Evaluating an Integrated Work Health Intervention Among Cleaners in Denmark: Challenges and Lessons

Abstract Introduction Work-related diseases and injuries pose a growing global health challenge. These risks are unequally distributed across job functions, and cleaners have been identified as a particularly vulnerable group. Integrated approaches that combine disease prevention and health promotion at work have been developed to address this. This study comprises a process evaluation assessing the implementation of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention among cleaners. Methods The ITASPA intervention was implemented at two workplaces in Denmark. At each site, committees of employees and line managers co-developed initiatives aimed at preventing work-related injuries and promoting health and well-being. Using the British Medical Research Council's framework for process evaluation, we assessed implementation through reach, dose, fidelity, adaptations, mechanisms of impact, and contextual factors. Data from focus group interviews and field notes were analyzed. Results Ninety-one cleaners provided data, and three workshops were held at each workplace. Implementation was challenged by limited information dissemination and low motivation among participants. Unintended power dynamics emerged, impacting participation. Contextual barriers included frequent staff replacements, time pressure, and absent management, which compromised fidelity and sustainability. Conclusions Integrated work health interventions have the potential to improve health and safety outcomes among workers when comprehensively implemented. However, attention must be paid to mitigating power imbalances in participatory approaches and ensuring management support. Future interventions should address these challenges and consider realist evaluation approaches to better capture the influence of contextual factors on implementation success. Key messages • Integrated work health interventions can improve well-being among cleaners but require strong management support. • Participatory approaches must carefully address unintended power dynamics to ensure equitable engagement.