Participants’ Perspectives of a Worksite Wellness Program Using an Outcome-Based Contingency Approach

  • David Gerard Bruno Valdosta State University
  • James R. Brown Assistant Professor, Dept of Social Work, Indiana University, Bloomington
  • Evan D. Holloway Fordham University
Keywords: Program evaluation, Worksite wellness, organizational culture,


Worksite wellness programs in the U.S. are increasingly common. Social workers in healthcare and administration should familiarize themselves with the various wellness programs and the impact they have on workers and organizations. This study examined a worksite wellness outcome-based contingency approach (WWOCA). This approach bases individual employee health insurance discounts on each participant achieving biometric goals. A mixed-method explanatory approach was used. Quantitative health measures of participants (n = 397) and six focus group discussions (n = 45) were conducted using a convenience sample. Results indicate that over half of the participants met their work-based health goals (i.e., body measurements at the average or excellent rankings) with increases from 56% in year one to 87% in year two and 90% by year three. However, focus group participants expressed a high sense of failure in relation to health goal attainment, frustration with loss of the financial incentive, and stress and anxiety linked to negative feedback about their body measurements. These results suggest that many participants’ self-worth was negatively impacted when participants had difficulty conforming to worksite wellness standards. Social workers in healthcare and administration will need to advocate for worksite wellness programs that promote human dignity and avoid discriminating based on employee health status. 

Author Biographies

David Gerard Bruno, Valdosta State University

First Author, Assistant Professor of Social Work,

Department of Social work, 


James R. Brown, Assistant Professor, Dept of Social Work, Indiana University, Bloomington

Assistant Professor of Social Work,

Dept. of Social Work,

Indiana University, Bloomington

Evan D. Holloway, Fordham University
Ph.D. Candidate at Fordham University


Arena, R., Guazzi, M., Briggs, P. D., Cahalin, L., Myers, J., Kaminsky, L.,…Lavie, C. J. (2013). Promoting health and wellness in the workplace: A unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs. Mayo Clinic Proceedings, 88(6), 605-617. doi:
Ayon, C. (2014). Service needs among Latino immigrant families: Implications for social work practice. Social Work, 59(1), 13-23. doi:
Berry, L. L., Mirabito, A. M., & Baun, W. B. (2010). What’s the hard return on employee wellness programs? Harvard Business Review, December, 104-112.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. doi:
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Clark, M., Jenkins, S., Limoges, K., Hagen, P., Lackore, K., Harris, A.,…Olsen, K. (2013). Is usage of a wellness center associated with improved quality of life? American Journal of Health Promotion, 27(5), 316-322. doi:
Corey, M., Corey, G., & Corey, C. (2014). Groups: Process and practice. Boston, MA: Cengage Learning.
Creswell, J., & Plano-Clark, V. (2011). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.
Dale, O., Smith, R., Chess, W. A., & Norlin, J. (2006). Human behavior in the social environment: A social systems model. Boston, MA: Allyn & Bacon.
Ferguson, K. M., & Islam, N. (2008). Conceptualizing outcomes with street-living young adults: Grounded theory approach to evaluating the social enterprise intervention. Qualitative Social Work, 7(2), 217-237. doi:
Gabel, J. R., Whitmore, H., Pickreign, J., Ferguson, C. C., Jain, A., Shova K. C., & Scherer, H. (2009). Obesity and the workplace: Current programs and attitudes among employers and employees. Health Affairs, 28(1), 46-56. doi:
Gates, D., Brehm, B., Hutton, S., Singler, M., & Poeppelman, A. (2006). Changing the work environment to promote wellness: A focus group study. AAOHN Journal, 54 (12), 515-520. doi:
Goetzel, R. Z., & Ozminkowski, R. J. (2008). The health and cost benefit of work site health-promotion programs. Annual Review of Public Health, 29, 303-323. doi:
Hepworth, D., Rooney, R., Rooney, G., & Strom-Gottfried, K. (2017). Direct social work practice: Theory and skills. Boston, MA: Cengage Learning.
Hill-Mey, P. E., Merrill, R. M., Kumpfer, K. L., Reel, J., & Hyatt-Neville, B. (2013). A focus group assessment to determine motivations, barriers, and effectiveness of a university-based worksite wellness program. Health Promotion Perspectives, 3(2), 154-164.
Horwitz, J. R., Kelly, B. D., & DiNardo, J. E. (2013). Wellness incentives in the workplace: Cost savings through cost shifting to unhealthy workers. Health Affairs, 32(3), 468-476. doi:
IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
Ivankova, N., Creswell, J., & Stick, S. (2006). Using mixed-methods sequential explanatory design: From theory to practice. Field Methods, 18(1), 3-20. doi:
Johnson, B., & Turner, I. A. (2003). Data collection strategies in mixed methods research. In A. Tashakkori & C. Teddlie (Eds.), Handbook of mixed methods in the behavioral and social sciences (pp. 297-320). Thousand Oaks, CA: Sage.
Lerner, D., Rodday, A. M., Cohen, J. T., & Rogers, W. H. (2013). A systematic review of the evidence concerning the economic impact of employee-focused health promotion and wellness programs. Journal of Occupational and Environmental Medicine, 55(2), 209-222. doi:
Madriz, E. (2000). Focus groups in feminist research. Handbook of qualitative research, In N. K. Denzin & Y. S. Lincoln (Eds.). (pp. 835-850) Thousand Oaks, CA: Sage.
Makrides, L., Heath, S., Farquharson, J., & Veinot, P. L. (2007). Perceptions of workplace health: Building community partnerships. Clinical Governance: An International Journal, 12(3), 178-187. doi:
Mattke, S., Hangsheng, L., Caloyeras, J. P., Huange, C. Y., Van Busum, K. R., Khodyakov, D., & Shier, V. (2013). Workplace wellness programs study: Final report.. Santa Monica, CA: RAND Corporation.
Mattke, S., Schnyer, C., & Van Busum, K. R. (2012). A review of the U.S. workplace wellness market. Santa Monica, CA: RAND Corporation.
MAXQDA [software for qualitative data analysis]. (2014). VERBI Software – Consult – Sozialforschung GmbH, Berlin, Germany.
Murray, C. J. L., & Frenk, J. (2010). Ranking 37th—measuring the performance of the U.S. health care system. The New England Journal of Medicine, 362(2), 98-99. doi:
National Association of Social Workers. (2006). NASW Code of Ethics. Washington, DC: NASW Press.
Padgett, D. (2004). The qualitative research experience. Belmont, CA: Wadsworth/ Thomson Learning.
Patton, M. (2002). Qualitative research and evaluative methods. Thousand Oaks, CA: Sage.
Pronk, N. P. (2009). American College of Sports Medicine’s worksite health handbook: A guide to building healthy and productive companies. Champaign, IL: Human Kinetics.
Robroek, S. J. W., van de Vathorst, S., Hilhorst, M.T., & Burdorf, A. (2012). Moral issues in workplace health promotion. International Archives of Occupation Environmental Health, 85, 327-331. doi:
Rubin, A., & Babbie, E. (2013). Research methods for social work. Belmont, CA: Thomson Brooks/Cole.
Santos, A., Hayward, T., & Ramos, H. M. (2012). Organizational culture, work and personal goals as predictors of employee well-being. Journal of Organizational Culture, Communication and Conflict, 16(1), 25-48.
Sidman, M. (1989). Coercion and its fallout. Boston, MA: Authors Cooperative, Inc.
Stewart, D., Shamdasani, P., & Rook, D. (2007). Focus groups: Theory and practice (2nd ed.). Thousand Oaks, CA: Sage. doi:
Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.
Task Force on Community Preventive Services. (2010). Recommendations for worksite-based interventions to improve workers’ health. American Journal of Preventive Medicine, 38(2S), S232-S236.
U.S. Centers for Medicare & Medicaid Services. (2017). Wellness program. Retrieved from
van Berkel, J., Meershoek, A., Janssens, R. M., Boot, C.R., Proper, K. I., & van der Beek, A. J. (2014). Ethical considerations of worksite health promotion: An exploration of stakeholders’ views. BioMed Central Public Health, 14, 458-468. doi:
Wood, F., & Jacobson, S. (2005). Employee perceptions of diabetes education needs: A focus group study. AAOHN Journal, 53(10), 443-449.
Yalom, I. D. (2005). The theory and practice of group psychotherapy. NY: Basic Books.