**1. Introduction**

In recent years, the National Institute for Occupational Safety and Health (NIOSH) has funded several *Total Worker Health*® Centers for Excellence at universities across the United States with the goal of building scientific evidence around innovative approaches to address complex problems faced by workers in the United States [1]. Occupational safety and health researchers and practitioners are increasingly called to navigate the complexities of a changing work landscape, in which work arrangements have increasingly shifted away from standard, full-time employment with benefits toward non-standard, "atypical", and precarious work arrangements such as employment in temporary or contract jobs [2]. The University of Illinois at Chicago (UIC) Center for Healthy Work, one of the NIOSH Total Worker Health (TWH) Centers for Excellence, has focused its efforts on understanding the barriers faced by workers in these precarious jobs in Illinois, and building evidence around the development of interventions to remove those barriers [3].

Over the past several years, a subset of researchers at the UIC Center for Healthy Work have engaged with individuals and organizations in Chicago and across the state of Illinois to better understand the causes and consequences of precarious work and initiatives that are already underway to address them. One of the Center for Healthy Work's aims is to work with a variety of organizational partners, across sectors and levels, to build organizations' capacities to develop and implement

interventions to address the barriers to healthy work. While some studies have examined the value and impacts of community–university engagement in research and practice partnerships [4–6], existing studies have not focused on universities as a convener for processes focused heavily on planning and preparing for action, and focused less on traditional research methodology. The UIC Center for Healthy Work is examining the role that a university can play in supporting knowledge, skills, and overall capacity-building efforts to foster the development of multi-level initiatives to address precarious work.

#### *1.1. Precarious Work and the Healthy Work Collaborative Initiative*

The term "precarious work" has been used to describe work that is "uncertain, unpredictable, and risky from the point of view of the worker" [7]. The rise in precarious work in the US can be linked to macroeconomic changes that resulted in increased global competition, which led to outsourcing of labor, weakened labor unions, and deregulation of the labor market [7]. Employers have sought to minimize costs by shifting jobs away from standard, full-time work arrangements toward a more flexible labor market. These more flexible, precarious work arrangements are characterized by low wages, a lack of protection from termination, variable work schedules, disproportionate exposure to health and safety hazards in the workplace, and working conditions that cause high psychosocial stress [2,8–10]. Without intervention, a growing share of workers in the US will experience precarious employment conditions, regardless of occupation [11].

Although studies increasingly show that these highly precarious work arrangements adversely affect the health of workers [12–15], interventions that improve the health of workers in these jobs are difficult to design and implement, given the nature of their work arrangements [16]. There is a substantial body of literature that posits that public health interventions that create the social and environmental conditions to promote and facilitate health are likely to be most effective and impactful on a population level [17–19]. Since many of the features of precarious work are not unique to a single occupation or to a single workplace, interventions aimed at addressing the causes of precarious work must be implemented at these broadly impactful social ecological levels. These types of interventions, typically in the form of policy, systems, and environmental (PSE) changes, are most effective when a diverse group of stakeholders are involved in intervention development and implementation, and when these stakeholders understand the problem and relevant power dynamics [17,20,21].

While there are several examples of successful, cross-sectoral PSE interventions to address public health issues, including tobacco control and measures to reduce automotive crashes [19], there is little evidence in the literature of similar strategies to address precarious work. Given the absence of existing best practices or evidence-based initiatives in this area, researchers at the UIC Center for Healthy Work engaged a group of multi-disciplinary stakeholders in a process designed to understand and begin to develop upstream action to address drivers of precarious work. This process, known as the Healthy Work Collaborative Initiative, involved a six-session series of instructional and planning-based activities for organizations that were interested in addressing precarious work.

The six session Healthy Work Collaborative (HWC) was part of a larger project in the UIC Center for Healthy Work. The overarching aim of this larger project was to use an action research framework to understand and address precarious work through cycles of inquiry and action planning [22]. The HWC was a component of this larger project, which was designed with an intent to increase stakeholders' individual and organizational capacities to apply PSE strategies to address drivers of precarious work. The primary goal of the HWC was to bring together health and labor organizations to explore initiatives that may address health in the context of precarious employment. The goal of this manuscript is to report on a study that examined the role of university-based facilitation in this HWC process, conceptualized as technical assistance (TA) provided by UIC researchers. The HWC and TA in the HWC are further described below.

UIC researchers recruited Chicago- and Illinois-based public health and healthcare organizations and their partners to participate in the six in-person HWC sessions; many participants were recruited through existing relationships between the School of Public Health researchers and representatives of these organizations. The researchers also recruited representatives of labor organizations, including Chicago-based worker centers and labor advocacy groups, to share content expertise with participants during the HWC sessions. All labor organizations represented in the HWC also had longstanding relationships with researchers in the UIC School of Public Health. All six in-person HWC sessions took place within a 10-week period in the spring and summer of 2018.

Collaborations between university groups and outside partner organizations have been described in various contexts in the literature. Much of the existing literature on community–university partnerships focuses on opportunities for knowledge translation, or the application of research findings in the community, and service-learning and community-based research [4,6]. While the HWC model shares some of the features of community–university partnerships highlighted in the literature, such as an opportunity to co-create knowledge and develop shared research and action agendas [4], the purpose of the HWC was primarily to drive action rather than to generate knowledge.

The researchers designed the HWC using an Action Learning (AL) approach, which is an approach to problem solving that emphasizes learning through action and reflection on the results of that action [23]. AL was originally conceptualized by Reg Revans in the early 1980s, but has been adapted by others to better suit emerging learning and action needs in different contexts. One of these adaptations is that of Marquardt et al., in which AL is used with the intent to build and sustain systems-level change [24]. Similar to Revan's original AL approach, that described by Marquardt et al. uses an iterative, participatory process, which combines scientific knowledge with evidence derived from learners' experiences to solve complex problems [24,25]. However, unlike Revan's approach, Marquardt et al.'s AL approach relies on AL "coaches", or facilitators who promote critical thinking through the probing and prompting of learners throughout a process. In the HWC, UIC researchers served in this facilitator role, which is further described below.

Activities within each HWC session were designed to build upon one another so that participants would leave with foundational knowledge and skills to begin to plan for and take action to address the drivers of precarious work. The HWC sessions were grouped into three phases (Table 1), all of which incorporated AL tools: (1) Understanding; (2) System, strategies, and approaches; and (3) Planning for action. A fourth phase, the Action phase, was not included in the HWC sessions. Each phase included two sessions. Table 1 details the purpose of each phase and the activities that were included in that phase's sessions.

Small stipends were provided to HWC participants to compensate for their time spent preparing for and participating in the sessions. This aligns with the community–university partnership literature that suggests that funding community engagement in university-sponsored activities both supports community involvement and demonstrates the value that the university places on community engagement [6]. Funding was also provided to representatives from local worker centers and other labor advocacy and educational organizations who served as TA providers in the HWC sessions. The various participant roles in the HWC are further described below.


**Table 1.** Healthy Work Collaborative (HWC) Initiative.

\* Experts included representatives from local worker centers and other labor advocacy organizations, as well as labor-focused academic partners from outside of the University of Illinois at Chicago (UIC) Center for Healthy Work. These experts are further described under "Technical Assistance (TA) in the Healthy Work Collaborative (HWC)".
