Empowering employees with chronic diseases; development of an intervention aimed at job retention and design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Persons with a chronic disease are less often employed than healthy persons. If employed, many of them experience problems at work. Therefore, we developed a training programme aimed at job retention. The objective of this paper is to describe this intervention and to present the design of a study to evaluate its effectiveness.</p> <p>Development and description of intervention</p> <p>A systematic review, a needs assessment and discussions with Dutch experts led to a pilot group training, tested in a pilot study. The evaluation resulted in the development of a seven-session group training combined with three individual counselling sessions. The training is based on an empowerment perspective that aims to help individuals enhance knowledge, skills and self-awareness. These advances are deemed necessary for problem solving in three stages: exploration and clarification of work related problems, communication at the workplace, and development and implementation of solutions. Seven themes are discussed and practised in the group sessions: 1) Consequences of a chronic disease in the workplace, 2) Insight into feelings and thoughts about having a chronic disease, 3) Communication in daily work situations, 4) Facilities for disabled employees and work disability legislation, 5) How to stand up for oneself, 6) A plan to solve problems, 7) Follow-up.</p> <p>Methods</p> <p>Participants are recruited via occupational health services, patient organisations, employers, and a yearly national conference on chronic diseases. They are eligible when they have a chronic physical medical condition, have a paid job, and experience problems at work. Workers on long-term, 100% sick leave that is expected to continue during the training are excluded. After filling in the baseline questionnaire, the participants are randomised to either the control or the intervention group. The control group will receive no care or care as usual. Post-test mail questionnaires will be sent after 4, 8, 12 and 24 months. Primary outcome measures are job retention, self efficacy, fatigue and work pleasure. Secondary outcome measures are work-related problems, sick leave, quality of life, acquired work accommodations, burnout, and several quality of work measures. A process evaluation will be conducted and satisfaction with the training, its components and the training methods will be assessed.</p> <p>Discussion</p> <p>Many employees with a chronic condition experience problems in performing tasks and in managing social relations at work. We developed an innovative intervention that addresses practical as well as psychosocial problems. The results of the study will be relevant for employees, employers, occupational health professionals and human resource professionals (HRM).</p> <p>Trial registration</p> <p>ISRCTN77240155</p

Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders:a qualitative study

Purpose. We conducted a qualitative study into the return-to-work process of workers partially on sick leave due to common mental disorders. Our objectives were to describe the barriers to a full return to work, solutions, communicating to the working environment and the aim of a full return to work, all as perceived by the workers. Method. Workers who had partially returned to work and were partially on long-term sick leave due to a stress-related, anxiety or depressive disorder were eligible for this study. Fourteen workers were interviewed and the interviews were transcribed verbatim and coded. Results. The perceived main barriers were: inability to set limits, recognise exhaustion and to control cognitions and behaviour such as perfectionism. A general pattern in the process was that all workers perceived barriers to a full return to work; most workers were able to mention solutions; all workers aimed for a full return to work, and after some time all workers were met with sufficient understanding and social support from their supervisor and health care professional. However, hardly any worker intended to implement or utilise the solutions at the workplace, except the structural adaptations of the work demands. Conclusions. The pattern we found suggests a critical intention-behaviour gap between solutions and intentions for a full return to work and its implementation at work. This implies that we should develop new interventions that focus on helping workers and their environment to bridge this gap

Empowering employees with chronic diseases: process evaluation of an intervention aimed at job retention

Purpose Employees with a chronic disease may experience work-related problems that contribute to the risk of job loss. We developed a group-based intervention programme aimed at clarifying problems, making these a subject of discussion at work, and realizing solutions. This process evaluation investigates the intervention's feasibility and the satisfaction of 64 participants in eight groups. Methods Data were collected through process evaluation forms and self-report questionnaires. Results The recruitment of participants was time-consuming. Highly educated women working in the service sector were overrepresented. The programme was administered as planned, although components were sometimes only discussed briefly, due to lack of time. Satisfaction with the overall programme among participants was high; it was perceived as effective and there were only three dropouts. In particular, the focus on feelings and thoughts about having a chronic disease was highly valued, as were the exchange of experiences and role-playing directed at more assertive communication. Conclusions A vocational rehabilitation programme aimed at job retention is feasible and is perceived to be effective. Such a programme should address psychosocial aspects of working with a chronic disease beside practical problems. The recruitment of participants is time-consuming. Cooperation with outpatient clinics is necessary in order to reach all groups of employees with a chronic disease that might benefit from job retention programmes. Trial registration: ISRCTN77240155

How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective

OBJECTIVES: A growing number of persons aged 16-65 is hampered by a chronic condition in performing job activities. Some of them quit the labour market prematurely. Vocational rehabilitation used to focus on (re)entering the labour market. Recently more attention is paid to interventions aimed at job retention. Some of these use an empowerment perspective. The objective of this study is to describe the characteristics, feasibility and effectiveness of such vocational rehabilitation interventions in order to decide which approaches are fruitful. METHOD: The Medline, Embase, Cinahl and Psycinfo databases were systematically researched for studies published between 1988 and March 2004. Studies were included if they were experimental, included an intervention that aimed at job retention by means of solving work-related problems, used an empowerment perspective and concerned employees with one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, COPD and asthma. RESULTS: Nine studies were detected. The aims of the intervention programs were to improve psychosocial skills or implement work accommodations. They were structured as individual (6x) or group programmes (3x). They used methods like education (9x), assessment (7x), counselling (5x), training or role playing (5x). The most important outcome measures were employment status (5x), actions to arrange work accommodations (3x), and psychosocial measures like self-efficacy and social competence (3x). Employment status was claimed to be positively influenced in four out of five studies, obtaining work accommodations was successful in all three studies and psychological outcome measures improved in two out of three studies. CONCLUSIONS: There is some evidence that vocational rehabilitation interventions that pay attention to training in requesting work accommodations and feelings of self-confidence or self-efficacy in dealing with work-related problems are effective. There is no evidence for greater effectiveness of group programs compared to individual programs. Attention has to be paid to feasibility aspects such as recruitment of participants and cooperation between medical professionals, occupational physicians, and vocational rehabilitation experts. Medical specialists and nursing specialists should pay more attention to work. Although many studies claim effectiveness, evidence for this was often weak due to short follow-up and the lack of control groups. More rigorous evaluation is neede

Effect of job maintenance training program for employees with chronic disease - a randomized controlled trial on self-efficacy, job satisfaction, and fatigue

Employees with a chronic physical condition may be hampered in job performance due to physical or cognitive limitations, pain, fatigue, psychosocial barriers, or because medical treatment interferes with work. This study investigates the effect of a group-training program aimed at job maintenance. Essential elements of the program are exploration of work-related problems, communication at the workplace, and the development and implementation of solutions. Participants with chronic physical diseases were randomly assigned to the intervention (N=64) or the control group (N=58). Participants were eligible for the study if they had a chronic physical disease, paid employment, experienced work-related problems, and were not on long-term 100% sick leave. Primary outcome measures were self-efficacy in solving work- and disease-related problems (14-70), job dissatisfaction (0-100), fatigue (20-140) and job maintenance measured at 4-, 8-, 12- and 24-month follow-up. We used GLM repeated measures for the analysis. After 24 months, loss to follow-up was 5.7% (7/122). Self-efficacy increased and fatigue decreased significantly more in the experimental than the control group [10 versus 4 points (P=0.000) and 19 versus 8 points (P=0.032), respectively]. Job satisfaction increased more in the experimental group but not significantly [6 versus 0 points (P=0.698)]. Job maintenance was 87% in the experimental and 91% in the control group, which was not a significant difference. Many participants in the control group also undertook actions to solve work-related problems. Empowerment training increases self-efficacy and helps to reduce fatigue complaints, which in the long term could lead to more job maintenance. Better understanding of ways to deal with work-related problems is needed to develop more efficient support for employees with a chronic diseas