Evaluating the implementation process of a participatory organizational level occupational health intervention in schools

Abstract

BackgroundThe importance of process evaluations in examining how and why interventions are (un) successful is increasingly recognized. Process evaluations mainly studied the implementation process and the quality of the implementation (fidelity). However, in adopting this approach for participatory organizational level occupational health interventions, important aspects such as context and participants perceptions are missing. Our objective was to systematically describe the implementation process of a participatory organizational level occupational health intervention aimed at reducing work stress and increasing vitality in two schools by applying a framework that covers aspects of the intervention and its implementation as well as the context and participants perceptions.MethodsA program theory was developed, describing the requirements for successful implementation. Each requirement was operationalized by making use of the framework, covering: initiation, communication, participation, fidelity, reach, communication, satisfaction, management support, targeting, delivery, exposure, culture, conditions, readiness for change and perceptions. The requirements were assessed by quantitative and qualitative data, collected at 12 and 24 months after baseline in both schools (questionnaire and interviews) or continuously (logbooks).ResultsThe intervention consisted of a needs assessment phase and a phase of implementing intervention activities. The needs assessment phase was implemented successfully in school A, but not in school B where participation and readiness for change were insufficient. In the second phase, several intervention activities were implemented at school A, whereas this was only partly the case in school B (delivery). In both schools, however, participants felt not involved in the choice of intervention activities (targeting, participation, support), resulting in a negative perception of and only partial exposure to the intervention activities. Conditions, culture and events hindered the implementation of intervention activities in both schools.ConclusionsThe framework helped us to understand why the implementation process was not successful. It is therefore considered of added value for the evaluation of implementation processes in participatory organizational level interventions, foremost because of the context and mental models dimensions. However, less demanding methods for doing detailed process evaluations need to be developed. This can only be done if we know more about the most important process components and this study contributes to that knowledge base.Trial registrationNetherlands Trial Register NTR3284.

Systematic literature review on the effects of occupational safety and health (OSH) interventions at the workplace

“…This is not surprising because it is difficult and sometimes even unethical to perform RCT at the workplace level, and the complexity of many workplace interventions and contexts render RCT unfeasible in the real world. Other alternative designs for the evaluation of occupational health interventions have recently been proposed (83). Tompa et al (5) also reviewed the literature and used a "best evidence" synthesis to assess the strength of evidence.…”

The Need for Dual Openness to Change: A Longitudinal Study Evaluating the Impact of Employees’ Openness to Organizational Change Content and Process on Intervention Outcomes

“…Two recent exceptions exist, however. A study by Schelvis et al (2016) found that a participatory organizational intervention implemented in two schools was unsuccessful due to poor implementation fidelity and that these could be explained by poor readiness for change, low participation and contextual barriers. In another study, implementation fidelity as well as adaptation to four components of adherence (i.e., content, dose, coverage and timeliness) was evaluated, showing that adaptations were made to all four adherence components on the individual, unit and organizational levels (von Thiele Schwarz, Hasson, & Lindfors, 2015).…”

A study protocol for a cluster randomised controlled trial on mindfulness-based stress reduction: Studying effects of mindfulness-based stress reduction and an additional organisational health intervention on mental health and work-related perceptions of teachers in Dutch secondary vocational schools

“…and 3) participants' mental models [57,77]. The process components of Themes 2 and 3 may mediate or moderate the link between any intervention exposure and intervention effects [77].…”