Organisation: Health Economics and Epidemiology Research Office (HE2RO), Ezintsha, Washington University and University of Liverpool
Study objectives: The Healthy Jozi project aims to design and evaluate a comprehensive workplace-based programme that improves screening, linkage to care, and healthy food choices for employees in Johannesburg. The study will be conducted in two phases: 1) co-design interventions for non-communicable diseases (NCDs) screening and linkage to care, 2) evaluate these interventions in workplaces. The study integrates behavioural science, human-centred design, and implementation science to co-design person-centred interventions to address NCDs especially diabetes and hypertension at workplaces in the city of Johannesburg.
Phase 1 objectives are to:
- Identify behavioural barriers and preferences related to screening, linkage to care, and healthy food choices in workplace programmes through contextual inquiry and discrete choice experiments
- Co-design, prototype, and develop an innovative workplace intervention package combining screening, linkage to care, and healthy food choice components
Phase 2 objectives are to:
- Evaluate the effectiveness of the integrated workplace intervention using a cluster-randomised trial focused on hypertension in Johannesburg workplaces
- Assess provider satisfaction with the referral process from the linkage programme
- Conduct an economic evaluation of the comprehensive workplace intervention package
- Disseminate successful innovations to key stakeholders, including medical insurers, occupational health programmes, and government implementers
Intervention description:
The Healthy Jozi intervention will be co-designed with employees, workplace managers, community organisations, and food suppliers. It may include:
- Staged screening events for selected chronic diseases
- Linkage-to-care support like referral information, SMS reminders, and navigation for those not linked
- Healthy food choice components (behaviourally informed messaging, improved visibility of healthy options, and contextual education)
- Prototyping will occur through multiple rounds in the Indlela B-Hub, ensuring interventions are acceptable and feasible before full rollout
Evaluation description:
Phase 1
Contextual inquiry on employee and manager preferences for screening, linkage, and food options:
- 30 semi-structured interviews will be conducted with employees at workplaces
- 4 focus group discussions will be conducted with managers at the workplaces
- Discrete choice experiments will be conducted with employees and managers
Phase 2
- A factorial cluster-randomised trial across 52 workplaces
- An economic evaluation will be conducted to determine the cost and cost-effectiveness of the intervention package
Study outcome:
Phase 1
- Co-designed workplace intervention to be evaluated in Phase 2
Phase 2
Primary outcome:
- Successful completion of the hypertension screening and linkage to care if indicated, among all employees at each workplace
Secondary outcomes:
- Acceptability, appropriateness, and feasibility
- Cost per person screened and linked
Study site: Workplaces across Johannesburg
Target population:
Inclusion criteria (employees and managers)
- ≥18 years
- Employed at a workplace in Johannesburg
- Willing and able to provide informed consent
- Willing to be contacted for follow-up
Exclusion criteria
- Unable or unwilling to provide informed consent
- Planning to relocate during the follow-up period (for screening participants)
Sample size & analysis:
Phase 1:
- 30 employees for SSIs
- 4 FGDs (8-10 managers each)
- 300 employees + 100 managers for DCEs
Phase 2:
- ±2,600 employees across 52 workplaces in a factorial cluster-randomised trial
Analysis:
- Qualitative data coded deductively & inductively
- DCEs analysed using mixed logit models and latent class analysis
- Trial outcomes analysed using mixed-effects logistic regression
- Economic evaluation using provider-perspective costing
Duration: 27 months
