Evaluating the implementation of an integrated work health intervention among cleaners in Denmark: Challenges and lessons learned

Introduction: Work-related diseases and injuries represent a rising global health challenge, with 2.9 million deaths attributed to work-related causes in 2019. Work-related risk factors and diseases are unequally distributed across occupational groups, with cleaners identified as a vulnerable occupational group. Integrated approaches combining the prevention of disease and promotion of health in work health interventions have been developed. This process evaluation aims to assess the implementation of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention. Methods: The ITASPA intervention was implemented at two workplaces among cleaners in Denmark. At each workplace, a committee of employees and line managers was formed to develop initiatives to prevent work-related injuries and diseases and promote workers’ health, safety, and well-being. Using the British Medical Research Council’s framework, this process evaluation assessed the implementation through reach, dose, fidelity, adaptations, mechanisms of impact, and contextual factors. Data from focus group interviews and field notes were utilized to evaluate the implementation. Results: A total of 91 cleaners provided data, and three workshops were held at each workplace. Lack of information about the intervention and motivation challenged the implementation. Furthermore, unwanted power dynamics were unintended consequences of the intervention. Contextual factors, such as many replacements, time pressure, and the absence of managers, challenged the implementation and fidelity. Conclusion: Integrated approaches to work health interventions among employees with short or no education can positively impact employees’ health, well-being, and safety if comprehensively implemented. However, attention should be given to unintended power dynamics arising from participatory approaches and the importance of management during implementation. Future interventions may benefit from increased attention to such factors to enhance long-term sustainability as well as realist evaluation approaches for more comprehensive evaluations of contextual factors. Trial registration: ITASPA was retrospectively registered at Clinicaltrials.gov on the 19 May 2023 (NCT05866978).