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Does Implementation Follow Design? A Case Study of a Workplace Health Promotion Program Using the 4-S Program Design and the PIPE Impact Metric Evaluation Models

Äikäs, Antti Hermanni MPEd; Pronk, Nicolaas P. PhD; Hirvensalo, Mirja Hannele PhD; Absetz, Pilvikki PhD

Journal of Occupational and Environmental Medicine: August 2017 - Volume 59 - Issue 8 - p 752–760
doi: 10.1097/JOM.0000000000001067
Original Articles

Objective: The aim of this study was to describe the content of a multiyear market-based workplace health promotion (WHP) program and to evaluate design and implementation processes in a real-world setting.

Methods: Data was collected from the databases of the employer and the service provider. It was classified using the 4-S (Size, Scope, Scalability, and Sustainability) and PIPE Impact Metric (Penetration, Implementation) models. Data analysis utilized both qualitative and quantitative methods.

Results: Program design covered well the evidence-informed best practices except for clear path toward sustainability, cooperation with occupational health care, and support from middle-management supervisors. The penetration rate among participants was high (99%) and majority (81%) of services were implemented as designed.

Conclusion: Study findings indicate that WHP market would benefit the use of evidence-based design principles and tendentious decisions to anticipate a long-term implementation process already during the planning phase.

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Faculty of Sport and Health Sciences, University of Jyväskylä, Finland (Mr Äikäs); Health Partners, Minneapolis, Minnesota (Dr Pronk); Harvard University, T.H. Chan School of Public Health, Boston, Massachusetts (Dr Pronk); Faculty of Sport and Health Sciences, University of Jyväskylä, Finland (Dr Hirvensalo); University of Eastern Finland, Kuopio, Institute of Public Health and Clinical Nutrition (Dr Absetz); and University of Tampere, School of Health Sciences, Tampere, Finland (Dr Absetz).

Address correspondence to: Antti Hermanni Äikäs, MPEd, Hauskankatu 1b, 50100 Mikkeli, Finland (

Metsämiesten säätiö, Finland, supported financially this study and the manuscript writing process.

Corresponding author (AÄ) is an employee of 4event ltd, which designed and implemented the ENSO program.

Author Pilvikki Absetz has kept two single team workshops for 4event ltd during 2013 to 2015; the participants (10 to 20 persons) were employee of Stora Enso Metsä.

Other authors have no conflicts of interest.

Consultant Jouni Lahti, PhD, Adjunct Professor in the University of Helsinki has no conflicts of interest.

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Copyright © 2017 by the American College of Occupational and Environmental Medicine