The prevention dilemma and ways to increase participation rates


Prevention dilemma & participation rates

Workplace health promotion (WHP) has established itself as an important aspect of the modern work 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 services. This problem is closely related to the prevention dilemma, which can reduce the effectiveness of preventive measures [2]. In this article, we will take a closer look at the prevention dilemma and show how low-threshold and tailor-made health promotion offers can help to improve the participation rate of health offers.

The prevention dilemma and its effects:

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

Social selection and unequal impact of preventive measures can result in access to health services being made more difficult for certain groups of employees. The reasons for this are many and varied. Examples include financial barriers, limited access to health information, time constraints or lack of awareness of the benefits of health promotion. This leads to an uneven distribution of health promotion and reinforces existing inequalities [4].

Low-threshold health services as a solution:

In order to overcome the prevention dilemma and improve the participation rate in health services, low-threshold health promotion services 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 participate.

In fact, the accessibility of health promotion services played a decisive role in the founding of Deep Care. Although our five-member founding team had been employed by well-known companies with extensive occupational health management, they were not reached by the existing measures. The reasons for this were manifold, but can be reduced to too much participation effort and time conflicts. In combination with the fact that the employees themselves suffer from back pain due to sitting, among other things, the idea was born to create a programme that would promote movement and provide ergonomic coaching during everyday work. Gradually, ISA came into being, an assistance device for everyday office life that recognises bad posture and lack of movement and prevents them by means of targeted instructions on a screen. ISA is of course only one example of how health offers can be designed in a target group-oriented way in order to minimise participation barriers and increase participation rates. You can find out more about ISA here

Other examples of low-threshold health offerings could be:


  • Information and awareness-raising: Providing easy-to-understand information about health-promoting measures and their benefits can encourage employees to improve their own well-being. This can take the form of brochures, posters, newsletters or internal communication channels. By using internal communication channels such as emails or intranet, companies can inform their employees about the available offers and increase their willingness to participate [5]. In order to ensure low-threshold, the content should be kept short and presented clearly with meaningful images and videos.
  • Health actions & campaigns: By organising short, concise health actions or campaigns, such as health days or challenges, employees can be made aware of health-conscious behaviour in a playful and informative way [6]. Originality can also help to arouse interest.
  • Company sports or exercise programmes: The provision of sports activities and fitness courses can make participation easier, but often appeals to employees who are already health-conscious. Physical activity measures that take effect directly at the workplace reduce the barriers to participation because they can be integrated into the daily work routine and therefore more often appeal to employees with a lower health motivation..

Tailor-made offers for individual needs:

Tailor-made health offers are another important approach to improve the participation rate of health offers. 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 offers to stress management programmes to nutritional counselling or smoking cessation programmes. By tailoring the offers to employees’ specific working conditions, health risks and preferences, they are more likely to engage and benefit [7].

As described above, ISA was developed specifically for the working conditions of, for example, desk jobs and is primarily aimed at employees who are at risk of musculoskeletal disorders but do not want to make a big effort to avoid it. Even though ISA is designed for a broad target group, it is advisable to identify the needs of your own employees in advance. This ensures that the offer is accepted by many, that it can be communicated to the appropriate target groups and that they can be addressed in a way that is appropriate to the target group. Here you can see an example of how this can be done in practice. 


The prevention dilemma and the low participation rate in health services are challenges that companies have to face in the context of workplace health promotion. However, low-threshold and tailor-made workplace health promotion offers can help to overcome these problems. 

In order to increase the participation rate in workplace health promotion programmes, it is important to:

  • Ensure accessibility: Offers 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 with little effort can help to reduce barriers.
  • Take employees’ needs into account: Regular needs assessments and employee surveys can help determine which health topics and services are most relevant to employees. In this way, offers can be specifically tailored to their needs.
  • Communication and promotion: Effective internal communication and targeted promotion of health offerings are crucial to raise awareness and increase motivation to participate. This can be done through various communication channels such as emails, intranet, posters or internal events. For tips on BGF marketing, click here.
  • Encourage employee participation and engagement: 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 in the company.

Low-threshold offers that are easily accessible and have few barriers create a broader participation base. At the same time, tailored offers allow employees to address their individual health promotion needs and interests.

By recognising the prevention dilemma and taking targeted measures to provide low-threshold and tailored health offers, companies can increase the participation rate in BGF offers and sustainably promote the health and well-being of their employees.

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Sources and further links

  1. Eurofound: Working conditions in sectors (
  2. Bundeszentrale für gesundheitliche Aufklärung: BZgA-Leitbegriffe: Prävention und Krankheitsprävention
  3. Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104.
  4. World Health Organization. (2013). Closing the gap in a generation: Health equity through action on the social determinants of health.
  5. Baicker, K., Cutler, D., & Song, Z. (2010). Workplace wellness programs can generate savings. Health Affairs, 29(2), 304-311.
  6. Centers for Disease Control and Prevention. (2014). Workplace Health Promotion.
  7. Pronk, N. P., Peek, C. J., & Goldstein, M. G. (2004). Addressing multiple behavioral risk factors in primary care: a synthesis of current knowledge and stakeholder dialogue sessions. American Journal of Preventive Medicine, 27(2S), 4-17.