138 Chapter 5 Table 2. Overview of themes and related contextual factors Theme Contextual factors Difficulties in early identification of employees at risk for health problems • Methods for the identification of employees at risk mainly focus on indicated prevention • Limited availability of occupational physicians to preventively address problems on multiple life domains • Occupational social workers or occupational nurses more accessible than occupational physicians to preventively address problems on multiple life domains • Organizations not always willing to invest in preventive conversations with occupational health professionals or in preventive interventions Risk of conflicting role for supervisors in addressing problems on multiple life domains • Supervisors play an important role in the early identification of workers at risk for health problems • Supervisors play an important role in referring employees to an OHP on time • Supervisors discussing problems on multiple life domains may disadvantage employees • Privacy regulations to discuss problems on multiple life domains are unclear The Importance of Addressing Problems on Multiple Life Domains Among Employees with a Lower SEP The majority of the stakeholders recognized that employees with a lower SEP more often have problems on multiple life domains, as opposed to employees with a higher SEP. Although, several stakeholders representing all three levels described that employees with a higher SEP also encounter problems on multiple life domains, it was more important to address these problems among employees with a lower SEP. Employees with a lower SEP more often have unhealthy working and living conditions, and other problems in- and outside the workplace, such as unhealthy lifestyles or financial problems. Problems pile up and could further accumulate if not addressed on time, which makes it even harder to solve problems. As a result, stakeholders at all three levels described that employees with a lower SEP risk ending up in a negative spiral, wherein one problem perpetuates another problem, or one problem makes it difficult to solve another problem. S9 (socio-political macro level): “Yes, it more often leads to problems, in particular because it is not one aspect, it is often an accumulation of, and then lifestyle has a more negative effect. And there are more things that make them vulnerable, and these things are also interrelated. So lifestyle can be hard, because they may need an investment or money to solve that, and if you have a low income or struggling to
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