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Assessing Personal Strengths for Wellness: Improving Upon the HRA With Judd Allen

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Assessing Personal Strengths for Wellness: Improving Upon the HRA With Judd Allen

  1. 1. A New Direction inPersonal Assessment
  2. 2. Overview• Provide background on HRA• Discuss challenges faced by HRA• Discuss a strengths-based approach to personal assessment• Share future research goals
  3. 3. Health Risk Appraisal A health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Commonly a HRA incorporates three key elements – an extended questionnaire, a risk calculation or score, and some form of feedback i.e. face-to-face with a health advisor or an automatic online report. The Centers for Disease Control and Prevention define a HRA as: “a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.”
  4. 4. HRA Measures There are a range of different HRAs available, however most capture information relating to: • Demographic characteristics – age, sex • Lifestyle – exercise, smoking, alcohol intake, diet • Personal and family medical history (in the US, due to the current interpretation of the Genetic Information Non- discrimination Act, questions regarding family medical history are not permitted if there is any incentive attached to taking a HRA) • Physiological data – weight, height, blood pressure, cholesterol • Attitudes and willingness to change behavior in order to improve health
  5. 5. HRA Goals The main objectives of a HRA are to: • Assess health status • Estimate the level of health risk • Inform and provide feedback to participants to motivate behavior change to reduce health risks
  6. 6. HRA HistoryThe original concept of the HRA can be traced backto a project, led by Dr. Lewis C. Robbins of thePublic Health Service in FraminghamMassachusetts. The study was based on in-depthlongitudinal studies of 5,000 families. Originalguidance for personal assessment was available in1970. It wasnt until 1980, when the Centers forDisease Control and Prevention released a publiclyavailable version, that the HRA became widely used,particularly in workplace settings.
  7. 7. Lifestyle Change Happens in ClustersFor better and for worse health behaviors spreadfrom person to person. The behaviors investigatedso far are: Healthy Smoking Eating Physical Alcohol Activity Abuse HappinessSource: Framingham Heart Health Study 1971 – 2007 of 4,439 friends, familyand neighbors sited in Connected: The Surprising Power of Our SocialNetworks and How They Shape Our Lives by Nicholas A. Christakis andJames H. Fowler, New York: Little, Brown and Company, 2009.
  8. 8. HRA EfficacyExtensive research has shown that HRAs can be usedeffectively to:• Identify health risk factors• Predict health-related costs• Measure absenteeism and presenteeism• Evaluate the efficacy and return on investment of health promotion strategiesIt is generally accepted that HRAs are most effective atpromoting behavior change when they form part of anintegrated, multi-component health promotion program. TheHRA is used primarily as a tool to identify health risks within apopulation and then target health interventions and behaviorchange programs to address these areas.
  9. 9. White Paper on HRAs A Framework for Patient-Centered Health Risk AssessmentsProviding Health Promotion and Disease Prevention Ser vices to Medicare BeneficiariesRon Z. Goetzel, PhD; Paula Staley, MPA, RN1; Lydia Ogden,PhD, MPP; Paul Stange, MPH1; Jared Fox, PhD, MPP; JasonSpangler, MD, MPH; Maryam Tabrizi, MS; MeghanBeckowski, MPH; Niranjana Kowlessar,
  10. 10. HRA Challenges• Medical implications seem most appropriate in primary care conversation• Privacy, trust and economic concerns make the employer and health plan less appropriate for HRA administration (HIPA, ADA, Incentives in Health Care Reform)• Low completion rates make HRA less suitable for program planning/evaluation
  11. 11. A Cultural Perspective on HRAs• Medical, illness and death framework versus wellness quality-of-life framework• Risk language (negative framework) versus lifestyle strengths (positive framework)• Individual focus may undercut attention to supportive environments
  12. 12. StrengthsBuilder Measures• Lifestyle improvement goals• Past lifestyle change successes• Personal lifestyle strengths (e.g., not smoking, physical activity, etc.)• Support system strengths
  13. 13. Employees Are Attempting toto Achieve Healthier LifestylesLast Year’s Goals Attempted at Least One GoalLifestyle Change YesLose weight 69.9% No 14%Eat healthier 80.6%Increase physical activity 81.4%Manage stress 77.6%Improve social relationships 67.0%Stop smoking 21.9%Address alcohol or other drug abuse problems 15.2% YesIncrease Health Screenings 70.1% 86%Other lifestyle goal 4.7%
  14. 14. Some Employees are Successful Moderately Successful 53% Very Successful 30% Not Successful 17%
  15. 15. Employees Are Planning for Lifestyle ImprovementNext Year’s Goals Planning to Pursue at Least One Lifestyle Change GoalFuture Lifestyle change YesLose weight 63.2%Eat healthier 60.9%Increase physical activity 70.7% No 21%Manage stress 57.1%Improve social relationships 33.8%Stop smoking 6.0%Address alcohol or other drug abuse problems 1.5%Increase health screenings 33.8% YesOther lifestyle goal 0.8% 79%
  16. 16. Cultivating Healthy Behavior Norms Shared Touch Values Points Behavior Choices Peer Climate Support
  17. 17. Assessing Our Personal Wellness Zones AmongAt Work Friends In theAt Home Community
  18. 18. Research Agenda• Can we use measures of lifestyle strengths to predict health and economic outcomes (adapting HRA research findings)?• Will a strengths-based approach to individual assessment be more appealing to employees?• Is the new approach a better starting place for follow-up (coaching, targeted health information, peer mentoring, and program recruitment)?• Is the new approach suitable for program planning and evaluation?• What impact does the new approach have on the wellness culture (shared values, norms, climate etc.)?
  19. 19. Likely FindingSuccess = Initiative + Support

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