Historically the predominant models of programming have evolved from mid to large size employer settings. Yet the majority of employees in any given community work for organizations that employ fewer than 500 employees. These small employers also constitute a disproportionate majority of all employers. Wellness practitioners need to develop programming models and strategies that are designed specifically for these small employer organizations. This article establishes a perspective for bringing wellness to the small employer based on recent research and considering the implications of the differences between small and large employers from a programming perspective. Finally, several anticipated aspects of future programming are described along with summary conclusions.

BackgroundIn the United States, worksite wellness programs are more often offered by larger employers. The Massachusetts Working on Wellness (WoW) program is an innovative, statewide capacity-building model designed to increase the number of smaller employers (200 or fewer workers) adopting health promotion initiatives. This article describes the WoW program design and approaches to recruitment, implementation, and evaluation.Methods/designWoW provides employer training, technical assistance and seed funding, utilizing a Wellness Program Development framework based on recognized good practices. For-profit employers with 200 employees or fewer are eligible for and encouraged to apply for a Massachusetts Small Business Wellness Tax Credit. During the phase described in this paper, employer organizations applied to the program and committed to designating a champion responsible for program implementation. Interventions were to include policy and environmental supports, as well as those targeting individual behavior change through raising awareness and education. Supports provided to employers included seed grants for qualifying activities (up to $10,000 with matching required), community linkages, data collection and organization-specific feedback tools, an on-line curriculum supplemented with technical assistance, and an expert webinar series. Data collection at multiple time points, from the initial application through program completion, provides information for evaluation of recruitment, planned and completed activities.DiscussionThis model is grounded in literature on good practices as well as in local knowledge about Massachusetts employers. It does not directly address the influence of working conditions, which can affect both worker participation and health behaviors. Implementation may be less successful with some organizations, such as those with many workers who are part-time or geographically distributed rather than in a centralized physical location. Program evaluation will assess the extent to which WoW achieves its goals. The data are expected to increase understanding of the needs of smaller employers and industries not traditionally implementing employee wellness programs.Electronic supplementary materialThe online version of this article (10.1186/s12889-019-6405-1) contains supplementary material, which is available to authorized users.

As the field of Worksite Health Promotion and Wellness matures, greater pressure is being place on programs that produce mitigation of health risks, improved employee productivity and increased levels of economic return. To achieve these expected results and to successfully contend with the challenges of today's workplace and work force it will likely become even more critical to carefully plan both new and existing programs each year. A model for the planning and development of worksite programs is presented and discussed along with a variety of design implications for different population segments.

The movement toward evidence-based practices and intervention is now very prevalent in the fields of medicine, health care, mental health, management, public policy, and education, to list just a few examples. 1 Worksite health promotion programs, understandably, are beginning to experience growing interest in using evidence-based interventions as well. Within the Patient Protection and Affordable Health Care Act (P.L. 111-148 as amended) 2 the term ''evidence-based'' is used 41 times, indicating a fairly high level of congressional familiarity with the term and a high level of expectation for the use of the concept. Thirteen of those uses of the term ''evidence-based'' were included in Title IV, Prevention of Chronic Disease and Improving Public Health, which is the prevention and health promotion centerpiece within the legislation. It is clear that health promotion practitioners will increasingly be expected to provide evidence-based programming, including planning, design, implementation, interventions, and evaluation of services, to their target populations, and thus the reason for addressing this topic in this edition of The Art of Health Promotion. We will be exploring the following aspects of the topic:

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