This paper firstly aimed to explore associations between characteristics of employees with a low and medium level of education and interest in WHPP participation. The second aim was to explore their perceptions to gain an in-depth understanding of the underlying reasons.
Characteristics of employees who expressed an interest in participating in WHPPs
Regarding employee characteristics, we found that employees with a medium level of education were more likely to be interested in participating in a WHPP than those with a low level. One explanation was that employees with a low level of education were more likely to work in jobs with disadvantageous working conditions, such as shift work and high physical activity [14, 18], which might have been a barrier to being interested in WHPP participation. The focus group results supported the impact of unfavourable working conditions on employee perceptions. Another explanation was that we explored employees’ hypothetical interest in participation, which might have been more abstract to practice-oriented employees with a low level of education than those with a medium level.
Although previous studies have found associations between being a woman [27, 28], being older , having a healthy weight or overweight weight status  and WHPP participation, our study did not find these associations concerning interest in WHPP participation. These aforementioned studies included people with a high SEP. Therefore, their results might not be comparable to our findings. Furthermore, we did not study actual participation but focused on the intention to participate under certain proposed conditions. Intention has frequently been described as a proxy for actual behaviour [45, 46], though a relationship between intention and WHPP participation has not always reflected actual participation [27, 47].
Perceptions regarding WHPPs
Overall, over one-third of respondents in study 1 expressed an interest in participating in an employer-provided WHPP. This finding was comparable to the median participation of 33% found in a review on initial participation in a WHPP, where participation levels varied from 10 to 64%, and people with a high level of education were included . In our questionnaire study almost half the respondents showed no interest in participating in a WHPP. Moreover, the results from the focus groups indicated that their limited interest was related to a high workload.
Limited interest in WHPP participation may partly be explained by job demands and the working environment. First, physically demanding work is an inherent feature of many blue-collar jobs , typically performed by employees with a low or medium level of education. These high physical demands might have influenced the level of interest in WHPPs with a physical activity component. Second, the limited interest in WHPP participation might have been influenced by a broad range of working environment factors. Organizational culture can hinder participation if it does not prioritize health promotion [49, 50]. Furthermore, the physical working environment plays an important role, as the presence of health-promoting facilities (e.g., a kitchen where employees can prepare food) can contribute to healthier behaviour .
Our results also indicated that the participants were positive about a healthcare specialist as the WHPP source or provider. Commonly mentioned reasons were the possibility of receiving support and gaining knowledge from this specialist. Similarly, a study in an Australian transport company found that personal communication and the physical presence of a healthcare specialist (i.e. a registered dietitian or exercise physiologist) were evaluated highly by the employees participating in such programmes .
Concerning the preferred channel of programme delivery, no consensus emerged. For instance, receiving the WHPP at work scored higher in the questionnaire study than web-based options, but web-based channels were more frequently mentioned in the focus groups because they were perceived as user-friendly and commonly used. Prior research might help to explain these divergent findings, as online channels have previously been viewed as incredibly convenient , while face-to-face options have been shown to enable group interaction components . Another explanation was that the perceptions regarding preferred channels might have been related to possible working environments.
Regarding participation from their participant’s social environment, no clear preference was found in the questionnaire study as to who this person should be. The focus group study might partially explain this finding. Participants considered that including someone from their social circle would motivate them to participate, without specifying whose participation they preferred. This finding was confirmed by a study that stressed the importance of social support to stimulate behaviour change and increase self-efficacy .
However, participants also argued that the decision to have someone from their social environment participate was not theirs but the person’s. From this perspective, one could argue that answering this question might have been challenging. This difficulty might explain why more than a quarter of respondents in the questionnaire study answered ‘I do not know’ to this theme.
The last theme involved conditions for participation. In the questionnaire study, most respondents reported it was either important or very important that their employer paid for the WHPP. Previous research has demonstrated that cost concerns should be considered when delivering lifestyle interventions to adults with a low SEP . The focus groups showed a greater variety of opinions, perhaps because they frequently wished to keep work and their private lives separate. This outcome might have been related to the desire to pay for the programme themselves.
Moreover, preferences regarding the time of day varied throughout the questionnaire and focus group studies, which might be explained by the focus group findings, in which a preference for the time of day seemed to be highly dependent on the type of job and related tasks.
Strengths and limitations
To the best of our knowledge, this is the first study of its kind to use a mixed-methods design to explore the characteristics of employees with a low and medium level of education related to interest in WHPP participation and their in-depth perceptions of WHPPs. This research design allowed for the triangulation of quantitative and qualitative data, which proved beneficial as the following focus groups revealed valuable underlying information. Therefore, the findings contribute to the bigger picture of understanding this population’s interrelated perceptions of work, health and lifestyle.
However, we asked employees to think hypothetically about whether they would be interested in participating in a WHPP. This request required abstract thinking, which occasionally might have been challenging for these practice-oriented employees. Nevertheless, we believe the results are valuable because we have tried to concretise them in the best possible way through additional descriptions in the questionnaire and visual aids during the focus groups. Some additional limitations are noted for both studies separately.
Study 1: Questionnaire study
The questionnaire’s convergent, divergent, and criterion validity could not be tested because we did not compare it with another questionnaire or theoretical construct. However, the questionnaire’s face validity was shown, and its B1 language level was considered appropriate for the respondents because it is comprehensible to 95% of people living in the Netherlands . Although the two samples of the questionnaire study differed based on demographic characteristics, this difference was justified by mutually reporting the results of both samples.
Study 2: Focus group study
The qualitative results should be interpreted with caution as other settings (e.g. solely urban or regional areas) might achieve different results. The extent to which data saturation was obtained was difficult to justify as new themes might have emerged with participants at other organisations in different areas in the Netherlands. However, the findings suggested satisfactory data saturation because the fifth focus group did not reveal new themes.
We found variability in employees’ perceptions, underscoring the need to incorporate sufficient space for flexible WHPP design to meet employees’ needs. Our study clarified that interest in WHPP participation might be more feasible for some employees when both the time and place are aligned with their type of job and working conditions. For example, some employees might benefit from partially participating during and after working hours, benefiting from their employer’s WHPP facilitation. Other studies have also recommended tailoring these programmes to employees’ needs  and working conditions [56, 57]. In addition, the physical working environment should be considered when designing WHPPs. For example, using nudging strategies in worksite cafeterias may guide employees’ purchasing behaviour toward healthier food choices .
Another possibility is participation at another location than the workplace. Although most occupational health initiatives currently target healthy functioning in the workplace , this point corresponds with a recent meta-analysis that recommended new directions for such health promotion activities . Similarly, WHPP recruitment should match these blue-collar employees’ job and working conditions, as some teams might read recruitment flyers on the intranet while others might only find such flyers on notice boards in their workplace. Thus, we recommend that WHPP designers incorporate a flexible programme design and recruitment strategies to meet employees’ needs and working conditions.
Another recommendation concerns support from someone in the participant’s social environment and a healthcare specialist. Our results show that these types of support could be motivating factors for potential WHPP participation. Other studies have shown that employees with a high level of social support are more likely to have positive intentions toward WHPP participation , and individual coaching by an expert can be a significant weight loss predictor .
For example, a healthcare specialist could support employees by making consulting appointments based on their needs and schedules, which might suit their different needs regarding when they would like to participate in a WHPP. Furthermore, a healthcare specialist could focus on increasing the participants’ self-efficacy, which has been associated with a positive intention toward WHPP participation . Tailored support might lower the threshold for WHPP participation and should be considered part of WHPP implementation.
Future research should explore the underlying reasons for educational differences regarding interest in WHPP participation in further depth. Exploring this group’s capabilities and possibilities in conjunction with their preferred programme characteristics might also yield a broader understanding of their perceived worlds. These insights could provide WHPP designers and implementers guidance on the appropriate WHPP design, recruitment and implementation that suits employees with different levels of education and working conditions. Subsequently, the possibility of contributing to reducing socioeconomic health inequities might expand.
Another area for future research might be exploring employers’ perceptions of sustainable WHPP implementation, associated implementation tools and delivery modes. Together with this study’s insights, these perceptions could lead to a mutual understanding of WHPPs according to employees and employers. This two-way comprehension could contribute to the effective design, development and sustainable implementation of such programmes.