[Motivational and Volitional Processes in the Context of Applying for Medical Rehabilitation Services]. / Motivationale und volitionale Prozesse im Kontext der Beantragung einer medizinischen Rehabilitationsleistung.

OBJECTIVES: We analyzed if intention and planning of an application for medical rehabilitation can be described using the health action process approach. MATERIAL AND METHODS: Data were used from the "Third German Sociomedical Panel of Employees". A questionnaire comprising 8 scales was developed. The scales assess outcome expectancies (3 scales), support by family and physicians (2 scales), self-efficacy, intention and action planning (1 scale each). A confirmatory factor analysis was performed to examine the factorial validity of the questionnaire. Structural equation modeling was used to explain intention and planning of an application for medical rehabilitation. RESULTS: 3 294 persons participated in the survey. The average age was 47.9 years (range 40-54 years, SD=4.1). 53% of the participants were women. Further analyses included data of 2 911 (listwise deletion) and 3 288 participants (estimated missing values), respectively. The anticipated 8-factor structure of the questionnaire was confirmed. The model fit of the structural equation model was good. Intention was explained by family-related negative outcome expectancies, self-efficacy, and support by family and physicians. Intention and support by physicians directly affected planning. Additionally, family-related negative outcome expectancies, family and physician support, and self-efficacy were indirectly associated with planning. This indirect effect was mediated by intention. 51% of the variance of intention and 65% of the variance of planning were explained. DISCUSSION: The findings of the structural equation model indicate that the health action process approach is useful to describe the process of applying for medical rehabilitation. A validation of the model needs longitudinal data on actual applications. CONCLUSION: The health action process approach supports our understanding of motivational and volitional determinants of an application for medical rehabilitation. Our results underline the important role that family doctors and occupational physicians have if an application for medical rehabilitation is needed.

Self-Reported Poor Work Ability--An Indicator of Need for Rehabilitation? A Cross-Sectional Study of a Sample of German Employees.

OBJECTIVE: The purpose of this study was to assess associations of self-reported work ability as measured by the Work Ability Index (WAI) with modifiable behavioral and occupational health risks, health service utilization, and intended rehabilitation and pension requests. DESIGN: This is a cross-sectional study of a random sample of German employees aged 40-54 yrs on sickness benefits in 2012 (trial registration: DRKS00004824). RESULTS: In total, 1312 male and 1502 female employees were included in the analyses. Low WAI scores (i.e., <37 points) were associated with a higher prevalence of occupational and behavioral health risks; a higher likelihood of frequent visits to general, somatic, and psychologic specialists as well as hospital stays; and four to six times higher risks of intended rehabilitation and pension requests. A two-item version of the WAI was as strongly associated with intended rehabilitation and pension requests as the total score. CONCLUSIONS: This study indicates that the WAI is a sensitive screening tool to identify workers on sick leave with a probable need for rehabilitation. The WAI could support the assessment of need for rehabilitation by occupational health services in return-to-work strategies, which include the opportunity to access multiprofessional rehabilitation.