Process evaluation of workplace health promotion in a sheltered workplace: a care ethics perspective.

Despite the potential health benefits of workplace health promotion for employees in sheltered workplaces, participation is often limited. The aim of this study was (i) to understand this limited participation, and (ii) to find opportunities for adapting workplace health promotion, such that it better meets the needs of the target population. A responsive process evaluation of an extensive multi-component workplace health promotion program targeting lifestyle behaviors, financial behaviors, literacy and citizenship, was performed in a large, sheltered workplace in the Netherlands (>3500 employees). To understand the limited participation, interviews with employees (n = 8), supervisors (n = 7) and managers (n = 2), and 10 participant observations were performed. To find opportunities for improving workplace health promotion in the sheltered workplace, 7 dialogs with employees were performed (n = 30). The interview data on the barriers for participation were evaluated through the lens of care ethics, as this allowed to understand the role of various stakeholders in the limited participation, as well as the indirect role of the institutional context. Findings showed that participation in workplace health promotion could increase if it is organized in a way that it encourages employees to work on health together, allow to tailor activities to different needs and capabilities of employees, and connects activities to employees' daily lives. A strength of this study is that the responsive process evaluation focused both on barriers for participation, as well as on opportunities to increase participation.

People who cannot participate in work without adaptations, for example, due to disability, can work in sheltered workplaces. These employees face various health risks, which are prompted by, for example, low income or low (health) literacy. More and more sheltered workplaces provide health promotion programs to improve health of their employees, such as educational workshops about physical exercise and healthy nutrition. However, participation of employees in such programs is limited. In this study, we investigated why participation is limited, and what are possible ways to make workplace health promotion programs that aim to improve health more attractive to employees in a sheltered workplace. We used different methods, such as interviews, group dialogs and participant observations. We concluded that workplace health promotion programs seem to rely too much on the individual employee, who prefers to work on health together with peers. Employees also value that activities in the health program are useful for their daily lives. This increases the relevance of the program for them and makes employees more inclined to participate.

Responsive evaluation: an innovative evaluation methodology for workplace health promotion interventions.

Background: Workplace health promotion (WHP) interventions have limited effects on the health of employees with low socioeconomic position (SEP). This paper argues that this limited effectiveness can be partly explained by the methodology applied to evaluate the intervention, often a randomised controlled trial (RCT). Frequently, the desired outcomes of traditional evaluations may not match employees'-and in particular employees with low SEP-needs and lifeworld. Furthermore, traditional evaluation methodologies do not function well in work settings characterised by change resulting from internal and external developments. Objective: In this communication, responsive evaluation is proposed as an alternative approach to evaluating WHP interventions. Responsive evaluation's potential added value for WHP interventions for employees with low SEP in particular is described, as well as how the methodology differs from RCTs. The paper also elaborates on the different scientific philosophies underpinning the two methodologies as this allows researchers to judge the suitability and quality of responsive evaluation in light of the corresponding criteria for good science.

Stakeholder dialogue on dilemmas at work as a workplace health promotion intervention including employees with a low SEP: a Responsive Evaluation.

BACKGROUND: The aim of this study was to evaluate the perceived changes of an innovative workplace health promotion intervention and evaluation. In this study, a bottom-up approach was taken to define the central themes and relevant outcomes of an intervention. These central themes and relevant outcomes of the intervention were defined together with stakeholders, including employees with a low socioeconomic position. METHODS: The intervention consisted of a series of structured stakeholder dialogues in which dilemmas around the - by employees defined -health themes were discussed. The intervention was implemented in a harbor service provider with approximately 400 employees. Over a two-year period, 57 participants engaged in eight dialogues of one hour. 15 interviews and six participant observations took place for the evaluation of the intervention. RESULTS: Together with the stakeholders, high workload and mental health were defined as central themes for the dialogue intervention in the male-dominated workplace. The dialogue intervention contributed to changes, on different levels: individual, team, and organization. Overall, the stakeholder dialogues advanced the understanding of factors contributing to high workload and mental health. In reply to this, several actions were taken on a organizational level. CONCLUSIONS: Taking a bottom-up approach in WHP allows to understand the health issues that are important in the daily reality of employees with a low socioeconomic position. Through this understanding, workplace health promotion can become more suitable and relevant for employees with a low socioeconomic position. TRIAL REGISTRATION: Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, Retrospectively registered https://www.trialregister.nl.

The effectiveness of workplace health promotion programs on self-perceived health of employees with a low socioeconomic position: An individual participant data meta-analysis.

The aim of the current study was to evaluate whether workplace health promotion programs improve self-perceived health of employees with a low socioeconomic position (SEP), and whether differential effects exist between individuals with a low SEP for gender, marital status or age. Individual participant data from six Dutch intervention studies aiming at promoting healthy behavior and preventing obesity in the work setting, with a total of 1906 participants, were used. The overall intervention effect and interaction effects for gender, marital status and age were evaluated using two-stage meta-analyses with linear mixed regression models. In the first stage effect sizes of each study were estimated, which were pooled in the second stage. Compared to control conditions, workplace health promotion programs did not show an overall improvement in self-perceived health of employees with a low SEP (ß0.03 (95%CI: -0.03 to 0.09)). Effects did not differ across gender, marital status and age. Future research could be focused on the determinants of self-perceived health next to health behavior to improve the health of employees with a low SEP.

Responsive evaluation of stakeholder dialogue as a worksite health promotion intervention to contribute to the reduction of SEP related health inequalities: a study protocol.

BACKGROUND: Large health inequalities exist in the Netherlands among individuals with a high compared to a low socioeconomic position. Worksite health promotion interventions are considered promising to reduce these inequalities, however, current interventions seem not to have the desired effects. This study proposes 'moral case deliberation', a form of stakeholder dialogue on moral dilemmas, as an integrated and inclusive intervention for worksite health promotion. This intervention takes into account three factors that are considered possible underlying causes of low effectiveness of current interventions, namely the lack of deliberate attention to: 1) the diverging values and interests of stakeholders in worksite health promotion, 2) the ethical issues of worksite health promotion, and 3) the connection with the lived experience (lifeworld) of lower SEP employees. Moral case deliberation will help to gain insight in the conflicting values in worksite health promotion, which contributes to the development of a vision for worksite health promotion that is supported by all parties. METHODS: The intervention will be evaluated through Responsive Evaluation, a form of participatory research. Key to Responsive Evaluation is that stakeholders are consulted to determine relevant changes as a result of the intervention. The intervention will be evaluated yearly at both fixed moments (baseline and annual evaluation(s)) and continuously. Mixed methods will be used, including interviews, participatory observations, analyses of HRM-data and short questionnaires. In addition, the intervention will be evaluated economically, on both monetary and non-monetary outcomes. DISCUSSION: This protocol proposes an innovative intervention and a novel participatory evaluation in the context of worksite health promotion. The study aims to gain understanding in how dialogue on moral dilemmas on health and health promotion can contribute to heightened personal and mutual understanding among stakeholders and practice improvements in the work context. By evaluating the intervention in more than one setting, findings of this study will provide knowledge about how MCD can be adapted to specific work settings and what changes it may lead to in these settings. TRIAL REGISTRATION: Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, retrospectively registered. https://www.trialregister.nl/.