62 Chapter 3 Step 3 & 4: program design and program production In the third step, the design of the PA with a broader perspective on health was developed consisting of theory and evidence-based change methods to influence the change objectives for the behavioral and environmental outcomes in step 2. Next, practical strategies were identified to deliver the change methods. In the fourth step, the program structure and organization of the PA with a broader perspective were described in an intervention program, training, and materials. All gathered information from the previous steps was synthesized and translated to adapt the PA. Step 5 & 6: program implementation and evaluation plan In the fifth step, a plan for the implementation of the adapted PA was developed. In the implementation plan potential users of the PA were specified. Next, program outcomes, performance objectives and practical strategies were developed for the users to enable optimal delivery. In the sixth and final step of the IM process, an evaluation design was chosen and a plan for the evaluation of the PA was developed to investigate the implementation of the adapted PA in practice. Results Step 1: logic model of the problem Planning group The planning group consisted of 3 health scientists (RS, AB, CB), 2 occupational health physicians (FS, JA) and 1 ergonomist (MH). This multidisciplinary planning group was established to adapt the PA for workers with a low SEP. Furthermore, throughout the IM process relevant stakeholders at the workplace were consulted, namely workers with a low SEP, OHPs and employers. Needs assessment Health problems among workers with a low SEP Literature on the perception of health among workers with a low SEP showed that health has been described as a multidimensional concept (22, 23). This is in line with the ‘Positive Health approach’, which defines health as the ability to adapt and self-manage, in the light of physical, emotional, and social challenges of life (20). In this approach health is a dynamic phenomenon that should be seen as an integral part of life, rather than something that is only considered when illness occurs. Research shows that this concept is highly appreciated, as it addresses people as more than just their illness, and people themselves can decide what is important to them (24). According to this concept, health consists of multiple domains (e.g. bodily and mental functions, social and societal participation) and these domains were also recognized by workers with a low SEP (23).
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