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Health Education & Behavior
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Using Theory to Understand the Multiple Determinants of Low Participation in Worksite Health Promotion Programs

Laura A. Linnan, ScD, CHES

University of North Carolina at Chapel Hill, School of Public Health, Chapel Hillllinnan{at}sph.unc.edu

Glorian Sorensen, PhD, MPH

Dana Farber Cancer Institute, Boston

Graham Colditz, MD, DrPH

Harvard Medical School, Boston

Neil Klar, PhD

Department of Biostatistics, Dana Farber Cancer Institute, Boston

Karen M. Emmons, PhD

Dana Farber Cancer Institute, Boston

Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective—political economy of health—that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.

Health Education & Behavior, Vol. 28, No. 5, 591-607 (2001)
DOI: 10.1177/109019810102800506
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