Abstract Body: Low-wage workers comprise 1/3 of workers in the U.S., are essential in many workplaces, and have high risk of cardiometabolic conditions compared to higher-wage workers. Workplaces have the potential to reduce health inequities by offering targeted employee health programs, however, these resources are often underutilized by low-wage workers. Mobile health tools (e.g., SMS, activity trackers) are effective in increasing engagement in health interventions, but their acceptability among low-wage workers is not well understood. This study aimed to explore barriers and facilitators of engagement in workplace health programs among low-wage hospital workers.
Methods
Semi-structured qualitative interviews elicited workers’ experiences with workplace health programs, perspectives on mobile health tools, and suggestions for improving engagement. Participants were hospital service workers (janitorial and food service staff; n=43) in a San Diego health system. Interviews were audio-recorded, transcribed, and analyzed by two independent raters using Dedoose 9.0.107 software and structured thematic analysis.
Results
Participants (M age=49 years, range: 21-65) were mostly women (76%), Latinx (88%), and many preferred Spanish (45%). They reported low utilization of workplace health promotion or employee assistance programs. Barriers to engagement included lack of awareness, concerns about privacy, stigma, scheduling challenges, lack of programs in preferred languages, lack of time, and competing needs (e.g., food/housing insecurity). Recommended solutions included in-person vs. email program announcements, increased privacy, flexible delivery modality (e.g., phone, video), flexible scheduling, and resources for social needs (e.g., transportation, childcare, food). They reported high acceptability and willingness to use SMS and activity trackers. Many reported prior use of activity trackers (e.g., FitBits) and use of texts for health purposes (e.g., to communicate with a provider), but described important limitations (e.g., accessing texts only on breaks; not being allowed to wear watch-style trackers in food service work).
Conclusions
To improve health equity and engagement in health programs among low-wage workers, employers should consider providing face-to-face announcements, flexible modality and scheduling, increased privacy assurances, social needs resources, and incorporation of mobile health tools - while considering important limitations.