Exploring return to work barriers through the lens of model of human occupation. The NOW WHAT project.

BACKGROUND: The challenges of returning to work after sickness absence demands a wide conceptual understanding of what hinders the employee's work participation. Thus, there is a need to know more about self-perceived barriers for Return to Work (RTW). AIM: This study aimed to investigate RTW barriers experienced by employees on long-term sick leave, through the lens of the Model of Human Occupation (MOHO). MATERIAL AND METHODS: The study was a large-scale qualitative interview study (n = 85) using semi-structured telephone interviews. Eligible participants had received sick leave benefits for between 6 months and 1.5 years. The data were analysed with quantitative and qualitative content analysis. A deductive approach using the MOHO concepts guided the analysis process. RESULTS: The study generated 941 coded meaning units describing barriers for RTW, of which we were able to code 895 within the framework of MOHO. In the person-specific concepts, performance capacity barriers were most often described (n = 303), followed by volitional barriers (n = 165) and barriers related to habituation (n = 66). Barriers related to the environmental components amounted to 361. Barriers in the occupational environment was dominant (n = 214). CONCLUSION: Experienced barriers related to both environmental components and person-specific concepts. SIGNIFICANCE: The habituational and volitional perspective on barriers can contribute to the identification and communication of performance capacity-related barriers not previously identified.

"Navigating Between Unpredictable Icebergs": A Meta-Ethnographic Study of Employment Specialists' Contributions in Providing Job Support for People with Mental Illness.

Purpose To explore and synthesize the views of Supported Employment clients, employment specialists and their supervisors on the core contributions of employment specialists to job support within the mental health field. Methods We systematically searched four databases with no time limitations and identified 16 qualitative studies published between 2006 and 2018 to be included in this meta-ethnographic study. Results The overarching metaphor of "Navigating an Unpredictable Iceberg-laden Sea" (a workplace) and seven themes were revealed: (1) "It's you and me looking," which represented the relationship between the client and ES, and (2) taking job seekers' ambitions and needs seriously, (3) mapping the route, (4) exploring the hidden, (5) being on tap, (6) avoiding crashes, and (7) bridging, which embodied the work of employments specialists. Conclusion. Our iceberg metaphor illustrates the importance of employment specialists being competent in addressing clients' work performance difficulties related not only to the individual's illness, age, gender, and cultural-related challenges, but also to psychosocial, behavioral, and environmental workplace factors. Given the effects of the specific characteristics of the working alliance developed in supported employment, we suggest that employment specialists' training and supervision be enriched by paying more attention to these important relational processes.

An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study.

BACKGROUND: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. METHODS: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). RESULTS: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. CONCLUSION: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. TRIAL REGISTRATION: NCT04083404 Registered 05 September 2019 (retrospectively registered).

Post-incident review after restraint in mental health care -a potential for knowledge development, recovery promotion and restraint prevention. A scoping review.

BACKGROUND: Use of physical restraint is a common practice in mental healthcare, but is controversial due to risk of physical and psychological harm to patients and creating ethical dilemmas for care providers. Post-incident review (PIR), that involve patient and care providers after restraints, have been deployed to prevent harm and to reduce restraint use. However, this intervention has an unclear scientific knowledge base. Thus, the aim of this scoping review was to explore the current knowledge of PIR and to assess to what extent PIR can minimize restraint-related use and harm, support care providers in handling professional and ethical dilemmas, and improve the quality of care in mental healthcare. METHODS: Systematic searches in the MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Science databases were carried out. The search terms were derived from the population, intervention and settings. RESULTS: Twelve studies were included, six quantitative, four qualitative and two mixed methods. The studies were from Sweden, United Kingdom, Canada and United States. The studies' design and quality varied, and PIR s' were conducted differently. Five studies explored PIR s' as a separate intervention after restraint use, in the other studies, PIR s' were described as one of several components in restraint reduction programs. Outcomes seemed promising, but no significant outcome were related to using PIR alone. Patients and care providers reported PIR to: 1) be an opportunity to review restraint events, they would not have had otherwise, and 2) promote patients' personal recovery processes, and 3) stimulate professional reflection on organizational development and care. CONCLUSION: Scientific literature directly addressing PIR s' after restraint use is lacking. However, results indicate that PIR may contribute to more professional and ethical practice regarding restraint promotion and the way restraint is executed. The practice of PIR varied, so a specific manual cannot be recommended. More research on PIR use and consequences is needed, especially PIR's potential to contribute to restraint prevention in mental healthcare.

Who initiates and organises situations for work-related alcohol use? The WIRUS culture study.

AIMS: Alcohol is one of the leading causes of ill health and premature death in the world. Several studies indicate that working life might influence employees' alcohol consumption and drinking patterns. The aim of this study was to explore work-related drinking situations, with a special focus on answering who initiates and organises these situations. METHODS: Data were collected through semi-structured group interviews in six Norwegian companies from the private ( n=4) and public sectors ( n=2), employing a total of 3850 employees. The informants ( n=43) were representatives from management and local unions, safety officers, advisers from the social insurance office and human-resource personnel, health, safety and environment personnel, and members from the occupational environment committee. Both qualitative and quantitative content analyses were applied in the analyses of the material. RESULTS: Three different initiators and organisers were discovered: the employer, employees and external organisers. External organisers included customers, suppliers, collaborators, sponsors, subcontractors, different unions and employers' organisations. The employer organised more than half of the situations; external organisers were responsible for more than a quarter. The differences between companies were mostly due to the extent of external organisers. CONCLUSIONS: The employer initiates and organises most situations for work-related alcohol use. However, exposure to such situations seems to depend on how many external relations the company has. These aspects should be taken into account when workplace health-promotion initiatives are planned.

Do psychological job demands, decision control and social support predictreturn to work three months after a return-to-work (RTW) programme? The rapid-RTW cohort study.

BACKGROUND: Long-term sickness absence is a considerable health and economic problem in the industrialised world. Factors that might predict return to work (RTW) are therefore of interest. OBJECTIVE: To examine the impact of psychosocial work characteristics on RTW three months after the end of a RTW programme. METHODS: A cohort study of 251 sick-listed employees from 40 different treatment and rehabilitation services in Norway recruited from February to December 2012. The Job Content Questionnaire was used to gather information on the psychosocial work conditions. Full or partial RTW was measured three months after the end of the RTW programme, using data from the national sickness absence register. Logistic regression analyses were performed to investigate the association between the psychosocial work characteristics and RTW. RESULTS: Having low psychological job demands (OR = 0.4, 95% CI: 0.2-0.9), high co-worker- (OR = 3.4, 95% CI: 1.5-5.8), and supervisor support (OR = 3.4, 95% CI: 1.6-7.3), and being in a low-strain job (low job demands and high control) (OR = 4.6, 95% CI: 1.1-18.6) were predictive of being in work three months after the end of the RTW programme, after adjusting for several potential prognostic factors. CONCLUSION: Interventions aimed at returning people to work might benefit from putting more emphasise on psychosocial work characteristics in the future.

"Balancing on Skates on the Icy Surface of Work": a metasynthesis of work participation for persons with psychiatric disabilities.

PURPOSE: To explore how persons with psychiatric disabilities experience facilitators of and barriers to participation in paid work in transitional, supported, and open employment settings, in order to provide guidance for efforts to attract and retain these persons in gainful employment as a key dimension of recovery and community life. METHODS: A metasynthesis was conducted using 16 qualitative studies published between 1990 and 2011. RESULTS: Ten themes, two phases, and an overarching metaphor were identified. The first five themes describe facilitators of and impediments to getting a job (getting off the bench): (1) fighting inertia; (2) taking control; (3) encouraging peers; (4) disruptions related to the illness; (5) lack of opportunities and supports. The next five themes represent facilitators of and impediments to working (skating on the ice); (6) going mainstream; (7) social cohesion; (8) clarity in role and responsibilities; (9) environmental factors; (10) managing self-disclosure. We chose as our overarching metaphor "Balancing on Skates on the Icy Surface of Work," as we view both iceskaters and workers with psychiatric disabilities as needing to achieve and maintain their balance while being "on the edge" between various extremities. CONCLUSION: We have shown that, for persons with psychiatric disabilities to "get off the bench" and "onto the ice" of employment, they may need to be supported in finding and maintaining their balance in new situations through a combination of learning new skills and competencies (learning how to skate) while receiving in vivo assistance from empathic and knowledgeable supporters (being coached while on the ice).

Challenging evidence-based decision-making: a hypothetical case study about return to work.

A hypothetical case study about return to work was used to explore the process of translating research into practice. The method involved constructing a case study derived from the characteristics of a typical, sick-listed employee with non-specific low back pain in Norway. Next, the five-step evidence-based process, including the Patient, Intervention, Co-Interventions and Outcome framework (PICO), was applied to the case study. An inductive analysis produced 10 technical and more fundamental challenges to incorporate research into intervention decisions for an individual with comorbidity. A more dynamic, interactive approach to the evidence-based practice process is proposed. It is recommended that this plus the 10 challenges are validated with real life cases, as the hypothetical case study may not be replicable.

Loss of health certificates among offshore petroleum workers on the Norwegian Continental Shelf 2002-2010.

BACKGROUND: A health certificate is required to work on the offshore petroleum installations of the Norwegian Shelf. Loss of health certificate (loss of licence, LOL) may cause economic problems for the individual worker. A private compensation system (OSO) was established for Norwegian offshore workers in 2002, comprising 8000-11,000 individual members of workers organisations: approximately one third of the population offshore. This study aims at describing the reasons for compensation of offshore workers who have lost their certificates. MATERIALS AND METHODS: Of 595 workers who applied for compensation in the period 2002-2010, 38 declined to participate in the study. Of the remaining 557, 507 were granted and 50 were denied compensation. All medical records held by the scheme concerning the 507 compensated applicants were examined. Health data were systematically extracted, analysed, and compared with general population statistics. RESULTS: Musculoskeletal conditions were the most frequent conditions causing LOL for both sexes (42.5%), followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular (19%), neurological, and psychiatric conditions for men. Musculoskeletal disorders were more prevalent than in the general population, and the prevalence of knee problems was particularly high. Among malignant diseases we found a high proportion of brain tumours and renal cancer. The causes are unknown and warrant further investigation in this population. Among women granted compensation, 78% were catering workers, while 50% of the men were process workers, reflecting the gender distribution in these working groups. CONCLUSIONS: Musculoskeletal conditions were the most frequent cause of application for LOL compensation for both sexes, followed by psychiatric, neurological, and malignant diseases for women, and cardiovascular, neurological, and psychiatric conditions for men. The cause of the higher incidence of musculoskeletal diseases, brain tumours, and renal cancer found in this study compared to the general population warrants further investigation.

Occupational therapists' perception of their practice: A phenomenological study.

BACKGROUND: International literature seems consistent in reporting that occupational therapists value their methods. However, little empirical evidence has been generated supporting the basic system of belief for occupational therapy. Few studies have explored the nature of the occupational therapists' experiences and thoughts about their use of occupation as means and ends, and which strategies they use to implement their tools in their current practice. Accordingly, the aim of this study was to explore how occupational therapists understood and presented their practice and interventions. METHODS: A sample of six occupational therapists graduated in different decades, from diverse client populations and health-care settings was selected to participate in a semistructured interview. RESULTS: Three main themes were developed: 'To make the client's potentials visible', 'reaching a position one values' and 'looking with other eyes'. Whatever their specialities, the participants were unanimous in the way they described their role. Their common focus was 'activities of daily living'. However, they had problems describing their therapeutic tools, and were not able to clearly articulate the 'common sense aspects' of their own methods. The participants were engaged in constructing their professional identities, and stressed the need to construct professional boundaries relevant to their particular work. CONCLUSION: The occupational therapists perceived their practice and interventions as distinctly different from other team members, thus, they provided a 'counterpoint'. The participants used various ways of marketing their perspectives. While the novices tended to go along with the team, the experienced therapists tended to assert their own special contribution.

Leadership qualities in the return to work process: a content analysis.

INTRODUCTION: Supervisors have a core role to play in facilitating the safe and effective return to work (RTW) of employees on long-term sick leave. Previous studies have revealed that the risk of long-term sick leave increases with lower social support from the supervisor and lower management quality. The aim of this study was to elucidate leadership qualities that are valued in the RTW process of employees. METHODS: The study formed part of the Rogaland RTW study, and was designed as a qualitative case study that included interviews with subordinates (n = 30) on long-term sick leave (>8 weeks) and their supervisors (n = 28) from 19 companies. The informants represented a heterogeneous sample regarding diagnoses, types of occupations, positions, company sector, branches, and sizes. Qualitative and quantitative content analysis of the transcripts obtained during interviews identified leadership qualities. RESULTS: Three-hundred-and-forty-five descriptions of leadership qualities were identified, which were categorized into 78 distinct leadership qualities and 7 leadership types. The five most valued leadership qualities were "ability to make contact", "being considerate", "being understanding", "being empathic", and "being appreciative". The three most valued leadership types were the Protector, Problem-Solver, and Contact-Maker. While the subordinates gave more descriptions to the Encourager, Recognizer, and Protector types, the supervisors described the Responsibility-Maker and Problem-Solver most often. The most frequent reported combination of types was the Protector and Problem-Solver, reported by 54% of the informants, while the most common three-types-combination was the Protector, Problem-Solver, and Contact-Maker reported by 37% of the informants. CONCLUSIONS: This study revealed that there is a wide spectrum of valued leadership qualities, with those reported as being valuable differing between employees and supervisors.

Clients using community occupational therapy services: sociodemographic factors and the occurrence of diseases and disabilities.

PURPOSE: The aim of this study was to describe sociodemographic factors and the occurrence of diseases and disabilities among a representative sample of clients who were using community occupational therapy services in Norway. METHOD: A postal survey of occupational therapists about their last clients (n=168) was carried out in 2001. A survey questionnaire based on the International Classification of Functioning, Disability, and Health (ICF) was developed. Diagnoses were coded according to the International Classification of Primary Care (ICPC-2). RESULTS: This study showed that more than half of the clients were adults, youths, or children. Only 17% of adults participated in "ordinary working life", and of those approximately 10% were on sick leave and 62% were on disablement pension. A predominance of neurological diseases such as multiple sclerosis and Parkinson's disease was found (24%). Stroke was the most common principal diagnosis (19%). Musculoskeletal (16%) and mental diseases (13%) were also frequently reported. "Movement impairments" (96%) were most common in the body function component. Frequent problems in several domains of the activity and participation components were reported, in particular in "education, work and employment" (93-94%) and "recreation and leisure" (94%). CONCLUSION: Clients using community occupational therapy in Norway had numerous types of chronic and severe diseases, and a high occurrence of musculoskeletal impairment, activity limitations, and participation restrictions.