Training for Supervisors to Improve Sustainable Employment of Employees with a work Disability: A Longitudinal Effect and Process Evaluation from an Intervention Study with Matched Controls.

PURPOSE: Supervisors play a crucial role in sustainable employment of employees with a work disability. The 'Mentorwijs' (literal translation: Mentorwise) training was developed to train supervisors in knowledge, attitudes and skills needed to guide these employees. This study evaluated the effect of 'Mentorwijs' on employees' employment and supervisors' behavioral outcomes. METHODS: Register- and questionnaire data were obtained from 73 employees and 1,526 matched controls to measure employment (≥ 1/month, ≥ 12 h/week and ≥ 3 consecutive months (≥ 1 h/month)) during a 12-month follow-up period. Questionnaire data were obtained from 127 supervisors who followed the 'Mentorwijs' training, to assess their knowledge, self-efficacy, intention to adopt and applied behaviors. RESULTS: Employment for ≥ 1 h/month did not significantly improve after 3 (ß = 0.05; CI=-0.07-0.16), 6 (ß = 0.07; CI=-0.04-0.18), 9 (ß = 0.08; CI=-0.02-0.18) and 12 (ß = 0.01; CI=-0.08-0.10) months among employees whose supervisors followed 'Mentorwijs' compared to those who did not. Significant effects were found after 8 months (ß = 0.11; CI = 0.01-0.21). Comparable effects were found for employment ≥ 12 hour/week and ≥ 3 consecutive months (≥ 1 hour/month). Supervisors' knowledge and self-efficacy significantly improved as a result of 'Mentorwijs', but no effects were found for intention to adopt and applied behaviors. CONCLUSIONS: 'Mentorwijs' is a promising training to improve the guidance of employees with a work disability. Further research is needed to examine how long-term effects of 'Mentorwijs' on employment can be sustained.

Process evaluation of the 'Grip on Health' intervention in general and occupational health practice.

BACKGROUND: For working patients with a lower socioeconomic position, health complaints often result from a combination of problems on multiple life domains. To prevent long-term health complaints and absence from work, it is crucial for general and occupational health professionals to adopt a broad perspective on health and to collaborate when necessary. This study aimed to evaluate how the 'Grip on Health' intervention is implemented in general and occupational health practice to address multi-domain problems and to promote interprofessional collaboration. METHOD: A process evaluation was performed among 28 general and occupational health professionals, who were trained and implemented the Grip on Health intervention during a six-month period. The 'Measurement Instrument for Determinants of Innovations' was used to evaluate facilitators and barriers for implementing Grip on Health. Data included three group interviews with 17 professionals, a questionnaire and five individual interviews. RESULTS: While most health professionals were enthusiastic about the Grip on Health intervention, its implementation was hindered by contextual factors. Barriers in the socio-political context consisted of legal rules and regulations around sickness and disability, professional protocols for interprofessional collaboration, and the Covid-19 pandemic. On the organizational level, lack of consultation time was the main barrier. Facilitators were found on the level of the intervention and the health professional. For instance, professionals described how the intervention supports addressing multi-domain problems and has created awareness of work in each other's healthcare domain. They recognized the relevance of the intervention for a broad target group and experienced benefits of its use. The intervention period was, nevertheless, too short to determine the outcomes of Grip on Health. CONCLUSION: The Grip on Health intervention can be used to address problems on multiple life domains and to stimulate interprofessional collaboration. Visualizing multi-domain problems appeared especially helpful to guide patients with a lower socioeconomic position, and a joint training of general and occupational health professionals promoted their mutual awareness and familiarity. For a wider implementation, stakeholders on all levels, including the government and professional associations, should reflect on ways to address contextual barriers to promote a broad perspective on health as well as on collaborative work.

Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review.

BACKGROUND: Until now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods. METHODS: Studies published between January 2001-October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4-18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (> 75% positive), moderate (50-75%) or low (< 50%). RESULTS: Of the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N = 50), followed by responsiveness (N = 36), adherence (N = 26) and quality of delivery (N = 8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n = 77). CONCLUSIONS: There is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective.

The Grip on Health Intervention to Prevent Health Problems Among Workers With a Lower Socioeconomic Position: A Pilot Implementation Study.

OBJECTIVE: Workers with a lower socioeconomic position (SEP) often face problems on multiple life domains. This study evaluated an intervention to identify and solve problems on multiple life domains, called "Grip on Health." METHODS: A mixed-methods process evaluation was performed among occupational health professionals (OHPs) and lower SEP workers with problems on multiple life domains. RESULTS: Thirteen OHPs delivered the intervention to 27 workers. For seven workers, the supervisor was involved, and for two, stakeholders from outside the workplace were involved. Agreements between OHPs with employers often affected implementation. OHPs were essential to help workers identify and solve problems. The intervention increased workers' health awareness and self-control, and led to small and practical solutions. CONCLUSIONS: Grip on Health can support lower SEP workers with solving problems on multiple life domains. However, contextual factors make implementation difficult.

Participatory Approach to Create a Supportive Work Environment for Employees With Chronic Conditions: A Pilot Implementation Study.

OBJECTIVE: To evaluate a pilot implementation of an organizational-level intervention. The participatory approach (PA) was used to create a supportive work environment for employees with chronic conditions, with a key role for occupational physicians (OPs). METHODS: Twenty-eight semi-structured interviews were conducted with OPs and stakeholders within their organizations. Furthermore, observational data and research notes were gathered. Data analysis occurred through content analysis. RESULTS: Recruitment of organizations was challenging, with a reach of 25%. Dose delivered, dose received, and fidelity differed across the three organizations. Organizations were positive about the PA as a method to improve support for employees with chronic conditions. CONCLUSIONS: The PA could be of added value for creating a supportive work environment. However, research is needed on activating organizations to improve support for employees with chronic conditions.

The Implementation of Preventive Health Measures in Small- and Medium-Sized Enterprises-A Combined Quantitative/Qualitative Study of Its Determinants from the Perspective of Enterprise Representatives.

The workplace is an ideal environment for promoting workers' health. Nevertheless, preventive health measures are insufficiently implemented, especially in small and medium-sized enterprises (SMEs) with up to 250 employees. The aim of this study was to investigate determinants for the implementation of measures to prevent musculoskeletal and mental health disorders from the perspective of enterprise representatives in Dutch SMEs. An online survey was completed by 79 SME representatives (e.g., owners, HR professionals and occupational health and safety officers) in the cleaning, care, construction and transport sectors. In addition, semi-structured interviews were conducted with 18 enterprise representatives. The interview transcripts were analyzed using an inductive approach. Survey data showed that the focus of prevention efforts by SMEs is on improving working conditions and complying with legally required occupational health requirements, while lifestyle measures are rarely implemented. The determinants of implementation according to enterprise representatives were associated with 10 distinct themes. These were (1) available resources (both finances and staff), (2) complexity of implementation of measures, (3) awareness, (4) knowledge and expertise, (5) availability of time, (6) employer and worker commitment, (7) workers' openness for measures, (8) communication, (9) workers' trust and autonomy and (10) integration in organizational policy. These findings can serve as a support for developing strategies for implementing preventive health measures in SMEs.

[New paths to interprofessional collaboration: collaboration between assistant practitioners and practice nurses in general and occupational health care]. / Nieuwe wegen naar arbocuratieve samenwerking: samen werken van praktijkondersteuners huis- en bedrijfsarts bij multiproblematiek.

Background: To this date, there is little to no interprofessional collaboration between professionals in general and occupational health care in the Netherlands. Where earlier initiatives for improvement focused on general practitioners (GPs) and occupational physicians (OPs), we examine the role that professionals working under task delegation of GPs and OPs can play in addressing problems on multiple life domains as well as in interprofessional collaboration.Methods: We conducted three focus group interviews with 7 assistant practitioners (APs) in general practice, 11 practice nurses (PNs) in general practice and 8 APs in occupational health practice.Results: All PNs and APs in our study are confronted with multi-domain problems and see a role for themselves in addressing these problems. Moreover, in case of multi-domain problems, they acknowledge the relevance of interprofessional collaboration to provide good care. At this moment, however, there is practically no collaboration at the level of PNs and APs. Challenges are found in the formal task delegation and role identity of the APs in occupational health practice, unfamiliarity and prejudices among especially general practice PNs and APs regarding occupational health care, and practical barriers as privacy laws and reachability.Conclusion: Interprofessional collaboration among PNs and APs in general and occupational health care is possible, provided that a solution is found for fundamental and practical challenges. Potential solutions are to shift the focus from sharing medical information to communicating about the needs of working patients to function healthily on multiple life domains, to address interprofessional collaboration in educations, to adapt consultation protocols to include work and to organize joint meetings between professionals in general and occupational health practice. Finally, addressing structural barriers such as privacy laws and financing requires political action.

The effects of exit from work on health across different socioeconomic groups: A systematic literature review.

Exit from work leads to different effects on health, partially depending on the socioeconomic status (SES) of people in the work exit. Several studies on the effects of exit from work on health across socioeconomic groups have been performed, but results are conflicting. The aim of this review is to systematically review the available evidence regarding the effects of exit from work on health in high and low socioeconomic groups. A systematic literature search was conducted using Pubmed, Embase, Web of Science, CINAHL and PsycINFO. Search terms related to exit from work, health, SES and design (prospective or retrospective). Articles were included if they focused on: exit from work (early/statutory retirement, unemployment or disability pension); health (general, physical or mental health and/or health behaviour); SES (educational, occupational and/or income level); and inclusion of stratified or interaction analyses to determine differences across socioeconomic groups. This search strategy resulted in 22 studies. For general, physical or mental health and health behaviour, 13 studies found more positive effects of exit from work on health among employees with a higher SES compared to employees with a lower SES. These effects were mainly found after early/statutory retirement. In conclusion, the effects of exit from work, or more specific the effects of early/statutory retirement on health are different across socioeconomic groups. However, the findings of this review should be interpreted with caution as the studies used heterogeneous health outcomes and on each health outcome a limited number of studies was included. Yet, the positive effects of exit from work on health are mainly present in higher socioeconomic groups. Therefore, public health policies should focus on improving health of employees with a lower SES, in particular after exit from work to decrease health inequalities.