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The prevention dilemma and ways to increase the participation rate

May 13, 2024
A team of employees stands in the office, each holding a sign with a question mark in front of their face.

The Workplace health promotion (BGF) has established itself as an important aspect of the modern working environment. Companies are increasingly recognising the importance of promoting the health and well-being of their employees [1]. However, they often face the challenge of low participation rates in health programmes. This problem is closely linked to the prevention dilemma, which can impair the effectiveness of prevention measures [2]. In this article, we will take a closer look at the prevention dilemma and show how low-threshold and customised WHP offers can help to improve the participation rate in health programmes.

Prevention dilemma & participation rate in health programmes - Topic overview

The prevention dilemma and its effects

Low-threshold health services as a solution

Customised offers for individual needs


The prevention dilemma and its effects:

The prevention dilemma, also known as social selection, describes the unequal impact of prevention measures on different groups of employees. It can lead to certain employees having difficulties participating in or benefiting from health programmes. The dilemma can be due to social and economic differences, such as the level of education (health awareness) and income, but also one's own working conditions (e.g. work culture or workload) [3].

Social selection and the unequal impact of preventive measures can make it more difficult for certain groups of employees to access health services. There are many reasons for this. Examples include financial barriers, limited access to health information, time restrictions or a lack of awareness of the benefits of health promotion. This leads to an unequal distribution of health promotion and reinforces existing inequalities [4].

Do the same people always use your health services? 

Anyone involved in prevention work has certainly already been confronted with the effects of the prevention dilemma. It often becomes apparent when health programmes reach people who already lead a healthy lifestyle. These people are already motivated to take care of their health and are therefore more likely to take advantage of prevention programmes. People who may have a higher risk of health problems or are less health-conscious are not reached in the same way.

The prevention dilemma poses a challenge for prevention work, as the aim is to reach as many people as possible and make health-promoting measures accessible to all. It requires a conscious effort to reach out to those who are not naturally health-conscious or less privileged.

By recognising and addressing the prevention dilemma, health services can be better targeted to appeal to a greater diversity of people, improve participation rates in health services and promote health equity.

Low-threshold health services as a solution:

In order to overcome the prevention dilemma and improve the participation rate in health programmes, low-threshold BGF offers play a decisive role. Low-threshold offers are characterised by their easy accessibility and low barriers. They should appeal to as many employees as possible and motivate them to take part.

In fact, the accessibility of WHP programmes played a decisive role in the founding of Deep Care. Although our team of five founders worked for well-known companies with comprehensive occupational health management programmes, they were not reached by the existing measures. The reasons for this were manifold, but can be reduced to excessive participation costs and time conflicts. In combination with the fact that they themselves were affected by back pain due to sitting so much, the idea was born to create a programme that would promote movement and ergonomic coaching during the working day. Little by little, this led to the creation of ISA, an assistance device for everyday office life that recognises poor posture and lack of movement and prevents them by providing targeted instructions via a screen. ISA is of course just one example of how health offers can be designed in a target group-oriented way in order to minimise barriers to participation and increase participation rates in health offers. You can find out more about ISA here

Other examples of low-threshold health services could be

  • Information and sensitisation: By providing easy-to-understand information about health-promoting measures and their benefits, employees can be encouraged to improve their own wellbeing. This can take the form of brochures, posters, newsletters or internal communication channels. By utilising internal communication channels such as emails or intranet, companies can inform their employees about the available offers and increase their willingness to participate [5]. To ensure low-threshold accessibility, the content should be kept short and clearly presented with informative images and videos.
  • Health actions & campaigns: By organising short, concise health activities or campaigns, such as health days or challenges, employees can be made aware of health-conscious behaviour in a fun and informative way [6]. Originality can also help to arouse interest.
  • Company sports or exercise programmes: The provision of sporting activities and fitness courses can make participation easier, but often appeals to employees who are already health-conscious. Measures to promote physical activity that take effect directly at the workplace reduce the barriers to participation, as they can be integrated into everyday working life and therefore appeal more frequently to employees with a lower health motivation.

Customised offers for individual needs:

Tailor-made health programmes are another important approach to improving the participation rate in health programmes. This is because they take into account the individual needs and interests of employees. Through regular needs analyses and employee surveys, companies can find out which health topics and offers are most relevant to their workforce.

The customised offers can take various forms. From company sports and exercise programmes to stress management programmes, nutritional advice or smoking cessation programmes. By adapting the programmes to the specific working conditions, health risks and preferences of employees, the likelihood that they will get involved and benefit from them is increased [7].

As described above, ISA was developed specifically for the working conditions of desk jobs, for example, and is aimed primarily at employees who are at risk of musculoskeletal disorders but do not want to go to great lengths to avoid them. Even though ISA was designed for a broad target group, it is advisable to determine the needs of your own employees in advance. This will ensure that the programme is accepted by many, that it can be communicated to the relevant target groups and that they can be addressed in a target group-specific manner. Here you can see an example of how this can be implemented in practice. 


The prevention dilemma and the low participation rate in health programmes are challenges that companies have to face in the context of workplace health promotion. However, low-threshold and customised WHP programmes can help to overcome these problems.
It is important to increase the participation rate in BGF programmes:

  • Ensure accessibility: Programmes should be accessible to all employees, regardless of their position in the company, their income or their working hours. Flexibility in participation, such as different time slots or decentralised offers as well as offers that require little effort can help to break down barriers.
  • Consider the needs of employees: Regular needs analyses and employee surveys can be used to determine which health topics and services are most relevant to employees. This allows the programmes to be tailored specifically to their needs.
  • Communication and advertising: Effective internal communication and targeted advertising for the health programmes are crucial to raise awareness and increase motivation to participate. This can be done via various communication channels such as emails, intranet, posters or internal events. You can find tips on BGF marketing here
  • Promote employee participation and commitment: Involving employees in the design and implementation of health programmes can increase their motivation to participate. This can be done, for example, by setting up a health committee or forming health ambassadors within the company.

Low-threshold programmes that are easily accessible and have few barriers create a broader participation base. At the same time, customised offers enable employees to take their individual needs and interests in the area of health promotion into account.

By recognising the prevention dilemma and taking targeted measures to provide low-threshold and tailored health services, companies can increase the participation rate in WHP programmes and promote the health and well-being of their employees in the long term.

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