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      Development and Fidelity Testing of the Test@Work Digital Toolkit for Employers on Workplace Health Checks and Opt-In HIV Testing

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          Abstract

          Background: In the UK, few employers offer general health checks for employees, and opt-in HIV testing is rarely included. There is a need to provide evidence-based guidance and support for employers around health checks and HIV testing in the workplace. An Agile approach was used to develop and evaluate a digital toolkit to facilitate employers’ understanding about workplace health screening. Methods: The Test@Work toolkit development included an online survey (STAGE 1: n = 201), stakeholder consultation (STAGE 2: n = 19), expert peer review (STAGE 3: n = 24), and pilot testing (STAGE 4: n = 20). The toolkit includes employer guidance on workplace health promotion, workplace health screening, and confidential opt-in HIV testing with signposting to resources. Pilot testing included assessment of fidelity (delivery and engagement) and implementation qualities (attitudes, resources, practicality, acceptability, usability and cost). Results: STAGE 1: The vast majority of respondents would consider offering general health checks in the workplace that included confidential opt-in HIV testing, and this view was broadly comparable across organisation types ( n = 201; public: 87.8%; private: 89.7%; third: 87.1%). STAGES 2 and 3: Stakeholders highlighted essential content considerations: (1) inclusion of the business case for workplace health initiatives, (2) clear pathways to employer responsibilities, and (3) presenting HIV-related information alongside other areas of health. With regards presentation, stakeholders proposed that the toolkit should be concise, with clear signposting and be hosted on a trusted portal. STAGE 4: Employers were satisfied with the toolkit content, usability and utility. The toolkit had high fidelity with regards to delivery and employer engagement. Assessment of implementation qualities showed high usability and practicality, with low perceived burden for completion and acceptable cost implications. Very few resource challenges were reported, and the toolkit was considered to be appropriate for any type of organisation, irrespective of size or resources. Conclusions: Employers perceived the Test@Work toolkit to be useful, meaningful and appropriate for their needs. This digital resource could be used to support employers to engage with health screening and opt-in HIV testing within the context of workplace health promotion.

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          Most cited references36

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          HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

          Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.
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            Improving Employee Well-Being and Effectiveness: Systematic Review and Meta-Analysis of Web-Based Psychological Interventions Delivered in the Workplace

            Background Stress, depression, and anxiety among working populations can result in reduced work performance and increased absenteeism. Although there is evidence that these common mental health problems are preventable and treatable in the workplace, uptake of psychological treatments among the working population is low. One way to address this may be the delivery of occupational digital mental health interventions. While there is convincing evidence for delivering digital psychological interventions within a health and community context, there is no systematic review or meta-analysis of these interventions in an occupational setting. Objective The aim of this study was to identify the effectiveness of occupational digital mental health interventions in enhancing employee psychological well-being and increasing work effectiveness and to identify intervention features associated with the highest rates of engagement and adherence. Methods A systematic review of the literature was conducted using Cochrane guidelines. Papers published from January 2000 to May 2016 were searched in the PsychINFO, MEDLINE, PubMed, Science Direct, and the Cochrane databases, as well as the databases of the researchers and relevant websites. Unpublished data was sought using the Conference Proceedings Citation Index and the Clinical Trials and International Standard Randomized Controlled Trial Number (ISRCTN) research registers. A meta-analysis was conducted by applying a random-effects model to assess the pooled effect size for psychological well-being and the work effectiveness outcomes. A positive deviance approach was used to identify those intervention features associated with the highest rates of engagement and adherence. Results In total, 21 randomized controlled trials (RCTs) met the search criteria. Occupational digital mental health interventions had a statistically significant effect post intervention on both psychological well-being (g=0.37, 95% CI 0.23-0.50) and work effectiveness (g=0.25, 95% CI 0.09-0.41) compared with the control condition. No statistically significant differences were found on either outcome between studies using cognitive behavioral therapy (CBT) approaches (as defined by the authors) compared with other psychological approaches, offering guidance compared with self-guidance, or recruiting from a targeted workplace population compared with a universal workplace population. In-depth analysis of the interventions identified by the positive deviance approach suggests that interventions that offer guidance are delivered over a shorter time frame (6 to 7 weeks), utilize secondary modalities for delivering the interventions and engaging users (ie, emails and text messages [short message service, SMS]), and use elements of persuasive technology (ie, self-monitoring and tailoring), which may achieve greater engagement and adherence. Conclusions This review provides evidence that occupational digital mental health interventions can improve workers’ psychological well-being and increase work effectiveness. It identifies intervention characteristics that may increase engagement. Recommendations are made for future research, practice, and intervention development.
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              The effectiveness of interventions to change six health behaviours: a review of reviews

              Background Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency). Methods The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis. Results We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours. Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities. Conclusions Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                06 January 2020
                January 2020
                : 17
                : 1
                : 379
                Affiliations
                [1 ]School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; sarah.somerset@ 123456nottingham.ac.uk (S.S.); catrin.evans@ 123456nottingham.ac.uk (C.E.)
                [2 ]National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham NG7 2UH, UK
                Author notes
                [* ]Correspondence: holly.blake@ 123456nottingham.ac.uk ; Tel.: +44-(0)115-823-1049
                Author information
                https://orcid.org/0000-0003-3080-2306
                Article
                ijerph-17-00379
                10.3390/ijerph17010379
                6982120
                31935985
                8cc0a110-0b4c-49ab-8af6-fd68723831b2
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 03 December 2019
                : 29 December 2019
                Categories
                Article

                Public health
                occupational health,health promotion,hiv,technology
                Public health
                occupational health, health promotion, hiv, technology

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