Support needs for return to work among self-employed workers: A focus group study.

OBJECTIVE: The aim of this study is to gain insight into the facilitators, barriers, and support needs of Dutch self-employed workers when returning to work (RTW) after sick leave. METHODS: Three focus groups were conducted, involving 15 Dutch self-employed workers who were on sick leave due to health problems. The transcripts were analysed through thematic content analysis. RESULTS: Five main themes regarding barriers, facilitators and needs of self-employed workers to RTW were identified: autonomy, social support, client management, financial security and information on sick leave. Having autonomy was considered a facilitator for RTW. However, the participants expressed a need for more financial support, additional guidance from occupational health professionals, and tailored information regarding RTW. CONCLUSION: The results of this study emphasize a need for optimizing national policy and support for self-employed workers regarding sick leave and RTW.

The effect of the Progressive Goal Attainment Program on cognitions, perceptions, and work participation of workers with chronic health problems: study protocol for a randomized controlled trial.

BACKGROUND: Cognitions and perceptions of workers with chronic health problems, such as catastrophizing thoughts and fear-avoidance beliefs, can negatively influence work participation. The Progressive Goal Attainment Program (PGAP) is an intervention developed in Canada with the aim of decreasing limiting cognitions and perceptions and increasing work participation. The objective of this protocol article is to describe the design of a randomized controlled superiority trial to study whether PGAP is effective in decreasing limiting cognitions and perceptions and increasing workability and work participation of workers with chronic health problems in the Netherlands. METHODS: This study is a randomized controlled superiority trial with two (parallel) groups, in which workers on sick leave are randomly assigned to an intervention group (PGAP intervention) or to a waiting-list control group (care as usual). The PGAP intervention consists of a maximum of 10 weekly individual sessions provided by a trained PGAP professional in which the worker learns about staying active, planning activities, and setting goals. Participants in this risk-targeted behavioral activation intervention also learn to be more aware of their cognitions and perceptions and learn about solution-focused problem-solving skills in challenging situations. The primary outcome is the degree of catastrophizing. Secondary outcomes are other personal cognitions and perceptions (e.g., expectations regarding return to work, self-efficacy), health symptoms (e.g., fatigue, depression), work participation (e.g., sick leave status, work hours), and other work-related outcomes (e.g., workability, quality of working life). DISCUSSION: Although PGAP shows positive effects in Canada, we do not know whether this intervention is effective in the Netherlands. This study is the first randomized controlled trial to test the effect of PGAP on limiting cognitions and perceptions and on work participation of workers with chronic health problems in the Netherlands. If PGAP is effective it could be implemented in the Netherlands in order to stimulate workability and work participation of workers. TRIAL REGISTRATION: The protocol of this study is registered in the Netherlands Trial Register (NL9832) in October 2021.

Effects of a training program for occupational health professionals on the cognitions and perceptions of workers: a randomized controlled trial.

PURPOSE: To evaluate the effects of a training program for occupational health professionals (OHPs) on their ability to identify the cognitions and perceptions of workers with a chronic disease that may hinder work participation, and on their ability to recommend evidence-based interventions aimed at the identified cognitions and perceptions. METHODS: A randomized controlled trial was conducted in which OHPs were randomly assigned to a training program on the cognitions and perceptions of workers with a chronic disease (n = 29) or to a control group that did not receive training (n = 30). Participants received home assignments in which they had to identify the cognitions and perceptions of workers in video vignettes and had to indicate which interventions they would recommend to foster work participation. A generalized linear model repeated measures ANOVA was conducted to study the effects of the training program. RESULTS: The results of the analyses showed an increase in the ability to identify the cognitions and perceptions of workers of OHPs who received the training compared to the control group (p < 0.001). The results also showed an increased ability to recommend evidence-based interventions aimed at these cognitions and perceptions (p < 0.001) as a result of participation in the training. CONCLUSION: The training program helps OHPs to identify cognitions and perceptions and to recommend evidence-based interventions. This can support them in their activities to increase the work participation of workers with a chronic disease.

Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation.

BACKGROUND: In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs' satisfaction with the training and the feasibility of the training and learned skills. METHODS: The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills. RESULTS: The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time. CONCLUSIONS: OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease.

Assessing significant others' cognitions and behavioral responses in occupational health care for workers with a chronic disease.

PURPOSE: To examine current practices of occupational health professionals in assessing significant others' cognitions and behavioral responses that may influence work outcomes of workers with a chronic disease. METHODS: A survey study among occupational health professionals, focusing on the assessment of illness perceptions, work-related beliefs and expectations, and behavioral responses of significant others of workers with a chronic disease. We performed linear regression analyses to investigate which factors are related to occupational health professionals' assessment practices. We used thematic analysis to analyze qualitative data on occupational health professionals' reasons to assess or overlook significant others' cognitions and behavioral responses. RESULTS: Our study sample included 192 occupational health professionals. Most seldom asked about significant others' cognitions and behavioral responses. Organizational norms and occupational health professionals' self-efficacy were related to reported assessment practices. Reasons to assess significant others' cognitions and behavioral responses included recognizing their influence on work participation, and occurrence of stagnation. However, occupational health professionals indicated some doubt whether such assessment would always contribute to better care. CONCLUSIONS: It is not common practice for occupational health professionals to assess significant others' cognitions and behavioral responses, although they recognize the influence of these factors on work outcomes. More research is needed as to how occupational health professionals can best address the role of significant others, and apply these new insights in their daily practice.Implications for rehabilitationMost occupational health professionals do not commonly ask about significant others' cognitions and behavioral responses despite the possible influence of these factors on work outcomes.Occupational health professionals may be able to better support workers with a chronic disease by paying more attention to the influence of significant others.Aside from asking about practical support, occupational health professionals should consider asking about significant others' illness perceptions, work-related beliefs and expectations, and other behavioral responses.

Interventions on cognitions and perceptions that influence work participation of employees with chronic health problems: a scoping review.

BACKGROUND: Cognitions and perceptions, such as motivation and return to work (RTW) expectations, can influence work participation of employees with chronic health problems. This makes these cognitions and perceptions important factors for occupational health professionals to intervene upon in order to increase work participation. There is, however, no overview of interventions that influence these factors and are aimed at increasing work participation. Therefore, the purpose of this scoping review is to explore available interventions that are focused on cognitions and perceptions of employees with chronic health problems and aimed at increasing work participation. METHODS: A scoping review was carried out following the framework of Arksey and O'Malley. Ovid MEDLINE and PsycINFO were searched for original papers published between January 2013 and June 2020. We included studies that describe interventions that focus on at least one of ten cognitions and perceptions and on work participation. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. RESULTS: In total, 29 studies were identified that studied interventions aimed at changing at least one of ten cognitions and perceptions in order to change work participation. The interventions that were included mainly focused on changing recovery and RTW expectations, self-efficacy, feelings of control, perceived health, fear-avoidance beliefs, perceived work-relatedness of the health problem, coping strategies and catastrophizing. No interventions were found that focused on changing motivation or on optimism/pessimism. Four interventions were judged as effective in changing coping, self-efficacy, fear-avoidance beliefs, or perceived work-relatedness and work participation according to results of randomized controlled trials. CONCLUSIONS: This review provides an overview of interventions that focus on changing cognitions and perceptions and work participation. Evidence was found for four effective interventions focused on changing these factors and increasing work participation. Occupational health professionals may use the overview of interventions to help employees with chronic health problems to increase their work participation.

Physicians' Perspectives on Person-Related Factors Associated With Work Participation and Methods Used to Obtain Information About These Factors.

OBJECTIVE: Person-related factors influencing work participation of employees with health problems are important. However, the best method to obtain information about them, according to occupational physicians (OPs) and insurance physicians (IPs), is unknown. METHODS: Questionnaires in which OPs and IPs rated the importance of and described methods to obtain information about 10 person-related factors: expectations regarding recovery or return to work, optimism/pessimism, self-efficacy, motivation, feelings of control, perceived health, coping strategies, fear-avoidance beliefs, perceived work-relatedness, and catastrophizing. RESULTS: OPs and IPs perceived all person-related factors, except for optimism/pessimism and perceived health as important for work participation. Information about the factors could best be obtained with use of a topic list during consultations. CONCLUSIONS: OPs and IPs should take person-related factors into account during consultations and it is best to use a topic list when discussing them.

Obtaining person-related information from employees with chronic health problems: a focus group study.

PURPOSE: The objective of this focus group study is to assess how occupational physicians (OPs) and insurance physicians (IPs) can best obtain information concerning person-related factors from employees. The research question was: what is the most effective way for OPs and IPs to obtain information concerning person-related factors, in the opinion of employees with chronic health problems? METHODS: Three focus group discussions were conducted comprising of a total of 23 employees with work limitations due to chronic health problems. Employees discussed how physicians could best obtain information related to ten person-related cognitions and perceptions that are associated with work participation. The discussions were recorded, transcribed verbatim and analyzed through qualitative content analysis. RESULTS: Employees indicated that information addressing person-related factors could best be obtained through discussing them directly during consultations, as opposed to the use of questionnaires or diaries. Important prerequisites to having fruitful conversations include a mutual trust between employee and physician, a sense of genuine physician interest, and the understanding of the physician of employees and their health concerns. Employees described various factors that influence these conversations, including the knowledge and communication skills of physicians, employee anxiety, and the atmosphere and time frame of the consultation. CONCLUSIONS: Information concerning the person-related factors of employees can best be obtained by discussing them during consultations. However, there has to be mutual trust, interest and understanding before employees feel comfortable to talk about these factors with a physician. OPs and IPs should consider these, and other identified factors, when asking about person-related factors during consultations.

Person-related factors associated with work participation in employees with health problems: a systematic review.

PURPOSE: The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems? METHODS: A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies. RESULTS: In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation. CONCLUSIONS: The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.