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Health Promotion in Small Business: A Systematic Review of Factors Influencing Adoption and Effectiveness of Worksite Wellness Programs

McCoy, Kira BA; Stinson, Kaylan MSPH; Scott, Kenneth MPH; Tenney, Liliana MPH; Newman, Lee S. MD, MA

Journal of Occupational and Environmental Medicine: June 2014 - Volume 56 - Issue 6 - p 579–587
doi: 10.1097/JOM.0000000000000171
Original Articles

Objective: To assess the evidence regarding the adoption and efficacy of worksite health promotion programs (WHPPs) in small businesses.

Methods: Peer-reviewed research articles were identified from a database search. Included articles were published before July 2013, described a study that used an experimental or quasiexperimental design and either assessed adoption of WHPPs or conducted interventions in businesses with fewer than 500 employees. A review team scored the study's rigor using the WHO-adapted GRADEprofiler “quality of evidence” criteria.

Results: Of the 84 retrieved articles, 19 met study inclusion criteria. Of these, only two met criteria for high rigor.

Conclusions: Fewer small businesses adopt WHPPs compared with large businesses. Two high-rigor studies found that employees were healthier postintervention. Higher quality research is needed to better understand why small businesses rarely adopt wellness programs and to demonstrate the value of such programs.

From Hampshire College (Ms McCoy), Amherst, Mass; the Center for Worker Health and Environment (Ms Stinson, Mr Scott, Ms. Tenney, and Dr Newman), Colorado School of Public Health; Department of Medicine (Dr Newman), School of Medicine, University of Colorado, Aurora.

Address correspondence to: Kira McCoy, BA, 785 S. Garfield St., Denver, CO 80209 (

All authors were funded through a grant from the Centers for Disease Control, National Institute for Occupational Safety and Health, awarded to our institution, the University of Colorado. Ms McCoy is a former employee and all other authors are current employees at the University of Colorado Denver.

The authors declare no conflicts of interest.

Copyright © 2014 by the American College of Occupational and Environmental Medicine