Health Risk Assessment

In today’s fast paced world our busy lives leave little time, energy, or motivation for individuals  to focus on their own needs.

Those that do seek to improve their wellness traditionally turn to friends, family, professionals and published materials for support and information. All too often those support structures fail to make a lasting difference.

This happens for a number of reasons. Friends and family might not be capable of helping. Working with professionals is time consuming and costly and very few of us are effective at taking published, generic information and applying it to our own lives.

Gold’s Gym Winston-Salem has developed a new web-based wellness program that expands the range of support available to those wishing to make healthy lifestyle changes.

The wellness program, Gold’s Gym Health Coach, focuses on the daily challenges of making positive lifestyle changes and has the benefits of being more customized and efficient than generic, published information and less intense and costly than expert face-to-face counseling.

Utilizing a collaborative problem-solving model the goal isn’t to give advice, but rather to help individuals think through the problems and come to their own conclusions.

The coach offers ideas for consideration, helps the individual generate ideas of their own, helps the individual consider the various ideas, select a direction, and then supports them in the implementation of their decision.

Challenging the conventional wisdom that relationship formation requires in-person interaction; Gold’s Fitness Club has found that members and coaches are able to build meaningful relationships via online communication.

Utilizing industry leading technology a Gold’s Health Club Wellness Coach can offer members a secure, user-friendly personal website where they can access their coach in a real-time or via email with responses delivered in less than 24 hours.

The site permits coaches to hand select relevant articles that are written on a consumer level and that are targeted to the issue at hand and add them to a member’s online personal library.

The site also contains various health promotion programs and tools which are developed to assist the coach and member to set, implement and track specific goals.

The collaborative relationship formed between member and coach enhances the quality ice and efficiency of service.  The familiarity that a coach develops with a member’s circumstances and meaningful relationships permits them over time to more rapidly offer useful ideas and assistance.

With traditional call-in assistance lines, the time intensive exercise of getting background and contextual information is repeated each time. IN that scenario efficiency is lost.

Furthermore, Gold’s Fitness Club Wellness Coach has created a protocol based on key principals from the field of psychotherapy and behavior modification.

The protocol is embedded within a proprietary problem-solving that is based on the concept that people  often act without a great  understanding of a problem. Their responses then complicate matters and often make matters worse.

Gold’s Fitness Center Wellness Coach offers the opportunity to step back, take a second look at what has going on, and rapidly asses the factors influencing the situation. But, having an idea of “what” to do is very different than actually “doing” something about it.

People  need help with the follow-through. Additionally, after figuring out “what” to do, Gold’s Fitness Center Health Coach focuses on implementation.

Here Gold’s Gym Wellness Coach builds on sound research and experience from the field of behavior modification that has to do with goal-establishing and with implementation support.

The result is a highly customized, effective, user-friendly way of bettering the wellness of an individual.  The efficient nature of the internet based relationship allows Gold’s Gym Wellness Coach to keep the price point within reach of virtually anyone.

Information to evaluate your health promotion program comes from routinely accumulated screening and follow-up data of your health promotion program that look at process and outcomes of your program.

The Employee Health Program has available a computerized case-management system which includes queries that allow easy assessment of process and outcome results at any point in time.

Process Investigation

Process investigation looks at the health promotion program’s impact as seen at various points in time.

Information that is gathered from the various forms that wellness personnel fill out should supply you with the following

o Just how many workforce were screened?

o Exactly how many staff members who were referred to a physician went?

o Precisely how many personnel who expressed interest in health promotion programs went?

o Just how many staff who were referred to wellness programs went?

o Exactly how many workforce who went to wellness programs completed them?

o How many staff members are in follow-up caseload?

You can use this type of process evaluation to evaluate and learn about the health of your wellness program.

Health Promotion Program Outcome Investigation

A central objective of the wellness program is to enhance the health of staff members. Information on how to judge how well your wellness program is meeting this objective is called “outcome analysis” because you are reviewing  the results or outcome of your wellness program.

In health promotion programs, goals are measured by specific (outcomes) behavior changes and reductions in health risk levels. Have staff members lowered their blood pressure? Have they lost weight? Are they exercising more? is alcohol consumption at a safe level?

For example these are the types of questions you can ask to find out if you are reaching your objectives

o For workforce with high blood pressure (BP) (140 / 90 or higher or on medication) at screening, what percentage have it under control (below 140 / 90) a year later?

o What’s the change in average blood pressure levels among all personnel with high blood pressure 1 year after screening? Two years later?

o For workforce with high blood cholesterol levels (above 240) at screening, what percentage has reduced their cholesterol to borderline-high levels (200-239)?

o For workforce with borderline-high blood cholesterol levels, what percentages have decreased their cholesterol to the desirable range (below 200)?

o What’s the change in average cholesterol levels among all staff with high and borderline-high blood cholesterol levels 1 year after screening? Two years later?

o For staff who were overweight at screening, what percentage have lost 20 pounds or more a year later? Ten pounds or more? What’s the typical weight reduction?

o For employees who were smokers at screening, what percentages have quit smoking? for at least a year?

o For workforce whose level of alcohol consumption put them at-risk at screening, what percentage have quit drinking alcohol? Are consuming alcohol at levels considered safe by CDC guidelines? Have lowered their drinking, but are still at-risk?

o For staff, what percentages are exercising at least three times a week for at least 20 minutes?

o If fitness levels were measured, what percentages have improved fitness?

Make certain to set a regular time like every 6 months to look at which workers your wellness program is reaching and how effective it’s at assisting them reduce their health risks. Use this information to make new decisions about how to direct your wellness program efforts. Then make the change you need to improve your wellness program.

Some may feel that examination is a frill; it’s not. Analysis is a necessary part of a health promotion program. You’ll need to know what is working and what is not.

Decision-makers who fund the health promotion program need to be updated on the performance of the health promotion program. Evaluation will provide you with necessary data to maintain and expand the health promotion program and convince upper management to continue to support the health promotion program.

The keys to a successful health promotion program are persistent one-on-one outreach and follow-up counseling to encourage health improvement, adherence to treatment programs, changes in lifestyle behaviors, and to prevent relapse.

Periodic outreach and follow-up procedures provide employees with a safety net which keeps them involved in the health promotion program and avoids treatment dropout and relapse.

Counselors should follow up on workforce at least every 6 months throughout the career of the staff member at the worksite.  The goals of follow-up are to

o Involve staff that have health risks in treatment and risk reduction programs.

o Involve all personnel in health promotion programs and worksite-wide wellness activities.

o Support employees in carrying out the risk reduction or health betterment activities they have chosen.

o Make certain to help workforce follow their treatment programs.

o Avoid relapse.

o Avoid workforce from dropping out.

o Be sure to help staff members maintain behavior changes.

Follow-up could be conducted in individuals, by phone, mail, and via computer when the technology is available. Most preferable is an in-person contact.

Computer programs which may do case load management are available to help counselors track information and perform follow-up.

Priorities for Follow-Up

People  with multiple health risks should be at the top of the list. People  in key positions like union leaders or department heads with health risks should also be contacted early so that they learn what the wellness program is about and can share the information with others.

Individuals  who need a medical examination for high blood pressure or cholesterol should also be targeted early. A lot of staff will have seen their doctors then of the screening, but some will need more encouragement to do so. Those with no health risks may be followed up annually.

A follow-up counseling session can take 20 to 45 minutes.  At minimum, follow-up must include those who were told to seek medical evaluation for high blood pressure (BP) readings, high cholesterol readings, or borderline high blood cholesterol readings with 2 or more other risk factors.

It might include those who were identified as at-risk for one or more of the other major risk factors –  at-risk levels of alcohol consumption, being overweight, and having low HDL.

Follow-Up With Doctors

A letter (see forms) ought to be sent to the doctor or clinic of each staff member who’s high blood pressure, high cholesterol, or is under a doctor’s care.

The letter should explain the wellness program and should include the worker’s relevant, current health measurements.

Along with the letter, send a self-addressed return envelope. Follow-up with the doctor ought to be repeated every 6 months until it’s determined that the staff member is under satisfactory control.

Contacting the physician is important for three reasons

o The physicians receive employees’ health measurements taken at the workplace.

o You receive the blood pressure and cholesterol readings the doctor takes and information on the treatment the doctor prescribes.

Many times the worker does not have this information or does not remember it.  The information could be used when counseling the worker.

o Follow-up encourages physicians to pay closer attention to heart disease risk factors among their patients.

The menu approach offers employees a range of options to support lifestyle changes. It allows people  to select the type of help that suits their schedules and preferences.

The four basic types of wellness programs include

o Courses

o Minigroups

o Guided self help

o Individual counseling

Classes

Courses (8 or more) could be an effective means of providing education and social support for behavior change.  The length of a class can vary depending on topic requirements. It is not sufficient to give only classes at a workplace.

Many personnel are under time constraints with after work commitments and although they may be interested they simply cannot participate because of their schedules.

Employees could  be very eager to begin a wellness program but because of insufficient participants to meet class quotas, the wellness program is canceled.

Many national businesses like the American Heart Association, American Cancer Society, Weight Watchers, etc. offer classes; you should have little trouble in identifying a provider for class kind health promotion programs.

You may want to contact your local hospital, health department, or YMCA for possible choices. for choosing  a vendor to provide a wellness program you may want to review the section on wellness program structure.

Minigroups

When there is not enough interest to create a class, those who are interested in a given health topic could be formed into a minigroup (2 to 7).

The minigroup can cover the same content as a class but do so in a less formal manner. Presentation of information and discussion is the major format of the minigroup.

Guided Self-Help

Most employees don’t want formal help in making health changes; they prefer to do it on their own. In guided self-help, the wellness counselors provide support, materials, and encouragement.

Meeting times can be arranged and contact can be made either in individuals, by phone, or computer. Materials can be made available at the worksite, or mailed to the individual. Some worksites now make information available via intranets or the Internet.

Individual Counseling

Among the most successful ways to help person change and improve their health status is counseling (or coaching) on a one-on-one basis.

In published studies, health promotion programs which incorporated individual counseling as part of the health promotion program process achieved significantly higher participation rates and achieved greater risk reduction/risk elimination than standard group programs. Scientific studies have demonstrated that individual counseling is both cost effective and cost beneficial.

A wellness counselor must be trained in screening techniques, for in certain situations, they might be required to both screen individuals and counsel them. They should know how to do the following

o Review staff member health risks

o Contact workforce who have health risks.

o Counsel workforce on a one-on-one basis, helping them set goals, solve problems, and get specialist help when they need it.

o Make sure to help employees follow their treatment recommendations and make lifestyle and health behavior changes.

o Recruit employees into health promotion programs, such as losing weight and smoking cessation.

o Be sure to work with employees on a one-on-one basis using guided self-help.

o Conduct classes and minigroups when necessary.

o Make sure to work with wellness committee members to plan and conduct worksite-wide wellness activities.

Wellness counselors are health generalists; they must’ve basic understanding of a broad range of health topics and health risks.

Counselors must be able to consult with workers about their health problems and the treatments prescribed by their physicians.

They should have a very good  overview of nutrition, exercise physiology, pathophysiology of disease, pharmacology, psychology, and behavior change skills.

The educational program ought to include approaches to stress awareness/reduction at the environmental level and at the individual level.

Social, physical, and organizational stressors should be explained and methods to ease or elevate stressors should be presented.

At the individual level how changes in attitudes and behaviors help one to cope with stressors; learning approaches to minimize stress response, like meditation, relaxation response, and exercise.

Content of the program should provide the following

o Identifying sources of stress

o Relationship of stress to health

o Just how the individual experiences stress, personal, family, work

o Solutions for coping and managing stress

o Techniques for decreasing stress

o Value of stress, both negative and positive

o Practical steps of incorporating stress reduction into way of life

Personnel conducting stress management programs should’ve training in psychology, behavioral sciences, or related disciplines like psychological health experts, counselors, health educators, psychologists, and psychiatrists.

Training in a reputable program on how to teach the stress management course including group process skills is a must.

A nutrition education program should include a nutritional needs assessment, education counseling, and referral as necessary.

Nutrition education sessions and materials should include the following information

o The relationship of nutrition and chronic illnesss

o Improving consuming patterns

o Relationship of nutrition and proper weight maintenance

o Exercise

o Stress

o Blood pressure (BP)

o Cholesterol

o Diabetes and other chronic conditions.

o Nutritionally exact information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into eating habits. Suggestions for bettering eating habits ought to be based on or in line with national recommendations such as the Food Guide Pyramid.

Nutrition instructor ought to be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition.

If an allied health professional instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It is recommended that tobacco use cessation programs subscribe to the Code of Practice for Tobacco use Cessation Programs.

Use of tobacco cessation programs must be multi-component with a focus on skills to build positive voluntary behavior change practices.

Useful methods include establishing reasons for quitting, understanding the tobacco use habit, various methods for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term goal setting, weight control, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or frighten tactics.

In wellness programs that use aids like the “patch” or medications like “Zyban” appropriate consultation should be available on the usage of these aids.

The instructor should’ve formal training in tobacco use cessation from a nationally recognized organization like American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program like Smoke Enders.

Analysis of success is sometimes very dubious in tobacco use cessation programs. Measurement of success should include participation rate, including the number beginning the program, the number completing the program, and the typical number per session.

Furthermore included, number and% who stopped use of tobacco after the program, and the number and% who hadn’t resumed use of tobacco by the end of one year.

Participatory fitness plans ought to include education on advantages of regular exercise and risks of a sedentary lifestyle, its impact on cardiovascular health and diseases, its relationship with weight control and stress management, and aerobic exercise options.

Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components.  The wellness program follows guidelines by the American College of Sports Medicine.

Safety precautions ought to include the following

o Informed consent prior to starting exercise with clear and complete written and verbal instructions of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.

o A screening/evaluation of participants to determine if medical evaluation is necessary for exercise such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).

o Measurements of blood pressure (BP) and resting heart rate are useful screening information to determine exercise readiness.

o Participants who fail screening are medically referred and should obtain a written clearance from their physician to exercise.    

o The basic content of an group exercise program should include    

Warm up   5 to 10 minutes

Aerobic exercise   20 to 40 minutes

Cool down   5 to 10 minutes

Exercise instructors should have education and training in exercise physiology, physical education, physical therapy or comparable discipline, or possess a current certification by a nationally recognized sports medicine or exercise association, and be CPR licensed.   

Wellness Program offered is in line with scientific and medical recommendations for losing weight, reflects a multi-disciplinary approach which offers four components –  behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance for Treatment of Adult Obesity. It includes   

o Screening to verify that the participant has no medical or psychological conditions which would make losing weight inappropriate, and to identify the participant’s level of health risk, classifying participants not only on excess body weight, but also because of associated health conditions and overall heath risk.

o Referral for participants who are morbidly obese who’d require medical guidance for weight reduction.

o Informed consent, explanation of potential physical and psychological risk from losing weight and regain, likely long-term success of health promotion program, full cost of the health promotion program, credentials of the staff.

o Identification of factors to participant’s weight status, serving as the basis for an individualized losing weight plan which includes the weight goal and plans for nutrition, exercise, and behavioral components.

o Weight goal of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial losing weight goal doesn’t exceed loss of 10 percent of body weight, 1-2 pounds per week.

o Explanation of unsafe weight reduction methods.

o Daily calorie level is adapted to meet each participant’s advised rate of losing weight.

o Daily caloric intake is not less than 1,000 calories; when less, physician monitoring is required.

o Food plan designed so participants can choose foods which meet 100% of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, notwithstanding should not greatly exceed RDAs.    

o Nutrition education encouraging permanent healthy eating habits based on the Food Guide Pyramid.    

o Participant involved in meal planning and food selection.    

The protein, fat, carbohydrate, and fluid content of the food plan meet safety recommendations    

Protein   Between 0.8 and 1.5 grams of protein per kilogram of goal body weight, but no more than 100 grams of protein a day.

Fat   10 to 30% calories as fat.

Carbohydrate   At least 100 grams per day.

Fluid   At least one liter of water daily.

o Exercise component should be a significant portion of the health promotion program and be both didactic and experiential.

o Participant is appropriately screened for exercise using a screening questionnaire like the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.

o Participants work towards 30-60 minutes of exercise 5-7 days per week.

o No appetite suppressant drugs.

o Maintenance plan offered for continued support.

o Weight control programs ought to be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.

o Trained lay leaders may assist when supervised by nutrition specialist.

Note – There’s an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

Program is required to provide appropriate interpretation of cholesterol screening results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national guidelines

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 – 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows   

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, if history of coronary heart illness or if two or more CHD risk factors are detected refers to risk reduction program or health specialists, as appropriate.

200 - 239 mg/dl    When history of CHD or when two or more other risk factors are detected, refer to medical care or risk reduction service within two months; when no announced history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.

> 240mg/dl    Refer to medical care within two months.

HDL   

> 35 mg/dl   When fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Provide the following   

o The relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include high blood pressure 140/90 or higher or on hypertension medication; current cigarette smoking; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.

   o Negative risk factor –  high HDL 60 mg/dl or greater (subtract one risk factor).

   o Risk factors such as family history, smoking, high fat or other unhealthy diet, andphysical inactivity lead to the development of cardiovascular illness (CVD).

o Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements before diagnosis.    

o Wide range of treatment choices, including diet (e.g., importance of controlling fat intake less than 30 percent of sum calories from fat, less 10 percent saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.    

o Importance of following prescribed treatment and expert advice.