title: The effectiveness and cost-effectiveness of a rural employer-based wellness program.
abstract: BACKGROUND
  The cost-effectiveness of employer-based wellness programs has been previously investigated with favorable financial and nonfinancial outcomes being detected. However, these investigations have mainly focused on large employers in urban settings. Very few studies examined wellness programs offered in rural settings.
  
  
  OBJECTIVE
  This paper aims to explore the effectiveness and cost-effectiveness of a rural employer-based wellness program.
  
  
  METHODS
  Six rural employers were categorized into 3 groups: a control group and 2 intervention groups with varying degrees of wellness activities. Participants were asked to complete an annual health risk assessment (HRA) that addressed 16 wellness areas. At the conclusion of 4 years, HRA and effectiveness data were utilized to examine program effectiveness and combined with program costs to estimate cost-effectiveness.
  
  
  RESULTS
  The "Coaching and Referral" group-the highest in intensity of participant engagement-exhibited superior improvement in several wellness areas and in percentage of employees with good health indicators compared to the control and the Trail Marker, lower-intensity intervention groups. However, the Trail Markers had more favorable cost-effectiveness ratios.
  
  
  CONCLUSIONS
  Rural worksite wellness programs have shown great potential in their effectiveness and cost-effectiveness. Such programs need not be too aggressive, tedious, and costly to generate a favorable return for employers and funders. However, employers should be encouraged to experiment with different levels of wellness program intensities until a more favorable outcome can be realized.
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. ss117@aub.edu.lb
authors.forename: Shadi S
authors.initials: SS
authors.lastname: Saleh
authors.forename: Mohamad S
authors.initials: MS
authors.lastname: Alameddine
authors.forename: Dan
authors.initials: D
authors.lastname: Hill
authors.forename: Jessica
authors.initials: J
authors.lastname: Darney-Beuhler
authors.forename: Ann
authors.initials: A
authors.lastname: Morgan
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006293:Health Promotion / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D009786:Occupational Health Services / Q000191:economics* / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000191:economics* / Q000706:statistics & numerical data; D018570:Risk Assessment; D019035:Rural Health Services / Q000191:economics* / Q000458:organization & administration; D040241:Social Marketing; D013223:Statistics as Topic