Validation of the Return-to-Work Obstacles and Self-Efficacy Scale for Women on Sick Leave Due to Breast Cancer (ROSES-BC).

PURPOSE: Breast cancer (BC) is the most frequently diagnosed cancer among women. Approximately 40% of BC survivors are diagnosed during the peak years of their professional career. Women face numerous obstacles when returning to work (RTW) after BC. Their decision-making process and self-efficacy to overcome these barriers may undergo alterations. The objective of this study was to validate the Return-to-work Obstacles and Self-Efficacy Scale (ROSES) for BC survivors, with a focus on three psychometric properties: construct validity, test-retest reliability, and predictive validity. METHODS: This prospective study consists of three phases: Phase 1 (baseline, during sick leave) was conducted to evaluate construct validity, Phase 2 (2 weeks later) assessed test-retest reliability, and Phase 3 (6-month follow-up, RTW or not) aimed to evaluate predictive validity. A total of 153 BC survivors participated in Phase 1 of the study, where they completed the 10 dimensions of the ROSES (e.g., fear of relapse, cognitive difficulties). Confirmatory factor analyses (CFA), Pearson correlations, and Cox regressions were performed, with respect to each phase. RESULTS: The mean duration for RTW with the same employer was 62.7 weeks. CFAs confirmed the ROSES structure, which had previously been established for other health conditions, showing satisfactory coefficients. Significant Pearson correlation coefficients were observed between the ROSES dimensions from Phase 1 to Phase 2, ranging from 0.66 to 0.88. When considering various confounding variables, chemotherapy treatment and cognitive difficulties (ROSES dimension) emerged as the only significant predictors of RTW. CONCLUSION: These findings support the utilization of the ROSES in clinical and research settings for BC survivors to improve their successful RTW. After an initial screening using the ROSES, occupational health professionals can further conduct a focused and thorough evaluation of specific dimensions, such as cognitive difficulties. Additional research and information are required to assist BC survivors in dealing with cognitive impairments induced by chemotherapy when they return to work.

Food systems determinants of nutritional health and wellbeing in urban informal settlements: A scoping review in LMICs.

INTRODUCTION: Increasing food and nutritional inequities are apparent in urban settings across Low- and Middle-Income Countries (LMICs), along with nutrition transition towards ultra-processed diets high in fat, sugar, and salt. In urban informal settlements, characterized by insecurity and inadequate housing and infrastructure, food systems dynamics and their nutritional implications are poorly understood. OBJECTIVES: This paper explores the food system determinants of food and nutrition security in urban informal settlements in LMICs with the goal of identifying effective approaches and entry points for policy and program. METHODS: Scoping review. Five databases were screened spanning the period 1995 to 2019. A total of 3748 records were assessed for inclusion based on title and abstract followed by 42 full text reviews. At least two reviewers assessed each record. Twenty-four final publications were included, coded, and synthesized. RESULTS: Factors influencing food security and nutrition in urban informal settlements can be organized into three interconnected levels. Macro-level factors include globalization, climate change, transnational food corporations, international treaties and regulations, global and national policies such as SDGs, insufficient social aid programs, and formalization or privatization. Meso-level factors include gender norms, inadequate infrastructure and services, insufficient transportation, informal food retailers, weak municipal policies, marketing strategies, and (lack of) employment. Micro-level factors comprise gender roles, cultural expectations, income, social networks, coping strategies, and food (in) security. CONCLUSIONS: Greater policy attention should focus at the meso-level, with priority investments in services and infrastructure within urban informal settlements. The role and engagement of the informal sector is an important consideration in improving the immediate food environment. Gender is also crucial. Women and girls have a central role in food provisioning but are more vulnerable to various forms of malnutrition. Future research should include context-specific studies in LMIC cities as well as promoting policy change using a participatory and gender transformative approach.

Methodological Reflections of a Student- and Community-based Partnership on Operationalizing a Community-based Participatory Research Model: Recommendations for Building, Securing, and Sustaining Partnerships.

BACKGROUND: Community-based participatory research (CBPR) is an approach that values community expertise and ownership in creating knowledge. This approach's success is challenged by inherent cultural imbalances, making it difficult to sustain partnerships and build from what has been learned from a project as it develops. As student researchers and community members, we reflected on the challenges in CBPR and gave guidance to future novice researchers pursuing CBPR. OBJECTIVES: From the application of an initial CBPR model as a framework to our partnership, we propose empirical avenues to continuously adapt the CBPR approach. METHODS: A CBPR partnership between McGill's Family Medicine Graduate Student Society and Share the Warmth, a community-based organization aiming to fight poverty and hunger, was formed to collaboratively assess a music program offered in a socioeconomically disadvantaged community. The partnership process was based on a model that we conceptualized in three phases of our framework: building, securing, and sustaining. We reflect on the facilitators and challenges of this project and propose solutions to overcome identified barriers within the context of our partnership. RESULTS: We highlight the importance of integrating student partners in the community, reevaluating formal research agreements, and coordinating the transition of new partners in this adaptive CBPR model. We argue that this systematic and reflexive process has made the model especially useful as a framework for student and community partnerships. CONCLUSIONS: We propose adaptive components to the CBPR model. Our recommendations could help other partnerships cultivate CBPR to be more applicable in community health research.

Developing a collaborative and sustainable return to work program for employees with common mental disorders: a participatory research with public and private organizations.

PURPOSE: To disentangle the key steps of the return to work (RTW) process and offer clearer recovery-focused and sustainable RTW for people on sick leave due to common mental disorders (CMDs). METHODS: This participatory research involves two large Canadian organizations. In each organization, we established an advisory committee composed of RTW stakeholders. We collected information in semi-structured interviews from RTW stakeholders (n = 26) with each member of the advisory committee in each organization, as well as with employees who had recently experienced CMDs. The interviews examined the RTW process for employees on sick leave due to CMDs as well as RTW stakeholders' perceptions of barriers and facilitators. A thematic approach was used to synthesize the data, following which, results were discussed with the two advisory committees to identify solutions considering key RTW steps. RESULTS: Ten common key steps within the three RTW phases emerged from the semi-structured interviews with RTW stakeholders and discussions with the two advisory committees: 1) At the beginning of sickness absence and involvement of disability management team (phase 1), we found 3 steps (e.g., taking charge of the file), 2) during the involvement in treatment rehabilitation with health professionals and preparation of the RTW (phase 2), 4 steps (e.g., RTW preparation), and finally 3) the RTW and follow-up (phase 3) consists of 3 steps (e.g., gradual RTW). CONCLUSION: A participatory study involving RTW stakeholders helped identify 10 common key steps within three phases to support RTW sustainability of people with CMDs. Future research will need to address how RTW coordinators intervene in the RTW process of employees with CMDs within these steps.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals will benefit from a detailed description of the RTW process (10 steps spread out over 3 RTW phases), allowing them to standardize it while adopting a personalized approach for the employee on sick leave.Rehabilitation professionals are informed of stakeholders' role and actions required in the RTW process; as such the communication between RTW stakeholders should be improved.RTW coordinators will be able to tailor more precisely their intervention, considering the detailed RTW process and RTW stakeholders' role and actions, and thus will become the pivot occupational health specialists for the RTW process.

Conceptual foundations of organizational structure: re-structuring of women's health services.

PURPOSE: Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH: The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS: "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE: As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.

[Development and User Testing of the PRATICAdr Web Application: Return-to-work Platform Focused on Interaction and Communication Between Stakeholders, Integrating a Sustainable Recovery Program]. / Développement et tests utilisateurs de l'application Web PRATICAdr : Plateforme de Retour Au Travail axée sur les Interactions et la Communication entre les Acteurs, intégrant un programme Durable favorisant le Rétablissement.

Introduction Common mental disorders (CMDs) account for 30% to 50% of all illness absences. The success of RTW is not only due to the individual but rather to the result of the interaction between the stakeholders involved in the RTW process. Numerous mental health applications have been developed to improve patient management and optimize communication between professionals, but have not been validated. Moreover, no technological solution has been developed to date to facilitate both consultation among the RTW stakeholders (e.g., managers, health professionals) and systematic support for the employee in his or her RTW. Objective To address these shortcomings, the purpose of this article is twofold: 1) to describe the development of the PRATICAdr application (Return-to-Work Platform focused on Stakeholder Interaction and Communication: a Sustainable Recovery Program) and 2) to document PRATICAdr application user testing. Method The development of PRATICAdr has been operationalized in three phases: 1) needs assessment, 2) conceptualization of the internal mechanisms of the application and programming techniques and 3) testing of the application in real situation. The application is evaluated through questionnaires and interviews to measure user satisfaction. Results PRATICAdr allows to follow in real time the path of RTW stakeholders involved in the personalized support of the employee in his RTW. The operationalization of the RTW process and the inclusion of validated assessment tools help systematize the stakeholders' consultation and shared decision-making, as well as the monitoring and actions taken to undertake a recovery-promoting RTW. The PRATICAdr interface was developed to simplify the user experience for the employee on sick leave and all RTW stakeholders. Regarding user satisfaction, results show that the first 16 users of PRATICAdr, employees in a large healthcare organization returning to work following a CMD, were very satisfied (average>9/10) with the Web application, as well as the participation of RTW stakeholders and the questionnaires included in PRATICAdr. Improvements were also suggested. Conclusion PRATICAdr is implemented in two large organizations (>15,000 employees) in order to evaluate its effectiveness with employees on sick leave due to CMD registered in a RTW process. The aim of this article was to present not only the development of PRATICAdr, but also to measure user satisfaction. Preliminary results indicate a high level of satisfaction among employees on sick leave who used PRATICAdr. In terms of future avenues, the integration of e-learning will be addressed with the objective of customizing the RTW program according to the predictions of duration of sick leave and sustainable RTW.

Improving transparent team communication with the 'Glass Door' decal communication tool: a mixed methods analysis of family and staff perspectives.

OBJECTIVE: To determine the value and perspectives of intensive care unit (ICU) healthcare professionals (HCPs) and families about the Glass Door (GD) decal team communication tool. DESIGN: Quality improvement methodology was used to design, test and implement the GD. Uptake was measured through audit. Impact was assessed through mixed methodology (survey of ICU HCPs (n=96) and semi-structured interviews of HCPs (n=10) and families (n=7)). SETTING: Eighteen bed, closed, mixed medical-surgical-cardiac ICU in a tertiary care, university-affiliated, paediatric hospital. POPULATION: Interdisciplinary ICU HCPs and families of children admitted to the ICU. INTERVENTION: A transparent template (the GD) applied to the outside of ICU patients' doors with sections for HCPs names, physiological goals and planned tests and treatments for the day. Medical staff completed the GD in rounds (AM and PM) and any HCP caring for the patient updated it throughout the day. MEASUREMENTS AND MAIN RESULTS: After 3 months, 96% of 613 doors were employed of which 99% respected confidentiality. ICU HCPs reported improved understanding of the patient's plan (84% today vs 59% pre-GD, p<0.001) and sense that families were up-to-date (79% today vs 46% pre-GD, p<0.001). Based on semi-structured interviews, the GD promoted a shared understanding of the plan contributing to care continuity. The GD reassured families the team is working together and fostered family engagement in the care. Routine family experience surveys showed no change in families' sense of privacy during admission; families denied the GD's anticipated compromise of confidentiality. CONCLUSIONS: The GD decal communication tool, visible on the patient's door, improved ICU HCPs' perceived knowledge of their patient's plan. The GD improved the shared mental model, facilitated teaching and information transfer and fostered family engagement. Challenges included knowing the rules for use and consistent application. Concerns initially raised by HCPs about confidentiality were denied by families.

[Issues and Solutions in Mental Health and Work: Managers Perspectives of a Large Health Organization]. / Enjeux et solutions en santé mentale et travail : le point de vue des gestionnaires d'une grande organisation de santé.

Mental health problems in the workplace represent an important issue for public organizations, particularly for people working in the health sector who have been confronted to multiple changes following the recent health system reform in Quebec. Managers need to take into consideration employee mental health within their organization in order to ensure productive and healthy employees. Managers are thus called upon to take on a role that includes prevention (e.g., detection of early warning signs), team management (e.g., working on recognition at work) and coaching employees in their tasks when returning to work following a sick leave due to a common mental disorder (e.g., depression). Although there is an abundant literature on the manager's role in the prevention of mental health problems in the workplace and the work rehabilitation of employees on sick leave due to a common mental disorder, to our knowledge, little research has been conducted on these issues regarding managers' perceptions working in large health organizations. Furthermore, potential solutions have not been explored in this context. Objective The purpose of the study is to document, from the managers' perspective within a large health organization in Quebec, the issues pertaining to mental health and work (from prevention to work rehabilitation), and the solutions to deal with them. Method As part of a participatory research project, researchers and collaborators of a large health organization conducted focus groups with managers on the theme of mental health and work: issues and solutions. A total of 83 managers spread out in 10 focus groups participated in this study. Results From these focus groups, 6 broad categories of issues related to mental health in the workplace emerged: 1) the management framework, 2) human, financial, material and information resource management, 3) management of mental health and tools, 4), stakeholders' collaboration, roles and actions, 5) employees' sense of belonging to the organization and, 6) work-life balance. From these broad conceptual categories, 23 specific issues and associated solutions emerged. Conclusions From this study, the general consensus was the need to have access to a series of tools (e.g., toolbox) in order to assist managers across the different steps, from sick-leave prevention, to rehabilitation and return to work. The results also highlighted the need to better define the roles of each stakeholder in this process. These results bring a new light to the issues and potential solutions perceived by managers dealing with mental health and work issues in a large health organization. These results could eventually be replicated in other settings or large organizations.

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review.

The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job-seekers. Two complementary datasets were used: a self-report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ-5D-5L), the severity of psychiatric symptoms (18-item Brief Symptom Inventory) and self-declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision-making.