Research on workplace health promotion in the Nordic countries: a literature review, 1986-2008.

Workplace health promotion may include approaches focusing on behavioral change among employees and approaches with a holistic system-oriented thinking aiming at changing the physical, social and organizational factors of a setting. This literature review aimed to identify studies on workplace health promotion in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), to describe when, where and how the studies were performed and to further analyze the use of settings approaches and empowerment processes. Using scientific literature databases, we found 1809 hits when searching for Nordic studies published from 1986 to 2008 with the search term health promotion. Of these, 116 studies were related to workplace health promotion and 33 included interventions. We used content analysis to analyze the abstracts of all articles and the full articles of the intervention studies. Most studies were performed in Sweden and Finland. The focus was mainly on behavioral change rather than on holistic health promotion as defined by the Ottawa Charter for Health Promotion. This was especially obvious for the intervention studies. In addition to the intervention studies using non-settings approaches with top-down driven behavioral change, we identified studies with participatory settings approaches aimed at changing the setting. We categorized relatively few studies as having a non-participatory settings approach. The studies aiming specifically at improving employees' empowerment were evenly distributed between the categories market-oriented persuasion of empowerment, therapeutic empowerment and empowerment as a liberal management strategy. More studies on workplace health promotion using empowering and participatory settings approaches are needed in the Nordic countries, and a more theory-based approach towards this research field is needed.