- Title
- Examining the effect of workplace health promotion interventions on health behaviour and attitudes: an insight into health and wellness in the Australian mining sector
- Creator
- Bezzina, Aaron Thomas
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The burden of non-communicable diseases (NCD) continues to be a major public health issue. These diseases can be implicated by a range of factors, including genetic (sex), environmental (location), and social influences (social status), accounting for 74% of global deaths in 2019. As a result, current treatment approaches have not been able to stem the tide of disease, necessitating the need to consider novel treatment approaches. One novel approach involves using the workplace to promote health messaging and activities. The workplace is an ideal setting for the implementation of health promotion programs because employees spend large amounts of time there. Specific workplaces can reach desired demographics, like blue-collar male workers, who may otherwise be challenging to engage. An added benefit is the ability to target certain demographics and design health promotion initiatives that are relevant and effective for a group. The Australian mining industry serves as just one example of a blue-collar, male-dominated industry that would benefit from directed and industry-specific workplace health promotion programs. The industry is a major employer within Australia (~300,000 workers) and is a significant contributor to both the Australian and global economy. However, the sector experiences disproportionate levels of chronic disease amongst employees, with New South Wales (NSW) coal mining data indicating that nearly 80% of employers have a BMI that would classify them as either overweight or obese (compared to 67% for the average Australian adult). These statistics are further compounded by poor fruit and vegetable consumption and elevated rates of risky or hazardous drinking behaviours. This thesis presents a program of research including a series of publications that evaluate the efficacy and applicability of industry-specific health promotion programs that target modifiable health behaviours in the NSW coal mining industry. Firstly, a scoping review was conducted to understand the contemporary research landscape surrounding workplace health promotion programs that target weight outcomes in men. The review included 25 articles published between January 2010 and August 2020, which highlighted that most studies (68%) used both diet and physical activity to induce weight loss. Among all included studies evaluating weight, thirteen out of the nineteen (68%) interventions were successful at reducing weight outcomes. The review reinforced the notion that interventions, including diet and physical activity components, can produce significant weight loss in individuals compared to diet or exercise alone. Only two of the included studies incorporated a post-intervention follow-up in their study design, and the subsequent weight regain during the post-intervention period highlighted the need to consider sustainably implemented programs to avoid the yo-yo effects of dieting. The second publication in this thesis was a follow-up to the scoping review, whereby a rigorous and targeted systematic review and meta-analysis were conducted. The review evaluated the effectiveness of interventions implemented within the workplace that targeted smoking, nutrition, alcohol, physical activity, or a combination of these, in overweight and obese men. The systematic review differed in focus from the scoping review, including only Randomised Controlled Trails (RCT), focusing exclusively on all male studies, and expanding the modifiable health behaviours investigated. The review was contemporary in focus and included eleven studies. Overall, the results were mixed. Narrative synthesis revealed studies that targeted snacking frequency, sugar-sweetened beverages intake, and physical activity could be significantly improved through workplace health promotion programs; however, there were insufficient studies to conduct a meta-analysis on these outcomes. Regarding weight, meta-analysis highlighted a pooled mean decrease in body weight of -0.28kg up to 3 months, -1.38 kg for >3 months, and a pooled mean decrease in body mass index of 0.06kg/m2 up to 3 months, -0.27kg/m2 for >3 months, although these results did not reach significance (p > .05). The first intervention study in this thesis centred around the RESHAPE workplace health promotion philosophy. RESHAPE is an eight-step framework (based on the World Health Organization (WHO) ‘Health Workplace Framework and Model’) and was conceived by a sub-committee of the New South Wales Minerals Council (NSWMC) Work Health Safety Committee. The framework outlines a clear and sustainable approach to workplace wellness and incorporates a health promotion initiative that is implemented under the broader RESHAPE banner. Three NSW coal mine sites, comprising two open cut and one underground, were recruited into a study to assess the efficacy of RESHAPE as determined by changes in employee health outcomes after the implementation of a wellness program. At baseline, there were 949 respondents across the three sites, with 80% of respondents self-reporting BMI rates that would classify them as either overweight (40.9%) or obese (39.1%). However, the advent of the COVID-19 global pandemic fundamentally changed the scope and direction of the RESHAPE project. Two of the sites withdrew from the study due to constraints brought about by the pandemic, with only one site able to implement a wellness program and follow-up data collection to be completed. Notwithstanding, for the one site where data collection was available, there were n=389 respondents at baseline and n=420 at follow-up. A 12-week multicomponent (diet and exercise) workplace health promotion was implemented across the entire site and made available to all employees. There were no significant changes to weight and BMI at follow-up; however, when adjusting for usual hours worked per week, respondents at follow-up were statistically more likely to be meeting exercise and physical activity guidelines (OR 2.37, 95% CI: (1.05, 5.35), p= 0.039). Consequently, the study highlighted the potential for workplace health promotion programs to improve coal mining employees’ physical activity outcomes. The final study investigated an Australian mining-specific environmental intervention called ‘Out of the Box’, which was implemented across three coal mining organisations. The 'Out of the Box' initiative is a six-month workplace health promotion program designed in response to the challenges imposed by the COVID-19 global pandemic. The program's content, intervention strategies, and resources align with Bandura's Social Cognitive Theory, incorporating behaviour change techniques and mechanisms for action. Program content focused on diet, hydration, and alcohol, with key aims centred around increasing knowledge of guidelines and increasing self-efficacy. Despite the best efforts in intervention design, challenges brought about by COVID-19 still limited data collection and implementation. As a result, data for only one site was collected and reported (baseline n=163, follow-up n=106). At the 6-month follow-up, respondents had increased odds of recalling the current fruit (OR 1.29, p = 0.032) and vegetable (OR 1.76, p < 0.001) guidelines. Furthermore, there was a reported mean difference in AUDIT scores between baseline and follow-up (p = 0.021). The study underscored the possibility for environmental programs to shift health knowledge and behaviours, although further research is needed to validate these findings. The conclusions drawn from this thesis underscore the efficacy of workplace health promotion programs in encouraging positive changes in health behaviours and attitudes associated with NCD among employees within the Australian coal mining industry. The innovative strategies implemented as part of RESHAPE and 'Out of the Box' present an opportunity to serve as a foundational framework for further industry-engaged research. Careful consideration of organisational, policy, and research implications is paramount to address the escalating trend of chronic diseases among employees. Considering the prevalence of overweight and obesity among coal mining employees is around 80%, there is an immediate need for substantial investment and proactive measures. The mining industry, characterised by hazardous work conditions, elevated rates of chronic diseases, and a predominantly rural and remote workforce, is uniquely positioned to leverage the advantages offered by comprehensive workplace wellness initiatives. This occurrence underscores the urgency of implementing strategic interventions to address the health challenges confronting the industry's workforce.
- Subject
- workplace; health promotion; mining; nutrition; physical activity; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1511597
- Identifier
- uon:56513
- Rights
- Copyright 2024 Aaron Thomas Bezzina
- Language
- eng
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