243 General discussion Part II: The role of occupational health professionals in supporting lower socioeconomic position workers with problems on multiple life domains The second aim of this thesis was to develop and evaluate a preventive intervention for OHPs to improve the health and sustainable employability of workers with a lower SEP and with problems on multiple life domains, and to explore facilitators and barriers for implementation of these type of preventive interventions in occupational health practice. Chapter 3 describes that workers with a lower SEP more often experience problems on multiple life domains, but also perceive difficulties with solving problems or use passive or avoidance coping styles towards these problems. Therefore, an intervention mapping protocol was used to adapt the existing Participatory Approach at the workplace to include a broader perspective on health following the Positive Health approach. Herein, OHPs guide and support this group of workers in identifying and solving problems on multiple life domains to improve their health and sustainable employability. This resulted in the Grip on Health intervention, which was evaluated in a pilot implementation study, as described in chapter 4. OHPs were trained to deliver this intervention among lower SEP workers. A mixed methods process evaluation showed that the intervention can be a successful method to support lower SEP worker with problems on multiple life domains. However, OHPs experienced several barriers on organizational level to implement this intervention in practice, such as lack of time or permission from the involved employer to deliver the Grip on Health intervention. Chapter 5 further explored facilitators and barriers in the organizational and socio-political context for implementation of this type of interventions in a qualitative study. The results of this chapter showed that it is challenging to implement a preventive intervention that considers multiple life domains among workers with a lower SEP for several reasons. For an intervention that considers multiple life domains, both stakeholders and professionals in- and outside occupational health practice need to be involved. However, there is not only a lack of collaboration among these stakeholders and professionals, but also none of them feels fully responsible to solve problems on all life domains. Moreover, a preventive intervention is difficult to implement in occupational health practice, as stakeholders in chapter 5 experience that employers still insufficiently invest in the prevention of health risks and problems for their workers. In the end, employers in the Netherlands determine the amount of time OHPs can spend on prevention. As a result, OHPs need to spend their time mainly on guiding and supporting workers already on sick leave due to health problems, but not on preventing these problems. This was also illustrated by the results of the pilot implementation study in which many OHPs experienced a lack of time to implement the Grip on Health intervention (chapter 4). 8
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