What is the role of direct and indirect participation in organisational occupational health interventions? A configural perspective

Employee participation is considered an essential element when implementing organisational occupational health interventions (OOHIs), yet little is known about the relative importance of different forms of participation, such as direct and indirect participation. The current study examines whether direct participation is necessary to succeed with OOHIs or whether indirect participation is sufficient, as well as whether there are conditions where participation is less important, such as when the intervention is perceived as highly relevant. We used data from the intervention units of a randomised controlled OOHI trail implemented in 64 Danish preschools. We employed coincidence analysis (CNA) to analyse the data to assess causal complexity not captured by regression-based methods. Our results suggest that direct and indirect participation depend on each other – for instance, when one is low, the other needs to be high, and vice versa. Furthermore, perceptions of high relevance constitute an independent route to achieve intended intervention outcomes, questioning the central role of participation in OOHIs. The findings reveal the complexity involved in implementing OOHIs, and CNA offers a way forward to capture this complexity.