Chronic diseases are influencing American businesses’ competitiveness because of lost productivity and unstable healthcare costs. According to a study by the Integrated Benefits Institute (2012), which represents major U.S. employers and business coalitions, poor employee health costs the U.S. economy $576 billion annually. Of this cost, 39% is a direct result of “lost productivity” from employee absenteeism due to illness or presenteeism, when employees report to work but illness keeps them from performing at their best (1). In addition, lower employee well-being contributes to higher turnover rates and lower levels of engagement with work (2). Business leaders have taken stock of this evidence and are now viewing workforce health as a business issue, and that the health of their employees is a significant contributor to productivity and performance.
The average American worker between the ages of 25 and 54 yr spent 5 d·wk−1, with an average of 8.8 h·d−1, at the workplace (3). The use of effective workplace programs and policies can reduce health risks and improve the quality of life for American workers while decreasing health costs to their employers. Since 1974, more than 200 studies have been conducted examining the results of interventions at the worksite, and every study included showed clinical effectiveness of worksite intervention. Ninety of those studies evaluated cost outcomes, with the overwhelming majority demonstrating positive cost outcomes (4). The Bravewell Report was one of these studies that showed employers experienced an average 26% reduction in health care costs and an average of $5.81 returned for every $1 invested in workplace health promotion initiatives (4). Furthermore, a study by Milani and Lavie (5) evaluating clinical efficacy and cost-effectiveness of a 6-month comprehensive worksite health intervention found that of the employees categorized as high risk at baseline, 57% were converted to low-risk status and average employee annual claim cost decreased by 48% for the 12 months after the intervention, creating a sixfold return on investment.
The workplace has become a valuable intervention site for a number of reasons, including the significant amount of time Americans spend at work, the access to populations that may be difficult to engage outside the workplace, and the opportunity to use peer networks and employer incentives (6). Workplace wellness takes advantage of an employer’s access to employees when interventions can still change their long-term health trajectory (6). Research has shown that exercise and physical activity behaviors are very effective in enhancing overall employee health (7), including mental health (8), and reducing chronic disease (9).
To better understand the employees’ adoption of healthy behaviors, such as routine exercise and daily physical activity, the transtheoretical model (TTM) has often been used (10). The TTM is a model that explains an individual process of change, which can be described in five stages: (a) precontemplation (i.e., no intention of becoming physically active and awareness of the problems associated with this behavior), (b) contemplation (i.e., awareness of the negative effects of inactivity with intention to start practicing PA), (c) preparation (i.e., making small changes in behavior—joining a gym, for example—but still not meeting a criterion for physical activity), (d) action (i.e., meeting a criterion of physical activity, but only recently—usually within the past 6 months), and (e) maintenance (i.e., meeting a criterion for physical activity for 6 months or longer) (10). One of the important constructs associated with the TTM is self-efficacy, which refers to the degree of confidence a person has that he or she will not engage in a problem behavior in tempting situations. In short, self-efficacy is a person’s belief in their capabilities to overcome personal, social, and environmental barriers to exercise (11).
The American College of Sports Medicine (ACSM) lists several common individual-level barriers to physical activity and routine exercise. Several studies have substantiated many common barriers, including lack of time, social support, access to exercise facilities, and cost (12,13). In addition, incentives have been explored in the work setting, although findings were inconclusive (14). Understanding barriers and incentives can assist in the development of strategies that can be implemented to overcome them and increase the success of adherence to exercise.
Although previous research has been undertaken with respect to worksite wellness programs and with health concerns of the American workers, there has been few studies to investigate different types of occupations within an agency. Dodson et al. (15) investigated how the availability of worksite support differs across industries and occupation and found notable discrepancies among blue-collar, health care, and business occupations. Municipal agencies tend to have a wide range of workers, including office staff, firefighters, police officers, public utilities staff, administrative staff, and business staff. This study aims to better understand the barriers of rural municipal workers and what incentives might encourage consistent and ongoing exercise behaviors throughout various departments within the worksite setting. The purpose of this study was to identify the stage of change for exercise, exercise barriers, and incentives of rural municipal workers and to investigate if a difference exists between the different types of municipal worker in the southeastern Georgia area.
- 1) Are there differences between occupations of municipal workers and exercise stage of change?
- 2) What are the most common exercise barriers among municipal workers in the rural setting, and does this differ by occupation?
- 3) What incentives are most favorably viewed among municipal workers in the rural setting, and does this differ by occupation?
- 1) The type of occupation would influence an employee’s exercise stage of change.
- 2) The type of occupation would influence an employee’s incentive needed to engage in routine exercise.
- 3) The type of occupation would influence an employee’s barrier to routine exercise.
A cross-sectional, descriptive survey design was used to identify the exercise barriers and incentives among rural municipal workers and compare differences between occupations. The descriptive research attempts to describe the status of the population without influencing; the survey is the most common method of descriptive research (16). The Institutional Review Board of the sponsoring university approved this study.
The study was conducted by surveying employees of a southeastern rural municipal organization with departments including fire, police, public works, and other (business and administrative workers). An electronic survey was e-mailed out to all 309 workers by the Human Resource Department on November 2016. A note was included indicating that the survey was being conducted by the local university research team and that the employer would not have access at any individual survey information. The survey was completed online using Qualtrics (Version XM, Provo, UT) software. An informed consent form describing the purpose of the study was attached at the beginning of the survey; if the participant agreed to take the survey, they simply clicked to continue giving implied consent. Participants had their choice of completing the survey online or with pen and paper during the employee wellness fair during the second week of the survey’s open period; a research assistant was present in distributing and collecting those hard copies. Again, the consent form was presented before the survey, and participants who agree to take the survey gave implied consent. Therefore, completing and returning the questionnaire implied consent. The surveys were collected over a 2-wk period. A total of 146 employees (47.2%) responded to the survey. However, 23 surveys were removed due to incompleteness, leaving a completed pool of 123 participants (39.8%) for analysis. Employees were placed into four employment categories: police, fire, public works, and other.
The study was conducted in a municipal worksite wellness program in rural Georgia.
A 14-item research designed survey was used to collect the data: one question assessed readiness to change, using the TTM (10); one question was a ranking question (from 1 to 10) for exercise barriers; one question focused on motivators and incentives; and 11 questions focused on personal demographics. The survey content validity was supported by three area experts.
Participants were asked to rank the following exercise barriers from most (1) to least (10): 1) inconvenient time or location of facility, 2) lack of time to exercise, 3) lack of childcare, 4) nowhere comfortable to exercise, 5) worried about getting injured, 6) no one to exercise with, 7) do not know what to do, 8) cost is too much, 9) no motivation, and 10) feel awkward exercising. It is important to note that the municipal agency offers a free 24-h fitness facility for all employees and their spouses, which is located in the city center, and within walking distance from the police department, municipal court, and (one of two) fire stations. Most employees live within a 10-min commute. In addition, there are four other commercial fitness facilities located throughout the county.
Participants were provided seven common motivators to promote exercise and asked to select any or all that applied to them. The seven motivators were as follows: 1) no reward needed to participate, 2) financial incentive, 3) time off work, 4) free food, 5) small nonmonetary gift, 6) raffle or team prize, and 7) no reward enough to participate.
Data were summarized with appropriate descriptive statistics (e.g., mean and SD for continuous variables, percentages for categorical variables). Exercise barrier ranks and potential motivator percentages and TTM response were compared between employment categories using nonparametric Kruskal–Wallis tests for each component. Post hoc pairwise comparisons were further analyzed for all significant findings. Data were analyzed using the Statistical Package for the Social Sciences (version 23.0; IBM Corp., Armonk, NY).
Table 1 provides complete demographic characteristics of the 123 city employees, separated by employment category or department: police (n = 40; 32.5% of sample), fire (23; 18.7%), public works (27; 22.0%), and other (33; 26.8%). The majority of the sample population (mean age = 41.2, SD 11.5 yr) were Caucasian (69.2%), male (77.4%), non–tobacco users (79.4%), and had an annual income of $30,000–$39,999 (21.2%). Education status was varied among the population, with approximately a quarter of the sample having only a high school degree or less (24.3%) and another quarter having a bachelor’s degree (25.3%). The vast majority of the sample population were estimated to be overweight or obese (79.6%), with an average body mass index of 30.2 ± 6.3 kg·m−2.
No significant differences existed in stages of change between occupations (H3 = 3.390, P = 0.335). Nearly half (45.2%) of all city employees self-selected the action stage, although it was noted that total adherence to health behavior change was present. The other responses for the other stages of change were as follows, in order from most common response to least common response: maintenance, 20.5%; contemplation, 19.2%; preparation, 5.5%; and precontemplation, 2.7%. Table 2 shows the complete percentage breakdown of stages between departments.
Table 3 shows the percentage breakdown of ranks for each of the 10 exercise barrier questions. Across all respondents, the perceived exercise barriers ranked from most to least, based on median rank, with aggregated mean provided when medians were the same. Lack of time (95.2% inside the first five responses) and inconvenient time/location (91.9%) were the two biggest barriers across all occupations. No significant differences (P > 0.05) between occupations were found for nine of the perceived exercise barrier rankings. The perceived barrier of cost was the only significantly different result found (H3 = 9.967, P = 0.019) between occupations. Further examination revealed that employees from the fire department reported that cost was far less of a barrier (12.9%) compared with employees from the police (35.0%), public works (22.2%), and other (48.5%) departments. The only other perceived barrier that approached significance was “feel awkward exercising” (P = 0.054), with employees from the fire department again reporting that this barrier was less of a deterrent (8.6%) compared with employees from the police (15%), public works (18.5%), and other (12.1%) departments.
Motivators to Exercise
Across all employees, the potential motivators ranked from most to least, based on the percentage of yes responses, were as follows: 1) time off work (53.4%), 2) financial incentive (51.4%), 3) no reward needed to participate (40.4%), 4) raffle or team prize (24.7%), 5) free food (22.6%), 6) small nonmonetary gift (21.2%), and 7) no reward enough to participate (10.3%).
Several differences existed between occupations on potential motivators. Positive response to financial incentive was significantly different (H3 = 10.550, P = 0.018) between occupations. Post hoc analysis revealed that employees from the public works department responded less favorably to this motivator (35.1%) compared with the employees from the police (65.1%, P = 0.008) and fire (66.7%, P = 0.016) departments. Response to time off work was significantly different between occupation (H3 = 8.885, P = 0.031), with employees from the fire department responding more favorably to this incentive (75%) than employees from the public works (40.5%, P = 0.009) and other (42.9%, P = 0.020) departments. Response to raffle or team prize was also different between occupations (H3 = 8.412, P = 0.039). Although no occupation reported a strong response to this motivator, police (37.2%) reported a significantly higher opinion of this motivator compared with public works (16.2%, P = 0.030) and other (14.3%, P = 0.015). Lastly, a significant difference between groups was noted for response to “no reward enough to participate” (H3 = 8.391, P = 0.039). Public works employees responded significantly more frequently to this question (21.6%) compared with employees from the police (7%, P = 0.032) and fire (0.0%, P = 0.007) departments, with a trend toward significance with other department (9.5%, P = 0.078).
No significant differences existed between occupations for potential motivators of “no reward needed to participate” (P = 0.103) or “free food” (P = 0.423). Overall, nearly 41% of all employees stated that they would participate in exercise regardless of any incentive. The motivator “small nonmonetary gift” approached statistical significance (P = 0.051), with a larger percentage of employees from the police (32.6%) and fire (29.2%) departments stating this as a positive motivator compared with employees from the public works (10.8%) or other (14.3%) departments.
This study identified the exercise stage of change, exercise barriers, and incentives among rural municipal workers in the southeastern Georgia area and compared the differences between occupations.
Stage of Change
About 70% of all city employees reported being in the action or maintenance stage, which is consistent with adult populations (17–19). It is important to note that one of the four occupations of municipal workers (firefighters) is required to participate in physical activity for an hour per 24-h shift. However, even with this requirement, there were no significant differences in stages of change between occupations. This is encouraging to recognize that, even with diverse workers, the vast majority of them are ready for change (preparation 19.2%, action 45.1%, or maintenance 20.5%). The results of this study show that even if the participants slightly overestimated their actual physical activity, there is an overwhelmingly positive attitude toward exercise among all workers in the municipal setting. Being in these stages of change allows individuals to positively move forward with exercise interventions based on the theoretical construct of the model (10,11).
The main barriers across all occupations were that of the two biggest barriers across all occupations: lack of time and inconvenience location/time of the fitness facility. Time has consistently emerged as a top barrier for a variety of different demographic groups, including those studied based on race, sex, and age (20,21). When comparing work settings that allowed for time to exercise at work, several studies found that workload and having time during the day were the most critical factors in promoting exercise (22–24). Municipal agencies may consider using flexibility in work time and workloads to promote physical activity, especially when one department (occupation) is given paid time to exercise.
Similar to the findings of Reed and Phillips (24), where all participants and their spouses had access to free exercise facilities, participants have consistently indicated that time/location of the exercise facility could be a barrier to exercise. The current study revealed no difference between occupations, although specific departments (primarily police, some fire, and some other personal) were closer in proximity to the exercise facility than other departments. Further investigation of this barrier is warranted, assessing whether employees felt the location was inconvenient in general, or only when they were off of work, was not fully understood by the current researchers. Furthermore, although the current fitness facility has 24-h access, it is conceivable that while the facility is always open, employees may not feel safe at certain times. Although the facility is in proximity of the police and fire departments, it would not be considered in an ascetically pleasing or well-lit area, which is consistent with the findings of Salvo et al. (25) on the influence of the neighborhood as a barrier to exercise.
The cost barrier is consistently found as a barrier to exercise in other studies (26,27). Again, the participants in this study did have free access to a municipal fitness facility; however, the fitness facility could be described as poor condition compared with fitness industry standards. This may explain why employees from the fire department who are required to exercise on their shift in the municipal fitness facility reported that cost was far less of a barrier (12.9%) compared with employees from the police (35.0%), public works (22.2%), and other (48.5%) departments. The police, public works, and other groups are encouraged to exercise on their own personal time, and that may have influenced where they choose to exercise. The workers may choose to exercise at a private or public fitness facility in which they pay their own membership fees. Although this study did not investigate the perception of the facilities, further studies may want to consider facilities as a factor. The only other perceived barrier that approached significance was “felt awkward exercising.” Schwetschenau and colleagues (28) found that with the general population, internal barriers (e.g., feeling embarrassed to exercise around coworkers) significantly accounted for the frequency of fitness center visits among members. Lack of comfort, injury risk, and no one to workout with were other exercise self-efficacy barriers presented by the participants in this study. It has been suggested by previous research that improving exercise self-efficacy may lead to improved physical activity in the work setting (29,30).
Lack of childcare was the most varied barrier. This would indicate that those participants with children living at home found the absence of childcare at the exercise facility as a major barrier to consistently exercising. Previous studies have also indicated that programming should focus on efforts of improving the participant’s confidence to overcome exercise barriers, reducing their negative perceptions of barriers, and aiding parents in making specific plans for prioritizing and engaging in exercise (31–33).
Motivation and incentives for exercise have long been studied in health promotion. Traditionally, employers have used extrinsic motivators such as financial incentives, time off, prizes, and social recognition to promote employee exercise (3). In this population, four of the seven potential motivators or incentive to improve exercise adherence were found to have a significant difference. The variation of motivators and incentives, depending on occupational responses, could be a successful means of improving exercise in all employees, instead of implementing a single motivating tactic based on the raw majority (34).
In this study, just over 50% of participants listed financial incentive as a motivator to exercise. Previous research has produced mixed conclusions on the effectiveness of financial incentives on increasing exercise adherence. A meta-analysis by Mitchell and colleagues (35) revealed that positive (n = 8) and null (n = 3) effect studies suggest that financial incentives can increase exercise adherence in adults in the short term (<6 months). A more recent study showed no differences in physical activity or health-related variables within the incentivized and nonincentivized conditions (36). Tailoring to the different occupational employees’ needs and interest may best use incentives to promote healthy behaviors.
Time off was also found to be a major motivator for exercise in this study, which is consistent with other findings (23). Time off seems to be more favored by first responder departments (fire and police) compared with other departments (public works and other) in our study. This may be due to the increased psychological and physical demands of these first responder departments compared with that of the other departments (37). In addition, paid time off has been found to have a positive impact on an employee’s view of their employer (38). A significant number of participants responded that they did not require work incentives to participate in exercise. This response is encouraging, as extrinsic motivating tactics are often used to initiate change but do not promote sustained long-term changes in exercise behavior. Although a good portion of our participants did not require incentives to participate, other research has shown that incentives and particularly motivators, such as team text messaging and feedback, can be a potent method in maintaining exercise attendance and compliance.
We used a self-report instrument to measure stages of change; thus, the results were limited by the inherent biases of self-reported data. The electronic copy of the survey was sent through the employer listserve, which may have influenced participants’ answers to fit socially acceptable responses. As mentioned previously, not all occupational workers had the same employer support of exercise; the firefighters were required to exercise 1 h per 24-h shift. Furthermore, the police officers do not require an exercise hour on shift; however, they do tactical training through the year as part of their in-service and physical fitness is highly encouraged compared with the other departments. In addition, the findings of this study do not include the 52.8% of the city employees who did not respond to the survey.
The results of this study indicate that in this rural municipal worksite setting, most employees are ready for behavioral change, and their perceived barriers to exercise were relatively similar. In addition, although significant differences between occupations existed in four of the seven motivators, professionals could use these findings to mold and tailor motivators to particular occupations within the municipal organization. These findings also support citywide educational programming to remove or lessen the perceived barrier to exercise variables.
The authors acknowledge Deputy Chief Bobby Duggar and Jeff Grant, HR Director, and the employees from the City of Statesboro for their participation.
There were no funding sources for the development of this manuscript. The authors declare no conflicts of interest with this manuscript. The results of the present manuscript do not constitute endorsement by the American College of Sports Medicine.
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