American Journal of Health Promotion

To review applications of Ajzen's theory of planned behavior in the domain of health and to verify the efficiency of the theory to explain and predict health-related behaviors.

Most material has been drawn from Current Contents (Social and Behavioral Sciences and Clinical Medicine) from 1985 to date, together with all peer-reviewed articles cited in the publications thus identified.

The results indicated that the theory performs very well for the explanation of intention; an averaged R² of .41 was observed. Attitude toward the action and perceived behavioral control were most often the significant variables responsible for this explained variation in intention. The prediction of behavior yielded an averaged R² of .34. Intention remained the most important predictor, but in half of the studies reviewed perceived behavioral control significantly added to the prediction.

The efficiency of the model seems to be quite good for explaining intention, perceived behavioral control being as important as attitude across health-related behavior categories. The efficiency of the theory, however, varies between health-related behavior categories.

To identify demographic characteristics associated with worksite health promotion participation and to determine whether employees with high-risk health-related behaviors, as measured by a health risk appraisal, were participating in programs designed to address these behaviors.

Descriptive

A petrochemical research and development company where employees were offered a health risk appraisal questionnaire, a series of on-site wellness programs, and an on-site fitness center.

All employees (n = 2290) working continuously from May 1, 1990, through February 28, 1992.

Demographic and behavioral risk characteristics of participants and nonparticipants.

Participation was 37% (health risk appraisal), 64% (all wellness programs), and 10% (fitness center), with women participating at higher rates than men in all programs. Most programs attracted 10% to 40% of the employees at risk for the particular behavior addressed by the program, although lower penetration (7% to 9%) was observed for the on-site fitness center and blood pressure education programs. With the exception of wellness programs for weight, smoking, and blood pressure, employees at lower behavioral risk tended to be more likely to participate than employees at high risk.

Efforts to increase participation by all company employees, especially among those with high-risk behaviors, would benefit all health promotion programs, particularly the on-site fitness center.

To review critically the research literature on the health effects of worksite stress-management interventions.

Stress-management interventions were defined as techniques that are designed to help employees modify their appraisal of stressful situations or deal more effectively with the symptoms of stress. Stress-management studies that were worksite based, assessed a health outcome, and were published in the peer-reviewed literature were included in this review. The main search method was the one described in the lead article to this special issue of the JOURNAL, but supplementary sources included prior reviews of the research literature and expert contacts. Sixty-four studies met the criteria for inclusion in this review.

A variety of stress-management techniques was used in worksite studies, including muscle relaxation, meditation, biofeedback, cognitive-behavioral skills, and combinations of these techniques. The most common techniques used were muscle relaxation, cognitive-behavioral skills, and combinations of two or more techniques. Outcome measures to evaluate the success of stress interventions included physiologic and psychologic measurements, somatic complaints, and job-related measures. Nearly three-fourths of the studies offered the training to all workers and did not specifically recruit high-stress employees. Over half the studies were randomized control trials, but only 30 % conducted posttraining follow-up evaluations. The effectiveness of stress interventions varied according to the health-outcome measure used; some techniques were more effective for psychologic outcomes (e.g., cognitive-behavioral skills), whereas others were more effective for physiologic outcomes (e.g., muscle relaxation). Biofeedback was the least frequent technique used in work settings and also seemed to be the least effective technique. Meditation produced the most consistent results across outcome measures but was used in only six studies. In general, studies using a combination of techniques (e.g., muscle relaxation plus cognitive-behavioral skills) seemed to be more effective across outcome measures than single techniques.

The large number of different stress-management techniques coupled with the wide range of health outcome measures used in stress intervention studies makes it difficult to draw firm conclusions about the efficacy of each technique and each outcome. Also, the quality of the methodology varied substantially among studies. Nevertheless, the most positive results across the various health outcomes were obtained with a combination of two or more techniques. None of the stress interventions was consistently effective in producing effects on job/organization-relevant outcomes, such as absenteeism or job satisfaction. To produce changes on these types of measures, stress interventions will need to alter or modify the sources of stress in the work environment. It can be said that stress management in work settings can be effective in enhancing worker physical and psychologic health, but the choice of which stress-management technique to use should be based on the specific health outcomes that are targeted for change.

To review, evaluate, and summarize research published in scientific journals linking alcohol-related interventions in the worksite to either individual or organizational outcomes.

A review of the literature published in peer-review journals between 1970 and 1995 identified 24 articles that reported the results of studies on the impact of worksite programs on alcohol control on health and behavioral outcomes.

There is strong suggestive evidence and some conclusive evidence that worksite interventions including core components of employee assistance programs are effective in rehabilitating employees with alcohol problems. There is suggestive and conclusive evidence that worksite training oriented toward alcohol problems affects the attitudes of supervisors and employees for reasonable periods after the completion of training.

Investment in worksite interventions directed at reducing alcohol-related problems appears to be a sound strategy, although considerably more research is needed. This research should include broad representation of appropriate worksite populations. Similar measurements should be used across studies. To the extent possible, randomized control group designs should be employed. Without significant external sponsorship, it is not likely that such an improved body of research data will emerge.

To examine the individual and organizational health effects of HIV/AIDS interventions conducted at the worksite.

This review is part of a series of reviews that used search methods described in an introductory article. To supplement these methods, HIV/AIDS-specific periodicals were searched to include journals that might not be incorporated in the computerized databases. Twelve of the 20 articles identified through the Centers for Disease Control and Prevention and our own subsequent searches met the criteria and were included in this review.

Ten of the 12 studies reviewed reported positive effects of employee education programs on knowledge or attitudes. Nine of the studies involved health care workers or employees with potential occupational exposure to HIV, and nine lacked a comparison or control group. None of the studies however, examined the effects of policies, manager training, or family education on the organization or person.

Methodologic weaknesses in many of the studies reviewed, coupled with the small number of studies, led us to conclude that the research literature on worksite HIV/AIDS interventions is weak. Impact is, however, plausible. Future research should be directed toward developing valid measures of key variables, controlling for confounding factors, and ultimately examining the impact of organizational factors.