104 Chapter 4 to change, and see their own role in this process. If the worker does not see the problem or is not willing to take on an active role, it is likely that the intervention is less effective. Moreover, OHPs mentioned that some involved employers are not always willing to cooperate in the implementation of solutions or to pay for a solution resulting from the intervention. Finally, social pressure of colleagues or from the social environment of workers at home may also hamper the implementation of solutions. Program differentiation OHPs and participants of the intervention reported several essential intervention components that may contribute to positive effects. First, OHPs and participants expressed that the intervention provided an overview of all life domains, which provides workers more insight into (underlying) problems. As a result, workers became aware of problems they did not see themselves, or of problems that influenced their work functioning, as was described by a participant: P4: I thought it was primarily about the panic attack, but she asked me questions and she talked about certain things more deeply and then a completely different issue came up, which played a role on the background for a long time and the panic attack was an expression of that, and because she asked good questions, this came up all of a sudden. Second, OHPs and participants described that the structured method and visual materials helped workers to actively discuss problems and to get an overview of their problems. Finally, workers are in the lead to identify problems and solutions, which improves their feelings of self-control and a higher chance that solutions are being implemented. Discussion The aim of this study was to systematically evaluate the implementation process of the Grip on Health intervention in occupational health practice among OHPs and lower SEP workers. Grip on Health can be used to identify and solve problems on multiple life domains among lower SEP workers. Both OHPs and lower SEP workers were satisfied about the intervention and in particular with visual materials of the intervention, as this helped workers to actively discuss and identify their problems. However, many OHPs also experienced difficulties to deliver Grip on Health in occupational health practice. Many OHPs, including those who delivered the intervention, reported difficulties to preventively reach lower SEP workers, which was also described in other interventions (20). OHPs who succeeded to reach lower SEP workers in this study,
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