Development of an Intervention to Create a Supportive Work Environment for Employees with Chronic Conditions: An Intervention Mapping Approach

Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study

BACKGROUND

People living with cardiovascular diseases (CVD) often experience work participation problems. Good work-focused healthcare, defined as the received advice, treatment, and guidance focusing on work participation, can support the patient and work place. However, experiences with work-focused healthcare are generally not always positive which is a barrier for work participation. Therefore, the objective of this study is to gain insight into the work-focused healthcare journey from the perspective of patients with work participation problems due to CVD, to understand their experiences and needs, and to derive opportunities for improving work-focused healthcare service at a system level.

METHODS

Semi-structured interviews, preceded by preparatory assignments, were conducted with 17 patients who experience(d) work participation problems due to CVD. The patient experience journey map (PEJM) approach was used to visualize the patients' work-focused healthcare journey, including experiences and needs over time and place, from which opportunities to improve work-focused healthcare from the patient's perspective were derived.

RESULTS

An aggregated PEJM consisting of six phases was composed and graphically mapped. The first phase, working, represents a period in which CVD health problems and subsequent functional limitations occur. The next two phases, short- and long-term sick leave, represent a period of full sick leave. The last three phases, start-, partial-, and full vocational reintegration, focus on the process of return to work that takes place ranging from a few months up to several years after sick-listing. For each phase the touchpoints, timespan, stakeholders, activities, experiences and needs from the perspective of the patients were identified. Finally, for better work-focused healthcare nine opportunities for improvement were derived from the PEJM, e.g. emphasize the need for work adjustment prior to the medical intervention, provide more personalized advice on handling work limitations, and putting more compelling pressure on the employer to create suitable work positions for their employees.

DISCUSSION/CONCLUSION

This paper contributes insights to provide a more patient-centered work-focused healthcare trajectory for patients employed in paid jobs when living with CVD. The PEJM provides an understanding of the patients' perspectives throughout their work-focused healthcare journey and highlights opportunities for improvement towards a better suited and seamless patient journey, Although this research was conducted within the Dutch healthcare system, it can be assumed that the findings on integrated work-focused healthcare are largly transferable to other healthcare systems.

Selected Personality Traits and Employment as the Predictors of the Intensity of Psychosocial Problems Experienced by Chronically Ill Patients

BACKGROUND

This study sought to determine the effect of being employed or unemployed on the relationships between selected personal variables (acceptance of one's illness, self-efficacy, and self-actualization) and the intensity of psychosocial problems experienced by chronically ill persons (ChIP).

PARTICIPANTS AND PROCEDURES

The PCH-R Scale, the Generalized Self-Efficacy Scale, the Acceptance-of-Illness Scale, and the Self-Actualization Scale were used to collect information from 236 employed and unemployed ChIP.

RESULTS

Acceptance of illness and self-efficacy predicted the intensity of general psychosocial problems and problems in the personal, family, social, and occupational spheres in both employed and unemployed ChIP.

CONCLUSIONS

The results can significantly contribute to increasing the effectiveness of treatment and support offered to ChIP. Continued employment or reemployment after a period of intense therapy can protect them from a rapid degradation of their personal-and frequently, socio-economic-resources, which are necessary for them to be able to adapt to new challenges and maintain a good quality of life, despite experiencing a chronic illness.

Sustainable return to work after depression - A comparative study among occupational physicians and affected employees

Introduction

The number of sick days taken from work due to depression is steadily rising. A successful return to work (RTW) is essential for sustainable reintegration. This study aims to identify factors to optimize RTW and to investigate approaches for sustainable RTW (sRTW) after depressive episodes.

Methods

Semi-structured expert interviews with senior occupational physicians (OPs, N = 5) served to develop two surveys among OPs (N = 180) and employees after depressive episode (N = 192). Predictors of RTW rating, workplace-based RTW interventions and sRTW interventions were analyzed using multiple hierarchical regression, chi-square difference and t-tests.

Results

For OPs, employee training on mental illness prevention was found to be the strongest predictor of overall RTW rating, whereas understanding and appreciation in conversations and stigmatization were strongest predictors of overall RTW rating by the employees. Compared to the employees, OPs reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritized sufficient time and financial security during the RTW process more than OPs.

Conclusions

The study identified facilitating and hindering factors that can inform further research and practice to improve RTW after depressive episodes. To redress the awareness gap about the availability of workplace-based interventions, regular contact between OPs and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account during RTW.

Design of vestibules as transitional spaces in infection control: Necessity of working space changes to cope with communicable infections

BACKGROUND: After the spread of infectious diseases, people stay at home as a shelter space to be safe and sound. Current homes and work spaces have shown not to be a good environment for health and hygiene. During different crises of infectious diseases, architects and designers analyze the needs for change and evolve of environments to achieve a suitable design that prevents the spread of pathogens. OBJECTIVES: This proper design should help improve people’s living standards and mental health in terms of functionality and environmental psychology. METHODS: In the traditional architecture of some countries, such as Canada, Japan, and Iran, the vestibule has provided some possibility of separating the external and internal space. The design of the intermediate space with the appropriate scale of today’s buildings at the entrance can create a filter between the indoor and outdoor environments by dividing these spaces. RESULTS: The use of intermediate space by modern technology can prevent the transfer of viral infection into the interior of the building. This can be done by removing the virus from clothes, changing or covering shoes, disinfecting equipment, separating infected items, and creating proper ventilation in the intermediate space so that microorganisms cannot be transferred into the safe environment. CONCLUSIONS: In this paper, we looked at the architectural design in a new light to have a healthier life and more security, by inspiration of the patterns in traditional architecture and the human body.

Participatory Approach to Create a Supportive Work Environment for Employees With Chronic Conditions: A Pilot Implementation Study

OBJECTIVE

To evaluate a pilot implementation of an organizational-level intervention. The participatory approach (PA) was used to create a supportive work environment for employees with chronic conditions, with a key role for occupational physicians (OPs).

METHODS

Twenty-eight semi-structured interviews were conducted with OPs and stakeholders within their organizations. Furthermore, observational data and research notes were gathered. Data analysis occurred through content analysis.

RESULTS

Recruitment of organizations was challenging, with a reach of 25%. Dose delivered, dose received, and fidelity differed across the three organizations. Organizations were positive about the PA as a method to improve support for employees with chronic conditions.

CONCLUSIONS

The PA could be of added value for creating a supportive work environment. However, research is needed on activating organizations to improve support for employees with chronic conditions.

Strengthening supervisor support for employees with common mental health problems: developing a workplace intervention using intervention mapping

Background

This study presents the development of a workplace intervention to strengthen supervisor’s support for employees with common mental health problems (CMHP). CMHP have been increasing over the last years, resulting into negative work outcomes, such as absenteeism or reduced work performance. To date, organisational interventions have been promising in preventing these negative work outcomes, however it is yet unknown in what way the role of workplace stakeholders, in particular supervisors, can be strengthened. This study contributes to the literature of interventions on an organizational level which uses a preventative approach by promoting stay at work among employees with CMHP through supervisor support.

Methods

we applied the intervention mapping (IM) approach, by actively involving workplace stakeholders (employees with CMHP, supervisors and occupational health professionals) through the development process and the use of Integrated model of behaviour prediction for employers. All six steps of IM are followed and thematic analysis was used to analyse interviews and focus groups.

Results

Based on a comprehensive needs assessment, the intervention resulted in an online guideline, with five step-wise themes on how to support employees with CMHP to stay at work (SAW). The guideline addressed the most important and changeable actions using the Integrated model of behaviour prediction. The guideline presents how to signal and address problems in the workplace and find solutions by stimulating autonomy of employees, explore job accommodations and ask for occupational support. In addition, basic conditions on how to create mentally healthy workplaces were presented. Coaching sessions by occupational health professionals, that include practical strategies using the best available evidence, were identified by the stakeholders.

Conclusions

This SAW-Supervisor Guideline-intervention responds to the need of supervisors to be supported in their role, responsibility and ways to support employees with mental health issues, through a behaviour-oriented, preventative approach. Intervention mapping provided a systematic process to identify, structure and prioritize factors of supervisor support, resulting in a novel workplace intervention. The active involvement of workplace stakeholders throughout the process resulted into a well-received intervention. The theoretical framework provided practical ways to induce supportive behaviour of supervisors, bridging theory with practice.

A Worksite Self-management Program for Workers with Chronic Health Conditions Improves Worker Engagement and Retention, but not Workplace Function

Purpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program ("Manage at Work") (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20-69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability.Clinical trial registration: Clinicaltrials.gov #NCT01978392.

Being an older nurse or midwife in the healthcare workplace- A qualitative descriptive study

AIM

To explore the experiences of being an older nurse or midwife employed in the healthcare workplace.

DESIGN

A qualitative descriptive study.

METHOD

Semi-structured interviews were conducted with nurses and midwives who self-identified as older workers. All Australian states were represented and given recruitment was undertaken nationally, most interviews were conducted via telephone. Data were collected between November 2018 and October 2019. Audio recordings were transcribed verbatim and then thematically analysed.

RESULTS

A total of 50 nurses and midwives were recruited, aged between 46 and 74 years. Three themes were identified. Ageing body: Being an older worker meant increased fatigue and physical changes affecting their ability to function at full capacity. Youth focus: For many, being an older worker was about being viewed as a poor-quality worker, with limited access to education and promotional opportunities because of their age. Wise worker: For a small number of older nurses and midwives, it was about being valued and respected for their knowledge, experience and skills.

CONCLUSION

Participants self-identifying as older nurses or midwives represented a wide age range. Spanning across the age spectrum, many experienced fatigue, physical changes or loss of value to the workplace which often impacted on their working lives. The findings contributed to an understanding about what it is to be an older nurse or midwife in terms of how their contribution is regarded and valued by others in the workplace.

IMPACT

This study highlighted there is a need for support of older nurses and midwives in managing age-related fatigue and physical changes. It also suggests consideration of a wise-worker model as a means to recognize the important contribution that older workers can offer.

Professionals' and Students' Perceived Needs for an Online Supportive Application for Reducing School Absence and Stimulating Reintegration: Concept Mapping Study

Background

To limit students’ medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students’ autonomy regarding their situation.

Objective

This study aimed to identify professionals’ and students’ perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration.

Methods

Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers.

Results

Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option.

Conclusions

Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism.