title: Ethical considerations of worksite health promotion: an exploration of stakeholders' views.
abstract: BACKGROUND
  Developing, implementing and evaluating worksite health promotion requires dealing with all stakeholders involved, such as employers, employees, occupational physicians, insurance companies, providers, labour unions and research and knowledge institutes. Although worksite health promotion is becoming more common, empirical research on ethical considerations of worksite health promotion is scarce.
  
  
  METHODS
  We explored the views of stakeholders involved in worksite health promotion in focus group discussions and we described the ethical considerations that result from differences between these views. The focus group discussions were organised per stakeholder group. Data were analysed according to the constant comparison method.
  
  
  RESULTS
  Our analyses show that although the definition of occupational health is the same for all stakeholders, namely 'being able to perform your job', there seem to be important differences in the views on what constitutes a risk factor to occupational health. According to the employees, risk factors to occupational health are prevailingly job-related. Labour unions agree with them, but other stakeholders, including the employer, particularly see employee-related issues such as lifestyle behaviour as risk factors to occupational health. The difference in definition of occupational health risk factors translates into the same categorisation of worksite health promotion; employee-related activities and work-related activities. The difference in conceptualisation of occupational health risk factors and worksite health promotion resonates in the way stakeholders understand 'responsibility' for lifestyle behaviour. Even though all stakeholders agree on whose responsibility lifestyle behaviour is, namely that of the employee, the meaning of 'responsibility' differs between employees, and employers. For employees, responsibility means autonomy, while for employers and other stakeholders, responsibility equals duty. This difference may in turn contribute to ambivalent relationships between stakeholders.
  
  
  CONCLUSIONS
  All stakeholders, including employees, should be given a voice in developing, implementing and evaluating worksite health promotion. Moreover, since stakeholders agree on lifestyle being the responsibility of the employee, but disagree on what this responsibility means (duty versus autonomy), it is of utmost importance to examine the discourse of stakeholders. This way, ambivalence in relationships between stakeholders could be prevented.
authors.forename: Jantien
authors.initials: J
authors.lastname: van Berkel
authors.forename: Agnes
authors.initials: A
authors.lastname: Meershoek
authors.forename: Rien M J P A
authors.initials: RM
authors.lastname: Janssens
authors.affiliation: Department of Public and Occupational Health - EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. crl.boot@vumc.nl.
authors.forename: Cécile R L
authors.initials: CR
authors.lastname: Boot
authors.forename: Karin I
authors.initials: KI
authors.lastname: Proper
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek
mesh_terms: D017144:Focus Groups; D006293:Health Promotion; D006801:Humans; D009426:Netherlands; D009786:Occupational Health Services / Q000191:economics / Q000941:ethics* / Q000458:organization & administration; D017132:Workplace