on
THE DARKER SIDE OF HEALTH PROMOTION
PROGRAMS:
A study on the influence of HPP’s on health discrimination in the
workplace
Laura Behrens
S3203719
Master Thesis
University of Groningen
Faculty of Economics and Business
MSc. Human Resource Management
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Abstract
This research aimed to investigate the darker side of health promotion programs (HPP’s), as they could possibly change the way employees view health and in turn how they view their (un)healthy coworkers. It was proposed that whether HPP’s focus on individual or organizational responsibility could be a factor contributing to the influence of HPP’s on employee relationships. The introduction of a health promotion program focused on individual responsibility was expected to relate to employees’ attribution of health to internal causes, which in turn was hypothesized to be associated with moralization of health. This moralization of health was expected to increase discrimination in the workplace towards unhealthy coworkers. Data was gathered using two online questionnaires distributed to both HR managers and employees. Results show that there was no significant variance related to employees belonging to different firms, and thus being exposed to different health promotion programs, on internal attribution or the other two variables. Furthermore, a marginally significant relationship was found between internal attribution and moralization. Also, results show that moralization has a significant effect on discrimination, meaning that more moralization of health relates to more health discrimination in the workplace. Finally, the mediation analysis showed to be significant, and as such internal attribution of health was found to positively affect discrimination of health in the workplace through the moralization of health.
Keywords: health promotion programs, attribution, moralization, discrimination, exclusion,
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Introduction
A healthy lifestylehas become an increasingly important aspect of our lives and we are being confronted with it every day. We see it on TV, we see it on the internet, we see it on billboards in the streets and we see it at work. We are living in a time where the ageing population means rising healthcare expenses and having to work longer, leading to an ageing workforce. This ageing workforce is, in turn, thought to lead to several organizational consequences. Remery, Henkens, Schippers, and Ekamper (2003) conducted a study on the aging workforce and these possible consequences. They found, among other things, that 56 per cent of their questionnaire respondents, which included Dutch managers, company owners, personnel officers and managing directors, thought that increases in absenteeism were highly likely. Also, 73 per cent thought that rising labor costs would be a consequence of the ageing workforce. Furthermore, 50 per cent believed it to be highly likely that working conditions would need to be improved. An ageing workforce thus poses several organizational challenges and is thought to lead to increases in labor costs.
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It is important to understand health promotion programs, as they could possibly change the way employees view health, and in turn how they view their (un)healthy coworkers. When this view of unhealthy coworkers is negative, this could lead to all sorts of behaviors that can have a detrimental effect on coworker relations. Just as discrimination can be based on categories like gender, nationality and race, also, health related issues, such as fatness and smoking, can evoke negative reactions (e.g. Rozin & Singh, 1999; Crandall et al., 1999; Crandall & Martinez, 1996; Helweg-Larsen, Tobias & Cerban, 2010). It is important to understand whether health promotion programs contribute to negative reactions towards unhealthy coworkers, as coworker relationships have shown to have an effect on employee job satisfaction, effort and turnover intentions (Chiaburu & Harrison, 2008). This is significant, as low job satisfaction is shown to correlate with turnover intention and turnover (Tett & Meyer, 1993). A high turnover, in turn, can lead to high costs such as loss of investment, productivity losses or recruitment and training costs (Jones, 2004; Tziner & Birati, 1996). Thus even though the number of financial benefits related to HPP’s are important to consider, it is also vital to look at the other, moral, side of these programs.
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When employees sense this difference in type of HPP, this could possibly influence whether they attribute health to either internal or external causes. Specifically, research has shown that attribution is subject to environmental and contextual differences (e.g. Lundell, Niederdeppe, and Clarke, 2013; Popay et al., 2003; Blaxter, 1997; Teachman et al., 2003). I thus propose that the individual focus of HPP’s can change employees’ perception of health from being attributed externally, to it being attributed internally. This means that employee then believes that health is controllable and that everyone is responsible for their own health. Suddenly, he or she can ‘blame’ someone for not being healthy or for pursuing an unhealthy lifestyle. They might then also assign moral value to that activity: while previously considered morally neutral, they might suddenly feel that it is morally wrong to live unhealthy. This is the process of moralization. And eventhough in many studies, moralization is assumed to exist next to attribution (e.g. Crandall, D’Anello, Sakalli, Lazarus, Nejtardt & Feathers, 1999; Crandall & Martinez, 1996), there is also evidence that internal attribution influences moralization (e.g. Weiner, Perry & Magnusson, 1988). Despite this evidence, however, little to no research has specifically focused on the existance of this relationship between attribution and moralization. The current research will shed a light on the possibility of attribution influencing moralization, which will be a unique contribution to the existing literature.
Finally, when something is moralized, this can spark strong moral emotions and reactions (Rozin, Markwith, & Stoess, 1997), as different studies into moralization and its consequences have confirmed (e.g. Haidt, Rosenberg & Hom, 2003; Rozin et al., 1997; Rozin and Singh, 1999; Stein & Nemeroff, 1995). Therefore, this research will explore whether moralization of health is associated with discrimination among coworkers.
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moralization of health is expected to increase discrimination in the workplace towards unhealthy coworkers. This research thus aims to shed light on the darker side of health promotion programs, questioning whether they relate to discrimination, an issue unaccounted for by prior research. By investigating this, consequently, another contribution will be made to the literature by investigating whether attribution precedes moralization, an issue also lacking in the existing literature. This research will help understand the moral side of health promotion programs in the workplace and will highlight potential implicit costs of these programs. In turn it can provide managers insight into the ways health promotion programs play a role in employee relationships. This is important to understand as it is expected that these HPP’s could possibly be related to discrimination, exclusion and stigmatization, negatively impacting coworker relationships, which, as mentioned above, have shown to have an effect on employee job satisfaction, effort and turnover intentions (Chiaburu & Harrison, 2008). Understanding the way that these programs influence employee behavior and coworker relationships, allows designing HPP’s that counter these negative reactions and neutralize the expected negative effect on employee relationships.
In the following section, I will explain the relationships between the variables health promotion programs, internal attribution, moralization and discrimination in more detail, and will introduce a research model based on the formulated hypotheses.
Theory
Internal Attribution
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someone perceives a certain event to be of internal control, thus internally attributed, this person perceives this event to be contingent upon his own behavior or characteristics (Rotter, 1966). By contrast, external control or attribution is defined as ‘the result of luck, chance, fate, as under the control of powerful others, or as unpredictable because of the great complexity of the forces surrounding one’ (Rotter, 1966, p. 1). Whether someone interprets something to be of internal or external control thus influences how that person responds to the event. When someone attributes the cause of, for example, obesity to an external factor, that person will not change his or her behavior simply because he or she believes that changing behavior does not change the obesity. Important aspects of internal attribution include stability and controllability (Weiner, 1985), such that when something is perceived as neither stable nor controllable, it will not be attributed to an internal cause.
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found that when participants were told that obesity is caused mostly by overeating and lack of exercise, high internal attribution was exercised, whereas when they were told obesity was caused mostly by genetics, this did not result in a lower bias. These results show the importance of context when it comes to attribution, and that indeed, implicit biases related to obesity are modifiable to a certain extent.
Based on the above considerations, it appears plausible to assume that the way that health promotion programs (HPP) are set up influences whether individuals attribute health internally or externally. When these programs focus primarily on providing services for the individual (e.g. anti-smoking programs), rather than improving or changing things in the organization (e.g. working conditions), thus implying individual responsibility, employees may attribute health internally. The other way around might also be true. When these programs focus primarily on changing things in the organization, rather than providing services for the individual, thus implying organizational responsibility, employees may attribute health externally. Therefore I hypothesize:
Hypothesis 1: Healthcare promotion programs (HPP) focusing on individual
responsibility are associated with more internal attribution than HPP’s focusing on organizational responsibility.
Internal versus external attribution is important to consider in this context, as it is believed to be related to moralization. The next section will explain in detail why attribution in this research can be assumed to influence moralization.
Moralization
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defined as “the acquisition of moral qualities by objects or activities that previously were morally neutral” (Rozin et al., 1997, p. 67). When this occurs “preferences are converted into values” (Rozin, 1999). This may occur because of one of two different processes of moralization. The first is ‘moral expansion’, which occurs when an experience causes a person to adopt a new moral principle (Rozin, 1999). An example could be when someone sees a documentary about animal testing, sees the hurt these animals are put through and then decides that hurting animals is immoral. The second process is called ‘moral piggybacking’, when a previously neutral activity or object suddenly falls under an already existing moral principle because of new experiences or knowledge (Rozin, 1999). This could for example happen when someone already believes that hurting humans is wrong, he or she learns that asbestos is toxic, and then also believes that using asbestos in buildings is wrong, and that it should be removed. Both processes occur either as the result of cognitive-rational considerations or because of a more powerful affective experience or set of experiences (Rozin, 1999).
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other things, focused on the question how blame (or internal attribution) plays a role in rejection of fat people and their findings suggest that blame indeed predicts rejection.
An under researched proposition is that internal attribution influences moralization, however, some evidence for this relationship exists. For example, Weiner, Perry, and Magnusson (1988) argued, based on empirical evidence, that whether something is onset-controllable or onset-unonset-controllable can influence the degree of moral condemnation, and that by communicating specific information, this perception of controllability can be altered. Causal information in this context relates to whether something is caused by internal or external forces. Despite this evidence, however, little to no research has specifically focused on the existence of this relationship between attribution and moralization. The current research addresses this gap in the literature and I will thus argue that internal attribution influences moralization, contributing to the existing literature in a unique way. This is explained as follows: someone may perceive health promotion programs as individually focused, and this in turn changes his or her perception from health being caused by external forces to it being internally attributional. This may, in turn, cause that person to assign some moral value to health, while it previously had no moral value, thereby moralizing health. Therefore I hypothesize:
Hypothesis 2: Stronger internal attribution of health is associated with stronger
moralization of health.
11 Discrimination
When something acquires moral status, this can influence society and individual lives in several ways, as morality plays a big role in social interactions between people, and it is thus worthwhile to pay attention to the consequences of moralization (Rai & Fiske, 2011; Rozin, 1999). When moral value is assigned to an activity that previously had no moral value this can have several consequences, because values usually spark strong moral emotions (Rozin et al., 1997) and affects whether we trust people, are willing to cooperate with them, or act aggressively towards them (Ellemers & Bos, 2012).
For example, Stein and Nemeroff (1995) conducted a study using scenarios and a survey among 290 students to discover whether people make moral judgments of others based on what they eat. They indeed found that this was the case and that this in turn influenced how they saw that person. Good-food eaters were described with more positive features than where bad-food eaters. Rozin et al. (1997), in their study on vegetarianism, found that moral vegetarianism, as opposed to compliant vegetarianism, leads to the emotion of disgust. Moral vegetarianism occurs when someone becomes a vegetarian for moral reasons, such as animal harm. Compliant vegetarians do not eat meat because of health reasons. This study thus discovered that, as opposed to compliant vegetarians, moral vegetarians express feelings of disgust, thus providing evidence that when an issue is moralized, rather than neutral, it can provoke strong emotions. Another study by Rozin and Singh (1999) found that disgust correlates with moral concerns about smoking more than either correlate with health concerns. The recruitment of disgust reduces temptation and promotes motivated withdrawal from the offending object or situation. Individuals thus ‘feel empowered to censure those who practice the activity’ (Rozin & Singh, 1999, p. 323) that has moral value to them.
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desire to interact more than demographic diversity does. People thus prefer interacting with people that are different from them in demographic sense (e.g. ethnicity, gender, race) over interacting with people that differ from them in morals and values. Also, two studies on moral convictions and its consequences by Skitka, Bauman, and Sargis (2005); (cf. Skitka & Morgan, 2009) found that as people’s moral conviction of a certain issue increases, intolerance for people with dissimilar attitudes increases as well. ‘People do not want to live near, be friends with, or even shop at a store owned by someone who does not share their moral point of view’ (Skitka & Morgan, 2009, p. 367). Furthermore, morally dissimilar attitudes were found to increase social and even physical distance between two parties. A paradoxical effect is recognized by Haidt et al. (2003), as our ‘mission’ to root for our own moral values leads us to exhibit behavior that is generally seen as immoral (e.g. rejection, discrimination).
Based on the above considerations, I argue that the moralization of health will be related to the discrimination of unhealthy coworkers in the workplace, as moralization in general is found to be associated with to discriminatory behavior. I hypothesize:
Hypothesis 3: Stronger moralization of health is associated with more discrimination
towards unhealthy coworkers.
Summing up, the following model can be derived to depict the hypotheses formulated above (Figure 1).
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The next section will explain in detail how I measured the variables depicted in the theoretical model (Figure 1), how data was gathered, and how this data was analyzed to draw conclusions on the existence of relationships between the variables.
Method
SampleData was gathered trough two online questionnaires that were created using Qualtrics. The first questionnaire was aimed at HR managers. Companies were approached that are known for having HPP’s, and within which I had a personal contact. These personal contacts were approached either via email, telephone or in person to send the survey to their HR manager. The questionnaire was distributed via a link that was sent via email. To protect the confidentiality of the respondents, the survey was completely anonymous, and participation voluntary. This questionnaire measured the level of individual/organizational health promotion programs within the company. In total, 17 HR managers from 17 different companies completed the first questionnaire. All of these HR managers indicated that their company employed some form of a health promotion program. Most managers indicated that their HPP’s were slightly more focused on organizational responsibility, giving it a 5 on a scale of 1-7, where 1 is individual responsibility and 7 is only organizational responsibility.
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anonymous, and participation voluntary. The second questionnaire measured the level of internal attribution, moralization and discrimination exhibited by the employees. The way in which these variables were measured will be explained in the following section. In total, 204 employees took the second questionnaire. Of them, 128 were female and 75 male. Most were between 25 and 35 years old (option 2) (Mean = 3.08, SD = 1.23) followed by those with an age between 36-45 (option 3). Finally, most of the questioned employees had a tenure of 1-5 years (option 2) (Mean = 3.59, SD = 1.87).
Measures
All measures below focused not on health, but on weight and fatness as an indicator of health. The reason for this is that health is a very broad subject, encompassing many things such as illness, but also a healthy lifestyle, and a healthy living environment. As it is impossible to measure all the aspects of health in one, reliable, questionnaire, the choice was made to focus on one aspect of health, thus weight.
Health Promotion Programs
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questions were answered on a 1 to 7 scale, 1 being ‘absolutely not’ and 7 being ‘absolutely yes’. Higher values on this scale reflected more organizational, and lower values more individual responsibility as highlighted by the HPP. After this, an explanation of the difference between individual and organizational focused HPP’s was given, again along with some examples for both foci. Then a question was asked whether the manager believed the health promotion program implemented at their organization was more individually or organizationally focused. This was measured on a scale of 1 (entirely individual) to 7 (entirely organizational) .
When in the first question the manager indicated that there were no HPP’s in their organization, then the respondent would receive similar questions, only hypothetical of nature. However, as all managers indicated there were HPP’s in their organizations, no use was made of the hypothetical questions.
The questions regarding the nature of the HPP were combined into one scales after carrying out a factor analysis and reliability analysis (see Appendix I). This scale is called ‘HPP Focus’ (α = 0.81) and is a combination of the items regarding exercise opportunities, healthy food, workplace and save work. A high score on the scale means an organizational focus, whereas a low score relates to an individual focus.
Attribution
Attribution was measured following the three properties identified by Weiner (1985), namely locus, stability and controllability. The locus dimension focuses on the internal or external locus. Stability is related to whether the cause of a certain event is stable, both across time and situations. Finally, controllability refers to whether something is under the control of the person in question or not.
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Appendix II). The controllability dimension identified by Weiner (1985) is split between external and personal control. Each of three items corresponds to one of the four dimensions (locus, stability, external control, personal control). Each item was measured on a scale of 1 to 7. Depending on the question asked, these numbers represent two extreme answer categories, and the number in between represent a balance between the two extremes. The scale was slightly altered as ‘the cause(s)’ in the original questionnaire, were reframed into ‘the cause(s) of being overweight’ (see Appendix II).
After reliability analysis was carried out, it became apparent that only the ‘personal control’ dimension scale had significant reliability (α = 0.72). After carrying out a factor analysis, it became apparent that not four but three factors emerged. Two of these three factors simply represent the original scales of ‘external control’ and ‘stability’, both which have no significant reliability. The third factor is a combination of ‘personal control’ and ‘locus’, which has a significant reliability (α = 0.81). Therefore these two scales are combined into the variable ‘Internal Attribution’, which is used for further analysis.
Moralization
As mentioned in the theory section, moralization in this study is defined along the definition by Rozin et al. (1997) as “the acquisition of moral qualities by objects or activities that previously were morally neutral” (p. 67). As a clear scale of measurement for moralization has yet to be developed, in this research, I have developed measures myself, based on theory on moralization. All items were measured on a 1 (strongly disagree) to 7 (strongly agree) Likert Scale.
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weight is a duty, not a personal preference”. This will measure whether the respondent feels that having a healthy weight is a preference (no moralization) or that it is a duty, something more than just a preference (moralization). Furthermore, when something becomes more than a preference, it becomes important for that person to follow that value, therefore the measure “Having a healthy weight myself is something I pay attention to”, is included as well.
A third item is: “I find it difficult to maintain a healthy weight”. When something is moralized, this morally laden entity becomes internalized and more central to the self. It will become easier for the person who moralized that entity to maintain it, and to resist temptation (Rozin, 1999). Therefore, this measure is included, reflecting whether the respondent is able to resist temptation and maintain a healthy weight, as is usually the case when something is moralized.
Research suggests that moralization strongly correlates with disgust (e.g. Rozin et al., 1997; Rozin, 1999; Rozin & Singh, 1999), and this, in turn, is likely to relate to a high motivation to reject and avoid that activity, in this case being overweight. Therefore the following measures are included that reflect this rejection and avoidance: “Being overweight is something I morally disapprove of”, “Being overweight is something I don’t object to” (reverse-coded), and “I disapprove of being overweight”.
Finally, values (and their violations) tend to evoke strong emotions such as anger, contempt, guilt and shame (Rozin et al., 1997), therefore the following two items were included: “Being overweight myself is something I would feel guilty about”, “Being overweight myself is something I would be ashamed of”.
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Discrimination
Discrimination of overweight colleagues was measured, as introduced by Jaarsma (2014), using two pictures of the same women as end points of a scale. In one picture the women is overweight, in the other she is a normal weight. Below the pictures, nineteen positive and negative words were presented, such as “lazy”, “weak”, “patient”, and “reliable”. Respondents were asked to rate, along a 1-7 scale, if they believe the word belongs more to the overweight person (1), or the normal weight person (7).
This method of measuring discrimination was chosen as it is more subtle as opposed to asking questions directly related to discriminating overweight people, such as “I dislike overweight people”. These types of questions can ‘shock’ respondents and lead to more socially desirable answers than this more subtle way of measuring discrimination.
All negative words were reverse coded in order to combine the items into one variable. The variable ‘Discrimination’ was created (α = 0.82). A high score on this scale means a high level of weight discrimination.
Data Analysis
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variables, to test hypothesis 1. To test hypotheses 2 and 3, a mediation analysis was carried out using the PROCESS macro by Andrew F. Hayes (2012).
Results
Correlations and Descriptives
In Table 1 an overview is presented of the means, standard deviations and correlations of all the variables used in the analysis. This shows that HPP Focus was not significantly correlated with Internal Attribution (r = -0.04, p > 0.05). However, Moralization was positively related to Internal Attribution (r = 0.18, p < 0.05) and Discrimination (r = 0.32, p < 0.01).
Furthermore, a question was asked to both HR managers and employees about the presence of a HPP in their organization. All 17 HR managers indicated the presence of such a program, however, not all employees perceived these programs to be present. A total of 42 out of the 171 respondents indicated that they did not perceive a HPP. This employee perception was labelled ‘HPP Perception’. There were no significant correlations found between this variable and Internal Attribution and Moralization. However, a significant correlation was found between HPP Perception and HPP Focus (r = -.36, p < 0.01). The more the focus of the HPP is towards organizational, the higher the likelihood that a respondent also perceives the presence of an HPP. This can be explained as such that most HPP measures focused on organizational responsibility are directly visible as opposed to individual responsibility measures.
Table 1: Means, Standard Deviations and Correlations
Mean SD 1 2 3 4 5 1 HPP Focus 3.19 0.91 - 2 Internal Attr. 5.31 0.83 -.04 - 3 Moralization 4.27 0.89 -.01 .18* - 4 Discrimin. 4.60 0.48 -.11 .14 .32** - 5 HPP Perc. 1.25 0.43 -.36** .50 .09 .10 -
20 Hypothesis Testing
Hypothesis 1
Hypothesis 1 stated that HPP’s focusing on individual responsibility should be associated with more internal attribution than HPP’s focusing on organizational responsibility. Looking at the results from the mixed model analysis, it became clear that the higher level variable ‘HPP Focus’ did not explain significant variance in the lower level variable ‘Internal Attribution’ (H1: F = 0.324, p = 0.57). Therefore I can conclude that Hypothesis 1 is not supported. Thus the level of organizational responsibility or individual responsibility has no effect on the level of internal attribution employees exhibited in my study.
HPP Focus also did not explain significant variance in the lower level variables Moralization (F = 0.016, p = 0.90) nor Discrimination (F = 1.339, p = 0.31). This means that whether an HPP has more of an individual or organizational focus has no effect on the level of Internal Attribution (Mean = 5.31, SD= 0.83), Moralization (Mean = 4.27, SD = 0.89) or Discrimination (Mean = 4.60, SD = 0.48), and variation in any of these variables cannot be explained by variation in the variable HPP Focus.
A One-Way ANOVA was run in SPSS to analyze if there was a significant difference between the groups of employees belonging to different firms and thus different HPP’s. The test focused on comparing the effect of being exposed to a certain HPP on the three variables Internal Attribution, Moralization and Discrimination. The analysis of variance showed that the effect of being exposed to a certain HPP on Internal Attribution was not significant (F(16,169) = 0.660, p = 0.83). Furthermore, the effect was also not significant for Moralization (F(16,165) = 1.008, p = 0.45) and Discrimination (F(16,155) = 1.355, p = 0.17). Therefore I can conclude that there was no significant variance related to employees belonging to different firms, and thus being exposed to different Health Promotion Programs, on either of three variables.
Hypotheses 2 and 3
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of internal attribution on discrimination, and whether this effect is mediated by moralization. The standard mediation model was used, using a bootstrap technique with 5000 intervals.
The mediation analysis shows that the relationship between Internal Attribution and Moralization is marginally significant (H2: F(1,170) = 3.53, p = 0.062, R2adj = 0.02). Hypothesis 2 predicted that stronger internal attribution of health would be associated with stronger moralization of health. The results indicate that Internal Attribution has a marginally significant effect on moralization, meaning that Hypothesis 2 is supported. The model for Discrimination was also significant (H3: F(2,169) = 10.49, p = 0.000, R2adj = 0.11). As Hypothesis 3 predicted that stronger moralization would be associated with more discrimination, I can conclude that Hypothesis 3 is supported. The direct effect of Internal Attribution on Discrimination was not significant (β = 0.05, t = 1.32, p = 0.189). The indirect effect through Moralization was significant, as the 95% confidence interval did not include zero (CI95% 0.003, 0.061). These results support Hypothesis 2 and 3 in that internal attribution of health positively affects discrimination of health in the workplace through the moralization of health. Figure 2 shows the observed associations between the variables.
Figure 2 – Observed Associations Mediation
*** p < 0.001, **p < 0.01, *p < 0.05.
DISCUSSION
The aim of this study was to investigate whether a certain focus of a health promotion program, namely more individual or more organizational, would increase workplace discrimination through the mediating role of internal attribution and moralization. Three
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hypotheses were proposed. First, I expected that HPP’s focusing on individual responsibility would be associated with more internal attribution than HPP’s focusing on organizational responsibility (H1), and thus this would mean that I also expected HPP’s focusing on organizational responsibility to be associated with less internal attribution. Furthermore, I expected that stronger internal attribution of health would be associated with stronger moralization of health (H2). Finally, I also expected that stronger moralization of health would be associated with more discrimination towards unhealthy coworkers (H3). These hypotheses were tested using online questionnaires, distributed to 17 companies in which an HR manager filled in one questionnaire, and a number of employees filled in another. Participants were HR managers and employees working in organizations employing Health Promotion Programs in the Netherlands.
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negative attitude. The same could apply to the influence of the focus of an HPP on an employee’s prior attitude towards health.
Furthermore, a marginally significant association was found between Internal Attribution and Moralization. This implies that the level of health moralization someone experiences, is influenced by their level of internal attribution towards health. Despite the previous conception that internal attribution and moralization are parts of the same construct (e.g. Pizarro & Tannenbaum, 2011) instead of internal attribution influencing moralization, results of this study show evidence for the existence of such a relationship. These results are in line with the evidence found by Weiner et al. (1988), who conducted two experiments on the perceived controllability and stability of the causes of 10 stigmas, one of which obesity. Their results also show that perceived controllability (or attribution) can influence the level of moral condemnation exercised. They further show that this perceived controllability, and in turn the level of moral condemnation, is subject to change when specific information in communicated that pleas for a certain level of controllability. An example could be when someone learns information that a heart disease is caused by smoking and drinking, or that obesity is caused by a thyroid problem, this heart disease can suddenly be seen as controllable, whereas the obesity can swiftly be seen as uncontrollable.
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discrimination include feelings of disgust (Rozin et al., 1997), which in turn promote feelings of withdrawal (Rozin & Singh, 1999), and assigning negative features to people exhibiting moralized behavior (Stein & Nemeroff, 1995). Especially these results found by Stein & Nemeroff (1995) are very much in line with the results found in this study, as discrimination was measured by the assignment of features to either a normal weight or overweight person.
Finally, given the fact that I found the influence of Internal Attribution on Moralization to be marginally significant, and that the influence between Moralization and Discrimination was also found to be significant, it is no surprise that the mediation analysis also showed that the mediation relationship between Internal Attribution, Moralization and Discrimination was significant. On the other hand, the direct relationship between Internal Attribution and Discrimination was found not to be significant. This means that evidence shows that the relationship between internal attribution and discrimination of health in the workplace is mediated by the level of moralization of health, whereas no association exists between Internal Attribution and Discrimination directly.
Theoretical and Practical Implications
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health. However, there are many other aspects to HPP’s that could possibly influence employees’ health perceptions, such as their mere presence or the attention given to the program, and I hope, with this research, to have made people think about the other, possibly darker, side of health promotion programs, and to have stimulated further research into this subject.
One of my aims with this research was to shed a light on the possible relationship between internal attribution and moralization, that until now, has not been researched much. Most previous research has focused on the presumption that moralization and internal attribution are part of the same construct and exist next to each other. This research, however, assumed that the level of (internal) attribution of health, influences the level of moralization. The results in this research support this relationship between moralization and internal attribution, and therefore contributes to the literature on these two subjects. It sheds a light on the possibility that maybe future research into the relationship between internal attribution and moralization should investigate this relationship more, as it can change the way we look at both these constructs in a fundamental way.
Finally, this study contributes to the research conducted on the subject of moralization, as results did show that stronger moralization of health is associated with more discrimination towards unhealthy coworkers. Specifically, the discrimination of assigning of negative features to people exhibiting the moralized behavior, in this case unhealthy behavior, was researched. Moralization is a relatively new concept, with most research starting during the 1990s, and not much research existing on the concept specifically. Therefore this research strengthens the findings of previous research regarding moralization and its consequences.
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health promotion program, one does not have to worry about whether the program is more organizationally focused, or more individually focused, when it comes to workplace discrimination of health. However, of course, one does have to think about the composition of the HPP and the type of measures it employs, as these measures individually, or other aspects of the HPP composition, could possibly influence workplace discrimination of health. For example, a study by Stein and Nemeroff (1995) showed that people judge others based on what they eat. Based on this one could argue for only healthy food in the cafeteria, as a means of reducing workplace discrimination of health.
Furthermore, an interesting finding with regards to the descriptives is that 20,6% of the responding employees believes that their organization does not employ a HPP, despite the fact that all 17 participating organizations employ one, as indicated by the HR managers. This seems to show a positive correlation with the focus of the health promotion program. This can be explained by the fact that most organizationally focused measures are usually directly noticeable by employees, such as climate control, only healthy food in the cafeteria, and providing desks and chairs with adaptable heights and positions. Personally focused measures, on the other hand, often include things such as discounts at the local gym, that have to be communicated towards employees. What this shows is that when companies employ a health promotion program that has elements of individual responsibility, these elements have to be clearly communicated to employees in order for them to experience their presence and make use of them.
27 Limitations and Future Research
Despite the fact that this study replicated findings of previous research, this study has several limitations that affect both the generalizability and the interpretation of results. First, the sample size of this study consisted of 204 participants, of 17 companies only. Future studies, with larger sample sizes might be able to find different results or lead to more conclusive evidence. Also, more studies with larger sample sizes on this subject have to be conducted in order to increase generalizability of the findings. Furthermore, a large share of the 204 participants belonged to two companies, together making up 50 per cent of the total respondents. This may have influenced the results, and future research should therefore focus on using more equal groups of employees.
Another possible limitation of this research is the fact that a self-report questionnaire was used, which may have affected the validity of the research. Honest answers were encouraged as much as possible by stressing the anonymity of the research and the confidential treatment of results. However, as weight and fatness are controversial subjects, and questions such as “I disapprove of being overweight” can evoke conflicting emotions, social desirable answers are a big possibility in this study. Social desirability is “the pervasive tendency of individuals to present themselves in the most favorable manner relative to prevailing social norms” (King & Bruner, 2000, p.80). This is a difficult bias to eliminate and future research should focus on trying to eliminate it as much as possible by finding ways to measure the variables less obviously and less confronting, thus evoking less feelings of having to answer socially desirable. This can for example be done by using an Implicit Association Test (IAT) for weight. This test measures differential associations of two targets concepts with an attribute by measuring their underlying automatic evaluation (Greenwald, McGhee, & Schwartz, 1998).
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new scales had to be composed. Despite both scales being reliable and valid, time constraints limited the possibility of developing the most reliable and most valid scale possible. Therefore, future research should focus on investigating the best way to measure these both variables.
Finally, this research focused only of the difference between HPP’s in influencing discrimination, and no attention was paid to the mere presence of an HPP possibly already influencing discrimination. Reason for this was that no firms were found that did not employ some form of a health promotion program. There were, however, some employees that did not perceive the presence of an HPP in their organization. The findings that employees perception of this presence (HPP Perc.) did not significantly correlate with any of the three variables at employee level, does signal that the mere presence of an HPP does not influence the mediating relationship between Internal Attribution, Moralization and Discrimination. However, future research should also include the effect of the presence of a HPP on discrimination to confirm these results.
CONCLUSION
29 ACKNOWLEDGEMENTS
30
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Appendix I – Survey Items
Table A1
Focus of Health Promotion Program (HPP Focus)
HP1 Does this program contain measures to get employees moving and exercising? (e.g. discount on gym, Wii or fitness equipment in breakroom, joining a sportsevent with the company?
HP2 Does this program contain measures to get employees to eat healthier? (e.g. (only) healthy food in the cafeteria, healthy snacks in the snack machine)
HP4 Does this program contain measures to give employees a healthy workspace? (e.g. adjustable desks and chairs, screens at an appropriate distance)
HP5 Does this program contain measures to make employees work as healthy as possible? (e.g. mandatory breaks, safety measures/campaigns,
restrictions on computer time)
Excluded*
HP3 Does this program contain measures to make the work environment as healthy as possible? (e.g. climate control, prohibition on smoking)
HP6 Does this program contain measures to keep employees mentally as healthy as possible? (e.g. discount/offering mental coaching, support, brain training.
* Excluded as they lowered the α significantly
Table A2 Internal Attribution
Locus of Control
LOCUS1 The cause(s) of being overweight is something that is: inside of you (7), outside of you (1)
LOCUS2 The cause of being overweight is: something about you (7), something about others (1)
Personal Control
PC1 The cause of being overweight is something: manageable by you (7), not manageable by you (1)
PC2 The cause of being overweight is something: you can regulate (7), you cannot regulate (1)
PC3 The cause of being overweight is something: over which you have power (7), over which you have no power (1)
Excluded*
LOCUS3 The cause(s) of being overweight is something that: reflects an aspect of yourself (7), reflects an aspect of the situation (1)
Stability
ST1 The cause of being overweight is something that is: permanent (7), temporary (1).
ST2 The cause of being overweight is something that is: stable over time (7), variable over time (1)
35 External Control
EC1 The cause of being overweight is something: over which others have control (7), over which others have no control (1)
EC2 The cause of being overweight s something: under the power of other people (7), not under de power of other people (1)
EC3 The cause of being overweight is something: other people can regulate (7), other people cannot regulate (1)
* Excluded as they lowered the α significantly
Table A3 Moralization
MORAL1 Having a healthy weight is a duty, not a preference
MORAL2 I find it difficult to maintain a healthy weight (reverse-coded)
MORAL3 Being overweight is something I morally disapprove of
MORAL4 Being overweight is something I don’t object to (reverse-coded)
MORAL5 Being overweight myself is something I would feel guilty about
MORAL6 Being overweight myself is something I would be ashamed of
MORAL7 I disapprove of being overweight
MORAL8 Having a healthy weight myself is something I pay attention to
Table A4 Discrimination
DISCR1 Lazy (reverse-coded)
DISCR2 Has will power
DISCR3 Good self-control
DISCR4 Fast
DISCR5 Has endurance
DISCR6 Active
DISCR7 Weak (reverse-coded)
DISCR8 Self-indulgent (reverse-coded)
DISCR9 Insecure (reverse-coded)
DISCR10 Low self-esteem (reverse-coded)
DISCR11 Attractive
DISCR12 Likes food (reverse-coded)
DISCR13 Shapeless (reverse-coded)
DISCR14 Under eats
DISCR15 Patient
DISCR16 Ambitious
DISCR17 Competent
DISCR18 Generous
