106 Chapter 4 for not delivering all intervention steps. For example, workers who were not willing to continue or who were not able to come to an agreement with their supervisor, while readiness to participate and having an open mind is a precondition to participate in this participatory intervention (7). Involving professionals from outside the workplace in solving problems was considered too complex by the OHPs in this study. This is probably related to the strict separation in the Netherlands between occupational and curative healthcare, which makes collaboration difficult between professionals from in- and outside the workplace (9). Moreover, literature suggests that skills of OHPs to involve stakeholders play an important role, and training OHPs in involving stakeholders would be useful (26). For instance, a study on involving significant others, such as the partner, showed that OHPs have an important role in informing workers about the possibility to involve significant others (27). This kind of skills were not addressed in the Grip on Health training and could therefore also have played a role in the limited involvement of stakeholders outside the workplace. In this study, the role of the process leader was perceived as challenging by most OHPs in this study. They are used to take on the role of the expert and to provide advice to workers on how to solve their problems. Moreover, OHPs described that lower SEP workers find it difficult to take self-control, as they are less able to identify problems and/or solutions on their own. However, both OHPs and workers in this study stated that the intervention was perceived as effective, mainly due to increasing workers’ awareness of health problems. Increasing awareness is the first stage in the transtheoretical model of change (28). This is called the precontemplation phase, wherein people do not intend to act, and they are often unaware of their problems. This study showed that the intervention provided more insight into problems by discussing different life domains. This is very helpful, as literature shows that lower SEP workers may have a lower awareness and risk perception of their health problems (8, 17). Moreover, people with problems on multiple life domains are often in a state of chronic stress, wherein they are unable to oversee their problems (29). As a result, people may find it more difficult to be aware of problems and could use passive or avoidant coping styles towards their problems. This may underline the finding in this study that the intervention was also perceived relevant for higher SEP workers. For instance, another study that evaluated Grip on Health also found that this intervention could be applied to a wider group of people (22). People with problems on multiple life domains, and especially people with psychological health complaints, have less structure and overview which temporarily affects their problem-solving skills. These findings may indicate that it is not about the classification of groups into a lower or higher SEP, but about the circumstances in which people live (30).
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