Article Nielsen & Randall (2013; untill the PE methods)

Question 1

Organizational-level occupational health interventions

Answer 1

Planned, behavioral, science-based actions to remove or modify the causes of job stress.

Question 2

Why has the strategy in current European legislation on organizational-level occupational health inerventions been criticized?

Answer 2

Because of the lack of a large and consistent body of evidence that shows these interventions to have a positive impact on working conditions and employee health and well-being.

Others have argued that there is evidence of the positive impact of organizational-level occupational health interventions but that too few studies have examined why and how such interventions have succeeded or failed thus placing limits on the external validity of much of the small body of evaluation research

A review concluded that the published literature focused on effect evaluation and contained relatively little, potentially important, process evaluation data about how interventions were planned and implemented.

Question 3

What are studies hat attempted process evaluation based on?

Answer 3

Anecdotal data that have not been subjected to structured analysis.

Question 4

What is the aim of this study?

Answer 4

To present a three-level evidence-based process evaluation model to provide a structure that researchers can sue to guide the rigorous collection of detailed process evaluation data.

Question 5

In what way are organizational-level occupational health interventions proactive?

Answer 5

In the way that they are focused on reducing or eliminating the sources of job stress.

Question 6

What is the reason for the mixed evidence of organizational-level occupational health interventions?

Answer 6

A prevailing focus on effect only evaluation.

It is difficult to conclude why and how an intervention worked from effect evaluation data only because effect-only evaluation data masks intervention effects that are sensitive to variations in intervention processes.

Question 7

What does the nature of organizational-level indicate?

Answer 7

That their working mechanisms are unlikely to be separate from the systems within which they operate.

These interventions require changes to complex social systems and may be met with much resistance and have unintended side-effects

Question 8

What is needed to identify how the potentiale ffects o interventions on health and well-bnig are moderated and mediated by intervention processes?

Answer 8

Evaluation models and methods

Question 9

What happens when you look inside the black box?

Answer 9

The black box reveals various sources of variation.

Question 10

Theory/programme failure

Answer 10

That the theory behind the intervention did not address the problem.

Question 11

Implementation failure

Answer 11

That the way the intervention was implemented was incomplete or designed in such a way that the intervention would have failed even if the theory behind the intervention was correct.

Question 12

Intervention process

Answer 12

Individual, collective and management perceptions and actions in implementing any intervention and their influence on the overall result of the intervention.

Question 13

What can process evaluation (PE) be used for?

Answer 13

• To provide feedback for improving interventions
• To replicate interventions in other settings minimizing the number of pitfalls associated with a given intervention
• To interpret the outcomes of interventions
• To help us conclude on the generalizability, applicability, and transferability of interventions studies

Question 14

PE

Answer 14

Process evaluation

Question 15

What can be a reason that PEE is lacking in current research on organizational-level occupational health interventions?

Answer 15

That researchers are uncertain about what should be included in such evaluation.

There is no integrated, evidence-based framework that describes the elements that need to be included in process evaluations of organizational-level occupational health interventions.

Question 16

What are the three themes that factors that may have an impact on the outcomes of an organizational-level occupational health intervention can be grouped into?

Answer 16

1. The intervention design and implementation
2. The intervention contexts
3. Participants’ mental models (of the intervention and their work situation)

Question 17

What does the intervention design and implementation determine?

Answer 17

The maximum levels of intervention exposure that can be achieved

Question 18

What do the intervention contexts and participants’ mental models represent?

Answer 18

The factors that may moderate or mediat the link beten any intervention exposure and its outcomes.

Question 19

What literature is focused on in this article? And why?

Answer 19

Literature on health and well-being interventions at the organizational level and the factors and elements identified in this literature.

This is because PE models are needed that fit with the measurement opportunities and constraints operating in this domain; however, models of PE have been used with considerable success in other disciplines such as public health, organizational development, and organizational change

Question 20

On what three overarching elements does the article focus?

Answer 20

• Initiation
• Intervention activities
• Implementation strategy

Question 21

True or false: the overarching themes in this article are orthogonal

Answer 21

False.

These themes are not orthogonal because we are describing interlinked and complex organizational processes, issues within a theme may also interact with other issues in other themes.

Question 22

Mental models in the model of PE

Answer 22

Mental models

• Readiness for change
• Perceptions of intervention activities

Changes in mental models

Question 23

Intervention in the model of PE

Answer 23

Initiation

Intervention activities

• Risk assessment
• Action plans

Implementation strategy

• Drivers of change: participation, senior management, middle managers and consultants
• Communication and information

Question 24

Context in the model of PE

Answer 24

Hindering and facilitating factors

• Omnibus
• Discrete

Question 25

Initiation

Answer 25

Who initiated the intervention and for what purpose?

The motivation driving an intervention may be related to problems internal to the organization, external challenges or a combination of both.

Any intervention can stabilize or displace current power structures and therefore reasons for the intervention are likely to influence the buy-in of key stakeholders.

It is therefore important to explore who defined the problem, who decided what should be done, and who should implement change.

Question 26

What was found on interventions initiated for performance reasons and interventions whose rationale was to improve employee health and well-being?

Answer 26

Interventions for performance reasons were found to have an adverse impact on employee health and well-being.

Whereas, interventions whose rationale was to improve employee health and well-being was found to have a positive effect on these same outcome measures.

Question 27

Developing intervention activities

Answer 27

Did the intervention activities target the problems of the workplace?

Correct tailoring of an interventions to the needs of stakeholders requires a thorough risk assessment.

Question 28

Risk assessment

Answer 28

A thorough risk assessment is a crucial diagnostic process and provides information that can be used to check whether intervention activities addressed the problems perceived by organizational members.

Question 29

Context-independent organizational-level strategies

Answer 29

They have been described as unlikely to succeed as each organization is unique and therefore require unique solutions.

Question 30

True or false: tailoring of organizational-level interventions usually includes adapting interventions to meet the requirements of specific individual employees

Answer 30

False.

It does not usually include adapting interventions to meet the requirements of specific individual employees.

This is a potential problem with organizational interventions.

An optimal strategy may be to use a combination of different interventions.

Question 31

WHat can facilitate effective intervention?

Answer 31

Individual-level activities implemented during the development of organizational-level interventions may prime participants to support and engage in organizational-level changes when they are implemented.

Developing structured action plans.

The contents of action plans also often highlight the potential “active ingredients” of the intervention that could be linked to intervention outcomes

Question 32

Developing structured action plans

Answer 32

Such plans describe intervention activities in terms of the resources needed, the activities undertaken, and how the intervention is implemented, including identifying who is responsible and who were the targets of intervention.

Question 33

Implementing intervention activities

Answer 33

Did the intervention reach the target group?

Documentation of intervention activities highlights any discrepancies between the planned intervention and its implementation.

Question 34

Active ingredients in implementing intervention activities

Answer 34

The potential active ingredients of the intervention need to be reexamined and compared to the active ingredients identified in the intervention plan.

This identification helps to rule out rival hypotheses for intervention results.

Question 35

What has the focus on the implementation strategy section?

Answer 35

The roles and behaviours of key stakeholders.

Question 36

Drivers of change and the roles of key stakeholders

Answer 36

Who were/are the drivers of change?

The stakeholders must be identified and their role in the change process explored.

Question 37

Participatory approaches - involving employees

Answer 37

Did employees participate significantly in decision making and how many were involved?

The participatory approach has been advocated as a desirable intervention strategy and plays a major role in well-known organizational occupational health intervention approaches.

Question 38

What is the essence of participation?

Answer 38

A conscious and intended effort made by individuals at a higher level in an organization to provide visible extrarole or role-expanding opportunities and enhanced control for individuals or groups at a lower level in the organization.

Question 39

What different forms can participation take?

Answer 39

• Informal or delivered through formal changes in roles and responsibilities
• Directly experienced or indirectly through union representatives
• The breadth and depth of participation and the extent of influence linked to the participatory activities can vary

Question 40

Who benefits most from a directive type of participation where they were told what to do?

Answer 40

Employees with little formal education

Question 41

How is the amount of participation related to resistance of change, achievement of goals and organizational commitment?

Answer 41

It is negatively related to resistance of change.

It is postively related to achievement of goals and organizational commitment.

Question 42

What are high levels of reported participation in change associated with?

Answer 42

Low levels of behavioural stress symptoms and higher job satisfaction after the intervention.

Question 43

How did employees react to only having influence over parts of the intervention programme?

Answer 43

They reacted negatively

Question 44

What is the degree of participation in the resolution of occupational health concernc associated with?

Answer 44

Decreased work demands, increased social support, and lowered stress levels.

Question 45

Senior management support: What was the role of senior managers?

Answer 45

Senior managers

• are often involved in the allocation of resources to intervnetion projects
• may acts as role models through their attitudes to the intervention
• may be actively involved in intervention activities

However, because of their seniority and own work demands they are rarely able to follow intervention development activity and implementation closely.

Question 46

What is seldom formally evaluated?

Answer 46

Senior management support, even though the importance is often discussed.

Question 47

What is the “trickle down” effect?

Answer 47

When the lack of support from senior management also had an effect on middle managers, who reported they did not support the intervention project as they were allocated no resources to implement initiatives.

Question 48

What was the role of middle managers?

Answer 48

While senior managers often make the decision to implement the intervnetion it is usually middle managers that are subsequently responsible for communicating and implementing change.

They therefore play a crucial role in many organizational-level occupational health interventions in which they can hinder or facilitate change.

They can also brin about changes in intended intervention exposure patterns.

Question 49

How have middle managers often reacted to interventions?

Answer 49

Middle managers had often exerted passive resistance that had damaged and diluted some intervention activities.

Question 50

Middle managers and PE

Answer 50

Middle managers’ motivation for implementing change should be documented along with the actions they take to facilitate or obstruct change.

This documentation is especially immportant because such data may not be captured in their performance appraisals and in times of pressure they may therefore choose to prioritize other aspects of their jbo over and above intervention activities.

Question 51

Consultants: What was the role of consultants?

Answer 51

Large intervention projects often use external consultants to design, implement and facilitate aspects of the intervention process.

Question 52

How do consultant facilitate organizational changes?

Answer 52

By giving feedback on the progress of change and on group dynamics.

Question 53

Consultants and PE

Answer 53

In order to isolate intervention effectiveness it is important to evaluate whether the consultants had the necessary skills and abilities to enhance the intervention process by motivating and guiding participants through the intervention process.

When external consultants have total responsibility for change they might not leave an infrastructure within the organization for sustaining and continuing improvements they initiated, thus reducing long-term intervention effects.

For intervention effects to be maintained in the long term, a shift must take place in which organizational members gradually take more responsibility for the intervention from the consultant.

Question 54

Information and communication about the intervention

Answer 54

What kind of information was provided to participants during the study?

The level of information and communication plays an important role in the effects of interventions.

Question 55

What is the effect of providing information about a change to employees?

Answer 55

It keeps employees up to date about

• anticipated events
• the consequences of change
• changes in work roles linked to the intervention

Question 56

Open communication to employees

Answer 56

It helps employees to understand the intentions behind organizational-level occupational health interventions.

Thus, improving employee commitment to and participation in the intervention.

Question 57

The effects of communication

Answer 57

Communication is likely to influence employees’ sense making and this appears to be closely linked to their commitment to intervention activities.

Question 58

Communication and PE

Answer 58

It is important to examine what kind of information has been distributed, to whom, and how it has been received and perceived.

Question 59

What important questions need to be answered about information and communication about the intervention?

Answer 59

1. Were participants informed about the project?
2. Were risk assessment results fed back?
3. To what extent are all participants updated about progress?

Question 60

Were participants informed about the project?

Answer 60

Receiving adequate information about an intervention project predicted the extent to which employees participated in intervention activities.

Where information was not followed up by actual activities, employees were disappointed and reported negative results.

Question 61

Were risk assessment results fed back?

Answer 61

This feedback has been found to lead to more intervention activities.

The most significant changes were in parts of the organization where employees had received detailed information about the problems identified in the risk assessment.

Question 62

To what extent are all participants updated about progress?

Answer 62

Employees that are not directly involved in intervention planning and implementation tended to be less aware of the progress of te intervention.

These employees also reported that the intervention had little effect.

Question 63

Context definition

Answer 63

Situational opportunities and constraints that affect the occurrence and meaning of organizational behaviour as well as functional relationships between variables.

Question 64

Why context?

Answer 64

The validity can only be enhanced if the influence of the social and organizational context on intervention outcomes is measured and analysed.

Question 65

Context and implementation

Answer 65

Context may either facilitate or hinder succesful implementation.

Question 66

Intervention context

Answer 66

It can provide a link between intervention plans and intervention exposure (i.e., mediator).

It can dilute or strengthen the effects of intervention activities (i.e., moderator).

Question 67

Omnibus context

Answer 67

This refers to the story told and prompts several process evaluation questions.

The underlying theme of these questions is: “How did the intervention fit in with the culture and conditions of the intervention group?”

Question 68

Context and job demands in interventions

Answer 68

A context in which there were high job demands often hindered participation in interventions.

Question 69

Organizational culture and intervention activities

Answer 69

Being part of a larger organization hindered the development of intervention activities.

Question 70

What has been found to affect organizational occupational health inervention outcomes?

Answer 70

The preintervention healthiness of an organization.

Its past use of and experience with such interventions.

Question 71

Which workplaces may have more time and resources to involve workers and managers in participation and integration of interventions?

Answer 71

Workplaces with low demands, high levels of support, and low stress levels.

But, these organizations might not need interventions.

Question 72

Intervention paradox

Answer 72

Ceiling effects may prevent further improvement in intervention outcomes, even if the theory behind interventions is correct.

In this paradox the omnibus context can inhibit intervention where it is needed most.

Question 73

Discrete context

Answer 73

Focuses on specific events that may have influenced the effects of the intervention.

Factors at both the intraorganizational and national level should be considered.

Question 74

What are some factors that have been identified in the discrete context?

Answer 74

• New project management demands
• Conflicting priorities
• Concurrent use of multiple change programmes
• A lack of integration of the intervention with important corporate strategic decision-taking activities

Question 75

What has recent research begun to examine?

Answer 75

How individuals’ perceptions and appraisals of an organizational-level occupational health intervention are linked to outcomes through how they drive the behaviour of key stakeholders.

Question 76

What may help to explain change outcomess?

Answer 76

The underlying psychological process that employees, managers and other key stakeholders may have diverse and potentially conflicting agendas that may influence how they behave and react to the intervention.

Question 77

Mental models

Answer 77

They are used to make sense of the world.

Explicit efforts at sense making take place when the world is perceived to be different from the expected state of the world.

Question 78

Mental models and intervention context

Answer 78

Mental models determine how participants react to the intervention and its activities and help explain the behaviours of key stakeholders throughout the intervention project.

Question 79

Example of different mental models in interventions

Answer 79

Different stakeholders have conflicting mental models about what constitutes success.

Question 80

Different stakeholders and individual-level interventions

Answer 80

Managers preferred individual-level interventions, i.e., putting responsibility for change at the individual.

In contrast, employees held negative attitudes to these interventions because they felt that this strategy was a way for managers to escape responsibility thus failing to adress the problems in the workplace.

Question 81

What is needed for interventions to be effective?

Answer 81

Employees should

• perceivee that they have problems that need to be addressed.
• believe that the intervention will be effective in addressing those problems.
• be motivated to actively support the intervention by participating in intervention activities.

Question 82

Initiative fatigue

Answer 82

If organizational-level occupational health interventions have previously been conducted but little learning has taken place, this failure may have a detrimental impact on participants’ perceptions of later initiatives and their willingness to participate in intervention activities.

Question 83

What happens to the mental models of people that work closely together?

Answer 83

They may develop similar models to interpret and react to the world.

Question 84

Mental models and PE

Answer 84

PE should be used to examine the mental models and the degree to which mental models are shared by participants.

Question 85

What can reduce employee engagement?

Answer 85

If they believe activities do not address the problems raised or are of a poor quality.

Employees’ perceptions of the drivers of change and the intervention objectives are likely to influence their willingness to participate in intervention activities.

Question 86

What was related to lower levels of stress and higher levels of job satisfaction after the programme?

Answer 86

The perceived smoothness of implementation of the training programme and the depth of programme content.

Question 87

What was positively linked to postintervention well-being?

Answer 87

Individuals’ appraisal of the quality and sustainability of intervention activities.

Question 88

What is particularly important to examine in participatory action research projects where employee representatives are involved in making change?

Answer 88

The mental models of those not directly involved in decision making but who were targeted by the intervention.

Question 89

Perceptions of key stakeholders’ expertise

Answer 89

Employees with little education and experience with dealing with occupational health issues appraised an external occupational health practitioner more postively because of her directive approach and a focus on individual issues.

Question 90

Changes in mental models of the job

Answer 90

Participants and key stakeholders must unlearn old mental maps of their working conditions and learn new ones in order for real changes to happen as a result of an intervention.

Question 91

Theries-in-use

Answer 91

The mental models that guide our behaviour.

Question 92

Espoused theories

Answer 92

The attitudes and beliefs that we tell others guide our behaviour.

Question 93

What is an important driver of changing mental maps?

Answer 93

The degree to which intervention activities prompt a shift from espoused theories about the intervention to theories-in-use.

Question 94

What should individuals change in order for real change to happen?

Answer 94

Their theories-in-use

Question 95

What is an important part of process evaluation when talking about changes in mental models of the job?

Answer 95

The measurement of change in employees’ knowledge of the intervention, their expectations that the intervention can bring about changes, and that these changes can have an impact and be sustained as part of continuous improvements at work.