Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services

Abstract Background Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. Methods The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention’s cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out. Discussion The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed. Trial registration ClinicalTrials NCT02563743 Sep 28 2015

Study protocol of an effect and process evaluation of the Stamina model; a Structured and Time-effective Approach through Methods for an Inclusive and Active working life

Background: The working environment should be a naturally integrated part of business development. Provisions are in place that address the employer's obligations to investigate, carry out and follow up activities in such a way that ill health and accidents at work are prevented and a satisfactory working environment is achieved. Still, there are organizations that not properly perform systematic work environment management. In order to improve adherence, interventions and models focused on these issues need to be easy to understand and provide rapid feedback of results in order to be implemented. The Stamina model has recently been implemented in Sweden. The model is a participatory organizational systematic model facilitating the work environment, productivity and quality. It is a support model that provides structured and recurrent feedback in the systematic work environment management. The aim of the present paper is to thoroughly describe the Stamina model and the studies that are designed to investigate the effect, to increase the understanding of how and why the model was or was not effective, and to identify factors that facilitate implementation. Methods: The paper presents a project consisting of two related evaluation parts. Part one is an effect evaluation with an active group applying the Stamina model and a control group. This part investigate effects on proxy outcomes that are relevant for health and productivity. Part two is a process evaluation with a qualitative design. This part will be based on semi-structured interviews with various stakeholders, such as employees, first line managers, project managers, facilitators and representatives from the management group, in the organizations. Discussion: Many interventions found to be effective in research projects fail to translate into meaningful outcomes across multiple contexts. In this project a participatory approach will be adopted, including the possibility to modify the model according to organizational needs and preconditions. Valuable knowledge regarding the design and implementation of the model will be generated in order to develop a model that is suitable and sustainable in organizations