Selection of sources of evidence
A total of 26 WHP initiatives from the United Kingdom were initially identified. Figure 1 provides the PRISMA flowchart detailing the selection process. Sixteen of the 26 WHP initiatives were excluded (2 were based outside of the United Kingdom, 4 were superseded by more recent initiatives, 5 were out-of-scope as they were concerned with health and safety or occupational health only, 2 had no assets we could retrieve despite reaching out to the programme manager via email, and 3 were eliminated for other reasons, including no longer current). This resulted in a set of 10 initiatives retained for in-depth content analysis.
Characteristics of the sources of evidence
The 10 WHP initiatives included are characterised in Table 1. Most initiatives were predominantly national in scope, a few were regional, and most targeted a diverse range of organisations. Some were specific to regions such as North East and Cumbria and Wales, while others were more broadly applicable, including initiatives for organisations in London and those with no geographical restrictions.
The employee size criteria for eligibility also varied, ranging from small organisations with 8 + employees to larger organisations with 50 + or more employees (Table 1). The majority (80%) had a general focus on workplace health and addressed a wide range of health-related issues.
Others had a specific focus, including one targeting mental health (10%) and another focusing on stress (10%). The types of schemes included award processes, accreditation schemes, certification schemes, benchmarking tools, and guides for conducting workplace health needs assessments.
One initiative featured a multitiered accreditation system with five levels: Bronze, Silver, Gold, Continuing Excellence, and Maintaining Excellence. Most of the initiatives were provided by the government (70%), two by charity providers (20%) and one by a private scheme (10%). The establishment year was available for all initiatives spanning 16 years (between 2004 and 2019), with the majority inaugurated since 2014; Table 1.
On average, we were able to access 1.8 assets per initiative, with a range of 1 to 4. These assets varied considerably in length, from 6 to 169 pages (mean = 39.8 pages ± 43.3 SD. Further details of the initiatives and the assets used are included in Supplementary File 4.
Synthesised results
In this section, we first review the extent of each WHP initiative’s engagement with the seven pillars of self-care and our new pillar of inequality (Tables 2 & 3). We then turn to the synthesised list of Best Buys recommendations for WHP (Table 3), along with their feasibility for deployment (Supplementary Table 5).
Engagement with the seven pillars of self-care and the new inequality pillar
In Table 2, the number of times that each asset engaged (mentioned) each of the predefined search terms (e.g., stress, obesity, etc.) is shown with a number. For example, in the upper left of Table 2, the Better Health at Work Award assets reviewed had zero mentions of stress and one mention of physical activity.
The total aggregate mentions for each term are listed in the matrix (Table 2), with ‘league’ assigned to indicate the most frequently mentioned (1st place) or the least frequently mentioned (8th place).
The most frequently engaged categories were mental health and risk avoidance, with more than 150 instances extracted for each. Regarding mental health, nonclinical aspects of mental health, e.g., “stress”, were more frequently mentioned than clinical aspects, e.g., “depression” and “anxiety”. Regarding risk avoidance, the data extracted the most frequently mentioned items to avoid “smoke” (focused on cigarettes rather than tobacco), "substance/drug misuse", or "alcohol/drinking".
The next most frequently engaged pillars were physical health, healthy eating, and health needs assessments, with between 80 and 100 data points extracted for each. For the health needs assessment, the data included “surveys” or “assessments” of individual health states, and fewer mentioned evaluating health needs within organisations. For healthy eating, the data were primarily about “health food/options” or “diet”. Notably, the terms “obesity” and “BMI” never appeared in the assets.
For physical wellbeing, the assets included terms such as “activity” promotion, “musculoskeletal” concerns, and sports. The last three categories were engaged fewer times, with the frequency of appearance of relevant terms under the categories of hygienic/safe facilities and health screening appearing less than 30 for each. Regarding hygienic/safe facilities, the data focused on the physical work environment, e.g., “equipment”. Health screenings were rarely mentioned. Finally, the new inequalities pillar was not frequently engaged, with only 30 data items extracted; these items more often focused on health conditions or disabilities than ethnicity (Table 2).
Table 2
Frequency of appearance of search terms per WHP initiative
Best Buy recommendations for workplace health
The consolidated lists of the 58 ‘Best Buys for WHP’ are shown in Table 3. Recommendations to promote physical and mental health were the most common, while recommendations to tackle inequalities and promote health screenings and health needs assessments were the least common.
Regarding mental health, the three most common Best Buys for tackling stress were concerned with implementing a stress prevention strategy, regularly promoting campaigns to raise awareness of stress, and providing training to identify causes of stress. The recommendations to tackle anxiety were based on changes to approach work (e.g., dispute, disciplinary and grievance procedures) and training for managers to develop people skills.
Regarding physical health, most recommendations consisted of promoting and raising awareness of the benefits of physical health, which require modest funding. These include promotional materials around the workplace, developing physical activity recommendations in the WHP policy, and monitoring employees’ lifestyle activities through online surveys. Another recommendation was to raise awareness of MSK problem prevention through promotional information, support staff with an individual care plan, offer staff with MSK self-management courses, and allow staff to access physiotherapy during working hours.
The Best Buys for Healthy Eating commonly focused on raising awareness of the benefits of healthy eating and replacing the unhealthy options available with healthy options facilitated by providing healthy options in the canteen and vending machines and a healthy eating plan with input from employees.
Regarding risk avoidance, Best Buy for smoking included raising awareness of the harms of smoking and signposting smoke-free areas, whereas tackling substance misuse focused on raising awareness of the harms of alcohol and drug misuse and implementing a code of conduct/policy that outlines behavioural expectancies for alcohol and substances.
We identified only three instances recommending the provision of health screening (e.g., using health checks), including recommendations for surveys/assessments focused on conducting consultations, surveys and focus groups to gauge staff satisfaction and priorities and to develop an action plan and congruent health and wellbeing policies.
Engagement with the seven pillars of self-care and the inequality pillar
Table 3 highlights how each of the 58 Best Buy recommendations for WHP mapped to the seven pillars of self-care and the inequalities pillar. Four recommendations (6.8%) mapped to Health Literacy (Pillar 1), 13 (22.4%) mapped to Mental Wellbeing (Pillar 2), 13 (22.4%) mapped to Physical Activity (Pillar 3), 7 (12.1%) mapped to Healthy Eating (Pillar 4), 10 (17.2%) mapped to Risk Avoidance (Pillar 5), 1 (1.7%) mapped to Hygiene (Pillar 6) and 6 (10.3%) mapped to the Rational Use of Products and Services (Pilar 7); Table 3. A total of 6 (10.3%) mapped to the themes of equality, diversity, inclusion, and tackling inequality (Pillar 8).
Feasibility of implementing each Best Buy Recommendation for WHP
The feasibility of each Best Buy option is outlined in Supplementary Table 5. Our pragmatic assessment indicated that most of these strategies are practical and can be implemented with minimal to moderate resource investment, making them accessible for a wide spectrum of workplaces.
Embedding and monitoring a stress prevention strategy was deemed highly feasible, with no special equipment or personnel needed, indicating a straightforward implementation path. Conversely, Best Buys, which called for recommendations requiring training to identify causes of stress, necessitated moderate funding and expert involvement, suggesting a need for targeted resource allocation.
Activities promoting physical health, such as the dissemination of information and development of policies, were assessed as low-cost and requiring minimal resources, signifying their high feasibility for broad adoption. Recommendations aimed at enhancing healthy eating options within the workplace were also considered easily implementable, with minimal to no additional costs or requirements for specialised personnel, underscoring their practicality. Strategies to reduce smoking and substance misuse were marked by their low to medium resource needs, implying that these recommendations could be executed with relatively little financial strain.
The provision of health screenings and the execution of surveys to assess health needs were also identified as actions that can be implemented with low financial investment, although they may require specialised input for interpretation and follow-up actions. Improvements in the physical work environment, specifically regarding equipment and cleanliness, were found to be feasible, requiring only modest adjustments and investments.
Table 3
List of 58 ‘Best Buy’ recommendations for workplace health promotion across the 7 pillars of self-care and inequality theme
Category
(n = total number of BBR)
|
Best Buy Recommendation
(n = frequency of appearance)
|
Pillar of Self-Care
|
Tackling Inequalities pillar
|
Total count
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
Health Literacy
|
Mental wellbeing
|
Physical activity
|
Healthy Eating
|
Risk Avoidance
|
Good Hygiene
|
Rational use
|
Awareness & Health Screening (n = 5)
|
1. Conduct consultations/surveys, focus groups & training needs analysis on employee needs (incl. mental health & staff satisfaction) & use data to guide future activities (n = 12)
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
2. Offer & perform a health needs assessment (free for night shift workers) & follow up to determine priorities & develop action plan (n = 7)
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
3. Complete self-assessment checklist & develop action plan (n = 7)
|
|
|
|
|
+
|
|
+
|
+
|
3
|
4. Provide health screening (e.g., health checks) (n = 5)
|
+
|
|
|
|
+
|
|
+
|
+
|
4
|
5. Promote managerial awareness in how to support staff health & wellbeing at work (n = 2)
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
Stress
(n = 10)
|
6. Embed & regularly monitor (any changes to) stress prevention strategy (n = 12)
|
|
+
|
|
|
+
|
|
|
|
2
|
7. Regular promotional campaigns/materials to raise awareness about stress prevention (n = 11)
|
+
|
+
|
|
|
|
|
+
|
+
|
4
|
8. Provide training to identify causes of stress, implement stress risk assessment & mental health awareness training (n = 9)
|
+
|
+
|
|
|
+
|
|
|
|
3
|
9. Managers discuss stress & causes in performance reviews & meetings & support staff vulnerable to stress (n = 9)
|
+
|
+
|
|
|
+
|
|
|
+
|
4
|
10. Gather organisational data on staff wellbeing & mental health, including stressors & links to absences (n = 9)
|
|
+
|
|
|
+
|
|
+
|
+
|
4
|
11. Conduct regular stress risk assessments with a focus on organisational issues & take action on results (n = 9)
|
|
+
|
|
|
+
|
|
|
|
2
|
12. Produce action plan to reduce stress & improve social support (n = 7)
|
|
+
|
|
|
+
|
|
+
|
+
|
4
|
13. Consider changes to work practices or design that could precipitate stress & provide adequate equipment to support stress management strategy (n = 4)
|
|
+
|
|
|
+
|
|
+
|
+
|
4
|
14. Promote a supportive workplace culture by promoting the mental health & wellbeing of employees (n = 2)
|
|
+
|
|
|
+
|
|
|
+
|
3
|
15. Structure job design & equipment to minimise risk of mental health (n = 1)
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
Anxiety
(n = 3)
|
16. Include dispute, disciplinary & grievance procedures (n = 4)
|
|
+
|
|
|
+
|
|
|
+
|
3
|
17. Making reasonable adjustments e.g., for social anxiety (n = 2)
|
|
+
|
|
|
|
|
|
+
|
2
|
18. Training for managers to develop people’s skills & in resolving disputes (n = 2)
|
|
+
|
|
|
+
|
|
|
+
|
3
|
Physical Activity
(n = 6)
|
19. Actively promote physical activity opportunities, awareness of activities & reward schemes/incentives (n = 11)
|
|
|
+
|
|
|
|
+
|
+
|
3
|
20. Physical activity should be supported by the physical environment & provide information on sporting activities & local leisure centres/fitness clubs & consider the effect of physical health when designing jobs & allow reasonable adjustments for fitness for work (n = 8)
|
|
|
+
|
|
|
|
+
|
+
|
3
|
21. Provide materials that support sporting activities & raise awareness on importance & health benefits of physical activity (n = 7)
|
+
|
|
+
|
|
|
|
+
|
+
|
4
|
22. Develop & promote a physical activity policy in WHP programme, ideally linked to travel plan (n = 7)
|
+
|
|
+
|
|
|
|
+
|
+
|
4
|
23. Larger organisations should have in place a champions lead for mental health, physical activity, MSK, etc., (n = 3)
|
+
|
|
+
|
|
|
|
+
|
+
|
4
|
24. Monitor organisation’s healthy lifestyle activities through sport & physical activity surveys (n = 2)
|
|
|
|
|
+
|
|
+
|
+
|
3
|
MSK
(n = 7)
|
25. Provide promotional information on the prevention of MSK, links with mental health problems, awareness activities & managing MSK health (n = 5)
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
26. Support staff with MSK through individual care plans relating to pain management (n = 5)
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
27. Structured return to work for those with MSK/long-term illness & support for visiting healthcare professionals (n = 5)
|
|
+
|
|
|
+
|
|
+
|
+
|
4
|
28. Identify risks of MSK & develop action plan to safeguard MSK health (n = 3)
|
|
|
|
|
+
|
|
|
+
|
2
|
29. Offer staff with MSK self-management courses/training or physiotherapy services (n = 3)
|
+
|
|
|
|
+
|
|
+
|
+
|
4
|
30. Allow staff with MSK to access physiotherapy during the day (n = 3)
|
|
+
|
|
|
+
|
|
|
+
|
3
|
31. Work-based Care Plans should consider individual’s MSK health & be adapted to maximise health (n = 2)
|
+
|
|
|
|
+
|
|
|
+
|
3
|
Healthy Food
(n = 6)
|
32. Provide promotional information on healthy food choices, dietary issues, nutritional content, weight management & allergens (n = 14)
|
+
|
|
|
+
|
+
|
|
+
|
+
|
5
|
33. Availability of healthy & balanced food in the workplace & for social & company events (n = 12)
|
|
|
|
+
|
+
|
|
+
|
+
|
4
|
34. Limit unhealthy snacks, including in vending machines (n = 12)
|
|
|
|
+
|
+
|
|
+
|
|
3
|
35. Policy on procuring local suppliers for food, nutrition policy, health & wellbeing plan, or healthy eating statement developed with input from staff (n = 12)
|
+
|
|
|
+
|
+
|
|
+
|
+
|
5
|
36. Healthy eating campaigns to raise awareness on the benefits of healthy eating, how to prepare & weight management (n = 3)
|
+
|
|
|
|
+
|
|
+
|
|
3
|
37. Support for staff to lose weight, improve diet, & enable healthy eating choices (n = 2)
|
+
|
+
|
|
+
|
+
|
|
+
|
+
|
6
|
Smoking
(n = 5)
|
38. Implement smoke-free policy which bans smoking in the workplace grounds & prohibits the use of e-cigarettes in open areas = (n = 9)
|
+
|
|
|
|
+
|
|
+
|
+
|
4
|
39. Regular promotional information on the risks of smoking & smoking cessation services & campaigns & support services (n = 9)
|
+
|
|
|
|
+
|
|
+
|
+
|
4
|
40. Signpost smoke-free areas & promote the health benefits of smoking cessation/harm reduction (n = 9)
|
|
|
|
|
+
|
|
|
|
1
|
41. Raise awareness by promoting & encouraging staff to attend smoking cessation services (n = 5)
|
+
|
|
|
|
+
|
|
|
|
2
|
42. Allow time off to attend stop-smoking campaigns (n = 4)
|
+
|
|
|
|
+
|
|
|
+
|
3
|
Substance misuse
(n = 5)
|
43. Run awareness raising sessions & raise awareness of the harms of alcohol & drug misuse & induction (n = 13)
|
+
|
|
|
|
+
|
|
+
|
+
|
4
|
44. Ensure employees are aware of the distinction between illegal substances & prescription drugs (n = 13)
|
+
|
|
|
|
+
|
|
|
+
|
3
|
45. Embed an alcohol & substance abuse policy which prohibits alcohol during work (n = 9)
|
|
|
|
|
+
|
|
+
|
|
2
|
46. Implement a code of conduct for alcohol & substances outlining behavioural expectations around alcohol, drugs & other substances & address this during inductions (n = 6)
|
+
|
|
|
|
+
|
|
+
|
|
3
|
47. Provide training on alcohol awareness & specialist support for alcohol misuse cases & promote responsible drinking through an external agency (n = 3)
|
+
|
|
|
|
+
|
|
+
|
|
3
|
Food hygiene
|
48. High food hygiene score, kitchen facilities should be safe for preparation & storage of food (n = 7)
|
|
|
|
+
|
+
|
+
|
|
|
3
|
Policy, optimisation strategy
(n = 4)
|
49. Enhance people management, staff engagement & satisfaction through workforce feedback with surveys (n = 12)
|
|
|
|
|
+
|
|
+
|
+
|
3
|
50. Develop a health & wellbeing policy (n = 5)
|
|
|
|
|
+
|
|
|
|
1
|
51. Ensure safety procedures are followed (incl. Safety clothing/equipment) & ensure equipment is safe & available (n = 1)
|
|
|
|
|
+
|
|
+
|
+
|
3
|
52. Ensure a healthy workplace environment by optimising it to support the health of staff & maintain all facilities (incl. kitchen equipment) (n = 1)
|
|
|
|
|
+
|
+
|
+
|
+
|
4
|
EDI,
org. culture
& tackling inequalities
(n = 6)
|
53. Develop a policy for ethnic & religious diversity & disability policy to promote value, trust, employment & retention of staff & disadvantaged groups (n = 2)
|
|
|
|
|
|
|
|
+
|
1
|
54. Raise awareness & offer support for long-term medical conditions.
|
+
|
|
|
|
+
|
|
+
|
+
|
4
|
55. Promote positive links between health & work & reduce the stigma related to work & stress
|
+
|
+
|
|
|
+
|
|
|
+
|
4
|
56. Record demographic information
|
|
|
|
|
|
|
+
|
+
|
2
|
57. Remove things from the workplace which can be detrimental to staff wellbeing (e.g., discrimination)
|
|
|
|
|
+
|
|
+
|
+
|
3
|
58. Guide managers to support staff with personal issues (e.g., bereavement) & recognise needs & support staff affected by mental health
|
+
|
+
|
|
|
+
|
|
+
|
+
|
5
|
|
Total count
|
30
|
23
|
5
|
6
|
49
|
2
|
39
|
46
|
98
|