A Systematic Review of Internet-Based Worksite Wellness Approaches for Cardiovascular Disease Risk Management: Outcomes, Challenges & Opportunities

Context The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. Evidence Acquisition We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing – weight, BP, lipids, smoking, physical activity, diet, and blood glucose. Evidence Synthesis A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6 – 24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Conclusion Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.

A model of school managerial control : the systematic analysis of managerial behaviors, processes, and indicators

The theoretical construct of control has been defined as necessary (Etzioni, 1965), ubiquitous (Vickers, 1967), and on-going (E. Langer, 1983). Empirical measures, however, have not adequately given meaning to this potent construct, especially within complex organizations such as schools. Four stages of theory-development and empirical testing of school building managerial control using principals and teachers working within the nation's fourth largest district are presented in this dissertation as follows: (1) a review and synthesis of social science theories of control across the literatures of organizational theory, political science, sociology, psychology, and philosophy; (2) a systematic analysis of school managerial activities performed at the building level within the context of curricular and instructional tasks; (3) the development of a survey questionnaire to measure school building managerial control; and (4) initial tests of construct validity including inter-item reliability statistics, principal components analyses, and multivariate tests of significance. The social science synthesis provided support of four managerial control processes: standards, information, assessment, and incentives. The systematic analysis of school managerial activities led to further categorization between structural frequency of behaviors and discretionary qualities of behaviors across each of the control processes and the curricular and instructional tasks. Teacher survey responses (N=486) reported a significant difference between these two dimensions of control, structural frequency and discretionary qualities, for standards, information, and assessments, but not for incentives. The descriptive model of school managerial control suggests that (1) teachers perceive structural and discretionary managerial behaviors under information and incentives more clearly than activities representing standards or assessments, (2) standards are primarily structural while assessments are primarily qualitative, (3) teacher satisfaction is most closely related to the equitable distribution of incentives, (4) each of the structural managerial behaviors has a qualitative effect on teachers, and that (5) certain qualities of managerial behaviors are perceived by teachers as distinctly discretionary, apart from school structure. The variables of teacher tenure and school effectiveness reported significant effects on school managerial control processes, while instructional levels (elementary, junior, and senior) and individual school differences were not found to be significant for the construct of school managerial control.