59 Participatory Approach to improve the health of low socioeconomic position workers Background Socioeconomic health inequalities are a major societal problem. Workers with a low socioeconomic position (SEP) have a higher risk for health deterioration and premature mortality (1–3). Therefore, morbidity and mortality rates are generally higher than among workers with a high SEP (4, 5). Workers with a low SEP may also be more prone to health problems, because unfavorable physical and psychosocial working conditions and unhealthy behaviors are more prevalent among this group of workers (6, 7). Unfavorable working conditions and unhealthy behaviors are linked to poor health outcomes, which increases the risk for a disability and premature dropout from the labor market (8–10). Hence, workers with a low SEP are more likely to be unemployed or stop working due to a disability, as compared to workers with a high SEP. Furthermore, dropout from work is likely to lead to further deterioration of health (11). To prevent work disability among workers with a low SEP it is important to improve work functioning and health of workers with a low SEP which can be achieved by a workplace intervention. In the past decades there has been a growing awareness for interventions at the workplace that aim to solve health risks at the workplace through involvement of relevant stakeholders. One of these interventions is the Participatory Approach (PA). The effectiveness of the PA has been extensively investigated and these studies have shown that the PA had a positive impact on physical and mental health outcomes and return to work (RTW) (12, 13). The PA consists of a stepwise process to identify and solve problems at the workplace in a participatory way (14). This process is guided by an independent occupational health professional (OHP), wherein equivalent and active input of the worker, supervisor and other relevant stakeholders at the workplace is required and together they reach consensus on the most important problems and solutions (15). Stakeholder involvement may lead to a higher acceptance and implementation of solutions (16, 17). Moreover, participation of stakeholders may also lead to a better adherence to solutions, which increases the chance that solutions are sustained over time (13). Gradually the PA has been increasingly implemented in occupational health practice. Herein, the PA originally had an organizational preventive approach and was later on adapted to an individual (RTW) approach (15, 18). Although the PA is a promising method to reduce health risks at the workplace, this approach solely focuses on problems at the workplace and does not take into account that problems outside the workplace may also interfere with work functioning and health. Workers with a low SEP often face problems on multiple life domains (19), e.g. next to musculoskeletal problems experienced at the workplace, they could also have psychosocial problems or poor housing conditions. According to the new concept of health ‘The Positive Health approach’ the lack of ability to 3
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