Optimization and evaluation of "Bewegen Werkt"
Werklozen hebben vaker gezondheidsproblemen in vergelijking met werkenden. Gezondheidsproblemen kunnen een belemmering zijn om te participeren in de maatschappij. Het beweegprogramma Bewegen Werkt is gericht op het bevorderen van de gezondheid en (arbeids)participatie van uitkeringsgerechtigden in Nederland.
Het doel van het project is het optimaliseren en evalueren van Bewegen Werkt. De optimalisatie is gericht op 1) een integrale aanpak van gezondheid & re-integratie, 2) begeleiding van gedragsverandering met motiverende gesprekstechnieken, en 3) inzet WhatsApp voor ondersteuning van cliënten gedurende- en na afloop van het beweegprogramma. We evalueren zowel de effecten (o.a. fysieke en mentale gezondheid, arbeidsparticipatie) als de implementatie van de interventie.
Inzicht wordt verkregen in bevorderende en belemmerende factoren voor implementatie. De Bewegen Werkt modelgetrouwheidsschaal wordt ontwikkeld om implementatie te monitoren in verschillende gemeenten in Nederland.
Samenvatting van de aanvraag
In the Netherlands, large socioeconomic health inequalities exist. Unemployment is an important factor underlying these health inequalities. Unemployment can lead to poorer health, which in turn will reduce the likelihood of re-employment. To enhance re-employment, health improvement is an important starting point. The intervention “Bewegen Werkt” (BW) [“Exercise Works”] is a re-activation programme for unemployed persons with health problems consisting of physical activity, lifestyle education and individual coaching. An evaluation study among 102 participants showed improvements in physical health, self-confidence and well-being directly after the programme. However, there are still several challenges to overcome to optimize the effectiveness of BW. The main challenge is to maintain the effects of the programme on the long-term. The aim of this study is to optimize the BW programme and to evaluate the effectiveness of the BW programme on mental and physical health, health behaviours, and participation among unemployed persons with health problems. The BW programme will be optimized by 1.Emphasizing the intersectoral approach, combining efforts of the BW coach and the case manager of the municipality; 2.Educating BW coaches in Motivational Interviewing; an evidence-based technique to enhance motivation for behaviour change; 3.Prolonging the BW programme with follow-up meetings after the end of the programme; 4.Using WhatsApp to enhance communication and support from the coach and the other group-members during and after the BW programme. The research questions concern the effectiveness on primary (physical and mental health, and participation), and secondary outcomes (healthy behaviours, self-esteem, mastery, and happiness), as well as the implementation process (barriers and facilitators for implementation, costs and benefits), A focus group with case managers and BW coaches will be organized to get insight into barriers and facilitators for carrying out the intersectoral collaboration. In a brainstorm session, barriers will be brought up and ideas will be generated to overcome these barriers. In addition, interviews with professionals (10 case managers, 10 BW coaches, 5 policy officers) and clients (10 participants, 10 drop-outs, 10 ex-participants) will be performed to get insight into barriers and facilitators for implementation of the BW programme. With a quasi-experimental study design, insight is gained into the effect of the BW programme on health, health behaviour and participation. An intervention group consisting of 250 clients participating in the programme and a control group consisting of 250 clients with comparable characteristics, but not participating in the programme are followed for one year. The propensity score matching technique will be used as alternative research design to evaluate the effectiveness of the BW programme because a randomized controlled trial is not feasible. A fidelity scale will be developed, consisting of 25-50 questions on the practical implementation of the BW programme. For each municipality, the level of implementation will be measured. It will be investigated whether the BW programme shows better results in municipalities with a higher score on the fidelity scale. A monitoring committee is formed to monitor the progress of the research and to promote the dissemination of the results. Clients councils of the municipalities are invited for the monitoring committee. The knowledge concerning the effectiveness and implementation of Bewegen Werkt will be shared with various stakeholders, such as professionals of the municipality, policy makers, researchers, employers, lifestyle coaches and the target population. 1) A guide for municipalities is developed and published on a website, which describes how the intervention can be implemented. The "Bewegen Werkt" fidelity scale can be downloaded from the website. 2) With two YouTube videos, a wide spread of the knowledge and experience gained is promoted among 1) professionals of the municipalities and 2) the target group of unemployed persons. 3) A brochure with infographics provides information on how to work towards personal goals to adopt a more active and healthy lifestyle. 4) Information about the effectiveness of the intervention is shared through intervention databases of Blik op Werk (blikopwerk.nl), and RIVM (loketgezondleven.nl) to social service departments and employers in the Netherlands. The project team consists of a strong consortium of researchers from Erasmus MC (expertise in health promotion and reintegration of the unemployed) and the University of Groningen (expertise in behavior change and influencing), the intervention owner of "Bewegen Werkt" and municipalities. Six municipalities (Emmen, Deventer, Oldebroek, Borger Odoorn, Coevorden, Den Haag) indicated that they are willing to participate in this project and signed the letter of support.