Unboxing vitality: a realist approach within sheltered employment

Abstract Background Employees in sheltered workplaces often face complex combinations of physical, cognitive, and social challenges affecting their health and vitality. In Rotterdam, a sheltered workplace offers a multicomponent vitality program to stimulate participation in health-promoting activities. Our study explores the program's impact, its alignment with employees’ needs, and the contextual factors and mechanisms shaping its implementation and reception. We expected that social components, such as engagement of team coaches, could support participation and positive experiences (short-term), and ultimately support healthier behaviour at home and at work and sustainable employability (long-term). Methods Given the complexity of evaluating an ongoing program, a realist evaluation (RE) was used to explore how context and mechanisms shape outcomes. This multi-method design is tailored to the target group's capacities. Phase 1 developed an Initial Program Theory (IPT) through interviews with staff. Data were analysed using a theory-based approach. Results Interviews revealed contextual factors affecting participation and positive experiences, as shown in our IPT. At individual level, low health literacy and self-esteem were seen as barriers; tailoring interventions to active learning and skill-building could enhance inclusivity in participation. At organizational level, staff highlighted that when team coaches are engaged and have clear responsibilities, their modelling and support foster participation and healthier behaviours. However, time constraints and work pressure, were seen as limiting factors. Recommendations Tailor interventions to fit low literacy contexts and to include practical skill-building. Support healthy behaviours at work by strengthening the coach role and aligning vitality goals with organizational priorities. Finally, RE proves valuable in complex contexts, offering context-sensitive insights that can bridge research, practice, and policy.