7/31/2014

1

Step it Up, Charleston!

Jim Neal and Dr. Diane Neal

Step it Up. Charleston! The Problem HealthIssues WorkLoss

The Idea The Execution Recruitment Instruments Process

Results  Conclusions Recommendations Q and A

Sedentary Lifestyles

Definition:  

doingorinvolvingalotofsitting notdoingorinvolvingmuchphysicalactivity

Consequences:

Obesity Type2diabetes Cardiacdisease

7/31/2014

2

Obesity and Health

Definitions

≥30kg/m2

>25%bodyfatinmenand30%inwomen

Consequences

HeartDisease HBP Diabetes ShortenedLifespan

Obesity, Diabetes, and Insulin Use

Diabetes

Type1 Type2

Management

Diet Exercise Pills Shots

Walking for Health

7/31/2014

3

The Problem

Lost Equipment Operators 

05101520253035404550

2008 2009 2010 2011 2012 2008‐2012

Start

Finish

Causes of Losses

MedicalCauses

Diabetes

DiabeteswithInsulin

HBP/Stroke

Back

Costs of Losses: Financial

Pay out costs:  Severance,A/L,Insurance:Average:$35,000

Lost time  Generally3‐4monthstorehire:Average:$21,000

Rehire costs:  Over $1000 Advertisement testingandevaluation

Productivity losses Skillsetlost: Knowledgeloss: Trainingcosts:$4000– 10,000dependingonskilllevel

7/31/2014

4

Costs: Emotional and Personal 

Disruptions to the work group

Lostefficiency Crew Department

Effects on morale 

Extraworkfortheremainingteam Trainingthenewguy Pickinguptheslack

Idea

Background

Initial conversation

Development of Idea

Theories

Behaviorchange Incentives Teams

How Applied

7/31/2014

5

R Q Process, Attitude, and Exercise

Percent Completion

Changes in Attitude towards Exercise

Changes in Steps

Changes in Exercise Patterns

RQ Associations Changes in Steps related to BMI, Age, Job Category, Crew

Changes in Exercise Attitude related to BMI, Age, Job Category, Crew

Changes in Exercise Behavior related to BMI, Age, Job Category, Crew

Changes in Steps and Attitude

Changes in Steps and Patterns

Changes in Attitude and Patterns

Flowchart

Wrap‐up

Follow‐upsurveyandcheckup Awards

PilotStudy

3months(13weeks) WeeklyrecordedSteps

Recruitment

Informedconsent Initialsurveyandcheckup

7/31/2014

6

Stakeholders

County/Citizens/Taxpayers

Public Works Department

Human Resources

staff WellnessCommittee

Employees

Employees’ families

Co‐Workers

The Process

Approval of Leadership

Procurement of Pedometers

Establish Goals, Milestones, and incentives

Coordination with outside agencies

HealthandWellnesscommittee(HR) SafetyandRiskManagement CountyOccupationalHealth

Kick off

The Process (continued)

Data Collection

Recognition

Weeklyannouncements–posters,emails

Monthlymeetings–distributionofawardsandprizes.

Closing Ceremony

Cookout Trophies

7/31/2014

7

First  and Last Week

Completion 

ComputationofFinalTotalsandChanges(Steps)

Healthsurvey Biometricreading Height Weight BP

Kick off

Distributionofpedometersandcalibration

Healthsurvey Biometricreading

Height Weight BP

The Survey Questionnaire

3 questions about current levels of exercise

11 questions asking intensity of responses 0 (not true) through 4 (very true) to positives about exercise

4 questions asking intensity of response to negatives about exercise

4 questions asking intensity of response to questions about pressure to exercise

Data Collection Weeks 2 ‐ 12

Crews CrewMembersprovidePedometerstoForeman/Leadperson

Previous7daysstepscountstakenmanuallyfromPedometer,crewmembernotesdiscrepancies

Foreman SubmitdataonThursdaytocollectors Followuponproblems

Collectors Process ErrorCheck ResolvedataissueswithForeman/Crew

7/31/2014

8

Description of Participants  

Average Age 44

Average BMI 32.3

Average Systolic BP 131

Average Diastolic BP 83

Average Exercise Status 

Before intervention 50%

Average Attitude towards 

Exercise Before Intervention 48%

Participants by Job Category

Jobs assigned to 4 categories:

1

2917

9

Sales

Administrative

EquipmentOperators

MaintenanceWorkers

Technicians

Results: Percent Completion

40

42

44

46

48

50

52

54

56

1 2 3 4 5 6 7 8 9 10 11 12 13

Participants

WeekofStudy

Thanksgiving

89%Completed

7/31/2014

9

Results: Changes in Attitude towards Exercise

From Survey Questionnaire

Exercise Attitude Percent= (positive responses – negative responses) / maximum score (44)

Pre‐Intervention:  47.7% 

Post‐Intervention:  53.1%

Difference: 5.4%

Results: Changes in Average Daily Steps

Due to dropouts, late starters, and missing values, used first and last full week of steps to compute the change for each participant.

First:  Average 12718 Daily Steps

Last:   Average 14155 Daily Steps

Difference: Increase of 1436 Daily Steps

Results: Changes in Exercise Patterns

Exercise Patterns= (Strenuous time*5) + (Moderate*3) + (Mild * 1)/ maximum score (Daily 15 minutes of all 3 levels = 63)

Pre‐Intervention:  51.6%

Post‐Intervention:  48.2% ???

7/31/2014

10

Results: Associations of Changes in Attitude

UsedBivariateCorrelationstolookforAssociations

Age:Nocorrelationbetweenageandchangesinattitudefrompretopostintervention

BMI:NocorrelationbetweenBMIpre‐interventionandchangesinattitudefrompretopostintervention.

Results: Associations of Changes in Steps

BMI:Therewasaweakpositiveassociation,soasBMIincreasedsodidthechangeinsteps

Age:Therewasaweaknegativeassociation,soasageincreasedthechangeinstepsdecreased.

Results: Associations of Changes in Exercise Patterns

BMI:Therewasaweakpositiveassociation,soasBMIincreasedsodidthechangeinexercisepatterns

Age:Therewasaweaknegativeassociation,soasageincreasedthechangeinexercisepatternsdecreased

7/31/2014

11

Results: Job Category and Changes in Attitude, Steps, and Exercise Patterns

JobCategory:

JobCategory Attitude Steps ExercisePatterns

Pre Post Pre Post Pre Post

EquipmentOperators

0.50 0.55 17561 22012 0.54 0.49

MaintenanceWorkers

0.43 0.51 8344 6840 0.48 0.46

Technicians 0.46 0.49 6795 5562 0.45 0.46

Thechangeinstepsforequipmentoperatorswasanincreaseofanaverageof4452dailystepsperweek.

Results: Additional Associations

AssociationofChangesinStepsandExercisePatterns:Aweakpositiveassociation– asstepsincreasedsodidexercisestatusasmeasuredbythequestionnaire

AssociationofChangesinStepsandAttitude:Nocorrelation

AssociationofChangesinAttitudeandExercisePatterns:Aweaknegativeassociation– asattitudeincreased,exercisebehaviordecreased

Results: Morale

Increase in Department Morale

Biggest Elements of Change: Communicationsbetweencamps,crews,andteams

Increasedsenseofteam Betterperformance Increasedsenseofpride BetterimageofPublicWorks Recognitionbypeers Buyin– manystillusetheirpedometers

7/31/2014

12

Conclusions: The Process

To improve or change:

Dayoffincentives Teamincentives Betterpedometer(electronicdatacapture) Betterinterimincentives Widervarietyofincentivestoincreaseparticipation(morethan1winner)

Distributedleaders(separatefromforeman) Patches,badges,orotherrecognitionthatmaybedisplayed

Conclusions: Changes in Steps

The target (operators) had the most change

Thereisevidencethattheyseetheneed,butneedmotivation

Crewleadercompetitivenessanddrivemakesthebiggestdifference

The right incentives are vital

Adayoff(withpay)wasamuchbiggermotivatorthanwehadhypothesized

Incentivesarenot“onesizefitsall”

Conclusions:  Changes in Attitude towards Exercising

Program lead to greater awareness of health issues and how they could positively affect their health 

Showed them they could do it

It was not just work

That even the most out of shape employees will try to improve if given incentives

7/31/2014

13

Conclusions: Changes in Exercise Patterns

MoreparticipationinCountyWellnessprograms

Ifyougivethemapedometer,theywillgenerallycontinuetouseit,evenaftertheprogramends

Lowerscoresafterinterventionmaybeduetoanincreasedunderstandingofwhatexerciseis

Conclusions: Morale

Competitionenhancescrewanddepartmentmorale

ProgramssuchasStepItupCharleston!demonstratecaring

ProgramssuchasStepItupCharleston!canhelptoimproveefficiencyandreducecosts

Recommendations DO IT! Developaprogramthatfitsyourunit Incentivesmustbetailoredtotheworkforce Involvestaffintheplanningearlyon

Trackprogress/DataCollection KIS(S) Frequentchecks

KeepuptheEnergy!(realchangetakestime) Get Support!! Leadership Stakeholders Yourstaff

Believe!!!

7/31/2014

14

Q and A

What are your questions??