Influence of chronic diseases on societal participation in paid work, volunteering and informal caregiving in Europe: a 12-year follow-up study

Multimorbidity and patient experience with general practice: A national cross-sectional survey in Norway

BACKGROUND

Patient experience is an important indicator of the quality of healthcare. Patients with multimorbidity often face adverse health outcomes and increased healthcare utilisation. General practitioners play a crucial role in managing these patients. The main aim of our study was to perform an in-depth assessment of differences in patient-reported experience with general practice between patients living with chronic conditions and multimorbidity, and those with no chronic conditions.

METHODS

We performed secondary analyses of a national survey of patient experience with general practice in 2021 (response rate 41.9%, n = 7,912). We described the characteristics of all survey respondents with no, one, two, and three or more self-reported chronic conditions. We assessed patient experience using four scales from the Norwegian patient experience with GP questionnaire (PEQ-GP). These scales were used as dependent variables in bivariate and multivariate analyses and for testing the measurement model, including confirmatory factor analysis and a multigroup CFA to assess measurement invariance. Sentiment and content analysis of free-text comments was also performed.

RESULTS

Patients with chronic conditions consistently reported lower scores on the GP and GP practice experience scales, compared to those without chronic conditions. This pattern persisted even after adjustment for patient background variables. The strongest associations were found for the scale of "Enablement", followed by the scales of "GP" and "Practice". The subscale "Accessibility" did not correlate statistically significantly with any number of chronic conditions. The analysis of free-text comments echoed the quantitative results. Patients with multimorbidity stressed the importance of time spent on consultations, meeting the same GP, follow-up and relationship more often than patients with no chronic conditions. Our study also confirmed measurement invariance across patients with no chronic conditions and patients with multimorbidity, indicating that the observed differences in patient experience were a result of true differences, rather than artifacts of measurement bias.

CONCLUSIONS

The findings highlight the need for the healthcare system to provide customised support for patients with chronic conditions and multimorbidity. Addressing the specific needs of patients with multimorbidity is a critical step towards enhancing patient experience and the quality of care in general practice.

Including 'Work as a Treatment Goal' in the Care for Patients with Chronic Diseases : The Development of a Generic Care Model-A Descriptive Study

BACKGROUND

The Netherlands faces 60% prevalence of chronic conditions by 2040, impacting societal participation and quality of life. Current clinical care inadequately addresses these consequences, and most hospitals do not integrate occupational health in their care.

OBJECTIVES

To develop a generic person- and work-oriented medical care model (WMCM) based on real life experiences with work-oriented care and supporting the chronically ill in active societal participation.

METHODS

A qualitative research project with a participative approach in one hospital (November 2019 until March 2020). In an expert meeting, a schematic representation of a work-oriented care model was developed. Subsequent discussion rounds, with professionals from different patient groups, iteratively refined the model to a WMCM.

RESULTS

Consensus was reached after seven rounds of discussion, defining the model's core elements (1) a combination of biomedical and biopsychosocial approaches, (2) involvement of a clinical occupational physician in the treatment team, (3) a coordinating role for nursing specialists, and (4) incorporation of a work-oriented intervention plan (WoIP) into the treatment plan. Advocating early attention to societal participation, the model emphasises the WoIP and consensus on monitoring indicators. The final goal is a sustainable return to societal participation, considering both quality of life and work.

CONCLUSION

It is feasible to develop a generic person- and work-oriented care model for patients with chronic illness within a hospital care setting. Collaboration between healthcare professionals and a specialised occupational physician, with a central role for nurses, is deemed crucial.

Longitudinal reciprocal associations between volunteering, health and well-being: evidence for middle-aged and older adults in Europe

BACKGROUND

There is substantial evidence on the importance of voluntary activities for the health of middle-aged and older adults. Evidence on the effects of health and well-being on volunteering is more limited. This study examines reciprocal longitudinal associations between voluntary and/or charity activities and 21 indicators related to physical health, well-being, cognitive impairment and daily life functioning among middle-aged and older adults.

METHODS

Longitudinal data were collected between 2011 and 2020 from a sample of 19 821 middle-aged and older adults from 15 countries participating in the Survey of Health, Ageing and Retirement in Europe. An outcome-wide analysis and an exposure-wide analysis were applied and generalized estimating equations were used. Robustness analyses were conducted.

RESULTS

Voluntary and/or charity activities almost every week or more often were prospectively associated with greater emotional well-being, reduced risks of limitations in activities of daily living and of being diagnosed with Alzheimer's disease at a 6-year follow-up. Positive reverse associations were found from emotional well-being to volunteering. Limitations in daily life activities, increased loneliness, high blood cholesterol, hypertension and chronic lung disease were found to impede participation in voluntary and/or charity activities over time. Feedback loops between voluntary and/or charity activities and well-being and limitations in daily activities may exist.

CONCLUSION

Understanding the reciprocal nature of the relationship between volunteering and health and well-being can help identify strategies to encourage volunteering among middle-aged and older adults with specific health conditions and to target health promotion efforts towards volunteers.

Helping and Volunteering During COVID-19: Associations With Well-Being and Psychological Distress

INTRODUCTION

Salutogenic effects of volunteering and helping activities have been well recognized in the pre-COVID-19 era. This study examines associations between helping others as well as additional volunteer activities during the first wave of the COVID-19 pandemic and 6 psychological distress and well-being outcomes one year later.

METHODS

Longitudinal data collected between 2019 and 2021 were used. Analyses were based on data from 42,005 middle-aged and older adults from 27 European countries who participated in the Survey of Health, Ageing, and Retirement in Europe (SHARE) and two SHARE Corona Surveys. Prospective associations were examined using generalized estimating equations. A series of secondary analyses and the sensitivity of the associations to unmeasured confounding provided evidence for the robustness of results. All analyses were conducted in December 2022.

RESULTS

Helping others outside one's home in the first wave of COVID-19 was associated with subsequent increased risks of depression and anxiety. It was concurrently associated with an increased probability of an uplifting, hope, and happiness-inducing experience. Engagement in volunteer activities conducted in addition to helping was found to be prospectively associated with higher probability of an uplifting experience, but not with depression and anxiety. These associations were independent of demographic and socioeconomic characteristics, personality traits, prior quality of life and health history as well as pre-COVID-19 engagement in altruistic activities.

CONCLUSIONS

Helping and volunteering during the COVID-19 pandemic likely led to positive experiences. However, a negative impact on psychological distress of the same activities was also noted.

Quantifying the Contribution of Work Characteristics to Educational Disparities in Health-Induced Work Limitations

OBJECTIVES

To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age.

METHODS

We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80.

RESULTS

We found disparities to be profound and persistent over time. Blinder-Oaxaca threefold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates.

DISCUSSION

Work environments appear to play an important role in educational disparities in mid- to late-life disability.

Handgrip strength and work limitations: A prospective cohort study of 70,820 adults aged 50 and older

The purpose of the study was to investigate the association between handgrip strength and the incidence of work limitations in European adults aged 50 and older. We conducted a prospective cohort study among adults aged 50 and older from 27 European countries and Israel. Data were collected from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 1, 2, 4, 5, 6, and 7. Handgrip strength was measured using a hand dynamometer (Smedley, S Dynamometer, TTM) and participants replied to questions about work limitations. Cox regression was conducted for statistical analyses. A total of 70,820 older adults (mean age 61 ± 7.7 years; 54.3 % women) were followed during a mean of 3.8 ± 2.9 years. The fully adjusted model showed that participants with low handgrip strength (<16 kg in women and <27 kg in men) had a significantly higher risk of work limitations compared with participants with normal values of handgrip strength (hazard ratio: 1.36; 95 % confidence interval: 1.28-1.44). Kaplan-Meier trajectories revealed that the survival probability to experience work limitations in the normal handgrip category was 20 % lower than in the low handgrip category in most of the follow-up period. We identified low level of handgrip strength as a risk factor for work limitations in adults aged 50 years or older. This could be used as an accessible measure to screen workers at risk of developing work limitations.

Inequalities in the impact of having a chronic disease on entering permanent paid employment: a registry-based 10-year follow-up study

BACKGROUND

This study aimed to investigate among unemployed persons (1) the impact of having a chronic disease on entering paid employment and obtaining a permanent contract and (2) whether these associations differed by educational attainment.

METHODS

Register data from Statistics Netherlands on employment status, contract type, medication and sociodemographic characteristics were linked. Dutch unemployed persons between 18 and 64 years (n=667 002) were followed up for 10 years (2011-2020). Restricted mean survival time analyses (RMSTs) were used to investigate differences in average months until entering paid employment and until obtaining a permanent contract between persons with and without cardiovascular diseases, inflammatory conditions, diabetes, respiratory illness, common mental disorders and psychotic disorders. Interaction terms were included for education.

RESULTS

One-third of the unemployed persons at baseline entered paid employment during follow-up. Persons with chronic diseases spent more months in non-employment compared with persons without chronic diseases (difference ranging from 2.50 months (95% CI 1.97 to 3.03 months) to 10.37 months (95% CI 9.98 to 10.77 months)), especially for persons with higher education. Conditional on entering paid employment, the time until a permanent contract was longer for persons with cardiovascular diseases (4.42 months, 95% CI 1.85 to 6.99 months), inflammatory conditions (4.80 months, 95% CI 2.02 to 7.59 months) and diabetes (8.32 months, 95% CI 4.26 to 12.37 months) than for persons without these diseases. These latter differences were similar across educational attainment.

CONCLUSIONS

Having a chronic disease is a barrier to entering permanent paid employment. The findings underline the need to prevent chronic diseases and promote an inclusive workforce.

The role of physical and cognitive/emotional functioning in the associations between common health conditions and working

The degree to which functional abilities explain the negative associations between chronic disease and employment is not well understood. If functional limitations play an important role, then increasing access to accommodations and rehabilitation could facilitate employment among people with chronic illness. If not, other barriers related to living with chronic illness may be at play, calling for other interventions. The goal of this study was to 1) assess how health conditions were associated with employment for adults ages 30-69, and 2) test how much of these illness-employment associations was explained by physical and cognitive/emotional functioning. We fielded the state-of-the-art Work Disability Functional Assessment Battery (WD-FAB) in the nationally-representative RAND American Life Panel (N = 1774) in 2020, stratifying the sample by age and educational attainment. We found that mental health conditions, nervous system/sensory conditions, and cardiovascular conditions were significantly associated with large reductions in the probability of working, at -8, -10, and -19 percentage points (pp) respectively, while there were no significant associations for other conditions. Functional abilities were positively associated with employment to different degrees depending on education. Among those without college degrees, physical functioning (+16 pp) but not cognitive/emotional functioning was significantly associated with working. Among those with college degrees, both physical (+6 pp) and cognitive/emotional (+4 pp) functioning were associated with working. Older workers (ages 51-69) showed a larger association between physical functioning and work with no association between cognitive/emotional functioning and work. Importantly, accounting for functioning reduced the negative associations with employment for mental health and nervous system/sensory conditions but not for cardiovascular conditions. This implies that, for the former conditions, accommodating functional limitations could promote greater employment. However, broader accommodations, such as paid sick leave, increased control over work schedules, and other improvements to working conditions may be necessary to reduce work exits due to cardiovascular conditions.

Factors Associated With Resilience During Long-Term Hemodialysis

BACKGROUND

Resilience has been associated with greater adherence to treatment, better outcomes, and improved quality of life (QOL) in people with chronic health conditions. This study aimed to identify sociodemographic, treatment accessibility-related, clinical, and psychological variables associated with resilience in patients with advanced chronic kidney disease (CKD) undergoing long-term hemodialysis (>6 months).

METHODS

This was a multicenter, cross-sectional, and correlational study. The instruments used were the Spanish versions of the Connor-Davidson Resilience Scale, the Perceived Stress Scale-10, and the Kidney Disease Quality of Life-36. The participants were categorized as resilient (with a score of ≥49.37 on the Connor-Davidson Resilience Scale) or nonresilient. Binary logistic regression analysis was performed to identify variables with predictive power for the group with the resilient profile.

RESULTS

Perceived stress, general QOL, and subcomponents of QOL, such as the physical component and burden of kidney disease, were identified as factors related to the resilient profile.

DISCUSSION

Identifying the factors related to resilient adjustment in patients with advanced CKD may assist health caregivers in improving adherence to treatment, treatment outcomes, and QOL.

Work-related support in clinical care for patients with a chronic disease: development of an intervention

BACKGROUND

Patients with a chronic disease are more vulnerable in the labor market, and work-related support in clinical care would enhance the timely support greatly needed in each phase of their working life. This paper describes the development of a generic stay-at-work intervention to provide work-related support in clinical care to patients with a chronic disease.

METHODS

Steps 1-4 of Intervention Mapping (IM) were combined with action research principles. A needs assessment (Step 1) involved the project group formation, a literature review, qualitative studies with healthcare professionals (HCPs; n = 9) and patients (n = 10), consultation with financial staff and testing, and resulted in objectives (Step 2). Guided by methods and applications (Step 3), the intervention was developed, tested and finalized (Step 4).

RESULTS

The needs assessment revealed the importance of behavioral change in HCPs, including changing attitude, self-efficacy, and social influence. For that purpose, a pathway and training sessions were developed. Testing these unveiled the need for practical tools and intervision. The final intervention comprises a care pathway as part of working routines, including screening, risk stratification, and tailored support. Practical tools, training sessions, and intervision for HCPs were developed.

CONCLUSIONS

Combining IM with action research principles resulted in a generic stay-at-work intervention in clinical care via behavioral change in HCPs. A generic care pathway, practical tools, training sessions, and intervision were developed. More specific alignment to specific patient groups is possible. To implement the intervention in another hospital, the local context, (financial) resources, and the national legislation should be considered.

Assessing the outcomes and experiences of care from the perspective of people living with chronic conditions, to support countries in developing people-centred policies and practices: study protocol of the International Survey of People Living with Chronic Conditions (PaRIS survey)

INTRODUCTION

In view of growing populations with chronic conditions, many countries are redesigning their health systems. However, little information is available about how health systems perform from the perspective of people living with chronic conditions. The Organisation for Economic Co-operation and Development (OECD) Member States therefore mandated the OECD to initiate the International Survey of People Living with Chronic Conditions (PaRIS survey), which aims to provide insight in outcomes and experiences of care as reported by people living with chronic conditions. The PaRIS-SUR consortium has been tasked by the OECD to support the development and implementation of the survey.

METHODS AND ANALYSIS

As primary care services play a pivotal role in the management of chronic conditions, the PaRIS survey will be implemented in the primary care setting. Data will be collected with a survey among users of primary care services aged 45 years or older, of whom many have chronic conditions. An additional survey is conducted among their primary care providers. The nested study design will allow analysis of the patient-reported data in relation to characteristics of and care provided by primary care providers within and across countries. In 2022, the survey will be tested in a Field Trial in participating countries. Data for cross-country comparison will be collected by the Main Survey in 2023.

ETHICS AND DISSEMINATION

Informed consent will be obtained from primary care providers and service users. National Project Managers search ethical approval of the survey in their country, if required. Reporting by the OECD will focus on questions for international comparison. A secured information technology platform will be developed for participants and stakeholders in countries to receive feedback and answer their own questions. Findings will also be disseminated through an international OECD flagship report, conferences, scientific papers and policy briefs, to inform strategies to improve care for people living with chronic conditions throughout the world.

The effect of the Progressive Goal Attainment Program on cognitions, perceptions, and work participation of workers with chronic health problems: study protocol for a randomized controlled trial

Background

Cognitions and perceptions of workers with chronic health problems, such as catastrophizing thoughts and fear-avoidance beliefs, can negatively influence work participation. The Progressive Goal Attainment Program (PGAP) is an intervention developed in Canada with the aim of decreasing limiting cognitions and perceptions and increasing work participation. The objective of this protocol article is to describe the design of a randomized controlled superiority trial to study whether PGAP is effective in decreasing limiting cognitions and perceptions and increasing workability and work participation of workers with chronic health problems in the Netherlands.

Methods

This study is a randomized controlled superiority trial with two (parallel) groups, in which workers on sick leave are randomly assigned to an intervention group (PGAP intervention) or to a waiting-list control group (care as usual). The PGAP intervention consists of a maximum of 10 weekly individual sessions provided by a trained PGAP professional in which the worker learns about staying active, planning activities, and setting goals. Participants in this risk-targeted behavioral activation intervention also learn to be more aware of their cognitions and perceptions and learn about solution-focused problem-solving skills in challenging situations. The primary outcome is the degree of catastrophizing. Secondary outcomes are other personal cognitions and perceptions (e.g., expectations regarding return to work, self-efficacy), health symptoms (e.g., fatigue, depression), work participation (e.g., sick leave status, work hours), and other work-related outcomes (e.g., workability, quality of working life).

Discussion

Although PGAP shows positive effects in Canada, we do not know whether this intervention is effective in the Netherlands. This study is the first randomized controlled trial to test the effect of PGAP on limiting cognitions and perceptions and on work participation of workers with chronic health problems in the Netherlands. If PGAP is effective it could be implemented in the Netherlands in order to stimulate workability and work participation of workers.

Trial registration

The protocol of this study is registered in the Netherlands Trial Register (NL9832) in October 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06698-8.

The positive impact of a care-physical activity initiative for people with a low socioeconomic status on health, quality of life and societal participation: a mixed-methods study

Background

Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care–physical activity (care–PA) initiatives may improve participants’ lifestyles and thereby lower overweight and obesity rates. A two-year care–PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. Here, we study the impact of X-Fittt 2.0 on health, quality of life (QoL) and societal participation using a mixed-methods design.

Methods

Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t₀) and after 12 weeks (t₁), one year (t₂) and two to three years (t₃). We also held 17 group discussions (t₁, n = 71) and 68 semi-structured interviews (t₂ and t₃). Continuous variables were analysed using a linear mixed-model analysis (corrected for gender, age at t₀, height, education level and employment status at the different time points), while we used descriptive statistics for the categorical variables. Qualitative data were analysed using a thematic analysis.

Results

Body weight was significantly lower at all three post-initiative time points compared with the baseline, with a maximum of 3.8 kg difference at t₂. Body Mass Index, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks. A positive trend regarding paid work was observed, while social visits decreased. The latter might be explained by the COVID-19 pandemic, as lockdowns limited social life. Furthermore, participants reported increased PA (including sports) and a few stopped smoking or drinking alcohol. Participants mentioned feeling healthier, fitter and more energetic. Additionally, participants’ self-esteem and stress levels improved, stimulating them to become more socially active. However, the participants also mentioned barriers to being physically active, such as a lack of money or time, or physical or mental health problems.

Conclusions

X-Fittt 2.0 improved the health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results. More complete data are needed to confirm the findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13936-w.

The Cross-Country Comparison Model for Labor Participation (CCC Model for LP) of Persons with Chronic Diseases

Purpose To design a model based on the three pillars of new institutional theory (NIT), that facilitates cross-country comparison of labor participation (LP) of people with chronic diseases. This model should support getting a comprehensive overview of factors representing country differences, understanding these differences and should support estimating cross-country transferability of policies and interventions in the context of Work Disability Prevention. Methods Based on NIT, a draft model was designed by means of (1) a literature review of empirical studies; (2) theoretical books and articles; (3) a focus group with six expert researchers. This draft model was (4) adapted in the context of academic education. Literature was searched on Web of Science and EBSCO host. Feedback on (use of) the model was received from the focus group, four different academic courses at 28 occasions and two international conferences. Results The cross-country comparison model for labor participation (CCC model for LP) of persons with chronic diseases is proposed consisting of five factors: (1) Legislation; (2) Norms & values in practice; (3) Culture; (4) Organization of WDP in practice; (5) Labor market characteristics. Within these factors and based on (in)direct empirical evidence, subfactors are distinguished. The feedback received led to renaming (sub) factors, improved visual representation and a tool for estimating transferability. Conclusions The CCC model for LP of persons with chronic diseases allows for a comprehensive understanding of country differences and cross-country transferability of policies and interventions. The CCC model can be used for other populations when population-specific subfactors are included.

Age, Cognitive Factors, and Acceptance of Living with the Disease in Rheumatoid Arthritis: The Short-Term Perspective

Rheumatoid arthritis is a chronic inflammatory disease leading to disability, reduced quality of life, and severe depressive symptoms. Theoretical models and research emphasize the importance of cognitive factors such as illness-related beliefs and cognitive appraisals in the process of adapting to life with a chronic disease.

OBJECTIVES

The aim of this study was to analyze the role of age, disease duration, and cognitive factors in the level of acceptance of life with rheumatoid arthritis and determine the factors responsible for short-term (one week) changes without the use of interventions. We also assessed differences in predictors between rheumatoid arthritis, vascular diseases, and diabetes.

METHODS

Data were collected using a panel study. The first part of the analysis included 83 participants who declared a medical diagnosis of rheumatoid arthritis. In the second part of the analysis, in addition to people with rheumatoid arthritis (69 participants), two control groups were also included: diabetes (n = 26) and vascular disease (n = 26). The analysis examined basic sociodemographic and clinical data, cognitive appraisals, illness-related beliefs, and acceptance of living with the disease twice in one week.

RESULTS

The relationship between age and levels of acceptance of living with the disease was cubic, but the groups distinguished based on age and disease duration did not differ in terms of the analyzed variables. Cognitive appraisals (both baseline and changes over one week) were responsible for changes in acceptance of living with the disease, although other variables (sociodemographic, clinical, and illness-related beliefs) also played a role. The predictors of change in acceptance of living with the disease differed between analyzed diagnoses.

CONCLUSIONS

Cognitive factors are an important aspect of the adaptation process to living with an illness. Potential clinical applications and future directions of research are discussed.

Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation

BACKGROUND

In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs' satisfaction with the training and the feasibility of the training and learned skills.

METHODS

The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills.

RESULTS

The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time.

CONCLUSIONS

OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease.

'I Live a Kind of Shadow Life': Individual Experiences of COVID-19 Recovery and the Impact on Physical Activity Levels

Understanding of strategies to support individuals recovering from coronavirus disease 2019 (COVID-19) is limited. ‘Long COVID’ is a multisystem disease characterised by a range of respiratory, gastrointestinal, cardiovascular, neurological, and musculoskeletal symptoms extending beyond 12 weeks. The aim of this study was to explore individuals’ experiences of recovering from COVID-19 to provide a better understanding of the acute and long-term impact of the disease on physical activity (PA). Individualised semi-structured interviews were conducted with 48 adults recovering from COVID-19 at 6–11 months post-infection. An inductive thematic analysis approach was used, reaching saturation at 14 interviews (10 female; 47 ± 7 years). Four overarching themes were identified: (i) Living with COVID-19, including managing activities of daily living; (ii) Dealing with the Unknown and self-management strategies; (iii) Re-introducing physical activity; and (iv) Challenges of returning to work. The return to PA, whether through activities of daily living, work or exercise, is often associated with the exacerbation of symptoms, presenting a range of challenges for individuals recovering from COVID-19. Individually tailored support is therefore required to address the unique challenges posed by COVID-19.

Prevalence, types, and combinations of multiple problems among recipients of work disability benefits

PURPOSE

For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these "non-medical" problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients.

METHODS

We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit.

RESULTS

Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level.

CONCLUSIONS

Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management.Implications for rehabilitationClients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs.Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation.For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.

Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative

BACKGROUND

This study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4-12 year olds).

METHODS

The Healthy Primary School of the Future (HPSF; a healthy school lunch and structured physical activity) and the Physical Activity School (PAS; structured physical activity) were compared to the regular Dutch curriculum (N = 1676). An adolescence model, calculating weight development, and the RIVM Chronic Disease Model, calculating overweight-related chronic diseases, were linked to estimate the lifetime impact on chronic diseases, quality adjusted life years (QALYs), healthcare, and productivity costs. Cost-effectiveness was expressed as the additional costs/QALY gained and we used €20,000 as threshold. Scenario analyses accounted for alternative effect maintenance scenarios and equity analyses examined cost-effectiveness in different socioeconomic status (SES) groups.

RESULTS

HPSF resulted in a lifetime costs of €773 (societal perspective) and a lifetime QALY gain of 0.039 per child versus control schools. HPSF led to lower costs and more QALYs as compared to PAS. From a societal perspective, HPSF had a cost/QALY gained of €19,734 versus control schools, 50% probability of being cost-effective, and beneficial equity impact (0.02 QALYs gained/child for low versus high SES). The cost-effectiveness threshold was surpassed when intervention effects decayed over time.

CONCLUSIONS

HPSF may be a cost-effective and equitable strategy for combatting the lifetime burden of unhealthy lifestyles. The win-win situation will, however, only be realised if the intervention effect is sustained into adulthood for all SES groups.

TRIAL REGISTRATION

Clinicaltrials.gov ( NCT02800616 ). Registered 15 June 2016 - Retrospectively registered.

The influence of unhealthy behaviours on early exit from paid employment among workers with a chronic disease: A prospective study using the Lifelines cohort

OBJECTIVES

This study examined the risk of unhealthy behaviours and the additive effects of multiple unhealthy behaviours on exit from paid employment among workers with a chronic disease and investigated effect modification by gender and educational level.

METHODS

Data from the Lifelines cohort, collected between 2006 and 2013, were enriched with registry data from Statistics Netherlands with up to 11 years follow-up. Workers with a chronic disease were selected (n = 11,467). The influence of unhealthy behaviours (physical inactivity, smoking, unhealthy diet, high alcohol intake, and obesity) on exit from paid employment (unemployment, disability benefits, early retirement, and economic inactivity) was examined using competing risk models. To examine effect modification by gender and educational level, interaction terms were added.

RESULTS

Smoking and low fruit intake increased the risk to exit paid employment through unemployment and disability benefits. Low vegetable intake increased the risk of unemployment, obesity the risk of receiving disability benefits, and high alcohol intake the risk of early retirement. Physical inactivity was not associated with any exit from paid employment. Having multiple unhealthy behaviours increased the risk of both unemployment and of receiving disability. No consistent effect modification for gender or educational level was found.

CONCLUSIONS

Unhealthy behaviours increased the risk to exit paid employment through unemployment and disability benefits among workers with a chronic disease, and this risk increased when having multiple unhealthy behaviours. Health promotion to support workers with chronic diseases to make healthier choices may help to extend their working life.

Mediating engagement in a social network intervention for people living with a long-term condition: A qualitative study of the role of facilitation

Background

Successful facilitation of patient‐centred interventions for self‐management support has traditionally focussed on individual behaviour change. A social network approach to self‐management support implicates the need for facilitation that includes an orientation to connecting to and mobilizing support and resources from other people and the local environment.

Objective

To identify the facilitation processes through which engagement with a social network approach to self‐management is achieved.

Method

Thematic analysis was used to analyse data from a longitudinal study design using quasi‐ethnographic methods comprising non‐participant observation, video and qualitative interviews involving 30 participants living with a long‐term condition recruited from a marginalized community.

Results

Findings centred on three themes about the social network approach facilitation processes: reversing the focus on the self by bringing others into view; visualization and reflection as a mediator of positive disruption and linking to new connections; personalized matching of valued activities as a means of realizing preference elicitation.

Discussion and conclusions

Engagement processes with a social network approach illuminated the relevance of cognizance of an individual's immediate social context and forefronting social participation with others as the bases of self‐management support of a long‐term condition. This differs from traditional guided facilitation of health behaviour interventions that frame health as a matter of personal choice and individual responsibility.

Educational inequalities in the impact of chronic diseases on exit from paid employment among older workers: a 7-year prospective study in the Netherlands

OBJECTIVES

The study aimed to investigate the relative and absolute risks of early exit from paid employment among older workers with a chronic disease, and to assess whether these risks differ across educational groups.

METHODS

Data on chronic diseases and demographics from 9160 Dutch workers aged 45-64 years were enriched with monthly information on employment status from Statistics Netherlands. Subdistribution hazard ratios (SHR) and 7-year probabilities among workers with a chronic disease of exit from paid employment through disability benefits, unemployment benefits, early retirement benefits or economic inactivity were estimated using competing risks regression analyses based on Fine and Gray's models.

RESULTS

Workers with one chronic disease had a higher risk to exit paid employment through disability benefits (SHR 4.48 (95%CI 3.22 to 6.25)) compared with workers without chronic disease, and this risk further increased for multiple chronic diseases (SHR 8.91 (95%CI 6.33 to 12.55)). As occurrence of chronic diseases was highest among low educated workers, the 7-year probabilities to exit paid employment through disability benefits were highest among this group. Cardiovascular, musculoskeletal, psychological and respiratory diseases were associated with disability benefits (SHRs ranging from 2.11 (95%CI 1.45 to 3.07) to 3.26 (95%CI 2.08 to 5.12)), whereas psychological diseases were also related to unemployment (SHR 1.78 (95%CI 1.33 to 2.38)).

CONCLUSIONS

Older workers with a chronic disease have a higher risk to exit paid employment through disability benefits. As multimorbidity has an additive effect, addressing multimorbidity as a risk factor for sustainable employment is needed.