Abstract
BackgroundThe relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health.MethodsA longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abdominal muscle strength, and low back and hamstring flexibility. Potential determinants of change in physical health were demographic variables, psychological variables (self-esteem, mastery, and kinesiophobia), and self-perceived health.ResultsThe initial response was 73% and 252 persons had complete data collection at baseline. In total, 36 subjects were lost during follow-up. Participants were predominantly low educated, long-term unemployed, and in poor health. Participation in the programme was not influenced by demographic and psychological factors or by self-reported health. Drop-outs were younger and had a lower body mass index at baseline than subjects who completed the programme. At post-test, participants' cardiorespiratory fitness, abdominal muscle strength, and flexibility had increased by 6.8%–51.0%, whereas diastolic and systolic blood pressures had decreased by 2.2%–2.5%. The effect sizes ranges from 0.17–0.68.ConclusionParticipants with the poorest physical health benefited most from the programme and gender differences in improvement were observed. Physical health of unemployed persons with health complaints improved after participation in this health promotion programme, but not sufficiently, considering their poor physical health at baseline.
Highlights
The relationship between poor health and unemployment is well established
The relationship between unemployment and poorer health has been well established. [1,2,3] This relationship is bi-directional with both a selection mechanism with poor health reducing the likelihood on paid employment, and a causation mechanism whereby unemployment will results in a poorer health. [1,4] These associations may be mediated by other variables, such as health behaviour and psychosocial variables
The invitation to participate in the health promotion programme was send out by the provider of this programme, with a supporting letter from the city of Rotterdam stipulating that attending the programme for at least 70% was more or less mandatory, and that refusal might result in a cut in the social benefits received
Summary
The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health. The relationship between unemployment and poorer health has been well established. [1,2,3] This relationship is bi-directional with both a selection mechanism with poor health reducing the likelihood on paid employment, and a causation mechanism whereby unemployment will results in a poorer health. A low self-esteem, for instance, is a determinant of self-reported poor health [5] and decreases the likelihood of employment. Mastery or the sense of control over one's life, and self-esteem have been associated with a better self-reported physical health. [5]
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