Responsive evaluation of stakeholder dialogue to promote health among employees with a lower socioeconomic position

A lower socioeconomic position (SEP) is associated with health problems. The work setting is considered promising for health promotion, because of its potential reach and possibilities to target both the social and working environment and individual behaviour. However, the work setting is also complex for health promotion. The ethical issue how far an employer can go in terms of promoting health of employees often rises. Different stakeholder views play a role in that multifaceted issue, for instance on whether (and to what extent) employees are responsible for their health or whether their employer is. In general, employees lack voice in the development of worksite health promotion, but their perspective should be the starting point of health promotion in order to be effective. Besides, not only SEP is associated with health problems: gender and cultural background (also known to affect health) might interact with lower SEP. Hence, an approach of worksite health promotion that embraces its complexity in dealing with different stakeholder perspectives and with diversity among employees is warranted.

In this unique multidisciplinary project, we aim to develop a stakeholder dialogue as an integrated worksite health promotion intervention to reduce health inequalities at work (i.e. to improve employees’ health in general, and lower SEP employees in particular). The intervention consists of moral case deliberation, a specific form of organized stakeholder dialogue. In dialogue sessions, stakeholders (i.e. team leaders, HRM, (lower SEP) employees) are invited to bring forward a health-related case to discuss, that is based on their own experience. Trained facilitators (i.e. researchers) help focus on the moral dimension of the case, in other words: what can be considered the right thing to do in that case. Participants are challenged to explore their own thinking, and the perspective of others. By confronting different perspectives, this form of stakeholder dialogue creates a learning process.
We aim to evaluate effects of the intervention on health-related outcomes on an individual level (such as self-regulation), on a team level (such as social support) and on organisational level (such as health registrations) through a novel evaluation method for the field of worksite health promotion: responsive evaluation.

Responsive evaluation is a form of interactive, participatory research, making use of mixed methods. In addition to interviews, survey data, recordings of the dialogue sessions, and HRM-data, researchers (PhD and post-doc) will perform participatory observations, for which they observe while performing work, attend meetings and engage in activities of the current health programs within two organisations. We propose this form of participatory research could be a solution to low participation rates, as insight can be gained on (lower SEP) employees’ perspective on conditions of participation can be studied, and – because of the flexible design- prerequisites of the (adaptive) intervention can be adjusted accordingly.

Furthermore, an economic evaluation of the stakeholder dialogue will be performed on both monetary outcomes (budget) from an organisational perspective, and on non-monetary value created by the intervention from a stakeholder perspective (social return on investment).

To ensure utilization of knowledge already in early stages of this project, we will form an advisory board, consisting of different stakeholders involved in worksite health promotion (e.g. HRM professionals, occupational physicians, insurance companies, employers, employees). Furthermore, knowledge generated in this project will be used to develop a communication training for HRM professionals (and student HRM professionals), in which they can develop their capacity to organize a stakeholder dialogue at work about health-related issues. Lastly, insights from this project on the suitability of responsive evaluation will be used to design a manual for responsive evaluation for worksite health promotion.