“Engagement” in Wellness Programs: Separating Fact from Fiction

We receive e-mails almost weekly from various wellness vendors, professional organizations, and publications with articles, webinars, and programs offering solutions for increasing participation and building “engagement” into wellness programs. However, in every case it is evident there is a fundamental confusion on what engagement really is and why it matters. Let’s look at how Miriam-Webster defines these two terms:

  • Engagement:  an emotional involvement or commitment
  • Participate:  to take part in an activity or event

In healthcare, there has recently been an increased focus on patient engagement and the patient experience — recognizing how important both are to the quality of patient care and health outcomes. If you ask most healthcare providers, they say they would much rather have patients engaged in their own health and treatment plans versus just showing up expecting the healthcare team to “magically” do all of the work (i.e., participating).

In education, there is also an increased focus on engagement and how that translates into the student experience. In an article discussing the importance of engagement versus participation on college campuses, the authors argue that “Rather than promoting engagement primarily through programs and publications, campuses could inspire students by transforming their entire experience.” Again, if you ask most teachers, they say they would much rather have students engaged in their own learning versus just showing up to take part in class and do the minimum to get by (i.e., participating).

And organizational leaders who understand the value and importance of employee engagement and the employee experience focus on creating the conditions for highly engaged employees. There are more than 50 identified conceptual definitions of “employee engagement.” The Conference Board (a global, independent business membership and research association working since 1916 to provide organizations with the practical knowledge they need to improve their performance and better serve society) assembled a committee of experts in 2007 that came up with this composite definition:

“Employee engagement is a heightened emotional and intellectual connection that an employee has for his/her job, organization, manager, or coworkers that, in turn, influences him/her to apply additional discretionary effort to his/her work.”1

Engagement is said to occur when employees:

  • Know what’s expected of them
  • Feel valued
  • Are able to leverage their strengths
  • Have quality relationships at work
  • Are cognitively stimulated 2

Engaged employees are not only satisfied, but they go above and beyond to help the organization achieve success. Disengaged employees, on the other hand, are apathetic, toxic to the work environment, and can erode the culture and negatively impact productivity. Herein lies the issue…

In the world of worksite wellness/health promotion, the term “engagement” is often used synonymously and interchangeably with “participation.” Clearly however, participation and engagement are NOT the same, not even close. When people refer to “wellness engagement rates,” they are really referring to program participation or completion. Employees can participate in (and even complete) a program without being engaged. In fact, the more incentives are used and the more hoops employees have to jump through to earn the incentive, the more their participation becomes compliance-focused and engagement drops. Likewise, employees can be very much engaged in their job and engaged in their own personal wellbeing yet not participate in programs or activities.

So why should those involved with employee wellbeing care about semantics? Because employee engagement is powerfully connected to individual wellbeing:

  • Highly engaged employees miss fewer days of work due to illness and are more resilient with respect to organizational change.3
  • Total cholesterol and triglyceride levels significantly decrease as engagement levels increase; likewise, cholesterol and triglyceride levels increase as engagement levels decrease.4
  • 62% of engaged employees feel their work lives positively affect their physical health and 78% believe their work lives benefit them psychologically.5
  • 54% of actively disengaged employees feel their work lives negatively affected their physical health and 51% feel their work lives negatively affect their psychological wellbeing.5
  • Actively disengaged employees are nearly twice as likely to be diagnosed with depression and anxiety as are engaged employees.6
  • Individuals in workgroups in the bottom quartile of engagement average 62% more accidents than workgroups in the top quartile of engagement.7

And according to the latest research, some 70% of U.S. employees are not engaged; costing businesses in this country 100s of billions of dollars every year. That’s of much greater significance than the unfounded ROI and healthcare cost-savings claims from many wellness programs.

Confusing participation with engagement is problematic, particularly so for employee wellbeing since the typical 4P (pry, prod, poke, and punish) “wellness or else” program is more likely to diminish engagement than it is to improve it.

So the next time you hear a vendor, consultant, or program provider referring to their “engagement rates,” beware. Ask how these individuals measure engagement and how they distinguish it from participation. Our guess is they will have difficulty providing an answer but rather will start describing all of the programs employees can complete (which they then define as being engaged in the program).

Bottom Line:

If you want to create the conditions for thriving organizational and employee wellbeing, focus on supporting engagement, not coercing participation in wellness programs.

Watch this great video by my colleague, Dr. Jon Robison, on “Words & the Art of Treating Employees like Adults.”


  1. Marciano, P.L., Ph.D., “Carrots and Sticks Don’t Work:  Build a Culture of Employee Engagement with the Principles of RESPECT™.”
  2. Harter, J.K., Schmidt, F.L., & Keys, C.L.M., Well-being in the workplace and its relationship to business outcomes: A review of the Gallup studies. In C.L.M. Keys & H. Haidt (Eds.), “Flourishing:  the positive person and the good life” (pp. 205-224). Washington, DC: American Psychological Association.
  3. Watson Wyatt, “Driving business results through continuous engagement.
  4. Harter, J.K., Canedy, J. & Stone, A., “A longitudinal study of engagement at work and physciologic indicators of health.” Presented at the 2008 Work, Stress, and Health Conference, Washington, D.C.
  5. Crabtree, S., “Engagement keeps the doctor away.” Gallup Management Journal Online, 1-5.
  6. Agrawal, S. & Harter, J. K.,”Engagement at work predicts change in depression and anxiety status in the next year.” Omaha, NE: Gallup.
  7. Senge, P.M.,The Fifth Discipline: The Art & Practice of the Learning Organization.”
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