8 Barriers To Wellness Program Participation

Corporate wellness programs are designed to support employees as they identify, adopt, and maintain wellness-enhancing behaviors. They often contain a variety of elements, ranging from physical activity competitions to tobacco cessation programs to educational courses on financial wellness.

These programs have steadily increased in popularity over the past several years. According to one survey, 84% of large employers (defined as having 200 employees or more) offered wellness programs in 2019—up 15 percentage points in the last decade. This number is likely even higher today as employees demand enhanced benefits to offset the negative impacts of the COVID-19 pandemic.

Though wellness programs are on the rise, they often fail to reach their intended population. A ccording to Gartner’s 2021 Employee Value Proposition Survey, only a quarter of employees that have access to mental and emotional well-being offerings make use of them. Similar results were found for physical and financial well-being programs. This poses a significant challenge to organizations hoping to improve the health and well-being of their employees with wellness programs, as the benefits they contain can’t have the desired impact if employees don’t utilize them.

At first glance, these findings may seem perplexing. If wellness programs are in high demand, why are 75% of the employees who have access to them not participating? The answer is that while employees want to be well, there are several under-discussed barriers to participation that make it difficult for them to use their organization's wellness offerings.

Gone are the days when wellness was thought to be determined solely by one’s physical health. Instead, leaders now recognize well-being as a holistic, multi-dimensional phenomenon.

Because well-being is complex and multi-faceted, there is ample room for individuals to differ in their wellness needs. For example, some may have their physical health in order but struggle with their financial wellness. Others may be thriving financially while suffering emotionally. As a result, programs that contain offerings to help employees achieve or maintain wellness in every domain are much more likely to garner high participation rates.

With that said, tackling every area of well-being may not be enough. In any specific domain, the road to wellness doesn’t look the same for everyone. For some, increasing their daily step counts can greatly contribute to their physical well-being. At the same time, individuals with certain physical conditions won’t be able to improve their physical well-being by competing in step-tracking competitions. Similarly, while some can achieve financial wellness through a retirement plan or 401(k) contributions, others require help paying off their student loans. As a result, programs must deploy a one-size-fits-one solution.

To meet employees where they stand, employers must learn about their employees’ individual wellness needs. A good way to accomplish this is to send out a survey that asks employees to rate the usefulness of a wide range of benefits, with a free-response option to specify benefits or resources that were not included. Once an organization has a clear idea of where its employees need wellness help, leaders can create comprehensive programs that incorporate all the dimensions of well-being while offering inclusive and personalized solutions to maximize one’s full potential.

It’s worth emphasizing that a benefits preference survey will likely reveal that no single benefit is universally valued. As such, employers should provide a comprehensive set of benefits, prioritizing the ones that are greatest in demand and align with their goals and objectives. Although no single wellness offering will appeal to everyone, the portfolio of offerings will increase overall participation.

According to the theory of planned behavior, all individuals consider their self-perceived ability to act when deciding whether to attempt something. For instance, many people avoid picking up new talents because they feel they would not be successful if they tried.

Feelings of low self-efficacy frequently appear when individuals are deciding whether or not to adopt or maintain a new healthy behavior. Thus, feelings of low self-efficacy can explain why employees either flow through or get stuck at several stages of the transtheoretical model of behavior change.

Treating low self-efficacy can be difficult. However, researchers have uncovered some effective strategies. For instance, one study found that financial incentives effectively motivate those with low self-efficacy to begin or continue participating in wellness programs. However, this works the best on individuals at the pre-contemplation and contemplation stages.

At the maintenance stage, social support and positive feedback are crucial. To help employees who are unsure of their ability to stick with a newly acquired healthy behavior, employers should organize support groups where workers can help each other stay committed to their healthy habits.

Praise is another essential factor in helping employees gain a strong sense of self-efficacy. However, it is worth noting that the praise does not need to be explicitly directed at their performance in wellness programs. Because feelings of self-efficacy can spill over from one area to another, employers can positively impact participation rates in wellness programs by creating systematic processes that allow managers and peers to express gratitude and recognize employees’ hard work in or outside of the wellness program.

To outweigh the perceived costs of participating in a wellness program and increase its expected utility, programs often offer extrinsic incentives or rewards (e.g., cash payments, discounted gym memberships, company swag, etc.) to employees who participate.

Though rewards can be effective in some circumstances, studies have found that several factors impact how well they motivate employees to participate in a wellness activity or program. For example, researchers have found that incentives are far more effective in certain “program types” that vary based on the benefits they offer. One study found that comprehensive programs, which contain a broad range of offerings, are associated with much stronger intrinsic motivation than more limited programs. Additionally, incentives were more effective in programs that focused on prevention (e.g., managing unhealthy behaviors) than on interventions designed to treat diseases.

Moreover, the impact of incentives appears to diminish over time. This means that incentives are more effective at initiating behaviors than sustaining them, so they are best used to nudge individuals in the pre-contemplation, contemplation, and preparation stages of behavior change. By the time an employee reaches the maintenance stage, incentives may have less value or motivational pull.

It is also worth noting that employees may view some rewards unfavorably. One study found that approximately 9% of participants believed that their wellness program incentives were unfair, with one respondent stating, “This payment is unfair to the employees who choose not to do it for whatever reason. They are penalized for not doing the program.” This reaction was especially common for incentives that took the form of punishments (e.g., withholding benefits from employees who choose not to participate). In response to these types of incentives, one respondent stated that “It is unethical for an employer to hold benefits back in exchange for participation.”

None of this is to say that incentives should be avoided entirely. In many cases, they are one of the best tools an organization has for increasing participation. However, employers must be mindful of how and when they use incentives as they won’t have the same effects in all circumstances, and in some cases, they may not be effective at all.

Some wellness programs include elements that ask employees to reveal potentially sensitive information. For instance, though they have become much less popular in recent years, some wellness programs contain biometrics screenings, which often include measures of a worker’s height, weight, blood pressure, cholesterol, and blood sugar levels.

Unsurprisingly, many employees are reluctant to participate in wellness programs for this very reason. One study found that privacy was the most commonly cited reason among employees who refused to participate. 

Though many employees have strong privacy concerns, there are laws in place to protect them. For example, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which protects sensitive patient health information, applies to wellness programs that are part of a group health plan. Even for programs that are not connected with a group health plan, HIPPA laws may apply if they are collecting clinical information.

There are several ways of addressing privacy concerns. First, companies can educate employees about the relevant laws and how they protect their privacy. If certain laws do not apply, companies should remain transparent and communicate a clear intention to abide by them anyway. Organizations should also inform their employees of the information they’ll have access to. In many cases, companies can only view anonymized, aggregated data. Though vendors may have more information, employees may feel better knowing that their employer can’t connect their name to their data.

Employers can also communicate their intentions with the data. Employees may be more comfortable sharing information if they know how the data is intended to be used (measuring the success of a program vs. creating penalties for non-compliance). If employers are offering wellness benefits for the right reasons, employees will appreciate knowing why, and the transparency will help build trust in the program.

Since vendors may have access to more sensitive information, employers must vet them carefully and communicate to employees that they did so. For example, they should ask what their privacy policies are. Companies can also ask how vendors plan to protect the data they collect and what precautions they are taking to decrease the chances of a data breach as they are becoming increasingly common. In 2021 alone, there were 686 healthcare data breaches which exposed 44,993,618 healthcare records.

Finally, companies can remove the wellness offerings that ask for sensitive information. However, it is worth noting that not all information is considered equally sensitive. For example, employees may be more concerned about the information collected in biometric screenings than the step counts obtained during physical activity competitions. In any case, employers should ask their workers what information they feel comfortable providing. This takes the guess work out of the equation and allows organizations to make precise determinations as to whether a wellness activity asks for more information than their employees wish to give.

Wellness programs are not always viewed favorably by the workers who have access to them for several reasons.

To start, some employees do not believe that wellness programs in general, or the specific ones they are being asked to engage in, are effective. In other words, they believe that even if they were to participate, they wouldn’t achieve their wellness goals because the activities aren’t wellness-enhancing.

When running a program for the first time, the best way to respond to these potential participants is by providing them with research demonstrating that engaging in these behaviors results in significant health benefits. For example, companies can refer these employees to studies that show the physical and mental health benefits of increased physical activity. Organizations that have run several programs can supplement this strategy by having employees who previously participated advocate for its efficacy.

Aside from lacking the confidence that wellness programs are effective, employees may harbor negative opinions about their organization’s motives for offering one. Rather than valuing the well-being of their employees for its own sake, some workers may feel that their employers are focusing on well-being to maintain a certain brand; cut down on health care costs; and achieve higher levels of productivity, engagement, and retention.

Some experts speculate that these negative perceptions will result in lower program satisfaction and commitment. For example, Dr. Lisa H. Nishii, Professor of Organizational Psychology at Cornell University, states:

When employees perceive that the intended goals of HR practices connote lower levels of concern for employees and a more cost-driven control-focus (i.e., cost reduction and exploiting employees HR attributions), lower levels of satisfaction and commitment are likely to ensue.

Thus, when employees believe that their organizations are encouraging them to participate in a wellness program purely because it will benefit the company, they are likely to feel exploited and refuse to be involved.

Fortunately, there are several measures that corporations can take to alleviate this perception. First, they should check their actual motivations. While it is appropriate to be motivated by positive organizational outcomes, employee health and well-being must be viewed as an end in and of itself. Employees will sense when this value is insincerely espoused.

Second, companies should avoid focusing on how wellness is associated with organizational optimization when promoting their wellness programs. While employees may want to feel more engaged at work, learning from their company that wellness results in greater engagement won’t give rise to positive perceptions of the program.

Another way of addressing this issue is through organizational culture. Different cultures are likely to be associated with different motivations for implementing a wellness program. For instance, in competitive and profit-oriented cultures, employees are more likely to be suspicious of their organization’s motives than in collaborative and supportive cultures. As a result, companies running wellness programs must be mindful of their culture’s influence on employee perception and participation.

Many employees feel that they lack the time or energy needed to effectively participate in their company’s wellness program. After working 40 or more hours in a week, workers are not looking to tackle strenuous tasks and behaviors. Moreover, employees often have several other obligations to attend to after work is over, meaning they don’t have space in their schedules for wellness activities.

With the growing mental health crisis, employees will have an even tougher time finding extra energy to dedicate to wellness activities. This is because mental health ailments can significantly decrease motivation and energy levels. Feelings of fatigue and lethargy are so common among those suffering from depression that they are listed as one of the main symptoms in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

An obvious solution is to avoid overworking employees. Not only will this increase participation, it will also have direct impacts on employee health and well-being. Studies have found that as overwork increases, so do rates of cardiovascular disease, hypertension, chronic fatigue, stress, anxiety, poor sleep quality, alcohol use, and smoking. By getting rid of overwork, organizations can decrease the prevalence of these adverse health outcomes before employees begin participating in their wellness programs.

Another option is to allow employees to engage in wellness-enhancing activities during regular work hours. To make it clear to workers that they won’t be judged for taking time off to participate, leaders should lead by example and set aside time to focus on their well-being during the workday. When leaders show that they are willing to set work time aside to engage in wellness activities, employees are likely to do the same without fear of retribution.

Employees are unaware of the benefits available to them all too frequently. This poses a significant barrier to benefits utilization since employees can’t use benefits they don’t know exist. To address this problem, employers must communicate their offerings more effectively. Fortunately, there are several steps that employers can take to accomplish this.

Organizations must ensure they are providing benefits information through multiple communication channels. They must go beyond distributing employee handbooks and sending emails as many employees may not read them. For example, organizations can set up information stations in high-traffic office areas. Some experts recommend creating more engaging ways for employees to discover their benefits (e.g., a benefits scavenger hunt or a benefits quiz with prizes for those who complete it first).

Making sure the information has been heard is only half the battle. One study found that nearly 50% of employees feel they don’t understand the benefits that are offered. To offset this problem, employers should simplify their messages by getting riding of jargon and other complex terms that employees may be unfamiliar with.

Companies should also learn about the benefits that are important to their employees. Often, the benefits that employees understand the best are the ones they care most about in the short term. To address this problem, companies should identify the benefits that employees may perceive to have less value in the near term (e.g., retirements plans) and spend extra time explaining how they work.

According to the transtheoretical theory of behavioral change, perceived social pressure to engage in or avoid a behavior is one of the three main factors influencing an individual’s intention to adopt a new healthy habit.

For some healthy behaviors, subjective or group norms are positive. For example, people generally have a favorable view of those who keep their physical health in order. Staying active isn’t the sort of behavior that one would expect others to judge them for.

Unfortunately, this is not the case for all aspects of wellness. Though the stigma associated with mental health has subsided to some degree, it still presents a significant barrier for many individuals. For example, a recent survey of over 45,000 individuals found that while several other challenges prevented respondents from seeking help for clinical or subclinical mental health symptoms, 22% were deterred due to stigma.

According to a 2021 report from McKinsey & Company, though 75% of employers acknowledge the presence of stigma, they ranked reducing stigma last when asked to list their behavioral health priorities. This suggests that employers aren’t sure how to combat stigma effectively.

One of the more impactful options is to allow employees who are comfortable talking about their mental health struggles to share their stories. This method can be even more powerful when delivered by one of the companies’ leaders. When employees see that their colleagues and leaders are not ashamed to admit they have dealt with mental health challenges and sought out care, they will feel more comfortable doing the same.

Additionally, employers should ensure that they provide an equal amount of health coverage for mental health conditions as they do for physical health and other less stigmatized areas of wellness. Uneven coverage can send the message to employees that mental health conditions are either taboo, unimportant, or untreatable.

In the fight to increase employee participation in wellness programs, knowledge is power. With a clear understanding of the psychology that underlies health behavior changes along with the common barriers that discourage employees from utilizing the benefits available to them, employers can focus their energy on the most significant pain points and implement theoretically and empirically grounded strategies to remove them.