Socioeconomic health differences in the Netherlands are large, complex and persistent (Bosma, 2014; Jansen, 2017; VTV, 2014). Extra effort for increasing the health of low educated people is necessary (WRR, 2017). The workplace seems to be a good starting point to improve the health of low educated employees: 39% of the Dutch working population is low educated (Statline, 2017). Even though low educated employees are more at risk for poor health, they hardly participate in workplace health interventions (Meershoek et al., 2011) and when they do participate they tend to profit to a lesser extent (effectiveness of these programs is lower for them; Burdorf et al., 2016). It seems plausible that the inverse care law (the higher educated people profiting more from health care services than the low educated; Hart, 1971) also applies to occupational health interventions (cf. Kooiker, 2011; Koornstra & Acda, 2017; Meershoek et al., 2011). This is explained by a mismatch between these interventions and programs on the one hand, and the health literacy, needs, circumstances, adverse working conditions, resilience, general level of skills and knowledge of low educated employees on the other (e.g. Koornstra & Acda, 2017; Rademakers, 2014; Van Lenthe & Beenackers, 2017). In addition, low educated employees do not consider lifestyle as a domain that is completely disentangled from other life domains, such as work, leisure time, social and private life (Bosma, 2014). Interventions that target too narrow may thus not fit to the reality of this group of employees, and realities may differ across organizations (Houkes et al., 2015). There seems to be a discrepancy between the needs of low educated employees and existing interventions. Thus, interventions need to be better tuned to the needs of this target group, who should have a say in the intervention development in their organization. Therefore, this project aims to develop the generic MAISE-toolkit for organizations to support the development and implementation of health promotion interventions aligned to the needs of low educated employees (first objective). We aim to develop this toolkit in cooperation with two to four organizations deploying low educated employees. Employers and low educated employees will be represented in one or two expert groups which will advise on the development of the MAISE-toolkit. The toolkit consists of (1) needs assessment tools; (2) intervention development tools; (3) implementation tools. This classification of tools is based on the intervention mapping approach (Bartholomew et al., 2011). The entire toolkit will be tuned to the target group. Each organization can choose their own tools and develop their own specific interventions. For the needs assessment, the MAISE (MAastricht Instrument for Sustainable Employability; Houkes & De Rijk, 2017) is proposed. MAISE is a questionnaire that taps employee opinions on their health and influencing factors, developed in earlier (ZonMw funded) research on employee perspectives on workplace health. MAISE will be complemented with other questionnaires. As part of the proposed research, the necessity to adapt MAISE to lower educated employees will be studied and MAISE will be adapted accordingly. Tools for intervention development and implementation tools will be dialogue-based. It is expected that interventions will be much more effective when employees themselves are truly involved in the problem analysis and development of tailor-made interventions (Zoller, 2003). Starting a dialogue between employees and their employers is crucial in this respect (Francis et al, 2013; Cabot, 2003; O’Brien et a. 2004). The toolkit will be used in two or three different organizations to develop and implement interventions tailored to the lower educated employees (second objective), and the processes of development and implementation as well as the effects of the interventions in these organizations will be evaluated according to a ‘case-study’ design (each organization being one case) by means of qualitative (interviews, participating observation) and quantitative methods (repeated administration of MAISE, monitoring, checklists), including a budget impact analysis (third objective). In order to get an overview of the conditions in which the approach adopted in this project works best, the two or three cases included in the evaluation will be compared with each other with regard to all aspects included in the evaluation.
Please see appendix for a Dutch summary of this project.