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Developing Two Culture of Health Measurement Tools

Examining Employers’ Efforts to Influence Population Health Inside and Outside Company Walls

Kent, Karen B., MPH; Goetzel, Ron Z., PhD; Roemer, Enid Chung, PhD; McCleary, Katherine, MS, CHES; Henke, Rachel Mosher, PhD; Head, Michael A., MS; Fabius, Raymond, MD

Journal of Occupational and Environmental Medicine: December 2018 - Volume 60 - Issue 12 - p 1087–1097
doi: 10.1097/JOM.0000000000001438

Objective: The aim of the study was to develop tools that quantify employers’ investment in building cultures of health (COH)—inside and outside company walls.

Methods: Two COH instruments were developed through literature reviews and expert consultation. The first focused on internal culture of health (COH-INT), that is, programs, policies, and attributes of the physical and social environments that support employees’ health and well-being. The second focused on external culture of health (COH-EXT), that is, programs, policies, and environmental supports that promote communities’ health. We administered these tools to 32 employers and examined instrument reliability, distribution of scores, and correlation between the two instruments.

Results: Both tools demonstrated adequate reliability. COH-EXT scores changed minimally over the 3-year study timeframe. There was little correlation between the COH-INT and COH-EXT scores.

Conclusions: More research is needed to further develop and validate COH-EXT instruments.

Institute for Health and Productivity Studies, Johns Hopkins Bloomberg School of Public Health, Washington, DC (Ms Kent, Dr Goetzel, Dr Roemer, Ms McCleary); IBM Watson Health, Bethesda, Maryland and IBM Watson Health, Cambridge, Massachusetts (Dr Goetzel, Dr Henke, Mr Head); HealthNEXT, Unionville, Pennsylvania (Dr Fabius).

Address correspondence to: Ron Z. Goetzel, PhD, IBM Watson Health, 7700 Old Georgetown Rd., Suite 650, Bethesda, MD 20814 (

Funding for this study was provided by the Robert Wood Johnson Foundation, Grant no. 74318.

The authors report no conflicts of interest.

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Copyright © 2018 by the American College of Occupational and Environmental Medicine