Background Obesity and unemployment are complex social and health issues with underlying causes that are interconnected. While a clear link has been established, there is lack of evidence on the underlying causal pathways and how health-related interventions could reduce obesity and unemployment using a holistic approach. Objectives The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce obesity, overweight and unemployment and to determine for whom and under what circumstances these interventions were successful or unsuccessful and why. Methods A realist synthesis approach was used. Systematic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. The evidence from included studies were synthesised into Context-Mechanism-Outcome configurations (CMOcs) to better understand when and how programmes work, for which participants and to refine the final programme theory. Results A total of 83 articles met the inclusion criteria. 8 CMOcs elucidating the contexts of the health-related interventions, underlying mechanisms and outcomes were identified. Interventions that were tailored to the target population using multiple strategies, addressing different aspects of individual and external environments led to positive outcomes for reemployment and reduction of obesity. Conclusion This realist synthesis presents a broad array of contexts, mechanisms underlying the success of health-related interventions to reduce obesity and unemployment. It provides novel insights and key factors that influence the success of such interventions and highlights a need for participatory and holistic approaches to maximise the effectiveness of programmes designed to reduce obesity and unemployment. Trial registration PROSPERO 2020 CRD42020219897.
Objectives Obesity, overweight and unemployment are intertwined, with common underlying causes however limited studies have examined this association. Holistic approaches are therefore required to understand this inter-relationship. The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce weight and unemployment and to understand the contexts and mechanisms that determine effectiveness. Methods Electronic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. Data from included articles were extracted and coded for Context-Outcome-Mechanism configurations (CMOcs). A realist approach to thematic analysis was used to synthesis and refine the final program theory building on the initial program theory. Results are presented using a narrative synthesis. Results A total of 83 studies meeting the inclusion criteria and assessment for rigor and relevance were included. 17 CMOcs were identified that demonstrated interactions between intervention strategy, context of intervention, responses generated by the intervention (mechanism) and outcomes. Findings indicate implementation of multicomponent interventions tailored to the needs of the target group are more likely to result in positive outcomes. Additionally, consideration of both individual and external contextual factors would enhance the design, delivery and effectiveness of health-related interventions designed to reduce obesity and improve re-employment. Conclusions This is the first realist review of health-related interventions implemented to reduce overweight, obesity and unemployment. The findings contribute to a deeper understanding of the determinants of effectiveness and how to holistically address unemployment and obesity using common strategies. Funding Sources This work is funded by grants from the EU Interreg European Regional Development Fund.
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