Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers.

BACKGROUND: Employment contributes to cancer survivors' quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been developed in other clinical contexts, existing interventions have demonstrated inconsistent effectiveness in supporting cancer survivors at work. We conducted this study as a preliminary step toward program development for employment support among survivors at a rural comprehensive cancer center. OBJECTIVE: We aimed (1) to identify supports and resources that stakeholders (cancer survivors, health care providers, and employers) suggest may help cancer survivors to maintain employment and (2) to describe stakeholders' views on the advantages and disadvantages of intervention delivery models that incorporate those supports and resources. METHODS: We conducted a descriptive study collecting qualitative data from individual interviews and focus groups. Participants included adult cancer survivors, health care providers, and employers living or working in the Vermont-New Hampshire catchment area of the Dartmouth Cancer Center in Lebanon, New Hampshire. We grouped interview participants' recommended supports and resources into 4 intervention delivery models, which ranged on a continuum from less to more intensive to deliver. We then asked focus group participants to discuss the advantages and disadvantages of each of the 4 delivery models. RESULTS: Interview participants (n=45) included 23 cancer survivors, 17 health care providers, and 5 employers. Focus group participants (n=12) included 6 cancer survivors, 4 health care providers, and 2 employers. The four delivery models were (1) provision of educational materials, (2) individual consultation with cancer survivors, (3) joint consultation with both cancer survivors and their employers, and (4) peer support or advisory groups. Each participant type acknowledged the value of providing educational materials, which could be crafted to improve accommodation-related interactions between survivors and employers. Participants saw usefulness in individual consultation but expressed concern about the costs of program delivery and potential mismatches between consultant recommendations and the limits of what employers can provide. For joint consultation, employers liked being part of the solution and the possibility of enhanced communication. Potential drawbacks included additional logistical burden and its perceived generalizability to all types of workers and workplaces. Survivors and health care providers viewed the efficiency and potency of peer support as benefits of a peer advisory group but acknowledged the sensitivity of financial topics as a possible disadvantage of addressing work challenges in a group setting. CONCLUSIONS: The 3 participant groups identified both common and unique advantages and disadvantages of the 4 delivery models, reflecting varied barriers and facilitators to their potential implementation in practice. Theory-driven strategies to address implementation barriers should play a central role in further intervention development.

Work limitations as a moderator of the relationship between job crafting and work performance: results from an SEM analysis of cross-sectional survey data.

PURPOSE: Job crafting is an incremental, employee-initiated job design process used to achieve a better fit between job demands and worker skills. Persons with work limitations face multiple barriers to optimal work performance. Some persons with work limitations may innately use job crafting as a strategy to achieve better alignment with their job tasks and demands, however the extent to which job crafting may be helpful in improving work performance and engagement is unknown. The purpose of this study is (1) to examine the moderating role of work limitations in the relationship between job crafting and work performance and (2) to understand the complex relationship between job crafting, work limitations, work engagement, work performance, readiness to change, and worker characteristics. METHODS: We conducted an online survey of workers with and without disabilities (final N = 742) in 2020-2021. Our sample included workers aged 18 and older. Descriptive statistics, bivariate statistics, and Partial Least Squares-Structural Equation Modeling (PLS-SEM) were used to assess the relationships among job crafting, work limitations, work engagement, work performance, readiness to change, and worker characteristics. RESULTS: Work limitation moderates the relationship between job crafting and work performance by weakening the impact of innate job crafting on work performance. Worker characteristics such as education and years of work experience predict crafting behaviors and work engagement mediates the relationship between job crafting and work performance. CONCLUSIONS: Work limitation weakens the relationship between job crafting and work performance. Workers with limitations may benefit from job crafting interventions to increase work engagement and performance.

"Today I felt like my work meant something": A pilot study on job crafting, a coaching-based intervention for people with work limitations and disabilities.

BACKGROUND: People's work life and career can ultimately be deconstructed to the day-to-day job tasks they perform, the people they interact with, and the value and meaning attached to their jobs. Individuals with work limitations and disabilities consistently experience disparities in the workplace resulting in a less than optimal work experience in all three areas. OBJECTIVE: The purpose of this study is to conduct a pilot study to test the effectiveness of job crafting as an occupational therapy (OT) intervention strategy for workers with health conditions and impairments. Job crafting is a proactive, strengths-based, bottom-up approach where workers renegotiate and redefine their job tasks in a personally meaningful way. METHODS: A mixed-methods study (n = 11) was conducted with workers who experience work limitations and disabilities. OT graduate students conducted in-depth interviews and facilitated the use of job crafting to improve work-related outcomes. Pre-and post-intervention data was analyzed using descriptive statistics and Wilcoxon signed-rank tests. Qualitative data was transcribed, coded, and synthesized. RESULTS: The job crafting intervention improved work-related self-efficacy (p < 0.05) and crafting behaviors (p < 0.05) in the workplace. Participants accomplished goals to manage their work limitations, meet job demands, and other non-disability related challenges. CONCLUSIONS: Job crafting has the potential to be used as a holistic OT intervention strategy to improve work-related self-efficacy among workers with work limitations and disabilities.

A qualitative study exploring the parceived impact of race on leprosy-affected persons' experiences of diagnosis and treatment of leprosy in Southeast Brazil

Leprosy is a chronic, yet curable, infectious disease that causes severe morbidity in Brazil with an annual incidence of 33,000 new cases. Recent studies in Brazil showed a correlation between leprosy and the percentage of non-whites affected. Racial discrimination has been documented as a barrier to accessing healthcare. This study seeks to explore whether patients perceive race to have impacted on their leprosy care. A qualitative study was undertaken. 20 semi-structured interviews were conducted with patients' at Instituto Lauro de Souza Lima (ILSL), Brazil. Thematic analysis was used to analyse the data. 4 main themes were generated: racism is part of Brazilian culture, difficulties associated with the diagnosis of Leprosy, barriers to accessing treatment, and a lack of health education. Participants felt that racism infiltrates all aspects of Brazilian society, with isolated incidents in healthcare settings. Racism is known to be associated with socioeconomic inequalities. Leprosy control continues to be hindered by various social determinants of health. This, in turn, affects patients' access to leprosy treatment and care. This study may inform the continuing development of equitable leprosy control strategies in Brazil.

Job Crafting Among American Workers with Disabilities.

Purpose Job crafting is an informal, employee-initiated approach to job re-design that has not been tested among people with disabilities, thus far. The purpose of this study is to examine crafting behaviors of workers with disabilities and individual factors associated with crafting behaviors. Methods We conducted a survey of employees with disabilities who were 18-64 years old and had at least 1 year of work experience. Bivariate and multivariate methods were used to: (1) compare the use of job crafting behaviors between our sample and published results from a sample of the general population; (2) identify individual characteristics associated with job crafting for workers with disabilities. Results Persons with disabilities engage in job crafting behaviors, albeit at lower levels than that reported in a broader sample (Int J Wellbeing, https://doi.org/10.5502/ijw.v3i2.1 , 2013). Education, and disability type (visual and mobility impairment) were associated with certain types of crafting behaviors. Conclusions As job crafting can be associated with higher levels of engagement and career growth among persons without disabilities, findings from this research can be utilized to design programs and policies that support the career goals of people with disabilities beyond labor force participation.

Perceptions and experiences regarding the impact of race on the quality of healthcare in Southeast Brazil: a qualitative study.

Objective: To explore the impact of race on the quality of healthcare received by patients attending a primary care centre in Brazil.Design: This was a qualitative study consisting of 19 semi-structured interviews conducted on patients from six racial groups (as defined in Brazil as white, yellow, brown, black and indigenous and one self-identified 'other' group). The interviews were analysed using thematic analysis.Results: Four main themes were identified during analysis; factors affecting the access to healthcare, experiences regarding quality of healthcare, discrimination in healthcare and deep-rooted societal discrimination, which were categorised into a number of sub-themes. Within these themes, interviewees reported (1) experiences of racism in society towards the black racial group, (2) one personal perception and two observations of racial discrimination in healthcare, (3) perceived racial discrimination due to healthcare professional behaviour and (4) other factors, such as delays in appointments and long waiting times in health facilities were felt to impact access to care.Conclusion: The findings suggest that racial discrimination exists in Brazilian society but its direct impact on healthcare access was felt to be less obvious. Instead, organisational level factors were felt to contribute to difficulty accessing care. Interviewees perceived that racial discrimination may affect the quality of care, particularly for those designated as 'black'. Socio-economic factors were felt to influence discrimination in healthcare. The findings can help inform further studies and educational initiatives to help address discrimination and access to healthcare in Brazil.

Operationalizing workplace accommodations for individuals with disabilities: A scoping review.

BACKGROUND: The provision of workplace accommodations is a proven strategy in supporting individuals with disabilities at work. Accommodations include a wide range of supports and strategies that are not very well defined beyond the Americans with Disabilities Act in the United States. Understanding the landscape of accommodations is important to measure the impact of programs that support employment of individuals with disabilities. OBJECTIVE: To conduct a scoping review and thematic analysis of research literature to identify how workplace accommodations are operationalized and to identify knowledge gaps in its conceptualization. METHODS: Keywords searches were conducted in seven electronic databases. Title, abstract, and full text screening was conducted followed by a thematic analysis of the content to identify how workplace accommodations are operationalized. RESULTS: Overall, 47 studies were selected for review. 433 different types of accommodations were identified, of which assistive technology and specialized equipment represented the most frequently reported type of accommodation (40%). A very small percentage of studies included policy changes (9%) and human assistance (5%) as an accommodation strategy. CONCLUSIONS: This scoping review aims to clarify how accommodations are operationalized in the research literature. Key knowledge gaps identified include the systematic exclusion of certain types of supports or disability types.

Community and social participation among adults with mobility impairments: A mixed methods study.

BACKGROUND: Community and social participation is a complex phenomenon that is influenced by personal and environmental factors and is linked to a good quality of life and well-being. Individuals with mobility impairments are at risk of experiencing limitations in participating in community activities due to a wide range of factors. OBJECTIVE: To understand community participation as defined by adults with mobility impairments and to examine relationships among factors that influence community participation. METHODS: A mixed-methods study design was used. In-depth interviews of 13 adults with mobility impairments were conducted and themes related to community participation were identified. Data from the Americans' Changing Lives Survey were used to construct variables that mimic the themes from the qualitative phase and structural equation modeling was used to examine the relationships among those variables including community participation. RESULTS: Individuals with mobility impairments identified health and function, neighborhood factors and self-efficacy as possible factors influencing participation in community activities. Findings from the SEM suggest a strong causal pathway between health and function and community and social participation. Neighborhood factors and health and function had a significant impact on self-efficacy, and a possible indirect effect through self-efficacy on community and social participation. CONCLUSIONS: Our study provides new empirical evidence that health and function have a significant impact on community and social participation. Our quantitative findings did not support the direct influence of neighborhood factors in community and social participation, yet these factors may have an indirect role by influencing the self-efficacy of individuals with mobility impairments.