title: Barriers and facilitators for participation in health promotion programs among employees: a six-month follow-up study.
abstract: BACKGROUND
  Health promotion programs (HPPs) are thought to improve health behavior and health, and their effectiveness is increasingly being studied. However, participation in HPPs is usually modest and effect sizes are often small. This study aims to (1) gain insight into the degree of participation of employees in HPPs, and (2) identify factors among employees that are associated with both their intention to participate and actual participation in HPPs.
  
  
  METHODS
  Employees of two organizations were invited to participate in a six-month follow-up study (n = 744). Using questionnaires, information on participation in HPPs was collected in two categories: employees' intention at baseline to participate and their actual participation in a HPP during the follow-up period. The following potential determinants were assessed at baseline: social-cognitive factors, perceived barriers and facilitators, beliefs about health at work, health behaviors, and self-perceived health. Logistic regression analyses, adjusted for demographics and organization, were used to examine associations between potential determinants and intention to participate, and to examine the effect of these determinants on actual participation during follow-up.
  
  
  RESULTS
  At baseline, 195 employees (26%) expressed a positive intention towards participation in a HPP. During six months of follow-up, 83 employees (11%) actually participated. Participants positively inclined at baseline to participate in a HPP were more likely to actually participate (OR = 3.02, 95% CI: 1.88-4.83). Privacy-related barriers, facilitators, beliefs about health at work, social-cognitive factors, and poor self-perceived health status were significantly associated with intention to participate. The odds of employees actually participating in a HPP were higher among participants who at baseline perceived participation to be expected by their colleagues and supervisor (OR = 2.87, 95% CI: 1.17-7.02) and among those who said they found participation important (OR = 2.81, 95% CI: 1.76-4.49).
  
  
  CONCLUSIONS
  Participation in HPPs among employees is limited. Intention to participate predicted actual participation in a HPP after six months of follow-up. However, only 21% of employees with a positive intention actually participated during follow-up. Barriers, facilitators, beliefs about health at work, social-cognitive factors, and a poor self-perceived health status were associated with intention to participate, but hardly influenced actual participation during follow-up.
authors.forename: Anne
authors.initials: A
authors.lastname: Rongen
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands. s.robroek@erasmusmc.nl.
authors.forename: Suzan J W
authors.initials: SJ
authors.lastname: Robroek
authors.forename: Wouter
authors.initials: W
authors.lastname: van Ginkel
authors.forename: Dennis
authors.initials: D
authors.lastname: Lindeboom
authors.forename: Bibiëlle
authors.initials: B
authors.lastname: Altink
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003144:Communication Barriers; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009786:Occupational Health Services; D010358:Patient Participation; D012044:Regression Analysis; D011795:Surveys and Questionnaires