Ethical considerations of worksite health promotion: an exploration of stakeholders’ views

Abstract

BackgroundDeveloping, implementing and evaluating worksite health promotion requires dealing with all stakeholders involved, such as employers, employees, occupational physicians, insurance companies, providers, labour unions and research and knowledge institutes. Although worksite health promotion is becoming more common, empirical research on ethical considerations of worksite health promotion is scarce.MethodsWe explored the views of stakeholders involved in worksite health promotion in focus group discussions and we described the ethical considerations that result from differences between these views. The focus group discussions were organised per stakeholder group. Data were analysed according to the constant comparison method.ResultsOur analyses show that although the definition of occupational health is the same for all stakeholders, namely ‘being able to perform your job’, there seem to be important differences in the views on what constitutes a risk factor to occupational health. According to the employees, risk factors to occupational health are prevailingly job-related. Labour unions agree with them, but other stakeholders, including the employer, particularly see employee-related issues such as lifestyle behaviour as risk factors to occupational health. The difference in definition of occupational health risk factors translates into the same categorisation of worksite health promotion; employee-related activities and work-related activities. The difference in conceptualisation of occupational health risk factors and worksite health promotion resonates in the way stakeholders understand ‘responsibility’ for lifestyle behaviour. Even though all stakeholders agree on whose responsibility lifestyle behaviour is, namely that of the employee, the meaning of ‘responsibility’ differs between employees, and employers. For employees, responsibility means autonomy, while for employers and other stakeholders, responsibility equals duty. This difference may in turn contribute to ambivalent relationships between stakeholders.ConclusionAll stakeholders, including employees, should be given a voice in developing, implementing and evaluating worksite health promotion. Moreover, since stakeholders agree on lifestyle being the responsibility of the employee, but disagree on what this responsibility means (duty versus autonomy), it is of utmost importance to examine the discourse of stakeholders. This way, ambivalence in relationships between stakeholders could be prevented.

Aufgeklärte Mitarbeiter/innen – Die informierte Einwilligung als ethische Orientierung für Verhaltensprävention im betrieblichen Kontext

“…Außerdem kann Transparenz in der Kommunikation, z. B. bezüglich der Ziele der Verhaltensprävention oder des Datenschutzes, Manipulation vorbeugen [25].…”

Responsive evaluation of stakeholder dialogue as a worksite health promotion intervention to contribute to the reduction of SEP related health inequalities: a study protocol

“…For example, employers may want to promote employees' health for cost-saving aspects, sustainable employability in the light of aging workforce, and good employment practice for company image building. Intervention providers at their turn want to sell their programs to employers, as that is how they derive their reason of existence [16]. For employees however, it is not selfevident that they receive WHP programs with open arms [17].…”

“…Employees can experience WHP interventions as interference in their privacy, which in its turn can a play role in employees' decision whether to or not to participate [20]. On the other hand, as employees depend on their employer to maintain their job, employees might feel coerced to participate in WHP interventions [16]. Also, questions such as how far an employer can go in promoting employees' health often rises [20] as well as whether (and to what extent) employees are responsible for their health or whether their employer is [19].…”

Development of a multiple risk factor Brief Health Check for workplaces

“…The requirement of workers and worker organisations for confidentiality and autonomy must be included during implementation. 4,5 This paper describes the design of the Brief Health Check (BHC), one of two components of the program, Get Healthy at Work (GHaW). The BHC is a health risk assessment (HRA) tool, which aims to establish an individual worker's risk of diabetes and cardiovascular disease (CVD), improve understanding of modifiable risk factors, increase participation in healthy lifestyle programs to reduce this risk, and refer high-risk workers to a general practitioner (GP) for medical assessment.…”