Impact of workforce characteristics and monetary incentives on uptake of health and wellbeing initiatives in the United Kingdom

There are economic and social benefits associated with promoting the health and wellbeing (HWB) of workers. The workplace is an important setting for HWB promotion, however, small and medium size enterprises (SMEs) are less likely to offer these programmes. Uptake is also uneven across demographic groups, contributing to inequalities outcomes. This study investigates if uptake of HWB promotion programmes in SMEs differs by employee demographics and if these factors interact with the effectiveness of organisational-level monetary incentives to improve uptake. In a secondary analysis of quantitative data from a cluster-randomised controlled trial, multilevel logistic regression models were fitted to examine the relationship between the outcome (uptake of HWB initiatives) and employee demographics (age, gender, ethnicity, education level). Models included interactions between the trial arm (monetary incentive or control) and employee demographics. Results showed that employees in the incentive arm had similar uptake of HWB initiatives compared to the control (adjusted OR 1.11, CI 0.72, 1.70, p = 0.64). In tests of the demographic factors, employees 55+ years had 56% lower odds of uptake (CI 0.25, 0.76, p = 0.003) compared to employees aged 17 to 24 years and these results were robust to treating age as a continuous variable. There were no statistically significant interactions between the incentive and the other employee demographic groups for the uptake of HWB initiatives. Organisational-level monetary incentives do not appear to differ in their effectiveness according to employee demographics, although some sub-groups appeared under-represented in the trial including ethnic minorities and those with education below degree-level. Older workers in SMEs may be less likely to engage in workplace HWB initiatives and could be targeted in terms of workplace HWB implementation, policy, and research.