Development and implementation of a dyadic illness perception intervention for lower educated workers with a chronic disease and their partners: the DIPI-study.

Low educated workers experience more difficulties in adapting to the consequences of having a chronic disease than high educated workers, which contributes to persistent health inequalities between groups in lower and higher socio-economic position (SEP). Lower health literacy has been found to play an important role in health inequalities. It influences people's coping and self-management behavior and is consistently associated with poor health outcomes, which affect people’s ability to continue work. Low health literacy has shown to be one of the major pathways leading to incorrect illness perceptions, e.g. misbeliefs about what caused the illness, its expected effects, and controllability. Identifying individuals with incorrect illness perceptions and targeting interventions toward changing these perceptions are promising developments in improving perceived health and sustained labor market participation of low SEP workers with chronic diseases. Including significant others (SO), like partner or relative, in an illness perception intervention may reinforce the effects of interventions on illness perceptions, as it affects workers’ responses to chronic disease. In the clinical setting, this has been shown to be more effective than focusing on the patient alone. The proposed project aims to: 1. develop a dyadic illness perception intervention (DIPI) for lower educated workers with a chronic disease and their partner, combining the three core elements: illness perception, health literacy and dyadic intervention; 2. evaluate the implementation process of DIPI in four organizations, offered by occupational physicians (OP), to evaluate effectiveness and to understand why the implementation was successful or not. The project will focus on low SEP workers with diabetes mellitus type II, chronic obstructive pulmonary disease, musculoskeletal disorders, and cardiovascular disease. These are the most common chronic diseases in low-SEP workers, moreover, illness perceptions have found to be strongly associated with unhealthy lifestyles and adverse health-and work outcomes. The project consists of two phases: development phase and implementation phase. The development of DIPI will be based on existing evidence based interventions, and consultation of research experts on the core elements. In addition, a needs assessment will be conducted, i.e. intensive consultation with relevant stakeholders (low educated workers and their partners, OPs and key informants of the employers) to identify the wishes, experiences and needs. The development phase will yield a first draft, and the DIPI will be pilot-tested for clarity and functionality within a few intervention sites. In addition, a training module will be developed to train OPs in the DIPI method. This training will be developed in collaboration with experts from the Netherlands School of Public and Occupational Health. DIPI will be implemented in routine occupational healthcare practice of the four participating organizations: Asito B.V., Facility Service UMCG, Sheltered workplace Reestmond, Province of Groningen). The outcome and process of the implementation of the DIPI will be evaluated in a 12 month follow-up pre-post test design. Effectivity of the DIPI will be evaluated in 60 dyads by assessing changes of illness perceptions, perceived health, work ability, and sickness absence. DIPI will be offered by trained OPs. Repeated measures ANOVA will be applied to detect any overall differences between related means. For evaluating the implementation process of the DIPI, the framework by Nielsen and Randall for the evaluation of organizational level occupational health interventions will be applied. Three sources of mixed methods (i.e. questionnaires, interviews, mirror conversations will be collected over the course of 12 months to study the implementation components from multiple perspectives (dyads, occupational physicians, managers). The project will be conducted by the department of Community and Occupational Medicine (COM), in collaboration with the department of Health Psychology (UMCG), Zorgbelang Groningen and four employers with low-skilled jobs in North-East region of the Netherlands. COM will coordinate all research activities which will be carried out in the context of this project. Zorgbelang Groningen (Care Interest Groningen) participates as an independent partner in the research process, and collaboration with this organization ensures that the target group will be extensively involved and that their interests will be managed. All project members will be involved in monitoring progress and quality of the research project. An Advisory Board consisting of all relevant stakeholders and experts will be installed to ensure that the interests of all stakeholders are represented during the project. It will monitor that the DIPI to be developed fits in with daily practice of professionals, and that it fits with the low SEP worker perception and needs.