Process evaluation of the ‘Grip on Health’ intervention in general and occupational health practice

Abstract

Background For working patients with a lower socioeconomic position, health complaints often result from a combination of problems on multiple life domains. To prevent long-term health complaints and absence from work, it is crucial for general and occupational health professionals to adopt a broad perspective on health and to collaborate when necessary. This study aimed to evaluate how the ‘Grip on Health’ intervention is implemented in general and occupational health practice to address multi-domain problems and to promote interprofessional collaboration. Method A process evaluation was performed among 28 general and occupational health professionals, who were trained and implemented the Grip on Health intervention during a six-month period. The ‘Measurement Instrument for Determinants of Innovations’ was used to evaluate facilitators and barriers for implementing Grip on Health. Data included three group interviews with 17 professionals, a questionnaire and five individual interviews. Results While most health professionals were enthusiastic about the Grip on Health intervention, its implementation was hindered by contextual factors. Barriers in the socio-political context consisted of legal rules and regulations around sickness and disability, professional protocols for interprofessional collaboration, and the Covid-19 pandemic. On the organizational level, lack of consultation time was the main barrier. Facilitators were found on the level of the intervention and the health professional. For instance, professionals described how the intervention supports addressing multi-domain problems and has created awareness of work in each other’s healthcare domain. They recognized the relevance of the intervention for a broad target group and experienced benefits of its use. The intervention period was, nevertheless, too short to determine the outcomes of Grip on Health. Conclusion The Grip on Health intervention can be used to address problems on multiple life domains and to stimulate interprofessional collaboration. Visualizing multi-domain problems appeared especially helpful to guide patients with a lower socioeconomic position, and a joint training of general and occupational health professionals promoted their mutual awareness and familiarity. For a wider implementation, stakeholders on all levels, including the government and professional associations, should reflect on ways to address contextual barriers to promote a broad perspective on health as well as on collaborative work.

The Grip on Health Intervention to Prevent Health Problems Among Workers With a Lower Socioeconomic Position

“…OHPs may hold different views on the intervention than lower SEP workers themselves, 34 affecting the credibility and transferability of findings 33 . However, the contextual factors affecting the implementation of Grip on Health in this study were also found in other studies, 9,22 suggesting good transferability and confirmability of findings. Another limitation is that selection bias may have occurred.…”

“…Moreover, OHPs who succeeded to deliver the intervention could not always deliver all intended steps because of the online consultation sessions. In line with this, another study evaluating Grip on Health among OHPs and general practitioners showed that it was not feasible to use the materials in an online meeting 22 . Furthermore, during the COVID-19 pandemic, stakeholders at the workplace may have had other priorities than to support preventive interventions focused on multiple life domains.…”

“…This may underline the finding in this study that the intervention was also perceived relevant for higher SEP workers. For instance, another study that evaluated Grip on Health also found that this intervention could be applied to a wider group of people 22 . People with problems on multiple life domains, and especially people with psychological health complaints, have less structure and overview, which temporarily affects their problem-solving skills.…”

“…In line with this, another study evaluating Grip on Health among OHPs and general practitioners showed that it was not feasible to use the materials in an online meeting. 22 Furthermore, during the COVID-19 pandemic, stakeholders at the workplace may have had other priorities than to support preventive interventions focused on multiple life domains. Involving stakeholders at the workplace with lower SEP workers is in general considered difficult, because they do not always have time or see the added value of preventive interventions, as was described in this study and in the literature.…”

“…For instance, another study that evaluated Grip on Health also found that this intervention could be applied to a wider group of people. 22 People with problems on multiple life domains, and especially people with psychological health complaints, have less structure and overview, which temporarily affects their problem-solving skills. These findings may indicate that it is not about the classification of groups into a lower or higher SEP, but about the circumstances in which people live.…”