Effectiveness of 'motivational interviewing' on sick leave: a randomized controlled trial in a social insurance setting

Objective This study aimed to evaluate the effectiveness of motivational interviewing (MI) – a counselling approach offered by caseworkers at the Norwegian Labor and Welfare Administration (NAV) – on return to work (RTW) for individuals sick-listed for ≥8 weeks due to any diagnoses. MI was compared to usual case management and an active control during 12 months of follow-up. Methods In a randomized clinical trial with three parallel arms, participants were randomized to MI (N=257), usual case management (N=266), or an active control group (N=252). MI consisted of two MI sessions while the active control involved two sessions without MI, both were offered in addition to usual case management. The primary outcome was number of sickness absence days based on registry data. Secondary outcomes included time to sustainable RTW, defined as four consecutive weeks without medical benefits. Results The median number of sickness absence days for the MI group was 73 days [interquartile range (IQR) 31–147], 76 days (35–134) for usual care, and 75 days (34–155) for active control. In total 89%, 88% and 86% of the participants, respectively, achieved sustainable RTW. The adjusted hazard ratio (HR) for time to sustainable RTW was 1.12 (95% CI 0.90–1.40) for MI compared to usual case management and HR 1.16 (95% CI 0.93–1.44) compared to the active control. Conclusions This study did not provide evidence that MI offered by NAV caseworkers to sick-listed individuals was more effective on RTW than usual case management or an active control. Providing MI in this context could be challenging as only half of the MI group received the intervention.publishedVersio

Personal Dispositions and Shift Work Tolerance. A Longitudinal Study of Shift Workers in Trondheim Municipality

The aim of the present study was to investigate how dispositional resistance to change (RTC) and neuroticism could predict shift work tolerance (SWT) over a period of six months. Electronic questionnaire were completed by 74 shift workers employed in Trondheim municipality in January 2013 (T1) and in June 2013 (T2). The results showed that age, gender, neuroticism, and RTC were related to SWT. Age at T1 predicted better SWT at T2, while male gender predicted worse SWT at T2. RTC at T1 predicted better SWT at T2, while neuroticism at T1 predicted worse SWT at T2. The findings suggest that individual differences, especially neuroticism, can predict SWT over a period of six months

Early phase of long-term sick leave and motivational interviewing

Norsk sammendrag: Bakgrunn Langtidssykemelding (åtte uker eller mer) er et folkehelseproblem og en utfordring for dem det gjelder. Retur til arbeid er en kompleks prosess for den sykemeldte. NAV anbefaler sine veiledere å bruke motiverende intervju (MI) når de følger opp sykmeldte arbeidstakere, men det er lite forskning som viser hvilke faktorer som hemmer eller fremmer bruken av MI i sykefraværsoppfølging. Denne avhandlingen inngår i en større randomisert kontrollert studie som undersøker effekten av MI ved tilbakeføring til arbeid hos sykmeldte arbeidstakere. Formål Formålet med denne avhandlingen var å utforske hvordan sykmeldte arbeidstakere opplever å være langtidssykmeldt og hvordan de opplever å få MI gitt av NAV-veiledere, samt å evaluere hemmende og fremmende faktorer for implementering av MI som et tiltak i NAV for å hjelpe sykmeldte arbeidstakere tilbake i jobb. Metode Avhandlingen består av tre delstudier. Studie I og II er kvalitative intervjustudier, hver med 16 sykmeldte arbeidstakere. Studie I utforsker hvordan det oppleves å være langtidssykmeldt i den tidlige fasen av langtidssykmelding (8 uker eller mer). Studie II undersøker erfaringer hos sykemeldte arbeidstakere som har gjennomgått to MI-samtaler hos NAV. I studie III er det benyttet data fra fokusgruppeintervju med NAV-veiledere som har fått opplæring innen MI og utfører MI-samtaler, analyser av kvaliteten på MI-samtalene og spørreskjema til sykmeldte arbeidstakere. Resultater Langtidssykmelding opplevdes som nødvendig grunnet en blanding av helse-, arbeids-, og familiebelastninger. Disse belastningene gjorde det vanskelig for de sykmeldte arbeidstakerne å se hvordan de skulle komme seg tilbake i jobb. Retur til arbeid var ønskelig for de sykmeldte, men avhengig av faktorer som opplevdes å være utenfor den sykmeldte sin kontroll (Studie I). De sykmeldte arbeidstakerne i studie II opplevde en god og støttende relasjon til NAV-veilederne som brukte MI. MI-samtalene var en positiv opplevelse som bidro til å legitimere det å være sykmeldt, samtidig som det reduserte skam- og skyldfølelsen hos de sykmeldte. Ved å få informasjon, støtte og tilbakemeldinger på oppfølgingsplan, opplevdes MI-samtalene som nyttig, hvor de sykmeldte arbeidstakerne fikk økt mestringstro på retur til arbeid. Faktorer som hemmet implementering av MI i sykefraværsoppfølgingen i NAV var den store mengden av øving og ressurser som krevdes for å mestre de ulike ferdighetene i MI for NAV-veilederne. I tillegg opplevde NAV-veilederne i dette prosjektet manglende støtte blant kolleger og ledelsen. Nivået av MI-kompetanse hos NAV-veilederne var tilstrekkelig for den tekniske delen av MI, men utilstrekkelig på den relasjonelle delen av MI. NAV-veilederne sin motivasjon for å lære og mestre MI fremmet implementering, i tillegg til at tidlige oppfølgingssamtaler var foretrukket både av NAV-veiledere og sykmeldte arbeidstakere. Konklusjon Langtidssykmeldte arbeidstakere som strever med å finne løsninger på sine utfordringer til å komme tilbake i jobb, kan ha nytte av tidlige oppfølgingssamtaler som fokuserer på personlige og arbeidsrelaterte faktorer som påvirker retur til arbeid prosessen. MI kan være et nyttig verktøy når man veileder sykmeldte, men implementering av MI hos NAV er komplekst og krever mye ressurser fra både veilederne og organisasjonen gjennom hele implementeringsprosessen

Health, Work, and Family Strain – Psychosocial Experiences at the Early Stages of Long-Term Sickness Absence

Background: Knowledge about the psychosocial experiences of sick-listed workers in the first months of sick leave is sparse even though early interventions are recommended. The aim of this study was to explore psychosocial experiences of being on sick leave and thoughts about returning to work after 8–12 weeks of sickness absence. Methods: Sixteen individuals at 9–13 weeks of sick leave participated in semi-structured individual interviews. Data was analyzed through Giorgi’s descriptive phenomenological method. Results: Three themes emerged: (1) energy depleted, (2) losing normal life, (3) searching for a solution. A combination of health, work, and family challenges contributed to being drained of energy, which affected both work- and non-work roles. Being on sick leave led to a loss of social arenas and their identity as a contributing member of society. Participants required assistance to find solutions toward returning to work. Conclusion: Even in this early stage of long-term sick leave, sick listed workers faced complex challenges in multiple domains. Continuing sick leave was experienced as necessary but may challenge personal identity and social life. Those not finding solutions may benefit from additional early follow-up that examine work-related, social and personal factors that influence return to work

Complex return to work process – caseworkers’ experiences of facilitating return to work for individuals on sick leave due to musculoskeletal disorders

Musculoskeletal disorders (MSD) are the largest contributor to disability worldwide. In addition to burdening individuals, there are large socioeconomic costs involved. MSD accounts for a considerable use of health services, and for the greatest proportion of lost productivity in the workplace. In Norway, MSD are the most common cause of sickness absence and represent the largest health challenge for workers in terms of prevalence and cost measured in worse health and disability in addition to sickness absence

Workplace flexibility important for part-time sick leave selection—an exploratory cross-sectional study of long-term sick listed in Norway

Background Part-time sick leave (PTSL) where sick-listed individuals work a percentage corresponding to their remaining work capabilities is often used to promote return to work. The effects of PTSL are uncertain due to participant selection on personal and social factors, which are not easily captured by evaluations that primarily rely on register-data. More knowledge of health-related, workplace and personal characteristics that influence the propensity to utilize PTSL is needed. The objective of the present study was to explore whether individuals on PTSL and full-time sick leave (FTSL) differ in terms of self-reported health, workplace resources and psychological resilience while also considering known sociodemographic factors that influence PTSL selection. Methods The study utilized a cross-sectional sample of 661 workers sick listed for 8 weeks with a 50–100% sick-listing degree. Differences between those on PTSL and FTSL with regard to current self-reported health, previous long-term sick leave, workplace adjustment latitude, psychosocial work environment, work autonomy, coping with work demands, and psychological resilience were examined and adjusted for known selection factors (age, education, gender, sector, diagnosis, and physical work) using logistic regression. Results An inverse U-shaped curvilinear association between self-reported health and PTSL was identified. Those on PTSL also reported greater workplace adjustment latitude and better psychosocial work environment than those on FTSL. These differences persisted after adjusting for previously known selection factors. Furthermore, the PTSL group reported more work autonomy and poorer coping with work demands, but these differences were more uncertain after adjustment. The groups did not differ in terms of previous long-term sick leave or psychological resilience. Conclusion The present study found differences between those on PTSL and FTSL with regards to self-reported health, workplace adjustment latitude and psychosocial work environment that were independent of differences identified in previous research. These results are important for future evaluations of the effect of PTSL on RTW, suggesting more attention should be paid to self-reported health status and workplace characteristics that are not captured using register data

Workplace flexibility important for part-time sick leave selection—an exploratory cross-sectional study of long-term sick listed in Norway

Background Part-time sick leave (PTSL) where sick-listed individuals work a percentage corresponding to their remaining work capabilities is often used to promote return to work. The effects of PTSL are uncertain due to participant selection on personal and social factors, which are not easily captured by evaluations that primarily rely on register-data. More knowledge of health-related, workplace and personal characteristics that influence the propensity to utilize PTSL is needed. The objective of the present study was to explore whether individuals on PTSL and full-time sick leave (FTSL) differ in terms of self-reported health, workplace resources and psychological resilience while also considering known sociodemographic factors that influence PTSL selection. Methods The study utilized a cross-sectional sample of 661 workers sick listed for 8 weeks with a 50–100% sick-listing degree. Differences between those on PTSL and FTSL with regard to current self-reported health, previous long-term sick leave, workplace adjustment latitude, psychosocial work environment, work autonomy, coping with work demands, and psychological resilience were examined and adjusted for known selection factors (age, education, gender, sector, diagnosis, and physical work) using logistic regression. Results An inverse U-shaped curvilinear association between self-reported health and PTSL was identified. Those on PTSL also reported greater workplace adjustment latitude and better psychosocial work environment than those on FTSL. These differences persisted after adjusting for previously known selection factors. Furthermore, the PTSL group reported more work autonomy and poorer coping with work demands, but these differences were more uncertain after adjustment. The groups did not differ in terms of previous long-term sick leave or psychological resilience. Conclusion The present study found differences between those on PTSL and FTSL with regards to self-reported health, workplace adjustment latitude and psychosocial work environment that were independent of differences identified in previous research. These results are important for future evaluations of the effect of PTSL on RTW, suggesting more attention should be paid to self-reported health status and workplace characteristics that are not captured using register data

Health, Work, and Family Strain – Psychosocial Experiences at the Early Stages of Long-Term Sickness Absence

Background Knowledge about the psychosocial experiences of sick-listed workers in the first months of sick leave is sparse even though early interventions are recommended. The aim of this study was to explore psychosocial experiences of being on sick leave and thoughts about returning to work after 8–12 weeks of sickness absence. Methods Sixteen individuals at 9–13 weeks of sick leave participated in semi-structured individual interviews. Data was analyzed through Giorgi’s descriptive phenomenological method. Results Three themes emerged: (1) energy depleted, (2) losing normal life, (3) searching for a solution. A combination of health, work, and family challenges contributed to being drained of energy, which affected both work- and non-work roles. Being on sick leave led to a loss of social arenas and their identity as a contributing member of society. Participants required assistance to find solutions toward returning to work. Conclusion Even in this early stage of long-term sick leave, sick listed workers faced complex challenges in multiple domains. Continuing sick leave was experienced as necessary but may challenge personal identity and social life. Those not finding solutions may benefit from additional early follow-up that examine work-related, social and personal factors that influence return to work