Creating a healthy work environment: what do employees in small and medium-sized enterprisesneed in rural areas? Presenting a cross-industry perspective using a mixed method approach

Background. Even though workplace health promotion has become increasingly established in recent years, there is still a deficit in the implementation of workplace health promotion in small and medium-sized enterprises. The possibilities of codetermination and the consideration of individual needs should be used in a targeted way for successful implementation. Objective. Cross-sectoral analysis and presentation of work demands and related stress perceptions as well as the need for occupational health services among employees in small and medium-sized enterprises in rural areas. Methods. A multimethod study approach was used: in a cross-sectional study, work demands, related perceptions of stress and needs for workplace health services were quantitatively assessed in four companies. Semi-structured focus group interviews across companies were used to explore (stressful) work demands and employees' needs for health promotion in more depth. Quantitative data were analyzed descriptively, while qualitative data were analyzed using qualitative content analysis according to Kuckartz. Results. A total of 251 employees (68.9% female; 50.6% > 45 years) from four companies in different sectors (e.g. health care, information technology) participated in the cross-sectional study (response rate: 51.6%). Independent and self-determined work is the most common requirement across all industries. High work intensity is the most stressful work requirement. The most frequently requested topics were back health and stress management. Sufficient financial and time resources as well as employee motivation are key prerequisites for implementing health promotion programs. Conclusion. A participatory and method-integrated approach to needs assessment lays the foundation for successful implementation and sustainable anchoring of workplace health promotion in small and medium-sized enterprises.