247 General discussion the life-course perspective, SEP can be seen as a dynamic aspect that varies over an individual life’s course (2). Recent research shows that the social status may be a better indicator to identify workers with a lower SEP. The social status refers to the material circumstances in which people grow up and live and have a major influence on the ways in which people think and act with their social environment (8). Individuals with more unhealthy conditions are more orientated on how to deal with the external (unhealthy) environment and have a lower sense of personal control due to a lack of resources available to deal with (health) problems (8). As a result, they are their whole life disadvantaged making it more difficult to benefit from educational and employment opportunities to increase their social status. Considering the information described above, we could also debate whether the group of workers in this thesis really consisted of workers with a lower SEP and whether the results in this thesis accounts for the whole population of workers with a lower SEP. Workers with a lower SEP included in the studies of this thesis had regular jobs, while there may also be a group of people with an even lower SEP, affecting generalizability of findings in this thesis. For example, precarious workers, workers in sheltered workplaces or those long-term unemployed with physical and/or mental health problems. Hence, researchers need to carefully consider which indicators they use to identify workers with a lower SEP, as it is a dynamic aspect, and the use of certain indicators does not guarantee that lower SEP workers are identified. Recruitment and participation of workers in a vulnerable position For the pilot evaluation of the Grip on Health intervention we aimed to recruit 50 workers. However, in the end OHPs implemented the intervention among 27 workers. Hence, it was difficult to recruit workers with a lower SEP, as was also described in chapter 3 and 5. This is a limitation, because including the perspective of workers in research is essential; workers may hold other views, as opposed to other stakeholders at the workplace (9) and involving workers in research allows a better understanding and insight about the problems they experience and how to solve these problems (10). Despite the relatively low number of workers who participated in Grip on Health, chapter 3 and 5 still provided relevant insights on whether Grip on Health can support lower SEP workers in solving problems on multiple life domains and can be implemented in occupational health practice. Reasons for the difficulty to recruit workers with a lower SEP were also identified in these chapters, and mainly focused on the role of OHPs who implemented the intervention. For the process evaluation in chapter 5, OHPs were asked to preventively implement Grip on Health, as part of their daily practice. The main difficulty for OHPs to recruit workers with a lower SEP was that they were more often in 8
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