1
|
Cook CE, Bailliard A, Bent JA, Bialosky JE, Carlino E, Colloca L, Esteves JE, Newell D, Palese A, Reed WR, Vilardaga JP, Rossettini G. An international consensus definition for contextual factors: findings from a nominal group technique. Front Psychol 2023; 14:1178560. [PMID: 37465492 PMCID: PMC10351924 DOI: 10.3389/fpsyg.2023.1178560] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023] Open
Abstract
Objective Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers. Design The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities. Setting International. Main outcome measures The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last. Participants The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research. Results A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: (1) an overall definition; (2) qualifiers that serve as examples of the key areas of the definition; and (3) how contextual factors may influence clinical outcomes. Conclusion Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating and/or mediating clinical outcomes.
Collapse
Affiliation(s)
- Chad E. Cook
- Department of Orthopaedics, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - Antoine Bailliard
- Department of Orthopaedics, Duke University, Durham, NC, United States
- Occupational Therapy Doctorate Division, Duke University, Durham, NC, United States
| | - Jennifer A. Bent
- Department of Rehabilitation, Duke University Hospital System, Durham, NC, United States
| | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- Brooks-PHHP Research Collaboration, Gainesville, FL, United States
| | - Elisa Carlino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Luana Colloca
- Departement of Pain and Translational Symptom Science and the Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gżira, Malta
| | - Dave Newell
- Anglo-European College of Chiropractic University College, Bournemouth, United Kingdom
| | - Alvisa Palese
- Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | | |
Collapse
|
2
|
Sharpe K, McGrail K, Mustard C, McLeod C. A Framework for Understanding How Variation in Health Care Service Delivery Affects Work Disability Management. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:215-224. [PMID: 35138519 DOI: 10.1007/s10926-021-10016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Introduction Differences in disability duration after work injury have been observed across jurisdictions, regions and urban and rural settings. A key aspect of effective disability management is the access and utilization of appropriate and high quality health care. This paper presents a framework for analyzing and thus understanding how health service spending and utilization vary across and within work disability management schemes and affect work disability management. Methods Our framework was developed through a literature review and policy analysis. Existing frameworks describing geographic variation in general health care systems identified factors believed to drive that variation. A review of policy and practice documents from Canada's no-fault cause-based work disability management system identified factors relevant to work disability systems. Results We expand on previous frameworks by taking a systems approach that centers on factors relevant to the work disability management system. We further highlight predisposing, enabling, workplace environment and need-based factors that could lead to variation in health care spending and utilization across and within jurisdictions. These factors are described as shaping the interactions between workers, health care providers, employers and work disability management system actors, and influencing work disability management health and employment outcomes. Conclusion Our systems-focused approach offers a guide for researchers and policymakers to analyze how various factors may influence spending and utilization across regions and to identify areas for improvement in health care delivery within work disability management systems. Next steps include testing the framework in an analysis looking at geographic variation in spending and utilization across and within Canadian work disability management systems.
Collapse
Affiliation(s)
- Kimberly Sharpe
- Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada.
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
| | - Cameron Mustard
- Institute for Work & Health, 400 University Avenue, Toronto, ON, M5G 1S5, Canada
| | - Christopher McLeod
- Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
| |
Collapse
|
3
|
Hudon A, MacEachen E, Lippel K. Framing the Care of Injured Workers: An Empirical Four-Jurisdictional Comparison of Workers' Compensation Boards' Healthcare Policies. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:170-189. [PMID: 35038105 DOI: 10.1007/s10926-021-10021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? METHODS We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. RESULTS We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. CONCLUSIONS This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.
Collapse
Affiliation(s)
- Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montreal, Pavillon du Parc, Office 402-5, C.P. 6128, Succ. Centre-ville, Montréal, QC, H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC, Canada.
- Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada.
| | - Ellen MacEachen
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Katherine Lippel
- Faculty of Law, Civil Law Section, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
4
|
What Social Supports Are Available to Self-Employed People When Ill or Injured? A Comparative Policy Analysis of Canada and Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095310. [PMID: 35564702 PMCID: PMC9099523 DOI: 10.3390/ijerph19095310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 12/04/2022]
Abstract
Self-employment (SE) is a growing precarious work arrangement internationally. In the current digital age, SE appears in configurations and contours that differ from the labor market of 50 years ago and is part of a ‘paradigm shift’ from manufacturing/managerial capitalism to entrepreneurial capitalism. Our purpose in this paper is to reflect on how a growing working population of self-employed people accesses social support systems when they are not working due to injury and sickness in the two comparable countries of Canada and Australia. We adopted ‘interpretive policy analysis’ as a methodological framework and searched a wide range of documents related to work disability policy and practice, including official data, legal and policy texts from both countries, and five prominent academic databases. Three major themes emerged from the policy review and analysis: (i) defining self-employment: contested views; (ii) the relationship between misclassification of SE and social security systems; (iii) existing social security systems for workers and self-employed workers: Ontario and NSW. Our comparative discussion leads us toward conclusions about what might need to be done to better protect self-employed workers in terms of reforming the existing social security systems for the countries. Because of similarities and differences in support available for SE’d workers in the two countries, our study provides insights into what might be required to move the different countries toward sustainable labour markets for their respective self-employed populations.
Collapse
|
5
|
Khan TH, MacEachen E, Hopwood P, Goyal J. Self-employment, work and health: A critical narrative review. Work 2021; 70:945-957. [PMID: 34744041 DOI: 10.3233/wor-213614] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Self-employment (SE) is a growing precarious and non-standard work arrangement internationally. Economically advanced countries that favor digital labor markets may be promoting the growth of a demographic of self-employed (SE'd) workers who are exposed to particular occupational diseases, sickness, and injury. However, little is known about how SE'd workers are supported when they are unable to work due to illness, injury, and disability. OBJECTIVE Our objective was to critically review peer-reviewed literature focusing on advanced economies to understand how SE'd workers navigate, experience, or manage their injuries and illness when unable to work. METHODS Using a critical interpretive lens, a systematic search was conducted of five databases. The search yielded 18 relevant articles, which were critically examined and synthesized. RESULTS Five major themes emerged from the review: (i) conceptualizing SE; (ii) double-edged sword; (iii) dynamics of illness, injury, and disability; (iv) formal and informal health management support systems; and (v) occupational health services and rehabilitation. CONCLUSION We find a lack of research distinguishing the work and health needs of different kinds of SE'd workers, taking into consideration class, gender, sector, and gig workers. Many articles noted poor social security system supports. Drawing on a social justice lens, we argue that SE'd workers make significant contributions to economies and are deserving of support from social security systems when ill or injured.
Collapse
Affiliation(s)
- Tauhid Hossain Khan
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Ellen MacEachen
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Pamela Hopwood
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Julia Goyal
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| |
Collapse
|