Workplace Health and the Cauldron of Evidence

Scott Lloyd and Sarah Slater, Advanced Public Health Practitioners, Public Health South Tees 

Systematic reviews are brilliant. They take all the available evidence for a particular topic, do something special (stick the results into a big cauldron) and churn out a finding that informs us mere mortals in policy and practice where we should and shouldn’t be investing our money and capacity.

Double, double toil and trouble...

In these austere times, such evidence about what works and what doesn’t is so important – especially when combined with the how and why. This recent review by Jenna Panter and colleagues is an excellent example of what works and how.

However, there is one sphere of public health where we feel that systematic reviews may not paint a full and fair picture.

Let us explain.

Workplace Health

Most public health colleagues have a speciality or five. This might be a topic (e.g. nutrition or addiction) or part of the life-course (e.g. children and young people or older adults).

We are Workplace Health Specialists with 28 years of combined experience. We’ve supported employers of all descriptions, including businesses of different sizes and in different sectors. We’ve worked on national workplace health programmes, such as the Well@Work programme led by the British Heart Foundation between 2005 and 2007, and have been involved in the North East Better Health at Work Award since its launch in 2009 (arguably the biggest and most successful workplace health programme in England). We’ve a lot of experience of supporting NHS organisations who are trying to improve the health of staff – sometimes successfully, sometimes less so.

Working with such a variety of employers to improve staff health is a challenge of both knowledge and skill because they are looking to you, as the expert, to come up with evidence-based suggestions. Consider how you might support the below employers (real examples for us) to encourage physical activity in their workforce:

• A tea factory which operates 24 hours a day with mixed shifts and a predominantly female, part-time workforce
• A call centre for a bank employing 1,200 mostly young staff, in a mainly sedentary occupation
• A call centre for a public sector organisation employing workers typically aged 40 plus, in a mainly sedentary occupation
• A mining company at which the majority of the workforce arrive, take a lift down a shaft for 20 minutes, work a shift underground in 40 degree heat, resurface in the lift and get straight in the car to head home
• A category B prison. 

How would you support an employer to encourage physical activity in a call centre?

What you might suggest to each of the above five employers (and what might work) could be completely different (and probably would be). At least in each of those scenarios, the workforce is likely to be pretty homogenous. Consider working with a huge employer such as a Local Authority or NHS Trust which arguably have massive internal differences in staffing groups in terms of age, gender, hours, and roles (e.g. office staff vs refuse collectors).

We believe that these differences make workplace health a different kettle of fish compared to other settings, such as schools, colleges, universities, and prisons, which could be comparatively homogeneous. They aren’t of course – there are massive differences between schools for example, but our suggestion is that they have the potential to be very similar if all variable things (e.g. culture, policies etc.) were the same. 

What’s our point?

Firstly, that lumping trials of workplace health interventions and programmes into a systematic review masks these potentially huge differences. We’re not sure how we get around this issue but we are raising it as an issue.

Secondly, to suggest that there is a lot more research to be done. There are some workplaces that should be considered a priority. For example, the majority of the working population in the private sector (60%) are employed by small-to-medium sized enterprises (less than 250 employees) and this is an area that no-one has cracked in terms of health and wellbeing via the workplace. Another example is call centres: given the sedentary, pressured nature of the work. One feasibility trial has recently been completed (Morris et al. 2019)[1] and another is underway (involving Scott). We can’t do individual studies for every type of workplace but some should be considered a priority.

Thirdly, to highlight the skills possessed by our peers who lead on workplace health. Employers and employees can throw all sorts of issues at you from bread and [low fat] butter stuff like physical activity and mental wellbeing to stuff like menopause awareness and sleep. Not only does a workplace health specialist need to maintain a base knowledge of all these topics, but they also need to understand how it might be tackled in the various types of workplace highlighted above.

It would be remiss of us not to plug the North East Better Health at Work Award. It needs a stronger evaluation building on previous work (Braun et al. 2014)[2], but we’re talking about a programme that was launched in 2009 and has actively engaged hundreds of employers every single year since (456 currently engaged at January 2020), supporting them to promote the health and wellbeing of their staff (potential combined reach of 202,962 working adults as of January 2020) and the wider community. We’re always recruiting more businesses so if you would like to know more visit www.betterhealthatworkne.org.


References

1. Morris, A.S., Murphy, R.C., Shepherd, S.O., Healy, G.N., Edwardson, C.L. & Graves, L.E.F. (2019). A multi-component intervention to sit less and move more in a contact centre setting: a feasibility study. BMC Public Health, 19 (1), 292                                    https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6615-6
2. Braun, T., Bambra, C., Booth, M., Adetayo, K. & Milne, E. (2014). Better health at work? An evaluation of the effects and cost–benefits of a structured workplace health improvement programme in reducing sickness absence. Journal of Public Health, 37 (1), 138 –142  https://academic.oup.com/jpubhealth/article/37/1/138/1559494

Image 2: Photo by Arlington Research on Unsplash

Starting out and getting ahead in obesity research

Guest post by Enzo Di Battista, Research Dietitian at Aneurin Bevan University Health Board

In the lead up to the UK Congress of Obesity (#UKCO2018), I attended an Early Career Research Workshop in the beautiful grounds of Newcastle University.

Dr Maria Bryant chaired the event in which we had three talks with some interactive elements.  Here I share a few reflections and tips from the workshop.

Grant application and interview success

Professor Judith Rankin kicked off with ‘Skills to enhance the success of (fellowship) interviews’. The talk was split into three main sections – completing a fellowship application, what to do prior to the interview and what to do during the interview.

On listening to Professor Rankin’s advice on completing a grant application for research, I noted ‘5 tips’:

1. Start early on the application – you should take about a year to draft, critique, draft, critique, and draft and critique (you get the idea).
2. Ensure you have a good supervisory team around you for advice and support.
3. Speak with additional experts in research methods. This might be a statistician or an experienced qualitative/mixed-methods researcher.
4. Contact senior people in the obesity field. Most are friendly people willing to take a look at draft applications, if given plenty of time to do so.
5. Liaise with your local clinical trials unit for advice (England), (Scotland), (Wales). 

Getting the application shortlisted is just the first step however, you have to convince funders of your credibility to give you the money. The post-doc fellowship interview is all about YOU, your vision for the research project (not a supervisors) and your commitment to a research career. To ensure you’re ready for interview, Judith stressed the importance of mock interviews. To demonstrate, Dr Bryant stepped up to role play with Judith and we had video interview examples.

To increase the likelihood of success at interview, a panel expects that you have: 

1. Enthusiasm for your project.
2. Designed an achievable project.
3. An understanding of the questions you are trying to address.
4. An understanding of the experimental approaches you plan to use. 

Influencing health-care policy

Dr Barbara McGowan was next to take to the floor for the second talk titled ‘Conducting research with an aim to influence health-care policy’.  She talked us through her career development, from working in the city as an analyst to becoming a medical doctor and research lead. Her story left the impression that her early work had given her an 'edge', improving her data interpretation skills and had benefited her research career path.

The main take-home for me was the clinical research Barbara was undertaking in pharmacotherapy (therapy using pharmaceutical drugs) for obesity. I summarised it in this tweet at the time:

Medications for obesity - findings of Liragultide & Semaglutide: Wt-loss of 8-12% at 1below -3 years.

Research to influence health care policy by Dr Barbara McGowan

Early Career Research Network for #UKCO2018 pic.twitter.com/KBDeFfPJ32

— Dr Enzo Di Battista (@EnzoRD_PhD) 5 September 2018

Semaglutide isn’t licenced in the UK but Barbara feels it will be in the next year or so.

Evaluating public health interventions

Upon returning from a comfort break we settled down to listen to Professor Ashley Adamson, Director of Fuse, talk about‘Evaluating public health interventions’. Ashley highlighted “The value of collaboration” and taking time to develop networks across sectors (industry, public sector, third sector, local government) to establish and maintain public health interventions.

Ashley asked us to form groups and consider how we would implement and evaluate a breakfast club initiative in primary schools. It was a useful exercise to consider what skills (e.g. project management, capacity/network building) and processes (ethics and legalities of working with school children/participant group) were needed for public health interventions and evaluation.

My favourite slide from the talk was entitled ‘An ideal evaluation’ which, as you can see from the picture below has 5 key points, with full references (BRILLIANT!).

Before closing the workshop, Maria asked for everyone’s opinions on the afternoon and what they would like from future events. On reflection, I felt that maintaining such a high calibre of speakers was key to the quality of the workshop – so that needs to be consistent. Perhaps in future, it would be interesting to hear about emerging subjects within the obesity field and to invite someone who has recently completed a PhD or Post-doc fellowship to share their personal experiences.

If you have any thoughts on what makes for an excellent Early Career Research Workshop please feel free to post a comment below and I can feed it back to the UKCO2019 organising committee. Many thanks!