The WORK TOGETHER program: Using a systems approach to update an occupational health service and reduce the health gap

Research problem and specific questions The workplace is a promising setting to reduce health inequalities, but issues must be resolved to make it inclusive and effective.

Therefore, the overall aim of the Work Together program is to improve the reach and effectiveness of an existing and nationwide occupational health service program (OHSP) to reduce health inequalities by targeting high-risk groups that need the program most.

The program will consist of 3 inter-related work packages (WP):- WP1 Evaluation of reach and effectiveness of the existing program (Project 1)To study the reach and effectiveness of the existing OHSP during the past 30-years, specifically pertaining to under-represented and high-risk groups.- WP2 Program evaluation and development (Project 2,3 and 4)To identify barriers and facilitators for participation in, implementation and delivery of the existing OHSP (aim WP2A); to conduct a content analysis of the existing OHSP and contrast this with the best-evidence to find areas of improvement (aim WP2B); to use merged knowledge from WP2A and B to create an updated OHSP, adapted to target under-represented and high-risk groups (aim WP2C).- WP3 Implementation, effectiveness, efficacy and experience of the updated program (Project 5)To study the implementation of the updated program in real-world setting, as well as the effectiveness and efficacy, and the experience of the updated program, targeting under-represented and high-risk groups.Data and method WP1: Will use available individual-level data from n≈550,000 individuals (45% women) attending the existing OHSP since 1988 and link it to national registers.

WP2: Using a co-creation approach, we will conduct semi-structured individual and focus groups interviews (A), a content analysis of the existing OHSP program and map its content onto existing theoretical frameworks and taxonomies (B), and consequently adapt and update the OHSP (C).

WP3: We will perform a feasibility study, randomized controlled trial and semi structured individual interviews.Relevance and utilisation The program will provide significant knowledge on the ways an OHSP can be updated to be more inclusive and effective, consequently reducing health inequalities in Swedish work life, specifically for under-represented and high-risk groups.

Long term, nationwide utilisation of the updated OHSP is likely, based on the close collaboration with the OHS infrastructure, which will enable knowledge transfer to key stakeholders and end-users.Plan for program realisationThe program consortium consists of 10 senior and 2 junior researchers from 3 independent institutions, 3 collaborating partners, and an advisory board with 3 internationally leading researchers.

Clearly defined roles, responsibilities, decision making structures, processes and procedures will be implemented to ensure efficient and effective functioning of the program. Salary costs for participating research staff constitute most of the budget.