Self-Efficacy Beliefs Predict Sustained Long-Term Sick Absenteeism in Individuals With Chronic Musculoskeletal Pain

[Is the relationship between depressive symptoms and work-related factors mediated by pain self-efficacy in non-specific chronic low back pain?]

BACKGROUND

The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy.

OBJECTIVE

Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms?

METHODS

Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP.

RESULTS

The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship.

CONCLUSION

To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.

Predictors of return to work among women with long-term neck/shoulder and/or back pain: A 1-year prospective study

Background

Sick leave due to musculoskeletal pain, particularly in the neck/shoulders and back, is one of the major public health problems in Western countries such as Sweden. The aim of this study was to identify predictors of return to work (RTW) among women on sick leave due to long-term neck/shoulder and/or back pain.

Methods

This was a prospective cohort study with a 1-year follow-up. The study participants were recruited from a local Swedish Social Insurance Agency register and had all been on sick leave for ≥ 1 month due to long-term (≥ 3 months) neck/shoulder and/or back pain. Data on predictors and outcome were collected using a self-administered questionnaire. A total of 208 women aged 23–64 years were included at baseline, and 141 responded at the 1-year follow-up. Cluster analyses were performed to identify one predictor from each cluster for use in the regression model.

Results

At the 1-year follow-up, 94 of the 141 women had RTW and 47 had not. Women who engaged in more coping through increasing behavioral activities (OR: 1.14, 95% CI: 1.03–1.25) and those who more strongly believed they would return to the same work within 6 months (OR: 1.22, 95% CI: 1.10–1.37) had an increased probability of RTW. Receiving more social support outside work (OR: 0.50, 95% CI: 0.28–0.92) decreased the odds of RTW at the 1-year follow-up.

Conclusions

Behavioral activities, beliefs about returning to the same work, and social support outside work were predictors of RTW at the 1-year follow-up. Healthcare professionals should consider these predictors in their efforts to prevent prolonged sick leave and to promote RTW in this population.

Prevalence and Risk-Factors of Musculoskeletal Disorders Among Provincial High School Teachers in the Philippines

Pain in the muscles and tendons is one of the most common complaints among teachers. The objective of this study was to investigate the prevalence of musculoskeletal disorders (MSDs) and their risk factors among public school teachers in the Philippines. It involved 200 public school teachers in the secondary level from Calbayog City division, Samar Province, Philippines, and used an English version of the Korean Occupational Safety and Health Agency's questionnaire on MSDs for an analysis of musculoskeletal symptoms. The researchers employed frequency and percentages computations to determine the prevalence of MSDs in the respondents. Chi-square test and logistic regression were utilized to compute the correlation among socio-demographic profiles, teaching variables and MSDs. The reported overall prevalence of musculoskeletal pain was 74.5%, with legs (56.5%) and lower back (56%) having the highest prevalence. Significant differences in the prevalence of MSDs were found between age-groups (P = 0.032) and salary-groups (P = 0.045). Musculoskeletal disorders were prevalent among secondary public school teachers in the Philippines, suggesting that school administrators, curriculum and policy makers, and other stakeholders should improve the working conditions of teachers.

Transcultural validation of the return-to-work self-efficacy scale in Korean patients with work-related injuries

Background

This study aimed to develop a Korean version of the Return-to-Work Self-Efficacy (RTWSE)-19 Scale using forward- and backward-translation and investigate the validity of the RTWSE Scale specifically for Korean workers with work-related injuries.

Methods

Participants were 202 injured workers who had filed a claim accepted by the workers’ compensation system and had received medical rehabilitation at workers’ compensation hospitals following a work-related musculoskeletal injury. Among these participants, 88.1% were male, 54.5% were over 45 years, 45.5% were manufacturing employees, and 54.5% were craft or machine operator and assemblers. The 19 item RTWSE-19 scale was developed by Shaw et al. and have three underlying subscales: (i) meeting job demands, (ii) modifying job tasks, and (iii) communicating needs to others. Statistical analysis included exploratory factor analysis (maximum likelihood estimation with oblique quartimin rotation), internal consistency reliability using Cronbach’s alpha, and correlations with related measures: pain intensity; fear-avoidance beliefs; general health; depression; and general self-efficacy.

Results

Using exploratory factor analysis, three factors with 17 items were identified: meeting job demands, modifying job tasks, and communicating needs to others. The removal of two items in the modifying job tasks domain resulted in an increased reliability. The Korean version of the RTWSE-17 showed reasonable model fit (CFI = .963; TLI = .943; RMSEA = .068; SRMR = 0.029), satisfactory reliability (r = 0.925), no floor and ceiling effect, and construct validity.

Conclusions

The Korean RTWSE-17 scale was found to possess good psychometric properties and could address different injury types ranging from fractures to amputations involved in sub-acute and rehabilitation phases in the Korean context. This study’s findings provide insights for practitioners and researchers to return to work after rehabilitation in a Korean clinical and workplace setting.

Returning to Work After Sick Leave - The Role of Work Demands and Resources, Self-Efficacy, and Social Support

Returning to work after sick leave is a process that begins with the initial steps of functional recovery and results in full vocational capacity. Different personal and situational factors could influence an employee's well-being after returning. The following research was conducted in order to examine how occupational demands and resources, self-efficacy, and social engagement contribute to the return-to-work process. A total of 256 employees took part in the study, who were later divided into two groups: short- (less than 30 days), and long-term (more than 30 days) sick leave. We measured their self-efficacy at the workplace, recent job demands and resources, social engagement, and work satisfaction after returning to work after sick leave. The results showed that personal (gender, age, and self-efficacy), social (social engagement), and occupational (job demands and resources) factors are associated with the duration of sick leave. Participants who were on shorter sick leaves reported being more satisfied with their work after returning than those returning from long-term sick leave. The research presents important insights that could help employers better understand the needs of employees who are returning to work after sick leave.

Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial

Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group's self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10-0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI - 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54-0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

Sickness Absence due to Chronic Musculoskeletal Pain: The Exploration of a Predictive Psychological Model Including Negative Moods, Subjective Health and Work Efficacy in an Adult County Population (The HUNT Study)

The relation between musculoskeletal pain and sickness absence was tested in an adult county population. Maximal explained variance in absence from work due to chronic musculoskeletal pain (sickness absence) was tested in a model in which subjective health was expected to mediate the associations between such pain and dysphoria, respectively, and work efficacy. In turn, work efficacy was expected to mediate the link between subjective health and sickness absence. All the residents in the County of Nord-Trøndelag, Norway, aged 20 and older, were invited to take part in a public health survey during 1995-97 (HUNT-2), and 66,140 (71.2%) participated. Prevalence of musculoskeletal pain, dysphoria, subjective health and work efficacy were assessed, as well as sickness absence last year due to musculoskeletal pain. The model test was performed by use of the LISREL procedure based upon data from 30,158 employees reporting chronic musculoskeletal pain last year. The measurement model fitted the data well: χ2 = 9075, df = 52, p < .0004, Critical N = 1041, RMSEA = 0.038, CFI = 0.99, SRMR = 0.020. The structural model fitted the data equally well, and the best prediction of sickness absence was obtained with lower back pain, upper and lower extremity pain, as well as dysphoria as the primary variables affecting subjective health that, in turn, was the convergent predictor of work efficacy that, finally, best explained the variance in sickness absence (56%). The data supported an indirect sequence of complaint-health-efficacy (CHE-model) as the best predictor of sickness absence due to musculoskeletal pain.

Person-related factors associated with work participation in employees with health problems: a systematic review

PURPOSE

The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems?

METHODS

A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies.

RESULTS

In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation.

CONCLUSIONS

The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.

A pilot study of the individual placement and support model for patients with chronic pain

Background

Individual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients’ experiences with the IPS job support model.

Methods

We recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients’ experiences were investigated through semi-structured interviews 3 months after inclusion in the study.

Results

The participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment.

Conclusions

This is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.

How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury?

Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.

Development of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES) and Validation with Workers Suffering from a Common Mental Disorder or Musculoskeletal Disorder

Introduction Common mental disorders (CMDs) and musculoskeletal disorders (MSDs) lead the list of causes for work absence in several countries. Current research is starting to look at workers on sick leave as a single population, regardless of the nature of the disease or accident. The purpose of this study is to report the validation of the Return to Work Obstacles and Self-Efficacy Scale (ROSES) for people with MSDs and CMDs, based on the disability paradigm. Methods From a prospective design, the ROSES' reliability and validity were investigated in a Canadian sample of workers on sick leave due to MSDs (n = 206) and CMDs (n = 157). Results Exploratory and confirmatory factor analyses revealed that 46 items spread out on 10 conceptual dimensions (e.g., Fears of a relapse, Job demands, Difficult relation with the immediate supervisor), with satisfactory alpha coefficients and test-retest reliability for all subscales. Finally, several dimensions of ROSES also predict the participant's RTW within 6 months for MSDs (e.g., job demands), and CMDs (e.g., difficult relation with the immediate supervisor), even when adjusted by several variables (e.g., age, severity of symptoms). Apart from the job demands dimension, when the ROSES dimension is more external to the individual, only the perception of obstacles remains significant to predict RTW whereas it is the opposite result when the dimension is more internal (e.g., fears of a relapse). Conclusion The ROSES demonstrated satisfactory results regarding its validity and reliability with people having MSDs or CMDs, at the time of the return-to-work process.

Factors associated with return to work among people on work absence due to long-term neck or back pain: a narrative systematic review

OBJECTIVE

The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain.

METHODS

A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category.

RESULTS

Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW.

CONCLUSIONS

Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.

WITHDRAWN: Functional capacity evaluations for the prevention of occupational re-injuries in injured workers

This review did not find any studies to include in 2010. Systematic searches have not revealed any new studies having been published up to November 2015. As the current author team cannot commit to updating the review and as we haven’t found new authors keen to take on the task, we decided to withdraw this review.

The editorial group responsible for this previously published document have withdrawn it from publication.

Measures of patients' expectations about recovery: a systematic review

INTRODUCTION

Patients' expectations regarding their prognosis has been shown to affect recovery. We completed a systematic review to identify measures that assess patients' expectations of recovery.

METHODS

Eligible studies explored the association between patients' expectations of recovery, and return to work or claim resolution. We searched electronic databases (MEDLINE and PSYCInfo) from inception to June 21, 2014, bibliographies of eligible studies, relevant systematic reviews and our personal files. Reviewers determined study eligibility and study quality, and completed data extraction.

RESULTS

Of 14,509 unique citations, 46 studies were eligible with majority of the studies (n = 27; 59 %) rated as low quality, primarily due to substantial missing data and inappropriate adjustment for age, gender and illness severity in their regression models. We identified 5 measures and 41 individual items assessing recovery expectations. Three of seven (43 %) studies using a measure to assess recovery expectations reported psychometric properties, with only one reporting both reliability and construct validity. Only two measures (Expectations of Recovery Scale and the Work-related Recovery Expectations Questionnaire) were externally validated in different populations. Overall, 44 (96 %) studies found that patient recovery expectations was a significant predictor of return to work or sick leave/disability claim resolution.

CONCLUSIONS

Very few studies assessing recovery expectations use a psychometrically valid measure. Current evidence suggests that patients with lower recovery expectations are less likely to resolve their disability claim or return to work versus patients with higher recovery expectations. Further validation of existing measures for assessing patient recovery expectations, or development of a new measure that addresses the limitations of existing ones, is required.

Psychometric properties of the readiness for return to work scale in inpatient occupational rehabilitation in Norway

AIM

To investigate internal consistency and construct validity of the Readiness for return to work (RTW) scale in a sample participating in a Norwegian inpatient occupational rehabilitation program.

METHODS

A cross-sectional study was conducted on baseline measures from a prospective cohort study evaluating a 5 days inpatient occupational rehabilitation program. The participants in the program were 18-67 years, on sickness absence or at risk of sickness absence (N = 193). The Readiness for RTW scale, sociodemographic-, work- and health-related questionnaires were answered by the participants on their first day in the program. Statistical analysis included exploratory factor analyses, reliability analyses and correlations with related instruments.

RESULTS

In the scale for those not working (N = 124) two factors were found, representing (1) RTW inability and (2) RTW uncertainty. These factors corresponded to the precontemplation and contemplation stages in a previous Canadian study. The original prepared for action stages were not identified in this sample. In the scale for those working shortly before the program (N = 60) two factors were identified, representing (1) Uncertain work maintenance and (2) Proactive work maintenance, comparable to the stages in the Canadian study. The factors had satisfactory internal consistency (Cronbach's alpha >0.7), except for proactive work maintenance (Cronbach's alpha = 0.59). Expected relationships were found between the readiness for RTW stages and the pain stages of change, fear avoidance beliefs for work, subjective health complaints, decision control and coping at work.

CONCLUSION

Internal consistency and construct validity of the readiness for RTW stages found were satisfactory, except for proactive work maintenance. The results indicate that the construct of readiness for RTW may vary by culture and patient setting.

Early multidisciplinary assessment was associated with longer periods of sick leave: a randomized controlled trial in a primary health care centre

OBJECTIVE

To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre.

DESIGN

Randomized controlled trial.

SETTING

Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to "standard care". The therapists used methods and tools they normally use in their clinical work.

MAIN OUTCOME MEASURE

Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave. Results. At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).

CONCLUSIONS

In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.

The impact and burden of chronic pain in the workplace: a qualitative systematic review

BACKGROUND

Chronic pain (CP) poses a diverse and substantial burden for employees, employers, and society. The deleterious consequences of CP in the workplace are frequently underestimated.

OBJECTIVE

To estimate the burden of CP in the European workplace.

METHODS

A systematic review following PRISMA statement guidelines was conducted to identify studies reporting work-related outcomes for people with CP. EMBASE, MEDLINE, EconLit, and Cochrane Library databases were searched up to 18th August 2010.

RESULTS

We identified 91 observational studies. Few were specifically designed to investigate the association between CP, productivity, and employment. The focus for this review was studies clearly reporting outcomes relating to the burden of CP on employment status (n = 37), sickness absence (absenteeism, n = 47), and loss of productivity because of reduced ability at work (presenteeism, n = 8).

CONCLUSION

The body of evidence identified from the systematic review indicates that CP has a substantial negative impact on work-related outcomes, supporting the importance of interventions to reduce the burden of CP. Well-designed prospective studies specifically assessing the direct consequences of CP on employment are needed to confirm these findings.

Functional capacity evaluations for the prevention of occupational re-injuries in injured workers

BACKGROUND

Functional capacity evaluation (FCE) has been widely used to assess workers' physical state of readiness to return to work (RTW) after an injury and to make recommendations for the time and capacity in which they might return. FCEs are also used to prevent re-injury after RTW. Despite being a commonly used tool, little is known about how effective FCE is in preventing occupational injuries.

OBJECTIVES

To assess the effectiveness of FCE-based return to work recommendations in preventing occupational re-injuries of injured workers compared with no intervention or alternative interventions.

SEARCH STRATEGY

We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1980 to December 2009), PsycINFO (1983 to December 2009) and PEDro (1929 to December 2009). The searches were not restricted by date, language or type of publication.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of FCE-based return to work recommendations for preventing occupational re-injuries in injured workers.

DATA COLLECTION AND ANALYSIS

Four authors (NM, ES, JV, ML), in pairs, independently selected studies for inclusion, extracted data and assessed risk of bias.

MAIN RESULTS

We found no studies that compared FCE to no intervention. We found one RCT with 372 participants in which a short-form of one FCE was compared to the standard long-form FCE (Isernhagen Work Systems). Outcomes were recurrence rates of re-injuries. There was no significant difference between the two forms of FCE.We rated the overall quality of the evidence as low.

AUTHORS' CONCLUSIONS

There is no evidence for or against the effectiveness of FCE compared to no intervention. A short version of FCE showed similar effectiveness to a long version in preventing re-injury. More RCTs are needed.

The feasibility of a web-based counselling program for occupational physicians and employees on sick leave due to back or neck pain

Background

The objective of this feasibility study was to gain insight into occupational physicians' (OPs) and employees' use of, and attitudes towards, 'Snelbeter' (Get Well Fast), a new web-based counselling program for employees on sick leave due to non-specific back or neck pain and their OPs.

Methods

Registered user information was collected from the website to get insight in the use of the program by employees (n = 24). Qualitative information was obtained through semi-structured in-depth interviews with 19 OPs and nine employees in order to get insight in the actual use of the provided information, the attitudes towards the program and possible improvements of the program.

Results

Actual use of the program among OPs was low. The majority of OPs, eight out of 11 (73%), never or only occasionally signed in. The greatest obstacle for OPs to use the program was the low number of eligible employees involved. Employees appreciated the program but their use was moderate. A small majority of the employees who used the program, 14 out of 24 (58%), opened 50% to 100% of the provided documents, a majority of the interviewed employees, seven out of nine (78%), used the provided information sometimes or regularly. The absence of personal contact was found to be a major barrier towards use of the program by employees.

Conclusion

Although both OPs and employees appreciated the idea of the program and employees appreciated using it, program utilization was moderate to low. The discussion section reveals that before implementation can be started to any extent, the program will need adaptations that make it more attractive to use. The program should be considered for both return to work (RTW) and the prevention of sick leave. Adding personal contact (e.g. involving physiotherapists) to the program may also be promising.

The prevalence of work-related stress, and its association with self-perceived health and sick-leave, in a population of employed Swedish women

BACKGROUND

Women report more occupational ill-health and are more sick-listed than men. Exploration of women's working conditions would therefore seem to be valuable. In this study we investigated the prevalence of work-related stress and its association with self-perceived health and sick-leave in a population of employed, working Swedish women.

METHODS

This cross-sectional population study comprised 424 employed, working women who answered questionnaires on work-related stress, self-perceived health and sick-leave. The odds ratio (OR) with 95% confidence interval (CI) was calculated in order to analyse the association between the exposure variables of work-related stress and outcome variables of ill-health symptoms, self-rated health and sick-leave.

RESULTS

Ten percent of the group reported high perceived stress owing to indistinct organisation and conflicts, and 25% high perceived stress owing to individual demands and commitment. Twenty-two percent reported low influence at work and 33% reported work interference with leisure time. All categories of overall work-related stress were significantly associated with increased odds of high level of illness symptoms, with the highest OR for high perceived stress owing to indistinct organisation and conflicts and high perceived stress owing to individual demands and commitment with an OR of 3.17 (CI = 1.51-6.62) and 4.53 (CI = 2.71-7.56) respectively. High perceived stress owing to indistinct organisation and conflicts and low influence at work were significantly associated with sick-leave with an OR of 3.85 (CI = 1.59-9.30) and 2.54 (CI = 1.17-5.48) respectively.

CONCLUSION

This study showed an association between, on the one hand, work-related stress, and on the other hand, illness symptoms and sick-leave. Distinguishing between the occurrence of negative work characteristics, and the immediate perception of stress because of these, resulted in a broad view of women's working conditions and expanded knowledge of work-related stress in women.

Self-efficacy and self-care: missing ingredients in health and healthcare among adults with serious mental illnesses

To help inform the design of a self-management intervention for improving the physical health of adults with serious mental illnesses, we conducted focus groups about their perceived medical care and physical health needs. Adults with serious mental illnesses participated in four semi-structured focus groups conducted at a transitional living facility, a social club, and a Hispanic outpatient mental health clinic. Questions included their recent experiences of seeking medical care, the effect of having a mental illnesses diagnosis, strategies for active self-care, and perceived barriers to better physical health. In addition to various systemic barriers to better medical care, participants articulated limited knowledge and self-efficacy regarding active self-management of their physical health. Despite their interest in learning more about health promotion, most participants expressed a sense of personal futility and powerlessness in improving their health. These data suggest that any effort to improve the wellbeing of these adults will need to address self-efficacy in the hope of improving self-care for their physical health needs.