Department of Social Sciences, Chair group Consumption & Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, 6706, Wageningen, KN, The Netherlands.
Department of Medical Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
BMC Health Serv Res. 2020 Mar 12;20(1):196. doi: 10.1186/s12913-020-5020-2.
Large health inequalities exist in the Netherlands among individuals with a high compared to a low socioeconomic position. Worksite health promotion interventions are considered promising to reduce these inequalities, however, current interventions seem not to have the desired effects. This study proposes 'moral case deliberation', a form of stakeholder dialogue on moral dilemmas, as an integrated and inclusive intervention for worksite health promotion. This intervention takes into account three factors that are considered possible underlying causes of low effectiveness of current interventions, namely the lack of deliberate attention to: 1) the diverging values and interests of stakeholders in worksite health promotion, 2) the ethical issues of worksite health promotion, and 3) the connection with the lived experience (lifeworld) of lower SEP employees. Moral case deliberation will help to gain insight in the conflicting values in worksite health promotion, which contributes to the development of a vision for worksite health promotion that is supported by all parties.
The intervention will be evaluated through Responsive Evaluation, a form of participatory research. Key to Responsive Evaluation is that stakeholders are consulted to determine relevant changes as a result of the intervention. The intervention will be evaluated yearly at both fixed moments (baseline and annual evaluation(s)) and continuously. Mixed methods will be used, including interviews, participatory observations, analyses of HRM-data and short questionnaires. In addition, the intervention will be evaluated economically, on both monetary and non-monetary outcomes.
This protocol proposes an innovative intervention and a novel participatory evaluation in the context of worksite health promotion. The study aims to gain understanding in how dialogue on moral dilemmas on health and health promotion can contribute to heightened personal and mutual understanding among stakeholders and practice improvements in the work context. By evaluating the intervention in more than one setting, findings of this study will provide knowledge about how MCD can be adapted to specific work settings and what changes it may lead to in these settings.
Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, retrospectively registered. https://www.trialregister.nl/.
在荷兰，高社会经济地位和低社会经济地位的个体之间存在较大的健康不平等。工作场所健康促进干预措施被认为是减少这些不平等的有希望的方法，但目前的干预措施似乎没有达到预期的效果。本研究提出“道德案例审议”，即一种关于道德困境的利益相关者对话形式，作为工作场所健康促进的综合和包容性干预措施。这种干预措施考虑到了三个被认为是当前干预措施效果不佳的可能潜在原因，即缺乏对以下因素的刻意关注：1）工作场所健康促进中利益相关者的不同价值观和利益，2）工作场所健康促进的伦理问题，以及 3）与低社会经济地位员工的生活体验（生活世界）的联系。道德案例审议将有助于深入了解工作场所健康促进中的冲突价值观，这有助于制定一个得到各方支持的工作场所健康促进愿景。
该干预措施将通过响应性评估进行评估，这是一种参与式研究形式。响应性评估的关键是咨询利益相关者，以确定干预措施的相关变化。该干预措施将每年在固定时间（基线和年度评估）和连续时间进行评估。将使用混合方法，包括访谈、参与式观察、人力资源管理数据分析和简短问卷。此外，还将对干预措施进行经济评估，包括货币和非货币结果。
本方案提出了一种创新的干预措施和一种新的参与式评估方法，用于工作场所健康促进。本研究旨在深入了解健康和健康促进方面的道德困境对话如何有助于增进利益相关者之间的个人和相互理解，并改善工作环境中的实践。通过在多个环境中评估干预措施，本研究的结果将提供有关如何使道德案例审议适应特定工作环境以及它可能在这些环境中带来哪些变化的知识。
荷兰试验注册中心（NRT）：NL8051。注册日期：2019 年 9 月 28 日，回顾性注册。https://www.trialregister.nl/。
