63 Participatory Approach to improve the health of low socioeconomic position workers Workers with a low SEP often face problems on multiple life domains (19), which could interfere with work functioning and health. In the interviews, workers with a low SEP recognized that not only health complaints are related to problems at work, but that problems in other life domains also interfere. Workers with a low SEP also mentioned that problems at work are often caused by underlying problems in other life domains that are not always identified by OHPs. OHPs and employers acknowledged in the focus groups that problems outside the workplace are relevant to discuss in occupational health practice and are often not identified. The time and energy that workers need for problems outside the workplace could negatively affect their work functioning (19). Moreover, short term social or economic problems may hinder workers with a low SEP to improve their health on the longer term (19, 25). For example, adherence to lifestyle interventions is often only feasible when short term problems in daily life are resolved (26, 27). Main determinants for health problems among workers with a low SEP Workers with a low SEP have a larger risk for health problems for three different reasons. First, unfavorable work-related determinants, including both physical and psychosocial factors. Physical factors prevalent among workers with a low SEP are biomechanical, chemical, and biological exposures which increases the risk for physical health problems (6, 28, 29). Workers with a low SEP also often have jobs that include repetitive work, heavy lifting and with poorer working arrangements, such as shift work (6, 30). Psychosocial factors prevalent among workers with a low SEP are low job control, high job insecurity and low levels of social support (6, 28, 29, 31), which may result in a lower psychological wellbeing and an increased risk for mental health problems (32). Second, unfavorable non-work-related determinants are more prevalent among workers with a low SEP. Workers with a low SEP more often have unhealthy lifestyle behaviors, such as smoking, physical inactivity, heavy drinking, and unhealthy dietary patterns (19, 28, 33). In addition, workers with a low SEP generally have limited financial resources, and these limited resources could hinder them to live healthy (25, 33). Healthy behaviors are often more costly than unhealthy behaviors. For example, healthy food is often more expensive than unhealthy food (34). Moreover, workers with a low SEP have more limited social networks than people with a higher SEP (23). Social networks can provide resources, such as support or knowledge in enabling healthy behaviors (33). Access to resources through social networks refers to the concept of ‘Social Capital’ (35). Moreover, social capital may also be a work-related determinant, consisting of support from for example, the supervisor. People with a low SEP generally have lower levels of social capital which limits their access to obtain and use diverse resources (36). This may lead to poorer health outcomes among people with a low SEP, as compared to people with a high SEP (35–37). Hence, increasing social capital could 3
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