Health Promotion in Small Business A Systematic Review of Factors Influencing Adoption and Effectiveness of Worksite Wellness Programs

Objective: To assess the evidence regarding the adoption and efficacy of worksite health promotion programs (WHPPs) in small businesses. Methods: Peer-reviewed research articles were identified from a database search. Included articles were published before July 2013, described a study that used an experimental or quasiexperimental design and either assessed adoption of WHPPs or conducted interventions in businesses with fewer than 500 employees. A review team scored the study's rigor using the WHO-adapted GRADEprofiler "quality of evidence" criteria. Results: Of the 84 retrieved articles, 19 met study inclusion criteria. Of these, only two met criteria for high rigor. Conclusions: Fewer small businesses adopt WHPPs compared with large businesses. Two high-rigor studies found that employees were healthier postintervention. Higher quality research is needed to better understand why small businesses rarely adopt wellness programs and to demonstrate the value of such programs.