Exploring reasons for sick leave due to common mental disorders from the perspective of employees and managers:what has gender got to do with it?

PURPOSE: The purpose of this study was to explore the employee and the managerial experience of reasons for sick leave due to CMDs in relation to work and private life, through the lens of a transactional perspective of everyday life occupation and gender norms. METHODS: Semi-structured interviews were conducted with 17 employees on sick leave due to CMDs and 11 managers. By using transactional and gender perspectives in a reflexive thematic analysis, themes were generated in a constant comparative process. FINDINGS: Four themes were identified: a) struggling to keep up with work pressure and worker norms; b) struggling with insecurity in an unsupportive work environment; c) managing private responsibilities through flexible work schedules, and d) managing emotions alongside unfavourable working conditions. CONCLUSION: Sick leave due to CMDs was understood as related to experiences of accumulated events situated in different social, cultural, and societal contexts of everyday life. Practices and policies should encourage an open dialogue about work and private life and health between employees and managers. To build healthy and sustainable work environments practices should also aim for increased awareness of social norms. A better understanding may facilitate the identification of situations in work and private life that are problematic for the employee

Experiences of participating in a problem-solving intervention with workplace involvement in Swedish primary health care:a qualitative study from rehabilitation coordinator's, employee's, and manager's perspectives

BACKGROUND: Work-directed interventions that include problem-solving can reduce the number of sickness absence days. The effect of combining a problem-solving intervention with involvement of the employer is currently being tested in primary care in Sweden for employees on sickness absence due to common mental disorders (PROSA trial). The current study is part of the PROSA trial and has a two-fold aim: 1) to explore the experiences of participating in a problem-solving intervention with workplace involvement aimed at reducing sickness absence in employees with common mental disorders, delivered in Swedish primary health care, and 2) to identify facilitators of and barriers to participate in the intervention. Both aims targeted rehabilitation coordinators, employees on sickness absence, and first-line managers.METHODS: Data were collected from semi-structured interviews with participants from the PROSA intervention group; rehabilitation coordinators (n = 8), employees (n = 13), and first-line managers (n = 8). Content analysis was used to analyse the data and the Consolidated Framework for Implementation Research was used to group the data according to four contextual domains. One theme describing the participation experiences was established for each domain. Facilitators and barriers for each domain and stakeholder group were identified.RESULTS: The stakeholders experienced the intervention as supportive in identifying problems and solutions and enabling a dialogue between them. However, the intervention was considered demanding and good relationships between the stakeholders were needed. Facilitating factors were the manual and work sheets which the coordinators were provided with, and the manager being involved early in the return-to-work process. Barriers were the number of on-site meetings, disagreements and conflicts between employees and first-line managers, and symptom severity.CONCLUSIONS: Seeing the workplace as an integral part of the intervention by always conducting a three-part meeting enabled a dialogue that can be used to identify and address disagreements, to explain CMD symptoms, and how these can be handled at the workplace. We suggest allocating time towards developing good relationships, provide RCs with training in handling disagreements, and additional knowledge about factors in the employee's psychosocial work environment that can impair or promote health to increase the RCs ability to support the employee and manager.</p

Patient participation: A qualitative study of immigrant women and their experiences

Patient participation in healthcare is a neglected area of interest in the rather extensive amount of research on immigrant so-called Selma patients in Swedish health care as well as worldwide. The aim is to explore the phenomenon “patient participation” in the context of the Swedish health care from the perspective of immigrants non-fluent in Swedish. A phenomenological lifeworld approach was chosen. Data were collected from patients within a municipal home care setting in Sweden. Eight women agreed to participate. In seven interviews, an interpreter was necessary for the translation of the interview. Five authorized interpreters were used. Data were analysed in accordance to a descriptive phenomenological method for caring research. The analysis led to an essence of the phenomenon with three constituents, “to experience participation,” “to refrain from participation,” and “to be deprived of participation.” Patient participation from the perspective of immigrant women means that patients are involved and active in their own health and caring processes. For these women, it is particularly important to have the opportunity to express themselves. Patient participation presupposes professional caregivers who act in a way that increases the patients' opportunities to take part. A skilled interpreter is often necessary in order to enable the patient participation

To be an immigrant and a patient in Sweden: A study with an individualised perspective

The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, “cultural competence” merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation

Att vara invandrare och patient i Sverige : Ett individorienterat perspektiv

This thesis focuses on immigrants in Sweden. What experiences from the meeting with Swedish society do immigrants have and what meaning does the immigrant background have when they have been patients within the Swedish health and medical service? Former research about patients with an immigrant background can be divided into two perspectives. One which illuminates ethnically demarcated immigrant groups and specific needs. The other perspective has an individually adopted approach independently of the patients’ ethnical background. Here it is mainly the communication problems that are stressed, since these make it hard to understand the individual’s needs. The two empirical studies of the thesis start from an individualised perspective, a life world perspective. Research data have been collected through open interviews. The overall purpose was to develop a deepened understanding of what it means to live as an immigrant in Sweden and receive care. The aim of the pre-study was to examine immigrants’ experiences of participation in municipal home care. In the main study the overall purpose was used and two research questions were asked: What do persons with an immigrant background have to tell us about their situation in Swedish society? How does the situation as an immigrant in Sweden influence the experience of being a patient in Swedish health and medical care? The pre-study shows that participation means making demands and meeting caregivers who view the patient as an actor with the right to make his or her own decisions. One important postulate seems to be access to a good interpreter. To refrain from participation seems to be about adopting a passive attitude as a patient. It seems as if it is the caregivers who are the active ones and the ones setting the standards for the contents of the care. To experience not being invited to participation mainly seems to originate from the fact that the interviewees could neither understand nor make themselves understood. One consequence is that patients are just looked upon as carriers of a symptom. The main study shows that the interviewees’ existential existence as patients involves the whole life situation. Different forms of unsurmountable difficulties might reinforce each other. The ambition to establish oneself in a new home country might therefore be passivised. For patients with immigrant background earlier experiences from exposed situations seem to influence how the patients feel about their treatment. The additional knowledge is that problems seem to reinforce each other. Patients with an immigrant background must be treated as individuals. Every individual’s story has to be made visible. The thesis shows that caregivers ought to endeavour to understand the individual. To encourage dialogue, despite language problems, is of importance for the patient to be able to express his or her needs. The use of an interpreter may have a positive influence on these patients’ possibilities to exert an influence. This means that caregivers who consult an interpreter should build up their competence to communicate through an interpreter

Moving from knowledge to action in partnership : A case study on program adaptation to support optimal aging in the context of migration

This case study explored how a researcher-community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners' perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners' opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration

The meaning of learning to live with medically unexplained symptoms as narrated by patients in primary care: A phenomenological–hermeneutic study

Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of learning to live with MUS as narrated by patients in primary health-care settings. Methods: A phenomenological–hermeneutic method was used. Narrative interviews were performed with ten patients suffering from MUS aged 24–61 years. Data were analysed in three steps: naive reading, structural analysis, and comprehensive understanding. Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining insights and moving on, was based on subthemes describing the patients’ search for explanations, learning to take care of oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky's theory of sense of coherence and Kelly's personal construct theory. Possibilities and obstacles, on an individual as well as a structural level, for promoting patients’ capacity and learning were illuminated. Conclusion: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged as a conventional and necessary care activity

Are psychosocial work factors and work-home interference associated with time to first full return-to-work after sick leave due to common mental disorders?

Objective To (1) examine the time to first full return-to-work (RTW), and (2) investigate whether psychosocial work factors and work-home interference are associated with time to first full RTW after sick leave due to common mental disorders (CMDs). Methods The cohort study comprised 162 employees on sick leave due to CMDs participating in a two-armed cluster-randomised controlled trial in Sweden. Baseline data consisted of a web-based questionnaire and follow-up data of repeated text messages every fourth week for 12 months. The time to first full RTW was estimated using the Kaplan–Meier Estimator. Parametric Weibull survival models with interval-censored outcomes were used to determine associations between psychosocial work factors and work-home interference with time to first full RTW. In a post hoc analysis, time-interval differences in associations for 0– ≤ 6- versus &gt; 6–12 months were tested. Results During the 12-month follow-up, n = 131 (80.9%) reported a first full RTW. The median time to this RTW was 16 weeks (95% CI 12; 20). High psychological job demands, high emotional job demands, high work-to-home interference (WHI), and low social job support were independently associated with a longer time to first full RTW. Time-interval differences were found for job control and emotional job demands. Conclusions Psychosocial work demands and WHI are associated with a longer time to RTW after sick leave due to CMDs. Work organisations and rehabilitation practices should include accommodations for high psychological and emotional job demands during RTW, as well as pay attention to the risk of spill-over of high job demands into employees’ private lives