A Programme Theory evaluation of initiatives to support Health and Safety improvement: an Italian cross-sectional study

Companies of all sizes and sectors have been realising that they can no longer overlook the adverse economic and social effects of poor health and safety. Therefore, a constantly growing number of them is keen to improve workers’ health and safety conditions, by putting in place robust and effective Occupational Safety and Health (OSH) management. However, companies, especially Small and Medium-sized Enterprises (SMEs), might need external help to manage OSH interventions since they lack resources and skills. Thus, national health authorities in different countries are trying to reduce this gap by promoting support initiatives. The purpose of this research is to analyse several recent support initiatives, developed in Italy by the local health units (ASL in Italian), which aim at supporting companies in reducing injuries and illnesses. To this end, a survey has been sent to three of the most active ASLs asking them to describe support initiatives, paying attention to the processes that led to their design and development. The Programme Theory has been used to examine each of these initiatives because it allows detecting the mechanisms that produce consequential outcomes in specific contexts. Therefore, it has been possible to understand what led to the success or failure of any initiative and why it happened, so determining possible beneficial and detrimental mechanisms that affected the initiative’s outcome. This work emphasizes the strengths of the programme theory for reviewing initiatives and highlights some likely areas for further development; in particular, the programme theory in nature does not target a longitudinal view, thus complicating the assessment over time of initiatives’ effectiveness and sustainability, which is an undisputed priority for health and safety improvement at the workplace.