Online health check for reducing alcohol intake among employees: a feasibility study in six workplaces across England

Khadjesari, Z., Newbury-Birch, D., Murray, E., Shenker, D., Marston, L. and Kaner, E. (2015). Online health check for reducing alcohol intake among employees: a feasibility study in six workplaces across England. PLOSIVE 23.3.15 (OPEN ACCESS)

Alcohol misuse remains a global health and economic concern (World Health Organisation, 2014; Rehm and Shield, 1012). The World Health Organisation advocates screening and brief intervention (SBI) for adults drinking at hazardous and harmful levels, yet novel approaches are needed to achieve population level access (World Health Organisation, 2010). Two ways of broadening the reach of SBI is to deliver interventions over the Internet and in non-health care settings. Evidence for online approaches is mounting, but is limited to student populations (Khadjesari et al., 2011; Bewick et al., 2008; Carey et al., 2009; Riper et al., 2011; Rook et al., 2010; Donaghue et al., 2014). Most hazardous and harmful drinkers are of working age and do not seek help with their drinking, therefore the workplace setting offers a unique opportunity to universally screen employees across a wide range of socioeconomic and ethnic groups. Limited research has been conducted on the use of online SBI in the workplace setting to date (Webb et al., 2009; Schulte et al., 2014), yet its adoption is gaining popularity in a small number of private and public sector workplaces in England. This study explored the feasibility and acceptability of providing an online health check with personalised feedback on a range of health behaviours. It explored privacy concerns around the Internet and workplace setting, usefulness of personalised feedback, and whether concerns differ by demographic characteristics and health behaviours, and differences between different types of organisations.

To undertake a feasibility study of online screening, personalised feedback and access to an extensive online alcohol intervention in six workplace settings in the North and South of England.

To determine whether a definitive multicentre trial is feasible by estimating study parameters and thereby informing a sample size calculation. Study parameters included rates of eligibility, recruitment and retention at three months.

To explore the acceptability to employees of completing an online health screen, receiving feedback on health behaviours and access to an online alcohol intervention, and completing follow-up measures, with particular reference to perceived risks to confidentiality.

To determine the extent of access to an extended online alcohol intervention, and its suitability for this population.

A multi-site feasibility study of electronic screening and brief intervention for reducing alcohol intake in employees of six workplace settings in the North and South England.

Six organisations were selected for their diversity, including five public sector and one private sector organisations (three local authorities, one hospital, one university and one petrochemical company).

Eligible participants were employees at each of the six workplaces, providing informed consent. As employees of these companies, participants were adults with the ability to read English. Employees needed to gain access to the Internet to participate in this study.

Employees were invited to complete an online health screen and to take part in a study led by researchers from UCL (University College London) and NCL (Newcastle University). The study was advertised via the occupational health and Human Resources leads choice of email, Intranet, newsletter / magazine (electronic and hard copy), electronic noticeboard and posters. Employees were invited to visit the study website to access the health check, following online consent, which included questions alcohol, smoking, diet and physical activity. Demographic data on gender, age, ethnicity and occupational classification were collected before provision of feedback on health behaviours.

All participants received instantaneous personalised feedback from the health screen in-line with standard NHS recommendations for healthy living. Participants who scored eight or more on the AUDIT, smoked, ate less than five portions of fruit and vegetables a day or did less than 150 minutes of moderate or vigorous physical activity a week received feedback on the government’s recommendations and the benefits of changing their behaviour, in addition to hyperlinks to corresponding pages of the NHS Choices and NHS Livewell websites for further information. Participants exceeding the AUDIT threshold received brief advice on the harms of excess drinking, along with details of local alcohol services and a hyperlink to the Down Your Drink (DYD) website, based on motivational enhancement, cognitive behavioural therapy, and relapse prevention.

All participants were contacted by email three months after baseline data collection to complete follow-up questionnaires online, via hyperlink, regardless of level of alcohol consumption at baseline. Outcome measures included the AUDIT and a questionnaire designed by the research team that explored the acceptability and potential risk of delivering electronic screening and brief intervention to employees in the workplace.

Engagement with the online tool varied greatly between workplaces, with an average of 14% of employees accessing the online tool across the six workplaces. A total of 1,254 (8%) employees across the six workplaces completed the health check and received personalised feedback on their alcohol intake, alongside feedback on smoking, fruit and vegetable consumption and physical activity.

Most participants were female (65%) and of ‘White British’ ethnicity (94%), with a mean age of 43 years (SD 11). Participants were mostly in Intermediate occupations (58%), followed by Higher managerial / professional (39%) and Routine and manual occupations (2%). A quarter of participants (25%) were drinking at hazardous levels (33% male, 21% female), which decreased with age. Prevalence of smoking among employees across all workplaces was 10%, median level of physical activity was 350 (IQR 201, 560) minutes a week (with 85% exceeding recommended threshold) and median fruit and vegetable consumption was 3 portions a day (with 30% exceeding threshold).

Sixty-four percent (n=797) of participants completed online follow-up at three months. Most participants were supportive of workplaces offering employees an online health check (95%), their preferred format was online (91%) and many were confident of the confidentiality of their responses (60%). Whilst the feedback reminded most participants of things they already knew (75%), some were reportedly motivated to change their behaviour (13%). A small number of participants drinking at hazardous levels accessed further support with their drinking via the Down Your Drink website.

Workplaces identified in the Northeast and Southern England were keen to offer an online approach to raise alcohol awareness, as part of a health check.

Promotion of an online health check in workplace settings appeared to attract relatively healthy individuals, with lower smoking prevalence, higher levels of physical activity than the general population, and with levels of alcohol intake and fruit and vegetable consumption comparable to the general population. This may help explain the finding that an online health check approach was largely seen as acceptable among employees in this study.

What are the barriers to completing an online health check in the workplace setting?

Which intervention approach attracts the greatest proportion of hazardous drinkers – alcohol-specific focus or health check approach?

Which interventions are most acceptable to older employees, ethnic minorities, routine and manual employees?

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