Return to work : exploring paths toward work after spinal cord injury and designing a rehabilitation intervention

Introduction: Return to work (RTW) after spinal cord injury (SCI) often involves a complex and extended process for the person, due to consequences of the injury. There is limited evidence on how to support a person with SCI during the RTW process, and employment rates are low in Sweden, as well as internationally. It is important when developing a rehabilitation intervention for RTW after SCI, that the intervention derives from a contextually relevant evidence base, as well as from collaboration with persons with SCI. Aim: The overall aim was to explore and generate knowledge about RTW for adults with SCI, in order to develop and evaluate the design and feasibility of a complex intervention that can serve as a complement to current RTW systems. Methods: This thesis draws on the Medical Research Council’s (MRC) guidance for developing and evaluating complex interventions. Study I was a follow-up study in which narrative interviews and participant observations were used to explore experiences of RTW in the context of everyday life, 7-11 years after SCI. In study II, a participatory approach drawing on photovoice methods was used to explore experiences of barriers and possibilities in RTW among working adults with SCI. In study III, constructive grounded theory and focus group interviews were used to generate knowledge on how professional stakeholders organize and experience the RTW process for the person with SCI. The findings in studies I- III in combination with research in the field and theoretical resources, constituted the evidence base for modelling ReWork-SCI, a person-centred, structured, and coordinated intervention process for RTW after SCI. The feasibility of ReWork-SCI and the study design for evaluating ReWork-SCI, with regard to adherence, acceptability, recruitment, retention, and use of outcome measures, was explored in study IV. Findings: Studies I-III illustrate that the RTW process was experienced as fragmented by the person with SCI and difficult to navigate for the professional stakeholders. Moreover, findings show how the RTW process was situated in a person’s everyday life. Further, tensions between intentions for fair support and possibilities to enable such, meant challenges in when and how a RTW process could be initiated and realized. Study IV shows that ReWork-SCI was feasible although modifications to the intervention, and the study design was necessary prior to a full-scale trial. Conclusion: This thesis adds to the understanding of complexities in the RTW process after SCI. Supporting the person in untangling problematic dimensions of how RTW is situated in everyday life is a critical outset in the process. This thesis shows how a RTW coordinator based in the SCI rehabilitation team can collaborate with the person and provide coordination between stakeholders throughout the RTW process and how ReWork-SCI has the potential to guide when and how a RTW process after SCI can be made possible

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

A Stolen Childhood: Why Governments’ use Children in Armed Conflict

Abstract: Guided by the research question ‘Why do some governments use child soldiers while others do not?, this article examines the relationship between conflict intensity and government use of child soldiers. Through a qualitative and comparative analysis between Chad and Somalia 2012-2022, the study specifically investigates how low education provision and the strategic need for military innovation impact this phenomenon. The findings suggest that the combination of these factors could make child soldier recruitment into government forces especially prevalent. However, these findings are limited and more research is needed to better understand the complex interactions among various factors influencing child soldier recruitment by government forces

Dokumentation ur ett genusperspektiv - En diskursanalys av portfolios i en förskola

Titel: Dokumentation ur ett genusperspektiv - en diskursanalys av portfolios i en förskola.Författare: Eva Holmlund och Lisa StenströmArbetet är en kritisk diskursanalys om portfoliodokumentation i en förskola ur ett genusperspektiv. Syftet är att undersöka genusrelaterade mönster i dokumentationen, såväl likheter som olikheter studeras. Vår textanalys bygger på 12 barns portfoliotexter från en Reggio Emilia-inspirerad förskola. En av Reggio Emilia-filosofins grundstenar är dokumentation. De frågeställningar vi utgått från är: Skiljer sig språket åt i den skriftliga dokumentationen för pojkar respektive flickor och i så fall hur? Vad dokumenteras hos pojkar respektive flickor? Går det att utläsa skillnader och likheter i vilka processer/lärosituationer som dokumenteras för pojkar respektive flickor? Till grund för vår analys ligger Faircloughs tredimensionella modell (Winther Jørgensen & Phillips, 2000). Vi analyserar portfoliotexter med hjälp av ett antal genusteoretiska perspektiv. Vår undersökning har visat att det finns både skillnader och likheter i det genusrelaterade språket i de undersökta portfoliotexterna. Vår slutsats är att trots att Lpfö98 (Skolverket, 2006) ålägger pedagogerna att motverka traditionella könsroller och mönster så lever dessa fortfarande kvar i portfoliotexterna. Genustänkandet har inte nått den nedtecknade delen av verksamheten

Dokumentation ur ett genusperspektiv - En diskursanalys av portfolios i en förskola

Titel: Dokumentation ur ett genusperspektiv - en diskursanalys av portfolios i en förskola.Författare: Eva Holmlund och Lisa StenströmArbetet är en kritisk diskursanalys om portfoliodokumentation i en förskola ur ett genusperspektiv. Syftet är att undersöka genusrelaterade mönster i dokumentationen, såväl likheter som olikheter studeras. Vår textanalys bygger på 12 barns portfoliotexter från en Reggio Emilia-inspirerad förskola. En av Reggio Emilia-filosofins grundstenar är dokumentation. De frågeställningar vi utgått från är: Skiljer sig språket åt i den skriftliga dokumentationen för pojkar respektive flickor och i så fall hur? Vad dokumenteras hos pojkar respektive flickor? Går det att utläsa skillnader och likheter i vilka processer/lärosituationer som dokumenteras för pojkar respektive flickor? Till grund för vår analys ligger Faircloughs tredimensionella modell (Winther Jørgensen & Phillips, 2000). Vi analyserar portfoliotexter med hjälp av ett antal genusteoretiska perspektiv. Vår undersökning har visat att det finns både skillnader och likheter i det genusrelaterade språket i de undersökta portfoliotexterna. Vår slutsats är att trots att Lpfö98 (Skolverket, 2006) ålägger pedagogerna att motverka traditionella könsroller och mönster så lever dessa fortfarande kvar i portfoliotexterna. Genustänkandet har inte nått den nedtecknade delen av verksamheten

Return-to-work : Exploring professionals' experiences of support for persons with spinal cord injury

Purpose: To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI). Methods: Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding. Findings: The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions. Conclusions: In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process

Navigating work and life– a qualitative exploration of managers’ and employees’ views of return-to-work after sick leave due to common mental disorders

Abstract Background Incorporating multiple perspectives and contexts in knowledge mobilisation for return-to-work after sick leave due to common mental disorders can promote interprofessional and organisational strategies for facilitating the return-to-work process. This study aimed to explore the facilitators of and barriers to return-to-work after common mental disorders. This exploration considered the perspectives of employees and managers and the realms of work and private life. Methods A qualitative approach was used with data from 27 semi-structured telephone interviews. The strategic sample consisted of employees who returned to work after sick leave due to common mental disorders (n = 17) and managers responsible for their return-to-work process (n = 10). Thematic analysis conducted in a six-step process was used to generate themes in the interview data. Results The analysis generated three main themes with subthemes, illustrating experiences of barriers to and facilitators of return-to-work positioned in the employees’ private and work contexts: (1) Getting along: managing personal difficulties in everyday life; (2) Belonging: experiencing social connectedness and support in work and private life; and (3) Organisational support: fostering a supportive work environment. The results contribute to a comprehensive understanding of the return-to-work process, including the challenges individuals face at work and in private life. Conclusions The study suggests that return-to-work after sick leave due to CMDs is a dynamic and ongoing process embedded in social, organisational, and societal environments. The results highlight avenues for an interprofessional approach and organisational learning to support employees and managers, including space for the employee to recover during the workday. Trial registration This study recruited employees from a two-armed cluster-randomised controlled trial evaluating a problem-solving intervention for reducing sick leave among employees sick-listed due to common mental disorders (reg. NCT3346395)

Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders : a qualitative study

Purpose Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs). Material and methods 41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values. Results Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders’ interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities. Conclusion The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator’s professional role, and facilitate ongoing boundary work between stakeholders

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 > 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

Evaluating the feasibility of ReWork-SCI : a person-centred intervention for return-to-work after spinal cord injury

Objectives To evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures. Design Pre-test and post-test, single group, feasibility study. Setting Spinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden. Participants Two women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish. Intervention ReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council's guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team. Outcome measures The feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews. Results All eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team. Conclusions ReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed