Assessing Personal Strengths for Wellness: Improving Upon the HRA With Judd Allen

A New Direction in Personal Assessment

Overview

• Provide background on HRA• Discuss challenges faced by HRA • Discuss a strengths-based approach

to personal assessment • Share future research goals

Health Risk AppraisalA health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Commonly a HRA incorporates three key elements – an extended questionnaire, a risk calculation or score, and some form of feedback i.e. face-to-face with a health advisor or an automatic online report.

The Centers for Disease Control and Prevention define a HRA as: “a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.”

http://en.wikipedia.org/wiki/Health_risk_assessment

HRA MeasuresThere are a range of different HRAs available, however most capture information relating to:• Demographic characteristics – age, sex• Lifestyle – exercise, smoking, alcohol intake, diet• Personal and family medical history (in the US, due to the

current interpretation of the Genetic Information Non-discrimination Act, questions regarding family medical history are not permitted if there is any incentive attached to taking a HRA)

• Physiological data – weight, height, blood pressure, cholesterol

• Attitudes and willingness to change behavior in order to improve health

http://en.wikipedia.org/wiki/Health_risk_assessment

HRA GoalsThe main objectives of a HRA are to:

• Assess health status• Estimate the level of health risk• Inform and provide feedback to participants to

motivate behavior change to reduce health risks

http://en.wikipedia.org/wiki/Health_risk_assessment

HRA HistoryThe original concept of the HRA can be traced back to a project, led by Dr. Lewis C. Robbins of the Public Health Service in Framingham Massachusetts. The study was based on in-depth longitudinal studies of 5,000 families. Original guidance for personal assessment was available in 1970. It wasn't until 1980, when the Centers for Disease Control and Prevention released a publicly available version, that the HRA became widely used, particularly in workplace settings.

http://en.wikipedia.org/wiki/Health_risk_assessment

Lifestyle Change Happens in Clusters

For better and for worse health behaviors spread from person to person. The behaviors investigated so far are: Healthy

EatingSmoking

Physical Activity

Alcohol Abuse

Happiness

Source: Framingham Heart Health Study 1971 – 2007 of 4,439 friends, family and neighbors sited in Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives by Nicholas A. Christakis and James H. Fowler, New York: Little, Brown and Company, 2009.

HRA EfficacyExtensive research has shown that HRAs can be used effectively to:• Identify health risk factors• Predict health-related costs• Measure absenteeism and presenteeism• Evaluate the efficacy and return on investment of health

promotion strategies

It is generally accepted that HRAs are most effective at promoting behavior change when they form part of an integrated, multi-component health promotion program. The HRA is used primarily as a tool to identify health risks within a population and then target health interventions and behavior change programs to address these areas.

http://en.wikipedia.org/wiki/Health_risk_assessment

White Paper on HRAs

A Framework for Patient-CenteredHealth Risk Assessments

Providing Health Promotion and Disease Prevention Ser vices to Medicare Beneficiaries

Ron Z. Goetzel, PhD; Paula Staley, MPA, RN1; Lydia Ogden, PhD, MPP; Paul Stange, MPH1; Jared Fox, PhD, MPP; Jason Spangler, MD, MPH; Maryam Tabrizi, MS; Meghan Beckowski, MPH; Niranjana Kowlessar,

http://www.cdc.gov/policy/opth/hra/FrameworkForHRA.pdf

HRA Challenges • Medical implications seem most appropriate

in primary care conversation• Privacy, trust and economic concerns make

the employer and health plan less appropriate for HRA administration (HIPA, ADA, Incentives in Health Care Reform)

• Low completion rates make HRA less suitable for program planning/evaluation

A Cultural Perspective on HRAs • Medical, illness and death framework

versus wellness quality-of-life framework

• Risk language (negative framework) versus lifestyle strengths (positive framework)

• Individual focus may undercut attention to supportive environments

StrengthsBuilder Measures

• Lifestyle improvement goals• Past lifestyle change successes• Personal lifestyle strengths (e.g., not

smoking, physical activity, etc.)• Support system strengths

Employees Are Attempting to to Achieve Healthier Lifestyles

Last Year’s Goals Attempted at Least One Goal

Yes 86%

No 14%Lifestyle Change YesLose weight 69.9%Eat healthier 80.6%Increase physical activity 81.4%Manage stress 77.6%Improve social relationships 67.0%Stop smoking 21.9%Address alcohol or other drug abuse problems 15.2%

Increase Health Screenings 70.1%Other lifestyle goal 4.7%

Some Employees are Successful

Not Successful

17%

Moderately Successful

53%

Very Successful

30%

Employees Are Planning for Lifestyle Improvement

Next Year’s Goals Planning to Pursue at Least One Lifestyle Change Goal

Yes 79%

No 21%

Future Lifestyle change YesLose weight 63.2%Eat healthier 60.9%Increase physical activity 70.7%Manage stress 57.1%Improve social relationships 33.8%Stop smoking 6.0%Address alcohol or other drug abuse problems 1.5%Increase health screenings 33.8%Other lifestyle goal 0.8%

Cultivating Healthy Behavior

Behavior Choices

Norms

Touch Points

ClimatePeer Support

Shared Values

Assessing Our Personal Wellness Zones

At Work Among Friends

At Home In the Community

Research Agenda• Can we use measures of lifestyle strengths to predict

health and economic outcomes (adapting HRA research findings)?

• Will a strengths-based approach to individual assessment be more appealing to employees?

• Is the new approach a better starting place for follow-up (coaching, targeted health information, peer mentoring, and program recruitment)?

• Is the new approach suitable for program planning and evaluation?

• What impact does the new approach have on the wellness culture (shared values, norms, climate etc.)?

Likely Finding

Success = Initiative + Support