*3.4. Program Impact*

At the organizational level, as discussed above, a markedly larger number of activities was carried out in the PIP centers, compared with the control sites. The PIP teams had a number of positive impacts on their health environment at work. All three, independently, addressed lack of healthy food options as a priority and were able to obtain healthier food choices in vending machines. In one facility, the kitchen agreed to provide soups, salads, and sandwiches at reduced cost to employees. One team initiated the creation of a community garden.

The post-intervention surveys demonstrated slightly more organizational changes in the PIP centers than the NPHP centers (Table 4). These included both better communication and more opportunities to voice opinions and influence decisions. More staff members in the PIP sites (28% versus 16% in NPHP sites) said that they were consulted for program suggestions, and in general they reported slightly more opportunities to participate in decision-making and contribute suggestions. Qualitative data (focus groups and interviews) indicated that staff awareness of and participation in team-sponsored activities were higher in PIP centers. Further, researcher notes confirmed that

the participatory teams with non-supervisory staff and administrator involvement generated more wellness activities than supervisor-only teams or those with no administrator involvement.


**Table 4.** Comparison of post-intervention survey responses between PIP and NPHP centers regarding changes in the work environment since the program began.

<sup>a</sup> from chi-square statistic; \* *p* < 0.05.

From follow-up survey data, the PIP sites had slightly more employees participating in company exercise (18%) and nutrition programs (25%) than in the NPHP group. There was also notable participation in team-sponsored gardening (9%) and healthy back training (8%), and utilization of outdoor furniture niches set up by the teams for mental relaxation (14%).

At the individual level, there was no within-person difference in self-reported health status (chronic disease diagnosis, musculoskeletal pain, stress levels, etc.) from pre-intervention to post-intervention in either group (Table 2). There were few notable changes in individual health conditions, health self-efficacy, or selected work factors, and all differences were modest. There was a 6% cumulative incidence of self-reported diabetes in both the PIP and NPHP groups. The NPHP group had a slightly higher incidence of new hypertension (14%) compared to the PIP group (11%). In contrast, the PIP group had a higher incidence of elevated cholesterol (15%) than the NPHP group (11%) (Table 2).

Self-efficacy for eating a healthy diet, avoiding fatty foods, and exercise worsened slightly in both groups over time. The NPHP group gained and the PIP group lost self-efficacy for losing weight, compared to their baseline ratings. Neither group had a change in self-efficacy for managing stress, avoiding smoking or alcohol, and there were no statistically significant differences (*p* < 0.05) between groups for any of these metrics (data not shown).

Decision latitude had been slightly higher in the PIP (*p* = 0.001) than the NPHP group at baseline, while it increased slightly in the NPHP group relative to the PIP group (Table 2). In fact, at follow-up decision latitude was (surprisingly) slightly higher in NPHP than in PIP. This was the only statistically significant change over time in group mean ratings of working conditions. Psychological job demands were reported slightly higher in the PIP group than the NPHP group in both surveys. Coworker support was slightly higher in the NPHP group at baseline and remained stable over time. In contrast, supervisor support decreased slightly in both the groups over time but was slightly better in the PIP group than the NPHP group at follow-up. Ratings of physical exertion at work dropped between the time periods in both groups, which might have reflected the impact of the company's safe resident handling program [23,37]. The PIP group improved more and had lower physical exertion than the NPHP post-intervention. Workplace safety climate was similar between the two groups and remained stable over time.
