Interactive Health Communications and Employee Assistance Programs:
What We Have Learned

Deborah M. Galvin, Ph.D., SAMHSA
EAPA, New Orleans, November, 2003

Distance and on-line learning are becoming fundamental tools in a newly defined field, "Interactive Health Communications." This field focuses on the individual's interaction with health information transmitted with multimedia communication technologies designed to share health information or provide guidance and support on a health-related issue. According to the IOM report, "The Future of Public's Health in the 21^st Century" (2002), interactive health communications has been shown to be a successful method to enhance public health. A recent Harris poll conducted in 2002 estimated 101 million U.S. web users have sought health care information on line in the past year.

Over the past decade, we have invested more and more in interactive health communications, including the distance and on-line learning and training process with on-line courses, websites, tv satellite, video-conferences, teleconference, video streaming and the use of multifarious multimedia technologies. There have been estimates that in the past year online distance learning has become a $1.8 billion market in tuition revenues for institutions reaching thousands of students and growing 40 percent annually. (Eduventures, 2002) According to Information Week (January 2000), workplaces have priced conventional classroom instruction at approximately $75 an hour, with full-week programs costing $3,000 to $5,000 whereas computer-based training costs about half that or less. Training via the Web has no seat, time or travel restrictions and can be provided globally at no extra cost.

For EAPs, the investment in distance learning and training has been found to be an effective and equitable means of providing employers, employees and supervisors with appropriate substance abuse prevention and early intervention and health/wellness learning and training as well as ongoing, supplemental training for EAPs themselves.

These courses are becoming more popular for EAPs to use in their workplace as they:

• Maintain confidentiality and the integrity of the learning environment;
• Reach a wider audience of employees and their families including those with disabilities;
• Offer content from a wider range of sources;
• Reach a critical mass of participants to affect change and/or workplace norms/culture;
• Reduce the stigma of discussing substance abuse and related issues of co-morbidity;
• Allow for learners to learn at their own pace at their own time in a flexible, accessible manner within the workplace setting, home, public library, local school or other available setting;
• Increase the reach and contact of the EAP to all employees and their families in an unobtrusive fashion;
• Increase of response of employees and their families in obtaining early intervention;
• Reduce stress for employees;
• Increase understanding of substance abuse issues and their impact on health/wellness and workplace issues;
• Increase understanding of risky behaviors including drinking.

One of the most important factors for successful distance and on-line learning is a caring, concerned EAP, that is confident, experienced, at ease with the on-line learning materials and technologies, uses the media creatively and maintains a high level of interactivity with the employees. Any successful program must focus on the employees' needs rather than the technology itself. Additionally, it is essential to consider the employees' cultural and socioeconomic background, their discipline/occupation, their ages, familiarity with distance learning and delivery systems and the needs of the employer.

To enable a successful learning experience within this environment, distance and on-line learning programs should provide the following elements:

• Presentation of materials should be up-to-date, accurate, compelling and engaging including use of color, design, size of print, amount of information on a page, graphics, sound, and animation.
• Open forum or contact with EAP should be available and accessible for all learners
• Support should be provided including answers to questions
• Materials should meet the needs of the employer, employee and EAP.

To date, we have found a variety of impacts of distance and on-line learning including:

• improved decision-making
• more cost-effective course delivery
• enhanced exchange between EAPs, employees and their families and retirees

An example of an interactive health communication tool which has a broad health promotion approach (including substance abuse prevention messages) is the SAMHSA website: Getfit@SAMHSA.Gov.

GetFit@SAMHSA.Gov is a research-based health/wellness workplace oriented Web site which is an effective interactive health communications tool. Available at http://getfit.samhsa.gov, this free Web site is a "one-stop shop" for employees and their families seeking information on or need help with physical health, mental health, or alcohol or drug issues. GetFit aids EAPs in providing substantial, state-of-the-art information on substance abuse issues in a nonthreatening fashion which includes health risk assessment tools such as alcohol screening and a wealth of information for employees and their families on issues related to health/wellness, stress reduction, and healthy lifestyles. For those who travel, there is a convenient AA finder across the U.S.; a treatment facility finder; and a variety of tools to better understand substance abuse and its related issues. The website has a range of self-screening tests (e.g., alcohol, depression, etc.) designed to provide front line prevention interventions to many who may be unaware that their behaviors could be unsafe or dangerous. In these cases, employees and their families are able to address their issues sooner.

GetFit was adopted from a similar website developed by Dr. Robert Matano's 3-year SAMHSA Workplace Managed Care grant program. In this study, the website was found to be effective in increasing the number of people who contact their EAP and reducing the stigma associated with seeking assistance from an EAP. Further, the program was an effective intervention for reducing alcohol consumption in moderate and high risk drinkers. The website was further enhanced according to research findings from SAMHSA National Registry of Effective Programs (NREP) of Drs. Snow, Heidrich and Cook which supported the addition of health/wellness information, leading to greater use and familiarity with the website for employees and their families.

EAPs can specifically tailor GetFit, on-line, to meet the needs of their programs. Currently there are a number of EAPs who have adopted the program including Operation Redblock (a transportation oriented peer to peer program) and the Association of Flight Attendants. EAPs can provide contact information; background history and documentation of their approach, methods, and services; and other pertinent information for their specific populations. Each adopter receives their own unique username, such as GETFIT@company name.net. Additionally, customizing GetFit allows EAPs to select graphics and display logos.

From June 2003 to October 2003, since Get Fit has been available, the entire site (generalized and tailored) has received more than 740,000 hits; more than 1,200 hits per day; and close to 14,000 unique visitors. From looking at the Get Fit site tailored by Operation Redblock, it is notable that there were 144,643 hits for the site from June to October, with an average per day hit of 947 and unique visitors equaled 3,021. This means that the site can be a useful means for EAPs to reach employees and their families; and that many people return to the site continuously for additional information and advice.

In an evaluation of the "On the Right Track," the Redblock tailored version we found the following:

• More than 75% of Captains in the Redblock program who reported that they referred employees to On The Right Track stated that co-workers or supervisors had communicated that 1) they accessed the website; and 2) they found On The Right Track provided them with new information regarding substance abuse prevention and other health issues.
• More than 90% of Captains who reported that they referred employees to On The Right Track stated that 1) On The Right Track assisted them in being a better peer or manager; 2) They agreed or strongly agreed that On The Right Track provided them with a vehicle to provide the appropriate information to employees who did not wish to discuss their substance abuse or health issues; and 3) On The Right Track represented an important source of information and opportunity for employees who did not wish to discuss their substance abuse or health issues with others.

Further, Get Fit, across all those workplaces who have adopted it, has proven to be a positive health communications method for workplaces to provide immediate information and resources for new and emerging health problems including new substance abuse issues such as the misuse of oxycotin; SARS, anthrax and post traumatic stress disorder following 9/11. Those from the American Flight Association and Operation Redblock who travel frequently found the AA locator a considerable assistance in relapse prevention. Likewise, many users reported that the site was especially beneficial in assisting family members and friends in obtaining appropriate information and treatment.

Conclusion

The use of interactive health communications technologies in the work of Employee Assistance Programs has been a growing practice across the Nation. For workplaces, the use of effectual substance abuse prevention and health/wellness communications has been shown to raise the awareness of employees and their families; provide them with the impetus and adeptness necessary to decrease risks and increase resiliency while strengthening and stimulating positive attitudes; and assist them with more readily finding the appropriate support from EAPs and others in their health care system. These technologies also encourage a workplace culture in which social norms support healthy habits and improved quality of life while enhancing employee satisfaction with the EAP, health care system and workplace. Finally, there is value to be gained by investing and implementing interactive health communications technologies in EAP programs within the workplace that builds essential communication networks between the EAP, health professionals and employees and their families.