Health Education & Behavior

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Results of Employee Involvement in Planning and Implementing the Treatwell 5-a-Day Work-Site Study
Mary K. Hunt, Ruth Lederman, Steven Potter, Anne Stoddard and Glorian Sorensen
Health Educ Behav 2000 27: 223
DOI: 10.1177/109019810002700208
The online version of this article can be found at:
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Hunt et al. / Employee Involvement

Health Education & Behavior (April 2000)

Results of Employee Involvement in

Planning and Implementing the
Treatwell 5-a-Day Work-Site Study
Mary K. Hunt, MPH, RD, FADA
Ruth Lederman, MPH
Steven Potter, MS
Anne Stoddard, ScD
Glorian Sorensen, PhD, MPH

When work-site health promotion programs incorporate theories of community organization, it is likely that
employee ownership and participation are enhanced. This article reports quantitative indicators of involvement
of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of
implementation and variables associated with behavior change and work-site support. The results reported here
indicate that a greater number of EAB member hours spent on program activities was associated with a greater
number of events implemented. Smaller work-site size was associated with greater employee awareness of the
program and greater participation in project activities as reported on the employee survey. These results suggest
that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.

Community-organizing principles are an important component of state-of-the-art

work-site health promotion programs.1-5 Involving employees in the planning process
increases the likelihood of greater employee participation in intervention activities

Mary K. Hunt is associate director, Dana-Farber Cancer Institute, Center for Community-Based Research,
Boston, Massachusetts. Ruth Lederman is assistant director of evaluation, Center for Community-Based
Research, Dana-Farber Cancer Institute, Boston, Massachusetts. Steven Potter is a data manager, Center for
Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts. Anne Stoddard is an associate professor, University of Massachusetts School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts. Glorian Sorensen is a professor, Center for Community-Based Research,
Dana-Farber Cancer Institute, Division of Cancer Epidemiology and Control, Boston, Massachusetts;
Department of Health and Social Behavior, Harvard School of Public Health, Harvard University, Boston,
Massachusetts.
Address reprint requests to Mary K. Hunt, MPH, RD, FADA, Center for Community-Based Research,
Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115; phone: (617) 632-2184; fax: (617) 6321999; e-mail: Mary_Hunt@DFCI.harvard.edu.
This study was supported by Grant 5 R01 CA59728 from the National Cancer Institute. The authors acknowledge the support of additional grants from the Liberty Mutual Group, the Boston Edison Company, and
New England Electric. The authors are indebted to the 22 community health centers that participated in this
study and to the Project Director, Evelyn Stein, MPH, LLD; and intervention staff Flora Baker, MS, EdM, RD,
Candace Combe, MS, RD, and Valerie Brinkman-Kaplan, MS, RD, who implemented interventions and maintained the process tracking data documented here.
Health Education & Behavior, Vol. 27 (2): 223-231 (April 2000)
2000 by SOPHE

223

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Health Education & Behavior (April 2000)

because employee representatives have a voice in shaping interventions to suit the company culture. High levels of employee participation in activities enhance the possibility of
greater positive health behavior change.1,3,6,7 Several models of community organizing
and community building have evolved during the past several decades.6 Many community
and work-site-based studies have used community-organizing strategies based on the
8,9
locality development and social planning typologies suggested by Rothman. Locality
development includes a process of consensus and cooperation in building group identity,
whereas the social planning model often uses outside experts and is more task oriented,
stressing rational-empirical approaches to problem solving. In the Treatwell 5-a-Day
work-site study, these theories were operationalized by designating primary work-site
contacts (work-site coordinators) and forming employee advisory boards (EABs).
Work-site coordinators served on the EABs. Members represented a variety of departments and occupational categories. Dana-Farber Cancer Institute (DFCI) staff served as
outside experts and EABs used a combination of consensus building and task orientation
to plan and implement interventions.
The purposes of this article are (1) to report quantitative measures of the amount of
EAB member involvement in program planning and implementation and (2) to examine
the correlations of an indicator of EAB involvement, amount of EAB member time
devoted to project activities, and work-site size with number of events implemented;
employee awareness, participation, and behavior change; and work-site support.

METHOD
Study Design and Setting
Treatwell 5-a-Day was one of the nine community studies supported by the National
Cancer Institutes Five-a-Day for Better Health campaign, which examined the efficacy of interventions in increasing the consumption of fruits and vegetables to five or
10
more servings a day. Treatwell 5-a-Day was a randomized, controlled work-site intervention study that investigated the role of household support in increasing employees
fruit and vegetable consumption.4,11,12 This work-site study was conducted in 22 community health centers (CHCs) in Massachusetts. The CHCs ranged in size from 27 to 640
employees; 9 of the 22 sites had fewer than 100 employees. The CHCs were randomly
assigned to one of two intervention conditions or a third condition, minimal intervention
control. One intervention condition focused on the work site only (WO). The second
intervention condition focused on both work sites and employees families (WPF).
Employees in the WO intervention reported a 7% increase (approximately 0.2 servings)
in daily servings of fruits and vegetables, while those in the WPF condition reported a
19% increase (approximately 0.5 servings). There was no change observed in the minimal intervention control condition. The overall difference among the intervention groups
12
was statistically significant (p = .05).
Employee Involvement in Intervention
Planning and Implementation
The Treatwell 5-a-Day intervention model incorporated three key constructs: (1)
employee involvement based on principles of community organization; (2) use of a
socioecological model that addressed individual, family, coworker, and organizational

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influences on employee eating behavior; and (3) the incorporation into intervention
activities of tested behavioral and educational strategies. While the overall process tracking system was designed to document all three key constructs, this article focuses on the
employee involvement component. Details of the complete intervention model,4 final
results,12 and measurement of the extent of intervention implementation and reach13 are
described elsewhere. In this article we refer to two levels of employee participation; one is
the participation of employees in program activities and the other is employee involvement in program planning and implementation through EABs.
EABs met monthly with project staff to plan interventions. Typical responsibilities of
board members included planning for the implementation of core intervention activities,
designing EAB-initiated activities, promoting program activities and events, staffing program activities and events, delivering intervention messages to coworkers, and maintaining required documentation.
Data Collection
Data used in this article were collected from three sources: the EAB questionnaire, the
process tracking system, and the employee survey.
Employee Advisory Board Questionnaire
DFCI staff administered the 34-item EAB questionnaire in seven WO and seven WPF
health centers during Month 12 of the 19.5-month intervention. It was administered at one
of the monthly meetings with follow-up by the work-site coordinator of current members
not attending the meeting and former EAB members.
Process Tracking System
EAB involvement data were collected with the process tracking system. The term
event is used to describe either multiple-activity interventions or single-activity events.
The term activity refers to components of multiactivity events.
Employee Survey
Self-administered baseline and follow-up surveys were given to a census of eligible
employees in 20 sites with 120 or fewer employees, and to a random sample of 100
employees in the two larger sites employing 350 and 600 workers. Those eligible for the
survey were permanent employees working at least 15 hours per week. The baseline survey was distributed to 1,588 employees and completed by 1,359 (response rate 87%;
range across work sites: 75%-100%), and the follow-up survey was distributed to 1,824
eligible employees and completed by 1,306 (response rate 76%; range across work sites:
56%-100%).
Measures
Employee Advisory Board Questionnaire
The EAB questionnaire included demographic items and 22 questions that were
used to form three scales measuring EAB members perception of work-site autonomy/

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Health Education & Behavior (April 2000)

independence, management involvement and support, and institutionalization/commitment. These scales were developed and tested in the Working Well Trial and were found
to have excellent to adequate internal consistency.14 The autonomy/independence scale
consisted of six questions designed to measure the level of work-site autonomy related to
activities such as deciding on the meeting agenda, chairing meetings, deciding what
activities occur, when activities occur, who prepares promotional materials, and who runs
the activities. The management involvement/support scale consisted of six items including the levels of enthusiasm, participation, and support of executive directors and
midlevel managers. The institutionalization/commitment scale consisted of four questions, that is, provision of logistic support, financial contributions, and the provision of
food and incentives such as prizes and gifts.
Process Tracking System
Measures of employee involvement and measures of the extent of implementation and
reach were documented with the process tracking system.
For employee involvement, staff recorded the demographic characteristics of EAB
members and the number of hours EAB members spent on each project activity. Measures
of the extent of intervention implementation and reach included the number and type of
intervention activities and events and the number of employees attending intervention
activities and events.
Employee Survey
Items from the follow-up employee survey used for this article included measures of
awareness of the project, participation in nutrition-related activities, and fruit and vegetable consumption. Awareness and participation were included because they serve as mile15
stones on a continuum that may lead to behavior change. That is, employees must first
be aware of a program so they can participate and learn how to change their behavior.
Fruit and vegetable consumption was calculated by using a fruit and vegetable screener
administered at both the baseline and follow-up surveys.
Program awareness. The program awareness question asked, During the past 2 years,
have any of the following health promotion programs or activities been offered at your
workplace? Respondents chose from five possible program names. Yes responses to
the Treatwell 5-a-Day choice indicated program awareness.
Program participation. To measure participation, we asked, During the past 2 years,
have you participated in any of the following nutrition-related activities in your workplace? Five possible responses included nutrition classes or programs; centerwide events
such as holiday parties, picnics, or potlucks that included nutrition-related activities; fruit
and vegetable taste tests; nutrition-related contests or games; and a learn-at-home nutrition
program. Yes responses on one or more items were counted as participation.
Fruit and vegetable consumption was measured using the screener that was developed
for use in the National Cancer Institutes nine 5-a-Day for Better Health research projects,
16,17
based on the national 5-a-Day survey and other fruit and vegetable screeners. The following items were used to assess fruit and vegetable consumption: the frequency of daily

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servings of orange or grapefruit juice; other fruit juices; green salad; baked, boiled, or
mashed potatoes; vegetables not counting salad or potatoes; and fruit not counting juices.
Data Analysis
Results from each assessment (EAB survey, process tracking, and employee survey)
were aggregated to the work-site level and the work site was used as the unit of analysis.
For the process tracking data, the number of members and number of hours and events
were summed across each work site and a total was recorded. To obtain rates per
employee, the totals were divided by the number of employees in a specific work site. For
the EAB survey, the involvement scales were computed for each EAB member and then
averaged across the work site. Similarly for fruit and vegetable consumption, the servings
per day were calculated for each respondent to the baseline and follow-up surveys. These
were averaged across the work site at each time point, and the work-site specific mean
change was computed by subtraction. For program awareness and participation, the percentage of employees for each work site was computed.
Analyses were conducted using Statistical Analysis System (SAS) Version 6.10 where
the CHC was the unit of analysis. General descriptive statistics of mean and standard
deviation, minimums, and maximums were calculated on all variables. Pearson productmoment correlations were calculated to evaluate the bivariate relationships between
hours of EAB time devoted to project activities and work-site size with the number of
events, variables on the behavior change continuum, and indicators of work-site support.

RESULTS
The number of hours spent by EAB members on project activities, the number of
events implemented per site, the number of events offered per employee, and increase in
consumption of fruits and vegetables were greater in the WPF condition. The number of
EAB members per site and percentage participation per event were greater in the WO
condition (see Table 1). The conditions were similar in the number of EAB hours per
employee; the number of EAB members per employee; and percentage awareness of, and
participation in, programs. Measures of work-site-level involvementthat is, autonomy,
management involvement, and institutionalizationwere similar in both conditions.
To examine the relationships between the variables of interest, we combined the conditions. EAB involvement was a key construct in both intervention conditions and an
exploration of items associated with this involvement was not condition dependent.
As delineated in Table 2, greater numbers of EAB hours spent on program activities
were correlated with greater numbers of events. Smaller work-site size was associated
with higher levels of employee awareness of the project and employee participation in
project activities. There were no statistically significant correlations between indicators
of work-site support and the variables of interest.
The scales measuring work-site support were examined for internal consistency using
the Cronbachs alpha statistic. These were then compared with the alphas found in the
Working Well Trial in which the scales were developed. Comparing the Working Well Trial
with Treatwell 5-a-Day, the alphas for the autonomy/independence scale were .89 versus
.83, for management support .90 versus .85, and for institutionalization .65 versus .70.

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Table 1.

Means and Standard Deviations for Variables by Condition

Work Site
Only

Variables documented with process tracking system

Number hours/EAB member/site
Number EAB members/site
Number EAB hours/employee/site
Number EAB members/employee
Number events/site
Number events/employee
Percentage participation/event
Variables measured with the employee survey
Percentage aware of the program
Percentage participation in events
Change in servings of fruits and vegetables
per day
Measures of indicators of work-site support
from survey of EAB members
Autonomy/independencea
Management involvementa
Institutionalizationb
Work-site coordinatorsa
Average number of employees per site

Work Site
Plus Family

SD

SD

17.3
11.0
2.1
0.10
32.7
0.33
0.35

8.0
3.3
1.6
0.04
5.0
0.18
0.11

27.4
7.6
2.2
0.09
46.4
0.57
0.29

10.4
3.1
1.5
0.07
5.4
0.35
0.12

90
81

5.3
9.9

89
79

15.2
16.3

0.4

0.29

0.6

0.69

3.4
3.2
2.8
4.8
134

0.63
0.61
0.63
0.10
109

3.2
3.3
2.6
4.9
186

0.20
1.0
0.52
0.05
267

NOTE: EAB = employee advisory board.

a. High numerical score indicates higher level of the variable.
b. Low numerical score indicates a higher level of institutionalization.

DISCUSSION
These results provide quantitative measures of the level of EAB involvement achieved
in Treatwell 5-a-Day as well as correlations of an indicator of EAB involvement, number
of EAB hours spent on project activities, with the number of events implemented. Small
work-site size was associated with higher levels of employee awareness of the project and
participation in project activities. The main findings from these analyses support empirical evidence for what is commonly understood among health promotion program planners, that is, that the amount of employee involvement is likely to have an impact on the
extent of interventions implemented and that it may be advisable to calibrate the
amount of EAB member time to the size of the work site. In Treatwell 5-a-Day, it appears
that the amount of time spent by EAB members on project activities may have been the
most important employee involvement factor. While there were fewer EAB members per
site in the WPF condition, where the sites achieved a significant change in fruit and vegetable consumption, the number of hours per member spent on project activities was considerably larger.
These results provide quantitative support for the findings of other investigators about
the potential impact of using community or work-site members in program planning and
6,18
implementation. From a qualitative perspective, Treatwell 5-a-Day EAB members
worked with DFCI to plan and deliver educational and behavior change strategies in a

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Table 2.

229

Correlations of EAB Involvement Variables With Indicators of the Extent of Intervention Implementation and Reach, Items on the Behavior Change Continuum, and Indicators of Work-Site Support
Total Hours
EAB Time

Extent of intervention implementation

Total number of events
Behavior change continuum
Awareness
Participation
Consumption of fruit and vegetables
Indicators of work-site support
Autonomy
Management involvement
Institutionalization
Work-site coordinator support

Number of
Employees/Site

p Value

p Value

.58

.03*

.25

.12
.19
.34

.68
.51
.23

.95
.76
.25

.0001**
.001**
.39

.21
.16
.18
.49

.47
.58
.55
.08

.25
.18
.30
.05

.38
.53
.29
.87

.38

NOTE: EAB = Employee Advisory Board.

*p < .05. **p < 0.01.

way that appealed to employees with different ethnic backgrounds, ages, and household
composition unique to their work sites. For example, all work sites implemented contests
that included taste tests with recipes and prize drawings. In some sites, these activities
were combined to form family poetry contests, while in others the activities were delivered as family recipe contests. EAB members also identified and recruited other employees to help with implementation of events and recruited coworkers to participate in program events.
Process evaluation systems typically use both quantitative and qualitative data
19,20
Much of the literature on process evaluation has been in the form of case studsources.
ies and descriptive analysis.20 Evaluators have identified a need for quantitative measures
that provide empirical evidence of the extent of intervention implementation and its relationship to outcome.21 Two other studies have reported quantitative results for employee
involvement as part of work-site health promotion. Sorensen et al. identified a relation1
14
ship between program awareness and employee involvement and Linnan et al. developed quantitative scales that measured EAB members perceptions of work-site support
of health promotion programming.
The correlation of the number of EAB hours spent per employee on project activities
was strongly and significantly (p = <.01) associated with both awareness of the project
and participation in project activities as measured with the employee survey (r = .64 for
both). When we computed the partial correlation of hours per employee controlling for
number of employees, the correlations declined to .49 and .43, respectively, and neither
was statistically significant. These correlations are in the moderate range, even though
they are not statistically significant. Thus, although some of the association appears to be
due to the fact that it may be easier to have an impact in small work sites, this does not
account for all of the correlation. Indeed, this correlation may suggest that the amount of
EAB effort may need to be adjusted to work-site size.

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Health Education & Behavior (April 2000)

There are limitations to the interpretation of the findings reported here. Generalizability is limited because these data were collected in small CHCs. These data were generally
self-reported and so cannot be applied with the same level of confidence as those that are
validated with objective measures. The product-moment correlation coefficient provides
a measure of the general level of association. The test of hypothesis is very sensitive to
departures from the assumption of bivariate normality and to the sample size, thus the p
values need to be interpreted with caution. Correlation does not indicate causation; however, correlation coefficients of .40 or greater indicate that the two measures vary together
or that there may be factors influencing them in common.
In conclusion, this study provides quantitative indicators of the level of employee
involvement that was achieved in a work-site health promotion program, which incorporated principles of community organization theory and practice. As noted by others, such
involvement increases the likelihood for success in the change process and fosters work6,18
site ownership of programs. Future studies will benefit from the use of process tracking
systems that provide further quantification of employee involvement in program planning and implementation and in examining the relationships between employee involvement, process indicators of the extent of intervention implementation, and study
outcomes.

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