HW425 Unit 2 Needs Assessment Example

Forty-One Percent at Risk, Nine Percent Ever Told: A Unit 2 Needs Assessment for an Eleven-Store Grocery Chain

[Student Name]

Purdue University Global

HW425: Health and Wellness Programming - Design and Administration

Unit 2 Needs Assessment

[Instructor Name]

[Date]

Tallgrass Market, its employees, survey results and plan data are composite; the risk test's validation study and the prevention research cited are real.

The Request

In March, the two owners of Tallgrass Market, a family-owned grocery chain, asked the human resources department to "do something to get our people healthier." They had read about employer wellness programs and were concerned about rising health plan costs. The request named no health problem, no group and no budget. This assessment set out to find out whether there was a specific need worth addressing, among whom and with what constraints.

Employer Profile

Tallgrass Market operates eleven stores in two counties, with 740 employees. Fifty-eight percent, about 430, work part time. The chain's self-funded health plan covers the 310 full-time employees and their families. Stores run three shifts: day, evening and, at seven of the eleven stores, an overnight stocking crew that clocks in at ten and leaves after dawn, staffed by 64 employees; for most of them Spanish is the language of home. Each store has a pharmacy, and the chain employs a retail dietitian who gives store tours and writes the weekly newsletter.

Source One: Anonymous Survey

An anonymous paper and online survey, offered in English and Spanish, included the seven questions of the CDC Prediabetes Risk Test, which is based on a validated self-assessment score for diabetes risk using age, sex, family history, high blood pressure, physical activity and weight (Bang et al., 2009). A score of 5 or higher indicates high risk for prediabetes. The survey also asked whether a clinician had ever told the respondent they had prediabetes and when they could attend a program.

Results:

1. Responses: 402 of 740 employees, 54 percent.

2. High risk, score 5 or higher: 41 percent of respondents, rising to 68 percent among those aged 55 and older.

3. Ever told by a clinician they had prediabetes: 9 percent.

4. Preferred program time: 52 percent chose "during my shift, paid," 23 percent "right before or after my shift," 11 percent "weekends."

The gap between 41 percent at high risk and 9 percent ever told is the assessment's central finding. Most employees at risk do not know it.

Source Two: Health Plan Aggregate Data

The plan administrator provided aggregate, de-identified data for the 310 covered employees. Over the past year, 11 percent had a diagnosis of type 2 diabetes, and diabetes-related claims made up a growing share of plan spending. Because part-time employees are not on the plan, these data describe only full-time staff.

Source Three: Focus Groups

Four focus groups of six to eight employees each were held: two with day-shift staff, one with evening staff and one, in Spanish, with overnight stockers. Common themes were limited time, fatigue and food at work; day staff said the break room vending machines were the only option on short breaks. Overnight stockers said they rarely received company communications, never saw the newsletter and would not attend anything after their shift ended at 6:30 a.m. Several said their supervisors would not release them from the floor for anything that was not required.

What the Three Sources Agree On

The survey, the plan data and the focus groups were collected separately and in different ways, yet they point in the same direction. The survey shows a large share of employees at high risk and unaware of it. The plan data show diabetes already present among full-time staff and growing as a share of spending. The focus groups explain why employees have not acted: limited time, food options at work that make healthy eating hard and a sense that company programs are not meant for them. When three independent sources agree, a planner can have more confidence that the need is real and not an artifact of one method.

The sources also disagree in one useful way. The survey suggests broad interest in a program held on paid time, but the focus groups add that supervisors may not release staff even for a paid session. That tension, between willingness and permission, will shape the design more than any health statistic.

Why Prediabetes

The evidence points to diabetes prevention as a specific, addressable need. In the federally funded prevention trial, coached changes in diet and exercise kept many more high-risk adults from crossing into diabetes during roughly three years of follow-up than a placebo pill did (Diabetes Prevention Program Research Group, 2002). The CDC's National Diabetes Prevention Program now offers a lifestyle change program based on that trial, and the participant-level evaluation of its first four years tied each extra session attended to additional weight lost (Ely et al., 2017).

The owners asked for health in general, and the evidence answered with a specific need: four in ten employees who answered the survey are at high risk for prediabetes, and nearly all of them have never been told.

Who the Evidence Barely Reached

A needs assessment should say where its evidence is thin. Three groups were poorly represented.

1. Overnight stockers. Only 14 of 64 returned the survey, 22 percent, compared with 54 percent overall. The single focus group was the main source of their views.

2. Part-time employees. They were included in the survey but not in the health plan data, so claims-based evidence describes only full-time staff.

3. Employees who did not respond. Those who skipped the survey may differ from those who answered; people who suspect a health problem may be more or less likely to respond.

What the Owners Should Not Expect

A needs assessment can also prevent false hopes. The owners mentioned health plan costs as part of their motivation. The evidence gathered here supports a prevention program for health reasons, but it does not suggest that such a program would lower claims quickly. Diabetes that is prevented in a given year would show up as avoided costs only over several years, and only for the full-time staff on the plan. Saying so now protects the program from being judged later on a measure it was never designed to move.

Constraints for Planning

The assessment identified constraints any program must address: supervisors' reluctance to release staff, the overnight shift's schedule and language, the lack of break-time healthy food and the fact that part-time employees are outside the health plan.

Conclusion

Tallgrass Market has a clear, measurable need: a large share of its workforce is at high risk for type 2 diabetes and unaware of it. A diabetes prevention program offered on paid time, in English and Spanish and at times overnight staff can attend would fit the evidence. The next step is to set objectives that define what such a program would need to achieve.

References

Bang, H., Edwards, A. M., Bomback, A. S., Ballantyne, C. M., Brillon, D., Callahan, M. A., Teutsch, S. M., Mushlin, A. I., & Kern, L. M. (2009). Development and validation of a patient self-assessment score for diabetes risk. Annals of Internal Medicine, 151(11), 775-783. https://doi.org/10.7326/0003-4819-151-11-200912010-00005

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393-403. https://doi.org/10.1056/NEJMoa012512

Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., Rolka, D. B., & Albright, A. L. (2017). A national effort to prevent type 2 diabetes: Participant-level evaluation of CDC's National Diabetes Prevention Program. Diabetes Care, 40(10), 1331-1341. https://doi.org/10.2337/dc16-2099