Realist Approach to Social Policies (RASP) study to reduce socioeconomic health inequalities through systems change: protocol for a research project combining mixed-methods realist research with institutional action research.

INTRODUCTION: Health inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy. About 25% of Dutch citizens experience deprivation of such resources. Social policy consists of crucial instruments for improving resources in those groups but can also have adverse effects and lead to additional burdens. This project aims to contribute to the reduction of health inequalities through (1) a better understanding of how social policy interventions can contribute to reducing health inequality through the redistribution of burdens and resources and (2) developing anticipatory governance strategies to implement those insights, contributing to a change in social policy systems. METHODS AND ANALYSIS: Two systems approaches are combined for establishing a systems change in the Netherlands. First, a realist approach enables insights into what in social policy interventions may impact health outcomes, for whom and under what circumstances. Second, an institutional approach enables scaling up these insights, by acknowledging the crucial role of institutional actors for accomplishing a systems change. Together with stakeholders, we perform a realist review of the literature and identify existing promising social policy interventions. Next, we execute mixed-methods realist evaluations of selected social policy interventions in seven municipalities, ranging from small, mid-size to large, and in both urban and rural settings. Simultaneously, through action research with (national) institutional actors, we facilitate development of anticipatory governance strategies. ETHICS AND DISSEMINATION: This study is not liable to the Medical Research Involving Subjects Act (WMO). Informed consent to participate in the study is obtained from participants for the use of all forms of personally identifiable data. Dissemination will be codeveloped with target populations and includes communication materials for citizens, education materials for students, workshops, infographics and decision tools for policy-makers and publications for professionals.

Physical workload and obesity have a synergistic effect on work ability among construction workers.

PURPOSE: Obesity and high physical workload are both associated with poor work ability, but the interaction between obesity and high physical workload on work ability is not yet fully understood. Obesity and high physical workload may share a common mechanical pathway, possibly leading to a synergistic negative effect on work ability. The purpose of this study was to investigate the effect of obesity on work ability in workers with high versus low physical work load. METHODS: A longitudinal study was conducted among 36,435 Dutch construction workers who participated in at least two periodic medical examinations during the years 2008-2015. Logistic regression analyses were used to investigate the effect of manual material handling and strenuous work postures in sports on the association between obesity and work ability. Work ability was measured using the self-reported Work Ability Index consisting of seven dimensions. Confounding effects were tested for age, educational level, smoking, vigorous physical activity, psychosocial work demands, and working hours. Additive interaction between obesity and physical workload on work ability was tested using the relative excess risk due to interaction (RERI). RESULTS: Construction workers with overweight (OR = 1.09; 95% CI 1.02-1.16) or obesity (OR = 1.27; 95% CI 1.17-1.38) had an increased risk of poor/moderate work ability. Exposure to manual material handling (OR = 1.58; 95% CI 1.49-1.68) or strenuous work postures (OR = 1.80; 95% CI 1.70-1.90) also increased the risk of poor/moderate work ability. The effect of the combination of obesity with high physical workload was greater than the sum of the individual effects (strenuous work postures: RERI = 0.39; 95% CI 0.10-0.67; manual material handling: RERI = 0.26; 95% CI 0.02-0.51). CONCLUSIONS: Obesity and high physical workload were associated with poor work ability and had a synergistic, negative effect on work ability. Interventions that prevent obesity and high physical workload might have a beneficial effect on work ability.

Strategies of employees in the construction industry to increase their sustainable employability.

BACKGROUND: The aging work force makes sustainable employability (SE) of workers a priority. However, it is unknown to what extent employees use implemented SE measures. OBJECTIVE: To determine the utilization of 1) SE measures offered by employers, 2) employee SE strategies, and 3) to identify barriers and facilitators of SE strategies. METHODS: Survey data were collected among 731 blue collar and 879 white collar workers to determine the utilization of employer SE measures. Focus groups were held with 16 blue collar and 17 white collar workers to identify employee SE strategies and their barriers and facilitators. RESULTS: Utilization of employer SE measures was highest for personal development measures. Strategies applied by blue collar workers included using equipment, suggesting improvements of their working conditions, and seeking promotion to a less physically demanding job. White collar workers named engaging in leisure time physical activity and seeking an adequate work-life balance. Implementation of these strategies was influenced by employee awareness and self-efficacy, the accessibility and costs and benefits of the strategy, management support and company culture. CONCLUSION: Usage of employer SE measures was generally low and recommendations are given for both blue and white collar workers to improve SE strategies.

The Employer Perspective on Sustainable Employability in the Construction Industry.

OBJECTIVE: To determine the measures employers in the construction industry take to promote sustainable employability, the barriers and facilitators that influence implementation and employer needs. METHODS: Questionnaire among 499 employers and interviews with 17 employers. RESULTS: Employers expressed a need for alternative jobs for workers who can no longer perform physically demanding tasks, as well as means to stimulate proactive employee behavior. Measures frequently targeted the work environment (95%) and employee health (79%), less frequently personal development (63%) and organization (65%). Implementation was influenced by economic factors, rules and regulations, client demands, employee demands, company vision, company culture, and time/manpower/expertise. CONCLUSIONS: Implementation of measures aimed at reducing physical load and the promotion of personal development are needed.

Process Evaluation of the Nationwide Implementation of a Lifestyle Intervention in the Construction Industry.

OBJECTIVE: The aim of this study was to monitor the national scale up of the effective lifestyle intervention Health Under Construction in the Dutch construction industry. METHODS: Data were collected on seven process indicators, ie, reach, dose delivered, dose received, fidelity, competence, satisfaction, and barriers. RESULTS: The intervention reached 2.4% of the target group. Thirty-eight percent of the participants received five to seven consultations and 41% discussed all six intervention components. None of the counselors attained motivational interviewing proficiency. Participants perceived their counselor as competent and were satisfied with the intervention. Counselors were moderately satisfied with the intervention and experienced various barriers. CONCLUSIONS: Even though important conditions for scale up were met, the implementation was characterized by a low reach, a high drop-out rate, and a low quality of the counseling technique.