The analysis is structured in three main themes; 1) municipality and management considerations, 2) project manager considerations, and 3) employee considerations and positions. The first two themes are analysed based on the informants from the municipality and the management, while the third main theme are identified from the HCWs and three subthemes were identified: a. focus on health and weight loss, b. pressure from the environment and c. struggle for recognition.
Municipality and management considerations
The municipality and the management at the home-care centre both were motivated by a possible economical gain of the project, however the manager also cared for the health of her employees. For the municipality, the primary reason for conducting the intervention was to provide a good service for the elderly and secondary to promote health of the employees.
“I have to deliver a product. The fact that my employers need to be healthy is not the main product, even though I would like it to be. The main product is that they (the HCW’s) are there for the elderly. I believed that the HCW’s possibly could have fewer sick days and remain longer on the job market than they otherwise would have.” (Representative of the municipality)
For the manager at the home-care centre the initial thoughts were that the project was well suited with existing initiatives, but the manager also wanted to participate for the care of her employees and because the project provided knowledge on healthy living.
“I hoped of course to get some employees who have gained insight in how their bodies function physically and how their body feels when it’s fit. Also in relation to diet: - what is a healthy regular diet, without being fanatical. You could say that everyone gets a picture of what a healthy lifestyle is. And I was also hoping that it could provide some unity […] and I was hoping, of course that it could provide something regarding absence due to sickness.” (Manager at the home-care centre)
All the informants that were involved in the weight loss intervention had considerations regarding the health of the HCW’s, but for the manager the primary goal was to inform and educate her employees on healthy living. When asked if the home-care centre had an obligation to provide health-promoting initiatives, the manager replied:
“I don’t think that we are obliged, but I think that you as an employer, as a municipality, as a human being have a sort of social task or duty to help each other to live healthy, without it being annoying, boring or tiresome.” (Manager at the home-care centre)
Project manager considerations
The project manager had a scientific approach in her motivation for participating in the weight loss project. The project manager was mainly concerned with helping a group of people whom she believed struggled to optimize their health on their own. When asked what she wished to achieve with the project and what the project could change, she replied:
“…to ensure that they (the HCW’s) are not sick, make sure that they do not get musculoskeletal pain. Yes, to avoid sickness absence and to prevent the HCW’s from being worn out and to avoid them being injured in the long run. That was the overall purpose of the project.” (Project manager)
Her focus was primarily on the physical and mental improvement that the project could provide for the participants.
“Evidence-wise, we know that the more the HCW’s participate in such projects, the higher the probability that the projects have a positive effect and therefore I obviously wanted as many people (HCW’s) as possible to participate in the project.” (Project manager)
Hereby, the project manager puts much emphasis on what provides the best results. Her concerns are firstly scientifically and secondly how to increase the well-being of the HCW’s.
Therefore, it can be acceptable if some feel pressured to participate in the project, if it can help them improve their health.
“There are some who may feel pressured to participate. Now we know that there is a correlation between obesity and constantly having back pain. Especially in this line of work (health-care) because the HCW’s need to pull and push and be close to the burden (the elderly) that they are moving. If you are overweight, or especially if you are a person with obesity, you can’t (the HCW) come close to the elderly, and your reaching distance will be very long. This increases the pressure on the spine and joints, increasing the probability for injury and musculoskeletal pain. In the retirement rates within the HCW’s we can also see that many can’t manage this job in a lifespan. So knowing this, I think we have a co-responsibility - or should we just close our eyes? So the question is whether it is okay that some feel pressured to do something. But of course there will be some who feel pressured to join, even though they do not want to.” (Project manager)
The project manager express the opinion that we as a society have an obligation to help the employees at risk of wearing themself out, even if they feel a bit pressured to participate. With this standpoint the project manager shares the ideas of joint responsibility presented by the government and the manager at the home-care centre.
Employee considerations and positions
The employees were influenced by several factors when engaging in a weight loss project. These can be classified as a. focus on health and weight loss, b. pressure from the environment and c. struggle for recognition.
Focusing on health and weight loss
One informant’s motivation for involvement in the project was to improve her health. She stated a desire to lose weight and hoped that the project would give her the necessary help to succeed. When realising her body-age measured at baseline, it was no longer a question of whether she should lose weight, but a feeling of wanting to do better.
“I thought: ‘ that is too bad, it’s too embarrassing, you can do better’. I didn’t think I was that old, because I feel fresh and there was nothing (wrong). I did not think I had difficulty doing anything. I thought that everything was easy and I could ride the bicycle and I could [hesitation] no, I could not run, but I did think I could walk fast. It was not as if I was troubled by my weight.” (Informant 1)
Another participant also wished to lose weight and maintain the weight loss. She clarifies:
“…I know very well that you should lose weight, and I know very well what to do to prevent all those lifestyle diseases. I am in the public health sector, I know very well what I should eat and not eat and I have to advise others, so it does not help that one becomes heavier and heavier and then you tell Mrs Petersen: ‘you jolly well need to eat healthy and then you look like a bear. It doesn’t make sense’.” (Informant 2)
Being an individual with obesity and advising others does not coincide. In order to do her job properly and advice the elderly to a healthy diet, the informant feels that she must lose weight.
Pressure from the environment
For some participants there could have been a pressure to participate in the project. One of the informants, not only felt a pressure from the workplace but also from the project manager. She felt that participation was mandatory.
“It was spruced up completely, it was a bit to much. I know, at least in our workgroup, we would perhaps like to do it in our own pace. We thought it was a little too much. So you get a bit, not antipathy, but you are still a little like: ‘they shouldn’t be the ones to decide if I should participate or not. It was a bit like that’.” (Informant 3)
The feeling of owing the workplace to do something about your health can put even more pressure on the HCW’s, although no one expressed that it was the case.
“I am certainly proud to tell where I work. Everyone is very envious of the project and say: ‘Wow, that’s amazing, how can it be done?’ And then I say: ‘That is because they want us to be healthy’, then I think we owe it to them to do something about it.” (Informant 1)
Struggle for recognition
Other people’s views and meaning seems to have played a role in the HCW’s decision to participate in the project.
“Well simply because, I’d probably like to be healthy, I want to be flawless and you are not flawless, when you are fat and chubby […] my doctor […] when I had visited to get weighed. He said: ‘You are too smart to look like you do.’ And it’s a bit true, because you know it well. It’s just to get started.” (Informant 1)
She clearly agrees with her doctor that it is not wise to be an individual with obesity. The doctors’ statement illustrates the importance of looking healthy and how we perceive other people. The way we are perceived can be connected with a desire to be accepted and be part of a unity. As one informant elaborated on why she changed her mind in participating in the project, she said:
“Just to be part of that community they had. At the beginning it was because you actually felt a bit left out: then they went biking and then they did something else. So you felt a bit left out.” (Informant 4)
This informant was influenced by her surroundings and the values at the workplace. By joining the values at the workplace, one can align and gain recognition from other colleagues. But it was not only at the workplace it mattered what people thought.
“When I run and my neighbour says, ‘ Well - are you off again? I’ll say it is the third time this week’. It is just completely different from going for a walk as I did before.” (Informant 5)
“I didn’t care if I weighted 88 kilos as I do today. That is not the most important thing, because people cannot se that I weight that much, but it is important that people can see: ‘Oh my, you have lost some weight’. Yes I have!” (Informant 2)
Just like informant 5, informant 2 shared the longing for recognition from other people. By eating healthy and exercising, the HCW’s can gain recognition from their surroundings.