90 Chapter 4 The importance of process evaluations is increasingly being recognized, as implementation data are valuable for understanding how interventions work in real world settings (14). However, a review on process evaluations of workplace health promotion interventions showed that process evaluations mainly focused on what is delivered and on participation levels, rather than how an intervention is delivered, the quality of delivery, and reasons whether or not to participate in the intervention (13). To obtain comprehensive, in-depth information on the implementation process there is a need for systematic approaches in process evaluations, with data on a wide range of components, collected from different perspectives and with different type of methods (13-15). Therefore, this study evaluated the implementation process of the Grip on Health intervention in occupational health practice among OHPs and lower SEP workers, using both quantitative and qualitative methods. Methods Study design The implementation process is evaluated by applying the Medical Research Council (MRC) process evaluation framework (12). Following this framework, the process evaluation consists of three parts: implementation (i.e. what is delivered and how?), mechanism of impact (how is the intervention perceived and how does it produce change?) and context (i.e. how does context affect implementation and outcomes?). The mixed methods process evaluation was performed between July 2019 and June 2021 by conducting questionnaires, checklists and semi structured (group) interviews among OHPs, semi structured interviews among lower SEP workers who participated in the intervention, and researcher logs. The Medical Ethics Committee of the VU University Medical Center approved the study protocol. OHPs and lower SEP workers signed written informed consent before participation. The Grip on Health intervention The intervention is a conversation method that consists of a stepwise process to identify and solve problems on multiple life domains that affect work functioning, with the involvement of at least one relevant stakeholder. This process is guided by an independent OHP who is in the role of process leader. In this intervention the PA is used, meaning that the process leader guarantees equivalent and active input of all participants (i.e. worker and other stakeholder) in each step of the intervention and generates consensus on the most important problems and solutions. Therefore, the PA is part of the intervention as a method to reach consensus among stakeholders, which is not the same as participatory action research. Participatory (action) research is a methodology to conduct research, in which researchers actively work together with participants to collect data and
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