65 Participatory Approach to improve the health of low socioeconomic position workers Only improving the ability of workers with a low SEP to self-manage and adapt health problems is not enough, this group of workers also need a supportive environment on how to perform the desired behavior. For example, a study among truck drivers showed that those who were motivated to change their lifestyle did not succeed, as they didn’t know how to overcome the obstacles in their work and private life (48). For that reason, workers with a low SEP need support in tackling these problems, such as making an action plan, that includes information on how and when the behavior can be performed and thinking about strategies on how to overcome potential obstacles (49). Moreover, workers with a low SEP also need a supportive environment as they have a lower control (i.e. autonomy) over decisions in and outside the workplace. Workers with a low SEP have, compared to workers with a high SEP, a lower decision latitude which is a predictor for health problems at the workplace (6). Outside the workplace workers with a low SEP experience a lower control over decisions in their day-to-day lives, due to a lack of resources needed for health and wellbeing (25, 50). Finally, supportive environments are associated with a decrease in work-family conflicts and an increase in social capital (35, 51, 52). This could be relevant for workers with a low SEP, as they experience more negative health effects of work-family conflicts and have lower levels of social capital (36, 43). So, to effectively self-manage and adapt problems on multiple life domains, relevant stakeholders (e.g. supervisor or partner) need to be involved in the decision-making process of solving problems. OHPs could play an important role in this process by bringing together the worker and relevant stakeholders. A supportive environment can consist of an OHP who supports the worker in solving problems on multiple life domains. However, occupational health practice is mainly focused on healthy functioning at the workplace (53). As a result, OHPs may insufficiently consider problems on other life domains than work or may lack competencies on how to support workers with a low SEP in solving problems on other life domains than work. Therefore, occupational health care should provide more attention to the interplay of problems in and outside the workplace and how this could affect work functioning and health of workers with a low SEP. Furthermore, preventive interventions wherein OHPs provide early support to workers with a low SEP could be difficult. OHPs are not always easily reached in organizations; they could be seen as someone who works for the employer (i.e. lack of trust) and workers could be unfamiliar with the preventive role of OHPs (54). Finally, as was mentioned above, workers with a low SEP have a lower awareness and risk perception of health problems. As a result, workers with a low SEP do not easily ask for help from an OHP. For that reason, OHPs need to create a safe environment for workers with a low SEP and improve their familiarity among workers at the workplace. 3
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