250 Chapter 8 workers’ needs and relevant factors in the work context. Moreover, they provide more knowledge on how and under what circumstances interventions work and how they can be improved and adapted to a specific context. The evaluation of the ‘Mentorwijs’ training contained an effect evaluation among supervisors and workers with a work disability. The evaluation among supervisors consisted of a before- and after measurement without a control group. Among workers a difference-in-difference study design was used, with a control group, but not randomized. A difference-in-difference is a feasible alternative for an RCT, because it is a more feasible approach to study changes as a result of the intervention (18). In the difference-in-difference analysis we could evaluate the effect of ‘Mentorwijs’ under real world conditions and strive for optimal comparability between the intervention and control group, as we could control for major confounding variables. Also, researchers do not need to consider a control group during implementation. However, in the evaluation of ‘Mentorwijs’ it was difficult to differentiate effects of the intervention from unmeasured and/ or unmeasurable factors in the organization, such as organizational culture and HR-policies (18). Although an RCT may have circumvented this issue, it may have been too rigid to handle the flexibility of the ‘Mentorwijs’ training, wherein the trainers had the possibility to adjust the protocol of the training and respond to the supervisors’ needs. Also, supervisors had the opportunity to choose what parts of the training they implemented or not implemented in practice. Therefore, also in this case, other study designs, such as participatory action research, realist evaluation and responsive evaluation, would be desirable in the future to gain more knowledge on how the ‘Mentorwijs’ training is implemented and to determine how and under what real world conditions the intervention is effective. Reflecting on the complexity of systems The role of the worker in the complexity of systems Throughout this thesis we focused on the health and sustainable employability of workers in a vulnerable position who are more at risk for problems on multiple life domains and for early drop out of the labor market. To reduce health inequalities, we therefore need to focus more on the needs of this group of workers and how we as society can provide additional support to improve their health and sustainable employability. However, in the Netherlands, much emphasis is placed upon the individual responsibility and self-control of individuals. This is also reflected in the definition of the Positive Health approach, which states that health is the ability to adapt and manage oneself in the light of the physical, emotional, and social challenges of life (23). However, research shows that not every individual has that ability. A recent report of the Netherlands scientific council of government policy (WRR in Dutch) showed that people’s ability for self-control is dependent on their
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