The Work@Health project team (the team) developed the program’s core curriculum after conducting formative research that included a review of the literature and key informant interviews with national workplace health promotion experts and representatives from nine employers with workplace health programs. While there is no definitive theory or model representing a comprehensive, evidence-based workplace health program, the team reviewed best practices and consensus documents from the Health Enhancement Research Organization, the American College of Occupational and Environmental Medicine, the National Institute for Occupational Safety and Health, and others outlining key, foundational elements for establishing a culture of health critical to program success and sustainability. These elements reinforced the logic of the core employer curricula (Grossmeier, Terry, Cipriotti, & Burtaine, 2010; Loeppke et al., 2003; Loeppke, 2012; National Institute for Occupational Safety and Health, 2015; Pronk, 2014). Additionally, CDC’s comprehensive workplace health program model emphasizes implementation of evidence-based strategies to influence health at multiple levels of the organization, drawing from the socioecological framework (McLeroy, Bibeau, Steckler, & Glanz, 1988). These include individual-level, health-related programs such as health education and counseling, as well as organizational-level policies, health benefit design, and changes to the work environment (Koffman, Lang, & Chosewood, 2013; Sallis, Bauman, & Pratt, 1998).

T3 participants were trained to deliver the Work@Health core curriculum, which onsisted of eight modules designed to guide employers through the assessment, planning, implementation, and evaluation phases of an evidence-based worksite health promotion program. The modules and their learning objectives included (1) Making the Business Case: to identify the value and benefit of a worksite health program and develop a business case to present to leadership; (2) Assessing Your Worksite: to describe health and productivity-related metrics, identify health promotion needs and interests, and assess organizational capacity; (3) Building Leadership Support: to secure and maintain leadership support at all levels and establish a health promotion committee and peer-support network; (4) Developing Policy, Benefit, and Environmental Supports: to implement policies, benefit changes, and environmental supports promoting preventive screenings, healthy lifestyles, and employee well-being; (5) Designing Effective Communications: to conduct a communications audit, develop a unique brand, and select communication channels to address programming goals; (6) Evaluating Your Program: to identify measures aligned with program objectives, establish baseline measures, and integrate evaluation within the planning process; (7) Planning and Designing Your Program: to identify and prioritize needs from the assessment process, create a strategic plan, and design program components to build and sustain a workplace culture of health; and (8) Implementing and Sustaining Your Program: to involve health promotion committees, implement a master schedule, identify operational approaches to manage and sustain programs, manage the evaluation process, and access Work@Health technical assistance for support.

The T3 training was designed to prepare participants to recruit and train other employers on the Work@Health core curriculum. For training purposes, train-the-trainers were required to train a minimum of five employers (and a maximum of 10) because the program was designed to allow T3 trainees to demonstrate their knowledge and skill on a small, manageable number of employers prior to becoming certified. T3 participants completed the Work@Health core curriculum and then completed six additional modules designed to enhance their training and facilitation skills. The Work@Health T3 curriculum was developed and implemented using a problem-based learning strategy built on the theories of cognitivism, constructivism, and adult learning (Cooper, 1993; Ertmer & Newby, 1993). Problem-based learning was selected as the learning strategy to ensure active and engaged learning experiences, reflection, and application of knowledge. When applied, participants were motivated to obtain a deeper knowledge of the content and skills they learned rather than to merely read slides or manuals. Research indicates that adults are more likely to retain the knowledge and skills gained through this strategy more readily than through traditional learning (Edutopia, 2011; Knowles, Holton, & Swanson, 2015). The goals of the T3 program were for participants to (1) become experts in the Work@Health core curriculum content, and workplace health promotion more generally and (2) develop the skills needed to effectively deliver the Work@Health core curriculum. T3 participants were given technical assistance on recruiting employers, conducting outreach, and setting up training logistics. The T3 participants were given guidance and up to $1,000 to support marketing, recruiting, securing a training venue, and preparing to deliver a Work@Health live training session to employers. Last, they participated in a debriefing with their peers and Work@Health trainers to help them to identify areas for improvement.

The following sections describe the steps taken to recruit T3 participants, the implementation of the training, the data collected to evaluate the extent to which Work@Health effectively prepared T3 participants to train other employers, and the results from the initial full training group of T3 participants.

The outreach and recruitment plan targeted individuals who had previous training experience and knowledge of workplace health programs (e.g., wellness coordinators and health educators), and who wished to train others. Outreach efforts focused on professional associations and organizations such as health departments and health-related professional associations. The team provided these professional associations and organizations with Work@Health materials that could be tailored and sent to their membership via newsletter, listserv, website, social media, and at conferences and meetings. The project team planned four regional T3 training workshops in April and May of 2014 in Baltimore, Oakland, Atlanta, and Chicago.

Interested individuals applied to participate in Work@Health by completing an online application with questions about current position and employer, prior training and workplace health promotion experience, and confidence in training other employers. The team reviewed and scored the applications based on applicants’ experience and other factors.

Of the 265 individuals who completed an application for the T3 program, 103 met eligibility requirements, were selected and enrolled. A number of applicants did not meet one of two eligibility requirements (1) having a minimum of 1 year of experience in a leadership role implementing a workplace health or wellness program and/or (2) including a letter of recommendation/support from their parent organization as part of their application. There were also eligible applicants who did not enroll in the program because they did not complete enrollment requirements such as completing the pretraining survey used to establish a baseline of the participant’s knowledge, motivation, and confidence levels, or were not scored as highly (scale of 1–10) as those accepted into the competitive program on criteria such as general training experience, workplace health practice experience, or number/type of professional certifications obtained. Last, a small percentage of applicants withdrew themselves from consideration prior to the start of the program and did not enroll because of the time commitments, ability to train other employers as a condition of participation, or shifting work responsibilities that no longer aligned with the Work@Health program. Among those who were selected and enrolled, 87 completed the training portion of the program, and 51 completed the full program. Participants came from 30 states and Puerto Rico. More than one third of those who completed the program listed their job role as wellness manager or health program coordinator. The next most common roles were CEO/president/owner, followed by professional instructor/trainer. Table 1 presents the regions where participants resided, their job titles, and the types of organizations where they worked. About one quarter (27 of 103) of T3 participants came from public health departments, and another quarter (29) were from health or wellness vendors. Fourteen participants worked within a health care system, 12 were employed by insurance brokers, and the rest (21) fell into the “other/missing” category. Organizations in the “other” category included universities and business coalitions.

The focus of the T3 training was on facilitation skills for delivering the employer curricula. Prior to their T3 workshop date, participants completed the eight modules of the Work@Health core curriculum online and five T3 modules online. The modules and their learning objectives included (1) Understanding the Landscape: thoroughly understand the core elements of Work@Health, define their roles while training employers, and assess the match between their current skills and characteristics of effective trainers; (2) Building the Roadmap: to distinguish between different adult learning styles and deliver training and technical assistance using specific presentation and communication skills; (3) Preparing for Delivery: to develop techniques to create a positive learning environment and apply strategies to maintain the fidelity of the Work@Health core curriculum; (4) Evaluating for Results: to understand the importance of integrating evaluation into program goals and planning and apply evaluation tools in the worksite setting; and (5) Supporting Technical Assistance: to apply a range of technical assistance services to support employers. Participants had 3 weeks to complete the online work. Selected participants were notified of the date and location of a 1-day in-person training lab that completed their training following the online work, and each was assigned to work with a Work@Health coach. The coaches were experienced worksite wellness professionals who had received extensive training on the Work@Health curriculum. The Work@Health online learning platform provided tools for the participants to interact with their coaches and with other T3 participants who were assigned to the same workshop group. Each Work@Health T3 regional training lab lasted approximately 8 hours and was facilitated by a lead instructor and a subject matter expert (SME).

The training lab was designed to give all participants an opportunity to practice presenting the Work@Health curriculum and receive feedback from coaches and other T3 participants. Trainees completed four main training lab activities, usually working in small groups of three to four. All the activities were video-recorded and concluded with group members, the instructor, and the SME providing reinforcement, constructive feedback, and recommendations for improvement after viewing the recordings. Activities included

“TV News” One-Minute Oral Presentation—To help them become conversational about the program, participants conducted mock interviews with one another and tried to clearly and succinctly describe the Work@Health program. This helped trainees prepare their “elevator speech” for communicating key messages and recruiting employers.

After the training, participants received 6 to 10 months of technical assistance in the form of phone and online coaching, live and recorded webinars, and online interactions with peers (e.g., sharing experiences related to recruiting employers). During the technical assistance period, participants were expected to complete three milestones. The first milestone required participants to develop plans for marketing their training session to employers, recruiting employers, and tailoring the training session to meet their employers’ needs. The second milestone required participants to deliver the training and submit a 15-minute recorded segment from their training session. The final milestone required them to participate in an online debriefing session with their coach and a small number of their T3 peers to review the recording of their training and obtain constructive feedback. T3 participants documented progress toward milestone completion in progress reports they submitted to and discussed with their coaches. If all three milestones were successfully completed, participants were considered certified trainers, presented with a certificate, and allowed to continue to train employers independently (up to 25 employers at a time).

We used a single group pre- and posttest evaluation design to assess changes in T3 participants’ knowledge and attitudes related to training others in workplace health promotion. We calculated descriptive statistics summarizing responses from data collection instruments and the milestone tracking system. We used SPSS statistical software to conduct paired t tests to compare participants’ attitudes and knowledge before and after the training and technical assistance using data from the 82 participants who completed the Participant Survey in 2014 and again in 2015.

Overall, participants gave favorable ratings to their trainers, the training content, and training delivery. Of the 103 individuals who started the training program, 90 provided posttraining ratings. The majority (84.4%) agreed that their trainers effectively delivered the training activities. Most participants (89.7%) agreed that they would be able to use what they learned at their jobs. A high percentage also agreed that they have the information they need to train others in worksite health programs (73.9%); they understood how to apply what they learned (72.7%); the training was effective (71.6%); and the training topics met their needs (70.5%). More than half agreed that the training prepared them to train others (65.9%); they would recommend the training to others in their position (63.3%); and the training met their expectations (51.1%).

Changes in participant knowledge quiz scores, attitudes, and self-rated training skills are presented in Table 2. Scores on the knowledge item portion of the T3 Participant Survey significantly increased between 2014 and 2015, from a mean of 65.9% of knowledge items correct to 69.6% correct, t(81) = −2.61, p < .01. Participants’ mean ratings on the question, “To what extent do you feel prepared to train employers on a worksite health program?” was significantly higher in 2015 compared with 2014, t(79) = −3.65, p < .01. Participants’ mean self-rated confidence in their ability to deliver a worksite health training program did not change significantly from where the group started in 2014 at “very confident.” Participants self-rated their strength on nine training skills. Participants’ mean ratings in 2015 were significantly higher than in 2014 for three skills: asking questions to gain information from individuals or a group, t(80) = −2.21, p = .03; encouraging individual and group problem solving, t(80) = −2.40, p = .02; and public and online speaking and presenting, t(79) = −1.66, p = .02.

Participants rated their proficiency in training employers in Work@Health on the 2015 version of the Participant Survey. As Figure 1 shows, 67.5% of participants reported that they fully understood how to conduct a worksite health training and another 22.5% reported that they partially understood how to conduct such a training.

On the 2015 Participant Survey, T3 participants reported the number of employers they trained and the number of training sessions they conducted. The goal was for each T3 participant to conduct one training session with five employers participating within 10 months after the training lab. A total of 51 T3 participants trained employers. Most (60%) of these participants trained five employers, but the number of employers varied between 2 and 10. Collectively, the T3 participants trained 233 employers.

Ninety-six employers trained by 15 of the T3 participants completed Reaction Surveys. Overall, the employers rated the T3 participants favorably as training facilitators. The majority of employers agreed that T3 participants demonstrated a good understanding of the material (96.9%), effectively delivered the training (98.5%), effectively delivered feedback assessments (98.5%), and did a good job generating participant interaction (87.5%).

Fifty-one (59%) of the 87 participants who completed the training component of the program successfully reached all three of the program’s milestones (marketing, recruiting employers, and tailoring and delivering the training; and participating in an online debriefing session), becoming certified trainers. More than half (47) of these 87 participants signed an annual licensing agreement allowing them to continue training employers using the Work@Health curriculum.

To better understand participants’ experience, the T3 Participant Survey included an item about the challenges T3 participants experienced when attempting to recruit and train employers. As shown in Table 3, the most common challenge from among the potential responses was recruiting employers, followed by marketing. Participants shared that these challenges were caused by a lack of strong connections to employers or employer groups in the community, and not feeling comfortable cold-calling employers to build new relationships. More than half of the respondents indicated that they had experienced “other challenges,” which they specified as the amount of time required to schedule and conduct trainings, rescheduling training when employers canceled, the length of the training sessions, and the cost of conducting trainings.