Sustainable return to work (RTW) after ill-health: personal, social and organisational factors

Etuknwa, Abasiama (2020) Sustainable return to work (RTW) after ill-health: personal, social and organisational factors. Doctoral thesis, University of East Anglia.

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Background: Musculoskeletal and common mental disorders (MSDs and CMDs) have been recognized as the most common causes of sickness absence in developed countries, and it has become a major research focus, especially as the economic cost on sickness absence is growing yearly. While there is a strong body of evidence on the effectiveness of workplace-based interventions in facilitating a return to work after sickness absence caused by these conditions, evidence of the sustainability of return to work is limited. Sustainable RTW is defined as a stable full-time or part-time RTW to either the original or modified job for a period of at least three months without relapse or sickness absence re-occurrence. With the insignificant reductions in reported lost days to work as a result of these conditions, it has become imperative to better understand what factors could play a role in sustainable RTW for the benefits of both employees and employers. This research therefore seeks to investigate the role of personal and social factors in facilitating a sustainable RTW for employees sick-listed with MSDs and CMDs. It also aims to explore the extent to which gender influences the factors that facilitate or impede a sustainable RTW.

Methods: This thesis employed a multi method consisting of a systematic review and a qualitative study which was conducted in a sequential order. In the first study, a systematic review was conducted to evaluate the impact of important personal and social factors on sustainable return to work (RTW) after ill-health due musculoskeletal disorders (MSDs) and common mental disorders (CMDs) and to compare the effects of these personal and social factors across both conditions. A literature search was conducted in 13 databases and 79 studies were selected for the review, and the methodological design was graded as very high, high and low quality.

A qualitative study was conducted using a modified realist evaluation approach thereafter to determine the extent to which factors that facilitate a sustainable RTW may vary across men and women. A realist evaluation is an approach grounded in realism which involves development of initial theories, testing and refining of theories by exploring the context, mechanism and outcome (CMO) interactions. Findings from the initial systematic review and five face to face interviews conducted with managers informed the development of thirteen initial theories. Theory here refers to the assumption about how a programme or process is expected to achieve its desired outcome. Initial theories were then configured within the CMO structure and were then tested by conducting two semi-structured interviews with 22 participants sick-listed for MSDs and CMDs from two public organisations at an interval of two months. Second interviews were conducted for the purposes of clarification. Data analysis was conducted using a hybrid form of thematic analysis consisting of inductive, deductive and abductive inferences.

Results: In the systematic review, personal factors identified in the included studies comprised of attitude, self-efficacy, age, gender, education, economic status/income, length of sickness absence, job contract/ security. Social factors identified included support from leaders and co-workers (where leaders include managers, line managers, supervisors etc.) and job crafting. The most consistent evidence for achieving sustainable RTW for both MSDs and CMDs was from support from line managers or supervisors and co-workers, positive attitude, self-efficacy, young age and higher education levels. Job crafting, economic status, length of absence and job contract/security showed promising results, but too few studies exist to draw definite conclusions. Results regarding the effects of gender were inconsistent and unclear, as such, a qualitative study was conducted on gender as inconsistent findings indicated a major gap in the literature.

Fifteen main codes and 29 sub-codes explaining what factors, for whom and under what circumstance they influence or facilitate RTW outcomes were identified in the qualitative data. These codes were grouped under three main categories based on their RTW outcomes; factors that motivate or influence RTW after a sick leave period, factors that impact on the sustainability of RTW and factors that impede sustainable RTW or contribute to poor RTW outcomes. As a result of validating CMO configurations with accounts of participants, out of the thirteen initial theories developed apriori, one theory was discarded, four were retained, and in some cases updated to include more explanations and eight were refined. Eighteen new theories were developed from inductive themes identified in the transcript using the CMO configuration. In total, 30 theories were developed explaining the context in which various mechanisms are activated to facilitate RTW outcomes.
The main findings from the qualitative study showed that while some factors that influenced employee’s decisions to RTW after a period of absence were gender-specific, sustainable RTW outcomes were mainly facilitated or impeded by a good quality or poorly implemented RTW strategy. RTW process was considered of a good quality and effective when implemented by a competent and supported line manager who works in collaboration with other support services. However, implementation of effective RTW by line-managers appeared to be hinged on a supportive higher management. Factors that impacted RTW for female participants included: engaging workplace health services, work as evidence of achievement, work for social interaction, sick leave guilt, and workload clarity. For men, a fear of increasing workload and extended absence played a role in RTW outcomes.

Conclusions: Findings from the review demonstrate that a variety of personal and social factors have positive and negative influences on sustainable RTW. I suggest that the social environment and how it interrelates with personal factors like attitudes and self-efficacy should be studied in more detail in the future as the inter-relationship between these factors appears to impact positively on sustainable RTW outcomes. Areas for future research include more high-quality studies on job crafting, economic status/income, length of absence, job contract/security and gender. Findings from the qualitative study shows that while gender-based factors influence decisions to RTW, sustainability of RTW is mainly facilitated by organisational factors. This study also highlights the role of competent and supportive line-managers in the implementation of effective RTW strategies for returning workers. Proper education and training are imperative for these workplace actors as sustainable RTW for sick-listed workers appears to be hinged on their efficiency in managing the RTW process. This thesis highlights a number of contributions to the knowledge of sustainable RTW for people sick-listed with CMDs and MSDs. Specifically, the identification of certain approaches or elements of the RTW process that benefits individuals classed as short-term or long-term absentees is a new addition to knowledge in this field and it would prove useful in the implementation of more effective RTW plans for sick-listed workers.

Overall, findings from this thesis highlights the interacting role of personal and social factors in either facilitating or impeding sustainable RTW outcomes for people sick-listed with MSDs and CMDs on a short-term or long-term basis. It therefore suggests that when employers or RTW coordinators are careful to take account of these factors on a case by case basis during the RTW process, the potential to impact positively on lost days from work as result of ill-health may be heightened. Hence, sustainable RTW after ill-health hinges on employer’s ability to effectively uphold their duty of care to employees.

Keywords: Return to work. Musculoskeletal pain. Mental disorders. Systematic review. Occupational health. Qualitative Study. Realist Evaluation.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Social Sciences > Norwich Business School
Depositing User: Chris White
Date Deposited: 02 Dec 2020 10:33
Last Modified: 02 Dec 2020 10:33

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