Protocol for a pilot cluster randomised controlled trial of a multicomponent sustainable return to work IGLOo intervention.

BACKGROUND: Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave. METHODS AND DESIGN: A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial. DISCUSSION: The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave. TRIAL REGISTRATION: ISRCTN11788559 (prospectively registered, date registered 6 October 2022).

Managing Minds at Work: Development of a Digital Line Manager Training Program.

Mental ill-health is the leading cause of sickness absence, creating a high economic burden. Workplace interventions aimed at supporting employers in the prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work is a digital intervention aimed at supporting line managers in promoting better mental health at work through a preventative approach. This intervention was developed as part of the Mental Health and Productivity Pilot, a wider initiative aimed at supporting employers across the Midlands region of the United Kingdom to improve the future of workplace mental health and wellbeing. The aim of the study is to describe the design and development of the Managing Minds at Work digital training program, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). An agile methodology was used to co-create intervention content with a stakeholder virtual community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. It was considered by stakeholders to be appropriate for any type of organization, irrespective of their size or resources. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that the program was perceived to be useful, relevant, and easy to use by managers across sectors, organization types, and sizes. We identified positive impacts on manager attitudes and behavioral intentions related to preventing mental ill-health and promoting good mental wellbeing at work. The next step is to explore the feasibility and acceptability of Managing Minds at Work with line managers in diverse employment settings.

Job crafting as a work adjustment strategy for workers returning after long-term sickness absence due to common mental disorders.

The purpose of this qualitative study was to examine the way workers with common mental disorders use job crafting to adjust their work to their levels of functioning after returning from long-term sick leave. Thirty-eight workers who had returned within the last 24 months from sickness absence due to common mental disorders were interviewed using semistructured interviews. Questions were asked about how they job crafted to match their changed needs for work functioning post return. To interpret the results, we coded the data according to the Wrzesniewski and Dutton typology of job crafting and conducted thematic analysis. We identified task, relational and cognitive job crafting strategies that workers had employed after returning to work. Our findings have important implications for how managers and organizations can support workers to make adjustments that enable them to stay and thrive at work with reduced work functioning.

Neutrophil gelatinase-associated lipocalin: its response to hypoxia and association with acute mountain sickness.

Acute Mountain Sickness (AMS) is a common clinical challenge at high altitude (HA). A point-of-care biochemical marker for AMS could have widespread utility. Neutrophil gelatinase-associated lipocalin (NGAL) rises in response to renal injury, inflammation and oxidative stress. We investigated whether NGAL rises with HA and if this rise was related to AMS, hypoxia or exercise. NGAL was assayed in a cohort (n = 22) undertaking 6 hours exercise at near sea-level (SL); a cohort (n = 14) during 3 hours of normobaric hypoxia (FiO2 11.6%) and on two trekking expeditions (n = 52) to over 5000 m. NGAL did not change with exercise at SL or following normobaric hypoxia. During the trekking expeditions NGAL levels (ng/ml, mean ± sd, range) rose significantly (P < 0.001) from 68 ± 14 (60-102) at 1300 m to 183 ± 107 (65-519); 143 ± 66 (60-315) and 150 ± 71 (60-357) at 3400 m, 4270 m and 5150 m respectively. At 5150 m there was a significant difference in NGAL between those with severe AMS (n = 7), mild AMS (n = 16) or no AMS (n = 23): 201 ± 34 versus 171 ± 19 versus 124 ± 12 respectively (P = 0.009 for severe versus no AMS; P = 0.026 for mild versus no AMS). In summary, NGAL rises in response to prolonged hypobaric hypoxia and demonstrates a relationship to the presence and severity of AMS.

Use of prescribed medication at work in employees with chronic illness.

BACKGROUND: This study examined factors associated with the use of prescribed medication at work. METHODS: Questionnaire survey of employees with diagnosed chronic illnesses from four UK organizations. Data were collected on type of chronic illness, health status, health beliefs, work limitations, occupational health support, general practitioner (GP) and line manager support. Data were analysed using univariate logistic regression. RESULTS: A total of 1474 employees with chronic illness participated. Medication use at work (yes versus no) was predicted by age, pain, diagnosis of heart disease, medication use at home, benefit of prescribed medication to health, ease of using medication at work, practical support from families and practical and emotional support from GP and line manager. In a multivariate logistic regression model, medication use at work was predicted by medication use at home and ease of using medication at work only. CONCLUSIONS: The ease of taking medication at work was found to be a key predictor of medication use at work, suggesting occupational health may play a vital role in finding ways to support employees in their usage of medication. This may be for example by providing help and guidance in storing medication at work and encouraging employees to disclose medication use to employers and managers where necessary. Occupational health services can help create a workplace culture that places a high value on health, educating staff on the value of looking after their health and the benefits of following advice.