On-line program has a high-touch component
Personal side of wellness can’t be ignored
In the rush to get on board for the latest and greatest "cyber" solutions to wellness issues, health promotion professionals must take care not to overlook the personal side of wellness.
That warning is both offered and heeded in a new on-line product recently launched by The StayWell Company, a San Bruno, CA-based provider of patient education and consumer health improvement programs, products, and services to employers, health care organizations, and health care providers. The program, StayWell Online, was unveiled in September. Its components include:
• HealthPath, HealthStep, and HealthShare Online health risk assessments;
• Well Advised Online, a self-care guide;
• WellTimes Online, a wellness newsletter;
• Personal Action Guide Online, skill-building booklets that help employees improve health behaviors;
• HealthSCOUT@StayWell Online, daily personalized health news;
• A health events calendar.
Despite all the high-tech components of the program, StayWell has been keenly aware throughout its development process of the need to maintain a "high-touch" feel.
"The underlying design philosophy was based on the idea that while on-line services will help us extend program reach and gain new efficiencies, a total population health management approach requires that complementary off-line services be available, and that the on-line service simply provides an additional entry point to high-touch services," explains Eric M. Zimmerman, MPH, MBA, director, on-line and interactive products.
"We began with an entirely different premise," adds David R. Anderson, PhD, vice president, programs and services. "That premise was that on-line services can play a role in a comprehensive management solution, but they can’t be the solution."
Listening to users
StayWell took well over a year to design its full suite of on-line services, including beta-site testing over the course of the past year. During that period, they listened to what the users had to say.
"The survey work we have done shows that while about 50% of employees of major corporations do have on-line access, about 50% don’t. And even those who have on-line access don’t always prefer to use it," Zimmerman explains. (See the "On-line vs. Paper" survey results on p. 138.)
Paper or . . . On-line: Employees Speak |
| In developing the StayWell Online program, The StayWell Company, San Bruno, CA, conducted extensive surveys of both on-line and paper participants. They show distinct differences between the two groups — not only in terms of preferences, but in terms of demographic and risk characteristics. Here are some of their findings: |
| Readiness Characteristics | ||
| Ready to Change | On-line | Paper |
| Nutrition | 53% | 54% |
| Weight | 62% | 56% |
| Exercise | 63% | 65% |
| Back Care | 13% | 10% |
| Driving | 7% | 6% |
| Smoking | 7% | 4% |
| Stress | 30% | 30% |
| Self-Care | 7% | 11% |
| Exams | 14% | 18% |
| On-line Satisfaction Ratings | |
| Very Easy to Complete | 89% |
| Introductions Clear | 98% |
| Feedback Valuable | 96% |
| Liked Layout | 98% |
| Easier to Navigate | 98% |
| More Likely to Take Action | 78% |
| Quicker than Paper | 72% |
| HRA "More Fun" On-line | 83% |
| Completed in >1 Session | 46% |
| Risk Characteristics | ||
| Elevated Risk in | On-line | Paper |
| Nutrition | 59% | 56% |
| Stress | 60% | 55% |
| Self-Care | 48% | 49% |
| Exercise | 48% | 49% |
| Blood Pressure | 16% | 36% |
| Cholesterol | 59% | 36% |
| Employee Focus Group Findings: | ||
| • 100% "white-collar" access vs. 43% "blue-collar" | ||
| • 41% have access at work vs. 25% at home | ||
| • 57% prefer taking HRA on-line vs. paper | ||
| • Top uses for on-line health: Program information, enrollment, reminders, links, e-mail reminders | ||
| • Pros: Convenient, personalized, Q&A ability | ||
| • Cons: Junk e-mail; not as "personal" | ||
| Demographic Characteristics | ||
| On-line | Paper | |
| Female | 26% | 27% |
| Under 40 | 54% | 59% |
| Management | 22% | 20% |
| Professional | 62% | 53% |
| Other | 16% | 27% |
| Reasons for Not Participating | ||
| Too Busy | 60% | |
| No Access | 15% | |
| Confidentiality | 10% | |
| Not Aware | 8% | |
| No Interest | 5% | |
| Lost ID | 5% | |
This had a significant impact on the design of the program, he explains. For example, StayWell has traditionally done a lot of work with health risk appraisals (HRAs) and follow-up programs. "We knew for that for these components, the on-line tools needed be completely compatible with paper-based tools to serve corporate users with equity and consistency," Zimmerman notes.
By offering different options, StayWell believes it can induce employees to become more engaged in their company’s wellness program. "The more options you provide, the better results you will get," Zimmerman asserts.
In practice, StayWell Online is slightly different for every client. "We build the [on-line] site for each client and assemble the components that best meet their objectives," explains Zimmerman.
The three different HRAs are a perfect example. "Some companies want longer, more comprehensive HRAs; others are more concerned with time and literacy issues, while still others are more medically oriented," he notes. "HealthShare, for instance, is more focused around disease management and prevention, and is generally far more appropriate for managed care."
Once an employee is at the HRA site, further customization is possible. "We can even add question items," Zimmerman notes.
Other components also recognize the individuality of the user. The Personal Action Guide is aimed at those employees who are closer to the "preparation" and "action" stages of change.
"The scientific literature shows that a significant number of people are able to make a change on their own, with little or no outside help," says Anderson. "So, the key was to reach people who are really committed to change. Another group needs some outside support, but in the form of information — for those, on-line is a really terrific vehicle. Then, there are a considerable number who won’t succeed on their own — or will take a long time to do so. They need a fairly intensive hands-on process."
The self-care guide, as its name implies, is aimed at helping employees make smart health care decisions.
The personalized daily health news is extremely important, Zimmerman notes. "As an individual, you have to have a reason to come back [to the site]," he says. What this site offers is additional contact from the outside world, reviewed first by an advisory panel. "We push headlines to your desktop base on your HRA responses, via a licensed news feed from HealthSCOUT, a leading provider of Internet-based health news," Zimmerman explains. The news feed is accessed on a nightly basis.
The health events calendar is a valuable asset for health promotion professionals, says Zimmerman. "Program managers need communication tools," he notes. "We give them the ability to publicize events and make employees aware of wellness program resources. These, too, can be totally customized."
It’s very easy to think that by providing resources on the Internet that you’ve "done it," Zimmerman warns. "You need to reach different segments with the right sorts of resources and messages."
Since the program is so new, it is constantly being updated. Recent, StayWell added the ability to enroll in HRA follow-on programs on-line.
"This iIlustrates one of the greatest values of on-line services," says Anderson. "It offers a way to get more people into interventions and reduce health risks and make long-term changes. It is very immediate."
StayWell research indicates that health promotion professionals are keenly aware of the potential pitfalls of on-line services. "Many people expressed the concern that high-tech solutions would cause programs to lose sight of their person-to-person contact, which they perceived as a key benefit. That was really corroborated by a lot of anecdotal comments we got from the recent AWHP [Association for Worksite Health Promotion] conference in Houston," says Zimmerman.
In one StayWell study, 80% of health promotion professionals said they see on-line services as extension of, and not a replacement for, more traditional wellness services.
"Our general experience is that our customers are pretty sophisticated about this need for a really broad approach," adds Anderson. "In a sense, we have already addressed this need in that we have designed an on-line suite to kind of overlay and plug in with regular programming."
For new clients, StayWell also offers an ongoing consulting program. "This helps your wellness program manager to think through some of these issues we’ve identified," he notes.
[For more information, contact: Eric Zimmerman, The StayWell Company, 1100 Grundy Lane, San Bruno, CA 94066. Telephone: (650) 244-4442. E-mail: [email protected]; David Anderson, The StayWell Company, 1340 Mendota Heights Road, St. Paul, MN 55120. Telephone: (651) 905-6973. E-mail: [email protected]. Web site: www. staywell.com.]
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