*3.1. Baseline Site Comparability*

In the six centers, a total of 47 interviews were conducted with management (administrators and directors of nursing), supervisors (department heads and unit/office managers), wellness champions, and individual PIP team members. In addition, qualitative data were obtained from three focus groups of PIP team members, three focus groups of employees engaged in wellness at NPHP sites, and eight focus groups with other employees at the six facilities conducted in 2011 and 2012.

According to the baseline survey of wellness champions, and consistent with the criteria for their selection, the NPHP centers had well-developed programs at that time, whereas the PIP centers had emerging programs, i.e., 1–2 activities loosely organized by staff.

Questionnaires were collected from a total of 645 workers at baseline and 649 workers at follow-up. The PIP and NPHP sites each had more than half of employees in clinical jobs and a predominantly female staff (Table 1). The PIP staff were slightly younger on average. Fewer than 8% in either group indicated fair or poor self-rated health. The average scores were similar for health self-efficacy, prevalence of diabetes and low back problems. Workers in the NPHP centers had slightly higher baseline prevalence of hypertension and elevated cholesterol (Table 1). Decision latitude was higher among PIP staff than NPHP staff at baseline (*p* < 0.01) (Table 2).


**Table 1.** Baseline characteristics of skilled nursing facility employees (all jobs): 3 participatory intervention program (PIP) and 3 non-participatory health promotion (NPHP) centers.

\* Jobtitles had missing values of 12.1%.


**Table 2.** Worker health and working conditions in pre- and post-intervention matched pair surveys: Comparison of PIP and NPHP centers.

<sup>a</sup> from exact test statistic; <sup>b</sup> from t-test of independent samples; \**p* < 0.01.

#### *3.2. Fidelity and Amount of Intervention*

The participatory teams were active with the guidance of the researchers. In the intervention sites (I-1, I-2, I-3), the number of regularly attending PIP team members ranged from 4 to 8 of the 10 original members at each site. No NPHP control site (C-1, C-2, C3) had an active team or wellness committee engaging front-line workers.

At the start of this project, not all facilities had a wellness champion appointed. However, by three years after initiation of the program, all six centers had wellness champions, as required under the corporate-sponsored wellness program. Wellness champions were individuals appointed by site administrators to coordinate HP activities in addition to their regular duties. In the PIP centers, these were office staff in ancillary non-supervisory jobs like human resource payroll benefits, medical records manager, and data coordinator. Wellness champions in NPHP centers were all in supervisory positions (assistant admissions director, maintenance manager, and admission director). Interviews and focus groups showed that many staff in the PIP centers knew the identity of their wellness champions. In two of the three NPHP centers, focus group participants were unaware of their wellness champions.

The three PIP teams met every two weeks for one hour. They were planned to involve only non-supervisory personnel, and they began as such. However, at two of the centers, (I-1 and I-3), they were later expanded by managerial decision to include supervisory and administrative employees.

PIP teams were guided to utilize the program planning form and project proposals for approval from center administrators. The use of these forms and proposals became less consistent towards the end of the 5 years as some supervisors and managers became members of these participatory teams.
