Adaptation and validation of the cardiovascular version of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES-CVD) to the Italian context

PURPOSE

Effective cardiac rehabilitation interventions must provide adequate support to overcome psychosocial return-to-work (RTW) barriers. No validated instrument is available for this aim for cardiovascular patients. The Return-to-work Obstacles and Self-Efficacy Scale (ROSES) measures RTW obstacles workers perceive and the self-efficacy for overcoming them through 46 items and ten dimensions. This study aimed to adapt and validate ROSES for cardiovascular disease (CVD) in the Italian context.

METHODS

This prospective study involved 183 CVD working patients at baseline and 121 six months later. ROSES-CVD internal consistency, construct, and predictive validity was evaluated with Cronbach's α, Confirmatory factor analyses (CFA), and ANCOVAs.

RESULTS

CFAs adequately replicated the original ROSES model (CFI = .92-.96; TLI = .91-.94; RMSEA = .042-.057; SRMR = .046-.071) with α close or higher than .70 for all dimensions. Four ROSES-CVD dimensions significantly predicted the number of days to RTW controlling for age, gender, educational level, and surgery type. Workers who perceived salient RTW obstacles and low self-efficacy in any of these dimensions in mean returned to work from 38 to 53 days later.

CONCLUSIONS

The study supported the validity and reliability of ROSES-CVD. This tool can be used in rehabilitation to detect CVD patients at risk of a longer RTW process and define appropriate cardiac rehabilitation intervention.IMPLICATIONS FOR REHABILITATIONVocational rehabilitation interventions should provide tailor-made support to overcome RTW barriers based on individual risk assessmentThe Italian translation of ROSES-CVD is a valid and reliable tool to measure psychosocial barriers to RTW among CVD working patientsThe use of ROSES-CVD would allow detection of CVD patients at risk of longer RTW processAdministering ROSES-CVD can help focus traditional vocational intervention on individually relevant obstacles to RTW.

Health lifestyles during adolescence: clustering of health behaviours and social determinants in Italian adolescents

BACKGROUND

Health behaviours in adolescence have a high impact on both current and future health. The literature claims a focus on social determinants and shows that these behaviours are associated. The concept of 'health lifestyles' should be considered to account for co-occurring health behaviours and determinants interactions. The aim of this study is to increase our understanding of adolescents' health lifestyles and to (i) cluster adolescents according to a comprehensive number of health behaviours and (ii) describe these groups according to sociodemographic characteristics, perceptions of life contexts (family, school, peers or neighbourhood) and perceived physical and psychosocial health conditions.

METHODS

In Italy, 906 15-year-old students participated in the cross-national Health Behaviour of School-aged Children study. Clusters were identified by applying the KAMILA clustering method and compared using analysis of variance and chi-squared tests.Results: Four clusters were identified: 'substance consumers', 'media lovers', 'active students' and 'passive students'. Each cluster exhibited different characteristics related to health behaviours and social determinants.

CONCLUSIONS

Interesting associations between health behaviours were identified, which showed the relevance of considering the adolescents' overall lifestyles. The description of each cluster permitted the identification of risks and protective factors, which may be important for designing effective health promotion activities.

Telework quality and employee well-being: Lessons learned from the COVID-19 pandemic in Italy

The coronavirus disease 2019 (COVID-19) forced organisations to implement intensive telework for many of their workers overnight. This scenario was completely new, and the emergency caused by COVID-19 created the possibility of experimenting with new ways of working with an unknown impact on employee well-being. Drawing on previous literature, we defined a model of telework quality consisting of the following four core domains: agile offices within organisations, functional remote workstations, flex-time and engaging management. We identified two high-quality and low-quality telework profiles using latent profile analysis on a data sample of 2295 insurance and financial sector employees. Demographic, occupational and procedural characteristics were associated with the probability of being in the positive or negative profiles. Our results showed that employees' emotional exhaustion and work engagement levels were related to telework quality. This study suggests that organisations need to consider the quality of telework to effectively adopt new ways of working that foster employee well-being.

The Relationship between Work, Health and Job Performance for a Sustainable Working Life: A Case Study on Older Manual Employees in an Italian Steel Factory

BACKGROUND

Supporting and retaining older workers has become a strategic management goal for companies, considering the ageing of the workforce and the prolongation of working lives. The relationship between health and work is especially crucial for older workers with manual tasks, considering the impact of long-standing health impairments in older age. Although different studies investigated the relationship between work ability and job performance, few studies have analysed the impact of workers' capability to balance between health and work demands, including managerial and organisational support (work-health balance). Considering health as a dynamic balance between work and health demands influenced by both individual and environmental factors, we assess the mediator role of work-health balance in the relation between work ability and job performance, both self-reported and assessed by the supervisor.

METHODS

The study utilises data from a case study of 156 manual workers, who were 50 years old or older and employed in a steel company in Italy. Data were collected inside the company as an organiational initiative to support age diversity.

RESULTS

The findings show that work-health balance partially mediates the relationship between work ability and self-rated job performance, while it does not mediate the relationship with job performance as rated by the supervisor. Supervisor-rated job performance is positively associated with work ability, while it decreases with the increasing perceived incompatibility between work and health.

CONCLUSION

A perceived balance between health and work is a strategic factor in increasing manual older workers' job performance. For older workers, not only the perceived capability to work is important but also the organisational health climate and supervisor's support. More studies are needed to verify if managers overlook the importance of health climate and support, as strategic elements that can foster performance for older employees.

Health Literacy Levels among Italian Students: Monitoring and Promotion at School

Health literacy was identified as an important determinant of health, particularly for adolescents. However, more efforts are needed to monitor this construct and provide inputs for policy development. This study aims to: (a) Assess the validity and reliability of the Italian version of the Health Literacy for School-Aged Children (HLSAC-I); (b) Identify the health literacy levels among Italian students and compare them with other countries’ levels; and (c) Identify the associations between health literacy and multiple social determinants (social stratifiers, family, and school connectedness). Data came from the Health Behaviour School-Aged Children survey, carried out in the Lombardy region in northern Italy in 2018. A representative sample of 2,287 13- and 15-year-old Lombardian students was involved. The results support the validity and reliability of the HLSAC-I. A total of 18.7% of the sample reported low levels, and only 6.8% reported high levels. Italian students reported the lowest levels of health literacy compared with other countries. School connectedness and educational approach are the most relevant associated factors. This study confirms a school’s role in reducing inequalities and promoting health. It highlights the importance of monitoring health literacy and implementing health promotion policies at school through a whole-school approach.

Work with cancer or stop working after diagnosis? Variables affecting the decision

BACKGROUND

Studies about work and cancer predominantly considered the return to work of cancer survivors. However, some studies highlighted that many patients work with cancer even immediately after the diagnosis. Little is known about the frequency, causes, and consequences of this behavior.

OBJECTIVE

This study aimed to estimate how many cancer patients continue working in the month after the diagnosis in an Italian context and to determine which factors affect the decision to stop working in the same period.

METHODS

One hundred seventy-six patients with breast, gastrointestinal, prostate, or female reproductive system cancer completed a survey with demographic, occupational, and psychosocial information. Clinical information was collected from medical records. We measured how many workers continued working in the month after cancer diagnosis without substantial interruptions and selected the best logistic regression model of this behavior's predictors.

RESULTS

Sixty-eight percent of the patients continued working in the month after the diagnosis. Patients were more likely to stop working with a higher level of perceived work-health incompatibility (OR = 2.64; 95%CI: 1.48-4.69), an open-ended contract (OR = 3.20; CI: 1.13-9.09), and a complex treatment (surgery+chemo-/radio-therapy, OR = 4.25; CI: 1.55-11.65) and less likely with breast cancer (OR = 0.20; CI: 0.07-0.56), and more children (OR = 0.59; CI: 0.37-0.96).

CONCLUSIONS

To continue working with cancer is a common practice among the newly diagnosed. The decision to suspend work activity relates to evaluating how much work activities hamper one's health care needs and the practical difficulties expected in handling cancer care and work.

A Systematic Search and Review of Questionnaires Measuring Individual psychosocial Factors Predicting Return to Work After Musculoskeletal and Common Mental Disorders

Purpose Individual psychosocial factors are crucial in the return to work (RTW) process of workers with musculoskeletal disorders (MSDs) and common mental disorders (CMDs). However, the quality and validity of the questionnaires used to measure these factors have rarely been investigated. The present systematic search and literature review aims at identifying, categorizing, and evaluating the questionnaires (measurement tools) used to measure individual psychosocial factors related to the perception of the personal condition and motivation to RTW that are predictive of successful RTW among workers with MSDs or CMDs. Methods Through a systematic search on PubMed, Web of Science, and PsycINFO library databases and grey literature, we identified the individual psychosocial factors predictive of successful RTW among these workers. Then, we retrieved the questionnaires used to measure these factors. Finally, we searched for articles validating these questionnaires to describe them exhaustively from a psychometric and practical point of view. Results: The review included 76 studies from an initial pool of 2263 articles. Three common significant predictors of RTW after MSDs and CMDs emerged (i.e., RTW expectations, RTW self-efficacy, and work ability), two significant predictors of RTW after MSDs only (i.e., work involvement and the self-perceived connection between health and job), and two significant predictors of RTW after CMDs only (i.e., optimism and pessimism). We analyzed 30 questionnaires, including eight multiple-item scales and 22 single-item measures. Based on their psychometric and practical properties, we evaluated one of the eight multiple-item scales as questionable and five as excellent. Conclusions: With some exceptions (i.e., self-efficacy), the tools used to measure individual psychosocial factors show moderate to considerable room for improvement.

Tools Appraisal of Organizational Factors Associated with Return-to-Work in Workers on Sick Leave Due to Musculoskeletal and Common Mental Disorders: A Systematic Search and Review

Purpose The objective of this study was to identify organizational factors that are predictive of return-to-work (RTW) among workers with musculoskeletal (MSD) and common mental disorders (CMD), and to subsequently catalogue and characterize the questionnaires (tools) used to measure them. Methods A systematic search on PubMed, Web of Science and PsycINFO library databases and grey literature was conducted. First, a list of organizational factors predictive of RTW for the two populations considered was built. Second, the questionnaires used to measure these factors were retrieved. Third, we looked in the scientific literature for studies on the psychometric properties and practical relevance of these questionnaires. Results Among the factors retained, perceived social support from supervisor and co-workers, work accommodations, and job strain were identified as common RTW factors. Other risk/protective factors, and associated tools, specifically targeting either people with MSD or CMD were also analysed. Conclusions Researchers and practitioners are often uncertain of which tools to use to measure organizational factors which can facilitate or hinder RTW. This study provides an evaluation of the tools measuring predictive organizational RTW factors in people with MSD and CMD. The identified tools can be used in everyday practice and/or research.

Quality of life in patients with primary biliary cholangitis: A cross-geographical comparison

Background & aims

Several symptoms impair the quality of life (QoL) of patients with primary biliary cholangitis (PBC). They are reported to vary significantly in different countries. Aim of our study was to explore whether there is a geographical clustering that accounts for symptoms in PBC.

Methods

Data was analysed from four cohorts of PBC patients from the UK, Spain, Japan and Italy using the PBC-27 scale.

Results

Overall, 569 patients from four cohorts were identified, including 515 females (90.5%) with a mean age of 61 years. The analysis provided evidence for strict factorial invariance of the scale, a robust indicator of its validity for cross-cultural research. The mean of the fatigue domain of British patients was significantly greater than that of the Japanese (p ​< ​0.05), Italian (p ​< ​0.05), and Spanish patients (p ​< ​0.001). The mean of the cognitive domain after 54 years of age, was significantly greater in the British patients than in the Japanese (p ​< ​0.05) and Spanish patients (p ​< ​0.01). However, after 69 years of age, there were not significant differences between countries. The mean of the emotion domain after 54 years of age, was greater in the British that in the Spanish (p ​< ​0.01) and Italian patients (p ​< ​0.01).

Conclusions

Differences in the four countries concerning fatigue, cognitive and emotional dysfunction were found. The association of latitude and symptoms might provide new insights into the role of sun exposure, genetics and/or cultural component into disease phenotype in PBC.

Well-Being at Work after Return to Work (RTW): A Systematic Review

Background: Employees’ well-being at work after the return to work (RTW) is considered a key aspect of rehabilitation and maintenance of workability. This systematic review aimed at identifying the common psychosocial factors that predict the subjective and psychological well-being in RTW processes after having a long-standing health problem or disability. Objective: To evaluate the subjective and psychological well-being at work of employees with chronic or long-standing health problems or those returning to work after any cause of disability. Data source: Systematic review of articles published in English or Spanish using PsycINFO, PsycARTICLES, MEDLINE, Psychology, and Behavioral Sciences Collection, and Pubpsych. An additional study was identified by contacting expert academics in the field. The search equations used included terms such as Return to Work, Long-Standing Health Problems or Disability, Work Health Balance, and job satisfaction or subjective well-being. Eligibility criteria for the studies: Studies that included a measure of employees’ well-being at work following return to work were selected for the review. Evaluation of the studies and synthesis methods: The studies were selected using predefined fields which included quality criteria. Results: Of the 264 articles returned by the initial search, a total of 20 were finally selected. Results were organized around the three different theoretical approaches for understanding RTW and its antecedents and consequences: (a) RTW and autonomy at work have a positive effect on psychological well-being; (b) job demand is linked to less job satisfaction, whereas a higher level on the work–health balance is associated with job satisfaction and work engagement; (c) internal and external support is linked to job satisfaction in the case of a disease. Limitations: The evidence provided by the results is restricted by the limited availability of studies focusing on well-being at work following return to work. Moreover, the studies identified are of different kinds, thereby preventing comparisons. Conclusions and implications of the main findings: Employees’ subjective well-being after return to work has received very little attention to date. Given its importance in the current configuration of the labor market, it should be the object of more research.

How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression?

Background In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that "the supervisors' intention to take measures to facilitate their employees' RTW" was the only significant predictor of the RTW at the time of the interview. The Kaplan-Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Adjustment between work demands and health needs: Development of the Work-Health Balance Questionnaire

PURPOSE

This study presented the construct of Work-Health Balance (WHB) and the design and validation of the Work-Health Balance Questionnaire (WHBq). More and more workers have a long-standing health problem or disability (LSHPD). The management of health needs and work demands is crucial for the quality of working life and work retention of these workers. However, no instrument exists measuring this process. The WHBq assesses key factors in the process of adjusting between health needs and work demands.

METHOD

We tested the reliability and validity of 38 items with cross-sectional data from a sample of 321 Italian workers (mean age = 45 ± 11 years) using exploratory factor analysis (EFA), Rasch analyses, and the correlations with other relevant variables.

RESULTS

The instrument ultimately consisted of 17 items that reliably measured three factors: work-health incompatibility, health climate, and external support. These dimensions were associated with well-being in the workplace, dysfunctional behaviors at work, and general psychological health. A higher level on the WHB index was associated with lower levels of presenteeism, emotional exhaustion, workaholism, and psychological distress and with higher levels of job satisfaction and work engagement, supporting the construct validity of the instrument.

CONCLUSION

The WHBq shows good psychometric characteristics and strong and theoretically consistent relationships with important and well-known variables. These results make the WHBq a promising tool in the study and management of health of employees, especially for the work continuation of employees returning to work with LSHPD. (PsycINFO Database Record

Measuring family satisfaction with inpatient rehabilitation care

PURPOSE

The purpose of this paper is to investigate the psychometric characteristics of the Questionnaire of Family members' Satisfaction about the Rehabilitation (QFSR), a new questionnaire assessing the satisfaction of patients' families with the in-hospital rehabilitation service, i.e., the organizational procedure, medical treatment, relationship with nurses/other health workers, and outcome.

DESIGN/METHODOLOGY/APPROACH

The QFSR (13 items) was administered to 1,226 (F=60.4 percent; mean age=57.4, SD 15 years) family members of patients admitted to two units for inpatient rehabilitation, i.e., cardiovascular and neuromotor.

FINDINGS

Confirmatory factor analysis (CFA) confirmed the theoretical four-factor structure of the questionnaire in a subsample of 308 respondents randomly selected from the sample (SB χ² (61)=57.4, p=0.61; RMSEA=0.0; 90 percent CI [0.0, 0.031], CFI=1.00). The remaining 708 respondents (393 relatives of cardiovascular unit inpatients and 315 relatives of neuromotor unit inpatients) were used to test measurement invariance between the groups of family members with patients in the two units. The configurial, scalar, and strict factorial invariance provided a good fit to the data.

ORIGINALITY/VALUE

The QFSR, specifically developed to measure the satisfaction of family members of patients undergoing rehabilitation, appears to be a promising brief questionnaire that can provide important indications for continuous improvement in the delivery of healthcare.