105 Grip on Health intervention among lower socioeconomic position workers indicated that the intervention was often initiated by the employer or was part of a preventive occupational health examination or absenteeism consultation. Thus, it seems that lower SEP workers do not tend to visit an OHP on their own initiative. OHPs in this study stated that familiarity of the preventive role of OHPs is low, which is in line with findings of another implementation study (21). OHPs in this study described that any type of OHP could deliver this intervention, as most OHPs already discuss problems on multiple life domains, and it is part of their normal way of working. Moreover, the group of OHPs who did and those who did not deliver the intervention both consisted of a variety of professions. However, discussing and solving problems on multiple life domains can take a lot of time, which was not always available in practice, as was mentioned as one of the reasons to not deliver the intervention. The lack of time experienced by some OHPs often relates to agreements between OHPs and involved employers about the duration of their consultation time. Furthermore, no permission from contracted employers to deliver the intervention was also one of the main reasons to not deliver the intervention. A review on health promotion programs in the workplace showed that management support was the most frequently reported facilitator for delivering interventions (13). In the Netherlands, employers pay for, and therefore largely determine, the content and extent of occupational health services provided. In addition, a context analysis for implementation of preventive interventions that consider multiple life domains showed that not all employers feel primarily responsible for solving problems on multiple life domains and still invest too little in prevention (9). Findings of this study also showed that implementation of the intervention was (very) limited. One contextual factor which has probably played a role is the Covid19 pandemic and the increased use of online consultations instead of face-to-face consultations. Moreover, OHPs who succeeded to deliver the intervention could not always deliver all intended steps due to the online consultation sessions. In line, another study evaluating Grip on Health among OHPs and general practitioners, showed that it was not feasible to use the materials in an online meeting (22). Furthermore, during the Covid-19 pandemic stakeholders at the workplace may have had other priorities than to support preventive interventions focused on multiple life domains. Involving stakeholders at the workplace with lower SEP workers is in general considered difficult, because they not always have time or see the added value of preventive interventions, as was described in this study and in literature (23, 24). It is, however, difficult to conclude that the implementation of Grip on Health was either successful or has failed. In implementation science there has been a debate about the balance between fidelity (i.e. intervention is delivered as intended) and the need for adaptation (i.e. changes in the intervention to fit the context) (25). The results of this study showed that for some parts adaptation to the intended intervention was valid. OHPs often had good reasons 4
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