Using theory to understand the multiple determinants of low participation in worksite health promotion programs

Low participation at the employee or worksite level limits the potential pu blic health impact of worksite-based interventions. Ecological models sugge st that multiple levels of influence operate to determine participation pat terns in worksite health promotion programs. Most investigations into the d eterminants of low participation study the intrapersonal, interpersonal, an d institutional influences on employee participation. Community- and policy -level influences have not received attention, nor has consideration been g iven to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective-political economy of he alth-that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite h ealth promotion programs. The authors argue that using theory to investigat e the full spectrum of determinants offers a more complete range of interve ntion and research options for maximizing employee and worksite levels of p articipation.