What employees with rheumatoid arthritis, diabetes mellitus and hearing loss need to cope at work

The audiological rehabilitation of workers with hearing loss in the UK: a qualitative study of workers' perspectives

PURPOSE

Unaddressed hearing loss can adversely affect employment and day-to-day work-life. Efficient and effective audiology support can help optimise hearing in the workplace. This study explores the audiological rehabilitation experiences of workers with hearing loss (WHL).

MATERIALS AND METHODS

Twenty-four WHL with experience of a wide range of audiology services across the UK participated in semi-structured interviews. Interviews were analysed using inductive thematic analysis.

RESULTS

Three main themes were generated: Theme 1: mixed experiences with audiology services (subdivided into two subthemes and four sub-subthemes). Theme 2: audiology role in work support (subdivided into three subthemes). Theme 3: "I think support could be improved if…" (subdivided into two subthemes).

CONCLUSION

The audiological rehabilitation for working-age adults with hearing loss needs improvements to deliver sufficient support and quality care. Some of the barriers to having better-functioning hearing healthcare require fundamental standards in healthcare quality, such as access to services, staff (including audiologists) deaf awareness, information and technology support, and personalised care that considers work-life needs. Further research is required to evaluate the feasibility and cost-effectiveness of improvements, such as support that extends beyond hearing aid care, whether from audiology or non-audiology services.

The costs of chronic pain-Long-term estimates

BACKGROUND

Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain.

METHODS

The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence.

RESULTS

In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss.

CONCLUSION

Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain.

SIGNIFICANCE

This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.

"But at a certain point, the lights literally went out": A qualitative study exploring midlife women's experiences of health, wellbeing, and functioning in relation to paid work

BACKGROUND

In the Netherlands, the fact that midlife women constitute a considerable segment of the working population is relatively new. Generally paid work contributes to midlife women's wellbeing, but they also report health challenges, such as work-related fatigue and the menopause.

OBJECTIVE

The objective of this study is to understand how midlife women themselves perceive their health, wellbeing, and functioning in relation to paid work.

METHODS

In this exploratory qualitative study, 28 women participated in five ethnically homogeneous focus group discussions (FGDs). De FGDs were recorded, transcribed verbatim, and thematically analyzed using MAXQDA.

RESULTS

We identified exhaustion as central to our analysis. During midlife, exhaustion seems to occur once a certain limit has been reached, both physically and mentally, with women feeling to have reached the end of their rope. Besides obvious physiological challenges, we identified two major themes in which we discuss challenges both in paid work and private life: (1) work environment and working conditions, and (2) burdens in private life. Participants took various measures to manage and try to reduce exhaustion, including finding a new job or negotiating different job tasks, and reducing work hours.

CONCLUSION

This study indicates that the extent to which women experience exhaustion is associated with challenges in both paid work and private life. The underlying processes do not seem to reflect individual problems, but reflect a complex set of factors at the structural level. Nevertheless, women take several individual measures to reduce their exhaustion, including reducing their participation in paid work.

Psychosomatic Features, Compliance and Complementary Therapies in Rheumatoid Arthritis

This review highlights the issue of psychosomatic conditions in rheumatoid arthritis, paying special attention to new researches and trends in this field. Emerging concepts in all the major parts of the problem are covered consecutively, from the impact of chronic musculoskeletal pain on the emotional state to disease influence over quality of life, socio-psychological, and interpersonal relationships. Chronic pain is closely related to emotional responses and coping ability, with a pronounced positive effect of psychotherapeutic interventions, family and social support on it. Psychosexual disorders, anxiety, depression also commonly coexist with rheumatoid arthritis, leading to further decrease in quality of life, low compliance, and high suicide risk. Influence of psychosomatic conditions on the overall treatment effect is usually underestimated by rheumatologists and general practitioners. Psychosomatic considerations are of great importance for up-to-date management of rheumatoid arthritis, as they strongly influence the quality of life, compliance, and thereby disease outcomes. Two major approaches of psychological rehabilitation exist, both coping with pain through the regulation of emotion and psychotherapeutic intervention, which not only helps patients in coping with the disease, but also aimed at improving the overall adaptation of the patient. It includes techniques of relaxation, cognitive-behavioral therapy, and biofeedback therapy. Current data about the efficacy of the additional correcting therapies for patients with rheumatoid arthritis, both emerging and common ones, are discussed in the review.

Key findings about hearing loss in the working-life: a scoping review from a well-being perspective

OBJECTIVE

This scoping review investigated key findings about hearing loss (HL) in the working life (WL) from a well-being perspective.

DESIGN

A scoping review protocol was used to search the literature and to explore and extract key findings. A narrative analysis of key findings was used to group the data into themes. Study sample: Fifty-three articles from 29 different journals were included in the analysis.

RESULTS

The narrative analysis identified three broad themes; individual aspects, work environment and work organisation. Individual aspects concerned problems that workers with HL experienced in their working lives, strategies they used to manage their working lives and different aspects of health in relation to WL. Work environment focussed on the physical, organisational and social work environment. Work organisation identified aspects related to division of labour and employment status.

CONCLUSIONS

Several of the included papers revealed lots of findings but did not substantially discuss the findings from a WL perspective. HL and well-being in WL is a multidimensional phenomenon due to the interplay between the individual and the environment. This interplay is rarely discussed in the included papers. Furthermore, intersectional aspects are infrequently highlighted and need to be further explored in future research.

Factors influencing the need for recovery in employees with hearing loss: a cross-sectional study of health administrative data

Objective

Need for recovery is a predictor of work stress and health problems, but its underlying factors are not yet well understood. We aimed to identify hearing-related, work-related, and personal factors influencing need for recovery in hearing-impaired employees.

Methods

We retrospectively identified hearing-impaired employees (N = 294) that were referred to the Amsterdam University Medical Center between 2004 and 2019. Routinely obtained healthcare data were used, including a survey and hearing assessments. A directed acyclic graph was constructed, revealing the hypothesized structure of factors influencing need for recovery as well as the minimal set of factors needed for multiple regression analysis.

Results

Four variables were included in the regression analysis. In total, 46.1% of the variance in need for recovery was explained by the factors feeling that something should change at work (B = 19.01, p < 0.001), self-perceived listening effort (B = 1.84, p < 0.001), personal adaptations scale score (B = − 0.34, p < .001), and having a moderate/poor general health condition (B = 20.06, p < 0.001). Although degree of hearing loss was associated with self-perceived listening effort, the direct association between degree of hearing loss and need for recovery was not significant.

Conclusions

The results suggest that the way employees perceive their hearing loss and how they cope with it directly influence need for recovery, rather than their measured degree of hearing loss. Additionally, general health condition was found to be an independent factor for need for recovery. The results should be confirmed by future, longitudinal research.

Trends in working conditions and health across three cohorts of older workers in 1993, 2003 and 2013: a cross-sequential study

Background

Over the past decades, the number of older workers has increased tremendously. This study examines trends from 1993 to 2013 in physical, cognitive and psychological functioning among three successive cohorts of Dutch older workers. The contribution of the changes in physical and psychosocial work demands and psychosocial work resources to change in functioning is examined. Insight in health of the older working population, and in potential explanatory variables, is relevant in order to reach sustainable employability.

Methods

Data from three cohorts (observations in 1993, 2003 and 2013) of the Longitudinal Aging Study Amsterdam (LASA) were used. Individuals aged 55–65 with a paid job were included (N = 1307). Physical functioning was measured using the Timed Chair Stand Test, cognitive functioning by a Coding Task and psychological functioning by the positive affect scale from the CES-D. Working conditions were deduced from a general population job exposure matrix. Linear and logistic regression analyses were performed.

Results

From 1993 to 2013, time needed to perform the Timed Chair Stand Test increased with 1.3 s (95%CI = 0.89–1.71), to a mean of 11.5 s. Coding Task scores increased with 1.7 points (95%CI = 0.81–2.59), to a mean of 31 points. The proportion of workers with low positive affect increased non-significantly from 15 to 20% (p = 0.088). Only the improvement in cognitive functioning was associated with the change in working conditions. The observed decrease of physically demanding jobs and increase of jobs with higher psychosocial resources explained 8% of the improvement.

Conclusions

Changes in working conditions may not contribute to improved physical and psychological functioning, but do contribute to improved cognitive functioning to some extent. Further adjustment of physical work demands and psychosocial work resources may help to reach sustainable employability of older workers.

Willingness to pay for flexibility at the workplace for people with diabetes and chronic disease: a discrete choice experiment in a population of workers in Denmark

Background

The number of people of working age suffering from chronic disease is increasing. Chronic diseases such as diabetes can cause negative work-related consequences in the form of early retirement or absenteeism. Providing flexible workplace accommodations may enable the person with diabetes to retain their position in the labor market. However, the successfulness of such accommodations depends largely on the perceptions of those not suffering from diabetes. The purpose of this study was to examine preferences of a population of workers in Denmark for flexibility at the workplace, for people with diabetes and for people with chronic disease in general, measured as their willingness to pay (WTP).

Methods

Respondents were drawn from online panels and randomized to answer an online survey regarding flexibility at the workplace for people with diabetes or chronic disease in general. One thousand one hundred and three respondents were included in the analysis. Based on discrete choice experiments included in the survey, we analyzed WTP for five flexibility attributes: part-time, customizing job description, additional break with pay and time off for medical visits with and without pay. We further examined perceptions of the employer’s responsibility to ensure workplace flexibility for five different specific chronic diseases including diabetes. Finally, we analyzed differences in WTP for flexibility across subgroups.

Results

Respondents’ WTP was significantly higher for chronic disease in general compared to diabetes for the possibility of part-time (81€/month vs. 47€/month, p < 0.001) and customizing job description (58€/month vs. 41€/month, p = 0.018) attributes, as well as for the overall average (49€/month vs. 36€/month, p = 0.008). Ensuring workplace flexibility for patients with a specific chronic disease other than diabetes (cancer, heart disease, arthritis and COPD) was to a higher degree considered a responsibility of the employer. Average WTP for flexibility varied across subgroups, consistently yielding a larger amount for chronic disease in general.

Conclusions

The population examined in this study are willing to pay less for flexibility at the workplace for people with diabetes compared to people with chronic disease in general. This finding was evident in terms of specific flexibility attributes and on average across subgroups.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6919-6) contains supplementary material, which is available to authorized users.

Ototoxicity: Visualized in Concept Maps

Ototoxicity refers to the damage to structures and function of the auditory-vestibular system caused by exogenous agents such as pharmaceuticals, chemicals, and ionizing radiation. There are many potentially ototoxic substances. For example, depending on how ototoxicity is defined, there are 200 to 600 medications that can cause damage to hearing and/or balance. Ototoxicity encompasses cochleotoxicity, vestibulotoxicity, and neurotoxicity. A variety of professional disciplines are involved in determining causation, prevention, and management of ototoxic effects. Research to identify and develop otoprotectants and otorescue agents is emerging and will translate basic scientific discovery into applications for use in hearing conservation programs, safety operations, and clinical care. Original concept maps are presented here to visually represent knowledge pathways, domains, and relationships essential to the understanding of ototoxicity.

Relations Between Psychosocial Job Characteristics and Work Ability in Employees with Chronic Headaches

Purpose The aim of the study was to determine (a) to which extent job demands and job resources predict work ability in employees with chronic headaches, and (b) whether work ability in these employees is more hampered by high demands and more enhanced by resources than in employees without chronic disease. Methods All employees with chronic headaches (n = 593) and without chronic disease (n = 13,742) were selected from The Netherlands Working Conditions Survey conducted in 2013. This survey assessed amongst others job characteristics and various indicators of work ability, i.e. sick leave, employability, work engagement, and emotional exhaustion. Hierarchical regression analyses were conducted for employees with chronic headaches and compared to employees without chronic disease, controlling for age, gender and educational level. Results In employees with chronic headaches higher quantitative and emotional demands contributed to higher emotional exhaustion, and higher emotional demands to higher sick leave. Higher cognitive demands were however associated with higher work engagement. Higher autonomy was related to higher employability and lower emotional exhaustion. Higher supervisor and colleague support was associated with higher employability, higher engagement and lower emotional exhaustion. Higher supervisor support was associated with lower sick leave. Supervisor support emerged as a stronger predictor for emotional exhaustion in the employees with chronic headaches than in the employees without chronic disease. Conclusions Job demands and job resources are important for work ability in employees with chronic headaches. Furthermore, results suggest that these employees benefit more strongly from supervisor support than employees without chronic disease.

Value of work for employees with a chronic disease

Background

Most people with a chronic disease value participation in work. Knowledge is limited, however, as to what extent employees with a chronic disease value participating in work, and the main reasons for this. Limited research is available on which specific factors contribute to the perceived value of work.

Aims

To evaluate main reasons for, and the extent to which employees with a chronic disease value participation in work, and factors which motivate or demotivate employees in work.

Methods

A survey of members of three large patient federations was performed. Respondents had a chronic disease and were of working age. The extent and reasons for valuing work were analysed using descriptive statistics; (de)motivating aspects were qualitatively analysed using specific software.

Results

The 1683 respondents valued work with an average of 8 on a scale from 1 to 10 (1: 'work is not at all important to me' and 10: 'work is extremely important to me'). Most frequent reported reasons for valuing work were the provision of income, social contact and the ability to contribute to society. Motivational aspects for work were being financially independent, having positive social contact with colleagues or clients and having the ability to contribute to society. In contrast, negative social contact, performing useless work and having little autonomy demotivated people.

Conclusions

Employed people with a chronic disease generally value work, mainly because it makes them financially independent, provides social contact and enables them to contribute to society.

The Physiologic and Psychophysical Consequences of Severe-to-Profound Hearing Loss

Substantial loss of cochlear function is required to elevate pure-tone thresholds to the severe hearing loss range; yet, individuals with severe or profound hearing loss continue to rely on hearing for communication. Despite the impairment, sufficient information is encoded at the periphery to make acoustic hearing a viable option. However, the probability of significant cochlear and/or neural damage associated with the loss has consequences for sound perception and speech recognition. These consequences include degraded frequency selectivity, which can be assessed with tests including psychoacoustic tuning curves and broadband rippled stimuli. Because speech recognition depends on the ability to resolve frequency detail, a listener with severe hearing loss is likely to have impaired communication in both quiet and noisy environments. However, the extent of the impairment varies widely among individuals. A better understanding of the fundamental abilities of listeners with severe and profound hearing loss and the consequences of those abilities for communication can support directed treatment options in this population.

The Effectiveness of a Vocational Enablement Protocol for Employees With Hearing Difficulties: Results of a Randomized Controlled Trial

The aim of this study was to evaluate the effectiveness of a vocational enablement protocol (VEP) on need for recovery (NFR) after work as compared with usual care for employees with hearing difficulties. In a randomized controlled trial design, 136 employees with hearing impairment were randomly assigned to either the VEP or the control group. VEP is a multidisciplinary program integrating audiological and occupational care for individuals experiencing difficulties in the workplace due to hearing loss. The primary outcome measure was NFR. Secondary outcome measures were communication strategy subscales (e.g., self-acceptance and maladaptive behavior), distress, and self-efficacy. Data were collected using questionnaires at baseline and at 3, 6, 9, and 12 months follow-up. No significant difference over the complete follow-up period was found between the intervention and control group for NFR. However, we observed a significant difference for one of the secondary outcomes after 12 months. “Self-acceptance” increased significantly in the VEP group, compared with the controls. The mean difference between the two groups was small, being only 0.24 (95% CI [0.04, 0.44]) on a scale of 1 to 5. The results do not support the use of VEP if the aim is to reduce NFR after work at 12 months follow-up. It may be that NFR does not adequately capture what is covered in the VEP. Although marginal, the effect on self-acceptance was significant. This is encouraging given that positive effects on self-acceptance have rarely been shown for audiological rehabilitation programs. Suggestions for further improvement of the VEP are discussed.

Fatigue and depressive symptoms improve but remain negatively related to work functioning over 18 months after return to work in cancer patients

Purpose

The aims of this study are to investigate the course of work functioning, health status, and work-related factors among cancer patients during 18 months after return to work (RTW) and to examine the associations between these variables and work functioning over time.

Methods

Data were used from the 18-month longitudinal “Work Life after Cancer” (WOLICA) cohort, among 384 cancer patients who resumed work. Linear mixed models were performed to examine the different courses during 18-month follow-up. Linear regression analyses with generalized estimating equations (GEE) were used to examine the associations and interactions.

Results

Cancer patients reported an increase of work functioning and a decrease of fatigue and depressive symptoms in the first 12 months, followed by a stable course between 12 and 18 months. Cognitive symptoms were stable during the first 18 months. Working hours increased and social support decreased during the first 6 months; both remained stable between 6 and 18 months. Fatigue, depressive, and cognitive symptoms were negatively associated with work functioning over time; working hours and supervisor social support were positively associated.

Conclusions

Interventions to improve cancer patients’ work functioning over time might be promising if they are aimed at reducing fatigue, depressive symptoms, cognitive symptoms, and encouraging supervisor social support.

Implications for Cancer Survivors

It is important to monitor cancer patients not only in the period directly after RTW but up to 18 months after RTW, allowing for timely interventions when needed.

Swimming Against the Current: A Qualitative Review of the Work Experiences and Adaptations Made by Employees With Arthritis

OBJECTIVE

To describe the experiences and strategies of employees with arthritis to maintain employment, and to use this information to build a conceptual model.

METHODS

We conducted a systematic review of qualitative studies that examined the work experiences of employees with arthritis. Published studies on arthritis and employment were searched from electronic databases (1980-2017) and bibliographic reviews of relevant studies. We used meta-ethnography to synthesize the findings.

RESULTS

We reviewed 17 studies that reported on the experiences of 873 employees. We identified 11 main themes that highlight common issues experienced by employees with arthritis and grouped these into 4 higher-order categories: changing nature of the disease (emotional issues, cognitive struggles, unpredictable physical symptoms), intrapersonal issues (personal meaning of work, preserving a work identity), interpersonal issues (managing disclosure, gaining coworker support, organizational culture issues), and work-sustainability strategies (making personal adjustments, using social support, using workplace accommodations). Using these themes, we developed the Job Sustainability Model to illustrate how disease, personal, and work-related factors interact to influence what type of coping behaviors are used and when. Initially, employees with arthritis rely on making personal adjustments, using social support, and medical intervention. However, when these coping behaviors fail to be effective, they draw upon workplace accommodations and resources.

CONCLUSION

Arthritis disrupts an employee's work life by impairing his or her capacity to be a productive worker. Our results highlight how employees with arthritis make strategic adaptations to maintain a productive work life for as long as possible. The findings of this study have implications for work-related interventions aimed at preserving employment.

Perspectives of People with a Chronic Disease on Participating in Work: A Focus Group Study

Purpose To explore solutions that people with a chronic disease use to overcome difficulties they experience regarding participating in work, and the support they require to identify or implement these solutions. Methods Focus groups were held to explore solutions and support requirements of people with a chronic disease. Participants were recruited through a research institution's patient panel, a patient federation and personal networks. Analysis was conducted by means of open and selective coding, using the MAXQDA software package. Results Five focus groups were held with 19 participants with different chronic diseases. Solutions that were identified included learning to accept and cope with the disease, which is frequently supported by family and friends. Disclosing the disease to employers and colleagues, identifying active ways to help with duties, and implementing adaptations to the work environment were all effective solutions with the help, empathy and understanding of people in the work environment. Solutions mostly supported by patient associations included providing sufficient information about the disease, relevant help and protective legal regulations regarding work participation. Finally, health professionals could support solutions such as incorporating periods of rest, promoting self-efficacy and gaining insight into an individual's ability to participate in work. Conclusions People with a chronic disease suggested various solutions that can help overcome difficulties surrounding participating in work. Support from friends and family, patient associations, employers, colleagues and occupational health professionals is needed to help identify and implement suitable solutions.

A systematic review of workplace disclosure and accommodation requests among youth and young adults with disabilities

PURPOSE

The objective of this systematic review is to critically appraise the literature on disability disclosure and workplace accommodations for youth and young adults with disabilities.

METHODS

Systematic searches of nine international databases identified 27 studies meeting our inclusion criteria. These studies were analyzed with respect to the characteristics of the participants, methodology, results of the studies and the quality of the evidence.

RESULTS

Among the 27 studies, 18,419 participants (aged 14-33, mean 23.9 years) were represented across seven countries. Barriers to disability disclosure and requests for workplace accommodations were found at the individual (i.e., disability type, severity, poor self-concept, and advocacy skills), employment (i.e., type of industry, and working conditions, lack of supports), and societal levels (i.e., stigma/discrimination). Facilitators of disability disclosure included individual factors (i.e., knowledge of supports and workplace rights, self-advocacy skills), employment (i.e., training/supports, effective communication with employers, realizing the benefits of accommodations), and societal factors (i.e., positive attitudes toward people with disabilities). There was little consensus on the processes and timing of how disability should be discussed in the workplace among youth with disabilities.

CONCLUSIONS

Our findings highlight the complexities of disability disclosure for youth with disabilities. More studies are needed to explore issues of workplace disclosure and accommodations for young people to improve disclosure strategies and the process of providing appropriate accommodations. Implications for Rehabilitation Clinicians, educators, and parents should support youth to become self-aware and build self-advocacy skills so they can make an informed decision about how and when to disclose their condition to employers. Clinicians, educators, and employers should help youth with disabilities to understand the benefits of disclosing their disability, and educate them on the supports available so they can remain healthy and productive in the workplace. Clinicians should advocate for employers to create a positive and supportive environment where youth feel comfortable disclosing their condition.

What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review

BACKGROUND

Self-management support is essential to perform self-management behavior. To provide this support in an effective way, insight in the needs for self-management support is necessary.

OBJECTIVE

To give an overview of self-management support needs from the perspective of rheumatoid arthritis patients to help nurses to improve self-management.

DESIGN

We conducted a scoping review for the period of January 2002 to May 2013 using the following inclusion criteria: (1) studies on adult patients aged 18 years and older, (2) studies from the perspective of rheumatoid arthritis patients, (3) studies reporting results on support needs, and (4) empirical studies using any design.

DATA SOURCES

We searched in PubMed, CINAHL, and PsycINFO.

REVIEW METHODS

Following the steps of a scoping review, we (1) identified the research question, (2) identified relevant studies, (3) selected studies, (4) charted the data, and (5) collated, summarized, and reported results. We incorporated the optional sixth step of consultation of a multidisciplinary panel of professionals and patients to validate our findings.

RESULTS

Seventeen articles were included. Our review shows that rheumatoid arthritis patients have informational, emotional, social and practical support needs. We found an information need for various topics, e.g. exercises and medication. Patients express a need for emotional support in daily life, given through other RA patients, colleagues and supervisors and nurses. For information needs, emotional and social support it is important that it is tailored to the individual needs of the patient.

CONCLUSION

The most important support needs for self-management mentioned by rheumatoid arthritis patients are more informational, social and practical support and emotional support. Considering patients' perspective as a starting point for delivering support for self-management can lead to the development of nursing interventions tailored to the needs of rheumatoid arthritis patients.

Development of a self-management intervention for employees with complaints of the arm, neck and/or shoulder (CANS): a focus group study with experts

Background

Many people suffer from complaints of the arm, neck and/or shoulder (CANS). The complaints are persistent and there is a need for intervention programs for those with longstanding CANS. Studies suggest that a behavioural change is needed in employees with CANS. A self-management program with an add-on eHealth module might be an effective option to achieve the behavioural change needed to manage the complaints in employees with CANS. The aim of this study was to determine the content and strategies of the intervention and to gain insight into possible barriers and facilitators for implementation. Therefore, we examined the views of experts on the problems and characteristics associated with employees with CANS as well as their opinion on a self-management program consisting of self-management sessions and an eHealth module.

Methods

A qualitative study was performed consisting of three focus groups involving a total of 17 experts (with experience with CANS, self-management and/or eHealth interventions). Experts were asked their opinion about the content and requirements of a self-management program for employees with CANS, including an eHealth module. Data were analysed using qualitative data analysis. After coding, the emergent themes were used to organise the data into main categories, expressing the ideas and opinions of experts on CANS, self-management and/or eHealth interventions.

Results

The experts pointed out that the intervention should focus on increasing employees’ self-efficacy and empowerment, and address topics related to the possible risk factors for CANS, symptoms, work environment, social environment and personal factors. The eHealth module should be self-explanatory and attractive, and the information provided should be brief, clear and concise.

Conclusions

Experts appeared to see a role for a self-management program for employees with CANS. They indicated that the combination of group sessions and eHealth can work well. Experts provided valuable information with regard to the content of the self-management intervention and the design of the eHealth module.

Quality of working life issues of employees with a chronic physical disease: a systematic review

PURPOSE

To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease.

METHODS

A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software.

RESULTS

From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability.

CONCLUSION

This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.

Impact of end-stage kidney disease on academic achievement and employment in young adults: a mixed methods study

PURPOSE

Young adult kidney patients are at an important stage of development when end-stage kidney disease (ESKD) may adversely influence progress in education and employment. This study is designed to assess the impact of ESKD on education and employment outcomes in young adults.

METHOD

This cross-sectional study was a mixed methods design. Education and career achievements in young adults with ESKD were recorded quantitatively using a questionnaire survey (n = 57): 14 of 57 representative participants were subsequently selected for semistructured interview.

RESULTS

Questionnaire survey was conducted in 57 young adults (median age 25): 8.8% (n = 5) were predialysis; 14.0% (n = 8) dialysis; and 78.9% (n = 45) were kidney transplant recipients. Median school-leaving age was 16 (interquartile range = 15-19). Of 57 young adults, 10 (17.5%) were still studying, 43 (75.4%) had completed education, 34 (59.7%) were employed (23 full time and 11 part time), and 19 (33.3%) were unemployed. Twenty-seven of 45 transplanted patients were employed (60.0%). Of these 27, 21 were full time (77.8%). Five of eight dialysis patients were employed: only one of eight was full-time employed (12.5%). Themes impacting on education and employment included low energy levels, time missed, loss of self-esteem, and feelings of loneliness and isolation, which may progress to depression and recreational drug use. Lack of understanding from educators and employers resulting in lost work, and career ambitions changed or limited because of dialysis.

CONCLUSIONS

Dialysis has a major negative impact on education and reduced employment rates of young adults. There is a general lack of understanding among educators and employers of the impact of ESKD. Low energy levels, lack of self-esteem, and depression are key factors. There is a need for health care providers to recognize this issue and invest in supporting young adults with ESKD.

Developing a service user informed intervention to improve participation and ability to perform daily activities in primary Sjögren's syndrome: a mixed-methods study protocol

INTRODUCTION

A significant proportion of patients with primary Sjögren's syndrome (PSS) is functionally impaired and experience difficulties participating in various aspects of everyday life. There is currently no evidence of efficacy for non-pharmacological interventions aimed specifically at supporting the patients with PSS to improve their participation and ability to perform daily activities. This paper describes a research protocol for a mixed-methods study to develop an intervention to improve these outcomes. The protocol follows the Medical Research Council framework for complex interventions.

METHODS AND ANALYSIS

We will use group concept mapping with the patients, adults who live with them and healthcare professionals to identify factors which prevent people with PSS from participating in daily life and performing daily activities. The factors will be prioritised by participants for importance and feasibility and will inform an intervention to be delivered within a National Health Service (NHS) setting. Evidence-based intervention techniques will be identified for the prioritised factors and combined into a deliverable intervention package. Key stakeholders will comment on the intervention content and mode of delivery through focus groups, and the data will be used to refine the intervention. The acceptability and feasibility of the refined intervention will be evaluated in a future study.

ETHICS AND DISSEMINATION

The study has been approved by an NHS Research Ethics Committee, REC Reference: 13/NI/0190. The findings of this study will be disseminated in peer-reviewed journals and through presentation at national and international conferences.

TRIAL REGISTRATION NUMBER

UKCRN Study ID: 15939.

Occupational challenges of young adult patients with congenital heart disease

Background

Despite improved survival of adults with congenital heart disease (CHD), higher rates of unemployment and work-related problems are seen, especially among younger adults. This study was performed to gain insight into current barriers and facilitating experiences at work among young adult patients with CHD.

Methods

This qualitative study consisted of semi-structured face-to-face interviews, based on a self-constructed model from several existing models, which were held among outpatients with CHD from a large tertiary referral centre. Verbatim transcribed audio-taped data were analysed using a directed model-based content analysis approach.

Results

Fifteen patients had been interviewed when data saturation was reached. Work was important for all participants. Several barriers and facilitating factors were identified. Barriers were mostly on physical aspects and lack of opportunities for recovery. Important facilitating factors were good relationships with colleagues and employer and having sufficient opportunities for recovery. Most of these factors are also seen among patients with other chronic diseases, but with a different priority.

Conclusion

This is the first study that has identified qualitative factors at work of young adult CHD patients. Work is important to them. Challenges are dealing with the physical barriers and getting enough support from colleagues. Specific coaching or a tailored group intervention could thereby be helpful. Future research should aim at the aetiology of problems and identifying patients who would benefit most from specific coaching.

Experiences of employees with arm, neck or shoulder complaints: a focus group study

Background

Many people suffer from complaints of the arm, neck or shoulder (CANS). CANS causes significant work problems, including absenteeism (sickness absence), presenteeism (decreased work productivity) and, ultimately, job loss. There is a need for intervention programs for people suffering from CANS. Management of symptoms and workload, and improving the workstyle, could be important factors in the strategy to deal with CANS. The objective of this study is to evaluate the experienced problems of employees with CANS, as a first step in an intervention mapping process aimed at adaptation of an existing self-management program to the characteristics of employees suffering from CANS.

Methods

A qualitative study comprising three focus group meetings with 15 employees suffering from CANS. Based on a question guide, participants were asked about experiences in relation to continuing work despite their complaints. Data were analysed using content analysis with an open-coding system. During selective coding, general themes and patterns were identified and relationships between the codes were examined.

Results

Participants suffering from CANS often have to deal with pain, disability, fatigue, misunderstanding and stress at work. Some needs of the participants were identified, i.e. disease-specific information, exercises, muscle relaxation, working with pain, influence of the work and/or social environment, and personal factors (including workstyle).

Conclusions

Employees suffering from CANS search for ways to deal with their complaints in daily life and at work. This study reveals several recurring problems and the results endorse the multi-factorial origin of CANS. Participants generally experience problems similar to those of employees with other types of complaints or chronic diseases, e.g. related to their illness, insufficient communication, working together with healthcare professionals, colleagues and management, and workplace adaptations. These topics will be addressed in the adaptation of an existing self-management program to the characteristics of employees suffering from CANS.

How persons with a neuromuscular disease perceive employment participation: a qualitative study

INTRODUCTION

A qualitative study was carried out to understand how people with a slow progressive adult type neuromuscular disease (NMD) perceive employment participation.

METHODS

16 paid employed persons with NMD were interviewed in open, in-depth interviews. Data were analyzed using the constant comparison method.

RESULTS

Four themes were identified in the analyses: (1) Experiences regarding the meaning of work; (2) Solving problems oneself; (3) Reaching a turning point; and (4) Taking into account environmental aspects. Persons with NMD highlighted benefits of staying at work as well as the tension they felt how to shape decisions to handle progressive physical hindrances in job retention. This study shows how participants at work with NMD were challenged to keep up appearances at work and at home, the tension felt around when and if to disclose, the effect of their condition on colleagues and work reorganisation challenges. Participants experienced that disclosure did not always make things better. With increasing disability participants' focus shifted from the importance of assistive products towards considerate colleague, in particular superior's willingness in supporting job retention.

CONCLUSIONS

Implications for health professionals might include awareness of the significant impact of changes in physical condition on employment. Timely communication and if appropriate referral to a health or occupational professional may empower employees with NMD to handle employment issues at a for themselves appropriate way. Assistive products and a supportive superior might enhance employment participation.

Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research

BACKGROUND

Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult.

PURPOSE

This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease.

METHODS

Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes.

FINDINGS

For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments.

IMPLICATIONS

Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.

Workers with a chronic disease and work disability. Problems and solutions

The prevalence of chronic diseases in the age group 18-65 years is high. Cardiometabolic conditions and musculoskeletal diseases are the most frequent chronic diseases. Depending on disease and comorbidity, the employment rates are considerably lower than for healthy individuals. Chronically ill workers may have problems in meeting job demands, they may experience physical, cognitive or sensory limitations, have fatigue or pain complaints or other disease symptoms. Psychological distress, depressive feelings, feelings of shame or guilt, lack of coping or communicative skills, and non-supportive colleagues and supervisors may add to work-related problems. The ICF Model (International Classification of Functioning, Disability and Health) of the WHO offers a framework for understanding and considering health-related problems at work and finding solutions. Interventions to prevent problems in functioning, sickness absence and work disability may focus on the worker, the workplace, or health care. Multidisciplinary vocational rehabilitation, exercise therapy, cognitive behavioural interventions, workplace interventions and empowerment are interventions with at least some evidence of effectiveness. Future policy could focus more on promotion of workers' health and future research should include the interests and motivations of employers concerning disability management, skills of line managers, the feasibility of interventions to prevent work disability and the context sensitivity of study outcomes.

Hotel housekeeping work influences on hypertension management

BACKGROUND

Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management.

METHODS

For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami-Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas.ti software for code and theme identification.

RESULTS

Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co-worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices.

CONCLUSIONS

Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers.

Examining the relationship between chronic conditions, multi-morbidity and labour market participation in Canada: 2000–2005

Relatively little attention has been paid to understanding and addressing the potential health-related barriers faced by older workers to stay at work. Using three representative samples from the Canadian Community Health Survey, we examined the relationship between seven physical chronic conditions and labour market participation in Canada between 2000 and 2005. We found that all conditions were associated with an increased probability of not being able to work due to health reasons. In our adjusted models, heart disease was associated with the greatest probability of not working due to health reasons. Arthritis was associated with the largest population attributable fraction. Other variables associated with not being able to work due to health reasons included older age, female gender and lower educational attainment. We also found particular combinations of chronic conditions (heart disease and diabetes; and arthritis and back pain) were associated with a greater risk than the separate effects of each condition independently. The results of this study demonstrate that chronic conditions are associated with labour market participation limitations to differing extents. Strategies to keep older workers in the labour market in Canada will need to address barriers to staying at work that result from the presence of chronic conditions, and particular combinations of conditions.

Effect evaluation of a self-management program for dutch workers with a chronic somatic disease: a randomized controlled trial

PURPOSE

The objective of this study is to investigate the effect of a Self-Management Program for workers with a chronic disease. This program is based on the Chronic Disease Self-Management Program of Stanford University, modified for workers with a chronic somatic disease.

METHODS

In a randomized controlled trial, the effectiveness of a Self-Management Program was evaluated. Participants were randomly assigned to the experimental group (n = 57) and the control group (n = 47). The experimental group received an intervention, the control group received care as usual. Primary outcome measures were self-efficacy at work and the attitude towards self-management at work. Secondary outcomes were the SF-12 health survey questionnaire, job satisfaction and intention to change job. The results were measured at baseline, after the intervention and 8 months after the intervention.

RESULTS

The attitude towards self-management at work (enjoyment) improved after 8 months for the intervention group (p = 0.030). No other outcome variable differed significantly. As an interaction effect, it was found that low educated workers developed a better physical health quality (SF-12) in the intervention group compared with the control group. The attitude towards self-management at work (importance) improved in the intervention group for older and female workers and the attitude toward enjoying self-management at work improved for female workers only.

CONCLUSION

The results show that low educated workers, older workers and women benefit significantly more from the training than higher educated workers, younger workers and men.

In-depth study of the workers' perspectives to enhance sustainable working life: comparison between workers with and without a chronic health condition

PURPOSE

To gain in-depth understanding of the number and type of experienced ageing problems, obstacles to perform work tasks, retention factors to maintain work and support needs to continue working life in the next years among workers aged 45 years and older with and without a chronic health condition.

METHODS

A survey of workers' perspectives on problems, obstacles, retention factors and needs due to ageing was carried out in 3,008 workers aged 45 years and older in nine different companies. To classify the open-ended questions we used the International Classification of Functioning and disability (ICF).

RESULTS

Older workers with a chronic health condition reported more problems due to ageing (56 vs 34 %; p < .001), more obstacles (42 vs 16 %; p < .001) and more needs (51 vs 31 %; p < .001) compared to those without a chronic health condition. No relevant differences were found on type of experienced problems, obstacles, retention factors and needs between both groups. Problems and obstacles were found on physiological and psychological functions. Retention factors and needs to enhance sustainable working life were particularly reported on work-related environmental factors.

CONCLUSION

Because workers with a chronic health condition experienced more problems, obstacles and needs, the largest gain of occupational intervention can be achieved in these workers. However, our findings suggest that interventions aimed to enhance sustainable working life of older workers can be similar in content for persons with and without chronic health conditions and should have a central focus on work-related factors.

Work Limitations and Their Relationship to Morbidity Burden among Academic Health Center Employees with Diabetes

The objective of this study was to determine the prevalence of work limitations and their relationship to morbidity burden among academic health center employees with diabetes. Employees with diabetes were surveyed via Internet and mail using the Work Limitations Questionnaire. Morbidity burden was measured using the Adjusted Clinical Groups methodology. Seventy-two percent of the employees with diabetes had a work limitation. Adjusted odds ratios for overall, physical, time, and output limitations were 1.81, 2.27, 2.13, and 2.14, respectively. Morbidity burden level is an indicator of work limitations in employees with diabetes and can be used to identify employees who may benefit from specialized services aimed at addressing their work limitations associated with diabetes.

A combination of illness invalidation from the work environment and helplessness is associated with embitterment in patients with FM

OBJECTIVES

The aim of this study in employed people with FM was to test the hypothesis that embitterment is a function of the joint experience of invalidation from the work environment and helplessness regarding one's illness.

METHODS

Sixty-four full-time (36%) or part-time (64%) employed patients with FM (60 females, mean age 45 years) completed the Illness Invalidation Inventory (3*I) to assess work-related discounting and lack of understanding, the Illness Cognition Questionnaire (ICQ) to assess helplessness and the Bern Embitterment Inventory (BEI) to assess embitterment. Hierarchical regression analysis was performed.

RESULTS

Sixteen percent of the participants experienced embitterment levels in the clinical range. The interaction or combination of discounting and helplessness (P = 0.02) and the combination of lack of understanding and helplessness (P = 0.04) were associated with greater embitterment.

CONCLUSIONS

The construct of embitterment has substantial face validity and may result from a combination of invalidation and helplessness. Whereas helplessness is a common target of cognitive-behavioural therapy, evidence-based interventions to redress invalidation and embitterment are needed. It is possible, however, to target invalidation by educating people in the work environment about the consequences of FM and patients' valid needs for work that is manageable, given each patient's specific health-related limitations.

Characteristics of suitable work from the perspective of patients with fibromyalgia

OBJECTIVES

The evaluation of work ability of patients with FM is difficult. Our aim was to investigate the characteristics of suitable work from the perspective of patients with FM.

METHODS

Interviews with patients yielded statements about characteristics of suitable work. Patients individually sorted these statements according to similarity. Hierarchical cluster analysis was applied to these sortings.

RESULTS

The hierarchical structure included 74 characteristics of suitable work. The 10 clusters at the lowest level included (i) recovery opportunities, (ii) pace of work, (iii) not too high workload, (iv) keeping energy for home and free time, (v) match between work and capabilities, (vi) development opportunities, (vii) understanding from colleagues, (viii) help from colleagues, (ix) support from management and (x) work agreements with management.

CONCLUSIONS

According to patients with FM, suitable work is paced in such a way that one can perform the job well and with satisfaction while keeping energy for home and free time and having acknowledgement and help from management and colleagues. The brief suitable work checklist that is provided can help patients with FM to negotiate with employers and job professionals to improve the match between job demands and capabilities.

Workplace problems and solutions for employees with chronic diseases

BACKGROUND

While many employees who have a chronic disease manage their jobs well, others are hampered in work performance, experience work-related problems and are at risk for job loss.

AIMS

To identify the practical and psychosocial barriers recognized by employees with chronic disease who experience work-related problems and to examine preferred work accommodations.

METHODS

A questionnaire was sent by mail and completed by current workers who have a chronic disease and experience serious problems at work.

RESULTS

One hundred and twenty-two employees participated in this study. On average, they had been ill for 10 years and 44% had more than one disease. The most outstanding work-related problems were psychosocial, including work-home interference and a lack of acceptance of the chronic disease. Performing and finishing work tasks and social relationships with supervisors or colleagues were also felt to be slightly problematic. The most preferred work accommodations included fewer work hours, working from home, a slower work pace and more autonomy in planning work tasks. Almost three-quarters of the respondents were so fatigued that they were at risk of sickness absence or work disability.

CONCLUSIONS

A chronic physical disease may lead to both practical and psychosocial problems and serious fatigue. Managing psychosocial problems may decrease fatigue.

'I have come here to learn how to cope with my illness, not to be cured': a qualitative study of patient expectations prior to a one-week self-management programme

BACKGROUND

Self-management programmes (SMPs) have been developed to help patients with chronic rheumatic diseases to manage their health problems. Patients' expectations prior to treatment are important determinants of outcomes, and should therefore be identified, to ensure that interventions meet the participants' needs. The aim of the present study was to determine participant expectations with respect to a one-week inpatient SMP for those with fibromyalgia (FM) and rheumatoid arthritis (RA).

METHODS

A qualitative study consisting of semi-structured interviews was used to explore the expectations of eight participants with FM and eight with RA. The data were analysed using thematic analysis.

RESULTS

The findings show that the participants expected the SMP to be a turning point towards a better future and to empower them to assume more responsibility for their own health and self-care. They also expected the SMP to facilitate acceptance, help them to gain new knowledge and be a forum in which to share their experience. Participants who were employed assumed that participation in the SMP would help to ensure that they would continue in their jobs.

CONCLUSIONS

This qualitative study indicated that identifying expectations prior to an SMP provides important information which has implications for the programme's implementation. Additional themes, such as acceptance of the illness and management of work, should also be included in the programmes and they should focus more on sharing experience.

Experiences and needs for work participation in employees with rheumatoid arthritis treated with anti-tumour necrosis factor therapy

PURPOSE

To investigate the experiences and needs with respect to work participation of employees with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy.

METHOD

Face-to-face interviews in 14 employees with RA on anti-TNF therapy focused on experiences, offered support and needs with respect to work participation.

RESULTS

Experiences regarding work participation varied and ranged from fatigue at work, having no job control, not being understood by the work environment or difficulty dealing with emotions as a result of interaction within the work environment. Support by health care professionals for work participation was considered important, especially concerning social or psychological issues. Advice in becoming aware of one's changes in abilities was highly appreciated, as was the availability of professional advice in times of an urgent work issue due to RA. Employees mentioned an increase in social support at work and job control as important facilitating factors for work participation.

CONCLUSION

Although patients with RA report improvement in their work functioning after starting anti-TNF therapy, employees continue facing challenges in working life due to RA. For support concerning work participation, it is recommended that health care professionals are more aware of work-related problems in patients with RA treated with anti-TNF therapy.

Facilitating job retention for chronically ill employees: perspectives of line managers and human resource managers

BACKGROUND

Chronic diseases are a leading contributor to work disability and job loss in Europe. Recent EU policies aim to improve job retention among chronically ill employees. Disability and occupational health researchers argue that this requires a coordinated and pro-active approach at the workplace by occupational health professionals, line managers (LMs) and human resource managers (HRM). Little is known about the perspectives of LMs an HRM on what is needed to facilitate job retention among chronically ill employees. The aim of this qualitative study was to explore and compare the perspectives of Dutch LMs and HRM on this issue.

METHODS

Concept mapping methodology was used to elicit and map statements (ideas) from 10 LMs and 17 HRM about what is needed to ensure continued employment for chronically ill employees. Study participants were recruited through a higher education and an occupational health services organization.

RESULTS

Participants generated 35 statements. Each group (LMs and HRM) sorted these statements into six thematic clusters. LMs and HRM identified four similar clusters: LMs and HRM must be knowledgeable about the impact of chronic disease on the employee; employees must accept responsibility for work retention; work adaptations must be implemented; and clear company policy. Thematic clusters identified only by LMs were: good manager/employee cooperation and knowledge transfer within the company. Unique clusters identified by HRM were: company culture and organizational support.

CONCLUSIONS

There were both similarities and differences between the views of LMs and HRM on what may facilitate job retention for chronically ill employees. LMs perceived manager/employee cooperation as the most important mechanism for enabling continued employment for these employees. HRM perceived organizational policy and culture as the most important mechanism. The findings provide information about topics that occupational health researchers and planners should address in developing job retention programs for chronically ill workers.

Empowering employees with chronic diseases: process evaluation of an intervention aimed at job retention

Purpose

Employees with a chronic disease may experience work-related problems that contribute to the risk of job loss. We developed a group-based intervention programme aimed at clarifying problems, making these a subject of discussion at work, and realizing solutions. This process evaluation investigates the intervention’s feasibility and the satisfaction of 64 participants in eight groups.

Methods

Data were collected through process evaluation forms and self-report questionnaires.

Results

The recruitment of participants was time-consuming. Highly educated women working in the service sector were overrepresented. The programme was administered as planned, although components were sometimes only discussed briefly, due to lack of time. Satisfaction with the overall programme among participants was high; it was perceived as effective and there were only three dropouts. In particular, the focus on feelings and thoughts about having a chronic disease was highly valued, as were the exchange of experiences and role-playing directed at more assertive communication.

Conclusions

A vocational rehabilitation programme aimed at job retention is feasible and is perceived to be effective. Such a programme should address psychosocial aspects of working with a chronic disease beside practical problems. The recruitment of participants is time-consuming. Cooperation with outpatient clinics is necessary in order to reach all groups of employees with a chronic disease that might benefit from job retention programmes. Trial registration: ISRCTN77240155

Using intervention mapping (IM) to develop a self-management programme for employees with a chronic disease in the Netherlands

Background

Employees with a chronic disease often encounter problems at work because of their chronic disease. The current paper describes the development of a self-management programme based on the Chronic Disease Self-Management programme (CDSMP) of Stanford University to help employees with a chronic somatic disease cope with these problems at work. The objective of this article is to present the systematic development and content of this programme.

Methods

The method of intervention mapping (Bartholomew 2006) was used to tailor the original CDSMP for employees with a chronic somatic disease. This paper describes the process of adjusting the CDSMP for this target group. A needs assessment has been carried out by a literature review and qualitative focus groups with employees with a chronic disease and involved health professionals. On the basis of the needs assessment, the relevant determinants of self-management behaviour at work have been identified for the target population and the objectives of the training have been formulated. Furthermore, techniques have been chosen to influence self-management and the determinants of behaviour and a programme plan has been developed.

Results

The intervention was designed to address general personal factors such as lifestyle, disease-related factors (for example coping with the disease) and work-related personal factors (such as self-efficacy at work). The course consists of six sessions of each two and a half hour and intents to increase the self management and empowerment of employees with a chronic somatic disease.

Conclusion

Intervention mapping has been found to be a useful tool for tailoring in a systematic way the original CDSMP for employees with a chronic somatic disease. It might be valuable to use IM for the development or adjusting of interventions in occupational health care.