Effectiveness and cost efficiency of interventions in health promotion

Abstract

There is a general lack of evidence of the efficacy and cost efficiency of interventions in the area of health promotion. The lack of evidence is frequently cited as a reason programs are not adopted. Resources are limited, and it is important that evidence be generated through research to allow for informed choices to be made. The purpose of this study was to evaluate a stress management program and determine overall effectiveness and cost efficiency. Two research hypotheses addressed effectiveness. The first, volunteers who attended a stress management program and practiced relaxation on a daily basis had lower anxiety following treatment than volunteers who did not attend, and second, had lower blood pressure. Cost efficiency was addressed by two research hypotheses. The benefits of the stress management seminar exceeded the costs of the seminar for the employer and second, benefits exceeded personal costs for the individual. Demand analysis from economic theory served as the conceptual framework for the study. The study was experimental in design. The sample (n=64) consisted of U. S. Army employees stationed at the Pentagon. Subjects were enrolled in the Army's FIT TO WIN Program and targeted for the stress management course. Prior to random assignment of subjects to groups, volunteers were stratified according to their level of external stressors. Effectiveness was measured by examining state anxiety, stress related physical symptoms and blood pressure, measured by the Dynamap automatic monitor. In addition, state anxiety and blood pressure were monitored one month following the intervention to examine the effect over a longer period of time. Cost efficiency determinations utilized the variables of physical complaints and blood pressure readings as compared to cost. Analysis of Covariance was utilized to address overall effectiveness with preintervention scores as covariates. Multiple regression analysis was used to address cost efficiency. Effectiveness was supported by significant differences in stress related physical symptoms for the treatment group. There was not a statistically significant difference between groups for state anxiety and blood pressure. Those who practiced relaxation on a regular basis had significantly lower systolic blood pressure. Cost efficiency was achieved for individuals in terms of stress related symptoms. Actual cost per unit of improvement was also calculated. There was a statistically significant improvement on all measures by FIT TO WIN participants in treatment and control groups. These findings support the effectiveness of a stress management program as part of a larger health promotion program. Results of cost evaluation demonstrate the benefits from a program with relatively low overall costs.