Health promotion interventions in social
economy companies in Flanders (Belgium)
Anne Hublet1*, Lea Maes1
, Jasmine Mommen1
, Benedicte Deforche1,2 and Ilse De Bourdeaudhuij3
Abstract
Background: Disadvantaged groups are often not reached by mainstream health promotion interventions.
Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach
those people. The implementation of these interventions in social economy companies was studied. Factors that
could be related to the implementation of HP and being supportive towards implementation in the future, were
investigated.
Methods: An online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the
questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors
(such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person
responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed.
Results: Respondents of 88 workshops completed the questionnaire. Almost 60 % of the workshops implemented
environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and
having the subjective norm that employees are positive towards health promotion at work, were related to being
more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly
related to being more supportive towards the implementation of HP in the multivariate analyses.
Conclusions: Sheltered and social workshops are open to HP interventions, but more can be done to optimize the
implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing
attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.
Keywords: Health promotion, Persons with disabilities, Supported employment
Background
People with intellectual and physical disabilities, or psychiatric
problems are more likely to be at risk of an unhealthy
lifestyle. They are more likely to have obesity
and to be less physically active [1–3], more at risk for
depression [4] and more likely to be a smoker [2].
Research concerning Health Promotion (HP) for
people with disabilities or psychiatric problems is
underdeveloped and this population is hard to reach
by mainstream HP initiatives [5, 6]. Therefore, HP for
people with disabilities should be implemented in
their natural settings such as in supported living facilities
and day care centers [5].
One of these natural settings can be the social economy
companies. These companies “seek to serve the
community’s interest rather than profit maximization”
[7]. They employ society’s most fragile members, and in
that way, contribute to social cohesion, employment and
the reduction of inequalities. Also in Flanders-Belgium,
social economy companies employ a diverse group of
people who are (yet) unable to work in the regular economy.
Most of them have a low educational level and are
living in precarious life conditions [8].
The focus of this study is on HP interventions in social
economy companies, defined as the promotion of
healthy nutrition, physical activity, better mental health,
and the prevention of smoking and alcohol (ab)use,
themes also found in the health targets of the Flemish
Government [9]. An unhealthy lifestyle is one of the
major risk factors for noncommunicable diseases (e.g.
* Correspondence: Anne.Hublet@UGent.be 1
Department of Public Health, Ghent University, De Pintelaan 185, 4K3, 9000
Ghent, Belgium
Full list of author information is available at the end of the article
© 2015 Hublet et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Hublet et al. BMC Public Health (2016) 16:11
DOI 10.1186/s12889-015-2682-5
cardiovascular diseases, cancers) [10]. Employees with
an unhealthy lifestyle are more likely to be absent due to
sickness, the length of their absenteeism is longer and
their productivity lower [11].
Research has shown that HP at the workplace has
positive effects on the health of employees and has advantages
for the company. Verweij et al. found evidence
that physical activity and nutrition interventions at the
workplace had a positive effect on body weight, BMI and
body fat [12]. While for the company, the promotion of
health behaviour had a positive influence on absenteeism,
job performance [13], productivity and presenteeism
[14].
But not all interventions are equally effective. Interventions
with an environmental component that include
environmental modifications were found to be
more effective, than those without environmental
changes [12, 15]. Also policy measures (e.g. smoking
or alcohol regulations) had more chance to have
long-lasting results [16]. These interventions (further
called ‘environmental HP interventions’) influence
both the conscious and unconscious behaviour and
habits of the employees [17]. Other interventions
such as temporary educational group sessions, individual
counseling and short running actions were less
effective in the long-term [18].
In order to promote HP interventions in social economy
companies, it is important to get insight into the
determinants that are related to the implementation of
these interventions. These factors can be characteristics
of the company (such as size and sector), but also individual
factors of the person responsible for the implementation
of HP interventions. The Theory of Planned
Behaviour [19] can be used to explain the implementation
of HP interventions at an individual level. In this
model, the three constructs ‘attitude’, ‘subjective norm’
and ‘behavioural control’, predict the intention to implement
HP interventions, while the intention predicts the
implementation. Besides these three ‘classical’ constructs,
Ajzen [20] argued that in some contexts, personal feelings
of moral responsibility could add power to the
model.
In this study, three aims were formulated. The first
aim was to investigate the current status of the implementation
of HP interventions in social economy companies
in Flanders- Belgium. The second aim was to
investigate which characteristics of the company and factors
of the person responsible for implementing HP,
were related to the implementation of environmental
HP interventions. The third aim was to investigate
which characteristics of the company and which personal
factors of the person responsible for implementing
HP, were related to being supportive towards investing
more in HP in the future.
Methods
Design
An online, quantitative survey was organized. An email
with an invitation to participate was sent to all sheltered
and social workshops in Flanders (n = 148). The social
economy in Flanders comprises four types of companies,
each with their own target population [8]. In this study,
two types were included which employ the largest group
of disadvantaged people. Sheltered workshops employ
mainly people with disabilities (intellectual and physical).
Social workshops provide employment to people with
physical, social or psychological problems (e.g. people
with psychiatric problems, people reintegrating into society
after prison, immigrants). The two excluded types
of social economy companies were the local service
economy who employ older people who are already
long-term unemployed, and the insertion companies
who provide a job for people with a low education level
together with a history of long-term unemployment. The
email-list was provided by the umbrella-organization for
the social economy (CollondSe). The person who would
normally be responsible for implementing HP interventions,
completed the questionnaire. After two weeks, a
reminder was sent. The study was executed from February
to April 2013. The study was approved by the ethical
committee of the Ghent University Hospital (2013/076).
The respondents gave their informed consent for participation
in the study by clicking on the link to the
questionnaire.
Questionnaire
In the first part of the questionnaire, the current status
of HP interventions and the characteristics of the workshop
were questioned. The current status of HP was
assessed by: “Does the company organize HP actions,
besides the obligatory smoking ban at the workplace?
Yes or no” and “If so, for which themes and how did the
company organize HP?”. Examples were given for each
HP action to make sure respondents knew what is
understood under HP. The examples were: policy
changes (e.g. an alcohol ban during lunch), environmental
changes (e.g. providing fruit for free), education in
groups (e.g. group session on healthy food), individual
guidance (e.g. counseling at the social department), and
short running actions (e.g. a smoke-free day). The
themes were: nutrition, physical activity, smoking, alcohol
use and mental health. Five new variables were
constructed by recoding per theme the options ‘policy
changes’ or ‘environmental changes’. The sum of
these five variables was made and recoded into a new
variable with categories ‘implemented an environmental
intervention’ and ‘no environmental intervention
implemented’.
Hublet et al. BMC Public Health (2016) 16:11 Page 2 of 9
Three characteristics of the workshop were assessed.
First, the type of workshop (sheltered or social workshops)
was asked. Second, the si