No abstract

BackgroundLifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands.MethodsPrior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison.ResultsHypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS.ConclusionThe findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.

Implementation of measures aimed at reducing physical load and the promotion of personal development are needed.

Usage of employer SE measures was generally low and recommendations are given for both blue and white collar workers to improve SE strategies.

Even though important conditions for scale up were met, the implementation was characterized by a low reach, a high drop-out rate, and a low quality of the counseling technique.

Individuals in multiproblem situations frequently seek frontline legal support. The support by frontline legal professionals is limited by its focus on the legal issue instead of the underlying problems. A strong focus on client valuesi.e. on the outcome that these services yield in the client's perceptionmay lead to a more effective approach by targeting underlying problems. Through individual interviews with clients and professionals, the current study examines client values and services that may contribute to those client values. Besides functional client values that focus on resolving the problem situation, emotional client values, such as trust prove at least as important. Furthermore, client values are not only supported by the professional's legal expertise, accessibility and ability to build a relationship, but also by the professional's knowledge and skills relevant to multiproblem situations, such as his ability to empower the client, the willingness to work on concrete needs, and his ability to adopt an integrated approach. Research findings confirm the relevance of an integrated approach to multiproblem situations, with due attention to different client values. Similarly, it proves important to incorporate skills and knowledge that specifically address multiproblem situations in education and training programmes of frontline legal professionals.

IntroductionThere is few research on the causal pathways in the link between obesity and work ability. Furthermore, there are indications that the effects of obesity on work ability differ for workers with different levels of physical workload. This study aimed to investigate the moderating effect of physical workload in the relation between obesity and work ability.MethodsA longitudinal study was conducted among 36,435 Dutch construction workers who participated in at least two periodic medical examinations during the years 2008–2015. Logistic regression analyses were used to investigate the effect of manual material handling and strenuous work postures on the association between obesity and work ability. Confounding effects were tested for age, educational level, smoking, vigorous physical activity, psychosocial work demands, and working hours. Additive interaction between obesity and physical workload on work ability was tested using the relative excess risk due to interaction (RERI).ResultsConstruction workers with overweight (OR=1.09; 95% CI: 1.02 to 1.16) or obesity (OR=1.27; 95% CI: 1.17 to 1.38) had an increased risk of poor/moderate work ability. Exposure to manual material handling (OR=1.58; 95% CI: 1.49 to 1.68) or strenuous work postures (OR=1.80; 95% CI: 1.70 to 1.90) also increased the risk of poor/moderate work ability. The effect of the combination of obesity with high physical workload was greater than the sum of the individual effects (strenuous work postures: RERI=0.39; 95% CI: 0.10 to 0.67; manual material handling: RERI=0.26; 95% CI: 0.02 to 0.51).DiscussionObesity and high physical workload were associated with poor work ability and had a synergistic, negative effect on work ability. To prevent poor work ability, there is a need for interventions that promote a healthy lifestyle and increase physical capacity, as well as for interventions that tailor physical workload to the individual physical capacity.

No abstract