title: Health promotion in small business: a systematic review of factors influencing adoption and effectiveness of worksite wellness programs.
abstract: OBJECTIVE
  To assess the evidence regarding the adoption and efficacy of worksite health promotion programs (WHPPs) in small businesses.
  
  
  METHODS
  Peer-reviewed research articles were identified from a database search. Included articles were published before July 2013, described a study that used an experimental or quasiexperimental design and either assessed adoption of WHPPs or conducted interventions in businesses with fewer than 500 employees. A review team scored the study's rigor using the WHO-adapted GRADEprofiler "quality of evidence" criteria.
  
  
  RESULTS
  Of the 84 retrieved articles, 19 met study inclusion criteria. Of these, only two met criteria for high rigor.
  
  
  CONCLUSIONS
  Fewer small businesses adopt WHPPs compared with large businesses. Two high-rigor studies found that employees were healthier postintervention. Higher quality research is needed to better understand why small businesses rarely adopt wellness programs and to demonstrate the value of such programs.
authors.affiliation: From Hampshire College (Ms McCoy), Amherst, Mass; the Center for Worker Health and Environment (Ms Stinson, Mr Scott, Ms. Tenney, and Dr Newman), Colorado School of Public Health; Department of Medicine (Dr Newman), School of Medicine, University of Colorado, Aurora.
authors.forename: Kira
authors.initials: K
authors.lastname: McCoy
authors.forename: Kaylan
authors.initials: K
authors.lastname: Stinson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Scott
authors.forename: Liliana
authors.initials: L
authors.lastname: Tenney
authors.forename: Lee S
authors.initials: LS
authors.lastname: Newman
mesh_terms: D006293:Health Promotion; D006302:Health Services Research; D006801:Humans; D009786:Occupational Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D016896:Treatment Outcome; D017132:Workplace