Worksites offer an environment in which effective behavioral changes can be promoted among large populations (Minkler and Wallerstein, 1997). Several studies used models of participatory research and included individuals from the worksite in the intervention development process. Although the levels of intensity of the interventions and the levels of participation in the interventions varied, those that were most successful used multiple strategies across multiple levels (the individual, the family, and the environmental levels).
According to the Diet Report’s review of worksite studies (Agency for Healthcare Research and Quality, 2001a), fat intake was the primary outcome measured in three studies (Bauer et al., 1985; Sorensen et al., 1992; Strychar et al., 1998), fruit and vegetable consumption was the primary outcome measured in one study (Buller et al., 1999), and five studies addressed fat intake and fruit and vegetable consumption combined (Anderson and Dusenbury, 1999; Hanlon et al., 1995; Sorensen et al., 1992, 1996; Thompson et al., 1999; Tilley et al., 1999a). Interventions were delivered by a diverse group of professionals, including dietitians (n = 3 studies), doctors or medical staff (n = 2 studies), and peers or counselors (n = 2 studies). Family components were included in at least three studies (Bauer et al., 1985; Sorensen et al., 1992; Tilley et al., 1999a). Environmental changes such as increasing the availability of healthy food choices and labeling of foods were notable in two studies (Sorensen et al., 1992, 1996).
Multiple behavioral components were included in interventions addressing fat intake only. Four studies incorporated multiple theoretical perspectives into their intervention designs, including community organization and activation theories, social and adult learning theory, stages of change, social support, and the health belief model (Kristal et al., 2000b; Sorensen et al., 1992, 1996; Strychar et al., 1998). For example, the Treatwell study incorporated employee advisory boards to plan interventions that included organized screenings, courses, goal setting, and cafeteria modifications, in addition to a family component (Sorensen et al., 1992). The Working Well study included interactive activities and contests plus multiple environmental changes, such as altering food choices in vending machines, with significant effects on the levels of both fruit and vegetable consumption and fat intake (Sorensen et al., 1996).
The Next Step Trial targeted both fruit and vegetable consumption and fat intake for change. Strategies reflected various theoretical perspectives and included nutrition classes, individualized feedback on intakes, mailed self-help materials, and a family component to enhance home support for change (Kristal et al., 2000a; Tilley et al., 1999a). Measurements obtained from a food frequency questionnaire indicated at the 1-year follow-up that the intervention groups had significantly increased their levels of fruit and vegetable consumption and lowered their total level of fat intake. However,