tives, short- and long-term disability, including programs for worker compensation, lifestyle, disease management and care, with additional evaluation of the effects of presenteeism on health status. A growing body of evidence shows that factors related to worker well-being—other than those addressed by traditional occupational health programs—have a quantifiable affect on workplace productivity, underscoring the value of extending programs beyond traditional health, safety, and health promotion, and into the realm of health-related behavioral change (Goetzel et al., 1998a; Burton et al., 1999; Sorensen et al., 2004).


The health behavior change approach is based on a strong theoretical foundation. Theoretical models developed by the behavioral and social sciences have guided research on health behavior change. Various theoretical frameworks suggest that worker health is the result of a complex interplay of factors involving the individual worker, the immediate work environment, and factors within the larger contexts in which both the individual worker and the worksite are embedded (Robins and Klitzman, 1988; Sorensen et al., 1995; Baker et al., 1996; Stokols et al., 1996).

The social-contextual model (Sorensen et al., 2003, 2004) integrates multiple social and behavioral theories to describe factors influencing social disparities in health behaviors. Structural forces may influence the social context of workers’ lives, reflected, for example, in their material circumstances or experiences of discrimination, and ultimately may shape health behavior outcomes. In their research, this team of investigators has applied this model to the design interventions for working class and multi-ethnic populations, aimed at health behavior changes such as tobacco control, diet, and physical activity. By applying this model in behavior change strategies, it may be possible to change some elements of the workers’ social context, and also to enhance the quality and relevance of interventions through an understanding of the social realities of workers’ lives.

The social-ecological model (see Chapter 3 and Table 3-1) provides a structure for incorporating theories that operate at various levels of influence, including at the individual, interpersonal, organizational, community, and public policy levels. This approach builds on an array of social and behavioral theories including the Health Belief Model (Rosenstock, 1982; Rosenstock et al., 1988), Theory of Planned Behavior (Expectancy X Model) (Ajzen, 1991; Montano et al., 1997), Social Cognitive Theory (Bandura and Walters, 1963; Baranowski et al., 1997), the Transtheoretical Model (Prochaska and DiClemente, 1994; Prochaska et al., 1997), and the Community Organization Model (Minkler and Wallerstein, 1997).

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