school leaders, MLA created a worksite
health program (WHP) in 2012 in hopes of improving employee wellness. MLA has invested
IMPLEMENTATION OF A WELLNESS PROGRAM 50
time and resources into the implementation of their WHP, however; the program effectiveness
has not been evaluated, and factors have not been determined as to why employees participate
and what barriers may prevent their participation.
Purpose of Study
The purpose of this study was to understand the phenomenon of why employees choose
to participate in the MLA WHP. It sought to understand promising practices utilized by
comprehensive WHPs and the barriers that hinder participation in WHPs. The following
research questions were addressed by this study:
1. Why do MLA employees participate in WHP?
2. What role, if any, do constraints play in MLA employees’ decision to participate
in the WHP?
IMPLEMENTATION OF A WELLNESS PROGRAM 51
Chapter Three: Methodology
This chapter provides an overview of the methodology and a description of the research
approach and includes a discussion on demographics and characteristics of participants. It then
describes instruments and protocols, followed by a section illustrating the data collection process
and procedure. Finally, it finishes with an analysis of the data obtained for themes that emerged
for findings.
Rationale for Method of Study
Mixed-methods research uses a combination of qualitative and quantitative methods
within a single study (Maxwell, 2013). It is a research approach whereby the investigator
collects both quantitative (close-ended) and qualitative (open-ended) data and fuses and analyzes
the two based on the connected strengths of both sets of data in order to understand the research
problems (Creswell, 2013; Merriam & Tisdell, 2016). Moreover, a mixed-methods study allows
for triangulation, which involves the use of different methods for the purpose of having each
method check in on the other to determine if the different strengths and limitations of the
methods all support a single conclusion (Maxwell, 2013).
Creswell’s (2013) explanatory sequential design was utilized in this study. First,
quantitative data were collected through a survey instrument, and then qualitative data followed
with the utilization of a focus group discussion instrument. The purpose of this research design
was to explain the results and findings in greater depth. The aim of the study was to gain an
understanding of factors that influence employees in choosing to participate in the MLA WHP.
It sought to understand promising practices utilized by comprehensive WHPs and barriers that
hinder participation in WHPs.

IMPLEMENTATION OF A WELLNESS PROGRAM 52
Participants
For this study, the researcher focused the data collection of employees at one specific
private international school, MLA. There were three main categories of employee participants:
MLA faculty, MLA support staff, and MLA administration. A list of all MLA employees was
obtained, along with the employment status of administrative, faculty, or support staff hire. A
purposeful and deliberative manner was utilized for the selection of participants for the
qualitative portion. In this study, there were two procedures, one for the survey instrument and
the other for the focus group discussion.
Survey participants. Total population sampling was utilized for the survey. There were
642 employees who were sent the quantitative survey using a Qualtrics online survey system
through the University of Southern California (USC). The survey was distributed in the
following groups through the Qualtrics online system: elementary support staff, elementary
faculty, middle school support staff, middle school faculty, high school support staff, high school
faculty, central administration support staff, and administration.
Access to survey participants. The researcher met with the Deputy Superintendent of
MLA as well as the Director of Human Resources and was granted approval to distribute the
survey to all employees. All MLA employees were sent an individual email invitation to
participate in an eight- to ten-minute online survey through Qualtrics. The email explained the
purpose of the study and also asked for the employees’ consent to participate in the survey.
There was a 49% response rate to the survey, with 313 out of 642 employees completing it (see
table 3.1).

IMPLEMENTATION OF A WELLNESS PROGRAM 53
Table 3.1

Survey Participants

Category and Division of
Employees with Number of
Surveys Sent to Each Group
Number of Participants that
Completed the Survey
Potential Participants
Elementary Support Staff,
n=115

49 Early Learning Center – Grade
5 Support Staff employees

Elementary Faculty, n=167

103 Early Learning Center – Grade
5 Faculty employees

Middle School Support Staff,
n=21
12 Grade 6-8 Support Staff
employees

Middle School Faculty, n=92

45 Grade 6-8 Faculty employees

High School Support Staff,
n=25
8 Grades 9-12 Support Staff
employees

High School Faculty, n=116 54 Grade 9-12 Faculty employees

Central Administration Support
Staff, n=82
29 Central Administration
Support Staff include
employees of the following
offices: Communications,
Office of Learning, Central
Admin, Facilities,
Advancement, and IT
Departments

Administration, n=24 13 MLA Administrator status
positions

Focus group participants. Two focus groups were conducted to gather qualitative data
from employee participants at MLA. A purposeful selection was used in the faculty and support
staff employee groups within the divisional areas of elementary, middle school, high school, and
IMPLEMENTATION OF A WELLNESS PROGRAM 54
central administration. The focus groups were stratified with simple random sampling. More
employees were selected out of the elementary division because it is the largest division in the
school. Also, in order to ensure balanced perspectives, purposeful selection of a varied years of
experience at MLA was utilized in selecting participants for the focus groups. One focus group
discussion was conducted with only faculty and another focus group discussion with only
support staff. The two focus groups were broken into these types of participant categories
because of the similarities in employment contracts.
Access to focus groups participants. The researcher met with the Deputy Superintendent
of MLA as well as the Director of Human Resources and was granted approval to conduct two
focus groups with support staff and faculty employees. An individualized invitation email was
sent to participants based on selection criterion stated above. The email described the purpose of
the study and invited participation in a 60-minute focus group discussion. It also asked the
employee consent to the focus group discussion. In regard to focus groups, times and dates were
provided for choice. The invitation was sent to 20 employees, 10 support staff employees and 10
faculty employees. A total of 12 employees responded with six in each focus group (see table
3.2).
Table 3.2

Focus Group Participants

Focus Groups Including
Employment Status and Number of
Participants Invited to Participate
Number of Participants
in Research Study
Potential Types of Participants
Support Staff Employee Status
Focus Group 1, n=10

6 All Support Staff employees
Faculty Employees Status Focus
Group 1, n=10

6 All Faculty employees

IMPLEMENTATION OF A WELLNESS PROGRAM 55
Instruments
There were two instruments used for this study, a Qualtrics online survey and two focus
groups. The researcher utilized multiple data collection instruments to increase credibility of the
study. Merriam and Tisdell (2016) asserted that, “triangulation - whether you make use of more
than one data collection method, multiple sources of data, multiple investigators, or multiple
theories - is a powerful strategy for increasing the internal credibility or internal validity of your
research” (p. 245).
Survey. The quantitative research instrument used in this study was a Worksite Wellness
Program survey for employees. Surveys are designed to systematically express the
characteristics and facts of a given phenomenon, or the relationship between a phenomena and
events (Merriam & Tisdell, 2016). The questions for the employee wellness survey were
formulated based on the Center for Disease Control and Prevention (CDC) Behavioral Risk
Factor Surveillance System Questionnaire and wellness program evaluation rubrics from the
CDC and the World Health Organization (WHO), as well as an employee sample survey
developed by Dr. Michael O’Donnell (CDC, 2016b; O’Donnell, 2017; WHO, 2017f).
The survey questions were multiple choice or “check all that apply.” The six main
categories of questions were background information, individual health and wellness, MLA
WHP awareness, WHP participation, WHP program satisfaction, and motivation, interests, and
overall thoughts on the MLA WHP. The questions sought to gain an understanding of the
knowledge, skills, and motivators related to employee participation in their personal health and
the MLA Wellness Program (See appendix D).
Focus groups. Another instrument used in this study is a semi-structured focus group
guide. A focus group is an interview with a group of people who have knowledge on a selected
IMPLEMENTATION OF A WELLNESS PROGRAM 56
topic (Merriam & Tisdell, 2016). Focus groups grant participants the ability to express their own
thoughts as well as react to and build on the comments of others, which may provide different
perspectives from those in an individual interview (O’Donnell, 2017). The focus group guide
was divided into two sections. The first section was comprised of questions focusing on factors
that influence participation, possible barriers, and behavior change as they pertain to wellness.
Section two centered on personal perspectives on the MLA Wellness Program. The focus groups
ran between 45-60 minutes.
The questions were loosely based on a CDC WHP questionnaires (CDC, 2017d). The
focus group questions sought to gather data concerning perceptions of the factors that influence
why employees choose to participate in the MLA WHP, as well as employee perceptions of
promising practices utilized by comprehensive WHPs and barriers that hinder participation in
WHPs (see appendix A).
Data Collection Procedure
In this study, there were two data collection procedures, one for the survey instrument
and the other for the focus group discussion. The original intention was to also complete a
document analysis on the MLA wellness program’s policies and procedure; however, upon
inquiry, it was learned that the school does not possess documents on the wellness program’s
policies and procedures.
The survey and focus group instruments were used to gather specific data to better
understand the phenomenon of how people interpret and construct their experiences as well as
the meaning they attribute to their experiences (Merriam & Tisdell, 2016).
Procedure phase I – surveys. The first instrument administered was the survey. The
decision to use a survey to collect data was based on a desire to systematically describe the facts
IMPLEMENTATION OF A WELLNESS PROGRAM 57
and characteristics of the phenomenon (Merriam & Tisdell, 2016). The survey provided a
“numeric description of trends, attitudes, or opinions of a population by studying a sample of that
population” (Creswell, 2013, p. 155).
For the survey procedure, total population sampling was used; however, participants were
grouped in stratified sampling groups based on the characteristics of their employment status.
The three categories of employment were support staff, faculty, and administration. The
researcher used the Qualtrics online survey system to conduct the survey. Participants were
emailed an invitation to participate in the research study, and the purpose and protocol of the
study was shared with participants in the email and at the beginning of the online survey.
Participants were informed that data would be kept private and confidential and names would not
be collected in the surveys. After two weeks of the Qualtrics online survey being open for
participants to complete, the researcher sent out a follow-up reminder to those in the Qualtrics
system who had been sent an initial survey invite, but who had not yet completed the survey.
Procedure phase II – focus groups. According to Creswell (2014), a focus group is one
in which the researcher interviews participants within a group setting. In this type of setting, the
research has an advantage of observing participant facial expressions, body language and other
non-verbal cues that cannot be perceived from a paper or online survey. Furthermore, the
research facilitator is able to control the group discussion with the questions posed to the group.
During the focus group discussion, it is vital that the interviewer was non-judgemental,
respectful, and non-threatening (Creswell, 2013; Dexter, 1970; Maxwell, 2013; Merriam &
Tisdell, 2016). The second instrument administered in this study was the focus group discussion.
This instrument was utilized so that more participants could be interviewed in the study and a
group setting allowed for further discussions based on participants’ responses.
IMPLEMENTATION OF A WELLNESS PROGRAM 58
Each focus group took place in a collaborative space conference room on the MLA
campus. This space is designed for group meetings and provides a private, quiet environment.
Each focus group was allocated 90 minutes but, in reality, both focus groups took between 47-53
minutes. The researcher used two voice-recording devices, which were an iPhone 7 plus and a
Sony digital voice recorder, which allowed the researcher to avoid missing data collection due to
equipment failure. The participants were provided a focus group protocol and purpose of the
study (see Appendix A). Participants were notified that the session would be recorded for
transcribing the data after the interview so that the research would be free to interact with
participants during the discussion. Participants were also notified that they were allowed to ask
the interviewer to stop recording at any time during the focus group discussion. In addition to
the voice recordings, the research took notes on observations of interactions and non-verbal
communication. This helped guide further probing questions during the discussion.
Ethical Considerations
Attention to ethical issues in research is becoming increasingly recognized as important,
not only for ethical reasons, but as a key aspect of research as well. Ethical considerations should
be considered in all aspects of research design (Maxwell, 2013). In order to clearly articulate the
purpose of the study and what the study entails, the researcher communicated this to participants
before any data were collected. This study allows MLA to understand the phenomenon of why
employees participate in the wellness program, as well as possible improvements in relation to
knowledge and skills, motivation, and organization of the WHP. The study was strictly
voluntary, and the researcher did not pressure employees to participate in the research. This was
communicated to participants and they were told that they could withdraw their participation at
any time from the study. Further, pseudonyms were used for each participant and data were
IMPLEMENTATION OF A WELLNESS PROGRAM 59
protected. Finally, the researcher also ensured that there was no falsifying or changing of data
and findings.
Data Analytic Strategy
Data analysis began once the data was collected with this study. This occured in two
phases with the two different research instruments, surveys and focus group discussions. The
first step in the quantitative data analysis was to read over the survey results and make notes on
general impressions and overall ideas from the survey and possible themes that emerged. The
results were also analyzed through the Qualtrics online survey system via charts and graphs.
Through the results generated by the Qualtrics online system, descriptive data was copied and
pasted into a spreadsheet under the column labeled as possible key themes, with one unit of
descriptive data per row.
The second step was the qualitative data analysis with the focus group discussions. After
the focus groups were conducted, it was critical for the researcher to read the focus group
transcriptions and observational notes in this qualitative data analysis (Creswell, 2014; Maxwell,
2013; Merriam & Tisdell, 2016). After the transcribing of the collected data, the researcher
replaced all names of participants to protect their identity.
A system was developed for sorting and analyzing the data by creating codes for themes
that aligned with the survey data analysis. Codes were connected to the online survey results as
well as the research questions in this study based on the following:

IMPLEMENTATION OF A WELLNESS PROGRAM 60
Table 3.3

Key Themes and Color Codes

Key Themes Color Code
Prior Knowledge and Skills Blue Highlight
Social Influence Red Highlight
Health Benefits Yellow Highlight
Time Green Highlight
Work-Life Balance Purple Highlight
Lack of Organizational Support and Resources Orange Highlight

Merriam and Tisdell (2016) posited that, “coding is nothing more than assigning some
sort of shorthand designation to various aspects of your data so that you can easily retrieve
specific pieces of data” (p. 199). The researcher developed a matrix with which to connect
categories and themes with the research questions that the data supported (Maxwell, 2013). The
research questions and literature review helped guide the researcher through the study and the
data analyses.
IMPLEMENTATION OF A WELLNESS PROGRAM 61
Chapter Four: Findings
The purpose of this study was to understand the phenomenon of why employees choose
to participate in the MLA WHP. It sought to understand promising practices utilized by
comprehensive WHPs and the barriers that hinder participation in WHPs. Hence, the sample
chosen for the study was one that was appropriate based on a set of predetermined criteria
(Merriam & Tisdell, 2016).
This mixed-methods study focused on the entire MLA employee population as well as
two subset groups of employees to further study participation. While MLA has dedicated
resources towards the implementation of the employee WHP, there is limited understanding of
why the MLA employees participate in WHP, and what role, if any, constraints play in MLA
employees’ decision to participate in the WHP. This chapter shares the findings that emerged
from the data collected and analysis of that data.
Research Question #1: Why do MLA Employees Participate in WHP?
Research question one sought to understand the factors that influenced why employees
choose to participate in the MLA WHP. Three themes emerged from the data collected and
analyzed for this question: knowledge and skills; benefits of health; and social influences.
Knowledge and skills. WHPs play an important role in providing employees with the
knowledge and skills to lead happier and healthier lifestyles (Fertman, 2015; Gantner; 2012).
The theme of knowledge and skills emerged from the data collected on the employee survey and
was supported in each of the focus group discussions. There is a common understanding and
belief among participants that wellness is important for overall health. In fact, 294 employees
(95%) who answered survey question eight, “Would you say your general health is...” responded
that their general health is “good” or “very good” (see figure 4.1).
IMPLEMENTATION OF A WELLNESS PROGRAM 62

Figure 4.1. Would you say your general health is?
Question nine of the employee survey asked participants, “Do you believe you have the
knowledge needed to live a healthy lifestyle?” (see figure 4.2). Out of all the survey respondents,
99.35% answered “somewhat agree” or “completely agree” in response to this question.

Figure 4.2. Do you believe you have the knowledge needed to live a healthy lifestyle?
IMPLEMENTATION OF A WELLNESS PROGRAM 63
Also, question 10 on the survey asked, “Do you believe you have the skills needed to live a
healthy lifestyle?” (see figure 4.3). Out of all the survey participants, 91% answered that they
“somewhat agree” or “completely agree.” The results of these three survey questions are
consistent with the notion that MLA employees perceive that they have the knowledge and skills
to lead a healthy lifestyle.

Figure 4.3. Do you believe you have the skills needed to live a healthy lifestyle?
In response to focus group question one, “What are some healthy lifestyle choices or
changes that you’ve made recently,” employee A2 explained that “I used to snack in the office,
but I cut down and now eat fruits or oranges. It makes a lot of difference. And I don’t stock up
anything in the cabinet anymore.” Employee B3 mentioned that “I started walking to the MRT
station instead of taking the shuttle bus from campus.” Health literacy is the level to which
individuals have the capacity to acquire, process, and understand basic health information needed
to make appropriate health decisions (WHO, 2017e). Results from the focus group discussions
IMPLEMENTATION OF A WELLNESS PROGRAM 64
supported the notion that participants believe they have the knowledge and skills needed to lead
healthy lifestyles.
Knowledge from health screenings. Another reason MLA survey participants want to
improve their wellness is due to the knowledge gained through health screenings. Out of all the
survey participants, 79% had a comprehensive medical check-up within the past two years
according to responses for survey question 11, “When was the last time you had a
comprehensive medical check-up by a doctor” (see figure 4.4).

Figure 4.4. When was the last time you had a comprehensive medical check-up by a doctor?
In addition, when asked survey question 22, “What would motivate you to improve your
wellness,” 135 of 313 respondents (43%) selected “feedback from a medical professional (i.e.,
medical check-ups or health screenings on or off campus, etc.)” as a reason (see figure 4.5).

IMPLEMENTATION OF A WELLNESS PROGRAM 65

Figure 4.5. What would motivate you to improve your wellness?
The survey results were supported by responses in the focus group discussions. The
focus groups were asked question two, “What are the factors that influenced you to make these
healthy lifestyle choices or changes?” Participants in the second focus group of faculty members
all agreed with employee B4 when he/she stated:
When you have your blood test results from your health screening, and the doctor follows
up saying…did you know you have this problem; that is really a wake-up call. You’re
like, I didn’t know that and now that I do know, I need to change some bad habits for my
health.
Knowledge and skill development is the base for an effective WHP for employees
(O’Donnell, 2017). It is vital to have the knowledge and skills to commit to healthy behaviors as
IMPLEMENTATION OF A WELLNESS PROGRAM 66
it increases perceived benefits to change behavior and confidence to conquer barriers (Faghri &
Buden, 2015). Again, these findings are consistent with the notion that participants have a
common understanding of health and that regular health-checks are important.
Benefits of health. Another theme that emerged from the study was the benefits of
health. Wellness is the process of empowering people to increase control over their health and
its determinants by learning new life skills and becoming conscious of and making purposeful
choices towards a more balanced and healthy lifestyle (WHO, 2017f). In connection with the
knowledge and skills acquired through health awareness, MLA survey respondents participated
in the WHP because of anticipated benefits of health. According to survey question 18, “Which
of the following reasons explain why you chose to participate in the MLA Wellness Program,”
157 of 313 respondents (50%) selected that they participate in the MLA WHP because they are
“interested in improving their health” and 138 of 313 respondents (44%) selected “because it
feels good to participate in wellness activities” (see figure 4.6).

Figure 4.6. Which of the following reasons explain why you chose to participate in the MLA
W.O.W Program?
IMPLEMENTATION OF A WELLNESS PROGRAM 67
Furthermore, survey question 12 asked, “What are the top three health priorities for you
to work on this year?” (see figure 4.7). It should be noted that three of the top four survey
responses that were selected had to do with physical health (exercise, nutrition, and sleep). Two-
hundred and ten of 313 respondents (67%) selected exercise; 134 of 313 respondents (43%)
selected nutrition; and 123 of 313 respondents (39%) selected improving sleep. This emphasis
on improving physical health correlates with global research findings of the major risk factors
that contribute to non-communicable diseases (NCDs), such as unhealthy diets, physical
inactivity, and unrelieved stress (CDC, 2017a; WHO, 2017a). This further identifies that
participants in this study have the knowledge and understanding that improving physical health
will benefit their overall health and wellness to possibly prevent NCDs.

Figure 4.7. What are the top three health priorities for you to work on this year?
IMPLEMENTATION OF A WELLNESS PROGRAM 68

Intrinsic motivation. Survey participants were asked question 22, “What would motivate
you to improve your wellness” (see figure 4.5). The top response was “possibility of positive
outcomes (i.e., improved strength, or improved health)” with 197 of 313 participants (63%)
selecting this option. Another response that was selected for this question was “if it aligns with
personal interests and passions.” One hundred and eighty-one of 313 respondents (58%) chose
this as an option for motivating their participation. In addition to these two options, 116 of 313
respondents (37%) selected “no extrinsic incentives, just intrinsic motivation.”
These three survey responses connect with the idea of intrinsic motivators being a factor
for employee participation in the WHP. Intrinsic incentives are driven by interest or enjoyment
and involve internal feelings within an individual (O’Donnell, 2017; Seifert et al., 2012). WHPs
resources either intrinsically motivate engagement by fulfilling internal psychological needs, or
extrinsically motivate engagement by providing employees incentives and rewards to achieve
work-related goals (Bakker et al., 2011; O’Donnell, 2017). It is evident in the findings that
survey participants are more often motivated by intrinsic motivation through the benefits of
health and well-being. However, it is important to note that there is still a need for extrinsic
motivation as well. In response to question 22, “What would motivate you to improve your
wellness,” 105 of 313 participants (33%) mentioned “incentives (i.e., financial, medical benefits,
rewards, etc.)” as a motivator (see figure 4.5).
These survey findings were further supported during both focus group discussions when
participants were asked question two, “What are the factors that influenced you to make these
healthy lifestyle choices or changes?” Employee B6 said “a regular commitment to working out
makes you feel good. It’s not to look good, but to feel good too.” Moreover, all focus group
participants gave specific examples of why they were interested in improving their health, and
IMPLEMENTATION OF A WELLNESS PROGRAM 69
the majority of those responses connected with the big idea of the benefits of health throughout a
lifetime. Also, for focus group question two, employee A3 shared:
For me, it’s more because the general wellbeing for the health. Because I only have one
daughter. I’m just thinking about if I had health issues later on, she will have to take care
of me. So, I’m trying to make it easier on her if I can be healthier longer and not have
like, you know, the usual ailments. It is helpful to her I think.
Employee A4 agreed with employee A3 by adding “I agree with her. I have only one child, so
for me, I agree with her because I have family history. My dad has high cholesterol and my mom
too. I want to try and make sure I keep my cholesterol in check.” Also, employee B1 mentioned:
Basically, for me, it is longevity. I want to see my grandchildren. Both my kids are
really young now, but I still think about that. The reality is, at our school, we get stressed
a lot, and if we don’t take care of ourselves, it’s gonna be damaging to our health. It’ll
shorten our lifespan and I want to meet my grandchildren!
Health enables people to realize their hopes and dreams, fulfil their needs, and manage
their environment in order to live a long successful life (CDC, 2016e). The finding of MLA
employees valuing the benefits of health is consistent with the purpose of why WHPs are
important within organizations. WHPs directly impact the physical, mental, social, and
economic well-being of employees, which, in turn, also affects the well-being of employees’
families and their communities (WHO, 2017e).
Social influences. A third theme that emerged in this study was social influences. A
wellness culture is a social environment within the workplace that nurtures an employee’s
initiative to adopt healthier lifestyles, values and promotes healthy options for well-being, and
supports social influences that lead all people toward healthy behavior regardless of their
IMPLEMENTATION OF A WELLNESS PROGRAM 70
background (CDC, 2017f; Fertman, 2015; Goetzel et al., 2014). In a wellness culture, social
influences steer people towards healthy choices and behaviors (O’Donnell, 2017).
As part of the current research, survey question 18 asked, “Which of the following
reasons explain why you chose to participate in the MLA Wellness Program?” The findings
suggest that social influences are a factor in many employees’ participation in the WHP (see
figure 4.6). Eighty-five of 313 respondents (27%) said they participated in the WHP because
“their friends or colleagues were participating” in it, and 67 of 313 participants (21%) selected
that they participated in the WHP “to socialize and meet more colleagues.”
These findings on social influences were corroborated with responses given during focus
group discussions. Focus group question 6b asked, “What are some factors that would
encourage you to increase your participation in the MLA wellness program initiatives and
events?” Employee A5 mentioned, “It’s the social accountability. Like having a colleague
around who will invite you to the gym or to a wellness activity. That motivates me to go.”
Employee B2 talked about wellness courses during the MLA In-Service Days. It was
highlighted that “[i]t’s a good bonding time, not just learning about healthy cooking or working
out, but good bonding time with colleagues because our campus is so big, it is hard to see
colleagues.” Employee A6 stated that “[i]t is not only the MLA In-Service Day courses, but the
Family Fun Day as well. It’s not only about the wellness activities, but you can mingle with
your colleagues and their families and it is not work.”
The survey and focus group results corroborate the idea that social influences motivate
many participants to get involved with the WHP. This is further supported by research findings
that organizations creating a wellness culture are able to influence the social environment within
a workplace (Fertman, 2015). WHPs that create and support opportunities for social interactions
IMPLEMENTATION OF A WELLNESS PROGRAM 71
help influence employees toward adopting healthy behaviors (Goetzel et al., 2014). The data
findings from this study identify the need for the MLA WHP to further investigate social
influences and how continuing to develop a culture of wellness could help support employee
wellness.
Research Question #2: What role, if any, do constraints play in MLA employees’ decision
to participate in the WHP?
Research question two was intended to uncover barriers and constraints to MLA
employees’ decisions to participate in the WHP. Three themes emerged from the data analysis
for constraints: lack of time, work-life balance, and lack of organizational support and resources.
Time. Lack of time was the theme that was most often identified as a constraint to
employee participation in the WHP program at MLA. Survey question 17 asked, “Which of the
following reasons explain why you chose not to participate in at least one or all of the MLA
WHP Programs?” The most frequently selected response by participants was “programs were not
scheduled at convenient times,” with 120 of 313 respondents (38%) choosing this option (see
figure 4.8). Furthermore, out of 33 responses that were written in under “other” for this question,
22 responses referenced time. One employee shared that “our schedule at school is too hectic. I
would love to participate but extra meetings, etc. make it not doable.” Another employee wrote
that “when we have wellness activities during inservice days, there is no downtime. The grab and
go breakfast is an anachronism to healthy mindfulness.” Another employee noted that there was
“too much to do and too little time, so I work instead of worry about my health.”

IMPLEMENTATION OF A WELLNESS PROGRAM 72

Figure 4.8. Which of the following reasons explain why you chose not to participate in at least
one or all of the MLA WHP Programs?
The findings from survey question 17 connected with responses given during the focus
group discussion. In both focus groups, time was mentioned by all employees for the focus
group question three, which was “If you would like to make better choices or changes for your
wellness, what are some barriers or challenges that prevented you from doing so?” Employee B4
mentioned “I find that those In-Service Days are so tightly scheduled, there is no time for
wellness.” In the first focus group, employee A5 stated “[w]e cannot use the MLA wellness
facilities until 4:15pm, so that’s one hour (after school finishes) that we have to stay around, but
if you don’t have anything to do, you won’t stay.” Employee A2 mentioned that “[m]y biggest
barrier is time because right now I don’t exercise so much because I don’t have a lot of time.”
IMPLEMENTATION OF A WELLNESS PROGRAM 73
In Chapter Two of this study, research was not included as to time specifically being a
barrier with WHPs. However, research in the literature review emphasized organizational
planning and the importance of building a healthy organizational culture that allows employees
to focus on their wellness throughout the day. It would be challenging to find a workplace where
employee health is not a value held by everyone; yet, it is one of many values that compete for
time and energy within an organization (Fertman, 2015).
Work-life balance and stress management. Another theme for a constraint that
emerged from this study was work-life balance. In addition to the spike in global health issues,
there is a similar jump in other well-being issues, particularly stress (CDC, 2017e). According to
recent studies, the workplace has become a leading source of stress for individuals around the
world; on average, twice as many workers in larger organizations are reporting stress, with a
growing impingement on work-life balance being a main driver for this rise (WHO, 2017d).
Survey question 12 asked, “What are the top three health priorities for you to work on
this year?” (see figure 4.7). Respondents identified a focus on work-life balance as a top
priority. In response to this question, 128 of 313 survey respondents (41%) chose “work-life
balance.” Furthermore, 73 of 313 respondents (23%) selected “stress management” as one of
their top three health priorities to work on this year.
In addition, survey participants were asked question 17, “Which of the following reasons
explain why you choose not to participate in at least one or all of the MLA wellness programs?”
Seventy-three of 313 participants (23%) responded that “I would rather do a wellness activity on
my own outside of MLA” (see figure 4.8). The findings indicate that these participants would
rather do wellness activities outside their place of employment and during their own personal
IMPLEMENTATION OF A WELLNESS PROGRAM 74
time. This could possibly be for their own work-life balance; however, further follow-up
questions would need to be asked for clarification.
The survey findings of work-life balance and stress-reduction correlate with the results of
the focus group discussion. Focus group question five asked, “In general for MLA employees,
what area of wellness (example: physical, emotional, intellectual, etc.) do you believe needs the
most attention?”
Employee B5 described a stress factor for emotional health:
Undefined job duties create a lot of stress. I feel like I need to do certain things because
if I don’t do it, then no one else is gonna do it. It’s consuming and stressful, but I try to
help new teachers figure out our MLA system, but also to make sure that the kids in
whatever grade-level side get the same quality of instruction as well.
Moreover, employee B3 noted, “If you want balance, I think it needs to be somehow injected
into the organization.” Employee B6 added:
So when we think of balance, I think of the other b-word; and that is boundaries. We
have to set that up and give ourselves permission to say that this is what I can do
professionally, but I need my personal time within my waking hours too. We have to set
up boundaries and be given permission from MLA for that, as an organization, that this is
what we value…balance and an individual’s boundaries.
In a recent study, employers recognized that poor work-life balance, excessive
workloads, and 24/7 technology access are fueling high stress levels, yet they also found that
actions they took to combat these concerns were extremely challenging (Goetzel et al., 2011).
The results of this study identified that many participants perceive that their work-life balance
and compounding levels of stress are barriers to their wellness.
IMPLEMENTATION OF A WELLNESS PROGRAM 75
Lack of organizational support and resources. The third and final theme that emerged
as a constraint in this study’s data analysis was a lack of organizational support and resources for
employee wellness. Supportive WHP environments include a supportive culture, policies,
programming, and facilities. Access to opportunities to practice a healthy lifestyle is a crucial
factor in helping an employee advance from building new skills to forming healthy habits
(Goetzel et al., 2011). A WHP program that has a supportive organizational environment, which
includes leadership support, continual motivation and opportunities to practice healthy behaviors,
as well as purposeful wellness facilities, will have a greater chance of success than a less
comprehensive WHP program (O’Donnell, 2017).
Accessibility to courses and programs. Survey question 17 asked, “Which of the
following reasons explain why you chose not to participate in at least one or all of the MLA
WHP Programs?” As described earlier in this chapter, the most frequently selected response to
that question was “programs were not scheduled at convenient times,” with 120 of 313
respondents (38%) choosing this reason (see figure 4.8). This finding not only supports the
theme of lack of time, but also reveals a shortfall in organizational planning and implementation
of the WHP.
During the focus group discussion, participants were asked question seven, “What are
some of the factors that have prevented you from participating in the MLA wellness program?”
Employee A3 addressed an issue concerning the In-Service Day courses: “Some of the classes
fill up so fast. So before I could enter my name, the spot was taken. It makes it hard to
participate when you cannot even join the activities you want to join.” In addition, employee A6
stated that “[w]e have great facilities, but it’s not accessible at all times. There are only specific
times that MLA employees can use it. Super early in the morning before school, or after
IMPLEMENTATION OF A WELLNESS PROGRAM 76
4:30pm.” Employee A2 followed up this comment by saying, “Employees don’t generate
income for the school. Students have priority because they are our stakeholders. So that’s why
we’re not the priority.”
Furthermore, survey participants were asked question 22, “What would motivate you to
improve your wellness” (see figure 4.5). One hundred and forty-six of 313 respondents (47%)
chose “onsite facilities and courses for employee wellness.” Both focus groups discussed the
importance of employee wellness courses offered at MLA. Participants were asked question 6b,
“What are some factors that would encourage you to increase your participation in the MLA
WHP initiatives and events?” The theme of time was brought up again in both groups, as well as
access to courses. For example, employee A1 explained:
The schedule of wellness courses on in-service days could be better. Maybe it is
something that becomes compulsory or mandated? If it was mandated that employees
focus on their wellness from 7:30-8:30am, and you have to pick one activity to do, then
we are given permission to focus on our wellness and not work or have a meeting. I
think it is a good way to encourage participation by giving time.
Employee B2 stated, “I’m just wondering, if like, we offer all these after-school courses for our
kids, why don’t we offer more free activities for adults? Something like yoga or zumba.
Something that is free or cheap for employees, but something that is consistent each week.”
These findings align with best practices of providing programing and courses that nurtures
wellness within the workplace (O’Donnell, 2017).
Furthermore, in response to survey question 22, “What would motivate you to improve
your wellness,” 157 of 313 respondents (50%) selected “permission and support to focus on
wellness throughout the workday (i.e., during personal breaks, lunchtime, etc.)” (see figure 4.5).
IMPLEMENTATION OF A WELLNESS PROGRAM 77
Also, for the same survey question, 103 of 313 respondents (33%) mentioned “support from
school leadership” as a motivator for improving wellness. The survey responses indicated that a
larger percentage of MLA employees would be motivated to improve their wellness if they
received organizational support.
Support for employees to focus on their wellness throughout the day was also heard in
the focus group discussions. Focus group question nine asked participants, “What other wellness
programs have you heard about or experienced in a previous school/company that you believe
are impactful programs to improve employee participation?” Each focus group discussion had
participants mention that they had heard of, or had spouses that worked at, companies or
organizations that supported employee wellness throughout the day. Employee B1 stated, “At
my husband’s company, employees can go to the gym when they feel like it. Also, no one thinks
twice if you need to take a little extra time over your lunch break to visit a doctor or dentist.”
Employee B4 mentioned:
Yes, I have a good friend and she teaches at another international school. Her
superintendent actually said to her, when she was first hired, that we hope to see you at
the school gym. She said the gym is open for faculty throughout the day. The
superintendent mentioned that if you find that you have a half an hour break, and you
need to work some energy off; go to the pool, go use the gym, and do what you need to
do to be well. I think that sort of support for employee wellness would be quite helpful
here at MLA too.
In addition to courses, focus group participants also brought up access to healthy meals as
a way to improve employee health. Employee A3 stated, “I find it difficult to find healthy halal
food on campus. The other cafeterias have a salad bar, but there really aren’t many healthy
IMPLEMENTATION OF A WELLNESS PROGRAM 78
options for halal.” Employee A6 agreed and mentioned that “[e]ating healthy is something I
want to work on, but it is hard to maintain my healthy diet when MLA offers so many unhealthy
options in the cafeteria.”
It is also important to note that survey question 30 asked, “Please share whether you
agree or disagree with the following statement . . . my organization allows me to maintain good
health.” Seventy-eight of 292 respondents (27%) disagreed or strongly disagreed with this
statement (see figure 4.9). Furthermore, 59 of 292 participants (20%) responded, “disagree” or
“strongly disagree” to the statement, “I believe my organization cares about my wellness.”
These findings indicate that some participants believe they are not being supported and cared for
by their organization in terms of maintaining good health and wellness. However, it should be
noted that a large majority of survey participants do feel supported and cared for in regard to
wellness.

Figure 4.9. Please share whether you agree or disagree with the following statement…my
organization allows me to maintain good health.

IMPLEMENTATION OF A WELLNESS PROGRAM 79
Accessibility to facilities and resources. Access to facilities and resources throughout
the working day was a part of this theme’s findings as well. Again, in survey question 22,
participants were asked, “What would motivate you to improve your wellness?” (see figure 4.5).
146 of 313 respondents (47%) chose “onsite facilities and courses for employee wellness.”
During the focus group discussions, participants were asked, “What types of physical
environments or facilities would better promote wellness at MLA?” Employee A3 mentioned:
I think we have good facilities. Really the workout gym is the best gym I’ve ever been
to. Like if you go to public gyms, it’s not always the best conditions. It’s terrible. I
don’t go to the public gyms at all, so I’m very thankful to have a gym here at MLA.
Even though all employees acknowledged that a large private international school like MLA has
state-of-the-art facilities, it was emphasized that participants believe the presence of wellness
facilities on campus does not mean they have access to these facilities throughout the day or
during convenient times.
When asked focus group question seven, “What are some factors that have prevented you
from participating in the MLA wellness program?”, several employees agreed that a barrier was
utilizing the same facilities as students. Employee B4 said:
The workout facilities are complicated because we know they are not intended for staff.
Being able to use the wellness facilities after 4:30pm is an add-on since it is created for
students and sport teams. Also, I am not as comfortable seeing my students while I am
working out. If I had the choice, I would rather have a facility for adults then share with
students, but that is me personally.
Employee B4 added, “We have like four or five treadmills in there, but when everybody comes
after school at 4:15-4:30pm, often they are occupied.” Employee B2 mentioned, “It’s not only
IMPLEMENTATION OF A WELLNESS PROGRAM 80
about workout facilities, but we are lacking faculty lounges too. We need spaces where we can
meet as teachers and be social without it having to be a formal meeting or PLC (Professional
Learning Community).” It should also be noted that both employee A5 and employee B3
approached the researcher after the focus group discussions. They mentioned that they would
have liked to have added that MLA should consider having quiet spaces on campus, spaces
where people can pray, meditate, or just find a quiet space because there are many employees
that need a place for prayer or meditation during the day to support their spiritual wellness.
A comprehensive WHP will truly be successful when it has a supportive organizational
environment, leadership support, as well as continual motivation and opportunities created to
practice healthy behaviors (O’Donnell, 2017). Lack of organizational support and resources is a
possible constraint for the MLA WHP, as participants of this study have pointed out some of the
barriers in this area.
Conclusion
The mixed-methods data collected from the survey and focus group discussions exhibited
(a) employee perceptions on how the WHP has been implemented at MLA; (b) some promising
practices that have motivated employees to participate in the WHP; and (c) barriers experienced
by employees that have prevented them from participating in the MLA WHP. There are a total
of six themes that emerged from the study, three motivator themes and three constraint themes.
In chapter five, there will be a summary of themes and implications for the implementation of a
WHP, as well as recommendations for future research.

IMPLEMENTATION OF A WELLNESS PROGRAM 81
Chapter Five: Discussion
The purpose of this study was to understand the phenomenon of why employees choose
to participate in the MLA WHP. It sought to understand promising practices utilized by
comprehensive WHPs and the barriers that hinder participation in WHPs. The context of this
study was the employee population of Modern Learning Academy (MLA), a preschool to 12
private international school, where a Worksite Health Program (WHP) has been in place for the
past six year. Even though the school has committed time, resources, and manpower to the
implementation of a WHP, there is limited understanding of the phenomenon of (1) why
employees chose to participate in the MLA WHP, (2) the promising practices utilized by
comprehensive WHPs, and (3) the barriers that hindered participation in a WHP. The following
research questions were utilized to guide this study:
1. Why do MLA employees participate in WHP?
2. What role, if any, do constraints play in MLA employees’ decision to participate
in the WHP?
This mixed-methods study utilized the quantitative data collection of a survey, and
qualitative data collection of focus groups. Creswell’s (2014) explanatory sequential design was
utilized where quantitative data were collected initially, and the qualitative data followed for the
purpose of explaining the results and findings more in depth. A total population sampling of 642
employees was used for the online survey with 313 employees completing the survey. A
stratified sampling with simple random sampling was utilized for the purposeful selection of six
faculty and six support staff employees for the two focus group discussions. The data collected
from the survey and focus group discussion were recorded, transcribed, coded, and analyzed.
IMPLEMENTATION OF A WELLNESS PROGRAM 82
Chapter Five shares a summary of findings, implications for practices and recommendations for
the future.
Summary of Findings
An analysis of the mixed-methods data collected from the survey and focus groups
revealed promising practices that an international school has used when implementing a WHP.
In addition, the mixed-methods data provided an understanding of why employees participate in
a WHP, as well as the barriers participants face in doing so. From the data analysis, a total of six
findings emerged regarding participation. Three findings supported participation and three were
constraints. These findings are:
1. MLA employees perceive they have the knowledge and skills to lead healthy lifestyles.
2. MLA employees value the benefits of health and are motivated to participate in wellness
activities because of the possibility of positive outcomes for their health. They want to
participate in WHP because it feels good to participate in wellness activities.
3. Social influences are a motivator for some employees to participate in the WHP through
social accountability. Employees seek a wellness culture within the WHP where they can
build relationships.
4. A significant barrier for employee participation in the WHP is time.
5. MLA employees seek work-life balance. The workplace can be stressful and these same
individuals perceive it to be challenging to balance and create boundaries between their
professional roles and responsibilities and their personal life.
6. There is a perceived lack of organizational support and resources for wellness at MLA.
A barrier to the implementation of the WHP is that employees believe courses are
planned to occur at inconvenient times. Courses and facilities are not accessible
IMPLEMENTATION OF A WELLNESS PROGRAM 83
throughout the day, which hinders participation. The lack of dedicated facilities,
resources, and support by MLA leadership is a perceived constraint for participation in
the WHP.
The first finding from the study demonstrates that participants perceive that they have the
knowledge and skills needed to live healthy lifestyles. Not only was that apparent in the survey,
but all participants in the focus groups addressed their knowledge and understanding of health
and wellness. This finding is important because successful WHPs develop their programs on the
foundation of promoting the knowledge and skills of wellness for employees (O’Donnell, 2017).
It is vital to have the knowledge and skills in order to engage in healthy behaviors as it increases
recognized benefits to change behavior and the perseverance to overcome barriers (Faghri &
Buden, 2015). This finding reveals that participants believe they have the foundation of health
literacy. The MLA WHP has provided opportunities for employees to be informed about their
health and wellness and has also provided access to health screenings that further knowledge
about an individual’s health and wellness.
The second finding relates to the participants’ perceived benefits of health. Wellness is
the process of empowering people to gain control over their health by learning new life skills and
making purposeful choices towards a more balanced and healthy lifestyle (WHO, 2017f). This
finding from the study demonstrated that employees participate in the WHP because of
anticipated benefits of health. The data revealed that employees want to improve their health
because of the possible positive outcomes; they want to participate in WHP because it feels good
to participate in wellness activities.
These findings also correlate with previous research on intrinsic motivators of wellness
that are driven by interest or enjoyment, and involve internal feelings within an individual
IMPLEMENTATION OF A WELLNESS PROGRAM 84
(O’Donnell, 2017; Seifert et al., 2012). Intrinsic incentives motivate these healthy behaviors
because it feels good or happiness follows (O’Donnell, 2017). WHPs resources either
intrinsically motivate engagement by fulfilling internal psychological needs, or extrinsically
motivate engagement by providing employees incentives and benefits to achieve work related
goals (Bakker et al., 2011; O’Donnell, 2017). There is ample evidence in the findings that MLA
participants are motivated by intrinsic motivation through the benefits of health and well-being.
Furthermore, the top health priorities for participants aligned with ways to prevent non-
communicable diseases, such as nutrition, exercise, stress-reduction, and sleep (CDC, 2017a).
Participants want to improve their health and wellness because they have the knowledge and
motivation that the benefits of wellness include the prevention of health risk factors and an
increase in their chances for a longer healthier life.
The third finding from the study revealed that social influences are a factor for why some
employees participate in the WHP. A wellness culture is a social environment within the
workplace that fosters employees’ actions to adopt healthier lifestyles and supports social
influences that lead all people toward healthy behavior (CDC, 2017; Goetzel et al., 2014). The
correlated findings between the survey responses and focus group discussion support the need
for social accountability among some participants, as well as the development of a wellness
culture where employees are able to interact with one another in and outside of working hours.
In a wellness culture, social influences steer people towards healthy choices and behaviors
(O’Donnell, 2017). Findings suggest MLA employees are motivated to participate in the WHP
by social accountability and community building activities.
There were three findings that revealed barriers to the implementation of a wellness
program within an international school. A significant barrier exposed within the data findings
IMPLEMENTATION OF A WELLNESS PROGRAM 85
was time. The findings of the survey responses and focus group discussion corroborated to
uncover that many employees do not participate in the WHP because of the lack of time. Time
as a factor was not identified within this study’s literature review; however, the data findings
from this study reiterate the importance for the organizing and planning components of WHPs
and identify the need for a program re-evaluation of the WHP implementation. The findings
suggest that the MLA WHP should consider creating more time for employees to foster their
health and wellness since this is a perceived barrier. It would be difficult to find a workplace
where employee health is not a value held by everyone, yet it is one of many values that compete
for time and energy within an organization (Fertman, 2015).
Another barrier that emerged revealed that work-life balance is a perceived constraint to
employee participation in the WHP. The findings for the survey and focus group corroborated to
reveal that a top priority for many participants is work-life balance and stress management. This
also corresponds with the constraint of time; however, the findings reveal that some participants
of this study believe that the workplace is stressful and that individuals lack boundaries between
their personal and professional life. In recent studies, employers have acknowledged that poor
work-life balance, exorbitant amounts of workload, and all-day technology access are instigating
high stress levels (Goetzel et al., 2011). In addition, previous studies suggest that employee
healthy behaviors and stress levels are shaped by workplace norms (Hoert et al., 2016). Coping
strategies have been the debate of much research because those that are effective have been
identified as a fundamental intervention in aiding to build higher levels of well-being and
engagement, while protecting teachers from the negative effects and increased demands they
face on a daily basis (Cooper et al., 2001; Parker & Martin, 2009). The study’s findings
IMPLEMENTATION OF A WELLNESS PROGRAM 86
identified that participants not only need strategies to cope with stress, but possible wellness
interventions on how to create work-life balance and ‘boundaries’ in their lives.
The last barrier that was revealed in this study was the possible lack of organizational
support and resources for wellness. A high percentage of participants in this study believe WHP
programs and initiatives are planned at inconvenient times. It was revealed that participants of
this study would like the organization to consider allowing employees to have access to wellness
facilities and resources throughout the workday instead of only before or after-school at 4:30pm.
Also, a part of this barrier for the MLA WHP participation is the lack of dedicated facilities and
resources for employees that are supported by MLA leadership. A comprehensive WHP will
truly be successful when it has a supportive organizational environment, leadership support, as
well as continual motivation and opportunities created to practice healthy behaviors (O’Donnell,
2017).
Implications
This study focused on how a WHP has been implemented; promising practices utilized
by a WHP to support participation; and possible barriers preventing employee participation in a
WHP. It is apparent that MLA has invested time and resources into implementing a WHP.
Therefore, in order to continue improving the implementation of the WHP, MLA should be made
aware of the implications drawn from this study’s research and findings. These implications are:
1) reassess allocated time for employee wellness 2) reassess employee access to courses and
facilities 3) assess the WHP and continue developing a culture of wellness and 4) continue to
foster and support knowledge and skills of health and wellness.
Reassess allocated time for employee wellness. The first implication acknowledges the
importance of time. MLA has implemented a WHP, but because the school is faced with other
IMPLEMENTATION OF A WELLNESS PROGRAM 87
initiatives and greater priorities within their educational setting, it is important that the school
revisits how the WHP is implemented, and how it manages the time allocated to support
employee wellness. Given what we have learned from the data findings, employee participants
perceive time to be a major barrier in the sustainability of their health and wellness and for their
participation in the WHP. It is recommended that MLA leaders and WHP coordinators
collaborate in hopes of diminishing this barrier. This could greatly affect employee wellness
throughout the workday and school year.
Reassess employee access to courses and facilities. The second implication reiterates
the first because improving employee access to courses and facilities cannot be considered
without the underpinning of allotted time. Given what emerged from this study, it is vital that
the MLA WHP and leadership team re-evaluates when courses and facilities are made available
for employees. The participants in this study communicated that current programs and initiatives
are planned at inconvenient times; the MLA WHP could increase employee buy-in through the
consideration of designated employee wellness facilities or courses that could be utilized at more
convenient times throughout the workday. Furthermore, since exercise, nutrition, work-life
balance, sleep, and stress management are the top five priorities of employees, it is
recommended that courses offered by the WHP support these areas of wellness.
Also, since social influences and accountability are motivators for some participants, it is
recommended that the MLA leadership team and WHP coordinators ascertain the possibility of
integrating some wellness activities within already formed professional learning communities. It
is recognized that many employees within a school environment cannot have flexible work
schedules because of scheduled classes with students. However, the integration of wellness
activities or courses within the allocated time for professional learning communities could
IMPLEMENTATION OF A WELLNESS PROGRAM 88
alleviate some of the pressure of finding time throughout the workweek. The engagement in
these wellness activities as a professional learning community could also aid in relationship
building among team members, supporting social accountability. This shift would require more
WHP planning and resources; hence, it would involve leadership buy-in and support in
alignment with the MLA office of learning. It is also recommended that the MLA WHP looks at
how other international schools have allocated time and resources for employee wellness
courses, activities and facilities.
Assess the WHP and continue developing a culture of wellness. The third implication
is that, in order to engage in the reassessments of the previous two implications, an overall
assessment of the MLA WHP should also be undertaken. In chapter two, it was stated that the
WHP at MLA had never done a workplace health assessment or an evaluation of the workplace
health program. The CDC Worksite Health Model emphasizes that the evaluation process
should feed into a continuous quality improvement loop to enhance and strengthen existing
activities; determine potential gaps in current offerings; and describe the efficiency and
effectiveness of the resources invested in the program (CDC, 2016c). Dynamic WHPs utilize a
framework that focuses on needs assessment for employees, plan of action, implementation and
evaluation (CDC, 2016c). When done right, the benefits of effective WHPs far outweigh the
negatives and WHPs are one of our greatest hopes for diminishing the worldwide epidemic of
non-communicable diseases (WHO, 2017f).
It is evident that a culture of wellness is starting to form at MLA; however, it is highly
recommended that the entire MLA WHP be further evaluated using research-based tools and
measurements. Future findings could help the continuation of building a culture of wellness at
MLA. A healthy supportive organizational culture where employees thrive and are more
IMPLEMENTATION OF A WELLNESS PROGRAM 89
productive and effective while enjoying their relationships and work environment is something
that all good organizational leaders should want (O’Donnell, 2017).
Continue to foster and support knowledge and skills of health and wellness. The
fourth and final implication acknowledges the foundation of health literacy that MLA
participants have attained, which, in turn, supports their understanding of the benefits of health
and wellness. Wellness is the empowering of people to develop and enhance their health while
learning new life skills and making purposeful choices towards a more sustainable and healthy
lifestyle (WHO, 2017f). Participants perceive they have the knowledge to lead healthy lifestyles;
however, through years of research, it has been discovered that education is not enough to
change behavior for most people. As has been observed, if knowledge was enough, everyone
would exercise and no one would smoke (Fertman, 2015; Gantner, 2012).
It is recommended that the MLA WHP considers this study’s findings as to why MLA
employees participate and the barriers that prevent them from participating in order to further
support wellness within the employee population. Moreover, with a 49% response rate (313
participants) for this study’s wellness survey, it is clear that MLA employees are interested in
wellness. Participants have the knowledge of wellness and exhibit interest; however, it is
recommended that a yearly WHP assessment be done to determine if this is the case because
MLA is an international school and results could change yearly with a transient employee
population.
Recommendations for Future Research
This study focused on employee participation and the WHP implementation within a
private international school in Southeast Asia. An analysis of the data identified that there were
multiple perspectives on what employees considered a barrier for participation, and what
IMPLEMENTATION OF A WELLNESS PROGRAM 90
supported participation. Therefore, as the MLA WHP evolves to meet the wellness needs of the
employee population, it is recommended that another assessment be conducted after changes or
adjustments have been made to the WHP implementation. Moreover, it is suggested that yearly
assessments be done through a program evaluation of the WHP.
In addition, it would be insightful to conduct similar studies in other international schools
around the world that have implemented employee wellness programs. Further studies be
conducted to understand how WHPs have been implemented within a variety of international
schools to engage employees in wellness. Another topic worth exploring through quality
research would be the possibility of a WHP changing a school’s culture so that the organization
as a whole is more sustainable in terms of health and wellness. What programs, policies, and
behaviors would be needed to initiate a change in a concept so broad as organizational culture?
This would be another worthwhile area for future research.
Conclusion
The potential and possibility to have the highest attainable standard of health is a
fundamental right for every person (WHO, 2017g). Health enables people to realize their
aspirations, fulfill their needs, and manage their living and work situation in order to have a long
successful life (CDC, 2016e). There is growing acknowledgement of the important role WHPs
play in improving employee wellness. The World Health Organization views the workplace as
an important setting for health promotion in today’s world (WHO, 2016c). When done
effectively, WHPs can be of great benefit to employers and employees. However, if the WHP is
not assessed, planned, implemented, and evaluated adequately; it is highly unlikely that it will
create positive results (Goetzel et al., 2014; O’Donnell, 2017). Historically, employers have
struggled to maintain, promote, and increase participation in their WHPs, mainly because of a
IMPLEMENTATION OF A WELLNESS PROGRAM 91
lack of understanding of what spurs employee participation (Gingerich et al., 2012; O’Donnell,
2017; Seaverson et al., 2009).
The purpose of this study was to understand the phenomenon of why employees choose
to participate in the MLA WHP. It sought to understand promising practices utilized by
comprehensive WHPs and the barriers that hinder participation in WHPs. MLA has devoted
resources and manpower to the implementation of their WHP. Findings from this study can be
used to inform promising practices that can leverage employee participation and program
effectiveness. Overall, the implementation of the MLA WHP has been positive in supporting the
knowledge and understanding of the benefits of health. Further research is recommended to
better understand the nuances that are essential to successful implementation of WHPs,
especially when time, work-life balance, and organizational support and resources have been
found as barriers for participation.

IMPLEMENTATION OF A WELLNESS PROGRAM 92
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Appendices
Appendix A: WHP Focus Group Discussion Guide

Interview Guide on Employee Wellness Programs at MLA

Hello Everyone!
Thank you for agreeing to participate in this focus group discussion. I value your
thoughts and views on employee wellness. Information gathered today is part of my dissertation
study and it will assist in my understanding of the needs and implementation of the Worksite
Wellness Program at MLA.
There are two main parts to this focus group interview. The first part will focus on
factors that influence behavior change with wellness. The second part will focus on your
personal perspective on the MLA employee wellness program.
In order to accurately capture your responses, I would like to record this session with your
permission. The recording will only be used to transcribe the results. I will not use your real
names; I will use pseudonyms to provide anonymity. Any personally identifiable information
will be masked. Do you have any questions or concerns about the process?

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Part I: What factors influence participation and behavior change?

1. What are some healthy lifestyle choices or changes that you’ve made recently?
2. What are the factors that influenced you to make these healthy lifestyle choices or changes?
3. If you would like to make better choices or changes for your wellness, what are some barriers
or challenges that prevented you from doing so?

Part II: Personal perspectives on the SAS Wellness Program

4. What are some wellness events, initiatives, or activities that you are interested in?
5. In general for MLA employees, what area of wellness (example: physical, emotional,
intellectual, etc.) do you believe needs the most attention? Why?
6. Have you heard of the MLA wellness program?
- if yes, how did they hear about it?
- if not, what would be the best way to let employees know about it?
- (if they don’t know, then briefly explain and then ask subsequent questions)
6b. What are some factors that would encourage you to increase your participation in the MLA
wellness program initiatives and events?
7. What are some factors that have prevented you from participating in the MLA wellness
program?
8. What types of physical environments or facilities would better promote wellness at MLA?
9. What other wellness programs have you heard about or experienced in a previous
school/company that you believe are impactful programs to improve employee participation?

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Appendix B: Request for Focus Group Participation E-mail

Dear__________________________,

I am writing to request your participation in my research study that seeks to understand the
phenomenon of why employees choose to (or not to) participate in the MLA Wellness
Program. This work is part of my dissertation research to meet the requirements of the USC EdD
program here at MLA in which I am enrolled. Participation in this research is voluntary. You
may decline participation at any time throughout the study. The research questions for this study
are the following:
1. Why do (or do not) MLA employees participate in the employee Wellness Program?
2. What role, if any, do constraints play in MLA employees’ decision to participate in the
Wellness Program?
3. What factors influence participation in the MLA Wellness Program?

For the purpose of this research, I am requesting that you participate in a focus group. The focus
group session will last approximately 60 minutes and will occur on MLA school grounds. Any
information I obtain from the interview will be used for research purposes only. You will remain
anonymous; information gathered may be used in my reporting. I will not use your name; but
instead, a pseudonym will be used. If you have questions regarding this study please feel free to
contact me, or my committee chair, Ruth Chung, at rchung@rossier.usc.edu
If you are willing to volunteer to be part of the focus group, please reply to this email. I will
follow up with a calendar invite. Thank you for your consideration.

Sincerely,
Anne Wenstrom

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Appendix C: Request for Focus Group Participation E-mail

Dear Colleagues,

I am conducting a study to better understand the factors that go into employee participation in a
wellness program as part of my doctoral dissertation study. I would appreciate you taking the
time to complete the following survey that should take about 10 minutes. Your participation is
voluntary and all responses will be held confidential and reported only in summary form.

To thank you for your participation, at the end of the survey there will be a lucky draw. Eight
lucky participants will be given a $25 gift voucher. Following your survey submission, you will
be taken to a separate link where you may enter your email address to enter this lucky draw.

If you have questions regarding this study please feel free to contact me, or my committee chair,
Dr. Ruth Chung, at rchung@usc.edu.

Thank you in advance for your participation and support!

Sincerely,
Anne Wenstrom

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Appendix D

Qualtrics Employee Wellness Survey

Wellness Survey

Start of Block: Default Question Block

Please complete the following survey. There are no wrong or right answers. I am genuinely
interested in your thoughts and behaviors in relation to a variety of aspects of wellness and
participation in a wellness program. Your responses will be confidential and will only be
reported in summary form so that you cannot be identified by them. If you do not feel
comfortable answering a question, you may skip it. There is no penalty for stopping at any point.

Please proceed to the survey by clicking the arrow in the bottom right corner.

Page Break

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Background Information:

Q1 Please select your age within the following ranges:
o 20-30 years old
o 31-40 years old
o 41-50 years old
o 51-60 years old
o 60 and above

Q2 What is your gender?
o Male
o Female
o Rather not say

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Q3 Which of the following best describes how you identify in terms of your primary
racial/ethnic background?
▢ Caucasian
▢ Latino or Latina
▢ African origin
▢ Native American origin
▢ Asian Chinese origin
▢ Asian Indian origin
▢ Asian Malaysian/Indonesian origin
▢ Asian Other: ________________________________________________
▢ Pacific Islander origin
▢ Rather not say
▢ Other: ________________________________________________

Q4 What is your nationality?
________________________________________________________________

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Q5 What division do you work in at MLA?
o Elementary
o Middle School
o High School
o Central Admin
o Other: ________________________________________________

Q6 How many years have you been an MLA employee?
o 0-2 years
o 3-5 years
o 6-10 years
o 11-15 years
o 16 years or more

Q7 Please specify your employment classification group:
o Support Staff
o Faculty
o Administrator

Please click on the arrow in the bottom right corner to go to the next page...

IMPLEMENTATION OF A WELLNESS PROGRAM 112
Page Break

Please take some time to think of your own health and wellness:

Q8 Would you say your general health is...
o Very Good
o Good
o Poor
o Very Poor

Q9 Do you believe you have the knowledge needed to live a healthy lifestyle?
o Completely Agree
o Somewhat Agree
o Somewhat Disagree
o Completely Disagree

Q10 Do you believe you have the skills developed to lead a healthy lifestyle?
o Completely Agree
o Somewhat Agree
o Somewhat Disagree
o Completely Disagree

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Q11 When was the last time you had a comprehensive medical check-up by a doctor?
o Never
o Less than 1 month ago
o Less than 6 months ago
o Less than 1 year ago
o 1 - 2 years ago
o Over 2 years ago

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Q12 What are the top three health priorities for you to work on this year?
▢ Allergies
▢ Asthma
▢ Avoiding Colds and Flu
▢ Sleep
▢ Blood Pressure
▢ Cholesterol
▢ Chronic Pain Management
▢ Dental Care
▢ Diabetes
▢ Work-life Balance
▢ Exercise
▢ Financial Management
▢ Injury Treatment and Prevention
▢ Nutrition
▢ Self-esteem
▢ Stress Management
▢ Tobacco Cessation
▢ Other: ________________________________________________
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Q13 How difficult is it for you to get information or advice about evidence-based research
on health or wellness topics if you need it? Would you say it is…
o Extremely Easy
o Somewhat Easy
o Somewhat Difficult
o Extremely Difficult
o I don't look for health or wellness information

Please click on the arrow in the bottom right corner to go to the next page...

Page Break

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MLA Wellness Program Awareness:

Q14 Prior to seeing this survey, were you aware that MLA offered a wellness program to its
employees?
o Yes
o No

Q15 In the past 12 months, do you remember seeing, hearing, or receiving any program
information regarding the MLA employee health promotion program?
Yes No
Wellness Program announcements
during meetings
o o
Emails
o o
Word of mouth from colleagues
o o
Wellness Program website on MLA
employee portal
o o
Other (please specify):
o o

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IMPLEMENTATION OF A WELLNESS PROGRAM 117

Program Participation:

Q16 In the past 12 months, have you participated in any of the MLA employee health promotion
program offerings?
o Yes
o No

Q17 Which of the following reasons explain why you chose NOT to participate in at least one or
all of the MLA Wellness Program? (Check all that apply)
▢ DOES NOT APPLY - I participated in all MLA Wellness Program offerings
▢ Did not know about the MLA Wellness Program
▢ Lack of interest
▢ Lack of motivation
▢ Lack of facilities
▢ Programs were not scheduled at convenient times
▢ Cost
▢ Program offerings were not accessible and near my area of work on campus
▢ I would rather do a wellness activity on my own outside of MLA
▢ Other: ________________________________________________

IMPLEMENTATION OF A WELLNESS PROGRAM 118

Q18 Which of the following reasons explain why you chose to participate in the MLA Wellness
Program? (check all that apply)
▢ DOES NOT APPLY - I did not participate in any MLA Wellness Program offerings
▢ Interested in improving my health
▢ It feels good to participate in wellness activities
▢ My family encouraged my participation
▢ To earn rewards or incentives
▢ My friends/colleagues were participating
▢ Felt pressure from management/senior leaders
▢ To socialize and meet more colleagues
▢ Other (please specify): ________________________________________________

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IMPLEMENTATION OF A WELLNESS PROGRAM 119

Program Satisfaction and Impact:

Q19 In the past 12 months, how satisfied were you with the overall MLA employee Health
Promotion Program
o Extremely Satisfied
o Somewhat Satisfied
o Somewhat Dissatisfied
o Extremely Dissatisfied

IMPLEMENTATION OF A WELLNESS PROGRAM 120
Q20 In the past 12 months, what effect has the employee health promotion program had on
your…

Very Positive
Effect
Positive Effect No Effect Negative Effect
Very Negative
Effect
Morale
o o o o o
Productivity
o o o o o
Satisfaction with
your job
o o o o o
Satisfaction with
your employer
o o o o o
Physical Health
o o o o o
Emotional
Health
o o o o o
Social Health
o o o o o
Overall
Wellness
o o o o o

IMPLEMENTATION OF A WELLNESS PROGRAM 121
Q21 In the past 12 months, in which of the following health improvement activities have you
participated?

As part of the Wellness
Program
Outside of MLA No Participation
Counseling or coaching
with a health promotion
professional
o o o
Regularly attended fitness
classes or a gym
o o o
Joined a weight
management program
o o o
Improved my eating habits
o o o
Began implementing
stress management or
mindfulness
o o o
Reduced alcohol
consumption
o o o
Participated in a smoking
cessation course
o o o
Participated in preventive
screenings (e.g.
cholesterol, diabetes,
health screening)
o o o
Completed a Health Risk
Assessment (HRA)
o o o

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IMPLEMENTATION OF A WELLNESS PROGRAM 122

Motivation, Personal Interest, and Overall Thoughts on Wellness:

Q22 What would motivate you to improve your wellness? (check all that apply)
▢ Incentives (i.e. financial, medical benefits, rewards, etc.)
▢ Rewards that recognize accomplishments or outcomes
▢ Rewards that recognize participation
▢ No extrinsic incentives, just intrinsic motivation
▢ Possibility of positive outcomes (i.e. improved strength, or improved health)
▢ Instructor or coach's feedback (i.e. positive and/or constructive feedback)
▢ Onsite facilities and courses for employee wellness
▢ Feedback from medical professionals (i.e. Medical check-ups, Health Screenings on or
off campus, etc.)
▢ If it aligns with personal interests and passions
▢ Permission and support to focus on wellness throughout the workday (i.e. during personal
breaks, lunchtime, etc.)
▢ Support from family, friends, or colleagues
▢ Support from school leadership
▢ Other: ________________________________________________

IMPLEMENTATION OF A WELLNESS PROGRAM 123
Q23 Please share how appealing each of the following incentives are for improving health to
you, assuming equal monetary value.
Very Appealing Somewhat Appealing Not Appealing at all
Direct cash payments (as a
check or extra
compensation)
o o o
Gift cards or gift vouchers
o o o
Discounts on wellness
courses, activities, or
products in Singapore
o o o
Free or reduced price
wellness courses at place
of employment
o o o
Gift items (e.g., water
bottle, pedometers, etc.)
o o o
Reduced premiums on
health insurance
o o o

IMPLEMENTATION OF A WELLNESS PROGRAM 124
Q24 What types of wellness areas interest you? (check all that apply)
▢ Physical Wellness (i.e. Exercise, nutrition, sleep, etc.)
▢ Emotional Wellness (i.e. Stress relief, mindfulness, positive self-esteem, etc.)
▢ Social Wellness (i.e. Relationship building, building support systems, positive conflict
resolution, etc.)
▢ Intellectual Wellness (lifelong learning, creativity, critical thinking, global awareness,
seeking out new challenges, etc.)
▢ Occupational Wellness (i.e. enjoyment at work, purpose and meaning through your work,
professional goals, work-life balance, etc.)
▢ Spiritual Wellness (i.e. individual purpose, meaning, values, beliefs, etc.)
▢ Environmental Wellness: (i.e. stimulating environments that support well-being,
appreciation of the external cues and stimuli that an environment can provide, seeking to
understand the role a person plays in the environment, etc.)
▢ Financial Wellness (i.e. manage finances for short-term and long term, awareness of
current financial state, etc.)
▢ Cultural Wellness (i.e. awareness of your own cultural background, intrinsic respect and
appreciation for all aspects of diversity, etc.)

IMPLEMENTATION OF A WELLNESS PROGRAM 125
Q25 For your physical wellness, what types of exercise courses interest you? (check all that
apply)
▢ Cardio types of exercise
▢ Strength training types of exercise
▢ Yoga/Pilates types of exercise
▢ Team sports
▢ Individual sports
▢ Other: ________________________________________________

Q26 For your physical wellness, what types of nutrition courses interest you? (check all that
apply)
▢ Courses that focus on healthy eating habits
▢ Specific diet types of nutrition courses (i.e. paleo diets, vegan diets, etc.)
▢ Easy food preparation courses
▢ Nutrition courses for a family
▢ Other: ________________________________________________

IMPLEMENTATION OF A WELLNESS PROGRAM 126
Q27 For your social wellness, what types of activities interest you? (check all that apply)
▢ Family participation events (i.e. Family Fun Day, etc.)
▢ Social events where people exercise together (i.e. nature walks, etc.)
▢ Service or volunteer types of activities
▢ Events limited to adults in social settings
▢ Team-building and team challenges
▢ Corporate races
▢ Other: ________________________________________________

IMPLEMENTATION OF A WELLNESS PROGRAM 127
Q28 What other types of wellness courses or activities interest you? (check all that apply)
▢ Mindfulness courses and activities
▢ Life counseling sessions
▢ Stress reduction or relaxation courses
▢ Gratitude or self-reflection journaling
▢ Global awareness group discussions
▢ Creative, artistic, or musical courses
▢ Engaging in new learning opportunities in connection with your interests and passions
▢ Financial consultation
▢ Cultural competence and diversity training
▢ Environmental courses on improving home living areas and office spaces for your well-
being
▢ Environmental sustainability courses
▢ Sleep improvement courses
▢ Happiness and/or finding your purpose courses
▢ Challenges including personalized goal-setting for your wellness
▢ Courses on how to better manage work-life balance
▢ Other: ________________________________________________

IMPLEMENTATION OF A WELLNESS PROGRAM 128
Q29 To what extent do you feel that your personal health and wellness plays a part in the healthy
organizational culture at SAS?
o Highly Likely
o Likely
o Somewhat Likely
o Not Likely

Q30 Please share whether you agree or disagree with the following statements…
Strongly Agree Agree Disagree Strongly Disagree
I would recommend
my organization as a
great place to work.
o o o o
My work
environment allows
me to maintain good
health.
o o o o
I believe my
organization cares
about my wellness.
o o o o

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For additional resources - http://dissertationedd.usc.edu/
DSC contact information – rsoedsc@rossier.usc.edu or (213)740-8099

IMPLEMENTATION OF A WELLNESS PROGRAM 129

Abstract (if available)

Abstract The assumption that healthier employees are happier, more productive, safer, and contribute to a positive work culture has helped to promote Workplace Health Program (WHPs) initiatives and remains a focus of many WHPs today (O’Donnell, 2017

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Asset Metadata

Creator Wenstrom, Anne Patricia (author)

Core Title Implementation of a wellness program, and the initiatives and strategies needed for employee engagement at a private international school

School Rossier School of Education

Degree Doctor of Education

Degree Program Education (Leadership)

Publication Date 07/29/2018

Defense Date 07/28/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag employee health programs,employee wellness programs,international schools,OAI-PMH Harvest,Schools,wellness,wellness programs,workplace wellness programs,worksite wellness programs

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Chung, Ruth Gim (committee chair), Datta, Monique (committee member), Picus, Lawrence (committee member)

Creator Email awenstro@usc.edu,awenstrom@sas.edu.sg

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-39900

Unique identifier UC11670850

Identifier etd-WenstromAn-6551.pdf (filename),usctheses-c89-39900 (legacy record id)

Legacy Identifier etd-WenstromAn-6551.pdf

Dmrecord 39900

Document Type Dissertation

Format application/pdf (imt)

Rights Wenstrom, Anne Patricia

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA