Facilitators, barriers and support needs for staying at work with a chronic condition: a focus group study

Towards person-centred work-focused healthcare for people with cardiovascular disease: a qualitative exploration of patients' experiences and needs

PURPOSE

To explore the experiences and needs concerning work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease based on all facets of person-centred care.

METHODS

Nineteen patients who experienced or continue to experience problems with work participation due to cardiovascular disease participated in semi-structured interviews preceded by preparatory written assignments. The transcripts were analysed by means of directed qualitative content analysis. Adapted principles of the Picker Institute for Person-Centred Care provided a template for the analysis.

RESULTS

28 experiences and needs emerged and were grouped into the eight principles for person-centred work-focused healthcare. Randomly presenting one theme for each of the eight principles, the themes included: (1) frequent encounters with occupational healthcare professionals; (2) substantive work-related advice; (3) transparency in communication; (4) support for family; (5) information provision on the work-focused healthcare process; (6) personal control during the process; (7) empathy for the personal situation; and (8) tailored work-focused support.

CONCLUSIONS

The identified experiences and needs for work-focused healthcare of patients experiencing problems with work participation due to cardiovascular disease clearly indicate the need to improve the delivery of person-centred work-focused healthcare to better meet the individual needs of patients.

Exploring the working conditions of disabled employees: a scoping review

PURPOSE

Disabled people are often overlooked in considerations about work design, which contributes to their exclusion from the labor market. This issue also reflects within research, as the body of knowledge on the working conditions of disabled employees remains relatively limited.

METHODS

A scoping review was conducted to assess the research landscape concerning the working conditions of disabled employees. Five databases have been searched, focusing on relevant studies published between 2017 and 2022.

RESULTS

One hundred fourteen studies were included in the review. It was found that social aspects of work appeared within a substantial portion of the examined studies. Furthermore, it became evident that the interplay of accessibility and flexibility provides an important dynamic to make work design both inclusive and feasible.

CONCLUSION

The recurrent prominence of social aspects, accessibility, and flexibility across the studies shows common challenges and potentials within the work situation of disabled employees. This suggests avenues for future research and inclusive work design.

Clinical Work-Integrating Care in Current Practice: A Scoping Review

PURPOSE

Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do.

METHODS

A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed.

RESULTS

In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available.

CONCLUSION

Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.

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.

Job satisfaction and job security as moderators in the relationships among job demands, musculoskeletal symptoms, and work performance

PURPOSE

This study examined whether job satisfaction and job security moderate the path from physical demands and job strain to impaired work performance via musculoskeletal symptoms in the upper extremities (MSUE). Moderation effects on five paths were examined: (1) from job strain to MSUE; (2) from job strain to work performance; (3) from physical demands to MSUE; (4) from physical demands to work performance; (5) from MSUE to work performance.

METHODS

This was a cross-sectional study of 669 full-time workers from 9 manufacturing and 3 healthcare facilities. Data were collected via health interviews, on-site physical exposure assessments, and computation of the Strain Index by ergonomists, and self-administered questionnaires on psychosocial factors. Structural equation modeling and zero-inflated negative binomial regression analysis were performed to examine the moderation effect on each path.

RESULTS

Job satisfaction moderated the relationship between MSUE and impaired work performance (B = - 0.09, 95% CI: - 0.15, - 0.04) and job security moderated the relationship between physical demands and MSUE (B = - 0.64, 95% CI: - 1.17, - 0.11). Interaction between job satisfaction and MSUE was significant on both the occurrence (OR: 0.92, 95% CI: 0.87, 0.97) and the degrees of impaired work performance (mean ratio: 0.99, 95% CI: 0.97, 0.99), while the interaction between job security and physical demands was significant only on the degrees of MSUE (mean ratio: 0.94, 95% CI: 0.89, 0.99).

CONCLUSION

Job satisfaction and job security can, respectively, mitigate the adverse impacts of working with MSUE and physical demands on work performance. Workplace interventions to improve workers' job satisfaction and job security can contribute to their musculoskeletal health and work performance.

Experiences of vocational rehabilitation and support services for people living with a long term condition: qualitative systematic review

PURPOSE

Identify and synthesise qualitative research evidence on activities and processes within formal vocational service provision that contribute to experiences of effective support to gain employment for people living with long term conditions.

METHODS

A pre-published protocol was developed using PRISMA guidelines. Seven databases were searched to identify qualitative research. Results of the search were screened against inclusion criteria and for methodological quality. Findings from included studies were extracted and then analysed using thematic synthesis methods.

RESULTS

Twenty two studies met the inclusion criteria. Six themes were identified that elucidated factors that contribute to experiences of supportive and effective vocational rehabilitation service delivery: a personalised service with service user preferences at the core; sustainable, timely and ongoing support; proactive collaboration with the employing organisation; peer support, the essential and necessary skills for gaining employment; and critical vocational worker skills, knowledge and attitudes.

CONCLUSION

This study demonstrates the utility of synthesising qualitative research to provide insight into the factors that contribute to experiences of supportive and effective vocational rehabilitation services that traverse various contexts. Future high quality qualitative research is required to probe a broader range of long term conditions to better identify the similarities and differences across services and groups.IMPLICATIONS FOR REHABILITATIONAcross qualitative studies, common aspects of "good" vocational services can be identified that contribute to experiences of effective support to gain paid work for people living with long term conditions.Services are experienced positively when they are personalised, flexible, collaborative and take into account both lived experience and knowledge of the person's condition.Vocational rehabilitation services should proactively build collaborative relationships between the job seeker, employing organisation and other agencies and services.Specific skills and services that people living with long-term conditions find particularly helpful include peer support, work-focused skill development and workplace adjustment and accommodations.

Qualitative study of barriers and facilitators encountered by individuals with physical diseases in returning and continuing to work

BACKGROUND

The number of employees with physical diseases is increasing, and there is a need for support to help them return and continue to work. To provide effective support, it is important to identify barriers and facilitators for individuals in returning and continuing to work. Previous studies have reported barriers and facilitators for specific diseases. However, few reports have dealt with these issues across various diseases. To identify a range of barriers and facilitators that may apply to different physical diseases, we conducted a qualitative analysis by interviewing patients with diverse characteristics being treated for diseases.

METHODS

We conducted semi-structured interviews based on the criteria for qualitative research. We investigated three disease groups to obtain details of barriers and facilitators: impairments that were visible to other people (mainly stroke); impairments invisible to others (mainly heart disease); and impairments that changed over time (mainly cancer). Interview transcripts were analyzed and the results reported using systematic text condensation.

RESULTS

We extracted 769 meaning units from 28 patient interviews. We categorized barriers and facilitators that were generalizable to various diseases into three themes (personal factors, workplace factors, and inter-sectoral collaboration and social resources) and 10 sub-themes (work ability, psychological impacts, health literacy, social status, family background, workplace structure, workplace system, workplace support, inter-sectoral collaboration, and social resources).

CONCLUSIONS

This study identified 10 sub-themes that can be applied for workers with physical diseases; those sub-themes may be used as a basis for communicating with those individuals about returning and continuing to work. Our results suggest that various barriers and facilitators for workers with physical diseases should be understood and addressed at medical institutions, workplaces, and support sites.

Unravelling the Complexities of Workplace Disclosure Among Persons with Non-Visible Disabilities and Illnesses: A Qualitative Meta-Ethnography

BACKGROUND

Deciding whether and how to disclose a disability at work for persons with non-visible disabilities and illnesses involve complex processes. Research has focused on antecedents and outcomes of disclosure. More research is needed to understand the lived experiences related to disclosure decision-making and actual navigation of disclosure and concealment at work.

PURPOSE

To understand the experiences of persons with non-visible disabilities and illnesses regarding workplace disclosure decision-making, navigating disclosure and/or concealment, and experiential differences across disability and illness types, ages, geographic locations, and genders.

METHODS

We conducted a qualitative meta-synthesis using Noblit and Hare's seven steps of meta-ethnography. Searches were conducted via six databases. Studies were analyzed to develop conceptual categories, third-order constructs (themes), and a line-of-argument with comparisons drawn from the disclosure decision making model, disclosure process model, and consideration of disability and illness types, genders, ages, and geographic locations.

RESULTS

Twenty-four studies were included involving 489 participants, aged 16 to 81, from nine countries, focusing on one non-visible disability or illness, or multiple. We developed four themes for the disclosure decision-making process (self- and other-focused, experiential, and environmental/workplace factors) and two themes for the disclosure/concealment event (disclosure/concealment logistics and timing) and noted emerging trends across ages, genders, disability and illness types, and geographic locations.

CONCLUSIONS

Knowledge obtained could be used among professionals who support persons with non-visible disabilities and illnesses to help them navigate disclosure at work, and to consider the role of age, genders, disability and illness types, and geographic locations on disclosure.

A Context Analysis with Stakeholders' Views for Future Implementation of Interventions to Prevent Health Problems Among Employees with a Lower Socioeconomic Position

Purpose Health problems among employees with a lower socioeconomic position (SEP) often result from an interplay of problems on multiple life domains. Contextual factors greatly affect implementation of interventions that aim to solve these type of problems. The aim of this study was to gain insight into the organizational and socio-political context for implementation of preventive interventions that consider multiple life domains among employees with a lower SEP. Methods In total 16 semi-structured interviews were conducted with stakeholders at organizational level, occupational health service (OHS) level, and at socio-political macro level. Thematic analysis was performed to identify themes that describe the perceptions of stakeholders about the impact of contextual factors on implementation. Results The following themes were identified: (1) the importance of addressing problems on multiple life domains among employees with a lower SEP, (2) unclarity of responsibilities for solving problems on multiple life domains, (3) necessity of better collaboration between occupational and curative healthcare, (4) insufficient investments in prevention by employers, (5) difficulties in early identification of employees at risk for health problems, and (6) risk of conflicting role for supervisors in addressing problems on multiple life domains. Conclusions Implementation of preventive interventions considering multiple life domains among lower SEP employees is challenging, due to various contextual factors. To improve the feasibility, many different stakeholders both in- and outside occupational health practice need to be involved, collaborate, and need to be convinced of the added value to prevent problems on multiple life domains among employees with a lower SEP.

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.

The Function of Occupational Activity for Health as Perceived by Chronically Ill People

Existing studies confirm the benefits of employment for chronically ill persons’ health, but few studies so far have delved into how they themselves perceive employment in relation to their health. There is also a paucity of information about individual factors influencing the formation of their perceptions. This study sought to determine differences between chronically ill persons with and without jobs regarding their perceptions of the function of employment for the physical, mental and social dimensions of health, as well as how their occupational activity or inactivity moderates the associations between the perception of work as health beneficial or health adverse and selected individual characteristics, such as self-efficacy, acceptance of illness, actualisation of self, and psychosocial problems. The study involved 80 adults with chronic illnesses and was conducted using the following psychological tools: the WH Scale, the Generalized Self-Efficacy Scale, the Acceptance of Illness Scale, the Actualization of Self Scale and the Psychosocial Problems of Persons with Chronic Illness Scale. It has been found that the way in which chronically ill persons perceive the function of employment for health is unrelated to whether or not they have a job, and that occupational activity moderates associations between the sense of self-efficacy and the perception of work as benefitting health.

Promoting Factors to Stay at Work Among Employees With Common Mental Health Problems: A Multiple-Stakeholder Concept Mapping Study

Most individuals affected by common mental health problems are employed and actually working. To promote stay at work by workplace interventions, it is crucial to understand the factors perceived by various workplace stakeholders, and its relative importance. This concept mapping study therefore explores perspectives of employees with common mental health problems (n = 18), supervisors (n = 17), and occupational health professionals (n = 14). Per stakeholder group, participants were interviewed to generate statements. Next, each participant sorted these statements on relatedness and importance. For each group, a concept map was created, using cluster analysis. Finally, focus group discussions were held to refine the maps. The three concept maps resulted in several clustered ideas that stakeholders had in common, grouped by thematic analysis into the following meta-clusters: (A) Employee’s experience of autonomy in work (employee’s responsibility, freedom to exert control, meaningful work), (B) Supervisor support (being proactive, connected, and involved), (C) Ways to match employee’s capacities to work (job accommodations), (D) Safe social climate in workplace (transparent organizational culture, collective responsibility in teams, collegial support), and (E) professional and organizational support, including collaboration with occupational health professionals. Promoting stay at work is a dynamic process that requires joined efforts by workplace stakeholders, in which more attention is needed to the interpersonal dynamics between employer and employee. Above all, a safe and trustful work environment, in which employee’s autonomy, capacities, and needs are addressed by the supervisor, forms a fundamental base to stay at work.

Exploring Employer Perspectives on Their Supportive Role in Accommodating Workers with Disabilities to Promote Sustainable RTW: A Qualitative Study

PURPOSE

Employers play an important role in facilitating sustainable return to work (RTW) by workers with disabilities. The aim of this qualitative study was to explore how employers who were successful in retaining workers with disabilities at work fulfilled their supportive role, and which facilitators were essential to support these workers throughout the RTW process.

METHODS

We conducted a semi-structured interview study among 27 employers who had experience in retaining workers with disabilities within their organization. We explored the different phases of RTW, from the onset of sick leave until the period, after 2-years of sick-leave, and when they can apply for disability benefit. We analyzed data by means of thematic analysis.

RESULTS

We identified three types of employer support: (1) instrumental (offering work accommodations), (2) emotional (encouragement, empathy, understanding) and (3) informational (providing information, setting boundaries). We identified three facilitators of employer support (at organizational and supervisor levels): (1) good collaboration, including (in)formal contact and (in)formal networks; (2) employer characteristics, including supportive organizational culture and leadership skills; and (3) worker characteristics, including flexibility and self-control.

CONCLUSIONS

Employers described three different possible types of support for the worker with disabilities: instrumental, emotional, and informational. The type and intensity of employer support varies during the different phases, which is a finding that should be further investigated. Good collaboration and flexibility of both employer and worker were reported as facilitators of optimal supervisor/worker interaction during the RTW process, which may show that sick-listed workers and their supervisors have a joint responsibility for the RTW process. More insight is needed on how this supervisor/worker interaction develops during the RTW process.

Barriers to and Facilitators of Sustained Employment: A Qualitative Study of Experiences in Dutch Patients With CKD

RATIONALE & OBJECTIVE

Although patients with chronic kidney disease (CKD) are at risk for work disability and loss of employment, not all experience work disruption. We aimed to describe the barriers to and facilitators of sustained employment experienced by Dutch patients with CKD.

STUDY DESIGN

Qualitative study using semistructured interviews.

SETTING & PARTICIPANTS

27 patients with CKD glomerular filtration rate categories 3b-5 (G3b-G5) from 4 nephrology outpatient clinics in The Netherlands.

ANALYTICAL APPROACH

Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health framework.

RESULTS

Participants were 6 patients with CKD G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition), personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit), and environmental barriers and facilitators. Environmental barriers were related to nephrology care (waiting time, use of a hemodialysis catheter) and work context (reorganization, temporary contract, working hours, physical demands); environmental facilitators were related to nephrology care (personalized dialysis, preemptive transplant), work context (large employer, social climate, job requiring mental rather than physical labor, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and support at home. Occupational health services and social security could be barriers or facilitators.

LIMITATIONS

The study sample of Dutch patients may limit the transferability of these findings to other countries.

CONCLUSIONS

The wide range of barriers and facilitators in all International Classification of Functioning, Disability and Health components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational health care as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.

Supporting employees with chronic conditions to stay at work: perspectives of occupational health professionals and organizational representatives

Background

Supporting employees with chronic conditions can prevent work-related problems and facilitate sustainable employment. Various stakeholders are involved in providing support to these employees. Understanding their current practices and experienced barriers is useful for the development of an organizational-level intervention to improve this support. The aim of this study was to explore the current practices of occupational physicians and organizational representatives, identifying both barriers to providing support and opportunities for improvement.

Methods

Two focus groups with sixteen occupational physicians and seven semi-structured interviews with organizational representatives were held between January and June 2018. Data was analyzed using thematic content analysis.

Results

Several barriers to offer support were identified, including barriers at the organizational level (negative organizational attitudes towards employees with chronic conditions), the employee level (employees’ reluctance to collaborate with employers in dealing with work-related problems), and in the collaboration between occupational physicians and organizational representatives. In addition, barriers in occupational health care were described, e.g. occupational physicians’ lack of visibility and a lack of utilization of occupational physicians’ support. Opportunities to optimize support included a shared responsibility of all stakeholders involved, actively anchoring prevention of work-related problems in policy and practice and a more pronounced role of the health care sector in preventing work-related problems.

Conclusions

Preventing work-related problems for employees with chronic conditions can be achieved by addressing the identified barriers to provide support. In addition, both occupational physicians and organizational representatives should initiate and secure preventive support at the organizational level and in occupational health care. These insights are helpful in developing an intervention aimed at supporting employees with chronic conditions to stay at work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10633-y.