Wellness programs: failure to evaluate
Most readers would agree that wellness programs are alive and flourishing in Canada, given that these programs are prominently featured in publications such as Working Well and at benefits conferences.
It may surprise you, then, that our research team’s review of Canadian scientific literature on wellness and disease management programs found that evidence supporting these programs is severely lacking. Even when evaluations are done, they are often done poorly.
We’re not saying that wellness programs don’t work. Rather, we’re arguing that there is a need for well-designed evaluations of these programs in Canada in order to establish their value.
Why should you care if the evidence is scant? During an economic downturn, employers and other key stakeholders will take a closer look at their health benefits—especially programs that haven’t yet demonstrated a favourable return on investment. And without a solid body of peer-reviewed studies, it is difficult for those who have implemented these programs in Canada to learn from others and improve their own programs accordingly.
So, if evaluation is important, how should you do it? It may be easier to point out what to avoid and thus prevent the common mistakes that others make. Here are some tips to keep in mind:
1. Don’t use a shoddy study design—Not every evaluation has to meet the rigorous publication standards of The New England Journal of Medicine, but it should be designed so that you can determine the program’s impact with confidence. Far too many evaluations rely on a simplistic pre/post design.
2. Don’t offer poorly defined interventions—Many evaluations fail to clearly define the components of the wellness program—a common mistake. The evaluation team should be able to answer the question: “What are we measuring?”
3. Don’t exclude key outcomes—I recommend including economic, clinical and humanistic outcomes to ensure that you capture a comprehensive mix. Focusing on economic outcomes alone—such as changes in drug costs—will often miss key intended and unintended effects.
Dr. Neil J. MacKinnon is an associate professor at Dalhousie University’s College of Pharmacy and Faculty of Medicine in Halifax, N.S. He will be speaking at our Healthy Outcomes Conference in Whistler, B.C., Mar. 31 to Apr. 2, 2009.
neil.mackinnon@dal.ca
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© Copyright 2009 Rogers Publishing Ltd. This article first appeared in the January/Feburary 2009 edition of WORKING WELL magazine.