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Promotion of healthy behaviour and prevention of obesity in workers with a lower socioeconomic position: an equity specific analysis of what works and why

Projectomschrijving

Doel

Overgewicht en een ongezonde leefstijl komen vaker voor bij volwassenen met een lage sociaal economische positie (SEP). Dit draagt bij aan de sociaaleconomische ongelijkheden op gezondheidsgebied. De werksetting lijkt een belangrijke omgeving om ongezond gedrag aan te pakken, want het maakt het mogelijk om een grote groep volwassenen te bereiken. Eerder uitgevoerd internationaal onderzoek over leefstijlinterventies suggereert dat deze interventies vooral effectief zijn op gezond gedrag en het verminderen van obesitas bij werknemers met een hoge sociaaleconomische positie (SEP). Tot nu toe is het onduidelijk of dit ook geldt voor leefstijlinterventies in Nederland. Door de recente toename van Nederlandse leefstijlinterventies op de werkplek is het mogelijk een meta-analyse uit te voeren. Zijn interventies (in)effectief bij werkenden met een lage SEP? En onder welke omstandigheden zijn de interventies het meest effectief?

Aanpak/werkwijze

In dit project is de data van vijftien Nederlandse interventiestudies met 8709 werknemers verzameld en zijn deze opnieuw geanalyseerd. Met een individuele participanten data (IPD) meta-analyse is onderzocht wat de deelname en de effectiviteit van interventies voor werknemers is en of deze verschilt tussen sociaaleconomische groepen. De uitkomstmaten hierbij zijn de Body Mass Index (BMI), fysieke activiteit, voeding, alcohol gebruik en roken.

Resultaten

De onderzochte interventies laten geen significante verbetering zien op het bevorderen van gezond gedrag of het verminderen van BMI. Interventies met een individuele benadering, een counseling component, of met meer dan 5 sessies blijken wel effectief in het verlagen van BMI. Ook interventies gericht op hoog risicogroepen (bijvoorbeeld mensen met een risico op hart- en vaatziekten) blijken hierin effectief. Verder is geen verschil gevonden in effect en deelname aan de interventies tussen de verschillende sociaaleconomische groepen. Het project laat zien dat huidige interventies niet effectief zijn om mensen met een lage SEP te bereiken. Daarom is onderzoek nodig naar nieuwe type interventies om gezond gedrag en BMI te verbeteren, met meer aandacht voor werknemers met lage SEP.

Producten

Titel: Socioeconomic inequalities in reach, compliance and effectiveness of lifestyle interventions among workers: protocol for an individual participant data meta-analysis and equity-specific reanalysis
Auteur: Oude Hengel, Karen M, Coenen, Pieter, Robroek, Suzan J W, Boot, Cecile R L, van der Beek, Allard J, Van Lenthe, Frank J, Burdorf, Alex
Magazine: BMJ Open
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398771/
Titel: Socioeconomic inequalities in effectiveness of and compliance to workplace health promotion programs: an individual participant data (IPD) meta analysis
Auteur: Pieter Coenen, Suzan J. W. Robroek, Allard J. van der Beek, Cécile R. L. Boot, Frank J. van Lenthe, Alex Burdorf & Karen M. Oude Hengel
Magazine: International Journal of Behavioral Nutrition and Physical Activity
Link: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-01002-w
Titel: Socio-economic inequalities in the effectiveness of workplace health promotion programmes on body mass index: An individual participant data meta-analysis
Auteur: Suzan J.W. Robroek, Karen M. Oude Hengel, Allard J. van der Beek, Cécile R.L. Boot, Frank J. van Lenthe, Alex Burdorf, Pieter Coenen
Link: https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13101
Titel: The influence of unhealthy behaviours on early exit from paid employment
Titel: Leefstijlinterventies op het werk, wat werkt?
Titel: Een prospectieve studie met Lifelines cohort: Invloed ongezond gedrag op vroegtijdig verlaten arbeidsmarkt bij chronisch zieken
Titel: Editorial "Decades of workplace health promotion research: marginal gains or a birght future ahead"
Auteur: Suzan Robroek, Pieter Coenen & Karen Oude Hengel
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058620/
Titel: Factsheet
Titel: Leefstijl interventies op de werkplek

Verslagen


Samenvatting van de aanvraag

PROBLEM DEFINITION Unhealthy behaviour and obesity contribute substantially to socioeconomic health inequalities in the working population. Lifestyle interventions in the work setting seem particularly promising to contribute to the reduction of these inequalities, because they can target those in lower social groups directly, and because of the ability to combine environmental and individual determinants. Yet, and despite an urgent call from policy makers and employers, little is known how to do this effectively. Over the past years, many interventions in the work setting for workers on promotion of healthy behaviour and obesity prevention have been conducted. Previous studies suggest that (inter)national lifestyle interventions are mainly effective among workers with a high socioeconomic position (SEP). However, it is unknown whether these socioeconomic differences also hold for lifestyle interventions in the Dutch context. This raises the questions whether the lifestyle interventions themselves are (in)effective for workers with low SEP or that those workers are less compliant to the interventions. And which intervention characteristics (e.g. content, duration) and work context (e.g. company size, social support) influence the effectiveness and compliance among workers with low SEP. We will integrate the findings of high quality studies on the effectiveness of Dutch intervention studies aimed at promoting healthy behaviour and obesity prevention. This meta-analysis will provide this knowledge and thereby contribute to developing and implementing effective interventions among workers with low SEP to reduce socioeconomic health inequalities. META-ANALYSIS OF DUTCH LIFESTYLE INTERVENTIONS The proposed study will re-analyse a broad range of existing Dutch interventions aimed at promoting healthy behaviour and obesity prevention among workers with low and high SEP separately. In a pilot study, principal investigators of 15 eligible Dutch studies were approached and informed about the proposed project, were asked if their evaluation studies included an indicator of socioeconomic position and if they were willing to participate in the project. This pilot showed that data of at least 12 studies is available, and they showed all great willingness to participate in the project. The study consists of four steps. First, we will conduct subgroup analyses to SEP for each study separately, following guidelines on the definition of SEP and outcome measures. The results will be visualized by harvest plotting for different socioeconomic groups. Studies will be classified in one of three groups: a negative social gradient (intervention more effective in lower socioeconomic groups), no gradient, or a positive gradient. Harvest plots will be made for different outcomes of healthy behaviour. Second, as obesity measures (BMI and waist circumference) are assessed identically across the majority of the studies, we will evaluate the effects on obesity by pooling the individual data of these studies and investigate the effects and moderators (education level) of the interventions on these outcomes. If significant interaction effects will be found, then stratified analyses will be carried out. Third, we will investigate the impact of the Dutch work context and intervention characteristics on the effectiveness of the intervention workers with low SEP in both step 1 and step 2. Lastly, as workers with low SEP seem less willing to participate in the interventions, this step will provide knowledge about the compliance of workers with low SEP based on data retrieved from existing process evaluations. And we will study whether intervention characteristics and work context can contribute to higher compliance. The results from this project will provide scientifically solid, practical guidance as to how to develop effective lifestyle interventions for workers with low SEP as well as how to implement and deliver the interventions to these workers. KNOWLEDGE TRANSFER According to the needs assessment among the most important stakeholders (companies, sector organizations, representatives of occupational physicians and a public health service), there is a wide recognition of the added value for practice of knowledge that will be obtained from this project. Moreover, we will translate preferences and needs into tailored materials for the stakeholders (e.g. MOOC and factsheet) and the target group of workers with low SEP (e.g. infographic). Involvement of the stakeholders is ensured by NSPOH as project member as well as by organizing meetings during the project with the above described stakeholders. EXPERTISE OF THE RESEARCH GROUP The consortium members have extensive and documented experience in research on socioeconomic inequalities, interventions on preventing unhealthy behaviour and obesity and conducting meta-analyses. Participation of NSPOH will ensure knowledge on dissemination and education in occupational health setting.

Kenmerken

Projectnummer:
531001411
Looptijd: 100%
Looptijd: 100 %
2018
2020
Gerelateerde subsidieronde:
Projectleider en penvoerder:
Dr. K.M. Oude Hengel
Verantwoordelijke organisatie:
Erasmus MC