GAIN – Working healthy in inclusive enterprises

Status:

completed 07/2025

Aims:

The research project examined how workplace health promotion (WHP) measures in sheltered workshops for people with disabilities (Inklusionsbetriebe) can be designed, adapted, and implemented effectively. The starting point is the persistently lower employment rate of people with disabilities compared to the non-disabled population and the specific role of Inklusionsbetriebe at the interface between sheltered workshops and the general labour market. These enterprises operate in a field of tension between economic competitiveness and a social mandate for inclusion, where working and health conditions are often only partially adapted to individual needs.

The aim of the project was to systematically assess work-related exposures and health-relevant working conditions in Inklusionsbetriebe, to develop specific prevention measures, and to implement them in a participatory manner together with employees.

Activities/Methods:

Methodologically, a mixed-methods approach was adopted, combining social science and occupational health perspectives: ethnographic observations, on-the-job shadowing, semi-structured and problem centred interviews, cognitive interviews for questionnaire development, surveys on musculoskeletal complaints in easy-to-read language, risk assessments using a DGUV checklist, and kinematic posture analyses using Xsens with WIDAAN evaluation.

Two Inklusionsbetriebe served as practice partners – an industrial laundry (predominantly standing, physically demanding tasks) and a digital services company (predominantly sedentary office work). In addition, a non-inclusive regular company (battery production) was included as a comparison enterprise, and an inclusive health centre acted as a partner for the development and implementation of health-promoting measures. The work packages comprised a literature and best-practice review, an assessment of the status quo, the identification of intervention needs, and the implementation and evaluation of selected measures.

Results:

The results show high physical and psychological workloads in all enterprises studied. Particularly striking are musculoskeletal complaints in the neck/cervical spine and lumbar spine regions, with 12-month prevalence rates partly exceeding 70 %, followed by shoulders, thoracic spine, and hands/wrists. Complaints are frequently chronic (lasting more than three months) and affect work ability, but only rarely lead to interruptions or absences – many employees continue working despite persistent pain. Qualitative analyses revealed a far-reaching "normalisation of pain": pain and fatigue are accepted as an unavoidable part of the job and are seldom addressed or treated proactively. At the same time, decision latitude is low, work processes are highly regulated, and knowledge about health-promoting behaviour is limited.

Within the framework of the interventions, both behavioural and structural measures were implemented. A key behavioural measure was the further development of an existing "active break" programme in the laundry into a station-specific 12-week training programme, in which 92 employees participated; 57 employees attended regularly (more than 50 % of sessions). Physical performance tests showed significant improvements in selected flexibility and strength parameters (e.g. cervical spine extension, lateral flexion, wrist mobility, chair-rising performance), while self-reported wellbeing in the questionnaire data did not change significantly overall. In addition, structural measures such as the introduction of height-adjustable work tables in the folding area were implemented. The kinematic posture analyses showed only limited shifts towards more favourable ergonomic exposure ranges but highlighted specific starting points for further ergonomic optimization. Qualitative interviews indicated high acceptance of the measures, particularly when they took place in teams, at fixed times, and were visibly integrated into everyday work routines.

The project culminates in practice-oriented recommendations for inclusive workplace health promotion that systematically combine behavioural and structural approaches. Central elements are participatorily developed, low-threshold, and linguistically accessible offers that are closely aligned with actual work demands and organisational conditions (e.g. ergonomic workplace design, micro-breaks, job rotation models, training on pain and workload management). An inclusive communication culture and flexible, adaptable assessment instruments that enable participation regardless of language, educational background, or cognitive prerequisites are essential. Inklusionsbetriebe should understand health promotion as a strategic component of their inclusion mandate – not only to safeguard work ability, but also as a contribution to equal participation and social justice in working life.

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