TABLE OF CONTENTS

Chapter 1 The Problem and Its Background Pages 1-3

Chapter 2 - Review of Related Literature Pages 4-17

Chapter 3 Methods of the Study Pages 18-

Chapter 4 Results of the Study Pages

Chapter 5 Discussion and Conclusion Pages

Bibliography

Appendix A

Appendix B Survey Instrument

 Chapter 1
The Problem and Its Background

Over the years one of the most neglected aspect of public health is the workplace. Where in, workplace
is one of the largest part of the global population. The needs to provide a health program is a must due
to increasing number of non-communicable diseases. The non-communicable diseases is one of the
leading causes of mortality and morbidity worldwide. Unhealthy lifestyle is one of the causes of the
increasing cases of non-communicable disease locally and globally. In the aspect of workplace where in
many of the global population are engaged with, it is important for the public health to take emphasis on
workplace area of health promotion. The Workplace Health Promotion is a tool that will help to the
company and employee to achieve a better health and better productivity.

According to World Health Organization (2019), workplace directly influences the physical, mental,
economic and social well-being of workers and it turn the health of their families, communities and
society. It offers an idea setting and infrastructure to support the promotion of health of a large
audience. The health of workers is also affected by non-work related factors.

In addition to WHO (2019), the concept of the health promoting workplace (HPW) is becoming
increasingly relevant as more private and public organizations recognize that future success in a
globalizing marketplace can only be achieved with healthy, qualified and motivated workforce. A HPW
can ensure a flexible and dynamic balance between customer expectation and organizational targets on
the one hand and employee’s skills and health needs on the other, which can assist companies and work
organizations to complete in the marketplace.

The European Network for Workplace Health Promotion has defined WHP as the combined effort of
employers, employees and society to improve the health and well being of people at work. This vison of
WHP places particular emphasis on improving the work organization in shaping the working
environment, and encouraging personal skills and professional development (World Health Organization,
2019).

The WHO (2019) also stated that proper attention to workers' health and safety has extensive benefits:
healthy workers are productive and raise healthy families; thus healthy workers are a key strategy, i.e.
goal, for overcoming poverty. Workplace health risks are higher in the informal sector and small industry
which are key arenas of action on poverty alleviation, where people can work their way out of poverty;
safe workplaces contribute to sustainable development, which is the key to poverty reduction; the
processes of protecting workers, surrounding communities and the environment for future generations
have important common elements, such as pollution control and exposure reduction; much pollution
and many environmental exposures that are hazardous to health arise from industrial processes, that
may be influenced by occupational health and safety programmes; occupational safety and health can
contribute to improving the employability of workers, through workplace (re)design, maintenance of a
healthy and safe work environment, training and retraining, assessment of work demands, medical
diagnosis, health screening and assessment of functional capacities; occupational health is fundamental
to public health, for it is increasingly clear that major diseases (e.g. AIDS, heart disease) need workplace
programmes as part of the disease control strategy. Lifestyle related non-communicable diseases are the
predisposing factors on the increasing mortality and morbidity rate in work place.

Two of the known problem of workers are the non-communicate disease due to lifestyle of the workers
and the mental health problem due to stress at work. According to World Health Organization (2019),
NCDs kill 41 million people each, equivalent to 71% of all deaths globally. They also stated that each year,
15 million die from NCDs between the ages of 30 and 69 years; over 85% of these “premature” deaths
occur in low and middle-income countries. Globally, an estimated 264 million people suffer from
depression, one of the leading causes of disability, with many of these people also suffering from
symptoms of anxiety. A recent WHO-led study estimates that depression and anxiety disorders cost the
global economy US$ 1 trillion each year in lost productivity. Unemployment is a well-recognized risk
factor for mental health problems, while returning to, or getting work is protective. A negative working
environment may lead to physical and mental health problems, harmful use of substances or alcohol,
absenteeism and lost productivity. Workplaces that promote mental health and support people with
mental disorders are more likely to reduce absenteeism, increase productivity and benefit from
associated economic gains.

There are many risk factors for mental health that may be present in the working environment. Most
risks relate to interactions between type of work, the organizational and managerial environment, the
skills and competencies of employees, and the support available for employees to carry out their work.
For example, a person may have the skills to complete tasks, but they may have too few resources to do
what is required, or there may be unsupportive managerial or organizational practices. Risks to mental
health include: inadequate health and safety policies; poor communication and management practices;
limited participation in decision-making or low control over one’s area of work; low levels of support for
employees; inflexible working hours; and unclear tasks or organizational objectives (WHO, 2019).

The municipality of San Andres lies on the southern most tip of Bondoc Peninsula, province of Quezon. It
is bounded on the north by Bahay River, on the south by Sibuyan Sea, east by Ragay Gulf and the west by
the municipality of San Francisco, Quezon. The total land area of the municipality is 17,655.3 hectares
more or less including Alibijaban Island. It has a total agricultural area of 16,083.72 hectares basically
planted by rice and corn. The rest, 10% consist of pastureland, mangrove, forest and residential areas.
The topographical condition is rolling to hilly and mountainous terrain which varies from 5 to 25 degrees
slope.

The local government of San Andres has 69 permanent and 118 casuals employees. Each of them are
assigned or designated to 12 different departments or offices. Wellness awareness campaign will create
a new knowledge and wisdom. It will give them a realization of the needs to have a behavioral change. A
behavioral change is one of the component for the employees to participate in wellness program.
Managing health for better productivity is the main objective of this program.

Showing all the information about the importance of WHP, the main goal of this research is to develop a
better health among the LGU San Andres employees for them to become more efficient and productive
employees. It is vital for them to have a good mental, physical and social well-being while performing
their work. Providing this kind of health promotion will build a better productivity in the municipality of
San Andres, Quezon.
 Chapter 2
Review of Related Literature

Journal articles and other reviews were collected using online databases of scientific literature for the
conduct of this literature review. Pubmed via Medline, Ovid via Medline, and PsycINFO were all searched
using keywords such including: “workplace wellness”, “wellness”, “health promotion”, “8 dimensions of
wellness”, and other related tags. Articles were evaluated at first by reading the abstract and looking for
key concepts and results that pertained to this literature review. These abstracts must have contained
information regarding evaluating workplace wellness, benefits and limitations, as well as results
providing conclusions to implementing a more effective worksite wellness program to be further
evaluated for this review. After the initial reading of the abstracts, the articles were read in depth for
pertinent findings that related specifically to improving workplace wellness and regarding the positive
and negative outcomes of the programs.

Definitions
Companies define their wellness initiatives based on what they either have currently implemented, or
strive to achieve in the near future. The Center for Disease Control (CDC) provides a broader definition of
workplace wellness by stating, “Workplace health programs are a coordinated and comprehensive set of
health promotion and protection strategies implemented at the worksite that includes programs,
policies, benefits, environmental supports, and links to the surrounding community designed to
encourage the health and safety of all employees” (CDC, 2015). This definition was meant to be an
umbrella approach to all workplace wellness programs. Goetzel and Ozminkowski in 2008 defined
worksite health promotion (WHP) more specifically, to include the studies targeted beneficiates, “WHP
programs are employer initiatives directed at improving the health and well-being of workers and, in
some cases, their dependents”(Goetzel & Ozminkowski, 2008, p. 304). A recent survey noted that 77% of
employers offering health benefits also offered a workplace wellness program (Pronk, 2014). The
remaining 23% do not have a defined workplace wellness program or incentives for health promotion.
Similar to company’s mission and vision statements, their definitions of workplace wellness can vary
depending on a company’s goals and needs. To be a valid WHP program, at minimum one of many
categories must be accessible to employees at any given time (Pronk, 2014; Strickland, 2015). Categories
include weight loss programming, gym membership, on-site exercise facilities, smoking cessation
programming, health coaching, classes in nutrition or healthy living, health screenings (e.g. body mass
index, blood pressure, blood glucose), or even resources via the internet for educational purposes
(Pronk, 2014). By understanding the definitions of WHP and workplace wellness programs, we can
determine the differences in wellness initiatives compared to health programs. Although the concepts
are similar, there are differentiates, which will be discussed later in this review. Studies completed in
social and psychological fields have determined that to consider someone “well”, they should have a
balance of all dimensions of wellness (Myers et al., 2000). Findings included those who were not
sufficient in one dimension, were not as healthy or “well” as compared to those who were balanced in
each dimension (Myers et al., 2000). The dimensions noted in these studies were Intellectual, Emotional,
Physical, Social, Occupational, and Spiritual (Hettler, 1980). There are only six dimensions in Hettler’s
study of promoting wellness on a university campus, compared to East Carolina University’s eight
dimensions. In Hettler’s model, the environmental dimension was combined in the social dimension, as
was financial was included in the occupational. At East Carolina University (ECU), the wellness program
for employees, students, and all of campus follows these same eight dimensions of wellness. It creates
the “backbone” to ECU’s approach to wellness. ECU looks at wellness in a holistic approach (Myers et al.,
2000). In order to consider a person to be overall well, all eight dimensions must be included regularly in
their lives. Being strong or efficient in just one category does not lead to a balanced wellbeing. In
addition, that deficiency in other dimensions may have a relationship to decreased job satisfaction and
health risks. This potential cause and effect is the reason this study can have an impact not just at East
Carolina University, but also in the workplaces and universities settings elsewhere. Universities,
corporate companies, and employers of all backgrounds are finding that workplace wellness can be a
vital addition to their businesses due to the positive outcomes that are associated with workplace
wellness programs (Myers et al., 2000). Along with defining workplace wellness as a whole, these
studies defined some of the top most positive and negative health issues in a work environment. The
negative influences ranged from low to moderate up to moderate and high; as shown in:

Table 1 reproduced from the study of the relation of health promotion programs and employee
absenteeism (Aldana & Pronk, 2001).
Risk/Program Strength of the Association
Body mass index/obesity Moderate-to-high
Hypercholesterolemia Unknown
High Stress Moderate-to-high
No fitness program participation Low-to-moderate Low
Fitness/physical activity Unknown
Hypertension Unknown
Multiple risk factors Low-to-moderate
No health promotion program participation Low-to-moderate

This article examined 43 other articles previously published on topics directly related to the defined
health risks above. To further explain, obesity often relates to higher rates of absenteeism due to the
higher rates of various diseases such as cardiovascular diseases, diabetes, and all forms of cancer. Stress
from either being on the job, or throughout the daily lives of those studied correlated with rates of
absenteeism because stress has a known negative impact on bodily physiological functions (Aldana &
Pronk, 2001). By knowing, what health risks increase an unhealthy population in the work environment,
programs could be tailored to improving those risks can be created based on the needs of the company.
For example, to decrease rates of stress in employees, which was found to be a moderate to high risk
factor, a program, that involved removing employees temporarily from their stress or educating those
employees on how to manage that stress. This solution could reduce the incidence of stress related
unhealthy habits within the workplace. 8 Dimensions of Wellness Within all the definitions of workplace
wellness, a common consensus was derived about the meaning of being well. A balanced, or a holistic
approach, was agreed upon between many studies as the root to all successful programs and initiatives.
In one research article, it was noted that during a focus group the participants stated a more “holistic
approach” would better suit their needs and help to increase moral of the employees (Henke, Goetzel,
McHugh, & Isaac, 2011). “Wellness can be defined as an active process through which the individual
becomes aware of and makes choices toward a more successful existence” (Hettler, 1980). This process
individuals must undergo involve balancing the 8 dimensions of wellness in their own lives. Halbert Dunn
defined this pursuit as “an integrated method of functioning which is oriented toward maximizing the
potential of which the individual is capable, within the environment where he is functioning” (Hettler,
1980). Anyone who wants to become balanced in wellness, or is motivated to incorporate these
dimensions must do so in their natural lives each day. Substance Abuse and Mental Health Services
Administration (SAMHSA) definitions of all eight dimensions (SAMHSA, 2015) are discussed in the
following paragraphs.

According to studies, the need for physical activity, healthy foods, and sleep were essential to be in good
health. Although, Cooper and Barton (2015) found that 42% of respondents (N = 502) did not meet the
requirements of daily physical activity using the IPAQ, a self-reported survey on physical activity. This
study defined physical activity guidelines by using the US Health and Human Services’ definition which
states individuals should complete at least 150 minutes of moderate physical activity per week (Cooper
& Barton, 2015). The WEMWBS, a mental well-being survey, uses a 14-item, Likert-type scale of positive
mental health rating from 1 to 5. The minimum score is 14 and the maximum is 70 whereas the higher
the score the better the mental well-being for the individual (Cooper & Barton, 2015). This scale was
used since a previous study found a high content validity with a Cronbach’s alpha of 0.89 and a high
reliability of 0.83 with the survey conducted (Stewart-Brown et al., 2011). Significant differences were
statistically analyzed between low, moderate, and high physical activity compared to mental well-being
scores. A mean score of 46.0 (9.1) was reported for those participants who scored low on the IPAQ,
while a mean score of 50.6 (8.4) was reported for participants that scored high on the IPAQ (Cooper &
Barton, 2015). It correlated that those who scored higher in physical activity averaged a higher score in
mental well-being. In addition, another article studied the effect of exercise on employee neuro-
cognitive performance (Wollseiffen et al., 2015). At baseline, the employees were asked to perform an
arithmetic challenge to measure decision-making performance, complete a memory challenge to
measure spatial recall, and assess their current mood to their interpretation. Employees were divided
into four groups: 1) Employees biked on a stationary bike ergometer at 70% their max heart rate for 20
minutes (considered moderate exercise), 2) Employees took a class of boxing exercises at different
intervals (considered vigorous exercise), 3) Employee sat in a massage chair listening to relaxing sounds
and music for 20 minutes (representing a relaxed/restful state), and 4) Employees continued to work
through the 20 minutes (the control group). Wollseiffen et al found that just 20 minutes of physical
activity increased the physical state of employees by 6.11% in the boxing group, 9.69% in the biking
group, but only 1.73% in the group without a break (Wollseiffen et al., 2015). Improvement in
psychological state because of exercise included a rise in the boxing group by 12.45%, 5.44% in the biking
group, and 3.89% in the group without a break (Wollseiffen et al., 2015). This concluded that when
employees participated in some form of exercise, the more beneficial it was for their physical and
psychological wellness. Within the workplace, frequent breaks of sedentary behavior, such as prolonged
sitting at a desk, can prove to be more beneficial in the long term for universities and companies alike.

Emotional wellness includes coping effectively with life and creating satisfying relationships (Jacobson et
al., 1996). Jacobsen et al. (1996) found that higher self-reported rates of stress were associated with
higher rates of absenteeism from the workplace. Studying 79,070 employees from over 250 various
companies, 51.83% of men were considered low stress, 40.51% were classified as moderately stressed,
and 8.11% were highly stressed (Jacobson et al., 1996). Respectively, of the women studied, 44.84%
were found to be considered low stressed, 42.66% moderately, and 12.49% highly stressed (Jacobson et
al., 1996). To associate the levels of stress with absenteeism, each gender category was to report either
zero days absent from work, 1-2 days, 3-4 days, or 5+ days. Employees were told to only report days
absent due to illness-related reasons. Collectively, 30.58% of employees, both male and female, were
absent from work 1-2 days, 19.17% were absent 3-4 days, and overwhelmingly 32.48% of employees
were absent 5+ days (Jacobson et al., 1996). This demonstrates high levels of stress throughout the
workplace can related to high levels of absenteeism when the significance value was set a Within the
study, each employee reported which life area affected stress levels to the point the employees chose to
be absent. The breakdown of life areas and their respected values are shown below in Table 2 recreated
from the study.

Table 2 Percent of Stress By Gender and Life Area

Life Area Percent Men/Women Percent Men (n=42,302) Percent Women
(n= 79,070) (n=36,768)
Work
Low 20.8 20.7 20.8
Moderate 45.1 47.3 42.8

High 31.1 32 36.3

Finance/Bills
Low 48.5 52.4 44.1
Moderate 33.1 33.4 32.7
High 18.4 14.2 23.2
Family
Low 46.7 51.3 42
Moderate 38.5 38.2 38.9
High 14.6 10.5 19.1
Health
Low 75.5 78.5 72.2
Moderate 20.3 18.6 22.1
High 4.2 2.9 5.7
Legal
Low 94 94.5 93.5
Moderate 4.4 4.2 4.6
High 1.6 1.3 1.9
Social/Friends
Low 85.5 87.1 82.9
Moderate 12.1 10.8 13.5
High 2.9 2 3.7
Environment
Low 78.6 78.5 78.7
Moderate 17.1 17.5 16.6
High 4.4 4 4.7

Spiritual
Spiritual wellness involves the individual expanding the sense of purpose and meaning in their life. To be
more specific, Myers et al. in 2000 defined different aspects of life tasks that create a holistic wellness
model for counseling. Life task 1 was spirituality and was defined as “an awareness of a being or force
that transcends the material aspects of life and gives a deep sense of wholeness or connectedness to the
universe” (Myers et al., 2000, p. 252). Myers et al. (2000) defined spirituality as a broader term focusing
on individuals to be aware of themselves and their personal attributes as compared to a narrow topic of
religion. Included in the discussion of spirituality are positive thinking, and optimism. As concluded in
previous literature, positive thinking and optimism are directly related to a positive mental state and
further, a more positive well-being (Jacobson et al., 1996; Myers et al., 2000). Similar to the researched
conducted by Myers et al. (2000), there is research examining the relationship of individual’s self-
reported purpose of life, optimism, and sense of coherence on their perceived wellness (Adams, Bezner,
Drabbs, Zambarano, & Steinhardt, 2000). Adams et al. (2000) noted that the dimension of spirituality
does not directly related to religion, but religion can deepen a person’s perception of spirituality. In this
study, the main purpose was to evaluate if there was a relationship between undergraduate students’
optimism, life purpose, and sense of coherence with their perceived wellness. One hundred twelve
students (81% female; 81% white, 23.2 ± 5.4 years) enrolled in a health class at the University of Texas at
Austin completed a survey to determine their spiritual and psychological dimensions of wellness (Adams
et al., 2000). Individually, each determinant (life purpose, optimism, sense of coherence, and perceived
wellness) scored separately to determine how high or low students would rate themselves. Life purpose
scored had a mean of 47.8 ± 8.12 out of a possible 63 total points. Optimism had a mean of 23.9 (± 4.51)
out of 32 possible points. Sense of coherence scored 62.4 (± 10.89) out of 91 points, and finally
perceived wellness scored 16.5 (± 3.14) out of the potential 29 total points (Adams et al., 2000). All
determinants scored above average on the respected scales separately, concluding that students felt
their perception of each determinant was with the better half of spiritual and psychological wellness.
The relationship between perceived wellness and the determinants (life purpose, optimism, and sense of
coherence) showed significance in the results. Using the Pearson product-moment correlation
coefficients, the study resulted in the correlation of life purpose and perceived wellness at r = .53,
optimism and perceived wellness at r = .55, and sense of coherence and perceived wellness having the
highest correlation at r = .66 (Adams et al., 2000). This study concluded that their initial hypothesis that a
positive relationship between perceived wellness and each determinant would have significant support
(Adams et al., 2000).

Environmental
To be considered environmentally well, an individual should be in good health by occupying pleasant,
stimulating environments that support well-being. Environmental wellness within a workplace may not
always be the most assessable resource. It was noted in a study about worksite culture, environment,
and policies that influence healthy eating and physical activity plus the barriers to those behaviors that
some worksites do not influence healthy behaviors (Strickland, 2015). This creates a more difficult time
for employees to adopt those healthier behaviors. This cause-and-effect relationship is why there is a lot
of literature as to how WHP can positively influence not only the employees, but also the company itself.
In order to study the effect of WHP, many studies conduct strictly controlled environments.
Environments that require participants to partake in either education modules or fitness classes at a
minimum 3 times a week as well as control the participants diet which may not be “normal” for most
people. In the study conducted by Sforzo et al. (2012), the primary research question was, would
participants voluntarily utilize their supportive environment if it were offered by the company. In other
words, they wanted to study how free choice would affect the willingness of participants to stick to their
health regimen. The study created two test groups: 1) educational classes on health and wellness, a 25%
discount card for healthy food options within the company’s cafeteria, and complimentary membership
to the company’s fitness facility and 2) only the 25% discount card as well as the complimentary
membership. The control offered none of these options. Participants were stressed they had free choice,
and use of any of these options was strictly voluntary. At the end, the researchers found that on average
across all participants, gym facility use was only about 1.3 times per week and the healthy meal card was
used 1.5 times per week (Sforzo, Kaye, Calleri, & Ngai, 2012). Although the use of options for a healthier
lifestyle were not significant, the studied showed that there was a significant increase in moderate and
vigorous activity among the employees p< .01 (Sforzo et al., 2012). It was also shown that those who
received the educational classes, significantly increased knowledge (p<0.01) and significantly increased
life satisfaction (p< .05) (Sforzo et al., 2012). It concluded that participants might not fully utilize all
options when offered a supportive environment for healthier habits, but those who do voluntarily use
their environment for the better typically more balanced in their personal well-being.

Occupational
Personal satisfaction and enrichment from one’s work entails the meaning of occupational wellness. Job
satisfaction as well as employee moral (either personal or companywide) are common characteristics of
occupational wellness. Researchers have found a relationship between wellness programs and an
increase in job satisfaction plus employee moral (Cooper & Barton, 2015; Pronk, 2014). Obtaining higher
job satisfaction and morale throughout employees may be an obstacle many worksites may face.
Without support for a healthier workplace from supervisors or higher ups in the company, employees
may find it hard to enjoy their job and find meaning within it (Strickland, 2015). Boswell, Boudreau, and
Tichy (2005) found most models of employee turnover, if not all, include job satisfaction as a primary
reason for the employee leaving their company. They noted a “Honeymoon” and “Hang-Over” effect
with employee turnover (Boswell, Boudreau, & Tichy, 2005). The “Honeymoon” phase of a new job is
where the employee has a higher sense of optimism, being in a new position, and lacking full
comprehension of all responsibilities of the new position choosing only to see the positives. This phase
creates a higher sense of job satisfaction. The “Hang-Over” phase happens when the employee typically
gains more experience within the new position and begins to see all aspects, positive and negative,
accompanied with the new position. The “Hang-Over” effect typically returns the employee to the
original level of job satisfaction as the previous position or below. In the course of their 5 year
longitudinal study, Boswell, Boudreau, and Tichy (2005) surveyed 538 high level managers (x = 45 years
old; 93% male; 91% White) in executive search firms. (Boswell et al., 2005). Each respondent of the
survey was in his or her original position for at minimum 3 years. Each year, over the course of 5 years,
researchers sent the employees a survey via mail asking their level of job satisfaction using a 3-item scale
from a previous study. The survey also asked if the employee changed positions to another company
within the measured year. If the employee answered “yes” to the voluntary job change, follow up
questions regarding why and their new level of job satisfaction were asked. Two-hundred and fifty-five
mangers completed all five surveys at the end of the study. Respondents to complete the entire study
were found to be farther from the CEO top position. This had the possible explanation that those who
currently held higher positions in the corporation (closer to the CEO position) were more likely to retire
before the conclusion of the study. Researchers found a relationship between job satisfaction and
voluntary job change within employees. Employees who were close to changing jobs, or were in the
process of changing jobs had a decrease in job satisfaction before the change (Boswell et al., 2005). After
the change, there was an initial spike in levels of job satisfaction (the “Honeymoon Effect”) followed by a
gradual decrease in job satisfaction over time (the “Hang-Over Effect”) (Boswell et al., 2005). In the
recreated figure 1 below from the study conducted by Boswell, Boudreau, and Tichy, there is an initial
drop in levels of job satisfaction at T2, which represents the second survey completed by the employees.
T3, in red, represents the “Honeymoon Phase” where the employee experiences a significant increase in
job satisfaction. T4, in blue, represents the “Hang-Over Effect” in which the employee finds a gradual
decrease in levels of job satisfaction while gaining more experience in their position (Boswell et al.,
2005).To compensate for this decrease in job satisfaction, companies and universities should focus on
the optimism of their employees.Optimism has shown to have a higher relationship with quality of life,
and a more rounded wellness for employees. When companies support health behaviors, factors such as
job satisfaction and morale increase (Cox et al., 1981). Cox et al. (1981) recruited 392 (male = 161;
female = 231) volunteers from a company and enrolled the employees in an exercise program lasting 6
months. The exercise program consisted of a 30-minute class, ranging from moderate activity to
vigorous, at a frequency of 3 times a week. After the 6 months, 47% of participants expressed a more
positive and less routine worksite (Cox, Shephard, & Corey, 1981) and 63% of participants expressed
better personal reactions like more patience and less fatigue throughout the work day (Cox et al., 1981).
The study also found that within a 10 month period around the time of the study, there was a 10%
turnover rate of employees, compared to 15% for a typical turnover rate for the company (Cox et al.,
1981). The decrease in employee turnover also had a positive effect on productivity, which increased
about 7.04% across the participants (Cox et al., 1981). If companies have a low turnover rate of
employees, the positive outcome would be less money spent on training and recruitment. All of these
benefits are associated with workplace wellness programs and initiatives.

Social
Developing a sense of connection, belonging, and a well-developed support system is the practical
definition of social balance and wellness. When Wollseiffen et al. (2015) studied 50 participants (male =
27; female = 23), the participants stated after physical activity, they felt more willing to seek contact with
others and personal self-confidence rose (Wollseiffen et al., 2015). Only the biking group and the boxing
group saw an increase in “willingness to seek contact” as part of the psychological aspect of their survey.
Both increased by 18.52% and 5.56% respectively (Wollseiffen et al., 2015). Additionally, all 3 groups,
biking, boxing, and zero break, saw a rise in self-confidence by 9.42% in the biking group, 18.37% in the
boxing group, and 0.50% in the zero break group (Wollseiffen et al., 2015). Comparing the difference of
the levels in self-confidence between the zero-break group, and both the biking, and boxing groups; the
conclusion that having a break with some type of physical activity can lead to a positive outcome for
employees. It also noted within the study, the “Usual break” group, which conducted a 20-minute break,
saw an increase in self-confidence by 15.45% (± 27.35%). It was concluded that those employees spent
their time doing physical activity (i.e. walking the building or outside) and socializing (Wollseiffen et al.,
2015). What this study showed overall was that friendly and positive social interaction can and does
improve well-being throughout the workplace.

Intellectual
Intellectual wellness is defined as recognizing creative abilities and finding ways to expand knowledge
and skills (SAMHSA, 2015). Finding ways to expand knowledge and skills are the foundation of most
wellness programs. At Johnson & Johnson, their wellness program consists of online coaching for
tobacco cessation, blood pressure reduction, weight-management, and chronic disease control (Henke et
al., 2011). To evaluate how their program has worked over a 7-year period (2002-2008), they conducted
a study comparing their employees to employees in companies that recently introduced a wellness
program. To create a near identical baseline, Johnson & Johnson used statistical matching of employees
to find matches for the control group (Henke et al., 2011). After evaluating 7 years of Johnson &
Johnson’s employee data, the study found that their coaching programs have reduced the use of tobacco
use in their company by 3.7% and a difference of 10.6% compared to the “twin” companies (Henke et al.,
2011). Other data found a 6.7% difference between Johnson & Johnson and the twin company in
nutritional rates, a 6.6% difference in obesity rates, and a 4.1% difference in blood pressure rates (Henke
et al., 2011). Johnson & Johnson was not the only company to find expansion of knowledge in their
wellness program to be beneficial. In the Sforzo et al. (2012) study on free choice, they conducted a 10-
question quiz on their participants’ (n= 80, 34 men, ≈34.5 years old) wellness knowledge, before and
after the study period (Sforzo et al., 2012). Each participant was randomized into 1 of 3 groups: either
educational plus access (n= 21), access only (n= 30), or the control group (n= 29). The educational plus
access group had 21 participants, 30 placed into the access-only group, and 29 were control. The
educational + access group was the only group to increase their knowledge from going to a 0.50 ±0.14 to
0.69 ±0.14 (Sforzo et al., 2012). The access only group actually decreased their wellness knowledge from
0.53 ±0.10 to 0.51±0.14, and the control group decreased from 0.52 ±0.15 to 0.50 ±0.14 on a scale of 0
to 1 (Sforzo et al., 2012). Each increase represents a positive difference in group means when measuring
wellness knowledge through the 10-question quiz given to participants.

Financial
To be financially well is to have satisfaction with the current and future financial situations. To be
financially stressed means to be economically stressed, strained, in a hardship, or even under pressure
(Kim & Garman, 2003). Financial stress can come in many forms including spending more than one
would earn, not earning enough to fulfill expenses for the month, and carrying excessive credit card debt
(Kim & Garman, 2003). Credit debt is an exponentially increasing problem for Americans (Drentea &
Lavrakas, 2000). On average, Americans and Europeans spend between three and four times their annual
salary in debt (Drentea & Lavrakas, 2000) creating an ever increasing amount of debt. In research
conducted by Drentea and Lavrakas (2000), “In the case of debt, it is plausible that financial hardship and
stress as indicated by incurring credit card debt, paying high interest rates, and so on may be associated
with non-healthy behaviors such as excessive drinking, smoking or being overweight” (Drentea &
Lavrakas, 2000). Those unhealthy behaviors can increase the amount of stress in the workplace and lead
to absenteeism. Stress, whether it be from economic hardship or personal reasons, has increased rates
of absenteeism over 300% since 1995 (Kim & Garman, 2003) and having an employee absent from the
workplace accounts for 6% of employee’s pay, which equals close to all vacation and sick days (Kim &
Garman, 2003). On the other side of financial stress is financial wellness. The adequate knowledge of
personal finance facts, terminology, and management leads to a person’s more proper financial literacy
(Joo & Garman, 1998). Many potential employees look for companies and businesses with financial
education programs for their employees. Financial education programs within companies and
universities do correlate with employee productivity, but they also help to improve employee
recruitment and retention (Joo & Garman, 1998; Kim & Garman, 2003). In a self-reported survey, Joo and
Garman (1998) had 271 white-collar workers rank their financial behavior in a 12-item questionnaire.
Some examples of questions from the behavioral survey included “I set money aside for savings” and “I
had to use a credit card because I ran out of cash”. These behaviors then correlated with rates of
absenteeism. Absenteeism was rated on a scale from “none”, “1 to 3 days”, “4 to 6 days”, “7 to 9 days”,
“10 to 12 days”, and “12 or more days” (Joo & Garman, 1998). After a regression analysis, the authors
found that for every additional point, up to 48 points on the behavioral survey, there was a decrease of
0.029 units of absenteeism (Joo & Garman, 1998). This meant that assuming an average 8 hour work day,
for 3 workdays, an employee could reduce their rate of absenteeism by 42 minutes (Joo & Garman,
1998). This same study looked at the relation of financial behaviors compared to the proper use of work
time. Researchers found that out of those same 271 white collar workers, 50.3% of workers used work
time to deal with financial obligations (Joo & Garman, 1998). Those obligations ranged from calling
financial advisors or reviewing credit card statements. It was estimated that each financial obligation
tended to took away at least 15 minutes of an employee’s work day (Joo & Garman, 1998). Many
successful companies strategically look into their workplace wellness programs in order to evaluate
effectiveness. The best programs share common characteristics such as placing the value of employee
above all (Kaspin, Gorman, & Miller, 2013). One of the biggest differences is wellness initiatives overall
goal is employee satisfaction and retention (Aldana & Pronk, 2001), as well as out-come based results
(Strickland, 2015). Return on Investments (ROI) is one major category that universities and companies
alike, are able to evaluate for the effectiveness of the workplace wellness programs. Return on
investment is a major study aspect when it comes to workplace wellness. Most companies want to know
the hard numbers that contribute to saving the company money as well as increasing the overall
wellness of all employees. A study conducted in 2006 found that companies spent approximately $3,615
per year on single employee coverage and around $8,508 per year for family coverages (Goetzel &
Ozminkowski, 2008). Companies with workplace wellness programs in effect found an average of $3
return for every $1 spent on wellness initiatives (Naydeck, Pearson, Ozminkowski, Day, & Goetzel, 2008).
Furthermore, the company of Highmark decided to conduct its own study to determine the extent of the
effectiveness of their wellness program. By subtracting selective biasness, the company statistically
matched individuals together to create similar intervention and control groups. Highmark then
compared the average dollars spent on medical claims after 2002, when they initiated their wellness
program, and dollars spent prior to 2002. They discovered that those who participated in the wellness
programs on average saved the company $176.47 per person, per year with the biggest savings coming
from inpatient procedures which saved the company $181.78 per person, per year (Naydeck, Pearson,
Ozminkowski, Day, & Goetzel, 2008). Return on investment can differ between companies depending on
their definitions of wellness expenses. Although some companies found a range of ROI, all companies
concluded that having a workplace wellness program or initiative decreased the rise in rate of health
insurance premiums (Henke et al., 2011; Naydeck et al., 2008; Volpp, Asch, Galvin, & Loewenstein, n.d.).
Because of the addition of workplace wellness programs and initiatives, companies are now trending to
hire new, healthier employees because they are learning that healthy employees and promoting health
are cost effective for their workplace (Hettler, 1980). Combining the improvement of workplace wellness
in a university and business settings, with the trend of hiring on healthier individuals allows maximal
potential to decrease health care costs and increase return on investment. Defining an exact number for
ROI is difficult to account for because many other factors can influence the success of a business’s
wellness. Whether they include maintenance for facilities, memberships, dietitians and counseling
services in expenses for a workplace wellness program can demote the measure of their returns. This is
why ROI cannot be the only variable studied in the effectiveness of a worksite wellness program.
Limitations
Since WHP and workplace wellness are such general terms, many limitations are present in these
studies. Limitations are restrictions to research that could have an impact on the data collected or the
conclusion drawn at the end. Some articles were essay based, meaning that they provided observations
and opinions about singular work environments. The essays did not compare to other studies or data
collections, so the conclusions could not be included into considerations for this literature review. One
study utilized surveys, interviews, and focus groups to collect the data. Although these methods
statistically controlled for, and included a replicated coding system for interpretations, the participants in
the study were unionized representatives. This presents a limitation because the representatives can
have bias with their answers, or externally influenced to report particular answers. Despite the
possibility of bias through unionized representation, this study presented a strong conclusion regarding
improvements to workplace wellness programs that are applicable for other companies and universities.
In order to study workplace wellness, the design of the study has to be highly regulated to account for
many variables (Aldana & Pronk, 2001). Multiple studies noted negative health habits that were
consistent throughout companies. The World Health Organization has observed that smoking, alcohol
misuse, physical inactivity, and poor diet are among the top five contributors to disease and injury
worldwide (Goetzel & Ozminkowski, 2008; Pronk, 2014; SAMHSA, 2015). These reasons are the
foundation to why employers should invest in workplace wellness programs. Although, this is not always
the case. Recruitment for studies or even recruitment for participation within established workplace
wellness programs is difficult. Common reasons not to participate in wellness programs or initiatives in
one university study included not enough time during the workday (64.9%), not enough time before or
after work (44.4%), facility expenses such as memberships or equipment costs (26.5%), lack of energy
(17.4%), boredom of programs (6.2%) and fear of injury due to exercise (1.4%) (Cooper & Barton, 2015).
These percentages add up to over 100% because the studied allowed participants to select more than
one reason. It was important not only to know not only what health habits could lead to negative
outcomes, but also what caused these habits in the work environment and why those habits may have
been encouraged without the knowledge of employees or the company. One study attempted to control
for multiple limitations that usually occur within a worksite (Sforzo, Kaye, Calleri, & Ngai, 2012) wellness
study. Sforso et al. (2012) wanted a study that measured the “free choice” of participants that would be
controlled for in other research (Sforzo, Kaye, Calleri, & Ngai, 2012). This study found that available time
was a limitation that is the most difficult to control. In addition, by giving participants free membership
to a fitness center and discounted options to healthier food, the motivation for employees to increase
their overall wellness was still limited. There was still an increase in employee participation in the
wellness program and the program did presume effective, but compared to research, which has strict
restrictions for inclusion there was not as significant differences between groups. Across many studies,
there is a common limitation noted, selective biasness. Selective biasness states that participants who
are already healthier by standards and motivated to improve their wellness due to their voluntary nature
(Henke et al., 2011; Kaspin et al., 2013; Naydeck et al., 2008) produce most data collected. Employee
wellness programs will have this limitation occur frequently. Employees that have the resources and the
time to improve their health are usually the employees who show up to most, if not all, the wellness
programs. To account for selective biasness, some research studies conducted matching programs
(Henke et al., 2011; Naydeck et al., 2008). These programs used a mathematical algorithm to account for
similarities between participants. Once a mathematical “twin” calculated, taking into account of
demographics of each participant, the subjects then split into the intervention group and the control
group. Accounting for limitation, barriers, or just obstacles for other studies will help this current study
by learning what other scientists have controlled for additional variables.

Chapter 3
Methods of the Study

Participants
The participants for the Study are the employees of the Municipal Government of San Andres, Quezon,
as defined in the following Table.

Table 3. General Profile of the Participants

PARTICULAR MALE FEMALE TOTAL

Elective Municipal Officials
Department Heads
Permanent Employees
Casual Employees
Job Order
TOTAL

The local government of San Andres has 69 permanent employees (including elective officials and
department heads), 118 casual employees and ___ job orders . Breakdown of male and female and the
total per Particular are defined in Table 3. Each of them are assigned or designated to 12 different
departments or offices.

Specific Aims / Interventions of the Study

Wellness awareness campaign will create a new knowledge and wisdom. It will give them a realization of
the needs to have a behavioral change. A behavioral change is one of the component for the employees
to participate in wellness program. Managing health for better productivity is the main objective of this
program.
In the end, the specific aims of the study shall be:

1. To subject the participants to an initial survey to grasp the degree of satisfaction of the
employees in their work, their salary, relationship with workmates, performance at work, stress
level, to name a few, and their daily routines on health, social, economic and physical activities
at work , at home, or in any occasions and places;
2. To provide interventions in terms of team building, physical health activities, trainings, to name a
few, based on the consolidated results of the survey; and
3. After three months of interventions (8 Sessions), the participants shall again be subjected to the
same survey instrument to determine the positive changes that has transpired after the
provision of interventions.

After determining the initial results of the survey, the eight (8) Sessions shall be conducted as
interventions for the participants, to wit:

Session 1 – Briefing on Wellness Program and Goal Setting

The participants shall be briefed on the general overview of Wellness Program and Goal Setting. Ice
breaker games shall be undertaken to instill camaraderie among participants and to be comfortable
in the environment. The participants shall internalize the importance of having goals and setting
SMART goals, which stands for specific, measurable, action-oriented, realistic, and times (deadlines).
Using the SMART acronym, participants create their own personal short-term goals for the duration of
the intervention.

Session 2 – Physical Wellness

The participants shall be engaged in a presentation about how various concepts play into an individual’s
physical wellness, more than just physical activity. It included a healthy diet, proper sleep, and more.
Participants shall learn a hands-on approach to incorporate physical activity into their sedentary lives
using resistance bands, body-weight movements, and surrounding objects.

Session 3 – Nutrition
The participants shall be informed about how much sugar, and saturated fat are found in the
common food, and drinks people ingest each day. They will learn the difference between saturated
fat and unsaturated fat, carbohydrates, and protein. They shall be instructed how to read food labels
and look for specific “red flags” for unhealthy options. Portion sizes for each meal, as well as
healthier alternatives for popular food and drink items, shall be discussed during this session.

Session 4 – Social/Intellectual Wellness

Participants shall learn about the definition of social and intellectual wellness plus how the two
dimensions compliment each other. Each individual shall participate in an interactive demonstration of
how various situations can be interpreted differently. The interpretations shall come from the personality
of the individual, and can vary greatly. Participants shall learn that this variety can create conflict within a
workplace, but when addressed properly can create a better social understanding.

Session 5 – Individual Goals

Participants shall be given the option to tour a particular recreational facility, choose an exercise option
for themselves (group classes, personal training, or their own workout routine), or have an information
sessions on a topic of their choice. This session also includes a current evaluation of the the goals set on
the first meeting, which involves looking at the progress towards reaching those goals and adjusting the
goals, if necessary.

Session 6 – Emotional Wellness

The participants shall engage in an activity that will visually analyze their own wellness in each
dimension. The point of this activity is to show the participants on how each dimension can affect other
dimensions. in their own lives. It shall also demonstrate that they may not be as balanced in their overall
wellness as they previously believed. The emotional wellness presentation also focused on stress
management and how becoming imbalanced in the participant’s overall wellness could cause stress
emotionally, physically, and mentally. This session shall be concluded with tips, tricks, and relevant apps
available on mobile devices to aide in stress management.

Session 7 – Occupational and Financial Wellness

Occupational wellness is the balance between one’s work and life outside of work. During this session,
participants shall interact with a hands-on survey to visually represent the participants’ strengths and
weaknesses inside a work environment. There is also an in-depth presentation about finding your career
path, whether you like your current profession or are looking for a change. In addition, the employees
shall learn what career resources are available.

The second half of this session includes an open discussion type environment where the participants can
ask questions and concerns regarding debt, credit cards, budgeting, and finances in general.
Session 8 – Creating a Wellness Environment/ Celebration of Completion

Participants shall revisit each dimension and what they represented in each individual’s lives. Together,
each dimension should balance an individual’s overall well-being to create a healthy living environment.
A healthy living environment not only includes incorporating all the dimensions of wellness together, but
it also focuses on the environmental wellness specifically. Finding and creating an environment that
works for the individual is a key to finding balance and continuing to incorporate all dimensions of
wellness into their lives each day. Each participant shall reflect on their experience in the Employee
Wellness Program and write down what they learned for the 8 sessions in the program, their own
personal definition of wellness after participating in the intervention and how they can incorporate all 8
dimensions in their lives each day, and new goals to strive for after evaluating the previous goals from
the beginning of the intervention.

Each participant shall also complete a feedback survey to allow program staff to evaluate the positive
and negative comments to plan for future Employee Wellness Program, as well as a post-intervention
survey comprised of the same questions the pre-intervention survey included to evaluate each
individual’s progress from completing the intervention.

Instruments/Procedures
Survey Instrument (attached as Appendix B) shall be initially served to all participants to determine their
degree of satisfaction in their work, their salary, relationship with workmates, performance at work,
stress level, their personal habits, physical activities, attitudes towards work, etc. , to serve as baseline
data to the proper interventions to be provided to them, in terms of team building, health related
activities, traininings and other related interventions.

A Memorandum of the Mayor addressed to all concerned re: Filling-Up of the Survey Instrument shall be
distributed to all Departments. After a week, the filled-up survey instrument shall be retrieved by the
thesis maker for him to consolidate and make an analysis of the results of the survey.

Statistical Analysis

We shall use a paired t-test to measure the pre-intervention questionnaires to the post-intervention
questionnaires for average scores, and proficiency rates of each participant in each dimension. Because
we are measuring each employee twice is why we used the paired instead of independent sampling t-
test. Proficiency rates are defined as scoring above 75% of the total possible points in each dimension of
wellness. We also measure Cohen’s d to determine the effect size. Effect size is measured as below .04
equals a small effect size, .05-.07 equals a medium effect size, and above .08 equals a large effect size.
Statistical significance was set at p < .05. To account for missing data, the average number of steps taken
for that specific session for each individual participant is calculated and placed where missing data is
located.

For qualitative data, one-on-one interviews are conducted with each participant. The first part of each
interview included a welcome, followed by the overview of the questions to be asked. Next, ground rules
are discussed and established. Finally, questions are posed to participants. Each interview shall be held in
a private space to ensure confidentiality, to last approximately 30 minutes, and is audio-taped. All
interviews are led by a trained individual with experience facilitating discussion; the interviewer shall use
probes to further elicit responses from participants. Researcher shall use an open-ended, structured
question guide. As the interview progresse, the interviewer shall adapt the protocol to incorporate new
issues or pose follow-up questions. Each individual interview is then transcribed by a researcher. Once
the interview scripts are obtained, three researchers code the data separately using a thematic analysis
to determine themes for each construct of the EWI (Vaismoradi, Jones, Turunen, & Snelgrove, 2016).
After each researcher provide themes for each EWI participant interview, discussion among the three
researchers occur, resulting in the themes. Finally, the researchers look for emerging themes for the
overall study.
Chapter 4
Results of the Study
 Chapter 5
Discussion and Conclusion
APPENDIX A
APPENDIX B – SURVEY INSTRUMENT

“Galaw-Galaw Sa Kalusugan para sa Empleyadong Mahuhusay”

Work Place Health Promotion Program among employees, LGU San Andres, Quezon

Demographic Profile:

Age: _____ Gender: _____ Civil Status: _________ Religion: _______________

Status of Employment ( ) Permanent ( ) Casual ( ) Job Order

Employee’s Office/Department:____________________________________________

Length of work in San Andres LGU ( in years )_______________________________

Demographic Questions:
1. Are you happy with your work? ( ) Yes ( ) No
If NO, why?
_______________________________________________________________________
_______________________________________________________________________
2. Are you contented with the salary that you received from your work? ( ) Yes ( ) No
If NO , why?
_______________________________________________________________________
_______________________________________________________________________
3. Do you have a good relationship with your workmates? ( ) Yes ( ) No
If NO, why?
_______________________________________________________________________
_______________________________________________________________________
4. Do you enjoy performing your daily activity at work? ( ) Yes ( ) No
 If NO why?
_______________________________________________________________________
_______________________________________________________________________
5. Do you feel stressed at work? ( ) Yes ( ) No. If yes, please answer no. 6
6. What are the causes of your stress at work?____________________________________
_____________________________________________________________________

7. Do you smoke ? ( ) Yes ( ) No

8. Do you engage in any physical activity ? ( ) Yes ( )No
If YES, what are those activities?
( ) walking
( ) jogging
( ) sports
( ) swimming
( ) others, please specify: ___________________________
9. How many times do you exercise per week ?
( ) everyday
( ) 3-4x a week
( ) 5x per week

RESEARCH QUESTION
Knowledge
YES NO

1. A cigarette stick contains thousands of poisonous chemicals.

2. Alcohol is good as it contains anti-oxidant.

3. Exercise makes my blood pressure normal.

4. Getting enough quality of sleep is a key to a healthy lifestyle.

5. Eating fatty foods will have a negative effect on my body.

 6. Obesity has nothing to do with getting a disease.

7. Vitamins supplementation is good to boost my immune system.

8. Drinking more than 8 glasses of water a day is good for my

digestion.
9. Have you attended trainings and seminars to enhance your
performance at work

Attitude
YES NO

1. I consider my workplace as my second home.

2. I believe environment influence my lifestyle behaviour.

3. I consider my work stressful.

4. I take physical activity seriously to improve my lifestyle.

5. I am willing to be a part of the wellness program conducted by

LGU.
6. I am eager to learn different outdoor activity.

7. I am serious in putting physical activity as my daily routine.

8. I tried my best to lose weight.

Practice

1-Never, 2-Occasionally, 3-Undecided, 4-Often, 5-Always

1 2 3 4 5

1. I walked rather than riding motorcycle.

2. I do simple stretching.

3. I visit a health care professional (doctor, nurse and midwife) even if I

don’t have illness.
4. I check my blood pressure regularly.
5. I express my anger and anxiety in a way that I will not hurt myself and
others.
6. I eat in a fast food restaurant.

7. I engage in physical activity.

8. I take snack in the office.