Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Promotion

First Committee Member

Dr. Paul Estabrooks

Second Committee Member

Mrs. Chris Blanke

Third Committee Member

Dr. Lynette Smith

Fourth Committee Member

Dr. Sharon Medcalf


Due to increasing obesity rates, public health approaches must focus on improving healthy behaviors and reducing the risk of obesity-related health problems (“Nebraska State Nutrition Profile,” 2012; “State of Obesity,” 2016). Worksites offer opportunities to stimulate behavior change through environmental supports and provide natural structures for social support; therefore, worksites are ideal locations for teaching and implementing health promotion programs (Beresford et al., 2001; Salinardi et al., 2013; Sorensen et al., 1996; Touger-Decker et al., 2008). The Social Ecological Model (SEM), which illustrates that various factors are intertwined at multiple levels to influence behaviors, has been shown to produce significant results when used in health promotion interventions (Beresford et al., 2001; McLeroy, Bibeau, Steckler & Glanz, 1988; Sorensen et al., 2004; Sorensen, Linnan & Hunt, 2004).

This study was a multiple case-study design with a pretest-posttest evaluation of a multileveled intervention informed by the SEM, and strived to answer the following research question: to what extent does a healthy work environment, measured by a health-related environmental audit with organizational feedback, and individually targeted, existing, evidence-based intervention change employee behaviors? Seven businesses, roughly 575 total employees, within the Four Corners Health Department district were recruited to participate in the worksite wellness program called “Path to Wellness…Eat Fit Thrive.”

At the individual level, the SuperTracker Worksite Wellness Toolkit, an evidence-based program that provides employees with personalized recommendations, helps in creating health goals, and can easily track calorie consumption, energy expenditure and change in weight over time, was utilized. The toolkit incorporates the SuperTracker, a free, online diet and physical activity tracking tool, which was implemented to improve healthy eating and assess behavior change. Individual assessments included physical measurements as well as a questionnaire that analyzed dietary behaviors. The intervention was administered over eight weeks, and physical and behavior changes were measured.

The Checklist of Health Promotion Environments at Worksites (CHEW) is an auditing tool that was used to evaluate the physical and informational environments of each worksite. The entire CHEW assessment was completed during the pretest phase of the study. Individual and overall reports of the businesses were composed and given to employers to display positive characteristics of the worksite, areas that could be improved to create a healthier work environment, and the accrued participant results.

Seventy-five participants were enrolled in the program, and fifty-two participants completed the post-assessment. This study found that participants in the multilevel intervention significantly improved various health measures, including weight (p=0.001), BMI (p=0.001), eating habits (p=0.001), waist circumference (p=0.009), minutes of physical activity per day (p=0.016), and systolic blood pressure (p=0.025).

Public health professionals need to think upstream and recognize the impact that multilevel interventions could have on the health and well-being of their communities. Finding the most effective and efficient ways to improve healthy behaviors and reduce the risk of obesity-related health problems is crucial, as obesity has become a national epidemic. Multilevel interventions targeting health promotion might be an approach that significantly reduces this chronic disease.

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