Breaking Down Barriers: Reaching Diverse Workforces Through Culturally Competent Worksite Wellness Programming

Mission
The mission of Diversity Wellness is to promote healthy living by providing culturally competent, language specific health improvement programs that are backed by scientific research. Diversity Wellness achieves this goal by integrating comprehensive programs into the culture of each of its clients and by customizing programs to meet their unique needs.

Diversity Wellness Programs
Diversity Wellness programming includes comprehensive health promotion programs available in Spanish and English that reach-out to participants individually to help them reduce their high risk health factors. Programming combines on-site or telephone-based bilingual Wellness Coaches to provide comprehensive, personalized support to employees, empowering them to make healthy lifestyle choices and informed healthcare decisions.

Diversity Wellness also offers similar programs and services to other population health management companies, including health screenings, Health Risk Assessment (HRA), and bilingual internet and telephone based lifestyle management programs supported by advanced technology.

The Case for Cultural Competence

For over two decades, reports have cited the positive health benefits of worksite wellness programs. By 1999, 95 percent of employers with more than 50 employees reported offering at least one health promotion activity at their worksite.

Evidence supports the efficacy of worksite wellness programming. Employee surveys indicate employees feel wellness programs are important and health-related activities should be offered at the worksite.Statistics show that:

• Well-planned programs save companies money and are cost-effective. 
• Such programs provide the added benefits of attracting and retaining personnel, reducing job turnover, improving a company’s public image, decreasing absenteeism, boosting morale, increasing productivity, and promoting company allegiance. 1

Yet, while growth in worksite health promotion programs has been on the rise since 1985, many programs continue to lack in comprehensive design or sufficient duration, potentially limiting program impact on employee health and well-being.

Furthermore, participation rates in worksite health promotion programs are generally low and worksite statistics indicate that enrollees in worksite health promotion programs tend to be salaried employees whose general health is better than average and better than that of those working in administrative support, service, crafts, and trades where health, illness, and injury risks are generally higher. Contributing factors for such inequalities include:

• Differences in socioeconomic status.
• Nature of work.
• Access to and extent of health insurance coverage.
• Exclusion of certain workers from worksite health promotion programs (noting exclusion as an unintentional result of failing to market the program effectively to diverse workers). 2

Emerging work in the area of cultural competence reinforces the value of taking a culturally competent approach when designing worksite wellness programming. According to the National Center for Cultural Competence: “A key challenge in health promotion with diverse populations is honoring traditions and beliefs of the intended audience, while recognizing that some of those beliefs and practices may not be congruent with emerging knowledge of what supports health outcomes. Culturally competent health promotion supports and honors those practices and beliefs that are protective or benign, and respectfully helps identify and change those beliefs and practices that have a negative health impact.”3

Diversity Wellness’ Commitment to Cultural Competence

Recognizing the economic and health opportunities of wellness programming to employer and employee alike, Diversity Wellness seeks to break down the barriers prohibiting participation in worksite wellness programs to historically hard-to-reach groups—most notably Latino employees—through a unique model that is: 

• Theory-based, incorporating elements of what has been proven to work from the Health Belief Model and concepts of self-efficacy and social learning.
• Backed by science that supports wellness programs that include three levels of intervention—awareness, lifestyle, and supportive environment—shown to affect knowledge, attitude, and skills.

• Ecological in scope, incorporating key strategies that target health behavior and change on the personal, interpersonal, and environmental levels.

Diversity Wellness programs go beyond the basics of language specificity to focus on:

• Recognizing that unique cultural beliefs play a critical role in health behavior.
• Understanding and respecting common health practices.
• Using linguistically appropriate words and medical terminology.
• Reaching low-literacy employees.

Diversity Wellness’ approach integrates the above concepts into its:

• Program messaging.
• Communications and promotional materials (graphics and pictures used, language, and literacy levels).
• Materials distribution points.
• Formats for information delivery (Internet, on-site Wellness Coach/Promotora, telephone coaching, etc.). 

A Closer Look at Latino Employees—the Fastest Growing Minority Workforce
A focus on cultural competence requires a look at today’s fastest growing labor demographic. Recently released data from the Bureau of Labor Statistics (BLS), covering a ten-year period from 2004-14, projects the Latino labor force to reach 25.8 million workers by 2014. This reflects Latinos comprising almost 16% of the total labor growth for this period. 4 Additionally, the Latino labor force added 867,000 workers between the second and third quarters of 2005 and 2006, accounting for about 40% of all workers added to the U.S. labor force. 5 These numbers underscore the important role Latinos play in the U.S. labor force and the importance of addressing the health of this vital segment of the workforce.

Traditionally, Latinos have low participation rates in worksite wellness programs. While concrete research is scarce as to the factors for low participation, conclusions can be drawn that traditional worksite wellness programs have failed to address the cultural and linguistic barriers many Latino employees face.

Cutting-Edge Approach: Inclusion and Diversity in Worksite Wellness
While Diversity Wellness’ niche is working with companies who have diverse workforces—particularly with large numbers of Latino employees—it typically works with its clients to create materials that speak to multiple audiences within an organization. This multi-level approach enables Diversity Wellness to effectively reach, engage, and motivate varying levels of workers within a single organization without leaving behind those hard-to-reach employees many worksite wellness programs miss. 

According to Brenda Schmidt, Managing Director of Diversity Wellness, “While health education and lifestyle management program content are fairly standard, it is how we adapt these materials using a combination of culturally competent messaging, language-specificity, and varied delivery methods that allows us to reach and engage significantly more employees.”

Diversity Wellness’ ability to engage a greater percentage of employees begins with culturally competent messaging in all aspects of the promotional campaign. Schmidt states, “Employees can immediately tell if the employer is committed to reaching a diverse group of employees. Messaging specifically targeting Latino employees may be branded completely differently in Spanish. Literal translations of promotional and health education materials do not have the flavor and warmth that will motivate a Latino employee to participate.”

Diversity Wellness frequently brands English and Spanish programs differently. For example, at a large poultry producer, the tag line for the English program is “Hatching a New You” whereas the Spanish tagline is “Apoyando Nuestra Salud” (Supporting Our Health), which reflects the more collective approach used by Latinos.

A Grassroots Strategy
In the case of one Diversity Wellness client, a previous attempt at having their Latino employees complete a Health Risk Assessment (HRA) resulted in only nine employees completing the process, despite a $240 cash incentive per employee. Diversity Wellness was contracted the following year to conduct the HRA and health screening for the client with the goal of vastly increasing program reach. Diversity Wellness succeeded in reaching over 95% of Latino employees during the HRA and health screening process.

The Diversity Wellness model is about taking an employee-centric approach that considers aspects of the organizational culture as well as the important and subtle differences associated with minority employee groups. Schmidt notes that, “We understand that cultural competence is about being flexible. It’s a very grassroots approach at times, and we have learned that this works. Such an approach allows us to gain employees’ trust when asking for personal health information.”

In the case with this client, this approach meant taking the HRA and health screening process to the employees it sought to reach, which happened to be those working in the field. This approach broke down the barriers to participation by limiting how much time off-the-line an employee had to take to complete the HRA and health screening. It also mitigated the intimidation factor by bringing the process directly into the employees’ work environment, where they could more readily step away from their work for a few minutes to complete the HRA and health screening.

The Wellness Coach/Promotora Approach
On-site, bilingual Wellness Coaches/Promotoras also help bridge the culture gap. The Wellness Coach/Promotora assists low-literacy employees with completing HRAs and explains the benefits of program participation. Additionally, Schmidt notes, “Wellness Coaches are familiar with low-cost community resources, and we create a community resource guide for each client’s locations.”

The Wellness Coach/Promotora approach is a well-documented health promotion model for reaching Latinos living in the U.S. The Wellness Coach/Promotora “serve as connectors between healthcare consumers and providers to promote health among groups that have traditionally lacked access to adequate care.”6

In the case with one Diversity Wellness client, Wellness Coaches/Promotoras have consistently been able to reach greater than 80% of employees at those sites. Because of the trusting relationship gained through similar experiences and culture, Wellness Coaches/Promotoras also serve as an effective communication conduit between employer and employee. This relationship can increase the value of the Wellness Coaches/Promotora model beyond the benefits of the employee wellness program.

Summary
Such innovative approaches to traditional worksite wellness programming are what set the Diversity Wellness model apart. Cultural competency in all aspects of its programming is what drives a wellness campaign’s development from day one, allowing the campaign to reach multiple levels of employees within an organization through one comprehensive suite of programs and services designed to reach, engage and motivate employees to make healthy lifestyle changes.

By reaching out to rather than excluding diverse employees through an evidence-based, culturally competent model, Diversity Wellness offers worksite wellness programming that allows employers to benefit from healthcare cost reductions and for employees to experience the benefits of living healthier lives.

Contact
For more information on Diversity Wellness and its culturally competent, personalized, bilingual health promotion programs, please contact Diversity Wellness at (800) 858-1714 or info@diversitywellness.com.

Visit us online at www.diversitywellness.com.