Achieve changes in health behavior, organizational wellness goals and the ROI to justify your efforts.

An initiative to provide shift-working British police officers with ‘information’ about strategies for sleep, eating, exercise and family life was found to make no difference in their health behaviors. 1

This initiative provides us with three insights into how to providing wellness programs for shiftworkers.

First, shiftworkers, like their non-shift working colleagues, do not change their health behaviors as a result of ‘information providing,’ wellness programs alone.

Secondly, shiftworkers, unlike their non-shift working colleagues, face additional constraints and barriers in accessing wellness programs, even if they are only ‘information providing’.

And finally, shiftwork information that does not account for individual differences in shiftwork adaptability and shift schedules is of little value to shiftworkers.

If you wish to engage shiftworkers and achieve changes in behavior, organizational wellness goals and the ROI to justify your efforts, consider the following:

1. To actually change health behaviors, employees need to’ buy-in’ and acknowledge the need to change, form an intention to change and then actually take action to implement the new behaviors.

a. Some shiftworkers who participate in a shiftwork education program have been shiftworkers for 10 or 20 years. They have found ways to cope and may see no need to change.

b. An information/education program for shiftworkers helps to create awareness and can provide some of the participants with useful tips for better sleep or diet. But it should be followed up with an initiative that targets those shiftworkers who are having more difficulty coping. (They are having excessive absenteeism, sick time and/or workplace conflict). A shiftwork specialist or health professional should first complete an assessment to determine the cause of the dysfunction. Then specific strategies can be directed to alleviate the actual cause of the problem.

c. Partners and families can be significant influencers in helping shiftworkers ‘buy-in’ and implement healthy behaviors. But to do so, they must have information about how to help a shiftworker. Information provided to families can be a very simple and cost-effective strategy in this regard.

2. Information programs for shiftworkers are usually generic in nature, that is, they don’t provide strategies based on an individual’s capacity for adapting to shiftwork or the shift schedule they are working. Therefore, aside from getting a few tips, most shiftworkers don’t find much of value in these presentations.

a. Insist that any shiftwork education program is premised on information about individual shiftwork adaptability and the shift schedule being worked.

b. Refrain from calling programs ‘shiftwork’ education because shiftworkers usually do not define ‘shiftwork’ as the problem. They see their issues as problems with sleeping and eating and information initiatives should focus on those subjects along with how to maintain family relationships.

c. A fatigue management program should be a staple of any shiftwork workplace. Though not specifically a health topic, education on strategies to manage fatigue and sleepiness and a review of strategies to reduce organizational factors contributing to fatigue can go a long way to improving health and well-being of shiftworkers.

d. Direct information to families. This is one group for whom ‘information’ about the challenges of shiftwork and how to support the shiftworker is usually very effective. They can effect changes which can be very helpful and supportive for the employee.

3. Depending on the shift schedule, shiftworkers may be more tired or sleep deprived than non-shift working employees.

a. This increases the chances that they may reach for whatever is available to address hunger, and often, these may not be healthy choices.

A successful wellness strategy could, therefore, not even involve the workers themselves, but instead involve an organizational effort to provide easily accessible, healthy food choices on all shifts.

b. Being sleep deprived may also mean that shiftworkers may forego exercise because they don’t have the energy for exercise.

c. Sleepiness and fatigue reduce motivation to act and to change. This means shiftworkers are less inclined to participate in wellness programs directed at health behaviors like smoking, exercise and weight management.

4. Shift schedules, overtime or call-in’s also reduce the opportunity to participate in wellness programs. Programs are often offered only during the day and the shiftworker may be working a different shift or be off work. Or they may sign up to participate in a program only to see their schedule change.

Participating in a wellness program often requires either foregoing or reducing the sleep period or having to come in on a day off. Shiftworkers may find themselves in a catch-22. If they don’t participate they forego an opportunity to potentially improve their health behavior, but if they choose to participate, they forego an opportunity for sleep which is fundamental health behavior.

a. Wellness programming in a shiftwork workplace should be available on all shifts. One option is to schedule programs so that they overlap two shifts. That gives shiftworkers the option of attending at the end of a shift on which they are working or coming in at the beginning of a shift for which they are scheduled to work.

b. Record presentations and make them available to those who were not able to attend in person.

c. Provide on-line health coaches, online courses or access to websites that provide individualized support so shiftworkers have more flexibility to access health resources.

Shiftworkers have been found to have poorer health habits. They smoke more, have less healthy diets and exercise less. Many report gastrointestinal problems and will usually be sleep deprived. They are at greater risk of heart disease, stroke, cancer and auto-immune conditions.  Ensuring they have access to wellness programs is critical, but extra efforts will have to be made to ensure that their specific needs and challenges are accommodated.

1. An Intervention using a self-help guide to improve the coping behaviour of nightshift workers and its evaluation. 2001. Wedderburn, Rankin (HSE Books)