**5. Conclusions**

Participatory programs such as the HWPP show promise as a methodology for creating effective Total Worker Health interventions. This approach is useful for developing activities that can be used by workers and are relevant to their health. This is particularly important for workers in lower paying jobs or in jobs that have complex or chaotic work environments which present other challenges for good health behaviors. The detailed evaluation showed that substantial resources are needed to deliver the program and that enthusiastic, consistent, and active support from management is a critical determinant of success. The broader workplace context may also present challenges which should not be minimized or ignored. Future research studies should explore creative approaches for addressing organizational/contextual challenges that arise during participatory programs and should examine the efficacy of participatory programs. The logic model in this paper offers a framework for evaluating both implementation and efficacy, while considering the unique organizational contexts in which the intervention occurs.

**Author Contributions:** Conceptualization, J.R.S., B.A.E. and A.M.D.; Data curation, J.R.S. and A.M.K.; Formal analysis, J.R.S., A.M.K. and A.M.D.; Funding acquisition, A.M.D.; Investigation, J.R.S., A.M.K. and A.M.D.; Methodology, J.R.S., B.A.E. and A.M.D.; Project administration, J.R.S.; Resources, J.R.S. and A.M.K.; Supervision, A.M.D.; Visualization, J.R.S. and A.M.D.; Writing—Original Draft, J.R.S. and A.M.K.; Writing—Review & Editing, B.A.E. and A.M.D.

**Funding:** This research was funded by Healthier Workforce Center of the Midwest, grant number CDC/NIOSH U19OH008868 and the Washington University Center for Diabetes Translation Research (WU-CDTR), grant number NIH/NIDDK P30DK09295.

**Acknowledgments:** We wish to thank our union and grocery store research partners, the design team members, and the steering committee for their support and effort during the program. We would also like to thank Jessica Schenk for all of her work on the project.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.
