Health promotion for shift workers in Europe: qualitative evidence

Background

Shift work (SW) is essential to the functioning of healthcare and industrial sectors, yet it is associated with health inequalities shaped by organisational and structural conditions. While workplace health promotion initiatives (WHPIs) are increasingly implemented, limited evidence exists on how shift workers (SWs) perceive their accessibility, usability, and relevance. This study examines how SWs across Europe perceive WHPIs and their contribution to workers’ health and well‑being.

Methods

This qualitative study was conducted within the EU‑funded Shift2Health project. Twenty‑four focus group discussions were carried out between July 2024 and March 2025 with 148 healthcare and industrial SWs in Austria, Denmark, Germany, the Netherlands, and Poland. Data were transcribed in national languages, analyzed using thematic analysis following Braun and Clarke.

Results

Five overarching themes emerged: availability versus usability of health initiatives, programmatic burden versus structural empowerment, physiological dignity versus normative compliance, technological support versus techno‑façade, towards a person‑centered workplace. SWs reported that employer‑led WHPIs efforts do not always align with the temporal and organizational realities of SW, as many activities remain tailored to daytime schedules. This limits access to support in key areas such as nutrition, physical activity, ergonomics, recovery spaces, and mental health. Participants emphasized that limited attention to the needs and expectations may reduce the effectiveness of WHPIs among SWs.

Conclusions

The findings demonstrate that investment in WHPIs for SWs requires a structural and equity‑oriented approach. Public health actions should prioritize integrating WHPIs tailored to shift times upgrading basic infrastructure, redesigning food environments, and supporting employee‑driven initiatives. These measures can enhance participation, human-centred approach and health equity among SWs.

Key messages

• WHPIs for SWs are increasingly available, but often misaligned with non standard schedules, limiting access to food facilities, ergonomics, recovery spaces, and mental health support.

• Effective WHPIs for SWs requires structural and equity oriented solutions that address their needs and integration of health promotion actions with everyday workplace conditions.