Longitudinal Participation in the American Heart Association's Workplace Health Achievement Index is Associated With Improvements in Workplace Culture of Health

Background: In 2016 the American Heart Association (AHA) launched the Workplace Health Achievement Index (WHAI) to increase implementation of 55 evidence-based policies, programs, and environmental supports (PPE) that promote a workplace culture of health. The WHAI is a voluntary online assessment where the total score is derived from the total PPE score and points for performance metrics based on Life’s Simple 7 data. The total PPE score is comprised by points awarded in 7 science-based domains: Leadership, Organizational and Environmental Policies, Communications, Programs, Engagement, Partnerships, and Reporting Outcomes. To date, companies have had the opportunity to complete the WHAI for three cycles (2015-2016, 2016-2017 and 2017-2018). Over 1,000 companies have completed at least one assessment and 135 companies have participated in in all three cycles. Research Questions: The purpose of this analysis was to answer three research questions: (1) Is annual participation associated with improved workplace culture of health as measured by the PPE total score?; (2) which WHAI domains are associated with the most improvement?; and (3) do results vary by company size? Methods: Data for the 135 companies that participated all three years were assessed. Longitudinal data from this convenience sample were analyzed for the period 2016-2017 and 2017-2018. Mean PPE total scores and domain sub-scores were tabulated to evaluate changes in performance using a linear mixed effects model. Due to the relatively low sample size, data were stratified by two company size categories: smaller (<250 employees) vs. larger (≥ 250 employees). Companies with missing PPE answers were excluded from analysis (n=15). Results: From 2016-2017, companies with complete data (N=120) significantly increased their mean PPE total score by 8.3 points (p=0.038; max points = 151). Total PPE score increased 6 points during 2017-2018; however, improvement was not statistically significant (p=0.167). Moreover, increases were significant (p<0.05) for all 7 domains during 2016-2017 whereas only 2 domains (Organizational and Environmental Policies, and Partnerships) were significant (p<0.05) the following year. Larger companies (n=97) demonstrated higher mean increases across both time periods (8.4 and 6.1, respectively) compared to smaller companies (n=23) (8.1 and 5.3, respectively); however, results were not statistically significant in both time periods for large companies (p=0.075 and p=0.24, respectively) and smaller companies (p=0.41 and p=0.86, respectively). Implications: Annual participation in the WHAI is associated with initial improvements in PPE measures with tapering in further improvements during the second year of tracking. Further efforts and resources, perhaps tailored by company size, are needed to facilitate additional enhancements in company performance over time.